CR2 Questions COPY Flashcards

Question 1

Q

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 2

Q

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 3

Q

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 4

Q

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Which is characterised by the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 5

Q

What is this an image of? [1]

Circumflex artery
LAD
Marginal branch
Posterior interventricular artery
Right coronary artery

Answer

A

]What is this an image of? [1]

Circumflex artery
LAD
Marginal branch
Posterior interventricular artery
Right coronary artery

Question 6

Q

Eccentric hypertrophy is caused by which of the following? [2]

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Eccentric hypertrophy is caused by which of the following? [2]

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 7

Q

Concentric hypertrophy is caused by which of the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Answer

A

Concentric hypertrophy is caused by which of the following?

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 8

Q

Which areas of the myocardium match up with each of the coronary arteries? [4]

Question 9

Q

What’s the difference between where you listen to heart valves and their exact location?
Why is this [1]

Question 10

Q

Label A-F

Answer

A

A: fossa ovalis
B: pectinate muscle
C: SVC
D: crista termanalis
E: ligamentum arteriosum
F: pulmonary trunk

Question 11

Q

Between which chambers does the foramen ovale shunt blood between? [2]

Answer

A

Right atrium –> Left atrium

Question 12

Q

Which organ is most directly effected by high BP?

Lungs
Heart
Kidneys
Eyes
Brain

Answer

A

Which organ is most directly effected by high BP?

Lungs
Heart
Kidneys
Eyes
Brain

Question 13

Q

The most important modifiable risk factor in CVA prevention is caused by? [1]

Answer

A

Controlling hypertension

Question 14

Q

Lacunar infarcts causes damage to which artery? [1]

Answer

A

Lacunar infarcts. High blood pressure can also lead to damage to the very small branches of the middle cerebral arteries, with the formation of lacunar infarcts, particularly in the thalamus, mid-brain and pons

Question 15

Q

What are the BP ranges for isolated diastolic BP? [1]

Answer

A

>140 / < 90 mmHg

Question 16

Q

Which leads have ST elevation in this ECG? [3]

Answer

A

II, III, aVF

Question 17

Q

Which coronary artery is most likely to have been affected by occlusion here?

Circumflex artery?
LAD
LCA
RCA

Answer

A

Which coronary artery is most likely to have been affected by occlusion here?

Circumflex artery?
LAD
LCA
RCA

Question 18

Q

What is the most common cause of heart failure?

Cardiomyopathy
Hypertension
Ischaemic Heart Disease

Answer

A

What is the most common cause of heart failure?

Cardiomyopathy
Hypertension
Ischaemic Heart Disease

Question 19

Q

Left-sided heart failure results in blood backing up into the lungs, what condition can this lead to? [1]

Answer

A

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

Question 20

Q

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

A

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

Question 21

Q

Which of the following conditions would cause eccentric hypertrophy [2]

Renal failure

Aortic stenosis

Aortic regurgitation

Increased BP

Answer

A

Which of the following conditions would cause eccentric hypertrophy [2]

Renal failure

Aortic stenosis

Aortic regurgitation

Increased BP

*Eccentric hypertrophy is caused by volume overload, so could be caused by renal failure (which increases blood volume). It could also be caused by valve regurgitation.

Aortic stenosis usually results in initial concentric hypertrophy, but this in itself can then leads to eccentric hypertrophy.*

Question 22

Q

What is the most common site for atherosclerotic plaque build up? [1]

Which area is most common for coronary artery athersclerotic plaque build up? [1]

Answer

A

Acceptable responses: Bifurcations, Bifurcation points, Points of bifurcation, Bifurcation

the anterior interventricular/left anterior descending branch being most commonly affected.

Question 23

Q

Where does fluid accumulate in pleural effusions? [1]

Answer

A

Acceptable responses: Pleural space

Question 24

Q

Question 25

Q

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

A

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)

Question 26

Q

Where does fluid accumulate in pulmonary oedema? [1]

Answer

A

Acceptable responses: Alveoli, Alveolar sacs

Question 27

Q

Define the term aneurysm [1]

Where do aortic aneurysms most commonly occur? [1]

Answer

A

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.

