EFA Flashcards
EFA 1
A 35 year old woman, with primary hypothyroidism diagnosed 13 years ago, complains of feeling exhausted for several months. She also complains of weight loss and dizziness. Blood pressure in clinic is 110/80 mmHg lying and 90/70 mmHg standing. Blood tests show:
* Sodium 128 mmol/L (133 – 146)
* Potassium 5.5 mmol/L (3.5 – 5.3)
* fT4 18 pmol/L (9 - 23)
* TSH 3.9 mU/L (0.3 – 4.2)
What is the next step in her management?
* Increase her thyroxine dose
* Measure 9AM cortisol and ACTH
* Measure a full blood count
* Measure plasma osmolality
* Reduce her thyroxine dose
Measure 9AM cortisol and ACTH
EFA 1
55 year old man sustains a head injury in a road traffic injury. A few days afterwards, he notices that he is very thirsty and passes lots of urine, both during the day and at night. After several weeks of these symptoms, he sees his GP who performs some investigations:
* Sodium 150 mmol/L (133 – 146)
* Potassium 4.9 mmol/L (3.5 – 5.3)
* Random glucose 6.9 mmol/L
* HbA1c 38 mmol/mol (10 - 41)
* Plasma osmolality 300 mOsm/kg H2O (275 - 295)
What is the most likely diagnosis
* Cranial diabetes insipidus
* Diabetes mellitus
* Post-traumatic stress disorder
* Psychogenic polydipsia
* Syndrome of Inappropriate Antidiuretic Hormone
Cranial diabetes insipidus
EFA 1
At his annual diabetes review, 55 year old man with a 10 year history of well controlled type 2 diabetes mellitus complains of erectile dysfunction. He takes metformin only. His GP checks some bloods:
* HbA1c 48 mmol/mol (20-41)
* Testosterone 3 nmol/L (10-20)
* Prolactin 25 000 IU/mL (45-375)
* FSH 0.1 mIU/mL (1.6-11)
* LH 0.2 mIU/mL (1.3-8)
What should the GP do next?
* Anterior Pituitary MRI
* Counsel him that erectile dysfunction is common in type 2 diabetes mellitus
* Intensify his glycaemic control
* Perform a testicular examination
* Repeat the blood tests at a different time of day
Anterior Pituitary MRI
EFA 1
Which lobe of the brain is primarily concerned with processing sensory information such as touch and pain?
* Frontal
* Limbal
* Occipital
* Parietal
* Temporal
Parietal
EFA 1
The table below shows the pKa of four different opioid drugs. All four drugs are weak bases. Which of the four drugs would be most unionized at a tissue pH of 7.4?
* Alfentanil
* Morphine
* Pethidine
* Remifentanil
Alfentanil
EFA 1
A 65 year old woman presents to the Accident and Emergency department with vomiting and constipation.She has a previous history of lung cancer which was treated by surgery and chemotherapy 1 year ago. On examination, she looks dehydrated. Routine biochemistry shows:
* Normal renal function
* Calcium 2.90 (reference range 2.15-2.60 mmol/L)
* Phosphate 0.90 (reference range 0.80-1.40 mmol/L)
* 25 hydroxyvitamin D 60 (reference range 70-150 mmol/L)
* PTH < 0.1 (reference range 1.1-6.8 mmol/L)
* Abdominal x ray is normal
What treatment should she receive next?
IV fluids
EFA 1
A 34 year old woman presents to her GP with weight loss and palpitations. Her GP checks some thyroid function tests:
* fT4 32 pmol/L (9 - 23)
* fT3 13 pmol/L (3.1 – 6.8)
* TSH < 0.01 mU/L (0.3 – 4.2)
Prior to this, she has been fit and well, with no medical problems and is not taking any medications.
What medications should she start to provide immediate improvement in symptoms?
Non selective beta blocker AND anti-thyroid drug
EFA 1
A patient has a stroke which causes weakness and sensory deficits in the right arm and the right side of the face.
Precisely which major artery is likely to have been involved?
Left middle cerebral artery
EFA 1
A patient is due to undergo neurosurgery in an attempt to prevent the spread of electrical activity during epileptic seizures from one hemisphere to the other.
Which white matter tract will be severed during this surgical procedure?
Corpus callosum
EFA 1
Thirty minutes after administration, blood levels of a drug are higher in the hepatic portal venous system than in the major arteries (systemic blood levels).
Which route of administration was utilized for this drug?
