Royal Free and University College Medical School Phase 1, Year 2, February assessments 2004 Copyright © 2004, Royal Free and University College Medical School Multiple Choice Question (MCQ) paper There are 30 questions in this paper – each consists of 5 statements to be marked true or false. You should attempt all questions. You must also assess your confidence in your answer; marks will be awarded as follows: 0 = Not very confident 1= Fairly confident 2 = Very confident If you are correct + 1 + 2 + 3 If you are incorrect 0 - 2 - 6 Questions for which you do not enter a confidence assessment may not be counted at all. If you are unsure of your answer enter confidence level 0. You are advised to mark your answers on this question paper, , then transfer your answers to the computer-readable card, using a pencil. Make reasonably firm marks on the card – thin hesitant marks cannot always be read by the computer scanner – but do not press so hard that you indent through the card If you make a mistake, erase your incorrect response as thoroughly as possible, and enter your revised answer clearly. Do not “score through” an incorrect response – the computer will read this as your response.

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1) In order to determine whether there is evidence for the effectiveness of home blood glucose monitoring at improving blood glucose control in patients with type II (non-insulin-dependent) diabetes mellitus, a systematic review was carried out. Mark the following statements true or false - in the systematic review:

A) Randomised controlled trials should be included B) Unpublished studies should be excluded C) Studies of home blood glucose monitoring in type I (insulin dependent) diabetes should be

included D) Uncontrolled studies should be excluded E) Studies with unusual results should be excluded

2) Asidah Musally, who is 15, has a steady boy friend and wants to stop using condoms. She wants her GP to prescribe oral contraceptives, but says it would be catastrophic if her parents knew. Mark the following statements true or false - if her GP is to act according to legal and GMC principles, he must bear in mind that:

A) A child under 16 cannot give valid consent to medical examination or treatment B) If a competent child refuses to allow parental involvement in any medical procedure, the

doctor must apply for a court order C) The criteria for assessing competence to consent are the same whatever the age of the

patient D) A doctor must always act in the child’s best interests E) A child under sixteen must be regarded as incompetent to consent to medical treatment until

shown to be competent.

3) Mark the following statements true or false. In a patient with diabetes the following symptoms suggest a peripheral neuropathy

A) Foot pain B) Extensor plantar responses C) Penetrating foot ulcers D) Palpable peripheral pulses E) Absent ankle jerks

4) Suppose a neurologist sees a young man who has suffered a severe head injury but is unsure of whether to administer corticosteroids. Mark the following sources of information true if they would be particularly worth referring to, to inform the neurologist’s decision, or false if not (more than one may be “True”):

A) The Cochrane library database B) Advice from a pharmaceutical company representative C) Published randomised controlled trials of corticosteroids for head injury D) Results obtained in a series of ten head injury patients treated by a neurologist specialist at a

London teaching hospital E) Reports of comparisons between use of corticosteroids at the Hospital A with non-use of

corticosteroids at Hospital B 5) Mark the following statements true or false. When treating a non-competent patient, a doctor who is following the law and professional guidelines must:

A) Get the next of kin to sign a consent form as proxy for the patient B) Make saving the life of the patient the highest priority C) Act in what he decides is the patient’s best interests D) Consult close relatives to find out the patients’ own views E) Do nothing that might result in litigation by the relatives

6) Mark the following statements concerning the neurological examination of the motor system in the lower limb true if they are correct, or false if not.

A) A lower motor neuron lesion is associated with an extensor plantar response B) An absent ankle jerk reflects a lesion of the S1 nerve route in the spinal cord. C) Innervation of the hip flexors comes from L4 / 5 D) Clonus is a sign of increased tone E) A spastic lower limb is held characteristically in a flexed position

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7) Mark the following statements true or false. Characteristic histological features of the endocrine glands include:

A) Secretory granules in the nucleus B) Mesenchymal origin C) Increased lymphatic channels D) Static cell population E) High nucleo/cytoplasmic ratio

8) Mark the following statements concerning anterior pituitary tumours true or false:

A) They frequently metastasise B) They sometimes present with hypopituitarism C) They are rarely non-secretory D) They release oxytocin E) They sometimes present with Cushing’s disease

9) Mark the following statements concerning histological compartments of the adrenal true or false:

A) The medulla forms the central part of adrenal gland. B) The chromaffin cells secrete aldosterone. C) Catecholamines are primarily secreted in the zona glomerulosa. D) Adenomas of the medulla are a cause of Cushing’s disease E) Atrophy of the medulla is a characteristic feature seen in ACTH secreting pituitary adenomas.

10) Mark the following statements true or false. The functioning of the thyroid can be reduced by:

A) Thioureylene derivatives e.g. carbimazole B) Radio-iodine C) Potassium iodide D) Iodide E) Thyrotrophin-releasing hormone (TRH)

11) Mark the following statements concerning diabetes mellitus true or false.

A) Insulin is given orally B) Insulin is administered for mature onset (adult-type) diabetes C) Insulin duration of action can be increased by combining it with zinc D) Glibenclamide acts on ATP-dependent K+ channels E) The suphonylurea drugs are used therapeutically in mature-onset diabetes

12) Mark the following statements concerning general anaesthesia true or false.

A) Halothane gives good analgesia B) Nitrous oxide sensitizes the heart to catecholamines C) Halothane and nitrous oxide may be used together D) Thiopentone (thiopental) is given by inhalation E) Thiopentone (thiopental) is lipophilic

13) Mark the following statements true or false. The following have an anti-emetic action

A) Histamine H2-receptor antagonists B) 5-Hydroxytryptamine 5-HT3 receptor antagonists C) Dopamine D2 receptor antagonists D) Metoclopramide E) Muscarinic agonists

14) Mark the following statements concerning the peripheral mechanisms of pain true or false:

A) They involve activation of polymodal C-fibres and also A-delta fibres B) They can be mediated by chemicals from the vasculature such as bradykinin and 5HT. C) They include production of prostaglandins through activation of the enzyme COX-2 but not

COX-1 D) They can be blocked by local anaesthetics which inactivate potassium channels E) They involve sodium channel activity especially after nerve injury

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15) Mark the following statements true or false. Antidepressants can have one or more of the following actions:

A) Prevent metabolism of noradrenaline and/or 5-hydroxytryptamine B) Block the actions of GABA C) Inhibit the neuronal uptake of 5-hydroxytruptamine D) Block β-adrenoceptors E) Potentiate the actions of acetylcholine at muscarinic receptors

16) Mark the following statements concerning anti-psychotic drugs (used to treat schizophrenia) true or false:

A) They may induce grand mal epilepsy B) They may also be used as hypnotics C) They may be antagonists at dopamine receptors D) They include imipramine E) They may evoke “Parkinson-like” symptoms

17) Mark the following true if the drugs can interfere with transmission at the neuromuscular junction or false if not:

A) Hexamethonium B) Aminoglycoside antibiotics (e.g. streptomycin) C) Botulinum Toxin D) Atropine sulphate E) Pancuronium

18) Mark the following statements concerning suxamethonium true or false:

A) It is a nicotinic receptor antagonist at ganglia B) It blocks the effect of parasympathetic nerve stimulation C) It blocks the effect of acetylcholine on smooth muscle D) It blocks the effect of acetylcholine on arterioles E) It increases the release of acetylcholine from motor nerves

19) Mark the following statements concerning the anti-inflammatory action of the glucocorticoid steroids true or false:

A) They are believed to involve receptor antagonism of inflammatory mediators B) They are believed to involve induction of the formation of lipocortin C) They are believed to involve direct inhibition of lipoxygenase activity D) They are believed to involve reduced expression of some cytokines E) They are believed to involve increased synthesis of prostaglandin F2α

20) Mark the following statements concerning hyperthyroid patients true or false:

A) They tend to be overweight and lethargic B) They tend to be thin and hyperactive C) They tend to complain of the cold D) They tend to be heat intolerant E) They have difficulty sleeping

21) Mark the following statements true or false. A patient with hypothyroidism may be expected to:

A) Be on hormone replacement therapy for life B) Be encouraged to join the British Thyroid Foundation C) Be encouraged to join the Thyroid Eye Disease Association D) Enter into remission E) Be fully restored to euthyroid status

22) Mark the following statements true or false. A patient with achondroplasia:

A) Suffers from disproportionate growth failure B) Will have a normal level of circulating growth hormone C) Will have a low level of circulating growth hormone D) Will have a high level of circulating growth hormone E) Will respond to exogenous growth hormone

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23) Mark the following statements concerning growth velocity true or false. A) It is very low in the first year of life B) It plateaus throughout pre-pubertal childhood C) It increases in puberty, first on boys and later in girls D) It declines to zero at the end of puberty E) It can be reduced following cranial irradiation

24) Mark the following statements concerning receptors for growth hormone true or false:

A) They are cell surface receptors coupled to a G-protein B) They are cell surface receptors coupled to tyrosine kinase C) They exist as preformed dimers D) They dimerise after occupation E) They can be shed into the circulation

25) Mark the following statements concerning acromegaly true or false:

A) It is a common endocrine disorder B) It is associated with high levels of IGF-1 C) It is associated with an increased risk of developing diabetes insipidus D) It can be treated surgically E) It can be treated by curing the diabetes insipidus

26) Mark the following statements concerning osteoporosis true or false

A) It is not normally reversible. B) It is characterised by faster loss of bone at cortical than at trabecular sites. C) It results from vitamin D deficiency. D) It is commonly associated with gonadal steroid deficiency. E) It is caused by death of osteocytes.

27) Mark the following statements concerning the actions of catecholamines true or false

A) Catecholamines act via a mixture of both alpha- and beta-adrenergic receptors. B) Alpha-adrenergic receptors are usually coupled to the cAMP signalling pathway. C) Beta-adrenergic receptors have a characteristically short extracellular N-terminus. D) Beta-adrenergic receptors have a long complex extracellular N-terminus. E) Noradrenaline and adrenaline exert exactly the same physiological actions.

28) APUD cells can be derived either from the neural crest or from non-neural tissue. Mark the following statements true or false. The neural crest-derived cells (associated with MEN2) are located in the following glands:

A) Adrenal medulla B) Anterior pituitary C) Endocrine pancreas D) Parathyroid glands E) Thyroid gland

29) Oxytocin stimulates the contraction of smooth muscles. Mark the following true or false; this action of oxytocin is mediated by:

A) Cyclic AMP B) Cyclic GMP C) Calcium D) Diacylglycerol E) Inositol trisphosphate

30) Mark the following statements concerning Cushing's syndrome (excessive secretion of hormones from the adrenal cortex) true or false

A) The adrenal cortical hormones are small peptides. B) With excessive secretion of hormones due to a hormone-producing tumour of the adrenal

cortex, levels of circulating ACTH will be high. C) The hormones will cause a rise in blood glucose. D) The hormones will cause retention of sodium. E) The hormones will cause retention of potassium. End of paper

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