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336 Cards in this Set
- Front
- Back
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Pathological lesion that characterises primary TB |
Ghon complex |
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State 2 sites of involvement of lung and surrounding tissue that characterise primary pulmonary TB |
Hilar lymph nodes, sub-pleural/peripheral, middle zone |
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State the 2 key histological features of a granuloma |
epithelioid histiocytes, cuff of lymphocytes, giant cells |
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state 3 non-specific (innate) mechanisms that prevent microorganisms from reaching the lungs |
mucociliary escalator, nasal hairs, coughing, sneezing, warming of inspired air by nose, humidification of inspired air by nose |
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state 2 socioeconomic factors that are associated with an increasing prevalence of tuberculosis |
poverty, overcrowding, poor nutrition, low socio-economic class, migrants |
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state 3 metabolic or physiological factors that reduce peripheral vascular resistance |
nitric oxide, hypoxia, hypercapnia, reduced sympathetic stimulation, parasympathetic stimulation |
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describe 3 characteristics of the pain caused by an acute MI |
crushing central pain in jaw or neck pain in arm lasts >30mins severe |
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define ischaemia |
reversible damage to tissues as a result of impaired vascular perfusion depriving tissues of vital nutrients and oxygen |
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define infarction |
irreversible death/necrosis of tissue due to ischaemia |
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state 4 features describing structure and components of an atheromatous fibrolipid plaque |
fibrous cap lipid core smooth muscle cells macrophages lymphocytes calcium cholesterol crystals |
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list 2 possible complications of an infarct |
death arrhythmias heart failure pericarditis pericardial effusion |
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normal oesophagus is lined by what type of epithelium |
stratified squamous non-keratinising |
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list 3 structures that lie anterior to the oesophagus in the thorax |
heart/left atrium trachea left main bronchus diaphragm |
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state 4 histological features of a primary malignant neoplasm that differentiate it from a benign neoplasm |
rapid growth high mitotic rate necrosis invasion hyperchromatism irregular border |
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state 1 group of lymph nodes to which oesophageal carcinoma commonly metastasises |
para-oesophageal supraclavicular |
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define carcinoma |
malignant neoplasm of epithelial cells |
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a lady has cardiac failure- state 2 pathophysiological reasons why her ankles are swollen |
raised systemic venous pressure salt and water retention |
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a lady has cardiac failure- what is the most likely cause of her tiredness? |
decreased cardiac output |
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A lady with cardiac failure has a prominent pulsation of her internal jugular vein which occurs at exactly the same time as the carotid artery pulsation, what heart valve is functioning abnormally to explain this observation? |
Tricuspid |
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lady with cardiac failure- over the last 3 weeks she has lost her appetite and her abdo has become swollen, state 2 abnormalities that you might expect to find on an exam of the abdomen |
enlarged liver pulsatile liver ascites oedema of skin |
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lady with cardiac failure- why does she suddenly become breathless whilst in bed at night?
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pulmonary oedema/acute heart failure/alveolar oedema |
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state 3 clinical features of shock |
low BP low urine output sweating pallor rapid pulse |
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your pt has been passing black tarry stools for 2wks prior to admission, what is the explanation for this? |
loss of blood from the stomach |
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an FBC shows your pt is anaemia, state 2 features that may be seen as regards RBC appearance that would make you think that the anaemia was due to iron deficiency |
Hypochromia microcytosis pencil cells target cells |
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state 3 possible causes of gastric ulcers |
hyperacidity alterations in mucin duodeno-gastric reflux H. pylori |
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what hormone is responsible for production of gastric juice and which 2 organs secrete it? |
Gastrin Stomach pancreas |
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Name 2 viruses that may cause viral hepatitis |
Hep A Hep B Hep C Epstein Barr virus |
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What diagnostic blood test would you perform for viral hepatitis? |
Test for viral serology |
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Name 4 important risk factors for Hep B infection |
Needle stick injury IVDU unprotected sex unscreened blood transfusion materno-foetal transmission |
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State 1 change in stools and 1 change in urine you would expect to see on inspection of these whilst your pt is jaundiced |
pale stools dark urine |
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on exam of pt, you note a mass in abdomen, name 2 features that would lead you to conclude that it is the spleen |
LUQ can't feel upper border on palpation |
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List 3 factors that may predispose pt to carcinoma in ascending colon |
increasing age +ve FH adenoma HNPCC APC |
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what 3 factors are specified in the TNM staging system for cancers? |
Tumour Nodes Metastases |
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Define median survival |
The time at the end of which 50% of index cases are still alive |
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which artery supplies blood to terminal ileum and ascending colon? |
superior mesenteric artery |
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List 2 possible early indication symptoms for bowel cancer |
rectal bleeding fatigue caused by anaemia abdo pain constipation diarrhoea altered bowel habit |
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How is a 5yr survival rate determined? |
The proportion of diagnosed pts still living 5yrs after diagnosis of the disease |
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How much absolute alcohol is there in a unit of alcohol? Give an example of a drink with 1 unit |
8 grams 1 small glass of wine |
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State 2 pathological changes that occur in the liver with continued consumption of excessive amounts of alcohol |
Fatty liver Alcoholic hepatitis Cirrhosis |
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state one possible pathological mechanism for oedema in fatty liver disease |
Hypoalbuminaemia |
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In CF, the inherited abnormality of the CFTR impairs transport of which ion across the epithelial cell membrane? |
Chloride |
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State 2 reasons why CF increases the viscosity and tenacity of bronchial mucus |
failure to excrete chloride ions is associated with increased sodium retention in epithelial cells; Reduced secretion of sodium and chloride and thus of water |
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why is a pt with pneumonia cyanosed? |
excess reduced haemoglobim |
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On abdominal examination you are able to palpatehis liver 4cm below the ribs (i.e. below the costal margin) on the right. You also find that find that the upper borderof the dullness to percussion caused by the liver is at the level of the 6thrib. What is the explanation of these clinical findings? |
