Yr 2 EOYS ^2 > Quick Facts 4 > Flashcards

Quick Facts 4 Flashcards

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1
Q

Which is the predominant ketone body in Diabetic Ketoacidosis (DKA)?

A Acetone
B Acetoacetate
C Beta-hydroxybutyrate
D Vaccenic acid
E Palmitoleic acid

A

Which is the predominant ketone body in Diabetic Ketoacidosis (DKA)?

A Acetone
B Acetoacetate
C Beta-hydroxybutyrate
D Vaccenic acid
E Palmitoleic acid

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2
Q

Which of the following is not considered a complication of diabetic ketoacidosis?

A Cerebral oedema
B Hyponatraemia
C Hypokalaemia
D Hypoglycaemia
E Adult-respiratory distress syndrome

A

Which of the following is not considered a complication of diabetic ketoacidosis?

A Cerebral oedema
B Hyponatraemia
C Hypokalaemia
D Hypoglycaemia
E Adult-respiratory distress syndrome

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3
Q

Which of the following is the most common cause for precipitation of Diabetic ketoacidosis (DKA)?

A Infection
B Non-compliance
C Inappropriate dose alteration
D New diagnosis of diabetes
E Myocardial infarction

A

Which of the following is the most common cause for precipitation of Diabetic ketoacidosis (DKA)?

A Infection
B Non-compliance
C Inappropriate dose alteration
D New diagnosis of diabetes
E Myocardial infarction

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4
Q

A 91-year-old female, with known congestive cardiac failure, is seen by the GP with increasing shortness of breath. She is now getting breathless while at rest and requiring an increasing amount of support at home.

What is this patient’s New York Heart Association (NYHA) functional classification stage?

A 0
B I
C II
D III
E IV

A

A 91-year-old female, with known congestive cardiac failure, is seen by the GP with increasing shortness of breath. She is now getting breathless while at rest and requiring an increasing amount of support at home.

What is this patient’s New York Heart Association (NYHA) functional classification stage?

E IV

I - Cardiac disease, but no symptoms and no limitations in ordinary physical activity
II - Mild symptoms on ordinary activity
III - Marked limitation on minimal activity, but comfortable at rest
IV - Severe limitations experienced at rest

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5
Q

State the different NYHA functional classifications [4]

A

I - Cardiac disease, but no symptoms and no limitations in ordinary physical activity
II - Mild symptoms on ordinary activity
III - Marked limitation on minimal activity, but comfortable at rest
IV - Severe limitations experienced at rest

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6
Q

Statins block HMG Co-A reductase. Which pathway does this cause to be inhibited? [1]

A

mevalonate pathway

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7
Q

Q
Whilst in general practice, you review Susan a 48-year-old patient with hypertension. Despite taking ramipril, her blood pressure remains clinically elevated. Based on current guidelines you consider add-on therapy with a thiazide-like diuretic.

Which of the following electrolyte disturbances may occur with this new treatment?

Hypercalciuria
Hyperkalaemia
Hypermagnesemia
Hypokalaemia
Hypolipidaemia

A

Q
Whilst in general practice, you review Susan a 48-year-old patient with hypertension. Despite taking ramipril, her blood pressure remains clinically elevated. Based on current guidelines you consider add-on therapy with a thiazide-like diuretic.

Which of the following electrolyte disturbances may occur with this new treatment?

Hypercalciuria
Hyperkalaemia
Hypermagnesemia
Hypokalaemia
Hypolipidaemia

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8
Q

Name a drug that reduces conductivity within the atrioventricular (AV) node and is a positive inotrope [1]

A

Digoxin

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9
Q

Which drugs would you use to manage IPF ? [2]

A

pirfenidone, nintedanib

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10
Q

Q
Name a common AE of digoxin

A

A
Gynaecomastia

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11
Q

Which of the following treatments for TB blocks causes mycoloic acid synthesis [2]

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following treatments for TB blocks causes mycoloic acid synthesis [2]

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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12
Q

Describe the MoA of desmopressin for the treatment of haemophilia [2]

A

Desmopresssin / DDAVP (S/C) -** causes the release of von Willebrand’s antigen from the platelets** and the cells that line the blood vessels where it is stored

. Von Willebrand’s antigen is the protein that carries factor VIII.

