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

  • Question 1 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.

      In CICR, which membrane protein in the sarcoplasmic reticulum is involved?

      Your Answer: Sarcoplasmic and endoplasmic reticulum ATP-ase

      Correct Answer: Ryanodine receptor

      Explanation:

      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.

      An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.

      The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      18.5
      Seconds

  • Question 2 - An 82-year-old woman was brought in an ambulance to the Emergency Department with...

    Correct

    • An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia.

      A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.

      Out of the following, which step would be the most appropriate as the next step in her management?

      Your Answer: Labetalol 10 mg IV

      Explanation:

      A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:
      1. Systolic blood pressure greater than 185 mmHg
      2. Diastolic blood pressure greater than 110 mmHg

      But delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke.

      Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.

      Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.

      A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      18.4
      Seconds

  • Question 3 - Fat necrosis is typically seen in which of the following: ...

    Correct

    • Fat necrosis is typically seen in which of the following:

      Your Answer: Acute pancreatitis

      Explanation:

      Fat necrosis typically occurs following either direct trauma or from enzymatic lipolysis in acute pancreatitis, where release of triglyceride elicits a rapid inflammatory response and fat is phagocytosed by neutrophils and macrophages with subsequent fibrosis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      4.9
      Seconds

  • Question 4 - Regarding hepatitis A, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hepatitis A, which of the following statements is CORRECT:

      Your Answer: Disease is most severe in children and infants.

      Correct Answer: Anti-HAV IgM antibodies are diagnostic.

      Explanation:

      Anti-HAV IgM antibodies are diagnostic. Disease in children is more commonly asymptomatic, risk of symptomatic disease increases with age. Transmission is by the faecal-oral route. Faecal shedding has been demonstrated for 2 – 3 weeks before and about a week after, the onset of jaundice. Infection confers lifelong immunity.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      14.9
      Seconds

  • Question 5 - A patient complains of stomach ache. You see a midline scar in the...

    Correct

    • A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.

      The stomach mucous neck cells secrete which of the following substances?

      Your Answer: Bicarbonate

      Explanation:

      Foveolar cells, also known as gastric mucous-neck cells, are cells that line the stomach mucosa and are found in the necks of the gastric pits. Mucus and bicarbonate are produced by these cells, which prevent the stomach from digesting itself. At pH 4, the mucous allows the acid to penetrate the lining, while below pH 4, the acid is unable to do so. Viscous fingering is the term for this procedure.

      The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:

      Cell type/ Substance secreted/ Function of secretion
      Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
      Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
      Chief cells/ Pepsinogen/ Protein digestion
      Chief cells/ Gastric lipase/ Fat digestion
      G-cells/ Gastrin/ Stimulates gastric acid secretion
      Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
      Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
      D-cells/ Somatostatin/ Inhibits gastric acid secretion

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      12.7
      Seconds

  • Question 6 - Which of the following nerves innervates the gastrocnemius muscle? ...

    Correct

    • Which of the following nerves innervates the gastrocnemius muscle?

      Your Answer: Tibial nerve

      Explanation:

      The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      2.9
      Seconds

  • Question 7 - A patient with a wound infection on his right leg has reddening and...

    Incorrect

    • A patient with a wound infection on his right leg has reddening and oedema of the surrounding muscles. His condition has worsened considerably over the past few hours with the area now appearing blackened. There is also palpable crepitus under the skin. You suspect gas gangrene.

      Which statement about Clostridium perfringens is true?

      Your Answer: Is the cause of around 40% of cases of gas gangrene

      Correct Answer: Gas gangrene is caused by the release of an alpha-toxin

      Explanation:

      Clostridium perfringens, a Gram-positive, anaerobic, spore forming rod-shaped, pathogenic bacterium is the most commonly associated with gas gangrene (85-90% of cases), although other species can also be implicated.

      Clostridium perfringens is capsulate and produces a range of toxins. Alpha-toxin is the most important and is the cause of gas gangrene.

