MET2 Qs Flashcards

Question 1

Q

Which of the following is the EAS?

A
B
C
D
E

Answer

A

Which of the following is the EAS?

A
B
C
D
E

Question 2

Q

Which of the following is the IAS?

A
B
C
D
E

Answer

A

Which of the following is the IAS?

A
B
C
D
E

Question 3

Q

Our first patient was having difficulty swallowing, which nerves mediate the gag reflex?

Hypoglossal, Facial & Vagus?
Vagus and Glossopharnygeal
Vagus only

Answer

A

Our first patient was having difficulty swallowing, which nerves mediate the gag reflex?

Hypoglossal, Facial & Vagus?
Vagus and Glossopharnygeal
Vagus only

Question 4

Q

which nerve provides motor supply to the muscles of mastication?

Mandibular
Glossopharnygeal
Facial
Hypoglossal
Vagus

Answer

A

which nerve provides motor supply to the muscles of mastication?

Mandibular
Glossopharnygeal
Facial
Hypoglossal
Vagus

Question 5

Q

Which cranial nerve provides motor supply to the muscles of mastication? [1]

Answer

A

Acceptable responses: V3, Mandibular nerve, Mandibular

Question 6

Q

Name the 4 muscles of mastication [4]

Which bone do theses muscles directly move? [1]

Answer

A

Temporalis, Masseter, Medial pterygoid and Later pterygoid.

Move the mandible directly

Question 7

Q

The MRI image below shows parotid adenocarcinoma. Which of the following cranial nerve signs would you expect to see in this patient?

Unilateral facial paralysis
Uvular deviation
Reduced facial sensation
Bitemporal heminaopia

Answer

A

The MRI image below shows parotid adenocarcinoma. Which of the following cranial nerve signs would you expect to see in this patient?

Unilateral facial paralysis
Uvular deviation
Reduced facial sensation
Bitemporal heminaopia

Despite not innervating the Partoid glad the Facial nerve runs through the gland. This relationship is important as swelling or surgery on the parotid gland can compress facial nerve branches

Question 8

Q

The motor innervation for the constrictor muscles is provided by which nerve?

Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII)

Answer

A

The motor innervation for the constrictor muscles is provided by which nerve?

Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII)

Question 9

Q

When pharyngeal of swallowing occurs, how does the pharynx’s structure change? [2]

Which two muscles cause the larynx to elevate? [2]

Answer

A

The pharynx widens and shortens to receive the bolus of food as the suprahyoid and longitudinal pharyngeal muscles contract elevating the larynx.

Question 10

Q

Pharyngeal muscle is [] muscle and therefore receives a [] supply.

Answer

A

Pharyngeal muscle is skeletal muscle and therefore receives a somatic supply.

Question 11

Q

As the food bolus is pushed into the pharynx the epiglottis of the larynx is pulled inferiorly to prevent food being aspirated.

Which nerve is responsible for closure of the larynx?

Superior laryngeal nerve
Recurrent laryngeal nerve
Glossopharnygeal nerve
Vagus nerve

Answer

A

As the food bolus is pushed into the pharynx the epiglottis of the larynx is pulled inferiorly to prevent food being aspirated.

Which nerve is responsible for closure of the larynx?

Superior laryngeal nerve
Recurrent laryngeal nerve
Glossopharnygeal nerve
Vagus nerve

As the recurrent laryngeal nerve innervates all muscles of the larynx (except cricothyroid) it is responsible for the closure during swallowing.

Question 12

Q

What are the 3 oesophageal sphincters

Answer

A

External OS:
Arch of aorta and left main bronchus pass over the O
Lower OS

Question 13

Q

Which nerve provides motor supply to the oesophagus? [1]

Answer

A

Acceptable responses: Vagus, Vagus nerve, CN X, X, cranial nerve 10

Question 14

Q

The openings at each end of the inguinal canal are the [] ring and the [] ring.

Answer

A

The openings at each end of the inguinal canal are the deep (internal) ring and the superficial (external) ring.

Question 15

Q

What structure is this arrow pointing at? [1]

Answer

A

Inferior epigastric vessels [1]

Question 16

Q

What does this arrow point to? [1]

Answer

A

Linea alba

Question 17

Q

Damage to the recurrent LN causes what effect?

Damage to the external LN causes what effect?

Answer

A

Damage to the recurrent LN causes what effect?
Horseness

Damage to the external LN causes what effect?
Monotone

Question 18

Q

What is the structure of gallbladder cells?

Simple columnar
Simple squamous
Simple cuboidal
Stratified columnar
Stratified squamous

Answer

A

What is the structure of gallbladder cells?

Simple columnar: very tall !!
Simple squamous
Simple cuboidal
Stratified columnar
Stratified squamous

Question 19

Q

Gallbladder constriction is caused by secretion of which hormone? [1]

Question 20

Q

Which pro-inflam makers are produced when cirrhosis occurs? [3]

Answer

A

Chronic inflammation (TNF alpha, TGF beta, IL1 from Kupffer cells, endothelial cells, bile duct cells and hepatocytes)

Question 21

Q

AST > ALT indicates what cause of liver disease?

Alcohol
Fat / Metabolic Syndrome
Biliary Disease
Autoimmune
Viral Hepatitis

Answer

A

AST > ALT indicates what cause of liver disease?

Alcohol
Fat / Metabolic Syndrome
Biliary Disease
Autoimmune
Viral Hepatitis

Question 22

Q

A patient coughing up sputum that grows acid-fast bacilli that stains red with Zeihl-Neelsen staining. What is the bacilli?

Answer

A

This is mycobacterium tuberculosis and the diagnosis is TB.

Question 23

Q

Which stage of shock would you see elevated lactic acid?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see elevated lactic acid?

Initial
Compensatory
Progressive
Refractory

Question 24

Q

Which stage of shock would you see altered level of consciousness?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see altered level of consciousness?

Initial
Compensatory
Progressive
Refractory

Question 25

Q

Which stage of shock would you see altered level of resp acidosis?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see altered level of resp acidosis?

Initial
Compensatory
Progressive
Refractory

Question 26

Q

Which stage of shock would you see increased aldoesterone?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see increased aldoesterone?

Initial
Compensatory
Progressive
Refractory

Question 27

Q

Which stage of shock would you see increased SNS activated?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see increased SNS activated?

Initial
Compensatory
Progressive
Refractory

Question 28

Q

Which stage of shock would you see cellular death ?

Initial
Compensatory
Progressive
Refractory

Answer

A

Which stage of shock would you see cellular death ?

Initial
Compensatory
Progressive
Refractory

Question 29

Q

Where is T4 converted to T3? [1]

Question 30

Q

Liquorice can induce HTN - but what is the mechanism?

Inhibition of 5 alpha reductase
Augmentation of aldoseterone synthase
Inhibitition of 11 beta HSD2
21 hydroxylase inhibition

Answer

A

Liquorice can induce HTN - but what is the mechanism?

Inhibition of 5 alpha reductase
Augmentation of aldoseterone synthase
Inhibitition of 11 beta HSD2
21 hydroxylase inhibition

Converts cortisol to cortisone.

Question 31

Q

The synthetic replacement for aldosterone is known as? [1]

Answer

A

Fludrocortisone

Question 32

Q

The synthetic replacement for cortisol is known as? [1]

Answer

A

hydrocortisone

Question 33

Q

Overtreament with hydrocortisone replacement may lead to what? [4]

Answer

A

Cushings syndome:

Hypokalameia (lose K, retain HCO3-)
Weight gain
Skin thinning
Met. alkalosis

Question 34

Q

Exopthalmus is associated with which disease? [1]

Answer

A

Graves disease

Question 35

Q

Which drug would you use to test if have Cushings disease? [1]

Answer

A

Dexamethasone: give and should reduce

Question 36

Q

Peripheral tremor, palpitations and weight loss are associated with which of the following endocrinopathies?

Graves
Panhypopituitarism
Hypercalcemia
MEN1 Syndrome

Answer

A

Peripheral tremor, palpitations and weight loss are associated with which of the following endocrinopathies?

Graves
Panhypopituitarism
Hypercalcemia
MEN1 Syndrome

Question 37

Q

Which drugs are mainstay of Graves disease treatment? [2]

Answer

A

Propylthiouracil
Carbimazole

Question 38

Q

Urinary metanepharines are used in diagnosis of which disease?

Answer

A

Paragangliomas

Question 39

Q

Flusing, watery diarrhoea and wheeze are suggestive of which endocrinopathy?

Graves
Pituitary macroadenoma
Ectopic ACTH production
Carcinoid syndrome

Answer

A

Flusing, watery diarrhoea and wheeze are suggestive of which endocrinopathy?

Graves
Pituitary macroadenoma
Ectopic ACTH production
Carcinoid syndrome

Question 40

Q

PYY is released by:

Islet of Langerhan D cells
Islet of Langerhan A cells
Islet of Langerhan B Cells
Intestinal L cells
Stomach A cells

Answer

A

PYY is released by:

Islet of Langerhan D cells
Islet of Langerhan A cells
Islet of Langerhan B Cells
Intestinal L cells
Stomach A cells

Question 41

Q

Oxontymodulin works by decreasing the level of which hormone:

Insulin
Glucagon
Ghrelin
Leptin
PYY

Answer

A

Oxontymodulin works by decreasing the level of which hormone:

Insulin
Glucagon
Ghrelin
Leptin
PYY

Question 42

Q

Which hormone is the major peripheral orexigenic hormone?

Insulin
Glucagon
Ghrelin
Leptin
PYY

Answer

A

Which hormone is the major peripheral orexigenic hormone?

Insulin
Glucagon
Ghrelin
Leptin
PYY

Question 43

Q

Which cells secretes the major peripheral orexigenic hormone?

Islet of Langerhan D cells
Islet of Langerhan A cells
Islet of Langerhan B Cells
Intestinal L cells
Stomach A cells

Answer

A

Which cells secretes the major peripheral orexigenic hormone?

Islet of Langerhan D cells
Islet of Langerhan A cells
Islet of Langerhan B Cells
Intestinal L cells
Stomach A cells

Question 44

Q

At which nucleus are the POMC, CART, NPY and AGrP located?

Paraventricular nucleus
Supraventricular Nucleus
Nucleus solitary Tract
Arcuate Nucleus

Answer

A

At which nucleus are the POMC, CART, NPY and AGrP located?

Paraventricular nucleus
Supraventricular Nucleus
Nucleus solitary Tract
Arcuate Nucleus

Question 45

Q

Which receptor mediates the effect of PYY most strongly?

Y1
Y2
Y3
Y4
Y5

Answer

A

Which receptor mediates the effect of PYY most strongly?

Y1
Y2
Y3
Y4
Y5

Question 46

Q

POMC/CART neurones in arcuate nucleus of hypothalamus cause the release of which hormone? [1]

Answer

A

α-melanocortin-stimulating hormone (α-MSH)

Question 47

Q

Vagal-Brain pathway is mediated by stimulation of which of the following by the Vagus Nerve?

Paraventricular nucleus
Supraventricular Nucleus
Nucleus solitary Tract
Arcuate Nucleus

Answer

A

Vagal-Brain pathway is mediated by stimulation of which of the following by the Vagus Nerve?

Paraventricular nucleus
Supraventricular Nucleus
Nucleus solitary Tract
Arcuate Nucleus

Question 48

Q

Which of the following is 4?

Vagus Nerve
Superior Laryngeal Nerve
External Laryngeal Nerve
Recurrent Laryngeal Nerve
Internal Laryngeal Nerve

Answer

A

Which of the following is 4?

Vagus Nerve
Superior Laryngeal Nerve
External Laryngeal Nerve
Recurrent Laryngeal Nerve
Internal Laryngeal Nerve

Question 49

Q

Rectal varices can occur because of portal hypertension affecting which two veins?

Inferior mesenteric and external iliac vein
Inferior mesenteric and internal iliac vein
Superior mesenteric and external iliac vein
Superior mesenteric and internal iliac vein

Answer

A

Rectal varices can occur becuase of portal hypertension affecting which two veins?

Inferior mesenteric and external iliac vein
Inferior mesenteric and internal iliac vein
Superior mesenteric and external iliac vein
Superior mesenteric and internal iliac vein

Question 50

Q

Oespheogeal varices can occur because of portal hypertension affecting which two veins? [2]

Answer

A

Azygous and splenic veins

Question 51

Q

Umbil

Question 52

Q

Label A-E

Answer

A

A: pineal gland
B: interthalamic adhesion
C: sphenoid bone
D: infundibulum
E: hypothalamus

Question 53

Q

Which of the following is responsible for melatonin & therefore circadiuan rhythm

A
B
C
D
E

Answer

A

Which of the following is responsible for melatonin & therefore circadiuan rhythm

A
B
C
D
E

Question 54

Q

Look at this midsagittal slice taken from an MRI scan of the brain below. Which structure looks enlarged?

Hypothalamus
Pituitary
Thalamus
Pineal gland

Answer

A

Look at this midsagittal slice taken from an MRI scan of the brain below. Which structure looks enlarged?

Hypothalamus
Pituitary
Thalamus
Pineal gland

The pituitary gland appears moderately enlarge. Here, we can see it filling the sella turcica, and we can see the hypothalamus displaced superiorly

The hypothalamus itself appears normal, as do the thalamus and pineal gland, which are just about visible.

Question 55

Q

Question 56

Q

Which brain structure is responsible for regulating anterior pituitary hormone synthesis? [1]

Answer

A

Acceptable responses: hypothalamus

The hypothalamus regulates the production of anterior pituitary hormones by releasing hypothalamic hormones into the hypothalamo-pituitary portal circulation.

Note that the pituitary releases its hormones into the systemic circulation via the hypophyseal veins.

Question 57

Q

Which bone must be drilled through in pituitary surgery?

Ethmoid
Frontal
Temporal
Sphenoid

Answer

A

Which bone must be drilled through in pituitary surgery?

Ethmoid
Frontal
Temporal
Sphenoid

This operation is known as transnasal, transsphenoidal hypophysectomy. An endoscope is passed into the nasal cavity, the mucosa is stripped away from the bone, and the surgeon drills through the sphenoid bone to visualise the pituitary from below. The procedure has revolutionised pituitary surgery, as it was previously very difficult to access the pituitary.

Question 58

Q

During a thryroidectomy the recurrent laryngeal nerve is damaged.

How would you expect this present in the patient?

Hoarse voice
Aphonic
Monotonous voice

Answer

A

During a thryroidectomy the recurrent laryngeal nerve is damaged.

How would you expect this present in the patient?

Hoarse voice
Aphonic
Monotonous voice

The recurrent laryngeal nerve innervates the muscles of the larynx (apart from cricothyroid). Damage to one nerve results in a hoarse voice, and damage to both would result in aphonia

Question 59

Q

Label 1-5

Answer

A

1: omohyoid
2: sternohyoid
3: thyroid gland
4: recurrent laryngeal nerve
5: superior thyroid artery

Question 60

Q

A 35 year old male presents with a left cervical mass, that had grown within about 8 weeks. His MRI is shown below.

Based on this, what signs would you expect his to present with?

Hoarse voice
Dysphagia
Dyspnea

Answer

A

A 35 year old male presents with a left cervical mass, that had grown within about 8 weeks. His MRI is shown below.

Based on this, what signs would you expect his to present with?

Hoarse voice
Dysphagia
Dyspnea

Question 61

Q

Which adrenal gland is pyramidal?

Left
Right

Answer

A

Which adrenal gland is pyramidal?

Left
Right

Question 62

Q

Question 63

Q

Brian has an abdominal examination. Which of the following statements best describes a normal Liver examination?

A healthy liver is not easily palpable
A healthy liver can be palpated during expiration only
The Liver is palpated most easily posteriorly

Answer

A

Brian has an abdominal examination. Which of the following statements best describes a normal Liver examination?

A healthy liver is not easily palpable
A healthy liver can be palpated during expiration only
The Liver is palpated most easily posteriorly

Question 64

Q

The liver has an anterior/superior surface and an inferior/visceral surface. It is divided into 4 lobes. Remind yourself of the lobes on the flashcards below.