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13
Q

Describe the MoA of Ivabradin [1]

A

A

Ivabradine: lowers heart rate through inhibition of cardiac ‘funny channels’

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14
Q

Q
Which of the following can cause severe hypotension as an AE?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Q
Which of the following can cause severe hypotension as an AE?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

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15
Q

Which of the following inhibits L type calcium channel [2]

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following inhibits L type calcium channel [2]

Amlodipine
Verapamil

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16
Q

Explain mechanism of how heparin works to treat PE

A

Heparin binds to antithrombin and activates it; activated complex then inactivates factor Xa, preventing conversion of prothrombin to thrombin (thrombin converts fibrinogen into fibrin - integral step in clot formation)

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17
Q

Q
Which of the following is not considered a mechanism of GLP-1

A Inhibition of gastrointestinal motility
B Inhibition of gastrointestinal secretion
C Enhances the secretion of insulin
D Increases gastric emptying
E Promotes fullness and satiety

A

D Increases gastric emptying

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18
Q

Describe the MoA of Nicorandil [1]

A

Nicorandil: potassium channel agonist, which inhibits voltage-gated calcium channels leading to muscle relaxation

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19
Q

Describe the MoA of clonidine [1]

A

Stimulate presynaptic α2-adrenergic receptors in the CNS → dilates peripheral blood vessels → lowers peripheral resistance → reduces blood pressure

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20
Q

Describe the difference between DOACs MoA

A

E.g. Dabigatran direct thrombin inhibitor;
Rivaroxaban & Apixaban: Orally active factor Xa inhibitors – stop enzyme activating thrombin - prothrombin

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21
Q

What are the drug classes for Vaughan-Williams classification groups for antiarrhtmatic drugs? [4]

A

Class I - block sodium channels
Class II - beta-blockers
Class III - block potassium channels
Class IV - block calcium channels

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22
Q

Which of the following calcium channel blockers are selective for voltage gated calcium channels in blood vessels to cause vasodilation and decrease TPR.

Dobutamine
Verapamil
Diltiazem
Amlodipine
Nifedipine

A

Which of the following calcium channel blockers are selective for voltage gated calcium channels in blood vessels to cause vasodilation and decrease TPR.

Dobutamine
Verapamil
Diltiazem
Amlodipine
Nifedipine

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23
Q

Explain effect of ACE-Inhibitor like Ramipril on K levels [1]

A

Hyperkalaemia (Less Angiotensin II, NO aldosterone, less K secreted, less Na reabsorbed)

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24
Q

Which electrolyte abnormality would you expect with the use of high doses of salbutamol?

A Hypernatraemia
B Hypokalaemia
C Hyperkalaemia
D Hyponatraemia
E Hyperphosphataemia

A

Which electrolyte abnormality would you expect with the use of high doses of salbutamol?

A Hypernatraemia
B Hypokalaemia
C Hyperkalaemia
D Hyponatraemia
E Hyperphosphataemia

