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Question 1
Incorrect
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Which of the following is an expected change in pulmonary function seen during a moderate asthma attack?
Your Answer: Increased arterial pCO2
Correct Answer: Decreased forced expiratory volume in 1 sec (FEV1)
Explanation:Asthma is a lung condition that causes reversible narrowing and swelling of airway passages. It is classified by the frequency and severity of symptoms.
The following are symptoms of moderate asthma:
Symptoms include cough, wheezing, chest tightness, or difficulty breathing which occurs daily
Decreased activity levels due to flare-ups
Night-time symptoms 5 or more times a month
Lung function test FEV1 is 60-80% of predicted normal values
Peak flow has more than 30% variabilityWith moderate asthma attacks, the arterial pCO2 levels may decrease, but as severity increases, so does the pCO2, reaching normal levels, and then exceeding them in severe asthma attacks.
Airway obstruction increases the functional residual capacity.
Concentration of serum bicarbonate would not increase in moderate asthma, but it could possibly increase in life-threatening asthma via the same mechanism as what increases arterial PCO2.
FEV1 is a good measure of airway obstruction. and is reduced in acute asthma attacks.
In the case of a pneumothorax, a decrease in arterial PO2 is higher.
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This question is part of the following fields:
- Pathophysiology
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Question 2
Incorrect
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A 45-year-old man is being operated on for emergency laparotomy as he presented with bowel perforation. During the surgery, the marginal artery of Drummond is encountered and preserved.
Which of the following two arteries fuse to form the marginal artery of Drummond?Your Answer: Inferior mesenteric artery and sigmoid arteries
Correct Answer: Superior mesenteric artery and inferior mesenteric artery
Explanation:The arteries of the midgut (superior mesenteric artery) and hindgut (inferior mesenteric artery) give off terminal branches that form an anastomotic vessel called the marginal artery of Drummond. It runs in the inner margins of the colon and gives off short terminal branches to the bowel wall.
The marginal artery is formed by the main branches and arcades arising from the ileocolic, right colic, middle colic, and left colic arteries. It is most apparent in the ascending, transverse, and descending colons and poorly developed in the sigmoid colon.
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This question is part of the following fields:
- Anatomy
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Question 3
Correct
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This vertebrae can be easily differentiated from the rest because of its prominent spinous process.
Your Answer: C7
Explanation:The spinous process is the part of a vertebrae that is directed posteriorly.
Typical cervical vertebra have spinous processes that are small and bifid, except for C7, which has a long and prominent spinous process.
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This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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From the following electromagnetic waves, which one has the shortest wavelength?
Your Answer: Ultraviolet light
Correct Answer: X rays
Explanation:Electromagnetic waves are categorized according to their frequency or equivalently according to their wavelength. Visible light makes up a small part of the full electromagnetic spectrum.
Electromagnetic waves with shorter wavelengths and higher frequencies include ultraviolet light, X-rays, and gamma rays. Electromagnetic waves with longer wavelengths and lower frequencies include infrared light, microwaves, and radio and televisions waves.
Different electromagnetic waves according to their wavelength from shorter to longer are X-rays, ultraviolet radiations, visible light, infrared radiation, radio waves. X-ray among electromagnetic waves has the shortest wavelength and higher frequency with wavelengths ranging from 10*-8 to 10* -12 and corresponding frequencies.
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This question is part of the following fields:
- Anaesthesia Related Apparatus
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Question 5
Incorrect
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What is factually correct regarding correlation and regression?
Your Answer: A t-test is a common test of correlation
Correct Answer: Regression allows one variable to be predicted from another variable
Explanation:Linear regression, using a technique called curve fitting, allows us to make predictions regarding a certain variable.
Correlation coefficient gives us an idea whether or not the two parameters provide have any relation of some sort or not i.e. does change in one prompt any change in other?
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This question is part of the following fields:
- Statistical Methods
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Question 6
Correct
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An individual who recently moved his residence from the plains to the mountains will experience immediately which physiologic response to high altitude and hypoxia?
Your Answer: Increased cardiac output
Explanation:A person remaining at high altitudes for days, weeks, or years becomes more and more acclimatized to the low PO2, so it causes fewer deleterious effects on the body.
After acclimatization, it becomes possible for the person to work harder without hypoxic effects or to ascend to still higher altitudes. The principal means by which acclimatization comes about are (1) a great increase in pulmonary ventilation, (2) increased numbers of red blood cells, (3) diffusing capacity of the lungs, (4) increased vascularity of the peripheral tissues, and (5) increased ability of the tissue cells to use oxygen despite low PO2.
The cardiac output often increases as much as 30% immediately after a person ascends to high altitude but then decreases back toward normal over a period of weeks as the blood haematocrit increases, so the amount of oxygen transported to the peripheral body tissues remains about normal.
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This question is part of the following fields:
- Pathophysiology
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Question 7
Incorrect
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Which of the following is true about the bispectral index (BIS)?
