MET2 Qs Flashcards

Question

Which stage of shock would you see altered level of resp acidosis? Initial Compensatory Progressive Refractory

Answer 1

Which stage of shock would you see altered level of resp acidosis? Initial Compensatory **Progressive** Refractory

Answer 2

Which stage of shock would you see increased aldoesterone? Initial **Compensatory** Progressive Refractory

Answer 3

Which stage of shock would you see increased SNS activated? Initial **Compensatory** Progressive Refractory

Answer 4

Which stage of shock would you see cellular death ? Initial Compensatory Progressive **Refractory**

Answer 5

Liquorice can induce HTN - but what is the mechanism? Inhibition of 5 alpha reductase Augmentation of aldoseterone synthase **Inhibitition of 11 beta HSD2** 21 hydroxylase inhibition Converts cortisol to cortisone.

Answer 6

Fludrocortisone

Answer 7

hydrocortisone

Answer 8

Cushings syndome: * Hypokalameia (lose K, retain HCO3-) * Weight gain * Skin thinning * Met. alkalosis

Answer 9

Graves disease

Answer 10

Dexamethasone: give and should reduce

Answer 11

Peripheral tremor, palpitations and weight loss are associated with which of the following endocrinopathies? **Graves** Panhypopituitarism Hypercalcemia **MEN1 Syndrome**

Answer 12

Propylthiouracil Carbimazole

Answer 13

Paragangliomas

Answer 14

Flusing, watery diarrhoea and wheeze are suggestive of which endocrinopathy? Graves Pituitary macroadenoma Ectopic ACTH production **Carcinoid syndrome**

Answer 15

PYY is released by: Islet of Langerhan D cells Islet of Langerhan A cells Islet of Langerhan B Cells **Intestinal L cells** Stomach A cells

Answer 16

Oxontymodulin works by decreasing the level of which hormone: Insulin Glucagon **Ghrelin** Leptin PYY

Answer 17

Which hormone is the major peripheral orexigenic hormone? Insulin Glucagon **Ghrelin** Leptin PYY

Answer 18

Which cells secretes the major peripheral orexigenic hormone? Islet of Langerhan D cells Islet of Langerhan A cells Islet of Langerhan B Cells Intestinal L cells **Stomach A cells**

Answer 19

At which nucleus are the POMC, CART, NPY and AGrP located? Paraventricular nucleus Supraventricular Nucleus Nucleus solitary Tract **Arcuate Nucleus**

Answer 20

Which receptor mediates the effect of PYY most strongly? Y1 **Y2** Y3 Y4 Y5

Answer 21

α-melanocortin-stimulating hormone (α-MSH)

Answer 22

Vagal-Brain pathway is mediated by stimulation of which of the following by the Vagus Nerve? Paraventricular nucleus Supraventricular Nucleus **Nucleus solitary Tract** Arcuate Nucleus

Answer 23

Which of the following is 4? Vagus Nerve Superior Laryngeal Nerve External Laryngeal Nerve **Recurrent Laryngeal Nerve** Internal Laryngeal Nerve

Answer 24

Rectal varices can occur becuase of portal hypertension affecting which two veins? Inferior mesenteric and external iliac vein **Inferior mesenteric and internal iliac vein** Superior mesenteric and external iliac vein Superior mesenteric and internal iliac vein

Answer 25

Azygous and splenic veins

Answer 26

A: **pineal gland** B: **interthalamic adhesion** C: **sphenoid bone** D: **infundibulum** E: **hypothalamus**

Answer 27

Which of the following is responsible for melatonin & therefore circadiuan rhythm **A** B C D E

Answer 28

Look at this midsagittal slice taken from an MRI scan of the brain below. Which structure looks enlarged? Hypothalamus **Pituitary** Thalamus Pineal gland *The pituitary gland appears moderately enlarge. Here, we can see it filling the sella turcica, and we can see the hypothalamus displaced superiorly* *The hypothalamus itself appears normal, as do the thalamus and pineal gland, which are just about visible.*

Answer 29

*Acceptable responses: hypothalamus* The hypothalamus regulates the production of anterior pituitary hormones by releasing hypothalamic hormones into the hypothalamo-pituitary portal circulation. Note that the pituitary releases its hormones into the systemic circulation via the hypophyseal veins.

Answer 30

Which bone must be drilled through in pituitary surgery? Ethmoid Frontal Temporal **Sphenoid** This operation is known as transnasal, transsphenoidal hypophysectomy. An endoscope is passed into the nasal cavity, the mucosa is stripped away from the bone, and the surgeon drills through the sphenoid bone to visualise the pituitary from below. The procedure has revolutionised pituitary surgery, as it was previously very difficult to access the pituitary.

Answer 31

During a thryroidectomy the recurrent laryngeal nerve is damaged. How would you expect this present in the patient? **Hoarse voice** Aphonic Monotonous voice *The recurrent laryngeal nerve innervates the muscles of the larynx (apart from cricothyroid). Damage to one nerve results in a hoarse voice, and damage to both would result in aphonia*

Answer 32

1: omohyoid 2: sternohyoid 3: thyroid gland 4: recurrent laryngeal nerve 5: superior thyroid artery

Answer 33

A 35 year old male presents with a left cervical mass, that had grown within about 8 weeks. His MRI is shown below. Based on this, what signs would you expect his to present with? **Hoarse voice** **Dysphagia** **Dyspnea**

Answer 34

Which adrenal gland is pyramidal? Left **Right**

Answer 35

Brian has an abdominal examination. Which of the following statements best describes a normal Liver examination? **A healthy liver is not easily palpable** A healthy liver can be palpated during expiration only The Liver is palpated most easily posteriorly

Answer 36

Which structure separates the left lobe from the quadrate lobe? Gall bladder **Ligamentum teres** IVC Falciform ligament *The ligamentum teres (round lig of liver) runs between the left and quadrate lobes.*

Answer 37

*Acceptable responses: umbilical vein, left umbilical vein*

Answer 38

Which structures are within the Porta hepatis? **Hepatic artery proper** Common hepatic artery Hepatic vein **Hepatic portal vein** **Common bile duct**

Answer 39

Which blood vessel provides 75% of the blood supply for the Liver Hepatic artery proper Common hepatic artery Hepatic vein **Hepatic portal vein** Common bile duct

Answer 40

Brian has right sided heart failure. Into which vessels will blood back up? Pulmonary trunk Pulonary veins **IVC** **SVC**

Answer 41

*Acceptable responses*": Answer 1, Enlarged IVC, Dilated IVC, Enlarged Inferior vena cava, Dilated inferior vene cava

Answer 42

Which of the following transports iodine out of the follicular cell into the colloid NIS **PDS**: DUOX2 TPO IYD TSHR

Answer 43

Which of the following allows iodine to react with H2O2, allowing it bind it to Tyroglobulin NIS PDS DUOX2 **TPO** IYD TSHR

Answer 44

21-hydroxylase

Answer 45

Pretibial myxoedema Exophthalmos Diffuse goitre (without nodules)

Answer 46

**Carbimazole** is the first line anti-thyroid drug **Propylthiouracil** is the second line anti-thyroid drug.

Answer 47

Which one of the following features is most commonly seen with hypothyroidism? Weight loss **Constipation** Pretibial myexoedma Palpitations

Answer 48

Which one of the following features is most commonly seen with thyrotoxicosis? Constipation **Atrial fibrillation** Decreased tendon reflexes Lethargy

Answer 49

Which of the following is not a tributary to the splenic vein? Short gastric veins Pancreatic veins **Left gastric vein**: goes into portal vein Left gastro-omental vein

Answer 50

A 40-year-old woman presents with lethargy, weakness and weight loss. On examination her blood pressure is 80/50 mmHg and there is hyperpigmentation of the skin. What is likely disease? **Addisons** Cushings Hashimotos Graves

Answer 51

Which one of the following is most characteristically caused by thiazides? Hypocalcemia **Hypercalcemia** Hyperkalemia Hypernatremia

Answer 52

Thiazide duiretics primarily work at: PCT LoH **DCT** CD

Answer 53

One important adverse effect of long-term thiazide use is loss of potassium resulting in hypokalaemia.

Answer 54

Blocks NaKCl2: less Na reabsorbed into blood, so more water excreted into kidney

Answer 55

Blocks MR receptor: aldosterone antagonist Causes less Na reabsorbtion

Answer 56

Proinsulin --> Insulin and C-peptide Therefore if have low C-peptide levels, indicates that habe low insulin too and therefore DMT1

Answer 57

11β-HSD1 converts inactive cortisone into cortisol 11β-HSD2 inactivates cortisol to cortisone

Answer 58

Which scoring system would you used to indicate someone has a decomponsated liver Wells STAMP **Child-Pugh**: > 7 MUST

Answer 59

Which of the following is located outside of the external spermatic fascia Vas deferens Cremaster muscle Genitofemoral nerve Testicular vessels **Ilioinguinal nerve**

Answer 60

What structure is found at the mid point of the inguinal ligament? Femoral artery Femoral vein **Deep inguinal ring** Superficial inguinal ring

Answer 61

**alpha intercalated cells** of CD

Answer 62

A: Infindibulum B: Anterior lobe C: Hypothalamus D: Posterior lobe

Answer 63

CN4 – trochlear CN V1 & V2 - trigeminal (opthalmic and maxillary) CN 6 - abudecens ICA

Answer 64

What is the embryonic origin of the adrenal cortex? Neural crest cells **Mesoderm** Midgut Ectoderm

Answer 65

**'B' represents the zona fasiculata, which produces and secretes corticosteroids such as cortisol.**

Answer 66

Testosterone: **sexual characteristics** Cortisol: **stress response** Aldosterone: **regulation of sodium**

Answer 67

A: cortex B: zona glomerulosa C: zona fasciculata D: zona reticularis E: medulla

Answer 68

Which of the following produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids. A B C **D**: zona reticularis E

Answer 69

Which of the following produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids. A B C **D** E

Answer 70

Which of the following secrete adrenaline? A B C D **E**

Answer 71

Which of the following secretes aldosterone? A **B**: zona glomerulosa C D E

Answer 72

Which of the following secretes cortisol? A B **C** : zona fasciculata D E

Answer 73

Right and left adrenal veins drain the glands. The **right adrenal vein** drains into the **inferior vena cava** The **left adrenal vein** drains into the **left renal vein**.

Answer 74

A: Thyrohyoid B: Sternothyroid C: Omohyoid D: Sternohyoid

Answer 75

C5-T1 Sits on **Cricoid cartilage**

Answer 76

A: External carotid artery B: Superior thyroid artery C: Left parathyroid glands D: Inferior thyroid artery E: Thyrocervical trunk F: Recurrent laryngeal nerve G: Right parathryoid artery

Answer 77

A: Vagus nerve B: Superior laryngeal nerve C: Internal branch, superior laryngeal nerve D: External branch, superior laryngeal nerve

Answer 78

A: superior thyroid artery (from external carotid artery) B: Inferior thyroid artery (from tyrocervical trunk) C: Thyroid IMA artery (from brachiocephalic trunk)

Answer 79

A: IJV B: Superior thyroid vein C: middle thyroid vein D: inferior thyroid vein E: cricothryoid ligament

Answer 80

Parathyroid glands release parathyroid hormone, which mediates the release of which ion? K+ **Ca2+** NADH Na+ Cl-

Answer 81

Thyroid IMA: because is so variable Can cause post op. haemorrage which compresses the trachae

Answer 82

Which of the following is the splenic vein? A B C D **E**

Answer 83

Which of the following is the inferior pancreatoduodenal vein? A B C **D** E F

Answer 84

Which of the following is the superior pancreatoduodenal vein? A **B** C D E F

Answer 85

Which of the following is the portal vein? **A** B C D E F

Answer 86

Which of the following is the Which of the following is the inferior mesenteric vein? vein? A B C D E **F**

Answer 87

Above: **SMA** Below: **SMV**

Answer 88

Which of the following is the superior mesenteric vein? A B **C** D E

Answer 89

The superior, middle and inferior thyroid veins are responsible for the venous drainage of the thyroid gland. Where does the inferior thyroid vein empty into? External jugular vein Internal jugular vein **Brachiocephalic vein** Facial vein

Answer 90

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion? Branchial cyst Thyroid nodule Cystic hygroma **Thyroglossal cyst**

Answer 91

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion? Branchial cyst Thyroid nodule Cystic hygroma **Thyroglossal cyst**

Answer 92

Which embryological remnant might explain a central neck lump which ascends on tongue protrusion? Branchial cyst Thyroid nodule Cystic hygroma **Thyroglossal cyst**

Answer 93

Which organ secretes calcitonin? Kidney **Thyroid** Parathyroid Thymus Calcitonin is secreted by the thyroid glands. The synthesis of calcitriol is completed in the kidneys. Parathyroid hormone is secreted by the parathyroid glands. The thymus secretes thymosin, a hormone necessary for T cell development.

Answer 94

Which of the following is synthesised by intestinal epithelial cells? Calcitriol **Calbindin-D** Vitamin D3 24,25-Dihydroxycholecalciferiol Once synthesised, calcitriol is released into the bloodstream. It then stimulates intestinal epithelial cells to increase the synthesis of calbindin-D proteins. Calbindin-D proteins increase the intestinal absorption of calcium by facilitating the transport of calcium from the intestinal brush border to the basolateral membrane, where it is released into the bloodstream.