Answer 59

A

Which structure separates the left lobe from the quadrate lobe?

Gall bladder
Ligamentum teres
IVC
Falciform ligament

The ligamentum teres (round lig of liver) runs between the left and quadrate lobes.

Answer 60

A

Acceptable responses: umbilical vein, left umbilical vein

Answer 61

A

Which structures are within the Porta hepatis?

Hepatic artery proper
Common hepatic artery
Hepatic vein
Hepatic portal vein
Common bile duct

Answer 62

A

Which blood vessel provides 75% of the blood supply for the Liver

Hepatic artery proper
Common hepatic artery
Hepatic vein
Hepatic portal vein
Common bile duct

Answer 63

A

Brian has right sided heart failure. Into which vessels will blood back up?

Pulmonary trunk
Pulonary veins
IVC
SVC

Answer 64

A

Acceptable responses”: Answer 1, Enlarged IVC, Dilated IVC, Enlarged Inferior vena cava, Dilated inferior vene cava

Answer 65

A

Which of the following transports iodine out of the follicular cell into the colloid

NIS
PDS:
DUOX2
TPO
IYD
TSHR

Answer 66

A

Which of the following allows iodine to react with H2O2, allowing it bind it to Tyroglobulin

NIS
PDS
DUOX2
TPO
IYD
TSHR

Answer 67

A

21-hydroxylase

Answer 68

A

Pretibial myxoedema
Exophthalmos
Diffuse goitre (without nodules)

Answer 69

A

Carbimazole is the first line anti-thyroid drug
Propylthiouracil is the second line anti-thyroid drug.

Answer 70

A

Which one of the following features is most commonly seen with hypothyroidism?

Weight loss
Constipation
Pretibial myexoedma
Palpitations

Answer 71

A

Which one of the following features is most commonly seen with thyrotoxicosis?

Constipation
Atrial fibrillation
Decreased tendon reflexes
Lethargy

Answer 72

A

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein: goes into portal vein
Left gastro-omental vein

Answer 73

A

A 40-year-old woman presents with lethargy, weakness and weight loss. On examination her blood pressure is 80/50 mmHg and there is hyperpigmentation of the skin.

What is likely disease?

Addisons
Cushings
Hashimotos
Graves

Answer 74

A

Which one of the following is most characteristically caused by thiazides?

Hypocalcemia
Hypercalcemia
Hyperkalemia
Hypernatremia

Answer 75

A

Thiazide duiretics primarily work at:

PCT
LoH
DCT
CD

Answer 76

A

One important adverse effect of long-term thiazide use is loss of potassium resulting in hypokalaemia.

Answer 77

A

Blocks NaKCl2: less Na reabsorbed into blood, so more water excreted into kidney

Answer 78

A

Blocks MR receptor: aldosterone antagonist

Causes less Na reabsorbtion

Answer 79

A

Proinsulin –> Insulin and C-peptide

Therefore if have low C-peptide levels, indicates that habe low insulin too and therefore DMT1

Answer 80

A

11β-HSD1 converts inactive cortisone into cortisol
11β-HSD2 inactivates cortisol to cortisone

Answer 81

A

Which scoring system would you used to indicate someone has a decomponsated liver

Wells
STAMP
Child-Pugh: > 7
MUST

Answer 82

A

Which of the following is located outside of the external spermatic fascia

Vas deferens
Cremaster muscle
Genitofemoral nerve
Testicular vessels
Ilioinguinal nerve

Answer 83

A

What structure is found at the mid point of the inguinal ligament?

Femoral artery
Femoral vein
Deep inguinal ring
Superficial inguinal ring

Answer 84

A

alpha intercalated cells of CD

Answer 85

A

A: Infindibulum
B: Anterior lobe
C: Hypothalamus
D: Posterior lobe

Answer 86

A

CN4 – trochlear
CN V1 & V2 - trigeminal (opthalmic and maxillary)
CN 6 - abudecens
ICA

Answer 87

A

What is the embryonic origin of the adrenal cortex?

Neural crest cells
Mesoderm
Midgut
Ectoderm

Answer 88

A

‘B’ represents the zona fasiculata, which produces and secretes corticosteroids such as cortisol.

Answer 89

A

Testosterone: sexual characteristics

Cortisol: stress response

Aldosterone: regulation of sodium

Answer 90

A

A: cortex
B: zona glomerulosa
C: zona fasciculata
D: zona reticularis
E: medulla

Answer 91

A

Which of the following produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids.

A
B
C
D: zona reticularis
E

Answer 92

A

Which of the following produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids.

A
B
C
D
E

Answer 93

A

Which of the following secrete adrenaline?

A
B
C
D
E

Answer 94

A

Which of the following secretes aldosterone?

A
B: zona glomerulosa
C
D
E

Answer 95

A

Which of the following secretes cortisol?

A
B
C : zona fasciculata
D
E

Answer 96

A

Right and left adrenal veins drain the glands.
The right adrenal vein drains into the inferior vena cava
The left adrenal vein drains into the left renal vein.

Answer 97

A

A: Thyrohyoid
B: Sternothyroid
C: Omohyoid
D: Sternohyoid

Answer 98

A

C5-T1

Sits on Cricoid cartilage

Answer 99

A

A: External carotid artery
B: Superior thyroid artery
C: Left parathyroid glands
D: Inferior thyroid artery
E: Thyrocervical trunk
F: Recurrent laryngeal nerve
G: Right parathryoid artery

Answer 100

A

A: Vagus nerve
B: Superior laryngeal nerve
C: Internal branch, superior laryngeal nerve
D: External branch, superior laryngeal nerve

Answer 101

A

A: superior thyroid artery (from external carotid artery)

B: Inferior thyroid artery (from tyrocervical trunk)

C: Thyroid IMA artery (from brachiocephalic trunk)

Answer 102

A

A: IJV
B: Superior thyroid vein
C: middle thyroid vein
D: inferior thyroid vein
E: cricothryoid ligament

Answer 103

A

Parathyroid glands release parathyroid hormone, which mediates the release of which ion?

K+
Ca2+
NADH
Na+
Cl-

Answer 104

A

Thyroid IMA: because is so variable

Can cause post op. haemorrage which compresses the trachae

Answer 105

A

Which of the following is the splenic vein?

A
B
C
D
E

Answer 106

A

Which of the following is the inferior pancreatoduodenal vein?

A
B
C
D
E
F

Answer 107

A

Which of the following is the superior pancreatoduodenal vein?

A
B
C
D
E
F

Answer 108

A

Which of the following is the portal vein?

A
B
C
D
E
F

Answer 109

A

Which of the following is the Which of the following is the inferior mesenteric vein?
vein?

A
B
C
D
E
F

Answer 110

A

Above: SMA
Below: SMV

Answer 111

A

Which of the following is the superior mesenteric vein?

A
B
C
D
E

Answer 112

A

The superior, middle and inferior thyroid veins are responsible for the venous drainage of the thyroid gland. Where does the inferior thyroid vein empty into?

External jugular vein

Internal jugular vein

Brachiocephalic vein

Facial vein

Answer 113

A

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion?

Branchial cyst

Thyroid nodule

Cystic hygroma

Thyroglossal cyst

Answer 114

A

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion?

Branchial cyst

Thyroid nodule

Cystic hygroma

Thyroglossal cyst

Answer 115

A

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion?

Branchial cyst

Thyroid nodule

Cystic hygroma

Thyroglossal cyst

Answer 116

A

Which organ secretes calcitonin?

Kidney
Thyroid
Parathyroid
Thymus

Calcitonin is secreted by the thyroid glands. The synthesis of calcitriol is completed in the kidneys. Parathyroid hormone is secreted by the parathyroid glands. The thymus secretes thymosin, a hormone necessary for T cell development.

Answer 117

A

Which of the following is synthesised by intestinal epithelial cells?

Calcitriol
Calbindin-D
Vitamin D3
24,25-Dihydroxycholecalciferiol

Once synthesised, calcitriol is released into the bloodstream. It then stimulates intestinal epithelial cells to increase the synthesis of calbindin-D proteins. Calbindin-D proteins increase the intestinal absorption of calcium by facilitating the transport of calcium from the intestinal brush border to the basolateral membrane, where it is released into the bloodstream.

Answer 118

A

Lopez presented to his primary care physician complaining of numbness around his mouth and a tingling sensation in his hands and feet. Blood tests were ordered which revealed that his blood calcium levels were decreased. In physiological response to this, which hormone would typically be released to raise blood calcium levels?

Insulin
Thyroxine
Calcitonin
Parathyroid Hormone

Answer 119

A

What type of cells secrete parathyroid hormone?

Beta cells
Chief cells
Chromaffin cells
Parafollicular cells: secrete calcitoncin which reduces Ca2+ levels

Answer 120

A

Patients with hypocalcaemia can develop cardiac arrhythmias. Specifically, patients can develop prolonged QT intervals on an ECG. What causes this?

An increase in the resting membrane potential, rendering the cell hyper-excitable

An increase in the resting membrane potential, rendering the cell hypo-excitable

A decrease in the resting membrane potential, rendering the cell hyper-excitable

A decrease in the resting membrane potential, rendering the cell hypo-excitable

Answer 121

A

Which of the following can cause hypocalcaemia?

Hyperparathyroidism

Respiratory alkalosis

Thiazide diuretics

Vitamin D intoxication

Answer 122

A

Which hormones are secreted when blood calcium levels fall?

Parathyroid hormone and calcitonin

Parathyroid hormone and calcitriol

Calcitriol only

Calcitonin only

Answer 123

A

Which of the following can cause hypercalcaemia?

Hypoparathyroidism

Hyperphosphatemia

Vitamin D deficiency

Thiazide diuretics

Answer 124

A

Which of the following can cause hypercalcaemia?

Hypoparathyroidism

Hyperphosphatemia

Vitamin D deficiency

Thiazide diuretics

Answer 125

A

What are the main secretory cells of the adrenal medulla?

Chief cells

Juxtaglomerular cells

Chromaffin cells

Kupffer cells

Answer 126

A

What is the general mechanism for release of adrenaline from the adrenal medulla?

Stimulation of Chromaffin cells by a protein-based stimulating hormone

Stimulation of Chromaffin DNA transcription by steroid-based stimulating hormone

Stimulation of Chromaffin cells by sympathetic nervous system directly

Mechanism unknown

Answer 127

A

Which of the following is a symptom of phaechromocytoma?

Hypotension

Hypertension

Hypoglycaemia

Exophthalmos

Answer 128

A

Which enzyme catalyses the final step on the synthesis pathway for cortisol?

3β-hydroxysteroid dehydrogenase

11β-hydroxylase

21β-hydroxylase

17,20-lyase

Answer 129

A

Which enzyme catalyses the final step on the synthesis pathway for cortisol?

3β-hydroxysteroid dehydrogenase

11β-hydroxylase

21β-hydroxylase

17,20-lyase

Answer 130

A

Which of the following best describes the primary function of the Zona Glomerulosa?

Breakdown of aldosterone

Synthesis of testosterone

Synthesis of mineralocorticoids

Storage of adrenaline

Answer 131

A

Which of the following best describes the primary function of the Zona Glomerulosa?

Breakdown of aldosterone

Synthesis of testosterone

Synthesis of mineralocorticoids

Storage of adrenaline

Answer 132

A

Which of the following best describes the primary function of the Zona Glomerulosa?

Breakdown of aldosterone

Synthesis of testosterone

Synthesis of mineralocorticoids

Storage of adrenaline

Answer 133

A

Which of the following would produce an increase in the rate of aldosterone production?

Increase in plasma pH (becomes more alkaline)

Decrease in potassium ion concentation

Increase in plasma Angiotensin-II

All of the above

Answer 134

A

Conn’s syndrome is characterised by…

Excess adrenaline secretion

Excess ADH secretion

Insufficient aldosterone secretion

Excess aldosterone secretion

Answer 135

A

Which layers of the adrenal gland book-end the Zona Reticularis?

Zona Fasiculata & Zona Glomerulosa

Zona Glomerulosa & Medulla

Zona Fasiculata & Medulla

Zona Fasiculata & Cortex

Answer 136

A

Where are androgens such as DHEA converted to testosterone and oestrogen?

Adrenal Medulla

Liver

Gonads

Kidney

Answer 137

A

Bronzing of the palmar creases in Addison’s disease occurs by which mechanism?

Increased production of POMC leads to increased production of ACTH and MSH which stimulates pigmentation

The adrenal cortex produces decreased amounts of cortisol which causes direct disinhibition of melanin production

Melanin production is stimulated by pituitary hormones that mimic the action of MSH

In Addison’s, excess cortisol production causes the hypothalamus to signal to the skin to produce more melanin

Answer 138

A

In an abnormal short synACTHen test, which result is most definitive of Addison’s disease?

Raised cortisol at baseline

Low cortisol at baseline

Low cortisol 2 hours post ACTH administration

Raised ACTH at baseline

Answer 139

A

Cortisol exerts its effects by which mechanism?

Binding to plasma membrane receptors

Stimulating a chaperone to bind to an intracellular receptor

Binding to two GRs before translocating to the nucleus

Dissociating with glucocorticoid response elements within the nucleus

Answer 140

A

The hypothalamus secretes which hormone in the HPT axis?

Thyroid stimulating hormone (TSH)

Thyroid inhibitory hormone (TIH)

Triiodothyronine (T3)

Thyrotrophin releasing hormone (TRH)

Answer 141

A

What are the main direct actions of growth hormone?

Lipolysis, stem cell differentiation, protein synthesis

Carbohydrate oxidation, protein synthesis

Stem cell differentiation, glycogenolysis, lipolysis

Lipolysis, protein synthesis, protein synthesis

Answer 142

A

Which of the following symptoms best describes GH deficiency?

Reduced bone mass, lack of energy, increased mood, arrhythmias

Arrhythmias, lower muscle mass, reduced energy, low mood

Low mood, anxiety, fibromyalgia, reduced energy, arrhythmias

Increased muscle mass, arrhythmias, increased energy, low mood

Answer 143

A

Osteocytes secrete which of the following involved in Ca homeostasis

Calcitriol
Vit D
FGF23: reduces serum P levels
PTH
1 alpha hydroxylase

Answer 144

A

Which pathology of the thyroid is depicted here?

Graves disease
Thyroiditis
Hashimoto’s disease: can see lymphotcyte infiltration
Thyroid adenoma

Answer 145

A

Where is a kidney stone in theis imaging?

Uteropelvic junction
Pelvic inlet
Uterovesical junction

Answer 146

A

Where is a kidney stone in theis imaging?

Uteropelvic junction
Pelvic inlet
Uterovesical junction

Answer 147

A

Where is a kidney stone in theis imaging?

Uteropelvic junction
Pelvic inlet
Uterovesical inlet

Answer 148

A

Renal pelvis

Answer 149

A

A: Renal artery
B: Segmental arteries
C: Interlobar arteries
D: Arcuate arteries
E: Interlobal arteries

Answer 150

A

A: Afferent arterioles
B: Glomerulus
C: Efferent arterioles
D: Peritubular capillaries / vasa recta

Answer 151

A

Renal Angle [1]
Junction of 12th rib and lateral border of erector spinal [1]

Answer 152

A

Potential space that separates the liver and the right kidney [2]

Answer 153

A

A: Right suprarenal gland
B: liver
C: duodenum
D: right colic flexure
E: small intestines

Answer 154

A

Which is the only nerve of the lumbar plexus that passes through the psoas major? [1]

Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous nerve
Femoral nerve

Answer 155

A

A: perinephtic fat
B: renal fascia
C: paranephric fat

Answer 156

A

The renal fascia, commonly known as Gerota’s fascia, is a collagenous connective tissue sheath which separates the perirenal fat from the pararenal fascia

Answer 157

A

A: renal pyramid
B: major calyx
C: minor calyx
D: renal pelvis
E: ureter

Answer 158

A

left gonadal (ovarian/testicular) vein,
left inferior phrenic vein
left adrenal veins.

