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  • Question 1 - Detection of urinary Bence-Jones protein would be most suggestive of which of the...

    Incorrect

    • Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:

      Your Answer: Hodgkin lymphoma

      Correct Answer: Multiple myeloma

      Explanation:

      Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      26.7
      Seconds
  • Question 2 - The mechanism of action of abciximab is by: ...

    Incorrect

    • The mechanism of action of abciximab is by:

      Your Answer: Inhibition of platelet thromboxane A2 synthesis

      Correct Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites

      Explanation:

      Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      22.8
      Seconds
  • Question 3 - Digoxin is contraindicated in all of the following EXCEPT for: ...

    Incorrect

    • Digoxin is contraindicated in all of the following EXCEPT for:

      Your Answer: Ventricular tachycardia

      Correct Answer: Asthma

      Explanation:

      Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      8
      Seconds
  • Question 4 - Which of the following blood groups is the universal donor: ...

    Correct

    • Which of the following blood groups is the universal donor:

      Your Answer: O

      Explanation:

      Blood group O has no antigens, but both anti-A and anti-B antibodies and thus is the universal donor.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      44.4
      Seconds
  • Question 5 - A 23-year-old male is referred to your haematology clinic after an acute attack...

    Correct

    • A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago.

      Which ONE of the following options is FALSE with regards to this disorder?

      Your Answer: Acute haemolysis can be triggered by cephalosporin antibiotics

      Explanation:

      Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.

      Triggers include:
      1) Fava beans
      2) Sulphonamides
      3) Primaquine
      4) Anti-TB drugs
      5) Infections

      Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      21
      Seconds
  • Question 6 - Which of the following is NOT typically associated with eosinophilia: ...

    Incorrect

    • Which of the following is NOT typically associated with eosinophilia:

      Your Answer: Psoriasis

      Correct Answer: Whooping cough

      Explanation:

      An eosinophil leucocytosis is defined as an increase in blood eosinophils above 0.4 x 109/L.It is most frequently due to:
      Allergic diseases (e.g. bronchial asthma, hay fever, atopic dermatitis, urticaria)
      Parasites (e.g. hookworm, ascariasis, tapeworm, schistosomiasis)
      Skin diseases (e.g. psoriasis, pemphigus, urticaria, angioedema)
      Drug sensitivity

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      99.5
      Seconds
  • Question 7 - An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before...

    Correct

    • An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.

      Which of the following valve disorders is an absolute contraindication to the use of GTN?

      Your Answer: Mitral stenosis

      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. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
      2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
      3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)

      The nitrate drugs cause vasodilation via the action of nitric oxide.

      The contraindications to the use of nitrate are the following:
      1. Allergy to nitrates
      2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
      3. Right ventricular infarction
      4. Hypertrophic cardiomyopathy
      5. Cardiac tamponade
      6. Constrictive pericarditis
      7. Hypotensive conditions
      8. Hypovolaemia
      9. Marked anaemia
      10. Mitral stenosis
      11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
      12. Toxic pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      37.3
      Seconds
  • Question 8 - A blood culture was performed from a sample taken from a patient. It...

    Correct

    • A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.

      Among the following microorganisms, which is considered an example of a Gram-positive coccus?

      Your Answer: Staphylococcus aureus

      Explanation:

      Bacillus cereus = Gram-positive bacillus
      Neisseria meningitidis = Gram-negative coccus
      Salmonella enterica & Escherichia coli = Gram-negative bacilli

      In Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative.
      The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      26.3
      Seconds
  • Question 9 - 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: No exclusion period

      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
      42.4
      Seconds
  • Question 10 - A patient with a high potassium level is at risk of going into...

    Incorrect

    • A patient with a high potassium level is at risk of going into cardiac arrest. What changes in the ECG may indicate the incident of cardiac arrest in this patient?

      Your Answer: Downsloping ST depression with flattened T waves

      Correct Answer: Peaked T waves and broad QRS complex

      Explanation:

      Severe hyperkalaemia can result in a heart attack or a life-threatening arrhythmia.

      T waves become narrow-based, pointed, and tall if hyperkalaemia is not treated.

      The QRS complex widens and eventually merges with the T wave, resulting in a classic sine-wave electrocardiogram. Ventricular fibrillation and asystole are likely to follow.

    • This question is part of the following fields:

      • Physiology
      • Renal
      45.9
      Seconds
  • Question 11 - You are instructed by a senior to administer Mannitol to an RTA patient...

    Incorrect

    • You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure.

      Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.
      Out of the following, which is a contraindication to the use of mannitol?

