1
Q
Which antiviral is a nucleotide reverse transcriptase inhibitor
A
Tenofovir, the others are nucleoside
2
Q
Which part of the meniscus is vascular/avascular
A
Medial and lateral meniscus out 1/3rd is vascular
Inner 2/3rds is avascular
3
Q
What is propafenone
A
Class 1c antiarrhythmic, similar to beta blocker with weak beta blocking activity
4
Q
What is the half life of
Enalapril
Paracetamol
Aspirin
Digoxin
Warfarin
A
Enalapril 3
Paracetamol 1-2
Aspirin 15mins
Digoxin 39
Warfarin 37
5
Q
How does the EHL tendon cross the tibialis anterior artery med to lat or lat to medial
A
Lateral to medial
6
Q
Where are MHC receptors found
What do they interact with
A
Antigen presenting cells
MHC I for CD8
MHCII for CD4
7
Q
How do sodium valproate, phenytoin and phenobarbitone affect clearance of Carbamazepine
A
Valproate inhibits clearance
- Cyp inhibitor
Phenytoin and phenobarbitone increase clearance
- Cyp inducers
8
Q
What is the Vd and T1/2 of Valproate
A
Vd 10.5/70kg
T1/2 9-18hrs
9
Q
How does food affect the absorption of L-dopa
A
Food delays absorption of L dopa
10
Q
What is the most common side effect of procainamide
A
Hypotension
11
Q
What is the duration of action of the following NM blockers
Mivacurium
Atracurium
Vecuronium
Rocuronium
Pancuronium
A
Mivacurium 10-20
Atracurium 20-35
Vecuronium 20-35
Rocuronium 20-35
Pancuronium 35-40
12
Q
Which inhaled anaesthetic has the greatest MAC out of NO2, Halothane, Isoflurane, Methoxyflurane
A
NO 100%
Isoflurane 1.4%
Halothane 0.75%
Methoxyflurane 0.16%
13
Q
Which NM blocker causes the greatest histamine release
A
Mivacurium
plus
Atracurium
14
Q
Which NM blockers have little to no effect on CVS
A
Vecuronium
Atracurium
Pipecuronium
15
Q
How do you distinguish Amide from Ester local anaesthetics
A
Amide’s have 2 ‘i’s in their name e.g. prilocaine, lignocaine
Ester’s do not
Cocaine, procaine
16
Q
What is the relating feature between carbamazepine and TCA
A
They have a similar chemical structures, their MOA’s are unrelated
17
Q
What is buspirone
A
Non benzo anxiolytic
Partial agonist 5HT
Presynaptic agonist D2
Partial alpha 1 receptor agonist
18
Q
Whats the difference between salicysm and cinchonism
A
Chinconism from bark of chincon tree has tinnitus similar to aspirin toxicity but usually normnal haemodynamics
19
Q
What are the toxic effects of phenyotin
A
Nystagmus, diplopia, ataxia
Gingival hyperplasia
Hirsuitism
Coarse facial features
Hyporeflexia
Vitamin D deficiency
Foetal hydantoin
Low folate and megaloblastic anaemia
20
Q
What is pramipexole
A
Dopamine agonist used in Parkinson’s and restless legs syndrome
Non-ergot derivative
High affinity for D2, D3
Directly stimulate striatum
21
Q
What is pralidoxime
A
Antidote for organophosphate poisoning
Needs to be given before irreversible binding
Given with atropine
22
Q
What is dantrolene
A
Antidote for malignant hyperthermia acting on Ca channels
23
Q
What is the earliest manifestation of lithium toxicity
A
Tremor
24
Q
What food substance affects MAO inhibitors
A
When taken with Tyramine causes severe hypertension
25
What is the order of blockade of local anaesthetics
Sympathetic
Pain
Temperature
Touch
Proprioception
C, B, A
26
What is transient neurological syndrome
Rare but devastating complication of neuraxial local anaesthetic administration i.e. spinal and epidural
Most frequently from lidocaine
27
What is lamotrigine
Na channel blocker used in insomnia
Lama Yeshe, monks don't sleep!
