Weekly Quizes Flashcards
A 35 year old man has 6 months of lower back pain. He is otherwise well. An MR scan of his pelvis performed.
Which joint is highlited by the white arrows?
Iliac crest
Sacrococcygeal joint
Lumbosacral joint
Sacroiliac joint
Symphysis pubis
Sacroiliac joint
What is the function of the structure labelled X?
Provides growth factors to allow endometrial proliferation
Prevents fertilisation of gamete until entry into the uterus
Provide lymphatic drainage from the ovary
Regulates menstruation
Transport gametes and eaerly embryos to the body of the uterus
Transport gametes and eaerly embryos to the body of the uterus
The structure is the fallopian or uterine tube which acts both as a site of early fertilsation and transport of gametes and embryo to the uterine body. These tubes can be ligated to enable sterilisation, which some women choose as a firm of birth control once they have finished their family.
What is the structure indicated by the X label?
Deep transverse
External anal spincter
Levator Ani
Superficial transverse perineal
Urethral sphincter
Urethral sphincter
The image shows a male pelvis with some of the muscles of the perineum. The highlighted structureis the urethral sphincter which has important roles in maintaining continence.
A 30 year old woman vists her GP to get advice about pregnancy. She has a previous unplanned pregnancy which was termintaed as the baby had anencephaly. She drinks 10 units of alcohol per week. Her BMI is 29.
What advice is most likely to reduce the risks of a subsequent neural tube defect?
Abstinence from alcohol
Oral folic acid once she has a positive pregnancy test
High dose oral folic acid while trying to conceive
High dose vitamin D while trying to conceive
Avoid any antibiotics while trying to conceive
High dose oral folic acid while trying to conceive
Anencepahly is a form of neural tube defect. Patients who have had a previous baby so affected should be advised to take high dose folic acid as part of the pre-conception counselling. Although alcohol abstinence and vitamin D supplementation are advised during pregnancy they do not alter risks of NTD.
What is the first step in the cellular production of sperm in the testes?
Differentiation of germ cells
Meiosis of spermatogonia
Mitosis of spermatogonia
Meiosis of germ cells
Mitosiss of sertoli cells
Mitosis of spermatogonia
Spermatogonia are the testes stem cells. the first step is mitosis (so mantaining a full complement of chromosomes). So of these cells remain as stem cells to produce further sperm. it is after this initial mitotic step that some daughter cells go on to meiosis.
Which part of the intestinal tract does the pancreas drain into?
Duodenum
Gall bladder
Jejunum
Ileum
Stomach
Duodenum
The pancreatic and main biliary duct drain into the duodenum through papilla.
A 34 year old man has 3 months of indigestion and heartburn.
He is prescribed lansoprazole to relieve his symptoms.
What is the mechanism of action of this drug?
Blocks histamine receptors on gastric parietal cells
Increases tone of the oesophageal sphincter
Increases bicarbonate production by gastric mucus cells
Inhibits hydrogen ion secretion by gastric parietal cells
Inhibits proliferation of Helicobacter pylori
Inhibits hydrogen ion secretion by gastric parietal cells
Lansoprazole is part of a class of drugs known as proton pump inhibitors. This reduce acid secretion (hydrogen ions) by gastric parietal cells. Hydrogen ions are pumped out of the cell in exchnage for potassium ions.
What is the name of the anatomical region of the GI tract indicated by the arrow?
First part of the duodenum
Cardia of the stomach
Fundus of the stomach
Body of the stomach
Pylorus of the stomach
Pylorus of the stomach
The stomach nas 4 main anatomical regions. The area highlighted is the pyloris of the stomach. This has a sphincter which regulates flow of partially digested food into the duodenum.
A 56 year old woman is reviewed by her GP as part of a health screen. She is well.
Her BMI is 30. Her blood pressure is 132/85 mmHg.
Investigations
Creatinine 72 μmol/L (60-110)
Haemoglobin A1c 58 mmol/mol (20-42)
Cholesterol 4.8 mmol/L (<5.0)
What is the most appropriate treatment at this stage?
