second_year_exams_copy_20180310144444 Flashcards
1
Q
name 3 symptoms of a pleural effusion
A
SOBpleuritic chest paindry coughfeverweigh lossmalaise
2
Q
exudative pleural effusions are most likely to be unilateral or bilateral?
A
unilateral as most of them are due to inflammation
3
Q
which of the following drugs should not be used in pregnant women?A. verapamilB. nifedipine MRC. atenololD. methyl dopa
A
verapamil should not be used in pregnant women. it is a rate limiting CCB that can cause bradycardia - diltiazem can have a similar effect
4
Q
t wave inversion is present in STEMI’s - true or false?
A
false. correct answer is NONSTEMIT wave inversion is characteristic of partial coronary occlusion and so in NSTEMI there will be no ST elevation and no pathological Q waves but there will be inverted t waves with subendocardial damage
5
Q
tetralogy of fallot is caused by what cardiac defects?
A
- pulmonary stenosis-RVH- VSD- dexposition of the aorta
6
Q
What are CT-PET scans used for?
A
to check the metabolic activity of active tumours
7
Q
What are the following results in a patient with life-threatening asthma?PEF?PaO2?PaCO2?SaO2?
A
PEF will be below 33%PaO2 will be below 8kPaPaCO2 WILL BE NORMAL SO REMEMBER THIS OBISaO2 will be below 92%
8
Q
what is the process for real time sampling in lung cancer tissue investigation?
A
endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA)
9
Q
stable angina will usually last for under 20 minutes - true or false?
A
true
10
Q
what structure forms the ligamentum venosum
A
ductus venosus
11
Q
suggest 3 signs that may be biochemically and clinically seen in a patient with hyperlipidamia
A
clinically:corneal arcusxanthomataxanthalasmata obese (BMI>30)Hypertensionbiochemically:- LDL- HDL-cholesterol- TAG
12
Q
the muscular part of the IV septum (interventricular) of the primordial heart will develop from the fusion of the bulbar ridges with the endocardial cushions - T/F?
A
false it develops from the proliferation of the medial wall. the IV foramen is closed from fusion of the bulbar ridges with the endocardial cushion forming the membranous part of the IV septum
13
Q
what are the investigations done for bronchiectasis? Name 5 most important ones
A
- HRCT of thorax gold standard- serum immunoglobuins (including IgE)- sputum culture for infection- Aspergillus precipitations - Cystic fibrosis genotyping
14
Q
What are the main 3 surgery treatments for pulmonary hypertension?
A
- pulmonary septostomy which will create a shunt to increase the cardiac output - pulmonary endarterectomy but is mainly done for hypertension from a proximal pulmonary embolism- transplant
15
Q
spacers used in inhalers will affect how much of the drug in the propellant will reach the lung - T/f?
A
trueslows down the speed of the propellant and so less deposition in the oropharynx and more to the target
16
Q
what is the major complication of thrombolysis?
A
hemorrhage (generally bleeding)
17
Q
what are two contraindications of giving thrombolysis]be specific and name 3
A
- previous intracranial bleed2. recent stroke3. severe hypertension4. surgery/warfarin (be cautious)
18
Q
Name the 3 main functions of the chorion in embryology
A
- forms the placenta2. allows for implantation3. responsible for secreting HCG
19
Q
the foramen ovale will arise form the closure of the septum primum true or false?
A
false. the septum secondum will turn into the foramen ovale
20
Q
what are the risk factors for venous thrombosis?
A
- OCP/ HRT2. pregnancy3. age4. trauma5. smoking6. cancer
21
Q
what is heritable thrombophilia?
A
the genetic predisposition to venous thrombosis
22
Q
what is the most preventable thrombophilia?
A
Factor V leiden
23
Q
How is DVT diagnosed?
A
D dimer testthen do a duplex scan
24
Q
how is a pulmonary embolism diagnosed?
A
Computer tomography pulmonary angiography - CTPA gold standardD dimerV/Q scan
25
what are the pressures imposed by the anti-embolism stalkings?
18mmHg at the ankle14mmHg at the mid-calf8mmHg at the upper thigh
26
what is the management plan for dilated cardiomyopathy?
1. treat arrhythmia's and heart failure then give thromboembolic prophylaxis2. then give synchronization therapy with an ICD
27
Name 3 types of emphysema patterns
periacinar (bullous emphysema)panacinarcentriacinar
28
the somatopleuric mesoderm will give rise to the serous (parietal) pericardium and the fibrous pericardium - T/F?
true
29
In bronchitis, there is no wheeze or crepitations - T/F?
true, bronchitis doesn't present with wheeze or crepitations
30
what are the common nodes which are sampled in endoscopic bronchial ultrasound of lung cancer
1. hilar nodes2. sub-carinal nodes3. para-tracheal nodes
31
suggest a chemotherapy drug used to treat SCLC, adenocarcinoma and squamous cell cancer
cisplatin
32
what is the treatment of obstructive sleep apnoea in children?
CPAPweight lossadenotonsilectomy avoid tobacco smoke
33
how many times can streptokinase be used for thrombolysis?
once as after this time people will develop resistance to it
34
where are oogonium found?
found in the follicles of ovaries
35
how may loss of normal epithelium will result in an ectopic pregnancy (may be the case in pelvic inflammatory disease)
loss of normal epithelium will mean that the blastocyst cannot migrate to the endometrium wall and therefor the blastocyst is stuck inside the uterine tubes leading to an ectopic prgenancy
36
what are the 3 main functions of the placenta?
1. remove waste such as CO22. provide nutrients - O2 and Glc3. immunological role
37
what is neuralation?
the formation of the neural tube
38
which germ layer do somites develop from?
to get the mark must say paraxial mesodermal layers
39
what does the QT interval relate to on an ECG - systole or diastole?
systole
40
in which patients should an ACEI and ARB not be given to as an anti-hypertensive treatment?
black peopleover 55 pregnant
41
Name the 4 types of mesothelioma cancers
desmoplastic epithlioid biphasicsarcomatid
42
what is the frank stirling law?
the stroke volume of the heart is related to the pre-load of the heart.
43
what structure is the chorion made from?
the trophoblast will go on to form the chorion
44
where is the decidua basalis located?
in the endometrium deep to the implanted conceptus
45
the cartilage of the larynx will develop from which pharyngeal arches?
the 4th to 6th
46
where do SCLC tend to develop?
larger airways
47
where do carcinoid tumours develop?
in the endocrine system and in the large airways
48
hypertrophic pulmonary osteoarthropathy - HPOA is common to which kind of cancer?
adenocarcinoma
49
what is the presentation of hypertrophic pulmonary osteoarthropathy - HPOA
pain in the hands and legs
50
name a feature of large cell lung cancer
gynecomastia
51
name 4 neoplastic syndromes that will accompany SCLC
SIADHACTHSVCOCarcinoidEaton larmbert
52
what are three neoplastic syndromes that will accompany squamous cell LC
pancoast tumour - weakness in upper limbshorners syndorme - ptosis, anhydrosis and miosisPTHrH (hypercalcaemia)
53
what are 3 general tests that are involved with coeliac disease serology?
1. Gliadin2. tissue transglutaminase3. IgA levels
54
what may a urea breath test be used for diagnostically?
helicobacter pylori infection
55
Name 2 other breath tests that can be carried out in GI disease investigation
1. Hydrogen breath test - bacterial overgrowth2. lactose intolerance
56
Suggest 2 tests which are used to assess oesophageal motility
1. manometry2. Barium swallow3. oesophageal pH test4. Upper GI endoscopy
57
Name 2 general complications of endoscopic investigation
1. perforation2. hemorrhage3. aspiration
58
suggest a bowel preparation that is used prior to endoscopy
picolax
59
aspartate and alanine require a ratio greater than what to be considered in the diagnosis of alcoholic liver disease?
AST/ALT>2for diagonsis of alcoholic liver disease you can also carry out an USSalcoholic patients will also have a raised gamma GT, macrocytosis and thrombocytopenia
60
describe 3 exclusions you would like to make before you make a diagnosis of hepatic encephalopathy?
1. infection2. intracranial bleed3. hypoglycaemiathis is known as the differential diagnoses of hepatic encephalopathy
61
describe the treatments which are used for hepatic encephalopathysuggest 4 things
1. enema2. lactulose3. antibiotics4. NG tube5. ITU6. airway support7. bowel clear out
62
what condition is more likely to present with malabsorption?A - Crohns diseaseB - Ulcerative colitis
the majority of absorption will occur inside the small intestine. UC will only affect the large colon with the exception of extra-intestinal manifestations. Crohns disease will affect the SI so is the most likely to cause malabsorption.
63
Name 5 inflammatory indices that will be found in inflammatory bowel disease or IBD
1. CRP elevation2. ESR elevation 3. low albumin4. low haemoglobin5. high platelets6. high white cell count
64
ulcerative colitis will not have which of the following?a. erythema nodosum2. uveitis3. renal calculi4. sclerosing cholangitis
although a common extra-intestinal manifestation of IBD, renal calculi are only found in Crohns disease (CD)the rest of the listed conditions will be found in ulcerative colitis.
65
what is the standard dose of melasazine in first line treatment of IBD?
3g per daybare in mind that there will be no significant improvement in remission rate or adverse side effects.
66
steroids are 2nd line treatment for outpatients with IBD. what are two steroids used?
prednisolone (40mg/day with tapering reduction over 4 weeks)budesonide - less effective than prednisolone but there are less adverse side effects. budesonide can only be used in ileal and ascending colon disease also.
67
name 3 side effects of using the thioprine, azathioprine as immunosupression for IBD
1. leukopenia2. hepatotoxicity (therefore will require blood monitoring weekly for 8 weeks then every 8 weeks)3. pancreatitis4. long term lymphoma risks
68
which cranial nerve will provide innervation to the middle ear? (maleus, stapes and incus)
Jacob's nerve which is a branch of the glossopharyngeal nerve (CN IX)- the tympanic branch of the glossoopharyngeal
69
what is Arnald's nerve?
arnalds nerve is the auricular branch of the vagus nerve. it will innervate the posterior third of the external auditory canal.
70
what nerve will innervate the anterior external auditory canal?
the facial nerve CN VII
71
which aminotransferase is likely to be elevated in steatohepatitis?
alanine aminotransferase (ALT)
72
describe a method of definitive diagnosis of steatohepatits
liver biopsy
73
what is the treatment for steatohepatitis?
1. weight loss2. exercise
74
what are the two most important treatments in alcoholic hepatitis?
1. steroids2. thiamine
75
3 structural changes at neurons will occur during long term memory. describe them
1. more neurotransmitter release sites 2. neurotransmitter release vesicles stored and released3. increase in the number of pre-synaptic vesicles
76
describe the 4 classes of biliary atresia
I - common bile duct affectedII - common hepatic ductIII - common hepatic duct and the bile and cystic ductIV - hepatic ducts, common hepatic duct, bile and cystic ducts
77
name 4 risk factors of cholangiocarcinoma
1. primary sclerosing cholangitis2. congenital cystic disease3. contrast dyes such as thorotrast4. carcinogens (aflatoxins)
78
what are 3 main presentations of cholangiocarcinoma?
1. obstructive jaundice2. pruritis3. non-specific symptoms
79
what is the main treatment for inflammatory muscle disease?
immunosupression
80
what investigations should you carry out for inflammatory muscle disease?