Answer 95

Lopez presented to his primary care physician complaining of numbness around his mouth and a tingling sensation in his hands and feet. Blood tests were ordered which revealed that his blood calcium levels were decreased. In physiological response to this, which hormone would typically be released to raise blood calcium levels? Insulin Thyroxine Calcitonin **Parathyroid Hormone**

Answer 96

What type of cells secrete parathyroid hormone? Beta cells **Chief cells** Chromaffin cells Parafollicular cells: secrete calcitoncin which reduces Ca2+ levels

Answer 97

Patients with hypocalcaemia can develop cardiac arrhythmias. Specifically, patients can develop prolonged QT intervals on an ECG. What causes this? An increase in the resting membrane potential, rendering the cell hyper-excitable An increase in the resting membrane potential, rendering the cell hypo-excitable **A decrease in the resting membrane potential, rendering the cell hyper-excitable** A decrease in the resting membrane potential, rendering the cell hypo-excitable

Answer 98

Which of the following can cause hypocalcaemia? Hyperparathyroidism **Respiratory alkalosis** Thiazide diuretics Vitamin D intoxication

Answer 99

Which hormones are secreted when blood calcium levels fall? Parathyroid hormone and calcitonin **Parathyroid hormone and calcitriol** Calcitriol only Calcitonin only

Answer 100

Which of the following can cause hypercalcaemia? Hypoparathyroidism Hyperphosphatemia Vitamin D deficiency **Thiazide diuretics**

Answer 101

Which of the following can cause hypercalcaemia? Hypoparathyroidism Hyperphosphatemia Vitamin D deficiency **Thiazide diuretics**

Answer 102

What are the main secretory cells of the adrenal medulla? Chief cells Juxtaglomerular cells **Chromaffin cells** Kupffer cells

Answer 103

What is the general mechanism for release of adrenaline from the adrenal medulla? Stimulation of Chromaffin cells by a protein-based stimulating hormone Stimulation of Chromaffin DNA transcription by steroid-based stimulating hormone **Stimulation of Chromaffin cells by sympathetic nervous system directly** Mechanism unknown

Answer 104

Which of the following is a symptom of phaechromocytoma? Hypotension **Hypertension** Hypoglycaemia Exophthalmos

Answer 105

Which enzyme catalyses the final step on the synthesis pathway for cortisol? 3β-hydroxysteroid dehydrogenase **11β-hydroxylase** 21β-hydroxylase 17,20-lyase

Answer 106

Which enzyme catalyses the final step on the synthesis pathway for cortisol? 3β-hydroxysteroid dehydrogenase **11β-hydroxylase** 21β-hydroxylase 17,20-lyase

Answer 107

Which of the following best describes the primary function of the Zona Glomerulosa? Breakdown of aldosterone Synthesis of testosterone **Synthesis of mineralocorticoids** Storage of adrenaline

Answer 108

Which of the following best describes the primary function of the Zona Glomerulosa? Breakdown of aldosterone Synthesis of testosterone **Synthesis of mineralocorticoids** Storage of adrenaline

Answer 109

Which of the following best describes the primary function of the Zona Glomerulosa? Breakdown of aldosterone Synthesis of testosterone **Synthesis of mineralocorticoids** Storage of adrenaline

Answer 110

Which of the following would produce an increase in the rate of aldosterone production? Increase in plasma pH (becomes more alkaline) Decrease in potassium ion concentation **Increase in plasma Angiotensin-II** All of the above

Answer 111

Conn’s syndrome is characterised by… Excess adrenaline secretion Excess ADH secretion Insufficient aldosterone secretion **Excess aldosterone secretion**

Answer 112

Which layers of the adrenal gland book-end the Zona Reticularis? Zona Fasiculata & Zona Glomerulosa Zona Glomerulosa & Medulla **Zona Fasiculata & Medulla** Zona Fasiculata & Cortex

Answer 113

Where are androgens such as DHEA converted to testosterone and oestrogen? Adrenal Medulla Liver **Gonads** Kidney

Answer 114

Bronzing of the palmar creases in Addison’s disease occurs by which mechanism? **Increased production of POMC leads to increased production of ACTH and MSH which stimulates pigmentation** The adrenal cortex produces decreased amounts of cortisol which causes direct disinhibition of melanin production Melanin production is stimulated by pituitary hormones that mimic the action of MSH In Addison’s, excess cortisol production causes the hypothalamus to signal to the skin to produce more melanin

Answer 115

In an abnormal short synACTHen test, which result is most definitive of Addison’s disease? Raised cortisol at baseline Low cortisol at baseline **Low cortisol 2 hours post ACTH administration** Raised ACTH at baseline

Answer 116

Cortisol exerts its effects by which mechanism? Binding to plasma membrane receptors Stimulating a chaperone to bind to an intracellular receptor **Binding to two GRs before translocating to the nucleus** Dissociating with glucocorticoid response elements within the nucleus

Answer 117

The hypothalamus secretes which hormone in the HPT axis? Thyroid stimulating hormone (TSH) Thyroid inhibitory hormone (TIH) Triiodothyronine (T3) **Thyrotrophin releasing hormone (TRH)**

Answer 118

What are the main direct actions of growth hormone? Lipolysis, stem cell differentiation, protein synthesis Carbohydrate oxidation, protein synthesis **Stem cell differentiation, glycogenolysis, lipolysis** Lipolysis, protein synthesis, protein synthesis

Answer 119

Which of the following symptoms best describes GH deficiency? Reduced bone mass, lack of energy, increased mood, arrhythmias **Arrhythmias, lower muscle mass, reduced energy, low mood** Low mood, anxiety, fibromyalgia, reduced energy, arrhythmias Increased muscle mass, arrhythmias, increased energy, low mood

Answer 120

Osteocytes secrete which of the following involved in Ca homeostasis Calcitriol Vit D **FGF23**: reduces serum P levels PTH 1 alpha hydroxylase

Answer 121

Which pathology of the thyroid is depicted here? Graves disease Thyroiditis **Hashimoto's disease**: can see lymphotcyte infiltration Thyroid adenoma

Answer 122

Where is a kidney stone in theis imaging? **Uteropelvic junction** Pelvic inlet Uterovesical junction

Answer 123

Where is a kidney stone in theis imaging? **Uteropelvic junction** Pelvic inlet Uterovesical junction

Answer 124

Where is a kidney stone in theis imaging? Uteropelvic junction Pelvic inlet Uterovesical inlet

Answer 125

Renal pelvis

Answer 126

A: Renal artery B: Segmental arteries C: Interlobar arteries D: Arcuate arteries E: Interlobal arteries

Answer 127

A: Afferent arterioles B: Glomerulus C: Efferent arterioles D: Peritubular capillaries / vasa recta

Answer 128

Renal Angle [1] Junction of 12th rib and lateral border of erector spinal [1]

Answer 129

Potential space that separates the **liver** and the **right kidney** [2]

Answer 130

A: Right suprarenal gland B: liver C: duodenum D: right colic flexure E: small intestines

Answer 131

Which is the only nerve of the lumbar plexus that passes through the psoas major? [1] Iliohypogastric Ilioinguinal **Genitofemoral** Lateral femoral cutaneous nerve Femoral nerve

Answer 132

A: **perinephtic fat** B: **renal fascia** C: **paranephric fat**

Answer 133

The renal fascia, commonly known as Gerota's fascia, is a collagenous connective tissue sheath which separates the **perirenal fat** from the **pararenal fascia**

Answer 134

A: renal pyramid B: major calyx C: minor calyx D: renal pelvis E: ureter

Answer 135

left gonadal (ovarian/testicular) vein, left inferior phrenic vein left adrenal veins.

Answer 136

A: Ultrapelvic junction B: Pelvic inlet C: Uterovesical junction

Answer 137

A: trigone of bladder B: prostatic urethra C: urethretic oriface D: detrusor muscle E: vas deferes

Answer 138

IUS and EUS are either side of **prostate**

Answer 139

A: prostatic urethra B: membranous urethra C: penile urethra D: bulbar urethra

Answer 140

What structures have been injured? **capsule / segmental arteries** Why flank pain? **referred pain from visceral afferents sensed at flank dermatomes** Why is the blood confined to the left? **renal fascia** Why haematuria? **Rupture of renal pelvis**

Answer 141

Explain the following: 1. Pain occurring in ‘waves’ 2. Location of stone 3. Radiation of pain to groin

Answer 142

In a storage vesicle containing endogenous insulin, what is the ratio of insulin to free c-peptide? **1:1** 2:1 3:1 1:2

Answer 143

Which of the following best describes the mechanism by which insulin allows cells to uptake glucose? Activation of GLUT4 receptors Upregulation of DNA transcription of GLUT4 receptors **Activation of insulin receptor's integrated tyrosine kinase** Cooperative diffusion of glucose with insulin

Answer 144

Which of the following hormones promotes gluconeogenesis? **Cortisol** Insulin Pyruvate Acetyl-CoA

Answer 145

After how many hours of fasting does gluconeogenesis begin? **8 hours** 4 hours 24 hours 12 hours

Answer 146

What causes inhibition of fatty acid oxidation in alcohol abuse? Decreased NADH levels **Excess NADH levels** Decreased ATP levels Increased NAD+ levels

Answer 147

What molecule is depleted in alcohol abuse? Lactate GTP NADH **Pyruvate** Pyruvate is depleted in alcohol abuse, whereas NADH is in excess.

Answer 148

DMT1 LADA (Late autoimmune diabetes

Answer 149

- Short / Fast acting: **Humalog** - Long acting: **Glargine**

Answer 150

Which of the following drug treatments for diabetes utilise the followng mechanism of actions? *Inhibits liver gluconeogenesis and enahnaces insulin sensitivity* * Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide * **Metformin** * SGLT2 Inhibitors * Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 151

Which of the following drug treatments for diabetes utilise the followng mechanism of actions? * **Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide** * Metformin * SGLT2 Inhibitors * Thiazolidinediones e.g Pioglitazone or Rosiglitazone *Bind and close K+ channel in beta cells to* *depolarise the cell and release insulin*

Answer 152

Which of the following drug treatments for diabetes utilise the followng mechanism of actions? *Activate PPARγ to reduce insulin insensitivity and better glucose use via gene expression changes* * Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide * Metformin * SGLT2 Inhibitors *** Thiazolidinediones e.g Pioglitazone or Rosiglitazone**

Answer 153

Which of the following drug treatments for diabetes causes weight loss? * Sulfonylureas - e.g. gliclazide, glibenclamide and tolbutamide * Metformin * **SGLT2 Inhibitors**: excreting glucose * Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 154

Which of the following drug treatments for diabetes causes weight gain? [2] * **Sulfonylureas** - e.g. gliclazide, glibenclamide and tolbutamide * Metformin * SGLT2 Inhibitors * **Thiazolidinediones** e.g Pioglitazone or Rosiglitazone

Answer 155

Which of the following has similar action to prandial glucose regulators? * **Sulfonylureas** - e.g. gliclazide, glibenclamide and tolbutamide * Metformin * SGLT2 Inhibitors * Thiazolidinediones e.g Pioglitazone or Rosiglitazone

Answer 156

arachidonic acid is which type of omega fatty acid? omega 2 fatty acid omega 3 fatty acid omega 4 fatty acid omega 5 fatty acid **omega 6 fatty acid**

Answer 157

Phospholipase A2

Answer 158

Flavinoids are important because they reduce inflammatory enzymes such as **NADPH oxidase**

Answer 159

Which of the following is the action of PYY? **Inhibits excitatory appetite neurones** Stimulates excitatory appetite neurones Inhibits inhibitory appetite neurones None of the above

Answer 160

Which of these transmitters is stimulatory for appetite? **NPY** POMC a-MSH CART

Answer 161

Which structure in the hypothalamus is a key player in appetite control? Preoptic nucleus Supraoptic nucleus **Arcuate nucleus** Lateral nucleus

Answer 162

Which hormone may be deficient in a patient with severe obesity, hyperphagia, and a reduced metabolic rate? Ghrelin Insulin **Leptin** PYY (peptide tyrosine tyrosine)

Answer 163

Release of which of the following substances is inhibitory for appetite? Ghrelin AgRP (Agouri-related peptide) NPY (Neuropeptide Y) **CART**

Answer 164

Alpha-MSH and Beta-endorphin may be produced from which neurotransmitter? CART (cocaine- and amphetamine regulated transcript) **POMC (pro-opiomelanocortin)** NPY (Neuropeptide Y) AgRP (Agouri-related peptide)

Answer 165

A 50-year-old woman with a BMI of 39 presents with her son. The son says that her mother just cannot stop eating and would like to explore various treatment options to curtail her eating habits. The woman's history is significant for severe hypertension and diabetes mellitus. A resistance in which of the following hormones is most likely responsible for his mother's presentation? A. Ghrelin **B. Leptin** C. Cholecystokinin D. Secretin

Answer 166

A 5-year-old male is brought to the clinic by his mother for evaluation of his growth. The patient is in the 10th percentile for height and weight, with an otherwise normal physical evaluation. Which of the following plays a role as a growth hormone-releasing peptide and may be deficient in this child? A. Cholecystokinin B. Leptin C. **Ghrelin** D. Hormone peptide YY

Answer 167

L cells in GI tract produce: Cholecystokinin Leptin Ghrelin **Hormone peptide YY**

Answer 168

A 35 year old female is 4 weeks post-partum and presents with a 3 day history of progressively worsening right upper quadrant pain that radiates to her shoulder, and is worse after eating particularly fatty food. She occasionally has nausea and vomiting after meals. She denies any fevers or malaise. She notes that she had gallstones incidentally found on an ultrasound in the past, but they have never bothered her before. What has likely changed to make her asymptomatic gallstones now symptomatic? Gallstones are seeded with intestinal bacteria Gallstones have likely increased in size and number Gallstones have migrated into the common hepatic duct **Gallstones are now obstructing the cystic duct causing gallbladder distention**

Answer 169

A: Left lobe B: Right lobe C: Quadrate lobe D: Caudate lobe

Answer 170

Which of the following is hepato-renal recess? A B C **D** E F

Answer 171

A: Falciform ligament B: Right subphrenic space C: epiploic foramen D: hepato-renal reccess E: subphrenic space F: lesser sac

Answer 172

A: Anterior coronary ligament B: Falciform Ligament C: Round ligament of the liver / ligamentum teres

Answer 173

A: Right triangular ligament B: Posterior coronary ligament C: Left triangular ligament D: Falciform ligament E: Anterior coronary ligament

Answer 174

Which of the following is the quadrate lobe? A B C D E **F**

Answer 175

Which of the following is the ligamentum teres ? A B C D **E** F

Answer 176

Which of the following is the ligamentum venosum ? **A** B C D E F

Answer 177

Which of the following is the caudate lobe ? A **B** C D E F

Answer 178

Which of the following is the lportahepatis? A B **C** D E F

Answer 179

**umbilical vein** to the **inferior vena cava**

Answer 180

A: Ligamentum venosum B: Falciform ligament C: Round ligament of the liver/ Ligamentum teres

Answer 181

Within free border of lesser omentum is the **hepatic portal vein, hepatic artery proper and the bile duct.**

Answer 182

A: Hepatic portal vein B: Hepatic artery C: Bile duct D: Bile canalliculi E: Central vein

Answer 183

At what vertebral level do the two common iliac veins unite to form the inferior vena cava? L2 **L5** T5 T8

Answer 184

Which vein does NOT drain directly into the inferior vena cava? Left renal vein **Splenic vein** Right hepatic vein Right testicular vein The splenic vein drains into the portal system, which in turn empties into the inferior vena cava.

