Clinical Science Flashcards
1
Q
Which Interleukin in sepsis ?
A
IL 1 ( Cowboy with Interlocked guns, escaping the cage)
IL1–hypotension and vasodilation.
2
Q
IL 1 is seen in ?
A
Sepsis and inflammation—Triggering hypotension and vasodilation
3
Q
Patient in sepsis. Now hypotension. Why hypotension ?
A
Due to IL1–Hypotension and vasodilation
4
Q
Fabry’s disease is due to deficiency of ?
A
Alpha Galactosidase deficiency
5
Q
IL-1 is released by which cell ?
A
Macrophage. ( Cowboy with Interlocked guns, escaping the cage—Macrophage)
6
Q
Which receptor is involved in the pathophysiology of myasthenia gravis?
A
Nicotinic acetylcholine receptors
7
Q
Congenital Toxoplasmosis clinical features :
A
Hydrocephalus( Mother washing baby’s head with water) + Cerebral Calcification ( Milk got spilled on baby’s Head ) + Chorioretinits( Baby is rubbing his eyes, as milk got spilled into his eyes )
8
Q
Chorioretinits is seen in :
A
Congential toxoplasmosis
9
Q
natural reservoir of toxoplasmosis
A
Cat feces ( cat pooped on the groom’s tuxedo—toxoplasmosis )
10
Q
IL-8 - main functions include
A
Neutrophil Chemotaxis
( guard throwing Net(neutrophil) on escaping guard to recruit him back to jail( chemotaxis)
11
Q
Which one of the following immunoglobulins are present in the lowest concentration in blood?
A
IgE—Plasma eels are the rarest types of eels
12
Q
Young+ u/l Visual Loss + Prepapillary telangeictasia + Mother and grandmother affected.
Dx and Mode of inheritance :
A
Leber’s Optic Neuropathy
Inheritance : Mitochondrial
13
Q
Eculizumab inhibits what ? And predisposes to which infection ?
A
Inhibits terminal complement activation (C5-C9)
C5-C9 deficiency predisposes to Neisseria meningitidis infections
14
Q
Which collagen is defected in Good pasture ?
A
Collagen defect 4
Door(4) which has sickle
15
Q
Which complement deficiency leads to SLE ?
A
C4
16
Q
Androgen insensitivity syndrome Mode of inheritance ?
A
X linked Recessive
17
Q
X linked recessive diseases:
A
Lady Harding Girls don’t care about Foolish wrods
Lesch Nyhan
Haemophilias
G6PD
Duchene Muscular Dystrophy
Colour Blindness
Agammaglobulinaemia
Androgen insensitivity Syndrome
18
Q
Trimethoprim in breastfeeding ?
A
Considered safe
19
Q
Main function of p53 :
A
Encodes protein which regulate cell cycle
20
Q
Nitric oxide : ___ platelet aggregation
A
Inhibits platelet aggregation
vasodilation would dilate the blood vessel, allowing platelets to be spaced further apart and reducing the aggregation between them
21
Q
Amiodarone in pregnancy ?
A
Not Safe
22
Q
Asthma and epilepsy drugs in pregnancy ?
A
Safe
23
Q
Which one of the following types of immunoglobulins are responsible for haemolytic blood transfusion reactions?
A
IgM
24
Q
the receptor for the Ebstein-Barr virus?
A
CD 21
25
The general surgery department is trying to establish a best practice prophylactic antibiotic policy with regard to surgical site infections. To do so, they design a study, which examines whether a group of similarly matched patients (Group A) given antibiotic A develop a higher rate of post-operative surgical site infections when compared to a group (Group B) given antibiotic B. The proportion of patients in groups A and B developing surgical site infections are recorded.
What is the best test to determine if there is a statistically significant difference between the two groups?
Chi-squared test - used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions
26
ARDS patient— As a rescue therapy, the medical team decided to administer inhaled nitric oxide to improve his oxygenation.
What is the mechanism by which this medication improves oxygenation?
Pulmonary Vasodilation via increased Cyclic GMP
27
IgD is involved in:
The activation of B cells
28
Interferon Gamma is produced by :
Natural killer cells or T helper cells
Natural killer cells or T helper cells—Interferon Gamma—activated Macrophages —Produces IL 1 and IL8
29
Troponin C binds to
Calcium Ions
30
LBBB occurs due to damage of the left bundle branch and associated___
Purkinje Fibres
31
A prolonged QRS (>120ms) with a dominant S wave in V1 is suggestive
LBBB
32
A cardiology doctor undertakes a study to assess the impact of a piece of AI software which analyses ECGs in patients who present to the emergency department with chest pain. The AI software gives a score out of 5 for the probability that ECG changes are due to myocardial ischaemia. This data has non-normal distribution.
The cardiologist wants to analyse the data to see if there is a correlation between the patient's pain scores and the AI scores for ischaemia.
What test of significance is most appropriate for analysing this specific aspect of the study?
Co relation of non parametric data:
Spearman’s
33
Peroxisomes are responsible for:
the catabolism of long chain fatty acids
34
DNA Maintainance
RNA Transcription
RNA Splicing
It takes place in Nuclues
35
Dermatitis herpitiformis is ass with which condition and its HLA ?
Coeliac’s disease
Dermatitis Herpetiformis is associated with HLA DR3
36
IgE is produced by ?
Plasma cells
( Mutant Plasma Eels—Eels: IgE
37
Anaphylactic reaction in patient , which cells are implicated ?
Anaphylaxis—Caused by IgE cells—
IgE is produced by Plasma cells
38
Which test are used to detect mutated oncogenes?
Polymerase Chain reaction
39
The occurrence of breast and ovarian cancer in multiple members of a family under the age of 45-years-old. Given the likely cause, what is the likely test that will be performed on the blood sample?
