Summatives Past Papers 1 Flashcards
A 45 year old male, Mr A, with a 25 year history of insulin dependent diabetes mellitus (IDDM) presents to his GP with a sore on his foot which has persisted for 3 weeks. On examination the GP finds an ulcer on the top (dorsal aspect) of his right big toe (hallux). The ulcer is 1 cm in diameter, the base of which is covered in yellowish exudate. The surrounding skin is red and swollen.
(a) What is a skin ulcer?
Skin Ulcer = an open sore on the external surface of the body, caused by a break in the skin which fails to heal.
“ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inflamed necrotic tissue.”
= a circumscribed loss of tissue.
An ulcer may be superficial, or it may extend into the deeper layer of the skin or other underlying tissue.
(b) Describe the histological appearance of the base of a chronic ulcer.
Chronic Ulcer - Histology
Active ulcers have 4 prototypical zones:
- Surface neutrophils, bacteria, necrotic debris and possibly Candida.
- Fibrinoid necrosis at base and margins.
- Granulation tissue with chronic inflammatory cells.
- Fibrous or collagenous scars in muscularis propria with thickened blood vessels showing endarteritis obliterans.
Histological features of Chronic Inflammation
- Mononuclear cell infiltrate – lymphocytes, plasma cells and macrophages
- Macrophages = major cell in chronic inflammation
- Tissue destruction
- Fibrosis and angiogenesis
List five (5) factors (not diseases) which may adversely affect wound healing in general (not specifically in this patient).
(7 Local Factors & 14 Systemic Factors)
Local Factors that Retard Wound Healing
- Blood supply
- Mechanical stress
- Denervation
- Necrotic tissue
- Local infection
- Foreign body
- Haematoma
Systemic Factors that Retard Wound Healing
- Age
- Malnutrition
- Anaemia
- Obesity
- Drugs (steroids, cytotoxic medications, intensive antibiotic therapy)
- Systemic infection
- Temperature
- Trauma, hypovolemia and hypoxia
- Genetic disorders (osteogenesis imperfecta, Ehlers-Danlos syndrome, Marfan syndrome)
- Uraemia, vitamin deficiency (vitamin C)
- Hormones
- Trace metal deficiency (zinc, copper)
- Diabetes
- Malignant disease
A 45 year old male, Mr A, with a 25 year history of insulin dependent diabetes mellitus (IDDM) presents to his GP with a sore on his foot which has persisted for 3 weeks. On examination the GP finds an ulcer on the top (dorsal aspect) of his right big toe (hallux). The ulcer is 1 cm in diameter, the base of which is covered in yellowish exudate. The surrounding skin is red and swollen.
Of the factors inhibiting ulcer healing that you listed in Question 2, which three (3) reasons are the most likely to explain why Mr A’s ulcer has not healed?
- Blood Supply
- Infection
- Diabetes (Systemic illness)
This is a section of skin (H&E stain. X40)
a) Identify the layers labelled: A & B.
b) Name the structures labelled: C, D, & E.
c) What is the nerve supply to the structure marked C?
A - Stratum Lucidum of the Epidermis
B - Dermis
C - Apocrine Sweat Gland → adrenergic sympathetic innervation.
D - Sebaceous Gland
E - Arrector Pili Muscle
a) Name three (3) environmental factors prevailing in the skin which favour the predominance of Gram-positive bacteria.
Persistent colonization is the result of the ability of bacteria to adhere to skin epithelium, grow in a relatively dry and acidic milieu, and rapidly re-adhere during the normal process of desquamation.
- Skin pH (normal is slightly acidic at ~pH 5)/Low pH = 4 – 6.8
- Dry
- Temperature
- Oxygen:carbon dioxide ratio
- Salty
- Desquamation of skin cells
- Presence of Lysozyme enzymes
How can anaerobic organisms (such as Propionibacterium acnes) survive in the skin which is continuously exposed to air?
They can become trapped in a hair follicle, it may grow rapidly and cause inflammation and acne.
Comedogenesis, the transformation of the pilosebaceous follicle into the primary acne lesion, the comedone, is the product of abnormal follicular keratinization related to excessive sebum secretion. During this process, P. acnes often gets trapped in layers of corneocytes and sebum and rapidly colonizes the comedonal kernel, resulting in a microcomedone.
Mr A’s blood glucose has been more difficult to control in recent months, and he has increased his insulin dosage. His blood sugar level measured with a glucometer is 15mmol/litre.
a) Briefly describe the process by which insulin regulates the uptake of glucose into muscle cells.
Insulin Receptors
In skeletal muscle and adipose tissue, insulin promotes membrane trafficking of the glucose transporter GLUT4 from GLUT4 storage vesicles to the plasma membrane, thereby facilitating the uptake of glucose from the circulation.
b) Describe the effects of insulin on the various metabolic pathways in the non-diabetic liver.
Effects of Insulin on the Liver
- Reduced Gluconeogenesis
- Increased Lipogenesis
- Increased Glycogen synthesis
Explain how insulin deficiency in IDDM affects the liver to contribute to the development of hyperglycaemia.
Hyperglycaemia Pathophysiology in IDDM
- IDDM = Insulin Dependent Diabetes Mellitus*
- Actions of insulin (hypoglycemic effect):Increase uptake and utilisation of glucose by most cells i.e. ↑ glycolysis.
- 1) Increaseuptakeofglucosebymostcells
o Increase storage of glucose as glycogen (↑ glycogenesis, ↓ glycogenolysis) and 2) Increase storage of glucose as glycogen and triglyceride in the liver,
triglyceride in the liver, muscle and fat.
Explain how insulin deficiency in IDDM affects the liver to contribute to the development of hyperglycaemia.
Pathophysiology of Hyperglycaemia in IDDM
- Actions of insulin (hypoglycemic effect):
- Increase uptake and utilisation of glucose by most cells i.e. ↑ glycolysis.
- Increase storage of glucose as glycogen (↑ glycogenesis, ↓ glycogenolysis)
- Inhibit glucose synthesis from triglycerides and proteins = ↓ gluconeogenesis.
- In the liver, glucose enters via GLUT2 transporter (insulin insensitive → insulin does not increase its activity.
- However, in muscles and adipocytes, insulin binds to insulin receptor → GLUT4 transporter incorporated in cell wall → glucose enters the cell (require insulin before glucose can enter).
- Insulin deficiency:
- Causes hyperglycaemia because glucose is not being taken up muscle and adipocytes → ∴ despite high BGL, peripheral cells are starving → counter-regulatory hormones (e.g. glucagon) are released to promote glycolysis and gluconeogenesis.
- Leads to a depletion of glycogen, protein and fat stores (type 1 diabetic will hence lose weight, experience hyperlipidemia (CV pathology e.g. atherosclerosis) and feel lethargic (tissue protein depleted)).
Using the table below, list three (3) lifestyle factors or general pathological processes that may affect Mr A’s insulin requirement.
Comment on the effect (increase or decrease) each factor will have on insulin requirement and briefly explain how this occurs.
The GP asks Mr A if he has been monitoring his own blood sugar levels. Mr A responds “Well actually no doctor, I haven’t for a long time now. I used to check them regularly and adjust my dose of insulin according to the result, just how you told me, but I started getting terrible hypos and worried that I wouldn’t be able to drive. I really need to be able to drive for my work and I can’t afford to have an accident or lose my job.”
What broad psychosocial issues and historical detail of Mr A’s problems with his blood sugar levels need to be considered in this consultation, in order to help him achieve more normal blood sugar levels more safely?
Provide three (3) examples of strategies to address these issues. (Details of treatment and insulin regimes etc are NOT required in your answer to this question).
Psychosocial Issues with poor Diabetes control
- Impact of poor diabetes control on eyesight
- ??
Strategies to address these issues
- Healthy lifestyle choices (physical activity, healthy eating, tobacco cessation, weight management, and effective coping)
- Disease self-management (taking and managing medications and, when clinically appropriate, self-monitoring of glucose and blood pressure)
- Prevention of diabetes complications (self-monitoring of foot health; active participation in screening for eye, foot, and renal complications; and immunizations)
The GP adjusts Mr A’s insulin regime and orders further tests, one of which is a HbA1c which comes back the following day at 10 percent (normal range less than 7%). He asks Mr A to return next week. When he returns, his random blood sugar level is 18mmol/litre and he complains of “hypos” during the previous week. The GP thinks “If only these patients were more compliant with instructions, they’d be better off and my job would be much easier”.
Explain why this GP’s approach is considered by some people to be ethically unacceptable and clinically sub-optimal.
1st issue = shouldn’t leave a raised HbA1c without discussing implications and dangers with patient.
Ideal patient management is not to tell them what to do but to inform them and encourage them - patient-centred approach.
Work collaboratively with the patient don’t just leave it up to them.
Strategies
- Goal setting
- Education
- Support with Diabetes support worker/nurse
- Positive reinforcement > Negative reinforcement
Issues associated with the management of Chronic Disease
- Quality of life
- Burdensomeness of treatment
- Futility (treatment won’t cure illness)
- Management requires a balance between treatment regimes and quality of life considerations
- Impact
- Identity
- May feel isolated and segregated
- Struggle to form an identity away from disease
- Self esteem
Diabetes is a major risk factor for ischaemic heart disease. List five (5) other major risk factors for ischaemic heart disease. Indicate which factors are “fixed” and which are “potentially modifiable”.
(5 Non-modifiable risk factors of IHD & 7 Modifiable risk factors of IHD)
Ischaemic Heart Disease (IHD)
Non-modifiable risk factors of IHD
- Age → atherosclerosis is a slowly progressive disease
- Gender → males > females
- Family hx of premature CVD → genetic predisposition
- Social hx including cultural identity, ethnicity and SES
- Previous AMI
Modifiable risk factors of IHD
- Smoking → atherosclerosis
- BP → hypertension damages vessel walls.
- Serum lipids → hyperlipidaemia: hypercholesterolemia plays a more significant role than hypertriglyceridemia.
- ↑ risk w/ high LDL levels; HDL = cardioprotective.
- Waist circumference & BMI → Obesity
- Nutrition – high salt, fat & sugar
- Physical activity level
- Excessive alcohol consumption
Which of the following is correct?
- A. The cell bodies of melanocytes are found in the stratum granulosum layer with dendritic processes extending downward toward the basement membrane.
- B. The epithelial layer is of endodermal origin.
- C. The nuclei of keratinocytes usually disappear in the stratum spinosum.
- D. Merkel cells are most abundant on the chest and back.
- E. Chronic sun exposure decreases Langerhans cell numbers.
- A. The cell bodies of melanocytes are found in the stratum granulosum layer with dendritic processes extending downward toward the basement membrane → FALSE: melanocytes are the in Stratum basale
- B. The epithelial layer is of endodermal origin → FALSE: Epidermis is derived from Ectoderm
- C. The nuclei of keratinocytes usually disappear in the stratum spinosum → FALSE: usually disappear in the stratum lucidum
- D. Merkel cells are most abundant on the chest and back → FALSE: They are predominantly found among basal keratinocytes in areas of high tactile sensitivity, such as the lips, digits, oral cavity, and hair follicles.
- E. Chronic sun exposure decreases Langerhans cell numbers.→ TRUE!
Identify the structure labelled A in the image.
- A. Sebaceous gland
- B. Sympathetic ganglion
- C. Adipose tissue
- D. Mucous gland
- E. Nerve bundle
Identify the structure labelled A in the image.
