CR2 Questions Flashcards

Question

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

Answer 1

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)*

Answer 2

Acceptable responses: **Alveoli, Alveolar sacs**

Answer 3

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.**

Answer 4

A ventricular septal defect (VSD) is most commonly a failure of which component of the septum development? **Membranous** Muscular

Answer 5

Which pathology is depicted here? Kerley B lines Cardiomegaly Upper Lobe Diversion Pleural effusion Fluid leak into alveoli

Answer 6

Which pathology is depicted here? **Kerley B lines** Cardiomegaly Upper Lobe Diversion Pleural effusion Fluid leak into alveoli

Answer 7

Which pathology is depicted here? Kerley B lines Cardiomegaly Upper Lobe Diversion **Pleural effusion** Fluid leak into alveoli

Answer 8

Which pathology is depicted here? Kerley B lines Cardiomegaly **Upper Lobe Diversion** Pleural effusion Fluid leak into alveoli

Answer 9

Which pathology is depicted here? Kerley B lines Cardiomegaly Upper Lobe Diversion Pleural effusion **Fluid leak into alveoli**

Answer 10

Which form is iron stored in cell? **Ferritin** Ferroportin Hepcidin Transferrin Haem

Answer 11

Name the transport channel that Fe2+ leaves the cell via [1] **Ferroportin** Name the molecule that transports Fe3+ around the body [1] **transferrin**

Answer 12

serum ferritin tests are used to diagnoise irone deficiency anaemia. But ferritin is released if have inflammation from the liver - so may mask anaemia

Answer 13

Where is EPO made? Myeloid tissue **Kidney** Liver Heart Spleen

Answer 14

Which of the following allows Fe into the cell? **DMT1** DMT2 DMT3 SGLT1 GLUT2

Answer 15

Which of the following blocks ferroportin? transferrin ferritin DMT1 Haem **Hepcidin**

Answer 16

Where is transferrin mainly taken up? **Myeloid tissue** Kidney Liver Heart Spleen

Answer 17

Which of the following is the where erythrocytes are produced at 6 weeks old? **liver** spleen yolk sac bone marrow

Answer 18

Which of the following is the where erythrocytes are produced at 3 weeks old? liver spleen **yolk** **sac** bone marrow

Answer 19

Which of the following is the where erythrocytes are produced at 8 weeks old? liver **spleen** yolk sac bone marrow

Answer 20

Which of the following is excreted in urine? **urobilinogen** stercobilin bilirubin glucoronic acid unconjugated bilirubin

Answer 21

Which of the following is excreted in faeces? urobilinogen **stercobilin** bilirubin glucoronic acid urobilin

Answer 22

Which of the following is excreted in urine? urobilinogen stercobilin bilirubin glucoronic acid **urobilin**

Answer 23

Anaemia from which of the following causes the image below? **B12 deficiency: glossitis** Lead poisoning Thalassemia Iron deficiency

Answer 24

Anaemia from which of the following causes the image below? B12 deficiency Lead poisoning Thalassemia **Iron deficiency**

Answer 25

Anaemia from which of the following causes the image below? B12 deficiency Lead poisoning Thalassemia **Iron deficiency**

Answer 26

Anaemia from which of the following causes the image below? B12 deficiency Lead poisoning **Thalassemia** Iron deficiency

Answer 27

Which part of platelet structure contains pro-coagulant factors? Membrane **Alpha granules** Dense granules Metabolites

Answer 28

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**

Answer 29

Which is most likely to caused by liver toxicity or alcohol poisoning? Macrocytic Microcytic Normocytic Megaloblastic **Macronormoblastic**

Answer 30

Which is most likely to caused by IDA? Macrocytic **Microcytic** Normocytic Megaloblastic Macronormoblastic

Answer 31

Which is most likely to caused by pernicious anaemia? **Macrocytic** Microcytic Normocytic **Megaloblastic** Macronormoblastic

Answer 32

Which is most likely to caused by B12 or folate deficiency? **Macrocytic** Microcytic Normocytic **Megaloblastic** Macronormoblastic

Answer 33

The results in this blood film would indicate which of the following? Macrocytic Microcytic Normocytic **Megaloblastic** Macronormoblastic

Answer 34

Haemolytic anaemia

Answer 35

Which of the following causes haemolytic anaemia if in cold conditions? **IgM** IgA IgE IgD IgG

Answer 36

Which of the following causes haemolytic anaemia if in warm conditions? IgM IgA IgE IgD **IgG**

Answer 37

Folate is used to make which of the following? Uracil Adenine Guanosine **T****hymidine** Cytosine

Answer 38

What is the inheritance pattern of G6PD deficiency? Autosomal dominant Autosomal recessive Y-linked **X-linked**

Answer 39

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**

Answer 40

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.)***

Answer 41

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*

Answer 42

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.**

Answer 43

What does this ECG indicate? Atrial fibrillation **Ventricular fibrillation** Atrial flutter AVN reentrant tachycardia Junctional Rhythm

Answer 44

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**

Answer 45

What does this ECG indicate? **STEMI** Non STEMI Atrial Flutter Atrial Fibrillation AVN Reentrant Tachycardia

Answer 46

What does this ECG indicate? STEMI Non STEMI Atrial Flutter **Atrial Fibrillation: lack of P wave** AVN Reentrant Tachycardia

Answer 47

What does this ECG indicate? STEMI **Non STEMI** Atrial Flutter Atrial Fibrillation AVN Reentrant Tachycardia

Answer 48

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block **Wolf-Parkinson-White Syndrome** AVN Reentrant Tachycardia Atrial Flutter

Answer 49

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block Wolf-Parkinson-White Syndrome AVN Reentrant Tachycardia **Atrial Flutter: saw toothed !!**

Answer 50

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block Wolf-Parkinson-White Syndrome AVN Reentrant Tachycardia Atrial Flutter

Answer 51

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.**

Answer 52

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

Answer 53

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**](https://www.osmosis.org/learn/Atrioventricular_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.**

Answer 54

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

Answer 55

Right bundle branch block

Answer 56

Left branch bundle block

Answer 57

``` A = Afib B = Atrial flutter (saw toothed) ```

Answer 58

What is the normal duration of a QRS complex? \<1.5 seconds * \< 0.8 seconds * **\< 0.12 seconds** * \> 0.8 seconds * \>0.1 seconds

Answer 59

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”.**

Answer 60

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.)**

Answer 61

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**

Answer 62

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

Answer 63

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*

Answer 64

Alpha globin gene is found on: Chromosome 12 Chromosome 8 Chromsome 15 **Chromosome 16** Chromsome 4

Answer 65

Beta globin gene is found on: **Chromosome 11** Chromosome 14 Chromsome 9 Chromosome 16 Chromsome 2

Answer 66

Which of the following represents the structure of fetal Hb? - α2, β2 - α2, ζ2 * *- α2, Y2** - α2, δ2 - δ2, β2

Answer 67

Which of the following represents the structure of adult Hb A? * *- α2, β2** - α2, ζ2 - α2, Y2 - α2, δ2 - δ2, β2

Answer 68

Which of the following represents the structure of adult Hb A2? - α2, β2 - α2, ζ2 - α2, Y2 - **α2, δ2** - δ2, β2

Answer 69

A = V1-V4: **LAD** B: II, III & AVF: **Right coronary artery** C: I, V5 & V6: **circumflex**

Answer 70

Which artery is occluded to cause this ECG? **\*\*a) LAD**: Anterior ST elevation: V1-V4 elevated \*\*b) RCA c) LCA d) circumflex artery

Answer 71

Which artery is occluded to cause this ECG? \*\*a) LAD: Anterior ST elevation: V1-V4 elevated \*\*b) RCA c) LCA d) circumflex artery

Answer 72

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**

Answer 73

Pathological **Q waves** on **V1-V3** Q wave has to be first inversion

Answer 74

Von Willebrand Factor is a carrier for which of the following? Factor VII **Factor VIII** Factor IX Factor X Factor XI

Answer 75

Warfarin is an antagonist to which vitamin? Vitamin C Vitamin B **Vitamin K** Vitamin A Vitamin E

Answer 76

reduces levels of **factor II, VII, IX, X** - reducing clotting ability.

Answer 77

Which of the following describes the inheritance for thalassaemia? Autosomal dominant **Autosomal recessive** X dominant X recessive Y linked

Answer 78

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

Answer 79

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

Answer 80

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**

Answer 81

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

Answer 82

Yolk Sac / A: **Z2, E2** Fetal liver / B: **A2, γ2** Bone marrow / C: **A2, B2**

Answer 83

fascia adherens desmosomes gap junctions

Answer 84

\*\*purkinje fibres\*\*

Answer 85

A: \*\*tunica adventitia\*\* B: \*\*tunica media\*\* C: \*\*endothelial cell\*\*

Answer 86

blood flow within the capillary bed is controlled by \*\*arterioles\*\* [1] and \*\*precapillary sphincters\*\*

Answer 87

Heart valves: A: Fibrosa B: Spongiosum C: Ventricularis

Answer 88

\*\*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.

Answer 89

1. \*\*Lipids\*\* (intracellular & extracellular) 2. \*\*Connective tissue\*\* - collagen & fibrin 3. \*\*Cells\*\* - macrophages & smooth muscle

Answer 90

A = thickened arterial wall. B = intraluminal haemorrhage. C = ulceration.

Answer 91

A = adventitia. B = lipid core. C = fibrous cap.

Answer 92

Which is the most common cause of heart failure? **Coronary artery disease** Anaemia Hypertension Cardiomyopathy Valvular heart disease

Answer 93

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.

Answer 94

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**

Answer 95

sublingual GTN [1]

Answer 96

Stop Warfarin [0.5] Give patient vitamin K [0.5] Because warfarin is a vitamin K antagonist [1]

Answer 97

1. Low molecular weight heparin [1] 2. Thrombolytics [1] only indicated for very serious PE e.g. occluding both pulm arts due to significant side effects

Answer 98

P2Y12 antagonist used as part of post-MI anti-platelet therapy

Answer 99

P2Y₁₂ receptor is involved in [platelet aggregation](https://en.wikipedia.org/wiki/Platelet_aggregation#Adhesion_and_aggregation)

Answer 100

The length of murmur that correlates to intensity of pathology occurs with which of the following? Mitral regurgitation **Mitral stenosis** Aortic regurgitation Aortic stenosis

Answer 101

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

Answer 102

**DLCO = Lung surface area available for gas exchange (Va) X rate of capillary blood CO uptake (Kco)** _Kco is particularly affected by IPF_

Answer 103

Nasopharyngitis is mostly commonly caused by which of the following? Adenoviruses Echoviruses Coronaviruses **Rhinoviruses**

Answer 104

**Toll-like receptors [1]** **Retinoic acid-inducible gene-I-like (RIG) receptors [1]**

Answer 105

TNF-alpha IFN CXCL8

Answer 106

Streptococcus pneumoniae

Answer 107

Secondary haemostasis

Answer 108

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

Answer 109

MI [1] Hyperkalemia [1]

Answer 110

**Junctional rhythm:** lack of P wave; bradycardia

Answer 111

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

Answer 112

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

Answer 113

What does this ECG indicate? Atrial fibrillation **Ventricular fibrillation** Atrial flutter AVN reentrant tachycardia Junctional Rhythm

Answer 114

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**

Answer 115

What does this ECG indicate? **STEMI** Non STEMI Atrial Flutter Atrial Fibrillation AVN Reentrant Tachycardia

Answer 116

What does this ECG indicate? STEMI Non STEMI Atrial Flutter **Atrial Fibrillation: lack of P wave** AVN Reentrant Tachycardia

Answer 117

What does this ECG indicate? STEMI **Non STEMI** Atrial Flutter Atrial Fibrillation AVN Reentrant Tachycardia

Answer 118

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block **Wolf-Parkinson-White Syndrome** AVN Reentrant Tachycardia Atrial Flutter

Answer 119

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block Wolf-Parkinson-White Syndrome AVN Reentrant Tachycardia **Atrial Flutter: saw toothed !!**

Answer 120

What does this ECG indicate? Type 1 Heart Block Type 3 Heart Block Wolf-Parkinson-White Syndrome AVN Reentrant Tachycardia Atrial Flutter

Answer 121

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.**

Answer 122

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

Answer 123

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**](https://www.osmosis.org/learn/Atrioventricular_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.**

Answer 124

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

Answer 125

Right bundle branch block

Answer 126

``` A = Afib B = Atrial flutter (saw toothed) ```

Answer 127

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.**

Answer 128

**What view of the heart do leads V3 and V4 represent?** Septal Lateral **Anterior** Inferior

Answer 129

**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.*

Answer 130

**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.*

Answer 131

**What is the duration of a normal PR-interval?** 0. 04-0.12 secs 0. 04-0.08 secs 0.08-0.12 secs **0.12-0.2 secs**

Answer 132

**Which of the following is a common cause of right axis deviation?** VSD ASD **Right ventricular hypertrophy** Left ventricular hypertrophy

Answer 133

**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

Answer 134

**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

Answer 135

**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.*

Answer 136

**What view of the heart do leads I, aVL, V5 and V6 represent?** Anterior Inferior **Lateral** Septal

Answer 137

**What would it suggest if lead I became more positive than lead II and lead III became negative?** **Left axis deviation** Right axis deviation

Answer 138

**What is the most common cause of left axis deviation?** Right ventricular hypertrophy ASD **Defects of the conducting system** Left ventricular hypertrophy

Answer 139

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**.

