MOCK3.txt

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hradoc
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249768
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MOCK3.txt
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2013-11-30 04:59:43
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MCEMA
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  1. Korsakoff's syndrome is caused by
    · thiamine (vitamin B1) deficiency.
  2. There are six main symptoms of Korsakoff's syndrome:
    • · Anterograde amnesia
    • · retrograde amnesia
    • · confabulation
    • · meagre conversation
    • · lack of insight and apathy.
  3. The symptoms of Korsakoff's can sometimes be improved by the administration of
    • · thiamine
    • · however Korsakoff's is a persistent and irreversible process.
  4. Wernicke's syndrome is
    · reversible by the administration of thiamine.
  5. Tthe commonest cause of the Wernicke-Koraskoff syndrome.
    · Chronic alcohol abuse
  6. Diagnosis of acute compartment syndrome should be considered + mmHg
    · Interstitial tissue pressures > 30 mmHg
  7. acute compartment syndrome + Complications include
    • · rhabdomylosis
    • · renal failure
    • · Volkmann's contracture.
  8. Prolonged exercise can cause
    · chronic compartment syndrome->relieved by discontinuing the exercise and is not dangerous.
  9. Labetolol is indicated Treating hypertension in acute stroke has been shown to reduce the risk of intracranial if the
    · systolic BP is > 220 mmHg or the diastolic BP is > 120 mmHg. haemorrhage.
  10. Propranolol can be used in the prophylaxis of
    · migraine.
  11. Atenolol dose
    · not cross the blood brain barrier.
  12. Bisoprolol has a half life of
    • · 10-12 hours
    • There are three phases of wound healing:
    • 1. inflammatory phase (up to 48 hours after injury)
    • 2. proliferative phase (up to 3 weeks after injury)
    • 3. maturation phase (up to 1 year after injury)
  13. The inflammatory phase (up to 48 hours after injury)
    • · Blood vessels dilate to allow antibodies, white blood cells, growth factors, enzymes and nutrients to reach the wounded area.
    • · The characteristic signs of inflammation are seen.
    • · The predominant cell types seen are neutrophils and macrophages, which serve to autolyse and devitalized necrotic tissue.
  14. The proliferative phase (up to 3 weeks after injury)
    • · New granulation tissue
    • · comprised of collagen and extracellular matrix develops.
    • · Angiogenesis occurs with fibroblasts and capillaries growing into the necrotic areas.
  15. The maturation phase (up to 1 year after injury)
    • · The final phase occurs when the wound has closed.
    • · Remodeling of collagen from type I -> type III.
    • · Cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases.
  16. Wound remodeling continues for
    · up to 1 year.
  17. Causes of thrombocythaemia
    · Hyposplenism.
  18. Megaloblastosis causes
    · low platelets.
  19. Other disease processes that can cause a raised platelet count include:
    • · inflammatory bowel disease
    • · sarcomas
    • · rheumatoid arthritris
    • · nephrotic syndrome
    • · sepsis.
  20. Sepsis can cause both
    · raised and lowered platelet counts.
  21. The ulnar nerve arises from the
    • · medial cord of the brachial plexus.
    • · a root value of C8 / T1
  22. The ulnar nerve lies
    · medial to brachial artery at the midpoint of the humerus.
  23. The ulnar nerve supplies
    • · flexor carpi ulnaris
    • · medial half of flexor digitorum profundus
    • · hypothenar muscles,
    • · interossei
    • · adductor pollicis
    • · medial 2 lumbricals.
    • Regarding the paediatric airway:
    • a)
    • The larynx in children lies at the level of C5/C6.
    • The larynx in children lies high and anterior in children at the level of
    • · C2/C3.
  24. The narrowest part of the airway in children.
    · cricoid ring
  25. Uncuffed tubes should be used during resuscitation, by those without paediatric anaesthesia experience, for children up until approximately
    · 10 years of age.
  26. Regarding traumatic aortic disruption + Survivors usually have an
    · incomplete laceration near the ligamentum arteriosum of the aorta.
  27. The ligamentum venosum is the
    · fibrous remnant of the ductus venosus -> attached to the left branch of the portal vein within the porta hepatis.
  28. The ligamentum arteriosum tends to fix the
    · aorta in place during rapid deceleration and recoil-> ruptured aorta.
  29. Regarding traumatic aortic disruption It is the
    • · second leading cause of death after traumatic brain injury.
    • · Approximately 18% of deaths following RTA.
