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  • Question 1 - You are prescribing ipratropium bromide for a patient who has presented with an...

    Incorrect

    • You are prescribing ipratropium bromide for a patient who has presented with an exacerbation of her COPD. What is the mechanism of action of ipratropium bromide:

      Your Answer: Beta-2 agonist

      Correct Answer: Muscarinic antagonist

      Explanation:

      Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.

      The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
      The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).

      Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
      The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      21.5
      Seconds
  • Question 2 - A 43-year old male is taken to the Emergency Room for a lacerated...

    Correct

    • A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.

      Which of these anatomic structures is the most superficial structure injured in the case above?

      Your Answer: Camper’s fascia

      Explanation:

      The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:

      Skin
      Fatty layer of the superficial fascia (Camper’s fascia)
      Membranous layer of the superficial fascia (Scarpa’s fascia)
      Aponeurosis of the external and internal oblique muscles
      Rectus abdominis muscle
      Aponeurosis of the internal oblique and transversus abdominis
      Fascia transversalis
      Extraperitoneal fat
      Parietal peritoneum

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      41.9
      Seconds
  • Question 3 - An 11-year-old boy was brought to the emergency room due to fever and...

    Incorrect

    • An 11-year-old boy was brought to the emergency room due to fever and pain in the ears. Upon physical examination, it was observed that the mastoid area is erythematous and there is a presence of a boggy, tender mass. A diagnosis of acute mastoiditis was made.

      Which of the following parts of the temporal bone is most likely involved?

      Your Answer: Squamous part

      Correct Answer: Petrous part

      Explanation:

      Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity.

      The temporal bone is composed of four parts: the mastoid process, the petrous pyramid, the squamous, and tympanic portions. The mastoid process and the petrous pyramid are the portions of particular interest because of the prevalence of suppurations within these parts of the temporal bone.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      44.2
      Seconds
  • Question 4 - Regarding local anaesthetics, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Bupivacaine takes up to 30 minutes for a full effect.

      Correct Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.

      Explanation:

      It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      53.7
      Seconds
  • Question 5 - 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: Lymphocytes

      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
      17.2
      Seconds
  • Question 6 - Regarding the refractory period, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding the refractory period, which of the following statements is INCORRECT:

      Your Answer: Action potentials cannot occur in the absolute refractory period.

      Correct Answer: Action potentials can occur in the relative refractory period but the amplitude of the action potential is smaller.

      Explanation:

      Following the action potential, Na+channels remain inactive for a time in a period known as the absolute refractory period where they cannot be opened by any amount of depolarisation. Following this there is a relative refractory period where the temporary hyperpolarisation (due to delayed closure of rectifier K+channels) makes the cell more difficult to depolarise and an action potential can be generated only in response to a larger than normal stimulus. The refractory period limits the frequency at which action potentials can be generated, and ensures that, once initiated, an action potential can travel only in one direction. An action potential is an all or nothing response so the amplitude of the action potential cannot be smaller.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      19.3
      Seconds
  • Question 7 - Antidiuretic hormone (ADH) levels are found to be increased in a young ladyĀ with...

    Incorrect

    • Antidiuretic hormone (ADH) levels are found to be increased in a young ladyĀ with unexplained hyponatraemia.

      In a healthy patient under normal circumstances, in which of the following conditions would ADH not be released?

      Your Answer:

      Correct Answer: Increased alcohol intake

      Explanation:

      Antidiuretic hormone (ADH) is produced in the hypothalamus’s supraoptic nucleus and then released into the blood via axonal projections from the hypothalamus to the posterior pituitary.

      It is carried down axonal extensions from the hypothalamus (the neurohypophysial capillaries) to the posterior pituitary, where it is kept until it is released, after being synthesized in the hypothalamus.
      The secretion of ADH from the posterior pituitary is regulated by numerous mechanisms:
      Increased plasma osmolality: Osmoreceptors in the hypothalamus detect an increase in osmolality and trigger ADH release.