- A. Sebaceous gland → The rounded cells are filled with lipid filled vacuoles.
- B. Sympathetic ganglion
- C. Adipose tissue
- D. Mucous gland
- E. Nerve bundle
Which of the following structures has a retro-peritoneal location?
- A. Pancreas
- B. Ileum
- C. Sigmoid colon
- D. Transverse colon
- E. Stomach
Retroperitoneal Organs = SAD PUCKER
- S = Suprarenal (adrenal) glands.
- A = Aorta/Inferior Vena Cava.
- D = Duodenum (second and third segments)
- P = Pancreas.
- U = Ureters.
- C = Colon (ascending and descending only)
- K = Kidneys.
- E = Esophagus.
Answer = A. Pancreas
In which of the following areas is the opening of duct X located?
- A.
- B.
- C.
- D.
- E.
Duct X = Pancreatic Duct
The pancreatic duct runs the length of the pancreas and unites with the common bile duct, forming the hepatopancreatic ampulla of Vater. This structure then opens into the duodenum via the major duodenal papilla. Secretions into the duodenum are controlled by a muscular valve – the sphincter of Oddi.
Answer = B. Duodenum
The oesophageal phase of normal swallowing begins as a food bolus passes below the upper oesophageal sphincter, and terminates with lower oesophageal sphincter activity, allowing the bolus to pass into the stomach.
The muscle activity associated with this phase of swallowing is termed:
- A. normal oesophageal peristalsis.
- B. primary oesophageal wave.
- C. secondary oesophageal wave.
- D. upper GI peristalsis.
- E. lower GI peristalsis.
Anatomically, swallowing has been divided into three phases: oral, pharyngeal, and esophageal.
Answer ??
Mrs. Keen has been told that she should limit her intake of red meats and use 1% milk. She uses 2 cups (500mL) homogenised milk (3.4%fat) a day, and responds that she does not like the watery taste of 1% milk and would sooner drink juice.
What nutrients might you be concerned about for this patient if she chooses to modify her diet to avoid dairy products and red meat to reduce fat intake?
- A. Calcium
- B. Folate
- C. Essential amino acids
- D. Zinc
- A. Calcium
- B. Folate
- C. Essential amino acids
- D. Zinc
Hard to get calcium from non-dairy sources but can get essential amino-acids and zinc from non-meat sources.
The energy-yielding nutrients are
- A. fats, minerals and water
- B. proteins, minerals and vitamins
- C. carbohydrate, fats and vitamins
- D. carbohydrates, fats and protein
- E. carbohydrate, fats and minerals
The energy-yielding nutrients are
- A. fats, minerals and water
- B. proteins, minerals and vitamins
- C. carbohydrate, fats and vitamins
- D. carbohydrates, fats and protein
- E. carbohydrate, fats and minerals
Patients with insufficiency of exocrine pancreatic secretion are not likely to have the following:
- A. normal fat digestion provided that bile is still produced
- B. malabsorption of vitamin B12
- C. bleeding tendency
- D. inefficient protein digestion and loss of body weight
- E. excessive water loss
The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats.
Pancreatic Insufficiency - Not likely to see:
- A. normal fat digestion provided that bile is still produced
- B. malabsorption of vitamin B12
- C. bleeding tendency → VitK deficiency
- D. inefficient protein digestion and loss of body weight
- E. excessive water loss
Cholecystokinin
- A. inhibits contraction of gall bladder.
- B. inhibits synthesis of bile salts.
- C. stimulates secretion of bicarbonate by pancreatic duct cells.
- D. stimulates gastric secretion and gastric emptying.
- E. secretion is increased by presence of food products in the duodenum.
Cholecystokinin
- A. inhibits contraction of gall bladder → FALSE: stimulates gallbladder to contract.
- B. inhibits synthesis of bile salts → FALSE: doesn’t impact on bile synthesis only increases its release
- C. stimulates secretion of bicarbonate by pancreatic duct cells → TRUE
- D. stimulates gastric secretion and gastric emptying → FALSE: delays gastric emptying
- E. secretion is increased by presence of food products in the duodenum.
Secretory diarrhoea may be the result of which of the following?
- A. inactivation of pancreatic lipase
- B. Zollinger-Ellison syndrome (gastrinoma)
- C. cholera
- D. lactase deficiency
- E. Celiac disease
Secretory diarrhea occurs when your intestine cannot properly absorb or secrete electrolytes and fluid.
May be a result of;
- A. inactivation of pancreatic lipase
- B. Zollinger-Ellison syndrome (gastrinoma)
- C. cholera
- D. lactase deficiency
- E. Celiac disease
Types of Diarrhoea = DOMES
An 18-year-old student was diagnosed to have cholera. What is the most probable source of the infection?
- A. Water
- B. Chickens
- C. Pigs
- D. Cows
- E. Pigeons
The cholera bacterium is usually found in water or in foods that have been contaminated by feces (poop) from a person infected with cholera bacteria. Cholera is most likely to occur and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.
- A. Water
- B. Chickens
- C. Pigs
- D. Cows
- E. Pigeons
Which one (1) of the following is not part of the respiratory portion of the respiratory system?
- A. Trachea
- B. Alveolar ducts
- C. Respiratory bronchioles
- D. Alveolar sac
- E. Alveoli
The respiratory system consists of two components: The conducting portion brings the air from outside to the site of the respiration. The respiratory portion helps in the exchange of gases and oxygenation of the blood.
The conducting portion of the respiratory system includes the nose, nasopharynx, larynx, trachea, and a whole series of successive narrowing segments of bronchi and bronchioles. The conducting portion end at the terminal bronchiole. The respiratory portion begins from the respiratory bronchiole and continues with the alveolar ducts, alveolar sacs, and finally ends at the alveoli where the significant exchange of gases takes place.
Answer: A. Trachea
Which of the following organisms is a normal flora of the upper respiratory tract?
- A. Bacillus cereus
- B. Streptococcus pneumoniae
- C. Bacteroides fragilis
- D. Streptococcus agalactiae
- E. Coagulase-negative staphylococci
Which of the following organisms is a normal flora of the upper respiratory tract?
- A. Bacillus cereus
- B. Streptococcus pneumoniae
- C. Bacteroides fragilis → colon
- D. Streptococcus agalactiae → female genital tract
- E. Coagulase-negative staphylococci
Liam O’Reilly is a 28 year old man, who was diagnosed with cystic fibrosis when he was 12 months old. He has had repeated admissions to hospital with lower respiratory tract infections. On two occasions he has had life threatening haemoptyses. His lung function has deteriorated to 40 % predicted and he has developed marked bilateral ankle swelling. He is being assessed for a heart-lung transplant.
If the causative agent of his respiratory infection is a Gram-negative rod, you would expect the organism to
- A. be highly susceptible to many antibiotics used to treat pneumonia.
- B. be oxidase-negative.
- C. produce an alginate slime coat.
- D. be more prevalent in his home than in a hospital.
If the causative agent of his respiratory infection is a Gram-negative rod, you would expect the organism to
- A. be highly susceptible to many antibiotics used to treat pneumonia
- B. be oxidase-negative → FALSE: Many Gram-negative, spiral curved rods are oxidase-positive.
- C. produce an alginate slime coat
- D. be more prevalent in his home than in a hospital.
A man with chest pain and breathlessness has a pO2 of 55 mmHg and pCO2 of 36 mmHg. The parameter which is NOT required to calculate the (A-a) DO2 (alveolar - arterial difference for oxygen) is:
- A. Barometric pressure.
- B. Minute ventilation.
- C. PaCO2
- D. Water vapour pressure at body temperature.
- E. FI02 (inspired oxygen fraction).
The alveolar to arterial difference of oxygen [(A-a)DO2]
= A-a gradient
A-a Gradient = PAO2 – PaO2.
- A. Barometric pressure.
- B. Minute ventilation
- C. PaCO2
- D. Water vapour pressure at body temperature.
- E. FI02 (inspired oxygen fraction).
A 40 year old asthmatic presented to A&E with increasing shortness of breath and wheezing. He was recently started on an antihypertensive drug once daily. On examination, he was speaking in 3-4 word sentences, but was not cyanosed. His vital signs were: HR 110/min R 40/min, temperature 37.8°C, BP 150/90 mmHg and peak expiratory flow rate was 40% predicted. His arterial blood gases on room air were:
pH 7.5 (normal range pH 7.35 – 7.45), pO2 80mmHg (normal range pO2 80 – 100mmHg), pCO2 30mmHg (normal range pCO2 36 – 44mmHg), HCO3 22mM (normal range HCO3 21 – 28mM), oxygen saturation 96%.
What is his acid base disturbance?
- A. Uncompensated metabolic alkalosis.
- B. Uncompensated respiratory alkalosis.
- C. Compensated metabolic alkalosis.
- D. Compensated respiratory alkalosis.
- E. Combined respiratory and metabolic alkalosis.
- Acidosis or Alkalosis → look at pH = 7.5 = alkalosis
- Respiratory → the PaCO2 will abnormal = low - respiratory alkalosis
- Metabolic → HCO3- will be abnormal = normal
- Compensated = HCO3 will change to compensate for the low PCO2
What is his acid-base disturbance?
- A. Uncompensated metabolic alkalosis.
- B. Uncompensated respiratory alkalosis.
- C. Compensated metabolic alkalosis.
- D. Compensated respiratory alkalosis.
- E. Combined respiratory and metabolic alkalosis.
A 16 year old male being treated for asthma develops skeletal muscle tremors. Which of the following agents is most likely to be responsible for this finding?
- A. Ipratropium bromide.
- B. Montelukast.
- C. Beclomethasone.
- D. Sodium cromoglycate.
- E. Salmeterol.
Skeletal muscle tremors are an adverse side effect of beta adrenergic receptor agonists.
- A. Ipratropium bromide → M3 Receptor Antagonists
- B. Montelukast → Leukotriene receptor antagonists
- C. Beclomethasone → Corticosteroids
- D. Sodium cromoglycate → Cromones
- E. Salmeterol → Long Acting β2 Receptor Agonists
A spirometry test carried out on a 40 year old woman gave the following results:
- FVC: 4.5 L (predicted = 5.5 L)
- FEV 1: 4 L
- PEF: 6.73 L /s (predicted = 6.33 L/s)
Based on the above data, the woman is most likely to have
- A. Emphysema.
- B. Obstructive lung disease.
- C. Restrictive lung disease.
- D. Bronchoconstriction.
- E. Chronic bronchitis.
Spirometry
- Forced vital capacity (FVC): maximum volume of gas forcibly expelled after maximal inspiration.
- Forced expiratory volume in 1 second (FEV1): volume of air expelled during FVC test in the first second.
- FEV1/FVC is the ratio of FEV1 to FVC.
- Normal = 70–80%.
- Peak expiratory flow (PEF) is the maximal flow (or speed) achieved during the maximally forced expiration initiated at full inspiration, measured in liters per minute or in liters per second.
- Simple method of measuring airway obstruction – detects moderate to severe disease.
- Worsens with asthma
- Simple method of measuring airway obstruction – detects moderate to severe disease.
FVC = low, FEV1/FVC = 4/4.5 = 88% high, PEF = high → Restrictive
- A. Emphysema → COPD
- B. Obstructive lung disease.
- C. Restrictive lung disease.
- D. Bronchoconstriction → Obstructive (eg. in Asthma)
- E. Chronic bronchitis → Obstructive (narrowed lining of bronchial tubes)
List some causes of Restrictive Lung Disease.