Oral route
EFA 1 - SAQ
A 30y old woman discontinued the oral contraceptive pill nine months ago to plan for a pregnancy.
She has not had a period since.
She attends her GP surgery concerned about what to do next.
- Pregnancy test negative
- BMI 22 kg/m2
What hormone is measured in the urine to confirm pregnancy (full name, no
abbreviated)? (1 mark)
Beta human chorionic gonadotrophin
EFA 1 - SAQ
A 30y old woman discontinued the oral contraceptive pill nine months ago to plan for a pregnancy.
She has not had a period since.
She attends her GP surgery concerned about what to do next.
- Pregnancy test negative
- BMI 22 kg/m2
Her GP checks some blood tests:
* Oestradiol: < 70 pmol/L (>200)
* FSH: 0.7 mU/L (1.5 – 10)
* LH: 0.8 mU/L (2 - 10)
* Prolactin: 15 000 IU/L (< 500) Macroprolactin negative
* Normal thyroid function
Name two other symptoms, in addition to her amenorrhoea, which you should ask her about. (2 marks)
- Galactorrhoea
- Low libido
- Vasomotor symptoms
EFA 1 - SAQ
A 30y old woman discontinued the oral contraceptive pill nine months ago to plan for a pregnancy.
She has not had a period since.
She attends her GP surgery concerned about what to do next.
- Pregnancy test negative
- BMI 22 kg/m2
Her GP checks some blood tests:
* Oestradiol: < 70 pmol/L (>200)
* FSH: 0.7 mU/L (1.5 – 10)
* LH: 0.8 mU/L (2 - 10)
* Prolactin: 15 000 IU/L (< 500) Macroprolactin negative
* Normal thyroid function
Describe the mechanism by which high prolactin can cause secondary hypogonadism. (4 marks)
Prolactin binds to prolactin receptors on hypothalamic kisspeptin neurons to inhibit kisspeptin release (2 marks), this results in a reduction in gonadotrophin releasing hormone pulsatility (1 mark) which in turn reduces FSH and LH secretion from the anterior pituitary (1 mark).
EFA 1 - SAQ
A 30y old woman discontinued the oral contraceptive pill nine months ago to plan for a pregnancy.
She has not had a period since.
She attends her GP surgery concerned about what to do next.
- Pregnancy test negative
- BMI 22 kg/m2
Her GP checks some blood tests:
* Oestradiol: < 70 pmol/L (>200)
* FSH: 0.7 mU/L (1.5 – 10)
* LH: 0.8 mU/L (2 - 10)
* Prolactin: 15 000 IU/L (< 500) Macroprolactin negative
* Normal thyroid function
The GP requests a pituitary MRI which shows a small (0.5cm) pituitary tumour.
Looking at the blood tests results and pituitary MRI findings, what is the diagnosis? (1 mark)
Microprolactinoma
EFA 1 - SAQ
A 30y old woman discontinued the oral contraceptive pill nine months ago to plan for a pregnancy.
She has not had a period since.
She attends her GP surgery concerned about what to do next.
- Pregnancy test negative
- BMI 22 kg/m2
Her GP checks some blood tests:
* Oestradiol: < 70 pmol/L (>200)
* FSH: 0.7 mU/L (1.5 – 10)
* LH: 0.8 mU/L (2 - 10)
* Prolactin: 15 000 IU/L (< 500) Macroprolactin negative
* Normal thyroid function
The GP requests a pituitary MRI which shows a small (0.5cm) pituitary tumour.
What treatment should she be offered? How does this work? (2 marks)
Dopamine agonist treatment eg cabergoline (1 mark)
* Binds to D2 receptors on prolactinoma to reduce prolactin and shrink tumour. (1 mark)
EFA 2
A 67-year old man visits his opticians after noticing that he finds it increasingly difficult to focus on the words in his books and newspapers, even when wearing his glasses. What is a likely cause of this?
* Astigmatism
* Emmetropia
* Hypermetropia
* Myopia
* Presbyopia
Presbyopia
EFA 2
A 23 year old patient with type 1 diabetes goes out clubbing and forgets to take his long acting insulin before he leaves the house. He gets home late and feels too tired to check his capillary blood glucose or to take any insulin. When he wakes the following morning, he feels thirsty, but blames this on a hangover. He notices he is passing urine frequently. He tries to drink some water, but can’t manage it as he starts to retch and vomit. He attends his local Accident and Emergency department. Some bedside blood tests show:
* pH:7.1 (7.35-7.45)
* Glucose: 24 mmol/L(3.7-5.2)
* Bicarbonate: 8 mmol/L (22-29)
* Capillary blood ketones: 4.1 mmol/L (< 1 mmol/L)
What is the next step in his management?
