Who are the better peer tutors?

Ronan

100

What’s the most common brain tumour?

Metastatic 

30% of brain tumours are metastatic. Astrocytomas are most common primary brain tumour (60% of adult brain tumours)

200

Name the 5 parameters that are part of the diagnosis for metabolic syndrome

Waist circumference, blood pressure, HDL, triglycerides, fasting glucose

Wrong if you mention LDL!!!!

-TAGs > 150mg/dL (1.7mmol/L)

-HDL < 40mg/dL (1.03 mmol/L) in males, HDL < 50mg/dL (1.29 mmol/L) in females, 

-systolic > 130/diastolic >85, fasting glucose > 5.6mmol/L

-waist circumference > 90/94cm in men (depending on race), >80cm in women

300

Describe the distribution of disease in Coeliac disease, tropical sprue and Whipple disease

Coeliac: proximal SI. Tropical sprue: whole SI. Whipple disease: systemic

Whipple disease is a systemic infection with Tropheryma Whipplei - affects GIT (lamina propria of duodenum), CSF, lymph nodes, endocardium, synovium

400

(Roughly) outline the age groups commonly affected in bacterial meningitis by:

-L. Monocytogenes

-N. Meningitidis

-Group B. strep

-H. influenzae

-L. Monocytogenes: extremes of age

-N. Meningitidis: middle age groups

-Group B strep: newborn

-H influenzae: few months to 5-6 y/o

-L monocytogenes: <1m, >50-60y

-N. Meningitidis: 1m -> >60y

-Group B. strep: <1m

-H. Influenzae: 1-3m -> 5-6y

500

What is the sensation supplied by the anterior spinothalamic tracts, lateral spinothalamic tracts and dorsal columns?

-Anterior = crude touch, pressure

-Lateral = temperature, pain

-Dorsal = fine touch, vibration

-Anterior = someone pushing you

-Lateral = hot knife stabbed in side

-Dorsal  = lying on bed of needles 

Lily

100

The first line pharmacological management for Type II Diabetes and it’s mechanism of action.

Metformin (increase sensitivity of peripheral tissue to insulin (→ decreases gluconeogenesis)

Followed by sulfonylurea (blockade of ATP-sensitive K channels). DDP-4 (dipeptidyl peptidase-4) and SGLT2 (sodium-glucose co-transporter-2) inhibitors add on.

200

Would agonist or antagonists for each of the following parameters make it a good anti-epileptic?
1. Calcium channels
2. Glutamatergic input
3. Sodium channels for impulse transmission
4. GABAergic input

1. Antagonism 
2. Antagonism 
3. Antagonism 
4. Agonism

Anti-epileptics work via decreasing excitatory inputs to prevent seizures.

300

A serotonin antagonist which works by blocking the 5-HT3 receptor

Ondansetron

Antiemetic. Other antiemetics include D2 inhibitors Metoclopramide, H1 antagonists Diphenhydramine and muscarinic antagonists (hyoscine)

400

Young boy presents to ED with severe polyuria and polydipsia. His breath smells strongly of acetone. What are 2 of the 3 immediate management of this condition?

2 of: Insulin, fluids and potassium

Management of diabetic ketoacidosis

500

What is the moa of lantus and what element of this drug prevents self-association after injection?

Long acting insulin with addition of extra arginine respide

Abiola

100

This image was found incidentally in an 80 year old woman who did not complain of abdominal discomfort, what is the most likely pathology?

Diverticulosis. 

You can see out-pouching on the sigmoid colon without inflammation, suggesting diverticulosis (so uncomplicated diverticular disease). The main thing here is that the patient was asymptomatic, the other forms would have some sort of presentation, specifically pain and altered bowel movement. Majority @ sigmoid colon unless Asia where mainly right sided 

Extras:

Weakness of the colonic wall is where diverticulum form (outpouching on the colon). This can occur for many diff reasons (diet = fibre, genetics, colon microbiota, decreased colonic motility with age etc)

200

What are the 3 stages of Paget’s disease and what is the characteristic microscopic finding?

