Last one Flashcards

Question

B-Raf is an oncogene that belongs to Growth factor receptors Signal transduction proteins Transcription factors Anti-antopic proteins

Answer 1

B-Raf is an oncogene that belongs to Growth factor receptors **Signal transduction proteins** Transcription factors Anti-antopic proteins This protein plays a role in regulating the MAP kinase/ERKs signaling

Answer 2

Cancers are initiated and progress by mutations in genes which result in either a gain or loss of function. Which of the following best describes the gain of function mutation observed in lung adenocarcinoma? Mutation in CDKN2A (cyclin dependent kinase inhibitor) Mutation in Rb (retinoblastoma protein) **Mutation in EGFR (epidermal growth factor receptor)** Mutation in MYC Mutation in TP53 (tumour protein 53)

Answer 3

Which of the following is derived from E. coli and deprives tumour cells of the required amino acids and inhibits protein synthesis Trabectedin **L-Asparaginase** Actinomycin-D Busulfan

Answer 4

Which of the following binds to the minor groove of DNA, bending the helix towards the major groove, which leads to interference with the intracellular transcription pathways and DNA-repair pathways Trabectedin L-Asparaginase **Actinomycin-D** Busulfan

Answer 5

Q Which chemotherapy drug would cause Flagellate Erythema ? Capecitabine **Bleomycin** Doxorubicin Imatinib

Answer 6

Bleomycin inhibits which of the following G1 S **G2** M

Answer 7

There are three checkpoints in the cell cycle which allow fidelity of DNA replication and cell division. Which of the following proteins are most likely to be mutated if a damaged cell does not stop at the G2/M checkpoint? B-cell lymphoma 2 (Bcl-2) **BRCA 1 (breast cancer 1)** Myc p53 pRB (retinoblastoma protein)

Answer 8

3 Measurement of neonatal plasma concentrations of this substance is used as a predictive test for the condition of congenital hypothyroidism. A. desmopressin B. mono-iodotyrosine C. oxytocin D. thyroglobulin **E. thyrotrophin**

Answer 9

M3 antagonist at bladder: relaxes and stops contractions of the bladder

Answer 10

Which vitamin should be given to patients with alcoholic cirrhosis, to prevent possibility of Wernicke-Korsakoff encephalopathy? A. vitamin A **B. vitamin B1** C. vitamin B6 D. vitamin B12 E. vitamin K

Answer 11

Pyridoxine deficiency would refer to a lack of A. vitamin A B. vitamin B1 **C. vitamin B6** D. vitamin B12 E. vitamin K

Answer 12

Which of the following does Pabrinex give a supply of? A B9 B B2 **C B1** - **treats Wernicke's encephalopathy with high dose thiamine** D B6 E B12

Answer 13

Which one of the following statements regarding obstetric haemorrhage is true? A Obstetric haemorrhage is a common cause of maternal death in the UK B Obstetric haemorrhage is the leading cause of maternal death in the UK **C Obstetric haemorrhage is the leading cause of maternal death worldwide** D Obstetric haemorrhage kills around two women per year in the UK E Obstetric haemorrhage is always maternal blood and never fetal in origin

Answer 14

Secondary PPH is defined as vaginal bleeding from **24** hrs postpartum to **12** weeks postpartum.

Answer 15

Which of the following values would be considered a normal APGAR score? A 0 B 2 C 4 D 6 **E 8** The APGAR score is a 'vitality index' that is measured in virtually every newborn at one and five minutes with a **'normal' score being between 7 and 10**

Answer 16

i) **Conjugated bilirubin** cannot access the gut (½ mark ) and be converted to stercobilin which causes colouration of faeces (½ mark). ii) **Conjugated bilirubin** refluxes back into general circulation (½ mark) where unlike bilirubin, it can be excreted in urine which causes dark colouration of urine (½ mark).

Answer 17

**Calcidiol**

Answer 18

Initial weight loss is due to reduction in body glycogen stores (and their associated water) (1 mark)

Answer 19

6. Which one of the following can be a physiological mechanism associated with systemic paraneoplastic syndrome? **A Production of cross reacting antibodies** B Nodal metastases C Distant organ metastases D Local tumour invasion E Tumour extravasation

Answer 20

11. What is the tissue of origin of a papilloma? A Embryonic **B Epithelial** C Hematopoietic D Mesenchymal E Neuroectodermal

Answer 21

Inactivation of E-cadherin contributes to the development of which hallmark of cancer? A. Evading apoptosis B. Insensitivity to anti-growth signals **C. Invasion and metastasis** D. Self-sufficiency of growth signals E. Sustained angiogenesis

Answer 22

17 Usually, what is considered to be the weight of the smallest clinically detectable tumour mass? A. 0.01 g B. 0.1g **C. 1g** D. 10g E. 100g

Answer 23

Answer: **lower paravertebral venous plexus (Batson’s plexus)** (1 mark)

Answer 24

What is the predominant enzyme that converts testosterone to dihydrotesterone in the prostate gland. A. 5-α-reductase type I **B. 5-α-reductase type II** C. Phosphodiesterase type 5 D. Prostaglandin E1 E. Prostate specific antigen (kallikrein-3)

Answer 25

Fetal heart rate: cardiotocography – pattern of variation indicates the degree of distress Doppler ultrasound of umbilical arteries – measures umbilical artery flow Volume of amniotic fluid; Oligohydramniosis may indicate reduced placental function

Answer 26

2 from: Retinopathy of prematurity – retinal damage due to high O2 tension during ventilation Bronchopulmonary displasia – lung damage due to artificial ventilation Cerebral palsy – brain damage aused by bleeding, anoxia or suboptimal nutrition

Answer 27

Highest = (umbilical vein) Lowest = superior vena cava

Answer 28

Heparin binds to antithrombin and activates it; activated complex then inactivates factor Xa, preventing conversion of prothrombin to thrombin (thrombin converts fibrinogen into fibrin - integral step in clot formation)

Answer 29

Nicorandil: **potassium channel agonist**, which inhibits voltage-gated calcium channels leading to muscle relaxation

Answer 30

Stimulate presynaptic α2-adrenergic receptors in the CNS → dilates peripheral blood vessels → lowers peripheral resistance → reduces blood pressure

Answer 31

Which of the following disrupts the membrane potential in TB causing death? Rifampicin Isoniazid **Pyrazinamide** Ethambutol

Answer 32

**C Reversible muscarinic acetylcholine receptor antagonist** Atropine transiently blocks the action of the vagus nerve (i.e. parasympathetic nervous system) leading to increased SAN electrical activity and increased conduction through the AVN. This results in an increase in heart rate.

