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EMQs

EMQ CHRISTMAS 2008 1. Anaemia 2. STI 3. NMJ / AP 4. NTD + Trisomy 21 5. Pharm – COX 6. Pharm 7. O2 dissociation curve 8. Neoplasia terms 9. Ear anatomy 10. Skin histology 11. Wrist anatomy – falling on outstretched arm etc EMQ SUMMER 2009 1. Stats – PPV etc 2. Stats – CI 3. Pharm – AB’s 4. Pharm – cardiac drugs 5. STIs 6. Ulcers 7. Muscle fibers – chain, bag, alpha and beta 8. Lymph – little finger, gonads 9. Knee – ligaments 10. Anatomy of back – S2,3,4 11. Osmolality / compartments – decrease BV, burns etc 12. Ear anatomy 13. Hernia anatomy 14. Cranial nerves 15. Pain 16. Exercise 17. Bile 18. Cancer – xeroderma pigmentosum 19. Ethics 20. Bile EMQ REPEAT AUGUST 2009 1. Female perineum 2. Surface anatomy – lungs 3. Male testes 4. Liver lobule structure 5. Stomach / liver / kidney – ligaments / omentum 6. Muscles of gait – eccentric / concentric – hip, knee, ankle 7. Fetal circulation – liver bypass, apoptosis primum, secundum, deoxy perineum -> mother; umbilical artery, foramen ovale 8. Bacteria parts – wall etc 9. Anemia – types – ulcer (dark stools), pernicious, macrocytic, chemo, sickle cell 10. Diabetic complications – erection, glove and stocking neuropathy, joint (swollen + pain) 11. Hypo – pit hormones 12. Reproduction hormones – temp increase 13. Parts of CNS – eye afferent – accommodation efferent – hand off hot stove – mid brain / hind – tachycardia, hypotension – cerebral cortex, cerebellum 14. Cells in inflammation etc 15. Nerve injures – umbilicus level, herpes, ptosis, miosis, wasting intrinsic hand muscles 16. Cranial nerves 17. Headache 18. ECG – ventricle depolarization – Purkinje fibbers 19. Rheumatology drugs – Reyes (encephalopathy), folate, ocular problems 20. Stats – P values, incidence 1. 2. 3. EMQ Christmas 2009 (1st year – Class of 2013) Ear – anatomy and physiology Anaemia – different types Biostats – data distribution (skewed, uniform, symmetrical etc)

12. 47XXY. also inc tissue types involved eg ciliated epithelium etc Antibiotics – indications. Don't hurt the patient. Helen tells Dr Jarman that she “will be consulting her naturopath because he has cured a lot of conditions that conventional medicine cant touch”. 45X. 9. Biostats – different types of clinical trials Immuology – types of cells . 17. Don't give all the care to the rich people etc. a. 18. Turners syndrome Actions of male and female sex hormones ?? possibly another immunology! SAQs SAQ CHRISTMAS 2008 1. Arnold-Chiari malformation etc STIs – symptoms Neoplasia – tumour types eg papilloma. (Where do you draw the line? Euthanasia in terminal illness? Injections hurt. leiomyoma. interactions etc Karyotypes – Downs. Article 40. Dr Jarman explains that surgery is a possible treatment in some cases. 11. what's in the best interests of the patient. malignant Partial pressures of O2. ETHICS – AUTONOMY Helen has been diagnosed as having Otosclerosis. alveoli and mitrochondria! Contraception Action potential. Where do doctors find guidance on how to ensure respect for patient autonomy in clinical practice? (2 marks) c. 20.WBCs mainly I think Immunology – cells. with reference to your definition of ethical principal of autonomy how Dr Jarman should respond to Helen. 46XY etc Birth defects – meningocele. meningoencephalocoele. blood vessels. chemical mediators etc Immunology – more of the same. 7. bodily integrity and privacy. Ectopic pregnancy. ligand-gated ion channels opened or closed at different stages Bacteria structure Osteoporosis Infertility/Fertility – PCOS. benign. 6. 13. 8. Explain briefly. 16. 19. Nonmaleficence: Don't be bold.3 of the Irish Constition – protects the right to self determination. 14. Helen is exercising her autonomy in consulting a naturopath.4. Hippocratic oath o o · Guidance: · · · Beneficence: Do good. Trisomy. 5. Autonomy o o . Autonomy – · Autonomy: the basic idea of personal autonomy is that everyone’s actions and decisions are their own. Medical Counsel Guidelines 2009. In order to exercise autonomy. Nerve synapse. CO2 and N2 in tissues. 10. right?) Justice: Making the best use of resources possible. 15. Therefore the patient has the right to decide what happens to their own body. What is meant by autonomy in medical ethics (3 marks) b. NMJ – which voltage-gated. a person should be an adult and of sound mind.