The occurrence of breast and ovarian cancer in multiple members of a family under the age of 45-years-old—BRCA 1 Mutation which is a mutated oncogene.
Test to detect mutated oncogene—Polymerase chain reaction
40
Behcets HLA and Chromosome ?
HLA—HLA B51 on chromosome 6
Behcet—5ehcet—Area 51, Behcet—6 letter—chromosome 6
41
parasitic helminth Infection, which cells are involved ?
Plasma cells
42
Which virus is associated with oropharyngeal cancer ?
HPV 16/18
43
HPV 16/18 association :
Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyngeal cancer
44
chromosomal abnormalities is detected by :
FISH
Fluorescence in situ hybridization
45
Angular chelitis is caused by which deficiency ?
Vitamin B2 ( Riboflavin—Rib flavoured sauce—Man with bee shoes ( B 2 ) eating food with rib flavoured sauce which has spilled on his mouth—Angular Chelitis )
46
Odds ratio formula :
Affeted / unaffected
47
Hereditary spherocytosis is transmitted via :
Autosomal Dominant manner
48
Noonan Syndrome is :
Autsomal Dominant
49
Which skin layer contains Melanocytes ?
Stratum Basale/ germinativum
Come lets get sun burned
Corneum
Lucidum
Granulosum
Spinosum
Basale
50
Which one of the following is the most common genetic cause of Prader-Willi syndrome?
Deletion of chromosome 15
Prader-Willi - paternal
51
leptin is produced by :
Adipose tissue
52
Higher level of leptin does what ?
Higher level decreases Appetite
53
Obese patients have higher or lower level of Leptin ?
Obese patients have higher level of leptin
More adipose tissue —more leptin
54
Where does leptin act ?
Acts on satiety centre—higher level of leptin decreases appetite
55
Which cells mediate hyperacute organ rejection?
B cells
56
Nicotinic acetylcholine receptor ?
ligand-gated ion channel receptor
57
Two groups of patients with gastro-oesophageal reflux disease are randomly allocated to receive treatment with peppermint oil or omeprazole for a four week period.
At the end of the four week trial period, each participant is asked to rate the effectiveness of their specific treatment on relieving their symptoms. The rating scale is from 1-5, where 1 indicates 'very ineffective' and 5 indicates 'very effective'.
Given the data is not normally distributed, what statistical test should be used to determine if there is a statistically significant difference between the two treatments?
Man Whitney U test
58
His mother developed a flu-like illness during a pregnancy that was otherwise unremarkable.
Examination reveals sensorineural hearing loss and chorioretinitis.
A CT head is organized, which demonstrates scattered cerebral calcification bilaterally and hydrocephalus.
Congenital Toxoplasmosis
58
The P-value for the study is computed (0.02). What is the probability of obtaining a result by chance at least as extreme as the one actually observed, assuming the null hypothesis was true?
0.02=2%
59
P value definition :
P value - is the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true
60
Oropharyngeal cancer is caused by which HPV ?
HPV 16
61
The patient has just gone to sleep and is easily rousable. You wonder if these were hypnagogic jerks.
Which stage of sleep ?
NREM Stage 1
62
A 42-year-old male patient presents to the GP surgery with a 6-months history of progressive weakness of both lower limbs. He complains of difficulty climbing stairs, lethargy and muscle loss in the lower limbs. He had a history of type 2 diabetes mellitus and admits to heavy alcohol use for the last 4 years. On examination, there is a marked loss of fine touch and proprioception in a stocking distribution bilaterally. There is no evidence of ataxia.
Dry beri beri—due to thiamine deficiency
This patient has a rapidly progressive polyneuropathy. Given the alcohol history, the most likely diagnosis from the options is dry beriberi, caused by thiamine deficiency.
63
Which cel organelle is involved in degradation of various intracellular proteins tagged with extensive ubiquitination?
Proteasome
64
Which supplementation can aid iron absorption from the gut by conversion of Fe3+ to Fe2+
Vitamin C—Ascorbic acid supplementation
65
What happens to pulmonary artery in hypoxia ?
Pulmonary artery vasoconstriction
In contrast to the systemic circulation, pulmonary arteries constrict in response to hypoxia, diverting blood away from poorly oxygenated lung regions.
66
The Cushing reflex is:
Hypertension + Bradcardia + Wide Pulse pressure
67
Fredrick’s ataxia Mode of inheritance :
Autosomal Recessive
68
T helper cells subset 2= TH2 subset produces :
IL4
TH1 = IL2, IL3
69
Which chromosomal disorder is most associated with Crohn’s ?
Turner’s syndrome
70
Myc is a tumour suppressor gene ?
No
Myc is a oncogene
71
Superiority trials require big or small sample size ?
Superiority trials require big sample size
72
Is duodenum retro peritoneal ?
Yes
73
During which of the following stages of mitosis does chromatin condense to form chromosomes?
Pro metaphase / Prophase
74
Which one of the following is the most important stimulator of the central chemoreceptors?
Fall in PH
75
Haldane effect :
Increase in Po2 means, co2 will bind less to Haemoglobin
76
Is recurrent stones a feature of homocytinuria ?
No
77
ocular features of homocytinuria :
Lens subluxation down
Myopia
78
DVT in Homocystinuria :
Yes
79
deficiency in homocystinuria ?
Cystathionine Beta Synthetase
80
RX in Homocytinuria ?
Pyridoxine
81
learning disability in Homocytinuria ?
yes
82
What does B blocker do to Renin ?
B blockers decreases secretion of renin
Beta-blockers work by blocking the effects of the hormone adrenaline, also known as epinephrine. They do this by binding to beta receptors on cells in the heart and blood vessels, which are the sites where adrenaline acts. This prevents adrenaline from causing an increase in heart rate, blood pressure, and renin secretion. Therefore, beta-blockers reduce the secretion of renin.
