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  • Question 1 - The enzyme protein gastric lipase is responsible for the breakdown of lipids in...

    Incorrect

    • The enzyme protein gastric lipase is responsible for the breakdown of lipids in the stomach.

      Which of the following cell types secretes gastric lipase?

      Your Answer: ECL cells

      Correct Answer: Chief cells

      Explanation:

      Gastric lipase, commonly known as LIPF, is an acidic lipase released by gastric chief cells, which are found deep within the stomach lining’s mucosal layer. It’s an enzymatic protein that’s in charge of fat digestion in the stomach.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      34.4
      Seconds

  • Question 2 - Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis...

    Incorrect

    • Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:

      Your Answer: Dyspnoea, tachypnoea, wheeze and hypoxia with no skin or mucosal changes

      Correct Answer: Generalised urticaria and angioedema alone

      Explanation:

      Anaphylaxis is characterised by sudden onset and rapidly developing, life-threatening airway, breathing and circulation problems associated with skin and/or mucosal changes. Reactions can vary greatly, from hypotension alone, to reactions with predominantly asthmatic features, to cardiac/respiratory arrest. Skin or mucosal changes may be absent or subtle in up to 20% of cases but skin or mucosal changes alone are not a sign of an anaphylactic reaction.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      22
      Seconds

  • Question 3 - Which of the following is NOT a feature characteristic of intravascular haemolysis: ...

    Incorrect

    • Which of the following is NOT a feature characteristic of intravascular haemolysis:

      Your Answer: Methaemalbuminaemia

      Correct Answer: Bilirubinuria

      Explanation:

      Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.8
      Seconds

  • Question 4 - Which of the following globin chains makes up haemoglobin A2 (HbA2)? ...

    Incorrect

    • Which of the following globin chains makes up haemoglobin A2 (HbA2)?

      Your Answer: Two alpha and two beta chains

      Correct Answer: Two alpha chains and two delta chains

      Explanation:

      Haemoglobin is a 64.4 kd tetramer consisting of two pairs of globin polypeptide chains: one pair of alpha-like chains, and one pair of non-alpha chains. The chains are designated by Greek letters, which are used to describe the particular haemoglobin (e.g., Hb A is alpha2/beta2).

      Two copies of the alpha-globin gene (HBA2, HBA1) are located on chromosome 16 along with the embryonic zeta genes (HBZ). There is no substitute for alpha globin in the formation of any of the normal haemoglobins (Hb) following birth (e.g., Hb A, Hb A2, and Hb F). Thus, absence any alpha globin, as seen when all 4 alpha-globin genes are inactive or deleted is incompatible with extrauterine life, except when extraordinary measures are taken.

      A homotetramer of only alpha-globin chains is not thought to occur, but in the absence of alpha chains, beta and gamma homotetramers (HbH and Bart’s haemoglobin, respectively) can be found, although they lack cooperativity and function poorly in oxygen transport. The single beta-globin gene (HBB) resides on chromosome 11, within a gene cluster consisting of an embryonic beta-like gene, the epsilon gene (HBE1), the duplicated and nearly identical fetal, or gamma globin genes (HBG2, HBG1), and the poorly expressed delta-globin gene (HBD). A heme group, consisting of a single molecule of protoporphyrin IX co-ordinately bound to a single ferrous (Fe2+) ion, is linked covalently at a specific site to each globin chain. If the iron is oxidized to the ferric state (Fe3+), the protein is called methaemoglobin.

      Alpha globin chains contain 141 amino acids (residues) while the beta-like chains contain 146 amino acids. Approximately 75 percent of haemoglobin is in the form of an alpha helix. The non helical stretches permit folding of the polypeptide upon itself. Individual residues can be assigned to one of eight helices (A-H) or to adjacent non helical stretches.

      Heme iron is linked covalently to a histidine at the eighth residue of the F helix (His F8), at residue 87 of the alpha chain and residue 92 of the beta chain. Residues that have charged side groups, such as lysine, arginine, and glutamic acid, lie on the surface of the molecule in contact with the surrounding water solvent. Exposure of the hydrophilic (charged) amino acids to the aqueous milieu is an important determinant of the solubility of haemoglobin within the red blood cell and of the prevention of precipitation.

      The haemoglobin tetramer is a globular molecule (5.0 x 5.4 x 6.4 nm) with a single axis of symmetry. The polypeptide chains are folded such that the four heme groups lie in clefts on the surface of the molecule equidistant from one another.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      6.3
      Seconds

  • Question 5 - A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She...

    Correct

    • 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: 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
      6.6
      Seconds

  • Question 6 - At which opioid receptors do opioid analgesics act primarily? ...

    Correct

    • At which opioid receptors do opioid analgesics act primarily?

      Your Answer: Mu

      Explanation:

      Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      4.5
      Seconds

  • Question 7 - Regarding aspirin at analgesic doses, which of the following statements is CORRECT: ...

    Correct

    • Regarding aspirin at analgesic doses, which of the following statements is CORRECT:

      Your Answer: It is contraindicated in patients with severe heart failure.

      Explanation:

      Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      21.4
      Seconds

  • Question 8 - A 30-year-old man suffers from an open fracture of his forearm. As a...

    Correct

    • A 30-year-old man suffers from an open fracture of his forearm. As a consequence of his injury, the nerve that innervates the pronator quadratus muscle was severed.

      Which of the following statements regarding the pronator quadratus muscle is considered correct?

      Your Answer: Its deep fibres bind the radius and ulna together

      Explanation:

      Pronator quadratus is a deep-seated, short, flat, and quadrilateral muscle with fibres running in a parallel direction.

