Quick Facts Flashcards
Broca’s area is which Brodmann areas? [2]
44 & 45
Wernicke’s area is which Brodmann area? [1]
22
Frontal eye field is which Brodmann area? [1]
8
Primary somatosenory cortex is which Brodmann’s areas? [3]
1,2,3
Primary motor cortex is which Brodmann area? [1]
4
Primary auditory cortex is which Brodmann area? [1]
41
Locus coeruleus causes the release of which hormone? [1]
Noradrenaline
Shingles is most likely to activate in which branch of the trigeminal nerve? [1]
V1; opthalmic nerve
Shaken baby syndrome has a triad of which three signs? [3]
Retinal haem.; encephalopathy; subdural haem.
Tx for status epilepticus? [1]
Lorezapam
A
B
C
D
E
C: thalamus
How would bilateral pleural effusion present on auscultation
a. Fine crackles
b. Course crackles
c. Wheeze
d. Increased breath sounds
e. Absent breath sounds
e. Absent breath sounds
What is the Thomas’ test assessing
a. Fixed flexion deformity
b. Fixed extension deformity
c. Fixed rotation deformity
d. Tenderness over the acetabulofemoral joint
e. Sciatic nerve compression
a. Fixed flexion deformity
What would be the results of the Weber and Rinne test in a sensorineural loss?
a. Weber’s test: Both ears equal, Rinne’s test: Bone louder than air
b. Weber’s test: Louder in affected ear, Rinne’s test: Bone louder than air
c. Weber’s test: Louder in unaffected ear, Rinne’s test: Air louder than bone
d. Weber’s test: Both ears equal, Rinne’s test: Air louder than bone
e. Weber’s test: Louder in affected ear, Rinne’s test: Bone louder than air
c. Weber’s test: Louder in unaffected ear, Rinne’s test: Air louder than bone
A medical student is testing pupillary reflexes, and notices that when they shine a light onto the left eye, the left eye constricts but the right eye stays the same. What nerve is most likely damaged?
a. Left optic nerve
b. Right optic nerve
c. Left oculomotor nerve
d. Right oculomotor nerve
e. Both optic and oculomotor nerves
d. Right oculomotor nerve
A patient is undergoing a neurological exam. When testing power, they are able to move when there is no resistance. What grade in the MRC power grading scale does this come under?
3
A patient presents with colicky pain, and upon examination is shown to have a positive Murphy’s test. He is not jaundiced. What does he most likely have, and where would the pathology be located? (vSAQ)
Gallstones, in the cystic duct / cholecystitis
Chronic myeloid leukaemia occurs from a translocation which two chromosomes? [2]
9 & 22
Colorectal cancer increases the liklihood of secreting with molecule? [1]
Serum carcinoembryonic antigen (CEA)
Substantia nigra
Arcuate nucleus
Ventral tegmental area
Caudal raphe nuclei
Dorsal raphe nuclei
Answer: Ventral tegmental area
The mesolimbic pathway is a dopaminergic pathway connecting the ventral tegmental area to the ventral striatum (the nucleus accumbens and the olfactory tubercle), the amygdala and the hippocampus.
Damage to the fornix causes what type of memory loss? [1]
Anterograde amenesia
Narrowing of the cerebral aqueduct leads to hydrocephalus. How can this present in patients? [1]
Bilateral vertical gaze palsy
The midbrain is supplied by which artery? [1]
PCA
The midbrain is supplied by which artery? [1]
PCA
Label A-D of this ECHO
A - Right ventricle
B - Left ventricle
C - Right atrium
D - Left atrium
Seropositive RA patients are associated with HLA [1] and which gene? [1]
HLA DRB1
Gene: PTPN22
Seronegative RA patients are associated with which gene? [1]
IRF5 = human interferon regulatory factor-5: Mediates virus induced immune response
Describe the 4 stages of Perthes disease [4]
Stage 1 ~ necrosis
Insufficient blood supply to femoral head causing ischaemia and subsequently necrosis
Femoral head begins to flatten
Crescent sign (subchondral translucency indicating susceptibility to fracturing) may be present on the femoral head
Stage 2 ~ fragmentation
Necrotic bone is re-absorbed and femoral hand flattens completely and fragments
Slight subluxation of femoral head out of acetabulum
Stage 3 ~ re-ossification
Growth of new bone to replace necrotic tissue
Stage 4 ~ healed
Femoral head has fully healed, however structural irregularities, such as enlargement or flattening of the femoral head, may be present
What stage of Perthe’s disease is this? [1]
Stage 3
What is A?
Femoral artery
Anterior tibial artery
Deep artery of the thigh
Posterior tibial artery
Brachial artery
What is A?
Femoral artery
Anterior tibial artery
Deep artery of the thigh
Posterior tibial artery
Brachial artery
Which of the following best describes the curvature of the vertebral column shown on this X-ray?
Kyphosis; concave curvature of the spine
Lordoses; convex curvature of the spine
Kyphosis; convex curvature of the spine
Scoliosis; lateral curvature of the spine
Lordoses; concave curvature of the spine
Normal; no extreme deviation of the spine
Explain the effect of Pott’s disease on reflexes [2]
Pott’s Disease can lead to exaggerated deep tendon reflexes due to damaging the descending corticospinal tracts.
What is C? [1]
Answer: Extensor pollicis brevis
Which of the following is responsible for percinious anaemia?
A
B
C
D
E
B
Characteristic histological features of gastric parietal cells include; eosinophilic cytoplasm and central, rounded nucleus. They have a ‘fried egg’ appearance
Less tan 1 day
1-3 days
3-7 days
1-3 weeks
3-6 weeks
3-7 days: prescence of macrophages indicates 3-7
At the 3-7 day window following a myocardial infarct, early granulation tissue (vascularised tissue which develops over wound sites) will form. Phagocytosis of dead myocardial cells and a hyperaemic border can also be observed.
