Mock Questions Flashcards
What are the products of glycolysis?
3 pyruvate
2 NADH
2 ATP
A child is brought into A&E, X-rays show rib fracture. Looks a bit distressed. You suspect NAI, what 2 emotion and 2 physical observations would you make?
Emotional - attachment (disorganized, ambivalent, avoidant), lack of crying, fearful of parent
Physical - injuries in non-ambulant babies, malnourished, poor hygiene, unkempt, burns, signs of neglect
Delayed presentation, story not credible, changing history
What are risk factors leading to NAI for each of the following categories - social, the child, the parents?
Social - low socio-economic background, lack of support, education status, resources available, poverty, social isolation
Parental - previous history of abuse, depressed, uneducated, learning difficulties, young parents, lack of help, single parent, substance abuse, mental illness, domestic violence
Child - multiple pregnancies, disability, 3 children under 5
Name 3 things that an OT would modify about the patient’s bathroom to prevent falls?
Insert hand rails for lowering into bath/toilet
Insert seat in bath
Stick any rugs to the floor
By what mechanism naproxen can cause asthma?
NSAID-induced bronchospasm
Inhibition of COX-1 pathway activates lipoxygenase pathway causing the release of leukotrienes – causing bronchospasm and asthma exacerbation
Describe how NICE decides what treatment should be available.
They do an economic evaluation by a process called technology appraisal, looking at the health impact, QALYs, cost effectiveness, pricing, clinical and economic evidence.
In what ways is the governmen trying to reduce the number of alcohol related conditions in the UK?
Increase price of alcohol
Lowering the recommended weekly limit to 14 units
Strict laws on drink driving and underage drinking
Public health campaigns and education of public
Alcohol can cause slurred speech, give 5 other physiological effects of alcohol.
Cutaneous vasodilation Loss of motor co-ordination Loss of balance Loss of inhibitions Hypertension and vasoconstriction
A footballer was playing then accidently twisted his ankle and fell to the ground. When he tried to get up he had difficulty moving his knee joint.
A. What was most likely to be injured?
B. How would you test for this injury?
C. What radiological investigation would you do and why?
A. ACL
B. Anterior drawer test
C. Ultrasound - dynamic test and fast, MRI is preferable - better imaging of ligaments
Describe the spinal reflexes that control muscle tension
Golgi - tendon reflex – Normal component of eh reflex arc of the spinal nervous system. The tendon reflex operates as a feedback mechanism to control muscle tension by causing muscle relaxation before muscle force becomes to great and the tendons might tear.
Stretch-reflex - A muscle contraction in response to stretching within the muscle. It has the shortes latency of all spinal reflexes. It is a monosynaptic reflex that that produces autonomic regulation of the skeletal muscle length. Whe the muscle lengthens the muscle spindle is stretched and its nerve activity increases. This increases alpha neurone activity, causing the muscle fibres to contract.
Name 5 cellular things that antibiotics target
- Cell wall - Penicillins, Cephalosporins
- Cell Membrane - Daptomycin, Polymxyin B
- Protein synthesis - Erythromycin
- Folate synthesis - Trimethoprim, sulfonamides
- DNA synthesis - fluoroquinolone
- Ribosomes - macrolides, tetracyclines, aminoglycosides
Describe difference between bacteriostatic and bactericidal
Bactericidal = bacterial death
Bacteriostatic = stops growth
A. Define sensitivity
B. Define specificity
C. 3 cellular changes which show cancerous phenotype
D. Scanning mechanism to screen for breast cancer
A. The ability of a test to correctly identify patients with a disease - True positive
B. The ability of a test to correctly identify patients without a disease - True negative
C. High nuclear to cytoplasmic ratios, Variation in nuclear size(pleomorphism) and are dark(hyperchromasia), Irregular nuclear membranes, Irregular chromatin distribution +/- Prominent nucleoli
D. Mammogram - x-ray
Retinoblastoma:
A. What type of cancer gene is the RB gene?
B. It could be hereditary or sporadic retinoblastoma. Explain both.
C. Two ways the RB gene can become inactivated
A. tumour suppressor gene
b. Hereditary RB is a inherited mutation, germline. Sporadic is a non inherited mutation that is acquired randomly, somatically.
