MOCK2.txt

-Is a peptide hormone.

• • Hypervolaemia
• • Tension pneumothorax
• • Heart failure
• • Pleural effusion
• • Pulmonary embolus
• • Cardiac tamponade
• • Mechanical ventilation (PEEP)
• • Forced exhalation

-deep inhalation.

• 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.

Ø between 0.2-0.5%.

Ø subclavian artery and brachial plexus à they pass between the anterior scalene and middle scalene muscles at the superior thoracic aperture.

• • Scalenus anticus syndrome
• • Cervical rib syndrome
• • Costoclavicular syndrome
• • Pancoast tumour
• • Trauma

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.

• 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

• 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

Ø extracapsular.

• Ø anteriorly
• Ø
• Regarding the neck of the femurà intertrochanteric crest lies
• Ø posteriorly.

Ø placement of a dynamic hip screw.

Ø muscarinic receptor antogonist -> reduces parasympathetic activity.

Ø cycloplegic (paralyses the ciliary muscle of the eye) -> paralyses the accommodation reflex. It is also a mydriatic, causing pupillary dilatation.

Ø smooth muscle in the gut, urinary tract and biliary tree.

• 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.

• Ø random order.
• Ø suitable for chronic disorders that are not cured but for which treatment may give temporary relief.

Ø observational study.

Ø observational study

• • 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

• Ø mucopolysaccharide.
• Ø Decreases surface tension.
• Ø Keeps alveoli dry
• Ø Increases compliance

• Ø Tibial nerve
• Ø nerve roots S1 and S2.
• Ø Sural arteries

• 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.

Ø plantar-flexion of the ankle and flexion of the knee.

• Ø gastrocnemius
• Ø soleus
• Ø plantaris.

Ø 90-140 mmHg

Ø 60-90 mmHg.

Ø (diastolic blood pressure + 1/3 of the pulse pressure) and = 70-105 mmHg.

Ø 60-100 ml/beat

Ø 80-100 mmHg

Ø Dane particle.

• Ø acute infection and high infectivity
• Ø
• Regarding hepatitis B % become chronic carriers
• Ø 5-10% become chronic carriers.

• Ø recent acute infection
• Ø only present for less than 6 months.

Ø bacterial and fungal infections.

Ø allergic response.

Ø parasitic infections.

• Monocytes share the phagocytic function of neutrophils but live
• Ø much longer.

• 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.

• Ø piperazine phenothiazines
• o (fluphenazine, prochlorperazine and trifluoperazine)
• Ø butyrophenones
• o (benperidol and haloperidol).

Ø Reduce dosis->increased cerebral sensitivity

Ø NO-> increased risk of mortality in elderly pt-> increased risk of cardiovascular events and infections such as pneumonia.

Ø approximately 16-17%.

• 10 L/min of oxygen via a mask with a reservoir bag can deliver an inspired oxygen concentration of
• Ø 85%.

Ø reducing lung compliance.

• 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.

Ø eclampsia and acute asthma.

Ø lateral to the femoral artery and vein.

Ø L2-L4.

• 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.

• Ø anterior cutaneous branches
• Ø branches to pectineus and sartorius.

• Ø rectus femoris
• Ø vastus lateralis
• Ø vastus medialis
• Ø vastus intermedius.

• Vicryl is
• Ø absorbable
• Ø synthetic suture made primarily of polyglactin.
• Ø its tensile strength for 3-4 weeks.
• Ø braided suture

• · It averages 6-7 metres in length.
• · pain ->referred to the T9-T10 dermatomes.

· thicker due to its thick circular folds (the plicae circularis).

· ileum.

• · 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.

· Von Willebrand disease

· factor VIII deficiency.

· factor IX deficiency.

· aortic stenosis -> gastrointestinal bleeding (Heyde's syndrome).

· glycoproteins

· cAMP as a second messenger.

· cGMP as a second messenger.

• · 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.

· chromosomes 9 and 22.

· Heaf test.

· 5 Tuberculin units (0.1mL) intradermally.

• • 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

• • 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

· anterior triangle of the neck.

• · 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

· phagocytic uptake of bacteria

· binding iron and preventing microbial iron uptake.

