Mini Quizzes Sem 2

Question 1

A 75 year old woman presents to emergency with acute onset of dyspnoea. The following are her blood gas results: pH = 7.25 (Normal: 7.35 to 7.45) PaCO2 = 55 (Normal: 36 to 44 mmHg) HCO3- = 24 (Normal: 22 to 26 mmol/L). Which one of the following is the most correct interpretation of these findings?

1. Acute metabolic acidosis with no compensation
2. Acute respiratory acidosis with no compensation
3. Metabolic acidosis and respiratory acidosis
4. Metabolic acidosis with respiratory compensation
5. Respiratory acidosis with metabolic compensation

Answer 1

B. Acute respiratory acidosis with no compensation

• pH = 7.25 –> ACIDIC
• PaCO2 = 55 –> HIGH = respiratory
• HCO3 = NORMAL = no compensation

Respiratory acidosis = failure of ventilation and an accumulation of CO2

Patient unable to breath out the accumulation CO2 –> results in decreased ratio of arterial bicarbonate to arterial PCO2

To compensate for the disturbance in the balance between CO2 + HCO3-, the kidneys begin to excrete more acid in the forms of H+ and NH4+ and reabsorb more base in the form of HCO3. Here, HCO3 levels are normal so kidneys not doing that yet!

Question 2

A 14-year-old boy presents with an acute onset of wheezing, cough and dyspnoea. He is having difficulty speaking in sentences. He has a long history of mild intermittent asthma. His symptoms are temporarily improved by inhaled bronchodilators. On chest auscultation he has widespread wheezing. Which one of the following is the corticosteroid medication that should be recommended for this patient?

1. Budesonide
2. Beclomethasone
3. Disodium cromoglycate
4. Prednisolone
5. Salbutamol

Answer 2

1. Budesonide → ICS but preventor
2. Beclomethasone → ICS but preventor
3. Disodium cromoglycate → Not a corticosteroid = Cromo
4. Prednisolone → ICS but more immediate than the others
5. Salbutamol → Not a corticosteroid = B2 receptor agonist

Budesonide and Beclomethasone are only locally acting in the lungs, so they’re not going to do too much in an acute asthma attack.

Pred will work systemically, and calm the immune response down enough to get the patient stable.

Question 3

A 35-year-old man is taking a medication that suppresses his immune system. Which one of the following vaccines is contraindicated in this patient?

1. Influenza
2. Hepatitis B
3. Measles
4. Pertussis
5. Tetanus

Answer 3

A 35-year-old man is taking a medication that suppresses his immune system. Which one of the following vaccines is contraindicated in this patient?

1. Influenza
2. Hepatitis B
3. Measles
4. Pertussis
5. Tetanus

Question 4

A 75-year-old woman is prescribed oral corticosteroids over a 6-month period after being diagnosed with polymyalgia rheumatica. Which one of the following is the most likely long-term side effect of this medication?

1. Diplopia
2. Hyperkalaemia
3. Muscle hypertrophy
4. Suppression of catecholamine release
5. Suppression of normal response to infection

Answer 4

1. Diplopia = double vision
2. Hyperkalaemia
3. Muscle hypertrophy
4. Suppression of catecholamine release
5. Suppression of normal response to infection → affect the way WBCs work

Question 5

A 60-year-old man is admitted to the medical ward with an acute onset of dyspnoea. The following are his arterial blood gas results: pH = 7.01 (7.35 to 7.45) PaCO2 = 105 mmHg (36 to 44) HCO3- = 28.6 mmol/L (22 to 26). Which one of the following is the most correct interpretation of these findings?

1. Acute metabolic acidosis with no compensation
2. Acute respiratory acidosis with no compensation
3. Metabolic acidosis and respiratory acidosis
4. Metabolic acidosis with respiratory compensation
5. Respiratory acidosis with metabolic compensation

Answer 5

E. Respiratory acidosis with metabolic compensation

• pH = 7.01 = Acidic
• PaCO2 = HIGH → Respiratory
• HCO3- = HIGH → Compensation by kidneys (↑HCO3 and ↓H+ and ↓NH4+)

Question 6

To be effective at providing protection in a population, vaccines do not need to be 100% effective in all individuals that are vaccinated. This is because:

1. Not all individuals may be exposed to the infectious agent
2. Not all individuals may choose to be vaccinated
3. If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
4. The infectious agent might not cause serious disease in all individuals
5. Only humoral responses are required

Answer 6

1. Not all individuals may be exposed to the infectious agent
2. Not all individuals may choose to be vaccinated
3. If the majority of individuals are protected the chances of exposure of non-immunised individuals will be reduced
4. The infectious agent might not cause serious disease in all individuals
5. Only humoral responses are required

Question 7

Which one of the following structures carries nutrient and oxygenated blood?

1. coronary arteries
2. great cardiac vein
3. inferior vena cava
4. pulmonary arteries
5. superior vena cava

Answer 7

Which one of the following structures carries nutrient and oxygenated blood?

1. coronary arteries = supply the heart itself with O2
2. great cardiac vein = deoxygenated
3. inferior vena cava = big vein (deoxygenated)
4. pulmonary arteries = carry deoxygenated blood to the lungs to be oxygenated
5. superior vena cava = big vein (deoxygenated)

Question 8

In spermatogenesis:

1. FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
2. FSH and LH are produced by the Sertoli and Leydig cells as they mature during puberty
3. Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids
4. The Sertoli cells produce the male sex hormone, testosterone
5. The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa

Answer 8

In spermatogenesis:

1. FSH and LH levels in the blood stream rise during the early stages of puberty to allow the testes to grow and mature
2. FSH and LH are produced by the Sertoli and Leydig cells as they mature during puberty → FALSE: FSH & LH are produced by the anterior pituitary and Sertoli cells = seminiferous tubules & Leydig cells = interstitial cells adjacent to the seminiferous tubules in the testes.
3. Testosterone is secreted by the anterior pituitary to control the maturation of the spermatids → FALSE: Leydig cells secrete testosterone
4. The Sertoli cells produce the male sex hormone, testosterone → FALSE
5. The maturation of the sperm is complete when the Leydig cells consume the unneeded portion of the spermatozoa → FALSE: The Sertoli cells do that

Question 9

Each of the cardiac valves:

1. opens and closes in response to changes in pressure
2. attaches to the ventricular walls via chordae tendinae
3. ensures two-way blood flow through the heart
4. receives blood supply directly from the coronary artery
5. has three leaflets

Answer 9

Each of the cardiac valves:

1. opens and closes in response to changes in pressure
2. attaches to the ventricular walls via chordae tendinae → FALSE: only the mitral & tricuspid valves have this
3. ensures two-way blood flow through the heart → FALSE: one way or blood backflow (regurgitation)
4. receives blood supply directly from the coronary artery
5. has three leaflets → FALSE

4 heart valves

• 2 AV Valves: Mitral & Tricuspid
• 2 SL Valves: Pulmonary & Aortic
• 3 leaflets = Tricuspid & Pulmonary & Aortic
• 2 leaflets = Mitral (Bicuspid)

Question 10

A couple present to discuss fertility issues. They have been having unprotected intercourse for twelve months and are starting to worry that they might be infertile.

