Random Flashcards
1
Q
Peptic Ulcer is where?
a) Stomach
b) colon
A
Stomach
2
Q
Which is the middle layer in stomach?
a) Lamina Propria
b) muscaris mucosa
A
Lamina Propria
3
Q
Parietal cells secrete what?
a) Hydrochloric Acid
b) bicarbonate
A
Hydrochloric acid
4
Q
Chief cells secrete what?
a) pepsinogen
b) secretin
A
pepsinogen
5
Q
What does Gastrin stimulate?
a) parietal cells to secrete hydrochloric acid
b) Brunner cells
A
parietal cells to secrete hydrochloric acid
6
Q
Where are Brunner Glands found?
a) duodenum
b) pancreas
A
duodenum
7
Q
H Pylori are?
a) Gram Negative
b) gram positive
A
Gram Negative
8
Q
Alternative cause of Peptic Ulcer?
a) NSAIDS
b) PPI
A
NSAIDS
9
Q
Rare cause of peptic ulcer?
a) Zollinger Ellison Syndrome
b) HIV
A
Zollinger Ellison
10
Q
Treatment of Peptic Ulcer?
a) Antibiotics and PPI eg Omeprazole
b) take the stomach out
A
a)Antibiotics and PPI eg Omeprazole
11
Q
Barret’s Oesophagus is linked with?
a) Oesophageal Adenocarcinoma.
b) oesophageal squamous cell carcinoma
A
a) Oesophageal Adenocarcinoma.
12
Q
Treatment for GORD?
a) Antacids, PPI eg Omeprazole and Fundoplication
b) Surgery
A
a) Antacids, PPI eg Omeprazole and Fundoplication
13
Q
Gold Standard Gord Test?
a) Ph Manometry
b) colonoscopy
A
Ph Manometry
14
Q
Ascending Cholangitis affects?
a) inflammation of bile ducts
b) inflammation of liver
A
Inflammation of bile ducts
15
Q
Common cause of ascending cholangitis?
a) gallstones
b) liver disease
A
Gallstones
16
Q
Common bacteria in ascending cholangitis?
a) E coli, Klebsiella and Enterococcus
b) strep pneumocccous
A
E coli, Klebsiella and Enterococcus
17
Q
Charcot’s triad is made up of?
a) Fever, RUQ Pain and Jaundice
b) Fever, LUQ Pain and Jaundice
A
Fever, RUQ Pain and Jaundice
18
Q
Diagnosis of Ascending Cholangitis?
a) bloods and ERCP
b) MRI
A
Bloods and ERCP
19
Q
What does Intra hepatic mean?
a) inside liver
b) outside liver
A
inside liver
20
Q
what does extra hepatic mean?
a) outside liver
b) inside liver
A
outside liver
21
Q
Presentation with Primary Sclerosing Cholangitis?
a) Raised IgM and Panca
b) raised IgG
A
Raised IgM and Panca
22
Q
Test results in Primary Sclerosing Cholangitis?
a) Raised Conjugated Bilirubin and ALP and GGT
b) Decreased Conjugated Bilirubin and ALP and GGT
A
Raised Conjugated Bilirubin and ALP and GGT
23
Q
Test for Primary Sclerosing Cholangitis?
a) ERCP
b) Ultrasound
A
ERCP
24
Q
Treatment for Primary sclerosing cholangitis?
a) immunosuppresant
b) antibiotic
A
Immunosuppresant
25
What is Primary Sclerosing Cholangitis?
a) Hardening of bile duct for no reason
b) softening of bile duct
Hardening of bile duct for no reason
26
Acute Cholecystitis is what?
a) inflammation of gallbladder
b) infection
Inflammation of gallbladder
27
Where does CCK come from?
a) gallbladder
b) pancreas
Gallbladder
28
Most common malignant tumour in Hepatic?
a) extrahepatic hilar
b) intrahepatic hilar
Extraheptic Hilar
29
Primary biliary cholangitis is said to be
a) intrahepatic
b) extra hepatic
Intrahepatic
30
What happens to serum alkaline phosphatase in Primary Biliary Cholangitis?
a) raised
b) decreased
raised
31
Cirrhosis is a response of the liver to?
a) chronic injury
b) acute injury
Chronic Injury
32
Hepatitis which causes Cirrhosis?
a) hep b and c
b) hep a
Hep B and C
33
What is Cholelithiasis
a) gallstones
b) liver tumour
Gallstones
34
Extra Hepatic Duct Obstruction cause?
a) gallstones
b) liver tumour
Gallstones
35
Calcular Obstructive Jaundice. What happens to weight?
a) no weight loss
b) weight loss
No weight loss
36
In presence of palpable gallbladder, jaundice is said to be?
a) unlikely to be caused by gallstones
b) likely to be gallstones
unlikely to be caused by gallstones
37
What vitamin deficiency in absence of bile?
a) Vitamin K
b Vitamin A
Vitamin K
38
Which Immunoglobulin is relevant to Coeliac?
a) IgA
b) IgG
IgA
39
Which conditions are associated with Coeliac?
a) Dermatitis, Autoimmune Hepatitis, Primary Biliary Cholangitis, Autoimmune Gastritis
b) Splenectomy
Dermatitis, Autoimmune Hepatitis, Primary Biliary Cholangitis, Autoimmune Gastritis
40
Colorectal Cancer Test Gold Standard?
a) colonoscopy and biopsy
b) Endoscope
Colonscopy and biopsy
41
An illeostomy is usually?
a) LIF
b) RIF
RIF
42
A colostomy is usually
a) LIF
b) RIF
LIF
43
Upper GI bleeds are said to be?
a) distal to ligament of trietz
b) proximal to ligament of trietz
Proximal to Ligament of Trietz
44
Lower GI bleeds are said to be?
a) distal to ligament of trietz
b) proximal to ligament of trietz
Distal to Ligament of Trietz
45
what would you expect to see regarding urea in upper GI bleeds?
a) elevated
b) depressed
elevated
46
Which condition causes recurrent poor healing duodenal ulcers?
a) Zollinger ellison
b) coeliac
Zollinger Ellison
47
Mallory Weiss Tear is a tear where?
a) oesophago-gastric junction
b) pyloric sphincter
Oesophago-Gastric Junction
48
Angiodysplasia is what?
a) vascular malformation
b) vascular growth
Vascular Malformation
49
In Ischaemic colitis what happens to mucosa?
a) dark blue, swollen
b) bleeding
dark blue, swollen
50
How to treat radiation proctitis?
a) APC, Enema
b) chemo
APC, Enemas
51
Telipressin does what in GI Bleed?
a) vasoconstrictor
b) vasodilator
Vasoconstrictor
52
Most common colorectal cancer?
a) adenocarcinoma
b) squamous cell
Adenocarcinoma
53
Are Adenomas Malignant?
a) No Pre-Malignant
b) yes
No Pre-Malignant
54
Most Colorectal Polyps are said to be?
a) Villous
B) Tubulovillous
C) Tubular
Tubular
55
Which oncogenes have to be activated in colorectal cancer?