Give lifestyle advice about diet, exercise and weight loss
Start insulin treatment
Start metformin
Start a sulphonylurea
Start a statin
Give lifestyle advice about diet, exercise and weight loss
The patient probably has type 2 diabetes mellitus (Haemoglobin A1c is the amount of haemoglobin with glucose attached) and a further test will be performed to confirm the diagnosis. At this stage in the absence of symptoms the initial focus would be to give lifestyle advice to help achieve weight loss.
A 55 year old man has two days of right upper quadrant abdominal pian, nausea and vomiting. He has type 2 diabetes mellitus.
His temperature is 37.7°C, pulse 92 bpm and blood pressure 122/90 mmHg. he has tenderness in the right upper quadrant with guarding. His BMI is 30.
Investigations
White cell count 16.4 x 109/L (4.0-11.0)
Ultrasound scan abdomen is inconclusive.
CT scan abdomen is performed.
What is the structure highlighted by the arrow?
Duodenum
Gallbladder
Pancreas
Liver
Stomach
Gallbladder
This is the presentation of acute cholecystitis, which is inflammation in the gallbladder normally due to stones. The gallbladder wall is thickened with multiple stones within it.
A 25 year old man is admitted to the Emergency Department following a bike crash.
He has tenderness on the right side of his chest.
Chest X-ray: see image
Which anatomical structure,highlighted in the black circle, has been damaged?
10th thoracic vertrbra
Right hemidiaphragm
9th right rib
8th right rib
7th right rib costal cartilage
9th right rib
The X-ray shows a fracture of the 9th right rib. You should practcie counting down the ribs from 1 or counting up from the 12th.
Which anatomical structure is highlighted by the yellow arow as it passes over the first right rib?
Vertebral vein
Internal jugular vein
External carotid artery
Superior vena cava
Subclavian vein
Subclavian vein
The subclavian vein is shown crossing anteriorly over the right rib which has agroove to accommodate it.
A 70 year old man has one year of wrosening breathlessness and cough. He is an ex-smoker with a 40 pack year smoking history. He has hypertension and takes amlodipine.
His pulse is 72 bpm and blood pressure 131/80 mmHg. He has occasional expiratory wheeze.
Investigations
Spirometry:
FEV1 1.4 L (predicted 2.6)
FVC 2.3 L (predicted 3.2)
FEV1/FVC 60%
Post bronchodilator
FEV1 1.4 L (predicted 2.6)
FVC 2.4 L (predicted 3.2)
FEV1/FVC 58%
What is the most appropriate description of the spirometry?
Obstructive pattern without significant reversibility
Obstructive pattern with reversibility
Mixed obstructive and restrictive pattern
Restrictive pattern
Mixed obstructive and restrictive pattern with reversibility
Mixed obstructive and restrictive pattern
But also without significant reversibility
They say:
The results show an obstructive pattern, most likely due to COPD. The small increase in FEV1 is not sufficient to show reversibility. This requires an increase in FEV1 of >400 mL or >12%.
But this feels wrong, low FVC implies a level of restriction also due to severity of COPD
A study is conducted on 10,000 people of a new lateral flow test for Covid-19 and compared to the reference standard of PCR testing using 3 separate primers.
A summary of the resuts is provided in the table.
What is the false negative rate for the index test?
0.00002%
5.6%
58.4%
41.5%
71.0%
41.5%
The false negatives are those which are negative on the lateral flow test (index test) but positive on the PCR test (reference standard). That is 220/530 X 100= 41.5%
A 62 year old man has six months of increasing breathlessness. He has smoked 30 cigarettes per day from age 18 until his 50th birthday.
How many pack years is his smoking history?
48
A pack year is 20 cigarettes for one year. He has smoked 30 cigarettes per year for 32 years, which is 1 and half packs per year. Thus 20 x 1.5=48 pack years
An 18 year old man is admitted with breathlessness and anxiety. He feels light-headed and has tingling in his fingers. He has had previous episodes of panic attacks associated with hyperventilation. He has no other medical history.
His pulse is 100 bpm and respiratory rate 30 breaths per minute.
What is the most likely effect on his arterial blood gas compared to before the panic attack?
Decrease oxygen and carbon dioxide level
Increased oxygen level, no change in carbon dioxide level
No change in oxygen level, decreased carbon dioxide level
No change in oxygen or carbon dioxide level
Increased oxygen and carbon dioxide level
No change in oxygen level, decreased carbon dioxide level
Hyperventilation is common clinical presentation. arterial evel of carbon dioxide is reduced as this is removed more rapidly, but there is no significant chnage in the level of oxygen.