Answer 185

Which of the following is not a tributary to the splenic vein? Short gastric veins Pancreatic veins **Left gastric vein** Left gastro-omental vein **The left gastric vein is a tributary of the portal vein.**

Answer 186

A: cystic duct B: common hepatic duct C: Right hepatic duct D: Left hepatic duct E: Common bile duct

Answer 187

Stone blocks bile leaving the gall bladder, when gall bladder contracts, **RUQ pain AND Bilary colic** (Biliary colic happens when the gallbladder contracts and causes a gallstone to temporarily block the duct).

Answer 188

A: splenic artery B: gastroduodenal artery C: hepatic artery proper D: SMA E: SMV F: Hepatic portal vein

Answer 189

A: Coronary Ligament B: Right Triangular Ligament C: Left triangular Ligament

Answer 190

A: coronary ligaments B: falciforms ligament

Answer 191

Which of the following is the hepatic artery proper A B C D E F G **H**

Answer 192

Which of the following is the common hepatic duct A B C **D** E F G H

Answer 193

Which of the following is the hepatic portal vein A B C D E F **G** H

Answer 194

Which of the following is the cystic duct A **B** C D E F G H

Answer 195

(a) Gallbladder with stones (b) Stone in bile duct (c) Pancreatic duct (d) Duodenum.

Answer 196

Which of the following types of hyperparathyroidism best describes a high plasma PTH concentration secondary to low plasma calcium concentrations? Primary hyperparathyroidism **Secondary hyperparathyroidism** Tertiary hyperparathyroidism Malignant hyperparathyroidism This is an example of secondary hyperparathyroidism, where low calcium from other causes (eg renal) trigger an increase in PTH secretion. ## Footnote ****

Answer 197

Which embryological origin do the superior parathyroid glands come from? 1st pharyngeal pouch 2nd pharyngeal pouch 3rd pharyngeal pouch **4th pharyngeal pouch** 5th pharyngeal pouch mesoderm

Answer 198

Which of the following best describes the ARTERIAL supply to the Thyroid gland? Superior artery Inferior artery Superior, Middle and Inferior arteries **Superior and Inferior arteries**

Answer 199

Kal protein

Answer 200

V2 receptors

Answer 201

Which hypothalamic nuclei is involved with particularly with the HPA axis? [1] Arcuate nucleus **Paraventricular nucleus** Supra-optic nucleus Nuclues solitary tract

Answer 202

Which hypothalamic nuclei is involved with circadian rythym and sleep cycle? [1] Arcuate nucleus Paraventricular nucleus **Supra-optic nucleus** Nucleus solitary tract

Answer 203

Growth Hormone regulation is derived from which nucleus? **Arcuate nucleus** Paraventricular nucleus Supra-optic nucleus Nucleus solitary tract

Answer 204

Growth Hormone regulation is derived from which nucleus? **Arcuate nucleus** Paraventricular nucleus Supra-optic nucleus Nucleus solitary tract

Answer 205

Gigantism and acromegaly due to Xq26 micropduplications and **GPR101 mutation**

Answer 206

**Kisspeptin**

Answer 207

Kal protein

Answer 208

Q Which of the following is the most effective type of diuretic? Carbonic anhydrase inhibitors Thiazide **Loop** Potassium sparing diuretics Osmotic diuretics

Answer 209

there is a very good correlation between high **C4d** levels and **donor specific** antibodies.

Answer 210

Below arcuate line the abdo wall is weaker

Answer 211

**ASIS** to **pubic tubercle**

Answer 212

A: Internal spermatic fascia B: cremaster muscle C: external spermatic fascia

Answer 213

A: transversalis fascia B: transversalis abdominis C: internal oblique D: external oblique

Answer 214

cysteic artery

Answer 215

A: **coeliac trunk** B: **splenic artery** C: **hepatic artery proper** D: **gastroduodenal**

Answer 216

jejnunal and ileal branches of SMA are found in the **mesentary**? - photo = **jejunum**

Answer 217

A: **jenunal** B: **superior mesentric C ileocolic**

Answer 218

hepatic artery proper and hepatic portal vein

Answer 219

**A: left colic B: sigmoidal C: superior rectal**

Answer 220

When does primitive gut tube develop? After 2 weeks After 3 weeks **After 4 weeks** After 5 weeks

Answer 221

PPI Puborectalis Puboccygeus Iliococcygeus

Answer 222

Which muscle is depicted? Puborectalis **Pubcoccygeus** Iliococcygeus

Answer 223

Which muscle is depicted? **Puborectalis** Pubcoccygeus Iliococcygeus

Answer 224

Which muscle is depicted? Puborectalis Pubcoccygeus **Iliococcygeus**

Answer 225

valves of Houston

Answer 226

EAS and puborectalis muscles

Answer 227

A 58-year-old man presents to the breast clinic with an isolated lump in the upper-right quadrant of his right breast. The nodule is smooth and firm. He is told the most likely diagnosed with gynecomastia. He has a past medical history of non-alcoholic liver disease, hypertension and gout. His current medications include: Bisoprolol Naproxen Allopurinol What is the most likely cause of his breast lump? **Liver disease - This is the correct answer, Liver disease is associated with impaired oestrogen metabolism, which can cause breast tissue growth.**

Answer 228

A 50-year-old female presents to the GP with concerns about her weight. She has a body mass index (BMI) of 31 and you are concerned about a diagnosis of metabolic syndrome. Which of the following is one of the diagnostic criteria for this? BMI >25 Peripheral arterial disease **Dyslipidaemia** Steatohepatitis HDL-cholesterol >50 mg/dL

Answer 229

A patient presents with weight loss, nausea, vomiting, abdominal pain, and hyperpigmentation of the skin. The doctor orders a urea & electrolyte test and a short Synacthen test which comes back abnormal and diagnoses the patient with Addison's disease. What electrolyte abnormality would you most likely expect to see in this patient? **Hyperkalaemia & hyponatraemia** Hypokalaemia & hyponatraemia Hyperkalaemia & hypernatraemia Hypokalaemia & hypernatraemia Normal sodium and potassium levels **Addison's disease - no aldosterone or cortisol is produced**

Answer 230

A 34-year-old male presents to the GP with a new diagnosis of Conn's syndrome. As a result of this they are producing too much aldosterone. What will this do to the sodium and potassium balance in the blood? Decreased sodium, increased potassium Decreased sodium, decreased potassium **Increased sodium, decreased potassium** Increased sodium, increased potassium No change

Answer 231

A 22-year-old lady presents with an episode of renal colic and following investigation is suspected of suffering from MEN IIa. Which one of the following abnormalities of the parathyroid glands are most often found in this condition? Hypertrophy **Hyperplasia** Adenoma Carcinoma Metaplasia Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma - multiple endocrine neoplasia type IIa

Answer 232

A 34-year-old gentleman presents to the general practice as for the past fortnight he has been feeling weak and has been getting regular muscle cramps. He is otherwise asymptomatic. On examination, you find a widespread hyporeflexia. You perform a blood test, which shows hypokalaemia. You have not yet identified a cause for the abnormality. Which of the following conditions is associated with hypokalaemia? Congenital adrenal hypoplasia Metabolic acidosis Addison's disease **Conn's syndrome** Rhabdomyolysis The correct answer is Conn's syndrome. Conn's syndrome describes a condition of primary hyperaldosteronism. Aldosterone is important in maintaining potassium balance as it binds to and activates Na+/K+ pumps. This causes the movement of potassium into the cells. However, in excess, like that found in Conn's syndrome, the resultant movement of potassium into cells can result in hypokalaemia.

Answer 233

Use of corticosteroids can worsen diabetic control due to their anti-insulin effects

Answer 234

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition? **Formation of IgG antibodies to the TSH receptors on the thyroid gland** Formation of IgG antibodies to the TRH receptors on the anterior pituitary Formation of IgM antibodies to the TSH receptors on the thyroid gland Formation of IgA antibodies to the TSH receptors on the thyroid gland Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 235

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition? **Formation of IgG antibodies to the TSH receptors on the thyroid gland** Formation of IgG antibodies to the TRH receptors on the anterior pituitary Formation of IgM antibodies to the TSH receptors on the thyroid gland Formation of IgA antibodies to the TSH receptors on the thyroid gland Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 236

A 22-year-old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work up results in a diagnosis of Graves disease. Which one of the following best describes the pathophysiology of the condition? **Formation of IgG antibodies to the TSH receptors on the thyroid gland** Formation of IgG antibodies to the TRH receptors on the anterior pituitary Formation of IgM antibodies to the TSH receptors on the thyroid gland Formation of IgA antibodies to the TSH receptors on the thyroid gland Formation of IgM antibodies to the TRH receptors on the anterior pituitary

Answer 237

A young girl presents with her mother due to ambiguous genitalia that is causing them concern. After taking a history and several investigations, her doctor diagnoses her with congenital adrenal hyperplasia and says that this is due to a deficiency of a particular enzyme. Which enzyme is this? 5-a reductase **21-hydroxylase** Aromatase 17B-HSD Aldosterone synthase 21-hydroxylase deficiency results in low production of cortisol and compensatory adrenal hyperplasia. This results in increased androgen production and ambiguous genitalia. Other implicated enzymes are 11-beta hydroxylase and 17-hydroxylase.

Answer 238

A 42-year-old lady presents to her GP with racing palpitations with no apparent trigger and intermittent headaches. She has no significant past medical history and denies stress at home or at work. On examination you find her to be sweating with pallor of the conjunctiva. Her heart rate is 120bpm regularly regular and her blood pressure is 150/100mmHg. You suspect a phaeochromocytoma, a tumour of the adrenal medulla. What test is most likely to be diagnostic? 24 hour urinary free cortisol Aldosterone-renin plasma ratio Short synacthen test Plasma testosterone level **Urinary free adrenaline**

Answer 239

A 42-year-old lady presents to her GP with racing palpitations with no apparent trigger and intermittent headaches. She has no significant past medical history and denies stress at home or at work. On examination you find her to be sweating with pallor of the conjunctiva. Her heart rate is 120bpm regularly regular and her blood pressure is 150/100mmHg. You suspect a phaeochromocytoma, a tumour of the adrenal medulla. What test is most likely to be diagnostic? 24 hour urinary free cortisol Aldosterone-renin plasma ratio Short synacthen test Plasma testosterone level **Urinary free adrenaline**

Answer 240

A 59-year-old man is a known type 2 diabetic. He presents to the GP for review and is started on a new medication, a glucagon-like peptide (GLP-1) analogue. Physiologically, from what part of the body is this hormone normally secreted? Jejunum Pancreas Duodenum **Ileum** Liver

Answer 241

A 41-year-old woman has been admitted to the renal ward with acute kidney injury. A blood test shows that her potassium is above normal limits. Renal failure is a cause of hyperkalaemia and you note that this patient's potassium disturbance is likely due to her current renal function. However, on exploring her past medical history the patient tells you that she has an endocrine disorder, but cannot remember its name. You note that this may be important as you know that some endocrine disorders can cause disturbances in potassium. Which of the following endocrine disorders is associated with hyperkalaemia? Phaeochromocytoma **Addison's disease** Hyperthyroidism Conn's syndrome Cushing's syndrome

Answer 242

mother brings her 15-year-old daughter to see you as she is worried about her development. She is very tall for her age, has not yet started her menstrual cycle and has developed dark facial hair. She is referred to a specialist who diagnoses mild congenital adrenal hyperplasia. What deficiency is the most common cause of this condition? 17-hydroxylase deficiency 17β-hydroxysteroid dehydrogenase deficiency 5-alpha reductase deficiency **21-hydroxylase deficiency** 11-beta hydroxylase deficiency 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia making option 4 the correct answer.

Answer 243

A 44-year-old lady presents with a pathological fracture of the left femur. She has previously undergone a renal transplant for end stage renal failure. Her blood test results are as follows: Serum Ca2+ 2.80 PTH 88pg/ml Phosphate 0.30 A surgeon decides to perform a parathyroidectomy on the basis of these results. When the glands are assessed histologically, which of the appearances is most likely to be identified? Metaplasia the gland Hypertrophy of the gland **Hyperplasia of the gland** Parathyroid carcinoma Necrosis of the parathyroid gland This is likely to be a case of tertiary hyperparathyroidism (high Calcium, high PTH, low phosphate). Therefore the glands will be hyperplastic. Hypertrophy is not correct as this implies an increase in size without an increase in cellularity.

Answer 244

A 54-year-old patient presents to his general practitioner for a review of his diabetes treatment. He takes metformin. He is worried about adding additional medications that might cause hypoglycaemia. He has a past medical history of bladder cancer, which was surgically treated. The examination is unremarkable other than an elevated body mass index (32 kg/m²). Recent blood test results: HbA1c 61 mmol/L (more than 48) His GP would like to commence him on a medication that does not cause weight gain or hypoglycaemia. What is the likely mechanism of action of this drug? Agonist of PPAR-gamma receptor Binding of ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells Exogenous insulin Inhibition of intestinal alpha glucosidases **Reduction of the peripheral breakdown of incretins such as glucagon-like peptide (GLP-1)**

Answer 245

A 56-years-old man with a past medical history of type II diabetes mellitus returns to his GP for a follow up. He denies polyuria and polydipsia. Repeat blood tests at clinic showed: HbA1c 67 mmol/mol Random plasma glucose 15.6 mg/l He currently only takes metformin and his GP decides to add in gliclazide to his regular medication. What is the mechanism of action of gliclazide? Inhibits dipeptidyl peptides-4 **Stimulates sulphonylurea-1 receptors** Inhibits alpha-glucosidase enzymes Glucagon-like peptide-1 analogues Inhibits sodium-glucose cotransporter 2

Answer 246

A 13-year-old boy is brought into the clinic by his mother, who is concerned that he is much shorter than other boys his age. The boy also reveals that many people comment on his appearance, likening him to a toy doll. What can be said about the release pattern of the hormone he is most likely to be deficient in? Secreted throughout the day Only released at night Released diurnally **It is released in a pulsatile manner** Released in a single spike at 8am The boy's presentation is indicative of growth hormone deficiency. This can result in short stature, forehead prominence and maxillary hypoplasia, giving the doll appearance. The release of growth hormone is controlled by growth hormone releasing hormone, which is released by the hypothalamus in a pulsatile manner. For this reason, measurements of GHRH are not useful in investigating growth hormone deficiency.