A) Kras and Cymyc
b)APC,P53,DCC
Kras and Cmyc
56
Which genes are tumour suppressor?
A) Kras and Cymyc
b)APC,P53,DCC
APC,P53,DCC
57
Best test for Rectal Tumour?
A) CT
B)MRI
MRI
58
Is Bilary Dyskinesia Functional or Organic?
a) functional
b) organic
Functional
59
What happens in IBS-C?
a) Contractions Reeduced
B) Contractions Stronger
contractions reduced
60
Stapled Anopexy is used for what?
a) prolapse/haemorrhoids
b) rectal cancer
prolapse/haemorrhoids
61
Most common colorectal cancer site?
a) Right colon
b) left colon
c) transverse
left colon
62
How to treat Anorectal Adenocarcinoma?
a) neoadjuvant chemo
b) radiotherapy
neoadjuvant chemo
63
How to treat anorectal squamous cancer?
a) neoadjuvant chemo
b) radiotherapy
radiotherapy
64
What is dynamic bowel obstruction
a) increasing peristalsis
b) cessation of peristalsis
c) no interference of blood supply
a) increasing peristalsis
65
what is adynamic bowel obstruction?
a) increasing peristalsis
b) cessation of peristalsis
c) no interference of blood supply
cessation of peristalsis
66
what is simple bowel obstruction?
a) increasing peristalsis
b) cessation of peristalsis
c) no interference of blood supply
c) no interference of blood supply
67
Adhesions can cause an
a) inside wall obstruction
b) outside wall obstruction
outside wall obstruction
68
How to treat bowel obstruction?
a) ng tube
b) nothing
Ng Tube
69
Most common locations of volvulus
a) caecal or sigmoid
b) ascending colon
caecal or sigmoid
70
Coffee bean sign is seen on x-ray in which condition?
a) sigmoid volvulus
b) adhesive sbo
sigmoid volvulus
71
How to treat Sigmoid volvulus
a) Colonscopy
B) flex sigmoidoscopy
B) flex sigmoidoscopy
72
Adhesive SBO diagnosis is established by?
a) CT
b) MRI
CT
73
What can be given to patients that do not improve who have Adhesive SBO?
a) PPI
b) Gastrografin
Gastrografin
74
Gallstone Ileus is impaction where?
a) Terminal Ileum
b) sigmoid colon
Terminal Ileum
75
Lamina Propria is
a) Loose Connective Tissue
B) Thin Smooth Muscle
a) Loose Connective Tissue
76
Meissner's Plexus is said to be
a) Parasympathetic
B) sympathetic
parasympathetic
77
Which two plexuses make up enteric nervous system?
a) Submucosal and Myenteric
B) Brachial and Somatic
a) Submucosal and Myenteric
78
Long reflexes are said to be
a) parasympathetic
b) ENS
parasympathetic
79
Short reflexes are said to be
a) parasympathetic
b) ENS
ENS
80
Superior Mesenteric Artery Supplies
a) Small intestine, caecum, ascending colon and transverse colon
b) descending colon, sigmoid colon, rectum.
a)Small intestine, caecum, ascending colon and transverse colon
81
Inferior Mesenteric Artery Supplies
b)descending colon, sigmoid colon, rectum.
82
Medical Management of Fissure?
a) GTN/Diltiazem + Lignocaine
b) PPI
a)GTN/Diltiazem + Lignocaine
83
Medical Management of Faecal Incontinence?
a) Loperamide
b) PPI
Loperamide
84
Most common gene associated with IBD?
a) PIMM
B) NDO2
NDO2
85
Smoking is what for Ulcerative Colitis?
a) Protective
b) destructive
protective
86
Aphthous Ulcers are associated with?
a)Crohns
B) ulcerative colitis
Crohns
87
Non caseating granulomatous reaction is typical feature in
a)Crohns
B) ulcerative colitis
crohns
88
What can be used to induct/maintain remission for mild/moderate colitis?
a) 5ASA
B) Systemic Corticosteroid
5ASA
89
What can be used to rescue severe colitis?
a) Systemic corticosteroid
b) 5asa
a) Systemic corticosteroid
90
What two drugs can be used for induction/maintain remission for moderate to severe colitis?
a) immunomodulators/biologics
b) topical corticosteroids/systemic corticosteroids
a) immunomodulators/biologics
91
What do immumomodulators do in colitis?
block purine metabolism
92
What do biologics in colitis do?
| a) block tnf
block tnf
93
Name a biologic agent used in colitis?
a) inflimab
b) athioprine
infliximab
94
Strictures are common or uncommon in crohns
common
uncommon
common
95
Where does fat digestion take place?
a) small intestine
b) large intestine
small intestine
96
What aids fat digestion
a) pancreatic lipase
b) amylase
a) pancreatic lipase
97
Micelles are made up of
a) bile salt + monoglyceride + fatty acid + phospholipid
b) Bile Salt + Disaccharide + fatty acid + phospholipid
a) bile salt + monoglyceride + fatty acid + phospholipid
98
Are Micelles absorbed?
a) yes
b) no
no
99
Where are Fats reinforced into Triacylglycerols?
a) Smooth Endoplasmic Reticulum
B)Rough Endoplasmic reticulum
a) Smooth Endoplasmic Reticulum
100
Can vitamins be absorbed by active diffusion?
a) yes
b) no
no
101
Iron is transported across?
a) brush border membrane via DMT1 into duodenal enterocytes
b) brush border membrane via DMT2 into duodenal enterocytes
a) brush border membrane via DMT1 into duodenal enterocytes
102
Iron in blood binds to?
a) transferrin
b) feratin
a) transferrin
103
What does Hyperaemia do?
a) Increase ferritin
b) decrease ferritin
increase ferritin
104
What does Anaemia do?
a) increase ferritin
b) decrease ferritin
decrease ferritin
105
iron uptake by body is regulated by?
a) hepcidin
b) ferritin
hepcidin
106
Chewing is controlled by
a) somatic nerves
b) sympathetic nerves
somatic nerves
107
Amylase catalyses breakdown of polysaccharide into?
a) monosaccharide
b) disaccharide
polysaccharide
108
What does Sympathetic and parasympathetic nervous system do to secretion of saliva?
a) stimulate
b) inhibit
stimulate
109
Oesophagus is lined by?
a) Non Keratinised Stratified Squamous Epithelium
B) Keratinised Stratified Squamous Epithelium
a) Non Keratinised Stratified Squamous Epithelium
110
Upper 1/3 of Oesophagus s?
a) Skeletal
B) Smooth
Skeletal
111
Lower 2/3 of Oesophagus is?
a) Skeletal
B) Smooth
Smooth
112
Swallowing centre is?
a) medulla
b) pons
medulla
113
Stomach produces?
a) vitamin a
b) intrinsic factor
intrinsic factor
114
Chief cells produce?
a) pepsinogen
b) mucus
pepsinogen
115
Parietal cells produce
a) pepsinogen
b) chi
hci
116
In Gastric Acid Secretion. Neurocrine is modulated by?
a) Vagus/Local reflexes
B) gastrin
Vagus/Local reflexes
117
In Gastric Acid Secretion. Endocrine is modulated by?
a) Gastrin
b) histamine
gastrin
118
In gastric acid secretion. Paracrine is modulated by?
a) histamine
b) gastrin
histamine
119
Vagal/Enteric Reflexes are affected by?
