Mini Quizzes Sem 2 Flashcards

Question 1

Q

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

Answer

A

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!

Question 2

Q

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

Answer

A

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.

Question 3

Q

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

Answer

A

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

Question 4

Q

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

Answer

A

Diplopia = double vision
Hyperkalaemia
Muscle hypertrophy
Suppression of catecholamine release
Suppression of normal response to infection → affect the way WBCs work

Question 5

Q

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

Answer

A

E. Respiratory acidosis with metabolic compensation

pH = 7.01 = Acidic
PaCO2 = HIGH → Respiratory
HCO3- = HIGH → Compensation by kidneys (↑HCO3 and ↓H+ and ↓NH4+)

Question 6

Q

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

Answer

A

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

Question 7

Q

Which one of the following structures carries nutrient and oxygenated blood?

coronary arteries
great cardiac vein
inferior vena cava
pulmonary arteries
superior vena cava

Answer

A

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)

Question 8

Q

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

Answer

A

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

Question 9

Q

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

Answer

A

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)

Question 10

Q

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?

Answer

A

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

Question 11

Q

List and briefly describe 4 functions of the Sertoli cell in the seminiferous tubules of the testis.

(10 examples)

Answer

A

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

Question 12

Q

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 ………….

Answer

A

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.

Question 13

Q

List the 3 hormones necessary to maintain pregnancy?

Answer

A

Hormones necessary to maintain pregnancy:

Oestrogen
Progesterone
Human chorionic gonadotropin

Question 14

Q

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?

Answer

A

Pre-conception Advice

Vaccination status – rubella, varicella
Folate supplementation
No smoking
Avoidance of alcohol
Dietary and exercise advice

Question 15

Q

Briefly outline 3 ethical issues related to the use of artificial reproductive technologies.

Answer

A

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.

Question 16

Q

The graph depicts a normal menstrual cycle. On the graph, label the 4 hormones involved:

Answer

A

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 !!

Question 17

Q

Describe the Calendar Rhythm method (natural family planning) and explain the principles of this method, with reference to the normal menstrual cycle.

Answer

A

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.

Question 18

Q

What are two other methods used with the calendar rhythm method to naturally predict post-ovulation?

Answer

A

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

Question 19

Q

Briefly describe 3 mechanisms of action of the combined oral contraceptive pill.

Answer

A

Combined Oral Contraceptive Pill - Mechanism of Action

Hypothalamus suppression of ovary leading to anovulation
Altered tubal motility
Less receptive endothelium − Hostile cervical mucus

Question 20

Q

What forms of progesterone-only contraception are available?

Answer

A

Progesterone-only contraception

Intramuscular depot injection (Depo-Provera)
Progesterone only oral pill (Mini-pill)
Levonorgestrel implant (implanon)

Question 21

Q

What are two common reasons for the use of progesterone-only contraceptive options?

Answer

A

Indications for progesterone-only contraceptive

During breastfeeding
Women for whom estrogens are contraindicated (eg liver disease, migraine with aura, history of coagulopathy)

Question 22

Q

List the 3 cardiac layers and identify the histological features of each layer.

Answer

A

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

Question 23

Q

How is carbon dioxide carried in the blood? Complete the equation below:

CO2 + H2O →

Answer

A

Blood Buffer Equation

Question 24

Q

Compare the differences in gas exchange in the lungs, and the peripheral tissues.

Answer

A

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+

Question 25

Q

List the three main types of vaccines currently used in human vaccination:

Answer

A

Live attenuated whole virus vaccine
Inactivated whole virus vaccine
Subunit vaccines

Question 26

Q

Vaccination aims to provide antigen-specific immunity. Describe how the immune response to vaccination protects an individual from infection.

Answer

A

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.

Question 27

Q

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?

Answer

A

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:
1. Cardiac defects
2. Hearing loss
3. Cataracts
4. Intellectual disability

Question 28

Q

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.

Answer

A

24-hour urine for creatinine.
24-hour urine for protein.
Urine albumin:creatinine ratio.
Urine electrophoresis.
Urine microscopy.