When taking a medical history from a couple regarding fertility, what are 6 relevant questions to ask each member of the couple?

Answer 10

Questions to Female

1. Menstrual history (regularity and timing)
2. Previous pregnancy
3. Frequency of intercourse & technique
4. Timing of intercourse
5. Contraception use
6. Age of partner

Questions to male

1. Past pregnancies
2. Age of partner
3. Frequency of intercourse & technique
4. Drug and alcohol use
5. Previous infections (eg mumps)
6. Damage or surgery to testes

Question 11

List and briefly describe 4 functions of the Sertoli cell in the seminiferous tubules of the testis.

(10 examples)

Answer 11

Sertoli cells - Functions

1. Support cell for developing sperm
2. Provides structural organisation to the tubul
3. Divides the seminiferous tubule wall into basal and luminal (or two) compartments
4. Separates mitotic spermatogonia from meiotic spermatocytes and spermatids
5. Controls metabolic exchange with spermatogenic cells
6. Forms the blood-testis barrier to prevent autoimmunity to sperm
7. Concentrates testosterone in the luminal compartment of the tubule
8. Phagocytoses the residual body from spermiogenesis
9. Anchors spermatogenic cells, especially spermatids (either cell type or both)
10. Secretes substances that regulate sperm production

Question 12

Choose the most appropriate missing words from the list below. You may use any of the words as many times as needed, or not at all.

spermatids, spermatogonia, spermatogenesis, spermatocytes, spermiogenesis, spermatozoa

1) ………….. are the source of new sperm through clonal proliferation.
2) …………… are stages of meiosis that end in the formation of ………..
3) The process of physical transformation of these cells into ……….. is called ………….

Answer 12

1) Spermatogonia are the source of new sperm through clonal proliferation.
2) Spermatogenesis are stages of meiosis that end in the formation of spermatids.
3) The process of physical transformation of these cells into spermatozoa is called spermiogenesis.

Question 13

List the 3 hormones necessary to maintain pregnancy?

Answer 13

Hormones necessary to maintain pregnancy:

1. Oestrogen
2. Progesterone
3. Human chorionic gonadotropin

Question 14

A 28 year old female patient seeks advice about starting a family. What are 5 key issues you would raise with her as she plans for conception and pregnancy?

Answer 14

Pre-conception Advice

1. Vaccination status – rubella, varicella
2. Folate supplementation
3. No smoking
4. Avoidance of alcohol
5. Dietary and exercise advice

Question 15

Briefly outline 3 ethical issues related to the use of artificial reproductive technologies.

Answer 15

Ethical issues around artificial reproductive technologies

1. Family relationships
   
   • The use of donor sperm, donor eggs and surrogacy can create issues around who is the legal as opposed to biological parent of the child.
   • Issues around the need to ‘adopt’ the child in some cases.
2. Informed consent.
   
   • The need for full disclosure and fair representation of all the potential medical, social and emotional outcomes and risks.
3. Embryo status
   
   • The ethical and legal status of the human embryo.

Question 16

The graph depicts a normal menstrual cycle. On the graph, label the 4 hormones involved:

Answer 16

The graph depicts a normal menstrual cycle. On the graph, label the 4 hormones involved:

1. E2 = Oestradiol → thickens the lining of the uterus
2. LH = Luteinizing Hormone → triggers release of egg
3. FSH = Follicle Stimulating Hormone →
4. Pr = Progesterone

FINISH THIS OFF !!

Question 17

Describe the Calendar Rhythm method (natural family planning) and explain the principles of this method, with reference to the normal menstrual cycle.

Answer 17

Calendar Rhythm Method of Contraception

A natural method of birth control that uses the menstrual cycle to predict the most fertile time of the month for ovulation and then to employ barrier or abstinence during this time to avoid fertilisation of the egg and therefore pregnancy.

The principles are to avoid intercourse 6 days before ovulation, on the day of ovulation and one day afterwards.

Question 18

What are two other methods used with the calendar rhythm method to naturally predict post-ovulation?

Answer 18

Methods used with the calendar rhythm method to naturally predict post-ovulation?

1. Ovulation method: checking for cervical mucus
2. Temperature method: checking body temperature noting a rise in temp after ovulation

Question 19

Briefly describe 3 mechanisms of action of the combined oral contraceptive pill.

Answer 19

Combined Oral Contraceptive Pill - Mechanism of Action

1. Hypothalamus suppression of ovary leading to anovulation
2. Altered tubal motility
3. Less receptive endothelium − Hostile cervical mucus

Question 20

What forms of progesterone-only contraception are available?

Answer 20

Progesterone-only contraception

1. Intramuscular depot injection (Depo-Provera)
2. Progesterone only oral pill (Mini-pill)
3. Levonorgestrel implant (implanon)

Question 21

What are two common reasons for the use of progesterone-only contraceptive options?

Answer 21

Indications for progesterone-only contraceptive

1. During breastfeeding
2. Women for whom estrogens are contraindicated (eg liver disease, migraine with aura, history of coagulopathy)

Question 22

List the 3 cardiac layers and identify the histological features of each layer.

Answer 22

Cardiac Histology - 3 Layers

1. Endocardium – simple squamous epithelium, connective tissue, collagen, elastin
2. Myocardium - cardiac myocytes
3. Epicardium – simple squamous epithelium, collagen, elastin; visceral layer of serous pericardium

Question 23

How is carbon dioxide carried in the blood? Complete the equation below:

CO2 + H2O →

Answer 23

Blood Buffer Equation

Question 24

Compare the differences in gas exchange in the lungs, and the peripheral tissues.

Answer 24

Gas exchage at the:

Lungs:

• O2 is picked up from alveoli, CO2 is released into the lungs from H2CO3, diffuses from plasma into the alveoli.
• Hb releases CO2 from carbamino haemoglobin, (HbCO2).
• O2 combines with acid Haemoglobin, HHb, to form oxyhaemoglobin, HbO2 and H+ is released.