A 53-year-old female patient was diagnosed with HER-2 positive breast cancer after having discovered a lump in her breast in the shower. She was referred for surgery, but was also prescribed two monoclonal antibody treatments, pertuzumab and trastuzumab.
Which of the following is a major side effect of the monoclonal antibody treatment trastuzumab?
alopecia
arthritic swelling
chronic kidney disease
congestive heart failure
liver toxicity
chronic kidney disease
Rheumatic fever develops following an immunological reaction [] infection
Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Streptococcus pyogenes
Rheumatic fever develops following an immunological reaction [] infection
Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Streptococcus pyogenes
Rectocoele
Cystocoele
Vaginocoele
Uterocoele
Cystocoele
What type of treatment for OA is this? [1]
Mosaicplasty
Name this sign of gout [1]
podogra
RA particularly affects the eye because of the high composition of which type of collagen?
Type 1
Type 2
Type 3
Type 4
Type 2
The image shows an anterior view of a right humerus. What muscle has attachment at the label A?
Coracobrachialis
Deltoid
Lattisimus dorsi
Teres major
Pectoralis major
Deltoid
What is the origin of the long head of triceps brachii tendon?
Infraglenoid tubercle
Acromion
Posterior surface of humerus
Supraglenoid tubercle
Coracoid process
Infraglenoid tubercle
Which of the rotator cuff muscles inserts onto the lesser tubercle of the humerus?
Subscapularis
Teres major
Supraspinatus
Teres minor
Infraspinatus
Subscapularis
A new drug is discovered to help improve erythropoiesis in fetuses suffering from an inability to produce adequate amounts of fetal hemoglobin. However, this drug must be injected directly into the organ where the majority of erythropoiesis occurs. Given a fetus with a gestational age of 20 weeks who is struggling to produce enough fetal hemoglobin, into which organ should this drug be injected?
A. Endodermal yolk sac
B. Bone marrow
C. Spleen
D. Liver
Most of the hematopoiesis occurs in the liver during gestation
B = Iliohypogastric
Lateral cutaneous nerve of the thigh is
A
B
C
D
E
G
E
The cremaster is controlled by:
A
B
C
D
E
F
G
D: Genitofemoral Nerve
Rheumatoid factor is [] that targets the fc portion of a []
- IgG; targets IgA
- IgA; targets IgM
- IgM; targets IgG
- IgA; targets IgM
- IgG; targets IgA
- IgM; targets IgG
Tetralogy of Fallot
Hypoplastic left heart syndrome
Coarctation of the aorta
Transposition of the Great Vessels
Ventricular septal defect
Coarctation of the aorta
On an X-ray, it can be identified through the presence of notching of the ribs and the figure 3 sign. Rib notching occurs due to increased blood flow being redirected to the intercostal arteries supplying the ribs. This results in distortion of the inferior aspect of the ribs, with ribs 3 to 8 being most commonly affected. The figure 3 sign arises from dilatation of the aortic arch and subclavian artery proximal to the site of constriction, a notch at the constriction site and finally dilatation of the descending aorta distal to the site of constriction. In severe cases, enlargement of the left ventricle may be observed due to an increased pressure being generated to pump out the backlog of blood.
Cloaca
Mesonephros
Metanephros
Nephric Duct
Pronephros
Metanephros
Pedunculated
Subserosal
Submucosal
Intramural
Subserosal
A
Dipyridamole is a non-specific phosphodiesterase inhibitor and decreases cellular uptake of []
adenosine
A positive Trendelenburg sign indicates damage to which nerve? [1]
superior gluteal nerve
State the effect of hypothyroidism on Na+ levels [1]
Hypothyroidism causes hyponatraemia
State the role of the mamillary bodies with regards to memory [1]
Recollective memory
State a musculoskeletal symptom of Wilson’s disease [1]
Chorea
Which cancer drug causes pulmonary fibrosis as a side effect? [1]
Bleomycin
State the vertebral levels that causes ankle reflex [1]
S1 / S2
State the effect of sciatic nerve lesions on:
Plantar, ankle and knee reflex [3]
Plantar and ankle reduced
Knee intact
State which disease causes reduced lung compliance [1]
Pulmonary fibrosis
Macrolides include erythromycin, clarithromycin, azithromycin, fidaxomicin and telithromycin.
What is their MoA? [1]
Inhibit 50S ribosomal subunit and inhibit protein synthesis
What dermatome is the knee? [1]
L3
Central sensitisation of a migraine occurs due to connection of which two parts of the brain? [2]
spinal trigeminal (SpV) to thalamus
Describe the Na+ and K+ concentration of endolymph [2]
Low Na+; High K+
Leptin targets which nucleus? [1]
Arcuate nucleus
Labyrinthitis occurs from infection to which structures? [1]
Semi-circular canals
Which spinal cords are carried in the lateral spinothalamic cords?
Which spinal cords are carried in the anterior spinothalamic cords?
Lat: Adelta and C
Ant: Adelta, Abeta & C
Which does the lateral spinothalamic cords pathway finish?
Which does the anterior spinothalamic cords pathway finish?