Answer 140

How much fluid needs to accumulate in the pleura before it is visible on CXR 100ml **200ml** 300ml 400ml 500ml

Answer 141

BUT: more often dont actually know / cant ID the cause Streptococcus pneumoniae= 50% Haemophilus influenzae = 20%

Answer 142

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 f**luid 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**

Answer 143

Which of the following is the most common cause of heart failure? 1. **Coronary artery disease** 2. Hypertension 3. Valvular disease 4. Myocarditis

Answer 144

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).*

Answer 145

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.*

Answer 146

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.*

Answer 147

Middle cerrebral artery

Answer 148

3 Ps! PE Pulmonary oedema Pneumonia

Answer 149

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*

Answer 150

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

Answer 151

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

Answer 152

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.*

Answer 153

* **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

Answer 154

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

Answer 155

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

Answer 156

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.*

Answer 157

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.*

Answer 158

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.*

Answer 159

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*

Answer 160

Orthopnoea can differentiate heart failure from COPD [1]

Answer 161

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.*

Answer 162

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

Answer 163

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.*

Answer 164

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\*

Answer 165

Which pathology is depicted here? Pneumonia \*\*TB\*\* Small cell carcinoma Asthma Squamous cell carnicoma \*Under the microscope multinucleate giant cells and granulomatosis are seen\*

Answer 166

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\*

Answer 167

Which pathology is depicted here? Pneumonia TB \*\*Small cell carcinoma\*\* Asthma Squamous cell carnicoma

Answer 168

Which pathology is depicted here? Pneumonia \*\*TB\*\* Small cell carcinoma Asthma Squamous cell carnicoma \*Caseous necrosis and granulomatosis\*

Answer 169

Which pathology is depicted here? \*\*Pneumonia\*\* TB Small cell carcinoma Asthma Squamous cell carnicoma

Answer 170

\* 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.

Answer 171

\*\*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]

Answer 172

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.\*

Answer 173

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

Answer 174

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\*\*

Answer 175

\*\*Rifampicin\*\*: Raised transaminases & induces cytochrome P450; Orange secretions / urine \*\*Isoniazid\*\*: Peripheral neuropathy (prevent with pyridoxine 10mg od); Hepatotoxicity \*\*Pyrazinamide\*\*:Hepatotoxicity \*\*Ethambutol\*\*: Visual disturbance

Answer 176

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.\*

Answer 177

CXCL8 made by **macrophages** Acts a **neutrophil** attractant

Answer 178

Which of the following is caused by hypoventilation? * *1) Respiratory acidosis** 2) Respiratory alkalosis 3) Metabolic acidosis 4) Metabolic alkalosis

Answer 179

Respiratory acidosis causes: Decreased Ca2+ levels **Increased Ca2+ levels** Increased K+ levels Decreased K+ levels

Answer 180

Which of the following reduces the activity of carbonic anhydrase 1) Respiratory acidosis * *2) Respiratory alkalosis** 3) Metabolic acidosis 4) Metabolic alkalosis

Answer 181

Tuberculosis (TB) is an infection caused by **Mycobacterium tuberculosis**

Answer 182

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

Answer 183

Which of the following would stain mTB fluorescent? Orcein Ziehl-neelsen H&E Gram stain **Auramine**

Answer 184

Which of the following would stain mTB red/pink? Orcein **Ziehl-neelsen** H&E Gram stain Auramine

Answer 185

Which of the following is where the lymphocytes are located in the lymph node? A B C \*\*D\*\* : cortex E F

Answer 186

Which are more likely to develop cancer: Anterior cervical nodes \*\*Deep cervical nodes\*\*

Answer 187

Which of the following recieves lymphatric drainage from the heart? Interpulmonary nodes Superior tracheobronchial nodes \*\*Inferior tracheobronchial nodes\*\* Bronchomediastinal trunks Interlobar lymph vessels

Answer 188

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

Answer 189

Which lymph nodes are swollen here? Deep cervical **Superficial cervical** Occipital Posterior auricular

Answer 190

What is the most likely cause of this swollen arm? Radical neck dissection Laceration of the thoracic duct Liver metastasis blocking ducts ## Footnote **Radical masectomy**

Answer 191

Which of the following is responsible for mast cell proliferation in asthma Ptx? IL-5 IL-6 IL-7 IL-8 **IL-9**

Answer 192

Which of the following is responsible for eosinophil cell activation in asthma Ptx? **IL-5** IL-6 IL-7 IL-8 IL-9

Answer 193

In non-asthmatic Ptx the response to allergen is driven by: IgA IgE **IgG** IgD IgM

Answer 194

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.

Answer 195

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

Answer 196

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*

Answer 197

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

Answer 198

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

Answer 199

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** → **L**ower oxygen delivery, caused by * **L**ow [H+] (alkali) * **L**ow pCO2 * **L**ow 2,3-DPG * **L**ow temperature

Answer 200

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

Answer 201

Excessive vasodilation causes which type of shock? Obstructive shock Cardiogenic shock Hypovolaemic shock Restrictive shock

Answer 202

Excessive vasodilation causes which type of shock? Obstructive shock Cardiogenic shock Hypovolaemic shock **Restrictive shock**

Answer 203

Anaphylactic shock can be categorised as Obstructive shock Cardiogenic shock Hypovolaemic shock **Restrictive shock**

Answer 204

Tension pneumothorax can be categorised as **Obstructive shock** Cardiogenic shock Hypovolaemic shock Restrictive shock

Answer 205

Neurogenic shock would cause which of the following type of shock? Hypovolaemic shock Obstructive shock **Distributive shock** Cardiogenic shock

Answer 206

Which immunoglobin is associated with anaphylactic shock? IgD IgM **IgE** IgG IgA

Answer 207

Which artery is most common to have a stroke in? [1] ## Footnote Anterior cerebral artery **Middle cerebral artery** Posterior cerebral artery Basilar artery AICA

Answer 208

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**

Answer 209

Reduces levels of **CXCL8, IL-6, TNF-aO**

Answer 210

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

Answer 211

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

Answer 212

ICS acts on which of the following in asthma ptx? IL-4 IL-5 **IL-6** IL-7 (& TNF-a and CXCL8)

Answer 213

Which of the following attracts eosinophils in asthma ptx? IL-4 **IL-5** IL-6 IL-7

Answer 214

Dry powder inhalers should be taken in which of the following ways? **Quick and deep** Slow and steady Slow and deep Quick and steady

Answer 215

Aerosol asthma inhalers should be taken in which of the following ways? Quick and deep **Slow and steady** Slow and deep Quick and steady

Answer 216

FEV1/ FVC below which of the following is an indication for COPD? 0.5 0. 6 * *0.7** 0. 8

Answer 217

What is the first line of treatment for COPD? ICS **SABA** ICS + LABA LABA

Answer 218

A 78-year-old patient attends a routine follow-up appointment. They describe how their exercise tolerance is declining and that they now struggle with stairs. Occasionally they get central chest pain which radiates through to their back, which is relieved by rest. The pain is never present at rest. On examination, they have a regular, slow-rising pulse with a recorded blood pressure of 110/95mmHg. On auscultation of the precordium, you note an ejection systolic murmur. An echocardiogram is arranged for further assessment of cardiac function and valves. Given the most likely diagnosis, what further exam findings are you most likely to detect? **S4 heart sound** Hepatomegaly Malar flush Pistol shot femoral pulses Quincke's sign *S4 is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff ventricle*

Answer 219

A 70-year-old man comes to the office due to progressive shortness of breath. During the last several weeks, he has frequently become easily fatigued and short of breath, and at night he needs several pillows to sleep comfortably. He has also had ankle swelling. He has a 50-pack-year smoking history. Bibasilar crackles are heard on physical examination. Echocardiography reveals no valvular disease and a non-dilated left ventricle with an ejection fraction of 55%. What is most strongly associated with the patient's current condition? Glomerular hyper-filtration **Increased left ventricular afterload** Increased left ventricular compliance Left ventricular thrombus formation *Heart failure with preserved ejection fraction patients have diastolic dysfunction - impaired ventricular filling during diastole*

Answer 220

Soft S2 is/are most characteristically seen in: Mitral regurgitation Patent ductus arteriosus Aortic regurgitation Mitral stenosis **Aortic stenosis**

Answer 221

**Ischaemic changes in leads V4-6, I, aVL** would be most likely caused by a lesion of the: Right coronary **Left anterior descending or left circumflex** Left circumflex Left anterior descending

Answer 222

Which one of the following actions is directly caused by **B-type natriuretic peptide**? Increases gut absorption of phosphate **Inhibits renin secretion** Increases gluconeogenesis Converts angiotensinogen to angiotensin I Stimulates ADH release Inhibits inflammatory and immune responses

Answer 223

With respect to ischaemic heart disease, **migrate from the tunica media into the intima forming a fibrous capsule over the plaque**: **Smooth muscle cells** Macrophages Fibroblasts LDL HMG-CoA reductase Prostaglandin

Answer 224

Which one of the following actions is directly caused by **B-type natriuretic peptide**? Stimulates ADH release **Increases renal water and sodium excretion** Increases glycogenolysis Increases gallbladder contraction Increases gluconeogenesis Promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels

Answer 225

**Hypertrophic obstructive cardiomyopathy**: Causes include Duchenne muscular dystrophy Is typically triggered by stress **Causes predominately diastolic dysfunction** The majority of patients improve with supportive treatment Causes include cocaine Causes predominately systolic dysfunction

Answer 226

**A 70-year-old man presents with chest pain and dyspnoea. On examination he has an ejection systolic murmur which radiates to his carotids** is a stereotypical history of: Mitral regurgitation Left ventricular aneurysm Hypertrophic obstructive cardiomyopathy **Aortic stenosis** Dressler's syndrome Mitral stenosis

Answer 227

**Diastolic dysfunction** is the most common mechanism associated with which one of the following: Ischaemic heart disease Anaemia **Restrictive cardiomyopathy** Dilated cardiomyopathy Paget's disease Thyrotoxicosis

Answer 228

**PR interval is constant but the P wave is often not followed by a QRS complex** in a question is most likely to indicate: Second degree heart block (Mobitz type I) Left ventricular free wall rupture Acute pericarditis Brugada syndrome Wolff-Parkinson White syndrome **Second degree heart block (Mobitz type II)**

Answer 229

Which one of the following is/are most characteristic of **mitral stenosis**? Wide pulse pressure Soft S1 Collapsing pulse Soft S2 Slow rising pulse Malar flush

Answer 230

**An ECG shows progressive prolongation of the PR interval until a dropped beat occurs** is a stereotypical history of: Aortic stenosis Mitral regurgitation Second degree heart block (Mobitz II) **Second degree heart block (Mobitz I)** Dressler's syndrome Cardiac tamponade *Second-degree heart block* * *type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs* * *type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex*

Answer 231

Which of the following is found in a Ptx with tetralogy of Fallot Atrial septal defect Left ventricular hypertrophy Aortic stenosis **Right ventricular hypertrophy**

Answer 232

Which of the following forms the right ventricle? Truncus ateriosus **Bulbus cordis** Sinus venosus Primitive ventricle Primitive atria

Answer 233

Which of the following forms the coronary sinus? Truncus ateriosus Bulbus cordis **Sinus venosus** Primitive ventricle Primitive atria

Answer 234

Which of the following forms the proximal aorta and pulmonary artery? **Truncus ateriosus** Bulbus cordis Sinus venosus Primitive ventricle Primitive atria

Answer 235

Which of the following forms the ventricular outflow tracts? Truncus ateriosus **Bulbus cordis** Sinus venosus Primitive ventricle Primitive atria

Answer 236

A baby is premature, born at 30 weeks, putting her at higher risk for delayed ductus venosus closure. Which structures does the ductus venosus act as a communication between in the fetus? IVC and umbilical artery Umbilical vein and umbilical artery **IVC and umbilical vein** Hepatic portal vein and aorta Aort and pulmonary artery

Answer 237

A baby is premature, born at 30 weeks, putting her at higher risk for delayed ductus venosus closure. Which structures does the ductus venosus act as a communication between in the fetus? IVC and umbilical artery Umbilical vein and umbilical artery **IVC and umbilical vein** Hepatic portal vein and aorta Aort and pulmonary artery

