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  • Question 1 - Which of the following is typically a cause of a normal anion gap metabolic...

    Correct

    • Which of the following is typically a cause of a normal anion gap metabolic acidosis:

      Your Answer: Diarrhoea

      Explanation:

      FUSEDCARS can be used to remember some of the causes of a normal anion gap acidosis:
      Fistula (pancreaticoduodenal)
      Ureteroenteric conduit
      Saline administration
      Endocrine (hyperparathyroidism)
      Diarrhoea
      Carbonic anhydrase inhibitors (e.g. acetazolamide)
      Ammonium chloride
      Renal tubular acidosis
      Spironolactone

    • This question is part of the following fields:

      • Physiology
      • Renal
      32.7
      Seconds
  • Question 2 - A 16-year old boy is brought to the emergency room after suffering a...

    Correct

    • A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.

      Which of the following is the most probable cause of this manifestation?

      Your Answer: Brown-Séquard syndrome

      Explanation:

      Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      14.1
      Seconds
  • Question 3 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Correct

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.

      Which of the following is the patient's preferred drug treatment?

      Your Answer: 25% of the mean arterial pressure over the first hour

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.

      Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.

      Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.

      The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
      An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      39.8
      Seconds
  • Question 4 - A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement...

    Correct

    • A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.

      Which of these is an action of insulin?

      Your Answer: Stimulates lipogenesis

      Explanation:

      Insulin is an anabolic hormone. Its actions can be broadly divided into:
      Lipid metabolism
      Protein metabolism and
      Carbohydrate metabolism

      For lipid metabolism, insulin:
      Stimulates lipogenesis
      Inhibits lipolysis by lipase

      For carbohydrate metabolism, insulin:
      Decreases gluconeogenesis
      Stimulates glycolysis
      Promotes glucose uptake in muscle and adipose tissue
      Promotes glycogen storage
      Increases glycogenesis
      Decreases glycogenolysis

      Protein metabolism:
      Stimulates protein synthesis
      Accelerates net formation of protein
      Stimulates amino acid uptake
      Inhibits protein degradation
      Inhibits amino acid conversion to glucose

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      43.9
      Seconds
  • Question 5 - Regarding the trachea, which of the following statements is INCORRECT: ...

    Correct

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

      Your Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.

      Explanation:

      A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      142.5
      Seconds
  • Question 6 - Which of the following statements regarding hookworm is FALSE: ...

    Incorrect

    • Which of the following statements regarding hookworm is FALSE:

      Your Answer: Hookworm larvae mature into adult worms in the small intestine.

      Correct Answer: Transmission of hookworm is via ingestion of contaminated food and water.

      Explanation:

      The hookworm life cycle begins with the passage of eggs from an adult host into the stool. Hookworm eggs hatch in the soil to release larvae that mature into infective larvae. Infection is usually transmitted by larval penetration into human skin (duodenal infection may also be transmitted by the oral route). From the skin, larvae migrate into the blood vessels and are carried to the lungs, where they penetrate the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      76.9
      Seconds
  • Question 7 - The patient is a 61-year-old man with severe central chest pain. An acute...

    Correct

    • The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.

      Clopidogrel's direct mechanism of action is which of the following?

      Your Answer: Inhibition of platelet ADP receptors

      Explanation:

      Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.8
      Seconds
  • Question 8 - You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus....

    Correct

    • You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?

      Your Answer: Potentiates effect of GABA

      Explanation:

      Lorazepam is a type of benzodiazepine.

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      12
      Seconds
  • Question 9 - Through which of the following anatomical structures does an indirect inguinal hernia pass?...

    Incorrect

    • Through which of the following anatomical structures does an indirect inguinal hernia pass?

      Your Answer: Transverse abdominis

      Correct Answer: External oblique

      Explanation:

      Inguinal hernias are subdivided into direct and indirect.

      An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.

      A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

      The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      21.5
      Seconds
  • Question 10 - Flucloxacillin is used first line for all of the following infections EXCEPT for:...

    Correct

    • Flucloxacillin is used first line for all of the following infections EXCEPT for:

      Your Answer: Otitis media

      Explanation:

      Flucloxacillin is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. Amoxicillin is first line for acute otitis media.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      9.2
      Seconds
  • Question 11 - A 63-year-old man complains of chest pain and syncope on occasion. His heart...

    Correct

    • A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.

      Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?

      Your Answer: Give atropine 500 mcg

      Explanation:

      Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.

      If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
      Shock
      Syncope
      Myocardial ischemia
      Insufficiency of the heart

      If this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.

      The ALS bradycardia algorithm also suggests the following interim measures:
      Transcutaneous pacing
      Isoprenaline infusion 5 mcg/min
      Adrenaline infusion 2-10 mcg/minutes
      Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate)

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      41.8
      Seconds
  • Question 12 - You review a patient with a history of Addison’s disease. He takes 100...