EMGbiopsyCK
81
what 3 tests must be carried out for epilepsy?
CT/MRIEEGvideo telemetryy
82
what differences may be found between polymyositosis and derrmatomyositosis
DM will have a characteristic rash and is humoral mediated with CD4 and B cellspolymyositosis will have CD8 cells on biopsy
83
alkaline phosphate is an aminotransferase found within hepatocytes and is elevated when there is obstruction or liver infiltration - T/F?
false. alkaline phosphatase is found in bile ducts. it is however elevated in obstruction or liver infiltrationalkaline phosphatase is also present in bone, placenta and in the intestines.
84
what clinical presentations may a patient have with hepatic jaundice in comparison to post-hepatic jaundice
hepatic jaundice will present with 1. ascites2. spider naevi3. gynaecomastia patient is likely to be an IVDApost hepatic jaundice will present with 1. abdominal pain2. cholestasis (pale stool, pruritis and very dark urine)3. palpable gall bladder
85
describe 3 investigations you would carry out for a patient with jaundice
1. USS of abdomen2. Hep B and Hep C 3. antibody profile4. serum immunoglobulins5. ferritin6. transferrin saturation7. copper8. caeruloplasm
86
what are 3 treatment options for hepatic encephalopathy?
1. neomycin2. rifaximin3. phosphate enema4.lactulose
87
all of the semicircular canals in the ear will connect to the utricle - T/F?
true
88
what is the function of the semicircular canals?
to inform the brain on rotational acceleration
89
what is the respective functions of the utricle and the saccule?
the utricle will detect back and front tiltsthe saccule will detect vertical movements (in a lift)
90
what is the name of the reflex that will make rapid postural adjustments to stop you from falling?
dynamic righting reflex
91
describe the static reflex
this reflex will cause you to either intort or extort your eyes to compensate for the angle of your head
92
basal cell papilloma (seborrhoeic keratosis) is typically greasy, flat, brown and oval. is it related to sun exposure?
no
93
name an important precursor for malignant melanoma
melanocytic naevus
94
suggest preventative measures for sudden death caused by hypertrophic cardiomyopathy
1. ICD2. septal ablation3. surgical resection4. screening for Vtach syncope and exercise hypotension
95
where are the somites derive from?
para-axial mesodermthere are 33 somites in total
96
describe the nerve innervation of the branchial arches
1 - V32. facial3. glossopharyngeal4. superior laryngeal nerve (external)6. recurrent laryngeal
97
how many processes is the face made from?
51 frontonasal2 maxillary 2 mandibular
98
in MS, activated t cells will cross the BBB to cause the demyelination of white matter. t/f?
true
99
describe the most effective imaging test for the diagnosis of MS
MRI
100
males are more likely to develop MS - T/F?
false - females
101
describe 3 presentations of optic neuritis
subacute loss of visionpain on moving the eyecolour distortionoptic disc swelling and atrophypupillary reflex deficitthere is a resolution of symptoms over a few weeks
102
what are 3 differential diagnoses of optic myelitis?
1. neuromyelitis optica2. ischaemic optic neuropathy3. sarcoidosis4. wegners granulomatosis (c-ANCA)
103
there are no relapses in primary progressive MS - TF?
truein primary progressive MS there will however be bladder symptoms and it will present in the old. there is no predilection towards males and females
104
the gold standard for detecting coeliac disease is a distal duodenal biopsy - what may be found?
increased intra-epithelial lymphocytespatial/subtotal villous atrophy with IgA deposits
105
what are 2 other diagnostic tests which can be carried out?
anti-endomysial IgAanti-gliadinanti tissue transglutaminase (95% specific and sensitive)
106
describe 3 complications of coeliac disease
1. small bowel lymphoma2. esophageal carcinoma3. colon cancer4. small bowel adenocarcinoma
107
describe the symptom and treatment of Giardia Lambia
Giardia Lambia will result in malabsorption and hypogammaglobulinaemia treatment is with metronidazole
108
describe 2 treatments for lyme disease
oral doxycyclineIV ceftriaxone
109
what are 3 investigations you can carry out for lyme disease
PCR of CSFEMGNerve conduction studies (NCS)MRI brain and spineserological testing
110
what is the treatment for tertiary syphillis
very high dose penicillin
111
what is the treatment for tetanus in increased risk patients
penicillin and immunoglobulins
112
describe 3 investigations for CJD (Creutzfeldt–Jakob disease)
MRI (pulvinar sign in variant CJD)CSFEEG
113
what may be found in the CSF of someone with Creutzfeldt–Jakob disease?
increased protein or immunoassasay 14-3-3 brain protein
114
describe an electrophysiological test which records optic nerve function
Visually evoked potential
115
Electroretinogram will measure the retinal function and record action potentials from the retina - TF?
truea wave will correspond to the photoreceptorsb wave will correspond to the Muller cells
116
describe an electrophysiological test that measures the RPE and photoreceptors of the eye
electro-oculogram. it will measure the resting potential difference between the RPE and the photoreceptors.it will measure the maximum and potential difference in a light and dark adapted eyethe Arden ratio is equal to 1.85
117
what is the difference between an electro-oculogram and an electro-retinogram?
electro-oculogram will measure the resting potential difference between the RPE and the photoreceptors. the electroretinogram will measure the retinal function and record action potentials from the retina
118
the optic nerve is around 20 degrees from the fovea and is a physiological blind spot - TF?
true.there are no rod or cone receptors on the optic nerve
119
the peak amount of which photoreceptors are at the fovea centralis?
there is the peak amount of cones and incidentally the minimum number of rods
120
hypo and hyperkalaemia can have the same effect on the heart - TF?
truethey can both induce fibrillation and heart block
121
what is the need for DAPT (dual anti-platelet therapy) in cardiac stenting
the stents will need time to vascularise so to prevent thrombosis and blockage of the vessel give anti-platelets. premature discontinuation may lead to death. DAPT is for up to a year.
122
what are the diagnostic tests for ACS (acute coronary syndrome)?
troponinECGCT angiographyGFRanaemiacholesterol
123
what layer of the lateral plate mesoderm is closest to the endoderm?
splanchnic mesoderm
124
what is the most common type of tracheo-oesophageal fistula?
oesophageal atresia with distal tracheo-oesophageal fistula (OATOF)
125
what is the causative agent in whipples disease?
Tropheryma Whipelli
126
describe 3 symptoms of Whipple's disease
weight lossabdominal painmalabsorption(PAS material may be seen in the villi)
127
What is the treatment of Giardia Lamblia?
Metronidazole
128
what is the first line treatment for partial and secondary generalized seizures?
lamotriginecarbemazepine
129
what is the first line treatment of absence seizures?
ethosuxamide
130
what is the second line treatment for status epilepticus
valproate and phenytoin
131
what is first line treatment for status epilepticus?
lorazepam and diazepam
132
describe 2 side effects of using the anti-convulsant topiramate
weight lossdifficulty finding words tingling in hands and feet
133
which two lobes of the brain will the lateral sulcus separate?
temporal and frontal lobes
134
which sulcus will separate the parietal from the occipital lobes?
parieto-occipital sulcus
135
what is the exact location of the primary auditory cortex - also give the Broddman areas
superior temporal gyrus BA areas 41 and 42 - Herschel's convolutions
136
which hemisphere is Wernicke's area and what does it do?
Wernicke's area is the Receptive area of speech (undertsanding spoken word)and is found in the dominant hemisphere - in most people the left hemisphere
137
what is the score of glasgow alcoholic hepatitis that requires steroidal treatment of alcoholic hepatitis?
9
138
name the 5 components of the score
ageWCCureaINRbilirubin
139
what is the treatment of alcoholic hepatitis?
If Maddrey's discriminant function is greater than 32 then treat with oral steroids4.6x (PT-control PT) +bilirubinthiamineprevent against GI bleed, constipation, infection, alcohol withdrawal and airway protection
140
suggest three causes of fatty liver (non-alcoholic)
obesitydiabetes hypercholesterolaemia
141
What are the lines of Zahn composed of?
plateletsfibrin mesh-workRBC
142
what is Cushing syndrome?
excess production of cortisol (non-ACTH dependent) from the adrenal glands
143
Name 2 outcomes of critical limb ischaemia
gangreneulcerationcritical limb ischaemia is when the patient will have pain at rest
144
if after CXR, CT and aspiration there is still no diagnosis of pleural effusion, what test can be done next?
video-assisted thorascopy which allows for the direct inspection of the pleura with directed biopsies. it can be therapeutic
145
name the reflex that is responsible for the axis of the head in a constant relationship with the rest of the body?
labyrinthine reflex
146
if you irrigate the left ear of someone with cold water in caloric stimulation what direction would they experience nystagmus?
right nystagmus
147
Suggest 5 bedside investigations for GI disease
BMIpulse oximetryECGcapillary glucoseurinalysis
148
faecal elastase is an indication of what conditions?
malabsorptionpancreatic insufficiency
149
calprotectin will be raised in IBS - TF?
falseit is raised in inflammatory conditions and allows for the quantitative analysis useful for monitoring disease activity
150
obstructive liver function tests would see what elevations in blood tests?
alkaline phosphatasebilirubin
151
Name 3 risk factors for vitamin D deficiency
ageAsianpigmented skin is less able to to make vitamin D3 in repsonse to UV radiation malnutritionkidney diseaseChapatti flour will contain phyphate that binds dietary calcium
152
in the sympathetic nervous system the synapses between the pre and post ganglionic cells are...finish the sentence
cholinergic and nicotinicthis is also true for the parasympathetic nervous system
153
in the parasympathetic nervous system the synapses between the post ganglionic cells and their targets are adrenergic and nicotinic - TF?
falsethey are muscarinic and cholinergic
154
which of the following is false?post-ganglionic cells in the adrenal medulla will a. release adrenalineb. have no axonsc. are part of the sympathetic nervous systemd. contributes to mass activation
none are false - all statements are true
155
tremor is a consequence of which of the following anti-convulsants?A. sodium valproateB. carbamazepineC. lamotrigineD. levetiracetam
sodium valproate will result in tremor and also the following:1. weight gain2. transient hair loss3. pancreatitis 4. hepatitis5. drowsiness6. ataxia
156
which of the following is not a side effect of carbemazepine?a. ataxiab. drowsinessc. nystagmusd. insomniae. reduced sodium
insomnia
157
which of the following drugs following drugs will cause irritability and depression?A. sodium valproateB. carbamazepineC. lamotrigineD. levetiracetam
levetiracetam
158
describe 2 side effects from using zonisamide
cognitive problems and bowel upset
159
the urinary system will develop from the cloaca and the para-axial mesoderm - TF?
false - cloaca and the intermediate mesoderm
160
what arises form the intermediate mesoderm in the urinary system?
kidneys and ureters
161
the urogenital ridge forms 3 sets of tubular nephric structures - name them
pronephrosmetanephrosmesanephros
162
what is the most common cause of acute hepatitis in grampian?
hepatitis E infection (HEV)
163
name the 3 risk factors for NAFLD
obesitydiabeteshyperlipidaemiagenetics - PNPLA3hypertensionageethnicity
164
describe 2 tests which can be used for the diagnosis of NAFLD besides the following:1. US2.MR/CTAST/ALT ratio
1. liver biopsy2. fibroscan3. cytokeratin -18MR spectroscopy (quantify fat)
165
what score on the glasgow criteria will suggest severe pancreatitis?
greater than or equal to 3
166
name 6/8 of the components of the glasgow criteria used to grade pancreatits
1. urea2. calcium3. oxygen4. LDL5. AST6. albumin7. Blood glucose8. WCC
167
Name an inflammatory marker which is not on the glasgow criteria which however can be used as an indication of severe pancreatitis
CRP>150
168
describe 5 aspects in the management of acute pancreatitis
give oxygeninsulinNG tubeblood transfusionanalgesiaIV fluidsmonitor urine output
169
what are two management complications in the management of acute pancreatitis?
abscess - antibiotics and drainagepseudocyst - endocscopic drainage or surgery
170
name 4 sites of extra-intestinal manifestation of inflammatory bowel disease
joints - arthritiseyes - epislceritis, conjunctivitis and uveitiskidney - renal calculi (only in Crohns disease)skin - erythema nodosum, vasculitis and pyoderma gangrenomsumliver/biliary tree - sclerosing cholangitis, gall stones, fatty change and pericholangitis
171
name 6 extra-intestinal manifestations of IBD
renal calculierythema nodosumepiscleritisuveitisconjunctivitissclerosing cholangitisarthritis gall stonespyoderma gangrenosum
172
what are the common inflammatory indices of IBD?
