Week 1-16 Mega Quiz!

Week 1-4

100

Define Allergy & Atopy?

_{1) Allergy:}

• Type 1 / Immediate hypersensitivity reaction initiated by an immunological mechanism
• Primarily mediated by antigen-specific immunoglobulin E (IgE)

_{2) Atopy:}

• Individual or familial tendency to produce IgE antibodies in response to low doses of allergens and accompanied by typical symptoms
• Atopic Triad:
  • Hay fever (allergic rhinitis)
  • Eczema (Atopic Dermatitis)
  • Asthma

200

What are some symptoms & signs of basic arrhythmias? 

• SOB
• Chest pain
• Reduced consciousness
• Hypotension
• Bradycardia
• Pulmonary oedema
• Acute MI
• Shock

300

Within the cardiac cycle, what does a ____ on an ECG represent?

1. P wave

2. T wave

3. QRS complex 

1. P wave - Atrial depolarisation -> Atrial contraction/systole 

2. T wave - Ventricular Repolarisation -> Ventricular relaxation/diastole 

3. QRS complex - Ventricular Depolarisation -> Ventricular contraction/systole 

(See image...)

400

What is the clinical significance of their close relationship with the clavicle and the 1st rib ?

Thoracic Outlet syndrome!

• Subclavian vein can become compressed -> pain in the shoulders and neck and numbness/weakness and coldness in the fingers

500

What are the 3 main types of anaemias & 2 causes of each? 

• Hypochromic & Microcytic = Iron deficiency anaemia & thalassemia
• Normochromic & Normocytic = Acute blood loss & hypoplastic anaemia
• Normochromic & Macrocytic = Megaloblastic anaemia & liver disease

(See image....)

Week 5-8

100

Lymphatic drainage is mainly unilateral but in the ____ it drains bilaterally.

List 4 structures!!

Lymphatic drainage is mainly unilateral but in the posterior tongue, soft palate, epiglottis & nasopharynx it drains bilaterally

200

Name these audiograms?

(See image....)

1. Conductive Loss
2. Sensorineural Loss

300

Describe the pathophysiology of pneumonia?

• Infection of lung parenchyma, resulting in inflammation with lung consolidation
• Secondary to impairment of pulmonary defence mechanisms:
  • Loss cough reflex (may lead to aspiration
  • Injury to mucociliary apparatus
  • Pulmonary congestion & oedema
  • Interference with alveolar macrophages
  • CF or bronchial obstruction
  • Alcohol, tobacco, gas inhalation, viral disease, contaminated oxygen inhalation or genetic causes
• Occurs when alveolar macrophages can no longer keep up with clean up -> initiate an inflammatory response             

Steps:

1. Pathogen encounters host -> Enters the respiratory tract due to failure of the physical defence system, multiplies & spreads to establish an infection
2.  Immune system is activated -> release inflammatory markers & neutrophils -> fluid fills alveoli -> injury to lung parenchyma -> consolidation (seen on chest x-ray), abnormal gas exchange (low V/Q), increased Work of Breathing (WOB) & reduced compliance

400

MOCK OSCE!

Please demonstrate the correct technique for performing spirometry. Please also list the contraindications of this procedure!

Technique:

1. Patient must sit upright
2. Apply a nose clip to patient & clean mouthpiece to device. 
3. Ask patient to take a deep breath to full capacity, create a tight seal with mouth & breath out as fast/hard as they can until lungs feel empty
4. Repeat x 3 for acceptable reading, discard mouthpiece & do HH
5. Analyse graph for normal, restrictive or obstructive diseases

Contraindications:

• Recent syncope/fainting/dizziness
• Pneumothorax
• Can't physically sit upright
• Recent angina/MIA
• Cerebral aneurysm
• Young age - usually above 10 years to understand instructions 

500

Describe the MOA & adverse reactions of the following treatment of autoimmune diseases:

1. Immunosuppressive drugs e.g. cyclosporine?

2.  bDMARDs e.g. infliximab?

