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All formatives Flashcards

1
Q

A 45 year old man undergoes gastrectomy for treatment of a benign ulcer, which of the following hormones is likely to be most deficient as a result:

  1. Cholecystokinin
  2. Gastrin
  3. Motilin
  4. Secretin
  5. Vasoactive intestinal polypeptide
A

b. gastrin

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2
Q

A 20 year old man consulted his general practitioner complaining of bloating of his stomach after eating. A barium meal showed normal gastric mucosal appearance but delayed gastric emptying. The excess production of which of the following hormones may be responsible:

  1. Cholecystokinin
  2. Gastrin
  3. Motilin
  4. Secretin
  5. Somatostatin
A

a. CCK

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3
Q

A digestive tract enzyme may be initially released in the inactive form. What is the best term to describe this compound:

  1. Enterokinase
  2. Enzyme
  3. Polypeptide
  4. Protease
  5. Zymogen
A
  1. zymogen
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4
Q

A 19 year old man ate a large bar of white chocolate. Which of the following digestive processes is most important to promote digestion of the food:

  1. Conjugation
  2. Emulsification
  3. Enterohepatic circulation
  4. Glycolysis
  5. Phosphorylation
A

b. emulsification

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5
Q

A 23 year old male with a history of alcohol misuse presented with acute upper-abdominal pain and vomiting. He was found to have a raised serum amylase. What is the most likely diagnosis:

  1. Acute appendicitis
  2. Acute pancreatitis
  3. Cholangitis
  4. Dissecting aortic aneurysm
  5. Peptic ulcer
A

B - acute pancreatitis

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6
Q

A 47 year old man was referred for investigation of impaired defecation. Which of the following mechanisms best describes the normal defecation mechanism:

  1. Stretch receptors in the rectal wall activate both sympathetic and parasympathetic centers in the spinal cord
  2. Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord
  3. Stretch receptors in the rectal wall activate sympathetic centers in the spinal cord
  4. The external anal sphincter contracts
  5. The internal anal sphincter is consciously relaxed
A
  1. Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord
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7
Q

A 50 year old man presented to the emergency department complaining of a 3 month history of epigastric pain and a 2 day history of a very high volume of vomiting. What is the most likely anatomic site of bowel obstruction to cause this symptom:

  1. Distal ileum
  2. Gastro-oesophageal junction
  3. Mid-oesophagus
  4. Sigmoid colon
  5. Third part of the duodenum
A
  1. third part of the duodenum
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8
Q

A 45 year old woman has surgical removal of her distal ileum to treat inflammatory bowel disease. Which of the following vitamins is she at risk of becoming deficient in:

  1. Vitamin B1
  2. Vitamin B5
  3. Vitamin B6
  4. Vitamin B12
  5. Vitamin C
A

D. vitamin B12

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9
Q

A 24 year old has an inherited defect and is unable to produce intrinsic factor. The absorption of which of the following substances is most likely to be impaired:

  1. Bile salts
  2. Free amino acids
  3. Glucose
  4. Vitamin B12
  5. Water
A

4 - vitamin B12

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10
Q

A 55 year old man presents with a 6 year history of progressive painless jaundice and weight loss. On inspection, he is jaundiced. Abdominal palpation is normal. What is the most likely diagnosis:

  1. Crohn’s disease
  2. Diverticular disease
  3. Duodenal ulcer
  4. Pancreatic cancer
  5. Renal carcinoma
A
  1. pancreatic cancer
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11
Q

A 30 year old man presents with jaundice. He has been complaining of intermittent right hypochondrial pain and nausea for several months, but the pain has worsened, his urine is darker than usual and his stools pale. Which imaging is most appropriate in the first instance:

  1. Abdominal radiograph
  2. Abdominal ultrasound
  3. Computed tomography
  4. Isotope liver scintigraphy
  5. Positron emission tomography
A
  1. abdominal ultrasound
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12
Q

A 45 year old man is stabbed in the lower chest. The knife cuts most of the vagus nerve fibres around the oesophagus. He makes a good recovery. Which of the following is most likely to occur as a result of the nerve injury:

  1. Delayed gastric emptying
  2. Increased gastrin secretion
  3. Increased intestinal peristalsis
  4. Increased pancreatic enzyme production
  5. Reduced bile production
A
  1. delayed gastric emptying
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13
Q

A 40 year old man has a total colectomy to treat a colonic carcinoma. The operation is curative. Which of the following is most likely to occur as a result of this operation:

  1. Constipation
  2. Excessive water retention
  3. Hyponatremia
  4. Reduced absorption of vitamin A
  5. Reduced glucose absorption
A
  1. hyponatraemia
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14
Q

A 70 year old woman presents with jaundice. She has been complaining of right abdominal pain and altered bowel habit for several months. On examination she has a hard craggy mass in her right iliac fossa and hepatomegaly. An abdominal ultrasound is performed. Which of the following is the most likely finding in the liver at ultrasound:

  1. Cholecystitis
  2. Gallstones impacted in the common bile duct
  3. Liver abscess
  4. Macronodular cirrhosis
  5. Multiple liver metastases
A
  1. multiple liver metastases
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15
Q

A 70 year old man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph shows multiple dilated loops of bowel. Which of the following bowel findings on abdominal x-ray would be in keeping with small bowel obstruction:

  1. Central distribution of loops of bowel
  2. Haustral mucosal folds
  3. Peripheral distribution of loops of bowel
    .4. Relatively few loops
  4. Wide angle of curvature of loops of bowel
A
  1. Central distribution of loops of bowel
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16
Q

A 70 year old man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph shows multiple dilated loops of bowel. Which of the following bowel findings on abdominal x-ray would be in keeping with small bowel obstruction:

  1. Central distribution of loops of bowel
  2. Haustral mucosal folds
  3. Peripheral distribution of loops of bowel
    .4. Relatively few loops
  4. Wide angle of curvature of loops of bowel
A
  1. Central distribution of loops of bowel
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17
Q

A 45 year old smoker presents with massive haematemesis and melaena. Endoscopy reveals an actively bleeding posterior ulcer in the first part of the duodenum. Which artery is most likely to be bleeding:

  1. Aorta
  2. Common hepatic
  3. Gastroduodenal
  4. Right gastric
  5. Splenic
A
  1. Gastroduodenal
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18
Q

A 20 year old female medical student suffers from severe secretory diarrhoea while backpacking in India. She remembers that oral rehydration therapy (ORT) is an effective way to counter the dehydration caused by intestinal fluid loss. Which of the following ingredients would be required to make up a suitable ORT solution:

  1. Potassium chloride + fructose
  2. Potassium chloride + glucose
  3. Sodium chloride + fructose
  4. Sodium chloride + glucose
  5. Sodium chloride + monoglyceride
A
  1. Sodium chloride + glucose
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19
Q

A patient underwent a cholecystectomy for treatment of chronic cholecystitis. During the operation, the surgeon noticed arterial blood loss from the gallbladder neck. Which artery is most likely to have been injured:

  1. Coeliac trunk
  2. Cystic artery
  3. Inferior pancreaticoduodenal artery
  4. Splenic artery
  5. Superior mesenteric artery
A
  1. Cystic artery
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20
Q

A 50 year old patient has chronic peptic ulcer disease that has not responded to drug therapy and undergoes surgical removal of the gastric antrum to reduce gastric acid production. How does the surgical procedure reduce acid production:

  1. Decreases gastrin production
  2. Decreases pepsin synthesis
  3. Increases bile production
  4. Increases cholecystokinin production
  5. Increases gastric emptying
A
  1. Decreases gastrin production
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21
Q

A 25 year old woman presents with a 6-week history of diarrhoea and oral aphthous ulcers. Her stool contains blood and mucous. What is the most likely diagnosis:

  1. Crohn’s disease
  2. Diverticulitis
  3. Infective diarrhoea
  4. Irritable bowel syndrome
  5. Ulcerative colitis
A
  1. Crohn’s disease
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22
Q

A 25 year old man presents with fever, bloody diarrhoea and cramping for several weeks that does not resolve with antibiotic therapy. Proctosigmoidoscopy reveals red, raw mucous and pseudopolyps. What is the most likely cause:

  1. Campylobacter infection
  2. Crohn’s disease
  3. Irritable bowel disease
  4. Ulcerative colitis
  5. Viral gastroenteritis
A
  1. Ulcerative colitis
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23
Q

A 20 year old man presents with a 12-history of collicky periumbillical pain, which shifts to the right iliac fossa, fever and a loss of appetite. What is the most likely diagnosis:

  1. Acute appendicitis
  2. Acute pancreatitis
  3. Acute viral hepatitis
  4. Diverticular disease
  5. Perforated peptic ulcer
A
  1. Acute appendicitis
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24
Q

A 45 year old man was admitted to hospital after ingesting 25 g of paracetamol 3 days earlier. He had no past medical history of note, took no regular medication and rarely consumed alcohol. Which of the following signs would be consistent with his presentation:

  1. Finger clubbing
  2. Gynaecomastia
  3. Jaundice
  4. Palmar erythema
  5. Spider naevi
A
  1. Jaundice
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25
Q

A researcher is investigating enzymatic digestion of polysaccharides. Which of the following combinations of disaccharides and digested products is correct.

