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GEM 1 Flashcards

1
Q

Name the three most common anatomical planes and their divisions

A

Sagittal = left and right
Transverse or axial = superior and inferior
Coronal = posterior and anterior

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2
Q

Name the four basic types of tissue and give examples?

A

Connective tissue (bone, blood, adipose, cartilage, reticular)

Epithelial tissue (squamous, columnar, cuboidal)

Muscle tissue (skeletal, smooth, cardiac)

Nervous tissue (neurons, glial)

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3
Q

Name the 8 cranial bones

A
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4
Q

Name the systolic followed by diastolic reference ranges (mmHg) for: hypotension, normal, hypertension

A

<90/60 (hypotensive)
<120/80 (normal range)
>140/90 (hypertensive)

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5
Q

Name two functions of the blood in relation to thermoregulation

A

Distributing heat from active organs

Vasodilation or vasoconstriction to regulate blood flow towards the skin (convection)

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6
Q

Name five transport functions of the circulatory system

A

(Hormones) from endocrine glands to target tissues

Molecules and cells for the (immune system)

(Nutrients) from the digestive tract to the liver

(Oxygen) from the respiratory system to the cells

(Waste products) from our cells to the respiratory and excretory systems

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7
Q

What are the two hormones secreted by alpha and beta cells in the pancreas and what do they do?

A

Alpha cells secrete glucagon which stimulates the liver to release glucose into the blood and stops the liver from taking up more glucose.

Beta cells secrete insulin which stimulates the liver, skeletal muscle, and adipose tissue to take up glucose.

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8
Q

How much glucose (g) circulates in the blood of an average (70kg) adult at a given time?

A

4g

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9
Q

What are the three dietary monosaccharides?

A

Glucose, fructose, galactose

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10
Q

What are the three different types of capillaries and give some examples of where they can they be found?

A

Continuous - allow small molecules through (found in muscle, skin, fat, and nerve tissue)

Fenestrated - found where extensive molecular exchange occurs (small intestine, kidneys, endocrine glands)

Sinusoidal - contains larger gaps and an incomplete basement membrane for exchange of larger molecules and even cells (liver, spleen, lymph nodes)

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11
Q

Describe the ultrastructure of the arteries

A

Lumen - typically narrower in arteries compared to veins and without valves

Tunica intima - endothelium made up of simple squamous epithelial cells, followed by a basement membrane and internal elastic lamina

Tunica media - typically the thickest layer, made up of smooth muscle cells that can vasoconstrict or dilate, followed by the external elastic lamina

Tunica adventitia - consists of elastic and connective tissue as well as vasa and nervi vasorum

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12
Q

Describe the path of blood through the systemic circulation, starting from the pulmonary veins and ending with the capillaries

A
  • Left atrium
  • Mitral valve
  • Left ventricle
  • Aortic (Semilunar) valve
  • Aorta
  • Arteries
  • Arterioles
  • Metarterioles
  • Capillary bed
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13
Q

What is pulse pressure and what is the normal range?

A

Difference between systolic and diastolic blood pressure

40-60mmHg

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14
Q

What is peripheral (vascular) resistance and where is it highest?

A

The resistance that must be overcome to circulate blood

Highest in arterioles (narrow lumen)

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15
Q

What are the four main components of blood?

A

55% plasma (water, proteins, ions, dissolved gases)
45% Erythrocytes
Leucocytes
Thrombocytes

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16
Q

What are the 3 main plasma proteins?

A

Albumin - Maintains oncotic pressure, carries molecules and drugs, scavenges free radicals

Fibrinogen - clotting factor

Globulins - Alpha (such as HDL), beta (such as LDL), gamma (Antibodies)

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17
Q

If fibrinogen and other clotting factors are removed from plasma, what is left?

A

Serum

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18
Q

What are 4 main steps of haemostasis?

A

Vasospasm - smooth muscle tissue contracts to reduce bloodflow

Platelet plug - collagen and von Willebrand factor in the vessel wall are exposed to thrombocytes, which activate and become dendritic. Thrombocytes also release Ca2+ which signals thrombocyte aggregation

Coagulation - fibrinogen is then converted to fibrin, which forms a mesh that traps more platelets and erythrocytes to form a thrombus

Fibrinolysis - plasmin breaks down the clot and anticoagulants and vasodilators are released

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19
Q

What are the four pillars of medical ethics?

A

Autonomy (of patient’s)
Beneficence
Non-maleficence
Justice

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20
Q

What is a solvent and give an example?

A

The liquid in which a solute is dissolved in to make a solution.

E.g. water is a solvent for salt (solute) which makes brine (solution)

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21
Q

How many particles does one mole (mol) contain?

A

6.02 x 10^23

Known as Avogadro’s constant

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22
Q

What is the relative charge and relative mass of the three subatomic particles?

A

Electrons: 1/2000 mass, -1 charge
Protons: 1 mass, +1 charge
Neutrons: 1 mass, 0 charge

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23
Q

What are the 3 dietary disaccharides?

A

Sucrose, Lactose, Maltose

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24
Q

Define cations and anions?

A

Positively (cation) or negatively (anion) charged atoms

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25
Q

What is an isotope?

A

A different form of an element that contains the same number of protons and electrons but a different number of neutrons

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26
Q

Which three factors affect Ionisation energy?

A
  1. Nuclear charge (number of protons)
  2. Distance from the nucleus (reduces with distance)
  3. Shielding (number of electrons between an outer electron and the nucleus)
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27
Q

Why does it take more energy to remove each successive electron from an atom?

A

Electrons are being removed from an increasingly positive ion so the force of attraction due to be broken is greater.

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28
Q

Why is it easier to remove an electron from an orbital containing two electrons?

A

Electron repulsion (as electrons are both negatively charged)

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29
Q

What happens to ionisation energy when moving down groups in the periodic table?

A

Ionisation energy reduces.

Each element down a group has an extra electron shell, (increased distance and electron shielding from inner shells)

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30
Q

What happens to ionisation energy when moving across periods in the periodic table?

A

Ionisation energy increases.

Increased number of protons (nuclear attraction) but at roughly the same level (no electron shielding)

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31
Q

What are valence electrons?

A

An electron in the outer shell of an atom which can participate in the formation of chemical bonds (e.g. covalent bonds)

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32
Q

Describe the structure of a neuron

A
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33
Q

Are epithelial tissues vascularised?

A

No. Epithelial tissues are avascular

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34
Q

What are the two main types of nerve cells?

