Biology Black Book

1
THE
BLACK
BOOK
ACEM I
2
Contents Page
Introduction 4-7
Prog. Outline 8-9
Weekly study plan 10-29
Exam checklist 30-31
Appendices
Anatomy key facts 33-37
Pathology summaries 38-49
Physiology Ganong table references 50-52
Viva topic frequency analysis 53-77
ACEM I Vivas 78-238
Recalled Past MCQs 239-339

3
“It is said that if you know your enemies and know yourself, you will not be
imperiled in a hundred battles; if you do not know your enemies but do know
yourself, you will win one and lose one; if you do not know your enemies nor
yourself, you will be imperiled in every single battle.” - The Art of War, Sun Tzu
4
Introduction
Overwhelmed. This single word described my feelings as the stark realisation of what lay
ahead dawned on me. Four simple words - “Anatomy, Pathology, Physiology, and
Pharmacology” were to become the bane of my existence for the best part of 6 months. I
searched aimlessly for advice from my peers, and supervising consultants, only to
discover that everyone that had gone through this had different views on how to prepare
for such an exam.
The following guide is by no means revolutionary. It was born from one individuals
frustration, anger and self imposed isolation during the preceding months to the exam. It is
an evolution of advice and guidance I received from those I consider to be far wiser than
myself, along with a collation of other resources and summaries from various other
sources (mentioned below). The idea was to put all of this information in one place, thus
saving precious time for the more onerous task of revision. Rather than being a strict plan,
it was intended to be fluid, to evolve over time, so that subsequent exam candidates would
be free to add their pearls to this guide if they so wished.
Included in this guide is the core knowledge required from the major topics that will be
tested in the exam, and weighting of material in the guide is based on the current 2008
exam matrix provided by the college.
Due to time constraints, I have deliberately glossed over the topics that will feature as only
a cursory glance in the exam. The aim of this guide is to take you through the essential
study topics, allowing you to score heavily on those parts that will gain you the most
marks.
This programme is based on the assumption that in addition to your normal employment
duties, you will undertake an additional 20 -30 hours per week of study time.
Make no mistake, the commitment required is huge, and those who have other
commitments – i.e family and children will find this especially difficult. The whole process
can be thought of as a polygamous marriage between you, and the four recommended
textbooks, with the aim being to file for divorce after the programme is complete.
Exam Specific Preparation

The primary exam itself consists of four MCQ papers, with 60 questions each, with 90
minutes allowed for each paper. The viva component comprises four 10 minute vivas, with
5 questions per viva, at approximately 2 minutes per question.
The key to this programme is using a problem-based approach. If you want to excel in
MCQs and vivas, then surely the best way is to practise MCQs and vivas, ad nauseum, in
the style of the exam. From personal experience, my level of recall was far less than ideal
when reading chapter after chapter in a book. By adopting a problem based approach, by
the time the exam comes around, it is likely that you will have covered many of the
questions you will be asked, during your preparation.
So, do as many MCQs as you can, and find a study partner to practise vivas with. Take no
prisoners. Tough love is the order of the day, and I advise you to push your study partner
5
as hard as you can, and vice versa. Push yourself to answer questions at a higher
standard than that which you will face in the exam.
Weekly Study Sessions

A certain level of commitment is required, and you will be expected to attend the weekly
sessions. The focus in these sessions will be on the viva component of the exam.
Study Materials
Anatomy
Clinically Oriented Anatomy (5th Edition)

Moore & Dalley
Lippincott Williams & Wilkins; 5 Pap/Cdr edition (May 1, 2005)
Recommended by the college as a replacement to Lasts.
Instant anatomy
Whitaker and Borley Blackwell Publishing, Incorporated; 3 edition (November 1,
2006)
Great book for revision in the weeks running up to the exam. Concise and packed with
useful diagrams and lists
Atlas of Human Anatomy: With Netteranatomy.com (Netter Basic Science)

(Paperback) Saunders; 4 edition (June 26, 2006)
Use this book in conjunction with Moore’s clinically Orientated Anatomy
McMinn's Color Atlas of Human Anatomy (Paperback)

Good for viva practise
Clinical Anatomy
Ellis
Blackwell Publishing; 11Rev Ed edition (Oct 2006)
This is a great book for general understanding of clinical anatomy. Ellis is truly a master.
Pathology
Robbins & Cotran Pathologic Basis of Disease, Seventh Edition

Vinay Kumar, Nelso Fausto, and Abul Abbas
(Hardcover) Saunders; 7 edition (July 30, 2004)
This book is the Daddy of Pathology textbooks. The first 4 chapters are essential reading.
Pocket Companion to Robbins and Cotran Pathologic Basis of Disease (Paperback)

Saunders; 7 edition (January 25, 2006)
Use this as a revision tool in the run up to the exam for the smaller topics
6
Pathology Secrets (Paperback)

Ivan Damjanov
Hanley & Belfus Inc.; 2Rev Ed edition (31 Dec 2004)
This is a great book for viva practise. Use it to torture your study partner.
Physiology
Review of Medical Physiology (Paperback)

William F. Ganong
McGraw-Hill Medical; 22 edition (March 8, 2005)
This remains the recommended text for physiology, and the MCQs and Vivas are based on
the information in this book. There are about 40 tables and figures in there that you should
be able to reproduce for the exam.
Textbook of Medical Physiology: (Textbook of Medical Physiology) (Hardcover)

Arthur C. Guyton and John E. Hall
Saunders; 11 edition (September 1, 2005)
This is a readable if not waffly physiology text. It has a great cardiovascular physiology
section in it, but beware, although it is recommended by the college, the numerical values
for all the cardiovascular MCQs still appear to come from Ganong.
Respiratory Physiology: The Essentials (Respiratory Physiology: The Essentials

(West))
John B West
Lippincott Williams & Wilkins; 7 edition (May 1, 2004)
A very concise, readable book from one of the greats in physiology. You MUST know this
book for the exam.
Vander's Renal Physiology (Lange Physiology) (Paperback)

Douglas C. Eaton, John Pooler, and Arthur J. Vander
McGraw-Hill Medical; 6 edition (February 15, 2002)
A very useful little book on renal physiology. Easy to read, and ideally used in conjunction
with Ganong.
The Physiology Viva: Questions & Answers

Kerry Brandis
http://www.anaesthesiamcq.com/vivabook.php
This is an invaluable revision aid for the Physiology Viva. Aimed primarily at anaesthetic
primary exam candidates, there is a lot overlap with ACEM. Don’t be surprised if one or
two questions from the viva come directly from this book. It has all the diagrams and
formulas you will need. Excellent.
7
Pharmacology
Basic & Clinical Pharmacology (Basic and Clinical Pharmacology) (Paperback)

Bertram G. Katzung
McGraw-Hill Medical; 10 edition (December 5, 2006)
A great source for all your pharmacology needs. Be warned, it is long, but many MCQs will
come straight from the text.
Katzung and Trevor's Pharmacology (Katzung & Trevor's Pharmacology:

Examination & Board Review) (Paperback)
Anthony J. Trevor, Bertram G. Katzung, and Susan B. Masters
McGraw-Hill Medical; 7 edition (September 1, 2004)
This is excellent. It takes all that is good from the parent text, makes it more readable, and
includes some useful MCQs at the end of each chapter.
Chapter headings and numbers are based on the parent text.
The Pharmacology of Common Drugs in Emergency Medicine

Members of the Auckland Regional Training Program In Emergency Medicine (1996)
This is simply brilliant. A list of 90+ drugs, in the format required by ACEM.
The only downside is that it does not contain some of the newer pharmacological agents.
Even so, it is an excellent resource for both the MCQ and viva.
Miscellaneous
MCQ Primer For the ACEM Primary Exam
Volumes 1 & 2
Editor: Associate Professor Anne-Maree Kelly
Western Hospital 1998
These two gems are available from the Western emergency department – either give them
a call, or email them - Dr Zeff Koutsogiannis, Zeff.Koutsogiannis@wh.org.au
They are well worth borrowing from colleagues if they have them, or purchase your own.
They are key preparation tools, and I recommend that you do the relevant MCQs from
here as you go through the programme.
Be warned, there are some inconsistencies in the answers, and if you are unsure, it is
worth looking answers up to be sure.
8
ACEM PART I PROGRAM
APRIL-SEPTEMBER 2008
Week Pharmacology Physiology Anatomy Pathology

1 Pharmacodynamics Body Fluids Tissues and Normal Cell
Receptors structures. Injury/Adaptations
2nd Messenger
Dose response
2 Pharmacokinetics Nerve & Muscle Nervous System Inflammation
Clearance Transmission AP Brain & Spinal Cord
VD Musc contraction
Half life NMJ
3 Biotransformation Nervous System Upper Limb – Healing & Repair
Phase 1&2. Reflex pectoral girdle/axilla
CP450 +/- Senses
4 CV Antiarrhythmic CVS – heart, cardiac Upper Limb – Upper Fluid &
Inotropes cycle, conduction Arm haemodynamics
5 CV Antianginal CVS – Pressure/flow/ Upper Limb – Immune System
Antihypertensive Resistance/ Vessels Forearm & Neoplasia
6 CV Diuretics CVS – Control – Upper limb – Wrist/ Infectious Disease

Autoregulation Local, Hand
Neural RAA
7 CV Anticoagulant CVS – CO/VR Upper Limb – Blood Vessels –
Clopidogrel/Asp Special Circulation Neurovascular & Atherosclerosis
Heparin/warfarin transitional zones Aneurysm, HT
TPA/Strep
8 Neuro –ANS Resp – Structure & Lower Limb – Ant/ Heart – IHD, HF,
SNS/PNS function Post/Medial Thigh Valvular
Atropine etc
9 Neuro Resp – Ventilation & Lower Limb – Pelvis Heart –
GA/LA/M Relaxants diffusion – regional & Lateral rotators Cardiomyopathy
difference Pericarditis
10 Neuro - Resp – Blood flow/ Lower Limb - Lungs – Asthma/
Anticonvulsants metabolism/ Popliteal fossa & COPD/ARDS
Sedatives Gas transport Knee
Ethoh
11 Neuro – Resp – Control – Lower Limb – Lower Lungs –
Antidepressants periph/central Leg ant/post Pneumonia/APO/PE
Antipsychotics chemoreceptors compartment
Parkinsons Altitude & exercise
12 ABx Betalactam Renal Lower Limb – foot & Renal –
Aminoglycosides GFR, RBF/RPF, Sole Glomereular
Sulphonamides clearance disease, ARF/CRF
13 ABx Quinolones Renal Lower Limb – Renal – calculi, GU
Macrolides Nephron, tubule neurovascular & disorders
Resistance function transitional zones
14 ABx Acid Base Head & Neck Skull & Liver cirrhosis,
TB treatment Buffers Foramina + hepatitis,
Antivirals Renal/Resp Revision Triangles
Antiseptics
15 Analgesic Absorption & Head & Neck Mouth, Pancreas

Opiate Digestion Pharynx, Larynx Pancreatitis, acute
NSAID/Steroid Lipids/Fats/Proteins & chronic
9
Week Pharmacology Physiology Anatomy Pathology

16 Resp & GI GIT Thorax – Chest Wall, GI tract & Endo
Sympathomimetic Structure and Mediastinum, Lungs Thyroid/Adrenals
Methylxanthine function Diabetes
AntiMuscarinics
Antiemetics/PPI
17 Autocoids & Endo Endocrinolgy Thorax – Heart & CNS
Histamine/5HT Thyroid Great Vessels Stroke, meningitis,
Diabetes, Insulin Adrenal/pancreas SOL, degerative
Thyroid drugs Calcium/Renal
18 Toxicology Metabolism Abdo – Abdominal MS & skin
Charcoal Carbs/Prot/Fat wall & peritoneum – Fractures, OA/RA
Common OD Aorta/Vena Cava Haematology
Interactions
TCA/Paracetamol/
organophosphate
19 Old Age/Pregnancy Blood Abdo – Bowel, Environmental
Miscellaneous Plasma/Blood Viscera, Ureters Radiation/Heavy
groups/Lymph metal/pollution etc
20 MCQ & Viva practise MCQ & Viva practise MCQ & Viva practise MCQ & Viva
practise
10
Week 1
Subject Topics Source Questions
material
Pharm Pharmacodyna Katzung • Definitions – Receptors, potency, efficacy, agonist,
mics antagonist, spare receptor
• Name different types of antagonist, and give
examples
• Draw – Dose response curves for agonist/
antagonist/partial agonist
• Describe different types of receptor, and give
examples.
• Describe mechanism of action of 2nd Messengers
with examples
Physiology Body Fluids Ganong • Definitions – osmosis, osmolality, osmolarity,
solute, diffusion
• Describe the distribution of water in the body, and
percentages in each compartment
• Describe the principles of measurement of ECF/
Plasma/Total body water
• Give values of intracellular/extracellular cations
and anions
• Describe the movement of ions across cell
membranes and the various pumps involved
Anatomy Tissues and Moore • Describe the structure of skin and glands
Structures • Describe the structure of hair
• Describe structure of muscles and tendons
• Describe structure of bone
• Describe comparative anatomy of a child
Pathology Normal Cell Robbins • Definitions of hypertrophy, hyperplasia, atrophy,

Injury/ metaplasia, dysplasia,
Adaptations • Describe mechanisms of cell inj. and death
• Describe morphology of reversible and irreversible
injury
• What is apoptosis, and describe its mechanism,
and morphology
• Describe different types of necrosis, with
examples, and morphology
• What is the mechanism of reperfusion injury
11
Week 2
material
Pharm Pharmacokineti Katzung • Definitions – VD, clearance, half life,
cs bioavailability, dosing rate, loading dose
• What factors affect the volume of distribution
• What is zero order and first order kinetics
• Give examples of drugs with high/low extraction
ratios
Physiology Nerve & Ganong • Define the resting membrane potential. How does
Muscle it arise?
• Describe ionic basis of action potentials.
• Describe the different types of nerve fibre, and
their susceptibility to hypoxia, pressure and local
anaesthesia
• Describe transmission of AP at synapse, and NMJ
• Describe how a muscle contracts – sliding filament
theory. SM/cardiac
Anatomy Nervous Moore • Describe layout of CNS/PNS
System • Components of autonomic nervous system
• Gross structure of brain and spinal cord.
• Describe segmental innervation in terms of
dermatomes/myotomes
• Be able to demonstrate dermatome distribution and
myotomes, and root values of major upper and
lower limb movements and reflexes
Pathology Inflammation Robbins • Describe the key features of acute inflammatory
response
• Describe the vascular response to injury
• Describe mechanisms of increased vascular
permeability
• Can you list the key inflammatory mediators of
inflammation
• What are the outcomes of acute inflammation
• What are the cell types involved in chronic
inflammation
• What are the morphological features of acute and
chronic inflammation
12
Week 3
material
Pharm Biotransformati Katzung • Describe biotransformation reactions in the liver,
on using paracetamol as e.g
• List phase 1, and 2 reactions
• List drugs that induce Cytochrome P450 pathways
• List drugs that inhibit Cytochrome P450 pathways
• Describe process of clinical trials
Physiology Nervous Ganong • Describe simple stretch/ withdrawal reflexes.
System • Describe sensory pathway of vision
• What is the reticular activating system
• Describe the functions of the hypothalamus &
temperature regulation
• Describe the ascending and descending tracts in
the spine
• Describe features of central cord syndrome/cauda
equina, cord transection
Anatomy Upper Limb I Moore • What is a girdle, how does it function?
Pectoral Girdle • Osteology of clavicle, scapula and humerus
Axilla • Describe the AC and sternoclavicular joint, +
ligaments
• Describe attachments and nerve supply of muscles
attaching limb to trunk
• Describe the blood supply to the breast
• Describe boundaries and contents of axilla
• Describe the scapular anastomosis
Pathology Healing and Robbins • Describe the process of wound healing, and scar
Repair formation
• What is healing by primary and secondary
intention
• What cells are capable of regeneration and can you
describe the cell cycle.
• Describe the process of fracture healing
• Describe the factors that affect wound and fracture
healing
• What is metastatic and dystrophic calcification?
13
Week 4
material
Pharm CV drugs I Katzung • List the Vaughn Williams classification for
Antiarrhythmic antiarrhythmic drugs
s • List the drugs in each class
Inotropes • Learn PK of Amiodarone
• Learn about mechanisms of additional drugs –
digoxin and adenosine
• Compare and contrast use of adrenaline/
noradrenaline/dopamine
• Which situations would you use the above drugs?
Physiology CVS I – heart, Ganong • Describe electrophysiological basis of ECG
cardiac cycle, & Guyton • Describe (Draw) AP of SA node and AV node, and
conduction compare with myocyte
• What is the ionic basis of AP in AV node, and the
diastolic pre potential
• Which fibres have the fastest and slowest
conduction
• Describe the cardiac cycle (draw). Volume
pressure loop.
Anatomy Upper Limb II Moore • Osteology of humerus
Upper Arm • Quadrangular and triangular space
• What muscles attach to the coracoid process
• What are the muscle attachments to the
intertubercular groove
• Describe the attachments and nerve supply of
biceps, coracobrachialis, brachialis, and triceps.
• What are the features contributing to stability of
shoulder joint?
Pathology Fluid Robbins • Describe the pathogenesis of oedema (starling
haemodynamic forces etc)
s • List different types of shock
• Describe pathogenesis of shock (detail on septic
and haemorrhagic)
• Definition of haemorrhage/ecchymosis/petechial
bleeding
• Define embolism/thrombus/infarction
• Can you draw the coagulation cascade and
describe main features
14
Week 5
material
Pharm CV drugs II Katzung • Describe pharmacological properties of nitrates
Anti-anginals • Describe pharmacological basis of calcium
Antihypertensi channel blockade using verapamil as an example
ves • Describe the main features of B-Blockers and list
different types, and the types of blockade that they
cause
• Discuss the side effects and toxicology of B
blockade (Propranolol)
Physiology CVS II Ganong • What is Poiseuille’s Law?
Physics of & Guyton • Describe laminar and turbulent flow
Flow • What is Reynolds number?
Pressure • What is compliance and distensibility of vessels?
Resistance • Describe Laplace’s law, and its relevance to
Vessels aneurysm formation
• Principle of autoregulation – myogenic theory,
local factors
Anatomy Upper Limb III Moore • Name the muscles /attachments/nerve supply of
Forearm the flexor compartment
• Name the muscles /attachments/nerve supply of
the extensor compartment
• What are the individual compartments of the
extensor compartment
• What are the boundaries and contents of the
cubital fossa
• Describe osteology of radius and ulnar. What is the
carrying angle?
• What is the axis of rotation for pronation/
supination
• Describe the ligaments around the elbow joint
Pathology Immune Robbins • Describe host barriers to infection. Outline innate/
System humoral immunity.
Neoplasia • What is the role of macrophage/B Cell/T cell in
immune response
• Outline the role of complement, and draw
complement cascade
• Define hypersensitivity reactions, describe, with
examples of each
• What is an oncogene? Define paraneoplastic
syndrome and give examples.
• Benign V malignant tumour and invasion.
• Discuss pathogenesis of common cancers - lung
15
Week 6
material
Pharm CV drugs III Katzung • Describe the pharmacological basis of different
Diuretics types of diuretic
• Indicate which part of the nephron different
diuretics act on
• Describe PK of frusemide, thiazides, carbonic
anhydrase inhibitor, as well as K sparing
• Toxicology/side effects of diuretics – and uses in
hypercalcaemia
Physiology CVS III Ganong • Describe reflex controls of BP – baroceptors
Control & Guyton • Describe physiological response to loss of 1L of
Autoregulation blood
Renin • Describe physiological response to infusion of 1L
angiotensin of normal saline
Aldosterone • Describe long term control of BP – RAA axis
• Discuss factors influencing CO and venous return
• Draw vascular function curves of Guyton and
Starling
• Discuss autoregulation in brain/kidney/coronary
circulation
Anatomy Upper Limb IV Moore • Describe the flexor retinaculum
Wrist • Describe the structure and layout of carpal tunnel
Hand • Describe extensor expansion, and function of
lumbricals (innervation too)
• Function of interossei and thenar/hypothenar
muscles (OAF)
• Nerve distribution to the hand
• Describe boundaries and contents of anatomical
snuff box
• Osteology of carpal bones
Pathology Infectious Robbins • Classification of bacteria
disease • Define virulence factors of staph. Aureus
• Describe pathogenesis of cholera/typoid/
salmonella
• Describe pathogenesis of HIV/herpes simplex/
CMV/Measles
• Describe different organisms involved in
pneumonia/meningitis/endocarditis and UTI
• Compare and contrast hepatitis A-D
16
Week 7
material
Pharm CV drugs IV Katzung • What are mechanisms of heparin/warfarin/aspirin/
Anticoagulants clopidogrel/TPA
• What is mechanism of Vit K
• Adverse effects of heparin
• Adverse effects of warfarin
• Interactions of heparin and warfarin
Physiology CVS – IV Ganong • Describe CSF circulation in the brain. How much/
CO/VR & Guyton where etc
Special • Describe coronary circulation – subendocardial/
circulations epicardial – flow during systole and diastole in RV
& LV
• Describe renal blood flow
• Describe pulmonary blood flow
• Learn table in Ganong with CO and flow through
various organs
Anatomy Upper Limb V Moore • Draw brachial plexus
NV • What is the course of median/radial/ulnar nerve in
Transitional arm and forearm
zones • What are branches of axillary artery? Where does
it start and end
• Describe the blood supply to hand
• Describe the venous drainage of upper limb
• Quadrangular/triangular space/Axilla/Cubital
fossa/Carpal Tunnel/anatomical snuff box
Pathology Blood vessels Robbins • Describe pathogenesis of atherosclerosis
• Describe pathogenesis of aneurysms and
classification
• What is aortic dissection?
• Describe pathogenesis of vessel wall damage
17
Week 8
material
Pharm Neuro I Katzung • Describe the classification of cholinoreceptors
• Describe the actions and give examples of
anticholinesterase inhibitors
• Describe the pharmacology of anticholinergics –
atropine
• Can you describe the classification of inotropes
• Describe the effects of adrenoceptors and
distribution in the body
Physiology Resp I Ganong • Describe gas transport in the lung
Structure and & West • What is anatomical dead space, and the Bohr
function equation
• Define lung volumes – draw curves, and describe
method of measurement
• O2 and CO2 transport in lung – concept of
diffusion v perfusion limited
• Where is most resistance in the airways?
Anatomy Lower Limb I Moore • Outline contents and boundaries of femoral
triangle
• Describe the different compartments of the thigh,
with muscles and nerve
• Describe the femoral canal/ring, and relations,
landmarks for fem art. Line
• What are the boundaries and contents of the
adductor canal?
• Describe the course of the sciatic nerve
• Describe the stability of the hip
• Osteology of pelvis and femur
Pathology Heart I Robbins • Pathogenesis of IHD/MI including risk factors and
distribution of thrombus
• Sequelae of AMI
• What is reperfusion injury
• What is the microscopic and macroscopic
morphology of MI?
• Describe the pathogenesis of bacterial endocarditis
and list the common pathogens.
18
Week 9
material
Pharm Neuro II Katzung • Describe pharmacological properties of lignocaine
LA and prilocaine
GA • Describe the pharmacological properties of
Muscle common agents – NO, Isoflurane
relaxants • What is the MAC?
• Classify muscle relaxants
• Pharmacology of suxamethonium vs atracurium.
Physiology Resp II Ganong • Describe regional differences in ventilation and
Ventilation and & West perfusion in the lung
diffusion • What is the alveolar gas equation?
• Can you classify the causes of hypoxia?
• Which cells synthesize surfactant, and what is its
function
• What is lung compliance? Can you give causes of
increased and reduced complicance?
Anatomy Lower limb II Moore • Describe the muscles / attachments/nerves of
Pelvis gluteals and lateral rotators
Lateral rotators • Define greater and lesser sciatic foramina, and list
what goes through each
• Relations and surface markings of the sciatic nerve
and piriformis
• Describe osteology of the pelvis
• Describe the ligaments of the pelvis, and the SI
joint.
• Which is stronger – anterior or posterior SI joint?
Pathology Heart II Robbins • Describe the morphology of cardiomyopathies
• What is pericarditis
• What are the common causes of pericarditis?
• What is rheumatic fever?
• Which antibodies are associated with rheumatic
fever?
19
Week 10
material
Pharm Neuro III Katzung • Describe the PK of thiopental/propafol/ketamine –
Sedatives side effects (ICP)
Anticonvulsant • Describe the mechanism of action of
s benzodiazepine
Etoh • Describe ionic/receptor basis for inhibition –
GABA Chloride channel
• Describe acute and chronic effect of alcohol
ingestion
• Describe tolerance with relation to ethanol
Physiology Resp III Ganong • Describe the pulmonary circulation
Blood flow & West • Describe the phenomenon of hypoxic
Metabolism vasoconstriction
Gas transport • What substances are metabolised/removed by the
lungs?
• How is CO2 and O2 transported in blood?
• Draw O2 and CO2 dissociation curves
• Explain Bohr Effect and Haldane Effect
Anatomy Lower Limb III Moore • Describe the boundaries and contents of the
Popliteal fossa popliteal fossa
Knee • Describe the knee joint
• Describe the action and significance of popliteus
• Which bursae communicate with the knee joint?
• What are offers stability to the knee joint and
patella?
• Describe the cruciate anastomosis around the knee
• Describe the knee capsule and ligaments
Pathology Lungs I Robbins • What is atelectasis?
Atelecatsis • Describe the pathogenesis and morphology of
Asthma asthma
COPD • Describe the morphology and pathogenesis of the
ARDS COPDs
• What types of emphysema are there?
• How does alpha 1 antitrypsin relate to
emphysema?
• What is the pathogenesis and morphology of
ARDS
• What are the most common causes of ARDS?
20
Week 11
material
Pharm Neuro IV Katzung • Describe the biogenic amine theory for depression
Antidepressant • Describe classification of antidepressants
s • Describe classification of antipsychotics
Antipsychotics • What are the adverse effects of the antipsychotics?
• What is serotonin syndrome?
• What is PK of lithium?
Physiology Resp IV Ganong • Describe the different sensors involved in

