REGUB

REGUB 1st Sitting MAY 2009.

1. In a patient who has suffered a major loss of blood following a stab
wound systemic pressure drops below 80 mmHg. Describe the two main
theories to explain autoregulation of renal blood flow. What response
within the kidney would you expect from the sympathetic nervous
system?
2. Describe how the kidney compensates for respiratory acidosis.
3. Describe the countercurrent multiplier mechanism in the renal
medulla and explain the role of the distal tubule and collecting ducts
in excreting concentrated urine.
4. Contrast the mechanisms of action of the Type II diabetes
treatments, sulphonylureas and thiazolidinediones.
5. A young male subject is brought to the hospital emergency department
in a deep coma. Documentation on his person inform that he is a Type I
diabetic subject and a rapid blood glucose measurement indicates
severe hypoglycaemia. Injection of glucagon i.m. is indicated.
a) Explain briefly the necessity of administering a hyperglycaemic.
b) Describe why glucagon and not cortisol is administered in this
situation and discuss the contrasting modes of action of glucagon
and cortisol at the molecular / biochemical level.
6. The hypothalamus has different kinds of connections with the anterior
and posterior pituitary gland. Write a short note discussing these two
types of connections. Include in your answer specific examples of how
the hypothalamus influences secretions of the pituitary gland.
7. A patient that is urinating excessively is diagnosed with diabetes
insipidus. What are the two major effects that vasopressin normally has
in the body. Discuss (i) the role played by vasopressin in diabetes
insipidus and (ii) the causes of the two types of this disease.
SNQ REGUB 3 SEP 2009

HIS SNQ Paper I SEPTEMBER 2009

REGUB SNQ Paper I 30 AUGUST 2010

HIS SNQ Paper I 30 AUGUST 2010

HIS SNQ Paper I 01 SEPTEMBER 2010

REGUB SNQ Paper I JANUARY 2010

REGUB SNQ Paper I 01 JUNE 2011

REGUB SNQ Paper I 23 AUGUST 2011

Short Note Paper September 2007 REGUB

1. A 52 year old man was diagnosed as having Addisons disease or primary
hypoaldosteronism having collapsed at work; he was found to have a low
blood pressure. Briefly outline some of the mechanisms involved in the
reabsorption of sodium from the renal tubules and describe how the lack of
aldosterone, which acts on the distal renal tubules, is implicated in the clinical
presentation of primary hypoaldosteronism as described above.

2. A 66 year old woman is prescribed hydrochlorothiazide, a thiazide diuretic,

for the treatment of hypertension. Explain how this diuretic produces its
effects. What side-effects may she encounter with the use of this diuretic?
3. What is the range of mean arterial blood pressures over which renal blood
flow is autoregulated? Describe the tubuloglomerular feedback mechanism
for autoregulating renal blood flow.
4. An elderly female patient has been admitted to hospital following two days
of severe vomiting. The data on the acid-base status of the patient is as
follows:
Blood pH = 7.5 (reference range = 7.35-7.45)
Plasma PaCO2 = 50 mmHg (reference range = 35-45 mmHg)
Plasma [HCO3-] = 38 mmol/l (reference range = 22-26 mmol/l)
(a) Identify, giving your reasons, the acid-base disturbance from which the
patient is suffering.
(b) Explain why the plasma [HCO 3-] has risen above the normal value
following the severe vomiting.
5. A young man involved in a car accident sustained severe crush injuries to
his lower limbs and lost a considerable volume of blood. Following admission
to hospital, he developed acute renal failure due to acute tubular necrosis.
Some of the results of the initial laboratory investigations indicated that he
was severely hyperkalaemic (high plasma [K+]).
(a) Describe the mechanism in the distal nephron for secreting K+ into the
filtrate.
(b) Explain how the patients crush injuries could have contributed to the
hyperkalaemia.
6. What is the most common molecular defect underlying the condition,
congenital adrenal hyperplasia (CAH) in human subjects? Why does
hyperplasia of the adrenals result from this defect and why do affected female
subjects present very often with physical signs of virilisation?
7. What are the three main hormones involved in the regulation of calcium
in the body? Describe the action of PTH and its role in the activation of
vitamin D.
8. Methimazole is used in the treatment of hyperthyroidism. Describe how
methimazole produces its desired effect. Why is propylthiouracil used in
pregnant women? What are the major side-effects associated with anti-thyroid
therapy?
9. Synthetic growth hormone is used illegally by some athletes and body
builders. What actions of growth hormone are enticing athletes to take
supplemental doses of growth hormone? What are the potential side effects of
these supplements?