Answer 247

A 22-year-old woman attends her GP surgery as she is finding it exceedingly difficult to lose weight. She currently has a body mass index (BMI) approaching 40 kg/m², and it is severely affecting her mental and physical health. A strict diet and exercise regime has not made a significant difference. The GP decides to prescribe her an anti-obesity agent, orlistat. How does the prescribed medication promote weight loss? Increases metabolism through mitochondrial uncoupling **Reduces fat digestion by inhibiting lipase** Promotes glucose uptake through increased insulin secretion Suppresses appetite through reduced uptake of serotonin Improves satiety by reducing gastric emptying

Answer 248

A 26-year-old female attends an outpatients appointment having recently diagnosed with Grave's disease. This is typically characterised by three unique signs. Along with thyroid eye disease what other signs are they? Thyroid acropachy & thyroid lymphoedema Thyroid arthritis & pretibial myxoedema Thyroid arthritis & thyroid lymphoedema Thyroid acropachy & deep vein thrombosis **Thyroid acropachy & pretibial myxoedema**

Answer 249

A 19-year-old man presents to the emergency department with abdominal pain, vomiting, polyuria, polydipsia and confusion for the last 12 hours. On examination, he has mild generalised abdominal tenderness without guarding. His breathing is noted to be deep and rapid. He has a history of type 1 diabetes but he admits to poor compliance with his insulin. Which of the following is the likely pathophysiology? Activation of the sympathetic nervous system secondary to decreased levels of glucose Elevated serum lactate levels Inflammation of the inner lining of the vermiform appendix Inflammatory reaction of the urinary tract in response to bacteria **Uncontrolled lipolysis which results in an excess of free fatty acids** DKA

Answer 250

An 8-year-old boy with type 1 diabetes presents to the emergency department with vomiting. You take a brief history and establish he has recently had a chest infection. Upon investigation, you find ketones in the urine and his blood sugars are elevated, therefore highly suspect diabetic ketoacidosis. Which is the primary ketone body involved in diabetic ketoacidosis? **Acetoacetate** Beta-hydroxybutyrate Acetone Beta-hydroxypentanoate Succinate

Answer 251

A 72-year-old woman with back pain and chronic renal failure has the following blood test results: Reference range Ca2+ 2.03 2.15-2.55 mmol/l Parathyroid hormone 10.4 1-6.5 pmol/l Phosphate 0.80 0.6-1.25 mmol/l What is the most likely diagnosis? Hypoparathyroidism Primary hyperparathyroidism **Secondary hyperparathyroidism** Tertiary hyperparathyroidism Pseudohypoparathyroidism In relation to secondary hyperparathyroidism; there is a HIGH PTH and the Ca2+ is NORMAL or LOW. In secondary hyperparathyroidism there is hyperplasia of the parathyroid glands in response to chronic hypocalcaemia (or hyperphosphataemia) and is a normal physiological response. Calcium is released from bone, kidneys and the gastrointestinal system.

Answer 252

A 31-year-old alcoholic woman is admitted to the gastroenterology ward with visible jaundice and confusion. On examination, she has a distended tender abdomen with hepatomegaly and shifting dullness is present. All her observations are normal. Blood tests are reported below. Hb 121 g/L Females: 115 - 160 g/L MCV 103 g/L 82-100 g/L Bilirubin 78 µmol/L 3 - 17 µmol/L ALP 112 u/L 30 - 100 u/L ALT 276 u/L 3 - 40 u/L AST 552 u/L 3 - 30 u/L γGT 161 u/L 8 - 60 u/L An aspirate of fluid is taken and shows a serum-ascites albumin gradient (SAAG) of 14 g/L. What diagnosis most likely explains the SAAG value of the patient? Biliary ascites Bowel obstruction Nephrotic syndrome **Portal hypertension** Severe malnutrition **Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension**

Answer 253

Sam, a 6-year-old boy, undergoes surgery to correct a inguinal hernia. During the operation the surgeon is able to identify the hernia and its surrounding vessels and structures. He can confirm that Sam has a indirect inguinal hernia due to the hernias relationship to the epigastric vessels. Which of the following can help the surgeon confirm an indirect hernia? Indirect hernia is anterior to the epigastric vessels Indirect hernia is posterior to the epigastric vessels Indirect hernia is medial to the epigastric vessels **Indirect hernia is lateral to the epigastric vessels** Indirect hernia is superior to the epigastric vessels

Answer 254

A 64-year-old presents to the emergency department with a large swelling of the abdomen. He admits to drinking increasing volumes of alcohol over the 5 years since losing his job but otherwise has no significant history. On examination, shifting dullness is present. The doctor orders an ascitic tap (paracentesis) to be performed as well as liver function tests. The doctor suspects portal hypertension. Which of the following results would most strongly indicate this? Cloudy ascitic fluid appearance Serum-ascites albumin gradient (SAAG) of 0.9 g/L AST:ALT ratio <1 Serum-ascites albumin gradient (SAAG) of 4.5 g/L **Serum-ascites albumin gradient (SAAG) of 13.1 g/L**

Answer 255

A 47-year-old lady presents to the Emergency Department with chronic dull pain in the upper right part of her abdomen. Ultrasound shows a gallbladder mass. Biopsy reveals adenocarcinoma of the gallbladder. This is a tumour originating from gallbladder epithelial cells. What would be the best description of these epithelial cells? **Simple columnar** Simple cuboidal Simple squamous Pseudostratified columnar Transitional

Answer 256

A 57-year-old man who has had multiple emergency department admissions for alcohol related injuries and admissions under the general medical team for alcohol withdrawal, presents acutely unwell after a twelve day drinking binge. He is icteric, confused and has hepatomegaly. There are stigmata of chronic liver disease. Admission blood work shows a thrombocytopaenia, transaminitis with hyperbilirubinemia and a severe coagulopathy. A diagnosis of severe acute alcoholic hepatitis is made. With respect to the coagulopathy associated with liver disease, which clotting factor is characteristically increased? **Factor VIII** Factor II Factor IX Factor VII Factor XII In liver failure all clotting factors are low, except for factor VIII which is paradoxically supra-normal. This is because factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells

Answer 257

A 58-year-old solicitor is brought into hospital with severe abdominal pain which began earlier in the day and has lasted for over 3 hours. The pain is sharp and radiates through to his back. He rated the pain 8/10 on the pain scale. The pain is reduced when he sits up. On examination he is extremely restless, cold and clammy with a pulse rate of 124bpm, a blood pressure of 102/65 and you notice some purple colouration in his left flank. Bowel sounds were normal. His social history reveals that he has a history of excessive alcohol consumption. Which of the following is the most likely diagnosis? Intestinal obstruction Paralytic ileus **Acute pancreatitis** Acute appendicitis Chronic kidney disease Pancreatitis is the most likely diagnosis for the following reasons. The history suggests that the man is an alcoholic and this is a risk factor in itself for pancreatitis. The sharp pain is severe and radiates to the back which is typical in pancreatitis. There is evidence of jaundice and circulation collapse

Answer 258

A 73-year-old lady presents with a femoral hernia. Which one of the following structures forms the lateral wall of the femoral canal? Pubic tubercle **Femoral vein** Femoral artery Conjoint tendon Femoral nerve

Answer 259

A neonate rapidly becomes unwell and develops jaundice six hours after birth. Blood tests reveal an unconjugated hyperbilirubinaemia. Which of the following is a precursor to bilirubin and is being released in excess amounts, resulting in this child's presentation? Albumin **Haem** Urobilinogen Glutamate Glucuronic acid

Answer 260

A 44-year-old woman presents to the emergency department with severe right-sided abdominal pain. On further questioning, the pain is crampy, comes and goes in waves and radiates to her right shoulder. She is apyrexial. The patient reports that the pain is worst after eating. What hormone is responsible for this variation in pain? **Cholecystokinin** Gastrin Insulin Secretin Vasoactive intestinal peptide **CCK - increases gallbladder contraction**

Answer 261

A patient presents to the GP with swelling in the groin, on the left. It does not have a cough impulse. The GP suspects a femoral hernia. Which of the following is the most common risk factor for femoral hernias? Male gender **Female gender** Young children Obesity Pregnancy

Answer 262

A 65-year-old man presents with severe upper abdominal pain, fever, and vomiting. He is diagnosed with acute pancreatitis. Which of the following liver function tests is raised disproportionately in pancreatitis? Unconjugated bilirubin Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) **Amylase** Gamma glutamyltransferase (GGT)

Answer 263

Which of the following liver function tests is raised disproportionately in obstructive liver diseases? Unconjugated bilirubin Alanine aminotransferase (ALT) **Alkaline phosphatase (ALP)** Amylase Gamma glutamyltransferase (GGT)

Answer 264

Which of the following liver function tests is raised disproportionately in hepatic injury? Unconjugated bilirubin **Alanine aminotransferase (ALT)** Alkaline phosphatase (ALP) Amylase Gamma glutamyltransferase (GGT)

Answer 265

Which of the following liver function tests is raised disproportionately in hepatic injury? Unconjugated bilirubin **Alanine aminotransferase (ALT)** Alkaline phosphatase (ALP) Amylase Gamma glutamyltransferase (GGT)

Answer 266

**An AST/ALT ratio higher than one** (where the AST is higher than ALT) means you may have cirrhosis.

Answer 267

raised ALP (with GGT also raised)

Answer 268

Raised ALT

Answer 269

An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have **non-alcoholic fatty liver disease.**

Answer 270

**Cirrhosis**

Answer 271

An AST/ALT ratio higher than 2:1 (where the AST is more than twice as high as the ALT) is a sign of **alcoholic liver disease**

Answer 272

Ella, an 18-year-old girl with type 1 diabetes mellitus, presents to the emergency department with vomiting, abdominal pain and confusion. On examination she has tachycardia and tachypnoea. The doctors organises a range of investigations including an arterial blood gas. Results are as follows: pH 7.29 mmol/l K+ 6.0 mmol/l Glucose 15mmol/l The doctors begin to treat for diabetic ketoacidosis. What abnormality can be seen on the ECG, with regards to Ella's potassium level? Tall P waves Delta waves U waves and T wave depression Tall tented T waves and tall P waves **Tall tented T waves and flattened P waves**

Answer 273

A 48-year-old woman presents to the Emergency Department with colicky abdominal pain. She reports that for the last three months, she has experienced intermittent pain in the right upper quadrant, particularly after the ingestion of fatty foods. What cells are responsible for producing the hormone implicated in this presentation? B cells D cells G cells **I cells** : produce CCK in samll intestine S cells

Answer 274

A 56-year-old woman presents to the GP with a 3-month history of colicky right upper quadrant pain occurring periodically. Her worst episode lead her to present today, it occurred last night after she had a takeaway. The pain was so bad it made her vomit. On examination, her temperature was 37.7ºC, respiratory rate 14/min, blood pressure 118/75mmHg and oxygen saturation was 98%. Her abdomen was soft and non-tender. Murphy's sign was negative. What hormone is causing her symptoms? **Cholecystokinin (CCK)** - Cholecystokinin (CCK) is the correct answer as this woman is suffering from a classic presentation of biliary colic. CCK is released from the duodenum when fatty foods are ingested, to increase gallbladder contraction, which leads to biliary colic. Gastrin Prostaglandin Secretin Somatostatin

Answer 275

A 22-year-old man presents to the emergency department with abdominal pain and vomiting. He has not opened his bowels for the past four days. His past medical history includes a ruptured appendix two years previously. The patient has no other past medical or family history of note. On examination, you note abdominal distension and tinkling bowel sounds. Abdominal X-ray reveals dilated loops of small bowel. What is the most common cause of the likely diagnosis in this case? **Adhesions** - Adhesions are the most common cause of small bowel obstruction Due to the patient's past medical history they are likely to have received abdominal surgery. They are therefore at risk of developing adhesions - a band of scar tissue that can cause internal body surfaces to stick together. Hernia Intussusception Malignancy Volvulus

Answer 276

A 55-year-old male is brought to your clinic by his wife due to concerns of his 'skin and eyes looking yellow' and has worsened since it started 3 months ago. On systematic examination, you noticed jaundice and cachexia but it is otherwise unremarkable. On further questioning the man himself reports that his urine has been getting darker as well as stools becoming paler. You order an urgent CT scan which showed a mass lesion at the head of the pancreas. Which of the following process directly explains the colour of his stools? Increase in unconjugated bilirubin in the systemic circulation **Decrease in stercobilin** - question asks about the stools Increase in amount of bilirubin metabolised to urobilinogen Lack of conjugation of bilirubin by the liver Decreased overall production of bilirubin

Answer 277

Which one of the following forms the medial wall of the femoral canal? Pectineal ligament Adductor longus Sartorius **Lacunar ligament** Inguinal ligament

Answer 278

A 73-year-old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily? Para aortic **Internal iliac** Superficial inguinal Meso rectal None of the above

Answer 279

A 73-year-old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of the following lymph nodes will the tumour drain primarily? Para aortic **Internal iliac** Superficial inguinal Meso rectal None of the above

Answer 280

A 65-year-old man is referred with hypertension. He has a past medical history of angina and peripheral vascular disease. On examination you note a left sided renal bruit. What is the best method to assess **renal blood flow** in this patient? Inulin clearance Modification of Diet in Renal Disease (MDRD) equation **Para-aminohippurate (PAH) clearance** Cockcroft-Gault equation Serum creatinine The Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault equation are used to estimate creatinine clearance.

Answer 281

An obese 40-year-old female patient suffering constant abdominal pain in her right upper quadrant that radiates to her right shoulder, nausea and vomiting. On examination she has a palpable abdominal mass in her right upper quadrant and is Murphy's sign positive. What is most likely to be shown in her LFT results? ALT 205 u/L, AST 198 u/L, ALP 150 u/L ALT 205 u/L, AST 198 u/L, ALP 549 u/L **ALT 113 u/L, AST 129 u/L, ALP 549 u/L** ALT 35 u/L, AST 28 u/L, ALP 70 u/L ALT 35 u/L, AST 28 u/L, ALP 22 u/L Highly raised alkaline phosphatase enzymes and mildly raised liver transaminase enzymes is suggestive of biliary disease

Answer 282

A 56-year-old woman was admitted 2 weeks ago due to pneumonia for which she was started on oral antibiotics. These antibiotics were changed after she developed a Clostridium difficile infection 9 days ago which she is still recovering from. Her pneumonia has now improved. She is otherwise fit and well and is on no long-term medications. What would be seen on her arterial blood gas? Low anion gap metabolic acidosis **Normal anion gap metabolic acidosis** Normal anion gap metabolic alkalosis Raised anion gap metabolic acidosis Raised anion gap metabolic alkalosis The patient has developed diarrhoea secondary to a Clostridium difficile infection. This causes a normal anion gap metabolic acidosis due to a loss of bicarbonate. This is compensated by an increase in chloride concentration, thus leading to a normal anion gap metabolic acidosis.