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25
Which of the following disrupts the membrane potential in TB causing death? Rifampicin Isoniazid Pyrazinamide Ethambutol
Which of the following disrupts the membrane potential in TB causing death? Rifampicin Isoniazid **Pyrazinamide** Ethambutol
26
What pharmacological treatment consider for sarcoidosis?
A Treat with **corticosteroids** (but has negative impact on immune system). Remember than patients may have spontaneous resolution so have to weigh up options !!
27
What is the mechanism of action of atropine? A Non-selective beta-adrenoreceptor agonist B Beta-adrenergic receptor antagonist C Reversible muscarinic acetylcholine receptor antagonist D Calcium channel receptor antagonist E Relaxation of smooth muscle
**C Reversible muscarinic acetylcholine receptor antagonist** Atropine transiently blocks the action of the vagus nerve (i.e. parasympathetic nervous system) leading to increased SAN electrical activity and increased conduction through the AVN. This results in an increase in heart rate.
28
Name a longer acting alternative to GTN [1]
Isosorbide mono/dinitrate
29
Which of the following side-effects is commonly associated with metformin? A Headache B Gastrointestinal upset C Reduced vision D Hearing loss E Nail changes
Which of the following side-effects is commonly associated with metformin? A Headache **B Gastrointestinal upset** C Reduced vision D Hearing loss E Nail changes
30
Describe the MoA of: [2] Streptokinase Alteplase (tPA)
A **Streptokinase**: Clot buster; Activates fibrinolytic pathway **Alteplase** (tPA): Increase clot; breakdown by increasing Plasmin formation
31
Q Which of the following reduce heart rates by prolonging refractory period of AVN? Amlodipine Nicorandil Diatelzem Lisinopril Verapamil
Q Which of the following reduce heart rates by prolonging refractory period of AVN? Amlodipine Nicorandil Diatelzem Lisinopril **Verapamil**
32
Name 4 AEs of salbutamol [5]
A trembling, particularly in the hands nervous tension headaches suddenly noticeable heartbeats (palpitations) muscle cramps
33
Which muscarinic receptor subtype is thought to be most important in the treatment of chronic airway disease? A M1 B M2 C M3 D M4 E M5
Which muscarinic receptor subtype is thought to be most important in the treatment of chronic airway disease? A M1 B M2 **C M3** D M4 E M5
34
ICS acts on which of the following in asthma ptx? IL-4 IL-5 IL-6 IL-7
ICS acts on which of the following in asthma ptx? IL-4 IL-5 **IL-6** IL-7
35
Dry powder inhalers should be taken in which of the following ways? Quick and deep Slow and steady Slow and deep Quick and steady
Dry powder inhalers should be taken in which of the following ways? **Quick and deep** Slow and steady Slow and deep Quick and steady
36
Q Which of the following forms the right ventricle? Truncus ateriosus Bulbus cordis Sinus venosus Primitive ventricle Primitive atria
Q Which of the following forms the right ventricle? Truncus ateriosus **Bulbus cordis** Sinus venosus Primitive ventricle Primitive atria
37
What receptor does T3 recruit to activate transcription? [1]
**Retinoid acid receptor**
38
Which antibodies are present in Grave's disease? [2]
Anti-TPO and anti-TSHR
39
What morphological change will you see on the ECG of a patient with hypothyroidism? [1]
J waves
40
Which artery do the hypophyseal arteries branch from? [1]
**ICA**
41
Which two hormones do somatostatin inhibit? [2] a)LH b)FSH c)TSH d)GH e)Prolactin
Which two hormones do somatostatin inhibit? a)LH b)FSH **c)TSH** **d)GH** e)Prolactin
42
Which hormone stimulates production of GnRH? a)Progesterone b)Kisspeptin c)Somatostatin d)Ghrelin
Which hormone stimulates production of GnRH? a)Progesterone **b)Kisspeptin** c)Somatostatin d)Ghrelin
43
What does TPO do in healthy thyroids? [1]
Oxidises iodide ions using H2O2
44
Describe how the deiodinase enzymes work to control T3/T4 levels [3] State the locations [3]
.
45
Which deiodinase enzyme is high during hypothyroidism? [1]
**D2**
46
Name an SGLT-2 inhibitor [1]
dapagliflozin
47
How can you treat sickle cell anaemia by stimulating production of foetal HB? [1]
**Hydroxycarbamide /hydroxyurea**
48
Which hormone does warfarin inhibit? [1]
Inhibits vitamin K epoxide reductase
49
Name a muscarinic antagonist used to treat bradycardia? [1]
**Atropine** is a muscarinic antagonist= bradycardia medication
50
Name a drug that activates the vagal nerve to reduce conduction via AVN [1]
**Digoxin**
51
How can you spot a drug is a SABA? [1] How can you spot a drug is a LAMA? [1]
Have **-but-** in them; salbutamol; terbutaline long acting muscarinic antagonists: -**ium** tiotropium, glycopyrronium ium- in ur muscarinic system
52
What is first choice drug fo pneumonia? [1]
**Doxycycline**
53
Which cell types excrete H+ in nephron to help maintain acid-base balance and thus allowing H+ to bind to NH3 and HPO4- [1]
**alpha intercalated cells**
54