Your Answer: Values are expressed in Hz
Correct Answer: Sevoflurane lowers BIS more than ketamine
Explanation:The bispectral index (BIS) monitors works to determine the level of consciousness of a patient by processing electroencephalographic (EEG) signals to obtain a value between 0 and 100, where 0 reflects no brain activity, and 100 reflects a patient is completely awake.
The general meaning of BIS values are:
>95: Patient is in an awake state.
65-85: Patient is in a sedated state.
40-65: Patient is in a state that is optimal for general surgery.
<40: Patient is in a deep hypnotic state It is important in measuring the depths of anaesthesia to prevent haemodynamic changes or patient awareness during surgery. The nature of anaesthetic agent used is a determinant factor in resultant BIS values. Intravenous agents, such as propofol, thiopental and midazolam, result in a deeper hypnotic state, whilst inhalation agents have a lesser hypnotic effect at the same BIS values. Certain agents result in inaccurate BIS values such as ketamine and nitrous oxide (NO). These two agents appear to increase the BIS value, whilst putting the patient in a deeper hypnotic state, and should therefore not be used with BIS monitoring. Hypothermia also affects the BIS value as it causes a 1.12 per °C decrease in body temperature. -
This question is part of the following fields:
- Clinical Measurement
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Question 8
Incorrect
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All of the following statements are false regarding tetracyclines except:
Your Answer: Bind to the 50S subunit
Correct Answer:
Explanation:Tetracyclines inhibit protein synthesis through reversible binding to bacterial 30s ribosomal subunits (not 50s) which prevent binding of new incoming amino acids (aminoacyl-tRNA) and thus interfere with peptide growth.
They penetrate macrophages and are thus a drug of choice for treating infections due to intracellular organisms.
Tetracycline does not inhibit transpeptidation. Meanwhile, it is chloramphenicol which is responsible for inhibiting transpeptidation.
Tetracycline can get deposited in growing bone and teeth due to its calcium-binding effect and thus causes dental discoloration and dental hypoplasia. Due to this reason, they should be avoided in pregnant or lactating mothers.
Simultaneous administration of aluminium hydroxide can impede the absorption of tetracyclines.
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This question is part of the following fields:
- Pharmacology
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Question 9
Correct
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A 45-year old gentleman is in the operating room to have a knee arthroscopy under general anaesthesia.
Induction is done using fentanyl 1mcg/kg and propofol 2mg/kg. A supraglottic airway is inserted and the mixture used to maintain anaesthesia is and air oxygen mixture and 2.5% sevoflurane. Using a Bain circuit, the patient breathes spontaneously and the fresh gas flow is 9L/min. Over the next 30 minutes, the end-tidal CO2 increase from 4.5kPa to 8.4kPa, and the baseline reading on the capnograph is 0kPa.
The most appropriate action that should follow is:Your Answer: Observe the patient for further change
Explanation:Such a high rise of end-tidal CO2 (EtCO2) in a patient who is spontaneously breathing is often encountered.
Close observation should occur for further rises in EtCO2 and other signs of malignant hyperthermia. If this were to rise even more, it might be wise to ensure that ventilatory support is available.
A lot would depend on whether surgery was almost completed. At this stage of anaesthesia, it would be inappropriate to administer opioid antagonists or respiratory stimulants.
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This question is part of the following fields:
- Physiology
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Question 10
Incorrect
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All of the following statements are true about blood clotting except:
Your Answer: Protein C is a vitamin K dependent substance
Correct Answer: Administration of aprotinin during liver transplantation surgery prolongs survival
Explanation:Even though aprotinin reduces fibrinolysis and therefore bleeding, there is an associated increased risk of death. It was withdrawn in 2007.
Protein C is dependent upon vitamin K and this may paradoxically increase the risk of thrombosis during the early phases of warfarin treatment.The coagulation cascade include two pathways which lead to fibrin formation:
1. Intrinsic pathway – these components are already present in the blood
Minor role in clotting
Subendothelial damage e.g. collagen
Formation of the primary complex on collagen by high-molecular-weight kininogen (HMWK), prekallikrein, and Factor 12
Prekallikrein is converted to kallikrein and Factor 12 becomes activated
Factor 12 activates Factor 11
Factor 11 activates Factor 9, which with its co-factor Factor 8a form the tenase complex which activates Factor 102. Extrinsic pathway – needs tissue factor that is released by damaged tissue)
In tissue damage:
Factor 7 binds to Tissue factor – this complex activates Factor 9
Activated Factor 9 works with Factor 8 to activate Factor 103. Common pathway
Activated Factor 10 causes the conversion of prothrombin to thrombin and this hydrolyses fibrinogen peptide bonds to form fibrin. It also activates factor 8 to form links between fibrin molecules.4. Fibrinolysis
Plasminogen is converted to plasmin to facilitate clot resorption -
This question is part of the following fields:
- Physiology And Biochemistry
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