mock papers Flashcards
(151 cards)
1
Q
3 examples of a secondary cartilagenous joints
A
intervertebral disc
pubic symphesis
manubriosternal joint
2
Q
the tunica intima of arteries is made up of ?
A
endothelium
3
Q
layers of artery walls
A
Tunica intima - endolthelial
tunica media - smooth muscle, elastic tissue, collagen
Tunica externa/adventitia - connective tissue, collagen
4
Q
what is an inverse agonist
A
a drug that binds to the same receptor as an agonist but induces a pharmacological response opposite to that of the agonist
they reduce constitutive activity as a receptor
5
Q
the concept of a spare receptor describes
A
that it is possible to elicit a maximal biological response at a concentration of agonist that does not result in full occupancy of available receptors
6
Q
EC50 is
A
concentration of a drug that produces 50% maximal effect
7
Q
ED50 is
A
the dose for 50% of the population to obtain the therapeutic effect
8
Q
what is the rate limiting step of glycolytic pathways
A
phosphofructokinase
9
Q
Absorption of iron from the GI tract is best in what form
A
ferrous form
10
Q
origin and termination of popliteal artery
A
Origin; continuation of femoral artery when it passes through the adductor hiatus
termination; lower border of popliteus muscle
11
Q
You review a recent angiogram and note the patient had multiple collateral vessels. If two vessels are connected in parallel, their total resistance to blood flow is
A
less than the resistance of either vessel alone
12
Q
Heparin biological activity is dependent on
A
endogenous antithrombin III
13
Q
The initial event in atherosclerosis is
A
endothelial dysfunction
14
Q
suprascapular nerve supplies
A
Suprspinatous
infraspinatous
15
Q
long thoracic nerve supplies
A
serratus anterior
16
Q
expiration is assisted by what muscles
A
subcostal muscles
17
Q
with salbutamol when will it show a peak bronchodilator effect
A
15-30 mins
18
Q
what is the clinical effect of ipratropium
A
blockage of airway smooth muscle contraction via reduced vagal activity
19
Q
at the hilum of the lung visceral pleura becomes continuous with which part of the parietal pleura
A
mediastinal part
20
Q
Elderly patients have physiological changes that affect the prescribing of medication. The greatest change in the liver is
A
changes to phase 1 reactions
21
Q
two patients have different clinical response to the same drug, what is the most important mechanism for variation in drug responses
A
differences in active transport systems
22
Q
bioavailability of diazepam
A
100%
23
Q
Ficks law describes
A
passive flux of molecules down a concentration gradient
24
Q
patient with HTN and diabetic nephropathy, initiating antihypertensive therapy would be with
A
ACEi
25
A patient presents with profound hypertension and headache of acute onset. They were on opiate withdrawal maintenance regime and had ceased all medications 4 days ago. What drug likely caused this
Clonidine
26
mechanism of action of furosemide
blockade of Na/K/Cl transporter in loop if henle
27
what part of the vasculature is most sensitive to the vasodilating effects of nitrates
Veins
28
Flecainide is what class of drug in Vaughan-Williams classification
1c
29
what time post stroke should thrombolysis be given ideally
<3 hours
30
warfarins mechanism of action is via
Inhibition of gamma-carboxylation of factors II VII IX X
31
paraesthesia of index finger and thumb is damage to what dermatome
C6
32
the major pathological mechanism causing 'nutmeg' liver in CCF is?
hepatic hypo-perfusion
33
what type of underlying genetic abnormality is most commonly seen in CF
deletions
34
pathology of ACS primarily involves
mural thrombosis of an epicardial artery
35
most common site of origin of emboli causing cerebrovascular disease is
heart
36
a factor that stimulates the proliferation of smooth muscle cells also relates to the pathogenesis of athersclerosis is
platelet derived growth factor
37
several days post STEMI a patient develops a new pansystolic murmur and increased left atrial pressures from late systole to early diastole. Which lesion is most likely to have caused this?
rupture of the papillary muscle
38
Successful immune response to HIV during the acute phase of infection results from?
development of CD8+ virus specific cytotoxic cells
39
organ transplant rejection is what type of hypersensitivity reaction
type IV, II and III
40
Excitatory amino acids in the brain are
GABA
glycine
41
major site of airway resistance is ?
medium sized bronchi
42
as a red cell passes through systemic capillaries its size will...
increase
because of increases intracellular osmoles
43
Immediately after inspiration commences what pressure changes would you expect?
intrapleural pressure and intrapulmonary pressure both fall
44
third heart sound is
turbulence during rapid ventricular filling in early diastole
45
turbulence is most likely to occur in blood vessels if
the velocity of blood within the vessels increases
46
A patient with abdominal pain that is visceral in origin, true visceral pain arises from?