Central and & West ventilation
Peripheral • Describe the respiratory sensors in the brain
control • Where are the peripheral chemoreceptors located
and how do they respond to changes in CO2 and
O2?
• What is the Herring Breuer reflex?
• What is the role of stretch receptors in the lung?
Anatomy Lower limb IV Moore • Describe the compartments of the leg, including
Lower leg muscle attachments and nerve supply
• What is the blood supply to the leg?
• Describe the medial and lateral ligaments of the
ankle
• Describe the relations of the medial malleolus
• Describe the myotome segmental innervation to
leg
• Osteology of tibia and fibula
Pathology Lungs II Robbins • Describe the pathogenesis and morphology of
Pneumonia pneumonia
APO • What are the pathogens involved in pneumonia (+
PE atypicals and immunocompromised)?
• What is the pathogenesis of APO, and what is the
morphology?
• What is a PE? Where do they come from? Name
different types of embolus and their source.
• What are the complications of PE?
21
Week 12
material
Pharm ABx I Katzung • What is the mechanism of action of these agents?
Betalactam • Classify the cephalosporins into generations.
Aminoglycosid • What is the PK and toxicology of Gentamycin?
es • What is unique about doxycycline?
Sulphonamides • What is concentration dependent, and time
dependent killing?
• What is trimethoprim? What is it’s mechanism of
action and PK
Physiology Renal I Ganong • Describe structure and function of kidney –
& Vander medulla/cortex
• How would you measure renal blood flow? What
would you use?
• What is renal clearance and how is it measured?
• What factors affect GFR?
• What is the JGA?
• What causes mesangial contraction?
Anatomy Lower Limb V Moore • Describe the sensory distribution of the foot
Foot • Describe the layers of the sole
• Describe the arterial supply and venous drainage
of the foot
• What do the lumbricals of the foot do?
• Describe the components of the longitudinal and
transverse arches of the foot
• Osteology of the foot/ attachments
Pathology Renal I Robbins • Classify the main glomerular diseases
• Describe the pathogenesis of ARF/CRF
• What are the causes of ARF?
• What are the stages and outcomes of ARF?
• Post is post strep glomerulonephritis? How does it
present?
• What are the features of nephrotic syndrome?
22
Week 13
material
Pharm Abx II Katzung • Describe mechanism of action of macrolides
Macrolides • Erythromycin vs azithromycin
Quinolones • What pathogens do the macrolides target
Resistance • Describe the pharmacology of norfloxacin
• Describe the main mechanisms of bacterial
resistance
Physiology Renal II Ganong • Describe the features of ionic movements in the
& Vander nephron
• Describe the counter current multiplier system in
the loop of henle
• Describe the role and action of diuretics on various
parts of the nephron
• Describe the effects of vasopressin on the
collecting duct
• Describe hydrogen ion excretion and the kidney
• What is tubuloglomerular feedback?
Anatomy Lower limb VI Moore • Femoral triangle/adductor canal
Transitional • Popliteal fossa – boundaries and contents
Zones • Achilles tendon
Neurovascular • Distribution of saphenous veins
• Arterial supply to leg
• Superficial and deep inguinal nodes and what they
drain
Pathology Renal II Robbins • Pathogenesis and classification of renal stones
Calculi • List the main GU diseases
GU
23
Week 14
material
Pharmacol Abx III Katzung • Describe the treatment of TB
ogy TB • Describe PD and PK of acyclovir
Antivirals • What conditions can acyclovir treat?
Antiseptics • What is chlorhexidine and how does it work?
Physiology Acid Base Ganong • Describe major buffer systems in the ECF and ICF
Buffers (HCO3- etc)
• Derive the Henderson Hasselbach equation
• How does the lung and the kidney help regulate
acid base balance?
• What are the causes of metabolic acidosis?
• What are the causes of metabolic alkalosis
• What is the anion gap?
• Affects of exercise and altitude
Anatomy Head & Neck I Moore • Describe boundaries and contents of ant/post
Triangles of triangles of neck
neck • Describe the deep fascia in the neck.
Foramina of • Describe layers pierced for a cricothyroidotomy
skull • What are the branches of external carotid?
• List the foramina of skull and what go through
them
• Describe the osteology of typical vertebrae from
C/T/L spine
• Describe osteology of C1/2/atlantooccipital//
atlantoaxial joint
Pathology Liver Robbins • Describe the pathogenesis and morphology of
Cirrhosis alcoholic liver disease
Hepatitis • What are the sequelae of alcoholic liver disease?
• What are the causes of jaundice?
• Classify hepatitis A-D – features, carrier state etc
• What parasites can affect the liver?
• What is the pathogenesis of malaria?
24
Week 15
material
Pharm Analgesic Katzung • Describe the pharmacology of morphine/fentanyl
Drugs and naloxone
Opiates • What are the 3 different opiate receptors, and what
NSAIDS do they cause?
Paracetamol • What is the mechanism of action of ibuprofen?
• Describe PK and metabolism of paracetamol
• Describe management of paracetamol toxicity
Physiology Digestion and Ganong • Describe how carbs/protein/fat is absorbed and
absorption digested in the GIT
• What are the carriers for glucose/fat/proteins?
• Where are the vitamins ADEK absorbed?
• Where is iron absorbed?
• Where is the most water absorbed?
Anatomy Head & Neck Moore • Describe innervation of tongue

II • Describe the structure and landmarks of the larynx
Face • Describe the nerve supply of the intrinsic muscles
Mouth of the larynx
Larynx • What is the course of the facial nerve?
Pharynx • What are the branches of the facial nerve?
• What bones make up the orbit?
• What is the neurovascular supply of the scalp?
• Describe the Circle of Willis and venous drainage
Pathology Pancreas Robbins • Describe the pathogenesis and morphology of
acute pancreatitis
• Describe the pathogenesis of diabetes mellitus
types 1 & 2
• Describe the pathogenesis of cholecystitis
25
Week 16
material
Pharm Respiratory & Katzung • Describe the pharmacology of salbutamol and
GI aminophylline
• Describe the pharmacology of ipratropium
bromide
• Describe the pharmacology of sodium
cromoglycate
• Describe the pharmacology of corticosteroids
• Describe the pharm of PPI, and antiemetics
Physiology GIT Ganong • Describe how the GIT is regulated (Enteric
Nervous System)
• Describe factors affecting gastrin/gastric acid
secretion
• Describe the factors affecting insulin and glucagon
secretion
• Describe the composition of bile salts
• Describe the physiology of peristalsis
Anatomy Thorax I Moore • Describe the structure of the chest wall and
Heart and great intercostal space
vessels • Describe the divisions and contents of various
parts of the mediastinum
• Describe what levels the aorta/oesophagus/inf.
Vena cava enter the thorax
• Describe the course of the thoracic duct
• What are the relations of the first rib
• Describe landmarks for a ICC and what layers do
you go through?
• What are the surface markings of lungs and
pleura?
Pathology GIT Robbins • Describe the pathogenesis of Graves disease
Endo • Describe the pathogenesis of Diabetes Type 1 &2
• Describe the features of panhypopituitarism
• Describe the pathogenesis of Cushings/Conns/
Addisons
• Describe the pathogenesis of inflammatory bowel
disease
• Describe the pathogenesis of ischaemic bowel
26
Week 17
material
Pharm Autocoids & Katzung • Can you outline the current rational for migraine
endocrine treatment?
• How do antihistamines work?
• Describe the pharmacology of insulin and
glucagon
• Describe the adverse effects of Carbimazole
Physiology Endocrinology Ganong • Describe key steps in synthesis of thyroid
Thyroid hormones
Adrenal • Describe the synthesis of catecholamines and
Pancreas enzymes involved
Calcium • Describe the physiology of insulin effects on
adipose/muscle/liver
• Describe how calcium homeostasis is achieved
• What are the responses to hypocalcaemia/
hypercalcaemia
Anatomy Thorax II Moore • Describe the surface marking of the heart in the
Heart & Great anatomical position
Vessels • What makes up the right and left border on CXR
• Describe the blood supply to heart, and venous
drainage
• What is R & L dominance?
• Describe the aortic arch and relations to trachea
• Describe the internal surface of R atrium
• Describe relations of the trachea and blood supply
Pathology CNS Robbins • Describe the pathogenesis of CVA
• Describe pathogenesis of cerebral aneurysm
• Describe pathogenesis of meningitis viral and
bacterial
• What are non infective causes of meningitis
• Pathogenesis of common brain tumours
• Describe the pathogenesis of MS/Guillan Barre.
27
Week 18
material
Pharm Toxicology Katzung • Paracetamol
• Opiate
• Benzodiazepine
• TCA
• Anti depressants
• Use of charcoal
Physiology Metabolism Ganong • Describe metabolism pathways for carbs/protein/
fat
• What are the RQ values for brain/muscle?
Anatomy Abdomen I Moore • Abdominal wall and peritoneum – structures –

T12/L1 cross section CT
• Branches of abdominal aorta and vena cava,
coeliac trunk
• Fascial layers of the abdomen
• Relations of the ingunal canal
• Foregut – stomach and blood supply
• Surface markings of spleen.
• What are the relations of the kidneys?
Pathology Musculoskeleta Robbins • Fracture healing
l • Disease of bone
Skin • What is pathogenesis of RA/OA
• What are the main myeloproliferative disorders?
• ALL/CLL/lymphoma
• Aplastic anaemia
• Skin infections
28
Week 19
material
Pharm Old age/ Katzung • Pharmacological considerations of the elderly
Pregnancy • Which drugs should be used in caution in the
elderly?
• How does metabolism in the liver change in the
elderly
• Give examples of drugs that are not safe in
pregnancy
Physiology Blood Ganong • Describe the physiology of plasma and lymph
• Describe the ABO system for transfusion
•
Anatomy Abdomen II Moore • Stomach/Small bowel/Large bowel

& Spine • What are the relations of head of pancreas?
• What are the relations of the duodenum – describe
its course and vertebral levels
• Describe blood supply to gut/liver/spleen
• Describe the course of the ureters
• Ligaments of the vertebral column, and layers for
lumbar puncture
Pathology Environmental Robbins • Effects of smoking
• What are the effects of lead poisoning
• Describe the pathogenesis of electrical injury
• Describe the effects of radiation on various parts of
the body
• Describe long term effects to ethanol abuse
29
Week 20 Bringing it All Together

material
Pharm Key areas AMK books • Review of cardio/renal drugs
Past exam Qs • Review of anaesthetic agents
• Review of sedatives
• Review of PK/PD/Biotransformation
Physiology Integration AMK books • Inter-relations of CVS/Lung/Central control

Past exam Qs • Affects of altitude and exercise on
Phys Viva book cardiorespiratory function
– Kerry Brandis • Learn 20 listed tables from Ganong
Anatomy Transitional AMK books • Triangles of neck

Zones Past exam Qs • Axilla
McMinn Atlas • Cubital Fossa
Skeleton • Carpal Tunnel
Netter Flash • Femoral triangle/canal
Cards • Popliteal Fossa
Models
Pathology Morphology AMK books • MI/Reperfusion Injury
Past exam Qs • Aneurysm/Atherosclerosis/Dissection
Pathology • Asthma/ARDS/APO/PE/COAD
Secrets • Cirrhosis/Pancreatitis
• Inflammatory bowel/Ischemic Bowel
• Arthritis
• HIV/HSV/CMV/Varicella/Measles/Hepatitis
30
Week 23 – EXAM WEEK

Exam Check List
These are things you will need to acquire or do before the exam
Accommodation & Flights

If the exam venue is out of state, then please remember to book flights and
accommodation early on. Try and research the venue, and pick a place that is close by,
and preferably a quiet setting. The last thing you need is to be sleep deprived due to
excessive noise from a night club/pub, the night before the exam.
Try and travel a couple of days before if possible. This will allow for any nasty surprise
delays at the airport, and also it will allow you to get accustomed to the local weather
conditions.
If the venue is in your home city, it’s worth swinging by the exam venue in the run up, to
work out transport routes etc.
Suit/Formal Viva clothing

The college say work attire is recommended for the viva component – please note, that
this does not mean scrubs and trainers, even if they are ironed (as a good friend from
Glasgow once suggested).
So, this means a suit for the guys, and something smart and conservative for the girls.
From personal experience – please don’t buy new shoes for the exam – unless they are
worn in, they can be very uncomfortable.
Don’t leave it until 2 days before the viva to dust off that suit in the closet. The stress and
intensity of the revision process may have caused you to gain/lose a few pounds.
You do not want to find out your suit is a poor fit on the morning of the exam.
Equipment
The only equipment you will require for the exam is a couple of 2H pencils, and a decent
eraser.
You may wish to take a watch into the exam, but there is usually a clock at the front of the
exam hall.
Paperwork
Do not forget you candidate photo ID or your viva timetable.
You will not be allowed into the examination hall without your photo ID.
Nothing should be new to you going into the exam, so make sure you have had a dress
rehearsal, ideally at the mock exam. Treat the mock as the real deal; it’s better for any
logistical errors to be made on that day, than the exam day itself.
The Night Before

It is imperative that you get a good night sleep before the exam. If you have studied hard
for this exam, last minute cramming is unlikely to make any difference at this stage.
Although I am sure ACEM does not intend to make the exam deceptive, you will have to
keep your wits about you, as the MCQs will contain some “negative” stems. You need to
be alert to spot these.
31
Final Note
Remember, your preparation for this exam has been excellent. Therefore you will have an
excellent chance of passing whichever subjects you are sitting. It is quite normal to not feel
ready in the run up to the exam, and this is by no means an indication as to what your
performance might be.
I wish you the very best of luck.

32
Appendices
1. Anatomy key facts
2. Pathology summaries
3. Physiology – Ganong table and figure references
4. ACEM I Viva statistics (Dr. J Stevens)

A useful tally of common viva topics in recent years.
5. ACEM Viva Questions
6. ACEM I Recalled MCQs
7. Notes
33
Anatomy Key Facts
Anterior triangle of neck

Boundaries
Midline
Ant. Border sternocleidomastoid
Inf. Border of mandible
Contents
Digastric, omohyoid, platysma, hyoid bone
Larynx, thyroid gland, trachea, oesophagus
Lymph nodes
Common/int/ext carotids and branches
Hypoglossal Nerve, vagus, int/ext laryngeal nerve, ansa cervicalis
Posterior triangle of neck

Boundaries
Post. Border sternocleidomastoid
Ant. Border of trapezius
Middle third of clavicle
Contents
Splenius capitus, scalene muscles, prevertebral fascia
Inf. Belly of omohyoid
Accessory nerve, brachial plexus trunks,
Cervical lymph nodes
EJV
Axilla
Boundaries
Anterior – pec major/minor
Posterior – subscapularis, teres major, lat dorsi
Medial – serratus anterior, upper 3 ribs
Lateral – intertubercular groove of humerus
Apex – convergence of first rib, scapula, clavicle
Floor – Suspensory ligament
Contents
Axillary vessels and branches
Axillary nodes
Cords of brachial plexus
Fat
Quadrangular space
Boundaries
Superior – subscapularis
Inferior – teres major
Medial – long head of triceps
Lateral – humerus
Contents
Axillary nerve, posterior circumflex humeral artery and vein
34
Triangular space
Boundaries
Superior – teres major
Inferior – long head of triceps
Lateral - humerus
Contents
Radial nerve, profunda brachii
Cubital fossa
Borders
Superior – intercondylar line
Lateral – pronator teres
Medial – brachioradialis
Floor – brachialis, supinator
Roof – fascia, medial cubital vein
Contents
Lateral to medial – bicep Tendon, brachial Artery, median Nerve
Carpal tunnel
Boundaries
Flexor retinaculum
Carpal bones
Contents
Long flexors
Median nerve
Anatomical snuffbox
Boundaries
Radial – EPV, APL
Ulnar - EPL
Contents
Radial artery, cephalic vein, scaphoid, trapezium, radial nerve
Greater sciatic foramen

Boundaries
Greater sciatic notch
Sacrospinous/tuberous ligaments
Contents
Piriformis
Superior gluteal vessels and nerves
Inferior gluteal vessels and nerves
Internal pudendal artery
Sciatic nerve
Pudendal nerve
Posterior femoral cutaneous nerve
Nerves to obturator internus and quadratus femoris
35
Lesser sciatic foramen

Boundaries
Lesser sciatic notch
Sacrospinous/tuberous ligaments
Contents
Tendon of obturator internus
Internal pudendal vessels
Pudendal nerve
Femoral triangle
Boundaries
Superior - Inguinal ligament
Lateral - Sartorius
Medial - Adductor longus
Floor – Iliopsoas, adductor longus
Roof – Fascia lata
Contents
Femoral nerve, artery, vein,
Femoral Nerve NOT in femoral canal
Adductor canal
Boundaries
Lateral – vastus medialis
Medial – adductor longus/magnus
Roof – Subsartorial plexus
Floor – adductor magnus
Contents
Femoral artery, vein, saphenous nerve, nerve to vastus medialis
Popliteal fossa
Boundaries
Superior lateral – biceps femoris
Superior medial – semitendinosus/membranosus
Inferior medial/lateral – heads of gastrocnemius
Floor – posterior capsule of knee, popliteus
Roof – fascia
Contents
Popliteal vessels, short saphenous vein
Tibial nerve, common peroneal nerve, sural nerve,
Lymph nodes and fat,
36
Layers for surgical airway – tracheostomy

Skin
Subcut. Fat
Platysma
Investing layer of cervical fascia
Strap muscles
Pre-tracheal fascia
Isthmus of thyroid
Trachea
Layers for chest drain

5th intercostal space, mid/ant axillary line
Skin
Fat
Deep fascia
Serratus anterior
External intercostal
Internal intercostal (neurovascular plane between this and innermost)
Innermost intercostal
Parietal pleura
Layers for lumbar puncture

Skin
Fat
Deep fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Dura mater
Arachnoid mater
37
Vertebral landmarks
C3
Hyoid bone
C4
Bifurcation of common carotid
C6
Cricoid cartilage,
Start of trachea,
vertebral art. enters transversarium
T3/4
Top of aortic arch,
Manubrium
T4/5
Angle of Louis,
Bifurcation of trachea
T8
Diaphragm opening for IVC,
R phrenic nerve
T10
Diaphragm opening for oesophagus,
Vagi,
L gastric vessel
T12
Diaphragm opening for aorta,
Azygous/hemiazygous veins,
Thoracic duct,
Coeliac axis
L1
Transpyloric plane,
End of spinal cord,
Pylorus,
2nd part of duodenum,
Neck of pancreas,
Portal vein,
Hila of kidneys,
SMA origin
L1/2
Origin of renal arteries
L3
Origin of IMA
L4
Bifurcation of aorta
L5
Formation of IVC
38
Pathology Summaries
Irreversible Cell injury

