Part 1 UM 6/5/21.

Paper 1. Basic science.

-Most of the questions- answers are in the intensive course lecture slides esp physiology of
renal/respi/GI and antibiotics and organisms-so really need to study the slides. Only a few anatomy
questions.

135 SBA questions 120 minutes.

1. Breat ca grading based on

-mitotic count/Nuclear pleomorphism

2. Bladder wall epithelium

-transitional cell

3. Syringomyelia tract affected

-spinothalamic (no lateral spinothalamic as answer choice). (Answer has lateral corticospinal to
confuse you).

4. Skeletal muscle physiology

5. Hashimotos thyroiditis will lead to

- non hodgkin lymphoma

6. Hashimotos thyroiditis will lead to: hypercholesterolaemia

7. Pseudomonas antibiotics:

-cefipime

8. UTI community acquired commonly

- E. Coli

9. Clamydia antibiotics
- doxycycline

10. Gas gangrene organism and antibiotics : clostridial, penicillin and clindamycin, most
common Clostridium perfringens.  Clostridium perfringens, Clostridium septicum, and Clostridium
histolyticum. C. septicum

Reasonable broad-spectrum coverage includes vancomycin and tazobactam or a carbapenem or

ceftriaxone with metronidazole. If the provider suspects gas gangrene or a necrotizing soft tissue
infection, then penicillin plus clindamycin should be added which will also treat group A
streptococcal necrotizing fasciitis. Clindamycin should be strongly considered because it inhibits the
synthesis of clostridial exotoxins and will lessen the systemic effects of these toxins. Because
clindamycin is bacteriostatic and not bactericidal, it should be used in conjunction with a second
anti-microbial such as penicillin.

11. Segmental lung removal

- tertiary bonchus

12. Diaghragmatic hernia

- posterolateral

13. Unable to initiate shoulder abduction

- supraspinatus

14. Head of fibular fracture

- common peroneal nerve

15. Structure move with swallowing. With fascia covering:

- pretracheal (thyroid)

16. Sensory nerve to conjunctiva

- opthalmic nerve

17. Abduction of vocal cord during intubation

- posterior cricoarytenoid, anterior division of the recurrent laryngeal nerve

18. Breast necrosis post trauma

- fat necrosis

19. Histamine released by

- mast cells , IgE, type 1 hypersensitivity

20. ABO incompatibility due to

Type 2 reactions are cytotoxic reactions and are cell mediated. ABO-

incompatibility reactions are of this type.

21. Diphteria precautions

- droplet precaution until 2 negative culture

22. PT, aptt, platelet normal; what underyling disease will cause hypercoagubility for the pt ?
Christmas disease ?factor v mutation ?Protein c mutation ?anti thrombin III mutation

https://oxfordmedicine.com/view/10.1093/med/9780190862800.001.0001/med-9780190862800-
chapter-67#:~:text=Definition.,may%20be%20multiple%20factors%20present.
 Inherited clotting disorders
1. i. Factor V Leiden mutation is the most common inherited factor associated with
hypercoagulability. This mutation causes resistance of factor V to the cleaving action of
activated protein C.
2. ii. Prothrombin G20210A mutation is the second most common inheritable factor
associated with hypercoagulability and results in an mRNA that has an increased half-
life, leading to elevated levels of prothrombin protein. When coinherited with a factor V
Leiden mutation, patients have a substantially increased risk for the development of a
clot as well as an increased risk for recurrent DVT.
3. iii. Protein C or Protein S deficiency is uncommon but displays a high penetrance for
the occurrence of venous thromboembolism (VTE). These proteins normally function to
reduce levels of factor Va and factor VIIIa, leading to decreased thrombin generation.
Patients with deficiencies fail to properly regulate the coagulation cascade.
4. iv. Antithrombin (or antithrombin III) deficiency is a rare autosomal dominant
disorder with a relatively high level of penetrance for DVT. The normal protein functions
as a protease inhibitor of factor IIa (thrombin) and factor Xa Its activity is modulated by
heparin, leading to the basis of its clinical use. Deficiencies in antithrombin lead to
dysregulation of the clotting cascade.
5. v. Rare disorders include dysfibrinogenemia, plasminogen deficiency, heparin cofactor
II deficiency, factor XII deficiency, and elevated clotting factor levels.