      Hypovolaemia causes a drop in atrial pressure, which stretch receptors in the atrial walls and big veins detect (cardiopulmonary baroreceptors). ADH release is generally inhibited by atrial receptor firing, but when the atrial receptors are stretched, the firing reduces and ADH release is promoted.

      Hypotension causes baroreceptor firing to diminish, resulting in increased sympathetic activity and ADH release.
      An increase in angiotensin II stimulates angiotensin II receptors in the hypothalamus, causing ADH production to increase.

      Nicotine, Sleep,Ā Fright, and Exercise are some of the other elements that might cause ADH to be released.
      Alcohol (which partly explains the diuretic impact of alcohol) and elevated levels of ANP/BNP limit ADH release.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds
  • Question 8 - A 59-year-old man presents to the emergency room with chest pain. He was...

    Incorrect

    • A 59-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.

      Which of the following is abciximab (ReoPro) mechanism of action?

      Your Answer:

      Correct Answer: Antagonism of the glycoprotein IIb/IIIa receptor

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 9 - A patient is sent in by her GP with suspected ectopic pregnancy. Tubal...

    Incorrect

    • A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:

      Your Answer:

      Correct Answer: Ampulla

      Explanation:

      Ectopic pregnancyĀ most commonly occurs in the ampulla (70% of cases).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 10 - A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis...

    Incorrect

    • A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.
      Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.

      Your Answer:

      Correct Answer: Vancomycin

      Explanation:

      In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.
      Other bacteria that can cause osteomyelitis include:
      Enterobacter spp.
      Group A and B streptococcus
      Haemophilus influenzae
      The current recommendations by NICE and the BNF on the treatment of osteomyelitis are:
      Flucloxacillin first-line
      Consider adding fusidic acid or rifampicin for initial 2 weeks
      If penicillin allergic use clindamycin
      If MRSA is suspected use vancomycin
      Suggested duration of treatment is 6 weeks for acute infection

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds
  • Question 11 - Which of the following has the most potent glucocorticoid effect: ...

    Incorrect

    • Which of the following has the most potent glucocorticoid effect:

      Your Answer:

      Correct Answer: Dexamethasone

      Explanation:

      Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      0
      Seconds
  • Question 12 - The interquartile range (IQ) is often displayed using which of the following: ...

    Incorrect

    • The interquartile range (IQ) is often displayed using which of the following:

      Your Answer:

      Correct Answer: Box and whisker plot

      Explanation:

      A boxplot is a vertical or horizontal rectangle used to display the interquartile range, with the ends of the rectangle corresponding to the upper and lower quartiles of the data values. The box contains 50% of the data values. A line drawn through the rectangle corresponds to the median value. Whiskers, starting at the ends of the rectangle usually indicate the minimum and maximum values, therefore the entire box and whisker plot represents the range. Any outliers can be plotted independent of the box and whisker plot.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
      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:

      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
      0
      Seconds
  • Question 14 - Which of the following is characterised by passive carrier-mediated transport down a chemical...

    Incorrect

    • Which of the following is characterised by passive carrier-mediated transport down a chemical concentration gradient:

      Your Answer:

      Correct Answer: Facilitated diffusion

      Explanation:

      Facilitated diffusion is the process of spontaneous passive transport of molecules or ions down their concentration gradient across a cell membrane via specific transmembrane transporter (carrier) proteins. The energy required for conformational changes in the transporter protein is provided by the concentration gradient rather than by metabolic activity.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds
  • Question 15 - Osteoclasts are a type of bone cell that are critical in the maintenance,...

    Incorrect

    • Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.
      Which of the following inhibits osteoclast activity? Select ONE answer only.

      Your Answer:

      Correct Answer: Calcitonin

      Explanation:

      Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.
      Osteoclastic activity is controlled by a number of hormones:
      1,25-dihydroxycholecalciferol increases osteoclastic activity
      Parathyroid hormone increases osteoclastic activity
      Calcitonin inhibits osteoclastic activity
      Bisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
      Seconds
  • Question 16 - Which of the following hormones is dysfunctional in diabetes insipidus: ...