Membrane dysfunction
Nuclear changes
Protease activation
Increase IC Ca
ATP depletion – cellular swelling
Mitochondial – MPT
Necrosis
Cell death
Nuclear changes – pyknosis, karyolysis, karyorrhexis
Coagulative – solid organs, architecture preserved
Liquefactive – abscess
Caseous – TB
Fat necrosis – saponification, e.g pancreatitis
Apoptosis
Pathogenesis
Physiological – involution of tissues – thymus, death of immune cells, intestinal epithlia
Pathological – radiation, viruses, drugs, cancer
Initiation – intrinsic/extrinsic
Execution - Caspases
Morphology
Cell shrinkage,
Chromatin condensation
Fragmentation
Apoptotic bodies
Cellular blebbing
Lack of inflammation
Reperfusion Injury
Damage due to oxygen free radicals
Free radicals promote MPT
Ischaemia causes inflammation – neutrophil infiltrate – reperfusion increases local
inflammation
Activation of complement – IgM deposition, and subsequent inflammation
In MI – contraction bands due to increased IC calcium
39
Atherosclerosis
Pathogenesis
• Chronic endothelial injury, usually subtle, with resultant endothelial dysfunction, yielding
increased permeability, leukocyte adhesion, and thrombotic potential
• Accumulation of lipoproteins, mainly LDL, with its high cholesterol content, in the vessel
wall
• Modification of lesional lipoproteins by oxidation
• Adhesion of blood monocytes (and other leukocytes) to the endothelium, followed by
their migration into the intima and their transformation into macrophages and foam cells
• Adhesion of platelets
• Release of factors from activated platelets, macrophages, or vascular cells that cause
migration of SMCs from media into the intima
• Proliferation of smooth muscle cells in the intima, and elaboration of extracellular
matrix, leading to the accumulation of collagen and proteoglycans.
• Enhanced accumulation of lipids both within cells (macrophages and SMCs) and
extracellularly.
Morphology
Morphology. The key processes in atherosclerosis are intimal thickening and lipid
accumulation. An atheroma consists of a raised focal lesion initiating within the intima,
having a soft, yellow, grumous core of lipid (mainly cholesterol and cholesterol esters),
covered by a firm, white fibrous cap.
Outcomes
• Focal rupture, ulceration, or erosion of the luminal surface of atheromatous plaques
may result in exposure of highly thrombogenic substances that induce thrombus
formation or discharge of debris into the bloodstream, producing microemboli
composed of lesion contents (cholesterol emboli or atheroemboli).
• Haemorrhage into a plaque, especially in the coronary arteries, may be initiated by
rupture of either the overlying fibrous cap or the thin-walled capillaries that vascularize
the plaque. A contained hematoma may expand the plaque or induce plaque rupture.
• Superimposed thrombosis, the most feared complication, usually occurs on disrupted
lesions (those with rupture, ulceration, erosion, or hemorrhage) and may partially or
completely occlude the lumen. Thrombi may heal and become incorporated into and
thereby enlarge the intimal plaque.
• Aneurysmal dilation may result from ATH-induced atrophy of the underlying media, with
loss of elastic tissue, causing weakness and potential rupture, discussed later.
40
Aneurysm
Pathogenesis
Atherosclerosis
Hypertension
Matrix metalloproteinases.
A decreased level of tissue inhibitor of metalloproteinases (TIMP)
Morphology
True aneurysm – bounded by 3 vessel wall layers
False aneurysm – extravascular haematoma that communicates with intravascular space
Outcomes
• Rupture into the peritoneal cavity or retroperitoneal tissues with massive, potentially
fatal, hemorrhage
• Obstruction of a vessel, particularly of the iliac, renal, mesenteric, or vertebral branches
that supply the spinal cord leading to ischemic tissue injury
• Embolism from atheroma or mural thrombus
• Impingement on an adjacent structure, such as compression of a ureter or erosion of
vertebrae
• Presentation as an abdominal mass (often palpably pulsating) that simulates a tumor.
Aortic Dissection
Pathogenesis
Dissection of blood along laminar planes of aortic media, forming intramural blood filled
channel.
Hypertension, damage to ECM
Connective tissue disorders.
Morphology
Type A – proximal lesion involving ascending aorta
Type B – Distal lesion, usually distal to subclavian artery
Outcomes
Rupture
Haemorrhage
Death
41
MI
Pathogenesis
• The initial event is a sudden change in the morphology of an atheromatous plaque
• Exposed to subendothelial collagen and necrotic plaque contents, platelets undergo
adhesion, aggregation, activation, and release of potent aggregators including
thromboxane A2, serotonin, and platelet factors 3 and 4.
• Vasospasm is stimulated by platelet aggregation and the release of mediators.
• Frequently within minutes, the thrombus evolves to completely occlude the lumen of
the coronary vessel.
• Vasospasm
• Emboli: from the left atrium in association with atrial fibrillation, a left-sided mural
thrombus or vegetative endocarditis; or paradoxical emboli from the right side of the
heart or the peripheral veins which cross to the systemic circulation, through a patent
foramen ovale, causing coronary occlusion.
Feature Time
Onset of ATP depletion Seconds
Loss of contractility <2 min
ATP reduced
to 50% of normal 10 min
to 10% of normal 40 min
Irreversible cell injury 20-40 min
Microvascular injury >1 hr
Morphology
Gross
6-12 hours - no change
18-24 hrs - pale, cyanotic
1 week - yellow, softened
Hyperemic granulation
White fibrous Scar
Microscopic
1 hr – intercellular oedema
12-72hrs – hypoeosinophilia, coagulative necrosis, neutrophil infiltration
3-7 days – macrophages
7-10 days – granulation, then dense fibrous scar
Outcomes
Arrhythmia and sudden death.
Cardiogenic shock
CHF
Rupture of ventricle
Pericarditis
Mural thrombus
Aneurysm
Extension of infarct
42
ARDS
Pathogenesis
Alveolar damage, involving capillary endothelium and epithelium.
Increased cap. Permeability, oedema, fibrin exudate, hyaline membranes
Activated neutrophils
Activated macrophages
Loss of surfactant and compliance
Shock
Sepsis
Gastric aspiration
Trauma
Morphology
Wet, heavy lungs, red
Diffuse alveolar damage
Type 2 pneumocyte proliferation
Outcomes
Pulmonary oedema, respiratory failure, arterial hypoxemia refractory to oxygen therapy
Pneumonia
Pathogenesis
Congestion
Consolidation, red hepatization
Grey hepatization
Resolution
CAP – strep pneumoniae, haemophilus influenzae, staph aureus, Legionella,
Enterobacteriaceae, pseudomonas
Atypicals – Mycoplasma pneumoniae, Chlamydia, RSV, SARS
Immunocomp – CMV, pneumocysis jiroveci, mycobacterium avium intracellulare,
aspergillosis, candida
Morphology
Bronchopneumonia – patchy consolidation of parencyma. Lung shows suppuration,
consolidation. Neutrophil infiltrate
Lobar pneumonia – involves large portion of entire lobe
Outcomes
Abscess
Empyema
Fibrotic scar
Sepsis
43
Emphysema
Pathogenesis
Abnormal permanent enlargement of airspaces distal to terminal bronchioles, with alveolar
wall destruction.
Protease-antiprotease hypothesis
Increased elastase activity
Smoking activates alveolar macrophages
Morphology
Centrilobular – proximal/central acinus, upper lobe, apex, smokers
Panacinar – uniform destruction, lower, basal zone, a1 antitrypsin deficiency
Distal – distal acinus
Overinflated lungs
Enlarged alveolar airspaces
Outcomes
Respiratory failure
Infection
Asthma
Pathogenesis
Type 1 hypersensitivity
Reversible bronchial hyperresponsiveness, chronic.
Atopic – common, allergens, atopy, IgE, mast cell degranulation, eosinophilia
Non-atopic – infection, exercise, cold air, no IgE involvement
Morphology
Overinflated lungs
Atelectasis
Mucus plugs
Curschman spirals
Charcot leyden crystals
Smooth muscle and submucosal gland hypertrophy
Outcomes
Pneumothorax
Infection
44
PE
Pathogenesis
DVT – 95%, Diffuse alveolar damage, pulmonary hypertension, atheroclerosis
Virchows triad
Starling forces
Morphology
Large – death, cardiovascular collapse – 5%
Middle – 20-35% induce haemorrhage and infarction
Small – 60-80% - clinically silent, transient chest pain
Outcomes
Death
Chest pain
Infarction
Cor Pulmonale
Cirrhosis
Pathogenesis
Progressive fibrosis and reorganisation of vascular microarchitecture.
Collagen I, III deposition
Disruption of ECM
Causes – etoh, hepatitis, bilirary disease, haemochromatosis, Wilsons, a1 antitrypsin
deficiency
Morphology
Fibrosis
Nodules
Disruption of parenchyma
Myofibroblast proliferation
Outcomes
Hepatic failure
Portal hypertension – varices
Hepatocellular carcinoma
45
Pancreatis
Pathogenesis
Pancreatic duct obstruction – gallstones
Primary acinar cell injury – virus, drugs, trauma
Defective intracellular transport of proenzymes
Enzyme – trypsin activation, inappropriately, activates other enzymes – elastases
Causes - etoh, gallstones, infection – mumps, ERCP/surgery, shock,
Morphology
Proteolysis, lipolysis, haemorrhage
Oedema
Fatty necrosis
Outcomes
Resolution
Abscess
Pseuducyst
Chronic pancreatits
Graves
Pathogenesis
Most common cause of endogenous hyperthyroidism.
Hyperthyroidism
Exophthalmos
Pretibial myxoedema
Autoimmune process involving autoantibodies to TSH receptor
Morphology
Enlarged gland
Hypertrophy
Hyperplasia of follicular epithelium
Outcomes
Raised T4, T3, low TSH. Increased metabolism and iodine uptake.
46
Thiamine deficiency
Pathogenesis
Thiamine from diet, polished rice and flour have little
Absorbed from gut, used as enzyme cofactor for maintenance of neural membrane and
nerve conductance
Morphology
Myelin degeneration
Flabby heart
Mammillary body haemorrhage
Outcomes
Polyneuropathy
High output failure – Beri Beri
Wernicke-Korsakoff Syndrome
Shock (septic)
Pathogenesis
Systemic hypoperfusion from reduced CO or circulating volume, - hypotension, impaired
tissue perfusion, cellular hypoxia. Shock is the final common pathway for many lethal
events
Septic shock – spread of localised infection into blood
Gram –ve bacilli with LPS endotoxin
LPS alone can induce changes of septic shock
Activation of complement
Activation of cytokines – TNF, IL1
Systemic vasodilation
Dimished contractility
Widespread endothelial damage
ARDS
DIC
Morphology
Hypoxic tissue injury, end organ effects
Brain - hypoxic encephalopathy
Heart - coagulative necrosis, contraction bands
Kidneys – ATN
Lungs – seldom effected in hypovolaemia, diffuse alveolar damage in traumatic shock
Outcomes
Hypotension
Multi-organ failure
Death
Mortality of septic shock high.
47
ATN
Pathogenesis
Most common cause of ARF
Renal epithelial destruction due to ischaemia or nephrotoxins
Tubular damage
Arteriolar vasoconstriction
Tubular obstruction
Back leak of tubular fluid
Altered glomerular ultrafiltration
Morphology
Ischaemic ATN – patch tubular necrosis, proximal tubule and thick ascending LOH
Nephrotoxic ATN – tubular injury & necrosis, proximal tubule, other segments too
Distal tubules - protein and cellular casts. Mitotic figures and hyperchromatic nuclei
Outcomes
Initiation
Maintenance – renal failure and hyperkalemia
Recovery - hypokalemia
Prognosis good in nephrotoxic ATN
Staph. Aureus
Pathogenesis
Gram +ve cocci, grow in clusters
Cause skin infections, impetigo, osteomyelitis, pneumonia, endocarditis, food poisoning,
toxic shock syndrome
Virulence:
Surface proteins - adherence
Enzymes to degrade host proteins
Toxins - haemolysins, exfoliative toxins, enterotoxins, superantigens
VZV
Pathogenesis
Acute VZV causes chickenpox, reactivation causes shingles
VSV infects mucous membranes, skin, neurons and latent infection to sensory ganglia
Transmission via droplet, vesicular skin rash
Shingles when latent VZV in dorsal root ganglia becomes active – painful vesicular lesions
in dermatomal distribution
48
HIV
Pathogenesis
Retrovirus, destroys T cells
Lipid host derived envelope with a cone shaped electron dense core
Contains major capsid protein p24, nucleocapsid protein, genomic RNA, three enzymes –
protease, integrase, reverse transcriptase
Destruction of T cells
Altered macrophage function
Outcomes
CD4+ depletion
Opportunistic infection
CMV
Crytococcus Neoformans
TB
Pneumocystis jiroveci
Malignancy – lymphoma, KS, meningitis
Clostridium
Pathogenesis
Gram +ve bacillary anaerobes that produce spores
C. Perfringens – gangrene, food poisoning
C. Tetani – wounds, neurotoxin (tetanospasmin)
C. Botulinum – canned food, causes flaccid paralysis of respiratory and skeletal muscle
C. Difficile – pseudomembranous colitis in abx treatment
Viral Gastroenteritis
Pathogenesis
1-7 days, diarrhoea, anorexia, headache, fever
Rotavirus 25-65% worldwide
Caliciviruses
Enteric adenoviruses
Astroviruses
Morphology
Small intestine – shortened villi, lamina propria inflammation, enterocyte damage
49
Hepatitis B
Pathogenesis
DNA virus – hepadnavirus – Dane particle
Percutaneous, perinatal, sexual transmission 4-6 wk incubation
HBV infects hepatocytes, cellular injury due to immune response to liver cells CD8+ cells
mediate damage.
HBsAg appears before symptoms.
HBeAg HBV DNA
Outcomes
Chronic hepatitis – 5-10%
Carrier state
Cirrhosis
Hepatocellular Ca
Meningitis
Causes
Neonates – E Coli and group B strep
Infants and children – Strep pneumo, H. Infulenzae
Adults – Neisseria meningitidis
Elderly – Strep pneumo, listeria
50
Physiology Table & Figure References

Ganong 22nd Edition
It is a good idea that you learn these tables, and diagrams and are able to reproduce them
for the exam. They make excellent MCQ fodder.
Chapter 1
Figure 1-1 Body Fluid Compartments, Page 2
Table 1-1 Total body water in relation to age and sex, Page 3
Figure 1-27 Electrolyte composition of human body fluids. Page 30
Chapter 2
Figure 2-6, Action potential in a neuron, Page 55
Table 2-1, Nerve fiber types in mammalian nerve, Page 61
Table 2-3, Relative susceptibility of mammalian A,B,C nerve to conduction block produced
by various agents, Page 61
Chapter 3
Figure 3-3, Sarcomere, Page 67
Table 3-2, Sequence of events in contraction of skeletal muscle, Page 70
Table 3-3, Classification of fiber types in skeletal muscle, Page 73
Chapter 4
Table 4-5, Physiologic effects produced by stimulation of opiate receptors, Page 113
Chapter 13
Table 13-2, Responses of effector organs to autonomic nerve impulses and circulating
catecholamines, Page 227
Chapter 14
Table 14-3, Summary of stimuli affecting vasopressin secretion, Page 245
Table 14-5, Body heat production and heat loss, Page 252
Table 14-6, Temperature-regulating mechanisms, Page 254
Chapter 17
Table 17-1, Factors affecting the metabolic rate, Page 281
51
Chapter 19
Table 19-3, Principal actions of insulin, Page 336
Table 19-4, Effects of insulin on various tissues, Page 337
Table 19-6, Factors affecting insulin secretion, Page 345,
Table 19-8, factors affecting glucagon secretion, Page 349
Chapter 24
Table 24-1, Factors that affect renin secretion, Page 458
Table 24-2, Conditions that increase renin secretion, Page 458
Chapter 26
Table 26-3, Stimuli that affect gastrin secretion, Page 485
Table 26-11, Approximate composition of faeces on an average diet,

Page 509
Chapter 28
Figure 28-1, Conduction system of the heart, Page 548
Figure 28-2, Membrane potential of pacemaker tissue, Page 549
Table 28-1, Conduction speeds in cardiac tissue, Page 549
Chapter 29
Figure 29-2, Pressure volume loop of LV, Page 566
Figure 29-3, Events of cardiac cycle, Page 567
Table 29-3, Effects of various conditions on cardiac output, Page 572
Figure 29-8, Frank Starling curve, Page 574
Chapter 30
Table 30-1 Characteristic of various types of blood vessels in humans,
Page 578
Table 30-4 Causes of increased interstitial fluid volume and oedema,

Page 594
Chapter 31
Table 31-2, Summary of factors affecting calibre of arterioles, Page 603
Table 31-3, Factors affecting the activity of vasomotor area in medulla,

Page 605
Table 31-4, Factors affecting heart rate, Page 610

52
Chapter 32
Table 32-1, Resting blood flow and O2 consumption in various organs,
Page 612
Figure 32-9, Autoregulation of cerebral flow, Page 617
Figure 32-13, Blood flow in L and R coronary arteries, Page 621
Chapter 33
Table 33-2, Cardiac output and regional blood flow, Page 634
Table 33-4, Compensatory reactions activated by haemorrhage, Page 637
Chapter 34
Figure 34-7, Lung volumes, Page 652
Figure 34-15, Compliance pressure-volume changes, Page 658
Table 34-6, Biologically active substances metabolised by the lungs,

Page 665
Chapter 35
Figure 35-2, Oxygen-haemoglobin dissociation curve, page 667
Table 35-2, Fate of CO2 in blood, Page 670
Chapter 38
Table 38-3, Agents causing contraction and relaxation of mesangial cells, Page 707
Table 38-4, Factors affecting the GFR, Page 708
Table 38-8, Permeability and transport in nephron, Page 715
Chapter 39
Table 39-1, H+ concentration and pH of body fluids, Page 731
Table 39-2, Principal buffers in body fluids, Page 733

53
ACEM VIVA TOPIC FREQUENCY

ANALYSIS
54
Anatomy Viva History

Upper Limb
Bone
Radius IIII
1/95, 1/00, 2/02, 1/04
Extensor tendons at wrist
Ulna III
1/00, 2/00, 1/03
Stability (prox)
Clavicle III
1/95, 2/02, 1/04
Humerus IIII
2/95, 2/98, 1/03, 1/06
Common # sites & nerve injuries
Carpus II
2/96, 1/05
Flexor retinaculum
Scapula III
1/98, 1/05, 02/06
Muscle attachments, rotator cuff
Shoulder joint I
2/01
Stability esp rotator cuff
Elbow I
1/06
Knee I
1/06
Photo
Axilla I
2/00
Median nerve I
1/00
Brachial plexus II
2/02, 2/04
Xray
Elbow III
1/97, 2/03, 2/04
Capsule & ligaments, vascular relations, ossification
Carpal bones III
1/97, 2/99, 2/04
Boundaries of ASB SA
Shoulder I
2/98
Stability
Wrist/hand II
2/03, 2/05
Identify bones & ligamentous attachments
Model
Forearm
Flexor IIIII
2/95, 2/97, 1/01, 1/02, 2/06
Middle finger flexion @ MCP, PIP & DIP II
55
Extensor I
2/97
Pronation/supination I
1/00
Hand
Extensor I
1/96
Palmar II
1/96, 2/99
Flexor tendons I
1/98
Thumb II
1/98, 2/99
Movement
Cubital fossa IIII
1/95, 2/98, 1/05, 1/06
Median nerve
AC & coracoclavicular joints I
1/97
Axilla
Brachial plexus II
1/97, 1/99
Shoulder joint I
2/98
Stability
Muscles involved in movement III
1/01, 1/02, 2/02
Pectoral girdle muscles I
1/04
Wrist
Carpal tunnel I
2/98
Elbow III
1/99, 1/01, 1/02
Stability, flex/ext
Biceps I
1/00
Forearm extension
Discussion
Wrist & hand I
1/95
Carpal tunnel SA IIII
1/99, 2/02, 1/04 2/06
Sensation ring finger I
2/00
Nerves involved in thumb movement II
2/01, 1/05
Sensory innervation of palm I
2/02
Dorsum of wrist I
1/03
Vascular supply I
2/03
Flexion of middle finger at MCP, PIP & DIP I
1/05
Cubital fossa II
1/95, 2/96
Venous drainage SA II
2/99, 1/03
56
Dermatomes I
2/04
Radial nerve lesion
Median nerve distal to elbow I
2/05
Lower Limb
Bone
Femur III
1/95, 2/98, 1/05
Blood supply to head
Pelvis IIIIII
1/96, 1/98, 1/99 x 2, 2/02, 2/05
Inguinal ligament, hip joint & ligaments, greater sciatic notch/nerve
Tibia I
1/96
Foot III
1/97 2/06
Photo
Femoral triangle I
1/00
Femoral nerve III
1/01, 1/02, 2/04
Femoral artery III
1/01, 1/02, 1/06
Back of thigh III
2/02, 1/04, 1/06
Course of sciatic
Xray
Foot III
2/95, 1/01, 1/02
Arch stability
Midtarsal joint I
2/99
Pelvis III
2/96, 2/98, 1/04
Course of ureters
Hip joint & pubis I
2/98
Knee IIII
1/00, 1/03, 2/04, 1/06
Ligaments
Ankle IIIII
1/01, 1/02, 1/05, 1/06, 2/06
Ligaments
Model
Knee joint IIIIIII
2/95, 2/97, 1/00, 2/03, 2/04, 2/05, 09/06
Stability, locking, patella stability & extension
Hip joint III
1/96, 2/98, 2/03
Blood supply & relations, stability & movements
Ankle joint IIII
2/96, 2/97, 2/98, 1/03
Nerves
Extensor ligaments I
2/99
57
Flexion/extension I
2/00
Inversion/eversion I
2/00
Anterior thigh
Femoral triangle II
2/96, 2/05
Femoral artery
Abductor canal I
1/97
Sciatic nerve I
1/97
Leg
Posterior compartment III
1/97, 2/00, 2/01
Peroneal compartment I
1/99
Neurovascular
Anterior compartment I
1/99
Neurovascular
Popliteal fossa III
1/98, 2/99, 2/01
Inguinal ligament I
1/98
Foot
Dorsum I
2/98
Discussion
Structures surrounding ankle II
1/95, 2/04
Great saphenous vein
Myotomes & reflexes SA II
2/99, 2/04
Common peroneal nerve lesion
Myotomes & femoral nerve I
1/06
Sensory innervation of sole I
2/02
Sensory innervation ankle/foot – dermatomes & peripheral I
2/03
Venous drainage I
1/04
Innervation great toe I
1/05
Peripheral, dermatomes & myotomes for same segment
Posterior compartment of the leg I
2/05
Achilles
Head & Neck

Bone
Lumbar vertebrae IIIIII
1/95, 2/96, 2/98, 1/01, 1/02, 1/05
Base of skull I
2/95
Cervical spine
C1 & C2 II
58
2/00, 2/03
Stability & features
C2 II
2/97, 2/99
Ligaments
Typical – C6 II
2/99, 2/04
Thoracic vertebra II
2/00, 2/03
Stability, rib articulation
Mandible II
2/97, 2/99
Skull – facial bones II
2/04, 2/06
Infraorbital nerve
Photo
Sensory supply head & neck I
1/00
Face III
1/03, 1/05, 1/06
Face blood supply I
2/00
Lateral face/neck – muscles & innervation I
2/03,
blood supply – carotid arteries
Facial nerve II
1/04, 2/05
Anterior triangle I
1/05
SCM relationships
Xray
Cervical spine IIIIII
1/96, 2/97, 2/99, 2/00, 2/02, 1/05
Stability, head movements
PEG view II
2/02, 1/06
Facial II
2/97, 1/00
Infraorbital nerve
Mandible I
2/01
Zygomatic bone I
2/01
Orbital bones I
Infraorbital nerve
Skull I
1/98
Lumbar spine I
2/98
Model
Temporal region I
1/95
Triangles of neck I
1/95
Anterior I
2/99
59
Carotid
Larynx IIIII
2/95, 1/98, 2/99, 2/02, 2/04
Intrinsic muscles
Facial nerve & facial muscles II
2/96, 2/98
Carotid sheath I
2/96
Upper airway – tongue, pharynx, palate I
1/98
Tongue II
1/01, 1/02
Eye IIII
1/05
CN palsies
Structures & pupil reflexes II
1/05 2/06
Aqueous humour drainage I
1/06
Mandible/larynx I
1/05
Discussion
Face
Sensory supply II
1/99 2/06
Blood supply I
1/99
Extraocular muscles I
2/01
Muscles of mastication I
2/00
LP II
1/03, 1/06
CNS
Bone
Photo
Xray
Model
Discussion
Thorax
Bone
Rib II
1/97, 1/04
ICS landmarks & structures
1st rib I
2/05
Relationship of nerves & vessels
Photo
Thoracic inlet IIIIII
1/00, 2/01 x 2, 2/04, 1/05 2/06
Venous drainage of H&N/UL, arterial supply of head, IJV
60
Xray
CXR IIIIIII
1/95, 1/98, 1/99, 2/00, 2/02, 1/03, 1/05
Cardiac silhouette, SA of lung & pleura
Model
Intercostal space I
1/96
Arch of aorta II
1/96, 2/96
Heart IIIIIIII
1/97, 1/01, 1/02, 2/02, 1/04, 2/04, 2/05, 1/06
Blood supply, great vessels – PDA in newborn, chambers/valves
Blood supply of conducting system
Lung I
1/97
Discussion
Lung & pleura SA I
2/99
ICC insertion I
1/06
Abdomen
Bone
Photo
Ureters III
2/00, 1/03, 2/05
Posterior abdo wall – course & branches of aorta II
2/02, 2/03
Vasculature
Venous drainage I
1/05
Xray
AXR IIIII
2/96, 1/99, 2/00, 1/04, 2/05
Renal tract, course of abdominal aorta, soft tissues
CT – relations of the spleen 2/06
CT – relations of Liver II
Model
Retroperitoneum
Kidneys & ureters II
2/95, 2/98
Upper abdo – liver I
2/97
Abdominal aorta II
2/98 2/06
Branches & distribution
Spleen I
2/98
Discussion
61
Pathology Viva History