10. 35 year old woman was recently diagnosed with hyperthyroidism. She
initially presented to her GP complaining of weight loss. She also complained
of heat intolerance and sweating.
(a) Describe the sequence of events which leads to sweating in hyperthyroid
patients.
(b) Explain why hyperthyroid patients usually have warm extremities.
1. Describe the process for production of angiotensin II, including
reference to the organs and enzymes involved. What are the major effects of
angiotensin II in the body? Briefly comment on the activity of aldosterone.
2. In the accident & emergency room a patient is treated with a loop diuretic
to reduce the acute pulmonary edema of congestive heart failure:
[a] name a specific example of this class of diuretics;
[b] describe how this drug acts as a diuretic;
[c] list the possible adverse effects.
3. List the criteria which a substance must fulfil so that its clearance is a
measure of the glomerular filtration rate (GFR). Explain why creatinine
clearance is a measure of the GFR in spite of the fact that it does not fulfil all
of the criteria you have listed.
4. A 40 year old man, who had been been admitted to hospital 3 days
previously with pneumonia, has now been diagnosed with the syndrome of
inappropriate ADH secretion (SIADH).
[a] Describe the role of ADH in water reabsorption in the collecting ducts of
the kidneys and explain how SIADH is likely to affect plasma and urine
osmolarity in the patient.
[b] If you were provided with a value for the patients plasma sodium
concentration, indicate, giving your reasons, how you would calculate an
approximate value for plasma osmolarity.
5. A 22 year old known diabetic man presents with severe polyuria and
polydipsia. He is dehydrated and hypotensive. Urinalysis is strongly positive
for glucose and ketones. The data on his acid-base status is as follows:
Blood pH = 7.31 (reference range = 7.35-7.45)
Plasma Pa CO2 = 27 mmHg (reference range = 35-45 mmHg)
Plasma [HCO3-] = 13 mmol/l (reference range = 22-26 mmol/l)
[a] Identify, giving your reasons, the acid-base disturbance from which the
man is suffering.
[b] Indicate the type of compensation which is occurring and describe the
mechanism which underlies it.
7. What is parathyroid hormone? Describe its actions in health.
8. A 19 year old woman presents to her GP with palpitations and sweats. On
examination she appears to be agitated, tremulous and is tachycardic at 130
beats per minute in atrial fibrillation. She is admitted to hospital and improves

with beta blockers and carbimazole. Discuss the likely cause of this womans
condition and how the drugs may act to relieve her symptoms.
9. A woman in substantial pain called her doctor. She was crying and was
worried that she was about to have her baby right now. The doctor calmed
her down and asked her how she knew this. She explained that her water had
broken and that her husband could see the babys head.
[a] Was she going to deliver her baby ? If so, what stage of labor was she in?
[b] Explain whether or not she would have time to get to a hospital that was
1.5 hours away to deliver the baby ?
[c] Describe the role of physical and hormonal factors in parturition.
10. A 26 year old woman has had insulin-dependent diabetes mellitus for the
past fifteen years. Diabetic nephropathy has now been diagnosed. Describe
the symptoms and consequences of diabetic nephropathy. What are
advanced glycation end products and how may these contribute to this
diabetic complication?
GIHEP
January 2009
Q1. A 64 year old lady undergoes surgical repair of her pelvic diaphragm to
help treat her urinary incontinence. Draw or describe the pelvic diaphragm,
including its parts, attachments and innervation. What other problems may
this lady experience with a lax (loose) pelvic diaphragm?
Q2. A 45 year old male presents to Accident and Emergency, stating that he
has started vomiting blood earlier that day (haematemesis). He undergoes
endoscopy and an ulcer is found in the first part of his duodenum. Draw or
describe the duodenum, including its parts, relations and blood supply. Why
was this patient vomiting blood?
Q3. A young man is stabbed in the abdomen resulting in a tear through the
greater omentum. Omentum is a form of peritoneum.
(a)
(b)
(c)
(d)

What are the attachments of the greater and lesser omenta?

What is the Foramen of Winslow (epiploic foramen) and what are its
boundaries?
What is Pringles Manoevre and why is it performed?
What are the greater and lesser omenta derived from?

Q4. A patient with cholera is given oral rehydration therapy with a solution
of glucose and salt. Describe, using a diagram, how the sodium, chloride,
glucose and water will be absorbed.
Q6. A patient with Type I Diabetes who is non-compliant with their insulin
therapy will typically present with hyperglycaemia, ketosis and

hypertriglyceridaemia. Describe briefly the mechanisms underlying these

three phenomena in such a patient.
Q10. Both in family practice and in the hospital setting, nausea and vomiting
are commony encountered. Classify potential causes of nausea and
vomiting and distinguish how they are treated with drugs having differing
mechanisms of action.
GIHEP SNQ Paper I JANUARY 2010
1. A rural GP (doctor) sees an 18 year old male patient in his clinic with a
2 month history of a right groin lump. The GP identifies this as an
inguinal hernia. Draw or describe the inguinal canal. What are the
surface markings of the deep and superficial rings? What is the
difference between a direct and an indirect inguinal hernia?