Identify the tissue.
- A. Serous gland.
- B. Smooth muscle.
- C. Sensory ganglion.
- D. Cardiac muscle.
- E. Sweat gland.
Identify the tissue.
- A. Serous gland.
- B. Smooth muscle.
- C. Sensory ganglion.
- D. Cardiac muscle.
- E. Sweat gland.
The myofilaments of cardiac muscle are arranged in a similar pattern to skeletal muscle, resulting in cross-striations. The fibers are crossed by linear bands called intercalated discs.
Cardiac myocytes are joined together via intercalated discs, which coincide with Z lines. They appear as lines that transverse the muscle fibers perpendicularly when examined with a light microscope.
Which part of the heart normally forms the right border of the heart?
- A. Right atrium.
- B. Left ventricle.
- C. Aortic arch.
- D. Right ventricle.
Which part of the heart normally forms the right border of the heart?
- A. Right atrium.
- B. Left ventricle.
- C. Aortic arch.
- D. Right ventricle.
Which of the following is NOT a compensatory mechanism that becomes activated during hemorrhagic shock?
- A. Activation of parasympathetic nerves to the heart.
- B. Activation of sympathetic nerves to the heart.
- C. Activation of sympathetic nerves to arteries.
- D. Activation of sympathetic nerves to veins.
- E. Withdrawal of parasympathetic nerves to the heart.
The cardiovascular system responds to hypotension and hypovolemic shock by increasing the heart rate, increasing myocardial contractility and constricting peripheral blood vessels as result of the direct stimulation via the sympathetic system on heart and vessels by the cardiac and vasomotor centers in the reticular activating substance of lower pons and medulla oblongata. The cardiac and vasomotor centers via parasympathetic vagal nerves modulate heart rate and via sympathetic spinal cord-peripheral nerves control the basal tone of the entire circulation (heart, arterioles and venules), indirectly affecting macrocirculation and microcirculation driving pressures as consequence of upstream flows and pressures regulation.
During exercise, which organ systems will show vasoconstriction?
- A. Brain and heart.
- B. Heart and skin.
- C. Heart and skeletal muscle.
- D. Kidney and intestine.
- E. Brain and skin.
During exercise, which organ systems will show vasoconstriction?
- A. Brain and heart.
- B. Heart and skin.
- C. Heart and skeletal muscle.
- D. Kidney and intestine.
- E. Brain and skin.
The location of the main baroreceptors in the arterial system is where?
- A. Carotid body.
- B. Carotid sinus.
- C. Renal arteriole.
- D. Middle cerebral artery.
- E. Brachial artery.
The location of the main baroreceptors in the arterial system is where?
- A. Carotid body → chemoreceptors
- B. Carotid sinus.
- C. Renal arteriole.
- D. Middle cerebral artery.
- E. Brachial artery.
Arterial baroreceptors are located within the carotid sinuses and the aortic arch.
Calcium enters the ventricular myocardium during which part of the action potential?
- A. Pacemaker potential.
- B. Rapid upswing of action potential.
- C. Repolarization of action potential.
- D. Plateau phase of action potential.
- E. Hyperpolarization phase of action potential.
We know that when calcium enters muscle cells it will lead to contraction. And this is exactly what occurs during phase 2 of the cardiac myocyte action potential. L-type calcium channels are open, and an influx of calcium ions into the cell leads to myocyte contraction.
Calcium enters the ventricular myocardium during which part of the action potential?
- A. Pacemaker potential.
- B. Rapid upswing of action potential.
- C. Repolarization of action potential.
- D. Plateau phase of action potential.
- E. Hyperpolarization phase of action potential.
The refractory period of a ventricular myocyte (concerning generation of action potentials) is about how long?
- A. 1 millisecond.
- B. 3 millisecond.
- C. 0.1 second.
- D. 0.3 second.
- E. 1 second.
The refractory period of a ventricular myocyte (concerning the generation of action potentials) is about how long?
- A. 1 millisecond.
- B. 3 millisecond.
- C. 0.1 second.
- D. 0.3 second = 300 milliseconds
- E. 1 second.
The cardiac action potential duration is closer to 100 ms (with variations depending on cell type, autonomic tone, etc.). After an action potential initiates, the cardiac cell is unable to initiate another action potential for some duration of time (which is slightly shorter than the “true” action potential duration). This period of time is referred to as the refractory period, which is 250ms in duration and helps to protect the heart.
Persistent fetal circulation describes a neonatal cardio-respiratory difficulty due to:
- A. congenital heart disease.
- B. massive alveolar atelectasis.
- C. right to left shunt through a patent ductus arteriosus and Foramen ovale.
- D. hypoventilation.
- E. anomalous pulmonary venous drainage to the right atrium.
Persistent fetal circulation (PFC), also known as persistent pulmonary hypertension of the newborn, is defined as postnatal persistence of right-to-left ductal or atrial shunting, or both in the presence of elevated right ventricular pressure.
- A. congenital heart disease.
- B. massive alveolar atelectasis.
- C. right to left shunt through a patent ductus arteriosus and Foramen ovale.
- D. hypoventilation.
- E. anomalous pulmonary venous drainage to the right atrium.
Which of the following is NOT a secondary cause of hypertension?
- A. Chronic renal disease.
- B. Hypothyroidism.
- C. Hypoadrenalism.
- D. Phaeochromocytoma.
- E. Renal artery stenosis.
Which of the following is NOT a secondary cause of hypertension?
- A. Chronic renal disease.
- B. Hypothyroidism.
- C. Hypoadrenalism
- D. Phaeochromocytoma.
- E. Renal artery stenosis.
A patient who shows clinical signs of dehydration is producing large volumes of urine. The patient has renal disease in which the mechanism of urine concentration is impaired. ADH levels are normal.
The defect could involve a decreased concentration (osmolality) of fluid in the
- A. proximal convoluted tubules.
- B. Bowman’s capsule.
- C. the ascending limb of the loop of Henle.
- D. distal convoluted tubules.
- E. tissue spaces of the renal medulla.
decreased concentration (osmolality) = failed to get rid of water OR you’ve failed to reabsorb salts.
ADH = normal so its not the water that’s the issue its the ions.
- A. proximal convoluted tubules
- B. Bowman’s capsule.
- C. the ascending limb of the loop of Henle.
- D. distal convoluted tubules.
- E. tissue spaces of the renal medulla.
A 36-year-old woman was admitted in a semi-comatose state. She had been ‘ill’ for several weeks and her breathing was deep and rapid. The following arterial blood gas results were obtained.
What is the acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
E. Mixed acid-base imbalance
- pH = 6.96 → Acidosis
- pCO2 = LOW
- PO2 = Normal
- HCO3- = LOW
What is the acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
E. Mixed acid-base imbalance
A young man was brought in to casualty with multiple injuries from a motor vehicle accident. He underwent surgery. He passed only 250 ml of urine in 24 hours. His plasma biochemistry showed:
The most likely diagnosis is that:
- A. he has chronic renal failure from severe blood loss.
- B. the urea and creatinine results are indicative of pre renal failure.
- C. he has acute renal failure.
- D. the hyperkalemia is unexpected and is most likely a laboratory error.
- E. he is in pre renal failure from hypovolaemia.
- Oliguria
- Serum sodium → Low
- Potassium → High
- HCO3 → Low
- Cl → Low =
- Urea → High = kidney dysfunction
- Creatinine → High = kidney dysfunction
- Urea: Creatinine Ratio = how to distinguish between the types of Acute renal failure
- A. he has chronic renal failure from severe blood loss.
- B. the urea and creatinine results are indicative of prerenal failure.
- C. he has acute renal failure.
- D. the hyperkalemia is unexpected and is most likely a laboratory error.
- E. he is in prerenal failure from hypovolaemia.
In the human body, we maintain a normal blood pressure by a process called homeostasis.
Define the term homeostasis and describe the contribution of feedback loops in homeostasis.
(6 points)
Homeostasis
- Homeostasis is the process to maintain an “equilibrium” in the body’s internal environment.
- Homeostasis is regulated by feedback loops (positive or negative).
- Feedback loops consist of a receptor, a control center, and an effector.
- The receptor monitors changes (stimuli) and sends this information to the control center.
- The control center compares this input with other information from other receptors, and notifies and effector to make an appropriate change.
- The effector makes the appropriate response.
Briefly describe two examples of a positive feedback loop linked to falling blood pressure that can occur in irreversible shock.
(5 examples)
Positive Feedback Loops in Irreversible Shock
Irreversible shock → patient’s condition has progressed so far that death is unavoidable despite interventions.
-
Cardiac Failure
- Decreased BP → decreased coronary blood flow → decreased contractility → decreased stroke volume → decreased CO → Decreased BP
-
Vasomotor failure
- Decreased BP → decreased cerebral blood flow → decreased brain activity → decreased vasomotor tone → decreased TPR → decreased BP
-
Fall in Blood pH
- Decreased BP → decreased tissue perfusion → increased anaerobic metabolism → increased lactic acid → fall in blood pH → vasodilation → decreased BP
- Decreased BP → decreased tissue perfusion → Build up of CO2 → fall in blood pH → vasodilation → decreased BP
-
Hypovolaemia
- Decreased BP → decreased tissue perfusion → tissue hypoxia → loss of intimal barrier function → increased capillary permeability → hypovolaemia → decreased BP
-
Haemostasis (“sludged blood”)
- Decreased BP → decreased blood flow → intravascular clot formation leading to vessel plugging
- intimal cell death → release of pro-coagulants → intravascular clot formation leading to vessel plugging
Describe how the skin functions in the following:
- Thermoregulation
- Protection
- Sensation
Skin Functions
Thermoregulation
- The response to the reduction in body temperature results in decreased blood flow to the skin (vasoconstriction) to reduce heat loss, an increase in body temperature results in increased blood flow (vasodilatation) to the skin to increase heat loss.
- An increase in body temperature will stimulate sweat secretion and promote heat loss.
Protection
- A stratified epithelium provide protection from abrasive stress (mechanical protection)
- Anti-microbial defenses such as sebum and keratin (or)
- UV absorbing pigment (melanin) protects against UV damage
Sensation
- Sensory receptors including: thermoreceptors (heat) & pain receptors (nociceptors) or mechanoreceptors (pressure/touch) provides sensation
For each of the listed digestive secretions, state:
i) One major function of this secretion and
ii) Name one enzyme found in this secretion and states its role in digestion.
- Saliva
- Gastric Juice
- Pancreatic Juice
6-month-old Jayden presents with a brief history of an upper respiratory tract infection and vomiting. On quick observation he looks unwell and is trembling and sweating. You note that his breathing is rapid. Further examination reveals that Jayden has an enlarged liver (hepatomegaly). His mother states that he often becomes very sweaty and distressed with trembling during the night. Jayden is stabilised with intravenous fluids and further investigations have shown that Jayden has a problem with the enzyme glucose-6-phosphatase, resulting in it being non- functioning. The metabolic pathway that involves this enzyme is outlined below.
Based on your understanding of the above biochemical pathway, what is Jayden’s blood sugar level likely to be during periods of fasting? Why?
Glucose-6-phosphatase Deficiency - Fasting State
Blood Sugar Level will be - Lower than normal range
Glucose 6-phosphatase is an enzyme that hydrolyzes glucose 6-phosphate, resulting in the creation of a phosphate group and free glucose. Glucose is then exported from the cell via glucose transporter membrane proteins.