83
Which gene is affected in Achondroplasia ?
Fibroblast Growth Factor Receptor 3
(FGFR-3)
3 Fig trees—FGFR 3
84
Homogentisic acid is raised in which condition ?
Alkaptonuria ( Owl Captain)
Homogentisic Acid—Home Made Joint
Owl captain is making Home made joint
85
prior knee replacement + Joint pain + Bluish discolouration in Sclera, Skin and ears. Dx?
Alkaptonuria
86
Likelihood ratio for a positive test result:
sensitivity / (1 - specificity)
87
Left Ventricular Ejection Fraction :
(stroke volume / end diastolic LV volume ) * 100%
Stroke volume—End diastolic - End systolic
88
Which CA— in ovarian cancer ?
CA 125
89
Which phase phase determines cell cycle length?
G1 phase
90
p53 Functions :
plays a crucial role in the cell cycle, preventing entry into the S phase until DNA has been checked and repaired
91
Fabry’s Disease mode of inheritance ?
X linked recessive
92
Men with BRCA mutations have an increased risk of :
Breast
Prostrate cancer
Pancreas cancer
( Bp2)
93
B waves is seen in which sleep cycle stage ?
REM
BREM Stage.
94
Hoskins lymphoma is associated with which CD ?
CD 15
95
Vincristine acts on which stage of cell cycle ?
Metaphase stage
96
Micro tubule function :
Microtubules help guide movement during intracellular transport and also help bind internal organelles
97
Mitochondrial diseases are transmitted only via ?
They are transmitted only Via Mothers
98
Young + stroke + seizures + High lactic acidosis
MELAS
Mitochondiral disease , transmitted only via mothers
99
Alzheimer’s is associated with which chromosomal abnormalities ?
Associated with Down’s
100
Insulin binds to which receptors ?
Tyrosine kinase receptors
Tyres outside insulated chocolate factory
101
Most common renal stones :
Calcium Oxalate
102
Troponin T binds to
Tropomyosin
103
Tuberous sclerosis Mode of inheritance :
Autosomal Dominant
104
Congenital Adrenal Hyperplasia Mode of inheritance :
Autosomal Recessive
105
Nitric oxide , second messenger
Cyclic GMP
106
Western blot is used for :
Protein
SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)
107
Good pasture HLA ?
HLA DR2
108
A study is performed comparing two chemotherapy regimes for patients with small cell lung cancer. The end point of the study is survival time. Which one of the following types statistical measures is it most appropriate to compare survival time with?
Hazard ratio
109
Which obesity hormone increases hunger ?
Ghrelin
110
Which ear problem occurs in Rubella ?
SNHL
111
Atrial natriuretic peptide function :
Powerful vasodilator
112
Learning disabilities in Homocystinuria ?
Yes
113
Atrial natriuretic factor In an example of which receptor ?
Granylate cyclase receptor
114
Epinephrine/Adrenergic receptor is :
G coupled receptor
115
Down’s syndrome chances at age 30 :
1 in 1,000.
116
Down’s chances at age 45:
1 in 50
117
ITP is which type of reaction ?
Type 2 reaction
Sensor shoe (2) kicking the red ball so hard that it blasted off ( ITP)
118
Z.Glomerulosa produces :
Aldosterone.
GFR: ACD
Z.Glomerulosa—Aldosterone
Z.Fasisculata—Cortisol
Z. Reticularis—DHEA
119
Peripheral neuropathy is caused by which TB drugs ?
Isoniazid
120
The fastest conduction velocities in the heart are in the :
Purkinjee Fibres
121
Dual action of nitric oxide:
Vasodilate and inhibition of platelet aggregation
122
Phosphate is absorbed in which tubule ?
Absorbed in Proximal Tubule
123
Liposarcoma + Breast cancer, Dx?
Li Fraumeni Syndrome
124
Which part of the renal tubule is impermeable to water?
Thin Ascending loop of Henle
125
Immune cells bind to which part of antibody ?
Fc region
Cells—C—Fc region
126
Antigen binds to which part of the antibody ?
FAB region
127
During cell division, at what stage do sister chromatids move to opposite ends of the cell?
Anaphase
128
Prolactinoma Rx:
Cabergoline
129
Diabetic nephropathy histological findings:
Kimmelstiel-Wilson lesions, nodular glomerulosclerosis
130
Proteus infection related stone :
Struvite stones ( Ammonium Magnesium Phosphate )
131
Cardiac abnormalities of DiGeorge syndrome:
Truncus arteriosus and tetralogy of fallout
132
Left eye horizontal Diplopia , which Cranial Nerve is involved?
Left Cranial Nerve 6 is involved
Left Abducens nerve is involved—causing horizontal diplopia in left eye
133
cerebral oedema with brain tumours Rx?
Dexamethasone
134
Which HLA in Sjogren ?
HLA DR 3
Sjogr3n
135
Which HLA in Rheumatoid Arthritis ?
HLA DRB 1 and HLA DR 4
There is only one (HLA DRB 1) disease with a room( 4 walls—HLA DR 4 )
136
What leads to formation of granulomas ?
Natural killer cells/T cells—Interferron gamma—Macrophage—forms granuloma
137
Which clotting factors are involved in Vitamin K ? `
1972
10,9, 7, 2
138
Seizures + developmental delay + cherry red spot on macula + No Organomegaly :
Tay Sachs disease
139
Noonan Syndrome Karyotype ?
Normal
140
Mode of inheritance in Vitamin d resistant rickets:
Autosomal Dominant
141
Diagnosis of Vitamin D resistant rickets :
Increased urinary excretion of phosphate
142
X ray of vitamin D resistant rickets :
Cupped metaphysis
143
Rx of vitamin D resistant rickets :
High dose vitamin D supplements and oral phosphate supplements
144
calcium and phosphate levels in vitamin D resistant rickets :
Normal serum calcium + low phosphate + Elevated ALP
145
Adrenaline is released by :
Adrenal Medulla
146
Which one of the following cell organelles contains double-stranded circular DNA?