Answer 159

A

A: Ultrapelvic junction
B: Pelvic inlet
C: Uterovesical junction

Answer 160

A

A: trigone of bladder
B: prostatic urethra
C: urethretic oriface
D: detrusor muscle
E: vas deferes

Answer 161

A

IUS and EUS are either side of prostate

Answer 162

A

A: prostatic urethra
B: membranous urethra
C: penile urethra
D: bulbar urethra

Answer 163

A

What structures have been injured?
capsule / segmental arteries

Why flank pain?
referred pain from visceral afferents sensed at flank dermatomes

Why is the blood confined to the left?
renal fascia

Why haematuria?
Rupture of renal pelvis

Answer 164

A

Explain the following:
1. Pain occurring in ‘waves’
2. Location of stone
3. Radiation of pain to groin

Answer 165

A

In a storage vesicle containing endogenous insulin, what is the ratio of insulin to free c-peptide?

1:1

2:1

3:1

1:2

Answer 166

A

Which of the following best describes the mechanism by which insulin allows cells to uptake glucose?

Activation of GLUT4 receptors

Upregulation of DNA transcription of GLUT4 receptors

Activation of insulin receptor’s integrated tyrosine kinase

Cooperative diffusion of glucose with insulin

Answer 167

A

Which of the following hormones promotes gluconeogenesis?

Cortisol

Insulin

Pyruvate

Acetyl-CoA

Answer 168

A

After how many hours of fasting does gluconeogenesis begin?

8 hours

4 hours

24 hours

12 hours

Answer 169

A

What causes inhibition of fatty acid oxidation in alcohol abuse?

Decreased NADH levels

Excess NADH levels

Decreased ATP levels

Increased NAD+ levels

Answer 170

A

What molecule is depleted in alcohol abuse?

Lactate

GTP

NADH

Pyruvate

Pyruvate is depleted in alcohol abuse, whereas NADH is in excess.

Answer 171

A

DMT1
LADA (Late autoimmune diabetes

Answer 172

A

Short / Fast acting: Humalog
Long acting: Glargine

Answer 173

A

Which of the following drug treatments for diabetes utilise the followng mechanism of actions?

Inhibits liver gluconeogenesis and enahnaces insulin sensitivity

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors
Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 174

A

Which of the following drug treatments for diabetes utilise the followng mechanism of actions?

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors
Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Bind and close K+ channel in beta cells to
depolarise the cell and release insulin

Answer 175

A

Which of the following drug treatments for diabetes utilise the followng mechanism of actions?

Activate PPARγ to reduce insulin insensitivity and better glucose use via gene expression changes

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors
* Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 176

A

Which of the following drug treatments for diabetes causes weight loss?

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors: excreting glucose
Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 177

A

Which of the following drug treatments for diabetes causes weight gain? [2]

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors
Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 178

A

Which of the following has similar action to prandial glucose regulators?

Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide
Metformin
SGLT2 Inhibitors
Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 179

A

arachidonic acid is which type of omega fatty acid?

omega 2 fatty acid
omega 3 fatty acid
omega 4 fatty acid
omega 5 fatty acid
omega 6 fatty acid

Answer 180

A

Phospholipase A2

Answer 181

A

Flavinoids are important because they reduce inflammatory enzymes such as NADPH oxidase

Answer 182

A

Which of the following is the action of PYY?

Inhibits excitatory appetite neurones

Stimulates excitatory appetite neurones

Inhibits inhibitory appetite neurones

None of the above

Answer 183

A

Which of these transmitters is stimulatory for appetite?

NPY

POMC

a-MSH

CART

Answer 184

A

Which structure in the hypothalamus is a key player in appetite control?

Preoptic nucleus

Supraoptic nucleus

Arcuate nucleus

Lateral nucleus

Answer 185

A

Which hormone may be deficient in a patient with severe obesity, hyperphagia, and a reduced metabolic rate?

Ghrelin

Insulin

Leptin

PYY (peptide tyrosine tyrosine)

Answer 186

A

Release of which of the following substances is inhibitory for appetite?

Ghrelin

AgRP (Agouri-related peptide)

NPY (Neuropeptide Y)

CART

Answer 187

A

Alpha-MSH and Beta-endorphin may be produced from which neurotransmitter?

CART (cocaine- and amphetamine regulated transcript)

POMC (pro-opiomelanocortin)

NPY (Neuropeptide Y)

AgRP (Agouri-related peptide)

Answer 188

A

A 50-year-old woman with a BMI of 39 presents with her son. The son says that her mother just cannot stop eating and would like to explore various treatment options to curtail her eating habits. The woman’s history is significant for severe hypertension and diabetes mellitus. A resistance in which of the following hormones is most likely responsible for his mother’s presentation?

A. Ghrelin
B. Leptin
C. Cholecystokinin
D. Secretin

Answer 189

A

A 5-year-old male is brought to the clinic by his mother for evaluation of his growth. The patient is in the 10th percentile for height and weight, with an otherwise normal physical evaluation. Which of the following plays a role as a growth hormone-releasing peptide and may be deficient in this child?

A. Cholecystokinin
B. Leptin
C. Ghrelin
D. Hormone peptide YY

Answer 190

A

L cells in GI tract produce:

Cholecystokinin
Leptin
Ghrelin
Hormone peptide YY

Answer 191

A

A 35 year old female is 4 weeks post-partum and presents with a 3 day history of progressively worsening right upper quadrant pain that radiates to her shoulder, and is worse after eating particularly fatty food. She occasionally has nausea and vomiting after meals. She denies any fevers or malaise. She notes that she had gallstones incidentally found on an ultrasound in the past, but they have never bothered her before. What has likely changed to make her asymptomatic gallstones now symptomatic?

Gallstones are seeded with intestinal bacteria

Gallstones have likely increased in size and number

Gallstones have migrated into the common hepatic duct

Gallstones are now obstructing the cystic duct causing gallbladder distention

Answer 192

A

A: Left lobe
B: Right lobe
C: Quadrate lobe
D: Caudate lobe

Answer 193

A

Which of the following is hepato-renal recess?

A
B
C
D
E
F

Answer 194

A

A: Falciform ligament
B: Right subphrenic space
C: epiploic foramen
D: hepato-renal reccess
E: subphrenic space
F: lesser sac

Answer 195

A

A: Anterior coronary ligament
B: Falciform Ligament
C: Round ligament of the liver / ligamentum teres

Answer 196

A

A: Right triangular ligament
B: Posterior coronary ligament
C: Left triangular ligament
D: Falciform ligament
E: Anterior coronary ligament

Answer 197

A

Which of the following is the quadrate lobe?

A
B
C
D
E
F

Answer 198

A

Which of the following is the ligamentum teres ?

A
B
C
D
E
F

Answer 199

A

Which of the following is the ligamentum venosum ?

A
B
C
D
E
F

Answer 200

A

Which of the following is the caudate lobe ?

A
B
C
D
E
F

Answer 201

A

Which of the following is the lportahepatis?

A
B
C
D
E
F

Answer 202

A

umbilical vein to the inferior vena cava

Answer 203

A

A: Ligamentum venosum
B: Falciform ligament
C: Round ligament of the liver/ Ligamentum teres

Answer 204

A

Within free border of lesser omentum is the hepatic portal vein, hepatic artery proper and the bile duct.

Answer 205

A

A: Hepatic portal vein
B: Hepatic artery
C: Bile duct
D: Bile canalliculi
E: Central vein

Answer 206

A

At what vertebral level do the two common iliac veins unite to form the inferior vena cava?

L2
L5
T5
T8

Answer 207

A

Which vein does NOT drain directly into the inferior vena cava?

Left renal vein
Splenic vein
Right hepatic vein
Right testicular vein

The splenic vein drains into the portal system, which in turn empties into the inferior vena cava.

Answer 208

A

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein
Left gastro-omental vein

The left gastric vein is a tributary of the portal vein.

Answer 209

A

A: cystic duct
B: common hepatic duct
C: Right hepatic duct
D: Left hepatic duct
E: Common bile duct

Answer 210

A

Stone blocks bile leaving the gall bladder, when gall bladder contracts,

RUQ pain AND Bilary colic

(Biliary colic happens when the gallbladder contracts and causes a gallstone to temporarily block the duct).

Answer 211

A

A: splenic artery
B: gastroduodenal artery
C: hepatic artery proper
D: SMA
E: SMV
F: Hepatic portal vein

Answer 212

A

A: Coronary Ligament
B: Right Triangular Ligament
C: Left triangular Ligament

Answer 213

A

A: coronary ligaments
B: falciforms ligament

Answer 214

A

Which of the following is the hepatic artery proper

A
B
C
D
E
F
G
H

Answer 215

A

Which of the following is the common hepatic duct

A
B
C
D
E
F
G
H

Answer 216

A

Which of the following is the hepatic portal vein

A
B
C
D
E
F
G
H

Answer 217

A

Which of the following is the cystic duct

A
B
C
D
E
F
G
H

Answer 218

A

(a) Gallbladder with stones
(b) Stone in bile duct
(c) Pancreatic duct
(d) Duodenum.

Answer 219

A

Which of the following types of hyperparathyroidism best describes a high plasma PTH concentration secondary to low plasma calcium concentrations?

Primary hyperparathyroidism

Secondary hyperparathyroidism

Tertiary hyperparathyroidism

Malignant hyperparathyroidism

This is an example of secondary hyperparathyroidism, where low calcium from other causes (eg renal) trigger an increase in PTH secretion.

Answer 220

A

Which embryological origin do the superior parathyroid glands come from?

1st pharyngeal pouch

2nd pharyngeal pouch

3rd pharyngeal pouch

4th pharyngeal pouch

5th pharyngeal pouch

mesoderm

Answer 221

A

Which of the following best describes the ARTERIAL supply to the Thyroid gland?

Superior artery

Inferior artery

Superior, Middle and Inferior arteries

Superior and Inferior arteries

Answer 222

A

Kal protein

Answer 223

A

V2 receptors

Answer 224

A

Which hypothalamic nuclei is involved with particularly with the HPA axis? [1]

Arcuate nucleus
Paraventricular nucleus
Supra-optic nucleus
Nuclues solitary tract

Answer 225

A

Which hypothalamic nuclei is involved with circadian rythym and sleep cycle? [1]
Arcuate nucleus
Paraventricular nucleus
Supra-optic nucleus
Nucleus solitary tract

Answer 226

A

Growth Hormone regulation is derived from which nucleus?

Arcuate nucleus
Paraventricular nucleus
Supra-optic nucleus
Nucleus solitary tract

Answer 227

A

Growth Hormone regulation is derived from which nucleus?

Arcuate nucleus
Paraventricular nucleus
Supra-optic nucleus
Nucleus solitary tract

Answer 228

A

Gigantism and acromegaly due to Xq26 micropduplications and GPR101 mutation

Answer 229

A

Kisspeptin

Answer 230

A

Kal protein

Answer 231

A

Q
Which of the following is the most effective type of diuretic?

Carbonic anhydrase inhibitors
Thiazide
Loop
Potassium sparing diuretics
Osmotic diuretics

Answer 232

A

there is a very good correlation between high C4d levels and donor specific antibodies.

Answer 233

A

Below arcuate line the abdo wall is weaker

Answer 234

A

ASIS to pubic tubercle

Answer 235

A

A: Internal spermatic fascia
B: cremaster muscle
C: external spermatic fascia

Answer 236

A

A: transversalis fascia
B: transversalis abdominis
C: internal oblique
D: external oblique

Answer 237

A

cysteic artery

Answer 238

A

A: coeliac trunk
B: splenic artery
C: hepatic artery proper
D: gastroduodenal

Answer 239

A

jejnunal and ileal branches of SMA are found in the mesentary?

photo = jejunum

Answer 240

A

A: jenunal
B: superior mesentric
C ileocolic

Answer 241

A

hepatic artery proper and hepatic portal vein

Answer 242

A

A: left colic
B: sigmoidal
C: superior rectal

Answer 243

A

When does primitive gut tube develop?

After 2 weeks
After 3 weeks
After 4 weeks
After 5 weeks

Answer 244

A

PPI

Puborectalis
Puboccygeus
Iliococcygeus

Answer 245

A

Which muscle is depicted?

Puborectalis
Pubcoccygeus
Iliococcygeus

Answer 246

A

Which muscle is depicted?

Puborectalis
Pubcoccygeus
Iliococcygeus

Answer 247

A

Which muscle is depicted?

Puborectalis
Pubcoccygeus
Iliococcygeus

Answer 248

A

valves of Houston

Answer 249

A

EAS and puborectalis muscles

Answer 250

A

A 58-year-old man presents to the breast clinic with an isolated lump in the upper-right quadrant of his right breast. The nodule is smooth and firm. He is told the most likely diagnosed with gynecomastia.

He has a past medical history of non-alcoholic liver disease, hypertension and gout. His current medications include:
Bisoprolol
Naproxen
Allopurinol

What is the most likely cause of his breast lump?

Liver disease - This is the correct answer, Liver disease is associated with impaired oestrogen metabolism, which can cause breast tissue growth.

Answer 251

A

A 50-year-old female presents to the GP with concerns about her weight. She has a body mass index (BMI) of 31 and you are concerned about a diagnosis of metabolic syndrome. Which of the following is one of the diagnostic criteria for this?

BMI >25
Peripheral arterial disease
Dyslipidaemia
Steatohepatitis
HDL-cholesterol >50 mg/dL

Answer 252

A

A patient presents with weight loss, nausea, vomiting, abdominal pain, and hyperpigmentation of the skin. The doctor orders a urea & electrolyte test and a short Synacthen test which comes back abnormal and diagnoses the patient with Addison’s disease.

What electrolyte abnormality would you most likely expect to see in this patient?

Hyperkalaemia & hyponatraemia

Hypokalaemia & hyponatraemia

Hyperkalaemia & hypernatraemia

Hypokalaemia & hypernatraemia

Normal sodium and potassium levels

Addison’s disease - no aldosterone or cortisol is produced

Answer 253

A

A 34-year-old male presents to the GP with a new diagnosis of Conn’s syndrome. As a result of this they are producing too much aldosterone. What will this do to the sodium and potassium balance in the blood?

Decreased sodium, increased potassium
Decreased sodium, decreased potassium
Increased sodium, decreased potassium
Increased sodium, increased potassium
No change

Answer 254

A

A 22-year-old lady presents with an episode of renal colic and following investigation is suspected of suffering from MEN IIa. Which one of the following abnormalities of the parathyroid glands are most often found in this condition?

Hypertrophy
Hyperplasia
Adenoma
Carcinoma
Metaplasia

Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma - multiple endocrine neoplasia type IIa

Answer 255

A

A 34-year-old gentleman presents to the general practice as for the past fortnight he has been feeling weak and has been getting regular muscle cramps. He is otherwise asymptomatic. On examination, you find a widespread hyporeflexia. You perform a blood test, which shows hypokalaemia. You have not yet identified a cause for the abnormality. Which of the following conditions is associated with hypokalaemia?

Congenital adrenal hypoplasia
Metabolic acidosis
Addison’s disease
Conn’s syndrome
Rhabdomyolysis

The correct answer is Conn’s syndrome. Conn’s syndrome describes a condition of primary hyperaldosteronism. Aldosterone is important in maintaining potassium balance as it binds to and activates Na+/K+ pumps. This causes the movement of potassium into the cells. However, in excess, like that found in Conn’s syndrome, the resultant movement of potassium into cells can result in hypokalaemia.

Answer 256

A

Use of corticosteroids can worsen diabetic control due to their anti-insulin effects

Answer 257

A

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition?

Formation of IgG antibodies to the TSH receptors on the thyroid gland
Formation of IgG antibodies to the TRH receptors on the anterior pituitary
Formation of IgM antibodies to the TSH receptors on the thyroid gland
Formation of IgA antibodies to the TSH receptors on the thyroid gland
Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 258

A

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition?

