Mini Quizzes Sem 2 Flashcards
A 75 year old woman presents to emergency with acute onset of dyspnoea. The following are her blood gas results: pH = 7.25 (Normal: 7.35 to 7.45) PaCO2 = 55 (Normal: 36 to 44 mmHg) HCO3- = 24 (Normal: 22 to 26 mmol/L). Which one of the following is the most correct interpretation of these findings?
- Acute metabolic acidosis with no compensation
- Acute respiratory acidosis with no compensation
- Metabolic acidosis and respiratory acidosis
- Metabolic acidosis with respiratory compensation
- Respiratory acidosis with metabolic compensation
B. Acute respiratory acidosis with no compensation
- pH = 7.25 –> ACIDIC
- PaCO2 = 55 –> HIGH = respiratory
- HCO3 = NORMAL = no compensation
Respiratory acidosis = failure of ventilation and an accumulation of CO2
Patient unable to breath out the accumulation CO2 –> results in decreased ratio of arterial bicarbonate to arterial PCO2
To compensate for the disturbance in the balance between CO2 + HCO3-, the kidneys begin to excrete more acid in the forms of H+ and NH4+ and reabsorb more base in the form of HCO3. Here, HCO3 levels are normal so kidneys not doing that yet!
A 14-year-old boy presents with an acute onset of wheezing, cough and dyspnoea. He is having difficulty speaking in sentences. He has a long history of mild intermittent asthma. His symptoms are temporarily improved by inhaled bronchodilators. On chest auscultation he has widespread wheezing. Which one of the following is the corticosteroid medication that should be recommended for this patient?
- Budesonide
- Beclomethasone
- Disodium cromoglycate
- Prednisolone
- Salbutamol
- Budesonide → ICS but preventor
- Beclomethasone → ICS but preventor
- Disodium cromoglycate → Not a corticosteroid = Cromo
- Prednisolone → ICS but more immediate than the others
- Salbutamol → Not a corticosteroid = B2 receptor agonist
Budesonide and Beclomethasone are only locally acting in the lungs, so they’re not going to do too much in an acute asthma attack.
Pred will work systemically, and calm the immune response down enough to get the patient stable.
A 35-year-old man is taking a medication that suppresses his immune system. Which one of the following vaccines is contraindicated in this patient?
- Influenza
- Hepatitis B
- Measles
- Pertussis
- Tetanus
A 35-year-old man is taking a medication that suppresses his immune system. Which one of the following vaccines is contraindicated in this patient?
- Influenza
- Hepatitis B
- Measles
- Pertussis
- Tetanus
A 75-year-old woman is prescribed oral corticosteroids over a 6-month period after being diagnosed with polymyalgia rheumatica. Which one of the following is the most likely long-term side effect of this medication?
- Diplopia
- Hyperkalaemia
- Muscle hypertrophy
- Suppression of catecholamine release
- Suppression of normal response to infection
- Diplopia = double vision
- Hyperkalaemia
- Muscle hypertrophy
- Suppression of catecholamine release
- Suppression of normal response to infection → affect the way WBCs work
A 60-year-old man is admitted to the medical ward with an acute onset of dyspnoea. The following are his arterial blood gas results: pH = 7.01 (7.35 to 7.45) PaCO2 = 105 mmHg (36 to 44) HCO3- = 28.6 mmol/L (22 to 26). Which one of the following is the most correct interpretation of these findings?
- Acute metabolic acidosis with no compensation
- Acute respiratory acidosis with no compensation
- Metabolic acidosis and respiratory acidosis
- Metabolic acidosis with respiratory compensation
- Respiratory acidosis with metabolic compensation
E. Respiratory acidosis with metabolic compensation
- pH = 7.01 = Acidic
- PaCO2 = HIGH → Respiratory
- HCO3- = HIGH → Compensation by kidneys (↑HCO3 and ↓H+ and ↓NH4+)
To be effective at providing protection in a population, vaccines do not need to be 100% effective in all individuals that are vaccinated. This is because:
- Not all individuals may be exposed to the infectious agent
- Not all individuals may choose to be vaccinated
- If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
- The infectious agent might not cause serious disease in all individuals
- Only humoral responses are required
- Not all individuals may be exposed to the infectious agent
- Not all individuals may choose to be vaccinated
- If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
- The infectious agent might not cause serious disease in all individuals
- Only humoral responses are required
Which one of the following structures carries nutrient and oxygenated blood?
