To learn

Question 1

An A level Biology teacher shows her students a diagram to illustrate base pairing in DNA

Which two bases are illustrating this interaction in the diagram?

Adenine : Adenine

Adenine : Thymine

Cytosine : Cytosine

Guanine : Cytosine

Guanine : Guanine

Answer 1

Guanine : Cytosine

Question 2

A 40 year old woman develops involuntary and irregular movements of her limbs, neck, head, and face (chorea) and is referred to a consultant neurologist by her GP. Further testing reveals that the woman has Huntington’s disease, an autosomal dominant inherited disease caused by mutation of the huntingtin gene.

What type of mutation results in this disease?

1. Deletion of 3 nucleotides resulting in loss of phenylalanine at position 508 (ΔF508)
2. Frameshit mutation (+1 insertion)
3. Increased number of CAG repeats
4. Missense mutation resulting in a Glu to Val substitution
5. Nonsense mutation resulting in a premature stop codon at position 508

Answer 2

CORRECT – Huntington’s is a trinucleotide repeat disorder. Trinucleotide repeat disorders result from errors in DNA replication leading to increasing numbers of repeated sequences of three nucleotides. In general, the greater the number of trinucleotide repeats, the greater the chance of exhibiting symptoms and the worse the clinical manifestations.

Question 3

A 26 year old butcher slips holding a knife and badly cuts his arm. The bleeding from the wound stops within 10 minutes due to the process of haemostasis

What sequence of events occurs during this physiological process?

A platelet plug forms, arteries contact, fibrin filaments accumulate and trap red blood cells.

• A platelet plug forms, fibrin filaments accumulate and trap red blood cells, arteries contract.
• Arteries contract, a platelet plug forms, fibrin filaments accumulate and trap red blood cells.
• Arteries contract, fibrin filaments accumulate and trap red blood cells, a platelet plug forms.
• Fibrin filaments accumulate and trap red blood cells, a platelet plug forms, arteries contract.

Answer 3

Arteries contract, a platelet plug forms, fibrin filaments accumulate and trap red blood cells.

CORRECT – This is the correct sequence of events in haemostasis. The severed artery contracts, not enough to stop the bleeding but enough to decrease the pressure downstream (contraction doesn’t occur in veins but the pressure in them is much lower). A primary haemostatic plug of activated platelets then forms at the hole in the vessel, sticking to the injured vessel and the connective tissue outside it. This is fragile but may control the bleeding and forms in seconds to minutes. The secondary haemostatic plug of fibrin filaments forms as fibrin filaments stabilise the friable platelet plug into a blood clot. This forms in approximately 30 minutes.

Question 4

A 42 year old woman presents her GP with a 12-week history of pain in the right upper quadrant of her abdomen and a low-grade fever. On examination, the woman is Murphy’s sign positive. The GP believes that the woman may have chronic cholecystitis and organises a biopsy. A histological section from this the biopsy is shown below:

What type of cell is indicated by the green arrows?

Answer 4

Macrophage

CORRECT – The word ‘macrophage’ means ‘big eater’. Before macrophages enter the tissue spaces and whilst they are circulating in the blood, they are called monocytes. Once they enter the tissue spaces, they are called macrophages (or histiocytes). Monocytes are made in the bone marrow and circulate in the blood for about six days. They then enter the tissues and become dormant until activated by a local challenge. Macrophages appear to live for many months and can replicate (unlike neutrophils). The macrophage is a very versatile cell and it is the mastermind of chronic inflammation and the immune response. They arrive at the site of inflammation after the neutrophils and then take over from them. Macrophages have many functions. They include phagocytosis (although not always as effectively as neutrophils, they are better at destroying some difficult to kill bacteria such as Mycobacterium tuberculosis), secretion of numerous (in the order of 100) substances that summon and activate other cells, presenting antigens to the immune system and initiation of the immune response, stimulating angiogenesis (the formation of new blood vessels) which is important in wound healing, inducing fibrosis and inducing fever, acute phase reaction and cachexia.

Question 5

hypertrophy

Answer 5

Hypertrophy refers to an increase in tissue or organ size due to an increase in cell size without an increase in cell numbers.