Osteolytic, Mixed (osteolytic-osteoblastic) and Osteosclerotic stage which leads to → messy laying down of bones forming Mosaic Pattern

Extras:

300

A patient was brought in by paramedics found on the street who smelled of alcohol and was in a state of confusion. He was unable to walk in a straight line and his eyes had repetitive uncontrolled movement when examining eye movement. What vitamin may be deficient in this patient and immediately required? This condition can progress to a more chronic form known as without treatment?

Vitamin B1 (thiamin). Classic Triad confusion, ataxia and ophthalmoplegia (nystagmus) in an alcoholic suggests Wernicke’s encephalopathy due to a deficiency in thiamine. Progression of Wernicke Encephalopathy → Korsakoff syndrome if left untreated

400

A patient with ongoing abdominal pain after eating, bloating, weight loss and now black tarry stool. He says his wife also experiences abdominal pain but not as severely as he does and you find out he recently immigrated from Sudan. What non-invasive test can you order to confirm your diagnosis & how should he be managed (meds + MOA)

Pain after eating suggests Peptic ulcer which is caused mainly (80%) by H. Pylori. Least invasive and preferred mode of diagnosis is a  urease breath test (UBT). Usually treat with Triple Therapy with PPI (omeprazole), 2 Ab (amoxicillin = PBP → impaired cell wall synthesis & Clarithromycin = 50s subunit bind → impaored protein synthesis)

Extras:

Peptic Ulcer Types:

Gastric Ulcer = pain with eating → weight loss

Duodenal ulcer = relief of pain with eating → weight gain  

500

Frank is 55 year old  man with an extensive CVS history, he was brought into the ED with a sudden onset of severe headache and an altered level of consciousness. He presents with total right sided weakness, pupils are dilated and his eyes are oriented down and out. What artery will this lesion most likely located?

Posterior Cerebral Artery (PCA). 

This question requires the utilisation of the rule of 4s and knowledge of the brainstem blood supply. Classic down and out eyes suggest oculomotor (CN III) lesion, it also functions to elevate eyelid and pupillary constriction, all of which have been impacted. Midbrain is the site of CNIII and CNIV, so we can narrow down that the midbrain was affected. Only the PCA supply the midbrain specifically. It cannot be MCA since there is complete motor weakness of the right side, not just the arms and face. Additionally in the Localisation of Stroke lecture (slide 34-35), the image provided stated that the midbrain is involved in the maintenance of consciousness, so the altered level of consciousness in the question stem was another push towards the idea that the midbrain was affected. 

Extras:

Jack

100

What is the pathology seen on this tricky CT scan?

Bilateral Subdural Haematoma

Extras:

Must get both!

200

What is the time window for which tPA can be used for an ischaemic stroke and what are 3 contraindications to its use.

Within 4.5 hours of the onset of symptoms.

Contraindications: Active bleeding or bleeding diathesis

Significant closed head injury within 3 months.

Prior intracranial haemorrhage 

Suspected aortic dissection  etc etc etc

Extras:

Must get both 

300

Compression of which area of the brain leads to Parinaud's Syndrome?

What is Superior Colliculi

Extras:

Parinaud syndrome is defined as a constellation of upward gaze palsy, convergence retraction nystagmus, light-near dissociation, and bilateral lid retraction.

Most commonly due to Pineal Tumours.

Can also be caused by MS, stroke and Hydrocephalus.

400

38yo female walks into the GP clinic with a wide-cased, unsteady gait. During consultation, you also notice slurred speech. Social history includes long-standing alcohol consumption. Which single area of the brain is most likely affected to produce these symptoms?

Cerebellar vermis

Extras: Truncal ataxia and dysarthria are caused by degeneration of the cerebellar vermis

500

What is the radiological sign seen in these images and what disease does it suggest. I make no apologies for the disgustingly specific condition.

Moyamoya Disease

Tom

100

A positive Babinski sign is elicited when the patient has a LMN or UMN lesion?

