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Medex Surgery MCQ > Physiology > Flashcards

Physiology Flashcards

1
Q

A 23 year old is stabbed in the groin and develops hypovolaemic shock. What is the most likely finding on analysis of his urine?

A. Decreased specific gravity
B. Increased specific gravity
C. Increased urinary glucose
D. Increased urinary protein
E. Increased red blood cells in the urine

A

B. Increased specific gravity

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2
Q

There is decreased secretion of which one of the following hormones in response to major surgery:

A. Insulin
B. Cortisol
C. Renin
D. Anti diuretic hormone
E. Prolactin

A

A. Insulin

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3
Q

Which of the following statements related to the coagulation cascade is true?

A. The intrinsic pathway is the main pathway in coagulation
B. Heparin inhibits the activation of Factor 8
C. The activation of factor 8 is the point when the intrinsic and the extrinsic pathways meet
D. Tissue factor released by damaged tissue initiates the extrinsic pathway
E. Thrombin converts plasminogen to plasmin

A

D. Tissue factor released by damaged tissue initiates the extrinsic pathway

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4
Q

Which of the following is not secreted by the parietal cells?

A. Hydrochloric acid
B. Mucus
C. Magnesium
D. Intrinsic factor
E. Calcium

A

B. Mucus

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5
Q

A 45 year old male is diagnosed with carcinoma of the head of the pancreas. He reports that his stool sticks to the commode and will not flush away. Loss of which of the following enzymes is most likely to be responsible for this problem?

A. Lipase
B. Amylase
C. Trypsin
D. Elastase
E. None of the above

A

A. Lipase

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6
Q

A 34 year old man receives morphine following an appendicectomy. He develops constipation as a result. Which of the following best accounts for this process?

A. Stimulation of DOPA receptors
B. Inhibition of DOPA receptors
C. Stimulation of μ receptors
D. Stimulation of serotonin release
E. Inhibition of serotonin release

A

C. Stimulation of μ receptors

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7
Q

Which of the following is not well absorbed following a gastrectomy?

A. Vitamin c
B. Zinc
C. Vitamin B12
D. Copper
E. Molybdenum

A

C. Vitamin B12

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8
Q

Which vitamin is involved in the formation of collagen?

A. Vitamin A
B. Vitamin B
C. Vitamin C
D. Vitamin D
E. Vitamin E

A

C. Vitamin C

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9
Q

A 56 year old man has long standing chronic pancreatitis and develops pancreatic insufficiency. Which of the following will be absorbed normally?

A. Fat
B. Protein
C. Folic acid
D. Vitamin B12
E. None of the above

A

C. Folic acid

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10
Q

A 56 year old male presents to the acute surgical take with severe abdominal pain. He is normally fit and well. He has no malignancy. The biochemistry laboratory contacts the ward urgently, his corrected calcium result is 3.6 mmol/l. What is the medication of choice to treat this abnormality?

A. IV Pamidronate
B. Oral Alendronate
C. Dexamethasone
D. Calcitonin
E. IV Zoledronate

A

A. IV Pamidronate

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11
Q

An over enthusiastic medical student decides to ask you questions about ECGs. Rather than admitting your dwindling knowledge on this topic, you bravely attempt to answer her questions! One question is what segment of the ECG represents ventricular repolarization?

A. QRS complex
B. Q-T interval
C. P wave
D. T wave
E. S-T segment

A

D. T wave

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12
Q

The oxygen-haemoglobin dissociation curve is shifted to the right in which of the following scenarios?

A. Hypothermia
B. Respiratory alkalosis
C. Low altitude
D. Decreased 2,3-DPG in transfused red cells
E. Chronic iron deficiency anaemia

A

E. Chronic iron deficiency anaemia

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13
Q

A 73 year old lady is admitted for a laparoscopic cholecystectomy. During her pre-operative assessment it is noted that she is receiving furosemide for the treatment of hypertension. Where is the site of action of this diuretic?

A. Proximal convoluted tubule
B. Descending limb of the loop of Henle
C. Ascending limb of the loop of Henle
D. Distal convoluted tubule
E. Collecting ducts

A

C. Ascending limb of the loop of Henle

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14
Q

Which of the following physiological changes do not occur following tracheostomy?

A. Alveolar ventilation is increased.
B. Anatomical dead space is reduced by 50%.
C. Work of breathing is increased.
D. Proportion of ciliated epithelial cells in the trachea may decrease. E. Splinting of the larynx may lead to swallowing difficulties.

A

C. Work of breathing is increased.

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15
Q

A 43 year old lady is recovering on the intensive care unit following a Whipples procedure. She has a central venous line in situ. Which of the following will lead to the “y” descent on the waveform trace?

A. Ventricular contraction
B. Emptying of the right atrium
C. Emptying of the right ventricle
D. Opening of the pulmonary valve
E. Cardiac tamponade

A

B. Emptying of the right atrium

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16
Q

Which of the following are not characteristic features of central chemoreceptors in the control of ventilation?

A. They are located in the medulla oblongata
B. They are stimulated primarily by venous hypercapnia
C. They are relatively insensitive to hypoxia
D. They are less sensitive to changes in arterial pH than other ventillatory receptors
E. During acute hypercapnia the carotid receptors will be stimulated first

A

B. They are stimulated primarily by venous hypercapnia

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17
Q

A 32 year old man has a glomerular filtration rate of 110ml / minute at a systolic blood pressure of 120/80. If his blood pressure were to fall to 100/70 what would glomerular filtration rate be?

A. 110ml / minute
B. 100ml/ minute
C. 55ml/ minute
D. 25ml/ minute
E. 75ml/ minute

A

A. 110ml / minute

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18
Q

Which of the following does not stimulate insulin release?
A. Gastrin
B. Atenolol
C. Protein
D. Secretin
E. Vagal cholinergic action

A

B. Atenolol

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19
Q

A 63 year old female is referred to the surgical clinic with an iron deficiency anaemia. Her past medical history includes a left hemi colectomy but no other co-morbidities. At what site is most dietary iron absorbed?

A. Stomach
B. Duodenum
C. Proximal ileum D. Distal ileum
E. Colon

A

B. Duodenum

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20
Q

Which of the following drugs increases the rate of gastric emptying in the vagotomised stomach?

A. Ondansetron
B. Metoclopramide
C. Cyclizine
D. Erythromycin
E. Chloramphenicol

A

D. Erythromycin

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21
Q

Which of the following haemodynamic changes is not seen in hypovolaemic shock?

A. Decreased cardiac output
B. Increased heart rate
C. Reduced left ventricle filling pressures
D. Reduced blood pressure
E. Reduced systemic vascular resistance

A

E. Reduced systemic vascular resistance

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22
Q

An otherwise fit 30 year old male donates 500ml of blood. Which of the processes outlined
below is most likely to occur?

A. Reduction of urine output
B. Activation of the renin angiotensin system
C. Sweating
D. Fall in mean arterial pressure
E. Tachypnoea

A

B. Activation of the renin angiotensin system

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23
Q

A 25 year old man is undergoing respiratory spirometry. He takes a maximal inspiration and maximally exhales. Which of the following measurements will best illustrate this process?

A. Functional residual capacity
B. Vital capacity
C. Inspiratory capacity
D. Maximum voluntary ventilation
E. Tidal volume

A

B. Vital capacity

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24
Q

Which of the following does not decrease the functional residual capacity?

A. Obesity
B. Pulmonary fibrosis
C. Muscle relaxants
D. Laparoscopic surgery
E. Upright position

A

E. Upright position

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25
Q

What causes increased functional residual capacity (FRC)?

