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  • Question 1 - A breakthrough lipid-lowering therapy for stroke had a number needed to treat (NNT)...

    Incorrect

    • A breakthrough lipid-lowering therapy for stroke had a number needed to treat (NNT) of 20 for the prevention of the primary end-point. These results can be best described as:

      Your Answer: 20 extra patients in the placebo group had a stroke

      Correct Answer: For 1000 patients treated with active therapy, there would be 50 fewer strokes

      Explanation:

      Number needed to treat (NNT) is a time specific epidemiological measure that indicates how many patients would be require for an intervention to prevent one additional bad outcome. A perfect NNT would be 1, where everyone improves with treatment, thus the higher the NNT, the less effective the treatment.

      Thus if you treat 1000 patients then you will expect to have 50 fewer strokes.

    • This question is part of the following fields:

      • Statistical Methods
      9.9
      Seconds
  • Question 2 - Blood pressure monitoring is a requirement for in-patient care. Different factors can result...

    Incorrect

    • Blood pressure monitoring is a requirement for in-patient care. Different factors can result in an inaccurate blood pressure reading, including the damping of an arterial waveform.

      How does a damped arterial waveform affect blood pressure measurements?

      Your Answer: The systolic pressure and diastolic pressure are higher with a higher mean

      Correct Answer: The systolic pressure is lower and the diastolic pressure higher with the same mean

      Explanation:

      Damping is the reduction of energy in a system achieved by reducing the amplitude of oscillations. It is necessary to some degree to prevent wave overshoots.

      Critical damping usually causes the system to be slow, so optimal damping is normally applied to provide a balance between speed and distortion.

      Damping can cause errors if excessive (overdamping) or inadequate (Underdamping). The amount of damping in a system can be determined using the damping coefficient (D), where:

      Undamped: 0
      Critically damped: 1
      Optimally damped: 0.64

      An overdamped system will cause an artificial decrease in the systolic blood pressure, and an artificial increase in the diastolic blood pressure.

      An underdamped system will cause an artificial increase in systolic blood pressure and an artificial decrease in diastolic blood pressure.

      Damping can be caused by a number of factors affecting different parts of the system, including:

      The tubing/cannula: The presence of air bubbles, increased blood viscosity or formation of blood clots.
      The diaphragm/tubing: Increased malleability/compliance
      The tubing: Presence of kinks, narrowing or too many ports of injection.

      The answer here is a damped system will have a low systolic pressure, a high diastolic pressure with a normal mean pressure.

    • This question is part of the following fields:

      • Clinical Measurement
      7.7
      Seconds
  • Question 3 - A 68-year-old man with nausea and vomiting is admitted to the hospital.

    For temporal...

    Correct

    • A 68-year-old man with nausea and vomiting is admitted to the hospital.

      For temporal arteritis, he takes 40 mg prednisolone orally in divided doses. His prescription chart will need to be adjusted to reflect his inability to take oral medications.

      What is the equivalent dose of intravenous hydrocortisone to 40 mg oral prednisolone?

      Your Answer: 160 mg

      Explanation:

      Prednisolone 5 mg is the same as 20 mg hydrocortisone.

      Prednisolone 40 mg is the same as 8 x 20 mg or 160 mg of prednisolone.

      Mineralocorticoid effects and variations in action duration are not taken into account in these comparisons.

      5 mg of prednisolone is the same as Dexamethasone 750 mcg, Hydrocortisone 20 mg, Methylprednisolone 4 mg, and Cortisone acetate 25 mg.

    • This question is part of the following fields:

      • Pharmacology
      10.7
      Seconds
  • Question 4 - A 49-year-old woman is admitted to hospital. She is scheduled for surgery and...

    Incorrect

    • A 49-year-old woman is admitted to hospital. She is scheduled for surgery and is undergoing preoperative assessment.

      As part of the preoperative assessment, her functional capacity is estimated. At 50kg in weight, she is able to cycle along a flat surface at a speed of 10-14 miles/hour (8 metabolic equivalents or METs).

      Provide the best estimated value of oxygen consumption (VO2) for eight METs.

      Your Answer: 1050 mL/minute

      Correct Answer: 1400 mL/minute

      Explanation:

      Oxygen consumption (VO2) refers to the optimal amount of oxygen used by the body during exercise.