During periods of fasting the blood glucose (a fundamental source of energy for cells) level drops, the body is normally able to increase the blood glucose through the gluconeogenesis & glycogenolysis pathway, however Jayden is unable to convert glucose-6-phosphate to glucose, this step is essential for the glucose to be able to be exported across the cell membrane into the blood stream (the final common step in these pathways), thus the glucose is not able to be exported from the liver and enter the bloodstream.
NOTE - Glucose-6-phosphotase is not the same enzyme as Glucose-6-phosphate dehydrogenase!
Glucose-6-phosphate dehydrogenase enzyme participates in the pentose phosphate pathway, a metabolic pathway that supplies reducing energy to cells (eg. erythrocytes) by maintaining the level of the co-enzyme nicotinamide adenine dinucleotide phosphate (NADPH).
Briefly outline how the abnormality in glucose-6-phosphatase leads to the following clinical signs being observed in Jayden.
Glucose-6-Phosphatase Deficiency - Clinical Features
Sweating & trembling
- Hypoglycaemia triggers a stress response in the body, part of which is the release of noradrenaline and the activation of the sympathetic NS.
- The effect of this at the skin level is increased sweating & as the sweat evaporates the body will cool, resulting in shivering/ trembling.
Rapid Breathing – there are 3 mechanisms that create metabolic acidosis.
- As a result of the metabolic acidosis there is a shift in the acid-base balance which creates increased CO2, which result in an increased respiratory rate in order to try and remove the excess CO2 via lungs (Kussmaul Breathing).
- The activation of the stress response due to hypoglycaemia also results in the mobilization of free fatty acids from lipid stores, the metabolism of these fatty acids results in the release of beta-keto acids.
- Within the liver there is a build up of glucose 6 phosphate which cannot be exported. This excess substrate, will be diverted to the synthesis of fatty acids result in lactic acidosis & increased flux through the pentose phosphate pathway which results in increased purine nucleotide synthesis which results in increased uric acid as a by- product.
Hepatomegaly
- The liver is unable to export glucose from the cell, thus glyocogen accumulates in the liver resulting in an enlarged liver.
Describe 6 possible fates for fatty acids in the liver.
Fatty Acids in the Liver
- Conversion to triacylglycerol or cholesterol esters for export in plasma lipoproteins.
- Conversion into hepatocyte phospholipids.
- Oxidation and conversion to ketone bodies for export to other tissues.
- β oxidation to acetyl-CoA, and further oxidation via citric acid cycle for ATP production.
- β oxidation to acetyl- CoA, followed by synthesis of cholesterol from acetyl-CoA.
- Binding to serum albumin for transport to heart and skeleton.
What are the 3 major mediators of acute inflammation?
Describe the functions of each of these mediators.
Mediators of Acute Inflammation = Histamine, IL-8 and C5a.
Histamine → Increases vascular permeability and dilates arterioles but constricts larger arteries, induction of chemokines.
IL-8 → Polymorph and monocyte localization (it is a chemokine).
C5a → mast cell degranulation, neutrophil and macrocyte chemotaxis, neutrophil activation, smooth muscle contraction, increased capillary permeability.
18-year-old Alexis has a history of asthma. She presents with difficulty breathing and on examination she is noted to have a wheeze.
a) What is a wheeze?
b) Briefly describe the underlying pathophysiology in asthma that results in the clinical presentation of wheeze.
A Wheeze = a high pitched, whistling sound that is audible during inspiration and/ or expiration.
Pathophysiology of a Wheeze in Asthma
- Wheeze occurs in asthma because of narrowing of the airways resulting in turbulence of airflow/ vibration of the bronchial walls.
- Narrowing is caused by bronchoconstriction and mucosal swelling due to inflammation, which is triggered by an IgE response to allergens/irritants.
a) Name 5 effective strategies for reducing alcohol-related problems and harms.
b) Name 5 ineffective strategies for reducing the rate of alcohol related problems and harms.
Reducing alcohol-related problems and harms
Effective strategies
- Minimum legal purchase age
- Government monopoly of retail sales
- Restriction on hours or days of sale
- Outlet density restrictions
- Alcohol taxes
- Random breath tests
- Lowered BAC levels for driving
- Driver license suspension
- Graduated licensing for new drivers
- Brief intervention for hazardous drinkers
Ineffective Strategies
- Voluntary industry codes of practice (e.g. in bars)
- Alcohol education in schools
- Public service messages
- Non-specific warning labels on alcoholic drinks
- Promoting alternatives – alcohol free activities
- Designated drivers and ride services
Martha Gype, aged 34 years presents for investigation of infertility. She describes having a cycle of 5 days of bleeding every 28 days. As part of the investigation you order a day 21 progesterone test (post ovulation test). The result comes back as Progesterone level 10nmol/L. You may use the figure (p.20) to assist you to answer the following questions.
a) What is the normal day 21 progesterone level and interpret Martha’s result?
b) If Martha advised you that she had a menstrual cycle of 5 days every 35 days, how would your assessment have altered?
c) How does the endometrium change from being proliferative in nature to becoming secretory in the second half of the cycle?
a) What is the normal day 21 progesterone level and interpret Martha’s result?
The normal level is >20nmol/L. Martha’s result indicates that she did not ovulate in this cycle. Anovulation may be a cause of infertility.
b) If Martha advised you that she had a menstrual cycle of 5 days every 35 days, how would your assessment have altered?
You would have ordered the progesterone level on day 28 instead of day 21.
c. How does the endometrium change from being proliferative in nature to becoming secretory in the second half of the cycle?
In the first half of the cycle it is predominantly under the influence of oestrogen by following ovulation it is under the influence of progesterone.
Roger and Harriet Andrews are excited as a home pregnancy test was positive. They have been trying to conceive a child for 4 months. Harriet advised that her last menstrual period was on 10th September 2008. She usually menstruates for 4 days and her cycle occurs every 28 days. You repeat the pregnancy test and confirm it is positive.
a) What hormone is measured in a pregnancy test?
b) When is the baby due (expected date of delivery EDD)?
c) If Harriet’s menstrual period lasted 6 days and occurred every 35 days, how would this alter the EDD?
a) What hormone is measured in a pregnancy test?
= Human chorionic gonadotropin (hCG)
b) When is the baby due (expected date of delivery EDD)?
=17th June 2009
- A typical pregnancy lasts, on average, 280 days, or 40 weeks—starting with the first day of the last normal menstrual period as day 1. An estimated due date can be calculated by following steps 1 through 3:
- First day of your last menstrual period = 10th Sept 2008
- Next, count back 3 calendar months from that date = 10th June 2008
- Lastly, add 1 year and 7 days to that date = 17th June 2009
c) If Harriet’s menstrual period lasted 6 days and occurred every 35 days, how would this alter the EDD?
Add 7 days = 24th June 2009 (usually every 28 days, instead = 35 days so add 7 days)
Harriet’s previous obstetric history is as follows. Comment on her major risks as identified in this history and suggest the most appropriate model of care for Harriet.
High-Risk Pregnancy
Risks:
- Antepartum haemorrhage
- Preterm birth,
- Two previous C/S
- Postpartum haemorrhage
- Post-natal depression
Model: High risk pregnancy clinic
Smoking in pregnancy is a risk factor for a number of health problems in the perinatal period and childhood.
List 5 well established health problems in the perinatal period and childhood related to tobacco smoking in pregnancy.
Risks of Smoking During Pregnancy
- Low birth weight
- Prematurity
- SIDS (sudden infant death syndrome)
- Recurrent and chronic otitis media
- Asthma/ respiratory diseases
- Behavioural problems
- Reduced IQ
a) What are nociceptors?
b) List their principle locations in the body?
a) What are nociceptors?
Nociceptors are unmyelinated nerve endings that signal body tissue is being damaged or at risk of being damaged.
b) List their principle locations in the body?
- They are present in:
- Skin
- Bone
- Muscle
- Most internal organs
List the 9 Bradford-Hill criteria for assessing whether a statistically valid association between exposure and outcome is also a causal association.
Bradford-Hill Criteria → a group of nine principles that can be useful in establishing epidemiologic evidence of a causal relationship between a presumed cause and an observed effect.
- Temporal relationship
- Dose-response relationship or biological gradient
- Strength of association
- Consistency
- Plausibility
- Experimental evidence
- Specificity
- Coherence
- Analogy
a) Define ‘resting membrane potential’.
b) Describe the distribution of charges which create the resting membrane potential and how it is maintained.
Resting Membrane Potential = the difference in electric potential across the cell membrane, when the cell is not stimulated in any way.
It is created by an uneven distribution of electrical charges inside and outside the cell, with the inside of the cell is more negative with respect to the outside of the cell.
It is maintained by:
- An unequal distribution of ions, high Na+ concentration outside the cell and high K+ concentration inside the cell.
- The presence of ion channels and ion pumps in the plasma membrane.
- A small resting ion permeability across the cell membrane.
Write the formula (including units) for the calculation of BMI.
What is the normal range for BMI for adults?
Formula for Calculating BMI
Wt (Kg) / Ht (m)2
Normal range for BMI for adults = 20 -25
From what energy metabolite are ketone bodies derived?
What are two important roles for ketone bodies during fasting?
Ketone Bodies
Ketone bodies are formed from acetyl-CoA (are formed when there is an excess of acetyl-CoA).
Ketone bodies can be used to synthesis glucose; can be used as an alternative fuel to glucose (by tissues such as the brain).
Describe five possible fates for glucose 6-phosphate in the liver.
Possible Fates of Glucose 6-phosphate in the liver
- Conversion to liver glycogen.
- Dephosphorylation and release of glucose into bloodstream.
- Oxidation via the pentose phosphate pathway
- Oxidation via glycolysis and the citric acid cycl
- Oxidation to acetyl-CoA, which then serves as precursor for synthesis of triacylglycerols, phospholipids, and cholesterol.
Give a simple definition for each of the following terms:
- Polploidy
- Polysomy
- Translocation
- Deletion
- Polploidy = multiple copies of all chromosomes
- Polysomy = multiple copies of a single chromosome
- Translocation = transfer of genes between non-homologous chromosomes.
- Deletion = loss of a portion of a chromosome or loss of nucleotide in a gene
Which one of the following statements about the shoulder joint is correct?
- A) The joint capsule is deficient posteriorly between the middle and inferior glenohumeral ligaments.
- B) Full range of motion above ninety degrees requires concurrent movement of the scapula.
- C) It has very good ligamentous and bony support.
- D) It is less commonly dislocated than the hip joint.
- E) Inflammation of this joint is easily detected clinically by palpation.
A) The joint capsule is deficient posteriorly between the middle and inferior glenohumeral ligaments → FALSE: The rotator cuff muscles act to reinforce the joint capsule superiorly, posteriorly, and anteriorly.
B) Full range of motion above ninety degrees requires concurrent movement of the scapula → TRUE: The deltoid muscle abducts the arm, but at 90 degrees the humerus bumps into the acromion. Beyond this point, further abduction is the result of upward scapular rotation.
C) It has very good ligamentous and bony support → FALSE: It is a shallow ball and socket joint.