A

Neurons and glial cells

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35
Q

Where is the pyloric sphincter and what does it do?

A

At the inferior end of the stomach. Allows chyme to pass into the duodenum.

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36
Q

What are the three phases of digestion?

A

Cephalic
Gastric
Intestinal

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37
Q

What are the 3 main roles of the liver?

A

Detoxification - the liver filters all blood from the stomach and intestines and metabolises drugs and toxins into less harmful/more usable components

Synthesis - of bile which is used for fat digestion, neutralising chyme, and for moving waste along the intestine

Storage - of fat soluble vitamins (A,D,E,K) and glycogen

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38
Q

What is the function of the gallbladder?

A

To concentrate and store bile which is synthesised in the liver

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39
Q

What is the role of the pancreas?

A

Produces digestive enzymes which are secreted into the duodenum (lipase, protease, amylase)

Produces pancreatic hormones (glucagon, insulin)

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40
Q

Where are leptin and ghrelin produced?

A

Leptin is produced in adipose tissue and inhibits hunger. Leptin production is directly proportional to the amount of adipose tissue one has.

Ghrelin is produced in the stomach. Ghrelin levels are highest before a meal

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41
Q

What are the two forms of endocytosis?

A

Phagocytosis - ingestion of particles

Pinocytosis - ingestion of liquid droplets

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42
Q

What is erythropoietin?

A

A hormone made in the kidneys that stimulates erythropoiesis (erythrocyte production).

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43
Q

What are the roles of the kidneys?

A
  • Removal of wastes
  • Control of blood pressure
  • Control of blood pH
  • Erythropoietin production
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44
Q

What could high levels of erythropoietin indicate?

A

Anaemia

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45
Q

How long is the average lifespan of an erythrocyte?

A

100-120 days

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46
Q

What is HbA1c and why is it unreliable in patients with sickle cell disease?

A

HbA1c measures glycated haemoglobin in the bloodstream and indicates average levels over the past 3 months (limited by erythrocyte lifespan of 100-120 days).

HbA1c is underestimated in sickle cell disease as erythrocyte lifespan is only 10-20 days.

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47
Q

Describe the structure of haemoglobin

A

2 alpha and 2 beta globins surround 4 heme groups. Heme group contains a porphyrin ring and one iron atom per group.

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48
Q

What is the mesentary and what is it’s function?

A

A fold of membrane that attaches the intestine to the abdominal wall.

Prevents intestines from collapsing or twisting.

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49
Q

What is the role of the smooth endoplasmic reticulum?

A

Synthesises and stores lipids (such as cholesterol and phospholipids).

Has various other functions.

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50
Q

What is the defining feature and what is the role of the rough endoplasmic reticulum?

A

Is studded with ribosomes.

Synthesises proteins

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51
Q

What is the function of the Golgi apparatus?

A

Responsible for modifying and packaging proteins and lipids into vesicles for exocytosis or transport around the cell

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52
Q

What is a lysosome?

A

Membrane bound organelles that contain digestive enzymes for invading pathogens or worn out cell parts

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53
Q

Give an overview of haematopoiesis and the two main lineages

A
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54
Q

Where are mast cells found and what is their role?

A

Located in connective tissue close to the external environment (mucosal surfaces, skin, intestines etc.)

Contains granules with histamine, heparin, cytokines and other inflammatory mediators. Involved with allergic reactions and parasitic defence

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55
Q

What is saltatory conduction?

A

Occurs in myelinated axons where an action potential in a node of ranvier triggers the flow of current to the next node, speeding up the transfer of nerve signals

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56
Q

What is the difference between the autonomic and somatic nervous system?

A

Autonomic - mediates unconscious activities. Only has motor pathways

Somatic - mediates conscious activities. Has motor and sensory pathways

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57
Q

What does a natural killer cell do?

A

Innate immune cells that destroy damaged cells which no longer produce major histocompatability complex 1 (mhc1) on their cell surface

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58
Q

What is haematocrit and what are the normal ranges in men and women?

A

% of erythrocytes in the blood.

Men: 41-50%
Women: 36-48%

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59
Q

What is the glycocalyx?

A

The sugar coat on the outer surface of the plasma membrane.

It aids in the binding of some cells and facilitates cell recognition.

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60
Q

What would happen if an erythrocyte was placed in a Hypertonic solution?

A

The fluid bathing the erythrocyte contains a high level of solute relative to the cytoplasm, therefore water would diffuse out of the cell, causing the cell to shrivel (Crenation).

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61
Q

Name two carrier-mediated transport systems and provide examples?

A

Facilitated Diffusion - Ion channels transported down an electrochemical gradient.

Active transport - Uses ATP to transport solutes against their concentration gradiets e.g. Na+, K+ pump

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62
Q

What is a gene?

A

A sequence of DNA that codes for a protein or polypeptide

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63
Q

How many homologous pairs of chromosomes do humans inherit?

A

23 pairs

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64
Q

What is the genotype?

A

The set of genes possessed by a particular organism

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65
Q

What is the phenotype?

A

The expression of the genotype - may also have environmental influences!

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66
Q

What are Newtons 3 laws of motion?

A
  1. A body will remain in a uniform state of motion unless acted upon by an external force
  2. F = ma
  3. For every action, there is an equal and opposite reaction
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67
Q

What is the starling principle?

A

Fluid movements between blood and tissues are determined by differences in hydrostatic and oncotic pressures between plasma inside microvessels and fluid outside them

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68
Q

What is the difference between laminar and turbulent flow and when do they occur?

A

Laminar flow is constant and often occurs at low velocities. Turbulent flow involves irregular fluctuations and mixing, often at higher velocities.

E.g. A waterfall exhibits both from start (laminar) to finish (turbulent) as water accelerates due to gravity.

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69
Q

In chemistry compounds ending in ‘ide’ are types of what?

A

Anions (negatively charged ions)

(e.g. chloride, oxide, sulphide)

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70
Q

What is a covalent bond?

A

A chemical bond that involves the sharing of electron pairs between atoms.

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71
Q

What is an ionic bond?

A

A type of chemical bond that involves the electrostatic attraction between oppositely charged ions, or between two atoms with sharply different electronegativities.

Ionic bones tend to be stronger than covalent bonds

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72
Q

Is a water molecule polar or nonpolar, and what is the net charge of a water molecule?