23. Parotid gland laceration nerve involved

-facial nerve
24. Midshaft humerus fracture nerve involved

- radial nerve

25. Which pt need to postpone procedure in asymptomatic bacteruria

- Pt undergoing TURP

26. Pt with pulmonary oedema chest xray changes

- blunted costophrenic angles

27. Vessel at risk tracheotomy - thyroid ima artery

28. Vessel to preserve subtotal gastrectomy- left gastric artery

29. Anterior lgment foramen of winslow- hepatoduodenal lgmt

30. Portosystemic shunt splenic vein - left renal vein

31. Cut in scalp bleeding profusely - abundant blood vessels in scalp

32. BPH - transitional zone

33. T cell congenital defiency - di george

34. Ecg changes in hyperK - wide qrs

35. Hormone contraction of GB- cck

36. Post inguinal hernia repair haematoma - testicular vein

37. Immediately after birth what will happen- closure of foramen ovalae
38. Blood supply for brain visual field - posterior cerebral artery

39. Nasal bleed likely from - anterior ethmoidal artery

40. Cavernous sinus infection spread from- facial vein

 from the facial veins (via the superior and inferior ophthalmic veins) as well
as the sphenoid and middle cerebral veins

41. PTH fxn in kidney- activate vit D

42. How does ORS work? What channel

43. Microcephaly baby caused by- toxoplasma

44. Oral contraceptive pills causing liver tumour type- liver adenoma.

45. Starlings law- stroke volume and end diastolic volume

46. Tetralogy of falot- VSD

47. Post hip replacement patient.hallmark for infected prosthesis?

48. Primary peritonitis organism- E. coli , klebsiella pneumonia

49. Na reabsorption in renal nephrons. -Which channel in which tubule.

50. How renal compensatory reabsorp hco3 , which channel which tubule

51. Law of projection in CNS - phantom limb

52. Lymph node drainage of side of tounge. -submandibular

53. MEN2A pt. Most likely has high level of - calcitonin (Medullary thyroid ca)

54. Blood group A-. What antibodies can the pt have?

55. Marker of reversibility - ?creatinine ?trop i?

56. Ghon focus in TB

57. Why capillaries has lowest flow? Surface area/distance from heart/

58. Mechanics of inspiration- which pressure falls?

Interpleural/intrathoracic/interalveolar/transpulmonary
59. Coal miner patient. What affects his oxygen diffusion capacity?
60. Achalasia -myenteric plexus

61. Pregnant lady rectal bleed stops after given birth. ?Cause - haemorrhoids

62. Functional residual capacity increased in ...aging/laparoscopic surgery/obesity

63. Intake of protein will increase/decrease: insulin/glucagon/growth hormone.

64. Receptive relaxation of stomach - fundus.

65. Effect of small bowel resection - watery faeces

66. Testicular cancer markers. Alfa fetoprotein and ?

67. Pt wt 80kg. How much interstitial? 32L. (60/40/20 rule)

68. Features of large bowel - appendices epiploicae

69. Father has colon ca age 53. Daughter also colon ca age 45. What genetic disease? Hnpcc/fap
70. Pt after horseriding/biking. Haematoma butterfly shape in perineal area not involving inguinal
canal. Which part of urethra involved -membranous urethra/bulbar urethra/prostetic urethra/penile
urethra

71. What growth factor cause angiogenesis? vascular endothelial growth factor (VEGF),
fibroblast growth factor (FGF), tumor necrosis factor-alpha (TNF-α), transforming growth
factor-beta (TGF-β), and the angiopoietins (Ang).

72. Treatment of myasthenia gravis- edrophonium. How does it work?  reversible

acetylcholinesterase inhibitor. It prevents breakdown of the neurotransmitter acetylcholine and
acts by competitively inhibiting the enzyme acetylcholinesterase

73. Polycystic kidney disease association- cerebral berry aneurysm.

74. Nodules on elbow excised; hpe shows cholesterol. What is it? -xanthoma

75. Name of bacteria that invade and live in host to avoid phagocytosis.

76. Covid 19 pt. precaution- ?droplet/?airborne/?contact/?wash hand after touch surrounding

77. Otitis media and sore throat ?cause- eustachian tube

78. Autosomal dominant disease pattern. What is the chance to get for the son if one parent has the
disease.

79. Meckels diverticulum origin- yolk stalk (the same name as vitello intestinal duct)

80. Varicose vein and venous ulcers.

81. Tb tuberculin mantoux test is what type of hypersensitivity.

82. Conns syndrome

83. Brachial plexus injury -erbs palsy c5/c6 upper trunk

84. Peau de orange in breast is due to?

85. Glycosuria in diabetics -TmGlu

86 Type of amyloid in multiple myeloma - AL