SHIDA 10

NOTE!! All the questions & answers were collected from Quizzes, sample answers from Moodle and small tutorials from lecturers.

MCQS

1. Which ONE of the following statements about heart valves is correct? Choose one answer. (a) The aortic valve has a total of three cusps (b) The pulmonary valve has a total of two cusps (c) The mitral valve lies between the right atrium and the right ventricle (d) The mitral valve has a total of three cusps (e) The tricuspid valve is located at a level superior to that of the pulmonary valve 2. Which ONE of the following statements about the sensory nerve supply to the hand is correct? Choose one answer. (a) The T1 dermatome includes part of the skin covering the hand (b) The median nerve gives sensory innervation to the skin of the little finger (c) Branches of the radial nerve innervate the skin on the dorsal surface of the hand (d) The radial nerve provides most of the sensory innervation to the skin of the palm (e) The ulnar nerve gives sensory innervation to the skin of the thumb 3. Patients with respiratory disease can have a lower than normal arterial blood PO2. A lower than normal arterial blood PO2 causes which ONE of the following: Choose one answer. (a) respiratory acidosis (b) stimulation of arterial chemoreceptors (c) pulmonary arterial hypotension (d) inhibition of Hering-Breuer inflation receptora (e) stimulation of central chemoreceptors 4. The following treatment for heart failure has been shown to reduce mortality: Choose one answer. (a) Digoxin (b) Phosphodiesterase Inhibitors (c) Calcium Channel Blockers (d) Diuretics (e) ACE (angiotensin-converting enzyme) inhibitors 5. In the heart, which ONE of the following statements is CORRECT? Choose one answer. (a) The pulmonary veins drain into the right atrium (b) The branches of the coronary arteries do not form anastomoses (c) All the venous blood from the myocardium drains through the coronary sinus

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(d) The left atrioventricular valve normally has a total of three cusps (e) The diaphragmatic surface of the heart is formed mainly by the left ventricle 6. Mr Murphy is 65 years old and has been a heavy smoker all his life. As a result he suffers from chronic obstructive airways disease and it chronically hypoxic. Pulmonary function tests confirm Mr Murphy's diagnosis. Which ONE of the following is not helpful in the diagnosis of chronic obstructive airways disease? Choose one answer. (a) Forced expiratory volume in 1 second (FEV1) (b) Peak expiratory flow rate (PEFR) (c) Forced vital capacity (FVC) (d) Respiratory exchange ratio (e) Partial pressure of oxygen in arterial blood (PaO2) 7. In the ECG, what does the R-R interval represent? Choose one answer. (a) duration of systole (b) conduction time from atria to ventricles (c) duration of one cardiac cycle (d) conduction time in bundle branches (e) duration of diastole 8. A 54 year old woman has surgery involving the right axilla. She has difficulty lifting her arm over her head. Which ONE of the following is most likely to have been affected? Choose one answer. (a) Serratus anterior (b) Pectoralis major (c) Sternocleidomastoid (d) Latissimus dorsi (e) Rhomboid muscles 9. A patient admitted to hospital is suspected of having a disturbance of sodium balance. Which ONE of the following statements about sodium balance is correct: Choose one answer. (a) It results in a change in plasma osmolarity (b) It often results from eating processed foods (c) It rarely occurs in renal failure (d) It results in a change in blood volume (e) It results in a marked change in plasma sodium concentration 10. Following surgery for carcinoma of the breast with some clearance of lymph nodes a young woman experiences swelling in her arm. The following changes may cause oedema:

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Choose one answer. (a) Increased lymphatic function (b) Increased interstitial fluid pressure (c) Decreased plasma proteins (d) Decreased capillary blood pressure (e) Arteriolar vasoconstriction 11. A middle aged woman is brought to the Accident and Emergency Department complaining of acute chest pain. She had previously noticed some discomfort or even mild chest pain on exercise but this present episode commenced at home after her evening meal. There was a strong family history of ischaemic heart disease. An ECG is recorded. Which ONE of the following statements is correct? Choose one answer. (a) The P-R interval is normally more than 0.2 sec. (b) The P wave begins when the A-V valves are closed (c) The T wave begins when the aortic valve is open (d) The QRS complex includes atrial depolarization. (e) The T wave represents atrial repolarisation 12. With regard to the foetal circulation the following statements are true EXCEPT: Choose one answer. (a) The bulbus cordis becomes incorporated into the walls of the developing ventricles (b) Fallot's tetralogy may be caused by unequal division of the truncus arteriosus into a small pulmonary trunk and a large ascending aorta (c) Postpartum closure of the foramen ovale is mediated by bradykinin a substance released from the lungs during initial inflation (d) The ductus arteriosus is formed by the persistence of part of the 6th aortic arch on the left side (e) The sinus venosus receives blood from the vitelline common cardinal and umbilical veins via the right and left sinus horns 13. A trauma victim is being resuscitated in the Accident and Emergency Department. Haemodynamic monitoring includes central venous pressure (CVP). Which ONE of the following statements regarding CVP is correct? Choose one answer. (a) The waveform is similar to that of the arterial pulse (b) It reflects left atrial pressure changes (c) The pressure range is similar to that of systemic arterial blood pressure (d) The venous return contributes to CVP (e) Measurement of CVP is based on the Doppler principle 14. Which ONE of the following is not true of familial hypercholesterolaemia: Choose one answer.

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(a) It can be treated with statins (b) It is caused by a deficiency in HDL receptors (c) It leads to early development of atherosclerosis (d) Sudden cardiac death is the first symptom in 1/3 of patients (e) It is present in about 1/500 of the population 15. A 62 year man presents to his GP with a pericardial effusion and pericarditis (inflammation of the pericardium). With regard to the pericardium the following statements are true EXCEPT? Choose one answer. (a) The fibrous pericardium is derived from the septum transversum (b) The oblique sinus of the pericardium is a cul-de-sac between the two left and right pulmonary veins and the inferior vena cava (c) The fibrous pericardium lies on the central tendon of the diaphragm from which it may easily be separated (d) The pain of pericarditis is transmitted via the phrenic nerve (e) The fibrous pericardium merges with the adventitia of the great vessels (aorta and pulmonary artery) superiorly 16. Cardiac arrhythmia is treated by different classes of drugs depending on its type. All of the following are characteristics of class 1 anti-arrhythmic drugs EXCEPT? Choose one answer. (a) They inhibit sodium channels (b) They have negative inotropic effects (c) Reduce the rate of rise of the action potential upstroke (phase 0) (d) They are pro-arrhythmics (e) They are only used in ventricular arrhythmias 17. Deficiency of lung surfactant would be expected to produce all of the following EXCEPT? Choose one answer. (a) Decrease in recoil force of the lung (b) Increased work of breathing (c) Collapse of alveoli (d) Difficulty in expanding the lung (e) Emptying of air from small into large alveoli 18. A 29 year old man is brought to the Accident and Emergency Department following a motorcycle accident. He landed awkwardly on his shoulder when falling with his neck and head being forced in the opposite direction. Which of the following statements regarding the brachial plexus is INCORRECT? Choose one answer. (a) An injury to the upper brachial plexus causes loss of sensation on the lateral aspects of the arm and forearm. (b) An injury to the upper brachial plexus causes paralysis of the abductors and lateral