Overexpanded lungs pushing down on liver and displacing it |
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A 58-year-old male complains of pain in his right leg when walking. The pain occurs after he has walked for abouta 100 metres but he notices it sooner if he is walking up a hill. He has had these symptoms for the last threemonths. On physical examination hispulse rate is 100 and the rhythm is irregularly irregular. His blood pressure is 196/124. The apex beat is felt in the seventhintercostal space over the side of the chest wall rather than in themid-clavicular line. What disease process has caused this man's symptoms? |
Atherosclerosis |
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give 2 risk factors for atherosclerosis |
Hypertension high lipid levels smoking |
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On exam you find a pulsatile mass, what surface marking will enable you to conclude that the swelling is due to an aortic aneurysm? |
Swelling above line joining the iliac crests |
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(Pt has atherosclerosis) State the heart rhythm that most likely accounts for irregularly irregular pulse |
Atrial fibrillation |
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What part of the heart are you feeling when you palpate the apex beat? |
Left ventricle |
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Pt has atherosclerosis, shortly after admission to hospital, suddenly develops v severe central abdo pain, state 2 possible likely causes of his abdo pain |
aortic aneurysm disssection mesenteric artery occlusion from local atherosclerosis/thromboembolus from LA |
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What malabsorbed substance causes pale and smelly stools |
Fat |
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What malabsorbed substance causes swollen ankles |
protein |
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what malabsorbed substance causes bruising |
vitamin K |
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What are the 2 key stages of fat digestion in the gut? |
Emulsification Triglyceride hydrolysis |
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What is the main function of bile micelles in fat absorption from the gut? |
Lipid transport system |
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State 2 possible triggers which might cause an asthma attack |
allergens exercise infection temperature change allergic history drugs |
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what is the most likely source of a tremor in an asthma attack? |
Beta agonist therapy |
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State 3 pathological changes in the wall of bronchus that cause these symptoms: - wheezy and cough with clear sputum |
Muscle spasm Swelling of wall Excess mucus |
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State 2 findings from physical exam that would be consistent with anaphylaxis (Other than breathless, wheezy, rash, cyanosed, low BP, low resp rate) |
swollen tongue, lips, eyes laryngeal oedema swollen epiglottis |
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state 2 reasons why you would have low BP during anaphylaxis |
Vasodilatation Increased vascular permeability Fluid loss from vascular space |
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State the class of Ig, the name of the cell and name of the chemical mediator of anaphylaxis |
IgE Mast cell Histamine |
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Give the leading cause of hyperthyroidism |
Grave's disease |
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Give 4 signs and symptoms of hyperthyroid disease |
signs- tachycardia, fine tremor, thin hair, ptosis, lid lag, opthalmoplegia, pretibial myxoedema, goitre symptoms- weight loss, irritability, diarrhoea, heat intolerance, increased appetite, sweating, irregular periods, infertility |
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Give 1 medical treatment for hyperthyroidism |
Carbimazole Beta blockers eg propanolol Radioiodine |
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What is HbA1C a measure of? |
Glycated haemoglobin, a form of Hb that is measure to identify the 3-month average plasma glucose conc |
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A type 2 diabetic pt has been taking metformin, name one class of drug you may add into their glucose control regime |
Sulfonylura Glitazone DPP-4 inhibitor |
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Give 3 potential complications of poorly controlled diabetes |
diabetic retinopathy diabetic neuropathy increased risk of heart attack/stroke recurrent infection slow wound healing angina cataracts |
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You review a patient who has been taking oral prednisolone long term.You notice that since you last saw him his face has gotten puffy, he has gainedweight around his belly and his cheeks are red. What condition do you think hehas developed? |
Cushing's syndrome |
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Which 3 ECG leads would you expect ST elevation in, in an inferior STEMI? |
II, III, aVF |
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What is the emergency treatment for inferior STEMI? |
emergency angioplasty to reopen the obstructed artery |
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What is a classic ECG finding of pericarditis? |
Saddle-shaped ST elevation PR depression |
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A50-year-old woman presents with exertional dyspnoea and orthopnoea. O/E youfind a Pansystolic murmur radiating to the axilla and an S3 gallop. The womanalso has hepatosplenomegaly and pitting oedema up to her shins. What valvular heart disease does this women have? |
Mitral regurgitation |
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What 2 signs would you see on a pts hands who has infective endocarditis? |
Splinter haemorrhages Osler's nodes |
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What is the most common bacteria that causes infective endocarditis? |
Strep Viridans |
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A 55 year old South East Asian male presents toyour GP clinic with hypertension. What is the first line medication to starthim on? |
Any calcium channel blocker eg Amylodipine |
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What are the 6Ps of critical ischaemia? |
P-Pale P- Paralysed P- Pulseless P- Painful P- Paraesthesia P- Perishingly cold |
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A 67 year old man hasbeen referred to your clinic following a three-month history of weight loss,coughing up blood, and shortness of breath. He also complains of a dull ache inhis back, being very thirsty, and tired. He smokes 30 cigarettes a day and hasdone so for the last 25 years. What type of lung cancer is he most likely to have? |
Squamous cell carcinoma |
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A 67 year old man hasbeen referred to your clinic following a three-month history of weight loss,coughing up blood, and shortness of breath. He also complains of a dull ache inhis back, being very thirsty, and tired. He smokes 30 cigarettes a day and hasdone so for the last 25 years. What hormone is secreted by squamous cell carcinoma that is causing his symptoms? |
Parathyroid hormone-related protein (PTHrP) |
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What symptoms make up Horner's syndrome? |
Miosis- constricted pupil Partial ptosis- weak, droopy eyelid Anydrosis- loss of sweating |
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What is the first line treatment for TB and for how long should they be given? What is the main side effect for each drug? |
Rifampicin-6mths- orange discolouration of urine Isoniazid-6mths- neuropathy Pyrazinamide-2mths- optic neuritis Ethambutol-2mths- arthralgia |
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What is the medium used to grow mycobacterium tuberculosis? |
Lowenstein-Jensen medium |
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define a false positive |
result positive when the disease isnt present |
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what is specificity |
when the test is positive, the disease is present |
