Mini Quizzes Sem 2 Flashcards

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?

  1. Acute metabolic acidosis with no compensation
  2. Acute respiratory acidosis with no compensation
  3. Metabolic acidosis and respiratory acidosis
  4. Metabolic acidosis with respiratory compensation
  5. Respiratory acidosis with metabolic compensation
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!

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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?

  1. Budesonide
  2. Beclomethasone
  3. Disodium cromoglycate
  4. Prednisolone
  5. Salbutamol
A
  1. Budesonide → ICS but preventor
  2. Beclomethasone → ICS but preventor
  3. Disodium cromoglycate → Not a corticosteroid = Cromo
  4. Prednisolone → ICS but more immediate than the others
  5. 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.

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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?

  1. Influenza
  2. Hepatitis B
  3. Measles
  4. Pertussis
  5. Tetanus
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?

  1. Influenza
  2. Hepatitis B
  3. Measles
  4. Pertussis
  5. Tetanus
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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?

  1. Diplopia
  2. Hyperkalaemia
  3. Muscle hypertrophy
  4. Suppression of catecholamine release
  5. Suppression of normal response to infection
A
  1. Diplopia = double vision
  2. Hyperkalaemia
  3. Muscle hypertrophy
  4. Suppression of catecholamine release
  5. Suppression of normal response to infection → affect the way WBCs work
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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?

  1. Acute metabolic acidosis with no compensation
  2. Acute respiratory acidosis with no compensation
  3. Metabolic acidosis and respiratory acidosis
  4. Metabolic acidosis with respiratory compensation
  5. Respiratory acidosis with metabolic compensation
A

E. Respiratory acidosis with metabolic compensation

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

  1. Not all individuals may be exposed to the infectious agent
  2. Not all individuals may choose to be vaccinated
  3. If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
  4. The infectious agent might not cause serious disease in all individuals
  5. Only humoral responses are required
A
  1. Not all individuals may be exposed to the infectious agent
  2. Not all individuals may choose to be vaccinated
  3. If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
  4. The infectious agent might not cause serious disease in all individuals
  5. Only humoral responses are required
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7
Q

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

  1. coronary arteries
  2. great cardiac vein
  3. inferior vena cava
  4. pulmonary arteries
  5. superior vena cava
A

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

  1. coronary arteries = supply the heart itself with O2
  2. great cardiac vein = deoxygenated
  3. inferior vena cava = big vein (deoxygenated)
  4. pulmonary arteries = carry deoxygenated blood to the lungs to be oxygenated
  5. superior vena cava = big vein (deoxygenated)
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8
Q

In spermatogenesis:

  1. FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
  2. FSH and LH are produced by the Sertoli and Leydig cells as they mature during puberty
  3. Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids
  4. The Sertoli cells produce the male sex hormone, testosterone
  5. The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa
A

In spermatogenesis:

  1. FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
  2. 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.
  3. Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids → FALSE: Leydig cells secrete testosterone
  4. The Sertoli cells produce the male sex hormone, testosterone → FALSE
  5. The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa → FALSE: The Sertoli cells do that
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9
Q

Each of the cardiac valves:

  1. opens and closes in response to changes in pressure
  2. attaches to the ventricular walls via chordae tendinae
  3. ensures two-way blood flow through the heart
  4. receives blood supply directly from the coronary artery
  5. has three leaflets
A

Each of the cardiac valves:

  1. opens and closes in response to changes in pressure
  2. attaches to the ventricular walls via chordae tendinae → FALSE: only the mitral & tricuspid valves have this
  3. ensures two-way blood flow through the heart → FALSE: one way or blood backflow (regurgitation)
  4. receives blood supply directly from the coronary artery
  5. 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)
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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?

A

Questions to Female

  1. Menstrual history (regularity and timing)
  2. Previous pregnancy
  3. Frequency of intercourse & technique
  4. Timing of intercourse
  5. Contraception use
  6. Age of partner

Questions to male

  1. Past pregnancies
  2. Age of partner
  3. Frequency of intercourse & technique
  4. Drug and alcohol use
  5. Previous infections (eg mumps)
  6. Damage or surgery to testes
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11
Q

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

(10 examples)

A

Sertoli cells - Functions

  1. Support cell for developing sperm
  2. Provides structural organisation to the tubul
  3. Divides the seminiferous tubule wall into basal and luminal (or two) compartments
  4. Separates mitotic spermatogonia from meiotic spermatocytes and spermatids
  5. Controls metabolic exchange with spermatogenic cells
  6. Forms the blood-testis barrier to prevent autoimmunity to sperm
  7. Concentrates testosterone in the luminal compartment of the tubule
  8. Phagocytoses the residual body from spermiogenesis
  9. Anchors spermatogenic cells, especially spermatids (either cell type or both)
  10. Secretes substances that regulate sperm production
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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 ………….

