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Regarding the small intestine:
- • It averages 6-7 metres in length.
- • pain ->referred to the T9-T10 dermatomes.
The wall of the jejunum is
• thicker due to its thick circular folds (the plicae circularis).
Peyer’s patches are organized lymphoid nodules that are present in the
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.
The most common inherited coagulation disorder
• Von Willebrand disease
Haemophilia A is due to a
• factor VIII deficiency.
Haemophilia B is due to
• factor IX deficiency.
Acquired vWD occurs in patients with
• aortic stenosis -> gastrointestinal bleeding (Heyde's syndrome).
Regarding membrane receptors for hormones: They are often
Catecholamines, glucagon and luteinizing hormone are examples of hormones that uses
• cAMP as a second messenger.
Atrial natriuretic peptide (ANP) and nitric oxide use
• cGMP as a second messenger.
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.
Philadelphia chromosome is a balanced translocation between
• chromosomes 9 and 22.
The injection of 100,000 units/ml of tuberculin purified protein derivative into the skin using a Sterneedle gun is the
• Heaf test.
The Mantoux test involves the injection of
• 5 Tuberculin units (0.1mL) intradermally.
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
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
The ansa cervicalis is a loop of nerves that form part of the cervical plexus. It lies within the
• 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
Regarding acute phase proteins: facilitate the
• phagocytic uptake of bacteria
Ferritin acts by
• 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.
CRP is synthesized in the
An FEV1/FVC ratio normal values
• approximately 80%.
In restrictive lung disease the FEV1and FVC ratio are
• equally reduced, therefore the FEV1/FVC ratio is usually normal.
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.
Pulse oximetry gives
- • NO information about ventilation
- • only provides information about oxygenation.
Levator palpabrae superioris is innverated by the
• oculomotor nerve.
The inferior oblique muscle
• rotates the eye away from the nose (extorsion), moves the eye upwards (elevation) and outwards (abduction).
The relations of the descending colon are:
- • Anteriorly: small intestine
- • Posteriorly: left kidney, iliacus, quadratus lumborum
The normal range for chloride is
• 95-105 mmol/l
- Type 1 renal tubular acidosis
- • hypokalaemia
- • low bicarbonate level
- • high urinary pH.
- • normal anion gap.
Type 1 renal tubular acidosis is associated with
• nephrocalcinosis ->of calcium stones to develop at alkaline urinary pHs. -> renal colic.
The anion gap is calculated using the following formula:
• Anion gap = (Na + K) – (Cl + HCO3)
The normal anion gap is
• 8-16 mmol/l
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
Howell-Jolly bodies are basophilic nuclear remnants that are seen in
- • asplenia.
- • haemolytic anaemias
- • megaloblastic anaemias
- • hereditary spherocytosis
- • myelodysplastic syndromes.
Tear drop cells, or dacrocytes, are associated with
Basophilic stippling is seen in
- • lead poisoning
- • sideroblastic anaemia.
Ecstasy is a
phenylethylamine compound with similarities to amphetamines and mescaline.
Ecstasy + Recognised side effects include:
- • fulminant hyperthermia
- • convulsions
- • rhabdomylosis
- • inappropriate ADH secretion
- • DIC
- • liver failure
- • cerebrovascular accidents.
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
Damage to the median nerve at the wrist results in:
• NO-> bc the long flexors are intact as they are supplied by the anterior interosseus branch which arises in the forearm.
Median nerve lesions result in
- • wasting of the thenar eminence
- • except adductor pollicis.
The hyopthenar muscles are supplied by the
• ulnar nerve.
The risk of contracting Hepatitis C from a Hepatitis C positive source patient is between
• 3 - 10%.
Examples of monosynaptic reflexes include:
- • Jaw jerk reflex
- • Biceps reflex
- • Brachioradialis reflex
- • Triceps reflex
- • Knee jerk reflex (Patellar reflex)
- • Ankle jerk reflex (Achilles reflex)
- • Plantar reflex
- • both gelofusine and 0.9% saline contain 154 mmol/l of sodium.
- • The average molecular gelatine weight of gelofusine is 30,000.
- • It has a pH of 7.4.
