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Yr 2 EOYS ^2 > Last one > Flashcards

Last one Flashcards

1
Q

What cell type are mature neutrophils derived from?

A. Lymphoblasts
B. Macrophages
C. Mast cells
D. Monoblasts
E. Myeloblasts

A

Myeloblasts

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2
Q

What cell type are mature monocytes derived from?

G. Lymphoblasts
H. Macrophages
I. Monoblast
J. Megakaryocyte
K. Myeloblasts

A

Monoblast

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3
Q

11 A 19 year old woman was seen by her general practitioner with general malaise and a sore throat. On examination she had a temperature of 39oC, an inflamed throat and generalised lymphadenopathy. Her blood count was normal apart from a lymphocytosis. Many of the lymphocytes appeared reactive. What is the diagnosis?

A. Bacterial pneumonia
B. Human immunodeficiency virus (HIV)
C. Infectious mononucleosis (glandular fever)
D. Pertussis
E. Viral pneumonia

A

Infectious mononucleosis (glandular fever)

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4
Q

2 List three classes of drug which can be used for rate control in atrial fibrillation. (3 marks)

A

Beta blockers, calcium channel blockers, amiodarone, cardiac glycosides

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5
Q

6 Explain why the immune system has a particular problem when dealing with tuberculosis infection. (3 marks)

A

Macrophages ingest the bacteria (1 mark) but find it difficult to destroy them as they have a thick waxy cell wall (1 mark) rich in mycolic acid (1 mark) which resists breakdown in lysosomes (1 mark) ( any marks up to 3)

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6
Q

What aspect of cell wall makes M. tuberculosis difficult t break down by lymphocytes? [1]

A

Mycolic acid

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7
Q

11 Explain how a blood clot in a damaged blood vessel is removed when the vessel is healed. [2 marks]

A
  • Plasminogen is a plasma protein which is converted to the active form plasmin (1/2 mark) by tissue plasminogen activator (TPA) (1/2 mark).
  • Plasmin breaks down fibrin in clots (1/2 mark) and they then break up.
  • TPA is released from intact endothelium but is suppressed by injured tissue (½ mark).
  • When the wound has healed TPA is released to activate plasmin (1/2 mark).
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8
Q

The results of this test demonstrate intermittent episodes of atrial fibrillation.

What the most appropriate management option for this patient?

A Warfarin and metoprolol
B Dabigatran monotherapy
C Amiodarone
D Digoxin
E Flecainide

A

Flecainide: Flecainide is a class 1c anti-arrhythmic agent. This type of regime is typically described as “pill-in-the-pocket”. When patients start to experience symptoms they are meant to take the medication, which should cease the abnormal rhythm. Flecainide is generally reserved for patients without underlying structural heart disease, who have infrequent episodes that last < 24 hours.

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9
Q

State two things that would suggest have AML from a blood smear? [2]

A

pancytopenia

Auer rodsare red staining, needle-like bodies seen in the cytoplasm of myeloblasts, and/or progranulocytes in certain leukemias.Auer rods(see arrow in image) are cytoplasmic inclusions which result from an abnormal fusion of the primary (azurophilic) granules.

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10
Q

How would determine a patient has acute lymphoblastic leukaemia? [1]

A

In acute lymphoblastic leukemia (ALL), too many immature lymphocytes are present in the bone marrow and the blood. Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces

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11
Q

Name a cause of pencil cells in a blood film [1]

A

IDA

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12
Q

How long after an MI do the green and yellow arrows represent? [2]

A

green: 12 to 24 hours
yellow: 10 to 14 days.

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13
Q

What do the arrows point to in these injured hepatocytes? [1]

A

Councilman Bodies: Eosinophilic globule with often fragmented nucleus. It represents a hepatocyte that is undergoing apoptosis

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14
Q

What are the Councilman bodies and which cells do you find them in? [1]

A

Formation of Councilman Bodies- Eosinophilic globule with often fragmented nucleus. It represents a hepatocyte that is undergoing apoptosis

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15
Q

Spotty necrosis is a sign of what damage to hepatocytes? [1]

A

acute viral infection

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16
Q

Describe the pathology shown in this hepatocyte slide [1]

A

Cholestatic Syndrome (Jaundice)

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17
Q

Glomerulonephritis: describe the biopsy features [2]

What is the primary cause of this in 80% of the time? [1]

A
  • Podocytes show effacement of foot processes
  • progressive thickening, glomeruli may become sclerosed

caused by autoantibodies against podocyte antigens.

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18
Q

What pathology does this indicate? [1]

A

Membranous glomerulonephritis characterised by thickening of glomerular basement membrane due to presence of subepithelial immune deposits

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19
Q

What type of cancer is referred to as ‘small round blue cell tumour’ [1]

A

Wilms tumour

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20
Q

What type of ovarian tumour is this?

Epithelial - endometrioid
Epithelial - mucinous
Epithelial - serous
Germ - teratoma

A

Epithelial - serous

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21
Q

What type of ovarian tumour is this?

Epithelial - endometrioid
Epithelial - mucinous
Epithelial - serous
Germ - teratoma

A

mucinous

larger and polycystic, lined by mucin-producing epithelial cells, and larger areas of necrosis and haemorrhage

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22
Q

Which factors do platelets secrete which promote clot formation? [4]

A

secrete ADP, thromboxane A2 calcium ion and serotonin

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23
Q

The patient is referred to haematology and a diagnosis of chronic myeloid leukaemia is made.

Which of the following medications has dramatically improved prognosis in recent years?

Infliximab
Imatinib
Vincristine
Rituximab

A

The patient is referred to haematology and a diagnosis of chronic myeloid leukaemia is made.

Which of the following medications has dramatically improved prognosis in recent years?

Infliximab
Imatinib
Vincristine
Rituximab

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24
Q

Q
Which of the following binds to CTLA4?

Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab

A

Q
Which of the following binds to CTLA4?

Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab

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25
Q

B-Raf is an oncogene that belongs to

Growth factor receptors
Signal transduction proteins
Transcription factors
Anti-antopic proteins

A

B-Raf is an oncogene that belongs to

Growth factor receptors
Signal transduction proteins
Transcription factors
Anti-antopic proteins

This protein plays a role in regulating the MAP kinase/ERKs signaling

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26
Q

Cancers are initiated and progress by mutations in genes which result in either a gain or loss of function.

Which of the following best describes the gain of function mutation observed in lung adenocarcinoma?

Mutation in CDKN2A (cyclin dependent kinase inhibitor)

Mutation in Rb (retinoblastoma protein)
Mutation in EGFR (epidermal growth factor receptor)
Mutation in MYC

Mutation in TP53 (tumour protein 53)

A

Cancers are initiated and progress by mutations in genes which result in either a gain or loss of function.

Which of the following best describes the gain of function mutation observed in lung adenocarcinoma?

Mutation in CDKN2A (cyclin dependent kinase inhibitor)

Mutation in Rb (retinoblastoma protein)
Mutation in EGFR (epidermal growth factor receptor)
Mutation in MYC

Mutation in TP53 (tumour protein 53)

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27
Q

Which of the following is derived from E. coli and deprives tumour cells of the required amino acids and inhibits protein synthesis

Trabectedin
L-Asparaginase
Actinomycin-D
Busulfan

A

Which of the following is derived from E. coli and deprives tumour cells of the required amino acids and inhibits protein synthesis

Trabectedin
L-Asparaginase
Actinomycin-D
Busulfan

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28
Q

Which of the following binds to the minor groove of DNA, bending the helix towards the major groove, which leads to interference with the intracellular transcription pathways and DNA-repair pathways

Trabectedin
L-Asparaginase
Actinomycin-D
Busulfan

A

Which of the following binds to the minor groove of DNA, bending the helix towards the major groove, which leads to interference with the intracellular transcription pathways and DNA-repair pathways

Trabectedin
L-Asparaginase
Actinomycin-D
Busulfan

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29
Q

Q
Which chemotherapy drug would cause Flagellate Erythema ?

Capecitabine
Bleomycin
Doxorubicin
Imatinib

A

Q
Which chemotherapy drug would cause Flagellate Erythema ?

Capecitabine
Bleomycin
Doxorubicin
Imatinib

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30
Q

Bleomycin inhibits which of the following

G1
S
G2
M

A

Bleomycin inhibits which of the following

G1
S
G2
M

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31
Q

There are three checkpoints in the cell cycle which allow fidelity of DNA replication and cell division.

Which of the following proteins are most likely to be mutated if a damaged cell does not stop at the G2/M checkpoint?

B-cell lymphoma 2 (Bcl-2)

BRCA 1 (breast cancer 1)

Myc

p53

pRB (retinoblastoma protein)

A

There are three checkpoints in the cell cycle which allow fidelity of DNA replication and cell division.

Which of the following proteins are most likely to be mutated if a damaged cell does not stop at the G2/M checkpoint?

B-cell lymphoma 2 (Bcl-2)

BRCA 1 (breast cancer 1)

Myc

p53

pRB (retinoblastoma protein)

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32
Q

3 Measurement of neonatal plasma concentrations of this substance is used as a predictive test for the condition of congenital hypothyroidism.

A. desmopressin
B. mono-iodotyrosine
C. oxytocin
D. thyroglobulin
E. thyrotrophin

A

3 Measurement of neonatal plasma concentrations of this substance is used as a predictive test for the condition of congenital hypothyroidism.

A. desmopressin
B. mono-iodotyrosine
C. oxytocin
D. thyroglobulin
E. thyrotrophin

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33
Q

Describe the MoA Of oxybutinin [1]

A

M3 antagonist at bladder: relaxes and stops contractions of the bladder

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34
Q

Which vitamin should be given to patients with alcoholic cirrhosis, to prevent possibility of Wernicke-Korsakoff encephalopathy?

A. vitamin A
B. vitamin B1
C. vitamin B6
D. vitamin B12
E. vitamin K

A

Which vitamin should be given to patients with alcoholic cirrhosis, to prevent possibility of Wernicke-Korsakoff encephalopathy?

A. vitamin A
B. vitamin B1
C. vitamin B6
D. vitamin B12
E. vitamin K

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35
Q

Pyridoxine deficiency would refer to a lack of

A. vitamin A
B. vitamin B1
C. vitamin B6
D. vitamin B12
E. vitamin K

A

Pyridoxine deficiency would refer to a lack of

A. vitamin A
B. vitamin B1
C. vitamin B6
D. vitamin B12
E. vitamin K

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36
Q

Which of the following does Pabrinex give a supply of?

A B9
B B2
C B1
D B6
E B12

A

Which of the following does Pabrinex give a supply of?

A B9
B B2
C B1 - treats Wernicke’s encephalopathy with high dose thiamine
D B6
E B12

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37
Q

Which one of the following statements regarding obstetric haemorrhage is true?

A Obstetric haemorrhage is a common cause of maternal death in the UK
B Obstetric haemorrhage is the leading cause of maternal death in the UK
C Obstetric haemorrhage is the leading cause of maternal death worldwide
D Obstetric haemorrhage kills around two women per year in the UK
E Obstetric haemorrhage is always maternal blood and never fetal in origin

A

Which one of the following statements regarding obstetric haemorrhage is true?