Mitochondria
147
Which foramen does the maxillary nerve go through?
Foramen Rotundrum
148
Ulnar nerve causes weakness of which eminence ?
Hypothenar eminence
149
genotype:phenotype correlation In mitochondrial condition ?
Poor.
This statement is true because mitochondrial diseases often exhibit poor genotype-phenotype correlation, meaning that the same genetic defect can result in a wide range of clinical manifestations.
150
Leiner disease is caused by which Complement deficiency ?
c5 deficiency
Li5 disease—Leiner disease
151
Where is the majority of iron found in the body?
Haemoglobin
152
What inhibits the release of endothelin ?
Nitric oxide
Prostacyclin
153
Interferon alpha is used in Rx of :
Hepatitis B
Hepatitis C
Kaposi Sarcoma
Metastatic renal cell carcinoma
154
Interfron Alpha does not treat :
Chronic Granulomatous disease
155
Testis size in fragile X ?
Large testis
Long ball shaped ear of donkey
156
Fragile X syndrome features ?
Long Facies + Large testis + Long elevated ears + Developmental delay
157
Which of the following findings would exclude giant cell arteritis?
Normal plasma viscosity
Viscosity, ESR and CRP are almost invariably raised in patients with active giant cell arteritis
158
Vitamin k MOA :
Vitamin K acts as a cofactor in the carboxylation of clotting factors (II, VII, IX, X)
159
Opthalmoplegia + ptosis + retinitis pigmentosa
Kearn Sayres Syndrome
Mitochondrial disease—only transmitted via mothers
160
How does Vitamin D increases serum calcium?
By primarily increasing its absorption from the small intestine
161
What is the relationship between standard deviation and variance?
Variance= square of SD
162
what cytokine plays a key role in the pathophysiology of still’s disease ?
macrophage activation syndrome
Interferon gamma activates Macrophages
163
The patient has had a significant upper gastrointestinal bleed as suggested by the clinical history, anaemia, and disproportionately raised urea. Which blood value will be increased ?
Reticulocytes will be increased.
In a bleeding patient with anaemia and a functioning bone marrow, then we would expect a compensatory reticulocytosis response.
164
Lung compliance in fibrosis ?
Decreased
165
Vivid dreams and kicking in which sleep cycle stage ?
REM Stage
166
bleeding gums + perifollicular petechial rash + spherocytes in blood film
Ascorbic acid deficiency—scurvy
167
Golgi apparatus function :
Adds mannose 6 phosphate to proteins — for trafficking to lysosome
Old manny ( Mannose) in his apartment with a stick (6) , has trafficked Columbian woman and sending them to LA ( Lysosome )
168
HLA in Psoriatic arthritis :
HLA B27
169
Surfactant is produced by :
Type 2 pneumocytes
170
Anti diuretic hormone site of action :
Collecting duct
171
Burkitt’s Lymphoma oncogene ?
C-Myc
172
RNA splicing takes place in :
Nucleus
173
Endothelin causes :
Pulmonary constriction
174
Persistent hoarseness , not relieved by any factor. Suspected diagnosis and cause ?
Oropharyngeal cancer
Due to HPV 16/18
175
Glucose is absorbed in which tubule ?
Proximal Convoluted Tubule
176
Adrenaline acts on which receptor ?
Adrenaline acts on G receptors
If you can administer Adrenaline in emergency, you are a top G
177
Troponin 1 binds to :
Actin
178
A 45-year-old man attends your clinic. He is concerned as his father has just been diagnosed with Huntington's disease. He is aware that this is a genetic condition and wants to be tested. He also wants more information about the likely course of the condition. You explain that, if he tests positive, he will likely develop symptoms earlier than his father did.
What aspect of the condition gives rise to this phenomenon?
Anticipation
Anticipation in trinucleotide repeat disorders = earlier onset in successive generations
179
A decision is made to start empagliflozin, due to its cardioprotective value in patients with heart failure with reduced ejection fraction.
What is the primary site of action for this new medication?
-Flozins are SGLT2 inhibitors
Sodium-Glucose co transport protein inhibitors.
Sodium-glucose cotransporter (SGLT2) proteins are responsible for the resorption of approximately 90% of filtered glucose.
Most of the glucose is re absord in proximal convoluted tubule.
So flozins , site of action is PXT
180
HLA DR2 is associated with :
Narcolepsy
181
Narcolepsy HLA ?
HLA DR2
182
Ph in Vomitting ?
Metabolic alkalosis
183
Scabies which Hypersensity ?
Type 4 Hypersensitivity reaction
184
the null hypothesis is accepted when it is false. Which error is this ?
type 2 error
185
Type 2 error is :
the null hypothesis is accepted when it is false
1-reject the truth
2-Accept the false
186
Shoulder abduction by :
Axillary nerve—which supplies deltoid muscle
187
Funnel Plots shows :
show publication bias in meta-analyses
188
Usual outcome of case control study is :
Odds ratio
189
Usual outcome of Cohort study is :
Relative risk
190
Protein is detected by :
Western Blotting
191
the commonest cause of Down's syndrome:
Maternal Nondisjunction
192
Rapid Depolarisation is caused by ?
D-NA:
Rapid Depolarisation is caused by Rapid sodium influx
193
Eye signs in downs :
Epicanthal Folds + Brushfield spots( white spots in iris )
194
HIV uses which CD ?
CD 4
195
Which of the following is an oncogene for neuroblastoma?
N-Myc
196
Which dermatome in thumb and index fingers?
C6
Make a 6 with your left hand by touching the tip of the thumb & index finger together - C6
C7-middle finger
C8-Ring and little finger
197
which dermatome in middle finger ?
