Multiple choice questions
Multiple Choice Questions
Increased erythropoietin production
Increased heart rate
Increased cardiac output
Enhancement in oxygen extraction
The answer for this question is b. increased heart rate. A reduction in tissue oxygenation as happens in anemia stimulates increased production of erythropoietin through a complex feedback mechanism. Increased production of erythropoietin enhances erythropoiesis in anemia. Increased extraction of oxygen in anemia is a compensatory mechanism that is mediated by an increase in 2, 3-diphosphoglycerate concentrations. Increased cardiac output is the main hemodynamic compensatory mechanism in anemia that aims to increase blood flow to the body organs. An increase in heart rate in anemia is not a compensatory mechanism. Rather, it is a consequence of increased sympathetic activity and hypoxia-stimulated chemoreceptors (Metivier et al., 2000).
Massive transfusions i.e. replacement of the total blood volume of a patient in less than 24 hours can cause all of the following complications except?
Hypocalcemia
Acid-base imbalance
Hyperthermia
Hyperkalemia
Hyperthermia is the correct answer in this question. Massive blood transfusions can cause hypocalcemia, acid-base imbalances, hypothermia, and hyperkalemia. Massive transfusion of fresh frozen plasma and platelets which contain high levels of citrate can lead to hypocalcemia. Citrate binds calcium reducing the concentration of ionized plasma calcium. The concentration of potassium in blood increases during storage. After transfusion, the Na+–K+ ATPase pumping mechanism in the membranes of red blood cells is re-established following which reuptake of cellular potassium occurs rapidly. Hyperkalemia is a rare complication that occurs in patients who are acidotic and hypothermic. Massive transfusion can cause metabolic alkalosis as the citrate in the anticoagulant is rapidly metabolized into bicarbonate in the liver. Red blood cells are usually stored at 40C. Transfusion of such blood in a rapid manner lowers the core temperature of the recipient causing hypothermia (Maxwell & Hilson, 2006).
The following statements are true about abdominal aortic aneurysms (AAA) with the exception of?
Most are asymptomatic
They occur between the birfucation of the aorta and the diaphragm
Patients with ruptured AAA are likely to present with abdominal pain and hypertension
They are characterized by a permanent focal dilatation of an artery of 1.5 times of its normal diameter
C is the answer to this question. While patients with ruptured AAA are likely to present with abdominal and groin pain, they are unlikely to have hypertension. Rather, they are likely to have hypotension as a result of internal bleeding (Kent, 2014).
Obstruction of pulmonary blood flow in pulmonary embolism leads to?
Right ventricular failure
Left ventricular failure
Pulmonary hypotension
Hypertension
Obstruction of pulmonary blood flow leads to right ventricular failure. This is because the acute development of pulmonary hypertension in pulmonary embolism leads to a rise in right ventricle afterload which presents as dilation of the right ventricle and can eventually cause right-heart failure if not corrected (Belohlavek, Dytrych, & Linhart, 2013).
The classic presenting complaint in peripheral arterial disease is?
Intermittent claudication
Ulcers
Gangrene
Pallor
Intermittent claudication, defined as the presence of exercise induced pain which is relieved by rest, is the most common presentation of peripheral arterial disease. The other symptoms, ulcers, pallor, and gangrene occur in advanced peripheral artery disease (McDermott, 2015).
The following statements are true about warfarin. Which one is not?
It is a vitamin K agonist
It is a vitamin K antagonist
Its optimal maintenance does varies from patient to patient
The primary enzymes responsible for its metabolism are cytochrome P450 (CYP450)
The correct answer in this question is a. Warfarrin is an antagonist of vitamin K that exerts its effects by inhibiting vitamin K epoxide reductase. This is the enzyme that recycles oxidized vitamin K epoxide back to its hydroquinone form which is an important cofactor for the activation of clotting factors II, VII, IX and X. The optimal dose of warfarrin varies from patient to patient as its metabolism and distribution are influenced by factors such as age, genes, and weight. Lastly, warfarin is primarily metabolized by the enzyme CYP450 in the liver (Gong et al., 2011).
One of the following statements is true about clopidogrel?
It is an adenosine diphosphate receptor agonist
It is a prodrug that is converted to its active metabolite thiol in the body
It produces a uniform response in all patients
After oral administration, less than 40% of the drug is absorbed from the intestines
The correct answer is b. Clopidogrel is a prodrug that is converted into its active form in the body by a series of CYP450 enzymes. It exerts its effects by blocking the adenosine phosphate receptor. Response to the drug shows wide interindividual variability to genetic polymorphisms in the genes that encode the enzymes responsible for metabolizing the drug. Approximately 50% of the drug is absorbed from the intestines after oral administration (Gladding et al., 2008; Jiang, Samant, Lesko, & Schmidt, 2015).
Compared to unfractionated heparin, enoxaparin exhibits all these properties except?
