CR2 Questions Flashcards
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which is characterised by the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
What is this an image of? [1]
Circumflex artery
LAD
Marginal branch
Posterior interventricular artery
Right coronary artery
]What is this an image of? [1]
Circumflex artery
LAD
Marginal branch
Posterior interventricular artery
Right coronary artery
Eccentric hypertrophy is caused by which of the following? [2]
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Eccentric hypertrophy is caused by which of the following? [2]
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Concentric hypertrophy is caused by which of the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Concentric hypertrophy is caused by which of the following?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which areas of the myocardium match up with each of the coronary arteries? [4]
Left co
What’s the difference between where you listen to heart valves and their exact location?
Why is this [1]
Label A-F
A: fossa ovalis
B: pectinate muscle
C: SVC
D: crista termanalis
E: ligamentum arteriosum
F: pulmonary trunk
Between which chambers does the foramen ovale shunt blood between? [2]
Right atrium –> Left atrium
Which organ is most directly effected by high BP?
Lungs
Heart
Kidneys
Eyes
Brain
Which organ is most directly effected by high BP?
Lungs
Heart
Kidneys
Eyes
Brain
The most important modifiable risk factor in CVA prevention is caused by? [1]
Controlling hypertension
Lacunar infarcts causes damage to which artery? [1]
Lacunar infarcts. High blood pressure can also lead to damage to the very small branches of the middle cerebral arteries, with the formation of lacunar infarcts, particularly in the thalamus, mid-brain and pons
What are the BP ranges for isolated diastolic BP? [1]
>140 / < 90 mmHg
Which leads have ST elevation in this ECG? [3]
II, III, aVF
Which coronary artery is most likely to have been affected by occlusion here?
Circumflex artery?
LAD
LCA
RCA
Which coronary artery is most likely to have been affected by occlusion here?
Circumflex artery?
LAD
LCA
RCA
What is the most common cause of heart failure?
Cardiomyopathy
Hypertension
Ischaemic Heart Disease
What is the most common cause of heart failure?
Cardiomyopathy
Hypertension
Ischaemic Heart Disease
Left-sided heart failure results in blood backing up into the lungs, what condition can this lead to? [1]
Acceptable responses: oedema, pulmonary oedema, pulmonay edema, edema
Aortic stenosis (narrowing of the aortic valve) would most likely lead to concentric hypertrophy of which chamber of the heart?
Left atria
Right atria
Left ventricle
Right ventricle
Aortic stenosis (narrowing of the aortic valve) would most likely lead to concentric hypertrophy of which chamber of the heart?
Left atria
Right atria
Left ventricle
Right ventricle
Which of the following conditions would cause eccentric hypertrophy [2]_
Renal failure
Aortic stenosis
Aortic regurgitation
Increased BP
Which of the following conditions would cause eccentric hypertrophy [2]
Renal failure
Aortic stenosis
Aortic regurgitation
Increased BP
*Eccentric hypertrophy is caused by volume overload, so could be caused by renal failure (which increases blood volume). It could also be caused by valve regurgitation.
Aortic stenosis usually results in initial concentric hypertrophy, but this in itself can then leads to eccentric hypertrophy.*
What is the most common site for atherosclerotic plaque build up? [1]
Which area is most common for coronary artery athersclerotic plaque build up? [1]
Acceptable responses: Bifurcations, Bifurcation points, Points of bifurcation, Bifurcation
the anterior interventricular/left anterior descending branch being most commonly affected.
Where does fluid accumulate in pleural effusions? [1]
Acceptable responses: Pleural space
An 18 year-old pregnant patient has her 19 week ultrasound. A defect in the foetal heart is picked up.
The foetal heart is shown in the image. On the right is the Doppler image showing blood flow.
Based on your knowledge of congenital heart defects, which defect do you think the doppler image is demonstrating?
Transposition of the great vessels
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
An 18 year-old pregnant patient has her 19 week ultrasound. A defect in the foetal heart is picked up.
The foetal heart is shown in the image. On the right is the Doppler image showing blood flow.
Based on your knowledge of congenital heart defects, which defect do you think the doppler image is demonstrating?
Transposition of the great vessels
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
This image here shows the ventricles of the heart, and the mixing of blood between the ventricles indicates a ventricular septal defect (VSD)
Where does fluid accumulate in pulmonary oedema? [1]
Acceptable responses: Alveoli, Alveolar sacs
Define the term aneurysm [1]
Where do aortic aneurysms most commonly occur? [1]
An aneurysm is a dilatation of a vessel greater than 1.5 times its usual width.
Aneurysms usually occur just above the bifurcation of the abdominal aorta.
A ventricular septal defect (VSD) is most commonly a failure of which component of the septum development?
Membranous
Muscular
A ventricular septal defect (VSD) is most commonly a failure of which component of the septum development?
Membranous
Muscular
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which pathology is depicted here?
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli
Which form is iron stored in cell?
Ferritin
Ferroportin
Hepcidin
Transferrin
Haem
Which form is iron stored in cell?
Ferritin
Ferroportin
Hepcidin
Transferrin
Haem
Name the transport channel that Fe2+ leaves the cell via [1]
Name the molecule that transports Fe3+ around the body [1]
Name the transport channel that Fe2+ leaves the cell via [1]
Ferroportin
Name the molecule that transports Fe3+ around the body [1]
transferrin
Why might you miss if someone is deficient in iron? [1]
serum ferritin tests are used to diagnoise irone deficiency anaemia. But ferritin is released if have inflammation from the liver - so may mask anaemia
Where is EPO made?
Myeloid tissue
Kidney
Liver
Heart
Spleen
Where is EPO made?
Myeloid tissue
Kidney
Liver
Heart
Spleen
Which of the following allows Fe into the cell?
DMT1
DMT2
DMT3
SGLT1
GLUT2
Which of the following allows Fe into the cell?
DMT1
DMT2
DMT3
SGLT1
GLUT2
Which of the following blocks ferroportin?
transferrin
ferritin
DMT1
Haem
Hepcidin
Which of the following blocks ferroportin?
transferrin
ferritin
DMT1
Haem
Hepcidin
Where is transferrin mainly taken up?
Myeloid tissue
Kidney
Liver
Heart
Spleen
Where is transferrin mainly taken up?
Myeloid tissue
Kidney
Liver
Heart
Spleen
Which of the following is the where erythrocytes are produced at 6 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is the where erythrocytes are produced at 6 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is the where erythrocytes are produced at 3 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is the where erythrocytes are produced at 3 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is the where erythrocytes are produced at 8 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is the where erythrocytes are produced at 8 weeks old?
liver
spleen
yolk sac
bone marrow
Which of the following is excreted in urine?
urobilinogen
stercobilin
bilirubin
glucoronic acid
unconjugated bilirubin
Which of the following is excreted in urine?
urobilinogen
stercobilin
bilirubin
glucoronic acid
unconjugated bilirubin
Which of the following is excreted in faeces?
urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin
Which of the following is excreted in faeces?
urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin
Which of the following is excreted in urine?
urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin
Which of the following is excreted in urine?
urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency: glossitis
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Anaemia from which of the following causes the image below?
B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency
Which part of platelet structure contains pro-coagulant factors?
Membrane
Alpha granules
Dense granules
Metabolites
Which part of platelet structure contains pro-coagulant factors?
Membrane
Alpha granules
Dense granules
Metabolites
If ferritin in the blood is low it is highly suggestive of WHAT? [1]
If ferritin is high then this is likely to be related to WHAT? [1]
If ferritin in the blood is low it is highly suggestive of WHAT? [1]
IDA
If ferritin is high then this is likely to be related to WHAT? [1]
If ferritin is high then this is difficult to interpret and is likely to be related to inflammation rather than iron overload
Which is most likely to caused by liver toxicity or alcohol poisoning?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by liver toxicity or alcohol poisoning?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by IDA?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by IDA?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by pernicious anaemia?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by pernicious anaemia?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by B12 or folate deficiency?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Which is most likely to caused by B12 or folate deficiency?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
The results in this blood film would indicate which of the following?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
The results in this blood film would indicate which of the following?
Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic
Increased levels of reticulocytes, bilirubin & LDH would indicate which type of anaemia?
Haemolytic anaemia
Which of the following causes haemolytic anaemia if in cold conditions?
IgM
IgA
IgE
IgD
IgG
Which of the following causes haemolytic anaemia if in cold conditions?
IgM
IgA
IgE
IgD
IgG
Which of the following causes haemolytic anaemia if in warm conditions?
IgM
IgA
IgE
IgD
IgG
Which of the following causes haemolytic anaemia if in warm conditions?
IgM
IgA
IgE
IgD
IgG
Folate is used to make which of the following?
Uracil
Adenine
Guanosine
Thymidine
Cytosine
Folate is used to make which of the following?
Uracil
Adenine
Guanosine
Thymidine
Cytosine
What is the inheritance pattern of G6PD deficiency?
Autosomal dominant
Autosomal recessive
Y-linked
X-linked
What is the inheritance pattern of G6PD deficiency?
Autosomal dominant
Autosomal recessive
Y-linked
X-linked
Which of the following could cause A to be seen?
Pyruvate kinase deficiency
Damage to endothelium from burns
Hereditary spherocytosis
IgG or IgM attacking rbc
Glucose-6-dehydrogenase deficiency
Which of the following could cause A to be seen?
Pyruvate kinase deficiency
Damage to endothelium from burns
Hereditary spherocytosis
IgG or IgM attacking rbc
Glucose-6-dehydrogenase deficiency
What valvular pathology would cause a murmur that radiates to the carotids?
Tricuspid regurgitation
Aortic stenosis
Mitral stenosis
Mitral regurgitation
Pulmonary stenosis
What valvular pathology would cause a murmur that radiates to the carotids?
Tricuspid regurgitation
Aortic stenosis
Mitral stenosis
Mitral regurgitation
Pulmonary stenosis
Think of the radiation of murmurs to occur in the direction of the blood flow (i.e. aortic stenosis the blood flows towards the carotids – therefore radiates there. In mitral regurgitation the blood flows backwards towards the left axilla – therefore radiates there.)
Which artery supplies the posterior aspect of the left ventricle
- Right coronary artery
- Circumflex artery
- Left pulmonary artery
- Left anterior descending artery
- Brachiocephalic artery
Which artery supplies the posterior aspect of the left ventricle
- Right coronary artery
- Circumflex artery
- Left pulmonary artery
- Left anterior descending artery
- Brachiocephalic artery
- Left Coronary Artery becomes the circumflex and left anterior descending*
-
Right Coronary Artery (RCA) supplies
- Right atrium
- Right ventricle
- Inferior aspect of left ventricle
- Posterior septal area
-
Circumflex Artery supplies
- Left atrium
- Posterior aspect of left ventricle
-
Left Anterior Descending (LAD) supplies
- Anterior aspect of left ventricle
- Anterior aspect of septum
What ventricular rate would you expect in atrial flutter?
- 300 bpm
- 200 bpm
- 150 bpm
- 75 bpm
- 100 bpm
What ventricular rate would you expect in atrial flutter?
- 300 bpm
- 200 bpm
- 150 bpm
- 75 bpm
- 100 bpm
Atrial flutter consists of a 2:1 block. This means it takes 2 atrial beats for each ventricular beat.