    Incorrect

    • Which of the following hormones is dysfunctional in diabetes insipidus:

      Your Answer:

      Correct Answer: Antidiuretic hormone

      Explanation:

      Diabetes insipidus (DI) may result from a deficiency of ADH secretion (cranial DI) or from an inappropriate renal response to ADH (nephrogenic DI). As a result, fluid reabsorption at the kidneys is impaired, resulting in large amounts of hypotonic, dilute urine being passed with a profound unquenchable polydipsia.
      The biochemical hallmarks of DI are:
      HighĀ plasma osmolality (> 295 mOsm/kg)
      Low urine osmolality (< 300 mOsm/kg)
      Hypernatraemia (> 145 mmol/L)
      High urine volume

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds
  • Question 17 - In the emergency room, a patient was diagnosed with acute bacterial tonsillitis. Which...

    Incorrect

    • In the emergency room, a patient was diagnosed with acute bacterial tonsillitis. Which of the following postinfectious complications is most commonly linked to Streptococcus pyogenes:

      Your Answer:

      Correct Answer: Glomerulonephritis

      Explanation:

      Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific nephritogenic strains of group A beta-haemolytic streptococcus. The clinical presentation of PSGN varies from asymptomatic, microscopic haematuria to the full-blown acute nephritic syndrome, characterized by red to brown urine, proteinuria (which can reach the nephrotic range), oedema, hypertension, and acute kidney injury.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 18 - Swelling of the lips, tongue, and face is observed in a 59-year-old African-American...

    Incorrect

    • Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.

      Which of the following drugs is most likely to have caused her symptoms?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.

      Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.

      Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.

      The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.

      Other medications that are less frequently linked to angioedema include:
      Angiotensin-receptor blockers (ARBs)
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      Bupropion (e.g. Zyban and Wellbutrin)
      Beta-lactam antibiotics
      Statins
      Proton pump inhibitors

      The majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 19 - Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Infection usually requires antibiotic treatment.

      Explanation:

      Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 20 - The percentage of patients with hepatitis B that develop chronic infection is about:...

    Incorrect

    • The percentage of patients with hepatitis B that develop chronic infection is about:

      Your Answer:

      Correct Answer: 10%

      Explanation:

      With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 21 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
      Which SINGLE statement regarding mannitol is true?

      Your Answer:

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
      Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
      Decreasing the rate of CSF formation,and;
      Withdrawing extracellular fluid from the brain across the BBB
      Other uses of mannitol include:
      Short-term management of glaucoma
      Treatment of rhabdomyolysis
      Preserve renal function in peri-operative jaundiced patients
      To initiate diuresis in transplanted kidneys
      Bowel preparation prior to colorectal procedures
      The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
      Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
      Anuria
      Intracranial bleeding (except during craniotomy)
      Severe cardiac failure
      Severe dehydration
      Severe pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 22 - Which of the following is NOT an effect of benzodiazepines: ...

    Incorrect

    • Which of the following is NOT an effect of benzodiazepines:

      Your Answer:

      Correct Answer: Analgesic effect

      Explanation:

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhanceĀ inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 23 - The Meissner’s plexus acts as the main control for gastrointestinal secretion and local...

    Incorrect

    • The Meissner’s plexus acts as the main control for gastrointestinal secretion and local blood flow within the gut.

      The Meissner’s plexus lies in which layer of the gut wall?

      Your Answer:

      Correct Answer: Submucosa

      Explanation:

      The Meissner’s plexus (submucosal plexus), an enteric nervous plexus, acts as the main control for gastrointestinal secretion and local blood flow within the gut.

      It is located in the submucosal layer on the inner surface of the muscularis externa.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      0
      Seconds
  • Question 24 - In adult advanced life support, which of the following best describes the correct...

    Incorrect

    • In adult advanced life support, which of the following best describes the correct administration of adrenaline for a non-shockable rhythm:

      Your Answer:

      Correct Answer: Give 1 mg of adrenaline as soon as intravenous access is achieved and every 3 - 5 minutes thereafter

      Explanation:

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 25 - The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This...

