Qs Flashcards
What are prostaglandins used for in labour?
Used in a pessary intra-vaginally to induce labour
What is oxytocin used for in labour?
To augment a slow non-obstructed labour
What is used to slow labour by direct action on uterine smooth muscle receptors?
Beta adrenoreceptor agonist
What is the likely mode of transmission of dengue fever?
Biting insects
What is the likely mode of transmission of rotavirus?
Ingestion
What is the likely mode of transmission of papillomavirus?
Skin contact
Nearly all cervical cancer is due to 2 types of HPV. Which HPV strains account for 70% of all cases?
HPV16 and HPV18
Which HPV strains commonly cause genital warts and laryngeal papillomatosis?
HPV6 and HPV11
What does rotavirus cause?
Severe diarrhoea in young children by faecal-oral transmission
A 30 year old man with HIV AIDS is found to have a vascular pigmented lesion on his trunk and another on his neck. This is thought to be Kaposi’s sarcoma.
Which microorganism is associated with this cancer?
Human herpesvirus type 8
A 57 year old woman presents with a blood-stained vaginal discharge. She is found to have an abnormal mass arising in the region of the cervix.
Which microorganism is associated with this cancer?
Human papilloma virus
A 65 year old man presents with weight-loss and epigastric pain he is found to have an ulcer on the greater curve of the stomach which on biopsy is found to be malignant.
Which microorganism is associated with this cancer?
Helicobacter pylori
What is the MOA of dacarbazine used in Hodgkin’s disease.
- Bifunctional alkylation of DNA and proteins
- Cytotoxic antibody
- Hormone receptor antagonism
- Ionisation of biological molecules
- Microtubule disruption
- Monofunctional alkylation of DNA and protein
- Structural analogue of a metabolite
- Topoisomerase inhibition
- Tyrosine kinase inhibition
Monofunctional alkylation of DNA and protein
What is the MOA of the anthracycline, doxorubicin used to breast cancer.
- Bifunctional alkylation of DNA and proteins
- Cytotoxic antibody
- Hormone receptor antagonism
- Ionisation of biological molecules
- Microtubule disruption
- Monofunctional alkylation of DNA and protein
- Structural analogue of a metabolite
- Topoisomerase inhibition
- Tyrosine kinase inhibition
Topoisomerase inhibition
What is the MOA of the nitrogen mustard, cyclophosphamide widely used in solid tumours and leukaemias?
- Bifunctional alkylation of DNA and proteins
- Cytotoxic antibody
- Hormone receptor antagonism
- Ionisation of biological molecules
- Microtubule disruption
- Monofunctional alkylation of DNA and protein
- Structural analogue of a metabolite
- Topoisomerase inhibition
- Tyrosine kinase inhibition
Bifunctional alkylation of DNA and proteins
Formation of acute skin abscesses are involved with which cell type.
- Basophils
- Eosinophils
- Giant cells
- Lymphocytes
- Macrophages
- Mast cells
- Monocytes
- Neutrophils
- Plasma cells
Neutrophils
Release of histamine in the tissues is involved with which cell type?
- Basophils
- Eosinophils
- Giant cells
- Lymphocytes
- Macrophages
- Mast cells
- Monocytes
- Neutrophils
- Plasma cells
Mast cells
Which cell type is associated with the precursor in the blood of tissue mast cells?
- Basophils
- Eosinophils
- Giant cells
- Lymphocytes
- Macrophages
- Mast cells
- Monocytes
- Neutrophils
- Plasma cells
Basophils
Release of what is activated by decreased afferent arteriolar pressure and filtered sodium load?
Renin
What is angiotensinogen the substrate for?
Renin - they combine to form angiotensin I
Where is angiotensinogen and renin released from?
Renin - juxtaglomerular kidney cells
Angiotensinogen - liver
The juxtaglomerular cells are stimulated to release renin by signaling from what?
The macula densa (an area closely packed specialized cells lining of the DCT)
What is the macula densa?
The macula densa is the thickening where the distal tubule touches the glomerulus.
The cells of the macula densa are sensitive to the concentration of sodium chloride in the distal convoluted tubule.
What type of joint is the Glenohumeral joint?
What movements does it permit?
Synovial (ball and socket)
- Flexion and extension
- Adduction and abduction
- Circumduction
What type of joints are present at the proximal and distal radio-ulnar joints?
Synovial pivot joints
Allow for supination and pronation
What type of joint is in the wrist?
What type of movement does it allow?
Synovial condyloid joint
Flexion, extension, adduction, abduction, circumduction
A 45 year old man undergoes gastrectomy for treatment of a benign ulcer, which of the following hormones is likely to be most deficient as a result:
- Cholecystokinin
- Gastrin
- Motilin
- Secretin
- Vasoactive intestinal polypeptide
- Gastrin
A 20 year old man consulted his general practitioner complaining of bloating of his stomach after eating. A barium meal showed normal gastric mucosal appearance but delayed gastric emptying. The excess production of which of the following hormones may be responsible:
- Cholecystokinin
- Gastrin
- Motilin
- Secretin
- Somatostatin
- CCK
A digestive tract enzyme may be initially released in the inactive form. What is the best term to describe this compound:
- Enterokinase
- Enzyme
- Polypeptide
- Protease
- Zymogen
- Zymogen
A 19 year old man ate a large bar of white chocolate. Which of the following digestive processes is most important to promote digestion of the food:
- Conjugation
- Emulsification
- Enterohepatic circulation
- Glycolysis
- Phosphorylation
- Emulsification
A 23 year old male with a history of alcohol misuse presented with acute upper-abdominal pain and vomiting. He was found to have a raised serum amylase. What is the most likely diagnosis:
- Acute appendicitis
- Acute pancreatitis
- Cholangitis
- Dissecting aortic aneurysm
- Peptic ulcer
- Acute pancreatitis
A 47 year old man was referred for investigation of impaired defecation. Which of the following mechanisms best describes the normal defecation mechanism:
- Stretch receptors in the rectal wall activate both sympathetic and parasympathetic centers in the spinal cord
- Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord
- Stretch receptors in the rectal wall activate sympathetic centers in the spinal cord
- The external anal sphincter contracts
- The internal anal sphincter is consciously relaxed
- Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord
A 50 year old man presented to the emergency department complaining of a 3 month history of epigastric pain and a 2 day history of a very high volume of vomiting. What is the most likely anatomic site of bowel obstruction to cause this symptom:
- Distal ileum
- Gastro-oesophageal junction
- Mid-oesophagus
- Sigmoid colon
- Third part of the duodenum
- Third part of the duodenum
A 45 year old woman has surgical removal of her distal ileum to treat inflammatory bowel disease. Which of the following vitamins is she at risk of becoming deficient in:
- Vitamin B1
- Vitamin B5
- Vitamin B6
- Vitamin B12
- Vitamin C
- Vitamin B12
A 24 year old has an inherited defect and is unable to produce intrinsic factor. The absorption of which of the following substances is most likely to be impaired:
- Bile salts
- Free amino acids
- Glucose
- Vitamin B12
- Water
- Vitamin B12
A 55 year old man presents with a 6 year history of progressive painless jaundice and weight loss. On inspection, he is jaundiced. Abdominal palpation is normal. What is the most likely diagnosis:
- Crohn’s disease
- Diverticular disease
- Duodenal ulcer
- Pancreatic cancer
- Renal carcinoma
- Pancreatic cancer
A 30 year old man presents with jaundice. He has been complaining of intermittent right hypochondrial pain and nausea for several months, but the pain has worsened, his urine is darker than usual and his stools pale. Which imaging is most appropriate in the first instance:
- Abdominal radiograph
- Abdominal ultrasound
- Computed tomography
- Isotope liver scintigraphy
- Positron emission tomography
- Abdominal ultrasound
A 45 year old man is stabbed in the lower chest. The knife cuts most of the vagus nerve fibres around the oesophagus. He makes a good recovery. Which of the following is most likely to occur as a result of the nerve injury:
- Delayed gastric emptying
- Increased gastrin secretion
- Increased intestinal peristalsis
- Increased pancreatic enzyme production
- Reduced bile production
- Delayed gastric emptying
A 40 year old man has a total colectomy to treat a colonic carcinoma. The operation is curative. Which of the following is most likely to occur as a result of this operation:
- Constipation
- Excessive water retention
- Hyponatremia
- Reduced absorption of vitamin A
- Reduced glucose absorption
- Hyponatremia
One of the major functions of the intact large intestine is to absorb water and electrolytes. After colectomy, as much as 400-1000 ml of nearly isotonic ileostomy fluid may be excreted, resulting in a chronic salt and water depletion.
