Formative

Question 1

Which type of cartilage degenerates first in osteoarthritis?

Answer 1

Hyaline/articular cartilage

Question 2

What are clinical signs of osteoarthritis?

Answer 2

Crepitus
Pain
Reduced range of movement
Swelling
Stiffness
Mal-alignment of the joint

Question 3

What does the Trendelenburg test? (which muscles hold the pelvis in a horizontal position)

Answer 3

Gluteus medius and minimums - superior gluteal nerve

Stability of ipsilateral pelvis

Question 4

What are pathological features that are identifiable by radiology in osteoarthritis and rheumatoid arthritis?

Answer 4

LOSS (narrowing of joint space, osteophytes, subchondral cysts, sclerosis)

LESS (narrowing of joint space, bony erosion, synovial inflammation/soft tissue swelling, subluxation)

Question 5

Which muscles /muscle groups in the hand does the ulnar nerve supply?

Answer 5

Hypothenar group: opponents digiti minimi, flexor digiti minimi, abductor digiti minimi)

Interossei (planar and dorsal)

Adductor pollucis

Lumbricals 3 and 4

Question 6

What tests can be done to assess the ulnar nerve in the hand?

Answer 6

Digit adduction: hold sheet of paper between the digit and resist it being pulled out

Digit abduction: abduct the digits and resist examiner pushing against them

Froment’s sign: test thumb adduction and look for flexion at DIP

Question 7

Describe events of wound healing within the first 48 hours

Answer 7

Haemostasis/blood clotting
Fibrin clot formation
Neutrophils migrate towards fibrin clot
Epithelial cells from wound edges migrate and proliferate along the dermis

Question 8

What are clinical findings of a localised wound infection?

Answer 8

Erythema
Swelling of the wound
Pus formation/leakage
Pain/tenderness
Raised local temperature
Loss of function
Local lymphadenopathy in area drained

Question 9

Which pathogen is most likely to cause a wound infection?

Answer 9

Staphylococcus Aureus

Question 10

What effect would anterior thigh compartment syndrome have on the leg and foot?

Answer 10

Loss of function - cold and clammy

Femoral artery main blood supply; if compressed in anterior compartment then leg/foot won’t receive blood supply

Question 11

Which local factors affect wound healing?

Answer 11

Infection
Poor vascular supply
Mechanical factors (early mobility)
Foreign bodies
Large wound size

Question 12

What elements are being assessed in a multifactorial falls risk assessment?

Answer 12

Vision
Osteoporosis
History of falls
Gait, balance, mobility
Home hazards
Cognitive impairment
Urinary incontinence 
Cardiovascular examination

Question 13

What interventions that can reduce future falls?

Answer 13

Medication review
Individualised strength and balance training (physio)
Vision assessment
Home hazard assessment

Question 14

What’s the main risk factor for malignant melanoma in the UK?

Answer 14

UV exposure

Question 15

In what layer of the epidermis are melanocytes found and what’s their usual role?

Answer 15

Stratum basale

Protect DNA of skin cells from UV radiation induced damage

Question 16

Which axillary lymph nodes would a melanoma on the back of the arm spread to first?

Answer 16

Humeral nodes

Question 17

What are hand signs of a median nerve lesion?

Answer 17

Hand of benediction (unable to flex digits 1-3 when trying to make a fist)
Weakness of thumb opposition
Ulnar deviation of the wrist on flexion

Question 18

What examination finding in a hand is indicative of carpal tunnel median nerve damage?

Answer 18

Weakness of thumb opposition

Question 19

Which part of the brachial plexus relates to rib 1 and therefore compression at rib 1 will present how?

Answer 19

Lower part (C8-T1 roots)
T1 predominantly supplies small muscles of the hand = unable to grip a piece of paper between two fingers

Question 20

What movement of the hip does gluteus medius do?

Answer 20

Abduction

Question 21

Which bone cells develop from: mesenchyme and monocyte progenitor cells?

Answer 21

Mesenchyme -> osteoprogenitor cells -> osteoblasts -> osteocytes

Monocyte progenitor cells -> osteoclasts (macrophage lineage)

Question 22

What type of drug is Denosumab and what’s it’s molecular target?

Answer 22

Monoclonal antibody

RANKL = prevents it binding to RANK for osteoclast activation

Question 23

How does botulism result in flaccid paralysis?

Answer 23

Disrupts ACh release from the presynaptic membrane - degrades SNARE protein complex which is responsible for docking and fusion of vesicles

Question 24

In which region of the sarcomere is ATP hydrolysed to ADP + Pi?

Answer 24

In the A band (overlap between thick and thin filaments, where Myosin head can bind Actin and ATP)

Question 25

In muscle contraction what does ATP hydrolysis do?

Answer 25

Provides energy to make actin and myosin move relative to each other via cross bridge cycling

Question 26

What would the Ca2+ and PO4 levels be in primary, secondary and tertiary hyperparathyroidism?

Answer 26

Primary: high Ca2+ low PO4
Secondary: normal/low Ca2+, any level of PO4
Tertiary: high Ca2+ high PO4

Question 27

What’s the normal role of Dystrophin?

Answer 27

Links Actin cytoskeleton to plasma membrane and ECM = tethering of actin to plasma membrane is affected in DMD

Question 28

What are the 2 layers of the dermis?

Answer 28

Reticular (deeper) and papillary (more superficial)