      Your Answer: Rhabdomyolysis

      Correct Answer: Severe pulmonary oedema

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      19.7
      Seconds
  • Question 12 - About what percentage of filtered Na+is reabsorbed in the proximal tubule: ...

    Incorrect

    • About what percentage of filtered Na+is reabsorbed in the proximal tubule:

      Your Answer: 80 - 90%

      Correct Answer: 65 - 70%

      Explanation:

      Of the filtered sodium, about 65% is reabsorbed in the proximal tubule.

    • This question is part of the following fields:

      • Physiology
      • Renal
      67.5
      Seconds
  • Question 13 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Incorrect

    • Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:

      Your Answer: Gonococcal infections

      Correct Answer: Staphylococcal infections

      Explanation:

      Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      60.1
      Seconds
  • Question 14 - Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:...

    Incorrect

    • Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:

      Your Answer: ITP is a diagnosis of exclusion.

      Correct Answer: ITP is classically associated with massive splenomegaly.

      Explanation:

      Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged.  In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      42.5
      Seconds
  • Question 15 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Apoptosis may be pathological or physiological.

      Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.

      Explanation:

      Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      35.2
      Seconds
  • Question 16 - A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy...

    Incorrect

    • A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.

      Which of these transfusions reactions most likely occurred?

      Your Answer: TACO

      Correct Answer: Febrile transfusion reaction

      Explanation:

      Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.

      Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.

      Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.

      Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.

      Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      80.5
      Seconds
  • Question 17 - Regarding V/Q mismatch, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding V/Q mismatch, which of the following statements is CORRECT:

      Your Answer: In a pure shunt, the V/Q ratio = ∞.

      Correct Answer: In a true shunt, increasing inspired oxygen has no effect on improving hypoxaemia.

      Explanation:

      Both ventilation and perfusion increase towards the lung base, because of the effects of gravity, but the gravitational effects are greater on perfusion than ventilation and therefore there is a regional variation in V/Q ratio from lung apex (high V/Q) to lung base (low V/Q). In a pure shunt, there is normal perfusion but absent ventilation and the V/Q ratio = 0. In a true shunt increasing oxygen fraction has no effect because the oxygen-enriched air fails to reach the shunted blood. An increased A-a gradient is seen in V/Q mismatch.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      24.7
      Seconds
  • Question 18 - Which of the following is NOT an effect of cytokine activity: ...

    Incorrect

    • Which of the following is NOT an effect of cytokine activity:

      Your Answer: Fever

      Correct Answer: Opsonisation of bacteria for phagocytosis

      Explanation:

      Cytokines are a family of chemical messengers, secreted by leucocytes, that act over short distances by binding specific receptors on target cell surfaces. They include: interleukins (act between leucocytes), interferons (inhibit replication of viruses within cells and activate macrophages and natural killer cells), growth factors, and tumour necrosis factors (kill tumour cells). Effects include: induction of fever and acute phase response, stimulation of leucocyte differentiation and maturation, leucocyte recruitment and activation and increased antibody production.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      50.6
      Seconds
  • Question 19 - Which cervical interspace is most likely injured if a patient presents with difficulty...

    Incorrect

    • Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?

      Your Answer: C2-C3

      Correct Answer: C4-C5

      Explanation:

      In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.

      Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.

      For a C4-C5 injury, the following symptoms may present:

      Weakness in the deltoid muscle (front and side of the shoulder) and upper arm
      Shoulder pain
      Numbness along the outside of the upper arm

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      11.2
      Seconds
  • Question 20 - 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
      123.4
      Seconds
  • Question 21 - Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT: ...

    Incorrect

    • Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:

      Your Answer: The majority of NHL are of T-cell origin.

      Correct Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.

      Explanation:

      Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.
      NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
      The following are recognised risk factors for NHL:
      Chromosomal translocations and molecular rearrangements
      Epstein-Barr virus infection
      Human T-cell leukaemia virus type-1 (HTLV-1)
      Hepatitis C
      Congenital and acquired immunodeficiency states
      Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis
      The most common clinical features at presentation are:
      Lymphadenopathy (typically asymmetrical and painless)
      Weight loss
      Fatigue
      Night sweats
      Hepatosplenomegaly
      For clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.
      Indolent (low-grade) NHL:
      The cells are relatively mature
      Disease follows an indolent course without treatment
      Often acceptable to follow a ‘watch and wait’ strategy
      Local radiotherapy often effective
      Relatively good prognosis with median survival of 10 years
      High-grade NHL:
      Cells are immature
      Disease progresses rapidly without treatment
      Significant number of patients can be cured with intensive combination chemotherapy regimens
      Approximately 40% cure rate
      Lymphoblastic NHL:
      Cells are very immature and have a propensity to involve the CNS
      Treatment and progression are similar to that of acute lymphoblastic leukaemia (ALL)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      47.4
      Seconds
  • Question 22 - Which of the following factors decreases insulin secretion: ...