C. Gene inactivation through chromosomal mutation or functional inactivation by viral oncoproteins binding in cancers.
Pt has RA, 2 kids under 10, has a really busy schedule and taking medication for RA which is contraindicated in pregnancy:
List one advantages and disadvantages of each contraceptive method for this specific patient:
Condom, progesterone-only pill, intrauterine device, and contraceptive implant
Condom - low risk of STI, but can break, allergies to latex
POP - decreases menstrual cramps and acne but need to remember to take everyday, side effects - clots, headaches, depression
Intrauterine device - doesn’t require daily attention, high protection but risk of infection, painful and uncomfortable insertion, copper can have heavy periods
Contraceptive implant - requires minor surgery to implant and remove, could get infected but good long term method for 3 years that don’t need to think about
A. Describe obesity in terms of energy imbalance.
B. Why dietary fat leads to obesity?
A. Energy intake that exceeds energy expenditure is the main driver of weight gain
B. Induces overconsumption and weight gain through its low satiety properties and high caloric density
Describe the 3 main steps of a fracture healing normally.
Will heal by secondary healing
Main cytokines: TGF-B, FGF, BMP, PDGF, IL, GMCSF and osteonectin
Inflammatory phase - bleeding from torn vessels. Clotting cascade activated, and inflammatory cells (platelets, PMNs, Macrophages) brought into the Area. Haematoma forms in fracture gap. Immediate from injury, peaks at 48hrs, subsides by one week.
Reparative phase – Mesenchymal stem cells become fibroblasts, osteoblasts and chondroblasts at the fractures site. Callus formed by intramembranous ossification at cortical bone ends (hard callus) and by chondrogenesis at the periphery (soft callus). Endochondral ossification converts callus to woven bone. Starts within first few days and lasts few weeks.
Remodelling phase – Woven bone replaced by lamellar bone, and excess callus resorbed. Begins a few weeks after injury and lasts years.
Psychological factors that influence chronic pain?
Depression Anger Fear/anxiety, lack of control Family pressures, employment, finances Compensation/legal issues Cultural expectations
Describe four ways in which Wakefield’s research was ethically problematic.
He falsified information claiming it had been approved by a research ethics committee
The procedures involved were invasive and not clearly justified
The justification for the research was not clear
Wakefield had an undisclosed conflict of interest
We don’t know if he gained informed consent from parents because of the lack of research ethics approval
Name the five components of the biopsychosocial model that can be used to help understand the treatment of chronic back pain.
Sensory (nociception) Cognition (pain) Affective (suffering) Illness (pain behaviour) Social/ cultural
Describe four features of the anger stage of the grieving process.
Frustrated expression of bottled-up emotion - annoyed, infuriated
Person may recognise anger as irrational and misplaced, but unable to control it.
May drive away well-meaning help and support - hostile
Most anger expressed by those who are more socially isolated
- Verbal
- Envy
- Physical
- Aggression to health care staff
- Self blame
When addressing concerns about safeguarding, describe four ethical issues that Clinical Teams should consider when sharing clinical or personal information.
The patient’s consent to disclose
The patient’s competence/ capacity
The patient’s autonomy
The relationship between the patient and their carer
Nature of the disclosure – is it intrinsically personal or idiosyncratic?
Consequences of disclosure/ best interest of patient
Doctors’ motivation of disclosure
Personal nature- obtain consent from person who might have been abused
Describe how paracetamol helps to reduce fever
Paracetamol is a COX enzyme inhibitor. It is thought to be selective for COX-3. COX enzymes stimulate the production of prostaglandins. Paracetamol helps to prevent PGE2 synthesis which is the main compound that alters the homeostatic temperature set point in the hypothalamic neurons that regulate body temperature. In fever, the temperature set point is elevated by the production of PGE2. PGE2 production is stimulated by cytokines (IL-1, TNF alpha), which are produced by the action of bacteria/viruses on the immune system. By blocking PGE2 production, paracetamol brings down the temperature set point to normal..
Describe the differences between the functions of tendons and ligaments.
Ligaments join bone to bone.
Maintains joint stability by preventing bones from moving apart. Ligaments usually provide a stop point, or prevent a movement.
A tendon is attached to the end of muscle fibres at one end and bone at the other, which allow movement as the two points of attachment can move closer or further away. A tendon allows movement whereas a ligament is designed to prevent it.
Tendons transmit muscle power generated by contraction to the bones to allow movement to occur.