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what is sensitivity |
when the disease is present, the test is positive |
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in diabetes- screening asymptomatic patients is a form of which prevention- primary, secondary or tertiary? |
secondary- detecting early disease and preventing or halting the progression of the disease |
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which criteria is used to select whether a screening programme should be introduced in the health care system? |
Wilson and Jungner criteria |
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Name the 4 elements to capacity |
1. Be able to understand the info given 2. Be able to retain the information 3. Be able to weigh up and form judgement 4. Be able to communicate their decision |
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What pharmacological treatment is used to treat a relapse of symptoms in a multiple sclerosis sufferer? |
Methyprednisolone |
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A patient presents with pain , numbness and tingling in the thumb, indexfinger and middle finger which generally worsens at night time. Which nerve isbeing compressed in this patient? How would you treat this patient? |
Median Wrist splint and/or corticosteroid injection |
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A 55 year old male presents with jaw pain which comes on graduallywhilst chewing as well as constant scalp tenderness. What investigations do youarrange in order to diagnose this patient ? |
Temporal artery biopsy- shows granulomatous inflammation ESR- raised |
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Name one first line pharmacological treatment option for absence seizures |
Ethosuximide or sodium valproate |
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Which vessel is most commonly affected in an extradural haemorrhage? |
middle meningeal artery |
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what class of drug is the first line treatment for prevention of migraine in adults? |
A beta blocker |
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What are the 4 cardinal features of Parkinson's disease? |
Bradykinesia Tremor at rest Rigidity Postural instability |
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What is the pathological change in Parkinson's disease? |
reduction of dopamine in the pars compacta of the substantia nigra |
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which 2 receptors are most commonly affected in Myasthenia gravis sufferers? |
Primarily acetylcholine also muscle-specific receptor Tyrosine Kinase |
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A42 year old female patient presents with jaundice, fatigue and pruritus. She isfound to have anti-mitochondrial antibodies. What is the likely diagnosis? |
Primary biliary cirrhosis |
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Givetwo medicinal treatments for gastro-oesophogeal reflux disease other thanantacids. Give both the class of drug and an example. |
Histamine 2 receptor antagonists- eg ranitidine, nizatidine etc PPIs eg Omeprazole |
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Name 2 antibodies involved in coeliac disease |
IgA Tissue transglutaminase IgA anti-endomysial |
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Carcinoid tumours of the gut arise from which type of cells? |
Enterochromaffin cells (produce serotonin) |
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What is required for carcinoid tumours to cause carcinoid syndrome? |
Liver metastases |
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A patient is known to have hereditary nonpolyposis colorectal cancer, what staging system would you use for this? |
Duke staging |
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What 3 clinical features make up Virchow's triad? and what is the likely diagnosis if these 3 symptoms are present? |
Fever, Jaundice, RUQ pain Acute cholangitis |
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Name the 2 autoantibodies most commonly associated with RA |
Rheumatoid Factor Anti-cyclic citrullinated peptide |
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What is the class and name of the drug used to prevent further episodes of gout? |
Allopurinol Xanthine oxidase inhibitor |
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What is the classical relieving factor of ankylosing spondylitis? |
Exercise |
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A lady with SLE (systemic lupus erythmatosus) isstruggling to conceive - she so far has had 4 miscarriages. What condition,linked with lupus is she likely to have? |
Antiphospholipid syndrome |
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What is the mechanism of action for bisphosphonates? |
inhibit osteoclast activity- reduce resorption of bone |
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on microscopy, how do the crystals from gout and pseudogout differ? Give the crystal characteristics of each one |
Gout- negatively birefringent needles Pseudogout- positively birefringent rhomboids |
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Which streptococcus is optochin sensitive? |
Streptococcus pneumoniae |
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Name the 2 most common bacteria that can be grown on chocolate agar |
Haemophilus influenzae Neisseria meningitides |
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What is the culture plate used to grow TB? |
Lowenstein-Jensen culture |
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What would the commonest cause of female lower UTI look like under the microscope? |
E coli- Gram negative rods |
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what is the commonest cause of sepsis in the neonate <24hrs old? |
Group B strep |
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Methicillin resistant staphylococcus aureus is an increasing problem in hospitals. What Abx is used to treat it? |
Vancomycin |
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What are the 3 most likely locations for renal stones to get stuck? |
Pelviureteric brim Pelvic brim Vesicoureteric junction |
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What are renal stones most commonly composed of? |
Calcium oxalate |
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List 3 pre-renal causes of AKI |
Skin/heart/liver failure Infection Haemorrhage/dehydration Renal artery stenosis Thrombosis |
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What are the 2 most important markers for renal failure? |
Creatinine Urine output |
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What is the triad of nephrotic syndrome? |
Hypoalbuminaemia Oedema Proteinuria |
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What measure is used to stage CKD? |
eGFR |
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Methods of renal stone removal if they are too large to pass |
Medical eg nifedipine Extra-corporeal shockwave lithotripsy Percutaneous nephrolithotomy |
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1) 60 year old man in hospital goes into renalfailure. On his drug card you see paracetamol, amlodipine, ramipril and laxido.What do you immediately cancel? |
Ramipril |
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Hyperkalaemia is a dangerous complication of renal failure. How would you treat it and why does this work? |
Calcium gluconate- cardioprotective Insulin- drives potassium into cells Dextrose- compensates for glucose loss into cells Can use salbutamol nebs |
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Triad to diagnose nephrotic syndrome |
hypoalbuminaemia oedema proteinuria |
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why are nephrotic syndrome patients prone to infections? |
Immunoglobulins lost in urine Steroids used in treatment are immunosuppressive |
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Features of nephritic syndrome |
Haematuria Hypertension Oliguria (proteinuria but less than in nephrotic) |
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Nephrotic or nephritic? Post strep FSGS (Focal segmental glomerulosclerosis) Diabetes IgA nephropathy Goodpastures |
Post strep- nephritic FSGS- nephrotic Diabetes- nephrotic IgA nephropathy- nephritic Goodpastures- nephritic |