Steven's Johnson risk
28
How is ACh formed and broken down
Acetyl Coenzyme A + Choline -> ACh
Via Choline acetyl transferase (CHAT)
Acetylcholinesterase breaks it down
Acetate and choline
29
Barbituates vs benzos
GABAa potentiators
Barbie keeps her legs open for longer
Benzo increased frequency
30
What is felbamate
Used for focal epilepsy
31
Which MAOi is irreversible
Tranylcypromine
32
What is Pyrimethamine
Antimicrobial 1st line in combo with sulfadiazine to treat toxoplasmosis
It is a dihydrofolate reductase inhibitor
Has action againsy Fallciparum vivax and ovale
33
What activity does Chloramphenicol have
Against the three main types of meningitis
- Meningococcus
- Strep pneumonia
- Haemophilus influenza
Not used because of toxicity
34
Which abx should be avoided in G6PD deficiency
Sulphonamides due to haemolytic anaemia
35
Which antihypertensives are arterial only
Hand Foot And Mouth Disease
Hydralazine
Fenlodopam
Minoxidil
Diazoxide
36
What are drugs used in treating Pneumocystis J
Co-trimoxazole
Pentamidine
Clindamycin plus primaquine
Atovaquone
Trimethoprim-Dapsone
37
What is the half life of the following NSAID's
Aspirin
Diclofenac
Ibuprofen
Indomethacin
Celecoxib
Naproxen
Piroxicam
All Day I Imagine Chewing Nice Potatoes
Aspirin 15mins
Diclofenac 1.1hrs
Ibuprofen 2hrs
Indomethacin 4-5hrs
Celecoxib 11hrs
Naproxen 14hrs
Piroxicam 57hrs
38
What is Winter's formula
(1.5xHCO3)+8 +/- 2
What is expected CO2
39
What is the H2CO3:HCO3 ratio at the following pH's
6.0
7.1
7.3
7.4
6.0 = 0.9
7.1 = 10
7.3 = 16
7.4 = 20
40
When is urine acidification used
In overdose of methamphetamine and PCP OD
Alkilinsation used in aspirin
41
How does splenectomy affect plts
Increases platelet numbers, less sequestered and destroyed
42
Which tissue contains no bradykinin
RBC's
Bradykinin found in pancreas, kidneys, salivary glands, pituitary, prostate, testes
43
What affect does dopamine have on the kidneys
Natriuresis
44
Which sedative in contraindicated in porphyria
Phenobarbitones
45
How many urea transporters are there
4
46
What affect does bicarb have on dopamine
Dopamine is inactivated by bicarb
47
What is the O2 concentration of 1ml of blood at 100% sats
1.34ml/mlO2
48
Which cephalosporins contain a methylthiotetrazole group
Why is this relevant
Cefamandole
Moxalactam
Cefmetazole
Cefotetan
Cefoperazone
Can cause hypoprothrombinaemia, 10mg Vit K can prevent this
49
What are the following qualities of 1L NaCl 0.9%
mmol of Na
mmol of Cl
g of NaCl
mosmol
pH
154mmol of Na
154mmol of Cl
9g of NaCl
308mosmol
pH 5.0
50
Hartmann's values for
mmol/L Na
mmol/L Cl
mmol/L Lactate
mmol/L K
mmol/L Ca
mOsm/L
131mmol/L Na
111mmol/L Cl
29mmol/L Lactate
5mmol/L K
2mmol/L Ca = 4mEq/L
279mOsm/L
51
What is the concentration of CO2 per DL of blood
49ml/dL
52
What is the Sublime tubercle
Anteromedial facet of coronoid process that ulnar nerve lies on
53
Which Abx have little protein binding
Amikacin, Tobra, Gent
Amoxicillin, ampicillin
Acyclovir
Cephalexin
Zidovudine 25%
Ethambutol
54
Which CVS drugs have little protein binding
Atropine
Atenolol
Digoxin
Clonidine
Metoprolol
Sotalol - not metabolized by liver either
55
Which anti-inflammatories have little protein binding
Paracetamol
Methotrexate
56
What other drugs have little protein binding
Lithium
Terbutaline
Cimiteidine
Procainamide
57
Which drugs aren't metabolized by the liver
Lee Is Very Mad At Destroying His HAT
Lithium
Insulin - kidneys
Vacomycin - minimal heptic
Metformin - not metabolized
Aminoglycosides - renal excretion unchanged
Heparin - RES system
Hoffman elimination of atracurium
58
Which drugs inhibit osteoclasts
Bisphosphonates
Calcitonin
Oestrogen
Denosumab