Peripheral tissues:

• O2 is released to tissues from HbO2 on red blood cells, CO2 is picked up at the tissues.
• CO2 produced diffuses into plasma, where it dissolves and forms H2CO3.
• Haemoglobin buffers both CO2 and H+

Question 25

List the three main types of vaccines currently used in human vaccination:

Answer 25

1. Live attenuated whole virus vaccine 2. Inactivated whole virus vaccine 3. Subunit vaccines

Question 26

Vaccination aims to provide antigen-specific immunity. Describe how the immune response to vaccination protects an individual from infection.

Answer 26

The initial exposure to the pathogen in the vaccine provokes the adaptive immune response without causing infection. B cells and T cells are activated by antigen exposure to eliminate the infected host cells. Antigen-specific memory B cells are created which provide immunity upon subsequent exposure.

Question 27

A woman who is 10 weeks pregnant presents with symptoms indicating rubella infection. She is found to have raised IgM for rubella on her serology results. What are the implications for the development of her baby?

Answer 27

**Rubella infection during Pregnancy** * Raised IgM indicates current rubella infection. * In the first trimester of pregnancy this has serious outcomes for the development of the fetus. * Common congenital abnormalities associated with rubella include: 1. Cardiac defects 2. Hearing loss 3. Cataracts 4. Intellectual disability

Question 28

A 55-year-old man has been recently diagnosed with hypertension. His BP is 155/95 mmHg. Apart from the eGFR, which one of the following investigations is most appropriate to exclude renal complication? 1. 24-hour urine for creatinine. 2. 24-hour urine for protein. 3. Urine albumin:creatinine ratio. 4. Urine electrophoresis. 5. Urine microscopy.

Answer 28

1. 24-hour urine for creatinine. 2. 24-hour urine for protein. 3. **Urine albumin:creatinine ratio.** 4. Urine electrophoresis. 5. Urine microscopy.

Question 29

Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker? 1. Propranolol 2. Timolol 3. Sotalol 4. Metoprolol 5. Pindolol

Answer 29

Which one of the following drugs is a cardioselective ß1-adrenoceptor blocker? 1. Propranolol 2. Timolol 3. Sotalol 4. **Metoprolol** 5. Pindolol

Question 30

The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system? 1. Eye 2. Gastrointestinal tract 3. Heart 4. Salivary glands 5. Veins and arterioles

Answer 30

The predominant autonomic (resting) tone in which one of the following tissues is mediated by the sympathetic nervous system? 1. Eye 2. Gastrointestinal tract 3. Heart 4. Salivary glands 5. **Veins and arterioles**

Question 31

The Lineweaver-Burk plot is used to: 1. determine the equilibrium constant for an enzymatic reaction. 2. extrapolate for the value of reaction rate at infinite enzyme concentration. 3. illustrate the effect of temperature on an enzymatic reaction. 4. solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration. 5. solve, graphically, for the ratio of products to reactants for any starting substrate concentration.

Answer 31

The Lineweaver-Burk plot is used to: 1. determine the equilibrium constant for an enzymatic reaction. 2. extrapolate for the value of reaction rate at infinite enzyme concentration. 3. illustrate the effect of temperature on an enzymatic reaction. 4. **solve, graphically, for the rate of an enzymatic reaction at infinite substrate concentration.** 5. solve, graphically, for the ratio of products to reactants for any starting substrate concentration.

Question 32

A 43-year-old woman is found to have a BP of 150/90 mmHg on a routine check-up. She is otherwise well. She does not take any regular medications. She has never smoked, and drinks 2 standard drinks of alcohol per week. There is no family history of ischaemic heart disease. An ECG is performed. Which one of the following is the most appropriate reason for performing an ECG? 1. Baseline before commencing on antihypertensives. 2. Evidence of previous myocardial infarction. 3. Evidence of left ventricular hypertrophy. 4. Part of routine check-up. 5. Tachyarrhthymia.

Answer 32

1. Baseline before commencing on antihypertensives. 2. Evidence of previous myocardial infarction. 3. **Evidence of left ventricular hypertrophy.** 4. Part of routine check-up. 5. Tachyarrhthymia.

Question 33

One of the enzymes involved in glycolysis, aldolase, requires Zn2+ for catalysis. Under conditions of zinc deficiency, when the enzyme may lack zinc, it would be referred to as the: 1. Apoenzyme 2. Coenzyme 3. Holoenzyme 4. Prosthetic group 5. Substrate

Answer 33

One of the enzymes involved in glycolysis, aldolase, requires Zn2+ for catalysis. Under conditions of zinc deficiency, when the enzyme may lack zinc, it would be referred to as the: 1. **Apoenzyme** 2. Coenzyme 3. Holoenzyme 4. Prosthetic group 5. Substrate

Question 34

The primary blood pressure lowering effect of nifedipine is due to a block of: 1. voltage-gated sodium channels in the sino-atrial node 2. voltage-gated calcium channels in ventricular tissue 3. voltage-gated calcium channels in the smooth muscle of blood vessels 4. ß1-adrenergic receptors in the sino-atrial node 5. ß1 – adrenergic receptors in the ventricular tissue

Answer 34

The primary blood pressure lowering effect of nifedipine is due to a block of: 1. voltage-gated sodium channels in the sino-atrial node 2. voltage-gated calcium channels in ventricular tissue 3. **voltage-gated calcium channels in the smooth muscle of blood vessels** 4. ß1-adrenergic receptors in the sino-atrial node 5. ß1 – adrenergic receptors in the ventricular tissue

Question 35

The stimulus for activation of the renin-angiotensin-aldosterone system is: 1. an increase in blood sodium levels 2. an increase in blood levels of antidiuretic hormone (ADH) 3. a decrease in blood glucose levels 4. a decrease in glomerular filtration rate 5. a decrease in mean arterial pressure

Answer 35

The stimulus for activation of the renin-angiotensin-aldosterone system is: 1. an increase in blood sodium levels 2. an increase in blood levels of antidiuretic hormone (ADH) 3. a decrease in blood glucose levels 4. a decrease in glomerular filtration rate 5. **a decrease in mean arterial pressure**

Question 36

A 75-year-old woman with a background of congestive cardiac failure presents with an acute onset of dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea. Physical examination shows widespread crackles in both lung fields and sacral oedema. Which one of the following medications is the most appropriate diuretic for treatment of this patient? 1. Acetazolamide 2. Frusemide 3. Hydrochlorothiazide 4. Mannitol 5. Triamterene