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at what stage of CKD would you create a fistula for dialysis? |
Stage 4 |
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At what stage of CKD would you start dialysis? |
Stage 5 |
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Most common mode of inheritance for PKD (polycystic kidney disease) |
Autosomal dominant |
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How can PKD cause brain haemorrhage? |
Berry aneurysm formation |
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List 3 risk factors for pyelonephritis |
anatomical anomalies pregnancy stones diabetes prostatic hyperplasia |
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Pyelonephritis most common causative organisms |
E coli Proteus mirabilis Klebsiella |
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What abx would you use for pyelonephritis? |
Ciprofloxacin or Co-amoxicillin |
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Name a complication of pyelonephritis |
Sepsis Renal abscess |
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Most common type of renal cancer |
Renal cell carcinoma |
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Where does renal cell carcinoma usually arise? |
Proximal convoluted tubule |
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List 2 risk factors for renal cell carcinoma |
smoking obesity hypertension occupational exposure- lead, asbestos |
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state and define the stages of labour |
latent- dilatation active- expulsion post partum- after birth |
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what hormone is a marker for a positive pregnancy test? |
Beta-HCG |
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what examinations and investigations can be carried out to find out how far gone a pregnant woman is? |
12 week dating USS Blood analysis for chemical markers |
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An increase in plasma conc of which pituitary hormone stimulates the maturation of follicles? |
FSH |
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An increase in plasma conc of which pituitary hormone initiates ovulation? |
oestrogen |
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is the ability of oestrogen to initiate LH surge an example of positive or negative feedback? |
positive |
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a decrease in plasma conc of which hormone is responsible for menstruation? |
progesterone |
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at what age does a woman have the maximum number of oocytes? |
0-1yrs |
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what is the normal concentration of sperm in an ejaculate? |
>=15 million/ml |
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young man has suffered meningitis, a few months later, he complains of feeling unwell, having headaches and has gained a lot of weight, what is the cause of his weight gain? |
increased appetite due to damage to satiety and hunger centres in hypothalamus |
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Why is creatinine used as an estimate of the GFR? |
Freely filtered Not secreted Not metabolised |
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State the signs of an UMN lesion |
hyper-reflexia spastic paresis increased tone lack of muscle atrophy positive babinski sign |
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Give an example of a gene that can cause obesity |
MCR4- Melanocortin receptor 4 |
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Risk factors of atherosclerosis |
Male sex Smoking Hypertension Hyperlipidaemia FH Physical inactivity Obesity |
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typical lesion of atherosclerosis |
atherosclerotic plaque with fibrous cap and lipid core |
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cell components of atheromatous plaque |
fibroblasts macrophages smooth muscle cells |
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name 2 non-respiratory health conditions that smoking is a risk factor for |
atherosclerosis cancer |
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Name a medical treatment for smoking |
Nicotine patch |
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define osteomalacia |
impaired mineralisation resulting in softening of the bone and accumulation of unmineralised osteoid |
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Give 3 causes for osteomalacia |
lack of exposure to sunlight darker skin housebound CKD anticonvulsants malabsorption |
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2 internal organs which may be involved in osteomalacia |
thyroid glands parathyroid glands |
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What is the underlying pathology of Graves disease? |
autoimmune hyperthyroidism autoantibodies mimick TSH and binds to TSHR -> stimulates release of T3 and T4 -> hyperthyroidism |
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3 drug treatments for graves disease |
anti-thyroid drugs- Carbimazole Thyroxine Radio-iodine |
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Name a side effect of radioiodine therapy |
hypothyroidism |
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define opportunity cost |
the sacrifice in terms of benefits forgone from not allocating resources to the next best activity |
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State 2 principles healthcare officials use to allocate scarce resources |
age social status prognosis causation |
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State 3 types of economic evaluation |
Cost minimisation analysis Cost effectiveness analysis Cost utility analysis Cost benefit analysis |
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define BMI |
BMI = weight/height^2 |
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3 health problems that could be exacerbated or caused by obesity |
type2 diabetes ischaemic heart disease osteoarthritis |
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characteristics of obesogenic environment |
physical- TV remote, lifts/cars socio-cultural- safety fears, family eating patterns economic environment- expensive fruit and veg |
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In Parkinson's disease, what areea is affected and what substance is deficient? |
substantia nigra Dopamine |
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Name 3 basal ganglia |
Putamen Caudate nucleus Globus pallidus Subthalamic nucleus Substantia nigra |
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In Huntington's, what area is affected and what is the neurotransmitter defected? |
Caudate nucleus GABA |
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Mode of inheritance for Huntington's |
Autosomal dominant |
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Where is nerve stimulation applied for progressive Parkinson's |
Subthalamic nucleus |
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Name 5 functions of the skin |
barrier to infection protection against trauma protection against UV vitamin D synthesis thermoregulation regulates water loss |
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name 2 hormones that regulate melanin secretion |
ACTH MSH |
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Which disease is characterised by destruction of melanocytes and hypopigmentation |
vitiligo |
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What is the organelle used to store melanin in melanocytes? |
Melanosome |
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What is the karyotype for Klinefelter's |
47XXY |
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What abnormality in meiosis causes the karyotype 47XXY in Klinefelter's? |
Non-disjuntion at meiosis 1 |
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what are the 2 hormones from the pituitary that control menstrual cycle? |
FSH LH |
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How do fibroids cause menorrhagia? |
increases surface area of endometrium and also they are vascular and bleed |
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What is present in segmental bronchi but not respiratory bronchioles? |
Cartilage |
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Name 4 drug types used to treat asthma |
SABA- salbutamol ICS- beclamethasone LABA- salmeterol Theophylline |