A

Water is a polar molecule as the oxygen atom hogs electrons, giving it a partial negative charge, whereas the hydrogen atoms have a partial positive charge.

The net charge of water is zero

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73
Q

Why is water both cohesive (sticks together) and adhesive (sticks to other things)?

A

Due to its polarity

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74
Q

Outline the main divisions of the human nervous system and their roles

A
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75
Q

What are the two human gametes?

A

Sperm cell - male
Egg cell - female

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76
Q

Are gametes diploid or haploid?

A

Haploid (23 chromosomes)

All other human cells are diploid, containing 23 chromosome pairs

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77
Q

What are the four main types of macromolecules?

A

Carbohydrates
Lipids
Proteins
Nucleic Acids

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78
Q

What are the four bases of DNA?

A

A - adenine
T - thymine

G - guanine
C - cytosine

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79
Q

What are the four RNA bases?

A

A - adenine
U - uracil

C - cytosine
G - guanine

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80
Q

What are the four protein structure types?

A
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81
Q

Describe the basic structure of an amino acid

A

Central Carbon atom
- Hydrogen
- Carboxyl group
- Amino group
- R side chain

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82
Q

List the four main types of carbohydrates and give examples for each

A
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83
Q

What are the three main types of lipids?

A

Phospholipids - used to make the polar bilayer of human cells

Sterols - Cholesterol is the primary sterol in humans. Formed in the liver and used to make hormones and bile salts. Phytosterols are found in plants.

Triglycerides - Found in food, the blood, and adipocytes. Either unsaturated or saturated

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84
Q

Describe the chemical structure of a phospholipid

A
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85
Q

Describe the chemical structure of a triglyceride

A

Glycerol backbone bound to 3 fatty acid chains

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86
Q

What are the three types of polysaccharides and their functions?

A

Starch - (amylose and amylopectin) plant energy storage

Glycogen - animal medium-term energy storage

Cellulose - plant structure (indigestible)

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87
Q

What is an enzyme?

A

Proteins that help to speed up chemical reactions in animals.

Enzymes convert ‘substrates’ into ‘products’ at the active site

Human enzymes normally work best at 37c and at a specific pH related to their area of operation.

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88
Q

Where are the adrenal glands located?

A

On top of the kidneys

‘Add’ - ‘Renal’

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89
Q

Describe how DNA is stored

A

As tangled chromatin fibres during interphase. Chromatin forms into chromosomes during Prophase.

Chromosomes are made from tight strands of chromatin. Chromatin is made of tight bundles of histones. DNA is wound around histones to form nucleosomes

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90
Q

Describe osmolarity

A

Osmolarity is the measure of solute concentration in a liquid.

Measured as Osmoles per litre (Osm/L)

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91
Q

What section of the nervous system does a reflex arc fall under?

A

Somatic nervous system

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92
Q

Why is iodine important for the thyroid?

A

Iodine is used to create thyroid hormones, namely triiodothyronine (t3) and thyroxine (t4).

Iodine deficiency slows the metabolism and eventually caused an enlarged thyroid (goiter)

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93
Q

Which part of the body regulates homeostasis?

A

Hypothalamus (via autonomic nervous and endocrine systems)

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94
Q

Which three pathways do the hypothalamus and pituitary gland use to direct neuroendocrine function?

A

HPT axis (homeostasis)
HPA axis (flight or fight)
HPG axis (reproduction)

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95
Q

What is cardiac output?

A

The amount of blood the heart pumps in 1 minute

= stroke volume (ml/beat) x BPM

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96
Q

What is a normal cardiac output for an average sized human at rest?

A

5-6 litres (per minute)

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97
Q

What is stroke volume and what is a normal range?

A

Volume of blood ejected out of the left ventricle at each heart beat.

50-100ml

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98
Q

Explain a reduction-oxidation (Redox) reaction

A

‘OIL RIG’

Oxidation is loss of electrons (becomes positively charged)

Reduction is gain of electrons (becomes negatively charged)

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99
Q

What is an electronegative element? Give an example

A

An element which attracts electrons (to fill a shell).

Fluorine is the most electronegative element (1 electron away from filling its shell)

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100
Q

What is the ratio of the sodium-potassium pump found in a neuron?

A

3:2

3 Na+ pumped out for every 2 K+ brought in

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101
Q

Outline the process of an action potential

A
102
Q

What is the usual charge of an animal cell?

A

Cells are normally negatively charged (at rest)

103
Q

Does a human have more neurons or glial cells?

A

Glial cells.

Outnumber neurons 10 to 1

104
Q

How often do neurons divide?

A

Most never divide and are amitotic in adults

105
Q

If a 16 atom radioisotope has a half life of 10 seconds, how long will it take for the isotope to be eliminated?

A

Due to exponential decay, an isotope is never truly eliminated.

However, there are a discreet number of atoms in this question (16) and it will decay to <1 atom after around 40 seconds.

106
Q

Why are alpha particles dangerous in the body but less so when emitted outside the body?

A

Alpha particles are heavy and energetic, so can cause great damage in cells, but cannot travel far.

107
Q

Describe alpha, beta, and gamma radiation

A

Alpha particles - large, positive, emitted from the nucleus, made of 2 protons and 2 neutrons

Beta particles - small, negative, emitted from the nucleus.

Gamma rays - weightless, high energy

108
Q

A hydrogen bond is a bond between a hydrogen and an…

A

Electronegative element.

Example: water. Oxygen hoggs electrons from its covalent bonds with hydrogen, making oxygen electronegative, which can in turn form a hydrogen bond with other H2O molecules.

109
Q

Rank the following alcohols in order of chain length: Hexane, Heptane, Ethanol, Propane, Butane, Octanol, Methanol, Pentanol

A

C - Methanol
C2 - Ethanol
C3 - Propane
C4 - Butane
C5 - Pentanol
C6 - Hexane
C7 - Heptane
C8 - Octanol

110
Q

Which of the following has the highest boiling point?

Octanol, Ethanol, Methanol, Hexanol

A

Octanol

Has the longest chain (C8)

111
Q

How many carbon atoms do the following molecules contain?
methanol,
butan-1-ol,
propan-2-ol,
ethanol

A

Methanol: 1
Ethanol: 2
Propan-2-ol: 3
Butan-1-ol: 4

112
Q

How many carbon atoms are found in Butane?

A

4

113
Q

What is an unsaturated compound?

A

Contains double or triple bonds.

Liquid (oil) at room temperature.

114
Q

What is a saturated compound?

