Formative

Question 1

In a partial gastrectomy which secretion of the stomach is likely to be reduced to a level whereby adverse effects are seen on the body?

Answer 1

Intrinsic factor - necessary for vitamin B12 absorption (crucial for DC function - proprioception, fine touch and conscious proprioception)

Question 2

What hormones stimulates the pancreas to secrete HCO3- and enzymes?

Answer 2

Secretin - HCO3-

CCK - enzymes

Question 3

What’s the transport for absorption of amino acids across the luminal and then basolateral membrane in the intestine?

Answer 3

Luminal: symport (cotransport) with Na+
Basolateral: passive diffusion

Question 4

What’s the role of bile salts and where are they reabsorbed?

Answer 4

Emulsify fats so they can be easily digested by pancreatic lipase
Majority of bile salts are reabsorbed in the terminal ileum

Question 5

What class of drug is Oxybutinin? What receptors and for what

Doxasozin?

Answer 5

Oxybutinin = anti-spasmodic to treat urinary incontinence by blocking M3 receptors on detrusor

Doxasozin (a1 adrenoceptor blocker) = treatment of retention (BPH) by blocking a1 receptor at internal urethral sphincter to relax

Question 6

What drug can produce symptomatic relief of diarrhoea and how?

Answer 6

Loperamide = u opioid agonist to increase rhythmic contractions of the colon by reduce propulsive activity

(increasing dietary fibre and osmotic laxatives would increase colonic motility)

Question 7

What stimulates and inhibits parietal cell acid secretion?

Answer 7

Stimulate: gastrin, histamine, ACh (mAChR)
Inhibit: somatostatin, prostaglandin, intestinal hormones

Question 8

What would bruits on the transpyloric plane indicate?

Answer 8

Renal stenosis (T1)

Question 9

What’s a posterior relation to the kidney that’s at risk in superior kidney pole biopsy that’s approached from the back?

Answer 9

Parietal pleura = could damage this and the lung, leading to pneumothorax (air into the damaged pleural cavity will cause pain)

Question 10

What makes indirect hernia’s clinically obvious?

Answer 10

Reducible, remains reduced when pressure placed over the region of the deep inguinal ring (midpoint of inguinal ligament)

Question 11

What cell type is raised in acute inflammation?

Answer 11

Neutrophil (able to phagocytose and produce immediate response to injury)

Question 12

Which class of diuretics can give hypokalaemia?

Answer 12

Loop diuretics (Furosemide) on thick ascending loop of henle, Na+K+2Cl- co transporter inhibitor

Question 13

What type of epithelium forms the filtration barrier in the glomerulus?

Answer 13

Simple squamous

Question 14

Which gastric cell type secretes Pepsinogen?

Answer 14

Chief cells

Pepsinogen -> Pepsin to break down proteins when stimulated by low pH

Question 15

What’s the function of lacteals in the small intestine?

Answer 15

Carry products of digestion through the capillary walls (chylomicrons, packages of triglyceride droplets, are exported across the basolateral membrane into lacteal)

Question 16

Which cell type has low affinity glucose transporters?

Answer 16

Hepatocytes - glucose uptake via low affinity GLUT2 = activity varies significantly with glucose concentration

Question 17

What’s a high affinity glucose transporter?

Answer 17

GLUT1 (almost always operating near transport maximum)

GLUT1, 3, 4

Question 18

What’s a gravity dependent recess in the abdominal space where fluid can accumulate and cause infection?

Answer 18

Hepatorenal (will cause right hypocondrial pain that may radiate to right shoulder because of diaphragm irritation)

Question 19

How does SIADH and diabetes insipidus differ?

Answer 19

SIADH = too much ADH = too much fluid retention and hyponatreamia

DI = neurogenic whereby insufficient ADH produced by hypothalamus, or nephrogenic whereby CD is insensitive to ADH

Question 20

What’s the main factor for ADH release?

Answer 20

Released from posterior pituitary in response to raised plasma osmolarity

Question 21

Why do you get hyponatreamia in SIADH?

Answer 21

Aquaporins inserted into collecting duct
Too much water reabsorption
Plasma electrolytes diluted

Question 22

What substance controls osmotic gradient of the kidney and therefore what class of drugs are most powerful in regulating this?

Answer 22

Urea
Loop diuretics (NaCl also controls - NaK+Cl- cotransporters)

Question 23

What type of consent is sufficient for taking blood?

Answer 23

Implied consent = Dr explains procedure to patient so that they have enough information, then patient rolls up sleeve and presents arm, implying they understand and agree to having blood taken

Verbal consent = Dr explains procedure to patient and then verbally asks if they agree - patient verbally agrees to having the procedure

Question 24

What ethical principle underlies the legal doctrine of informed consent?

Answer 24

Respect for autonomy = patient has right to make decisions over their own body and therefore decide to consent to treatment or not

Question 25

How are thyroid hormones transported in blood?

Answer 25

Freely (T4/T3)

Bound to: plasma albumin, thyroxine binding globulin, thyroxine binding pre-albumin, plasma proteins

Question 26

Which organs can refer pain to the epigastric region?

Answer 26

Stomach
Liver
Distal oesophagus
Pancreas
Gallbladder
1st and 2nd parts duodenum

Question 27

Outline how PPIs can reduce epigastric pain

Answer 27

Inhibit H+/K+ ATPase pump to prevent formation of HCL (acid) by gastric parietal cells
This neutralises stomach acid so there is less irritation to mucosa by acidic content reflux

Question 28

Why can symptoms of GORD return after 3 days following PPI?

Answer 28

PPI irreversibly inhibit the proton pump by becoming trapped in parietal cell canaliculi, therefore new proton pumps need to be made and inserted to parietal cell epithelium to restart acid secretion

Question 29

What are strengths of the infectious diseases notification process?

Answer 29

Timeliness - weekly report to PHE
Representative - routine national data
Linked to other data (labs) to improve accuracy

Question 30

What are the 2 coding systems for input to Hospital Episode Statistics?

Answer 30

ICD-10 for all admissions, procedures etc

OPCS-4 for all operations

Question 31

What are the 4 principles of person-centred care?

Answer 31

Personalised
Enabling
Coordinated
Treats patient with dignity, compassion and respect