Mock Exam Q&A

Question 1

Answer 1

Question 2

Answer 2

Phase 1 - up to 2 months
Active coping
Belief that pain is controllable
Anxiety

Phase 2 - 2-6 months
Testing of different coping styles
Depression may occur

Phase 3, 6-24 months
Hope of cure diminishes
Reduced activity
Belief that pain is uncontrollable
Depression is common

Question 3

Sciatic and OA - risk factors, characteristics of pain, two findings on examination

Answer 3

Question 4

Describe four features of the anger stage of the grieving process

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

Name 4 of the most common symptoms associated with the late stage of dying (2 marks)

Answer 8

Question 9

Answer 9

Question 10

Osteoporosis

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

Question 14

What class of hormone is cortisol?

What are the other classes?

Answer 14

Steroid hormone. (Lipo-Philic - fat loving, can transfuse freely across cell membrane) made from cholesterol.

Other examples of steroid hormones are oestrogen, progesterone, testosterone.

Other classes are protein/peptide hormones (insulin, leptin, oxytocin, prolactin) and amine hormones (adrenaline, thyroxin).

Question 15

Answer 15

Question 16

Describe in detail the physiological pathway of pain transmission from a joint to the brain (3 marks)

Answer 16

Summary: Detection → spinal cord (which fibres) → decussation → thalamus → cortex

Question 17

What is the difference between A-delta and C fibres?

Answer 17

A-delta fibres: myelinated, sharp immediate pain

C fibres: non-myelinated, slower duller pain

Question 18

Describe the pathway of A-delta fibres, including which tract they travel in

Answer 18

• A-delta fibres enter the dorsal root
• synapse with second order neurones
• decussate (send fibres to contralateral side)
• travel in spinothalamic tract

Question 19

Describe the pathway of C fibres, including which tract they travel along

Answer 19

• C fibres enter and terminate at the dorsal root
• synapse with axons that pass through the anterior commissars to the contralateral side
• and up the spino-reticulocytes-thalamic tract

Question 20

What is a mortise ankle X-ray?

Answer 20

Ankle X-rays can be AP, lateral or mortise. The UK uses mortise and lateral as standard, other countries do all 3.

Mortise X-ray is 15 degrees of internal rotation. This allows the best view of the ankle bones.

Question 21

What is the reason trimethoprim should not be given work methotrexate?

Answer 21

Trimethoprim is a folate antagonist, therefore there’s an increased risk of pancytopenia

(Same reason for co-trimoxazole / septrin)

Question 22

Answer 22

Vasodilation - histamine
Margination - integrins
Emigration - histamine
Chemotaxis - cytokines

Question 23

Describe two responsibilities towards the patient and two rights of the health professional according to the sick role (4 marks)

Answer 23

Question 24

What is the highest quality type of research?

Answer 24

Systematic review of high quality randomised controlled trials. Limit confounding and bias.

Question 25

What is the definition of ‘stress’?

Answer 25

Demands of a situation exceed our resources to cope with the situation

Question 26

Answer 26

Question 27

How to assess for ulnar nerve function in the hand

Answer 27

Adduction and abduction of fingers - small Muscles of the hand. Little and ring finger flexion

Question 28

Describe the stages of bone healing from a fracture

Answer 28

* Inflammatory phase - bleeding from torn vessels. Clotting cascade activated, and inflammatory cells (platelets, macrophages) arrive. Haematoma forms in fracture gap. Immediate from injury, peaks at 48hrs, subsides by one week. * Reparative phase – Mesenchymal stem cells become fibroblasts, osteoblasts and chondroblasts at the fractures site. Callus formed by intramembranous ossification at cortical bone ends (hard callus) and by chondrogenesis at the periphery (soft callus) . Endochondral ossification converts callus to woven bone. Starts within first few days and lasts few weeks. * Remodelling phase – Woven bone replaced by lamellar bone, and excess callus resorbed. Begins a few weeks after injury and lasts years.

Question 29

Describe the main physiological processes involved in the sensation and transmission of pain from one part of the body to the brain

Answer 29

Initial pain is sensed by nociceptors – free nerve endings in the skin, muscle and other tissues * Pain is transmitted by primary sensory neurons to the dorsal horn of the spinal cord - A-delta fibres for fast, acute pain and C-fibres for slow, throbbing/dull pain * In the dorsal horn, the primary sensory neuron will synapse with a second order neuron of the spinothalamic tract * This second order neuron immediately decussates and passes up to the thalamus * In the thalamus, second order neurons synapse with third order neurons leading to the sensory cortex and limbic system

Question 30

Answer 30

Question 31

Answer 31

Haematoma | Fibrin mesh - scaffold for inflammatory cells and fibroblasts

Question 32

Describe fracture healing one week after the fracture

Answer 32

Soft callus | See below

Question 33

Describe fracture healing 3 weeks after the fracture

Answer 33

Bony callus Osteoprogenitor cells deposit woven bone Cartilage undergoes endochondral ossification

Question 34

What are the systemic complications that can be associated with bone fractures or damage to associated soft tissues? (3 marks)

Answer 34

Shock, myoglobinuria, fat emboli, bone marrow emboli, thromboembolism

Question 35

What population characteristics do you need to know to calculate incidence and prevalence? What is incidence? What is prevalence?

Answer 35

Question 36

Levels of disease prevention. A national screening programme for Chlamydia would be what level of disease prevention?

Answer 36

Secondary prevention

Question 37

What are the three main differences between the innate and adaptive immune responses? (3 marks)

Answer 37

Speed of response - slower / quicker Non-specific/ specific No memory / memory

Question 38

Describe how the adaptive immune system is activated and the two major cell types involved in this process (3 marks)

Answer 38

Antigen presentation | T cells and B cells

Question 39

Describe how morphine works (2 marks)

Answer 39

Question 40

Describe four late complications that can arise from a fracture (2 marks)

Answer 40

``` Malunion Non union Joint stiffness Avascular necrosis Osteomyelitis Deformity Chronic regional pain syndrome CRPS ```