Quick facts 9 Flashcards
(135 cards)
1
Q
What is being tested in this photo? [1]
A
True leg length: anterior superior iliac spine (ASIS) to the medial malleolus.
2
Q
What measurement is being recorded? [1]
A
Apparent leg length
3
Q
Most prostaglandins cause relaxation of vascular smooth muscle as part of the normal homeostatic role.
What role in the inflammatory process would this have in an osteoarthritic joint?
Cause joint to become hot and red
Cause loss of function of the joint
Cause pain
Increase number of immune cells
Increase production of synovial fluid
A
Most prostaglandins cause relaxation of vascular smooth muscle as part of the normal homeostatic role.
What role in the inflammatory process would this have in an osteoarthritic joint?
Cause joint to become hot and red
Cause loss of function of the joint
Cause pain
Increase number of immune cells
Increase production of synovial fluid
4
Q
A 14 year old body presents with fever and knee pain of sudden onset over 12 hrs. The knee is swollen and there is limited knee flexion. The gadolinium fat supressed T1 weighted image is shown.
What is the name of this region of bone
Diaphysis
Epiphysis
Epiphyseal growth plate
Metaphysis
Periosteum
A
A 14 year old body presents with fever and knee pain of sudden onset over 12 hrs. The knee is swollen and there is limited knee flexion. The gadolinium fat supressed T1 weighted image is shown.
What is the name of this region of bone
Diaphysis
Epiphysis
Epiphyseal growth plate
Metaphysis
Periosteum
5
Q
Define metaphysis [1]
A
neck portion of a long bone between the epiphysis and the diaphysis. It contains the growth plate, the part of the bone that grows during childhood, and as it grows it ossifies near the diaphysis and the epiphyses.
6
Q
What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland
A
What region of the skin is most responsible for the heat retention thermoregulation function
Dermis
Epidermis
Sebaceous gland
Subcutaneous tissue
Sweat gland
7
Q
Melanocytes are found in which layer of the skin? [1]
A
stratum basalis
8
Q
A
8
Q
What colour do eumelanin and pheomelanin produce? [2]
A
Eumelanin (black and brown), pheomelanin (red)
9
Q
Where is Neuromelanin produced? [1]
A
Brain
10
Q
The arrow is pointing to which type of cell in the skin? [1]
A
Merkel cells
11
Q
What type of hypersensitivity reaction is urticarial classed as?
Hypersensitivity type I
Hypersensitivity type II
Hypersensitivity type III
Hypersensitivity type IV
Hypersensitivity type V
A
What type of hypersensitivity reaction is urticarial classed as?
Hypersensitivity type I
Hypersensitivity type II
Hypersensitivity type III
Hypersensitivity type IV
Hypersensitivity type V
12
Q
Describe the difference in action of HLAs corresponding to MHC class A,B & C compared to DP,DM,DOA,DOB,DQ, andDR [2]
A
HLAs corresponding to MHC class I (A,B, andC) present peptides from inside the cell. For example, if the cell is infected by a virus, the HLA system brings fragments of the virus to the surface of the cell so that the cell can be destroyed by the immune system.
HLAs corresponding to MHC class II (DP,DM,DOA,DOB,DQ, andDR) present antigens from outside of the cell to T-lymphocytes
13
Q
Which ligaments are commonly implicated in DISH [1]
A
anterior longitudinal ligaments
14
Q
What is DISH? [1]
Which side of the spine does it commonly occur on and why? [2]
A
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by characteristic ossification patterns that can occur in the spine and peripheral entheses. DISH most commonly affects the spine and often presents as back pain and stiffness
DISH in the spine most commonly occurs on the right side of the thoracic region. The literature supports the original theory of the protective effect and mechanical barrier preventing DISH formation on the contralateral (i.e., left) side of the thoracic spine secondary to the pulsatile descending aorta
15
Q
Why is bone formation more likely to occur at enthesis when injured compared to synovial fluid? [1]
A
At the enthesis there are more chances to form bone than in a joint, as you have mesenchymal fibroblasts that can convert to chondrocyte, whereas in the joint you have synovial macrophages that can become an osteoclast.
16
Q
A 70 year old man presented with pain in his upper back for many months and gradually progressive weakness in lower limbs with inability to walk. MRI of the vertebral column revealed epidural abscess with vertebral body involvement of the thoracic 3 to 5th vertebra.
What is the most likely diagnosis
DISH
Osteoarthritis
Osteomyelitis
Osteoporosis
Rheumatoid arthritis
A
A 70 year old man presented with pain in his upper back for many months and gradually progressive weakness in lower limbs with inability to walk. MRI of the vertebral column revealed epidural abscess with vertebral body involvement of the thoracic 3 to 5th vertebra.
What is the most likely diagnosis
DISH
Osteoarthritis
Osteomyelitis
Osteoporosis
Rheumatoid arthritis
Infection from TB
17
Q
Why is avascular necrosis of the femoral head a posibility with a femoral neck fracture? [2]
A
In approximately 80% of the adult population the acetabular artery from obturator has become closed and fibrotic. (1 mark)
The femoral head receives a retrograde blood supply from the medial and lateral circumflex and femoral neck fractures may disrupt this blood supply. (1 mark)
18
Q
Robert is an 87-year old man who has osteoporosis with co-morbid osteomalacia.
