Presentation is loading. Please wait.

Presentation is loading. Please wait.

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.

Similar presentations


Presentation on theme: "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."— Presentation transcript:

1 MCQs 2014 Summer exams

2 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!

3 Which type of spina bifida has the worst outcome? (a)Spina Bifida Occulta (b)Myeloschisis (c)Meningocele (d)Myelomeningocele (e)Meningeal Cyst

4 (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)

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

6 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)

7 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

8 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)

9 Why of the following is a not a sign of Carpal Tunnel Syndrome? A.Wasting of thenal eminence muscles B.Positive Tinel’s test C.Reduced grip strength D.Numbness over thenar eminence E.Paraesthesia in median nerve distribution

10 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.

11 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

12 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).

13 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 X b)III, V, VII and X c)II, VII, IX and X d)II, V, VII and X e)II, V, IX and X

14 Answer: C

15 What does the biceps reflex test? a)C7, C8 b)C8, T1 c)C6, C7 d)C5, C6

16 Answer D

17 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 II b)CN III c)CN IV d)CN VI e)All of above

18 Answer: B

19 What respiratory drug class causes bronchodilation through blocking the action of phospholipase C? a)Beta agonists b)Anti-cholinergics c)Beta blockers d)Methylxanthines e)Monoclonal antibody

20 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.

21 1.What scoring system/criteria are used to determine the risk of DVT/PE? A.Light’s criteria B.Wells score C.Gleason score D.Vichow’s criteria E.CHADS 2 score

22 Answer: B

23 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-dimer B.CXR C.Doppler Ultrasound scan D.CT Pulmonary Angiography E.ABG

24 Answer: D

25 1.You confirm Mrs Jones has a PE, what is the most appropriate drug/drug combination to start treatment with? A.Streptokinase alone B.Low molecular weight heparin alone C.Warfarin alone D.Streptokinase + Warfarin E.Low molecular weight heparin + Warfarin

26 Answer: E

27 1.Streptokinase… A.Inhibits vitamin K epoxide reductase B.Activates antithrombin III C.Is a direct thrombin inhibitor D.Activates plasminogen  plasmin E.Inhibits the activation of fibrinogen  fibrin

28 Answer: D

29 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 sulphate B.Vitamin K C.Fresh frozen plasma D.Blood transfusion E.Prothrombin complex concentrate

30 Answer A

31 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

32 Answer: D

33 1.Erythrocytes stay in circulation for ---- days? a.120 b.180 c.60 d.220 e.30

34 Answer A

35 1.The toxic dose of paracetamol is --- a.10 milligrams b.1000 milligrams c.5 grams d.500 milligrams e.10 grams

36 Answer: E

37 1.What inactivates the toxic metabolite of paracetomol? a.Glutathione b.Tyramine c.Nitric oxide d.Glucaronic acid e.Salicylic acid

38 Answer A

39 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.

40 Answer: C

41 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

42 Answer: A

43 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

44 Answer: A

45 1.How many erythrocytes can be made from 1 committed stem cell? a.12 b.16 c.8 d.18 e.20

46 Answer: B

47 1.Iron stored in macrophages is known as - --? a.Ferritin b.Macroferritin c.Macrosidderin d.Hemosiderin e.Haemoferritin

48 Answer: D

49 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 of a regular cycle

50 Answer: A

51 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

52 Answer: B

53 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%

54 Answer: A

55 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

56 Answer: E (A also makes sense)

57 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

58 Answer: A

59 1.Lactulose is an example of what type of laxative? a.Purgatory b.Bulk c.Faecal softener d.Stimulatory e.Osmotic

60 Answer: E

61 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.