  30. Regarding traumatic aortic disruption + Helical contrast enhanced CT scanning has
    · 100% sensitivity and specificity for aorta rupture, however CT scanning should be reserved
  31. Troponin C has
    · 4 binding sites.
  32. Posterior MI is associated with the following ECG changes:
    • • Tall, broad R waves in leads V1-V3
    • • ST depression in leads V1-V3
    • • Dominant R wave in lead V2
    • • Upright T waves in leads V1-V3
  33. The anacrotic limb is the
    • · first phase of the arterial pulse cycle
    • · ventricles contract ->eject blood into the arterial tree.
    • · The arterial pressure rises to the end-systolic pressure at the peak of the anacrotic limb.
  34. The dicrotic limb is the
    • · second phase of the pulse cycle
    • · fall in arterial pressure -> reaches end-diastolic pressure.
  35. A short systolic time represents
    • · hypovolaemia
    • · high systemic vascular resistance.
  36. Arterial lines measure systolic/diastolic blood pressure approximately than non-invasive blood pressure (NIBP) measurement
    • · Systolic 5 mmHg higher
    • · Diastolic 8 mmHg lower.
  37. Sodium channels are made up of
    · polypeptide chains.
  38. The following mechanisms of injury would prompt transfer to a trauma centre:
    • • Fall > 20 feet for adult, > 10 feet for child
    • • High risk auto crash (intrusion > 12 in occupant site, intrusion > 18 in any site, ejection, death in same passenger compartment)
    • • Auto vs pedestrian / bicyclist (thrown, run over or > 20 mph at impact)
    • • Motorcycle crash > 20 mph
  39. Mannitol
    • · osmotic diuretic derived from sugar by reduction
    • · treat raised intracranial pressure following head injury.
    • · usual dose is 1 g/kg of 20% solution given as an IV bolus.
  40. There are three major classes of second messenger:
    • 1. Cyclic nucleotides (e.g. cAMP and cGMP)
    • 2. Inositol triphosphate and diacylglycerol
    • 3. Calcium ions
  41. Atrial natriuretic peptide (ANP) and nitric oxide use
    · cGMP as a second messenger.
  42. C3 is important for
    Opsonisation
  43. Deficiency in C3 results in a susceptibility to
    • · infections caused by encapsulated bacteria such as
    • o Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus Influenzae.
  44. Deficiency in C5-C9 (which form the membrane attack complex) result in increased susceptibility to infection with
    · Neisseria spp.
  45. Deficiency in complement is associated with rheumatological conditions including
    · systemic lupus erythematosus.
  46. In western countries is the commonest complement deficiency (1 in 10,000 of the population)
    · C2
  47. The commonest complement deficiency in Japan and Korea.
    · C9 deficiency
  48. The blood supply to the stomach is as follows:
    • • Left gastric artery: derived from the coeliac trunk
    • • Right gastric artery: derived from the hepatic artery
    • • Left gastroepiploic artery: derived from the splenic artery
    • • Right gastroepiploic artery: derived from the gastroduodenal branch of the hepatic artery
    • • Short gastric arteries: derived from the splenic artery
  49. The relations of the stomach are as follows:
    • • Anteriorly: diaphragm, abdominal wall, left lobe of the liver
    • • Posteriorly: diaphragm, aorta, spleen, left kidney, pancreas, transverse mesocolon, colon, lesser sac of peritoneum
  50. Abciximab
    · chimeric monoclonal antibody -> irreversibly binds glycoprotein IIb/IIIa receptors on platelets->preventing ->platelet activation and aggregation.
  51. EPIC trial (1995) showed that abciximab reduced the risk of
    · death, myocardial infarction, repeat angioplasty, CABG and balloon pump insertion for patients undergoing high-risk coronary angioplasty.
  52. The typical urinary findings in pre-renal uraemia are:
    • • Urinary sodium < 20 mmol/l
    • • Urine: plasma osmolality ratio > 1.5:1
    • • Fractional sodium excretion < 1%
    • • Urine: plasma urea ratio > 10:1
    • • Urine volume < 1.5 L
  53. Prolongation of the QT interval can be caused by:
    • · Romano Ward syndrome.
    • · Hypothermia
    • · hypomagnesaemia
    • · hypocalcaemia
    • · hypokalaemia.
  54. Romano Ward syndrome.
    · autosomal dominant form of the long QT syndrome.
  55. Other drugs that cause prolongation of the QT interval include:
    • · Procainamide
    • · Quinidine
    • · Sotalol
    • · methadone.