Lat: rostral insula, ACC
Ant: primary somatosensory cortex
The mesolimbic pathway occurs between which two locations? [1]
Which NT? [1]
VTA to NA
Uses noradrenaline
Cocaine decreases activation of which dopamine receptor? [1]
D2
Drug addiction causes chronic activation of which gene? [1]
FOSB
Locked in syndrome occurs from damage to which part of the brain stem? [1]
Ventral pons
Which benzodiazepine is used in chronic sleep insomnia? [1]
Eszopiclone
Which is the only tongue muscle to be innervated by the CN X [1]
Palotoglossus
State the difference between alpha and beta EEG waves [2]
Alpha: occurs with eyes closed
Beta: eyes open
Which molecule is involved with cheese and phenelzine? [1]
Tyramine
Which drug is used to treatment resistent SCH [1]
Clozapine
Which enzyme inactivates cortisol? [1]
11HSD B2
Which enzyme activates vit D? [1]
1 alpha hydroxylase
Which hormone decreases the action of 1 alpha hydroxylase? [1]
FGF23
What is the effect of B3 and M3 activation at the bladder? [2]
B3: relaxes the bladder
M3: contracts the bladder
Which drug inhibits the production of NH3 in the gut? [1]
Rifaximin
Which drug inhibits glutamine to glutamathine
l-ornithine larginine
What is the most common cause of optic neuritis? [1]
MS
What is the MoA of carbimazole? [1]
prevents iodination of tyrosine to thryoglobin
Inheritance of haemophilia? [1]
X-linked
You ID breast cysts histologically via what method? [1]
Some of the larger cysts in fibrocystic change may have a bluish appearance from outside (blue-domed cysts)
ID which is a breast cyst and which is apocrine metaplasia [2]
Apocrine metaplasia: left
Cyst: Right (have bluish tint around them)
Jenny, a 35-year-old actress has recently been diagnosed with cervical cancer. She went through the 2-week cancer patient pathway and had surgery to remove her tumour. She was then followed up with adjuvant radiotherapy to minimize the risk of reoccurrence of the cancer.
Which drug which acts as a radiosensitizer was given at the same time as radiotherapy, to enhance the effect of the radiation?
Abraxane
Velcade
Lutrate
Idarubicin
Cisplatin
Cisplatin
Which brain region is stimulated in treatment resistant depression?
Anterior of the fornix
Hypothalamus
Nucleus accumbens
Subcallosal cingulate
Thalamic centromedia/parafascicular complex
Subcallosal cingulate
A 92-year-old female is brought into the emergency department following a fall at home. She was found by her neighbour and told the paramedics she had fallen 6 hours before but had been unable to get up due to osteoarthritis in her knees.
Which blood test is it important to do in a patient who has had a long duration of time lying on the floor unable to move?
Calcium
Sodium
Troponin
Creatine kinase
BNP
Creatine kinase
In an elderly person who has had a long lie, the pressure of muscles can lead to muscle necrosis and rhabdomyolysis. This results in skeletal muscle breakdown and the release of muscle contents into the circulation. An important consequence of this is hyperkalaemia. This is a medical emergency and can lead to cardiac arrest.
Thus in patients who have had a long lie testing creatine kinase is important to identify and diagnosis rhabdomyolysis. Creatinine kinase will be raised and may be up to several 10,000s.
The narrowing of renal arteries is known as renal artery stenosis (RAS), which typically gives rise to []
The narrowing of renal arteries is known as renal artery stenosis (RAS), which typically gives rise to resistant hypertension
Which vertebral layers does the thyroid cartilage sit between
C3-T2
C4-T2
C5-T2
C4-T1
C5-T1
Which vertebral layers does the thyroid cartilage sit between
C3-T2
C4-T2
C5-T2
C4-T1
C5-T1
What is the effect of IGF-1 activated on renal GNG [1] and glucose transport? [1]
GH is a regulator of IGF1, specifically it decreases renal GNG and increases glucose transport
Which of the following secretes FGF-23
osteoblast
osteoclast
chondrocyte
osteocyte
Which of the following secretes FGF-23
osteoblast
osteoclast
chondrocyte
osteocyte
technetium-99m is used in a radio-active scan to diagnose which overactive organ? [1]
parathyroid
Which type of diuretic may be used to treat kidney stones?
Loop diuretics
Thiazide like diuretics
K sparing diuretics
Carbonic anhydrase inhibitors
Thiazide like diuretics: cause hypercalcemia
Where are the 3 places that kidney stones get stuck in the ureters? [3]
Uteropelvic junction
Pelvic inlet (and iliac vessels)
Uterovesical junction
Short synacthen test is used to diagnose
Addisons disease
Cushing syndrome
Conns syndrome
Graves disease
Addisons disease
Why might HCO3- rise in Ptxs? [4]
As H+ is lost:
* Diarrhoea
* Diuretics
* Mineralocorticoid excess
* Vomiting/NG drainage
As H+ moves into cells: Hypokalaemia
How do you treat congenitial Listeria? [2]
Ampicillin plus an aminoglycoside
Drug management for herpes? [3]
Acyclovir, Famciclovir, Valaciclovir
Defects in which factors can cause repeated miscarriages? [2]
- Defects in factor XIII and factor XII
What is typically the first symptom of an ectopic pregnancy?
lower abdominal pain
vaginal bleeding
dizziness
breast tenderness
syncope
lower abdominal pain
Q
When during gestation is surfactant started to be made? [1]
By how many weeks gestation is it that babies produce enough to breathe normally by? [1]
Starts between weeks 24 and 28 of pregnancy.
By 34 weeks babies produce enough to breathe normally by.
How do you treat postnatal psychosis? [3]
Mood stabilizer: (lithium, valproic acid and carbamazepine)
How can you distinguish a direct and indirect hernia clinically? [1]
A direct hernia can be distinguished from an indirect hernia clinically by reducing it then putting manual pressure over the deep inguinal ring and asking the patient to cough.
A direct hernia should reappear; an indirect hernia should no
which hormone causes endometrial thickening?
LH
FSH
Oestrogen
Progesterone
Testosterone
LH
what happens during the menstrual cycle when FSH and LH fall? [1]
FSH and LH fall, the corpus luteum degenerates
Degeneration of the corpus luteum results in loss of progesterone production.
The subsequent falling level of progesterone triggers menstruation and the entire cycle begins again
Late neonatal death occurs for a child of how old? [1]
7-28 days
IUGR is associated with which congenital heart defect in neonates? [1]
Patent ductus ateriosus - causes hypoxia
What serotype has the strongest association with this disease?
