Progress Test 3 Flashcards
(298 cards)
1
Q
Where is the bladders lymphatic drainage
A
Internal and external iliac lymph nodes
2
Q
What clinical sign is associated with mid shaft humeral fracture
A
Wrist drop due to radial nerve damage
3
Q
What clinical sign is associated with distal humeral fracture
A
Hand of benediction due to median nerve damage
4
Q
What nerve damage causes an ulnar claw
A
Ulnar nerve
5
Q
What structure causes a Volkmann’s contracture
A
Brachial artery
6
Q
What structure causes a waiters tip
A
C5 and C6 roots of brachial plexus
7
Q
What haemoglobin trait is seen in mild sickle cell
A
HbA HbS
8
Q
What haemoglobin trait is seen in sickle cell disease
A
HbS HbS
9
Q
What does IL-1 do and where does it arise
A
Acute inflammation and fever induction, macrophages
10
Q
What does IL-2 do and where does it arise
A
Stimulates growth and differentiation of T-cell response, TH1 cells
11
Q
What does IL-3 do and where does it arise
A
Differentiation and proliferation of myeloid progenitor cells, Activated T-Helper cells
12
Q
What does IL-4 do and where does it arise
A
Proliferation and differentation of B cells, TH2 cells
13
Q
What does IL-5 do and where does it arise
A
Stimulates eosinophil production, Th2 cells
14
Q
What does IL-6 do and where does it arise
A
Stimulates differentiation of B cells, induces fever, macrophages, Th2 cells
15
Q
What does IL-8 do and where does it arise
A
Neutrophil chemotaxis, macrophages
16
Q
What does IL-10 do and where does it arise
A
Inhibits Th1 production - its anti-inflammatory, Th2 cells
17
Q
What does IL-12 do and where does it arise
A
Activates NK cells and stimulates differentiation of naive T-cells into Th1 cells, macrophages, B-cells
18
Q
What is the first line management for diveticular disease
A
Increased fibre
19
Q
What is the gold standard for diagnosis of coeliac disease
A
Endoscopic intestinal biopsy
20
Q
What other electrolytes are important to check with calcium alterations
A
- Magnesium 2. Phosphate (high phosphate with low calcium can indicate hypoparathyroidism)
21
Q
What is the most common type of breast cancer
A
Invasive ductal carcinoma
22
Q
How does Factor V Leiden lead to hypercoagulability
A
Activated protein C resistance
23
Q
What is the Budd-Chiari Triad
A
Abdo pain, ascites, hepatomegaly
Its hepatic venous outflow tract obstruction
24
Q
What is the mnemonic for femoral nerve supply
A
(Dont) MIS VQ Scan for PE
Medial cutaneous nerve of the thigh
Intermediate cutaneous nerve of the thigh
Saphenous nerve
Vastus
Quadriceps femoris
Sartorious
Pectineus
25
What are the femoral nerve roots
L2,3,4
26
What is the most common feature of papilloedma
Bilateral swelling
27
What is the nerve to stapedius a branch of
Facial nerve
28
Where is CCK produced and by what
I cells in upper small intestine
29
What does CCK do
Stimulates gallbladder contraction
30
What are symptoms of cholecystitis
RUQ pain after fatty meal, pale floating stool
Due to reduced responsiveness to CCK because of inflammation
31
How does GTN spray work
Nitrates cause nitric oxide release in smooth muscle, activating guanylate cyclase which converts GTP to cGMP which causes smooth muscle relaxation
32
What is the most appropriate way to assess osteoporosis risk
FRAX tool
33
What are the most common underlying molecular pathologies in Alzheimers/dementia
Extraneuronal amyloid plaques and intraneuronal neurofibrillary tangles
34
What is the longest phase of wound healing
Remodelling
35
What might raise PSA (non medical reasons)
Ejaculation and vigorous exercise within 48 hours
36
What is the appropriate management for a patient 5 days post cataract surgery who has increasing pain and decreasing visual acuity
Urgent same day referral to an ophthalmologist as it could be post-operative endophthalmitis
37
What drugs can cause gynaecomastia
Spironolactone, digoxin, cannabis, finestaride, GnRH agonists, oestrogens, anabolic steroids
38
In a patient with Crohn's post ileum resection, what are the most common side effects
Bile acid malabsorption leading to steatorrhoea and malabsorption of vitamin ADKE
39
What structures does the endoderm give rise to
Epithelial lining of GI tract, liver, pancreas, thyroid, parathyroid, urethra, bladder
40
What structures does the mesoderm give rise to
Think tissues in the middle
Muscle, bones, cartilage, dermis of skin
Notochord
Kidneys, gonads and adrenal cortex
Circulatory system
Spleen
41
What structures does the ectoderm give rise to
Think outer tissues
Epidermis of skin, hair, nails, melanocytes
Linings of mouth, teeth, outer anus