A Obstetric haemorrhage is a common cause of maternal death in the UK
B Obstetric haemorrhage is the leading cause of maternal death in the UK
C Obstetric haemorrhage is the leading cause of maternal death worldwide
D Obstetric haemorrhage kills around two women per year in the UK
E Obstetric haemorrhage is always maternal blood and never fetal in origin

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38
Q

Secondary PPH is defined as vaginal bleeding from [] hrs postpartum to [] weeks postpartum.

A

Secondary PPH is defined as vaginal bleeding from 24 hrs postpartum to 12 weeks postpartum.

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39
Q

Which of the following values would be considered a normal APGAR score?

A 0
B 2
C 4
D 6
E 8

A

Which of the following values would be considered a normal APGAR score?

A 0
B 2
C 4
D 6
E 8

The APGAR score is a ‘vitality index’ that is measured in virtually every newborn at one and five minutes with a ‘normal’ score being between 7 and 10

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40
Q

Explain how post-hepatic obstructive jaundice may cause i) pale stools and ii) dark urine [2]

A

i) Conjugated bilirubin cannot access the gut (½ mark ) and be converted to stercobilin which causes colouration of faeces (½ mark).

ii) Conjugated bilirubin refluxes back into general circulation (½ mark) where unlike bilirubin, it can be excreted in urine which causes dark colouration of urine (½ mark).

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41
Q

25-hydroxyvitamin D is

Calcidiol
Cholecalciferol
Calcitriol
Ergocalciferol

A

Calcidiol

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42
Q

9 Why do many diets display a significant initial weight loss and then the rate slows? [1 mark]

A

Initial weight loss is due to reduction in body glycogen stores (and their associated water) (1 mark)

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43
Q
  1. Which one of the following can be a physiological mechanism associated with systemic paraneoplastic syndrome?

A Production of cross reacting antibodies
B Nodal metastases
C Distant organ metastases
D Local tumour invasion
E Tumour extravasation

A
  1. Which one of the following can be a physiological mechanism associated with systemic paraneoplastic syndrome?

A Production of cross reacting antibodies
B Nodal metastases
C Distant organ metastases
D Local tumour invasion
E Tumour extravasation

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44
Q
  1. What is the tissue of origin of a papilloma?

A Embryonic
B Epithelial
C Hematopoietic
D Mesenchymal
E Neuroectodermal

A
  1. What is the tissue of origin of a papilloma?

A Embryonic
B Epithelial
C Hematopoietic
D Mesenchymal
E Neuroectodermal

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45
Q

Inactivation of E-cadherin contributes to the development of which hallmark of cancer?

A. Evading apoptosis
B. Insensitivity to anti-growth signals
C. Invasion and metastasis
D. Self-sufficiency of growth signals
E. Sustained angiogenesis

A

Inactivation of E-cadherin contributes to the development of which hallmark of cancer?

A. Evading apoptosis
B. Insensitivity to anti-growth signals
C. Invasion and metastasis
D. Self-sufficiency of growth signals
E. Sustained angiogenesis

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46
Q

17 Usually, what is considered to be the weight of the smallest clinically detectable tumour mass?

A. 0.01 g
B. 0.1g
C. 1g
D. 10g
E. 100g

A

17 Usually, what is considered to be the weight of the smallest clinically detectable tumour mass?

A. 0.01 g
B. 0.1g
C. 1g
D. 10g
E. 100g

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47
Q

5 Name the specific drainage system through which prostate cancer normally metastasizes through to the lumbar vertebrae. (1 mark)

A

Answer: lower paravertebral venous plexus (Batson’s plexus) (1 mark)

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48
Q

What is the predominant enzyme that converts testosterone to dihydrotesterone in the prostate gland.
A. 5-α-reductase type I
B. 5-α-reductase type II
C. Phosphodiesterase type 5
D. Prostaglandin E1
E. Prostate specific antigen (kallikrein-3)

A

What is the predominant enzyme that converts testosterone to dihydrotesterone in the prostate gland.
A. 5-α-reductase type I
B. 5-α-reductase type II
C. Phosphodiesterase type 5
D. Prostaglandin E1
E. Prostate specific antigen (kallikrein-3)

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49
Q

5 Name two different methods of assessing the degree of fetal distress during the third trimester of pregnancy and indicate in each case what is being measured. (2 marks)

A

Fetal heart rate: cardiotocography – pattern of variation indicates the degree of distress

Doppler ultrasound of umbilical arteries – measures umbilical artery flow

Volume of amniotic fluid; Oligohydramniosis may indicate reduced placental function

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50
Q

6 Name two long-term characteristic complications in children who were premature and/or small for dates and received intensive care. In each case briefly indicate what the mechanism of the complication is. (2 marks)

A

2 from:
Retinopathy of prematurity – retinal damage due to high O2 tension during ventilation
Bronchopulmonary displasia – lung damage due to artificial ventilation
Cerebral palsy – brain damage aused by bleeding, anoxia or suboptimal nutrition

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51
Q

10 In the fetus, name the blood vessels that contains blood with the highest and lowest oxygen tension 2 marks

A

Highest = (umbilical vein)
Lowest = superior vena cava

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52
Q

Which molecule carries Factor VIII? [1]

A

VWF

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53
Q

Explain mechanism of how heparin works to treat PE

A

Heparin binds to antithrombin and activates it; activated complex then inactivates factor Xa, preventing conversion of prothrombin to thrombin (thrombin converts fibrinogen into fibrin - integral step in clot formation)

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54
Q

Describe the MoA of Nicorandil [1]

A

Nicorandil: potassium channel agonist, which inhibits voltage-gated calcium channels leading to muscle relaxation

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55
Q

Describe the MoA of clonidine [1]

A

Stimulate presynaptic α2-adrenergic receptors in the CNS → dilates peripheral blood vessels → lowers peripheral resistance → reduces blood pressure

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56
Q

Which of the following disrupts the membrane potential in TB causing death?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following disrupts the membrane potential in TB causing death?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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57
Q

What is the mechanism of action of atropine?

A Non-selective beta-adrenoreceptor agonist
B Beta-adrenergic receptor antagonist
C Reversible muscarinic acetylcholine receptor antagonist
D Calcium channel receptor antagonist
E Relaxation of smooth muscle

A

C Reversible muscarinic acetylcholine receptor antagonist

Atropine transiently blocks the action of the vagus nerve (i.e. parasympathetic nervous system) leading to increased SAN electrical activity and increased conduction through the AVN. This results in an increase in heart rate.

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58
Q

Describe the MoA of: [2]

Streptokinase
Alteplase (tPA)

A

A
Streptokinase: Clot buster; Activates fibrinolytic pathway

Alteplase (tPA): Increase clot; breakdown by increasing Plasmin formation

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59
Q

Q
Which of the following reduce heart rates by prolonging refractory period of AVN?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Q
Which of the following reduce heart rates by prolonging refractory period of AVN?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

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60
Q

ICS acts on which of the following in asthma ptx?

IL-4
IL-5

IL-6

IL-7

A

ICS acts on which of the following in asthma ptx?

IL-4
IL-5

IL-6

IL-7

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61
Q

Q
Which of the following forms the right ventricle?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

A

Q
Which of the following forms the right ventricle?

Truncus ateriosus
Bulbus cordis
Sinus venosus
Primitive ventricle
Primitive atria

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62
Q

What receptor does T3 recruit to activate transcription? [1]

A

Retinoid acid receptor

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63
Q

Which antibodies are present in Grave’s disease? [2]

A

Anti-TPO and anti-TSHR

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64
Q

What does TPO do in healthy thyroids? [1]

A

Oxidises iodide ions using H2O2

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65
Q

Describe how the deiodinase enzymes work to control T3/T4 levels [3]
State the locations [3]

A

.

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66
Q

Name an SGLT-2 inhibitor [1]

A

dapagliflozin

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67
Q

Which hormone does warfarin inhibit? [1]

A

Inhibits vitamin K epoxide reductase

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68
Q

How can you spot a drug is a SABA? [1]

How can you spot a drug is a LAMA? [1]

A

Have -but- in them; salbutamol; terbutaline

long acting muscarinic
antagonists: -ium
tiotropium, glycopyrronium
ium- in ur muscarinic system

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69
Q

Which hormone, secreted by which cells stimulate parietal cells to secrete hydrochloric acid? [2]

A

Gastrin is released by G cells and stimulates parietal cells to secrete hydrochloric acid.

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70
Q

Which cells are important in the secretion of pepsinogen?

A Parietal cells
B Chief cells
C Goblet cells
D G cells
E Enterochromaffin-like cells

A

Which cells are important in the secretion of pepsinogen?

A Parietal cells
B Chief cells
C Goblet cells
D G cells
E Enterochromaffin-like cells

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71
Q

What is the most common cause of primary hyperparathyroidism?

A Parathyroid cancer
B Parathyroid hyperpalsia
C Multiple endocrine neoplasia
D Paraneoplastic syndrome
E Parathyroid adenoma

A

What is the most common cause of primary hyperparathyroidism?

E Parathyroid adenoma

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72
Q

Which of the following best explains the mechanism leading to osteopaenia in Cushing’s syndrome?

A Cortisol directly promotes resorption of bone
B Cortisol stimulates the release of calcitonin
C Cortisol promotes the activity of osteoclasts
D Cortisol inhibits the activity of osteoblasts
E Cortisol is toxic to the bone marrow

A

Which of the following best explains the mechanism leading to osteopaenia in Cushing’s syndrome?

A Cortisol directly promotes resorption of bone
B Cortisol stimulates the release of calcitonin
C Cortisol promotes the activity of osteoclasts
D Cortisol inhibits the activity of osteoblasts
E Cortisol is toxic to the bone marrow

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73
Q

Which enzyme is most commonly affected within congenital adrenal hyperplasia?

A Angiotensin-converting enzyme
B 11-beta-hydroxylase
C 21-hydroxylase
D 17-hydroxyprogesterone
E 5-alpha-reductase

A

Which enzyme is most commonly affected within congenital adrenal hyperplasia?

A Angiotensin-converting enzyme
B 11-beta-hydroxylase
C 21-hydroxylase
D 17-hydroxyprogesterone
E 5-alpha-reductase

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74
Q

Which DMT2 treatment causes increased uric acid secretion? [1]

A

SGLT2 inhibitors

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75
Q

Dulaglutide is which drug class

DPP-4 inhibitor
SGLT-2 inhibitor
Biguanide
Thiazolidinediones
GLP-1agonists
Sulfonylureas

A

Dulaglutide is which drug class

GLP-1agonists

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76
Q

Explain the mechanism of action of Propylthiouracil [2]

A

A
Blocks thyroxine deiodinase I in the liver

Blocks thyroxine deiodinase II in the periphery to stop T4 to T3 conversion

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77
Q

Which drug class does indapamide belong to?

DPP-4 Inhibitors
SGLT 2 Inhibitors
Metformin
Thiazolidinediones
Sulfonylureas

A

Which drug class does indapamide belong to?

DPP-4 Inhibitors
SGLT 2 Inhibitors
Metformin
Thiazolidinediones
Sulfonylureas

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78
Q

Sexual dysfunction can be a result of

DPP-4 Inhibitors
SGLT 2 Inhibitors
Metformin
Thiazolidinediones
Sulfonylureas

A

Sexual dysfunction can be a result of

DPP-4 Inhibitors
SGLT 2 Inhibitors
Metformin
Thiazolidinediones
Sulfonylureas

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79
Q

A 65-year-old man presents with severe upper abdominal pain, fever, and vomiting. He is diagnosed with acute pancreatitis. Which of the following liver function tests is raised disproportionately in pancreatitis?