A 70 year old woman presents with jaundice. She has been complaining of right abdominal pain and altered bowel habit for several months. On examination she has a hard craggy mass in her right iliac fossa and hepatomegaly. An abdominal ultrasound is performed. Which of the following is the most likely finding in the liver at ultrasound:
- Cholecystitis
- Gallstones impacted in the common bile duct
- Liver abscess
- Macronodular cirrhosis
- Multiple liver metastases
- Multiple liver metastases
A 70 year old man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph shows multiple dilated loops of bowel. Which of the following bowel findings on abdominal x-ray would be in keeping with small bowel obstruction:
- Central distribution of loops of bowel
- Haustral mucosal folds
- Peripheral distribution of loops of bowel
.4. Relatively few loops - Wide angle of curvature of loops of bowel
- Central distribution of loops of bowel
A 45 year old smoker presents with massive haematemesis and melaena. Endoscopy reveals an actively bleeding posterior ulcer in the first part of the duodenum. Which artery is most likely to be bleeding:
- Aorta
- Common hepatic
- Gastroduodenal
- Right gastric
- Splenic
- Gastroduodenal
A 20 year old female medical student suffers from severe secretory diarrhoea while backpacking in India. She remembers that oral rehydration therapy (ORT) is an effective way to counter the dehydration caused by intestinal fluid loss. Which of the following ingredients would be required to make up a suitable ORT solution:
- Potassium chloride + fructose
- Potassium chloride + glucose
- Sodium chloride + fructose
- Sodium chloride + glucose
- Sodium chloride + monoglyceride
- Sodium chloride + glucose
A patient underwent a cholecystectomy for treatment of chronic cholecystitis. During the operation, the surgeon noticed arterial blood loss from the gallbladder neck. Which artery is most likely to have been injured:
- Coeliac trunk
- Cystic artery
- Inferior pancreaticoduodenal artery
- Splenic artery
- Superior mesenteric artery
- Cystic artery
A 50 year old patient has chronic peptic ulcer disease that has not responded to drug therapy and undergoes surgical removal of the gastric antrum to reduce gastric acid production. How does the surgical procedure reduce acid production:
- Decreases gastrin production
- Decreases pepsin synthesis
- Increases bile production
- Increases cholecystokinin production
- Increases gastric emptying
- Decreases gastrin production
A 25 year old woman presents with a 6-week history of diarrhoea and oral aphthous ulcers. Her stool contains blood and mucous. What is the most likely diagnosis:
- Crohn’s disease
- Diverticulitis
- Infective diarrhoea
- Irritable bowel syndrome
- Ulcerative colitis
- Crohn’s disease
A 25 year old man presents with fever, bloody diarrhoea and cramping for several weeks that does not resolve with antibiotic therapy. Proctosigmoidoscopy reveals red, raw mucous and pseudopolyps. What is the most likely cause:
- Campylobacter infection
- Crohn’s disease
- Irritable bowel disease
- Ulcerative colitis
- Viral gastroenteritis
- Ulcerative colitis
A 20 year old man presents with a 12-history of collicky periumbillical pain, which shifts to the right iliac fossa, fever and a loss of appetite. What is the most likely diagnosis:
- Acute appendicitis
- Acute pancreatitis
- Acute viral hepatitis
- Diverticular disease
- Perforated peptic ulcer
- Acute appendicitis
A 45 year old man was admitted to hospital after ingesting 25 g of paracetamol 3 days earlier. He had no notable past medical history, took no regular medication and rarely consumed alcohol. Which of the following signs would be consistent with his presentation:
- Finger clubbing
- Gynaecomastia
- Jaundice
- Palmar erythema
- Spider naevi
- Jaundice
A researcher is investigating enzymatic digestion of polysaccharides. Which of the following combinations of disaccharides and digested products is correct.
- Maltose = 3 glucose
- Maltose = 1 glucose + 1 fructose
- Sucrose = 1 galactose + 1 glucose
- Lactose = 1 glucose + 1 galactose
- Sucrose = 2 glucose
- Lactose = 1 glucose + 1 galactose
A 71 year old man had a malignant tumour of the middle third of the oesophagus. What is the most likely histopathological diagnosis:
- Adenocarcinoma
- Adenoma
- Gastrointestinal stromal tumour
- Liposarcoma
- Squamous cell carcinoma
- Squamous cell carcinoma
Name the different skin layers
Epidermis
Dermis
Hypodermis
Which of the following skin cells are responsible for immediate type hypersensitivity reactions in the skin
- Neutrophils
- Lymphocytes
- Mast cells
- Melanocytes
- Mast cells
A small, superficial, circumscribed elevation of the skin, less than 0.5cm, that contains serous fluid is called
- Papule
- Macule
- Nodule
- Vesicle
- Vesicle = small fluid filled
Acute urticaria is an example of which type of hypersensitivity reaction
- Type 1 = IgE produced specific to an antigen
- Type 2 = antibodies bind to antigens on self-surface
- Type 3 = accumulation of immune complexes that give rise to an inflammatory response
- Type 4 = delayed (2-3 days) T cell-mediated response
- Type 1 = IgE produced specific to an antigen
All of the following can be used in the treatment of atopic eczema except
- Topical steroids
- Antihistamines
- Emollients
- Antifungal cream
- Antifungal cream
Impetigo is a skin infection caused by
- Gram positive cocci
- Gram negative bacilli
- Anaerobes
- Protozoa
- Gram positive cocci = staphylococcus aureus and streptococcus pyogenes
List 4 risk factors for melanoma skin cancer
Previous history of skin cancer
Family history of skin cancer
Fair skin (type 1 + 2 skin)
Living in tropical countries for more than 1 year
Working outdoors
Immunosuppressive diseases or immunosuppressive treatment
The cell of origin in a squamous cell carcinoma
- Melanocytes
- Basal cells
- Keratinocytes
- Endothelial cells
- Keratinocytes = SCC
Melanocytes = melanoma
Basal cells = BBC
Treatment of actinic keratosis involves all of the following except:
- Topical mupirocin
- Topical 5 fluorouracil
- Liquid nitrogen
- Topical imiquimod
- Topical mupirocin
Acne vulgaris is a common skin condition which is characterised by
- Comedones, papules, pustules and nodulocysts
- Vesicles and bullae
- Scales and crusts
- Ulceration and erosions
- Comedones, papules, pustules and nodulocysts
What unit of measurement can be used for topical medicines?
Fingertip unit measurement (FTU)
List 3 clinical types of psoriasis
Plaque psoriasis Guttate psoriasis Erythrodermic psoriasis Pustular psoriasis Palmoplantar psoriasis Nail psoriasis Scalp psoriasis
A well-circumscribed, elevated, superficial, solid lesion, greater than 1cm in diameter is termed
- Papule
- Nodule
- Pustule
- Plaque
- Plaque = larger raised area
Papule = small raised area Nodule = ? Pustule = small pus filled Plaque = larger raised area
A 56 y old man presented with multiple, well-defined warty and greasy papules with a ‘stuck on’ appearance on his back; what is the most likely diagnosis
- Melanocytic nevi
- Malignant melanoma
- Seborrheic warts
- Cherry angioma
- Seborrheic warts
A 19 year old lady presented with red, dry excoriated patches on her face, back, arms, cubital and popliteal fossae; her mother and sister have the same problem; what is the most likely diagnosis
- Scabies
- Seborrheic dermatitis
- Urticaria
- Atopic dermatitis
- Atopic dermatitis
What are 3 types of medications that can be applied topically?
Topical steroids
Topical antifungals
Topical immunosuppressive
Topical antibiotics
Name the 3 types of skin cancer
SCC
BCC
Melanoma
What are the functions of the skin (name at least 3)?