* Start intrevenous 5% dextose
* Start intravenous sodium chloride
* Give him a large dose of subcutaneous short acting insulin
* Give him an anti-emetic (anti-sickness drug)
* Check his renal function
Start intravenous sodium chloride
EFA 2
In which order does motor unit recruitment occur during a voluntary movement?
* Fast fatigable, fast fatigue resistant, slow
* Fast fatigable, slow, fast fatigue resistant
* Fast fatigue resistant, fast fatigable, slow
* Slow, fast fatigable, fast fatigue resistant
* Slow, fast fatigue resistant, fast fatigable
Slow, fast fatigue resistant, fast fatigable
EFA 2
Which drug target site (labelled 1-5) is partly responsible for the therapeutic effectiveness of venlafaxine?
* 1
* 2
* 3
* 4
* 5
2
EFA 2
In humans, overexpression of DUX proteins causes Facio-Scapulo-Humeral Dystrophy, which is characterized by mis-expression early developmental genes in adult myoblasts. Mouse embryos that are deficient in DUX proteins fail to progress beyond the morula stage. Which key developmental event are DUX proteins likely to be essential for?
* Compaction
* Zygotic Genome Activation
* Gastrulation
* Placentation
* Lineage segregation
Zygotic Genome Activation
EFA 2
In the cerebral cortex, which functional area relates to the cytoarchitectural regions 1,2 & 3 based on Brodmann’s classification system?
* Premotor
* Primary auditory
* Primary somatosensory
* Primary motor
* Supplementary
Primary somatosensory
EFA 2
What evidence supports a strong genetic component for obesity?
* Non identical twins have more similar body mass indexes than identical twins
* Obesity rates have increased rapidly across the developed world over the last 30 years
* Specific gene variants have been associated with differences in body mass index
* More than 650 million adults worldwide are estimated to be clinically obese
* Lifestyle changes are usually ineffective in obesity management
Specific gene variants have been associated with differences in body mass index
EFA 2
The amnestic presentation of Alzheimer’s disease is related to atrophy of which temporal lobe structure?
Hippocampus
Amnestic – involved in memory - pertaining to amnesia. Loss of neurons in the hippocampus is seen in Alzheimer’s disease.
EFA 2
A patient has unusual sensations of head tilting, but these are not normally accompanied by spinning sensations. Dysfunction of which structures of the inner ear could account for these symptoms?
Utricle or saccule
The utricle and saccule detect linear acceleration, either horizontal (utricle) or vertical (saccule). The semi-circular canals detect angular (rotatory) acceleration. The symptoms of tilt without spinning suggest that the semi-circular canals are not involved.
EFA 2
A 44 year old woman presents to her GP because she has not enjoyed anything, including things that she used to enjoy, for 5 weeks. What is the best term to describe this symptom?
Anhedonia
Anhedonia refers to a person losing the capacity to feel pleasure and is a core symptom of depression.
EFA 2
A patient is started on risperidone, an antipsychotic, and experiences side effects including galactorrhoea and gynaecomastia. The increased release of which hormone in response to treatment underpins these adverse effects?
Prolactin
Dopamine inhibits the release of prolactin from the anterior pituitary gland. Dopamine blockade by antipsychotics reduces this inhibition, leading to increased prolactin release. This can cause symptoms like galactorrhoea and gynaecomastia.
EFA 2
A 52 year old woman presents to her GP with symptoms of persistent low mood, increased sleep, increased appetite and suicidal thoughts. Which blood test would be the most useful when considering differential diagnoses?
Thyroid function tests
Hypothyroidism is an important differential diagnosis to consider when a patient presents with depression, as severe hypothyroidism can cause depressive symptoms. This patient is also sleeping and eating more, which can be associated with hypothyroidism as well as depression.
EFA 2
The table below provides mechanistic information for one of the anti-epileptic drugs – labelled drug A. Which drug do you think this is?
Levetiracetam
EFA 2
Which phase of migraine can include visual, sensory disturbances (numbness/paraesthesia) and weakness?
Aura
EFA 2 - SAQ
Identify the arteries providing the blood supply in the perfusion fields indicated on the diagram above. (3 marks)
A - Anterior cerebral
B - Middle cerebral
C - Posterior cerebral
EFA 2 - SAQ
List 3 of the main risk factors for stroke.
