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CONSULTANT SURGEON
D.H.Q. TEACHING HOSPITAL / SAHIWAL MEDICAL COLLEGE SAHIWAL PAKISTAN Email: surgeonshirazi@yahoo.com Cell No: +92 300 8690150
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Important MCQ colloction for part-1 MRCOG(1)) 1- Prostaglandin PGI2 (prostacyclin).. A- reduces arterial smooth muscle tone .....................T B- is a product of arachidonic acid metabolism ............................T C- production is inhibited by non-steroidal anti-inflammatory drugs .............T D- increases platelet cyclic AMP concentration ...................T E- inhibits platelet aggregation to damaged vessel walls ...................T 2- The antiphosphopholipid syndrome is associated with: A- myocardial infarction ...............................T B- venous thrombosis ..................................T C- left ventricular thrombus ..........................T D- pulmonary hypertension ..........................T E- recurrent abortion ...................................T Antiphospholipid syndrome is the association of arterial and venous thrombosis with antibodies directed against phospholipids. Originally noted as a complication in approximately 30% of patients with systemic lupus erythematosus, it is now also diagnosed in patients with thrombotic episodes and anti-phospholipid antibodies (aPL) but without clinical features of SLE - primary antiphospholipid syndrome. It is associated with MI, Recurrent miscarriages, DVT, Stroke, pulmonary hypertension (due to thromboembolic disease) and LV thrombus rarely reported. 3- Natural Killer cells ....... A- are a type of T lymphocyte ...................T B- are predominantly found in lymph nodes ..............................F C- express cell surface CD-3 ...................................................F D- kill antibody coated cells ....................................................T E- release tumour necrosis factor ...........................................T a) Natural Killer cells are a lymphocytic lineage discrete from T + B lymphocytes and are involved in defence against malignancy, viruses and probably bacteria and parasites. b) rarely found in thymus / lymph nodes - unlike T cells c) NK cells are CD3-ve and CD16 and CD56 +ve (the opposite is true of T
B- guanine (G) always pairs with thymidine (T) and adenine (A) with cytosine (C) ...............F C- each DNA strands have a pentose-phosphate backbone with projecting bases ..................T
E- each amino acids may be coded by more than one codon. ......T Pyrimidine bases are thymidine (T) and Cytosine (C). G always pairs with C and T with A. 9- The adductor canal :
A- contains an artery which contributes to the genicular anastomosis .........T B- contains a nerve supplying the tensor fascia lata muscle .................F C- contains the deep femoral artery ...........................F D- contains the nerve to the vastus medialis muscle ................T E- contains the saphenous nerve .....................T The adductor canal is a gutter shaped groove between the vastus medialis muscle and in front of the adductor muscle. The gutter is roofed by the sartorius muscle, underneath which a fascia contains the subsartorial plexus. The calan transmits the femoral artery and veing, saphenous nerve and, in the upper part, the nerve to the vastus medialis muscle. The tensor fascia lata muscle is supplied by the superior gluteal nerve (L4, L5, S1), which crosses the buttock and ends in the muscle. 10- Characteristic findings in anorexia nervosa are: A- a decrease in Cortisol levels ...............................F B- an increase in LH levels ......................................F C- impaired glucose tolerance .............................T D- raised androgen levels .....................................F
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A- Are earth referenced generators .................................................F B- Operated in a frequency range of 400-600 kHz .............................F
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53.Regarding the human chromosomes: A- There are 23 pairs of autosomal chromosomes...............................F B- The Y chromosome is larger than the X chromosome......................F C- Cells containing YO chromosome are not compatible with life...........T D- Barr body is caused by the presence of an inactive X chromosome.....T E- Barr body is only found in people who are phenotypically female........F There are 22 pairs of autosomes, and one pair of sex chromosomes. The Y chromosome is smaller than the X chromosome, no YO individuals have been identified, not even aborted foetuses. It has been suggested that there is something fundamental on the X chromosome that is needed for life. The Barr body is visible during interphase and chromosomes are too tenuous to be stained and seen by light microscopy. However, a dense, stainable structure, called a Barr body (after its discoverer) is
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Virulence factors are important in the bacterial survival in vivo. In this sense bacterial extracellular proteolytic enzymes can be recognized as the legitimate target for this approach since they are involved either in direct or indirect destruction of an infected/colonized tissue and in dysregulation of many host defense pathways. The best example of the last is an effect of bacterial proteinases on fibrinolytic, kallikrein-kinin and complement cascades, as well as degradation of immunoglobulins, inactivation of endogenous proteinase inhibitors, and dysregulation of cytokine network system. Proteolytic enzymes are responsible for the virulence and activity of organisms such as Strep Pyogenes, Staphylococcus aureus, E coli and Clostridium welchii enabling the necrolytic effects on the
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Thyroid hormone production is stimulated by the anterior pituitary hormone TSH and secretion begins from approximately the 12th week of gestation. T3 and T4 are manufactured within the thyroid cells through iodination of tyrosine. The synthesized T3 and T4\ are then stored within the colloid at the centre of the thyroid follicles. The thyroid like most other endocrine organs moderately enlarges during pregnancy. 60. The human testis secretes: A- Androstenedione .......................................................................T B- Luteinising hormone ...................................................................F C- Oestradiol ..................................................................................T D- Inhibin .......................................................................................T E- Fructose .....................................................................................F
The testis is responsible for secreting testosterone, androstenedione, Oestradiol, inhibin as well as a small amount of progesterone. The anterior pituitary produces LH and FSH. Fructose and prostaglandins that nourish the spermatozoa are secreted by the seminal vesicles. 61. Staphylococcus epidermidis: A- is coagulase positive .................................................................F B- on microscopy are Gram positive cocci in chains .......................F C- are usually sensitive to penicillin ...................................................F D- grown in blood cultures are due to contamination and should be ignored ...........F E- are destroyed by povodine iodine ...................................................T Staph. epidermidis is part of the normal skin flora. As for Staph. aureus, Gram positive cocci in bunches are seen on microscopy.
