Just questions

Xmas pre-mock chill playlist

Why does foetal haemoglobin have a higher affinity for oxygen than
adult haemoglobin?

A) Foetal Circulation is at a lower temperature.

B) Foetal Haemoglobin contains 2,3 DPG
C) Foetal Haemoglobin cannot bind to Carbon Monoxide
D) Foetal Haemoglobin lacks a binding site for 2,3 DPG
E) It has more binding sites
What are the boundaries of the anterior triangle of the neck?

A) Posteriorly, the anterior border of the sternocleidomastoid, the midline of the

neck medially and superiorly, the inferior aspect of the mandible

B) Posteriorly, the anterior border of the trapezius, anteriorly the posterior border of
the sternocleidomastoid and inferiorly the middle third of the clavicle

C) Posteriorly, the posterior border of the sternocleidomastoid, anteriorly, the

midline and superiorly inferior aspect of the mandible

D) Posteriorly, the anterior border of the trapezius, anteriorly the posterior border of
the sternocleidomastoid and superiorly the middle third of the clavicle

E) It is a square, not a triangle

A 46yo nurse takes an intentional paracetamol OD, a suicide note is
discovered on scene. PMHx includes epilepsy which is well controlled
with carbamazepine. She has taken around 30 tablets. Blood samples
are taken in hospital and a collateral history reveals the OD likely
happened 6h ago.

A)IV Saline + 4 hourly LFTs + PTT

B) Activated charcoal and repeat LFTs in 4h
C) Repeat paracetamol level at 8h
D)Give oral methionine
E) Give IV acetylcysteine
48yo man is admitted with chronic alcoholic liver disease. He
gives very little history. Exam shows grade 1 encephalopathy,
4cm enlarged liver and clinically significant ascites.
Which of the following combinations is most reflective of
synthetic liver function?

A)PTT + ALP
B) PTT + albumin
C) ALT + AST
D)Albumin + ALP
E) PTT, albumin + ALP
A 47y/o sprained his ankle 2 weeks ago and has been self managing with
ibuprofen gel and tablets. His wife, a nurse, is worried about his kidneys.
Which part of the nephron do NSAIDs act on?

A) afferent arteriole
B) efferent arteriole
C) glomerulus
D) macula densa
E) PCT
A 40 year old lady visits the GP. She has a 6 month history of weight loss
despite increased appetite, increased anxiety and feels like she is getting
hot flushes. She is convinced that she may be going into menopause and is
worried. Looking at the blood results, what is the most likely diagnosis?
Test Result Normal Range
Capillary 6.2 4.0 – 6.0 | < 7.8
blood glucose
A) Late onset T1DM
pH 7.4 7.35 – 7.45
B) Primary hypothyroidism Bicarb 24 22 - 26
Lactate 0.8 0.5-2.2
C) Primary hyperthyroidism Na+ 140 133-146
K+ 4.0 3.5 – 5.3
D) Secondary hyperthyroidism TSH <0.1 0.4 – 4.0
T4 55 9.0 – 25.0
E) Secondary hypothyroidism
Urine analysis NAD
A fit, healthy 27y/o runs a 10k race, they sweat a lot, drink some
water, and recover well after the race. What is the mechanism of
action for angiotensin ll?

A) stimulate reabsorption of water and salt in kidneys

B) vasodilates of blood vessels and stimulates aldosterone release
C) vasoconstricts blood vessels and stimulates aldosterone
release
D) stimulates release of renin
E) stimulates aldosterone release
A 17 year old girl is brought into A&E unconscious. She vomited three times that morning, had
blurred vision and an unbearable headache. On arrival she was tachycardic and had a funny
smell.

Turns out the smell was similar to pear drops. Further bloods and a urine dip were also done on
this patient. Both were positive for ketones. What is the top differential?

A) HHS

B) DKA

C) Acute Liver failure

D) Influenza

E) Alcohol poisoning
A 25 year old primary school teacher visits the GP complaining of frequent
loose stools, with the appearance of blood in her stools in the past 2 weeks.
She’s has a history of crampy abdominal pain and often has to rush to the
toilet. Stool microscopy was negative, but she was found to be anaemic. She
was referred for colonoscopy. Looking at the image of the distal colon what
is the likely diagnosis?

A) Coeliac disease
B) Colon cancer
C) Polyps
D) Crohn’s disease
E) Ulcerative colitis
A father want his son to be tested for Coeliac disease, as he himself has
it. Which of these is the gold-standard for diagnosis of Coeliac Disease?

A) High anti-transglutaminase

B) Duodenal biopsy showing high intra-epithelial WBC and crypt

hyperplasia

C) HLA DQ2 and DQ8 genotyping

D) High anti-endomysial antibodies

A 55-year-old man presents with a 6-month history of upper abdominal discomfort and
bloating, which worsens on lying flat. He notices these symptoms especially after
mealtimes. He denies dysphagia, vomiting, hematemesis, or melaena. On direct
questioning he admits to losing 5kg in weight in the last month. He reports losing this
weight because he has been eating less after noticing that large meals cause him increasing
abdominal discomfort. What is the next most important step in management?

A) Advise weight reduction

B) Start eradication therapy for helicobacter pylori

C) Start omeprazole

D) Test for helicobacter pylori

E) 2 week wait referral for upper GI endoscopy

A 58-year-old man, with a history of GORD, undergoes an upper GI endoscopy.
Redness is observed extending up into the oesophagus from the gastro-
oesophageal junction (pictured).

Which one of the following pathological events is most likely to explain this
process?

A) Metaplasia
B) Anaplasia
C) Dysplasia
D) Hypoplasia
E) Hyperplasia