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rotators of the shoulder joint. (c) All 5 nerve roots contribute to the posterior cord of the brachial plexus. (d) The brachial plexus is formed by the anterior (ventral) rami of C5, C6, C7, C8 and T1 (e) An injury to the upper brachial plexus causes a claw hand deformity of the distal upper limb. 19. With regard to the structure and histology of the lung, the following statements are true EXCEPT? Choose one answer. (a) Pseudostratified ciliated columnar epithelium lines all surfaces of the respiratory system (b) The trachea contains incomplete C-shaped rings of hyaline cartilage to stiffen the walls and maintain patency (c) Type II pneumocytes are present within the alveolar walls and produce surfactant to reduce alveolar surface tension (d) Carbon dioxide moves out of the alveolar capillaries into the lumen of the alveoli during respiration by means of passive diffusion along a concentration gradien (e) The thin connective tissue layer between the alveolar epithelium and the capillaries contains elastin 20. With regard to the sympathetic chain within the thorax, all of the following statements are true EXCEPT: Choose one answer. (a) The sympathetic trunks lie on the necks of the ribs bilaterally within the thoracic cavity. (b) The first thoracic ganglion may be fused with the lowest cervical ganglion to form the stellate ganglion (c) The sympathetic trunks pass into the abdomen by passing behind the medial arcuate ligaments of the diaphragm. (d) The least splanchnic nerve arises from the fifth thoracic ganglion. (e) The sympathetic chains receive white preganglionic rami from the spinal nerves. 21. Prior to elective surgery a patient is found to have a haemoglobin of 6g/dl. Which ONE of the following statements is correct? Choose one answer. (a) Haemoglobin and myoglobin contribute equally to the carriage of oxygen in the circulation (b) The normal range is not gender specific (c) Erythropoietin is a stimulus to haemopoiesis in response to hypoxia (d) A haemoglobin of 6g/dl is within the normal range (e) Adult and foetal haemoglobin have the same affinity for oxygen

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SNQS 1. Give the surface markings of ALL of the following: (a) the oblique fissure of the right lung (b) the formation of the brachiocephalic veins (c) the deep palmar arterial arch (d) the position for auscultation of the pulmonary valve (e) the boundaries of the anatomical snuff box (a) (b) (c) (d) (e) spinous process T2/3, along spine of the scapula (T3), along 6th rib to the 6th CC. behind the sternoclavicular joint level of the base of the extended thumb 2nd intercostal space left of sternum EPL, EPB and APL

2. High Density Lipoprotein (HDL) is sometimes referred to as good cholesterol because it is involved in returning cholesterol from peripheral tissues to the liver from where it can be eliminated from the body. Describe how HDL carries out this function. Include mention of how cholesterol is picked up by HDL and the three ways in which that cholesterol is transferred to the liver. What is the major health problem caused by elevated cholesterol in the blood? The ABC1 protein on peripheral cells transfers cholesterol to the HDL particle. Within HDL, lecithin-cholesterol acyl transferase (LCAT) attaches an acyl chain to the cholesterol molecule and the cholesterol ester sinks into the interior of the particle. The cholesterol may be transferred to the liver in 3 ways: i. Cholesterols esters may be transferred to remnant particles (VLDL and chylomicron) via the cholesterol ester transfer protein, and the remnant particles are taken up into liver cells. ii. cholesterol esters may be transferred to liver cells directly via a scavenger receptor this transfer does not require endocytosis iii. HDL particles with high amounts of apoE may be endocytosed into liver cells The major health problem caused by elevated plasma cholesterol is atherosclerosis. This is particularly due to elevated LDL. Macrophages have scavenger receptors which allow them to engulf LDL particles these receptors have low affinity and thus function more efficiently at higher LDL levels. Such macrophages may deposit their load of cholesterol as a fatty streak at sites of damage in arterial walls. Eventually, the deposits may build up enough to prevent blood flow and thus cause tissue damage due to oxygen deprivation. 3. Describe the effects on the heart of blocking the response to a) vagal and b) sympathetic stimulation.

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(a) Block of vagal stimulation with atropine results in tachycardia to above 100 bts/min at rest by blocking the vagal drive to the heart at rest. (b) Blockade of beta-adrenoceptors with a beta-blocker may result in a small bradycardia at rest, demonstrating a small beta-component to resting heart rate. Block of beta receptors will also reduce sympathetic tachycardia and decrease force of contraction of the ventricle. Additional information: Possible initial bradycardia to low doses of atropine