    Correct

    • You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
      What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.

      Your Answer: 25 mg

      Explanation:

      Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
      The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
      Corticosteroid
      Potency relative to hydrocortisone
      Prednisolone
      4 times more potent
      Triamcinolone
      5 times more potent
      Methylprednisolone
      5 times more potent
      Dexamethasone
      25 times more potent

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      34.5
      Seconds
  • Question 13 - Which of the following statements is true regarding a pleural aspiration? ...

    Correct

    • Which of the following statements is true regarding a pleural aspiration?

      Your Answer: The needle should be inserted just above the upper border of the chosen rib

      Explanation:

      Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.

      In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      51.3
      Seconds
  • Question 14 - A 6-year-old child presents with profuse watery diarrhoea and dehydration.

    Which of the...

    Correct

    • A 6-year-old child presents with profuse watery diarrhoea and dehydration.

      Which of the following statements is considered correct regarding infective diarrhoea?

      Your Answer: E.Coli can cause diarrhoea and renal failure

      Explanation:

      E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimes
      collectively referred to as enterovirulent E. coli or diarrheagenic E. coli.

      Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.

      Rotaviruses are the most common cause of viral gastroenteritis
      in infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirus
      season was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.

      Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.

      G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      29
      Seconds
  • Question 15 - Pressure across the wall of a flexible tube (the transmural pressure) increases wall...

    Correct

    • Pressure across the wall of a flexible tube (the transmural pressure) increases wall tension and extends it.

      Which law best describes transmural pressure?

      Your Answer: Laplace’s law

      Explanation:

      The transmural pressure (pressure across the wall of a flexible tube) can be described by Laplace’s law which states that:
      Transmural pressure = (Tw) / r
      Where:
      T = Wall tension
      w = Wall thickness
      r = The radius
      A small bubble with the same wall tension as a larger bubble will contain higher pressure and will collapse into the larger bubble if the two meet and join.

      Fick’s law describes the rate of diffusion in a solution

      Poiseuille’s law is used to calculate volume of flow rate in laminar flow

      Darcy’s law describes the flow of a fluid through a porous medium.

      Starling’s law describes cardiac haemodynamics as it relates to myocyte contractility and stretch.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      36.2
      Seconds
  • Question 16 - Which of these statements about experimental studies is true? ...

    Incorrect

    • Which of these statements about experimental studies is true?

      Your Answer: They must be blinded

      Correct Answer: Randomisation serves to remove potential bias

      Explanation:

      In experimental studies, the researcher introduces an intervention and studies the effect. The study subjects are allocated into different groups by the investigator through the use of randomisation. Randomisation serves to remove any potential bias.

      A cohort study is a form of longitudinal, observational study that follows a group of patients (the cohort) over a period of time to monitor the effects of exposure to a proposed aetiological factor upon them.

      A case-control study is a type observational study. Here, patients who have developed a disease are identified and compared on the basis of proposed causative factors that occurred in the past, to a control group.

      Clinical trials are experimental studies. Examples include: double blind, single blind, and unblinded studies(both patient and researcher are aware of the treatment they receive)

    • This question is part of the following fields:

      • Evidence Based Medicine
      8.6
      Seconds
  • Question 17 - Which of the following is the site of secretion of intrinsic factor: ...

    Correct

    • Which of the following is the site of secretion of intrinsic factor:

      Your Answer: Stomach

      Explanation:

      Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      7.6
      Seconds
  • Question 18 - You need to give your patient antibiotics, so you call microbiology for some advice.

    Of...

    Correct

    • You need to give your patient antibiotics, so you call microbiology for some advice.

      Of the following antibacterial drugs, which of them is a protein synthesis inhibitor?

      Your Answer: Erythromycin

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolides. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and, as a result, inhibit protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered into the infection site as a result.

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

      The function of the cell membrane is disrupted
      Nystatin
      Polymyxins
      Amphotericin B

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

      Nucleic acid synthesis inhibition
      Quinolones
      Trimethoprim
      Rifampicin
      5-nitroimidazoles
      Sulphonamides
      Anti-metabolic activity
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      14
      Seconds
  • Question 19 - A 55 year old man presents to ED complaining of leg weakness. Your...

    Correct

    • A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:

      Your Answer: Weakness of hip extension

      Explanation:

      Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      53.6
      Seconds
  • Question 20 - A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a...

    Incorrect

    • A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a history of type I diabetes mellitus. On blood gas analysis, she has metabolic acidosis. Diabetic ketoacidosis (DKA) is diagnosed, and therapy is initiated. She becomes increasingly confused when intravenous fluids and insulin are administered.

