extra

Question 1

Carotid Endarterectomy should be considered if there is more than 70% stenosis of the internal carotid artery which is symptomatic.

a. True
b. False

Answer 1

a. True

True – carotid artery disease is a common cause of ischaemic stroke and TIA, and severe stenosis is more likely to be symptomatic.

Question 2

Amoxicillin will treat pneumonia caused by most typical and atypical organisms.

a. True
b. False

Answer 2

False –

Amoxicillin does not have much activity against atypical organisms. When pneumonia is severe or atypical infection is suspected, treatment should include a macrolide antibiotic like clarithromycin, or an alternative like doxycycline, levofloxacin or co-trimoxazole.

Question 3

Conn’s Syndrome involves overproduction of Aldosterone.

a. True
b. False

Answer 3

True.

This is one of the more common causes of secondary hypertension.

Question 4

Diarrhoea and vomiting are a feature of atypical pneumonia.

a. True
b. False

Answer 4

True –

pneumonia caused by atypical organisms classically presents slightly differently to typical pneumonia. Features include diarrhoea and vomiting, headache, myalgia (muscle ache) and dry cough.

Question 5

Pulmonary TB most commonly affects the apices of the lungs.

a. True
b. False

Answer 5

True –

TB is an aerobic bacterium, and is an inhaled pathogen, therefore commonly affects the apices of the lungs (remember that during normal tidal breathing, more air goes to the apex than the base of the lung).

Question 6

Regarding atheromatous plaque formation: Platelet-derived growth factor brings about proliferation of intimal smooth muscle cells.

a. True
b. False

Answer 6

a. True

this is part of the process that forms the fibrous tissue cap over the atheroma lipid core.

Question 7

Aphasia

Answer 7

Aphasia is when a person has difficulty with their language or speech. It’s usually caused by damage to the left side of the brain (for example, after a stroke).

Question 8

Right sided weakness and aphasia points to stroke being on the left side of the brain

a. true
b. false

Answer 8

a. True

Question 9

An 81 year old woman has a sudden-onset of weakness affecting her right arm, leg and lower half of face. Power in the left limbs and face is normal. She is aphasic and has a right homonymous hemianopia. A CT-head is consistent with an acute ischaemic stroke. Is it true or false that the left side of the patient’s brain is affected?

a. true
b. false

Answer 9

a. true

This as a total anterior circulation stroke. Right sided weakness and visual field defect points towards left side of brain being affected. Similarly, the presence of aphasia points towards the dominant hemisphere (which is normally the left) being affected.

Question 10

The dorsalis pedis pulse is felt lateral to the extensor hallux tendon.

a. True
b. False

Answer 10

a. True

Question 11

posterior tibial pulse is felt halfway behind the medial malleolus and Achilles tendon

a. true
b. false

Answer 11

a. true

Question 12

In chronic bronchitis, new goblet cells appear in small airways.

a. True
b. False

Answer 12

a. True

True – goblet cells produce mucus. Chronic inflammation leads to new goblet cells appearing in small airways, and an increase in the number of goblet cells in larger airways.

Question 13

COPD is a cause of finger-clubbing.

a. True
b. False

Answer 13

b. False

Question 14

The peripheral chemoreceptors respond to changes in levels of oxygen in solution (PO2) and not the amount of oxygen wrapped up in hemoglobin (where most of the blood oxygen in found).

a. true
b. false

Answer 14

a. true

Question 15

Amiodarone blocks Potassium channels.

a. True
b. False

Answer 15

True - Amiodarone is a Class III antiarrhythmic, and blocks the potassium channels that allow repolarisation of the heart.

thus Prolongs repolarisation and AP

long refractory peirod

Question 16

New blood vessel formation and collagen deposition begins 1-3 days after a myocardial infarction.

a. True
b. False

Answer 16

False – this occurs 7-10 days post infarction.

Question 17

A patient presents with unilateral calf swelling and a raised D-dimer, DVT is suspected. Imaging with compression ultrasound is required to confirm the diagnosis.

a. True
b. False

Answer 17

a. True

True - Diagnosis is based on clinical assessment, D-dimer levels and imaging for example a compression ultrasound scan.