Question 29

Q

Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker?

Propranolol
Timolol
Sotalol
Metoprolol
Pindolol

Answer

A

Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker?

Propranolol
Timolol
Sotalol
Metoprolol
Pindolol

Question 30

Q

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

Answer

A

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

Question 31

Q

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.

Answer

A

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.

Question 32

Q

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.

Answer

A

Baseline before commencing on antihypertensives.
Evidence of previous myocardial infarction.
Evidence of left ventricular hypertrophy.
Part of routine check-up.
Tachyarrhthymia.

Question 33

Q

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

Answer

A

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

Question 34

Q

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

Answer

A

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

Question 35

Q

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

Answer

A

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

Question 36

Q

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

Answer

A

Acetazolamide
Frusemide
Hydrochlorothiazide
Mannitol
Triamterene

Question 37

Q

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

Answer

A

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

Question 38

Q

Define FEV1 and FVC

Answer

A

FEV1 = forced expiratory volume of air in the first second

FVC = amount of gas forcibly expelled after a deep breath as rapidly as possible.

Question 39

Q

How are FEV1 and FVC values used in interpreting the spirometry of a patient with asthma?

Answer

A

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

Question 40

Q

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.

Answer

A

Hx of Asthma - Symptoms to Ask About

Wheezing
Coughing (especially nocturnal)
Chest tightness
Breathlessness

Question 41

Q

When examining this patient, what would indicate the presence of pulsus paradoxus?

Answer

A

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.

Question 42

Q

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.

Answer

A

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%

Question 43

Q

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.

Answer

A

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

Question 44

Q

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)

Answer

A

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

Question 45

Q

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.

Answer

A

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?

Question 46

Q

A 50-year-old man presents for a routine check-up. His BP is 160/90 mmHg (sitting) and 150/85 mmHg standing. He had a similar BP 2 months ago in the clinic. His BMI is 29 kg/m2.

What is the most likely cause of hypertension in this patient?

Answer

A

Essential (or idiopathic) hypertension

Question 47

Q

Other than Essential Hypertension, what are 3 common causes of hypertension?

Answer

A

Common Causes of Hypertension

Renal disease (renal artery stenosis, renal parenchymal disease such as analgesic nephropathy)
Endocrine disease (hyperaldosteronism (Conn’s syndrome), thyrotoxicosis, pheochromocytoma, Cushing ’s syndrome)
Coarctation of the aorta

Question 48

Q

List four complications of untreated hypertension

Answer

A

Complications of untreated hypertension

Left ventricular failure
Cerebral ischemic events
Renal failure
Retinopathy; also ischaemic heart disease, peripheral vascular disease

Question 49

Q

The patient’s father died from a cerebrovascular accident. He asks if there are any changes he could make to his lifestyle that would reduce his chances of a similar fate. List 4 most important recommendations.

Answer

A

Most Important Lifestyle Changes for CVD Risk

Reduce weight
Appropriate diet (low in saturated fat, recommend low-salt and reduced salt foods as part of a healthy eating pattern.)
Limited alcohol intake: ≤ two standard drinks per day for men
Exercise – 5 x 30mins/week as a target

Question 50

Q

A 30-year-old medical registrar working at a tertiary teaching hospital is seen by his colleagues as being exhausted and ‘snappy’ to others around him.

List up to 3 reasons why this doctor might be experiencing stress.

Answer

A

Reasons why doctors might experience stress

Intensity of demand on doctors, conflicting demands and time pressure
The gravity, emotional intensity and responsibility entailed in the job
Insufficient resources provided in the public sector
Requirements for accreditation and continuing professional development
Medicolegal threat and unreasonable expectations and demands of patients
Demanding, hostile and emotionally difficult patients and even actual violence
Maintaining amicable relationships with colleagues and staff within the work environment
Loss of the traditional status of doctors, and negative media representation
After-hours and on-call work
Interference with family life
Poor remuneration (compared with expended effort)
Lack of appreciation

Question 51

Q

List up to 3 ‘red flags’ that would indicate to the doctor’s colleagues that he might be an impaired practitioner.