ESR/CRPincreased WCC increased plateletslow haemoglobinlow albumin
173
acute angle closure glaucoma will present with severe pain - TF?
true
174
how may a patient with acute angle closure glaucoma present? name 4 things
severe painvomitingfixed/dilated pupilheadachepericorneal redness with no discharge
175
describe the redness in someone with a corneal ulcer
pericorneal redness
176
what are the 4 main investigations which can be carried out in a cholangiocarcinoma?
USS/EUSERCP/MRCPCT/MRPTCFDG-PETcytology and cholangioscopy
177
what are two treatment options for ampillary tumours?
endoscopic resectiontransduodenal excisionpncreatico-duodenectomy
178
describe the motor and sensory signs observed in a LMN lesion?
motor signs - weakness- decreased tone- absent reflexes- muscle wastingsensory - dermatomal pattern of weakness
179
which spinal artery will supply the motor tracts?
the anterior spinal artery
180
what is demyelinating myelitis?
pathological lesions of inflammation/demyelination leading to temporary neuronal dysfunction. it will affect the white matter ans lesions can be numerous
181
describe the treatment for NAFLD suggest 3 things other than weight reduction and exercise/diet
1. diet, exercise and weight loss (may be surgical)2. insulin sensitizers (metformin and pioglitazone - thiazolidinedione)3. GLP-1 analogues such as liraglutide4. farnesoid X nuclear receptor ligand (obetocholic acid)5. vitamin E
182
suggest a treatment for autoimmune hepatitis
long termazathioprine
183
what is the difference in diagnosis between autoimmune hepatitis, primary biliary and primary sclerosing cholangitis?
autoimmune hepatitis will have autoantibodies ANA SMA and LKMI/SLA. autoimmune hepatitis will also have an elevated IgG levelprimary biliary cholangitis will have anti-mitochondrial antibodies as well as IgMprimary sclerosing cholangitis is found in association with IBD and will also have pANCA with MRCP
184
what are the two physiologically active thyroid hormones?
thyroxine and triiodothyronine
185
which will have an elevated IgM level:a. primary biliary cholangitisb. primary sclerosing cholangitisc. atuoimmune hepatitis
a - primary biliary cholangitis will be diagnosed with anti-mitochondrial antibodiesand IgM
186
where are the body's main sources of tyrosine and iodine?
diet
187
what transporter will allow iodine to enter the follicular cells from the plasma?
sodium/iodine co-transporterthe iodine is taken up against a concentration gradient
188
what is the name of the protein that binds thyroxine and T3 inside the plasma?
thyroglobulin - thyroxine binding globulin
189
what are the two main cell types in the thyroid gland?
C cells - calcitonin productionfollicular cells - surround the colloid
190
what is the name of the enzyme that catalyses the reaction producing T4/T3 from iodide and tyrosine?
thyroperoxidase
191
which transporter is responsible for transporting the iodide into the colloid?
pendrin transports
192
suggest 4 investigations to carry out in the diagnosis of multiple slcerosis
1. MRI (black holes or lesions)2. lumbar puncture - oligocloncal bands of IgG3. bloods - exclude other inflammatory conditions4. evoked potentials
193
optic neuritis is a good prognostic indicator for multiple sclerosis - TF?
trueoptic neuritis, being female, having a long interval between the first and second relapsesfew relapses for the first 5 years are all good prognostic indicators for multiple sclerosis
194
being male is a bad prognostic indicator for MS - TF?
trueold age, multifocal and motor signs/symptoms will all be bad prognostic indicators for mutiple sclerosis
195
how may a patient with hepatic encephalopathy present?
confusiontremor - asterixisfoetor hepaticusascites
196
what are 3 things that will precipitate hepatic encephalopathy?
infectionconstipationdrugsdehydrationGI bleedsSEDATION MEDICATION (pls remember for exam)
197
what is the typical presentation of a patient with cholestasis?
pale stoolshighly colourised urinepruritisjaundice
198
hepatocellular carcinoma is the most common liver cancer and is strongly associated with Hepatitis B and Hepatitis C infection. how may hepatocellular carcinoma present?
jaundicemass in abdomenbleeding from tumour - anaemia or haematemesis/malaena splenomegallypain weight lossdecompensation signs from the liver - ascites etc
199
what is the difference between using ERCP and MRCP?
ERCP will be used to visualise the pancreatic and biliary ducts. it has a higher complication rate than MRCP and has a mortality associated with it. it is also a risk factor for acute pancreatitisMRCP has intra and extraductal views and is associated with fewer complications however claustrophobia is an issue.MRCP also doesnt use radiation however ERCP can be used as a therapeutic option
200
what is the difference between lymphoma and leukaemia?
lymphoma is the proliferation of haematopoeitic cells maturing the lymphatic systemleukemia is the proliferation of haematopoeitic cells maturing inside the blood
201
what are the tumours called that are derived from connective tissue?
sarcomacarcinomas are derived from epithelial tissue
202
what type of cells are blastomas derived from?
precursor cells
203
name the 4 main causes of sudden painless loss of vision?
1. stroke2. ischaemic optic neuropathy3. central retinal vein occlusion4. central retinal artery occlusion5. vitreous hemorrhage6. retinal detatchment
204
what are 4 symptoms of giant cell arteritis?
1. jaw claudication2. scalp tenderness3. headache4. loss of vision5. stiff neck6. nausea and anorexia
205
how would you diagnose giant cell arteritis?
1. temporal artery biopsy2. ESR and CRP3. MRA4. doppler5. PET scantreat with high doses of prednisoloneOften, one or both of the temporal arteries are tender with a reduced pulse and a hard, cord-like feel and appearance
206
what are two embryological structures the urinary system will develop from?
the urinary system will develop from the intermediate plate mesoderm and the cloaca
207
what structure will give rise to the bladder and the urethra?
the cloaca will give rise to the bladder and the urethra
208
the Wollfian duct will form from which structure in the embryological kidney?
the mesonephros will give rise to the mesonephric tubules and the mesonephric duct (Wollfian) which then persists and opens to the the cloaca
209
Crohns disease will have a continuous inflammation TF?
false. crohns disease is characteristic for its skip lesions and can occur anywhere in the gut tube from oesophagus to anus.
210
suggest 6 things a patient would present with who had Crohns disease
clinically a patient with Crohns disease is likely to have diarrhoea and have lost weight.1. malaise2. lethargy3. anorxeia4. NV5. low grade fever6. abdominal pain7. anaemia and vitamin deficiency
211
describe 4 histological differences between Crohns disease and Ulcerative colitis
1. Crohns disease will have transmural effects of the gut tube where as in ulcerative colitis only the mucosal layer is affect. as a result of this CD may present with fistulae also2. Crohns disease will have characteristic skip lesions whereas ulcerative colitis will have continuous inflammation usually always starting from the anus and then work proximally.3. Ulcerative colitis will have crypt abscesses and depleted goblet cells.4. Crohns disease will have granuloma's which are non-caseating.
212
describe 4 things that a patient may present with for you to suspect they have diabetic ketoacidosis
1. abdominal pain2. dehydrated3. thirsty4. Kussmaul's breathing5. tachycardia6. low BP7. sweet breath
213
suggest 4 investigations to carry out in a patient with diabetic ketoacidosis
do a glucose test and also a venous blood gas first 1. Urinalysis sample for ketones and glucose2. FBC/electrolytes3. blood urine culture4. ECG/cardiac monitor5. CXRbefore taking any investigations remember to do a rapid ABC assessment of the patient. get their vital signs and IV access as well as doing a clinical assessment too
214
describe 4 tests which can be used to diagnose myasthenia gravis
1. Acetylcholine receptor antibodies2. Anti- Musk anitbodies3. Tensilon test4. CT chest 5. EMG/repetitive stimulation
215
describe 2 treatment options for myasthenia gravis
1. anti-cholinesterase 2. prednisolone and azathioprine
216
what is the treatment for motor neurone disease?
riluzole and supportive treatment (NIV and PEG)
217
what are the 3 criteria for thyectomy in myasthenia gravis
1. female2. under 403. malignant thyoma
218
name 4 risks associated with ERCP
1. perforation2. acute pancreatitis3. haemorrhage/bleeding4. mortality5. infection
219
endoscopic ultrasound can be used in the staging and cyst drainage in the GIT. TF?
true
220
what structure does enteroscopy allow visualisation of?
the small intestine.enteroscopy will also allow for the biopsy or therapy for small bowel pathology. capsule enteroscopy is less invasive but no biopsy is possible.
221
Name 2 non-specific signs of coeliac disease and Crohns disease
1. malabsorption2. weight loss3. nausea and vomiting 4. aphthous ulceration5. clubbing
222
what is dermatitis herpetiformis and what GI disease is it associated with?
dermatitis herpetiformis is cutaneous manifestation of coeliac disease. it is intense pruritis, IgA will be deposited within the skin particularly the elbows, shoulders and knees. there will be profound blistering.
223
describe 4 tests to investigate the structure of the small intestine
1. duodenal/jejunal aspirate 2. H2 breath test (lactulose and glucose substrate)3. anti-transglutaminase IgA.4. CT5. biopsy6. white cell scan7. capsule/MRI enteroscopy
224
what is the gold standard diagnosis for coeliac disease?
take a distal duodenal biopsy
225
name the 3 main electro-physiological eye tests
1. Visually evoked potentials - looking at the optic nerve function and records the activity that is in the visual cortex.latency of the test will suggest optic neuritis and reduced cell functiona decreased amplitude will suggest a decreased cell number or ischaemia2. Electro-oculogram (EOG) - will measure the resting potential difference between the RPE and the photoreceptors. it will measure an arden ratio which should be 1.85. it takes into account the maximum potential difference in a light and a dark adapted eye.3. electro-retinogram - measures the retinal function. a waves are from photoreceptors whilst b waves are from Mullers cells.