Protection Sensation Temperature regulation Immunity Excretion
Name 2 benign skin lesions
Benign melanocytic nevus
Seborrheic keratosis
Concerning the motor homunculus. Which of the following structures is represented the most medially:
- Eye
- Face
- Knee
- Tongue
- Wrist
- Knee
An 80 year old man presents to his GP with gradual onset of walking difficulties, urinary incontinence and cognitive decline. Heh as no headache. These symptoms are most typical of:
- Frontal lobe tumour
- Multiple sclerosis
- Normal pressure hydrocephalus
- Parkinson’s disease
- Vascular dementia
- Normal pressure hydrocephalus
A 51 year old man is noted to have a left trigeminal nerve palsy. Which of the following is the most likely examination finding:
- He has absent taste sensation to the anterior 2/3 of the left of the tongue
- He has numbness over the left mandible
- He has numbness over the right maxilla
- He has numbness over the right posterior aspect of the scalp
- He is unable to smile with the left side of his mouth
- He has numbness over the left mandible
A 36 year old woman attends her GP stating that she feels like she can’t cope looking after her 3 month old baby. She says that she worries all the time about her ability to raise her child. Which of the following could not be explained by anxiety:
- Brisk reflexes with flexor plantar responses
- Excessive sweating and palpitations
- Fatigue and feeling of something stuck in the throat
- Numb legs and extensor plantar responses
- Poor concentration and forgetfulness
- Numb legs and extensor plantar responses
A 50 year old right handed barman presents with cognitive language dysfunction. He has difficulty expressing what he wishes to say and difficulty reading e-mails. He has been taking dihydrocodeine (oral opiates) for rib pain for the last 6 weeks. Which of the following is the most likely explanation for these findings:
- Alcohol intoxication
- Lesion in left temporo-parietal area
- Lesion in right temporo-parietal area
- Opiate dependence
- Right chronic subdural haematoma
- Lesion in left temporo-parietal area
A 69 year old man presented with left-sided neglect. Which of the following structures is most likely to be affected:
- Left frontal lobe
- Left parietal lobe
- Right frontal lobe
- Right parietal lobe
- Right temporal lobe
- Right parietal lobe
A 21 year old man is involved in a road traffic accident. On arrival in the accident and emergency department his Glasgow Coma Scale (GCS) is 6 and he is subsequently intubated and ventilated. In order to assess his head injury further, what is the most appropriate investigation:
- Computerised tomography (CT) brain
- Functional magnetic resonance imagine (MRI)
- Magnetic resonance imaging (MRI) brain
- Positron emission tomography (PET) scan
- Skull X-rays
- Computerised tomography (CT) brain
A 47 year old woman who is known to have multiple sclerosis (MS), presents to her GP with new onset of diplopia. In MS there is demyelination of axons in the brain and spinal cord. Which of the following glial cells form the myelin sheaths in the central nervous system:
- Astrocyte
- Endothelial cells
- Microglia
- Oligodendrocyte
- Schwann cell
- Oligodendrocyte
A 19 year old woman was noted to have decreased vision. Which of the following is an appropriate method of testing the function of the 2nd cranial nerve:
- Asking the patient to screw her eyes shut
- Assessing the corneal reflex
- Assessing the pupil response to light
- Assessing the vestibulo ocular reflex
- Looking for nystagmus
- Assessing the pupil response to light
Asking the patient to screw her eyes shut = CN 7
Assessing the corneal reflex = CN 5
response to light
Assessing the vestibulo ocular reflex = CN 8
Looking for nystagmus = CN 8
Which of the following is an appropriate method of testing the function of the 7th cranial nerve:
- Asking the patient to screw her eyes shut
- Assessing the corneal reflex
- Assessing the pupil response to light
- Assessing the vestibulo ocular reflex
- Looking for nystagmus
- Asking the patient to screw her eyes shut
Which of the following is an appropriate method of testing the function of the 8th cranial nerve:
- Asking the patient to screw her eyes shut
- Assessing the corneal reflex
- Assessing the pupil response to light
- Assessing the vestibulo ocular reflex
- Looking for nystagmus
- Assessing the vestibulo ocular reflex
5. Looking for nystagmus
Which of the following is an appropriate method of testing the function of the 5th cranial nerve:
- Asking the patient to screw her eyes shut
- Assessing the corneal reflex
- Assessing the pupil response to light
- Assessing the vestibulo ocular reflex
- Looking for nystagmus
- Assessing the corneal reflex
A 40 year old man is admitted for assessment of suspected syphilis. Which organism is responsible for syphilis:
- Borrelia burgdorferi
- Leptospira interrogans
- Staphylococcus aureus
- Streptococcus anginosus
- Treponema pallidum
- Treponema pallidum
A 55 year old man has difficulty walking and attends his GP. Which of the following is the most likely feature of an upper motor neurone lesion:
- Absent reflexes
- Dysdiadochokinesia
- Hypotonia
- Muscle fasciculations
- Sustained clonus
- Sustained clonus
A 16 year old boy presented with a spinal cord injury with absent motor response below C7. Which of the following is an example of a descending spinal cord tract:
- Anterior spinocerebellar tract
- Dorsal column pathway
- Lateral corticothalamic tract
- Lateral spinothalamic tract
- Posterior spinocerebellar tract
- Lateral corticothalamic tract
Which of the following is an example of an ascending spinal cord tract:
- Anterior corticospinal tract
- Lateral corticospinal tract
- Corticobulbar tracts
- Medial reticulospinal tract
- Lateral reticulospinal tract
- Rubrospinal tract
- Tectospinal tract
- Dorsal column pathway
- Dorsal column pathway
Other examples:
- Anterior spinothalamic tract – carries the sensory modalities of crude touch and pressure.
- Lateral spinothalamic tract – carries the sensory modalities of pain and temperature.
- Posterior spinocerebellar tract – Carries proprioceptive information from the lower limbs to the ipsilateral cerebellum.
- Cuneocerebellar tract – Carries proprioceptive information from the upper limbs to the ipsilateral cerebellum.
- Anterior spinocerebellar tract – Carries proprioceptive information from the lower limbs. The fibres decussate twice – and so terminate in the ipsilateral cerebellum.
- Rostral spinocerebellar tract – Carries proprioceptive information from the upper limbs to the ipsilateral cerebellum.
What muscles do the corticobulbar tracts supply?
The corticobulbar tracts arise from the lateral aspect of the primary motor cortex. They receive the same inputs as the corticospinal tracts. The fibres converge and pass through the internal capsule to the brainstem.
The neurones terminate on the motor nuclei of the cranial nerves. Here, they synapse with lower motor neurones, which carry the motor signals to the muscles of the face and neck.
List cardinal signs of upper motor neuron lesions.
Hypertonia – an increased muscle tone
Hyperreflexia – increased muscle reflexes
Clonus – involuntary, rhythmic muscle contractions
Babinski sign – extension of the hallux in response to blunt stimulation of the sole of the foot
Muscle weakness
A 51 year old man is noted to have poor coordination. Which of the following is an appropriate method of testing coordination of the lower limb:
- Ask the patient to state if his toe is moved up or down, when his eyes are shut
- Assessing the patient’s ability to sit up from lying
- Assessing the plantar response
- Finger-nose test
- Heel-shin test
- Heel-shin test
A 30 year old man developed intense burning pain in his arm after spilling concentrated bleach on it by accident. This pain response was mediated by the C class of pain nociceptor. Which of the following properties is most associated with C fibres:
- Efferent
- Fast conduction (20m/s)
- Nucleus located in the thalamus
- Typical diameter of 1-5um
- Unmyelinated
- Unmyelinated
A 64 year old man presented with a haemorrhage in his left internal capsule. Which of the following arteries is most likely to supply this area:
- Left external carotid artery
- Left middle cerebral artery
- Left posterior cerebral artery
- Right anterior cerebral artery
- Right middle cerebral artery
- Left middle cerebral artery
A 75 year old man presents to his GP with a progressive impairment of his cognitive function. He is diagnosed with dementia. Which of the following is suggestive of a vascular aetiology for his dementia:
- Abnormal movements
- Myoclonus
- Parkinsonism
- Rapid progression of the dementia
- Stepwise progression
- Stepwise progression
A 51 year old man was noted to have an upper motor neuron 7th nerve palsy. Which of the following is an appropriate method of testing the function of the 7th cranial nerve:
- Asking the patient to clench his teeth
- Asking the patient to smile in order to show you his teeth
- Assessing the jaw jerk
- Looking for wasting of the temporalis muscle
- Testing light touch over the mandible and maxilla
- Asking the patient to smile in order to show you his teeth
A 63 year old woman presents with a gradual onset of a right sided weakness and early morning headaches. She undergoes a computerised tomography (CT) scan of her brain. The report of this suggests that she has a metastatic lesion to her left parietal lobe. Tumours from which of the following primary sites commonly metastasise to the brain:
- Bone
- Breast
- Meninges
- Schwann cells
- Tongue squamous cell
- Breast
A 47 year old woman presented to the emergency department with severe back pain and urinary retention. She was numb around her perineum and had absent ankle jerks. Which of the following is the most likely diagnosis:
- Cauda equina syndrome
- Gerstmann’s syndrome
- Guillain-barre syndrome
- L3 radiculopathy
- S1 radiculopathy
- Cauda equina syndrome
A condition due to damage to the bundle of nerves below the end of the spinal cord known as the cauda equina.