  1. Maltose = 3 glucose
  2. Maltose = 1 glucose + 1 fructose
  3. Sucrose = 1 galactose + 1 glucose
  4. Lactose = 1 glucose + 1 galactose
  5. Sucrose = 2 glucose
A
  1. Lactose = 1 glucose + 1 galactose
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26
Q

A 71 year old man had a malignant tumour of the middle third of the oesophagus. What is the most likely histopathological diagnosis:

  1. Adenocarcinoma
  2. Adenoma
  3. Gastrointestinal stromal tumour
  4. Liposarcoma
  5. Squamous cell carcinoma
A
  1. Squamous cell carcinoma
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27
Q

Name the different skin layers

A

Epidermis
Dermis
Hypodermis

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28
Q

Which of the following skin cells are responsible for immediate type hypersensitivity reactions in the skin

  1. Neutrophils
  2. Lymphocytes
  3. Mast cells
  4. Melanocytes
A
  1. Mast cells
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29
Q

A small, superficial, circumscribed elevation of the skin, less than 0.5cm, that contains serous fluid is called

  1. Papule = small raised area
  2. Macule = small circumscribed area
  3. Nodule
  4. Vesicle = small fluid filled
A
  1. Vesicle = small fluid filled
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30
Q

Acute urticaria is an example of which type of hypersensitivity reaction

  1. Type 1 = IgE produced specific to an antigen
  2. Type 2 = antibodies bind to antigens on self-surface
  3. Type 3 = accumulation of immune complexes that give rise to an inflammatory response
  4. Type 4 = delayed (2-3 days) T cell-mediated response
A
  1. Type 1 = IgE produced specific to an antigen
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31
Q

All of the following can be used in the treatment of atopic eczema except

  1. Topical steroids
  2. Antihistamines
  3. Emollients
  4. Antifungal cream
A
  1. Antifungal cream
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32
Q

Impetigo is a skin infection caused by

  1. Gram positive cocci = staphylococcus aureus & streptococcus pyogenes
  2. Gram negative bacilli
  3. Anaerobes
  4. Protozoa
A
  1. Gram positive cocci = staphylococcus aureus & streptococcus
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33
Q

Can you list 4 risk factors for melanoma skin cancer

A

Previous history of skin cancer
Family history of skin cancer
Fair skin (type 1 & 2 skin)
Living in tropical countries for more than 1 year
Working outdoors
Immunosuppressive diseases or immunosuppressive treatment

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34
Q

The cell of origin in a squamous cell carcinoma

  1. Melanocytes
  2. Basal cells
  3. Keratinocytes
  4. Endothelial cells
A
  1. Keratinocytes = SCC

Melanocytes = melanoma
Basal cells = BBC

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35
Q

Treatment of actinic keratosis involves all of the following except

  1. Topical mupirocin
  2. Topical 5 fluorouracil
  3. Liquid nitrogen = used
  4. Topical imiquimod = used
A
  1. Topical mupirocin
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36
Q

Acne vulgaris is a common skin condition which is characterised by

  1. Comedones, papules, pustules and nodulocysts
  2. Vesicles and bullae
  3. Scales and crusts
  4. Ulceration and erosions
A
  1. Comedones, papules, pustules and nodulocysts
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37
Q

What unit of measurement can be used for topical medicines

A

Fingertip unit measurement (FTU)

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38
Q

Can you mention 3 clinical types of psoriasis

A 
Plaque psoriasis 
Guttate psoriasis 
Erythrodermic psoriasis
Pustular psoriasis
Palmoplantar psoriasis
Nail psoriasis
Scalp psoriasis
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39
Q

A well-circumscribed, elevated, superficial, solid lesion, greater than 1cm in diameter is termed

  1. Papule = small raised area
  2. Nodule
  3. Pustule = small pus filled
  4. Plaque = larger raised area
A
  1. Plaque = larger raised area
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40
Q

A 56 y old man presented with multiple, well-defined warty and greasy papules with a ‘stuck on’ appearance on his back; what is the most likely diagnosis

  1. Melanocytic nevi
  2. Malignant melanoma
  3. Seborrheic warts
  4. Cherry angioma
A
  1. Seborrheic warts
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41
Q

A 19 year old lady presented with red, dry excoriated patches on her face, back, arms, cubital and popliteal fossae; her mother and sister have the same problem; what is the most likely diagnosis

  1. Scabies
  2. Seborrheic dermatitis
  3. Urticaria
  4. Atopic dermatitis
A
  1. Atopic dermatitis
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42
Q

What are 3 types of medications that can be applied topically?

A

Topical steroids
Topical antifungals
Topical immunosuppressive
Topical antibiotics

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43
Q

Name the 3 types of skin cancer

A

SCC
BCC
Melanoma

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44
Q

What are the functions of the skin (name at least 3)

A 
Protection
Sensation
Temperature regulation
Immunity
Excretion
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45
Q

Name 2 benign skin lesions

A

Benign melanocytic nevus

Seborrheic keratosis

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46
Q

Concerning the motor homunculus. Which of the following structures is represented the most medially:

  1. Eye
  2. Face
  3. Knee
  4. Tongue
  5. Wrist
A
  1. Knee
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47
Q

An 80 year old man presents to his GP with gradual onset of walking difficulties, urinary incontinence and cognitive decline. Heh as no headache. These symptoms are most typical of:

  1. Frontal lobe tumour
  2. Multiple sclerosis
  3. Normal pressure hydrocephalus
  4. Parkinson’s disease
  5. Vascular dementia
A
  1. Normal pressure hydrocephalus
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48
Q

A 51 year old man is noted to have a left trigeminal nerve palsy. Which of the following is the most likely examination finding:

  1. He has absent taste sensation to the anterior 2/3 of the left of the tongue
  2. He has numbness over the left mandible
  3. He has numbness over the right maxilla
  4. He has numbness over the right posterior aspect of the scalp
  5. He is unable to smile with the left side of his mouth
A
  1. He has numbness over the left mandible
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49
Q

A 36 year old woman attends her GP stating that she feels like she can’t cope looking after her 3 month old baby. She says that she worries all the time about her ability to raise her child. Which of the following could not be explained by anxiety:

  1. Brisk reflexes with flexor plantar responses
  2. Excessive sweating and palpitations
  3. Fatigue and feeling of something stuck in the throat
  4. Numb legs and extensor plantar responses
  5. Poor concentration and forgetfulness
A
  1. Numb legs and extensor plantar responses
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50
Q

A 50 year old right handed barman presents with cognitive language dysfunction. He has difficulty expressing what he wishes to say and difficulty reading e-mails. He has been taking dihydrocodeine (oral opiates) for rib pain for the last 6 weeks. Which of the following is the most likely explanation for these findings:

  1. Alcohol intoxication
  2. Lesion in left temporo-parietal area
  3. Lesion in right temporo-parietal area
  4. Opiate dependence
  5. Right chronic subdural haematoma
A
  1. Lesion in left temporo-parietal area
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51
Q

A 69 year old man presented with left-sided neglect. Which of the following structures is most likely to be affected:

  1. Left frontal lobe
  2. Left parietal lobe
  3. Right frontal lobe
  4. Right parietal lobe
  5. Right temporal lobe
A
  1. Right parietal lobe
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52
Q

A 21 year old man is involved in a road traffic accident. On arrival in the accident and emergency department his Glasgow Coma Scale (GCS) is 6 and he is subsequently intubated and ventilated. In order to assess his head injury further, what is the most appropriate investigation:

  1. Computerised tomography (CT) brain
  2. Functional magnetic resonance imagine (MRI)
  3. Magnetic resonance imaging (MRI) brain
  4. Positron emission tomography (PET) scan
  5. Skull X-rays
A
  1. Computerised tomography (CT) brain
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53
Q

A 47 year old woman who is known to have multiple sclerosis (MS), presents to her GP with new onset of diplopia. In MS there is demyelination of axons in the brain and spinal cord. Which of the following glial cells form the myelin sheaths in the central nervous system:

  1. Astrocyte
  2. Endothelial cells
  3. Microglia
  4. Oligodendrocyte
  5. Schwann cell
A
  1. Oligodendrocyte
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54
Q

A 19 year old woman was noted to have decreased vision. Which of the following is an appropriate method of testing the function of the 2nd cranial nerve:

  1. Asking the patient to screw her eyes shut
  2. Assessing the corneal reflex
  3. Assessing the pupil response to light
  4. Assessing the vestibulo ocular reflex
  5. Looking for nystagmus
A
  1. Assessing the pupil response to light

Asking the patient to screw her eyes shut = CN 7
Assessing the corneal reflex = CN 5
response to light
Assessing the vestibulo ocular reflex = CN 8
Looking for nystagmus = CN 8

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55
Q

A 40 year old man is admitted for assessment of suspected syphilis. Which organism is responsible for syphilis:

  1. Borrelia burgdorferi
  2. Leptospira interrogans
  3. Staphylococcus aureus
  4. Streptococcus anginosus
  5. Treponema pallidum
A
  1. Treponema pallidum
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56
Q

A 55 year old man has difficulty walking and attends his GP. Which of the following is the most likely feature of an upper motor neurone lesion:

  1. Absent reflexes
  2. Dysdiadochokinesia
  3. Hypotonia
  4. Muscle fasciculations
  5. Sustained clonus
A
  1. Sustained clonus
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57
Q

A 16 year old boy presented with a spinal cord injury with absent motor response below C7. Which of the following is an example of a descending spinal cord tract:

  1. Anterior spinocerebellar tract
  2. Dorsal column pathway
  3. Lateral corticothalamic tract
  4. Lateral spinothalamic tract
  5. Posterior spinocerebellar tract
A
  1. Lateral corticothalamic tract
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58
Q

A 51 year old man is noted to have poor coordination. Which of the following is an appropriate method of testing coordination of the lower limb:

  1. Ask the patient to state if his toe is moved up or down, when his eyes are shut
  2. Assessing the patient’s ability to sit up from lying
  3. Assessing the plantar response
  4. Finger-nose test
  5. Heel-shin test
A
  1. Heel-shin test
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59
Q

A 30 year old man developed intense burning pain in his arm after spilling concentrated bleach on it by accident. This pain response was mediated by the C class of pain nociceptor. Which of the following properties is most associated with C fibres:

  1. Efferent
  2. Fast conduction (20m/s)
  3. Nucleus located in the thalamus
  4. Typical diameter of 1-5um
  5. Unmyelinated
A
  1. Unmyelinated
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60
Q

A 64 year old man presented with a haemorrhage in his left internal capsule. Which of the following arteries is most likely to supply this area:

  1. Left external carotid artery
  2. Left middle cerebral artery
  3. Left posterior cerebral artery
  4. Right anterior cerebral artery
  5. Right middle cerebral artery
A
  1. Left middle cerebral artery
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61
Q

A 75 year old man presents to his GP with a progressive impairment of his cognitive function. He is diagnosed with dementia. Which of the following is suggestive of a vascular aetiology for his dementia:

  1. Abnormal movements
  2. Myoclonus
  3. Parkinsonism
  4. Rapid progression of the dementia
  5. Stepwise progression
A
  1. stepwise progression
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62
Q

A 51 year old man was noted to have an upper motor neuron 7th nerve palsy. Which of the following is an appropriate method of testing the function of the 7th cranial nerve:

  1. Asking the patient to clench his teeth
  2. Asking the patient to smile in order to show you his teeth
  3. Assessing the jaw jerk
  4. Looking for wasting of the temporalis muscle
  5. Testing light touch over the mandible and maxilla
A
  1. Asking the patient to smile in order to show you his teeth
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63
Q

A 63 year old woman presents with a gradual onset of a right sided weakness and early morning headaches. SHe undergoes a computerised tomography (CT) scan of her brain. The report of this suggests that she has a metastatic lesion to her left parietal lobe. Tumours from which of the following primary sites commonly metastasise to the brain:

  1. Bone
  2. Breast
  3. Meninges
  4. Schwann cells
  5. Tongue squamous cell
A
  1. Breast
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64
Q

A 47 year old woman presented to the emergency department with severe back pain and urinary retention. She was numb around her perineum and had absent ankle jerks. Which of the following is the most likely diagnosis:

  1. Cauda equina syndrome
  2. Gerstmann’s syndrome
  3. Guillain-barre syndrome
  4. L3 radiculopathy
  5. S1 radiculopathy
A
  1. Cauda equina syndrome
65
Q

A 47 year old man was referred to a neurosurgeon with a spinal cord tumour. The tumour was compressing his posterior (dorsal) columns on the right hand side. Which of the following statement is most likely to be true:

  1. There is likely to be a loss of nociceptive sensation below the level of the lesion on the contralateral side
  2. There is likely to be a loss of temperature sensation below the lesion on the contralateral side
  3. There is likely to be a loss of temperature sensation below the lesion on the ipsilateral side
  4. There is likely to be a loss of vibration and proprioception below the lesion on the contralateral side
  5. There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
A
  1. There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
66
Q

A 55 year old woman presents to her GP with a headache which is associated with scalp tenderness over the right temporal artery. The GP diagnoses giant cell arteritis and commences treatment. Which of the following laboratory results would you expect in this condition:

  1. Elevated erythrocyte sedimentation rate (ESR)
  2. Elevated urate
  3. Elevated white cell count
  4. Reduced haemoglobin
  5. Reduced erythrocyte sedimentation rate (ESR)
A
  1. Elevated erythrocyte sedimentation rate (ESR)
67
Q

A 75 year old man presented to his general practitioner (GP) with difficulty initiating walking. His GP notices a pill rolling tremor and suspected Parkinson’s disease. Which of the following is the most likely neurotransmitter to be affected:

  1. Adrenaline
  2. Dopamine
  3. Histamine
  4. Serotonin
  5. Substance P
68
Q

A 20 year old man was assaulted whilst watching a football match. On arrival at the local accident Accident and Emergency department he opened his eyes to pain, said inappropriate words and localised to pain. What is his Glasgow Coma Score (GCS):

  1. 6
  2. 7
  3. 8
  4. 9
  5. 10
69
Q

Many structures in the human body receive parasympathetic innervation. Which of these is most likely to occur due to its stimulation:

  1. Constriction of pupils
  2. Dilation of pupils
  3. Increased heart rate
  4. Reduced saliva production
  5. Relaxation of the bladder wall
A
  1. Constriction of pupils
70
Q

A 44 year old woman is noted to have an 11th nerve palsy. Which of the following is an appropriate method of testing the function of the 11th cranial nerve:

  1. Look for fasciculation in the deltoid muscle
  2. Look for wasting over the deltoid muscle
  3. Look for fasciculation in the platysma muscle
  4. Look for hypertrophy in the trapezius muscle
  5. Look for wasting of the sternocleidomastoid muscle
A
  1. Look for wasting of the sternocleidomastoid muscle
71
Q

GFR would increase if

  1. There is afferent arteriole constriction
  2. There is efferent arteriole constriction
  3. There is an increase in tissue pressure in Bowman’s capsule
  4. There is an increased release of renin from the JG cells
  5. There is an obstruction of the ureters
A
  1. There is efferent arteriole constriction