Q A 45-year-old male is returned to a surgical ward following a renal transplant. 90 minutes after the transplantation, diuresis suddenly decreases. The patient is immediately transferred back to surgery where the transplanted kidney shows signs of hyperacute rejection and is removed. Histopathological examination is consistent with hyperacute rejection. This patient has experienced which of the following types of reaction? Type I hypersensitivity Type II hypersensitivity Type III hypersensitivity Type IV hypersensitivity Type V hypersensitivity
. Histopathological examination is consistent with hyperacute rejection. This patient has experienced which of the following types of reaction? **Type II hypersensitivity**
55
What is a normal and abnormal response to Dexamethasone suppression test? [2]
**Abnormal**: high levels of cortisol **Normal**: low levels of cortisol
56
Inferior thyroid artery arises from which artery? [1]
Thyrocervical
57
What is the typical male urinary flow rate? 15-20ml/s 20-25ml/s 25-30ml/s 30-35ml/s
What is the typical male urinary flow rate? 15-20ml/s **20-25ml/s** 25-30ml/s 30-35ml/s
58
Short synacthen test is used to diagnose Addisons disease Cushing syndrome Conns syndrome Graves disease
Short synacthen test is used to diagnose **Addisons disease** Cushing syndrome Conns syndrome Graves disease
59
Which blood vessel provides 75% of the blood supply for the Liver Hepatic artery proper Common hepatic artery Hepatic vein Hepatic portal vein Common bile duct
Which blood vessel provides 75% of the blood supply for the Liver Hepatic artery proper Common hepatic artery Hepatic vein **Hepatic portal vein** Common bile duct
60
Which enzyme is the final step in testosterone production? 21-hydroxylase 11B-hydroxylase 5a-reductase 17B-HSD
Which enzyme is the final step in testosterone production? 21-hydroxylase 11B-hydroxylase 5a-reductase **17B-HSD**
61
Which of the following is the remnant of the umbilical vein? A B C D
Which of the following is the remnant of the umbilical vein? A B C **D**
62
What molecule is depleted in alcohol abuse? Lactate GTP NADH Pyruvate
What molecule is depleted in alcohol abuse? Lactate GTP NADH **Pyruvate**
63
Which protein guides the formation of neuron that will eventually cause releae of LH /FSH? [1]
**Kal protein**
64
What is an important AE of corticosteroids with reards to diabetic patients? [1]
Use of corticosteroids can worsen diabetic control due to their anti-insulin effects
65
Defecation involves the relaxation of which two muscles? [2]
EAS and puborectalis
66
The cremaster is formed from which muscle? [1]
Internal oblique
67
Salbutamol is a β2 receptor agonist. What metabolic effect can this drug have that you might need to monitor? Hyperkalaemia Hypernatraemia Hypocalcaemia Hyponatraemia Hypokalaemia
**Hypokalaemia**
68
A 56-year-old woman was admitted 2 weeks ago due to pneumonia for which she was started on oral antibiotics. These antibiotics were changed after she developed a Clostridium difficile infection 9 days ago which she is still recovering from. Her pneumonia has now improved. She is otherwise fit and well and is on no long-term medications. What would be seen on her arterial blood gas? Low anion gap metabolic acidosis Normal anion gap metabolic acidosis Normal anion gap metabolic alkalosis Raised anion gap metabolic acidosis Raised anion gap metabolic alkalosis
A 56-year-old woman was admitted 2 weeks ago due to pneumonia for which she was started on oral antibiotics. These antibiotics were changed after she developed a Clostridium difficile infection 9 days ago which she is still recovering from. Her pneumonia has now improved. She is otherwise fit and well and is on no long-term medications. What would be seen on her arterial blood gas? Low anion gap metabolic acidosis **Normal anion gap metabolic acidosis** Normal anion gap metabolic alkalosis Raised anion gap metabolic acidosis Raised anion gap metabolic alkalosis
69
Growth Hormone regulation is derived from which nucleus? Arcuate nucleus Paraventricular nucleus Supra-optic nucleus Nucleus solitary tract
Growth Hormone regulation is derived from which nucleus? **Arcuate nucleus** Paraventricular nucleus Supra-optic nucleus Nucleus solitary tract
70
Why does salbutamol cause hypokalaemia? [1]
Salbutamol reduces serum potassium levels by increasing the **shift of extracellular potassium into the intracelluar space.**
71
Label A-C [3]
A: Inferior epigastric vessels B: Direct hernia C: Vas def
72
Which brain structure is responsible for regulating anterior pituitary hormone synthesis? [1]
**Hypothalamus**
73
Overtreament with hydrocortisone replacement may lead to what? [4]
A **Cushings** **syndome**: Hypokalameia (lose K, retain HCO3-) Weight gain Skin thinning Met. alkalosis
74
What liver function test result would reveal that have cirrhosis ? [1]
An AST/ALT ratio higher than one (where the AST is higher than ALT) means you may have cirrhosis.
75
The synthetic replacement for aldosterone is known as? [1]
**Fludrocortisone**
76
A 5-year-old male is brought to the clinic by his mother for evaluation of his growth. The patient is in the 10th percentile for height and weight, with an otherwise normal physical evaluation. Which of the following plays a role as a growth hormone-releasing peptide and may be deficient in this child? A. Cholecystokinin B. Leptin C. Ghrelin D. Hormone peptide YY