Explain why these two conditions are often co-morbid.
A
Both conditions are linked to low vitamin D. (1 mark), If you have low Vit D that will also cause less Ca2+ and so less good bone is formed ((1 mark)
Low vitamin D is linked to poorer diet (1/2 mark) and not being as active or going outside as much. (1/2 mark)
19
Q
State SIX histological changes that you will find in the articular cartilage of Mrs Fox’s knees?
A
Chondrocyte necrosis (more marked in the superficial layers) (1/2 mark)
Large isogenic clusters of the remaining chondrocytes (1/2 mark)
Cracks and fissures in the cartilage (1/2 mark)
Duplication of the tidemark (1/2 mark)
More collagen type I (1/2 mark)
Fewer proteoglycans (1/2 mark)
20
Q
State the effect of more ACPA being produced in RA [1]
A
(ii) ACPA causes monocytes to differentiate as osteoclasts and they produce IL8 that creates the autocrine loop. (1 mark)
21
Q
Mary is a 63- year old woman who has a 22 year history of rheumatoid arthritis. She is presently taking methotrexate (MTX) and infliximab was added 5 years previously but the efficacy of the infliximab has started to wane.
Briefly explain why the efficacy of the infliximab is starting to wane?
A
Infliximab is a chimeric anti-TNF alpha antibody designed against the mouse binding site of TNF alpha and the remaining 75% is mouse meaning that the body will see it as foreign and mount an immune response against the drug (1 mark). With time both neutralising and non-neutralising antibodies will be produced (1 mark). These will directly interfere, form immune complexes and increase clearance of the infliximab. (1 mark)
22
Q
Name the FOUR stages of fracture healing.
A
Fracture hematoma
Soft callus (fibrocartilage callus)
Bony callus
Bone remodelling
23
Q
The initial management of osteoarthritis is the use of NSAIDs, these drugs antagonise the COX2 enzyme in the joint.
How and what leads to the induction of COX2 in the affected joint?
A
Inflammatory signals (TNFalpha, IL1 and IL17) can directly induce the expression of COX2 in the joint (1 mark)
but the inflammatory stimuli can also indirectly activate COX2 by inducing iNOS that where the free radicals induce COX2. (1 mark).
24
An eight year old boy is diagnosed with Blounts disease.
Briefly explain why children are at risk of developing this condition?
Blounts disease is damage to the **epiphyseal growth plate (squashing)** (1 mark) both the **cartilage** of the **epiphyseal growth plate** and the **woven bone** it makes are **softer** and **more** **deformable** than and adults lamellar bone. (1 mark).
25
Which nerves control each movement? [3]
Median
Ulnar
Radial
26
Left hip abductors
27
Tibial
28
A 4-year old boy is brough to the GP as he is showing delayed motor milestones. When the boy is asked to get up from a seated position on the floor he goes through the following stages to stand. He also has a waddling gait.
What you would expect to see on a Quadricep muscle biopsy?
Degenerating and regenerating fibres, fibrosis and fat infiltration
Hypertrophy of the fast twitch fibres
Loss of fast twitch fibres
Loss of slow twitch fibres
Normal biopsy, but overall loss of muscular tissue
A 4-year old boy is brough to the GP as he is showing delayed motor milestones. When the boy is asked to get up from a seated position on the floor he goes through the following stages to stand. He also has a waddling gait.
What you would expect to see on a Quadricep muscle biopsy?
**Degenerating and regenerating fibres, fibrosis and fat infiltration**
Hypertrophy of the fast twitch fibres
Loss of fast twitch fibres
Loss of slow twitch fibres
Normal biopsy, but overall loss of muscular tissue
29
Septic arthritis
30
Weakness in wrist extension
Weakness in DIP flexion
Weakness in thumb flexion
No functional deficit
Weakness in PIP flexion
Weakness in wrist extension
Weakness in DIP flexion
Weakness in thumb flexion
**No functional deficit**
Weakness in PIP flexion
31
Describe the defining charactersitic of osteomalacia with regards to bone structure [2]
Osteomalacia the amount of bone is normal but the ratio of matrix to mineral is increased (1 mark)
32
3 What substance provides the skin with its waterproofing and where is it produced and give 2 sites where this substance is not produced on the body.
(2 marks)
Sebum (0.5 marks)
Produced by the sebaceous gland (0.5 marks)
Palm, soles, lips (0.5 marks each)
33
Which circumflex artery provides the majority of the retinacular arteries of the hip joint? [1]
The **medial** circumflex provides the majority of the retinacular arteries of the hip joint and enters through the neck of the femur so are affected here (1 mark)
34
Describe biochemical changes to OA bone [3]
* Biochemically
* **increase** in **water** in **cartilage**
* **decreased** **proteoglycans**
* **loss** of **collagen** network
35
Describe microscopic changes in bone in OA [2]
**chondrocyte necrosis** with **focal clonal proliferation** (1 mark) so **patchy** **repair** change in properties from **hyaline to fibrocartilage change** from **type** **II** **collagen** to **type I** (1 mark).