CNS and PNS
Adrenal medulla and pituitary gland
Mammary glands
Eyes
42
What is the rule of thirds in carcinoids
1/3 of these tumours are multiples
1/3 are in the small bowel
1/3 metastasize
1/3 have a second cancer elsewhere in the body
43
What hormone is released by carcinoids
Serotonin
44
What must a patient be counselled on before starting ciclosporin
Nephrotoxicity
Electrolyte imbalance
Hirsutism
Gingival hyperplasia
Hypertension
Tremor, headache, parasthesia
Nausea, vomiting, diarrhoea
45
What is ciclosporin
Calcineurin inhibitor thus an immunosuppressant
Blocks amplification of certain T cell responses and suppresses IL-2 synthesis and release
46
What nutrient deficiencies are associated with coeliac disease
Iron, folate and B12
47
What test is used for coeliac diagnosis
Anti TTG (normal is 0-15)
48
What should be offered as first line HRT to women with a uterus
Must also contain progesterone - e.g., estradiol with norethisterone
49
What structure contributes most to blood pressure stability
Arterioles - site of highest resistance in the cardiovascular system
50
What cranial nerve is associated with ptosis (eyelid drooping), down and out eye, dilated fixed pupil
Oculomotor nerve (CN III) - function eye movement, pupil constriction, eyelid opening
51
What cranial nerve is associated with defective downward gaze --> vertical diplopia (double vision where the double image is below not beside)
Trochlear nerve (CN IV/4)
52
What cranial nerve is responsible for facial sensation and chewing
Trigeminal (CN V/5)
53
What cranial nerve is responsible for defective eye abduction leading to horizontal diplopia
Abducens (CN VI/6)
Think abduSIX
54
What cranial nerve is responsible for facial movement, taste in anterior 2/3rds of tongue, lacrimation, salivation
Facial (CN VII/7)
55
What cranial nerve is responsible for hearing and balance
Vestibulocochlear (CN VIII/8)
V for VIII and vesti. Its a long word so three 'i'
56
What cranial nerve is responsible for taste in posterior 1/3 of tongue, salivation, swallowing, mediates input from carotid body and sinus
Glossopharyngeal (CN IX/9)
57
What cranial nerve is responsible for phonation, swallowing, innervating viscera
Vagus (CN X/10)
Vagus, vagina - talking leading to sex leading to gagging. seX, CN X
58
What cranial nerve is responsible for head and shoulder movement
Accessory (CN XI/11)
You put accessories on your head and shoulders
11 looks like two arms
59
What cranial nerve is responsible for tongue movement
Hypoglossal (CN XII/12)
60
A lesion on this cranial nerve results in uvula deviation away from lesion site, loss of efferent gag reflex
Vagus
Vagus, vagina - talking leading to sex leading to gagging. seX, CN X
61
A lesion on this cranial nerve results in hypersensitive carotid reflex, loss of afferent gag reflex
Glossopharyngeal (CN IX)
62
What is the most likely cause of lethargy and a sore tongue with a history of gastrectomy
B12 deficiency
63
Where does the majority of glucose reabsorption occur
Proximal convoluted tubule of the nephron
64
First line treatment for a band like headache with no other symptoms
Tension headache: aspirin, paracetamol, NSAIDs
65
What drugs can cause hyperkalaemia
Spironolactone
ACE inhibitors
ARBs
Potassium sparing diuretics like amiloride, triamterene
66
What drugs can cause hypokalaemia
Thiazide diuretics
Loop diuretics
Acetazolamide
67
A 60-year-old female is undergoing a Whipples procedure for adenocarcinoma of the pancreas. As the surgeons begin to mobilise the pancreatic head they identify a large vessel passing inferiorly over the anterior aspect of the uncinate process. What is it likely to be?
Superior mesenteric artery
68
A 70 years old retired manual labourer attends his GP practice with the complaint of slowly progressive loss of extension of his 4th and 5th finger. The doctor also notices nodules between his 4th and 5th finger.
Dupuytren's contracture
69
What fingers are most commonly affected with a Dupuytren's contracture
Ring and little finger
70
What cytokine is most likely to be elevated during sepsis and why is that bad
IL-1
Causes vasodilation and thus hypotension
71
What gene is defective with Li-Fraumeni syndrome
P53
72
A 45-year-old man attends your clinic. He is concerned as his father has just been diagnosed with Huntington's disease. He is aware that this is a genetic condition and wants to be tested. He also wants more information about the likely course of the condition. You explain that, if he tests positive, he will likely develop symptoms earlier than his father did.