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Which cell types produce- Gastrin HCl Intrinsic factor Pepsinogen and where in the stomach are these most commonly found? |
Gastrin- G cells- antrum HCl/Intrinsic factor- Parietal/oxyntic cells- fundus and body Pepsinogen- chief cells- fundus, body and pylorus |
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what 2 things other than gastrin mediate the release of HCl? |
acetylcholine histamine |
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which glucocorticoid is most common in man? |
cortisol |
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what 2 hormones do glucocorticoids inhibit? |
ACTH CRH |
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which 2 anatomical areas are involved in glucocorticoids negative feedback loop? |
Hypothalamus Anterior pituitary |
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which hormone from the pituitary gland stimulates the release of glucocorticoids and what class of receptor does it bind to? |
ACTH G-protein coupled receptor |
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how does progesterone act on the uterus? |
thickening of the lining prevents uterine smooth muscle contraction |
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name 2 effects that oestrogen has on the endometrium |
uterine smooth muscle growth softening of the cervix and pelvic ligaments |
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name one hormone from the pituitary and one from the chorion/decidua that induce labour |
pituitary- oxytocin chorion/decidua- PGs |
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give 3 causes of polyneuropathy other than diabetes |
Guillain-Barre syndrome Alcohol Vitamin deficiency (B12) |
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in polyneuropathy, what 2 senses will be reduced on examination of the sole of the foot? |
pain and temperature |
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in polyneuropathy, what will the ankle reflex be like? |
diminished |
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Patient’s wife complains of wasting in thethenar muscles and loss of sensation in thumb and first two fingers. Whichnerve is compressed and what structure is compressing it? |
Median nerve flexor retinaculum |
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What test can be used to score subjective pain? |
McGill Pain questionnaire |
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how do women and men differ in their responses to pain? |
women report pain more readily but tolerate more pain than men |
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Lady with osteoporosis has lost a fewcentimetres in height and has a stooped posture. What would you see on an X-rayof the spine? |
Smaller vertebral bodies |
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Lady with osteoporosis has lost a fewcentimetres in height and has a stooped posture. She also had scalp tenderness, shoulder and pelvic girdle pain, what is your diagnosis and what drug would you use to treat her? |
Polymyalgia Rheumatic Corticosteroids |
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what is the gene test associated with rheumatoid arthritis? |
HLADR4 |
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what 2 structures in the skin are affected in eczema? |
corneodesmosomes keratinocytes |
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name 3 ways that the mucous membranes of the upper resp tract and upper gut contribute to innate immunity |
mucus traps bacteria muco-ciliary escalator low pH of HCl in stomach |
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give one oxygen-dependent method that phagocytes use to kill ingested material |
Reactive Oxygen species |
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Give one oxygen-independent method that phagocytes use to kill ingested material |
Complement |
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Which of the following is an example of acute inflammation? glandular fever leprosy appendicitis tuberculosis |
appendicitis |
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which of the following is an example of hyperplasia? bodybuilder's biceps enlarged left ventricle benign prostate enlargement wasting of quadriceps after immobilisation |
benign prostate enlargement |
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in which one of the following does granulomatous inflammation occur? crohns disease acute appendicitis infectious mononucleosis lobar pneumonia |
Crohns disease |
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Which one of the following is not associated with dementia? downs syndrome huntingtons disease alzheimers disease cerebral palsy |
Cerebral palsy |
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which one of the following has autosomal dominant inheritance? familial adenomatous polyposis colour blindness cystic fibrosis sickle cell disease |
familial adenomatous polyposis |
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which one of the following is not an example of apoptosis? loss of cells from tips of duodenal villi loss of cells during embryogenesis renal infarction graft versus host disease |
renal infarction |
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which one of the following is a chronic inflammatory process from its start? appendicitis cholecystitis infectious mononucleosis lobar pneumonia |
infectious mononucleosis |
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Which one of these pathologies can end in resolution? lobar pneumonia cerebral infarction MI partial nephroctomy |
lobar pneumonia |
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what is the name of a malignant tumour of striated muscle? lipoma rhabdomyosarcoma adenoma rhabdomyoma |
rhabdomyosarcoma |
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which of the following tumours does not commonly metastasise to bone? breast cancer lung cancer prostate cancer liposarcoma |
Liposarcoma |
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what is the name of a benign tumour of the glandular epithelium? adenoma adenocarcinoma papilloma lipoma |
adenoma |
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which one of the following is not known to be a carcinogen in humans? hep C virus ionising radiation aromatic amines aspergillus niger |
hep C virus |
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What is the name of a malignant tumour of glandular epithelium? adenocarcinoma adenoma squamous cell carcinoma transitional cell carcinoma |
adenocarcinoma |
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a transitional cell carcinoma of the bladder is a malignant tumour- True or False? |
TRUE |
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A leiomyoma is a benign tumour of smooth muscle- True or False? |
TRUE |
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Which tumour has the shortest median survival? basal cell carcinoma of the skin malignant melanoma of the skin breast cancer anaplastic carcinoma of the thyroid |
basal cell carcinoma of the skin |
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which of the following drugs is a receptor ligand? Omeprazole Enalapril Propranolol Fluoxetine Amlodipine |
Propranolol |
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Which of the following drugs is a receptor agonist? Atropine Atenolol Morphine Tubocurare Neostigmine |
Morphine |
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which of the following drugs is a receptor antagonist? Adrenaline Dopamine Salbutamol Propranolol Furosemide |
Propranolol |
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Factors that influence the activity of an antagonist are... Affinity of antagonist for the receptor Efficacy of antagonist at the receptor Number of receptors in the system Signal transduction processes All of the above |
Affinity of antagonist for the receptor |
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which of the following drugs is an irreversible enzyme inhibitor? Enalapril Aspirin Suxamethonium Ibruprofen Rocuronium |
Aspirin |
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Which of the following drugs is manufactured as a recombinant human protein? Aspirin Prednisolone Cyclosporin Amoxicillin Insulin |
insulin |
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mouse monoclonal antibodies and humanised monoclonal antibodies that recognise the same target may do so because of similarities in their... Light chains Heavy chains Fc regions Fab regions Hypervariable regions |