59
What is the difference in T1/2 between 25VitD and 1,25VitD
25Vit D T1/2 = several weeks
1,2VitD = hours
60
What do the following drugs do
Buspirone
Ketanserin
Cyproheptadine
Buspirone - Non benzo anxiolytic
- Partial agonist 5HT1A
- Presynaptic agonist D2
- Partial alpha 1 receptor agonist
Ketanserin
- 5HT2 antagonist
- Potently blocks alpha 1
Cyproheptadine
- H1 blocking
- 5HT2A blocking
61
Bowel transit times to caecum and passage
4hours to caecum
72hrs to a week for total passage
62
When is HCG first detectable in blood and urine
6 days in blood
2 Weeks in urine
63
What is the Wolf Chaikoff effect
Giving iodine inhibits T4 production
64
What are the following stains used for
Giemsa
India Ink
Silver stain
Acid fast
Acid Schiff
Giemsa = Lieshmaniasis, Campylobacter malaria
- Chlamydia
India ink = Cryptococcus (in HIV)
Silver stain = pneumocystis Jirovecii
Acid Fast = TB
Acid Schiff = Amoebiasis
65
Which is a quicker onset lactrodectism or irukandji
Red back 10-14
Irukandji 20-45
66
Which part of the nephron is iso-osmotic with the interstitium
Proximal thin descending limb
67
What is duret haemorrhage
2ry haemorrhage in transtentorial herniation
Duvet in a tent
68
What are the most common locations of the appendix
Retrocaecal = 64%
Pelvic = 32%
Retrocolic
Retroileal least
69
What are examples of the following joints
Fibrous
Primary cartilagenous
Secondary cartilaginous
Synovial
Fibrous - Distal tib-fib or radio-ulna or cranial sutures
Primary - costochondral
Secondary - symphysis , intervertebral disc
70
What part of the blood vessl is injured in Berry aneurysms
The tunica media
71
What effect does haemolysis have on haptoglobin
Reduced haptoglobin
72
What % of PE's cause lung infarction
What % ob pulmonary blood flow obstruction before haemodynamic compromise
5-15%
60%
73
What is the equation for the anion gap
Na + -( Cl + HCO3)
74
What are the main side effects of the TB drugs
R
I
P
E
Rifampacin - red/orange colouring
Isoniazid - peripheral neuropathy, take with pyridoxine
Pyrazinamide - Gout hyperuricaemia
Etham butol - Eyes, retrobulbar neuritis
75
What % is passive ventricular filling
What about atrial systole
70-80% passive
~20%
76
How do you remember the cephalosporin classes
1st Cephalexin, cephazolin
2nd Two FURry FOXes drinking TEa on th FLOR
Cefuroxime, Cefoxitin, Cefotetan, Cefaclor
3rd You can TRI TAXing me but you won't get a DIME
Ceftriaxone, Ceftaxime, Ceftazadime
4th CeFOURpime
Cefipime
5th CefSTARoline -> Stars 5points, MARS in space = MRSA
Ceftaroline
77
Which cephalosporin has pseudomonas cover
You can SUE me but you won't get a DIME
Ceftazadime 3rd
Cefipime
78
What is the relevance of aztreonam
Monobactam, no cross reactivity with other beta lactam antibiotics
Gram negatives only = pseudomonas
(Except ceftazadime because of a side chain)
No renal insufficiency
79
What are the carbapenems
Imipenem
Carbapenem
Meropenem
80
Which carbapenem is given alongside cilastin
Imipenem because it causes proximal tubule toxicity
81
Which cerbapenem does not cover psuedomonas
Ertapenem
E = exception to rule
82
Which aminoglycoside has less resistance to
Amikacin
83
What do tetracyclines cover
Gram -ve, gram +ve incl MRSA, atypicals and weird stuff
Sitting on a DOCK by the SEA (DOXYCYCLINE) eating CLAMS, having ROCK oysters with squeeze LIME
Chlamydia
Rocky Moutain Spotted Fever
Lyme Disease
84
Which antibiotic is affected by antacids
Tetracyclines
Fluoroquinolones
85
What is the difference between the fluoroquinolones
Moxifloxicillin
- Respiratory fluro
- Best gram +ve cover, atypicals and anaerobes
Levofloxacillin
- Respiratory fluroquinolones
- Good gram +ve, atypical