• CRP binds phosphocholine expressed on the
• · surface of dying cells and certain bacteria in order to activate the complement system.

· liver.

· approximately 80%.

· equally reduced, therefore the FEV1/FVC ratio is usually normal.

• · 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.

• · NO information about ventilation
• · only provides information about oxygenation.

· oculomotor nerve.

· rotates the eye away from the nose (extorsion), moves the eye upwards (elevation) and outwards (abduction).

• • Anteriorly: small intestine
• • Posteriorly: left kidney, iliacus, quadratus lumborum

• · hypokalaemia
• · low bicarbonate level
• · high urinary pH
• · normal anion gap

· 95-105 mmol/l

· nephrocalcinosis ->of calcium stones to develop at alkaline urinary pHs. -> renal colic.

· Anion gap = (Na + K) – (Cl + HCO3)

· 8-16 mmol/l

• • G-6-PD deficiency
• • NADPH deficiency
• • Chronic liver disease
• • Alpha-thalassaemia

• · asplenia.
• · haemolytic anaemias
• · megaloblastic anaemias
• · hereditary spherocytosis
• · myelodysplastic syndromes.

· myelofibrosis.

• · lead poisoning
• · sideroblastic anaemia.

phenylethylamine compound with similarities to amphetamines and mescaline.

• · fulminant hyperthermia
• · convulsions
• · rhabdomylosis
• · inappropriate ADH secretion
• · DIC
• · liver failure
• · cerebrovascular accidents.

• · 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

-> 70% of cases of post-primary tuberculosis.

• - thyroid autoantibodies that activate the TSH receptor stimulating thyroid hormone synthesis.
• -Approximately 30-50% ->Grave’s ophthalmopathy.

• - catechol (a 1,2-dihydroxybenzene group) and an amine side-chain.
• - have a half-life of a few minutes.

->cannot cross the blood-brain-barrier.

• - 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.

• - 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)

• -(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.

-> Cerebral blood vasodilation

• -Gram-negative, helix shaped (curved rod), microaerophilic bacterium.
• -outer membrane -> phospholipids and lipopolysaccharide
• -typically has 4-6 lophotrichous flagella->highly motile.

• • P - Phenytoin
• • C - Carbemazepine
• • B - Barbiturates
• • R - Rifampicin
• • A - Alcohol (chronic ingestion)
• • S - Sulphonylureas
• • S - Smoking

->cytochrome p450 enzyme inhibitor ->potentiates the effects of warfarin (increases the INR).

• - 1 in 5000 males.
• - X-linked RECESSIVE disorder.

- 1 in 50,000 males.

· longer half life than factor VIII.

• - mild form of haemophilia that occurs in both sexes.
• - It predominantly affects in Ashkenazi Jews.

• -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.

• • 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

• 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.

-> 3.5 kPa.

->decreased oxygen affinity of Hb allowing more Oxygen to be available to the tissues.

-> extracapsular.

-> intracapsular.

• -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.

-> fusiform.

• -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.

-> 2% of patients.

-> IgG anti-platelet antibodies

-> rare feature of digoxin toxicity.

• • Age over 55
• • Male gender
• • Underlying heart disease
• • Pre-existing renal failure

• · 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.

- either a dexamethasone suppression test or 24-hour urinary free cortisol collection

• -> 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

• • High flow oxygen
• • Short acting beta2 agonist via large-volume spacer or nebuliser
• • PO Prednisolone or IV hydrocortisone

• Inhaled ipratropium bromide via nebuliser

• • 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.

• ->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.

• 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

• ->the internal thoracic artery
• ->the superior and inferior thyroid arteries.

• -The majority of Caucasian men -> rhesus positive.
• -Anti-A and anti-B antibodies -> usually IgM type.

->AB rhesus positive

->the development is autoimmune haemolytic anaemias and haemolytic disease of the newborn.

• -Neisseria menigitidis.
• -Moraxella catarrhalis.

-> C6.

-> T3.

-> T12.

-> L1/L2.

->T4/T5. The statement is true.