A

+ Erect position
+ Emphysema
+ Asthma

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26
Q

What causes decreased functional residual capacity (FRC)?

A

+ Pulmonary fibrosis
+ Laparoscopic surgery
+ Obesity
+ Abdominal swelling
+ Muscle relaxants

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27
Q

Which of the following is the main site of dehydroepiandrosterone release?

A. Posterior pituitary
B. Zona reticularis of the adrenal gland
C. Zona glomerulosa of the adrenal gland
D. Juxtaglomerular apparatus of the kidney
E. Zona fasciculata of the adrenal gland

A

B. Zona reticularis of the adrenal gland

Adrenal cortex (mnemonic GFR - ACD)

  • Zona glomerulosa (on outside): mineralocorticoids, mainly aldosterone
  • Zona fasciculata (middle): glucocorticoids, mainly cortisol
  • Zona reticularis (on inside): androgens, mainly dehydroepiandrosterone (DHEA)
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28
Q

What are the factors stimulating renin secretions? (5 marks)

A
  • Low BP
  • Hyponatraemia
  • Sympathetic nerve stimulation
  • Catecholamines
  • Erect posture
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29
Q

Secretions from which of the following will contain the highest levels of potassium?

A. Rectum
B. Small bowel
C. Gallbladder
D. Pancreas
E. Stomach

A

A. Rectum

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30
Q

What is the typical stroke volume in a resting 70 Kg man?

A. 10ml
B. 150ml
C. 125ml
D. 45ml
E. 70ml

A

E. 70ml

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31
Q

A patient loses 1.6L fresh blood from their abdominal drain. Which of the following will not decrease?

A. Cardiac output
B. Renin secretion
C. Firing of carotid baroreceptors
D. Firing of aortic baroreceptors
E. Blood pressure

A

B. Renin secretion

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32
Q

Release of vasopressin from the pituitary will result in which of the following?

A. Vasoconstriction of the afferent glomerular arteriole
B. Increased permeability of the mesangial cells to glucose
C. Reduced permeability of the inner medullary portion of the collecting duct to urea
D. Increased secretion of aldosterone from the macula densa
E. Increased water permeability of the distal tubule cells of the kidney

A

E. Increased water permeability of the distal tubule cells of the kidney

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33
Q

Which of the following hormones is mainly responsible for sodium - potassium exchange in the salivary ducts?

A. Vasopressin
B. Angiotensin I
C. Aldosterone
D. Somatostatin
E. Cholecystokinin

A

C. Aldosterone

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34
Q

In a 70 Kg male, what proportion of total body fluid will be contributed by plasma?

A. 50%
B. 5%
C. 35%
D. 65%
E. 25%

A

B. 5%

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35
Q

A 23 year old man is undergoing an inguinal hernia repair under local anaesthesia. The surgeon encounters a bleeding site which he manages with diathermy. About a minute or so later the patient complains that he is able to feel the burning pain of the heat at the operative site. Which of the following nerve fibres is responsible for the transmission of this signal?

A. A α fibres
B. A β fibres
C. B fibres
D. C fibres
E. None of the above

A

D. C fibres

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36
Q

What is the approximate volume of pancreatic secretions in a 24 hour period?

A. 100ml
B. 200ml
C. 500ml
D. 1500ml
E. 3000ml

A

D. 1500ml

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37
Q

A 34 year old lady has just undergone a parathyroidectomy for primary hyperparathyroidism. The operation is difficult and all 4 glands were explored. The wound was clean and dry at the conclusion of the procedure and a suction drain inserted. On the ward she becomes irritable and develops respiratory stridor. On examination her neck is soft and the drain empty. Which of the following treatments should be tried initially?

A. Administration of intravenous calcium gluconate
B. Administration of intravenous lorazepam
C. Removal of the skin closure on the ward
D. Direct laryngoscopy
E. Administration of calcichew D3 orally

A

A. Administration of intravenous calcium gluconate

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38
Q

Acute respiratory acidosis:

A. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol
B. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5, Base
excess +1.8 mmol
C. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol, Base excess -10.6
D. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base excess 5.3
E. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base excess -7.9

A

A. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol

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39
Q

Metabolic acidosis with a compensatory respiratory alkalosis:

A. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol
B. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5, Base
excess +1.8 mmol
C. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol, Base excess -10.6
D. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base excess 5.3
E. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base excess -7.9

A

E. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base excess -7.9

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40
Q

Chronic respiratory acidosis with a compensatory metabolic alkalosis:

A. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol
B. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5, Base
excess +1.8 mmol
C. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol, Base excess -10.6
D. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base excess 5.3
E. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base excess -7.9

A

D. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base excess 5.3

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41
Q

A 23 year old man presents with blunt abdominal trauma and a splenic bleed is suspected. He is commenced on an infusion of tranexamic acid. Which of the following best describes its mechanism of action?

A. Inhibition of plasmin
B. Inhibition of thrombin C. Inhibition of factor II
D. Inhibition of factor Xa
E. Activation of factor VIII

A

A. Inhibition of plasmin

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42
Q

A 34 year old male donates a unit of blood. It is stored at 4 C. After 72 hours which of the following
clotting factors will be most affected?

A. Factor V
B. Factor II
C. Factor VII
D. Factor IX
E. Factor XI

A

A. Factor V

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43
Q

Cortisol is predominantly produced by which of the following?

A. Zona fasciculata of the adrenal
B. Zona glomerulosa of the adrenal
C. Zona reticularis of the adrenal
D. Adrenal medulla
E. Posterior lobe of the pituitary

A

A. Zona fasciculata of the adrenal

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44
Q

Which of the following is not an intravenous colloid?

A. Gelofusine
B. Dextran 40
C. Human albumin solution
D. Hydroxyethyl starch
E. Bicarbonate 8.4%

A

E. Bicarbonate 8.4%

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45
Q

A 73 year old man presents to pre operative clinic for an elective total hip replacement. He is on frusemide for hypertension. He is found to have the following blood results:
Na 120
Urine Na 10 (low)
Serum osmolality 280 (normal)

Please select the most likely reason for hyponatraemia:

A. Hypotonic hypovolaemic hyponatraemia
B. Hypotonic hypervolaemic hyponatraemia
C. Pseudohyponatraemia
D. Syndrome of inappropriate ADH secretion (SIADH)
E. Hypertonic hyponatraemia
F. Over administration 5% dextrose

A

A. Hypotonic hypovolaemic hyponatraemia

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46
Q

A 67 year old man presents to pre operative clinic for an elective hernia repair. He is on frusemide for heart failure. He is found to have the following blood results:
Na 120
Urine Na 35 (high)
Urine osmolality 520 (high) Serum osmolality 265 (low)

Please select the most likely reason for hyponatraemia:

A. Hypotonic hypovolaemic hyponatraemia
B. Hypotonic hypervolaemic hyponatraemia
C. Pseudohyponatraemia
D. Syndrome of inappropriate ADH secretion (SIADH)
E. Hypertonic hyponatraemia
F. Over administration 5% dextrose

A

D. Syndrome of inappropriate ADH secretion (SIADH)

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47
Q

A 77 year old man presents to pre operative clinic for a total knee replacement. He is on frusemide for hypertension. He is known to have multiple myeloma. He is found to have the following blood results:
Na 120
Serum osmolality 280 (normal)
Urine osmolallity normal Urine Na normal

Please select the most likely reason for hyponatraemia:

A. Hypotonic hypovolaemic hyponatraemia
B. Hypotonic hypervolaemic hyponatraemia
C. Pseudohyponatraemia
D. Syndrome of inappropriate ADH secretion (SIADH)
E. Hypertonic hyponatraemia
F. Over administration 5% dextrose

A

C. Pseudohyponatraemia

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48
Q

A 25 year old man undergoes an appendicetomy for appendicitis. The appendix is submitted for histopathological evaluation. Which of the following is most likely to be identified microscopically?