A 5 month old baby boy presents in december with two days of fever, cough and wheezing. This was preceded by nasal congestion and dicharge.
His temperature is 38.7°C, pulse 160 bpm (normal 110-160) and respiratory rate 48 breaths per minute (normal 30-40). His oxygen saturation is 90% breathing air. Wheeze can be heard in the chest.
What is the most likely microbial cause?
Beta-haemolytic streptococcus
Bordatella pertussis
Respiratory syncytial virus
Influenza A
Streptococcus penumoniae
Respiratory syncytial virus
Respiratory distress in a baby is most likely due to bronciolitis. This is most commonly due to respiratory syncytial virus (RSV) infection (~80% cases). it is most common is the winter months.
A study is looking at the role of car pollution in risk of developing chronic obstructive pulmonary disease. The shows that there is an increased prevalence of chronic obstructive pulmonary disease in people who live closer to A roads in a city. It is lower in those who live in residential streets with lower flows of traffic and lower still in those living in rural areas. The level of pollution measured near the A roads is higher than in the quieter residential streets and in rural areas.
Which aspect of the Bradford Hill criteria for causality does this best fit?
Biological gradient
Confounding
Strength
Temporality
Specificity
Biological gradient
The lower the level of pollution the lower the prevalence of COPD. This is an example of biological gradient. There may also be a degree of analogy as smoking and dust exposure are also implicated in development of COPD.
A study is conducted looking at incidence of birth defects in women who took an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) during the first trimester of pregnancy. The study found that the relative risk of birth defects was 1.8 in births in women who took these drugs compared to all other births. However more women had diabetes mellitus in the cohort taking an ACEi or ARB compared to the control group.
What is the best epidemiological description of diabetes mellitus in this study?
Causal
Confounder
Association
Non-specific
Non-significant
Confounder
This is well recognised confounder that needs to be controlled for. So it is unclear if the risk is definitely due to taking an ACEi or ARB or is a risk factor associated with diabetes mellitus.
A 65 year old man has four days of increasing breathlessness and productive cough. He has COPD with an exercise tolerance of no more than 100 m.
His temperature is 38.2°C, pulse 96 bpm, blood pressure 119/80 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 82% breathing air.
Investigations:
Arterial blood gas breathing air
pH 7.22 (7.35-7.45)
PaO2 7.4 kPa (12-15)
PaCO2 8.2 kPa (4.5-6.0)
Bicarbonate 32 mmol/L (22-28)
Which is the best description of the arterial blood gas result?
Acute respiratory acidosis with metabolic compensation
Type 1 respiratory failure with metabolic alkalosis
TYpe 2 respiratory failure with metabolic acidosis
Type 1 respiratory failure
Type 2 respiratory failure with acute on chronic respiratory acidosis
Type 2 respiratory failure with acute on chronic respiratory acidosis
The type 2 respiratory failure is defined by hypoxamia and elevated carbon dioxide. There is a respiratory acidosis due to the elevated CO2. The presence of elevated serum bicarbonate indicates that this patient has been retaining CO2 before this acute presentation.
The following diagram shows lung volunes during inspiration at rest and after maximal breath in and out.
Match the numbers to the correct description
Expiratory reserve volume
Tidal volume
Residual volume
Inspiratory reserve volume
Vital capacity
1
Tidal volume
2
Expiratory reserve volume
3
Inspiratory reserve volume
4
Vital capacity
5
Residual volume
Which mediastinal structure is highlighted by the arrow?
Azygos vein
Superior vena cava
Oesophagus
Trachea
Right main bronchus
Trachea
The central highlighted structure is the trachea. It appears black as it contains air. The oesophagus will be psoterior to the trachea.
A 32 year old woman has 5 days of headache with fever and purulent nasal discharge.
Her temperature is 38.0°C. She is tender over the right cheek with mild overlying erythema.
What is the most likely anatomical site of infection?
Ethmoid sinus
Frontal sinus
Maxillary sinus
Nasal turbinates
Sphenoidal sinus
Maxillary sinus
This is a typical presentation of sinusitis most likely affecting the maxillary sinus.