Normal cell I
Cell injury & adaptation

Atrophy, hyperplasia, hypertrophy, metaplasia IIII
1/96, 2/97, 2/01 x 2, 2/04
Reversible ischaemia & necrosis IIIIII
2/99, 1/02, 2/02, 2/03, 1/06
Following ischaemia rev vs irrev II
Reversible Δ associated with ischaemia II
Irreversible Δ
Initial cell Δs with acute ischaemia I
2/04
Biochemical hallmarks of cell injury I
2/04
Ischaemic injury I
2/05
Reperfusion injury III
2/05, 1/06 2/06
Necrosis I
2/97
Types II
1/96, 2/00
Infarction I
2/98
Apoptosis IIII
2/01, 2/04, 2/05 2/06
Metastatic calcification I
2/04
Steatosis I
2/04
Inflammation
Cells of immune system I
2/96
Macrophages I
1/95
Neutrophils I
1/96
Leucocytes (role) I
1/01
Chemical mediators of (acute) inflammation III
2/95, 1/99, 2/02
Chronic inflammation I
1/98
Acute inflammation
Vascular response II
2/03, 1/06
Wound repair
Skin wound healing IIIIIIII
1/95, 1/98, 2/98, 1/02, 2/02, 1/04, 2/04, 1/05
1° vs 2°
Pathologic factors influencing I
62
1/00
Angiogenesis I
2/04
Fibrosis & scar formation II
2/04, 1/05
Immunity
T Cells II
1/00, 2/00
B Cells II
1/01, 1/03
Complement system II
1/02, 1/03
Hypersensitivity I
1/95
Type I IIII
1/98, 1/99, 2/00, 1/02
Mediators inv
Type II (transfusion) IIII
1/99, 2/00, 1/01, 2/05
Type III III
2/99, 2/03, 2/05
Type IV I
2/99
AIDS II
2/96, 2/99
HIV abnormalities of immune function I
2/98
Virus & transmission II
1/01, 2/03
Haemostasis, thrombosis & shock

Clotting cascade IIII
1/95, 2/99, 1/05 2/6
Inhibitors I
2/03
Platelets IIII
2/99, 2/03, 1/05 2/06
Embolism II
2/95, 1/98*
Systemic II
1/97, 1/99
Thrombosis IIII
1/97, 2/99, 1/04, 1/05
Endothelial cell role I
2/02
Venous thrombosis I
1/96
Arterial vs venous I
1/01
Shock
Irreversible I
2/97
Septic III
2/97, 2/00, 2/05
Cardiogenic I
1/98
Haemorrhagic II
2/99, 1/03
Oedema IIII
63
2/98, 2/99, 1/02, 1/03

Generalised
DIC II
2/00, 2/03
Infectious diseases
Host barriers I
2/95
Viral
Mechanisms of cell injury I
1/02
VZV III
2/01, 2/05, 1/06
Bacterial
Mechanisms of cell injury I
1/02
Clostridial infections II
1/01, 1/04
Tetanus II
1/95, 2/98
Staphylococcal II
2/95, 2/99
Streptococcal infections III
1/96, 1/00, 1/04
Meningococcus I
1/02
TB III
2/98, 2/03, 1/05
1°
Anaerobes I
2/99
Protozoa
Malaria II
2/01, 2/03
Neoplasms
Benign vs malignant II
1/95, 2/99
Benign I
2/97
Invasion of ECM I
1/05
Metastasis I
1/05
Paraneoplastic I
1/05
Genetics
Cardiovascular
Atherosclerosis IIIII
1/95, 2/99, 1/01, 2/01, 1/03
Microscopic features of atheroma I
1/00
Aneurysms II
1/95, 1/04
Aortic
AAA I
2/04
Aortic dissection I
64
2/04
MI IIII
1/99, 1/00, 2/01, 2/03
Infective endocarditis II
2/00, 2/02
Essential hypertension I
2/01
Hypertensive heart disease I
1/03
Pericarditis
Acute I
2/03
AS – calcific I
2/04
Cardiomyopathy
Hypertrophic I
1/06
Haematology
Anaemia I
2/95
Haemolytic II
1/97, 1/99
Microcytic I
2/97
Blood groups III
1/95, 2/96, 1/98
Transfusions I
2/96
Leucopenia I
1/97
Respiratory
APO I
1/96
ARDS III
2/96, 1/01, 1/04
Asthma IIIIII
2/96, 1/98, 1/00, 1/02, 1/04, 1/06
COPD I
1/97
Emphysema III
2/98, 2/00, 1/06
Chronic bronchitis I
1/99
Restrictive lung disease I
1/97
PE III
1/98, 1/00, 2/02
Pneumonia III
1/99, 2/99, 2/00
Legionella III
1/01, 2/02, 1/05
Atypical I
1/03
Influenza I
1/05
GIT
Bacterial enteritis II
65
2/01, 2/02
Salmonella II
2/04, 1/06
Cholera II
2/04, 1/06
Gastroenteritis I
2/04
IBD
Crohn’s I
2/05
Ulcerative colitis I
2/05
Ischaemic bowel I
2/05
Hepatobiliary
Ascites I
2/95
Hepatitis
Serum markers I
2/98
Pathogenesis I
2/98
Fulminant I
2/01
HAV I
2/05
HBV III
1/97, 2/02, 2/05
Serology II
1/96, 1/04
HCV III
1/00, 2/01, 2/02
Chronic viral I
2/01
Alcoholic I
2/02
Cirrhosis II
1/97, 1/05
Portal hypertension I
1/05
Jaundice IIII
2/97, 2/98, 2/99, 2/00
Cholelithiasis I
2/02
Pancreas
Acute pancreatitis IIIII
2/96, 1/98, 2/02, 1/04, 1/05 2/06
Chronic pancreatitis I
2/96
Renal
Calculi IIII
1/95, 1/99, 2/02, 1/06
Renal failure
Hypertensive I
2/96
Acute renal failure I
2/96
66
Pyelonephritis II
1/99, 2/00
Acute tubular necrosis III
1/00, 1/02, 1/06
Obstructive uropathy I
1/00
Analgesic abuse nephropathy I
2/00
Post streptococcal GN I
1/06 2/6
Joints
OA II
1/98, 2/05
OA vs RA I
2/01
RA I
2/05
Gout I
2/05
Musculoskeletal
Fracture healing IIIIIII
1/96, 2/98, 2/00, 2/01, 2/02, 1/03, 1/05
Pathologic factors affecting
Avascular necrosis I
2/01
Environmental
Radiation injury III
1/95, 2/97, 2/03
Thermal burns I
2/95
Air pollution & lung injury I
2/97
Cigarette smoke constituents I
1/01
Smoke effect on lung I
2/03
Heroin I
2/03
Endocrinology
Thyroid
Hyperthyroidism I
2/97
Thyroiditis I
2/98
Grave’s disease I
1/06
IDDM III
1/98, 1/04, 1/06
NIDDM I
1/06
Neurology
Nerve repair III
2/98, 2/00, 1/03
Meningitis I
2/00
Non-bacterial I
1/03
67
Pharmacology Topics
Pharmacodynamics
Agonist vs antagonist IIII
1/98, 2/99, 1/02, 2/03
Antagonists
Mechanisms I
1/95
Reversible vs Irreversible – response curves I
1/96
Potency & Efficacy IIII
2/95, 1/98, 1/05, 1/06
Define
Dose-response II
2/02 2/6
Receptors I
2/96
Interactions I
2/98
Second messengers IIIII
2/98, 2/99, 2/03, 2/04 2/6
Variations in drug responsiveness II
1/04, 1/05
Cellular basis I
1/00
Pharmackinetics
Definition I
2/01 (aspirin)
Volume of distribution IIIIII
1/95, 1/99, 2/00, 2/01, 1/03, 1/06
Vd/Loading dose; TCA OD
Half life IIII
2/95, 2/98, 2/00 2/6
Loading dose I
1/96
Absorption II
2/02, 2/05
First pass effect II
1/97, 1/04
Bioavailability II
2/03, 1/05
Clearance I
1/97
Elimination kinetics IIII
1/99, 2/00, 1/02, 1/06
Elimination I
2/02
Metabolism & influence on dosing I
2/05
Steady state I
2/97
In elderly I
2/04
Biotransformation IIIII
2/96, 2/99, 1/00, 1/03, 2/05
68
Evaluation of new drugs I

2/04
Antibiotics
Mechanisms I
1/00
Resistance II
1/00, 2/05
β-lactams I
1/95
Penicillin III
2/03, 1/05 2/6
Allergy & SEs
Flucloxacillin I
2/99
Cefalosporins III
2/96, 1/02, 2/04
Antiobiotic acting of cell wall I
2/98
Acting on protein synthesis I
2/98
Macrolides IIII
2/95, 1/99, 2/00, 1/05
Azithromycin
Tetracyclines IIII
1/96, 1/98 (PID), 1/03, 1/04
Aminoglycosides III
1/97, 1/99, 2/03
Choramphenicol I
2/97
Quinolones IIIII
2/00, 2/01, 1/03, 1/04, 2/04
Ciprofloxacin I
2/98
Sulfonamides IIII
2/01, 1/02, 1/05 2/6
Antiprotozoals
Metronidazole I
1/98
**Rx of diverticulitis – Metronidazole”
Anti-TB I
1/97
Antivirals I
2/96
Acyclovir II
2/97, 2/00
Opiates II
1/04, 2/05
Bioavailability I
1/95
Toxicity I
2/02
Morphine vs pethidine I
1/98
Pethidine I
2/00
Receptors I
1/99
Fentanyl I
69
1/00
ANS
Atropine I
1/01
Cholinomimetics
Indirect I
2/03
Muscarinic blockers I
2/03
Adrenaline II
2/95, 1/01
Dopamine I
1/97
Atropine II
2/96
Simpathomimetics I
2/05
β-Agonists I
2/03
β-Blockers IIIII
2/98*, 1/99, 2/01, 2/04, 1/06
Atenolol II
2/00, 2/02
Carvedilol I
1/05
Neuro
GA
Thiopentone III
2/99, 2/01, 102
Propofol III
2/99, 1/01, 1/03
Ketamine II
1/01 2/6
Halothane I
2/00
Nitrous oxide II
2/01, 1/06
NM blockers
Suxamethonium IIIII
1/95, 2/99, 2/00, 1/03, 1/06
Non-depolarising muscle relaxants I
1/96
Vecuronium I
2/00
Suxemethonium vs vecuronium I
1/98
LA I
2/04
Lignocaine IIIII
2/99, 1/02, 2/02, 2/04, 1/05
Bupivicaine I
2/01
Topical I
1/06
Antidepressants
TCA
Pharmacodynamics I
2/95
70
MAOIs III
2/96, 1/01, 1/04
SSRIs III
2/98, 1/01, 1/04
TCA vs SSRI I
1/99
Lithium I
2/05
Anticonvulsants I
2/05
Carbamazepine III
2/96, 2/98, 2/02
Phenytoin vs diazepam I
1/98
Phenytoin IIII
1/98, 2/98 (vs diazepam), 1/99, 1/00
Valproate I
1/05
Antipsychotics
Phenothiazines I
2/02
Chlorpromazine I
1/97
Haloperidol II
1/97, 1/98
Olanzepine I
1/06
Side effects I
1/05
Sedative-Hypnotics
Benzodiazepines III
2/00, 2/02, 2/05
Midazolam II
2/99, 2/04
Parkinson’s & movement
Benztropine II
1/01 2/6
Alcohol
Chronic toxicity I
2/02
Methanol I
1/05
CVS
Antiarrhythmics
Sotalol I
2/95
Amiodarone IIII
1/97, 2/99, 1/04, 1/06
Class I II
2/96 2/6
Adenosine IIII
2/96, 2/99, 1/03, 2/05
Antihypertensves
ACEI – captopril IIIII
1/96, 2/98, 2/00 (&AAs), 1/02, 1/03
AIIA I
2/05
71
Nitroprusside I
1/98 “IV control of HT”
Vasodilators – Antianginals
Antianginals II
2/98 (βB), 1/00
Nitrates II
2/02, 2/04
CCBs IIIII
2/96, 1/98, 1/99, 2/02 2/6
Verapamil I
2/01
Diuretics
Frusemide III
2/99, 1/02, 2/04
Anti-failure I
1/00
Cardiac glycosides III
1/04, 2/04, 1/06
NSAIDs etc
Aspirin IIIII
1/95, 1/99, 2/00, 2/01, 2/03
Toxicity I
1/06
Indomethacin II
1/97, 2/01
COX2 inhibitors II
2/03, 1/05
Colchicine I
1/97
Paracetamol III
2/01, 2/04, 2/05
Endocrinology
Insulin III
1/95, 2/04
Oral hypoglycaemics III
1/01, 1/03, 2/03
Glucagon II
2/03, 2/05 (role as antidote)
Corticosteroids
Prednisolone II
2/96, 1/01
Hydrocortisone II
2/97, 2/03
Toxicology
Methods of ↓absorption from GIT I
1/95
Immunisations
Hepatitis immunisation I
1/95
Active vs passive I
2/95
Respiratory
Inhaler I
1/06
Salbutamol III
72
1/95, 1/01
Ipratropium bromide II
2/95, 2/02
Cromoglycate I
2/02
Methylxanthines I
2/02
GIT
TPN I
1/96
Ranitidine vs omeprazole I
2/98
Antiemetics I
1/05
Metoclopramide I
2/01
Laxatives I
2/05
Anticoagulants
Warfarin III
2/97, 2/99, 1/06
Heparin IIIII
2/97, 2/99, 2/00, 1/03, 1/06
Antiplatelet drugs III
2/03, 1/05 2/6
Vit K I
1/06
Thrombolysis I
2/99
Streptokinase vs t-PA I
2/98
Pregnancy & lactation II

2/98, 1/00
Age III
2/98, 1/00, 2/04
Histamine
H1 & H2 antagonists I
1/02
H2 antagonists I
1/04
H1 antagonists I
2/04
NO donors etc
Nitric acid I
1/05
Ergot alkaloids
Anti-migraine I
2/05
73
Physiology Viva History

Basic
Resting membrane potentials II
1/95, 2/98
Transport across cell membranes IIII
2/98, 2/01, 1/03, 2/05
Diffusion II
2/95, 2/98
Body fluid compartments I
2/96
Electrolyte composition of body fluids I
2/96
Protein synthesis II
2/01, 2/05
IC communication II
2/01, 2/05
cAMP I
1/03
Neurology
AP III
1/03, 1/04, 1/05
Nerve cell conduction
Ion flux III
1/96, 2/99
Electrophysiology I
1/01
Ions & fibre type II
1/00, 2/01
Sensory pathways III
1/95, 1/99, 2/00
Motor pathways I
2/00
Stretch reflex IIIIIII
2/95, 1/00, 2/01, 1/04, 1/05, 1/06 2/06
Visual pathway II
2/95, 1/99
Nerve types & function II
1/96, 1/00
Cholinergic synaptic transmission III
2/99, 2/02, 2/04
NA synaptic transmission III
2/99, 2/02, 2/04
ADH/vasopressin II
1/02, 2/03
Temperature regulation I
2/05
Muscle
Contraction/relaxation events
Skeletal muscle IIII
1/96, 1/97, 2/98, 2/02
And length-tension II
2/00, 2/01
Smooth muscle (visceral) I
2/98
NMJ transmission III
1/97, 1/01, 2/04
Excitation-contraction I
74
1/05
Length-tension I
2/00
Circulation
Plasma composition I
1/95
Autoregulation I
1/95
Cerebral I
1/98
Pressure/flow/resistance II
1/95, 2/05
Laminar flow (Reynolds) I
1/99
AP & contraction IIII
2/98, 2/00 (V), 1/02 (V), 2/05
Cardiac cycle IIIIIII
1/95, 1/97, 1/00, 2/01, 2/02, 2/03, 1/05
Factors controlling CO IIIIII
2/95, 1/00, 2/01, 2/02, 2/03, 1/04
Their interaction with control of BP I
2/98
Factors influencing contractility (Frank-Starling) III
2/95, 2/97, 1/06
Effect of exercise II
1/96, 1/99
Capillary fluid exchange II
1/96, 2/98
Chemoreceptors I
2/96
Baroreceptors II
2/96, 2/04
Conducting system of heart I
1/97
BP control
Medulla II
2/97, 2/98
Neural II
2/00, 2/01
Humoral I
2/04
Arteriolar tone
Neural I
2/03
Humoral I
2/03
Local I
2/03
Jugular pulse I
1/98
Coronary blood flow IIII
1/98, 2/99, 1/01, 1/06
Cerebral blood flow IIII
2/99, 1/01, 1/02, 2/05
Pressure Δ in aorta & LV I
1/98
Law of Laplace I
1/99
Pacemaker potentials IIIII
75
1/99, 2/00, 1/02, 1/03, 1/04

SA node
Effect of infusion of IL N. Saline III
2/99, 1/01, 2/02
Cardiovascular response to overload I
1/05
Effect of loss of IL N. Saline III
2/99, 1/01, 2/02
Cardiovascular response to shock I
1/05
Factors affecting CVP I
2/03
Endothelium & blood flow regulation I
2/04
ECG I
1/06
Respiratory
Alveolar stability IIII
1/95, 2/97, 2/99, 2/05
Lung volumes I
2/95
Dead space III
1/95, 1/97, 2/04
Oxygen dissociation curve II
1/95, 2/99
Alveolar gas equation IIII
2/95, 2/99, 1/01, 1/02
Control of ventilation IIIIII
1/96, 2/00, 2/01, 2/02, 2/04, 1/05
Neural I
2/98
Humoral I
2/98
Effect of posture on V/Q I
1/96
CO2 transport IIIIIII
2/96, 1/99, 2/99, 1/01, 1/02, 1/03, 1/06
O2 transport II
2/96, 1/06
Regional differences in V & Q IIIIIIIII
1/97, 2/99, 2/00 x 2, 1/01, 2/01 x 2, 2/02, 1/05
Intrapleural P & lung volume ⇒ regional diff V I
2/03
Factors that determine pulmonary blood flow II
1/04 2/06
Compliance III
2/97, 1/01 2/06
Diffusion
Perfusion limited II
1/98, 2/03
Diffusion limited II
1/98, 2/03
Exercise III
2/98, 1/00, 2/04
Pressure changes in inspiration & expiration I
1/99
Pulmonary circulation II
2/99 2/06
76
Gas transfer across capillary II

2/99, 1/06
Altitude III
1/00, 1/03, 1/05
Work of breathing I
2/03
Draw lung volume curve at normal & maximal respiration I
1/04
Respiratory compensation for acid-base & other functions I
2/05
Davenport diagram I
2/05
Airway resistance I
1/06
Renal
Renal blood flow IIIII
1/95, 1/02, 2/04, 2/05 2/6
Buffers II
1/95, 2/05
Dilute urine I
1/96
H secretion III
2/96, 1/05 2/6
K secretion IIII
2/96, 2/98, 2/04, 1/06
Na secretion IIII
2/98, 1/04, 1/05, 1/06
Na & Cl I
2/00
Water excretion I
1/06
Respiratory acidosis I
1/97
Respiratory alkalosis I
1/97
Metabolic acidosis II
1/98, 1/00
Metabolic alkalosis II
1/98, 1/00
Glucose reabsorption II
2/97, 2/98
Osmotic diuresis I
2/97
Regulation of osmolality* III
2/99, 2/02, 2/04
Factors affecting GFR III
1/03, 1/05, 1/06 (general discuss GF)
Acid secretion I
1/03
Response to acute moderate haemorrhage I
1/04
Response to acid load I
1/04
Loop of Henle structure & function I
2/05
Endocrinology & Metabolism

Renin-angiotensin system IIIIII
2/95, 1/97 x 2, 2/01, 1/03, 2/03
77
Factors determining BSL III

2/96, 1/00, 1/04
Glucose homeostasis I
1/05
CHO homeostasis in exercise I
2/96
Fatty acids metabolism I
1/97
Protein metabolism I
1/97
Effects of insulin II
2/97, 1/06
Regulation of insulin secretion I
1/03
Glucagon I
2/97
Noradrenaline I
1/98
Adrenaline I
1/98
Glucocorticoid III
1/99, 2/01, 2/05
Erythropoietin I
1/99
Thyroid III
1/00, 2/02, 1/05
Ca metabolism IIII
2/00, 2/02, 2/04, 1/06
Dihydrocholecalciferol I
1/98
PTH I
1/98
Mineralocorticoid I
2/01
Adrenal medullary hormones III
1/02, 2/04, 1/06
Endocrine pancreas I
2/02
Aldosterone I
2/03
Pituitary hormones I
1/05
GIT
Gastric motility & emptying I
2/97
Regulation of gastric secretion IIII
2/97, 2/00, 1/02, 1/06
Exocrine pancreas II
2/00, 2/05
Bilirubin & bile III
2/00, 1/02, 1/06
Fe II
2/00, 2/04
Digestion & absorption of
CHO I
2/03
Proteins & nucleic acid I
2/03
Lipids I
2/03
78
ACEM I VIVAS
Here is a selection of viva questions that are similar in style to the ones you will get in the
exam. Many of them are based on past questions, and I have tried to include all the
common questions that have come up over the last few years. Some of the questions are
intentionally difficult, and I have marked them as “5th Question”, just to reassure you just in
case you didn’t feel the question was fair.
Go through these questions on your own, or with your study partner, and practise getting
the answers out succinctly, bearing in mind you have 2 minutes per question. Try and
categorise your answers, to make it easier for the examiners to give you the marks. For
example, if they ask you the causes of a particular disease, pause and think before
blurting the first thing that comes into your mind. Try and give the most common things
first, and leave the obscure answers for the end. It is the common points that will get you
the marks.
If you are asked a question that you really have no idea about, just say, “I’m sorry, I don’t
know the answer to that”. The examiners will either prompt you, and give you a small clue
as to what they want, or they will move onto another question. Remember, the examiner is
there to try and get you through, and if you are struggling, it will be in your best interests to
move onto something that you can score marks on. The examiner will have an eye on the
clock, as it will be his/her responsibility to get you through to the 5th question.
In the viva, there will be two examiners, one asking the question, and one marking your
answers. Try and be confident, and maintain eye contact with the examiner asking the
questions, but also remember to acknowledge the other examiner as well.
79
ANATOMY VIVAS
80
ACEM PRIMARY VIVA QUESTIONS
SUBJECT: ANATOMY
TOPIC: Upper limb
Question What structures pierce clavipectoral Marks

fascia?
Points 1. Cephalic vein (in)
Required
2. Lymphatic vessels (in)
3. Lateral pectoral nerve (out)
4. Thoracoacromial trunk (out)
Describe nerve supply to forearm and
hand
1 .Flexors – median N, except FCU and
ulnar half of FDP which are supplied by
ulnar, Extensors – radial N
2. Intrinsic muscles of hand – ulnar N,
EXCEPT lateral two lumbricals, opponens
pollicis, abductor pollicis brevis, and flexor
pollicis brevis – LOAF – median N
81
SUBJECT: ANATOMY
TOPIC: Axillary Artery
Question What are the branches of the axillary Marks

artery?
Points Pec minor splits the artery into 3 parts
Required
Axillary A commences at lateral border of
first rib and ends at inferior border of teres
major
1st part gives 1 branch – superior thoracic
2nd part gives 2 branches – acromio-

thoracic, lateral thoracic
3rd part gives 3 branches – subscapular

artery, ant & post circumflex humerals
Mnemonic - SALSAP
2nd Question What is the significance of the scapular

anastomosis?
Scapular anastomosis bring the
subclavian, axillary and upper intercostal
arteries into contact.
They allow adequate perfusion to upper
limb when there is any occlusion to the
main trunk.
Subclavian gives 2 branches to the
anastomosis – suprascapular, and deep
branch of transverse cervical. These
anastomose with the subscapular artery.
82
SUBJECT: ANATOMY
TOPIC: Axilla
Question Define the boundaries and contents of Marks

the axilla
Points Axilla is a pyramid shaped space
Required
Boundaries – medially – ribs, serratous
anterior, laterally – intertubercular sulcus,
anteriorly – pec major, minor, subclavius,
posteriorly – subscapularis, lat. dorsi
tendon, teres minor.
Floor – suspensory ligament,

