-
Royal Free and University College Medical School Phase 1, Year
1: resit 2003 Copyright 2003 Royal Free and University College
Medical School Modified Essay Question paper 3 hours are allowed
for this paper. You should attempt all 20 questions, answering each
one on the page for that question
if you need more space, continue on the reverse of the page for
that question only. Pages will be separated and given to different
people to mark.
You are provided with a sheet of bar-code labels. Place one
label in the space marked
on the computer-readable card and one label on the page for each
question except questions 3 and 14 these questions are answered on
the computer-readable card.
For questions 3 and 14 you must transfer your answers to the
appropriate numbered
lines of the mark-sense (computer-readable) card that is
provided. For this type of card there is only one correct answer (A
P) on each line, and if you enter more than one answer on a line
you will score zero for that line. Some answers may be used more
than once and some may not be used at all
You should read through all parts of each question before you
begin to answer it the
number of marks for each part question is shown. Most questions
are linked to clinical scenarios. Information about the patient is
shown
at the top of each question; this may differ from one question
to another, as additional information is relevant to the question
being asked. Some questions do not refer to any specific
patient.
This question paper must not be removed from the examination
room.
-
Place your bar-code label here
Question 1
Malcolm Elks is a 50-year old man. He comes to A&E
complaining of severe chest pain. He tells the nurse that over
recent months he has experienced a similar pain when exercising.
However, on this occasion the onset was not linked to exercise and
has persisted for several hours. What is the most important
mechanism controlling coronary vascular resistance: local, nervous
or hormonal? (1 mark) Left ventricular coronary blood flow occurs
mainly in which part of the cardiac cycle, and why ?
(3 marks) How is the regulation of coronary blood flow impaired
in coronary heart disease?
(2 marks) If the SA and AV nodes are supplied by the right
coronary artery, what possible effects will a disease leading to
impaired blood flow through this artery have on the heart beat?
(2 marks) As the left coronary artery supplies the majority of
the left ventricle what effect will a disease limiting blood flow
through this vessel have on myocardial oxygen supply and what
condition will develop?
(2 marks) What is the possible outcome if the condition is not
treated?
(1 mark) Give the three important groups of drugs used to treat
angina.
(1 mark each) Give 3 main ways in which anti-anginal drugs
improve myocardial blood flow and reduce myocardial oxygen
consumption?
(1 mark each)
Year 1 MEQ resit 2003 1
-
Place your bar-code label here
Question 2
Malcolm Elks is 167 cm tall and weighs 87 kg. What is his Body
Mass Index: BMI = weight (kg) / height2 (m)
(1 mark) Would you classify him as being of desirable weight,
overweight or obese?
(1 mark) Mr Elks has a total daily energy expenditure of about
12 MJ /day and a BMR of 8.4 MJ / day. What is his physical activity
level (PAL)?
(2 marks) How much weight would you expect him to lose per week
if he reduced his food intake from 12 MJ /day to 10 MJ /day ?
(assume that the loss will be only adipose tissue, which is 15%
water, 5% protein and 80% triacylglycerol protein yields 17 kJ /g
and triacylglycerol 37)
(4 marks) Mr Elks GP recommends him to take more exercise and
suggests that he walks moderately gently (3.5 km /h, a PAR of 3.0)
for two hours each day. What will be his additional energy
expenditure per day?
(3 marks) Assuming that he maintains a food intake of 12 MJ
/day, how much adipose tissue would he lose per week at this level
of increased activity?
(4 marks)
Year 1 MEQ resit 2003 2
-
Question 3
Answer this question on lines 1 8 of the computer-readable card.
There is only one correct answer for each line. Some answers may
not be used at all and some may be used more than once. An
angiogram of Malcolm Elks heart reveals narrowing of the coronary
arteries and cardiac enlargement
Diagram 1
A B C D E
Diagram 2
F
G
H I
J
K
F
G
H I
J
K
Referring to the labels in the diagrams above, answer the
following questions: (2 marks each)
1. In diagram 1, which area of the heart (A E) is normally
supplied by the left coronary artery?