      Gas gangrene develops when a devitalized wound becomes infected with Clostridium perfringens spores from the environment. The spores germinate and multiplies in the ischaemic conditions, releasing toxins, which further damage tissues.

      Usually, the clinical features of gas gangrene appear within 24 hours of injury.

      Clostridium perfringens spores are not destroyed by cooking. During slow cooling and unrefrigerated storage, they germinate to form vegetative cells.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      26.9
      Seconds

  • Question 8 - Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism...

    Incorrect

    • Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism of action is best described by which of the following?

      Your Answer: NMDA receptor antagonist

      Correct Answer: Nicotinic acetylcholine receptor antagonist

      Explanation:

      Atracurium is a non-depolarizing neuromuscular blocker that is used to help with intubation and controlled ventilation by causing muscle relaxation and paralysis.

      At the neuromuscular junction’s post-synaptic membrane, atracurium competes with acetylcholine for nicotinic (N2) receptor binding sites. This prevents the receptors from being stimulated by acetylcholine.

      Muscle paralysis occurs gradually due to the competitive blockade.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      18.8
      Seconds

  • Question 9 - Which of the following is NOT a typical feature of an abducens nerve...

    Correct

    • Which of the following is NOT a typical feature of an abducens nerve palsy:

      Your Answer: Inability to look up

      Explanation:

      CN VI palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      8.6
      Seconds

  • Question 10 - A 6-year-old girl is brought into the paediatric emergency room by her mother...

    Correct

    • A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months.

      The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Trimethoprim

      Explanation:

      The NICE guidelines for children and young people under 16 years lower UTIs are:
      1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility
      2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.
      3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria
      4. If urine culture and susceptibility report is sent
      – Review the choice of antibiotic when the results are available AND
      – change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possible

      The choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:
      1. Children under 3 months:
      – Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s
      2. Children over 3 months:
      – First-choice
      Nitrofurantoin – if eGFR >45 ml/minute
      Trimethoprim – (if low risk of resistance*)
      – Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)
      Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choice
      Amoxicillin (only if culture results available and susceptible)
      Cefalexin

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      19
      Seconds

  • Question 11 - 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
      7.4
      Seconds

  • Question 12 - An injury to which nerve affects innervation to the adductor portion of the...

    Incorrect

    • An injury to which nerve affects innervation to the adductor portion of the adductor magnus?

      Your Answer: Anterior branch of the obturator nerve

      Correct Answer: Posterior branch of the obturator nerve

      Explanation:

      The nerves that supply the adductor magnus muscle have an embryologic origin from the anterior divisions of the lumbosacral plexus and include the obturator nerve, posterior division (L2-4), and the tibial portion of the sciatic nerve (L4). It is innervated by the posterior division of the obturator nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      6.2
      Seconds

  • Question 13 - Which of the following best describes digoxin: ...

    Correct

    • Which of the following best describes digoxin:

      Your Answer: A positive inotrope and negative chronotrope

      Explanation:

      Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      4.8
      Seconds

  • Question 14 - By what mechanism does Vibrio cholerae causes diarrhoea? ...

    Correct

    • By what mechanism does Vibrio cholerae causes diarrhoea?

      Your Answer: Increases Cl- secretory channels in crypt cells

      Explanation:

      Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP).

      cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      4.3
      Seconds

  • Question 15 - Which of the following statements is correct with regards to Klebsiella spp? ...

    Correct

    • Which of the following statements is correct with regards to Klebsiella spp?

      Your Answer: They are typically associated with nosocomial infection.

      Explanation:

      Klebsiella is a type of bacteria commonly found in nature. In humans, the bacteria are often present in parts of the digestive tract and respiratory flora, where they do not generally cause problems. They are anaerobic Gram-negative rods. They are usually opportunistic pathogens which cause nosocomial infections, the most common ones being pneumonia and UTI.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      4.8
      Seconds

  • Question 16 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is...

    Correct

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is born with bilateral deafness as a result of this.

