MCQs

MCQs

2014 Summer exams

If you notice any errors in these questions please let us know and let those using these questions know. Every effort has gone into making sure there are no errors however they may still occur.

Good luck with your exams!

• Which type of spina bifida has the worst outcome?

(a)Spina Bifida Occulta(b)Myeloschisis(c)Meningocele(d)Myelomeningocele(e)Meningeal Cyst

• (ANSWER: b (myeloschisis is a TYPE of myelomingocele, but myelomeningocele can often be repaired whereas myeloschisis results in some form of disability + meningitis- Anatomy, Block 2 and 5)

• Which one of these is not found in the tarsal tunnel?

(a)Tendon of Tibialis Posterior(b)Tendon of Flexor Digitorum(c)Anterior Tibial Artery(d)Tendon of Flexor Hallucis Longus(e)Tibial Nerve

• ANSWER: c – the posterior tibial artery passes through the tarsal tunnel; the anterior tibial artery passes lateral to the extensor hallucis longus tendon on the dorsal part of the foot (and medial to extensor digitorum tendon)

•

• Which of these does not describe the attitude of a child who has secure attachment with their parent?

(a)Can separate from parent(b)Becomes very distressed when parent leaves(c)Prefers the parent versus a stranger(d)When parents enter a room child reacts with

positive emotions(e)Seek comfort from the parent when

• Answer: b- in secure attachment, there is some distress when parents leave, but very distressed children are usually those who have ambivalent attachment (unavailable mother)

• Why of the following is a not a sign of Carpal Tunnel Syndrome?

A.Wasting of thenal eminence musclesB.Positive Tinel’s testC.Reduced grip strengthD.Numbness over thenar eminenceE.Paraesthesia in median nerve distribution

• Correct Answer: D. • Explanation: Sensation to the skin over the

thenar eminence is provided by palmar cutaneous branch of the median nerve which does not travel through the carpal tunnel. It comes off the median nerve proximal to the flexor retinaculum and travels superficially to the flexor retinaculum and is therefore not compressed.

• The tendons of which muscles does De Quervain's syndrome classically affect?

A.Flexor pollicis longus and flexor pollicis brevis B. Abductor pollicis longus and abductor pollicis

brevis C. Extensor pollicis brevis and abductor pollicis

longus D.Extensor carpi radialis and extensor pollicis longus

• Correct Answer: C.• Explanation: De Quervain syndrome is a tenosynovitis of

the sheath or tunnel that surrounds two tendons that control movement of the thumb. Symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping. The two tendons concerned are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles, which run side by side, have almost the same function: the movement of the thumb away from the hand in the plane of the hand (radial abduction).

• Warfarin works by inhibiting an enzyme that is required for the synthesis of vitamin K-dependent clotting factors. What are these factors?

a) III, VII, IX and Xb)III, V, VII and Xc) II, VII, IX and Xd)II, V, VII and Xe) II, V, IX and X

• Answer: C

• What does the biceps reflex test?

a)C7, C8b)C8, T1c) C6, C7d)C5, C6

• Answer D

• A patient presents with diplopia due to a lesion of a single cranial nerve. On examination he is found to have a left sided ptosis, left mydriasis and a divergent strabismus.

• Which cranial nerve is affected?

a) CN IIb) CN IIIc) CN IVd) CN VIe) All of above

• Answer: B

• What respiratory drug class causes bronchodilation through blocking the action of phospholipase C?

a) Beta agonistsb)Anti-cholinergicsc) Beta blockersd)Methylxanthinese)Monoclonal antibody

• Mrs Jones is a 66 year old woman who presents to A&E with a pleuritic left sided chest pain and SOB. She has recently had a hip replacement and is currently receiving treatment for breast cancer.

1.What scoring system/criteria are used to determine the risk of DVT/PE?

A.Light’s criteriaB.Wells scoreC.Gleason scoreD.Vichow’s criteriaE.CHADS2 score

• Answer: B

1. What would be the most appropriate first investigation if the scoring system determined Mrs Jones to have a high pre-test probability of PE?

A.D-dimerB. CXRC. Doppler Ultrasound scanD.CT Pulmonary AngiographyE. ABG

• Answer: D

1.You confirm Mrs Jones has a PE, what is the most appropriate drug/drug combination to start treatment with?

A.Streptokinase aloneB.Low molecular weight heparin alone C.Warfarin aloneD.Streptokinase + WarfarinE.Low molecular weight heparin + Warfarin

• Answer: E

1.Streptokinase…A.Inhibits vitamin K epoxide reductaseB.Activates antithrombin IIIC.Is a direct thrombin inhibitorD.Activates plasminogen plasminE. Inhibits the activation of fibrinogen fibrin

• Answer: D

1. Should you need to reverse the effects of heparin in a patient, for example in cases of overdose, what would be the most appropriate treatment to give them?