During atrial flutter there will be a atrial rate of 300 and a ventricular rate of 150 bpm.
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm: starts at AVN not SAN: no P wave & bradycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation: lack of P wave
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter: saw toothed !!
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
Which does the following describe best?
Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
This is reflected as the PR interval getting progressively longer and longer until all of a sudden, the heart drops a beat.
Which does the following describe best?
Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.
So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.
Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.
On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Couple of normal PR intervals followed by a dropped beat.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
What does this ECG indicate?
Right bundle branch block
What does this ECG indicate?
Left branch bundle block
Name the causes of A and B [2]
A = Afib B = Atrial flutter (saw toothed)
What is the normal duration of a QRS complex?
<1.5 seconds
- < 0.8 seconds
- < 0.12 seconds
- > 0.8 seconds
- >0.1 seconds
What is the normal duration of a QRS complex?
<1.5 seconds
- < 0.8 seconds
- < 0.12 seconds
- > 0.8 seconds
- >0.1 seconds
You are asked by your consultant to examine a patient with a murmur. She asks you to feel the patient’s carotid pulse.
When you feel the pulse, it feels as though the blood is shot up under high pressure, then immediately disappears.
What valvular pathology would this stereotypical pulse indicate?
Mitral regurgitation
- Mitral stenosis
- Aortic regurgitation
- Aortic stenosis
- Tricuspid regurgitation
You are asked by your consultant to examine a patient with a murmur. She asks you to feel the patient’s carotid pulse.
When you feel the pulse, it feels as though the blood is shot up under high pressure, then immediately disappears.
What valvular pathology would this stereotypical pulse indicate?
Mitral regurgitation
- Mitral stenosis
- Aortic regurgitation
- Aortic stenosis
- Tricuspid regurgitation
This rapidly increasing then collapsing pulse is typical of aortic regurgitation. The blood is forced through the systemic vascular system under high pressure during systole, then the incompetent aortic valve allows blood to flow straight back into the heart. this gives a collapsing feeling to the pulse.
When this pulse is felt in the peripheral pulses, it is typically referred to as “Watson’s water hammer pulse”. When it is felt in the carotids it is typically referred to as “Corrigan’s pulse”.
What valvular pathology may cause a murmur that radiates to the left axilla?
Mitral regurgitation
- Mitral stenosis
- Aortic regurgitation
- Aortic stenosis
- Tricuspid regurgitation
What valvular pathology may cause a murmur that radiates to the left axilla?
Mitral regurgitation
- Mitral stenosis
- Aortic regurgitation
- Aortic stenosis
- Tricuspid regurgitation
Think of the radiation of murmurs to occur in the direction of the blood flow (i.e. aortic stenosis the blood flows towards the carotids – therefore radiates there. In mitral regurgitation the blood flows backwards towards the left axilla – therefore radiates there.)
Other than atrial fibrillation, what can cause an irregularly irregular pulse?
- Wolff-Parkinson-White Syndrome
- Mobitz Type 2
- Supraventricular tachycardia
- Mobitz Type 1
- Ventricular ectopics
Other than atrial fibrillation, what can cause an irregularly irregular pulse?
- Wolff-Parkinson-White Syndrome
- Mobitz Type 2
- Supraventricular tachycardia
- Mobitz Type 1
- Ventricular ectopics
A 64 year old presents complaining of shortness of breath, worse on exertion and when lying flat at night.
He is known to have ischaemic heart disease and is on medication for angina. He has had two previous NSTEMIs.
On ausculatation you hear a grade 3, pan-systolic murmur loudest at the apex.
What is the most likely cause for his murmur?
- Mitral regurgitation
- Mitral stenosis
- Tricuspid regurgitation
- Aortic regurgitation
- Aortic stenosis
A 64 year old presents complaining of shortness of breath, worse on exertion and when lying flat at night.
He is known to have ischaemic heart disease and is on medication for angina. He has had two previous NSTEMIs.
On ausculatation you hear a grade 3, pan-systolic murmur loudest at the apex.
What is the most likely cause for his murmur?
- Mitral regurgitation
- Mitral stenosis
- Tricuspid regurgitation
- Aortic regurgitation
- Aortic stenosis
Which artery supplies the posterior septal area of the heart?
- Circumflex artery
- Right coronary artery
- Left anterior descending artery
- Left pulmonary artery
- Brachiocephalic artery
Which artery supplies the posterior septal area of the heart?
- Circumflex artery
- Right coronary artery
- Left anterior descending artery
- Left pulmonary artery
- Brachiocephalic artery
- Right coronary artery (RCA) supplies*
- Right atrium
- Right ventricle
- Inferior aspect of left ventricle
- Posterior septal area
Alpha globin gene is found on:
Chromosome 12
Chromosome 8
Chromsome 15
Chromosome 16
Chromsome 4
Alpha globin gene is found on:
Chromosome 12
Chromosome 8
Chromsome 15
Chromosome 16
Chromsome 4
Beta globin gene is found on:
Chromosome 11
Chromosome 14
Chromsome 9
Chromosome 16
Chromsome 2
Beta globin gene is found on:
Chromosome 11
Chromosome 14
Chromsome 9
Chromosome 16
Chromsome 2
Which of the following represents the structure of fetal Hb?
- α2, β2
- α2, ζ2
- α2, Y2
- α2, δ2
- δ2, β2
Which of the following represents the structure of fetal Hb?
- α2, β2
- α2, ζ2
- *- α2, Y2**
- α2, δ2
- δ2, β2
Which of the following represents the structure of adult Hb A?
- α2, β2
- α2, ζ2
- α2, Y2
- α2, δ2
- δ2, β2
Which of the following represents the structure of adult Hb A?
- *- α2, β2**
- α2, ζ2
- α2, Y2
- α2, δ2
- δ2, β2
Which of the following represents the structure of adult Hb A2?
- α2, β2
- α2, ζ2
- α2, Y2
- α2, δ2
- δ2, β2
Which of the following represents the structure of adult Hb A2?
- α2, β2
- α2, ζ2
- α2, Y2
- α2, δ2
- δ2, β2
Label A-C, which highlights which arteries are affected by ECG changes
A = V1-V4: LAD B: II, III & AVF: Right coronary artery C: I, V5 & V6: circumflex
Which artery is occluded to cause this ECG? a) LAD b) RCA c) LCA d) circumflex artery
Which artery is occluded to cause this ECG? **a) LAD: Anterior ST elevation: V1-V4 elevated **b) RCA c) LCA d) circumflex artery
Which artery is occluded to cause this ECG? a) LAD b) RCA c) LCA d) circumflex artery
Which artery is occluded to cause this ECG? **a) LAD: Anterior ST elevation: V1-V4 elevated **b) RCA c) LCA d) circumflex artery
Which artery is occluded here? Explain what type of ACS is causing this ECG [1] a) LAD b) RCA c) LCA d) circumflex artery
Which artery is occluded here? Explain what type of ACS is causing this ECG [1] a) LAD b) RCA c) LCA d) circumflex artery: ST depression in V5 & V6
Development of which type of waves on an ECG indicates an MI? [1]
Pathological Q waves on V1-V3
Q wave has to be first inversion
Von Willebrand Factor is a carrier for which of the following?
Factor VII
Factor VIII
Factor IX
Factor X
Factor XI
Von Willebrand Factor is a carrier for which of the following?
Factor VII
Factor VIII
Factor IX
Factor X
Factor XI
Warfarin is an antagonist to which vitamin?
Vitamin C
Vitamin B
Vitamin K
Vitamin A
Vitamin E
Warfarin is an antagonist to which vitamin?
Vitamin C
Vitamin B
Vitamin K
Vitamin A
Vitamin E
Which clotting factors does administering warfarin cause to be reduced? [4]
reduces levels of factor II, VII, IX, X - reducing clotting ability.
Which of the following describes the inheritance for thalassaemia?
Autosomal dominant
Autosomal recessive
X dominant
X recessive
Y linked
Which of the following describes the inheritance for thalassaemia?
Autosomal dominant
Autosomal recessive
X dominant
X recessive
Y linked
A 69-year-old man presents to his GP after several episodes of paroxysmal nocturnal dyspnoea and progressive orthopnoea. The GP suspects heart failure and requests a chest X-ray. Which of the following signs would be suggestive of heart failure on a chest X-ray?
A cardiothoracic ratio of 45%
Surgical emphysema
Upper zone vessel enlargement
Increased opacity in left upper zone
Cavitation in the right upper zone
A 69-year-old man presents to his GP after several episodes of paroxysmal nocturnal dyspnoea and progressive orthopnoea. The GP suspects heart failure and requests a chest X-ray. Which of the following signs would be suggestive of heart failure on a chest X-ray?
A cardiothoracic ratio of 45%
Surgical emphysema
Upper zone vessel enlargement
Increased opacity in left upper zone
Cavitation in the right upper zone
A 78-year-old diabetic man presents with a heart attack. A coronary angiogram is eventually performed. Which coronary vessel(s) supplies the anterior septum of the heart?
Left anterior descending
Circumflex artery
Posterior descending artery
Marginal branches
Right coronary artery
A 78-year-old diabetic man presents with a heart attack. A coronary angiogram is eventually performed. Which coronary vessel(s) supplies the anterior septum of the heart?
Left anterior descending
Circumflex artery
Posterior descending artery
Marginal branches
Right coronary artery
A 34-year-old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 4th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?
Mitral valve
Aortic valve
Pulmonary valve
Right ventricular aneursym
Tricuspid valve
A 34-year-old male is being examined in the pre-operative assessment clinic. A murmur is identified in the 4th intercostal space just next to the left side of the sternum. From where is it most likely to have originated?
Mitral valve
Aortic valve
Pulmonary valve
Right ventricular aneursym
Tricuspid valve
A 2-month-old baby is diagnosed with a ventricular septal defect. This is due to a failure in embryological development of which cardiovascular structure?
Atrioventricular canal
Endocardial cushions
Truncus arteriosus
Foramen ovale
Primitve ventricle
A 2-month-old baby is diagnosed with a ventricular septal defect. This is due to a failure in embryological development of which cardiovascular structure?
Atrioventricular canal
Endocardial cushions
Truncus arteriosus
Foramen ovale
Primitve ventricle
Label the type of Hb that are dominant in each stage of life [3]
Yolk Sac / A: Z2, E2
Fetal liver / B: A2, γ2
Bone marrow / C: A2, B2
When conducting a blood test, which substance is elevated if you have infarct / damage to myocytes? [1]
Troponin
what type of cell junctions do u find in intercalated disc? [3]
fascia adherens desmosomes gap junctions
what is A? [1]
**purkinje fibres**
label A-C
A: **tunica adventitia** B: **tunica media** C: **endothelial cell**
blood flow within the capillary bed is controlled by WHAT? [1]
blood flow within the capillary bed is controlled by **arterioles** [1] and **precapillary sphincters**
Label A-C [3]
Heart valves: A: Fibrosa B: Spongiosum C: Ventricularis
**Fibrolipid plaque.** They contain lots of macrophages which have ingested lipids and have a fatty lipid core (foam cells). They can often rupture leading to lipid spilling out into the fibrolipid plaque core.