A

Contains single bonds

Solid at room temperature

115
Q

What are halogens?

A

Occupy second to last group on the right of the periodic table.

7 valence electrons, so very reactive

116
Q

Which of the following carboxylic acids will have the highest boiling point?

Decanoic acid
Hexanoic acid
Nonanoic acid

A

Decanoic acid

(Longest chain)

117
Q

What is Pascal’s law?

A
118
Q

What is epistaxis?

A

A nosebleed.

90% occur at the vulnerable kisselbach plexus

119
Q

What is an occlusion?

A

A complete or partial blockage of a blood vessel

120
Q

What is the difference between a haematoma and a thrombus?

A

When an injury causes bleeding outside the blood vessel into the tissue around it, and that blood then clots, it’s called a hematoma. When blood clots inside a blood vessel, it’s called a thrombus.

121
Q

What is the treatment for cachexia?

A

There is no approved treatment for cachexia and quality of life care is the focus.

Stimulating appetite or intubation cannot reverse the condition, although research is ongoing into drugs that modulate Ghrelin production

122
Q

What are catecholamine hormones?

A

Hormones produced by the adrenal glands.

The main types are dopamine, norepinephrine, and epinephrine

123
Q

What is the vagus nerve?

A

Cranial nerve X

Responsible for internal organ functions such as digestion, heart rate, breathing, cardiovascular activity, reflexes (coughing, sneezing, vomiting). Important role in the gut-brain axis

124
Q

Explain the seven portions of the electromagnetic spectrum

A
125
Q

What is the difference between X-Rays and Gamma Rays?

A

They have the same basic properties.

X-rays are emitted from processes outside the nucleus, but gamma rays originate inside the nucleus.

In general, nuclear transitions are more energetic than electronic transitions, so gamma rays are usually more energetic and penetrating.

126
Q

What is the difference between effusion, perfusion, and diffusion?

A

Effusion - gases escaping through a hole or orifice

Perfusion - bathing an organ or tissue in fluid (e.g. bloodflow to capillaries)

Diffusion - movement of molecules from a high concentration to a low concentration

127
Q

Define the ‘Octet Rule’

A

The octet rule states that atoms
desire eight electrons in their valence shells, as this gives them the electron configuration of a noble gas.

Most atoms have to bond with other atoms to acquire this electron configuration.

128
Q

Name the three major types of intramolecular bonds

A

Ionic bonds: electrons are transferred from a metal to
nonmetal

Covalent bonds: electrons are shared between nonmetals

Metallic bonds: electrons “float” between a lattice of metallic nuclei

129
Q

Define ‘Molality’

A

Molality represents the number of moles of solute dissolved into one kilogram of solvent

130
Q

Define ‘Osmotic Pressure’

A
131
Q

What is the molecular formula of this molecule?

A
132
Q

Define ‘Capillary Action’

A

The movement of water within the spaces of a porous material due to the forces of adhesion (surface of container), cohesion (between water molecules), and surface tension.

133
Q

Name the 14 facial bones

A
134
Q

Name the ossicles of the skull

A

Malleus
Incus
Stapes

135
Q

Name the postcranial bones of the axial skeleton

A

Hyoid
Sternum
Ribs x24
Cervical vertebrae x7
Thoracic vertebrae x12
Lumbar vertebrae x5
Sacrum
Coccyx

136
Q

What is peripheral oedema?

A

Swelling under the skin in the appendages (multiple causes)

137
Q

What is Lymphoedema?

A

Chronic swelling in the tissues (failure of the lymphatic system)

138
Q

Name the appendicular bones of the hand and wrist

A

Scaphoid (she)
Lunate (looks)
Triquetrum (too)
Pisiform (pretty)
Trapezium (try)
Trapezoid (to)
Capitate (catch)
Hamate (her)

Metacarpals
Proximal phalanges
Intermediate phalanges
Distal phalanges

139
Q

Name the inferior appendicular bones of the legs and hip (not including the distal region)

A

Ilium x2
Ischium x2
Pubis x2
Femur x2
Patella x2
Tibia x2
Fibula x2

140
Q

Name the appendicular bones of the feet and ankles

A

Talus (tiger)
Calcaneus (cubs)
Navicular (need)
Medial cuneiform (m)
Intermediate cuneiform (i)
Lateral cuneiform (L)
Cuboid (c)

Metatarsals
Proximal phalanges
Intermediate phalanges
Distal phalanges

141
Q

Define ‘Tenesmus’

A

Tenesmus is the frequent urge to go to the toilet but not being able to go / the incomplete evacuation of the bowels.

Severe inflammation that irritates the nerves involved in defecation is often the cause.

142
Q

In what part of the cell does DNA transcription mainly happen?

A) Cytoplasm
B) Endoplasmic Reticulum
C) Golgi Apparatus
D) Mitochondrion
E) Nucleus

A

Transcription (production of mRNA) occurs in the nucleus as it requires a DNA template.

Once mRNA is produced, it leaves the nucleus for translation (protein synthesis). Translation occurs in the cytoplasm, on ribosomes which are both free and on the rough endoplasmic reticulum

143
Q

What is the major lipid component of the plasmalemma?
A) Cholesterol
B) Linoleic acid
C) Myelin
D) Phospholipid
E) Triglyceride

A

Plasmalemma is a less common term for the cell membrane. The membrane consists of lipids and proteins. The major lipid component is the Phospholipid bilayer

144
Q

A patient undergoes rapid weight loss in preparation for bariatric surgery. Their total adipocyte count reduces markedly. True or false?

A

False. In adults, adipocyte numbers remain stable over time despite a large turnover in these cells. A decrease or increase in weight will change cell volume.

145
Q

Which of the following is not a common analyte? What does it tell you?
A) Blood gases test
B) CRP test
C) Full blood count
D) Troponin
E) Heel prick test
F) HbA1c

A

E. The heel prick test (newborn blood spot test) is carried out on all newborns aged 5 days. The test screens for genetic conditions such as Cystic Fibrosis, Phenylketonuria, and Congenital Hypothyroidism. The heel prick test is not as common as the other tests, which may be administered more routinely and frequently throughout a patient’s life.

146
Q

Define the abbreviation ‘AAA’

A

Abdominal aortic aneurysm

A swelling in the aorta (which feeds the abdomen). There is no early warning symptom of AAA so screening is important. Screening is offered to all men aged over 65. AAA’s are dangerous if they are at a high risk of rupture.