A.Protamine sulphateB. Vitamin KC. Fresh frozen plasmaD.Blood transfusionE. Prothrombin complex concentrate

• Answer A

1. What are the 5 things needed for erythropoiesis to occur?

a. Copper, Vitamin B1, Folate, Erythropoietin and bone marrow

b. Oxidised Iron, Vitamin B12, folate, erythropoietin and bone marrow

c. Iron, Vitamin B12, folate, growth factor and bone marrow

d. Iron, Vitamin B12, Folate, Erythropoietin and bone marrow.

e. Iron, Vitamin B1, folate, erythropoietin and bone marrow

• Answer: D

1.Erythrocytes stay in circulation for ---- days?

a. 120

b.180

c. 60

d.220

e. 30

• Answer A

1.The toxic dose of paracetamol is ---

a. 10 milligrams

b.1000 milligrams

c. 5 grams

d.500 milligrams

e. 10 grams

• Answer: E

1.What inactivates the toxic metabolite of paracetomol?

a. Glutathione

b.Tyramine

c. Nitric oxide

d.Glucaronic acid

e. Salicylic acid

• Answer A

1. What is a polymorphic distribution?

a. A differential trait that is expressed by more than 5% of the population.

b. A differential trait that is expressed by more than 0.1% of the population.

c. A differential trait that is expressed by more than 1% of the population.

d. A differential trait that is expressed by more than 10 % of the population.

• A differential trait that is expressed by more than 0.5 % of the population.

• Answer: C

1. Stomach emptying is decreased by

a. Hypertonicicity, high fat and high acidic chyme in the duodenum

b. Hypertonicicity, high fat and high acidic chyme in the stomach

c. Hypotonicicity, low fat and high alkaline chyme in the stomach

d. Hypotonicicity, low fat and high alkaline chyme in the duodenum

e. Hypertonicicity, low fat and high alkaline chyme in the duodenum

• Answer: A

1.T cells are called T cells because

a. They mature in the thymus

b.They are T shaped

c. They have 3 nuclei which form a T shape

d.They have a cyto-toxic function

e. They are activated by thyroid hormones

• Answer: A

1.How many erythrocytes can be made from 1 committed stem cell?

a. 12

b.16

c. 8

d.18

e. 20

• Answer: B

1.Iron stored in macrophages is known as ---?

a. Ferritin

b.Macroferritin

c. Macrosidderin

d.Hemosiderin

e. Haemoferritin

• Answer: D

1.The secretory phase of the menstrual cycle refers to ---

a. Uterus changes only

b.Changes to the cervix only

c. Changes to both the uterus and cervix

d.The menses only

e. Days 14-28 of a regular cycle

• Answer: A

1.An indirect hernia passes ---- to the ---

a. Medial to the inferior epigastric artery

b.Lateral to the inferior epigastric artery

c. Lateral to the superior epigastric artery

d.Medial to the superior epigastric artery

e. Anterior to the inferior epigastric artery

• Answer: B

1. COPD can be defined as ---

a. A chronic irreversible airway disease characterised by chronic bronchitis, emphysema and a FEV1/FVC below 70%

b. A chronic irreversible airway disease characterised by chronic bronchitis, emphysema and a FEV1/FVC below 80%

c. A chronic irreversible airway disease characterised by chronic bronchitis, emphysema and a FEV1/FVC below 40%

d. An acute irreversible airway disease characterised by chronic bronchitis, emphysema and a FEV1/FVC below 70%

e. A chronic irreversible airway disease characterised by chronic bronchitis, emphysema, and a FEV1/FVC below 75%

• Answer: A

1.A hernia is examined and is unable to be pushed back into place, it can therefore be described as ---

a. Non reducible

b. Strangulated

c. A hernia

d. Protruded

e. Incarcerated

• Answer: E (A also makes sense)

1.The gastrocolic reflex is mediated by

a. Gastrin and extrinsic nerves

b.CCK and intrinsic nerves

c. Gastrin and intrinsic nerve

d.CCK and extrinsic nerves

e. Gastrin and the vagus nerve

• Answer: A

1.Lactulose is an example of what type of laxative?

a. Purgatory

b.Bulk

c. Faecal softener

d.Stimulatory

e. Osmotic

• Answer: E

• Lactulose works by? A. Providing sugar to the gut bacteria. They break the sugar down and release enzyme which stimulate gut movement. B. Being poorly digestible, its breakdown products are glucaronic and glucose and these create an osmotic pull of water into the lumen of the GI tract. C. Being poorly digestible, its breakdown products are acetic acid and lactic acid and these create an osmotic pull of water into the lumen of the GI tract. D. Being poorly digestible, it pulls water across the tissues of the GI tract and into the lumen E. Being poorly digestible water is pulled out of it and the faces it is in, leading to an anti-diarrhoeal effect.

