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Phase 1 Year 2: February 2009Copyright @ 2009, University
College London Medical School
MGQ paper - extended matching sets
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One hour is allowed for this paper.
There are 80 questions altogether in this paper.
The questions in this paper are arranged in groups of 5; each
group is headed by a theme or briefclinical scenario.
There is a list of possible answers, labelled A), B), G), etc
for each theme or scenario:Only one answer is correct for each
numbered question. lf you mark more than one answer forany single
question you score zero for that question. There is no negative
marking.
Some answers from the list may be used more than once, some may
not be used at all.
You should answer each question numbered 1 - 80 on the lineOf
the card that has the same numberas the quesiion, and mark
gdy!!93!Sggl from the list.
You are advised to mark your answers on this question paper,
then transfer your answers tothe computer-readable card, usinq a
Dencil.
Make reasonably firm marks on the card - thin hesitant marks
cannot always be read by the computerscanner - but do not press so
hard that you indent through the card.
lf you make a mistake, erase your incorrect response as
thoroughly as possible, and enter yourrevised answer clearly. Do
not "score through" an incorrecl response - the computer will read
thisas vour resoonse.
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Theme: evaluation of evidence
Possible answers are:A) ValidityB) Test of heterogeneityC)
Relative riskD) ReliabilityE) T{estF) Confidence intervalG)
ResponsivenessH) P-valuel) CorrelationcoefficientJ) KappaK) None of
the above
From the above list, seleci the one statistical value that is
best described by each of the following:
1. The quantity used to summarise inter-rater reliability for a
categorical outcome.2. The quantity used to summarise v_gliglity of
a measuring instrument with a continuous scale.3. The quantiiy that
refers to a measuring instruments sensitivity to change. \-.--4,
The quantity used to summarise rg_sllgBsivqgsE of a measuring
instrument with a continuous scale.5. The quantity that refers to a
measuring instruments ability to correctly measure what it
purports.
Theme: ion movements underlying electrical phenomena
A)
D)F)G)H)r)J)
,K)L)
A net inward movement of calcium ionsA net inward movement of
chloride ionsA net inward movement of potassium ionsA net inward
movement of sodium ionsA net ouhvard movement of calcium ionsA net
outward movement of chloride ionsA net outward movement of
Dotassium ionsA net outvvard movement of sodium ionsNo net movement
of calcium ions since ion is close to eouilibriumNo net movement of
chloride ions since ion is close to equilibriumNo net movement of
potassium ions since ion is close to equilibriumNo net movement of
sodium ions since ion is close to equilibrium
v; From the above list of ion movements, select the one that
best describes the flux through the channelsand conditions listed
below, all other conditions being those of a typical motoneurone in
a healtfrysubject:6. An open voltage qated sodium channel when the
membrane voltage is -70 mV.7. An open i6iiElE-@teO sodiuT channel
when the membrane voltage is +10 mV.8. An open pe!e.g!j_gm channel
when the membrane voltage is -70 mV.9. An open ionotropic glutamate
receptor when the membrane voltage is equal to the potassium
equilibrium voltage.10. An open GABA receptor when the membrane
voltage is
-20 mV.
Y2 EMQ FEB 09
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Theme: dermatome distribution of lower limb
Possible answers are:A) L1B) L2D) L4F) 51\].f Dz
r) s4
For each part of the body described below, choose the one nerve
root that supplies that area from theabove list of oplions. Each
option may be used once, more than once, or not at all.
I 1 . The sole of the foot12. The medial aspect of the anterior
lgleg (calf) and big toe.13. The posterior aspect of the upper leg
(thigh)14. The posterior aspect of the lower leg (calf)15. The
lower-medial aspect of the anterior upper leg (thigh)
Theme: Treatment of Psychosis
A young man was prescribed a drug to control his schizophrenia.
However he then suffered frominvoluntary muscle movements, tremor
and rigidity. The drug was then changed to another in order
toreduce his movement disorders.