Anatomy – female pelvic viscera VISCERA=Grand. Outline the changes which occur in bone with osteoporosis – decrease in bone density / loss of bone mass. The explanation you give the patient and the patient’s refusal should be clearly documented in the patient’s medical records. When a spurious association arises due to a failure to adjust fully for factors related to both the risk factor and the ourcome Likelihood ratios . Random allocation of patients 9. Wash out period This arises in a cross-over trial. the experimenter. all participants (clinicans. where possible. even if you disagree with that decision.6 e. In these circumstances. 2 rx that would be appropriate for Mary – biphosphates. Explain T-score of 2. e. 10. increase fragility / risk of fractures b. 13. family hx. premature menopause. patients. 7. low BMI. 3. steroid use. you should clearly explain to the patient the possible consequences of refusing treatment and offer the patient the possible consequences of refusing treatment and offer the patient the opportunity to receive a second medical opinion if possible. Confounding bias 15. 11. b. · 2. Stats – definitions 5. knows which participants are subject to which procedure (or took which treatment etc). In addition to her age. 1. assessors) in a trial should be blinded or masked to the treatment allocation.How to respond: · · · Every adult with capacity is entitled to refuse medical treatment. Double blind technique Neither the patients. What investigation? DEXA d. The patients will receive 2 treatments (eg. give 3 risk factors which GP should ask about – smoking. Assessment bias When patients and/or clinicians are aware of the treatment allocation. Therfore. nor any of the assessors of the results. Referred for investigation – found to have T score of -2. Stats – definitions a. The wash-out period is the amount of time that has to be left between treatments so that the first treatment is no longer in the patients system – In the absence of a wash-out period. When patients are randomly allocated to one of two independent groups d. half will receive new treatment followed by control and half will receive control treatment followed by new tx. c. You must respect a patient’s decision to refuse treatment. 6. hyperparathyroidism c. Osteoporosis Mary – 80 year old with osteoporosis a.6. calcium and vitamin D supplements 4. This helps to ensure and biases or expectations will not influence results 8. 14. a positive or negative effect could be wrongly attributed to the second tx. 12. An awareness of treatment allocation may influence the recording of signs of improvements or adverse events. particularly if the response is subjective.

Then.Da b. hallucinations etc. and also postural hypotension.Entacapone d.e. Explain why heart is less seriously affected by hypoxia than brain. it may allow them to reduce their dose of L-DOPA. Pathophysiology of cor pulmonale c. Explain briefly why lack of O2 leads to brainstem death b. (basically it becomes less effective). effectiveness of the test at indentifying true positives).a) The likelihood ratio for a positive result is the likelihood of a patient who has been clinically diagnosed as having a disease having a positive result according to a screening test (i.e. Define COPD b. COMT . Explain in 4 sentences why O2 is needed. Ropinirole is good for newly diagnosed you patients starting therapy as there are less motor fluctuations and dyskinesias. 17. which metabolize px deficient neurotransmitter and are therapeutic agents in PD? – MAO-B = selegiline. long-term there can be a shortened duration of action of each dose and symptoms can develop between doses. SAQ SUMMER 1. The formula for this is (1 . false negative rate with the screening test). What is deficient? . compared to the likelihood of a patient who does not a disease having a positive result according to the screening test (i.Sensitivity) / Specificity 16. false positive rate with CAGE). It is also good for advanced patients who are experiencing symptoms between doses of L-DOPA. amino acid = tyrosine c. compared to the likelihood of a patient who has been clinically diagnosed as not having a disease having a negative result according to the screening test (i. c.Michael Jackson (see sample questions) a. 2 enzymes. COPD AND EMPHYSEMA a. 2. Explain what factors should be taken into account in choosing between these 2 options for px tx with reference to relative efficacy and adverse affects of 2 drugs classes you have chosen? Both L-DOPA and ropinirole cause nausea vomiting and psychiatric symptoms such as vivid dreams. L-DOPA was the usual first line treatment. FEV1 (54%) FVC (70%) – explain abnormalities .Anatomy – lungs – surface anatomy etc.e. NTD from sample questions 3. The formula for this is (Sensitivity) / (1 – Specificity) b) The likelihood ratio for a negative result is the likelihood of a patient who has been clinically diagnosed as having a disease having a negative result according to the screening test (i. More powerful drug: L-DOPA with dopa decarboxylase inhibitor and dopamine agonist (eg Ropinirole). effectiveness of the screening test at identifying true negatives). Precursor and amino acid – in vivo precursor levodopa (L-DOPA). e.e. PARKINSONS a. but there are some issues: at first there can be dyskinesias from over medication until the correct dosage can be determined.