2. A 2-year-old child was brought to the outpatient clinic because he has had
constipation and poor weight gain for approximately one year. Examination
revealed anemia and abdominal distension. A barium enema X ray was
requested and the diagnosis of Hirschsprungs disease was suspected. This
was confirmed by rectal biopsy.
(a) With the aid of a diagram, describe the defecation reflex.
(b) Explain why there is severe constipation in Hirschsprungs disease.
Model answer:
(a) Defecation reflex:
INTRINSIC REFLEX:
- Rectal distension causes peristalsis in the descending and sigmoid colon
and in the rectum and relaxation of the internal anal sphincter.
- This intrinsic reflex is controlled by intramural plexuses. Therefore, with
lesions of the extrinsic nerves or spinal cord, defecation is still possible.
EXTRINSIC REFLEX:
- Rectal distension activates stretch receptors sensory information running
in the sacral parasympts.
- This reflexly activates parasympt. efferents causing reflex peristalsis in the
colon and rectum and relaxation of the internal anal sphincter. Sympts do the
opposite but are less important.
CONSCIOUS CONTROL:
- Conscious control is through the pudendal nerves to the external anal
sphincter (striated muscle). During defaecation, there is voluntary relaxation of
the sphincter and a Valsalva manoeuvre.
- Rectal stretch receptors convey the sense of fullness to the brain.
- Conscious control is absent in infants, cord and nerve injuries and mental
retardation.

SPINAL
CORD

SACRAL
PARASYMPATHETICS

PUDENDAL
NERVES

INTERNAL ANAL
SPHINCTER
EXTERNAL ANAL
SPHINCTER

(b): Constipation in Hirschsprungs disease:

- In Hirschsprungs disease, there is a congenital lack of ganglion cells in
plexuses of the distal colon very weak peristalsis stool cannot move
forward normally severe constipation and megacolon.
3. A patient is diagnosed with the condition steatorrhea, which are fatty stools
and indicates the patient is suffering from fat malabsorption (not absorbing fat
from their diet). Describe how fat is digested, absorbed and transported in the
body.

HIS SNQ Paper I January 2009

HIS SNQ Paper I 30 AVRIL 2010

GIHEP SNQ Paper I 17 JANUARY 2011

ALIMENTARY SYSTEM
Q1

What is jaundice? Briefly describe the mechanism by which Bilirubin is

detoxified and excreted by the liver.

Q2
You are asked by your consultant surgeon to assist her in a
hysterectomy.
She discusses the anatomy of the uterus with you prior to
the operation.
a)
Explain the normal position of the uterus.
b)
What is the blood supply of the uterus?
c)
What is the lymphatic drainage of the uterus? Where can lymph
nodes
draining the uterus be palpated?
d)
What are the supports of the uterus?
Q3
A 44-year-old female presented with a 6-month history of fatigue,
myalgia
(muscle
pain), and decreased production of saliva and
tears. Antibodies to the SSA antigen
were positive and the diagnosis of
Sjogrens syndrome was confirmed.
a)
Outline the functions of saliva.

b)

Briefly describe normal control of salivation.

HIS SNQ Paper I 17 AUGUST 2011

Paper I 16 JANUARY 2011

GIHEP SNQ Paper I SPTEMBER 2008

1. You have been asked to insert a urinary catheter into a male patient.
Describe the anatomy of the male urethra, including its position, parts and
relations.
2. An elderly gentleman presents to the accident and emergency department
with bowel infarction (loss of blood supply to the bowel). Describe the origin
and branches of the superior mesenteric artery (SMA). What does it supply?
Where does the venous drainage from the superior mesenteric vein go?
Which parts of the gastrointestinal tract are derived from the embryological
midgut?
3. A lady attends her GP with severe dull pain in her epigastrium and back,
associated with weight loss. A CT scan confirms a pancreatic carcinoma.
Describe the pancreas, including its parts, relations and blood supply. What is
an annular pancreas?
4. A 45 year old gentleman attends the accident and emergency unit with
severe upper abdominal pains, following a night of heavy alcohol
consumption. Blood tests reveal an elevated serum amylase level; in
addition, his liver transaminases are mildly elevated. A CT scan is performed,
which shows evidence of early cirrhosis of the liver and an acutely inflamed
pancreas. Describe the different phases of bile secretion from the liver.
5. The folded structure of proteins is crucial to determining their biological
activity in the body. Describe briefly the primary, secondary and tertiary
structure of proteins, using diagrams as appropriate.
6. Briefly outline some of the mechanism by which the liver can detoxify
foreign compounds giving some examples.
7. . The Cori cycle involves the recycling of lactate in the human body. When
this cycle is active, what tissues are involved and what is achieved by its
operation?
8. Describe the digestion and absorption of fats. Include reference to causes
and consequences of fat malabsorption.

