1) Flashcards
A 64 year old with a known malignancy is found to have hypercalcaemia. A blood test reveals a high level of parathyroid hormone related protein. Which neoplasm is this patient most likely to have? Adenocarcinoma of the prostate. Bronchial small cell carcinoma. Bronchial squamous cell carcinoma. Clear cell carcinoma of the kidney. Medullary carcinoma of the thyroid.
Bronchial squamous cell carcinoma. CORRECT – Bronchial squamous cell carcinoma can produce parathyroid hormone related peptide.
A 29 year old woman with a severe infection of a wound on her leg develops sepsis. Which of the following is a specific investigation when identifying this condition? Analysing cerebrospinal fluid Conducting a liver function test Measuring C-Reactive Protein level Measuring haemoglobin and lactate Taking a full blood count
Analysing cerebrospinal fluid CORRECT – A specific investigation aims to identify a bacterial species. An analysis of cerebrospinal fluid will allow the identification of a pathogenic species if it has spread to the fluid. The identification could be done by GRAM staining the sample or testing its antibiotic sensitivity.
After the construction of a new road in Leicester, GPs at various practices in the city began to notice an increase in the number of children that attended their clinics with asthma. Researchers acting on behalf of NHS England investigated the issue by looking at GP records at practices that were located at different distances from the new road and identified the new number of child asthma cases at each practice. This is an example of which type of study? Case Control Study Cross-Sectional Study Ecological Study Historical Cohort Study Prospective Cohort Study
Ecological Study CORRECT – The researchers have divided their sample of GP records by location and then assessed the prevalence of new asthma cases in each group. This is typical of an ecological study, the methodology of which is to divide a sample into groups based on certain characteristics and then assessing the prevalence of a disorder in each group.
Approximately what percentage of a population’s cancer risk is due to extrinsic factors, i.e., is potentially avoidable? A. 25% B. 35% C. 55% D. 75% E. 85%
The answer is a staggering 85%. Tobacco use alone is associated with approximately 25% of all cancer deaths. Other important extrinsic factors are obesity, low fruit and vegetable intake, lack of physical activity, alcohol use, and exposure to chemicals, radiation and infections.
Spinal nerves are mixed nerves which carry motor, sensory, and autonomic signals between the spinal cord and the body. How many pairs of spinal nerves are there in the human body? 25 28 30 31 32
31 CORRECT – A human adult has 8 pairs of cervical spinal nerves, 12 pairs of thoracic spinal nerves, 5 pairs of lumbar spinal nerves, 5 pairs of sacral spinal nerves and 1 pair of coccygeal spinal nerves. The total is 31 pairs of spinal nerves.
A 68 year old man is admitted to A&E with a severe pain in his right leg. The pain started this morning and his leg is pale and cold. On examination, the patient has reduced leg power and diminished sensation in his toes. Both the posterior tibial and the dorsalis pedis pulses are absent. The man has a history of hyperlipidaemia and a 40-pack-year history of smoking. What is the most likely diagnosis? Acute Limb Ischaemia Critical Limb Ischaemia Chronic Venous Insufficiency Deep Vein Thrombosis Intermittent Limb Claudication
Acute Limb Ischaemia CORRECT – Acute limb ischaemia occurs when there is an occlusion of an artery in a limb that occurs within minutes or days. As this occlusion occurs so quickly there is not time for any collateral circulation to develop. Symptoms can be remembered by the ‘Six Ps’: pain, pallor, perishing with cold, pulseless, paraesthesia, paralysis. This ischaemia can rapidly lead to necrosis of the limb and so this is a medical emergency. Patients with suspected acute limb ischaemia should immediately be referred to a vascular surgical unit who will try to thrombolyse the clot. The patient has an acute history that would be expected in acute ischaemia and all of the ‘Six Ps’ expected in acute limb ischaemia are present. Acute_Limb_Ischaemia
Which of the following two signs would be indicative of Graves’ disease over other types of hyperthyroidism? Staring eyes and Goitre Staring eyes and Lid lag Lid lag and Goitre Exopthalmos and Pre-tibial myxoedema
Exopthalmos and Pre-tibial myxoedema Correct. Exopthalmos is a bulging of the eye anteriorly out of the orbit. In Graves’ disease this is casued by an infiltration of the orbital connective tissue by lymphocytes and other immune cell types in response to TSI recognising antigens in orbital fat and connective tissue. The inflammation results in a deposition of collagen and glycosaminoglycans in the muscles leading to subsequent enlargement and fibrosis. Exopthalmos occurs in ~25-50% of patients with Graves’ disease but is not present in other types of hyperthyroidism (the inflammation results from TSI rather than an increase in thyroid hormone per se). Pretibial myxoedema (also known as Graves’ dermopathy) is an infiltrative dermopathy that is as a rare complication in about 1-5% of patients suffering with Graves’ disease. Again pre-tibial myxoedema is a consequence of TSI rather than an increase in thyroid hormone.