Answer 33

A **Streptokinase**: Clot buster; Activates fibrinolytic pathway **Alteplase** (tPA): Increase clot; breakdown by increasing Plasmin formation

Answer 34

Q Which of the following reduce heart rates by prolonging refractory period of AVN? Amlodipine Nicorandil Diatelzem Lisinopril **Verapamil**

Answer 35

ICS acts on which of the following in asthma ptx? IL-4 IL-5 **IL-6** IL-7

Answer 36

Q Which of the following forms the right ventricle? Truncus ateriosus **Bulbus cordis** Sinus venosus Primitive ventricle Primitive atria

Answer 37

**Retinoid acid receptor**

Answer 38

Anti-TPO and anti-TSHR

Answer 39

Oxidises iodide ions using H2O2

Answer 40

dapagliflozin

Answer 41

Inhibits vitamin K epoxide reductase

Answer 42

Have **-but-** in them; salbutamol; terbutaline long acting muscarinic antagonists: -**ium** tiotropium, glycopyrronium ium- in ur muscarinic system

Answer 43

**Gastrin is released by G cells** and stimulates parietal cells to secrete hydrochloric acid.

Answer 44

Which cells are important in the secretion of pepsinogen? A Parietal cells **B Chief cells** C Goblet cells D G cells E Enterochromaffin-like cells

Answer 45

What is the most common cause of primary hyperparathyroidism? **E Parathyroid adenoma**

Answer 46

Which of the following best explains the mechanism leading to osteopaenia in Cushing’s syndrome? A Cortisol directly promotes resorption of bone B Cortisol stimulates the release of calcitonin C Cortisol promotes the activity of osteoclasts **D Cortisol inhibits the activity of osteoblasts** E Cortisol is toxic to the bone marrow

Answer 47

Which enzyme is most commonly affected within congenital adrenal hyperplasia? A Angiotensin-converting enzyme B 11-beta-hydroxylase **C 21-hydroxylase** D 17-hydroxyprogesterone E 5-alpha-reductase

Answer 48

**SGLT2 inhibitors**

Answer 49

Dulaglu**tide** is which drug class **GLP-1agonists**

Answer 50

A Blocks thyroxine deiodinase I in the liver Blocks thyroxine deiodinase II in the periphery to stop T4 to T3 conversion

Answer 51

Which drug class does indapamide belong to? DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas

Answer 52

Sexual dysfunction can be a result of DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas

Answer 53

**Amylase**

Answer 54

19 Tonsil of cerebellum 20 Flocculus of cerebellum

Answer 55

Intracranial calcification Hydrocephalus Chorioretinitis (inflammation of the choroid and retina in the eye)

Answer 56

**Streptococcus pneumoniae** (diplococci)

Answer 57

Methylphenidate has been ordered for a 10-year-old male in the inpatient child and adolescent psychiatry unit for attention deficit-hyperactivity/disorder. Methylphenidate blocks the reuptake of which neurotransmitter? A. Acetylcholine **B. Dopamine** C. Gamma-aminobutyric acid (GABA) D. Serotonin

Answer 58

Q An 8-year-old female is brought to the clinic by her mother for an annual examination. The mother inquires as to when her daughter will likely begin puberty. Which of the following is the most notable and reliable first sign of puberty in girls? A. Menarche **B. Thelarche** C. Pubarche D. Linear growth

Answer 59

Which of the following is anti-cholinergic? **Oxybutynin** Tamsulosin Prazosin Bethanecol

Answer 60

Acceptable responses: **bulbosongiosus, bulbospongiosus**

Answer 61

Round ligament

Answer 62

Which of the following drug induces labour by causing the **cervix** to contract? Oxytocin **Misoprostol** Carboprost Mifepristone

Answer 63

Group A streptococcus (GAS): e.g. **Streptococcus pyogenes**

Answer 64

Give prophylactic in mother: - **Pyrimethamine** - **sulfadiazine** - **folinic acid**

Answer 65

**Tranexamic acid1**(intravenous)

Answer 66

Acute treatment: * **Labetalol** – alpha and beta blocker / antagonist * **Hydralazine** Chronic management * **Methyldopa** – alpha 2 agonist (feeds back and stops noradrenaline being released) * **Nifedipine** - CCB

Answer 67

what is A? **1. conjoint tendon** 2. internal oblique muscle 3. inguinal ligament 4. spermatic cord 5. superficial inguinal ring 6. rectus sheath **sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle, joining the muscle to the pelvis**

Answer 68

Identify the cranial nerve indicated on this diagram of the dorsal aspect of the brain stem 1. trochlear * *2. abducens** 3. oculomotor 4. trigeminal 5. facial 6. opthalmic

Answer 69

In the diagram of the pupillary eye reflex shown, what is A? 1. oculomotor nucleus 2. sympathetic ganglion 3. pretectal nucleus 4. Edinger Westphal nucleus 5. medial vestibular nucleus * *6. ciliary ganglion**

Answer 70

What region/zone of the epiphyseal growth plate is indicated by the double headed arrows? 1. dying 2. calcifying 3. hypertrophying 4. resting * *5. proliferating**

Answer 71

which muscle attaches here? 1. deltoid 2. supraspinatus 3. teres minor 4. infraspinatus 5. long head of biceps * *6. subscapularis**

