phase 1 mock sba

Question 1

A scientist uses an unknown stain on a group of cells under the microscope he sees that the nuclei have all turned blue. What stain has been used?

A) Periodic acid schiff
B) Alcian blue
C) Haemotoxylin
D) Eosin
E) Ziehl-Nielsen stain

Answer 1

answer- c
A) Stain hexose sugars a magenta colour e.g basement membranes
B) Alcian blue stains Glycoaminoglycan rich structures blue e.g goblet cells
C) haemotoxylin is a stain that is used to stain cell nuclei and RNA blue
D) Eosin stains cytoplasm and colloidal proteins pink/ Keratin orangey-red
E) Stain used to identify acid fast bacilli

Question 2

The control of the pH of the stomach is a vital physiological process. Acetylcholine released from parasympathetic nerves acts directly on cells lining the stomach to stimulate/inhibit their action. Stimulation of G cells in the gastric mucosa to release gastrin is crucial for the digestion of what substance/substances?
A) Carbohydrates
B) Lipids
C) Proteins
D) Vitamin A
E) Vitamin C

Answer 2

C) Proteins

Feedback
This question requires knowledge about the role of gastrin in the stomach and protein digestion.
Conversion of pepsinogen to pepsin (enzyme that breaks down proteins) requires a low pH. Gastrin is a chemical that increases gastric acid release in the stomach. Therefore, gastrin is important for protein digestion.

Question 3

Toby, a keen 3rd year medical student, is looking at a histology slide of glandular tissue under a microscope in The Diamond. The gland that the slide was taken from secretes into the mouth. The secretory cells are arranged in spherical clumps that resemble bunches of grapes - they appear dark pink when stained. Which of these chemicals is secreted by this type of glandular tissue?

A) Alpha amylase
B) Beta amylase
C) Mucus
D) Mucus and alpha amylase
E) Mucus and beta amylase

Answer 3

A) Alpha amylase
Feedback
This question requires knowledge about the histology of the salivary glands and their different secretions.
The parotid gland (stains dark pink) produces an enzyme rich secretion containing alpha amylase
The sublingual glands (pale staining) produce a mucus rich secretion
The submandibular glands (have dark pink and paler staining parts) produce both a mucus and enzyme rich secretion
Make sure you know the histological appearance of each of the salivary glands and their different secretions

Question 4

Carbohydrates are digested in a series of hydrolysis reactions in the gastro-intestinal tract. Starch/glycogen are hydrolysed by salivary and pancreatic amylase to produce disaccharides, which are further hydrolysed to monosaccharides. The absorption of which monosaccharide does NOT require energy from ATP?

A) Maltose
B) Glucose
C) Fructose
D) Sucrose
E) Galactose

Answer 4

C) Fructose
Feedback
2 processes are used to absorb monosaccharides into the blood: active transport (which requires energy from ATP) and facilitated diffusion (which does not)
Both glucose and galactose are absorbed via secondary active transport
Whereas fructose is absorbed via facilitated diffusion

Sucrose and maltose are disaccharides

You need to have a basic understanding of the mechanisms of digestion and absorption of carbohydrates, proteins and lipids

Question 5

Most people have around one bowel movement every day. However this is not the case for Rudge - a second year medical student. Rudge has recently begun suffering from bowel incontinence, meaning he has lost control of his bowel movements. At Rudge’s appointment, the doctor explains that weakness in one of Rudge’s pelvic floor muscles is responsible for this incontinence. Weakness of which muscle is most likely to lead to a widening of the anorectal angle and thus bowel incontinence?
1/1
A) Puborectalis

B) Coccygeus
C) Internal sphincter
D) Pubococcygeus
E) Iliococcygeus

Answer 5

answer- A
feedback
There are 2 main muscular components of the pelvic floor: the levator ani muscles and the coccygeus muscle. The levator ani muscles are:
Puborectalis, which when contracted bends the anal canal and maintains continence (therefore is the correct answer)
Pubococcygeus, which provides support to abdominal organs
Iliococcygeus, which elevates the pelvic floor and anal canal

The coccygeus muscle supports the pelvic viscera and flexes the coccyx

The internal sphincter is not part of the pelvic floor muscles, and doesn’t create an anorectal angle

You are expected to know about the maintenance of urinary continence in detail, but that doesn’t mean you should completely ignore bowel continence. Knowing the basics is still important.

Question 6

Carbamoyl phosphate synthetase deficiency I is an autosomal recessive disorder which causes toxic ammonia to accumulate in the body. Babies born with this disorder have a deficiency of the enzyme carbamoyl phosphate synthetase. In severe cases, this leads to respiratory distress, seizures and coma. What stage of the urea cycle is the enzyme carbamoyl phosphate synthetase important for?

A) Conversion of arginine to ornithine
B) Conversion of ornithine to citrulline
C) Conversion of citrulline to argininosuccinate
D) Conversion of argininosuccinate to arginine
E) Conversion of arginine to urea

Answer 6

Correct answer
B) Conversion of ornithine to citrulline

Question 7

Albumin, which is produced in the liver, is a vital plasma protein that has many functions in the body. Which of the following is NOT a function of albumin?