Answer

A

Impaired Practitioner - ‘Red Flags’

Increasing incidence of complaints about a doctor
Uncharacteristic interpersonal and other behaviour
Falling standards and clinical errors
Failure to keep abreast of administrative demands (eg, paperwork)
Lack of responsiveness and poor punctuality when called
Overt signs or symptoms of substance misuse or psychiatric illness

Question 52

Q

A 65-year-old man presents to an Emergency Department with a 3-hour history of worsening central chest pain. He is nauseated, diaphoretic and has mild dyspnoea.

What are two important investigations that should be performed?

Answer

A

ECG
Troponin level

Question 53

Q

Further history reveals this man is being treated for hypercholesterolemia with statin therapy. He is a smoker with a 25-pack-year history. He has a BMI of 30 kg/m2 and BP of 145/95 mmHg.

How do these risk factors contribute to the development of ischemic heart disease in this patient?

Answer

A

Pathogenesis of Atherosclerosis

These risk factors act together in the development of atherosclerosis. Endothelial injury to the vascular wall (caused by smoking, haemodynamic disturbances and hypercholesterolemia in this patient) followed by accumulation of lipoproteins (such as LDL and its oxidized forms) and further chronic inflammatory changes contribute to atherosclerotic plaque within the vessel.

Question 54

Q

Describe the role of lipoproteins and lipoprotein receptors in regulating the metabolism of lipoproteins.

Answer

A

Metabolism of Lipoproteins

Chylomicrons: transports lipids (from diet) from small intestine to body cells and helps cell to remove lipids.
Chylomicrons remnants: return dietary lipid to liver.
Very low-density lipoprotein (VLDL): deliver endogenous lipids.
Intermediate density lipoprotein (IDL): return endogenous lipid to liver – precursor of LDLs.
Low-density lipoprotein (LDL): deliver cholesterol to cells.
High-density lipoprotein (HDL): to exchange proteins and lipid with other lipoproteins. Reverse cholesterol transport.
LDL receptor complexes are present in clathrin-coated pits and mediates cell uptake of LDL-cholesterol.

Question 55

Q

Outline four steps involved in the uptake of LDL into cells via LDL receptors.

Answer

A

LDL Uptake

LDL is taken up from the blood via LDL receptors that are in clathrin coated pits.
Upon binding of LDL to LDLR, the complex is endocytosed and the endossome fuses with lysosome.
Lytic enzymes degrade LDL components into free Cholesterol / fatty acids / amino acids.

Question 56

Q

What are 4 examples of primary prevention of cardiovascular disease?

Answer

A

Primary prevention → aims to prevent disease or injury before it ever occurs.

Primary prevention of CVD

Attempts to reduce CV disease morbidity/mortality through risk factor modification in people without evidence of established CV disease:

For example:

Smoking cessation advice and programs
Healthy diet advice
Exercise programs
Treatment for hypertension or hypercholesterolemia

Question 57

Q

A 70-year-old man presents for a check-up. He is usually healthy and does not take any regular medications. He is a smoker, smoking 20 cigarettes daily. He drinks 2 standard drinks of alcohol per day. His BP is 160/70 mmHg, PR is 90/min. His total cholesterol is 6.9 mmol/L (≤4.5) and HDL cholesterol is 0.8 mmol/L (≥1.0).

A. What is this patient’s absolute cardiovascular risk?

B. What does this value mean?

Answer

A

A. What is this patient’s absolute cardiovascular risk?

41% over 5 years

B. What does this value mean?

Absolute risk = the numerical probability of a cardiovascular disease event occurring within five years, expressed as a percentage.
For example, if a patient’s risk is 41%, then you can tell them that 41 out of every 100 people like him are likely to have a CVD event within the next five years.

Question 58

Q

A 65-year-old man is being discharged from the hospital following an admission for an acute myocardial infarction. He was not taking any regular medications before admission. List 5 medications that should have been commenced, provided he has no contraindications or allergies.