Possible answers are:A) AmantadineB) BromocriptineC)
ChlorpromazineD) ClozapineE) Dopamine D1 receptorsF) Dopamine D2
receptorsG) Dopamine D3 receptorsH) Muscarinic receotorsl)
OestrogenJ) ProgesteroneK) ProlactinL) Selegiline
For each of the following statements or questions select the one
most appropriate answer from the listabove:16. The blockade of
these receptors is thought to be responsible for the involuntary
muscle
movements, tremor and rigidity.17. The first drug that was
prescribed caused a high degree of sedation as it also blocks
histamine
receptors. Which drug is it?18. Both drugs lead to a high
circulating concentration of a hormone, reducing fertility in
women.
Which hormone is elevated in response to these drugs?19. The
second drug that was prescribed causes agranulocytosis. Which drug
is it?20. The movement disorders caused by the first drug can be
prevented by prescribing an additional
drug that blocks a different receptor system. However, this
causes a dry mouth. Which receptorsystem is blocked by this
additional drug?
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Theme: Pain
A middle-aged man has undergone a hernia repair. In the
immediate post-operative period he wasgiven two drugs that relieve
his pain. He recovered well and returned to work but several months
laterhas numbness, burning pain and touch-evoked pain. He is given
a different drug.
Possible answers are:A) GlutamateB) ProstaglandinsC) lbuprofenD)
DiazepamE) Substance PF) MorphineG) Calcium channelsH) Neuropathic
painI) GABAJ) cabaDentinK) Selective serotonin reuptake inhibitors
(SSRls)L) 5-hydroxytryptamine (5-HT; Serotonin)
For each of the following statements or questions, select the
one most appropriate answer from the listADOVC:21. What transmitter
is likely to be involved in spinal transmission of both pain
st!!tqs?22. Name one drug that would be used as the first line for
the posfoperative p6in.23. Name another drug that also would be
used for post-operative pain.24. What drug was he given for the
delayed chronic pain25. What is the pharmacological site of
action.6f this drug
Theme: Adrenal
Possible answers are:A) Adrenal arteryB) Adrenal capsuleC)
Adrenal cortex - Fetal zoneD) Adrenal cortex - Zona fasciculataE)
Adrenal cortex - Zona glomerulosaF) Adrenal cortex - Zona
granulosaG) Adrenal cortex - Zona reticularisH) Adrenal cortex -
Zona reticulatal) Adrenal medullaJ) Adrenal vein
From the above list of regions in the adrenal gland, select the
major site of synthesis for each of thefollowing:26. "Adrenal
androgens"27. Adrenaline28. Cortisol29. 1
6-Hydroxy-androstenediol30. Mineralocorticoids
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Theme: Muscle contraction
Possible answers are:A) ActinB) Blood glucoseC) Calcium ionsD)
Hydrolysis of ATPE) Muscle glycogenF) Myasthenia gravisG) MyosinH)
Plasma non-esterified fatty acids (nefa)l) Release of ADPJ) Thick
filamentK) Thin filamentL) Potassium ions
For each of the following, select the one correct answer from
the Iist A - L above:
31. Intracellular (sarcoplasmic) concentration increased in
response to cholinergic stimulation atneuromuscular junctions.
32. The protein that is the target for the cyclic peptide
phalloidin, which is a product of some toxicmusnrooms.
33. A fall in the RQ (ratio of CO2 produced : 02 consumed)
indicates that this is the major fuel beingused by muscle.
34. Increased breakdown in response to activation of
phosphorylase kinase by calcium35. The region of striated muscle
where myosin is the major protein.
Theme: the hip jointSelect the most suitable term to place in
each of the spaces where a word is replaced by a number.Each answer
may be used once, more than once or not at all.
A) the femoral nerveB) the obturator nerveC) the hamstringsD)
the superior gluteal nerveE) the iliopsoas muscleF) tensor fasciae
lataeG) obturator internusH) the inferior gluteal nervel) the
sciatic nerveJ) the genitofemoral nerveK) gluteus minimus and
medius
The hip joint is siabilized by strong ligaments and muscles.