A) Anticoagulation
B) Maintenance of oncotic pressure
C) Neutralisation of free radicals
D) Bind to and transport bilirubin
E) Bind to and transport iron

Answer 7

Correct answer
E) Bind to and transport iron
Feedback
Albumin is the most important plasma protein that you need to know about - you need to know about its functions and its movement through the circulatory system.
Albumin is important in anticoagulation, maintenance of oncotic pressure and neutralisation of free radicals
Albumin carries many chemicals around the body, such as bilirubin, thyroxine, hormones and some cations. However, it DOES NOT transport iron ions, they are carried by transferrin

Question 8

Darcey, a senior lecturer at the university, is giving a lecture on public health. She is describing a report into health inequalities to her students. Darcey gives an outline of the report, saying “published in 1998, the report stated that reducing income inequality was an important step in reducing health inequalities, and that emphasis should be put on the health of families with children to reduce health inequalities in future. It recommended that all policies that may impact health should undergo health assessments to see what impact they will have” Which report is Darcey describing?
0/1
A) The Acheson Report
B) The Black Report
C) The Marmot review
D) The Morrison review
E) The Whitehall report

Answer 8

Correct answer
A) The Acheson Report
Feedback
It’s important that you know about some of the main publications that have contributed to health policy, most important ones are the Acheson report and the Black report

Acheson report - as described in question above
Black report - published in 1980, found that there are inequalities in mortality between different social groups, also working class people have less access to and less uptake of preventative measures
Marmot review - published in 2010, proposed the most effective evidence based strategies for reducing health inequalities in England
Morrison review - isn’t real
Whitehall report - 2 studies of British civil servants, found that those in higher ‘grades’ of employment had much lower mortality

I know public health can seem very daunting, but as long as you know a little bit about the main topics covered, then you should be able to pick up a reasonable amount of marks from the questions. As always with phase 1 - it’s better to know a little about a lot than a lot about a little!
The phase 1 MedSoc drive has an excellent document that covers all the main themes of public health

Also, don’t fall into the trap of thinking public health is all common sense, the things that you’re going to be examined on (and therefore the things you need to revise) are beyond common sense.

Question 9

A study was set up to test the diagnostic accuracy of a new test.
Sample of 100 people- 25% who have disease, After using new testing method 30 were flagged as being positive- of which 20 actually had the disease.

What is the specificity and sensitivity of this study?

0/1
A) Specificity= 13% Sensitivity= 80%
B) Specificity= 86% Sensitivity= 80%
C) Specificity= 80% Sensitivity= 86%

D) Specificity= 80% Sensitivity= 13%
E) Specificity= 83% Sensitivity= 13%

Answer 9

Correct answer
B) Specificity= 86% Sensitivity= 80%
Feedback
100-30=70 negative tests
25-20= 5 true positives that are negative
70-5= 65 negatives that are negative
65/75= 86.67% specificity

20/25= 80% sensitivity

Sensitivity= Likelihood of a positive person by test being positive
specificity= Likelihood of a negative person by test being negative
Positive predictive value= probability of the test picking up someone positive
Negative predicted value= probability of the test proving someone negative

Question 10

Neha, a student living it large in Tanzania, wants to investigate the risk factors for Creutzfeldt-Jakob disease (rare type of dementia) by interviewing patients diagnosed in the past 5 years. Which study model type would be most suitable?
0/1
A) Ecological
B) Case control
C) Cohort
D) Cross sectional
E) Randomised control trial

Answer 10

Correct answer
B) Case control
Feedback
Case Control- Compares histories from a group with a condition to a group without - she wants to know risk factors for people with established disease, other models mentioned are less applicable, also useful for rare diseases

Ecological- more for rates in population level- not really precise for things such as dementia risk factors

Cohort- follows a group of people over time- she wants to look back in time talking to patients with established disease, not look forward

Cross-sectional- observe population/ collect data at a single point in time- not very useful in what we’re trying to do

Randomised Control trial- used for comparing a placebo vs treatment (known as gold standard study type - secondary to meta analysis of multiple RCTs)

Just know your study types at the least, public health/stats is not a favourite for many people but it will come up and its better to know a bit about it rather than know nothing at all

Question 11

A patient Ibrahim comes into the clinic complaining of swelling of hands and feet, sudden onsets of pain and vision problems, the doctor orders a blood test and the results show that Ibrahim has sickle cell anaemia, what is type of genetic mutation is responsible for this?
0/1
A) Deletion
B) non-sense mutation

C) mis-sense mutation
D) splice site mutation
E) expansion of tri-nucleotide repeat

Answer 11

Correct answer
C) mis-sense mutation
Feedback
mis-sense mutation. Sickle cell is a disease caused by a single nucleotide polymorphism where CAG is changed to CTG this causes a change from amino acid glutamine to valine to form HbS instead of beta haemoglobin. This causes the red blood cells to form a sickle shape which can cause occlusion in capillaries known as crises

A) mutation that involves the loss of one or more nucleotides from a segment of DNA
B) point mutation that causes a stop codon resulting in an incomplete protein
C) correct answer
D) intron isn’t removed so alters the protein coding sequence
E) triple repeat is repeated multiple times in the first part of the coding sequence

Question 12

What is the rate limiting enzyme in Krebs and what step does it go from and to?
1/1
A) Isocitrate dehydrogenase converts citrate to isocitrate
B) Citrate synthase converts citrate to isocitrate
C) Citrate synthase converts oxaloacetate to citrate
D) Isocitrate dehydrogenase converts isocitrate to alpha-keto glutarate
E) Succinate dehydrogenase converts succinate to fumarate

Answer 12

Feedback
Correct answer – D) the rate limiting enzyme is isocitrate dehydrogenase which converts isocitrate to alpha ketoglutarate. This is just one of them processes you need to commit to memory just write it out loads of times until it sticks.

Question 13

Linguini is a chef working at a restaurant and whilst cutting vegetables he cuts his upper arm, he is bleeding profusely and he had put pressure on the wound to try stop the bleeding, which one of the following allows platelets to bind to exposed collagen fibres.
0/1
A) thrombin
B) thromboxane A2
C) factor Xa
D) Von willerbrand factor
E) Tissue factor
Correct answer
D) Von willerbrand factor

Answer 13

Feedback
Correct answer D) VWF is a factor that allows the platelets that aggregate around the site of the injury to bind to exposed collagen fibres to try and form a platelet plug

A) Thrombin and enzyme which converts fibrinogen to insoluble fibrin
B) Thromboxane A2 amplifies platelet activation and recruits additional platelet
C) Factor Xa catalyses the production of prothrombin to thrombin
D) Correct answer
E) Tissue factor binds to factor VII which activates it