A. Macrophages
B. Neutrophils
C. Fibroblasts
D. Lymphocytes
E. Stem cells

A

B. Neutrophils

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49
Q

A 53 year old man is on the intensive care unit following an emergency abdominal aortic aneurysm repair. He develops abdominal pain and diarrhoea and is profoundly unwell. His abdomen has no features of peritonism. Which of the following arterial blood gas pictures is most likely to be present?

A. pH 7.45, pO2 10.1, pCO2 3.2,Base excess 0,Lactate 0
B. pH 7.35, pO2 8.0, pCO2 5.2,Base excess 2,Lactate 1
C. pH 7.20, pO2 9.0, pCO2 3.5,Base excess -10,Lactate 8
D. pH 7.29, pO2 8.9, pCO2 5.9, Base excess -4, Lactate 3
E. pH 7.30, pO2 9.2 pCO2 4.8, Base excess -2, lactate 1

A

C. pH 7.20, pO2 9.0, pCO2 3.5,Base excess -10,Lactate 8

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50
Q

A 48 year old women suffers blunt trauma to the head and develops respiratory compromise. As a result she develops hypercapnia. Which of the following effects is most likely to ensue?

A. Cerebral vasoconstriction
B. Cerebral vasodilation
C. Cerebral blood flow will remain unchanged
D. Shunting of blood to peripheral tissues will occur in preference to CNS perfusion
E. None of the above

A

B. Cerebral vasodilation

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51
Q

A patient is seen in clinic complaining of abdominal pain. Routine bloods show:
Na+ 142 mmol/l K+ 4.0 mmol/l Chloride 104 mmol/l Bicarbonate 19 mmol/l Urea 7.0 mmol/l Creatinine 112 μmol/l

What is the anion gap?

A. 4 mmol/L
B. 14 mmol/L
C. 20 mmol/L
D. 21 mmol/L
E. 23 mmol/L

A

E. 23 mmol/L

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52
Q

A 73 year old man has an arterial line in situ. On studying the trace the incisura can be seen. What is the physiological event which accounts for this process?

A. Atrial repolarisation
B. Mitral valve closure
C. Ventricular repolarisation
D. Elastic recoil of the aorta E. Tricuspid valve closure

A

D. Elastic recoil of the aorta

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53
Q

A surgeon is considering using lignocaine as local anasthesia for a minor procedure. Which of the following best accounts for its actions?

A. Blockade of
neuronal acetylcholine receptors
B. Blockade of neuronal nicotinic receptors
C. Blockade of neuronal sodium channels
D. Blockade of neuronal potassium channels
E. Blockade of neuronal calcium channels

A

C. Blockade of neuronal sodium channels

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54
Q

A 22 year old man suffers a blunt head injury. He is drowsy and has a GCS of 7 on admission. Which of the following is the major determinant of cerebral blood flow in this situation?

A. Systemic blood pressure B. Mean arterial pressure C. Intra cranial pressure
D. Hypoxaemia
E. Acidosis

A

C. Intra cranial pressure

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55
Q

A 43 year old man has recurrent episodes of dyspepsia and treatment is commenced with oral antacids. Which of the hormones listed below is released in response to increased serum gastrin levels and decreases intra gastric pH?

A. Cholecystokinin
B. Histamine
C. Somatostatin
D. Insulin
E. Vasoactive intestinal peptide

A

B. Histamine

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56
Q

Which main group of receptors does dobutamine bind to?

A. α-1
B. α-2
C. ß-1
D. ß-2
E. D-1

A

C. ß-1

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57
Q

Which of the following is responsible for the release and synthesis of calcitonin?

A. Parathyroid glands
B. Anterior pituitary
C. Thyroid gland
D. Posterior pituitary
E. Adrenal glands

A

C. Thyroid gland

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58
Q

What is the half life of insulin in the circulation of a normal healthy adult?

A. Less than 30 minutes
B. Between 1 and 2 hours C. Between 2 and 3 hours D. Between 4 and 5 hours E. Over 6 hours

A

A. Less than 30 minutes

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59
Q

Which of the following statements about blood clotting is untrue?

A. Platelet adhesion to disrupted endothelium is dependent upon von Willebrand factor
B. Protein C is a vitamin K dependent substance
C. The bleeding time provides an assessment of platelet function
D. The prothrombin time tests the extrinsic system
E. Administration of aprotinin during liver transplantation surgery prolongs survival

A

E. Administration of aprotinin during liver transplantation surgery prolongs survival

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60
Q

A 78 year old manwith diabetes develops autonomic gastropathy and persistant a troublesome vomiting. Please select the most appropriate drug for the given scenario.

A. Ondansetron
B. Metoclopramide
C. Cyclizine
D. Erythromycin
E. Cisapride
F. Haloperidol

A

D. Erythromycin

Unlike metoclopramide the effects of erythromycin on gastric empyting are not mediated via the vagus nerve.

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61
Q

A drug which blocks the chemoreceptor trigger zone in the area postrema.
Please select the most appropriate drug for the given scenario.

A. Ondansetron
B. Metoclopramide
C. Cyclizine
D. Erythromycin
E. Cisapride
F. Haloperidol

A

A. Ondansetron

HT3 blockers are most effective for many types of nausea for this reason.

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62
Q

A 48 year old man with oesphageal varices has a profuse haemorrhage on the ward. Please select the most appropriate drug for the given scenario.

A. Ondansetron
B. Metoclopramide
C. Cyclizine
D. Erythromycin
E. Cisapride
F. Haloperidol

A

B. Metoclopramide

Intravenous metoclopramide causes increased oesophageal pressure and this may temporarily slow the rate of haemorrhage whilst more definitive measures are instigated.

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63
Q

Which of the following cell types is least likely to be found in a wound 1 week following injury?

A. Macrophages
B. Fibroblasts C. Myofibroblasts
D. Endothelial cells
E. Neutrophils

A

C. Myofibroblasts

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64
Q

The blood - brain barrier is not highly permeable to which of the following?

A. Carbon dioxide
B. Barbiturates
C. Glucose
D. Oxygen
E. Hydrogen ions

A

E. Hydrogen ions

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65
Q

A 43 year old presents to the urology clinic complaining of impotence. Which of the following will occur in response to increased penile parasympathetic stimulation?

A. Detumescence
B. Ejaculation
C. Erection
D. Vasospasm of the penile branches of the pudendal artery
E. Contraction of the smooth muscle in the epididymis and vas deferens

A

C. Erection

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66
Q

In class II haemorrhagic shock in a 70Kg male, one would not expect to find?

A. Blood loss greater than 750ml
B. Tachycardia
C. Normal blood pressure
D. Urine output less than 20ml
E. Anxiety

A

D. Urine output less than 20ml

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67
Q

Which of the following best accounts for the action of PTH in increasing serum calcium levels?

A. Activation of vitamin D to increase absorption of calcium from the small intestine.
B. Direct stimulation of osteoclasts to absorb bone with release of calcium.
C. Stimulation of phosphate absorption at the distal convoluted tubule of the kidney.
D. Decreased porosity of the vessels at Bowmans capsule to calcium.
E. Vasospasm of the afferent renal arteriole thereby reducing GFR and calcium urinary loss.

