2017

Which of the following are negative symptoms

relating to schizophrenia?

A. Thought interference
B. Thought broadcasting
C. Avolition
D. Persecutory delusions
E. Auditory hallucinations
 Avolition
• Schizophrenia is characterized by "positive symptoms during an
acute episode and ongoing negative symptoms throughout the life
of the individual. "First Rank" positive symptoms include audible
thoughts, running commentary, voices heard arguing, and passivity
phenomena. Negative symptoms describe the gradual longitudinal
deterioration of the personality and development of cognitive
deficits. These include avolition (lack of motivation), alogia
(reduction in spontaneous speech), affect blunting (reduction in
experience of mood), and asociability (lack of interest in
relationships). Negative symptoms are less responsive to
pharmacological treatment.
Which of the following is an inhibitor of
cytochrome P450?

A. St Johns Wort
B. Carbamazepine
C. Erythromycin
D. Rifampacin
E. Phenytoin
Erythromycin

• Some drugs inhibit cytochrome P450 (such as amiodarone,

omeprazole, disulfiram, erythromycin, valproate, cimetidine,
grapefruit juice) and this forms the basis of potential drug
interactions with other hepatically metabolised drugs.
Others are capable of inducing liver enzymes (such as
phenytoin, carbamazepine, barbiturates, rifampicin, St Johns
Wort and sulphonylureas), which can result in the more
rapid inactivation of drugs such as warfarin, the oral
contraceptive pill and hydrocortisone after ingestion.
Which of the following measurements would best
help distinguish upper airway obstruction from
asthma?

A. PEFR
B. Flow/ volume loop
C. KCO
D. TLC
E. FEV1/FVC
Flow/ volume loop

• Airway obstruction can be diagnosed through peak

expiratory flow rate (PEFR) or via the ratio of forced
expiratory volume in 1 second to the functional vital capacity
(FEV1/FVC). These measures do not distinguish upper from
lower airway obstruction though. A maximum flow/volume
loop is useful here as resistance to flow is greatest at low
volumes in lower airway obstruction, whilst resistance to
expiratory flow is greatest at higher lung volumes for upper
airway obstruction.
Which of the following are poor prognostic
markers early in paracetamol overdose?

A. Plasma bilirubin >200

B. Plasma pH>7.3
C. Creatinine<120mol/l
D. Lactate>3.5mmol/l
E. INR>2
 Lactate>3.5mmol/l
• Paracetamol toxicity arises as the pathways of conjugation by glucuronidation
and sulphonation become saturated. The drug is then metabolized by
cytochrome P450 to form a toxic intermediate metabolite, which initially is
conjugated with sulphhydryl groups from glutathione, but in overdosage these
stores become depleted. At this point the toxic intermediaries can cause liver
nęcrosis. Raised INR and hypoglycaemia can result from liver damage and an
INR>3.0, plasma pHk7:3, lactate >3.5 mmol/I and raised creatinine within 24
hours after ingestion are poor prognostic markers. N-acetyl cysteine replenishes
liver stores of glutathione and protects against toxicity. The British National
Formulary gives guidance n administration of N-acetyl cysteine depending on
plasma paracetamol levels in relation to time from ingestion. Note that
concurrent üse of other hepatically metabolized drugs increases the risk of liver
failure.
Which of the following is a non-membrane bound
organelle, which degrades proteins targeted by
ubiquitylation:

A. Endoplasmic reticulum
B. Lysosomes
C. Golgi apparatus
D. Endosomes
E. Proteasomes
 Proteasomes
• proteosomes are organelles that degrade proteins targeted by
ubiquitylation. Endosomes are vacuoles containing proteins that have been
internalized by endocytosis to be translocated between the plasma
membrane, Golgi apparatus and lysosomes. Lysosomes are acidic vesicles
containing hydrolase enzymes. The endoplasmic reticulum (ER) can be
rough or smooth depending on the pręsence of ribosomes. Rough ER is
found adjacent to the nucleus and is where translation of protein destined
for secretion or insertion in the plasma membrane occurs. Smooth ER is
less abundant and is where the synthesis of lipids and the metabolism of
steroids, carbohydrates and drugs occurs. In muscle cells, it acts as a store
of calcium ions (sarcoplasmic reticulum). Proteins synthesised in the rough
ER are transferred to the Golgi apparatus in vesicles. After modification (for
example, glycosylation), they exit and fuse with the trans-Golgi network
where they are sorted for delivery to the plasma membrane.
Which of the following is not a notifiable disease
in the UK under the Health Protection
(Notification) Regulations 2010?