Symptoms include: low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control.
What is the most effective imaging test for the diagnosis of MS?
MRI
A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which muscle tendon is intact and has normal function?
Teres Major
A 35-year-old left-handed baseball pitcher experiences a severe spasm of pain while abducting his left arm in beginning to throw a pitch, and is unable to continue playing. Subsequently, he cannot initiate abduction of the left arm. However, if that arm is passively elevated through the first 15° of abduction, he can complete bringing the arm up to a right angle. The tendon of which of the muscle is most likely torn?
Supraspinatus
An 18-year-old boy is cut severely on the lateral wall of his right chest during a knife fight. Following healing, his scapula moves away from the thoracic wall when he leans on his right hand, giving the appearance indicated in the given photo. Which of the nerve is likely damaged?
Long thoracic nerve
A 22-year-old woman professional soccer player falls hard onto her outstretched right hand during a game, injuring her wrist. Manipulation of the wrist during postgame physical examination by the team physician elicits deep pain in the anatomical snuffbox. Follow-up radiographs will most likely reveal a fracture of which of the bone?
Scaphoid
A 38-year-old baseball pitcher felt a sharp pain in his shoulder when he threw the ball very hard. After a visit by the pitching coach, he threw another pitch but he told the catcher that the pain was unbearable. He left the game and went to the dressing room where he was examined by the team’s orthopedic surgeon, who detected tenderness near the greater tubercle of the humerus. An MRI taken the next day revealed a tear in the pitcher’s rotator cuff. What is the most likely cause of the pitcher’s sore shoulder?
Acute rupture of the supraspinatus part of the rotator cuff.
Physical examination of a 40-year-old man injured in an automobile accident indicates that he has suffered nerve damage affecting his left upper limb. The patient exhibits significant weakness when pronating his left forearm and flexing his left wrist. What nerve is most likely damaged?
Median nerve
A 45-year-old secretary experienced “pins and needles” sensations (paresthesia) and pain in her right hand during the night. These sensations involved the palmar surface of her thumb and the lateral two and a half fingers. Her colleagues told her that she probably has carpal tunnel syndrome. Her family physician confirmed that this was the condition she was experiencing. She also told the physician that she was having some difficulty typing. On further examination, the physician detected some weakness of her right thenar muscles when compared with the left side. Otherwise motor functions were unimpaired currently.
Distal (carpal) compression of the median nerve
A 10-year-old boy was running across a parking lot when he tripped and received lacerations on the base of his thumb from a broken glass bottle. On examination, his thumb was unable to oppose to his fingers, and the thumb also showed weakness when abducting and flexing. No sensory deficits were reported. What nerve was most likely severed?§
Recurrent branch of median nerve
The ulnar nerve innervates _______________.
part of flexor digitorum profundus.
A 14-year-old boy falls on his outstretched hand and has a fracture of the scaphoid bone. The fracture is most likely accompanied by a rupture of which artery?
Radial artery
As part of a physical examination to evaluate muscle function in the hand, a physician holds the four fingers (digits 2 through 5) and asks the patient to spread their fingers, as shown below. What muscle(s) is/are the doctor testing?
Dorsal interosseous muscles
A 20-year-old man fell from the parallel bar during the Olympic trial. A neurologic examination reveals that he has a lesion of the lateral cord of the brachial plexus. Which of the muscle is most likely weakened by this injury?
Pectoralis major
A 31-year-old patient complains of sensory loss over the anterior and posterior surfaces of the medial third of the hand and the medial one and one-half fingers. He is diagnosed by a physician as having “funny bone” symptoms. Which of the nerve is injured?
Ulnar nerve
The first bone in the body to ossify and one of the most commonly fractured bones in the body is the______________.
Clavicle
A 12-year-old boy walks into your office. He fell out of a tree and fractured the upper portion of his humerus. Which nerves are intimately related to the humerus and are most likely to be injured by such a fracture?
Radial and axillary
A 33-year-old tennis player with a history of biceps tendinitis experienced vague pain in the anterior region of her glenohumeral joint. She said she had the sensation of popping during her third set. During the preliminary examination by her trainer, he noted tenderness over the intertubercular groove in the humerus, flexion and supination weakness of the forearm, and an abnormal bulge in the distal part of the anterior part of her arm. Radiographs of the shoulder and arm did not reveal skeletal abnormalities. Rupture of what is most likely the symptoms and signs in this case?
Rupture of the tendon of the long head of the biceps
A secretary comes in to your office complaining of pain in her wrists from typing all day. You determine that she likely has carpal tunnel syndrome. Which condition would help you determine the diagnosis?
Flattened thenar eminence
A 3-year-old girl is brought to the emergency room holding her right arm with the elbow flexed and the forearm pronated. She refuses to move her arm and complains her elbow “hurts a lot.” Her mother reports they were holding hands and running in the park when the child tripped. The mother pulled on the child’s hand to prevent her from hitting the ground. Given the nature of this injury and the age of the patient, what structure is most likely damaged?
Annular ligament of radius
A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. The damaged nerve causes numbness of the lateral side of the arm. Cell bodies of the injured nerve fibers involved in sensory loss are located in which structure?
Dorsal root ganglion
A 64-year-old man with a history of liver cirrhosis has been examined for hepatitis A, B, and C viruses. In an attempt to obtain a blood sample from the patient’s median cubital vein, a registered nurse inadvertently procures arterial blood. During the procedure, the needle hits a nerve medial to the artery. Which of the nerve is most likely damaged?
Median
A 56-year-old woman was stopped at a light when her car was rear-ended by another car. She had her right arm on the steering wheel, and the impact caused forced flexion at her elbow. Several months later, she comes to her physician complaining of numbness and a “pins and needles” sensation in her right little finger when she talks on the phone, rests her head on her right hand at work, or spends most of her day typing at work. She also notices the quality of her typing and her ability to play the violin have diminished. Which nerve is compressed at what location?
Ulnar nerve in the elbow
A 21-year-old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which muscle?
Latissimus Dorsi
A 27-year-old patient presents with an inability to draw the scapula forward and downward because of paralysis of the pectoralis minor. What would most likely be a cause of his condition?
Fracture of coracoid process
A 16-year-old boy fell from a motorcycle, and his radial nerve was severely damaged because of a fracture of the midshaft of the humerus. Which conditions would most likely result from this accident?
Loss of wrist extension leading to wrist drop
During an attempted suicide, a depressed young woman slashes her wrist with a straight razor. She cuts just proximal to the pisiform bone to the depth of the superficial aspect of the flexor retinaculum before passing out at the sight of her own blood. As a result of this wound, she may suffer what kind of neuromuscular deficit?
Inability to adduct thumb
Lateral rotation of the arm is an important mechanical component of “bringing the arm back” when preparing to throw an object. What muscle acts to produce lateral rotation of the arm?
Teres minor
A dermatologist performed a biopsy on a suspicious mole on the right side of the posterior neck of a 57-year-old male construction worker. Pathology confirmed a malignant melanoma, so the physician excised a substantial amount of tissue surrounding the mole. After the procedure, the patient experienced difficulty elevating his right shoulder and lifting his right arm over his head. No sensory deficits were seen. What nerve was most likely damaged in this patient?
