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1
Q

Which structure connects intermediate filaments in one cell to the intermediate filaments in another?

A

Desmosome

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2
Q

What do Adherens junctions do?

A

joins an actin bundle in one cell to a similar bundle in it’s neighbouring cell

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3
Q

what do Gap junctions do?

A

allows the passage of small, water-soluble ions and molecules

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4
Q

what do Hemidesmosomes do?

A

anchors intermediate filaments in one cell to the basal lamina

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5
Q

What do Zonula Occludens do?

A

also known as tight junction.

seal neighbouring cells together in an epithelial sheet to prevent leakage of molecules

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6
Q

What type of protein structure would zinc fingers, helix-turn-helix and beta-alpha-beta be classed as?

A

Superior secondary

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7
Q

what does periodic acid shift do?

A

stains brush borders and hexose sugars dark pink (magenta)

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8
Q

What are test results for arterial blood gas of metabolic alkalosis?

A 
high pH (normal: 7.35-7.45)
normal O2 (10-14)
normal CO2 (4.5-6.0)
high H3O3- (22-26)
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9
Q

In a 70kg male, how many litres of the total body water distribution are accounted for by the interstitial fluid?

A

11L

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10
Q

Which enzyme unwinds the DNA double helix in DNA replication, relieving the supercoiling?

A

DNA topoisomerase

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11
Q

what does DNA helicase do?

A

separates DNA by breaking the hydrogen bonds between bases

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12
Q

what does DNA topoisomerase do?

A

unwinds the double helix, relieving the supercoils.

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13
Q

what does DNA ligase do?

A

makes the DNA continuous by using the template strand to fill complementary bases

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14
Q

what are Okazaki fragments?

A

fragments of DNA that are linked together by DNA ligase to create the “lagging strand” in DNA replication

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15
Q

what does DNA primate do?

A

catalyses the synthesis of RNA primers which serve as the starting points for DNA synthesis

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16
Q

what is endocytosis?

A

It is a process where cells ingest material from outside the cell by enclosing it within a portion of their cell membrane which buds off to form a vesicle

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17
Q

does endocytosis involve active transport?

A

YES

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18
Q

what is exocytosis?

A

the fusion of a vesicle from the Golgi apparatus resulting in expulsion of materials from a cell

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19
Q

what is pinocytosis?

A

a type of endocytosis

the uptake of solutes dissolved in extracellular fluid by a cell

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20
Q

what is phagocytosis?

A

a type of endocytosis

the engulfing of large, solid particles such as worn out cells, whole bacteria or viruses

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21
Q

what is non-disjunction?

A

During Meiosis, the failure of homologous chromosomes or sister chromatids to separate can result in genetic disorders such as Trisomy 21 (Down’s syndrome)

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22
Q

what is lyonisation?

A

the process of X-inactivation, by which one of the copies of the X chromosome is inactivated in females.
The inactive X chromosome is silenced by it being packaged into a transcriptionally inactive structure called heterochromatin.

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23
Q

what is gametogenesis?

A

the process in which cells undergo meiosis to form gametes

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24
Q

what is penetrance?

A

the extent to which a particular gene or set of genes is expressed in the phenotypes of individuals carrying it, measured by the proportion of carriers showing the characteristic phenotype.

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25
Q

what is basic substitution?

A

a type of gene-level mutation, which involves the swapping of one nucleotide for another during DNA replication

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26
Q

what is selection bias?

A

error in the process of selecting participants for the study and assigning them to particular arms of the study

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27
Q

what is measurement bias?

A

when information is recorded in a distorted manner (e.g. an inaccurate measurement tool)

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28
Q

what is observer bias?

A

when variables are reported differently between assessors

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29
Q

what is procedure bias?

A

subjects in different arms of the study are treated differently (other than the exposure or intervention)

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30
Q

what is misclassification bias?

A

occurs when a variable is classified incorrectly

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31
Q

describe the positive predictive value

A

The proportion of people with a positive test result who actually have the disease

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32
Q

describe the sensitivity of a test

A

The proportion of people with a disease who are correctly identified by a test

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33
Q

describe the specificity of a test

A

The proportion of people without the disease who are correctly excluded by the test

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34
Q

describe the incidence of a disease

A

The number of new cases, within a specified time period divided by the population size initially at risk

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35
Q

describe the prevalence of a disease

A

The proportion of the population found to have the disease

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36
Q

what does the ST segment correspond to?

A

the plateau phase (phase 2) of the action potential. An ST segment deviation can be an indication of an acute myocardial ischemia.

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36
Q

what does the ST segment correspond to?

A

the plateau phase (phase 2) of the action potential. An ST segment deviation can be an indication of an acute myocardial ischemia.

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37
Q

what does the T-wave reflect?

A

the rapid depolarisation of contractile cells (phase 3)

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38
Q

what does the QRS complex represent?

A

the depolarisation of the ventricles

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39
Q

what does the P wave reflect?

A

atrial depolarization

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40
Q

what does the PR segment reflect?

A

the slow impulse conduction through the AV node

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41
Q

what is the right marginal a branch of?

A

the right coronary artery

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42
Q

what is the correct order of conduction in the heart?