Pathophysiology of Cor Pulmonale: Mechanism: 1. n. Loss of capillary beds (eg. In chronic bronchitis there are blockages in the airways due to excess secretion of mucus/inflammation and thus air cannot be exhaled easily.it just takes time and effort for them to remove the trapped air. In general FVC is not affected as much as the FEV1. Leads to right heart failure. one term is used to describe them. HCV. FEV1 = 54% Reason: In emphysema the lung is less compliant and cannot expire air as easily. o. coal tar. Explain abnormalities: FEV1 measures the forced expiratory volume in 1 second. 2 physical oncogenes – lead. alcohol d. 4.d. hypercapnia. p. u. l. XR. due to bullous changes in COPD) 2. ATM c. Increased alveolar pressure (eg. e. Name 2 cell cycle enzyme checkpoints – P53. EBC. h. m. chronic asthma). PITUITARY HORMONES . Why is cancer a disease of the old? f. their chronic pathological changes (emphysema) or physiological correlates (pink puffers. s. FVC is a measure of the maximum amount of air that you can blow out of your lungs voluntarily. FEV1/FVC ratio less than 70% = obstructive disease f. FVC = 70% Reason: It is may be reduced in COPD patients due to damage of the lung tissue/small airways. q. r. Increased workload (afterload ) for RHS of heart 3. w. t. UVA light creates free radicals – indirect DNA damage e. These chronic conditions are classified according to the clinical features (chronic bronchitis. during mechanical ventilation) Demands on the RV may be intensified by increased blood viscosity due to hypoxia-induced polycythemia. HHV8 5. i. j. Pulmonary hypertension * 2. k. BRCA 2 g. blue bloaters). Define COPD: Obstructive pulmonary diseases cause difficulty in expelling air from the lungs. Oncogene and tumor suppressor gene b. As these diseases often coexist and overlap. HBV. v. UV damage to DNA – UVB light causes thiamine dimers – direct DNA damage. Breast cancer genes – BRCA 1. or both 3.. g. 2 viruses that cause cancer – HPV. in COPD. CANCER a. Vasoconstriction caused by hypoxia. Chronic obstructive pulmonary disease (COPD) is a term which denotes a group of chronic conditions associated with lung tissue damage and airflow obstruction with little or no reversibility. which is COPD. asbestos. *COPD causes pulmonary hypertension by several mechanisms: 1.