Answer 283

A 39-year-old man is admitted to the gastroenterology ward with a flare-up of his Crohn's disease. He has been opening his bowels up to 6 times a day for the past 2 weeks and has lost approximately 5kg in weight. What biochemical abnormalities would most likely be seen in the above presentation? Metabolic acidosis, normal anion gap, hyperkalaemia **Metabolic acidosis, normal anion gap, hypokalaemia** Metabolic acidosis, raised anion gap, hyperkalaemia Metabolic alkalosis, hyperkalaemia Metabolic alkalosis, hypokalaemia

Answer 284

A 4-year-old boy is undergoing a renal biopsy following a recent history of haematuria and proteinuria. Histological analysis found immune complex deposition within the glomeruli. Further investigation confirms that the complexes include IgG, IgM, and C3. What is the most likely diagnosis? Minimal change disease IgA nephropathy **Post-streptococcal glomerulonephritis** Amyloidosis Focal segmental glomerulosclerosis

Answer 285

A 42-year-old female presents to her general practitioner with 'pins and needles' around her mouth and frequent muscle cramps. On examination, she appears well, however when taking her blood pressure reading, her wrist and fingers began to cramp and flex. What is the most likely diagnosis? Hyperkalaemia Hypermagnesaemia **Hypocalcaemia** Key features of hypocalcaemia - perioral paraesthesia, cramps, tetany and convulsions Hypokalaemia Hyponatraemia

Answer 286

A patient is seen in clinic complaining of abdominal pain. Routine bloods show: Na+ 142 mmol/l K+ 4.0 mmol/l Chloride 104 mmol/l Bicarbonate 19 mmol/l Urea 7.0 mmol/l Creatinine 112 µmol/l What is the anion gap? 4 mmol/L 14 mmol/L 20 mmol/L 21 mmol/L **23 mmol/L** The anion gap may be calculated by using (sodium + potassium) - (bicarbonate + chloride) = (142 + 4.0) - (104 + 19) = 23 mmol/L

Answer 287

A 40-year-old man presents with pedal oedema, frothy urine and passing a lot less urine than is usual for him. He has no other relevant medical history. You suspect that this patient's nephrotic syndrome is due to a common cause of idiopathic glomerulonephritis among adults. Which initial investigation would be most useful to support this specific diagnosis? Anti-streptolysin O titre (ASOT) Lipid profile Renal function **Anti-phospholipase A2 antibodies** 24-hour urine collection Antibodies against a glomerular phospholipase A2 receptor have been implicated in the pathogenesis of this condition. Therefore, measuring anti-phospholipase A2 levels is likely to confirm the specific diagnosis, making this option correct.

Answer 288

A 56-year-old lady is undergoing an adrenalectomy for Conns syndrome. During the operation the surgeon damages the middle adrenal artery and haemorrhage ensues. From which of the following structures does this vessel originate? **Aorta** Renal artery Splenic artery Coeliac axis Superior mesenteric artery

Answer 289

A 68-year-old female is routinely referred to the cardiology department by her GP after experiencing chest pain upon exertion. The cardiologist decides to assess for blockage of the coronary arteries and orders a coronary computed tomography (CT) angiography. As part of the imaging, the radiologist will intravenously inject a contrast dye. Which is the most important blood test to order before administration of the contrast medium? Cardiac enzymes Full blood count Liver function tests Thyroid function tests **Urea and electrolytes** As contrast medium is nephrotoxic, renal function must be tested by checking the urea and electrolytes (U&Es) prior to administration.

Answer 290

A 45-year-old man presents to the GP with haematuria. He has noticed two episodes of haematuria in the last week. He has no abdominal pain or fevers, and is otherwise asymptomatic; however, he did notice a cough and runny nose that resolved about a week ago. An examination is unremarkable. A nephrologist referral is made with ultrasound and cystoscopy negative. Ongoing microscopic haematuria is present, so a decision to perform a renal biopsy is made. Histology demonstrates mesangial hypercellularity. What is the most likely diagnosis? Acute proliferative glomerulonephritis Alport syndrome Henoch-schonlein purpura **IgA nephropathy** IgA nephropathy - histology shows mesangial hypercellularity with positive immunofluorescence for IgA & C3 Lupus nephritis

Answer 291

Hypokalemia is very commonly associated with **metabolic alkalosis.** This is due to 2 factors: 1) the common causes of metabolic alkalosis (vomiting, diuretics) directly induce H+ and K loss (via aldosterone) and thus also cause hypokalemia 2) hypokalemia is a very important cause of metabolic alkalosis by three mechanisms. The initial effect is by causing a transcellular shift in which K leaves and H+ enters the cells, thereby raising the extracellular pH. The second effect is by causing a transcellular shift in the cells of the proximal tubules resulting in an intracellular acidosis, which promotes ammonium production and excretion. Thirdly, in the presence of hypokalemia, hydrogen secretion in the proximal and distal tubules increases. This leads to further reabsorption of HCO3-. The net effect is an increase in the net acid excretion.

Answer 292

A 72-year-old woman presents to the endocrinology clinic with a history of muscle cramps, headaches, and lethargy. Her observations in the clinic are heart rate 82/min, respiratory rate 16/min, blood pressure 152/102 mmHg, temperature 36.2ºC, saturations 98% on air. Some of her recent blood tests are shown below: Na+ 147 mmol/L (135 - 145) K+ 3.1 mmol/L (3.5 - 5.0) Bicarbonate 29 mmol/L (22 - 29) Urea 6.1 mmol/L (2.0 - 7.0) Creatinine 92 µmol/L (55 - 120) An abdominal CT scan shows an adrenal mass. Given the likely diagnosis, where is the hormone responsible for these symptoms produced? Adrenal medulla Juxtaglomerular apparatus Zona fasciculata Zona glomerulosa Zona reticularis Aldosterone - zona glomerulosa of adrenal cortex The correct answer is zona glomerulosa. This patient is suffering from symptoms of hyperaldosteronism, likely due to an adenoma of the zona glomerulosa as evidenced by the mass on CT (this is also known as Conn's syndrome). The mass will stimulate aldosterone production, resulting in hypokalemia and hypertension.

Answer 293

A 72-year-old woman presents to the endocrinology clinic with a history of muscle cramps, headaches, and lethargy. Her observations in the clinic are heart rate 82/min, respiratory rate 16/min, blood pressure 152/102 mmHg, temperature 36.2ºC, saturations 98% on air. Some of her recent blood tests are shown below: Na+ 147 mmol/L (135 - 145) K+ 3.1 mmol/L (3.5 - 5.0) Bicarbonate 29 mmol/L (22 - 29) Urea 6.1 mmol/L (2.0 - 7.0) Creatinine 92 µmol/L (55 - 120) An abdominal CT scan shows an adrenal mass. Given the likely diagnosis, where is the hormone responsible for these symptoms produced? Adrenal medulla Juxtaglomerular apparatus Zona fasciculata Zona glomerulosa Zona reticularis Aldosterone - zona glomerulosa of adrenal cortex The correct answer is zona glomerulosa. This patient is suffering from symptoms of hyperaldosteronism, likely due to an adenoma of the zona glomerulosa as evidenced by the mass on CT (this is also known as Conn's syndrome). The mass will stimulate aldosterone production, resulting in hypokalemia and hypertension.

Answer 294

A 72-year-old woman presents to her GP with symptoms of weakness in her limbs, fatigue, and easy bruising. She also feels that she has gained some weight on her abdomen recently despite trying to eat healthily. After a positive high dexamethasone test, she is diagnosed with Cushing's disease secondary to a pituitary adenoma. What part of the adrenal gland is the hormone involved in the pathophysiology of her symptoms produced from? Adrenal medulla Juxtaglomerular apparatus **Zona fasciculata** Zona glomerulosa Zona reticularis

Answer 295

A 30-year-old man with known end-stage renal failure secondary to polycystic kidney disease is undergoing investigations for a potential renal transplant. Several family members have undergone donor screening which includes human leukocyte antigen (HLA) testing. What class of HLA is the most important to reduce the risk of rejection for this patient? A B DP DQ **DR**

Answer 296

You are asked to see a newly born baby on the delivery suite after the newborn physical examination revealed abnormalities. The doctor performing the examination attempted to feel the testicles but was unable to do so, and recorded the genitalia to be ambiguous. Further investigations are carried out, which reveals a raised 17-hydroxyprogesterone, which is attributed to a deficiency in an enzyme that is usually responsible for the conversion of progesterone to 11-deoxycorticosterone. Which enzyme is deficient in this baby? Aldosterone Cortisol Hexokinase Trypsin **21-hydroxylase**

Answer 297

Whilst on the ward, you notice that a severely underweight 22-year-old female patient with anorexia nervosa has become acutely drowsy and confused. You are told that she was artificially fed 30 minutes ago, are handed a set of blood tests taken since her new symptoms began and suspect that she has refeeding syndrome. Which of the following best reflects what you are likely to see in the blood results? Hyperkalaemia, hypophosphataemia and hypermagnesemia Hypokalaemia, hypophosphataemia and hypermagnesemia Hyperkalaemia, hypophosphataemia and hypomagnesemia Hyperkalaemia, hyperphosphataemia and hypermagnesemia **Hypokalaemia, hypophosphataemia and hypomagnesemia** A large release of insulin in refeeding syndrome causes a rapid shift of K+, Mg2+ and PO4- into cells, causing hypokalaemia, hypophosphataemia and hypomagnesemia

Answer 298

A 67-year-old man with type 2 diabetes mellitus is receiving his annual diabetic check. He is feeling more fatigued than usual. He has not attended his previous three annual check-ups. His blood glucose control has been poor and he has not been compliant with his medications. Blood pressure is 170/90 mmHg. Urinalysis shows microalbuminuria. A blood test reveals his glomerular filtration rate (GFR) is 27mL/min per 1.73m². If a renal biopsy was to be performed in this patient, what would be the expected findings? **Nodular glomerulosclerosis and hyaline arteriosclerosis** Apple-green birefringence under polarised light Enlarged and hypercellular glomeruli Crescent moon shaped glomeruli Wirelooping of capillaries in the glomeruli Diabetic nephropathy histological findings-**Kimmelstiel-Wilson lesions,** nodular glomerulosclerosis Important for meLess important This patient has a poorly controlled T2DM with an underlying diabetic nephropathy. The histological findings are Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) and hyaline arteriosclerosis. This is due to nonenzymatic glycosylation.

Answer 299

A 60-year-old lady with a history of heart failure attended the emergency department with palpitations. When taking a history you discover that she regularly takes ramipril and paracetamol but her cardiologist prescribed a further medication a week ago. She does not know what the medication is called but describes it as a 'water tablet'. A subsequent electrocardiogram shows abnormal tall T waves. What 'water tablet' has been started recently? Furosemide (loop diuretic) Bendroflumethiazide (thiazide diuretic) Acetazolamide (carbonic anhydrase inhibitor) Mannitol (osmotic diuretic) **Spironolactone (potassium-sparing diuretic)**

Answer 300

A 46-year-old man complains of swelling in his legs over the past three weeks. There was no history of other illnesses in the past except sore throat when he was 16. He is not taking any medications. On examination, he has a blood pressure of 155/94 mmHg. He has pitting oedema, and urinalysis shows 4+ protein with no RBC casts. Biopsy confirms the diagnosis of membranous glomerulonephritis. Which is the following is the most likely cause of his condition? **Anti-phospholipase A2 antibodies** Hypertension Malignancy Sore throat Systemic lupus erythematosus Idiopathic membranous glomerulonephritis is related to anti-phospholipase A2 antibodies

Answer 301

A 65-year-old man presents with frequent urination and pronounced thirst. You wish to investigate for diabetes insipidus. What is the most appropriate investigation of choice? Short Synacthen test **Water deprivation test** Desmopressin Thiazide diuretics Vasopressin

Answer 302

Addison's disease.

Answer 303

A patient attends the renal clinic having been diagnosed with **chronic kidney disease stage 4**, secondary to long-standing hypertension and diabetes. She asks about the diet she should be keeping to. What is the most appropriate price of advice about her diet she should be given? High protein and phosphate Low potassium, high sodium High protein, low sodium High phosphate, low potassium **Low protein, phosphate, potassium and sodium**

Answer 304

A 68-year-old man with chronic kidney failure has been advised by his nephrologist that he needs to follow a 'renal diet'. He comes to see you to learn more about this. Which one of the following is usually advised to patients with chronic kidney disease? High calcium diet High protein diet **Low potassium diet** Low starch diet High phosphorus diet

Answer 305

A 35-year-old man is brought to the emergency department due to abdominal pain, nausea and vomiting for a few hours. He has type 1 diabetes mellitus, which is treated with insulin. He admits that he ran out of his insulin a few days back. His temperature is 37.8ºC, the pulse is 120/min, his respirations are 25/min, and his blood pressure is 100/70 mmHg. Examination shows dry mucous membranes. He has a fruity odour on his breath. Laboratory studies show: Hb 144 g/L Male: (135-180) Female: (115 - 160) Platelets 240 * 109/L (150 - 400) WBC 10.9 * 109/L (4.0 - 11.0) Na+ 137 mmol/L (135 - 145) K+ 5 mmol/L (3.5 - 5.0) Urea 2.5 mmol/L (2.0 - 7.0) Creatinine 115 µmol/L (55 - 120) Glucose 25 mmol/L (4 - 7) Which of the following sets of laboratory findings would most likely be found in this patient? **PH 7.1; pCO2 2.3 kPa; Anion Gap 21** PH 7.2; pCO2 6.5 kPa; Anion Gap 11 PH 7.3; pCO2 3.9 kPa; Anion Gap 14 PH 7.4; pCO2 3.3 kPa; Anion Gap 23 PH 7.5; pCO2 2.3 kPa; Anion Gap 25 This patient has diabetic ketoacidosis. Patients with diabetic ketoacidosis have raised anion gap metabolic acidosis. The first step in answering this question is to rule out all options with normal and raised pH (pH 7.4 and 7.5 ruled out). We should only consider options with a pH under 7.35. The next step is to rule out all options with respiratory acidosis. This patient with increased respiratory rate should have low pCO2. This rules out the option with pCO2 of 6.5 kPa. Finally, we need to know the anion gap. The normal anion gap is 3 to 16. Since this patient should have a raised anion gap, the option with an anion gap of 21 is correct.