A

SA node > AV node > Bundle of His > Bundle branches > Purkinje fibres

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43
Q

Which type of blood cell is typically elevated in parasitic infections?

A

Eosinophil

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44
Q

Which type of blood cell is typically elevated in bacterial infections and acute inflammation?

A

neutrophils

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45
Q

what are T-helper cells used for?

A

to activate the adaptive immune system and help plasma cells develop antibodies

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46
Q

what are basophils involved in?

A

inflammatory reactions, especially to allergic reaction eg. anaphylaxis

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47
Q

Which type of blood cell is typically elevated in acute and chronic infections?

A

Cytotoxic (CD8) T-lymphocytes

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48
Q

What is ANP and what is it’s role in blood pressure?

A

ANP is secreted by the atria in response to increased fluid in the vasculature.
It is secreted when the atria are stretched by the increased fluid. ANP inhibits the Renin-Angiotensin-Aldosterone system and increases excretion of sodium and water.
ANP also acts as a vasodilator.

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49
Q

What does angiotensin II do?

A

causes constriction of the blood vessels.
stimulates secretion of aldosterone which increases sodium reabsorption. These combine to increase fluid in the vascular system and increase blood pressure. This has the opposite effect of ANP.

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50
Q

What does vasopressin do?

A

increases the water reabsorption from the collecting duct which increases fluid in the blood. This increases blood pressure.

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51
Q

what does Stimulation of the β2 receptor in the heart do?

A

increases the contractility and the heart rate which both serve to increase cardiac output. Increased cardiac output increases the blood pressure.

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52
Q

what does aldosterone do?

A

increases sodium reabsorption from the renal tubules which draws in water into the blood. These factors increase the blood pressure.

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53
Q

what does stimulation of α2 receptor cause?

A

vasodilation of the peripheral vascular system and reduces blood pressure. Adrenaline can serve as a vasoconstrictor or vasodilator depending on the receptor it acts on.

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54
Q

What is the function of ductus arteriosus in utero?

A

shunts blood from the pulmonary trunk to the aorta

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55
Q

what does the activation of baroreceptors do?

A

decreased ADH, inhibit RAAS system to reduce blood, reduce cardiac output and activate the depressor region to reduce the sympathetic input to the heart

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56
Q

what causes the first heart sound?

A

closing of the AV valves

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57
Q

what is bradykinin?

A

a vasodilator that relaxes smooth muscle and will cause a decrease in blood pressure.

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58
Q

what are Prostaglandins?

A

vasodilators secreted by the endothelial cells that reduce blood pressure.

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59
Q

what is Endothelin-1?

A

vasoconstrictor that increases blood pressure.

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60
Q

is nitric oxide a vasodilator or vasoconstrictor?

A

vasodilator

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61
Q

when is atrial natriuretic peptide released? what does it do?

A

secreted by the atria in response to stretch.

It inhibits the RAAS and dilates the blood vessels to decrease blood pressure.

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62
Q

what is the equation used to calculate blood pressure?

A

Cardiac output × Total Peripheral resistance

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63
Q

how is stroke volume measured?

A

Stroke volume = End diastolic volume – End systolic volume

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64
Q

how is mean arterial pressure calculated?

A

Mean arterial pressure = Diastolic pressure - 13 (Systolic – Diastolic pressure)

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65
Q

how is cardiac output calculated?

A

Cardiac output = Heart rate × Stroke volume

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66
Q

how is the ejection fraction calculated?

A

(Stroke volume/End diastolic volume) × 100

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67
Q

Define the functional residual capacity (FRC).

A

The volume of air present in lungs after a passive expiration

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68
Q

Define total lung capacity (TLC)

A

Volume of air present in chest after full inspiration

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69
Q

Define residual volume

A

The amount of air that remains in a person’s lungs after fully exhaling

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70
Q

Define tidal volume

A

The amount of air a person inhales during a normal breath

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71
Q

define expiratory reserve volume (ERV)

A

The amount of extra air, above normal breath, exhaled on forceful expiration

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72
Q

What type of hypersensitivity does an anaphylactic response represent?

A

Type 1

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73
Q

Which part of the anatomic dead space has got the largest area?

A

Trachea

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74
Q

What type of the alveolar cells produce the surfactant?

A

Type 2 pneumocytes

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75
Q

What do goblet cells produce?

A

mucus

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76
Q

What are type 1 pneumocytes?

A

flat, elongated cells lining alveoli, responsible for the gas exchange

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77
Q

What are the spinal nerves of the phrenic nerve?

A

C3, C4, C5

“3,4,5 keep the diaphragm alive”

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78
Q

Which epithelium lines the vocal folds?

A

Stratified squamous

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79
Q

What lines the GI system ?

A

simple columnar epithelium

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80
Q

where is stratified squamous epithelium found?

A

usually located in the areas where friction forces occur (skin, oesophagus, vagina, etc.)

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81
Q

where is simple cuboidal epithelium found?

A

usually found on secretory/ excretory surfaces (convoluted tubules, ependyma, thyroid etc.)

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82
Q

where is simple squamous epithelium found?

A

permeable epithelium, present in places where a transport of small molecules (via filtration or diffusion) occurs. It can be found in lungs, capillaries, alveoli.