Unconjugated bilirubin
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
Amylase
Gamma glutamyltransferase (GGT)

A

Amylase

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80
Q

Which numbers are the floccus and tonsil? [2]

A

19 Tonsil of cerebellum
20 Flocculus of cerebellum

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81
Q

The preganglionic neurons of the sympathetic nervous system are located in this
section.

A

D

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82
Q

There is a classic triad of features in congenital toxoplasmosis. What are they? [3]

A

Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)

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83
Q

Which gram +ve bactria is indicated in this slide? [1]

A

Streptococcus pneumoniae (diplococci)

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84
Q

Methylphenidate has been ordered for a 10-year-old male in the inpatient child and adolescent psychiatry unit for attention deficit-hyperactivity/disorder. Methylphenidate blocks the reuptake of which neurotransmitter?

A. Acetylcholine
B. Dopamine
C. Gamma-aminobutyric acid (GABA)
D. Serotonin

A

Methylphenidate has been ordered for a 10-year-old male in the inpatient child and adolescent psychiatry unit for attention deficit-hyperactivity/disorder. Methylphenidate blocks the reuptake of which neurotransmitter?

A. Acetylcholine
B. Dopamine
C. Gamma-aminobutyric acid (GABA)
D. Serotonin

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85
Q

Q
An 8-year-old female is brought to the clinic by her mother for an annual examination. The mother inquires as to when her daughter will likely begin puberty. Which of the following is the most notable and reliable first sign of puberty in girls?

A. Menarche
B. Thelarche
C. Pubarche
D. Linear growth

A

Q
An 8-year-old female is brought to the clinic by her mother for an annual examination. The mother inquires as to when her daughter will likely begin puberty. Which of the following is the most notable and reliable first sign of puberty in girls?

A. Menarche
B. Thelarche
C. Pubarche
D. Linear growth

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86
Q

Which of the following is anti-cholinergic?

Oxybutynin
Tamsulosin
Prazosin
Bethanecol

A

Which of the following is anti-cholinergic?

Oxybutynin
Tamsulosin
Prazosin
Bethanecol

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87
Q

Q
Which is the main muscle involved in helping to maintain erection? [1]

EXAM Q

A

Acceptable responses: bulbosongiosus, bulbospongiosus

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88
Q

What is 14? (in a women)

A

Round ligament

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89
Q

Which of the following drug induces labour by causing the cervix to contract?

Oxytocin
Misoprostol
Carboprost
Mifepristone

A

Which of the following drug induces labour by causing the cervix to contract?

Oxytocin
Misoprostol
Carboprost
Mifepristone

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90
Q

Necrotising fasciitis in children may be caused by infection from which pathogen, aftern an initial infection from VZV? [1]

A

Group A streptococcus (GAS): e.g. Streptococcus pyogenes

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91
Q

Treatment of congenital toxoplasmosis? [3]

A

Give prophylactic in mother:
- Pyrimethamine
- sulfadiazine
- folinic acid

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92
Q

How can you treat blood coagulation protein / platelet defects causing repeated miscarriages? [1]

A

aspirin

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93
Q

Name a drug for PPH that is an antifibrinolytic that reduces bleeding [1]

A

Tranexamic acid1(intravenous)

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94
Q

Which anti-hypertensives & anticonvulsants would you use for acute [2] and chronic treatment? [2]

A

Acute treatment:
* Labetalol – alpha and beta blocker / antagonist
* Hydralazine

Chronic management
* Methyldopa – alpha 2 agonist (feeds back and stops noradrenaline being released)
* Nifedipine - CCB

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95
Q

what is A?

  1. conjoint tendon
  2. internal oblique muscle
  3. inguinal ligament
  4. spermatic cord
  5. superficial inguinal ring
  6. rectus sheath
A

what is A?

1. conjoint tendon
2. internal oblique muscle
3. inguinal ligament
4. spermatic cord
5. superficial inguinal ring
​ 6. rectus sheath

sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle, joining the muscle to the pelvis

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96
Q

Identify the cranial nerve indicated on this diagram of the dorsal aspect of the brain stem

  1. trochlear
  2. abducens
  3. oculomotor
  4. trigeminal
  5. facial
  6. opthalmic
A

Identify the cranial nerve indicated on this diagram of the dorsal aspect of the brain stem

​1. trochlear

  • *2. abducens**
    3. oculomotor
    4. trigeminal
    5. facial
    6. opthalmic
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97
Q

In the diagram of the pupillary eye reflex shown, what is A?

  1. oculomotor nucleus
  2. sympathetic ganglion
  3. pretectal nucleus
  4. Edinger Westphal nucleus
  5. medial vestibular nucleus
  6. ciliary ganglion
A

In the diagram of the pupillary eye reflex shown, what is A?

  1. oculomotor nucleus
  2. sympathetic ganglion
  3. pretectal nucleus
  4. Edinger Westphal nucleus
  5. medial vestibular nucleus
    * *6. ciliary ganglion**
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98
Q

What region/zone of the epiphyseal growth plate is indicated by the double headed arrows?

  1. dying
  2. calcifying
  3. hypertrophying
  4. resting
  5. proliferating
A

What region/zone of the epiphyseal growth plate is indicated by the double headed arrows?

​1. dying

  1. calcifying
  2. hypertrophying
  3. resting
    * *5. proliferating**
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99
Q

which muscle attaches here?

  1. deltoid
  2. supraspinatus
  3. teres minor
  4. infraspinatus
  5. long head of biceps
  6. subscapularis
A

which muscle attaches here?

​1. deltoid

  1. supraspinatus
  2. teres minor
  3. infraspinatus
  4. long head of biceps
    * *6. subscapularis**
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100
Q

MCP is the middle cerebellar peduncle in this section.
The fibre tract indicated by the arrow is the

  1. medial
    longitudinal
    fasciculus
  2. spinocerebellar
    tract
  3. corticospinal
    tract
  4. medial
    lemniscus
  5. spinothalamic
    tract
A

MCP is the middle cerebellar peduncle in this section.
The fibre tract indicated by the arrow is the

1. medial
longitudinal
fasciculus
2. spinocerebellar
tract
3. corticospinal
tract
4. medial
lemniscus
5. spinothalamic
tract

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101
Q

what is A?

  1. middle cerebral artery
  2. anterior communicating artery
  3. anterior cerebral artery
  4. inferior sagital sinus
  5. superior sagital sinus
A

what is A?

  1. middle cerebral artery
  2. anterior communicating artery
    * *3. anterior cerebral artery**
  3. inferior sagital sinus
  4. superior sagital sinus
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102
Q

In this highly simplified diagram of the corneal blink reflex, identify the nucleus labelled A that receives the afferent information.

  1. facial
  2. supraoptic
  3. optic
  4. vestibulocochlear
  5. trigeminal
  6. oculomotor
A

In this highly simplified diagram of the corneal blink reflex, identify the nucleus labelled A that receives the afferent information.

​1. facial

  1. supraoptic
  2. optic
  3. vestibulocochlear
    * *5. trigeminal**
  4. oculomotor
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103
Q

Match the letters to the appropriate tracts.

A
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104
Q

This image shows a ‘fatty streak’ in a coronary artery. ‘Foam’ cells at the arrows
can be derived from
macrophages and what other cell type?

  1. Endothelial
    cells
  2. Adipocytes
  3. Mesothelial
    cells
  4. Lymphocytes
  5. Neutrophils
  6. Smooth
    muscle cells
A

This image shows a ‘fatty streak’ in a coronary artery. ‘Foam’ cells at the arrows
can be derived from
macrophages and what other cell type?

​1. Endothelial
cells
2. Adipocytes
3. Mesothelial
cells
4. Lymphocytes
5. Neutrophils
6. Smooth
muscle cells

The fatty streak forms in the intima of a blood vessel and is comprised of
foam cells which sequester lipid. These cells are macrophages and
smooth muscle cells that have migrated there (smooth muscle cells come
in part from the underlying tunica media).

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105
Q

Respiratory tract: The arrow indicates

  1. Bronchus associated lymphoid tissue
  2. Smooth muscle
  3. Internal elastic lamina
  4. Hyaline cartilage
  5. Elastic cartilage
  6. Fibrocollagenous tissue
A

Respiratory tract: The arrow indicates

​1. Bronchus associated lymphoid tissue

  • *2. Smooth muscle**
    3. Internal elastic lamina
    4. Hyaline cartilage
    5. Elastic cartilage
    6. Fibrocollagenous tissue

This is a bronchiole with alveoli surrounding it. The bronchiole has
prominent smooth muscle obvious from its elongated nuclei and dark
pink staining cytoplasm.

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106
Q

Identify A

  1. greater omentum
  2. coronary ligament
  3. triangular ligament
  4. falciform ligament
  5. lesser omentum
  6. hepatogastric ligament
A

Identify A

  1. greater omentum
  2. coronary ligament
  3. triangular ligament
    * *4. falciform ligament**
  4. lesser omentum
  5. hepatogastric ligament
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107
Q

Which of the following best describes C?

Hinge joint

Condylar joint

Plane joint

Ball and Socket joint

Saddle joint

A

Which of the following best describes C?

Hinge joint

Condylar joint

Plane joint

Ball and Socket joint

Saddle joint

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108
Q

Ia primary afferents, carrying information from muscle spindles, synapse in this
area.

A
B
C
D
E
F
G

A

Ia primary afferents, carrying information from muscle spindles, synapse in this
area.

A
B
C
D
E
F
G

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109
Q

Lesion of this region leads to spastic paralysis.

A
B
C
D
E
F
G

A

Lesion of this region leads to spastic paralysis.

A
B
C
D
E
F
​G

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110
Q

Axons carrying nociceptive information decussate in which area?

A
B
C
D
E
F
G

A

Axons carrying nociceptive information decussate in which area?
​
A
B
C
D
E
F
G

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111
Q

The corticospinal tract is identified by which letter?

A
B
C
D
E
F

A

The corticospinal tract is identified by which letter?

A
B
C
D
E
​F

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112
Q

What is indicated by the arrows in the reticular formation shown in these diagrams?

  1. substantia nigra
  2. raphe nuclei
  3. ventral tegmental area
  4. locus coeruleus
  5. basal pons
A

What is indicated by the arrows in the reticular formation shown in these diagrams?

  1. substantia nigra
    * *2. raphe nuclei**
  2. ventral tegmental area
  3. locus coeruleus
  4. basal pons
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113
Q

In the diagram of the pupillary eye reflex shown, what is A?

  1. sympathetic ganglion
  2. ciliary ganglion
  3. pretectal nucleus
  4. oculomotor nucleus
  5. medial vestibular nucleus
  6. Edinger Westphal nucleus
A

In the diagram of the pupillary eye reflex shown, what is A?

  1. sympathetic ganglion
  2. ciliary ganglion
    * *3. pretectal nucleus**
  3. oculomotor nucleus
  4. medial vestibular nucleus
  5. Edinger Westphal nucleus
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114
Q

What is A?

  1. left testicular vein
  2. ureter
  3. left testicular artery
  4. inferior mesenteric artery
  5. inferior mesenteric vein
A

What is A?
​
1. left testicular vein
2. ureter
3. left testicular artery
4. inferior mesenteric artery
5. inferior mesenteric vein

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115
Q

This image depicts the layers of the inguinal canal in a male.