Answer 306

A nephrologist is reviewing an 11-year-old girl who was found to have proteinuria and haematuria on urine dipstick by her general practitioner. Her initial presenting complaint was general malaise. After a thorough history and examination, the nephrologist organises a renal biopsy. The biopsy report included the following statement: 'immunofluorescence of the sample demonstrated a granular appearance'. What is the most likely diagnosis? IgA nephropathy Normal biopsy result Pyelonephritis Minimal change disease **Post-streptococcal glomerulonephritis** Post-streptococcal glomerulonephritis - granular appearance on immunofluorescence

Answer 307

A 44-year-old female is currently admitted to hospital for investigation of new-onset hypertension, myalgia and a facial rash. During her stay in hospital, her kidney function declines and she begins to complain of muscle aches and ankle swelling. A urine sample and kidney biopsy are taken. Histopathological assessment of the kidney biopsy shows a proliferative **'wire-loop'** glomerular lesion. The urinalysis detects proteinuria, but no leukocytes or nitrites. What is the most likely diagnosis? Acute tubular necrosis Congestive cardiac failure IgA nephropathy Pyelonephritis **Systemic lupus erythematous** Proliferative 'wire-loop' glomerular histology in the presence of proteinuria and systemic symptoms is characteristic of lupus nephritis

Answer 308

A 42-year-old lady presents to her GP for her review after starting metformin 6 months ago. She is particularly concerned about what she read on the internet about how diabetes will affect her kidneys long term. By which mechanism does most damage occur directly to the kidneys in this patient population? Osmotic damage Deposition of amyloid Antigen-antibody complex deposition Renal tubular acidosis **Non-enzymatic glycosylation**

Answer 309

A 46-year-old lady presents to the Emergency Department with acute intermittent sharp pain in her right flank and haematuria. She has slight nausea, but feels otherwise fine in herself. She has a history of hyperparathyroidism, but has not experienced these symptoms before. She has a body mass index of 28kg/m² and reveals that her diet involves regular takeaways. On examination she appears restless and has right flank tenderness. What substance is most likely to be causing the pain in this patient? **Calcium oxalate** Struvite Calcium phosphate Uric acid Cystine Renal stones are most commonly composed of calcium oxalate

Answer 310

A 66-year-old man is undergoing a radical cystectomy due to T2 non-invasive bladder cancer. You are one of the medical students shadowing the urological surgeons during the procedure. During the procedure, inferior and superior vesical arteries must be ligated. The surgeon asks you, from which vessel do these arteries originate? Direct branch of the aorta External iliac artery Inferior mesenteric artery **Internal iliac artery** Renal artery

Answer 311

A 37-year-old male presents to his GP for a routine follow-up of his hypertension. His blood pressure is consistently measured at or above 160/100 mmHg, despite treatment. He is currently on a maximally tolerated dose of ramipril, amlodipine, and spironolactone. On further questioning, the GP discovers that the patient has experienced periods of extreme anxiety, palpitations, and fear with associated sweating about twice a week for the past 6 months. Which of the following describes the origin of the hormone responsible for this man's symptoms? **Adrenal medulla** displaying symptoms of a phaeochromocytoma; hypertension refractory to treatment, and severe episodes of sweating, palpitations, and anxiety. Pituitary gland Zona fasciculata of adrenal cortex Zona glomerulosa of adrenal cortex Zona reticularis of adrenal cortex

Answer 312

A 36-year-old female is undergoing renal transplant surgery. A few minutes after the donor kidney has been inserted the donor organ starts to lose colour and becomes flaccid. You suspect hyperacute transplant rejection. What is the mechanism of this? Cell arteritis leading to atrophy of organ Damaged donor organ Donor T cells mounting a response against the host cells Mast cell degranulation **Pre-existing recipient antibodies against donor HLA/ABO antigen**

Answer 313

A 34-year-old single mum has been referred for genetic testing following her 8-months-old son being diagnosed with congenital nephrogenic diabetes insipidus. She is asymptomatic and is not aware of any family history of this condition. Which of the following structure of the kidney is most commonly affected in this condition? **Vasopressin receptor** Angiontensin II receptor Epithelial sodium channel (ENaC) Sodium-chloride co-transporter (NCCT) Aquaporin 1 channel (AQP1 Nephrogenic diabetes insipidus may be caused genetic mutations: the more common form affects the vasopression (ADH) receptor the less common form results from a mutation in the gene that encodes the **aquaporin 2 **channel

Answer 314

A 15-year-old girl presents to the emergency department with an acute exacerbation of asthma. As part of her treatment, she is given salbutamol and ipratropium bromide nebulisers with IV steroids. Salbutamol is a β2 receptor agonist. What metabolic effect can this drug have that you might need to monitor? Hyperkalaemia Hypernatraemia Hypocalcaemia Hyponatraemia **Hypokalaemia**

Answer 315

A 45-year-old male is returned to a surgical ward following a renal transplant. 90 minutes after the transplantation, diuresis suddenly decreases. The patient is immediately transferred back to surgery where the transplanted kidney shows signs of hyperacute rejection and is removed. Histopathological examination is consistent with hyperacute rejection. This patient has experienced which of the following types of reaction? Type I hypersensitivity **Type II hypersensitivity** : Hyperacute transplant rejection is an example of a type II hypersensitivity reaction Type III hypersensitivity Type IV hypersensitivity Type V hypersensitivity

Answer 316

n 85-year-old woman visits her GP for a follow up appointment after commencing trimethoprim for a urinary tract infection 7 days ago. She mentions that her urinary symptoms have gone but that she has been feeling generally tired and weak for the last 4 weeks (before the urinary tract infection). She asks you if this could be to do with the new medication she started 5 weeks ago. You look at her medical history and see she was started on ramipril 5 weeks ago. She mentions that her osteoarthritic pain has been quite bad recently, which is why she missed her most recent medication review appointment, but she has been taking more paracetamol and ibuprofen than normal. Considering the combination of medication and her vague symptoms you have a suspicion and decide to perform an ECG. The ECG shows tall, tented T waves, prolonged PR interval, and bradycardia. What is the cause of these ECG changes? Hypernatraemia **Hyperkalaemia** Hyponatraemia Hyperthyroidism Hypercalcaemia

Answer 317

A 38-year-old woman is referred to rheumatology by her general practitioner (GP) due to ongoing symptoms of fatigue and arthralgia. These have been ongoing for the last 2 months. A urine dipstick is positive for proteinuria, and subsequent renal biopsies demonstrate proliferative 'wire-loop' glomerulonephritis on histology. What is the most likely diagnosis? Acute interstitial nephritis Anti-glomerular basement membrane disease (Anti-GBM disease) Autosomal recessive polycystic kidney disease (ARPKD) Diabetic nephropathy **Systemic lupus erythematosus (SLE)**

Answer 318

A six-year-old boy is undergoing investigations for recurrent urinary tract infections. Imaging shows the inferior poles of both his kidneys are fused abnormally. Diagnosis of horseshoe kidney is made. During fetal development, horseshoe kidneys are trapped under which of the following structures following their anterior ascent? Superior mesenteric artery **Inferior mesenteric artery** Left common iliac artery Right common iliac artery Aortic bifurcation

Answer 319

Jack has just finished running a marathon and is now dehydrated. The reduced perfusion pressure in his kidneys is detected by baroreceptors which causes the activation of the renin-angiotensin-aldosterone system (RAAS). Renin cleaves angiotensinogen to angiotensin I which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). The effect that angiotensin II has on the branch of the renal artery that carries blood away from the glomerulus will contribute to increasing Jack's blood pressure (mmHg) back to normal. What impact does angiotensin II have on this arteriole and what does this do to the glomerular filtration rate (GFR)? Vasoconstriction - decreases GFR **Vasoconstriction - increases GFR** Vasodilation - decreases GFR Vasodilation - increases GFR Vasodilation - no effect on GFR

Answer 320

43-year-old lady is donating her left kidney to her sister and the surgeons are harvesting the left kidney. Which one of the following structures will lie most anteriorly at the hilum of the left kidney? Left renal artery **Left renal vein** Left ureter Left ovarian vein Left ovarian artery The renal veins lie most anteriorly, then artery and ureter lies posteriorly.

Answer 321

At which level is the hilum of the left kidney located? **L1** Remember L1 ('left one') is the level of the hilum of the left kidney L2 T12 T11 L3

Answer 322

A 24-year-old man is involved in a road traffic accident. His right leg is trapped for 6 hours whilst he is moved. On examination his foot is insensate and a dorsalis pedis pulse is only weakly felt. Which of the biochemical abnormalities listed below is most likely to be present? Alkalosis Hypercalcaemia Hypocalcaemia **Hyperkalaemia** Hyponatraemia In this scenario the patient will have a compartment syndrome, delayed diagnosis and muscle death. The effect of muscle death will result in the release of potassium. It is also highly likely that there will be a degree of renal impairment, the result of which is that the serum potassium is likely to be high.

Answer 323

A 70-year-old man with a past medical history of hypertension is acutely short of breath. He is prescribed a drug that generates a high osmotic gradient in the medullary interstitium of the kidney. What is the most likely mechanism of action of this drug? **Inhibition of the sodium, potassium and chloride co-transporter in the ascending loop of Henle** - Furesomide Increasing water reabsorption in the descending loop of Henle Altering glucose reabsorption in the proximal tubules Altering potassium reabsorption in the proximal tubules Altering sodium reabsorption in the proximal tubules

Answer 324

A two year old boy presents to the GP with a swelling in the groin. His mother has noticed it in the evenings and also when he cries. On examination there is a small, painless lump on the right just above the scrotum. The testicles are normal and the spermatic cord is easily palpable. There is a cough impulse and the contents of the lump are easily reducible. What is the underlying abnormality? Persistent tunica vaginalis Failure of the gubernaculum **Patent processus vaginalis** indirect inguinal hernia Persistence of the Mullerian tract Obliterated processus vaginalis

Answer 325

Minimal change disease is the most common cause of nephrotic syndrome in children. It is characterised by the **triad of oedema, hypoalbuminaemia and proteinuria.**

Answer 326

GSP oncogene

Answer 327

mosaic mutation in GNAS gene

Answer 328

More Na at macula densa: glomerulus afferent arteriole constriction, which normalises GFR

Answer 329

Loop duiretic: **Ca secretion** Thiazide duiretics: **Ca retention**

Answer 330

McCune Albright syndrome Acromegaly is seen in about 20% of patients with MAS

Answer 331

Which pathology is depicted using immunohistocomplex staining? **IgA nephropathy** Membranous change disease DIabetic nephropathy Glomerulosclerosis

Answer 332

Which pathology is depicted using immunohistocomplex staining? **IgA nephropathy** Proliferation and hypercellularity of the mesangium is seen in the glomerulus Membranous change disease DIabetic nephropathy Glomerulosclerosis

Answer 333

Which pathology is depicted using immunohistocomplex staining? IgA nephropathy Membranous change disease **DIabetic nephropathy** Staining of the lipohyaline caps with periodic acid Schiff stain. Note the subendothelial location of the deposits filling the capillary lumina.

Answer 334

Which pathology is depicted using immunohistocomplex staining? IgA nephropathy Membranous change disease **DIabetic nephropathy** - note the Kimmelstiel-Wilson nodules Glomerulosclerosis

Answer 335

Which pathology is depicted using immunohistocomplex staining? **IgA nephropathy - mesengial hypercellulairty** Membranous change disease DIabetic nephropathy Glomerulosclerosis

Answer 336

Which pathology is depicted using immunohistocomplex staining? IgA nephropathy **Membranous change disease** DIabetic nephropathy Glomerulosclerosis

Answer 337

What is this patient presenting with, based off the ECG? Hypokalaemia **Hyperkalaemia** - tall tented T waves Hypothermia Hypocalcaemia Hypercalcaemia

Answer 338

Surina Folkes, 22, has a history of Crohn's disease. She presents to her GP with fatigue, shortness of breath on exertion in addition to pins and needles in her fingers. On examination, she is noticed to have pale conjunctiva and atrophic glossitis. As part of her work-up, you send off a set of bloods which reveal the following results: Hb 80 (g/l) MCV 120 (82-100 fl) Ferritin 100 (20-230 ng/ml) What is the most likely diagnosis? **Vitamin B12 deficiency** Crohn's disease often affects the terminal ileum where vitamin B12 is absorbed. It may, therefore, cause a deficiency which presents with macrocytic anaemia. Notably, B12 is also important in maintaining the nervous system so a deficiency may present with neurological symptoms. Iron deficiency anaemia Anaemia of chronic disease Sideroblastic anaemia Folate deficiency

Answer 339

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight. Which of the following blood results is most likely to be low? **T4** Hypothyroidism is a recognised cause of menorrhagia or abnormally heavy bleeding during menstruation. There is an association between autoimmune hypothyroidism (Hashimoto's thyroiditis) and other autoimmune diseases, such as this lady's Diabetes Type 1. She also has signs suggesting hypothyroidism such as low mood and weight gain. The correct answer is, therefore, T4, which would be low in hypothyroidism. Total iron binding capacity Testosterone TSH Folate

Answer 340

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis? Amyand hernia De Garengeot hernia **femoral hernia** direct inguinal hernia indirect inguinal hernia obturator hernia

Answer 341

This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis? Amyand hernia De Garengeot hernia femoral hernia direct inguinal hernia **indirect inguinal hernia** obturator hernia

Answer 342

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia direct inguinal hernia **indirect inguinal hernia** Inferior epigastric vessels medial to hernial neck (arrowhead) are visible obturator hernia

Answer 343

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia **direct inguinal hernia** anguinal hernia (arrow), which passes medially to inferior epigastric ar tery and vein (arrowhead) indirect inguinal herni obturator hernia

Answer 344

Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? De Garengeot hernia femoral hernia **direct inguinal hernia** T image shows par t of bladder (arrow) is contained within direct lef t inguinal hernia medial to inferior epigastric neurovascular bundle (arrowhead) indirect inguinal hernia obturator hernia

Answer 345

What type of hernia would it be if came out at the *? De Garengeot hernia **femoral hernia** direct inguinal hernia indirect inguinal hernia obturator hernia

Answer 346

A: direct hernia

Answer 347

What of the following depicts the inferior epigastric arteries Solids arrows **Open arrows** Curved arrows Arrowheads

Answer 348

What of the following depicts the deep inguinal ring Solids arrows Open arrows **Curved arrows** Arrowheads

Answer 349

What of the following depicts the deep inguinal ring Solids arrows Open arrows Curved arrows **Arrowheads**

Answer 350

What of the following depicts the inguinal ligament **Solids arrows** Open arrows Curved arrows Arrowheads

Answer 351

Sigmoid volvulus Grossly-dilated loop of large bowel has a 'coffee-bean shape' and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 352

Sigmoid volvulus Grossly-dilated loop of large bowel has a 'coffee-bean shape' and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Answer 353

A 64-year-old lady with a BMI of 37 presents to you complaining of incontinence. She has previously had two children, both were delivered vaginally and the first required forceps due to slow progression of the second stage of labour. She takes no regular medication and has no other significant past medical history. Given her risk factors, which type of urinary incontinence is she most likely to suffer from? Overflow incontinence Mixed inctontinence Urge incontinence **Stress incontinence** Due to her previous forceps delivery, she is most likely to be suffering from stress incontinence. Stress incontinence is the loss of urine associated with a rise in intra abdominal pressure such as coughing or sneezing. Risk factors include increasing age, traumatic vaginal delivery, obesity, and previous pelvic surgery.