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Testosterone, like oestradiol, feeds back at the hypothalamus / pituitary to inhibit GnRH secretion and
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Important MCQ colloction for part-1 MRCOG(3) 76. Genes on sex chromosomes are responsible for the inheritance of: A- Glucose 6 phosphate dehydrogenase deficiency .............................T B- Achondroplasia ..........................................................................F C- Hairy ear rims ...........................................................................T D- Homocystinuria .........................................................................F E- Hurler's syndrome ......................................................................F Genes on sex chromosomes would typically give rise to X-limked recessive and dominant conditions such as G6PD, haemophilia, vitamin D resistant rickets. 77. Beta-thalassaemia major (homozygous) A- is characterised by persistance of HbF .........................................T B- is associated with a chronic marked reticulocytosis .......................F C- is always associated with a raised proportion of HbA2 ...................F D- is very rarely associated with nucleated red cells .........................F E- is a cause of pathological fracture of long bones ...........................T nucleated red cells always seen, retics low. HbA2 raised in beta-thalassaemia trait. 78. In mitosis A- the number of chromosomes is halved..........................................F B- anaphase lag may produce Turner syndrome................................T C- the stage of metaphase shows separation of whole chromosomes........F D- nondisjunction increases with decreasing maternal age...................F E- an abnormal plane of division of the chromatids produce isochromosomes...............T
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Each time new cells are produced, there is a mitotic cycle it must go through. They are: Interphase (before mitosis) Prophase Metaphase Anaphase Telophase 79. Which of the following are adhesion molecules? A- cadherin ...................................................................................T B- laminin .....................................................................................T C- fibronectin .................................................................................T D- integrin ....................................................................................T E- secretin .....................................................................................F
During an inflammatory response adhesion molecules serve to enhance pairing between many less avid receptors and their ligands and transmit signals that direct specific effector functions. At least four superfamilies of adhesion molecules participate in these events: the selectins, the integrins, certain members of the immunoglobulin superfamily and cadherins. Secretin is a duodenal hormone which stimulates pancreatic exocrine secretion. 80. In the T cell response to antigen: A- A process of affinity maturation of the T cell receptor occurs............F B- Intact antigen is presented in association with self MHC molecules.....F C- Co-operation with other cell types is required for T cell recognition of antigen...............T D- gamma/delta + T cells respond to antigen presented in association with MHC class II molecules...........F E- Interactions of the TcR with an appropriate Ag/MHC complex activates a resting T cell..............F a) Affinity maturation in an ongoing immune response is a feature of the antibody response. There is no evidence that a similar process occurs in the T cell response. b) MHC molecules present short antigen-derived peptides, not the intact antigen. c) T cells recognise antigen only when presented by (self) MHC molecules on an antigen presenting cell. d) MHC class II molecules present antigen to CD4+, alpha/beta+ T cells. It is still not clear how gamma/delta+ T cells recognise antigen, however most gamma/delta+ T cells do not appear to be restricted by (self) MHC molecules. e) Additional 'costimulatory' signals are required to activate a resting
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The lymphatics from the cervix pass either laterally in the base of the broad ligament or posteriorly along the uterosacral ligaments to reach the side wall of the pelvis. Most of the vessels drain to the internal iliac, obturator and external iliac nodes, but vessels also pass directly to the common iliac and lower para-aortic nodes. 91. In the vulva A- The blood supply is partly derived from the middle rectal artery.........F B- The blood supply is partly derived from the external pudendal artery..........T C- Lymph drains to the inguinal group of nodes. .................................T
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Spermatogenesis takes place between the the Sertoli cells with leydig cells releasing testosterone to encourage the process. The time required for spermatogenesis in humans is approximately 75 days. Spermatozoa develop through a process of meiosis so diploid spermatocytes provide four spermatids. There is a certain percentage of abnormal sperm allowed to be present in a normal semen analysis. 93. Carbimazole: A- May cause fetal hyperthyroidism ...................................................F B- Can be used sublingually ............................................................F C- Is secreted in significant quantities in breast milk .........................T
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Prolactin is produced from the anterior pituitary gland, A number of other hypothalamic releasing hormones induce increased prolactin secretion; Prl rises throughout pregnancy. PRL & HPL are peptide hormones but they are not identical. Human placental lactogen is a single-chain polypeptide with two intramolecular disulfide bridges. The structures of hPL, prolactin, and growth hormone are very similar. Eighty-five percent of its amino acids are identical to human pituitary growth hormone and human pituitary prolactin Furthermore, hPL shares biologic properties with both growth hormone and prolactin Thus, it has primarily lactogenic activity but also exhibits some growth hormone-like activity; therefore, it is also referred to as chorionic growth hormone (hCGH) or human chorionic somatomammotropin (hCS). Oxytocin controls milk ejection. The dopamine antagonist metaclopramide abolishes the pulsatility of prolactin release and increases serum prolactin levels 95.placebo in a clinical trial A- has no effects .............................................................................F B- is pharmacologically inert .............................................................T C- should not be given to patients with carcinoma ..............................F D- should be identical in appearance to the drug being studied ............T E- is best administered by a person who is unaware of the drug's identity ...............T
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Insulin (and C-peptide which is inactive) is secreted by the beta cells within the islets of Langherhan as the active molecule following cleavage from preproinsulin, then proinsulin. It is metabolised in the liver and undergoes renal excretion. Half life is roughly 4 mins. 108. The following are recognised carcinogens A- nicotine ......................................................................................F B- electromagnetic microwaves .......................................................F C- Infra-red radiation .....................................................................F D- beta-naphthylamine .....................................................................T E- Arsenic .......................................................................................T 109. Concerning gonadal development: A- The histological appearance of the primitive gonad is similar in both sexes until 42 days after fertilization .............................................T B- The ovary develops in the medulla of the primitive gonad. ...............F C- The histo-differentiation of the testis begins later than that of the ovary ...............F D- Primary sex cells (gonocytes) have a haploid number of chromosomes ............F E- Mitosis in oogonia is not completed by the end of the first year of life ................F
The appearance of the primitive gonad is similar in both sexes until 42 days after fertilization when seminiferous differentiation occurs. At 10 weeks conception there is meiotic entry of
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The urinary system develops from the intermediate mesoderm. During development of the fetus there are 3 overlapping kidney systems - the pro, meso, and metanephric systems. The metanephros forms the permanent kidney. Bowman's capsule and the glomerulus develop as part of the metanephros 111. Regarding Escherichia Coli A- Is a gram positive rod ...................................................................F B- grows anaerobically .....................................................................T C- characteristically produces a malodourous infection ..........................F D- Most strains are not pathogenic .....................................................F E- produces an enterotoxin .............................................................T E coli is a gram negative anaerobe and produces both endotoxins and enterotoxins (enterotoxigenic E Coli). It does not typically produce a malodourous infection as it is likely that other anaerobes are responsible for this - eg Bacteroides etc. Most strains have the potential to be pathogenic. 112. Hypokalaemia may be caused by: A- Bendroflumethiazide ....................................................................T B- Digoxin ......................................................................................F C- Spironolactone ............................................................................F D- Carbenoxolone ............................................................................T
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Carbenoxolone may cause hypokalaemic hypertension like liquorice through inhibition of 11beta hydroxysteroid dehydrogenase (11bHSD). Bendroflumethiazide is a thiazide diuretic and promotes potassium excretion. Amiloride, like spironolactone is a potassium sparing diuretic and causes hyperkalaemia. Digoxin toxicity is exacerbated by hypokalaemia but it does not cause hypokalaemia 113. Thrombocytopenia is a recognised adverse effect of the following drugs: A- aspirin .........................................................................................T B- oxymethalone .............................................................................F C- thiazide diuretics .........................................................................F D- gold ...............................................................................................T E- dapsone .......................................................................................F A - aspirin causes reduced platelet function, thrombocytopaenia and increased bleeding time. For further details on thrombocytopaenia. Thrombocytopaenia is a decrease in the number of platelets in the blood - it reduces the ability of the blood to clot and is thus a bleeding diathesis. It is defined as a platelet count less than 100 x 10^9/L (<100,000 per cubic mm). In addition, it is important to consider also the causes of apparent thrombocytopaenia - i.e. conditions where there is platelet dysfunction. Neonatal thrombocytopaenia has a modified differential diagnosis. 114. Which of the following are effective in the treatment of menopausal flushes? A- Raloxifene ..................................................................................F B- Clonidine .....................................................................................T C- 17 beta-oestradiol .......................................................................T D- Norethisterone ............................................................................F E- Venlafaxine ..................................................................................T
There are numerous drugs other than oestrogens that are effective in the treatment of PM flushing. Venlafaxine the SSRI has some benefit in reducing fluches particularly in those subjects that are unable to use osestrogens. Clonidine is well established for this purpose also. Progestogens do not help flushes but are used in as combined HRT with estrogens in women with an intact uterus. Raloxifene, the SERM, may exacerbate flushes.
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Glucocorticoids , steroids, may cause iatrogenic cushing's, with thin skin ease of bruising, glucose intolerance/diabetes, hypertension and hypokalaemia, hirsutism, osteoporosis and it may result in hypogonadotrophic hypogonadism (hence amenorrhoea). Therapy may also be associated with aseptic necrosis of the femoral head. 116. Which of the following are potassium sparing diuretics? A- Triamterene ...............................................................................T B- Bendroflumethiazide ...................................................................F C- Furosemide .................................................................................F D- Spironolactone ............................................................................T E- Captopril .....................................................................................F
Potassium sparing diuretics include spironolactone, trimaterene and amiloride. They act on the distal convoluted tubule inhibiting through various mechanisms the loss of potassium in exchange for sodium. Furosemide is a loop diuretic and bendroflumethiazide a thiazide diuretic. Captopril is not a diuretic but an ACE inhibitor. 117. Wound healing by secondary intention takes place: A- when the wound does not break apart ...........................................F B- when the wound edges are brought together .................................F C- when there is irrepairable skin loss ..............................................F D- much more slowly than healing by first intention ...........................T E- when the wound becomes infected ................................................T
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Healing by secondary intention occurs when the wound edges are apart. Angiogenesis and fibroblast proliferation result in the formation of granulation tissue, which contracts to reduce the wound area and allows epithelialisation across it's surface to achieve wound closure. Where the wound edges are apposed, healing proceeds rapidly to closure and this is known as primary healing. If there is irrepairable skin loss then the process would be very slow and the resultant healed surface is a thin layer of epithelium on scar tissue that may not prove durable in the longterm. Healing by secondary intention is a slower process due to the formation and contraction of granulation tissue resulting in a slow apposition of the opposing skin appendages. When the wound is infected it should heal by secondary intention. Attempting to heal the wound by primary measures would leave an underlying infection, that would lead to wound breakdown.