Dipole dipole interactions c. Aldosterone increases Na and H20 reabsorption in cortical collecting ducts– Renin Angiotensin system: low blood volume  juxtaglomerular apparatus increase rennin secretion  angiotensin II  adrenal cortex  aldosterone. HB STRUCTURE a. List 2 different types of vascular accident caused by CVA . . b. CHO and lipid metabolism.Ischemic / haemorrhagic b.Van der waals forces . d.Intro of more positive charged amino acid in place of negatively charge one in Beta chain means that highly negative charged allosteric effector 2-3 BPG binds even more strongly to Hb beta chains – stabilizing deoxy form of Hb . 4 hormones give young boy with Hypopituitarism and hypogonadism GH – normal growth: acts on liver to produce IGF-1.H20 molecule attached to each of 4 Fe atoms in deoxy Hb b. All stimulate secretion (exception DA which inhibits and GH which can stimulate or inhibit). ACTH (+FSH. How does it differ in fetal Hb? .a. Prolactin) a.Hydrogen bonds . Involved in controlling the metabolic rate and influencing physical development. Draw optic chiasm 6. e. Regulation of secretion Controlled by hypophysiotropic hormones released by hypothalamus. 4 anterior pituitary hormones Regulation of secretion 2 hormones involved in water and salt balance and how they work 4 hormones give young boy with Hypopituitarism and hypogonadism Draw optic chiasm LH. protein synthesis. 4 anterior pituitary hormones b. e. protein anabolism. Risk factors that should be identified and / or treated in px with CVA .Relaxed – taut – cooperative facilitates binding. GH. d.Hydrophobic interactions . What happens to Hb on oxygenation? Why is this effect sometimes described as cooperative? . c.Ferrous iron attached to each of 4 chains . 2 hormones involved in water and salt balance and how they work ADH and aldosterone ADH (vasopressin) released by posterior pituitary increases aquaporin channels in collecting ducts  increased H20 reabsorption. LH – act on Leydig cells to secrete testosterone (male 2 sexual characteristics) ACTH – acts on adrenal cortex (zona fasiculata) to produce glucorticoids TSH – acts on thyroid gland to produce thryoxine and triiodothyronine. d. Briefly describe the quaternary structure of normal HbA. Speculate why amino acids substitution observed in Chaturis Hb causes decreased affinity for O2. TSH. .2 alpha and 2 beta chains .haem group attached to each of 4 chains . SHOULDER ANATOMY SAQ REPEAT AUGUST 2009 1. -ve feedback loops control secretion  high circulating levels trigger hypothalamus and pituitary to stop production.Ionic bonds . CVA a. Describe the non-covalent forces stabilizing the quaternary structure of Hb.Opposite situation to that in HbF where gamma chains are present rather than Beta chains – gamma chains higher affinity for O2 because decreased positive charge in gamma chains making 2-3 BPG bind less readily => stabilizing oxy form of Hb. 2. c.

high cholesterol. How does error in one phase cause DS (2) Non-disjunction – chromosome or chromatid fail to separate either in meiosis I or II 14/21 Robertsonian translocation d. Clopidogrel. b. HOMEOSTASIS Describe the homeostatic mechanisms that will be activated in different bodily organs and systems in an attempt to conserve water. S – cell copies chromosome. M – cell division Meiosis I · Prophase I – duplicate chromosome  sister chromatids in pairs = homologous chromosomes o (different from Mitosis. What is risk of recurrence if mother / father is carrier? If mom has Robertsonian translocation 1:8 If dad has Robertsonian translocation 1:50 4. a. which is pairs of chromosomes – each pair = a sister chromatid) o crossing over occurs – homologous chromosomes attached at random points called chiasmata · Metaphase I – pairs of sister chromatids line up at midline – attached to spindles · Anaphase I – pairs of sister chromatids get pulled apart by spindles to opposite poles · Telophase I – cell divides. ticlopidine – Antiplatelet d.Aspirin. DOWN SYNDROME a. DOWN SYNDROME 3. alcohol. hyperglycemia c. Brain Vascular Kidney Endocrine .including number. 2 medications used for secondary prevention and mode of action . b. Define karyotype (1) Karyotype – a photo representation of a stained metaphase in which the chromosomes are numbered in order of decreasing length · characterization of the chromosomal complement . each cell with a sister chromatid Meiosis II · Prophase II – no duplication – chromosomes already in pairs · Metaphase II – sister chromatids line up at midline · Anaphase II – sister chromatids separate into individual chromosomes · Telophase II – cell divides. each cell with a chromosome c. Structures of circle of Willis 3. and size of the chromosomes. Outline normal phases of meiosis (3) · Interphase – G1 – cell grows. c. What does geneticist mean by Robertsonian translocation? (2) Robertsonian translocation – two acrocentric chromosomes join and the short arm is lost · 14/21 Robertsonian translocation e.. d. G2 – cell grows. form.HTN. prepare for division.

