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Question 1
Correct
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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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 2
Incorrect
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A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve. Which one of the following statements best describes the healing process of peripheral nerves?
Your Answer: Multiple cell bodies lie along the axon supplying nutrients for regeneration
Correct Answer: Peripheral nerve fibres regenerate at around 1mm per day
Explanation:Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate. If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete. Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm. If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 3
Correct
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Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer: Anti-D antibodies are usually IgG.
Explanation:Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 4
Correct
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Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Correct
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Regarding airway resistance, which of the following statements is CORRECT:
Your Answer: Airway resistance is predominantly determined by the radius of the airway as described by Poiseuille's law.
Explanation:Flow through airways is described by Darcy’s law which states that flow is directly proportional to the mouth-alveolar pressure gradient and inversely proportional to airway resistance. Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. Parasympathetic stimulation causes bronchoconstriction and sympathetic stimulation causes bronchodilation, but mediated by beta2-adrenoceptors. Muscarinic antagonists e.g. ipratropium bromide cause bronchodilation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 6
Incorrect
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A new test is being developed to diagnose chlamydia. 1000 people aged 15 – 35 years attending a GUM clinic undergo the new test and the current gold standard nucleic acid amplification test (NAAT) to confirm the diagnosis. Of the 1000 people, 250 are diagnosed with chlamydia. Of the patients diagnosed with chlamydia, 240 test positive with the new diagnostic test and of the patients not diagnosed with chlamydia, 150 test positive with the new diagnostic test. What is the positive predictive value of this test:Chlamydia YesChlamydia NoTotalPositive testa= 240b = 150390Negative testc = 10d = 600610Total2507501000
Your Answer: 0.96
Correct Answer: 0.62
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.Positive predictive value (PPV) = a/(a+b) = 240/390 = 0.62 = 62%This means there is a 62% chance, if the test is positive, that the patient actually has chlamydia.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 7
Correct
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A 32-year-old woman diagnosed with hyperthyroidism has her T 4 levels grossly elevated and she is started on carbimazole.A release of which of the following from the hypothalamus is inhibited by increase in T4 levels?
Your Answer: Thyrotropin-releasing hormone
Explanation:A negative feedback mechanism involving the hypothalamic-pituitary-thyroid axis controls the release of T3 and T4 into the bloodstream. When metabolic rate is low or serum T3 and/or T4 levels are decrease, this triggers the secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus.TRH goes to the anterior pituitary gland and stimulates secretion of thyroid-stimulating hormone (TSH). An increased serum level of T3 and T4 inhibits the release of TRH.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 8
Correct
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One of the benefits of wound healing through first intention is:
Your Answer: Minimisation of scar tissue formation
Explanation:Primary wound healing, or healing by first intention, occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Healing by first intention can occur when the wound edges are opposed, the wound is clean and uninfected and there is minimal loss of cells and tissue i.e. surgical incision wound. The wound margins are joined by fibrin deposition, which is subsequently replaced by collagen and covered by epidermal growth.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 9
Incorrect
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Which of the following best describes an intention to treat analysis:
Your Answer: All patients are included in the analysis according to the group into which they were randomised only if they remain in the study.
Correct Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.
Explanation:An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 10
Correct
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Regarding dermatophytes, which of the following statement is CORRECT:
Your Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.
Explanation:Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Incorrect
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Regarding folate requirements, which of the following statements is CORRECT:
Your Answer: Pernicious anaemia results in severe folate deficiency.
Correct Answer: Dietary folate is found particularly in leafy green vegetables and liver.
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Incorrect
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Regarding water and electrolyte absorption in the small intestine, which of the following statements is INCORRECT:
Your Answer: K+ leaves the cell across the basolateral membrane down its concentration gradient linked to an outward movement of Cl-.
Correct Answer: Na+ enters the cell across the apical membrane against its concentration gradient by both membrane channels and transporter protein mechanisms.
Explanation:As the contents of the intestine are isotonic with body fluids and mostly have the same concentration of the major electrolytes, their absorption is active. Water cannot be moved directly, but follows osmotic gradients set up by the transport of ions, primarily mediated by the sodium pump.Na+/K+ ATPase located on the basolateral membrane of the epithelial cells pumps three Na+ ions from the cell in exchange for two K+ ions, against their respective concentration gradients. This leads to a low intracellular concentration of Na+ and a high intracellular concentration of K+. The low intracellular concentration of Na+ ensures a movement of Na+ from the intestinal contents into the cell down its concentration gradient by both membrane channels and transporter protein mechanisms. Na+ is then rapidly pumped again by the basolateral sodium pump. K+ leaves the cell across the basolateral membrane down its concentration gradient linked to an outward movement of Cl- against its concentration gradient (Cl- having entered the cell across the luminal membrane down its concentration gradient).
