Mock Questions

Question 1

What are the products of glycolysis?

Answer 1

3 pyruvate
2 NADH
2 ATP

Question 2

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?

Answer 2

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

Question 3

What are risk factors leading to NAI for each of the following categories - social, the child, the parents?

Answer 3

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

Question 4

Name 3 things that an OT would modify about the patient’s bathroom to prevent falls?

Answer 4

Insert hand rails for lowering into bath/toilet
Insert seat in bath
Stick any rugs to the floor

Question 5

By what mechanism naproxen can cause asthma?

Answer 5

NSAID-induced bronchospasm

Inhibition of COX-1 pathway activates lipoxygenase pathway causing the release of leukotrienes – causing bronchospasm and asthma exacerbation

Question 6

Describe how NICE decides what treatment should be available.

Answer 6

They do an economic evaluation by a process called technology appraisal, looking at the health impact, QALYs, cost effectiveness, pricing, clinical and economic evidence.

Question 7

In what ways is the governmen trying to reduce the number of alcohol related conditions in the UK?

Answer 7

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

Question 8

Alcohol can cause slurred speech, give 5 other physiological effects of alcohol.

Answer 8

Cutaneous vasodilation
Loss of motor co-ordination
Loss of balance
Loss of inhibitions
Hypertension and vasoconstriction

Question 9

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?

Answer 9

A. ACL
B. Anterior drawer test
C. Ultrasound - dynamic test and fast, MRI is preferable - better imaging of ligaments

Question 10

Describe the spinal reflexes that control muscle tension

Answer 10

 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.

Question 11

Name 5 cellular things that antibiotics target

Answer 11

• Cell wall - Penicillins, Cephalosporins
• Cell Membrane - Daptomycin, Polymxyin B
• Protein synthesis - Erythromycin
• Folate synthesis - Trimethoprim, sulfonamides
• DNA synthesis - fluoroquinolone
• Ribosomes - macrolides, tetracyclines, aminoglycosides

Question 12

Describe difference between bacteriostatic and bactericidal

Answer 12

Bactericidal = bacterial death

Bacteriostatic = stops growth

Question 13

A. Define sensitivity
B. Define specificity
C. 3 cellular changes which show cancerous phenotype
D. Scanning mechanism to screen for breast cancer

Answer 13

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

Question 14

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

Answer 14

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.

Question 15

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

Answer 15

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

Question 16

A. Describe obesity in terms of energy imbalance.

B. Why dietary fat leads to obesity?

Answer 16

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

Question 17

Describe the 3 main steps of a fracture healing normally.

Answer 17

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.

Question 18

Psychological factors that influence chronic pain?

Answer 18

Depression
Anger
Fear/anxiety, lack of control
Family pressures, employment, finances
Compensation/legal issues
Cultural expectations

Question 19

Describe four ways in which Wakefield’s research was ethically problematic.

Answer 19

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

Question 20

Name the five components of the biopsychosocial model that can be used to help understand the treatment of chronic back pain.

Answer 20

Sensory (nociception)
Cognition (pain)
Affective (suffering)
Illness (pain behaviour)
Social/ cultural

Question 21

Describe four features of the anger stage of the grieving process.

Answer 21

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

Question 22

When addressing concerns about safeguarding, describe four ethical issues that Clinical Teams should consider when sharing clinical or personal information.

Answer 22

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

Question 23

Describe how paracetamol helps to reduce fever

Answer 23

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..

Question 24

Describe the differences between the functions of tendons and ligaments.

Answer 24

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.

Question 25

Where is cortisol synthesised?

Answer 25

Zona fasciculata of adrenal cortex/gland

Question 26

Describe how cortisol transduces its signal.

Answer 26

It is a lipid soluble hormone, which diffuses into cells.
To bind to its receptor inside the cell in the cytoplasm.
The receptor/ hormone complex moves into the nucleus to bind to DNA and activate or repress gene expression.

Question 27

Describe the physiology behind the mechanism of action of the oral contraceptive pill.

Answer 27

Synthetic oestrogens inhibit FSH release by negative feedback, suppressing follicular development.
Synthetic progesterone like compounds (progestins) block the oestrogen-mediated positive feedback surge in LH release, preventing ovulation, also change the properties of cervical mucous so that it is hostile to sperm
Endometrial development is scant and not favourable for implantation.

Question 28

Describe in detail the physiological pathway of pain transmission from a joint to the brain

Answer 28

Chemicals/inflammatory mediators (histamine, bradykinin, 5-HT, NGF, K+, adrenaline, cytokines, prostaglandins etc.) released locally as a result of injury/inflammation.
Produce pain either by direct stimulation or sensitising free nerve endings.
Pain is mediated via the myelinated A-delta and non-myelinated C fibres.

A fibres enter/terminate the dorsal root; synapse with second-order neurones; decussate/send fibres to the contralateral side; travel in spinothalamic tract.
C fibres enter and terminate at the dorsal root; synapse with axons that pass through the anterior commissure to the contralateral side and up the spino-reticulo-thalamic tract.

Then both via thalamic pathways to and from the cortex to register pain and mediate emotional components.

Question 29

Briefly describe the physiological pathway(s) in the brain thought to be involved in nicotine addiction.