- • There is a higher incidence of anaphylaxis with gelofusine than with 0.9% saline administration.
brachial plexus: The superior trunk is formed by
• C5 and C6.
brachial plexus: C7 continues as the
• middle trunk
C8 and T1 unite to form the
- • inferior trunk.
- The Neer classification system refers to
- • proximal humerus fractures
The Garden classification system refers to
• intracapsular neck of femur fractures.
The rectus sheath is formed by the aponeuroses of the
- • transversus abdominis
- • external and internal oblique muscles.
- • It contains the rectus abdominis and pyramidalis muscles.
A Spigelian hernia emerges from the
• lateral part of the rectus sheath at the level of the arcuate line of Douglas.
The troponin test is negative in
- • unstable angina
- • but positive in non ST-eIevation and ST-elevation MI.
- • A positive troponin test indicates myocyte necrosis.
The smooth muscle of the affected artery wall contracts in response to plaque fissuring and haemorrhage. This causes further
• constriction of the lumen of the artery.
LDH starts to rise at
- • 10 hours
- • peaks at 24-48 hours.
The long head of Biceps femoris is innervated by the
- • tibial division of the sciatic nerve
- • and the short head is innervated -> common peroneal nerve.
Semitendinosus and semimembranosus are innervated by the
• tibial division of the sciatic nerve.
Semitendinosus and semimembranosus act together to
- • extend the hip and flex the knee.
- • also assist with internal rotation of the knee.
Type I hypersensitivity reactions are implicated in
- • anaphylaxis
- • atopic disease such as asthma and eczema.
- • Overproduction of IgE on mast cells and basophils results in the release of vasoactive substances such as histamine and chemokines which in turn leads to vasodilatation, bronchoconstriction and increased vascular permeability
Rhesus incompatibility is an example of a type
• II hypersensitivity reaction.
Flexor hallucis longus is innervated by the
tibial nerve -> nerve roots S2 and S3.
The muscles of the calf can be divided into two groups, superficial and deep.
- • The superficial group
- • gastrocnemius, soleus and plantaris.
- • The deep group
- • politeus, flexor hallucis longus, flexor digitorum longus and tibialis posterior.
Proximal DVTs are more frequently
whereas distal DVTs have a
more equal left to right distribution.
The MCV is usually low in circumstances of
- • blood loss
- • thalassemia
- • iron deficiency and chronic disease.
The MCV is usually high in
- • haemolytic anaemia
- • pernicious anaemia
- • B12 and folate deficiency and in alcoholism.
The RDW is a measure of the variation of RBC width. Mathematically the RDW is calculated by the formula:
• RDW = (Standard deviation of MCV / Mean MCV) x 100.
Regarding alpha thalassaemia Two genes control
• beta globin chain production
Regarding alpha thalassaemia and four genes control
• alpha globin chain production.
Alpha thalassaemia is caused by an
- • autosomal recessive inherited gene defect ->decreased alpha globin chain production.->excess beta globin chain production in adults and excess gamma globin chain production in neonates
- Alpha thalassaemia If one allele is affected
- • there are three alpha globin genes, which is enough to permit normal haemoglobin production, and there are usually no clinical symptoms.
If two alleles are affected alpha thalassaemia trait results.
• Two alpha genes permit almost normal erythropoiesis -> mild microcytic hypochromic anaemia occurs.
Alpha thalassaemia If three alleles are affected then
- • Haemoglobin H disease results.
- Haemoglobin H is a tetramer of beta globin chains that are unable to pair with alpha globin chains.
- • microcytic hypochromic anaemia + splenomegaly.
Alpha thalassaemia If all four alleles are affected then
- • alpha thalassaemia major results.
- • The haemoglobin that is present is all tetramic gamma globin chains
- • fetus cannot survive outside of the uterus and may not survive the gestation->hydrops fetalis characterized by severe oedema.
Beta thalassaemia minor causes
• elevated HbA2 levels.
Perthes’ disease affected bone
• Femoral head
Scheuermann’s disease affected bone
Freiberg’s disease affected bone
• 2nd metatarsal head
Kohler’s disease affected bone
Keinbock’s disease affected bone
Panner’s disease affected bone
Osgood-Schlatter’s disease affected bone
• Tibial tuberosity
Johansson-Larsen’s disease affected bone
• Lower pole of patella
Sever’s disease affected bone
Lamellar corpuscles (Pacinian corpuscles) are responsible for
• vibration and pressure sense.
