MCQs Week 4 - The Tamworth Primary Course

1. Lymph

Has an increased protein content compared with plasma

Has a differing protein concentration in different areas

Fats cannot enter lymph

Has no lymphocytes

Question 1 of 26

2. Regarding the pharmacology of the cholinergic junction

Acetylcholine is transported into the presynaptic nerve terminal by a sodium dependent choline transporter (CHT)

Acetylcholine release from the presynaptic nerve terminal occurs in response to a decrease in intracellular calcium levels

Botulinum toxin blocks expulsion of acetylcholine from the presynaptic nerve terminal

Acetylcholine is synthesised from acetyl-alcohol and choline through the enzyme choline acetyltransferase

Question 2 of 26

3. With regards to phases of the cardiac cycle - isovolumetric contraction of the ventricle

Occurs during ventricular ejection

Follows atrial systole

Immediately precedes closure of the mitral valve

Is associated with closure of the aortic valve

Question 3 of 26

4. Regarding the muscles of the arm, which of the following is FALSE

Anconeus has a role in forearm extension

Triceps brachii is supplied by the radial nerve C5/C6

Brachialis is the main flexor of the forearm

Coracobrachialis is supplied by the musculocutaneous nerve

Question 4 of 26

5. The principal energy source for the heart of a healthy fasting subject is

Free fatty acids

Glucose

Lactate and pyruvate

Polypeptides

Question 5 of 26

6. White infarcts typically occur in the

Small intestine

Ovary

Lung

Spleen

Question 6 of 26

7. In the eye

Alpha adrenoreceptors cause contraction of the circular papillary muscle

Cyclospasm is a feature of organophosphate poisoning

Beta agonists will reduce intra-ocular pressure

Antipsychotic drugs such as chlorpromazine have no effect on the eye

Question 7 of 26

8. Regarding platelets in haemostasis, all of the following are true EXCEPT

Alpha granules contain adenine nucleotides and ionised calcium

On contact with collagen platelets undergo adhesion and change shape

ADP is a potent mediator of platelet aggregation and potentiates further ADP release from other platelets

The secondary haemostatic plug is an irreversibly fused mass of platelets mixed with red cells and leucocytes

Question 8 of 26

9. Which of the following features of organophosphate poisoning is NOT due to muscarinic effects?

Salivation

Tachycardia

Bronchospasm

Vomiting

Question 9 of 26

10. When rising from the supine to the standing position

Stroke volume rises initially

Total peripheral resistance falls initially

Cardiac output initially falls by up to 25%

The central venous pressure rises initially

Question 10 of 26

11. Which enzyme is responsible for the removal of acetylcholine outside the synapse?

Acetylcholinesterase

Pseudocholinesterase

True cholinesterase

Simulocholinesterase

Question 11 of 26

12. Which of the following ocular medications can precipitate glaucoma?

Homatriptine

Pilocarpine

Timolol

Latanoprost

Question 12 of 26

13. Which of the following is correct regarding pulmonary embolism?

Antiphospholipid is an example of a primary hypercoagulable state

Most emboli are derived from thrombi in the superficial leg veins

It often results in respiratory compromise, which is due to alveolar hypoventilation

It commonly causes pulmonary infarcts, especially in young patients

Question 13 of 26

14. When the radius of the resistance vessels is increased, which of the following is also increased?

Diastolic blood pressure

Viscosity of blood

Haematocrit

Capillary blood flow

Question 14 of 26

15. The pressure in a skeletal muscle capillary is 35mmHg at the arteriolar end and 14mmHg at the venular end. The interstitial pressure is 0mmHg. The colloid osmotic pressure is 25mmHg in the capillary and 1mmHg in the interstitium. The net force producing fluid movement across the capillary at it's arteriolar end is

3mmHg out of the capillary

3mmHg into the capillary

10mmHg out of the capillary

11mmHg out of the capillary

Question 15 of 26

16. Regarding fat embolism and it's associated syndrome, all of the following are true EXCEPT

It can occur in up to 90% of individuals with severe skeletal injuries but less than 10% will have clinical findings

It's syndrome is characterised by pulmonary insufficiency, neurologic symptoms, anaemia and thrombocytopenia

Symptoms of fat embolism syndrome typically begin 5-7 days after injury

A diffuse petechial rash is seen in up to 50% of fat embolism cases

Question 16 of 26

17. Regarding the pathophysiology of embolic disease

There is a risk of sudden death, right heart failure or cardiovascular collapse once 30% of the pulmonary circulation is obstructed

80% of systemic thromboembolism arise from intracardiac mural thrombi

Generally, about 5cc of air is required to form a pulmonary 'air' embolism

The mortality rate of amniotic fluid embolism is approximately 30%

Question 17 of 26

18. The cholinesterase inhibitor with the shortest duration of action is

Physostigmine

Edrophonium

Neostigmine

Malathion

Question 18 of 26

19. Thrombosis is potentiated by all of the following EXCEPT

Von Willebrand factor deficiency

Protein S deficiency

Heparin induced thrombocytopenia

Acute leukaemia

Question 19 of 26

20. Regarding the brachial plexus

The long thoracic nerve innervates serratus anterior

The dorsal scapular nerve innervates latissimus dorsi

The thoracodorsal nerve is a supraclavicular branch of the brachial plexus

The nerve to subclavius innervates the acromioclavicular joint

Question 20 of 26

21. With regards to the cardiac cycle

Phase 1 represents atrial systole

The aortic valve opens at the beginning of phase 2

The T wave of the ECG occurs during phase 4

The second heart sound is due to the closure of the mitral valve

Question 21 of 26

22. In normal haemostasis

Activated Factor V inhibits thrombosis

Thrombomodulin binds thrombin and converts it from a procoagulant into an anticoagulant

PGI2 produced by endothelial cells favours platelet aggregation

Platelet aggregation is inhibited by von willebrand factor

Question 22 of 26

23. Which of the following statements about the axilla are FALSE?

The base is formed by concave skin and deep axillary fascia

The anterior wall is formed by the pectoralis muscles and clavipectoral fascia

The medial wall is formed by the thoracic wall (ribs 1-4) and serratus anterior

The lateral wall is a narrow bony window on the lesser trochanter of the humerus

Question 23 of 26

24. The humerus

Has a surgical neck formed by the groove circumscribing the head and separating it from the greater and lesser tubercles

Is in direct contact with the ulnar nerve at it's medial epicondyle

When fractured is rarely impacted

Is in direct contact with the radial nerve at it's surgical neck

Question 24 of 26

25. An elderly patient presents with increasing breathlessness. There is a raised JVP, bibasal lung crepitations and pitting oedema of the lower limbs. This oedema is associated with

High protein content

Low aldosterone levels

Increased plasma hydrostatic pressure

Increased plasma oncotic pressure

Question 25 of 26

26. Considering the rotator cuff muscles

Have a small role supporting the glenohumeral joint

Are made up of Supraspinatous, Subcapularis, Infraspinatous and Teres major

Are supplied predominantly by C5/C6

Subscapularis is a lateral rotator of the arm

Question 26 of 26