Formation of IgG antibodies to the TSH receptors on the thyroid gland
Formation of IgG antibodies to the TRH receptors on the anterior pituitary
Formation of IgM antibodies to the TSH receptors on the thyroid gland
Formation of IgA antibodies to the TSH receptors on the thyroid gland
Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 259

A

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition?

Formation of IgG antibodies to the TSH receptors on the thyroid gland
Formation of IgG antibodies to the TRH receptors on the anterior pituitary
Formation of IgM antibodies to the TSH receptors on the thyroid gland
Formation of IgA antibodies to the TSH receptors on the thyroid gland
Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 260

A

A young girl presents with her mother due to ambiguous genitalia that is causing them concern. After taking a history and several investigations, her doctor diagnoses her with congenital adrenal hyperplasia and says that this is due to a deficiency of a particular enzyme. Which enzyme is this?

5-a reductase
21-hydroxylase
Aromatase
17B-HSD
Aldosterone synthase

21-hydroxylase deficiency results in low production of cortisol and compensatory adrenal hyperplasia. This results in increased androgen production and ambiguous genitalia. Other implicated enzymes are 11-beta hydroxylase and 17-hydroxylase.

Answer 261

A

A 42-year-old lady presents to her GP with racing palpitations with no apparent trigger and intermittent headaches. She has no significant past medical history and denies stress at home or at work. On examination you find her to be sweating with pallor of the conjunctiva. Her heart rate is 120bpm regularly regular and her blood pressure is 150/100mmHg. You suspect a phaeochromocytoma, a tumour of the adrenal medulla.

What test is most likely to be diagnostic?

24 hour urinary free cortisol
Aldosterone-renin plasma ratio
Short synacthen test
Plasma testosterone level
Urinary free adrenaline

Answer 262

A

A 42-year-old lady presents to her GP with racing palpitations with no apparent trigger and intermittent headaches. She has no significant past medical history and denies stress at home or at work. On examination you find her to be sweating with pallor of the conjunctiva. Her heart rate is 120bpm regularly regular and her blood pressure is 150/100mmHg. You suspect a phaeochromocytoma, a tumour of the adrenal medulla.

What test is most likely to be diagnostic?

24 hour urinary free cortisol
Aldosterone-renin plasma ratio
Short synacthen test
Plasma testosterone level
Urinary free adrenaline

Answer 263

A

A 59-year-old man is a known type 2 diabetic. He presents to the GP for review and is started on a new medication, a glucagon-like peptide (GLP-1) analogue. Physiologically, from what part of the body is this hormone normally secreted?

Jejunum
Pancreas
Duodenum
Ileum
Liver

Answer 264

A

A 41-year-old woman has been admitted to the renal ward with acute kidney injury. A blood test shows that her potassium is above normal limits. Renal failure is a cause of hyperkalaemia and you note that this patient’s potassium disturbance is likely due to her current renal function. However, on exploring her past medical history the patient tells you that she has an endocrine disorder, but cannot remember its name. You note that this may be important as you know that some endocrine disorders can cause disturbances in potassium. Which of the following endocrine disorders is associated with hyperkalaemia?

Phaeochromocytoma

Addison’s disease

Hyperthyroidism

Conn’s syndrome

Cushing’s syndrome

Answer 265

A

mother brings her 15-year-old daughter to see you as she is worried about her development. She is very tall for her age, has not yet started her menstrual cycle and has developed dark facial hair. She is referred to a specialist who diagnoses mild congenital adrenal hyperplasia.

What deficiency is the most common cause of this condition?

17-hydroxylase deficiency
17β-hydroxysteroid dehydrogenase deficiency
5-alpha reductase deficiency
21-hydroxylase deficiency
11-beta hydroxylase deficiency

21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia making option 4 the correct answer.

Answer 266

A

A 44-year-old lady presents with a pathological fracture of the left femur. She has previously undergone a renal transplant for end stage renal failure. Her blood test results are as follows:

Serum Ca2+ 2.80
PTH 88pg/ml
Phosphate 0.30

A surgeon decides to perform a parathyroidectomy on the basis of these results. When the glands are assessed histologically, which of the appearances is most likely to be identified?

Metaplasia the gland

Hypertrophy of the gland

Hyperplasia of the gland

Parathyroid carcinoma
Necrosis of the parathyroid gland

This is likely to be a case of tertiary hyperparathyroidism (high Calcium, high PTH, low phosphate). Therefore the glands will be hyperplastic. Hypertrophy is not correct as this implies an increase in size without an increase in cellularity.

Answer 267

A

A 54-year-old patient presents to his general practitioner for a review of his diabetes treatment. He takes metformin. He is worried about adding additional medications that might cause hypoglycaemia. He has a past medical history of bladder cancer, which was surgically treated.

The examination is unremarkable other than an elevated body mass index (32 kg/m²).

Recent blood test results:

HbA1c 61 mmol/L (more than 48)

His GP would like to commence him on a medication that does not cause weight gain or hypoglycaemia.

What is the likely mechanism of action of this drug?

Agonist of PPAR-gamma receptor
Binding of ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells
Exogenous insulin
Inhibition of intestinal alpha glucosidases
Reduction of the peripheral breakdown of incretins such as glucagon-like peptide (GLP-1)

Answer 268

A

A 56-years-old man with a past medical history of type II diabetes mellitus returns to his GP for a follow up. He denies polyuria and polydipsia. Repeat blood tests at clinic showed:

HbA1c 67 mmol/mol
Random plasma glucose 15.6 mg/l

He currently only takes metformin and his GP decides to add in gliclazide to his regular medication. What is the mechanism of action of gliclazide?

Inhibits dipeptidyl peptides-4
Stimulates sulphonylurea-1 receptors
Inhibits alpha-glucosidase enzymes
Glucagon-like peptide-1 analogues
Inhibits sodium-glucose cotransporter 2

Answer 269

A

A 13-year-old boy is brought into the clinic by his mother, who is concerned that he is much shorter than other boys his age. The boy also reveals that many people comment on his appearance, likening him to a toy doll. What can be said about the release pattern of the hormone he is most likely to be deficient in?

Secreted throughout the day
Only released at night
Released diurnally
It is released in a pulsatile manner
Released in a single spike at 8am

The boy’s presentation is indicative of growth hormone deficiency. This can result in short stature, forehead prominence and maxillary hypoplasia, giving the doll appearance. The release of growth hormone is controlled by growth hormone releasing hormone, which is released by the hypothalamus in a pulsatile manner. For this reason, measurements of GHRH are not useful in investigating growth hormone deficiency.

Answer 270

A

A 22-year-old woman attends her GP surgery as she is finding it exceedingly difficult to lose weight. She currently has a body mass index (BMI) approaching 40 kg/m², and it is severely affecting her mental and physical health. A strict diet and exercise regime has not made a significant difference. The GP decides to prescribe her an anti-obesity agent, orlistat.

How does the prescribed medication promote weight loss?

Increases metabolism through mitochondrial uncoupling
Reduces fat digestion by inhibiting lipase
Promotes glucose uptake through increased insulin secretion
Suppresses appetite through reduced uptake of serotonin
Improves satiety by reducing gastric emptying

Answer 271

A

A 26-year-old female attends an outpatients appointment having recently diagnosed with Grave’s disease. This is typically characterised by three unique signs. Along with thyroid eye disease what other signs are they?

Thyroid acropachy & thyroid lymphoedema
Thyroid arthritis & pretibial myxoedema
Thyroid arthritis & thyroid lymphoedema
Thyroid acropachy & deep vein thrombosis
Thyroid acropachy & pretibial myxoedema

Answer 272

A

A 19-year-old man presents to the emergency department with abdominal pain, vomiting, polyuria, polydipsia and confusion for the last 12 hours. On examination, he has mild generalised abdominal tenderness without guarding. His breathing is noted to be deep and rapid.

He has a history of type 1 diabetes but he admits to poor compliance with his insulin.

Which of the following is the likely pathophysiology?

Activation of the sympathetic nervous system secondary to decreased levels of glucose

Elevated serum lactate levels

Inflammation of the inner lining of the vermiform appendix

Inflammatory reaction of the urinary tract in response to bacteria

Uncontrolled lipolysis which results in an excess of free fatty acids DKA

Answer 273

A

An 8-year-old boy with type 1 diabetes presents to the emergency department with vomiting. You take a brief history and establish he has recently had a chest infection. Upon investigation, you find ketones in the urine and his blood sugars are elevated, therefore highly suspect diabetic ketoacidosis. Which is the primary ketone body involved in diabetic ketoacidosis?

Acetoacetate

Beta-hydroxybutyrate

Acetone

Beta-hydroxypentanoate

Succinate

Answer 274

A

A 72-year-old woman with back pain and chronic renal failure has the following blood test results:

Reference range
Ca2+ 2.03 2.15-2.55 mmol/l
Parathyroid hormone 10.4 1-6.5 pmol/l
Phosphate 0.80 0.6-1.25 mmol/l

What is the most likely diagnosis?

Hypoparathyroidism

Primary hyperparathyroidism

Secondary hyperparathyroidism

Tertiary hyperparathyroidism

Pseudohypoparathyroidism

In relation to secondary hyperparathyroidism; there is a HIGH PTH and the Ca2+ is NORMAL or LOW. In secondary hyperparathyroidism there is hyperplasia of the parathyroid glands in response to chronic hypocalcaemia (or hyperphosphataemia) and is a normal physiological response. Calcium is released from bone, kidneys and the gastrointestinal system.

Answer 275

A

A 31-year-old alcoholic woman is admitted to the gastroenterology ward with visible jaundice and confusion. On examination, she has a distended tender abdomen with hepatomegaly and shifting dullness is present. All her observations are normal. Blood tests are reported below.

Hb 121 g/L Females: 115 - 160 g/L
MCV 103 g/L 82-100 g/L
Bilirubin 78 µmol/L 3 - 17 µmol/L
ALP 112 u/L 30 - 100 u/L
ALT 276 u/L 3 - 40 u/L
AST 552 u/L 3 - 30 u/L
γGT 161 u/L 8 - 60 u/L

An aspirate of fluid is taken and shows a serum-ascites albumin gradient (SAAG) of 14 g/L.

What diagnosis most likely explains the SAAG value of the patient?

Biliary ascites

Bowel obstruction

Nephrotic syndrome

Portal hypertension

Severe malnutrition

Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension

Answer 276

A

Sam, a 6-year-old boy, undergoes surgery to correct a inguinal hernia. During the operation the surgeon is able to identify the hernia and its surrounding vessels and structures. He can confirm that Sam has a indirect inguinal hernia due to the hernias relationship to the epigastric vessels.

Which of the following can help the surgeon confirm an indirect hernia?

Indirect hernia is anterior to the epigastric vessels
Indirect hernia is posterior to the epigastric vessels
Indirect hernia is medial to the epigastric vessels
Indirect hernia is lateral to the epigastric vessels
Indirect hernia is superior to the epigastric vessels

Answer 277

A

A 64-year-old presents to the emergency department with a large swelling of the abdomen. He admits to drinking increasing volumes of alcohol over the 5 years since losing his job but otherwise has no significant history.

On examination, shifting dullness is present. The doctor orders an ascitic tap (paracentesis) to be performed as well as liver function tests. The doctor suspects portal hypertension.

Which of the following results would most strongly indicate this?

Cloudy ascitic fluid appearance
Serum-ascites albumin gradient (SAAG) of 0.9 g/L
AST:ALT ratio <1
Serum-ascites albumin gradient (SAAG) of 4.5 g/L
Serum-ascites albumin gradient (SAAG) of 13.1 g/L

Answer 278

A

A 47-year-old lady presents to the Emergency Department with chronic dull pain in the upper right part of her abdomen. Ultrasound shows a gallbladder mass. Biopsy reveals adenocarcinoma of the gallbladder. This is a tumour originating from gallbladder epithelial cells.

What would be the best description of these epithelial cells?

Simple columnar
Simple cuboidal
Simple squamous
Pseudostratified columnar
Transitional

Answer 279

A

A 57-year-old man who has had multiple emergency department admissions for alcohol related injuries and admissions under the general medical team for alcohol withdrawal, presents acutely unwell after a twelve day drinking binge. He is icteric, confused and has hepatomegaly. There are stigmata of chronic liver disease. Admission blood work shows a thrombocytopaenia, transaminitis with hyperbilirubinemia and a severe coagulopathy. A diagnosis of severe acute alcoholic hepatitis is made. With respect to the coagulopathy associated with liver disease, which clotting factor is characteristically increased?

Factor VIII
Factor II
Factor IX
Factor VII
Factor XII

In liver failure all clotting factors are low, except for factor VIII which is paradoxically supra-normal. This is because factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells

Answer 280

A

A 58-year-old solicitor is brought into hospital with severe abdominal pain which began earlier in the day and has lasted for over 3 hours. The pain is sharp and radiates through to his back. He rated the pain 8/10 on the pain scale. The pain is reduced when he sits up. On examination he is extremely restless, cold and clammy with a pulse rate of 124bpm, a blood pressure of 102/65 and you notice some purple colouration in his left flank. Bowel sounds were normal. His social history reveals that he has a history of excessive alcohol consumption. Which of the following is the most likely diagnosis?

Intestinal obstruction
Paralytic ileus
Acute pancreatitis
Acute appendicitis
Chronic kidney disease

Pancreatitis is the most likely diagnosis for the following reasons. The history suggests that the man is an alcoholic and this is a risk factor in itself for pancreatitis. The sharp pain is severe and radiates to the back which is typical in pancreatitis. There is evidence of jaundice and circulation collapse

Answer 281

A

A 73-year-old lady presents with a femoral hernia. Which one of the following structures forms the lateral wall of the femoral canal?

Pubic tubercle

Femoral vein

Femoral artery

Conjoint tendon

Femoral nerve

Answer 282

A

A neonate rapidly becomes unwell and develops jaundice six hours after birth. Blood tests reveal an unconjugated hyperbilirubinaemia.

Which of the following is a precursor to bilirubin and is being released in excess amounts, resulting in this child’s presentation?

Albumin
Haem
Urobilinogen
Glutamate
Glucuronic acid

Answer 283

A

A 44-year-old woman presents to the emergency department with severe right-sided abdominal pain. On further questioning, the pain is crampy, comes and goes in waves and radiates to her right shoulder. She is apyrexial. The patient reports that the pain is worst after eating.

What hormone is responsible for this variation in pain?

Cholecystokinin

Gastrin

Insulin

Secretin

Vasoactive intestinal peptide

CCK - increases gallbladder contraction

Answer 284

A

A patient presents to the GP with swelling in the groin, on the left. It does not have a cough impulse. The GP suspects a femoral hernia.

Which of the following is the most common risk factor for femoral hernias?

Male gender
Female gender
Young children
Obesity
Pregnancy

Answer 285

A

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)

Answer 286

A

Which of the following liver function tests is raised disproportionately in obstructive liver diseases?

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

Answer 287

A

Which of the following liver function tests is raised disproportionately in hepatic injury?

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

Answer 288

A

Which of the following liver function tests is raised disproportionately in hepatic injury?

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

Answer 289

A

An AST/ALT ratio higher than one (where the AST is higher than ALT) means you may have cirrhosis.

Answer 290

A

raised ALP (with GGT also raised)

Answer 291

A

Raised ALT

Answer 292

A

An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have non-alcoholic fatty liver disease.

Answer 293

A

Cirrhosis

Answer 294

A

An AST/ALT ratio higher than 2:1 (where the AST is more than twice as high as the ALT) is a sign of alcoholic liver disease

Answer 295

A

Ella, an 18-year-old girl with type 1 diabetes mellitus, presents to the emergency department with vomiting, abdominal pain and confusion.

On examination she has tachycardia and tachypnoea. The doctors organises a range of investigations including an arterial blood gas.

Results are as follows:
pH 7.29 mmol/l
K+ 6.0 mmol/l
Glucose 15mmol/l

The doctors begin to treat for diabetic ketoacidosis.

What abnormality can be seen on the ECG, with regards to Ella’s potassium level?