Bulbous corpuscles (Ruffini's corpuscles) are responsible for
Free nerve endings are responsible for
• pain sensation (nociception).
Meissner's corpuscles are responsible for
• light touch.
This is the '3-for-1' rule. Most patients with significant haemorrhagic require
• 300 mL of crystalloid for every 100 mL of blood loss to restore haemodynamic normality.
Regarding Clostridium tetani infection:
- • The incubation period of tetanus is 1 day to 3 weeks.
- • production of the exotoxin tetanospasmin.
The BTS guidelines for the management of life threatening asthma are:
- • High flow oxygen
- • Short acting beta2 agonist via large-volume spacer or nebuliser
- • PO Prednisolone or IV hydrocortisone
- • Inhaled ipratropium bromide via nebuliser
- Monitor response for 15-30 minutes and if response poor:
- • IV aminophylline or;
- • IV magnesium sulphate
management of life threatening asthma -> loading dose of aminophylline is
• 5 mg/kg over 20 minutes.
The following features are characteristic of Addison's disease:
- • Hypercalcaemia
- • hypoglycaemia
- • hyponatraemia
- • hyperkalaemia
- • eosinophilia
- • metabolic acidosis.
- • Is innervated by the tibial nerve.
- • pulls back the lateral meniscus.
- • ‘key of the knee joint'-> unlocks the extended knee by external rotation of the femur on the tibia->allowing full knee flexion to occur.
- • Assists with knee extension.
• vasoconstriction of arterioles.
Regarding glucose-6-phosphate dehydrogenase (G6PD) deficiency: It shows
- • X-linked recessive inheritance.
- • Most pts asymptomatic.
(G6PD) deficiency Acute haemoylsis is typically triggered by certain
- • anti-malarial drugs
- • sulphonamides
- • aspirin
- • few non-sulfa antibiotics such as nitrofurantoin but not cephalosporins or penicillins.
Bacillus cereus is a gram
• positive bacillus.
Moraxella catarrhalis is a gram
• negative coccus.
Intermittent claudication affects approximately
• 5% of men aged over 50 years.
The ABPI in patients with intermittent claudication is usually between
Regarding intermittent claudication at 5 years after diagnosis of patients with intermittent claudication will have progressed to amputation.
At 10 years after diagnosis of patients with intermittent claudication will have died from ischaemic heart disease.
Noradrenaline is an
• alpha and beta1 agonist with no clinically significant beta2 effects.
Isoproterenol is a powerful
• beta agonist with virtually no alpha effects.
The tibial nerve:
- • branch of the sciatic nerve.
- • descends through the popliteal fossa and lies on popliteus. It then runs inferiorly on tibialis posterior with the posterior tibial vessels and passes into the foot by running posterior to the medial malleolus.
- • It terminates beneath the flexor retinaculum ->dividing into the medial and lateral plantar nerves.
At rest the blood in the coronary vein is
• 25% saturated with oxygen.
The blood flow in the coronary artery is
• directly proportional to the mean arterial blood pressure.
Transmission of rotavirus is
- • primarily via the faeco-oral route
- • but also via airborne spread in some cases.
The Norwalk virus has been linked to outbreaks in
• institutions such as nurseries, retirement homes, schools and hospitals.
This is the end-diastolic volume (EDV).
approximately 120 ml of blood is present in the ventricles.
Eosinophilia is defined as an eosinophil count
• > 0.5 x 109/l.
Tropical eosinophilia is caused by
- • Wucheria bancrofti, a type of filarial infection.
- • asthma, coughing and splenomegaly.
The inguinal canal transmits the
- • spermatic cord in the male
- • round ligament in the female.
- • ilioinguinal nerve in both sexes.
The deep inguinal ring lies
• 1 cm above the midpoint of the inguinal ligament.
The superficial inguinal ring lies
• above and medial to the pubic tubercle.
The prothrombin time measures the
- • extrinsic pathway of coagulation
- • measures factors I, II, V, VII and X.
The prothrombin time is prolonged in the presence of
- • vitamin K deficiency
- • liver failure
- • warfarin usage
- • disseminated intravascular coagulation.
Bernard-Soulier syndrome is a rare
- • autosomal recessive coagulaopathy
- • deficiency of glycoprotein Ib.-> thrombocytopenia and increases the bleeding time.