If we constrict the efferent arterioles we increase the pressure in the Bowman’s capsule; filtrate increases

72
Q

How would drinking a large amount of water affect osmolarity and volume of the ECF

  1. Decreased osmolarity and increased volume
  2. Both would increase
  3. No change in osmolarity with increased volume
  4. No change in either
  5. Greater increase in ECF volume than ICF volume
A
  1. Decreased osmolarity and increased volume

Dilute the electrolytes in the body whilst increasing the volume

73
Q

Antidiuretic hormone (ADH)

  1. Is produced by the anterior pituitary
  2. Inserts aquaporins into all parts of the kidney tubule
  3. Causes the hypertonic medullary gradient to be established
  4. Is released in response to cellular dehydration
  5. Is released in response to increased plasma urea
A
  1. Is released in response to cellular dehydration

Produced by the hypothalamus and stored in the posterior pituitary gland; it only inserts aquaporins into the collecting duct; it uses the medullary gradient to increase the reabsorption of sodium etc

74
Q

If Drug A’s clearance is greater than inulin clearance, then which of the following would be true of drug A

  1. Net reabsorption
  2. No reabsorption
  3. No secretion
  4. Net secretion
  5. Reabsorbed and secreted
A
  1. Net secretion
75
Q

The following acid/base values were obtained pH = 7.25 / [HCO3-] = 12 mmoles/L / PCO2 = 3.3kPa (25 mmHg)

  1. They are indicative of a respiratory acidosis
  2. The reduction in PCO2 is a result of under-breathing
  3. The subject has probably been taking bicarbonate of soda
  4. It could be related to impaired renal function
  5. The subject may have been vomiting very badly
A
  1. It could be related to impaired renal function
    Metabolic acidosis = pH drops; metabolic is indicated by a decrease in bicarbonate / respiratory is indicated by an increase in partial pressure of carbon dioxide

Rule is = in metabolic acidosis / alkalosis, the HCO / PCO drop or rise with it respectively whilst in respiratory types if the pH drops (acidosis) the PCO rises (with the HCO rising too in chronic situations) and if the pH rises (alkalosis) the PCO drops (with the HCO dropping too in chronic situations)

76
Q

The following acid / base values were obtained: pH = 7.45 / [HCO3-] = 12 mmoles/L / PCO2 = 2.7 kPa (20 mmHg) = chronic respiratory alkalosis

  1. The subject is clearly very unwell
  2. The subject is likely to have spent a long time at altitude
  3. The subject needs bicarbonate
  4. The subject is unlikely to be hypoxic
  5. This is typical of a metabolic alkalosis
A
  1. The subject is likely to have spent a long time at altitude
77
Q

The following acid / base values were obtained: pH = 7.28 / [HCO3-] = 36 mmoles/L / PCO2 = 8 kPa (60 mmHg) = chronic respiratory acidosis

  1. This is typical of an acute respiratory acidosis
  2. The subject will be excreting large amounts of bicarbonate ions
  3. The subject will be excreting large amounts of ammonium ions
  4. The plasma potassium level is likely to be decreased
  5. He has as metabolic alkalosis because of the raised bicarbonate
A
  1. The subject will be excreting large amounts of ammonium ions
78
Q

The following acid / base values were obtained: pH = 7.50 / [HCO3-] = 45 mmoles/L / PCO2 = 8 kPa (60 mmHg) = metabolic alkalosis

  1. This may be the result of bad diarrhoea
  2. The subject will be excreting bicarbonate ions
  3. The subject will be excreting ammonium ions
  4. The plasma potassium level is likely to be increased
  5. The subject has a respiratory acidosis because of the raised PCO2
A
  1. The subject will be excreting bicarbonate ions
79
Q

The following values were made for an elderly female diabetic patient’s creatinine clearance: 24hr urine volume = 1.44L / serum creatinine concentration = 100 umol/L / urine creatinine concentration = 6.6 mmoles/L

  1. Clinical features of renal impairment would be expected
  2. Serum creatinine alone indicates impaired renal function
  3. Serum potassium should be measured urgently
  4. The data suggests there may be renal impairment
  5. There is reason to suspect an incomplete renal collection
A
  1. The data suggests there may be renal impairment
80
Q

A patient with lung cancer develops the syndrome of inappropriate ADH secretion; which of the following values for Na+ concentration might be expected to be seen (normal = 135-140 mmol/L)

  1. 140 mmol/L
  2. 145 mmol/L
  3. 150 mmol/L
  4. 138 mmol/L
  5. 128 mmol/L
A
  1. 128 mmol/L
81
Q

Which of the following are classed as loop diuretics:

  1. Furosemide
  2. Spironolactone
  3. Bendroflumethiazide
  4. Mannitol
  5. Amiloride
A
  1. Furosemide
82
Q

A 6 year old child presents with swelling of his face and legs; his serum albumin concentration is 18g/L (normal 37-42) and his mother notices that his urine is frothy; what is the most likely diagnosis

  1. Ig-A glomerulonephritis
  2. Minimal change disease
  3. Focal and segmental glomerulonephritis
  4. Membranous nephropathy
  5. Lupus nephritis
A
  1. Minimal change disease
83
Q

A 23 year old woman complains of flank pain, dysuria and frequency of micturition; she has taken ibuprofen for the pain; her urinalysis shows protein, nitrites and blood; what is the most likely diagnosis

  1. Acute pyelonephritis
  2. Cystitis
  3. Chronic pyelonephritis
  4. Reflux nephropathy
  5. Analgesic nephropathy
A
  1. Acute pyelonephritis
84
Q

A 40 year old man was found to have asymptomatic proteinuria and microscopic haematuria during routine employment-related examination; his BP was found to be 160/100 mmHg and serum creatinine 170 micromol/L (normal 86-116); he has no urinary symptoms; what is the next most important symptoms

  1. Chest X-ray
  2. Echocardiogram
  3. Intravenous urogram
  4. Ultrasound of the urinary tract
  5. Renal biopsy
A
  1. Ultrasound of the urinary tract
85
Q

A 60 year old man has stage 5 chronic kidney disease with a serum creatinine of 500 umol/L (normal 88-116); which of the following is likely to be present

  1. High serum calcium
  2. Low serum phosphate
  3. High serum phosphate
  4. Normal serum calcium
  5. Normal serum phosphate
A
  1. High serum phosphate
86
Q

A 60 year old man has stage 5 chronic kidney disease with a serum creatinine of 500 umol/L (normal 88-116); which of the following is likely to be present:

  1. Low serum calcium
  2. Normal serum calcium
  3. Low serum phosphate
  4. Normal serum calcium
  5. High serum calcium
A
  1. Low serum calcium
87
Q

Patients with renal failure are often anaemic; what is the best treatment for their anaemia:

  1. Oral iron therapy
  2. Intravenous iron
  3. Vitamin B12
  4. Erthryopoietin
  5. Blood transfusion
A
  1. Erthryopoietin
88
Q

For an uncomplicated urinary infection which of the following organism is the most likely cause:

  1. Staphylococcus aureus
  2. Klebsiella sp
  3. Pseudomonas aeruginosa
  4. Candida albicans
  5. Escherichia coli
A
  1. Escherichia coli
89
Q

A 70 year old man complains of poor stream of urine, nocturia and post-micturition dribbling; which of the following is the most likely cause:

  1. Diabetic neuropathy
  2. Urinary tract infection
  3. Chronic kidney disease
  4. Prostatic hypertrophy
  5. Bladder cancer
A
  1. Prostatic hypertrophy
90
Q

A 60 year old man presents with tiredness and malaise; routine investigations reveal a raised serum creatinine and an estimated GFR of 35 ml/min; which of the following stages of CKD is he in

  1. Stage 1
  2. Stage 2
  3. Stage 3
  4. Stage 4
  5. Stage 5
91
Q

The commonest urological malignancy in patients with painless frank haematuria is:

  1. Kidney cancer
  2. Testicular cancer
  3. Bladder cancer
  4. Penile cancer
  5. Prostate cancer
A
  1. Bladder cancer
92
Q

What is the commonest type of renal tract stones in adults:

  1. Calcium phosphate
  2. Calcium oxalate
  3. Cystine
  4. Magnesium ammonium phosphate
  5. Uric acid
A
  1. Calcium oxalate
93
Q