Answer 238

A 71-year-old gentleman presents to the general practice complaining of a one-day history of palpitations and light-headedness. For the past month, he has been feeling fatigued and weak. On examination, you note widespread hypotonia and hyporeflexia. You perform an ECG and note that signs of hypokalaemia are present. Which of the following is an ECG sign of hypokalaemia? Small / absent P waves Broad QRS complexes **Prominent U waves** Tall tented T waves short PR interval

Answer 239

Acceptable responses: **Internal jugular vein, Internal jugular, Subclavian, Subclavian vein, Femoral, Femoral vein**

Answer 240

Left heart failure often leads to which symptom: **pleural oedema** Right heart failure often leads to which symptom: **peripheral oedema**

Answer 241

Positive Rombergs sign (patient is unable to maintain balance with their eyes closed)

Answer 242

Heparin binds to which of the following? Prothrombin Factor Xa Thrombin **Antithrombin** Factor X Heparin binds to **antithrombin** and **activates** it; activated complex then **inactivates factor Xa,** **preventing** **conversion** of **prothrombin to thrombin** (thrombin converts fibrinogen into fibrin - integral step in clot formation)

Answer 243

Factor VIII and IX

Answer 244

prominent a wave

Answer 245

During which of the following does aortic stenosis normally cause an ejection click? S1 S2 S3 \*\*S4\*\*

Answer 246

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\*\*

Answer 247

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. Which of the following is most likely for the above patient? Mitral regurgiation \*\*Mitral stenosis\*\* Aortic regurgitation Aortic stenosis

Answer 248

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

Answer 249

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. \*\*Mitral regurgiation\*\* Mitral stenosis Aortic regurgitation Aortic stenosis

Answer 250

Which of the following is depicted in this heart murmur? \*\*Mitral regurgiation\*\* Mitral stenosis Aortic regurgitation Aortic stenosis

Answer 251

Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis Aortic regurgitation \*\*Aortic stenosis\*\*

Answer 252

Which of the following is depicted in this heart murmur? Mitral regurgiation Mitral stenosis \*\*Aortic regurgitation\*\* Aortic stenosis

Answer 253

Which of the following is depicted in this heart murmur? Mitral regurgiation \*\*Mitral stenosis\*\* Aortic regurgitation Aortic stenosis

Answer 254

Which of the following radiates to the left axilla? \*\*Mitral regurgiation\*\* Mitral stenosis Aortic regurgitation Aortic stenosis

Answer 255

Which of the following would you be most likely to find a ghon focus in? Pneumonia \*\*TB\*\* Small cell carcinoma Asthma Squamous cell carnicoma

Answer 256

Which of the following depicts the Langhan cell in TB Ptx? A \*\*B\*\* C D

Answer 257

Ziehl-Nielson

Answer 258

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\*

Answer 259

Which pathology is depicted here? Pneumonia \*\*TB\*\* Small cell carcinoma Asthma Squamous cell carnicoma \*Under the microscope multinucleate giant cells and granulomatosis are seen\*

Answer 260

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\*

Answer 261

Which pathology is depicted here? Pneumonia TB \*\*Small cell carcinoma\*\* Asthma Squamous cell carnicoma

Answer 262

Which pathology is depicted here? Pneumonia \*\*TB\*\* Small cell carcinoma Asthma Squamous cell carnicoma \*Caseous necrosis and granulomatosis\*

Answer 263

Which pathology is depicted here? \*\*Pneumonia\*\* TB Small cell carcinoma Asthma Squamous cell carnicoma

Answer 264

\* 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.

Answer 265

\*\*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]

Answer 266

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.\*

Answer 267

TH1 subtype

Answer 268

Left: \*\*Bronchopneuomia\*\* Right: \*\*Lobal pneumonia\*\*

Answer 269

Emphysema \*Abnormal enlargement of air spaces distal to the terminal bronchioles characterized by destruction of the alveolar septa with little or no fibrosis\*

Answer 270

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\*\*

Answer 271

metastatic small cell carcinoma - blue cluster note: - orange myeloid precursors - fat cells - blue erythoid precursors - megakaryocytes

Answer 272

Investigating eosinophil levels in blood would help ID which pathology? \*\*Asthma\*\* Pneumonia Pleural effusion Mesothelioma Carcinoma Tuberculosis

Answer 273

Which of the following micrographs is from an adenocarcinoma? A \*\*B\*\* C

Answer 274

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

Answer 275

A: Basement membrane thickening B: Eosinophilia C: Goblet cell hyperplasia D: Mucus secretion \*\*E: Muscular hyperplasia \*\*

Answer 276

What is the structure labelled with a star? A: Alveolus B: Bronchus C: Bronchiole \*\*D: Terminal Bronchiole\*\* E: Trachea

Answer 277

Which of the following arrows shows a thickened basement membrane? A B \*\*C\*\* D

Answer 278

Which of the following arrows shows smooth muscle hypertrophy? A B C \*\*D\*\*

Answer 279

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

Answer 280

What is the diagnosis from this histology? Adenocarnioma \*\*Small cell cancer\*\* : morphology where can only see nuclei - looks like nuclei molding Squamous cell cancer

Answer 281

Which of the following is the vagus nerve? 1 2 3 **4** 5

Answer 282

Acceptable responses: **Internal jugular vein, Internal jugular, Subclavian, Subclavian vein, Femoral, Femoral vein**

Answer 283

II, III, aVF

Answer 284

Which coronary artery is most likely to have been affected by occlusion here? Circumflex artery? LAD LCA **RCA**

Answer 285

What is the most common cause of heart failure? Cardiomyopathy Hypertension **Ischaemic Heart Disease**

Answer 286

Acceptable responses: **oedema, pulmonary oedema, pulmonay edema, edema**

Answer 287

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

Answer 288

**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.

Answer 289

Acceptable responses: **Pleural space**

Answer 290

Acceptable responses: **Alveoli, Alveolar sacs**

Answer 291

Acceptable responses: **Bifurcations, Bifurcation points, Points of bifurcation, Bifurcation** ## Footnote **the anterior interventricular/left anterior descending branch being most commonly affected.**

Answer 292

At what time does ductus arteriosus normally close? Seconds after birth **1-3 days after birth** 2 weeks after birth 6 months after birth

Answer 293

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)*

Answer 294

A ventricular septal defect (VSD) is most commonly a failure of which component of the septum development? **Membranous** Muscular

Answer 295

A: Brachiocephalic B: Common carotid C: Internal carotid D: External Carotid

Answer 296

The laryngeal prominence occurs at which vertebral level C3 \*\*C4\*\* C5 C6 C7

Answer 297

The carotid bifurication occurs at which vert. level? C3 \*\*C4\*\* : \*\*carotid pulse can be palpated either side of thyroid cartilage\*\* C5 C6

Answer 298

The cricoid cartilage occurs at which vert. level? C3 C4 C5 \*\*C6\*\*

Answer 299

The thyroid gland occurs at which vert. level? C3 C4 C5 \*\*C6\*\*: overlies cricoid cartilage

Answer 300

Thyroid gland overlies which laryngeal cartilage? Thyroid cartilage \*\*Cricoid cartilage\*\* Epiglottis Artyenoid cartilages

Answer 301

\*\*C3-C6\*\*

Answer 302

The vocal cords attach anteriorly to which cartilage? Cricoid cartilage Cuneiform cartilage Epiglottis Arytenoid cartilage \*\*Thyroid cartilage\*\*

Answer 303

Which of the following is the only complete cartilaginous ring within the upper airway? \*\*Cricoid cartilage\*\* Cuneiform cartilage Epiglottis Arytenoid cartilage Thyroid cartilage

Answer 304

The vocal cords attach anteriorly to which of the following? Cricoid cartilage Cuneiform cartilage Epiglottis \*\*Arytenoid cartilages\*\* Thyroid cartilage

Answer 305

Recurrent laryngeal nerve

Answer 306

A: reduced gag reflex B: reduced range of pitch

Answer 307

Palsy to which nerve causes reduced gag reflex? Superior laryngeal nerve external branch **Superior laryngeal nerve, internal branch** Recurrent layngeal nerve, bilateral damage Recurrent layngeal nerve, unilateral damage

Answer 308

Palsy to which nerve causes reduced range of pitch? **Superior laryngeal nerve external branch** Superior laryngeal nerve, internal branch Recurrent layngeal nerve, bilateral damage Recurrent layngeal nerve, unilateral damage

Answer 309

Palsy to which nerve causes horseness of voice? Superior laryngeal nerve external branch Superior laryngeal nerve, internal branch Recurrent layngeal nerve, bilateral damage **Recurrent layngeal nerve, unilateral damage**

Answer 310

Palsy to which nerve causes loss of phonation? Superior laryngeal nerve external branch Superior laryngeal nerve, internal branch **Recurrent layngeal nerve, bilateral damage** Recurrent layngeal nerve, unilateral damage

Answer 311

Could be caused by retinal HTN causing haemorrhage: cotton wool spots

Answer 312

Copper-wiring, arteriovenous nicking and silver-wiring seen in a patient with hypertensive retinopathy Narrowing of retinal arteries / vaspconstriction

Answer 313

What type of mask is this? **Nasal Cannulae** Simple face mask Non-rebreather mask (reservoir mask) Venturi mask

Answer 314

What type of mask is this? Nasal Cannulae Simple face mask Non-rebreather mask (reservoir mask) **Venturi mask**

Answer 315

What type of mask is this? Nasal Cannulae Simple face mask **Non-rebreather mask (reservoir mask)** Venturi mask

Answer 316

What type of mask is this? Nasal Cannulae **Simple face mask** Non-rebreather mask (reservoir mask) Venturi mask

Answer 317

What type of mask is this? Nasal Cannulae Simple face mask **Non-rebreather mask (reservoir mask)** Venturi mask

Answer 318

What type of sensitivity is anaphylactic shock **_Type 1_** Type 2 Type 3 Type 4

Answer 319

A new drug is being developed for use in heart conduction disorders. As part of the experimental research, a laboratory scientist records the conduction velocities in different parts of a bovine heart using two electrodes. Following a series of velocity measurements, the scientist marks the part of the heart with two red hat pins where he has measured the highest velocity in the heart at around 4 m/s. What is the most likely location of the red hat pins? [AV node](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bachmann's bundle](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bundle of His](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Myocardium](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Purkinje fibres**](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 320

Each one of the following promotes the release of endothelin, except: [**_Prostacyclin_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ADH](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Angiotensin II](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hypoxia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Mechanical shearing force](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 321

A 62-year-old man presents with an acute deterioration of heart failure. A previous echocardiogram shows an ejection fraction of 70%. He is very short of breath and on auscultation of the lungs, there are bi-basal crackles. What type of heart failure does this man likely have? [Left and right-sided systolic dysfunction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Left-sided diastolic dysfunction**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Left-sided systolic dysfunction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Right-sided diastolic dysfunction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Right-sided systolic dysfunction13%](https://www.passmedicine.com/v7/question/questions.php?q=0#) Heart failure with preserved ejection fraction patients have diastolic dysfunction - impaired ventricular filling during diastole

Answer 322

A 60-year-old woman complains of dull, central chest pain and is admitted to the emergency department. An ECG reveals a new left bundle branch block. If a histological examination of her heart were to be performed within the first 24 hours post-MI, what would be the most likely findings? **Coagulative necrosis** Granulation tissue Liquefactive necrosis Macrophages Mature scar tissue Submit answer

Answer 323

An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation. What enzyme does the drug inhibit? [Protein C1](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Epoxide reductase**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Gamma-glutamyl carboxylas](https://www.passmedicine.com/v7/question/questions.php?q=0#) [CYP2C9](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Thrombin](https://www.passmedicine.com/v7/question/questions.php?q=0#) Warfarin works by inhibiting epoxide reductase preventing Vitamin K from being converted to its activated form

Answer 324

A 67-year-old male with a past history of severe aortic stenosis undergoes valve replacement surgery. As part of his continued management, he begins taking regular dipyridamole in the post-operative period. What is the mechanism of action of this drug? Activated factor 10 (Xa) antagonist Non-selective cyclooxygenase (COX) antagonist **Non-specific phosphodiesterase antagonist** P2Y12-receptor agonist P2Y12-receptor antagonist Dipyridamole is a non-specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine

Answer 325

A 74-year-old man attends the emergency department complaining of palpitations, dizziness, and chest pain. He has a past medical history of mitral stenosis and denies any smoking or alcohol use. An ECG is immediately performed, which shows positively directed sawtooth deflections in lead I, and negatively directed sawtooth deflections in leads II, III, and aVF. Which of the following pathologies is this finding indicative of? **Atrial flutter** Left bundle branch block Ventricular fibrillation Wolff-Parkinson-White syndrome Mobitz type 1 heart block

Answer 326

You are a medical student in general practice. You see a patient with difficult to control hypertension, the decision is made to start them on Bendroflumethiazide. What is a reason not to start this medication? [Allergy to Spironolactone](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Refractory hyperkalaemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hypocalcaemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Gout_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Conn's syndrome](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 327

**warfarin:** This is an anticoagulant that has been linked to an increased incidence of spontaneous abortion and stillbirth and therefore should be avoided in pregnancy.