It has a longer plasma half life
More consistent and higher bioavailability after subcutaneous administration
More reliable anticoagulant effect
Stronger inhibitor of bone formation
The correct answer to this question is d. Enoxaparin is a less potent inhibitor of bone formation than unfractionated heparin. It, however, has a longer plasma half-life, more consistent and higher bioavailability, and more reliable anticoagulant effects than unfractionated heparin (Fareed et al., 2003).
The following statements are true about alteplase except?
It is rapidly cleared from circulating plasma (within 5 minutes)
Excretion is primarily hepatic
Recommended dose is 2.0mg/kg
Maximum recommended dose is 90mg
The correct answer is C. The recommended dose of alteplase is 0.9mg/kg and the maximum dose that should be administered is 90mg. Excretion of alteplase is primarily hepatic and occurs within 5 minutes (Sivanandy, Thomas, Krishnan, & Arunachalam, 2011).
Which of the following drugs is associated with increased risk of oxidative stress?
Ferrous sulfate
Folic acid
Vitamin B12
Aspirin
The body has no mechanism to excrete excess iron. Excess iron in the body causes mitochondrial dysfunction and accumulation of reactive oxygen species and in effect oxidative stress (Lee et al., 2015). The answer to this question is thus ferrous sulfate.
A patient with compartment syndrome after casting following a fracture is likely to present with the following symptoms except?
Excessive pain
Pallor
Normal sensation
Paralysis
Compartment syndrome is a complication of fracture treatment modalities such as application of casts and internal and external fixation. It is characterized by excessive pain more than what is expected for the specific type of injury, altered sensations, pale and cold extremity as compared to the rest of the body, paralysis, and weak or absent peripheral pulses (Whiteing, 2008). The answer to this question is thus c. normal sensation.
The risk factors of osteoporosis include all of the following except
Advanced age
Consumption of alcohol and tobacco
Use of glucocorticoids
Male sex
The answer to the question is d. Male sex is not a risk factor for osteoporosis. Osteoporosis is more common amongst females (Metcalfe, 2008). Use of glucocorticoids, advanced age, and consumption of alcohol and tobacco have also been linked with the development of osteoporosis.
The structural changes that characterize osteoarthritis include
Progressive loss of articular cartilage
Increased thickness of the subchondral plate
Deposition of osteophytes at joint margins
All of the above
The answer to the above question is d. The structural changes in osteoarthritis include the above three processes (a, b, and c) as well as development of subchrondral bone cysts and calcified cartilage in the tidemark region (Goldring & Goldring, 2006).
A patient with rheumatoid arthritis can present with one of the following systemic manifestations
Anemia
Osteoporosis
Depression
All of the above
Anemia, osteoporosis, and depression are all systemic effects of rheumatoid arthritis hence the correct answer to this question is d (Choy, 2015).
Which of the following is an indication for intercostal catheter insertion
Pleural effusion
Asthma
Bronchiolitis
Chronic obstructive pulmonary disease
Pleural effusion is one of the indications for insertion of an ICC. Others include heamothorax, pneumothorax, tension pneumothorax, and heamopneumothorax (Heng et al., 2004).
The following statements about dexamethasone are false
It has minimal mineralcorticoid activity
Its duration of action is 36-72 hours
Long-term use can cause osteoporosis
The correct answer to this question is D. it is true that dexamethasone has minimal mineralcorticoid activity, its duration of action is 36-72 hours, and prolonged use of steroids can cause osteoporosis (Liu et al., 2013).
Which of the following statements about diclofenac is true
It has a half-life of 1-3 hours in plasma
Its use can cause cardiovascular events
Its available in oral, sustained release, intravenous, intramuscular forms
All of the above
Diclofenac has a half-life of 1-3 hours and has been shown to cause thrombotic events. It is available in parenteral and oral forms (Crofford, 2013). The answer to this question is thus D.
Allopurinol
Is a xanthine oxidase agonist
Is eliminated primarily by the liver
Is extensively metabolized to oxypurinol
Its clearance is not affected by renal impairment
Allopurinol is extensively and rapidly metabolized to its active metabolite oxypurinol in the body. Its clearance is primarily renal hence it’s reduced in renal impairment (Day et al., 2007). The correct answer is thus c.
Alendronate is contraindicated in patients
With hypocalcemia
With normal esophageal emptying
Who cannot sit or stand upright for 30 minutes
a and b
D is the correct answer as alendronate is contraindicated in patients with hypocalcemia and those who cannot sit or stand upright for 30 minutes. The latter contraindication is for oral forms of the drug as patients are expected to sit or stand upright for 30 minutes after taking the drug. It is also contraindicated in patients with delayed esophageal emptying (Bell et al., 2012).
Methotrexate interacts with the following drugs
NSAIDS
Salicylates
Barbiturates
All of the above
D is the correct answer to this question as salicylates, NSAIDS, and barbiturates displace methotrexate from its protein binding sites and thus can increase serum levels of the drug. NSAIDS and salicylates also reduce renal excretion of methotrexate (Jones & Patel, 2000).
