Practice exam Flashcards
What are the red flag questions we would ask with someone who has a suspicion of cancer? (7)
Nausea, Generally feeling unwell, Night pain, Strong family history of Cancer, Night sweats, Unexplained weight loss, History of cancer in self (1 mark for each point)
List three symptoms of cauda equina? (3)
Bilateral symptoms, Erectile dysfunction, Night pain, Numbness, Saddle anaesthesia, Worsening neurology, Loss of anal tone, Retention of urine (Any of the answers up to three points. 1 mark for each right answer)
List the 5 different meniscal tears? (5)
Longitudinal, bucket handle, raidial, flap, horizontal, degenerative (1 mark for each correct point)
Explain the pathophysiology of a frozen shoulder (4)
The disease process affects the antero-superior joint capsule, axillary recess,and the coracohumeral ligament (1 mark)
Evidence suggests there is synovial inflammation followed by capsular fibrosis, in which type I and III collagen is laid down with subsequent tissue contraction (1 mark)
Elevated levels of serum cytokines have been noted and facilitate tissue repair and remodelling during inflammatory processes (1 mark)
It is proposed that there is an imbalance between aggressive fibrosis and a loss of normal collagenous remodelling, which can lead to stiffening of the capsule and ligamentous structures (1 mark)
Explain the differences between a CAM, pincer and mixed FAI? (6)
Cam impingemenet is where the abnormality is located on the femoral side of the hip joint, the deformity is extra bone formation at the anterolateral head neck junction, causing a non- spherical femoral head (1 mark).
So particularly into flexion and internal rotation , the cam deformity can be forced into the acetabulum causing shearing forces at the chondro labral joint (1 mark)
Pincer impingement is where the abnormality of the acetabulum leading to an over coverage of the femoral head (1 mark).
This can either manefest as a deep acetabular or as a retroverted acetabulum which are most commonly seen anteriorly (1 mark).
This type of impingement can also lead to labral and cartilage damage throughout the acetabulum (1 mark).
Both can exist together. This is called a mixed or a combined FAI (1 mark)
What is a hemiarthroplasty and name one indication for this surgery? (3)
Surgical procedure that involves replacing half of the hip joint (1 mark)
Replaces only the femoral head portion of the joint (1 mark)
Can be elective or traumatic (1 mark)
Indications; Fractured femoral neck (from a fall / trauma), avascular necrosis, fracture, non-union, OA (1 mark for any of these points).
How is COPD characterised? (2 marks)
COPD is characterised by airflow obstruction that is progressive in severity and not fully reversible.
What conditions does COPD cover? (1 mark- for all 3 no half marks)
Chronic Bronchitis, Emphysema and Chronic Asthma.
What are the main causes of COPD? (4 marks)
Smoking
Occupational exposure
Alpha 1 antitrypsin deficiency
Social deprivation
What are the 3 main signs in Bronchitis? (3 marks)
Inflammation
Increased sputum production
Wheezing from narrowed airways
Define Diabetes. (2 marks)
A metabolic disorder (1 mark).It is the absence, deficit or resistance to insulin leading to hyperglycaemia (1 mark).
What are the types of diabetes and what are their associated risk factors? (6 marks)
Type 1 (1 mark) Type 2 (1 mark) Type 1 - Family history, viral infection, autoimmune disease and Type 2 – obesity, hypertension, poor lifestyle, diet, age, ethnicity (1/2 mark for any, max of 4 marks total)
How is each type of diabetes managed? (2 marks)
Lifestyle changes (type 2) – “HIITS” & “Starvation diets”, Insulin injections (type 1), Insulin tablets (type 2) (max 2 marks for any of these)
Define Pneumonia (3 marks)
Is an inflammatory (1 mark) condition of the lung leading to abnormal alveolar filling (1 mark) with consolidation and exudation (1 mark)
Describe the pathology of pneumonia (4 marks)
During pulmonary infection, acute inflammation (1 mark) results in the migration of neutrophils out of capillaries and into airspaces (alveoli) (1 mark), these cells phagocytose and release antimicrobial enzymes and inhibitors (1 mark) → more inflammation and oedema (1 mark)
List 3 potential causes of pneumonia (3 marks)
Bacteria e.g. Streptococcus pneumonia, haemophilus influenza type b (Hib) Fungi Virus e.g. respiratory syncytial Parasites Chemical Aspiration Inhalation (smoke, burns)
Define cancer. (1 mark)
Cancer = Highly invasive and destructive neoplasms (1 mark)
Give any 3 characteristics of a benign tumour. (3 marks)
Benign Tumours Differentiated cells Similar to normal cells Mitosis fairly normal Relatively slow growth Expanding mass Frequently encapsulated Remains localised Systemic effects-rare Only life threatening in certain locations (e.g. brain)
Give any 3 characteristics of a malignant tumour. (3 marks)
Malignant Tumours Cells vary in size & shape, large nuclei Many undifferentiated cells Mitosis increased & atypical Rapid growth Cells not adhesive, infiltrate tissue No capsule Invades nearby tissue or metastatises to distant sites through blood & lymph vessels Systemic effects-often present Life threatening by tissue destruction & spread of tumours
State the 3 stages associated with the development of cancer. (3 marks)
The initiating event causes a mutation in a cell, changes in the cell DNA. This initial change does not create an active neoplasm. The initiating event may eventually be indentified but many times it is not.
The promoting event is an expansion of the mutated cell’s growth and reproduction. Exposure to “promoters” later causes further changes in DNA, resulting in less differentiation and an increased rate of mitosis
The continued growth of the cell depends on continued exposure to the promoter. Dysplasia (presecence of abnormal cells) or anaplasia (cells that have lost their identity) may be evident at this time. This process leads to development of the tumour.
A common cancer promoter is chronic inflammation. Others include hormones and chemicals in the environment.
Progression is an extension of the promoter stage with one exception: now the cancer growth is no longer dependent on exposure to the promoter. The growth now becomes autonomous. The cell is capable of functioning outside of the rules that regulate cell growth, division and death.
a. Draw a picture and label the circulation of the brain. (4 marks)
You will only need to label: anterior cerebral artery, middle cerebral artery, posterior cerebral artery, vertebral artery, basilar artery and carotid arteries.
b. Describe the areas of the brain affected by a large embolus partially blocking the basilar artery. (2 marks)
Basilar artery ischaemic stroke – all of the brainstem, cerebellum and cranial nerves
c. Explain the resultant clinical features of this embolus. (4 marks)
Clinical features – loss of vital functions such as respiratory control, cardiac control, potential mortality because of this. Less severe problems - balance and coordination difficulties due to the impact on the cerebellum. Lack of control of the face (smell, eyes, mouth, auditory and facial muscles) due to impact on the cranial nerves.
a. Give a definition of Parkinson’s disease. (1 mark)
Parkinson’s Disease is a chronic, progressive neurodegenerative disorder characterised by tremor and disturbance of voluntary movement, posture and balance