Answer 328

**warfarin:** This is an anticoagulant that has been linked to an increased incidence of spontaneous abortion and stillbirth and therefore should be avoided in pregnancy.

Answer 329

A 17-year-old competitive swimmer attends the paediatric clinic; she has presented due to episodes of palpitations during races or intense training, although she has never had shortness of breath or chest pain. One such episode was persistent and resulted in her presenting to the emergency department, where an ECG was taken. A provisional diagnosis of Wolff-Parkinson-White syndrome was made based on the presence of a shortening of one of the ECG intervals. What does this section of the ECG that is likely to be abnormal represent in terms of electrical activity? Atrial repolarisation alone The depolarisation of the sinoatrial node **The time between atrial depolarisation and ventricular depolarisation** The time between ventricular depolarisation and repolarisation Ventricular depolarisation alone

Answer 330

A 36-year-old man presents with intermittent palpitations and lightheadedness. He denies dyspnoea, chest pain and peripheral leg swelling. Systematic physical examination is unremarkable. An ECG done shows a shortened PR interval and presence of delta waves. Given the most likely diagnosis, what is the underlying pathophysiology? Ectopic atrial foci **Accessory pathway** Sodium channelopathy Left bundle branch block Ventricular ischaemic tissues

Answer 331

A 36-year-old man presents with intermittent palpitations and lightheadedness. He denies dyspnoea, chest pain and peripheral leg swelling. Systematic physical examination is unremarkable. An ECG done shows a shortened PR interval and presence of delta waves. Given the most likely diagnosis, what is the underlying pathophysiology? Ectopic atrial foci **Accessory pathway** Sodium channelopathy Left bundle branch block Ventricular ischaemic tissues The symptoms of intermittent palpitations and lightheadedness is non specific, however the ECG findings of a shortened PR interval and delta wave points towards a diagnosis of Wolff-Parkinson-White syndrome. This is caused by an accessory pathway between the atrium and ventricle.

Answer 332

You are a medical student in the short-stay surgical theatre witnessing a parathyroidectomy. During the procedure, blood vessels supplying the parathyroid glands are ligated. The ENT consultant asks you to name the arteries that supply oxygenated blood to the parathyroid gland. Which one of the following options correctly identify the blood supply of the parathyroid glands? [Inferior parathyroid arteries](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Super and inferior parathyroid arteries](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Subclavian artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Superior and inferior thyroid arteries**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Middle thyroid arteries](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 333

A 38-year-old lady is due to undergo a parathyroidectomy for hyperparathyroidism. At operation the inferior parathyroid gland is identified as being enlarged. A vessel is located adjacent to the gland laterally. This vessel is most likely to be the: [External carotid artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Common carotid artery_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Internal carotid artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [External jugular vein](https://www.passmedicine.com/v7/question/questions.php?q=0#) [None of the above](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 334

A 56-year-old woman is diagnosed with angina. She is started on some medications, both for symptom control and as secondary prevention. The doctor also wants her to work on changing her diet. Whilst explaining this to the patient, the doctor describes why excess fat in the blood can lead to angina. Under normal circumstances, which apolipoprotein do macrophages recognise in order to uptake lipids? [ApoF](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ApoA-II1](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_ApoB100_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ApoC-II](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ApoA-I](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 335

A 60-year-old lady presents to the general practice with increasing tiredness and weakness. There are no other symptoms of note and examination is unremarkable. You perform a series of blood tests. This shows a low serum potassium. You call the patient to tell her the news, whereupon she tells you that she has been having palpitations for a few hours and feels lightheaded. You ask her to the emergency department so she can have an ECG and receive treatment. Which of the following is an ECG sign of hypokalaemia? Small or absent P waves Tall tented T waves **ST segment depression** Broad bizarre QRS complexes Short PR interval

Answer 336

Which one of the following clotting factors is not affected by warfarin? Factor II Factor VII **Factor XII** Factor IX Factor X

Answer 337

A teenage boy collapses while playing tennis and is pronounced dead in hospital. The post-mortem reveals heart abnormalities. What is the most likely abnormality? **Hypertrophic cardiomyopathy** Acute myocarditis Dilated cardiomyopathy Restrictive cardiomyopathy Atrial myxoma Hypertrophic cardiomyopathy is the only condition listed above that typically presents with sudden death, which rules out the other options.

Answer 338

A 45-year-old patient is admitted to the cardiology department with infective endocarditis. During the examination of the patient's hands, the doctor identifies a collapsing pulse. What further finding might you expect to find in your examination? [Diastolic murmur in pulmonary area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Diastolic murmur in the aortic area_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Diastolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Ejection systolic murmur in the aortic area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pansystolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) Aortic regurgitation - collapsing pulse

Answer 339

A 45-year-old patient is admitted to the cardiology department with infective endocarditis. During the examination of the patient's hands, the doctor identifies a collapsing pulse. What further finding might you expect to find in your examination? [Diastolic murmur in pulmonary area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Diastolic murmur in the aortic area_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Diastolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Ejection systolic murmur in the aortic area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pansystolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) Aortic regurgitation - collapsing pulse

Answer 340

A 45-year-old patient is admitted to the cardiology department with infective endocarditis. During the examination of the patient's hands, the doctor identifies a collapsing pulse. What further finding might you expect to find in your examination? [Diastolic murmur in pulmonary area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Diastolic murmur in the aortic area_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Diastolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Ejection systolic murmur in the aortic area](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pansystolic murmur in the mitral area](https://www.passmedicine.com/v7/question/questions.php?q=0#) Aortic regurgitation - collapsing pulse

Answer 341

An 80-year-old man with a history of heart failure, ischaemic heart disease and type 2 diabetes mellitus. He returns to the cardiology clinic with symptoms of dyspnoea and leg swelling. Examination reveals bibasal crackles on auscultation of his lungs and bilateral pitting oedema up to the mid-shin level. Auscultation of the heart is unremarkable. The cardiologist prescribes furosemide in an attempt to relieve his symptoms. Where in the kidney does furosemide act upon? **Na-K-2Cl symporter in the thick ascending loop of Henle** Na-Cl symporter in the distal convoluted tubules Aquaporins in the collecting ductsRenin-producing Juxtaglomerular cells Basolateral Na-K pumps in the distal convoluted tubules

Answer 342

An 80-year-old gentleman comes into the GP surgery, complaining of shortness of breath especially when lying down. His ejection fraction is normal. What could be a possible explanation for this? [He has increased atrial compliance](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_He has diastolic dysfunction_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [He has increased ventricular compliance](https://www.passmedicine.com/v7/question/questions.php?q=0#) [He has systolic dysfunction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [He has decreased afterload](https://www.passmedicine.com/v7/question/questions.php?q=0#) In systolic dysfunction, stroke volume is decreased and this decreases ejection fraction. Ejection fraction is not a useful measure in someone with diastolic dysfunction, due to the fact that stroke volume may be reduced whilst end-diastolic volume may be reduced. Diastolic dysfunction may arise when there is reduced compliance of the heart.

Answer 343

An ECG is performed on a patient in the cardiology ward. On the ECG there are regular p waves present, and a QRS complex is associated with each p wave. The PR interval is 0.26 seconds. There are no missed p waves. What is the most likely diagnosis? 2nd degree heart block - Mobitz type I (Wenckebach) 2nd degree heart block - Mobitz type II 3rd degree heart block Sinus rhythm **1st degree heart block**

Answer 344

A 55-year-old man is admitted to the emergency department with sudden onset chest pain. His ECG shows ST depression in leads II, III, & aVF. His troponin is also found to be raised. He is treated for an NSTEMI (non-ST-elevation myocardial infarction), and as part of this treatment regime, he is given ticagrelor. What is the mechanism of action of this drug? Activates antithrombin III which mainly inhibits factors Xa and IIa **Inhibits ADP binding to platelet receptors** Inhibits prothrombinase complex-bound and clot-associated factor Xa Inhibits the production of prostaglandins Inhibits vitamin K epoxide reductase complex 1 Ticagrelor has a similar mechanism of action to clopidogrel - inhibits ADP binding to platelet receptors

Answer 345

A 45-year-old female is found to have a blood pressure of 185/102mmHg following ambulatory blood pressure monitoring. She is started on the ACE inhibitor Ramipril. What is the most common side effect of this drug? **A dry cough** Oedema Shortness of breath Excessive urine output Headaches Mechanism of action of an ACE inhibitor is to block the production of angiotensin II and inhibit bradykinin breakdown.

Answer 346

A 72-year-old patient is started on warfarin following a diagnosis of atrial fibrillation. She has a past medical history of a metallic heart valve. She is told that she will be monitored using INR levels. Since warfarin affects a certain aspect of clotting, INR is used to give a ratio of the value during warfarin treatment to the normal value. What value is used during this monitoring? [Activated partial thromboplastin time](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bleeding time](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Fibrinogen levels](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Prothrombin time_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Thrombin time](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 347

A 73-year-old is rushed to the Emergency Room following a collapse at home. Despite resuscitation efforts, he dies. Five weeks ago, he had suffered a myocardial infarction. What would be the most likely histological findings on his heart? Coagulative necrosis, neutrophils, wavy fibres, hypercontraction of myofibrils **Contracted scar** Macrophages and granulation tissue at margins Macrophage and T cell infiltration Neutrophils and T cell infiltration

Answer 348

A 13-year-old male immigrant from India presents to his primary care physician with a gradually worsening shortness of breath worse on physical exertion as well as widespread joint pain. His past medical history includes a severe throat infection which was untreated. His vaccination record is complete. On physical examination, there is a high-pitch holosystolic murmur loudest at the apex with radiation to the axilla. Hb135 g/lPlatelets150 \* 10⁹/lWBC9.5 \* 10⁹/lAnti-streptolysin O titres\>200units/mL What is the most likely histological finding in his heart? [**Aschoff bodies**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Councilman bodies](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Mallory bodies](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Call-Exner bodies](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Schiller-Duval bodies](https://www.passmedicine.com/v7/question/questions.php?q=0#) Aschoff bodies are granulomatous nodules found in rheumatic heart fever

Answer 349

Question 103 of 203 An 82-year-old lady with a history of heart failure presents to the general practice with a 5-day history of constipation. On further questioning, she tells you that she has been feeling weaker this week, and has been getting muscle cramps regularly On examination, there is reduced tone and hyporeflexia bilaterally in both the upper and lower limbs. You think this lady's presentation may be due to hypokalaemia. The patient takes a number of diuretics to control her heart failure. Which of the following diuretics is associated with hypokalaemia? Triamterene **Furosemide** Spironolactone Eplerenone Amiloride

Answer 350

One of the patients at your general practice was recently admitted to hospital and diagnosed with myeloma. It was found that he had severe chronic kidney disease. He presents to update you on the situation. In light of the new diagnosis and renal function information, you review his medications. He is currently taking ramipril for the treatment of hypertension. ACE inhibitors contraindicated in renal failure. Which of the following statements most accurately describes the action of ACE inhibitors on the glomerular filtration pressure? [Vasoconstriction of the afferent arteriole](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vasodilation of the afferent arteriole](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vasoconstriction of the efferent arteriole](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Vasodilation of the efferent arteriole_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Increases glomerular filtration pressure](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 351

You are a junior doctor clerking a patient before an elective knee replacement. On auscultation of the heart, you hear a diastolic murmur and notice a collapsing pulse when taking a heart rate. When examining the hands, you notice pulsations of red colouration on the finger nailbeds. Examination is otherwise normal. What is the likely cause of these examination findings? **Aortic regurgitation** Aortic stenosis Mitral regurgitation Mitral stenosis Tricuspid stenosis

Answer 352

You are a junior doctor clerking a patient before an elective knee replacement. On auscultation of the heart, you hear a diastolic murmur and notice a collapsing pulse when taking a heart rate. When examining the hands, you notice pulsations of red colouration on the finger nailbeds. Examination is otherwise normal. What is the likely cause of these examination findings? **Aortic regurgitation** Aortic stenosis Mitral regurgitation Mitral stenosis Tricuspid stenosis

Answer 353

A mother is very concerned that her newborn baby is looking blue, after a forceps delivery. Which of the following is responsible for the closure of the ductus arteriosus at birth? [**Reduced level of prostaglandins**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Increased left atrial pressure](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Nitric oxide](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vascular endothelial growth factor (VEGF)](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Decreased oxygen tension](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 354