226
Gall bladder polyps are benign - TF?
true
227
describe 5 risk factors for gall stones
1. age2. gender3. oral contraceptive 4. obesity 5. cirrhosis6. cystic fibrosis7. haemolytic anaemia8. bile infection
228
describe 5 presentations of a patient with choledocho-lithiasis
1. pain2. jaundice3. dark urine4. pale stool5. pruritis 6. steatorrhoea
229
what is the treatment for Multiple sclerosis myelitis?
supportive - methyl prednisolone
230
the anterior cerebral artery will supply the medial part of the homonculus so its occlusion would result in paralysis and loss of sensation where in the body
in the lower limbs namely the legs and feet. there will be the loss of gait.it will have contralateral effectsso for example, if there was an occlusion on the right ACA then the left side would be affected. dont forget the decussation of the fibres is yet to happen for motor fibres
231
name the 3 most common symptoms of middle cerebral artery occlusion
1. hemiplegia2. homonymous hemianopia 3. dysphasiaif the LHS was affected then there would be RHS paralysis but gaze deviation to the LHS.
232
what 5 blood tests may you want to perform in a patient with suspected gall stones?
1. alkaline phosphatase2. amylase3. lipase4. WCC5. AST6. ALT
233
describe 4 radiographic tests which you may wish to perform on a patient with suspected gallstone?
1. IV cholangiography2. ERCP/MRCP3. PTC - percutaneous transhepatic cholangiography4.. EUS/US5. CT
234
describe 2 non-operative treatment of gallstones
1. dissolution2. ESWL - endoscopic shockwave lithotripsy
235
what is the gold standard operative treatment of gallstones?
laparoscopic cholecystectomy +/- on table cholangiogram (OTC)
236
a child with a mother who has T1DM is more likely to develop the condition than a child who has a father with T1DM - TF?
false.father - 6%mother - 1%both parents - 30%sibling - 8%monozygotic twin - 30%heterozygotic twin - 10%
237
name 3 drugs which are known for inducing retinopathy
1. anti-malarials - chloroquine and hydroxychloroquine 2. phenothiazines3. tamoxifen
238
how does conjunctivitis affect vision of a patient?
their vision will be normalto differentiate between viral, bacterial and allergic conjunctivities can be done with the colour of the discharge - yellow (bacteria), clear (viral), mucous (allergic)
239
describe the redness of the eyes in a patient with conjunctivitis
peripheral diffuse
240
what eye structures are involved with intermediate uveitis?
1. iris2. ciliary body3. vitreous
241
uveitis can be caused by infection, systemic disease, idiopathic or by masquerade. name a cause from each
systemic - sarcoidosis, wegners and SLEinfection - TB, toxoplasm and syphilismasquerade - leukaemia, intraocular lymphoma
242
what is the labyrinthine reflex?
keeping the axis head in a constant relationship with the rest of the body
243
describe the dynamic righting reflex
rapid postural adjustments to stop you falling
244
name the risk factors for squamous cell carcinoma of the oesophagus
smokingalcoholdietary carcinogens
245
what is the normal concentration of K ions in the blood
4mmol/l
246
what is the result of liver cirrhosis on the spleen?
splenomegally
247
how may an LFT identify the effects of liver cirrhosis on the spleen?
decreased plateletsthe liver is an important source of thrombopoeitin
248
liver cirrhosis is an indirect marker of portal hypertension
true
249
give 3 characteristics of Devic's disease?
1. optic neuritis2. myelitis3. aquaporin 4 antibodies
250
Progressive multifocal leukoencephalopathy (PML) is brought on by the JC virus and immunosuppressants/AIDS. give 3 drugs used to treat multiple sclerosis that can predispose a patient to PML
1. fingolimod2. dimethyl fumartate3. natazilumab
251
what is the first line treatment for multiple sclerosis?
1. beta interferon and glatiramer acetate.you can also use teriflunomide and dimethyl fumartatethe side effects are liver dysfunction and infection
252
what is the treatment for acute illness in multiple sclerosis?
1. prednisolone
253
there is a decreased risk of developing JC virus 3 months post partum -TF?
false - there is an increased risk
254
prior to AAA therapeutic surgery, what tests/investigations should you carry out?
1. Cardiac assessment - ECG, echocardiography and perfusion scanning2. abdominal - CT abdomen3. do bloods for anaemia3. Pulmonary assessment - CXR and PFT
255
Name the symptoms of varicose veins
1. cosmesis2. pruritis3. nocturnal cramps4. acute haemorrhage5. superficial thrombophlebitis6. skin changes
256
what coronary artery will supply the sino-atrial nodes?
right coronary artery
257
which artery supplies the atrio-ventricular node?
the right coronary artery
258
what are the two main revascularisation methods in stable angina?
1. PCI2. CABG
259
a visually evoked potential is an electrophysiological test which is used to record optic nerve function. it will measure the responses in the visual cortex in response to flashing light or checker board patterns. what may cause a reduced amplitude in readings and what may cause latency in readings?
1. reduced amplitudedecreased number of cellsischaemia2. latencyoptic neuritis (demyelination)reduced cell function
260
give 4 considerations for a differential diagnoses of blackout
1. first, hypoxic or concussive seizure2. syncope3. narcolepsy4. migraine5. cardiac arrhythmias
261
what are 3 causes of vasovagal syncope?
1. standing for a long time2. vasalva manouvre3. coughing/ laughing4. venepuncture5. standing to quickly6. micturition
262
non-epileptic attacks are commonest in women or men?
women
263
what 4 things would you want to discuss with a 24 y/o male regarding his diagnosis of 'first seizure'
1. occupation2. driving3. potentially hazardous leisure activities4. copies of the information sheet regarding first seizures
264
a 29 y/o female comes to clinic with no FH of bowel disease. there is a 2 year history of irregular bowel habits - loose and increased frequency. she also reports having colicky pain but that is alleviated by defecation. there is also no blood or weight loss.a. what is your most likely diagnosis?b. what tests would you like to perform?c. what are the clinical features of IBS
a. IBSb. physical and rectal exam, faecal occultblood testing (FOBT)c. bloating, altered bowel habit, abdominal pain, belching wind and mucous in stool
265
irritable bowel syndrome (IBS) is more common than inflammatory bowel disease (IBD) - true or false?
true
266
where will the abdominal pain of constipation most likely radiate to?
lower back
267
give 3 common presentations of bloating
1. flatulence2. relaxation of abdominal wall muscles3. mucous in stool
268
Name 3 signs that may be seen under examination of mitral stenosis
JVP with a prominent a waveRV heavetapping apex beatnormal pulsediastolic thrill (after s2)
269
CAGE, FAST and audit are used for the screening of what condition?
alcoholism
270
in FAST screening for alcoholism, what score is positive?
>3
271
in AUDIT (screening for alcoholism), what score corresponds to possible dependence?
>20
272
a patient has an AUDIT score of 17. is it true to say that they are in the increasing risk category for developing alcoholism?
no. they are in the higher risk category. 8-15 = increasing risk16-19= higher risk20+= possible dependence
273
in what layer of skin are nociceptors found?
dermis
274
proprioception is mediated by which type primary afferent fibres?
A alpha and Abeta - muscle spindles and golgi tendon organs
275
A beta and C fibres will decussate at different points in the body before reaching the somatosensory cortex. describe their paths.
A beta fibres are responsible for proprioception. they will enter the dorsal column of the spinal cord ipsilaterally and then ascend synapsing at the cuneate and gracile nuclei. they will synapse again in the thalamus and decussate in the medulla. they end up in the somatosensory cortex.C fibres will decussate in the spinal cord and synapse there. they will ascend in the lateral column of the spinal cord and ascend. they synapse again in the thalamus. their tertiary neurones will arrive in somatosensory cortex.
276
name 4 factors that will activate the signal transduction pathways in nociceptors
1. acidity (low pH)2. heat (ASIC and TRPV1)3. bradykinin4. prostaglandins5. histamine
277
what is the function of calcitonin and where is it produced
calcitonin is produced in the thyroid land by C cells and it will act to regulate and decrease plasma levels of calcium
278
what is the effect of cortisol on calcium levels within the body?
cortisol will inhibit osteoblasts and increase the renal excretion of Calcium and phosphate. it will reduce the intestinal reabsorption of calcium and also decrease the plasma calcium levels.all of this will cause PTH levels to rise and cause the bone resorption to increase and inhibition of osteoblasts. a decreased bone formation as well as the combined effects of cortisol will result in osteoporosis.
279
name the 3 conditions that will encompass NAFLD
1. steatohepatitis2. simple steatosis3. cirrhosis and fibrosis
280
which gene is commonly implicated in NAFLD?
PNPLA3
281
suggest 5 tests that can be done for the diagnosis of NAFLD?
1. USS2. MR/CP3. AST/ALT ratio4. fibroscan5. MR spectroscopy6. cystokeratin - 187. liver biopsy
282
name the 6 components taken into account when considering the NAFLD score
1. age>452. platelets <1503. albumin<344. AST/ALT5. BMI>306. Diabetesput this question as 1 until you can name them all consistently 4 times
283
bilirubin is a breakdown product of haem. bilirubin levels will decrease if there is hepatic parenchymal damage or if there is hepatic haemolysis - TF?
false. under these circumstances the bilirubin levels will actually increase.
284
what is bilirubin initially bound to before its conjugation in the liver?
it is initially bound to albumin
285
which aminotransferase is more specific - AST or ALT?
ALT. AST can be found in the heart, brain and kidney tc.
286
a defective bilirubin uptake, conjugation or excretion by hepatocytes would result in which kind of jaundice?
hepatic jaundice is mainly caused by defective bilirubin uptake, conjugation and secretion.
287
what may cause post-hepatic jaundice?
defective transport of bilirubin by the biliary ducts- choledocholithiasis, cholestasis
288
a 33 year old female will present to clinic with pallor and splenomegally. she is heavily jaundiced. she has a history of fatigue, dyspnoea and chest pain. what type of jaundice may she have?
pre-hepatic jaundice - it typically presents with splenomegally and a history of dyspnoea, chest pain and fatigue (haemolysis)
289
which kind of cells do sulphonylureas act on?
they will act on sulphonylurea receptors (SUR-1) on pancreatic Beta cells. they are second line treatment for T2DM and is associated with weight gain and moderate risk of hypoglycaemia.
290
Name a drug from the thiazolidedione family
pioglitazone
291
which of the following are true statements?a. metformin should be stopped if the eGFR is below 30 or creatinine is below 150b. sulphonylureas will block ATP-K channels to increase the release of insulinc. sulphonylureas and pioglitazone will result in weight lossd. contraindication of pioglitazone are congestive cardiac failure and bladder neoplasmse. the main side effects of glitazone is oedema, weight gain and fractures.
everything is true except c
292
how may a patient with hepatic encephalopathy present?
ascitesasterixisconfusion foetor hepaticus
293
what are 3 things that will precipitate hepatic encephalopathy?
infectionconstipationGI bleedssedationdehydration
294
what is the typical presentation of a patient with cholestasis?
pale stoolpruritisdark urinesteatorrhoeajaundice
295
hepatocellular carcinoma is the most common cancer and is strongly linked to hep B and hep C. how may HCC present?