What are the 3 main constituents of an atheromatous plaque? [3]
- **Lipids** (intracellular & extracellular) 2. **Connective tissue** - collagen & fibrin 3. **Cells** - macrophages & smooth muscle
This is a cross section through an aorta. Note the complicated atheromatous plaque on the left side of the image. Please label the picture (a) to (c).
A = thickened arterial wall. B = intraluminal haemorrhage. C = ulceration.
This is a magnification of a fibrolipid plaque. Note the lumen in the top left corner. Label the picture A-C. Note A is part of the normal arterial wall.
A = adventitia. B = lipid core. C = fibrous cap.
Which is the most common cause of heart failure?
Coronary artery disease
Anaemia
Hypertension
Cardiomyopathy
Valvular heart disease
Which is the most common cause of heart failure?
Coronary artery disease
Anaemia
Hypertension
Cardiomyopathy
Valvular heart disease
Which of the following is a carbonic anhydrase inhibitor?
Dexamethasone
Acetazolamide
Which of the following is a carbonic anhydrase inhibitor?
Dexamethasone
Acetazolamide
carbonic anhydrase inhibitors
4mg qds, (four times daily) oral or iv (steroid): corticosteroid medication used to prevent brain swelling and inflammation.
A 78 year old man presented with episodes of loss of consciousness on exertion. On examination, the carotid pulse is rising slowly. There is a loud ejection systolic murmur at the aortic area, radiating to both carotid arteries.
Which of the following is this patient most likely to have?
Mitral regurgiation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
A 78 year old man presented with episodes of loss of consciousness on exertion. On examination, the carotid pulse is rising slowly. There is a loud ejection systolic murmur at the aortic area, radiating to both carotid arteries.
Which of the following is this patient most likely to have?
Mitral regurgiation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
What medication is given to patients to prevent/relieve exertional angina? [1]
sublingual GTN [1]
A patient on warfarin following a PE presents with a GI bleed, what is your next step? Explain [2]
Stop Warfarin [0.5]
Give patient vitamin K [0.5]
Because warfarin is a vitamin K antagonist [1]
What are the treatment options for confirmed Dx of PE ? [3]
- Low molecular weight heparin [1]
- Thrombolytics [1] only indicated for very serious PE e.g. occluding both pulm arts due to significant side effects
What is clopidogrel used for? [1]
P2Y12 antagonist used as part of post-MI anti-platelet therapy
What is P2Y12 receptor involved with? [1]
P2Y12 receptor is involved in platelet aggregation
The length of murmur that correlates to intensity of pathology occurs with which of the following?
Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
The length of murmur that correlates to intensity of pathology occurs with which of the following?
Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
A 45 year old lady, who moved to the UK from India 5 years ago, presented with increasing exertional dyspnoea and orthopnoea. On examination, the apex beat is tapping, with a loud first heart sound, and an apical mid-diastolic rumble.
Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
A 45 year old lady, who moved to the UK from India 5 years ago, presented with increasing exertional dyspnoea and orthopnoea. On examination, the apex beat is tapping, with a loud first heart sound, and an apical mid-diastolic rumble.
Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
Which parameter of DLCO is particularly affected by IPF? [1]
DLCO = Lung surface area available for gas exchange (Va) X rate of capillary blood CO uptake (Kco)
Kco is particularly affected by IPF
Nasopharyngitis is mostly commonly caused by which of the following?
Adenoviruses
Echoviruses
Coronaviruses
Rhinoviruses
Nasopharyngitis is mostly commonly caused by which of the following?
Adenoviruses
Echoviruses
Coronaviruses
Rhinoviruses
Name the receptors that detect human rhinovirus infection in airway epithelial cells [2]
Toll-like receptors [1]
Retinoic acid-inducible gene-I-like (RIG) receptors [1]
Name 3 pro-inflam mediators that are released after HRV infection [3]
TNF-alpha
IFN
CXCL8
What is the most frequent causative agent of pneumonia? [1]
Streptococcus pneumoniae
Factor deficiency would arise from a primary or secondary haemostasis disorder? [1]
Secondary haemostasis
Increasing VWF causes an increase in which of the following:
factor VII
factor VIII
factor IX
factor X
factor XI
Increasing VWF causes an increase in which of the following:
factor VII
factor VIII: Von Willebrand’s antigen is the protein that carries factor VIII.
factor IX
factor X
factor XI
When might you see larger T waves that expected? [2]
MI [1]
Hyperkalemia [1]
What pathology does this ECG indicate? [1]
Junctional rhythm: lack of P wave; bradycardia
Which of the following best describes:
there’s an extra electrical pathway (called an accessory pathway) in the heart, which is caused by additional tissue in the area of your heart which the electrical signals travel through. This causes signals to bypass the usual route.
Atrial flutter
Atrial fibrillation
AVN Reentrant Syndrome
Wolf-Parkinson-White Syndrome
Ventricular fibrillation
Which of the following best describes:
there’s an extra electrical pathway (called an accessory pathway) in the heart, which is caused by additional tissue in the area of your heart which the electrical signals travel through. This causes signals to bypass the usual route.
Atrial flutter
Atrial fibrillation
AVN Reentrant Syndrome
Wolf-Parkinson-White Syndrome
Ventricular fibrillation
Which of the following is characterised on an ECG by a delta wave?
Atrial flutter
Atrial fibrillation
AVN Reentrant Syndrome
Wolf-Parkinson-White Syndrome
Ventricular fibrillation
Which of the following is characterised on an ECG by a delta wave?
Atrial flutter
Atrial fibrillation
AVN Reentrant Syndrome
Wolf-Parkinson-White Syndrome
Ventricular fibrillation
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
What does this ECG indicate?
Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm: starts at AVN not SAN: no P wave & bradycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation: lack of P wave
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter: saw toothed !!
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
What does this ECG indicate?
Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
Which does the following describe best?
Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
This is reflected as the PR interval getting progressively longer and longer until all of a sudden, the heart drops a beat.
Which does the following describe best?
Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.
So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.
Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.
On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.
Which of the following does this ECG best represent?
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
Which does the following describe best?
Couple of normal PR intervals followed by a dropped beat.
First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block
What does this ECG indicate?
Right bundle branch block
Name the causes of A and B [2]
A = Afib B = Atrial flutter (saw toothed)
What ventricular rate would you expect in atrial flutter?
- 300 bpm
- 200 bpm
- 150 bpm
- 75 bpm
- 100 bpm
What ventricular rate would you expect in atrial flutter?
- 300 bpm
- 200 bpm
- 150 bpm
- 75 bpm
- 100 bpm
Atrial flutter consists of a 2:1 block. This means it takes 2 atrial beats for each ventricular beat.
During atrial flutter there will be a atrial rate of 300 and a ventricular rate of 150 bpm.
What view of the heart do leads V3 and V4 represent?
Septal
Lateral
Anterior
Inferior
What view of the heart do leads V3 and V4 represent?
Septal
Lateral
Anterior
Inferior
Which artery is most likely to be affected in the context of ST elevation being present in leads V3 and V4?
RCA
Left circumflex
LAD
All of the above
Which artery is most likely to be affected in the context of ST elevation being present in leads V3 and V4?
RCA
Left circumflex
LAD
All of the above
Leads V3 and V4 represent the anterior portion of the heart. ST elevation in these leads would be suggestive of anterior myocardial infarction. The anterior portion of the heart is supplied primarily by the left anterior descending artery.
A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?
Wolf-Parkinson-White Syndrome
Left bundle branch block
AVN fibrosis
Right bundle branch block
A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?
Wolf-Parkinson-White Syndrome
Left bundle branch block
AVN fibrosis
Right bundle branch block
In WPW syndrome, an accessory pathway known as the bundle of Kent is present. Most individuals are asymptomatic, however, there is a risk of sudden death without treatment.
What is the duration of a normal PR-interval?
- 04-0.12 secs
- 04-0.08 secs
- 08-0.12 secs
- 12-0.2 secs
What is the duration of a normal PR-interval?
- 04-0.12 secs
- 04-0.08 secs
0.08-0.12 secs
0.12-0.2 secs
Which of the following is a common cause of right axis deviation?
VSD
ASD
Right ventricular hypertrophy
Left ventricular hypertrophy
Which of the following is a common cause of right axis deviation?
VSD
ASD
Right ventricular hypertrophy
Left ventricular hypertrophy
An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?
1st degree heart block
Atrial fibrillation
Atrial flutter
Junctional rhythm
2nd degree heart block
An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?
1st degree heart block
Atrial fibrillation
Atrial flutter
Junctional rhythm
2nd degree heart block
An ECG is performed and reveals a progressively increasing PR interval and dropping of QRS complexes at regular intervals. Which of the following is the most likely diagnosis?
1st degree heart block
Second-degree heart block (Mobitz type 1)
Second-degree heart block (Mobitz type 2)
Hyperalkaemia
An ECG is performed and reveals a progressively increasing PR interval and dropping of QRS complexes at regular intervals. Which of the following is the most likely diagnosis?
1st degree heart block
Second-degree heart block (Mobitz type 1)
Second-degree heart block (Mobitz type 2)
Hyperalkaemia
If ST-elevation was noted in leads II, III and aVF, what would it suggest?
A posterior MI
A septal MI
An anterior MI
An inferior MI
If ST-elevation was noted in leads II, III and aVF, what would it suggest?
A posterior MI
A septal MI
An anterior MI
An inferior MI
Leads II, III and aVF all view the heart in the inferior plane. ST-elevation in only these leads would be suggestive of an inferior myocardial infarction.
What view of the heart do leads I, aVL, V5 and V6 represent?
Anterior
Inferior
Lateral
Septal
What view of the heart do leads I, aVL, V5 and V6 represent?
Anterior
Inferior
Lateral
Septal
What would it suggest if lead I became more positive than lead II and lead III became negative?
Left axis deviation
Right axis deviation
What would it suggest if lead I became more positive than lead II and lead III became negative?
Left axis deviation
Right axis deviation
What is the most common cause of left axis deviation?
Right ventricular hypertrophy
ASD
Defects of the conducting system
Left ventricular hypertrophy
What is the most common cause of left axis deviation?
Right ventricular hypertrophy
ASD
Defects of the conducting system
Left ventricular hypertrophy
How could a HRV nasopharyngitis infection impact asthma patients?
The host reaction to HRV in atopic asthmatic subjects is characterised by a T-helper (Th)2-type immune response.
Causes increased synthesis and release of cytokines, such as interleukin (IL)-4, IL-5, IL-10 and IL-13, which are capable of increasing the expression of intercellular adhesion molecule (ICAM)-1, the major HRV receptor, on the surface of bronchial epithelial cells (BECs)
Causes BECS more sus. to infection.
How much fluid needs to accumulate in the pleura before it is visible on CXR
100ml
200ml
300ml
400ml
500ml
How much fluid needs to accumulate in the pleura before it is visible on CXR
100ml
200ml
300ml
400ml
500ml
Q
What is the most frequent causative agent of pneumonia? [1]
What is the second most frequent causative agent of pneumonia? [1]
BUT: more often dont actually know / cant ID the cause
Streptococcus pneumoniae= 50%
Haemophilus influenzae = 20%
Name a complication that pneuomonia a risk factor for [1]
Sepsis
What is BNP?
When is is released?
Where is it made?
What physiological effects does it have?
In which condition is it raised?