- Age
- Hypertension
- Cardiac disease
- Smoking
- Diabetes mellitus
EFA 2 - SAQ
List 2 symptoms that might be associated with a thrombo-embolic stroke affecting the vessels perfusing areas A (2 marks) and B (2 marks) in the diagram above.
A:
* Paralysis of contralateral leg > arm
* Face
* Disturbance of intellect
* Executive function and judgement (abulia)
* Loss of appropriate social behaviour
B:
* Contralateral hemiplegia: arm > leg
* Contralateral hemisensory deficits
* Hemianopia
* Aphasia (L sided lesion)
EFA 3
Cervical ripening is associated with which biological processes?
* Change in cervical compliance but retention of competence
* Monocyte infiltration and interleukin secretion
* Increase in hyaluronidase expression and hyaluron breakdown
* Elevated collagen breakdown by matrix metalloproteinases
* Recovery of tissue integrity
Monocyte infiltration and interleukin secretion
EFA 3
A 48 year old man reports a burning sensation in his chest. His electrocardiogram is shown below. Estimate his ventricular axis
* -30 to 0 degrees
* 0 to 30 degrees
* 30 to 60 degrees
* 60 to 90 degrees
* 90 to 120 degree
30 to 60 degrees
EFA 3
A 48 year old male presents to A&E with shortness of breath, coughing and a fever and is suspected of having a SARS-CoV-2 infection. As a result more invasive monitoring is carried out. Observations were O2 saturation of 90% on BiPAP, a heart rate of 80 bpm, a respiratory rate of 20/minute, blood pressure of 145/85 mmHg and a temperature of 38 degrees Celsius. A Schwanz ganz catheter indicates end diastolic volume of 256 mL and end systolic volume 111 mL. Which of the following describes his cardiac output, ejection fraction and mean arterial blood pressure?
* CO: 11.6L EF: 64% MAP: 95 mm Hg
* CO: 11.6L EF: 57% MAP: 105 mm Hg
* CO: 10.5L EF: 57% MAP: 105 mm Hg
* CO: 10.5L EF: 65% MAP: 95 mm Hg
* CO: 10.5L EF: 63% MAP: 101 mm Hg
CO: 11.6L EF: 57% MAP: 105 mm Hg
MAP = DP + 1/3 (SP-DP) SV = EDV – ESV CO = HR x SV EF = SV/EDV x 100
EFA 3
Consider the following first line anti-hypertensive drugs – Amlodipine, Felodipine, Lisinopril, Ramipril, Irbesartan. Which drug might be less effective at lowering blood pressure in a patient with hepatic impairment compared with an individual with healthy liver function?
* Amlodipine
* Felodipine
* Lisinopril
* Ramipril
* Irbesartan
Ramipril
Ramipril is a pro-drug and therefore requires liver enzymes to produce the active blood pressure lowering component.Someone with hepatic impairment would not activate the pro-drug as well as someone with normal liver function.
EFA 3
A 67 year old man with a history of COPD and lung cancer is admitted to hospital confused, breathless and with a fever. His O2 saturation is 95 %, he his blood pressure is 85/65 mmHg and his respiratory rate is 32 breaths per minute. Microbiological cultures reveal the presence of Mycoplasma pneumoniae. What classes of antibiotics should be administered to this person?
* Penicillins and Rifamycins
* Penicillins and Tetracyclins
* Aminoglycosides and Macrolides
* Penicillins and Macrolides
* Penicillins and aminoglycosides
Penicillins and Macrolides
Mycoplasma pneumoniae is the most common cause of atypical community acquired pneumonia and responsive to macrolides rather than penicillins – however the high CRB-65 assessment indicates severe pneumonia which means rapid treatment with both classes of antibiotic is preferred.
EFA 3
The TNM8 lung cancer staging system uses primary tumour site, tumour size, regional lymph node metastases and which other characteristic to score lung cancer progression?
Extrathoracic metastasis
The final stage of staging lung cancer is to assess the presence of metastases outside the thoracic cavity.
EFA 3
A patient admitted with bacterial pneumonia but despite antibiotics develops sepsis, and acute respiratory distress syndrome. The clinical team have measured O2 saturation, positive end point pressure and chest radiology. What else would they measure in order to accurately score the severity of ARDS.
Compliance
It is Murray Score.
EFA 3
An individual is treated with a thiazide diuretic. Where in the kidney (labelled 1-5 in the diagram below) might you expect to see an increase in potassium excretion into the kidney tubule?