Answer 354

A 76-year-old gentleman with a history of primary hypothyroidism attends his GP for the first time in many years for a routine check-up. He divulges that he has not been complying fully with his levothyroxine therapy as he sometimes cannot make it to a pharmacy to refill his prescription. Which of the values below is most likely to be low in this gentleman? Mean cell volume (MCV) LDL Cholesterol **Core temperature** TSH Body mass index

Answer 355

Which of these pathologies would cause a high anion gap metabolic acidosis? Diarrhoea **Methanol poisoning** Emesis Renal tubular acidosis

Answer 356

A 55-year-old overweight man with a background of type 2 diabetes presents to the GP with tiredness. He is otherwise well and does not smoke or drink alcohol. Bloods reveal an elevated ALT and AST. The rest of his blood results are normal. An ultrasound scan of his liver is reported as 'echobright' with no focal areas of abnormality. What is the most likely diagnosis? Hepatocellular carcinoma Pancreatic cancer Gilbert's syndrome **Non-alcoholic fatty liver disease** This patient is middle aged, overweight and has type 2 diabetes. This puts him at risk of non-alcoholic fatty liver disease (NAFLD), which causes raised liver transaminases (ALT and AST) and otherwise normal bloods. The only way to distinguish this from alcoholic liver disease is the alcohol intake and, as this patient does not drink, it suggests that NAFLD is the diagnosis. Management is through risk factor modification which would include weight loss. If NAFLD is not managed, it leads to a risk of developing hepatocellular carcinoma. This gentleman's ultrasound, however, only showed the early 'echobright' stage of NAFLD and no evidence of any masses. Acute viral hepatitis

Answer 357

**gliclazide**: Gliclazide is an insulin secretagogue, increasing the amount of endogenous insulin produced. Sometimes too much Insulin can be secreted, resulting in hypoglycaemia Metformin is an insulin sensitiser and therefore makes the amount of insulin in the body more effective. While metformin reduces average blood sugars it very rarely causes hypoglycaemia. Therefore reducing the offending drug, gliclazide, is the most appropriate management option.

Answer 358

Most patients have a history of an **upper respiratory tract infection** and, either at the onset or within the first 24-48 hours, there is **gross haematuria that lasts for less than three days**. The urine is red or brown and there may also be loin pain

Answer 359

A 32-year-old male presents to the emergency department with bilateral flank pain and red coloured urine. Approximately five days ago he experienced a sore throat with nasal discharge. He has no pertinent family medical history and no chronic medical problems. He denies smoking and is an occasional alcohol drinker. Review of systems is unremarkable. His observations are as follows: Blood pressure: 125/65 mmHg Pulse: 88 BPM Temperature: 37.4 °C Respiratory rate: 15 breaths per minute On physical examination, he has bilateral mild flank tenderness but the remainder of the physical examination is normal. Laboratory investigations demonstrate a normal full blood count and chemistry panel. The urine dipstick is positive for blood and protein but shows no signs of white blood cells or nitrites. Further examination of the urine reveals red blood cell casts. A CT KUB scan of the abdomen and pelvis in the emergency department is also normal. What is the most likely diagnosis? **IgA nephropathy** Alport syndrome Minimal change disease Acute post-streptococcal glomerulonephritis Kidney stones

Answer 360

Biliary colic Ascending cholangitis Liver cirrhosis Hepatic carcinoma **Primary biliary cirrhosis** Ascending cholangitis would typically have fever and pain Malignancy would usually feature weight loss and general malaise Biliary colic would feature pain This leaves two potential diagnoses: primary biliary cirrhosis or liver cirrhosis. There are no risk factors for liver cirrhosis and her LFTs do not show a hepatitic pattern of derangement (AST, ALT, bilirubin, albumin all normal). The raised ALP and GGT suggest a cholestatic picture, making primary biliary cirrhosis (also known as primary biliary cholangitis) the most likely diagnosis

Answer 361

Pancake kidney

Answer 362

Pancake kidney

Answer 363

Horseshoe kidney

Answer 364

Polycystic kidney disease

Answer 365

Polycystin gene

Answer 366

Abdominal CT showing **polycystic kidneys**

Answer 367

A: **mesonephric bud** B: **uteric bud**

Answer 368

What type of renal pathology is depicted here? IgA neuropathy Membrane change disease Glomerulonephritis **Acute rejection from kidney transplant** Focal glomerulitis in active antibody mediated rejection-Banff score g3. Dilated glomerular capillaries are filled with swollen endothelial cells and inflammatory cells (PAS, 200×).

Answer 369

Inflammatory cells (arrows) infiltrate the intima in intimal arteritis, due to **acute cell mediated rejection**

Answer 370

A: Falciform ligament B: fundus of gall bladder C: stomach D: Ligamentum teres

Answer 371

A: IVC B: Cystic duct C: Cystic artery D: Ligamentum teres E: Ligamentum venosum

Answer 372

A: Quadrate lobe B: Caudate lobe

Answer 373

11 Superior mesenteric artery 2 Middle colic artery 3 Right colic artery 10 Superior mesenteric vein 13 Jejunal arteries

Answer 374

**Ascites**. Axial CT scan of the abdomen shows low density ascitic fluid surrounding the liver, spleen and stomach.

Answer 375

1 Left hepatic duct 2 Right hepatic duct 3 Cystic duct 7 Common hepatic duct 8 Common bile duct 9 Pancreatic duct 10 Greater duodenal papilla

Answer 376

Hashimotos thyroiditis

Answer 377

Graves disease

Answer 378

Acropachy in association with thyroid ophthalmopathy

Answer 379

Toxic multinodular goitre Graves Disease Toxic adenoma

Answer 380

Lack of PDS

Answer 381

**biguanide**

Answer 382

Insulin normally drives potassium into cells Without insulin, potassium is not added to and stored in cells. Serum potassium can be high or normal in diabetic ketoacidosis, as the kidneys continue to balance blood potassium with the potassium excreted in the urine, **however total body potassium is low** because no potassium is stored in the cells. When treatment with insulin starts, patients can develop severe hypokalaemia (low serum potassium) very quickly, and this can lead to fatal arrhythmias.

Answer 383

fatal arrhythmias.

Answer 384

A: **Non-proliferative** - cotton wool spots B **proliferative**

Answer 385

**Nonproliferative** Funduscopic features of nonproliferative diabetic retinopathy include retinal hemorrhages and hard exudates (yellow patches)

Answer 386

**Proliferative** The key funduscopic feature of proliferative diabetic retinopathy is neovascularization, seen here around the optic disk.

Answer 387

A 65-year-old man presents to his GP with vision loss, headaches and cold intolerance. He also mentions he has unintentionally gained 5kg in the last 3 months. On examination, he is found to have a bitemporal hemianopia and a pulse of 50 bpm. A thyroid function test is ordered. Which of the following test results is most likely to belong to this patient? **TSH: Low T4: Low T3: Low** TSH: high T4: low T3: low TSH: high T4: normal T3: normal TSH: low T4: high T3: high This man most likely has a pituitary adenoma causing secondary hypothyroidism. In addition to thyroid function tests, he would also need an MRI of the head to confirm the presence of an adenoma. His thyroid function tests would be expected to show TSH: Low T4: Low T3: Low. In this case secretion of TSH is most likely suppressed due to compression of TSH secreting cells (thyrotrophs) by a pituitary mass.

Answer 388

Which one of the following diabetes medication classes has been shown to be weight-neutral/weight-losing in patients with T2DM? **SGLT-2 inhibitors** Sulphonylureas Insulins Thiazolidinediones (glitazones)

Answer 389

A 49-year-old woman is investigated following an osteoporotic hip fracture. The following results are obtained: Free T4 29pmol/L (normal 9-18) TSH < 0.05 mu/L (normal 0.5-5.5) Which one of the following autoantibodies is most likely to be present? **TSH receptor stimulating autoantibodies** Anti-thyroid peroxidase autoantibodies Anti-nuclear antibodies Anti-thyroglobulin autoantibodies

Answer 390

During a routine physical examination, a 65-year-old woman with diabetes mellitus has her balance checked. She is first asked to stand with her feet together (eyes open) and does this well. When she closes her eyes, she begins to fall and is caught by the examiner. Additional neurological findings include absent ankle jerk reflexes and absent perception of vibration at her toes bilaterally. A lesion to which of the following is the most likely cause of her balance difficulty? **Peripheral nerves** Vestibular system Upper motor neurons Cerebellum Basal ganglia

Answer 391

Which of the following is most associated with this skin condition? **Polycystic ovarian syndrome** Graves' disease Small cell lung cancer Addison's disease Methotrexate use This is a typical appearance of acanthosis nigricans; symmetrical, dark, 'velvety' plaques which arise on the neck, axillae and groin creases in conditions associated with raised insulin, such as: Obesity Type 2 diabetes Polycystic ovarian syndrome Cushing's disease

Answer 392

Which of the following are released from the stomach: A: GLP-1 B: PYY **C: Ghrelin** D: Leptin E: Insulin

Answer 393

Which of the following is the action of PYY? **Inhibits excitatory appetite neurones** Stimulates excitatory appetite neurones Inhibits inhibitory appetite neurones None of the above

Answer 394

Which of these transmitters is stimulatory for appetite? **NPY** POMC a-MSH CART

Answer 395

Which structure in the hypothalamus is a key player in appetite control? Preoptic nucleus Supraoptic nucleus **Arcuate nucleus** Lateral nucleus

Answer 396

Which peptide hormone released by cells in the ileum and colon suppresses appetite? Insulin Leptin Ghrelin **PYY (peptide tyrosine tyrosine)**

Answer 397

Release of which of the following substances is inhibitory for appetite? Ghrelin AgRP (Agouri-related peptide) NPY (Neuropeptide Y) **CART (cocaine- and amphetamine regulated transcript)**

Answer 398

Alpha-MSH and Beta-endorphin may be produced from which neurotransmitter? CART (cocaine- and amphetamine regulated transcript) **POMC (pro-opiomelanocortin)** POMC can be cleaved into other neurotransmitters such as alpha-MSH and beta-endorphin. **These also act to suppress hunger**. NPY (Neuropeptide Y) AgRP (Agouri-related peptide)

Answer 399

Blue arrows: segmental arteries Green arrows: interlobar arteries

Answer 400

14 Superior suprarenal artery 19 Right inferior phrenic artery 20 Left inferior phrenic artery 21 Middle suprarenal artery 22 Inferior suprarenal artery

Answer 401

5 Splenic artery 6 Upper pole of kidney 7 Anterior branch of renal artery 8 Interlobular arteries 9 Left renal artery 10 Lower pole of kidney

Answer 402

1 Celiac trunk 2 Superior mesenteric artery 3 Middle colic artery 4 Abdominal aorta (with catheter)

Answer 403

A: Internal branch of superior laryngeal nerve B: Inferior thyroid artery C: Superior laryngeal nerve D: Glossopharyngeal nerve E: Inferior laryngeal branch of recurrent laryngeal nerve

Answer 404

40 Internal carotid artery 41 External carotid artery 42 Superior laryngeal artery 43 Superior thyroid artery 44 Common carotid artery 45 Thyroid ansa of sympathetic trunk and inferior thyroid artery

Answer 405

cholestasis

Answer 406

Liver injury with cholestasis typically results in an increase of what laboratory value? Alanine aminotransferase Albumin **Alkaline phosphatase** Aspartate aminotransferase

Answer 407

Pheochromocytoma

Answer 408

Adrenalectomy with **pheochromocytoma**. Thin fibrous bands impart a nested look to pheochromocytoma.

Answer 409

Which of the following does the transervalis fascia become? external spermatic fascia **internal spermatic fascia** cremaster muscle tunica vaginalis

Answer 410

Which of the following does the external oblique become? **external spermatic fascia** internal spermatic fascia cremaster muscle tunica vaginalis

Answer 411

Which of the following does the processus vaginalis become? external spermatic fascia internal spermatic fascia cremaster muscle **tunica vaginalis**

Answer 412

Which of the following does the internal oblique become? external spermatic fascia internal spermatic fascia **cremaster muscle** tunica vaginalis

Answer 413

**internal oblique**: A = Cremaster

Answer 414

Tunica vaginalis is A B C D **E**

Answer 415

Which of the following is where lymph drainage of D occurs **Pre-aortic nodes** Superficial inguinal Deep inguinal Lumbar nodes

Answer 416

What is A Middle colic artery Jejunal arteries **Ileal colic artery** Right colic artery

Answer 417

A Jejunal arteries B Ileal arteries

Answer 418

A: Left colic artery B: IMA C: Ileal arteries D: Ileocolic artery E: Right colic artery

Answer 419

**Middle colic artery**

Answer 420

Inferior epigastric artery

Answer 421

5 Classically, appendicitis initially presents with generalized or periumbilical abdominal pain that later localizes to the right lower quadrant.

Answer 422

**Cyclosporin** and **tacrolimus**

Answer 423

**IL-2** | Learn x

Answer 424

Which of the following targets IL-2 gene activation / suppresses IL-2 activation Azathioprine **Prednisolone** Cyclosporin Tcrolimus Mycophenolic acid

Answer 425

Which of the following are calcineurin inhibitors? [2] Azathioprine Prednisolone **Cyclosporin** **Tacrolimus** Mycophenolic acid

Answer 426

Which of the following are calcineurin inhibitors? [2] Azathioprine Prednisolone **Cyclosporin** Tacrolimus Mycophenolic acid

Answer 427

Which of the following are anti-proliferative? [2] **Azathioprine ** Prednisolone Cyclosporin Tacrolimus **Mycophenolic acid**

Answer 428

Calcineurin is an enzyme that **activates T-cells of the immune system.**

Answer 429

Cold ischaemia time: **12 hrs** Warm ishaemia time: **1 hour**

Answer 430

**Polycystin gene** - codes for **primary cilia**

Answer 431

**Mineralocorticoid** hormone

Answer 432

- increase sodium reabsorption - increase potassium excretion

Answer 433

Conn's syndrome causes which of the following effects - **increase sodium reabsorption; increase potassium excretion** Conns syndrome: XS aldosterone

Answer 434

**hypokalemia**, **hypernatremia** and **metabolic alkalosis**

Answer 435

**B. Decreased serum potassium, increased urinary potassium, and increased extracellular fluid volume** increased production of aldosterone. Serum levels of potassium are decreased, and the urinary excretion of potassium is increased. Decreased serum potassium levels result in the symptoms of polyuria and polydipsia due to hypokalemia-induced nephrogenic diabetes insipidus. As a result of increased reabsorption of sodium due to aldosterone excess, more water is retained. The retained water causes extracellular fluid volume expansion, which is the mechanism behind persistent hypertension.