Tall P waves
Delta waves
U waves and T wave depression
Tall tented T waves and tall P waves
Tall tented T waves and flattened P waves

Answer 296

A

A 48-year-old woman presents to the Emergency Department with colicky abdominal pain. She reports that for the last three months, she has experienced intermittent pain in the right upper quadrant, particularly after the ingestion of fatty foods.

What cells are responsible for producing the hormone implicated in this presentation?

B cells

D cells

G cells

I cells : produce CCK in samll intestine

S cells

Answer 297

A

A 56-year-old woman presents to the GP with a 3-month history of colicky right upper quadrant pain occurring periodically. Her worst episode lead her to present today, it occurred last night after she had a takeaway. The pain was so bad it made her vomit.

On examination, her temperature was 37.7ºC, respiratory rate 14/min, blood pressure 118/75mmHg and oxygen saturation was 98%. Her abdomen was soft and non-tender. Murphy’s sign was negative.

What hormone is causing her symptoms?

Cholecystokinin (CCK) - Cholecystokinin (CCK) is the correct answer as this woman is suffering from a classic presentation of biliary colic. CCK is released from the duodenum when fatty foods are ingested, to increase gallbladder contraction, which leads to biliary colic.

Gastrin
Prostaglandin
Secretin
Somatostatin

Answer 298

A

A 22-year-old man presents to the emergency department with abdominal pain and vomiting. He has not opened his bowels for the past four days.

His past medical history includes a ruptured appendix two years previously. The patient has no other past medical or family history of note.

On examination, you note abdominal distension and tinkling bowel sounds.

Abdominal X-ray reveals dilated loops of small bowel.

What is the most common cause of the likely diagnosis in this case?

Adhesions - Adhesions are the most common cause of small bowel obstruction
Due to the patient’s past medical history they are likely to have received abdominal surgery. They are therefore at risk of developing adhesions - a band of scar tissue that can cause internal body surfaces to stick together.

Hernia

Intussusception

Malignancy

Volvulus

Answer 299

A

A 55-year-old male is brought to your clinic by his wife due to concerns of his ‘skin and eyes looking yellow’ and has worsened since it started 3 months ago. On systematic examination, you noticed jaundice and cachexia but it is otherwise unremarkable. On further questioning the man himself reports that his urine has been getting darker as well as stools becoming paler. You order an urgent CT scan which showed a mass lesion at the head of the pancreas. Which of the following process directly explains the colour of his stools?

Increase in unconjugated bilirubin in the systemic circulation

Decrease in stercobilin - question asks about the stools

Increase in amount of bilirubin metabolised to urobilinogen

Lack of conjugation of bilirubin by the liver

Decreased overall production of bilirubin

Answer 300

A

Which one of the following forms the medial wall of the femoral canal?

Pectineal ligament
Adductor longus
Sartorius
Lacunar ligament
Inguinal ligament

Answer 301

A

A 73-year-old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily?

Para aortic
Internal iliac
Superficial inguinal
Meso rectal
None of the above

Answer 302

A

A 73-year-old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily?

Para aortic
Internal iliac
Superficial inguinal
Meso rectal
None of the above

Answer 303

A

A 65-year-old man is referred with hypertension. He has a past medical history of angina and peripheral vascular disease. On examination you note a left sided renal bruit.

What is the best method to assess renal blood flow in this patient?

Inulin clearance
Modification of Diet in Renal Disease (MDRD) equation
Para-aminohippurate (PAH) clearance
Cockcroft-Gault equation
Serum creatinine

The Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault equation are used to estimate creatinine clearance.

Answer 304

A

An obese 40-year-old female patient suffering constant abdominal pain in her right upper quadrant that radiates to her right shoulder, nausea and vomiting. On examination she has a palpable abdominal mass in her right upper quadrant and is Murphy’s sign positive.

What is most likely to be shown in her LFT results?

ALT 205 u/L, AST 198 u/L, ALP 150 u/L

ALT 205 u/L, AST 198 u/L, ALP 549 u/L

ALT 113 u/L, AST 129 u/L, ALP 549 u/L

ALT 35 u/L, AST 28 u/L, ALP 70 u/L

ALT 35 u/L, AST 28 u/L, ALP 22 u/L

Highly raised alkaline phosphatase enzymes and mildly raised liver transaminase enzymes is suggestive of biliary disease

Answer 305

A

A 56-year-old woman was admitted 2 weeks ago due to pneumonia for which she was started on oral antibiotics. These antibiotics were changed after she developed a Clostridium difficile infection 9 days ago which she is still recovering from. Her pneumonia has now improved.

She is otherwise fit and well and is on no long-term medications.

What would be seen on her arterial blood gas?

Low anion gap metabolic acidosis
Normal anion gap metabolic acidosis
Normal anion gap metabolic alkalosis
Raised anion gap metabolic acidosis
Raised anion gap metabolic alkalosis

The patient has developed diarrhoea secondary to a Clostridium difficile infection. This causes a normal anion gap metabolic acidosis due to a loss of bicarbonate. This is compensated by an increase in chloride concentration, thus leading to a normal anion gap metabolic acidosis.

Answer 306

A

A 39-year-old man is admitted to the gastroenterology ward with a flare-up of his Crohn’s disease. He has been opening his bowels up to 6 times a day for the past 2 weeks and has lost approximately 5kg in weight.

What biochemical abnormalities would most likely be seen in the above presentation?

Metabolic acidosis, normal anion gap, hyperkalaemia
Metabolic acidosis, normal anion gap, hypokalaemia
Metabolic acidosis, raised anion gap, hyperkalaemia
Metabolic alkalosis, hyperkalaemia
Metabolic alkalosis, hypokalaemia

Answer 307

A

A 4-year-old boy is undergoing a renal biopsy following a recent history of haematuria and proteinuria. Histological analysis found immune complex deposition within the glomeruli. Further investigation confirms that the complexes include IgG, IgM, and C3.

What is the most likely diagnosis?

Minimal change disease
IgA nephropathy
Post-streptococcal glomerulonephritis
Amyloidosis
Focal segmental glomerulosclerosis

Answer 308

A

A 42-year-old female presents to her general practitioner with ‘pins and needles’ around her mouth and frequent muscle cramps. On examination, she appears well, however when taking her blood pressure reading, her wrist and fingers began to cramp and flex.

What is the most likely diagnosis?

Hyperkalaemia
Hypermagnesaemia
Hypocalcaemia Key features of hypocalcaemia - perioral paraesthesia, cramps, tetany and convulsions

Hypokalaemia
Hyponatraemia

Answer 309

A

A patient is seen in clinic complaining of abdominal pain. Routine bloods show:

Na+ 142 mmol/l
K+ 4.0 mmol/l
Chloride 104 mmol/l
Bicarbonate 19 mmol/l
Urea 7.0 mmol/l
Creatinine 112 µmol/l

What is the anion gap?

4 mmol/L
14 mmol/L
20 mmol/L
21 mmol/L
23 mmol/L

The anion gap may be calculated by using (sodium + potassium) - (bicarbonate + chloride)

= (142 + 4.0) - (104 + 19) = 23 mmol/L

Answer 310

A

A 40-year-old man presents with pedal oedema, frothy urine and passing a lot less urine than is usual for him. He has no other relevant medical history. You suspect that this patient’s nephrotic syndrome is due to a common cause of idiopathic glomerulonephritis among adults.

Which initial investigation would be most useful to support this specific diagnosis?

Anti-streptolysin O titre (ASOT)
Lipid profile
Renal function
Anti-phospholipase A2 antibodies
24-hour urine collection

Antibodies against a glomerular phospholipase A2 receptor have been implicated in the pathogenesis of this condition. Therefore, measuring anti-phospholipase A2 levels is likely to confirm the specific diagnosis, making this option correct.

Answer 311

A

A 56-year-old lady is undergoing an adrenalectomy for Conns syndrome. During the operation the surgeon damages the middle adrenal artery and haemorrhage ensues. From which of the following structures does this vessel originate?

Aorta
Renal artery
Splenic artery
Coeliac axis
Superior mesenteric artery

Answer 312

A

A 68-year-old female is routinely referred to the cardiology department by her GP after experiencing chest pain upon exertion. The cardiologist decides to assess for blockage of the coronary arteries and orders a coronary computed tomography (CT) angiography. As part of the imaging, the radiologist will intravenously inject a contrast dye.

Which is the most important blood test to order before administration of the contrast medium?

Cardiac enzymes

Full blood count

Liver function tests

Thyroid function tests

Urea and electrolytes As contrast medium is nephrotoxic, renal function must be tested by checking the urea and electrolytes (U&Es) prior to administration.

Answer 313

A

A 45-year-old man presents to the GP with haematuria. He has noticed two episodes of haematuria in the last week. He has no abdominal pain or fevers, and is otherwise asymptomatic; however, he did notice a cough and runny nose that resolved about a week ago. An examination is unremarkable.

A nephrologist referral is made with ultrasound and cystoscopy negative. Ongoing microscopic haematuria is present, so a decision to perform a renal biopsy is made. Histology demonstrates mesangial hypercellularity.

What is the most likely diagnosis?

Acute proliferative glomerulonephritis

Alport syndrome

Henoch-schonlein purpura

IgA nephropathy
IgA nephropathy - histology shows mesangial hypercellularity with positive immunofluorescence for IgA & C3

Lupus nephritis

Answer 314

A

Hypokalemia is very commonly associated with metabolic alkalosis.

This is due to 2 factors:
1) the common causes of metabolic alkalosis (vomiting, diuretics) directly induce H+ and K loss (via aldosterone) and thus also cause hypokalemia

2) hypokalemia is a very important cause of metabolic alkalosis by three mechanisms. The initial effect is by causing a transcellular shift in which K leaves and H+ enters the cells, thereby raising the extracellular pH. The second effect is by causing a transcellular shift in the cells of the proximal tubules resulting in an intracellular acidosis, which promotes ammonium production and excretion. Thirdly, in the presence of hypokalemia, hydrogen secretion in the proximal and distal tubules increases. This leads to further reabsorption of HCO3-. The net effect is an increase in the net acid excretion.

Answer 315

A

A 72-year-old woman presents to the endocrinology clinic with a history of muscle cramps, headaches, and lethargy. Her observations in the clinic are heart rate 82/min, respiratory rate 16/min, blood pressure 152/102 mmHg, temperature 36.2ºC, saturations 98% on air. Some of her recent blood tests are shown below:

Na+ 147 mmol/L (135 - 145)
K+ 3.1 mmol/L (3.5 - 5.0)
Bicarbonate 29 mmol/L (22 - 29)
Urea 6.1 mmol/L (2.0 - 7.0)
Creatinine 92 µmol/L (55 - 120)

An abdominal CT scan shows an adrenal mass.

Given the likely diagnosis, where is the hormone responsible for these symptoms produced?

Adrenal medulla

Juxtaglomerular apparatus

Zona fasciculata

Zona glomerulosa

Zona reticularis

Aldosterone - zona glomerulosa of adrenal cortex
The correct answer is zona glomerulosa. This patient is suffering from symptoms of hyperaldosteronism, likely due to an adenoma of the zona glomerulosa as evidenced by the mass on CT (this is also known as Conn’s syndrome). The mass will stimulate aldosterone production, resulting in hypokalemia and hypertension.

Answer 316

A

A 72-year-old woman presents to the endocrinology clinic with a history of muscle cramps, headaches, and lethargy. Her observations in the clinic are heart rate 82/min, respiratory rate 16/min, blood pressure 152/102 mmHg, temperature 36.2ºC, saturations 98% on air. Some of her recent blood tests are shown below:

Na+ 147 mmol/L (135 - 145)
K+ 3.1 mmol/L (3.5 - 5.0)
Bicarbonate 29 mmol/L (22 - 29)
Urea 6.1 mmol/L (2.0 - 7.0)
Creatinine 92 µmol/L (55 - 120)

An abdominal CT scan shows an adrenal mass.

Given the likely diagnosis, where is the hormone responsible for these symptoms produced?

Adrenal medulla

Juxtaglomerular apparatus

Zona fasciculata

Zona glomerulosa

Zona reticularis

Aldosterone - zona glomerulosa of adrenal cortex
The correct answer is zona glomerulosa. This patient is suffering from symptoms of hyperaldosteronism, likely due to an adenoma of the zona glomerulosa as evidenced by the mass on CT (this is also known as Conn’s syndrome). The mass will stimulate aldosterone production, resulting in hypokalemia and hypertension.

Answer 317

A

A 72-year-old woman presents to her GP with symptoms of weakness in her limbs, fatigue, and easy bruising. She also feels that she has gained some weight on her abdomen recently despite trying to eat healthily. After a positive high dexamethasone test, she is diagnosed with Cushing’s disease secondary to a pituitary adenoma.

What part of the adrenal gland is the hormone involved in the pathophysiology of her symptoms produced from?

Adrenal medulla
Juxtaglomerular apparatus
Zona fasciculata
Zona glomerulosa
Zona reticularis

Answer 318

A

A 30-year-old man with known end-stage renal failure secondary to polycystic kidney disease is undergoing investigations for a potential renal transplant. Several family members have undergone donor screening which includes human leukocyte antigen (HLA) testing.

What class of HLA is the most important to reduce the risk of rejection for this patient?

A

B

DP

DQ

DR

Answer 319

A

You are asked to see a newly born baby on the delivery suite after the newborn physical examination revealed abnormalities. The doctor performing the examination attempted to feel the testicles but was unable to do so, and recorded the genitalia to be ambiguous.

Further investigations are carried out, which reveals a raised 17-hydroxyprogesterone, which is attributed to a deficiency in an enzyme that is usually responsible for the conversion of progesterone to 11-deoxycorticosterone.

Which enzyme is deficient in this baby?

Aldosterone
Cortisol
Hexokinase
Trypsin
21-hydroxylase

Answer 320

A

Whilst on the ward, you notice that a severely underweight 22-year-old female patient with anorexia nervosa has become acutely drowsy and confused. You are told that she was artificially fed 30 minutes ago, are handed a set of blood tests taken since her new symptoms began and suspect that she has refeeding syndrome.

Which of the following best reflects what you are likely to see in the blood results?

Hyperkalaemia, hypophosphataemia and hypermagnesemia
Hypokalaemia, hypophosphataemia and hypermagnesemia
Hyperkalaemia, hypophosphataemia and hypomagnesemia
Hyperkalaemia, hyperphosphataemia and hypermagnesemia
Hypokalaemia, hypophosphataemia and hypomagnesemia

A large release of insulin in refeeding syndrome causes a rapid shift of K+, Mg2+ and PO4- into cells, causing hypokalaemia, hypophosphataemia and hypomagnesemia

Answer 321

A

A 67-year-old man with type 2 diabetes mellitus is receiving his annual diabetic check. He is feeling more fatigued than usual. He has not attended his previous three annual check-ups. His blood glucose control has been poor and he has not been compliant with his medications. Blood pressure is 170/90 mmHg. Urinalysis shows microalbuminuria. A blood test reveals his glomerular filtration rate (GFR) is 27mL/min per 1.73m².

If a renal biopsy was to be performed in this patient, what would be the expected findings?

Nodular glomerulosclerosis and hyaline arteriosclerosis

Apple-green birefringence under polarised light

Enlarged and hypercellular glomeruli

Crescent moon shaped glomeruli

Wirelooping of capillaries in the glomeruli

Diabetic nephropathy histological findings-Kimmelstiel-Wilson lesions, nodular glomerulosclerosis
Important for meLess important
This patient has a poorly controlled T2DM with an underlying diabetic nephropathy. The histological findings are Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) and hyaline arteriosclerosis. This is due to nonenzymatic glycosylation.

Answer 322

A

A 60-year-old lady with a history of heart failure attended the emergency department with palpitations. When taking a history you discover that she regularly takes ramipril and paracetamol but her cardiologist prescribed a further medication a week ago. She does not know what the medication is called but describes it as a ‘water tablet’. A subsequent electrocardiogram shows abnormal tall T waves. What ‘water tablet’ has been started recently?