A) ACH
b) gastrin
ACH
120
ECL Reflexes are affected by?
a) Histamine
b) gastrin
Histamine
121
Stopping eating does what to vagal activity?
a) increase
b) decrease
decrease
122
Decreased ph and increased HCI does what to gastrin in the gastric phase?
a) decreases
b) increases
decreases
123
Fat/CHO in duodenum does what to gastrin and parietal HCI?
a) decrease
b) increase
decrease
124
Acid in duodenum causes what to release?
a) secretin
b) gastrin
secretin
125
Enterogastrones does what?
a) Inhibit gastric acid secretion and reduce emptying
b) increase gastric acid secretion and increase emptying
a) Inhibit gastric acid secretion and reduce emptying
126
Pepsinogen is secreted by
a) chief cells
b) parietal cells
chief cells
127
Parietal cells secrete?
a) HCI
b) chief cells
HCI
128
Gastrin does what to contraction?
a) increases
b) decreases
increases
129
Bicarbonate is produced from?
a) Brunner cells
b) parietal cells
bruner cells
130
Endocrine portion of pancreas has?
a) Islets of Langherhan
b) acinar cells
Islets of Langherhan
131
What prevents auto digestion of pancreas?
a) zymogen
b) pepsinogen
zymogen
132
What converts trypsinogen to trypsin?
a) enterokinase
b) peptide
enterokinase
133
Bicarbonate secretion is stimulated by?
a) secretin
b) gastrin
secretin
134
Hco3 is secreted by
a) hepatocytes
b) duct cells
duct cells
135
CCK causes?
a) decreased gastric emptying
b) increased gastric emptying
decreased gastric emptying
136
Crypt cells secrete?
a) CI and water
B)H
CI and Water
137
Mucosa epithelium
a) simple columnar stratified squamous
b) cuboidal columnar
simple columnar stratified squamous
138
Defecation reflex is under
a) Parasympathetic via Pelvic Splanchic
b) sympathetic
a) Parasympathetic via Pelvic Splanchic
139
Voluntary delay of defecation comes from
a) ascending pathways
b) descending pathways
descending pathways
140
What do enterotoxigenic bacteria cause?
a) increased h20 secretion
b) decreased h20 secretion
increased h20 secretion
141
Adenocarcinomas are commonly
a) prox and mid third oesophagus
b) distal oesophagus
distal oesophagus
142
squamous cell carcinomas are commonly
a) prox and mid third oesophagus
b) distal oesophagus
a) prox and mid third oesophagus
143
Commonly raised bloods in alcoholic hepatitis?
a) Bilirubin, GGT and Alk P
b) Wcc
a) Bilirubin, GGT and Alk P
144
Refeeding is commonly associated with?
a) Hypophosphatemia
b) hypovolemia
a)Hypophosphatemia
145
Pancreatic Cancer. Does it have obstructive jaundice or not?
a) yes
b) no
yes
146
Recurrent pancreatitis. What would you question?
a) Pancreatic Cancer
b) Ascending Cholangitis
Pancreatic Cancer
147
Which skin condition can be associated with acute pancreatitis?
a) mumps
b) measles
mumps
148
Which oxidative product is associated with acute pancreatitis?
a) acetaldehyde
b) fatty acid ethyl esters
a) acetaldehyde
149
Which autosomal dominant genes are associated with chronic pancreatitis?
a) autosomal dominant (codon 29 and 122
b) autosomal recusant (codon 30 and 133)
a)autosomal dominant (codon 29 and 122
150
Which enzyme would you look for in Chronic pancreatitis?
a) elastase
b) amylase
elastase
151
Treatment for Peptic Ulcer
a) NSAIDS
b) Eradication therapy including PPI eg Omeprazole
b) Eradication therapy including PPI eg Omeprazole
152
Large bowel have villi or not?
a) no villi
b) have villi
no villi
153
Large bowel crypts
a) tubular
b) square
tubular
154
H2 Antagonists such as Rantidine used to treat/prevent
a) Peptic and Duodenal Ulcer
b) Rectal Ulcer
Peptic and Duodenal Ulcer
155
Cyclizine which is an antihistamine helps with?
a) Vomiting/Nausea
B) Headache
Vomiting/Nausea
156
Myelin Sheath does what to conduction speed?
a) increase
b) decrease
increase
157
myelin sheath is formed by what in PNS?
a) Schwann cells
b) oligodendrocytes
Schwann cells
158
myelin sheath is formed by what in CNS?
a) Schwann cells
b) oligodendrocytes
oligodendrocytes
159
Cerebellum is involved in?
a) Balance and coordination
b) memory
balance and coordination
160
Where does the 3rd ventricle lie within?
a) diencephalon
b) hippocampus
a) diencephalon
161
Where does the cerebral aqueduct lie?
a) midbrain
b) hindbrain
midbrain
162
Where does the 4th ventricle lie?
a) hindbrain
b) midbrain
hindbrain
163
How many lateral ventricles
a) 2
b) 4
2
164
Which space contains CSF?
a) Subarachnooid
b) Subdural
Subarachnoid
165
Where is CSF made?
a) choroid plexus
b) 3rd ventricle
choroid plexus
166
where is csf absorbed
a) by arachnoid villi into saggital sinus
b) by Pia villi
a) by arachnoid villi into saggital sinus
167
Neural tube develops from
a) endoderm
b) ectoderm
ectoderm
168
Medulla Oblongata continues as spinal cord at which foramen?
a) foramen magnum
a) foramen munro
foramen magnum
169
Surface feature of medulla oblongata laterally?
a) pyramid
b) olive
olive
170
what connects medulla oblongata to cerebellum?
a) inferior cerebellar peduncle
b) anterior cerebellar peduncle
inferior cerebellar peduncle
171
Which ventricle is posterior to pons)
a) IV
b) I
IV
172
Which cranial nerves originate from Pons surface?
a) V,VI, VII, VIII
b) V,VI,VII,X
a) V,VI, VII, VIII
173
The pyramidal tract is said to be
a) motor
b) sensory
motor
174
Cerebral aqueduct connects which ventricles
a) III and IV
b) I and II
a) III and IV
175
Midbrain develops from
a) diencephalon
b) mesencephalon
mesencephalon
176
Central cavity of midbrain is
a) cerebral aqueduct
b) foramen of munro
cerebral aqueduct
177
The midbrain is the origin of which cranial nerves
a) oculomotor and trochlear
b) trigeminal and accessory
a) oculomotor and trochlear
178
Which nerve is the only nerve to originate posteriorly
a) trochlear
b) oculomotor
trochlear
179
Cerebellum hemispheres separated by
a) vermis
b) sulci
vermis
180
How many peduncles connect cerebellum to brainstem?