118. The following micro-organisms are generally sensitive to Benzylpenicillin: A- Streptococcus Pneumonaie ..........................................................T B- Cryptococcus neoformans ...........................................................F C- Bordetella pertussis ....................................................................F D- Streptococcus viridans .................................................................T E- Mycoplasma pneumoniae .............................................................F Penicillin binds to specific penicillin-binding proteins (PBP's) in the cell wall, mainly of gram positive organisms. Penicillin resistance is usually due to production of altered PBPs or betalactamases which leave the penicillin molecule. Penicillin is mainly useful for Group A Strep., Group B Strep., meningococcal and pneumococcal infections, though and anthrax are also sensitive. Pneumococci with modified PBPs are an increasing problem. 119. Regarding the capsulated bacteria: A- Meningococci are carried by farm animals .....................................F B- Streptococcus pneumoniae produces a -haemolysis when cultured on blood agar ....................T C- Neisseria species are Gram positive ..............................................F D- Escherichia coli carries V antigens which allow serotyping .....................F E- Neisseria lactamica and Neisseria meningitidiscan be differentiated on the basis of carbohydrate utilisation ................T
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Examples Examples of opsonin molecules include: antibodies: IgG and IgA components of the complement system: C3b, C4b, and iC3b Mannose-binding lectin (initiates the formation of C3b) The most important are IgG and C3b 135. Octreotide: A- is a somatostatin analogue ............................................................T B- is an effective treatment for Cushing's syndrome ............................F C- is an effective treatment for carcinoid syndrome .............................T D- is used in the treatment of polycystic ovarian syndrome ..................F
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Prophylaxis for those undergoing potentially contaminated colorectal surgery or appendectomies and may be combined with neomycin Acute gingivitis and other dental infections (TGA approved, non-Food and Drug Administration (FDA) approved) Crohn's disease with colonic or perianal involvement (non-FDA approved)- believed to be more effective in combination with ciprofloxacin Topical metronidazole is indicated for the treatment of rosacea, and in the treatment of malodorous fungating wounds 143. Which of the following antihypertensives are ACE inhibitors A- Verapamil ....................................................................................F B- Propranolol ..................................................................................F C- Lisinopril .....................................................................................T D- Ramipril ......................................................................................T
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6- Ethyl Alcohol : Action Inhibits the release of oxytocin from the posterior pituitary gland. Suppresses the myometrial activity directly. Inhibits prostaglandin F2 a synthesis. Dosage It is given IV and the dose is adjusted to maintain blood alcohol level of 0.9-1.6 mg/litre. Side effects Nausea, vomiting and depression. Drunken mother and foetus. Maternal and foetal acidosis. 150.
Important MCQ colloction for part-1 MRCOG(5) : A- Hyoscine hydrobromide .................................................................T B- Morphine sulphate .........................................................................F C- Chloropropamide .........................................................................T D- Promethazine hydrochloride ..........................................................T E- Perphenazine ...............................................................................T
Hyoscine is an alkaloid, Promethazine is an antihistamine, Perphenazine is an antipsychotic and all 3 have antiemetic properties. The sulphonyl urea chloropropramide may have antiemetic properties and has thus been marked as true. Morphine has an emetic action. An antiemetic is a drug that is effective against vomiting and nausea. Anti-emetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics and chemotherapy directed against cancer. 1- Promethazine
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These drugs have the following effects vasodilation, bronchial relaxation, intestinal and genitourinary wall relaxation, cardiac stimulation, renin release, glycogenolysis, gluconeogenesis, lipolysis 152. Thiopentone sodium administration intravenously: A- Is a potent muscle relaxant ...........................................................F B- Is predominantly excreted by the kidney .......................................F C- Binds to protein ...........................................................................T D- Is fat soluble ...............................................................................T E- Crosses the placenta ....................................................................T
Thiopentone sodium produces general anaesthesia. Although bound to plasma proteins thiopentone sodium rapidly crosses the blood-brain barrier. Thiopentone sodium is slowly metabolised by the liver. Only a small proportion of the active drug is excreted in the urine. 153. The following antibiotics act on bacterial walls: A- Penicillin .....................................................................................T B- Ceftazidime ................................................................................T C- Metronidazole ..............................................................................F D- Clindamycin ................................................................................F E- Gentamicin ..................................................................................F
Mode of action of antibiotics can be classified as below 1.Inhibition of nucleic acid synthesis- Metronidazole 2.Inhibition of protein synthesis - Clindamycin, Gentamicin 3.Action on cell membrane - Polymyxin 4.Interference with enzyme system (antimetabolites) - Trimethoprim 5.Action on cell wall - Penicillins and Cephalosporins 154. Isoprenaline
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2) Indications Ventricular dysfunction especially RV(combination of pulmonary dilation & inotropic support) Bronchoconstriction Bradycardias Pulmonary hypertension (inotrope of choice if require inotropic support in such a patient)
3) Effects on organsside effects Also increases venous return to heart 4) Toxic effects/ precautions with administration Tachycardias, dysrythmias (due to b1 effects)
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Prostaglandins are long-chain hydroxy fatty acids derived from arachidonic acid, which is released from cell membrane phospholipids and catalysed by the enzymes cyclo-oxygenase and endoperoxidase. Prostaglandins are produced locally. The original source was the prostate. GI side effects include diarrhoea and abdominal pains. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring. They are mediators and have a variety of strong physiological effects. Prostaglandins are found in most tissues and organs. They are produced by all nucleated cells except lymphocytes. They are autocrine and paracrine lipid mediators that act upon platelets, endothelium, uterine and mast cells. They are synthesized in the cell from the essential fatty acids .......... Function
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Prostaglandins are believed to be important mediators of uterine contractions in women. Furthermore, there appears to be good correlation between the amount of prostaglandin production and cramps associated with dysmenorrhoea. It is now thought that as prostaglandin production increases, there is increased uterine cramping that results in uterine ischaemia and pain. Studies have shown that prostaglandin production increased during the first 48-72 hours of menstrual flow. Decreasing prostaglandin production with medications can decrease the pain. Since the arteriolar contraction and endometrial necrosis are caused by prostaglandins, it is apparent that prostaglandins play a pivotal role in controlling menstrual blood loss. PGF2a and PGE2 cause myometrial contraction and hence oxytocic. Prostaglandins are useful in obstetrics for induction of labour and termination of pregnancy
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Both penicillins and the aminoglycosides such as gentamicin are bactericidal whereas the others are bacteriostatic 158. Following are characteristics of hypoxic cell death a- apoptosis b- Phagocytosis c -Pyknosis d- Poiklocytosis e- Release of Phospholipids 159. Oestrogen receptors ....... A- Is localised to the nucleus only following ligand binding B- Does not undergo nucleocytoplasmic shuttling C- Binds heat shock protein 90 on activation D- Is regulated by phosphorylation E- Is similar to the androgen receptor 160. Copper-containing IUCDs A- Should be changed every year B- Have a higher incidence of actinomycosis colonization than plastic devices C- Causes a relative increase in ectopic pregnancies D- Have been implicated as a cause of fatal infection in pregnancies E- Do not cause menorrhagia
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The mechanism of IUDs is not well understood. It's known however that the presence of a device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium. Copper IUDs act by impairing sperm function and movement through the uterus, as copper is toxic to sperm. They do this by instigating a reaction which induces cellular and humoural inflammatory response to the presence of the copper within the cervical mucous, uterine cavity and fallopian tube. The copper and the inflammatory response are both spermicidal. They also cause changes in the lining of the uterus which prevents an egg attaching to the endometrium if it does happens to get fertilised. It is this irritation that leads to the increased bleeding and heavier periods. The more modern copper IUDs are associated with less blood loss and are also more efficacious 1- Copper releasing IUDs can cause cramps, longer and heavier menstrual periods, and spotting between periods. 2- The intrauterine system does NOT provide protection against the transmission of sexually transmitted diseases .On average, menstrual blood loss increases by 2050% after insertion of a copper-T IUD; increased menstrual discomfort is the most common medical reason for IUD removal. 3- Development of PID is very rare despite earlier beliefs that they occur commonly in women using IUDs. The risk of PID is highest within the first 3 weeks following insertion, while after that the risk is minimal. Women with cervical infections caused by chlamydia or gonorrhoea at the time of insertion have a 3-5% chance of developing an infection in the first 20 days. Screening for vaginal and cervical infections should be carried out prior to insertion to reduce risk of infection being passed to the uterus. Symptoms of infection : Pain or tenderness in lower abdomen; Unusual bleeding from vagina; Fever or chills; Discharge from vagina; Pain during intercourse; Burning sensation when passing urine. 4- The risk of ectopic pregnancy to a woman using an IUD is lower than the risk of ectopic pregnancy to a woman using no form of birth control. However, of pregnancies that do occur during IUD use, a higher than expected percentage (34%) are ectopic .