A 65-year-old man is admitted for a below knee amputation. He is taking digoxin. Clinically the patient has an irregularly irregular pulse. What would you expect to see when you examine the jugular venous pressure? [Absent y waves](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Slow y descent](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Cannon waves](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Steep y descent](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Absent a waves_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) Absent a waves = Atrial fibrillation

Answer 355

A 53-year-old man presents to the emergency department with central chest pain which began 20 minutes ago. An ECG is ordered which shows ST elevation in leads I, aVL, and V6. Which of the coronary arteries is most likely to be obstructed? [Right marginal artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Left circumflex artery**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Left anterior descending artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Posterior interventricular artery](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Right coronary artery](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 356

Mrs Smith, a 69-year-old woman presents to her general practitioner complaining of a 1-month history of dizzy spells. She reports first noticing them approximately three-weeks after starting a long-acting nitrate for heart failure. A sitting blood pressure (BP) is taken and compared to her previous blood pressure readings. Current BP 87/70mmHg BP two months ago 125/85mmHg It is concluded that this hypotension has been caused by the new drug. What underlying molecular mechanism could explain this change in blood pressure? **Nitrate causing a decrease in intracellular calcium** Nitrate causing a decrease in intracellular potassium Nitrate causing an increase in intracellular calcium Nitrate causing an increase in intracellular potassium Nitrate causing an increased in intracellular sodium

Answer 357

An 86-year-old man currently admitted to the medical ward develops an abnormal heart rhythm and the doctor on call is asked to see him. The patient is experiencing light-headedness but denies any chest pain, sweating, nausea or feeling of palpitations. His pulse rate is 165 beats per minute, respiratory rate is 16 breaths per minute, blood pressure is 165/92 mmHg, his body temperature is 37.8 º C and his oxygen saturation is 97% on air. An electrocardiogram (ECG) shows a polymorphic pattern and the doctor on call advises to treat with magnesium sulfate to prevent the patient from going into a ventricular fibrillation. The doctor also looks at the patient's previous ECG and notices that there was a QT prolongation that went unnoticed by the intern doctor. The patient has a past medical history of type 2 diabetes mellitus, hypertension, heart failure, and chronic kidney disease. Which electrolyte abnormality that is most likely to have caused this patient abnormal heart rhythm? [Hyponatremia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hyperkalemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hypercalcemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Hypocalcemia**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hypermagnesemia](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 358

Which of the following is true regarding endothelin? It is a potent vasodilator It is produced mainly by pulmonary tissue It acts on target cells by stimulating guanylate cyclase Release is stimulated by nitric oxide **Endothelin antagonists are useful in primary pulmonary hypertension**

Answer 359

A 46-year-old woman has recently had some screening blood tests, and her cholesterol levels are far too high. You want to prescribe her atorvastatin. When she comes into the clinic, she says that some of her friends were unable to tolerate taking it and have had to stop their treatment. What is a common adverse effect of the medication that is being prescribed? Angio-oedema Gallstones **Myalgia** Pruritis Rhabdomyolysis Myalgia is a very common side effect of statin therapy

Answer 360

Jack, a 56-year-old male, presents to his GP with chest pain. He states that the pain is worse when he is walking and is relieved by rest. Past medical history includes diabetes, hypercholesterolaemia and hypertension. He has a family history of myocardial infarction. With the suggestive history, the GP diagnoses angina and prescribes a nitrate spray. During which stage in the cardiac cycle to the coronary arteries predominantly fill? [Ventricular systole and diastole](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Ventricular diastole**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Ventricular systole](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Isovolumetric contraction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Atrial diastole](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 361

A 3-year-old child is seen by his mother to suddenly turn blue around the lips after an episode of crying. This has happened many times previously and the child quickly adopts the squatting position to relieve his symptoms. On previous examinations, the child has been seen to have multiple cardiac problems, including a boot-shaped heart on chest x-ray. Based on the most likely diagnosis, which of the following is the underlying cause of his condition? [Failure of the endocardial cushion to develop](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Failed migration of the neural crest cells**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Defect in the ostium primum](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Defect in the ostium secundum](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Low oxygen levels after birth](https://www.passmedicine.com/v7/question/questions.php?q=0#) The truncus arteriosus divides into the aorta and the pulmonary trunk due to neural crest cell migration from the pharyngeal arches. This can lead to Tetralogy of Fallot

Answer 362

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being 'really annoying' and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications? Reassure her that the majority of ACE related coughs resolve within three months **Switch her to an angiotensin II receptor blocker** Switch her to bendroflumethiazide Switch her to amlodipine Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

Answer 363

A 55-year-old man is under investigation by the cardiologists due to increasing breathlessness, fatigue and exertional chest pain. He undergoes an echocardiogram which shows a thickened interventricular septum and decreased filling of the left ventricle. Which of the following diagnoses do these findings best fit with? [Dilated cardiomyopathy](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Hypertrophic obstructive cardiomyopathy**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Left ventricular aneurysm](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Restrictive cardiomyopathy](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Ventricular septal defect](https://www.passmedicine.com/v7/question/questions.php?q=0#) Restrictive cardiomyopathy also leads to reduced compliance of the chamber walls, however the myocardium is not thickened. Typically the right atrium appears enlarged on echocardiogram.

Answer 364

A 29-year-old pregnant woman presents to the Emergency Department with sudden-onset pleuritic chest pain and dyspnoea. She has recently arrived back from a holiday in New Zealand. From the options, what is her ECG most likely to show, if anything? [Sinus bradycardia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Signs of left heart strain](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Atrial fibrillation](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ST elevation in leads II, III and aVF](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**T wave inversion in the anterior leads**](https://www.passmedicine.com/v7/question/questions.php?q=0#) Possible ECG signs in patients with pulmonary embolism are: * Sinus tachycardia (the most common) * Signs of right heart strain (not left) * T wave inversion in the anterior leads * S1Q3T3

Answer 365

A 29-year-old pregnant woman presents to the Emergency Department with sudden-onset pleuritic chest pain and dyspnoea. She has recently arrived back from a holiday in New Zealand. From the options, what is her ECG most likely to show, if anything? [Sinus bradycardia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Signs of left heart strain](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Atrial fibrillation](https://www.passmedicine.com/v7/question/questions.php?q=0#) [ST elevation in leads II, III and aVF](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**T wave inversion in the anterior leads**](https://www.passmedicine.com/v7/question/questions.php?q=0#) Possible ECG signs in patients with pulmonary embolism are: * Sinus tachycardia (the most common) * Signs of right heart strain (not left) * T wave inversion in the anterior leads * S1Q3T3

Answer 366

A 68-year-old man has recently been discharged from hospital following a non-ST-elevation myocardial infarction (NSTEMI). He has a history of angina, hypertension and hypercholesterolaemia and was already taking aspirin, atorvastatin, bisoprolol and ramipril prior to his NSTEMI. Following his hospital discharge, he has been instructed to also take ticagrelor for the next 12 months. What is the mechanism of action of this newly-started drug? Activated factor X (Xa) inhibitor Cyclooxygenase inhibitor Direct thrombin inhibitor Glycoprotein IIb/IIIa receptor antagonist **P2Y12 receptor antagonist**

Answer 367

A 78-years-old man with a history of stable angina visits his GP for a routine visit. He recently had an admission to the hospital with decompensated heart failure. A brain natriuretic peptide (BNP) level was taken and it was markedly raised. He was subsequently treated with intravenous furosemide and responded well. Which of the following shows the cardiovascular effects of BNP? Increases preload and afterload **Decreases preload and afterload** Increases preload and decreases afterload Decreases preload and increases afterload Increases afterload only

Answer 368

A 56-year-old woman presents to the emergency department with shortness of breath. She has a past medical history of idiopathic interstitial lung disease. Her temperature was 37.1ºC, oxygen saturation 76% on air, heart rate 106 beats per minute, respiratory rate of 26 breaths per minute and blood pressure 116/60 mmHg. What physiological change would occur in the lungs in response to her oxygen saturation? [Diffuse bronchoconstriction](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Hypersecretion of mucus from goblet cell](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Pulmonary artery vasoconstriction**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pulmonary artery vasodilation](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Tracheal deviation](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 369

A 16-year-old girl is brought in with difficulty breathing. She is unable to talk in full sentences and is panicking. She is known to have asthma. On examination she has a respiratory rate of 28 breaths/minute, a heart rate of 105 beats/minute and her chest is silent. Which of the features in this girl's history is most concerning? [Unable to talk in full sentences](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Panicking](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Respiratory rate of 28 breaths/minute](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Heart rate of 105 beats/minute](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Silent chest**](https://www.passmedicine.com/v7/question/questions.php?q=0#) A silent chest is a life-threatening feature of an asthma attack

Answer 370

A 25-year-old man comes to the emergency department due to a sensation of food being stuck in his throat. His symptoms started 2 hours ago after eating fish at a local seafood restaurant. The patient has no difficulty with breathing. Laryngoscopy reveals a fish bone lodged in the left piriform recess. During retrieval of the fish bone, a nerve is injured deep to the mucosa overlying the recess. What is most likely to be impaired in this patient? [**Cough reflex**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Mastication](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pharyngeal reflex](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Salivation](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Taste sensation in the anterior 2/3rd of the tongue](https://www.passmedicine.com/v7/question/questions.php?q=0#) Foreign bodies lodged in the piriform recess may damage the internal laryngeal nerve

Answer 371

A 58-year-old woman attends respiratory clinic for routine spirometry testing. One of the measures taken during the testing is functional residual capacity. How is this defined? **Functional residual capacity = expiratory reserve volume + residual volume** Functional residual capacity = tidal volume + inspiratory reserve volume Functional residual capacity = inspiratory capacity + expiratory reserve volume Functional residual capacity = vital capacity + residual volume Functional residual capacity = inspiratory capacity - inspiratory reserve volume

Answer 372

A 72-year-old lady presents to her GP with a persistent cough. She has smoked approximately 15 cigarettes per day for the last 25 years and is concerned that this might be the cause of her symptom. The GP tells her that she has chronic obstructive pulmonary disease (COPD) likely secondary to chronic bronchitis. What is the definition of chronic bronchitis? [Chronic dry cough constantly for at least a year](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Chronic productive cough for at least 3 months in at least 2 years**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Enlargement of air spaces distal to the terminal bronchioles](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Enlargement of air spaces proximal to the terminal bronchioles](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Chronic productive cough for at least half the time for at least a year](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 373

A 10-year-old boy is referred to a respiratory physician for persistent bouts of shortness of breath. He also has severe hay fever and eczema. He undergoes a peak expiratory flow test, which suggests signs of outflow obstruction of his lungs. He is trialled on beclomethasone and salbutamol. The physician also informs the mother that he should be kept away from dust, as asthma is a condition that commonly arises from hypersensitivity to dust. Which hypersensitivity is asthma associated with? [**Type 1 hypersensitivity**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Type 2 hypersensitivity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Type 3 hypersensitivity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Type 4 hypersensitivity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Type 5 hypersensitivity](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 374

A 68-year-old male has sadly received a diagnosis of lung cancer following a short illness where he presented to the GP with a cough and weight loss. His GP has received his histology report following a recent bronchoscopy which has shown a squamous cell carcinoma. Given the diagnosis, which of the following would you expect in this patient? [Excessive ADH secretion](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Excessive ACTH secretion](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Lambert- Eaton syndrome](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Gynaecomastia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Clubbing**](https://www.passmedicine.com/v7/question/questions.php?q=0#) Squamous cell carcinoma is associated with hypertrophic pulmonary osteoarthropathy (HPOA)

Answer 375

A 42-year-old woman presents to the GP after attending the Emergency Department with a foreign body stuck in her throat 2 days prior. The foreign body had been removed, but she complains of difficulty swallowing. On further probing, she reports she has altered sensation when swallowing, describing it as 'feeling like there is no food being swallowed' when eating. What nerve/nerves is/are most likely to be damaged? Cervical plexus External laryngeal nerve **Internal laryngeal nerve** Recurrent laryngeal nerve Superior laryngeal nerve

Answer 376

A 31-year-old cyclist arrives in the emergency department via air ambulance after suffering a collision with a car. At the scene she was intubated. Her Glasgow Coma Score is currently 8. Where does control and regulation of the respiratory centres occur? [Parietal lobe](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Occipital lobe](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Thalamus](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Cerebellum](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Brainstem**](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 377

A 25-year-old lady, who was diagnosed with eczema and asthma in childhood, attends her annual asthma review. Over the past 3 months, she has frequently required her salbutamol reliever. She is worried that the deterioration in asthma control coincides with the adoption of a kitten. In the pathophysiology of allergic asthma which cell is found in inappropriately increased numbers? Mast cells **Eosinophils** Dendritic cells Macrophages Neutrophils