Anticipation
73
What is anticipation and where is it seen
Age of onset of a condition decreases
Mostly in trinucleotide repeat disorders; Huntington's, myotonic dystrophy, fragile-X
74
What muscles abduct the hip
Gluteus medius and minimus
75
What muscle externally rotates and extends the hip
Gluteus maximus
76
How do macrolides work
Inhibit protein synthesis by acting on the 50S subunit of ribosomes
77
What is the 'worst thing' about 3rd degree burns
Third space fluid loss
Oedema, tachycardia and hypotension
78
What is a Colle's fracture and how does it typically present
Think D
Dorsally (posterior) displaced distal radius
Dinner fork deformity
79
What does a FOOSH usually result in
Colle's fracture
80
If a rupture occurred in the colon, where would gas/blood accumulate
Retroperitoneal space
81
What is the mnemonic for retroperitoneal organs
SAD PUCKER
Suprarenal (adrenal)
Aorta and IVC
Duodenum (except 1st part)
Pancreas (except tail)
Ureter
Colon
Kidney
Esophagus
Rectum
82
What is the mnemonic for intraperitoneal organs
SALTD SPRSS (salted spurs)
Stomach
Appendix
Liver
Transverse colon
Duodenum (first part)
Sigmoid colon
Pancreas tail
Rectum (upper third)
Spleen
Small intestine - jejunum and ileum
83
A 25-year-old man presents to the GP with muscle weakness in his right foot. The GP notes difficulty with inversion and suspects muscular weakness in the back of the leg.
Tibialis posterior
84
Where is the site of the lesion; hemiparesis and sensory loss with the lower extremity being more affected than the upper
Anterior cerebral artery - opposite to whatever side is affected
85
Why can omeprazole make anaemia worse
Gastric acid increases iron absorption
86
What cells mediate acute and chronic organ rejection
Helper T cells
87
A simple x-ray shows she has a shaft fracture of the humerus.
Given the likely nerve damage, which of the following movements will Georgia struggle with?
Wrist extension due to radial nerve damage
88
A simple x-ray shows she has a supracondylar fracture of the humerus.
Given the likely nerve damage, which of the following movements will Georgia struggle with?
Wrist flexion, thumb movement due to median nerve damage
89
A simple x-ray shows she has a fracture of the humeral epicondyles/fracture of radial head/dislocation of the elbow.
Given the likely nerve damage, which of the following movements will Georgia struggle with?
Finger adduction due to ulnar nerve damage
90
An 85-year-old woman is found collapsed in her home. She is taken to the hospital for further investigations and is found to be hypotensive secondary to dehydration. Which of the following is the most likely physiological reaction?
Renin is released due to reduced renal perfusion
Renin starts the RAAS cascade which basically eventually leads to Angiotensin II production which increases BP
91
What is Klumpke's paralysis
Damage to C8-T1 nerves
Seen in pts with lung cancer where its spread to involve roots of brachial plexus
Leads to claw hand and hand weakness
Often seen with Horner syndrome which is a result of T1 damage
92
Why is betamethasone given during labour pre 35 weeks
Enhances foetal lung maturation
93
Where is the bleeding from in a subdural haemorrhage
Bridging veins between the cortex and venous sinuses
94
What does PGI2 do to blood clots
Decreases platelet aggregation
95
How does the sympathetic nervous system increase heart rate
Increased conduction velocity of the AV node
96
What oncogene is most associated with breast and ovarian cancer
HER2/neu (Erb-B2)
97
A 45-year-old woman presents to the outpatient department with an inability to recognise objects by touch in her right hand. Pain, temperature, and proprioceptive sensation remain intact. There are no visual deficits, and muscle strength and coordination are normal.
What part of the cerebral lobe is most likely affected?
Parietal lobe lesions may cause astereognosis
98
What is the most common histological type of malignant renal cancer
Clear cell carcinoma
99
What is the most appropriate medication for croup
Dexamethasone due to very high glucocorticoid activity allowing settling of oedema and inflammation in the larynx
100
After complaining of increasing irritability, difficulty concentrating and pain and weakness in his limbs a patient with a history of alcoholism is sent for blood tests. The results reveal a vitamin deficiency. What is it and what is the condition called
Beri-beri, B1/Thiamine deficiency
101
What structure is generally at the highest risk of damage with a surgical neck fracture if the humerus?
Axillary
102
What is the mnemonic for the cardiac action potential
0: Summit: <-- sodium, rapid depolarisation
1: Plummet: --> potassium, repolarisation
2: Plateau: <-- calcium, slow
3: Plummet: --> potassium, repolarisation
4: Rest: <-- sodium, slow
103
What is the most appropriate investigation for diabetes insipidus
Water deprivation test
104
What is the most appropriate test for Addison's disease
Short synacthen test
105
What immunoglobulin provides immunity to parasites
IgE
106
What are some histological findings of Crohn's
Increased goblet cells and granulomas
Inflammation from mucosa to serosa
107
What is Waterhouse-Friderichsen syndrome and what is it most commonly caused by
Adrenal gland failure due to bleeding into the adrenal gland. Neisseria meningitidis
108
What is this: unilateral spastic paresis and loss of proprioception/vibration sensation with loss of pain and temperature sensation on the opposite side beginning at the umbilicus
Left-sided Brown-Sequard syndrome at T10
109
A 19-year-old man attends the Emergency Department with a 5-day history of fever, fatigue, sore throat, and generalised body aches. On examination, he has cervical lymphadenopathy and splenomegaly. His tonsils are swollen and covered with exudates.