      From the  following antibiotics, which one is most likely to cause this side effect?

      Your Answer: Gentamicin

      Explanation:

      Aminoglycosides cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      4.9
      Seconds

  • Question 17 - A 42-year-old patient with worsening epigastric pain has been referred to you by...

    Correct

    • A 42-year-old patient with worsening epigastric pain has been referred to you by a GP. The patient has been taking omeprazole for a month, but her symptoms are getting worse.

      Which of the following is NOT a well-known side effect of proton pump inhibitor treatment?

      Your Answer: Pelvic fracture

      Explanation:

      Proton pump inhibitors (PPIs) have a variety of side effects, including:
      Vomiting and nausea
      Pain in the abdomen
      Flatulence
      Diarrhoea
      Constipation
      Headache

      PPIs have been linked to a significant increase in the risk of focal tachyarrhythmias (link is external).
      Low serum magnesium and sodium levels have been linked to long-term use of PPIs, according to the US Food and Drug Administration (link is external).

      Long-term PPI use has also been linked to an increased risk of fracture, according to epidemiological evidence (link is external). Observational studies have discovered a slight link between hip, wrist, and spine fractures. However, there is no link between the two and an increased risk of pelvic fracture. For this reason, the MHRA recommends that patients at risk of osteoporosis who take PPIs maintain an adequate calcium and vitamin D intake.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      6.9
      Seconds

  • Question 18 - A p value < 0.05 obtained from a study with a significance level...

    Incorrect

    • A p value < 0.05 obtained from a study with a significance level (α) of 0.05, means all of the following, EXCEPT:

      Your Answer: the result is statistically significant.

      Correct Answer: the result is clinically significant.

      Explanation:

      A p value < 0.05:is statistically significantmeans that the probability of obtaining a given result by chance is less than 1 in 20means the null hypothesis is rejectedmeans there is evidence of an association between a variable and an outcomeNote that this does not tell us whether the result is clinically significant.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      8.2
      Seconds

  • Question 19 - A 50-year-old man from Russia presents with a history of cough with blood-stained...

    Correct

    • A 50-year-old man from Russia presents with a history of cough with blood-stained sputum, fever, night sweats, and weight loss. Suspecting tuberculosis, you begin investigations.

      All the following statements regarding tuberculosis (TB) are true EXCEPT?

      Your Answer: Corticosteroid use is not a risk factor for developing TB

      Explanation:

      Immunosuppressants like corticosteroids may be an important risk factor for developing tuberculosis.

      All of the other statements are true.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      18.2
      Seconds

  • Question 20 - You are reviewing a patient in the Emergency Department brought in by the...

    Incorrect

    • You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol.

      Which one of the following statements about this medicine is TRUE?

      Your Answer:

      Correct Answer: It decreases cardiac output by approximately 20%

      Explanation:

      Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.

      Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.

      The main side effects of propofol are:
      Pain on injection (in up to 30%)
      Hypotension
      Transient apnoea
      Hyperventilation
      Coughing and hiccough
      Headache
      Thrombosis and phlebitis

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Cellular Physiology (0/1) 0%
Physiology (2/3) 67%
Cardiovascular Pharmacology (2/2) 100%
Pharmacology (6/7) 86%
Inflammatory Responses (1/1) 100%
Pathology (1/1) 100%
Microbiology (2/4) 50%
Pathogens (1/2) 50%
Gastrointestinal Physiology (1/1) 100%
Anatomy (2/3) 67%
Lower Limb (1/2) 50%
Specific Pathogen Groups (1/2) 50%
Anaesthesia (0/1) 0%
Cranial Nerve Lesions (1/1) 100%
Infections (2/2) 100%
Cardiovascular (1/1) 100%
Gastrointestinal (1/1) 100%
Gastrointestinal Pharmacology (1/1) 100%
Evidence Based Medicine (0/1) 0%
Statistics (0/1) 0%
Passmed
Retry this test Dashboard