Question 14

The spinal cord is the main pathway for information connecting the brain and peripheral nervous system. Brown-Sequard syndrome is a condition caused by a hemi-section of the spinal cord causing weakness and loss of fine touch ipsilateral to the lesion, and loss of pain and temperature sensation 1-2 spinal levels below the lesion contralaterally.
Which ascending tract carries sensation of pain and temperature?
0/1
A) Lateral Spinothalamic
B) Anterior Spinocerebellar
C) DCML
D) Anterior Spinothalamic
E) Rostral Spinocerebellar

Answer 14

Correct answer
A) Lateral Spinothalamic
Feedback
Lateral Spinothalamic carries pain and temperature
Anterior spinocerebellar carries lower limb proprioception
DCML carries fine touch, vibration and proprioception
Anterior spinothalamic carries crude touch and pressure
Rostral spinocerebellar carries upper limb proprioception

These are all AFFERENT tracts carrying information to your brain.
Make sure you learn the different tracts both ascending(sensory/afferent) and descending (motor/efferent).

Question 15

The spinal cord is the main pathway for information connecting the brain and peripheral nervous system. Brown-Sequard syndrome is a condition caused by a hemi-section of the spinal cord causing weakness and loss of fine touch ipsilateral to the lesion, and loss of pain and temperature sensation 1-2 spinal levels below the lesion contralaterally.
Which ascending tract carries sensation of pain and temperature?
0/1
A) Lateral Spinothalamic
B) Anterior Spinocerebellar
C) DCML
D) Anterior Spinothalamic
E) Rostral Spinocerebellar

Answer 15

Correct answer
A) Lateral Spinothalamic
Feedback
Lateral Spinothalamic carries pain and temperature
Anterior spinocerebellar carries lower limb proprioception
DCML carries fine touch, vibration and proprioception
Anterior spinothalamic carries crude touch and pressure
Rostral spinocerebellar carries upper limb proprioception

These are all AFFERENT tracts carrying information to your brain.
Make sure you learn the different tracts both ascending(sensory/afferent) and descending (motor/efferent).

Question 16

he tongue is a primary taste organ playing a vital role in swallowing. It was once thought that tongue maps represented the different types of taste in different regions of the tongue but this was wrong.
Which statement about the tongue is correct?
0/1
A) CN3 innervate the general sensation of the posterior ⅔ of the tongue
B) CN9 innervates the special sensory region of the tongue posterior to the circumvallate papillae
C) The V2 branch of CN5 innervate the tip of the nose down to the tip of the tongue
D) CN12 innervates all muscles of the tongue apart from the styloglossus which is innervated by CN10
E) CN7 innervates the general sensation of the anterior ⅔ of the tongue

Correct answer
B) CN9 innervates the special sensory region of the tongue posterior to the circumvallate papillae
Feedback
A) CN3 is occulomotor nerve (all ocular muscles apart from lateral rectus - CN6, and superior oblique - CN4) NOT tongue
B) CN9- Glossopharyngeal innervates the special sensory region of the tongue posterior to the circumvallate papillae (posterior ⅓ - also does general sensory there as well)
C) V3(Mandibular) branch innervates the anterior ⅔ general sensation of tongue.
D) CN12(Hypoglossal) innervates all muscles of tongue apart from Palatoglossus which is CN10(Vagus)
E) CN7 innervates special sensory(taste) for anterior ⅔ of the tongue

Was quite a mean question and easy to trip up on the answer.

Just understand the image- sensation/motor of

Answer 16

Correct answer
B) CN9 innervates the special sensory region of the tongue posterior to the circumvallate papillae
Feedback
A) CN3 is occulomotor nerve (all ocular muscles apart from lateral rectus - CN6, and superior oblique - CN4) NOT tongue
B) CN9- Glossopharyngeal innervates the special sensory region of the tongue posterior to the circumvallate papillae (posterior ⅓ - also does general sensory there as well)
C) V3(Mandibular) branch innervates the anterior ⅔ general sensation of tongue.
D) CN12(Hypoglossal) innervates all muscles of tongue apart from Palatoglossus which is CN10(Vagus)
E) CN7 innervates special sensory(taste) for anterior ⅔ of the tongue

Was quite a mean question and easy to trip up on the answer.

Just understand the image- sensation/motor of

Question 17

Which embryological structure is the precursor to the developing pons and cerebellum?
0/1
A) Mesencephalon
B) Diencephalon
C) Myelencephalon
D) Metencephalon
E) Telencephalon

Answer 17

Correct answer
D) Metencephalon
Feedback
We’re well aware that embryology is probably down there with histology for people’s preferences, but its one of those things that therell certainly be a few questions somewhere across your exams.
Even just having a vague understanding of how the structures come about in the body can help with your understanding of the body anatomically and even physiologically.
Best advice would be to learn basic/macroscopically if dont know already first so what germ layers do what and then expand into each system

Teachmeanatomys picture if you google brain embrology is a beautiful explanation for this question which i would not be able to do justice- Just learn it!

Question 18

Which embryological structure is the precursor to the developing pons and cerebellum?
0/1
A) Mesencephalon
B) Diencephalon
C) Myelencephalon
D) Metencephalon
E) Telencephalon

Answer 18

Correct answer
D) Metencephalon
Feedback
We’re well aware that embryology is probably down there with histology for people’s preferences, but its one of those things that therell certainly be a few questions somewhere across your exams.
Even just having a vague understanding of how the structures come about in the body can help with your understanding of the body anatomically and even physiologically.
Best advice would be to learn basic/macroscopically if dont know already first so what germ layers do what and then expand into each system

Teachmeanatomys picture if you google brain embrology is a beautiful explanation for this question which i would not be able to do justice- Just learn it!

Question 19

Which is true about the brain’s ventricles?
1/1
A) They are lined by dura mater which is made up of astrocytes
B) They are line by pia mater which is made up of oligodendrocytes
C) Only 60% of people have ventricles in the brain
D) They are lined by ependymal cells, which form a structure called the choroid plexus. It is within the choroid plexus that CSF is produced.