What is the commonest mode of presentation for patients with a renal or ureteric stone:

  1. Loin pain radiating to the flank and / or groin
  2. Frank haematuria
  3. Urinary tract infection
  4. Lower urinary tract symptoms
  5. Acute urinary retention
A
  1. Loin pain radiating to the flank and / or groin
94
Q

What are the features of acute urinary retention:

  1. Painful inability to void with a palpable or percussible bladder
  2. Slow stream of micturition with terminal dribbling and frequency
  3. Painless condition with a palpable or percussible bladder
  4. Dysuria with frank haematuria
  5. Bladder pain which is worse when the bladder is full and relieved by voiding
A
  1. Painful inability to void with a palpable or percussible bladder
95
Q

The following antibiotics are generally suitable for empirical treatment of complicated urinary tract infections except:

  1. Vancomycin
  2. Ciprofloxacin
  3. Ceftriaxone
  4. Gentamicin
  5. Co-amoxiclav
A
  1. Gentamicin
96
Q

A patient with hypothyroidism would demonstrate which of the following symptoms:

  1. Exopthalmos
  2. Increased heart rate
  3. Heat tolerance
  4. Increased protein metabolism
  5. Lethargy
97
Q

Goitre is a common symptom of thyroid dysfunction and can be present in both hypo- and hyperthyroidism. However it would not be present in which of the following thyroid pathologies

  1. Primary hypothyroidism
  2. Secondary hypothyroidism
  3. Primary hyperthyroidism
  4. Secondary hyperthyroidism
  5. Graves disease
A
  1. Secondary hypothyroidism
98
Q

A decrease in circulating cortisol levels would result in which of the following physiological responses

  1. Enhanced gluconeogenesis in the liver
  2. Hypotension
  3. Decreased ACTH secretion from the anterior pituitary
  4. Elevated fatty acid levels in the plasma
  5. Suppression of the immune system
A
  1. Hypotension
99
Q

A person with primary hypercortisolism would demonstrate

  1. Depressed ATH
  2. Elevated CRH
  3. Hypotension
  4. Hypoglycaemia
  5. Increased bone density
A
  1. Depressed ACTH
100
Q

Chronic glucocorticoid therapy is associated with which of the following

  1. Enhanced cortisol release from the adrenal glands
  2. Enhanced ACTH release from the anterior pituitary
  3. Enhanced CRH release from the hypothalamus
  4. Adrenal insufficiency
  5. Adrenal hypertrophy
A
  1. Adrenal insufficiency
101
Q

Which of the following will elevate free calcium levels in plasma

  1. Alkalosis
  2. Activation of osteoblasts
  3. Increased phosphate excretion at the kidneys
  4. Calcitonin
  5. All of the above
A
  1. Increased phosphate excretion at the kidneys
102
Q

Regarding growth hormone which of the following is correct

  1. It is also known as somatostatin
  2. It is also known as somatomedian
  3. It is a steroid hormone
  4. Levels in adults are at their highest during REM sleep
  5. It is relatively insignificant in terms of foetal and neonatal growth
A

5.It is relatively insignificant in terms of foetal and neonatal growth

103
Q

The adrenal zona glomerulosa secretes which hormone

  1. Testosterone
  2. Progesterone
  3. Aldosterone
  4. Cortisol
  5. Epinephrine / adrenaline
A
  1. Aldosterone
104
Q

Which of the following responses would you expect following insulin release

  1. Hepatic gluconeogenesis
  2. Increased ketone formation
  3. Increased uptake of glucose by the brain
  4. Adipose lipolysis
  5. Stimulation of Na/K ATPase
A
  1. Stimulation of Na/K ATPase
105
Q

Which of the following is not a glucose counter regulatory hormone

  1. Thyroid hormone
  2. Epinephrine (adrenaline)
  3. Glucagon
  4. Cortisol
  5. Growth hormone
A
  1. Thyroid hormone
106
Q

A 21 year old man is diagnosed with Type 1 DM. He is studying engineering at university and has a part-time job as a delivery driver. He had just got married and his wife is expecting their first child. What information should he receive shortly after diagnosis

  1. He should be told he cannot continue his driving job in the future
  2. He may be able to work off shore depending on his employer and where he is going
  3. He is likely to pass on his diabetes to his child
  4. He should be advised to stop drinking any alcohol
  5. He should be told he is unlikely to ever have any hypos (hypoglycaemic episodes) if he monitors his blood glucose regularly
A
  1. He may be able to work off shore depending on his employer and where he is going
107
Q

It is advisable for everyone to pursue a healthy lifestyle if he / she wishes the reduce the risks of long term illness. Which of the following would be considered appropriate to tell a sedentary man with an unhealthy diet who is keen to change to a more healthy lifestyle

  1. Do a minimum of 30 minutes of vigorous physical activity on most days of the week
  2. Aim to eat 5 portions of fruit / vegetables per day
  3. Aim to eat 4 portions of oily fish / week
  4. It is inadvisable to drink more than 20 units of alcohol per week
  5. All of the above
A
  1. All of the above
108
Q

A 53 year old man was diagnosed with T2 DM 6 months ago. He has lost 1 stone in weight, his BMI is 28 and HbA1c is 75 mmol/mol (9%). What is the next appropriate medication in his management

  1. Thiazolidinedione (e.g pioglitazone)
  2. Sulphonylurea (e.g metformin)
  3. Biguanide (e.g metformin)
  4. DPP IV inhibitor (e.g sitagliptin)
  5. Insulin
A
  1. Biguanide (e.g metformin)
109
Q

Which symptom below is not typical of hypoglycaemia

  1. Headache
  2. Itch
  3. Poor concentration
  4. Sweating
  5. Irritability
110
Q

A 32 year old patient with T1DM is reviewed at the diabetes clinic. His blood sugar is 3.2 mmol/L and he tells you he is feeling well. What is the best course of action next.

  1. Administer IM glucagon
  2. Send him home for lunch
  3. Give 200ml fresh orange juice
  4. Give digestive biscuit
  5. Administer his lunchtime insulin
A
  1. Give 200ml fresh orange juice
111
Q

A 25 year old with T1 DM mellitus presents with vomiting and diarrhoea. BP 80/54, RR 24 per minute. Which test is least important for immediate management

  1. Blood glucose
  2. pH
  3. Urine / blood ketones
  4. Electrolytes
  5. Liver function tests
A
  1. Liver function tests
112
Q

23 year old man diagnosed with hyperthyroidism and has been commenced on carbimazole. What do you need to counsel him about

  1. Neutropenia
  2. Fertility
  3. Metallic taste in mouth
  4. Renal function
  5. Discolouration
A
  1. Neutropenia
113
Q

A man with a large prolactinoma complains of impaired vision. What is the most likely pattern of visual field loss to be found on clinical confrontation

  1. Homonymous hemianopia
  2. Bitemporal hemianopia
  3. Total loss of vision in one eye
  4. Homonymous quadrantanopia
  5. Nasal hemianopia
A
  1. Bitemporal hemianopia
114
Q

A 38 year old lady presents feeling tired and dizzy. She is tanned and her investigations show (Na = 123; low), (K = 5.6; high). Thyroid function tests are normal and calcium is normal. Her cortisol is low, 50. What is her diagnosis

  1. Hyperparathyroidism
  2. Addison’s disease
  3. Cushing’s disease
  4. Grave’s disease
  5. Conn’s syndrome
A
  1. Addison’s disease
115
Q

All the conditions below are well recognised causes of secondary diabetes except one. Which condition is not a recognised cause of secondary diabetes.