Answer 36

1. Acetazolamide 2. **Frusemide** 3. Hydrochlorothiazide 4. Mannitol 5. Triamterene

Question 37

A 45-year-old man is commenced on a loop diuretic for treatment of congestive cardiac failure. Which one of the following is the most common complication of this medication? 1. Hypermagnesemia 2. Hypernatremia 3. Hypoglycaemia 4. Hypokalaemia 5. Metabolic acidosis

Answer 37

A 45-year-old man is commenced on a loop diuretic for treatment of congestive cardiac failure. Which one of the following is the most common complication of this medication? 1. Hypermagnesemia 2. Hypernatremia 3. Hypoglycaemia 4. **Hypokalaemia** 5. Metabolic acidosis

Question 38

Define FEV1 and FVC

Answer 38

**FEV1** = forced expiratory volume of air in the first second **FVC** = amount of gas forcibly expelled after a deep breath as rapidly as possible.

Question 39

How are FEV1 and FVC values used in interpreting the spirometry of a patient with asthma?

Answer 39

The FEV1/FVC ratio is used to define airflow obstruction – asthma is an obstructive lung condition. If the ratio is less than the lower limit of normal for age, this is interpreted as an obstructive pattern. FEV1 is expressed as a “percent predicted” to grade severity (for example, FEV1 \>80% predicted value = mild obstruction, \<60% = severe obstruction) Post-bronchodilator reversibility in FEV1 of \>12% and \>200mL indicates asthma

Question 40

A 23-year-old man presents for follow-up of his intermittent asthma. List up to 4 specific symptoms that should be asked about when taking the history.

Answer 40

Hx of Asthma - Symptoms to Ask About 1. Wheezing 2. Coughing (especially nocturnal) 3. Chest tightness 4. Breathlessness

Question 41

When examining this patient, what would indicate the presence of pulsus paradoxus?

Answer 41

**Pulsus Paradoxus** When the normal reduction in blood pressure with inspiration is exaggerated i.e. \>10mmHg * Systolic blood pressure normally falls during quiet inspiration in normal individuals. * Pulsus paradoxus can be observed in cardiac tamponade and in conditions where intrathoracic pressure swings are exaggerated or the right ventricle is distended, such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease.

Question 42

After 3 weeks the patient presents to the Emergency Department with an acute exacerbation of asthma. List 8 clinical signs that indicate severe asthma attack.

Answer 42

**Clinical Signs of a Severe Asthma Attack** 1. Physical exhaustion with paradoxical chest movement 2. Talks in words only 3. Pulse rate \>120bpm 4. Central cyanosis 5. Quiet chest 6. PEF\<50% 7. FEV1\<50% 8. Sa02 \<90%

Question 43

A 24-year-old man with a background of type 1 diabetes presents to the Emergency Department feeling acutely unwell. Investigations reveal that he has acute renal failure. List 4 likely causes in this patient.

Answer 43

**Causes of Acute Renal Failure in Diabetic Patients** 1. Pyelonephritis with acute tubular necrosis 2. Increased risk atheroma and embolism to already compromised kidneys. 3. Drug induced interstitial nephritis e.g. Sulphonamides antibiotics etc. 4. Acutely unwell diabetics with hyperglycemia can become dehydrated and get ATN

Question 44

A 65 year old man with established chronic kidney disease presents to his GP for his regular check up. What functions of the kidney should the GP be considering as she reviews this patient and orders investigations? (5)

Answer 44

**Functions of the Kidneys** 1. Disposal of nitrogenous wastes e.g. urea 2. Regulation of water and electrolyte balance 3. Regulation of plasma pH 4. Activation of Vitamin D 5. Stimulation of erythropoiesis

Question 45

A junior medical officer is called to the surgical ward in the evening to assess a post-operative patient’s fluid balance status. List 10 key clinical features that should be considered in their assessment.

Answer 45

**Fluid Balance - Key Clinical Features to Assess** 1. Fluid intake 2. Blood pressure 3. Urine output 4. Other losses eg stool, vomitus, surgical drains 5. Skin turgor 6. Mucous membrane eg tongue moisture 7. Capillary refill time/peripheral perfusion 8. JVP 9. Peripheral oedema 10. Breath sounds and lung percussion - are there signs of pulmonary oedema?

Question 46

A 50-year-old man presents for a routine check-up. His BP is 160/90 mmHg (sitting) and 150/85 mmHg standing. He had a similar BP 2 months ago in the clinic. His BMI is 29 kg/m2. What is the most likely cause of hypertension in this patient?

Answer 46

Essential (or idiopathic) hypertension

Question 47

Other than Essential Hypertension, what are 3 common causes of hypertension?

Answer 47

**Common Causes of Hypertension** 1. Renal disease (renal artery stenosis, renal parenchymal disease such as analgesic nephropathy) 2. Endocrine disease (hyperaldosteronism (Conn’s syndrome), thyrotoxicosis, pheochromocytoma, Cushing ’s syndrome) 3. Coarctation of the aorta

Question 48

List four complications of untreated hypertension

Answer 48

**Complications of untreated hypertension** 1. Left ventricular failure 2. Cerebral ischemic events 3. Renal failure 4. Retinopathy; also ischaemic heart disease, peripheral vascular disease

Question 49

The patient’s father died from a cerebrovascular accident. He asks if there are any changes he could make to his lifestyle that would reduce his chances of a similar fate. List 4 most important recommendations.

Answer 49

**Most Important Lifestyle Changes for CVD Risk** 1. Reduce weight 2. Appropriate diet (low in saturated fat, recommend low-salt and reduced salt foods as part of a healthy eating pattern.) 3. Limited alcohol intake: ≤ two standard drinks per day for men 4. Exercise – 5 x 30mins/week as a target

Question 50

A 30-year-old medical registrar working at a tertiary teaching hospital is seen by his colleagues as being exhausted and ‘snappy’ to others around him. List up to 3 reasons why this doctor might be experiencing stress.

Answer 50

**Reasons why doctors might experience stress** 1. Intensity of demand on doctors, conflicting demands and time pressure 2. The gravity, emotional intensity and responsibility entailed in the job 3. Insufficient resources provided in the public sector 4. Requirements for accreditation and continuing professional development 5. Medicolegal threat and unreasonable expectations and demands of patients 6. Demanding, hostile and emotionally difficult patients and even actual violence 7. Maintaining amicable relationships with colleagues and staff within the work environment 8. Loss of the traditional status of doctors, and negative media representation 9. After-hours and on-call work 10. Interference with family life 11. Poor remuneration (compared with expended effort) 12. Lack of appreciation

Question 51

List up to 3 ‘red flags’ that would indicate to the doctor’s colleagues that he might be an impaired practitioner.