three
181
Diecenphalon is found near?
a) III ventricle
b) IV ventricle
III ventricle
182
Internal carotid arteries enter skull through?
a) foramen lacerum
b) foramen munro
a) foramen lacerum
183
Vertebral arteries enter skull through
a) foramen lacerum
b) foramen magnum
foramen magnum
184
Middle cerebral arteries supply
a) lateral aspect of cerebral hemispheres
b) medial aspect of cerebral hemispheres
c) inferior aspect of cerebral hemispheres and occipital lobe
a) lateral aspect of cerebral hemispheres
185
Anterior cerebral arteries supply
a) lateral aspect of cerebral hemispheres
b) medial aspect of cerebral hemispheres
c) inferior aspect of cerebral hemispheres and occipital lobe
b)medial aspect of cerebral hemispheres
186
Posterior cerebral arteries supply
a) lateral aspect of cerebral hemispheres
b) medial aspect of cerebral hemispheres
c) inferior aspect of cerebral hemispheres and occipital lobe
c) inferior aspect of cerebral hemispheres and occipital lobe
187
How many semi circular canals in each ear?
a) 2
b) 3
3
188
Saccule gives
a) vertical acceleration
b) rotational acceleration
c) horizontal acceleration
a) vertical acceleration
189
semi circular canals give
a) vertical acceleration
b) rotational acceleration
c) horizontal acceleration
b)rotational acceleration
190
Utricle canals give
a) vertical acceleration
b) rotational acceleration
c) horizontal acceleration
c) horizontal acceleration
191
Sensory cells of semi circular canals are where?
a) macule
b) ampulla
ampulla
192
The macula in the utricle are orientated on the?
a) horizontal plane
b) vertical plane
horizontal plane
193
The saccule are orientated on the?
a) vertical plane
b) horizontal plane
vertical plane
194
Tilt of the head is detected by the?
a) macula in the utricle
b) ampulla
macula in utricle
195
What connects the 2 hemispheres of the brain?
a) Corpus Callosum
b) Corpus Mallosum
Corpus Callosum
196
Area 17 The Primary Visual Cortex in the brain is also known as
a) limbic lobe
b) occipital lobe
occipital lobe
197
Visual Association Cortex in Occipital lobe is also called?
a) Areas 18 and 19
b) area 20
areas 18 and 19
198
The hippocampus is found where?
a) medial aspect of temporal lobe
b) lateral aspect of temporal lobe
a) medial aspect of temporal lobe
199
Where does Substantia migraine lie?
a) Midbrain
b) hindbrain
midbrain
200
Which area is motor speech area?
a) broca
b) wernicke
broca
201
Which area is auditory association area?
a) broca
b) wernicke
wernicke
202
Internal capsule blood supply is from?
a) middle cerebral artery
b) anterior cerebral artery
middle cerebral artery
203
Temporal lobe is involved in?
a) hearing and smell
b) vision
hearing and smell
204
Which areas are associated with temporal lobe/primary auditory cortex?
a) areas 41 and 42
b) areas 19 and 20
areas 41 and 42
205
Parietal lobe is associated with what and which area
a) sensory and areas 3,1 and 2
b) motor and areas 3,1 and 2
a) sensory and areas 3,1 and 2
206
Frontal lobe is associated with?
a) motor
b) sensory
motor
207
area 4 is associated with?
a) precentral gyrus/primary motor cortex
b) sensory and areas 3,1 and 2
a) precentral gyrus/primary motor cortex
208
area 44 and 45 is associated with?
a) inferior frontal gyrus/broca
b) precentral gyrus/primary motor cortex
) inferior frontal gyrus/broca
209
Subcortical nuclei are
a) white matter
b) grey matter
grey matter
210
Posterior part of cerebral hemisphere is
a) sensory
b) motor
a) sensory
211
anterior part of cerebral hemisphere is
a) sensory
b) motor
motor
212
Is a meningioma benign or malignant?
a) benign
b) malignant
benign
213
What happens to FEV1/FVC ratio in restrictive lung disease?
a) normal
b) increased
c) decreased
normal
214
Questionaire for sleep apnoea?
a) montreal
b) epworth
epworth
215
TACS Stroke must have?
a) Hemniopia
b) Diplopia
hemniopia
216
TACS Stroke has
a) incomplete hemiparesis
b) complete hemiparesis
complete
217
Tacs Stroke has
a) Heminopia (loss of vision on eye side)
b) loss of vision both sides
a) Heminopia (loss of vision on eye side)
218
Lacunar stroke will not have
a) Will not have dysphasia, inattention or hemianopia
b) hemiparesis
a)Will not have dysphasia, inattention or hemianopia
219
Which feature is common in mitral stenosis?
a) malar flush
b) pan systolic murmur
malar flush
220
which feature is common in mitral stenosis
a) loud apex beat
b) tapping apex beat
tapping apex beat
221
Treatment for Heart disease
a) ACE
b) Diuretics, AntiCoag and Sometimes Surgery
b) Diuretics, AntiCoag and Sometimes Surgery
222
Which feature is common in mitral regurg
a) pan systolic murmur
b) loud apex beat
a) pan systolic murmur
223
what is common in aortic stenosis
a) low pulse pressure
b) wide pulse pressure
a)low pulse pressure
224
which features are common in aortic regard?
a) wide pulse and corrigan sign
b) pan systolic murmur
a) wide pulse and corrigan sign
225
Repair AAA at what size
a) >5.5cm
b<5.5cm
a) >5.5cm
226
How to diagnose AAA?
a) ultrasound
b) ct
ultrasound
227
Stage 2 Hypertension is
a) 160/100
b 140/80
a) 160/100
228
How to treat Hypertension in white person <55
a) ACE
B) Beta blocker
Ace
229
How to treat hypertension in >55 or Black
a) ARB
b) ccb
ARB
230
Patient with No ST elevation and no troponin rise
a) Unstable Angina
b) NSTEMI
Unstable Angina
231
Irregular irregular pulse is seen in?
a) Atrial fibrillation
b) ventricular fibrillation
a) Atrial fibrillation
232
How to test for Angina
a) bloods and ecg
b) echo
bloods and egg
233
How to treat angina
a) GTN and b blocker
b) ARB
gtn and b blocker
234
What to use in Heart failure
a) diuretics
b) ccb
diuretics
235
Common in ECG with Cor Pulmonale?
a) Right axis deviation
b) left axis deviation
a) Right axis deviation
236
Common features in critical limb ischaemia?
a) Hairless, Ulcers
B) heat
a) Hairless, Ulcers
237
What does Horners Syndrome present as?
a) Miotic Pupils, Ptosis and Anhydrosis
b) Mydriasis
a) Miotic Pupils, Ptosis and Anhydrosis
238
Crohns Treatment
a) Meselazine and Prednisolone
b) Sodium valproate
a) Meselazine and Prednisolone
239
Name an anti platelet drug?