Answer 378

A 25-year-old lady, who was diagnosed with eczema and asthma in childhood, attends her annual asthma review. Over the past 3 months, she has frequently required her salbutamol reliever. She is worried that the deterioration in asthma control coincides with the adoption of a kitten. In the pathophysiology of allergic asthma which cell is found in inappropriately increased numbers? Mast cells **Eosinophils** Dendritic cells Macrophages Neutrophils

Answer 379

A 23-year-old man was brought to the Emergency department with sudden onset breathlessness whilst playing football. He denies any trauma and is usually fit and well. On examination, it is noticed that he is quite tall and thin, and respiratory examination reveals decreased breath sounds with hyper-resonant percussion notes on his right side. Trachea remains central. A chest x-ray is ordered and confirms a diagnosis of a right sided pneumothorax with a collapsed lung. Which of the following explains why the lung does not reinflate? [Decrease in intrapleural pressure](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Loss of chest wall recoil``](https://www.passmedicine.com/v7/question/questions.php?q=0#) I[ncrease in intra-alveolar pressur](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**_Increase in intrapleural pressure_**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Loss of alveolar surfactant](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 380

A 48-year-old woman of African ethnicity presents to her family doctor complaining of a lump in her neck. She reports that the lump has been there for the past week and has not increased in size significantly. She denies any pain or swallowing difficulty. Her previous medical history is unremarkable, and she has never been admitted to the hospital before, except for a visit to the ophthalmologist last year for a red-eye, which necessitated treatment with topical steroid drops. Upon examination, the doctor notices some red tender nodules on the patient’s shin but the patient says that these come and go and do not bother her much. A chest x-ray reveals bilateral hilar lymphadenopathy with no other significant findings. Which one of the following is usually associated with this patient’s condition? [_Elevated angiotensin-converting enzyme levels_](https://www.passmedicine.com/v7/question/questions.php?q=0#) _-_ Elevated angiotensin-converting enzyme levels are associated with sarcoidosis [Hypocalcemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Poor sleep](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Exposure to silica](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pain in the small joints of the hand](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 381

A 57-year-old man presents to the GP with shortness of breath, coughing, and wheeze. He has a 40-pack-year history of smoking, although has recently cut down. He is referred for spirometry, which reinforces a diagnosis of chronic obstructive pulmonary disease. It is noted that his functional residual capacity is increased. How is this metric calculated? [**Expiratory reserve volume + residual volume**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Expiratory reserve volume + tidal volume + inspiratory reserve volume](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Inspiratory reserve volume + residual volume](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Residual volume + expiratory reserve volume + tidal volume + inspiratory reserve volume](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Tidal volume + inspiratory reserve volume](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 382

A 74-year-old woman with thyroid cancer is admitted due to shortness of breath. What is the best investigation to assess for possible compression of the upper airways? [Arterial blood gases](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Forced vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Transfer factor](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Peak expiratory flow rate](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Flow volume loop**](https://www.passmedicine.com/v7/question/questions.php?q=0#) Flow volume loop is the investigation of choice for upper airway compression.

Answer 383

A patient undergoes spirometry in which she is instructed to undergo maximum forced exhalation after maximum inhalation. The exhaled volume is measured. What is the term used to describe the difference between this volume and her total lung capacity? [Expiratory reserve volume](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Functional residual capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Inspiratory reserve volume](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Residual volume**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) Total lung capacity = vital capacity + residual volume

Answer 384

A 72-year-old man presents to a respiratory clinic with difficulty breathing after minimal activity. After your thorough assessment, you suspect idiopathic pulmonary fibrosis, so you check his previous notes to aid your diagnosis. The following spirometry results are recorded: Measurementvolume (ml)Vital Capacity (VC)4400Inspiratory Reserve Volume (IRV)3000Functional Residual Capacity (FRC)2800Residual Volume (RV)1200 What is the total lung capacity (TLC) of this patient? [4000ml](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**5600ml**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [5800ml](https://www.passmedicine.com/v7/question/questions.php?q=0#) [7200ml](https://www.passmedicine.com/v7/question/questions.php?q=0#) [7400ml](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 385

A 20-year-old patient is undergoing routine pulmonary function testing to review her chronic condition. These tests are compared to a standardised predicted value and given in the table below: FEV170% of predicted FVC65% of predicted FEV1/FVC108% What condition is this patient likely to suffer from that explains the above results? [Asthma](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bronchiectasis](https://www.passmedicine.com/v7/question/questions.php?q=0#) [COPD](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Neuromuscular disorder**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Pneumonia](https://www.passmedicine.com/v7/question/questions.php?q=0#) Neuromuscular disorders result in a restrictive pattern on pulmonary function tests

Answer 386

An elderly man who has smoked all his life is seen in the respiratory clinic for follow up of his emphysema. What changes on his lung function testing would you expect to see? [**Increased residual volume and reduced vital capacity**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Reduced residual volume and reduced vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Increased residual volume and increased vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Reduced residual volume and reduced vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Normal residual volume and normal vital capacity](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 387

A 55-year-old female is seen in GP after several episodes of shortness of breath and weakness. She claims that these episodes worsen during any mild-moderate exercise and worsen over time during the episode. She has noticed that these episodes have been getting progressively worse and now often feels 'dizzy' from the shortness of breath. She has no other past medical history and was a previous smoker of 10 years, smoking 10 cigarettes per day. She is referred for spirometry testing by her doctor which revealed a restrictive lung pattern. Which of the following is the most likely diagnosis? [Asthma](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Chronic obstructive pulmonary disease (COPD)](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Myasthenia gravis](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Alpha-1 antitrypsin deficiency](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Cystic fibrosis](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 388

A 55-year-old female is seen in GP after several episodes of shortness of breath and weakness. She claims that these episodes worsen during any mild-moderate exercise and worsen over time during the episode. She has noticed that these episodes have been getting progressively worse and now often feels 'dizzy' from the shortness of breath. She has no other past medical history and was a previous smoker of 10 years, smoking 10 cigarettes per day. She is referred for spirometry testing by her doctor which revealed a restrictive lung pattern. Which of the following is the most likely diagnosis? [Asthma](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Chronic obstructive pulmonary disease (COPD)](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Myasthenia gravis**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Alpha-1 antitrypsin deficiency](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Cystic fibrosis](https://www.passmedicine.com/v7/question/questions.php?q=0#) Since neutrophils, erythrocytes and platelets all derive from common myeloid progenitor cells, this suggests that the patient has an issue with this lineage. This means that options 1, 3 and 5 are incorrect, as these cancers involve the lymphoid lineage. Low levels of myeloid cells are seen in acute myeloid leukaemia as this cancer exhibits a differentiation block, meaning cells such as neutrophils do not develop. Raised neutrophil levels are seen in chronic myeloid leukaemia, as this cancer does not exhibit a differentiation block.

Answer 389

A 51-year-old male presents to the GP complaining of alterations to the sensation in his arms. He tells you that he first noticed changes three months ago where he could no longer feel the sleeves of his shirts on his arms when he wore them. This has now progressed to numbness and tingling in his forearms which began one month ago. He has no past medical history and is not on any medication. You ask him about his diet as you are concerned that he may be deficient in a vitamin. Which vitamin is this most likely to be? [Vitamin B](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vitamin E](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vitamin B6](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vitamin B](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Vitamin B12**](https://www.passmedicine.com/v7/question/questions.php?q=0#) In vitamin B12 deficiency, dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia

Answer 390

A 40-yr-old man comes to the GP complaining of tiredness, dizziness, and low mood. He mentions that he is recently divorced and perhaps that is influencing his low mood, however, the symptoms have been present for months. Blood was taken to assess any organic cause and he is found to have an MCV (mean cell volume) of 101 FL/RBC. (Normal range: 80-96 FL/RBC). His cells are also found to be normoblastic when investigated under a microscope. What is the most likely cause of the alterations in his red blood cells? [Hypothyroidism](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Intravascular haemolysis](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**High alcohol Intake**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Depression](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Vitamin B12 deficiency](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 391

A 23-year-old man presents with blunt abdominal trauma and a splenic bleed is suspected. He is commenced on an infusion of tranexamic acid. Which one of the following best describes its mechanism of action? **Inhibition of plasmin** Inhibition of thrombin Inhibition of factor II Inhibition of factor Xa Activation of factor VIII Tranexamic acid inhibits plasmin and this prevents fibrin degradation.

Answer 392

A 62-year-old female presents with fatigue, pallor and a tingling sensation in both hands. Screening blood tests reveal: Hb108 g/l (115-160 g/l)MCV110 fl (82-100 fl)B12142 ng/l (200-900 ng/l) What is the most common cause of this patient's macrocytic anaemia? Alcoholism **Pernicious anaemia** Lead poisoning Vegan diet Peptic ulcer disease

Answer 393

While on placement in general practice a 58-year-old female presents with new nipple discharge and dimpling in the skin over her breast. The GP does a breast exam including the surrounding lymph nodes. Which lymph nodes receive the majority of breast lymph? [**Axilliary lymph nodes**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Parasternal lymph nodes](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Internal thoracic chain](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Inferior phrenic lymph nodes](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Subdiaphragmatic lymph nodes](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 394

A 9-year-old girl is found by her GP to have a slightly low mean corpuscular volume (MCV) and a haemoglobin at the lower end of normal. She is investigated fully and found to have a gene missing for one of her four alpha globin alleles. Whilst explaining the condition to the girl and her parents, the doctor writes this: (aa/a-). What is the name of this condition? [Alpha thalassaemia trait: alpha(+) homozygous](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Silent carrier (alpha(+) heterozygous)**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Haemoglobin H disease](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Beta thalassaemia major](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Alpha thalassaemia major](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 395

A 56-year-old gentleman with stable angina undergoes an angiogram. The findings show stenosis of the left main artery of 60%. The patient is referred to the surgeons who recommend that he has a coronary artery bypass procedure. Which of the following structures is supplied by the vessel most likely to be used in this procedure? [Parotid gland](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Thyroid gland](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Thymus gland**](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Trachea](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Visceral pleura](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 396

A 40-year-old man is found to have a deep vein thrombosis (DVT) in his left calf. After investigation, it is discovered that this was caused by a genetic disease. What is the most common heritable cause of DVT? Antithrombin deficiency **Factor V Leiden** Protein S deficiency Von Willebrand disease Thalassaemia

Answer 397

Jenny, a 45-year-old woman, visits her general practitioner to discuss her medications. Recently, she was admitted to hospital with a deep vein thrombosis (DVT) and subsequently started on dabigatran. The GP explains that this is a 'blood thinner' that will reduce her risk of developing a DVT again. What is the mechanism of action of this anticoagulant? [Inhibits the activation of plasminogen](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Directly inhibits clotting factor Xa](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Directly inhibits thrombin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Inhibits the production of vitamin K related clotting factors](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Inhibits thromboxane synthesis](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 398

A 67-year-old man is referred to haematology clinic by his GP as he has been experiencing fatigue, night sweats and fevers. After undergoing all the necessary tests, he returns to clinic for his results and is informed that he has the most common form of adult leukaemia. Which of the following diagnoses is most likely? Acute lymphoblastic leukaemia Acute myelogenous leukaemia **Chronic lymphocytic leukaemia** Chronic myelogenous leukaemia Hairy cell leukaemia

Answer 399

Which of the following is the most common in children **Acute lymphoblastic leukaemia** Acute myelogenous leukaemia Chronic lymphocytic leukaemia Chronic myelogenous leukaemia Hairy cell leukaemia

Answer 400

A 44-year-old woman presents with fatigue, palpitations, and shortness of breath on exertion. She has been unwell recently with an upper respiratory tract infection. On examination, you note that she has conjunctival pallor, and her sclera are icteric. Investigations are carried out, with a Coombs test being positive, leading to a diagnosis of autoimmune haemolytic anaemia. In this condition, the breakdown of red blood cells leads to an increased level of free haemoglobin within the blood. Which of the following will play a role in recycling the increased levels of this substance? [Lactate dehydrogenase](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Haptoglobins**](https://www.passmedicine.com/v7/question/questions.php?q=0#) **-** Haptoglobin binds to free haemoglobin [Albumin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bilirubin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Reticulocytes](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 401

A 44-year-old woman presents with fatigue, palpitations, and shortness of breath on exertion. She has been unwell recently with an upper respiratory tract infection. On examination, you note that she has conjunctival pallor, and her sclera are icteric. Investigations are carried out, with a Coombs test being positive, leading to a diagnosis of autoimmune haemolytic anaemia. In this condition, the breakdown of red blood cells leads to an increased level of free haemoglobin within the blood. Which of the following will play a role in recycling the increased levels of this substance? [Lactate dehydrogenase](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Haptoglobins**](https://www.passmedicine.com/v7/question/questions.php?q=0#) **-** Haptoglobin binds to free haemoglobin [Albumin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bilirubin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Reticulocytes](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 402