Question 6

healing by primary intention

Answer 6

Healing by primary intention occurs in wounds with dermal edges that are close together (e.g a scalpel incision). It is usually faster than by secondary intention, and occurs in four stages:

1. Haemostasis – the action of platelets and cytokines forms a haematoma and causes vasoconstriction, limiting blood loss at the affected area
   
   • The close proximity of the wound edges allows for ease of clot formation and prevents infection by forming a scab
2. Inflammation – a cellular inflammatory response acts to remove any cell debris and pathogens present
3. Proliferation – cytokines released by inflammatory cells drive the proliferation of the fibroblasts and the formation of granulation tissue
4. Angiogenesis is promoted by the presence of growth mediators (e.g VEGF), allowing for further maturation of the granulation tissue; the production of collagen by fibroblasts allows for closure of the wound after around a week
5. Remodelling – collagen fibres are deposited within the wound to provide strength in the region, with the fibroblasts subsequently undergoing apoptosis

Question 7

Secondary Intention

Answer 7

Healing by secondary intention occurs when the sides of the wound are not opposed, therefore healing must occur from the bottom of the wound upwards.

Question 8

A 40 year old woman develops involuntary and irregular movements of her limbs, neck, head, and face (chorea) and is referred to a consultant neurologist by her GP. Further testing reveals that the woman has Huntington’s disease, an autosomal dominant inherited disease caused by mutation of the huntingtin gene.

What type of mutation results in this disease?

• Deletion of 3 nucleotides resulting in loss of phenylalanine at position 508 (ΔF508)
• Frameshit mutation (+1 insertion)
• Increased number of CAG repeats
• Missense mutation resulting in a Glu to Val substitution
• Nonsense mutation resulting in a premature stop codon at position 508

Answer 8

Increased number of CAG repeats

CORRECT – Huntington’s is a trinucleotide repeat disorder. Trinucleotide repeat disorders result from errors in DNA replication leading to increasing numbers of repeated sequences of three nucleotides. In general, the greater the number of trinucleotide repeats, the greater the chance of exhibiting symptoms and the worse the clinical manifestati

Question 9

Name the 2 daughter cells produced by meiosis 1 in oogenesis.

Answer 9

Answer

The secondary oocyte and the first polar body (both of which are haploid with 23 chromosomes and 46 chromatids)

Question 10

As sperm cells mature they move through between across the ……………. from the ………… compartment towards the …………. compartment of the seminiferous tubule.

Answer 10

As sperm cells mature they move between the sertoli cells from the basal compartment towards the adluminal compartment of the seminiferous tubule.

Question 11

Which type of reaction is depicted in the graph below?

endergonic or exergonic

Answer 11

endergonic

Question 12

the paradox of REM sleep

Answer 12

• EEG activity is similar to that seen during arousal (beta waves), however the person is difficult to rouse due to strong inhibition of the thalamus
• Muscle tone in most of the body is lost due to descending inhibition of LMNs by glycinergic fibres arising from the reticular formation and running down the reticulospinal tracts
• To stop us acting out our dreams e.g. sleep walking
• Eye movements and some other cranial nerve functions are preserved (e.g. nocturnal bruxism)
• Autonomic effects are seen including penile erection and loss of thermoregulation (how people die if they sleep without adequate shelter)

Question 13

as we get deeper into sleep the ……. become more deactivated

Answer 13

thalamus

• less sneosry info and motor info having to pass through the thalamus

Question 14

exam of a 2 month year old boy reveals a bulging fontanelle and a downward gaze. Most likely diagnosis

Answer 14

congenital hydrocephalus

Question 15

types of MRI

Answer 15

CSF is dark on T1-weighted imaging and bright on T2-weighted imaging.

T2 - white water (inc fat which is water rich)

Question 16

wher ein the ventricular system is a ventriculoperitonel shunt inserted

Answer 16

lateral ventricles

Question 17

describe how the ventricular septum forms

Answer 17

• msucular portion grows upwards from the floor of the ventricles
• membranous portion derive dfro the endocardial cushions and grows ndownwards to fuse with the muscular portion

Question 18

a ventircular spetal defect causes a left to right shunt. Give 2 other causes of left to right shunt

Answer 18

• atrial septal defect
• patent ductus arteriosus

Question 19

define secondary amenorrhea

Answer 19

Secondary amenorrhea is defined as the cessation of regular menses for three months or the cessation of irregular menses for six months.