BNP: Brain Natriuretic Peptide
is a hormone released by the heart when the ventricles are stretched e.g. by fluid overload.
The hormone then causes fluid and sodium loss in the urine and mild vasodilation.
In heart failure BNP levels are raised, and increase in level according to New York Heart Association classification. If BNP is normal it generally rules out heart failure.
Secreted by cardiomyocytes in the ventricles
Which of the following is the most common cause of heart failure?
- Coronary artery disease
- Hypertension
- Valvular disease
- Myocarditis
Which of the following is the most common cause of heart failure?
- Coronary artery disease
- Hypertension
- Valvular disease
- Myocarditis
Which of the following is the least pathological
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
An 85-year-old male with long standing untreated hypertension presents to the emergency department with chest pain. On examination of his ECG, there is noted to be tall QRS complexes across the whole ECG with high amplitude R-waves in the left side leads. What diagnosis does this point to?
STEMI
Dilated cardiomyopathy
Non STEMI
Left ventricular hypertrophy
Angina
An 85-year-old male with long standing untreated hypertension presents to the emergency department with chest pain. On examination of his ECG, there is noted to be tall QRS complexes across the whole ECG with high amplitude R-waves in the left side leads. What diagnosis does this point to?
STEMI
Dilated cardiomyopathy
Non STEMI
Left ventricular hypertrophy
Angina
In LVF the left ventricle becomes hypertrophied as a response to the greater pressure it has to push against in someone with long-standing hypertension. The ECG changes in this are typically an increase in the amplitude of the R-waves in the leads corresponding to the left ventricle (1, aVL and V4-6).
A 66-year-old man undergoes a coronary angiogram after being admitted into hospital with central crushing chest pain. Atherosclerosis is a process which can lead to the blockage of arteries.
Which of the following would be an expected change in the endothelium?
Reduced NO availability
Fatty infiltration of HDLs
Anti-oxidant
Anti-inflammatory
Increased NO availability
A 66-year-old man undergoes a coronary angiogram after being admitted into hospital with central crushing chest pain. Atherosclerosis is a process which can lead to the blockage of arteries.
Which of the following would be an expected change in the endothelium?
Reduced NO availability
Fatty infiltration of HDLs
Anti-oxidant
Anti-inflammatory
Increased NO availability
- The endothelium undergoes pro-inflammatory, pro-oxidant, proliferative and reduced nitric oxide bioavailability meaning the first three answers are incorrect.*
- Fatty infiltration occurs in the subendothelial space however this occurs with LDL particles.*
A 61-year-old woman visits her GP to review her anginal medication. She is concerned about her condition and asks about what has caused the narrowing of her coronary arteries.
Which of the following is a change which occurs in the process of atherosclerosis?
Phagocytosis of HDLS by macrophages, forming foam cells
Infiltration of the tunica externa by LDL particles
Fatty infiltration of the sub-endothelial space
Hypertrophy of the arterial layers
Increased NO bioavailability
A 61-year-old woman visits her GP to review her anginal medication. She is concerned about her condition and asks about what has caused the narrowing of her coronary arteries.
Which of the following is a change which occurs in the process of atherosclerosis?
Phagocytosis of HDLS by macrophages, forming foam cells
Infiltration of the tunica externa by LDL particles
Fatty infiltration of the sub-endothelial space
Hypertrophy of the arterial layers
Increased NO bioavailability
- Foam cells are formed by the phagocytosis of LDLs, not HDLs.*
- Infiltration occurs at the subendothelial space not the tunica externa.*
- There is proliferation of the smooth muscle not hypertrophy.*
- Nitric oxide bioavailability reduces due to endothelial dysfunction.*
Which artery is most common to have a stroke in? [1]
Middle cerrebral artery
Describe what the Bamford Stroke Classification is for:
Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar syndrome (LACS)
Posterior circulation syndrome (POCS)
Name 3 diseases that cause Type 1 Resp failure
3 Ps!
PE
Pulmonary oedema
Pneumonia
A 55-year-old woman comes to the emergency department due to intermittent palpitations over the last 6 months. The patient says these episodes occur randomly and resolve spontaneously or with sleep. The current episode started an hour ago and has been accompanied by lightheadedness.
On examination, there is mild peripheral oedema. A cardiac rhythm strip obtained in the emergency department reveals an irregularly irregular rhythm with varying R-R intervals and no P waves.
What anatomic structure is the most likely origin of this patient’s aberrant electrical activity?
AVN
Papillary mucsles
Pulmonary veins
Right ventricular outflow tract
Tricuspid valve annulus
A 55-year-old woman comes to the emergency department due to intermittent palpitations over the last 6 months. The patient says these episodes occur randomly and resolve spontaneously or with sleep. The current episode started an hour ago and has been accompanied by lightheadedness.
On examination, there is mild peripheral oedema. A cardiac rhythm strip obtained in the emergency department reveals an irregularly irregular rhythm with varying R-R intervals and no P waves.
What anatomic structure is the most likely origin of this patient’s aberrant electrical activity?
AVN
Papillary mucsles
Pulmonary veins
Right ventricular outflow tract
Tricuspid valve annulus
In atrial fibrillation, aberrant electrical activity between the pulmonary veins and the left atrium may overwhelm the regular impulses from the sinus node
A 42-year-old white male is found to have hypertension following a health checkup at his GP surgery. What is the first line antihypertensive in white males under the age of 55-years-old?
BB
Diuretics
CCBs
ACE inhibitor
Aspirin
A 42-year-old white male is found to have hypertension following a health checkup at his GP surgery. What is the first line antihypertensive in white males under the age of 55-years-old?
BB
Diuretics
CCBs
ACE inhibitor
Aspirin
A 42-year-old white male is found to have hypertension following a health checkup at his GP surgery. What is the first line antihypertensive in white males under the age of 55-years-old?
BB
Diuretics
CCBs
ACE inhibitor
Aspirin
A 42-year-old white male is found to have hypertension following a health checkup at his GP surgery. What is the first line antihypertensive in white males under the age of 55-years-old?
BB
Diuretics
CCBs
ACE inhibitor
Aspirin
A 25-year-old man presented to the emergency department after suffering from a syncope whilst playing football. He is usually fit and well with no previous medical history. He also reports intermittent palpitations, however, he attributes it to possibly being caused by alcohol or caffeine. On further questioning, his father has suddenly passed away at the age of 35-years-old with a ‘heart condition’. What is the underlying pathophysiological change for the patient?
VSD
Asymmetric septal hypertrophy
Emboli caused by mural thrombus
Accessory pathway
Uncontrolled electrical activity in the brain
A 25-year-old man presented to the emergency department after suffering from a syncope whilst playing football. He is usually fit and well with no previous medical history. He also reports intermittent palpitations, however, he attributes it to possibly being caused by alcohol or caffeine. On further questioning, his father has suddenly passed away at the age of 35-years-old with a ‘heart condition’. What is the underlying pathophysiological change for the patient?
VSD
Asymmetric septal hypertrophy
Emboli caused by mural thrombus
Accessory pathway
Uncontrolled electrical activity in the brain
- Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of mitral valve on echocardiogram or cMR support HOCM*
- A patient at this young age with symptoms of syncope and chest symptoms, plus a strong family history (first degree family member), should raise suspicion of hypertrophic cardiomyopathy. This is characterised by asymmetric septal hypertrophy.*
Defects in which genes cause Hypertrophic obstructive cardiomyopathy (HOCM)? [2]
- the most common defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin-binding protein C
- results in predominantly diastolic dysfunction
- left ventricle hypertrophy → decreased compliance → decreased cardiac output
- characterized by myofibrillar hypertrophy with chaotic and disorganized fashion myocytes (‘disarray’) and fibrosis on biopsy
A 76-years-old man presents to the emergency department with lightheadedness and fatigue. He also complains of getting short of breath on exertion. On examination, you note a pulse rate at 42 beats per min, mild bibasal crepitations and bilateral peripheral pitting oedema. His ECG shows a dissociation between the P waves and QRS complexes. Which part of the JVP waveform is most likely to be affected in this patient?
c wave
a wave
v wave
x descent
y descent
A 76-years-old man presents to the emergency department with lightheadedness and fatigue. He also complains of getting short of breath on exertion. On examination, you note a pulse rate at 42 beats per min, mild bibasal crepitations and bilateral peripheral pitting oedema. His ECG shows a dissociation between the P waves and QRS complexes. Which part of the JVP waveform is most likely to be affected in this patient?
c wave
a wave
v wave
x descent
y descent
The presence of a pulse rate of around 40 beats per min and the ECG findings both indicate a complete heart block. In this situation the atria and ventricles are both contracting in an unsynchronised manner. When the right atrium contracts against a closed tricuspid valve, this will cause the JVP to increases dramatically. This is known as the cannon a waves.
DiscussImprove
A 71-year-old gentleman presents to the emergency department with central crushing chest pain that radiates down his left arm and into his jaw. You perform an ECG, which shows ST-segment elevation in leads I, aVL and V4-V6. You diagnose an anterolateral ST-elevation MI. Which artery supplies the majority of the lateral aspect of the left ventricle?
LAD
Left circumflex artery
Sinoatrial nodal branch
RCA
Right marginal artery
A 71-year-old gentleman presents to the emergency department with central crushing chest pain that radiates down his left arm and into his jaw. You perform an ECG, which shows ST-segment elevation in leads I, aVL and V4-V6. You diagnose an anterolateral ST-elevation MI. Which artery supplies the majority of the lateral aspect of the left ventricle?
LAD
Left circumflex artery
Sinoatrial nodal branch
RCA
Right marginal artery
A young man is diagnosed with hypertension following routine appointments. The doctor explains that his young age makes it likely that his hypertension has a secondary cause. What is the most common cause of secondary hypertension?
Pregnancy
Renal disease
Malignancy
Endocrine disease
Medication
A young man is diagnosed with hypertension following routine appointments. The doctor explains that his young age makes it likely that his hypertension has a secondary cause. What is the most common cause of secondary hypertension?
Pregnancy
Renal disease
Malignancy
Endocrine disease
Medication
Renal disease is the most common cause of secondary hypertension.
A 45-year-old man with a background of hypertrophic cardiomyopathy (HOCM) attends for review at the cardiology clinic. During the examination, a fourth heart sound is heard.
Which of the following is a feature of this clinical finding?
It coincides with the P wave of the ECG
It is common finding in patients with afib
It occurs early in diastole
It occurs during passive left ventricular filling
It coincides with the T wave of the ECG
A 45-year-old man with a background of hypertrophic cardiomyopathy (HOCM) attends for review at the cardiology clinic. During the examination, a fourth heart sound is heard.
Which of the following is a feature of this clinical finding?
It coincides with the P wave of the ECG
It is common finding in patients with afib
It occurs early in diastole
It occurs during passive left ventricular filling
It coincides with the T wave of the ECG
- S4 coincides with the P wave on ECG*
- An S4 heart sound can be a sign of diastolic heart failure which results from severe left ventricular hypertrophy. This can be found in patients with HOCM or develop as a complication of hypertension or aortic stenosis.*
An 82-year-old lady comes into see her GP. Over the past 8 months, she has become increasingly breathless, especially at night, and has found that her ankles have become swollen. She has a history of ischaemic heart disease but an echocardiogram shows normal valve function. The GP listens to her heart and hears a low-pitch sound at the beginning of diastole, just after S2. What is the most likely cause of this sound?