Ciprofloxacillin
- Urinary fluoroquinolone
- Has a P, used for urine, prostatitis
- Best gram -ve coverage incl pseudomonas
86
What are the notable side effects of fluoroquinolones
QT prolongation
Tendinopathy
Precipitate myasthenic crisis
87
What are the high yeild indications for Macrolides
Chlamydia
Mycobacterium Avium Complex MAC for MAC
Community acquired pneumonia
Gastroparesis
COPD bacterial exacerbation
88
High yeild indications for Vancomycin
Poorly absorbed PO therefore useful for C Diff
MRSA
89
Which cancers usually metastasize to bone
Usually organs with two lobes
Lung
Breast
Prostate
Kidneys
Thyroid
Ovaries
70% of advanced breast or prostate have bony metastases
90
What pH is pyrazinamide active at
Acidic
91
Desfuroxamine increases chances of which infection
Yersinia
92
Which knee ligament forms part of the capsule
Medial collateral
Attaches to medial meniscus
The lateral is separated from the meniscus by the popliteal ligment
93
Which non depolarising NM blocker is excreted via the kidney which by the liver
Pancuronium kidney
Vecuronium by liver mostly
94
Which penicillin does not need dose adjustment
Dicloxacillin
95
Which vessel umbilial or uterine has the lowest PO2
Umbilical artery ~60% saturated
96
What is the maximal voluntary ventilation
125-170L/Min
97
Which vertebra have the largest vertebral foramen
Largest: Cervical
Lumbar
Smallest: Thoracic
98
What are the intermediate extrinsic back muscles
1. Superficial respiratory muscles
- Serratus inferior posterior
- Serratus superior posterior
99
What are the roots supplying axillary nerve
C5, C6
100
What percentage of pts using metoclopramide will develop EPSE's
5%
101
How well can clindamycin treat abscesses
Very well, penetrates abscesses
102
What is the half life of octreotide
80mins
103
How does tolerance to nitrates develop
Tolerance to nitrates is postulated to occur by 3 mechanisms:
Increased ROS
Reduced cGRP
DECREASED sulphhydryls
104
What organism causes scarlett fever
Strep pyogenes
105
What percentage of pts with Parkinson's will develop dementia
10%
106
What is the pressure definition of Pulmonary Arterial Hypertension
>25mmHg mean pulmonary artery pressure
107
What is a split second heart sound
The aortic valve closing just before the pulmonary valve in inspiration
108
What ion the the Noradrenaline transporter NET use
Sodium
109
Where does lymph from the larynx drain to
Above the vocal cords
- Superior deep cervical lymph nodes
Below the vocal cords
- Pre and paratracheal ymph nodes
110
What is the nerve supply of the digastric muscle
Anterior: V3
Posterior VII
111
112
113
How are fluoroquinolones predominantly metabolized. What is the exception
Predominantly renally excreted
Moxifloxacin is metabolised in liver
113
What are the tension lines in the skin called
Langer's lines
114
What level does the oesophagus start
C6
Same as trachea
Laryx in C3-C6
115
How does the H1 receptor cause its effect (which intracellular signalling pathway)
IP3 and increased intracellular calcium
116
How do the folowing affect warfarin use
Protein C deficiency
GI malignancy
Protein C: Hypercoaguable state
GI Ca: Resistance to therapy
117
What level of CO causes coma and death
60-70%
118
What is the most common cause of intestinal obstruction globally
Globally: hernias
Some countries like the US: Adhesions
In children: Intussuception
119
What % of acute hep C infections are asymptomatic
85%
Despite 80-90% eventually developing chronic hep C and cirrhosis
120
How does polio enter the body
Uptake through M cells in the GI tract
121
What are multinucleate cells pathognomic of
Measles
These giant cells are also called Warthin-Finkeldey cells.