Investigations:
EBV capsid antigen IgM Positive
EBV viral capsid antigen IgG Negative
Epstein-Barr nuclear antigen IgG Negative
Which is the most likely interpretation of this patient's condition?
Early primary EBV
110
Put simply, what are the features of compression at nerve roots L3-S1
L3: thigh problems
L4: knee problems
L5: dorsal foot and big toe area
S1: outer foot and shin
111
What does a positive femoral stretch test indicate
L3/L4 nerve root injury
112
What is the most common side effect of statin therapy
Myalgia
113
What is the formula for positive predictive value
TP/(TP+FP)
114
What is HPV associated with
Cervical cancer (HPV 16/18 most common)
Anal cancer
Penile cancer
Vulval cancer
Oropharyngeal cancer
115
What are desmoid tumours
Fibrous neoplasms most often containing myofibroblasts
Family history of adenomatous polyposis coli
116
What organism causes cerebral malaria and has RBC inclusion bodies shaped like signet rings
Plasmodium falciparum
117
What does 2-Naphthylamine increase risk of
Bladder cancer
118
Where does levothyroxine act
Nuclear receptors
119
How does glucagon work in the case of a beta blocker overdose (for example)
Increase in intracellular Ca2+ causing an increase in cAMP
120
What type of hypersensitivity reaction is allergic rhinitis
Type 1
121
On examination, he is found to have shoulder dislocation, weakness of flexion at the elbow, weakness of supination and loss of sensation on the lateral side of the forearm.
What nerve is most likely to be injured
Musculocutaneous nerve
122
What is Rovsing's sign
RIF pain on palpation of LIF - appendicitis
123
What cells and where produce gastrin
G cells in the antrum of the stomach
124
What must be done before prescribing a biologic
Interferon-gamme release assay to check for TB
125
What immunoglobulin and thus cell is associated with multiple myeloma
IgD which is involved in the activation of B cells
126
How does multiple myeloma cause hypercalcaemia
Increased osteoclast activity in response to cytokines released by myeloma cells
127
What is the normal lifespan of a red blood cell
120 days
128
What pancreatic cell membrane channel do sulfonylureas bind to
ATP-dependent potassium channel on cell membrance of pancreatic beta cells
129
What separates the tunica media from the tunica adventitia?
External elastic lamina
130
What separates the tunica intima from the tunica media?
Internal elastic lamina
131
A 56-year-old lady with metastatic breast cancer develops an oestolytic deposit in the proximal femur. One morning whilst getting out of bed she notices severe groin pain. X-rays show that the lesser trochanter has been avulsed. Which muscle is the most likely culprit?
The psoas major inserts into the lesser trochanter and contracts when raising the trunk from the supine position. When oestolytic lesions are present in the femur the lesser trochanter may be avulsed.
132
What is the lymph node drainage site for the testes
Para-aortic lymph nodes
133
What is the lymph node drainage site for the scrotum
Superficial inguinal lymph nodes
134
What is the lymph node drainage site for the glans penis
Deep inguinal lymph nodes
135
What is the lymph node drainage site for the anal canal above the pectinate line
Internal iliac lymph nodes
136
What is the lymph node drainage site for the descending colon
Inferior mesenteric lymph nodes
137
Where is infection causing a psoas abscess most likely to have spread
Kidneys
138
What nerve is responsible for skin sensation on the dorsal aspect of the hand
Radial nerve
139
What is the dose of adrenaline for people
<6 months: 100-150 ug
6 months - 6 years: 150ug
6-12: 300ug
12+: 500ug
Divide by 100 to get the X 1 in 1000
140
A 56-year-old woman presents to her GP with progressively worsening sensation over the ring and little finger on her right hand. She works as a receptionist and denies any strenuous activity or trauma.
What is most associated with the underlying pathology?
Ulnar nerve entrapment of the medial epicondyle - medial epicondylitis is is common in receptionists
141
What are the steps of PCR
Denature, anneal, elongate
142
What is the role of CD8+ T cells
Cytotoxic t cells bind to viral/tumour cell antigens and induce apoptosis
143
A 72-year-old man attends the Emergency Department with reduced urine output and general malaise over the past 48 hours.