Hypervariable regions |
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Myasthenia Gravis is characterised by loss of which receptors? a-adrenoreceptors Serotonin nAChR mAChR u-opioid |
nAChR |
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Adrenaline can be administered to treat anaphylaxis, which of the following triad of effects would be expected? Vasoconstriction, bronchoconstriction,increased cardiac output Vasodilation, bronchodilation, reducedcardiac output Vasodilation, bronchodilation, increasedcardiac output Vasoconstriction, bronchodilation,increased cardiac output Vasoconstriction, bronchodilation,reduced cardiac output |
Vasoconstriction, bronchodilation,increased cardiac output |
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The principal purpose of liver metabolism is to... Make compounds more water soluble Inhibit drug action Activate drugs Make drugs more gut absorbable Make compounds more lipid soluble |
Make compounds more water soluble |
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If you suspect an Adverse Drug Reactionand you believe that it might have an allergic basis, what follow up test mightyou perform? Measure total IgE levels Perform HLA typing Serum tryptase testing Measure drug serum conc Monitor drug metabolites |
Serum tryptase testing |
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Which of the following statements concerning prostanoids is incorrect? Arachidonic acid is a precursor PGE2 activates parietal cells Prostaglandins sensitise sensory nerve terminals Mast cells are a rich source of PGD2 PGI2 is known as prostacyclin |
PGE2 activates parietal cells |
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Which of the following criteria is unlikely to be a risk factor for drug interactions? Saturable drug metabolism A wide therapeutic index Renal disease Hepatic disease Polypharmacy |
A wide therapeutic index |
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Rifampicin is an inducer of the hepatic microsomeCYP3A4. What effect will rifampicin have on the kinetics of midazolam, asubstrate for this enzyme? increase its plasma conc antagonise its receptor binding slow its gastric absorption reduce its plasma conc prevent it from crossing the BBB |
reduce its plasma conc |
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Which of the following is least likely to interact with prescription drugs? Ginseng (herbal tea) St John's Wort (herbal medicine) Grapefruit juice Pulsatilla (homeopathic remedy) Cheese |
Pulsatilla (homeopathic remedy) |
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Tolerance can develop with continued useof an opioid such as morphine. What is the most likely mechanism underpinningthe tolerance? Increase in u-receptors Desesnsitisation of u-receptors Decreased pre-synaptic uptake of agonist Desensitisation of k-receptors Dimerisation of opioid receptors |
Desensitisation of u-receptors |
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Chains of purple cocci are seen on a gramfilm. They show alpha haemolysis when grown on blood agar. They don’t grow nearthe optochin disc. They are probably… Streptococcus pneumonia Staphylococcus epidermidis Streptococcus viridans Group A streptococci Neisseria meningitides |
Streptococcus pneumoniae |
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Which of these is a gram negative bacillus that ferments lactose? Shigella sonnei Listeria monocytogenes Neisseria meningitides Escheria coli Streptococcus pyogenes |
Escheria coli |
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Which of the following is incorrect? Haemophilus influenzae is an important cause of... Meningitis in pre-school children Otitis media Pharyngitis Gastroenteritis Exacerbations of COPD |
Gastroenteritis |
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Which is a normally sterile site? pharynx urethra pleural cavity skin |
pleural cavity |
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Which of these is not a means by which viruses cause disease? Direct destruction of host cells Cell proliferation and cell immortalisation Inducing immune system mediated damage Endotoxin production Modification of host cell structure or function |
Endotoxin production |
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When diagnosing viral infection which is not true? The sample must come from a sterile site Electron microscopy is rarely used Use a green swab not a black swab PCR results take 1-2 days A detectable IgM in serum may be diagnostic |
The sample must come from a sterile site |
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Which is the most accurate? The HIV virus envelope contains... RNA + capsid + DNA polymerase DNA + capsid + reverse transcriptase DNA + p24 + protease RNA + capsid + reverse transcriptase |
RNA + capsid + Reverse transcriptase |
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Which pair is correct? Pityriasis versicolor = baceterium Ringworm = Helminth Aspergillus fumigatus = mycobacterium Falciparum malariae = fungal Giardia lamblia = protozoal |
Giardia lamblia = protozoal |
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Mycobacteria, which is not a feature? Resistance to destaining by acid and alcohol Cell wall contains lipoarabinomannan They only divide every 20hrs They cannot withstand phagolysosomal killing May cause meningitis |
They cannot withstand phagolysosomal killing |
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Regarding antimicrobial resistance, which is true? It is spread by plasmid mediated gene transfer Spontaneous gene mutations do not occur MRSA refers to vancomycin resistant S Aureus Only Mereopenem is effective against all gram negative bacteria |
it is spread by plasmid mediated gene transfer |
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A 34y/o gay man who has had prolongeddiarrhoea presents with SoB with a dry cough and hypoxia. Which ismost accurate? This is bacterial pneumonia caused by pneumocystitis jivorecii It is too early for a 4th generation HIV test to be positive The CD4 T cell count will be between500-750 Even if the HIV test is negative this manhas AIDS With appropriate therapy he has agood prognosis |
With appropriate therapy he has a good prognosis |
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Infection control: which is false? The 5 steps of hand hygiene are to wash hands... Before contact with patient Before bodily fluid exposure Before aseptic procedures After contact with pt surroundings After pt contact |
Before bodily fluid exposure |
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Each litre of normal saline contains... Approx 150mmol of sodium ion Approx 150mmol of chloride ion Approx 300mmol of osmotically active ions Virtually no potassium All of the above |
All of the above |
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What is the meaning of 'normal' saline? It is physiologically similar to the normal composition of extracellular fluid It is physiologically similar to the normal composition of intracellular fluid |
Extracellular |
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In the context of SOB and swollen legs, low BP is most likely to be indicative of... Hypovolaemia Dehydration Filariasis Biventricular failure None of the above |
Biventricular failure |
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what could a thick-walled bowel be a sign of? |
bladder outflow obstruction |
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True or false- general anaesthetic is required for insertion of a suprapubic catheter |
True |
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True or false- there is a small risk of bowel injury during the insertion of a suprapubic catheter |
true |
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True or false- a general anaesthetic is required every time a suprapubic catheter is changed |
False |
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True or false- Kidney transplantation is lesscost-effective than dialysis, mainly because of the cost of the surgicalprocedure and the fact that plastics used in dialysis are getting cheaper asthe price of oil falls |
False |
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True or false- kidney transplant doubles life expectancy |
True |