E) The lateral ventricles are connected to the third ventricle by the foramen of Magendie which then connects to the fourth ventricle by the cerebral aqueduct

Answer 19

Feedback
A)The are not lined by dura and dura is made fibroblasts and extracellular collagen

Dura->Arachnoid->Pia
Astrocytes help form the blood brain barrier by their foot processes but not in the dura- or any of the pad layers

B) Oligodendrocytes are the myelinating cells of the CNS, Schwann cells are PNS

C) no

D)They are lined by ependymal cells, which form a structure called the choroid plexus. It is within the choroid plexus that CSF is produced.

E) Pathway of CSF: Lateral ventricles-> Foramen of Monro-> Third ventricle-> Cerebral aqueduct-> fourth ventricle.
Then from fourth ventricle can go through foramen of Luschka(Lateral) or Magendie (Medial)

Question 20

A patient presents to you with infero-lateral(down and out) deviation of the pupil and mild ptosis (upper eyelid drooping)
Which nerve has likely been affected?
0/1
A) Optic
B) Occulomotor
C) Trochlear
D) Abducens
E) Ophthalmic

Answer 20

Correct answer
B) Occulomotor
Feedback
A) Optic- carries visual messages from the eye
B)Occulomotor- this is because none of those muscles are contracting to oppose the movement of which the perfectly fine trochlear and abducens nerves are performing which is down and out and lateral movement.
C) Trochlear- innervates the superior oblique
D) Abducens- innervates the lateral rectus
E) Ophthalmic- branch of a trigeminal- sensory of the eye

Question 21

The direct and indirect basal ganglia pathway explain groups of brain structures which can co-ordinate either an initiatory or inhibitory movement response respectively. Similar to the papez circuit whereby many structures of the brain have a co-ordinated series of activity to illicit emotional control. What inhibits and excites the striatum in the indirect pathway of basal ganglia?
0/1
A) Inhibitor: Substantia nigra pars reticulata Excitor: Cerebral Cortex
B) Inhibitor: Substantia nigra pars compacta Excitor: Cerebral Cortex
C) Inhibitor: Substantia nigra pars reticulata Excitor: Thalamus
D) Inhibitor: Substantia nigra pars compacta Excitor: Thalamus
E) Inhibitor: Substantia nigra pars reticulata Excitor: Globus pallidus

Answer 21

Correct answer
B) Inhibitor: Substantia nigra pars compacta Excitor: Cerebral Cortex
Feedback
Inhibitor: Substantia nigra pars compacta Excitor: Cerebral Cortex

bear in mind in the direct pathway however both substantia nigra pars compacta and cerebral cortex are excitatory for the direct pathway

Know your pathways, Papez primarily probably, then direct and indirect. Obviously is a lot to learn by this point but just be aware of it at the least.

Again I wouldn’t do justice the diagrams out there online, 2 min neuroscience is lovely for the direct and indirect pathway. papez is quite easily findable as well

Question 22

what part of the membrane is the tegmentum on?

Answer 22

ventral

Question 23

In which layer of skin will you find Pacinian corpuscles?
0/1
A) Stratum Lucidum
B) Stratum Granulosum
C) Stratum Spinosum
D) Stratum Basale
E) Dermis
.

Answer 23

Correct answer
E) Dermis
Feedback
First 4 answers were referring to 4 of the 5 layers of epidermis:

Stratum Corneum, Stratum Lucidum, Stratum Granulosum, Stratum Spinosum, Stratum Basale

Also good to learn about pacinian/meissner corpuscles, (deep touch, vibration and fine touch and vibration ish respectively)

Eccrine glands - sweat glands that release through coiled tubules to skin

Question 24

David thinks running is fun and decided to practice sprinting on a Monday morning voluntarily. What are the end products of the glycolysis reaction ongoing in David’s cells?
0/1
A) 2 ATP, 2 NADH, 2 pyruvate
B) 4 ATP, FADH, 2 pyruvate
C) 2 ATP, 2 lactate
D) 4 ATP, 2 lactate
E) 4 ATP, 4 NADH, 4 pyruvate

Answer 24

Correct answer
C) 2 ATP, 2 lactate
Feedback
Correct answer – C – sprinting is a high intensity action which means that there becomes a shortage of oxygen supply to cells temporarily, this causes Davids cells to need to make energy without using oxygen so anaerobic glycolysis is used in which the products of a single cycle is 2 ATP and 2 lactate molecules

A) Products of aerobic glycolysis
B) No FADH involved glycolysis
C) Correct answer
D) Not correct
E) Not correct

Question 25

Which one of the following is the definition of penetrance?
0/1
A) Inheritance of the same mutant allele through two branches of the same family
B) The process of X chromosome inactivation in females
C) Where in some genes only 1 out of the 2 alleles are active and the other is inactive
D) Proportion of people with a gene/genotype who show the expected phenotype
E) Where a genetic disease shows earlier onset and is often more severe as it is passed down generations

Answer 25

Correct answer
D) Proportion of people with a gene/genotype who show the expected phenotype
Feedback
Correct answer – D)
A) Is describing autozygosity
B) Is describing lyonisation
C) Is describing imprinting
D) Correct answer
E) Is describing anticipation

Question 26

Which one of these does not originate from the ectoderm germ layer?
1/1
A) Central nervous system
B) Enamel of the teeth
C) Skin epidermis
D) sweat glands
E) kidney tubules

Answer 26

Feedback
Correct answer- E) kidneys tubules are from the mesoderm layer
Ectoderm – mainly structures that are on the outside of the body e.g CNS, skin epidermis, enamel
Mesoderm – give rise to urogenital system, circulatory system, skeletal muscle and bone
Endoderm- GI tract, resp tract and bladder, thyroid and parathyroid glands and liver (most of the internal organs)