• Answer: c

1. How do opioids work to reduce diarrhoea?

a. Diminish propulsive activity by binding to the Mu receptors in the myeneteric plexus

b. Diminish propulsive activity by binding to the Kappa receptors in the myeneteric plexus

c. Diminish propulsive activity by binding to the Delta receptors in the myeneteric plexus

d. Diminish propulsive activity by binding to the orphan receptors in the myeneteric plexus

e. Diminish propulsive activity by binding to the alpha 1 receptors in the myeneteric plexus

• Answer: A

1.What protein/s are associated with parkinsons?

A.Synlecein

B.Synlecin and parkin

C.Parkin

D.Amyloid plaques and tau tangles

E.Tau protein

• Answer: B

• Which of the following muscles is innervated by the superior laryngeal nerve?

a)Lateral cricoarytenoid

b)Posterior cricoarytenoid

c)Cricothyroid

d)Thyroarytenoid

• Buccinator

• Answer: C

• Which immunoglobulin is found in breast milk?

a)IgA

b)IgG

c)IgM

d)IgG

e)IgE

• Answer: A

• Which of the following most accurately describes cor pulmonale?

a) Pulmonary oedema as a result of left ventricular hypertrophy

b) Mitral valve regurgitation as a result of left ventricular hypertrophy

c) Pulmonary valve stenosis as a result of left ventricular dilation

d) Right ventricular hypertrophy as a result of pulmonary hypertension

e) Right ventricular hypertrophy as a result of increased venous return from the IVC

• Answer: D

• A 28 year old man suffers from a seizure, and describes how initially he felt as though he could smell something usual, and had been in this situation before. Which of the following areas is likely to have been the initial focal site?

a) Frontal lobe

b)Temporal lobe

c) Parietal lobe

d)Cerebellum

e) Occipital lobe

• Answer: B

• 1. A 32 year-old man is found unconscious and taken to A & E. His partner tells you that he had recently been prescribed valium for stress. Which drug do you give him?

• a. Tetrabenazineb. Naloxonec. Naltrexoned. Flumazenile. Haloperidol

• Answer: D

• 2. A 40 year-old woman presents with a red rash on her wrist. She tells you that she has just got a new watch and that it started a few days after she started wearing it. Which type of hypersensitive reaction has she suffered?

• a. Type Ib. Type IIc. Type IIId. Type IVe. Type V

• Answer: D

• 3. At what age can a baby roll over from a supine to a prone position?

• a. 9 monthsb.6-7 monthsc. 5-6 monthsd.12 monthse. 15 months

• Answer: B

• What feature does myocardium have that is not present in skeletal muscle?

• • 1 Branching Fibres• 2 Dense Bodies• 3 Multinucleate myocytes• 4 T-tubules?• 5 Z-Lines

• Ans: 1 Branching Fibres• • Only cardiac muscle has fibres that branch. Dense bodies

are areas for insertion of myofilaments in smooth muscle. Both Cardiac and Skeletal muscle are multinucleated striated muscles because they have sarcomeres composed of thin and thick fibres arranged in a regular pattern. This includes Z-Lines, where thin filaments attach. T-tubules are invaginations of sarcolemma that lie close to sarcoplasmic reticulum, this facilitates electrical-contraction coupling.

• What ventricular ion movements are responsible for the Q-T segment seen on ECG?

• • 1 Calcium influx only• 2 Potassium efflux only• 3 Sodium influx only• 4 Sodium and Calcium influx with Potassium efflux• 5 Sodium influx with potassium efflux

• Ans: 4 Sodium and Calcium influx with Potassium efflux• • The Q-T segment on ECG takes place during the plateau

phase of ventricular myocyte depolarisation. The plateau occurs when the sodium influx (through slow voltage-gated channels) and calcium influx that is balanced by the potassium efflux through voltage gated channels. Repolarisation occurs at the end of the plateau phase, when sodium and calcium channels shut but potassium efflux continues.

• What is the effect of increased beta-adrenergic stimulation on the heart?

• • 1 Increased EDV for any given central venous pressure.• 2 Increased Ejection Fraction for any given stroke

volume.• 3 Increased stroke volume for any given EDV.• 4 Reduced EDV for any given central venous pressure.• 5 Reduced Ejection fraction for any given EDV

• Ans 3 Increased stroke volume for any given EDV.• • Beta-adrenoreceptor stimulation increases ventricular

contractility, which reduces ESV at any given EDV. There is a vertical shift up the Frank-Starling curve with increasing sympathetic stimulation. This increases the Ejection fraction for any EDV. The relationship between central venous pressure and EDV is not affected. The change in stroke volume causes an increase in ejection fraction, so ‘B’ is not correct.