What is the name of the structure highlighted in green and indicated by the arrow?
Cricoid cartilage
Cricotracheal ligament
Thyroid cartilage
Thyrohyoid membrane
Hyoid bone
Thyroid cartilage
This strucrure is the thyroid cartilage. It is a large C shaped cartilage that is deficient posteriorly.
A baby girl is born prematurely at 28 weeks. She has respiratory distress with tachypnoea, grunting and hypoxaemia.
What is the primary abnormality in this baby’s condition?
Anaemia
Immunoglobulin deficiency
Patent ductus arteriosus
Pulmonary fibrosis
Surfactant deficiency
Surfactant deficiency
In the premature lung, inadequate surfactant activity results in high surface tension leading to instability of the lung at end-expiration, low lung volume, and decreased compliance. These changes in lung function cause hypoxemia due to a mismatch between ventilation and perfusion primarily due to collapse of large portions of the lung (atelectasis), with additional contributions of ventilation/perfusion mismatch from intrapulmonary and extrapulmonary right-to-left shunts.
A 27 year old woman is admitted with increasing cough and wheeze. She has asthma.
Her pulse is 120 bpm, blood pressure 118/78 mmHg, respiratory rate 30 breaths per minute and oxygen saturation 97% breathing high flow oxygen. She has widespread expiratory wheeze.
She has received nebulised salbutamol and remains breathless.
What additional treatment will be most effective in causing relaxation of airway smooth muscle?
Beta-1 adrenoceptor agonist
Beta-2 adrenoceptor antagonist
Muscarinic receptor antagonist
Phosphodiestarase inhibitor
Leukotriene receptor antagonist
Muscarinic receptor antagonist
The patient has an acute exacerbation of asthma. This will be treated with nebulised salbutamol (Beta-2 adrenoceptor agonist) and ipratropium , which is a muscarinic antagonist.
A study is conducted which looked at the mortality of 65,000 women over the age of 65 diagnosed with breast cancer. The researchers aim to look at relative survival.
What group should the patients be compared with to answer this question?
All adult women
Adult women aged over 65 without breast cancer
Adult women aged under 65 with breast cancer
Adult women aged 65 with any other type of cancer
Adult women aged over 65 with medical diagnoses other than cancer
Adult women aged over 65 without breast cancer
This study is looking at relative survival and the comparator group is women matched for age who do not have breast cancer. They may by chance have other diagnoses.
A 68 year old man has 3 months of intermittent palpitations and occasional breathlessness on exertion.
His pulse is 88 bpm, irregular and BP 134/80 mmHg.
Investigations:
ECG:
What complication is most commonly caused by this cardiac rhythm abnormality?
Hypertension
Pulmonary emboli
Ventricular fibrillation
Syncope
Stroke
Stroke
The ECG shows atrial fibrillation. This rhythm can lead to systemic emboli in particular strokes. Patients are normall started on anticoagulation. It may also increase risk of heart failure.
Atrial fibrillation - no distinguishable P waves
The attached diagram shows the pressure in the left ventricle and aorta.
What event happens at the point indicated by the arrow?
Aortic valve opens
Mitral valve opens
Mitral valve closes
Pulmonary valve opens
Tricuspid valve opens
Aortic valve opens
The arrow indicates the point at which ventruclar pressure equals aortic pressure so the aortic valve will open allowing blood to pass into the aorta.
The following diagram shows a ventricular action potential.
What is the main electrochemical cellular movements during phase 2?
Sodium and potassium cell entry
Calcium cell entry, potassium efflux
No electrochemical movement
Sodium cell entry, calcium efflux
Potassium cell entry, calcium efflux
Calcium cell entry, potassium efflux
This is the plateau phase of the cardiac action potential with inward slow calium current and potassium cell efflux along an electrochemical gradient.
The attached image shows an ECG rhythm strip.
What event happens at the point indicated by the red arrow?
Mitral and tricuspid valves open
Active ventricular filling from atria to ventricles
Aortic and pulmonary valve open
Aortic and pulmonary valve close
Passive ventricular filling from atria to ventricles
Active ventricular filling from atria to ventricles
The P wave on the ECG represents atrial depolarisation, causing atrial contraction. This results in active ventricular filling, optimising the venticular volume prior to ventricular systole. The miral and tricuspid valves are already open atbthis point as they open as soon as the ventricular pressure falls below that in the atria.