a) Clopidogrel
b) Warfarin
a) Clopidogrel
240
Treatment for Parkinsons?
a) Levodopa
b) Sodium Valproate
Levodopa
241
Where is Eustachian tube in the ear located?
a) mid
b) inner
c) outer
mid ear
242
Ratio of Tympanic Membrane to Stapes in middle ear is?
a) 17.1
b) 16.1
17.1
243
Which humour is in anterior segment of eye?
a) aqueous
b) vitreous
aqueous
244
Sclera in eye is said to be?
a) Opaque
b) Transparent
Opaque
245
What produces aqueous humour in eye?
a) ciliary body
b) sclera
ciliary body
246
What does Ciliary Body do in eye?
a) suspend lens and produce aqueous humour
b) control diameter of pupil
a) suspend lens and produce aqueous humour
247
What does Choroid do in eye?
a) supply blood
b) control diameter of pupil
a) supply blood
248
Rods and Cones in the eye are situated where?
a) retina
b) choroid
retina
249
What is accommodation in eye?
a) focusing
b) refraction
focusing
250
what controls the sharpness of vision in eye?
a) refraction
b) accommodation
refraction
251
Light waves from an object bend where in the eye?
a) cornea
b) retina
cornea
252
What is the cornea's bending power?
a) 45D
b) 15d
45d
253
What is the lens bending power?
a) 45d
b) 15d
15d
254
When an object is close what happens to the lens?
a) thicker/more powerful
b) thinner/more powerful
a)thicker/more powerful
255
What happens to eyes in accomodation
a) pupils constrict and eyes converge
b) pupils dilate and eyes converge
a)pupils constrict and eyes converge
256
Which muscle in eye contracts to make lens thicker?
a) oblique inferior
b) ciliary muscle
b) ciliary muscle
257
What causes ciliary body contraction?
a) parasympathetic
b) sympathetic
parasympathetic
258
Which muscles of the eye are used to converge?
a) Medial rectus
b) oblique rectus
medial rectus
259
Which opsins are present in eye cones?
a) S,L and M
b) S,L and N
a) S,L and M
260
Visual pigment rhodopsin is made up of?
a) opsin and 11 cis retinal
b) opsin and 13 cis retinal
a) opsin and 11 cis retinal
261
In the dark what happens to depolarised Na+ and Ca+ channels in eye?
a) Open
b) Closed
Open
262
Which fluid in eye helps maintain intraocular pressure?
a) aqueous
b) vitreous
aqueous
263
Conjuntiva does not cover which part of eye?
a) Inner eyelid
b) cornea
cornea
264
Intrinsic eye muscles do what?
a) control diameter
b) move eye
control diameter
265
extrinsic eye muscles do what?
a) control diameter
b) move eye
move eye
266
The superior oblique muscle in eye arises from?
a) roof of orbit posteriorly
b) floor of orbit posteriorly
a)roof of orbit posteriorly
267
The inferior oblique muscle in eye arises from?
a) roof of orbit posteriorly
b) floor of orbit posteriorly
b) floor of orbit posteriorly
268
The eye rectus muscles insert onto sclera?
a) anteriorly
b) posteriorly
anteriorly
269
Superior oblique muscle of eye origin?
a) lesser wing of sphenoid
b) greater wing of sphenoid
a) lesser wing of sphenoid
270
which nerve supplies lateral rectus of eye?
a) trochlear
b) abducens
abducens
271
Which nerve supplies superior oblique of eye?
a) trochlear
b) abducens
trochlear
272
What is intorsion of eye?
a) when top of eyeball rotates towards nose
b) then top of eyeball rotates away from nose
a) when top of eyeball rotates towards nose
273
What does Medial rectus of eye do?
a) adduction
b) abuction
adduction
274
what does lateral rectus of eye do?
a) abduction
b) adduction
abduction
275
What does superior rectus of eye do?
a) elevation
b) depression
elevation
276
what does inferior rectus of eye do?
a) depression
b) elevation
depression
277
What do oblique muscles of eye do?
a) Intorsion/extorsion
b) depression
intorsion/extorsion
278
What happens in the eyes with increased illumination?
a) parasympathetic constriction
b) sympathetic dilation
parasympathetic constriction
279
The pupillary reflex fibres go where in afferent limb?
a) EWL Fibres of one side
b) EWL fibres of both sides
b)EWL fibres of both sides
280
Trochlear nerve arises from?
a) dorsal part of midbrain
b) ventral part of midbrain
a) dorsal part of midbrain
281
Trochlear nerve supplies
a) superior oblique of eye
b) inferior oblique of eye
a) superior oblique of eye
282
Oculomotor nerve synapses at
a) ciliary ganglion
b) optic ganglion
ciliary ganglion
283
Abducens nerve supplies
a) lateral rectus
b) superior rectus
a)lateral rectus
284
Nasociliary nerve supplies medial part of orbit, ethmoidal air sinus and nasal cavity by going?
a) medially
b) laterally
medially
285
Lacrimal branch supplies lateral part of orbit and lacrimal gland by going?
a) medially
b) laterally
laterally
286
The cavernous sinus is?
a) immediately posterior to apex of orbit
b) immedlately anterior to apex of orbit
a)immediately posterior to apex of orbit
287
Central retinal artery supplies
a) inner layers of retina
b) outer layers of retina
a) inner layers of retina
288
Long Posterior ciliary arteries supply
a) anterior choroid, ciliary body and iris
b) retina
a) anterior choroid, ciliary body and iris
289
The lacrimal gland is situated in orbit?
a) laterally
b) medially
laterally
290
Tears drain on which side of each eyelid?
a) medial
b) lateral
medial
291
Tears eventually drain into?
a) inferior meatus
b) superior meatus
inferior meatus
292
Surface ectoderm forms?
a) eyelids, conjunctiva, corneal epithelium
b) choroid, cornea, sclera and extraocular muscles
a)eyelids, conjunctiva, corneal epithelium
293
Mesenchyme forms?
a) eyelids, conjunctiva, corneal epithelium
b) choroid, cornea, sclera and extraocular muscles
b)choroid, cornea, sclera and extraocular muscles
294
The eye oblique muscles do what when the eye is adducted?
a) depress/elevate
b) abduct
depress/elevate
295
The eye rectified do what when eye is abducted?
a) depress/elevate
b) aduct
a)depress/elevate
296
Cornea histology?
a) stratified squamous non keratinised
b) non stratified squamous non keratinised
a)stratified squamous non keratinised
297
Are there any blood vessels in cornea?
a) no
b) yes
no
298
How is transparency maintained in cornea
a) regular arrangement of collagen in stroma
b) irregular arrangement of collagen in stroma
a)regular arrangement of collagen in stroma
299
What s a corneal transplant called
a) Keratoplasty
b) Meratoplasty
a) Keratoplasty
300
Layer 1 of Tear film is known as?