Furosemide (loop diuretic)
Bendroflumethiazide (thiazide diuretic)
Acetazolamide (carbonic anhydrase inhibitor)
Mannitol (osmotic diuretic)
Spironolactone (potassium-sparing diuretic)

Answer 323

A

A 46-year-old man complains of swelling in his legs over the past three weeks. There was no history of other illnesses in the past except sore throat when he was 16. He is not taking any medications. On examination, he has a blood pressure of 155/94 mmHg. He has pitting oedema, and urinalysis shows 4+ protein with no RBC casts. Biopsy confirms the diagnosis of membranous glomerulonephritis.

Which is the following is the most likely cause of his condition?

Anti-phospholipase A2 antibodies
Hypertension
Malignancy
Sore throat
Systemic lupus erythematosus

Idiopathic membranous glomerulonephritis is related to anti-phospholipase A2 antibodies

Answer 324

A

A 65-year-old man presents with frequent urination and pronounced thirst. You wish to investigate for diabetes insipidus.

What is the most appropriate investigation of choice?

Short Synacthen test
Water deprivation test
Desmopressin
Thiazide diuretics
Vasopressin

Answer 325

A

Addison’s disease.

Answer 326

A

A patient attends the renal clinic having been diagnosed with chronic kidney disease stage 4, secondary to long-standing hypertension and diabetes. She asks about the diet she should be keeping to.

What is the most appropriate price of advice about her diet she should be given?

High protein and phosphate
Low potassium, high sodium
High protein, low sodium
High phosphate, low potassium
Low protein, phosphate, potassium and sodium

Answer 327

A

A 68-year-old man with chronic kidney failure has been advised by his nephrologist that he needs to follow a ‘renal diet’. He comes to see you to learn more about this.

Which one of the following is usually advised to patients with chronic kidney disease?

High calcium diet
High protein diet
Low potassium diet
Low starch diet
High phosphorus diet

Answer 328

A

A 35-year-old man is brought to the emergency department due to abdominal pain, nausea and vomiting for a few hours. He has type 1 diabetes mellitus, which is treated with insulin. He admits that he ran out of his insulin a few days back. His temperature is 37.8ºC, the pulse is 120/min, his respirations are 25/min, and his blood pressure is 100/70 mmHg. Examination shows dry mucous membranes. He has a fruity odour on his breath.

Laboratory studies show:

Hb 144 g/L Male: (135-180)
Female: (115 - 160)
Platelets 240 * 109/L (150 - 400)
WBC 10.9 * 109/L (4.0 - 11.0)
Na+ 137 mmol/L (135 - 145)
K+ 5 mmol/L (3.5 - 5.0)
Urea 2.5 mmol/L (2.0 - 7.0)
Creatinine 115 µmol/L (55 - 120)
Glucose 25 mmol/L (4 - 7)

Which of the following sets of laboratory findings would most likely be found in this patient?

PH 7.1; pCO2 2.3 kPa; Anion Gap 21
PH 7.2; pCO2 6.5 kPa; Anion Gap 11
PH 7.3; pCO2 3.9 kPa; Anion Gap 14
PH 7.4; pCO2 3.3 kPa; Anion Gap 23
PH 7.5; pCO2 2.3 kPa; Anion Gap 25

This patient has diabetic ketoacidosis. Patients with diabetic ketoacidosis have raised anion gap metabolic acidosis.

The first step in answering this question is to rule out all options with normal and raised pH (pH 7.4 and 7.5 ruled out). We should only consider options with a pH under 7.35.

The next step is to rule out all options with respiratory acidosis. This patient with increased respiratory rate should have low pCO2. This rules out the option with pCO2 of 6.5 kPa.

Finally, we need to know the anion gap. The normal anion gap is 3 to 16. Since this patient should have a raised anion gap, the option with an anion gap of 21 is correct.

Answer 329

A

A nephrologist is reviewing an 11-year-old girl who was found to have proteinuria and haematuria on urine dipstick by her general practitioner. Her initial presenting complaint was general malaise. After a thorough history and examination, the nephrologist organises a renal biopsy. The biopsy report included the following statement: ‘immunofluorescence of the sample demonstrated a granular appearance’.

What is the most likely diagnosis?

IgA nephropathy
Normal biopsy result
Pyelonephritis
Minimal change disease
Post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis - granular appearance on immunofluorescence

Answer 330

A

A 44-year-old female is currently admitted to hospital for investigation of new-onset hypertension, myalgia and a facial rash. During her stay in hospital, her kidney function declines and she begins to complain of muscle aches and ankle swelling. A urine sample and kidney biopsy are taken. Histopathological assessment of the kidney biopsy shows a proliferative ‘wire-loop’ glomerular lesion. The urinalysis detects proteinuria, but no leukocytes or nitrites.

What is the most likely diagnosis?

Acute tubular necrosis
Congestive cardiac failure
IgA nephropathy
Pyelonephritis
Systemic lupus erythematous

Proliferative ‘wire-loop’ glomerular histology in the presence of proteinuria and systemic symptoms is characteristic of lupus nephritis

Answer 331

A

A 42-year-old lady presents to her GP for her review after starting metformin 6 months ago. She is particularly concerned about what she read on the internet about how diabetes will affect her kidneys long term.

By which mechanism does most damage occur directly to the kidneys in this patient population?

Osmotic damage
Deposition of amyloid
Antigen-antibody complex deposition
Renal tubular acidosis
Non-enzymatic glycosylation

Answer 332

A

A 46-year-old lady presents to the Emergency Department with acute intermittent sharp pain in her right flank and haematuria. She has slight nausea, but feels otherwise fine in herself. She has a history of hyperparathyroidism, but has not experienced these symptoms before. She has a body mass index of 28kg/m² and reveals that her diet involves regular takeaways. On examination she appears restless and has right flank tenderness.

What substance is most likely to be causing the pain in this patient?

Calcium oxalate
Struvite
Calcium phosphate
Uric acid
Cystine

Renal stones are most commonly composed of calcium oxalate

Answer 333

A

A 66-year-old man is undergoing a radical cystectomy due to T2 non-invasive bladder cancer. You are one of the medical students shadowing the urological surgeons during the procedure. During the procedure, inferior and superior vesical arteries must be ligated.

The surgeon asks you, from which vessel do these arteries originate?

Direct branch of the aorta
External iliac artery
Inferior mesenteric artery
Internal iliac artery
Renal artery

Answer 334

A

A 37-year-old male presents to his GP for a routine follow-up of his hypertension. His blood pressure is consistently measured at or above 160/100 mmHg, despite treatment. He is currently on a maximally tolerated dose of ramipril, amlodipine, and spironolactone.

On further questioning, the GP discovers that the patient has experienced periods of extreme anxiety, palpitations, and fear with associated sweating about twice a week for the past 6 months.

Which of the following describes the origin of the hormone responsible for this man’s symptoms?

Adrenal medulla

displaying symptoms of a phaeochromocytoma; hypertension refractory to treatment, and severe episodes of sweating, palpitations, and anxiety.

Pituitary gland
Zona fasciculata of adrenal cortex
Zona glomerulosa of adrenal cortex
Zona reticularis of adrenal cortex

Answer 335

A

A 36-year-old female is undergoing renal transplant surgery. A few minutes after the donor kidney has been inserted the donor organ starts to lose colour and becomes flaccid. You suspect hyperacute transplant rejection.

What is the mechanism of this?

Cell arteritis leading to atrophy of organ
Damaged donor organ
Donor T cells mounting a response against the host cells
Mast cell degranulation
Pre-existing recipient antibodies against donor HLA/ABO antigen

Answer 336

A

A 34-year-old single mum has been referred for genetic testing following her 8-months-old son being diagnosed with congenital nephrogenic diabetes insipidus. She is asymptomatic and is not aware of any family history of this condition.

Which of the following structure of the kidney is most commonly affected in this condition?

Vasopressin receptor
Angiontensin II receptor
Epithelial sodium channel (ENaC)
Sodium-chloride co-transporter (NCCT)
Aquaporin 1 channel (AQP1

Nephrogenic diabetes insipidus may be caused genetic mutations:
the more common form affects the vasopression (ADH) receptor
the less common form results from a mutation in the gene that encodes the **aquaporin 2 **channel

Answer 337

A

A 15-year-old girl presents to the emergency department with an acute exacerbation of asthma. As part of her treatment, she is given salbutamol and ipratropium bromide nebulisers with IV steroids. Salbutamol is a β2 receptor agonist. What metabolic effect can this drug have that you might need to monitor?

Hyperkalaemia
Hypernatraemia
Hypocalcaemia
Hyponatraemia
Hypokalaemia

Answer 338

A

A 45-year-old male is returned to a surgical ward following a renal transplant. 90 minutes after the transplantation, diuresis suddenly decreases. The patient is immediately transferred back to surgery where the transplanted kidney shows signs of hyperacute rejection and is removed. Histopathological examination is consistent with hyperacute rejection.

This patient has experienced which of the following types of reaction?

Type I hypersensitivity
Type II hypersensitivity : Hyperacute transplant rejection is an example of a type II hypersensitivity reaction

Type III hypersensitivity
Type IV hypersensitivity
Type V hypersensitivity

Answer 339

A

n 85-year-old woman visits her GP for a follow up appointment after commencing trimethoprim for a urinary tract infection 7 days ago. She mentions that her urinary symptoms have gone but that she has been feeling generally tired and weak for the last 4 weeks (before the urinary tract infection). She asks you if this could be to do with the new medication she started 5 weeks ago. You look at her medical history and see she was started on ramipril 5 weeks ago. She mentions that her osteoarthritic pain has been quite bad recently, which is why she missed her most recent medication review appointment, but she has been taking more paracetamol and ibuprofen than normal. Considering the combination of medication and her vague symptoms you have a suspicion and decide to perform an ECG. The ECG shows tall, tented T waves, prolonged PR interval, and bradycardia. What is the cause of these ECG changes?

Hypernatraemia
Hyperkalaemia
Hyponatraemia
Hyperthyroidism
Hypercalcaemia

Answer 340

A

A 38-year-old woman is referred to rheumatology by her general practitioner (GP) due to ongoing symptoms of fatigue and arthralgia. These have been ongoing for the last 2 months. A urine dipstick is positive for proteinuria, and subsequent renal biopsies demonstrate proliferative ‘wire-loop’ glomerulonephritis on histology.

What is the most likely diagnosis?

Acute interstitial nephritis
Anti-glomerular basement membrane disease (Anti-GBM disease)
Autosomal recessive polycystic kidney disease (ARPKD)
Diabetic nephropathy
Systemic lupus erythematosus (SLE)

Answer 341

A

A six-year-old boy is undergoing investigations for recurrent urinary tract infections. Imaging shows the inferior poles of both his kidneys are fused abnormally. Diagnosis of horseshoe kidney is made.

During fetal development, horseshoe kidneys are trapped under which of the following structures following their anterior ascent?

Superior mesenteric artery
Inferior mesenteric artery
Left common iliac artery
Right common iliac artery
Aortic bifurcation

Answer 342

A

Jack has just finished running a marathon and is now dehydrated. The reduced perfusion pressure in his kidneys is detected by baroreceptors which causes the activation of the renin-angiotensin-aldosterone system (RAAS). Renin cleaves angiotensinogen to angiotensin I which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). The effect that angiotensin II has on the branch of the renal artery that carries blood away from the glomerulus will contribute to increasing Jack’s blood pressure (mmHg) back to normal.

What impact does angiotensin II have on this arteriole and what does this do to the glomerular filtration rate (GFR)?

Vasoconstriction - decreases GFR
Vasoconstriction - increases GFR
Vasodilation - decreases GFR
Vasodilation - increases GFR
Vasodilation - no effect on GFR

Answer 343

A

43-year-old lady is donating her left kidney to her sister and the surgeons are harvesting the left kidney. Which one of the following structures will lie most anteriorly at the hilum of the left kidney?

Left renal artery
Left renal vein
Left ureter
Left ovarian vein
Left ovarian artery

The renal veins lie most anteriorly, then artery and ureter lies posteriorly.

Answer 344

A

At which level is the hilum of the left kidney located?

L1 Remember L1 (‘left one’) is the level of the hilum of the left kidney

L2

T12

T11

L3

Answer 345

A

A 24-year-old man is involved in a road traffic accident. His right leg is trapped for 6 hours whilst he is moved. On examination his foot is insensate and a dorsalis pedis pulse is only weakly felt. Which of the biochemical abnormalities listed below is most likely to be present?

Alkalosis
Hypercalcaemia
Hypocalcaemia
Hyperkalaemia
Hyponatraemia

In this scenario the patient will have a compartment syndrome, delayed diagnosis and muscle death. The effect of muscle death will result in the release of potassium. It is also highly likely that there will be a degree of renal impairment, the result of which is that the serum potassium is likely to be high.

Answer 346

A

A 70-year-old man with a past medical history of hypertension is acutely short of breath. He is prescribed a drug that generates a high osmotic gradient in the medullary interstitium of the kidney. What is the most likely mechanism of action of this drug?

Inhibition of the sodium, potassium and chloride co-transporter in the ascending loop of Henle - Furesomide

Increasing water reabsorption in the descending loop of Henle

Altering glucose reabsorption in the proximal tubules

Altering potassium reabsorption in the proximal tubules

Altering sodium reabsorption in the proximal tubules

Answer 347

A

A two year old boy presents to the GP with a swelling in the groin. His mother has noticed it in the evenings and also when he cries. On examination there is a small, painless lump on the right just above the scrotum. The testicles are normal and the spermatic cord is easily palpable. There is a cough impulse and the contents of the lump are easily reducible. What is the underlying abnormality?

Persistent tunica vaginalis

Failure of the gubernaculum

Patent processus vaginalis indirect inguinal hernia

Persistence of the Mullerian tract

Obliterated processus vaginalis

Answer 348

A

Minimal change disease is the most common cause of nephrotic syndrome in children. It is characterised by the triad of oedema, hypoalbuminaemia and proteinuria.

Answer 349

A

GSP oncogene

Answer 350

A

mosaic mutation in GNAS gene

Answer 351

A

More Na at macula densa: glomerulus afferent arteriole constriction, which normalises GFR

Answer 352

A

Loop duiretic: Ca secretion
Thiazide duiretics: Ca retention

Answer 353

A

McCune Albright syndrome

Acromegaly is seen in about 20% of patients with MAS

Answer 354

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy
Membranous change disease
DIabetic nephropathy
Glomerulosclerosis

Answer 355

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy Proliferation and hypercellularity of the mesangium is seen in the glomerulus
Membranous change disease
DIabetic nephropathy
Glomerulosclerosis

Answer 356

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy
Membranous change disease
DIabetic nephropathy Staining of the lipohyaline caps with periodic acid Schiff stain. Note the subendothelial location of the deposits filling the capillary lumina.

Answer 357

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy
Membranous change disease
DIabetic nephropathy - note the Kimmelstiel-Wilson nodules
Glomerulosclerosis

Answer 358

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy - mesengial hypercellulairty
Membranous change disease
DIabetic nephropathy
Glomerulosclerosis

Answer 359

A

Which pathology is depicted using immunohistocomplex staining?

IgA nephropathy
Membranous change disease
DIabetic nephropathy
Glomerulosclerosis

Answer 360

A

What is this patient presenting with, based off the ECG?

Hypokalaemia
Hyperkalaemia - tall tented T waves
Hypothermia
Hypocalcaemia
Hypercalcaemia

Answer 361

A

Surina Folkes, 22, has a history of Crohn’s disease. She presents to her GP with fatigue, shortness of breath on exertion in addition to pins and needles in her fingers. On examination, she is noticed to have pale conjunctiva and atrophic glossitis.

As part of her work-up, you send off a set of bloods which reveal the following results:

Hb 80 (g/l)
MCV 120 (82-100 fl)
Ferritin 100 (20-230 ng/ml)
What is the most likely diagnosis?