UMN

200

which paired artery to the cerebellum is a branch of the vertebral artery?

posterior inferior cerebellar artery

300

Signals from the medial arcuate nucleus to the lateral hypothalamic area are (orexigenic or anorexigenic?)

orexigenic (NPY/AgRP) 

400

Which form of leptin (gastric or adipocyte) fluctuates with feeding?

gastric

500

Which cause of diarrhoea in children should not typically be treated with antibiotics due to the risk of precipitation of TTP or HUS?

EHEC (antibiotics result in cell lysis and release of bad things)

Nick

100

What four features of OA can be seen on X-ray?

Joint Space Narrowing, Osteophytes, Subchondral sclerosis, Subchondral cysts

Extras:

200

What would you expect on examination for Deformity (D), Motor (M) and Sensory (S) if the Common Fibular (Peroneal) Nerve is affected?

D) Foot drop (plantar flexed foot), M) Weakness of dorsiflexion and eversion, intact reflexes, S) Minimal loss of sensation over lateral aspect of dorsal foot

300

A 24-year-old male presents inflamed joints and conjunctivitis. 3 weeks ago, he was recovering from a Salmonella infection. Laboratory testing confirms he is HLA-B27 positive. What is your diagnosis?

Reactive Arthritis (Reiter syndrome)

Extras: Typically self-limiting but can manage symptoms with NSAIDS or steroids if severe. Remember: can’t see (conjunctivitis), can’t pee (urethritis) & can’t climb a tree (arthritis). But this classic triad only manifests in 1/3 of individuals

400

A 5-year-old boy is brought into hospital by his mother. She is concerned as he has difficulty standing up and the boy exhibits an odd gait (Gower’s sign). FHx: Uncle died when extremely young. Which two genetic disorders could this be and what is the most basic difference between the two?

Duchenne Muscular Dystrophy & Becker. DMD usually make little to no dystrophin (more extreme, early death) while Becker has reduced levels (less severe)

500

A 60-year-old woman presents to ED with left-sided face weakness.

On examination, her left eyebrow is drooped and so is the left corner of her mouth. There is reduced movement on the left side of her face; she cannot wrinkle her brow; she cannot completely close her left eye and when you ask her to smile it is asymmetrical. You notice her speech is slightly slurred.

The right side of her face is normal on examination.

Which finding is key to differentiating this patient's most likely diagnosis from a stroke?

Cannot wrinkle her brow

Extras: Bell’s Palsy is the diagnosis which is a LMN condition. Sparing of the forehead is due to crossover of UMN supply to the forehead, so UMN can compensate for lesion in the LMN to allow wrinkling of the brow

Avery

100

Name 3 causes/risk factors of hernia.

Any of: 

• Increased abdominal pressure (heavy lifting, straining etc.) 

• Weakened abdominal wall (ie. scar)

• Overweight

• Chronic sneezing and coughing 

• Ageing

• Pregnancy 

• Premature birth 

200

 Which types of diarrhoea stop with fasting?

Malabsorptive and Osmotic 

Extras:

Persistence with fasting = not due to content in GIT 

1. Secretory - Net secretion of anions or net inhibition of Na+ absorption = increased osmotic gradient out 

(enterotoxins – major causative agents) ie. cholera 

Isotonic stools 

Persists during fasting

2. Osmotic - Large amount of exogenous osmolyte in gut lumen

Excessive intake - way too much sugar or salt -draws water into lumen

Maldigestion (Coeliac; lactose intolerance)

Hyperosmotic stools 

Abates with fasting - If stop eating = slows diarrhea cause dependent on osmotic gradient 

3. Exudative - Inflammatory disease – blood, pus in stools (dysentery)

Persists during fasting

4. Malabsorptive - Failure of nutrient absorption

Steatorrhoea - too much fat 

Relieved by fasting

300

How does encephalitis differ from meningitis presentation? (list 2 differences)

Meningitis - headache, nausea or vomiting, double vision, drowsiness, sensitivity to bright light, and a stiff neck

Encephalitis - seizures, change in behavior, and confusion and disorientation

400

What are the primary infections associated with GBS? How do these lead to the main presentation of GBS/What is the main pathology of GBS?

