Peer Support End of Easter quiz

Disclaimer: these are not meant to be representative of exam questions

1

• Which cell in the stomach secretes pepsinogen? (1)

2

• The following drug is commonly used to treat reflux disease by blocking H+ Transport? (1)

A. Ranitidine B. Bismuth chelateC. Sodium alginateD. Lansoprazole E. Nizatidine

3

• CCK is a hormone that causes: (1)

A. Gall bladder contraction and Bicarbonate secretion

B. Enzyme secretion and Gall bladder contractionC. Bile Production and bicarbonate secretionD. Increased gastric emptyingE. Increased gastric acid secretion

4

• What is the function of hepatocytes in the excretion of bilirubin? (1)

5

• How to treat Hyperkalaemia?

6

• What are the six steps of bone healing (3)

7

• What is the principle driver for ADH release, and what does it conserve? (2)

8

• What criteria are used to diagnose SEPTIC patient

9

• Used in the relief of asthma, an example of a drug that blocks muscarinic receptors is (1)

1. Prednisolone2. Salbutamol3. Theophylline4. Tiotropium 5. Sodium cromoglycate

10

• Which of these is a sign of a life threatening Asthma attack? (1)

1. Heart rate > or = 110 bpm2. PEF 50% to 33% of expected3. Inability to complete sentences in

one breath4. Silent chest5. Tachypnoea

11

• Name this coronary artery and describe its supplied territory? (2)

12

• What does the second heart sound correspond to? (1)

13

• What does the T-wave on an ECG correspond to? (1)

14

• What plane does the aortic arch sit at? (1)

15

• Which three important structures are located immediately inferior to the aortic arch? (1)

16

• The external branch of the superior laryngeal nerve supplies what? (1) A loss of this would result in what change? (1)

17

• When in the cardiac cycle would you expect to hear a murmur if a patient has aortic stenosis? (1)

18

• Apart from interference with vocation or physical activity, give 4 other reasons for seeking medical help. (4)

19

Mary has smoked 25 cigarettes a day since she was 18. She is now 55 years old

What is her pack-year smoking history? (1)

20

Mrs Smith, a 55 office worker, comes to see you reporting gradually increasing difficulty in holding things in her right hand, which is greatly affecting her work. On examination, all four fingers on her right hand are clawed (extension of MCPs and flexion of interphalangeals). There is wasting of the hypothenar and the thenar eminences.

She also has a drooping right eyelid and and has noticed that the right side of her face is very dry. She has lost 7 kg over the last 3 months.

What is the likely diagnosis (1)

21

• Which disease is implicated by the loss of Striatum? (1)

• Which movement disorder is best described as: involuntary, irregular, random and dance-like? (1)

22

• Which of the following drugs is used in conjunction with Levodopa to inhibit Dopa-decarboxylase?

• Pramipexole• Entacapone• Benserazide• Selegiline• Ropinirole

23

• Give three side effects of opioid drugs? (2)

24

• Which two neurotransmitter pathways are implicated in depression? (1)

25

• What are the five main actions of TCA’s? (2)

26

• Homonymous hemianopia with centrally spared vision (shown below) would indicate a lesion where? (1)

27

• The facial canal runs between the internal auditory meatus and the stylomastoid foramen

• What are the three branches of CN VII that exit the facial canal BEFORE the stylomastoid foramen? (3)

28

• What are two post-ictal features of a SIMPLE Partial Epileptic seizure? (1)

• Which drug is normally only prescribed of absence seizures? (1)

• What is an important question to ask women who take sodium valproate? (1)

29

• Which rotator cuff muscle initially assists arm abduction? (1)

• Where is the pulsation of the brachial artery felt? (1)

30

• A raised solid skin lesion, measuring 4mm, is called what? (1)

• A scar of the chest extends superiorly beyond the initial site. What is the pathological name for this excessive formation? (1)

31

• Inability to extend wrist suggests damage to which nerve? (1)

• Where would you test sensation for above nerve in the hand? (1)

32

• Give 3 X-ray features of RA?

33

• List three national cancer screening programs in the UK? (1)

34

• What type of gene is Retinoblastoma (Rb) gene? (1)

35

• Three requirements for valid consent are: (1)

36

• What does the GMC say an Off-duty doctor must do when witnessing an emergency? (1)

37

To what do the Fraser guidelines refer to? (1)

39

• In relation to data quality, give TWO strengths and TWO weaknesses about the UK census?

40

• What is the Wilson and Junger’s criteria for screening

1

• Which cell in the stomach secretes pepsinogen? (1)

• Pepsin is secreted by chief cells in the form of the inactive precursor, pepsinogen.

2

• The following drug is commonly used to treat reflux disease by blocking H+ Transport? (1)

A. Ranitidine B. Bismuth chelateC. Sodium alginateD. Lansoprazole E. Nizatidine

• Irreversibly inhibit the H+/K+-ATPase

pump, the terminal step in the acid

secretory pathway.

3

• CCK is a hormone that causes: (1)

A. Gall bladder contraction and Bicarbonate secretion

B. Enzyme secretion and Gall bladder contractionC. Bile Production and bicarbonate secretionD. Increased gastric emptyingE. Increased gastric acid secretion

4

• What is the function of hepatocytes in the excretion of bilirubin? (1)

• Conjugation

5

• How to treat Hyperkalaemia?

• Beta2 receptor agonist• Calcium gluconate (cardiac protection)• Insulin dextrose drip

6

• What are the six steps of bone healing (3)

• Haematoma• Granulation tissue• Callus• Woven bone• Lamellar bone• Remodelling

7

• What is the principle driver for ADH release, and what does it conserve? (2)

• plasma osmolality by receptors in the HT

• Reduces WATER excretion (Note: not sodium, that is dealt with by aldosterone)

8

• What criteria are used to diagnose SEPTIC patient

1. temperature <36°C or >38°C2. heart rate >90/min3. respiratory rate >20/min or pCO2

<32mmHg4. WCC <4x109/dl or >12x109/dl or

>10% immature WBCs

9

• Used in the relief of asthma, an example of a drug that blocks muscarinic receptors is (1)

1. Prednisolone2. Salbutamol3. Theophylline4. Tiotropium 5. Sodium cromoglycate

Anti-cholinergics (ipratropium, tiotropium)

• Blockade of muscarinic (M3) receptors

• Reduces action of phospholipase C (PLC),

reducing calcium release from endoplasmic

reticulum

• Reduces smooth muscle contraction,

resulting in bronchodilation

10

• Which of these is a sign of a life threatening Asthma attack? (1)

1. Heart rate > or = 110 bpm2. PEF 50% to 33% of expected3. Inability to complete sentences in

one breath4. Silent chest5. Tachypnoea

11

• Name this coronary artery and describe its supplied territory? (2)

Left Atrium and VentricleAnterior IV septumAV bundleRight and left branches

Left coronary artery

12

• What does the second heart sound correspond to? (1)

Closure of the Aortic and Pulmonary valves

13

• What does the T-wave on an ECG correspond to? (1)

It represents ventricular repolarisation

14

• What plane does the aortic arch sit at? (1)

Sternal plane (T4 vertebral level)

15

• Which three important structures are located immediately inferior to the aortic arch? (1)

The left bronchus, the pulmonary truck and left recurrent laryngeal nerve.

16

• The external branch of the superior laryngeal nerve supplies what? (1) A loss of this would result in what change? (1)

• Cricothyroid• Less able to raise pitch of voice

17

• When in the cardiac cycle would you expect to hear a murmur if a patient has aortic stenosis? (1)

• Systolic, just after S1

18

• Apart from interference with vocation or physical activity, give 4 other reasons for seeking medical help. (4)

• interpersonal crisis • interference with social or personal relations• ‘sanctioning’ • a ‘temporalizing of symptomatology’-patient place a

time limit on their symptoms, and if they haven’t resolved then will seek for medical help

19

Mary has smoked 25 cigarettes a day since she was 18. She is now 55 years old

What is her pack-year smoking history? (1)

55-18 = 37 yearsAnswer = (25/20) x 37 = 46.25 pack years

20Mrs Smith, a 55 office worker, comes to see you reporting gradually

increasing difficulty in holding things in her right hand, which is greatly affecting her work. On examination, all four fingers on her right hand are clawed (extension of MCPs and flexion of interphalangeals). There is wasting of the hypothenar and the thenar eminences.

She also has a drooping right eyelid and and has noticed that the right side of her face is very dry. She has lost 7 kg over the last 3 months.

What is your diagnosis? (1)

Pancoast tumour in right lung with secondary Klumpke’s Palsy and Horner’s Syndrome

21

• Which disease is implicated by the loss of Striatum? (1)

• Which movement disorder is best described as: involuntary, irregular, random and dance-like? (1)

Huntington’s diseaseDegeneration of cholinergic cells in the striatum, particularly the caudate nucleus

Chorea – A primary cause of this is Huntington’s disease

22

• Which of the following drugs is used in conjunction with Levodopa to inhibit Dopa-decarboxylase?

• Pramipexole• Entacapone• Benserazide• Selegiline• Ropinirole

• Dopa-decarboxylase inhibitors: Benserazide, Carbidopa

23

• Give three side effects of opioid drugs? (2)

Any of the following:1. Respiratory depression2. Conscious depression/mood alterations3. Miosis (pinpoint pupils) – giveaway sign4. Reduced gastric motility5. Nausea and vomiting6. Smooth muscle spasm7. Anaphylaxis8. Psychiatric changes (e.g. Pentazocine, Tramadol)9. Tolerance and dependancy – addiction/withdrawal – Train spotting

24

• Which two neurotransmitter pathways are implicated in depression? (1)

• NA and 5HT

25

• What are the five main actions of TCA’s? (2)

5HT reuptake blockerNA reuptake blockerα1 adrenoreceptor antagonist

H1 receptor antagonist

M1 receptor antagonist

26

• Homonymous hemianopia with centrally spared vision (shown below) would indicate a lesion where? (1)

LEFT Anterior visual cortex – macular projections to the posterior pole are not affected so central vision is spared

27

• The facial canal runs between the internal auditory meatus and the stylomastoid foramen

• What are the three branches of CN VII that exit the facial canal BEFORE the stylomastoid foramen? (3)

Facial Canal

StapediusGreater Petrosal Nerve

Chorda tympani

Internal Acoustic Meatus

CNVIII

CNVIIMuscles of facial expression

Stylo-mastoid foramen

Parotid Gland

28

• What are two post-ictal features of a SIMPLE Partial Epileptic seizure? (1)

• Which drug is normally only prescribed of absence seizures? (1)

• What is an important question to ask women who take sodium valproate? (1)

• No Loss of consciousness or post ictal confusion• Ethosuximide• Could you be pregnant?

29

• Which rotator cuff muscle initially assists arm abduction? (1)

• Where is the pulsation of the brachial artery felt? (1)

• Supraspinatus• Medial to the biceps tendon, antecubital fossa

30

• A raised solid skin lesion, measuring 4mm, is called what? (1)

• A scar of the chest extends superiorly beyond the initial site. What is the pathological name for this excessive formation? (1)

• Papule• Keloid

31

• Inability to extend wrist suggests damage to which nerve? (1)

• Where would you test sensation for above nerve in the hand? (1)

• Radial nerve• First dorsal interosseous

32

• Give 3 X-ray features of RA?

• soft tissue swelling• juxta-articular osteopenia• joint space narrowing• periarticular erosions, • subluxation, • deformity

33

• List three national cancer screening programs in the UK? (1)

• Breast, Cervix and Bowel

34

• What type of gene is Retinoblast (Rb) gene? (1)

• Tumour suppressant gene

35

• Three requirements for valid consent are: (1)

• Capacity (competence)• Information• Voluntariness

36

• What does the GMC say an Off-duty doctor must do when witnessing an emergency? (1)

• The right to life must offer help if emergencies arise in clinical settings or in the community… (but NB caveats)

37

To what do the Fraser guidelines refer to? (1)

• Medical practitioners are offering contraceptive services to under 16's without parental knowledge or permission.

38

• Give three examples of the Bradford Hill Criteria for Inferring Causality? (2)

Strength of associationSpecificity of associationConsistency of associationTemporal sequenceDose responseReversibilityCoherence of theoryBiological plausibilityAnalogy

39

• In relation to data quality, give TWO strengths and TWO weaknesses about the UK census?

• Strengths • Completeness – 98% of population completes the census. Legal obligation to complete.• Representative - Information from census routinely available for different output areas: 200-500 people,

electoral wards 1500 to 15,000 people, to Shire Counties e.g. Warwickshire, to national.• Accuracy – checked by survey and found to be accurate (e.g. within 0.2% for total population size)

• Weaknesses• Timeliness - Carried out only every 10 years. Last census 2001, next 2011. • Variable completeness - 2% of census forms are not returned, with higher under-enumeration in young

people, babies, elderly, students, minority ethnic communities. Some of these groups may be affected more by ill health.

• Geographical areas not necessarily those in which user is interested (i.e. not for GP or PCT populations)• Health data is limited.

40

• What is the Wilson and Junger’s criteria for screening• The condition should be an important health problem• Should have treatment for it• Should have facilitates for diagnosis and treatment• Should have latent stage of the disease• Should have a test or examination for it• Test should be acceptable for population• Natural history should be adequately understood• Should be agreed policy on how to treat• Totally cost of finding a case should be cost effective