Question 28

Q

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

Membranous
Muscular

Answer

A

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

Membranous
Muscular

Question 29

Q

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Answer

A

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Question 30

Q

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Answer

A

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Question 31

Q

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Answer

A

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Question 32

Q

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Answer

A

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Question 33

Q

Question 34

Q

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Answer

A

Which pathology is depicted here?

Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural effusion
Fluid leak into alveoli

Question 35

Q

Question 36

Q

Which form is iron stored in cell?

Ferritin
Ferroportin
Hepcidin
Transferrin
Haem

Answer

A

Which form is iron stored in cell?

Ferritin
Ferroportin
Hepcidin
Transferrin
Haem

Question 37

Q

Name the transport channel that Fe2+ leaves the cell via [1]

Name the molecule that transports Fe3+ around the body [1]

Answer

A

Name the transport channel that Fe2+ leaves the cell via [1]
Ferroportin

Name the molecule that transports Fe3+ around the body [1]
transferrin

Question 38

Q

Why might you miss if someone is deficient in iron? [1]

Answer

A

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

Question 39

Q

Where is EPO made?

Myeloid tissue
Kidney
Liver
Heart
Spleen

Answer

A

Where is EPO made?

Myeloid tissue
Kidney
Liver
Heart
Spleen

Question 40

Q

Which of the following allows Fe into the cell?

DMT1
DMT2
DMT3
SGLT1
GLUT2

Answer

A

Which of the following allows Fe into the cell?

DMT1
DMT2
DMT3
SGLT1
GLUT2

Question 41

Q

Which of the following blocks ferroportin?

transferrin
ferritin
DMT1
Haem
Hepcidin

Answer

A

Which of the following blocks ferroportin?

transferrin
ferritin
DMT1
Haem
Hepcidin

Question 42

Q

Where is transferrin mainly taken up?

Myeloid tissue
Kidney
Liver
Heart
Spleen

Answer

A

Where is transferrin mainly taken up?

Myeloid tissue
Kidney
Liver
Heart
Spleen

Question 43

Q

Which of the following is the where erythrocytes are produced at 6 weeks old?

liver
spleen
yolk sac
bone marrow

Answer

A

Which of the following is the where erythrocytes are produced at 6 weeks old?

liver
spleen
yolk sac
bone marrow

Question 44

Q

Which of the following is the where erythrocytes are produced at 3 weeks old?

liver
spleen
yolk sac
bone marrow

Answer

A

Which of the following is the where erythrocytes are produced at 3 weeks old?

liver
spleen
yolk sac
bone marrow

Question 45

Q

Which of the following is the where erythrocytes are produced at 8 weeks old?

liver
spleen
yolk sac
bone marrow

Answer

A

Which of the following is the where erythrocytes are produced at 8 weeks old?

liver
spleen
yolk sac
bone marrow

Question 46

Q

Which of the following is excreted in urine?

urobilinogen
stercobilin
bilirubin
glucoronic acid
unconjugated bilirubin

Answer

A

Which of the following is excreted in urine?

urobilinogen
stercobilin
bilirubin
glucoronic acid
unconjugated bilirubin

Question 47

Q

Question 48

Q

Which of the following is excreted in faeces?

urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin

Answer

A

Which of the following is excreted in faeces?

urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin

Question 49

Q

Which of the following is excreted in urine?

urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin

Answer

A

Which of the following is excreted in urine?

urobilinogen
stercobilin
bilirubin
glucoronic acid
urobilin

Question 50

Q

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Answer

A

Anaemia from which of the following causes the image below?

B12 deficiency: glossitis
Lead poisoning
Thalassemia
Iron deficiency

Question 51

Q

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Answer

A

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Question 52

Q

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Answer

A

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Question 53

Q

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Answer

A

Anaemia from which of the following causes the image below?

B12 deficiency
Lead poisoning
Thalassemia
Iron deficiency

Question 54

Q

Which part of platelet structure contains pro-coagulant factors?

Membrane
Alpha granules
Dense granules
Metabolites

Answer

A

Which part of platelet structure contains pro-coagulant factors?