C jejuni and CMV

Antibodies and activated T-lymphocytes --> reacting with antigens present on peripheral nerves 

= destroying myelin and axons

500

What is the function of each of  the fat soluble vitamins?

Fat-soluble Vitamins ADEK

A - Vision, gene expression, reproduction, embryonic development, immune function

D - Maintenance of plasma [Ca] & [P]

E - Non-specific chain-breaking antioxidant

K - Coenzyme in the synthesis of many enzymes involved in clotting and bone metabolism

Lea

100

Name veins/sinus blood draining from the pinned structure goes through (START @ pinned structure, duh; HINT: last step is internal  jugular vein)

Pinned structure is superior sagittal sinus SSS
Drainage of blood: SSS -> Confluence of Sinus -> transverse sinus -> Sigmoid sinus ->  IJV

Extras:

200

What nerve supplies sensation to structure 21?

Maxillary division of Trigeminal

Extras: Contrast with Inferior teeth supplied by Inferior alveolar nerve  - branch of V3 or Mandibular division of CNV

300

What nerve precisely supplies taste to mucosa labeled B?

Glossopharyngeal CN IX

Extras:

400

Function of pinned structure

Learning point: Different function of cerebellum! 

1. Archicerebellum (= FLOCCULO-NODULAR LOBE + ITS NUCLEUS, THE FASTIGIAL NUCLEUS) = Maintenance of balance

2 Paleocerebellum (VERMIS + PARAVERMIS) = Muscle tone and posture ( -> gets information from muscles, joints, skin)

3. Neocerebellum ( LATERAL PART OF CEREBELLAR HEMISPHERES + ITS NUCLEUS, THE DENTATE NUCLEUS) = Motor coordination

500

Which nerve carries pre-ganglionic parasympathetic fibres to structure B? And which nerve carries general sensation?... 

Need BOTH to be correct

Parasympathetic: CN IX - glossopharyngeal

Sensation: Auriculotemporal nerve V3 - Trigeminal

Extras:

• Parasympathetic innervation (i.e.  secretion): Glossopharyngeal nerve (CNIX) via lesser petrosal nerve (pre-synmaptic fibres synpase in OTICganglion)

• GENERAL sensation to FASCIA surrounding gland: Auriculotemporal nerve - branhc of CNV3 (post-synaptic parasympathic fibres mentoned above hitchhike on this nerve) => this fascia doesn't have a lot of yield hence why inflammation of the gland is very painful

• Overlying skin to parotid: Great auricular nerve - cervical plexus

Sujal

100

What is the first line management of diabetes?

Lifestyle modifications (weight loss, eating healthy, not smoking)

200

A 3 month old baby presents with lethargy, low blood sugar, lactic acidosis, hyperuricemia, hyperlipidemia. Epinephrine challenge was done and there was no increase in blood glucose. What does this patient most likely have?

Glycogen storage disease / GSD/ Von geirkes

Extras: around 3 months is when these babies begin sleeping more and having less frequent meals → they aren't able to produce glucose so they become hypoglycemic etc

300

Describe the role of leptin and ghrelin and where they are secreted from

Leptin: from adipose tissue and Decreases appetite

Ghrelin: secreted by G cells (give them points anyway if they say secreted by stomach) and its role is to increase hunger

400

How is Vitamin B12 absorbed?

B12 is bound by haptocorrin (usually from salivary gland) → stomach → small intensive → haptocorrin unbinds → intrinsic factor binds B12 → gets absorbed in ileum 

Extras:

500

MOA of glucose on beta cell to release insulin

1. GLUT2 detects increase in BGL 

2. Glucose uptake into beta-cells 

3. Glucose metabolism makes ATP 

4. ATP blocks ATP-sensitive K+ channel so K remains inside 

5. Membrane depolarisation 

6. Ca influx via voltage-gated CC 

7. Release of insulin granules

Extras: need to get 5/7 to get the score