Which structure forms the internal spermatic fascia within the spermatic cord?

A
B
C
D
E

A

This image depicts the layers of the inguinal canal in a male.

Which structure forms the internal spermatic fascia within the spermatic cord?

A
B
C
D
​E

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116
Q

Soma
Axon hillock
Astrocytic process
Dendrite
Axon

A

Dendrite

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117
Q

The tissue shown in the photomicrograph of an intervertebral disc is

Hyaline cartilage
Elastic cartilage
Dense irregular connective tissue
Dense regular connective tissue
Fibrocartilage
A

The tissue shown in the photomicrograph of an intervertebral disc is

Hyaline cartilage
Elastic cartilage
Dense irregular connective tissue
Dense regular connective tissue **Fibrocartilage**
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118
Q
A

B

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119
Q
A

COPD

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120
Q
A

Collagen

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121
Q
A

Mucosa

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122
Q

Ascending Aorta

Ouflow tracts of the ventricles

Both ventricles

The artial auricles

The smooth walled region of atria

A

Ascending Aorta

Ouflow tracts of the ventricles

Both ventricles

The artial auricles

The smooth walled region of atria

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123
Q

Failure of foramen ovale to close

Faliure of septum secumdum to develop

Failure of the muscular portion of the septum to form

Heart tube twisting the wrong way

Restricted growth of the endocardial cushions

A

Failure of foramen ovale to close

Faliure of septum secumdum to develop

Failure of the muscular portion of the septum to form

Heart tube twisting the wrong way

Restricted growth of the endocardial cushions

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124
Q

Lindsay, an 80-year-old male, presents to his GP with atrial fibrillation and shortness of breath. He has pulmonary oedema.

Which radiological sign is seen when interlobular septa in the pulmonary interstitium become prominent?

Batwing sign

Blunted costophrenic angle

Bullae

Crescent sign

Kerley B lines

A

Lindsay, an 80-year-old male, presents to his GP with atrial fibrillation and shortness of breath. He has pulmonary oedema.

Which radiological sign is seen when interlobular septa in the pulmonary interstitium become prominent?

Batwing sign

Blunted costophrenic angle

Bullae

Crescent sign

Kerley B lines

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125
Q

Kerley B lines arise from the thickening of which structure in the lungs? [1]

A

Interlobular septa

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126
Q

What does the measurement labelled A represent?

Forced expiratory volume in 1 sec

Forced vital capacity

Inspiratory reserve capacity

Tidal volume

Total lung capacity

A

Forced vital capacity

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127
Q
A

absence of breath sounds

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128
Q

Patients with a history of abusing alcohol should be given vitamin B1 on admission to hospital as part of their treatment.

What molecule is formed in greater quantities when there is a severe deficiency of vitamin B1?

A

lactate, lactate acid, lactic acid

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129
Q
A

Left gastric and azygos veins

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130
Q

This is a photomicrograph of an ovarian tumour. What type of tumour is it?

Serous adenocarcinoma

Sex cord-stromal tumour

Dysgerminoma

Teratoma

Mucinous adenocarcinoma

A

This is a photomicrograph of an ovarian tumour. What type of tumour is it?

Serous adenocarcinoma

Sex cord-stromal tumour

Dysgerminoma

Teratoma

Mucinous adenocarcinoma

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131
Q

This cytology preparation is of a breast aspirate obtained from a lump in a woman’s breast.

What do the features suggest?

Fibroadenoma

Leiomyosarcoma

Leiomyoma

Fibrosarcoma

Adenocarcinoma

A

This cytology preparation is of a breast aspirate obtained from a lump in a woman’s breast.

What do the features suggest?

Fibroadenoma

Leiomyosarcoma

Leiomyoma

Fibrosarcoma

Adenocarcinoma

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132
Q

A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips.

Which muscle and tendon could be transferred to help this individual walk better?

Tibialis posterior

Tibialis anterior

Gastrocnemius

Fibularis longus

Flexor hallucis longus

A

A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips.

Which muscle and tendon could be transferred to help this individual walk better?

Tibialis posterior

Tibialis anterior

Gastrocnemius

Fibularis longus

Flexor hallucis longus

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133
Q

A 23-year-old male was involved in a motor vehicle accident and was admitted to hospital complaining of right leg paresis and bladder-bowel disorder. They had a computed tomography (CT) scan that is shown below.

A

(axial burst, axial burst fracture, burst, burst fracture)

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134
Q

During a teleconsultation, a 27-year old patient complains of a blocked nose in addition to her sore throat.

What is the major pharmacological action of decongestants?

Alpha-2 adrenoceptor agonist

Alpha-1 adrenoceptor agonist

Alpha-1 adrenoceptor antagonist

Alpha-2 adrenoceptor antagonist

Beta-2 adrenoceptor agonist

A

During a teleconsultation, a 27-year old patient complains of a blocked nose in addition to her sore throat.

What is the major pharmacological action of decongestants?

Alpha-2 adrenoceptor agonist

Alpha-1 adrenoceptor agonist

Alpha-1 adrenoceptor antagonist

Alpha-2 adrenoceptor antagonist

Beta-2 adrenoceptor agonist

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135
Q

Growth hormone (GH) is released by the pituitary gland.

Which of the following best describes the metabolic effects of GH?

Counteracts all effects of glucagon

Counteracts all effects of insulin on glucose and lipid metabolism, but shares protein catabolic properties with insulin

Counteracts the effects of insulin on glucose and lipid metabolism, but shares protein anabolic properties with insulin

Counteracts the effects of insulin on protein and lipid metabolism, but shares with insulin effects on glucose homeostasis

GH shares all effects of insulin

A

Growth hormone (GH) is released by the pituitary gland.

Which of the following best describes the metabolic effects of GH?

Counteracts all effects of glucagon

Counteracts all effects of insulin on glucose and lipid metabolism, but shares protein catabolic properties with insulin

Counteracts the effects of insulin on glucose and lipid metabolism, but shares protein anabolic properties with insulin

Counteracts the effects of insulin on protein and lipid metabolism, but shares with insulin effects on glucose homeostasis

GH shares all effects of insulin

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136
Q

3rd ventricle

4th ventricle

Cerebral aqueduct

Interventricular foramen

Lateral ventricle

A

3rd ventricle

4th ventricle

Cerebral aqueduct

Interventricular foramen

Lateral ventricle

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137
Q

Label A

A

Claustrum is a thin, bilateral collection of neurons and supporting glial cells, that connects to cortical (e.g., the pre-frontal cortex) and subcortical regions (e.g., the thalamus) of the brain.

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138
Q

A patient has a pulmonary embolism.

In which of the labelled structures would the embolus enter the lungs through?

A

B

C

D

E

A

A patient has a pulmonary embolism.

In which of the labelled structures would the embolus enter the lungs through?

A

B

C

D

E

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139
Q

This image depicts

Elliptocytosis

Presence of schistocytes

Presence of sickle cells

Pyropoikilocytosis

Spherocytosis

A

Pyropoikilocytosis:

Hereditary pyropoikilocytosis (HPP) is an autosomal recessive disorder of the red blood cell (RBC) membrane that is clinically related to, and is considered a subtype of, hereditary elliptocytosis (HE). HPP involves a functional defect in spectrin, which is the major cytoskeletal protein of the RBC cell membrane. It manifests as a severe hemolytic anemia with thermal instability of the red blood cells

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140
Q

This image depicts

Elliptocytosis

Presence of schistocytes

Presence of sickle cells

Pyropoikilocytosis

Spherocytosis

A

This image depicts

Elliptocytosis

Presence of schistocytes

suggests red blood cell injury from damaged endothelium and is a characteristic feature of microangiopathic hemolytic anemia.

Presence of sickle cells

Pyropoikilocytosis

Spherocytosis

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141
Q

The anterior spinothalamic tract eventually innervates the primary and secondary somatosensory cortex, basically controlling pain intensity. “Provide exact localisation and physical intensity of noxious stimulus”. To get there, where do the projection neuron terminate and innervate the third order neuron? (2 answers)

Ventral posterior lateral nucleus of the thalamus
Ventral posterior inferior nucleus of the thalamus
Mediodorsal nucleus of the thalamus
Ventral posteroinferior nucleus of the thalamus
Ventral posterolateral nucleus of the thalamus

A

The anterior spinothalamic tract eventually innervates the primary and secondary somatosensory cortex, basically controlling pain intensity. “Provide exact localisation and physical intensity of noxious stimulus”. To get there, where do the projection neuron terminate and innervate the third order neuron? (2 answers)

Ventral posterior lateral nucleus of the thalamus
Ventral posterior inferior nucleus of the thalamus
Mediodorsal nucleus of the thalamus
Ventral posteroinferior nucleus of the thalamus
Ventral posterolateral nucleus of the thalamus

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142
Q

This refers to which part of the limbic system?

Anterior cingulate gyrus
Primary somatosensory cortex
Insula
Amygdala
Nucleus accumbens

A

This refers to which part of the limbic system?

Anterior cingulate gyrus
Primary somatosensory cortex
Insula
Amygdala
Nucleus accumbens

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143
Q

If unsure on which strucutre is whihc, where do you find the amygdala compared to the insula? [1]

A

Amygdala below

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144
Q

Where is the raphe nucleus located?

Midbrain
Pons
Medulla
Basal ganglia
In the thalamus

A

Where is the raphe nucleus located?

Midbrain
Pons
Medulla
Basal ganglia
In the thalamus

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145
Q
A

Neurofibrillary tables

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146
Q
A
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147
Q
A
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148
Q

Name a complication of antidepressant drug use

A

Antidepressant drug discontinuation syndrome
A condition that can occur after a decrease in the dose of drug taken, an interruption of treatment or abrupt cessation of treatment; it can be prevented by a very gradual discontinuation of treatment, by using a very slow tapering of the doses taken by the patient

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149
Q
A

Bilateral removal of the amygdala

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150
Q

What is retrograde amnesia? [1]

A

inability to access memories or information from before an injury or disease occurred.

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151
Q

How long does the vegetative state need to persist before it is classified as permanent vegetative state after traumatic brain injury? [1]

A

12 months

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152
Q
A

Normal healthy individual

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153
Q
A

Decreased dopamine receptors

There is less metabolic activity especially around the prefrontal cortex and there is less blood flow to certain areas due to addiction

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154
Q
A

Cannabinoid receptor 1

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155
Q
A

CT
CXR
ERPs
Lumbar puncture
Angiogram

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156
Q

What frequency are alpha waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

A

What frequency are alpha waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

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157
Q

What frequency are beta waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

A

What frequency are beta waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

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158
Q

What frequency are delta waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

A

What frequency are delta waves?

13-30 Hz
8-12 Hz
3.5-7.5 Hz
Less than 3.5 Hz
10-12 Hz

159
Q

Which sleep waves are associated with sleep spindles? [1]

A

Theta

160
Q

What frequency is typically used for DBS? [1]

A

100Hz

161
Q

Which structure does the PAG surround? [1]

A

Cerebral aquaduct

162
Q

Which SSRI increases QT intervals? [1]

A

Citalopram

163
Q

Name some key side effects of phenytoin acute [2] chronic [3] and idiosynchratic use [1]

A
164
Q

Name and explain a MSK disease prolonged phenytoin use can cause

A

enhanced vitamin D metabolism causing osteomalacia

165
Q

Name two uses of amantadine [2]
State MoA [2]

A

Treats: Parkinson’s disease & PVS
NMDA receptor antagonistic effect & block dopaminergic reuptake

166
Q

Name a common side effect of Carbamazepine use [1]

A

Carbamazepine hypersensitivity: get a rash

167
Q

Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?

GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist

A

Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?

GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist

168
Q

Name two drugs used for seizure prophylaxis [2]

A

A
Phenytoin
Levetiracetam

169
Q

Which of the following is the most cardiotoxic?

Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine

A

Which of the following is the most cardiotoxic?

Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine

170
Q

Name a drug that used for epilepsy that has recent use for insomnia [1]

A

A
Pregabalin

171
Q

Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]

A

Amitriptyline

172
Q

What are the first three firstline drug classes recommended for neuropathic pain? [3]

A

SNRIs (duloxetine)
tricyclic antidepressants (amitrypyline)
calcium channel blockers(gabapentin, pregabalin)

173
Q

Which cell makes type 1 collagen?

osteoclasts
osteoblasts
osteocyte
osteoprogenitor

A

Which cell makes type 1 collagen?

osteoclasts
osteoblasts
osteocyte
osteoprogenitor

174
Q
A

A: Involucrum: A reactive shell of new bone forms around the sequestrum

B: sequestrum: necrotic bone fragment

175
Q

This HLA type has been associated with rheumatoid arthritis and type 1 diabetes melllitus? [1]

A

HLA-DR4

176
Q

Which treatment for RA targets IL-6?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Which treatment for RA targets IL-6?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

177
Q

Belimubab inhibits BAFF (B cell activating factor). It is used to treat

Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Rheumatoid arthritis

A

Belimubab inhibits BAFF (B cell activating factor). It is used to treat

Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Rheumatoid arthritis

178
Q

Granuloma formation is a which type of hypersensitivity reaction?

Type 1
Type 2
Type 3
Type 4

A

Type 4

179
Q

This person with a tattoo has an adverse reaction. This occurs due to

Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity

A

Immune complex mediated inflammation

180
Q

The acromioclavicular joint is which type of joint

saddle
plane
hinge
condyloid

A

The acromioclavicular joint is which type of joint

saddle
plane
hinge
condyloid

181
Q

Gout
Pseudogout
Osteoarthritis
Rheumatoid arthritis
Patella tendinitis

A

Pseudogout

The knee x-ray shows evidence of cartilage calcification, previously termed chondrocalcinosis, which is typical of pseudogout.

In hyaline cartilage, cartilage calcification will appear as a thin opaque line. **The knee is the most common joint to see pseudogout. **Another common place cartilage calcification occurs is the triangular fibrocartilage complex (TFCC) of the wrist.

182
Q

Osteomalacia

Rheumatoid arthritis

Pseudogout

Osteoporosis

Gout

A

Pseudogout

Pseudogout is a type of arthritis in which a layer of calcification can be seen between articulating surfaces.

183
Q

Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?

Consumption of too much alcohol

Inadequate elimination of uric acid via the kidneys

Infection causing build-up of uric acid

Production of too much uric acid in the body

A

Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?

Consumption of too much alcohol

Inadequate elimination of uric acid via the kidneys

Infection causing build-up of uric acid

Production of too much uric acid in the body

184
Q

Platelet rich plasma (PRP) is a novel treatment process for

Osteoporosis
Osteomalacia
Osteoarthritis
Rheumatoid arthritis

A

Platelet rich plasma (PRP) is a novel treatment process for

Osteoporosis
Osteomalacia
Osteoarthritis
Rheumatoid arthritis

185
Q

Omalizumab works by reducing which molecule? [1]

A

IgE

186
Q

Which prostaglandin causes the most bronchoconstriction in asthma patients?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

Which prostaglandin causes the most bronchoconstriction in asthma patients?

PGE2
PGD2
PGI2
PGF2α
TXA2

187
Q

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

A

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

188
Q

What is this skin pathology? [1]

A

Leukocytoclastic Vasculitis

Fibrin deposition can be identified within the vessel wall

The perivascular inflammatory infiltrate is comprised predominantly of neutrophils but eosinophils are also present.

189
Q

This symptom is a result of?

Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity

A

This symptom is a result of?

Antibody-mediated inflammation: Pemphigus Vulgaris

190
Q

This flower would cause

Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity

A

This flower would cause

Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity

191
Q

Molluscum contagiosum

[] bodies that contain virus particles are typical of histological slide

A

Henderson-Patterson bodies that contain virus particles.

192
Q

Describe MoA of Abatacept

A

Blocks T cell activation which thus means macrophages and B cells cannot be activated.

Competes with CD28 binding to CD80/86 by upregulating CTLA-4, which switches T cell off

Reduces production of TH17 cells
Thus reducing inflammation

193
Q

RA treatment:
The most important biologics to remember are the TNF inhibitors …. [3]

A

The most important biologics to remember are the TNF inhibitors adalimumab, infliximab and etanercept

194
Q

Hydroxychloroquine blocks TL9. What effect does this have? [1]

A

decreases activation of dendritic cells: less autoantobodies produced

195
Q

Name two roles of DOACs [2]

A

VTE
AF

196
Q

Treatment for HPV: viral warts and veruccas? [5]

A

Topical salicylic acid
Fluorouracil cream
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)

197
Q

Describe two biological DMARDs for SLE? [2]

A

Belimubab: inhibits BAFF (B cell activating factor)
Rituximab: CD20 blocker

198
Q

Name a bisphosphinate used to treat OA [1]

A

Alendronate

199
Q

Describe treatment regime of dermatomyositis [4]

A

Prednisilone (type of corticosteroid):
* 1 mg / kg per day until creatine kinase normal

Azthioprine

Methotrexate

Rituximab

200
Q

Treatment for leprosy? [3]

A

Rifampicin, dapsone and clofazimine

201
Q

Methotrexate may cause an increase in which liver marker? [1]

A

ALT: causes hepatoxcity

202
Q

What drug class is the first oral biological? [1]

A

JAAK inhibitor

203
Q

Label each type of fracture

A

Basicervical; transcervical ; sub capital

204
Q

Which is OP and which is OM? [2]

A

Osteomalacia on the left OP on the right

205
Q

Which is OP and which is OM? [2]

A

Osteomalacia on the left OP on the right

206
Q
A

SUFE

207
Q

What condition is this? [1]

A

Pes cavus

208
Q

What condition is this? [1]

A

Hammer toes

209
Q
A

Lamella: Trabecular

210
Q

What is this condition? [1]

A

Dupuytrens contracture

211
Q

Which muscle has caused this avulsion facture indicated by the two arrows in the image?

Hamstrings
Sartorius
Rectus femoris
Gluteal muscles
Iliopsoas

A

Which muscle has caused this avulsion facture indicated by the two arrows in the image?

Hamstrings
Sartorius
Rectus femoris
Gluteal muscles
Iliopsoas

212
Q

Tinea corporis is caused by what class of pathogen? [1]

Name two common genera [2]

A

Dermatophyte fungi of the genera Trichophyton and Microsporum.

213
Q
A

Woven bone

214
Q

Which two lines are used as diagnostic procedure in this x-ray? [2]

A

Hilgrenreiners and acetabular lines

215
Q
A

Tendon of extensor digitorum

216
Q
A

Syndesmophyte

are calcifications or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus.​ They are seen in only a limited number of conditions including:

ankylosing spondylitis
ochronosis
fluorosis
reactive arthritis
psoriatic arthritis

217
Q
A

Arthrodesis of the first metatarsophalangeal joint

218
Q

Dupuyten’s contracture is a contracture of the [] fascia that causes usually the [] and [] finger to go into flexion.

A

Dupuyten’s contracture is a contracture of the palmar fascia that causes usually the little and ringer finger to go into flexion.

219
Q
  1. osteoarthritis
  2. pseudo-gout
  3. osteomalacia
  4. osteomyelitis
  5. gout
A
  1. osteoarthritis
    2. pseudo-gout
  2. osteomalacia
  3. osteomyelitis
  4. gout
220
Q
  1. transverse
  2. greenstick
  3. spiral
  4. comminuted
  5. impacted
A
  1. transverse
  2. greenstick
    3. spiral
  3. comminuted
  4. impacted
221
Q
A

abduction
and
adduction
of the
digits

This is claw hand. The ulnar nerve innervates the intrinsic muscles of the hand so abduction and adduction
of the digits would be lost. The other movements are produced by the median and radial nerves that are not
affected in this individual.

222
Q

Label A-E

A

A Axillary nerve
B Radial nerve
C Musculocutaneous nerve Musculocutaneous nerve
D Median nerve
E Ulnar nerve

223
Q

What muscle tendon weakness could lead to this condition? [1]

  1. plantaris
  2. tibialis
    anterior
  3. extensor
    digitorum
  4. gastrocnemius
  5. extensor
    hallucis
    longus
A
  1. plantaris
    2. tibialis
    anterior
  2. extensor
    digitorum
  3. gastrocnemius
  4. extensor
    hallucis
    longus

tibialis anterior inserts onto the top of the medial longitudinal arch and provides a dynamic pull to maintain
the arch.

224
Q
  1. subscapularis
  2. trapezius and
    deltoid
  3. deltoid and
    supraspinatus
  4. biceps and
    triceps
  5. infraspinatus
    and teres
    minor
A
  1. infraspinatus
    and teres
    minor
225
Q

Phalen’s sign tests for which condition? [1]

A

Carpel tunnel

226
Q
  1. Paget’s
    disease
    osteoporosis
  2. osteomalacia
  3. osteomyelitis
  4. avascular
    necrosis
A
  1. Paget’s
    disease
    osteoporosis
    **3. osteomalacia **
  2. osteomyelitis
  3. avascular
    necrosis
227
Q
A

Pannus

228
Q

Describe the type of flexion at the ankle during club foot [1]

A

Plantar flexed at ankle and genu varum

229
Q
A

kyphoplasty

230
Q
A

loss of
medullary
fat signal in
AVN

231
Q

Which of the following is most common?

Teratoma
Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinoma

A

Which of the following is most common?

Teratoma
Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinoma

232
Q

Which is the most common cause of bacterial caused brain abscess?

Streptococcus agalactiae
Streptococcus mutans
Streptococcus pneumoniae
Neisseria meningitidis
Staphylococcus aureus

A

Which is the most common cause of bacterial caused brain abscess?

Streptococcus agalactiae
Streptococcus mutans
Streptococcus pneumoniae
Neisseria meningitidis
Staphylococcus aureus

233
Q

What type of imaging method is demonstrated here? [1]

A

Myelogram

234
Q
  1. follicular
    epithelium

2.sweat gland

  1. submandibular
    gland
  2. sebaceous
    gland
  3. dermal papilla
A
  1. follicular
    epithelium

2.sweat gland

  1. submandibular
    gland
  2. sebaceous
    gland
  3. dermal papilla
235
Q

Identify the structure which prevents adduction of the leg.

  1. A
  2. G
  3. B
  4. D
  5. F
  6. C
  7. E
A

Identify the structure which prevents adduction of the leg.