Accessory nerve
A physician tests the myotatic biceps reflex as shown. A normal response of involuntary contraction of the biceps brachii muscle is noted. This reflex confirms the integrity of what nerve?
Musculocutaneous nerve
A 58-year-old man who smokes presents with a single episode of moderate intensity chest pain, retrosternal and radiating to his jaw, and some mild sweatiness. The pain lasted 2 hours, and he came to A&E. Examination is normal, as is his ECG, and his troponin is not raised. Which of the following options should be followed?
A He may now be safely discharged home for further outpatient evaluation
B He has an acute coronary syndrome and must start dual antiplatelet therapy and low molecular weight heparin immediately
C He is most likely to have gastro-oesophageal reflux
D An aortic dissection is likely
E The diagnosis is open and he needs continued inpatient evaluation
E The diagnosis is open and he needs continued inpatient evaluation
A 67-year-old man presents with bilateral ankle oedema and pitting. Which of the following possible causes is most likely?
A A deep venous thrombosis B Cellulitis C A ruptured Baker's cyst D Amlodipine E Bisoprolol
D Amlodipine
DVT, cellulitis and a ruptured Baker’s cyst cause unilateral oedema, whereas bisoprolol does not cause bilateral oedema unless it has led to decompensated heart failure, which is possible, but not common.
In evaluating bilateral leg oedema, which of the following are important?
A Examining the jugular venous pressure B Rectal examination C Determining the presence of inguinal lymph nodes D A travel history E All the above
E.
The differential diagnosis of leg oedema is broad and includes heart failure, rectal/pelvic cancer, cellulitis, lymphatic obstruction due to cancer or to filariasis, and other causes. A full careful history and examination is always appropriate.
The commonest cause of palpitations seen in the GP surgery is which of the following?
A Non-arrhythmic e.g. due to anxiety B Related to ectopic beats C Due to thyrotoxicosis D Due to severe structural heart disease E Due to a serious heart rhythm disturbance
A Non-arrhythmic e.g. due to anxiety
Which of the following are true in investigating palpitations?
A The history is rarely helpful B The resting ECG is diagnostic C A 24-hour ECG is very useful D A family history is not needed E An ECG during an attack is diagnostic
E An ECG during an attack is diagnostic
A 48-year-old man presents with several months of increasing bilateral leg pain, particularly affecting the distal extremities, and he states that it feels ‘as if he is walking on cotton wool’. Examination shows him to be thin, with normal foot pulses, normal orthopaedic examination, decreased light touch and joint position sense distally, and absent ankle jerks. Which of the following is the diagnosis is likely to be?
A Psychological B Hyperviscosity syndrome C Raynoud's phenomona D Painful peripheral neuropathy E Referred pain from the back
D Painful peripheral neuropathy
Alcoholic peripheral neuropathy is often painful; the clue is likely to be in the general condition of the patient (thin, recent weight loss), along with the specific clinical findings. The neuropathy should be confirmed (by EMG), and then the full range of possible causes excluded.
A man presents with a unilateral, swollen, painful left leg 4 weeks after a left total hip replacement. Which of the following are inappropriate investigations?
A A full blood count B D-dimer C Chest X-ray D Doppler ultrasound of the leg E ECG
B. D-dimer
The pre-test probability of a deep venous thrombosis is very high; a D-dimer in no way alters this probability and is contraindicated.
An 85-year-old man presents with effort breathlessness associated with a retrosternal ache. Examination shows a normal rising carotid upstroke, a loud ejection murmur heard best at the apex, and an absence of the second heart sound. The diagnosis is likely to be which of the following?
A Mitral regurgitation B Pulmonary stenosis C Ventricular septal defect D Aortic stenosis E Anaemia with a flow murmur
D Aortic stenosis
The demographics, history and exam are all consistent with aortic stenosis. A normal carotid upstroke is very common in elderly patients with aortic stenosis.
A 35-year-old woman presents breathless at 35 weeks of pregnancy; she has a body mass index of 40, and a grade III/VI murmur along the mid left sternal edge, with no other cardiorespiratory signs. The likely diagnosis of the murmur is which of the following?
A A benign flow murmur B Aortic stenosis C Atrial septal defect D Aortic regurgitation E Mitral stenosis
A A benign flow murmur
A flow murmur is almost universal in advanced pregnancy.
In which of the following types of shock is giving an intravenous bolus of crystalloid most likely to lead to deterioration in the patient’s condition?
A Septic shock due to line sepsis
B Shock due to an acute myocardial infarction complicated by pulmonary oedema
C Shock due to an acute pulmonary embolus
D Anaphylactic shock
E Shock due to cardiac tamponade
B.
Fluid therapy is an appropriate treatment for most forms of shock when evidence of organ hypoperfusion persists. In cardiogenic shock there is a low COt and the heart will be operating on the flat part of the Frank–Starling curve. Increasing venous return is unlikely to increase cardiac output, which may stay the same or fall. Fluid therapy in these circumstances may make pulmonary oedema and hypoxia worse. Note that synthetic colloids may be a rare cause of anaphylactic shock; therefore one must be cautious about using colloids as fluid therapy in this condition as this may have been the original aetiology of anaphylaxis.
Which one of the following statements about common causes of persistent cough with a normal chest X-ray is FALSE?
A Oesophageal reflux
B Pulmonary fibrosis
C Post nasal drip
D Asthma
B.
Cough lasting more that 6 weeks in the context of a normal chest X-ray is commonly due to asthma, postnasal drip or acid reflux. Empirical treatment for these conditions following on from a careful history and examination results in resolution in the majority of patients. In pulmonary fibrosis the chest X-ray may be normal, but usually either clinical or radiological signs are present.
Which of the following does NOT typically cause wheeze?
A Chronic obstructive pulmonary disease B Asthma C Bronchiectasis D Tracheal tumour E Pulmonary oedema
D Tracheal tumour
Large airway obstruction by tracheal tumour results in stridor
Wheeze is result of any condition that causes narrowing of smaller airways
Which of the following investigations is NOT useful in the differential diagnosis of wheeze?
A Echocardiogram B Thoracic ultrasound C Spirometry D Chest CT E Flow volume loop
B Thoracic ultrasound
Wheeze is caused by vibration of the airway wall when airway narrowing occurs. It therefore occurs in conditions that lead to narrowing of the airways. These include obstructive pulmonary diseases, which can be diagnosed using spirometry and flow volume loops. Localized obstruction to airways may be revealed by CT of the chest. Pulmonary oedema leading to diffuse airway oedema and narrowing may present with ‘cardiac wheeze’. Echocardiography may occasionally be useful in making this diagnosis.
Which of the following does NOT cause an exudate (high protein content produced by any active process that leads to overproduction of fluid by the pleura)?
A Pancreatitis B Systemic lupus erythematosis C Mesothelioma D Nephrotic syndrome E Pneumonia
D. Nephrotic syndrome
Conditions such as cardiac failure, nephrotic syndrome and malnutrition typically cause transudates that are low in protein content and are caused by an imbalance between colloid oncotic pressure (which tends to hold fluid in the vascular compartment) and pressure driving fluid into the pleural space.
Which of the following statements is true?
A Plain chest X-ray is the most reliable way of diagnosing pneumothorax
B Primary spontaneous pneumothorax is commonly associated with lung disease
C Drainage of a primary spontaneous pneumothorax generally requires a large-bore chest drain
D Air travel is safe a month after pneumothorax
E Most patients with primary spontaneous pneumothorax will not have a recurrence
E. Most patients with primary spontaneous pneumothorax will not have a recurrence
Only 30% of patients with a primary spontaneous pneumothorax will subsequently have a recurrence.
After the second episode the recurrence rate rises above 50%. Pneumothorax is more reliably diagnosed by ultrasound or CT than on plain X-rays. Treatment is usually effective with either simple aspiration or narrow-bore chest drains. Air travel should be avoided for 3 months.
Which of the following signs does NOT suggest a TENSION pneumothorax?