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83
Q

what is the function of stratified columnar epithelium and where is it normally found?

A

Function - secretion and protection

Normally found - parts of pharynx, anus, in the uterus, etc.

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84
Q

What levels of PaO2 and PaCO2 indicate type 2 respiratory failure?

A

Low PaO2, high PaCO2

Both hypercapnia and hypoxia - type 2 means 2 things wrong!

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85
Q

What levels of PaO2 and PaCO2 indicate type 1 respiratory failure?

A

Low PaO2 - hypoxia

PaCO2 remains low/normal

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86
Q

What FEV1/FVC indicates airway obstruction?

A

<0.7

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87
Q

Airway smooth muscle constriction is stimulated by Ach release acting on which type of receptors?

A

M3 subtype of muscarinic receptors

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88
Q

What do enteroendocrine cells secrete?

A

GI hormones - secretin, ghrelin

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89
Q

What do chief cells secrete?

A

pepsinogen

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90
Q

What do parietal cells secrete?

A

intrinsic factor and gastric acid (HCl)

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91
Q

What do G cells secrete?

A

gastrin

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92
Q

what do enterochromaffin-like cells secrete?

A

histamine

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93
Q

What is Vit K deficiency associated with?

A

blood clotting disorders

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94
Q

What is vit A deficiency associated with?

A

night blindness

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95
Q

What is Vit D deficiency associated with?

A

poor bone growth & abnormal bone metabolism

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96
Q

Where is McBurney’s point?

A

one-third of the distance from the anterior superior iliac spine to the umbilicus. It is the approximate surface marking for the appendix in most individuals.

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97
Q

What is the effect of somatostatin?

A

GI hormone which has inhibitory effect on secretion of every hormone. Hence it decreases the secretion of all the above mentioned hormones, not increase them.

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98
Q

Which hormones, at the physiological level, has the strongest effect in inhibiting gastric emptying?

A

Cholecystokinin (CCK)

Released as a result of fat and protein digestion products being in the duodenum

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99
Q

Which vessel is the ileocolic artery a branch of? What does it supply?

A

Branch of: Superior mesenteric artery

Supplies: right colon and terminal ileum

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100
Q

NSAIDs such as ibuprofen and naproxen are well-known for causing duodenal ulcers. If a proximal duodenal ulcer gets too deep, it can erode into a nearby artery causing massive haemorrhage. Which artery is this most likely to be?

A

Gastroduodenal artery

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101
Q

What are the GI pacemaker cells?

A

Interstitial cells of Cajal.

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102
Q

What salivary gland has purely serous secretions?

A

Parotid gland

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103
Q

Which enzyme hydrolyses triglycerides to 2 fatty acids and 1 glycerol?

A

Lipoprotein lipase

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104
Q

what does hepatic lipase do?

A

converts intermediate density lipoprotein (IDL) into low density lipoprotein (LDL)

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105
Q

what does triglyceride lipase do?

A

breaks down dietary fats into fatty acids and glycerol.

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106
Q

what does aminotransferase do?

A

catalyses transamination of amino acids into alpha keto acids. It is used to measure liver function (ALT and AST)

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107
Q

what does gamma-glutamyl transferase do?

A

transfers a gamma-glutamyl group to an acceptor molecule.

It is used to measure liver function (GGT).

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108
Q

Where is the main site of exocrine secretion within the pancreas?

A

Pancreatic acini

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109
Q

The pancreas is formed from a fusion of a ventral and dorsal bud. Which areas of the pancreas does the ventral pancreatic bud form?

A

Uncinate process, main pancreatic duct and pancreatic head

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110
Q

Through what process is glutamate converted to ammonium (NH4+)?

A

Oxidative deamination

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111
Q

Within a distribution of data, if the median is greater than the mean of the data, what is the data described as?

A

Negatively skewed

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112
Q

How is prevalence worked out?

A

Prevalence = (TP + FN) / (TP + FP + FN + TN) x100

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113
Q

How is odds calculated?

A 
odds = number of events / number of non events 
e.g. = died in new treatment / survived in new treatment group
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114
Q

What are delta cells? Where are they found?

A

somatostatin-producing cells which can be found in the stomach and pancreatic Islet of Langerhans

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115
Q

What are oligodendrocytes?

A

a type of neuroglia that myelinate axons within the central nervous system

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116
Q

What are Renshaw cells?

A

a specialised population of interneurons that are stimulated by alpha motor neurons and through a feedback system can be inhibited by alpha motor neurons causing autoinhibition.

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117
Q

Which cranial nerve innervates the posterior 1/3 of the tongue?

A

Glossopharyngeal

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118
Q

What does the anterior cerebral artery supply?

A

the medial part of the motor cortex which innervates the leg.

119
Q

A patient is suffering from a cranial nerve palsy, causing one of her eyes to be locked in a characteristic ‘down and out’ position. Which cranial nerve has been affected?

A

III

120
Q

What is the name of the ligament connecting the laminae of the adjacent vertebrae?

A

Ligamentum flavum

121
Q

What vessels and nerves are within the cavernous sinus?