147
Q

Define the abbreviation ‘ABG’

A

Arterial blood gas

Measures the levels of oxygen and carbon dioxide in the radial or femoral artery (less common). Blood pH can also be determined. A common test in the IC unit. Pulse oximetry is a less invasive option in other environments.

148
Q

Define the abbreviation ‘ACE’

A

Angiotensin-converting enzyme

ACE converts the hormone Angiotensin I to the active Vasoconstrictor Angiotensin II. Therefore, ACE indirectly increases blood pressure by causing vasoconstriction. ACE inhibitors are commonly used drugs for cardiovascular disease treatment.

149
Q

When does a mother’s milk typically ‘come in’?

A

2-4 days postpartum

150
Q

Describe the 2 fontanelle’s in a standard case

A

The soft gaps where two sutures of a newborn’s cranium are yet to fuse. Posterior fontanelle and anterior fontanelle (larger). Posterior usually fuses at roughly 3 months, anterior between 9-18 months.

151
Q

Describe Phenylketonuria (aetiology, pathogenesis, diagnosis, treatment, prognosis)

A

Aetiology: Inborn error of metabolism. Autosomal recessive mutation of the phenylalanine hydroxylase gene.

Pathogenesis: Without the enzyme, phenylalanine builds up when consuming high protein foods or aspartame.

Diagnosis: High phenylalanine in the blood, taken via a heel prick test (routine newborn screening). Symptoms can include fairer skin, hair, eyes (low melanin) and a musty smell.

Treatment: Treated with specialist dietetic support (low protein diet and amino acid supplements). Regular blood tests.

Prognosis: There is no cure. If diagnosed early there can be no significant impacts. If untreated, causes severe intellectual disability, psychiatric disorders, and seizures.

152
Q

Which of the following is correct in eukaryotes?
A) There are 22 proteinogenic amino acids
B) There are 20 essential amino acids
C) There are around 500 amino acids throughout biology, with 20 proteinogenic amino acids in humans
D) There are 21 proteinogenic amino acids, which includes 9 essential amino acids
E) There are 9 essential amino acids, which make up some of the 22 amino acids in eukaryotes

A

D. There are 20 amino acids in the standard genetic code plus selenocysteine in humans. These are proteinogenic (incorporated into proteins during translation). 9 of these are essential.

Histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine

153
Q

Define Hypertrophy, Hyperplasia, Metaplasia, and Neoplasia

A

Hypertrophy: Increase in cell size

Hyperplasia: Increase in cell number

Metaplasia: Transformation of a cell

Neoplasia: Uncontrolled cell formation

154
Q

What is the difference between involution and atrophy?

A

Involution is a normal decrease in cellular / organ size (e.g., postpartum)

Atrophy is an induced reduction (e.g. , stress, toxicity, nutrition)

155
Q

Outline the difference between necrosis and apoptosis? After which stimulus do they occur?

A

Both occur after irreversible cell injury (a stressor which is too significant to adapt to). Apoptosis is programmed (controlled) whereas necrosis is passive.

*Autophagy (intracellular recycling) is another process which occurs in response to a stimulus. Notably autophagy occurs during extended fasting.

156
Q

Which of the following is the most common start codon for translation, coding for methionine
A) Cytosine, Guanine, Cytosine
B) Arginine, Uracil, Guanine
C) Arginine, Arginine, Arginine
D) Arginine, Thymine, Guanine
E) Guanine, Uracil, Guanine

A

B

AUG codes for methionine, which is the most common start codon in mRNA translation at the ribosome.

157
Q

What is the difference between lymphoid and myeloid cell lineages?

A

Lymphoid cells form the basis of the adaptive immune response

Myeloid cells form the basis of the innate immune response

158
Q

What are the primary lymphoid organs and what is their purpose?

A

Thymus and bone marrow.

These tissues are responsible for the development of lymphocytes, a type of immune system cell.

159
Q

What are the secondary lymphoid organs and what is their purpose?

A

Lymph nodes, spleen, tonsils, certain tissues in the mucous membrane layers of the body.

They support the maturation, survival, and activation of lymphocytes. They are located throughout the body.

(The lymphatic system also includes lymphatic vessels, which drain lymph, or interstitial fluid, from tissues and return it to the bloodstream)

160
Q

What are the five cardinal signs of inflammation?

A

Rubor (redness)
Tumour (swelling)
Calor (heat)
Dolor (pain)
Functio laesa (function)

161
Q

Cirrhosis is the proximate cause of liver disease. Which of the following is a likely root cause?

A) Excess Alcohol Consumption
B) Viral Hepatitis
C) Environmental Toxin Exposure
D) All of the Above

A

D

All of these can be the root cause of liver scarring, which will lead to liver disease. The proximate cause is an intermediary on the disease pathway

162
Q

What are the two main lymphoid cell types which mature in the Thymus?

A

Cytotoxic T cells (CD8+)
Helper T cells (CD4+)

163
Q

Why are ‘productive’ viruses often cytolytic?

A

Productive viruses rapidly produce progeny using cell machinery. This creates endoplasmic reticulum stress (ER stress), where there is a build up of unfolded or misfolded proteins.

ER stress can lead to cell death (apoptosis) or immune cell clearance (cytotoxic) as these cells are recognised as faulty. ER stress can also lead to tumour progression.

Viruses often induce cell lysis, allowing for attachment and infection of further cells

164
Q

What causes lymphadenopathy?

A

Lymph nodes swell during infection (both localised and generalised).

This is often due to an increase in number and size of lymphoid follicles and proliferation of lymphocytes to respond to an antigen.

165
Q

Explain the pathophysiology of lymphadenopathy

A

Lymphadenopathy refers to the swelling of lymph nodes. These glands swell due to multiplication of cells (lymphocytes, plasma cells, monocytes, or histiocytes).

Swelling is usually localised. Widespread swelling indicative of systemic infection

166
Q

What are the main functions of the spleen?

A

Filtration - removes old and damaged erythrocytes, and microorganisms, from the bloodstream.