9. In a busy family practice, disorders of bowel habit are common, with

extremes of function indicated by constipation and diarrhoea. Outline one
class of drug used to treat each of these extremes. Describe the mechanism
of action and adverse effects for each example.
10. The therapeutic index is an indicator of the safety profile of a drug.
Discuss this statement using quantal dose response curves to illustrate your
answer.
Short Note Paper January 2009
Q1. A 64 year old lady undergoes surgical repair of her pelvic diaphragm to
help treat her urinary incontinence. Draw or describe the pelvic diaphragm,
including its parts, attachments and innervation. What other problems may
this lady experience with a lax (loose) pelvic diaphragm?
Q2. A 45 year old male presents to Accident and Emergency, stating that he
has started vomiting blood earlier that day (haematemesis). He undergoes
endoscopy and an ulcer is found in the first part of his duodenum. Draw or
describe the duodenum, including its parts, relations and blood supply. Why
was this patient vomiting blood?
Q3. A young man is stabbed in the abdomen resulting in a tear through the
greater omentum. Omentum is a form of peritoneum.
1. (a) What are the attachments of the greater and lesser omenta?
2. (b) What is the Foramen of Winslow (epiploic foramen) and what are
its
boundaries?
3. (c) What is Pringles Manoevre and why is it performed?
4. (d) What are the greater and lesser omenta derived from?
Q4. A patient with cholera is given oral rehydration therapy with a solution of
glucose and salt. Describe, using a diagram, how the sodium, chloride,
glucose and water will be absorbed.
Q5. Metabolic processes in the body often require utilization of endergonic
chemical reactions which require the input of energy in order to proceed. This
is achieved by coupling such reactions to the hydrolysis of adenosine
triphosphate (ATP). Write a short note on the synthesis of ATP by
mitochondria, including comment on the significance of the impermeability of
the inner mitochondrial membrane.
Q6. A patient with Type I Diabetes who is non-compliant with their insulin
therapy will typically present with hyperglycaemia, ketosis and

hypertriglyceridaemia. Describe briefly the mechanisms underlying these

three phenomena in such a patient.
Q7. Epidermal growth factor (EGF) is a growth factor that plays an important
role in the regulation of cell growth, proliferation, and differentiation by binding
to its receptor EGFR. What type of receptor is the EGFR? Explain how
binding of EGF to its receptor produces a response in the target cell.
Q8. Describe the metabolic roles of vitamin A and vitamin D in the body.
Outline their dietary sources and the causes and effects of deficiency.
Q9. Write short notes on DNA replication describing how the leading and
lagging strands are synthesized. Diagrams may be used to illustrate your
answer.
Q10. Both in family practice and in the hospital setting, nausea and vomiting
are commony encountered. Classify potential causes of nausea and vomiting
and distinguish how they are treated with drugs having differing mechanisms
of action.
Short Note Paper September 2008 GIHEP
1. In clinical practice, disorders of the upper and lower gastrointestinal tract
are common causes of distress. Contrast the roles of histamine H 1
antagonists and histamine H2 antagonists in the treatment of such disorders.
3. Paracetamol is a drug that has different clinical indications.
[a] Briefly explain the metabolic pathway involved in producing liver necrosis
after ingestion of a high dose of this drug.
[b] Mention one antidote that can be used to reverse this toxicity. Briefly
explain the mechanism of action of that antidote.
4. A 37-year-old woman with a 2-year history of progressive dysphagia
(difficulty in swallowing) to both solids and liquids, as well as a 10-lb weight
loss, presented for evaluation. Barium studies suggested a diagnosis of
achalasia. Esophageal manometry showed absence of peristalsis and a high
lower esophageal sphincter pressure.
Describe the phases of swallowing. What is the effect of gastrin on the lower
esophageal sphincter?
6. The liver is an important organ for the detoxification of both endogenous
and exogenous compounds. Briefly describe the detoxification process
involved in the excretion of bilirubin. How may known alterations to this
process be used to diagnose liver disease?
9. Explain why steatorrhea results from the absence of bile salts or pancreatic
juice. Comment briefly on the enterohepatic circulation.