Answer

A

Medications after MI

Aspirin
ACE inhibitor or Angiotensin receptor blocker (ARB)
Beta Blocker
Short-acting nitrate
Statin

Question 59

Q

A 30-year-old woman has recently been on a 24-hour aeroplane flight. She presents with a hot and swollen left calf. In this patient, how might the three elements of Virchow’s triad interact to cause deep venous thrombosis?

Answer

A

Virchow’s Triad + DVT

Stasis disrupts laminar flow and brings platelets into contact with endothelium, and also prevents washout and dilution of activated clotting factors. In this patient, prolonged sitting on the flight might lead to venous stasis.
Hypercoagulability may be due to dehydration, or genetic or acquired factors leading to increased clotting potential of the blood.
Endothelial damage leads to platelet aggregation and clot formation at a venous site. This may be due to traumatic injury to the vessel, or the effect of stasis.

Question 60

Q

A 68-year-old woman with chronic renal failure presents with an abnormal calcium level.

What are the 3 main chemical factors involved in calcium homeostasis?

Answer

A

Calcium Homeostasis - Chemical Factors

Vitamin D
Parathyroid hormone
Calcitonin

Question 61

Q

Describe the role of the kidney in calcium homeostasis.

Answer

A

Role of the kidney in calcium homeostasis

The kidney excretes calcium and phosphate.
Parathyroid hormone acts on the kidney to induce wasting of PO4 and retention of Ca in response to hypocalcemia.
The renal enzyme 1a-hydroxylase converts 25-OH-Vitamin D into 1,25 – dihydroxyvitamin D (1,25(OH)2D), the most active form of Vitamin D.
1,25(OH)2D enhances the intestinal absorption of calcium and phosphate, and impacts on bone mineralisation to maintain plasma calcium and phosphate levels.

Question 62

Q

Further testing demonstrates elevated parathyroid hormone.

Describe the effect this has on this patient’s bone density.

Answer

A

PTH & Bone Density

Parathyroid hormone (PTH) induces the maturation of osteoclasts which dissolve bone to release calcium and phosphate into the circulation to maintain plasma levels.

An ongoingly elevated PTH level will cause decreased bone density leading to potential osteopenia or osteoporosis in the patient.

Question 63

Q

Define the following terms:

Metaphysis
Epiphysis
Diaphysis
Growth plate
Sesamoid bone
Apophysis

Answer

A

Metaphysis = zone adjacent to the growth plate on the diaphyseal side
Epiphysis = end of the bone
Diaphysis = the shaft of the bone
Growth plate = area of growing tissue in the long bones of children and adolescents
Sesamoid bone = a bone that ossifies within a tendon
Apophysis = normal developmental outgrowth of a bone which arises from a separate ossification centre, and fuses to the bone later in development

Question 64

Q

Indicate on the knee X-ray below the locations of each of the:

Metaphysis
Epiphysis
Diaphysis
Growth plate
Sesamoid bone
Apophysis

Answer 64

A

Criteria for health care funding distribution

Population characteristics
Population need
Existence of fee for service
Historic levels of funding
Cost effectiveness
Lobbying groups
Political processes eg elections

Answer 65

A

Who can consent for minors?

The patient themselves
Parent
Legal guardian
Court
Guardianship board

Answer 66

A

In a plain radiograph of the abdomen,

Gas is Black in colour
Calcium is White in colour
Soft tissue is Grey in colour
Fat is Dark Grey in colour

Answer 67

A

The Health Practitioner Regulation National Law (NSW) 86A

Answer 68

A

If the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time.
Resource: HPRNL s139C (c)

Answer 69

A

Reducing road traffic accidents in rural towns

The community could:

Work in collaboration with the police and use existing legislation to enforce of speed limits, blood alcohol limits for drivers on local roads, increased random breath testing on local roads and enforce laws for sales of alcohol to minors
Also work with the police to enforce vehicle registration requirements
Provide a safer choice to young people by organising affordable safe transport between the towns on Friday and Saturday nights
Collaborate with other partners such as health services and schools to provide health promotion messages for youth in increase their knowledge about the risks of both alcohol consumption and drinking and driving
Work with community members to develop a program to reduce access of young people to alcohol
Develop a supportive environment for youth with appropriate and attractive youth services and activities in Erewhon