  1. A
  2. G
  3. B
  4. D
  5. F
    6. C
  6. E
236
Q
  1. maturing and
    hypertrophying
    cartilage
  2. reserve
    cartilage
  3. degenerating
    cartilage and
    matrix
    calcification
  4. bone formation
  5. proliferating
A
  1. maturing and
    hypertrophying
    cartilage
    2. reserve
    cartilage
  2. degenerating
    cartilage and
    matrix
    calcification
  3. bone formation
  4. proliferating
237
Q
A
238
Q
A

The Smith’s is an anterior displacment of the distal fragment, so the hand is displaced anteriorly relative to the rest of the forarm. The Colles’s is a dorsal di
of the distal frgament, giving the classic dinner fork deformity.

239
Q

What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland

A

What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland

240
Q
A
241
Q

Where is Neuromelanin produced? [1]

A

Brain

242
Q

State SIX histological changes that you will find in the articular cartilage of Mrs Fox’s knees?

A

Chondrocyte necrosis (more marked in the superficial layers) (1/2 mark)
Large isogenic clusters of the remaining chondrocytes (1/2 mark)
Cracks and fissures in the cartilage (1/2 mark)
Duplication of the tidemark (1/2 mark)
More collagen type I (1/2 mark)
Fewer proteoglycans (1/2 mark)

243
Q

State the effect of more ACPA being produced in RA [1]

A

(ii) ACPA causes monocytes to differentiate as osteoclasts and they produce IL8 that creates the autocrine loop. (1 mark)

244
Q

Mary is a 63- year old woman who has a 22 year history of rheumatoid arthritis. She is presently taking methotrexate (MTX) and infliximab was added 5 years previously but the efficacy of the infliximab has started to wane.

Briefly explain why the efficacy of the infliximab is starting to wane?

A

Infliximab is a chimeric anti-TNF alpha antibody designed against the mouse binding site of TNF alpha and the remaining 75% is mouse meaning that the body will see it as foreign and mount an immune response against the drug (1 mark). With time both neutralising and non-neutralising antibodies will be produced (1 mark). These will directly interfere, form immune complexes and increase clearance of the infliximab. (1 mark)

245
Q

Name the FOUR stages of fracture healing.

A

Fracture hematoma
Soft callus (fibrocartilage callus)
Bony callus
Bone remodelling

246
Q

The initial management of osteoarthritis is the use of NSAIDs, these drugs antagonise the COX2 enzyme in the joint.

How and what leads to the induction of COX2 in the affected joint?

A

Inflammatory signals (TNFalpha, IL1 and IL17) can directly induce the expression of COX2 in the joint (1 mark)

but the inflammatory stimuli can also indirectly activate COX2 by inducing iNOS that where the free radicals induce COX2. (1 mark).

247
Q
A

Tibial

248
Q

11 Explain briefly, why the hip is more commonly affected by OA than the shoulder. (2 marks)

A

The hip is a weight bearing joint and is so subjected to more stress and wear and tear than the shoulder (1). OA is most likely to affect the weight bearing joints first (1).

249
Q

Describe how subchondral cysts occur in OA [1]

A

There may be focal pressure necrosis of the bone that leads to the formation of sub-chondral cysts. (1mark)

There is vascular engorgement, slowing of blood flow through the sub-chondral bone. (1 mark)

250
Q

What are Loosers zones on x-rays? [1]

A

Pseudofractures - Linear areas of low density surrounded by sclerotic borders

251
Q

What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
More bone mass and normal mineralisation
More bone mass but unmineralised
No effect

A

What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
More bone mass and normal mineralisation
More bone mass but unmineralised
No effect

252
Q

Which cell type would be most prominent in A and B in a patient with RA? [2]

A

A - synovial membrane: Th17 lymphocytes
B - synovial fluid: Neutrophils

253
Q

Blount’s disease is characterised by what abnormality to which bone? [2]

A

irreversible tibia varus is the pathophysiology behind

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

254
Q

Where is Klines line? [1]

How can you use this to diagnose SUFE? [1]

A

Klein’s line is drawn along superior border of femoral neck should cross at least a portion of the femoral head. When SUFE the femoral head drops below this line.

255
Q

Describe the points that Perkins line is found [1]

How is it used for assessment for CHD? (affected v unaffected)

A

Top of the acetabulum going down: ID where the femoral head is

Affected side will be more lateral to the side
Unaffected side: femoral head more medial

256
Q

Describe the pathophysiology of Perthes disease (Legg-Calve-Perthes disease) [3]

A

Idiopathic

Self limiting avascular necrosis of the femoral head

Dual blood supply to femoral head. Secondary ossification centre suffers blood loss and causes avascular necrosis.

If left untreated, the femoral neck grows and over time there is revascularisation or neovascularisation and healing of the femoral head.

257
Q

Describe the movement of the joint that occurs in SUFE [2]

A

Epiphysis actually stays in place it’s the neck and shaft of the femur that moves

Epiphysis moves posteriorly and medially

258
Q

Cytokines produced by a variety of immune cells can have redundant and over-lapping functions.

What do IL-10 and tumour growth factor B (TGFB) have in common?

Both are anti-inflammatory cytokines

Both induce apoptosis in virally-infected and neoplastic cells

Both modulate the activity of macrophages

Both promote the maturation of CD4 T cells to T1 helper cells

Both secreted by dendritic cells

A

Cytokines produced by a variety of immune cells can have redundant and over-lapping functions.

What do IL-10 and tumour growth factor B (TGFB) have in common?

Both are anti-inflammatory cytokines

Both induce apoptosis in virally-infected and neoplastic cells

Both modulate the activity of macrophages

Both promote the maturation of CD4 T cells to T1 helper cells

Both secreted by dendritic cells

259
Q
  1. The membrane potential of neurones during the resting phase is -75 mV.

Which channels are responsible for maintaining the resting potential?

K+ passive leak channels

Na+ passive leak channels

Na+/K+ ATPase pump

Voltage gated potassium channels

Voltage gated sodium channels

A
  1. The membrane potential of neurones during the resting phase is -75 mV.

Which channels are responsible for maintaining the resting potential?

K+ passive leak channels

Na+ passive leak channels

Na+/K+ ATPase pump

Voltage gated potassium channels

Voltage gated sodium channels

260
Q

Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.

What is the most likely chromosomal abnormality observed in these individuals?

A Robertsonian translocation between chromosomes 21 and 14

A Robertsonian translocation between chromosomes 21 and 11

  1. Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.

What is the most likely chromosomal abnormality observed in these individuals?

A Robertsonian translocation between chromosomes 21 and 14

A Robertsonian translocation between chromosomes 21 and 11

Mosaicism of chromosome 21

Trisomy 14

Trisomy 21

A

Mosaicism of chromosome 21

261
Q
A

Visceral pleura

262
Q

Which channels open to help restore the resting membrane potential at the end of the depolarization phase of an action potential? [1]

A

Voltage gated potassium (K+) channels

263
Q

Which of the following is the correct carrying angle in a man?

5-10 degrees

5-15 degrees

10-20 degrees

15-25 degrees

10-30 degrees

A

Which of the following is the correct carrying angle in a man?

5-10 degrees

5-15 degrees

10-20 degrees

15-25 degrees

10-30 degrees

264
Q

Boyle’s Law can be applied to the breathing process.

Which statement describe best Boyle’s law?

The volume of a gas correspond to its pressure divided the surface tension

The pressure of a gas is directly proportional to the surface tension

The pressure of a given quantity of gas is inversely proportional to the volume that contains it

The surface tension is inversely proportional to the pressure

The pressure of a gas is equal to the surface tension multiplied by the volume

A

Boyle’s Law can be applied to the breathing process.

Which statement describe best Boyle’s law?

The volume of a gas correspond to its pressure divided the surface tension

The pressure of a gas is directly proportional to the surface tension

The pressure of a given quantity of gas is inversely proportional to the volume that contains it

The surface tension is inversely proportional to the pressure

The pressure of a gas is equal to the surface tension multiplied by the volume

265
Q

Aldosterone is inhbiited by which enzyme? [1]

A
266
Q
A

Rubrospinal

267
Q

What measurement do you use to assess if have COPD? [1]

A

FEV1/FVC

268
Q

A 12 year-old girl develops an unproductive cough, shortness of breath, fever and malaise. An organism is detected by a test for the antibodies that it provokes. It is treated with erythromycin, because beta-lactams are ineffective.

What is the most likely causative organism?

Haemophilus influenzae

Mycoplasma pneumoniae

Staphylococcus aureus

Streptococcus agalactiae

Streptococcus pneumonia

A

A 12 year-old girl develops an unproductive cough, shortness of breath, fever and malaise. An organism is detected by a test for the antibodies that it provokes. It is treated with erythromycin, because beta-lactams are ineffective.

What is the most likely causative organism?

Haemophilus influenzae

Mycoplasma pneumoniae

Staphylococcus aureus

Streptococcus agalactiae

Streptococcus pneumonia

269
Q

Presentation of patellar dislocation? [1]

A

Knee held in flexion

270
Q

medial compartment of the thigh

  • cause what movement on the hip?
  • made by which muscles?
  • innervated by?
A

medial compartment of the thigh

  • cause what movement on the hip?
  • *adduction**
  • made by which muscles?
  • *adductor longus, brevis and magnus, gracilis, pectineus and obturator externus ​**
  • innervated by?
  • *obturator nerve**
271
Q

which ligaments of foot get stretched out when foot planted, sot that when you take a step, release energy and help lift off?

a) medial side [1]
b) lateral side [2]

A

which ligaments of foot get stretched out when foot planted, sot that when you take a step, release energy and help lift off?

a) medial side: spring ligament
b) lateral side: long and short plantar ligaments

272
Q

How do you treat a intertrochantric fracture? [1]

A

Dynamic hip screw: blate with barrel inserted to outside of femoral shaft. Screw goes through to femoral head gives controlled compression

273
Q

Which nerves supply sensory to colours shown?

A
274
Q

PCL helps to stabilise knne joint particularly in which movement? [1]

What is other role? [1]

A

Helps stabilise knee especially in flexion

Stops tibia moving backward on femur

Stronger the ACL

275
Q

Describe the role of ACL [3]

A

Stabilise knee in extension and prevents hyperextension and excessive internal rotation

Stops tibia moving forward on femur

276
Q

Compression of the tarsal tunnel can cause impingement to which nerve? [1]

A

Tibial nerve

277
Q

Name the Bradford Hill criteria and explain each one

A

a. Strength of the association - Is the result strong? This is usually measured by the HR, OR or RR, eg if OR >5 or < 1/5 then it is usually considered strong.
b. Dose response – Would expect risks to increase with increasing exposure
c. Reversibility – If you stop the exposure does the risk change revert to 1?
d. Temporality – Does the exposure occur a reasonable time before the disease?
e. Consistency – Has the result been repeated by different people in different places and in different circumstances and times?
f. Biological Plausibility – Is the result biologically plausible?
g. Coherence of Evidence – i.e. the results should be consistent with other sorts of studies such as cohort and cross-sectional as well as perhaps animal models.
h. Specificity – Is the relationship with the exposure limited to specific diseases

278
Q

What does the following describe? [1]

An individual’s perception of the degree to which they are capable of performing a given behaviour, or, their self-believe in their ability to change (1/2 mark for self- belief/perception and ½ mark for behaviour change).