Membrane
Alpha granules
Dense granules
Metabolites

Question 55

Q

If ferritin in the blood is low it is highly suggestive of WHAT? [1]

If ferritin is high then this is likely to be related to WHAT? [1]

Answer

A

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

Question 56

Q

Which is most likely to caused by liver toxicity or alcohol poisoning?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Answer

A

Which is most likely to caused by liver toxicity or alcohol poisoning?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Question 57

Q

Which is most likely to caused by IDA?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Answer

A

Which is most likely to caused by IDA?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Question 58

Q

Which is most likely to caused by pernicious anaemia?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Answer

A

Which is most likely to caused by pernicious anaemia?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Question 59

Q

Which is most likely to caused by B12 or folate deficiency?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Answer

A

Which is most likely to caused by B12 or folate deficiency?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Question 60

Q

The results in this blood film would indicate which of the following?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Answer

A

The results in this blood film would indicate which of the following?

Macrocytic
Microcytic
Normocytic
Megaloblastic
Macronormoblastic

Question 61

Q

Increased levels of reticulocytes, bilirubin & LDH would indicate which type of anaemia?

Answer

A

Haemolytic anaemia

Question 62

Q

Which of the following causes haemolytic anaemia if in cold conditions?

IgM
IgA
IgE
IgD
IgG

Answer

A

Which of the following causes haemolytic anaemia if in cold conditions?

IgM
IgA
IgE
IgD
IgG

Question 63

Q

Which of the following causes haemolytic anaemia if in warm conditions?

IgM
IgA
IgE
IgD
IgG

Answer

A

Which of the following causes haemolytic anaemia if in warm conditions?

IgM
IgA
IgE
IgD
IgG

Question 64

Q

Folate is used to make which of the following?

Uracil
Adenine
Guanosine
Thymidine
Cytosine

Answer

A

Folate is used to make which of the following?

Uracil
Adenine
Guanosine
Thymidine
Cytosine

Answer 59

A

What is the inheritance pattern of G6PD deficiency?

Autosomal dominant
Autosomal recessive
Y-linked
X-linked

Answer 60

A

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 61

A

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 62

A

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 63

A

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 64

A

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm

Answer 65

A

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 66

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia

Answer 67

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation: lack of P wave
AVN Reentrant Tachycardia

Answer 68

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia

Answer 69

A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter

Answer 70

A

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 71

A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter

Answer 72

A

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 73

A

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 74

A

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.

So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.

Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.

On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.

Answer 75

A

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 76

A

Right bundle branch block

Answer 77

A

Left branch bundle block

Answer 78

A

A = Afib
B = Atrial flutter (saw toothed)

Answer 79

A

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 80

A

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 81

A

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 82

A

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 83

A

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 84

A

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 85

A

Alpha globin gene is found on:

Chromosome 12
Chromosome 8
Chromsome 15
Chromosome 16
Chromsome 4

Answer 86

A

Beta globin gene is found on:

Chromosome 11
Chromosome 14
Chromsome 9
Chromosome 16
Chromsome 2

Answer 87

A

Which of the following represents the structure of fetal Hb?

α2, β2
α2, ζ2
*- α2, Y2**
α2, δ2
δ2, β2

Answer 88

A

Which of the following represents the structure of adult Hb A?

*- α2, β2**
α2, ζ2
α2, Y2
α2, δ2
δ2, β2

Answer 89

A

Which of the following represents the structure of adult Hb A2?

α2, β2
α2, ζ2
α2, Y2
α2, δ2
δ2, β2

Answer 90

A

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

Answer 91

A

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

Answer 92

A

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

Answer 93

A

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 94

A

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

Answer 95

A

Von Willebrand Factor is a carrier for which of the following?

Factor VII
Factor VIII
Factor IX
Factor X
Factor XI

Answer 96

A

Warfarin is an antagonist to which vitamin?

Vitamin C
Vitamin B
Vitamin K
Vitamin A

Vitamin E

Answer 97

A

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

Answer 98

A

Which of the following describes the inheritance for thalassaemia?

Autosomal dominant
Autosomal recessive
X dominant
X recessive
Y linked

Answer 99

A

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 100

A

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 101

A

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 102

A

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 103

A

Yolk Sac / A: Z2, E2

Fetal liver / B: A2, γ2
Bone marrow / C: A2, B2

Answer 104

A

fascia adherens desmosomes gap junctions

Answer 105

A

**purkinje fibres**

Answer 106

A

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

Answer 107

A

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

Answer 108

A

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

Answer 109

A

**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 110

A

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

Answer 111

A

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

Answer 112

A

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

Answer 113

A

Which is the most common cause of heart failure?