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 13
Incorrect
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Capillaries are designed with a small diffusion distance for nutrition and gaseous exchange with the tissues they serve. Capillaries come in a variety of shapes and sizes, each with its own function in transcapillary exchange.Which of the following types of capillaries is the least permeable in the human body?
Your Answer: Closed capillaries
Correct Answer: Continuous capillaries
Explanation:Capillaries are designed with a small diffusion distance for nutrition and gaseous exchange with the tissues they serve. Because oxygen and carbon dioxide are both highly soluble in lipids (lipophilic), they can easily diffuse along a concentration gradient across the endothelial lipid bilayer membrane. In contrast, glucose, electrolytes, and other polar, charged molecules are lipid-insoluble (hydrophilic). These chemicals are unable to pass through the lipid bilayer membrane directly and must instead travel through gaps between endothelial cells.Capillaries are divided into three types: continuous, fenestrated, and sinusoidal. Each of these capillary types contains different sized gaps between the endothelial cells that operate as a filter, limiting which molecules and structures can pass through.The permeability of capillaries is affected by the wall continuity, which varies depending on the capillary type.Skeletal muscle, myocardium, skin, lungs, and connective tissue all have continuous capillaries. These capillaries are the least permeable. They have a basement membrane and a continuous layer of endothelium. The presence of intercellular spaces allows water and hydrophilic molecules to pass across. Tight connections between the cells and the glycocalyx inhibit passage via these gaps, making diffusion 1000-10,000 times slower than for lipophilic compounds. The diffusion of molecules larger than 10,000 Da, such as plasma proteins, is likewise prevented by this narrow pore system. These big substances can pass through the capillary wall, but only very slowly, because endothelial cells have enormous holes.The kidneys, gut, and exocrine and endocrine glands all have fenestrated capillaries. These are specialized capillaries that allow fluid to be filtered quickly. Water, nutrients, and hormones can pass via windows or fenestrae in their endothelium, which are connected by a thin porous membrane. They are ten times more permeable than continuous capillaries due to the presence of these fenestrae. Fenestrated capillaries have a healthy basement membrane.The spleen, liver, and bone marrow all have sinusoidal capillaries, also known as discontinuous capillaries. Their endothelium has huge gaps of >100 nm, and their basement membrane is inadequate. They are highly permeable as a result, allowing red blood cells to travel freely.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 14
Incorrect
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About what percentage of patients with hepatitis A develop chronic infection:
Your Answer: 10 - 20%
Correct Answer: None
Explanation:Chronic hepatitis and carrier state does not occur in hepatitis A infection and complete immunity is attained after infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 15
Correct
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A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: 75% of cases occur before the age of 6 years.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 17
Incorrect
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You review a 50-year-old man that is requesting the seasonal influenza vaccination.Which of the following single clinical risk groups is NOT eligible to receive the seasonal influenza vaccination? Select ONE answer only.
Your Answer: Children aged 2 to 7 years
Correct Answer: Patients over the age of 50
Explanation:Patients with hypertension are only eligible for the seasonal influenza vaccination if they have co-existent cardiac complications.The UK national policy is that the seasonal influenza vaccine should be offered to the following groups:All those aged 65 years and olderChildren aged 2 to 15 yearsResidents of nursing and residential homes for the elderly (and other long-stay facilities)Carers of persons whose welfare may be at risk if the carer falls illAll those aged 6 months or older in a clinical risk groupThe following table outlines the clinical risk groups that are considered eligible for the vaccine:CategoryExamples of eligible groupsRespiratory diseaseCOPDInterstitial lung diseaseCystic fibrosisAsthma (requiring oral or inhaled steroids)Heart diseaseCongenital heart diseaseChronic heart failureCoronary heart disease (requiring medication and/or follow-up)Hypertension with cardiac complicationsKidney diseaseChronic kidney diseaseNephrotic syndromeRenal transplant patientsLiver diseaseLiver cirrhosisChronic hepatitisBiliary atresiaNeurological diseaseCerebrovascular accidentTransient ischaemic attackEndocrine diseaseType 1 and 2 diabetesImmunosuppressionPatients undergoing chemotherapyPatients taking immunosuppressive drug therapy (including systemic steroids)Asplenia or splenic dysfunctionHIV infectionPregnancyAll pregnant women
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 18
Correct
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A diagnosis of acute osteomyelitis was made on a patient with a known history of sickle cell disease. He has no joint prosthesis on in-dwelling metal work and no known drug allergies.Which of the following is most likely the causative agent of the case presented above?