A 5-year-old male is brought to the clinic by his mother for evaluation of his growth. The patient is in the 10th percentile for height and weight, with an otherwise normal physical evaluation. Which of the following plays a role as a growth hormone-releasing peptide and may be deficient in this child? A. Cholecystokinin B. Leptin **C. Ghrelin** D. Hormone peptide YY
77
An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have []
An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have **non-alcoholic fatty liver disease**.
78
Which hormone, secreted by which cells stimulate parietal cells to secrete hydrochloric acid? [2]
**Gastrin is released by G cells** and stimulates parietal cells to secrete hydrochloric acid.
79
The stomach is lined by which cell type? A Stratified squamous epithelium B Columnar epithelium C Squamous epithelium D Ciliated columnar epithelium E Pseudostratified columnar epithelium
The stomach is lined by which cell type? A Stratified squamous epithelium **B Columnar epithelium** C Squamous epithelium D Ciliated columnar epithelium E Pseudostratified columnar epithelium
80
Which cells are important in the secretion of pepsinogen? A Parietal cells B Chief cells C Goblet cells D G cells E Enterochromaffin-like cells
Which cells are important in the secretion of pepsinogen? A Parietal cells **B Chief cells** C Goblet cells D G cells E Enterochromaffin-like cells
81
Which of the following tests should be requested to investigate phaeochromocytoma? A MRI pituitary gland B Early morning cortisol C Serum aldosterone:renin ratio D Urinary 5-Hydroxyindoleacetic Acid E Plasma metanephrines
Which of the following tests should be requested to investigate phaeochromocytoma? A MRI pituitary gland B Early morning cortisol C Serum aldosterone:renin ratio D Urinary 5-Hydroxyindoleacetic Acid **E Plasma metanephrines**
82
What is the main mechanism of iodide transport into thyroid follicular cells from capillaries? A Passive diffusion B Facilitated diffusion C Active transport D Secondary active transport E Tertiary active transport
What is the main mechanism of iodide transport into thyroid follicular cells from capillaries? A Passive diffusion B Facilitated diffusion C Active transport **D Secondary active transport** E Tertiary active transport
83
Which enzyme is responsible for the activation of iodide in follicular cells? A Thyroperoxidase B Iodinase C Polymerase D Elastase E DNA ligase
Which enzyme is responsible for the activation of iodide in follicular cells? **A Thyroperoxidase** (TPO) B Iodinase C Polymerase D Elastase E DNA ligase
84
What is the most common cause of primary hyperparathyroidism? A Parathyroid cancer B Parathyroid hyperpalsia C Multiple endocrine neoplasia D Paraneoplastic syndrome E Parathyroid adenoma
What is the most common cause of primary hyperparathyroidism? **E Parathyroid adenoma**
85
Which amino acid is thyroid hormone derived from? A Tryptophan (W) B Glycine (G) C Tyrosine (Y) D Lysine (K) E Proline (P)
Which amino acid is thyroid hormone derived from? A Tryptophan (W) B Glycine (G) **C Tyrosine (Y)** D Lysine (K) E Proline (P)
86
Upon standing, receptors in the carotid sinus detect changes in the stretch of the arterial wall to help maintain perfusion to the brain. What is the name of these receptors? A Peripheral chemoreceptors B Central chemoreceptors C Baroreceptors D Thermoreceptors E Golgi organs
**C Baroreceptors** Baroreceptors, a type of mechanoreceptor, are responsible for detecting changes in **arterial stretch**
87
Which of the following best explains the mechanism leading to osteopaenia in Cushing’s syndrome? A Cortisol directly promotes resorption of bone B Cortisol stimulates the release of calcitonin C Cortisol promotes the activity of osteoclasts D Cortisol inhibits the activity of osteoblasts E Cortisol is toxic to the bone marrow
Which of the following best explains the mechanism leading to osteopaenia in Cushing’s syndrome? A Cortisol directly promotes resorption of bone B Cortisol stimulates the release of calcitonin C Cortisol promotes the activity of osteoclasts **D Cortisol inhibits the activity of osteoblasts** E Cortisol is toxic to the bone marrow
88
Where are the targets of T4 / T3? [1]
Thyroxine (T4) and triiodothyronine (T3) are steroid hormones, which cross the cell membrane and bind **intracellular targets.**
89
A rising osmolarity is detected by osmoreceptors within the central nervous system that triggers the release of anti-diuretic hormone (ADH) and our thirst response. Where are osmoreceptors primarily located within the central nervous system? A Posterior pituitary gland B Frontal lobe C Midbrain D Cerebral peduncles E Hypothalamus
A rising osmolarity is detected by osmoreceptors within the central nervous system that triggers the release of anti-diuretic hormone (ADH) and our thirst response. Where are osmoreceptors primarily located within the central nervous system? A Posterior pituitary gland B Frontal lobe C Midbrain D Cerebral peduncles **E Hypothalamus**
90