Heparin binds to and activates
• antithrombin III.-> inactivates thrombin and factor Xa ->anticoagulant effect->increases the prolonged (APTT)
The ulnar nerve arises from the
• medial cord of the brachial plexus.
The ulnar nerve lies
• medial to brachial artery at the midpoint of the humerus.
The ulnar nerve supplies
- • flexor carpi ulnaris
- • medial half of flexor digitorum profundus
- • hypothenar muscles
- • interossei
- • adductor pollicis
- • medial 2 lumbricals.
The concentration of H+ ions in normal arterial blood is
• 36-44 nmol/l.
The pH scale is a
• logarithmic scale.
Proteins and phosphates are the main intracellular buffers. The main extracellular buffers are
• plasma proteins and bicarbonate.
Secretin stimulates the release of:
- • Pepsin
- • Glucagon
- • Pancreatic polypeptide
- • Somatostatin
- • It enhances the effects of cholecystekinin.
Drugs that cause a type B lactic acidosis include
- • metformin
- • alcohol
- • salicylates
- • methanol
- • cyanide
- • theophyllines
- • nitroprusside
- • catecholamines.
Systemic disorders causing type B lactic acidosis include
- • sepsis
- • renal failure
- • liver failure
- • diabetes mellitus.
The causes of papillary constriction (miosis) include:
- • Age related senile miosis
- • Pontine haemorrhage
- • Horner’s syndrome
- • Argyll-Robertson pupil
- • Systemic drugs e.g. opiates
- • Topical drugs e.g. pilocarpine drops
- • Myotonic dystrophy
UNCOMMON features of salicylate poisoning include:
- • Haematemesis
- • Hyperpyrexia
- • Hypoglycaemia
- • Thrombocytopaenia
- • Disseminated intravascular coagulation
- • Renal failure
- • Non-cardiogenic pulmonary oedema
COMMON features of salicylate poisoning include:
- • Nausea and vomiting
- • Tinnitus
- • Lethargy
- • Dizziness
- • Restlessness
- • Sweating
- • Bounding pulses
- • Warm extremities
- • Hyperventilation
- • Acts mainly as an alpha1 adrenergic receptor agonist.
- • Causes a reflex bradycardia.
- • used in small bolus doses of 0.5-1mg and titrated to effect.
- • Onset of effect following intravenous injection is within 1-2 minutes.
Listeria monocytogenes can cause
- • intrauterine death
- • fetal abnormalities.
Toxoplasmosis can cause
- • intrauterine death
- • growth retardation
- • mental retardation
- • ocular defects including blindness.
Cytomegalovirus can cause
- • intrauterine death
- • hearing loss
- • visual impairment
- • blindness
- • mental retardation and epilepsy.
The following veins pass through the thoracic inlet:
- • Internal jugular veins
- • Subclavian veins
- • Brachiocephalic veins
• triceps in extending the forearm.
Anconeus is innervated by the
• radial nerve.
The following are examples of non-absorbable sutures:
- • Silk
- • Nylon (Ethilon)
- • Polyamide
- • Polypropylene (Prolene)
The IV dose of mannitol is
- • 0.25-2 g/kg over 1 hours.
- Gastrin is released in response to
- • vagal stimulation
- • stomach distension
- • presence of partially digested proteins, in particular amino acids.
- • Its release is inhibited by the presence of acid and somatostatin.
Cholecystokinin is a peptide hormone produced and released by the
• I-cells in the duodenum.
In order to diagnose COPD the
- FEV1 must be < 80%
- FEV1/FVC ratio < 0.7.
The classification of COPD according to FEV1 is as follows:
- • Mild COPD: FEV1 60-80% predicted
- • Moderate COPD: FEV1 40-60% predicted
- • Severe COPD: FEV1 < 40% predicted
The lungs become hyper-inflated in COPD, which results an
• increased total lung capacity and an increased residual volume.
The vital capacity usually in COPD.
• remains normal
The normal range for creatinine in an adult male is
• 60-110 µmol/l.
The plasma osmolality is calculated using the following formula:
• Plasma osmolality = 2(Na + K) + Urea + Glucose
This is blackwater fever and is caused by
- • Plasmodium falciparum.