D) It is less commonly dislocated than the hip joint → FALSE: This joint is considered to be the most mobile and least stable joint in the body, and is the most commonly dislocated diarthrodial joint
E) Inflammation of this joint is easily detected clinically by palpation → FALSE
An embolus from the left atrium may lodge in:
- A) the right side of the brain
- B) the inferior vena cava
- C) the superior vena cava
- D) the pulmonary trunk
- E) a pulmonary vein
An embolus from the left atrium may lodge in:
- A) the right side of the brain
- B) the inferior vena cava
- C) the superior vena cava
- D) the pulmonary trunk
- E) a pulmonary vein
- Pathway 1: Left atrium → Mitral valve → Left ventricle → Aortic valve → Aorta → Brachiocephalic trunk → Subclavian → Vertebral*
- Pathway 2: Left atrium → Mitral valve → Left ventricle → Aortic valve → Aorta → Brachiocephalic trunk → Common carotid → Internal carotid*
A truck driver was brought into the emergency department after a traffic accident and is diagnosed as having a fractured pelvis. Which of the following is normally located in the pelvic cavity and might be injured?
Contents of the Pelvic Cavity
The pelvic cavity primarily contains the reproductive organs, urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, and anal canal. In the female, the uterus, Fallopian tubes, ovaries and upper vagina occupy the area between the other viscera.
- A) Inferior vena cava
- B) Urinary bladder
- C) Pancreas
- D) Kidneys
- E) Transverse colon
Which of the following is true of pancreatic islet cells?
- A) Alpha cells produce glucagon.
- B) Beta cells secrete insulin when sugar levels are low.
- C) They constitute around 30% of the total pancreatic cells.
- D) They form the exocrine gland of the pancreas.
- E) They remain functional in cystic fibrosis.
A) Alpha cells produce glucagon → TRUE
B) Beta cells secrete insulin when sugar levels are low → FALSE: Beta cells secrete insulin when blood sugar levels are high. As circulating glucose levels rise such as after ingesting a meal, insulin is secreted in a dose-dependent fashion = glucose-stimulated insulin secretion (GSIS). Insulin allows glucose to enter cells.
C) They constitute around 30% of the total pancreatic cells → FALSE: Islets comprise 1-2% of the pancreatic mass. The exocrine components (acinar and duct cells + associated CT, vessels, and nerves) comprise more than 95% of the pancreatic mass.
D) They form the exocrine gland of the pancreas → FALSE: The islets form the exocrine component of the pancreas.
E) They remain functional in cystic fibrosis → FALSE: CF damages the islets. The CFTR proteins dont work properly, affecting the amount of fluid and bicarbonate that is produced. This lack of fluid causes the duct to become blocked = CF-Related Diabetes.
Biological oxidation-reduction reactions always involve:
- A) direct participation of oxygen.
- B) formation of water.
- C) mitochondria.
- D) transfer of electrons.
- E) transfer of hydrogens.
Biological Redox Reactions always involve:
- A) direct participation of oxygen.
- B) formation of water.
- C) mitochondria → Glycolysis but also others - eg. oxidation of carbon to yield carbon dioxide (CO2) or the reduction of carbon by hydrogen to yield methane (CH4).
- D) transfer of electrons.
- E) transfer of hydrogens → Acid-base reaction
One of the commonest GIT nematodes is the pinworm (enterobius) which cause pruritis, irritability & insomnia.
Which of the following summarises its life cycle?
- A) Ingest larva, migrate to gallbladder, defecate to soil & mature to lay eggs.
- B) Step on adult worm, burrows into skin, migrates to heart, form cyst, erupt eggs into bloodstream, migrate GIT, defecate to soil.
- C) Mosquito lays eggs with bite, mature in RBC, RBC erupt releasing adults, mosquito bites to transport to new host.
- D) Step on adult worm, burrows into skin, migrates to liver, form cysts, erupt eggs into GIT, defecate into soil.
- E) Ingest larvae, grow in GIT, crawl out anus onto skin, scratch skin & eggs transfer to hand, hand transfers to oral with eating.
Life Cycle of the Pinworm (common GIT nematode/enterobius)
- A) Ingest larva, migrate to gallbladder, defecate to soil & mature to lay eggs.
- B) Step on adult worm, burrows into skin, migrates to heart, form cyst, erupt eggs into bloodstream, migrate GIT, defecate to soil.
- C) Mosquito lays eggs with bite, mature in RBC, RBC erupt releasing adults, mosquito bites to transport to new host.
- D) Step on adult worm, burrows into skin, migrates to liver, form cysts, erupt eggs into GIT, defecate into soil.
- E) Ingest larvae, grow in GIT, crawl out anus onto skin, scratch skin & eggs transfer to hand, hand transfers to oral with eating.
The anterior drawer test is performed at 90 degrees and 30 degrees flexion of the knee. These tests were designed to test the integrity of one structure.
What is that structure?
- A) Anterior Cruciate Ligament
- B) Posterior Cruciate Ligament
- C) Posterior Arcuate Ligament
- D) Medial Collateral Ligament
- E) Lateral meniscus
Anterior Drawer Test - tests the:
- A) Anterior Cruciate Ligament
- B) Posterior Cruciate Ligament → tested with the posterior drawer test
- C) Posterior Arcuate Ligament → Dial Test
- D) Medial Collateral Ligament → Valgus/Abduction stress test
- E) Lateral meniscus → McMurrays Test
A difference between passive and active trans-membrane transport is:
- A) Passive transport moves substrates against their concentration gradient.
- B) Passive transport is energy-dependent.
- C) Active transport is facilitated.
- D) Active transport moves substrates down their concentration gradient.
- E) Active transport moves substrates against their concentration gradient.
A difference between passive and active trans-membrane transport is:
- A) Passive transport moves substrates against their concentration gradient.
- B) Passive transport is energy-dependent.
- C) Active transport is facilitated.
- D) Active transport moves substrates down their concentration gradient.
- E) Active transport moves substrates against their concentration gradient.
Mrs Aboud, 74 years old comes to see you with an X-Ray of her thoracic spine. The report says there are multiple crush fractures suggestive of osteoporosis.
Which of the following best describes the changes in her bones due to osteoporosis?
- A) Increased calcium.
- B) Lack of phosphate.
- C) Absence of Vitamin D.
- D) Decreased total bone protein matrix.
- E) Decreased numbers of osteoclasts.
Osteoporosis
- A) Increased calcium.
- B) Lack of phosphate.
- C) Absence of Vitamin D → Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D deficiency.
- D) Decreased total bone protein matrix.
- E) Decreased numbers of osteoclasts →
- Learn the 5 Stages of Bone Remodelling*
- Learn Osteoporosis vs. Osteopenia vs. Osteoarthritis vs. Osteomalacia*
Which of the following is an example of passive immunity?
- A) Rubella vaccination
- B) Tetanus toxoid for tetanus
- C) HPV vaccination
- D) Oral poliomyelitis (Sabin) vaccination
- E) Immunoglobulin for hepatitis B exposure
Example of Passive Immunity
- A) Rubella vaccination
- B) Tetanus toxoid for tetanus
- C) HPV vaccination
- D) Oral poliomyelitis (Sabin) vaccination
- E) Immunoglobulin for hepatitis B exposure
Passive immunity is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system.
Passive immunity is the transfer of active humoral immunity of ready-made antibodies. Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta, and it can also be induced artificially, when high levels of antibodies specific to a pathogen or toxin (obtained from humans, horses, or other animals) are transferred to non-immune persons through blood products that contain antibodies, such as in immunoglobulin therapy or antiserum therapy
Passive immunization is used when there is a high risk of infection and insufficient time for the body to develop its own immune response, or to reduce the symptoms of ongoing or immunosuppressive diseases. Passive immunization can be provided when people cannot synthesize antibodies, and when they have been exposed to a disease that they do not have immunity against.
The figure below depicts the time course drug concentration curves given by four different routes of administration: W, X, Y, and Z.
Label correctly for oral, intravenous, subcutaneous and intramuscular.
W = Intravenous → most direct method into the blood/plasma. IV administration does not involve absorption, and there is no loss of drug.
X = Intramuscular → Muscles are very vascular structures, and IM absorption occurs by drug diffusion from the interstitial fluid and capillary membranes into plasma, and so the onset of action is longer than IV injection.
Y= Subcutaneous → A subcutaneous injection or shot is one into the fatty tissues just beneath the skin. These injections are shallower than those injected into muscle tissues. Providers often use subcutaneous injections for medications that must be absorbed into the bloodstream slowly and steadily (eg. Insulin)
Z = Oral → Slowest to be absorbed into bloodstream.
The fastest route of absorption is inhalation.
The synthesis of which essential nutrient relies upon adequate exposure of the skin to the sun?
- A) Vitamin D
- B) Vitamin H
- C) Bile acids
- D) Lanosterol
- E) Cholecystokinin
The synthesis of which essential nutrient relies upon adequate exposure of the skin to the sun?
- A) Vitamin D
- B) Vitamin H
- C) Bile acids
- D) Lanosterol
- E) Cholecystokinin
Zero-order kinetics applies:
- A) When the rate of drug elimination is constant, independent of the drug concentration.
- B) Only in the case of ethanol.
- C) When the rate of drug elimination decreases as the drug concentration decreases.
- D) If the half-life is constant despite rising drug concentration.
- E) None of the above.
Zero-order kinetics applies:
- A) When the rate of drug elimination is constant, independent of the drug concentration.
- B) Only in the case of ethanol.
- C) When the rate of drug elimination decreases as the drug concentration decreases.
- D) If the half-life is constant despite rising drug concentration → rate of elimination is the same but the half-life will reduce as the drug is excreted because there is less of it to half.
- E) None of the above.
Which of the following is most correct about the mechanism of action of the beta-lactam class of antibiotics?
- A) Inhibit protein synthesis by binding to a portion of the bacterial ribosome.
- B) Inhibits bacterial cell wall synthesis.
- C) Blocks DNA synthesis by inhibiting DNA gyrase.
- D) Inhibits protein synthesis by binding to the subunit of the bacterial ribosome.
- E) Inhibiting folic acid metabolism.
Beta-lactam Antibiotics
- A) Inhibit protein synthesis by binding to a portion of the bacterial ribosome
- B) Inhibits bacterial cell wall synthesis.
- C) Blocks DNA synthesis by inhibiting DNA gyrase.
- D) Inhibits protein synthesis by binding to the subunit of the bacterial ribosome.
- E) Inhibiting folic acid metabolism.
β-lactam antibiotics are bactericidal, and act by inhibiting the synthesis of the peptidoglycan layer of bacterial cell walls.
Penicillin and most other β-lactam antibiotics act by inhibiting penicillin-binding proteins, which normally catalyze cross-linking of bacterial cell walls.
Which one of the following statements about pupillary light reflex is most correct?
- A) The efferent limb of the pupillary reflex is the optic nerve.
- B) The pupils dilate as the eyes converge.
- C) The pupil only constricts on the same side as the light stimulus.
- D) The efferent limb of the pupillary reflex is the oculomotor nerve.
- E) The afferent limb of the pupillary reflex is the oculomotor nerve.
Pupillary Light Reflex
Afferent limb = CNII = Optic Nerve
Efferent limb = CNIII = Oculomotor Nerve
- A) The efferent limb of the pupillary reflex is the optic nerve.
- B) The pupils dilate as the eyes converge.
- C) The pupil only constricts on the same side as the light stimulus.
- D) The efferent limb of the pupillary reflex is the oculomotor nerve.
- E) The afferent limb of the pupillary reflex is the oculomotor nerve.
Which one of the following statements is correct?
- A) Neurones are good examples of labile cells.
- B) Healing by first intention can still take place if the wound gets infected.
- C) Nerve axons will never regenerate.
- D) Healing by second intention occurs after tissue loss.
- E) Stable cells are not able to regenerate.