Urine dipstick and microscopy reveal muddy brown casts but no protein or red blood cells.
Which best describes the pathophysiology of the most likely diagnosis?
Acute tubular necrosis - Ischaemic damage causing occlusion of the tubular lumen by casts and cell debris
144
Examination of the oral cavity shows fasciculation of the tongue, and when asked to stick her tongue out it deviates to her left. The patient is unable to move her tongue towards her right-hand side when asked.
What is the most likely location of the lesion?
Left hypoglossal nerve - tongue deviates towards site of the lesion
145
What arteries does the oculomotor nerve run through
Posterior cerebral and superior cerebellar arteries
146
What is a common side effect of amphotericin
Nephrotoxicity
147
What does vitamin D supplementation do to electrolytes
Increases plasma calcium and phosphate
148
What nerve has been damaged if the patient can't adduct their thumb
Ulnar nerve - adductor pollicis is innervated by ulnar nerve
149
What vessel is likely to haemmorhage during an appendectomy and what supplies it
The appendicular artery supplied by the ileocolic artery
150
What subtype is most important to match in a renal transplant
HLA-DR
151
What structure forms the medial edge of Hesselbach's triangle
Direct hernias pass through Hesselbach's triangle - medial border is lateral edge of the rectus abdominis
152
A 26-year-old man comes to the consultant's office complaining of increased thirst and frequent urination over the past month. His past medical history is significant for several physical injuries due to a motor vehicle accident from which he suffered 3 months back. As of today, the patient is otherwise healthy and does not receive any medications. Urinalysis studies show decreased sodium concentration and urine osmolarity of 90 mOsm/L.
What does this patient have and what renal tubular changes would be expected
Central diabetes insipidus triggered by the motor vehicle accident (damage to posterior pituitary this decreasing ADH). This leads to decreased expression of aquaporin-2 channels in the collecting ducts.
153
A newborn baby has symptoms of an eye-infection four days after vaginal delivery. He has conjunctivitis with purulent discharge and his eyelids appear to be swollen. Treatment is started promptly to reduce the chance of complications.
Which two organisms are most commonly associated with this presentation?
Ophthalmia neonatorum organisms: Chlamydia trachomatis and Neisseria gonorrhoeae
154
A 22-year-old lady receives intravenous morphine for acute abdominal pain. Which one of the following best accounts for its analgesic properties?
Binding to u opioid receptors within the CNS
155
Where does adrenaline act
G-protein coupled receptors
156
What virus is a risk factor for oropharyngeal cancer
HPV 16/18
157
Which surgical procedure will have the greatest long term impact on a patients calcium metabolism?
Small bowel resection as that's where calcium is absorbed
158
What is the most common form of child abuse
Neglect
159
Which muscle is supplied by the superficial peroneal nerve?
Peroneus brevis
160
What kind of medication is digoxin
Inotrope
161
What is the outermost covering of the spermatic cord derived from
External oblique aponeurosis
162
What is the circumflex artery a branch of
Left coronary artery
163
A 23-year-old man receives a direct blow to his left side during a rugby match. Following the injury, the medial border of his scapula is elevated and protrudes medially. He experiences shoulder pain whilst trying to lift objects.
What nerve has he injured and what does it supply
Long thoracic nerve which supplies serratus anterior
164
What and where produces somatostatin
D cells in pancreas and stomach
165
What does elevated leukocyte count and low leukocyte alkaline phosphatase indicate and what translocation occurs
Chronic myelogenous leukaemia, t(9,22) translocation
166
Where is the location of a seizure characterised by lip smacking and post-ictal dysphagia (absence seizure)
Temporal lobe
167
What structure separates the occipital lobes from the cerebellum
Tentorium cerebelli
168
What visual characteristics would you expect when looking at a foot with diabetic foot disease
Wide shallow ulcer on plantar aspect of the forefoot
169
What nerve does loss of corneal reflex indicate
Trigeminal
170
Stimulation of what receptor compensates for blood loss
Alpha 1 adrenergic - causes smooth muscle contraction
171
What is the most common location of atherosclerosis in a patient with TIA/stroke
Internal carotid
172
What cells are changed with Barrett's oesophagus
Stratified squamous become columnar epithelial
173
What structure lies deepest in the popliteal fossa
Popliteal artery
174
A 32-year-old male visits general practice with a 2-day history of jaundice and general fatigue. He explains how this has occurred in the past on multiple occasions but he never sought medical advice until now. He alludes to having a particularly bad bout of flu the past few days. There is no past medical history of note and he lives an active healthy life remaining abstinent from alcohol and smoking.