How does the A-wave in a ductus venosus doppler ultrasound present in a normal and IUGR fetus? [2]
Normally ductus venosus shows positive A wave.
Reversal of the A wave may be seen in severe intrauterine growth restriction as well as in tricuspid regurgitation.
Which HLA is most associated with CD ? [1]
HLA DQ2
Which brain region is the deep brain stimulation (DBS) probe placed in for dystonia [1] and tremor [2]
Dystonia: Globus pallidus internal
Tremor: subthalamic nuclei; zone incerta
Two roles of SMA? [2]
Urgency of movement
Guides internal actions
Two roles of SMA? [2]
Urgency of movement
Guides internal actions
Describe the neurological effect of glycine [1]
Glycine acts as an inhibitory neurotransmitter by increasing chloride transmission across a cell membrane
suprachiasmatic nucleus (SCN) role? [1]
Does it promote or inhibit sleep? [1]
Controls circadian rhythm: promotes sleep
Which of the following antipsychotics is more likely to cause hyperglycaemia, insulin resistance and dyslipidaemia?
Clozapine
What is the role of calcium gluconate? [1]
Stabilises the myocardium to protect against hyperkalaemia
does NOT lower potassium levels
During somatic gene alterations in Wilm’s tumour
- Epigenetic changes at which locus? [2]
- Epigenetic changes at IGF2/H19 locus
Which oncogenes are involved with neuroblastoma? [3]
MYCN amplification, ALK & PHOX2B
What are the distinctive cell abnormalites that often occur in Pro-B cells and Pre-B cells? [2]
There are distinctive cell abnormalities:
Pro-B (CD19+, CD10-) always have translocation of MLL gene translocated
Pre-B always have translocation of chromosomes 12 & 22
What is the prognosis for patients with:
Pro-B ALL? [1]
Pre-B ALL [1]
Pro-B ALL / MLL translocation: unfavourable for children
Pre-B ALL: ETV6-RUNX1 translocation: more favourable
Which hormone decreasing creates atretic follicles? [1]
Triggered by decrease if FSH
Which cell type is the arrow pointing to? [1]
Reticulocyte
A patient with moderate - severe pneumonia should be prescribed with antibiotics for how
5 days
10 days
12 days
14 days
A patient with moderate - severe pneumonia should be prescribed with antibiotics for how
5 days
10 days: 7-10 days
12 days
14 days
What is the minimum number of days a patient with pneumonia should receive antibiotics for?
5 days
10 days
12 days
14 days
What is the minimum number of days a patient with pneumonia should receive antibiotics for?
5 days
10 days
12 days
14 days
An absent a wave on a JVP waveform would indicate
Pulmonary hypertension
Complete heart block / ventricular arrhythmias
Tricuspid regurgitation
Atrial fibrillation
An absent a wave on a JVP waveform would indicate
Pulmonary hypertension
Complete heart block / ventricular arrhythmias
Tricuspid regurgitation
Atrial fibrillation
Ejection fraction is defined as the % of blood to leave the:
Right ventricle
Left ventricle
Right & left ventricle
Right and left ventricles and atria
Left ventricle
Which co-morbidity is most strongly associated with chronic pain?
Depression
Lack of energy
Difficulty sleeping
Anxiety
Concentration difficulties
Difficulty sleeping
Describe diagnosis of pre-eclampsia [2]
Gestational hypertension is BP = 140/90 mmHg on two occasions, arising after 20 weeks of pregnancy. Resolves 6 weeks after having the baby.
Pre-eclampsia = Gestational hypertension + proteinuria. 300mg of protein in the urine in a 24 hour collection.
What is the name of the fatty acid transporter on a muscle cell? [1]
CD36
How do you close [1] and open [1] a PDA
Close: NSAIDs
Open: Prostaglandin E1
Which of the following is group A strep?
Streptococcus bovis
Streptococcus agalactiae
Staphylococcus aureus
Streptococcus pyogenes
Streptococcus viridans
Streptococcus pyogenes
What are potential secondary bacterial infections of VZV? [1]
Name a consequence of this secondary bacterial infection [1]
Strep. infection (specifically Strep A)
Causes Necrotizing fasciitis
Which two markers are rasied in non-seminoma cancers? [2]
AFP (alpha-fetoprotein) and/or beta-hCG are elevated in 80-85%
At what stage of James Tanner puberty is irreversible to treatment for precocious puberty? [1]
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage 3
Age related changes in the immune system:
Which cell type sees an incresed CD16+ pro-inflammatory population?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Age related changes in the immune system:
Which cell type sees an incresed CD16+ pro-inflammatory population?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types makes less IL12 due to older age?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types makes less IL12 due to older age?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types makes same level of IFN-ϒ?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types makes same level of IFN-ϒ?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types increases in number with old age?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Ageing affect on immune system.
Which of the following cell types increases in number with old age?