10. Dr. Gaylord prepared for running a 40km marathon by eating a high
carbohydrate meal the day before the race. Briefly describe:
[a] how and where glucose is stored in a readily mobilizable form in the body
[b] how glucose is released from those stores
Name the process that is used to provide glucose when those stores are
depleted and name one reaction unique to that process.
12. You pass a urinary catheter in a male patient. Describe or draw the parts
of the urethra through which the catheter passes. What type of epithelium
lines most of the urethra?
13. A patient presents to the accident and emergency department with a large
abscess, just lateral to his anal canal, which requires surgical drainage.
Describe the boundaries and contents of the ischiorectal fossa. What is
supplied by the nerve that runs in Alcocks canal?
14. You are a medical student attending a clinic in the pediatric unit. A 12 year
old boy is diagnosed with acute appendicitis. Describe the location / locations
and blood supply of the appendix. Explain why the patient has referred pain to
the umbilicus. Write a short note on the congenital abnormalities associated
with the vitelline duct.
15 On palpating a patients abdomen, you feel a large hard mass in the
epigastrium. A malignant tumour of the stomach is diagnosed. Describe the
position, parts, blood supply and lymphatic drainage of the stomach. To which
structures may this malignancy spread?
Short Note Paper SEPTEMBER 2006 GIHEP
Q1. Give the surface markings for the following:
1.
2.
3.
4.

a)
b)
c)
d)

The transpyloric plane

The base of the appendix
The spleen
The gall bladder

Q2. A 39 year old male presents to the Accident and Emergency Department
with ureteric colic. Describe the course of the ureter and structures that are
related to it. Outline the places where it is narrowed and why this is important.
Q3. A patient presents to Accident and Emergency Department and is
diagnosed with pancreatitis. Describe the anatomy of the pancreas with
particular reference to the parts, blood supply and venous drainage. Write a
note on the embryological origins of this organ and potential abnormalities
that may arise.
Q4. A 55 year old woman has been diagnosed with cancer of the uterus.
Describe the anatomy of the uterus. Include details on the structure, relations,
blood supply, venous and lymphatic drainage.

Q6. In clinical practice, nausea and vomiting can be a frequent occurrence

across all age ranges. Outline the receptors that are involved in the regulation
of emesis. Describe briefly how drugs acting at these receptors can be used
to control different forms of emesis.
Q8. Hypertriglyceridaemia (plasma triglyceride concentrations > 2.3 mmol/L)
is observed in both Type I and Type II diabetes mellitus and results in part
from failure of the normal regulation of triglyceride metabolism in adipose
tissue. Briefly describe:
1. a) The normal hormonal regulation of triglyceride synthesis and
breakdown in adipose tissue
2. b) The factors that contribute to the development of
hypertriglyceridaemia in diabetes
Q9. The human body stores energy in the form of glycogen and triglycerides.
Regarding glycogen stores, write BRIEF NOTES describing the following:
1. a) The location and relative size of glycogen stores in the human body
2. b) The differences regarding the physiological circumstances and
purposes to which these stores are utilised within the two main sites in
the body
3. c) The hormonal influences that determine when and which of these
storage sites is to be utilised to supply energy
Q10. Calcium is an essential dietary constituent. Write BRIEF NOTES in
response to the following:
1. a) What are good dietary sources of calcium?
2. b) How is it absorbed in the intestine and what kidney-derived
substance controls this process?
3. c) Where is the bulk of calcium found in the body, in what form and to
what extent?
4. d) What is the normal level of calcium in the blood, in what form is it
and name ONE function it is performing there?
5. e) What is the approximate concentration of free calcium within cells
and what ubiquitous protein often binds to it when it exerts its
physiological roles?
Q11. Mrs. Smith, a 48 year old publican, is complaining of abdominal pain,
with occasional vomiting. Blood tests revealed a low haemoglobin
concentration. The possibility of underlying liver disease should be considered
in a patient with this history. Briefly describe what biochemical test you
would request to exclude a post hepatic liver cause of the abdominal pain
and then discuss what biochemical changes you would expect if the
diagnosis was impacted gall stones.
Q15. Briefly describe the three major physiological factors causing gastric
acid secretion in normal digestion.