Vitamin B12 deficiency
Crohn’s disease often affects the terminal ileum where vitamin B12 is absorbed. It may, therefore, cause a deficiency which presents with macrocytic anaemia. Notably, B12 is also important in maintaining the nervous system so a deficiency may present with neurological symptoms.

Iron deficiency anaemia
Anaemia of chronic disease
Sideroblastic anaemia
Folate deficiency

Answer 362

A

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight.

Which of the following blood results is most likely to be low?

T4
Hypothyroidism is a recognised cause of menorrhagia or abnormally heavy bleeding during menstruation. There is an association between autoimmune hypothyroidism (Hashimoto’s thyroiditis) and other autoimmune diseases, such as this lady’s Diabetes Type 1. She also has signs suggesting hypothyroidism such as low mood and weight gain. The correct answer is, therefore, T4, which would be low in hypothyroidism.

Total iron binding capacity
Testosterone
TSH
Folate

Answer 363

A

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

Answer 364

A

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?

Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

Answer 365

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia Inferior epigastric vessels medial to hernial neck (arrowhead) are visible
obturator hernia

Answer 366

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia
anguinal hernia (arrow), which passes medially to inferior epigastric ar tery and vein (arrowhead)

indirect inguinal herni
obturator hernia

Answer 367

A

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?

De Garengeot hernia
femoral hernia
direct inguinal hernia

T image shows par t of bladder (arrow) is contained within direct lef t inguinal hernia medial to inferior epigastric neurovascular bundle (arrowhead)

indirect inguinal hernia
obturator hernia

Answer 368

A

What type of hernia would it be if came out at the *?

De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia

Answer 369

A

A: direct hernia

Answer 370

A

What of the following depicts the inferior epigastric arteries

Solids arrows
Open arrows
Curved arrows
Arrowheads

Answer 371

A

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

Answer 372

A

What of the following depicts the deep inguinal ring

Solids arrows
Open arrows
Curved arrows
Arrowheads

Answer 373

A

What of the following depicts the inguinal ligament

Solids arrows
Open arrows
Curved arrows
Arrowheads

Answer 374

A

Sigmoid volvulus

Grossly-dilated loop of large bowel has a ‘coffee-bean shape’ and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 375

A

Sigmoid volvulus

Grossly-dilated loop of large bowel has a ‘coffee-bean shape’ and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 376

A

A 64-year-old lady with a BMI of 37 presents to you complaining of incontinence. She has previously had two children, both were delivered vaginally and the first required forceps due to slow progression of the second stage of labour. She takes no regular medication and has no other significant past medical history.

Given her risk factors, which type of urinary incontinence is she most likely to suffer from?

Overflow incontinence
Mixed inctontinence
Urge incontinence
Stress incontinence

Due to her previous forceps delivery, she is most likely to be suffering from stress incontinence. Stress incontinence is the loss of urine associated with a rise in intra abdominal pressure such as coughing or sneezing. Risk factors include increasing age, traumatic vaginal delivery, obesity, and previous pelvic surgery.

Answer 377

A

A 76-year-old gentleman with a history of primary hypothyroidism attends his GP for the first time in many years for a routine check-up. He divulges that he has not been complying fully with his levothyroxine therapy as he sometimes cannot make it to a pharmacy to refill his prescription.

Which of the values below is most likely to be low in this gentleman?

Mean cell volume (MCV)
LDL Cholesterol
Core temperature
TSH
Body mass index

Answer 378

A

Which of these pathologies would cause a high anion gap metabolic acidosis?

Diarrhoea
Methanol poisoning
Emesis
Renal tubular acidosis

Answer 379

A

A 55-year-old overweight man with a background of type 2 diabetes presents to the GP with tiredness. He is otherwise well and does not smoke or drink alcohol. Bloods reveal an elevated ALT and AST. The rest of his blood results are normal. An ultrasound scan of his liver is reported as ‘echobright’ with no focal areas of abnormality.

What is the most likely diagnosis?

Hepatocellular carcinoma
Pancreatic cancer
Gilbert’s syndrome
Non-alcoholic fatty liver disease

This patient is middle aged, overweight and has type 2 diabetes. This puts him at risk of non-alcoholic fatty liver disease (NAFLD), which causes raised liver transaminases (ALT and AST) and otherwise normal bloods. The only way to distinguish this from alcoholic liver disease is the alcohol intake and, as this patient does not drink, it suggests that NAFLD is the diagnosis. Management is through risk factor modification which would include weight loss.

If NAFLD is not managed, it leads to a risk of developing hepatocellular carcinoma. This gentleman’s ultrasound, however, only showed the early ‘echobright’ stage of NAFLD and no evidence of any masses.

Acute viral hepatitis

Answer 380

A

gliclazide: Gliclazide is an insulin secretagogue, increasing the amount of endogenous insulin produced. Sometimes too much Insulin can be secreted, resulting in hypoglycaemia

Metformin is an insulin sensitiser and therefore makes the amount of insulin in the body more effective. While metformin reduces average blood sugars it very rarely causes hypoglycaemia. Therefore reducing the offending drug, gliclazide, is the most appropriate management option.

Answer 381

A

Most patients have a history of an upper respiratory tract infection and, either at the onset or within the first 24-48 hours, there is gross haematuria that lasts for less than three days. The urine is red or brown and there may also be loin pain

Answer 382

A

A 32-year-old male presents to the emergency department with bilateral flank pain and red coloured urine. Approximately five days ago he experienced a sore throat with nasal discharge. He has no pertinent family medical history and no chronic medical problems. He denies smoking and is an occasional alcohol drinker. Review of systems is unremarkable.

His observations are as follows:

Blood pressure: 125/65 mmHg
Pulse: 88 BPM
Temperature: 37.4 °C
Respiratory rate: 15 breaths per minute
On physical examination, he has bilateral mild flank tenderness but the remainder of the physical examination is normal. Laboratory investigations demonstrate a normal full blood count and chemistry panel. The urine dipstick is positive for blood and protein but shows no signs of white blood cells or nitrites. Further examination of the urine reveals red blood cell casts. A CT KUB scan of the abdomen and pelvis in the emergency department is also normal.

What is the most likely diagnosis?

IgA nephropathy
Alport syndrome
Minimal change disease
Acute post-streptococcal glomerulonephritis
Kidney stones

Answer 383

A

Biliary colic
Ascending cholangitis
Liver cirrhosis
Hepatic carcinoma
Primary biliary cirrhosis

Ascending cholangitis would typically have fever and pain
Malignancy would usually feature weight loss and general malaise
Biliary colic would feature pain

This leaves two potential diagnoses: primary biliary cirrhosis or liver cirrhosis. There are no risk factors for liver cirrhosis and her LFTs do not show a hepatitic pattern of derangement (AST, ALT, bilirubin, albumin all normal). The raised ALP and GGT suggest a cholestatic picture, making primary biliary cirrhosis (also known as primary biliary cholangitis) the most likely diagnosis

Answer 384

A

Pancake kidney

Answer 385

A

Pancake kidney

Answer 386

A

Horseshoe kidney

Answer 387

A

Polycystic kidney disease

Answer 388

A

Polycystin gene

Answer 389

A

Abdominal CT showing polycystic kidneys

Answer 390

A

A: mesonephric bud
B: uteric bud

Answer 391

A

What type of renal pathology is depicted here?

IgA neuropathy
Membrane change disease
Glomerulonephritis
Acute rejection from kidney transplant
Focal glomerulitis in active antibody mediated rejection-Banff score g3. Dilated glomerular capillaries are filled with swollen endothelial cells and inflammatory cells (PAS, 200×).

Answer 392

A

Inflammatory cells (arrows) infiltrate the intima in intimal
arteritis, due to acute cell mediated rejection

Answer 393

A

A: Falciform ligament
B: fundus of gall bladder
C: stomach
D: Ligamentum teres

Answer 394

A

A: IVC
B: Cystic duct
C: Cystic artery
D: Ligamentum teres
E: Ligamentum venosum

Answer 395

A

A: Quadrate lobe
B: Caudate lobe

Answer 396

A

11 Superior mesenteric
artery
2 Middle colic artery
3 Right colic artery
10 Superior mesenteric vein
13 Jejunal arteries

Answer 397

A

Ascites. Axial CT scan of the abdomen shows low density ascitic fluid surrounding the liver, spleen and stomach.

Answer 398

A

1 Left hepatic duct
2 Right hepatic duct
3 Cystic duct
7 Common hepatic duct
8 Common bile duct
9 Pancreatic duct
10 Greater duodenal papilla

Answer 399

A

Hashimotos thyroiditis

Answer 400

A

Graves disease

Answer 401

A

Acropachy

in association with thyroid ophthalmopathy

Answer 402

A

Toxic multinodular
goitre
Graves Disease
Toxic adenoma

Answer 403

A

Lack of PDS

Answer 404

A

biguanide

Answer 405

A

Insulin normally drives potassium into cells

Without insulin, potassium is not added to and stored in cells.

Serum potassium can be high or normal in diabetic ketoacidosis, as the kidneys continue to balance blood potassium with the potassium excreted in the urine, however total body potassium is low because no potassium is stored in the cells.

When treatment with insulin starts, patients can develop severe hypokalaemia (low serum potassium) very quickly, and this can lead to fatal arrhythmias.

Answer 406

A

fatal arrhythmias.

Answer 407

A

A: Non-proliferative - cotton wool spots
B proliferative

Answer 408

A

Nonproliferative
Funduscopic features of nonproliferative diabetic retinopathy include retinal hemorrhages and hard exudates (yellow patches)

Answer 409

A

Proliferative
The key funduscopic feature of proliferative diabetic retinopathy is neovascularization, seen here around the optic disk.

Answer 410

A

A 65-year-old man presents to his GP with vision loss, headaches and cold intolerance. He also mentions he has unintentionally gained 5kg in the last 3 months. On examination, he is found to have a bitemporal hemianopia and a pulse of 50 bpm. A thyroid function test is ordered. Which of the following test results is most likely to belong to this patient?

TSH: Low T4: Low T3: Low
TSH: high T4: low T3: low
TSH: high T4: normal T3: normal
TSH: low T4: high T3: high

This man most likely has a pituitary adenoma causing secondary hypothyroidism. In addition to thyroid function tests, he would also need an MRI of the head to confirm the presence of an adenoma. His thyroid function tests would be expected to show TSH: Low T4: Low T3: Low. In this case secretion of TSH is most likely suppressed due to compression of TSH secreting cells (thyrotrophs) by a pituitary mass.

Answer 411

A

Which one of the following diabetes medication classes has been shown to be weight-neutral/weight-losing in patients with T2DM?

SGLT-2 inhibitors
Sulphonylureas
Insulins
Thiazolidinediones (glitazones)

Answer 412

A

A 49-year-old woman is investigated following an osteoporotic hip fracture. The following results are obtained:

Free T4 29pmol/L (normal 9-18)
TSH < 0.05 mu/L (normal 0.5-5.5)

Which one of the following autoantibodies is most likely to be present?

TSH receptor stimulating autoantibodies
Anti-thyroid peroxidase autoantibodies
Anti-nuclear antibodies
Anti-thyroglobulin autoantibodies

Answer 413

A

During a routine physical examination, a 65-year-old woman with diabetes mellitus has her balance checked. She is first asked to stand with her feet together (eyes open) and does this well. When she closes her eyes, she begins to fall and is caught by the examiner. Additional neurological findings include absent ankle jerk reflexes and absent perception of vibration at her toes bilaterally.

A lesion to which of the following is the most likely cause of her balance difficulty?

Peripheral nerves
Vestibular system
Upper motor neurons
Cerebellum
Basal ganglia

Answer 414

A

Which of the following is most associated with this skin condition?

Polycystic ovarian syndrome
Graves’ disease
Small cell lung cancer
Addison’s disease
Methotrexate use

This is a typical appearance of acanthosis nigricans; symmetrical, dark, ‘velvety’ plaques which arise on the neck, axillae and groin creases in conditions associated with raised insulin, such as:

Obesity
Type 2 diabetes
Polycystic ovarian syndrome
Cushing’s disease

Answer 415

A

Which of the following are released from the stomach:

A: GLP-1
B: PYY
C: Ghrelin
D: Leptin
E: Insulin

Answer 416

A

Which of the following is the action of PYY?

Inhibits excitatory appetite neurones

Stimulates excitatory appetite neurones

Inhibits inhibitory appetite neurones

None of the above

Answer 417

A

Which of these transmitters is stimulatory for appetite?

NPY

POMC

a-MSH

CART

Answer 418

A

Which structure in the hypothalamus is a key player in appetite control?

Preoptic nucleus

Supraoptic nucleus

Arcuate nucleus

Lateral nucleus

Answer 419

A

Which peptide hormone released by cells in the ileum and colon suppresses appetite?

Insulin

Leptin

Ghrelin

PYY (peptide tyrosine tyrosine)

Answer 420

A

Release of which of the following substances is inhibitory for appetite?

Ghrelin

AgRP (Agouri-related peptide)

NPY (Neuropeptide Y)

CART (cocaine- and amphetamine regulated transcript)

Answer 421

A

Alpha-MSH and Beta-endorphin may be produced from which neurotransmitter?

CART (cocaine- and amphetamine regulated transcript)

POMC (pro-opiomelanocortin) POMC can be cleaved into other neurotransmitters such as alpha-MSH and beta-endorphin. These also act to suppress hunger.

NPY (Neuropeptide Y)

AgRP (Agouri-related peptide)

Answer 422

A

Blue arrows: segmental arteries

Green arrows: interlobar arteries

Answer 423

A

14 Superior suprarenal artery
19 Right inferior phrenic artery
20 Left inferior phrenic artery
21 Middle suprarenal artery
22 Inferior suprarenal artery

Answer 424

A

5 Splenic artery
6 Upper pole of kidney
7 Anterior branch of renal artery
8 Interlobular arteries
9 Left renal artery
10 Lower pole of kidney

Answer 425

A

1 Celiac trunk
2 Superior mesenteric artery
3 Middle colic artery
4 Abdominal aorta (with catheter)

Answer 426

A

A: Internal branch of superior
laryngeal nerve
B: Inferior thyroid artery
C: Superior laryngeal nerve
D: Glossopharyngeal nerve
E: Inferior laryngeal branch of recurrent
laryngeal nerve

Answer 427

A

40 Internal carotid artery
41 External carotid artery
42 Superior laryngeal artery
43 Superior thyroid artery
44 Common carotid artery
45 Thyroid ansa of sympathetic
trunk and inferior thyroid artery

Answer 428

A

cholestasis

Answer 429

A

Liver injury with cholestasis typically results in an increase of what laboratory value?

Alanine aminotransferase
Albumin
Alkaline phosphatase
Aspartate aminotransferase

Answer 430

A

Pheochromocytoma

Answer 431

A

Adrenalectomy with pheochromocytoma. Thin fibrous bands impart a nested look to pheochromocytoma.

Answer 432

A

Which of the following does the transervalis fascia become?

external spermatic fascia
internal spermatic fascia
cremaster muscle
tunica vaginalis

Answer 433

A

Which of the following does the external oblique become?

external spermatic fascia
internal spermatic fascia
cremaster muscle
tunica vaginalis

Answer 434

A

Which of the following does the processus vaginalis become?

external spermatic fascia
internal spermatic fascia
cremaster muscle
tunica vaginalis

Answer 435

A

Which of the following does the internal oblique become?

external spermatic fascia
internal spermatic fascia
cremaster muscle
tunica vaginalis

Answer 436

A

internal oblique: A = Cremaster

Answer 437

A

Tunica vaginalis is

A
B
C
D
E

Answer 438

A

Which of the following is where lymph drainage of D occurs

Pre-aortic nodes
Superficial inguinal
Deep inguinal
Lumbar nodes

Answer 439

A

What is A

Middle colic artery
Jejunal arteries
Ileal colic artery
Right colic artery

Answer 440

A

A Jejunal arteries
B Ileal arteries

Answer 441

A

A: Left colic artery
B: IMA
C: Ileal arteries
D: Ileocolic artery
E: Right colic artery

Answer 442

A

Middle colic artery

Answer 443

A

Inferior epigastric artery

Answer 444

A

5 Classically, appendicitis initially presents with generalized or periumbilical abdominal pain that later localizes to the right lower quadrant.