A 65 year old woman attends a well woman check. She tells the practice nurse she drinks one unit of alcohol a day and smokes five cigarettes a day. She has a BMI of 28 kg/m2 and a blood pressure of 145/95 mmHg. She eats little fibre in her diet. Which intervention will be LEAST helpful in decreasing her risk of atherosclerosis? A. Increasing fibre in her diet B. Loosing weight C. Treating hypertension D. Stopping drinking alcohol E. Stopping smoking
A moderate alcohol intake (1-2 units/day) appears to be protective for atherosclerosis (although excessive alcohol consumption produces secondary hyperlipidaemia which is a risk factor for atherosclerosis). Stopping drinking alcohol is therefore the correct answer. Food high in soluble fibre reduces circulating lipid and therefore conveys some protection against atherosclerosis. Obesity produces hypertension, diabetes mellitus, hypertriglyceridaemia and reduced HDL and is therefore a risk factor for atherosclerosis. Hypertension damages blood vessel walls and predisposes to plaque formation. Smoking causes inflammation of and damage to blood vessel walls predisposing to atherosclerosis. It also causes oxidation of lipids and an increased predisposition to thrombosis which can occur on the surface of plaques.
Which of the following facilitates uptake of ferrous iron (Fe2+) from the intestinal lumen into enterocytes? Divalent metal transporter 1 (DMT1) Ferroportin Hepcidin Hephaestin Transferrin
Correct. DMT1 is located on the apical membrane of enterocytes where it binds ferrous iron (Fe2+) in the intestinal lumen and facilitates its transport into the cell.
A researcher designing a cross-sectional study to investigate coronary heart disease in adult e-cigarette users employs power analysis to determine the sample size for her study. What parameter would increase as the number of people selected for this study increases? Bias Precision Prevalence of coronary heart disease Random error Systematic error
Precision
A 23 year old male involved in a motorbike accident is admitted to the accident and emergency department. The doctor believes the man may have sustained a brachial plexus lesion and assesses motor and sensory function in the man’s right arm. The anterior rami of which spinal nerves contribute to the superior trunk of this plexus?
A combination of C5 and C6 nerves
A combination of C8 and T1 nerves
A combination of C7 and C8 nerves
A combination of C6 and C7 nerves
The C7 nerve only
CORRECT – The anterior rami of the C5 and C6 spinal nerves contribute to the superior trunk. brachial_plexus
A 69 year old woman is admitted to the accident and emergency department with severe abdominal distension and a non-blanching rash. She is very confused and has slurred speech. Her respiratory rate is 35 breaths per minute and her systolic blood pressure is 89 mmHg. After further testing the on-call consultant determines that the woman has developed sepsis. What is the primary mechanism that has resulted in the confusion and slurred speech observed in this patient? Bronchoconstriction of the airways Damage to brain tissue as a result of an increase in the production of inflammatory cytokines Decreased perfusion of the brain as a result of systemic vasoconstriction Decreased perfusion of the brain as a result of systemic vasodilation Hypoxia as a result of decreased lung compliance
Decreased perfusion of the brain as a result of systemic vasodilation CORRECT – During sepsis systemic vasodilation and increased vascular permeability occurs. This leads to relative and absolute hypovolaemia and as a result there is less perfusion of end organs, including the brain. The decreased perfusion of the brain can present as confusion, drowsiness, slurred speech, agitation, anxiety or decreased level of consciousness.
Name the synthetic analogue of ACTH used in an ACTH stimulation test.
Answer Synacthen is a synthetic ACTH analogue used to test adrenal function. The administration of Synacthen intramuscularly, would normally increase plasma cortisol by >200 nmol/L. A normal response usually excludes Addison’s disease.
A 47 year old man notices a lump in his neck. This is thought by his GP to be a lymph node. The GP arranges for a biopsy to be taken. The histological appearance of the biopsy is shown in the attached picture. What type of necrosis is seen in this picture? Necrosis
A. Caseous
B. Coagulative
C. Fat
D. Fibrinoid
E. Liquifactive
The picture shows a granuloma in the middle of which is amorphous debris. This is caseous necrosis and the man is likely to have tuberculosis.
A 60 year old man presents with pneumonia. A blood culture, full blood count and C-reactive protein (CRP) is measured. The man’s CRP level is 85mg/L (Normal: <5mg/L).
What is the normal function of this protein?
To increase neutrophil production by the bone marrow
To facilitate opsonin-mediated phagocytosis
To trigger fever production in the hypothalamus
To increase fibrinogen levels
To vasodilate capillaries to increase blood flow to the site of the infection
To facilitate opsonin-mediated phagocytosis
CORRECT – CRP is produced in the liver and binds to the phosphocholine expressed on the surface of dead or dying cells and some bacteria. This activates the complement system which promotes phagocytosis by macrophages. This allows for the clearance of necrotic tissue, apoptotic cells and bacteria.
A 22 year old man is admitted to the accident and emergency department with a body temperature of 39.3oC, photophobia and a stiff nick. The doctor suspects that the man has developed meningitis and wants to test the man’s cerebrospinal fluid. In order to do this, the doctor must perform a lumbar puncture.
What is the most superficial structure of the spinal meninges?
Arachnoid Mater
Conus Medullaris
Dural Mater
Filum Terminale
Pia Mater
Dura mater
CORRECT – The spinal meninges consist of three membranes that envelope the spinal cord. There are three membrane, the deepest of which is the pia mater, then there is the arachnoid mater more superficial to this layer, and finally, the most superficial structure is the dura mater.