A Hypotension B Tracheal deviation C Tachycardia D Dyspnoea E Subcutaneous emphysema
E Subcutaneous emphysema (felt as a crackling under the skin) is a sign of air leaking into the skin.
It may occur in any pneumothorax and does not necessarily imply tension
Weight loss and malabsorption is commonly seen as a feature of which of the following?
A Lactose intolerance
B Pernicious anaemia
C Lymphocytic colitis
D Small bowel bacterial overgrowth
D. Small bowel bacterial overgrowth
- Lactose intolerance causes diarrhoea due to colonic fermentation
- Lymphocytic colitis causes colonic diarrhoea
- Pernicious anaemia results in selective deficiency of vitamin B12
Small bowel bacterial overgrowth can occur secondary to jejunal diverticulosis or small bowel motility problems (e.g. systemic sclerosis) and results in small bowel malabsorption.
Selective deficiency of vitamin B12 is a commonly seen feature of which of the following?
A Lactose intolerance
B Pernicious anaemia
C Lymphocytic colitis
D Small bowel bacterial overgrowth
B Pernicious anaemia
As a cause for malabsorption coeliac disease might be suggested by which of the following?
A Abdominal pain
B A characteristic rash
C Vomiting
D Steatorrhoea
B A characteristic rash
Dermatitis herpetiformis is a blistering rash present on the elbows and buttocks. It is now considered specific for coeliac disease.
Abdominal pain and vomiting are each unusual in malabsorption, whereas steatorrhoea is non-specific and does not infer one particular cause over any other.
Which of the following investigations are useful in suspected acute intestinal obstruction?
A Colonoscopy
B Gastroscopy/upper gastrointestinal endoscopy
C Computed tomography
D Abdominal ultrasound
C. CT with contrast (IV and possibly lumenal)
This will delineate the level of intestinal obstruction and may provide diagnostic clues as to the cause
Which one of the following does NOT indicate a significant upper GI bleed?
A A tachycardia of over 100
B Systolic hypotension
C A low red cell mean cell volume
D A raised serum urea
C A low red cell mean cell volume
This is indicative of iron deficiency and is more commonly seen in chronic intestinal blood loss rather than an acute bleed.
A mechanical cause for dysphagia (i.e. a stricture) may be suggested by which of the following?
A A feeling of a ‘lump in the throat’
B Food bolus impaction
C Coughing and spluttering when swallowing liquids
D Belching
B Food bolus impaction
Pain from a gallstone in the common bile duct can be confidently distinguished from one in the gallbladder by which of the following?
A The presence of jaundice
B Vomiting
C The severity of the pain
D The presence of fever
A.
A bile duct stone (choledocolithiasis) will cause intermittent or persisting biliary obstruction resulting in jaundice. Other features of biliary obstruction may include pale stools, dark urine and pruritis (itching)
Pain from the colon can typically be described by which of the following?
A Felt in the middle of the abdomen
B Persistant in quality
C Made worse by eating
D Associated with vomiting
The correct answer is C.
Colonic (hindgut) pain will be felt below the umbilicus. It is due to activation of pressure receptors (baroreceptors) in the wall of the colon, which accounts for its variable intensity (i.e. colicky nature). It will be exacerbated by eating despite activation of the gastro-colic reflex but will only cause vomiting if there is a significant obstruction
Cholestatic jaundice can be seen as an adverse reaction to which of the following drugs?
A Paracetamol
B Simvastatin
C Co-amoxiclav
The correct answer is C.
Co-amoxiclav is a recognized cause of an acute intrahepatic cholestasis similar to that seen as a consequence of using chlorpromazine-based major tranquilizers. Simvastatin is associated with an acute hepatitis but will rarely cause symptomatic jaundice. Paracetamol may cause fulminant liver failure if taken in sufficient quantitites as a deliberate act of self-harm.
A high protein content in ascitic fluid could indicate which of the following?
A Maligancy
B Advanced cirrhosis
C Heart failure
D Nephrotic syndrome
The correct answer is A.
Exudative ascites is reflected by a high protein content and should always arouse suspicion of maligancy or infection even in the setting of established chronic liver heart or renal disease.
Polyuria may be caused by which of the following?
A Increased antidiuretic hormone secretion B Lithium toxicity C Reduced serum sodium concentration D Hypocalcaemia E Hypoglycaemia
The correct answer is B. Increased ADH will reduce urine output. Reduced serum sodium, hypocalcaemia and hypoglycaemia do not directly affect urine output (though hypercalcaemia and hyperglycaemia can cause polyuria). Lithium toxicity is associated with polyuria due to a nephrogenic diabetes insipidus.
In an oliguric patient, which of the following signs point towards fluid depletion?
A A depressed haematocrit B An elevated jugular venous pressure C Pulmonary oedema D Postural hypotension E Hypertension
The correct answer is D.
Fluid depletion would be suggested by an increased haematocrit, a lowered JVP, postural hypotension and hypotension.
Which of the following features are most consistent with a urinary tract infection?
A Pyuria (100 000 white cells/mL of urine) and the presence of nitrite on dipstick
B Proteinuria on dipstick and fever
C Myoglobinuria and muscle pain
D Haematuria and renal impairment
A Pyuria and nitrates
Urinary tract infections are usually associated with pyuria and often by the presence of urinary nitrite which can be detected with dipstick tests.
In a patient with microscopic haematuria, which of the following favours a glomerular source?
A Red cell casts and proteinuria B Blood at the beginning of the urinary stream C Blood at the end of th eurinary stream D Suprapubic pain E Abnormal urine cytology
The correct answer is A.
In a patient red cell casts and proteinuria suggest a glomerular source of bleeding.
Visible blood in the urine (‘macroscopic’ haematuria) only occurs in a limited number of glomerulonephritides such as IgA nephropathy but might indicate a malignancy or other structural lesion of the renal tract.
In a patient with obesity which of the following anti-obesity therapies are currently available?
A Pioglitazone
B Orlistat
C Sibutramine
D Rimonabant
The correct answer is B.
Pioglitazone is associated with weight gain and is used in type 2 diabetes mellitus. C and D have both been withdrawn because of adverse risk profiles.
In a patient with hirsutism (abnormal hair growth on women’s face/body) which finding would make you question whether a diagnosis of polycystic ovary syndrome is incorrect?
A Hyperinsulinaemia
B Elevated 17-hydroxyprogesterone
C Elevated testosterone
D Increased luteinizing hormone/follicle-stimulating hormone ratio
E Elevated androstenedione
The correct answer is C.
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is associated with hirsutism and elevated 17-OH progesterone, whereas insulin resistance.
Hyperinsulinaemia is frequently associated with PCOS.
An increased LH/FSH ratio, and mild elevation of serum testosterone and androstenedione is found in patients with PCOS, but a markedly elevated testosterone (>5 mmol/L) is highly suspicious of an adrenal tumour or congenital adrenal hyperplasia.
Toxin production plays an important part in the pathogenesis of all the following EXCEPT which one?
A Tetanus B Clostridium difficile C Cholera D Haemophilus influenza E Escherichia coli O571
D. Haemophilus influenza
Toxin production is just one of the mechanisms through which bacteria can cause damage to host cells.
Acute viral infections, such as hepatitis A, are normally diagnosed using which of the following?
A White cell count B Erythrocyte sedimentation rate C Specific IgM D Specific IgG E Tissue culture
C. IgM is the first antibody type to develop and so indicates current or very recent infection. IgG is produced later and so can be used to check previous exposure or immunization.
C-reactive protein may be raised in all of the following EXCEPT which one?
A Acute bacterial infection B Diabetes C Autoimmune disease D Tuberculosis E Malignancy
B Diabetes
Non-infective causes of hyperthermia include which of the following?
A Malaria
B Hypothyroidism
C Alcohol use
D Amphetamines/ecstasy
D Amphetamines/ecstasy
Clostridium difficile is a nosocomial infection. Which of the following can be used to treat it?
A Broad spectrum antibiotics
B Proton pump inhibitors
C Probiotics
D Vancomycin or metronidazole
D
Staphylococcus aureus can cause a variety of types of pathology EXCEPT which of the following?
A Toxic shock syndrome B Scarlet fever C Scalded skin syndrome D Endocarditis E Bullous impetigo
The correct answer is B. Scarlet fever is caused by group A streptococci.