Answer 29

Nearly all dependence-producing drugs activate the mesolimbic and/or mesocortical dopaminergic pathways.

Nicotine, via attachment to nicotinic receptors, enhances synthesis and release of dopamine from dopamine containing neurons in the ventral tegmental area (VTA) of the hypothalamic/midbrain region.

Question 30

Describe the four changes that take place to facilitate the movement of cells of the immune system from the blood stream to the tissues, mentioning one important mediator for each change.

Answer 30

Vasodilatation, causes a change in laminar flow Mediated by histamine

Margination, partly due to change in laminar flow but also mediated by adhesion molecules (eg integrins and ICAM) which allow cells to adhere to endothelium

Emigration - The change in vascular permeability mediated by histamine, bradykinins and leukotrienes allows movement of fluid and cells from the vessel into the tissues

Chemotaxis - attracts cells to site where needed, mediated by complement components leukotrienes and cytokines

Question 31

In carrying out a literature search, give two issues that the specialist rheumatology registrar should consider in formulating their search strategy.

Answer 31

PICOS: 
o patient/population diagnosis
o Intervention
o Control treatment
o Relevant outcome
o Study type

Question 32

Briefly describe which study types are considered to provide the highest quality evidence and why?

Answer 32

Highest quality is systematic review of RCTs, then individual RCTs

These are considered the best form of evidence because high quality RCTs limit bias, and confounding.

Cochrane evidence base

Question 33

Describe the role of the Suprachiasmatic Nucleus (SCN) and the Pineal gland in the sleep-wake cycle.

Answer 33

The SCN becomes activated by changes in light levels detected via the optic chiasm.
The SCN activates/sends a signal to the pineal gland. (The SCN can be seen as the control centre of the sleep-wake cycle).

Once activated, the pineal gland produces melatonin (main sleep hormone) which reduces arousal in the brain and leads to sleep.

Question 34

Describe one type of biorhythm and provide an example.

Answer 34

Infradian rhythms, where each cycle happens less frequently than every 24 hours. Examples include the menstrual cycle and seasonal changes such as Seasonal Affective Disorder.

Ultradian rhythms, where each cycle happens more than once in 24 hours. Examples include the sleep cycle (not the sleep-wake cycle), blood circulation, hormone release, heart rate, bowel activity etc.

Question 35

Describe four risk factors for developing addiction to prescribed opiates

Answer 35

Current or past history of substance misuse including alcohol

Family member with history of substance misuse

Poor social support

Co-morbid psychiatric disorders (this may be for a number of reasons including
high levels of mental and substance abuse disorder co-morbidity and use of
analgesic medications to alleviate symptoms of mental illness)

Question 36

Describe ways in which the risk of opiate addiction could be reduced and managed

Answer 36

Addiction should be discussed with all patients being considered for long term opioid treatment

Opioids should be used only after other evidence based interventions have been tried

Opioids should be prescribed as part of a broader management plan aimed at improving function in a number of domains

Clear aims of therapy should be agreed with the patient before starting opioids

Advice from specialists in pain medicine and addiction medicine should be readily available

Patients should, where possible receive prescriptions from a one prescriber only

Modified release opioid preparations are preferred in the management of persistent symptoms

Injectable opioids play no role in the management of persistent pain

Opioid therapy should be monitored regularly and adjusted appropriately

Question 37

Describe how calcium is removed from the muscle cell to start muscle relaxation.

Answer 37

SERCA pump (Ca-ATPase) active transport across the sarcoplasmic reticulum.

Na/Ca exchanger leading to facilitated diffusion across the sarcolemma membrane into extracellular space.

Ca-ATPase active transport across the sarcolemma membrane into the extracellular space.

Question 38

Describe two characteristics of the condition that make it suitable for population screening and two characteristics of the test for population screening.

Answer 38

Characteristics of the condition
• The condition is important = common and disabling,
• the epidemiology & natural history is adequately understood
• there is a recognisable latent or pre-symptomatic phase
• All cost-effective primary prevention interventions should have been implemented

Characteristics of the Test
• The screening test is reliable, valid and repeatable
• The test is acceptable to the population
• easy to perform, sensitive, specific and low cost
• The treatment should be effective and available
• An agreed policy on whom to treat if test is positive
• Case-finding should be a continuous process and not once for all

Question 39

What population characteristics do you need to know in order to calculate incidence and prevalence?

Answer 39

Number of new cases

Number of people currently with disease

Total population at risk of having that disease

At a given point in time OR over a period of time

Question 40

What are types of resources/documents produced by NICE?

Answer 40

Producing evidence-based guidance and advice for health, public health and social care practitioners.

Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services.

Providing a range of information services for commissioners, practitioners and managers across health and social care

Question 41

What does QALY assess?

Answer 41

Quality-adjusted life year is a measure of the state of health of a person or group in which the benefits of length of life are adjusted to reflect the quality of life.

Cost wise for NICE- £20-30,000 deemed cost-effective

Question 42

Name 4 things taken into account when working out a QALY.

Answer 42

??

Estimating the years life remaining for a patient following a treatment or intervention.
Weighting each year of life with a quality of life score.
Normal level of freedom from pain + mental disturbance and ability to carry out activities of daily life
Cost