  56. The horizontal fissure of the right lung is
    • · incomplete in 60%
    • · absent in 10%.
  57. TB Pulmonary infection accounts for
    · 70% of cases of post-primary tuberculosis.
  58. Grave’s disease is caused
    • · thyroid autoantibodies that activate the TSH receptor stimulating thyroid hormone synthesis.
    • · Approximately 30-50% ->Grave’s ophthalmopathy.
  59. Catecholamines
    • - catechol (a 1,2-dihydroxybenzene group) and an amine side-chain.
    • - have a half-life of a few minutes.
  60. Dopamine
    · NOT cross the blood-brain-barrier.
  61. Regarding Sickle-cell disease
    • · Autosomal RECESSIVE
    • · 1/3 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.
  62. 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)
  63. 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.
  64. Response to hypercarbia
    · Cerebral blood vasodilation
  65. Helicobacter pylori is
    • · Gram-negative, helix shaped (curved rod), microaerophilic bacterium.
    • · outer membrane -> phospholipids and lipopolysaccharide
    • · typically has 4-6 lophotrichous flagella->highly motile.
  66. The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers-> inducers inhibit the effects of warfarin resulting in a reduced INR
    • • P - Phenytoin
    • • C - Carbemazepine
    • • B - Barbiturates
    • • R - Rifampicin
    • • A - Alcohol (chronic ingestion)
    • • S - Sulphonylureas
    • • S – Smoking
    • • (Un ave Phenix tiene un Carbon en su boca que lo dispara a un Barbon Alcohólico Fumador Diabético con SULFAS que vente Rifa en una feria)
  67. p450 enzyme inhibitor and potentiates the effects of warfarin (increases the INR).
    • · Sodium valproate
    • · Isoniazid
  68. Haemophilia A affects
    • · 1 in 5000 males.
    • · X-linked RECESSIVE disorder.
  69. Haemophilia B affects
    -1 in 50,000 males.
  70. Factor IX has a longer half life than
    · factor VIII.
  71. Haemophilia C
    • · mild form of haemophilia that occurs in both sexes.
    • · It predominantly affects in Ashkenazi Jews.
  72. 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.
  73. 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
  74. 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.
  75. Oxygen saturation of 50% the PaO2 is approximately
    • · 3.5 kPa.
    • ·
    • Right shift indicates
    • · decreased oxygen affinity of Hb allowing more Oxygen to be available to the tissues.
  76. The medical and lateral collateral ligaments are
    -> extracapsular.
  77. The anterior and posterior cruciate ligaments are
    -> intracapsular.
  78. 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.
  79. Most aortic aneurysms are
    -> fusiform.
  80. 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.
  81. Lung abscess is a rare complication of lobar pneumonia occurring in approximately
    · 2% of patients.
  82. thrombocytopenia of ITP is caused by
    · IgG anti-platelet antibodies
  83. Regarding digoxin toxicity: Xanthopsia is a
    · rare feature of digoxin toxicity.
  84. Risk factors for digoxin toxicity include:
    • • Age over 55
    • • Male gender
    • • Underlying heart disease
    • • Pre-existing renal failure
  85. Therapeutic range of digoxin is
    · 1-2 µg/l.
  86. digoxin toxicity 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.
  87. Cushing's syndrome can be confirmed by
    • · either a dexamethasone suppression test
    • · or 24-hour urinary free cortisol collection
  88. 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
  89. 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
    • • Monitor response for 15-30 minutes and if response poor:
    • • Inhaled ipratropium bromide via nebuliser
  90. 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
  91. If required the dose of IV magnesium sulphate is
    · 1.2-2 g IV given over 20-30 minutes.
  92. 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.
  93. 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
  94. The arterial supply to the thymus is derived from
    • · the internal thoracic artery
    • · the superior and inferior thyroid arteries.
  95. The oesphagus is transmitted at the level of
    · T10.
  96. The inferior vena cava is transmitted at the level of
    · T8.
  97. The following structures are transmitted through the diaphragm at the level of T12:
    • • The abdominal aorta (strictly speaking behind the diaphragm)
    • • The thoracic duct
    • • The azygous vein
    • • The hemiazygous vein
  98. The following are features of lithium toxicity:
    • • Nausea and vomiting
    • • Diarrhoea
    • • Tremor
    • • Ataxia
    • • Confusion
    • • Increased muscle tone
    • • Clonus
    • • Nephrogenic diabetes insipidus
    • • Convulsions
    • • Coma
    • • Renal failure

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