• having had previous periods before

Question 20

cause sof secondary amenorrhea

Answer 20

PCOS

Weight loss

Stress

Question 21

what hormone can be measured to reliably demonstatre ovulation has occured

Answer 21

progestrogen

at ovulation, the CL is formed–> secretes progesterone in the luteal phase –> showing ovulation hasa occured

Question 22

first tst in a women with secondary amenorrhea

Answer 22

pregnancy test

Question 23

where is RA in the hand most commonly found

Answer 23

metacarpophalangeal joint

Question 24

signs of RA on x-ray

Answer 24

narrowing of joint space

juxta articular bony erosions

soft tissue swelling

deformity

Question 25

signs of OA on X-raY

Answer 25

joint space loss, osteophyte formation, cyst formation and subchondral sclerosi

Question 26

2 autoantibodies associated with RA

Answer 26

Rheumatoid Factor and anticitrullinated protein antibodies (ACPAs)

Question 27

extra-articular features of RA

Answer 27

pulmonary fibrosis, vasculitis, skin ulceration, lymphadenopathy, peripheral neuropathy, splenomegaly, episcleritis or pericarditis.

Question 28

blood supply to the nose

Answer 28

sphenopalatine and kkieselbach plexus

Question 29

symptoms of sinusitis

Answer 29

Runny nose. Stuffy nose. Facial pain or pressure. Headache. Mucus dripping down the throat (post-nasal drip) Sore throat. Cough. Bad breath

Question 30

rare complication of sinusitis

Answer 30

venous sinus thrombosis

Question 31

mechanism of action of apixiban

Answer 31

inhibits factor Xa- DOAC

Question 32

stages of ehaling

Answer 32

Healing by primary intention occurs in wounds with dermal edges that are close together (e.g a scalpel incision). It is usually faster than by secondary intention, and occurs in four stages: Haemostasis – the action of platelets and cytokines forms a haematoma and causes vasoconstriction, limiting blood loss at the affected area The close proximity of the wound edges allows for ease of clot formation and prevents infection by forming a scab Inflammation – a cellular inflammatory response acts to remove any cell debris and pathogens present Proliferation – cytokines released by inflammatory cells drive the proliferation of the fibroblasts and the formation of granulation tissue Angiogenesis is promoted by the presence of growth mediators (e.g VEGF), allowing for further maturation of the granulation tissue; the production of collagen by fibroblasts allows for closure of the wound after around a week Remodelling – collagen fibres are deposited within the wound to provide strength in the region, with the fibroblasts subsequently undergoing apoptosis

Question 33

state 4 cardiovascular compensatory mechanisms mediated by the symapthetic nervous system in hypovolaemic shock

Answer 33

vasoconstriction venoconstriction increased stroke volume increased heart rate

Question 34

under what circumstances is lactate produced

Answer 34

anaerobic respiration

Question 35

how is alctate produced

Answer 35

lactate dehydrogenase converts pyruvate to lactate

Question 36

how is lactate utilise dby the body

Question 37

why does a pt with ischameic heart disease get itnense muscle cramps following vigorous exercise

Answer 37

reduced cardiac output (CO= SVxHR) therefore oxygenated blood delivered less efficiently to respiring muscles lactate builds up --\> cramps

Question 38

name 2 molecules that can cause metabolic acidosis

Answer 38

lactate ketones ATP

Question 39

most likely causative organism of an exacerbation of COPD

Answer 39

Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae.

Question 40

a 68 yea rold pt started smoking aged 26 and stopped 2 years ago. In the interim, she smoked an average of 40 cigs a day. Pack year?

Answer 40

40/20 x 40= 80 pack year

Question 41

type 1 vs type 2 respiratory failure

Answer 41

type 1= low oxygen \<8, normal CO2 Type 2= low oxygen, high CO2

Question 42

3 steps GP should take regarding subsequent management of COPD after exacerbation

Answer 42

pulmonary rehab rescue pack of antibiotics and steroids flu vaccinations

Question 43

method of investigating vaginal discharge

Answer 43

high vaginal swab endocervical swab

Question 44

2 risk factors for cotnracting a sexually transmitted infection

Answer 44

young age of first intercourse multiple partners alcohol and drug abuse

Question 45

the sciatic nerve typically exits the pelvis via the greater sciatic forament infeiror tow hich muscle

Answer 45

piriformis

Question 46

name the artery that accompanises the sciatic nerve at this point

Answer 46

superior gluteal artery

Question 47

name given to degeneration of enrve caused by injury

Answer 47

wallerian

Question 48

borders of the posteiror triangle

Answer 48

Anterior – posterior border of the sternocleidomastoid. Posterior – anterior border of the trapezius muscle. Inferior – middle 1/3 of the clavicle.