What does the patient have and what is he deficient in
Gilbert's syndrome (flares during times of stress), deficient in UDP glucuronosyltransferase
175
What kind of study is where patients pasts are examined
Case (patient) - control (past)
176
A 10-year-old boy presents with recurrent, prolonged episodes of sinusitis and bronchitis. He also gets gastrointestinal infections more regularly than his peers. These issues started two years ago. No other symptoms are present. Blood tests are taken to screen the boys immune system, and a type of primary immunodeficiency is discovered.
What does he have and what is it
Selective immunoglobulin A deficiency. Asymptomatic in 90-95% of cases. When symptoms do occur they're infections of resp and gastro, as IgA provides localised protection
177
What is the hallmark feature of myasthenia gravis
Fatiguable, painless muscle weakness that is improved with rest
178
What does Meckel's diverticulum show
Ectopic ileal/gastric or pancreatic mucosa
179
What condition is associated with episodes
of thrombophlebitis migrans (Trousseau's syndrome) and jaundice
Pancreatic adenocarcinoma
180
What is the most likely cause of painful constipation following a gastro surgery
Paralytic ileus
181
What is the mechanism of action of dabigatran
Direct inhibition of thrombin
182
What molecule does the golgi add to proteins for trafficking to lysosomes
Mannose 6-phosphate
183
What would be seen in an ABG with someone with bad diarrhoea
Metabolic acidosis and hypokalaemia
184
What is a cohort study
2 groups are selected, one with and one without a certain characteristic, and then followed up to see who got sick
185
What does gastrin do
Increases HCL production and gastrointestinal motility
186
What part of protein structure is interaction between R groups of amino acids
Tertiary
187
Currently, the medication is being tested on a small number of patients suffering from migraines. If the drug moves on to the next phase, it will be compared to currently used medication for migraines on a larger population of patients.
What clinical trial phase is the drug currently in?
Phase 2 - testing efficacy in small numbers
188
What immunoglobulin is most associated with atopy
IgE
189
What does the ductus venosus do in foetuses
Shunts left umbilical vein blood to the IVC
Closes between days 3-7 after birth
190
What structures make up the border of the anatomical snuffbox
Extensor pollicus brevis and abductor pollicus longus
191
How do taxanes like docetaxel work
Prevent microtubule depolymerisation and disassembly, decreasing free tubulin
192
A middle-aged woman presents with left-sided hemisensory loss and ipsilateral sensory inattention. The doctor suspects a space-occupying lesion. Where is this likely to be?
Right parietal lobe - Sensation and sensory attention are associated with the parietal lobe, damage of which causes contralateral deficits.
193
What nerve damage causes a hoarse voice after thyroid surgery
Recurrent laryngeal nerve - branch of the vagus nerve
194
What level of vertebrae does the superior mesenteric artery arise from the aorta
L1
195
What nerve has been damaged if someone can't extend their fingers
Radial nerve
196
What does buprenorphine do
Partial agonist of mu-opiod receptor and antagonist of kappa-opiod receptor
197
What is the most superficial structure on the parotid gland
Facial nerve
198
What type of hypersensitivity reaction is anaphylaxis
Type I
199
A 26-year-old man is brought into the emergency department after being found unconscious as home. He is a known intravenous drug user (IVDU).
He has a fever of 38.5oC and a cardiovascular examination reveals a new murmur heard loudest of the tricuspid region. An echocardiogram is ordered, which identifies a vegetation on the tricuspid valve.
A blood culture is ordered. Which of the following organisms is most likely growing on the valve?
Staph aureus due to the fact he injects with drugs
200
How is c diff spread
Faecal-oral by ingestion of spores
201
What bone might fracture on the thumb areas in a FOOSH
Scaphoid
202
What hormones are secreted by the anterior pituitary
Prolactin, TSH, ACTH, LH, FSH and melanocyte releasing hormone
203
What hormones are secreted by the posterior pituitary
ADH and oxytocin
204
Where is aldosterone released from
Zona gloumerulosa of the adrenal cortex
205
Where is cortisol released from
Zona fasiculata of the adrenal gland
206
What is doxorubicin and how does it work
Anthracycline, stabilises DNA-topoisomerase II, inhibits DNA and RNA synthesis
207
Where is adrenaline released
Adrenal medulla
208
What are the symptoms of phaeochromocytoma
Hypertension which doesn't respond to treatment
Severe episodes of sweating, palpitations and anxiety
209
What are the contents of the carotid sheath
Common carotid artery
Internal carotid artery
Internal jugular
Vagus nerve
210
What is the formula for relative risk
(Exposed patients with disease/exposed patients without disease)/(Unexposed patients with disease/unexposed without disease)
211
At what level does the inferior vena cava pass through the diaphragm
T8
212
How does calcitonin work
Inhibit osteoclast activity, which decreases plasma calcium levels
213
How does chloramphenicol work
Inhibits 50s subunit of ribosomes, inhibiting protein synthesis
214
When the light is shone in the left eye both pupils constrict however when the light is shone on the right eye both pupils dilate.
