00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
Retry this test Dashboard

  • Question 1 - A 26-year old female comes to the Emergency Room with complaints of bloody...

    Correct

    • A 26-year old female comes to the Emergency Room with complaints of bloody stools. She reports that prior to the passage of bloody stools, she experienced a sharp pain during defecation. Medical history reveals that she has been experiencing constipation for the past 2 weeks. After completing her medical history and physical examination, the attending physician gives an initial diagnosis of an anal fissure.

      Which of the following nerves transmit painful sensation from the anus, resulting in the pain associated with anal fissure?

      Your Answer: Inferior rectal nerve

      Explanation:

      A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma from either the passage of hard stool or prolonged diarrhoea. A tear in the anoderm causes spasm of the internal anal sphincter, which results in pain, increased tearing, and decreased blood supply to the anoderm. The site of the anal fissure in the sensitive lower half of the anal canal, which is innervated by the inferior rectal nerve, results in reflex spasm of the external anal sphincter, aggravating the condition. Because of the intense pain, anal fissures may have to be examined under local anaesthesia.

      The inferior rectal nerve is a branch of the pudendal nerve. This nerve runs medially across the ischiorectal fossa and supplies the external anal sphincter, the mucous membrane of the lower half of the anal canal, and the perianal skin.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      55.6
      Seconds

  • Question 2 - You evaluate a 80-year-old man who has a history of persistent heart failure...

    Correct

    • You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.

      Which of the following claims regarding capillary hydrostatic pressure (P c) is false?

      Your Answer: P c increases along the length of the capillary, from arteriole to venule

      Explanation:

      The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.
      Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).

      When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.

      When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.

      Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.

      Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.
      It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      251.1
      Seconds

  • Question 3 - Mannitol is primarily indicated for which of the following: ...

    Correct

    • Mannitol is primarily indicated for which of the following:

      Your Answer: Cerebral oedema

      Explanation:

      Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. 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).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      8.9
      Seconds

  • Question 4 - Which of the following does NOT affect the rate of flow of a...

    Incorrect

    • Which of the following does NOT affect the rate of flow of a liquid through a tube:

      Your Answer: Length of the tube

      Correct Answer: Surface tension

      Explanation:

      Flow through a tube is dependent upon:
      The pressure difference across the ends of the tube (P1– P2)
      The resistance to flow provided by the tube (R)
      This is Darcy’s law, which is analogous to Ohm’s law in electronics:
      Flow = (P1– P2) / R
      Resistance in the tube is defined by Poiseuille’s law, which is determined by the diameter of the tube and the viscosity of the fluid. Poiseuille’s law is as follows:
      Resistance = (8VL) / (πR4)
      Where:
      V = The viscosity of the fluid
      L = The length of the tube
      R = The radius of the tube
      Therefore, in simple terms, resistance is directly proportional to the viscosity of the fluid and the length of the tube and inversely proportional to the radius of the tube. Of these three factors, the most important quantitatively and physiologically is vessel radius.
      It can be seen that small changes in the radius can have a dramatic effect on the flow of the fluid. For example, the constriction of an artery by 20% will decrease the flow by approximately 60%.
      Another important and frequently quoted example of this inverse relationship is that of the radius of an intravenous cannula. Doubling the diameter of a cannula increases the flow rate by 16-fold (r4). This is the reason the diameter of an intravenous cannula in resuscitation scenarios is so important.
      *Please note that knowledge of the detail of Poiseuille’s law is not a requirement of the RCEM Basic Sciences Curriculum.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      27.7
      Seconds

  • Question 5 - Which of the following does NOT predispose to digoxin toxicity in a patient...

    Incorrect

    • Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:

      Your Answer: Hypercalcaemia

      Correct Answer: Hyponatraemia

      Explanation:

      Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      37.5
      Seconds

  • Question 6 - A 5 day old, full term neonate is with a unilateral purulent...

    Incorrect

    • A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.

      What is the most likely causative pathogen?

      Your Answer: Escherichia coli

      Correct Answer: Chlamydia trachomatis

      Explanation:

      Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      95.4
      Seconds

  • Question 7 - Which of the following is NOT a typical feature of a lesion to...

    Incorrect

    • Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:

      Your Answer: Nystagmus

      Correct Answer: Hyperacusis

      Explanation:

      Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      15.9
      Seconds

  • Question 8 - A trauma victim who has been intubated is tachycardic, hypotensive, and has a...

    Incorrect

    • A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).

      Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?

      Your Answer: Early systole

      Correct Answer: End diastole

      Explanation:

      The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).

      The structure of the CVP waveform is as follows:
      The CVP’s components are listed in the table below:
      Component of the waveform
      The cardiac cycle phase.
      mechanical event
      mechanical event Diastole 
      Atrial contraction
      a wave 
      C  wave 
      v wave
      Early systole
      The tricuspid valve closes and bulges 
      Late Systole 
      Filling of the atrium with systolic blood 
      x descent
      y descent
      Mid systole
      Relaxation of the atrium 
      Early diastole
      Filling of the ventricles at an early stage

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      110.7
      Seconds

  • Question 9 - All of the following are actions of insulin except: ...

    Incorrect

    • All of the following are actions of insulin except:

      Your Answer: Decreased glycogenolysis

      Correct Answer: Increased gluconeogenesis

      Explanation:

      Major Actions of Insulin:
      ↑ Glucose uptake into cells
      ↑ Glycogenesis
      ↓ Glycogenolysis
      ↓ Gluconeogenesis
      ↑ Protein synthesis
      ↓ Protein degradation
      ↑ Fat deposition
      ↓ Lipolysis
      ↓ Ketoacid production
      ↑ K+ uptake into cells

      Major Actions of Glucagon:
      ↓ Glycogenesis
      ↑ Glycogenolysis
      ↑ Gluconeogenesis
      ↓ Fatty acid synthesis
      ↑ Lipolysis
      ↑ Ketoacid production

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      19.5
      Seconds

  • Question 10 - A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints...

    Correct

    • A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints of red, swollen gums.

      Which of the following medications is most likely responsible for his symptoms?

      Your Answer: Phenytoin

      Explanation:

      Phenytoin is a commonly used antiepileptic drug. A well-recognized side-effect of phenytoin is gingival enlargement and occurs in about 50% of patients receiving phenytoin. It is believed that reduced folate levels may cause this, and evidence suggests that folic acid supplementation may help prevent this in patients starting phenytoin.

      As evidence suggests, drug-induced gingival enlargement may also improve by substituting with other anticonvulsant drugs and reinforcing a good oral hygiene regimen. Surgical excision of hyperplastic gingiva is often necessary to correct the aesthetic and functional impairment associated with this condition to manage it successfully.

      Phenytoin is also the only anticonvulsant therapy associated with the development of Dupuytren’s contracture.
      Other side effects are:
      1. Ataxia
      2. Drug-induced lupus
      3. Hirsutism
      4. Pruritic rash
      5. Megaloblastic anaemia
      6. Nystagmus

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      345.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen And Pelvis (1/1) 100%
Anatomy (1/2) 50%
Cardiovascular Physiology (1/2) 50%
Physiology (1/4) 25%
Cardiovascular (1/2) 50%
Pharmacology (2/3) 67%
Basic Cellular (0/1) 0%
Microbiology (0/1) 0%
Pathogens (0/1) 0%
Cranial Nerve Lesions (0/1) 0%
Endocrine (0/1) 0%
CNS Pharmacology (1/1) 100%
Passmed
Retry this test Dashboard