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Insulin secretion is stimulated by glucose, amino acids (arginine) and triglycerides. Pharmacologically its secretion is stimulated by sulphonylureas such as glibenclamide, and also glucagon (stimulating glucose release). Bendroflumethiazide may produce a deterioration in insulin sensitivity and hene increase insulin secretion. Propanolol may inhibit insulin secretion. 162. Nitric oxide: A- is generated from glutamine ----------------------------------------------F B- is produced by both inducible and constitutive forms of nitric oxide synthetase ------------T C- raises systemic vascular resistance --------------------------------------F D- is inactivated by oxygen free radicals -----------------------------------T E- is increased by cyclic AMP activation -------------------------------------F Nitric oxide is produced from l-arginine by nitric oxide synthase and is produced by the vascular endothelium in response to haemodynamic stress and produces smooth muscle relaxation and reduced vascular resistance. Nitric oxide is a free radical and may be inactivated through interaction with other oxygen free radicals e.g. oxidised LDL. It causes the production of cGMP as a second messenger
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The female breast extends from the 2nd to the 6th rib in the mid clavicular line, overlying pectoralis major. Beneath the breast there is a condensation of superficial fascia, which acts as a posterior capsule for the breast. There is a subareloar lymphatic plexus. Most of the lymph of the breast drains to the axilla, with lymph from the lateral breast draining into the axillary and infraclavicular nodes. Medially the lymph drains through the intercostal spaces into the parasternal (internal thoracic) nodes. However lymph from the breast may drain into any of the lymphatic basins and if one pathway becomes blocked, another is utilized. 165. Recognised features of acromegaly include A- hypocalciuria ----------------------------------------------------------------F B- intestinal polyposis --------------------------------------------------------T C- splenomegaly --------------------------------------------------------------T D- palpable peripheral nerves ----------------------------------------------T
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It should be appreciated that the risks to the fetus are small following exposure to chest Xrays but the far more with direct exposure following abdominal exposure. Generally there is an increased risk of childhood leukaemias and cancers. There appears to be no evidence for IUGR, diabetes nor mental retardation - although IQ on a population basis is significantly lower.
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Impartant MCQS FOR MECOG 1- the following substances are freely transferred across the placenta a-insulin. (false) b-thyroxine. (false) c-IgG. (true) d-warfarin (true). e-glucose. (true) Comments: There are many drugs that freely cross the placenta including the oral hypoglycaemic agents hence insulin is preferred in pregnancy. Warfarin also ocross the placenta hence the preferred use of heparin. Glucose a nutrient obviously cross the placenta. IgG pass but not IgM pass placenta. Thyroxine does not cross the placenta hence the reason for not using a block and replace regimen for treating thyrotoxicosis as carbimazole and propyl thiouracil does cross the placenta. 2- 2- in a consanguineous marriage a- the risk of a serious disease or defect is double that for an unrelated mating. (true) b-the risk of recurrence for autosomal recessive disorders is 50%.(false) c-there is an increased risk of producing mentally retarded child. (true) d-when it is between second cousins, does not carry an increased risk. (true) e-there is an increased risk of producing a deaf child. (true) Comments: Consanguinity (marriage to a blood relative) is associated with an increased risk of inherited disorders, birth defects as down syndrome and tends to be approximately double that of unrelated couples but not near 50%. This risk is attenuated as relationship between partners becomes more distant. 3- 3-Autoimmune addison's disease is associated with a-premature ovarian failure. (true) b-hypokalemia.(false) c-hypothyroidism. (true) d-vitiligo. (true) e-Sjogren's syndrome. (true) Comments: b- hyperkalemia. e-in 47% of patients with autoimmune Addison's disease at least one other autoimmune disorder was present. Primary hypothyroidism has the highest prevalence (20%) followed by vitiligo(9%), non toxic goiter, premature menopause, grave's disease, pernicious anaemia, sjogren's disease, hypoparathyroidism,type 1 diabetes mellitus and celiac disease. 4- 4- the following drugs cause hypokalemia a- commencement of digoxin for atrial fibrillation.(false) b-ACE inhibitors.(false) c-salbutamol for asthma. (true) d-vitamin B12 for the treatment of pernicious anaemia. (true)
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42 -51-In hypopituitarism: a-selective gonadotrohin deficiency may be present. (true) b-concomitant diabetes inspidus may be masked by anterior pituitary failure.(true) c-adrenal steroid replacement must be started before thyroid replacement. (true) d-mineralocorticoid replacement is usually necessary. (false) e-in men,androgen replacement will cause masculinisation and restore fertility. (false) Comments: Hypopituitarism is typically caused by a non functional pituitary tumour with a staged loss of hormones first GH then LH and FSH then ACTH and finally TSH.The secretion of aldosterone is unaffected as it depend on rennin secretion.Testosterone restores masculinatoin but not fertility. 52-Congenital hypothyroidism a-Cannot confidently be diagnosed before the age of 3 months. (false) b-is in some cases associated with a goiter. (true) c-affects approximately 1 in 10,000 infants. (false) d-may present with jaundice.(true) e-requires thyroxine treatment fro life. ( true) Comments: Diagnosis is possible within neonatal period, a goiter may be seen in the child and the disorder affects 1:3500 births.Jaundice, hypotonia, growth retardation and appearance may prompt diagnosis. Causes include embryological or congenital abnormalities plus maternal drugs thionamides. 53-Carbimazole: a-is contraindicated in breast feeding mothers. (false) b-may cause lymphadenopathy. (true) c-is a prodrug. (true) d-may cause reversible agranulocytosis. (true) e-is teratogenic. (false)
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76-the following can give a biochemical picture indistinguishable from extra hepatic obstructive jaundice: a-chlorpromazine. (true) b-halothane. (false) c-methyltestosterone. (true) d-isoniazid. (false) e-erythromycin estolate. (true) Comments: Extra hepatic would suggest raised bilirubin with raised alkaline phosphatase and GGT B+d- hepatic picture (raised AST and ALT ) c- dose related. 77-mycoplasma pneumonia: a-infection is associated with the development of agglutinins to a non haemolytic streptococcus. (true) b-can be grown on a cell free medium. (true) c-predominantly causes infection n the elderly. (false) d-infection is associated with polymorph nuclear leucocytosis. (false)
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96-Hypothyroidism: a-carpal tunnel syndrome is caused by amyloid deposits with the flexor ratinaculum. (false) b-may be associated with a microcytic or macrocytic anaemia. (true) c-may be caused by hashimoto's thyroiditis . (true) d-is the end result of subacute thyroiditis. (false) e-is often associated with pretibial myxoedema. (false) Comments: a-Myxoedematous change.