What structure is most likely to be affected?
Right optic nerve
215
What does a serious blow to the side of the head often lead to
Fracture of the temporal bone and laceration of the middle meningeal artery, leading to an epidural haematoma leading to brainstem compression
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What does HIV use to enter cells
CD4
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What structure is the thymus derived from
3rd and 4th pharyngeal pouches
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What kind of hernia is inferior and lateral to the pubic tubercle
Femoral hernia
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What kind of hernia is superior and medial to the pubic tubercle
Inguinal hernia
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How does abciximab work
Glycoprotein llb/lla receptor antagonist which prevents platelet aggregation
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How do sodium valproate and carbamazepine work
Inhibit sodium channels and suppress excitation
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What is the most appropriate treatment for myasthenia gravis and how does it work
Pyridostigmine, long-acting acetylcholinesterase inhibitor which reduces breakdown of acetylcholine in the neuromuscular junction
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What kind of seizure causes olfactory hallucinatoins
Temporal lobe
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Where do the left gonadal veins drain
Into the left renal vein
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IgM dimerises to what, to do what
To form a pentamer to activate the complement system
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How does baclofen work
Agonist of GABA receptors that act in the CNS
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What is the most common type of colorectal carcinoma
Adenocarcinoma
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What is the inheritance pattern of Gilbert's syndrome
Autosomal recessive
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What Trendelenburg gait and what does it appear like
The opposite hip dipping when weight on the other leg (think model walk). It can be caused by superior gluteal nerve damage.
230
How can Trendelenburg gait be differentiated from L5 radiculopathy or polio
Foot drop
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On neurological examination of the lower limbs, it is noticed that he has loss of plantarflexion and inversion of his left foot.
What nerve is most likely affected
Tibial nerve
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What is golimumabs mechanism of action
Tumour necrosis factor inhibitor
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What is the most abundant immunoglobulin in the blood
IgG
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What is the mechanism of action of aspirin
Irreversible COX1 and 2 inhibitor which suppresses prostaglandins and thromboxane A2
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On examination, flexion, extension, abduction and external rotation at the right shoulder are weakened. He reports a loss of sensation over the right lateral upper arm.
What muscle/s are innervated by the nerve damaged in this patient?
Axillary nerve supplies teres minor and deltoid muscle -
Regimental badge area of the upper arm; think of army, axillary forces
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Which nerve supplies sensation to the nail bed of the index finger
Median
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Where does the aorta bifurcate into common iliac arteries
L4
238
Which one of the following vessels is the main contributor to the arterial supply of the femoral head?
Circumflex femoral arteries
239
Into what vein does the middle thyroid vein drain
Internal jugular - which is why it bleeds so badly if a ligature slips
240
A 55-year-old man undergoes a colonoscopy and a colonic polyp is identified. It has a lobular appearance and is located on a stalk in the sigmoid colon. What process best accounts for this disease?
Dysplasia
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What dietary finding is associated with low collagen
Low Vitamin C
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What blood type is the universal blood type
O rhesus negative
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What atypical pneumonia organism can grow on Eaton agar
Mycoplasma pneumoniae
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What substance in the joint space causes gout
Monosodium urate
245
What is Wilson's disease, how does it present, and what is the most likely location it affects
Excessive copper deposition in the tissues due to reduced serum caeruloplasmin
Children often present with liver disease and young adults with neurological symptoms
Most copper is deposited in the basal ganglia
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Describe e coli
Aerobic gram negative rod
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What neurotransmitter does botulism affect
Blocks release of acetylcholine
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What kind of bias is gathering information at an inappropriate time
Late-look bias
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A 34-year-old woman is brought to the emergency department with a severe headache, nausea, vomiting, and confusion that have been progressing over the past 24 hours. She has recently started a new medication, sertraline, for her depression. She is hyponatraemic. What complication is she facing
Cerebral oedema due to acute severe hyponatraemia which can be induced by sertraline due to induction of SIADH
250
The median aperture (foramen of Magendie) of the fourth ventricle allow cerebrospinal fluid (CSF) to flow from the fourth ventricle into which space?
Cisterna magna
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What space does CSF fill
Arachnoid mater and pia mater
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Where is CSF reabsorbed into the venous system
Arachnoid granulations into superior sagittal sinus
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What nerve entrapment may be a cause of neuropathic pain following inguinal hernia surgery
Ilioinguinal nerve which passes through the superficial inguinal ring
254
What is the Drawer test
Used to investigate suspected rupture of the cruciate ligament of the knee; both hands around the proximal tibia, pull anteriorly then push posteriorly
Excessive push or pull indicates a tear in anterior or posterior
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What kind of signs can cauda equina illicit
Lower motor neuron signs such as S2-S4 anaesthesia
256
What is a Type 1 error in a clinical trial
Null hypothesis being rejected when its true
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What artery is likely to be occluded in the case of contralateral hemiparesis and sensory loss, with the upper body more affected than the lower, contralateral homonymous hemianopia and aphasia
Middle cerebral artery
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During a newborn physical examination, a paediatrician notes cleft palate, low-set ears and a holo-systolic murmur along the left lower sternal border. Blood tests show hypocalcaemia and chest x-ray reveals an absent thymic shadow and a 'boot-shaped' heart. Further investigations confirm a ventricular septal defect, right ventricular hypertrophy and an overriding aorta.