Question 49

68 year old lady fell and found24 hours later. what would you expect to find if you measured the paitnet surine osmolarity and volume? which components of the nephron and renal capillary network are involved in producing these changes to the osmolarity and volume of the urine?

Answer 49

increased osmolarity and decreased volume loop of henle and vasa recta

Question 50

name the hormone which regulated water reabsorption in the collecting duct and where it is synthesises and released from

Answer 50

ADH produced in the hypothalamus and released by the PP

Question 51

ADH MOA

Answer 51

Antidiuretic hormone stimulates water reabsorbtion by stimulating insertion of "water channels" or aquaporins into the membranes of kidney tubules.

Question 52

what is health inequality

Answer 52

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age.

Question 53

name 4 social determinants

Answer 53

gender education level transportation system homelessness employment opportunity

Question 54

according to wilkinson there is a clear relationship between income distribution and helath inequealities

Answer 54

rich countries dont necessarily have the best healthcare --\> richer the country has the biggest health inequalities egalitarian countries who priorities eveyrones health

Question 55

how do you precisely measure PR interval on an ECG trace

Answer 55

measure from the beginning of P and end of R

Question 56

main difference between first degree and second degree heart block on ECG

Answer 56

first degree --\> lengthening of PR intervals (always followed by QRS) second degree --\> mobitz I--\> progressive lenghtening then drop of QRS mobitz II--\> fixed PR just dropage of QRS

Question 57

difference between type 2i and type 2ii heartblock

Answer 57

Both Mobitz type 1 block and type 2 block result in blocked atrial impulses (ECG shows P-waves not followed by QRS complexes). The hallmark of Mobitz type 1 blockis the gradual prolongation of PR intervals before a blockoccurs. Mobitz type 2 block has constant PR intervals before blocks occur.

Question 58

Which term is used to describe the cycle by which the lactate produced in skeletal muscle is converted back to glucose in the liver? TCA cycle Urea cycle Cori cycle Alanine cycle

Answer 58

cori cycle

Question 59

Which condition would result due to hypothyroidism in a neonate? Myxedema Cretinism Gigantism Addison's disease Grave's disease

Answer 59

cretinism

Question 60

What is the half life of thyroxine (T4) in plasma? ~5-7 seconds ~5-7 minutes ~5-7 hours ~5-7 days ~5-7 weeks ~5-7 months ~5-7 years

Answer 60

5-7 days The half-life of T4 is ~5-7 days; the half-life of T3 is lower at ~1 day.

Question 61

What effect might the antacid Gaviscon® have on the absorption of iron? Decrease the rate of iron absorption Increase the rate of iron absorption

Answer 61

Decrease the rate of iron absorption

Question 62

Name two intracellular protein-iron complexes that are used to store iron.

Answer 62

Ferritin and haemosiderin Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion. Ferritin is found in most tissues as a cytosolic protein, but small amounts are secreted into the serum where it functions as an iron carrier. A ferritin blood test is therefore a useful diagnistic. Haemosiderin is also an iron-storage complex and is only found within cells. Haemosiderin is complex of ferritin, denatured ferritin and other material. Unlike ferritin, the iron within deposits of haemosiderin is very poorly available.

Question 63

If the BP drops below 60mmHg its V dangerous

Answer 63

* Activation of sympathetic nerves which cause systemic vasoconstriction * Renal failure (not enough oxygen or nutrients due to systemic vasoconstriction) * In response the kidneys try to increase perfusion and glomerular filtrationProstaglandins (NSAIDs inhibit prostaglandins so are not helpful for people with renal problems) are sent from the macula densa cells which causes dilation of the afferent arterioles * Slightly increased GFR * Flow through glomerulus increases * Juxtaglomerular cells release renin (in response to low BP) * Causes angiotensinogen to be converted into angiotensin 1 * In the lungs (vascular tissue) angiotensin 1 is converted to angiotensin 2 * Angiotensin 2 causes restriction of the efferent arterioles * Increases blood flow to glomerulus to maintain GFR

Question 64

A 58 year old man presents to his GP with a 2 month history of central crushing chest pain on exercise which is relieved on rest. The GP records an ECG (shown below). What is the patient’s heart rate?