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112-Thype 1 insulin dependant diabetes mellitus is associated with a-about a 1:3 positive family history. (false) b-decreased islet cells antibodies with increasing time from diagnosis. (true) c-an 80% concordance among identical twins. (false) d-high plasma glucagon. (true) e-insulin resistance. (false)
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147-hyperprolactinaemia may be associated with: a-myxaedaema. (true) b-galactorrhoea. (true) c-brommocriptine therapy. (false) d-chlorpromazine therapy. (true) e-non functioning pituitary tumour. (true) Comments: Hyperprolactinaemia is associated with non functional pituitary tumours due to stalk compression.also found in acromegaly and hypothyroidism. c-dopamine agonist used to treat hyperprolactinaemia. Cholorpromazine like haloperidol,domperidone is a dopamine antagonist and causes hyperprolactinaemia. 148-Side effects of thiazide diuretics include: a-hypercalcaemia.(true) b-acute pancreatitis. (true) c-hperglycaemia. (true) d-cholestatic jaundice. (true) e-necrotizing vasculitis. (true) Comments: Side effects of thiazide include,hyperglycaemia,hyperuricaemia,postural hypotension,impotence,hyponatraemia and hypokalaemia,mild calcium elevation,lipid abnormalities. Skin reactions including pemphigoid and rarely necrotizing vasculitis are recognized. 149-The following are true: A-carbimazole is teratogenic and must be avoided in pregnancy. (false) b-skin rashes due to carbimazole are unlikely to recur if therapy is changed to propylthiouracil.(true) c-relapse in thyrotoxicosis is very rare when carbimazole treatment is continued for 2 years. (false) d-carbimazol is secreted in milk. (true) e-symptomatic hypocalcaemia following subtotal thyroidectomy is generally transient. (true) Comments: Carbimazole is used in treatment of thyrotoxicosis with pregnancy. It is associated with aplasia cutis but this may be more associated with thyrotoxicosis per se than the drugs.thionamides are used in thyrotoxicosis for variable periods form 6 months to 2 years,but irrespective recurrence of thyrotoxicosis following withdrawal is of the order of 70% 150-Hyponatraemia is a recognized complication of: a-carbenoxalone therapy. (false)
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: Pharmacology [left] Pharmacology The following antibiotics are usually effective against pseudomonas aeruginosa: 1 F Cephradine. A F Amoxicillin. B T Carbenicillin. C T Gentamicin. D F Trimethoprim. E The following antibiotics act on bacterial cell walls: 2 T Penicillin A T Ceftazidime B F Metronidazole C F Clindamycin D F Gentamicin E Comment: Metranidazole inhibit nucleic acid synthesis. Clindamycin and gentamycin inhibit protein synthesis. listeria monocytogenes: 3 T Can grow at 6c. A F Is gut commensal B F Is a gram-negative bacillus C F Infection is best treated with benzylpenicillin D T Is a cause of septicaemia in neonates E Metronidazole: 4 T Is effective against giardia lamblia A T Is effective when administered per rectum B F Should not be administered intravenously C T Is usually effective against entamoeba histolytica D T Interferes with ethanol metabolism E Metronidazole: 5 F Is a folic acid antagonist A F Is ineffective when given per rectum B F Should not be administered intravenously C T Is effective against Entamoeba histolytica D T Interferes with ethanol metabolism E Gentamicin: 6 T Is ineffective systemically when given by mouth A F Is metabolized prior to excretion by the kidney B T May cause damage to the eighth cranial nerve C
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The following drugs are beta-sympathomimetic agonists: 10 T Adrenaline A T Noradrenaline B F Phenylephrine C T Ritodrine hydrochloride D F Oxprenolol hydrochloride E Comment: Phenylephrine is agonist
Beta sympathomimetic drugs may: 11 F Cause bronchospasm A T Reduce the frequency of uterine contractions B
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The following are beta-mimetic effects 12 F Constriction of bronchioles A T Increased heart rate B F A decrease in the force of cardiac contraction C F Constriction of arterioles in the skin D T Increased glycogenolysis in skeletal muscle E The following agents are bronchodilators: 13 T Salbutamol A F Atenolol B F Prostaglandin F2 C F Morphine D T Prednisolone E The following drugs can cause bronchoconstriction: 14 T Propranolol A F Atropine B T Morphine C F Ritordine D T Aspirin E Comments 2: These bronchoconstrictors act in the following manner - Porpanolol by being a beta blocker and Morphine causes histamine release. Aspirin induced bronchoconstriction is thought to be due to shunting of arachidonic acid into the lipooxygenase pathway or removal of cyclooxygenase product which prevent bronchospasm. Ritodrine is a beta symphatomimetic and atropine is an anticholinergic agent that causes broncodilation.
Ventilation is increased due to stimulation of central receptors by 15 T Nikethamide A T Hypoxia B T Doxapram C F Phenobarbitone D F Salbutamol E The following drugs stimulate myometrial contractility: 16 T Vasopressin A F Nifedipine B F Hydralazine hydrochloride C
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The following substances exert their diuretic actions upon the distal convoluted tubule: 29 T Bendrofluaside A F Fusemide B F Bumetanide C F Mannitol D F Alcohol E Fluid retention may be caused by the administration of: 30
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The following have an antiemetic action: 34 T Hyoscine hydrobromide A F Morphine sulphate B T Chlorpropamide C T Promethazine hydrochloride D T Perphenazine E Comments 2: Hyoscine is an alkaloid, Promethazine is an antihistamine, Perphenazine is an antipsychotic and all 3 have antiemetic properties. The sulphonyl urea chloropropramide may have antiemetic properties and has thus been marked as true. Morphine has an emetic action.
The following statements are true: 35 F Suxamethonium is non-depolarising muscle relaxant. A F Huxamethonium is a ganglion blocker. B T Tubocurarine is reversed by neostigmine C F Streptomycin is absorbed from the gastrointestinal tract D F Thiopentone can be given intramuscularly. E
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Treatment with morphine: 38 T Causes respiratory depression A F Increases gastric motility B T Causes side effects, all of which may be reversed C T Increases the secretion of anti-diuretic hormone D F Causes papillary dilatation E The following statements about morphine are true: 39 T All of its pharmacological actions are reversed by naloxone A T It is transferred into breast milk B F It does not cross the placenta in significant quantites C F Its analgesic effects last about 1 hour D F It causes papillary dilatation E Neostigmine in therapeutic doses: 40 F Acts for several days A T Inhibits hydrolysis of acetylcholine B F Causes paralytic ileus C F Reverses the action of carbachol D T Relieves the effects of myasthenia E Lignocaine used as a local anaesthetic: 41 T Cause tachycardia if given as systemic injection A F Has a longer lasting action than bupivicaine B F Is used in combination with adrenaline for ring block C F Causes vasoconstriction D T Is a week base E Comments 2: Lidocaine may cause tachycardia and rise in blood pressure on IV administration. Bupivicaine has a longer lasting action than lidocaine. Adenaline is a vasoconstrictor and cannot be used in
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Halothane produces: 42 T Cardiac arrhythmias A F Explosive mixtures with air B T Liver damage if given repeatedly C T Myometrial relaxation D F Bronchial irritation E Thiopentone sodium administered intravenously: 43 F Is a potent muscle relaxant A F Is predominantly excreted by the kidney B T Binds to protein C T Is fat soluble D T Crosses the placenta E Oestrogen therapy raises the plasma concentrations of: 44 T Thyroxine binding globulin. A F Free cortisol. B T Transferring. C F Albumin. D F Folate. E The following compounds are predominantly progestogens: 45 F Buserelin A T Dydrogesterone B T Norethisterone C T 17 -hydroxyprogesterone D F Androstenedione E The effectiveness of a combined oral contraceptive may be reduced by: 46 F Bromocriptine A T Phenytoin B T Rifampicin C T Ampicillin D F Sodium valproate E Clomifene citrate: 47 F Is an anti-androgen A T Does not stimulate ovulation directly B T Can produce visual disturbances C T Is generally prescribed throughout the proliferative phase of the menstrual cycle D T In the treatment of an ovulation, increases the risk of multiple pregnancy E Cyproterone acetate 48 F Is an oestrogen A F Is used for the treatment of amenorrhea B T Bind to androgen receptors C F Increases libido D T Inhibits spermatogensis E
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The following drug combinations have been shown to interact to produce the stated effects: 58 T Ampicillin enhances the anticoagulant action of warfarin. A T Aciclovir diminishes the effect of oral contraceptives. B F Cimetidine inhibits the metabolism of phenytoin. C T Aspirin diminishes the action of ritodrine. D F Tamoxifen increases the anticoagulant effect of warfarin. E Comment: Oestrogens (including tamoxifen) are pro-thrombotic and antagonise warfarin effects *. Anti-viral agents - nevirapine, nelfinavir, ritonavir - induce hepatic enzymes *.