- A) Neurones are good examples of labile cells → FALSE: they are permanent cells (no longer undergo mitosis). Good examples of labile cells = keratinocytes, intestinal epithelial cells.
- B) Healing by first intention can still take place if the wound gets infected → FALSE
- C) Nerve axons will never regenerate → FALSE:
- D) Healing by second intention occurs after tissue loss.
- E) Stable cells are not able to regenerate → FALSE: They can re-enter the cell cycle if stimulated
Peripheral NS Axon Regeneration
- Basement membrane is intact – Distal axonal process die
- Myelin sheath breaks down around this axonal tip
- Møs clear away debris
- Growth of axonal sprouts from the surviving stump begins
- Rate of 1-4mm/day
- Schwann cell
- Basement membrane directs axonal sprout growth
- Membrane ingrowths en-sheaths axonal sprout replacing myelin & restoring conductivity
Which one of the following statements is correct for the control of blood pressure and volume?
- A) Renin converts angiotensin I to angiotensin II producing vaso-constriction.
- B) Aldosterone increases blood pressure by decreasing sodium reabsorption in the renal tubules.
- C) Atrial natriuretic peptide (ANP) released by cells in the atria lowers blood pressure by causing vasodilatation.
- D) Antidiuretic hormone promotes water reabsorption in the proximal convoluted tubules.
- E) Epinephrine (adrenaline) produced in the adrenal cortex produces vasoconstriction.
RAAS - functions to elevate blood volume (+BP) and arterial tone in a prolonged manner. It does this by increasing sodium reabsorption, water reabsorption, and vascular tone.
- A) Renin converts angiotensin I to angiotensin II producing vaso-constriction → FALSE: renin causes change from angiotensinogen to angiontensin II.
- B) Aldosterone increases blood pressure by decreasing sodium reabsorption in the renal tubules → FALSE: preventing reabsorption would lead to more Na+ in the urine so water would follow = blood volume decrease = hypotension.
- C) Atrial natriuretic peptide (ANP) released by cells in the atria lowers blood pressure by causing vasodilatation.
- D) Antidiuretic hormone promotes water reabsorption in the proximal convoluted tubules → FALSE: ADH binds to receptors on cells in the collecting ducts of the kidney and promotes reabsorption of water back into the circulation.
- E) Epinephrine (adrenaline) produced in the adrenal cortex produces vasoconstriction → FALSE: Epinephrine is produced specifically in the adrenal medulla.
What are the two actions of angiotensin II?
- A) Decreased sodium reabsorption and vasoconstriction.
- B) Increased aldosterone secretion and decreased sodium reabsorption.
- C) Decreased sodium reabsorption and vasodilation.
- D) Increased sodium reabsorption and vasoconstriction.
- E) Decreased aldosterone secretion and vasodilation.
What are the two actions of angiotensin II?
- A) Decreased sodium reabsorption and vasoconstriction.
- B) Increased aldosterone secretion and decreased sodium reabsorption.
- C) Decreased sodium reabsorption and vasodilation.
- D) Increased sodium reabsorption and vasoconstriction.
- E) Decreased aldosterone secretion and vasodilation.
RAAS system wants to increase BP so it will increase blood volume by preventing secretion of ions and water and vasoconstrict.
Regarding the diagram below, which one of the following statements is most correct?
An embolus from a left leg vein may lodge in the:
- A) Left arm
- B) Right leg
- C) Left atrium
- D) Right lung
- E) Pulmonary vein
An embolus from a left leg vein may lodge in the:
- A) Left arm
- B) Right leg
- C) Left atrium
- D) Right lung
- E) Pulmonary vein
Pathway from left calf to lungs (DVT & PE):
Left & Right Common Iliac Veins unite to form the IVC → Right Atrium → Tricuspid Valve → Right Ventricle → Pulmonary valve → Pulmonary arteries → Lungs
Regarding the photograph below, which one of the following statements is correct?
Lymphatic spread of tumour from the breast may be to the:
- A) Anterior (or pectoral) group of superficial axillary nodes
- B) Posterior (or subscapular) group of superficial axillary nodes
- C) Ipsilateral parasternal nodes along the internal thoracic vessels
- D) Contralateral breast
- E) All of the above
Lymphatic Drainage of Breast
Lymphatic spread of tumour from the breast may be to the:
- A) Anterior (or pectoral) group of superficial axillary nodes
- B) Posterior (or subscapular) group of superficial axillary nodes
- C) Ipsilateral parasternal nodes along the internal thoracic vessels
- D) Contralateral breast
- E) All of the above
*Lymphatics follow arteries – may cross to the opposite side if blocked.
The population pyramid above shows several attributes of the Australian population over the years 1956-2005.
Choose the correct answer derived from the population pyramid above.
- A) The fertility rate (number of children born per woman of child-bearing age) has increased.
- B) The fertility rate has decreased.
- C) The death rate for male children aged 0-4 has reduced from about 11% to about 6%.
- D) The death rate for male children aged 0-4 has increased from about 6% to about 11%.
- E) All of the above.
- A) The fertility rate (number of children born per woman of child-bearing age) has increased.
- B) The fertility rate has decreased.
- C) The death rate for male children aged 0-4 has reduced from about 11% to about 6%.
- D) The death rate for male children aged 0-4 has increased from about 6% to about 11%.
- E) All of the above.
Referring to the above pyramid, which one of the following is correct?
- A) Average life expectancy for a male is 40-44 years.
- B) Average life expectancy for a female is 85+ years.
- C) There were more than twice as many females older than 85 years in 2005 than there were in 1956.
- D) There were more men than women aged more than 75 years in 2005.
- E) None of the above.
- A) Average life expectancy for a male is 40-44 years.
- B) Average life expectancy for a female is 85+ years.
- C) There were more than twice as many females older than 85 years in 2005 than there were in 1956.
- D) There were more men than women aged more than 75 years in 2005.
- E) None of the above.
In distinguishing between epidemic and endemic disease, which of the following statements is most correct?
- A) Tuberculosis in Australia could be described as endemic.
- B) An epidemic implies a constant number of cases of a disease occurring in large numbers.
- C) Endemic diseases occur as periodic large outbreaks.
- D) If the rate of meningococcal disease in Sydney ranged between 7-10 cases/100,000 population per year from between 2000 and 2007, a rate of 11/100,000 in 2008 would constitute an epidemic in 2008.
- E) Ebola virus has never been described in Australia before. One new case could be considered an epidemic.
- A) Tuberculosis in Australia could be described as endemic → FALSE: TB is not limited to a particular region of Australia as in an endemic.
- B) An epidemic implies a constant number of cases of a disease occurring in large numbers → FALSE: epidemic = unexpected increase in number of cases.
- C) Endemic diseases occur as periodic large outbreaks → FALSE: in an endemic the outbreak is consistently present.
- D) If the rate of meningococcal disease in Sydney ranged between 7-10 cases/100,000 population per year from between 2000 and 2007, a rate of 11/100,000 in 2008 would constitute an epidemic in 2008 → FALSE: epidemic = unexpected increase in number of cases 1 more case increase isn’t unexpected.
- E) Ebola virus has never been described in Australia before. One new case could be considered an epidemic.
Mass population screening is commonly performed in Australia. Which of the following criterion/ criteria is/ are the most important to consider in deciding which conditions should be screened?
- A) The condition should be an important health problem.
- B) There should be accepted treatment available.
- C) There should be a suitable test or examination – high specificity and sensitivity.
- D) The process should be a continuing one, not a “one-off for all”.
- E) All of the above.
Principles of Screening
- A) The condition should be an important health problem.
- B) There should be accepted treatment available.
- C) There should be a suitable test or examination – high specificity and sensitivity.
- D) The process should be a continuing one, not a “one-off for all”.
- E) All of the above.
Consent for a procedure is not legally required:
- A) In emergency life & death situations and the patient is unconscious.
- B) In a minor where the parents are not available to give the consent.
- C) In cases where the patient does not understand your language.
- D) In cases where the procedure is in the patient’s best interest.
- E) In a mentally deficient patient where the guardian is not available.
- A) In emergency life & death situations and the patient is unconscious.
- B) In a minor where the parents are not available to give the consent.
- C) In cases where the patient does not understand your language.
- D) In cases where the procedure is in the patient’s best interest.
- E) In a mentally deficient patient where the guardian is not available.
Levels of evidence are determined by the quality and nature of the research undertaken. Which one of the following research study designs is considered as the best in terms of levels of evidence?
- A) Cohort study.
- B) Cross-sectional analysis.
- C) Cross-over study.
- D) Randomised double-blinded controlled study.
- E) Randomised paired-design controlled study.
Levels of Evidence
- A) Cohort study.
- B) Cross-sectional analysis.
- C) Cross-over study.
- D) Randomised double-blinded controlled study.
- E) Randomised paired-design controlled study.
Concerning levels of evidence (NHMRC). Which is best?
- A) Level I
- B) Level II
- C) Level III-1
- D) Level III-2
- E) Level IV
Concerning levels of evidence (NHMRC). Which is best?
- A) Level I
- B) Level II
- C) Level III-1
- D) Level III-2
- E) Level IV
NMHRC = National Health and Medical Research Council
Mary is 5 years of age. She has leukaemia and unfortunately has not responded to chemotherapy. The only treatment alternative left is to have a bone marrow transplant and luckily Janet, her older sister age 15 is a perfect match.
A) Janet alone can provide medical consent for this procedure to go ahead.
B) Janet’s parents can provide ultimate consent for this procedure to go ahead.
C) If the parents and Janet refuse, then the treating doctor may apply to the court for judgment on this issue.
D) As Janet is already 15, she is deemed competent to give medical consent for this procedure.
E) Even though the parents and Janet refuses for the transplant to go ahead, the doctor cannot influence this decision and must respect their choice.
A) Janet alone can provide medical consent for this procedure to go ahead.
B) Janet’s parents can provide ultimate consent for this procedure to go ahead.
C) If the parents and Janet refuse, then the treating doctor may apply to the court for judgment on this issue.
D) As Janet is already 15, she is deemed competent to give medical consent for this procedure.
E) Even though the parents and Janet refuses for the transplant to go ahead, the doctor cannot influence this decision and must respect their choice.
Both complete atelectasis of the right lung and a total right pneumonectomy will decrease total lung volume to the same extent. In the absence of a significant decrease in alveolar ventilation, there is typically no significant long-term decrease in arterial O2 pressure following a pneumonectomy, but often a marked decrease in arterial O2 pressure with complete atelectasis.
Why?
Atelectasis = Lung collapse
- The decrease in arterial O2 pressure with complete atelectasis is due to a V/Q mismatch.
- When one lung has collapse there is still perfusion (Q) from blood vessels to the area but there is no ventilation as air isn’t coming into the lungs and entering the alveoli (V).
Pneumonectomy = a type of surgery to remove one of your lungs because of cancer, trauma, or some other condition.
- There is no V/Q mismatch in Pneumonectomy because the blood vessels supplying that lung are also removed.
- Perfusion Q is not mismatched to the ventilation you are simply relying on a smaller area for gas exchange to occur.
Outline the physiological mechanisms that are normal short-term and long-term regulators of blood pressure.