Question 18

Most patients with TB will present during their primary infection.

a. True
b. False

Answer 18

False –

the primary infection (i.e. the point at which the person becomes infected; the first exposure to TB) is often asymptomatic, and in the majority of people it will either be cleared completely or contained within a granuloma as latent TB. Most symptomatic presentations of TB result as a reactivation of latent TB.

Question 19

Tissue biopsy is required before a diagnosis of Usual Interstitial Pneumonitis (UIP) can be made.

a. True
b. False

Answer 19

False –

UIP is associated with characteristic radiological findings, which, if present and accompanied by a typical history, are sufficient evidence to treat as UIP without the need for tissue confirmation, although biopsies are still sometimes taken.

Question 20

The hyperinflammatory phase of Covid-19 is part of the normal physiological host response to infection.

a. True
b. False

Answer 20

a. True

False – this is a feature of severe Covid, and is a pathological host response. In the hyperinflammatory phase, a cascade of pro-inflammatory molecules (a cytokine storm) leads to uncontrolled inflammation.

Question 21

The atria and the ventricles are separated by the non-conducting annulus fibrosus, except for the very slow-conducting atrioventricular node.

a. True
b. False

Answer 21

a. True

Question 22

Generally, fluid from a transudative effusion contains 3g/dL of protein or more.

a. True
b. False

Answer 22

b. False

False – this describes the protein content of an exudative effusion, which is caused by inflammation.

Question 23

The pain associated with critical limb ischaemia is often felt most distally.

a. True
b. False

Answer 23

True - Critical limb ischaemia is severe narrowing of the arterial supply to a limb. Pain is at rest and is felt most distally.

Question 24

Infective endocarditis could cause a stroke.

a. True
b. False

Answer 24

a. True

Question 25

A patient who becomes hypoxaemic on exertion may have a diffusion impairment. a. True b. False

Answer 25

True – diffusion impairments in lung disease (such as interstitial lung disease) mean it takes longer for the blood and air oxygen to equilibrate. If you give the blood less time in contact with the alveoli (e.g. by increasing the heart rate during exercise) then often the arterial oxygen levels will fall.

Question 26

Concerning the cardiac cycle: The left atrial pressure rises at the start of systole. a. True b.False

Answer 26

a. True True. When the ventricle contacts, the mitral and tricuspid valves close and then bulge into the atria, creating the a wave on the atrial pressure trace, which terminates when the aortic and pulmonary valves open.

Question 27

Dilated cardiomyopathy is the end stage of many disease processes a. True b. False

Answer 27

Ischaemic heart disease, hypertension, some drugs, and some metabolic disorders can all cause dilated cardiomyopathy. However, when no other disease process is evident, a genetic cause can be found in about 20% of cases, and of these the most commonly affected gene is Titin. Interestingly, a proportion of patients with dilated cardiomyopathy attributed to alcohol excess or pregnancy also have a variant in TTN. Dilated cardiomyopathy may therefore have more than one cause even in a single individual.

Question 28

in dilated cardiomyopathy the ventricular function is impaired a. True b. False

Answer 28

a. true

Question 29

Hypertrophic cardimyopathy is automsomal dominant a. True b. False

Answer 29

a. True sarcomere gene

Question 30

impaired relaxation is a feature of hypertrophic cardiomyopathy a. True b. False

Answer 30

a. True

Question 31

Assessment of hypertrophic cardiomyopathy

Answer 31

ECG - repeated Echo Cardiac MRI Risk stratification

Question 32

inflammation of the pericardial layers with or without the myocardium

Answer 32

pericarditis

Question 33

sitting forward may improve the chest pain in pericarditis a. true b. false

Answer 33

a. true

Question 34

chest pain with pleuritic features, and sitting forward improves the pain

Answer 34

pericarditis

Question 35

heart defects associated with Downs Syndrome

Answer 35

Atrio-ventricular septal defects

Question 36

Turners syndrome girl with 45 chromosomes and only one X a. True b. False

Answer 36

a. True

Question 37

Heart defect associated with Turners syndrome

Answer 37

Coarctation of the aorta

Question 38

Puffy hands and short statue, neck webbing + coartaction of the aorta risk which congenital disorder?

Answer 38

Turners syndrome 45 X - girl

Question 39

noonan syndrome key - cardiac feature

Answer 39

pulmonary stenosis

Question 40

folate acid can reduce nonsyndromic cardiac defects a. true b. false

Answer 40

a. true