36
11 Explain briefly, why the hip is more commonly affected by OA than the shoulder. (2 marks)
The hip is a **weight bearing joint** and is so subjected to **more stress and wear** and tear than the shoulder (1). OA is most likely to affect the weight bearing joints first (1).
37
Describe how subchondral sclerosis occurs in OA [2]
When bone is **exposed** there are **microfractures** of the bone as bone does not have the same resilience as the cartilage. (1 mark)
In response there is increased **osteoblastic** **activity** and **new bone formation** leading to **sub-chondral scerlosis** of the bone. (1 mark)
38
Describe how subchondral cysts occur in OA [1]
There may be **focal pressure necrosis** of the bone that leads to the formation of sub-chondral cysts. (1mark)
There is vascular engorgement, slowing of blood flow through the sub-chondral bone. (1 mark)
39
State two non-dietary causes of rickets / osteomalacia [4]
* Malabosorption of vitamin D3 from malabsorption syndromes such as **coeliac disease**.
* **Chronic renal failure**, with r**educed 1-a-hydroxylation of 25-hydroxy vitamin D3 to active metabolic 1,25-(OH)2-D3**.
* **Renal tubular acidosis**
* **Tumours**
40
What are Loosers zones on x-rays? [1]
Pseudofractures - Linear areas of low density surrounded by sclerotic borders
41
19 What does the C-reactive protein measure, what induces its production and what is its function? (3 marks)
**C-reactive protein is a direct measure of inflammation** (1 mark). The C-reactive protein owes its name to the ability of this protein to precipitate pneumococcal C-polysaccharide in the presence of calcium.
CRP production is induced by the **liver** under the influence of **IL-1 and IL-6** (1 mark).
Its function in-vivo is to assist the immune system by **activation of the complement system, influence phagocytic cell function, and augmenting cell mediated cytotoxicity** (1mark).
42
Describe the pattern of CRP release [2]
It reaches **peak levels quickly, approximately 50 hours and also falls rapidly once the stimulus is removed**.
Thus the CRP provides a more immediate picture of the level of inflammation than does the ESR i
43
State a common complication of being RF positive [1]
Vasculitis
44
If left un-diagnosed and untreated this can lead to the formation of a new acetabulum in the ilium. There is a shortening of the leg because of this and there would be a positive Trendelenburg’s sign.
A. Blount’s disease
B. Congenital hip dysplasia
C. Osgood-Schlatter disease
D. Perthes disease
E. Slipped upper femoral epiphysis
If left un-diagnosed and untreated this can lead to the formation of a new acetabulum in the ilium. There is a shortening of the leg because of this and there would be a positive Trendelenburg’s sign.
A. Blount’s disease
**B. Congenital hip dysplasia**
C. Osgood-Schlatter disease
D. Perthes disease
E. Slipped upper femoral epiphysis
45
The x-ray changes include periarticular osteoporosis and bone erosions.
A. Gout
B. Osteoarthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Rheumatoid arthritis
The x-ray changes include periarticular osteoporosis and bone erosions.
A. Gout
B. Osteoarthritis
C. Psoriatic arthritis
D. Reactive arthritis
**E. Rheumatoid arthritis**
46
Myopathic infantile hypotonia
47
What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
More bone mass and normal mineralisation
More bone mass but unmineralised
No effect
What would be the effect on bone mass for the patients using teripartide?
Less bone mass and less mineralisation
Less bone mass with normal mineralisation
**More bone mass and normal mineralisation**
More bone mass but unmineralised
No effect
48
A 35 year old woman reports a 6 week history of symmetrical swelling and pain in the carpals. On examination there is “boggyness” in the metacarpal phalangeal joints as well as the carpals. Rheumatoid arthritis is diagnosed and she is started on methotrexate. 6 months later she has a synovectomy.
What is the most common immune cell in the synovial membrane?
* B-lymphocyte
* CD8 cytotoxic T-lymphocyte
* Histocyte
* Neutrophil
* TH17 CD4 T-lymphocyte
A 35 year old woman reports a 6 week history of symmetrical swelling and pain in the carpals. On examination there is “boggyness” in the metacarpal phalangeal joints as well as the carpals. Rheumatoid arthritis is diagnosed and she is started on methotrexate. 6 months later she has a synovectomy.
What is the most common immune cell in the **synovial membrane**?
* B-lymphocyte
* CD8 cytotoxic T-lymphocyte
* Histocyte
* Neutrophil
* **TH17 CD4 T-lymphocyte**
49
Which cell type would be most prominent in A and B in a patient with RA? [2]
A - synovial membrane: **Th17 lymphocytes**
B - synovial fluid: **Neutrophils**
50
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips. Which muscle and tendon could be transferred to help this individual walk better?