Defence - contains lymphocytes and macrophages

Storage - of blood and iron

167
Q

Define the terms ‘GALT’ and ‘MALT’

A

Gut-associated lymphoid tissue

Mucosa-associated lymphoid tissue

168
Q

Define Peyer’s patches and their function

A

Found in the small intestine (predominantly distal)

Antigens entering the intestinal tract encounter macrophages, dendritic cells, B-lymphocytes, and T-lymphocytes found in Peyer’s patches and other GALT sites. Peyer’s patches (gastrointestinal) are analogous to the tonsils (respiratory). They trap foreign particles, survey, and destroy them

169
Q

Which is not an example of an antigen?
A) Aflatoxin
B) PSA
C) CD8+ cell
D) Salmonella typhi
E) Herpes Zoster

A

‘C’ is not an antigen as it is a cytotoxic T cell (adaptive immunity).

Antigens are exogenous or endogenous substances that trigger an immune response in the body.

170
Q

Define ‘PSA’

A

prostate-specific antigen

171
Q

What are the three professional antigen presenting cells

A

Dendritic Cells
Macrophages
B Lymphocytes

Professional antigen presenting cells (APCs) are cells that process antigens and present them to T cells, initiating immune responses

172
Q

What are the most common immune cells

A

Neutrophils (40-60% of all Leukocytes)

173
Q

What are the main differences between Neutrophils and Macrophages?

A

Both are leukocytes which engage in phagocytosis and are part of the innate immune system.

Neutrophils are short-lived and found in the blood, macrophages are longer-lived and tissue bound.

Macrophages are primarily responsible for clearing away cellular debris, dead cells, and microbes. Neutrophils kill bacteria, fungi, and foreign debris

174
Q

What is an antigen?

A

Antigens are exogenous or endogenous substances that trigger an immune response in the body.

175
Q

How do antigens trigger an initial adaptive immune response?

A

Antigens trigger adaptive immunity by binding to antigen receptors on B and T lymphocytes

Antigen-presenting cells present antigens on their surface using MHC molecules. When an antigen binds to a lymphocyte’s antigen receptor, the lymphocyte becomes activated.

176
Q

Define Humoral Immunity

A

Process of adaptive immunity manifested by immunoglobulin production, by B lymphocytes, and complement protein support

177
Q

Why do lymphocytes congregate at certain lymphatic regions?

A

Lymphocytes congregate in secondary lymphoid organs (lymph nodes, spleen, and tonsils) to mount immune responses. These organs trap antigens for exposure to T and B lymphocytes, and are where mature lymphocytes continue to develop.

178
Q

Does innate immunity improve upon repeated pathogenic exposure?

A

No. The innate immune response to a particular pathogen is the same upon first exposure as it is following all subsequent exposures (i.e. no memory)

179
Q

Define PAMPS and DAMPS

A

Pathogen-associated molecular patterns (PAMPs) - derived from microorganisms. Alert the immune system to the presence of pathogens.

Damage-associated molecular patterns (DAMPs) - derived from host cells. Released in response to trauma, ischaemia, and tissue damage.

Both PAMPs and DAMPs bind to specific receptors on pattern recognition receptor (PRR)-bearing cells of the innate immune system

180
Q

Which is the best description of Chemotaxis?
A) An end-stage complication of oncologic treatment
B) Categorisation of chemical structures by type and function
C) Movement of an organism in response to a chemical stimulus
D) Chemical load on the host brought about by viral infection

A

C

181
Q

Outline the APGAR score methodology

A

Appearance (skin colour)
Pulse
Grimace
Activity (muscle tone)
Respiration

0–2 points per characteristic. A score >7 at 5 minutes post-birth is considered normal

182
Q

What is histamine? What is it’s function?

A

A signalling chemical which sends messages between cells. Histamine has numerous functions, but is primarily known for upregulating immune response. Activation of H1 receptors cause allergy symptoms (vasodilation, pruritis, tachycardia…)

Predominantly released by Mast Cells in the connective tissues.

183
Q

Define ‘Pruritus’

A

Itchy skin.

Often caused by allergic reactions to food, insect bites, pollen, and medicines

184
Q

Which 3 arteries branch off the aortic arch?

A

Brachiocephalic (right subclavian and right carotid)

Left carotid

Left subclavian

185
Q

Which blood vessels branch off the ascending aorta?

A

Left and right coronary arteries

186
Q

What are the main functions of the lymphatic vessels?

A

Fluid balance (draining excess interstitial fluid)

Transport (of immunological molecules, cells, and waste products)

187
Q

What is the correct compression rate (CPR) per minute?
A) 60-80
B) 130-150
C) 70
D) 100-120
E) 72

A

D. 100-120 compressions per minute

188
Q

How deep do chest compressions have to be for maximum effectiveness, according to 2021 resuscitation guidelines?

A

5-6cm

189
Q

Outline the SOCRATES acronym?

A

Site (arm)
Onset (2 days ago)
Character (intermittent)
Radiation (yes, from chest)
Associated Symptoms (tight chest)
Timing (worse upon exertion)
Exacerbation and relief (rest)
Severity (4-8)

Likely diagnosis = myocardial infarction

190
Q

Define type I and type II error and what impacts them

A

Type I = False Positive.
Determined against a preset significance level (termed alpha). Not affected by sample size. Increases if the number of end-points increases (due to chance findings).

Type II = False Negative. Determined by both sample size and alpha

191
Q

Define power

A

The power of a study is the probability of (correctly) rejecting the null hypothesis when it is false, i.e. the probability of detecting a statistically significant difference

192
Q

Which period does embryology cover?

A

Weeks 1-8 post conception

*Fetus = week 9 onwards

193
Q

When is a fetus viable? What is the viability cut-off?

A

24 weeks gestation

194
Q

What is the Carina and where is it situated?

A

The cartilage situated at the point where the trachea (windpipe) divides into the two bronchi.

195
Q

When are the zygote, embryo, and morula stages in fetal development?

A

Zygote = days 1-2. Pronuclei form and zygote undergoes mitosis

Embryo = Days 2-3. Zygote divides into smaller cells. Forms and embryo

Morula = Day 3. Embryo divides sequentially. Once it has 16 cells, it is a morula

196
Q

What is a blastocyst?

A

A fertilised egg, ready to attach to the uterus (endometrium)

197
Q

What is the Trophoblast and what does this form during pregnancy?

A

The trophoblast is the outer layer of cells of the blastocyst. It plays a crucial role in early pregnancy, forming two main structures:

Placenta
Chorion

198
Q

Drugs which carry a positive or negative charge are unable to cross membranes. Why?

A

Lipid solubility - Charged drugs have low lipid solubility and high water solubility, making them hydrophilic. They cannot easily penetrate cell membranes.

Electrical resistance - Charged drugs have high electrical resistance which prevents them from penetrating cell membranes.