• When is left coronary artery blood flow highest?• • 1 Early diastole• 2 Isovolumetric phase of contraction• 3 Isovolumetric phase of relaxation• 4 Late diastole• 5 Mid-systole•

• Ans 1 Early diastole• • Branches of the left coronary artery are subject to

compression by the transmural pressure of the left ventricle. The transmural pressure is greatest during systole and despite blood pressure being highest in mid-systole the left coronary artery is almost entirely occluded with very little flow. Transmural pressures are lowest during diastole and at early diastole arterial pressure results in maximum blood flow. Flow is lowest during isovolumetric phases of contraction and relaxation.

• Which mechanoreceptors may activate a vasovagal syncope?

• • 1 Aortic arch• 2 Carotid body• 3 Carotid sinus• 4 Renal artery• 5 Ventricular

• A vasovagal syncope can be activated by either high-threshold ventricular mechanoreceptors or from emotional stimuli via the defence response. The ventricular afferents are stimulated when the ventricle contracts with high contractility on a low volume e.g. after standing up after intense exercise. The other mechanoreceptors listed above are involved in the baroreflex. There are only chemoreceptors in the carotid body.

• Which of the following is not a type of Glial cell:

• a) Schwann Cell• b)Enterocyte Cell• c)Astrocyte• d) Ependymal cell

• Answer: B

• Which cranial nerve cells are involved in parasympathetic system?

• a) 4,7,9,11• b) 1,9,10,11• c) 3,7,9,10• d)1,9,7,3

• Answer: C

• What is dysarthia?• a) Difficulty in voice/speech production• b) Disorder of language affecting pronunciation

but not content or formation of speech• c) Shaky and/or unsteady gait• d)Jerky, involuntary movements primarily

affecting llimbs, head and face•

• Answer: B

• Which of the following motor pathways travels ipsilaterally up the spinal column?

• a) Anterior Spinothalamic• b) Lateral Spinothalamic• c)Posterior column

• Answer: C

• Which of these is a primary cause of peripheral neuropathy?

• a) Rheumatoid Arthritis• b) hypothyroidism• c) syphilis• d) Diabetes

• Answer: D

• Patient presents with total right sided loss of position, light touch and vibration sensation, below his umbilicus, and on his left side loss of pain and temperature sensation from the groin downwards. What is the likely diagnosis?

• a) Brown-Sequard syndrome• b)Complete transverse loss• c)Central Cord Lesion• d)Posterior column loss• e) Anterior spinal Syndrome

• Answer: A

• Which of the following is an upper motor neurone sign

• a) flaccid paralysis• b) Fasciculations• c) Clonus• d) Areflexia• e)hyporeflexia

• Answer: C

• Which sympathetic roots innervate cardiovascular control?

• a) T1-5• b) T1-4• c)T5-12• d)C8-T4• e) T2-7

• Answer: A

• Which is the primary cranial nerve for balance?

• a) CN6• b) CN10• c) CN 9• d) CN 5• e) CN 8

• Answer: E

• How can you differentiate between a transient ischaemic attack and a stroke?

• a) Patient fully recovers within 24 hours• b) If they're male or female• c)No loss of vision• d) Slurring of speech• e) Loss of movement in either arm

• Answer: A

• If a patient has Conduction Aphasia where would the lesion be?

• a) Broca's area• b) Wernicke's area• c) Pre-frontal cortex• d) Arcuate fasciculus• e) Cerebellum

• Answer: D

• Which of the following is a medical emergency?

• a) Status Epilepticus• b) Tonic-clonic seizure• c) Absent seizure• d) Complex partial seizure•

• Answer: A

• What type of degeneration is seen in diabetic neuropathy?

• a) Wallerian• b) Axonal• c) Myelin

• Answer: B

• Which of these is a reversible cause of dementia?

• a) B12/folate deficiency• b) Cerebral infarcts• c)Lewy body disease• d) Parkinson's• e) Huntington's

• Answer: A

• Which of the following is true about Parkinson's?• a) Rapid dementia, probable death within

12month• b) Due to overactive thalamus• c) Hypokinesia Due to under activity of the

thalamus• d) Caused by prion proteins which convert to an

insoluble form and accumulate in the brain• e) Is a notifiable disease

• Answer: C

• Which of the following is not a symptom of meningitis?

• a) Nuchal stiffness• b) Non-blanching rash• c) Photophobia• d) Fever• e) Hypersensitive to touch rash•

• Answer: E

Scenario 1: • A 20 year old 2nd year university student is brought into A&E by

her housemates. She is unconscious after taken large amount of alcohol but flexed her arms when rubbed on the sternum.