A 44-year-old woman presents with fatigue, palpitations, and shortness of breath on exertion. She has been unwell recently with an upper respiratory tract infection. On examination, you note that she has conjunctival pallor, and her sclera are icteric. Investigations are carried out, with a Coombs test being positive, leading to a diagnosis of autoimmune haemolytic anaemia. In this condition, the breakdown of red blood cells leads to an increased level of free haemoglobin within the blood. Which of the following will play a role in recycling the increased levels of this substance? [Lactate dehydrogenase](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**Haptoglobins**](https://www.passmedicine.com/v7/question/questions.php?q=0#) **-** Haptoglobin binds to free haemoglobin [Albumin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Bilirubin](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Reticulocytes](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 403

A 33-year-old man with a 5 year history of poorly controlled Crohn's disease presents to the gastroenterology clinic for review. Despite trials of multiple agents, he was referred for an **ileocaecal resection 18** months ago, which he reports 'went well', and his symptoms have now largely subsided. However, he is now reporting new symptoms of tiredness and reduced exercise tolerance. What is the most likely cause of these symptoms? [Anaemia of chronic disease](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Colorectal cancer](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Folate deficiency](https://www.passmedicine.com/v7/question/questions.php?q=0#) [Iron deficiency anaemia](https://www.passmedicine.com/v7/question/questions.php?q=0#) [**B12 deficiency**](https://www.passmedicine.com/v7/question/questions.php?q=0#)

Answer 404

A 49-year-old woman presents with dyspnoea and pleuritic chest pain to the Emergency Department. A full cardiovascular and respiratory examination is normal. Inspection of the lower limbs reveals an area of painful swelling in the left calf, suggestive of deep vein thrombosis. A Wells' score of 4.5 is calculated. Observations: * Blood pressure: 103/76 mmHg * Pulse: 120 bpm * Temperature: 36.8ºC * Respiratory rate: 22/min CT pulmonary angiography shows a left pulmonary embolism. The patient is started on a direct factor Xa inhibitor. What drug was most likely prescribed to this patient? Dabigatran Dalteparin Fondaparinux **Rivaroxaban** Warfarin

Answer 405

You are a medical student attached to a surgical team. Before a patient's operation, the FY1 doctor asks you to take a group and save blood test in case they need a transfusion, the patient is identified as blood group A, this means they have anti-B antibodies. What type of antibodies will they have? IgG IgA IgD **IgM** IgE

Answer 406

You are a medical student attached to a surgical team. Before a patient's operation, the FY1 doctor asks you to take a group and save blood test in case they need a transfusion, the patient is identified as blood group A, this means they have anti-B antibodies. What type of antibodies will they have? IgG IgA IgD **IgM** IgE

Answer 407

You are a medical student attached to a surgical team. Before a patient's operation, the FY1 doctor asks you to take a group and save blood test in case they need a transfusion, the patient is identified as blood group A, this means they have anti-B antibodies. What type of antibodies will they have? IgG IgA IgD **IgM** IgE

Answer 408

A 20 year old male patient presents to the emergency department with a syncopal episode whilst playing football. He has regained consciousness on arrival to the emergency department. He has no past medical history of note. His father died suddenly 2 years ago from a 'heart condition', but the patient is unsure of the name. Physical examination reveals a harsh ejection systolic murmur that decreases in intensity on squatting. Which of the following echocardiogram findings is consistent with the most likely diagnosis? Left ventricular dilation, ejection fraction \<55% Regional wall motion abnormality, ejection fraction \<55% **Asymmetric septal hypertrophy, diastolic dysfunction** Apical ballooning of the left ventricle Asymmetric septal hypertrophy, normal diastolic function

Answer 409

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

Answer 410

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

Answer 411

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

Answer 412

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

Answer 413

When would this histopatholigcal slide from an MI likely to have occurred Less than 1 day **Less than 7 days** 1-2 days 1-3 week 3-6 weeks

Answer 414

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

Answer 415

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

Answer 416

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

Answer 417

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

Answer 418

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

Answer 419

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

Answer 420

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

Answer 421

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**

Answer 422

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

Answer 423

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

Answer 424

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

Answer 425

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

Answer 426

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

Answer 427

Rheumatic fever

Answer 428

Aschoffs bodies

Answer 429

A: Normal B: Ashoff bodies C: Rheumatic mitral stenosis

Answer 430

Aschoff are **nodular inflammatory lesions** found in the **CT of the myocardium.** Aschoff bodies are **areas of necrosis** and **large distinctive macrophages**

Answer 431

Aschoff bodies may collect at the **mitral** valve toc cause **rheumatic** **mitral** **stenosis**.

Answer 432

Thyroglobulin (stores and secretes T3 & T4)

Answer 433

Hashimoto Thyroiditis

Answer 434

A: **Chief cells** B: **oxyphil cells**

Answer 435

A = zona glomerulosa, B = zona fasciculata, C = zona reticularis. D = Medulla.

Answer 436

Islet of Langerhans

Answer 437

Which cells have been stained in the islet of langerhans Alpha cells **Beta cells** : most abundant Delta cells PP cells

Answer 438

Which of the following are the majority of the endcorine cells in islet of langerhans? Alpha cells **Beta cells** Delta cells PP cells

Answer 439

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.

Answer 440

Arrows: Renal corpsucles *: collecting ducts

Answer 441

A: **podocytes** B: **basement membrane**

Answer 442

A: DCT B: PCT

Answer 443

Arrows: PCT Arrowheads: DCT

Answer 444

C = CD B: LoH

Answer 445

A: transitional epithelium B: LP C: muscualris mucosa D: adventitia

Answer 446

A: transitional epithelium B: LP C: muscularis

Answer 447

What type of liver cancer is depicted here? **Metastatic adenocarcinoma** Hepatic carcinoma

Answer 448

What type of liver cancer is depicted here? **Metastatic adenocarcinoma** Hepatic carcinoma

Answer 449

What type of liver cancer is depicted here? Metastatic adenocarcinoma **Hepatic carcinoma**

Answer 450

Pituicytes

Answer 451

Which of the following is safe to treat pregnant people? DOACS **Warfarin**: tetrogenic LMWH

Answer 452

Which of the following class of drug does indapamide fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker **Diuretics** thiazide-like diuretic Beta-blockers

Answer 453

Which of the following class of drug does metoprolol fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics **Beta-blockers**

Answer 454

Which of the following class of drug does amlodipine fall into? ACE inhibitors: Angiotensin-II receptor antagonists **Calcium-channel blocker** Diuretics Beta-blockers

Answer 455

Which of the following class of drug does enalapril fall into? **ACE inhibitors**: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics Beta-blockers

Answer 456

Which of the following class of drug does losartan fall into? ACE inhibitors: **Angiotensin-II receptor antagonists** Calcium-channel blocker Diuretics Beta-blockers

Answer 457

Which of the following is a not a source of endogenous NO? - Endothelium - Nerve fibres **- Connective Tissue** - Skeletal Muscle - Tunica intima

Answer 458

Which of the following is not a substrate used in the formation of NO using NOS - L-arginine **- BH4**: co factor - O2 - NADPH

Answer 459

What is the threshold for an urea score contributing to CURB65 score? >4 >5 >6 **>7** >8

Answer 460

When you see someone out of hospital with a CRB-65 score of anything other than [] NICE suggest considering referring to the hospital. **0** 1 2 3 4

Answer 461

Aortic Stenosis HTN

Answer 462

An [] is the test of choice in establishing the diagnosis of LVH ECG **Echocardiogram** Doppler Cardiac ultrasound MRI

Answer 463

Which of the following class of drug does indapamide fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker **Diuretics** thiazide-like diuretic Beta-blockers

Answer 464

Which of the following class of drug does metoprolol fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics **Beta-blockers**

Answer 465

Which of the following class of drug does amlodipine fall into? ACE inhibitors: Angiotensin-II receptor antagonists **Calcium-channel blocker** Diuretics Beta-blockers

Answer 466

Which of the following class of drug does enalapril fall into? **ACE inhibitors**: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics Beta-blockers

Answer 467

Which of the following class of drug does losartan fall into? ACE inhibitors: **Angiotensin-II receptor antagonists** Calcium-channel blocker Diuretics Beta-blockers

Answer 468

Which of the following would you use to deliver 24 – 30% O2 (maximum flow rate of 4L/min) for mild hypoxia? **Nasal cannulae** Simple face mask Non-rebreather mask Venturi mask

Answer 469

Which of the following would you use to deliver for patients with chronic obstructive pulmonary disease (COPD) due to the risk of type 2 respiratory failure. Nasal cannulae Simple face mask Non-rebreather mask **Venturi mask**

Answer 470

Which of the following would you use to deliver approximately 70% O2 when used with a 15L oxygen flow rate. Nasal cannulae Simple face mask **Non-rebreather mask** Venturi mask

Answer 471

Which of the following would you use to deliver 30 – 40% O2 (flow rate 5-10 L/min) Nasal cannulae **Simple face mask** Non-rebreather mask Venturi mask

Answer 472

Which of the following would used to treat patients with a significant degree of hypoxia (moderate to severe). Nasal cannulae Simple face mask **Non-rebreather mask** Venturi mask

Answer 473

What would DCLO be expected to be in COPD & asthma patients? DCLO reduced in COPD & asthma patients **DCLO reduced in COPD but raised in asthma patients** DCLO reduced in asthma but raised in COPD patients DCLO raised in COPD and asthma patients

Answer 474

**2** CURB-65 is a scoring system used to grade the severity of pneumonia: Confusion Urea > 7 Respiratory rate ≥ 30 Blood pressure <90mmHg systolic or ≤60mmHg diastolic Aged ≥ 65 years old

Answer 475

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

Answer 476

Which of the following treatments of pneumonia causes toxic optic neuropathy? Rifampicin Isoniazid **Ethambutol** Pyrazinamide

Answer 477

An 82-year-old lady presents to the hospital with a fever and confusion. A CXR is performed showing a right-sided basal pneumonia. Her blood tests reveal a urea of 12mmol/L. Her observations are shown below: Oxygen saturation 94% on air Heart rate 120 bpm Blood pressure 110/57 mmHg Respiratory rate 28 breaths per minute Temperature 38.1oC What is her CURB 65 score? 2 3 5 **4** 1 **She would score for confusion, urea, diastolic blood pressure and age, bringing her total score to 4.**

Answer 478

**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).

Answer 479

**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).

Answer 480

A 78-year-old male presents for evaluation of unexplained weight gain in the last few days. For the past four months, the patient reports drenching night sweats and dysphagia with an associated unexplained weight loss. However, he now has rapid weight gain and is concerned because he feels like he is "blowing up like a balloon." His vital signs reveal a temperature of 38.5 degrees Celcius, a pulse of 60/min, blood pressure of 140/90/min, and respirations of 15/min. On physical examination, generalized lymphadenopathy is noted. The left supraclavicular node is distinctly palpable. Based on the patient's findings, what pattern of edema would be seen? A. Entire right side and left leg **B. Entire left side and right leg** C. Left arm only D. Right arm only

Answer 481

Which of the following is not part of Weldeyer ring? Pharyngeal Tubal Lingual **Tonsular** Palatine

Answer 482

A 12-year-old male presents to the emergency department with a chief-complaint of wheezing, flushing, and a full-body rash after consuming a brownie at school. The patient has a history of peanut allergy and was not aware that peanut butter was one of the ingredients in the brownie. What is the patient currently experiencing? A. Type I hypersensitivity reaction that involves IgG, IgM, and sometimes IgA antibodies. B. Type II hypersensitivity reaction that involves immunoglobulin E antibodies. C. Type I hypersensitivity reaction that involves immunoglobulin E antibodies. D. Type IV hypersensitivity reaction that involves IgG, IgM, and sometimes IgA antibodies.

Answer 483

An 18-year-old female underwent endotracheal intubation for an emergent appendectomy. Post-procedure, the patient developed aphonia. Which of the following represents the site of injury of the most likely nerve involved? A. At the level of the oropharynx **B. Between the cricoid and thyroid cartilage** : RLN C. At the level of the epiglottic fold D. In between the thyroid and parathyroid gland

Answer 484

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

Answer 485

Which is not a good indicator of shock? - Reduced urine output - Reduced pH **- Reduced BP**: retained till the end via comp. mechanisms - Confusion

Answer 486

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

Answer 487

Which of the following is the most common leukemia in the pediatric population Chronic myeloid leukemia Acute myeloid leukemia Chronic lymphocytic leukemia **Acute lymphocytic leukemia**: accounting for up to 80% of cases in this group vs. 20% of cases in adults.