*by contrast, un-ionised drugs are usually lipid soluble and can diffuse readily across membranes

199
Q

Define the term ‘absorption’ from a pharmacokinetics perspective

A

Absorption refers to the intake of a drug into the systemic circulation.

Absorption rate can be modified by site of administration and drug formulation.

200
Q

Define the therapeutic window

A

The dose of a drug that provides safe and effective therapy with minimal adverse effects.

Too low a concentration will be ineffective. Too high a concentration will increase the risk of adverse effects

201
Q

Outline bioavailability (F) as a mathematical formula

A

F = quantity of drug reaching systemic circulation / quantity of drug administered

F = 100mg in circulation / 1g taken orally

202
Q

Define a drug analogue

A

A drug whose physical structure is related to that of another drug.

Although physical properties are comparable, biochemical properties may differ

203
Q

Patient A takes a large, orally administered drug in a fasted state. Patient B takes the same drug after a small breakfast of eggs. Which absorbs quicker?

A

There are numerous factors to drug absorption.

Based on this information, patient A will express a quicker absorption of the drug due to increased gastric emptying rate into the duodenum

204
Q

What is the fundus and where is it located?

A

Fundus is a non-specific term referring to the part of a hollow organ that is across from, or farthest away from, the organ’s opening.

A classic example is the upper part of the stomach, which forms a bulge above the level of the opening of the oesophagus (furthest from the pylorus)

205
Q

Define the ‘first pass effect’

A

Medication undergoes metabolism at a specific location in the body. This decreases the active drug’s concentration upon reaching systemic circulation of site of action.

This commonly refers to the liver, where drugs are often metabolised. Drugs can be administered via other methods to avoid first pass metabolism (sub-lingual, intravenous, rectal)

206
Q

What is glyceril trinitrate used for? Why is it delivered sub-lingually?

A

Used to treat angina.

Sub-lingual administration bypasses first pass metabolism and allows for rapid response

207
Q

Define ‘drug clearance’

A

The volume of plasma cleared of a drug over a specified time period

208
Q

Outline the stages of the Analgesic Stepladder, including examples

A
  1. Non-opioids (paracetamol, NSAIDs)
  2. Weak opioids (codeine, tramadol)
  3. Strong opioids (morphine, oxycodone, fentanyl)
209
Q

What is cranial nerve V?

A

Trigeminal nerve

Has motor (chewing, swallowing) and sensory functions (face)

210
Q

What is cranial nerve X?

A

Vagus nerve

Has motor and sensory functions. Main nerve of the parasympathetic nervous system (autonomic, ‘rest and digest’)

211
Q

What is the significance of the posterior cricoarytenoid (PCA)?

A

The only muscle that abducts the vocal folds, opening the rima glottidis.

Works with the adductor muscles to control phonation, swallowing, and coughing

212
Q

What is Choanal Atresia and what are the symptoms?

A

When a neonate has excess tissue that blocks the choanae, making it harder for them to breathe. If one passage is blocked, your baby may have mild symptoms. Babies born with both passages blocked need emergency treatment to support ventilation

213
Q

What are the 4 main functions of the Larynx?

A

Phonation - contains vocal cords, which vibrate as air passes through them, producing sound.

Respiratory Control - adductor and abductor muscles control airflow (notably, the posterior cricoarytenoid)

Protecting the Airway (Swallowing) - epiglottis covers the opening to the trachea during, directing food and liquids down the oesophagus

Cough Reflex - if something accidentally enters the larynx, it triggers a cough reflex

214
Q

Outline the key anatomical structures that air passes in the URT during normal respiration

A
  • Nares
  • Nasal Cavity
  • Turbinates (past the conchae and through the meatus
  • Choanae
  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
215
Q

Outline the tributaries of the aortic arch

A
216
Q

Outline the difference between anosmia, hyposmia, and hyperosmia

A

Anosmia - Loss of olfaction

Hyposmia - Reduced olfaction

Hyperosmia - Increased olfactory sensitivity

217
Q

Briefly outline transsphenoidal surgery

A
218
Q

Name the 3 branches of the trigeminal nerve (CN V)

A

Ophthalmic (V1): Carries sensory information from the scalp, forehead, upper eyelid, and nose.

Maxillary (V2): Carries sensory information from the cheeks, upper lip, upper teeth, and lower eyelid.

Mandibular (V3): Handles sensory input from the jaw, lower lip, lower teeth, and also controls muscles involved in chewing

219
Q

Where are the inferior, middle, and upper meatus situated?

A

Inferior Meatus - Located under the inferior nasal concha (the lowest turbinate). It’s the longest and lowest of the three meatuses.

Middle Meatus - Situated below the middle nasal concha. It’s in this region that the maxillary sinus and frontal sinus drain, making it an important passage for airflow and drainage.

Superior Meatus - Found beneath the superior nasal concha (the highest turbinate). This meatus is smaller and allows drainage from the posterior ethmoid air cells.

220
Q

Outline how DVT can cause PE and how it is less likely to cause cerebral embolism

A

Deep Vein Thrombosis is more likely to cause Pulmonary Embolism as a dislodged thrombus in the lower limbs will then travel via the inferior vena cava into the right side of the heart, then the lungs. At this point, the vessels decrease in size and an embolus can lodge. Prior to this, the vessels still have a wide lumen and less occlusion risk.

Cerebral Embolism would occur after an embolus leaves the left ventricle and travels up the carotid arteries. After this, the vessels narrow and an embolus can lodge.

221
Q

Define Aortic Hiatus

A

The aortic hiatus is an opening in the diaphragm that allows the descending aorta, thoracic duct, and sometimes the azygos and hemiazygos veins to pass through.

Located at T12 vertebral level

222
Q

What does a D-Dimer test show?

A

D-dimer is a protein fragment (small piece) that’s made when a blood clot dissolves. D-dimer isn’t usually found in the blood unless blood clots are being broken up.

High D-Dimer concentrations indicate a blood clotting disorder

223
Q

What are the gold standard biomarkers for detecting myocardial infarction?

A

Cardiac Troponins (cTnI & cTnT) have high sensitivity (low false negatives) and specificity (low false positives).

cTnI and cTnT rise 3-6 hours post infarction.

224
Q

Outline the role of Beta-1 and Beta-2 receptors and their locations

A

β1 primarily in heart and kidneys. β2 in lungs, blood vessels, and other smooth muscles.