Question 27

Which one of these is true about steroid hormones?
0/1
A) Steroid hormones are bound to transport proteins in the blood
B) Synthesised from tyrosine
C) Adrenaline is an example of a peptide hormone
D) Steroid hormones are water soluble
E) Steroid hormones generally signal transduction cascades

Answer 27

Correct answer
A) Steroid hormones are bound to transport proteins in the blood
Feedback
Correct answer- A) because steroids hormones are made of cholesterol they are water insoluble which is a major component in the blood so in order to travel to the cells they need to be bound to a transport protein to do this.
A) Correct answer
B) Amino acid derivative hormones are synthesised form tyrosine
C) Adrenaline is an example of a amino acid derivative hormone
D) Steroid hormones are lipid soluble and water insoluble
E) Peptide hormones like insulin usually signal transduction cascades, steroids affect the DNA directly

Question 28

Which immunoglobulins are found in mucus secretions?
0/1
A) IgA
B) IgD
C) IgE
D) IgG
E) IgM

Answer 28

Correct answer
A) IgA
Feedback
Correct answer - A) immunoglobulins are produced to bind to specific antigens and bring about an immune response. You should know that there are 5 main types of immunoglobulins and that they have different roles:

A) Correct answer. Is present in mucous secretions, second most common and protects from bacteria
B) Found in blood and lymphatics and is present on immature B cells
C) Lowest amount in blood effective against parasitic infections
D) Most common antibody, can cross the placental barrier to provide passive immunity and remember pathogen
E) First antibody that interacts with a new bacteria, initiates the primary immune response

Question 29

Which one of the following allows for two adjacent cells to join by joining the two neighbouring bundles of actin filaments?
0/1
A) desmosomes
B) tight junctions
C) adherens junctions
D) gap junctions
E) Hemidesmosomes

Answer 29

Correct answer
C) adherens junctions
Feedback
Correct answer - C) adherens junction join actin bundles of one cell to another actin bundle of another to keep them together

A) Desmosomes allow cell to cell adhesion via intermediate filaments
B) Tight junctions help stop leakage of molecules between them
C) Correct answer
D) Gap junction allow the passage of water soluble ions and molecules
E) Hemidesmosomes anchor filaments in a cell to the basement membrane

Question 30

Which one of the following is the location of non keratinised stratified squamous epithelium
1/1
A) oesophagus
B) large intestine walls
C) skin
D) renal pelvis
E) respiratory tract

Answer 30

Feedback
Correct answer -A) know some examples of each type of epithelium

A) Correct answer
B) Simple columnar
C) Keratinised stratified squamous
D) Urothelium
E) Ciliated pseudostratified columnar

Question 31

Which of these is the correct order of ketogenesis in the liver?
0/1
A) 2 acetyl COA, HMG COA, acetoacetyl COA, acetoacetate, B-hydroxybutyrate + acetone
B) 2 acetyl COA, Acetoacetyl COA, HMG CoA, acetoacetate, B-hydroxybutyrate + acetone
C) 2 acetyl COA, Acetoacetate, acetoacetyl COA, HMG COA, B-hydroxybutyrate + acetone
D) Acetoacetate, acetoacetyl COA, HMG COA, 2 acetyl COA, B-hydroxybutyrate + acetone
E) Acetoacetate, HMG COA, acetoacetyl COA, 2 acetyl COA, B-hydroxybutyrate + acetone

Answer 31

Correct answer
B) 2 acetyl COA, Acetoacetyl COA, HMG CoA, acetoacetate, B-hydroxybutyrate + acetone
Feedback
Correct answer – B) – the main points to do with ketogenesis is not really the steps in detail, but know that acetone and B-hydroxybutyrate. The latter enters the blood and is used as fuel in muscles and tissue, acetone however is expired by the lungs.
The liver even though it is the site of ketogenesis cannot use the ketone bodies as fuel due to the lack of appropriate enzyme.
Also ketogenesis occurs when there is too much acetyl COA to go through the Krebs cycle

Question 32

Which of these Is false concerning the differentiation of gonads and gentalia

1/1
A)The gonads derive from the wolffian and Müllerian ducts
B)In Males The Sertoli cells of the testes produce a mullerian inhibiting factor
C)The SRY gene inhibits mullerian inhibiting factor
D)The male and female gonads derive from the urogenital ridge embryologically
E)The testes descend into the scrotum due to stimulation by testosterone

Answer 32

Feedback
Correct answer – C) the SRY gene induces the expression of mullerian inhibiting factor this causes the Müllerian ducts to degenerate. The Müllerian duct will develop in females due to a lack of testosterone and MIF, and causes vagina and female external genitalia to develop. Whereas in males the MIF which is produced will causes wolffian ducts to develop and Müllerian ducts to degenerate. The wolffian duct develops into things like epididymis, vas deferens and seminal vesicles.

Where does fertilisation take place

Question 33

Which one of the following statements isn’t true about LH
1/1
A) There is a rise in LH that stimulates the formation of the corpus luteum from theca cells
B) LH increases dramatically just before ovulation
C) LH is increases when the corpus luteum degrades
D) LH acts on theca cells stimulating them to synthesise androgens
E) Granulosa cells secrete inhibin which mainly inhibits LH

Answer 33

Feedback
Correct answer – E) granulosa cells convert androgens to oestrogen, and also do secrete inhibin which MAINLY inhibits FSH but does somewhat inhibit LH

Which of the following is not a function of neutrophils?

Question 34

Which of the following is not a function of neutrophils?
0/1
A) Adhesion to the surface of endothelial cells.
B) Chemotaxis, the following of a chemotactic gradient to migrate towards the source of chemoattractants.
C) Degranulation in order to release histamine due to foreign particles.
D) Diapedesis in order to pass through the endothelial lining of vessels.
E) Identifying pathogens

Answer 34

Correct answer
C) Degranulation in order to release histamine due to foreign particles.
Feedback
Explanation:
6 steps for neutrophils:
1 - Identify threat
2 - Activation
3 - Adhesion
4 - Migration/chemotaxis(diapedesis occurs here)
5 - Phagocytosis
6 - Bacterial killing (through lysosomes)
Degranulation of mast cells is what releases histamines and this is in response to allergens and causes a hypersensitivity reaction.