Answer 488

Which of the following is the most aggressive cancer with a variable prognosis Chronic myeloid leukemia **Acute myeloid leukemia** Chronic lymphocytic leukemia Acute lymphocytic leukemia

Answer 489

Which of the following typically arises from reciprocal translocation and fusion of BCR on chromosome 22 and ABL1 on chromosome 9 **Chronic myeloid leukemia** Acute myeloid leukemia Chronic lymphocytic leukemia Acute lymphocytic leukemia

Answer 490

This slide depicts which of the following **Chronic myeloid leukemia** Acute myeloid leukemia Chronic lymphocytic leukemia Acute lymphocytic leukemia

Answer 491

A 65-year-old male with hypertension presented to his primary care provider for a regular check-up. A complete blood picture revealed a white blood cell count of 100,000/mm^3. The patient is asymptomatic. A peripheral smear shows significant lymphocytosis. What is the most likely diagnosis? A. Acute myelogenous leukemia B. Chronic myelogenous leukemia C. Acute lymphocytic leukemia **D. Chronic lymphocytic leukemia**

Answer 492

**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.

Answer 493

**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.

Answer 494

What does this slide depict? A. Acute myelogenous leukemia **B. Chronic myelogenous leukemia** C. Acute lymphocytic leukemia D. Chronic lymphocytic leukemia

Answer 495

What does this slide depict? A. Acute myelogenous leukemia **B. Chronic myelogenous leukemia** C. Acute lymphocytic leukemia D. Chronic lymphocytic leukemia

Answer 496

What does this slide depict? **A. Acute myelogenous leukemia** B. Chronic myelogenous leukemia C. Acute lymphocytic leukemia D. Chronic lymphocytic leukemia

Answer 497

What does this slide depict? **A. Acute myelogenous leukemia** B. Chronic myelogenous leukemia C. Acute lymphocytic leukemia D. Chronic lymphocytic leukemia

Answer 498

What does this slide depict? **A. Acute myelogenous leukemia** B. Chronic myelogenous leukemia C. Acute lymphocytic leukemia D. Chronic lymphocytic leukemia

Answer 499

What does this slide depict? A. Acute myelogenous leukemia B. Chronic myelogenous leukemia **C. Acute lymphocytic leukemia** D. Chronic lymphocytic leukemia

Answer 500

What does this slide depict? A. Acute myelogenous leukemia B. Chronic myelogenous leukemia **C. Acute lymphocytic leukemia** D. Chronic lymphocytic leukemia

Answer 501

What does this slide depict? A. Acute myelogenous leukemia B. Chronic myelogenous leukemia **C. Acute lymphocytic leukemia** D. Chronic lymphocytic leukemia

Answer 502

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).

Answer 503

What does this slide depict? A. Acute myelogenous leukemia B. Chronic myelogenous leukemia C. Acute lymphocytic leukemia **D. Chronic lymphocytic leukemia**

Answer 504

A patient's investigations reveal pancytopenia and macrocytosis. His peripheral smear shows hyper-segmented neutrophils. Serological tests reveal positive anti intrinsic factor antibodies. What other biochemical derangements might be observed in this patient? **D. Elevated plasma homocysteine** This patient likely has megaloblastic anemia due to a deficiency of vitamin B12. Vitamin B12 is an essential co-factor involved in two important enzymes. One of these enzymes is methionine synthase, which converts homocysteine to methionine. The deficiency of cobalamin will lead to the impaired functioning of this enzyme. This will result in an accumulation of homocysteine which can be detected in the blood.

Answer 505

Which factor, if in excess can cause a of hypercoagulable state Factor X Factor VII **Factor VIII** Factor IX

Answer 506

Which one of the following is not a cause of a hypercoagulable state Elevated factor VIII Malignancy Protein C deficiency Antiphospholipid syndrome **Elevated factor Xa**

Answer 507

Which of the following would you prescribe alongside aspirin for NSTEMI treatment Clopidogrel - (clopidogrel 300mg is an alternative if higher bleeding risk) Prasugrel **Ticagrelor** Abciximab

Answer 508

Name the receptor on platelets that is activated by ADP **P2Y12** COX-1 TXA2 Glycoprotein IIb/IIIa

Answer 509

Which of the following acts a receptor for von Willebrand Factor (vWF) P2Y12 COX-1 TXA2 **Glycoprotein IIb/IIIa**

Answer 510

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

Answer 511

This diagram depicts platelet adhesion to endothelium Which of the following is fibrinogen A **B** C D

Answer 512

This diagram depicts platelet adhesion to endothelium Which of the following is GpIIb/IIIa **A** B C D

Answer 513

This diagram depicts platelet adhesion to endothelium Which of the following is GpIb A B C **D**

Answer 514

Which of the following prevents the conversion of arachidonic acid to thromboxane A2 Heparin Warfarin **Aspirin** Dabigatran Edoxaban

Answer 515

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**.

Answer 516

Which of the following can cause thrombocytopenia **Heparin** Warfarin Aspirin Dabigatran Dipyridamole

Answer 517

Which of the following should not be used in pregnancy Heparin **Warfarin**: teratogenic Aspirin Dabigatran Dipyridamole

Answer 518

**Fondaprinux**

Answer 519

Which of the following is a non-specific phosphodiesterase inhibitor **Dipyridamole** Inhibits both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, an inhibitor of platelet function

Answer 520

Dabigatran Rivaroxaban Apixaban Edoxaban

Answer 521

**Direct factor Xa inhibitor** (more modern version of heparin)

Answer 522

**Direct thrombin inhibitor**

Answer 523

Which of the following is not a direct factor Xa inhibitor Rivaroxaban Apixaban Edoxaban **Dabigatran**: direct thrombin inhibitor

Answer 524

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.

Answer 525

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

Answer 526

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

Answer 527

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

Answer 528

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

Answer 529

Normal: **-30° and +90º** Right axis deviation: **+90º and +180º** Left axis deviation: **-30° and -90°**.

Answer 530

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.

Answer 531

Left axis deviation would occur from an MI in which part of the heart? Septal Anterior **Inferior** Lateral

Answer 532

Cold peripheries are caused by: **Beta blockers** Loop diuretics ACE inhibitors Thiazide-like diuretics

Answer 533

Which of the following is most associated with ACE inhbitors Hypokalaemia Dry mouth **Cough** Bradycardia Fluid retention

Answer 534

Eosinophil accumulation is also favored by: IL-1 IL-2 IL-3 IL-4 **IL-5**

Answer 535

Which of these is not a cause of systolic heart failure Ischaemic heart disease Dilated cardiomyopathy Myocarditis Arrhythmias **Cardiac tamponade** - diastolic failure

Answer 536

Streptokinase Alteplase (tPA)

Answer 537

**Streptokinase**: Clot buster; Activates fibrinolytic pathway **Alteplase (tPA)**: Increase clot; breakdown by increasing Plasmin formation

Answer 538

Which of the following inhibits L type calcium channel **Amlodipine** Nicorandil Diatelzem Lisinopril **Verapamil**

Answer 539

Which of the following drug is for voltage gated calcium channels in myocardium to reduce HR and O2 demand? Amlodipine Nicorandil Diatelzem Lisinopril **Verapamil** - CCB

Answer 540

Which of the following is a CCB that acts on both myocardium and vessels for dual effect? Amlodipine Nicorandil **Diatelzem** Lisinopril Verapamil

Answer 541

Which of the following is a vasodilator that opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels and causes release of NO? Amlodipine **Nicorandil** Diatelzem Lisinopril Verapamil

Answer 542

Which of the following that particularly reduces peripheral vascular resistance / lowers peripheral BP? **Amlodipine** Bind to L-Type calcium channel Peripheral arterial vasodilator Reduce peripheral vascular resistance – lower BP Calcium channel antagonist (smooth + cardiac muscle)

Answer 543

**Verapamil** - CCB Inhibit L-Type calcium channel Reduce contractility and peripheral resistance Reduce heart rate by prolonging refractory period of AVN.

Answer 544

Which of the following can cause severe hypotension as an AE? **Amlodipine** Nicorandil Diatelzem Lisinopril Verapamil

Answer 545

Rosuvostatin

Answer 546

**Competitive inhibitor** of **HMG-CoA Reductase** Reduction of the **mevalonate** **pathway** **Inhibit cholesterol synthesis** **Inhibit LDL uptake, VLDL synthesis.**

Answer 547

rhabdomyolysis

Answer 548

Ramipril Lisinopril Captopril

Answer 549

Converted to **ramiprilat** **Inhibits ACE**, stop ACE-1 --> ACE-II conversion **Reduce sodium and H2O reabsorption** Reduces **peripheral vascular resistance.**

Answer 550

ACE breaks down **bradykinin**: causes **Dry COUGH**

Answer 551

**Hyperkalaemia** (Less Angiotensin II, NO aldosterone, less K secreted, less Na reabsorbed)

Answer 552

Valsartan Losartan

Answer 553

Which of the following would you prescribe if a patient has ACE-I intolerance? **Losartan** - ARB Captopril lisinopril Digoxin Ivabradine

Answer 554

Which of the following is an inotrope? Losartan Captopril lisinopril **Digoxin** increases the force of **myocardial contraction** and **reduces conductivity within the atrioventricular (AV) node.** Ivabradine

Answer 555

increases the **force of myocardial contraction** and **reduces conductivity** within the **atrioventricular (AV) node** **Stimulate Vagus Nerve**, **reduce** **circulating** **noradrenaline** = lower heart rate

Answer 556

Gynaecomastia

Answer 557

Which of the following has a risk of gynaecomastia? Losartan Captopril lisinopril **Digoxin** Ivabradine

Answer 558

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

Answer 559

Both decrease HR and RAAS. Propranolol is **non-selective** Atenolol is **β1 selective**

Answer 560

Which of the following is an α2-agonist that causes a decrease in CO and vascular tone **Clonidine** Propranolol Atenolol Prazosin Doxazosin

Answer 561

Which of the following is an α2-agonist that causes a decrease in CO and vascular tone **Clonidine** Propranolol Atenolol Prazosin Doxazosin

Answer 562

Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate Clonidine Propranolol Atenolol **Prazosin** **Doxazosin**

Answer 563

**Pirfenidone**: used to treat IPF

Answer 564

**Ivabradine** Hyperpolarization-activated cyclic nucleotide-gated (**HCN**) **channel blockers** **Slows heart rate**

Answer 565

What is the first line treatment for Asthma? **Salbutamol** Salmeterol Beclomethasone (Becotide) Montelukast Ipratropium

Answer 566

**trembling, particularly in the hands** nervous tension headaches suddenly noticeable heartbeats (palpitations) muscle cramps

Answer 567

Which of the following is a Long-Acting Beta-2 Agonist (LABA) Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Ipratropiuma

Answer 568

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment? Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Ipratropiuma

Answer 569

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment? Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Prednisolone

Answer 570

Which of the following is a corticosteroid used to treat asthma and acts more globally Salbutamol Salmeterol Beclomethasone (Becotide) Montelukast **Prednisolone**

Answer 571

Which of the following is a corticosteroid used to treat asthma and acts more locally Salbutamol Salmeterol **Beclomethasone (Becotide)** Montelukast Prednisolone

Answer 572

Which of the following is associated with Cushings disease if long term use occurs Salbutamol Salmeterol Beclomethasone (Becotide) Montelukast **Prednisolone**

Answer 573

Which of the following treatment for asthma can be associated with oral thrush? Salbutamol Salmeterol **Beclomethasone (Becotide)** Montelukast Prednisolone

Answer 574

Which of the following is a leukotriene antagonist to treat asthma? Salbutamol Salmeterol Beclomethasone (Becotide) **Montelukast** Prednisolone

Answer 575

What are the 4 drugs used to treat TB? [4] Rifampicin Isoniazid Pyrazinamide Ethambutol

Answer 576

Which of the following treats TB by blocking mycolic acid synthesis required for mycobacterial cell wall synthesis? Rifampicin **Isoniazid** Pyrazinamide Ethambutol

Answer 577

Which of the following is a prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death? Rifampicin Isoniazid **Pyrazinamide** Ethambutol

Answer 578

Which of the following blocks mycolic acid synthesis? Rifampicin Isoniazid Pyrazinamide **Ethambutol**

Answer 579

Which of the following blocks bacterial RNA polymerase to treat TB? **Rifampicin** Isoniazid Pyrazinamide Ethambutol

Answer 580

Alongside prescribing oxygen, which other drug would you give someone with acute heart failure? **diuretic** ACE-I/ARB beta-blocker aldosterone inhibitor

Answer 581

Tachycardia

Answer 582

Respiratory distress

Answer 583

The laryngeal prominence occurs at which vertebral level C3 **C4** C5 C6 C7

Answer 584

A baby is premature, born at 30 weeks, putting her at higher risk for delayed ductus venosus closure. Which structures does the ductus venosus act as a communication between in the fetus? IVC and umbilical artery Umbilical vein and umbilical artery **IVC and umbilical vein** Hepatic portal vein and aorta Aort and pulmonary artery