ILA

Question 1

Which artery most frequently supplies the Atrio Ventricular Node?

Answer 1

Right coronary artery

Question 2

Which sentence best describes the relationships of BP & SVR with the parasympathetic nervous system?

Answer 2

Parasympathetic nerves do not have a major influence on peripheral blood vessel diameter as blood vessels do not have parasympathetic innervation.

Question 3

What is the purpose of the Ductus Arteriosus in the foetal cardiovascular system?

Answer 3

allow blood to bypass the foetal lungs by shunting it from the Pulmonary Artery to the Aorta

Question 4

Which nerve innervates the pericardium?

Answer 4

Phrenic nerve

Question 5

Which sentence best describes the relationships of SVR & BP with the sympathetic nervous system?

Answer 5

Sympathetic nerves decrease peripheral blood vessel diameter thereby increasing systemic vascular resistance and increasing blood pressure.

Question 6

Occlusion is most likely to result in a fatal heart attack

Answer 6

Left main coronary artery

Question 7

What is the term used to describe a malignant tumour of the pleural membranes?

Answer 7

Mesothelioma

Question 8

Which of these cells provides cilia for the mucociliary escalator?

Answer 8

Columnar Epithelial Cells

Question 9

Which of these factors will contribute to causing bronchodilation?

Answer 9

Adrenaline causes bronchodilation, by binding to β 2 -receptors in the smooth muscle of the bronchioles and causing their relaxation.

Question 10

Central chemoreceptors are located in the ventral medulla and respond to:

Answer 10

CSF pH

Question 11

Which of these substances is secreted by Enterochromaffin (ECL) Cells

Answer 11

Histamine

Question 12

Which of the following structures is NOT present in the Porta Hepatis?

Answer 12

Hepatic vein

Question 13

What is the action of the proton pump in the parietal cells of the stomach?

Answer 13

K+ into cell, H+ out of cell

Question 14

Which of the following structures is classified in embryology as part of the ‘foregut’

Answer 14

Gallbladder
Lower third of oesophagus
Proximal half of the Duodenum
Pancreas
Gallbladder

Question 15

You are trying to design a drug to act on histamine receptors on parietal cells to help patients with reflux disease. What would be the mechanism of this drug?

Answer 15

Inhibits Histamine 2 receptors to reduce acid secretion

Question 16

Which of these is not a function of the liver?

Answer 16

Glycogen storage

Question 17

Which of the following statements is True?

Answer 17

Cholecystokinin is released in response to the presence of amino acids in the gut.

Question 18

Which of the following statements is False?

Answer 18

The hepatic blood supply is 35-40% of the cardiac output.

Question 19

Obstructive jaundice is commonly caused by gall stones within what structure?

Answer 19

Common bile duct

Question 20

A 42-year-old female suffers a violent headache followed by sudden collapse. You notice that her left pupil is fixed and dilated and her left eye is deviated laterally and downwards. Which artery is likely to have been affected?

Answer 20

Posterior communicating artery

Posterior communicating artery
• This is most likely due to rupture of a posterior communicating aneurysm leading to a sub arachnoid haemorrhage.
• This has caused an ipsilateral third nerve palsy causing her pupil to dilate and the eye to deviate laterally and downwards.
• Paralysis of the third cranial nerve affects the medial, superior, and inferior recti, and inferior oblique muscles.
• The eye is incapable of movement upwards, downwards or inwards, and at rest the eye looks laterally and downwards owing to the overriding influence of the lateral rectus and superior oblique muscles respectively.

Question 21

A 53-year-old man with hypertension presents with sudden collapse; unable to move any part of his body except for eye movements, he appears to understand your questions but is unable to answer. Where is the likely lesion?

Answer 21

Brainstem

Brainstem lesions
• This is locked-in syndrome.
• Patients cannot move or communicate verbally due to paralysis of nearly all voluntary muscles.
• Blinking and vertical gaze may be preserved depending on the extent and level of the lesion within the brainstem
• They are conscious and aware.
• Complete recovery is rare.

Question 22

A 69-year-old lady was slurring her words at a church coffee morning. At the same time, her right arm began to feel heavy and weak. 24 hours later all her symptoms had resolved. Which of these is the likely cause?

Answer 22

Stroke/TIA

• Acute stroke is characterised by sudden onset of focal neurological deficit e.g. hemiplegia
• Can be ischaemic or haemorrhagic
• If function recovers within 24 hours then it is termed a transient ischaemic attack (TIA)

Question 23

A 40-year-old removal man felt immediate back pain and a popping sensation after lifting a heavy box. The next day he noticed he was tripping over his right foot as it was dragging along the floor. Where is the cause most likely to be located?

Answer 23

Nerve root

• This is a case of foot drop
• It is caused by paralysis of the muscles that lift the foot
• Given the history the most likely cause of damage is compression of the nerve root by a prolapsed vertebral disc.

Question 24

An elderly patient with a stiff flexed arm, and a stiff extended leg (both on the left) which the patient finds difficult to bend. Where is the cause most likely to be located?

Answer 24

Upper motor neurone

Question 25

A 30-year-old woman noticed both her eyelids becoming progressively more droopy with time (ptosis). Weeks later she began to experience double vision and found it progressively more tiring and difficult to chew while eating. Which of these is the likely cause?