The following cytotoxic drugs are correctly classified: 59 F Methotrexate: alkylating agent A T Cyclophosphomide: alkylating agent B F Vinblastine: antimetabolite C T Mercaptopurine: antimetabolite D F Fluoruracil: antibiotic E The following drugs should be avoided in renal impairment: 60 T Cephalothin A T Cisplatin B F Norethisterone C F Dopamine D T Gentamycin E [/left]
PATHOLOGY AND IMMUNOLOGY MCQS 85 STEM 27 Metastatic calcification may be seen in the following conditions: 1
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The following pairs indicate correct pathological association: 9 T Epstein-Barr virus: Burkett's lymphoma. A T Peutiz-Jeghers syndrome: intestinal carcinoma. B F Wood dust: pleural mesothelioma. C F Progestagens: endometrial carcinoma. D T Aniline dyes: bladder carcinoma. E Comment Wood dust causes nasal sinuses The following tumors produce characteristic blood markers: 10 F Clear cell carcinoma. A T Choriocarcinoma. B F Osteogenic sarcoma. C T Yolk sac tumor. D F Transitional cell tumor. E Comment: TUMOUR MARKERS ***** Hormones Human chorionic gonadotrophin - trophoblastic tumours, non-seminomatous testicular tumours * Calcitonin - medullary carcinoma of the thyroid Catecholamines and metabolites - phaeochromocytoma Onco-fetal antigens Alpha-fetoprotein - hepatocellular carcinoma, non-seminomatous germ cell tumours of testis, ovarian endodermal sinus / yolk sac tumour * Carcino-embryonic antigen - carcinoma of the colon, pancreas, lung, stomach, breast Enzymes Prostatic acid phosphatase - prostatic carcinoma. Neuron-specific enolase - small cell carcinoma of the lung, neuroblastoma Specific proteins Immunoglobulins - multiple myeloma Prostate specific antigen - prostate cancer Glycoproteins CA-125 - ovarian cancer *
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Adenocarcinoma of the large bowel: 14 T Most common originates in the ascending colon. A T May develop as a single polyp. B T May show signet ring features histologically. C F Characteristically metastasis to the liver before the lymph nodes. D T Is a recognized complication of long-standing ulcerative colitis. E Comment: MALIGNANT COLONIC TUMOURS ***** 60-70% located in the rectum and sigmoid colon. However, the incidence of carcinoma of the right colon is increasing * Over 95% are adenocarcinomas * May arise from a single polyp of from multiple polyps in patients with familial polyposis coli * Associated with dietary factors such as low vegetable fibre, high fat and high refined carbohydrate content. Oestrogen and NSAIDs may be protective Peak incidence in the 7th decade. Male : female = 2 : 1 May be fungating, ulcerating or infiltrating. Right sided tumours tend to be fungating but because of the wide diameter of the caecum, rarely cause obstruction while left sided tumours tend to be infiltrating and cause annular constriction of the bowel Spread is to regional lymph nodes. Haematogenous spread to liver, lungs and brain is late * Associated with increased levels of CEA (Carcino-embryonic antigen) in 19-40% of patients. Mucinous carcinomas produce mucin which may accumulate within the cells, pushing the nucleus to one side and giving the cell a signet ring appearance * May be the primary in a woman with a Kruken The following statements relate to embryonic tumors: 15 F An ovarian teratoma is usually malignant. A F A nephroblastoma may be benign. B T A neuroblastoma can arise in the adrenal medulla. C F A hamartoma is usually malignant. D T Choriocarcinoma may arise in a teratoma. E Comment: GERM CELL TUMOURS 15-20% of all primary ovarian tumours May be benign (mature terratomas, gonadoblastoma) or malignant TERRATOMAS Result from the differentiation of germ cell tumours into embryonic tissue MATURE TERRATOMA - DERMOID CYST ***** Tissues are microscopically similar to those seen in adult tissue
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Carcinoma in situ in epithelium (intraepithelial neoplasia) is characterized by: 18 T Increased mitotic activity. A T Loss of polarity. B F Increased adhesiveness to the underling stroma. C T Pyknosis. D T Increased thickness of the epithelium. E Comment: CERVICAL INTRA-EPITHELIAL NEOPLASIA **** Histological diagnosis made following cervical biopsy. The abnormality originates at the squamo-columnar junction Pre-malignant although CIN I and probably CIN II regresses spontaneously Associated with HPV 16, 18, 31, 33 * Atypical cells are characterised by: 1) Loss of cell polarity 2) Loss of maturation 3) Increased nuclear : cytoplasmic ratio with nuclear and cytoplasmic pleomorphism 4) Increased number of mitotic figures and the presence of abnormal mitotic figures CIN I - dysplastic cells are confined to the lower third of the epithelium CIN II - dysplastic cells are confined to the lower two thirds of the epithelium CIN III - the entire thickness of the epithelium is involved The parathyroid glands: 19 F Originate from the pharyngeal cleft ectoderm. A T Secrete parathyroid hormone via the chief cells. B F Secrete calcitonin via the oxyphil cells. C T May become hyperplastic in the presence of intestinal malabsorption. D T May develop adenomas in association with islet cell tumours of the pancreas. E The following conditions may lead to hydronephrosis: 20 F Mercury poisoning. A T Cervical carcinoma. B T Renal calculi. C F Renal vein thrombosis. D T Posterior urethral valves. E Acquired diverticular disease of the colon: 21 T Is present in at least 15% of Caucasians over the age of 50 years. A T Is due to a congenital abnormality of the bowel wall. B T Is associated with increased intra-luminal pressure. C F Is associated with muscular thickening. D T May result in intestinal obstruction. E Comment: DIVERTICULAR DISEASE ***** Saccular out-pouchings of the colon that develop in the recto-sigmoid with advancing age. Herniations of the mucosa and sub-mucosa at points of muscular weakness * Asymptomatic in the majority of cases Commoner in developed countries. Rare in those < 30 years old. Present in over 50% of those aged over 60 years *
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In healing by primary intention, the following events occur: 33 F Formation of fibrin-free haematoma. A T An acute inflammatory reaction. B F Migration of epithelial cells within 6 hours. C T Phagocytosis. D T Invasion by capillary buds within three days. E Comment: HEALING BY PRIMARY INTENTION ***** Wound associated with minimal loss of tissue and is without significant bacterial contamination The incision space is immediately filled with blood clot containing fibrin and blood cells * Dehydration of the clot forms a scab that seals the wound from the environment. Vascular and inflammatory phase:* An initial 5-10 minutes period of vasoconstriction is followed by more persistent vasodilatation. Within 24h: neutrophils appear at the margins of the incision. Their prime function is the phagocytosis and killing of contaminant bacteria. By day 3, neutrophils have largely been replaced by macrophages. They become activated and release proteases and vasoactive peptides as well as growth and chemotactic factors for fibroblasts and endothelial cells. Re-epithelisation: *Within 24-48h, spurs of epithelial cells from the edges grow along the cut margins of the dermis and beneath the surface of the scab to fuse in the mid-line forming a continuous thin epithelial layer. Proliferation is maximal at 48 to 72 hours after wounding and is reflected by a 17 fold increase in mitosis and epithelial hyperplasia at the wound edges Granulation tissue formation: * Granulation tissue consists of inflammatory cells, fibroblasts and new vasculature in a hydrated matrix of glycoproteins, collagen and glycosaminoglycans. Its formation begins within 3-5 days after wounding and overlaps with the preceding inflammatory phase. Wound contraction and neovascularisation occur at this stage. Contraction is maximal between 5 and 15 days after wounding and is mediated to a great extent by the myofibroblast and its specialized connections with the surrounding extracellular matrix Fibroplasia and matrix formation: * Collagen deposition begins by day 3 but is initially vertically oriented and do not bridge the wound. By day 5, collagen fibres are more abundant and begin to bridge the incision. Fibroblasts and epithelial cells proliferate and by day 5, the epidermis recovers its normal thickness with surface keratinisation Matrix and collagen remodelling: * During the second week, there is continuous accumulation of collagen and proliferation of fibroblasts and there is regression of vascular channels with blanching. Type I collagen becomes the major collagen present in the remodelled scar, reversing the earlier type III collagen predominance. The process of remodelling may continue for up to a year and maximal tensile strength is regained. Collagen: 34 F Has a double helical structure. A T Shows a regular banding pattern on electron microscopy. B T Is not formed normally in the absence of ascorbic acid. C F Is not found within basement membranes. D T Synthesis is inhibited by glucocorticoids. E Comment