C7
198
Which dermatome in ring and little finger ?
C8
199
HLA antigens are encoded in which chromosome ?
Chromosome 6
200
Bosentan is :
Endothelin Antagonist
201
How does ADH promote water reabsorption ?
Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels
202
What shows glomerular origin of hematuria?
Dysmorphic red blood cells if found in urine sediment indicates a glomerular origin of hematuria
But, sometimes, when something is wrong with the filters in your kidneys (like if they get hurt or sick), red blood cells can sneak out into your pee. When they do, sometimes they don’t look like normal round red blood cells anymore. Instead, they get squished or bent in funny shapes—these are called dysmorphic red blood cells
203
H/o Metabolic disorders in family + Child—Massive Hepato Splenomegaly. Dx?
Gaucher’s Disease
204
Which causes metabolic alkalosis , Barter or Fanconi ?
Barter’s disease
205
Barter occurs in which age group ?
Neonates
206
Most common cardiovascular abnormalities in Turners :
Coarctation of aorta
207
Elevated LH and FSH and Low estrogen:
Turner
208
Horomone level in Turner :
Elevated LH, FSH and Low estrogen
209
short stature, primary amenorrhoea, delayed puberty, webbed neck,
Turner
210
211
Brushfield Spots are seen in :
Downs
212
All the hormones in Down’s syndrome :
Elevated Inhibin A ( No entry sign above on the shelf )
Elevated BHCG( Churizo above on shelf )
Low level of PAP A ( puppy at the bottom of shelf trying for churizo )
Low level of Estradiol ( stroller at the bottom of shelf )
Low level of Alpha feto protein.
213
Intelligence level in turner :
Normal
214
Most likely kidney issue in turner :
Horse hoe kidney
215
Gastroenteritis— Now : Urinalysis and microscopy reveals muddy brown granular casts.+ Raised urea and creatinine + failure to respond to fluids
Acute Tubular Necrosis
This patient has experienced a prolonged period of dehydration and pre-renal acute kidney injury (AKI) secondary to bacterial gastroenteritis. Hypovolaemia reduces glomerular perfusion and filtration rates, which over time causes renal cell hypoxia and necrosis of the renal tubular epithelium. This is the mechanism of renal injury in this case, but acute tubular necrosis (ATN) can arise from other means e.g. sepsis or nephrotoxic agents.
On going Pre renal AKI : failure to respond to fluids hypovolaemia is no longer the direct cause of renal injury, and that the dysfunction is now intrinsic to the renal parenchyma itself.
Glomerulonephritis : it is typically associated with proteinuria, haematuria or both, neither of which are displayed here.
Acute interstitial Nephritis : he classic triad of rash, fever and eosinophilia are all not present.
216
Desmopressin site of action :
Desmopressin-Synthetic ADH—Site of action : collecting ducts
217
Vitamin D on Phosphate levels :
Increases plasma phophate level
218
Which blood disorder is associated with turners?
Haemophilia
219
Leukotriens causes :
Bronchoconstriction
220
Which food contain best source of folic acid ?
Liver
221
Which one of the following is equivalent to the pre-test probability?
Prevalence of a condition.
The pre-test probability represents the probability of a patient having a condition before any diagnostic test is performed, and this is fundamentally the same as the prevalence of that condition in the relevant population. This relationship forms the basis of Bayesian analysis in clinical diagnosis.
222
Which one of the following occurs during reverse transcriptase polymerase chain reaction?
RNA is converted to DNA
223
What is the main advantage of non-inferiority trials when testing a new drug?
Small sample size is required
224
Failure to abduct shoulders. Which C is involved ?
C5
225
C6 function :
supplies thumb and index finger ( make 6 with thumb and index)
Biceps reflex—Elbow flexion and wrist extension
226
C7 function :
triceps reflex—elbow extension and wrist flexion
227
In older adults, the main factor that accounts for a large pulse pressure is
Reduced Aortic Compliance
228
Recurrent infection is caused by which complement deficiecny ?
C3
229
A young boy is diagnosed as having DiGeorge syndrome. Which one of the following infections is he most at risk from, secondary to his immune system dysfunction?
Crypto coccus
230
There is however some sensory loss over the middle finger and palm of the hand. Which nerve root is most likely to be affected by the impingement?
C7
231
Which phase of clinical trials see efficacy of the drug ?
2B
232
What is require to carry out PCR ?
Thermostable DNA Polymerase such as : TAQ polymerase
233
Bohr Effect :
Increase in Acidity (Pc02) , Means oxygen binds less well to Haemoglobin
234
Most common cardiac abnormality seen in Downs ?
Endocardial cushion defect
235
Which of the following is responsible for the early repolarisation phase of the myocardial action potential?
Efflux of potassium
Repolarisation always occurs due to efflux of potassium
236
Atrial natriuretic peptide is secreted by :
Right atrium
237
Heart condition in William syndrome :
Supra valvular aortic stenosis
238
Cognitive delay + very friendly and social + elfin like facies—Wide vermilion border + small spaced teeth + Flat Nasal Bridge. + Supravalvular aortic stenosis.
William syndrome
239
William syndrome
Cognitive delay + very friendly and social + elfin like facies—Wide vermilion border + small spaced teeth + Flat Nasal Bridge. + Supravalvular aortic stenosis.
240
Lead-time bias:
occurs when two tests for a disease are compared, the new test diagnoses the disease earlier, but there is no effect on the outcome of the disease
241
occurs when two tests for a disease are compared, the new test diagnoses the disease earlier, but there is no effect on the outcome of the disease
Lead-time bias:
242
Power :
the probability of (correctly) rejecting the null hypothesis when it is false
243
Pathophysiology of cholesterol formation :
Smooth muscle proliferation and migration from the tunica media into the intima is the last step in the formation of an atheroma
244
Tall, long fingered, downward lens dislocation, learning difficulties, DVT:
Homocytinuria
245
Lens dislocation in homocystinuria ?