Short-Term Regulators of BP → Reflexes
There are several reflexes that bring about changes in MAP
- Baroreceptor reflexes
- Chemoreceptor reflexes
- CNS ischaemic responses
Long-Term Regulators of BP → Hormones
- RAAS
Rose Chan is the 12 year daughter of Mr and Mrs Chan. Two weeks before developing a flu like illness the family had gone to Sai Kung for a seafood luncheon to celebrate Mr and Mrs Chan’s wedding anniversary. Mrs Chan asks the local General Practitioner to see Rose. He finds her temperature to be 38.2oC and there were no abnormal findings on examination. Because the mother is very worried about the seafood visit the doctor decides to carry out a series of tests. Below are the results of the tests:
What illness is the mother most worried about?
- A. Hepatitis A
- B. Hepatitis B
- C. Hepatitis C
- D. Hepatitis D
- E. Hepatitis E
What illness is the mother most worried about?
- A. Hepatitis A → only type of hep that is spread by fecal-oral route & contaminated food (other than hep E which is secondary to D)
- B. Hepatitis B
- C. Hepatitis C
- D. Hepatitis D
- E. Hepatitis E
Parenteral transmission is defined as that which occurs outside of the alimentary tract, such as in subcutaneous, intravenous, intramuscular, and intrasternal injections.
The erythema is a consequence of increased blood flow through the injured area. The most likely mechanism underlying this change is
- A. Reduced venous drainage of the area.
- B. Effect of bacterial endotoxin on endothelial cells.
- C. Effect of prostaglandins on arteriolar smooth muscle.
- D. Effect of tumour necrosis factor on the post-capillary venules.
- E. effect of cytokines on the pre-capillary venules.
Cardinal Signs of Inflammation - Erythema/Redness (Rubor)
Which one of the following is the most likely cause of the swelling?
- A. Reduced venous drainage of the area.
- B. Effect of bacterial endotoxin on endothelial cells.
- C. Effect of prostaglandins on arteriolar smooth muscle.
- D. Effect of tumour necrosis factor on the post-capillary venules.
- E. effect of cytokines on the pre-capillary venules.
Rubor
- Redness is due to vasodilation and vascular congestion.
- There is relaxation of vascular smooth muscle at the arteriolar level with recruitment of capillary beds.
- Relaxation of arteriolar smooth muscle is mediated by histamine, Complement (C3a & C5a), NO, prostaglandins
Neutrophils kill bacteria by:
- A. secretion of antigen-specific antibodies.
- B. production of reactive oxygen metabolites.
- C. production of interleukin-2.
- D. complement-mediated lysis.
- E. production of bacterial endotoxins.
Neutrophils kill bacteria by:
- A. Secretion of antigen-specific antibodies.
- B. Production of reactive oxygen metabolites.
- C. Production of interleukin-2.
- D. Complement-mediated lysis.
- E. Production of bacterial endotoxins.
Neutrophil action on bacteria
- Neutrophils phagocytose the bacteria
- Killing and degredation occurs within neutrophils
- Microbial killing is accomplished largely by oxygen dependant mechanisms
- Phagocytosis induces an “oxidative burst” with production of reactive oxygen intermediates (ROI’s) within the lysosome
MHC restricted T cells recognize peptides presented with other components. Which one of the following pairs occur in an effective immune response?
- A. Self-peptides with self major histocompatibility complex Class II.
- B. Self-peptides with surface immunoglobulin.
- C. Antigenic peptides with surface immunoglobulin.
- D. Antigenic peptides with self major histocompatibility complex Class II.
- E. Antigenic peptides with foreign major histocompatibility complex Class II.
LEARN IMMUNOLOGY!!
- A. Self-peptides with self major histocompatibility complex Class II.
- B. Self-peptides with surface immunoglobulin.
- C. Antigenic peptides with surface immunoglobulin.
- D. Antigenic peptides with self major histocompatibility complex Class II.
- E. Antigenic peptides with foreign major histocompatibility complex Class II.
Mr. Imen Pane, a 35 year old man, arrives in the emergency room with a temperature of 39°C, nausea, lower right quadrant pain for 18 hours and leukocytosis. You make the diagnosis of appendicitis.
The process whereby T-cells capable of recognizing self MHC are rescued from apoptosis is known as _________. Alternatively, those T-cells which do not exhibit tolerance to self-antigens undergo apoptosis and are removed by phagocytosis. This is known as _________.
- A. Positive selection, affinity maturation.
- B. Negative selection, affinity maturation.
- C. Positive selection, negative selection.
- D. Affinity maturation, anergy.
- E. T-cell maturation, negative selection.
The process whereby T-cells capable of recognizing self MHC are rescued from apoptosis is known as Positive Selection. Alternatively, those T-cells which do not exhibit tolerance to self-antigens undergo apoptosis and are removed by phagocytosis. This is known as Negative Selection.
Which of the following structures is usually found in the free margin of the lesser omentum (the hepatoduodenal ligament)?
- A. The hepatic vein.
- B. The common bile duct.
- C. The hepatic portal artery.
- D. The common hepatic duct.
- E. The cystic duct.
The hepatoduodenal ligament is a double-layered tubular role of peritoneum that constitutes part of the lesser omentum. It stretches between the porta hepatis of the liver and the proximal portion of the duodenum. Its main function is to encompass and accompany the portal triad which are three structures running in close proximity: hepatic artery proper, the hepatic portal vein and the common bile duct.
- A. The hepatic vein.
- B. The common bile duct.
- C. The hepatic portal artery.
- D. The common hepatic duct.
- E. The cystic duct.
Which of the following statements correctly describes the peritoneum?
A. Peritoneum has a parietal, visceral and abdominal layers.
B. The falciform ligament is derived from the visceral layer and supports the liver.
C. The epiploic foramen leads to the greater sac.
D. The greater omentum attaches to the stomach and small intestines.
E. Mesentery supports solid organs, such as liver and spleen.
The peritoneum is a double-layered serous membrane that envelopes the abdominal organs and lines the walls of the abdominal cavity. The two layers are the visceral and parietal peritoneum.
Mesentery = A mesentery = a double layer of peritoneum, caused by invagination of an organ into the peritoneum, that connects the organ to the body wall and gives pathway to blood vessels, nerves and lymphatic ducts between the organ and the body wall.
A. Peritoneum has a parietal, visceral and abdominal layers → FALSE: it only has a parietal and visceral layer.
B. The falciform ligament is derived from the visceral layer and supports the liver → FALSE: The falciform ligament is a double-layered extension of parietal peritoneum that sweeps off the anterior abdominal wall to divide the liver into the asymmetric left and right lobes.
C. The epiploic foramen leads to the greater sac → The epiploic foramen (foramen of Winslow) is a passage between the greater sac (peritoneal cavity proper) and the lesser sac (omental bursa), allowing communication between these two spaces.
D. The greater omentum attaches to the stomach and small intestines → FALSE: Attached to the greater curvature of the stomach and the transverse colon of the large intestine.
E. Mesentery supports solid organs, such as liver and spleen.→ TRUE but it also supports hollow organs (eg. stromach)
Which of the following is not a characteristic of bilirubin formation and excretion?
A. Hemoglobin is released and taken up by the liver reticuloendothelial system.
B. Hemoglobin is broken into globin and heme.
C. When heme is cleaved, iron is released and the porphyrin ring is converted into bilirubin.
D. In blood, bilirubin combines with glucuronic acid to form glucuronide.
E. Bilirubin metabolites are excreted in feces and urine.
Bilirubin Metabolism
A. Hemoglobin is released and taken up by the liver reticuloendothelial system.
B. Hemoglobin is broken into globin and heme.
C. When heme is cleaved, iron is released and the porphyrin ring is converted into bilirubin.
D. In blood, bilirubin combines with glucuronic acid to form glucuronide → Bilirubin conjugated with glucuronic acid forms bilirubin diglucuronide = Conjugated bilirubin.
E. Bilirubin metabolites are excreted in feces and urine.
A 29 year old male presents with vitamin B12 deficiency. Investigations reveal that he had a deficiency of intrinsic factor. Which cell type in the stomach is possibly either absent or deficient in this patient?
- A. Parietal cells
- B. G-cells
- C. D-cells
- D. Mucous goblet cells
- E. Peptic cells
Vitamin B12 deficiency result from Intrinsic Factor Deficiency
Vit B12 is readily absorbed in the last part of the small intestine (ileum). However, to be absorbed, the vitamin must combine with intrinsic factor, a protein produced in the stomach. Without intrinsic factor, vitamin B12 moves through the intestine and is excreted in stool.
This patient is not absorbing Vit B12 because he is deficient in intrinsic factor. Instrinsic factor is made by the parietal cells of the stomach.
- A. Parietal cells
- B. G-cells → neuroendocrine cells present in the stomach (pyloric antrum), duodenum and pancreas that synthesise and secrete gastrin.
- C. D-cells → somatostatin-producing cells found in the stomach, intestine and the pancreatic islets.
- D. Mucous goblet cells
- E. Peptic cells
A 60 year old female has been taking non-steroid anti-inflammatory drugs (NSAIDS) for many years. The doctor is concerned about the development of ulcers. What is the mechanism by which NSAIDS cause peptic ulcers?
A. NSAIDs help promote the growth of Helicobacter pylori.
B. NSAIDs are acids that increase the acidity in the stomach.
C. NSAIDs stimulate the release of more acid.
D. NSAIDs inhibit the biosynthesis and release of prostaglandins.
E. NSAIDs cause a hypersensitivity reaction causing damage to the mucosa.
NSAID Induced Gastric Ulcers
A. NSAIDs help promote the growth of Helicobacter pylori.
B. NSAIDs are acids that increase the acidity in the stomach.
C. NSAIDs stimulate the release of more acid.
D. NSAIDs inhibit the biosynthesis and release of prostaglandins.
E. NSAIDs cause a hypersensitivity reaction causing damage to the mucosa.
Inhibition of COX-1 in the gastrointestinal tract leads to a reduction of prostaglandin secretion and its cytoprotective effects in gastric mucosa. This, therefore, increases the susceptibility to mucosal injury. Inhibition of COX-2 may also play a role in mucosal injury.
Which of the following diseases is caused by deficiency of both calories and protein?
- A. Rickets
- B. Pernicious anemia
- C. Goiter
- D. Marasmus
- E. Pellagra
Which of the following diseases is caused by deficiency of both calories and protein?
- A. Rickets = Vitamin D deficiency (can get VitD from sunlight)
- B. Pernicious anemia = impaired Vit B12 absorption due to lack of Intrinsic Factor from parietal cells stomach due to autoimmune disorder
- C. Goiter = enlarged thyroid due to iodine deficiency
- D. Marasmus
- E. Pellagra = niacin (Vit 3B) or tryptophan (essential amino acid) - can get from non-meat sources.
In the normal lung which one of the following is correct?
A. The middle lobe bronchus divides into the bronchus to the lingula and the bronchus to the left lower lobe.
B. Pulmonary vascular pressure is much higher than systemic vascular pressure.
C. Anatomical dead space is approximately 1,500 mls.
D. The combined cross-sectional area of the airways increases progressively as they subdivide.
E. The left lung can be divided into three distinct lobes.
A. The middle lobe bronchus divides into the bronchus to the lingula and the bronchus to the left lower lobe → FALSE: The left lung doesn’t have a middle lobe bronchus.
B. Pulmonary vascular pressure is much higher than systemic vascular pressure → FALSE: Systemic Vascular Pressure > Pulmonary Vascular Pressure
C. Anatomical dead space is approximately 1,500 ml → FALSE: Dead space represents the volume of ventilated air that does not participate in gas exchange. The two types of dead space are anatomical dead space and physiologic dead space. Anatomical dead space = volume of air that fills the conducting zone of respiration made up by the nose, trachea, and bronchi. This volume is considered to be 30% of normal tidal volume (500 mL); therefore, the value of anatomic dead space is 150 mL.