Coronary artery disease
Anaemia
Hypertension
Cardiomyopathy
Valvular heart disease

Answer 114

A

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 115

A

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 116

A

sublingual GTN [1]

Answer 117

A

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

Answer 118

A

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

Answer 119

A

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

Answer 120

A

P2Y₁₂ receptor is involved in platelet aggregation

Answer 121

A

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 122

A

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 123

A

DLCO = Lung surface area available for gas exchange (Va) X rate of capillary blood CO uptake (Kco)

Kco is particularly affected by IPF

Answer 124

A

Nasopharyngitis is mostly commonly caused by which of the following?

Adenoviruses
Echoviruses
Coronaviruses
Rhinoviruses

Answer 125

A

Toll-like receptors [1]

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

Answer 126

A

TNF-alpha
IFN
CXCL8

Answer 127

A

Streptococcus pneumoniae

Answer 128

A

Secondary haemostasis

Answer 129

A

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 130

A

MI [1]
Hyperkalemia [1]

Answer 131

A

Junctional rhythm: lack of P wave; bradycardia

Answer 132

A

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 133

A

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 134

A

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm

Answer 135

A

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 136

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia

Answer 137

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation: lack of P wave
AVN Reentrant Tachycardia

Answer 138

A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia

Answer 139

A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter

Answer 140

A

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 141

A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter

Answer 142

A

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 143

A

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 144

A

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.

So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.

Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.

On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.

Answer 145

A

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 146

A

Right bundle branch block

Answer 147

A

A = Afib
B = Atrial flutter (saw toothed)

Answer 148

A

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 149

A

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

Answer 150

A

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 151

A

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 152

A

What is the duration of a normal PR-interval?

04-0.12 secs
04-0.08 secs

0.08-0.12 secs

0.12-0.2 secs

Answer 153

A

Which of the following is a common cause of right axis deviation?

VSD
ASD
Right ventricular hypertrophy
Left ventricular hypertrophy

Answer 154

A

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 155

A

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 156

A

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 157

A

What view of the heart do leads I, aVL, V5 and V6 represent?

Anterior
Inferior
Lateral
Septal

Answer 158

A

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 159

A

What is the most common cause of left axis deviation?

Right ventricular hypertrophy
ASD
Defects of the conducting system
Left ventricular hypertrophy

Answer 160

A

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 161

A

How much fluid needs to accumulate in the pleura before it is visible on CXR

100ml
200ml
300ml
400ml
500ml

Answer 162

A

BUT: more often dont actually know / cant ID the cause

Streptococcus pneumoniae= 50%

Haemophilus influenzae = 20%

Answer 163

A

BNP: Brain Natriuretic Peptide

is a hormone released by the heart when the ventricles are stretched e.g. by fluid overload.

The hormone then causes fluid and sodium loss in the urine and mild vasodilation.

In heart failure BNP levels are raised, and increase in level according to New York Heart Association classification. If BNP is normal it generally rules out heart failure.

Secreted by cardiomyocytes in the ventricles

Answer 164

A

Which of the following is the most common cause of heart failure?

Coronary artery disease
Hypertension
Valvular disease
Myocarditis

Answer 165

A

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 166

A

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 167

A

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 168

A

Middle cerrebral artery

Answer 169

A

3 Ps!

PE
Pulmonary oedema

Pneumonia

Answer 170

A

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 171

A

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 172

A

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 173

A

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 174

A

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 175

A

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 176

A

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 177

A

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 178

A

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 179

A

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 180

A

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 181

A

Orthopnoea can differentiate heart failure from COPD [1]

Answer 182

A

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 183

A

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 184

A

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 185

A

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 186

A

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 187

A

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 188

A

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

Answer 189

A

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

Answer 190

A

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

Answer 191

A

* 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 192

A

**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 193

A

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 194

A

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 195

A

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 196

A

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

Answer 197

A

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 198

A

CXCL8 made by macrophages

Acts a neutrophil attractant

Answer 199

A

Which of the following is caused by hypoventilation?