The articulation of the rib with the vertebrae allows for respiratory movements. At the costovertebral joints the head of the 9th rib articulates with the body of vertebra/e:
- T8
- T8 and T9
- T9
- T9 and T10
- T10
2, T8 and T9
The lungs are dissimilar in their gross anatomical features. The left is characterised by:
- A cardiac notch in its posterior border
- An absence of visceral pleura within its fissures
- An eparterial bronchus in its hilum
- Oblique and transverse fissures
- Upper and lower lobes separated by the oblique fissure
- Upper and lower lobes separated by the oblique fissure
Whereas the Right lung has 2 fissures (transverse and oblique)
L lung = 2 lobes
R lung = 3 lobes
A 47 year old man was referred to a neurosurgeon with a spinal cord tumour. The tumour was compressing his posterior (dorsal) columns on the right hand side. Which of the following statement is most likely to be true:
- There is likely to be a loss of nociceptive sensation below the level of the lesion on the contralateral side
- There is likely to be a loss of temperature sensation below the lesion on the contralateral side
- There is likely to be a loss of temperature sensation below the lesion on the ipsilateral side
- There is likely to be a loss of vibration and proprioception below the lesion on the contralateral side
- There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
- There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
DCML = fine touch (tactile sensation), vibration and proprioception.
Pain and temp is via anterolateral system, specifically the lateral spinothalamic tract which eliminates 1-3.
A 55 year old woman presents to her GP with a headache which is associated with scalp tenderness over the right temporal artery. The GP diagnoses giant cell arteritis and commences treatment. Which of the following laboratory results would you expect in this condition:
- Elevated erythrocyte sedimentation rate (ESR)
- Elevated urate
- Elevated white cell count
- Reduced haemoglobin
- Reduced erythrocyte sedimentation rate (ESR)
- Elevated erythrocyte sedimentation rate (ESR)
A 75 year old man presented to his general practitioner (GP) with difficulty initiating walking. His GP notices a pill rolling tremor and suspected Parkinson’s disease. Which of the following is the most likely neurotransmitter to be affected:
- Adrenaline
- Dopamine
- Histamine
- Serotonin
- Substance P
- Dopamine
A 20 year old man was assaulted whilst watching a football match. On arrival at the local accident Accident and Emergency department he opened his eyes to pain, said inappropriate words and localised to pain. What is his Glasgow Coma Score (GCS):
- 6
- 7
- 8
- 9
- 10
- 10
Many structures in the human body receive parasympathetic innervation. Which of these is most likely to occur due to its stimulation:
- Constriction of pupils
- Dilation of pupils
- Increased heart rate
- Reduced saliva production
- Relaxation of the bladder wall
- Constriction of pupils
A 44 year old woman is noted to have an 11th nerve palsy. Which of the following is an appropriate method of testing the function of the 11th cranial nerve:
- Look for fasciculation in the deltoid muscle
- Look for wasting over the deltoid muscle
- Look for fasciculation in the platysma muscle
- Look for hypertrophy in the trapezius muscle
- Look for wasting of the sternocleidomastoid muscle
- Look for wasting of the sternocleidomastoid muscle
GFR would increase if
- There is afferent arteriole constriction
- There is efferent arteriole constriction
- There is an increase in tissue pressure in Bowman’s capsule
- There is an increased release of renin from the JG cells
- There is an obstruction of the ureters
- There is efferent arteriole constriction
If we constrict the efferent arterioles we increase the pressure in the Bowman’s capsule; filtrate increases
How would drinking a large amount of water affect osmolarity and volume of the ECF
- Decreased osmolarity and increased volume
- Both would increase
- No change in osmolarity with increased volume
- No change in either
- Greater increase in ECF volume than ICF volume
- Decreased osmolarity and increased volume
Dilute the electrolytes in the body whilst increasing the volume
Antidiuretic hormone (ADH)
- Is produced by the anterior pituitary
- Inserts aquaporins into all parts of the kidney tubule
- Causes the hypertonic medullary gradient to be established
- Is released in response to cellular dehydration
- Is released in response to increased plasma urea
- Is released in response to cellular dehydration
Produced by the hypothalamus and stored in the posterior pituitary gland; it only inserts aquaporins into the collecting duct; it uses the medullary gradient to increase the reabsorption of sodium etc
If Drug A’s clearance is greater than inulin clearance, then which of the following would be true of drug A
- Net reabsorption
- No reabsorption
- No secretion
- Net secretion
- Reabsorbed and secreted
- Net secretion
A 60 year old man has stage 5 chronic kidney disease with a serum creatinine of 500 umol/L (normal 88-116); which of the following is likely to be present
- High serum calcium
- Low serum phosphate
- High serum phosphate
- Normal serum calcium
- Normal serum phosphate
- High serum phosphate
The following acid/base values were obtained pH = 7.25 / [HCO3-] = 12 mmoles/L / PCO2 = 3.3kPa (25 mmHg)
- They are indicative of a respiratory acidosis
- The reduction in PCO2 is a result of under-breathing
- The subject has probably been taking bicarbonate of soda
- It could be related to impaired renal function
- The subject may have been vomiting very badly
- It could be related to impaired renal function
Metabolic acidosis = pH drops; metabolic is indicated by a decrease in bicarbonate / respiratory is indicated by an increase in partial pressure of carbon dioxide
Rule is = in metabolic acidosis / alkalosis, the HCO / PCO drop or rise with it respectively whilst in respiratory types if the pH drops (acidosis) the PCO rises (with the HCO rising too in chronic situations) and if the pH rises (alkalosis) the PCO drops (with the HCO dropping too in chronic situations)
The following acid / base values were obtained: pH = 7.28 / [HCO3-] = 36 mmoles/L / PCO2 = 8 kPa (60 mmHg) = chronic respiratory acidosis
- This is typical of an acute respiratory acidosis
- The subject will be excreting large amounts of bicarbonate ions
- The subject will be excreting large amounts of ammonium ions
- The plasma potassium level is likely to be decreased
- He has as metabolic alkalosis because of the raised bicarbonate
- The subject will be excreting large amounts of ammonium ions
A patient with lung cancer develops the syndrome of inappropriate ADH secretion; which of the following values for Na+ concentration might be expected to be seen (normal = 135-140 mmol/L)
- 140 mmol/L
- 145 mmol/L
- 150 mmol/L
- 138 mmol/L
- 128 mmol/L
- 128 mmol/L
Which of the following are classed as loop diuretics:
- Furosemide
- Spironolactone
- Bendroflumethiazide
- Mannitol
- Amiloride
- Furosemide
A 6 year old child presents with swelling of his face and legs; his serum albumin concentration is 18g/L (normal 37-42) and his mother notices that his urine is frothy; what is the most likely diagnosis
- Ig-A glomerulonephritis
- Minimal change disease
- Focal and segmental glomerulonephritis
- Membranous nephropathy
- Lupus nephritis
- Minimal change disease
The following acid / base values were obtained: pH = 7.50 / [HCO3-] = 45 mmoles/L / PCO2 = 8 kPa (60 mmHg) = metabolic alkalosis
- This may be the result of bad diarrhoea
- The subject will be excreting bicarbonate ions
- The subject will be excreting ammonium ions
- The plasma potassium level is likely to be increased
- The subject has a respiratory acidosis because of the raised PCO2
- The subject will be excreting bicarbonate ions
The following acid / base values were obtained: pH = 7.45 / [HCO3-] = 12 mmoles/L / PCO2 = 2.7 kPa (20 mmHg) = chronic respiratory alkalosis
- The subject is clearly very unwell
- The subject is likely to have spent a long time at altitude
- The subject needs bicarbonate
- The subject is unlikely to be hypoxic
- This is typical of a metabolic alkalosis
- The subject is likely to have spent a long time at altitude
The following values were made for an elderly female diabetic patient’s creatinine clearance: 24hr urine volume = 1.44L / serum creatinine concentration = 100 umol/L / urine creatinine concentration = 6.6 mmoles/L
- Clinical features of renal impairment would be expected