- • An autoimmune reaction between the parasite and quinine
- • causes haemolysis, haemoglobinuria, jaundice and renal failure. This can be fatal.
Plasmodium falciparum has an incubation period of
• 7-14 days.
The action of morphine action -> responsible for its main analgesic effects.
• µ-opioid receptors
The action of morphine action ->responsible for spinal analgesia.
• (x)κ-opioid receptors
The half-life of morphine is
- • 2-3 hours.
- • It has an onset of action of approximately 5 minutes.
Morphine has a duration of action of 1-2 hours whilst fentanyl has a duration of action of
• 30-40 minutes.
Obligate anaerobes are bacteria that live and grow in the absence of oxygen. Examples include:
- • Bacteroides spp
- • Clostridium spp
- • Peptostreptococcus spp
- • Trepenoma spp
- • Actinomyces spp
Listeria monocytogenes is a
• facultative anaerobe.
Examples of amine hormone
- • Dopamine
- • Thyroxine
- • Serotonin
The following are examples of peptide hormones:
- • Adrenocorticotropic hormone (ACTH)
- • Angiotensinogen and angiotensin
- • Atrial-natriuretic peptide (ANP)
- • Calcitonin
- • Cholecystokinin (CCK)
- • Corticotropin-releasing hormone (CRH)
- • Erythropoietin
- • Follicle stimulating hormone (FSH)
- • Gastrin
- • Gonadotropin-releasing hormone (GnRH)
- • Growth hormone-releasing hormone (GHRH)
- • Human chorionic gonadotropin
- • Growth hormone
- • Insulin
- • Insulin-like growth factor
- • Luteinizing hormone (LH)
- • Oxytocin
- • Parathyroid hormone (PTH)
- • Prolactin
- • Secretin
- • Somatostatin
- • Thyroid-stimulating hormone (TSH)
- • Thyrotropin-releasing hormone (TRH)
- • Brain natriuretic peptide (BNP)
- • Endothelin
- • Renin
- • Vasopressin
In type 4 renal tubular acidosis there is
- • hyporeninaemic
- • hypoaldosteronism
- • hyperkalaemia
- • mild renal impairment.
Type 4 RTA is commonly associated with
• diabetic nephropathy.
In alveoli that are ventilated but not perfused
• V/Q = infinity.
In alveoli that are perfused but not ventilated
• V/Q = zero.
A physiological shunt of
- • 4% can be present in an healthy individual.
- As shunts represent areas where gas exchange does not occur, 100% inspired oxygen will be
- • unable to correct the hypoxia caused by it.
The following are recognized side effects of suxamethonium:
- • hypotension
- • excessive salivation
- • malignant hyperthermia
- • muscle pains
- • rhabdomylosis
- • bradycardia
- • arrhythmias
- • hyperkalaemia
- • raised intraocular pressure.
The normal intracranial pressure in the resting state is 10 mmHg
- The normal intracranial pressure in the resting state is approximately
- • 10-15 mmHg.
Raised intracranial pressure is associated with
- • hypertension
- • bradycardia
- • Cheyne-Stokes (periodic) respiration.
The Sabin vaccine is the oral polio vaccine (OPV) and contains
• live attenuated strains of polioviruses 1-3.
The Salk vaccine is the
• inactivated polio vaccine (IPV) and therefore carries no risk of vaccine related polio.
The Sabin vaccine virus is
• excreted so therefore provides community benefit. Contacts of the recently immunized individual may get a second-hand dose of the vaccine.
The Salk vaccine is safer in
• immunocompromised individuals as it is an inactivated virus.
The Sabin vaccine is a live attenuated vaccine and should be avoided in the
- • immunocompromised and their household contacts.
- Deficiency in Von Willebrand factor (vWF) can result in a reduction in
- • factor VIII levels as vWF binds to factor VIII to protect it from rapid breakdown within the blood. vWF is also required for platelet adhesion and a deficiency of it will also result in abnormal platelet function.
The clinical severity of haemophilia is classified according to the factor level as:
- • severe = factor level < 1% of normal
- • moderate = factor level 1-5% of normal
- • mild factor level > 5% of normal.
Desmopressin can be used prophylactically in
- • mild haemophilia A when it is given intra-nasally.
- • Haemophiliacs should never be given intra-muscular injections.