- coronary arteries
- great cardiac vein
- inferior vena cava
- pulmonary arteries
- superior vena cava
Which one of the following structures carries nutrient and oxygenated blood?
- coronary arteries = supply the heart itself with O2
- great cardiac vein = deoxygenated
- inferior vena cava = big vein (deoxygenated)
- pulmonary arteries = carry deoxygenated blood to the lungs to be oxygenated
- superior vena cava = big vein (deoxygenated)
In spermatogenesis:
- FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
- FSH and LH are produced by the Sertoli and Leydig cells as they mature during puberty
- Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids
- The Sertoli cells produce the male sex hormone, testosterone
- The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa
In spermatogenesis:
- FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
- FSH and LH are produced by the Sertoli and Leydig cells as they mature during puberty → FALSE: FSH & LH are produced by the anterior pituitary and Sertoli cells = seminiferous tubules & Leydig cells = interstitial cells adjacent to the seminiferous tubules in the testes.
- Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids → FALSE: Leydig cells secrete testosterone
- The Sertoli cells produce the male sex hormone, testosterone → FALSE
- The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa → FALSE: The Sertoli cells do that
Each of the cardiac valves:
- opens and closes in response to changes in pressure
- attaches to the ventricular walls via chordae tendinae
- ensures two-way blood flow through the heart
- receives blood supply directly from the coronary artery
- has three leaflets
Each of the cardiac valves:
- opens and closes in response to changes in pressure
- attaches to the ventricular walls via chordae tendinae → FALSE: only the mitral & tricuspid valves have this
- ensures two-way blood flow through the heart → FALSE: one way or blood backflow (regurgitation)
- receives blood supply directly from the coronary artery
- has three leaflets → FALSE
4 heart valves
- 2 AV Valves: Mitral & Tricuspid
- 2 SL Valves: Pulmonary & Aortic
- 3 leaflets = Tricuspid & Pulmonary & Aortic
- 2 leaflets = Mitral (Bicuspid)
A couple present to discuss fertility issues. They have been having unprotected intercourse for twelve months and are starting to worry that they might be infertile.
When taking a medical history from a couple regarding fertility, what are 6 relevant questions to ask each member of the couple?
Questions to Female
- Menstrual history (regularity and timing)
- Previous pregnancy
- Frequency of intercourse & technique
- Timing of intercourse
- Contraception use
- Age of partner
Questions to male
- Past pregnancies
- Age of partner
- Frequency of intercourse & technique
- Drug and alcohol use
- Previous infections (eg mumps)
- Damage or surgery to testes
List and briefly describe 4 functions of the Sertoli cell in the seminiferous tubules of the testis.
(10 examples)
Sertoli cells - Functions
- Support cell for developing sperm
- Provides structural organisation to the tubul
- Divides the seminiferous tubule wall into basal and luminal (or two) compartments
- Separates mitotic spermatogonia from meiotic spermatocytes and spermatids
- Controls metabolic exchange with spermatogenic cells
- Forms the blood-testis barrier to prevent autoimmunity to sperm
- Concentrates testosterone in the luminal compartment of the tubule
- Phagocytoses the residual body from spermiogenesis
- Anchors spermatogenic cells, especially spermatids (either cell type or both)
- Secretes substances that regulate sperm production
Choose the most appropriate missing words from the list below. You may use any of the words as many times as needed, or not at all.
spermatids, spermatogonia, spermatogenesis, spermatocytes, spermiogenesis, spermatozoa
1) ………….. are the source of new sperm through clonal proliferation.
2) …………… are stages of meiosis that end in the formation of ………..
3) The process of physical transformation of these cells into ……….. is called ………….
1) Spermatogonia are the source of new sperm through clonal proliferation.
2) Spermatogenesis are stages of meiosis that end in the formation of spermatids.
3) The process of physical transformation of these cells into spermatozoa is called spermiogenesis.
List the 3 hormones necessary to maintain pregnancy?
Hormones necessary to maintain pregnancy:
- Oestrogen
- Progesterone
- Human chorionic gonadotropin
A 28 year old female patient seeks advice about starting a family. What are 5 key issues you would raise with her as she plans for conception and pregnancy?