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The normal plasma conc of sodium is... 135-145mol/L 3.5-5.0mol/L 135-145mmol/L 3.5-5.0mmol/L Varies depending on the time of day sample is analysed |
135-145mmol/L |
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The normal plasma conc of potassium is... 135-145mol/L 3.5-5.0mol/L 135-145mmol/L 3.5-5.0mmol/L Varies depending on the time of day the sample is taken |
3.5-5.0mmol/L |
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Which of the following is true about Angiotensin II? Prefential constricts the glomerular efferentarteriole to maintain glomerular filtration pressure Stimulates aldosterone secretion by theadrenal cortex Stimulates ADH secretion by the posteriorpituitary Decreases vasa recta blood flow thusreducing sodium washout and maintaining medullary hypertonicity All of the above |
All of the above |
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In the presence of urosepsis, ACEinhibitors and angiotensin receptor blockers are more likely to result in… •A reduction in glomerular filtrationpressure and worsening renal function •An increase in glomerular filtrationpressure and improvement in renal function •Reduced efficacy meaning the dose shouldbe doubled immediately •Reduced thirst meaning the patient willneed IV half normal saline •All of the above |
Reduction in glomerular filtration pressure and worsening renal function |
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The most common inherited cause of kidney failure is... Phenylketonuria Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease Von-Hippel-Lindau disease Anderson-Fabry disease |
Autosomal dominant polycystic kidney disease |
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What is the characteristic genetic abnormality in Chronic Myeloid Leukaemia? |
t(9;22) Philadelphia chromosome |
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Which age group is characteristically affected by Hodkin's lymphoma? Children Teenagers and young adults Middle aged (40-60yrs) Older aged (>60yrs) |
Teenagers and young adults |
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|
How is myeloma bone disease usually assessed? Plain x-ray Clinical assessment Isotope bone scan PET scan |
Plain x-ray |
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|
What is the correct mechanism of action for the anti-emetic drug Ondansetron? Peripheral D2 antagonist Central D2 antagonist Anti-cholinergic 5HT3 antagonist |
5HT3 antagonist |
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|
What is the commonest cause of microcytic anaemia? B12 deficiency Iron deficiency Haematologic malignancy Hereditary spherocytosis |
Iron deficiency |
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In sickle cell anaemia what would you expect to see the reticulocyte count? Absent Low Normal Raised |
Raised |
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Bacterial infection usually causes... Low lymphocytes Low neutrophils High lymphocytes High neutrophils |
High neutrophils |
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Which best outlines the approach to the management of a patient with suspected febrile neutropenia? Encourage fluids and paracetamol Perform cultures and wait for results before starting Abx Perform culture and start oral Abx Perform cultures and start broad spectrum IV Abx |
Perform cultures and start broad spectrum IV Abx |
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Malignant spinal cord compression usually presents with? Back pain, ataxia and sensory neuropathy Back pain, spastic paresis and a sensory level Perianal numbness and urinary incontinence Weak legs impaired joint position sense |
Back pain, spastic paresis and a sensory level |
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Which of the following clinical features is typical of osteoarthritis? 60 mins of early morning stiffness Painful, swelling across the MCP jts and proximal interphalangeal jts Pain in 1st carpo-metacarpal joints Mobile, subcutaneous nodules at points of pressure Alternating buttock pain |
Pain in the 1st carpo-metacarpal joints |
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Which of the following is an extra-articular manifestation of RA? Subcutaneous nodules Episcleritis Peripheral sensory neuropathy Pericardial effusion All of the above |
All of the above |
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Which of the following is a classical feature of RA on x-ray? Peri-articular sclerosis Sub-chondral cysts Osteophytes Peri-articular erosions New bone formation |
Peri-articular erosions |
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For a lytic tumour to be visible on x-ray it must have lost... >6% bone density >16% bone density >60% bone density >90% bone density 100% bone density |
>60% |
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MSK ultrasound... •Obtains good resolution using a highfrequency probe to look at superficial tissues •Obtains good resolution using a lowfrequency probe to look at superficial structures •Obtains good penetration using a highfrequency probe to look at deep tissues •Obtains good images through bones •Exposes patients to ionising radiation |
Obtains good resolution using a high frequency probs to look at superficial tissues |
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Which of the following is not an autoimmune connective tissue disease? SLE Ehler Danlos syndrome Primary Sjogrens syndrome Systemic sclerosis Dermatomyositis |
Ehler Danlos syndrome |
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A 23 y/o woman presents with mouth ulcers, fever, painful white fingers and pleuritic chest pain. She is antinuclear antibody (ANA) +ve, her ESR is high, and her WCC is low. Which of the following features would you not expect to be associated with her illness? Deforming arthritis Photosensitive rash Seizures Pulmonary embolism Thrombocytosis |
Thrombocytosis |
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Which of the following is used in the treatment of SLE? Anti-TNF Anti-malarials Ustekinumab (IL12/23 blocker) Sulfasalazine Allopurinol |
Anti-malarials |
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Which of the following is the most frequent infecting organism after hip replacement? MRSA Coagulase negative staphylococcus Salmonella Enterococcus faecalis Propionibacterium acne |
Coagulase negative staphylococcus |
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A 13 y/o girl presents with a 1 week history of systemic upset, associated with a rash, joint pain, a CRP of 121. A diagnosis of systemic onset JIA is made. Which of the following is not a typical feature of this condition? Thrombocytosis Hypoferritinaemia Daily fever Evanescent rash Splenomegaly |
Hypoferritinaemia |
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Which statement regarding MSK pain is NOT correct? Nociceptive MSK pain responds to opioid meds Tricyclic antidepressant meds are first line treatment for fibromyalgia Fatigue and sleep disturbance are typically associated with fibromyalgia Graded exercise therapy is important in managing chronic pain/fibromyalgia Levels of pain and degenerative change on knee x-rays are not well correlated |
Tricyclic antidepressant meds are first line treatment for fibromyalgia |
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What is the initial treatment for MS? |
Steroids |
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|
•A young woman presents with bilateral legweakness and numbness. This has developed over 4 days. She complains ofdifficult passing urine and constipation. 3 differentials could be? Whatinvestigations would you do? |
Prolapsed disc MS Spinal cord infarct MRI |
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Which lobe would deja vu and memory problems suggest an abnormality in? |
Temporal |
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A 75 y/o man is admitted with abdo pain and vomiting, and had not opened his bowels for 5 days. Exam revealed a distended abdomen with tympanic percussion and tinkling bowel sounds, he has no past medical history, what is the most likely underlying diagnosis? Colorectal cancer Adhesions Constipation Sigmoid volvulus Hernia |
Sigmoid volvulus |
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Which one of the following is FALSE regarding colorectal cancer? •Bowel cancer screening is offered topeople aged 55 or over •The majority of cancers occur in theproximal colon •FAP and HNPCC are 2 inherited causes ofcolon cancer •Proximal cancers usually have a worseprognosis •Patients with PSC and UC have anincreased risk of developing colon cancer |
