NHRA exam questions by profession

Answer: D. 15 to 20 g fast-acting sugar, recheck in 15 minutes

A conscious patient able to swallow is given 15 to 20 g of quick-acting carbohydrate such as glucose tablets or juice, with glucose rechecked after 10 to 15 minutes. Insulin would lower the glucose further.

Answer: A. Withhold simvastatin for the duration of the clarithromycin course

Clarithromycin is a strong CYP3A4 inhibitor and greatly increases simvastatin exposure, raising the risk of myopathy and rhabdomyolysis; the combination is contraindicated, so the statin is paused for the short course. Monitoring CK while continuing both does not prevent the harm. Reducing the antibiotic dose risks treatment failure.

Answer: C. 4 to 5 mg daily

Women with a previous NTD-affected pregnancy need high-dose folic acid, 4 to 5 mg daily, from before conception through the first trimester. The standard 400 microgram dose is for low-risk women.

Answer: B. Intravenous dantrolene 2.5 mg/kg, repeated as needed

These features indicate malignant hyperthermia, a hypermetabolic reaction to volatile agents and suxamethonium in susceptible patients. Dantrolene, which reduces calcium release from the sarcoplasmic reticulum, is the specific treatment, given as 2.5 mg/kg and repeated until signs resolve, together with active cooling and treatment of hyperkalaemia and acidosis. Non-depolarising relaxants do not relieve the muscle rigidity, and cooling alone does not stop the hypermetabolic process.

Answer: B. Light centric contacts and no excursive contacts

Implants lack a periodontal ligament, so implant-protected occlusion uses light centric contacts, a narrow occlusal table, shallow cusps and avoidance of contacts in lateral movements. These reduce lateral and bending forces. Steep cusps and cantilevers increase leverage on the implant and screw.

Answer: D. Dantrolene

This is malignant hyperthermia, a hypermetabolic reaction of skeletal muscle to volatile anaesthetics and suxamethonium; the triggering agent is stopped and dantrolene, which reduces calcium release from the sarcoplasmic reticulum, is given. Bromocriptine is used in neuroleptic malignant syndrome, which can look similar but is caused by dopamine antagonists, not anaesthetic agents.