B) Vascular: Vascular control is exerted by the cardiovascular baroreceptors. When concentration of the plasma changes. causing increased reabsorption of NaCl. and a drop in plasma volume decreases the GFR.) Side note: this is also why salty foods increase thirst.) C) Kidney A drop in arterial pressure causes less stretch of renal juxtaglomerular cells. There are different osmoreceptors in the same area (OVLT and SFO of the hypothalamus) that do not contribute to the experience of thirst. allowing increased reuptake of water. It also stimulates the secretion of potassium.comes from the posterior pituitary. SHOCK 25 yo male RR 34 / min Pulse oximetry 95% on 15l / min HR – 140 / min BP 79 / 48 Conscious.cotransporter in the ascending loop of henle. This channel increases the permeability of the nephron to sodium. D) Endocrine: Endocrine efforts to conserve water are due largely to vasopressin and aldosterone. The osmoreceptors. with a net loss of water. and also increases secretion of potassium. but rather activate the release of Vasopressin to decrease fluid output. 2) Aldosterone: Acts on nuclear mineralocorticoid receptors in the cells of the distal tubule and collecting duct of nephron. The reflex is initiated by baroreceptors which decrease their rate of firing when cardiovascular pressure decreases. 5. Vasopressin will then act on the collecting ducts to increase tubular permeability to H20 and thus increase reabsorption of water. For example. These osmoreceptors evoke the feeling of thirst. confused. This in turn leads to decreased NaCl delivery to macula densa. and thus overlap with what was discussed earlier. Vasopressin. despite being in the hypothalamus. just like when there was a deficit in water. via osmosis. plasma becomes concentrated. Vasopressin also causes widespread vasoconstriction-helping to restore blood pressure to normal. The renal juxtaglomerular cells then increase renin secretion. It stimulates the insertion of water channels (aquaporin 2) into the apical membrane of the Distal Convoluted Tubule and Collecting ducts. taking water out of the osmoreceptor cells via an osmotic shift. Water is passively reabsorbed with sodium which maintains sodium concentrations at a constant level. are not covered by the blood-brain-barrier (this is necessary for them to fulfill their duty).A) Brain: Central osmoreceptors are present in the hypothalamus. Aldosterone stimulates the active reabsorption of sodium from the tubular urine back into the nearby capillaries in the distal tubule. The exact parts of the hypothalamus they are in are called the organum vasculosum or the lamina terminalis (OVLT) and the subfornical organ (SFO). 1) Vasopressin: Also called antidiuretic hormone (ADH). The end result is the same: you get thirsty. It also stimulates the Na2/K/Cl. resulting in the upregulation of the Epithelial Sodium Channel (ENaC). It increases osmolality of urine/concentrates urine and decreases excretion of water. a ‘pressor’ drug is one that increases blood pressure. A drop in plasma volume due to water loss will cause these baroreceptors to signal the posterior pituitary to increase vasopressin secretion. which acts via the Renin-AldosteroneAngiotensin system to increase blood pressure (angiotensin – tenses the arteries) and increase sodium and water reabsorption (aldosterone). the diffusion of water into and out of the osmoreceptor cells change. open eyes to vocal stimuli and following simple commands 15cm laceration on leg . which drives countercurrent multiplication and creates the osmotic gradient needed for the reabsorption of water. (recall. it’s in the name. Aldosterone acts at the DCT and collecting ducts. Increased intake of water will increase plasma volume. Excess salt in the bloodstream saps water from the osmoreceptor cells. leading to decreased flow to the macula densa. It affects transcriptional changes typical of steroid hormone action. (More about this in the endocrine section.