The majority of cancers occur in the proximal colon |
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A 50y/o man presents with dysphagia. Which one of the following suggests a benign nature of his disease? weight loss dysphagia to solids initially then both solids and liquids dysphagia to solids and liquids occurring from the start anaemia recent onset of symptom |
dysphagia to solids and liquids occurring from the start |
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A 19y/o girl presents with abdo pain and loose stool. Which of the features suggest that she has irritable bowel syndrome? Anaemia Nocturnal diarrhoea Weight loss Blood in stool Abdo pain relieved by defaecation |
Abdo pain relieved by defaecation |
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A 56y/o man presents with abdo distension and SoB. Exam revealed fever of 38C, a tense distended abdo with shifting dullness. He also has dullness to percussion in R lung base. Several spider naevi are seen on his chest. Which is the most important test in the management of this pt? CXR USS abdo Echocardiogram Ascitic tap Urine dip |
Ascitic tap |
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Which of the following features best distinguished Ulcerative colitis from Crohn's disease? Ileal involvement Continuous colonic involvement on endoscopy Non-caseating granuloma Transmural inflammation Perianal disease |
Continuous colonic involvement on endoscopy |
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A 68 y/o lady presents with abdo pain and distension. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Exam reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is not likely to be the cause of her abdo pain and distension? Colon cancer Adhesions Ascites Diverticulitis Strangulated hernia |
Ascites |
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A 71 y/o man was admitted to hospital with pneumonia after her returned from a cruise holiday. He was treated with a week of co-amoxiclav for his pneumonia. On day 7 of his admission, he started having diarrhoea 10x a day without any blood. He feels unwell and dehydrated. What is the likely organism responsible for his diarrhoea? Norovirus E coli Giardia lamblia C diff Salmonella enteridis |
C diff- Abx use |
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A 16 y/o girl is admitted with vomiting and abdo pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following test results would you NOT expect to see? Metabolic acidosis A prolonged prothrombin time A raised creatinine Hyperglycaemia ALT 100 |
Hyperglycaemia |
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|
4 things youd ask in the history to support diagnosis of allergic asthma |
diurnal variation provoking factors other features of atopy- hay fever, ecema, reversibility/episodic nature wheeziness |
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|
4 possible triggers for exacerbation of asthma |
cold exercise menstrual cycle pets infections laughter emotion |
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|
what 4 questions would you ask during a consultation to assess whether the patient's asthma is poorly controlled? |
● In the last4 weeks has your asthma caused nocturnal waking? ● In the last 4 weeks has your asthma caused youto get less done than usual/interfered with ADLs? ● In the last 4 weeks how many times have you usedyour blue inhaler? ● In the last 4 weeks how often have you had shortness of breath/symptomsof asthma? |
|
|
Charcot's triad |
jaundice fever RUQ pain |
|
|
Name 2 gram neg bugs likely to cause ascending cholangitis |
Escherichia coli Klebsiella spp |
|
|
Serology in coeliac disease |
Anti-endomysial antibody Anti-transglutaminase antibody Anti-gliadin |
|
|
Some has blood tests for coeliac, they are feeling bloated and tired, what would you advise them to do until their results come back? |
Avoid gluten rich food- wheat, barley Fluid + rest |
|
|
2 histological features on small bowel biopsy in coeliac disease |
Crypt hyperplasia Villous atrophy Intra-epithelial lymphocytes |
|
|
Someone with suspected coeliac disease has a blistering skin rash, what might this be? |
Dermatitis herpetiformis |
|
|
Name 2 fat soluble vitamins and what their malabsorption causes |
Vitamin K -> clotting defects, purpura/petechiae Vitamin D -> hypocalcaemia -> osteomalacia, rickets (bone fracture, pain) |
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|
4 features of plaque psoriasis |
salmon pink, well demarcated on extensor side silver scale itchy |
|
|
What is rheumatoid factor? |
Autoantibody against Fc portion of IgG |
|
|
If a patient was rheumatoid factor +ve, would that mean he had rheumatoid arthritis? Justify |
No- RhF is only +ve in 70% of people with RA |
|
|
Differentiate RA and psoriatic arthritis clinically ie joint distribution |
Psoriatic- majority symmetrical, RhF -ve, could be in DIPJ of hand- not typical of RA pitting of finger/toenails in psoriatic but not RA |
|
|
4 signs of meningitis other than headache, fever, photophobia, rash |
Kernig's sign Brudzinski's sign altered mental state- confusion seizures vomiting irritability drowsiness |
|
|
How does meningococcal meningitis spread |
droplets of resp secretions during close contact eg coughing on someon |
|
|
How can you treat family members of someone diagnosed with meningococcal meningitis? |
Rifampicin 48hrs |
|
|
2 side effects later in life due to meningitis |
deafness learning difficulty epilepsy |
|
|
Give 2 reasons why someone with myeloma is confused |
anaemia hypercalcaemia hyperviscosity of blood |
|
|
what cells does myeloma arise from? |
plasma cells |
|
|
what would you find in the urine of someone with myeloma? |
Bence Jones protein |
|
|
Microbiology stain for TB |
Ziehl-Neelsen stain |
|
|
Why are homeless people more susceptible to TB? |
poor immunity- poor nutrition |
|
|
6 physical features of acromegaly |
large hands/spade feet oily skin protruding jaw protruding brow/forehead ridge spacing of the teeth large tongue |
|
|
What visual field defect may someone with acromegaly have? |
Bi-temporal hemianopia |
|
|
How to treat pituitary gland tumour |
Dopamine agonist- Cabergoline Somatostatin analogue- Octreotide GHR agonist- Pegvisomant Transphenoidal surgery |
|
|
Which hormone does GH cause liver to produce? |
Insulin-like growth hormone 1 |
|
|
4 risk factors for gout |
Metabolic syndrome High protein diet Obesity Kidney failure |
|
|
4 triggers for gout |
alcohol seafood infection starvation trauma surgery |
|
|
3 treatments other than allopurinol for gout |
NSAIDs Colchicine Etoricoxib Steroids |
|
|
Lifestyle advice for management of gout |
Weight loss Avoid prolonged fasting alcohol excess cut down avoid purine-rich meats |
|
|
Give 1 test a GP can do for hydrocoele |
Transillumination |
|
|
1 test the hospital would do for hydrocoele |
Doppler USS/ Doppler Angiography |
|
|
what is hydrocoele the embryological remnant of? |
Processus vaginalis |
|
|
2 causes of hydrocoele in 50yr old man apart from malignancy or trauma |
excessive production of fluid within the sac- infection/inflammation Defective absorption of the fluid Interference with lymphatic drainage of scrotal structures |
|
|
What is Starling's hypothesis |
Stroke volume of the heart increases in response to an increase in the vol of blood filling it increased vol of blood stretches ventricular wall- causing cardiac muscle to contract more forcefully Stretching of the muscle fibres augment cardiac muscle contraction by increasing the calcium sensitivity of the cardiac myofibrils -> greater number of actin-myosin cross-bridges to form |
|
|
what is the cause of breathlessness in heart failure? |
pulmonary oedema/pleural effusion |
|
|
what is the cause of increased JVP in heart failure |
increased pressure in R heart |
|
|
How do glucocorticoids work- in nucleus and cytoplasm |
nucleus- upregulates expression of anti-inflammatory proteins in nucleus cytoplasm- represses expression of pro-inflammatory proteins in cytosol by preventing translocation of their trnascription factors from cytosol into nucleus |
|
|
A patient is put on methotrexate- what advice should he be given? |
Mtx is a teratogenic- stay away from pregnant females Hepatotoxicity, ulcerative stomatitis, low WBC-> infection |