Answer 51

**Impaired Practitioner - 'Red Flags'** 1. Increasing incidence of complaints about a doctor 2. Uncharacteristic interpersonal and other behaviour 3. Falling standards and clinical errors 4. Failure to keep abreast of administrative demands (eg, paperwork) 5. Lack of responsiveness and poor punctuality when called 6. Overt signs or symptoms of substance misuse or psychiatric illness

Question 52

A 65-year-old man presents to an Emergency Department with a 3-hour history of worsening central chest pain. He is nauseated, diaphoretic and has mild dyspnoea. What are two important investigations that should be performed?

Answer 52

1. ECG 2. Troponin level

Question 53

Further history reveals this man is being treated for hypercholesterolemia with statin therapy. He is a smoker with a 25-pack-year history. He has a BMI of 30 kg/m2 and BP of 145/95 mmHg. How do these risk factors contribute to the development of ischemic heart disease in this patient?

Answer 53

**Pathogenesis of Atherosclerosis** These risk factors act together in the development of atherosclerosis. Endothelial injury to the vascular wall (caused by smoking, haemodynamic disturbances and hypercholesterolemia in this patient) followed by accumulation of lipoproteins (such as LDL and its oxidized forms) and further chronic inflammatory changes contribute to atherosclerotic plaque within the vessel.

Question 54

Describe the role of lipoproteins and lipoprotein receptors in regulating the metabolism of lipoproteins.

Answer 54

_Metabolism of Lipoproteins_ * **Chylomicrons**: transports lipids (from diet) from small intestine to body cells and helps cell to remove lipids. * **Chylomicrons** **remnants**: return dietary lipid to liver. * **Very low-density lipoprotein (VLDL):** deliver endogenous lipids. * **Intermediate density lipoprotein (IDL):** return endogenous lipid to liver – precursor of LDLs. * **Low-density lipoprotein (LDL):** deliver cholesterol to cells. * **High-density lipoprotein (HDL):** to exchange proteins and lipid with other lipoproteins. Reverse cholesterol transport. * LDL receptor complexes are present in clathrin-coated pits and mediates cell uptake of LDL-cholesterol.

Question 55

Outline four steps involved in the uptake of LDL into cells via LDL receptors.

Answer 55

**LDL Uptake** * LDL is taken up from the blood via LDL receptors that are in clathrin coated pits. * Upon binding of LDL to LDLR, the complex is endocytosed and the endossome fuses with lysosome. * Lytic enzymes degrade LDL components into free Cholesterol / fatty acids / amino acids.

Question 56

What are 4 examples of primary prevention of cardiovascular disease?

Answer 56

**Primary** **prevention** → aims to prevent disease or injury before it ever occurs. _Primary prevention of CVD_ Attempts to reduce CV disease morbidity/mortality through risk factor modification in people without evidence of established CV disease: For example: 1. Smoking cessation advice and programs 2. Healthy diet advice 3. Exercise programs 4. Treatment for hypertension or hypercholesterolemia

Question 57

A 70-year-old man presents for a check-up. He is usually healthy and does not take any regular medications. He is a smoker, smoking 20 cigarettes daily. He drinks 2 standard drinks of alcohol per day. His BP is 160/70 mmHg, PR is 90/min. His total cholesterol is 6.9 mmol/L (≤4.5) and HDL cholesterol is 0.8 mmol/L (≥1.0). A. What is this patient’s absolute cardiovascular risk? B. What does this value mean?

Answer 57

**A. What is this patient’s absolute cardiovascular risk?** 41% over 5 years **B. What does this value mean?** Absolute risk = the numerical probability of a cardiovascular disease event occurring within five years, expressed as a percentage. For example, if a patient’s risk is 41%, then you can tell them that 41 out of every 100 people like him are likely to have a CVD event within the next five years.

Question 58

A 65-year-old man is being discharged from the hospital following an admission for an acute myocardial infarction. He was not taking any regular medications before admission. List 5 medications that should have been commenced, provided he has no contraindications or allergies.

Answer 58

**Medications after MI** 1. Aspirin 2. ACE inhibitor or Angiotensin receptor blocker (ARB) 3. Beta Blocker 4. Short-acting nitrate 5. Statin

Question 59

A 30-year-old woman has recently been on a 24-hour aeroplane flight. She presents with a hot and swollen left calf. In this patient, how might the three elements of Virchow’s triad interact to cause deep venous thrombosis?

Answer 59

_Virchow’s Triad + DVT_ * **Stasis** disrupts laminar flow and brings platelets into contact with endothelium, and also prevents washout and dilution of activated clotting factors. In this patient, prolonged sitting on the flight might lead to venous stasis. * **Hypercoagulability** may be due to dehydration, or genetic or acquired factors leading to increased clotting potential of the blood. * **Endothelial** **damage** leads to platelet aggregation and clot formation at a venous site. This may be due to traumatic injury to the vessel, or the effect of stasis.

Question 60

A 68-year-old woman with chronic renal failure presents with an abnormal calcium level. What are the 3 main chemical factors involved in calcium homeostasis?

Answer 60

**Calcium Homeostasis - Chemical Factors** 1. Vitamin D 2. Parathyroid hormone 3. Calcitonin

Question 61

Describe the role of the kidney in calcium homeostasis.

Answer 61

**Role of the kidney in calcium homeostasis** * The kidney excretes calcium and phosphate. * Parathyroid hormone acts on the kidney to induce wasting of PO4 and retention of Ca in response to hypocalcemia. * The renal enzyme 1a-hydroxylase converts 25-OH-Vitamin D into 1,25 – dihydroxyvitamin D (1,25(OH)2D), the most active form of Vitamin D. * 1,25(OH)2D enhances the intestinal absorption of calcium and phosphate, and impacts on bone mineralisation to maintain plasma calcium and phosphate levels.

Question 62

Further testing demonstrates elevated parathyroid hormone. Describe the effect this has on this patient’s bone density.

Answer 62

**PTH & Bone Density** Parathyroid hormone (PTH) induces the maturation of osteoclasts which dissolve bone to release calcium and phosphate into the circulation to maintain plasma levels. An ongoingly elevated PTH level will cause decreased bone density leading to potential osteopenia or osteoporosis in the patient.