  1. Acromegaly
  2. Haemochromatosis
  3. Addison’s disease
  4. Cushing’s disease
  5. Chronic pancreatitis
A
  1. Addison’s disease
116
Q

The chambers of the heart possess unique, distinguishing features enabling them to function effectively and efficiently. The right atrium possesses:

  1. A bicuspid valve leading to the right ventricle = tricuspid valve found between right atrium + right ventricle
  2. An opening for the azygos vein = empties into the SVC
  3. An opening for the coronary sinus = drains all the blood supplied to the heart back into the right atrium
  4. An opening for the right brachiocephalic vein = stems from the SVC and goes on to form the right subclavian + right internal jugular / right external jugular
  5. An oval fossa in its anterior wall = fossa ovalis is found in the right atrium of the heart
A
  1. An opening for the coronary sinus = drains all the blood supplied to the heart back into the right atrium
117
Q

Which of these is NOT a shared feature of skeletal and cardiac muscle:

  1. Myocytes in both are electrically connected via gap-junctions = gap junctions fund in cardiac muscle but not in skeletal muscle (electrically coupling is also a cardiac trait)
  2. The duration of the depolarising phase of the action potential in both is less than
  3. 5 msec = skeletal muscle action potential is about 5ms but the cardiac one is about 250 ms
  4. They both exhibit sustained contraction (tetanus) in response to high frequency
  5. Stimulation = skeletal muscle can exhibit tetanus but cardiac muscle cannot due to a long refractory period
  6. They both have an unstable resting membrane potential = skeletal muscle has a very stable resting membrane potential whereas some cardiac muscle cells have an unstable resting membrane potential (thus acting as pacemakers)
  7. None of the above features are shared in common
A
  1. None of the above features are shared in common
118
Q

During embryological development, which of the following gives rise to the common carotid arteries?

  1. 2nd pair of aortic arches
  2. 3rd pair of aortic arches
  3. 4th pair of aortic arches
  4. 5th pair of aortic arches
  5. 6th pair of aortic arches
A
  1. 3rd pair of aortic arches = constitutes the commencement of the internal carotid artery and is therefore named the carotid arch
    4th pair of aortic arches = the 4th left arch forms the right subclavian / the 4th right arch becomes the aortic arch
    5th pair of aortic arches = disappears on both sides
    6th pair of aortic arches = forms the pulmonary arteries
    2nd pair of aortic arches = 1st / 2nd disappear early, a remnant of the 1st forms part of the maxillary artery (a branch of external carotid artery)
119
Q

The arterioles function as resistance vessels because:

  1. They only allow blood flow in one direction
  2. They have a relatively narrow lumen and a thin elastic wall
  3. They have a relatively narrow lumen and strong muscular wall
  4. They have a relatively wide lumen and strong muscular wall
  5. The statement is wrong - arterioles are not resistance vessels
A
  1. They have a relatively narrow lumen and strong muscular wall = narrow lumen gives them a high resistance and the strong muscular wall means they can contract or relax when the resistance needs to be changed

They have a relatively wide lumen and strong muscular wall
The statement is wrong - arterioles are not resistance vessels = of the arteries, arterioles are the muscular resistance arteries
They only allow blood flow in one direction = all other vessels only allow blood flow in 1 direction and are classed differently

120
Q

In the heart, the fast depolarising phase of the cardiac action potential is caused by:

  1. Influx of Ca2+
  2. Influx of Cl-
  3. Influx of K+
  4. Influx of Mg2+
  5. Influx of Na+
A
  1. Influx of Na+

Influx of Ca2+ = L-type calcium channels opening to allow calcium in is the reason for the plateau
Influx of Cl- = not present
Influx of K+ = would cause depolarisation but leaky K channels let K out (not in)
Influx of Mg2+ = not present
Influx of Na+ = entry of positive sodium ions does cause a depolarisation of the cardiac cell membrane

121
Q

In the electrocardiogram, depolarisation of the atria corresponds to the:

  1. P-wave = atrial depolarisation
  2. QRS complex = ventricular repolarization (+ atrial repolarization)
  3. T-wave = ventricular repolarisation
  4. U-wave = last bit of the ventricular repolarisation; interventricular septum OR the papillary muscle
  5. None of these
A

P-wave = atrial depolarisation

P-wave = atrial depolarisation
QRS complex = ventricular repolarization (+ atrial repolarization)
T-wave = ventricular repolarisation
U-wave = last bit of the ventricular repolarisation; interventricular septum OR the papillary muscle

122
Q

The second heart sound is heard when

  1. Blood enters the aortic = heart sounds are heard when valves shut
  2. The atria contract = heart sounds are heard when valves shut
  3. The atrioventricular valves close = first heart sound (S1 = LUB)
  4. The atrioventricular valves open = heart sounds are heard when valves shut
  5. The semilunar valves close = second heart sound (S2 = DUB)
A
  1. The semilunar valves close = second heart sound (S2 = DUB)

Blood enters the aortic = heart sounds are heard when valves shut
The atria contract = heart sounds are heard when valves shut
The atrioventricular valves close = first heart sound (S1 = LUB)
The atrioventricular valves open = heart sounds are heard when valves shut
The semilunar valves close = second heart sound (S2 = DUB)

123
Q

A heart rate in excess of 150 beats per minute is likely to:

  1. Decrease afterload and therefore decrease stroke volume
  2. Decrease contractility and therefore decrease stroke volume
  3. Decrease preload and therefore decrease stroke volume
  4. Increase afterload and therefore decrease stroke volume
  5. Increase preload and therefore decrease stroke volume
A
  1. Decrease preload and therefore decrease stroke volume = less time for cardiac filling; preload decreases; less stretch on the heart; smaller contractile strength; decreased stroke volume
124
Q

Activation of β1-adrenoceptors on cardiac myocytes will:

  1. Increase afterload and therefore decrease stroke volume
  2. Increase afterload and therefore increase stroke volume
  3. Increase contractility and therefore increase stroke volume
  4. Increase preload and therefore decrease stroke volume
  5. Increase preload and therefore increase stroke volume
A
  1. Increase contractility and therefore increase stroke volume = beta-1-adrenoceptors are present on the cardiac muscle cells so the sympathetic activation will produce a stronger strength of contraction for any given preload / afterload = ejects more blood so the stroke volume (ml/beat) is increased
125
Q

Which of the following is the most significant feature of the pulmonary circulation?

  1. Most pulmonary blood flow occurs during diastole
  2. Pulmonary arterioles constrict in response to local hypoxia
  3. Pulmonary arterioles express β1-adrenoreceptors
  4. The pulmonary circulation shows excellent pressure autoregulation
  5. The pulmonary circulation shows good active (metabolic) hyperaemia
A
  1. Pulmonary arterioles constrict in response to local hypoxia
126
Q

During exercise, venous pressure (and hence venous return to the heart) may be increased by:

  1. An increase in the systemic filling pressure
  2. Contraction of smooth muscle surrounding the veins
  3. Increased rate and depth of respiration
  4. Rhythmic contraction of skeletal muscle
  5. All of the above
A
  1. All of the above
127
Q

A 46-year-old woman is usually well but complains of intermittent rapid regular palpitations that are terminated by the valsalva manoeuvre. The most likely diagnosis is:

  1. Atrial fibrillation = irregular palpitations
  2. Supraventricular tachycardia = valsalva manoeuvre effects AV node, where the supraventricular tachycardias arise from
  3. Ventricular ectopics = irregular palpitations
  4. Ventricular fibrillation = leads to loss of cardiac output, collapse and death so since she is ‘usually well’
  5. Ventricular tachycardia = would be related to ventricles, valsalva manoeuvre affects AV node
A
  1. Supraventricular tachy
  2. Atrial fibrillation = irregular palpitations
  3. Ventricular ectopics = irregular palpitations
  4. Ventricular fibrillation = leads to loss of cardiac output, collapse and death so since she is ‘usually well’
  5. Ventricular tachycardia = would be related to ventricles, valsalva manoeuvre affects AV nodecardia
128
Q

A 65-year-old woman with a history of hypertension presents to the acute medical admissions unit with sudden onset of severe breathlessness, and paroxysmal nocturnal dyspnoea (PND). She is tachycardic with an elevated jugular venous pressure (JVP), crackles in both lung fields to the mid zones and significant peripheral oedema. Select the most appropriate drug treatment:

  1. Angiotensin converting enzyme inhibitor
  2. Angiotensin II blocker
  3. Beta blocker
  4. Intravenous diuretic
  5. Oral diuretic
A
  1. Intravenous diuretic
129
Q

A 65-year-old man with a blood pressure of 220/90 mmHg complains of breathlessness and fatigue. Select the single most informative investigation that could be used to determine the cause of his hypertension:

  1. Chest x-ray
  2. Echocardiography
  3. Renal arteriography
  4. Renal ultrasound
  5. Serum potassium
A
  1. Echocardiography
130
Q

A 40-year-old man presents with severe hypertension. You believe he may suffer from “white coat hypertension”. Select the single most informative investigation that could be used to confirm this:

  1. 24 hour ambulatory blood pressure recording
  2. 24 hour urinary catecholamines
  3. Echocardiography
  4. Renal arteriography
  5. Renal ultrasound
A
  1. 24 hour ambulatory blood pressure recording

need to confirm he suffers from genuine hypertension and not just ‘white coat hypertension’

131
Q

26-year-old lady in the first trimester of pregnancy presents with a deep vein thrombosis (DVT). Select the most appropriate treatment:

  1. Aspirin
  2. Clopidogrel
  3. Low molecular weight heparin
  4. Thrombolysis
  5. Warfarin
A
  1. Low molecular weight heparin - treatment of choice
132
Q

What is the congenital condition that is associated with coarctation of the aorta, short stature, neck webbing and gonadal dysgenesis?