5
Thiazide diuretics act at the early distal tubule (location 4) to block sodium and chloride ion reuptake. The increased sodium concentration in the kidney tubule would be passed along the kidney (location 5). At this point, the kidney will attempt to reabsorb the increased sodium in the filtrate.This will require sodium/potassium ATPase, with sodium being retained at the expense of potassium loss.
EFA 3
A 70-year-old woman is admitted to a local hospital emergency department with symptoms of heart failure. She complains of dyspnoea and fatigue with increased leg swelling. This was preceded by palpitations lasting a few minutes and occurring several times daily. She had been diagnosed with mitral valve prolapse 3 years ago. She was referred to a cardiologist but did not follow up. She has a past history of non-metastatic lung cancer for which she had SABR that is in remission. Which feature in the history is most likely suggestive that she might be suffering from mitral regurgitation leading to acute heart failure?
Mitral valve prolapse
Mitral valve prolapse is the common cause of acute MR leading to heart failure. Mitral valve prolapse leads to the mitral valve’s leafletsbulge backinto the left atrium during the heart’s contraction. This can prevent the mitral valve from closing tightly and leads to regurgitation.
EFA 3
A patient is admitted to A&E with severe headache, fever, nausea and vomiting, sensitivity to light (photophobia) and a stiff neck.
An infection of the central nervous system is suspected, but further tests are required, including CSF analysis. Given the symptoms described above, what might be the diagnosis?
Meningitis
EFA 3
Alcohol withdrawal can be potentially fatal. Which medication is most commonly used, in hospital, for acute detoxification in order to prevent complications?
* Buprenorphine
* Chlordiazepoxide
* Naltrexone
* Acamprosate
* Methadone
Chlordiazepoxide
Chlordiazepoxide (Librium) is the most commonly used medication for acute alcohol detoxification. Buprenorphne and methadone are used in opioid abstinence. Acamprostae is used in alcohol abstinence. Naltrexone is used in both alcohol and opioid abstinence.
EFA 3
What is the main mechanism by which low density lipoprotein promotes atherosclerosis?
* Deposited in artery walls, it easily oxidises, and is taken up by plaque macrophages, causing their activation.
* It interacts with plaque macrophage cholesterol transporters leading to removal in so-called reverse cholesterol transport
* It is taken up into macrophages primarily via Toll-like Receptor 4 thereby activating nuclear factor kappa B.
* Directly triggers apoptosis in plaque vascular smooth muscle cells.
* Promotes upregulation of adhesion molecules on the vascular endothelium promote leukocyte recruitment.
Deposited in artery walls, it easily oxidises, and is taken up by plaque macrophages, causing their activation.
EFA 3
The arterial blood gases of a patient are the following:
Describe the patients’ acid-base status.
Uncompensated mixed alkalosis
Acute alcohol withdrawal can present with a variety of signs and symptoms. Which condition, related to alcohol withdrawal, represents a life-threatening medical emergency?
Delirium tremens
This is a potentially fatal medical emergency characterised by confusion, tremor, hallucinations, fever, sweating, tachycardia and hypertension.
EFA 3
Name a commonly used, validated, cognitive questionnaire (scored out of 30) that is used in routine clinical practice to screen for dementia?
- Mini Mental State Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
Mini Mental State Examination (MMSE): This is a widely used dementia screening tool scored out of 30 points.
The Montreal Cognitive Assessment (MoCA): will also be accepted as an answer as it is a screening tool scored out of 30. The Addenbrooke’s Cognitive Examination (ACE-III) will not be accepted as an answer as this is a diagnostic tool scored out of 100.
Which artery supplies the part of the structure indicated by the arrow?
* Left gastric artery
* Right gastric artery
* Left gastro-omental artery
* Right gastro-omental artery
* Gastroduodenal artery
Left gastric artery
Identify the structure indicated by the arrow.
Left common iliac vein
Which spinal levels innervate the muscular structure indicated by the arrow?
* L1-L3
* L2-L4
* S1-S3
* S2-S4
* S5-C1
S2-S4
EFA 4
The arterial blood gases of a patient are the following. Describe the patients’ acid-base status:
Uncompensated mixed alkalosis
EFA 4
What does the radiograph below shows?
- Transverse fracture of fibula
- Spiral fracture of tibia
- Transverse fracture of radius
- Transverse fracture of tibia
- Spiral fracture of fibula
Transverse fracture of tibia
EFA 4 - SAQ
A research team in the GI surgical outpatient department of a London Hospital investigated the association between aspirin use and colon cancer using a cohort study design with 10 year follow up. The Hazard Ratio was 1.5. The demographics of the groups are reported in table 1.