Question 35

Rahul is a 45 year old man going for his weekly mountain hike and has decided to switch it up a bit go for Everest (he has family in Nepal). He gets too cocky and goes past the 3000m mark, and soon begins to suffer strong physiological changes. He becomes hypoxic, and as a result begins to hyperventilate. Which of the following set of changes is correct?
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A) ↑ PaCO2, ↑ minute ventilation, ↑ heart rate, ↑ blood pH
B) ↓PaCO2, ↑ minute ventilation, ↓ heart rate, ↑ blood pH
C) ↑ PaCO2, ↓ minute ventilation, ↓ heart rate, ↓ blood pH
D) ↓ PaCO2, ↑ minute ventilation, ↑ heart rate, ↑ blood pH
E) ↓ PaCO2, ↓ minute ventilation, ↓ heart rate, ↓blood pH
Correct answer
D) ↓ PaCO2, ↑ minute ventilation, ↑ heart rate, ↑ blood pH

Answer 35

Feedback
Explanation:
D is correct because:
- The hyperventilation would increase the minute ventilation (which is the amount of air entering the lungs per minute)
- The PaCO2 would decrease as the ventilation increases
- The heart rate would increase in order to counteract the reduced PaCO2
- The blood pH would increase as the PaCO2 decreases
(If that doesn’t make sense look at the bicarbonate buffer equation)

What are type I and II pneumocytes?

Question 36

what is the alveolar gas equation?

Answer 36

PAO2 = PiO2 - PaCO2/R

Question 37

Which of the following statements best describes slowly adapting stretch receptors (SASR’s)?
1/1
A) They are found between airway epithelial cells and respond to irritants. They have myelinated nerve fibres and upon activation, they stimulate bronchoconstriction.
B) They are found in airway smooth muscle and respond to lung distension. Activation ends inspiration and starts expiration.
C) They are found in capillary walls and respond to an increase in lung pressure because of fluid (embolisms, etc.) Activation leads to rapid shallow breathing and bronchoconstriction.
D) They are found in the medulla and respond to small increases in PaCO2. Activation leads to an increased respiratory rate.
E) They are found very near to the carotid sinus and in the arch of the aorta and respond to decreases in PaO2 and increases in H+. Activation stimulates the medullary inspiratory neurones and leads to an increased respiratory rate.

Answer 37

Feedback
Explanation:
A - RASR
B - SASR
C - J Receptor
D - Central chemoreceptor
E - Peripheral chemoreceptor

Question 38

What is the definition of vital capacity (VC)?
IRV = Inspiratory Reserve volume
TV = Tidal volume
ERV = Expiratory reserve volume
RV = Residual volume
IC = Inspiratory capacity
1/1
A) ERV + IC + RV
B) ERV + RV
C) IRV + TV
D) IRV + TV + ERV
E) IRV + TV + ERV + RV

Answer 38

Feedback
Explanation:
Vital capacity is the volume that can be exhaled after maximum inspiration - therefore the tidal volume (volume that enters and leaves with each breath) + the inspiratory reserve volume (extra volume that can be inspired above tidal volume) + the expiratory reserve (extra volume that can be expired below tidal volume).
IRV + TV = Inspiratory capacity
ERV + RV = Functional Residual capacity
IRV + TV + ERV + RV = Total lung capacity
ERV + IC + RV = Total lung capacity

Question 39

Joe is a 50 year old man who has just returned to Blackburn after living in Thailand for a year. Over the next few days he notices that he’s finding it more difficult to breathe, and that when he does he feels a sharp pain. He goes to his GP who diagnoses him with a pulmonary embolism. What is the main kind of hypoxia that a pulmonary embolism would cause?
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A) Diffusion impairment
B) Hypoventilation
C) Low-inspired oxygen partial pressure
D) Shunting
E) V/Q mismatch

Answer 39

Correct answer
E) V/Q mismatch

A - This results from the thickening of alveolar membranes or a decrease in their surface area. It causes the partial O2 and alveolar blood pressure to fail to equilibrate.
B - This is due to a failure to ventilate the alveoli adequately, which would not be caused by a PE (PE alters perfusion)
C - This is just low oxygen pressure which can be due to altitude, breathing inadequately re-oxygenated recycled breathing gas from a life support system etc.
D - This is where either venous blood passes from the right side of the heart to the left e.g. due to ventricular septal defect or an intrapulmonary defect means that mixed venous blood perfuses unventilated alveoli. Because PE alters perfusion rather than ventilation, it does not create an intrapulmonary shunt.
E - This would cause a V/Q mismatch (specifically there would be dead space - shunting is also a V/Q mismatch but is where there is a low V/Q ratio) as the PE stops blood flow to a well-perfused area

Question 40

Bailey is a 70 year old smoker from Barnsley who has come into A&E with some severe shaking and drowsiness. It’s discovered that he has hyperinflated lungs, and while his PaO2 is low, his PaCO2 is high. Which type of resp failure does he have, and which condition is most likely to be the cause?
1/1
A) Type 1 resp failure - COPD
B) Type 1 resp failure - Pulmonary oedema
C) Type 2 resp failure - COPD

D) Type 2 resp failure - Pulmonary embolism
E) Type 2 resp failure - Tuberculosis

Answer 40

Feedback
Hyperinflated lungs means that your lungs are larger than normal due to trapped air. It happens when you can’t exhale properly and leads to serious hypoventilation.
COPD can cause either type 1 or 2 resp failure. It is also, however, a common cause of hyperinflated lungs and therefore in this case it has led to hypoventilation which causes type 2 respiratory failure.
A - In this case it is type 2 resp failure.
B - It is type 2 resp failure.
C - Type 2 resp failure is commonly caused by COPD and the hyperinflation means it is the most likely option out of those available.
D - PE typically causes type 1 resp failure.
E - TB does not commonly cause resp failure.