The differential diagnoses for peptic ulcer disease include
Gastroesophegeal reflux disease
Gastritis
Cholelithiasis
a and b
The differential diagnoses for peptic ulcer disease include gastritis and gastroesophageal reflux disease because they tend to have similar symptoms such as nausea, burning sensation, epigastric pain, and abdominal discomfort. The answer for this question is thus d (Fashner & Gitu, 2015).
The following statements are true about the pathophysiology of bowel obstruction. Which one is not?
Its symptoms depend on the level of obstruction
Obstruction can be partial or complete
Bowel obstruction impacts on the body’s fluid/electrolyte balance
The symptoms of bowel obstruction are determined by the level at which the obstruction occurs. Bowel obstruction can be partial or complete. The loss of absorptive capacity, emesis, and edema associated with the condition lead to dehydration (Jackson & Manish, 2011). All the three statements about bowel obstruction about bowel obstruction are thus true and the correct answer is D.
Propon pump inhibitors (PPI) are the mainstay therapy for
PUD
GORD
Gastritis
Gastroenteritis
PPIs are the mainstay treatment of GORD as other drugs such as H2 receptor antagonists like ranitidine are not as effective in resolving the symptoms of GORD (Diamant, 2006).
Chronic GORD is associated with the following complications
Erosive esophagitis
Peptic strictures
Barett’s esophagus
All of the above
The answer to this question is D. Chronic GORD can cause erosion of esophageal mucosa causing ulcers, replacement of squamous epithelium by columnar-lined epithelium that is potentially malignant, and narrowing of the esophagus due to inflammation that heals with necrosis (Diamant, 2006).
The following are indications for NG tube insertion except
Gastric decompression
Feeding
Esophageal strictures
Administration of medications
NG tubes are indicated for gastric decompression, feeding for instance in unconscious patients, and administration of medications. Esophageal strictures are not an indication for NG tube placement (Tho, Mordiffi, Ang, & Chen, 2011).
The following statements about stomas are true
The most common stomas are ileostomies and colonostomies
They can be temporary or permanent
Trauma and intestinal perforation are not indications for stomas
They are associated with both early (within 30 days) and late complications
Trauma and intestinal perforation are emergency indications for stomas hence the answer to this question is C. The most commonly stomas are ileostomies and colonostomies. Stomas can be temporary for instance in the case of trauma. Permanent stomas are more commonly performed for malignancies. Stomas are associated with early and late complications such as retractions and parastomal hernia respectively (Kwiatt & Kawata, 2013).
The following statements are true about enteral feeding except
Malnutrition affects an estimated 40% of hospitalized patients
Elemental feeds, commercially prepared polymeric feeds, are the most commonly used type of enteral feed.
Nasoeneteric tube feeding is contraindicated in patients at high risk for aspiration due to the high potential of complications.
The false statement about enteric feeding is c. For patients at high risk for aspiration; measures such as raising the head of the bed to 300 and use of iso-osmotic feeds can help reduce the risk of aspiration. Statistics suggest that an estimated 40% of all hospitalized patients become malnourished due to nutritional losses or increased metabolic requirements. Malnourished patients receiving enteral feeds are at risk for refeeding syndrome that is potentially fatal shifts in electrolytes and fluids caused by metabolic and hormonal changes. Therefore, electrolyte levels should be monitored closely in these patients. Lastly, elemental feeds are the most commonly used enteric feeds(Stroud, Duncan, & Nightingale, 2003).
Bowel disease
Encompasses both ulcerative colitis and Crohn’s disease
Its etiology is attributed to both genetic and environmental factors
Has both intestinal and extraintestinal manifestations
All of the above
The answer to this question is d. Bowel disease collectively refers to both ulcerative colitis and Crohn’s disease. The two conditions are distinct although they share some similarities. They both have intestinal such as abdominal pain and extra intestinal manifestations such as weight loss. The etiology of both conditions is linked to genetic and environmental factors (Hendrickson, Gokhale, & Cho, 2003).
Which of the following statements about ranitidine is false
It is a selective and competitive antagonist of Histamine H2-receptor
It delays gastric emptying
Its bioavailability following oral administration is 50%
It is absorbed in the small intestine
B is the answer to this question. Ranitidine does not delay gastric emptying. It is true that it is a selective and competitive antagonist of Histamine-2 receptor, has a bioavailability of 50% following oral administration, and absorbed in the small intestine (Jha, Kharki, Puttegowda, & Ghosh, 2014).
The cytoprotective actions of misoprostol are linked to which of the following mechanisms
Increased thickness of the mucosa layer
Enhanced production of bicarbonate
Significant reductions in the pepsin content and volume of gastric secretions
All of the above
The answer to the question is D. The mechanisms of action of misoprostol include it inhibits histamine mediated secretion of gastric acid directly by acting on the parietal cells. Its other cytoprotective actions are linked to a number of mechanisms such as it increases the thickness of the mucosa layer, enhances production of bicarbonate, and significantly reduces secretion and amount of pepsin (Seth, 2002).
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