Questions to review

Question 1

What is the most useful test to confirm rheumatoid arthritis

Answer 1

Anti -CCP antibodies
More useful than RF

Question 2

What would you expect to see on analysis of synovial fluid on joint aspiration for gout

Answer 2

urate needle shaped crystals

Question 3

RA or OA?
Joint space narrowing
Subchondral sclerosis
Osteophytes
Osteopenia
Bony erosions

Answer 3

Joint space narrowing - both
Subchondral sclerosis - OA
Osteophytes - OA
Osteopenia - RA
Bony erosions - RA

Question 4

Features of NSTEMI

Answer 4

Plaque rupture which does NOT fully occlude blood vessel but narrows so you get pain at rest, ST depression on ECG, and increased troponin (due to death of myocytes and apoptosis)

Question 5

Features of unstable angina

Answer 5

Chest pain due to ischaemia to heart muscle. Occurs during exercise but resolves with rest.

Question 6

Features of STEMI

Answer 6

Complete occlusion of blood flow which can cause myocardial ischaemia and apoptosis. ST elevation.

Question 7

What is Hydroxocobalamin used to treat

Answer 7

vitamin B12 deficiency including pernicious anemia

Question 8

What is Adcal D3 for

Answer 8

osteoporosis

Question 9

What is atorvastatin for

Answer 9

high cholesterol

Question 10

What is bisoprolol for

Answer 10

hypertension

Question 11

What is a free fluid diet

Answer 11

you can take any item that is a smooth liquid, with no lumps or pieces, or anything that quickly melts in the mouth into liquid form

Question 12

What is a clear liquid diet

Answer 12

limits you to options such as water, broth and plain gelatin. These are easy to digest, and they don’t leave food bits in your digestive tract.Nothing thick.

Question 13

Pancreatitis nutritional support

Answer 13

Early enteral nutrition. Gastric and jejunal feeding are equally effective.
Parenteral nutrition should be considered in patients who cannot tolerate enteral nutrition.

Question 14

Where is GALT located

Answer 14

Mucosa, submucosa and lamina propria of the small intestine (Peyer’s patches)

Question 15

Ischaemic colitis vs acute mesenteric ischaemia

Answer 15

Ischaemic colitis - bloody diarrhoea and LLQ pain.
Acute mesenteric ischaemia - widespread pain, examination may be normal

Question 16

Rule of 1s for adrenal gland

Answer 16

If enzyme starts with 1 (eg 11 or 17 hydroxylase) it causes hypertension due to increased DOC which acts like aldosterone
If enzyme ends with 1 (eg 11 or 21 hydroxylase) it causes virilisation in females and precocious puberty in males

Question 17

Mechanism by which high prolactin causes secondary hypogonadism

Answer 17

Prolactin binds to prolactin receptors on hypothalamic kisspeptin neurons to inhibit
kisspeptin release, this results in a reduction in gonadotrophin releasing hormone pulsatility which reduces FSH and LH secretion from the anterior pituitary.

Question 18

What should you think of if you see low serum sodium and high serum potassium

Answer 18

Addison’s disease

Question 19

Which white matter tract connects the two hemispheres

Answer 19

Callosal fibres connect hemispheres. The major tract connecting the left and
right hemispheres is the corpus callosum.

Question 20

Treatment of prolactinoma

Answer 20

dopamine agonist cabergoline
Binds to D2 receptors on prolactinoma to reduce prolactin and shrink tumour.

Question 21

What type of hormone is growth hormone

Answer 21

Polypeptide / protein hormone (hence can’t be given orally)

Question 22

What type of hormone has a long duration of action

Answer 22

steroid hormones NOT peptides

Question 23

What do peptides act on

Answer 23

membrane bound receptors and have a second messenger

Question 24

acromegaly vs gigantism

Answer 24

Gigantism occurs when growth hormone hypersecretion occurs before the fusion of the long bone epiphysis and is characterized by tall stature. Acromegaly occurs when GH hypersecretion occurs after the fusion of the epiphysis leading to large extremities, prognathism, macroglossia.

Question 25

acromegaly treatment

Answer 25

Somatostatin analogues such as lanreotide and octreotide

Question 26

what enzyme converts testosterone to oestradiol

Answer 26

aromatase

Question 27

Unfractionated heparin - inactivation of what

Answer 27

Xa

Question 28

ECG axis normal

Answer 28

-30 to 90

Question 29

ECG right axis deviation

Answer 29

90 to 180

Question 30

ECG extreme axis deviation

Answer 30

180 to -90

Question 31

ECG left axis deviation

Answer 31

-90 to -30

Question 32

right ventricular hypertrophy what deviation

Answer 32

RAD

Question 33

ECG inferior heart

Answer 33

2, 3, aVF

Question 34

ECG lateral heart

Answer 34

1, aVL, aVR, V5, V6

Question 35

ECG anterior heart

Answer 35

V3, V4

Question 36

ECG septal heart

Answer 36

V1, V2

Question 37

ECG left circumflex artery

Answer 37

1, aVL, V5 and V6

Question 38

ECG left anterior descending

Answer 38

V1-V4

Question 39

ECG right coronary artery

Answer 39

2, 3, aVF

Question 40

acromegaly manifestation

Answer 40

cutis gyrata verticis

Question 41

strep virulence

Answer 41

Strepococcus pyogenes (β-haemolytic) attaches to epithelial surfaces via lipoteichoic acid portion of fimbriae
- Has M protein (anti-phagocytic) & hyaluronic acid capsule
- Produces erythrogenic exotoxins
- Produces streptolysins S and O

Question 42

what is recruitment (neuro)

Answer 42

Motor unit recruitment is the process by which different motor units are activated to produce a given level and type of muscle contraction (number of motor units activated)

Question 43

what is rate coding

Answer 43

increase in the frequency of the signal to a motor unit which leads to an increased rate of firing within that same motor unit