1. flank pain2. decompensation of the liver3. weight loss4. fever5. raised AFP in serum6. pain
296
both upper and lower GI bleeds will present with an elevated urea - TF?
false. it is more commonly seen in UGIBurea is normally normal in a LGIB
297
what is haematemesis?
blood in vomit
298
what is malaena?
dark tarry stool caused by an UGIB
299
what is the term used to describe passing fresh/altered blood per rectum?
haematochezia
300
name a side effect of using ethambutol in the treatment of tuberculosis
optic neuropathy
301
In dilated cardiomyopathy, the relaxation of the heart is compromised resulting in a decreased EDV - TF?
false this has just explained the pathology of HCM.
302
what is the management of DCM?
ICDthrombo-emoblic prophylaxisanti-arrhythmics - lidocaine
303
NSAIDs may precipitate DCM - true or false?
true
304
relaxation of the ventricular wall is an active process - TF?
true
305
what investigations should be done for restrictive cardiomyopathy?
ECG (checking for Lbbb - left bundle branch block)CXRBNPbloods - FBC, UE, sarcoid, haemochromatosisamyloid - non cardiac biopsyfabry - low plasma galactosidase A activity EchoCMRI
306
what is the effect of GIP on gastrin and parietal cell secretion?
GIP will inhibit their secretion
307
what is the result of vitamin B12 deficiency?
pernicious anaemia - no maturation of RBC
308
name the most common organism in bacterial gastritis
h. pylori
309
what is the function of the direct and indirect pathways of the basal ganglia?
the direct pathway will act to make specific motor actionsthere is positive feedback loops to the supplementary motor area (SMA). there is subsequent initiation of movements by the SMA. the globus pallidus neurones are spontaneously active and so they will tonically inhibit the Vl thalamus.the indirect pathway will act to inhibit/suppress any competing/inappropriate action. the will antagonise the direct route. the striatum (caudate and putamen) will inhibit GPe. GPe will inhibit the subthalamic nuclei (STN) and the GPi. the cortex will then excite the subthalamic nuclei (STN). STN will then excite GPi. GPi will then inhibit the thalamus.
310
name 2 common extra-intestinal manifestations which occur in IBD that occur in the eye and the joints
eyesconjunctivitis, episcleritis, uveitisjointsankylosing spondylitis and sacrolitis
311
what site of colitis in the intestinal tract is most associated with developing colonic carcinoma?
pancolitis - whole colon
312
what is the medical management procedure for an outpatient with IBD?
melasazine 3g/dsteroids if still no control then use immunosuppression- mercaptopurine-infliximabb-methotrexate-azathioprine
313
what is the purpose of the pacinian corpuscle?
to sense touch
314
what are the two mechanoreceptive fibres in the transmission of sensory information?
A alpha and Abeta
315
what spinal column will they use to ascend to the brain?
ipsilateral dorsal and synapse with cuneate and gracile nuclei. 2nd order fibres decussate in medulla and project to reticular formation, thalamus and cortex.
316
give 1 advantage and 1 disadvantage of convergence in sensory pathways
advantage - saves on neuronsdisadvantage - referred pain
317
name 2 higher centers responsible for closing the gate for pain
NRM - nucleus raphe magnusPeri-aqueductal grey matter (PAG)
318
what is the effect of prostaglandins on bradykinin?
they will sensitise nociceptors to bradykinin
319
what are the most common family of bacteria to cause a brain abscess?
streptococci in 70% of cases especially penicillin sensitive streptococci milleri group:a. strep anginosusb. strep intermediusc. strep constellatus
320
describe a method of diagnosing cryptococcal meningoencephalitis in an AIDS patient.
cryptococcal antigen, india inkJC Virus PCRCMV PCRHIV PCRtoxoplasma serology (IgG)
321
what are 3 causative spirochaetes in the CNS?
borellia burgoferi (lyme disease)treponema pallidum (syphilis)leptospira interogans (leptospirosis)
322
what are the two main causes for acute pancreatitis?
alcoholgall stonesit may also be caused by trauma: ERCP,steroids, azathioprine, diuretics, pancreatic carcinoma, HIV, CMV, cocksackie B4 and pancreatic carcinoma
323
what does ERCP stand for?
endscopic retrograde cholangiopancreatography
324
describe 5 main invesigations for acute pancreatitis
1. Bloods -amylase and lipase, calcium, glucose, coagulation, lipids, UE 3. LFT4. ERCP/MRCP5. AUS - oedema, gall stones and pseudocyst5. ABG6. AXR/CXR (pleural effusion)7. CT scan and contrast
325
what are the two main causes of chronic pancreatitis?
alcoholcystic fibrosis - there are an increased frequency of CFTR gene mutations in CR
326
what is the typical first line pharmaceutical treatment of T2DM?
metformin + SU if there are weight loss problems or osmotic problems
327
name 2 side effects of using thiazolidendiones in 2nd line treatment of T2DM
oedema and heart failure and weight gain but there is a low risk of hypos. SU and insulin will also result in weight gain
328
what effect do SGLT-2 inhibitors have on weight of a T2DM patient?
they result in weight loss and associated symptoms include Gastric ulcers and dehydration
329
suggest 4 pharmaceutical methods of increasing insulin release
sulphonylureasDPP-IV inhibitorsmetaglinidesincretin mimetics
330
biguanides, thiazolidinediones and weight reduction will all serve to improve insulin action - TF?
true
331
describe the difference in screening and definitive testing of microalbuminaemia
screening will do a first morning sample. there should be a normal albumin to creatinine ratio (albumin creatinine). in males it is under 2.5mg/mmol; in females it is <3.5mg/mmol.definitive testing will do a timed over night urine collections for albumin excretion rate (AER). normally this is under 20 microg/min but in microglobulinaemia it is between20-200microg/min
332
what is the target BP in those with T1DM?
125/75
333
suggest a drug group to slow the progression of kidney disease in diabetes
ACEI
334
what cranial nerves are most likely to be affected by mono-neuritis?
CN III, IV and VI
335
what nerve results in acute foot drop caused by mononeuritis?
peroneal nerve also - causing a foot drop
336
suggest 2 treatments for postural hypotension
NSAIDs and fludrocortisone
337
suggest 2 symptoms in autonomic neuropathy
erectile dysfunctionvomitinggastric stasisdiarrhoeaurinary retentionperipheral oedemaabnormal sweating
338
what is the other name for the lesser sac?
omental bursae
339
what transporter does galactose use to enter the lumen of the small intestine?
SGLUT1 - will also do glucose
340
what is the classical cinical presentation of diabetic peripheral neuropathy
sensory loss - glove and stocking with burning pain, paraesthesia and numbness. there may also be small muscle wasting
341
what is the treatment for peripheral neuropathy?
anual foot screenamiotryptillinegabapentinduloxetinecapsaiasin cream
342
in mononeuritis caused y diabetes what nerve is responsible for causing an acute foot drop?
the peroneal nerve
343
erectile dysfunction is common in diabtes. suggest 2 treatment methods of this symptoms
Cialis and Viagra - phosphodiesterase inhibitors prostaglandinsimplantsimplantable devices
344
what is the treatment of recurrent vomiting in gastric stenosis?
domperidonewill act on dopamine
345
what is the treatment for diarrhoea?
loperamide and codeine phosphate
346
a common complication of DM is microscopic retinopathy. describe 2 surgical treatments for proliferative retinopathy
vitrectomylaser photocoagulation
347
describe a medical procedure which can be used in the treatment of diabetic maculopathy
tight BP control and grid laser therapy.
348
poor glycaemic control will increase the likelihood of cataract - TF?
true but there is a very high success rate of surgery
349
enteroviruses will cause gastroenteritis - TF?
false - enterviruses will cause neurotropic CNS infections
350
describe the difference between a brain abscess and a subdural empyema
brain abscesses are localized areas of pus within the brainsubdural empyema are thin layer of pus between the dura and the arachnoid membranes over the surface of the brain.
351
describe 6 clinical features of someone with empyema/abscess
feverheadachefocal signs and symptoms - seizures, dysphasia and hemiparesismay have an have ICP - papilloedema and false localising signs meningism - photo/phonophobia and neck stiffness with fever mainly occurs in a subdural empyema)low GCS
352
what 4 investigations would you like to carry out for an abscess and subdural empyema?
MRI/CTculturebiopsy - drainageinvestigate source
353
what is cholestasis?
accumulation of bile in the hepatocytes or in the bile canaliculi
354
cholestasis is present in which of the following?A- pre-hepatic jaundiceB - hepatic jaundiceC- post-hepatic jaundice
cholestasis is found in hepatic jaundice
355
name a cause of hepatic jaundice
liver cirrhosis intra-hepatic bile duct obstruction such as:1. primary biliary cholangitis2. primary sclerosing cholangitis3. tumours:a. hepatocellular carcinomab. tumours of the intra-hepatic bile ductsc. metastatic tumours
356
name 4 causes of cholestasis
alcoholic hepatitis drugs such as OCP and azathioprine viral hepatitisliver failure
357
primary biliary cholangitis is an organ specific autoimmune disease. what liver function test may be elevated
ALP - alkaline phosphatase the loss of intrahepatic bile ducts are due to granulomatous inflammation. there will also be anti-mitochondrial antibodies (AMA)
358
which cells in the stomach will produce the following:a. mucousb. pepsinogenc. intrinsic factord. HCle. bicarbonate
a. mucous neck cellsb. chief cellsc. parietal cellsd. parietal cellse. bicarbonate isnt produced in the stomach
359
what is the name of an enzyme that facilitates the following reaction:CO2 + H2O > H2CO3
carbonic anhydrase
360
desacribe vitamin D deficiency in children and in adults
children - rickets in adults - osteomalacia
361
renal artery autoregulation will work to adjust the resistance of vasculature depending on arterial BP. what is the range of this autoregulation?
60mmHg - 130mmHg
362
50% of urea filtered at the glomerulus will be reabsorbed from the tubule - TF?
True
363
atropine will increase the heart rate - TF?
trueatropine will treat cardiac arrest, SA block and bradycardia.it will increase the firing of the SA node.
364
name 4 reasons for secondary hypertension
chronic renal failurepregnancy - pre-eclampsiarenal artery stenosisphaeochromocytomacushings diseaseconn's syndromesleep apnoeaacromegallyNSAIDspolycystic kidneysco-arctation of the aorta
365
if the signs/symptoms of DVT are not present, it is okay to rule out this diagnosis?
false - do imaging tests (US/doppler) and d dmimersigns and symptoms are not always present on DVT
366
what is virchow's triad a risk factor for?
thromboembolic disease (DVT and PE)
367
in all of the interstitial lung diseases, which is the most important to take an allergy history from?
EAA extrinsic allergic alveolitis - hypersensitivity pneumonitis.
368
why may the protein content of a pleural biopsy be taken?
to check if it a transudate or exudate and to help generally with the diagnosis - may be due to inflammation or tumour or may be due to RVHF etc.if the protein is below 25-35 then lights criteria would be used. it is exudate if:1. serum protein is greater than 0.5serum LDH is greater than 0.6LDH is in the top 60% of values.
369
what is sarcoidosis?
no one knows - it has an unknown etiology and is a multi system granulomatous disorderjust remember than sarcoidosis has granulomas.
370
intermittent claudication is a persistent pain that is present at rest - TF?
false. the cramp like pain will disappear after rest.