Question 63

# Define the following terms: * Metaphysis * Epiphysis * Diaphysis * Growth plate * Sesamoid bone * Apophysis

Answer 63

* **Metaphysis** = zone adjacent to the growth plate on the diaphyseal side * **Epiphysis** = end of the bone * **Diaphysis** = the shaft of the bone * **Growth** **plate** = area of growing tissue in the long bones of children and adolescents * **Sesamoid** **bone** = a bone that ossifies within a tendon * **Apophysis** = normal developmental outgrowth of a bone which arises from a separate ossification centre, and fuses to the bone later in development

Question 64

Indicate on the knee X-ray below the locations of each of the: * Metaphysis * Epiphysis * Diaphysis * Growth plate * Sesamoid bone * Apophysis

Answer 64

Question 65

List 5 common criteria that governments use to determine how funds are distributed for health care.

Answer 65

**Criteria for health care funding distribution** 1. Population characteristics 2. Population need 3. Existence of fee for service 4. Historic levels of funding 5. Cost effectiveness 6. Lobbying groups 7. Political processes eg elections

Question 66

List 4 persons, organisations or agencies that, depending on the situation, could provide consent to medical treatment of a person under the age of 18.

Answer 66

**Who can consent for minors?** 1. The patient themselves 2. Parent 3. Legal guardian 4. Court 5. Guardianship board

Question 67

``` # Fill in the blanks. In a plain radiograph of the abdomen, ``` 1. Gas is ...... in colour 2. Calcium is ..... in colour 3. Soft tissue is ..... in colour 4. Fat is ..... in colour

Answer 67

In a plain radiograph of the abdomen, ## Footnote 1. Gas is **Black** in colour 2. Calcium is **White** in colour 3. Soft tissue is **Grey** in colour 4. Fat is **Dark** **Grey** in colour

Question 68

What is the name of the main legislative instrument that governs the conduct of medical practitioners in NSW?

Answer 68

The Health Practitioner Regulation National Law (NSW) 86A

Question 69

Under 'The Health Practitioner Regulation National Law (NSW) 86A' a medical practitioner has a duty to render medical services within a reasonable time to a person if the practitioner has reasonable cause to believe the person is in need of urgent attention by a medical practitioner. Under what circumstance, in this legislation is a practitioner excused from this duty?

Answer 69

If the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time. Resource: HPRNL s139C (c)

Question 70

Over a six-month period, 7 young people aged under 18 years from the small rural community of Erewhon died in motor vehicle crashes, and 6 young people are still recovering from severe injuries. Surveillance data show that these incidents all occurred on Friday or Saturday nights, on the road between Erewhon and the nearest town about 40 kilometres away. Coronial inquests determined that **alcohol**, **excessive** **speed** and **inexperience** were factors in all incidents. Interviews with community members found that private motor vehicles are the only form of transport in the community, and that it is easy for young people to buy cheap cars from a local ‘wrecker’. Using the information above, identify and briefly describe 6 actions the Erewhon community could implement to reduce the incidence and severity of road traffic injury among young people in their community.

Answer 70

_Reducing road traffic accidents in rural towns_ The community could: 1. Work in collaboration with the police and use existing legislation to enforce of speed limits, blood alcohol limits for drivers on local roads, increased random breath testing on local roads and enforce laws for sales of alcohol to minors 2. Also work with the police to enforce vehicle registration requirements 3. Provide a safer choice to young people by organising affordable safe transport between the towns on Friday and Saturday nights 4. Collaborate with other partners such as health services and schools to provide health promotion messages for youth in increase their knowledge about the risks of both alcohol consumption and drinking and driving 5. Work with community members to develop a program to reduce access of young people to alcohol 6. Develop a supportive environment for youth with appropriate and attractive youth services and activities in Erewhon

Question 71

In March 2009 communicable disease surveillance system of the Government of Mexico identified several cases of influenza-like illness in otherwise healthy young adults, with a rapid rise in the number of cases over the next month. The viruses in this outbreak had not been previously detected in pigs or humans. Identify 9 population-level actions that could be taken to control the spread of this disease.

Answer 71

**Population-level Actions to Prevent Spread of Disease** 1. Use public health legislation available to protect public health and monitor disease 2. Use surveillance for influenza to measure and monitor the number of cases and guide decision making 3. Contain the spread of disease by identifying people with the disease by testing and placing them in quarantine 4. Actively identify their contacts and test those with symptoms 5. Encourage hand hygiene and physical distancing 6. Promote influenza immunisation as there may be cross protection 7. Encourage people to not go to work or school if they have respiratory symptoms to prevent spread 8. Communicate regularly and clearly at all times 9. Work to identify the original human source of infection.

Question 72

What phase of the cardiac cycle is represented by the T wave? * A. Atrial depolarisation * B. Atrial repolarisation * C. Ventricular depolarisation * D. Ventricular hyperpolarisation * E. Ventricular repolarisation

Answer 72

What phase of the cardiac cycle is represented by the T wave? * A. Atrial depolarisation * B. Atrial repolarisation * C. Ventricular depolarisation * D. Ventricular hyperpolarisation * **E. Ventricular repolarisation**

Question 73

A 34-year-old woman was diagnosed with a deep venous thrombosis in her left calf 9 months ago. Upon repeat Doppler ultrasound, the blood flow appears to have returned to this section of the vein. This process is thrombus evolution is known as: * A. Embolism * B. Fibrinolysis * C. Organisation * D. Propagation * E. Recanalization

Answer 73

A 34-year-old woman was diagnosed with a deep venous thrombosis in her left calf 9 months ago. Upon repeat Doppler ultrasound, the blood flow appears to have returned to this section of the vein. This process is thrombus evolution is known as: * A. Embolism * B. Fibrinolysis * C. Organisation * D. Propagation * **E. Recanalization** = the process of restoring flow to or reuniting an interrupted channel of a bodily tube.

Question 74

A 75-year-old man is reviewed by a general practitioner on a home visit. According to his son, the patient has been 'confused' for the past week. He has been disorientated to date and place, has been having auditory hallucinations and has been unwell with a respiratory tract infection. Which one of the following features is most useful in distinguishing delirium from dementia as a cause of 'confusion' in this patient? * A. Disorientation. * B. Hallucinations. * C. Intercurrent illness. * D. Patient age. * E. Onset.