A

Self-efficacy

279
Q
  1. In a case-control study the odds ratio for heroin use and testes cancer was 0.92 with a 95% confidence interval of 0.24 to 3.59. What does the confidence interval mean? (2 marks)
A

The 95% confidence interval tells us that we are 95% confident (½ mark) that in the population heroin use might decrease the risk of testes cancer by 76% (1-0.24) (½ mark) or it might increase it by 3.6 times.(½ mark). The confidence interval includes 1 so there is no evidence that heroin use will reduce the risk of testes cancer (p>0.05). (½ mark)

280
Q

Haematogenous osteomyelitis usually involves which bones in children? [1] and adults? 1[]

A

Haematogenous osteomyelitis usually involves the metaphysis of long bones in children or the vertebral bodies in adults

281
Q

Huntington’s chorea displays something called genetic “[]”.

A

Huntington’s chorea displays something called genetic “anticipation”. Anticipation is a feature of trinucleotide repeat disorders. This is where successive generations have more repeats in the gene, resulting in:

282
Q

Give very brief overview of HD [2]

A

The hyperkinetic presentation is due to the loss, in the dorsal striatum, of GABAergic medium spiny neurons of the indirect pathway (bearing dopaminergic D2 receptors)

DIrect pathway becomes dominant

283
Q

What stage of bone healing by a bone graft is the physical effect by which the matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone?

Osteoinduction

Osteogenesis

Osteopromotion

Osteoconduction

Mass transport

A

What stage of bone healing by a bone graft is the physical effect by which the matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone?

Osteoinduction

Osteogenesis

Osteopromotion

Osteoconduction

Mass transport

284
Q

Erythropoietin is produced by which of the following cells? [1]

A

interstitial cells

285
Q

Primary haemostasis (platelet number and function) is tested in lab using bleeding time. What is the range for normal bleeding time?

A

Normal bleeding time: 1-3 minutes

286
Q

Where is VWF synthesised [2] and stored? [3]

A

Synthesised by
* Endothelial cells
* Megakaryocytes

Stored in
* Subendothelial matrix (immobilized state)
* Present in the soluble state in the plasma
* Alpha granules of the platelets

287
Q

Factor X works by postive feedback due to continued activation from which factor? [1]

A

Factor VIIIa

288
Q
A
289
Q

Describe a downregulator of coagulation cascade [1]

A

Thrombomodulin is a cofactor for thrombin that converts Thrombin from a procoagulant to an anticoagulant by stimulating activation of the anticoagulant serine protease protein C.

290
Q

What are the 3 main anticoagulants of the body? [3]

A

antithrombin
protein c
protein s

291
Q

Describe how we differentiate between iron deficiency anaemia (IDA) from anaemia of
inflammation? [2]

How do you tell if a person has inflammation AND IDA the iron deficiency?

A

The most useful blood test is serum ferritin – it will be low in pure IDA and high in
anaemia of inflammation.

Serum transferrin receptor levels will be elevated in IDA and normal in anaemia
inflammation

The key caveat is that in a person with inflammation AND IDA the iron deficiency may be “masked” because ferritin is an acute phase reactant – in that case ferritin will be normal but in the low normal range.

292
Q

[] occurs when a remnant of the yolk sac (Vitelline duct) persists.

A

Meckel’s diverticulum occurs when a remnant of the yolk sac (Vitelline duct) persists.

293
Q

Draw the tracts of the spinal cord

A
294
Q

Describe the key characteristics of anterior spinal cord syndrome [2]

A

Damage to the anterior portion of the spinal cord will cause bilateral disruption of the spinothalamic tracts, resulting in bilateral loss of pain and temperature sensation.

The corticospinal tracts are also likely to have been affected, resulting in bilateral spastic paralysis and UMN signs

295
Q

Describe MoA of hycosine and state use [2]

A

Hycosine:
* M5 receptor antagonist; prevents Ach action in brainstem or vestibular nuclei

296
Q

Name two drugs given for motion sickness [2]

A

Diphyenydramine / dramamine
Cyclizine

297
Q

What is the MoA of Metclopramide? [2]

A

D2 receptor antagonist & 5HT4 agonist

298
Q

What is the MoA of ondansetron and alosetron? [1]
What is the clinical use? [1]

A

5HT3 agonist; used for chemo and radiotherapy induced emesis

299
Q

What are the antigens and antibodies for different blood groups?

A
300
Q

Which blood groups are the universal donor and recipients? [2]
Explain why [2]

A

O is therefore the universal donor as O blood cells have no antigens
AB is the universal recipient as it has no circulating AB antibodies

301
Q

Describe what causes blood anaphylaxis

A

Occurs when patients with IgA deficiency who have anti-IgA antibodies are given blood with IgA

302
Q

What is Transfusion-related acute lung injury (TRALI)?

A

Non-cardiogenic pulmonary oedema

Thought to be secondary to neutrophils activation
Degranulation of WBCs increases vascular permeability leading to inflammation and oedema

303
Q

When does neural tube normally close? [1]

A

CLOSURE OF NEURAL TUBE COMPLETE BY DAY 28

304
Q

A 53-year-old female patient was diagnosed with HER-2 positive breast cancer after having discovered a lump in her breast in the shower. She was referred for surgery, but was also prescribed two monoclonal antibody treatments, pertuzumab and trastuzumab.

Which of the following is a major side effect of the monoclonal antibody treatment trastuzumab?

alopecia

arthritic swelling

chronic kidney disease

congestive heart failure

liver toxicity

A

chronic kidney disease

305
Q

Rheumatic fever develops following an immunological reaction [] infection

Haemophilus influenzae

Pseudomonas aeruginosa

Staphylococcus aureus

Streptococcus pneumoniae

Streptococcus pyogenes

A

Streptococcus pyogenes

306
Q

Which cancer drug causes pulmonary fibrosis as a side effect? [1]

A

Bleomycin

307
Q

Macrolides include erythromycin, clarithromycin, azithromycin, fidaxomicin and telithromycin.

What is their MoA? [1]

A

Inhibit 50S ribosomal subunit and inhibit protein synthesis

308
Q

Which benzodiazepine is used in chronic sleep insomnia? [1]

A

Eszopiclone

309
Q

Which drug is used to treatment resistent SCH [1]

A

Clozapine

310
Q

Inheritance of haemophilia? [1]

A

X-linked

311
Q

which hormone causes endometrial thickening?

LH
FSH
Oestrogen
Progesterone
Testosterone

A

LH

312
Q

Which brain region is the deep brain stimulation (DBS) probe placed in for dystonia [1] and tremor [2]

A

Dystonia: Globus pallidus internal
Tremor: subthalamic nuclei; zone incerta

313
Q

Which of the following antipsychotics is more likely to cause hyperglycaemia, insulin resistance and dyslipidaemia?

A

Clozapine

314
Q

Which co-morbidity is most strongly associated with chronic pain?

Depression

Lack of energy

Difficulty sleeping

Anxiety

Concentration difficulties

A

Difficulty sleeping

315
Q

What is the name of the fatty acid transporter on a muscle cell? [1]

A

CD36

316
Q

Ageing affect on immune system.

Which of the following cell types increases in number with old age?

Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells

A

Ageing affect on immune system.

Which of the following cell types increases in number with old age?

Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells

317
Q

What endocrine disorders might you think about for proprionate short stature? [2]

A

Hypothyroidism
Hypercortisolism

318
Q

What are the pharmacological treatments for ADHD? [2]

A

Methlyphenidate (aka ritalin)
Lisdexamfetamine

319
Q

Describe the indirect pathway of the dorsal ganglia

A

Excitation of dorsal striatum causes the release of dorsal striatum GABA (inhibitory)

This causes projects onto globus pallidus external segment: causes increased inhibition of GPe

This causes the globus pallidus external segment to release inhibitory GABA onto the subthalamic nucleus: causes reduced inhibition of STN

This causes the subthalamic nucleus to release inhibitory GABA onto the globus pallidus internal segment: which increases the activation of GPi

This causes the globus pallidus internal segment to release inhibitory GABA onto the motor thalamus: which creates increased inhibition of motor thalamus

OVERALL DEACTIVATION OF MOTOR THALAMUS -> decreased motor cortex activation.
NO GO pathway.

320
Q

What is the name for this symptom?

Lesions to which region causes this symptom?

Subthalamic nuclei
Substantia nigra
Pre supplementary motor area
Lentiform nucleus
Dorsal striatum

A

athetosis

Lesions to which region causes this symptom?

Subthalamic nuclei
Substantia nigra
Pre supplementary motor area
Lentiform nucleus
Dorsal striatum

321
Q

Which drug used to treat Huntingdons Disease works by the mechanism of action depicted by A? [1]

A

Tetrabenazine

acts primarily as a reversible high-affinity inhibitor of mono-amine uptake into granular vesicles of presynaptic neurons by binding selectively to VMAT-2

322
Q

Alert waking is marked by what type of EEG? [3]

A

Desynchronised

Low amplitude

High frequency

323
Q

Rheumatoid arthritis is an example of a type [] hypersensitivity reaction.

A

Rheumatoid arthritis is an example of a type 3 hypersensitivity reaction.

324
Q

Which one of the following cells secretes the majority of tumour necrosis factor in humans?

Neutrophils

Macrophages

Natural killer cells

Killer-T cells

Helper-T cells

A

Macrophages

325
Q

s part of your full cerebellar and neurological examination for Parkinson’s disease you test for coordination of the lower limbs by asking him to place his right foot on his left knee and then slide the foot down his leg.

What is the most important muscle involved in this action?

Gastrocnemius
Psoas major
Tibialis anterior
Soleus
Sartorius

A

Sartorius

326
Q

Describe the effect of D1 neurones on direct pathway [2]
Describe the effect of D2 neurones on indirect pathway [2]

A

D1 activates the direct pathway: causes more movement (as usually is GO)
D2 inhibits the indirect pathway: causes more movement (as indirect usually causes NO GO)

327
Q

What is the frequency of tremor of PD? [1]

A

Tremor
* most marked at rest, 3-5 Hz

328
Q

What type of rhythm would you expect to see in the EEG of an individual in REM sleep? [1]

A

Beta

329
Q

What effect do benzodiazepines have on the receptors in which they bind to?

  • Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
  • Increase the frequency of channel opening so that potassium ions enter & hyperpolarise the membrane
  • Increase the frequency of channel opening so that sodium ions enter & hyperpolarise the membrane
  • Increase the duration of channel opening so that chloride ions enter & hyperpolarise the membrane
  • Increase the duration of channel opening so that potassium ions enter & hyperpolarise the membrane
A
  • Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
330
Q

Which areas of the brain become hyperactive? [4]

Which areas of the brain become hypoactive [2]

A

Hyperactive:
* amygdala
* hippocampus
* subgenual cingulate cortex
* medial prefrontal cortex

Hypoactive:
* Dorsolateral prefrontal cortex
* ventrolateral prefrontal cortex

331
Q

Which area of the brain the has the biggest increase in DMD during depresision? [1]

A

increased connectivity between DMN and fronto-parietal networks: especially left subgenual cingulate area

332
Q

Which of the following commonly causes damage to axons in the underlying brain

Epidural
Sub dural
Sub arachnoid
Intracranial

A

Sub dural

Blood from the ruptured vessels spreads freely through the subdural space and can envelop the entire hemisphere. Because of the forces involved in producing a subdural haemorrhage, there is very often damage to axons in the underlying brain as well

333
Q

which foramen is this?

Foramen ovale
Foramen spinosum
Internal acoustic meatus
Foramen lacerum
Foreman rotundum

A

Foramen lacerum

334
Q

Which amino acids can undergo this hyperphosphorlation post translational modification of tau? [3]

A

Tyrosine, serine and threonine.