Answer 72

MCP is the middle cerebellar peduncle in this section. The fibre tract indicated by the arrow is the **1. medial longitudinal fasciculus** 2. spinocerebellar tract 3. corticospinal tract 4. medial lemniscus 5. spinothalamic tract

Answer 73

what is A? 1. middle cerebral artery 2. anterior communicating artery * *3. anterior cerebral artery** 4. inferior sagital sinus 5. superior sagital sinus

Answer 74

In this highly simplified diagram of the corneal blink reflex, identify the nucleus labelled A that receives the afferent information. 1. facial 2. supraoptic 3. optic 4. vestibulocochlear * *5. trigeminal** 6. oculomotor

Answer 75

This image shows a ‘fatty streak’ in a coronary artery. ‘Foam’ cells at the arrows can be derived from macrophages and what other cell type? 1. Endothelial cells 2. Adipocytes 3. Mesothelial cells 4. Lymphocytes 5. Neutrophils **6. Smooth muscle cells** **The fatty streak forms in the intima of a blood vessel and is comprised of foam cells which sequester lipid. These cells are macrophages and smooth muscle cells that have migrated there (smooth muscle cells come in part from the underlying tunica media).**

Answer 76

Respiratory tract: The arrow indicates 1. Bronchus associated lymphoid tissue * *2. Smooth muscle** 3. Internal elastic lamina 4. Hyaline cartilage 5. Elastic cartilage 6. Fibrocollagenous tissue ## Footnote **This is a bronchiole with alveoli surrounding it. The bronchiole has prominent smooth muscle obvious from its elongated nuclei and dark pink staining cytoplasm.**

Answer 77

Identify A 1. greater omentum 2. coronary ligament 3. triangular ligament * *4. falciform ligament** 5. lesser omentum 6. hepatogastric ligament

Answer 78

_Which of the following best describes C?_ Hinge joint Condylar joint Plane joint Ball and Socket joint **Saddle joint**

Answer 79

Ia primary afferents, carrying information from muscle spindles, synapse in this area. A B C D **E** F G

Answer 80

Lesion of this region leads to spastic paralysis. A B C **D** E F G

Answer 81

Axons carrying nociceptive information decussate in which area? A B C D E F **G**

Answer 82

The corticospinal tract is identified by which letter? **A** B C D E F

Answer 83

What is indicated by the arrows in the reticular formation shown in these diagrams? 1. substantia nigra * *2. raphe nuclei** 3. ventral tegmental area 4. locus coeruleus 5. basal pons

Answer 84

In the diagram of the pupillary eye reflex shown, what is A? 1. sympathetic ganglion 2. ciliary ganglion * *3. pretectal nucleus** 4. oculomotor nucleus 5. medial vestibular nucleus 6. Edinger Westphal nucleus

Answer 85

What is A? **1. left testicular vein** 2. ureter 3. left testicular artery 4. inferior mesenteric artery 5. inferior mesenteric vein

Answer 86

This image depicts the layers of the inguinal canal in a male. Which structure forms the internal spermatic fascia within the spermatic cord? A **B** C D E

Answer 87

**Dendrite**

Answer 88

The tissue shown in the photomicrograph of an intervertebral disc is Hyaline cartilage Elastic cartilage Dense irregular connective tissue Dense regular connective tissue **Fibrocartilage**

Answer 89

Ascending Aorta Ouflow tracts of the ventricles Both ventricles The artial auricles **The smooth walled region of atria**

Answer 90

Failure of foramen ovale to close **Faliure of septum secumdum to develop** Failure of the muscular portion of the septum to form Heart tube twisting the wrong way Restricted growth of the endocardial cushions

Answer 91

Lindsay, an 80-year-old male, presents to his GP with atrial fibrillation and shortness of breath. He has pulmonary oedema. Which radiological sign is seen when interlobular septa in the pulmonary interstitium become prominent? Batwing sign Blunted costophrenic angle Bullae Crescent sign **Kerley B lines**

Answer 92

**Interlobular septa**

Answer 93

**Forced vital capacity**

Answer 94

**absence of breath sounds**

Answer 95

lactate, lactate acid, lactic acid

Answer 96

Left gastric and azygos veins

Answer 97

This is a photomicrograph of an ovarian tumour. What type of tumour is it? **Serous adenocarcinoma** Sex cord-stromal tumour Dysgerminoma Teratoma Mucinous adenocarcinoma

Answer 98

This cytology preparation is of a breast aspirate obtained from a lump in a woman's breast. What do the features suggest? **Fibroadenoma** Leiomyosarcoma Leiomyoma Fibrosarcoma Adenocarcinoma

Answer 99

A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips. Which muscle and tendon could be transferred to help this individual walk better? **Tibialis posterior** Tibialis anterior Gastrocnemius Fibularis longus Flexor hallucis longus

Answer 100

(axial burst, axial burst fracture, burst, burst fracture)

Answer 101

During a teleconsultation, a 27-year old patient complains of a blocked nose in addition to her sore throat. What is the major pharmacological action of decongestants? Alpha-2 adrenoceptor agonist **Alpha-1 adrenoceptor agonist** Alpha-1 adrenoceptor antagonist Alpha-2 adrenoceptor antagonist Beta-2 adrenoceptor agonist

Answer 102

Growth hormone (GH) is released by the pituitary gland. Which of the following best describes the metabolic effects of GH? Counteracts all effects of glucagon Counteracts all effects of insulin on glucose and lipid metabolism, but shares protein catabolic properties with insulin **Counteracts the effects of insulin on glucose and lipid metabolism, but shares protein anabolic properties with insulin** Counteracts the effects of insulin on protein and lipid metabolism, but shares with insulin effects on glucose homeostasis GH shares all effects of insulin

Answer 103

3rd ventricle **4th ventricle** Cerebral aqueduct Interventricular foramen Lateral ventricle

Answer 104

**Claustrum** is a thin, bilateral collection of neurons and supporting glial cells, that connects to cortical (e.g., the pre-frontal cortex) and subcortical regions (e.g., the thalamus) of the brain.