*1) Respiratory acidosis**
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis

Answer 200

A

Respiratory acidosis causes:

Decreased Ca2+ levels
Increased Ca2+ levels

Increased K+ levels
Decreased K+ levels

Answer 201

A

Which of the following reduces the activity of carbonic anhydrase

1) Respiratory acidosis
* *2) Respiratory alkalosis**
3) Metabolic acidosis
4) Metabolic alkalosis

Answer 202

A

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis

Answer 203

A

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 204

A

Which of the following would stain mTB fluorescent?

Orcein

Ziehl-neelsen
H&E
Gram stain
Auramine

Answer 205

A

Which of the following would stain mTB red/pink?

Orcein

Ziehl-neelsen
H&E
Gram stain
Auramine

Answer 206

A

IFN-y [1]

Answer 207

A

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

Answer 208

A

GI cancer

Answer 209

A

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

Answer 210

A

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

Answer 211

A

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 212

A

Which lymph nodes are swollen here?

Deep cervical
Superficial cervical
Occipital
Posterior auricular

Answer 213

A

What is the most likely cause of this swollen arm?

Radical neck dissection
Laceration of the thoracic duct
Liver metastasis blocking ducts

Radical masectomy

Answer 214

A

Which of the following is responsible for mast cell proliferation in asthma Ptx?

IL-5

IL-6

IL-7

IL-8

IL-9

Answer 215

A

Which of the following is responsible for eosinophil cell activation in asthma Ptx?

IL-5

IL-6

IL-7

IL-8

IL-9

Answer 216

A

In non-asthmatic Ptx the response to allergen is driven by:

IgA
IgE

IgG
IgD
IgM

Answer 217

A

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 218

A

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 219

A

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 220

A

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 221

A

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 222

A

A neonate born at term 12-hours ago by spontaneous vaginal delivery is reviewed by a paediatrician due to increased work of breathing.

On examination, there is moderate subcostal and intercostal recession and the neonate appears tachypnoeic. His temperature is 38.9ºC. A chest x-ray is requested, showing some consolidation in the right lower zone. The neonate is started on broad-spectrum antibiotics.

The neonate’s oxygen dissociation curve shows a leftward shift relative to the standard adult curve.

What is responsible for this appearance of the neonate’s oxygen dissociation curve?

Fetal HB

Hyperthermia
Increased 2,3 DPG
Lactic acidosis
Type 2 resp failure

The L rule

Shifts to L → Lower oxygen delivery, caused by

Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature

Answer 223

A

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 224

A

Excessive vasodilation causes which type of shock?

Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock

Answer 225

A

Excessive vasodilation causes which type of shock?

Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock

Answer 226

A

Anaphylactic shock can be categorised as

Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock

Answer 227

A

Tension pneumothorax can be categorised as

Obstructive shock
Cardiogenic shock
Hypovolaemic shock
Restrictive shock

Answer 228

A

Neurogenic shock would cause which of the following type of shock?

Hypovolaemic shock
Obstructive shock
Distributive shock
Cardiogenic shock

Answer 229

A

Which immunoglobin is associated with anaphylactic shock?

IgD
IgM
IgE
IgG
IgA

Answer 230

A

Which artery is most common to have a stroke in? [1]

Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Basilar artery
AICA

Answer 231

A

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 232

A

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

Answer 233

A

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 234

A

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 235

A

ICS acts on which of the following in asthma ptx?

IL-4
IL-5

IL-6

IL-7

(& TNF-a and CXCL8)

Answer 236

A

Which of the following attracts eosinophils in asthma ptx?

IL-4
IL-5

IL-6

IL-7

Answer 237

A

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 238

A

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 239

A

FEV1/ FVC below which of the following is an indication for COPD?

0.5

6
* *0.7**
8

Answer 240

A

What is the first line of treatment for COPD?