blood flow to vital organs. c.coupling Q4: Stats .Electron dense core of DNA . weight vs.drug efficacy Q5: ECG and some question about MI – heart failure? Q6: Viruses causing cancer.Polymerase chain reaction amplification of viral DNA d. d. Replication cycle of virus (4 marks) c.treatment and pathogenesis Q3: Heart disease .Risk factors for MI and treatments and atherosclerosis pathogenesis Q4: Downs syndrome . tachycardia .what causes it and two viruses. septic.Capsid surrounding core . autoantibodies associated with it and treatments Q5: Multiple-choice question of Abdominal scan with questions about innervation and blood supply of gut Q6: Stats . VIRUSES a.pathogenesis of autoimmunity.Shock due to blood loss – 2 14 gauge IV cannula . BP increases – 96/64 What is shock and how is it classified? . Structure of Herpes virus (3 marks) . How contracted? (1 mark) -Skin contact -Sexual contact Class of 2011: 1st Year (2007/2008): Q1: Depression risk factors and suicide risk factors Q2: Rheumatoid arthritis .Virus culture . increase symp activity – vasoconstriction (pallor and cold extremities). 2 methods used in diagnosis of HSV (2 marks) .Hypovolaemic.After infusions.Tegument surrounding capsid b.Hardy Weinberg calculations for cystic fibrosis SAMPLE QUESTIONS . CO = SV x HR. and types Q6: Shock different types and Circle of Willis multiple-choice picture 2nd Year Christmas exams (2008/2009) Q1: CT abdomen and steattorrhea Q2: Menorrhagia and period pain / menstrual cycle Q3: Marathon runner – muscles. b. and causes of cancer 2nd Year Summer exams (2008/2009) Q1: Multiple-choice question of cross section of spinal cord with motor and sensory nerves – Nigel’s lecture Q2: Pathogenesis of Atherosclerosis (not including fatty streak) and complications of heart disease/failure Q3: Stats .At least 40% circulating volume – 2 liters . endurance. neurogenic. muscle fibre contraction .kidney transplant survival Q4: SLE Autoimmune question . .Kaplan Meier survival curve . BP raises as product of CO and TPR. anaphylactic How much blood lost? Justify .Culture followed by immunoflourescence – determine virus type .Not until this degree of blood loss – would a young fit px become hypotensive What is the immediate physiological response to blood loss? How does it account for patient’s clinical signs? .Hypotension and confusion are due to blood loss being so large that these mechanisms are not able to compensate and maintain good CNS perfusion Explain in physiological terms how infused fluid causes increase in BP . cytotoxic.what is mosaicism and risk of offspring having it Q5: Cancer .Decrease BP – baroreceptors in aortic arch and carotid sinus.State where CO insufficient to meet metabolic demands of body .Gives 1L Hartman’s solution – crystalloid . cardiogenic.Increase in intravascular volume cases increase in venous return => Increase LVEDV -> starlings law – increase SV and CO.a. MAP = CO x TPR 6. increase HR and contractility.

He is intubated and ventilated and transferred to the ITU at MWRH. Antigen stimulation initially causes B cells to produce large amounts of IgM – ‘primary immune response”. The variable region at the tips of the Y varies among different antibodies and determines the antigen specificity of the antibody. IgD. On examination. Following his admission to hospital. IgM – pentamer IgG – monomer – 80% IgA – mucosal – dimer (b) B cells produce immunoglobulin that migrates to the cell surface to act as an antigen receptor. a. he had stopped breathing for at least 5 minutes before CPR was commenced. 2. a 57-year-old man has a cardio-respiratory arrest while watching a rugby match at Thomond Park. (a) There are 5 isotypes – IgM. IgA. She has recently adopted a stray kitten. The secreted antibody circulates in the bloodstream and binds with the antigen that induced its synthesis. The Fab portion is the antigen-binding site. OXYGEN Michael Jackson. Explain how the events described can lead to brainstem death (4 marks). IgG with undetectable IgM indicates remote response. who is 15 weeks pregnant. Immunoglobulins consists of 4 polypeptide chains . IgG. Explain how an antigenic stimulus results in the production of immunoglobulins (2) c. she is noted to have cervical lymphadenopathy and her GP is concerned that she has contracted toxoplasmosis. Serum antibody analysis shows a raised IgG antibody titre to Toxoplasma gondii but IgM antibodies are virtually undetectable. how might the medical team reach a decision not to resuscitate Mr. comes to her GP two days after she develops a flu-like illness.2 alpha chains . Do Ms Duffy’s lab results indicate recent or remote exposure to Toxoplasma? Explain your answer (2) d. ANTIBODIES Joan Duffy. tonsils and thyroid. c. Antibody production is increased by the stimulation of B cells by helper T cells. Some B cells undergo a class switch and differentiate into plasma cells expressing IgG – “secondary immune response”.2 heavy chains – 5 types per group – define class. The posterior cervical nodes extend in a line posterior to the sternomastoid but anterior to the trapezius. However. They drain the internal structures of the throat. When stimulated by an antigen. Describe the different isotypes of immunoglobulin and outline their structures (3 marks) b. The FC portion directs the biological activity. posterior pharynx. (d) The anterior cervical nodes are both superficial and deep and lie above and below the sternomastoid muscle. the B cell differentiates into plasma cells that express large amounts of secreted IgM. a. IgE. CPR is performed by St Johns Ambulance personnel.1. Jackson in the event of another cardio-respiratory arrest? (3 marks) . Outline the distribution of the cervical lymph nodes and the major anatomical structures that drain to them (3). (c) Results indicate remote exposures. b. his heart beat is restored and his BP returns to normal (120/80). Briefly explain why O2 is required for the body (3). They mainly drain the lungs. from the level of the mastoid process to the clavicle.