Neutrophils
Dendritic cells
Macrophages
Lymphocytes
Natural killer cells
Describe the physiopathology of Leri-Weill dyschonrosteosis (LWD):
- Inheritance pattern? [1]
- Mutation to which gene? [1]
- How do LWD individuals present? [4]
Leri-Weill dyschonrosteosis (LWD):
Autosomal dominant skeletal dysplasia
Short stature homebox gene (SHOX) - found on pseudoautosomal region of X & Y genes
Presentation:
- mesomelic (mid parts) limb shortening
- Bowing of radius
- dorsal dislocation of ulna
- Premature epiphyseal fusion
What endocrine disorders might you think about for proprionate short stature? [2]
Hypothyroidism
Hypercortisolism
Explain the link between methylation of DMD region and IGF-2 in mother and father
Mother:
* demethylated DMD region drives coding of H19 region
Father:
* DMD methylated (inactivated)
* Prevents coding of H19
* Causes IGF-2 to be created - drives growth of child in adolesence and middle age
Expand how each of the following present in ADHD children
Hyperactivity [2]
Inattention [3]
Impulsivity [2]
Where do symptoms need to occur for a diagnosis of ADHD? [1]
Symptoms need to be present in two locations (e.g. school and home)
Hyperactivity
* Restless and fidgety
* Unable to wait
Impulsivity
* Acts without thinking
* Answers before questions finished
Inattention
* Jumps from task to task
* Careless mistakes
* Doesnt listen properly
What are the pharmacological treatments for ADHD? [2]
Methlyphenidate (aka ritalin)
Lisdexamfetamine
Describe the indirect pathway of the dorsal ganglia
Excitation of dorsal striatum causes the release of dorsal striatum GABA (inhibitory)
This causes projects onto globus pallidus external segment: causes increased inhibition of GPe
This causes the globus pallidus external segment to release inhibitory GABA onto the subthalamic nucleus: causes reduced inhibition of STN
This causes the subthalamic nucleus to release inhibitory GABA onto the globus pallidus internal segment: which increases the activation of GPi
This causes the globus pallidus internal segment to release inhibitory GABA onto the motor thalamus: which creates increased inhibition of motor thalamus
OVERALL DEACTIVATION OF MOTOR THALAMUS -> decreased motor cortex activation.
NO GO pathway.
Describe the effect of the activation of the D2 dopaminergic receptors
The D2 dopaminergic receptor activated:
- decreases cAMP
- Decreaes the sensitivity of striatal GABA neurons to glutamate (makes the glutatemate LESS EXCITABLE)
- Causes increased inhibition of the sub-thalamic nucleus
- This means get increaed inhibition of the GPi
- This causes less inhibition of the VL / VA
End result: INCREASED MOTOR ACTIVITY
Explain pathophysiology of Parkinsons disease [2]
-Loss of dopaminergic neurons in the substantia nigra, which project to and innervate the dorsal striatum.
- Less D1 and D2 activation
- The indirect pathway is therefore faciliated and becomes dominant
What is the name for this symptom?
Lesions to which region causes this symptom?
Subthalamic nuclei
Substantia nigra
Pre supplementary motor area
Lentiform nucleus
Dorsal striatum
athetosis
Lesions to which region causes this symptom?
Subthalamic nuclei
Substantia nigra
Pre supplementary motor area
Lentiform nucleus
Dorsal striatum
Which drug used to treat Huntingdons Disease works by the mechanism of action depicted by A? [1]
Tetrabenazine
acts primarily as a reversible high-affinity inhibitor of mono-amine uptake into granular vesicles of presynaptic neurons by binding selectively to VMAT-2
Which treatment used in PD is good at managing tremors
Haloperidol
Ritotigone
L-DOPA
Orphenadrine
Which treatment used in PD is good at managing tremors
Haloperidol
Ritotigone
L-DOPA
Orphenadrine: anticholinergic
Pharmacological management of Parkinson’s disease
Name two drugs that can combined with L-DOPA (aka levodopa) that means it doesn’t get metabolised to dopamine outside the BBB [2]
What is their MOA? [1]
L-DOPA (levodopa) & carbidopa or benserazide
carbidopa, benserazide are decaboxylase inhibitors: allows L-DOPA to pass BBB where it can then be converted to dopamine
Pharmacological management of Parkinson’s disease
Name three drugs that are monoamine oxidase inhibitors [3]
Describe their MoA [1]
- rasagiline
- selegiline (in PBL)
- safinamide
MAO-B inhibitors stop Monoamine oxidase type B breaking down dopamine into DOPAC or homovanillic acid
Extrapyramidal tracts:
Desribe the function and path of medial vestibulospinal tract
Function: Performs the synchronization of the movement of the eyes with the movement of the head so that eyes do not lag behind when the head moves to one side
Pathway: Descends bilaterally in the medial longitudinal fasciculus. Synapses with the excitatory and inhibitory neurons of the cervical spine
Describe the function and path of the rubrospinal tract [2]
Function: Controls muscle tone in flexor muscle groups; Inhibits extensor tone
Path:
- Arises from the red nucleus in the brainstem
- crosses at medulla
- terminates primarily in the cervical and thoracic portions of the spinal cord
Which of the following controls flexor muscle tone
rubrospinal tract
reticulospinal tract
lateral vestibulospinal tract
medial vestibulospinal tract
Which of the following controls flexor muscle tone
rubrospinal tract
reticulospinal tract
lateral vestibulospinal tract
medial vestibulospinal tract
Which of the following synapses on the extensor antigravity motor neurons
rubrospinal tract
reticulospinal tract
lateral vestibulospinal tract
medial vestibulospinal tract
Which of the following synapses on the extensor antigravity motor neurons
rubrospinal tract
reticulospinal tract
lateral vestibulospinal tract
medial vestibulospinal tract
Alert waking is marked by what type of EEG? [3]
Desynchronised
Low amplitude
High frequency
In what phase of a tonic-clonic seizure would you observe cyanosis? [1]
In the tonic phase, muscles stiffen.
Stiffening of the chest walls may can impair breathing –> decreasing oxygen intake and causing cyanosis.
Methotrexate derived from folic acid acts on which section of the cell cycle? [1]
S phase
Rheumatoid arthritis is an example of a type [] hypersensitivity reaction.
Rheumatoid arthritis is an example of a type 3 hypersensitivity reaction.
Which one of the following cells secretes the majority of tumour necrosis factor in humans?
Neutrophils
Macrophages
Natural killer cells
Killer-T cells
Helper-T cells
Macrophages
s part of your full cerebellar and neurological examination for Parkinson’s disease you test for coordination of the lower limbs by asking him to place his right foot on his left knee and then slide the foot down his leg.