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.

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13
Q

List the 3 hormones necessary to maintain pregnancy?

A

Hormones necessary to maintain pregnancy:

  1. Oestrogen
  2. Progesterone
  3. Human chorionic gonadotropin
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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?

A

Pre-conception Advice

  1. Vaccination status – rubella, varicella
  2. Folate supplementation
  3. No smoking
  4. Avoidance of alcohol
  5. Dietary and exercise advice
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15
Q

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

A

Ethical issues around artificial reproductive technologies

  1. 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.
  2. Informed consent.
    • The need for full disclosure and fair representation of all the potential medical, social and emotional outcomes and risks.
  3. Embryo status
    • The ethical and legal status of the human embryo.
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16
Q

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

A

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

  1. E2 = Oestradiol → thickens the lining of the uterus
  2. LH = Luteinizing Hormone → triggers release of egg
  3. FSH = Follicle Stimulating Hormone →
  4. Pr = Progesterone

FINISH THIS OFF !!

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17
Q

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

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.

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18
Q

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

A

Methods used with the calendar rhythm method to naturally predict post-ovulation?

  1. Ovulation method: checking for cervical mucus
  2. Temperature method: checking body temperature noting a rise in temp after ovulation
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19
Q

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

A

Combined Oral Contraceptive Pill - Mechanism of Action

  1. Hypothalamus suppression of ovary leading to anovulation
  2. Altered tubal motility
  3. Less receptive endothelium − Hostile cervical mucus
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20
Q

What forms of progesterone-only contraception are available?

A

Progesterone-only contraception

  1. Intramuscular depot injection (Depo-Provera)
  2. Progesterone only oral pill (Mini-pill)
  3. Levonorgestrel implant (implanon)
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21
Q

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

A

Indications for progesterone-only contraceptive

  1. During breastfeeding
  2. Women for whom estrogens are contraindicated (eg liver disease, migraine with aura, history of coagulopathy)
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22
Q

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

A

Cardiac Histology - 3 Layers

  1. Endocardium – simple squamous epithelium, connective tissue, collagen, elastin
  2. Myocardium - cardiac myocytes
  3. Epicardium – simple squamous epithelium, collagen, elastin; visceral layer of serous pericardium
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23
Q

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

CO2 + H2O →

A

Blood Buffer Equation

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24
Q

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

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+
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25
Q

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

A
  1. Live attenuated whole virus vaccine
  2. Inactivated whole virus vaccine
  3. Subunit vaccines
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26
Q

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

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.

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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?

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
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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?

  1. 24-hour urine for creatinine.
  2. 24-hour urine for protein.
  3. Urine albumin:creatinine ratio.
  4. Urine electrophoresis.
  5. Urine microscopy.
A
  1. 24-hour urine for creatinine.
  2. 24-hour urine for protein.
  3. Urine albumin:creatinine ratio.
  4. Urine electrophoresis.
  5. Urine microscopy.
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29
Q

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

  1. Propranolol
  2. Timolol
  3. Sotalol
  4. Metoprolol
  5. Pindolol
A

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

  1. Propranolol
  2. Timolol
  3. Sotalol
  4. Metoprolol
  5. Pindolol
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30
Q

The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system?

  1. Eye
  2. Gastrointestinal tract
  3. Heart
  4. Salivary glands
  5. Veins and arterioles
A

The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system?