A

the internal carotid artery
oculomotor nerve (III)
trochlear nerve (IV)
ophthalmic branch of the trigeminal nerve (V1)
maxillary branch of the trigeminal nerve (V2)
abducens nerve (VI).

122
Q

Describe the path of sperm to outside

A

SREEVEN UP

Seminiferous tubules -> 
Rete testis ->
Efferent ducts -> 
Epididymis ->
Vas deferens -> 
Ejaculatory duct ->
nothing -> 
Urethra -> 
Penile urethra
123
Q

What hormone is likely to show as high in a menopausal woman?

A

FSH

due to lack of negative feedback from oestrogen and decline if inhibin

124
Q

What does the urogenital sinus differentiate into?

A

external genitalia: lower 1/3 vagina, labia majora, labia minora and clitorus

125
Q

What does the Mullerian duct differentiate into?

A

uterine tubes, cervix and upper 2/3 vagina

126
Q

The urogenital organs are developed from which layer of the germ cells?

A

intermediate mesoderm

127
Q

What level does the renal artery come off the abdominal aorta?

A

L2

128
Q

At what level does the oesophagus pass through the abdomen?

A

T10

129
Q

Where does the aorta pass through the abdomen?

A

T12

130
Q

At what level does the superior mesenteric artery branch off the aorta?

A

L1

131
Q

At what level do the renal arteries branch off the aorta?

A

L2

132
Q

At what level does the inferior mesenteric artery branch off the aorta

A

L3

133
Q

What do the urethral folds develop into?

A

Females: labia minora
Males: corpus spongiosum (enclosing urethra)

134
Q

What does the tubercle become?

A

Males: glans penis
Females: clitoris

135
Q

The labioscrotal folds fuse to form what?

A

Males: scrotum and ventral penis
Females: labia majora

136
Q

What does the superficial perineal pouch contain?

A

erectile tissues that form the penis and clitoris, and 3 muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles

137
Q

What does the cremasteric artery supply?

A

testes

138
Q

What is the immediate precursor molecule to adrenaline?

A

noradrenaline

139
Q

What are the 5 steps within catecholamine synthesis?

A

tyrosine -> l-dopa -> dopamine -> noradrenaline -> adrenaline

140
Q

What is the order of the histological layers of the epidermis from exterior to interior?

A 
Corneum
Lucidum
Granulonum 
Spinosum
Basale
141
Q

Which cells in the kidney tubule are responsible for controlling acid-base balance? Where are they present?

A

intercalated cells
in the collecting duct
Type A: control H+ conc
Type B: control HCO3- conc

142
Q

What dermatome is responsible for the suprapubic region?

A

L1

143
Q

What dermatome is responsible for the nipple?

A

T4

144
Q

What dermatome is responsible for the umbilicus?

A

T10

145
Q

What dermatome is responsible for the inguinal region?

A

L2

146
Q

Which part of the adrenal gland is responsible for the production and release of aldosterone?

A

Zona glomerulosa

147
Q

What does the zone reticularis release?

A

androgens

148
Q

What does the zone fasciculate release?

A

glucocorticoids

149
Q

What is the order of development of the renal system?

A

The pronephros develops first followed by the mesonephros and then the metanephros.
Each section develops caudally to the last.

150
Q

Where do the kidneys develop in embryo and how to they migrate?

A

the kidneys develop low in the pelvis and ascend.

151
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve as it passes through the carpal tunnel
Can lead to: tingling in hand, specifically the thumb, index finger, middle finger and part of her ring finger

152
Q

Patient presents with inability to flex the knee. What nerve is most likely effected?

A

Sciatic nerve

153
Q

What does the sciatic nerve innervate?

A

he posterior compartment of the thigh – the hamstring muscles which flex the knee

154
Q

What is the anatomical snuffbox?

A

a triangular depression found on the lateral aspect of the dorsum of the hand.

155
Q

What are the borders of the anatomical snuffbox?

A

Posterior border – tendon of extensor pollicis longus
Anterior border – tendons of extensor pollicis brevis and abductor pollicis longus
Proximal border – styloid process of radius
Distal border – apex of snuffbox triangle
Floor – trapezium and scaphoid

156
Q

What are the contents of the anatomical snuffbox?

A

radial artery, branch of the radial nerve, cephalic vein

157
Q

During a hip examination, a 70-year-old male is found to have a positive Trendelenburg’s sign. When he stands on only his left leg, his right pelvis drops. Which muscles are affected?

A

Left gluteus medius and gluteus minimus

Ride sided pelvis drop -> weakness on the left side

158
Q

Cartilage is an example of what type of collagen?

A

type 2 collagen

159
Q

placenta is an example of what type of collagen?

A

type 5 collagen

160
Q

bone skin and teeth are an example of what type of collagen?

A

Type 1 collagen

161
Q

basement membranes are an example of what type of collagen?

A

Type 4 collagen

162
Q

arteries are an example of what type of collagen?

A

type 3 collagen

163
Q

What are the Big 5 CAM (complimentary and alternative medicines) used in the NHS?

A

Acupuncture, chiropractic, herbal medicine, homeopathy, osteopath.

The Big 5 are professionally organised alternative therapies. They have an individual diagnostic approach and some scientific evidence of efficacy.