ICS
SABA
ICS + LABA
LABA

Answer 241

A

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 242

A

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 243

A

Soft S2 is/are most characteristically seen in:

Mitral regurgitation

Patent ductus arteriosus

Aortic regurgitation

Mitral stenosis

Aortic stenosis

Answer 244

A

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 245

A

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 246

A

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 247

A

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 248

A

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 249

A

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 250

A

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 251

A

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 252

A

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 253

A

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 254

A

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 255

A

Which of the following forms the right ventricle?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

Answer 256

A

Which of the following forms the coronary sinus?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

Answer 257

A

Which of the following forms the proximal aorta and pulmonary artery?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

Answer 258

A

Which of the following forms the ventricular outflow tracts?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

Answer 259

A

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 260

A

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 261

A

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 262

A

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

Answer 263

A

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

Answer 264

A

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

Answer 265

A

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 266

A

Factor VIII and IX

Answer 267

A

prominent a wave

Answer 268

A

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

Answer 269

A

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 270

A

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 271

A

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 272

A

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 273

A

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

Answer 274

A

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

Answer 275

A

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

Answer 276

A

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

Answer 277

A

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

Answer 278

A

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 279

A

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

Answer 280

A

Ziehl-Nielson

Answer 281

A

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 282

A

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 283

A

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 284

A

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

Answer 285

A

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

Answer 286

A

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

Answer 287

A

* 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 288

A

**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 289

A

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 290

A

TH1 subtype

Answer 291

A

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

Answer 292

A

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

Answer 293

A

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 294

A

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

Answer 295

A

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

Answer 296

A

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

Answer 297

A

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 298

A

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

Answer 299

A

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

Answer 300

A

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

Answer 301

A

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

Answer 302

A

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 303

A

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 304

A

Which of the following is the vagus nerve?

1
2
3
4
5

Answer 305

A

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

Answer 306

A

II, III, aVF

Answer 307

A

Which coronary artery is most likely to have been affected by occlusion here?

Circumflex artery?
LAD
LCA
RCA

Answer 308

A

What is the most common cause of heart failure?

Cardiomyopathy
Hypertension
Ischaemic Heart Disease

Answer 309

A

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

Answer 310

A

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 311

A

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 312

A

Acceptable responses: Pleural space

Answer 313

A

Acceptable responses: Alveoli, Alveolar sacs

Answer 314

A

Acceptable responses: Bifurcations, Bifurcation points, Points of bifurcation, Bifurcation

the anterior interventricular/left anterior descending branch being most commonly affected.

Answer 315

A

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 316

A

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 317

A

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

Membranous
Muscular

Answer 318

A

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

Answer 319

A

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

Answer 320

A

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

Answer 321

A

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

Answer 322

A

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

Answer 323

A

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

Answer 324

A

**C3-C6**

Answer 325

A

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

Answer 326

A

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

Answer 327

A

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

Answer 328

A

Recurrent laryngeal nerve

Answer 329

A

A: reduced gag reflex B: reduced range of pitch

Answer 330

A

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 331

A

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 332

A

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 333

A

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 334

A

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

Answer 335

A

Copper-wiring, arteriovenous nicking and silver-wiring seen in a patient with hypertensive retinopathy

Narrowing of retinal arteries / vaspconstriction

Answer 336

A

What type of mask is this?

Nasal Cannulae

Simple face mask

Non-rebreather mask (reservoir mask)

Venturi mask

Answer 337

A

What type of mask is this?

Nasal Cannulae

Simple face mask

Non-rebreather mask (reservoir mask)

Venturi mask

Answer 338

A

What type of mask is this?

Nasal Cannulae

Simple face mask

Non-rebreather mask (reservoir mask)

Venturi mask

Answer 339

A

What type of mask is this?

Nasal Cannulae

Simple face mask

Non-rebreather mask (reservoir mask)

Venturi mask

Answer 340

A

What type of mask is this?

Nasal Cannulae

Simple face mask

Non-rebreather mask (reservoir mask)

Venturi mask

Answer 341

A

What type of sensitivity is anaphylactic shock

Type 1
Type 2

Type 3

Type 4

Answer 342

A

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?

