TBL

Question 1

A patient who has recently undergone heart valve surgery presents with a fever. Cultures reveal a gram positive, catalase positive cocci. What is most likely to be responsible for this infection?

Answer 1

Staphylococcus aureus

Question 2

Following a chest infection, which was treated with co-amoxiclav, a patient subsequently develops diarrhoea, severe abdominal pain and a high fever. What is the likely diagnosis?

Answer 2

Clostridium difficile colitis (because co-amoxiclav was administered).

Alternative causes: cholecystitis, E. coli gastroenteritis, cholangitis.

Question 3

Name the bacterium that produces the ‘toxic shock syndrome toxin’ (TSST-1) super-antigen.

Answer 3

Staphylococcus aureus

Question 4

Define a super-antigen (2)

Answer 4

Antigens that activate a substantial proportion of T lymphocytes without need for antigen processing or conventional processing.

They bind MHC class II outside the antigen groove and T cell variable beta receptor.

Question 5

Name four microbiological features of Streptococcus pneumoniae (4)

Answer 5

It is gram-positive

Beta-haemolytic

Facultative anaerobic (respires aerobically if there is oxygen, but can respire anaerobically if required)

Coccus

Question 6

Name two routes of infection of prosthetic valve endocarditis (2).

Answer 6

If the organisms have direct access to the prosthesis and perivalvular tissue e.g. during a surgical procedure (most likely).

Organisms can enter the blood stream through broken skin.

Question 7

Describe three host responses to super-antigens which may lead to sepsis (3).

Answer 7

T-lymphocytes produce lymphotoxin, TNF-alpha, IFN-y and IL-2.

Vascular smooth muscle cells increase NO release (through iNOS) causing vasodilation.

Endothelial cells up-regulate adhesion molecules in response to cytokines, increasing neutrophil margination.

Question 8

Name two common portals of entry for infection caused by E coli in adults (2).

Answer 8

Urinary tract (most common)

Biliary tree

Question 9

Streptococcus pneumoniae expresses a number of virulence factors. Name four effects of these (4).

Answer 9

Pneumolysin is a protein that can cause lysis of host cells and activates complement

PspA (pneumococcal surface protein A) inhibits complement activation

Autolysin causes lysis of the bacteria, releasing their internal contents

Polysaccharide capsule limits the immune response to the bacteria

Question 10

Name four microbiological features of clostridium difficile (4).

Answer 10

It is gram-positive

Spore-forming

Anaerobic

Rod/bacillus

Question 11

Name two primary virulence factors of C. diff (2).

Answer 11

TcdA and TcdB

Question 12

Name two ways aldosterone affects potatssium excretion (2)

Answer 12

Upregulating Na/K/ATPase

Increasing the electronegativity of the principle cells

Question 13

Name four causes of chronic kidney disease, and specify the two most common (4)

Answer 13

Diabetes (most common)

Hypertension (second most common)

PKD

Long-term use of drugs such as NSAIDs

Question 14

Name three common features of a patient ECG with hyperkalaemia (3)

Answer 14

Tall tented T-waves (we’ve been taught this is the earliest sign)

Broad QRS complexes

Absent P-waves

(Sine waves are also found but only in very severe hyperkalaemia)

Question 15

At what GFR should dialysis commence for a CKD patient?

Answer 15

15ml/min

Question 16

Which fluid compartment would isotonic 0.9% saline increase?

Answer 16

Extracellular fluid volume

Question 17

Which fluid comparment would 5% dextrose increase (hypotonic)?

Answer 17

Intracellular fluid volume

Question 18

Name two cause of acidosis where the anion gap does not change (e.g. hyperchloremic acidosis) (2)

Answer 18

Diarrhoea (most common)

Mineralocorticoid deficiency

Question 19

Name two causes of high anion gap acidosis (2).

Answer 19

Renal failure

Laxative abuse

Question 20

Name three complications arising from chronic kidney disease (3).

Answer 20

Hyperkalaemia

Volume overload

Metabolic acidosis

Question 21

What effect on the kidneys does an increase in renal perfusion have?

Answer 21

Increased sodium excretion

Question 22

What effect on the kidneys does a decrease in renal perfusion have?

Answer 22

Increased renin release

Question 23

Lesions in which nuclei of the hypothalamus produce uncontrolled feeding and obesity in rats?

Answer 23

Ventromedial hypothalamus

(and also arcuate nucleus but this wasn’t mentioned in our lecture)

Question 24

Lesions in which nuclei of the hypothalamus cause hypophagia and weight loss?

Answer 24

Lateral hypothalamus

Question 25

Which drug would you prescribe first in patients with heart failure?

Answer 25

ACE inhibitor

(angiotensin receptor blocker if ACEi is not tolerated)

Question 26

Which heart valve is responsible for gate-keeping the movement of blood from the left atrium to the left ventricle?

Answer 26

Mitral valve

Question 27

Which heart valve is responsible for gate-keeping the movement of blood from the left ventricle to the aorta?

Answer 27

Aortic valve

Question 28

Which heart valve is responsible for gate-keeping the movement of blood from the right ventricle to the pulmonary artery?

Answer 28

Pulmonary valve

Question 29

Which heart valve is responsible for gate-keeping the movement of blood from the right atrium to the right ventricle?

Answer 29

Tricuspid valve

Question 30

A patient presents with bibasal crackles and a pan-systolic murmur, heard loudest at the apex. Which valvular disorder is most likely to be responsible?

Answer 30

Mitral regurgitation

Question 31

A patient presents with bibasal crackles and a soft S1 sound. Which valvular disorder is most likely to be responsible?

Answer 31

Aortic regurgitation

Question 32

A patient presents with bibasal crackles, a diastolic murmur and a loud S1 sound, heard loudest at the apex. Which valvular disorder is most likely to be responsible?

Answer 32

Mitral stenosis

Question 33

A patient presents with bibasal crackles and a slow rising pulse (weak and takes longer). Which valvular disorder is most likely to be responsible?

Answer 33

Aortic stenosis

Question 34

What is DAFNE?

Answer 34

It’s a five-day structured program to educate patients about nutritional management in diabetes.

Question 35

What is BERTIE?

Answer 35

It’s a nutritional program for type 1 diabetes patients over 4 weeks.

Question 36

What is DESMOND?

Answer 36

It’s 6 self-management courses for patients with type 2 diabetes.

Question 37

What is ICICLE?

Answer 37

It’s a 4 day or two-week type 1 diabetes course run by Imperial College.

Question 38

A patient presents with suspected heart failure. What is the most reliable test to confirm this?

Answer 38

BNP levels will be elevated.

Question 39

Which sound upon auscultation would confirm a suspected heart failure?

Answer 39

Third heart sound

Question 40

What is raised jugular venous pressure a common sign of?

Answer 40

Heart failure

Question 41

Which electrolytes are involved in the aetiology of re-feeding syndrome?

Answer 41

Potassium, magnesium, phosphorus (including PO4)

Question 42

What change in body composition is most commonly seen in a male around the age of 60?

Answer 42

Decreased muscle mass around the legs.

Question 43

Name the two principle actions of angiotensin-II.

Answer 43

Vasoconstriction and aldosterone release.