62 Answer: c

63 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

64 Answer: A

65 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

66 Answer: B

67 Which of the following muscles is innervated by the superior laryngeal nerve? a)Lateral cricoarytenoid b)Posterior cricoarytenoid c)Cricothyroid d)Thyroarytenoid Buccinator

68 Answer: C

69 Which immunoglobulin is found in breast milk? a)IgA b)IgG c)IgM d)IgG e)IgE

70 Answer: A

71 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

72 Answer: D

73 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

74 Answer: B

75 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.Tetrabenazine b.Naloxone c.Naltrexone d.Flumazenil e.Haloperidol

76 Answer: D

77 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 I b.Type II c.Type III d.Type IV e.Type V

78 Answer: D

79 3. At what age can a baby roll over from a supine to a prone position? a.9 months b.6-7 months c.5-6 months d.12 months e.15 months

80 Answer: B

81 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

82 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.

83 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

84 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.

85 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

86 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.

87 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

88 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.

89 Which mechanoreceptors may activate a vasovagal syncope? 1 Aortic arch 2 Carotid body 3 Carotid sinus 4 Renal artery 5 Ventricular

90 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.

91 Which of the following is not a type of Glial cell: a) Schwann Cell b)Enterocyte Cell c)Astrocyte d) Ependymal cell

92 Answer: B

93 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

94 Answer: C

95 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

96 Answer: B

97 Which of the following motor pathways travels ipsilaterally up the spinal column? a) Anterior Spinothalamic b) Lateral Spinothalamic c)Posterior column

98 Answer: C

99 Which of these is a primary cause of peripheral neuropathy? a) Rheumatoid Arthritis b) hypothyroidism c) syphilis d) Diabetes

100 Answer: D

101 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

102 Answer: A

103 Which of the following is an upper motor neurone sign a) flaccid paralysis b) Fasciculations c) Clonus d) Areflexia e)hyporeflexia

104 Answer: C

105 Which sympathetic roots innervate cardiovascular control? a) T1-5 b) T1-4 c)T5-12 d)C8-T4 e) T2-7

106 Answer: A

107 Which is the primary cranial nerve for balance? a) CN6 b) CN10 c) CN 9 d) CN 5 e) CN 8

108 Answer: E

109 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

110 Answer: A

111 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

112 Answer: D

113 Which of the following is a medical emergency? a) Status Epilepticus b) Tonic-clonic seizure c) Absent seizure d) Complex partial seizure

114 Answer: A

115 What type of degeneration is seen in diabetic neuropathy? a) Wallerian b) Axonal c) Myelin

116 Answer: B

117 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

118 Answer: A

119 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

120 Answer: C

121 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

122 Answer: E

123 Scenario 1: A 20 year old 2 nd 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

124 Answer: B

125 2) What is the score of the above assessment for this patient? A. 4 B. 5 C. 6 D. 7

126 Answer: B

127 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

128 Answer: C

129 4) Which of the following is NOT a description of consciousness? A. Alert B. Lethargy C. Stupor D. Death

130 Answer: D

131 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

132 Answer: C

133 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

134 Answer: B

135 7) Which of the following is not a coma-like state? A. Hypoglycemia B. Persistent vegetative state C. Locked in syndrome D. Akinetic mutism

136 Answer: A

137 8) Which of the following is not a factor consisting consciousness? A. Alertness B. Cognitive function C. Awareness D. Attention

138 Answer: B

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

140 Answer: A

141 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

142 Answer: A

143 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

144 Answer: A

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

146 Answer: C

147 3) Which of the phenomena below does Serotonin take part in controlling? A. Attention B. Agitation C. Alertness D. Tachycardia

148 Answer: B

149 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

150 Answer: B

151 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

152 Answer: C

153 6) Which of the following is NOT an example of sleep disorders? A. Insomnia B. Parasomnia C. Sleep apnoea D. Lethargy

154 Answer: D

155 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

156 Answer: A

157 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

158 Answer: C

159 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

160 Answer: D

161 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

162 Answer: C

163 In treating a patient with chronic kidney disease, which of the following would not be appropriate? a)Furosemide b)Bendroflumenthiazide c)Ramipril d)Amiloride e)Alfacalcidiol

164 In treating a patient with chronic kidney disease, which of the following would not be appropriate? a)Furosemide b)Bendroflumenthiazide c)Ramipril d)Amiloride e)Alfacalcidiol

165 Which of the following is a likely sign or result of chronic kidney disease? a)Hyporeflexia b)Hypotension (arterial) c)Hyponatraemia d)Hypocalcaemia e)Hypouraemia

166 Which of the following is a likely sign or result of chronic kidney disease? a)Hyporeflexia-hypokalaemia causes hyporeflexia; but K goes up in CKD b)Hypotension (arterial) – bp usually goes up c)Hyponatraemia- once fluid retention can dilute blood no more, hypernatraemia d)Hypocalcaemia- due to decreased Vit D e)Hypouraemia- urea goes up in CKD

167 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/1.73m 2. What could best explain her test result? a)Chronic Kidney disease, but eats a carnivorous diet b)Chronic Kidney disease, but with a 10 mile walk every day c)Chronic Kidney disease, but unilateral foot amputation 2 0 to neuropathy d)Congestive heart failure e)Chronic liver disease

168 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/1.73m 2. What could best explain her test result? a)Chronic Kidney disease, but eats a carnivorous diet b)Chronic Kidney disease, but with a 10 mile walk every day c)Chronic Kidney disease, but unilateral foot amputation 2 0 to neuropathy d)Congestive heart failure e)Chronic liver disease- oedema due to PHTN and hypoalbuminaemia -Itching due to bile salts -Restless legs are common without CKD

169 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/1.72m 2 (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.

170 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/1.72m 2 (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 measurements Diabetes mellitus- fasting blood glucose AND symptoms IgA glomerulonephritis (Berger’s)- IgA antibodies SLE- Anti-nuclear antibodies (dsDNA) Goodpasture’s Disease- antibodies to collagen IV Polycystic kidneys- USS

171 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/1.72m 2 (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.

172 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/1.72m 2 (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. -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

173 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/1.72m 2 (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?

174 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/1.72m 2 (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 symptoms CON -Time consuming and logistically difficult -Infection risk, particularly with peritoneal dialysis -20% mortality

175 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/1.72m 2 (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?

176 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/1.72m 2 (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? -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

177 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/1.72m 2 (severe renal failure). It is your job to manage her chronic kidney disease. 5. What will you prescribe to help her fatigue?

178 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/1.72m 2 (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

179 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/1.72m 2 (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?

180 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/1.72m 2 (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.

181 What part of the GI tract does Crohn’s Disease most commonly effect? a)Caecum b)Oesophagus c)Terminal ileum d)Rectum

182 What part of the GI tract does Crohn’s Disease most commonly effect? a)Caecum b)Oesophagus c)Terminal ileum d)Rectum

183 What is the medical term used to describe Ulcerative colitis that effects the entire colon? a)Proctitis b)Pancolitis c)Left-sided colitis d)Colitis

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

185 What is the medical term for pain on swallowing? a)Dysphasia b)Odynophagia c)Dysphagia d)Dysarthria

186 What is the medical term for pain on swallowing? a)Dysphasia – partial or complete impairment of the ability to communicate b)Odynophagia c)Dysphagia – Difficulty in swallowing d)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!

187 What is the histological lining of the oesophagus? a)Stratified squamous epithelium b)Non-keratinised stratified squamous epithelium c)Simple columnar epithelium d)Keratinised squamous epithelium

188 What is the histological lining of the oesophagus? a)Stratified squamous epithelium b)Non-keratinised stratified squamous epithelium c)Simple columnar epithelium d)Keratinised squamous epithelium

189 What do parietal cells mainly secrete? a)HCL b)Pepsinogen c)Intrinsic factor d)Gastrin

190 What do parietal cells mainly secrete? a)HCL b)Pepsinogen – Secreted by Chief cells c)Intrinsic factor – does secrete this, but not as much as it does HCL d)Gastrin – Secreted by G cells

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

192 Squamous cell carcinoma Adenocarcinoma

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

194 Haustrations Taenia Coli Appendices epiploicae

195 Where in the GI system is vitamin B12 absorbed? a)Caecum b)Duodenum c)Termial illeum d)Jejunum

196 Where in the GI system is vitamin B12 absorbed? a)Caecum b)Duodenum c)Termial illeum d)Jejunum

197 What is the only indespensible function of the stomach? a)Secretion of intrinsic factor b)Secretion of HCL c)Secretion of pepsinogen d)Secretion of gastrin

198 What is the only indespensible function of the stomach? a)Secretion of intrinsic factor b)Secretion of HCL c)Secretion of pepsinogen d)Secretion of gastrin

199 What are the 5 functions of the stomach?

200 1. To store food2. To minimise ingestion of bacteria (kills them with acid) 3. To dissolve and partially digest the macromolecules in food 4. To regulate the rate at which the contents of the stomach empty into the small intestine 5. 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.

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

202 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!

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

204 From Squamous to Glandular mucosa

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

206 Adenocarcinoma

207 What makes up the portal triad?

208 A branch of the common bile duct A branch of the proper hepatic artery A branch of the hepatic portal vein

209 Where is McBurney’s point?

210 1/3 of the way along the line connecting the ASIS to the umbilicus

211 Murphy’s sign is a positive sign for which of the following conditions? a)Cholecystitis b)Appendicitis c)Ascites d)Volvulus

212 Murphy’s sign is a positive sign for which of the following conditions? a)Cholecystitis b)Appendicitis c)Ascites d)Volvulus

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

214 Jaundice Palmar erythema Spider naevi Scratch marks

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

216 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.

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

218 Prehepatic jaundice - acute haemolysis Hepatic jaundice - cirrhosis Post 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

219 Which of the following is needed for vitamin B12 absorption? a)Intrinsic factor b)Pepsinogen c)Vitamin D d)Gastrin

220 Which of the following is needed for vitamin B12 absorption? a)Intrinsic factor b)Pepsinogen c)Vitamin D d)Gastrin

221 Describe the absorption of Vitamin B12.

222 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.

223 List 4 abdominal causes of clubbing.

224 The 4 C’s Crohn’s Cirrhosis Ulcerative colitis Coealiac’s disease

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

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

227 Oral - voluntary Pharyngeal - involuntary Oesophageal - involuntary

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

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

230 The superior mesenteric artery supplies what part of the gut? a)Foregut b)Hindgut c)Midgut d)Midgut and hindgut

231 The superior mesenteric artery supplies what part of the gut? a)Foregut b)Hindgut c)Midgut d)Midgut and hindgut

232 Ranitidine is what class of drug? a)Proton pump inhibitor b)H2 receptor antagonist c)Prostaglandin analogue d)SSRI

233 Ranitidine is what class of drug? a)Proton pump inhibitor b)H2 receptor antagonist c)Prostaglandin analogue d)SSRI

234 Which of the following drugs is a stimulant laxative? a)Lactulose b)Senna c)Methylcellulose d)Loperamide

235 Which of the following drugs is a stimulant laxative? a)Lactulose – osmotic laxative b)Senna c)Methylcellulose – Bulk forming laxitive d)Loperamide – opiod used for it’s anti-diarrhoea properties

236 Pain which is relieved by eating is most likely caused by what? a)Gastric ulcer b)Duodenal ulcer c)Appendicitis d)Crohn’s

237 Pain which is relieved by eating is most likely caused by what? a)Gastric ulcer – made worse by eating b)Duodenal ulcer c)Appendicitis d)Crohn’s

238 How much gastric juice is made by the stomach each day? a)1L b)2L c)3L d)500mL

239 How much gastric juice is made by the stomach each day? a)1L b)2L c)3L d)500mL

240 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

241 Answer: E

242 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

243 Answer: C

244 Which of the following immunoglobulins is involved in hypersensitivity reactions? a) IgG b) IgA c)IgM d)IgE e) IgD

245 Answer: D

246 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

247 Answer: C

248 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

249 Answer: C

250 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

251 Answer: A

252 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

253 Answer: A

254 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

255 Answer: C

256 Which are the "target cells" for HIV replication? a) CD4 Tcells b) CD 8 Tcells c) B cells d) Neutrophils e) Hepatocytes

257 Answer: A


Download ppt "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."

Similar presentations


Ads by Google