Pre-conception Advice
- Vaccination status – rubella, varicella
- Folate supplementation
- No smoking
- Avoidance of alcohol
- Dietary and exercise advice
Briefly outline 3 ethical issues related to the use of artificial reproductive technologies.
Ethical issues around artificial reproductive technologies
-
Family relationships
- The use of donor sperm, donor eggs and surrogacy can create issues around who is the legal as opposed to biological parent of the child.
- Issues around the need to ‘adopt’ the child in some cases.
-
Informed consent.
- The need for full disclosure and fair representation of all the potential medical, social and emotional outcomes and risks.
-
Embryo status
- The ethical and legal status of the human embryo.
The graph depicts a normal menstrual cycle. On the graph, label the 4 hormones involved:
The graph depicts a normal menstrual cycle. On the graph, label the 4 hormones involved:
- E2 = Oestradiol → thickens the lining of the uterus
- LH = Luteinizing Hormone → triggers release of egg
- FSH = Follicle Stimulating Hormone →
- Pr = Progesterone
FINISH THIS OFF !!
Describe the Calendar Rhythm method (natural family planning) and explain the principles of this method, with reference to the normal menstrual cycle.
Calendar Rhythm Method of Contraception
A natural method of birth control that uses the menstrual cycle to predict the most fertile time of the month for ovulation and then to employ barrier or abstinence during this time to avoid fertilisation of the egg and therefore pregnancy.
The principles are to avoid intercourse 6 days before ovulation, on the day of ovulation and one day afterwards.
What are two other methods used with the calendar rhythm method to naturally predict post-ovulation?
Methods used with the calendar rhythm method to naturally predict post-ovulation?
- Ovulation method: checking for cervical mucus
- Temperature method: checking body temperature noting a rise in temp after ovulation
Briefly describe 3 mechanisms of action of the combined oral contraceptive pill.
Combined Oral Contraceptive Pill - Mechanism of Action
- Hypothalamus suppression of ovary leading to anovulation
- Altered tubal motility
- Less receptive endothelium − Hostile cervical mucus
What forms of progesterone-only contraception are available?
Progesterone-only contraception
- Intramuscular depot injection (Depo-Provera)
- Progesterone only oral pill (Mini-pill)
- Levonorgestrel implant (implanon)
What are two common reasons for the use of progesterone-only contraceptive options?
Indications for progesterone-only contraceptive
- During breastfeeding
- Women for whom estrogens are contraindicated (eg liver disease, migraine with aura, history of coagulopathy)
List the 3 cardiac layers and identify the histological features of each layer.
Cardiac Histology - 3 Layers
- Endocardium – simple squamous epithelium, connective tissue, collagen, elastin
- Myocardium - cardiac myocytes
- Epicardium – simple squamous epithelium, collagen, elastin; visceral layer of serous pericardium
How is carbon dioxide carried in the blood? Complete the equation below:
CO2 + H2O →
Blood Buffer Equation
Compare the differences in gas exchange in the lungs, and the peripheral tissues.
Gas exchage at the:
Lungs:
- O2 is picked up from alveoli, CO2 is released into the lungs from H2CO3, diffuses from plasma into the alveoli.
- Hb releases CO2 from carbamino haemoglobin, (HbCO2).
- O2 combines with acid Haemoglobin, HHb, to form oxyhaemoglobin, HbO2 and H+ is released.
Peripheral tissues:
- O2 is released to tissues from HbO2 on red blood cells, CO2 is picked up at the tissues.
- CO2 produced diffuses into plasma, where it dissolves and forms H2CO3.
- Haemoglobin buffers both CO2 and H+
List the three main types of vaccines currently used in human vaccination:
- Live attenuated whole virus vaccine
- Inactivated whole virus vaccine
- Subunit vaccines
Vaccination aims to provide antigen-specific immunity. Describe how the immune response to vaccination protects an individual from infection.
The initial exposure to the pathogen in the vaccine provokes the adaptive immune response without causing infection.
B cells and T cells are activated by antigen exposure to eliminate the infected host cells.
Antigen-specific memory B cells are created which provide immunity upon subsequent exposure.
A woman who is 10 weeks pregnant presents with symptoms indicating rubella infection. She is found to have raised IgM for rubella on her serology results. What are the implications for the development of her baby?
Rubella infection during Pregnancy
- Raised IgM indicates current rubella infection.