D. The combined cross-sectional area of the airways increases progressively as they subdivide.
E. The left lung can be divided into three distinct lobes → FALSE: left lung only has 2 lobes
Pleural cavities arise from which one of the following structures?
- A. Foregut
- B. Cloaca
- C. Coelom
- D. Neural tube
- E. Hindgut
The paired pleural cavities are derivatives of the intraembryonic portion of the primitive coelom. The primitive coelom arises by splitting of the lateral mesoderm on either side of the embryo into splanchnic and somatic layers. These paired cavities are later separated by three partitions into three subdivisions: the pericardial cavity, the pleural cavities, and the peritoneal cavity.
The splanchnic mesoderm is the origin of the visceral pleura, and the somatic mesoderm is the origin of most of the parietal pleura.
A. Foregut → FALSE: forms the respiratory tube/lungs but not the pleura!
B. Cloaca → FALSE: A cloaca is a common chamber into which some or all of the digestive, urinary, and reproductive tracts discharge their contents. A cloaca exists in all human embryos up to 4–6 weeks, at which time it becomes partitioned into the urogenital sinus and the rectum. A cloaca forms when the cloacal membrane does not recede or the mesoderm does not invade.
C. Coelom → A special type of body cavity derived from the mesoderm, or middle layer of germ cells present in an embryo.
D. Neural tube → FALSE: cranial and caudal portions of the neural tube form the brain and spinal cord respectfully. Some of the cells that border the neural and non-neuronal ectoderm will migrate and create layers called neural crest cells. The neural crest will develop into the peripheral nervous system, spinal, and cranial nerves.
E. Hindgut
Which of the following statements best describes the changes that occur in the epithelial lining of the conducting and respiratory portions of the system?
A. Pseudostratified ciliated columnar epithelium is found throughout the system.
B. Pseudostratified epithelium is distributed throughout the system except in the alveoli which are lined with simple squamous epithelium.
C. Pseudostratified epithelium changes to simple columnar then to simple cuboidal epithelia in the bronchioles and then changes to simple squamous epithelium in the alveoli.
D. Simple columnar epithelium extends from the bronchi to the alveoli where a change to simple cuboidal epithelium occurs.
E. The simple cuboidal epithelium of the bronchi changes to simple squamous epithelium in the alveoli.
Conducting Zone & Respiratory Zone
The majority of the respiratory tree, from the nasal cavity to the bronchi, is lined by pseudostratified columnar ciliated epithelium. The bronchioles are lined by simple columnar to the cuboidal epithelium, and the alveoli possess a lining of thin squamous epithelium that allows for gas exchange.
A. Pseudostratified ciliated columnar epithelium is found throughout the system.
B. Pseudostratified epithelium is distributed throughout the system except in the alveoli which are lined with simple squamous epithelium.
C. Pseudostratified epithelium changes to simple columnar then to simple cuboidal epithelia in the bronchioles and then changes to simple squamous epithelium in the alveoli.
D. Simple columnar epithelium extends from the bronchi to the alveoli where a change to simple cuboidal epithelium occurs.
E. The simple cuboidal epithelium of the bronchi changes to simple squamous epithelium in the alveoli.
The asthmatic airway is characterized by each of the following except:
- A. mucosal infiltration with eosinophils and neutrophils.
- B. mucous glands hypertrophy.
- C. decrease in thickness of the basement membrane.
- D. edema of the mucosa.
- E. inflammation and remodeling of the airway wall.
The asthmatic airway is characterized by each of the following except:
- A. mucosal infiltration with eosinophils and neutrophils.
- B. mucous glands hypertrophy.
- C. decrease in thickness of the basement membrane → results in increased thickening of the basement membrane.
- D. edema of the mucosa.
- E. inflammation and remodeling of the airway wall.
Macroscopic pathology of asthmatic airways:
- Lung hyperinflation
- Smooth muscle hypertrophy
- Lamina reticularis thickening → the region of the basement-membrane zone in human large airways that accumulates collagen and leads to the subepithelial fibrosis associated with asthma.
- Mucosal oedema, epithelial cell sloughing, cilia cell disruption
- Mucus gland hyper-secretion with mucous “plugging”
Chronic Asthma Characteristics:
- Infiltration of the mucosa with inflammatory cells - Influx of neutrophils, monocytes, lymphocytes, basophils & eosinophils.
- Oedema of the mucosa, thickening of the basement membrane
- Damaged mucosal epithelium
- Hypertrophy of mucous glands with increased mucous secretion
- Smooth muscle constriction
In the foetus the most well-oxygenated blood is allowed into the systemic circulation by the:
- A. foramen ovale.
- B. ductus arteriosus.
- C. ductus venosus.
- D. ligamentum teres.
- E. ligamentum venosum.
In the foetus the most well-oxygenated blood is allowed into the systemic circulation by the:
- A. foramen ovale → pO2 in fetal Left Atrium = 70%
- B. ductus arteriosus → pO2 = 52%
- C. ductus venosus → pO2 = 75%
- D. ligamentum teres
- E. ligamentum venosum.
Fetal Circulation Pathway:
- Oxygen and nutrients from the mother’s blood are transferred across the placenta to the fetus through the umbilical cord.
- This enriched blood flows through the umbilical vein toward the baby’s liver. There it moves through a shunt called the ductus venosus.
- This allows some of the blood to go to the liver. But most of this highly oxygenated blood flows to a large vessel called the inferior vena cava and then into the right atrium of the heart.
- When oxygenated blood from the mother enters the right side of the heart, it flows into the right atrium. Most of the blood flows across to the left atrium through a shunt called the foramen ovale.
- From the left atrium, blood moves down into the left ventricle. It’s then pumped into the first part of the large artery coming from the heart (the ascending aorta).
- From the aorta, the oxygen-rich blood is sent to the brain and to the heart muscle itself. Blood is also sent to the lower body.
- Blood returning to the heart from the fetal body contains carbon dioxide and waste products as it enters the right atrium. It flows down into the right ventricle, where it normally would be sent to the lungs to be oxygenated. Instead, it bypasses the lungs and flows through the ductus arteriosus into the descending aorta, which connects to the umbilical arteries. From there, blood flows back into the placenta. There the carbon dioxide and waste products are released into the mother’s circulatory system. Oxygen and nutrients from the mother’s blood are transferred across the placenta. Then the cycle starts again.
Which of the following is considered to be the best estimate of afterload on the heart?
- A. venous return
- B. ventricular filling
- C. central venous pressure
- D. systemic arterial pressure
- E. pressure in the pericardium
Which of the following is considered to be the best estimate of afterload on the heart?
Afterload = the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction.
In the clinical setting, the most sensitive measure of afterload is systemic vascular resistance (SVR) for the left ventricle and pulmonary vascular pressure (PVR) for the right ventricle.
- A. Venous return
- B. Ventricular filling
- C. Central venous pressure
- D. Systemic arterial pressure
- E. Pressure in the pericardium
Afterload is defined as the force opposing fiber shortening during ventricular ejection. It is not synonymous with systemic arterial pressure, vasomotor tone, or vascular resistance. Instead, it should be thought of as the tension or stress in the ventricular wall during ejection. In accordance with the law of Laplace, afterload is directly related to intraventricular pressure and size and inversely related to wall thickness. Because of changing size, pressure, and wall thickness, afterload varies continuously during ventricular ejection. Thus it is difficult to quantify with precision. Despite the widespread use of aortic pressure for the LV and pulmonary artery pressure for the RV as indices of afterload in vivo, this approach should not be considered quantitative.
Under normal conditions, the colloid osmotic pressure of capillary blood:
- A. has a magnitude similar to that of the capillary hydrostatic pressure.
- B. is due primarily to the presence of glucose in the blood.
- C. is about 100 mmHg.
- D. is increased in liver diseases.
- E. is the primary determinant of the glomerular filtration rate.
Colloid osmotic pressure (Oncotic pressure) of capillary blood = a form of osmotic pressure induced by the proteins, notably albumin, in a blood vessel’s plasma (blood/liquid) that displaces water molecules, thus creating a relative water molecule deficit with water molecules moving back into the circulatory system within the lower venous pressure end of capillaries. It has the opposing effect of both hydrostatic blood pressure pushing water and small molecules out of the blood into the interstitial spaces within the arterial end of capillaries and interstitial colloidal osmotic pressure.
- A. has a magnitude similar to that of the capillary hydrostatic pressure.
- B. is due primarily to the presence of glucose in the blood.
- C. is about 100 mmHg.
- D. is increased in liver diseases → Albumin synthesis occurs exclusively in the liver. Hypoalhypoalbuminemia = less albumin in plasma (more water escapes into tissues) = decreased oncotic pressure.
- E. is the primary determinant of the glomerular filtration rate → Net Filtration Pressure: The NFP is the sum of osmotic and hydrostatic pressures.
https://courses.lumenlearning.com/suny-ap2/chapter/capillary-exchange/
Which of the following is not found in the sinus of the kidney?
- A. Renal artery
- B. Renal vein
- C. Renal pelvis
- D. Bowman’s capsule
- E. Major calyx
Which of the following is not found in the sinus of the kidney?
- A. Renal artery
- B. Renal vein
- C. Renal pelvis
- D. Bowman’s capsule
- E. Major calyx
The renal sinus is a fatty compartment located within the medial aspect of the kidney. It communicates with the perinephric space. It contains the renal hilum and is bordered by renal parenchyma laterally.
Renal Sinus Contents
- Renal artery and vein (major branches)
- Major and minor calyces
- Adipose tissue (main component)
- Increases with age and obesity
- Lymphatic channels
- Autonomic nerves
- Fibrous tissue (variable amount)
Which one of the following is correct?
- A. The Parasympathetic innervation of urinary bladder comes from S2-4.
- B. The Sympathetic innervation of urinary bladder comes from S2-4.
- C. The Sympathetic innervation of kidney comes from S2-4.
- D. The Parasympathetic innervation of kidney comes from T11-L2.
- E. The Parasympathetic innervation of male genital system comes from the vagus nerve.
Micturition
A. The Parasympathetic innervation of urinary bladder comes from S2-4.
B. The Sympathetic innervation of urinary bladder comes from S2-4.
C. The Sympathetic innervation of kidney comes from S2-4.
D. The Parasympathetic innervation of kidney comes from T11-L2.
E. The Parasympathetic innervation of male genital system comes from the vagus nerve.
- SNS – hypogastric nerve (T10-L2)
- PSNS – pelvic nerves (S2-S4) (also call splanchnic or pelvic splanchnic nerves)
- Somatic – pudendal nerves (S2-S4)
The sacral parasympathetic pathway controlling the sexual organs in both males and females originates in the sacral segments S2–S4 and reaches the target organs via the pelvic nerves.
Identify the structure labelled A above.
- A. Proximal convoluted tubule
- B. Distal convoluted tubule
- C. Collecting tubule
- D. Medullary ray
- E. Thick segment of loop of Henle
- A. Proximal convoluted tubule
- B. Distal convoluted tubule
- C. Collecting tubule
- D. Medullary ray
- E. Thick segment of loop of Henle
DCT vs PCT → Microvillus “brush” border - in the proximal convoluted tubules the “brush” border has sloughed and can be seen in the lumen; thus, the lumen appears partially filled.