122
What are the two different forms of cerebral oedema
Vasogenic: BBB disrupted
- Neoplasm
- Infection
- Ischaemia - late
Cytotoxic
- Early stroke
- Hypoxia
- Cardiac arrest
123
What is the mortality rate of mesothelioma at 1 year
What effect does smoking have
What is the latent period
What % of exposed workers will develop it
50%
No effect from smoking
Can be 25-45 years
10% - more likely to die from Lung Ca
124
How long does it take to develop serum sickness
10 Days
125
Which lymph nodes do Hodgkin's lymphoma rarely affect
Mesenteric
126
What are the impotant differences between Hodgkin and Non-Hodgkin lymphoma
1. HL = Reed- Sternberg cells, B cell, monoclonal
NHL = No Reed-Sternberg cells, B cells, T cells, NK
2. HL = contiguous spread
NHL = non contiguous, disseminated at presentation often
3. HL = Extranodal involvement is uncommon
NHL = can involve GI, Skin, CNS, bone marrow
4. HL = bimodal, young adults and 55
NHL = increases with age
5. HL = EBV association
NHL = HIV, Transplant, immunodeficiency
6. HL = painless LN, Curable
NHL = Can be aggressive and highly aggressive
127
Where does mitochondrial DNA come from
Maternal inherited
128
What is vitamin E deficiency associated with
Ataxia
129
Which is larger albumin of fibrinogen
Fibrinogen 340kDa
Albumin 69kDa
130
Which induction agent can cause a porphyric crisis
Thiopental
Thiopental is a barbiturate which induces CYP450, increasing demand for heme synthesis
Up regulate ALA synthase -> accumulation of porphyria precursors
131
What is an example of an irregular bone
Flat
Short
Long
Sesamoid
Facial
Flat - Cranium
Short - Carpal, tarsal
Long - humerus
Sesamoid - Patella
132
What nerves innervate the intrinsic back muscles
The posterior rami of spinal nerves
133
Which scapulo-humeral muscle is not a shunt muscle
Biceps brachii
134
Which antipsychotic is the least sedating
Which is the most
Aripiprazole
Chlorpromazine
135
What bug are cephalosporins ineffective against due to poor PBP binding
Ampicillin and Penicillin G are effective against this organism
Listeria
Add ampicillin in neonates
136
What is a paradoxical effect of antihistamines in children
Can cause excitation
137
What is the normal Hb concentration of 100mls of blood
15g per 100ml
15x1.39 = 20.8ml/100ml oxygen carrying capcity of blood
138
What is the oxygen concentration of dissolved oxygen in blood
0.003ml/dl.mmHg
139
Where and how does the thoracic duct cross the IJV
It crosses behind the LEFT IJV at C7
140
Which antibiotics are the best for antiprotozoal use
Not should be used in monotherapy in protozoa treatment
Metronidazole
Tetracycline - Doxycycline(+quinine)
Clindamycin slowly
Azithromycin and fluoroquinolones demonstrated efficacy but suboptimal
141
When do youhen is the first urge to void felt
150ml
142
What happens to GFR, plasma flow and filtration fraction during a fall in systemic blood pressure
Renal plsma flow falls more than GFR
Therefore increase in filtration fraction
143
What is the mol/l concentration of H+ pH 7.4
0.00000004
=4x10^-8
144
Does neuropeptide Y vasodilate or vasoconstrict
Vasoconstrict
Constrict until you neuopeptDied
145
How much does the MAP increase by for every cm below the heart
0.77mmHg
146
What is the O2 usage of the heart beating at 100/min
910ml/min
147
What are the factors that decrease growth hormone secretion
REM sleep
Glucose
Cortisol
FFA
Medroxyprogesterone
Growth hormone
IGF-1
148
In which tissue does thyroid hormone not have a calorigenic action
Brain
Testes
Uterus
Lymph nodes
Spleen
Anterior pituitry
149
Where is thirst control in the brain
Anterior hypothalamus
150
What is the biosynthesis of cholesterol
Aceto-acetylCoA ->
3-hydroxy-3-methylglutaryl-CoA (via HMG-CoA reductase) ->
Mevalonic acid (6x molecules) ->
Squalene
Cholesterol
151
What are the major anions/cations in:
ECF - Plasma
ECF - Interstitium
ICF
ECF:
Cations: Na
Anions: HCO3 25, Cl 100
- also Protein
ECF:
Cations: Na
Anions: HCO3 25, Cl 105
- No protein
ICF:
Cations: K 160
Anions: Phos 140, Protein 50
152
What is the absorption of vitamin B12