Answer 64

90 beats per minute CORRECT – The rhythm is an irregular non-sinus rhythm (i.e the RR intervals are irregular). Therefore, the only way to calculate the heart rate it to count the number of R peaks that occurs within 30 large squares (6 seconds) and multiply it by 10. In this case 9 R peaks occur within 30 large squares, so 9 x 10 = 90 beats per minute.

Question 65

skin terms

Answer 65

Question 66

A 27 year old woman is diagnosed with Neurocardiogenic Syncope (NCS), a condition resulting from disturbances to the function of the autonomic nervous system. What are the properties of the pre- and postganglionic neurones in the sympathetic branch of this division of the nervous system?

Answer 66

Question 67

white matter

Answer 67

**Funiculus** (largest subdivision) * A segment of white matter containing multiple distinct tracts * Impulses travel in multiple directions (ascend or descend) **Tracts** * Found within funiculi * An anatomically and functionally defined white matter pathway connecting two distinct regions of grey matter * Impulses travel in one direction * Ascending tracts in blue (sensory) * Descending tracts in green (motor) **Fasciculus** * Subdivision of tracts which supplies a distinct region of the body * Fasciculus cuneatus (lateral)- supplies upper half of body * Fasciculus gracilis (medial)- supplies lower half of body

Question 68

causes of parasthesia in fingers during panic attack

Answer 68

This hypocalcaemia related to alkalosis is responsible for the paraesthesia often seen with hyperventilation.

Question 69

A 48-year-old male has been admitted with a 24 hour history of abdominal distention and profuse vomiting. A CT scan reveals a large mass causing bowel obstruction. As part of the patient’s assessment, the surgical registrar requests that you check his blood gas (on air), with the results shown below: PaO2: 12.7 kPa (11 – 13 kPa) || 95.2 mmHg (82.5 – 97.5 mmHg) pH: 7.50 (7.35 – 7.45) PaCO2: 5.5 kPa (4.7 – 6.0 kPa) || 41 mmHg (35.2 – 45 mmHg) HCO3-: 29 (22 – 26 mEq/L) BE: +3 (-2 to +2)

Answer 69

metabolic alkalosis ## Footnote As a result of this patient’s profuse vomiting, they have lost significant amounts of HCL (e.g. stomach acid). This results in a net loss of H+ ions, meaning less H+ to bind to HCO3– and therefore more free HCO3– in the system. In addition, as a result of vomiting, the patient is volume depleted, which results in the release of aldosterone and other mineralocorticoids which in turn increase HCO3–reabsorption by the kidneys, further increasing the amount of free HCO3– in the serum.

Question 70

how can sepsis cause metabolic acidosis

Answer 70

This patient has presented profoundly septic, with fever, hypotension and evidence of reduced end-organ perfusion (reduced urine output). Reduced end-organ perfusion causes tissue hypoxia resulting in cells resorting to anaerobic respiration to generate energy. Anaerobic respiration produces lactic acid as a byproduct, which has resulted in the addition of acid to the patient’s serum causing lactic acidosis.

Question 71

dermatomes and myotomes are derived from

Answer 71

somites

Question 72

A dermatome is an

Answer 72

area of skin supplied by a single spinal nerve.

Question 73

A myotome is a

Answer 73

group of muscles innervated by a single spinal nerve.

Question 74

dermatomal map of the whole body

Answer 74

Question 75

myotomal movement

Answer 75

C4: shoulder shrugs C5: shoulder abduction and external rotation C6: elbow flexion and wrist extension C7: elbow extension and wrist flexion C8: thumb extension and finger flexion T1: finger abduction L2: hip flexion L3: knee extension L4: ankle dorsiflexion L5: big toe extension S1: ankle plantarflexion S4: bladder and rectum motor supply

Question 76

Plexuses

Answer 76

We can classify groups of nerves into plexuses: 1. Cervical plexus (C1 – C4): innervates the diaphragm, shoulders and neck. 2. Brachial plexus (C5 – T1): innervates the upper limbs. 3. Lumbosacral plexus (L2 – S1): innervates the lower extremities.