• • 1) What is the assessment for consciousness?• A. Glasgow Coma Outcome Score• B. Glasgow Coma Scale• C. Glasgow Consciousness Scale• D. Glasgow Consciousness Outcome•

• Answer: B

• 2) What is the score of the above assessment for this patient?

• A. 4• B. 5• C. 6• D. 7

• Answer: B

• 3) What are the maximum and minimum possible scores for the above assessment?

• A. Max: 16, Min: 0• B. Max: 16, Min: 3• C. Max: 15, Min: 3• D. Max: 14, Min: 0

• Answer: C

• 4) Which of the following is NOT a description of consciousness?

• A. Alert• B. Lethargy• C. Stupor• D. Death

• Answer: D

• 5) Which of the following is a correct description of decorticate response?

• A. flexion of legs and extension of arms• B. extension and medial rotation of arms and

flexion of legs• C. flexion of arms and extension of legs• D. indicates lower brain stem compression

involving red nucleus and below

• Answer: C

• 6) Which of the following is a correct description of decerebrate response?

• A. indicates thalamic compression• B. extension and medial rotation of arms and

extension of legs• C. caused by increased ICP in meningitis• D. localizing response indicating more severe

dysfunction

• Answer: B

• 7) Which of the following is not a coma-like state?

• A. Hypoglycemia• B. Persistent vegetative state• C. Locked in syndrome• D. Akinetic mutism

• Answer: A

• 8) Which of the following is not a factor consisting consciousness?

• A. Alertness• B. Cognitive function• C. Awareness• D. Attention

• Answer: B

9) Which of the following CT scan show an extradural haemorrhage?

• Answer: A

• 10) What is Contre-coup?• A. Old contusions showing orange appearance of

the brain tissue due to haemosiderin deposition• B. Acute haemorrhages causing orange appearance

of the brain tissue due to accumulation of blood• C. Chronic haemorrhages causing shrunken brain

tissue due to increased ICP• D. Chronic haemorrhage with Parkinsonism causing

shrunken brain tissues post mortem

• Answer: A

Scenario 2:

• 48 year-old lady complains of lethargy, low mood and loss of appetite recently.

• • 1) Where is dopamine mainly released from?• A. Substantia Nigra and ventral tegmental area• B. Tuberomamillary bodies• C. Raphe nuclei• D. Lateral tementum

• Answer: A

• 2) Where is 5HT mainly relased from?• A. Substantia Nigra and ventral tegmental area• B. Tuberomamillary bodies• C. Raphe nuclei• D. Lateral tementum

• Answer: C

• 3) Which of the phenomena below does Serotonin take part in controlling?

• A. Attention• B. Agitation• C. Alertness• D. Tachycardia

• Answer: B

• 4) Which of below are NOT a correct rhythm described in EEG?

• A. Alpha- mainly occipital, seen in quiet, eyes shut, meditation (8-13Hz)

• B. Beta- cortical, seen in deep sleep, coma• C. Gamma- binding’, responsible for learning and

memory• D. Theta- parietal and temporal, responsible for

alertness, learning and memory

• Answer: B

• 5) Which of the following is one of the sleep states?

• A. Slow-wave desynchronized sleep • B. Slow-wave rapid eye movement sleep• C. Paradoxial desynchronized sleep• D. Paradoxial synchronized sleep

• Answer: C

• 6) Which of the following is NOT an example of sleep disorders?

• A. Insomnia• B. Parasomnia• C. Sleep apnoea• D. Lethargy•

• Answer: D

• 7) What are the cardinal symptoms of depression?• A. Low mood, loss of interest and lack of energy for at

least a 2-week period• B. Feelings of worthlessness, diminished cognitive

capacity and recurrent thoughts of suicide in the last 2 months

• C. Insomnia, hypersomnia, anhedonia, suicidal thoughts and guilt in the last 2 months

• D. feelings of worthlessness with cycles of mania episodes for at least a 2-week period

• Answer: A

• 8) Which of the following is NOT a first line pharmacological treatment for depressive episodes?

• A. TCAs: Amitriptyline• B. SSRIs: Fluoxetine• C. MAOI-Bs: Selegiline• D. SNRIs: venlafaxine

• Answer: C

• 9) Which of the followings is NOT a management measure for depression?