A

A. Activation of vitamin D to increase absorption of calcium from the small intestine.

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68
Q

Which of the following drugs does not cause syndrome of inappropriate anti diuretic hormone release?

A. Haloperidol
B. Carbamazepine
C. Amitriptylline
D. Cyclophosphamide
E. Methotrexate

A

E. Methotrexate

Drugs causing SIADH: ABCD
A nalgesics: opioids, NSAIDs
B arbiturates
C yclophosphamide/ Chlorpromazine/ Carbamazepine
D iuretic (thiazides)

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69
Q

Which of the following changes are not typically seen in established dehydration?

A. Rising haematocrit
B. Urinary sodium <20mmol/ litre
C. Metabolic acidosis
D. Decreased serum urea to creatinine ratio
E. Hypernatraemia

A

D. Decreased serum urea to creatinine ratio

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70
Q

What is the most likely cause for this patients deterioration?

A. Acute respiratory alkalosis secondary to hyperventilation
B. Over administration of oxygen in a COPD patient
C. Metabolic acidosis secondary to severe pancreatitis
D. Metabolic alkalosis secondary to hypokalaemia
E. Acute respiratory acidosis secondary to pneumonia

A

B. Over administration of oxygen in a COPD patient

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71
Q

Which of the following does not cause an increased anion gap acidosis?

A. Uraemia
B. Paraldehyde
C. Diabetic ketoacidosis
D. Ethylene glycol
E. Acetazolamide

A

E. Acetazolamide

MUDPILES
M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates

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72
Q

Which one of the following is least associated with thrombocytopenia?

A. Heparin therapy
B. Rheumatoid arthritis
C. Infectious mononucleosis
D. Liver disease
E. Pregnancy

A

B. Rheumatoid arthritis

73
Q

Which of the following will increase the volume of pancreatic exocrine secretions?

A. Octreotide
B. Cholecystokinin
C. Aldosterone
D. Adrenaline
E. None of the above

A

B. Cholecystokinin

74
Q

Where is the majority of iron found in the body?

A. Bone
B. Haemoglobin
C. Ferritin and haemosiderin
D. Myoglobin
E. Plasma iron

A

B. Haemoglobin

75
Q

A 44 year old man recieves a large volume transfusion of whole blood. The whole blood is two weeks old. Which of the following best describes its handling of oxygen?

A. It will have a low affinity for oxygen
B. Its affinity for oxygen is unchanged
C. It will more readily release oxygen in metabolically active tissues than fresh blood
D. The release of oxygen in metabolically acitve tissues will be the same as fresh blood
E. It will have an increased affinity for oxygen

A

E. It will have an increased affinity for oxygen

76
Q

A 43 year old lady undergoes a day case laparoscopic cholecystectomy. The operation is more difficult than anticipated and a drain is placed to the operative site. Whilst in recovery the patient loses 1800ml of frank blood into the drain. Which of the following will not occur?

A. Release of aldosterone via the Bainbridge reflex
B. Reduced urinary sodium excretion
C. Increase in sympathetic discharge to ventricular muscle
D. Fall in parasympathetic discharge to the sino atrial node
E. Decreased stimulation from atrial pressure receptors

A

A. Release of aldosterone via the Bainbridge reflex

The Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood.

77
Q

Approximately what proportion of salivary secretions is provided by the submandibular glands?

A. 10%
B. 70%
C. 40%
D. 90%
E. 20%

A

B. 70%

78
Q

Which is not a cause of hyperuricaemia?

A. Severe psoriasis
B. Lesch-Nyhan syndrome
C. Hyperthyroidism
D. Diabetic ketoacidosis
E. Alcohol

A

C. Hyperthyroidism

Causes of hyperurecemia
‘Can’t leap’
C iclosporin
A lcohol
N icotinic acid
T hiazides

L oop diuretics
E thambutol
A spirin
P yrazinamide

79
Q

A 20 year old man is hit in the face and occludes his airway. Which of the following stimuli and receptor groups would the most potently activated as a result?

A. Receptors in the apneustic centre
B. Hypoxia of centrally located chemoreceptors
C. Hypoxia of peripherally located chemoreceptors
D. Hypercapnia of the carotid bodies
E. Hypoxia in the aortic arch receptors

A

D. Hypercapnia of the carotid bodies

80
Q

Which of the following statements relating to low molecular weight heparins is false?

A. They act via inhibition of Factor Xa
B. Large doses may be used prior to commencing cardiopulmonary
bypass
C. They have a highly predictable pharmacokinetic profile
D. They are derivatives of unfractionated heparin
E. They have a molecular mass in the range of 3000-10000Da

A

B. Large doses may be used prior to commencing cardiopulmonary
bypass

81
Q

A 43 year old lady presents with urinary incontinence. At which of the following locations is Onufs nucleus likely to be found?

A. Medulla oblongata
B. Anterior horn of L5 nerve roots
C. Micturition centre in the Pons
D. Anterior horn of S2 nerve roots
E. None of the above

A

D. Anterior horn of S2 nerve roots

82
Q

Which of the following is associated with reduced lung compliance?

A. Older age
B. Emphysematous type COPD
C. Decline in pulmonary blood flow
D. Adopting a vertical posture
E. Adjusting a ventilator to maintain high lung volumes

A

E. Adjusting a ventilator to maintain high lung volumes

83
Q

Which of the following statements relating to alveolar ventilation is untrue?

A. Anatomical dead space is measured by helium dilution
B. Physiological dead space is increased in PE
C. Alveolar ventilation is defined as the volume of fresh air entering the alveoli per minute
D. Anatomical dead space is increased by noradrenaline
E. Type 2 pneumocytes in the alveoli secrete surfactant

A

A. Anatomical dead space is measured by helium dilution

84
Q

Which opioid receptor does morphine attach to?

A. mu
B. alpha
C. sigma
D. beta
E. kappa

A

A. mu

85
Q

Which of the following inhibits the secretion of insulin?

A. Adrenaline
B. Glucagon
C. Gastrin
D. Arginine
E. Vagal cholinergic activity

A

A. Adrenaline

86
Q

What inhibit insulin release?

A

Inhibition of insulin release:
* Alpha adrenergic drugs
* Beta blockers
* Sympathetic nerves

87
Q

What is measured to obtain renal plasma flow?

A. Creatinine
B. Para-amino hippuric acid (PAH)
C. Inulin
D. Glucose
E. Protein

A

B. Para-amino hippuric acid (PAH)

88
Q

Which of the following is not a cause of hypercalcaemia?

A. Thiazides
B. Antacids
C. Coeliac disease
D. Sarcoidosis
E. Zolinger-Ellison syndrome

A

C. Coeliac disease

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison’s N eoplastic disease
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

89
Q

Which of the following surgical procedures will have the greatest long term impact on a patients calcium metabolism?

A. Distal gastrectomy
B. Cholecystectomy
C. Extensive small bowel resection
D. Sub total colectomy
E. Gastric banding for obesity

A

C. Extensive small bowel resection

90
Q

A 52-year-old woman with a history of gastrectomy reports lethargy and a sore tongue. Blood tests are reported as follows:
Hb 10.7 g/dl
MCV 121 fl
Plt 177 * 10^9/l
WBC 5.4 * 10^9/l
What is the most likely cause?

A. Vitamin B12 deficiency B. Vitamin C deficiency
C. Iron deficiency anaemia
D. Anaemia of chronic disease E. Vitamin E deficiency

A

A. Vitamin B12 deficiency

91
Q

A 43 year old lady is diagnosed with primary hyperparathyroidism. Her serum PTH levels are elevated. An endocrine surgeon performs a parathyroidectomy. How long will it take for the serum PTH levels to fall if the functioning adenoma has been successfully removed?