  1. Eye
  2. Gastrointestinal tract
  3. Heart
  4. Salivary glands
  5. Veins and arterioles
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31
Q

The Lineweaver-Burk plot is used to:

  1. determine the equilibrium constant for an enzymatic reaction.
  2. extrapolate for the value of reaction rate at infinite enzyme concentration.
  3. illustrate the effect of temperature on an enzymatic reaction.
  4. solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration.
  5. solve, graphically, for the ratio of products to reactants for any starting substrate concentration.
A

The Lineweaver-Burk plot is used to:

  1. determine the equilibrium constant for an enzymatic reaction.
  2. extrapolate for the value of reaction rate at infinite enzyme concentration.
  3. illustrate the effect of temperature on an enzymatic reaction.
  4. solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration.
  5. solve, graphically, for the ratio of products to reactants for any starting substrate concentration.
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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?

  1. Baseline before commencing on antihypertensives.
  2. Evidence of previous myocardial infarction.
  3. Evidence of left ventricular hypertrophy.
  4. Part of routine check-up.
  5. Tachyarrhthymia.
A
  1. Baseline before commencing on antihypertensives.
  2. Evidence of previous myocardial infarction.
  3. Evidence of left ventricular hypertrophy.
  4. Part of routine check-up.
  5. Tachyarrhthymia.
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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:

  1. Apoenzyme
  2. Coenzyme
  3. Holoenzyme
  4. Prosthetic group
  5. Substrate
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:

  1. Apoenzyme
  2. Coenzyme
  3. Holoenzyme
  4. Prosthetic group
  5. Substrate
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34
Q

The primary blood pressure lowering effect of nifedipine is due to a block of:

  1. voltage-gated sodium channels in the sino-atrial node
  2. voltage-gated calcium channels in ventricular tissue
  3. voltage-gated calcium channels in the smooth muscle of blood vessels
  4. ß1-adrenergic receptors in the sino-atrial node
  5. ß1 – adrenergic receptors in the ventricular tissue
A

The primary blood pressure lowering effect of nifedipine is due to a block of:

  1. voltage-gated sodium channels in the sino-atrial node
  2. voltage-gated calcium channels in ventricular tissue
  3. voltage-gated calcium channels in the smooth muscle of blood vessels
  4. ß1-adrenergic receptors in the sino-atrial node
  5. ß1 – adrenergic receptors in the ventricular tissue
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35
Q

The stimulus for activation of the renin-angiotensin-aldosterone system is:

  1. an increase in blood sodium levels
  2. an increase in blood levels of antidiuretic hormone (ADH)
  3. a decrease in blood glucose levels
  4. a decrease in glomerular filtration rate
  5. a decrease in mean arterial pressure
A

The stimulus for activation of the renin-angiotensin-aldosterone system is:

  1. an increase in blood sodium levels
  2. an increase in blood levels of antidiuretic hormone (ADH)
  3. a decrease in blood glucose levels
  4. a decrease in glomerular filtration rate
  5. a decrease in mean arterial pressure
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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?

  1. Acetazolamide
  2. Frusemide
  3. Hydrochlorothiazide
  4. Mannitol
  5. Triamterene
A
  1. Acetazolamide
  2. Frusemide
  3. Hydrochlorothiazide
  4. Mannitol
  5. Triamterene
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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?

  1. Hypermagnesemia
  2. Hypernatremia
  3. Hypoglycaemia
  4. Hypokalaemia
  5. Metabolic acidosis
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?

  1. Hypermagnesemia
  2. Hypernatremia
  3. Hypoglycaemia
  4. Hypokalaemia
  5. Metabolic acidosis
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38
Q

Define FEV1 and FVC

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.

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39
Q

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

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

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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.

A

Hx of Asthma - Symptoms to Ask About

  1. Wheezing
  2. Coughing (especially nocturnal)
  3. Chest tightness
  4. Breathlessness
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41
Q

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

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.
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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.

A

Clinical Signs of a Severe Asthma Attack

  1. Physical exhaustion with paradoxical chest movement
  2. Talks in words only
  3. Pulse rate >120bpm
  4. Central cyanosis
  5. Quiet chest
  6. PEF<50%
  7. FEV1<50%
  8. Sa02 <90%
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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.

A

Causes of Acute Renal Failure in Diabetic Patients

  1. Pyelonephritis with acute tubular necrosis
  2. Increased risk atheroma and embolism to already compromised kidneys.
  3. Drug induced interstitial nephritis e.g. Sulphonamides antibiotics etc.
  4. Acutely unwell diabetics with hyperglycemia can become dehydrated and get ATN
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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)

A

Functions of the Kidneys

  1. Disposal of nitrogenous wastes e.g. urea
  2. Regulation of water and electrolyte balance
  3. Regulation of plasma pH
  4. Activation of Vitamin D
  5. Stimulation of erythropoiesis
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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.