• A. Cognitive behaviour therapy• B. Transcranial magnetic stimulation• C. Electroconvulsive therapy • D. Vagal nerve stimulation

• Answer: D

• 10) What are some side effects of SSRIs?• A. postural hypotension and CNS excitability• B. Cheese reaction• C. Nausea, insomnia and anorexia• D. Weight gain and parkinsonism symptoms

• Answer: C

• In treating a patient with chronic kidney disease, which of the following would not be appropriate?a) Furosemideb) Bendroflumenthiazidec) Ramiprild) Amiloridee) Alfacalcidiol

• Which of the following is a likely sign or result of chronic kidney disease?a) Hyporeflexiab) Hypotension (arterial)c) Hyponatraemiad) Hypocalcaemiae) Hypouraemia

• Which of the following is a likely sign or result of chronic kidney disease?a) Hyporeflexia-hypokalaemia causes hyporeflexia;

but K goes up in CKDb) Hypotension (arterial) – bp usually goes upc) Hyponatraemia- once fluid retention can dilute

blood no more, hypernatraemiad) Hypocalcaemia- due to decreased Vit De) Hypouraemia- urea goes up in CKD

• A 70 year old woman presents with a history of diabetes mellitus, peripheral oedema, fatigue, itching and restless legs, but an eGFR of 85mL/min/1.73m2. What could best explain her test result?a) Chronic Kidney disease, but eats a carnivorous dietb) Chronic Kidney disease, but with a 10 mile walk every dayc) Chronic Kidney disease, but unilateral foot amputation 20

to neuropathyd) Congestive heart failuree) Chronic liver disease

• A 70 year old woman presents with a history of diabetes mellitus, peripheral oedema, fatigue, itching and restless legs, but an eGFR of 85mL/min/1.73m2. What could best explain her test result?a) Chronic Kidney disease, but eats a carnivorous dietb) Chronic Kidney disease, but with a 10 mile walk every dayc) Chronic Kidney disease, but unilateral foot amputation 20 to

neuropathyd) Congestive heart failuree) Chronic liver disease - oedema due to PHTN and

hypoalbuminaemia- Itching due to bile salts- Restless legs are common without CKD

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.1. List THREE main causes of chronic kidney disease, and for each one, a test you would use to confirm your diagnosis.

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.

1. List THREE main causes of chronic kidney disease, and for each one, a test you would use to confirm your diagnosis.

Hypertension- serial blood pressure measurementsDiabetes mellitus- fasting blood glucose AND symptomsIgA glomerulonephritis (Berger’s)- IgA antibodiesSLE- Anti-nuclear antibodies (dsDNA)Goodpasture’s Disease- antibodies to collagen IVPolycystic kidneys- USS

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.2. She complains of dyspnoea. Explain TWO mechanisms which can cause dyspnoea in CKD.


2. She complains of dyspnoea. Explain TWO mechanisms which can cause dyspnoea in CKD.

- Decreased sodium excretion results in increased water retention, as mediated by ADH, in order to maintain normal serum Na concentration. This leads to hypervolaemia with peripheral oedema and pulmonary oedema, which can cause dyspnoea.

- Decreased conversion of glutamine to bicarbonate in the principal cells of the collecting ducts results in a metabolic acidosis. Respiratory compensation could result in tachypnoea which may feel like SOB

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.3. She asks you about the future, and what the treatment for her kidneys will be like. What pros and cons of dialysis would you explain to her?

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.3. She asks you about the future, and what the treatment for her

kidneys will be like. What pros and cons of dialysis would you explain to her?

PRO-Increased life expectancy-Decreased symptomsCON-Time consuming and logistically difficult-Infection risk, particularly with peritoneal dialysis-20% mortality

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease. 4. She says that despite the seriousness of her disease, she does not want to go onto dialysis. She accepts that this may mean that she will die. How do you ensure that her wish is honoured?


4. She says that despite the seriousness of her disease, she does not want to go onto dialysis. She accepts that this may mean that she will die. How do you ensure that her wish is honoured?-Advance directive of the refusal of life sustaining treatment, which must be-made with capacity (understand, retain, weigh, communicate)-free of coercion-written, signed and witnessed-state explicitly that they will result in death

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.5. What will you prescribe to help her fatigue?

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.5. What will you prescribe to help her fatigue?

EPO analogue eg Aranesp

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.6. She comes in 2 months later with urethritis and urine

positive for nitrates and leukocytes. What do you need to bear in mind during her management?

• A 65 year old women comes to see you in the renal clinic at UHCW. She has a 1 year history of increasing shortness of breath, oedema and bone pain when walking. The GP sent blood off for Creatinine which has come back showing an eGFR of 20mL/min/1.72m2 (severe renal failure). It is your job to manage her chronic kidney disease.6. She comes in 2 months later with urethritis and urine positive for

nitrates and leukocytes. What do you need to bear in mind during her management?

Cephalosporins are nephrotoxic, so try to avoid when choosing Abx for her UTI.