Answer 105

A patient has a pulmonary embolism. In which of the labelled structures would the embolus enter the lungs through? A **B** C D E

Answer 106

**Pyropoikilocytosis**: Hereditary pyropoikilocytosis (HPP) is an autosomal recessive disorder of the red blood cell (RBC) membrane that is clinically related to, and is considered a subtype of, hereditary elliptocytosis (HE). **HPP involves a functional defect in spectrin**, which is the major cytoskeletal protein of the RBC cell membrane. It manifests as a severe hemolytic anemia with **thermal instability of the red blood cells**

Answer 107

This image depicts Elliptocytosis **Presence of schistocytes** suggests red blood cell injury from damaged endothelium and is a characteristic feature of microangiopathic hemolytic anemia. Presence of sickle cells Pyropoikilocytosis Spherocytosis

Answer 108

The anterior spinothalamic tract eventually innervates the primary and secondary somatosensory cortex, basically controlling pain intensity. “Provide exact localisation and physical intensity of noxious stimulus”. To get there, where do the projection neuron terminate and innervate the third order neuron? (2 answers) **Ventral posterior lateral nucleus of the thalamus** **Ventral posterior inferior nucleus of the thalamus** Mediodorsal nucleus of the thalamus Ventral posteroinferior nucleus of the thalamus Ventral posterolateral nucleus of the thalamus

Answer 109

This refers to which part of the limbic system? Anterior cingulate gyrus Primary somatosensory cortex **Insula** Amygdala Nucleus accumbens

Answer 110

Amygdala below

Answer 111

Where is the raphe nucleus located? Midbrain Pons **Medulla** Basal ganglia In the thalamus

Answer 112

Neurofibrillary tables

Answer 113

Antidepressant drug discontinuation syndrome A condition that can occur after a decrease in the dose of drug taken, an interruption of treatment or abrupt cessation of treatment; it can be prevented by a very gradual discontinuation of treatment, by using a very slow tapering of the doses taken by the patient

Answer 114

Bilateral removal of the amygdala

Answer 115

inability to access memories or information from before an injury or disease occurred.

Answer 116

Normal healthy individual

Answer 117

Decreased dopamine receptors There is less metabolic activity especially around the prefrontal cortex and there is less blood flow to certain areas due to addiction

Answer 118

Cannabinoid receptor 1

Answer 119

CT CXR **ERPs** Lumbar puncture Angiogram

Answer 120

What frequency are alpha waves? 13-30 Hz **8-12 Hz** 3.5-7.5 Hz Less than 3.5 Hz 10-12 Hz

Answer 121

What frequency are beta waves? **13-30 Hz** 8-12 Hz 3.5-7.5 Hz Less than 3.5 Hz 10-12 Hz

Answer 122

What frequency are delta waves? 13-30 Hz 8-12 Hz 3.5-7.5 Hz **Less than 3.5 Hz** 10-12 Hz

Answer 123

Cerebral aquaduct

Answer 124

Citalopram

Answer 125

enhanced vitamin D metabolism causing **osteomalacia**

Answer 126

Treats: **Parkinson's disease** & **PVS** **NMDA** receptor **antagonistic** effect & **block** **dopaminergic** **reuptake**

Answer 127

Carbamazepine hypersensitivity: get a rash

Answer 128

Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA? GABA-A antagonist **GABA-A agonist** NMDA Glutamate antagonist NMDA Glutamate agonist AMPA Glutamate antagonist

Answer 129

A Phenytoin Levetiracetam

Answer 130

Which of the following is the most cardiotoxic? **Amitriptyline** Nortriptyline Citalopram Sertraline Fluoxetine

Answer 131

A **Pregabalin**

Answer 132

Amitriptyline

Answer 133

**SNRIs** (duloxetine) **tricyclic antidepressants** (amitrypyline) **calcium channel blockers**(gabapentin, pregabalin)

Answer 134

Which cell makes type 1 collagen? osteoclasts **osteoblasts** osteocyte osteoprogenitor

Answer 135

A: **Involucrum**: A reactive shell of new bone forms around the sequestrum B: **sequestrum**: necrotic bone fragment

Answer 136

Which treatment for RA targets IL-6? Etanercept Adalimumab Anakinra Rituximab Abatacept **Tolizumab**

Answer 137

Belimubab inhibits BAFF (B cell activating factor). It is used to treat Ankylosing spondylitis **Systemic lupus erythematosus** Dermatomyositis Scleroderma Rheumatoid arthritis

Answer 138

**Immune complex mediated inflammation**

Answer 139

The acromioclavicular joint is which type of joint saddle **plane** hinge condyloid

Answer 140

Pseudogout The knee x-ray shows evidence of cartilage calcification, previously termed chondrocalcinosis, which is typical of pseudogout. In hyaline cartilage, cartilage calcification will appear as a **thin opaque line**. **The knee is the most common joint to see pseudogout. **Another common place cartilage calcification occurs is the triangular fibrocartilage complex (TFCC) of the wrist.

Answer 141

**Pseudogout** Pseudogout is a type of arthritis in which a layer of calcification can be seen between articulating surfaces.

Answer 142

Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid? Consumption of too much alcohol **Inadequate elimination of uric acid via the kidneys** Infection causing build-up of uric acid Production of too much uric acid in the body

Answer 143

Platelet rich plasma (PRP) is a novel treatment process for Osteoporosis Osteomalacia **Osteoarthritis** Rheumatoid arthritis

Answer 144

Which prostaglandin causes the most bronchoconstriction in asthma patients? PGE2 **PGD2** PGI2 PGF2α TXA2

Answer 145

This imaging supports a diagnosis of **Body inclusion myositis** Duchenne MD Myositis Sarcopenia Fibromyalgia

Answer 146

**Leukocytoclastic Vasculitis** Fibrin deposition can be identified within the vessel wall The perivascular inflammatory infiltrate is comprised predominantly of neutrophils but eosinophils are also present.