Answer 436

Conns syndrome patient presents with Respiratory alkalosis Respiratory acidosis **Metabolic alkalosis** Metabolic acidosis

Answer 437

This symptoms is suggestive of Conns syndrome Cushings syndrome **Addisons disease** Sunburn Hyperpigmentation is characteristic and occurs in almost all patients. Elevated ACTH and melanocyte-stimulating hormone are causative factors. It is believed that ACTH binds to the melanocyte receptors, which are responsible for pigmentation

Answer 438

low cortisol and aldosterone levels

Answer 439

What method is the most practical and accurate way to measure regional adiposity? **A. Waist and hip circumference** B. Skin-fold thickness testing C. Body mass index (BMI) D. Impedance measurement

Answer 440

Which of the following is not associated with obesity causing a dampened down immune system? RA MS **Systemic lupus erythematosus** Psoriasis

Answer 441

A Ptx present with greater span than height & shorter 4th metacarpal. Which of the following is most likely McCune-Albright Syndrome Patau Syndrome **Kallman Syndrome** Turners Syndrome

Answer 442

McCune-Albright syndrome is caused by a mutation on which gene Kal **GNAS** PIT1 GSP

Answer 443

**Kimmelstiel–Wilson nodules**

Answer 444

Where does spirolactone work? PCT LoH DCT **CD**

Answer 445

**Vasoconstriction at afferent arteriole** No effect at efferent (i think)

Answer 446

Which of the following has neuron development through the cribiform plate? **GnRH** TRH CRH ADH

Answer 447

hypothalamic stimulating hormone that causes the release of GnRH somatostatin PIT1 **kisspeptin** GPR54

Answer 448

Which of the following is the nerve that causes constriction of the pupil? **A**: CN 3 B C D E

Answer 449

Which of the following is the ophthalmic branch is the first division of the trigeminal nerve? A B C **D** E

Answer 450

Which of the following supplies the lateral rectus? A **B** C D E

Answer 451

Which pituitary hormone binding to cell surface-localize receptors (GHRs) induces a conformational change of the **dimerized receptors**? CRH TSH **GH** ADH

Answer 452

**Hypothyroidism**: * Low T3/T4 * Low TSH **Hyperthyroidism** * High T3/T4 * Low TSH

Answer 453

Which of the following would you use to treat hypothyroidism? Propylthiouracil **Levothyroxine** Iodine 131 Carbimazole Iodine 123

Answer 454

Which of the following is the remnant of the umbilical vein? A B C **D** - ligament teres

Answer 455

Which of the following deiodinase enzymes makes more inactive from of thyroid hormone? D1 & D2 convert T4 to T3 and cause **activation** **D3** : ** ** D4

Answer 456

**PDS** (**p**endred **s**yndome - **P**D**S**)

Answer 457

What is the name for naturally form of active thyroid hormone? Levothyroxine **Liothyronine**: T3 Thyrotrophin Thyroxine

Answer 458

Which sign of ascites is present in this CT Ascites **Caput medusae** Oesophageal varices Spider naevi

Answer 459

Which of the following would you use to diagnose a toxic adenoma ? Propylthiouracil Levothyroxine Iodine 131 - used to treat Carbimazole **Iodine 123**

Answer 460

Which of the following occurs in graves disease Increased insulin turnover; increased gluconeogenesis; increased insulin secretion Increased insulin turnover; decreased gluconeogenesis; increased insulin secretion Decreased insulin turnover; decreased gluconeogenesis; increased insulin secretion **Increased insulin turnover; increased gluconeogenesis; decreased insulin secretion**

Answer 461

NPY / AgRP neurones: **signals hunger** and **stimulates food intake** POMC / CART neurones: **signals satiety** and **reduces food intake**

Answer 462

Which of the following are antibodies produced **Latent Autoimmune Diabetes of Adults** type 1.5 Type two diabetes Gestatational diabetes Maturity Onset Diabetes of the Young

Answer 463

Which of the following type of diabetes is usually caused by one gene Latent Autoimmune Diabetes of Adults Type two diabetes Gestatational diabetes **Maturity Onset Diabetes of the Young**

Answer 464

PYY has the biggest effect on which part of the GI system Stomach Duodenum Jejunum Ileum **Colon**

Answer 465

PYY has the is produced from which type of cells: D cells A cells **L cells** B cells

Answer 466

B12 & Folate Deficiency Leads to **atherosclerosis**

Answer 467

A patient with which of the following HbA1c reading would have diabetes 41 mmol/mol 43 mmol/mol 45 mmol/mol 47 mmol/mol **49 mmol/mol** - 48 is the cut off

Answer 468

Which one of the following is aldosterone? **Mineralocorticoid** Catecholamine Androgens Glucocorticoid

Answer 469

Which one of the following is cortisol? Mineralocorticoid Catecholamine Androgens **Glucocorticoid**

Answer 470

**D. Increase serum glucose and decrease insulin secretion** **Pheochromocytoma** is a tumor of the adrenal medulla that causes excess catecholamine release. Catecholamines increase glucagon secretion via beta-2 receptors and activate glycogenolysis. This results in increased serum glucose.

Answer 471

A 48-year-old man embarks on a road trip across the country and becomes stranded in Nevada when his car breaks down. He is without food or water for over 72 hours. A hormone is released from which part of the adrenal gland in response to his hydration status? A. Zona fasciculata **B. Zona glomerulosa** C. Adrenal medulla D. Zona reticularis

Answer 472

Which of the following is the underlying problem in neurogenic diabetes insipidus? **Lack of vasopressin (antidiuretic hormone)** Lack of prolactin Lack of oxytocin Overproduction of prolactin Overproduction of vasopressin (antidiuretic hormone) Overproduction of oxytocin

Answer 473

In males which hormone stimulates Sertoli cells to produce androgen binding globulin (ABG)? Oxytocin **Follicle stimulating hormone (FSH)** Luteinizing hormone (LH) Gonadotrophin releasing hormone (GnRH)

Answer 474

Which of the following causes of Cushing's syndrome does the phrase "Cushing's disease" specifically refer to? **Pituitary adenoma** Adrenal adenoma Ectopic ACTH production Iatrogenic

Answer 475

Which one of the following statements best describes an Addisonian crisis? **Severe adrenal insufficiency resulting in dangerously low serum cortisol levels** Dangerously high serum cortisol levels Severe adrenal insufficiency resulting in dangerously low serum testosterone levels Dangerously high levels of testosterone

Answer 476

Which of the following investigations is the gold standard for diagnosing acromegaly? Growth hormone measurement Oral glucose tolerance test + Growth hormone measurement Growth hormone releasing hormone measurement Serum IGF1 measurement

Answer 477

What is the most common cause for the overproduction of growth hormone in acromegaly? Hypothalamic lesion **Pituitary adenoma** Pituitary lesion Hyperplasia of the pituitary stalk In around 99% of cases, acromegaly is caused by a pituitary adenoma, specifically overgrowth of the somatotrope cells which are responsible for growth hormone production. In very rare cases acromegaly can be caused by ectopic production of growth hormone by carcinoid tumours.

Answer 478

What is Addison's disease? **Addison’s disease is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.** Addison's disease involves the overproduction of androgens by the adrenal medulla. Addison's disease involves the underproduction of androgens by the adrenal medulla. Addison's disease involves the overproduction of cortisol and aldosterone by the adrenal cortex.

Answer 479

What is the most common cause of Cushing's syndrome? Ectopic ACTH production **Glucocorticoid treatment (iatrogenic)** Adrenal adenoma Pituitary adenoma The most common cause of Cushing's syndrome is the long term use of glucocorticoid treatments (steroids). These treatments are commonly used to suppress inflammation in many diseases. If these treatments are used long term they can result in the development of Cushing's syndrome. As a result, most steroid treatments are only given for short durations with the smallest dose possible.

Answer 480

**21-hydroxylase** 21-hydroxylase needed to produce **cortisol** and **aldosterone**

Answer 481

Which enzyme is the final step in cortisol production? 21-hydroxylase **11B-hydroxylase** 5a-reductase 17B-HSD

Answer 482

Which enzyme is the final step in testosterone production? 21-hydroxylase 11B-hydroxylase 5a-reductase 17B-HSD

Answer 483

Which one of the following is most characteristically caused by thiazides? Hypocalcemia **Hypercalcemia** Hyperkalaemia Hypernatraemia

Answer 484

Side-effects include gastrointestinal upset and lactic acidosis (**common in exams)** **Metformin** SGLT-2 Inhibitors GLP-1 agonists Thiazolidinediones

Answer 485

Which type of Ig caused activation of TSH receptor in Graves Disease? IgA **IgG** IgM IgD IgE

Answer 486

Relative deficiency of insulin due to an excess of adipose tissue and insulin resistance: MODY DMT1 **DMT2** Gestational Diabetes LADA

Answer 487

Which one of the following actions is directly caused by cortisol? Increases gastric motility Decreases osteoclastic activity Decreases renal reabsorption of phosphate **Upregulates alpha1 receptors on arterioles**

Answer 488

Thyrotoxicosis is most likely to present with the following blood tests: High TSH; Low T4 Low TSH; Low T4 High TSH; High T4 **Low TSH; High T4**

Answer 489

Primary hyperaldosteronism: * excess production of the **adrenal gland** (zona glomerulosa) * can present more commonly as a **primary tumor** in the gland known as **Conn syndrome** or **bilateral adrenal hyperplasia** Secondary hyperaldosteronism: * **Excessive** **activation** of **RAAS** * renin-producing tumor, renal artery stenosis, or edematous disorders like left ventricular heart failure, pregnancy, cor pulmonale, or cirrhosis with ascites.

Answer 490

Primary hyperthyroidism: * due to **thyroid pathology** Secondary hyperthyroidism: * the condition where the **thyroid** is producing excessive **thyroid hormone** as a result of **overstimulation by thyroid stimulating hormone**. * The pathology is in the **hypothalamus or pituitary**.

Answer 491

PTH raises Ca2+ levels Primary hyperparathyroidism: * **Parathyroid** **adenoma** * **Paraythyroid** **hyperplasia** * **Over-secreting PTH**; **high** **calcium** Secondary hyperparathyroidism: * Due to low serum calcium levels as a result of **another condition**: commonly **CKD or Vit D deficiency** * **High PTH, low Ca2+** Tertiary hyperparathyroidism: * Prolonged period of secondary hyperparathyroidism: **secrete PTH autonomously** * **High PTH, High Ca2+**

Answer 492

**5-alpha reductase Inhibitors** Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase.

Answer 493

**Cushing syndrome** **Dexamethasone** at **night** (i.e. 10pm) and their **cortisol and ACTH** is measured in the **morning** (i.e. 9am). The intention is to find out whether the dexamethasone **suppresses** their **normal morning spike of cortisol.**

Answer 494

Abnormal: high levels of cortisol Normal: low levels of cortisol

Answer 495

Short synacthen test is used to diagnose **Addisons disease** The test involves giving synacthen, which is synthetic ACTH. The **blood cortisol is measured at baseline, 30 and 60 minutes after administration**. The **synthetic ACTH** will stimulate healthy adrenal glands to **produce** **cortisol** and the cortisol level should at **least double**. A failure of cortisol to rise (less than double the baseline) indicates primary adrenal insufficiency (Addison’s disease).

Answer 496

Which drug targets B3 receptors in urge incontinence **Mirabegron** Finasteride Oxybutynin Botox

Answer 497

Lumbar splachnic nerve

Answer 498

Lesser and least splachnic nerve

Answer 499

Which of these is not a definition for constipation? infrequent stools, more than 3 per week passage of hard stools a sensation of incomplete evacuation **infrequent stools, more than 2 per week**

Answer 500

Which structure in the bladder is under voluntary somatic control? Detrusor muscle Internal urethral sphincter **External urethral sphincter** Rugae of the bladder

Answer 501

Stimulation of which receptor would treat urinary incontinence? Beta 1 Beta 2 **Beta 3** M3

Answer 502

The sympathetic nervous system acts on the internal urethral sphincter via which receptor? **Alpha 1** Alpha 2` Beta 2 Beta 3

Answer 503

Which nerve carries sympathetic innervation to the bladder? Ilioinguinal nerve **Hypogastric nerve** Pudendal nerve Pelvic nerve

Answer 504

Which of the following is correct regarding muscle activity during the storage phase of micturition? **Storage requires relaxation of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters**. Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters. Storage requires contraction of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters. Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.

Answer 505

Relaxation of the detrusor muscle and contraction of the internal urethral sphincter (IUS) is under the control of which receptors respectively? B2-adrenoreceptors and A1-adrenoreceptors respectively **B3-adrenoreceptors and A1-adrenoreceptors respectively** A1-adrenoreceptors and B3-adrenoreceptors respectively A1-adrenoreceptors and B2-adrenoreceptors respectively

Answer 506

**Inability for detrusor muscle to relax, inability for the internal urethral sphincter to contract, and constant relaxation of the external urethral sphincter.** After a spinal cord lesion above T12, **sympathetic input to the bladder is lost**, leading to an **inability of the detrusor muscle to relax**, and an **inability** of the **internal urethral sphincter** to **contract**. Afferent signals via the sensory pelvic nerve are also unable to reach the brain, so the **external urethral sphincter remains constantly relaxed.**

Answer 507

What is the action of B3-adrenoreceptor agonists on the control of micturition? Bind to B3-receptors on the detrusor muscle to cause contraction, promoting the voiding of urine. Bind to B3-receptors on the internal urethral sphincter to cause contraction, preventing the voiding of urine. Bind to B3-receptors on the internal urethral sphincter to cause relaxation, promoting the voiding of urine. **Bind to B3-receptors on the detrusor muscle to cause relaxation, increasing the bladders storage capacity.**

Answer 508

**M3 muscarinic receptors** β3-adrenoreceptors cause relaxation of the detrusor rather than contraction.

Answer 509

What is the typical male urinary flow rate? 15-20ml/s **20-25ml/s** 25-30ml/s 30-35ml/s