Rapid movement of blood entering verntricles from atria
Mitral stenosis
Aortic regurgitation
Forceful atrial contraction
PDA
An 82-year-old lady comes into see her GP. Over the past 8 months, she has become increasingly breathless, especially at night, and has found that her ankles have become swollen. She has a history of ischaemic heart disease but an echocardiogram shows normal valve function. The GP listens to her heart and hears a low-pitch sound at the beginning of diastole, just after S2. What is the most likely cause of this sound?
Rapid movement of blood entering verntricles from atria
Mitral stenosis
Aortic regurgitation
Forceful atrial contraction
PDA
This is a description of S3, an abnormal sound that can be heard in some patients with heart failure. The cause of the sound is rapid movement and oscillation of blood into the ventricles.
A 64-year-old man undergoes a coronary angiogram. The cardiologist notes significant coronary stenoses in multiple locations, correlating with the patient’s increasing symptoms of unstable angina. The patient has a multitude of risk factors - hypertension, significant smoker, hypercholesterolaemia and type 2 diabetes mellitus - for the development of atheromas.
Which of the following is the final step in the formation of this pathology?
Endothelial dysfunction
Fatty infiltration of subendothelial space
Foam cell formation
Leukocyte recruitment
Smooth muscle proliferation and migration
A 64-year-old man undergoes a coronary angiogram. The cardiologist notes significant coronary stenoses in multiple locations, correlating with the patient’s increasing symptoms of unstable angina. The patient has a multitude of risk factors - hypertension, significant smoker, hypercholesterolaemia and type 2 diabetes mellitus - for the development of atheromas.
Which of the following is the final step in the formation of this pathology?
Endothelial dysfunction
Fatty infiltration of subendothelial space
Foam cell formation
Leukocyte recruitment
Smooth muscle proliferation and migration
Smooth muscle proliferation and migration from the tunica media into the intima is the last step in the formation of an atheroma
How do can you distinguish COPD from heart failure? [1]
Orthopnoea can differentiate heart failure from COPD [1]
Beatrice is an 84-year-old female who attends the cardiology clinic for follow up. She had a myocardial infarction 6 months ago, and since has suffered from swollen ankles and shortness of breath upon laying flat. You consider heart failure and organise an echocardiogram, start some diuretic medications and take blood. Which blood marker can signal excessive stretch of the heart muscle?
BNP
Troponin
Creatine kinase
Lactate deyhdrogenase LDH
Myoglobin
Beatrice is an 84-year-old female who attends the cardiology clinic for follow up. She had a myocardial infarction 6 months ago, and since has suffered from swollen ankles and shortness of breath upon laying flat. You consider heart failure and organise an echocardiogram, start some diuretic medications and take blood. Which blood marker can signal excessive stretch of the heart muscle?
BNP
Troponin
Creatine kinase
Lactate deyhdrogenase LDH
Myoglobin
BNP is released by the ventricles of the heart in response to excessive stretching of the cardiomyocytes. The resulting overall action of this secretion is to decrease blood pressure through; decreasing systemic vascular resistance and increasing natriuresis.
A 70-year-old woman is brought to the Emergency Department by her relatives. For the past two hours she has experienced palpitations and ‘tightness’ in her chest. The ECG has a ‘sawtooth’ appearance with baseline atrial activity of around 300/min and a ventricular rate of 150/min. What is the most likely diagnosis?
Atrioventricular nodal re-entrant tachycardia
Atrial flutter
Atrioventricular re-entrant tachycardia
Junctional tachycardia
Atrial fibrillation
A 70-year-old woman is brought to the Emergency Department by her relatives. For the past two hours she has experienced palpitations and ‘tightness’ in her chest. The ECG has a ‘sawtooth’ appearance with baseline atrial activity of around 300/min and a ventricular rate of 150/min. What is the most likely diagnosis?
Atrioventricular nodal re-entrant tachycardia
Atrial flutter
Atrioventricular re-entrant tachycardia
Junctional tachycardia
Atrial fibrillation
A 39-year-old man presents to the emergency department complaining of palpitations and a feeling of light-headedness. He has had diarrhoea and vomiting for the past week. For the past three days, he has had muscle weakness and cramps. You suspect this patient may have hypokalaemia. You decide to perform an ECG. Which of the following is an ECG sign of hypokalaemia?
STEMI
Small P waves
Short PR interval
Broad QRS
Small or inverted T waves
A 39-year-old man presents to the emergency department complaining of palpitations and a feeling of light-headedness. He has had diarrhoea and vomiting for the past week. For the past three days, he has had muscle weakness and cramps. You suspect this patient may have hypokalaemia. You decide to perform an ECG. Which of the following is an ECG sign of hypokalaemia?
STEMI
Small P waves
Short PR interval
Broad QRS
Small or inverted T waves
- Small or inverted T waves is an ECG sign of hypokalaemia. The other ECG signs of hypokalaemia can be found below.*
- Small or absent P waves and broad bizarre QRS complexes are ECG signs of hyperkalaemia. Other ECG signs of hyperkalaemia include a long PR interval, tall tented T waves and a sine wave pattern.*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma **Asthma** Squamous cell carnicoma *resp epithelium with goblet cell hyperplasia eosinophils in lam prop +++ thickened BM SM hypertrophy mucous in lumen*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia **TB** Small cell carcinoma Asthma Squamous cell carnicoma *Under the microscope multinucleate giant cells and granulomatosis are seen*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB **Small cell carcinoma** Asthma Squamous cell carnicoma *Multiple mitotic figures are identified as well as scattered apoptotic tumor cells. The finely dispersed or salt and pepper chromatin with no distinct nucleoli is apparent in many of the cells, although the crush artifact caused by the biopsy process can make this feature more difficult to distinguish. The small cells lie among a background of delicate stroma that is sparse compared to the dense sheet of tumor cells*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB **Small cell carcinoma** Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia **TB** Small cell carcinoma Asthma Squamous cell carnicoma *Caseous necrosis and granulomatosis*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? **Pneumonia** TB Small cell carcinoma Asthma Squamous cell carnicoma
Describe the pathological changes that you would expect to see in the lungs of a smoker. [3]
* many dust cells (macrophages that have taken up carbon particles. * damage to the cilia that typically lines the airways, an increase in mucous-producing cells, squamous metaplasia, (protective adaptation) * Metaplastic and dysplastic structural changes could eventually lead to lung cancer.
Premature children do not produce adequate amounts of pulmonary surfactant. Name two cells that are involved and explain why this greatly increases the risk of death. What would you expect to see on a histological preparation of lung tissue from such an infant? [3]
**Type II pneumocytes** and **Clara cells** are both involved in surfactant production. The lung tissue histology of such an infant would appear with **collapsed alveoli**. [1]
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma **Squamous cell carnicoma** *Squamous cell carcinoma, well differentiated: epithelium shows marked keratinization and minimal nuclear pleomorphism.*
Mycobacteria are:
- gram-negative cocci shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative rod shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative spiral shaped bacteria
Mycobacteria are: - gram-negative cocci shaped bacteria - gram-postive cocci shaped bacteria gram-negative rod shaped bacteria - gram-postive rod shaped bacteria - gram-negative spiral shaped bacteria
Dr de Silva, a junior doctor, spent 6 months working in a refugee camp in Thailand. She presents to her GP with fatigue, malaise and cough of one month’s duration occasionally productive of rust-coloured sputum. Dr de Silva has also noted 3 kg weight loss in the last month. She does not smoke. Her GP arranges for a chest x-ray, image shown on the left. The radiologist phones the GP because she is concerned about the abnormalities shown by the arrows. **Q3a: What is the most likely diagnosis in this patient?** **Q3b: What type of abnormality(s) does the chest x-ray show? Describe in detail**. **Q3c: What are risk factors for the disease Dr de Silva most likely has? – list a minimum of three (they do not have to be specific to Dr de Silva).**
Dr de Silva, a junior doctor, spent 6 months working in a refugee camp in Thailand. She presents to her GP with fatigue, malaise and cough of one month’s duration occasionally productive of rust-coloured sputum. Dr de Silva has also noted 3 kg weight loss in the last month. She does not smoke. Her GP arranges for a chest x-ray, image shown on the left. The radiologist phones the GP because she is concerned about the abnormalities shown by the arrows. Q3a: What is the most likely diagnosis in this patient? **Patient’s symptoms and chest x-ray suggest primary TB** Q3b: What type of abnormality(s) does the chest x-ray show? Describe in detail. **Ghon foci – little arrow; primary TB site Enlarged hilar lymph nodes – big arrow – together called a Ghon COMPLEX. Consistent with primary TB (vs reactivation TB)** Q3c: What are risk factors for the disease Dr de Silva most likely has? – list a minimum of three (they do not have to be specific to Dr de Silva). **Recent arrival or travel country where TB endemic Work in areas endemic for TB HIV Poorly controlled Type 2 Diabetes Mellitus Other immunocompromise states (i.e. cancer for which patient undergoing chemotherapy) Homeless Drug users, prison inmates Close contacts of patients with MTB disease**
Q2: Please list the four first line medications used to treat TB, and for each medication one described side effect
**Rifampicin**: Raised transaminases & induces cytochrome P450; Orange secretions / urine **Isoniazid**: Peripheral neuropathy (prevent with pyridoxine 10mg od); Hepatotoxicity **Pyrazinamide**:Hepatotoxicity **Ethambutol**: Visual disturbance
Lara B, a 50 year old homeless woman living in London, presents to a shelter. The shelter staff note her weight has dropped 5 kg since her last visit 6 months ago, and on talking with Lara she states that she has had cough, haemoptysis, and night sweats for the past month or so. Concerned about infection with Mycobacterium tuberculosis the patient is referred to a clinic where a sputum smear is negative for acid-fast bacillus, and both a PPD and an Interferon gamma release assay are negative. What can be concluded about Lara’s condition? - The negative PPD makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - The negative interferon gamma release assay makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - The negative sputum smear rules out active Mycobacterium tuberculosis disease in Lara - The fact that the PPD, interferon gamma release assay and sputum smear are all negative makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - The fact that the PPD, interferon gamma release assay and sputum smear are all negative does not rule out the possibility of Mycobacterium tuberculosis disease.
Lara B, a 50 year old homeless woman living in London, presents to a shelter. The shelter staff note her weight has dropped 5 kg since her last visit 6 months ago, and on talking with Lara she states that she has had cough, haemoptysis, and night sweats for the past month or so. Concerned about infection with Mycobacterium tuberculosis the patient is referred to a clinic where a sputum smear is negative for acid-fast bacillus, and both a PPD and an Interferon gamma release assay are negative. What can be concluded about Lara’s condition? - The negative PPD makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - The negative interferon gamma release assay makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - The negative sputum smear rules out active Mycobacterium tuberculosis disease in Lara - The fact that the PPD, interferon gamma release assay and sputum smear are all negative makes the diagnosis of active Mycobacterium tuberculosis disease very unlikely - **The fact that the PPD, interferon gamma release assay and sputum smear are all negative does not rule out the possibility of Mycobacterium tuberculosis disease.** *The fact that the PPD, interferon gamma release assay and sputum smear are all negative does not rule out the possibility of Mycobacterium tuberculosis disease. *Sometimes patients with active MTB disease actually become anergic and will not react to the PPD test nor have a positive interferon gamma release assay. A negative sputum test SMEAR also does not rule out active disease – it may be negative in early TB or because the patient produced a weak cough. Furthermore, people with HIV/AIDS – and Lara is also at risk for HIV/AIDS – are more likely to have negative sputum smears. To definitively rule out MTB disease we have to wait for the **sputum** cultures.*
Which cells make CXCL8? [1]
What is the role of CXCL8? [1]
CXCL8 made by macrophages
Acts a neutrophil attractant
Which of the following is caused by hypoventilation?