Short Note PaperJanuary 2007 GIHEP

3. Peptic ulcer disease is suggested by the symptoms of abdominal pain and
occasional vomiting, together with low haemoglobin. What is the most
common cause of peptic ulcer? What initial treatment regimen would you
recommend and what is the mechanism of action of the acid suppressant
used in that regimen?
4. A 67-year-old man with a history of alcohol abuse was admitted with a 4day history of abdominal pain and vomiting. He was febrile, dehydrated, and
hypotensive. Laboratory evaluation showed anemia (hematocrit 29%) and
leukocytosis. Occult blood was present in the stool. Endoscopic examination
of the upper digestive tract confirmed the diagnosis of peptic ulcer disease.
Describe the mechanism of gastric hydrochloric acid secretion.
5. The liver is an important organ for the detoxification of both endogenous
and exogenous compounds. Briefly describe the detoxification process
involved in the excretion of bilirubin. How may known alterations to this
process be used to diagnose liver disease?
6. The human body mobilises its fat stores to provide fuel for the tissues in the
fasting state. Describe briefly [a] the process of lipolysis (triglyceride
breakdown) and [b] the hormonal stimuli that control the balance between
lipolysis and triglyceride synthesis.
7. There is a rare recessively inherited disease, called
abetalipoproteinaemia which, in affected subjects, is characterised by an
inability to form chylomicrons in the intestine. Affected individuals have only
20-25% of normal plasma cholesterol and triglyceride levels.They have
severe fat malabsorption and steathorrhea.BRIEFLY explain:[a]What are
chylomicrons.[b]What is your understanding of steathorrhea.[c]Why would a
subject with this genetic condition present with delayed blood clotting time,
atypical eye lesions and irregularly shaped RBCs which revert to normal in
response to megadoses of vitamin E.
8. Briefly describe the mechanisms for digestion and absorption of
proteins.
10. One of the bacterial toxins secreted by Clostridium perefringens, the
bacteria that causes gas gangrene, is a lipase that hydrolyses
phosphocholine from phosphatidylcholine and sphingomyelin. The resulting
lysis of cells provides nutrients for the bacterias growth. Discuss the different
classes of plasma membrane lipids, commenting on the role of fatty acid
chains in maintaining membrane fluidity.
12. A young man is brought to hospital after a road traffic accident with
abdominal pain. An abdominal CT scan shows that he has injured his spleen

and needs an operation. Describe the position of the spleen, including its
vascular supply and relations. In which direction does it expand if enlarged?
13. A patient presents to the accident and emergency department with a
bleeding duodenal ulcer. Describe the parts and relations of the duodenum.
Add a note on the embryology and blood supply of the duodenum
14. Mrs. Patel is a 52-year-old canteen supervisor. She presents with a history
of recurrent upper right abdominal pain associated with eating fatty meals.
The pain has been particularly bad for the past 24 hours and on this occasion
she is mildly jaundiced. Radiology confirms the presence of gallstones.
Outline the pathway by which bile passes from the cells in the liver to the
duodenum. Explain why she has become jaundiced.
15. A patient presents with faecal and urinary incontinence. Describe, briefly,
each of the anal and urinary sphincters, including their position and nerve
supply. Add a short note on the embryology of the anal canal.

4. Q4. Briefly describe the role of chylomicrons in the post absorption

processing of dietary fat.
5. Q5. Describe the post absorption utilization of amino acids with
reference to the fates of EITHER the amide or carbon skeleton
components.
6. Q6. Describe the metabolic fate of high post-prandial levels of
glucose, indicating the tissues involved in its utilization and /or
storage.
7. Q7. Briefly outline the mechanism for detoxifying foreign
compounds.
8. Q8. A 48 year-old man presents with chronic diarrhoea containing
blood and is given a diagnosis of Crohns disease. List the treatment
options and outline the mechanism of action and side effects of one
agent.
9. Q9. A 68 year old man is admitted through A & E with an abdominal
aortic aneurysm. Describe the anatomy of the abdominal aorta.
Outline the branches and the vertebral levels that they arise from.
How does the aorta enter the abdomen and how does it terminate?
10. Q10. A 48 year old male with a history of alcohol abuse is admitted to
hospital with haematemesis (vomiting blood). He has a history of
oesophageal varices. With the aid of diagrams describe the portal
circulation. Give 2 examples where portosystemic anastomoses
occur.
11. Q11. A patient presents with obstruction of the biliary tree. With the aid
of diagrams describe the histology of the liver and biliary tree.
Describe the vessels that are compressed during a Pringles
Manoeuvre and outline the relationship of these structures to each
other.
12. Q12. A 54 year old lady presents with bleeding due to haemorrhoids.
Describe the upper and lower halves of the anal canal with regard