What does the child have and what congenital heart disease is it associated with
DiGeorge Syndrome
Truncus arteriosus and tetralogy of Fallot
259
What structure forms the lateral wall of the femoral triangle
Sartorius
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Which oncogene is associated with Burkitt's lymphoma
c-MYC
261
What is the likely complication of stopping beta blockers suddenly
Rebound tachycardia
262
What does the deep peroneal nerve do
Sensation to webspace of first and second toes
Dorsiflexion of ankle joint
Extension of toes
Inversion of the foot
263
What is the mechanism of hypokalaemia due to thiazides
Decreased re-absorption of sodium in the distal convoluted tubule
264
What does the antigen HLA-B27 indicate
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
265
What is the function of the quadratus lumborum
Pulls rib cage inferiorly for lateral flexion
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What would the water deprivation test results for cranial DI show
Starting plasma High
Urine osmolarity Low
Urine osmolarity post desmopressin Normal
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What would the water deprivation test results for nephrogenic DI show
Starting plasma high
Urine osmolarity low
Urine osmolarity post desmopressin low
268
What structure, passing through the anatomical snuffbox, is most likely to be damaged in a FOOSH
Radial artery
269
What is the formula for sensitivity
TP/(TP+FN)
270
What is the formula for specificity
TN/(TN+FP)
271
What muscle is responsible for hip extension and external rotation
Gluteus maximus
272
Angiotensin I is a hormone that is important in the renin-angiotensin-aldosterone-system. It is derived from the hydrolysis of angiotensinogen in a reaction catalysed by which enzyme?
Renin
273
What class of molecules do Helper T cells recognise
MHC Class II
274
Hyperphosphorylation or abnormal phosphorylation of Tau protein commonly leads to what?
Reduced binding to microtubules and reduced microtubule stability
275
What are Drusen
Yellow deposits on the retina seen on fundoscopy and indicate age related macular degeneration
276
What is thoracic outlet syndrome
Disorder involving compression of the brachial plexus, subclavian artery or vein a the site of the thoracic outlet. People with a cervical rib have a higher chance of this
277
What type of joint is primarily affected in rheumatoid arthritis
Synovial
278
What cells are implicated in IBS
Enterochromaffin cells
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What cells are implicated in pheochromocytoma
Chromaffin cells
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What is a missense mutation
Change in amino acid sequence which may make the protein non-functional
281
What is a nonsense mutation
Change in amino acid that leads to a stop codon
282
What is the most appropriate advice to give to a pregnant vegan
Take B12 as the only source of B12 for humans is in animal based foods
283
How do beta blockers like timolol work in open-angle glaucoma
Reduces aqueous production
284
What is the bioavailability of an IV drug
100%
285
How does alcohol contribute to hypoglycaemia
Alcohol causes exaggerated insulin secretion
286
What ribs are most likely to be encountered during a posterior approach to the kidneys
11th and 12th
287
What area of the brain and thus artery occlusion would be responsible for sudden decline in speech
Broca's area, supplied by superior division of the left middle cerebral artery
288
Where does RNA splicing occur
Nucleus
289
What is a common cause of resistance to beta-lactams such as penicillin
Production of beta-lactamase which cleaves the beta-lactam ring of the antibiotic
290
What nerve fibres are activated to cause pain
C fibres
291
Which is the most important blood test to order before administration of the contrast medium?
U and E to check renal function
292
What is the difference in a massive venous v arterial bleed in terms of compensatory mechanism
Venous causes reduced preload which then reduces blood pressure which gets detected by baroreceptors. Arterial bleed causes an instant blood pressure drop
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What does hypovolaemic shock do to systemic vascular resistance
Increases it as a compensatory mechanism; RAAS leads to vasoconstriction in an attempt to maintain BP
294
What does the anterior cerebral artery supply
Frontal and parietal lobe
295
What are the 4 factors affecting stroke volume
Cardiac size, contractility, preload and afterload
296
Define preload and afterload
Preload is how much the ventricle is stretched when full just before diastole, and afterload is the amount of pressure it takes to squeeze the blood out
297
What is the sequence of cardiac electrical activation
SA node- atria - AV node- Bundle of His- right and left bundle branches- Purkinje fibres
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