a) mucinous layer overlying corneal epithelium
b) aqueous layer overlying mucinous layer
a) mucinous layer overlying corneal epithelium
301
Layer 2 of Tear film is known as?
a) mucinous layer overlying corneal epithelium
b) aqueous layer overlying mucinous layer
b)aqueous layer overlying mucinous layer
302
Roseacea is known as chronic or acute inflammation?
a) chronic
b) acute
chronic
303
Pulmonary Artery travels where?
a) away from heart
b) towards heart
away from heart
304
Which lung has a horizontal fissure?
a) Right lung
b) left lung
right lung
305
Type 1 Cells in Alveoli are?
a) gas exchange
b) synthesise surfactant
gas exchange
306
Type 2 Cells in Alveoli are?
a) gas exchange
b) synthesise surfactant
synthesise surfactant
307
How many times do the bronchi branch?
a) 12
b) 22
22
308
What is pulmonary circulation
a) deliver co2 to lungs and pick up 02
b) deliver 02 to lungs and pick up co2
a)deliver co2 to lungs and pick up 02
309
Parietal or Visceral is sensitive to pain?
a) parietal
b) visceral
parietal
310
Pleural fluid is positive or negative?
a) negative
b) positive
negative
311
Boyle's Law is what?
a) increase volume = decrease pressure
b) decrease volume=decrease pressure
a) increase volume = decrease pressure
312
Histamine acts as
a) bronchoconstrictor
b) bronchodilator
bronchoconstrictor
313
Pressure inside pleural cavity is always?
a) negative
b) positive
negative
314
Anatomical dead space volume is?
a) 150ml
b) 200ml
150ml
315
What is tidal volume?
a) volume of air breathed in or out of lungs during single expiration or inspiration
b) volume of air air which can be expelled from lungs at end of normal expiration
a)volume of air breathed in or out of lungs during single expiration or inspiration
316
What is expiratory reserve volume?
a) volume of air breathed in or out of lungs during single expiration or inspiration
b) volume of air air which can be expelled from lungs at end of normal expiration
b)volume of air air which can be expelled from lungs at end of normal expiration
317
What is residual volume?
a) volume of air breathed in or out of lungs during single expiration or inspiration
b) volume of gas in lungs at end of max expiration
b) volume of gas in lungs at end of max expiration
318
Vital capacity is made up of
a) tidal volume + inspiratory and expiratory reserve volumes
b) tidal volume + residual volume + inspiratory reserve volume
a)tidal volume + inspiratory and expiratory reserve volumes
319
Total lung capacity is made up of
a) Vital Capacity + Residual Volume
b) Tidal volume + inspiratory reserve volume
a)Vital Capacity + Residual Volume
320
Inspiratory capacity is made. up of ?
a) tidal volume + inspiratory reserve volume
b) expiratory reserve volume _+ residual volume
a) tidal volume + inspiratory reserve volume
321
Functional Residual volume is made up of?
a) tidal volume + inspiratory reserve volume
b) expiratory reserve volume _+ residual volume
b)expiratory reserve volume _+ residual volume
322
Surfactant production starts at?
a) 25 weeks gestation
b) 36 weeks gestation
a) 25 weeks gestation
323
Compliance does what from base to apex?
a) declines
b) increases
declines
324
What happens in emphysema to elasticity?
a) loss
b) increase
loss
325
What can be measured directly by spirometry?
a) tidal volume, expiratory volume, inspiratory reserve volume, inspiratory capacity and vital capacity?
b) residual volume
a) tidal volume, expiratory volume, inspiratory reserve volume, inspiratory capacity and vital capacity?
326
Pulmonary Ventilation is product of?
a) tidal volume and respiratory frequency
b) tidal volume and heart rate
a) tidal volume and respiratory frequency
327
Ventilation control is by
a) vagus nerve
b) phrenic nerve
phrenic nerve
328
Which nerve innervates external intercostal muscles?
a) phrenic
b) intercostal
intercostal
329
What happens with increase in thoracic cavity?
a) decrease in pressure
b) increase in pressure
decrease in pressure
330
Ventilation control is within
a) pons and medulla
b) hind brain
pons and medulla
331
What happens if you sever above C3-5?
a) breathing increases
b) breathing ceases
breathing ceases
332
Dorsal or ventral is associated with respiration?
a) Dorsal
b) ventral
dorsal
333
Dorsal respiratory group is?
a) inspiratory muscles
b) exhalation
a) inspiratory muscles
334
Central chemoreceptors respond directly to?
a) hydrogen ions
b) calcium
hydrogen ions
335
Peripheral chemoreceptors are located?
a) carotid and aortic bodies
b) medulla
carotid and aortic bodies
336
What happens when rise in hydrogen ions concentration for breathing?
a) reflex stimulation of ventilation
b) reflex inhibition of ventilation
a) reflex stimulation of ventilation
337
What happens when there's a rise in carbon dioxide in blood?
a) rise in hydrogen ions
b) decrease in hydrogen ions
rise in hydrogen ions
338
What happens with vomiting in respiratory?
a) Alkalosis and Ventilation inhibited
b) acidosis and ventilation inhibited
inhibited
339
Barbiturates and Opoids do what to respiratory centre?
a) depression
b) increase
depression
340
Gaseous anaesthetic agents do what to breathing?
a) increase respiratory but decrease tidal volume so decrease alveolar ventilation
b) decrease respiratory and tidal volume
a) increase respiratory but decrease tidal volume
341
Ntrous oxide does what to peripheral chemoreceptor?
a) blunts it
b) activates it
Blunts it
342
What do patients with chronic lung disease rely on?
a) changes in po2
b) changes in pco2
changes in po2
343
Hyperventilation does what to po2 and pco2?
a) increase po2 and decrease pco2
b) decrease po2 and increase pco2
a) increase po2 and decrease pco2
344
In anaemia what happens to pao2?
a) low
b) normal
normal
345
Respiratory cause of type 1 respiratory failure?
a) pneumonia or PE
b) lung cancer
a) pneumonia or PE
346
Type 2 respiratory failure respiratory causes
a) asthma, copd
b) pneumonia
asthma, copd
347
What happens to Paco2 in Type 2 respiratory failure?
a) increased
b) decreased
increased
348
In respiratory embryology. Pseudo-glandular is?
a) 5-17 weeks
b) 16-26 weeks
5-17 weeks
349
In respiratory embryology. Canalicular is?
a) 5-17 weeks
b) 16-26 weeks
16-26 weeks
350
```
The heart is situated anterior to which vertebrae in the recumbent (lying down) position?
A C4 - C7
B T1 - T5
C T5 - T8
D T6 - T9
E T10 - T12
```
T5-8
351
What features are common to both skeletal and cardiac muscle?
A Myocytes in both are electrically connected via gap-junctions
B The duration of the depolarising phase of the action potential in both is less than 5 msec
C They both exhibit sustained contraction (tetanus) in response to high frequency stimulation
D They both have an unstable resting membrane potential
E *None of the above features are shared in common
None of the above features are shared in common
352
```
During embryological development, which pair of aortic arches give rise to the common carotid arteries?