      It is calculated mathematically by:

      VO2 = 3.5 x 50 x 8 = 1400 mL/kg/minute

      where,

      1 MET = 3.5 mL O2/kg/minute is utilized by the body.

      Note:

      1 MET Eating
      Dressing
      Use toilet
      Walking slowly on level ground at 2-3 mph
      2 METs Playing a musical instrument
      Walking indoors around house
      Light housework
      4 METs Climbing a flight of stairs
      Walking up hill
      Running a short distance
      Heavy housework, scrubbing floors, moving heavy furniture
      Walking on level ground at 4 mph
      Recreational activity, e.g. golf, bowling, dancing, tennis
      6 METs Leisurely swimming
      Leisurely cycling along the flat (8-10 mph)
      8 METs Cycling along the flat (10-14 mph)
      Basketball game
      10 METs Moderate to hard swimming
      Competitive football
      Fast cycling (14-16 mph)

    • This question is part of the following fields:

      • Clinical Measurement
      3.9
      Seconds
  • Question 5 - Concerning calcium metabolism and its control, which of these is correct? ...

    Incorrect

    • Concerning calcium metabolism and its control, which of these is correct?

      Your Answer: In plasma, calcium binding to protein is pH independent

      Correct Answer: Cholecalciferol is 25-hydroxylated in the liver

      Explanation:

      When there is a fall in ionised plasma calcium levels, the chief cells of the parathyroid glands are stimulated to secrete parathyroid hormone (PTH).

      50% of extracellular calcium occurs as non-ionised, protein- (albumin-)bound calcium.

      The degree of ionisation increases with low ph and decreases with high pH.

      There is increased renal calcium excretion with secretion of calcitonin.

    • This question is part of the following fields:

      • Pathophysiology
      3.8
      Seconds
  • Question 6 - Drug X, a new intravenous induction drug, is being administered as a bolus...

    Correct

    • Drug X, a new intravenous induction drug, is being administered as a bolus at regular time intervals, and the following data were observed:

      Time following injection (hours) vs Plasma concentration of drug X (mcg/mL)
      2 / 400
      6 / 100
      10 / 25
      14 / 6.25

      Which of the following values estimate the plasma half-life (T½) of drug X?

      Your Answer: 2 hours

      Explanation:

      Half life (T½) is the time required to change the amount of drug in the body by one-half (or 50%) during elimination. The time course of a drug in the body will depend on both the volume of distribution and the clearance.

      Extrapolating the values from the plasma concentration vs time:

      Plasma concentration at 0 hours = 800 mcg/mL
      Plasma concentration at 2 hours = 400 mcg/mL
      Plasma concentration at 4 hours = 200 mcg/mL
      Plasma concentration at 6 hours = 100 mcg/mL
      Plasma concentration at 8 hours = 50 mcg/mL
      Plasma concentration at 10 hours = 25 mcg/mL
      Plasma concentration at 12 hours = 12.5 mcg/mL
      Plasma concentration at 14 hours = 6.25 mcg/mL

    • This question is part of the following fields:

      • Statistical Methods
      5
      Seconds
  • Question 7 - In a diagnosis of a compensated respiratory acidosis, which of the following arterial...

    Incorrect

    • In a diagnosis of a compensated respiratory acidosis, which of the following arterial blood gas results is likely to be seen?

      Your Answer: pH = 7.25
      PaCO2 = 7.3 kPa
      HCO3 = 22

      Correct Answer:

      Explanation:

      During normal tissue metabolism, there is production of CO2 (acid) which is then expired by the lungs. If metabolism switches from aerobic to anaerobic due to a lack of oxygen, the tissues are unable to completely oxidise sugars to CO2. As a consequence, the sugars can only be partially oxidised to lactic acid. Since lactic acid cannot be expired by the lungs, it remains in the circulation leading to metabolic acidosis.

      Also, normal tissue metabolism leads to the production of some amount of acid from the breakdown of proteins. These acids are excreted from the body by kidney filtration. Renal failure will therefore results in acidosis after several days.