Answer 74

Which one of the following features is most useful in distinguishing delirium from dementia as a cause of 'confusion' in this patient? * A. Disorientation. * B. Hallucinations. * C. Intercurrent illness. * D. Patient age. * **E. Onset.**

Question 75

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been prescribed metoprolol, a beta-blocker. Which one of the following is the most likely side effect of this medication? * A. Bronchospasm * B. Constipation * C. Hyperkalaemia * D. Hypertension * E. Tachycardia

Answer 75

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been prescribed metoprolol, a beta-blocker. Which one of the following is the most likely side effect of this medication? * **A. Bronchospasm** * B. Constipation * C. Hyperkalaemia * D. Hypertension * E. Tachycardia

Question 76

The osteon is the structural component of: * A. Compact bone * B. Elastic cartilage * C. Fibrocartilage * D. Hyaline cartilage * E. Trabecular bone

Answer 76

The osteon is the structural component of: * **A. Compact bone** * B. Elastic cartilage * C. Fibrocartilage * D. Hyaline cartilage * E. Trabecular bone

Question 77

A 68-year-old man presents to the Emergency Department complaining of central chest pain for the past 3 hours. Which one of the following is the most appropriate plasma protein to test for myocardial cellular injury in this patient? * A. Creatine kinase CK - MB isomer * B. Creatine kinase CK - MM isomer * C. Lactate dehydrogenase * D. Myoglobin * E. Highly-sensitive Troponin T

Answer 77

A 68-year-old man presents to the Emergency Department complaining of central chest pain for the past 3 hours. Which one of the following is the most appropriate plasma protein to test for myocardial cellular injury in this patient? * A. Creatine kinase CK - MB isomer * B. Creatine kinase CK - MM isomer * C. Lactate dehydrogenase * D. Myoglobin * **E. Highly-sensitive Troponin T**

Question 78

Which one of the following lipoproteins is predominantly responsible for promoting the inflammatory response in atherosclerosis? * A. Chylomicrons * B. High-density lipoprotein * C. Intermediate-density lipoprotein * D. Low-density lipoprotein * E. Very low-density lipoprotein

Answer 78

Which one of the following lipoproteins is predominantly responsible for promoting the inflammatory response in atherosclerosis? * A. Chylomicrons * B. High-density lipoprotein * C. Intermediate-density lipoprotein * **D. Low-density lipoprotein** * E. Very low-density lipoprotein

Question 79

The main effect of Parathyroid Hormone (PTH) is to increase plasma calcium by: * A. Acting on target cells in the bone, kidney and intestine * B. Rapidly altering Ca2+ transport * C. Initiating protein synthesis of enzymes in oesteoclasts * D. Enhancing renal reabsorption of calcium * E. Stimulation synthesis of 1,25 (OH)2D3 (Vitamin D3) by the kidney

Answer 79

The main effect of Parathyroid Hormone (PTH) is to increase plasma calcium by: * **A. Acting on target cells in the bone, kidney and intestine** * B. Rapidly altering Ca2+ transport * C. Initiating protein synthesis of enzymes in oesteoclasts * D. Enhancing renal reabsorption of calcium * E. Stimulation synthesis of 1,25 (OH)2D3 (Vitamin D3) by the kidney

Question 80

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been commenced on statin therapy during the admission. What level of prevention does this represent? * A. Primordial * B. Primary * C. Secondary * D. Tertiary * E. Quaternary

Answer 80

A 75-year-old man is discharged from hospital following a myocardial infarction. He has been commenced on statin therapy during the admission. What level of prevention does this represent? * A. Primordial * B. Primary * C. Secondary * **D. Tertiary** * E. Quaternary

Question 81

Elastin molecules: * A. Contain collagen fibres with high tensile strength * B. Enable elastic fibres to stretch and recoil * C. Enable tissues like bone to withstand torsion or twisting forces * D. Provide additional structural support in the basal lamina * E. Form important signaling proteins

Answer 81

Elastin molecules: * A. Contain collagen fibres with high tensile strength * **B. Enable elastic fibres to stretch and recoil** * C. Enable tissues like bone to withstand torsion or twisting forces * D. Provide additional structural support in the basal lamina * E. Form important signaling proteins

Question 82

Bone development and growth is best represented by which one of the following processes? * A. Diaphyseal plate chondrocyte hyperplasia * B. Endochondral ossification * C. Intermembranous ossification * D. Osteoclast activity after parathormone stimulation * E. Periosteal outer lining cells hypertrophy

Answer 82

Bone development and growth is best represented by which one of the following processes? * A. Diaphyseal plate chondrocyte hyperplasia * **B. Endochondral ossification** = the process by which growing cartilage is systematically replaced by bone to form the growing skeleton. * C. Intermembranous ossification * D. Osteoclast activity after parathormone stimulation * E. Periosteal outer lining cells hypertrophy

Question 83

Histological features of bone showing a thickened layer of matrix surrounded by normally mineralized trabeculae are characteristic of: * A. Osteoarthritis * B. Osteomalacia * C. Osteonecrosis * D. Osteopenia * E. Osteoporosis

Answer 83

Histological features of bone showing a thickened layer of matrix surrounded by normally mineralized trabeculae are characteristic of: * A. Osteoarthritis = the breakdown of the cartilage that overlies the ends of bones * **B. Osteomalacia** = deficient mineralization of bone without a loss in bone matrix. * C. Osteonecrosis = The death of bone tissue due to a lack of blood supply. * D. Osteopenia = Milder version of osteoporosis * E. Osteoporosis = Reduction in bone mass due to increased bone porosity

Question 84

A 22-year-old man sustained a deep laceration on the medial side of his left forearm and at the time was assessed to have severed his ulnar nerve. Six months later he is reviewed and is found to have a typical “claw hand” deformity on the left. A) Describe the deformities observed with a claw hand (4).

Answer 84

**Claw Hand = Ulnar nerve palsy** 1. Hyperextended metacarpophalangeal (MCP) joints (knuckles) 2. Flexed proximal and distal interphalangeal (IP) joints of the 4th and 5th digits 3. Abducted thumb 4. Hypothenar atrophy

Question 85

Describe the motor deficits associated with a claw hand.

Answer 85

Impaired adduction and abduction of the fingers. The **palmar interosseous** muscles aDduct the fingers. The **dorsal** **interossei**, which aBduct the fingers away from the middle finger. Both are supplied by the ulnar nerve.

Question 86

Describe the sensory deficits associated with a claw hand.

Answer 86