2. In diagram 2, which area of the heart (F K) is normally
supplied by the right coronary artery?
3. Identify the left coronary artery (A K)
4. Identify the branch of the right coronary artery to the
sinuatrial node (A K)
5. Identify the posterior interventricular artery (A K)
6. Identify the circumflex artery (A K)
The next two questions do not refer to the letters in the
diagrams 7. In which intercostal space should you palpate the apex
beat of a normal heart:
(2 marks) (A) 4th (B) 5th (C) 6th (D) 7th
8. In which intercostal space would you auscultat
(A) 5th left (B) 5th right (C) 2nd left (D) 2nd right
Year 1 MEQ resit 2003 e the aortic valve: (2 marks)
3
-
Place your bar-code label here Question 4
During his daily walk Mr Elks finds that he is very breathless.
He mentions his to his GP, who asks you to examine his respiratory
system. Describe how you would undertake this examination
(6 marks for communications skills, 8 marks for clinical skills)
Describe how you would measure his peak expiratory flow rate
(PEFR).
(6 marks).
Year 1 MEQ resit 2003 4
-
Place your bar-code label Question 5 here
The table shows Respiratory Function data collected from 3 men
attending an out-patient clinic at the Whittington Hospital. The
normal values (1 standard deviation) for healthy subjects matched
for age and body size are also shown below each patient.
PEFR litres min-1 FEV1 litres FVC litres Patient A 650 2.6 3.1
control 670 60 4.5 0.5 5.3 0.6 Patient B 230 1.7 4.1 control 560 60
3.5 0.5 4.5 0.6 Patient C 530 3.2 3.8 control 520 50 3.1 0.4 3.9
0.5
From the respiratory function data given, mark the following
statements true or false:
(1 mark each)
TRUE FALSE Patient B is normal Patient C is normal Patient A has
an obstructive defect Patient B has an obstructive defect Patient C
has an obstructive defect Patient A has a restrictive defect
Patient C has a restrictive defect
From abnormalities you have identified, mark the following
statements true or false:
(1 mark each)
TRUE FALSE Patient A might have bronchitis Patient A might have
fibrosis of the lungs Patient B might have fibrosis of the lungs
Patient B might have asthma Patient C might have emphysema Patient
C might have fibrosis of the lungs
Which patient(s) would you expect to derive benefit from
inhalation of a bronchodilator drug such as salbutamol (tick one
only)
(2 marks)
Patient A Patient B Patient C Patients A & B Patients A
& C Patients B & C
Year 1 MEQ resit 2003 5
-
Place your bar-code label Question 6 here
Mr Elks currently smokes 20 cigarettes a day. He started smoking
at the age of 11. Rates of smoking amongst adolescents in the UK
remain a public health concern. Outline a range of factors that may
influence young peoples smoking behaviour?
(5 marks) Describe what health promotion strategies can be
implemented to reduce rates of smoking amongst adolescents
(10 marks) What agencies outside of the NHS have an important
role to play in reducing adolescent smoking
(5 marks)
Year 1 MEQ resit 2003 6
-
Place your bar-code label here
Question 7
Mr Elks has been persuaded that he should give up smoking, but
finds it extremely difficult. He finds a report of the following
trial of nicotine patches on the web: A randomised double blind
study was conducted in order to investigate smoking cessation rates
for people given nicotine patches versus those given placebo
patches. Five hundred smokers were recruited to the trial 260 of
who were randomly allocated to receive nicotine patches and 240 of
who were allocated to receive placebo patches. At one-year
follow-up 130 people in the nicotine patches group and 60 in the
placebo patches group had successfully given up smoking according
to reports from doctor-patient interviews. The data was analysed on
an intention to treat basis. Explain what is meant by, and the
importance of, the study being: a) Double blind
(4 marks) b) Analysed on an intention to treat basis
(4 marks) Calculate and explain the number needed to treat
(NNT)
(12 marks)
Year 1 MEQ resit 2003 7
-
Place your bar-code label here Question 8
Mr Elks plasma cholesterol was 8.5 mmol /L, compared with a
desirable range of < 5 mmol /L, and he was placed on a low-fat,
cholesterol-free diet Cholesterol is carried by plasma
lipoproteins. Describe briefly the functions of the three main
types of plasma lipoprotein: Very low density lipoprotein
(VLDL)
(3 marks) Low density lipoprotein (LDL)
(3 marks) High density lipoprotein (HDL)
(3 marks)
After 3 months on the diet, Mr Elks plasma cholesterol was still
8.5 mmol /L. How is it possible for him to continue to have high
plasma cholesterol after adhering to a cholesterol-free diet for 3
months?