Using the PICO framework, name the population studied, intervention, comparator group and outcome. (2marks 1⁄2 mark for each)
- Patients attending the GI patient
- Clinic Aspirin
- Control
- Colon Cancer
EFA 4 - SAQ
A research team in the GI surgical outpatient department of a London Hospital investigated the association between aspirin use and colon cancer using a cohort study design with 10 year follow up. The Hazard Ratio was 1.5. The demographics of the groups are reported in table 1.
Explain what a confounder is, using an example from this study. (1 Mark 1/2 for each part)
A variable that is associated with both the exposure and the outcome that may provide an alternative explanation for the results. E.g., people taking aspirin may be more likely to have CVD and maybe the association is between CVD and colon cancer
EFA 4 - SAQ
A research team in the GI surgical outpatient department of a London Hospital investigated the association between aspirin use and colon cancer using a cohort study design with 10 year follow up. The Hazard Ratio was 1.5. The demographics of the groups are reported in table 1.
State which variable is most likely to be an effect modifier and explain why? (2marks)
Age because the cancer group is significantly older (12 years) and aging is associated with cancer
EFA 5
Angiotensin Converting Enzyme inhibitors (ACEi’s) can be used to treat proteinuria. In the diagram below, where is the main site of action of ACEi’s in treating proteinuria?
* 1
* 2
* 3
* 4
* 3&4
1
EFA 5
Which drug might be responsible for the blood test results observed in Patient A?
Trimethoprim
Trimethoprim inhibits the active secretion of creatinine. As a result, creatinine levels in the blood would start to rise. eGFR is measured using creatinine clearance, so trimethoprim invalidates this process, since creatinine is not excreted as normal in the presence of trimethoprim.
EFA 5 - SAQ
Below is a schematic diagram of the lower oesophageal sphincter (LOS) and its surrounding anatomical structures.
A – D are known to make important anatomical contributions to maintenance of a competent LOS. Identify the structures/anatomical features A, B, C & D: (4 marks)
- A: Diaphragm
- B: Angle of His
- C: Phrenoesophageal ligament
- D: Distal oesophagus within the abdomen
EFA 5 - SAQ
Below is a schematic diagram of the lower oesophageal sphincter (LOS) and its surrounding anatomical structures.
Name 3 mechanisms which help protect the distal oesophagus if reflux of gastric contents does occur: (3 marks)
- Volume clearance or oesophageal peristalsis reflex
- pH clearance or swallowing of saliva
- Barrier properties of the oesophageal epithelium
EFA 5 - SAQ
Below is a schematic diagram of the lower oesophageal sphincter (LOS) and its surrounding anatomical structures.
Name 3 consequences of persistent gastro-oesophageal reflux disease: (3 mark)
- Oesophagitis
- Peptic stricture
- Barrett’s oesophagus
- Oesophageal cancer
EFA 6
What is the name of the structure pointed at by the large blue arrow?
* Conus medularis
* Nerve root
* Spinal cord
* Cauda Equina
* Annulus fibrosis
Cauda Equina
EFA 6
A 65 year old patient presents to her general practioner with joint pains in the fingers, particularly the proximal and distal interphalangeal joints. The pain is worsened by gripping and opening jars. They have 15 mins of early morning stiffness. The patient’s hands are shown below. What is the diagnosis?
* Rheumatoid arthritis
* Gout
* Lupus
* Osteoarthritis
* Pseudogout
Osteoarthritis
EFA 6
How many of the chemical structures in the diagram below could function as competitive opioid receptor antagonists?
* 1
* 2
* 3
* 4
* 5
1
An opioid receptor antagonist must possess affinity i.e. the ability to bind to the opioid receptor.This requires a hydroxyl group at position 3 and a tertiary nitrogen.The two structures that possess these components are structure A and E.An antagonist also possesses no efficacy at the receptor. If the side chain on the tertiary nitrogen is longer than 2 carbons, then it will not possess efficacy.Structure A is the only option that possesses this component. Thus the answer is 1.
EFA 6
In a prospective study, obese and overweight patients were followed for 20 years and assessed for the development of diabetes mellitus type 2. Based on the results of the study presented in Table I, calculate the relative risk of developing diabetes mellitus type 2 in people who are obese compared with people who are overweight.
2.53