What part of the GI tract does Crohn’s Disease most commonly effect?a) Caecumb) Oesophagusc) Terminal ileum d) Rectum

What is the medical term used to describe Ulcerative colitis that effects the entire colon?a) Proctitisb) Pancolitisc) Left-sided colitisd) Colitis

What is the medical term used to describe Ulcerative colitis that effects the entire colon?a) Proctitis – UC effecting only the rectumb) Pancolitisc) Left-sided colitis – rectum, sigmoid and descending colond) Colitis – inflammation of the colon

What is the medical term for pain on swallowing?a) Dysphasiab) Odynophagiac) Dysphagiad) Dysarthria

What is the medical term for pain on swallowing?a) Dysphasia – partial or complete impairment of the ability to

communicateb) Odynophagiac) Dysphagia – Difficulty in swallowingd) Dysarthria – difficulty speaking that is caused by problems with the

muscles used in speech

Be very careful with definitions, ensure you know exactly what you are referring to when using medical terminology!

What is the histological lining of the oesophagus?a) Stratified squamous epitheliumb) Non-keratinised stratified squamous epitheliumc) Simple columnar epitheliumd) Keratinised squamous epithelium

What do parietal cells mainly secrete?a) HCLb) Pepsinogenc) Intrinsic factord) Gastrin

What do parietal cells mainly secrete?a) HCLb) Pepsinogen – Secreted by Chief cellsc) Intrinsic factor – does secrete this, but not as much as it does

HCLd) Gastrin – Secreted by G cells

Name the two most common types of carcinoma occurring in the oesophagus

Name the two most common types of carcinoma occurring in the oesophagus

Squamous cell carcinomaAdenocarcinoma

List three things that distinguish the colon from the small intestines on visual inspection

List three things that distinguish the colon from the small intestines on visual inspection

Haustrations Taenia ColiAppendices epiploicae

Where in the GI system is vitamin B12 absorbed?a) Caecumb) Duodenumc) Termial illeumd) Jejunum

What is the only indespensible function of the stomach?a) Secretion of intrinsic factorb) Secretion of HCLc) Secretion of pepsinogend) Secretion of gastrin

What are the 5 functions of the stomach?

What are the 5 functions of the stomach?1. To store food2. To minimise ingestion of bacteria (kills them with acid)3. To dissolve and partially digest the macromolecules in food4. To regulate the rate at which the contents of the stomach empty into the small intestine5. To secrete intrinsic factor (necessary for vitamin B12 absorption

It is HIGHLY unlikely to get a 5 mark question on this, however they may ask you for one or two.

What structures constitute the lower oesophageal sphincter (the gastro-oesophageal junction) (3 marks)?

What structures constitute the lower oesophageal sphincter (the gastro-oesophageal junction) (3 marks)?

There are 4/5 potential answers. 1 mark per answer below.1. Mucosal folds of the oesophagus act as a physiological valve which can be closed by circular muscle of the oesophagus

2. Acute angle of entry of oesophagus into stomach

3. Mucosal folds in the cardia of the stomach

4. Crura of the diaphragm, particularly right crus

5. Positive intra-abdominal pressure acting on on the abdominal part of the oesophagus (strictly speaking not a structure but is part of the sphincter mechanism)

Remember that the lower oesophageal sphincter is a physiological sphincter!

What is the metaplastic change seen in Barrett's Oesophagus?

What is the metaplastic change seen in Barrett's Oesophagus?

From Squamous to Glandular mucosa

What type of cancer is linked to Barrett’s Oesophagus?

What type of cancer is linked to Barrett’s Oesophagus?

Adenocarcinoma

What makes up the portal triad?

What makes up the portal triad?

A branch of the common bile ductA branch of the proper hepatic arteryA branch of the hepatic portal vein

Where is McBurney’s point?

Where is McBurney’s point?

1/3 of the way along the line connecting the ASIS to the umbilicus

Murphy’s sign is a positive sign for which of the following conditions?a) Cholecystitisb) Appendicitisc) Ascites d) Volvulus

List two skin changes you can observe in a patient with liver failure (2 marks).

List two skin changes you can observe in a patient with liver failure (2 marks).

JaundicePalmar erythemaSpider naeviScratch marks

Excluding such skin changes, give TWO relevant findings you would expect on abdominal examination of a patient with liver failure.

Excluding such skin changes, give TWO relevant findings you would expect on abdominal examination of a patient with liver failure.

Hepatomegaly Splenomegaly Caput medusa Ascites/distended abdomen Shifting dullness Small testes Evidence of weight loss

MAKE SURE YOU READ THE QUESTION. THIS ASKED FOR ABDOMINAL EXAMINATION FINDINGS! So, for example, clubbing would not be an acceptable answer.

Name the three types of jaundice, and for each name a cause.

Name the three types of jaundice, and for each name a cause.