Question 77

where is seratonin predominatley produced

Answer 77

the raphe nuclei

Question 78

where is NA peroduced

Answer 78

locus coeruleus

Question 79

where is ACh produced

Answer 79

nucleus basalis

Question 80

where is dopamine released from

Answer 80

4 different pathways mesolimbic (think schizophrenia) mesocortical nigrostriatal (think parkinsons) tubuloinfundibular

Question 81

neck lumps

Answer 81

midline * **thyroglossal cysts-** move on tongue protrusion * thryoid pathology- move on swallow lateral * Branchial cysts - wont move on swallowing or tongue protrusion (congenital)

Question 82

kidney function equations

Answer 82

Clearance = [U]_x x V / [P]_x Excretion= filtration - (reabsorption + secretion) therefore secretion = excretion- filtration (if not reabsorption) filtration= [P] x GFR excretion = [U] x V

Question 83

rtidk ratio vs odds ratio calc

Answer 83

risk ratio - work out percentage of both incidence and then divide by eachother e.g. (20/100)/ (30/100) odds ratio- need to work out ratios and then divide them into eachother e.g. 1:1.8 to 1:1.2 = 1.8/1.2= 1.5

Question 84

giant cells

Answer 84

touton- fat necrosis langhans- TB foreign body

Question 85

sensory innervation of the pharynx

Answer 85

Nasopharynx (maxillary nerve CN V2) Oropharynx ( glossopharyngeal nerve CN IX) Laryngopharynx (vagus nerve CNX)

Question 86

motor innervation of the pharynx

Answer 86

CNX -Vagus innervates all muscles Except stylopharyngeus (glossopharyngeal nerve (CN IX)

Question 87

larynx anatomy

Answer 87

* Thyroid (2 lamina – superior and inferior horn) * When one lamina meets the other lamina = laryngeal prominences – Adams apple * Cricoid cartilage -below thyroid * inferior horn of thyroid cartilage articulates with the cricoid cartilage- synovial joint * thicker at the back than front (signet ring) * Retinoid cartilage- sits on the cricoid cartilage * Epiglottis- attached by its stalk to the inner surface of the thyroid cartilage

Question 88

laryngeal inlet made up of the

Answer 88

aryepiglottic folds and epiglottis

Question 89

false and true vocal cords

Answer 89

folds formed by ligaments/membranes and cartilages * Quadrangular membrane (inferior boundary)- false vocal cord * Superior extension of the cricothyroid membrane- true vocal cord

Question 90

the larynx with the exception of the true vocal cords are lined with

Answer 90

pseudostratified ciliated columnar epithelium

Question 91

movement of vocal cords

Answer 91

**Vocalis** muscle run along the length of the vocal cords muscles associated with **arytenoid cartilage** causes widening of aperture --\>responsible for moving outwards and inwards of vocal cords * important one= **posterior cricoarytenoid** (only intrinsic muscle that acts to abduct vocal cords) * all the other intrinsic muscles will act to adduct vocal cords

Question 92

posterior cricoarytenoid

Answer 92

only intrinsic muscle that acts to abduct vocal cords

Question 93

most intrinsic muscles of the larynx supplies by the

Answer 93

recurrent branch of the laryngeal nerve - e.g. to open and close and cough

Question 94

cricothyroid muscle supplies by the

Answer 94

external branch of the superior laryngeal nerve

Question 95

**cricothryoid**

Answer 95

* Intrinsic muscle * Found on the outside of the cartilages * external branch of superior laryngeal nerve * will increase tension of vocal cords- important for reaching higher pitches

Question 96

external branch of the superiro laryngeal supplying the cricothyroid muscle is closely associated to and at risk during

Answer 96

(closely related to superior thryoid artery)--\> can be damaged during thryoid surgery - will cause hoarseness of voice particulalry when attempting higher pitched sounds

Question 97

torsades de pointes

Answer 97

polymorphic ventricular tachycardia characterized by a gradual change in amplitude and twisting of the QRS complexes around an isoelectric line on the electrocardiogram.