Answer 147

This symptom is a result of? **Antibody-mediated inflammation**: Pemphigus Vulgaris

Answer 148

This flower would cause Mast cell-mediated inflammation Antibody-mediated inflammation Immune complex mediated inflammation Delayed hypersensitivity **Automimmunity**

Answer 149

**Henderson-Patterson bodies** that contain virus particles.

Answer 150

**Blocks T cell activation which thus means macrophages and B cells cannot be activated**. **Competes with CD28 binding to CD80/86** by **upregulating CTLA-4,** which switches T cell off **Reduces production of TH17 cells** Thus reducing inflammation

Answer 151

The most important biologics to remember are the TNF inhibitors **adalimumab, infliximab and etanercept**

Answer 152

**decreases activation of dendritic cells**: less autoantobodies produced

Answer 153

Topical salicylic acid Fluorouracil cream Cryosurgery Surgical curettage Laser treatment (CO2 laser 582nm)

Answer 154

**Belimubab**: inhibits BAFF (B cell activating factor) **Rituximab**: CD20 blocker

Answer 155

Alendronate

Answer 156

Prednisilone (type of corticosteroid): * 1 mg / kg per day until creatine kinase normal Azthioprine Methotrexate Rituximab

Answer 157

Rifampicin, dapsone and clofazimine

Answer 158

ALT: causes hepatoxcity

Answer 159

JAAK inhibitor

Answer 160

Basicervical; transcervical ; sub capital

Answer 161

Osteomalacia on the left OP on the right

Answer 162

Osteomalacia on the left OP on the right

Answer 163

Hammer toes

Answer 164

Lamella: Trabecular

Answer 165

Dupuytrens contracture

Answer 166

Which muscle has caused this avulsion facture indicated by the two arrows in the image? Hamstrings Sartorius Rectus femoris Gluteal muscles **Iliopsoas**

Answer 167

**Dermatophyte fungi** of the genera **Trichophyton** and **Microsporum**.

Answer 168

Woven bone

Answer 169

Hilgrenreiners and acetabular lines

Answer 170

Tendon of extensor digitorum

Answer 171

**Syndesmophyte** are calcifications or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus. They are seen in only a limited number of conditions including: ankylosing spondylitis ochronosis fluorosis reactive arthritis psoriatic arthritis

Answer 172

Arthrodesis of the first metatarsophalangeal joint

Answer 173

Dupuyten's contracture is a **contracture of the palmar fascia** that causes usually the **little and ringer finger to go into flexion.**

Answer 174

1. osteoarthritis **2. pseudo-gout** 3. osteomalacia 4. osteomyelitis 5. gout

Answer 175

1. transverse 2. greenstick **3. spiral** 4. comminuted 5. impacted

Answer 176

abduction and adduction of the digits This is claw hand. The ulnar nerve innervates the intrinsic muscles of the hand so abduction and adduction of the digits would be lost. The other movements are produced by the median and radial nerves that are not affected in this individual.

Answer 177

A Axillary nerve B Radial nerve C Musculocutaneous nerve Musculocutaneous nerve D Median nerve E Ulnar nerve

Answer 178

1. plantaris **2. tibialis anterior** 3. extensor digitorum 4. gastrocnemius 5. extensor hallucis longus tibialis anterior inserts onto the top of the medial longitudinal arch and provides a dynamic pull to maintain the arch.

Answer 179

5. infraspinatus and teres minor

Answer 180

Carpel tunnel

Answer 181

1. Paget’s disease osteoporosis **3. osteomalacia ** 4. osteomyelitis 5. avascular necrosis

Answer 182

**Plantar flexed** at ankle and genu varum

Answer 183

kyphoplasty

Answer 184

loss of medullary fat signal in AVN

Answer 185

Which of the following is most common? **Teratoma** Dysgerminoma Yolk sac tumour Choriocarcinoma Embryonal carcinoma

Answer 186

Which is the most common cause of bacterial caused brain abscess? Streptococcus agalactiae Streptococcus mutans Streptococcus pneumoniae Neisseria meningitidis **Staphylococcus aureus**

Answer 187

1. follicular epithelium **2.sweat gland** 3. submandibular gland 4. sebaceous gland 5. dermal papilla

Answer 188

Identify the structure which prevents adduction of the leg. 1. A 2. G 3. B 4. D 5. F **6. C** 7. E

Answer 189

1. maturing and hypertrophying cartilage **2. reserve cartilage** 3. degenerating cartilage and matrix calcification 4. bone formation 5. proliferating

Answer 190

The Smith's is an anterior displacment of the distal fragment, so the hand is displaced anteriorly relative to the rest of the forarm. The Colles's is a dorsal di of the distal frgament, giving the classic dinner fork deformity.

Answer 191

What region of the skin is most responsible for the heat retention thermoregulation function Dermis Epidermis Sebaceous gland **Subcutaneous tissue** Sweat gland

Answer 192

Chondrocyte necrosis (more marked in the superficial layers) (1/2 mark) Large isogenic clusters of the remaining chondrocytes (1/2 mark) Cracks and fissures in the cartilage (1/2 mark) Duplication of the tidemark (1/2 mark) More collagen type I (1/2 mark) Fewer proteoglycans (1/2 mark)

Answer 193

(ii) ACPA causes **monocytes** to **differentiate** as **osteoclasts** and they **produce** **IL8** that creates the **autocrine** **loop**. (1 mark)

Answer 194

Infliximab is a chimeric anti-TNF alpha antibody designed against the mouse binding site of TNF alpha and the remaining 75% is mouse meaning that the body will see it as foreign and mount an immune response against the drug (1 mark). With time both neutralising and non-neutralising antibodies will be produced (1 mark). These will directly interfere, form immune complexes and increase clearance of the infliximab. (1 mark)

Answer 195

Fracture hematoma Soft callus (fibrocartilage callus) Bony callus Bone remodelling

Answer 196

Inflammatory signals **(TNFalpha, IL1 and IL17)** can **directly** **induce** the expression of **COX2** in the **joint** (1 mark) but the **inflammatory stimuli** can also **indirectly** activate **COX2** by **inducing** **iNOS** that where the **free radicals induce COX2**. (1 mark).