Prehepatic jaundice - acute haemolysisHepatic jaundice - cirrhosisPost hepatic jaundice – gallstones

1. Pre hepatic - where the liver is overloaded with excess bilirubin and it cant keep up, e.g. due to excessive haemolysis (breakdown of RBC's)

2. Hepatic or hepatocellular - Where diseases (e.g. cirrhosis) can disturb the uptake of bilirubin from the blood and the livers ability to conjugate or secrete bilirubin

3. Post hepatic or obstructive - prevention of passage of bile into the duodenum, e.g. by gallstone

Which of the following is needed for vitamin B12 absorption?

a) Intrinsic factorb) Pepsinogenc) Vitamin Dd) Gastrin

Describe the absorption of Vitamin B12.

Describe the absorption of Vitamin B12.

1. B12 is bound to protein R in the stomach.

2. In the duodenum and jejunum, vitamin B12 is released and binds to intrinsic factor.

3. In the terminal ileum, the vitamin B12-Intrinsic factor complex is absorbed by receptor mediated endocytosis.

4. Vitamin B12 is then released into the portal blood.

List 4 abdominal causes of clubbing.

List 4 abdominal causes of clubbing.

The 4 C’sCrohn’sCirrhosisUlcerative colitisCoealiac’s disease

State the three phases of swallowing & indicate whether they are under voluntary control or occur reflexly. (3 marks)

State the three phases of swallowing & indicate whether they are under voluntary or involuntary. (3 marks)

State the three phases of swallowing & indicate whether they are under voluntary or involuntary. (3 marks)

Oral - voluntaryPharyngeal - involuntaryOesophageal - involuntary

What are the three classifications of the causes of obstructive (post hepatic) jaundice?

What are the three classifications of the causes of obstructive (post hepatic) jaundice?

Luminal - somethig present inside the bile duct or common hepatic ductMural - something in the wall of the bile duct, e.g. bile duct cancerExternal - e.g. a cyst or mass in the head of the pancreas causing compression

The superior mesenteric artery supplies what part of the gut?

a) Foregutb) Hindgutc) Midgutd) Midgut and hindgut

Ranitidine is what class of drug?

a) Proton pump inhibitorb) H2 receptor antagonistc) Prostaglandin analogued) SSRI

Which of the following drugs is a stimulant laxative?

a) Lactuloseb) Sennac) Methylcellulose d) Loperamide

Which of the following drugs is a stimulant laxative?

a) Lactulose – osmotic laxativeb) Sennac) Methylcellulose – Bulk forming laxitived) Loperamide – opiod used for it’s anti-diarrhoea properties

Pain which is relieved by eating is most likely caused by what?

a) Gastric ulcerb) Duodenal ulcerc) Appendicitisd) Crohn’s

Pain which is relieved by eating is most likely caused by what?

a) Gastric ulcer – made worse by eatingb) Duodenal ulcerc) Appendicitisd) Crohn’s

How much gastric juice is made by the stomach each day?

a) 1Lb) 2L c) 3Ld) 500mL

• Which of the following is not an auto-immune disease?

• a) Multiple Sclerosis• b)Guillian-Barre syndrome• c)Crohn's disease• d) Lupus• e) Sickle cell disease

• Answer: E

• Which of these disease:reaction to relationships is incorrect?

• a)Graves - TSH receptor• b) Rheumatoid Arthritis RhF• c) Primary Billiary Cirrhosis - antiHBO• d) Lupus - ANA• e) Sjogren's - ANA

• Answer: C

• Which of the following immunoglobulins is involved in hypersensitivity reactions?

• a) IgG• b) IgA• c)IgM• d)IgE• e) IgD

• Answer: D

• Which of these best describes the classical pathway of the complement system?

• a) Lectin binding to pathogen surfaces --> Complement activation…..

• b) Pathogen surfaces --> Complement activation….

• c) Antigen:Antibody complexes --> Complement activation

• Answer: C

• Which of these is an example of primary antibody deficiency?

• a) Protein loss, e.g. nephrotic syndrome• b) Haematological malignancy• c)B cell defect• d) Steroid abuse• e) antibiotic therapy

• Answer: C

• Which of these is the correct definition of a Xenograft?

• a)between different species• b) between genetically different members of

the same species• c) to the same individual• d) To a blood relation• e) To your mum

• Answer: A

• Which of these does not indicate SIRS?• a)Systolic Blood Pressure below 90• b) Temp abover 38.5C or below 35C• c) Heart Rate over 90bpm• d) Resp rate over 20bpm• e) WBC under 4 or over 12

• Answer: A

• Which of the following would you not see in benign malaria (I.e. you would only see it in falciparum malaria)?

• a) Hot and Cold sweats• b) Hepatosplenomegaly• c) Hypoglycaemia• d) Headache• e) Diarrhoea and Vomiting

• Answer: C

• Which are the "target cells" for HIV replication?

• a) CD4 Tcells• b) CD 8 Tcells• c) B cells• d) Neutrophils• e) Hepatocytes

• Answer: A

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