Apex is convergence of 1st rib, clavicle,
and posterior triangle of neck which it
communicates with
Contains lymph nodes, fat, axillary

vessels, cords of brachial plexus, named
in relation to the axillary artery.
What is the arrangement of muscles in

the intertubercular sulcus?
Long head of biceps. Latissimus dorsi,
teres major, and pectoralis major. Long
head of biceps occupies the groove. Pec
major inserts into lateral lip, teres major
the medial lip, and lat dorsi into the floor.
Mnemonic – Lady Dee lies in bed
between two majors.
83
SUBJECT: ANATOMY
TOPIC: Radial N
Question Describe the course of the Radial N Marks

Points Branch of posterior cord of the brachial
Required plexus.
Enters posterior compartment with
profunda brachii artery between medial
and long head of triceps below teres
major.
It then enters spiral groove between
lateral and medial heads of triceps.
Pierces lateral intermuscular septum to
enter anterior compartment, descending
between brachialis and brachioradialis.
84
SUBJECT: ANATOMY
TOPIC: Shoulder joint and rotator cuff
Question Describe stabilizing features of Marks

shoulder joint. Use model scapula and
humerus.
Points 1. Shoulder is a synovial ball and socket.
Required
2. Stability - bony, ligamentous and
muscular.
3. Bony – deepening of glenoid cavity by
labrum. Coracoacromial arch.
4. Ligamentous – glenohumeral – 3 thick
bands between labrum and humerus,
coracohumeral – strong, from coracoid
process to greater tubercle
5. Muscular – rotator cuff – name all
muscles. Tendons fuse with lateral
capsule
6. Long heads of biceps and triceps splint
the joint
85
SUBJECT: ANATOMY
TOPIC: Rotator Cuff Muscles
Question Describe the attachments and actions Marks

of rotator cuff muscles
Points 1. Supraspinatus – origin – supraspinous
Required fossa, inserts to the superior facet of
greater tuberosity of humerus. Action –
initiates abduction, stabilises shoulder.
Suprascapular N
2. Infraspinatus – origin – Infraspinous
fossa, inserts into middle facet of the
greater tuberosity of humerus, laterally
rotates arm
3. Teres Minor – Origin is above teres
major, lat. Border of scapula. Inserts into
inferior facet of greater tuberosity, lateral
rotator supplied by axillary N
4. Subscapularis – Subscapular fossa,
inserts into lesser tuberosity of humerus,
medial rotator, supplied by upper and
lower subscapular N
Mnemonic : SITS
86
SUBJECT: ANATOMY
TOPIC: Cubital fossa/humerus
Question Name boundaries and contents of the Marks

cubital fossa
Points 1. Lateral - brachioradialis
Required
2. Medial – pronator teres
3. Superiorly – interepitrochlear line
4. Floor – brachialis and supinator
5. Roof – deep fascia of forearm, median
cubital vein
6. Contents – TAN – from lat to medial
- biceps tendon, brachial artery, median N
Which nerves can be damaged by
fractured humerus?
1. Axillary N in quadrangular space
2. Radial N in radial groove as it winds
around shaft of humerus
3. Ulnar N as it passes posterior to medial
epicondyle
4. Median N in supracondylar #
87
SUBJECT: ANATOMY
TOPIC: Elbow articulations
Question Describe the bony articulations and Marks

movements of elbow joint. (use model
elbow)
Points 1. Three articulations – humero-ulnar,
Required between trochlea and trochlea notch –
hinge (flex/ext)
2. Humero-radial – capitulum, and radial
head – ball and socket (flex/ext)
3. Radio-ulnar, radial head & radial notch
of ulna – pivot – (pronation/supination)
4. Bonus – axis of rotation in pronation
supination
88
SUBJECT: ANATOMY
TOPIC: Forearm flexors
Question Name the insertions of the forearm Marks

flexors.
Points 1. FCR – bases of 2nd and 3rd metacarpal
Required via groove in trapezium
2. FCU – pisiform, hook of hamate, base
of 5th MC
3. FDS – sides of middle phalanges of
medial 4 fingers
4. FDP – Distal phalanges of medial 4
fingers, tendon to index finger separates
early
5. Flexor pollicis brevis – base of prox
phalanx of thumb
6. Flexor pollicis longus – base of distal
phalanx of thumb
89
SUBJECT: ANATOMY
TOPIC: Carpal tunnel
Question Name the carpal bones on XR wrist/ Marks

hand
Points 1. Scaphoid, lunate, triquetrum, pisiform,
Required hamate, capitate, trapezoid, trapezium
Which carpal bones provide
attachment to flexor retinaculum, and
what passes through it?
1. Hook of hamate, lateral ridge of
trapezium
2. Pisiform, scaphoid tubercle
3. Contents – long flexors (bonus for FDP/
FDS arrangement), median nerve
90
SUBJECT: ANATOMY
TOPIC: Forearm
Question Define the space of Parona, and it’s Marks

th
clinical significance (this is a 5 Q!)
Points 1. Parona’s space is located deep in the
Required distal forearm between the pronator
quadratus muscle and the flexor digitorum
profundus tendons.
2. This space is contiguous with the radial
bursa, ulnar bursa and midpalmar space.
Infections in these spaces may follow
haematogenous spread, penetrating
injury or rupture of purulence from a flexor
tendon sheath infection.
91
SUBJECT: ANATOMY
TOPIC: Anatomical snuff box
Question What are the boundaries and contents Marks

of the anatomical snuffbox?
Points 1. Radial side – abductor pollicis longus,
Required extensor pollicis brevis tendons
2. Ulnar side – extensor pollicis longus
tendon
3. Contents – radial art. Radial N, tendons
of extensor carpi radialis longus and
brevis
92
SUBJECT: ANATOMY
TOPIC: Median N
Question Describe the course of the Median N Marks
Points Median N is formed by 2 roots – lateral

Required and medial cords of the brachial plexus
Initially the nerve lies lateral to the
brachial artery, and crosses anterior to the
artery to lie medial, as it descends into
cubital fossa.
Leaves the cubital fossa by passing under
the two heads of pronator teres
93
SUBJECT: ANATOMY
TOPIC: Tendons of hand
Question Describe the arrangement of muscles Marks

and tendons attached to middle finger.
Points Long flexors, extensor, second lumbrical,
Required interossei and adductor pollicis
FDP into base of distal phalanx. FDS
splits to allow FDP to pass through it.
FDS inserts into lateral base of middle
phalanx.
Single extensor attacheched to extensor
expansion/hood which sends slips to
bases of all 3 phalanges.
Lumbricals arise from profundus tendon,
passing laterally to digit, and inserted into
the extensor expansion.
Middle finger has no palmar interosseous
muscle attached to anterior border,
instead it receives transverse head of
adductor pollicis.
Two dorsal interossei insert into extensor
expansion and base of prox. phalanx.
94
SUBJECT: ANATOMY
TOPIC: Femoral triangle

of the femoral triangle?
Points Superior – inguinal ligament
Required Medial – Adductor longus (lateral edge)
Lateral – Sartorius (medial edge)
Roof – Fascia Lata
Floor – Iliacus, psoas tendon, pectineus,
adductor longus
Contents – from lateral to medial
Femoral N, artery, vein.
Mnemonic – NAVY
95
SUBJECT: ANATOMY
TOPIC: Femoral Sheath
Question What is the femoral sheath, and what Marks

does it contain?
Points Continuation of extraperitoneal fascia,
Required cylindrical structure that extends
approximately 30mm inferior to the
inguinal ligament.
It contains the femoral artery, vein, and
femoral canal which contains lymphatics.
N.B – it does not contain Femoral N
What is contained in the femoral
canal?
Medial part of sheath
Contains fat, lymph vessels and the
lymph node of Cloquet
96
SUBJECT: ANATOMY
TOPIC: Hunters Canal

of the canal of Hunter (Adductor Canal)
Points It is the “canal” formed under the middle
Required third of sartorius in the thigh. Ends at the
adductor hiatus, which is an opening in
the adductor magnus muscle, through
which go the vessels to the popliteal fossa
Anterior – Sartorius
Posterior – adductor longus and magnus
Lateral – vastus medialis
Contents –
Femoral vessels (becoming popliteal
vessels)
Superficial femoral artery
Femoral vein
Saphenous N
N to vastus medialis
97
SUBJECT: ANATOMY
TOPIC: Hip Joint
Question What type of joint is hip, and what Marks

factors provide stability?
Points Synovial ball and socket
Required
Bony – snug fit of femoral head and
acetabulum, deepened by labrum
Ligament – ileofemoral, ischiofemoral,
pubofemoral
Muscular – Piriformis, obturator internus,
gemelli, quadratus femoris.
98
SUBJECT: ANATOMY
TOPIC: Sciatic N
Question Describe course and surface markings Marks

of Sciatic N.
Points Largest N in the body. Emerges from
Required greater sciatic foramen distal to piriformis,
under cover of gluteus max, crosses
posterior ischium, crosses obturator
internus (and gemelli), quad femoris and
descends on adductor magnus. It lies
deep to hamstrings and crossed only by
long head of biceps. It divides into tibial
and common peroneal N
Surface Marking – midpoint between
ischial tuberosity and greater trochanter of
femur, vertically down to the apex of
popliteal fossa.
99
SUBJECT: ANATOMY
TOPIC: Pelvis
Question What are the boundaries and which Marks

structures pass through the greater
and lesser sciatic foramina?
Points GSF – superior/ant – greater sciatic notch
Required Posterior – sacrotuberous ligament
Inferior – sacrospinous ligament & ischial
spine.
Structures passing through GSF
Piriformis
Superior gluteal vessels and N
Inferior gluteal vessels and N
Sciatic N
Post. Cut N to thigh
N to Quadratus femoris and obturator int.
LSF – ant – ischium body and
sacrospinous ligament
Posterior – sacrotuberous ligament
Structures passing through LSF
Tendon of obturator internus
N to obturator internus
Pudendal N
100
SUBJECT: ANATOMY
TOPIC: Knee
Question Describe the bursae around the knee Marks

joint. Which are in direct
communication with the knee?
Points There are approx 12 bursae in the region
Required of the knee.
Three communicate with the joint.
Suprapatellar (Quad) bursa, popliteus,
medial gastrocnemius
Three others - prepatellar bursa
anteriorly, and superficial and deep
infrapatellar bursae on the sides of
ligamentum patellae.
There are also bursa around
semimembranosus and around the
collateral ligaments
101
SUBJECT: ANATOMY
TOPIC: Popliteal Fossa
Question Describe the boundaries and contents Marks

of the popliteal fossa
Points Laterally – biceps femoris and lateral
Required head of gastrocnemius
Medially – semimembranosus/tendinosus
and medial gastrocnemius
Roof –skin and superficial and deep
fasciae
Floor – popliteal surface of femur, capsule
of knee, and fascia covering popliteus
Contents – Connective tissue, lymph
nodes, popliteal artery and vein, terminal
branches of sciatic nerve – tibial nerve
and common peroneal nerve
102
SUBJECT: ANATOMY
TOPIC: Ankle
Question Describe the major ligaments of the Marks

ankle joint
Points Medial ligament (deltoid)
Required Superficial – navicular (ant), calcaneum
(central), talus (posterior)
Deep - talus
Lateral ligament –
1) anterior talofibular ligament
2) calcaneofibular ligament
3) posterior talofibular ligament
Which structures pass posterior to
medial malleolus?
Tibialis posterior
Flexor digitorum longus
Posterior tibial artery
Venae comitantes
Tibial N
Flexor Hallucis longus
103
SUBJECT: ANATOMY
TOPIC: Foot
Question Describe the layers of the sole (from Marks

superficial to deep)
Points 1) Abductor hallucis, abductor digiti
Required minimi, flexor digitorum brevis
2) Quadratus plantae, lumbricals, tendons
of FDL and FHL
3) Flexor hallucis brevis, adductor
hallucis, flexor digiti minimi
4) Interossei, tendons of tibialis posterior
and peroneus longus
Neurovascular plane between 1 & 2
Describe the arches of the foot
104
SUBJECT: ANATOMY
TOPIC: Foot
Question Describe the tendon insertions into the Marks

foot from the posterior and lateral
compartments of the lower leg.
Points Gastrocnemius - calcaneus
Required Plantaris - tendocalcaneus
Soleus - tendocalcaneus
FDL – base of distal phalanges of lat 4
toes
FHL – base of distal phalanx big toe
Tibialis Posterior – navicular & tarsal
bones
Peroneus brevis – base of 5th MT
Peroneus longus – base of 1st MT, med
cuneiform
105
SUBJECT: ANATOMY
TOPIC: First Rib
Question Describe the anatomy of the first rib Marks

Points First rib is flat, shortest and most curved
Required of all the ribs. Head articulates with body
of T1.
Most important landmark – scalene
tubercle – attachment of scalenus
anterior.
Scalenus medius attaches posteriorly.
Subclavian vein passes anterior to
tubercle
Subclavian artery passes posterior to
tubercle
106
SUBJECT: ANATOMY
TOPIC: Heart – blood supply
Question Describe the blood supply to the heart Marks

Points R & L coronary arteries which come off the
Required ascending aorta.
RCA from anterior aortic sinus, supplies SAN
in 60%. Main branch is marginal artery –
supplies RV
LCA from L posterior aortic sinus. Gives off
the LAD. LCA becomes circumflex supplies
SAN in 40%
Describe venous drainage of heart
Dual drainage 2/3 via coronary sinus and
anterior cardiac veins into RA
1/3 directly into all chambers of the heart
via small venae cordis minimae
Coronary sinus receives
Great cardiac vein – runs with LAD
Middle cardiac vein – runs in inf AV
groove
Small cardiac vein – runs with RMA
Oblique vein – across posterior aspect of
LA
107
SUBJECT: ANATOMY
TOPIC: Thoracic wall
Question What are the landmarks for chest drain Marks

insertion?
Points 4th intercostal space, anterior axillary line,
Required just superior to 5th rib
What layers does a chest drain go
through?
Skin
Subcutaneous fat
Deep fascia
Serratus anterior
Ext intercostal
Internal intercostal
Innermost intercostal
Endothoracic fascia
Parietal Pleura
108
SUBJECT: ANATOMY
TOPIC: Diaphragm
Question What goes through the openings in the Marks

diaphragm, and at which levels?
Points Three openings
Required
T8 – inf vena cava, R phrenic N,
lymphatics
T10 – Oesophagus, vagus N, L gastric
vessels, lymphatics
T12 – Aorta, azygous vein, thoracic duct
Describe the course of the thoracic
duct
Continuation of cisterna chyli, goes
through T12 with aorta.
Drains abdomen, lower limbs, L head and
neck. Drains into L brachiocephalic V
Ascends posteriorly to oesophagus,
crosses to L at T5. Then exits root of neck
and enters L brachiocephalic vein
109
SUBJECT: ANATOMY
TOPIC: Posterior abdominal wall
Question Describe the course of the ureters Marks

Points Commence in renal pelvis.
Required Retroperitoneal for entire course
In the abdomen, the descend vertically
anterior to psoas major
At pelvic brim, ureters pass anterior to ext
iliac artery.
Pelvic ureter descends posteriorinferiorly
anterior to internal iliac arteries, then
curves anteromedially to enter
posterolateral bladder
What structures do the ureters cross?
Prior to entering bladder, ureters are
crossed anteriorly by vas deferens/uterine
artery
Each ureter crossed by gonadal artery
and vein
Genitofemoral N passes behind ureter
110
SUBJECT: ANATOMY
TOPIC: Abdominal CT, axial view at L1
Question Name the structures in axial scan at Marks

the level of L1
Points Spleen
Required Pancreas
Liver
Stomach
Kidneys
Aorta
Inferior Vena Cava
Splenic vein
Renal vessels
L1 vertebral body
111
SUBJECT: ANATOMY
TOPIC: Blood supply to the Gut
Question Describe blood supply to the stomach Marks

Points Stomach is foregut – supplied by coeliac
Required trunk.
Lesser curve supplied by R & L gastric
arteries.
Greater curve supplied by R & L
gastroepiploic arteries
Fundus supplied by short gastric arteries
Describe blood supply to the colon
1st part Colon is midgut – supplied by
SMA (ileocaecal junction to splenic
flexure)
2nd part is hindgut – supplied by IMA
(splenic flexure to anus)
SMA branches – ileocolic, R colic, middle
colic
IMA – L colic, sigmoid arteries, superior
rectal
112
SUBJECT: ANATOMY
TOPIC: Abdominal Aorta
Question Describe the course of the abdominal Marks

aorta
Points Commences in midline as it passes
Required through diaphragm at T12. Runs in
retroperitoneum, in front of lumbar
vertebrae then bifurcates slightly to the L
of the midline at L4
Describe the branches of the
abdominal aorta
Coeliac axis – L1
SMA – L1
IMA – L3
Inf phrenic arteries – T12
Suprarenal arteries – L1
Renal arteries – between L1 & L2
Gonadal arteries – L2
4x paired lumbar arteries, L1,2,3,4
113
SUBJECT: ANATOMY
TOPIC: Triangles of the Neck

of the posterior triangle of the neck?
Points Anterior – sternocleidomastoid
Required Posterior – trapezius
Inferior – middle third of clavicle
Roof – Investing layer of deep cervical
fascia
Floor – Pre-vertebral fascia
Nerves – spinal accessory N, cervical
plexus, brachial plexus (trunks)
Arteries – third part of subclavian,
transverse cervical, suprascapular artery,
occipital artery
Veins – EJV
Lymph nodes
114
SUBJECT: ANATOMY
TOPIC: Fascial layers of the neck
Question Describe the deep fascia of the neck Marks

Points Investing layer - deep to platysma.
Required Encloses sternocleidomastoid and
trapezius
Pre-vertebral layer surrounds vertebral
column and associated muscles
Pre-tracheal layer surrounds trachea,
oesophagus and thyroid gland
Carotid sheath surrounds carotid artery
medially, IJV laterally, and vagus N.
Also contains lymph nodes and ansa
cervicalis.
115
SUBJECT: ANATOMY
TOPIC: Anterior Neck
Question What layers are traversed for Marks

tracheostomy?
Points Skin
Required Subcutaneous fat
Platysma
Investing layer of deep cervical fascia
Strap muscles
Pre-tracheal fascia
Thyroid isthmus
Trachea
116
SUBJECT: ANATOMY
TOPIC: Sensory supply to face
Question Describe the sensory supply to the Marks

face
Points Skin of face and head is supplied by the
Required trigeminal N and branches of the cervical
plexus
Parotid and angle of jaw supplied by
greater auricular N
Trigeminal N – 3 divisions
Ophthalmic - sensation to forehead,
upper lid, eye, anterior nose
Maxillary – sensation to cheek, lower lid,
lateral nose, upper teeth, upper lip
Mandibular – mandible, lower teeth and
lip, temporal skin, lower oral cavity
Describe motor supply to face
Muscles of expression supplied by facial
N (VII), mastication supplied by motor root
of trigeminal (V)
117
SUBJECT: ANATOMY
TOPIC: Structure of Eye, and drainage
Question Identify parts of the eye from this Marks

model
Points Cornea
Required Iris
Sclera
Choroid
Retina
Optic N
Vitreous body
Aqueous Humour
Describe the drainage of fluid from the
eye
Ciliary body secretes aqueous humour
into posterior chamber, this then passes
into the anterior chamber and is
reabsorbed into the sinus venosus
sclerae
118
SUBJECT: ANATOMY
TOPIC: Orbit
Question Which bones form the walls of the Marks

orbit?
Points Superior – Frontal bone
Required Inferior – Maxilla
Lateral – Zygoma
Medial – lacrimal and ethmoid
Posterior – both wings of sphenoid
Name the extraocular muscles and
their nerve supply
Medial Rectus (III)
Lateral Rectus (VI)
Superior Rectus (III)
Inferior Rectus (III)
Inferior Oblique (III)
Superior Oblique (IV)
Mnemonic – LR6SO4
119
SUBJECT: ANATOMY
TOPIC: External Carotid
Question What are the branches of the ext Marks

carotid artery?
Points Ascending pharyngeal
Required Superior thyroid
Lingual
Facial
Occipital
Posterior Auricular
Superficial temporal
Maxillary
120
SUBJECT: ANATOMY
TOPIC: Foramina of Skull
Question Look at the base of this skull and Marks

identify the foramina and structures
that pass through them
Points Foramen Ovale – Mandibular division of
Required trigeminal N
Carotid canal – Internal carotid artery
Jugular foramen – IJV (inf petrosal and
sigmoid sinuses)
Stylomastoid foramen – facial N,
stylomastoid artery
Foramen magnum – Spinal roots of
accessory N, ant & post spinal and
vertebral arteries
Foramen spinosum – middle meningeal
vessels
Foramen lacerum – internal carotid artery
(passes into foramen lacerum from
carotid canal)
121
SUBJECT: ANATOMY
TOPIC: Vertebrae
Question Describe features of C/T/L spine Marks

Points Cervical – small bodies, bifid spines,
Required foramen transversarium
Thoracic – heart shaped bodies, upper
and lower demifacets, long transverse
processes with facet for rib tubercles, long
down-turned spine
Lumbar – massive body, large transverse
process, triangular vertebral canal, large
backward projecting spines
Name layers traversed for lumbar
puncture
Skin
Subcutaneous fat
Deep fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Dura mater
Arachnoid mater
122
PATHOLOGY VIVAS
123
SUBJECT: PATHOLOGY
TOPIC: Cellular Adaptations
Question What is hypertrophy? Marks

Points This refers to an increase in size of cells,
Required resulting in increase in size of organ. No
new cells, just larger ones. Due to
increased functional demand.
Physiological example – skeletal, cardiac
muscle due to increased workload i.e
training. Also uterus during pregnancy.
Pathological – Heart failure/
cardiomyopathy
What is hyperplasia?
Increase in number of cells of a tissue or
organ.
Physiological - hormonal e.g breast in
puberty, compensatory, e.g liver
hyperplasia after hepatectomy
Pathological – excess hormonal
stimulation , or growth factors –
endometrial hyperplasia, prostate
hyperplasia
Pathologic hyperplasia provides a fertile
soil in which cancerous proliferation may
arise.
124
SUBJECT: PATHOLOGY
TOPIC: Apoptosis
Question What is apoptosis? Marks

Points Apoptosis is a pathway of cell death that
Required is induced by a tightly regulated
intracellular program in which cells
destined to die activate enzymes that
degrade the cells' own nuclear DNA and
nuclear and cytoplasmic proteins.
Physiological causes – endometrial cell
breakdown during menstruation
Regression of lactating breast after
weaning
Pathologic causes – radiation, cytotoxic
anticancer drugs, viral hepatitis, neoplasia
Morphology
Cell shrinkage
Chromatin condensation
Cytoplasmic blebs and apoptotic bodies
Phagocytosis of apoptotic bodies by
macrophages
Initiation phase – caspases
Execution phase – enzymes cause death
125
SUBJECT: PATHOLOGY
TOPIC: Hypersensitivity
Question Discuss Type 1 Hypersensitivity Marks

Points Mediated by IgE directed against specific
Required antigens. Synthesis of IgE requires CD4+,
to produce cytokines that contribute to
responses.
IL4, IL3, IL5, GM-CSF promote production
and survival of eosinophils.
IgE antibodies bound to mast cells. On re-
exposure, allergen binds to IgE and
results in – release of primary mediators,
de novo synthesis and release of
secondary mediators
For Type 1, there are 2 phases
- Initial rapid response within 5 – 30 mins
with primary mast cell mediator response
(histamine)
- Delayed phase with onset 2-24hrs with
inflammatory cell infiltration with tissue
damage, mediated by LTB4, C4, D4, E4,
prostaglandin D2, & PAF .
E.g Asthma, Anaphylaxis
126
Schematic for Type 1 Hypersensitivity

127
SUBJECT: PATHOLOGY

Points Mediated by antibodies vs intrinsic
Required allergens or extrinsic antigens.
Opsonization and complement (C5-9
MAC), NK cells antibody dependent cell
mediated cytotoxicity
Complement and Fc receptor mediated
inflammation – deposition of antibodies in
the ECM
Antibody mediated cellular dysfunction
E.g Goodpastures, Myasthenia Gravis

128
SUBJECT: PATHOLOGY

Points Immune complex mediated by antigen-
Required antibody complexes forming in the
circulation or at sites of antigen
deposition.
Deposition of immune complexes
activates complement cascade and
subsequent tissue damage
C3b – opsonization
C5a – chemotaxis
C3a, 5a – increase vascular permeability
C5-9 MAC mediates cytolysis
Immune complexes aggregate platelets
and activate factor XII (Hageman factor)
E.g Serum Sickness
129

130
SUBJECT: PATHOLOGY

Points Cell mediated type 4 HS is initiated by
Required sensitised T lymphocytes and includes
delayed type hypersensitivity and T cell
mediated cytotoxicity
E.g Mycobaterium tuberculosis, contact
dermatitis.