164
Q

What is the sequence of phases in stress response?

A

Alarm, adaptation, exhaustion

165
Q

What is the incremental cost-effectiveness ratio (ICER) and how is it calculated?

A

a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention

ICER = difference in costs/difference in benefits

166
Q

Describe the stress-illness model

A

“An individual’s susceptibility to disease or illness is increased because an individual is exposed to stressors which cause strain upon the individual, leading to psychological and physiological changes.”

167
Q

Describe eustress

A

A positive stress which is positive and motivating

168
Q

Wilson’s disease is a type of genetic disorder affecting the active transport in the body. What is the Na+/K+ -ATPase an example of?

A

Primary active transport

169
Q

What shape nucleus does a monocyte have?

A

Reniform (kidney bean shaped)

170
Q

Which artery is the main supply to the atrioventricular node (AVN)?

A

Posterior inter ventricular artery
(70% Right coronary artery only
20% Right & Left coronary arteries
10% Left coronary artery only)

171
Q

The maxillary artery arises from which of the aortic arches?

A

1st aortic arch.

172
Q

What is contained within the dense granules of platelets?

A

ADP and thromboxane A2

173
Q

What does the bulbus cordis develop into?

A

Right ventricle

174
Q

What is the function of the periciliary fluid?

A

It keeps the mucous at an optimum distance from the epithelia

175
Q

There are many tests that are very useful to help diagnose respiratory diseases. What is the purpose of exhaled nitric oxide test?

A

Indirect measuring of airway inflammation

176
Q

Where can you find central chemoreceptors?

A

In the brainstem

177
Q

What percentage of the surface area of an alveoli does a type 1 pneumocyte usually make up?

A

90%

178
Q

Which of the following cartilages are attached to the vocal cords?

A

Arytenoid

179
Q

What are the single cartilages?

A

cricoid cartilage, thyroid cartilage & epiglottis

180
Q

What are the 6 paired cartilages?

A

arytenoid, corniculate & cuneiform cartilages

181
Q

At which thoracic vertebral level does the hiatus for the inferior vena cava lie?

A

T8

182
Q

At which thoracic vertebral level does the hiatus for the oesophagus lie?

A

T10

183
Q

At which thoracic vertebral level does the hiatus for the descending aorta lie?

A

T12

184
Q

What are Peyer’s patches an example of?

A

mucosa-associated lymphoid tissue (MALT)

185
Q

Fluid is absorbed in the gastrointestinal tract by the small intestine. What percentage of fluid is absorbed in the small intestine?

A

80%

186
Q

Which is the main hormone stimulating bile secretion?

A

Cholocystokinin

187
Q

SIADH has a genetic component to it. What is a method of genetic testing in pregnancy?

A

Chorionic villus sampling OR amniocentesis

188
Q

Define penetrance in genetics

A

Proportion of people with a gene/genotype who show the expected phenotype

189
Q

Where does haematopoiesis occur in an adult and where does it occur in a foetus?

A

Adult = axial bone marrow

Foetus = one of: yolk sac OR liver OR spleen

190
Q

State the structural differences of foetal haemoglobin compared to adult haemoglobin

A 
Foetal = 2 alpha & 2 gamma chains
Adult = 2 alpha & 2 beta
191
Q

Total lung capacity was also measured. Name a method that can be used to measure total lung capacity.

A

Gas dilution OR total body plethysmography (body box)

192
Q

The gentleman’s FVC is below 80% of the predicted value for someone his age. What is this a sign of?

A

airway restriction

193
Q

State 2 effects of ageing on lung function.

A 
Delayed response to hypercapnia/hypoxia
decreased FEV/FVC
impaired gas exchange
decreased immune function change in shape of thorax stiffening of thoracic cartilage in ribs, decrease in respiratory muscle mass
loss of elastic recoil
194
Q

Where in the stomach are you most likely Enteroendocrine (G) cells?

A

Antrum

195
Q

Name 2 features that you can use to distinguish the small intestine from the colon?

A

Small intestine has mesentery. Large intestine has haustra

196
Q

What are 4 functions of the cell plasma membrane?

A

Acts as semi-permeable membrane
Hosts cell membrane receptors
Regulates what goes in and out of cell
Separates intracellular cell contents from extracellular cell contents

197
Q

What are the 3 lipid groups that make up the plasma membrane?

A

Phospholipids
Glycolipids
Sphingolipids
Cholesterol

198
Q

If BP = blood pressure, PVR = peripheral vascular resistance, and CO = cardiac output, write
an equation that indicates the interrelationship between these parameters.

A

BP = CO x PVR

199
Q

State three metabolic or physiological factors that reduce peripheral vascular resistance.

A

Nitric oxide/metabolic breakdown products, hypoxia, hypercapnia, reduced sympathetic
stimulation, parasympathetic stimulation

200
Q

State two effects that stimulating arterial baroreceptors has on systemic blood pressure.

A

Decreased sympathetic nervous system stimulation, decreased arteriolar vasoconstriction,
decreased blood pressure

201
Q

Which part of the stomach has parietal cells?

A

Fundus and body

202
Q

What do parietal cells secrete?