Answer 343

A

Each one of the following promotes the release of endothelin, except:

Prostacyclin

ADH

Angiotensin II
Hypoxia
Mechanical shearing force

Answer 344

A

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

Left-sided diastolic dysfunction

Left-sided systolic dysfunction

Right-sided diastolic dysfunction

Right-sided systolic dysfunction13%

Heart failure with preserved ejection fraction patients have diastolic dysfunction - impaired ventricular filling during diastole

Answer 345

A

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 346

A

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

Epoxide reductase

Gamma-glutamyl carboxylas

CYP2C9

Thrombin

Warfarin works by inhibiting epoxide reductase preventing Vitamin K from being converted to its activated form

Answer 347

A

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 348

A

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 349

A

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
Refractory hyperkalaemia
Hypocalcaemia
Gout
Conn’s syndrome

Answer 350

A

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 351

A

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 352

A

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 353

A

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 354

A

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 355

A

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

Super and inferior parathyroid arteries

Subclavian artery

Superior and inferior thyroid arteries

Middle thyroid arteries

Answer 356

A

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

Common carotid artery

Internal carotid artery

External jugular vein

None of the above

Answer 357

A

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?

Answer 358

A

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 359

A

Which one of the following clotting factors is not affected by warfarin?

Factor II

Factor VII

Factor XII

Factor IX

Factor X

Answer 360

A

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 361

A

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

Diastolic murmur in the aortic area

Diastolic murmur in the mitral area

Ejection systolic murmur in the aortic area

Pansystolic murmur in the mitral area

Aortic regurgitation - collapsing pulse

Answer 362

A

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

Diastolic murmur in the aortic area

Diastolic murmur in the mitral area

Ejection systolic murmur in the aortic area

Pansystolic murmur in the mitral area

Aortic regurgitation - collapsing pulse

Answer 363

A

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

Diastolic murmur in the aortic area

Diastolic murmur in the mitral area

Ejection systolic murmur in the aortic area

Pansystolic murmur in the mitral area

Aortic regurgitation - collapsing pulse

Answer 364

A

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 365

A

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

He has diastolic dysfunction

He has increased ventricular compliance

He has systolic dysfunction

He has decreased afterload

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 366

A

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 367

A

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 368

A

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 369

A

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
Bleeding time
Fibrinogen levels
Prothrombin time

Thrombin time

Answer 370

A

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 371

A

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
Councilman bodies
Mallory bodies

Call-Exner bodies
Schiller-Duval bodies

Aschoff bodies are granulomatous nodules found in rheumatic heart fever

Answer 372

A

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 373

A

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
Vasodilation of the afferent arteriole
Vasoconstriction of the efferent arteriole
Vasodilation of the efferent arteriole

Increases glomerular filtration pressure

Answer 374

A

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 375

A

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 376

A

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
Increased left atrial pressure
Nitric oxide
Vascular endothelial growth factor (VEGF)
Decreased oxygen tension

Answer 377

A

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
Slow y descent
Cannon waves
Steep y descent
Absent a waves

Absent a waves = Atrial fibrillation

Answer 378

A

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
Left circumflex artery
Left anterior descending artery
Posterior interventricular artery
Right coronary artery

Answer 379

A

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 380

A

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
Hyperkalemia
Hypercalcemia
Hypocalcemia
Hypermagnesemia

Answer 381

A

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 382

A

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 383

A

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

Ventricular diastole
Ventricular systole
Isovolumetric contraction
Atrial diastole

Answer 384

A

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
Failed migration of the neural crest cells
Defect in the ostium primum
Defect in the ostium secundum
Low oxygen levels after birth

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 385

A

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 386

A

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
Hypertrophic obstructive cardiomyopathy
Left ventricular aneurysm
Restrictive cardiomyopathy
Ventricular septal defect

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 387

A

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
Signs of left heart strain
Atrial fibrillation
ST elevation in leads II, III and aVF
T wave inversion in the anterior leads

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 388

A

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
Signs of left heart strain
Atrial fibrillation
ST elevation in leads II, III and aVF
T wave inversion in the anterior leads

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 389

A

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 390

A

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 391

A

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
Hypersecretion of mucus from goblet cell
Pulmonary artery vasoconstriction
Pulmonary artery vasodilation
Tracheal deviation

Answer 392

A

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
Panicking
Respiratory rate of 28 breaths/minute
Heart rate of 105 beats/minute
Silent chest

A silent chest is a life-threatening feature of an asthma attack

Answer 393

A

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
Mastication
Pharyngeal reflex
Salivation

Taste sensation in the anterior 2/3rd of the tongue

Foreign bodies lodged in the piriform recess may damage the internal laryngeal nerve