1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis
Which of the following is caused by hypoventilation?
- *1) Respiratory acidosis**
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis
Respiratory acidosis causes:
Decreased Ca2+ levels
Increased Ca2+ levels
Increased K+ levels
Decreased K+ levels
Respiratory acidosis causes:
Decreased Ca2+ levels
Increased Ca2+ levels
Increased K+ levels
Decreased K+ levels
Which of the following reduces the activity of carbonic anhydrase
1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis
Which of the following reduces the activity of carbonic anhydrase
1) Respiratory acidosis
* *2) Respiratory alkalosis**
3) Metabolic acidosis
4) Metabolic alkalosis
TB is an infection predominately caused by which bacteria? [1]
Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis
mycobacterium tuberculosis are:
- gram-negative cocci shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative rod shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative spiral shaped bacteria
mycobacterium tuberculosis are:
- gram-negative cocci shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative rod shaped bacteria
- gram-postive cocci shaped bacteria
- gram-negative spiral shaped bacteria
Which of the following would stain mTB fluorescent?
Orcein
Ziehl-neelsen
H&E
Gram stain
Auramine
Which of the following would stain mTB fluorescent?
Orcein
Ziehl-neelsen
H&E
Gram stain
Auramine
Which of the following would stain mTB red / pink?
Orcein
Ziehl-neelsen
H&E
Gram stain
Auramine
Which of the following would stain mTB red/pink?
Orcein
Ziehl-neelsen
H&E
Gram stain
Auramine
What do macrophages produce in response to mTB that is used as a test of infection? [1]
IFN-y [1]
Which of the following is where the lymphocytes are located in the lymph node? A B C D E F
Which of the following is where the lymphocytes are located in the lymph node? A B C **D** : cortex E F
Where is the primary site of cancer for elevated virchows node? [1]
GI cancer
Which are more likely to develop cancer: Anterior cervical nodes Deep cervical nodes
Which are more likely to develop cancer: Anterior cervical nodes **Deep cervical nodes**
Which of the following recieves lymphatric drainage from the heart? Interpulmonary nodes Superior tracheobronchial nodes Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels
Which of the following recieves lymphatric drainage from the heart? Interpulmonary nodes Superior tracheobronchial nodes **Inferior tracheobronchial nodes** Bronchomediastinal trunks Interlobar lymph vessels
Which of the following is located around the hilum of the lung? Interpulmonary nodes Superior tracheobronchial nodes Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels
Which of the following is located around the hilum of the lung? Interpulmonary nodes **Superior tracheobronchial nodes** Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels
Which lymph nodes are swollen here?
Deep cervical
Superficial cervical
Occipital
Posterior auricular
Which lymph nodes are swollen here?
Deep cervical
Superficial cervical
Occipital
Posterior auricular
What is the most likely cause of this swollen arm?
Radical neck dissection
Laceration of the thoracic duct
Liver metastasis blocking ducts
Radical masectomy
What is the most likely cause of this swollen arm?
Radical neck dissection
Laceration of the thoracic duct
Liver metastasis blocking ducts
Radical masectomy
Which of the following is responsible for mast cell proliferation in asthma Ptx?
IL-5
IL-6
IL-7
IL-8
IL-9
Which of the following is responsible for mast cell proliferation in asthma Ptx?
IL-5
IL-6
IL-7
IL-8
IL-9
Which of the following is responsible for eosinophil cell activation in asthma Ptx?
IL-5
IL-6
IL-7
IL-8
IL-9
Which of the following is responsible for eosinophil cell activation in asthma Ptx?
IL-5
IL-6
IL-7
IL-8
IL-9
In non-asthmatic Ptx the response to allergen is driven by:
IgA
IgE
IgG
IgD
IgM
In non-asthmatic Ptx the response to allergen is driven by:
IgA
IgE
IgG
IgD
IgM
What happens to FEV1 and FVC in an obstructive lung disease? [2]
In obstructive lung diseases there is a larger decrease in FEV1 than FVC. As a result, the FEV1/FVC ratio is lower than in normal patients. These patients have difficulty getting air out of their lungs and the hyperinflated lungs can be seen on a chest X-ray.
A 70-year-old man presents with a 3-month history of a dry persistent cough and unintentional weight loss of around 5kg. He denies chest pain, dyspnoea, fever and haemoptysis. He has a history of COPD (chronic obstructive pulmonary disease) and smokes 10 cigarettes a day for the last 50 years.
A nodule is found on chest x-ray. Biopsy reveals a tumour arising from the bronchial glands.
Which of the following is the most likely diagnosis?
Adenocarcinoma of the lung
Sarcoidosis
Small cell cancer of the lung
Squamous cell cancer of the lung
Bronchitis
A 70-year-old man presents with a 3-month history of a dry persistent cough and unintentional weight loss of around 5kg. He denies chest pain, dyspnoea, fever and haemoptysis. He has a history of COPD (chronic obstructive pulmonary disease) and smokes 10 cigarettes a day for the last 50 years.
A nodule is found on chest x-ray. Biopsy reveals a tumour arising from the bronchial glands.
Which of the following is the most likely diagnosis?
Adenocarcinoma of the lung: is the most common cause of lung caner
Sarcoidosis
Small cell cancer of the lung
Squamous cell cancer of the lung
Bronchitis
A 54-year-old woman presents to clinic with a worsening cough and sputum production over the last year. The patient also reported feeling short of breath and quite tired. She said it was the 4th time she had had a chest infection in the last 12 months, having been treated each time with antibiotics. She has no past medical or family history of lung problems and has never smoked.
The clinician suspects bronchiectasis might be the cause of her problems and ordered the appropriate investigations.
Which investigation is most likely to give a definitive diagnosis?
Chest radiography
High resolution CT
Histopathology
Pulmonary function test
Sputum culture
A 54-year-old woman presents to clinic with a worsening cough and sputum production over the last year. The patient also reported feeling short of breath and quite tired. She said it was the 4th time she had had a chest infection in the last 12 months, having been treated each time with antibiotics. She has no past medical or family history of lung problems and has never smoked.
The clinician suspects bronchiectasis might be the cause of her problems and ordered the appropriate investigations.
Which investigation is most likely to give a definitive diagnosis?
Chest radiography
High resolution CT
Histopathology
Pulmonary function test
Sputum culture
Characteristic feature include:
- Bronchial wall dilation
- Lack of bronchial tapering
A 42-year-old woman presents for an outpatient appointment in the respiratory clinic, she has recently been feeling more breathless, especially at night. She has a past medical history of long-standing COPD, heart failure and previous breast cancer which was treated with a mastectomy and radiotherapy. She is an ex-smoker of 20 cigarettes a day for 22 years.
Her respiratory rate is 23/min, oxygen saturations are 93%, blood pressure is 124/98mmHg, and temperature is 37.2ºC. A gas transfer test is done and her transfer factor is low.
What diagnosis is most likely?
Asthma
Pulmonary oedema
Polycythemia
Pulmonary haemorrhage
Left to right cardiac shunt
A 42-year-old woman presents for an outpatient appointment in the respiratory clinic, she has recently been feeling more breathless, especially at night. She has a past medical history of long-standing COPD, heart failure and previous breast cancer which was treated with a mastectomy and radiotherapy. She is an ex-smoker of 20 cigarettes a day for 22 years.
Her respiratory rate is 23/min, oxygen saturations are 93%, blood pressure is 124/98mmHg, and temperature is 37.2ºC. A gas transfer test is done and her transfer factor is low.
What diagnosis is most likely?
Asthma
Pulmonary oedema
Polycythemia
Pulmonary haemorrhage
Left to right cardiac shunt
A 68-year-old male with known chronic obstructive pulmonary disease (COPD) has been admitted and treated for infective exacerbations of COPD three times in the last year. Despite his chest problems he continues to smoke. His only current regular treatment is a short-acting beta2-agonist. He is now attending his COPD patient review with the nurse practitioner at his local general practice. The spirometry results show that his FEV1 has dropped from 65% to 58%.
What is the most effective management to slow any further reduction to his FEV1?
Add a LABA and a LAMA
And a LABA and ICS
Smoking cessation
Add theophylline
Add oral prenisolone
A 68-year-old male with known chronic obstructive pulmonary disease (COPD) has been admitted and treated for infective exacerbations of COPD three times in the last year. Despite his chest problems he continues to smoke. His only current regular treatment is a short-acting beta2-agonist. He is now attending his COPD patient review with the nurse practitioner at his local general practice. The spirometry results show that his FEV1 has dropped from 65% to 58%.
What is the most effective management to slow any further reduction to his FEV1?
Add a LABA and a LAMA
And a LABA and ICS
Smoking cessation
Add theophylline
Add oral prenisolone
A neonate born at term 12-hours ago by spontaneous vaginal delivery is reviewed by a paediatrician due to increased work of breathing.
On examination, there is moderate subcostal and intercostal recession and the neonate appears tachypnoeic. His temperature is 38.9ºC. A chest x-ray is requested, showing some consolidation in the right lower zone. The neonate is started on broad-spectrum antibiotics.
The neonate’s oxygen dissociation curve shows a leftward shift relative to the standard adult curve.
What is responsible for this appearance of the neonate’s oxygen dissociation curve?
Fetal HB
Hyperthermia
Increased 2,3 DPG
Lactic acidosis
Type 2 resp failure
A neonate born at term 12-hours ago by spontaneous vaginal delivery is reviewed by a paediatrician due to increased work of breathing.
On examination, there is moderate subcostal and intercostal recession and the neonate appears tachypnoeic. His temperature is 38.9ºC. A chest x-ray is requested, showing some consolidation in the right lower zone. The neonate is started on broad-spectrum antibiotics.
The neonate’s oxygen dissociation curve shows a leftward shift relative to the standard adult curve.
What is responsible for this appearance of the neonate’s oxygen dissociation curve?
Fetal HB
Hyperthermia
Increased 2,3 DPG
Lactic acidosis
Type 2 resp failure
The L rule
Shifts to L → Lower oxygen delivery, caused by
- Low [H+] (alkali)
- Low pCO2
- Low 2,3-DPG
- Low temperature
A pregnant woman has an arterial blood gas (ABG) carried out. What would be the expected result of a normal pregnant woman?
Resp. alkalosis
Metabolic alkalosis
Normal
Compensated resp. alkalosis
Compensated met. alkalosis
A pregnant woman has an arterial blood gas (ABG) carried out. What would be the expected result of a normal pregnant woman?
Resp. alkalosis
Metabolic alkalosis
Normal
Compensated resp. alkalosis
Compensated met alkalosis
Excessive vasodilation causes which type of shock?