A. Tuberculosis
B. Staphylococcus Aureus Infective endocarditis
C. Malaria
D. Legionnaire’s disease
E. smallpox
Staphylococcus Aureus Infective endocarditis
Which of the following drugs do not impact on
mortality in systolic heart failure?

A. ACE inhibitors
B. Furosemide
C. Nitrates and hydralazine
D. Beta- blockers
E. Eplerenone
Eplerenone

• The following drugs, amongst other, have all been shown to

improve mortality in systolic heart failure: Nitrates and
hydralazine (A-Heft trial), ACE inhibitors (eg. AIRE or SOLVD
trials), Eplerenone (EPHESUS trial) and beta-blockers (eg.
MERIT-HF, CIBIS II, CAPRICORN trials).
Which of the following is a direct thrombin
inhibitor?

A. Bivalirudin
B. Abciximab
C. Warfarin
D. Prasugrel
E. Rivaroxiban
Bivalirudin

• Bivalirudin is a bivalent direct thrombin inhibitor. An example

of a univalent direct thrombin inhibitor is Dabigatran.
Rivaroxiban is a direct Factor Xa inhibitor, Warfarin a vitamin
K antagonist, abciximab a glycoprotein llb/Illa inhibitor, and
prasugrel a thienopyridine platelet ADP receptor antagonist.
The layer of the epidermis responsible for
keratinocyte production is the ...

A. Stratum granulosum
B. Stratum spinosum
C. Stratum lucidum
D. Stratum germinativum
E. Stratum corneum
Stratum germinativum

• The Stratum germinativum/basale: This layer is responsible

for keratinocyte production and sits on the basement
membrane separating the dermis from the epidermis.
Melananocytes synthesize melanin in this layer which is
responsible for skin colouring and reduces damage caused by
ultra-violet radiation. Fingernails and toenails are hard plates
of keratinised epithelium, which originate from this layer.
Which of the following reduces gastric acid
secretion?

A. Histamine
B. Gastrin
C. Somatastatin
D. Acetylcholine
E. NSAIDS
 Somatastatin
• H+ secretion is mediated by H+/K+ ATPase proteins (inhibited by proton
pump inhibitors such as omeprazole), of parietal cells which are activated
when tubulovesicles possessing therm are united with the luminal
membrane. Fusion of tubulovesicles with the luminal membrane is
induced by acetylcholine (M, receptors) from the vagus nerve, gastrin
(CCK, receptors) from G cells and histamine (H, receptors) from
enterochromaffin-like (ECL) cells. Histamine release is also promoted by
ACh and gastrin and therefore acts a final 'common mediator on the
parietal cell. Conversely, somatostatin (via ST, receptors) reduces HCI
secretion: release of somatostatin from D cells is inhibited by Helicobacter
pylori, which predisposes to gastric and duodenal ulceration. NSAIDS
inhibit cyclo-oxygenase reducing levels of PGE, which would usually inhibit
parietal cell secretion of acid. PGE1 also usually increases mucus and
bicarbonate secretion. NSAID use can therefore predispose to gastric and
duodenal ulceration
Complete this sentence, Genetic anticipation ...

A. Occur in Cystic Fibrosis

B. Results from amplification of triplet repeats within genes
C. Refers to early diagnosis because of improved awareness
D. Is not seen with Huntingdon’s disease
E. Is characteristic of Neurofibromatosis type 2
 Results from amplification of triplet repeats
within genes
• Dynamic mutations are typically triplet sequences repeated many
times, the number of which expands with each successive
generation. The probability of expression of a mutant phenotype is
a function of the number of copies of the mutation and becomes
apparent when a threshold level of repeats is reached. The resultant
trinucleotide repeat disease presents at a younger age and with
increasingly severe phenotype with each successive generation (the
phenomenon of 'genetic anticipation')