A

Fluid Balance - Key Clinical Features to Assess

  1. Fluid intake
  2. Blood pressure
  3. Urine output
  4. Other losses eg stool, vomitus, surgical drains
  5. Skin turgor
  6. Mucous membrane eg tongue moisture
  7. Capillary refill time/peripheral perfusion
  8. JVP
  9. Peripheral oedema
  10. Breath sounds and lung percussion - are there signs of pulmonary oedema?
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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?

A

Essential (or idiopathic) hypertension

47
Q

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

A

Common Causes of Hypertension

  1. Renal disease (renal artery stenosis, renal parenchymal disease such as analgesic nephropathy)
  2. Endocrine disease (hyperaldosteronism (Conn’s syndrome), thyrotoxicosis, pheochromocytoma, Cushing ’s syndrome)
  3. Coarctation of the aorta
48
Q

List four complications of untreated hypertension

A

Complications of untreated hypertension

  1. Left ventricular failure
  2. Cerebral ischemic events
  3. Renal failure
  4. Retinopathy; also ischaemic heart disease, peripheral vascular disease
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.

A

Most Important Lifestyle Changes for CVD Risk

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

A

Reasons why doctors might experience stress

  1. Intensity of demand on doctors, conflicting demands and time pressure
  2. The gravity, emotional intensity and responsibility entailed in the job
  3. Insufficient resources provided in the public sector
  4. Requirements for accreditation and continuing professional development
  5. Medicolegal threat and unreasonable expectations and demands of patients
  6. Demanding, hostile and emotionally difficult patients and even actual violence
  7. Maintaining amicable relationships with colleagues and staff within the work environment
  8. Loss of the traditional status of doctors, and negative media representation
  9. After-hours and on-call work
  10. Interference with family life
  11. Poor remuneration (compared with expended effort)
  12. Lack of appreciation
51
Q

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

A

Impaired Practitioner - ‘Red Flags’

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

A
  1. ECG
  2. Troponin level
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?

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.

54
Q

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

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.
55
Q

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

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.
56
Q

What are 4 examples of primary prevention of cardiovascular disease?

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:

  1. Smoking cessation advice and programs
  2. Healthy diet advice
  3. Exercise programs
  4. Treatment for hypertension or hypercholesterolemia
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?

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.

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.

A

Medications after MI

  1. Aspirin
  2. ACE inhibitor or Angiotensin receptor blocker (ARB)
  3. Beta Blocker
  4. Short-acting nitrate
  5. Statin
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?

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.
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?

A

Calcium Homeostasis - Chemical Factors

  1. Vitamin D
  2. Parathyroid hormone
  3. Calcitonin
61
Q

Describe the role of the kidney in calcium homeostasis.

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.
62
Q

Further testing demonstrates elevated parathyroid hormone.

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

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.

63
Q

Define the following terms:

  • Metaphysis
  • Epiphysis
  • Diaphysis
  • Growth plate
  • Sesamoid bone
  • Apophysis
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
64
Q

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

  • Metaphysis
  • Epiphysis
  • Diaphysis
  • Growth plate
  • Sesamoid bone
  • Apophysis
A
65
Q

List 5 common criteria that governments use to determine how funds are distributed for health care.

A

Criteria for health care funding distribution

  1. Population characteristics
  2. Population need
  3. Existence of fee for service
  4. Historic levels of funding
  5. Cost effectiveness
  6. Lobbying groups
  7. Political processes eg elections
66
Q

List 4 persons, organisations or agencies that, depending on the situation, could provide consent to medical treatment of a person under the age of 18.

A

Who can consent for minors?

  1. The patient themselves
  2. Parent
  3. Legal guardian
  4. Court
  5. Guardianship board
67
Q
# Fill in the blanks.
In a plain radiograph of the abdomen,
  1. Gas is …… in colour
  2. Calcium is ….. in colour
  3. Soft tissue is ….. in colour
  4. Fat is ….. in colour
A

In a plain radiograph of the abdomen,

  1. Gas is Black in colour
  2. Calcium is White in colour
  3. Soft tissue is Grey in colour
  4. Fat is Dark Grey in colour
68
Q

What is the name of the main legislative instrument that governs the conduct of medical practitioners in NSW?