- In the first trimester of pregnancy this has serious outcomes for the development of the fetus.
- Common congenital abnormalities associated with rubella include:
- Cardiac defects
- Hearing loss
- Cataracts
- Intellectual disability
A 55-year-old man has been recently diagnosed with hypertension. His BP is 155/95 mmHg. Apart from the eGFR, which one of the following investigations is most appropriate to exclude renal complication?
- 24-hour urine for creatinine.
- 24-hour urine for protein.
- Urine albumin:creatinine ratio.
- Urine electrophoresis.
- Urine microscopy.
- 24-hour urine for creatinine.
- 24-hour urine for protein.
- Urine albumin:creatinine ratio.
- Urine electrophoresis.
- Urine microscopy.
Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker?
- Propranolol
- Timolol
- Sotalol
- Metoprolol
- Pindolol
Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker?
- Propranolol
- Timolol
- Sotalol
- Metoprolol
- Pindolol
The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system?
- Eye
- Gastrointestinal tract
- Heart
- Salivary glands
- Veins and arterioles
The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system?
- Eye
- Gastrointestinal tract
- Heart
- Salivary glands
- Veins and arterioles
The Lineweaver-Burk plot is used to:
- determine the equilibrium constant for an enzymatic reaction.
- extrapolate for the value of reaction rate at infinite enzyme concentration.
- illustrate the effect of temperature on an enzymatic reaction.
- solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration.
- solve, graphically, for the ratio of products to reactants for any starting substrate concentration.
The Lineweaver-Burk plot is used to:
- determine the equilibrium constant for an enzymatic reaction.
- extrapolate for the value of reaction rate at infinite enzyme concentration.
- illustrate the effect of temperature on an enzymatic reaction.
- solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration.
- solve, graphically, for the ratio of products to reactants for any starting substrate concentration.
A 43-year-old woman is found to have a BP of 150/90 mmHg on a routine check-up. She is otherwise well. She does not take any regular medications. She has never smoked, and drinks 2 standard drinks of alcohol per week. There is no family history of ischaemic heart disease. An ECG is performed. Which one of the following is the most appropriate reason for performing an ECG?
- Baseline before commencing on antihypertensives.
- Evidence of previous myocardial infarction.
- Evidence of left ventricular hypertrophy.
- Part of routine check-up.
- Tachyarrhthymia.
- Baseline before commencing on antihypertensives.
- Evidence of previous myocardial infarction.
- Evidence of left ventricular hypertrophy.
- Part of routine check-up.
- Tachyarrhthymia.
One of the enzymes involved in glycolysis, aldolase, requires Zn2+ for catalysis. Under conditions of zinc deficiency, when the enzyme may lack zinc, it would be referred to as the:
- Apoenzyme
- Coenzyme
- Holoenzyme
- Prosthetic group
- Substrate
One of the enzymes involved in glycolysis, aldolase, requires Zn2+ for catalysis. Under conditions of zinc deficiency, when the enzyme may lack zinc, it would be referred to as the:
- Apoenzyme
- Coenzyme
- Holoenzyme
- Prosthetic group
- Substrate
The primary blood pressure lowering effect of nifedipine is due to a block of:
- voltage-gated sodium channels in the sino-atrial node
- voltage-gated calcium channels in ventricular tissue
- voltage-gated calcium channels in the smooth muscle of blood vessels
- ß1-adrenergic receptors in the sino-atrial node
- ß1 – adrenergic receptors in the ventricular tissue
The primary blood pressure lowering effect of nifedipine is due to a block of:
- voltage-gated sodium channels in the sino-atrial node
- voltage-gated calcium channels in ventricular tissue
- voltage-gated calcium channels in the smooth muscle of blood vessels
- ß1-adrenergic receptors in the sino-atrial node
- ß1 – adrenergic receptors in the ventricular tissue
The stimulus for activation of the renin-angiotensin-aldosterone system is:
- an increase in blood sodium levels
- an increase in blood levels of antidiuretic hormone (ADH)
- a decrease in blood glucose levels
- a decrease in glomerular filtration rate
- a decrease in mean arterial pressure
The stimulus for activation of the renin-angiotensin-aldosterone system is:
- an increase in blood sodium levels
- an increase in blood levels of antidiuretic hormone (ADH)
- a decrease in blood glucose levels
- a decrease in glomerular filtration rate
- a decrease in mean arterial pressure
A 75-year-old woman with a background of congestive cardiac failure presents with an acute onset of dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea. Physical examination shows widespread crackles in both lung fields and sacral oedema. Which one of the following medications is the most appropriate diuretic for treatment of this patient?