      An increased acidosis stimulates the brain’s respiratory centres to increase the respiratory rate. This lowers the CO2 in the blood, leading to a decrease in its acidity. Renal excretion removes the excess acid, resulting in a normal pH, and a reduced PaCO2 and HCO3.

      pH PaCO2 (kPa) HCO3
      Compensated respiratory acidosis 7.34 7.2 29
      Acute respiratory acidosis 7.25 7.3 22
      Compensated metabolic acidosis 7.34 3.6 14
      Metabolic acidosis 7.21 5.3 15
      Metabolic alkalosis 7.51 5.1 30

    • This question is part of the following fields:

      • Pathophysiology
      1.4
      Seconds
  • Question 8 - A 240 volt alternating current (AC) socket from a wall is used to...

    Incorrect

    • A 240 volt alternating current (AC) socket from a wall is used to charge a direct current (DC) cardiac defibrillator.

      Name the electrical component that converts AC to DC.

      Your Answer: Step-down transformer

      Correct Answer: Rectifier

      Explanation:

      There are two types of defibrillators
      AC defibrillator
      DC defibrillator

      AC defibrillator,
      consists of a step-up transformer with primary and secondary winding and two switches. Since secondary coil consists of more turns of wire than the primary coil, it induces larger voltage. A voltage value ranging between 250V to 750V is applied for AC external defibrillator. And used to enable the charging of a capacitor.

      DC defibrillator,
      consists of auto transformer T1 that acts as primary of the high voltage transformer T2. Is an iron core that transfers energy between 2 circuits by electromagnetic induction. Transformers are used to isolate circuits, change impedance and alter voltage output. transformers do not convert AC to DC.

      Diode rectifier composed of 4 diodes made of semiconductor material allows current to flow only in one direction. Alternating current (AC) passing through these diodes produces direct current (DC). Capacitor stores the charge in the form of an electrostatic field.

      Capacitor is used to convert the rectified AC voltage to produce DC voltage but capacitors do not directly convert AC to DC.

      Inductor induces a counter electromotive force(emf) that reduces the capacitor discharge value.

      In step-down transformer primary coils has more turns of wire than secondary coil, so induced voltage is smaller in the secondary coil.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      4.5
      Seconds
  • Question 9 - Regarding thermocouple, which of the following best describes its properties? ...

    Incorrect

    • Regarding thermocouple, which of the following best describes its properties?

      Your Answer: Resistance at the measuring junction is proportional to temperature

      Correct Answer: The electromotive force at the measuring junction is proportional to temperature

      Explanation:

    • This question is part of the following fields:

      • Basic Physics
      1.9
      Seconds
  • Question 10 - Intracellular effectors are activated by receptors on the cell surface. These receptors receive...

    Incorrect

    • Intracellular effectors are activated by receptors on the cell surface. These receptors receive signals that are relayed by second messenger systems.

      In the human body, which second messenger is most abundant?

      Your Answer:

      Correct Answer: Calcium ions

      Explanation:

      Second messengers relay signals to target molecules in the cytoplasm or nucleus when an agonist interacts with a receptor on the cell surface. They also amplify the strength of the signal. The most ubiquitous and abundant second messenger is calcium and it regulates multiple cellular functions in the body.

      These include:
      Muscle contraction (skeletal, smooth and cardiac)
      Exocytosis (neurotransmitter release at synapses and insulin secretion)
      Apoptosis
      Cell adhesion to the extracellular matrix
      Lymphocyte activation
      Biochemical changes mediated by protein kinase C.

      cAMP is either inhibited or stimulated by G proteins.

      The receptors in the body that stimulate G proteins and increase cAMP include:

      Beta (?1, ?2, and ?3)
      Dopamine (D1 and D5)
      Histamine (H2)
      Glucagon
      Vasopressin (V2).

      The second messenger for the action of nitric oxide (NO) and atrial natriuretic peptide (ANP) is cGMP.

      The second messengers for angiotensin and thyroid stimulating hormone are inositol triphosphate (IP3) and diacylglycerol (DAG).

    • This question is part of the following fields:

      • Physiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Clinical Measurement (2/2) 100%
Pharmacology (1/1) 100%
Pathophysiology (1/2) 50%
Statistical Methods (1/1) 100%
Anaesthesia Related Apparatus (1/1) 100%
Basic Physics (1/1) 100%
Physiology (1/1) 100%
Passmed