Fibularis longus
Flexor hallucis longus
Gastrocnemius
Tibialis anterior
Tibialis posterior
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips. Which muscle and tendon could be transferred to help this individual walk better?
Fibularis longus
Flexor hallucis longus
Gastrocnemius
Tibialis anterior
**Tibialis posterior**
51
Blount's disease is characterised by what abnormality to which bone? [2]
**irreversible tibia varus** is the pathophysiology behind
osgood-schlatter
**blounts disease**
SUFE
Perthes
CDH
52
Describe the pathophysiology of Osgood Schlatters [2]
The patella tendon inserts into the tibial tuberosity. In patients with Osgood-Schlatter disease, multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially, this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender.
A hard, non-tender lump is then permanently present at the tibial tuberosity.
53
Osgood schlatters is characterised by which type of fractures to the tibia?
multiple **minor avulsion fractures** occur where the patella ligament pulls away tiny pieces of the bone.
54
What are the arrrows pointing to? [1]
**Schmorl’s nodes**
55
A kyphosis of greater than [] degrees would indicate the need for surgery for a patient with Sheuermann’s disease? [1]
**65 degrees**
56
Where is Klines line? [1]
How can you use this to diagnose SUFE? [1]
Klein’s line is drawn along **superior border of femoral neck should cross at least a portion of the femoral head**. When SUFE the femoral head drops below this line.
57
What is the best way to treat genu varum in an adult?
What is the procedure they have done to correct this deformity?
Distal femoral osteotomy
Proximal femoral osteotomy
Proximal fibular osteotomy
Proximal tibial closing wedge osteotomy
Proximal tibial open wedge osteotomy
Proximal tibial open wedge osteotomy
58
Sciatica would be an indication of which type of lordosis? [1]
Lumbar lordosis
59
apparent leg length discrepency may indicate which back problem? [1]
Scoliosis
60
Harrington rods
61
Which parts of the innvertebral disc have innervation? [1]
Lacks innervation in nucleus pulposus
Outer 1/3rd of annulus fibrosus innervated
62
Most common hernated discs are found where? [2]
Most commonly IV disc between L4/5 or L5/S1
63
OA or degenerative disc disease blocking the vertebral artery causes what pathology? [1]
Vertebral-basilar artery insufficiency
64
Name a pathological disease that causes lordosis
Muscular dystrophy
65
Describe the signs / symptoms of cauda equina syndrome [5]
Cauda equina syndrome results in **lower motor neurone signs and symptoms**:
* reduced or absent lower extremity reflexes
* reduced lower limb sensation (often bilateral)
* bladder or bowel dysfunction
* lower limb motor weakness
* severe back pain
* impotence.
66
Describe pathophsiology of Diffuse idiopathic skeletal hyperostosis (DISH) [2]
**Unilateral** **ossification** of **anterior longitudinal ligament** (+/- osteophytes)
**Not complete ossification**: looks like candle wax
**Disc height maintained**
67
Classic presentation of ankylosing spondylitis? [2]
Back pain
Ankylosing spondylitis is 3 times more frequent in men than in women and begins most often between ages 20 and 40
68
Describe pathophsiology of AS
95% of patients have **HLA B27**
**Narrowing and sclerosis** of both **sacroiliac joints**
**Sclerosis** and **ankylosis** of **vertebral bodies** with no loss of disc space
Bone formation extends across **anterior and lateral margins of IV discs**
69
Describe how HLA B27 is thought to cause ankylosing spondylitis [2]
HLA B27 influences the composition of the endogenous gut flora:
* B27 flora predisposes to a **leaky gut**
* Leaky gut allows substances that **trigger cascades of inflammatory reactions**
70
Describe how RA has cervical spine invovlement [3]
**Pannus** formation resulting in **bony erosion** and **ligamentous laxity**
This cascade can lead to cervical spinal instability in the form of **atlantoaxial instability (AAI)**
Also **compression of vertebral arteries**
71
CDH causes leg to be in which position? [1]
Everted
72
ID where the femoral head is
**Affected side will be more lateral to the side**
Unaffected side: femoral head more medial
73
Describe shape of babies feet and how this changes with age [2]
How can this process be pathological? [1]
**Flat foot:** fat pad present for energy reserves. As they grow this dissapears
In some children the **arch never fully develops**: presents as **weak ankles** and **turn inwards**
74
Name 5 causes of Talipes equinovarus
**Breech presentation**
**Connective tissue disorders** (Ehlers Danlos)
**Oligohydramnios**
**Genetic syndromes** (Edward’s Syndrome – trisomy 18)
**Family history**
75
Describe the treatment of Talipes equinovarus [2]
**Ponseti method** – manipulative technique to correct clubfoot without invasive surgery
Wear in night everyday
Places the foot in **abduction / valgum**: as the skeleton continues to grow don't have the deformity come back
76
Explain how you can interpret ultrasound to determine CHD level [4]
Ultrasound interpretation of CHD can also be done by interpretation of the **alpha-angle**, which is an angle formed by the a**cetabular roof to the vertical cortex of the ilium** and thus **reflects the depth of the bony acetabular roof**.