Your Answer: Salmonella spp .
Explanation:Patients with sickle cell disease are prone to infection of the bone and bone marrow in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease, the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Incorrect
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After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?
Your Answer: Acarbose
Correct Answer: Pioglitazone
Explanation:Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α. Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 20
Correct
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A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?
Your Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 21
Correct
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You examine a 34-year-old lady with symptoms that are consistent with acute sinusitis. You're thinking about giving her doxycycline for treatment.What is doxycycline's mechanism of action?Â
Your Answer: Inhibition of protein synthesis
Explanation:Doxycycline and other tetracycline antibiotics attach to the 30S subunit of the bacterial ribosome, preventing aminoacyl-tRNA binding and so protein synthesis beginning.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 22
Incorrect
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A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior inferior cerebellar artery
Correct Answer: Basilar artery
Explanation:The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 23
Correct
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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.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 24
Correct
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Regarding iron handling, which of the following statements is CORRECT:
Your Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 25
Correct
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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+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Incorrect
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Regarding carbon dioxide transport in the blood, which of the following statements is CORRECT:
Your Answer: The chloride shift refers to an efflux of Cl - ions from red blood cells to maintain electroneutrality.
Correct Answer: Deoxygenated haemoglobin acts as a buffer for H+ ions.
Explanation:CO2generated in the tissues and water combine to form carbonic acid which readily dissociates to form HCO3-and H+. The first part of this reaction is very slow in plasma, but is accelerated dramatically by the enzyme carbonic anhydrase present in red blood cells. Bicarbonate is therefore formed preferentially in red cells, from which it freely diffuses down its concentration gradient into plasma where it is transported to the lungs. The red cell membrane is impermeable to H+ions which remain in the cell. To maintain electroneutrality, Cl-ions diffuse into the cell to replace HCO3-, an effect known as the chloride shift. Deoxygenated haemoglobin acts as a buffer for H+, allowing the reaction to continue.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 27
Correct
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Which of the following statements is correct regarding hyponatraemia?
Your Answer: Correction of serum sodium that is too rapid can precipitate central pontine myelinolysis.
Explanation:Hyponatraemia refers to a serum sodium concentration < 135 mmol/L. It is safer to quickly correct acute hyponatremia than chronic hyponatremia but correction should not be too fast, especially in chronic hyponatraemia, because of the risk of central pontine myelinolysis. Hyponatraemia is usually associated with a low plasma osmolality. Under normal circumstances, if serum osmolality is low, then urine osmolality should also be low because the kidneys should be trying to retain solute. In SIADH, excess ADH causes water retention, but not the retention of solute. Therefore, urine that is concentrated and relatively high in sodium is produced, even though the serum sodium is low (urine osmolality > 100 mosmol/kg).
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 28
Correct
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A 56-year-old man presents with pneumonia 8 days after being admitted for an open fracture of his tibia and fibula. Upon history taking and observation, it was established that he has no known drug allergies, has coarse left basal crackles and evidence of consolidation in the left lower lobe based on his chest X-ray.Which of the following antibacterial agents would be the most appropriate to prescribe according to the latest NICE guidelines?
Your Answer: Ciprofloxacin
Explanation:The current NICE guidelines for hospital-acquired pneumonia are as follow:- First-choice oral antibiotic if non‑severe symptoms or signs, and not at higher risk of resistance (guided by microbiological results when available): co-amoxiclav- Alternative oral antibiotics if non‑severe symptoms or signs, and not at higher risk of resistance, for penicillin allergy or if co‑amoxiclav unsuitable (based on specialist microbiological advice and local resistance data): doxycycline, cefalexin, co-trimoxazole, levofloxacin- First-choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance (based on specialist microbiological advice and local resistance data): piperacillin with tazobactam, ceftazidime, ceftriaxone, cefuroxime, meropenem, ceftazidime with avibactam, levofloxacin- Antibiotics to be added if suspected or confirmed methicillin-resistant Staphylococcus aureus infection (dual therapy with a first-choice intravenous antibiotic): vancomycin, teicoplanin, linezolid
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 29
Correct
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Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?
Your Answer: Axillary nodes
Explanation:Lymph is the fluid that flows through the lymphatic system. Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly. The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 30
Incorrect
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections. Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