371
what layer of the lateral plate mesoderm are the fibrous pericardium and the parietal of the serous pericardium not derived from?
splanchnopleuric mesoderm
372
the anterior chamber of the eye will sit anterior to the iris - TF?
ture
373
zonules are attached to the ciliary body and the lens - TF?
true
374
which of the following are permeable to fluorescein - the dye used to investigate retinal disorders:a. zonula occludensb.choriocapillariesc. retinal capillaries
85% of fluorescein is bound. 15% remains unbound. the inner retinal barrier (retinal capillaries and the outer retinal barrier (zonula occludens are impermeable to fluorescein) but choriocapillaries are permeable to free fluorescein.
375
organisation is the typical outcome of pneumonia. what do COP and BOOP stand for?
cryptogenic organising pneumoniabronchiolitis obliterans organising pneumonia
376
name the 3 supplies of blood each horn of the sinus venosus will recieve
cardinal vein - body of embryo (lateral)vitelline vein - yolk sac (medial vein)umbilical vein - placenta (innermost vein)
377
what adverse effects will ICS (inhaled corticosteroids) have on children?
height suppressionoral candidiasisadrenal corticosupressioncataractshypertension
378
in hypertension if the patient has subsequent pulmonary oedema, sublingual GTN should be administered - TF?
falsenever give any medication sublingually in hypertension. in this scenario GTN will be given via IV or IV furosemide can be given.IV encephalopathy is given IV labetalol or IV esmolol
379
CURB score of 1 should be treated with :a. amoxicillin and clarithromycinb. amoxicillin or clarithromycinc. co-amoxiclav and clarithromycind. ethambutol and pyrazidine
b. amoxicillin or clarithromycinCURB0-1 = amoxicillin or doxycycline/clarithromycin2 = amoxicillin and clarithromycin/levotrexate3-5 = co-amoxiclav and carithromycin/levotrexate
380
what are the following treatments used for?- ethambutol- pyrazidineand how long are they administered for?
Tuberculosis 2 months
381
the notochord will induce the mesoderm to thick - TF?
false the notochord will induce ectodermal cells in the midline to form the neural tube by the thickening and dipping to form the neural plate. the neural tube will induce the mesoderm to thicken.
382
name a GPIIb/IIIa inhibitor
abciximab
383
aspirin is a COX1 inhibitor - TF?
true. COX1 will go on to form thromboxane A2
384
LMWH and fondaparinux are in the same family of anti-platelet drugs - TF?
false - LMWH is an anti-thromboticantiplatelets are drugs such as aspirin, ticagrelol, prasugrel and clopidogrel
385
what coagulation factors foes LMWH act on?
factor Xa
386
what is the treatment regime for pneumonia?
CURB will determine treatment0-1= amoxicillin or doxycycline/clarithromycin2= amoxicillin or clarithromycin/levofloxacin3-5 = co-amoxiclav and clarithromycin/levofloxacinalso give1. IV fluids2. CPAP3. oxygen as required4. intubation and ventilation
387
what is the function of the coronary and falciform ligament?
falciform ligament will connect the liver to the anterior abdominal wall. the coronary ligament will separate the bare area of the liver from the rest of the liver.
388
Name the layers of the gall bladder
mucosa - rugaemuscularis serosa
389
which duct will the gall bladder empty to?
cystic duct
390
what is the difference between primary sclerosing cholangitis and primary biliary cholangitis?
primary biliary cholangitis is an organ specific autoimmmune disease that mainly affects females. there are autoantibodies for anti-mitochondria in serum (AMA) there will be raised ALP levels and there is the presence of granulomatous inflammation affecting the bile ducts. there is loss of the intra-hepatic bile ducts and there may be the progression to cirrhosisprimary sclerosing cholangitis is chronic inflammation and fibrous obliteration of the bile ducts. intra-hepatic bile ducts are lost. it is associated with inflammatory bowel disease. there will also be the progression to cirrhosis and an increased risk of developing cholangiocarcinoma.
391
Name the four extrinsic muscles of the tongue
styloglossuspalatoglossushyoglossusgenioglossus
392
which of the extrinsic muscles of the tongue are not supplied by the hypoglassal nerve?
styloglossus - CN X
393
Name the 4 muscles of mastication
temporalismedial and lateral pterygoid musclesmasseter muscle
394
which duct will pierce the masseter muscle?
the parotid duct (Stensons duct)
395
what nerve will innervate the muscles of mastication?
the mandibular branch of the trigeminal nerve
396
what are the 3 main advantages of using ERCP over MRCP?
it can be a therapeutic optionsome patients may be claustrophobicit is metal tolerant
397
whata re the 3 necessary ascitic fluid analysis?
1. protein2.cell count3. albumin
398
describe 5 unhelpful tessts in ascitic fluid analysis
pHcholesterolfibronectinlactase
399
what is wilsons disease?
excess copper
400
what is primary haemochromatosis?
excess iron
401
primary haemochromatosis and Wilson's disease are both causes of liver cirrhosis. what are the 2 viral hepatitis' that will cause liver cirrhosis?
HBV HCV
402
name 3 complications of liver cirrhosis
HCChepatic jaundiceportal hypertensionliver failurecholangiocarcinoma.
403
liver is not a common site of metastases - TF?
false
404
Name 2 types of tumours in the liver
cholangiocarcinoma is a malignant tumour of the bile duct epitheliumhepatocellular carcinoma a malignant carcinoma of hepatocytes.
405
which of the following is associated with an increased incidence of multiple sclerosis?A. latitude of patients home countryB. high dietary cassavaC. hypercalcaemiaD. fungal toe nail infectionE. exposure to vinyl chloride
A. latitude of patient's home countrycassava is associated with a multi-nodular goitre as they contain thiocyanate
406
gabby sustains a hockey stick injury. she is initially dazed but rapidly recovers and continues with the match. 30 minutes later she collapses and the paramedics report her GCS as E2V3M3. what injury has she most likely sustained?a. acute subdural haemorrhageb. chronic subdural haemorragec. acute extradural haemorraged. cerebral contusione. ruptured cerebral aneurysm
C. acute extradural haemorrhage there is a lucid interval
407
'The other Andy' (ex-alcoholic) is living in a nursing home and it is noticed he has a steady deterioration in memory over 3 days. CT head shows an isodense convex mass between the right frontotemporal cortex and the skull. what is this lesion?a. meningiomab. chronic subdural haematomac. Alzheimer's amyloid plaqued. Frontotemporal dementia e. Choroid plexus cyst
B. chronic subdural haematoma
408
Ibby is performing poorly in school. the teachers complain of recurring episodes of daydreaming lasting for several seconds, from which he cannot be aroused. the boy denies these. what is the most likely cause?a. leukaemiab. attention deficit hyperactivity disorder (ADHD)c. narcolepsyd. cataplexye. absence seizures
E. absence seizures
409
Niall has a witnessed episode of becoming unresponsive, picking at his clothes and lip smacking. his face started twitching followed by his left arm and leg and then entire body. the whole episode lasts 5 minutes. he can remember picking at his clothes, but feeling dreamlike cannot remember the lip smacking. what is this called?a. simple partial seizureb. complex partial seizurec. complex partial seizure with secondary generalizationd. generalised tonic-clonic seizuree. dissociative (functional) seizure(pesudoseizure)
complex partial seizure with secondary generalization
410
Liam suffers an anterior circulation ischaemic stroke. the biggest modifiable risk factor for ischaemic stroke is:a. hypertensionb. hypercholesterolaemiac. smokingd. obesitye. diabetic control
hypertension
411
Matt presents to his GP with a 1 month history of breast swelling, tenderness and recently, occasional lactation. Pregnancy test is negative, but thyroid function tests show a low TSH and low free T3/T4. which blood test should his GP next undertake?a. serum LH/FSHb. serum vasopressinc. lumbar punctured. digital rectal exam for bantse. urinary catecholaminesf. serum prolactin
serum prolactin - may be caused by a prolactinoma
412
taste sensation for the posterior third of the tongue is transmitted to the brain by which nerve?a. CN Vb. CN VIIc. CN IXd. CN Xe. CN XII
CN IX - the glossopharyngeal nerve. make sure you know the number of the nerves
413
Eaton-Lambert Myasthenia Syndrome (LEMS) is characterised by what?a. anti-acetylcholine receptor antibodiesb. Anti-voltage-gated-calcium-channel receptor antibodies (anti VGC)c. anti-acetylcholinesterase antibodiesd. positive tensilon teste. sensory disturbance
b. anti-voltage-gated-calcium-channel receptor antibodies
414
which of the following is not a sign of an upper motor neurone deficit?a. weaknessb. tremorc. spasticityd. hyper-reflexiae. clasp-knife rigidity
tremor- this is an extra-pyramidal sign such as in parkinsons which affects the substantia nigra (part of the basal ganglia that is aka the extra-pyramidal system of the body)
415
which of the following drugs can be used to terminate tonic-clonic seizures?a. dihydrocodeineb. duloxetinec. percacetsd. dantrolenee. diclofenacf. diazepam
f. diazepam
416
which of the following is a sign of cerebellar lesion?a. shuffling gaitb. high-stepping gaitc. stamping gaitd. wide-based gaite. antalgic gait
D. wide based gaita shuffling gait is characteristic of parkinson'sa high stepping gait is the result of a foot drop (peroneal nerve in mononeuritis diabetes)stamping gait is due to a peripheral proprioceptive defectan antalgic gait is due to pain
417
horner's syndrome results from injury to which of the following structures:a. axillary nerveb. brachial plexusc. parotid glandd. cervical sympathetic ganglione. occulo-motor nerve
D. cervical sympathetic ganglion
418
which of the following conditions is associated with oligoclonal immunoglobulin bands on cerebrospinal fluid electrophoresis?a. multiple sclerosisb. meningitisc. stroked. intracranial abscesse. arachnoiditis
a. multiple sclerosis
419
paul is admitted following a seizure. he opens his eyes to voice but is confused asking nursing staff why they are in his house and pushes you away when you attempt to take blood. he is unable to follow simple instructions.what is his Glasgow coma score?a. E2V3M6b. E3V3M5c. E3V4M5d E3V5M5e. E4V5M4
E3V4M5
420
andy docherty crashes his car at 80mph. he is thrown through the windscreen, not wearing a seatbelt and collides with the road central reservation. at the roadside his airway is obstructed and he does not move, speak or even open his eyes in response to pain. what is his GCS?a. E0 V0 M0b. E1 V1 M1c. E2 V2 M2d. E2 V1 M1e. E1 V1 M2
B - E1V1M1
421
Which of the following signs is consistent with a right-sided parietal lobe lesion?a. Disinhibitionb. Loss of episodic memoryc. Cortical blindnessd. Cognitive regressione. Hemisensory neglect
E - hemisensory neglect
422
Patients with thiamine deficiency are at risk of which condition?a. Frontal dementiab. Idiopathic juvenile seizuresc. Central pontine myelinolysisd. Vanishing white matter diseasee. Wernicke’s encephalopathy
E - Wernicke's encephalopathy
423
What percentage of strokes are ischaemic in nature?a. 25%b. 45%c. 65%d. 85%e. 95%
d - 85%
424
Which of the following is not a form of cerebral herniation?a. Sprigelian herniationb. Cingulate herniationc. Subfalcine herniationd. Uncal herniatione. Tentorial herniation
a. Sprigelian herniation
425
Neurodegeneration in which of the following structures characterises Parkinson’s disease?a.Putamenb. Substantia nigrac. Globus pallidus internusd. Claustrume. Caudate nucleus
B - substantia nigra
426
Which of the following conditions shows genetic anticipation?a. Amyotrophic lateral sclerosisb. Huntington’s diseasec. Charcot-Marie-Tooth Diseased. Alzheimer’s diseasee. Lewy Body Dementia
b. Huntington’s disease
427
The foramen lacerum transmits which structure?a. Optic nerveb. Trigeminal nervec. Middle meningeal arteryd. Internal Carotid arterye. Jugular vein
internal carotid artery
428
Which of the following increases cerebral blood flow?a. Alkalosisb. Hyperventilationc. Hypothermiad. Hyperglycaemiae. Hypercapnia
Hypercapnia
429
Where is cerebrospinal fluid produceda. Venous sinusesb. Arachnoid granulationsc. Choroid plexusd. Spinal nerve rootse. Cavernous sinusesf. digital rectal exam just for bants
choroid plexus
430
Which of the following is associated with Migraine aura?a. Blurring of visionb. Hemiplegiac. Incontinenced. Diarrhoeae. Neck stiffness
blurring of vision
431