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Excessive vasodilation causes which type of shock?
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Excessive vasodilation causes which type of shock?
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Excessive vasodilation causes which type of shock?
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Anaphylactic shock can be categorised as
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Anaphylactic shock can be categorised as
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Tension pneumothorax can be categorised as
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Tension pneumothorax can be categorised as
Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock
Neurogenic shock would cause which of the following type of shock?
Hypovolaemic shock
Obstructive shock
Distributive shock
Cardiogenic shock
Neurogenic shock would cause which of the following type of shock?
Hypovolaemic shock
Obstructive shock
Distributive shock
Cardiogenic shock
Which immunoglobin is associated with anaphylactic shock?
IgD
IgM
IgE
IgG
IgA
Which immunoglobin is associated with anaphylactic shock?
IgD
IgM
IgE
IgG
IgA
Which artery is most common to have a stroke in? [1]
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Basilar artery
AICA
Which artery is most common to have a stroke in? [1]
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Basilar artery
AICA
Watershed stroke is associated with which pathology? [1]
sepsis
Bronchial epithelial cells produce which molecule to attract eosinophils in asthmatic ptx? [1]
Which T-cell derived cytokine attracts eosinophils in asthmatic ptx? [1]
Mast cells release which type o molecules to attract eosinophils in asthmatic ptx? [1]
Bronchial epithelial cells produce which molecule to attract eosinophils in asthmatic ptx? [1]
- eotaxin
Which T-cell derived cytokine attracts eosinophils in asthmatic ptx? [1]
* IL-5
Mast cells release which type o molecules to attract eosinophils in asthmatic ptx? [1]
chemotactic factors
ICS reduces levels of which three molecules in asthma ptx? [3]
Reduces levels of CXCL8, IL-6, TNF-aO
A 27 year old man presents with chest pain, breathlessness and productive cough. His CXR shows sign of consolidation. What is the likely diagnosis?
Asthma
Bronchitis
Pneumonia
COPD
A 27 year old man presents with chest pain, breathlessness and productive cough. His CXR shows sign of consolidation. What is the likely diagnosis?
Asthma
Bronchitis
Pneumonia
COPD
An examination of an ECG trace revealed right axis deviation. What is the most likely pattern of the R wave as seen in the limb leads?
Leads I and III are pointing away from each other so lead II is negative
Leads II and III are pointing away from each other
Leads I and III are pointing towards each other
Leads II and III are pointing towards each other
An examination of an ECG trace revealed right axis deviation. What is the most likely pattern of the R wave as seen in the limb leads?
Leads I and III are pointing away from each other so lead II is negative
Leads II and III are pointing away from each other
Leads I and III are pointing towards each other
Leads II and III are pointing towards each other
ICS acts on which of the following in asthma ptx?
IL-4
IL-5
IL-6
IL-7
ICS acts on which of the following in asthma ptx?
IL-4
IL-5
IL-6
IL-7
(& TNF-a and CXCL8)
Which of the following attracts eosinophils in asthma ptx?
IL-4
IL-5
IL-6
IL-7
Which of the following attracts eosinophils in asthma ptx?
IL-4
IL-5
IL-6
IL-7
Dry powder inhalers should be taken in which of the following ways?
Quick and deep
Slow and steady
Slow and deep
Quick and steady
Dry powder inhalers should be taken in which of the following ways?
Quick and deep
Slow and steady
Slow and deep
Quick and steady
Aerosol asthma inhalers should be taken in which of the following ways?
Quick and deep
Slow and steady
Slow and deep
Quick and steady
Aerosol asthma inhalers should be taken in which of the following ways?
Quick and deep
Slow and steady
Slow and deep
Quick and steady
FEV1/ FVC below which of the following is an indication for COPD?
0.5
- 6
- 7
- 8
FEV1/ FVC below which of the following is an indication for COPD?
0.5
- 6
* *0.7** - 8
Label A-D
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation Aortic stenosis
Which of the following is depicted in this heart murmur? **Mitral regurgiation** Mitral stenosis Aortic regurgitation Aortic stenosis
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation Aortic stenosis
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation **Aortic stenosis**
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation Aortic stenosis
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis **Aortic regurgitation** Aortic stenosis
Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation Aortic stenosis
Which of the following is depicted in this heart murmur? Mitral regurgiation **Mitral stenosis** Aortic regurgitation Aortic stenosis
Which of the following depicts the Langhan cell in TB Ptx? A B C D
Which of the following depicts the Langhan cell in TB Ptx? A **B** C D
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma **Asthma** Squamous cell carnicoma *resp epithelium with goblet cell hyperplasia eosinophils in lam prop +++ thickened BM SM hypertrophy mucous in lumen*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia **TB** Small cell carcinoma Asthma Squamous cell carnicoma *Under the microscope multinucleate giant cells and granulomatosis are seen*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB **Small cell carcinoma** Asthma Squamous cell carnicoma *Multiple mitotic figures are identified as well as scattered apoptotic tumor cells. The finely dispersed or salt and pepper chromatin with no distinct nucleoli is apparent in many of the cells, although the crush artifact caused by the biopsy process can make this feature more difficult to distinguish. The small cells lie among a background of delicate stroma that is sparse compared to the dense sheet of tumor cells*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB **Small cell carcinoma** Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia **TB** Small cell carcinoma Asthma Squamous cell carnicoma *Caseous necrosis and granulomatosis*
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? **Pneumonia** TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma Squamous cell carnicoma
Which pathology is depicted here? Pneumonia TB Small cell carcinoma Asthma **Squamous cell carnicoma** *Squamous cell carcinoma, well differentiated: epithelium shows marked keratinization and minimal nuclear pleomorphism.*
Label A-D of this granuloma
Which of the following is lobal pneumonia and which is bronchopneumonia?
Left: **Bronchopneuomia** Right: **Lobal pneumonia**
What pathology is shown here? [1]
Emphysema *Abnormal enlargement of air spaces distal to the terminal bronchioles characterized by destruction of the alveolar septa with little or no fibrosis*
What changes do COPD small airways undergo with developement on the disease? [1]
COPD small airways demonstrate marked remodelling, with the **overall thickness of the airway wall increased** compared to smokers without airflow limitation - **epithelial changes** - **mucoid plugs** - **increased density of inflammatory cell** - **smooth muscle hyperplasia and fibrosis**
What is the metastasis shown here?
metastatic small cell carcinoma - blue cluster note: - orange myeloid precursors - fat cells - blue erythoid precursors - megakaryocytes
Which of the following micrographs is from an adenocarcinoma? A B C
Which of the following micrographs is from an adenocarcinoma? A **B** C
The photmicrograph shows alveoli with the arrow pointing to increased neutrophils within the alveoli. What is likely disease? A: Asthma B: Bronchial pneumonia C: Lobar pneumonia D: Neoplasia E: None of the above
The photmicrograph shows alveoli with the arrow pointing to increased neutrophils within the alveoli. What is likely disease? A: Asthma B: Bronchial pneumonia **C: Lobar pneumonia** D: Neoplasia E: None of the above
The photmicrograph shows bronchial wall from an asthma patient, what tissue abnormality is highlighted by the black arrow? A: Basement membrane thickening B: Eosinophilia C: Goblet cell hyperplasia D: Mucus secretion E: Muscular hyperplasia
A: Basement membrane thickening B: Eosinophilia C: Goblet cell hyperplasia D: Mucus secretion **E: Muscular hyperplasia **
What is the structure labelled with a star? A: Alveolus B: Bronchus C: Bronchiole D: Terminal Bronchiole E: Trachea
What is the structure labelled with a star? A: Alveolus B: Bronchus C: Bronchiole **D: Terminal Bronchiole** E: Trachea
Which of the following arrows shows a thickened basement membrane in asthma patient? A B C D
Which of the following arrows shows a thickened basement membrane? A B **C** D
Which of the following arrows shows smooth muscle hypertrophy ? A B C D
Which of the following arrows shows smooth muscle hypertrophy? A B C **D**
Which of the following arrows shows smooth eosinophils in lamina propria and epithelium? A B C D
Which of the following arrows shows smooth eosinophils in lamina propria and epithelium?Which of the following arrows shows pseudostratified columnar epithelium with goblet cell hyperplasia ? A **B** C D
What is the diagnosis from this histology? Adenocarnioma Small cell cancer Squamous cell cancer
What is the diagnosis from this histology? Adenocarnioma **Small cell cancer** : morphology where can only see nuclei - looks like nuclei molding Squamous cell cancer
Which of the following is the vagus nerve?
1
2
3
4
5
Which of the following is the vagus nerve?
1
2
3
4
5
Which leads have ST elevation in this ECG? [3]
II, III, aVF
Which coronary artery is most likely to have been affected by occlusion here?
Circumflex artery?
LAD
LCA
RCA
Which coronary artery is most likely to have been affected by occlusion here?
Circumflex artery?
LAD
LCA
RCA
What condition is shown here?
Upper Lobe Blood Diversion
Due to the increased pressures, blood is pushed upwards creating a ‘stag antler’ appearance. Blood is diverted as fluid is more likely to build up lower down due to gravity and cause relative hypoxia and vasoconstriction, thus the blood is diverted to the upper zones.
In the midline of this film, we can also see several sternal sutures.
What is the most common site for atherosclerotic plaque build up? [1]
Which area is most common for coronary artery athersclerotic plaque build up? [1]
Acceptable responses: Bifurcations, Bifurcation points, Points of bifurcation, Bifurcation
the anterior interventricular/left anterior descending branch being most commonly affected.
An 18 year-old pregnant patient has her 19 week ultrasound. A defect in the foetal heart is picked up.
The foetal heart is shown in the image. On the right is the Doppler image showing blood flow.
Based on your knowledge of congenital heart defects, which defect do you think the doppler image is demonstrating?
Transposition of the great vessels
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
An 18 year-old pregnant patient has her 19 week ultrasound. A defect in the foetal heart is picked up.
The foetal heart is shown in the image. On the right is the Doppler image showing blood flow.
Based on your knowledge of congenital heart defects, which defect do you think the doppler image is demonstrating?
Transposition of the great vessels
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
This image here shows the ventricles of the heart, and the mixing of blood between the ventricles indicates a ventricular septal defect (VSD)
Label A-D
A: Brachiocephalic B: Common carotid C: Internal carotid D: External Carotid
Label the vert. layers of A-D
The laryngeal prominence occurs at which vertebral level C3 C4 C5 C6 C7
The laryngeal prominence occurs at which vertebral level C3 **C4** C5 C6 C7
The vocal cords attach anteriorly to which cartilage? Cricoid cartilage Cuneiform cartilage Epiglottis Arytenoid cartilage Thyroid cartilage
The vocal cords attach anteriorly to which cartilage? Cricoid cartilage Cuneiform cartilage Epiglottis Arytenoid cartilage **Thyroid cartilage**
The vocal cords attach anteriorly to which of the following? Cricoid cartilage Cuneiform cartilage Epiglottis Arytenoid cartilage Thyroid cartilage
The vocal cords attach anteriorly to which of the following? Cricoid cartilage Cuneiform cartilage Epiglottis **Arytenoid cartilages** Thyroid cartilage
What are the effects of superior, internal and external branch palsies? [A&B]
A: reduced gag reflex B: reduced range of pitch
What would cause this pathology?