What is the most important muscle involved in this action?
Gastrocnemius
Psoas major
Tibialis anterior
Soleus
Sartorius
Sartorius
Huntington’s disease is an autosomal dominant disease, associated with changes in the Huntingtin gene.
Which amino acid is abnormally repeated as a result of the mutations in the gene?
Alanine
Cysteine
Glutamine
Histidine
Methionine
Glutamine
What is the MoA of Propofol?
Propofol is a GABA receptor agonist
Describe the effect of D1 neurones on direct pathway [2]
Describe the effect of D2 neurones on indirect pathway [2]
D1 activates the direct pathway: causes more movement (as usually is GO)
D2 inhibits the indirect pathway: causes more movement (as indirect usually causes NO GO)
What is the frequency of tremor of PD? [1]
Tremor
* most marked at rest, 3-5 Hz
At what stage of levodopa dose are dyskinesias most likely to be seen? [1]
Name three types [3]
◦ dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)
more likely than levodopa to cause hallucinations in older patients. Nasal congestion and postural
hypotension are also seen in some patients
This applies to which drug class? [1]
Dopamine agonists
Which of the following blood markers provides the earliest indication of rheumatoid arthritis?
Anti-Ca-Fib
Anti-Ca-FCS
Anti-CCP
CRP
IgM-RF
Anti-CCP
Which of the Parkinson’s disease drugs below, should an individual presenting with ‘mild/moderate motor disability and no cognitive impairment’ be started on?
Amantadine
Benserazide
Rotigotine
Selegiline
Tolcapone
Rotigotine
What type of rhythm would you expect to see in the EEG of an individual in REM sleep? [1]
Beta
Which protein does dystrophin attach to in the intracellular cytoskeleton of the cell? [1]
Actin
Which spinal tract is responsible for mediating reflex coordination of the head and neck muscles with the extraocular eye muscles so that objects can be maintained in view despite movement of the body?
Reticulospinal tract
Rubrospinal tract
Tectospinal tract
Lateral vestibulospinal tract
Medial vestibulospinal tract
Medial vestibulospinal tract
What effect do benzodiazepines have on the receptors in which they bind to?
- Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that potassium ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that sodium ions enter & hyperpolarise the membrane
- Increase the duration of channel opening so that chloride ions enter & hyperpolarise the membrane
- Increase the duration of channel opening so that potassium ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
What effect do benzodiazepines have on the receptors in which they bind to?
- Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that potassium ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that sodium ions enter & hyperpolarise the membrane
- Increase the duration of channel opening so that chloride ions enter & hyperpolarise the membrane
- Increase the duration of channel opening so that potassium ions enter & hyperpolarise the membrane
- Increase the frequency of channel opening so that chloride ions enter & hyperpolarise the membrane
Which areas of the brain become hyperactive? [4]
Which areas of the brain become hypoactive [2]
Hyperactive:
* amygdala
* hippocampus
* subgenual cingulate cortex
* medial prefrontal cortex
Hypoactive:
* Dorsolateral prefrontal cortex
* ventrolateral prefrontal cortex
Which area of the brain the has the biggest increase in DMD during depresision? [1]
increased connectivity between DMN and fronto-parietal networks: especially left subgenual cingulate area
What are the different parameters for the Post Trauma amnesia scoring used to assess TBI? [3]
PTA:
Mild: less than 24hrs
Mild: 1-7 days
Severe: >7days
Where in the brain does locked-in syndrome occur because of injury to? [1]
Which tracts are effected if this area is damaged? [2]
A
ventral pons
causing interruption to corticospinal and corticobulbar tracts
primary erythromyalgia is exclusively caused by mutations in the gene [], the encoding the channel []
PE is exclusively caused by mutations in SCN9A, the encoding gene of sodium channel subtype Nav1.7
An uncul herniation commonly compresses which cranial nerve? [1]
CN3
Optic radiation
The paired optic tracts sweep posteriorly and send most axons to synapse in the [], in the [] nucleus.
The paired optic tracts sweep posteriorly and send most axons to synapse in the thalamus, in the lateral geniculate nucleus of the thalamus.
What is the role of the insula? [1]
Emotional aspect of risk taking
State the movement the following muslces do:
Superior rectus: [3]
Inferior rectus: [3]
Superior rectus: elevation, adduction and intorsion
Inferior rectus: depression, adduction and extorsion
Which of the following commonly causes damage to axons in the underlying brain
Epidural
Sub dural
Sub arachnoid
Intracranial
Sub dural
Blood from the ruptured vessels spreads freely through the subdural space and can envelop the entire hemisphere. Because of the forces involved in producing a subdural haemorrhage, there is very often damage to axons in the underlying brain as well
which foramen is this?
Foramen ovale
Foramen spinosum
Internal acoustic meatus
Foramen lacerum
Foreman rotundum
Foramen lacerum
Label A-D
A: foramen rotundum
B & D: foramen spinosum
C: foramen ovale
Where is the danger triangle of the face? [1]
Explain why this region is called the danger triangle [2]
The angular and ethmoidal veins drain this region of the face into the opthalmic veins which drain into the cavernous sinus.
This provides a potential route of infection from the nasal area to the brain, causing cavernous sinus thrombosis, meningitis or brain abscess.
Which amino acids can undergo this hyperphosphorlation post translational modification of tau? [3]
Tyrosine, serine and threonine.