A 2nd pair of aortic arches
B 3rd pair of aortic arches
C 4th pair of aortic arches
D 5th pair of aortic arches
E 6th pair of aortic arches
```
B 3rd pair of aortic arches
353
What anatomical features allow arterioles to function as resistance vessels?
A They have a relatively narrow lumen and a thin elastic wall
B They have a relatively narrow lumen and strong muscular wall
C They have a relatively wide lumen and a thin elastic wall
D They have a relatively wide lumen and strong muscular wall
E The statement is wrong; arterioles are not resistance vessels
| B They have a relatively narrow lumen and strong muscular wall
354
```
5. In the heart, the fast depolarising phase of the cardiac action potential is caused by the influx of which ions?
A Influx of Ca2+
B Influx of Cl-
C Influx of K+
D Influx of Mg2+
E. Influx of Na+
```
Influx of Na+
355
7. What event causes the second heart sound?
A Blood entering the aorta
B Closure of the semilunar valves
C Closure of the the atrioventricular valves
D Contraction of the atria
E Opening of the atrioventricular valves
B Closure of the semilunar valves
356
What effect is a heart rate in excess of 150 beats per minute is likely to have on the stroke volume?
A Decrease afterload and therefore decrease stroke volume
B Decrease contractility and therefore decrease stroke volume
C Decrease preload and therefore decrease stroke volume
D Increase afterload and therefore decrease stroke volume
E Increase preload and therefore decrease stroke volume
C Decrease preload and therefore decrease stroke volume
357
What effect will activation of beta1-adrenoceptors on cardiac myocytes have on stroke volume?
A Increase afterload and therefore decrease stroke volume
B Increase afterload and therefore increase stroke volume
C Increase contractility and therefore increase stroke volume
D Increase preload and therefore decrease stroke volume
E Increase preload and therefore increase stroke volume
C Increase contractility and therefore increase stroke volume
358
What is the distinguishing feature of the pulmonary circulation?
A Most pulmonary blood flow occurs during diastole
B Pulmonary arterioles constrict in response to local hypoxia
C Pulmonary arterioles express beta1-adrenoreceptors
D The pulmonary circulation shows excellent pressure autoregulation
E The pulmonary circulation shows good active (metabolic) hyperaemia
B Pulmonary arterioles constrict in response to local hypoxia
359
11. During exercise, what mechanism causes an increase in venous pressure, and hence venous return to the heart?
A An increase in the systemic filling pressure
B Contraction of smooth muscle surrounding the veins
C Increased rate and depth of respiration
D Rhythmic contraction of skeletal muscle
E All of the above
E All of the above
360
```
12. A 46 year old woman has intermittent rapid regular palpitations that are terminated by the valsalva manoeuvre. She feels well between these episodes.
Which is the most likely diagnosis?
A Atrial fibrillation
B Supraventricular tachycardia
C Ventricular ectopics
D Ventricular fibrillation
E Ventricular tachycardia
```
B Supraventricular tachycardia
361
```
13. A 65 year old woman with hypertension is admitted to the acute medical admissions unit with sudden onset of severe breathlessness, and paroxysmal nocturnal dyspnoea (PND). She is tachycardic with an elevated jugular venous pressure (JVP), crackles in both lung fields to the midzones and significant peripheral oedema.
Which is the most appropriate initial drug treatment?
A Angiotensin converting enzyme inhibitor
B Angiotensin II blocker
C Beta blocker
D Calcium channel blocker
E. Diuretic
```
E. Diuretic
362
```
A 68 year old man presents with exertional angina.
Which is the most appropriate treatment to improve symptoms?
A Angiotensin-converting-enzyme (ACE) inhibitor
B Aspirin 75mg/day
C Beta blocker
D Low dose warfarin
E Simvastatin
```
C Beta blocker
363
```
A 40 year old man is found to have high blood pressure. You believe he may suffer from “white coat hypertension”.
Which investigation would confirm this?
A 24 hour ambulatory blood pressure recording
B 24 hour urinary catecholamines
C Echocardiography
D Renal arteriography
E Renal ultrasound
```
24 hour ambulatory blood pressure recording
364
```
16. A 26 year old woman has a hot, swollen right leg following a flight from Australia. Ultrasound confirms deep vein thrombosis (DVT) in the right lower limb.
Which is the most appropriate initial treatment?
A Aspirin
B Clopidogrel
C Low molecular weight heparin
D Thrombolysis
E Warfarin
```
C Low molecular weight heparin
365
```
A child is born with coarctation of the aorta, short stature, neck webbing and gonadal dysgenesis.
Which is the most likely diagnosis?
A Down syndrome
B Noonan syndrome
C Shprintzen syndrome
D Turner syndrome
E Williams syndrome
```
D Turner syndrome
366
```
18. A 70 year old man has a three month history of pain in the back of both his calves after walking 100 metres. He is a smoker of 53 pack years.
Which is the most likely diagnosis?
A Arterial thromboembolus
B Baker's cyst
C Deep vein thrombosis
D Peripheral vascular disease
E Varicose veins
```
D Peripheral vascular disease
367
```
A newborn infant with a murmur is found to have an atrio-ventricular septal defect on echocardiography. The baby is hypotonic.
Which is the most likely diagnosis?
A 22q11 microdeletion
B Down syndrome
C Foetal alcohol syndrome
D Multifactorial congenital heart disease
E Turner syndrome
```
B Down syndrome
368
```
A 70 year old man presents with an ulcer of his left leg. His sleep is being interrupted by severe leg pain.
Which is the most likely cause of his ulcer?
A Chronic venous insufficiency
B Critical limb ischaemia
C Diabetic neuropathy
D Post-phlebitic syndrome
E Squamous carcinoma
```
Critical limb ischaemia
369
```
1. The maximum volume of air that can be voluntarily exhaled following a maximum inspiration is called:
A. Expiratory Reserve Volume
B. Functional Residual Capacity
C. Residual Volume volume
D. Vital Capacity
E. Vital Volume
```
D. Vital Capacity
370
2. Air flows into the lungs during inspiration because:-
A. The external intercostal and diaphragm muscles contract and thoracic volume decreases
B. The external intercostal and diaphragm muscles contract and thoracic
volume increases
C. The internal intercostal and abdominal muscles contract and thoracic volume decreases
D. The internal intercostal and abdominal muscles contract and thoracic volume increases
E. The internal intercostal and diaphragm muscles contract and thoracic volume increases
```
B. The external intercostal and diaphragm muscles contract and thoracic
volume increases (correct answer)
```
371
```
A male patient has a respiratory rate of 10 breaths per minute and a tidal volume of 700ml. If his residual volume measures 1000ml and his dead space volume measures 200ml what is his alveolar ventilation?
