ESA 2 practise paper

Question 1

Difference between anabolism and catabolism

Answer 1

Anabolism requires ATP. Catabolism does not

Question 2

What’s the importance of low energy signals

Answer 2

Indicate that cell has inadequate energy levels for its immediate needs so catabolism needs to occur to release energy from fuel molecules

Question 3

Anabolic processes that TCA cycle provides precursors doe

Answer 3

Fa synthesis
Aa synthesis
Haem synthesis
Glucose synthesis

Question 4

Medial boundary of cubital fossa

Answer 4

Pronator teres

Question 5

Lateral boundary of cubital fossa

Answer 5

Brachioradialis

Question 6

Cardiovascular compensatory mechanisms mediated by the sympathetic NS in hypovolemic shock

Answer 6

Vasoconstriction (inc systemic vascular resistance)
Venoconstiction
Inc Sv
Inc renin release
Inc contractility/ force of contraction

Question 7

Clinical signs of acute ishcaemia of a limb

Answer 7

• pulselessness
• paraesthesia
• pallor
• cold touch
• paralysis/muscle weakness
• reduced capillary refil

Question 8

How does the normal ventricular septum form?

Answer 8

Muscular portion grows upwards from floor of ventricles. The membranous portion is derived from endocardial cushions and grows downwards to fuse with muscular portion

Question 9

Which part of the ventricular septum is most vulnerable to anomalous development?

Answer 9

Membranous portion

Question 10

Causes of left to right shunt

Answer 10

Ventricular septal defect

Atrial septal defect

Patent ductus arteriosus

Question 11

Behavioural differences between benign and malignant cells

Answer 11

Benign have expansive growth (hyperplasia) whereas malignant have expansive and invasive growth

Benign grow locally whereas malignant metastasise

Benign - retain original function. Malignant less likely to. And can acquire addditional functions due to mutations.

Question 12

Expected bedside observations of septic patient

Answer 12

High resps
Low or normal oxygen
High pulse rate
Low (systolic) blood pressure

Question 13

Sepsis definition

Answer 13

Life threatening organ dysfunction due to dysregulated host response to infection

Question 14

Full E. coli name

Answer 14

Escherichia coli

Question 15

Scoring system used to determine likelihood of DVT

Answer 15

Wells score

Question 16

Why are women in late pregnancy predisposed to DVT

Answer 16

• hypercoaguable blood in preg
• presence of pelvic mass can compress venous outflow from leg > venous stasis
• patient less mobile > venous stasis

Question 17

Define embolism

Answer 17

Blockage of a blood vessel by solid liquid of gas at a site distant from its origin

Question 18

Saddle embolus?

Answer 18

A large embolus that straddles the bifurcation of an artery

Question 19

What can embolise?

Answer 19

Air
Amniotic fluid
Nitrogen
Medical equipment
Fat/bone marrow

Question 20

How is paracetamol overdose damaging to liver?

Answer 20

High levels of paracetamol- normal metabolism pathway saturated so metabolism switches pathway producing toxic product (NAPQI) > direct toxic effect on hepatocytes
> undergoes coagulation with glutathione and depletes the hepatocytes of this important antioxidant

Question 21

Basal metabolic rate define

Answer 21

Energy required for the functioning of various tissues of the body at physical,digestive and emotional rest

Question 22

Factors effecting BMR

Answer 22

body weight
Gender
Body temp
Thyroid status
Pregnancy
Lactation

Question 23

How are uncoupling proteins involved in heat generation in the body?

Answer 23

allow a leak of protons across the membrane
Reduce the proton motivated force so the energy is dissipated as heat rather than ATP
- UCP1 is expressed in brown adipose tissue and involved in thermogenesis

Question 24

Ways in which a C. difficile infection can arise?

Answer 24

Hospital acquired infection

Normal bowel commensal> proliferates after abx therapy and altered the balance of bacteria in the intestine

Question 25

Virulence factors of C. difficile that cause diarrhoea

Answer 25

Toxin A - has enterotoxin that causes excessive fluid secretion> acts on intestinal cell wall
Toxin B- cytotoxin that damages protein synthesis and cell structure> cytotoxin just a type of exotoxin (released by bacteria into surrounding env)

Question 26

Why are spores able to survive?

Answer 26

Resistant to heat, acid, abx and alcohol based cleansers

Question 27

Posterior dislocation after overflexing hip limb appears in what position?

Answer 27

Shortened and internally rotated

Question 28

Which nerve is most at risk of damage during posterior dislocation of hip?

Answer 28

Sciatic

Question 29

Sequence of vessels from femoral artery to coronary artery

Answer 29

Femoral artery
External iliac artery
Common iliac artery
Aorta

Question 30

Where is the opening of LCA located?

Answer 30

Left aortic sinus

Just above left leaflet of aortic valve

Question 31

Which acute ECG changes are seen if a thrombus occluded the anterior aspect of heart and inter ventricular septum?

Answer 31

ST EVEVATION

Question 32

Which enzyme controls the rate of glycogenesis?

Answer 32

Glycogen synthase

Question 33

Which enzyme controls the rate of glycogenolysis?

Answer 33

Glycogen phosphorylase

Question 34

Features of TAGs that make it a good energy storage molecule

Answer 34

• hydrophobic so stored in anhydrous form

- fatty acids are highly reduces so yield a lot of energy when oxidised

Question 35

Enzyme involved in mobilisation of TAGs from fat stores

Answer 35

Hormone sensitive lipase

Question 36

Bacteria that commonly cause community acquired pneumonia

Answer 36

• streptococcus pneumoniae
• haemophilus influenzae
• moraxella catarrhalis
• staphylococcus aureus
• legionella pneumophila
• mycoplasma pneumoniae

Question 37

Role of CRP

Answer 37

acts on opsonin by binding antigens on the surface of bacteria and initiating phagocytosis

Question 38

Penicillins which class? Mode of action?

Answer 38

Beta lactam

Cell wall synthesis inhibitor