Question 98

which HPV cause cancer

Answer 98

HPV 16 and 18

Question 99

which nucleotides are purines and which are pyridines

Answer 99

**purines** adenine and guanine **pyrimidines** thymine and cytosine and uracil

Question 100

Angiotensin 2 causes restriction of the ........ arterioles in response to hypovolemia or reduced GFR

Answer 100

efferent - think of the effects of ACEi and ARB

Question 101

prostaglandins cause dilation of the ......... arterioles in response to systemic vasconstriction (e.g. in hypovolemia) to ensure blood supply to the kidney

Answer 101

afferent --\> think about the effect of NSAIDS

Question 102

balantis

Answer 102

inflammation of the glans penis

Question 103

posthitis

Answer 103

inflammation of the foreskin

Question 104

LUTS are usually either

Answer 104

Voiding (suggestive of bladder outflow obstruction) * Hesitancy * Poor flow * Post micturition dribbling Storage * Nocturia * Urgency * Frequency

Question 105

physical BOO (bladder outflow obstruction)

Answer 105

urethra * phimosis * stricture prostate * benign (BPH) * malignant * bladder neck

Question 106

dynamic BOO

Answer 106

* prostate * bladder neck

Question 107

neurological BOO

Answer 107

lack of coordination between bladder and urinary sphincter - UMN

Question 108

spraying of urine suggests

Answer 108

urethral stricture

Question 109

Hydrocele (adult)

Answer 109

imbalance of fluid production and resorption between **tunica albuginea and tunica vaginalis** **Examination** * Testis not palpable separately * Can get above * Transilluminates *

Question 110

most common breast tumour

Answer 110

fibroadenoma *causes by fibrocystic change* * Present with a mass, usually mobile, or mammographic abnormality* * ‘Breast mouse’ – mobile and elusive*

Question 111

Phyllodes tumours

Answer 111

very similar to fibroadenomas * Most present in 6th decade * Have potential to be malignant but present much later

Question 112

Acute mastitis

Answer 112

Almost always occurs during lactation Usually Staphylococcus aureus infection from nipple cracks and fissures Erythematous painful breast, often pyrexia Usually treated by expressing milk and antibiotics (stopping breast feeding)

Question 113

most type of breast cancers are

Answer 113

adenocarcinomas * Most common in the upper outer quadrant (50%) * Other malignant tumours are very rare e.g. primary sarcomas such as angiosarcoma *

Question 114

breast cancer risk factors

Answer 114

Early menarche (\< 11 years) Late menopause Obesity and high fat diet Exogenous oestrogens – HRT slightly increases risk (1.2-1.7 times), long term users of COCP possibly have an increased risk

Question 115

how do we classify breast carcinoma

Answer 115

in situ invasive ductal lobular

Question 116

Invasive carcinoma

Answer 116

Neoplastic cells have invaded **beyond BM into stroma** * Can invade into vessels and can therefore metastasize to lymph nodes and other sites * By the time a cancer is palpable more than half of the patients will have axillary lymph node metastases * Peau d’orange – involvment of lymphatic drainage of skin

Question 117

How does breast cancer spread?

Answer 117

**Lymph nodes via lymphatics**– usually in the ipsilateral axilla **Distant metastases via blood vessels** – bones (most frequent site), lungs, liver, brain

Question 118

breast cancer prognosis

Answer 118

Question 119

stroke

Answer 119

a **neurological deficit** attributed to an **acute focal injury** of the **central nervous system** (CNS) by a **vascular cause**, including cerebral infarction, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)

Question 120

peripheral modulation of pain

Answer 120

Within the **substantia gelatinosa** in the dorsal horn * **Lamina 1 and 5** are where pain fibres transmit * E.g. * Stimulation of **Adelta + C** fibres due to tissue damage * Enters lamina 1 and 5 * Ascends the spinal cord via the spinothalamic tract and projects to the thalamus * Receive pain sensation in the primary somatosensory cortex * The tissue damage also sends inhibitory signals to the substantia gelatinosa- technically would make it feel as painful as possible * How do we modulate this? By ‘rubbing it better’ * **Ab fibres** are activated by rubbing the tissue and send stimulatory signals to the substantia gelatinosa * Send inhibitor signals to lamin 1 and 5, reducing amount of pain received by the thalamus

Question 121

characteristics of poorly differentiated cells (6)

Answer 121

* Increased nuclear size * Increases nuclear to cytoplasmic size * Increased nuclear staining (hyperchromasia) * Increased mitotic figures * Abnormal mitotic figures * Variation in size and shape of cells and nuclei (pleomorphism)