(b) O2 is required for the generation of ATP by oxidative phosphorylation. Normally the brain is protected from harmful and highly reactive species of oxygen (e. his next-of-kin might be asked their opinion of what Mr. . There is also a possibility of her seizures reoccurring if she were to stop her anticonvulsant. When in her teens. causing acidosis. The step requiring O2 is the terminal step of the electron transport chain (ETC). generating little ATP and causing a build up of lactic acid. hydroxyl radical) by protective enzymes (superoxide dismutase. through to conditions where the meninges with or without the spinal cord protrude from the spine.When in doubt .Resuscitation is likely to be followed by a length and quality of life that would not be in the patients best interest . (b) Closure of the neural tube is complete by about 5 weeks of embryonic age.resuscitate In Mr. (3 marks) (b) Susan asks whether stopping the sodium valproate is a good idea and whether it will reduce the chance of her baby having a NTD. (a) Briefly describe the nature of caudal NTDs and the forms they make take. On reperfusion.Advance directive . The brain can metabolise glucose anaerobically but this yields little energy while generating lactic acid.For the liver detoxification of drugs and other substances using the CYP450 system and NADPH . proteins and membranes. steroid hormones. (c) There are several options: . She and her partner normally use barrier methods for contraception. which continue to damage DNA. glutathione. O2 is also required: .Involve patient and next of kin before emergency . Ideally the patient’s wishes in this regard should be formally documented. She has been taking Sodium Valproate for about 6 years. This ranges from a mild form. These enzymes are lost / reduced when the brain is anoxic. 3. (c) A DNR decision is appropriate when: . Jackson would have wanted were he in a position to make a decision. superoxide. as bone and cartilage readily reflect sound waves . catalase) and free radical scavenging agents (e. Explain how they develop. All decisions made should be communicated and explained to his next of kin.g.CPR is against the stated wishes of a mentally competent patient. If the edges of the caudal portion of the tube do not fuse. the brain cannot eliminate the free radicals and toxic O2 derivatives. a defect known as spina bifida results.CPR is likely to he futile . H2O2.(a) The brain has a high-energy requirement and cerebral anoxia for 3 – 4 minutes leads to irreversible damage. the spinal cord is properly surrounded by the vertebral column.To generate heat of electron transport and oxidative phosphorylation are uncoupled. A home pregnancy test on the previous day was strongly positive. In the ETC. Her major worry is that the baby will have a NTD because of the drug she is taking. activated Vit D etc also using CYP450 . (3 marks) (d) Assuming that sodium valproate is the most effective anticonvulsant for Susan. Explain what you would say to her. what advice would you give her about planning future pregnancies? (2 marks) (a) Caudal NTDs develop during the rolling up of the flat neural plate to form the neural tube. in which there is only a small defect in the neural arches and in which the skin is intact (occulta). In spina bifida. NTDs Susan Gallagher is a healthy 21-year-old woman accountancy student who is in a stable relationship.an ultrasound is good in detecting structural defects in the vertebral column. One day she visits her GP because it is 8 weeks since her last period. Stopping her drug at this stage (8 weeks) would not lessen the chance of a NTD. ATP can only be generated by anaerobic glycolysis. she suffered some epileptic seizures for which no cause could be found. What advice would you give and why? (2 marks) (c) Susan further asks if any tests can be done to see if her baby is normal. peroxidase. to a severe defect in which the spinal cord is split and completely exposed (myeloschesis).g. RNA. Vit C). NADH and FADH2 are reoxidised to NAD+ and FAD+ to allow the continuation of oxidation of fuels by the Krebs cycle. Without O2. Jackson’s case.In the synthesis of bilirubin.

an NTD results in alpha fetoprotein (AFP) leaking into the amniotic fluid in greater concentrations and this can be detected by sampling the maternal blood by a direct amniocentesis. - . depends on peak levels. (d) The dose of sodium valproate should be kept as low as possible and should be given in divided doses throughout the day because teratogenicity is dose-dependant and in the cases of sodium valproate. Susan should also take folic acid supplements and her serum folate levels should be monitored.