Answer 445

A

Cyclosporin and tacrolimus

Answer 446

A

IL-2

Learn x

Answer 447

A

Which of the following targets IL-2 gene activation / suppresses IL-2 activation

Azathioprine
Prednisolone
Cyclosporin
Tcrolimus
Mycophenolic acid

Answer 448

A

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

Answer 449

A

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

Answer 450

A

Which of the following are anti-proliferative? [2]

**Azathioprine **
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

Answer 451

A

Calcineurin is an enzyme that activates T-cells of the immune system.

Answer 452

A

Cold ischaemia time: 12 hrs
Warm ishaemia time: 1 hour

Answer 453

A

Polycystin gene - codes for primary cilia

Answer 454

A

Mineralocorticoid hormone

Answer 455

A

increase sodium reabsorption
increase potassium excretion

Answer 456

A

Conn’s syndrome causes which of the following effects

increase sodium reabsorption; increase potassium excretion

Conns syndrome: XS aldosterone

Answer 457

A

hypokalemia, hypernatremia and metabolic alkalosis

Answer 458

A

B. Decreased serum potassium, increased urinary potassium, and increased extracellular fluid volume

increased production of aldosterone. Serum levels of potassium are decreased, and the urinary excretion of potassium is increased. Decreased serum potassium levels result in the symptoms of polyuria and polydipsia due to hypokalemia-induced nephrogenic diabetes insipidus.

As a result of increased reabsorption of sodium due to aldosterone excess, more water is retained. The retained water causes extracellular fluid volume expansion, which is the mechanism behind persistent hypertension.

Answer 459

A

Conns syndrome patient presents with

Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis

Answer 460

A

This symptoms is suggestive of

Conns syndrome
Cushings syndrome
Addisons disease
Sunburn

Hyperpigmentation is characteristic and occurs in almost all patients.
Elevated ACTH and melanocyte-stimulating hormone are causative factors. It is believed that ACTH binds to the melanocyte receptors, which are responsible for pigmentation

Answer 461

A

low cortisol and aldosterone levels

Answer 462

A

What method is the most practical and accurate way to measure regional adiposity?

A. Waist and hip circumference
B. Skin-fold thickness testing
C. Body mass index (BMI)
D. Impedance measurement

Answer 463

A

Which of the following is not associated with obesity causing a dampened down immune system?

RA
MS
Systemic lupus erythematosus
Psoriasis

Answer 464

A

A Ptx present with greater span than height & shorter 4th metacarpal. Which of the following is most likely

McCune-Albright Syndrome
Patau Syndrome
Kallman Syndrome
Turners Syndrome

Answer 465

A

McCune-Albright syndrome is caused by a mutation on which gene

Kal
GNAS
PIT1
GSP

Answer 466

A

Kimmelstiel–Wilson nodules

Answer 467

A

Where does spirolactone work?

PCT
LoH
DCT
CD

Answer 468

A

Vasoconstriction at afferent arteriole

No effect at efferent (i think)

Answer 469

A

Which of the following has neuron development through the cribiform plate?

GnRH
TRH
CRH
ADH

Answer 470

A

hypothalamic stimulating hormone that causes the release of GnRH

somatostatin
PIT1
kisspeptin
GPR54

Answer 471

A

Which of the following is the nerve that causes constriction of the pupil?

A: CN 3
B
C
D
E

Answer 472

A

Which of the following is the ophthalmic branch is the first division of the trigeminal nerve?

A
B
C
D
E

Answer 473

A

Which of the following supplies the lateral rectus?

A
B
C
D
E

Answer 474

A

Which pituitary hormone binding to cell surface-localize receptors (GHRs) induces a conformational change of the dimerized receptors?

CRH
TSH
GH
ADH

Answer 475

A

Hypothyroidism:
* Low T3/T4
* Low TSH

Hyperthyroidism
* High T3/T4
* Low TSH

Answer 476

A

Which of the following would you use to treat hypothyroidism?

Propylthiouracil
Levothyroxine
Iodine 131
Carbimazole
Iodine 123

Answer 477

A

Which of the following is the remnant of the umbilical vein?

A
B
C
D - ligament teres

Answer 478

A

Which of the following deiodinase enzymes makes more inactive from of thyroid hormone?

D1 & D2 convert T4 to T3 and cause activation
D3 : ** **
D4

Answer 479

A

PDS (pendred syndome - PDS)

Answer 480

A

What is the name for naturally form of active thyroid hormone?

Levothyroxine
Liothyronine: T3
Thyrotrophin
Thyroxine

Answer 481

A

Which sign of ascites is present in this CT

Ascites
Caput medusae
Oesophageal varices
Spider naevi

Answer 482

A

Which of the following would you use to diagnose a toxic adenoma ?

Propylthiouracil
Levothyroxine
Iodine 131 - used to treat
Carbimazole
Iodine 123

Answer 483

A

Which of the following occurs in graves disease

Increased insulin turnover; increased gluconeogenesis; increased insulin secretion
Increased insulin turnover; decreased gluconeogenesis; increased insulin secretion
Decreased insulin turnover; decreased gluconeogenesis; increased insulin secretion
Increased insulin turnover; increased gluconeogenesis; decreased insulin secretion

Answer 484

A

NPY / AgRP neurones: signals hunger and stimulates food intake

POMC / CART neurones: signals satiety and reduces food intake

Answer 485

A

Which of the following are antibodies produced

Latent Autoimmune Diabetes of Adults type 1.5
Type two diabetes
Gestatational diabetes
Maturity Onset Diabetes of the Young

Answer 486

A

Which of the following type of diabetes is usually caused by one gene

Latent Autoimmune Diabetes of Adults
Type two diabetes
Gestatational diabetes
Maturity Onset Diabetes of the Young

Answer 487

A

PYY has the biggest effect on which part of the GI system

Stomach
Duodenum
Jejunum
Ileum
Colon

Answer 488

A

PYY has the is produced from which type of cells:

D cells
A cells
L cells
B cells

Answer 489

A

B12 & Folate Deficiency

Leads to atherosclerosis

Answer 490

A

A patient with which of the following HbA1c reading would have diabetes

41 mmol/mol
43 mmol/mol
45 mmol/mol
47 mmol/mol
49 mmol/mol - 48 is the cut off

Answer 491

A

Which one of the following is aldosterone?

Mineralocorticoid
Catecholamine
Androgens
Glucocorticoid

Answer 492

A

Which one of the following is cortisol?

Mineralocorticoid
Catecholamine
Androgens
Glucocorticoid

Answer 493

A

D. Increase serum glucose and decrease insulin secretion

Pheochromocytoma is a tumor of the adrenal medulla that causes excess catecholamine release.

Catecholamines increase glucagon secretion via beta-2 receptors and activate glycogenolysis. This results in increased serum glucose.

Answer 494

A

A 48-year-old man embarks on a road trip across the country and becomes stranded in Nevada when his car breaks down. He is without food or water for over 72 hours. A hormone is released from which part of the adrenal gland in response to his hydration status?
A. Zona fasciculata
B. Zona glomerulosa
C. Adrenal medulla
D. Zona reticularis

Answer 495

A

Which of the following is the underlying problem in neurogenic diabetes insipidus?

Lack of vasopressin (antidiuretic hormone)
Lack of prolactin
Lack of oxytocin
Overproduction of prolactin
Overproduction of vasopressin (antidiuretic hormone)
Overproduction of oxytocin

Answer 496

A

In males which hormone stimulates Sertoli cells to produce androgen binding globulin (ABG)?
Oxytocin
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Gonadotrophin releasing hormone (GnRH)

Answer 497

A

Which of the following causes of Cushing’s syndrome does the phrase “Cushing’s disease” specifically refer to?

Pituitary adenoma
Adrenal adenoma
Ectopic ACTH production
Iatrogenic

Answer 498

A

Which one of the following statements best describes an Addisonian crisis?

Severe adrenal insufficiency resulting in dangerously low serum cortisol levels
Dangerously high serum cortisol levels
Severe adrenal insufficiency resulting in dangerously low serum testosterone levels
Dangerously high levels of testosterone

Answer 499

A

Which of the following investigations is the gold standard for diagnosing acromegaly?

Growth hormone measurement

Oral glucose tolerance test + Growth hormone measurement

Growth hormone releasing hormone measurement

Serum IGF1 measurement

Answer 500

A

What is the most common cause for the overproduction of growth hormone in acromegaly?

Hypothalamic lesion
Pituitary adenoma
Pituitary lesion
Hyperplasia of the pituitary stalk

In around 99% of cases, acromegaly is caused by a pituitary adenoma, specifically overgrowth of the somatotrope cells which are responsible for growth hormone production. In very rare cases acromegaly can be caused by ectopic production of growth hormone by carcinoid tumours.

Answer 501

A

What is Addison’s disease?

Addison’s disease is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.
Addison’s disease involves the overproduction of androgens by the adrenal medulla.
Addison’s disease involves the underproduction of androgens by the adrenal medulla.
Addison’s disease involves the overproduction of cortisol and aldosterone by the adrenal cortex.

Answer 502

A

What is the most common cause of Cushing’s syndrome?
Ectopic ACTH production
Glucocorticoid treatment (iatrogenic)
Adrenal adenoma
Pituitary adenoma

The most common cause of Cushing’s syndrome is the long term use of glucocorticoid treatments (steroids). These treatments are commonly used to suppress inflammation in many diseases. If these treatments are used long term they can result in the development of Cushing’s syndrome. As a result, most steroid treatments are only given for short durations with the smallest dose possible.

Answer 503

A

21-hydroxylase

21-hydroxylase needed to produce cortisol and aldosterone

Answer 504

A

Which enzyme is the final step in cortisol production?

21-hydroxylase
11B-hydroxylase
5a-reductase
17B-HSD

Answer 505

A

Which enzyme is the final step in testosterone production?

21-hydroxylase
11B-hydroxylase
5a-reductase
17B-HSD

Answer 506

A

Which one of the following is most characteristically caused by thiazides?

Hypocalcemia
Hypercalcemia
Hyperkalaemia
Hypernatraemia

Answer 507

A

Side-effects include gastrointestinal upset and lactic acidosis (common in exams)

Metformin
SGLT-2 Inhibitors
GLP-1 agonists
Thiazolidinediones

Answer 508

A

Increases

Answer 509

A

Which type of Ig caused activation of TSH receptor in Graves Disease?

IgA
IgG
IgM
IgD
IgE

Answer 510

A

Relative deficiency of insulin due to an excess of adipose tissue and insulin resistance:

MODY
DMT1
DMT2
Gestational Diabetes
LADA

Answer 511

A

Which one of the following actions is directly caused by cortisol?

Increases gastric motility
Decreases osteoclastic activity
Decreases renal reabsorption of phosphate
Upregulates alpha1 receptors on arterioles

Answer 512

A

Thyrotoxicosis is most likely to present with the following blood tests:

High TSH; Low T4
Low TSH; Low T4
High TSH; High T4
Low TSH; High T4

Answer 513

A

Primary hyperaldosteronism:
* excess production of the adrenal gland (zona glomerulosa)
* can present more commonly as a primary tumor in the gland known as Conn syndrome or bilateral adrenal hyperplasia

Secondary hyperaldosteronism:
* Excessive activation of RAAS
* renin-producing tumor, renal artery stenosis, or edematous disorders like left ventricular heart failure, pregnancy, cor pulmonale, or cirrhosis with ascites.

Answer 514

A

Primary hyperthyroidism:
* due to thyroid pathology

Secondary hyperthyroidism:
* the condition where the thyroid is producing excessive thyroid hormone as a result of overstimulation by thyroid stimulating hormone.
* The pathology is in the hypothalamus or pituitary.

Answer 515

A

PTH raises Ca2+ levels

Primary hyperparathyroidism:
* Parathyroid adenoma
* Paraythyroid hyperplasia
* Over-secreting PTH; high calcium

Secondary hyperparathyroidism:
* Due to low serum calcium levels as a result of another condition: commonly CKD or Vit D deficiency
* High PTH, low Ca2+

Tertiary hyperparathyroidism:
* Prolonged period of secondary hyperparathyroidism: secrete PTH autonomously
* High PTH, High Ca2+

Answer 516

A

5-alpha reductase Inhibitors

Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase.

Answer 517

A

Cushing syndrome

Dexamethasone at night (i.e. 10pm) and their cortisol and ACTH is measured in the morning (i.e. 9am). The intention is to find out whether the dexamethasone suppresses their normal morning spike of cortisol.

Answer 518

A

Abnormal: high levels of cortisol

Normal: low levels of cortisol

Answer 519

A

Short synacthen test is used to diagnose

Addisons disease

The test involves giving synacthen, which is synthetic ACTH. The blood cortisol is measured at baseline, 30 and 60 minutes after administration. The synthetic ACTH will stimulate healthy adrenal glands to produce cortisol and the cortisol level should at least double. A failure of cortisol to rise (less than double the baseline) indicates primary adrenal insufficiency (Addison’s disease).

Answer 520

A

Which drug targets B3 receptors in urge incontinence

Mirabegron
Finasteride
Oxybutynin
Botox

Answer 521

A

Lumbar splachnic nerve

Answer 522

A

Lesser and least splachnic nerve

Answer 523

A

Which of these is not a definition for constipation?

infrequent stools, more than 3 per week

passage of hard stools

a sensation of incomplete evacuation

infrequent stools, more than 2 per week

Answer 524

A

Which structure in the bladder is under voluntary somatic control?

Detrusor muscle

Internal urethral sphincter

External urethral sphincter

Rugae of the bladder

Answer 525

A

Stimulation of which receptor would treat urinary incontinence?

Beta 1

Beta 2

Beta 3

M3

Answer 526

A

The sympathetic nervous system acts on the internal urethral sphincter via which receptor?

Alpha 1

Alpha 2`

Beta 2

Beta 3

Answer 527

A

Which nerve carries sympathetic innervation to the bladder?

Ilioinguinal nerve

Hypogastric nerve

Pudendal nerve

Pelvic nerve

Answer 528

A

Which of the following is correct regarding muscle activity during the storage phase of micturition?

Storage requires relaxation of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.

Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.

Storage requires contraction of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.

Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.

Answer 529

A

Relaxation of the detrusor muscle and contraction of the internal urethral sphincter (IUS) is under the control of which receptors respectively?

B2-adrenoreceptors and A1-adrenoreceptors respectively

B3-adrenoreceptors and A1-adrenoreceptors respectively

A1-adrenoreceptors and B3-adrenoreceptors respectively

A1-adrenoreceptors and B2-adrenoreceptors respectively

Answer 530

A

Inability for detrusor muscle to relax, inability for the internal urethral sphincter to contract, and constant relaxation of the external urethral sphincter.

After a spinal cord lesion above T12, sympathetic input to the bladder is lost, leading to an inability of the detrusor muscle to relax, and an inability of the internal urethral sphincter to contract. Afferent signals via the sensory pelvic nerve are also unable to reach the brain, so the external urethral sphincter remains constantly relaxed.

Answer 531

A

What is the action of B3-adrenoreceptor agonists on the control of micturition?

Bind to B3-receptors on the detrusor muscle to cause contraction, promoting the voiding of urine.

Bind to B3-receptors on the internal urethral sphincter to cause contraction, preventing the voiding of urine.

Bind to B3-receptors on the internal urethral sphincter to cause relaxation, promoting the voiding of urine.

Bind to B3-receptors on the detrusor muscle to cause relaxation, increasing the bladders storage capacity.

Answer 532

A

M3 muscarinic receptors

β3-adrenoreceptors cause relaxation of the detrusor rather than contraction.

Answer 533

A

What is the typical male urinary flow rate?

15-20ml/s

20-25ml/s

25-30ml/s

30-35ml/s