What type of imaging would need to be conducted to ID a brainstem injury after TBI? [1]
MRI
Which spinal cord controls general arousal of the spinal cord? [1]
Reticulospinal tract
The primitive heart tube fusion happens on which day? [1]
21
Describe the effects of cocaine [1] and morphine [1] on:
spine density and dendrite branching in the medial prefrontal cortex (mPFC) and the nucleus accumbens (NAc)
Cocaine: increases
Morphine: decreases
Phenelzine, tranylcypromine belong to which drug class? [1]
Irreversible MONOAMINE OXIDASE INHIBITORS
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
A
5-HT1A agonists: buspirone ipsapirone
β-adrenoceptor antagonists: propranolol
which area of the brain would you use DBS to treat treatment resistant depression?
subcallosal cingulate
Name two SNRIs and two SSRIs used as anxiolytics [4]
SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias
SNRIs:
* venlafaxine, duloxetine
Important AEs of TCAs? [4]
Dangerous (cardiotoxic) in overdose
Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
Antihistaminic: sedation, weight gain.
Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects
As a result aren’t the first choice!
Which drug class reduce renin secretion? [1]
Beta blockers
substancia nigra pars compacta have mainly [] neurons
substancia nigra pars reticulata has mainly [] neurons
substancia nigra pars compacta have mainly dopaminergic neurons
substancia nigra pars reticulata has mainly GABAnergic neurons
Q
Give an example that is a chimeric monoclonal antibody used for treating B-Lymphomas [1]
What is the target? [2]
Rituximab: targets CD20 on malignant B-cells and CD3 on normal T cells
Together enhance cytotoxicity
Which of the following binds to CD19 in its mechansim of action to treat cancer?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Tisagenlecleucel (Kymriah)
Which virus is most commonly linked to a higher risk of developing Burkitt’s lymphoma ?
Epstein- Barr virus
Cytomegalovirus
Herpes simplex virus
HPV 16
HPV 18
Epstein- Barr virus
Name two drugs that inhibit CTLA-4
Ipilimubab
Tremelimubab
Which of the following is targeted by Atezolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
PD1-Ligand
What may a prolonged expiratory phase indicate in a patient? [1]
Asthma
What is MART / SMART therapies? [1]
is a form of combined ICS and LABA treatment in which a single inhaler, containing both ICS and a fast-acting LABA, is used for both daily maintenance therapy and the relief of symptoms as required.
What would ascultation of lungs of a pnwumonia patient sound like? [1]
Focal coarse crackles These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
Name a second generation tyrosine kinase inhibitor for EGFR in NSCLC [1]
Osimertinib
Where would LINAC based treatments: MV photons (mega voltage) [1]
What is dosing regimen like? [1]
More penetrative treatment and dose at depth
High dose radical treatments are fractionated (broken up into smaller daily treatments) to deliver treatment safely and avoid damage to adjacent normal tissues/organs
Name a cancer that neo-adjuvant chemotherapy is common for [1]
Ovarian
Name a common AE of alkylating agent [1]
hemorrhagic cystitis: condition in which the lining of the bladder becomes inflamed and starts to bleed.
A patient with complex mental health problems who is on a variety of medications comes into the clinic complaining of weight gain. Which of the following medications is likely to be responsible for this side effect?
Olanzapine
Sodium Valproate
Tramadol
Diazepam
Citalopram
Olanzapine
What is second line treatment of HER2-positive breast cancer? [2]
Trastuzumab - emtansine (Kadcycla)
Describe MoA of platinum agents [1]
Primary mode of cell death is damage to cellular DNA by the development of covalent adducts
Q
Which chemotherapy drug would cause Peri-Orbital Oedema?
Capecitabine
Bleomycin
Doxorubicin
Imatinib
Imatinib
Which chemotherapy drug would cause Palmar-Planter Erythrodysesthesia?
Capecitabine
Bleomycin
Doxorubicin
Imatinib
Which chemotherapy drug would cause Palmar-Planter Erythrodysesthesia?
Capecitabine
Bleomycin
Doxorubicin
Imatinib
Most common form of radiotherapy are the [], which are used to treat deeper cancers.
Most common form of radiotherapy are the MV photons, which are used to treat deeper cancers.
What is the inheritance pattern of Duchenne muscular dystrophy?
Autosomal dominant
Autosomal recessive
X-linked dominant
X-linked recessive
Y-linked
X-linked dominant
What is the approximate duration of 1 sleep cycle?
Alternatives
You selected D when answering this question
The contributor suggests C is the correct option
20-30 minutes
50-70 minutes
80-100 minutes
120-140 minutes
170-190 minutes
80-100 minutes: average is 90mins
What class of drug is venlafaxine?
SSRI
SNRI
TCA
MAO inhibitor
NARI
SNRI
Which brain region is the DBS electrode implanted into in a patient with epilepsy? [1]
Anterior nucleus of thalamus
What BPM would indicate a foetus had tachycardia? [1]
> 160 bpm
What direction do the stereocilia of the vestibular apparatus bend in to trigger depolarisation? Which ion channel opens?
Towards the kinocilium
Na+ ion channel
Away from the kinocilium
Na+ ion channel
Towards the kinocilium
K+ ion channel
Away from the kinocilium
K+ ion channel
Away from the kinocilium
Ca2+ ion channel
Away from the kinocilium
K+ ion channel
When ivestigating AD; what sample would you take, what results would you of
CSF sample taken
Low levels of amyloid beta
Elevated levels of p-tau
Hyperacute transplant rejection is an example of a type [] hypersensitivity reaction
Hyperacute transplant rejection is an example of a type II hypersensitivity reaction
Which gene below, when mutated, folic acid cannot convert to folate, causing infertility? [1]
MTHFR
What is the normal Q angle? [1]
15-20 degrees
A 59-year-old man is prescribed the most highly negatively inotropic drug for hypertension. His GP advises to not take beta-blockers with it as it may cause heart block. He does not have a history of diabetes.
What drug was most likely prescribed? [1]
Verapamil
Verapamil is the most highly negatively inotropic calcium channel blocker
On which day of the menstrual cycle is progesterone measured? [1]
Day 21
Which spinocerebellar tract [anterior / posterior] decussates twice? [1]
Anterior
What is the inheritance pattern for erythromelalgia? Which gene and ion channel are affected?