Answer 70

A

Population-level Actions to Prevent Spread of Disease

Use public health legislation available to protect public health and monitor disease
Use surveillance for influenza to measure and monitor the number of cases and guide decision making
Contain the spread of disease by identifying people with the disease by testing and placing them in quarantine
Actively identify their contacts and test those with symptoms
Encourage hand hygiene and physical distancing
Promote influenza immunisation as there may be cross protection
Encourage people to not go to work or school if they have respiratory symptoms to prevent spread
Communicate regularly and clearly at all times
Work to identify the original human source of infection.

Answer 71

A

What phase of the cardiac cycle is represented by the T wave?

A. Atrial depolarisation
B. Atrial repolarisation
C. Ventricular depolarisation
D. Ventricular hyperpolarisation
E. Ventricular repolarisation

Answer 72

A

A 34-year-old woman was diagnosed with a deep venous thrombosis in her left calf 9 months ago. Upon repeat Doppler ultrasound, the blood flow appears to have returned to this section of the vein. This process is thrombus evolution is known as:

A. Embolism
B. Fibrinolysis
C. Organisation
D. Propagation
E. Recanalization = the process of restoring flow to or reuniting an interrupted channel of a bodily tube.

Answer 73

A

Which one of the following features is most useful in distinguishing delirium from dementia as a cause of ‘confusion’ in this patient?

A. Disorientation.
B. Hallucinations.
C. Intercurrent illness.
D. Patient age.
E. Onset.

Answer 74

A

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been prescribed metoprolol, a beta-blocker. Which one of the following is the most likely side effect of this medication?

A. Bronchospasm
B. Constipation
C. Hyperkalaemia
D. Hypertension
E. Tachycardia

Answer 75

A

The osteon is the structural component of:

A. Compact bone
B. Elastic cartilage
C. Fibrocartilage
D. Hyaline cartilage
E. Trabecular bone

Answer 76

A

A 68-year-old man presents to the Emergency Department complaining of central chest pain for the past 3 hours. Which one of the following is the most appropriate plasma protein to test for myocardial cellular injury in this patient?

A. Creatine kinase CK - MB isomer
B. Creatine kinase CK - MM isomer
C. Lactate dehydrogenase
D. Myoglobin
E. Highly-sensitive Troponin T

Answer 77

A

Which one of the following lipoproteins is predominantly responsible for promoting the inflammatory response in atherosclerosis?

A. Chylomicrons
B. High-density lipoprotein
C. Intermediate-density lipoprotein
D. Low-density lipoprotein
E. Very low-density lipoprotein

Answer 78

A

The main effect of Parathyroid Hormone (PTH) is to increase plasma calcium by:

A. Acting on target cells in the bone, kidney and intestine
B. Rapidly altering Ca2+ transport
C. Initiating protein synthesis of enzymes in oesteoclasts
D. Enhancing renal reabsorption of calcium
E. Stimulation synthesis of 1,25 (OH)2D3 (Vitamin D3) by the kidney

Answer 79

A

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been commenced on statin therapy during the admission. What level of prevention does this represent?

A. Primordial
B. Primary
C. Secondary
D. Tertiary
E. Quaternary

Answer 80

A

Elastin molecules:

A. Contain collagen fibres with high tensile strength
B. Enable elastic fibres to stretch and recoil
C. Enable tissues like bone to withstand torsion or twisting forces
D. Provide additional structural support in the basal lamina
E. Form important signaling proteins

Answer 81

A

Bone development and growth is best represented by which one of the following processes?