Which enzyme is most commonly affected within congenital adrenal hyperplasia? A Angiotensin-converting enzyme B 11-beta-hydroxylase C 21-hydroxylase D 17-hydroxyprogesterone E 5-alpha-reductase
Which enzyme is most commonly affected within congenital adrenal hyperplasia? A Angiotensin-converting enzyme B 11-beta-hydroxylase **C 21-hydroxylase** D 17-hydroxyprogesterone E 5-alpha-reductase
91
Where is corticotropin-releasing hormone (CRH) synthesised? A Anterior pituitary B Supraoptic nucleus C Paraventricular nucleus D Third ventricle E Arcuate nucleus
Where is corticotropin-releasing hormone (CRH) synthesised? A Anterior pituitary B Supraoptic nucleus **C Paraventricular nucleus** D Third ventricle E Arcuate nucleus
92
What is the name of synthetic cortisol? [1] What is the name of synthetic aldosterone? [1]
Synthetic cortisol: **Hydrocortisone** Synthetic Aldosterone: **Fludrocortisone**
93
Which drug would you use as a stress test for cushings? [1]
Dexamethasone
94
Which of the following treatment for diabetes increases glucose uptake in adipose tissue, increased adipogenesis and decrease circulating lipids DPP-4 Inhibitors SGLT 2 Inhibitors Metformin Thiazolidinediones Sulfonylureas
Which of the following treatment for diabetes increases glucose uptake in adipose tissue, increased adipogenesis and decrease circulating lipids DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas
95
Which drug class impairs onset of dementia? [1]
**Angiotensin II blockers** have been shown to slow the onset of dementia.
96
Q Which of the folowing is an antibiotic which is an anti-anaerobe and useful for H. pylori Metronidazole Omeprazole Ranitidine Cimetidine
Q Which of the folowing is an antibiotic which is an anti-anaerobe and useful for H. pylori **Metronidazole** Omeprazole Ranitidine Cimetidine
97
GLP-1 is cleaved by which drug class? [1]
**Dipeptidyl-peptidase 4 (DPP-4)**
98
Thiazolidinediones activate which molecule to initiate their mechanism of action for diabetes? [1]
**PPARγ**
99
Which DMT2 treatment causes increased uric acid secretion? [1]
**SGLT2 inhibitors**
100
A 66-year-old lady with a long history of poorly controlled type-2 diabetes is started on a new medication. She is told it works by increasing urinary glucose excretion and the doctor says it is an SGLT-2 inhibitor. Which of the following medications is in this drug class? Tolbutamide Dapagliflozin Exenatide Linagliptin Pioglitazone
Tolbutamide **Dapagliflozin** Exenatide Linagliptin Pioglitazone **Gliflozins - SGLT2 inhibitors**
101
Describe the MoA of DPP-4 inhibitors [1]
DPP-4 inhibitors increase levels of incretins such as GLP-1 and GIP
102
sitagliptin is what class of diabetic drug? [1]
DPP-4 inhibitors
103
Tolbutamide is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Tolbutamide is which drug class **Sulfonylureas**
104
Dulaglutide is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Dulaglu**tide** is which drug class **GLP-1agonists**
105
Rosiglitazone is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Rosiglitazone is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide **Thiazolidinediones** GLP-1agonists Sulfonylureas
106
Empagliflozin is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Empagliflozin is which drug class DPP-4 inhibitor **SGLT-2 inhibitor** Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
107
Linagliptin is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Lina**gliptin** is which drug class **DPP-4 inhibitor** SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
108
Exenatide is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones GLP-1agonists Sulfonylureas
Exenatide is which drug class DPP-4 inhibitor SGLT-2 inhibitor Biguanide Thiazolidinediones **GLP-1agonists** Sulfonylureas
109
What is the mechanism of action of gliclazide? Inhibits dipeptidyl peptides-4 Stimulates sulphonylurea-1 receptors Inhibits alpha-glucosidase enzymes Glucagon-like peptide-1 analogues Inhibits sodium-glucose cotransporter 2
****What is the mechanism of action of gliclazide? Inhibits dipeptidyl peptides-4 **Stimulates sulphonylurea-1 receptors** Inhibits alpha-glucosidase enzymes Glucagon-like peptide-1 analogues Inhibits sodium-glucose cotransporter 2
110
He is keen to try an additional antidiabetic medication, and, after counselling on hypoglycaemic awareness, is started on tolbutamide. Which of the following most accurately describes the mechanism of action of this new medication? Increases insulin release by mimicking the binding of glucagon-like peptide-1 (GLP-1) to its receptor Inhibits the enzyme dipeptyl peptidase-4 (DPP-4), preventing the degradation of incretins such as GLP-1 Reduces renal glucose reabsorption via inhibition of sodium-glucose transport protein 2 (SGLT2) Stimulates peroxisome proliferator-activated receptor gamma (PPAR-γ), reducing insulin resistance Binds to and shuts pancreatic beta cell ATP-dependent K+ channels, causing membrane depolarisation and increased insulin exocytosis