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PATHOLOGY AND IMMUNOLOGY mandible 12, 2011 5:41 pm Amyloid: 39 F Is predominantly intracellular. A T Contains fibrils. B F Is enzymatic. C T Can be found in nerve tissue. D T Deposits occur with chronic sepsis. E Comment: AMYLOIDOSIS ***** Process characterised by extracellular* tissue deposits of amyloid in one or many organs Amyloid is characterised by Homogenous pink extracellular material on H & E staining Orange colour by light microscopy and green birefringence by polarising microscopy in sections stained with Congo red Fine non-branching 7.5 - 10nm on electron microscopy Beta-pleated sheet *structure of fibrils by x-ray diffraction Amyloid deposition may be either a primary (idiopathic) or secondary to some other condition and may be localized to one specific site or generalized throughout the body (systemic) Primary amyloidosis tends to involve mesodermal tissues, most frequently affecting peripheral nerves, skin, tongue, joints, heart, and liver while secondary amyloidosis mainly affects parenchymatous organs, such as spleen, kidneys, liver, and adrenals. Systemic forms of amyloid are derived from circulating protein precursors by conversion from soluble into insoluble (fibrillar) form.
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Multiple myeloma* Immunoglobulin lambda / kappa chain Secondary Chronic inflammation* TB, rheumatoid, lung abscess, chronic pyelonephritis, chronic osteomyelitis Non-immunoglobulin amyloid associated protein Secondary Hodgkin's disease Non-immunoglobulin amyloid associated protein Secondary Chronic renal failure / dialysis Beta-2-microglobulin Localised amyloidosis Medullary carcinoma of thyroid* Calcitonin Senile cardiac amyloidosis Transthyretin Senile cerebral amyloidosis, Alzheimers disease* Amyloid precursor protein
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In cystic fibrosis, abnormalities are seen in the: 43 T Pancreas. A T Salivary glands. B T Brain. C F Kidneys. D T Ileum. E The following are consequence of pulmonary embolism: 44 T Pulmonary infarction. A T Fibrinous pleurisy. B T Right ventricular hypertrophy. C T Sudden death. D T Haemoptysis. E Comment: PULMONARY EMBOLISM (PE) ***** An embolus is a detached intravascular solid, liquid or gas which is carried by blood to a site distant from its site of origin PE is one of the commonest preventable causes of death in hospital patients, especially following pregnancy or pelvic surgery Over 95% of all PE arise from thrombi in large veins of the lower limbs - popliteal, femoral,
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The following are adverse effects of blood transfusion: 46 T Hypothermia. A T Haemoglobinuria. B T Hypocalcaemia. C F Hypocalaemia. D F Thrombocytosis. E The following cause platelet aggregation: 47 T ADP(adenosine diphosphate). A F Prostacyclin. B
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Stored blood which is to be used for transfusion: 48 T Is kept at -4 C. A F Must be used within 1 week. B F Is tested for complement content before transfusion. C F May be used for platelet replacement. D T Contains an acid anticoagulant. E Platelets: 49 T Are approximately 50 micrometers in diameter. A T Contain myosin. B T Release a growth factor. C T Are formed from myeloblasts. D F Are prevented from aggregating by thromboxane A2. E Comment: PLATELETS ***** Attach to sites of endothelial injury, where sub-endothelial elements, particularly fibrillar collagen are exposed. Von Willebrands factor is necessary for adhesion * Secretion - platelets release the contents of their granules: alpha granules contain fibrinogen, fibronectin, platelet-derived growth factor, anti-heparin and cationic proteins. Dense bodies contain ADP, ionised calcium, histamine, adrenaline and serotonine * Aggregation - formation of platelet-platelet inter adherence promoted by the formation of thromboxane A2 which is also a vasoconstrictor. Activated platelets also produce ADP which is a platelet activator. The platelet aggregate forma the primary haemostatic plug. * Platelet activation also results in thrombin formation, a powerful platelet agonist and activates the clotting system. A secondary haemostatic plug is formed
In the pathogenesis of thrombosis: 50 F Prostacyclin induces platelet aggregation. A T Platelets synthesis thromboxane A2. B T Thromboxane A2 induces vasoconstriction. C T Contact with subendothelial collagen causes platelet aggregation. D F Thrombin inhibits platelet aggregation. E Comment: THROMBOSIS Three influences pre-dispose to thrombosis 1) Endothelial injury 2) Alterations in normal blood flow - turbulence or stasis 3) Alterations in the blood - hypercoagulability
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Complications of myocardial infarction include: 51 T Fibrous pericarditis. A F Aortic aneurysm. B T Ventricular mural thrombi. C F Coronary atherosclerosis. D T Ventricular aneurysm. E Comment: Complications of acute MI include: ***** a) Sudden death b) Arrhythmias c) Mitral incompetence following infarction +/- rupture of a papillary muscle d) Fibrinous or fibrinohaemorrhagic pericarditis - develops on day 2-3. May be localised or generalised e) Mural thrombosis with risk of peripheral embolism f) Ventricular aneurysm g) Myocardial rupture causing cardiac tamponade or left-to-right shunt
Osteoporosis is associated with: 52 F An increase in uncalcified bone matrix. A F Prolonged oestrogen therapy. B T Long term heparin treatment. C T Bone fractures. D
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Osteoporosis is associated with: 53 F An increase in uncalcified bone matrix (osteoid tissue). A F Prolonged oestrogen therapy. B T A normal histological bone structure. C T Bone fractures. D F Irregularity of epiphyseal plates. E The following are causes of hypokalaemia: 54 F Angiotensin-converting enzyme(ACE) inhibitors. A F Addison's disease. B T Diarrhea. C F Digoxin overdose. D T Metabolic alkalosis. E Osteomalacia is characterized by: 55 F Mineralization of the periosteum. A T Deposition of uncalcified bone matrix. B F Normal osteoblastic activity. C T Increased capillary fragility. D F Normal calcification of bone. E Comment: RICKETS & OSTEOMALACIA ***** Rickets occurs in children while osteomalacia occurs in adults Caused by vitamin D deficiency * Dietary deficiency, inadequate exposure to sun light, malabsorption, derangements in vitamin D metabolism (for instance, chronic renal failure), end-organ resistance or hereditary abnormalities of vitamin D metabolism There is a failure in bone mineralization resulting in excess un-mineralised matrix and abnormally wide osteoid seams * Rickets results in skeletal deformity with defective mineralization of the epiphyseal cartilage necessary to control cartilaginous growth while in the adult, there is a pre-disposition to fracture *