131
SUBJECT: PATHOLOGY
TOPIC: Complement
Question What is the role of complement in Marks

inflammation?
Points 1. Vascular phenomenon – C3a, C5a –
Required histamine release from mast cells,
increased vasc. permeability
2. C5a activates lipoxygenase pathway –
release of inflammatory mediators
3. C5a – leucocyte adhesion/chemotaxis/
activation
4. C3, C5 activated by proteolytic
enzymes in inflammatory exudate
nd
2 Question Can you draw the complement
cascade?
Refer to Robins.
Schematic diagram showing complement pathway

132
SUBJECT: PATHOLOGY
TOPIC: Thrombosis / role of platelets
Question Describe factors involved in Marks

thrombosis
Points 1. Thrombosis – inappropriate activation
Required of coagulation in uninjured vasculature
2. Virchows triad
Endothelial injury – exposed ECM, TF,

platelets
Turbulent flow/stasis – platelets form

connections with endothelium
Hypercoagulability – Factor V mutation,

Protein C/S def, MI, AF, Cancer,
Prosthetic valves, DIC, Lupus
Describe the role of platelets in clot
formation?
1. Adhesion and shape change – VWF –
bridges between platelet surface and
collagen, VWF glycoprotein 1b
association –strong
2. Secretion of alpha and delta granules,
ADP mediates platelet aggregation
3. Platelet aggregation – TXA2 stimulates
aggregation plus haemostatic plug,
generating thrombin, platelet contraction –
secondary plug, thrombin converts
fibrinogen to fibrin
133
SUBJECT: PATHOLOGY
TOPIC: Reperfusion injury
Question What is the pathological basis of Marks

reperfusion injury?
Points 1. Reperfusion injury leads to apoptosis
Required and necrosis – damage that is additional
to any initial ischaemic damage
2. Reoxygenation – free radicals from
endothelium and leucocytes
3. Free radicals increase MPT
4. Neutrophil influx causes further
damage
5. Complement – IgM deposited in
ischaemic tissue, when flow resumes,
complement proteins blind to IgM and
cause cell injury and inflammation
6. Bonus – contraction band due to
calcium influx during ischaemia – causes
increased contraction on reperfusion
134
SUBJECT: PATHOLOGY
TOPIC: Fracture Healing
Question Describe the stages of fracture healing Marks

Points 1. Haematoma formation – fracture gap
Required filled with fibrin mesh, acute inflammation,
new vessel formation, organization of
haematoma, formation of procallus
2. Procallus converted to
fibrocartilaginous callus, woven bone
formation, fracture ends bridged by bony
callus, weight bearing can be tolerated
3. Osseous callus formation – remodelling
along the line of weight bearing
List factors that affect the healing of
fracture
1. Malalignment
2. Comminution
3. Inadequate immobilization
4. Infection
5. Nutritional status
135
SUBJECT: PATHOLOGY
TOPIC: Wound healing
Question Describe the stages of cutaneous Marks

wound healing
Points 24hrs – neutrophil infiltrate
Required 24-48hrs spurs of epithelial cells move
from wound edges, creating a continuous
epithelial layer
Day 3 – Neutrophils replaced by
macrophages. Invasion of granulation
tissue. Collagen present
Day 5 – incision filled with granulation

tissue. Neovascularization maximal. More
collagen, surface keratinization
Week 2 – Collagen and fibroblast

accumulation. Blanching begins,
regression of vascular channels
End of month 1 – scar made of cellular

connective tissue, intact epidermis.
Tensile strength increasing.
Name factors that affect wound healing

Local – blood supply, denervation,
infection, foreign body, haematoma
Systemic – age, anaemia, drugs (steroid),

hormones, diabetes, cancer, nutritional
state
136
SUBJECT: PATHOLOGY
TOPIC: Inflammation
Question Can you describe the vascular Marks

changes in inflammation.
Points 1. Immediate transient response
Required (histamine, leukotrienes)
2. Delayed response – 2-8hrs (kinins,
complement)
3. Prolonged – direct endothelial injury
(burns)
nd
2 Question Can you list the mechanisms of
increased vascular permeability in
inflammation
1. Endothelial contraction – venules
(histamine)
2. Direct injury (arterioles, capillaries,
venules – burns)
3. Leucocyte dependent injury (venules)
4. Increased transcytosis (venules)
5. Angiogenesis
137
Diagram representing vascular damage in inflammation

138
SUBJECT: PATHOLOGY
TOPIC: Ischaemic injury
Question Describe the mechanism or Marks

pathogenesis of ischaemic injury
Points 1. Ischaemia is the most common type of
Required injury – reduced blood flow, anaemia,
reduced O2 availability. ISCHAEMIA
INJURY IS FASTER THEN HYPOXIA
2. Hypoxic – most common. Loss of
oxidative phosphorylation.
3. Reduced ATP
4. Failure of Na/K/ATPase pump
5. Swelling
6. Reduced protein synthesis
7. Cytoskeleton disperses
8. Loss of micro villi, and formation of
myelin figures
9. Irreversible injury – damage to
mitochondria, membrane, nucleus, ca
influx is a cardinal sign
139
Schematic diagram for mechanisms of cell damage in ischaemia

140
SUBJECT: PATHOLOGY
TOPIC: Septic Shock
Question Discuss the pathogenesis of septic Marks

shock
Points Most cases of septic shock
Required (approximately 70%) are caused by
endotoxin-producing gram-negative bacilli
hence the term endotoxic shock.
Endotoxins are bacterial wall
lipopolysaccharides (LPSs) that are
released when the cell walls are degraded
(e.g., in an inflammatory response). LPS
consists of a toxic fatty acid (lipid A) core
and a complex polysaccharide coat
(including O antigens) unique to each
bacterial species. Analogous molecules in
the walls of gram-positive bacteria and
fungi can also elicit septic shock.
All of the cellular and resultant
hemodynamic effects of septic shock may
be reproduced by injection of LPS alone.
Cytokines and secondary mediators result
in:
Systemic vasodilation
Diminished myocardial contractility
Widespread endothelial injury and

activation
Activation of coagulation system - DIC
Hypoperfusion leads to multiorgan failure

141
SUBJECT: PATHOLOGY
TOPIC: Malaria
Question Describe the pathogenesis of Marks

Plasmodium Falciparum Malaria
Points 1. Transmission by Anopheles Mosquito
Required
2. Sporzoites invade hepatocytes binding
to properdin receptors
3. Muliplication of parasite, release of
merozoites
4. Merozoites bind by lecitin like molecule
to red cell surface molecule
5. In red cells, parasites grow as
trophozoites, hydrolzing zoin pigment
Trophozoites divide to form schizonts
forming new merozoites that lyse host red
cells releasing more parasites
6. Some parasites develop into sexual
forms that infect more mozzies when they
feed
What are the virulence factors of
plasmodium falciparum?
Infects erythrocytes of any age
Ischaemia leading to erythrocyte
adherence to small vessel endothelium
Endothelial adhesion causes splenic
congestion and enlargement, fibrosis.
Liver becomes enlarged
Endothelial adhesion leads to cerebral
malaria, vessels plugged with parasites in
red cells with surrounding haemorrhage
and ischaemia
142
Diagramatic representation of Plasmodium Falciparum Lifecycle.

143
SUBJECT: PATHOLOGY
TOPIC: SARS
Question Discuss SARS (5th Question) Marks

Points 1. Definition – Severe Acute
Required Respiratory Syndrome
2. Dry cough, fever, malaise, less upper
resp tract symptoms
Progression to SOB, pleurisy, 10% die
3. Coronavirus
4. PCR, 29 nucleotide deletion in RNA in

human form compared to animal form –
may enhance pathogenicity
5. Diffuse Alveolar damage

Multinucleated giant cells
Coronavirus within pneumocytes on EM
144
SUBJECT: PATHOLOGY
TOPIC: Staph. Aureus
Question Describe the virulence factors of Marks

Staph. Aureus
Points 1. Surface proteins that allow cell
Required adherence
2. Enzymes that degrade host proteins
promoting invasion and tissue destruction
3. Toxins - haemolysins (vs cell
membranes), exfoliative toxins (skin
sloughing), enterotoxins (vomiting),
superantigens (shock)
nd
2 Question What infections does Staph. Aureus
cause
1. Skin infections
2. Osteomyelitis
3. Food poisoning and pneumonia
4. Endocarditis
5. Toxic shock syndrome
Effects of Staph. Aureus

145
SUBJECT: PATHOLOGY
TOPIC: Salmonella
Question Describe the pathogenesis and main Marks

features of salmonella infection
Points 1. Gram –ve bacteria, self limiting food
Required and waterborne gastroenteritis. Can
become life threatening systemic illness
2. Invades intestinal epithelia, and
macrophages
3. Invasion genes encode proteins
involved in adhesion and recruitment of
host cytoskeleton
4. Neural reflex pathways – increased
epithelial secretion in response
5. Clinically – week 1 – rigors,
bacteraemia
week 2 – rash, abdo pain
week 3 – ulceration, GI
bleed, shock.
146
SUBJECT: PATHOLOGY
TOPIC: Varicella Zoster
Question Describe the pathogenesis of VZV Marks

Points VZV infects mucous membranes, skin,
Required and neurons and causes a self-limited
primary infection in immunocompetent
individuals. Also like HSV, VZV evades
immune responses and establishes a
latent infection in sensory ganglia.
VZV is transmitted in epidemic fashion by
aerosols, disseminates haematogenously,
and causes widespread vesicular skin
lesions. VZV infects neurons and/or
satellite cells around neurons in the dorsal
root ganglia and may recur many years
after the primary infection, causing
shingles.
Localized recurrence of VZV is most
frequent and painful in dermatomes
innervated by the trigeminal ganglia,
where VZV is most likely to exist in a state
of latency.
Morphology
The chickenpox rash occurs
approximately 2 weeks after respiratory
infection and travels in multiple waves
centrifugally from the torso to the head
and extremities. Each lesion progresses
rapidly from a macule to a vesicle
Shingles occurs when VZVs that have
long remained latent in the dorsal root
ganglia after a previous chickenpox
infection are reactivated and infect
sensory nerves that carry viruses to one
or more dermatomes.
147
SUBJECT: PATHOLOGY
TOPIC: Measles
Question Describe the pathogenesis of measles Marks

Points Single stranded RNA virus of
Required paramyxovirus family
Measles virus is spread by respiratory
droplets, initially multiplies within upper
respiratory epithelial cells, and then
spreads to lymphoid tissues, where it can
replicate in mononuclear cells, including
T lymphocytes, macrophages, and
dendritic cells.
Virus then spreads by the blood
throughout the body.
Measles may cause croup, pneumonia,
diarrhoea with protein-losing enteropathy,
keratitis with scarring and blindness,
encephalitis, and hemorrhagic rashes
("black measles") in malnourished
children with poor medical care.
The blotchy, reddish brown rash of
measles virus infection on the face, trunk,
and proximal extremities is produced by
dilated skin vessels, oedema, and a
moderate, non-specific, mononuclear
perivascular infiltrate.
The lymphoid organs typically have
marked follicular hyperplasia, large
germinal centres, and randomly
distributed multinucleate giant cells
148
SUBJECT: PATHOLOGY
TOPIC: Neoplasia
Question Describe the processes involved in the Marks

invasion of ECM by cancer
Points 1. Hallmark of malignant tumour
Required
2. Steps involved detachment – loosening
of tumour cells from each other
- downregulation of E-cadherin
expression, catenin mutation
3. Attachment to matrix components
Laminin fibronectin attachment, integrins
on tumour cells
4. Degradation of ECM
Tumour secretes proteolytic enzyme/
antiprotease balance – serine, cysteine,
MMPs
5. Migration of tumour cells
Autocrine motility factor
149
SUBJECT: PATHOLOGY
TOPIC: Multiple Sclerosis
Question What is the pathogenesis of MS? Marks

Points MS is an autoimmune demyelinating
Required disorder characterized by distinct
episodes of neurologic deficits, separated
in time, attributable to white matter lesions
that are separated in space.
The lesions of MS are caused by a
cellular immune response that is
inappropriately directed against the
components of the myelin sheath.
The available evidence indicates that the
disease is initiated by CD4+ TH1 T cells
that react against self myelin antigens and
secrete cytokines, such as IFN-γ, that
activate macrophages. The demyelination
is caused by these activated
macrophages and their injurious products.
Examination of the CSF in MS patients
shows a mildly elevated protein level, and
in one third of cases, there is moderate
pleocytosis. The proportion of gamma
globulin is increased, and most MS
patients show oligoclonal bands. This
increase in CSF immunoglobulin is the
result of proliferation of B cells within the
nervous system; the target epitopes of
these antibodies are widely variable.
150
SUBJECT: PATHOLOGY
TOPIC: Meningitis
Question Describe the pathogenesis of bacterial Marks

meningitis
Points Meningitis refers to an inflammatory
Required process of the leptomeninges and CSF
within the subarachnoid space.
Infectious meningitis is broadly classified
into acute pyogenic (usually bacterial
meningitis), aseptic (usually acute viral
meningitis), and chronic (usually
tuberculous, spirochetal, or cryptococcal)
on the basis of the characteristics of
inflammatory exudate on CSF
examination and the clinical evolution of
the illness.
Organisms
Neonates – E Coli, group B strep
Elderly – Strep pneumoniae, listeria
Adults – Neisseria meningitidis.
CSF findings – white cells, raised protein,
reduced glucose.
Aseptic – viral, enterovirus. Echovirus,
Coxsackievirus and nonparalytic
poliomyelitis.
NSAIDS and Abx can also cause aseptic
meningitis.
151
SUBJECT: PATHOLOGY
TOPIC: Thiamine deficiency
Question Describe the pathogenesis of thiamine Marks

(B1) deficiency
Points Thiamine is widely available in the diet,
Required although refined foods such as polished
rice, white flour, and white sugar contain
little.
The major targets of thiamine deficiency
are the peripheral nerves, the heart, and
the brain, so persistent thiamine
deficiency gives rise to three distinctive
syndromes -
A polyneuropathy (dry beriberi). The
polyneuropathy is usually symmetric and
takes the form of a non-specific peripheral
neuropathy with myelin degeneration and
disruption of axons involving motor,
sensory, and reflex arcs.
wet beriberi is associated with peripheral
vasodilation, leading to more rapid
arteriovenous shunting of blood, high-
output cardiac failure, and eventually
peripheral oedema. The heart may be
normal, have subtle changes, or be
markedly enlarged and globular (owing to
four-chamber dilation), with pale, flabby
myocardium. The dilation thins the
ventricular walls. Mural thrombi are often
present, particularly in the dilated atria.
Wernicke-Korsakoff syndrome.
Wernicke encephalopathy is marked by
ophthalmoplegia; nystagmus; ataxia of
gait and stance; and derangement of
mental function, characterized by global
confusion, apathy, listlessness, and
disorientation.
152
SUBJECT: PATHOLOGY
TOPIC: Radiation injury
Question Describe the pathological effects of Marks

acute whole body exposure radiation
Points The acute effects of ionizing radiation
Required range from overt necrosis at high doses
(>10 Gy), killing of proliferating cells at
intermediate doses (1 to 2 Gy), and no
histopathologic effect at doses less than
0.5 Gy.
Depending on the dose, four clinical
syndromes are produced
Subclinical or prodromal syndrome - Mild
nausea and vomiting 100% survival
Haematopoietic syndrome - Petechiae,
haemorrhage, Maximum neutrophil and
platelet depression in 2 wk, May require
bone marrow transplant
Gastro-intestinal syndrome - Nausea,
vomiting, diarrhoea
Haemorrhage and infection in 1-3 wk
Severe neutrophil and platelet depression
- Shock and death in 10-14 days even
with replacement therapy
Central nervous system syndrome -
Intractable nausea and vomiting
Confusion, somnolence, convulsions
Coma in 15 min-3 hr - Death in 14-36 hr
153
SUBJECT: PATHOLOGY
TOPIC: Lead Poison
Question Describe features of lead poisoning Marks

Points The toxicity of lead is related to its
Required multiple biochemical effects:
High affinity for sulfhydryl groups.
Competition with calcium ions. As a
divalent cation, lead competes with
calcium and is stored in bone. It also
interferes with nerve transmission and
brain development.
Inhibition of membrane-associated
enzymes. Lead inhibits 5'-nucleotidase
activity and sodium-potassium ion pumps,
leading to decreased survival of red blood
cells (hemolysis), renal damage, and
hypertension.
Impaired production of 1,25-
dihydroxyvitamin D, the active metabolite
of vitamin D.
Describe the clinical syndromes
Injury to the central and peripheral
nervous systems causes headache,
dizziness, memory deficits, and
decreased nerve conduction velocity.
Gastrointestinal symptoms include colic
and anorexia. The kidneys are a major
route of excretion of lead. Acutely, there is
damage to the proximal tubules, with
intranuclear lead inclusions and clinical
evidence of renal tubule dysfunction.
Lead can cause infertility in men due to
testicular injury; failure of implantation of
the fertilized ovum can occur in women
154
SUBJECT: PATHOLOGY
TOPIC: Graves Disease
Question Describe the pathogenesis of Graves Marks

disease
Points Autoimmune disorder in which a variety of
Required antibodies may be present in the serum,
including antibodies to the TSH receptor,
thyroid peroxisomes, and thyroglobulin.
Of these, autoantibodies to the TSH
receptor are central to disease
pathogenesis.
T-cell mediated autoimmunity
Hyperthyroidism owing to hyper-
functional, diffuse enlargement of the
thyroid because of diffuse hypertrophy
and hyperplasia of thyroid follicular
epithelial cells.
Infiltrative ophthalmopathy with resultant
exophthalmos
Localized, infiltrative dermopathy,
sometimes called pretibial myxedema,
which is present in a minority of patients
Laboratory findings in Graves disease
include elevated free T4 and T3 levels
and depressed TSH levels.
155
SUBJECT: PATHOLOGY
TOPIC: Aortic dissection
Question What is aortic dissection Marks

Points Dissection of blood along the laminar
Required planes of aortic media, forming an
intramural blood filled channel, causing
sudden haemorrhage and death.
It is NOT usually associated with with pre-
existing dilation.
Causes – hypertension (90% of
dissections)
Connective tissue defects – marfans –
cystic medial degeneration
Complications – rupture, extension to
great arteries in neck, and retrograde
dissection of coronary arteries
Type A, and B
156
SUBJECT: PATHOLOGY
TOPIC: Atherosclerosis
Question Describe the pathogenesis of Marks

Atherosclerosis
Points Chronic endothelial injury
Required
Accumulation of LDL in vessel wall
Oxidation of LDL
Adhesion of monocytes, transformation to
macrophages, and then foam cells
Adhesion of platelets
Release of factors from activated
platelets, macrophages or vascular cells,
causing migration of smooth muscle cells
from media to intima
Proliferation of SMC and accumulation of
lipids
Outcomes include rupture, haemorrhage,
thrombus formation, aneurysmal dilation.
Pathogenesis of atherosclerosis
157
SUBJECT: PATHOLOGY
TOPIC: Aneurysms
Question What is an aneurysm and what types Marks

are there?
Points Aneurysms are focal abnormal vascular
Required dilations.
Two types – true and false (see below)
True is bound by all three vessel layers
False is an extravascular haematoma that
communicates with the intravascular
space
Causes – atherosclerosis, cystic medial
degeneration, syphilis, trauma, infection
Diagram illustrating true and false aneurysms

158
SUBJECT: PATHOLOGY
TOPIC: Emphysema
Question What are the different types of Marks

emphysema?
Points Emphysema is a condition of the lung
Required characterized by abnormal permanent
enlargement of the airspaces distal to the
terminal bronchiole, accompanied by
destruction of their walls and without
obvious fibrosis.
Centriacinar. The distinctive feature of
this type of emphysema is the pattern of
involvement of the lobules; the central or
proximal parts of the acini, formed by
respiratory bronchioles, are affected,
whereas distal alveoli are spared. The
lesions are more common and usually
more severe in the upper lobes,
particularly in the apical segments.
Centriacinar emphysema occurs
predominantly in heavy smokers, often in
association with chronic bronchitis.
Panacinar. In this type, the acini are
uniformly enlarged from the level of the
respiratory bronchiole to the terminal blind
alveoli. In contrast to centriacinar
emphysema, panacinar emphysema
tends to occur more commonly in the
lower zones and in the anterior margins of
the lung, and it is usually most severe at
the bases. This type of emphysema is
associated with α1-antitrypsin (α1-AT)
deficiency.
Paraseptal - In this type, the proximal
portion of the acinus is normal, but the
distal part is predominantly involved.
Irregular - Irregular emphysema, so
named because the acinus is irregularly
involved.
159
SUBJECT: PATHOLOGY
TOPIC: Asthma
Question Describe the pathogenesis of asthma Marks

Points Asthma is a chronic inflammatory disorder
Required of the airways that causes recurrent
episodes of wheezing, breathlessness,
chest tightness, and cough, particularly at
night and/or in the early morning. These
symptoms are usually associated with
widespread but variable
bronchoconstriction and airflow limitation
that is at least partly reversible, either
spontaneously or with treatment.
genetic predisposition to type I
hypersensitivity
acute and chronic airway inflammation,
and bronchial hyper-responsiveness.
structural changes in the bronchial wall,
referred to as "airway re-modelling."
hypertrophy of bronchial smooth muscles
and deposition of subepithelial collagen.
Over-distended lungs, mucus plugs,
Curschmann spirals, charcot leyden
crystals
Increased size of submucosal glands
Oedema and inflammation to bronchial
walls, with increased mast cells and
eosinophils.
160
SUBJECT: PATHOLOGY
TOPIC: ARDS
Question Describe the pathogenesis of ARDS Marks