A. 5000ml/min
B. 7200ml/min
C. 8000ml/min
D. 9000ml/min
E. 10,000ml/min
```
5000ml/min (correct answer) (TV-DS) x RR = alveolar ventilation
372
```
The partial pressure of oxygen in mixed venous blood is typically around:
A. 40 mmHg (5.3kPa)
B. 46 mmHg (6.1kPa)
C. 100mmHg (13.3kPa)
D. 160 mmHg (21.3kPa)
E. 200 mmHg (26.7kPa)
```
A. 40 mmHg (5.3kPa)
373
rterial partial pressure of oxygen will be reduced in which of the following conditions?
A. Anaemia resulting from iron deficiency
B. Anaemia resulting from vitamin B12 deficiency
C. Carbon monoxide poisoning
D. Emphysema
E. Traumatic peripheral haemorrhage
D. Emphysema (correct answer) this is the only answer where oxygen concentration in solution (PaO2) will be reduced. The other conditions may result in significant decreases in total oxygen content (due to lack of oxygen binding to Hb or loss of Hb) but oxygen in solution in plasma will be unaffected.
374
Which of the following statements is NOT true for individuals with chronic lung disease?
A. Arterial PCO2 levels are elevated due to poor alveolar ventilation
B. Nitrous oxide is a safe sedative to use
D. They have decreased sensitivity to PCO2
E. They rely on their peripheral chemoreceptors for stimulating ventilation
Nitrous oxide is a safe sedative to use (correct answer) Nitrous oxide blunts the peripheral chemoreceptor response to falling oxygen, and as these patients are on “hypoxic drive” this effectively leaves them with no intrinsic means of controlling their ventilation.
375
“Shunt” is a term that would be associated with which of the following situations:
A. Bulk transport of oxygen via haemoglobin to peripheral tissues
B. Movement of air through the conducting airways to the alveoli during inspiration
C. Pulmonary embolism (blockage of the pulmonary vessels by coagulated blood)
D. When perfusion exceeds ventilation in L/min
E. When ventilation exceeds perfusion in L/min
D. When perfusion exceeds ventilation in L/min (correct answer)
376
```
Which of the following is most likely to shift the haemoglobin oxygen binding curve to the right?
A. Asthma attack
B. Hypothermia
C. Presence of foetal haemoglobin
D. Respiratory alkalosis
E. Voluntary hyperventilation
```
Asthma attack (correct answer) poor ventilation would mean increased PCO2 in plasma, one of the factors that shifts the curve to the right, along with the associated acidosis
377
```
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:
A. T 8
B. T8 and T9
C. T9
D. T9 and T10
E. T10
```
T8 and T9
378
The lungs are dissimilar in their gross anatomical features. The left is characterised by:
A. A cardiac notch in its posterior border
B. An absence of visceral pleura within its fissures
C. An eparterial bronchus in its hilum
D. Oblique and transverse fissures
E. Upper and lower lobes separated by the oblique fissure
Upper and lower lobes separated by the oblique fissure
379
A 45 year old man has been smoking 30 cigarettes a day for 20 years.
Calculate his pack years. (20 cigarettes = 1 pack)
A. 20
B. 30
C. 40
D. 50
E. 60
30
Pack years is calculated by dividing the number of cigarettes smoked per day by 20 (no. of cigarettes in a pack) and multiplying by the number of years smoked.
(30/20) x 20 = 30
380
```
A 59-year-old man with known squamous carcinoma of the lung is admitted to hospital as an emergency with abdominal pain, constipation and confusion.
The most appropriate investigation would be:
A. Bronchoscopy
B. Chest x-ray
C. Mediastinoscopy
D. Serum calcium
E. Sputum cytology
```
Serum calcium (correct answer) Squamous cell lung cancer associated with hypercalcaemia due to parathyroid hormone related protein. Symptoms in this case classic for hypercalcaemia.
381
55 year old obese business man complains of excessive daytime somnolence, snoring and frequent napping. He undergoes overnight oximetry which shows 10 desaturations per hour.
His classification on the Obstructive Sleep Apnoea Severity scale is:
A Mild
B Moderate
C Normal - no further investigation required
D Normal - should be referred for limited sleep study
E Severe
Mild
382
```
A 50 year old oil man has lobar pneumonia.
The most likely organism to be involved is:
A Chlamydia psittaci
B Haemophilus influenzae
C Legionella pneumoniae
D Pseudomonas aeruginosa
E Streptococcus pneumoniae
```
Streptococcus pneumoniae
383
A 38-year-old with exacerbation of asthma is too tired to do a peak flow.
Normal values: pH 7.37 – 7.43, PaO2 11 – 15 kPa, PaCO2 4.6 – 6.4 kPa
His blood gas results are most likely to be:
A. pH 6.91, PaO2 16.7 kPa, PaCO2 2.9 kPa, on air
B. pH 7.5, PaO2 6.6 kPa, PaCO2 11.2 kPa, on air
C. pH 7.15, PaO2 29.6 kPa, PaCO2 10.6 kPa, on air
D. pH 7.22, PaO2 7.8 kPa, PaCO2 8.6 kPa, on air
D. pH 7.22, PaO2 7.8 kPa, PaCO2 8.6 kPa, on air (correct answer) Exhaustion and decreased ventilation leads to hypercapnia, hypoxia and acidosis
384
A 17 year old man is newly diagnosed with asthma.
Which initial medication should he be started on?
A. Inhaled beta-2 agonist and leukotriene receptor antagonist
B. Inhaled beta-2-agonist
C. Inhaled corticosteroids and inhaled beta-2-agonist
D. Inhaled leukotriene antagonist
E. Inhaled sodium cromoglycate
Inhaled corticosteroids and inhaled beta-2-agonist
385
```
A 19-year-old healthy man experiences sudden onset of sever right sided chest pain and breathlessness whilst walking upstairs.
Which is the most likely diagnosis?
A. Acute interstitial pneumonitis (Haman-Rich syndrome)
B. Aspiration pneumonia
C. Bronchiectasis
D. Primary pneumothorax
E. Pulmonary sequestration
```
Primary pneumothorax
386
```
A 32-year-old man is recovering from a bad attack of pneumonia for which he has been off work for several weeks. He goes on to develop rigors, a persistently poor appetite and increasing shortness of breath on exertion. He has not improved after one week of oral antibiotic treatment.
What is the most likely diagnosis?
A. Acute interstitial pneumonitis (Haman-Rich syndrome)
B. Aspiration pneumonia
C. Empyema thoracis
D. Giant pulmonary bulla
E. Tuberculosis
```
Empyema thoracis
387
```
A 30-year-old woman is admitted to the emergency department with an acute exacerbation of her chronic asthma. Her PaO2 was 7.8 kPa (normal 11- 15 kPa) and her PaCO2 was 8.6 kPa (normal 4.6 – 6.4 kPa) on air. Her arterial gas on admission confirmed type 2 respiratory failure requiring admission to the intensive care unit for possible ventilation.
Which is the most appropriate immediate treatment?
A. Inhaled beta-2 agonist
B. Inhaled corticosteroids
C. Leukotriene receptor antagonist
D. Nebulised beta-2 agonist
E. Oral beta-2 agonist
```
Nebulised beta-2 agonist