- Acetazolamide
- Frusemide
- Hydrochlorothiazide
- Mannitol
- Triamterene
- Acetazolamide
- Frusemide
- Hydrochlorothiazide
- Mannitol
- Triamterene
A 45-year-old man is commenced on a loop diuretic for treatment of congestive cardiac failure. Which one of the following is the most common complication of this medication?
- Hypermagnesemia
- Hypernatremia
- Hypoglycaemia
- Hypokalaemia
- Metabolic acidosis
A 45-year-old man is commenced on a loop diuretic for treatment of congestive cardiac failure. Which one of the following is the most common complication of this medication?
- Hypermagnesemia
- Hypernatremia
- Hypoglycaemia
- Hypokalaemia
- Metabolic acidosis
Define FEV1 and FVC
FEV1 = forced expiratory volume of air in the first second
FVC = amount of gas forcibly expelled after a deep breath as rapidly as possible.
How are FEV1 and FVC values used in interpreting the spirometry of a patient with asthma?
The FEV1/FVC ratio is used to define airflow obstruction – asthma is an obstructive lung condition. If the ratio is less than the lower limit of normal for age, this is interpreted as an obstructive pattern.
FEV1 is expressed as a “percent predicted” to grade severity (for example, FEV1 >80% predicted value = mild obstruction, <60% = severe obstruction)
Post-bronchodilator reversibility in FEV1 of >12% and >200mL indicates asthma
A 23-year-old man presents for follow-up of his intermittent asthma. List up to 4 specific symptoms that should be asked about when taking the history.
Hx of Asthma - Symptoms to Ask About
- Wheezing
- Coughing (especially nocturnal)
- Chest tightness
- Breathlessness
When examining this patient, what would indicate the presence of pulsus paradoxus?
Pulsus Paradoxus
When the normal reduction in blood pressure with inspiration is exaggerated i.e. >10mmHg
- Systolic blood pressure normally falls during quiet inspiration in normal individuals.
- Pulsus paradoxus can be observed in cardiac tamponade and in conditions where intrathoracic pressure swings are exaggerated or the right ventricle is distended, such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease.
After 3 weeks the patient presents to the Emergency Department with an acute exacerbation of asthma. List 8 clinical signs that indicate severe asthma attack.
Clinical Signs of a Severe Asthma Attack
- Physical exhaustion with paradoxical chest movement
- Talks in words only
- Pulse rate >120bpm
- Central cyanosis
- Quiet chest
- PEF<50%
- FEV1<50%
- Sa02 <90%
A 24-year-old man with a background of type 1 diabetes presents to the Emergency Department feeling acutely unwell. Investigations reveal that he has acute renal failure. List 4 likely causes in this patient.
Causes of Acute Renal Failure in Diabetic Patients
- Pyelonephritis with acute tubular necrosis
- Increased risk atheroma and embolism to already compromised kidneys.
- Drug induced interstitial nephritis e.g. Sulphonamides antibiotics etc.
- Acutely unwell diabetics with hyperglycemia can become dehydrated and get ATN
A 65 year old man with established chronic kidney disease presents to his GP for his regular check up.
What functions of the kidney should the GP be considering as she reviews this patient and orders investigations? (5)
Functions of the Kidneys
- Disposal of nitrogenous wastes e.g. urea
- Regulation of water and electrolyte balance
- Regulation of plasma pH
- Activation of Vitamin D
- Stimulation of erythropoiesis
A junior medical officer is called to the surgical ward in the evening to assess a post-operative patient’s fluid balance status. List 10 key clinical features that should be considered in their assessment.
Fluid Balance - Key Clinical Features to Assess
- Fluid intake
- Blood pressure
- Urine output
- Other losses eg stool, vomitus, surgical drains
- Skin turgor
- Mucous membrane eg tongue moisture
- Capillary refill time/peripheral perfusion
- JVP
- Peripheral oedema
- Breath sounds and lung percussion - are there signs of pulmonary oedema?