1. Released from food in acid in stomach
- binds to Haptocorrin from saliva
2. Pancreatic protease degrade haptocorrin, free B12 binds instrinsic factor (from parietal cells)
3. IF-B12 complex binds specific receptors in the ileum
153
How many mmol/ml does 8.4% NaHCO3 contain
1ml/ml
154
What is the equation for GFR
Urine concentration x Volume of urine produced / Plasma concentration
You can use haematocrit after to work out renal blood flow
155
What percentage of ATP is used for gluconeogenesis
9%
156
What is the main inhibitory neurotransmitter in the spinal cord
Glycine
157
WHat is suggamadex
It is a modified gamma cyclodextrin designed to selectively reverse the effects of the neuromuscular blockers rocuronium and vecuronium. There is evidence to suggest it is effective against pancuronium. It works by forming a complex with these drugs, reducing their availability to bind to nicotinic receptors in the neuromuscular junction
158
What is the action of hydrocortisone in Graves
Blocks peripheral conversion of T4 to T3
Also blocked by propylthiouracil and propranolol
159
What tissues does progesterone have effect on
Progesterone also has effects on
Brain: depressant an dhypnotic effects on the brain.
Breast: alveolar development
Endometrium: maturation following ovulation
Body temp: increases
Kidneys: competes with aldosterone for the mineral corticoid receptor in the renal tubule causing a decrease in sodium reabsorption.
Liver: promotes glycogen storage
160
What is Agammaglobulinaemia
Bruton Agammaglobulinaemia
X-linked
B cells fail to mature
Humoral arm of adaptive immunity
After 6 months of life
Recurrent respiratory diseases
161
What is Sixk Euthyroid syndrome
Sick euthyroid syndrome is a biochemical pattern of decreased circulating T3 levels, without a strong compensatory TSH response. It is due to a dysregulation of normal hormonal feedback in critical illness.
Extra:
Typical TFT abnormalities in sick euthyroid syndrome
T3: low
rT3: high
T3/rT3 ratio: low
T4: high or normal
TSH: high or normal
The above reflects the fact that normal hormonal feedback is dysregulated in critical illness. The “sick euthyroid” syndrome is part of the generalised response to critical illness, and reflects a sort of “hormonal economy”
162
What is Henoch-Schonlein purpura
Childhood syndrome 3-8yo
Purpuric skin lesions
- Extensor surfaces, buttocks
Abdo pain and intestinal bleeding
Arthralgia
Kidney issues
- Occur in 1/3rd of pts
- Haematuria, nephrotic or nephritic syndrome
163
What happens to thrombopoeitin when plts are high and low
Factor that promotes platelet production
Less platelets less bound to thrombopoeitin, more available so more produced
More platelets more bound to thrombopoeitin, less available less produced
164
What was the GUSTO trial, what did it show
A trial comparing fibrinolytic drugs, importantly streptokinase+heparin vs alteplase+heparin
It showed 1% reduction in mortality using alteplase and so there was a shift to using this (streptokinase was the standard before because it was cheaper)
It showed that alteplase was associated with higher rates of intracranial haemorrhage but the mortality reduction benefit remained
165
What are normal and abnormal Q waves
Normal depolarization L to R. Seen in L sided leads I, aVL, V5, V6
Abnormal if seen on the R sided leads or
- >2mm deep
- 25% of QRS complex
- Seen in leads V1-V3
- >40ms wide 1mm
166
In the elderly population are phase I or phase II biotransformation affected more
Phase I
167
What is the azygous vein
Greek = unpaired vein
Forms collateral between the IVC and SVC, hence on R side
- Drains the posterior thoracic wall
- Arches over R lung root, similar to aorta on L side
- Recieves mediastinal, oesophageal and bronchial veins
168
What is the hemi-azygous vein
Travels on L side draining subcostal and lumbar veins
- Travels up to T9
- Passes behind aorta, thoracic duct, crosses to the R to join azygous
Above, T5-T8 drained by accessory hemi-azygous
169
ACEM Primaries
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