to the anatomy, histology, arterial and venous drainage, lymph drainage

and nerve supply. Write a note on the embryological development.
13. Q13. A patient with constipation is given a laxative to increase colon
motility. Describe normal colon motility and how it is controlled.
Short Note Paper JANUARY 2006 GIHEP
1. Q2. John, a 52 year-old man, presented to his GP for a general checkup. Blood samples taken for biochemical analysis revealed the
following:
Total plasma cholesterol 9.0 mmol/L [reference range 3.5 6.5 mmol/L]
LDL cholesterol 6.2 mmol/L [reference range 2.0 4.5 mmol/L]
To manage Johns hyperlipidaemia, the GP prescribed Lipitor
(atorvastatin) and recommended a number of life-style changes. Lipitor
is a competitive inhibitor of the enzyme hydroxy-methyl-glutaryl CoA
Reductase (HMG-CoA reductase), which plays a key role in cholesterol
biosynthesis. Write a short note on enzyme inhibitors, covering
mechanisms of inhibition (irreversible, reversible, competitive and
noncompetitive) and describing the use of the Lineweaver-Burke plot to
identify the mechanism of action of an inhibitor.
2. Q3. Karen, a 25 year-old with a history of poorly controlled Type I
diabetes mellitus, presented to the Accident and Emergency
Department. During the consultation, Karen said that she had been
experiencing polyuria (frequent urination), polydipsia (increased fluid
intake), nausea and vomiting. When asked, she admitted that she had
neglected to take her Insulin injections over a period of days. Physical
examination revealed marked dehydration (dryness of skin and
tongue), hyperventilation (Kussmaul respiration) and her breath
smelled quite strongly of acetone. Arterial blood gas analysis
demonstrated a metabolic acidosis and biochemical testing showed
elevated levels of glucose and ketones in her blood and urine.
Briefly describe [a] the normal role of insulin and the biochemical
defects observed in Type I diabetes and [b] the mechanism that leads
to ketoacidosis in uncontrolled diabetes.

FUN IMMU
January 2009

4. Phagocytes are key to initiating the immune response to infection or injury.

Describe the role of these cells in the initiation and resolution of acute
infection.
5. The immune system has evolved ways to distinguish between different
infections. In the context of viral infection describe how the following two
mechanisms help contain the infection.
a.
type I interferons (IFNs)
b.
Cytotoxic T cells
6. Discuss the rationale underlying the use of biologic therapies in the
management of rheumatoid arthritis.
7. IL-2 is a key regulator of the immune response in auto-immune disease.
Describe two mechanisms by which drugs can be used to reduce the
actions of IL-2. Give an example of a drug in each class.
HIS SNQ Paper I 1 SEPTEMBER 2009

1
A 59 year old man presents to the Emergency Department with central
chest pain. He is diagnosed as having had a myocardial infarct (MI) and blood is
sent to the laboratory for determination of biomarkers to confirm the diagnosis. He
is treated immediately with a cocktail of aspirin, heparin and a thrombolytic drug.
Discuss the role of aspirin in this context and comment on its side effects.
Model answer: Aspirin is used in this context as an anti-platelet agent. It inhibits
the production of Thromboxane in response to platelet activation. It does this by
irreversibly inhibiting the cycloxygenase en zyme. By suppressing thromboxane
sysnthesis, aspirin prevents the recruiment of platelets to a growing thembus. It
has been shown to inhibit mortality from myocardial infarction by 25%. Its effects
are additive with heparin and streptokinase.
Major side effects of aspirin include gastric bleeding-due to inhibition of
cyclooxygenase in the endothelial cells of the stomach which affects the
regulation of acid secretion. Other adverse effects include reyes syndrome,
allergic reactions and CNS effects.
2. Respiratory syncytial virus (RSV) is the major cause of viral pneumonia in
infants and young children. It infects bronchial epithelial cells and infection results
in lung inflammation and decreased airway function. As a pathogen, RSV is

particularly well adapted to evading host immune responses. Write short notes on
the role of the following in antiviral immunity
1. type I IFNs
2. cytotoxic T cells
CJ
3. Discuss the rationale underlying the use of biologic therapies in the
management of rheumatoid arthritis.

HIS SNQ Paper I 26 AUGUST 2010

HIS SNQ Paper I SPTEMBER 2008

Q3:

The role of innate and adaptive immune responses is ultimately to

respond to and eliminate antigen. Briefly describe the effector
mechanisms that the following cells use to eliminate pathogens and
discuss
how
they
may
work
together:
(a)macrophages
(b) B cells.

Q4:

The Major Histocompatibility Complex (MHC) presents antigen to T

cells. Describe the role of MHC in an immune response to an
extracellular infection focussing on:
a. MHC molecule involved
b. Pathway of antigen presentation
c. T cell subtype it presents to
d. Downstream consequences of T cell activation

Q5: Haemolytic disease of the newborn is an example of rhesus

incompatibility. Describe i) the cause, ii) the consequences for the
developing foetus iii) and treatment of this condition.

Short Note Paper September 2007 FUN2 IMMU

1.