A

The Health Practitioner Regulation National Law (NSW) 86A

69
Q

Under ‘The Health Practitioner Regulation National Law (NSW) 86A’ a medical practitioner has a duty to render medical services within a reasonable time to a person if the practitioner has reasonable cause to believe the person is in need of urgent attention by a medical practitioner.

Under what circumstance, in this legislation is a practitioner excused from this duty?

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)

70
Q

Over a six-month period, 7 young people aged under 18 years from the small rural community of Erewhon died in motor vehicle crashes, and 6 young people are still recovering from severe injuries. Surveillance data show that these incidents all occurred on Friday or Saturday nights, on the road between Erewhon and the nearest town about 40 kilometres away. Coronial inquests determined that alcohol, excessive speed and inexperience were factors in all incidents. Interviews with community members found that private motor vehicles are the only form of transport in the community, and that it is easy for young people to buy cheap cars from a local ‘wrecker’.

Using the information above, identify and briefly describe 6 actions the Erewhon community could implement to reduce the incidence and severity of road traffic injury among young people in their community.

A

Reducing road traffic accidents in rural towns

The community could:

  1. 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
  2. Also work with the police to enforce vehicle registration requirements
  3. Provide a safer choice to young people by organising affordable safe transport between the towns on Friday and Saturday nights
  4. 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
  5. Work with community members to develop a program to reduce access of young people to alcohol
  6. Develop a supportive environment for youth with appropriate and attractive youth services and activities in Erewhon
71
Q

In March 2009 communicable disease surveillance system of the Government of Mexico identified several cases of influenza-like illness in otherwise healthy young adults, with a rapid rise in the number of cases over the next month. The viruses in this outbreak had not been previously detected in pigs or humans.

Identify 9 population-level actions that could be taken to control the spread of this disease.

A

Population-level Actions to Prevent Spread of Disease

  1. Use public health legislation available to protect public health and monitor disease
  2. Use surveillance for influenza to measure and monitor the number of cases and guide decision making
  3. Contain the spread of disease by identifying people with the disease by testing and placing them in quarantine
  4. Actively identify their contacts and test those with symptoms
  5. Encourage hand hygiene and physical distancing
  6. Promote influenza immunisation as there may be cross protection
  7. Encourage people to not go to work or school if they have respiratory symptoms to prevent spread
  8. Communicate regularly and clearly at all times
  9. Work to identify the original human source of infection.
72
Q

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
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
73
Q

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
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.
74
Q

A 75-year-old man is reviewed by a general practitioner on a home visit. According to his son, the patient has been ‘confused’ for the past week. He has been disorientated to date and place, has been having auditory hallucinations and has been unwell with a respiratory tract infection. 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.
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.
75
Q

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
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
76
Q

The osteon is the structural component of:

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

The osteon is the structural component of:

  • A. Compact bone
  • B. Elastic cartilage
  • C. Fibrocartilage
  • D. Hyaline cartilage
  • E. Trabecular bone
77
Q

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
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
78
Q

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
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
79
Q

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
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
80
Q

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
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
81
Q

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
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
82
Q

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

  • A. Diaphyseal plate chondrocyte hyperplasia
  • B. Endochondral ossification
  • C. Intermembranous ossification
  • D. Osteoclast activity after parathormone stimulation
  • E. Periosteal outer lining cells hypertrophy
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
83
Q

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

  • A. Osteoarthritis
  • B. Osteomalacia
  • C. Osteonecrosis
  • D. Osteopenia
  • E. Osteoporosis
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
84
Q

A 22-year-old man sustained a deep laceration on the medial side of his left forearm and at the time was assessed to have severed his ulnar nerve. Six months later he is reviewed and is found to have a typical “claw hand” deformity on the left.

A) Describe the deformities observed with a claw hand (4).

A

Claw Hand = Ulnar nerve palsy

  1. Hyperextended metacarpophalangeal (MCP) joints (knuckles)
  2. Flexed proximal and distal interphalangeal (IP) joints of the 4th and 5th digits
  3. Abducted thumb
  4. Hypothenar atrophy
85
Q

Describe the motor deficits associated with a claw hand.

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.

86
Q

Describe the sensory deficits associated with a claw hand.