      It arises from the oblique ridge on the anterior surface of the distal fourth of the Ulna. It is inserted in lateral border and anterior surface of the distal fourth of the radius. It is innervated by the anterior interosseous nerve, a branch of the median nerve (C8-T1). It is vascularized by the anterior interosseous artery.

      The action of the pronator quadratus muscle along with the pronator teres result in the pronation of the radioulnar joint. Contraction of this muscle pulls the distal end of the radius over the ulna, resulting in the pronation of the radioulnar joint

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      27
      Seconds

  • Question 9 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Correct

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:

      No. of post-menopausal women who took Calcium: 500
      No. of post-menopausal women who took Calcium and suffered a hip fracture: 10

      No. of post-menopausal women who took placebo: 500
      No. of post-menopausal women who took placebo and suffered a hip fracture: 25

      Compute for the absolute risk reduction of a hip fracture.

      Your Answer: 0.03

      Explanation:

      Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).

      ARR = ARC-ART
      ARR = (25/500) – (10/500)
      ARR = 0.03

    • This question is part of the following fields:

      • Evidence Based Medicine
      32.9
      Seconds

  • Question 10 - You review an 83-year-old woman who has stage 5 chronic kidney disease. She...

    Correct

    • You review an 83-year-old woman who has stage 5 chronic kidney disease. She has a number of electrolyte problems.
      Which ONE of the following decreases the renal reabsorption of phosphate?

      Your Answer: Parathyroid hormone

      Explanation:

      Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.
      The main actions of parathyroid hormone are:
      Increases plasma calcium concentration
      Decreases plasma phosphate concentration
      Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
      Increases renal tubular reabsorption of calcium
      Decreases renal phosphate reabsorption
      Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
      Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      11.9
      Seconds

  • Question 11 - Which of the following conditions require IV Lidocaine administration? ...

    Correct

    • Which of the following conditions require IV Lidocaine administration?

      Your Answer: Refractory ventricular fibrillation in cardiac arrest

      Explanation:

      IV Lidocaine is indicated in Ventricular Arrhythmias or Pulseless Ventricular Tachycardia (after defibrillation, attempted CPR, and vasopressor administration)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.2
      Seconds

  • Question 12 - The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian...

    Incorrect

    • The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).

      The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.

      Your Answer: Ramipril

      Correct Answer: Amlodipine

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.7
      Seconds

  • Question 13 - Cardiac myocytes are connected to each other by which of the following: ...

    Correct

    • Cardiac myocytes are connected to each other by which of the following:

      Your Answer: Intercalated discs

      Explanation:

      Adjacent cardiac myocytes are connected to each other by intercalated discs. The intercalated discs provide both a structural attachment by ‘glueing’ cells together at desmosomes and an electrical contact made up of proteins called connexons, called a gap junction, which essentially creates a low-resistance pathway between cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.5
      Seconds

  • Question 14 - A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the...

    Correct

    • A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.

      How long should you wait before taking her blood sample be taken?

      Your Answer: 4-6 hours

      Explanation:

      Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment.

      A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      9.3
      Seconds

  • Question 15 - A 52-year-old man presents to the emergency room with chest pain. He was...

    Correct

    • A 52-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 NOT a contraindication to abciximab (ReoPro) treatment?

      Your Answer: Major surgery within the last 6 months

      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.

      The use of abciximab is contraindicated in the following situations:
      Internal bleeding is present.
      Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
      Stroke in the previous two years
      Intracranial tumour
      Aneurysm or arteriovenous malformation
      Haemorrhagic diathesis is a type of haemorrhagic diathesis.
      Vasculitis
      Retinopathy caused by hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.1
      Seconds

  • Question 16 - 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: Pressure differences across the ends 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
      16.9
      Seconds

  • Question 17 - A 45-year old man presented to the emergency room with complains of chest...

    Correct

    • A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after.

      Which of the following complications is most likely to have occurred?

      Your Answer: Intercostal artery laceration

      Explanation:

      Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions.

      Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm.

      The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      15.8
      Seconds

  • Question 18 - Which of the following is NOT an effect of gastrin: ...

    Incorrect

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

      Your Answer: Stimulation of growth of gastric mucosa

      Correct Answer: Stimulation of insulin release

      Explanation:

      Gastrin acts to:
      Stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells)
      Stimulate pepsinogen secretion from chief cells
      Increase gastric motility
      Stimulate growth of gastric mucosa

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      13.6
      Seconds

  • Question 19 - An elderly patient presents to ED following a fall after feeling light headed...

    Correct

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      12.2
      Seconds

  • Question 20 - A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment....

    Incorrect

    • A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs.

      Which one is a nucleic acid synthesis inhibitor?

      Your Answer: Isoniazid

      Correct Answer: Ciprofloxacin

      Explanation:

      Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.
      The following is a summary of the many modes of action of various types of antimicrobial agents:

      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
      15.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal Physiology (0/1) 0%
Physiology (2/6) 33%
Pharmacology (6/9) 67%
Respiratory (0/1) 0%
Haematology (1/2) 50%
Pathology (1/2) 50%
Basic Cellular (0/2) 0%
Central Nervous System (2/2) 100%
Anatomy (2/2) 100%
Upper Limb (1/1) 100%
Evidence Based Medicine (1/1) 100%
Endocrine Physiology (1/1) 100%
Cardiovascular (3/3) 100%
Cardiovascular Pharmacology (1/2) 50%
Respiratory Pharmacology (1/1) 100%
Thorax (1/1) 100%
Gastrointestinal (0/1) 0%
Infections (0/1) 0%
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