A study is conducted on the effects of introducing a diet restricting carbohydrates in 220 patients with type 2 diabetes. 110 take a carbohydrate reduce diet and 110 continue with their normal diet. The study looked at the effect on glycated haemoglobin. At the end of two years a carbohydrate restricted diet produced a greater fall in glycated haemoglobin.
What sort of data best describes glycated haemoglobin in this study?
Demographic
Quantitative discrete
Qualitative continuous
Quantitative continuous
Normally distributed
Quantitative continuous
Glycated haemoglobin is used to monitor control of diabetes mellitus. It is quantitative and continuous data.
The attached image shows the abdominal aorta highlighted in pink.
Match the letters to the correct artery?
Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery
Renal artery
A is the left renal aretry
B is the coeliac trunk which supplies the hepatic artery, splenic artery and left gastric artery
C is the superior mesenteric aretry
D is the inferior mesenteric artery
The following image shows a blood test being taking to assess blood gases and hydrogen ion content.
Which vascular structure is being punctured to sample the blood?
Brachial artery
Deep palmar venous arch
Anterior interosseus vein
Radial artery
Ulnar artery
Radial artery
This blood sample is being taken from the radial artery. this is a common site to take arterial blood gas samples from.
A 56 year old woman has 2 weeks with increasing swelling and redness of her legs. The discolouration was there previously but has worsened. Ahe has diet controlled type 2 diabetes mellitus.
Her temperature is 36.9°C. Her legs are shown (see image), Her BMI is 30.
What is the most likely underlying diagnosis?
Acute leg ischaemia
Diabetic neuropathy
Heart failure
Lymphoedema
Venous insufficiency
Venous insufficiency
The clinical picture is acute lipodermatosclerosis with haemosidrin deposition. This is due to venous insufficiency/hypertension.
A 47 year old woman presents with 3 days of fever, rigors and a spreading erythematous rash on her right leg.
Her temperature is 38.1°C, pulse 100 bpm and blood pressure 122/68 mmHg. She has a warm, red rash extending from her ankle to her mid-calf of the right leg.
Blood cultures are sent and a gram stain shows gram positive cocci (see image)
What is the most likely microbial cause for the infection?
Escherichia coli
Clostridium difficile
Group B streptococcus
Neisseria meningitidis
Staphylococcus aureus
Staphylococcus aureus
The clinical picture is a cellulitis, which is a skin infection. It is commonly caused by some gram positive bacteria. The Gram stain shows gram positive organisms in clusters which is typical of staphylococcal aureus.
A 67 year old woman has 4 days of painful vesicular rash on her forehead (see image)
What aspect of ageing is most likely to have predisposed to this infection?
Dendritic cell senescence
Increased neutrophil activation
Loss of NK cell function
Reduced antibody production
Reduced skin keratinisation
Loss of NK cell function
This is the appearance of shigles affecting the ophthalmic branch of the trigeminal nerve. This is caused by reactivation of varcella zozter virus which causes chickenpox. The virus remains dormant in neurone cell bodies and infection is prevented by immune homeostasis, mostly due to NK cells. As we age we lose NK cell function and this allows viral activation.
A 45 year old man has 12 months of pain and stiffness in both hands. He has joint swelling and tenderness over metacarpophalangeal joints in both hands.
An X-ray of his hands shows periarticular erosions (highlighted by the arrows).
Which cell type is responsible for the formation of erosions?
Chondrocyte
Macrophage
Osteoclast
Osteoblast
Synoviocyte
Osteoclast
The patient most likely has rheumatoid arthritis with evidence of bony erosions. these are due to activation of osteoclasts which resorb bone.
A 24 year old woman has noticed an itchy rash and swelling on her arm having just come inside from her garden.
Which mediator is most likely to be directly responsible for the swelling and itch?
Adrenaline
Histamine
Interleukin-5
Cortisol
Tumour necrosis factor
Histamine
This is typical cutaneous allergic reaction, often called urticaria or hives. It is due to degranulation of mast cells which release large amounts of histamine which inturn result in vasdilation, increased endothelial permeability which cuase swelling and activate itch receptors in the skin.