A

HCl and intrinsic factor

203
Q

What do chief cells secrete?

A

Pepsinogen

204
Q

How do NSAIDs predispose you to peptic ulcers in the stomach?

A

Block COX (cyclo-oxygenase) → reduce PG (prostaglandin) production → reduced mucosal defence

205
Q

Explain how food in the duodenum can stimulate the downregulation of parietal cells in the
stomach.

A

Somatostatin + CCK inhibit gastrin and histamine.

Somatostatin release from pancreas inhibits HCl production by parietal cells.

206
Q

What hormones are secreted from Thyroid follicular epithelial cells?

A

Thyroxine

207
Q

What do Parafollicular cells release?

A

Calcitonin

208
Q

Dietary nutrient and amino acid required for hormone secreted by thyroid follicular epithelial
cells.

A

Dietary nutrient: Iodine

Amino acid: Tyrosine

209
Q

What two proteins in the blood do the hormones from the thyroid bind to?

A

Albumin
Thyroxine Binding Globulin
Transthyretin

210
Q

What eye-related features do you see in Grave’s disease?

A

Bulging eyes (exophthalmos)
Lid lag
Ophthalmoplegia
Lid retraction

211
Q

Name the hormones synthesised in the different zones of the glomerulus

A

Zona glomerulosa - Aldosterone, mineral corticoids
Zona fasciculata - Cortisol, glucocorticoids
Zona reticularis - DHEA, androgens

Go Find Rex Make Good Sex

212
Q

What enzyme is present in Zona glomerulosa that is not present anywhere else?

A

Aldosterone synthetase

213
Q

factors that activates secretion of aldosterone

A

increased K+

angiotensin II

214
Q

What is the hormone used to detect pregnancy?

A

Human chorionic gonadotropin

215
Q

4 Cardiovascular changes in pregnancy

A

Increased cardiac output,
decreased blood pressure,
decreased total peripheral resistance,
increased uterine blood flow

216
Q

Hormone that prevents myometrial contraction during pregnancy

A

progesterone

217
Q

What two hormones are secreted in the kidney?

A

Renin

Erythropoietin

218
Q

What hormones are secreted elsewhere but activated in the kidney?

A

Calcidiol,

Angiotensinogen

219
Q

Causes of metabolic acidosis?

A 
Lactic acidosis
Ketoacidosis
Diarrhoea
hyperkalaemia?
renal tubular acidosis
salycyclic acid overdose
methanol intoxication
220
Q

Name the 3 joints in the synovial cavity in the knee?

A 
Medial Tibiofemoral (condyloid)
Lateral Tibiofemoral (condyloid)
Patellofemoral (gliding)
221
Q

What protects the knee joint from dislocating anteriorly

A

Anterior Cruciate Ligament

222
Q

What causes a valgus deformity

A

Medial Collateral Ligament

223
Q

What protects the knee joint from dislocating posteriorly/ strengthens the back of the knee

A

Oblique popliteal

224
Q

Most common arthritis affecting the knee

A

osteoarthritis

225
Q

What is the difference between analgesic and anaesthetic?

A

Analgesic - loss of pain. Dulls sensation of pain.

Anaesthetic - loss of pain, temperature and touch. Blocks the sensation of pain

226
Q

Definition of distress

A

Negative stress, damaging and harmful

227
Q

Definition of eustress?

A

Positive stress, beneficial and motivating

228
Q

Signs of stress - 4 types and 4 examples apart from physiological

A

Biochemical - Altered endorphin levels, increase in cortisol
Behavioural - Increase in absenteeism, smoking and alcohol
Cognitive - Negative thoughts, loss of concentration
Emotional - Tearful, mood swings, irritable, aggressive, apathy

229
Q

What chronic stressors apart from work should the doctor ask about

A

Relationships, unstable financial status, lack of friends, poor physical health

230
Q

Name 2 non-pharmacological factors which mediate the effect of stress?

A

Social support, beliefs, personality, lifestyle, exercise

231
Q

In which part of the brain is the somatosensory cortex?

A

Left parietal lobe, post-central gyrus

232
Q

In which part of the brain is the premotor cortex?

A

Frontal lobe

Pre central gyrus

233
Q

What is the motor speech part and which lobe of the brain is affected.

A

Broca’s area

Frontal lobe of the dominant hemisphere

234
Q

What is the internal capsule?

A

Projection fibre

Axons from motor cortex to deep brain structures

235
Q

which lobe is affected?

Somatosensory

A

parietal lobe

236
Q

which lobe is affected?

muscle twitching

A

frontal lobe

237
Q

Which lobe is affected?

Visual flashing lights

A

occipital lobe

238
Q

Which lobe is affected? Auditory hallucination

A

Temporal lobe

239
Q

What lobe is affected?

Dejavu, visual hallucinations, fear

A

temporal lobe

240
Q

What structure joins the hemispheres together to allow a mirrored lesion so epilepsy affects contralateral side?

A

Corpus callosum

241
Q

Describe the role of a healthy liver in preventing bruising

A

Liver produced bile salts, essential for Vit K absorption
Vit K needed for synthesis for clotting factors 10,9,7,2
1972!