(3 marks) Why would administering an HMG CoA reductase inhibitor
lead to a fall in plasma LDL concentration?
(3 marks)
Year 1 MEQ resit 2003 8
-
Place your bar-code label here
Question 9
This question does not refer specifically to any particular
patient. Outline the potential areas of conflict between doctors
and pregnant women
(20 marks)
Year 1 MEQ resit 2003 9
-
Place your bar-code label Question 10 here
Aminata Shah is a 45 year old stockbroker who suffers from
gastric discomfort due to dyspepsia. She takes an antacid, drug A,
for this condition. Some months later she complains of
intermittent, upper abdominal pain and is referred by her GP to the
outpatients department. Endoscopy shows the presence of a gastric
ulcer. (A) Give an example of drug A and state its mechanism of
action
(4 marks) Does drug A cause any drug interactions ?
(2 marks) (B) What major drugs can be used for the treatment of
gastric ulcers and what are their mechanisms of action?
(10 marks)
Year 1 MEQ resit 2003 10
-
Place your bar-code label here
Question 11
Aminata Shah is a 45 year old stockbroker who suffers from
gastric discomfort due to dyspepsia and is subsequently found to
have a gastric ulcer.
Name the gastric cells that produce hydrochloric acid? (1
mark)
In which anatomical part and histological layer of the stomach
are they to be found?
(2 marks) List 3 functions of gastric HCl in a healthy
subject
(3 marks) With the aid of a diagram, explain the cellular
processes by which gastric HCl is produced and secreted. In your
answer describe the role of carbonic anhydrase and explain the term
alkaline tide of acid secretion.
(8 marks)
Year 1 MEQ resit 2003 11
-
Place your bar-code label here Question 12
Aminata Shah is a 45 year old stockbroker who suffers from
gastric discomfort due to dyspepsia and is subsequently found to
have a gastric ulcer.
Describe the role of efferent nerves in the control of gastric
acid secretion. (4 marks)
Explain why habitual aspirin ingestion may lead to peptic
ulceration.
(2 marks) What processes normally serve to reduce gastric HCl
secretion in order to prevent gastric pH from reaching dangerously
low levels?
(3 marks) How are the gastric and duodenal mucosal lining
normally protected from damage by secreted HCl?
(3 marks) Give two reasons why patients with peptic or duodenal
ulceration are often anaemic.
(2 marks)
Year 1 MEQ resit 2003 12
-
Place your bar-code label here
Question 13
Aminata Shah is a 45 year old stockbroker who suffers from
gastric discomfort due to dyspepsia and is subsequently found to
have a gastric ulcer. One of the drugs she was prescribed acts as
an irreversible enzyme inhibitor. Explain what is meant by the term
irreversible enzyme inhibitor?
(4 marks) Describe an experiment to determine whether a given
compound is a reversible or irreversible inhibitor you can assume
that there is a simple way of measuring the product of the enzyme
reaction you are studying.
(6 marks) What is the advantage to the patient of taking a
compound that acts as an irreversible inhibitor of a target enzyme,
rather than a reversible inhibitor?
(3 marks) What is a possible disadvantage of using an
irreversible inhibitor as a drug?
(3 marks) If a drug is an irreversible inhibitor of an enzyme,
why does the patient have to continue to take it?
(4 marks)
Year 1 MEQ resit 2003 13
-
Year 1 MEQ resit 2003 14
-
Place your bar-code label here
Question 15
Peter Choo is a medical student who acquired an intestinal
infection while on elective. He became dehydrated as a result of
severe vomiting and diarrhoea. His rate of urine production
decreased and urine became excessively hypertonic with a darker
colour than normal. Explain what is meant by the term
hypertonicity. (2 marks) State the normal range of values for
plasma and urine osmolality.