  1. Down syndrome
  2. Noonan syndrome
  3. Shprintzen syndrome
  4. Turner syndrome
  5. Williams syndrome
A
  1. Turner syndrome - all features

Down syndrome = atrioventricular septal defects
Noonan syndrome = pulmonary stenosis & septal defects
Shprintzen syndrome = tetralogy of Fallot
Williams syndrome = supravalvular aortic stenosis

133
Q

A 70-year-old male, who routinely walks his dog, presents with pain in the back of his calves after walking 500 metres. What is the most likely cause?

  1. Arterial thromboembolism
  2. Deep venous thrombosis
  3. Distended leg veins
  4. Gangrene
  5. Intermittent claudication
A
  1. Intermittent claudication = ischaemic pain resulting from the exertion of the calf muscles; increased oxygen demand cannot be met due to atherosclerosis of the supplying arteries
134
Q

A newborn infant with a murmur is found to have an atrioventricular septal defect on echocardiography. The baby is hypotonic. The most likely diagnosis is:

  1. 22q11 microdeletion
  2. Down syndrome
  3. Fetal alcohol syndrome
  4. Multifactorial congenital heart disease
  5. Turner syndrome
A
  1. Down syndrome = heart atrioventricular septal defects + reduced tone

22q11 microdeletion = tetralogy of Fallot
Fetal alcohol syndrome = neurological / craniofacial defects; septal defects CAN be found
Multifactorial congenital heart disease
Turner syndrome = coarctation of the aortic

135
Q

A 70-year-old man presents with an ulcer of his left leg. His sleep is being interrupted by severe lower limb pain. The most likely cause of the ulcer is:

  1. Chronic venous insufficiency
  2. Critical limb ischaemia
  3. Diabetic neuropathy
  4. Postphlebitic syndrome
  5. Squamous carcinoma
A
  1. Critical limb ischaemia = elevation of the leg causes pain; sleep

Chronic venous insufficiency = venous ulcers tend not to cause severe pain
Diabetic neuropathy = diabetic ulcers tend not to cause severe pain
Postphlebitic syndrome = a secondary condition of deep venous thrombosis
Squamous carcinoma = usually painless

136
Q

A 68-year-old man presents with exertional angina. What is the most appropriate treatment to improve symptoms?

  1. Introduce angiotensin-converting-enzyme (ACE) inhibitor
  2. Start aspirin 75 mg/day
  3. Start beta blocker
  4. Start low dose warfarin
  5. Start simvastatin
A
  1. Start beta blocker

warfarin has no evidence of benefit

137
Q

The maximum volume of air that can be voluntarily exhaled following a maximum inspiration is called:

  1. Expiratory Reserve Volume volume of air that can be voluntarily forcibly exhaled after normal expiration
  2. Functional Residual Capacity volume left in lungs after normal expiration (ERV + RV)
  3. Residual Volume volume of air in lungs that cannot be voluntarily expired
  4. Tidal Volume volume of air breathed in or out at rest
  5. Vital Capacity
A

5 Vital Capacity (correct answer - 4600 ml; from max (5800 ml to 1200 ml [residual volume])

138
Q

The upper respiratory tract includes all EXCEPT which of the following?

  1. Larynx
  2. Lungs
  3. Mouth
  4. Nasal cavity
  5. Pharynx
A
  1. Lungs (correct answer; lower respiratory tract; underneath the vocal cords in the larynx)
139
Q

Air flows into the lungs during inspiration because:-

  1. The external intercostal and diaphragm muscles contract and thoracic volumedecreases
  2. The external intercostal and diaphragm muscles contract and thoracic volume increases (correct answer)
  3. The internal intercostal and abdominal muscles contract and thoracic volume decreases
  4. The internal intercostal and abdominal muscles contract and thoracic volumeincreases
  5. The internal intercostal and diaphragm muscles contract and thoracic volume increases
A
  1. The external intercostal and diaphragm muscles contract and thoracic volume increases (correct answer)
140
Q

Mr Tickle has a respiratory rate of 10 breaths per minute and a tidal volume of 800ml. If his residual volume measures 1000ml and his dead space volume measures 200ml what is Mr Tickle’s alveolar ventilation?

  1. 5800 ml/min
  2. 6000 ml/min
  3. 6200 ml/min
  4. 8000 ml/min
  5. 10,000 ml/min
A
  1. 6000 ml/min (correct answer) (tidal volume - dead space) x respiratory rate = alveolar ventilation (800 - 200 = 600 x 10
141
Q

In terms of lung compliance which of the following statements is correct?

  1. Compliance is a measurement of lung elasticity
  2. Compliance is decreased in the lung disease emphysema
  3. Compliance is greatest at the base of the lungs
  4. Compliance is increased with the lung disease fibrosis
  5. High compliance is always a sign of healthy lungs
A
  1. Compliance is decreased in the lung disease emphysema (it is increased due to loss of elastic fibres)
  2. Compliance is greatest at the base of the lungs (correct answer)
142
Q

The partial pressure of oxygen in mixed venous blood is typically around:

  1. 40 mmHg (5.3kPa)
  2. 46 mmHg (6.1kPa)
  3. 100 mmHg (13.3kPa)
  4. 160 mmHg (21.3kPa)
  5. 200 mmHg (26.7kPa)
A
  1. 40 mmHg (5.3kPa) (correct answer)
143
Q

Arterial partial pressure of oxygen will be reduced in which of the following conditions?

  1. Anaemia resulting from iron deficiency (haemoglobin)
  2. Anaemia resulting from vitamin B12 deficiency (haemoglobin)
  3. Blood loss during childbirth (haemoglobin)
  4. Carbon monoxide poisoning (haemoglobin)
  5. Pulmonary oedema
A
  1. Pulmonary oedema (correct answer) this is the only answer where oxygen concentration in solution (PaO2) will be reduced. The other conditions may result in significant decreases in total oxygen content (due to lack of oxygen binding to Hb or loss of Hb) but oxygen in solution in plasma will be unaffected.
144
Q

Which of the following statements is NOT true for individuals with chronic lung disease?

  1. Arterial PCO2 levels are elevated due to poor alveolar ventilation
  2. Nitrous oxide is a safe sedative to use
  3. They are said to be on hypoxic drive because chronic elevation of PCO2 has blunted central response to CO2
  4. They have decreased sensitivity to PCO2
  5. They rely on their peripheral chemoreceptors for stimulating ventilation
A
  1. Nitrous oxide is a safe sedative to use (correct answer) Nitrous oxide blunts the peripheral chemoreceptor response to falling oxygen, and as these patients are on “hypoxic drive” this effectively leaves them with no intrinsic means of controlling their ventilation.
145
Q

“Shunt” is a term that would be associated with which of the following situations:

  1. Bulk transport of oxygen via haemoglobin to peripheral tissues
  2. Movement of air through the conducting airways to the alveoli during inspiration
  3. Pulmonary embolism (blockage of the pulmonary vessels by coagulated blood)
  4. When perfusion exceeds ventilation in L/min
  5. When ventilation exceeds perfusion in L/min
A
  1. When perfusion exceeds ventilation in L/min (correct answer)
146
Q

Which of the following is most likely to shift the haemoglobin oxygen binding curve to the right?