Question 41

Shunts are essential for foetal development, and the absence of shunts can be fatal. Which of these parts of the foetal circulatory system helps blood to bypass the liver?
0/1
A) Ductus arteriosus

B) Ductus venosus
C) Foramen ovale
D) Umbilical arteries
E) Umbilical vein

Answer 41

Correct answer
B) Ductus venosus
Feedback Explanation:
A - The ductus arteriosus allows blood to travel from the right atrium to the aorta.
B - The ductus venosus is what allows blood to bypass the liver and go to the inferior vena cava
C - The foramen ovale allows blood to be shunted from the right atrium to the left, bypassing pulmonary circulation.
D - The umbilical arteries allow deoxygenated blood to return to the placenta.
E - The umbilical vein allows oxygenated blood from the placenta to enter the foetus

Question 42

Excitation-contraction coupling is the process whereby an action potential stimulates skeletal muscle fibre contraction. In order for the muscle fibre to contract, myosin filaments need to slide past each other. These filaments bind to actin, but first another protein to reveal an actin binding site. What is this molecule called?
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A) ATP
B) Tropomyosin
C) Troponin C
D) Troponin I
E) Troponin T

Answer 42

Correct answer
C) Troponin C
Feedback
A - This attaches to myosin to allow it to detach from actin
B - This is what blocks myosin binding sites on actin molecules, preventing cross-bridge formation
C - Troponin C is what causes the tropomyosin to move and reveals a binding site on actin for myosin to form a cross-bridge with.
D - Troponin I binds to actin to hold the actin-tropomyosin complex in place. Together with tropomyosin, it Inhibits (troponin I) actin and myosin binding.
E - Troponin T binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex.

Question 43

In 10% of the population, an anatomical variance in the heart known as left dominance occurs. Here, the circumflex branches into an artery instead of the right coronary artery. What is the name of this branch?
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A) Left anterior descending artery
B) Left marginal artery
C) Posterior interventricular artery
D) Right marginal artery
E) Diagonal artery

Answer 43

Correct answer
C) Posterior interventricular artery
Feedback
Explanation:
A - LAD branches from the left coronary artery (LCA)
B - The left marginal branches from the circumflex but is not the variant which is only present in 10% of the population.
C - The PIV is supplied solely by the circumflex in only 10% of the population. It is supplied by the RCA in 70% of the population and supplied by an anastomosis of the left and right coronary arteries in 20% (co-dominance)
D - The right marginal is a branch of the right coronary artery
E - The septal arteries branch from the left anterior descending (the diagonals also branch from the LAD)

Question 44

When someone starts to bleed, a platelet plug begins to form. This is due to the coagulation cascade, where a series of factors combine and catalyse to eventually form a stable fibrin clot. One of these coagulation factors is thrombin. Which of the following processes shows the formation of thrombin in the cascade?
0/1
A) IIa catalyses I → Ia
B) VIIa + IIIa catalyse X → Xa

C) VIIIa + IXa catalyse X → Xa
D) Xa + Va catalyse II → IIa
E) XIIa catalyses XI → XIa
Correct answer
D) Xa + Va catalyse II → IIa
Feedback
IIa is thrombin, and therefore the answer has to be D
There’s a link to a useful infographic attached to learn the coagulation cascade (though use whatever you find most useful)

Answer 44

Correct answer
D) Xa + Va catalyse II → IIa
Feedback
IIa is thrombin, and therefore the answer has to be D
There’s a link to a useful infographic attached to learn the coagulation cascade (though use whatever you find most useful)https://www.osmosis.org/answers/coagulation-cascade

Question 45

Haematopoietic stem cells (HSCs) are responsible for all of the blood cells in the body and reside in the bone marrow. Which of the following best describes the development of basophils?
1/1
A) HSC → Common lymphoid progenitor → Basophil
B) HSC → Common myeloid progenitor → Mast cell → Basophil
C) HSC → Common myeloid progenitor → Monocyte → Basophil
D) HSC → Common myeloid progenitor → Myeloblast → Basophil
E) HSC → Common lymphoid progenitor → Natural Killer Cell → Basophil

Answer 45

D
Feedback
Explanation:
Common myeloid progenitors are the origin for lots of cells, among which are myeloblasts, which develop into myeloid leukocytes.
These include: eosinophils, basophils, neutrophils and monocytes.
The common lymphoid progenitors also give rise to lots of cells, including T cells, B cells and natural killer cells.

Question 46

What is a QT interval, and what are the normal values for a man?
1/1
A) It’s a measure of time for ventricular depolarization. It usually lasts less than 120ms.
B) It’s a measure of time for the interval between ventricular depolarization and repolarization. It lasts for between 80-100ms.
C) It’s a measure of time from atrial depolarization until ventricular depolarization and usually lasts between 120-200ms.
D) It’s a measure of time from ventricular depolarization to ventricular repolarization. It usually lasts between 350-440ms for men.
E) It’s a measure of the repolarization of ventricles. It usually lasts around 150ms.

Answer 46

Feedback
Explanation:
A - This time is for the QRS complex
B - This time is for the P wave
C - This time is for the PR interval
D - This time is for the QT interval
E - The QT interval is the measurement of the time from ventricular depolarization till repolarization - not repolarization.

Question 47

Joe, a 7 year old male, comes into clinic with unexplained muscle pain and weakness. He presents with signs of scurvy - a vitamin C deficiency disease. Fe(III) is converted to Fe(II) by vitamin C and is crucial in the hydroxylation step of collagen synthesis in muscles. What is the molecule that forms hydrogen bonds within tropocollagen?
1/1
A) Proline
B) Ramipril
C) Osteons
D) Hydroxyproline
E) Hydroxylysine

Answer 47

Feedback
D) hydroxyproline
Proline is a protein which is converted to hydroxyproline and this process requires Fe(II) and vitamin C as a co-factor. It forms hydrogen bonds within tropocollagen as it is a major player in type I collagen. Hydroxylysine is another molecule involved in this process but it is broken down by lysyl oxidase with copper as a co-factor to form covalent crosslinks in tropocollagen. Osteons are a component of mature bone and ramipril is an ACE inhibitor drug used as a first line treatment for hypertension.

