Choose how you want to revise

Select Questions

Revise with my preferences. Choose your difficulty or recap questions you've found hard.

Mock tests

Test myself against recent exam themes and ones curated by BMJ’s editorial team of doctors.

Group Learning

Play under a username and join friends or others for 10 questions. Move up of the daily leaderboard.

On the go

Download the app for offline access. Make revision easily fit into your schedule.

Revise with quality questions and detailed explanations

Demo Question

Serum calcium levels are influenced by a number of factors, including many hormones.

Which of the following scenarios would naturally occur in a normal, healthy individual as a response to hypocalcaemia?

   Decreased kidney phosphate reabsorption, high PTH, low calcitonin
   High calcitonin, low PTH, raised thyroid hormone
   High thyroid hormone, high PTH, high calcitonin
   Increased osteoblast activity, high PTH, low calcitonin
  Increased osteoclasts activity, low PTH, raised calcitonin

Key learning points

A perforated appendix implies that peritonitis occurred which increases the risk of future adhesions leading to bowel obstruction.

Explanation

PTH levels rise in response to hypocalcaemia, promoting decreased phosphate reabsorption at the kidneys. Serum calcium is found freely in an ionised form (50%) but also albumin bound (40%) and complexed (10%) with compounds such as phosphate. As such decreased serum phosphate will increase the availability of ionised calcium, the bioactive form. Calcitonin would be low in hypocalcaemia.

PTH levels rise in response to hypocalcaemia, promoting decreased phosphate reabsorption at the kidneys. Serum calcium is found freely in an ionised form (50%) but also albumin bound (40%) and complexed (10%) with compounds such as phosphate. As such decreased serum phosphate will increase the availability of ionised calcium, the bioactive form. Calcitonin would be low in hypocalcaemia.

Customer Reviews

Based on 11 reviews
100%
(11)
0%
(0)
0%
(0)
0%
(0)
0%
(0)
W
Wael

Excellent resource

A
Ali Thalji

easy access to important points, required to pass the exam

m
maged barsoum

an excellent source with good key points

Smart features to maximise your revision efforts

Daily questions

Keep on track. Set a time that suits you, we will send you a personalised revision question every day.

Revision plans

Turn weaknesses into strengths. Focus on the specialities that will give you the biggest learnings.

Feedback & peer comparison

Indicates how likely you are to pass. Detailed performance graphs show how you’re currently performing and benchmark you against your peers.

Customer Reviews

Based on 11 reviews
100%
(11)
0%
(0)
0%
(0)
0%
(0)
0%
(0)
W
Wael

Excellent resource

A
Ali Thalji

easy access to important points, required to pass the exam

m
maged barsoum

an excellent source with good key points

Save time and focus on the most important questions

High Impact Questions

Maximise your revision time. High Impact Questions instantly delivers you the most important questions, ranked by our clinical tutors and your peers.