Downward
246
Which cell disorder in Digeorge ?
T cell
247
He has plotted the studies on an axis with the treatment effect (odds ratio of in-hospital mortality due to COVID-19) on the horizontal axis and the standard error of the effect estimate on the vertical axis. What type of plot is this ?
Funnel Plot
A funnel plot is a meta-analytic plot with effect size (e.g. odds ratio) on the horizontal axis and a measure of the studies' standard error on the vertical axis (which is linked to study size). A symmetrical funnel plot suggests a lack of publication bias. An asymmetric funnel plot may be due to effects including publication bias or study heterogeneity.
248
Statistical analysis using Fisher's exact test results in a P value of 0.01.
How should this finding be interpreted?
0.01 is the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true
249
HLA for Rheumatoid Arthritis :
HLA DR4
250
Symmetrical Arthorpathy + she has synovitis of the 2nd and 3rd metacarpophalangeal joints
MTP joints + Symmetrical arthropathy—Rheumatoid arthritis
251
Does the risk remain the same for each successive pregnancy in autosomal dominant inheritance ?
Yes
252
A 28-year-old female with a history of primary amenorrhoea and short stature is reviewed in clinic. On examination blood pressure in her right arm is 175/84 mmHg and 170/82 mmHg in her left. What is the most likely cause for her elevated blood pressure?
Coarctation of aorta in Turner’s syndrome
253
Where does growth hormone act directly and indirectly ?
Growth hormone acts directly on—Chondrocytes and Osteoblasts
Growth Hormone acts indirectly on—Insulin like growth factor
254
Which Type of hormone is growth hormone ?
Anabolic
255
Growth Hormone is secreted by :
Somatrotroph cells
256
Growth hormone acts on which receptor ?
acts on trasnmembrane receptor
257
Damage to radial nerve leads to :
Rist drop— Wrist drop
258
Co receptor for MHC Class 1 :
CD 8
Mowhawk killer ( MCH class 1 ) —breaking the gate(8) which has code (CD) with a weapon( interferon gamma weapon )
259
A 15-year-old girl presents with an urticarial rash, angioedema and wheezing. Her mother states that she has just come from her younger sister's party where she had been helping to blow up balloons. What is the most likely diagnosis?
Latex allergy
260
Turners + Ejection systolic murmur , which cardiac abnormality ?
Bicuspid aortic valve
Coarctation of aorta— would have difference in BP in both arms/ radio femoral delay
261
Marfans symptoms + Learning disability. Dx?
Homocystinuria
262
Pulmonary surfactant - main constituent:
dipalmitoyl phosphatidylcholine (DPPC)
263
Origin of foam cells :
Macrophages
264
Hering-Bruer reflex:
Distention of lung causes slowing of respiratory rate
265
Anaphylaxis is which reaction ?
Type 1 Hypersensitivity reaction
266
A new antibody test is being researched to aid the early diagnosis of rheumatoid arthritis. It is found to have a specificity of 97%.
Which one of the following statements is correct?
97% of fit people will have negative test on the diagnostic test
267
primary immunodeficiency is a T-cell disorder?
Digeorge syndrome
268
gingivitis, non-healing ulcers, myalgia + convulsions. Which vitamin deficiency ?
Scurvy
269
Which enzyme deficiency in Fabry’s ?
Alpha Galactosidase A deficiency
270
Cleft palate + Hypocalcemia + interruption in aortic arch + which cell deficiency ?
Digeorge syndrome.
T cell deficiency
271
Primary amenorrhea + Short Stature. Dx?
Turner syndrome
272
the clinical geneticist explains that not all people who test positive for BRCA1 or BRCA2 gene mutations go on to develop breast cancer.
Which of the following best explains this phenomenon?
Penetrance
273
Where is G protein located ?
Located in cell membrane
274
Turner’s Karyotype ?
45 XO
275
Alport Mode of inheritance ?
X linked Dominant
276
Which one of the following best describes the characteristics of a negatively skewed distribution?
Mean < Median < Mode
Skewed distributions
alphabetical order: mean - median - mode
'>' for positive, '<' for negative
277
Positive skewed distribution :
Mean > Median > Mode.
Skewed distributions
alphabetical order: mean - median - mode
'>' for positive, '<' for negative
278
Following the application of a plaster cast patients should wait__ hours before short flights (< 2 hours) and __hours before longer flights.
24 and 48
279
Breakdown of Oligopeptides
Lysosomes.
Loligopeptides
280
Which of the following adverse effects are most likely to occur when patients are treated with interferon-alpha?
Depression and Flue like symptoms
281
Main action of PCR :
DNA amplification
282
Occulomotor nerve enters from ?
Superior orbital fissure
Super orbit 3D—Movie title
283
A 68-year-old man is admitted with haematemesis. A gastroscopy performed as an inpatient shows a carcinoma which is confirmed on biopsy. Who is the most appropriate person to inform the patient of the diagnosis?
Consultant in charge
284
Mean=median=mode occurs where ?
Normal distribution
285
You are caring for a local cardiology consultant's father who has been admitted following a myocardial infarction. He bleeps you from the switchboard and asks how his father is doing. You recognise his voice on the phone. What is the most appropriate response?
:
Ask permission from father and then give relevant details
286
You are a ST1 doctor in general medicine. A 19-year-old female who has type 1 diabetes mellitus is admitted with her fourth episode of diabetic ketoacidosis in the past two months. You suspect she runs her sugars high to keep her weight down. She is generally non-compliant and often self-discharges after 24 hours. What is the most appropriate response?