Answer 197

The hip is a **weight bearing joint** and is so subjected to **more stress and wear** and tear than the shoulder (1). OA is most likely to affect the weight bearing joints first (1).

Answer 198

There may be **focal pressure necrosis** of the bone that leads to the formation of sub-chondral cysts. (1mark) There is vascular engorgement, slowing of blood flow through the sub-chondral bone. (1 mark)

Answer 199

Pseudofractures - Linear areas of low density surrounded by sclerotic borders

Answer 200

What would be the effect on bone mass for the patients using teripartide? Less bone mass and less mineralisation Less bone mass with normal mineralisation **More bone mass and normal mineralisation** More bone mass but unmineralised No effect

Answer 201

A - synovial membrane: **Th17 lymphocytes** B - synovial fluid: **Neutrophils**

Answer 202

**irreversible tibia varus** is the pathophysiology behind osgood-schlatter **blounts disease** SUFE Perthes CDH

Answer 203

Klein’s line is drawn along **superior border of femoral neck should cross at least a portion of the femoral head**. When SUFE the femoral head drops below this line.

Answer 204

Top of the acetabulum going down: ID where the femoral head is Affected side will be more lateral to the side Unaffected side: femoral head more medial

Answer 205

**Idiopathic** Self limiting **avascular necrosis of the femoral head** Dual blood supply to femoral head. **Secondary ossification centre suffers blood loss** and causes avascular necrosis. If left untreated, the **femoral neck grows** and over time t**here is revascularisation or neovascularisation** and **healing of the femoral head**.

Answer 206

Epiphysis actually stays in place it’s the neck and **shaft of the femur that moves** **Epiphysis** moves **posteriorly and medially**

Answer 207

Cytokines produced by a variety of immune cells can have redundant and over-lapping functions. What do IL-10 and tumour growth factor B (TGFB) have in common? **Both are anti-inflammatory cytokines** Both induce apoptosis in virally-infected and neoplastic cells Both modulate the activity of macrophages Both promote the maturation of CD4 T cells to T1 helper cells Both secreted by dendritic cells

Answer 208

17. The membrane potential of neurones during the resting phase is -75 mV. Which channels are responsible for maintaining the resting potential? K+ passive leak channels Na+ passive leak channels **Na+/K+ ATPase pump** Voltage gated potassium channels Voltage gated sodium channels

Answer 209

Mosaicism of chromosome 21

Answer 210

Visceral pleura

Answer 211

Voltage gated potassium (K+) channels

Answer 212

Which of the following is the correct carrying angle in a man? 5-10 degrees **5-15 degrees** 10-20 degrees 15-25 degrees 10-30 degrees

Answer 213

Boyle’s Law can be applied to the breathing process. Which statement describe best Boyle’s law? The volume of a gas correspond to its pressure divided the surface tension The pressure of a gas is directly proportional to the surface tension **The pressure of a given quantity of gas is inversely proportional to the volume that contains it** The surface tension is inversely proportional to the pressure The pressure of a gas is equal to the surface tension multiplied by the volume

Answer 214

Rubrospinal

Answer 215

A 12 year-old girl develops an unproductive cough, shortness of breath, fever and malaise. An organism is detected by a test for the antibodies that it provokes. It is treated with erythromycin, because beta-lactams are ineffective. What is the most likely causative organism? Haemophilus influenzae **Mycoplasma pneumoniae** Staphylococcus aureus Streptococcus agalactiae Streptococcus pneumonia

Answer 216

Knee held in flexion

Answer 217

medial compartment of the thigh - cause what movement on the hip? * *adduction** - made by which muscles? * *adductor longus, brevis and magnus, gracilis, pectineus and obturator externus ** - innervated by? * *obturator nerve**

Answer 218

which ligaments of foot get stretched out when foot planted, sot that when you take a step, release energy and help lift off? a) medial side: **spring ligament** b) lateral side: **long and short plantar ligaments**

Answer 219

**Dynamic hip screw:** blate with barrel inserted to outside of femoral shaft. Screw goes through to femoral head gives controlled compression

Answer 220

Helps stabilise knee especially in **flexion** **Stops tibia moving backward** on femur **Stronger the ACL**

Answer 221

**Stabilise knee in extension** and **prevents** **hyperextension** and **excessive internal rotation** Stops tibia moving forward on femur

Answer 222

Tibial nerve

Answer 223

a. **Strength of the association** - Is the result strong? This is usually measured by the HR, OR or RR, eg if OR >5 or < 1/5 then it is usually considered strong. b. **Dose response** – Would expect risks to increase with increasing exposure c. **Reversibility** – If you stop the exposure does the risk change revert to 1? d. **Temporality** – Does the exposure occur a reasonable time before the disease? e. **Consistency** – Has the result been repeated by different people in different places and in different circumstances and times? f. **Biological Plausibility** – Is the result biologically plausible? g. **Coherence of Evidence** – i.e. the results should be consistent with other sorts of studies such as cohort and cross-sectional as well as perhaps animal models. h. **Specificity** – Is the relationship with the exposure limited to specific diseases

Answer 224

Self-efficacy

Answer 225

The 95% confidence interval tells us that we are 95% confident (½ mark) that in the population heroin use might decrease the risk of testes cancer by 76% (1-0.24) (½ mark) or it might increase it by 3.6 times.(½ mark). The confidence interval includes 1 so there is no evidence that heroin use will reduce the risk of testes cancer (p>0.05). (½ mark)

Answer 226

Haematogenous osteomyelitis usually involves the **metaphysis** of **long** **bones** in **children** or the **vertebral bodies in adults**

Answer 227

Huntington’s chorea displays something called genetic “**anticipation**”. Anticipation is a feature of trinucleotide repeat disorders. This is where successive generations have more repeats in the gene, resulting in:

Answer 228

The hyperkinetic presentation is due to the loss, in the dorsal striatum, of **GABAergic medium spiny neurons of the indirect pathway** (bearing dopaminergic D2 receptors) **DIrect pathway becomes dominant**

Answer 229

What stage of bone healing by a bone graft is the physical effect by which the matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone? Osteoinduction Osteogenesis Osteopromotion **Osteoconduction** Mass transport

Answer 230

interstitial cells

Answer 231

Normal bleeding time: 1-3 minutes

Answer 232

**Synthesised by** * Endothelial cells * Megakaryocytes **Stored in** * Subendothelial matrix (immobilized state) * Present in the soluble state in the plasma * Alpha granules of the platelets

Answer 233

Factor VIIIa

Answer 234

**Thrombomodulin** is a cofactor for thrombin that **converts Thrombin** from a **procoagulant** to an **anticoagulant** by stimulating activation of the anticoagulant serine protease **protein C.**

Answer 235

antithrombin protein c protein s

Answer 236

The most useful blood test is **serum ferritin** – it will be **low** in pure **IDA** and **high** in anaemia of **inflammation**. **Serum transferrin receptor** levels will be **elevated** in **IDA** and **normal** in anaemia **inflammation** The key caveat is that in a person with inflammation AND IDA the iron deficiency may be “masked” because ferritin is an acute phase reactant – **in that case ferritin will be normal but in the low normal range**.

Answer 237

**Meckel’s diverticulum** occurs when a remnant of the yolk sac (Vitelline duct) persists.

Answer 238

Damage to the anterior portion of the spinal cord will cause **bilateral disruption of the spinothalamic tracts**, resulting in **bilateral loss of pain and temperature sensation.** The **corticospinal tracts** are also likely to have been affected, resulting in **bilateral spastic paralysis and UMN signs**

Answer 239

**Hycosine**: * **M5** receptor **antagonist**; **prevents Ach action** in **brainstem** or **vestibular** **nuclei**

Answer 240

**Diphyenydramine / dramamine** **Cyclizine**

Answer 241

**D2 receptor antagonist** & **5HT4 agonist**

Answer 242

**5HT3 agonist**; used for chemo and radiotherapy induced emesis

Answer 243

O is therefore the universal donor as O blood cells have no antigens AB is the universal recipient as it has no circulating AB antibodies

Answer 244

Occurs when patients with **IgA deficiency** who have **anti-IgA antibodies** are **given blood with IgA**

Answer 245

**Non-cardiogenic pulmonary oedema** Thought to be secondary to neutrophils activation Degranulation of WBCs increases **vascular permeability** leading to **inflammation and oedema**

Answer 246

CLOSURE OF NEURAL TUBE COMPLETE BY DAY 28

Answer 247

**chronic kidney disease**

Answer 248

**Streptococcus pyogenes**

Answer 249

**Bleomycin**

Answer 250

**Inhibit 50S ribosomal subunit and inhibit protein synthesis**

Answer 251

**Eszopiclone**

Answer 252

**Clozapine**

Answer 253

**X-linked**

Answer 254

Dystonia: **Globus pallidus internal** Tremor: **subthalamic nuclei**; **zone incerta**

Answer 255

**Clozapine**

Answer 256

**Difficulty sleeping**

Answer 257

Ageing affect on immune system. Which of the following cell types increases in number with old age? Neutrophils Dendritic cells Macrophages Lymphocytes **Natural killer cells**

Answer 258

Hypothyroidism Hypercortisolism

Answer 259

**Methlyphenidate** (aka ritalin) **Lisdexamfetamine**

Answer 260

**Excitation** of **dorsal striatum** causes the release of **dorsal striatum GABA** (inhibitory) This causes projects onto **globus pallidus external segment**: causes **increased inhibition of GPe** This causes the **globus pallidus external segment** to **release inhibitory GABA** onto the **subthalamic nucleus**: causes **reduced inhibition of STN** This causes the **subthalamic nucleus** to **release inhibitory GABA** onto the **globus pallidus internal segment**: which **increases the activation of GPi** This causes the **globus pallidus internal segment** to **release inhibitory GABA** onto the **motor** **thalamus**: which creates **increased inhibition of motor thalamus** **OVERALL DEACTIVATION OF MOTOR THALAMUS -> decreased motor cortex activation.** NO GO pathway.

Answer 261

**athetosis** Lesions to which region causes this symptom? Subthalamic nuclei Substantia nigra Pre supplementary motor area Lentiform nucleus **Dorsal striatum**

Answer 262

**Tetrabenazine** acts primarily as a reversible high-affinity inhibitor of mono-amine uptake into granular vesicles of presynaptic neurons by binding selectively to VMAT-2

Answer 263

Desynchronised Low amplitude High frequency

Answer 264

Rheumatoid arthritis is an example of a **type 3 hypersensitivity reaction.**

Answer 265

**Macrophages**

Answer 266

**Sartorius**

Answer 267

D1 activates the direct pathway: causes more movement (as usually is GO) D2 inhibits the indirect pathway: causes more movement (as indirect usually causes NO GO)

Answer 268

Tremor * most marked at rest, **3-5 Hz**

Answer 269

* Increase the frequency of channel opening so that **chloride** **ions** enter & hyperpolarise the membrane

Answer 270

**Hyperactive**: * amygdala * hippocampus * subgenual cingulate cortex * medial prefrontal cortex **Hypoactive**: * Dorsolateral prefrontal cortex * ventrolateral prefrontal cortex

Answer 271

increased connectivity between DMN and fronto-parietal networks: **especially left subgenual cingulate area**

Answer 272

**Sub dural** Blood from the ruptured vessels spreads freely through the subdural space and can envelop the entire hemisphere. Because of the forces involved in producing a subdural haemorrhage, there is very often damage to axons in the underlying brain as well

Answer 273

**Foramen lacerum**

Answer 274

Tyrosine, serine and threonine.