A. 6 hours
B. 24 hours
C. 2 hours
D. 1 hour
E. 10 minutes

A

E. 10 minutes

PTH has a very short half life usually less than 10 minutes. Therefore a demonstrable drop in serum PTH should be identified within 10 minutes of removing the adenoma.

92
Q

Which of the following statements relating to abnormal coagulation is false?

A. Warfarin affects the synthesis of factor 2,7,9,10
B. The prothrombin time is prolonged in Haemophilia A
C. Cholestatic jaundice can cause vitamin K deficiency
D. Disseminated intravascular coagulation is associated with thrombocytopenia
E. Massive transfusion is associated with reduced levels of factor 5 and 8

A

B. The prothrombin time is prolonged in Haemophilia A

93
Q

A 34 year old man presents with a peptic ulcer. Which of the following is responsible for the release of gastric acid?

A. Chief cells
B. Parietal cells
C. Brunners Glands
D. G Cells
E. None of the above

A

B. Parietal cells

94
Q

Which of the following does not lead to relaxation of the lower oesophageal sphincter?

A. Metoclopramide
B. Botulinum toxin type A
C. Nicotine
D. Alcohol
E. Theophylline

A

A. Metoclopramide

Metoclopramide acts directly on the smooth muscle of the LOS to cause it to contract. Theophylline is a phosphodiesterase inhibitor (mimics action of prostaglandin E1) which causes relaxation of the LOS.

95
Q

Which of the following is not released from the islets of Langerhans?

A. Pancreatic polypeptide
B. Glucagon
C. Secretin
D. Somatostatin
E. Insulin

A

C. Secretin

Secretin is released from mucosal cells in the duodenum and jejunum.

Hormones released from the islets of Langerhans
Beta cells: Insulin (70% of total secretions)
Alpha cells: Glucagon
Deltacells: Somatostatin
F cells: Pancreatic polypeptide

96
Q

Which of the following is not classically seen in coning resulting from raised intra cranial pressure?

A. Coma
B. Hypotension
C. Unreactive mid sized pupils
D. Cheyne Stokes style respiratory efforts
E. Bradycardia

A

B. Hypotension

97
Q

Control of ventilation. Which statement is false?

A. Peripheral chemoreceptors are located in the bifurcation of the carotid arteries and arch of the aorta
B. Central chemoreceptors respond to changes in O2
C. The respiratory centres control the rate and depth of respiration
D. Involuntary control of respiration is from the medulla and pons
E. Irritant receptors cause bronchospasm

A

B. Central chemoreceptors respond to changes in O2

98
Q

A 54 year old lady has her serum calcium measured. Assuming her renal function is normal, what proportion of calcium filtered at the glomerulus will be reabsorbed by the renal tubules?

A. 5%
B. 15%
C. 25%
D. 50%
E. 95%

A

E. 95%

Most filtered calcium is reabsorbed (95%) a rare disorder of familial hypercalcemic calciurea may affect this proportion.

99
Q

Which of the following does not cause hyperkalaemia?

A. Haemolysis
B. Burns
C. Familial periodic paralysis
D. Type 4 renal tubular acidosis
E. Severe malnutrition

A

E. Severe malnutrition

‘Machine’ - Causes of Increased Serum
+ K
M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, haemolysis I - Intake - Excessive
N - Nephrons, renal failure
E - Excretion - Impaired

100
Q

Which of the following statements is true of glucagon?

A. Produced in response to hyperglycaemia
B. Released by beta cells
C. Inhibits gluconeogenesis
D. Produced in response to an increase of amino acids
E. Composed of 2 alpha polypeptide chains linked by hydrogen bonds

A

D. Produced in response to an increase of amino acids

101
Q

A 28 year old man undergoes a completion right hemicolectomy for treatment of a 5cm appendiceal carcinoid. As part of his follow up he is due to undergo 24 hour urine collection for 5-HIAA. Which of the following causes an elevated 5-HIAA in a 24-hour urine collection?

A. Naproxen
B. Oranges
C. Flucloxacillin
D. Amiodarone
E. Beef

A

A. Naproxen

102
Q

A 52 year old man develops septic shock following a Hartmans procedure for perforated diverticular disease. He is started on an adrenaline infusion. Which of the following is least likely to occur?

A. Peripheral vasoconstriction
B. Coronary artery vasospasm
C. Gluconeogenesis
D. Lipolysis
E. Tachycardia

A

B. Coronary artery vasospasm

103
Q

Intra cranial pressure is governed by the principles of the Monroe-Kellie doctrine. To which of the following does this concept not apply?

A. A 2 month old child
B. A 2 year old child
C. A 5 year old child
D. A 10 year old child
E. An adult

A

A. A 2 month old child

The Monroe-Kelly Doctrine assumes that the cranial cavity is a rigid box. In children with non fused fontanells this is not the case.

104
Q

Which of the following is not caused by cortisol in the stress response?

A. Anti-inflammatory effects
B. Hypoglycaemia
C. Skeletal muscle protein breakdown D. Stimulation of lipolysis
E. Mineralocorticoid effects

A

B. Hypoglycaemia

105
Q

Which of the following features does not put a patient at risk of refeeding syndrome?

2 A. BMI < 16 kg/m
B. Alcohol abuse
C. Thyrotoxicosis
D. Chemotherapy
E. Diuretics

A

C. Thyrotoxicosis

Diuretics increase the risk of re-feeding syndrome through a process of increasing the risk of depletion of key electrolytes.

106
Q

Which of the following statements relating to the regulation of renal blood flow is untrue?

A. In a healthy 70Kg male, the glomerular filtration rate will be the same at a systolic blood pressure of 120mmHg as a systolic blood pressure of 95 mmHg
B. Over 90% of the blood supply to the kidney is distributed to the cortex
C. The kidney receives approximately 25% of the total cardiac output at rest
D. A decrease in renal perfusion pressure will cause the juxtaglomerular cells to secrete renin
E. Systolic blood pressures of less than 65mmHg will cause the mesangial cells to secrete aldosterone

A

E. Systolic blood pressures of less than 65mmHg will cause the mesangial cells to secrete aldosterone

107
Q

A 39 year old lady undergoes a laparoscopic cholecystectomy as a daycase. The operation is more difficult than anticipated and the surgeon places a drain to the liver bed. In recovery 1.5 litres of blood is seen to enter the drain. Which of the following substances is the first to be released in this situation?

A. Angiotensinogen
B. Renin
C. Angiotensin I
D. Angiotensin II
E. Aldosterone

A

B. Renin

108
Q

Where is the best site for adrenaline injection?

A

The best site for IM injection is the anterolateral aspect of the middle third of the thigh. Adrenaline can be repeated every 5 minutes if necessary.

109
Q

Which of the following drugs causes hyperkalaemia?

A. Heparin
B. Ciprofloxacin
C. Salbutamol
D. Levothyroxine
E. Codeine phosphate

A

A. Heparin

110
Q

A 25-year-old man who has been morbidly obese for the past five years is reviewed in the surgical bariatric clinic. In this patient, release of which of the following hormones would increase appetite?

A. Leptin
B. Thyroxine
C. Adiponectin
D. Ghrelin
E. Serotonin

A

D. Ghrelin

Obesity hormones
* leptin decreases appetite
* ghrelin increases appetite

111
Q

Which of the following bony complications is not linked to excess glucocorticoids?