Could be caused by retinal HTN causing haemorrhage: cotton wool spots
What would cause this pathology?
Copper-wiring, arteriovenous nicking and silver-wiring seen in a patient with hypertensive retinopathy
Narrowing of retinal arteries / vaspconstriction
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
What type of mask is this?
Nasal Cannulae
Simple face mask
Non-rebreather mask (reservoir mask)
Venturi mask
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day coagulative necrosis
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week granulation occurring
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks scarring occurring
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week granulation
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
** Less than 1 day** coagualtive necrosis
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days accute inflam
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks scarring
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week granulation
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day coagulative necrosis
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
Summary of MI histology?
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day (12 hours)
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks
When would this histopatholigcal slide from an MI likely to have occurred
Less than 1 day
Less than 7 days
1-3 week
3-6 weeks scarring
Rheumatic fever is histologically identifiable which structures? [1]
Aschoffs bodies
Which of the following of A-C are:
Rheumatic mitral stenosis
Normal
Ashoff bodies
A: Normal
B: Ashoff bodies
C: Rheumatic mitral stenosis
Descibe what aschoff bodies are [2] and where they are found [1]
Aschoff are nodular inflammatory lesions found in the CT of the myocardium.
Aschoff bodies are areas of necrosis and large distinctive macrophages
Which substance is synthesised in the middle of theses structures?
Thyroglobulin (stores and secretes T3 & T4)
Which thyroid disease is depicted here? [1]
Hashimoto Thyroiditis
Label A-B of the parathyroid gland
A: Chief cells
B: oxyphil cells
Label A-D of the adrenal gland
A = zona glomerulosa, B = zona fasciculata, C = zona reticularis.
D = Medulla.
What is this depcited in pancreas?
Islet of Langerhans
Which cells have been stained in the islet of langerhans
Alpha cells
Beta cells
Delta cells
PP cells
Which cells have been stained in the islet of langerhans
Alpha cells
Beta cells : most abundant
Delta cells
PP cells
Which thyroid disease is depicted here? [1]
Graves
Follicular cells are taller and have larger nuclei.
Increased colloid use to produce T4 causes scalloping (S on right image).
Increased collide use also reduces the size of follicles.
Label A-F of the kidney
What do the arrows [1] and asterixes [1] depict of the kidney
Arrows: Renal corpsucles
*: collecting ducts
Label A & B of renal parenchyma
A: podocytes
B: basement membrane
Which of the following is the DCT and PCT? [2]
A: DCT
B: PCT
Which of the following is the DCT and PCT? [2]
Arrows: PCT
Arrowheads: DCT
Which is the loop of henle and which is the collecting duct?
C = CD
B: LoH
Label A-D of the ureter
A: transitional epithelium
B: LP
C: muscualris mucosa
D: adventitia
Label A-C of ureter
A: transitional epithelium
B: LP
C: muscularis
Label A-D of liver
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
What type of liver cancer is depicted here?
Metastatic adenocarcinoma
Hepatic carcinoma
Glial cells in the pituitary stalk are called WHAT? [1]
Pituicytes
Which of the following is the correct name for the piece of equipment shown in the image?
Nasal cannulae
Venturi mask
Nasopharyngeal airway
Reservoir mask
Hudson mask
Which of the following is the correct name for the piece of equipment shown in the image?
Nasal cannulae
Venturi mask
Nasopharyngeal airway
Reservoir mask
Hudson mask
A 36-year-old Norwegian female presents with a 4-month history of gradually progressive shortness of breath, a non-productive cough and fatigue. She also reports painful red lesions on her shins. She has no significant medical/surgical history and is on no regular medications. She has no family history of note. She is a non-smoker and non-drinker. She is married and works as a classroom assistant. Her review of systems is otherwise unremarkable.
She is afebrile and her vital signs are within normal limits. Respiratory examination is normal. On inspection of the lower limbs, there are tender erythematous nodules on the anterior aspects of her lower legs bilaterally.
Given the most likely underlying diagnosis, what is the most likely cause of the skin lesions on her lower limbs?
Necrobiosis lipoidica
Pyoderma gangrenosum
Acanthosis nigricans
Erythema multiforme
Erythema nodosum
Erythema nodosum
The most likely underlying diagnosis is sarcoidosis, given this patient’s Scandinavian ancestry, age, female gender and constellation of non-specific symptoms and signs. Erythema nodosum (painful, blue-red nodules most commonly affecting the shins) is associated with sarcoidosis. Other causes of erythema nodosum include TB, streptococci and certain drugs (eg. sulfonamides, dapsone, COCP).
A 36-year-old Norwegian female presents with a 4-month history of gradually progressive shortness of breath, a non-productive cough and fatigue. She also reports painful red lesions on her shins. She has no significant medical/surgical history and is on no regular medications. She has no family history of note. She is a non-smoker and non-drinker. She is married and works as a classroom assistant. Her review of systems is otherwise unremarkable.
She is afebrile and her vital signs are within normal limits. Respiratory examination is normal. On inspection of the lower limbs, there are tender erythematous nodules on the anterior aspects of her lower legs bilaterally.
Given the most likely underlying diagnosis, what is the most likely cause of the skin lesions on her lower limbs?
Necrobiosis lipoidica
Pyoderma gangrenosum
Acanthosis nigricans
Erythema multiforme
Erythema nodosum
Erythema nodosum
The most likely underlying diagnosis is sarcoidosis, given this patient’s Scandinavian ancestry, age, female gender and constellation of non-specific symptoms and signs. Erythema nodosum (painful, blue-red nodules most commonly affecting the shins) is associated with sarcoidosis. Other causes of erythema nodosum include TB, streptococci and certain drugs (eg. sulfonamides, dapsone, COCP).
This would cause which type of shock?
Hypovolaemic
Cardiogenic
Distributive
Obstructive
This would cause which type of shock?
Hypovolaemic
Cardiogenic
Distributive loss of sympathetic tone and thus unopposed parasympathetic response driven by the vagus nerve. Consequently, patients suffer from instability in blood pressure,
Obstructive
What does this histology depict?
Chronic myeloid leukemia
Acute myeloid leukemia
Chronic lymphocytic leukemia
Acute lymphocytic leukemia
What does this histology depict?
Chronic myeloid leukemia
Acute myeloid leukemia
Chronic lymphocytic leukemia
Acute lymphocytic leukemia
prominent myeloid hyperplasia without significant increase in blasts
This slide depicts which of the following
Chronic myeloid leukemia
Acute myeloid leukemia
Chronic lymphocytic leukemia
Acute lymphocytic leukemia
This slide depicts which of the following
Chronic myeloid leukemia
Acute myeloid leukemia
Chronic lymphocytic leukemia
Acute lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
C. Acute lymphocytic leukemia
In acute lymphoblastic leukemia (ALL), too many immature lymphocytes are present in the bone marrow and the blood. Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces. This slide shows many more immature lymphocytes than you would typically expect to see in a blood smear.
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
B. Chronic myelogenous leukemia
Chronic Myelogenous Leukemia (CML) is a form of leukemia caused by a chromosomal translocation known as the Philadelphia chromosome, which you will study in detail in Genetics. It is characterized by the unregulated growth of myeloid cells in the bone marrow, resulting in the presence of large numbers of mature and immature granulocytes in both the bone marrow and the blood.
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
Lymphocytes are small, mature without nucleoli, several smudged cells are present (high power).
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
What does this slide depict?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Acute lymphocytic leukemia
D. Chronic lymphocytic leukemia
Which of the following acts a receptor for von Willebrand Factor (vWF)
P2Y12
COX-1
TXA2
Glycoprotein IIb/IIIa
Which of the following acts a receptor for von Willebrand Factor (vWF)
P2Y12
COX-1
TXA2
Glycoprotein IIb/IIIa
This diagram depicts platelet adhesion to endothelium
Which of the following is VWF
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is VWF
A
B
C
D
glycoprotein IIb/IIIa (GPIIb/IIIa) an integrin complex found on platelets. It is a receptor for fibrinogen[1] and von Willebrand factor and aids platelet activation. The complex is formed via calcium-dependent association of gpIIb and gpIIIa, a required step in normal platelet aggregation and endothelial adherence
This diagram depicts platelet adhesion to endothelium
Which of the following is fibrinogen
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is fibrinogen
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is GpIIb/IIIa
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is GpIIb/IIIa
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is GpIb
A
B
C
D
This diagram depicts platelet adhesion to endothelium
Which of the following is GpIb
A
B
C
D
Which of the following prevents the conversion of arachidonic acid to thromboxane A2
Heparin
Warfarin
Aspirin
Dabigatran
Edoxaban
Which of the following prevents the conversion of arachidonic acid to thromboxane A2
Heparin
Warfarin
Aspirin
Dabigatran
Edoxaban
Explain the mechanism of action of aspirin [3]
Non-selective for COX-1 and COX 2 enzymes (prevent aggregation)
COX 2 inhibition prevents arachidonic acid conversion to Thromboxane A2
Thus preventing Thromboxane A2 formation, preventing platelet aggregation.
Describe MoA of the DOACs:
Rivaroxaban
Apixaban
Edoxaban
Direct factor Xa inhibitor (more modern version of heparin)
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with left ventricular hypertrophy?
A
B
C
D
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with left ventricular hypertrophy?
A
B
C
D
Left ventricular hypertrophy results in a thickening of the cardiac muscle. The increase in mass increases the magnitude of the depolarisation wave on the left side of the heart. This causes the left axis deviation.
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with normal heart?
A
B
C
D
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with normal heart?
A : normal heart axis = -30 to 90 degrees
B
C
D
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with right ventricular hypertrophy?
A
B
C
D
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with right ventricular hypertrophy?
A
B
C
D = 90 to 180 degrees
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with extreme axis deviation?
A
B
C
D
Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with extreme axis deviation?
A
B
C
D
Absent Q waves in V5-6 is most commonly due to:
LBBB
Mobitz type 1 AV block
RBBB
Wolff-Parkinson-White (WPW)
Mobitz type 2 AV block
Absent Q waves in V5-6 is most commonly due to:
LBBB
Mobitz type 1 AV block
RBBB
Wolff-Parkinson-White (WPW)
Mobitz type 2 AV block
What is the axis deviation of a healthy heart? [1]
Right axis deviation ranges between which degrees? [1]
Left axis deviation ranges between which degrees? [1]
Normal: -30° and +90º
Right axis deviation: +90º and +180º
Left axis deviation: -30° and -90°.
Which lead would you expect to see the biggest negative deflection in a healthy heart?
avL
avF
avR
Lead I
Lead II
Which lead would you expect to see the biggest negative deflection in a healthy heart?
avL
avF
avR
Lead I
Lead II
This is due to aVR looking at the heart in the opposite direction.
Name the diuretic that works by blocking epithelial sodium channels in in the late DCT, collecting tubules and collecting ducts
Amiloride
Spironolactone
Atenolol
Propranolol
Carvedilol
Name the diuretic that works by blocking epithelial sodium channels in in the late DCT, collecting tubules and collecting ducts
Amiloride
Spironolactone
Atenolol
Propranolol
Carvedilol
Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate [2]
Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin
Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate
Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin
