MOCK2.txt

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MOCK2.txt
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2013-11-29 22:08:00
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MCEMA
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  1. Adrenocorticotrophic hormone (ACTH):
    -Is a peptide hormone.
  2. The CVP is increased in:
    • • Hypervolaemia
    • • Tension pneumothorax
    • • Heart failure
    • • Pleural effusion
    • • Pulmonary embolus
    • • Cardiac tamponade
    • • Mechanical ventilation (PEEP)
    • • Forced exhalation
  3. The CVP falls with
    -deep inhalation.
  4. Any blood borne pathogen can be potentially transmitted via a needlestick injury including
    • Ø HIV
    • Ø hepatitis B, C and D
    • Ø herpes simplex
    • Ø herpes zoster
    • Ø diphtheria.
    • Regarding needlestick injuriesàrisk of transmission is higher with a
    • Ø hollow needle than with a solid needle.
  5. Regarding needlestick injuries-> risk of contracting HIV from an HIV positive source patient is
    Ø between 0.2-0.5%.
  6. Thoracic outlet syndrome involves compression of the
    Ø subclavian artery and brachial plexus à they pass between the anterior scalene and middle scalene muscles at the superior thoracic aperture.
  7. Causes of thoracic outlet syndrome include:
    • • Scalenus anticus syndrome
    • • Cervical rib syndrome
    • • Costoclavicular syndrome
    • • Pancoast tumour
    • • Trauma
  8. Thoracic outlet syndrome àAdson's sign is the
    Ø loss of the radial pulse in the arm caused by rotating the head to the ‘affected' side with an extended neck following deep inspiration.
  9. Benzodiazepines
    • Ø enhance the effects of GABA resulting in sedative, hypnotic, anxiolytic, anticonvulsant and muscle relaxant properties.
    • Midazolam is a short-acting benzodiazepine à half-life
    • Ø 2-6 hours
  10. BZD + first-line drug of choice in the emergency tranquilization of violent or disturbed patients.
    • Ø Oral lorazepam 1-2 mg or IM lorazepam 2-4 mg
    • The dose of lorazepam in adult status epilepticus is
    • Ø 4mg IV
    • Regarding the neck of the femurà Anteriorly the capsule attaches at
    • Ø intertrochanteric line
  11. Regarding the neck of the femuràposteriorly the lateral half of the femoral neck is
    Ø extracapsular.
  12. Regarding the neck of the femurà intertrochanteric line lies
    • Ø anteriorly
    • Ø
    • Regarding the neck of the femurà intertrochanteric crest lies
    • Ø posteriorly.
  13. Intertrochanteric fractures do not disrupt the blood supply entering through the retinacula on the neck and can therefore usually be managed with the
    Ø placement of a dynamic hip screw.
  14. Atropine is a
    Ø muscarinic receptor antogonist -> reduces parasympathetic activity.
  15. Atropine is
    Ø cycloplegic (paralyses the ciliary muscle of the eye) -> paralyses the accommodation reflex. It is also a mydriatic, causing pupillary dilatation.
  16. Atropine causes relaxation of the
    Ø smooth muscle in the gut, urinary tract and biliary tree.
  17. The side effects of atropine include:
    • Ø Nausea, dizziness, blurred vision, photophobia, dry mouth, urinary retention, confusion and hallucinations.
    • Ø Confusion and CNS side effects are particularly prominent in the elderly.
  18. In a cross-over study each patient receives treatment and placebo in a
    • Ø random order.
    • Ø suitable for chronic disorders that are not cured but for which treatment may give temporary relief.
  19. Case-control studies are a type of
    Ø observational study.
  20. Cross-sectional studies are a type of
    Ø observational study
  21. The proximal convoluted tubule reabsorbs approximately:
    • • 100% of filtered glucose
    • • 100% of filtered amino acids
    • • 80% of filtered phosphate
    • • 65% of filtered potassium
    • • 65% of filtered sodium
    • • 50% of filtered urea
  22. Pulmonary surfactant is a
    • Ø mucopolysaccharide.
    • Ø Decreases surface tension.
    • Ø Keeps alveoli dry
    • Ø Increases compliance
  23. Gastrocnemius is innervated by the
    • Ø Tibial nerve
    • Ø nerve roots S1 and S2.
    • Ø Sural arteries
  24. Anatomy of the calf + frequently a sesamoid bone called the
    • Ø fabella lying -> lateral head of the gastrocnemius muscle.
    • Ø present in 10-30% of the population and can be mistaken for a loose body or an osteophyte.
  25. Plantaris assists gastrocnemius in
    Ø plantar-flexion of the ankle and flexion of the knee.
  26. The sural arteries are two large branches arising from the popliteal artery that supply
    • Ø gastrocnemius
    • Ø soleus
    • Ø plantaris.
  27. Systolic blood pressure =
    Ø 90-140 mmHg
  28. Diastolic blood pressure =
    Ø 60-90 mmHg.
  29. The mean arterial pressure (MAP) =
    Ø (diastolic blood pressure + 1/3 of the pulse pressure) and = 70-105 mmHg.
  30. Stroke volume =
    Ø 60-100 ml/beat
  31. Partial pressure of oxygen =
    Ø 80-100 mmHg
  32. The complete hepatitis B virion is referred to as the
    Ø Dane particle.
  33. HBeAg indicates
    • Ø acute infection and high infectivity
    • Ø
    • Regarding hepatitis B % become chronic carriers
    • Ø 5-10% become chronic carriers.
  34. AntiHBc IgM signifies
    • Ø recent acute infection
    • Ø only present for less than 6 months.
  35. Neutrophils defend against
    Ø bacterial and fungal infections.
  36. Basophils release histamine as part of an
    Ø allergic response.
  37. Eosinophils primarily deal with
    Ø parasitic infections.
  38. Monocytes share the phagocytic function of neutrophils but live
    Ø much longer.
  39. Posterior myocardial infarction-> vessel involved is the
    • Ø right circumflex artery.
    • Ø Usually occurs as part of an inferior or lateral myocardial infarction.
    • Ø Tall R wave in lead V1 + ST depression in leads V1-V3.
  40. Regarding antipsychotic drugs + Extrapyramidal side effects occur most commonly with
    • Ø piperazine phenothiazines
    • o (fluphenazine, prochlorperazine and trifluoperazine)
    • Ø butyrophenones
    • o (benperidol and haloperidol).
  41. Regarding antipsychotic drugs + renal impairment
    Ø Reduce dosis->increased cerebral sensitivity
  42. Haloperidol is the first-line drug for dementia-related psychosis
    Ø NO-> increased risk of mortality in elderly pt-> increased risk of cardiovascular events and infections such as pneumonia.
  43. Rescue breathing (expired air ventilation) can only deliver an expired oxygen concentration of
    Ø approximately 16-17%.
  44. 10 L/min of oxygen via a mask with a reservoir bag can deliver an inspired oxygen concentration of
    Ø 85%.
  45. High inflation pressures tend to cause gastric inflation thereby
    Ø reducing lung compliance.
  46. Regarding magnesium + normal range is
    • Ø 0.75-1.2 mmol/l.
    • Ø
    • Regarding magnesium + body contains between
    • Ø 21-28 g of magnesium.
    • Ø
    • Regarding magnesium + primarily absorbed in the
    • Ø duodenum.
  47. Magnesium is an effective treatment both in
    Ø eclampsia and acute asthma.
  48. Regarding the femoral nerve lies
    Ø lateral to the femoral artery and vein.
  49. Regarding the femoral nerve + nerve roots
    Ø L2-L4.
  50. The femoral nerve is formed in the abdomen
    • Ø within the psoas major muscle and descends through the fibres of it and emerges at the lower part of its lateral border.
    • Ø It overlies the iliacus muscle.
  51. Regarding the femoral nerve + anterior division gives off the
    • Ø anterior cutaneous branches
    • Ø branches to pectineus and sartorius.
  52. Regarding the femoral nerve + posterior division gives off
    • Ø rectus femoris
    • Ø vastus lateralis
    • Ø vastus medialis
    • Ø vastus intermedius.
  53. Vicryl is
    • Ø absorbable
    • Ø synthetic suture made primarily of polyglactin.
    • Ø its tensile strength for 3-4 weeks.
    • Ø braided suture
  54. Regarding the small intestine:
    • · It averages 6-7 metres in length.
    • · pain ->referred to the T9-T10 dermatomes.
  55. The wall of the jejunum is
    · thicker due to its thick circular folds (the plicae circularis).
  56. Peyer’s patches are organized lymphoid nodules that are present in the
    · ileum.
  57. Regarding meningococcal septicaemia in children The commonest causative agent UK
    • · Neisseria meningitidis.
    • · The choice of fluid in septic children is debated but 4.5% human albumin should be given after an initial 2 boluses of crystalloid have been administered.
    • · dose of IV Ceftriaxone is 80 mg/kg.
  58. The most common inherited coagulation disorder
    · Von Willebrand disease
  59. Haemophilia A is due to a
    · factor VIII deficiency.
  60. Haemophilia B is due to
    · factor IX deficiency.
  61. Acquired vWD occurs in patients with
    · aortic stenosis -> gastrointestinal bleeding (Heyde's syndrome).
  62. Regarding membrane receptors for hormones: They are often
    · glycoproteins
  63. Catecholamines, glucagon and luteinizing hormone are examples of hormones that uses
    · cAMP as a second messenger.
  64. Atrial natriuretic peptide (ANP) and nitric oxide use
    · cGMP as a second messenger.
  65. Chronic myeloid leukaemia (CML): Philadelphia chromosome
    • · 90% of cases
    • · Almost all patients with CML eventually progress to blast crisis.
    • · low neutrophil alkaline phosphatase score
    • · serum B12 is typically high due to the production of a B12 binding protein by white cells.
  66. Philadelphia chromosome is a balanced translocation between
    · chromosomes 9 and 22.
  67. The injection of 100,000 units/ml of tuberculin purified protein derivative into the skin using a Sterneedle gun is the
    · Heaf test.
  68. The Mantoux test involves the injection of
    · 5 Tuberculin units (0.1mL) intradermally.
  69. The boundaries of the posterior triangle of the neck are:
    • • Superiorly (apex): the union of sternocleidomastoid and trapezius at the occiput
    • • Inferiorly (base): middle third of clavicle
    • • Anteriorly: posterior border of sternocleidomastoid
    • • Posteriorly: anterior border of trapezius
  70. The contents of the posterior triangle of the neck include:
    • • Muscles: Inferior belly of omohyoid, the scalenes, splenius and levator scapulae
    • • Veins: terminal part of external jugular vein
    • • Arteries: third part of subclavian, transverse cervical and suprascapular arteries
    • • Nerves: spinal root of accessory nerve (CN XI), branches of cervical plexus, root and trunks of brachial plexus, phrenic nerve
    • • Other structures: lymph nodes
  71. The ansa cervicalis is a loop of nerves that form part of the cervical plexus. It lies within the
    · anterior triangle of the neck.
  72. Mycobacterium tuberculosis:
    • · caseating granulomas -> Langhan's giant cells.
    • · lacks an outer cell membrane.
    • · NAAT is a rapid method for the detection
    • · Culture on Lowenstein-Jenson medium takes 4-6 weeks
  73. Regarding acute phase proteins: facilitate the
    · phagocytic uptake of bacteria
  74. Ferritin acts by
    · binding iron and preventing microbial iron uptake.
  75. CRP binds phosphocholine expressed on the
    · surface of dying cells and certain bacteria in order to activate the complement system.
  76. CRP is synthesized in the
    · liver.
  77. An FEV1/FVC ratio normal values
    · approximately 80%.
  78. In restrictive lung disease the FEV1and FVC ratio are
    · equally reduced, therefore the FEV1/FVC ratio is usually normal.
  79. suggestive of respiratory muscle weakness
    • · A reduction in vital capacity, FEV1, FVC and FEV1/FVC ratio
    • · Arterial blood gases are usually only abnormal in late and severe impairment of respiratory muscles and are less helpful in the evaluation of respiratory muscle weakness.
  80. Pulse oximetry gives
    • · NO information about ventilation
    • · only provides information about oxygenation.
  81. Levator palpabrae superioris is innverated by the
    · oculomotor nerve.
  82. The inferior oblique muscle
    · rotates the eye away from the nose (extorsion), moves the eye upwards (elevation) and outwards (abduction).
  83. The relations of the descending colon are:
    • • Anteriorly: small intestine
    • • Posteriorly: left kidney, iliacus, quadratus lumborum
  84. Type 1 renal tubular acidosis
    • · hypokalaemia
    • · low bicarbonate level
    • · high urinary pH
    • · normal anion gap
  85. The normal range for chloride is
    · 95-105 mmol/l
  86. Type 1 renal tubular acidosis is associated with
    · nephrocalcinosis ->of calcium stones to develop at alkaline urinary pHs. -> renal colic.
  87. The anion gap is calculated using the following formula:
    · Anion gap = (Na + K) – (Cl + HCO3)
  88. The normal anion gap is
    · 8-16 mmol/l
  89. Heinz bodies are inclusions within red blood cells composed of denatured haemoglobin. They can be caused by oxidant damage or inherited mutation. Causes include:
    • • G-6-PD deficiency
    • • NADPH deficiency
    • • Chronic liver disease
    • • Alpha-thalassaemia
  90. Howell-Jolly bodies are basophilic nuclear remnants that are seen in
    • · asplenia.
    • · haemolytic anaemias
    • · megaloblastic anaemias
    • · hereditary spherocytosis
    • · myelodysplastic syndromes.
  91. Tear drop cells, or dacrocytes, are associated with
    · myelofibrosis.
  92. Basophilic stippling is seen in
    • · lead poisoning
    • · sideroblastic anaemia.
  93. Ecstasy is a
    phenylethylamine compound with similarities to amphetamines and mescaline.
  94. Ecstasy + Recognised side effects include:
    • · fulminant hyperthermia
    • · convulsions
    • · rhabdomylosis
    • · inappropriate ADH secretion
    • · DIC
    • · liver failure
    • · cerebrovascular accidents.
  95. Medical emergency team (MET) calling criteria
    • · A respiratory rate of < 5 per minute or > 36 per minute
    • · A heart rate of < 40 per minute or > 140 per minute
    • · A systolic blood pressure < 90 mmHg
    • · A decrease in GCS of > 2 points
  96. TB Pulmonary infection accounts for
    -> 70% of cases of post-primary tuberculosis.
  97. Grave’s disease is caused
    • - thyroid autoantibodies that activate the TSH receptor stimulating thyroid hormone synthesis.
    • -Approximately 30-50% ->Grave’s ophthalmopathy.
  98. Catecholamines
    • - catechol (a 1,2-dihydroxybenzene group) and an amine side-chain.
    • - have a half-life of a few minutes.
  99. Dopamine
    ->cannot cross the blood-brain-barrier.
  100. Regarding Sickle-cell disease
    • - Autosomal RECESSIVE
    • - One third of all indigenous inhabitants of Sub-Saharan Africa carry the gene.
    • -Symptoms usually don't occur until after 4 months of age.
    • -painful crises typically affect -> long bones, back and chest.
  101. Normal cerebral blood flow is
    • - 50 ml of blood per 100 g brain tissue per minute.
    • - 750 ml per minute,
    • - 15% of the cardiac output.
    • - 20% of total body oxygen consumption. (approximately 3.3 mls of oxygen per 100 g of brain tissue per minute)
  102. Cerebral perfusion pressure
    • -(CPP) = mean arterial pressure (MAP) – intracranial pressure (ICP).
    • -Mean arterial pressure is usually around 90 mmHg and intracranial pressure is normal when less than 13 mmHg, therefore a normal CPP is -> 80 mmHg.
  103. response to hypercarbia
    -> Cerebral blood vasodilation
  104. Helicobacter pylori is
    • -Gram-negative, helix shaped (curved rod), microaerophilic bacterium.
    • -outer membrane -> phospholipids and lipopolysaccharide
    • -typically has 4-6 lophotrichous flagella->highly motile.
  105. Cytochrome p450 enzyme inducers inhibit the effects of warfarin resulting in a reduced INR. The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers:
    • • P - Phenytoin
    • • C - Carbemazepine
    • • B - Barbiturates
    • • R - Rifampicin
    • • A - Alcohol (chronic ingestion)
    • • S - Sulphonylureas
    • • S - Smoking
  106. Sodium valproate and Isoniazid are a
    ->cytochrome p450 enzyme inhibitor ->potentiates the effects of warfarin (increases the INR).
  107. Haemophilia A affects
    • - 1 in 5000 males.
    • - X-linked RECESSIVE disorder.
  108. Haemophilia B affects
    - 1 in 50,000 males.
  109. Factor IX has a
    · longer half life than factor VIII.
  110. Haemophilia C
    • - mild form of haemophilia that occurs in both sexes.
    • - It predominantly affects in Ashkenazi Jews.
  111. Regarding Starling's law of the heart:
    • -energy released during contraction depends on the initial fibre length.
    • - the stroke volumes of the left and right ventricles are matched.
    • -Peripheral vasoconstrcition -> increased systemic vascular resistance-> increases afterload ->decreases the velocity of fibre shortening->shifts the curve down and to the right.
  112. Dandy-Walker syndrome (cerebellum and the ventricular system)
    • • Enlargement of the 4th ventricle
    • • Complete or partial absence of the cerebellar vermis
    • • Cyst formation near the base of the skull
    • • Raised intracranial pressure may be present
  113. leucoerythroblastic blood picture -> 2 main causes:
    • 1. Bone marrow infiltration e.g. metastatic cancer, leukaemia, myeloma, lymphoma, myelofibroma, osteopetrosis and storage diseases such as Gaucher's disease.
    • 2. Acute severe illness e.g. severe haemolysis, massive trauma and sepsis.
  114. oxygen saturation of 50% the PaO2 is approximately
    -> 3.5 kPa.
  115. Right shift indicates
    ->decreased oxygen affinity of Hb allowing more Oxygen to be available to the tissues.
  116. The medical and lateral collateral ligaments are
    -> extracapsular.
  117. The anterior and posterior cruciate ligaments are
    -> intracapsular.
  118. The physiological effects of high altitude
    • -Blood pressure is usually unchanged in normal individuals but can rise slightly in hypertensive
    • -Cardiac output rises initially and returns to normal after acclimatization.
    • -increased erythropoietin production.
    • -initial fall in plasma volume at altitude that is gradually corrected with acclimatization.
  119. Most aortic aneurysms are
    -> fusiform.
  120. Regarding electrical shock injuries:
    • -Cardiac arrhythmias are more common when electrical energy passes transthoracically.
    • -Massive tissue necrosis -> rhabdomyolysis and myoglobinuria.
    • -Lichtenberg figures are feathery
    • -branching skin lesions seen most commonly after lightning strikes.
    • -Approximately 2/3 of patients struck by lightning have perforated eardrums.
  121. Lung abscess is a rare complication of lobar pneumonia occurring in approximately
    -> 2% of patients.
  122. thrombocytopenia of ITP is caused by
    -> IgG anti-platelet antibodies
  123. Regarding digoxin toxicity: Xanthopsia is a
    -> rare feature of digoxin toxicity.
  124. Risk factors for digoxin toxicity include:
    • • Age over 55
    • • Male gender
    • • Underlying heart disease
    • • Pre-existing renal failure
  125. Therapeutic range of digoxin is
    • · 1-2 µg/l.
    • · Severe toxic -> levels greater than 4.0 µg/l.
    • · Repeated doses of activated charcoal can be used and are thought to be of value in increasing elimination.
  126. Cushing's syndrome can be confirmed by
    - either a dexamethasone suppression test or 24-hour urinary free cortisol collection
  127. Regarding afterload: It is closely related to
    • -> both aortic pressure and ventricular wall stress.
    • - increase in afterload shifts the Frank-Starling curve down and to the right as it decreases the velocity of fibre shortening
  128. BTS guidelines for the management of acute severe asthma are:
    • • High flow oxygen
    • • Short acting beta2 agonist via large-volume spacer or nebuliser
    • • PO Prednisolone or IV hydrocortisone
  129. Monitor response for 15-30 minutes and if response poor:
    • Inhaled ipratropium bromide via nebuliser
  130. Refer those who fail to respond and require ventilatory support to intensive care / HDU and consider:
    • • IV beta2 agonist or;
    • • IV aminophylline or;
    • • IV magnesium sulphate->If required the dose of IV magnesium sulphate is 1.2-2 g IV given over 20-30 minutes.
  131. Clostridium difficile
    • ->Alcohol hand gel is ineffective against Clostridium difficile spores
    • -Clostridium difficile 027 is a hyper-virulent strain that is increasing in incidence mainly in North America and is also becoming more prevelant in the UK.
    • -The main infecting strain in the UK remains Clostridium difficile 001.
  132. Mycoplasma pneumoniae infection is not associated with infective endocarditis. It is associated with the following extra-pulmonary sequelae:
    • 1. Skin: Erythema multiforme, Stevens-Johnson syndrome
    • 2. CNS: Guillain-Barre syndrome, menegitis, encephalitis, optic neuritis, cerebellar ataxia and cranial nerve palsies
    • 3. GIT: Anorexia, nausea, diarrhoea, hepatitis and pancreatitis
    • 4. Haem: Cold agglutinins, haemolytic anaemia, thrombocytopenia and DIC
    • 5. CVS: Pericarditis and myocarditis
    • 6. Rheum: Arthralgia and arthritides
    • 7. Renal: Acute glomerulonephritis
  133. The arterial supply to the thymus is derived from
    • ->the internal thoracic artery
    • ->the superior and inferior thyroid arteries.
  134. Regarding ABO blood grouping:
    • -The majority of Caucasian men -> rhesus positive.
    • -Anti-A and anti-B antibodies -> usually IgM type.
  135. universal recipient.
    ->AB rhesus positive
  136. Anti-Kell antibodies play an important role in
    ->the development is autoimmune haemolytic anaemias and haemolytic disease of the newborn.
  137. gram negative cocci:
    • -Neisseria menigitidis.
    • -Moraxella catarrhalis.
  138. The pharynx becomes the oesophagus at
    -> C6.
  139. The oblique fissure of the lung lies at
    -> T3.
  140. The origin of the celiac axis lies at
    -> T12.
  141. The renal arteries arise at
    -> L1/L2.
  142. The trachea bifurcates at
    ->T4/T5. The statement is true.
  143. The larynx becomes the trachea at
    • -> C6.
    • The union of the common iliac veins occurs at
    • -> L5 (This is the formation of the inferior vena cava).
  144. The origin of the inferior mesenteric artery occurs at
    -> L3
  145. Openings in the diaphragm:
    • ->for the inferior vena cava lies at T8.
    • ->for the aorta lies at T12.
    • ->for the oespohagus lies at T10.
    • -> the thoracic duct at T12.
  146. following structures lie at the vertebral level of T4/T5:
    • - Sternal angle
    • -The start of the arch of the aorta lies at T4/T5.
    • -Bifurcation of the trachea
  147. The top of the arch of the aorta lies at
    -> T3/T4.
  148. The superior angle of the scapula lies at
    -> T2.
  149. following structures lie at the vertebral level of L1:
    • -Transpyloric plane of Addison
    • -Origen superior mesenteric artery
    • -fundus gallbladder
    • -hiia kedney
  150. C5 –
    The area over the deltoid
  151. C6 –
    The thumb
  152. C7 –
    The middle finger
  153. C8 –
    The little finger
  154. T4 –
    The nipple line
  155. T8 –
    The xiphisternum
  156. T10 –
    The umbilicus
  157. T12 –
    The symphysis pubis
  158. L4 –
    The medial aspect of the calf
  159. L5 –
    The webspace between the 1st and 2nd toe
  160. S1 –
    The lateral border of the foot
  161. S3 –
    The ischial tuberosity area
  162. S4 and S5 – The perianal region
  163. normal range for serum albumin is
    -> 35-50 g/l.
  164. normal range for creatinine in an adult male is
    -> 60-110 µmol/l.
  165. anion gap is calculated using the following formula:
    -> Anion gap = (Na) – (Cl + HCO3)
  166. normal range for the anion gap (when potassium is excluded) is
    -> 8-16 mmol/l.
  167. The anion gap is reduced by
    -> about 2.5 mmol/l for every 10 g/l fall in albumin concentration.
  168. plasma osmolality is calculated using the following formula:
    -> Plasma osmolality = 2(Na + K) + Urea + Glucose
  169. he platelet count needs to fall to less than before spontaneous bleeding will occur.
    · < 20 x109/l
  170. Cortisol is produced in the
    · zona fasciculata
  171. The main functions of cortisol are:
    • • Increasing blood glucose levels via stimulating gluconeogenesis
    • • Immunosuppression
    • • Fat, protein and carbohydrate metabolism
  172. Aplastic anaemia
    • -average age 25.
    • -Drugs such as chloramphenicol, phenytoin, quinine and benzene
    • -Associated with connective tissue disease ->SLE.
  173. Drugs that cause gynaecomastia include:
    • -Cimetidine-> resolve when it has been substituted with ranitidine.
    • -omeprazole
    • -spironolactone
    • -digoxin
    • -furosemide
    • -finasteride
    • -some anti-pyschotics.
  174. Marijuana usage has been linked with
    · gynaecomastia.
  175. Dane particle.
    ->The complete hepatitis B virion
  176. Hepatitis B
    -> 5-10% become chronic carriers.
  177. AntiHBc IgM signifies
    -> recent acute infection and it usually is only present for less than 6 months.
  178. causes of a raised amylase level:
    • • Infections e.g. mumps
    • • Inflammation e.g. acute pancreatitis, hepatitis, peritonitis
    • • Metabolic e.g. renal failure, DKA
    • • Neoplasia e.g. pancreatic carcinoma
    • • Vascular e.g. mesenteric ischaemia
    • • Drugs e.g. opiates, ciprofloxacin
  179. Tibialis anterior is innervated by the
    -> deep fibular nerve.
  180. The calcaneus is the
    ->largest bone in the tarsal region. The talus is the second largest.
  181. antibodies are associated with the following gastrointestinal and liver diseases:
    • • Anti-mitochondrial antibodies – primary biliary cirrhosis
    • • Anti-smooth muscle antibodies – auto-immune hepatitis, cryptogenic cirrhosis
    • • Anti-gliadin antibodies – coeliac disease
    • • Anti-endomysial antibodies – coeliac disease
    • • Intrinsic factor antibodies – pernicious anaemia
    • • Gastric parietal cell antibodies – pernicious anaemia, gastric atrophy
  182. The gallbladder is related inferiorly to the
    -> duodenum and the transverse colon.
  183. Enterohepatic circulation:
    -95% of bile salts that enter the small intestines in bile are recycled and reabsorbed into the portal circulation by active transport mechanisms in the distal ileum.
  184. Hepatocytes metabolise cholesterol to
    -> cholic acid and chenodeoxycholic acid.
  185. The total bile salt pool in a healthy adult is
    • -> approximately 5 g.
    • -> 20-30 mg of bile pigment is reabsorbed/day in a healthy adult.
  186. Scarlet fever has an incubation period of
    ->1-4 days.
  187. average 70kg adults at normal resting state:
    • -circulating volume would be approximately 5000ml.
    • -Approximately 15% of the blood is in the arterial system.
    • -venous system contains approximately 3000ml of blood.
    • - pulmonary circulation.25% (1250ml) of the blood volume is in the
  188. The classical pathway is activated by
    • -> antibody-antigen complexes.
    • The MAC is formed on
    • ->the surface of pathogenic bacterial cells as a result of the activation of the ALTERNATIVE pathway->transmembrane channels -> disrupt the phospholipid bilayer of target cells ->cell death.
    • An opsonin is a molecule that targets an
    • -> ANTIGEN for an immune response.
  189. following are causes of eosinophilia:
    • • Allergy e.g. asthma and hayfever
    • • Parasitic infections e.g. filariasis, ascariasis and toxocariasis
    • • Skin disease e.g. eczema and psoriasis
    • • Hodgkins disease
    • • Tropical eosinophilia
    • • Sarcoidosis
    • • Polyarteritis nodosa
  190. Aspirin is a non-competitive cyclo-oxygenase antagonist. It works by
    -> covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2.
  191. At low doses (75 mg per day) aspirin only inhibits
    -> COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect.
  192. At medium to high doses (500-5000 mg per day) aspirin inhibits
    -> both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses.
  193. The effects of a single dose of aspirin last
    -> 7-10 days, the time required for the bone marrow to generate new platelets.
  194. is classified as follows:
    • • Mild 32-35°C
    • • Moderate 30-32°C
    • • Severe < 30°C
    • Hypothermia
    • -J waves may be seen between the QRS complex and the T wave. The statement is true.
    • -AF and bradycardias are the commonest rhythm disturbances seen on ECG.
  195. Hypothermia
    -Defibrillation is appropriate at normal energy levels if VF or VT are present. If 3 shocks are unsuccessful then further shocks should be deferred until core the core temperature is > 30°C. Defibrillation is often ineffective below 30°C.
  196. Secretin
    • -> produced by the S-cells in the mucosa of the duodenum and jejunum
    • -> in response to increased acidity.
    • -> increases bicarbonate ion production and release from the exocrine pancreas, bile ducts and from the Brunner's glands in the duodenum-> bicarbonate ions act to neutralize the acid and establish a pH conducive to the action of other digestive enzymes.
  197. Secretin stimulates the release of:
    • • Pepsin
    • • Glucagon
    • • Pancreatic polypeptide
    • • Somatostatin
  198. AML/Myeloblasts stain
    -> + myeloperoxidase and Sudan black , - negative for PAS.
  199. Codeine phosphate and dihydrocodeine have
    -> similar potencies.
  200. At rest the blood in the coronary vein is
    -> 25% saturated with oxygen.
  201. Pain sensation is transmitted to the CNS via
    -> small unmyelinated C fibres.
  202. Wound healing is impaired by the following:
    • • Poor blood supply
    • • Superimposed wound infection
    • • Foreign material in the wound
    • • Nutrient deficiency e.g. vitamin C deficiency
    • • Drugs e.g. corticosteroids
  203. The common digital nerves are derived from
    • - median and ulnar nerves.
    • -They divide in the DISTAL palm -> paired volar branches.
    • -run with the digital vessels on either side of the flexor tendon sheath of each finger.
  204. dorsal digital nerves are derived from the
    -> ulnar and radial nerves.
  205. Following result in a raised Troponin:
    • -Cardiac contusion causes raised cardiac troponins.
    • -Desfibrillator shock
    • -Non-cardiac diseases: critically ill patients, high dose chemotherapy, primary pulmonary hypertension, pulmonary embolism, renal failure, subarachnoid haemorrhage, sepsis, stroke, ultra endurance exercise.
  206. The median eminence is
    ->part of the inferior boundary of the hypothalamus-> Regulatory hypophysiotropic hormones collect -> before entering the hypophyseal portal system->connects the hypothalamus with the anterior lobe of the pituitary gland.
  207. management of anaphylaxis in an 6-12 year old
    • · IM adrenaline in 6-12 year olds is
    • · 300 mcg (0.3 ml of 1:1000).
    • · Crystalloid 20 ml/kg.
    • · IV Adrenaline 1 mcg/kg/min.
    • · IV Hydrocortisone in 6-12 year olds is 100 mg.
  208. Platelets will be present in Whole blood but they will have lost function after
    -> approximately 24 hours.
  209. Fresh frozen plasma must be used within
    -> 1 hour of thawing.
  210. the neck of the femur:
    • -> Capsule->Anteriorly the capsule attaches at the intertrochanteric line, posteriorly the lateral half of the femoral neck is extracapsular.
    • - The intertrochanteric line -> anteriorly
    • - intertrochanteric crest ->posteriorly.
  211. The descending colon passes
    ->along the lateral border of the left kidney.
  212. Causes of cranial diabetes insipidus include:
    • • Idiopathic
    • • Craniopharyngiomas
    • • Trauma
    • • Pituitary surgery
    • • Infiltrative processes e.g. sarcoidosis, histiocytosis X
    • • Lymphocytic hypophysitis
    • • Dysgerminomas
  213. U waves occur in
    ->hypokalaemia, hypercalcaemia, thyrotoxicosis, digitalis exposure, in patients taking anti-arrhythmics and in long QT syndrome.
  214. Inverted U waves may represent
    ->myocardial ischaemia.
  215. Lamellar corpuscles (Pacinian corpuscles)
    ->vibration and pressure sense.
  216. Bulbous corpuscles (Ruffini's corpuscles)
    ->proprioception.
  217. Free nerve endings
    -> pain sensation (nociception).
  218. Meissner's corpuscles
    -> light touch.
  219. In HbS
    -> glutamic acid ->is replaced by valine.
  220. Ad fibres are
    • ->myelinated
    • ->velocity of approximately 20 m/sec.
    • -terminate in the upper laminae of the dorsal horn.
  221. C fibres are
    • ->non-myelinated
    • ->velocity of approximately 2 m/sec.
    • - transmit temperature sensation.
  222. Facultative anaerobic bacteria make ATP via aerobic respiration and are also capable of switching to fermentation. Examples include:
    • • Escherichia coli
    • • Staphylococcus spp
    • • Listeria spp
    • • Shewanella oneidensis
  223. chlordiazepoxide:
    • -half-life of 5-30 hours
    • -used as an adjunct in alcohol withdrawal. Diazepam is a suitable alternative and also commonly used.
    • -should be reduced in patients with renal impairment.
  224. the only benzodiazepine with predictable intramuscular absorption.
    -> Lorazepam
  225. following are the relations of the inguinal canal:
    • • Anteriorly – skin, Camper's fascia, Scarpa's fascia, aponeurosis of external oblique, superficial inguinal ring (medial 1/3 of canal)
    • • Posteriorly – transversalis fascia, conjoint tendon, deep inguinal ring (lateral 1/3 of canal)
    • • Superiorly – internal oblique, tranversus abdominis, medial crus of external oblique
    • • Inferiorly – inguinal ligament, lacunar ligament (medial 1/3 of canal), iliopubic tract (lateral 1/3 of canal)
  226. The sternal angle is located
    • -> opposite the second pair of costal cartilages.
    • The manubrium lies at
    • -> T3 and T4 vertebrae.
  227. A size 4 LMA requires
    -> 30 mls of air to inflate the cuff.
  228. The PLMA has an additional
    -> POSTERIOR cuff and a gastric drain tube.

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