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Plasma cells: 60 T Are increased in myeloma. A F Are characteristic of acute infection. B F Are phagocytic. C T Synthesis immunoglobulins. D T Are derived from B lymphocytes. E Comment: LYMPHOCYTES ***** Make up 20-45% of total leukocyte count Only immune cells with specific receptors for antigens Count is increased in viral infections, toxoplasmosis, brucellosis, and whooping cough Count is decreased in uraemia, Legionnaires disease, corticosteroid treatment, chemotherapy and radiotherapy and HIV infection Characterised by their differential expression of CD (cluster of differentiation) antigens. Following stimulation by antigen, some lymphocytes differentiate into memory cells which are capable of mounting a rapid response if the same antigen is later encountered Most lymphocytes are located in secondary lymphoid tissues - lymph nodes, the white pulp of the spleen, the gut- and bronchial-associated lymphoid tissues. The part of the B cell receptor that binds antigen is surface immunoglobulin* Subsequent B cell proliferation and maturation generates plasma cells that secrete this immunoglobulin * In contrast to B cell receptors, T cell receptors do not bind free antigen. The antigen must be processed into small peptides by antigen presenting cells and these antigen derived peptides are displayed on the antigen presenting cell surface in the clefts of molecules called major histocompatibility molecules (MHC) * There are three main types of T cells * 1) T helper cells that facilitate B cell responses to antigen 2) T inflammatory cells that facilitate macrophages in the eradication of intracellular infection 3) Cytotoxic T cells that recognise and destroy virus infected cells. B-LYMPHOCYTES ***** Mature in the bone marrow. Develop into antibody producing plasma cells. Only immune cells capable of antibody production * Have membrane-bound immunoglobulins which act as antigen receptors * Plasma cells migrate to the bone marrow where they produce small quantities of antibodies for long periods of time after the initial infection has been cleared B-cell receptors bind soluble antigens The bound antigen molecules are engulfed into the B cell by receptor-mediated endocytosis. *
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Lymphocytes in healthy: 61 F Form about 2% of the white cell count. A T Play an essential role in cell mediated immunity. B T Can change into plasma cells. C T Have proportionately more nuclear material than cytoplasm. D F Have a life span of about 30 days. E Comment: LYMPHOCYTES ***** Make up 20-45% of total leukocyte count Only immune cells with specific receptors for antigens Count is increased in viral infections, toxoplasmosis, brucellosis, and whooping cough Count is decreased in uraemia, Legionnaires disease, corticosteroid treatment, chemotherapy and radiotherapy and HIV infection Characterised by their differential expression of CD (cluster of differentiation) antigens Following stimulation by antigen, some lymphocytes differentiate into memory cells which are capable of mounting a rapid response if the same antigen is later encountered Most lymphocytes are located in secondary lymphoid tissues - lymph nodes, the white pulp of the spleen, the gut- and bronchial-associated lymphoid tissues. The part of the B cell receptor that binds antigen is surface immunoglobulin* Subsequent B cell proliferation and maturation generates plasma cells that secrete this immunoglobulin * In contrast to B cell receptors, T cell receptors do not bind free antigen. The antigen must be processed into small peptides by antigen presenting cells and these antigen derived peptides are displayed on the antigen presenting cell surface in the clefts of molecules called major histocompatibility molecules (MHC) * There are three main types of T cells * 1) T helper cells that facilitate B cell responses to antigen 2) T inflammatory cells that facilitate macrophages in the eradication of intracellular infection 3) Cytotoxic T cells that recognise and destroy virus infected cells. B-LYMPHOCYTES ***** Mature in the bone marrow. Develop into antibody producing plasma cells. Only immune cells capable of antibody production * Have membrane-bound immunoglobulins which act as antigen receptors * Plasma cells migrate to the bone marrow where they produce small quantities of antibodies for long periods of time after the initial infection has been cleared B-cell receptors bind soluble antigens The bound antigen molecules are engulfed into the B cell by receptor-mediated endocytosis. * The antigen is digested into fragments which are then displayed at the cell surface nestled inside a class II histocompatibility molecule. * Helper T cells with complementary TCRs bind the B cell and secretelymphokines that * 1) Stimulate the B cell to enter the cell cycle and develop, by repeated mitosis, into aclone of cells with identical BCRs;
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B lymphocytes: 62 F Produce tumor necrosis factor. A F Produce complement. B T Produce antibodies. C F Contribute to delayed hypersensitivity. D T Produce IgE. E T lymphocytes: 63 T Differentiate in the thymus. A T Are involved in the generation of both cell-mediated and immoral Immune responses. B T Are the predominant lymphoid population in decidua. C T Are the predominant lymphoid population in peripheral blood. D F Are the major cell type in the germinal centers of lymph nodes. E Comment: T-LYMPHOCYTES ***** Mature in the thymus gland * Can only recognise peptide antigens that are bound to MHC molecules on specialised antigen-presenting cells - MHC-restricted * CD4 positive T-cells are helper T-cells - help B cells produce antibodies and help phagocytes destroy ingested organisms * CD8 positive T-cells are cytotoxic T-cells - capable of killing host cells infected with intracellular organisms * Na-ve T-cells have antigen receptors but do not perform the functions required to eliminate the antigen. CD8+ T cells CD8+ T cells bind that are part of class I histocompatibility molecules. Almost all the cells of the body express class I molecules The best understood CD8+ T cells are cytotoxic T lymphocytes - secrete molecules that destroy the cell to which they have bound. The role of the CD8+ T cells is to monitor all the cells of the body, ready to destroy any that express foreign antigen fragments in their class I molecules. CD4+ T cells CD4+ T cells bind epitopes that are part of class II histocompatibility molecules. Only specialized antigen-presenting cells express class II molecules Essential for both the cell mediated and antibody-mediated branches of the immune system Bind to antigen presented by antigen-presenting cells and release lymphokines that attract other cells to the area. Bind to antigen presented by B cells, resulting in the development of clones of plasma cells secreting antibodies against the antigenic material. The following are recognized function of T lymphocytes: 64 F Antibody production. A T Cell-mediated immunity. B T Immune suppression. C F Phagocytosis. D
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Concerning immunoglobulin in pregnancy: 70 F Maternal IgM is responsible for rhesus isoimmunisation in the fetus. A F IgA concentration in cord blood is higher than that in maternal blood. B F IgE crosses the placenta readily. C
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The following are examples of type-III hypersensitivity (immune-complex) disease: 72 F Autoimmune haemolytic anaemia. A T Systemic lupus erythematosus. B T Glomerulonephritis. C F Tuberculosis. D F Sarcoidosis. E Comment: IMMUNE COMPLEX MEDIATED (TYPE III) HYPERSENSITIVITY ***** Caused by immune complex deposition in the blood vessels or tissues * These complexes activate macrophages, activate complement and cause the extracellular release of neutrophil granules and tissue damage * The inflammatory response is characterised by the Arthus reaction which is characterised by a neutrophilic infiltration and immunoglobulin + complement deposition * The inciting antigen may be -self- or -non-self- from infectious organisms Disease processes include * 1) Polyarteritis nodosa and SLE 2) Farmer's lung - occurring in patients sensitized to thermophilic actinomycetes; pigeonfancier's disease - these disorders are generally known as extrinsic allergic alveolitis 3) Post-streptococcal glomerulonephritis 4) Jarisch-Herxheimer reaction+
Type III hypersensitivity: 73 F Is mediated by specifically-sensitized T lymphocytes. A F Causes myasthenia gravis. B T Occurs in systemic lupus erythematosus. C T Is a recognized cause of glomerulonephritis. D F May cause allergic asthma. E Type III (immune complex-related) hypersensitivity is: 74 T Damage localized to a particular cell type. A
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Antibodies play an important part in the development of: 76 T Phagocytosis. A F The Mantoux response. B T Erythroblastosis fetalis. C F Hyperemesis gravidarum. D T Anaphylaxis. E Antibodies: 77 T Are proteins. A F Are formed in the fetus before 12 weeks of intrauterine life. B F Have an average molecular weight of around 10 000 Daltons. C T Of the rhesus type are genetically transmitted. D
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