Answer 25

Myasthenia gravis * Condition of the neuromuscular junction * Acetylcholine receptors are blocked by an autoimmune reaction between the receptor protein and anti-acetylcholine receptor antibody. * Women are more affected than men. Presents between 15 to 50 years. * Main symptom is abnormal fatigable weakness of muscles. * First symptoms are usually ptosis or diplopia. * Weakness of chewing, swallowing, speaking or limb movement can occur.

Question 26

A 51-year-old man has a 2-month history of weakness in both of his hands, he is now unable to open jars. His hands show wasting of the thenar eminence. He has recently developed slurred speech and difficulty swallowing. His tongue appears spastic and he is unable to protrude it. Which of these is the likely cause?

Answer 26

Motor Neurone Disease * Progressive disorder of unknown aetiology * Onset usually after age 50. Males are more likely to be affected. * Present with a combination of both UMN and LMN signs without sensory involvement. * Symptoms include – limb weakness, cramps, disturbance of speech or swallowing. * Signs – wasting and fasciculation of muscles, pyramidal tract involvement causing spasticity and exaggerated tendon reflexes * Symptoms can start focally but become widespread with time

Question 27

A 30-year-old pregnant lady complains to the GP of progressive hand weakness. She is unable to open jars and even grip her tea cup. The GP noticed that the muscles around her thumb were wasting. Where is the cause most likely to be located?

Answer 27

Peripheral nerve Carpal tunnel syndrome • This is due to compression of the median nerve in the carpal tunnel. • Wasting of the abductor pollicis brevis can develop with the following distribution of numbness and pain.

Question 28

A sexually active 75 year old gentlemen presents with a stamping gait. He is diagnosed with tabes dorsalis. On examination he has a loss of joint position sense and cannot feel the tuning fork (vibration) when placed on his medial malleolus. Which of the following spinal tracts is affected?

Answer 28

Dorsal column medial lemiscus pathway

Question 29

Which group of spinal nerves innervates the ankle reflex?

Answer 29

S1/S2

Question 30

The vagus nerve is composed of;

Answer 30

Parasympathetic motor and sensory fibres

Question 31

Which of the following statements is true?

Answer 31

The spinothalamic tract decussates within the spinal cord

Question 32

This descending motor tract originates in the cerebral cortex and synapses in the spinal cord

Answer 32

Corticospinal

Question 33

Which cell type listed below is NOT found in the central nervous system? Schwann cells ``` Ependymal cells Oligodendrocytes Astrocytes Schwann cells Microglia ```

Answer 33

Schwann cells

Question 34

A 75-year-old patient presents to their GP surgery with an intensely itchy vesicular rash in two separate horizontal lines at the level of the nipple and umbilicus respectively. Which dermatomal distribution is this affecting?

Answer 34

T4 and T10

Question 35

A 48-year-old obese diabetic man, who smokes 30 a day presents with bilateral “glove and stocking” loss of pain, temperature and pinprick sensation. Which of the following spinal tracts is affected?

Answer 35

Spinothalamic

Question 36

A 78-year-old lady presents to her GP surgery with an intensely itchy vesicular rash in a horizontal line at the level of the nipple. What is the most likely diagnosis?

Answer 36

Shingles * Caused by Herpes Zoster virus * Commonly affects the elderly * Produces a rash that is usually unilateral and has a dermatomal distribution

Question 37

Which of the following statements regarding the peripheral nervous system is TRUE?

Answer 37

The spinal cord is not part of the peripheral nervous system.

Question 38

If the renal clearance of a substance X is 250ml/min, then which of the following is true?

Answer 38

It must be actively secreted by the nephron Renal clearance of a molecule is ‘the volume of plasma cleared of that molecule per minute’ Clearance of molecule x (mls/min) is expressed as Cx = (Ux X V)/Px Ux = concentration of x in the urine Px = concentration of x in the plasma V = volume of urine formed per minute A molecule that is filtered and passes unchanged into the urine e.g. inulin has a renal clearance of ~125 mls/min A molecule that is filtered and reabsorbed will have a lower renal clearance e.g. urea ~ 80 mls/min A molecule that is filtered and actively secreted will have a higher renal clearance e.g Para-amino hippuric acid (PAH) ~ 650-700 mls/min

Question 39

Which of the following is true of urine production and flow?

Answer 39

Urine passes through the ureter by peristalsis * Urine is produced at a variable rate and is transported to the bladder by the peristaltic action of the ureters. * The collecting duct is formed by the distal convoluted tubules * The detrusor is under the control of the autonomic system with some voluntary control

Question 40

Which of the following is true concerning Atrial Natriuretic Peptides (ANPs)

Answer 40

They act on the renal collecting tubules to promote Na+ excretion.

Question 41

Which of the following would not cause pre-renal acute kidney injury?

Answer 41

Benign prostatic hypertrophy

Question 42

Which is of the following is false?

Answer 42

Renin converts Angiotensinogen to Angiotensin I by adding a short amino acid chain

Question 43

The ureter is lined by:

Answer 43

Transitional epithelium