  1. Hypothermia decrease in body temperature shifts curve to the left making it difficult to offload oxygen to peripheral tissues.
  2. Presence of foetal haemoglobin higher affinity for oxygen than adult haemoglobin so curve would shift to the left.
  3. Respiratory alkalosis decrease in [H+] pulls CO2 equilibrium to the right, reducing PCO2 so shifts haemoglobin binding curve to the left. 4. Running a marathon
  4. Voluntary hyperventilation decreases PCO2 so would shift curve to the left.
A
  1. Running a marathon (correct answer) increase in body temperature, CO2 and lactic acid production shifts curve to the right making oxygen extraction in peripheral tissues easier and therefore increases oxygen delivery.
147
Q

A 59-year-old man with known squamous carcinoma of the lung is admitted to hospital as an emergency with abdominal pain, constipation and confusion. The most appropriate investigation would be:

  1. Bronchoscopy Peripheral lesion can’t be accessed and tissue diagnosis known already
  2. Chest x-ray Known lung cancer and this would add nothing further
  3. Mediastinoscopy Cancer diagnosis known
  4. Sputum cytology cancer diagnosis known and would add nothing further
  5. Serum calcium
A
  1. Serum calcium (correct answer) Squamous cell lung cancer associated with hypercalcaemia due to parathyroid hormone related protein. Symptoms in this case classic for hypercalcaemia.
148
Q

A 79-year-old woman with a peripheral spiculated opacity on chest x-ray and an enlarged supraclavicular lymph node. The most appropriate investigation would be:

  1. Bronchoscopy Peripheral lesion may not be accessible
  2. CT thorax Ultimately a pathological diagnosis is needed
  3. Fine needle aspiration (FNA) lymph node (correct answer) A sample is needed for pathology to give a tissue diagnosis for cancer type. This offers an easily accessible option for this
  4. Lung function tests Would only be used for suspected airway obstruction
  5. Sputum cytology Unlikely to yield a diagnosis
A
  1. Fine needle aspiration (FNA) lymph node

A sample is needed for pathology to give a tissue diagnosis for cancer type. This offers an easily accessible option for this

149
Q

A 55-year-old business man complains of daytime somnolence. He normally sleeps 5 hours per night except on holiday when he will sleep 9 hours per night. His sleep study shows an Apnoea Hypopnoea Index (AHI) of 5 per hour. The most likely diagnosis is:

  1. Depression No other symptoms of depression
  2. Narcolepsy No features
  3. Obstructive sleep apnoea AHI is within normal range
  4. Poor sleep hygiene
  5. Respiratory muscle weakness
A
  1. Poor sleep hygiene (correct answer)

Change in sleep pattern indicates a behavioral aspect to his lack of sleep

150
Q

A 35-year-old man has cystic fibrosis. The most likely organism infecting his lungs is:

  1. Chlamydia psittaci
  2. Haemophilus influenzae
  3. Legionella pneumoniae
  4. Mycobacterium tuberculosis
  5. Pseudomonas aeruginosa
A
  1. Pseudomonas aeruginosa
151
Q

A 50-year-old man has lobar pneumonia. The most likely organism to be involved is:

  1. Chlamydia psittaci
  2. Haemophilus influenzae
  3. Legionella pneumoniae
  4. Pseudomonas aeruginosa
  5. Streptococcus pneumoniae
A
  1. Streptococcus pneumoniae
152
Q

A 38-year-old with exacerbation of asthma is too tired to do a peak flow. Normal values: pH 7.37 – 7.43, PaO2 11 – 15 kPa, PaCO2 4.6 – 6.4 kPa. His blood gas results are most likely to be:

  1. pH 6.91, PaO2 16.7 kPa, PaCO2 2.9 kPa, on air
  2. pH 7.5, PaO2 6.6 kPa, PaCO2 11.2 kPa, on air
  3. pH 7.15, PaO2 29.6 kPa, PaCO2 10.6 kPa, on air
  4. pH 7.22, PaO2 7.8 kPa, PaCO2 8.6 kPa, on air
  5. pH 7.41, PaO2 11.5 kPa, PaCO2 4.6 kPa, on air
A
  1. pH 7.22, PaO2 7.8 kPa, PaCO2 8.6 kPa, on air

Exhaustion and decreased ventilation leads to hypercapnia, hypoxia and acidosis

153
Q

The British Thoracic Guidelines for the treatment of chronic asthma recommend that a patient with newly diagnosed asthma who is waking up at night because of asthma should be commenced on:

  1. Inhaled beta-2 agonist and leukotriene receptor antagonist
  2. Inhaled beta-2-agonist
  3. Inhaled corticosteroids and inhaled beta-2-agonist
  4. Inhaled leukotriene antagonist
  5. Inhaled sodium cromoglycate
A
  1. Inhaled corticosteroids and inhaled beta-2-agonist (correct answer)

nighttime symptoms indicates need for inhaled corticosteroid

154
Q

A 19-year-old previously healthy woman experiences sudden onset of severe right sided chest pain whilst walking upstairs. The pain is associated with breathlessness. Both symptoms are still prominent when she presents to the Accident and Emergency Department one hour later. The most likely diagnosis is:

  1. Acute interstitial pneumonitis (Haman-Rich syndrome) Not so sudden onset
  2. Aspiration pneumonia
  3. Bronchiectasis
  4. Primary pneumothorax
  5. Pulmonary sequestration
A

Primary pneumothorax (correct answer) Should always be considered in sudden onset pain with shortness of breath in previously healthy person

155
Q

A 32-year-old man is recovering from a bad attack of pneumonia for which he has been off work for several weeks. He goes on to develop rigors, a persistently poor appetite and increasing shortness of breath on exertion. After a week of oral antibiotic treatment his GP refers him to the local respiratory medicine unit for admission. The most likely diagnosis is:

  1. Acute interstitial pneumonitis (Haman-Rich syndrome)
  2. Aspiration pneumonia
  3. Empyema thoracis
  4. Giant pulmonary bulla
  5. Tuberculosis
A
  1. Empyema thoracis (correct answer)
156
Q

A 30-year-old woman is admitted to the emergency department with an acute exacerbation of her chronic asthma. Her PaO2 was 7.8 kPa (normal 11- 15 kPa) and her PaCO2 was 8.6 kPa (normal 4.6 – 6.4 kPa) on air. Her arterial gas on admission confirmed type 2 respiratory failure requiring admission to the intensive care unit for possible ventilation.What would be the most appropriate immediate treatment?

  1. Inhaled beta-2 agonist Needs more aggressive treatment than normal inhaler as she is hypoxic and hypercapnic
  2. Inhaled corticosteroids
  3. Leukotriene receptor antagonist
  4. Nebulised beta-2 agonist
  5. Oral beta-2 agonist
A
  1. Nebulised beta-2 agonist (correct answer)
157
Q

The lungs are dissimilar in their gross anatomical features. The left is characterised by:

  1. A cardiac notch in its posterior border
  2. An absence of visceral pleura within its fissures
  3. An eparterial bronchus in its hilum
  4. Oblique and transverse fissures
  5. Upper and lower lobes separated by the oblique fissure
A
  1. Upper and lower lobes separated by the oblique fissure (correct answer); The only fissure present in the left lung – the oblique fissure – divides the left lung into 2 lobes: superior (upper) and inferior (lower), hence correct answer.
158
Q

The articulation of the rib with the vertebrae allows for respiratory movements. At the costovertebral joints the head of the 9th rib articulates with the body of vertebra/e:

  1. T8
  2. T8 and T9
  3. T9
  4. T9 and T10
  5. T10
A
  1. T8 and T9 (correct answer) —> N = (N & N-1The head of a typical rib (ribs 3-9), in this case rib 9, articulates with the body of the vertebra of the same number as itself as well as with the vertebra immediately preceding it at the costovertebral joints, hence with the bodies of vertebrae T8 and T9. Hence B is the correct answer. (The tubercle of rib 9 articulates with the transverse process of vertebra T9 only – this would be known as the costotransverse joint).) therefore 9 = (9 & 9-1)

second year exams (5 decks)

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