He is keen to try an additional antidiabetic medication, and, after counselling on hypoglycaemic awareness, is started on tolbutamide. Which of the following most accurately describes the mechanism of action of this new medication? Increases insulin release by mimicking the binding of glucagon-like peptide-1 (GLP-1) to its receptor Inhibits the enzyme dipeptyl peptidase-4 (DPP-4), preventing the degradation of incretins such as GLP-1 Reduces renal glucose reabsorption via inhibition of sodium-glucose transport protein 2 (SGLT2) Stimulates peroxisome proliferator-activated receptor gamma (PPAR-γ), reducing insulin resistance **Binds to and shuts pancreatic beta cell ATP-dependent K+ channels, causing membrane depolarisation and increased insulin exocytosis**
111
A 45-year-old man with type 2 diabetes mellitus, currently taking metformin, comes in for his diabetic review. His glycaemic control is deemed to be not under control and gliclazide is added to his treatment regimen. The doctor is advising the patient about the side effects of sulfonylureas. Which of the following is a side effect of sulfonylureas? Flatulence Fluid retention Nausea Hypoglycaemia Diarrhoea
A 45-year-old man with type 2 diabetes mellitus, currently taking metformin, comes in for his diabetic review. His glycaemic control is deemed to be not under control and gliclazide is added to his treatment regimen. The doctor is advising the patient about the side effects of sulfonylureas. Which of the following is a side effect of sulfonylureas? Flatulence Fluid retention Nausea **Hypoglycaemia** Diarrhoea
112
Q Which drug class does Tiamterene fall into? Thiazide Diuretics Loop Diuretics Carbonic Anhydrase Inhibitors Epithelial Sodium Channel Antagonist Aldosterone Antagonists
Q Which drug class does Tiamterene fall into? Thiazide Diuretics Loop Diuretics Carbonic Anhydrase Inhibitors **Epithelial Sodium Channel Antagonist** Aldosterone Antagonists
113
Explain the mechanism of action of Propylthiouracil [2]
A Blocks thyroxine deiodinase I in the liver Blocks thyroxine deiodinase II in the periphery to stop T4 to T3 conversion
114
Explain the mechanism of botox to treat an overactive bladder [1]
A **Prevent ACh release** at synaptic terminal
115
Which of the following treatment for diabetes causes increased GLUT 4 expression and increased insulin sensitivity DPP-4 Inhibitors SGLT 2 Inhibitors Metformin Thiazolidinediones Sulfonylureas
Which of the following treatment for diabetes causes increased GLUT 4 expression and **increased insulin sensitivity** DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas
116
Which drug class does indapamide belong to? DPP-4 Inhibitors SGLT 2 Inhibitors Metformin Thiazolidinediones Sulfonylureas
Which drug class does indapamide belong to? DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas
117
Sexual dysfunction can be a result of DPP-4 Inhibitors SGLT 2 Inhibitors Metformin Thiazolidinediones Sulfonylureas
Sexual dysfunction can be a result of DPP-4 Inhibitors SGLT 2 Inhibitors Metformin **Thiazolidinediones** Sulfonylureas
118
Ghrelin is involved with endocrine axis? [1]
**GH**
119
Describe the difference in role of the internal and external urethral sphincters [2]
The **internal urethral sphincter** regulates **involuntary control** of urine flow from the bladder to the urethra; **prevent retrograde flow of semen into the bladder during ejaculation**. The **external urethral sphincter** provides **voluntary** **control** of urine flow from the bladder to the urethra.
120
POMC/CART neurones in arcuate nucleus of hypothalamus cause the release of which hormone? [1]
**α-melanocortin-stimulating hormone** (α-MSH)
121
Which enzyme converts arachidonic acid into a pro-inflammatory molecule?
**Phospholipase A2**
122
Renal stones are most commonly caused by: Calcium oxalate Struvite Calcium phosphate Uric acid Cystine
Renal stones are most commonly caused by: **Calcium oxalate** Struvite Calcium phosphate Uric acid Cystine
123
Which of the following deiodinase enzymes makes more inactive from of thyroid hormone? D1 D2 D3 D4
Which of the following deiodinase enzymes makes more inactive from of thyroid hormone? D1 & D2 convert T4 to T3 and cause activation **D3** D4
124
Describe the action of calcineurin [1]
Calcineurin is an enzyme that activates T-cells of the immune system.
125
Out of metformin and gliclazide, which causes hypoglycaemia and why? [2]
**gliclazide**: Gliclazide is an i**nsulin secretagogue**, increasing the amount of endogenous insulin produced. Sometimes too much Insulin can be secreted, resulting in hypoglycaemia Metformin is an insulin sensitiser and therefore makes the amount of insulin in the body more effective. While metformin reduces average blood sugars it very rarely causes hypoglycaemia. Therefore reducing the offending drug, gliclazide, is the most appropriate management option.
126
A 65-year-old man presents with severe upper abdominal pain, fever, and vomiting. He is diagnosed with acute pancreatitis. Which of the following liver function tests is raised disproportionately in pancreatitis? Unconjugated bilirubin Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) Amylase Gamma glutamyltransferase (GGT)
**Amylase**
127