The **normal value is greater than or equal to 60 degrees**. Less than 60 degrees suggests dysplasia of the acetabulum
1. Grade 1 **> 60 degrees**
2. Grade IIa,b **50-59 degrees**
3. Grade IIc 43-49 **degrees**
4. Grasde IIIa, b, IV **< 43 degrees**
77
Describe the points that Perkins line is found [1]
How is it used for assessment for CHD? (affected v unaffected)
Top of the acetabulum going down: ID where the femoral head is
Affected side will be more lateral to the side
Unaffected side: femoral head more medial
78
Describe the pathophysiology of Perthes disease (Legg-Calve-Perthes disease) [3]
**Idiopathic**
Self limiting **avascular necrosis of the femoral head**
Dual blood supply to femoral head. **Secondary ossification centre suffers blood loss** and causes avascular necrosis.
If left untreated, the **femoral neck grows** and over time t**here is revascularisation or neovascularisation** and **healing of the femoral head**.
79
Describe the movement of the joint that occurs in SUFE [2]
Epiphysis actually stays in place it’s the neck and **shaft of the femur that moves**
**Epiphysis** moves **posteriorly and medially**
80
State 4 causes of SUFE [4]
**Obesity**
**Hypothyroidism**
**Deficiency or increased androgens**
* Adolescent growth spurt
**Trauma**
* SUFE = obese, underdeveloped sexual characteristics with sudden growth spurt
81
Where in the epiphyseal growth plate does a fracture occur in SUFE? [1]
How does this change the structure of the epiphyseal growth plate? [1]
Fracture occurs at **hypertrophic zone**
Changes to the epiphyseal plate zones **hypertrophic zone is 80% of the plate** (normal hypertrophic zone is 15-30% of the plate width)
82
Perthes disease can lead to which MSK disease? [1]
Osteoarthritis [1]
83
Consequences of not treating CDH? [2]
**Head of femur** will form a **new acetabulum on the back of pelvis:** creating a **leg length discrepancy** due to the moving of the femur further onto the back of the ilium.
The **acetabulum also forms of fibrocartilage** rather than **hyaline**, further affecting the joint properties.
84
Essential fatty acids cannot be synthesised in vivo and so must be included in the diet.
Which of the following is an essential fatty acid?
Alpha-linolenic acids
Lauric acid
Oleic acid
Palmitic acid
Stearic acid
Essential fatty acids cannot be synthesised in vivo and so must be included in the diet.
Which of the following is an essential fatty acid?
**Alpha-linolenic acids**
Lauric acid
Oleic acid
Palmitic acid
Stearic acid
85
11. The immune system employs a variety of receptors to recognise different types of antigen.
Which of the following best describes the nature of the antigen recognised using the T cell receptor (TCR)?
Conformational epitopes formed by protein folding
Lipopolysaccharide components of bacterial cell walls
Nucleic acids found only in microbes
Peptides presented on MHC molecules
Proteins in solution
11. The immune system employs a variety of receptors to recognise different types of antigen.
Which of the following best describes the nature of the antigen recognised using the T cell receptor (TCR)?
Conformational epitopes formed by protein folding
Lipopolysaccharide components of bacterial cell walls
Nucleic acids found only in microbes
**Peptides presented on MHC molecules**
Proteins in solution
86
Cytokines produced by a variety of immune cells can have redundant and over-lapping functions.
What do IL-10 and tumour growth factor B (TGFB) have in common?
Both are anti-inflammatory cytokines
Both induce apoptosis in virally-infected and neoplastic cells
Both modulate the activity of macrophages
Both promote the maturation of CD4 T cells to T1 helper cells
Both secreted by dendritic cells
Cytokines produced by a variety of immune cells can have redundant and over-lapping functions.
What do IL-10 and tumour growth factor B (TGFB) have in common?
**Both are anti-inflammatory cytokines**
Both induce apoptosis in virally-infected and neoplastic cells
Both modulate the activity of macrophages
Both promote the maturation of CD4 T cells to T1 helper cells
Both secreted by dendritic cells
87
17.
The membrane potential of neurones during the resting phase is -75 mV.
Which channels are responsible for maintaining the resting potential?
K+ passive leak channels
Na+ passive leak channels
Na+/K+ ATPase pump
Voltage gated potassium channels
Voltage gated sodium channels
17.
The membrane potential of neurones during the resting phase is -75 mV.
Which channels are responsible for maintaining the resting potential?
K+ passive leak channels
Na+ passive leak channels
**Na+/K+ ATPase pump**
Voltage gated potassium channels
Voltage gated sodium channels
88
19.
Different types of axons have separate biological functions.
Which type of axon mediates mechanical touch and pressure?
Aα (alpha) fibres
Aβ (beta) fibres
Aδ (delta) fibres
Aγ (gamma) fibres
C fibres
19.
Different types of axons have separate biological functions.
Which type of axon mediates mechanical touch and pressure?
Aα (alpha) fibres
**Aβ (beta) fibres**
Aδ (delta) fibres
Aγ (gamma) fibres
C fibres
89
The levels of serum enzymes can be used to detect damage in specific tissues.