Points is a clinical syndrome caused by diffuse
Required alveolar capillary damage. It is
characterized clinically by the rapid onset
of severe life-threatening respiratory
insufficiency, cyanosis, and severe arterial
hypoxemia that is refractory to oxygen
therapy and that may progress to
extrapulmonary multisystem organ failure.
Conditions associated with ARDS:
Sepsis
Gastric Aspiration
Trauma
Diffuse pulmonary infections
Describe the morphology
In the acute stage, the lungs are heavy,
firm, red, and boggy.
They exhibit congestion, interstitial and
intra-alveolar edema, inflammation, and
fibrin deposition.
The alveolar walls become lined with
waxy hyaline membranes
Alveolar hyaline membranes consist of
fibrin-rich edema fluid mixed with the
cytoplasmic and lipid remnants of necrotic
epithelial cells. In the organizing stage,
type II epithelial cells undergo proliferation
in an attempt to regenerate the alveolar
lining.
Marked thickening of the alveolar septa
ensues, caused by proliferation of
interstitial cells and deposition of collagen.
Fatal cases often have superimposed
bronchopneumonia.
161
SUBJECT: PATHOLOGY
TOPIC: Ischaemic Bowel
Question Tell me about ischaemic bowel Marks

Points Acute occlusion of one of the three major
Required supply trunks of the intestines-celiac,
superior mesenteric, and inferior
mesenteric arteries-may lead to infarction
of several meters of intestine.
Severity of injury ranges from
1) transmural infarction of the gut,
involving all visceral layers –
2) mural infarction of the mucosa and
submucosa
3) mucosal infarction, if the lesion
extends no deeper than the
muscularis mucosae.
Predisposing factors:
Arterial thrombosis
Arterial embolism
Venous thrombosis
Nonocclusive ischemia
Radiation injury, volvulus, stricture,

amyloidosis, diabetes mellitus
Ischemic injury has two phases: the initial

hypoxic injury at the onset of blood supply
compromise and secondary reperfusion
injury at the time of blood resupply to the
hypoxic tissue.
162
SUBJECT: PATHOLOGY
TOPIC: Crohn disease
Question Tell me about Crohns disease Marks

Points Crohn disease is characterized
Required pathologically by (1) sharply delimited and
typically transmural involvement of the
bowel by an inflammatory process with
mucosal damage, (2) the presence of
non-caseating granulomas, and (3)
fissuring with formation of fistulae.
In both CD and UC, the prime culprits
appear to be T-cells, particularly CD4+ T-
cells, and the lesions are likely caused by
T-cells and their products. Although
antibodies against certain self-antigens,
such as tropomyosin, have been detected
in some patients with UC, it is not clear
that these autoantibodies play a
pathogenic role.
Features include -
Skip lesions
Strictures
Thickened wall
Transmural inflammation
Fibrosis
Granuloma formation
Fistulae
Extraintestinal manifestations of this
disease include migratory polyarthritis,
sacroiliitis, ankylosing spondylitis,
erythema nodosum, and clubbing of the
fingertips.
163
SUBJECT: PATHOLOGY
TOPIC: Pancreatitis
Question Describe the causes of acute Marks

pancreatitis
Points Acute pancreatitis is a group of reversible
Required lesions characterized by inflammation of
the pancreas ranging in severity from
oedema and fat necrosis to parenchymal
necrosis with severe haemorrhage.
Major causes are gallstones and alcohol
abuse
Obstruction of the pancreatic duct system.
Medications. These include thiazide
diuretics, azathioprine oestrogens,
furosemide
Infections with mumps, coxsackieviruses,
and Mycoplasma pneumoniae
Acute ischemia induced by vascular
thrombosis, embolism, vasculitis and
shock
Trauma, both blunt trauma and iatrogenic
injury during surgery or endoscopic
retrograde cholangiopancreatography
164
SUBJECT: PATHOLOGY
TOPIC: Renal stones
Question What are the different types of renal Marks

stone made of?
Points Four main types of urinary calculi
Required
70% are calcium containing – calcium
oxalate or phosphate.
15% are struvite – magnesium

ammonium sulphate – urea splitting
bacteria (proteus and staph), convert urea
to ammonia
5-10% uric acid in hyperuricemia, gout
1-2% made of cystine – genetic defects
Organic matrix of mucoprotein making up

1% to 5% of stone by weight is present in
all calculi
165
SUBJECT: PATHOLOGY
TOPIC: ATN
Question Describe the pathogenesis of ATN Marks

Points ATN is characterized morphologically by
Required destruction of tubular epithelial cells and
clinically by acute diminution or loss of
renal function. It is the most common
cause of acute renal failure
Tubule cell injury – tubular epithelia are
very sensitive to ischaemia and are also
vulnerable to toxins
Ischaemia – reversible and irreversible
cell injury
Disturbances in blood flow –
haemodynamic alterations lead to
reduced GFR. Intrarenal vasoconstriction
due to renin angiotensin mechanism,
stimulated by tubuloglomerular feedback
and endothelial injury lead to endothelin
production and reduced nitric oxide and
PGI2.
Describe the Morphology
Ischemic ATN is characterized by focal
tubular epithelial necrosis at multiple
points along the nephron, with large skip
areas in between, often accompanied by
rupture of basement membranes
(tubulorrhexis) and occlusion of tubular
lumens by casts
Eosinophilic hyaline casts
Pigmented granular casts

166
PHARM VIVAS
167
SUBJECT: PHARMACOLOGY
TOPIC: Elimination kinetics
Question What is the difference between zero Marks

and first order kinetics?
Points Zero order is where the rate is
Required independent of the amount of drug
undergoing the process
First order is where the rate is directly
proportional to the amount of drug being
eliminated
Most drugs exhibit 1st order kinetics
Examples of drugs exhibiting zero order
are aspirin, phenytoin, ethanol
Can you demonstrate this by drawing
concentration time plots of both?
168
TOPIC: Drug responsiveness
Question List the mechanisms that contribute to Marks

variation in drug responsiveness in
patients.
Points 1. Alteration in concentration of drug
Required reaching receptor – age/sex/wt/renal
function etc
2. Variation in concentration of an
endogenous receptor ligand e.g
propranolol in hypertensive
phaeochromocytoma vs athlete
3. Changes in components of response
distal to receptor – wrong diagnosis,
compensation – e.g fluid retention by
kidneys leads to tolerance of
antihypertensive effect of vasodilator
4. Altered no. of receptors – down/up
regulation
169
TOPIC: Biotransformation reactions
Question Can you list the reactions in phase 1&2 Marks

biotransformation?
Points 1.Phase 1 – Oxidation, Reduction,
Required Deamination, Hydrolysis. Phase 1
involves cytochrome p450
2. Phase 2 – Glucuronidation, acetylation,
glutathione conjugation, sulphate
conjugation, methylation
Can you name drugs involved with
enzyme induction and inhibition?
1. Induction - phenytoin, ethanol,
barbiturates, benzopyrene, omeprazole,
rifampin, carbamazepine
2. Inhibition – Grapefruit juice,
omeprazole, cimetidine amiodarone,
metronidazole, macrolide antibiotics
170
TOPIC: Agonist and Antagonist
Question What is an agonist and antagonist Marks

Points An agonist combines with a receptor to
Required produce a pharmacological response
An antagonist has affinity for a receptor
but produces no response (or reduced)
Draw dose response curves.
171
TOPIC: Spare receptors
Question What indicates that a true receptor is Marks

present?
Points Specificity – Receptor acts with only one
Required type of molecule
Sensitivity - receptor-agonist complex
produces a defined result
Saturability – The rate of the reaction is
limited by available receptor sites
Reversibility – by displacement of agonist
or antagonist from the receptor site
172
TOPIC: Volume of Distribution & Bioavailability
Question What is volume of distribution Marks

Points This is the amount of drug administered,
Required divided by the observed concentration of
the drug
In general highly protein bound = small
VD
Highly lipid soluble = large VD
What is Bioavailability?
Refers to the proportion of drug
administered which is then available to
the circulation
IV – 100% bioavailability
Oral – first pass metabolism
173
SUBJECT: Pharmacology
TOPIC: Diuretics
Question Discuss the Pharmacodynamics and Marks

kinetics of frusemide.
Points 1. Inhibits Na+/K+/2Cl- transport system
Required in ascending loop of Henle. Decreases
absorption of NaCl, increases Mg2+ and
Ca2+ excretion
2. Rapidly absorbed from GI tract.
Duration of effect = 2hrs IV, 6-8 hrs oral
3. Extensively bound to plasma proteins –
>90%
4. Metabolised via gluronidation in liver.
Excreted renally and in faeces
What are the main indications and
adverse effects?
1. Oedema of CHF. Hyperkalemia, anion /4
OD
2. Electrolyte disturbance – hypokalemia, /2
rash
3. May increase cholesterol transiently /2
4. Hypochloraemic alkalosis /2
174
TOPIC: GTN
Question Describe PD & PK of GTN Marks

Points 1. Lipid soluble, so given topical, s/l,
Required buccal, IV, 10-20% oral bio
2. T1/2 = 2-8 mins
3. Metabolised by liver, excreted by
kidney
4. Effects due to decrease in myocardial
VO2 – decreased ventricular wall stress
(Laplace). Leads to SM relaxation, and
decreased platelet aggregation.
5. (bonus) activates guanylal cyclase –
leading to increased cGMP
Toxicity of GTN / side effects
1. Hypotension + headache
2. Reflex tachycardia may increase VO2
3. Coronary Steal phenomenon
4. Withdrawal vasospasm if occupational
exposure
175
TOPIC: Epinephrine
Question Describe the steps that metabolise Marks

th
tyrosine to epinephrine. (5 question!)
Points 1. L-tyrosine oxidised to L-dopa. Enzyme
Required – tyrosine hydroxylase
2. L-dopa decarboxylated to Dopamine.
Enzyme – dopa decarboxylase
3. Dopmaine oxidised to norepinephrine.
Enzyme – dopamine b hydroxylase
4. Norepinephrine methylated to
epinephrine.
Enzyme – phenylethanolomaine N methyl
transferase (PNMT)
176
TOPIC: Antiarrhythmics
Question Describe the Vaughn Williams Marks

Classification for antiarrhythmic
agents
Points 1. A, B & C.
Required Na channel blockade.
A increase AP length - disopyramide
B shortens AP length - lignocaine
C no effect on AP length - flecainide
2. B-blockers – propranolol
3. K channel blocker – sotalol
4. Ca channel blocker – verapamil,
nifedipine
177
TOPIC: Digoxin
Question Discuss digoxin Marks

Points 1. Class – cardiac glycoside, positive
Required inotrope, Na/K/ATPase inhibitor
2. Well absorbed orally 60-85% oral
bioavailibility, 10% harber bacteria that
inactivates digoxin
t1/2 = 4ohrs, VD – 6-8L/Kg, plasma
protein bound
3. Metabolised – not much
4. Excreted 2/3 unchanged by kidney,
with renal clearance proportional to creat
clearance
5. Increases intracellular calcium, and
therefore contractility
6. Electrical effects – increased PR
interval, increased AV node refractory
period, shortens QT, increased toxicity –
automaticity due to Ca overload
7. – toxicity GI, arrhythmia, confusion,
treatment - digibind, correct K
178
TOPIC: B-Blockers
Question Discuss pharmacological properties of Marks

Propranolol
Points 1. Well absorbed orally – peak 1-3 hrs.
Required Subject to first pass metabolism
2. rapid distribution, large VD, t1/2 =
3-10hrs
3. PD – suppress RAA, blocks B1 in
heart, increased airways resistance,
reduces intraocular pressue
4. Inhibits sympathetic nervous
stimulation of lipolysis
5. chronic use may elevate VLDL
6. Use – hypertension, IHD, anti
arrhythmic
7. Toxicity – rash, fever, sedation, sleep
disturbance, depression, asthma,
hypoglycaemia in diabetics
179
TOPIC: Adenosine
Question Discuss adenosine Marks

Points 1. Slows AV conduction, hyperpolarizes
Required cell membrane, decreases camp induced
influx
2. Absorption – IV
3. Metabolism – rapid degradation – t1/2
= 5-10 seconds
4. Used in SVT, adjunct to thallium scans.
Dose – 6, 12, 18mg etc.
5. Contraindications – asthma,
theophylline use
6. Adverse effects – doom, chest pain,
flushing
180
TOPIC: Lignocaine
Question Discuss the PK & toxicity of Marks

lignocaine,
Points Lignocaine is a class 1B antiarrhythmic
Required agent.
It is given IV, SC, epidural
Orally only 3% bioavailability
Wide volume of distribution
T1/2 = 2hrs (IV)
Excreted in urine
Causes seizures, arrhythmia, coma,

hypotension
181
TOPIC: Amiodarone
Question Discuss the PK, indications & toxicity Marks

of amiodarone
Points Amiodarone has class 1-4 anti arrhythmic
Required action
Oral absorption is erratic
Bioavailability ranges from 22-86%
Undergoes 1st pass metabolism
Strongly protein bound

Half life of 20-100 days
High VD – accumulates in adipose tissue/
heart/well perfused organs
Excreted via enterohepatic circulation
Used as an antiarrhythmic and antianginal

agent
Causes corneal microdeposits, alveolitis,

hepatotoxicity, metallic taste, peripheral
neuropathy, headaches ataxia, sinus
bradycardia
182
TOPIC: Ca channel blockers
Question Discuss the PK and toxicity of Marks

Verapamil
Points Bind to inner side of calcium channels to
Required decrease trans-membrane calcium
current. Blocks activated and inactivated
channels. Results in decreased in
cardiac contractility and output.
AV nodal conduction and refractory period
are prolonged. Suppresses both delayed
and early depolarization.
Relaxes smooth muscle causing
decreased lowered pressure and vascular
resistance
Bioavailability 20-35%
Onset 30mins orally and < 1.5 minsIV.
90% bound to plasma proteins.
Extensively metabolized by liver.
Plasma half life- = 6 hrs
Metabolites - 70% eliminated by kidney
and 15% by GI tract.
In AF and WPW there is a risk of inducing
VT.
Adverse - Cardiac depression/ cardiac
arrest/ bradycardia/ AV block/ CHF/
flushing/oedma/ dizziness/ gingival
hyperplasia/ constipation.
Toxic - Extension of clinical effect =
cardiac arrest, myocardial insufficincy
(treated with dopamine, dobutamine,
glycosides), hypotension.
Use high dose CaCl, consider pacing
bypass amrinone
183
TOPIC: Nitrous Oxide
Question Describe the PD & PK of Nitrous Oxide Marks

Points Inhalational anaesthetic / analgesic
Required 1. Powerful analgesic
2. CVS - direct depression of myocardial
contractility. Increased peripheral
resistance
3. Low potency (therefore usually used in
combination)
MAC > 100%
4. Amnestic properties
Rapid uptake (due to poor tissue

solubility)
Low blood/gas coefficient (0.47) therefore
quite insoluble in blood
Low solubility therefore reaches high
arterial tensions rapidly therefore rapid
equilibrium with brain therefore fast
induction
Probably not metabolised by humans
Rapid elimination (“washout”) by lungs
Repeated exposure ↑ risk BM
suppression
Prolonged exposure to N2O causes

megaloblastic anaemia (decreased
methionine synthetase activity)
Nausea/ vomiting- esp. high
concentrations
184
TOPIC: Atropine
Question Discuss the toxicity of atropine Marks

Points Reversible blocker of muscarinic
Required receptors
Decreased secretions
Mydriasis & cycloplegia
Cutaneous vasodilation
Excitement
Agitation
Hallucinations
Coma
Treat – charcoal, active cooling,
vasopressors for hypotension, control
seizures with diazepam. Use
cholinesterase if hyperthermic or rapid
SVT
185
TOPIC: Salicylates
Question What are the pharmacological actions Marks

of aspirin?
Points Cyclo-oxygenase inhibition – reduced
Required prostaglandin production and reduced
pain.
Reduced prostaglandin production and
fever (hypothalamus)
Oxidative phosphorylation uncoupling –
increased oxygen and glucose
requirements
Reduced thromboxane production –
inhibits platelet adhesion
Hyperpyrexia can occur due to increased
cellular oxygen consumption
186
TOPIC: Clopidogrel
Question Discuss the mechanism of action of Marks

clopidogrel
Points The mechanism of action of clopidogrel is
Required irreversible blockade of the adenosine
diphosphate (ADP) receptor on platelet cell
membranes.
This receptor is named P2Y12 and is
important in platelet aggregation, the cross-
linking of platelets by fibrin. The blockade of
this receptor inhibits platelet aggregation by
blocking activation of the glycoprotein IIb/IIIa
pathway.
What are the major adverse affects?
Severe neutropenia
Thrombotic thrombocytopenic purpura
Haemorrhage
Erectile dysfunction
187
TOPIC: Anticoagulants
Question Discuss heparin Marks

Points Large Sulfated polysaccharide polymer.
Required
Binds to antithrombin III. Complex
combines with an inactivates thrombin
(factor II) and factor Xa
1000 fold increase with heparin. Achieves
AC immediately.
Contraindicated in haemophilia,
hypersensitivity, hypertension, IC bleed,
infective endocarditis, TB, ulcers GI, renal
disease
Adverse effects - Increased bleeding.
Transient thrombocytopenia in 25%
Discuss the PK, and toxicity of
warfarin
100% bioavailability
99% albumin bound, VD=0.12L/Kg
Metabolised by liver (conjugation)
Excreted enterohepatic circulation, urine
and stool
Causes haemorrhage, tissue necrosis
188
TOPIC: tPA
Question What are the contraindications to Marks

using tPA?
Points Haemorrhagic diathesis.
Required
Recent internal bleeding.
Cerebral bleeding - within 2/12 of

intracranial / instraspinal surgery.
Major operation within 10 days.
Uncontrolled hypertension >200/110

Infective endocarditis.
Acute pancreatitis.
189
TOPIC: Dexamethasone
Question Describe pharmacological properties Marks

of Dexamethasone
Points Structure – glucocorticoid
Required
CNS – may cause convulsions and
increase ICP
CVS – no effect
RS – maybe used for asthma
Eliminated by the liver
190
TOPIC: Penicillin
Question Discuss Penicillin Marks

Points Thiazolidane ring attached to a beta
Required lactam ring
1. Attachment to specific penicillin binding
proteins (PBPs) that serve as drug
receptors on bacteria
2. Inhibition of cell wall synthesis by
blocking transpeptidation of peptidoglycan
3. Activation of autolytic enzymes in cell
wall
Parenteral - complete and rapid
(crystalline ‘G’ given IV, benzathine /
procaine IM)
Oral differs greatly with different
penicillins (phenoxymethyl ‘V’ given O)
Wide distribution in body fluids and
tissues except low in CNS, eye, prostate
T1/2 of penicillin G is 30-60mins in renal
failure it may be up to 10 hours
Excretion - renal - 10% by glomerular
filtration and 90% by tubular secretion to a
max of 2g / h in adult. Also excreted into
sputum and milk to levels 3-15 % of those
present in the serum.
Susceptible bugs - Pneumococi ,
streptococci, treponema , spirochetes ,
clostridial infections
Adverse effects - Anaphylaxis /
granulocytopenia / thrombocytopenia /
haemolytic anaemia / coagulation
disorders
191
TOPIC: Trimethoprim
Question Discuss the pharmacokinetics and Marks

adverse effects of trimethoprim
Points Trimethoprim inhibits dihydrofolate
Required reductase
100% bioavailability
Widely distributed, including CNS
Lipid soluble
65-70% protein bound
VD = 130L/70Kg
T1/2 = 11 hours
Renal excretion
Used in UTI, PCP, salmonella
Causes GI intolerance, skin rash,
interference with haemopoesis
192
TOPIC: Azithromycin
Question What is the mechanism of action of Marks

Azithromycin?
Points Inhibitory, or bactericidal, depending on
Required the organism
Binds to 50s ribosomal RNA. Protein
synthesis blocked
Gram +ves, pneumococci, strep, staph,
mycoplasma, legionella, chlamydia,
listeria, mycobateria, bordatella pertussis,
treponema pallidum, campylobacter.
Active vs M Avium
Resistance – plasmid encoded, active
efflux, hydrolysis, modification of binding
site
Community ac pneumo, and as penicillin
sub
Lacks the inhibition properties of other
macrolides
Anorexia, vomitting, diarrhoea
Acute hepato toxicity – cholestatic
hepatitis – prob hypersensitivity
rashes
193
TOPIC: Oxygen
Question Describe PK and adverse effects of Marks

Oxygen
Points 1. Absorption – diffusion
Required
2. Distribution – total body
3. Metabolism – all cells – oxidative

phosphorylation in mitochondria
4. Contraindication – depresses hypoxic

drive, combustion
5. Adverse effects - Pulmonary toxicity

Cough, decreased vital capacity
6. CNS tox – nausea, mood, vertigo,
convulsions
7. Retrolental fibroplasia
8. Mechanism of toxicity - Free radicals,
inhibition of enzymes, direct toxic effect
on cerebral metabolism
194
TOPIC: Suxamethonium
Question What are the adverse effects of Marks

suxamethonium?
Points Muscle pain – due to intense
Required fasciculations
Bradycardia – marked for second dose
Hypotension – due to histamine release,
muscle relaxation and bradycardia
Malignant hyperpyrexia
Raised IOP
Increased gastric secretion
Anaphylaxis
Hyperkalaemia – in burns, tetanus and
UMN lesions. Also in mytonia dystrophica
195
TOPIC: Midazolam
Question Discuss the pharmacodynamics of Marks

midazolam
Points Binds to gamma 2 subunit on the alpha
Required unit on GABA receptor, which increases
chloride channel conductance.
Increased efficiency of GABAergic
synaptic inhibition by decreased firing rate
of neurones and increased frequency of
channel opening events.
Describe the kinetic properties of

midazolam
Well absorbed orally
VD = 50L, 98% protein bound
T1/2 = 2-4 hrs
Metabolised in liver – phase 1 oxidation
Excreted in the urine 50-70%
196
TOPIC: Ketamine
Question Discuss pharmacology of ketamine Marks

Points Ketamine is a phenylcyclidine derivative
Required
NMDA receptor antagonist
Produces dissociative anaesthesia
Provides profound analgesia
Increases ICP
Bronchodilator
High VD
IV onset is 30-60 seconds
Causes emergence phenomena
197
TOPIC: Epilepsy
Question Describe how anticonvulsants work Marks

Points Break propagating neural circuits by
Required increasing inhibitory neurotransmitter
levels, or facilitating their action by
modulating GABA receptor function
Examples are benzodiazepines and
barbiturates, valproate, phenytoin
List different types of epilepsy and the
drugs that treat/prevent them.
Status epilepticus – IV diazepam, then
phenytoin
Absences – ethosuximide/valproate
Tonic clonic – carbamazepine/phenytoin
Myoclonic – valproate/clonazepam
Atypical – clonazepam/ethosuximide/
lamotrigine/ Phenytoin/valproate
198
TOPIC: Phenytoin
Question Tell me about phenytoin Marks

Points Diphenyl-substituted hydantoin.
Required Anti-epileptic drug.
Class 1B anti-arrhythmic.
Alters Na+, K+ and Ca++ conductances ,
membrane potentials, concentration of
amino acids and neurotransmitters
noradrenaline, acetylcholine and GABA.
Blocks sustained high frequency firing in
neurons .
Binds to and prolongs inactivated Na+
channels.
Highly plasma protein bound.
Concentration in CSF proportional to
plasma levels.
Accumulates in endoplasmic reticulum of
brain, liver, muscle and fat
Vd = 45L/70kg
Parahydroxylation plus subsquent
conjugation with glucuronic acid.
Metabolites inactive
Elimination is dose dependant. Cl =
Vmax / (Km+ Cp)
Excreted in urine
Half life = 12-36 hrs.
Toxicity - Nystagmus/ diplopia/ ataxia/
sedation/ gingival hyperplasia/ hirsuitism/
osteomalacia/ idiosyncratic rash/ fever /
agranulocytosis.
199
TOPIC: Carbamazepine
Question What is carbamazepine? What are its Marks

major interactions?
Points Anti epileptic / neurotropic / psychotropic
Required tricyclic compound derivitive of
iminostilbene
Chemical structure similar to imipramine
and other TCA
Also similar to phenytoin in 3D spatial
terms
Induces microsomal enzyme system
leading to increased metabolism of
primidone / phenytoin / ethosuximide /
valproate / clonazepam / OC pill.
Valproate, propoxyphene and
troleandomycin inhibit carbamazepine
clearance.
Phenytoin and phenobarbitone induce
metabolism of carbamazepine.
Urine retention and water intoxication.
Stupor / coma / convulsion / respiratiory/
depression / tachycardia/ hypo or
hypertension/ wide QRS
200
TOPIC: SSRI
Question Discuss SSRI, give examples Marks

Points Increase the level of 5HT at the neuronal
Required receptors.
Sedation is less marked than with the
tricyclic antidepressants
Diarrhoea, nausea, vomiting, headache,
anxiety may occur.
Do not commence SSRI until 2 weeks
after stopping MAOI (to prevent serotonin
syndrome)
Example – fluoxetine, paroxetine,
sertraline
Serotonin syndrome – hyperthermia/
muscle rigidity/myoclonus
Dialysis is of no use in toxic state
201
TOPIC: Lithium
Question Describe PK and toxicity of lithium Marks

Points Small monovalent cation. “Mood
Required stablizing agent”
Complete in 6-8 hrs.

