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Question 1
Correct
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An 81-year-old male presented to the emergency department following a fall at home. He was diagnosed with osteoporosis about five years ago. He presently complains of significant low back pain. A lumbar spine X-ray was suggestive of a fractured lumbar vertebra. A subsequent MRI scan of the lumbosacral spine revealed a new L3 burst fracture with no evidence of cord compression. A neurosurgical consult was sought and conservative management was planned accordingly in the form of pain control, physiotherapy, and mobilization (as allowed by the pain). He also has been diagnosed with chronic renal disease (stage IV) with a creatinine clearance of 21ml/min, he was started on a Buprenorphine patch. Which of the following opioids would be safest to use for his breakthrough pain?
Your Answer: Oxycodone
Explanation:Oxycodone is a safer opioid to use in patients with moderate to end-stage renal failure.Active metabolites of morphine accumulate in renal failure which means that long-term use is contraindicated in patients with moderate/severe renal failure. These toxic metabolites can accumulate causing toxicity and risk overdose. Oxycodone is mainly metabolised in the liver and thus safer to use in patients with moderate to end-stage renal failure with dose reductions.Adverse effects:Constipation is the most common overall side effect. Others include: asthenia, dizziness, dry mouth, headache, nausea, pruritus, etc. Medications in renal failure:Drugs to be avoided in patients with renal failureAntibiotics: tetracycline, nitrofurantoinNSAIDsLithiumMetforminDrugs that require dose adjustment:Most antibiotics including penicillin, cephalosporins, vancomycin, gentamicin, streptomycinDigoxin, atenololMethotrexateSulphonylureasFurosemideOpioidsRelatively safe drugs:Antibiotics: erythromycin, rifampicinDiazepamWarfarin
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 2
Correct
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Question 3
Correct
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Carotid bodies...
Your Answer: Are located near the bifurcation of the carotid arteries bilaterally
Explanation:The carotid body is a small cluster of chemoreceptors and supporting cells located near the fork (bifurcation) of the carotid artery (which runs along both sides of the throat).The carotid body detects changes in the composition of arterial blood flowing through it, mainly the partial pressure of oxygen, but also of carbon dioxide. Furthermore, it is also sensitive to changes in pH and temperature. Carotid bodies trigger an action potential through the afferent fibers of the glossopharyngeal nerve,
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 4
Incorrect
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The function of Troponin T in cardiac muscle is?
Your Answer: Binding site for Ca2+ to initiate muscle contraction
Correct Answer: Allows attachment of troponin components to tropomyosin
Explanation:Troponin T binds the troponin components to tropomyosin. Troponin I inhibits the interaction of myosin with actin, and troponin C contains the binding sites for the Ca2+ that helps initiate contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Correct
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Which of the following cells are attracted to the surface of endothelium by selectins?
Your Answer: Neutrophils
Explanation:Selectins are expressed on the surface of the endothelium. P selectins are released from weibel-palade bodies and E selectins are induced by cytokines (TNF and IL-1). They bind to receptors on the neutrophils called saiyl lewis X.
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This question is part of the following fields:
- Immunology
- Medicine
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Question 6
Correct
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An effect of aging on the kidney includes?
Your Answer: Decreased GFR
Explanation:The normal range of GFR, adjusted for body surface area, is 100 to 130 mL/min/1.73m2 in men and 90 to 120 ml/min/1.73m2 in women younger than the age of 40. After age 40, GFR decreases progressively with age, by about 0.4 mL/min to 1.2 mL/min per year.
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This question is part of the following fields:
- Medicine
- Renal
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Question 7
Correct
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How are the long chain fatty acids (more than 10 to 12 carbon atoms) absorbed?
Your Answer: Re-esterified to triglycerides and enter the lymphatics as chylomicrons
Explanation:Short and medium chain fatty acids are absorbed into the blood via intestinal capillaries and travel through the portal vein. Long chain fatty acids are not directly released into the intestinal capillaries. They are re-esterified to triglycerides and are coated with cholesterol and protein, forming chylomicrons. Chylomicrons are released in the lymphatic system.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 8
Correct
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Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which of the following statements is true concerning organophosphate poisoning?
Your Answer: Atropine is useful in the management of organophosphate poisoning
Explanation:The principal action of organophosphates is the inhibition of acetylcholinesterase’s, therefore leading to the accumulation of acetylcholine at muscarinic receptors (miosis, hypersalivation, sweating, diarrhoea, excessive bronchial secretions), nicotinic receptors (muscle fasciculations and tremor) and in the central nervous system (anxiety, loss of memory, headache, coma). Removal from the source of the organophosphate, adequate decontamination, supplemental oxygen and atropine are the initial treatment measures. Pralidoxime, an activator of cholinesterase, should be given to all symptomatic patients.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 9
Incorrect
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Question 10
Incorrect
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Where is Müllerian inhibiting substance (MIS) secreted?
Your Answer: Leydig cells
Correct Answer: Sertoli cells
Explanation:Müllerian inhibiting substance, also known as Anti-Müllerian hormone (AMH) or Müllerian-inhibiting hormone (MIH) is a glycoprotein hormone which prevents the development of the Müllerian ducts into the uterus. Its production by Sertoli cells continues during childhood in males and decreases after puberty.
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This question is part of the following fields:
- Endocrinology
- Medicine
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