- Serum creatinine alone indicates impaired renal function
- Serum potassium should be measured urgently
- The data suggests there may be renal impairment
- There is reason to suspect an incomplete renal collection
- The data suggests there may be renal impairment
A 23 year old woman complains of flank pain, dysuria and frequency of micturition; she has taken ibuprofen for the pain; her urinalysis shows protein, nitrites and blood; what is the most likely diagnosis
- Acute pyelonephritis
- Cystitis
- Chronic pyelonephritis
- Reflux nephropathy
- Analgesic nephropathy
- Acute pyelonephritis
A 40 year old man was found to have asymptomatic proteinuria and microscopic haematuria during routine employment-related examination; his BP was found to be 160/100 mmHg and serum creatinine 170 micromol/L (normal 86-116); he has no urinary symptoms; what is the next most important symptoms
- Chest X-ray
- Echocardiogram
- Intravenous urogram
- Ultrasound of the urinary tract
- Renal biopsy
- Ultrasound of the urinary tract
What are the features of acute urinary retention:
- Painful inability to void with a palpable or percussible bladder
- Slow stream of micturition with terminal dribbling and frequency
- Painless condition with a palpable or percussible bladder
- Dysuria with frank haematuria
- Bladder pain which is worse when the bladder is full and relieved by voiding
- Painful inability to void with a palpable or percussible bladder
A 60 year old man has stage 5 chronic kidney disease with a serum creatinine of 500 umol/L (normal 88-116); which of the following is likely to be present:
- Low serum calcium
- Normal serum calcium
- Low serum phosphate
- Normal serum calcium
- High serum calcium
- Low serum calcium
Patients with renal failure are often anaemic; what is the best treatment for their anaemia:
- Oral iron therapy
- Intravenous iron
- Vitamin B12
- Erthryopoietin
- Blood transfusion
- Erthryopoietin
For an uncomplicated urinary infection which of the following organism is the most likely cause:
- Staphylococcus aureus
- Klebsiella sp
- Pseudomonas aeruginosa
- Candida albicans
- Escherichia coli
- Escherichia coli
A 70 year old man complains of poor stream of urine, nocturia and post-micturition dribbling; which of the following is the most likely cause:
- Diabetic neuropathy
- Urinary tract infection
- Chronic kidney disease
- Prostatic hypertrophy
- Bladder cancer
- Prostatic hypertrophy
A 60 year old man presents with tiredness and malaise; routine investigations reveal a raised serum creatinine and an estimated GFR of 35 ml/min; which of the following stages of CKD is he in
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Stage 5
- Stage 3
The commonest urological malignancy in patients with painless frank haematuria is:
- Kidney cancer
- Testicular cancer
- Bladder cancer
- Penile cancer
- Prostate cancer
- Bladder cancer
What is the commonest type of renal tract stones in adults:
- Calcium phosphate
- Calcium oxalate
- Cystine
- Magnesium ammonium phosphate
- Uric acid
- Calcium oxalate
What is the commonest mode of presentation for patients with a renal or ureteric stone:
- Loin pain radiating to the flank and / or groin
- Frank haematuria
- Urinary tract infection
- Lower urinary tract symptoms
- Acute urinary retention
- Loin pain radiating to the flank and / or groin
The following antibiotics are generally suitable for empirical treatment of complicated urinary tract infections except:
- Vancomycin
- Ciprofloxacin
- Ceftriaxone
- Gentamicin
- Co-amoxiclav
- Gentamicin
A patient with hypothyroidism would demonstrate which of the following symptoms:
- Exopthalmos
- Increased heart rate
- Heat tolerance
- Increased protein metabolism
- Lethargy
- Lethargy
Goitre is a common symptom of thyroid dysfunction and can be present in both hypo- and hyperthyroidism. However it would not be present in which of the following thyroid pathologies
- Primary hypothyroidism
- Secondary hypothyroidism
- Primary hyperthyroidism
- Secondary hyperthyroidism
- Graves disease
- Secondary hypothyroidism
A decrease in circulating cortisol levels would result in which of the following physiological responses
- Enhanced gluconeogenesis in the liver
- Hypotension
- Decreased ACTH secretion from the anterior pituitary
- Elevated fatty acid levels in the plasma
- Suppression of the immune system
- Hypotension
A person with primary hypercortisolism would demonstrate
- Depressed ACTH
- Elevated CRH
- Hypotension
- Hypoglycaemia
- Increased bone density
- Depressed ACTH
Chronic glucocorticoid therapy is associated with which of the following
- Enhanced cortisol release from the adrenal glands
- Enhanced ACTH release from the anterior pituitary
- Enhanced CRH release from the hypothalamus
- Adrenal insufficiency
- Adrenal hypertrophy
- Adrenal insufficiency
Which of the following will elevate free calcium levels in plasma
- Alkalosis
- Activation of osteoblasts
- Increased phosphate excretion at the kidneys
- Calcitonin
- All of the above
- Increased phosphate excretion at the kidneys
Regarding growth hormone which of the following is correct
- It is also known as somatostatin
- It is also known as somatomedian
- It is a steroid hormone
- Levels in adults are at their highest during REM sleep
- It is relatively insignificant in terms of foetal and neonatal growth
5.It is relatively insignificant in terms of foetal and neonatal growth
The adrenal zona glomerulosa secretes which hormone
- Testosterone
- Progesterone
- Aldosterone
- Cortisol
- Epinephrine / adrenaline
- Aldosterone
Which of the following responses would you expect following insulin release
- Hepatic gluconeogenesis
- Increased ketone formation
- Increased uptake of glucose by the brain
- Adipose lipolysis
- Stimulation of Na/K ATPase
- Stimulation of Na/K ATPase
Which of the following is not a glucose counter regulatory hormone
- Thyroid hormone
- Epinephrine (adrenaline)
- Glucagon
- Cortisol
- Growth hormone
- Thyroid hormone
A 21 year old man is diagnosed with Type 1 DM. He is studying engineering at university and has a part-time job as a delivery driver. He had just got married and his wife is expecting their first child. What information should he receive shortly after diagnosis
- He should be told he cannot continue his driving job in the future
- He may be able to work off shore depending on his employer and where he is going
- He is likely to pass on his diabetes to his child
- He should be advised to stop drinking any alcohol
- He should be told he is unlikely to ever have any hypos (hypoglycaemic episodes) if he monitors his blood glucose regularly
- He may be able to work offshore depending on his employer and where he is going
It is advisable for everyone to pursue a healthy lifestyle if he / she wishes the reduce the risks of long term illness. Which of the following would be considered appropriate to tell a sedentary man with an unhealthy diet who is keen to change to a more healthy lifestyle
- Do a minimum of 30 minutes of vigorous physical activity on most days of the week
- Aim to eat 5 portions of fruit / vegetables per day
- Aim to eat 4 portions of oily fish / week
- It is inadvisable to drink more than 20 units of alcohol per week
- All of the above
- All of the above
A 53 year old man was diagnosed with T2 DM 6 months ago. He has lost 1 stone in weight, his BMI is 28 and HbA1c is 75 mmol/mol (9%). What is the next appropriate medication in his management?
- Thiazolidinedione (e.g pioglitazone)
- Sulphonylurea (e.g metformin)
- Biguanide (e.g metformin)
- DPP IV inhibitor (e.g sitagliptin)
- Insulin
- Biguanide (e.g metformin)
Which symptom below is not typical of hypoglycaemia
- Headache
- Itch
- Poor concentration
- Sweating
- Irritability
- Itch
A 32 year old patient with T1DM is reviewed at the diabetes clinic. His blood sugar is 3.2 mmol/L and he tells you he is feeling well. What is the best course of action next.
- Administer IM glucagon
- Send him home for lunch
- Give 200ml fresh orange juice
- Give digestive biscuit
- Administer his lunchtime insulin
- Give 200ml fresh orange juice
A 25 year old with T1 DM mellitus presents with vomiting and diarrhoea. BP 80/54, RR 24 per minute. Which test is least important for immediate management
- Blood glucose
- pH
- Urine / blood ketones
- Electrolytes
- Liver function tests
- Liver function tests
23 year old man diagnosed with hyperthyroidism and has been commenced on carbimazole. What do you need to counsel him about
- Neutropenia
- Fertility
- Metallic taste in mouth
- Renal function
- Discolouration
- Neutropenia