Distension
47
in normal circumstances largest volume of blood is located in ?
large veins
48
in hypokalaemia what would you see on ECG
U waves
widespread ST depression
Twave inversion
bradycardia
prolonged PR
49
Cushing triad of raised ICP
Bradycardia
Wide pulse pressure
irregular respirations
50
which hormone/ factor will result in an increase in pH of duodenal contents
secretin
51
a patient has a deep laceration to the arm which structure lies deepest and is least likely to be injured;
median nerve
basilic vein
flexor pollicis longus
ulnar nerve
flexor pollicis longus
52
nerve supplying skin over femoral triangle is
genitofemoral
53
oesophageal opening is at what level
T10
54
the anterior triangle of the neckhas a floor made up with which strucutres
submandibular gland
mylohyoid and hypoglossus muscles
55
the alar ligaments of the cervical spine connect what
dens to the foramen magnum
56
blood supply to the SA node is from?
SA nodal artery which arises from the RCA in 60% people
57
at the 4th finger PIPJ, flexion is primary the role of
flexor digitorum superficialis only
58
which subset of type A fibres is most sensitive to local anaesthetic
A delta
59
how long does paralysis with rocuronium last
25-35 mins
60
superior mesenteric artery and vein cross which part of the duodenum
inferior part
61
thoracic constriction of the oesophagus can be caused by its crossing which structure?
arch of aorta
left main bronchus
62
the styelomastoid foramen transmits the stylomastoid artery and ?
facial nerve
63
surface anatomy of the superior vena cava is best described as being related?
right border of the manubrium and upper 1/3 of the body of the sternum
64
type of cell injury seen in the myocardium following MI
coagulative necrosis
65
how much more potent is fentanyl compared to morphine
100 times more potent
66
on what vessels does angiotensin II principally act
arterioles
67
a week post fracture what stage of the pathology process would it be
fusiform uncalcified tissue uniting the fracture ends with no structural rigidity
68
where is responsible for the basic rhythm of ventilation
medullary respiratory centre
69
what IV fluid in large volumes of infusion can cause a normal anion gap metabolic acidosis
Normal saline
70
which IV fluid is considered to be a balanced solution
Hartmanns
71
which IV fluid is used to treat toxicity of drugs with a sodium channel blocking effect
sodium bicarbonate 8.4%
72
which organism do you need to consider specifically for burns
Pseudomonas aruginosa
73
Vasopressin’s antidiuretic effect is mediated by what mechanism
Binding V2 receptors and inducing insertion of aquaporin 2 into apical membranes of collecting ducts
74
Hydrogen ion secretion in the distal tubules and collecting ducts is controlled by what
Aldosterone control of ATP driven H+ pump
75
In nephrogenic diabetes insipid is what can the two genetic disorders be
1. mutation to V2 receptor (X linked recessive)
2. Mutation of the gene aquaporin 2 (autosomal)
76
Regarding diuretics what is the mechanism of action for ethanol
Inhibits vasopressin secretion
77
Type of diuretic and mechanism of action- acetazolomide
Carbonic anhydrase inhibitor
Profoundly decreases sodium bicarbonate reabsorption in the proximal tubule
78
Clinical application of acetazolamide
Acute mountain sickness
Glaucoma
Urinary / metabolic alkalosis
79
Pharmacokinetics of acetazolomide