(2 marks) What regions of the nephron are involved in the
production of hypertonic urine?
(2 marks) Briefly describe the tubular processes in the nephron
involved in the production of hypertonic urine.
(5 marks) What is the approximate normal body water content of a
healthy 70 kg male.
(2 marks) Approximately what percentage of total body water
is:
(1 mark each)
Plasma
Intracellular fluid
Extracellular fluid
Describe briefly how you would determine Peter Choos plasma
volume
(4 marks)
Year 1 MEQ resit 2003 15
-
Place your bar-code label here Question 16
Peter Choo is a medical student who acquired an intestinal
infection while on elective. He became dehydrated as a result of
severe vomiting and diarrhoea. His rate of urine production
decreased and urine became excessively hypertonic with a darker
colour than normal. Which hormone is particularly important in
minimising Peters excretion of water? State where it is released,
what physiological stimuli cause it to be released, and what major
renal actions it has.
(6 marks) Describe in outline the mechanism of action (at the
molecular level) of fast acting (peptide) hormones
(10 marks)
Year 1 MEQ resit 2003 16
-
Place your bar-code label here Question 17
Martina Swift was told by her optician at a routine eye test
that she should see her doctor as she had raised intra-ocular
pressure. Her GP prescribed the -adrenoceptor antagonist timolol as
eye drops. Two days later she returned to the surgery complaining
of great shortness of breath.
Explain how timolol caused this problem? (8 marks)
The GP subsequently prescribed pilocarpine eye drops. Describe
what effects this would have in the eye and indicate the mechanisms
involved.
(6 marks) Tropicamide, a muscarinic receptor antagonist, is used
to aid examination of the eye. State briefly why it is useful and
why it may be dangerous.
(6 marks)
Year 1 MEQ resit 2003 17
-
Place your bar-code label here
Question 18
This question does not concern a particular patient Draw the
oxygen dissociation curves for haemoglobin and myoglobin in the box
below. You must label the axes
(6 marks)
myoglobin haemoglobin
Explain briefly how the structures of haemoglobin and myoglobin
account for the difference in the curves you have drawn.
(6 marks) After even moderate exercise (eg climbing a flight of
stairs), there is a considerable increase in the plasma
concentration of lactate, resulting in lowering of plasma pH. What
is the effect of this fall in plasma pH on oxygen binding to
haemoglobin?
(4 marks)
Year 1 MEQ resit 2003 18
-
Place your bar-code label here Question 19
This question does not concern a particular patient Explain
briefly what is meant by each of the following terms:
(2 marks each) mRNA tRNA DNA replication Transcription
Translation Ribosome Polysome A number of antibiotics act to
inhibit bacterial protein synthesis but have little or no effect on
human protein synthesis. What differences between bacterial and
human protein synthesis explain this?
(6 marks)
Year 1 MEQ resit 2003 19
-
Place your bar-code label here
Question 20
A newborn girl developed a severe pneumococcal infection
(Streptococcus pneumoniae) at 8 weeks of age. She was investigated
and found to have low levels of IgG, increased neutrophils and
reduced levels of lymphocytes in her blood. On further examination
it was found that no cells with surface antibodies were present in
her blood stream. Describe what kind of immunodeficiency is
consistent with the clinical and laboratory findings
(2 marks) Where are the lymphocytes which are deficient in this
patient made in a healthy baby?
(2 marks) Why did the baby have IgG but not IgM in her blood
stream?
(2 marks) Describe the basic structure of an antibody
molecule
(5 marks) What forces contribute to the interaction between
specific antibody and its antigen
(5 marks)
Year 1 MEQ resit 2003 20
For questions 3 and 14 you must transfer your ansQuestion
1Answer this question on lines 1 8 of the comput
controlPatient B is normalPatient AQuestion 13This question does
not concern a particular patientThis question does not concern a
particular patient