Answer 394

A

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 395

A

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
Chronic productive cough for at least 3 months in at least 2 years
Enlargement of air spaces distal to the terminal bronchioles
Enlargement of air spaces proximal to the terminal bronchioles

Chronic productive cough for at least half the time for at least a year

Answer 396

A

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
Type 2 hypersensitivity

Type 3 hypersensitivity
Type 4 hypersensitivity
Type 5 hypersensitivity

Answer 397

A

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
Excessive ACTH secretion
Lambert- Eaton syndrome
Gynaecomastia

Clubbing

Squamous cell carcinoma is associated with hypertrophic pulmonary osteoarthropathy (HPOA)

Answer 398

A

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 399

A

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
Occipital lobe
Thalamus
Cerebellum
Brainstem

Answer 400

A

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 401

A

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 402

A

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
Loss of chest wall recoil``

Increase in intra-alveolar pressur
Increase in intrapleural pressure
Loss of alveolar surfactant

Answer 403

A

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 - Elevated angiotensin-converting enzyme levels are associated with sarcoidosis

Hypocalcemia
Poor sleep

Exposure to silica
Pain in the small joints of the hand

Answer 404

A

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
Expiratory reserve volume + tidal volume + inspiratory reserve volume
Inspiratory reserve volume + residual volume
Residual volume + expiratory reserve volume + tidal volume + inspiratory reserve volume
Tidal volume + inspiratory reserve volume

Answer 405

A

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
Forced vital capacity
Transfer factor
Peak expiratory flow rate
Flow volume loop

Flow volume loop is the investigation of choice for upper airway compression.

Answer 406

A

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
Functional residual capacity
Inspiratory reserve volume
Residual volume
Vital capacity

Total lung capacity = vital capacity + residual volume

Answer 407

A

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
5600ml
5800ml
7200ml
7400ml

Answer 408

A

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
Bronchiectasis
COPD
Neuromuscular disorder
Pneumonia

Neuromuscular disorders result in a restrictive pattern on pulmonary function tests

Answer 409

A

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
Reduced residual volume and reduced vital capacity
Increased residual volume and increased vital capacity
Reduced residual volume and reduced vital capacity
Normal residual volume and normal vital capacity

Answer 410

A

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
Chronic obstructive pulmonary disease (COPD)

Myasthenia gravis
Alpha-1 antitrypsin deficiency
Cystic fibrosis

Answer 411

A

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
Chronic obstructive pulmonary disease (COPD)

Myasthenia gravis
Alpha-1 antitrypsin deficiency
Cystic fibrosis

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 412

A

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

Vitamin E

Vitamin B6
Vitamin B
Vitamin B12

In vitamin B12 deficiency, dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia

Answer 413

A

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
Intravascular haemolysis
High alcohol Intake
Depression

Vitamin B12 deficiency

Answer 414

A

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 415

A

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 416

A

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
Parasternal lymph nodes
Internal thoracic chain
Inferior phrenic lymph nodes
Subdiaphragmatic lymph nodes

Answer 417

A

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
Silent carrier (alpha(+) heterozygous)
Haemoglobin H disease
Beta thalassaemia major
Alpha thalassaemia major

Answer 418

A

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
Thyroid gland
Thymus gland
Trachea
Visceral pleura

Answer 419

A

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 420

A

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
Directly inhibits clotting factor Xa
Directly inhibits thrombin
Inhibits the production of vitamin K related clotting factors
Inhibits thromboxane synthesis

Answer 421

A

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 422

A

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 423

A

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
Haptoglobins - Haptoglobin binds to free haemoglobin

Albumin
Bilirubin
Reticulocytes

Answer 424

A

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
Haptoglobins - Haptoglobin binds to free haemoglobin

Albumin
Bilirubin
Reticulocytes

Answer 425

A

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
Haptoglobins - Haptoglobin binds to free haemoglobin

Albumin
Bilirubin
Reticulocytes

Answer 426

A

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
Colorectal cancer
Folate deficiency
Iron deficiency anaemia
B12 deficiency

Answer 427

A

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 428

A

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 429

A

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 430

A

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 431

A

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 432

A

The laryngeal prominence occurs at which vertebral level

C3
C4
C5
C6
C7

Answer 433

A

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

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