Action potential propagation along an axon is dependent on which ion channels?a. Voltage gated calcium channelsb. Voltage gated sodium channelsc. Voltage gated potassium channelsd. Voltage gated magnesium channelse. Voltage gated chloride channels
B - voltage gated sodium channels
432
A 45 year old man undergoes gastrectomy for treatment of a benign ulcer, which of the following hormones is likely to be most deficient as a result:1. Cholecystokinin2. Gastrin3. Motilin 4. Secretin5. Vasoactive intestinal polypeptide
b. gastrin
433
A 20 year old man consulted his general practitioner complaining of bloating of his stomach after eating. A barium meal showed normal gastric mucosal appearance but delayed gastric emptying. The excess production of which of the following hormones may be responsible:1. Cholecystokinin2. Gastrin3. Motilin4. Secretin5. Somatostatin
a. CCK
434
A digestive tract enzyme may be initially released in the inactive form. What is the best term to describe this compound:1. Enterokinase2. Enzyme3. Polypeptide4. Protease5. Zymogen
5. zymogen
435
A 19 year old man ate a large bar of white chocolate. Which of the following digestive processes is most important to promote digestion of the food:1. Conjugation2. Emulsification3. Enterohepatic circulation4. Glycolysis 5. Phosphorylation
b. emulsification
436
A 23 year old male with a history of alcohol misuse presented with acute upper-abdominal pain and vomiting. He was found to have a raised serum amylase. What is the most likely diagnosis:1. Acute appendicitis 2. Acute pancreatitis3. Cholangitis 4. Dissecting aortic aneurysm5. Peptic ulcer
B - acute pancreatitis
437
A 47 year old man was referred for investigation of impaired defecation. Which of the following mechanisms best describes the normal defecation mechanism:1. Stretch receptors in the rectal wall activate both sympathetic and parasympathetic centers in the spinal cord2. Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord 3. Stretch receptors in the rectal wall activate sympathetic centers in the spinal cord 4. The external anal sphincter contracts5. The internal anal sphincter is consciously relaxed
2. Stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord
438
A 50 year old man presented to the emergency department complaining of a 3 month history of epigastric pain and a 2 day history of a very high volume of vomiting. What is the most likely anatomic site of bowel obstruction to cause this symptom:1. Distal ileum2. Gastro-oesophageal junction3. Mid-oesophagus4. Sigmoid colon5. Third part of the duodenum
5. third part of the duodenum
439
A 45 year old woman has surgical removal of her distal ileum to treat inflammatory bowel disease. Which of the following vitamins is she at risk of becoming deficient in:1. Vitamin B12. Vitamin B53. Vitamin B64. Vitamin B125. Vitamin C
D. vitamin B12
440
A 24 year old has an inherited defect and is unable to produce intrinsic factor. The absorption of which of the following substances is most likely to be impaired:1. Bile salts2. Free amino acids3. Glucose4. Vitamin B125. Water
4 - vitamin B12
441
A 55 year old man presents with a 6 year history of progressive painless jaundice and weight loss. On inspection, he is jaundiced. Abdominal palpation is normal. What is the most likely diagnosis:1. Crohn’s disease2. Diverticular disease3. Duodenal ulcer4. Pancreatic cancer5. Renal carcinoma
4. pancreatic cancer
442
A 30 year old man presents with jaundice. He has been complaining of intermittent right hypochondrial pain and nausea for several months, but the pain has worsened, his urine is darker than usual and his stools pale. Which imaging is most appropriate in the first instance:1. Abdominal radiograph2. Abdominal ultrasound3. Computed tomography4. Isotope liver scintigraphy 5. Positron emission tomography
2. abdominal ultrasound
443
A 45 year old man is stabbed in the lower chest. The knife cuts most of the vagus nerve fibres around the oesophagus. He makes a good recovery. Which of the following is most likely to occur as a result of the nerve injury:1. Delayed gastric emptying2. Increased gastrin secretion3. Increased intestinal peristalsis 4. Increased pancreatic enzyme production5. Reduced bile production
1. delayed gastric emptying
444
A 40 year old man has a total colectomy to treat a colonic carcinoma. The operation is curative. Which of the following is most likely to occur as a result of this operation:1. Constipation2. Excessive water retention3. Hyponatremia4. Reduced absorption of vitamin A5. Reduced glucose absorption
3. hyponatraemia
445
A 70 year old woman presents with jaundice. She has been complaining of right abdominal pain and altered bowel habit for several months. On examination she has a hard craggy mass in her right iliac fossa and hepatomegaly. An abdominal ultrasound is performed. Which of the following is the most likely finding in the liver at ultrasound:1. Cholecystitis 2. Gallstones impacted in the common bile duct3. Liver abscess4. Macronodular cirrhosis5. Multiple liver metastases
5. multiple liver metastases
446
A 70 year old man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph shows multiple dilated loops of bowel. Which of the following bowel findings on abdominal x-ray would be in keeping with small bowel obstruction:1. Central distribution of loops of bowel2. Haustral mucosal folds3. Peripheral distribution of loops of bowel.4. Relatively few loops5. Wide angle of curvature of loops of bowel
1. Central distribution of loops of bowel
447
A 70 year old man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph shows multiple dilated loops of bowel. Which of the following bowel findings on abdominal x-ray would be in keeping with small bowel obstruction:1. Central distribution of loops of bowel2. Haustral mucosal folds3. Peripheral distribution of loops of bowel.4. Relatively few loops5. Wide angle of curvature of loops of bowel
1. Central distribution of loops of bowel
448
A 45 year old smoker presents with massive haematemesis and melaena. Endoscopy reveals an actively bleeding posterior ulcer in the first part of the duodenum. Which artery is most likely to be bleeding:1. Aorta2. Common hepatic3. Gastroduodenal4. Right gastric5. Splenic
3. Gastroduodenal
449
A 20 year old female medical student suffers from severe secretory diarrhoea while backpacking in India. She remembers that oral rehydration therapy (ORT) is an effective way to counter the dehydration caused by intestinal fluid loss. Which of the following ingredients would be required to make up a suitable ORT solution:1. Potassium chloride + fructose2. Potassium chloride + glucose3. Sodium chloride + fructose4. Sodium chloride + glucose5. Sodium chloride + monoglyceride
4. Sodium chloride + glucose
450
A patient underwent a cholecystectomy for treatment of chronic cholecystitis. During the operation, the surgeon noticed arterial blood loss from the gallbladder neck. Which artery is most likely to have been injured:1. Coeliac trunk2. Cystic artery3. Inferior pancreaticoduodenal artery4. Splenic artery5. Superior mesenteric artery
2. Cystic artery
451
A 50 year old patient has chronic peptic ulcer disease that has not responded to drug therapy and undergoes surgical removal of the gastric antrum to reduce gastric acid production. How does the surgical procedure reduce acid production:1. Decreases gastrin production2. Decreases pepsin synthesis 3. Increases bile production4.Increases cholecystokinin production5. Increases gastric emptying
1. Decreases gastrin production
452
A 25 year old woman presents with a 6-week history of diarrhoea and oral aphthous ulcers. Her stool contains blood and mucous. What is the most likely diagnosis:1. Crohn's disease2. Diverticulitis3. Infective diarrhoea4. Irritable bowel syndrome5. Ulcerative colitis
1. Crohn's disease
453
A 25 year old man presents with fever, bloody diarrhoea and cramping for several weeks that does not resolve with antibiotic therapy. Proctosigmoidoscopy reveals red, raw mucous and pseudopolyps. What is the most likely cause:1. Campylobacter infection2. Crohn’s disease3. Irritable bowel disease4. Ulcerative colitis5. Viral gastroenteritis
4. Ulcerative colitis
454
A 20 year old man presents with a 12-history of collicky periumbillical pain, which shifts to the right iliac fossa, fever and a loss of appetite. What is the most likely diagnosis:1. Acute appendicitis2. Acute pancreatitis3. Acute viral hepatitis 4. Diverticular disease5. Perforated peptic ulcer
1. Acute appendicitis
455
A 45 year old man was admitted to hospital after ingesting 25 g of paracetamol 3 days earlier. He had no past medical history of note, took no regular medication and rarely consumed alcohol. Which of the following signs would be consistent with his presentation:1. Finger clubbing2. Gynaecomastia3. Jaundice4. Palmar erythema5. Spider naevi
3. Jaundice
456
A researcher is investigating enzymatic digestion of polysaccharides. Which of the following combinations of disaccharides and digested products is correct. 1. Maltose = 3 glucose2. Maltose = 1 glucose + 1 fructose3. Sucrose = 1 galactose + 1 glucose 4. Lactose = 1 glucose + 1 galactose5. Sucrose = 2 glucose
4. Lactose = 1 glucose + 1 galactose
457
A 71 year old man had a malignant tumour of the middle third of the oesophagus. What is the most likely histopathological diagnosis:1. Adenocarcinoma2. Adenoma3. Gastrointestinal stromal tumour4. Liposarcoma5. Squamous cell carcinoma
5. Squamous cell carcinoma
458
Name the different skin layers
Epidermis DermisHypodermis
459
Which of the following skin cells are responsible for immediate type hypersensitivity reactions in the skin 1. Neutrophils2. Lymphocytes3. Mast cells4. Melanocytes
3. Mast cells
460
A small, superficial, circumscribed elevation of the skin, less than 0.5cm, that contains serous fluid is called1. Papule = small raised area 2. Macule = small circumscribed area 3. Nodule4. Vesicle = small fluid filled
4. Vesicle = small fluid filled
461
Acute urticaria is an example of which type of hypersensitivity reaction1. Type 1 = IgE produced specific to an antigen 2. Type 2 = antibodies bind to antigens on self-surface 3. Type 3 = accumulation of immune complexes that give rise to an inflammatory response 4. Type 4 = delayed (2-3 days) T cell-mediated response
1. Type 1 = IgE produced specific to an antigen
462
All of the following can be used in the treatment of atopic eczema except1. Topical steroids2. Antihistamines3. Emollients4. Antifungal cream
4. Antifungal cream
463
Impetigo is a skin infection caused by1. Gram positive cocci = staphylococcus aureus & streptococcus pyogenes 2. Gram negative bacilli3. Anaerobes4. Protozoa
1. Gram positive cocci = staphylococcus aureus & streptococcus
464
Can you list 4 risk factors for melanoma skin cancer
Previous history of skin cancerFamily history of skin cancerFair skin (type 1 & 2 skin)Living in tropical countries for more than 1 yearWorking outdoorsImmunosuppressive diseases or immunosuppressive treatment
465
The cell of origin in a squamous cell carcinoma1. Melanocytes 2. Basal cells 3. Keratinocytes 4. Endothelial cells
3. Keratinocytes = SCC Melanocytes = melanoma Basal cells = BBC
466
Treatment of actinic keratosis involves all of the following except1. Topical mupirocin 2. Topical 5 fluorouracil 3. Liquid nitrogen = used 4. Topical imiquimod = used
1. Topical mupirocin
467
Acne vulgaris is a common skin condition which is characterised by1. Comedones, papules, pustules and nodulocysts 2. Vesicles and bullae3. Scales and crusts4. Ulceration and erosions
1. Comedones, papules, pustules and nodulocysts
468
What unit of measurement can be used for topical medicines
Fingertip unit measurement (FTU)
469
Can you mention 3 clinical types of psoriasis
Plaque psoriasis Guttate psoriasis Erythrodermic psoriasisPustular psoriasisPalmoplantar psoriasisNail psoriasisScalp psoriasis
470
A well-circumscribed, elevated, superficial, solid lesion, greater than 1cm in diameter is termed1. Papule = small raised area 2. Nodule3. Pustule = small pus filled 4. Plaque = larger raised area
4. Plaque = larger raised area
471
A 56 y old man presented with multiple, well-defined warty and greasy papules with a ‘stuck on’ appearance on his back; what is the most likely diagnosis 1. Melanocytic nevi2. Malignant melanoma3. Seborrheic warts4. Cherry angioma
3. Seborrheic warts
472
A 19 year old lady presented with red, dry excoriated patches on her face, back, arms, cubital and popliteal fossae; her mother and sister have the same problem; what is the most likely diagnosis 1. Scabies2. Seborrheic dermatitis3. Urticaria4. Atopic dermatitis
4. Atopic dermatitis
473
What are 3 types of medications that can be applied topically?
