EoY2 Formatives

Question 1

How does GTN spray help angina?

Answer 1

Ventilation increases blood flow to heart so more oxygen gets to cardiac muscle

Question 2

3 signs of hypercholesterolaemia?

Answer 2

Xanthelasma, Corneal arcus, tendon xanthoma

Question 3

What is the pathophysiology between high LDL and atherosclerosis?

Answer 3

1. LDL is susceptible to oxidative damage due to short half life
2. Oxidised LDL is taken up by macrophages
3. Macrophages are now foam cells which lie in tunica intimacy
4. This forms a fatty streak which can evolve into a plaque

Question 4

What are the potential medical complications of hypercholesterolaemia?

Answer 4

Srtoke
Acute coronary syndromes
Peripheral arterial disease

Question 5

State some chemical mediators in acute inflammation?

Answer 5

Histamines
prostaglandins
leukotrienes
coagulation proteins

Question 6

Describe the fibrous repair process

Answer 6

1. Phagocytosis of necrotic tissue debris
2. Proliferation of endothelial cells and angiogenesis of new capillaries
3. Proliferation of fibroblasts and myofibroblasts to synthesise collagen and cause wound contraction
4. Granulation tissue becomes less vascular and matures into a fibrous scar
5. The scar shrinks due to contraction of fibrils

Question 7

What pattern of inheritance does haemophilia A follow?

Answer 7

X linked recessive (factor VIII deficiency)

Question 8

What causes a subdural haematoma?

Answer 8

Significant trauma or minor injury in elderly due to cenile atrophy

Question 9

What is the first line treatment for a subdural haematoma?

Answer 9

Craniotomy

Question 10

What is the venous drainage in the brain?

Answer 10

superior sagittal sinus
confluence of sinuses
transverse sinus
sigmoid sinus
internal jugular vein

Question 11

Which bones form the foramen that the IJV flows through?

Answer 11

Petrous part of temporal bone
Occipital bone

Question 12

What are some examples of nephrotic syndrome?

Answer 12

Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
Diabetes

Question 13

Define emotional abuse

Answer 13

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.

Question 14

What is the toxic trio?

Answer 14

Domestic violence
Adult mental health issues
Substance abuse

Question 15

How can you diagnose active TB?

Answer 15

TB culture using a sputum smear and nucleic acid amplification test using sputum sample

Question 16

What should be done before initiating a patient on medications to treat depression?

Answer 16

Ensure they don’t have bipolar as antidepressants will destabilise there mood

Question 17

What herniation can occur in a extradural haemorrhage and what CN is at risk?

Answer 17

Transtentorial herniation
CN 3 palsy

Question 18

What are some changes to the respiratory system in the elderly?

Answer 18

Reduced compliance due to reduced elastic recoil
TLC reduced

Question 19

Which respiratory postoperative complications are common in the elderly?

Answer 19

Atelectasis
PE
Pneumonia

Question 20

What is the physiological definition of frailty?

Answer 20

Increased vulnerability due to ageing-associated decline in reserve and function
Across multiple physiologic systems
Affects everyday activities/ability to cope with stressors

Question 21

What term is used to describe a medical treatment that could be harmful?

Answer 21

Doctrine of double effect

Question 22

What defines a good death?

Answer 22

Choosing where to die
Option for pain relief
Knowing what to expect
Dignity & Privacy

Question 23

Where is the most common location of breast cancer?

Answer 23

Upper outer quadrant

Question 24

What are the resp and CVS symptoms of an allergic reaction?

Answer 24

Wheeze
Stridor
Cough
Struggling to breathe

Pallor
Hypotension
Tachycardia

Question 25

What medications would you give for allergy in addition to epinephrine?

Answer 25

Chlorphenamine (anti-histamine) Hydrocortisone

Question 26

Define atopy

Answer 26

A tendency to produce IgE antibodies in response to ordinary exposure to potential allergens

Question 27

Give an example of a sedating and non-sedating antihistamine?

Answer 27

Cetirizine (non-sedating) Chlorphenamine (sedating) ADR- Drowsiness, dry mouth

Question 28

Which cell type would be raised in the blood in an allergy?

Answer 28

Eosinophils

Question 29

What would be a positive response in a skin test?

Answer 29

Wheal - raised white bump surrounded by a small circle of itchy red skin (has low sensitivity so use with other tests)

Question 30

What are the 2 phases of allergy?

Answer 30

Sensitization phase- First encounter with the antigen. Activation of APCs and memory effector cells. Effector phase - Pathologic reaction upon re-exposure to the same antigen and activation of the memory cells of the adaptive immunity

Question 31

Why is baked milk more tolerated?

Answer 31

conformational (folded) epitopes are destroyed sequential epitopes preserved

Question 32

What are the differences between IgE and non IgE mediated?

Answer 32

IgE: presents any age, immediate response (mins) Non IgE: resents at infancy, delayed response (hours)

Question 33

What's the pathophysiology behind RA?

Answer 33

immune complexes are deposited in the tissue which cause complement activation Attracts neutrophils by chemotaxis, which adheres to the cells and degranulates causing cell membrane breakdown.

Question 34

How can we diagnose autoimmune disease?

Answer 34

Presence of autoantibodies/autoreactive T Cells Levels of autoantibodies correlate with disease severity Autoantibodies/autoreactive T cells found at site of tissue damage

Question 35

What is the mechanism behind type 1 hypersensitivity?

Answer 35

On 1st exposure - antigen specific IgE antibodies are made by plasma cells, the IgE antibodies attach to mast cells. On Second exposure - the IgE antibodies cross-link with the antigen, this causes mast cell degranulation. Activated mast cells release histamine and chemokines causes increased vascular permeability, vasodilation and bronchoconstriction (IgE mediated response)

Question 36

Define sensitisation

Answer 36

Production of IgE antibodies or IgE mediated response after repeated exposure to an allergen

Question 37

Stages of asthma exacerbations?

Answer 37

Oxygen therapy Nebulised Salbutamol Oral prednisolone or IV hydrocortisone Nebulised ipratropium bromide IV aminophylline/theophylline

Question 38

What are the clinical features of congestive heart failure?

Answer 38

Leg swelling/pitting oedema Bibasal crackles on auscultation of lungs Dry cough Dyspnoea

Question 39

What are common side effects of aspirin?

Answer 39

Dyspepsia (NSAID) Haemorrhage

Question 40

Why can’t NSAIDs and ACE inhibitors be co-prescribed?

Answer 40

NSAIDs affect the afferent arteriole ACEi affect the efferent arteriole Both together increases the risk of AKI

Question 41

How does aspirin work as an anti-pyretic?

Answer 41

Inhibition of hypothalamic COX-2

Question 42

Which abx can you use in penicillin allergy?

Answer 42

Clarithromycin

Question 43

Define allergy

Answer 43

A type 1 hypersensitivity reaction that is IgE mediated

Question 44

What inheritance does Huntington's follow?

Answer 44

Autosomal dominant

Question 45

What are some features of Huntington's?

Answer 45

Dystonia loss of coordination cognitive decline chorea

Question 46

What makes up Cushing's triad?

Answer 46

Hypertension Bradycardia Irregular breathing

Question 47

What is secondary ammenorhoea and give some causes?

Answer 47

Absent periods for at least 6 months in a woman that has had regular periods. Pregnancy Menopause PCOS (associated with hirsutism) Thyroid disease Stress Weight loss High prolactin

Question 48

What is the likely diagnosis with fishy discharge?

Answer 48

Bacterial vaginosis [Gardnerella vaginalis] Treated with Metronidazole