Extension is produced by L361, suppliedby the sciatic nerve, and
gluteus maximus, supplied by L37l and is limited to about 15" by
theiliofemoral ligament. Medial rotation and abduction are produced
by L38l and tensor fasciae latae,
' which are supplied by [_391. 60o of active flexion of the hip
is possible, through the action of iliopsoasand rectus femoris. The
latter is supplied by L401.
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II Theme: the developins eye
Possible answers are:A) They are derived from the outer layer of
the invaginated optic cup.B) They are derived from the surface
ectoderm of the head.C) Their density is the main determinant of
iris colour.D) Most of them degenerate during fetal life.E) They
are derived from the anterior epithelium of the lens vesicle.F)
They are among the last structures in the eye to begin their
differentiation.G) They invade the developing vitreous body.H) Some
of them contain a green pigment.l) They are derived from the
mesenchyme that surrounds the optic cup.J) They pass through the
choroid fissure of the optic cup.
Choose the one description from the list above that best matches
each of the following structures:
41 . Primary lens fibres42. Retinal pigment epithelial cells43.
Ciliaty muscle cells44. Retinal ganglion cell axons
lL 45. Photoreceotor cells
Theme: the pituitary gland
Select the most suitable term (A - L) to place in each of the
spaces where a word is replaced by anumber. Each answer may be used
once, more than once or not at all.
A) the anterior cranial fossaB) the body of the sphenoid boneC)
the cavernous sinusD) the posterior cerebral arteryE) the sella
turcicaF) the superior sagittal sinusG) the anterior cerebral
arteryH) the optic chiasml) djrect branches of the internal carotid
arteryJ) the inferior sagittal sinusK) the mammillary bodiesL) the
posterior cranial fossa
The pituitary gland is located in L461, directly above L471,
which is filled by an air sinus. The glandreceives its arterial
blood supply from L481. Venous drainage is into L49J, which drains
ultimatelyto the sigmoid sinus and internal jugular vein.
Anteriosuperior io the gland is [_50J, which may bedamaged by
enlargements of the gland.
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Theme: intracranial sinuses
select the most suitable term to place in each of the spaces
where a word is replaced by a number.Each answer may be used once,
more than once or not at all.
A) the sigmoid sinusB) the superior petrosal sinusC) the falx
cerebriD) the inferior Detrosal sinusE) the cavernous sinusF) the
tentorium cerebelliG) a transverse sinusH) the falx cerebellil) the
diaphragma sellaeJ) the superior sagittal sinusK) the great
cerebral veinL) the pterygoid plexus
The meninges surround the central nervous system. Within the
cranial cavity two large folds of durastabilise the brain. One
fold, L511, forms a sheet under the occipital lobes, preventing
rotation of thebrain around a transverse axis. In its fjxed margin
on each side is found L52_1. The other great fold ofmeninges,
L53-J, extends between the cerebral hemispheres. In its fixed
margin lies 1541, whichends by dralning into a transverse sinus. In
the middle cranial fossa the dura covers I 55 I at the sroeof the
pituitary fossa (or sella turcica).
Theme: poliomyelitis
Possible answers are:
amoebaDNA virusGram +ve bacteriumGram -ve bacteriumnematode
wormRNA virusinfection resulting in the appearance of antibodies
but no detectable symptomsinfection of non-human Drimatesmild fever
that is over by 6 days after infection with no further
symptomsmutation of an attenuated to a virulent strainpost-polio
syndrome in adultssignificant death of motor neurones in the spinal
cordsignificant death of Purkinje cells in the
cerebellumsignificant death of pyramidal cells in the motor
cortexsignificant death of sensory neurones in the dorsal root
gangliasjgnificant death of skeletal muscle fibres
From the list above, choose the object or phenomenon best
described by each ofthe following:56. The result of polio infection
in the majority (>90%) of cases.57. That this does not occur is
one ofthe reasons why eradication of polio is considered
possible.58. The primary lesion that causes limb weakness and
paralysis in people who catch polio.59. A phenomenon that can cause
risk to parents of children inoculated with Sabin (OPV) vaccine.60.
The lnfectious agent in polio.