242
Q

Explain the effects of low levels of albumin in the blood.

A
  • Albumin is a plasma protein that maintains oncotic pressure (2) because its presence causes the water concentration of the blood to be slightly lower than the water concentration in the interstitial fluid
  • This means that there is net flow of water into the blood (1) from the interstitial fluid
  • Low levels of albumin cause a decrease in the oncotic pressure (2) - This results in movement of water out of the blood into the interstitial fluid, causing oedema (1)
243
Q

Describe how changes in the osmolality of the extracellular fluid are detected.

A

Detected by osmoreceptors in the hypothalamus

244
Q

Describe how antibodies are specific to one antigen

A

Antibodies are bound to antigens via the variable region (1)
- The variable region determines the specificity of the antibody to the different amino acids that it contains, which change the shape of the antigen binding site (1)

245
Q

A key complication of type 1 diabetes is diabetic ketoacidosis. Explain the process of ketogenesis in the liver

A

High rates of fatty acid oxidation result in large amounts of acetyl-CoA production that exceed the capacity of the Krebs cycle (1)

  • 2 molecules of acetyl-CoA are converted into acetoacetyl-CoA by the enzyme thiolase (1)
  • Acetoacetyl-CoA is converted into acetoacetate (1)
  • This is then converted into b-hydroxybutyrate by b-hydroxybutyrate dehydrogenase and acetone spontaneously (1)
246
Q

Explain the mechanism of inheritance of Duchenne muscular dystrophy and why women are carriers

A

Duchenne muscular dystrophy is inherited in an X-linked recessive pattern (1) - This means that the mutated gene is located on the X chromosome (1) - Heidi is a carrier because females have 2 copies of the X chromosome
therefore one affected copy can be inherited, but is not enough to produce the affected phenotype (1)

247
Q

Name the process of X chromosome inactivation.

A

Lyonization

248
Q

What is preload?

A

The initial stretching of the cardiac myocytes (1) prior to contraction (1)

249
Q

What is afterload?

A

The pressure the left ventricle must overcome to eject blood (1) during systole / contraction (1)

250
Q

What does it mean if something is negatively chronotropic?

A

decreases heart rate

251
Q

Describe oesophageal innervation in terms of nervous innervation and voluntary/involuntary action.

A
  • Vagus nerve (1)
  • Upper portion of the oesophagus has voluntary (striated) fibres (1)
  • Lower portion of the oesophagus has involuntary (smooth) fibres (1). - (The middle third has a mixture of these).
252
Q

Name 3 differences between appearance of thoracic and cervical vertebrae.

A

Thoracic vertebrae have inferiorly slanting spinous process AND cervical have bifid spinous processes

  • Thoracic vertebrae have costal facets AND cervical do not
  • Thoracic vertebrae don’t have transverse foramina AND cervical do - Thoracic vertebrae have smaller heart shaped vertebral foramen AND cervical have larger more oval shaped one
253
Q

What sensory modalities does the spinothalamic tract carry, and where does this tract decussate?

A
  • Pain, crude touch, pressure and temperature (any 2)

- Decussation at 1-2 vertebral levels above the level of entry into the spinal cord (2)

254
Q

Which spinal tract is responsible for proprioception, and would this be lost ipsilaterally or contralaterally in Brown-Sequard syndrome?

A

DCML

ipsilateral

255
Q

What cells produce CSF, and where are these located?

A

Ependymal cells (1) in the choroid plexus (1) of the ventricles

256
Q

What is the name of the structure connecting the third and fourth ventricles?

A

Cerebral aqueduct

257
Q

CSF returns to venous circulation after drainage through dural venous sinuses. Which vein do all dural venous sinuses drain into?

A

internal jugular vein

258
Q

what colour does periodic acid schiff turn sugars?

A

pink/magenta

259
Q

what colour does Van Grieson stain elastics?

A

brown

260
Q

what colour does Alcian blue stain mucin

A

blue

261
Q

what colour does Perl’s stain iron

A

blue

262
Q

Lipofuscin is a pigment formed from peroxidation of lipids in older cells. What colour is it?

A

orange/brown

263
Q

Lipofuscin is a pigment formed from peroxidation of lipids in older cells. What organs is it most commonly found in?

A

liver and heart

264
Q

What are the two types of adipose tissue?

A

white adipose tissue

brown adipose tissue

265
Q

One of these types is found down the back and across the shoulders of a newborn child. What is its function?

A

thermoregulation

266
Q

Which type of muscle has no striations?

A

smooth

267
Q

Which type of muscle has nuclei that are not central?

A

skeletal

268
Q

Which type of muscle has branching?

A

cardiac

269
Q

Which type of muscle has intercalated discs?

A

cardiac muscle

270
Q

Which type of muscle has multiple nuclei?

A

skeletal

271
Q

Describe the effect that having cysts in the renal medulla may have on Francis’ urinary output.

A
  • The loop of Henle of juxtamedullary nephrons extend deep into the renal medulla
  • These are responsible for generating an osmotic gradient in the medulla that functions to reabsorb water
  • Cysts in the renal medulla, therefore, causes the patient to produce large volumes of dilute urine because the loop of Henle is unable to reabsorb water sufficiently
272
Q

Upon confirmation that Francis has PKD, the doctor prescribes ACE inhibitors. Explain the role of the kidneys in regulating blood pressure.