A. Avascular necrosis
B. Vertebral body collapse
C. Increased susceptibility to osteomyelitis from strep viridans
D. Decreased absorption of calcium from the gut
E. Growth retardation in children

A

C. Increased susceptibility to osteomyelitis from strep viridans

112
Q

A 54-year-old woman is admitted to the Surgical Admissions Unit with abdominal pain. Blood tests taken on admission show the following:

Magnesium 0.40 mmol/l (normal value 0.7-1.0 mmol/l)

Which one of the following factors is most likely to be responsible for this result?

A. Excessive resuscitation with intravenous saline
B. Digoxin therapy
C. Diarrhoea
D. Hypothermia
E. Rhabdomyolysis

A

C. Diarrhoea

113
Q

What are the causes of Hypomagnesaemia?

A

Cause of low magnesium
* Diuretics
* Total parenteral nutrition
* Diarrhoea
* Alcohol
* Hypokalaemia, hypocalcaemia

114
Q

What are the features of hypomagnesaemia?

A
  • Paraesthesia
  • Tetany
  • Seizures
  • Arrhythmias
  • Decreased PTH secretion –> hypocalcaemia
  • ECG features similar to those of hypokalaemia
  • Exacerbates digoxin toxicity
115
Q

A 43 year old man has a nasogastric tube inserted. The nurse takes a small aspirate of the fluid from the stomach and tests the pH of the aspirate. What is the normal intragastric pH?

A. 0.5
B. 2
C. 4
D. 5
E. 6

A

B. 2

116
Q

Which of the following is the equivalent of cardiac preload?

A. End diastolic volume
B. Stroke volume
C. Systemic vascular resistance
D. Mean arterial pressure
E. Peak systolic arterial pressure

A

A. End diastolic volume

117
Q

A 48 year old man undergoes a right hemicolectomy for a large caecal polyp. In the immediate post operative period which of the physiological processes described below is least likely to occur?

A. Glycogenolysis
B. Increased production of acute phase proteins
C. Increased cortisol production
D. Bronchoconstriction
E. Release of nitric oxide by vessels

A

D. Bronchoconstriction

118
Q

A 73 year old female is referred to the surgical clinic with an iron deficiency anaemia. As part of
the diagnostic work up the doctor requests a serum ferritin level. Which of the conditions listed is most likely to lead to a falsely elevated result?

A. Locally perforated sigmoid colonic adenocarcinoma
B. Colonic angiodysplasia
C. Dieulafoy lesion of the stomach
D. Transitional cell carcinoma of the bladder
E. Endometrial adenocarcinoma

A

A. Locally perforated sigmoid colonic adenocarcinoma

119
Q

Which of the following is least likely to cause a prolonged prothrombin time?

A. Cholestatic jaundice
B. Disseminated intravascular coagulation
C. Prolonged antibiotic treatment
D. Liver disease
E. Acquired factor 12 deficiency

A

E. Acquired factor 12 deficiency

120
Q

Which statement about peristalsis is true?

A. Longitudinal smooth muscle propels the food bolus through the oesophagus
B. Secondary peristalsis occurs when there is no food bolus in the oesophagus
C. Food transfer from the oesophagus to the stomach is 4 seconds
D. Circular smooth muscle is not involved in peristalsis
E. Peristalsis only occurs in the oesophagus

A

A. Longitudinal smooth muscle propels the food bolus through the oesophagus

121
Q

A 24 year old man is injured in a road traffic accident. He becomes oliguric and his renal function deteriorates. Which of the options below would favor acute tubular necrosis over pre renal uraemia?

A. No response to intravenous fluids B. Urinary sodium < 20mmol/L
C. Bland coloured urinary sediment
D. Increased urine specific gravity
E. None of the above

A

A. No response to intravenous fluids

122
Q

Which of the following is not an effect of cholecystokinin?

A. It causes gallbladder contraction
B. It increases the rate of gastric emptying
C. It relaxes the sphincter of oddi
D. It stimulates pancreatic acinar cells
E. It has a trophic effect on pancreatic acinar cells

A

B. It increases the rate of gastric emptying

123
Q

Which part of the jugular venous waveform is associated with the closure of the tricuspid valve?

A. a wave
B. c wave
C. x descent
D. y descent
E. v wave

A

B. c wave

124
Q

Which one of the following serum proteins is most likely to increase in a patient with severe sepsis?

A. Transferrin
B. Transthyretin
C. Ferritin
D. Albumin
E. Cortisol binding protein

A

C. Ferritin

125
Q

What the parameters for acute phase protein?

A

Acute phase proteins
+ CRP
+ procalcitonin
+ ferritin
+ fibrinogen
+ alpha-1 antitrypsin
+ caeruloplasmin
+ serum amyloid A
+ haptoglobin
+ complement

126
Q

What are the parameters of negative acute phase protein?

A

+ albumin
+ transthyretin (formerly known as prealbumin)
+ transferrin
+ retinol binding protein
+ cortisol binding protein

127
Q

A 45 year old man is admitted to the intensive care unit following a laparotomy. He has a central line, pulmonary artery catheter and arterial lines inserted.

The following results are obtained:
Pulmonary artery occlusion pressure: Low
Cardiac output: Low
Systemic vascular resistance: High

What are the probable diagnosis?

A. Hypovolaemia
B. Normal
C. Cardiogenic shock
D. Septic shock

A

A. Hypovolaemia

Cardiac output is lowered in hypovolaemia due to decreased preload.

128
Q

A 75 year old man is admitted to the intensive care unit following a laparotomy. He has a central line, pulmonary artery catheter and arterial lines inserted.

The following results are obtained:
Pulmonary artery occlusion pressure: High
Cardiac output: Low
Systemic vascular resistance: High

What are the probable diagnosis?

A. Hypovolaemia
B. Normal
C. Cardiogenic shock
D. Septic shock

A

C. Cardiogenic shock

In cardiogenic shock pulmonary pressures are often high. This is the basis for the use of venodilators in the treatment of pulmonary oedema.

129
Q

A 22 year old lady is admitted to the intensive care unit following a laparotomy. She has a central line, pulmonary artery catheter and arterial lines inserted.

The following results are obtained:
Pulmonary artery occlusion pressure: Low
Cardiac output: High
Systemic vascular resistance: Low

What are the probable diagnosis?

A. Hypovolaemia
B. Normal
C. Cardiogenic shock
D. Septic shock

A

D. Septic shock

Decreased SVR is a major feature of sepsis. A hyperdynamic circulation is often present. This is the reason for the use of vasoconstrictors.

130
Q

A 23 year old man has a routine ECG performed. Which part of the tracing obtained represents atrial repolarisation?

A. P wave
B. T wave
C. Q-T Interval
D. P-R interval
E. None of the above

A

E. None of the above

The process of atrial repolarisation is generally not visible on the ECG strip. It occurs during the QRS complex.

131
Q

A 72-year-old woman is admitted to the acute surgical unit with profuse vomiting. Admission bloods show the following:
Na+ 131 mmol/l K+ 2.2 mmol/l Urea 3.1 mmol/l Creatinine 56 μmol/l Glucose 4.3 mmol/l

Which one of the following ECG features is most likely to be seen?

A. Short PR interval
B. Short QT interval
C. Flattened P waves
D. J waves
E. U waves

A

E. U waves

Hypokalaemia - U waves onECG
J waves are seen in hypothermia
delta waves are associated with Wolff Parkinson White syndrome.

132
Q

What are the ECG features in hypokalemia?

A
  • U waves
  • Small or absent T waves (occasionally inversion)
  • Prolonged PR interval
  • ST depression
  • Long QT interval
133
Q

Which of the following secretions contains the highest composition of potassium?