Elevated levels of which of the following enzymes specifically indicates prostatic carcinoma?
Acid phosphatase
Alkaline phosphatase
Aspartate transaminase
Creatinine kinase
Lactate dehydrogenase
The levels of serum enzymes can be used to detect damage in specific tissues.
Elevated levels of which of the following enzymes specifically indicates prostatic carcinoma?
**Acid phosphatase**
Alkaline phosphatase
Aspartate transaminase
Creatinine kinase
Lactate dehydrogenase
90
The distribution of drugs is affected by the nature of the drug compound.
Where will large drug molecules tend to accumulate?
In fat
In the interstitial space
In the intracellular space
In the intravascular space
Evenly distributed between fat and the intracellular space
The distribution of drugs is affected by the nature of the drug compound.
Where will large drug molecules tend to accumulate?
In fat
In the interstitial space
In the intracellular space
**In the intravascular space**
Evenly distributed between fat and the intracellular space
91
26.
A 27-year-old has a severe head injury that has damaged the superior sagittal sinus.
Between which two layers of the meninges does the superior sagittal sinus form?
Arachnoid and pia
Dura mater (inner layer) and arachnoid
Dura mater (inner layer) and pia
Dura mater (outer layer) and arachnoid
Dura mater (outer layer) and dura mater (inner layer)
26.
A 27-year-old has a severe head injury that has damaged the superior sagittal sinus.
Between which two layers of the meninges does the superior sagittal sinus form?
Arachnoid and pia
Dura mater (inner layer) and arachnoid
Dura mater (inner layer) and pia
Dura mater (outer layer) and arachnoid
**Dura mater (outer layer) and dura mater (inner layer)**
92
Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.
What is the most likely chromosomal abnormality observed in these individuals?
A Robertsonian translocation between chromosomes 21 and 14
A Robertsonian translocation between chromosomes 21 and 11
41.
Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.
What is the most likely chromosomal abnormality observed in these individuals?
A Robertsonian translocation between chromosomes 21 and 14
A Robertsonian translocation between chromosomes 21 and 11
Mosaicism of chromosome 21
Trisomy 14
Trisomy 21
Mosaicism of chromosome 21
93
Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.
What is the most likely chromosomal abnormality observed in these individuals?
A Robertsonian translocation between chromosomes 21 and 14
A Robertsonian translocation between chromosomes 21 and 11
41.
Aneuploidy is a chromosomal mutation giving rise to Down Syndrome. Children with Down Syndrome will exhibit different severity of symptoms. Some of these individuals have fewer symptoms and less developmental delay.
What is the most likely chromosomal abnormality observed in these individuals?
A Robertsonian translocation between chromosomes 21 and 14
A Robertsonian translocation between chromosomes 21 and 11
Mosaicism of chromosome 21
Trisomy 14
Trisomy 21
Mosaicism of chromosome 21
94
Many oral drugs undergo phase II metabolic reactions in the liver which produce metabolites which are polar and water soluble.
Which class of enzymes catalyse these reactions?
Hydrolases
Lyases
Oxidases
Reductases
Transferases
Many oral drugs undergo phase II metabolic reactions in the liver which produce metabolites which are polar and water soluble.
Which class of enzymes catalyse these reactions?
Hydrolases
Lyases
Oxidases
Reductases
**Transferases**
95
The ionic composition of extracellular (ECF) and intracellular fluids (ICF) is tightly regulated.
Which best describes the composition of the ICF fluid?
Low in K+, low in Na+, high in Cl-
Low in K+, low in Na+, low in Cl-
High in K+, low in Na+, low in Cl-
High in K+, high in Na+, low in Cl-
High in K+, low in Na+, high in Cl-
The ionic composition of extracellular (ECF) and intracellular fluids (ICF) is tightly regulated.
Which best describes the composition of the ICF fluid?
Low in K+, low in Na+, high in Cl-
Low in K+, low in Na+, low in Cl-
**High in K+, low in Na+, low in Cl-**
High in K+, high in Na+, low in Cl-
High in K+, low in Na+, high in Cl-
96
The amino acid sequence of a protein will direct the bonding between adjacent regions and is critical in determining the secondary structure of proteins.
What type of bonds are found between amino acids in an alpha helical structure?
Covalent
Disulphide
Hydrogen
Ionic
Van der Waals
The amino acid sequence of a protein will direct the bonding between adjacent regions and is critical in determining the secondary structure of proteins.
What type of bonds are found between amino acids in an alpha helical structure?
Covalent
Disulphide
**Hydrogen**
Ionic
Van der Waals
97
Visceral pleura
98
Moving substances against their concentration gradient requires energy from ATP.
What is the name of the protein responsible for generating the electrochemical gradient for glucose uptake from the gastrointestinal tract?”
Cystic fibrosis transmembrane conductance regulator (CFTR) channel
Glut 2 facilitated diffusion
SGLT1 sodium/glucose cotransporter
Sodium/potassium ATPase
Voltage gated sodium channel
Moving substances against their concentration gradient requires energy from ATP.