Answer 275

subcallosal cingulate

Answer 276

Epstein- Barr virus

Answer 277

Trastuzumab - emtansine (Kadcycla)

Answer 278

**CSF** sample taken **Low** levels of **amyloid beta** **Elevated** levels of **p-tau**

Answer 279

**Rasburicase**

Answer 280

**Increased tactile fremitus** Tactile/vocal fremitus acts as an indirect measure of the amount of air and the density of tissue present within the lungs. In emphysema, due to the trapping of air and decreased density of the lung parenchyma, tactile fremitus is reduced.

Answer 281

An elderly male enters the general practice for his regular monitoring of his INR. His warfarin was prescribed five years ago after being diagnosed with atrial fibrillation. What enzyme does the drug inhibit? **Epoxide reductase**

Answer 282

Self-management in the context of chronic illness refers to: 1. People not going to the doctor 2. People attending courses on healthy lifestyles **3. Health professionals supporting people to self-care** 4. Informal care in the community 5. People making all their own decisions about how to manage their illness

Answer 283

The bottom 50% of households own approximately how much of the UK’s wealth? 1. 5% **2. 10%** 3. 25% 4. 40% 5. 50%

Answer 284

Which of the items below is a key finding of the Whitehall II study? 1. Diet affects health outcomes 2. Smoking affects health outcomes **3. Social position affects health outcome**s 4. Genetics affect health outcomes 5. Having a high demand job affects health outcomes

Answer 285

Mean and standard deviation

Answer 286

Median and interquartile range [2]

Answer 287

90%:**1.64 SD** 95%: **1.96 SD** 99%: **2.58 SD**

Answer 288

SE = **Standard deviation / sq root (sample size)** It is used as a **standard deviation of the distribution** of all **possible** **sample means** (used when dealing with sampling from the population)

Answer 289

95% CI = sample mean =/- 1.96 x standard error It means that we are 95% sure that in the population the mean BMI can be as low as 21.4 and as high as 22.6.

Answer 290

Avoids selection/allocation bias; make sure participants differ only by the treatment; ensures group receiving treatment is similar to control group

Answer 291

**Parallel group**: randomized indiv. Into one of the grps **Crossover**: randomized treatment sequence – participants change the treatment half way through **Cluster randomized trials:** randomized preexisting grps into one of the two treatments (schools, gp practices, villages) **Factorial:** assess 2 interventions using the same number of patients as 1 intervention (25% gets both treatments, 25% A and placebo etc)

Answer 292

**TT**: compare all subjects in treatment group regardless of whether they complied and acc took the drug **OT**: compare subjects who acc took the treatment **ITT is better as it is a better representation of what would happen in real life**

Answer 293

When 95% CI for that relative risk **excludes 1**

Answer 294

**Forest plot**

Answer 295

**Funnel plot**

Answer 296

Risk in exposed – risk in unexposed

Answer 297

Relative risk; odds exposure in cases/odds exposure in control

Answer 298

15 million

Answer 299

Management of chronic illness – focused on quality of life, setting goals, monitoring progress and identification of barriers

Answer 300

Based on social cognition and social learning theory by Bandura: * **increase confidence** by **setting** and **achieving** **goals** * **improve quality of life** by helping patient feeling more in **control** of their **condition** – patients often experts of their condition

Answer 301

Non-conscious bulk of identity (embodied ID) and so conscious change may be challenging to achieve bc of habitus

Answer 302

Stress as stimulus (**engineering**) Stress as response as response (**medicophysioloical**) Stress as transaction (**psychological**) **transaction** between the person and the situation is **best understood**

Answer 303

By Selye; stage 1 – alarm stage 2 – resistance stage 3 – exhaustion

Answer 304

Dialectical behavior therapy

Answer 305

Psychodynamic therapy

Answer 306

**Stage 7:** middle of adulthood, generalivity vs stagnation **Stage 8**: late adulthood, integrity vs despair

Answer 307

The reference range for 95% STD is mean ± 1.69 SDs **mean ± 1.96 SDs** mean ± 1.64 SDs mean ± 1.94 SDs mean ± 2.58 SDs

Answer 308

**Pearson correlation** evaluates the linear relationship between two continuous variables. **Spearman correlation**: Spearman correlation evaluates the monotonic relationship.

Answer 309

Mann Whitney U test would be used if Gaussian distribution is not followed and instead of which type test One sample T-test Paired T-test **Two sample T-test** Equal variance T-test

Answer 310

Wilcoxon signed rank test would be used if Gaussian distribution is not followed and for which type of test? One sample T-test **Paired T-test** Two sample T-test Equal variance T-test

Answer 311

self-rating inventory of masculine, feminine, and neutral personality characteristics

Answer 312

Learning theory

Answer 313

If 95% CI difference is means includes 0, result is not statisitically significant; if excludes 0 then is sig. If 95% CI difference is relative risk includes 1, result is not statisitically significant; if excludes 1 then is sig.

Answer 314

case-control trial

Answer 315

Cohort: rare exposure

Answer 316

Absolute difference in risk = 30%-10%=20% NNT = 100/20= 5

Answer 317

Health Belief Model (1 mark) Theory of Planned Behaviour (1 mark) Transtheoretical model (Stages of Change) (1 mark) Social Cognitive Theory (1 mark) Leventhal's Self-regulatory theory (1 mark) Michie's Behaviour Change Wheel (1 mark)

Answer 318

A: Result of study B: 95% CI of result

Answer 319

**OR or RR** have a null **effect value of 1**. For absolute statistics like Absolute Risk or ARR or SMD, the **null difference value is 0.**

Answer 320

Standard error

Answer 321

One-half of a person’s ability to recover from illness is determined by **socioeconomic** factors

Answer 322

A phenomenon where if a woman’s symptoms don’t conform to those of men, they are often misdiagnosed and poorly treated (Criado-Perez, 2019)

Answer 323

**random error**

Answer 324

**random error**

Answer 325

**case-control study**