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.
87
Q

A 43-year-old man presents for a routine health check. He states that he drinks 8 standard drinks of alcohol daily. List 7 examples of the chronic health effects of this patient’s alcohol consumption.

A

Chronic Alcohol Use - Health Effects

  1. Cancer of mouth / oesophagus / throat
  2. Alcoholic cirrhosis
  3. Memory loss / dementia / Korsakoff’s syndrome
  4. Peripheral neuropathy
  5. Cardiomyopathy / arrhythmia / heart failure
  6. Sexual impotence
  7. Recurrent falls and head injury
88
Q

A 23-year-old man sustains a 0.5cm long laceration on the pulp of his index finger from a sharp, clean knife while cutting an eggplant. He puts on a bandaid.

Outline the major processes of healing of his wound from the time of injury to one month.

A
89
Q

List 4 movements of the elbow joint

A
  1. flexion
  2. extension
  3. pronation
  4. supination
90
Q

Injury to which nerve will result in impaired sensation over the shaded areas of the hand below?

A

= Ulnar nerve

91
Q

List three major “support” roles of the neuroglia (glia cells) in the brain.

A
  1. Physical support
  2. Nutritional support
  3. Maintain ionic balance
  4. Immune function
  5. 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.
92
Q

A 50-year-old woman is brought into a general practice clinic by her carers who are concerned about recurrent abdominal pains. She is not able to communicate verbally since having a stroke 3 years ago. Physical examination and ultrasound shows that she has biliary colic which requires an elective laparoscopic cholecystectomy.

In order for the patient to give valid informed consent for this operation, which two requirements need to be fulfilled?

A
  • Can understand the nature and effects of the proposed treatment (1)
  • Can communicate (1)
93
Q
  1. A 50-year-old woman is brought into a general practice clinic by her carers who are concerned about recurrent abdominal pains. She is not able to communicate verbally since having a stroke 3 years ago. Physical examination and ultrasound shows that she has biliary colic which requires an elective laparoscopic cholecystectomy.

B. If the patient does not have the capacity to give informed consent, who can provide consent? List four in order of priority.

C. If no one is available to provide consent, then how can the doctor obtain consent for the procedure?

A

Priority of consent

  1. Guardian (including an enduring guardian) who has the function of consenting to medical, dental and health care treatments or, if there is no guardian
  2. 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:
  3. 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:
  4. 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)

94
Q

A 15-year-old girl visited her GP a month ago with symptoms of a urinary tract infection (UTI). Urine culture grew Esherischia coli (E.coli), sensitive to trimethoprim. The GP prescribed trimethoprim for her, and recommended her to increase her fluid intake.

A. Describe the appearance and Gram staining characteristics of E.coli?

B. Explain why E.coli is a pathogen commonly found in UTI.

A

E.Coli = Gram negative rod → stains pink

95
Q

The 2 layers that make up the dura mater are called:

  • A. Pial and meningeal
  • B. Serosal and meningeal
  • C. Periosteal and meningeal
  • D. Peritoneum and meningeal
  • E. Arachnoid and meningeal
A

2 layers of Dura Mater = C. Periosteal and meningeal

Arachnoid Mater

Pia Mater

96
Q
A
97
Q

Pupillary muscle groups are controlled by the autonomic nervous system. Parasympathetic activation causes pupillary ________, and sympathetic activation causes _________.

A
98
Q

A 33-year-old man is brought into the Emergency Department after getting punched in the face and hitting his head against the concrete floor. His left pupil is fixed, dilated and not reactive to light. The right pupil reacts normally. Which one of the following nerves is most likely to be involved?

  • A. Abducens
  • B. Oculomotor
  • C. Opthalmic
  • D. Optic
  • E. Trochlear
A

= B. Oculomotor

99
Q

The Obturator nerve innervates:

  • A. Biceps femoris
  • B. Obturator externus
  • C. Obturator internus
  • D. Piriformis
  • E. Quadratus femoris
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)
100
Q

The plasma membrane of a neuron is more permeable to potassium ions because:

  • A. of its positive electrical charge
  • B. there are more non-gated leak channels for K+ than Na+
  • C. protein molecules cannot exit through the cell membrane
  • D. calcium ions block Na+ and Cl- channels
  • E. there are more non-gated leak channels for Na+ than K+
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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>

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