      Which electrolyte imbalance is the MOST likely reason of the increased confusion

      Your Answer: Hypokalaemia

      Correct Answer: Hyponatraemia

      Explanation:

      Because of the shift of water from the intracellular to the extracellular compartment as a result of hyperglycaemia and increased plasma osmolality, dilutional hyponatraemia is common in diabetic ketoacidosis (DKA).

      If intravenous fluids are not delivered with caution, hyponatraemia might worsen, which can lead to increased degrees of disorientation. Hyponatraemia has also been linked to an increased risk of cerebral oedema, especially if blood glucose levels drop too quickly following treatment.

      Headache, recurrence of vomiting, irritability, Glasgow Coma Scale score, inappropriate heart rate slowing, and rising blood pressure are the most common causes of death in paediatric DKA, and children should be monitored for the symptoms mentioned above. To prevent this from developing,  s low osmolarity normalization, attention to glucose and salt levels, as well as hydration over 48 hours, is necessary. 

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
      227.3
      Seconds
  • Question 21 - A patient with rash is examined. He has some redness of the skin...

    Correct

    • 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: 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
      40.8
      Seconds
  • Question 22 - Regarding codeine, which of the following statements is INCORRECT: ...

    Correct

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

      Your Answer: There is a reduced risk of toxicity in patients who are ultra-rapid metabolisers of codeine.

      Explanation:

      Codeine phosphate is a weak opioid and can be used for the relief of mild to moderate pain where other painkillers such as paracetamol or ibuprofen have proved ineffective.Codeine is metabolised to morphine which is responsible for its therapeutic effects. Codeine 240 mg is approximately equivalent to 30 mg of morphine. The capacity to metabolise codeine can vary considerably between individuals; there is a marked increase in morphine toxicity in people who are ultra rapid metabolisers, and reduced therapeutic effect in poor codeine metabolisers. Codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers).Codeine is also contraindicated in children under 12, and in children of any age who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea due to reports of morphine toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      30.8
      Seconds
  • Question 23 - A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His...

    Correct

    • A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.

      Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?

      Your Answer: Penicillin

      Explanation:

      The most common cause of drug-induced anaphylaxis is penicillin.

      The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      15.3
      Seconds
  • Question 24 - A 18 year old with known asthma presents himself to ED with acute...

    Correct

    • A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:

      Your Answer: Salbutamol

      Explanation:

      High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      15.3
      Seconds
  • Question 25 - All of the following typically occurs as part of normal inspiration except: ...

    Correct

    • All of the following typically occurs as part of normal inspiration except:

      Your Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs).
      In inspiration, several movements occur. These are:
      1. elevation of the sternal ends of the ribs (‘pump handle’ movement),
      2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement)
      3. depression of the diaphragm.
      These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and air is drawn into the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      33.3
      Seconds
  • Question 26 - Which of the following states that the total pressure exerted by a mixture...

    Correct

    • Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:

      Your Answer: Dalton's law

      Explanation:

      Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      12.9
      Seconds
  • Question 27 - Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department...

    Correct

    • Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.

      Which of the following is NOT a contraindication for adenosine use?

      Your Answer: History of heart transplant

      Explanation:

      The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.

      Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.

      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

      It has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds.
      Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:
      a feeling of impending doom
      Flushing of the face
      Dyspnoea
      Uncomfortable chest
      Tastes metallic

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.1
      Seconds
  • Question 28 - Following the administration of a drug that was started a few months earlier,...

    Correct

    • Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.

      Which of the following drugs is most likely to cause peripheral neuropathy?

      Your Answer: Isoniazid

      Explanation:

      Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily.

      Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.

      Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      12.1
      Seconds
  • Question 29 -
    A patient with Conn’s syndrome will experience which of the following clinical features?
    ...

    Correct


    • A patient with Conn’s syndrome will experience which of the following clinical features?

      Your Answer: Hypernatraemia

      Explanation:

      Conditions to consider in the differential diagnosis of primary aldosteronism or Conn’s syndrome include hypertension, metabolic alkalosis, hypokalaemia, hypernatremia, and low renin levels.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      20.2
      Seconds
  • Question 30 - A 73-year-old woman arrives at the emergency department 48 hours after being discharged from...

    Correct

    • A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:

      Your Answer: Pseudomonas aeruginosa

      Explanation:

      Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community­ acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.

      Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :
      Pseudomonas Aeruginosa
      Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
      Klebsiella pneumoniae
      Escherichia coli

    • This question is part of the following fields:

      • Infections
      • Microbiology
      23.9
      Seconds

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Cardiovascular Pharmacology (4/4) 100%
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Endocrine Physiology (1/1) 100%
Head And Neck (1/1) 100%
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Abdomen And Pelvis (0/1) 0%
Infections (5/5) 100%
Endocrine Pharmacology (1/1) 100%
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