A. Diaphyseal plate chondrocyte hyperplasia
B. Endochondral ossification = the process by which growing cartilage is systematically replaced by bone to form the growing skeleton.
C. Intermembranous ossification
D. Osteoclast activity after parathormone stimulation
E. Periosteal outer lining cells hypertrophy

Answer 82

A

Histological features of bone showing a thickened layer of matrix surrounded by normally mineralized trabeculae are characteristic of:

A. Osteoarthritis = the breakdown of the cartilage that overlies the ends of bones
B. Osteomalacia = deficient mineralization of bone without a loss in bone matrix.
C. Osteonecrosis = The death of bone tissue due to a lack of blood supply.
D. Osteopenia = Milder version of osteoporosis
E. Osteoporosis = Reduction in bone mass due to increased bone porosity

Answer 83

A

Claw Hand = Ulnar nerve palsy

Hyperextended metacarpophalangeal (MCP) joints (knuckles)
Flexed proximal and distal interphalangeal (IP) joints of the 4th and 5th digits
Abducted thumb
Hypothenar atrophy

Answer 84

A

Impaired adduction and abduction of the fingers.

The palmar interosseous muscles aDduct the fingers.

The dorsal interossei, which aBduct the fingers away from the middle finger.

Both are supplied by the ulnar nerve.

Answer 85

A

Impaired pain sensation on the dorsal and palmer aspect of the 5th (little) finger, and medial aspect of the 4th (ring) finger.

There are three branches of the ulnar nerve that are responsible for its sensory innervation.

Two of these branches arise in the forearm, and travel into the hand:

Palmar cutaneous branch – innervates the medial half of the palm.
Dorsal cutaneous branch – innervates the dorsal surface of the medial one and a half fingers, and the associated dorsal hand area.

The last branch arises in the hand itself:

Superficial branch – innervates the palmar surface of the medial one and a half fingers.

Answer 86

A

Chronic Alcohol Use - Health Effects

Cancer of mouth / oesophagus / throat
Alcoholic cirrhosis
Memory loss / dementia / Korsakoff’s syndrome
Peripheral neuropathy
Cardiomyopathy / arrhythmia / heart failure
Sexual impotence
Recurrent falls and head injury

Answer 87

A

flexion
extension
pronation
supination

Answer 88

A

= Ulnar nerve

Answer 89

A

Physical support
Nutritional support
Maintain ionic balance
Immune function
Scavenge function

Oligodendrocytes form the myelin sheath around axons.
Astrocytes provide nutrients to neurons, maintain their extracellular environment, and provide structural support.
Microglia scavenge pathogens and dead cells.
Ependymal cells produce cerebrospinal fluid that cushions the neurons.

Answer 90

A

Can understand the nature and effects of the proposed treatment (1)
Can communicate (1)

Answer 91

A

Priority of consent

Guardian (including an enduring guardian) who has the function of consenting to medical, dental and health care treatments or, if there is no guardian
The most recent spouse or de facto spouse with whom the person has a close continuing relationship. ‘De facto spouse’ includes same sex partners; or, if there is no spouse or de facto spouse:
An unpaid carer who is now providing support to the person or provided this support before the person entered residential care or, if there is no career:
A relative or friend who has a close personal relationship with the person

No one available to consent = The Guardianship Division of the NSW Civil & Administration Tribunal (NCAT)

Answer 92

A

E.Coli = Gram negative rod → stains pink

Answer 93

A

2 layers of Dura Mater = C. Periosteal and meningeal

Arachnoid Mater

Pia Mater

Answer 94

A

= B. Oculomotor

Answer 95

A

The Obturator nerve innervates:

A. Biceps femoris - The biceps femoris muscle is supplied by the terminal branches of the sciatic nerve. The long head receives innervation from it’s tibial division, while the short is innervated by the common fibular division.
B. Obturator externus
C. Obturator internus - Nerve to obturator internus (sacral plexus: L5-S2)
D. Piriformis - ventral rami of S1 and S2
E. Quadratus femoris - nerve to quadratus femoris (L4-S1 sacral plexus)

Answer 96

A

Innervation. The triceps brachii is innervated by the radial nerve, which gives off a separate branch for each head. The C6 root value of the radial nerve innervates the lateral head, root value C7 innervates the long head, and root value C8 supplies the medial head.

The triceps reflex, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical (of the neck region) spinal nerve 7 nerve root (the small segment of the nerve that emerges from the spinal cord). The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves^<u>[</u>