Phase 3B 2013

Question 1

List the potential causes of confusion in patients with myeloma

Answer 1

Hypercalcaemia of malignancy
Tumour lysis syndrome
Hyperviscosity syndrome

Question 2

How do you investigate for bone mets in myeloma and why would you choose that means of imaging

Answer 2

Full skeletal survey

Technician measures osteoblastic activity and this is inhibited by IL-6 which is secreted by plasma cells

Question 3

Name 4 classic features of plaque psoriatic arthritis

Answer 3

Well demarcated 
Silver scales 
Symmetrical 
Areas of hyper proliferation 
Auspitz sign

Question 4

Out line the mechanism of action of NSAIDs

Answer 4

Inhibit the action of cyclooxyrgenase enzymes. These enzymes are involved in the synthesis of key biological mediators
Prostaglandins ( involved in inflammation)
Thromboxanes (involved in blood clotting)

Question 5

Outline the mechanism of steroids both intranuclealy and in the cytoplasm

Answer 5

Nucleas: Lipid soluble molecules pass through the cell membrane, bind to the nuclear receptors in the cytoplasm, translocation to nuclear bins to nuclear DNA leading to an increase in transcription of the relevant gene products

Cytoplasm:
Bind to the steroid receptors in the cytoplasm that regulate vital cell activities

Question 6

Side effects of methotrexate

Answer 6

Pulmonary fibrosis
Bone marrow suppression
Anaemia
Teratogenic

Question 7

Features of hypokalaemia

Answer 7

Flat or inverted T waves
Pathological U waves
Long OT waves
Depressed ST waves

Question 8

Were does spironolactone act and in what why

Answer 8

Collecting tubules
NA2+/K+ pump, exchanges sodium for potassium
Retains sodium and excrets potassium
Upregulated epithelial sodium channels increasing apical membrane permeability for sodium.

Question 9

Intracerebal causes of confusion in the elderly

Answer 9

Cerebral oedema 
Space occupying lesion 
Hydrocephalus 
Encephalitis 
Meningitis

Question 10

First line treatment for delirium terminus

Answer 10

Lorazapam

Question 11

Common causing organism of infective execrations in COPD

Answer 11

Haemophilis influenza (Gram -ve bacilli with fastidious growth requirements)
Streptococcus pneumoniae  (Gram +ve cocci, alpha haemolytic)

Question 12

Outline the ways in which you can assess COPD severity

Answer 12

Spirometry with bronchodilators
Trial of oral steroids
CXR look for any other pathology

Question 13

6 signs associated with hypothyroidism

Answer 13

Bradycardia 
Reflexes relax slowly 
Ataxia (cerebellar)
Dry thin hair 
Yawning, drowsy coma
Cold peripheries
Ascites
Non pitting oedema 
Pericardial or pleural effusion 
Round puffy face
Immobile 
Congestive cardiac failure

Question 14

Outline the target tissues for T4 and the effect it has there

Answer 14

Cell nuclei have a high affinity for T3(TRalpha1 in muscle and fat, alpha2 in brain and also in liver and kidneys

Metabolism of all substrates vitamins and mineral

Modulations of all other hormones and the target tissue response

Stimulation of )2 consumption and generation of metabolic heat

Regulation of protein synthesis, carb and lipid metabolism

Stimulation of demand for co-enzymes and related vitamins

Question 15

How does hypothyroidism result in a goitre

Answer 15

Thyroid stimulating hormone (TSH),this hormone stimulates the thyroid to produce thyroid hormone and to grow in size. This abnormal growth in size produces what is termed a “goiter.”
Is it hyperplasia or hypertrophy

Question 16

Why might levathyroxine not be working to full effect

Answer 16

Malabsorption
Non compliance
Pernicious anaemia (Polyglandular syndrome 1)
Dose titration
Medication interfering (ferrous sulphate, calcium, rifampicin, amiodarone)

Question 17

Risk factors for osteoporosis

Answer 17

Steroids 
Hyperparathyroidism 
Alcohol 
Testosterone low 
Thin 
Erosive bone disease (Ra/myeloma)
Renal/liver disease 
Early menopause
Dietary calcium low/malabsorption

Question 18

Outline the UMN and LMN signs associated with MND

Answer 18

UMN
-	Spasticity 
-	Increase reflexes 
-	Upgoing plantars 
LMN
-	Wasting 
-	Fasciculations

Question 19

Symptoms of bulbar or pseudo bulbar palsy

Answer 19

Dysphagia 
Labile mood 
Nasal regurgitation 
Weak, wasted and fasiculating tongue 
Loss of gag reflex 
Jaw jerk affected

Question 20

Define sensitivity

Answer 20

The proportion of people with the disease who are correctly identified as having the disease
True +ve/ True +ve + false -ve

Question 21

Define specificity

Answer 21

Proportion of people without the disease who are correctly identified as not having the disease.
True -ve/ false +ve + true negative

Question 22

Define PPV

Answer 22

Proportion of people with a +ve that truly have the disease

True +VE/ (true +ve + false +ve)

Question 23

histological features of Crohn’s

Answer 23

Skip lesions 
Transmural inflammation 
Granulomas 
Cobblestone mucose 
Marked fibrosis 
Fistulae

Question 24

What drugs is used to induce remission in Crohn’s

Answer 24

Corticosteroid

Question 25

Pathological change seen on the basement membrane in the kidney in nephrotic syndrome

Answer 25

Advanced glycosylation end products – inflammatory response
Deposition of type IV collagen and mesangial expansion
Arterial hyalinization
Thickening of the basement membrane, glomerulosclerosis

Question 26

Management of nephrotic syndrome

Answer 26

Dietary salt and water restriction 
Loop diuretics are often used in large doses 
Daily weights 
ACEi to reduce proteinuria 
Statin