Topical steroidsTopical antifungalsTopical immunosuppressiveTopical antibiotics
474
Name the 3 types of skin cancer
SCCBCCMelanoma
475
What are the functions of the skin (name at least 3)
ProtectionSensationTemperature regulationImmunityExcretion
476
Name 2 benign skin lesions
Benign melanocytic nevusSeborrheic keratosis
477
Concerning the motor homunculus. Which of the following structures is represented the most medially:1. Eye2. Face3. Knee4. Tongue5. Wrist
3. Knee
478
An 80 year old man presents to his GP with gradual onset of walking difficulties, urinary incontinence and cognitive decline. Heh as no headache. These symptoms are most typical of:1. Frontal lobe tumour2. Multiple sclerosis 3. Normal pressure hydrocephalus 4. Parkinson’s disease5. Vascular dementia
3. Normal pressure hydrocephalus
479
A 51 year old man is noted to have a left trigeminal nerve palsy. Which of the following is the most likely examination finding:1. He has absent taste sensation to the anterior 2/3 of the left of the tongue 2. He has numbness over the left mandible3. He has numbness over the right maxilla4. He has numbness over the right posterior aspect of the scalp5. He is unable to smile with the left side of his mouth
2. He has numbness over the left mandible
480
A 36 year old woman attends her GP stating that she feels like she can’t cope looking after her 3 month old baby. She says that she worries all the time about her ability to raise her child. Which of the following could not be explained by anxiety:1. Brisk reflexes with flexor plantar responses2. Excessive sweating and palpitations3. Fatigue and feeling of something stuck in the throat4. Numb legs and extensor plantar responses5. Poor concentration and forgetfulness
4. Numb legs and extensor plantar responses
481
A 50 year old right handed barman presents with cognitive language dysfunction. He has difficulty expressing what he wishes to say and difficulty reading e-mails. He has been taking dihydrocodeine (oral opiates) for rib pain for the last 6 weeks. Which of the following is the most likely explanation for these findings:1. Alcohol intoxication2. Lesion in left temporo-parietal area3. Lesion in right temporo-parietal area4. Opiate dependence5. Right chronic subdural haematoma
2. Lesion in left temporo-parietal area
482
A 69 year old man presented with left-sided neglect. Which of the following structures is most likely to be affected:1. Left frontal lobe2. Left parietal lobe3. Right frontal lobe4. Right parietal lobe5. Right temporal lobe
4. Right parietal lobe
483
A 21 year old man is involved in a road traffic accident. On arrival in the accident and emergency department his Glasgow Coma Scale (GCS) is 6 and he is subsequently intubated and ventilated. In order to assess his head injury further, what is the most appropriate investigation:1. Computerised tomography (CT) brain2. Functional magnetic resonance imagine (MRI)3. Magnetic resonance imaging (MRI) brain4. Positron emission tomography (PET) scan5. Skull X-rays
1. Computerised tomography (CT) brain
484
A 47 year old woman who is known to have multiple sclerosis (MS), presents to her GP with new onset of diplopia. In MS there is demyelination of axons in the brain and spinal cord. Which of the following glial cells form the myelin sheaths in the central nervous system:1. Astrocyte2. Endothelial cells3. Microglia4. Oligodendrocyte5. Schwann cell
4. Oligodendrocyte
485
A 19 year old woman was noted to have decreased vision. Which of the following is an appropriate method of testing the function of the 2nd cranial nerve:1. Asking the patient to screw her eyes shut 2. Assessing the corneal reflex 3. Assessing the pupil response to light4. Assessing the vestibulo ocular reflex 5. Looking for nystagmus
3. Assessing the pupil response to lightAsking the patient to screw her eyes shut = CN 7 Assessing the corneal reflex = CN 5 response to lightAssessing the vestibulo ocular reflex = CN 8 Looking for nystagmus = CN 8
486
A 40 year old man is admitted for assessment of suspected syphilis. Which organism is responsible for syphilis:1. Borrelia burgdorferi2. Leptospira interrogans3. Staphylococcus aureus4. Streptococcus anginosus5. Treponema pallidum
5. Treponema pallidum
487
A 55 year old man has difficulty walking and attends his GP. Which of the following is the most likely feature of an upper motor neurone lesion:1. Absent reflexes 2. Dysdiadochokinesia3. Hypotonia4. Muscle fasciculations5. Sustained clonus
5. Sustained clonus
488
A 16 year old boy presented with a spinal cord injury with absent motor response below C7. Which of the following is an example of a descending spinal cord tract:1. Anterior spinocerebellar tract2. Dorsal column pathway3. Lateral corticothalamic tract4. Lateral spinothalamic tract 5. Posterior spinocerebellar tract
3. Lateral corticothalamic tract
489
A 51 year old man is noted to have poor coordination. Which of the following is an appropriate method of testing coordination of the lower limb:1. Ask the patient to state if his toe is moved up or down, when his eyes are shut2. Assessing the patient’s ability to sit up from lying3. Assessing the plantar response4. Finger-nose test5. Heel-shin test
5. Heel-shin test
490
A 30 year old man developed intense burning pain in his arm after spilling concentrated bleach on it by accident. This pain response was mediated by the C class of pain nociceptor. Which of the following properties is most associated with C fibres:1. Efferent2. Fast conduction (20m/s)3. Nucleus located in the thalamus 4. Typical diameter of 1-5um5. Unmyelinated
5. Unmyelinated
491
A 64 year old man presented with a haemorrhage in his left internal capsule. Which of the following arteries is most likely to supply this area:1. Left external carotid artery2. Left middle cerebral artery3. Left posterior cerebral artery4. Right anterior cerebral artery5. Right middle cerebral artery
2. Left middle cerebral artery
492
A 75 year old man presents to his GP with a progressive impairment of his cognitive function. He is diagnosed with dementia. Which of the following is suggestive of a vascular aetiology for his dementia:1. Abnormal movements2. Myoclonus3. Parkinsonism4. Rapid progression of the dementia 5. Stepwise progression
5. stepwise progression
493
A 51 year old man was noted to have an upper motor neuron 7th nerve palsy. Which of the following is an appropriate method of testing the function of the 7th cranial nerve:1. Asking the patient to clench his teeth2. Asking the patient to smile in order to show you his teeth3. Assessing the jaw jerk4. Looking for wasting of the temporalis muscle 5. Testing light touch over the mandible and maxilla
2. Asking the patient to smile in order to show you his teeth
494
A 63 year old woman presents with a gradual onset of a right sided weakness and early morning headaches. SHe undergoes a computerised tomography (CT) scan of her brain. The report of this suggests that she has a metastatic lesion to her left parietal lobe. Tumours from which of the following primary sites commonly metastasise to the brain:1. Bone2. Breast3. Meninges4. Schwann cells5. Tongue squamous cell
2. Breast
495
A 47 year old woman presented to the emergency department with severe back pain and urinary retention. She was numb around her perineum and had absent ankle jerks. Which of the following is the most likely diagnosis:1. Cauda equina syndrome2. Gerstmann’s syndrome 3. Guillain-barre syndrome4. L3 radiculopathy 5. S1 radiculopathy
1. Cauda equina syndrome
496
A 47 year old man was referred to a neurosurgeon with a spinal cord tumour. The tumour was compressing his posterior (dorsal) columns on the right hand side. Which of the following statement is most likely to be true:1. There is likely to be a loss of nociceptive sensation below the level of the lesion on the contralateral side2. There is likely to be a loss of temperature sensation below the lesion on the contralateral side3. There is likely to be a loss of temperature sensation below the lesion on the ipsilateral side4. There is likely to be a loss of vibration and proprioception below the lesion on the contralateral side5. There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
5. There is likely to be a loss of vibration and proprioception below the lesion on the ipsilateral side
497
A 55 year old woman presents to her GP with a headache which is associated with scalp tenderness over the right temporal artery. The GP diagnoses giant cell arteritis and commences treatment. Which of the following laboratory results would you expect in this condition:1. Elevated erythrocyte sedimentation rate (ESR)2. Elevated urate3. Elevated white cell count4. Reduced haemoglobin5. Reduced erythrocyte sedimentation rate (ESR)
1. Elevated erythrocyte sedimentation rate (ESR)
498
A 75 year old man presented to his general practitioner (GP) with difficulty initiating walking. His GP notices a pill rolling tremor and suspected Parkinson’s disease. Which of the following is the most likely neurotransmitter to be affected:1. Adrenaline2. Dopamine3. Histamine4. Serotonin5. Substance P
2. Dopamine
499
A 20 year old man was assaulted whilst watching a football match. On arrival at the local accident Accident and Emergency department he opened his eyes to pain, said inappropriate words and localised to pain. What is his Glasgow Coma Score (GCS):1. 62. 73. 84. 95. 10
5. 10
500
Many structures in the human body receive parasympathetic innervation. Which of these is most likely to occur due to its stimulation:1. Constriction of pupils2. Dilation of pupils3. Increased heart rate4. Reduced saliva production5. Relaxation of the bladder wall
1. Constriction of pupils