A. Bile
B. Small bowel
C. Pancreatic juice
D. Gastric juice
E. Saliva

A

E. Saliva

Saliva 20-60 mmol/L
Gastric juice 5-10 mmol/L
Bile 5-8 mmol/L
Pancreatic juice 4-5 mmol/L
Small bowel 4-10 mmol/L

134
Q

The oxygen-haemoglobin dissociation curve is shifted to the left in:

A. With decreased 2,3-DPG in transfused red cells
B. Respiratory acidosis
C. High altitude
D. Pyrexia
E. Haemolytic anaemia

A

A. With decreased 2,3-DPG in transfused red cells

135
Q

Causes of left shift of dissociation curve = Lower oxygen delivery ?

A
  • HbF, methaemoglobin, carboxyhaemoglobin
  • low [H+] (alkali)
  • low pCO2
  • low 2,3-DPG
  • low temperature
    Shifts to Right = Raised oxygen delivery
136
Q

Causes of right shift of dissociation curve = Raised oxygen delivery ?

A

+ raised [H+] (acidic)
+ raised pCO2
+ raised 2,3-DPG
+ raised temperature

137
Q
A
138
Q

A homeless 42 year old male had an emergency inguinal hernia repair 24 hours previously. He has a BMI of 15. He has been put on a feeding regime of 35 kcal/kg/day with no additional medications. The nursing staff contact you as he has become confused and unsteady. On examination the patient is disorientated to place, has diplopia and nystagmus. What is the most likely diagnosis?

A. Cerebellar stroke
B. Acute dystonic reaction
C. Refeeding syndrome
D. Parkinsonism
E. Wernickes encephalopathy

A

E. Wernickes encephalopathy

139
Q

What are the Triad of Wernicke encephalopathy?

A
  • Acute confusion
  • Ataxia
  • Opthalmoplegia
140
Q

A 22 year old lady receives intravenous morphine for acute abdominal pain. Which of the following best accounts for its analgesic properties?

A. Binding to δ opioid receptors in the brainstem
B. Binding to δ opioid receptors at peripheral nerve sites
C. Binding to β opioid receptors within the CNS
D. Binding to α opioid receptors within the CNS
E. Binding to μ opioid receptors within the CNS

A

E. Binding to μ opioid receptors within the CNS

141
Q

What are the 4 types of opioid receptors ?

A
  • δ (located in CNS)- Accounts for analgesic and antidepressant effects
  • k (mainly CNS)- analgesic and dissociative effects
  • μ (central and peripheral) - causes analgesia, miosis, decreased gut motility
  • Nociceptin receptor (CNS)- Affect of appetite and tolerance to μ agonists.
142
Q

Which one of the following reduces the secretion of renin?

A. Erect posture
B. Adrenaline
C. Hyponatraemia
D. Hypotension
E. Beta-blockers

A

E. Beta-blockers

143
Q

What are the factors stimulating renin secretion?

A
  • hypotension causing reduced renal perfusion
  • hyponatraemia
  • sympathetic nerve stimulation
  • catecholamines
  • erect posture
144
Q

What are the factors reducing renin secretions?

A
  • drugs: beta-blockers, NSAIDs
145
Q

Which of the following stimulates prolactin release?

A. Leutinising hormone
B. Dopamine
C. Thyrotropin releasing hormone
D. Oestrogen
E. Follicle stimulating hormone

A

C. Thyrotropin releasing hormone

146
Q
A
147
Q

Please select the vitamin deficiency most closely associated with the situation described.

A 3 year old child presents with Rickets

A

Vitamin D

Vitamin D is needed to help mineralise bone. When this is deficient, mineralisation is inadequate and deformities mayt result.

148
Q

Please select the vitamin deficiency most closely associated with the situation described.

A 44 year old lady presents with jaundice. Following a minor ward based surgical procedure she develops troublesome and persistent bleeding.

A

Vitamin K

Patients who are jaundiced usually have impaired absorption of vitamin K. This can result in loss of the vitamin K dependent clotting factors and troublesome bleeding.

149
Q

Please select the vitamin deficiency most closely associated with the situation described.

A 69 year old man who has been living in sheltered accommodation for many months, with inadequate nutrition notices that his night vision is becoming impaired.

A

Vitamin A

Loss of vitamin A will result in impair rhodopsin synthesis and poor night vision.

150
Q

A 55 year old man undergoes a laparotomy and repair of incisional hernia. Which of the following hormones is least likely to be released in increased quantities following the procedure?

A. Insulin
B. ACTH
C. Glucocorticoids
D. Aldosterone
E. Growth hormone

A

A. Insulin

151
Q

Which of the following is not a major function of the spleen in adults?

A. Iron reutilisation
B. Storage of platelets
C. Storage of monocytes
D. Haematopoeisis in haematological disorders
E. Storage red blood cells

A

E. Storage red blood cells

Function
* Filtration of abnormal blood cells and foreign bodies such as bacteria.
* Immunity: IgM. Production of properdin, and tuftsin which help target fungi and bacteria for
phagocytosis.
* Haematopoiesis: up to 5th month gestation or in haematological disorders.
* Pooling: storage of 40% platelets.
* Iron reutilisation
* Storage red blood cells-animals, not humans.
* Storage monocytes

152
Q

Which one of the following is associated with increased lung compliance?

A. Kyphosis
B. Pulmonary oedema
C. Emphysema
D. Pulmonary fibrosis
E. Pneumonectomy

A

C. Emphysema

153
Q

Causes of increased lung compliance

A
  • age
  • emphysema - this is due to loss alveolar walls and associated elastic tissue
154
Q

Causes of decreased lung compliance

A
  • pulmonary oedema
  • pulmonary fibrosis
  • pneumonectomy
  • kyphosis
155
Q

Which of the following areas is predominantly concerned with thermoregulation?

A. Hypothalamus
B. Anterior pituitary
C. Cerebellum
D. Brain stem
E. Temporal lobe

A

A. Hypothalamus

The hypothalamus is primarily concerned with thermoregulation. It may relay to the cerebral cortex to induce behavioural adaptation to facilitate the thermoregulatory process.

156
Q

Please match the diagnosis with the arterial blood gas result.

Pulmonary embolus

A. pH 7.64 pO2 10.0 kPa pCO2 2.8 kPa HCO3 20
B. pH 7.25 pO2 8.9 pCO2 3.2 HCO3 10
C. pH 7.20 pO2 6.2 pCO2 8.2 HCO3 27
D. pH 7.60 pO2 8.2 pCO2 5.8 HCO3 40
E. pH 7.45 pO2 7.2 pCO2 2.5 HCO3 24

A

E. pH 7.45 pO2 7.2 pCO2 2.5 HCO3 24

157
Q

Please match the diagnosis with the arterial blood gas result.

High output ureterosigmoidostomy

A. pH 7.64 pO2 10.0 kPa pCO2 2.8 kPa HCO3 20
B. pH 7.25 pO2 8.9 pCO2 3.2 HCO3 10
C. pH 7.20 pO2 6.2 pCO2 8.2 HCO3 27
D. pH 7.60 pO2 8.2 pCO2 5.8 HCO3 40
E. pH 7.45 pO2 7.2 pCO2 2.5 HCO3 24

A

B. pH 7.25 pO2 8.9 pCO2 3.2 HCO3 10

158
Q

Please match the diagnosis with the arterial blood gas result.