What is the name of the protein responsible for generating the electrochemical gradient for glucose uptake from the gastrointestinal tract?”
Cystic fibrosis transmembrane conductance regulator (CFTR) channel
Glut 2 facilitated diffusion
SGLT1 sodium/glucose cotransporter
**Sodium/potassium ATPase**
Voltage gated sodium channel
99
Which cell initiates adaptive immune responses? [1]
Dendritic cell
100
Which channels open to help restore the resting membrane potential at the end of the depolarization phase of an action potential? [1]
Voltage gated potassium (K+) channels
101
Which enzyme is the target for quinolones?
DNA polymerase
Helicase
Ligase
Primase
Topoisomerase
Which enzyme is the target for quinolones?
DNA polymerase
Helicase
Ligase
Primase
**Topoisomerase**
102
In which lung disease is lung compliance reduced?
Asthma
Chronic Bronchitis
Chronic Obstructive Lung Disease
Emphysema
Pulmonary Fibrosis
In which lung disease is lung compliance reduced?
Asthma
Chronic Bronchitis
Chronic Obstructive Lung Disease
Emphysema
**Pulmonary Fibrosis**
103
What is the main process of energy production in cancer cells?
Aerobic glycolysis
Anaerobic glycolysis
Citric acid cycle
Oxidative phosphorylation
Substrate-level phosphorylation
What is the main process of energy production in cancer cells?
**Aerobic glycolysis**
Anaerobic glycolysis
Citric acid cycle
Oxidative phosphorylation
Substrate-level phosphorylation
104
49.
A 3 year old male child is assessed for developmental delay, and is found to have global developmental delay.
For a diagnosis of global developmental delay, how many of the four major domains must be delayed?
(2 or more, two, two domains, two or more, 2)
105
Klinfelter syndrome.
What would their karyotype show? [1]
47 xxy
106
Parietal pleura
107
Papillary muscle
108
Skeletal muscle
109
stomach
110
Which of the following is the correct carrying angle in a man?
5-10 degrees
5-15 degrees
10-20 degrees
15-25 degrees
10-30 degrees
Which of the following is the correct carrying angle in a man?
5-10 degrees
**5-15 degrees**
10-20 degrees
15-25 degrees
10-30 degrees
111
‘Weeping lubrication’ is a process by which nutrients and excretory materials are respectively absorbed and removed from articular cartilage. What is the macromolecule that provides the backbone for the aggrecan proteoglycan that facilitates this process?
hyalouronic acid,
112
Boyle’s Law can be applied to the breathing process.
Which statement describe best Boyle’s law?
The volume of a gas correspond to its pressure divided the surface tension
The pressure of a gas is directly proportional to the surface tension
The pressure of a given quantity of gas is inversely proportional to the volume that contains it
The surface tension is inversely proportional to the pressure
The pressure of a gas is equal to the surface tension multiplied by the volume
Boyle’s Law can be applied to the breathing process.
Which statement describe best Boyle’s law?
The volume of a gas correspond to its pressure divided the surface tension
The pressure of a gas is directly proportional to the surface tension
**The pressure of a given quantity of gas is inversely proportional to the volume that contains it**
The surface tension is inversely proportional to the pressure
The pressure of a gas is equal to the surface tension multiplied by the volume
113
Which law defines the relationship between pressure, surface tension and the radius within alveoli?
Boyle's law
Charles's law
Dalton's law
Henry's law
Laplace's law
Which law defines the relationship between pressure, surface tension and the radius within alveoli?
Boyle's law
Charles's law
Dalton's law
Henry's law
**Laplace's law**
114
Spirometry is used to measure lung volumes.
Which parameter can only be measured indirectly?
Residual volume
Vital capacity
Expiratory reserve volume
Tidal volume
Inspiratory reserve volume
Spirometry is used to measure lung volumes.
Which parameter can only be measured indirectly?
**Residual volume**
Vital capacity
Expiratory reserve volume
Tidal volume
Inspiratory reserve volume
115
The left side of the heart supplies oxygenated blood to the systemic circulation.
Blood distribution around the body is controlled primarily by which vessels?
Arteries
Arterioles
Capillaries
Veins
Venules
The left side of the heart supplies oxygenated blood to the systemic circulation.
Blood distribution around the body is controlled primarily by which vessels?
Arteries
**Arterioles**
Capillaries
Veins
Venules
116
During the first trimester the skeleton begins to ossify. By which process of ossification is the parietal bone of the skull formed? [1]
intermembraneous ossification,
117
A patient loses sensation in the web space between the big toe and second toe dorsally.
Which nerve is most likely affected?
Tibial nerve
Superifical peroneal nerve
Deep peroneal nerve
Common peroneal nerve
Sciatic nerve
A patient loses sensation in the web space between the big toe and second toe dorsally.
Which nerve is most likely affected?
Tibial nerve
Superifical peroneal nerve
**Deep peroneal nerve**
Common peroneal nerve
Sciatic nerve
118
Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
What is the mechanism of action of the cholera toxin alpha-subunit?