Which of the following can cause hypocalcaemia? Hyperparathyroidism Respiratory alkalosis Thiazide diuretics Vitamin D intoxication
Which of the following can cause hypocalcaemia? Hyperparathyroidism **Respiratory alkalosis** Thiazide diuretics Vitamin D intoxication
128
Osteocytes secrete which of the following involved in Ca homeostasis Calcitriol Vit D FGF23 PTH 1 alpha hydroxylase
Osteocytes secrete which of the following involved in Ca homeostasis Calcitriol Vit D **FGF23** PTH 1 alpha hydroxylase
129
Flavinoids are important because they reduce inflammatory enzymes such as []
**NADPH oxidase**
130
What are K levels like in compartment syndrome? [1]
**Hyperkalaemia**
131
Label A & B
A: Floccus B: Tonsil
132
Which numbers are the floccus and tonsil? [2]
Floccus: 10 Tonsil: 3
133
Which numbers are the floccus and tonsil? [2]
19 Tonsil of cerebellum 20 Flocculus of cerebellum
134
Which numbers are the floccus and tonsil? [2]
30 Flocculus of cerebellum 31 Cerebellar tonsil
135
Yellow arrow is pointing at? Tonsil vermis flocculonodular node anterior lobe posterior lobe
Yellow arrow is pointing at? **Tonsil** vermis flocculonodular node anterior lobe posterior lobe
136
Damage to area D results in apraxia to internal commands aphasia loss of conjugate gaze apraxia to external commands loss of voluntary control of movements
Damage to area D results in **apraxia to internal commands** aphasia loss of conjugate gaze apraxia to external commands loss of voluntary control of movements
137
Identify structure A Stria terminalis Anterior commissure Fornix Corpus callosum Posterior commisure
Identify structure A Stria terminalis Anterior commissure **Fornix** Corpus callosum Posterior commisure
138
dentify the arrowed structure uncus optic nerve olfactory gyrus midbrain Wernicke’s area
dentify the arrowed structure **uncus** optic nerve olfactory gyrus midbrain Wernicke’s area
139
The image shows deep brain stimulation to control Parkinson’s disease. Into which basal ganglia nucleus are the rods Caudate Putamen Globus pallidus external Globus pallidus internal subthalamic
The image shows deep brain stimulation to control Parkinson’s disease. Into which basal ganglia nucleus are the rods Caudate Putamen Globus pallidus external Globus pallidus internal **subthalamic**
140
In this decerebrate patient, the location of the lesion is In the medulla Between the vestibular nuclei and red nuclei Above the red nucleus Between the vestibular nucleus and trochlear nucleus Between the red nucleus and anterior lobe of the cerebellum
In this decerebrate patient, the location of the lesion is In the medulla **Between the vestibular nuclei and red nuclei** Above the red nucleus Between the vestibular nucleus and trochlear nucleus Between the red nucleus and anterior lobe of the cerebellum
141
Decerebrate posturing means which tract is not function ? [1] Explain why you see this position [1]
**Rubrospinal tract** red nucleus output **reinforces antigravity flexion** of the upper extremity. When its output is eliminated then the **unregulated reticulospinal and vestibulospinal tracts reinforce extension** tone of both upper and lower extremities.
142
Identify the brain region that is tested by asking a patient to draw a symmetrical object such as a clock face. A B C D E
Identify the brain region that is tested by asking a patient to draw a symmetrical object such as a clock face. **A** B C D E
143
Loss of dopaminergic input to the BG leads to insufficient activation of D1 receptors Activation of direct pathway Insufficient activation of D2 receptors Activation of thalamus Inhibiton of internal globus pallidus
Loss of dopaminergic input to the BG leads to **insufficient activation of D1 receptors** Activation of direct pathway Insufficient activation of D2 receptors Activation of thalamus Inhibiton of internal globus pallidus
144
The pathology shown in this image is Left tonsillar herniation Right tonsillar herniation Left uncal herniation Right uncal herniation Left subfalcine herniation Right subfalcine herniation
The pathology shown in this image is Left tonsillar herniation Right tonsillar herniation **Left uncal herniation** Right uncal herniation Left subfalcine herniation Right subfalcine herniation
145
The pathology shown in this image is Left tonsillar herniation Right tonsillar herniation Left uncal herniation Right uncal herniation Left subfalcine herniation Right subfalcine herniation
The pathology shown in this image is Left tonsillar herniation Right tonsillar herniation **Left uncal herniation** Right uncal herniation Left subfalcine herniation Right subfalcine herniation
146
B is 1. Nucleus raphe magnus 2. Dorsal horn 3. Reticular formation 4. periaqueductal grey 5. locus coeruleus
B is **1. Nucleus raphe magnus** 2. Dorsal horn 3. Reticular formation 4. periaqueductal grey 5. locus coeruleus
147
What is indicated by letter A? PAG Nucleus raphe magnus Nucleus reticularis paragigantocelluaris Dorsal horn VTA
What is indicated by letter A? **PAG** Nucleus raphe magnus Nucleus reticularis paragigantocelluaris Dorsal horn VTA
Yr 2 EOYS ^2
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