Widespread mesenteric infarction

A. pH 7.64 pO2 10.0 kPa pCO2 2.8 kPa HCO3 20
B. pH 7.25 pO2 8.9 pCO2 3.2 HCO3 10
C. pH 7.20 pO2 6.2 pCO2 8.2 HCO3 27
D. pH 7.60 pO2 8.2 pCO2 5.8 HCO3 40
E. pH 7.45 pO2 7.2 pCO2 2.5 HCO3 24

A

B. pH 7.25 pO2 8.9 pCO2 3.2 HCO3 10

159
Q

Which of the following drugs does not interfere with the measurement of cortisol levels?

A. Dexamethasone
B. Prednisolone
C. Hydrocortisone IV
D. Hydrocortisone PO
E. Hydrocortisone IM

A

A. Dexamethasone

160
Q

An elderly lady who presented with weight loss and malabsorption was found to have amyloid of the small bowel. On presentation she was found to have osteomalacia and was hypocalcaemic. Over the past seven days she has received total parenteral nutrition with adequate calcium replacement. Despite this she remained hypocalcaemic. Deficiency of which of the following electrolytes is most likely to account for this process?

A. Magnesium
B. Potassium
C. Sodium
D. Phosphate
E. None of the above

A

A. Magnesium

161
Q

What are the actions of cortisol?

A

+ Glycogenolysis
+ Glucaneogenesis
+ Protein catabolism
+ Lipolysis
+ Stress response
+ Anti-inflammatory
+ Decrease protein in bones
+ Increase gastric acid
+ Increases neutrophils/platelets/red blood cells
+ Inhibits fibroblastic activity

162
Q

A 19 years old man is attacked outside a club and beaten with a baseball bat. He sustains a blow to the right side of his head. He is brought to the emergency department and a policy of observation is adopted. His Glasgoq coma score deteriorates and he becomes comatose. Which of the following haemodynamic parameteres is most likely to be present?

A. Hypertension and bradycardia
B. Hypotension and tachycardia
C. Hypotension and bradycardia
D. Hypertension and tachycardia
E. Normotension and bradycardia

A

A. Hypertension and bradycardia

163
Q

Which of the following drugs does not cause pseudohaematuria?

A. Rifampicin
B. Quinine
C. Noradrenaline
D. Levodopa
E. Phenytoin

A

C. Noradrenaline

164
Q

A 74-year-old woman with thyroid cancer is admitted due to shortness of breath. What is the best investigation to assess for possible compression of the upper airways?

A. Arterial blood gases
B. Forced vital capacity
C. Transfer factor
D. Peak expiratory flow rate
E. Flow volume loop

A

E. Flow volume loop

165
Q

Which of the following statements relating to cerebrospinal fluid is untrue?

A. The choroid plexus is only present in the lateral ventricles
B. Total CSF volume is 100-150ml
C. CSF pressure is usually 10-15mmHg
D. The cerebral aqueduct connects the third and fourth ventricles
E. The foramen of Luschka are paired and lie laterally in the fourth ventricle

A

A. The choroid plexus is only present in the lateral ventricles

166
Q

What is the flow circulation of the cerebrospinal fluid?

A

Circulation
1. Lateral ventricles (via foramen Munro)
2. 3rd ventricle
3. Cerebral aqueduct (aqueduct Sylvius)
4. 4th ventricle (via foramina of Magendie and Luschka)
5. Subarachnoid space
6. Reabsorbed into venous system via arachnoid granulations in superior sagittal sinus

167
Q

Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate?

A. Glucose
B. Protein
C. Inulin
D. Creatinine
E. Para-amino hippuric acid

A

C. Inulin

Creatinine declines with age due to decline in renal function and muscle mass. Glucose, protein (amino acids) and PAH are reabsorbed by the kidney.

168
Q

A 45 year old man sustains a closed head injury. He is initially alert, however, his level of consciousness deteriorates on arrival at hospital. An intra cranial pressure monitor is inserted. What is the normal intracranial pressure?

A. 35 - 45mm Hg
B. 45 - 55mm Hg
C. <15mm Hg
D. 25 - 35mm Hg
E. 25-30mmHg

A

C. <15mm Hg

The normal intracranial pressure is between 7 and 15 mm Hg. The brain can accommodate increases up to 24 mm Hg, thereafter clinical features will become evident.

169
Q

Due to his smoking history a chest x-ray is ordered which is reported as normal. The Consultant asks you what is the most likely cause for the hyponatraemia?

A. Metformin
B. Lithium
C. Carbamazepine
D. Sodium valproate
E. Pioglitazone

A

C. Carbamazepine

170
Q

A 24 year old man is involved in a road traffic accident. His right leg is trapped for 6 hours whilst he is moved. On examination his foot is insensate and a dorsalis pedis pulse is only weakly felt. Which of the biochemical abnormalities listed below is most likely to be present?

A. Alkalosis
B. Hypercalcaemia
C. Hypocalcaemia
D. Hyperkalaemia
E. Hyponatraemia

A

D. Hyperkalaemia

171
Q

A 39 year old lady has recurrent attacks of biliary colic. What is the approximate volume of bile to enter the duodenum per 24 hours?

A. 500 mL
B. 50 mL
C. 100 mL
D. 2000 mL
E. 150 mL

A

A. 500 mL

Between 500 mL and 1.5 L of bile enters the small bowel daily. Most bile salts are recycled by the enterohepatic circulation. When the gallbladder contracts the lumenal pressure is approximately 25cm water, which is why biliary colic may be so painful.

172
Q

Which of the following is not a characteristic of the proximal convoluted tubule in the kidney?

A. Up to 95% of filtered amino acids will be reabsorbed at this site
B. It is a risk of damage in a patient with compartment syndrome due to
a tibial fracture
C. It is responsible for absorbing more than 50% of filtered water
D. Its secretory function is most effective at low systolic blood pressures (typically less than 100mmHg)
E. Glucose is reabsorbed by a process of facilitated diffusion

A

D. Its secretory function is most effective at low systolic blood pressures (typically less than 100mmHg)

173
Q

Which of the following does not cause a normal anion gap acidosis?

A. Pancreatic fistula
B. Acetazolamide
C. Uraemia
D. Ureteric diversion
E. Renal tubular acidosis

A

C. Uraemia

Normal Gap Acidosis: HARDUP

H-Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

174
Q

Which one of the following would cause a rise in the carbon monoxide transfer factor (TLCO)?

A. Emphysema
B. Pulmonary embolism
C. Pulmonary haemorrhage
D. Pneumonia
E. Pulmonary fibrosis

A

C. Pulmonary haemorrhage

175
Q

Causes of a raised TLCO?

A
  • asthma
  • pulmonary haemorrhage (Wegener’s, Goodpasteur)
  • left-to-right cardiac shunts
  • polycythemia
  • hyperkinetic states
  • male gender, exercise
175
Q

Causes of a lower TLCO?

A
  • pulmonary fibrosis
  • pneumonia
  • pulmonary emboli
  • pulmonary oedema
  • emphysema
  • anaemia
  • low cardiac output
176
Q

Release of somatostatin from the pancreas will result in which of the following?

A. Decrease in pancreatic exocrine secretions
B. Contraction of the gallbladder
C. Increase in the rate of gastric emptying
D. Increased synthesis of growth hormone
E. Increased insulin release

A

A. Decrease in pancreatic exocrine secretions

177
Q

A 34 year old lady develops septic shock and features of the systemic inflammatory response syndrome as a complication of cholangitis. Which of the following is not a typical feature of this condition?

oo A. Body temperature less than 36 C or greater than 38 C
B. Respiratory rate >20
C. Lactate <4 mmol/L
D. High levels of tumour necrosis factor α
E. WCC>12000 mm3

A

C. Lactate <4 mmol/L

Medex Surgery MCQ (5 decks)

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