Absorption - 100% oral bioavailability
Not metabolised
Excreted in urine
80
Contraindications of acetazolomide
Renal failure - worsens metabolic acidosis
Liver failure - decreases excretion of already elevated NH4 = hepatic encephalopathy
81
Mechanism of action of mannitol
Osmotic diuresis
Osmotic effect at proximal tubule and descending loop of henle
82
Pharmacokinetics of mannitol
Administered parenterally
Rapidly distributed
Not metabolised
Excreted in urine within 30-60 minutes
83
Clinical uses of mannitol
Increasing urine volume
Reduction of ICP
84
Mechanism of action of furosemide
Loop diuretic acting in the thick loop of henle
Blocks the Na K Cl co transporter
Increases Ca and Mg excretion
85
Pharmacokinetics of frusemide
Oral bioavailability 45-70% , IV
Rapid onset
Metabolised and excreted in the kidney
86
Clinical uses of furosemide
Oedema
Acute hypercalcaemia (with IV fluids)
Hyperkalaemia
Anion ingestion (bromide, fluoride, iodide)
87
Toxicity of furosemide
Hypokalaemic metabolic alkalosis
Ototoxicity
Hyperuricaemia - may precipitate gout
Hypomagnesaemia
88
Mechanism of action of chlorothiazide
Thiazide diuretic
Blocks Na Cl cotransporter in the distal tubule
Inhibits NaCl reabsorption = diuresis
89
Clinical uses of thiazide diuretics
Htn
Heart failure
Neohrolithiasis due to idiopathic hypercalciuria
Neohrogenic diabetes insipidus
90
Mechanism of action of spironalactone
A synthetic steroid and aldosterone antagonist
Competitive antagonist to aldosterone at its receptor in the collecting ducts
Inhibit NaK exchange by inhibiting aldosterone
91
Clinical uses of spironolactone
Primary hyper secretion - Conns syndrome, ectopic ACTH production
Secondary aldosteronism - heart failure, hepatic cirrhosis, nephrotic syndrome
92
Pharmacokinetics of spironolactone
Orally absorbed 70%
Extensive first pass metabolism
90% protein bound
Excreted urine and small amount in bile
93
Mechanism of action of amiloride and triamterene
Interfere directly with Na entry through the ENaC ion channel in the collecting tubule
94
At what gestation do ectopic pregnancies typically rupture
6 weeks
95
What is the urinary lower pH
4.5
96
A 6 year old indigenous male presents with joint pain, rash, new murmur 2 weeks following from a strep sore throat. What type of hypersensitivity is this?
Type II reaction
(Rheumatic fever)
97
Describe and give examples of type 1 hypersensitivity
IgE mediated
Mast cells and basophils
Results in allergy, anaphylaxis, atopic disease
98
Describe and give examples of type II hypersensitivity
Cytotoxic reaction mediated IgG or IgM
Mediated by antibodies directed towards antigens present on cell surfaces or extra cellular matrix
Eg blood transfusion reactions, rheumatic fever,
99
Describe and give examples of type 3 hypersensitivity
Antigen antibody complexes
Eg post strep glomerulonephritis
Sle , RA, serum sickness
100
Describe and give examples of type 4 hypersensitivity
Cell mediated
Eg transplant rejection, infectious contact dermatitis
101
Regarding cholera how does the toxin cause chloride secretion
The cholera toxin binds to epithelial cells
Opens CFTR channel that secretes chloride ions into the lumen
Massive Cl Na and HCO3 secretion
Osmotic H20 loss
Secretary diarrhoea
102
Which hormone is responsible for stimulating the acinar cells of the pancreas to release zymogen granules and pancreatic juice rich in enzymes?