Describe two ways cells of the immune system communicate with each
other giving examples of each. In each example describe the cell types
involved, and the functional effects that occur as a result.

2.

Activation of T helper cells is a multi-step process. Describe the role of

antigen recognition by the T cell receptor and co-stimulatory receptors in
this process.

3.

Biological DMARDs (Disease modifying anti-rheumatic drugs) are

used in the management of rheumatoid arthritis. Name three such
drugs and for one, discuss the rationale for its use, and its possible side
effects.

4.

Medical suppression of the immune system is necessary for the prevention

of allograft rejection and autoimmune disease. Write brief notes on the
difference in mechanism of action of Cyclosporine A and Sirolimus.

Short Note Paper SEPTEMBER 2006 FUN IMMUNOL

Q3 A 65 year old man has osteoarthritis and is prescribed a non-steroidal antiinflammatory drug (NSAID). Describe the common side effects associated
with NSAID therapy.
Q5 The humoral immune response is important for the clearance of
extracellular bacterial infections. Describe briefly how the complement
pathway aids in the clearance of a bacterial infection
Q6 Mr Jones, 62 years of age, has developed the syndrome of
inappropriate anti-diuretic hormone (SIADH) secretion resulting in
excessive water retention.
1. a) How is this excess fluid distributed throughout the body fluid
compartments?
2. b) How is body fluid osmolarity affected?
Q7 The main metabolic activities in the human erythrocyte are glycolysis and
the hexose monophosphate shunt. In what way is glycolysis in the
erythrocyte distinctive and unlike the process in other body tissues?
Q8 Describe, with the aid of a diagram, how cytotoxic T cells recognize and
kill virally infected cells. In your answer, indicate the important molecules
involved in these processes on T cells and virally infected cells.
9. Q10 A patient is on immunosuppressive therapy following a kidney
transplant. Briefly discuss the MOA of ONE immunosuppressive
drug.
FUN LL

HIS SNQ Paper I 11 JANUARY 2010

HIS SNQ Paper I 26 AUGUST 2010

Short Note Paper September 2008 FUN LL

Q1. A patient presents with pain referred along his sciatic nerve. Where is
the greater sciatic foramen? Draw or describe the structures that emerge
from the greater sciatic foramen. What is the safest injection site in the
gluteal region to use, in order to avoid sciatic nerve injury?
Q2. A 38-year-old lady is brought to the Accident & Emergency Department
with a bimalleolar ankle fracture following a fall on an icy pavement. Describe
the ankle joint, including its articulating surfaces, ligaments and the
movements that occur here. Which malleolus is the more commonly
fractured?
Q3. You are asked to examine the ligaments of the knee joint. Describe the
attachments of each ligament you mention, and state how you would test
them.
Q5. Compare and contrast the characteristics and pharmacological
properties of muscarinic and nicotinic cholinergic receptors in the autonomic
nervous system.
Q6. Malignant hyperthermia, a rare life-threatening condition that is
triggered by exposure to drugs used for general anaesthesia, is a
condition arising from mutations in components of the excitationcontraction coupling (ECC) mechanism of skeletal muscle. Briefly outline
the stages involved in ECC, making reference to the molecular
components in each stage. How does relaxation occur?
Q7. A patient is given a calcium channel blocker to reduce heart muscle
force. Describe the length-tension relationship for heart muscle. Why can
heart muscle not be tetanized?
HIS SNQ Paper I 11 JANUARY 2011
Q4
The

In October 2010, a cholera epidemic struck the rural Artibonite region of Haiti.
United Nations humanitarian agency reported more than 3500 confirmed

cases and more than 250 deaths. Describe the effects of cholera on body fluid
homeostasis, its
consequences, and the appropriate treatment strategy.
Q6
A 15-year-old schoolgirl was admitted to hospital as an emergency whilst on
holiday.
Her parents believed her to be allergic to nuts. At the age of 5 years,
she developed
marked angioedema of her face, lips and tongue, followed by
tightness of her throat
and vomiting following inadvertent ingestion of peanuts.
The emergency admission occurred following a single bite of a health food bar.
Within seconds, she developed angioedema of her lips and tongue, difficulty in
breathing and felt light-headed.
With respect to the above case answer the following:
1.
Describe the cells activated during the sensitisation phase of the
response
(first exposure to antigen).
2.
What role does IgE specific to the allergen play on subsequent
exposure to the allergen?

HIS SNQ Paper I 16 AUGUST 2011

HIS SNQ Paper I 30 AUGUST 2011

HIS SNQ

HIS SNQ Paper I 18 JANUARY 2012

HIS SNQ Paper I 12 JANUARY 2012

HIS SNQ Paper I 12 JANUARY 2012