    Correct

    • Which of the following factors decreases insulin secretion:

      Your Answer: Catecholamines

      Explanation:

      Factors that increase insulin secretion:
      ↑ Blood glucose
      ↑ Amino acids
      ↑ Fatty acids
      Glucagon
      Secretin
      Acetylcholine

      Factors that decrease insulin secretion:
      ↓ Blood glucose
      Somatostatin
      Catecholamines

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      1.2
      Seconds
  • Question 23 - Monoamine oxidase is primarily involved in the degradation of which of the following:...

    Correct

    • Monoamine oxidase is primarily involved in the degradation of which of the following:

      Your Answer: Noradrenaline

      Explanation:

      Catecholamines are broken down extracellularly and in the liver by catechol-O-methyltransferase (COMT) and intracellularly by monoamine oxidase (MAO).

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      52.8
      Seconds
  • Question 24 - A 40-year-old man with reduced urine output, nausea, and confusion also has a...

    Incorrect

    • A 40-year-old man with reduced urine output, nausea, and confusion also has a 150% rise of creatinine from baseline over the past 7 days. A diagnosis of acute kidney injury (AKI) is made after more tests are done.

      His AKI stage is?

      Your Answer: Stage 0

      Correct Answer: Stage 2

      Explanation:

      This patient with a 150% rise of creatinine above baseline within 7 days has stage 2 Acute kidney injury (AKI).

      AKI stages are as follows:
      Stage 1
      Creatinine rise of 26 micromole/L or more within 48 hours, or
      Creatinine rise of 50-99% from baseline within 7 days (1.5-1.99 x baseline),or
      Urine output <0.5 mL/kg/hour for more than 6 hours Stage 2
      Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),or
      Urine output <0.5 mL/kg/hour for more than 12 hours Stage 3
      Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), or
      Creatinine rise to 354 micromole/L or more with acute rise of 26 micromole/L or more within 48 hours or 50% or more rise within 7 days, or
      Urine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      18.7
      Seconds
  • Question 25 - Which of these increases osteoclast activity? ...

    Incorrect

    • Which of these increases osteoclast activity?

      Your Answer: Bisphosphonates

      Correct Answer: Parathyroid hormone

      Explanation:

      Osteoclasts are bone cell that break down bone tissue.

      Parathyroid hormone increases osteoclastic activity.

      1,25-dihydroxycholecalciferol increases osteoclastic activity

      Calcitonin inhibits osteoclastic activity

      Bisphosphonates are osteoclast inhibitors.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      6.7
      Seconds
  • Question 26 - At which opioid receptors do opioid analgesics act primarily? ...

    Correct

    • At which opioid receptors do opioid analgesics act primarily?

      Your Answer: Mu

      Explanation:

      Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      125.7
      Seconds
  • Question 27 - You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced...

    Correct

    • You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.

      Which of the following anti-D statements is correct?

      Your Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks

      Explanation:

      Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.

      Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly.

      The following are examples of potentially sensitising events:
      Birth
      Haemorrhage during pregnancy
      Miscarriage
      Ectopic pregnancy
      Death within the womb
      Amniocentesis
      Chorionic villus sampling
      Trauma to the abdomen

      The sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.

      At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.

      Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      43.5
      Seconds
  • Question 28 - Regarding the abductor pollicis longus, which of the following statements is true? ...

    Incorrect

    • Regarding the abductor pollicis longus, which of the following statements is true?

      Your Answer: It forms part of the thenar eminence

      Correct Answer: It extends the thumb at the carpometacarpal joint

      Explanation:

      Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.

      Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.

      Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.

      Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.

      Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      88.5
      Seconds
  • Question 29 - Which of the following best characterizes the correct administration of amiodarone for a...

    Incorrect

    • Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:

      Your Answer: Give 300 mg IV amiodarone after 3 shocks, and then every 3 - 5 minutes thereafter

      Correct Answer: Give 300 mg IV amiodarone after 3 shocks

      Explanation:

      After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      51.7
      Seconds
  • Question 30 - The following statements are not true of the flexor digiti minimi brevis, except?...

    Incorrect

    • The following statements are not true of the flexor digiti minimi brevis, except?

      Your Answer:

      Correct Answer: It is situated on the radial border of abductor digiti minimi

      Explanation:

      Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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