335
Q

which area of the brain would you use DBS to treat treatment resistant depression?

A

subcallosal cingulate

336
Q

Which virus is most commonly linked to a higher risk of developing Burkitt’s lymphoma ?

Epstein- Barr virus

Cytomegalovirus

Herpes simplex virus

HPV 16

HPV 18

A

Epstein- Barr virus

337
Q

What is second line treatment of HER2-positive breast cancer? [2]

A

Trastuzumab - emtansine (Kadcycla)

338
Q

What class of drug is venlafaxine?

SSRI

SNRI

TCA

MAO inhibitor

NARI

A

SNRI

339
Q

What BPM would indicate a foetus had tachycardia? [1]

A

> 160 bpm

340
Q

When ivestigating AD; what sample would you take, what results would you of

A

CSF sample taken

Low levels of amyloid beta

Elevated levels of p-tau

341
Q

What percentage of cancer patients now survive at least 10 years? [1]

A

50%

342
Q

Which type of brain herniation causes ipsilateral mydriasis (pupil dilation)? [1]

A

Uncal

343
Q

which drug for chronic gout catalyses the conversion of uric acid to allantoin? [1]

A

Rasburicase

344
Q

Increased expiration time

Increased tactile fremitus

Wheezing on auscultation

Hyper-expanded chest

Increased respiratory rate

A

Increased tactile fremitus

Tactile/vocal fremitus acts as an indirect measure of the amount of air and the density of tissue present within the lungs. In emphysema, due to the trapping of air and decreased density of the lung parenchyma, tactile fremitus is reduced.

345
Q

An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation.

What enzyme does the drug inhibit?

Protein C1

Epoxide reductase

Gamma-glutamyl carboxylas

CYP2C9

Thrombin

A

An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation.

What enzyme does the drug inhibit?

Epoxide reductase

346
Q

Self-management in the context of chronic
illness refers to:

  1. People not going to the doctor
  2. People attending courses on healthy lifestyles
  3. Health professionals supporting people to self-care
  4. Informal care in the community
  5. People making all their own decisions about how to
    manage their illness
A

Self-management in the context of chronic
illness refers to:

  1. People not going to the doctor
  2. People attending courses on healthy lifestyles
    3. Health professionals supporting people to self-care
  3. Informal care in the community
  4. People making all their own decisions about how to
    manage their illness
347
Q

The bottom 50% of households own
approximately how much of the UK’s wealth?

  1. 5%
  2. 10%
  3. 25%
  4. 40%
  5. 50%
A

The bottom 50% of households own
approximately how much of the UK’s wealth?

  1. 5%
    2. 10%
  2. 25%
  3. 40%
  4. 50%
348
Q

Which of the items below is a key finding of
the Whitehall II study?

  1. Diet affects health outcomes
  2. Smoking affects health outcomes
  3. Social position affects health outcomes
  4. Genetics affect health outcomes
  5. Having a high demand job affects health outcomes
A

Which of the items below is a key finding of
the Whitehall II study?

  1. Diet affects health outcomes
  2. Smoking affects health outcomes
    3. Social position affects health outcomes
  3. Genetics affect health outcomes
  4. Having a high demand job affects health outcomes
349
Q

What measures of location and spread are used in a data contained in normal distribution? [2]

A

Mean and standard deviation

350
Q

What measures of location and spread are used in the presence of outliers in the data? [2]

A

Median and interquartile range [2]

351
Q

How many standard deviations from the mean
(+ and -) is 90%, 95% and 99% of population contained? [3]

A

90%:1.64 SD
95%: 1.96 SD
99%: 2.58 SD

352
Q

How is standard error calculated and when is it used? [2]

A

SE = Standard deviation / sq root (sample size)

It is used as a standard deviation of the distribution of all possible sample means (used when dealing with sampling from the population)

353
Q

How is confidence interval calculated? What does 95% CI = 21.4 to 22.6 mean BMI? [2]

A

95% CI = sample mean =/- 1.96 x standard error

It means that we are 95% sure that in the population the mean BMI can be as low as 21.4 and as high as 22.6.

354
Q

What are the benefits of randomized controlled trial? [1]

A

Avoids selection/allocation bias; make sure participants differ only by the treatment; ensures group receiving treatment is similar to control group

355
Q

What are the types of randomized controlled trial? [4]

A

Parallel group: randomized indiv. Into one of the grps

Crossover: randomized treatment sequence – participants change the treatment half way through

Cluster randomized trials: randomized preexisting grps into one of the two treatments (schools, gp practices, villages)

Factorial: assess 2 interventions using the same number of patients as 1 intervention (25% gets both treatments, 25% A and placebo etc)

356
Q

What is the difference between intention-to-treat and on-treatment analyses? [2]

Which one is better and why? [2]

A

TT: compare all subjects in treatment group regardless of whether they complied and acc took the drug

OT: compare subjects who acc took the treatment

ITT is better as it is a better representation of what would happen in real life

357
Q

When is relative risk statistically significant? [1]

A

When 95% CI for that relative risk excludes 1

358
Q

What would be the relative risk if the treatment didn’t have any effect?

A

RR = 1

359
Q

What is the type of diagram used in meta-analyses? [1]

A

Forest plot

360
Q

What diagram is used to assess publication bias of meta-analyses?

A

Funnel plot

361
Q

How can the absolute excess risk be calculated? [1]

A

Risk in exposed – risk in unexposed

362
Q

What does odds ratio represent in rare disease? How do you calculate it? [1]

A

Relative risk; odds exposure in cases/odds exposure in control

363
Q

How many people in the UK live with chronic illness? [1]

A

15 million

364
Q

What is the main cause of disability in the UK? [1]

A

Arthritis

365
Q

What is control theory used for? [1]

A

Management of chronic illness – focused on quality of life, setting goals, monitoring progress and identification of barriers

366
Q

What is Expert Patient Programme based on? [2]

A

Based on social cognition and social learning theory by Bandura:

  • increase confidence by setting and achieving goals
  • improve quality of life by helping patient feeling more in control of their condition – patients often experts of their condition
367
Q

What is Habitus? [1]

A

Non-conscious bulk of identity (embodied ID) and so conscious change may be challenging to achieve bc of habitus

368
Q

What are three models of stress? [3]
Which is the best? [1]

A

Stress as stimulus (engineering)
Stress as response as response (medicophysioloical)
Stress as transaction (psychological)

transaction between the person and the situation is best understood

369
Q

What are the stages of the General Adaptation Syndrome [3] and who described it?

A

By Selye;
stage 1 – alarm
stage 2 – resistance
stage 3 – exhaustion

370
Q

What type of therapy is used for borderline personality disorder? [1]

A

Dialectical behavior therapy

371
Q

Which type of psychotherapy is based on Freud’s theories? [1]

A

Psychodynamic therapy

372
Q

What are the two adult stages of development? [2]

A

Stage 7: middle of adulthood, generalivity vs stagnation
Stage 8: late adulthood, integrity vs despair

373
Q

The reference range for 95% STD is

mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs

A

The reference range for 95% STD is

mean ± 1.69 SDs
mean ± 1.96 SDs
mean ± 1.64 SDs
mean ± 1.94 SDs
mean ± 2.58 SDs

374
Q

What value is changing between the different colours in this Gaussain Distribution?

Standard error
Standard deviation
Mean
Median
Inter quartile range

A

STD

375
Q

What value is changing between the different colours in this Gaussain Distribution?

Standard error
Standard deviation
Mean
Median
Inter quartile range

A
376
Q

When do you use Pearson vs Spearman correlation? [2]

A

Pearson correlation evaluates the linear relationship between two continuous variables.

Spearman correlation: Spearman correlation evaluates the monotonic relationship.

377
Q

Mann Whitney U test would be used if Gaussian distribution is not followed and for which type of test?

One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test

A

Mann Whitney U test would be used if Gaussian distribution is not followed and instead of which type test

One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test

378
Q

Wilcoxon signed rank test would be used if Gaussian distribution is not followed and for which type of test?

One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test

A

Wilcoxon signed rank test would be used if Gaussian distribution is not followed and for which type of test?

One sample T-test
Paired T-test
Two sample T-test
Equal variance T-test

379
Q

What is the Bem Sex Role Inventory (BSRI)? [1]

A

self-rating inventory of masculine, feminine, and neutral personality characteristics

380
Q

What is CBT based on? [1]

A

Learning theory

381
Q

How can you tell if 95% CI difference for means [1] and for relative risk [1] are significant in a cohort study [2]

A

If 95% CI difference is means includes 0, result is not statisitically significant; if excludes 0 then is sig.

If 95% CI difference is relative risk includes 1, result is not statisitically significant; if excludes 1 then is sig.

382
Q

Odds ratios are used instead of relative risk in which type of trial

cohort trial
case-control trial
randomised control trial
cross sectional trial

A

case-control trial

383
Q

Does exposure to blue asbestos cause lung cancer - What study should you do?

Case-control
Cohort
Clinical trial
Cross-sectional survey

A

Cohort: rare exposure

384
Q

In a randomised controlled trial of preventive PCI versus infarct artery only PCI in patients with ST elevated myocardial infarction, 10% of patients randomised to receive preventive PCI died, and 30% of patients randomised to receive infarct artery only PCI died.

Calculate the number needed to treat (NNT) with preventive PCI to prevent one death. Show your calculations. [1]

A

Absolute difference in risk = 30%-10%=20%
NNT = 100/20= 5

385
Q

Lifestyle behaviours are a major focus of public health campaigns.

Name THREE theories of health behaviour change. [3]

A

Health Belief Model (1 mark)
Theory of Planned Behaviour (1 mark)
Transtheoretical model (Stages of Change) (1 mark)
Social Cognitive Theory (1 mark)
Leventhal’s Self-regulatory theory (1 mark)
Michie’s Behaviour Change Wheel (1 mark)

386
Q

What do A & B represent on this forest plot? [2]

A

A: Result of study
B: 95% CI of result

387
Q

What is the difference in null difference value for OR & RR compared to absolute stastistics like Absolute risk

A

OR or RR have a null effect value of 1.

For absolute statistics like Absolute Risk or ARR or SMD, the null difference value is 0.

388
Q
A
389
Q

Which of the following best describes ‘measure of a statistical accuracy of an estimate’
Standard deviation
Confidence interval
Standard error
Median

A

Standard error

390
Q

One-half of a person’s ability to recover from illness is determined by [] factors? [1]

A

One-half of a person’s ability to recover from illness is determined by socioeconomic factors

391
Q

What is Yentl Syndrome? [1]

A

A phenomenon where if a woman’s symptoms don’t conform to those of men, they are often misdiagnosed and poorly treated (Criado-Perez, 2019)

392
Q

Confidence intervals are a good way to deal with

information bias
selection bias
confounding bias
random error

A

random error

393
Q

P-values are a good way to deal with

information bias
selection bias
confounding bias
random error

A

random error

394
Q

Objective
To assess the impact of breast feeding on the risk of being overweight in children at the time of entry to school

Methods
A group of overweight children were identified when they started school and the same number of normal weight children at the same school were identified.
Their mothers were asked about breastfeeding

Which of the following best describes this trial?

case-control study
cohort study
factorial study
cross sectional study

A

case-control study

Yr 2 EOYS ^2 (42 decks)

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