A
A 45 year old man presents to his GP six days after surgical removal of a skin lesion from his forearm. The sutures are still in place and the area around the incision is tender, red, warm, swollen and oozing a small amount of pus. This presentation is consistent with a wound infection.
How does the inflammatory response to infection produce the local signs and symptoms of this patient?
Inflammation is induced by chemical mediators released from cells in response to injury. These mediators stimulate vascular changes and leucocyte recruitment to the area. Vasodilation and increased blood flow cause the redness and heat (1 mark)
Changes in vascular permeability allow plasma fluid and proteins to leave the circulation, contributing to oedema/swelling and tenderness (1 mark).
Leucocyte activation allows elimination of pathogens and the formation of exudate (pus) (1 mark).
The complement system is important in host defence against infection, list three important functions of the complement system.
1. Lysis of cells (bacteria/viruses) 2. Opsonisation (covering of pathogen leads to phagocytosis particulate antigens) 3. Activation of Inflammatory Response Clearance of Immune Complexes (deposition spleen/liver)
A 65 year old man with established chronic kidney disease presents to his GP for his regular check up.
What functions of the kidney should the GP be considering as she reviews this patient and orders investigations?
disposal of nitrogenous wastes e.g. urea
regulation of water and electrolyte balance
regulation of plasma pH
activation of Vitamin D
stimulation of erythropoiesis
(or other appropriate answer)
Define patient autonomy:
Patient autonomy is the right (0.5) of competent patient (0.5) to make informed decisions (0.5) about their own medical care (0.5).
List four factors which can affect the rate of an enzyme-catalysed reaction
Concentration of substrate, Concentration of the enzyme, Concentration of the product, pH, Temperature, Co-factors
When the glucose is delivered to the liver, the liver will consume what it needs to sustain its functions. List up to three examples of the fate of any glucose that is not directly oxidised by the liver.
Excess glucose can be stored as glycogen
It can be used to synthesise fatty acids
It is transported to extra-hepatic tissues via systemic circulation
A junior medical officer is called to the surgical ward in the evening to assess a post-operative patient’s fluid balance status. List up to 6 key clinical features that should be considered in their assessment.
Fluid intake Blood pressure Urine output Other losses eg stool, vomitus, surgical drains Skin turgor Mucous membrane eg tongue moisture Capillary refill time/peripheral perfusion JVP Peripheral oedema Breath sounds and lung percussion - are there signs of pulmonary oedema?
(or other appropriate clinical signs)
Choose the most appropriate missing words from the list below. You may use any of the words as many times as needed, or not at all.
spermatids, spermatogonia, spermatogenesis, spermatocytes, spermiogenesis, spermatozoa
X are the source of new sperm through clonal proliferation. X are stages of meiosis that end in the formation of X. The process of physical transformation of these cells into X is called X.
Spermatogonia are the source of new sperm through clonal proliferation. Spermatogenesis are stages of meiosis that end in the formation of spermatids. The process of physical transformation of these cells into spermatozoa is called spermiogenesis.
Alcohol is the main cause of deaths on Australian roads. Based on the International Evaluation Literature, list up to five effective strategies available for the control of alcohol abuse in the community:
1. Minimum legal purchase age 2. Government monopoly of retail sales 3. Restriction on hours or days of sale 4. Outlet density restrictions 5. Alcohol tax Random Breath Testing Lower Blood Alcohol Concentration (BAC) limits Brief interventions for hazardous drinkers (or brief medical advice) Administrative license suspension Graduated licensing for novice drivers
A 70-year-old man presents with a chronic non-healing ulcer in his leg. List up to 5 factors that could be impairing his wound healing. Provide a brief explanation for each factor.
Immune status – reduced immunity makes infection more likely
Diabetes – elevated blood glucose level may impair white cell function, and contribute to vascular disease
Poor nutrition – lack of essential vitamins and minerals for healing to occur
Peripheral vascular disease – contributing to lack of oxygen and nutrient supply to tissues for cell function
Pain - causes vasoconstriction
Medication use - Corticosteroids and other drugs depress immune function
List the three hormones necessary to maintain pregnancy
1. Oestrogen 2. Progesterone 3. Human chorionic gonadotropin
What are some examples of primary prevention of cardiovascular disease?
• Attempts to reduce CV disease morbidity/mortality through risk factor modification in • people without evidence of established CV disease: • For example: • Smoking cessation advice and programs • Healthy diet advice • Exercise programs • Treatment for hypertension or hypercholesterolemia
A 44-year-old man presents with a 3-month history of epigastric discomfort. Endoscopy showed an ulcer in the duodenum. Biopsy did not show features of malignancy. The CLO test was positive.
List the two most appropriate medications for the effective treatment of this condition and briefly explain how they work
1. PPI/H2 receptor antagonist -- inhibiting/suppressing acid secretion in stomach
2. Antibiotics (e.g. amoxicillin/metronidazole/clarithromycin) -- eradication of H. pylori
Antacid - decrease acidity (1 mark max - as this is not definitive treatment)
Describe four (4) possible outcomes for glucose 6-phosphate biochemically in the liver.
1. conversion to liver glycogen 2. dephosphorylation and release of glucose into bloodstream 3. oxidation via the pentose phosphate pathway 4. oxidation via glycolysis and the citric acid cycle oxidation to acetyl-CoA, which then serves as precursor for synthesis of triacylglycerols, phospholipids, and cholesterol
A 65-year-old man is being discharged from the hospital following an admission for an acute myocardial infarction. He was not taking any regular medications before admission. List five medications that should have been commenced, provided he has no contraindications or allergies.
1. Aspirin 2. ACE inhibitor or Angiotensin receptor blocker (ARB) 3. Beta Blocker 4. Short-acting nitrate 5. Statin
List four movements of the elbow joint.
1. flexion 2. extension 3. pronation 4. supination
A 34-year-old patient with obesity requests dietary advice. List five principal food groups that would be recommended.
Grain products
Animal (meat/fish/eggs) or plant (nuts, legumes) derived sources of protein
Dairy or non-dairy sources of calcium
Vegetables
Fruits
Describe the biochemical effects of radiation on cellular DNA and the consequences for such cells
Biochemical Effects (0.5 mark each, max 1 mark)
Causes DNA strand breaks and adduct formation
Causes Mutations
DNA repair is capable of reversing much of this damage
Increases free radical damage to lipids and proteins
Turnover and replacement of damaged proteins and lipids reversed most of this damage
Consequences: (1 mark)
Cell death – apoptosis / necrosis
Increased DNA repair
List the three principal types of skin receptors
Mechanoreceptors
Thermoreceptors
Pain receptors / nociceptors
Define and describe apoptosis
Apoptosis, or programmed cell death (1), is the orderly biochemical process of cell death required in developmental processes (1) and to maintain cell homeostasis in the whole organism (1). It is characterised by cell shrinking, DNA fragmentation and membrane blebbing (1)