Question 48

A histopathologist has taken a biopsy of the biceps brachii from world class badminton player, Srinath, and wanted to have a look at the variety of muscle fibres. Which muscle fibre type is fatigable, has high glycogen content and synthesises ATP anaerobically?
0/1
A) Slow oxidative
B) Fast oxidative
C) Fast oxyhaemodynamic
D) Slow glycolytic
E) Fast glycolytic

Answer 48

Correct answer
E) Fast glycolytic
Feedback
Fast oxyhaemodynamic and slow glycolytic are not real muscle fibre types

Question 49

Serum phosphate is regulated in the kidney as some is reabsorbed and excess is excreted. However, sometimes kidney dysfunction can lead to pathology. Which one of the following is not a consequence of phosphate imbalance?
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A) Excessive formation of hydroxyapatite
B) Artery calcification
C) Lack of hydroxyapatite in bones
D) Deposition of phosphates in bones
E) Tumoral calcinosis

Answer 49

Correct answer
D) Deposition of phosphates in bones
Feedback
Deposition of phosphate in bones is normal as it is necessary in the formation of hydroxyapatite. Calcification is the process where calcium phosphate is deposited in tissues where there is not meant to be any deposition

Question 50

Srinath the world’s best badminton player goes to his physiotherapist with pain in what he thinks is his ligaments. However, the physiotherapist says the pain is more likely to come from tendons and she tries to explain to Srinath why this is. Which one of these is not a property of tendons?
0/1
A) High collagen I content
B) Connects muscle to bone
C) High elastin content
D) Highly organised fibres
E) Can be either vascular or avascular

Answer 50

Correct answer
C) High elastin content
Feedback
Tendons have very little elastin as they have high tensile strength in order to move the bones in coordination with muscle contraction and relaxation.

Question 51

Luis, a high level government spy, has been sacked because of irreversible nerve damage leading to the clinical sign of ‘wrist drop’. Which muscles are most likely to have lost their innervation and which nerve supplies the innervation?
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A) Extensor muscles supplied by ulnar nerve
B) Flexor muscles supplied by ulnar nerve
C) Extensor muscles supplied by radial nerve
D) Extensor muscles supplied by median nerve
E) Flexor muscles supplied by axillary nerve

Answer 51

Correct answer
C) Extensor muscles supplied by radial nerve
Feedback
The extensor muscles contract to help the wrist resist gravity and these are supplied only by the radial nerve. The ulnar nerve innervates muscles controlling the lateral 2 fingers and the median nerve innervates the thenar muscles. The axillary nerve does not innervate any muscles in the forearm as it innervates the deltoid muscle.

Question 52

A 20 year old medical student, Tom, hasn’t shown up to any of his lectures but it turns out he has had surgery but developed acute kidney injury in recovery. As a normal physiological response his body tries to increase his blood pressure. Which hormone does this and where does this hormone act to increase water?
0/1
A) Aldosterone in the collecting duct
B) Aldosterone in the proximal convoluted tubule
C) ADH in the collecting duct
D) ADH in the proximal convoluted tubule
E) Vasopressin in the Loop of Henle

Answer 52

Correct answer
C) ADH in the collecting duct
Feedback
Aldosterone increases sodium reabsorption and potassium excretion by increasing permeability of Na+/K+ channels and stimulates ADH secretion from the posterior pituitary
Vasopressin and ADH are the same and work by increasing transcription of Aquaporin-2 channels on the apical membrane of distal convoluted tubules and collecting ducts.

Question 53

Luis, a retired government spy, has undergone a right nephrectomy. The surgeons divided the renal artery. At what level does the right renal artery branch off the abdominal aorta?
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A) T9
B) T10
C) L2
D) L3
E) L4

Answer 53

Correct answer
C) L2
Feedback
Learn about the different branches off the aorta. There are a few useful diagrams online for this explaining the positions of important organs and vessels.

Question 54

Arun, a 14 year old boy, comes into clinic with his mum as she is concerned with his short height and is getting bullied at school because of this. What can be said about the release pattern of the hormone he is most likely to be deficient in?
1/1
A) Secreted throughout the day
B) Only released at night
C) Released diurnally
D) Released in a pulsatile manner

E) Released in a single spike in the morning

Answer 54

D
Feedback
Arun’s presentation is indicative of growth hormone deficiency. This can result in short stature, forehead prominence and maxillary hypoplasia. The release of growth hormone is controlled by growth hormone releasing hormone, which is released by the hypothalamus in a pulsatile manner. For this reason, measurements of GHRH are not useful in investigating growth hormone deficiency.

Question 55

Which part of the adrenal gland is cortisol produced in?question
0/1
A) Zona fasciculata
B) Medulla
C) Zona reticularis
D) Zona glomerulosa
E) Adrenal cortex

Answer 55

Correct answer
A) Zona fasciculata
Feedback
The adrenal cortex is split up into three layers:
Zona glomerulosa (mineralocorticoid e.g. aldosterone)
Zona fasciculata (glucocorticoid e.g. cortisol)
Zona reticularis (androgens e.g. testosterone precursor)

Question 56

Sagar is about to have surgery on his leg because of a nasty rugby tackle. During the operation which one of the following hormones will inhibit the release of insulin?
1/1
A) Arginine
B) Adrenaline
C) Gastrin
D) Glucagon
E) Vagal cholinergic activity

Answer 56

Feedback
Surgery has a huge physiological impact on the body and so glucagon release increases to make as much glucose free in the blood and so insulin decreases as a result of adrenaline release. 3 factors inhibit insulin release: alpha-adrenergic drugs, beta-blockers, sympathetic stimulation.