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A)B)D)F)G)H)r)J)K)L)M)N)o)P)
Y2 EMQ FEB 09
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III Theme: arches and nerves ofthe embryonic pharynx
Possible answers are:A) the first pharyngeal archB) the second
pharyngeal archC) the third pharyngeal archD) the fourth pharyngeal
archE) the fifth pharyngeal archF) the sixth pharyngeal archG) the
trigeminal nerveH) the facial nervel) the glossopharyngeal nerveJ)
the vagus nerveK) the hypoglossal nerve
Choose the one item from the list above that best matches each
of the following descriptions:
61. lt contains a vessel that will be major conduit of oxygen to
the brain.62. lt never has an independent identity in human
embryos.63. lt innervates the arch through which the aorta will
run.
v, 64. lt passes through several arches but the cells it
innervates originated from none of them.-'
65. Some of its fibr-es innervate taste buds but others subserve
general sensation.
Theme: Neuromuscular transmission
A patient is given a skeletal muscle "relaxant" drug to aid
tracheal intubation in preparation for surgery,and then given
another skeletal muscle "relaxant" drug to aid surgery.
Possible answers are:A) cr-adrenoceotorsB) atrooineC) dopamine
receptorsD) dyflosE) edrophoniumF) hemicholiniumG) hexamethoniumH)
muscarinlcreceptorsl) neostigmine
V J) nicotinic receptorsK) oancuroniumL) suxamethonium
For each of the following statements or questions, select the
one most appropriate response from thelist above:
66. The first muscle "relaxant" drug used caused transient
muscle twitches (fasciculation). Which drugwas it?
67. Which drug would be used to reverse the effects of the
second skeletal muscle "relaxant" drug thatwas used?
68. Both muscle "relaxant" drugs act on the same receptor type
and interference with this receptor canalso cause a fall in blood
pressure. Which receptor type is involved?
69. Patients with myasthenia gravis are abnormally sensitive to
one of the drugs listed above. Whichdrug is it?
70. Which of the drugs listed above is used to diagnose
myasthenia gravis?
Y2 EMQ FEB 09
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Theme: the action potential.
Possible answers are:A) A large inward current is carried by
potassium ions.B) The cell is depolarized from the resting state.
The inward current through voltage gated sodium
channels is greater than the outward current through potassium
channels.C) The cell is depolarized from the resting state. The
inward current through voltage gated sodium
channels is equal to the outward current through potassium
channels.D) The cell is depolarized from the resting state. The
outward current through potassium channels
is greater than the inward current through voltage gated sodium
channels.E) The net current aeross the plasma membrane is zero.
Most of the voltage gated sodium
channels are in the ready to open state, that is, they would
open if the cell were depolarized.F) The number of voltage gated
sodium channels that are open is less than in the resting cell.G)
The sodium/potassium ATPase (= the sodium pump) has ceased to
function at this time.
Each of the following five graphs represents a plot of membrane
voltage against time for an excitable
For each of lines 71 - 75 select the one most appropriate
description of the state of an excitable cell atthe time point
shown by the thick circle on the graph, from the list above.
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Theme: DepressionA 40 year old woman has been depressed after
losing her husband six months ago. She was given adrug and after
three weeks her mood had improved significantly. However, because
of side effects.she was then given a different drug.
Possible answers are:A) s-HT uotake inhibitionB) 5-HT2 receptor
antagonismC) cocaineD) diazeoamE) monoamine releasing agentF)
fluoxetineG) imiDramineH) monoamine oxidase inhibitionl)
mianserinJ) muscarinicreceptorsK) reserpineL) o2-adrenoceptors
For each of the following statements or questions, select the
one most appropriate response for thel ist above:
76. The first drug she was prescribed caused blurred vision and
constipation. Which drug was it?77. Both drugs that she was
prescribed have the same mechanism of action: what is this
mechanism
of action?78. Which of the drugs listed above is not an
antidepressant, but has a similar mechanism of action to
the two drugs that this patient was prescribed?79. She hears
that there is another group of antidepressant drugs, but certain
foods cannot be eaten
when they are being taken. What is the mechanism of action of
this group of drugs?80. Which of the drugs listed above can cause
depression in patients?
END OF PAPER
Y2 EMQ FEB 09 10