• -> C6.
• The union of the common iliac veins occurs at
• -> L5 (This is the formation of the inferior vena cava).

-> L3

• ->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.

• - Sternal angle
• -The start of the arch of the aorta lies at T4/T5.
• -Bifurcation of the trachea

-> T3/T4.

-> T2.

• -Transpyloric plane of Addison
• -Origen superior mesenteric artery
• -fundus gallbladder
• -hiia kedney

The area over the deltoid

The thumb

The middle finger

The little finger

The nipple line

The xiphisternum

The umbilicus

The symphysis pubis

The medial aspect of the calf

The webspace between the 1st and 2nd toe

The lateral border of the foot

The ischial tuberosity area

-> 35-50 g/l.

-> 60-110 µmol/l.

-> Anion gap = (Na) – (Cl + HCO3)

-> 8-16 mmol/l.

-> about 2.5 mmol/l for every 10 g/l fall in albumin concentration.

-> Plasma osmolality = 2(Na + K) + Urea + Glucose

· < 20 x109/l

· zona fasciculata

• • Increasing blood glucose levels via stimulating gluconeogenesis
• • Immunosuppression
• • Fat, protein and carbohydrate metabolism

• -average age 25.
• -Drugs such as chloramphenicol, phenytoin, quinine and benzene
• -Associated with connective tissue disease ->SLE.

• -Cimetidine-> resolve when it has been substituted with ranitidine.
• -omeprazole
• -spironolactone
• -digoxin
• -furosemide
• -finasteride
• -some anti-pyschotics.

· gynaecomastia.

->The complete hepatitis B virion

-> 5-10% become chronic carriers.

-> recent acute infection and it usually is only present for less than 6 months.

• • 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

-> deep fibular nerve.

->largest bone in the tarsal region. The talus is the second largest.

• • 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

-> duodenum and the transverse colon.

-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.

-> cholic acid and chenodeoxycholic acid.

• -> approximately 5 g.
• -> 20-30 mg of bile pigment is reabsorbed/day in a healthy adult.

->1-4 days.

• -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

• -> 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.

• • 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

-> covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2.

-> COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect.

-> 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.

-> 7-10 days, the time required for the bone marrow to generate new platelets.

• • 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.

-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.

• -> 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.

• • Pepsin
• • Glucagon
• • Pancreatic polypeptide
• • Somatostatin

-> + myeloperoxidase and Sudan black , - negative for PAS.

-> similar potencies.

-> 25% saturated with oxygen.

-> small unmyelinated C fibres.

• • Poor blood supply
• • Superimposed wound infection
• • Foreign material in the wound
• • Nutrient deficiency e.g. vitamin C deficiency
• • Drugs e.g. corticosteroids

• - 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.

-> ulnar and radial nerves.

• -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.

->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.

• · 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.

-> approximately 24 hours.

-> 1 hour of thawing.

• -> 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.

->along the lateral border of the left kidney.

• • Idiopathic
• • Craniopharyngiomas
• • Trauma
• • Pituitary surgery
• • Infiltrative processes e.g. sarcoidosis, histiocytosis X
• • Lymphocytic hypophysitis
• • Dysgerminomas

->hypokalaemia, hypercalcaemia, thyrotoxicosis, digitalis exposure, in patients taking anti-arrhythmics and in long QT syndrome.

->myocardial ischaemia.

• Lamellar corpuscles (Pacinian corpuscles)
• ->vibration and pressure sense.

->proprioception.

-> pain sensation (nociception).

-> light touch.

-> glutamic acid ->is replaced by valine.

• ->myelinated
• ->velocity of approximately 20 m/sec.
• -terminate in the upper laminae of the dorsal horn.

• ->non-myelinated
• ->velocity of approximately 2 m/sec.
• - transmit temperature sensation.

• • Escherichia coli
• • Staphylococcus spp
• • Listeria spp
• • Shewanella oneidensis

• -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.

-> Lorazepam

• • 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)

• -> opposite the second pair of costal cartilages.
• The manubrium lies at
• -> T3 and T4 vertebrae.

-> 30 mls of air to inflate the cuff.

-> POSTERIOR cuff and a gastric drain tube.