β1 increases heart activity (activated by adrenaline and noradrenaline)

β2 mediates smooth muscle relaxation.

225
Q

What is the clinical significance of finger clubbing?

A

It is often a sign of a significant underlying disease, prompting further diagnostic evaluation to identify the primary cause.

Strongly correlated with lung cancer

226
Q

At which vertebral level does the trachea bifurcate?
A) T1
B) C7
C) C3, C4, C5
D) T4, T5
E) T7, T8

A

D.

The trachea bifurcates at around Thoracic Vertebrae 4 or 5

227
Q

Define ‘Cerumen’

A

Earwax

Produced in the outer part of the ear canal. It is secreted by specialized glands called ceruminous glands and sebaceous glands, which are located in the skin of the outer ear canal. These glands produce a mix of secretions that combine with dead skin cells to form earwax, which helps protect and lubricate the ear canal, trapping dust, dirt, and microorganisms to prevent them from reaching the eardrum.

228
Q

What are the four main roles of prostaglandins in relation to inflammation?

A

Vasodilation:
Increased blood flow to affected tissues delivers immune cells and nutrients for healing. Also causes calor and rubor.

Vascular Permeability:
Allows immune cells and proteins to move more easily into damaged tissues. Causes tumor

Nociception:
Sensitises nerve endings. Pain acts as a protective mechanism, discouraging further use. Causes dolor and functio laesa

Pyrexia:
Some prostaglandins act on the hypothalamus. Inhibits pathogen growth and enhances immune response. Causes calor

229
Q

How do NSAIDs affect the gastric lining?

A

NSAIDs inhibit COX-1 and COX-2 enzymes.

COX-2 inhibition reduces pain and inflammation, but COX-1 inhibition reduces protection of the gastric wall.

Gastric ulcers are therefore a risk of NSAIDs, which should be administered with food to reduce side effects

230
Q

What is another name for the eustachian tube?

A

Pharyngotympanic tube

This provides anatomical clues as to where this structure is situated

231
Q

What is the main function of the cricoid cartilage?

A

Provides structural support to the airway in the larynx. It is the only complete ring of cartilage in the trachea

232
Q

Which anatomical landmark indicates the C5 vertebral level?

A

Thyroid cartilage (Adams apple)

233
Q

At which level does the oesophagus begin?

A

C6 vertebra

Level with the cricoid cartilage

234
Q

Is the adenoid visible through the oral cavity?

A

No

Adenoid tissue (pharyngeal tonsil) is located behind the nasal cavity and superior to the roof of the mouth. This area (nasopharynx) cannot be seen through the oral cavity

235
Q

What are the 5 main functions of the sinuses?

A
  1. Reducing skull weight
  2. Humidifying inhaled air
  3. Enhancing vocal resonance
  4. Trauma protection
  5. Mucus production (for pathogens)
236
Q

Outline how to conduct a mallampati assessment

A

Ask the patient to open their mouth and protrude their tongue as far as possible.

I: complete visualisation
II: whole uvula visible
III: partial uvula visible
IV: no visibility

237
Q

What is the location and significance of the Cribriform plate?

A

Located in the ethmoid bone at the roof of the nasal cavity.

Olfaction: Olfactory foramina allow olfactory nerve fibers to pass, transmitting sensory information.

Protection: Shields olfactory bulbs, which are located above the cribriform plate. These bulbs process smell information.

Structure: Contributes to the stability and separation of the nasal and cranial cavities.

238
Q

Name the four sinuses in superior to inferior order

A

Frontal sinus - superior to eyes
Ethmoid sinus - medial to eyes
Sphenoid sinus - posterior to nose
Maxillary sinus - inferior to eyes

239
Q

What is the clinical relevance of the C7 vertebra?

A

Prominent anatomical landmark (vertebra prominens)

Is vulnerable to trauma due to prominence and weight of the head

Innervates specific regions of the arm, forearm, and hand. Symptoms of nerve/vertebral injury can therefore be felt in the forearm and middle finger

240
Q

What are the functions of the uvula?

A
  1. Closes nasopharynx when swallowing
  2. Produces saliva
  3. Supports vocal resonance
  4. Triggers immune defence
  5. Triggers gag reflex
241
Q

Name the four tonsils and their locations

A

Palatine - back of oral cavity

Adenoids (pharyngeal) - in the nasopharynx

Lingual - at the base of the tongue

Tubal - entrance to the eustachian tubes

242
Q

What is the main difference between gram-negative and gram-positive bacteria?

A

Gram-positive bacteria have a thick peptidoglycan layer outside the cell membrane. Stains purple. Often more susceptible to antibiotics which target the peptidoglycan

Negative bacteria have a thin peptidoglycan layer between two membranes (inner and outer). Stains pink. Often more resistant to antibiotics and associated with more aggressive immune response

243
Q

Which branch of the complement system is activated by gram-negative bacteria?

A

Alternative complement pathway (activated by polysaccharides - peptidoglycan)

244
Q

What are the two types of respiratory failure and what defines them?

A

Type 1: Hypoxemic. Low O2. Caused by chronic conditions that damage lungs

Type 2: Hypercapnic. High CO2. Often due to reduced ventilation

245
Q

How does carbon dioxide level affect acidosis / alkalosis?

A

CO2 reacts with water to form carbonic acid. CO2 is therefore acidic

Hypocapnia = respiratory alkalosis
Hypercapnia = respiratory acidosis

246
Q

Define atopic

A

Atopic refers to a genetic predisposition to develop allergic reactions such as asthma, eczema, hay fever, and other allergic reactions.

Atopic individuals often produce more immunoglobulin E (IgE)

247
Q

What do high CRP levels indicate in the context of infection?
A) Viral infection
B) Parasitic Infection
C) Any / general infection
D) Bacterial infection
E) Fungal infection

A

D.

CRP levels are more specific to bacterial infections, but they can be elevated for every other type of infection in certain circumstances

248
Q

What does a high Eosinophil count likely indicate?

A

High eosinophils are a hallmark of Parasitic infection

249
Q

What does leukocytosis indicate?

A

Leukocytosis = high WBC

High WBC is often indicative of a bacterial infection, particularly when accompanied by a neutrophil predominance

250
Q

What is the gold standard test for cystic fibrosis?

A

Ionic sweat test (sweat chloride test)

Sweat is stimulated using pilocarpine. If collected sweat has a high chloride concentration, CF may be present

MBBS (3 decks)

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