Autosomal dominant
SCN9A
Nav1.7
A 46-year-old man presents to his GP due to haemoptysis. He notes that he wakes up due to severe sweating, and he has lost considerable weight in the last few weeks. He returned from a holiday in Pakistan just over a month ago. PCR on a sputum confirms the suspected diagnosis of tuberculosis. He is started on 4 different antibiotics and is prescribed pyridoxine, as one of these antibiotics causes vitamin B6 deficiency.
Which antibiotic is responsible for this side effect?
Pyrazinamide
Rifampicin
Isoniazid
Ethambutol
Amikacin
He is started on 4 different antibiotics and is prescribed pyridoxine, as one of these antibiotics causes vitamin B6 deficiency.
Which antibiotic is responsible for this side effect?
Isoniazid
What is the threshold for a bronchodilator reversibility test that would facilitate an asthma diagnosis in adults? [1]
> 12 %
Which of the following biological disease modifying anti-rheumatic drugs (bDMARD) works by blocking the action of CD80? [1]
Abatacept
Which option below best describe how Lamotrigine works?
Calcium channel blocker
GABAA receptor postive allosteric modulator
Neurotransmitter release inhibitor
Neurotransmitter uptake inhibitor
Sodium channel blocker
Which option below best describe how Lamotrigine works?
Sodium channel blocker
Hypersecretion of which hormone is associated with increased incidence of spontaneous abortion? [1]
LH
EPO controls erythropoiesis through which methods? [2]
EPO controls erythropoiesis through the following methods:
increases the speed of maturation of erythroblasts
increases proerythroblast formation
EPO controls erythropoiesis through which methods? [2]
EPO controls erythropoiesis through the following methods:
increases the speed of maturation of erythroblasts
increases proerythroblast formation
What percentage of cancer patients now survive at least 10 years? [1]
50%
Which congenital defect is most associated with the condition foetal alcohol syndrome? [1]
Which congenital defect is most associated with the congenital rubella [1]
VSD - FAS
PDA - Associated with congenital rubella
Which type of brain herniation causes ipsilateral mydriasis (pupil dilation)? [1]
Uncal
Calcium is important in long-term potentiation (LTP).
As a result of calcium’s entry into the cell, which receptors move into the synaptic membrane thereby leading to the strengthening of the synapse? [1]
AMPA
Which structures make up the lentiform nucleus? [2]
Globus Pallidus
Putamen
Which autoantibodies are associated with more severe, erosive rheumatoid arthritis?
Anti-CCP
Anti-CarP
Anti-MPO
Anti-PAD4
IgM-RF
Anti-PAD4
Label A-C
A: optic tract
B: lateral geniculate nucleus
C: optic radiations
What process in gout pathophysiology causes MSU crystals to precipitate even more? [1]
Nuetrophils piereced;
prescription of colchine would indicate that someone is suffering from what pathology? [1]
acute gout
which drug for chronic gout catalyses the conversion of uric acid to allantoin? [1]
Rasburicase
Describe the inheritence pattern of Duchenne & Becke Muscular Dystrophies?
Duchenne & Becke Muscular Dystrophies;
X-linked - recessive
The left marginal artery is a branch of the left circumflex artery and supplies the left ventricle.
Increased expiration time
Increased tactile fremitus
Wheezing on auscultation
Hyper-expanded chest
Increased respiratory rate
Increased tactile fremitus
Tactile/vocal fremitus acts as an indirect measure of the amount of air and the density of tissue present within the lungs. In emphysema, due to the trapping of air and decreased density of the lung parenchyma, tactile fremitus is reduced.
C + D
The Functional Residual Capacity (FRC) is the volume of air left in the lungs following passive expiration. It is calculated by adding the Expiratory Reserve Volume (ERV) to the Residual Volume (RV).
What is this pathology? [1]
Slipped upper femoral epiphysis
Explain mechanism of action of Dabigatran [1]
Direct thrombin inhibitor
An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation.
What enzyme does the drug inhibit?
Protein C1
Epoxide reductase
Gamma-glutamyl carboxylas
CYP2C9
Thrombin
An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation.
What enzyme does the drug inhibit?
Epoxide reductase
Describe the effect of ACE-inhibitor on afferent and effernet arterioles of the glomerulus [2]
Vasodilation of the efferent arteriole
No effect on other
Where is EPO made?[1]
Kidney
What does Q wave represent? [1]
Depolarisation of interventricular septum
What is the most common type of supraventricular tachycardia? [1]
AVNRT
How long does the normal delay in conduction at the atrioventricular node last?
A 120 ms
B 100 ms
C 90-200 ms
D 120-200 ms
E > 200 ms
How long does the normal delay in conduction at the atrioventricular node last?
D 120-200 ms
How can you tell from an ECG lead that the heart has normal axis deviation? [2]
If the QRS complex is upright (positive) in both lead I and lead aVF, then the axis is normal
How can you tell if heart has nromal deviation from an ECG? [1]
If the QRS complex is upright (positive) in both lead I and lead aVF, then the axis is normal
What effect would salbutamol have on an ECG? [1]
sinus tachycardia
Name a cause of third degree heart block [1]
Lyme disease
Where would you put the 10 leads for an 12-lead ECG trace? [10]
Red: right arm
Yellow: left arm
Green: left leg
Black: right leg
V1: sternal edge, right 4th intercostal space
V2: sternal edge, left 4th intercostal space
V3: between V2 and V4
V4: midclavicular line, left 5th intercostal space
V5: between V4 and V6, left 5th intercostal space
V6: mid-axillary line, left 5th intercostal space
P wave should be not more than about 2 small squares long ([] s or [] ms)
A
P wave should be not more than about 2 small squares long (0.08 s or 80 ms)