Note - bDMARDS = biological disease-modifying anti-rheumatic drugs  

1. Immunosuppressive drugs e.g. cyclosporine

• MOA:
  • Inhibits calcineurin by binding to intracellular proteins (Immunophilins)
  • Reduces production IL-2 & growth/activation/differentiation of T-cells
• Adverse reactions:
  • Increases risk of developing lymphomas & other malignancies (e.g skin)
  • Predisposes patients to bacterial/fungal/parasitic/viral infections with opportunistic pathogens
  • May affect renal & hepatic function

2. bDMARDs e.g. infliximab

• MOA - Inhibit TNF-a -> anti-inflammatory effect & reduction in no. T-cells
• Adverse reactions - increased risk lymphoma, skin cancers & infections (bacterial/fungal/viral)

Week 9-12

100

What are the 3 most common types of skin cancers?

1. Basal Cell Carcinoma (BCC)
2. Squamous Cell Carcinoma (SCC) 
3. Malignant melanoma

200

List 4 signs of a pulmonary embolism (PE) on an ECG?

• Sinus tachycardia (most common)
• Right axis deviation
• T wave inversion
• Right BBB
• S1, Q3, T3 patterns - large S wave in lead I, large Q wave in lead III, inverted T wave in lead III

300

List 3 signs & 3 symptoms of Chronic bronchitis?

Symptoms:

1. Chronic cough 

2. Chronic sputum production

3. SOB - progressive & persistent 

4.  Anxiety 

Signs:

1. Wheezing

2. Decreased breath sounds

3. Cyanosis

 4. Decreased airflow on spirometry

400

What layers do you go through in a tracheostomy?

 1. Skin

2. Subcutaneous tissue

3. Platysma muscle

4. Deep cervical fascia

5. Strap muscles (sternohyoid, sternothyroid)

6. Isthmus of the thyroid

7. 2nd or 3rd tracheal ring

500

Describe the 4 Stages of Haemostasis?

1. Constriction of a blood vessel (Vasoconstriction)
2. Formation of a temporary platelet plug (Primary Haemostasis)
3. Activation coagulation cascade (Secondary Haemostasis)
4. Formation of the fibrin plug or final clot (Stable clot formation) 

(See image...)

Week 13-16

100

What are the 3 main types of lung cancers?

1. Carcinoma - 90-95%

2. Carcinoids - 1-5%

3. Mesenchymal or other - 2-5%

200

Describe the 3 boundaries of the internal capsule?

Laterally - Lentiform nucleus

Medially - Head of the caudate nucleus

Posteriorly - Thalamus 

(see image...)

300

Explain this LFT (see image...)

• Firm liver -> fibrosis
•  Potential presence of fat -> enlarged liver
•  Very high rise GGT & AST>ALT -> Alcohol-related issue
• = Alcohol-related liver disease or potentially early cirrhosis

400

Describe the vascular and biliary causes of hepatobiliary disease ?

• Hepatobiliary disease: 
  • Biliary causes: 
    • Gallstones - cholelithiasis, choledocholithias
    • Cholecystitis
    • Biliary strictures
    • Primary biliary cholangitis      
    • Primary sclerosing cholangitis
  • Vascular causes: 
    • Portal vein thrombosis
    • Budd-Chiari syndrome
    • Right-sided HF

500

Mastication Process:

Part A - Define mastication?

Part B - List 4 primary & 4 secondary muscles of mastication?

Part A - Act of chewing food to break down a food bolus into smaller pieces for ease of swallowing

Part B:

Primary Muscles:

• Masseter

• Temporalis 

• Medial pterygoid

• Lateral pterygoid

Secondary Muscles - any of these:

• Suprahyoid - stylohyoid, geniohyoid, mylohyoid & digastric
• Infrahyoid - omohyoid, sternohyoid, sternothyroid  &thyrohyoid
• Neck muscle - SCM

(See Image...)