**Impaired pain sensation on the dorsal and palmer aspect of the 5th (little) finger, and medial aspect of the 4th (ring) finger.** There are three branches of the ulnar nerve that are responsible for its sensory innervation. Two of these branches arise in the forearm, and travel into the hand: * **Palmar cutaneous branch** – innervates the medial half of the palm. * **Dorsal cutaneous branch** – innervates the dorsal surface of the medial one and a half fingers, and the associated dorsal hand area. The last branch arises in the hand itself: * **Superficial branch** – innervates the palmar surface of the medial one and a half fingers.

Question 87

A 43-year-old man presents for a routine health check. He states that he drinks 8 standard drinks of alcohol daily. List 7 examples of the chronic health effects of this patient’s alcohol consumption.

Answer 87

**Chronic Alcohol Use - Health Effects** 1. Cancer of mouth / oesophagus / throat 2. Alcoholic cirrhosis 3. Memory loss / dementia / Korsakoff’s syndrome 4. Peripheral neuropathy 5. Cardiomyopathy / arrhythmia / heart failure 6. Sexual impotence 7. Recurrent falls and head injury

Question 88

A 23-year-old man sustains a 0.5cm long laceration on the pulp of his index finger from a sharp, clean knife while cutting an eggplant. He puts on a bandaid. Outline the major processes of healing of his wound from the time of injury to one month.

Answer 88

Question 89

List 4 movements of the elbow joint

Answer 89

1. flexion 2. extension 3. pronation 4. supination

Question 90

Injury to which nerve will result in impaired sensation over the shaded areas of the hand below?

Answer 90

= Ulnar nerve

Question 91

List three major “support” roles of the neuroglia (glia cells) in the brain.

Answer 91

1. Physical support 2. Nutritional support 3. Maintain ionic balance 4. Immune function 5. Scavenge function * **Oligodendrocytes** form the myelin sheath around axons. * **Astrocytes** provide nutrients to neurons, maintain their extracellular environment, and provide structural support. * **Microglia** scavenge pathogens and dead cells. * **Ependymal** cells produce cerebrospinal fluid that cushions the neurons.

Question 92

A 50-year-old woman is brought into a general practice clinic by her carers who are concerned about recurrent abdominal pains. She is not able to communicate verbally since having a stroke 3 years ago. Physical examination and ultrasound shows that she has biliary colic which requires an elective laparoscopic cholecystectomy. In order for the patient to give valid informed consent for this operation, which two requirements need to be fulfilled?

Answer 92

* Can understand the nature and effects of the proposed treatment (1) * Can communicate (1)

Question 93

8. A 50-year-old woman is brought into a general practice clinic by her carers who are concerned about recurrent abdominal pains. She is not able to communicate verbally since having a stroke 3 years ago. Physical examination and ultrasound shows that she has biliary colic which requires an elective laparoscopic cholecystectomy. B. If the patient does not have the capacity to give informed consent, who can provide consent? List four in order of priority. C. If no one is available to provide consent, then how can the doctor obtain consent for the procedure?

Answer 93

_Priority of consent_ 1. **Guardian** (including an enduring guardian) who has the function of consenting to medical, dental and health care treatments or, if there is no guardian 2. The most recent **spouse** or de facto spouse with whom the person has a close continuing relationship. 'De facto spouse' includes same sex partners; or, if there is no spouse or de facto spouse: 3. An **unpaid** **carer** who is now providing support to the person or provided this support before the person entered residential care or, if there is no career: 4. A **relative** or **friend** who has a close personal relationship with the person No one available to consent = **The Guardianship Division of the NSW Civil & Administration Tribunal (NCAT)**

Question 94

A 15-year-old girl visited her GP a month ago with symptoms of a urinary tract infection (UTI). Urine culture grew Esherischia coli (E.coli), sensitive to trimethoprim. The GP prescribed trimethoprim for her, and recommended her to increase her fluid intake. A. Describe the appearance and Gram staining characteristics of E.coli? B. Explain why E.coli is a pathogen commonly found in UTI.

Answer 94

E.Coli = Gram negative rod → stains pink

Question 95

The 2 layers that make up the dura mater are called: * A. Pial and meningeal * B. Serosal and meningeal * C. Periosteal and meningeal * D. Peritoneum and meningeal * E. Arachnoid and meningeal

Answer 95

2 layers of Dura Mater = C. Periosteal and meningeal Arachnoid Mater Pia Mater

Question 96

Answer 96

Question 97

Pupillary muscle groups are controlled by the autonomic nervous system. Parasympathetic activation causes pupillary \_\_\_\_\_\_\_\_, and sympathetic activation causes \_\_\_\_\_\_\_\_\_.

Answer 97

Question 98

A 33-year-old man is brought into the Emergency Department after getting punched in the face and hitting his head against the concrete floor. His left pupil is fixed, dilated and not reactive to light. The right pupil reacts normally. Which one of the following nerves is most likely to be involved? * A. Abducens * B. Oculomotor * C. Opthalmic * D. Optic * E. Trochlear

Answer 98

= B. Oculomotor

Question 99

The Obturator nerve innervates: * A. Biceps femoris * B. Obturator externus * C. Obturator internus * D. Piriformis * E. Quadratus femoris

Answer 99

The Obturator nerve innervates: * A. Biceps femoris - The biceps femoris muscle is supplied by **the terminal branches of the sciatic nerve**. The long head receives innervation from it's tibial division, while the short is innervated by the common fibular division. * **B.** **Obturator externus** * C. Obturator internus - Nerve to obturator internus (sacral plexus: L5-S2) * D. Piriformis - ventral rami of S1 and S2 * E. Quadratus femoris - nerve to quadratus femoris (L4-S1 sacral plexus)

Question 100

The plasma membrane of a neuron is more permeable to potassium ions because: * A. of its positive electrical charge * B. there are more non-gated leak channels for K+ than Na+ * C. protein molecules cannot exit through the cell membrane * D. calcium ions block Na+ and Cl- channels * E. there are more non-gated leak channels for Na+ than K+

Answer 100

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Question 103

Answer 103

Innervation. The triceps brachii is innervated by **the radial nerve**, which gives off a separate branch for each head. The C6 root value of the radial nerve innervates the lateral head, root value C7 innervates the long head, and root value C8 supplies the medial head. The **triceps reflex**, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical (of the neck region) spinal nerve [7](https://en.wikipedia.org/wiki/Cervical_spinal_nerve_7) nerve root (the small segment of the nerve that emerges from the spinal cord). The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves[^[](https://en.wikipedia.org/wiki/Triceps_reflex#cite_note-2)

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