A
  • Juxtaglomerular cells in the afferent arterioles are stimulated to release renin when the cells in the macula densa of the distal convoluted tubule detect less NaCl, sympathetic stimulation and little/no arterial stretch
  • Renin enters the bloodstream and cleaves angiotensinogen into angiotensin I
  • Angiotensin I is converted by angiotensin-converting enzyme (ACE) into the active agent, angiotensin II
  • Angiotensin II stimulates the cells of the zona glomerulosa in the adrenal cortex to release the steroid hormone, aldosterone
  • Aldosterone acts to vasoconstrict the efferent arteriole, increasing the pressure and causing an increased glomerular filtration rate
273
Q

State what is meant by glomerular filtration rate and give the equation used to calculate this.

A
  • The volume of fluid filtered from the glomerulus into Bowman’s space per unit of time
  • GFR = filtration coefficient (glomerular capillary hydrostatic pressure – Bowman’s space hydrostatic pressure – osmotic pressure in glomerular capillary)
274
Q

Describe how parathyroid hormone affects the kidneys.

A

Directly increases C2+ reabsorption in the kidneys

to decrease urinary excretion and increase plasma calcium

275
Q

List 3 main functions of the skin.

A
  • Protection against trauma
  • Barrier to pathogens / infection
  • Regulation of water loss
  • Protection against UV light
  • Thermoregulation
  • Vitamin D synthesis
276
Q

State 2 causes of hypoxia.

A

V/Q mismatch, hypoventilation, diffusion impairment, shunting

277
Q

Oxygen is transported in the blood via haemoglobin. Explain how the blood carries oxygen with reference to the oxygen dissociation curve.

A

At high partial pressures of oxygen, haemoglobin binds to oxygen to form oxyhaemoglobin (1)

  • The oxygen dissociation curve is a sigmoid shape because oxygen cooperatively binds to haemoglobin
  • This means that haemoglobin has a greater ability to bind to oxygen after a subunit has already been bound to oxygen (haemoglobin is most attracted to oxygen when 3 or 4 of the subunits are already bound)
278
Q

The patient also complains of coughing up small amounts of mucus. Describe how mucus is moved through the airways.

A
  • Mucus is transported by air flow and the mucociliary escalator (1) from the lower respiratory tract to the pharynx (1)
  • The mucociliary escalator brings up mucus by the cilia beating in directional waves up the airways (1)
279
Q

State the most common type of pulmonary macrophage and explain how these fight infections.

A

Alveolar macrophage
They destroy bacteria via phagocytosis
Bacteria is engulfed by phagosome
the membrane fuses with a lysosome, forming a phagolysosome
enzymes from the lysosome break down and destroy bacteria

280
Q

What is the anatomical name for where these dopamine neurons are found?

A

substantia nigra, pars compacta

281
Q

Which cortical tract is responsible for movement, and where does it decussate?

A

Corticospinal

Medulla oblongata

282
Q

If this patient had a lesion in the left parietal optic radiation (posterior to the optic chiasm and anterior to the visual cortex), how would you describe this visual defect?

A

right sided, homonymous, inferior, quadrantanopia

283
Q

Which specific area of the brain is involved in the ability to produce speech?

A

Frontal lobe

Broccas area

284
Q

A stroke affecting which area of the brain may result in difficulty in speech comprehension and results in a ‘word salad’ where the patient is able to physically
say words but they make no sense. Which specific area is affected, what lobe is it located in, and what Brodmann area is this?

A

Wernickes area
temporal lobe
brodmans area 22

285
Q

A patient present with a ‘foot drop’. State which nerve is affected, and its root

A

Common peroneal nerve

L5

286
Q

define osteoporosis

A

low bone density which presents with fractures (T score < -2.5)

287
Q

define osteopenia

A

decreased bone density

T score -1 > n > -2.5

288
Q

define osteomalacia

A

poor bone mineralisation

289
Q

Which three muscles form the anterior compartment of the upper arm, and what nerve innervates these muscles?

A

Biceps brachii
Coracobrachialis
Brachialis
Innervation - Musculocutaneous nerve

290
Q

What are the two measurements that are taken in spirometry that lead to a diagnosis of an obstructive disease, and the values you would expect to see?

A

FEV1 - <0.8

FVC - <0.7

291
Q

What happens to FEV1 and FVC in a restrictive lung disease

A

both reduce equally

292
Q

In spirometry, state the volumes that make up total lung capacity.

A

Inspiratory Capacity (IRV + TV) + Functional Residual Capacity (ERV + RV)

293
Q

The blood levels of what substances are detected by peripheral chemoreceptors?

A

PaO2
PaCO2
pH

294
Q

Where are peripheral chemoreceptors found?

A

Carotid bodies and aortic bodies e.g.

bifurcation of common carotid and aorta

295
Q

Where are central chemoreceptors found?

A

medulla

296
Q

Which lung receptors are rapidly adapting and initiate the cough and gasp responses?

A

irritant

rapid activated stitch receptors (RASR)

mock (3 decks)

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