*[CFTR]: Cystic fibrosis transmembrane conductance regulator
Blocks both i) CFTR and ii) Na+/Cl- symporter in a closed position, by decreasing cAMP
Blocks both i) CFTR and ii) Na+/Cl- symporter in an open position, by increasing cAMP
Blocks i) CFTR in an open position ii) Na+/Cl- symporter in a closed position, by increasing cAMP
Blocks the CFTR in an open position, by increasing cAMP
Blocks the Na+/Cl- symporter in a closed position, by increasing cAMP
Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
What is the mechanism of action of the cholera toxin alpha-subunit?
*[CFTR]: Cystic fibrosis transmembrane conductance regulator
Blocks both i) CFTR and ii) Na+/Cl- symporter in a closed position, by decreasing cAMP
Blocks both i) CFTR and ii) Na+/Cl- symporter in an open position, by increasing cAMP
**Blocks i) CFTR in an open position ii) Na+/Cl- symporter in a closed position, by increasing cAMP**
Blocks the CFTR in an open position, by increasing cAMP
Blocks the Na+/Cl- symporter in a closed position, by increasing cAMP
119
Serologic tests provide an effective first step in identifying patients with coeliac disease.
Which antibody is routinely tested for in suspected coeliac disease?
Anti-gliadin-IgA
Anti-gliadin-IgM
Tissue Transglutaminase-IgA
Tissue Transglutaminase-IgG
Tissue Transglutaminase-IgM
Serologic tests provide an effective first step in identifying patients with coeliac disease.
Which antibody is routinely tested for in suspected coeliac disease?
Anti-gliadin-IgA
Anti-gliadin-IgM
**Tissue Transglutaminase-IgA**
Tissue Transglutaminase-IgG
Tissue Transglutaminase-IgM
120
37.
The cell bodies of preganglionic neurons of the autonomic nervous system are located in specific regions of the spinal cord.
Which segments of the spinal cord contain the preganglionic neurons of sympathetic nerves that innervate the head?
C1 - C4
C5 - C8
T1 - T5
T6 - T12
L1 - L5
37.
The cell bodies of preganglionic neurons of the autonomic nervous system are located in specific regions of the spinal cord.
Which segments of the spinal cord contain the preganglionic neurons of sympathetic nerves that innervate the head?
C1 - C4
C5 - C8
**T1 - T5**
T6 - T12
L1 - L5
121
How big, in centimeters, does the cervix get when fully dilated? [1]
10cm
122
A 34 year old woman and her partner are trying to have a child. She has bought an ovulation predictor kit to help identify her most fertile period.
Which hormone, which surges 24 - 36 hours prior to ovulation, is detected by an ovulation predictor kit?
Oestrogen
Progesterone
Follicle stimulating hormone
Luteinizing hormone
Beta human chorionic gonadotrophin
A 34 year old woman and her partner are trying to have a child. She has bought an ovulation predictor kit to help identify her most fertile period.
Which hormone, which surges 24 - 36 hours prior to ovulation, is detected by an ovulation predictor kit?
Oestrogen
Progesterone
Follicle stimulating hormone
**Luteinizing hormone**
Beta human chorionic gonadotrophin
123
What causes the first heart sound (S1)?
Closure of mitral and aortic valves
Closure of mitral and tricuspid valves
Closure of mitral and pulmonary valves
Closure of aortic and tricuspid valves
Closure of aortic and pulmonary valves
What causes the first heart sound (S1)?
**Closure of mitral and aortic valves**
Closure of mitral and tricuspid valves
Closure of mitral and pulmonary valves
Closure of aortic and tricuspid valves
Closure of aortic and pulmonary valves
124
Where is the surface marking of the gallbladder?
Intersection of the right mid clavicular line and subcostal plane
Intersection of the left mid clavicular line and subcostal plane<
Intersection of the right mid clavicular line and transpyloric plane
Intersection of the left mid clavicular line and transpyloric plane
Intersection of mid-axillary line and costal margin
Where is the surface marking of the gallbladder?
Intersection of the right mid clavicular line and subcostal plane
Intersection of the left mid clavicular line and subcostal plane<
**Intersection of the right mid clavicular line and transpyloric plane**
Intersection of the left mid clavicular line and transpyloric plane
Intersection of mid-axillary line and costal margin
125
**Pulmonary trunk**
126
Superior lobar bronchus
127
Facial (VII)
128
Antrum
129
Abduction of the arm
Abduction of the digits
Extension of the elbow
Flexion of the elbow
Flexion of the digits
Abduction of the arm
**Abduction of the digits**
Extension of the elbow
Flexion of the elbow
Flexion of the digits
130
Hamstrings
131
**Conscious proprioception**
Subconscious proprioception
Pain
Motor to upper limbs
Motor to lower limbs
132
On the image of an epiphyseal growth plate below, identify the zone indicated A
proliferation
133
sertoli
134
Primordial follicle
Primary follicle
Secondary follicle
Graffian follicle
Oocyte
Primordial follicle
Primary follicle
**Secondary follicle**
Graffian follicle
Oocyte