CCK
103
What cells secrete CCK
Secreted by I cells in the mucous of the upper small intestine
104
What does CCK do/cause
Contraction of gall bladder
Stimulate acinar cells of pancreas to release pancreatic juice rich in enzymes
105
What cells produce Gastrin
Produced in G cells in the gastric antrum
106
What does Gastrin do / stimulate
Stimulation of gastric acid and pepsin secretion, growth of mucosa in stomach and large intestine , gastric motility
107
What type of laxative is docusate
Stool softener
108
Main mechanism of action of gliclazide
A sulfonylurea
Stimulating release of performed insulin from pancreatic islet cells
109
Examples of first and second generation sulfonylureas
1st - tolbutamide
2nd - glipizide glimipiride
110
Adverse effects of sulfonylureas
Hypoglycaemia
Flushing with alcohol
Dlutional hyponatraemia
111
Where is glucose maximally absorbed
Jejunum
112
Shoulder addiction myotome
C7/C8
113
Finger abduction myotome
T1
114
Elbow extension myotome
C7
115
Finger extension myotome
C7
116
Finger abduction myotome
T1
117
A weak acid is defined as
A neutral melecule that can reversibly dissociate an anion with a proton
118
What are on the axis of frank starling curve
Stroke volume ml
LV end diastolic pressure mmHg
119
Pathology of Graves’ disease
Type II hypersensitivity reaction
Autoantibodies to TSH receptors in the thyroid
120
Treatment for sulfonylurea induced hypoglycaemia
Octreitide
It inhibits insulin secretion
121
Central cord syndrome neurological findings
Variable loss of touch sensation with loss motor function in upper limbs > lower limbs
122
What is benztropine
A centrally acting anti muscarunic in Parkinson’s
123
How is bilirubin delivered to the liver
Bound to serum albumin
124
Which class of organisms is most sensitive to chlorhexidine
Gram positive cocci
125
ICF contributes to what % of total body weight and what % of total body water
40% total body weight
66% total body water
126
ECF contributes to what % total body weight and what % of total body of water
20% total body weight
33% total body of water
127
Type of hypersensitivity for post strep glomerulonephritis
Type 3
128
What organism causes post strep glomerulonephritis
Group A strep
129
Mechanism of action of digoxin
Inhibits action of Na/K ATPase pump
This increases sodium in the cell
Causing the sodium calcium channel to not bring Na in or move Ca out
So intracellular Ca increases
Increases contractility
Positive inotrope
Also increases vagus nerve supply to heart - negative chronotrope
130
Pharmacokinetics of digoxin
65-89% orally absorbed
Poorly lipid soluble
Widely distributed including to CNS
NOT extensively metabolised
2/3 excreted by kidneys
Half life 60 hrs
131
What two cell types are in the adrenal medulla
Adrenaline secreting 90%
Noradrenaline secreting 10%
132
What cells release renin
Juxtaglomerular cells
133
When is renin released and where does it go/what does it do
Released with low BP
Travels to the liver
Converts angiotensinogen to angiotensin I
134
What does angiotensin II do to the cns
Causes posterior pituitary to secrete ADH (vasopresssin) which causes water retention in collecting ducts
Also creates thirst
135
What does angiotensin II do to the adrenal gland
Causes aldosterone release from zona glomerulosa in the adrenal cortex
This increases Na and H2O reabsorption in the DCT
136
What does angiotensin II do to the kidneys
Causes vasoconstriction in efferent arteriales > afferent arterioles
Increases GFR
137
What inhibits renin
Increases pressure within the afferent arterioles
138
What are the vitamin k dependent clotting factors
II VII IX X
139
Attachment actions and innervation of superior rectus
Originated from superior part of the common tendinous ring
Attaches to the superior and anterior aspect of sclera
Main movement is elevation.
Also contributes to adduction and medial rotation
CN III
140
Attachments action and innervation of inferior rectus
Originates from the inferior part of the common tendinous ring
Attaches to inferior and anterior aspect of sclera
Main movement is depression
Contributed to addiction and lateral rotation
CN III
141
Attachment action and innervation of medial rectus
Originates from medial part of common tendinous ring
Attaches to antereromedial aspect of the sclera
CN III
142
Attachment action and innervation of lateral rectus
Originates from the lateral part of the common tendinous ring
Attaches to anterolateral aspect of sclera
Abducts the eye ball
CN VI abducens
143
Attachments action and supply of superior oblique
Originates from body of the sphenoid bone
Depress abducts and Medially rotates eyeball
Innervated by trochlear nerve CNIV
144
Attachments actions and innervation of inferior oblique
Originates from anterior aspect of orbital floor
Elevated abducts and laterally rotates the eyeball
Innervation CN III
145
What part of the heart is not on the posterior surface
Right ventricle
146
A complication of hydralazine
Can cause sle in 10-20% patients
147
In pacemaker cells what happens at phase 4
Funny current ion channels open
Conduct slow inward Na current
148
In pacemaker cells in phase 4 what happens at -50mV
Transient T type Ca channels open
149
In pacemaker cells what happens in phase 4 at -40mV
Second type of L type Ca channel opens
More calcium enters cell until action potential reached at -30mV
150
In pacemaker cells what happens phase 0
Influx of calcium through L type Ca channels
151
In pacemaker cells what happens at phase 3 of the cycle
K channels open and k moved out of the cell
Ca channels close
At end slow inward Na funny channels open