    Incorrect

    • The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.

      Which of the following medications is most likely to be the cause of this adverse reaction?

      Your Answer:

      Correct Answer: Amlodipine

      Explanation:

      Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 26 - A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She...

    Incorrect

    • A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.
      What is the most likely diagnosis in this case? Select ONE answer only.

      Your Answer:

      Correct Answer: Polycythaemia vera

      Explanation:

      Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.
      Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.
      The other clinical features of PCV include:
      Plethoric appearance
      Lethargy and tiredness
      Splenomegaly (common)
      Pruritis (in 40% – particularly after exposure to hot water)
      Headaches, dizziness and sweating (in 30%)
      Gouty arthritis (in 20%)
      Budd-Chiari syndrome (in 5-10%)
      Erythromyalgia (in <5% – burning pain and red/blue discolouration of hands and feet)
      Increased incidence of peptic ulcer disease (possibly related to increased histamine release from mast cells)
      The diagnosis of PCV requires two major criteria and one minor criterion, or the first major criterion and two minor criteria:
      Major criteria:
      HB > 18.5 g/dl in men, 16.5 g/dl in women
      Elevated red cell mass > 25% above mean normal predicted value
      Presence of JAK2 mutation

      Minor criteria:
      Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferation
      Serum erythropoietin level below normal range
      Endogenous erythroid colony formation in vitro
      The main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds
  • Question 27 - Regarding bronchiolitis, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Chest x-ray may show hyperinflation and increased peribronchial markings.

      Explanation:

      Acute bronchiolitis is caused most commonly by respiratory syncytial virus, occurring mostly in children aged 6 months to 2 years. Children with bronchiolitis are febrile and tachypnoeic with a dry cough and difficulty feeding. Examination may reveal chest hyperinflation, respiratory distress, wheezing and fine end-inspiratory crepitations. Chest x-ray may show hyperinflation and increased peribronchial markings (although CXR should only performed if there is diagnostic uncertainty or an atypical course). Treatment is usually supportive,Ā aerosolized ribavirin is reserved for severely ill or immunocompromised patients.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 28 - You are treating a patient with a Clostridium difficile infection. His condition was...

    Incorrect

    • You are treating a patient with a Clostridium difficile infection. His condition was found to be antibiotic-associated. Which of the following pieces of advice on preventing the spread of this disease should you give this patient?

      Your Answer:

      Correct Answer: Washing hands with soap and water

      Explanation:

      Clostridium difficile (C. diff) can cause colitis, or inflammation of the colon.

      To prevent its spread, one should practice good hand hygiene, regularly clean areas of the home that may become contaminated with C. difficile, practice good hand hygiene, and clean surfaces, spills, and accidents.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      0
      Seconds
  • Question 29 - The juxtacapillary receptors, or J receptors, are sensory cells that play an important...

    Incorrect

    • The juxtacapillary receptors, or J receptors, are sensory cells that play an important role in the control of respiration.
      At which of the following anatomical sites are the J receptors located? Select ONE answer only.

      Your Answer:

      Correct Answer: The alveolar walls

      Explanation:

      Juxtacapillary receptors (J receptors) are sensory cells that are located within the alveolar walls in juxtaposition to the pulmonary capillaries of the lung.
      The J receptors are innervated by the vagus nerve and are activated by physical engorgement of the pulmonary capillaries or increased pulmonary interstitial volume, for example, in the presence of pulmonary oedema, pulmonary embolus, pneumonia and barotraumas. They may also be stimulated by hyperinflation of the lung.
      Stimulation of the J receptors causes a reflex increase in breathing rateĀ and is also thought to be involved in the sensation of dyspnoea. The reflex response that is produced is apnoea, followed by rapid breathing, bradycardia, and hypotension.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      0
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  • Question 30 - You are seeing a child with known mitochondrial disease who has presented breathlessness...

    Incorrect

    • You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:

      Your Answer:

      Correct Answer: Energy production

      Explanation:

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

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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