After ward rounds, have a chat with her regarding why her control is so bad
287
You are a ST1 doctor in medicine. Whilst on-call you review a 60-year-old woman who is known to have COPD. She has been admitted with an infective exacerbation and has not responded to nebulisers and intravenous aminophylline. Her most recent blood gases show a worsening respiratory acidosis. You feel that non-invasive ventilation (NIV) is needed and bleep the on-call physio. After discussing the blood gas results over the phone she says that NIV is not indicated in her opinion and refuses to set it up. What is the most appropriate action?
As there is a disagreement in treatment plan, discuss it with the on call consultant
288
Majority of surfactant is :
Type 2 pneumocytes
289
Immune complex disorder is caused by which complement ?
C1q,C2,C4 deficiency
290
Which amenrorhhea is associated with Turner’s ?
Secondary
291
Which of the following is responsible for the plateau phase of the myocardial action potential?
Slow influx of calcium
292
What is elevated in HIV?
B2 Microglobulin levels.
They correlate well with the disease progression.
293
Which disease cause increase in lung compliance ?
Emphysema
294
does phyenylketonuria cause recurrent infection ?
No
295
Phenylketonuria features ?
Autsomal recessive (small bath cart)+ Learning disability (turtle designed curtain)+ Musty odour ( from urinal)+ eczema( red skin due to hot shower ) + seizures( shaking bath cart )
296
Which cell cycle determine the length of cell cycle ?
G1
297
Apart from bicuspid aortic valve and coarctation of aorta , what cardiac abnormality is seen in turners ?
Aortic dilatation and dissection
298
Angiokeratomas + cloudy cornea. Dx?
Fabry’s
299
Burning sensation of hand and feet + Proteinuria + Angiokeratomas. Dx?
Fabry’s
300
Stroke + angiokeratomas
Fabry’s
301
Does stroke and Mi occur in fabry’s ?
yes
302
Developmental delay + cherry red spot macula + No organomegaly
Tay Sachs.
Tay Sachs , lacks organ
Neimen Pick , Picks organ—Organomegaly.
303
Mutation which results in Stop Codon :
Nonsense mutation
304
Define power
the probability of (correctly) rejecting the null hypothesis when it is false. It is the probability of not making a type II error.
305
Wernicke’s underlying pathology :
Decreased activity of thiamine-dependent enzymes impairing glucose metabolism
306
What effect does meta analysis have on power and P value :
Meta analysis increases power.
Meta analysis decreases P values.
y combining a lot of data, they are able to get more information, which often leads to stronger evidence. Less likely due to chance—less P value
307
The trial is investigating the golgi apparatus and it's role in the trafficking of proteins to lysosomes. Researchers hope to adapt the molecules bound to proteins in an attempt to manage the disorder.
What molecule is responsible for binding and trafficking?
Mannose-6-phosphate.
6=Sex trafficking
308
A 14-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She comes from a family of Jehovah's Witnesses. Her haemoglobin on admission is 6.9 g/dl. She consents to a blood transfusion but her mother refuses. What is the most appropriate course of action?
Give the blood transfusion
309
Whilst reviewing a patient's drug card you notice that you prescribed the wrong dose of atenolol when the patient was initially clerked. Instead of 25mg atenolol od you prescribed 50mg atenolol od. She has received the incorrect dose on two occasions. On examining Mrs Smith you note her blood pressure and pulse are normal. Mrs Smith has a past history of anxiety and describes herself as a 'worrier'. What is the most appropriate action?
Apologise to patient, and complete the incident form,
In this scenario the patient appears to have come to no harm following the error. This should not however change your approach to the situation. The patient should be informed of what has happened, an apology should be made and reassurance give that there appears to be no ill effects. By completing a clinical incident form you add to a body of data which may in the long term change to practice.
310
You are a ST1 doctor in General Medicine. During an on-call you are in A&E seeing a patient who has a pneumothorax. On arriving you find the A&E ST2 doctor attempting to perform an aspiration. He appears to about to insert the needle at the wrong landmark. What is the most appropriate action?
Immediately voice your concerns and ask him to stop
311
You are a ST1 doctor on a gastroenterology ward. The F2 doctor has asked you to supervise him putting in an ascitic drain for a patient with liver cirrhosis. He is keen to get it signed off for his portfolio. He has never seen one put in before but has read around the subject. What is the most appropriate action?
in this scenario the F2 doctor has never seen one previously so it is not appropriate for him to insert the drain today. The best option is for him to watch you.
312
You are a ST1 doctor in medicine. A 67-year-old man has been investigated for anaemia and weight loss. Endoscopy shows a gastric tumour which is confirmed as an adenocarcinoma on biopsy. On discussing the diagnosis the patient states that he has had 'a good life' and doesn't want any treatment. Clinical examination is unremarkable. He is able to retain and understand the information you give to him, including the likely curative nature of surgery. What is the most appropriate action?
Respect his wishes and follow up appointment for 4 weeks
313
Which of the following cell types is most implicated in the development of coronary artery plaques?
Macrophages
314
A 77-year-old woman who lives alone is assessed. She has a history of Alzheimer's disease. Her neighbours are increasingly concerned about her behaviour - they often see her wandering around outside in an apparently confused state. You feel she may need a care package or residential care but she refuses to countenance such a proposal. What is the most appropriate legal framework to use to approach this issue?
Mental capacity act
315
Mitosis takes place in which phase of cell cycle ?
It takes place in M phase
316
Pain at the back of right knee+sudden in onset+ Swelling of calf + Ddimer- Normal + H/O Osteoarthritis
Ruptured popliteal cyst
Sudden onset of pain, particularly when this is associated first with symptoms behind the knee, and calf swelling, is very suspicious of an underlying ruptured popliteal cyst. The fact she is awaiting a right total knee replacement also suggests significant osteoarthritis of the knee, which predisposes to the condition.
Ddimer- Normal, therefore not DVT
317
You are a ST1 doctor in medicine doing a nightshift. An elderly patient with colorectal cancer has been admitted to the Emergency Department with suspected bowel obstruction. The Emergency Department F2 doctor has tried to refer the patient to the surgeons but was told that as no surgical intervention is likely the patient should be admitted to the medics. The F2 doctor therefore phones yourself and asks you to accept the patient. What is the most appropriate response
Go down to the emergency department and review the patient
318
K/c/o of CA breast + Now Headache , not relieved by analgesia
Cerebral Mets
Ix: MRI with contrast
319
Example of nonsense mutation
Duchene Mucular Dystrophy
320
One of your colleagues confides in you that he has just been diagnosed with hepatitis B. He has not told anyone else as he is worried he may lose his job. He is currently working as a general surgeon in the local hospital. You try to persuade him to inform occupational health but he refuses. What is the most appropriate action?
Inform your colleague’s employing body
321
Maximum mortality in turners is due to :
Thoracic aortic aneurysm.
Or Premature cardiovascular death
322
Dubin Johnson’s Mode of inheritance :
Autosomal Recessive
323
gene defect in alport :
COL4 A5 gene—which encodes for type 4 collagen
324
Wilsons pathology:
ATP7B gene defect—Impaired copper excretion—accumulation of copper in body
325
17 year old—heavy bleeding from gums—investigation for bleeding Disorder which affects both male and female.
Bleeding disorder which affects both male and female—VWD
Haemophilia only affects male.
326
Chromosome in VWD ?
Chromosome 12
327
Murmur in Marfan’s :
Early Diastolic Murmur
D/t : Aortic regurgitation, Aortic dilatation, Aortic dissection.
15 year old girl will dilate (Aortic dilation/regurgitation) her chut with bday sex
328
Xeroderma pigmentosum has high risk of cancer due to :
Nucleotide excision repair
329
spleen in Sickle cell :
Hyposplenism
330
Mode of inheritance in BRCA mutation :
Autosomal Dominant
331
Cause of mortality in Duchene muscular dystrophy :
Cardiomyopathy
332
RET oncogene causes :
Medullary thyroid carcinoma
333
Mutation in mitochondrial DNA :
Leads to abnormalities in energy metabolism
334
Hyper mobile joints + minor dermat manifestation
Hyper mobile Ehler Danlos
335
Severe dermat manifestation + high elasticity in skin + hyper mobile joints
Classic Ehler Danlos
336
Diagnostic test for Myotonic Dystrophy :
Genetic testing —To look for CTG repeats
337
Familial Dysbetalipoproteinemia Rx :
Fibrates and statin
338
Ataxia + B/L SNHL + Retinitis pigmentosa + Insulin Dependant DM+ Complete Heart Block. Dx?
Kearn Sayre syndromee
339
restrictive eye movement + retinitis pigmentosa. Think :
Kearn Sayre Syndrome
340
Differentiate hungtinton’s and Wilson’s:
Hungtinton’s : Onset- 30-40 + choreoform movement( dance linke )
Wilsons—Young onset(20s) + Parkinsonism + hepatic dysfunction + KF ring
341
Mild haemophilia ( 5% ) Rx?
Give Desmopressin (DDVAP) in mild haemophilia
342
What separates Strands of DNA in Replication ?
Helicase.
343
Helicase function :
Separates strands of DNA in replication
344
Which disease is characterised by genomic imprinting ?
Prader willi syndrome
345
Prader willi symptoms :
Weight gain + hyperflexibilty + Learning Disability
346
Severe burning in hand and feet after exercise + recent h/o stroke + family H/o renal failure
Fabrys
347
Familial Hypercholestrolaemia :
Autosomal dominant + Elevated cholesterol , mainly LDL + Xanthomas + H/o premature Cardiovascular death in family.
348
Father died in early 30s due to MI: Dx?
Familial Hypercholestrolaemia.
349
Gaucher’s disease is due to :
Accumulation of glucocerbroside
350
OC pills taken + Central Abdomen Pain + Weakness of legs.
AIP
351
recent renal transplant + Acute onset Headache
ADPKD
352
Allele is :
One form of gene
353
Mutation in Marfan’s
Fibriln 1 gene mutation
354
Most common cardiac manifestation in NOONAN’s ?
Pulmonary Stenosis
355
KRAS Gene Mutation :
Pancreatic Cancer + Icthyosis
356
Pancreatic Cancer + Icthyosis
KRAS gene Mutation
357
Mode of inheritance in prader willi :
Non Mendelian( genomic imprinting)
358
359
Askanazi Jew + Pancytopenia + Bone pain + Hepatospelnomegaly
Gaucher’s disease
360
How to screen for Hungtinton’s disease ?
PCR
361
Peripheral Neuropathy + Adrenal insufficiency ( low sodium , High potassium )
X linked Adrenoleukodystrophy
362
X linked Adrenoleukodystrophy
ABCD1 gene + Peripheral Neuropahty + Adrenal Insufficiecny ( Low sodium , High Pottasium )
363
Which gene defect in X linked Adenoleukodystrophy ?
ABCD1 gene defect
364
What is elevated in AIP ?
ALA—Aminoleuvilinic Acid and Porphobilinogen.
365
Hypertension, Abdominal pain and Vomitting—H/o Similar episodes in last 2 years. Elevated ALA and porphobilinogen:
AIP
366
Pseudohyoparathyroidism defect in :
G protein linked to PTH Hormone.
367
Pseudohypopathyroidism features :
Defect in G protein linked to PTH Hormone + Hypocalcemia + High Phosphate + Short stature + Short Metacarpals + Neurocognitive Impairement
368
Complete penetrance meaning :
When the people with Mutations invariably develop the phenotype
369
Most typical features of Mitochondrial disease :
Optic atrophy
370