Peak plasma levels in 30 mins to 2 hrs.
In total body water. Slow entry to
intracellular compartment.
Initial Vd = 0.5L/kg - increases to 0.9 L/kg.
no protein binding.
Entirely in urine. Clearance = 20% of
creatinine.
‘Plasma half life = 20 hrs.
Adverse - Tremor, / hyperactivity/ ataxia/
altered thyroid function/ goitre /
polydipsia/ polyuria/ nephrogenic DI / sick
sinus / oedema
Toxicity - MILD: N/V, tremors,
hyperreflexia, agitation, ataxia.
MODERATE: CNS depression, rigidity,
hypertonia, fasiculation.
SEVERE: Seizures, myoclonus, coma,
and hypotension. Permanent neurologic
injury (cerebellar or cognitive defects)
possible. Neuroleptic malignant syndrome
possible.
202
TOPIC: Antipsychotics
Question What are the major side effects of Marks

phenothiazines?
Points Antidopaminergic – antiemesis,
Required extrapyramidal - oculogyric crisis,
akithesia, parkinsonism, tardive
dyskinesia, increased prolactin secretion
Antimuscarinic – dry mouth, urine
retention, blurred vision
Anti-adrenergic – postural hypotension
Anti-histaminergic - sedation
Neuroleptic malignancy
203
PHYSIOLOGY VIVAS
204
SUBJECT: PHYSIOLOGY
TOPIC: Body fluid compartments
Question Describe the distribution of body fluids Marks

in a 70Kg man
Points TBW = 0.6 x Body Weight = 42L
Required
Out of 42L
14L is ECF (1/3 TBW)
28L is ICF (2/3 TBW)
Out of 14L ECF
Plasma = 3L (1/4 ECF)
Interstitial fluid = 10.5L (3/4 ECF)
Transcellular fluid = 0.5L
What agents are used to measure fluid

compartments?
TBW measured with deuterium oxide
ECF measured with inulin
Plasma – radioactive albumin / Evans

blue
Interstitial vol = ECF-plasma vol
205
SUBJECT: PHYSIOLOGY
TOPIC: Resting membrane potential
Question What is meant by the resting Marks

membrane potential for a cell?
Points This is the potential difference across the
Required cell membrane.
This occurs due to the ionic fluxes of Na+,
K+, Cl- across the membrane dependent
on their electrochemical gradients.
Typical value is -70mv
Na+/K+ ATPase pump transports 3 Na+

out of the cell for 2K+ pumped in. It
maintains the potential difference across
the cell (RMP)
206
SUBJECT: PHYSIOLOGY
TOPIC: Action potential
Question Describe the ionic basis for the action Marks

potential (drawing acceptable)
Points Once threshold reached, voltage sensitive
Required Na+ channels open causing rapid influx of
Na+ into cell, causing depolarisation.
During initial opening of Na+ channels,
positive feedback loop is initiated, leading
to rapid depolarisation.
The Na+ channels close rapidly
There is also a constant background

movement of K+ out of cell.
During repolarisation, voltage sensitive K

+ channels open, leading to K+ efflux
from cell. These stay open longer, and
react slower than Na+
Ionic environment returned to steady state
by Na+/K+ pumps
207
SUBJECT: PHYSIOLOGY
TOPIC: Response to loss of 1 L of blood
Question Discuss the compensatory Marks

cardiovascular responses to losing 1
litre of blood
Points 1. Sensors – baroreceptors in carotid
Required sinus, and low pressure receptors in veins
and RA. – sympathetic stimulation, inc
HR, contractility, peripheral
vasoconstriction.
2. Transfer of fluid from ICF to plasma
3. Redistribution of cardiac output –
decreased RBF, decreased GFR and
urine output, reduced flow to muscles,
4. Mobilisation of reserve volume –
pulmonary, and hepatic
5. Increased ADH release
6. Increased angiotensin and aldosterone
release
7. Increased stimulation of thirst receptors
in hypothalamus
8. Increased absorption of fluid from GIT
208
SUBJECT: PHYSIOLOGY
TOPIC: ADH secretion
Question What factors affect ADH secretion Marks

Points 1. Plasma osmotic pressure
Required
2. ECF volume – inverse relationship
3. Pain, emotion, stress, N&V
4. Posture – standing up
5. Drugs – carbamazepine, clofibrate
6. Angiotensin II
What factors affect renin excretion?

1. Afferent arteriolar pressure at JGA –
increased pressure causes decrease in
renin
2. Na+, and K+ conc in macula densa –
increased reabsorption leads to a
decrease in renin
3. Angiotensin II – inhibitory feedback
4. Circulating cathecholamine – increased
sympathetic activity increases renin
secretion.
209
SUBJECT: PHYSIOLOGY
TOPIC: Factors affecting arteriolar tone
Question Discuss local factors that affect Marks

arteriolar tone.
Points 1. Art tone changes to regulate local blood
Required flow across a range of pressures, 2
theories – myogenic, metabolic
2. Myogenic – distension of vessels with
increased pressure causes increased
stretch of smooth muscle, leading to
contraction of SM
3. Vasodilator – metabolites accumulate
in tissue when there is reduced flow,
leads to relaxation of SM
4. Vasodilators – hypoxia, acidosis, CO2,
heat, K+, lactate, histamine, adenosine
5. 5HT, thromboxane – vasoconstricts
after injury, prostacyclin – vasodilates
6. EDRF (dilates)/ Endothlin -
vasoconstricts
210
SUBJECT: PHYSIOLOGY
TOPIC: Cardiac cycle
Question Draw and label the pressure curves for Marks

LV and aorta in systole and diastole.
Points 1. labelled x and y axis
Required
2. Aortic pressure – dicrotic notch
3. Ventricular curve
4. Atrial curve
5. Points where valves open and close
6. Appropriate lengths of diastole and
systole
211
SUBJECT: PHYSIOLOGY
TOPIC: Starlings law of the heart
Question What is Starlings Law of Heart? Can Marks

you draw and label a Starling curve?
Points 1. Stroke vol. is proportional to LVEDV, to
Required pressure, and to length of myofibril
2. Starling curve – SV vs LVEDP
3. Show what happens with failing heart
4. Show increased contractility
What are Starling forces in capillaries?
1. Hydrostatic and oncotic pressures
2. Net filtration = (Pc- Pi) – (Πp-Πi)
Pc – cap hydrostatic pressure
Pi – Interstitial hydrostatic pressure
Πp – Plasma oncotic pressure
ΠI – Interstitial oncotic pressure
212
SUBJECT: PHYSIOLOGY
TOPIC: Cardiac action potentials
Question Can you draw cardiac action potential Marks

for a myocyte and a pacemaker cell?
Points 1. Phase 0 – Rapid depolarisation when
Required threshold reached (-60mv), Na channels
open, rapid influx.
2. Phase 1 – partial repolarisation –

closure of voltage gated Na channel
3. Phase 2 – Plateau – slow inward Ca

current
4. Phase 3 – repolarisation – Ca channel

closure, K leaks out.
5. Phase 4 Pacemaker potential –

spontaneous depolarisation due to
inherent instability of membrane potential
of cardiac myocyte.
213
SUBJECT: PHYSIOLOGY
TOPIC: Cardiac conduction
Question Describe conduction in the heart Marks

Points 1. SA node initiates impulse
Required
2. Internodal pathways conduct impulses
from SA node to AV node
3. AV node delays impulses from atria to
ventricles
4. AV bundle conducts impulse from AV
node to ventricles
5. R & L Purkinje fibres conduct to
ventricles
214
SUBJECT: PHYSIOLOGY
TOPIC: Baroceptor Reflex
Question Describe the baroceptor reflex Marks

Points 1. Baroceptors located in carotid sinus
Required and aortic arch – stimulated by stretch
2. Signal from carotid sinus to NTS in
medulla via glossopharyngeal N
3. Signal from aortic arch via vagus N
4. With increased stretch on vessels,
vasoconstrictor centre inhibited, vagus N
stimulated – venodilation and
vasodilation, reduced HR, reduced
contractility – BP is kept constant
215
SUBJECT: PHYSIOLOGY
TOPIC: Long term control of BP
Question Describe the role of the kidney in long Marks

term BP control
Points 1. Increased BP – increased renal
Required excretion of Na+ and water, normalising
blood vol
2. Reduction in BP – kidneys retain Na+
and water.
3. This takes several days to equilibrate,
and intake and output should be balanced
4. Therefore large increases in salt and
water intake cause a minimal rise in
arterial pressure
5. Candidate can illustrate with Guyton
renal curves, showing that as pressure
rises, increase in Na+ and water output.
216
SUBJECT: PHYSIOLOGY
TOPIC: Cardiac Output and Venous return
Question What is cardiac output and what Marks

factors influence it?
Points CO is the product of the heart rate and
Required the stroke volume. Normally 5-6L/min
Factors influencing SV are:
Preload
Afterload
Myocardial contractility
Heart rate
Preload determined by venous return.
Afterload equates to ventricular wall
tension that has to be generated in order
to eject blood out of the ventricle.
Myocardial contractility can be increased
via autonomic stimulation of intrinsic
sympathetic fibres. Stimulation of B1-
adrenoceptors by catecholamines also
increases contractility.
In physiological conditions, CO equates to
venous return
217
SUBJECT: PHYSIOLOGY
TOPIC: CSF Circulation
Question Describe circulation of CSF in the Marks

brain.
Points Volume of CSF = 150mls, 500mls
Required produced a day
Produced in choroid plexus (70%)
Blood vessels lining ventricular walls
From lateral ventricle – 3rd ventricle via
foramen of Monro
3rd ventricle to 4th ventricle through

aqueduct of Sylvius
4th ventricle to into subarachnoid space of

spinal cord through foramen of Magendie
and lateral foramina of Luschka
After going around spinal cord, fluid
enters the cranial vault through foramen
magnum and flows around subarachnoid
space of brain.
Absorbed in arachnoid villi (80%)
Spinal nerve roots (20%)
218
SUBJECT: PHYSIOLOGY
TOPIC: Cerebral Circulation
Question What is the rate of cerebral blood flow, Marks

and how is it regulated?
Points Rate – 50ml per 100g of brain tissue.
Required 15% of CO, 750ml per min
Autoregulation – myogenic response,
vasodilator washout
PaCO2 is main factor. H+ increases with
hypercarbia – increases flow
PaO2 – hypoxia – vasodilation (less
important than CO2)
Sympathetic stimulation (least important)
What is cerebral perfusion pressure,
and Monroe Kelly Doctrine?
CPP=MAP-ICP
Skull is closed cavity – if pressure
increases for whatever reason, other
factors must decrease – i.e displacement
of CSF etc.
219
SUBJECT: PHYSIOLOGY
TOPIC: Coronary Blood Flow
Question What factors are important in the Marks

control of coronary blood flow?
Points Metabolic factors – products of
Required myocardial metabolism, e.g CO2,
prostaglandins, and adenosine – all cause
vasodilation
Neural control – B2 adrenoceptor
stimulation by vasomotor sympathetic
nerves leads to vasodilation.
How does coronary blood flow vary
during the cardiac cycle?
Coronary flow greatest during diastole
(80% of flow). The lowest flow is during
isovolumetric contraction
Due to mechanical compression of the
coronary vessels during systole.
220
SUBJECT: PHYSIOLOGY
TOPIC: Pulmonary Blood Flow
Question What factors control pulmonary Marks

vascular resistance, and pulmonary
blood flow?
Points Pulmonary arterial and venous pressure
Required
Lung volume
Pulmonary vascular smooth muscle tone

– due to catecholamines, 5HT etc
Hypoxia – leads to vasoconstriction with

increase in PVR. This improves
ventilation/perfusion ration in lung in the
face of fall in PaO2
How is blood flow distributed in the

lung?
In standing position, lowest part of lung
receives greatest flow with linear increase
in flow from apex to base – due to
increased hydrostatic pressure
221
SUBJECT: PHYSIOLOGY
TOPIC: Renal blood flow
Question Discuss renal blood flow Marks

Points Kidneys receive 20-25% of the CO
Required
RBF is autoregulated between pressures
of 80-180mmHg
Autoregulation due to
Myogenic mechanism – increase in renal
vascular wall tension stimulates smooth
muscle cells to contract causing
vasoconstriction
Tubuloglomerular feedback – alterations
in flow that occurs with alterations in
arterial pressure lead to stimulation of
JGA. This leads to a feedback loop that
returns RBF to baseline.
Other factors that influence RBF
SNS – controls the tone of afferent and
efferent arteriole. Alpha1 receptors
stimulated to cause vasoconstriction
Angiotensin II - RAA system –
vasoconstriction
Local Mediators – PGE2, PGI2 cause
vasoconstriction
PAH used to measure RBF – completely
eliminated, non toxic. Clearance of PAH
equals RPF.
RBF=RPF/(1-hct)
222
SUBJECT: PHYSIOLOGY
TOPIC: Reticular Activating System
Question What is the RAS? (5th Question!) Marks

Points 1. RAS is a loosely arranged collection of
Required fibres and cells in the brainstem
2. Receives and integrates info from all of
the CNS
3. Outputs info to whole CNS
4. Responsible for arousal, and conscious
level
5. Projects to thalamus, cortex
6. Convergence onto RAS from sensory
tracts, trigeminal N, auditory N, olfactory
N
223
SUBJECT: PHYSIOLOGY
TOPIC: Muscle contraction
Question How does the action potential reaching Marks

the muscle fibre give rise to
contraction?
Points Excitation-contraction coupling.
Required
AP spreads out from motor endplate
through the T tubule system.
Mobilisation of Ca2+ from SR into
cytoplasm.
Ca2+ binds to troponin C on the light
chains.
This leads to the displacement of
tropomysin, - myosin binding sites are
exposed on the actin chain.
Actin and myosin chains cross link.
Myosin filaments slide onto actin

filaments.
This final stage is made possible by the
energy generated from the hydrolysis of
adenosine triphosphate (ATP) to
adenosine diphosphate (ADP) by ATPase
activity of myosin head
224
SUBJECT: PHYSIOLOGY
TOPIC: Nerve fibres
Question Can you classify nerve fibres in terms Marks

of size and function?
Points 1. A α – somatic motor, A β – touch,
Required pressure, proprioception, A γ – spindle
afferents, A δ – sharp pain, temp. B –
Preganglionic autonomic, C –
postganglionic, dull pain.
2, A, and B are myelinated
3. LA blocks small before large
4. Pressure affects large before small
225
SUBJECT: PHYSIOLOGY
TOPIC: Blood brain barrier
Question What is the blood brain barrier, and Marks

what are its main functions?
Points 1. Barrier prevents molecules passing
Required from blood to extracellular fluid of brain.
Protects consistency of brain ECF.
PROTECTED CHEMICAL
ENVIRONMENT
2. Physical component
Tight Junctions between endothelial cells
in cerebral capillaries.
Water sol molecules cannot pass. Cell
membrane has LOWER permeability than
other cells.
3. Chemical component
- Enzymatic degradation in endothelial
cells of certain substances. E.g dopa
decarboxylase prevention of amines
entering.
4. Substances crossing BBB - Oxygen,
carbon dioxide, lipid sol substances,
water.
Glucose and AA cross vis transporters
Electrolytes
226
SUBJECT: PHYSIOLOGY
TOPIC: Vagus N
Question What are the functions of the vagus N? Marks

(5th Question!)
Points 1. – Motor, sensory, secreto-motor. Has 3
Required nuclei – dorsal (mixed), nucleus
ambiguous (motor), nucleus tractus
solitarius (sensory – taste)
2. Motor to larynx, bronchial muscles,
alimentary tract (up to splenic flexure),
myocardium
3. Sensory to dura, ext auditory meatus,
respiratory tract, alimentary tract (up to
ascending colon), myocardium, epiglottis
4. Secretomotor – bronchial mucus
production, alimentary tract and adnexa
227
SUBJECT: PHYSIOLOGY
TOPIC: Stretch Reflex
Question Can you draw the components of the Marks

stretch reflex?
Points E.g Patellar tendon
Required
Strecth of tendon (following contact with
tendon hammer), stretching the quad
muscle also
Spindle fibres are stretched
Afferents from spindle discharge, relaying
to α motorneurone in spinal cord (ventral
horn). It is monosynaptic.
This leads to firing of the α motorneurone
– reflex contraction of quad.
Bonus mark – spindle afferent also
synapses with inhibitory interneurons that
inhibit contraction of hamstrings
228
SUBJECT: PHYSIOLOGY
TOPIC: Lung volumes
Question Draw spirometer trace illustrating Marks

various volumes that are represented.
How are they measured directly?
Points (see diagram below)
Required TV measured by spirometry
Direct measurement – TV, IRV, ERV
IC = TV + IRV, VC = IRV + TV + ERV
TLC = VC + RV
What is residual volume?
Volume that remains in the lung following
max expiration. Value is 1.2L-1.5L
RV and FRC measured by nitrogen
washout, gas dilution, or
plethysmography.
229
SUBJECT: PHYSIOLOGY
TOPIC: Carbon Dioxide Carriage
Question How is Carbon dioxide transported in Marks

the blood?
Points Bicarbonate - 85-90%
Required
Carbamino compounds 5-10%
Dissolved in solution 5%
Bicarbonate diffuses out of red cell and

into plasma. To maintain electrochemical
neutrality, a Cl- ion enters the red cell at
the same time as the bicarbonate leaves.
This is “chloride shift”
Bohr effect – describes changes in affinity
of haemoglobin chain for oxygen due to
variations in PaCO2, H+ and temperature
Haldane effect – describes changes in
affinity of blood for CO2 with variations in
PaO2. As the PaO2 increases, affinity of
blood for CO2 decreases.
230
SUBJECT: PHYSIOLOGY
TOPIC: Compliance
Question What is lung compliance? Can you Marks

draw the compliance curve?
Points Compliance is the change in volume per
Required unit change in pressure N=200ml/cmH2O
Compliance decreases with deflation of
lung as compared to inflation - hysteresis
Venous congestion
Oedema, ARDS (loss of surfactant)
Intermittent positive pressure ventilation
Fibrosis
Compliance increases with
COPD
Age
231
SUBJECT: PHYSIOLOGY
TOPIC: Dead Space
Question What is Anatomical dead space? Marks

Points This is the volume of the conducting
Required airways.
Normal value is 150mls, increases with
inspiration. Also dependent on size and
posture of the individual.
nd
2 Question What is Physiologic dead space?
How is it calculated?
Bohr equation:
VD/VT = (PaCO2 –PECO2)/PaCO2
Normal ratio of dead space to tidal
volume is 0.2-0.35 during resting
breathing
Bohr method measures volume of lung
that does not eliminate CO2.
Phys dead space and anatomical dead
space should be almost equal in normal
subjects. Pts with lung disease, phys
dead space maybe much larger
232
SUBJECT: PHYSIOLOGY
TOPIC: V/Q mismatch in the lung
Question How do ventilation and perfusion vary Marks

in different parts of the lung?
Points - Lower parts of the lung are better
Required perfused than the higher parts
- Lower parts are also relatively better
ventilated
- V/Q falls going from the apex to the
base of the lung (3.3-0.63)
What are the four general causes of
hypoxia?
Alveolar hypoventilation – leading to a
type II respiratory failure with increased
PaCO2
Diffusion abnormality - pulmonary fibrosis
Shunt – blood passes from right to left
heart without being oxygenated by the
lung – cyanotic congenital heart disease
V/Q mismatch – when the ratio of the 2 is
greater or less than 1, the blood returning
to the heart in the pulmonary veins will be
hypoxaemic – type I respiratory failure
PaO2 = PiO2 – PaCO2/R
Alveolar gas equation
233
SUBJECT: PHYSIOLOGY
TOPIC: Control of ventilation
Question What physiologic variables form the Marks

basis for the control of ventilation
Points PaCO2 – most important
Required PaO2
pH of blood ans CSF
Changes in the above are detected by
central and peripheral chemoreceptors
that stimulate the activity of the brainstem
respiratory centre.
Central chemoreceptors – ventral surface
of medulla. Sensitive to PaCO2
Peripheral chemoreceptors – in carotid
and aortic bodies. These are sensitive
mainly to a fall in PaO2 and pH, and
sensitive to a rise in PaCO2
Mechanical receptors such as pulmonary
stretch receptors and J receptors.
Distension of lung leads to slowing of
inspiration
Irritant receptors in the lungs and

nasopharynx
234
SUBJECT: PHYSIOLOGY
TOPIC: Digestion and absorption of carbohydrate
Question Describe the enzymes involved with Marks

digestion of carbohydrates
Points Amylase
Required
Pancreatic amylase
Oligosaccharidases
Alphadextrinase, isomaltase, lactase,
sucrase, trehelase
Final monosaccharides – alpha-dextrose,
maltotriose, maltose, trehalose, lactose,
glucose, fructose
Describe how carbohydrates are
absorbed
2 Phases – 1) into intestinal mucosal cell,
2) into ICF, capillaries & portal blood
Glucose/galactose – secondary active

transport with Na+ SGLT & 2
Glucose/galactose – facilitated diffusion

into ICF by GLUT2
Fructose – facilitated diffusion from lumen

by GLUT5 then GLUT2 into ICF
235
SUBJECT: PHYSIOLOGY
TOPIC: Regulation of gastric secretion
Question Describe the phases of gastric acid Marks

secretion
Points Cephalic phase – initiated by thought,
Required smell, and taste of food. Leads to vagal
activation that stimulates HCL and gastrin
secretion
Gastric phase – initiated by presence of
food in the stomach particularly protein
rich food.
Intestinal phase – initially the presence of
amino acid and food in the duodenum
stimulate acid production. Later there is
inhibition following the release of secretin
and CCK
Gastrin – stimulates gastric acid
secretion, exocrine pancreatic secretions,
and gastric motility
HCL secretion stimulated by
Ach from PNS
Gastrin – from pyloric G cells
Histamine – produced by mast cells
HCL secretion is inhibited by
Somatostatin – from cells of ENS
Secretin – produced in duodenum
CCK
236
SUBJECT: PHYSIOLOGY
TOPIC: Renal Na+ & K+ excretion
Question Describe the excretion of sodium and Marks

potassium by the kidney
Points - Na filtered in large amounts
Required - Actively transported out of all
portions of nephron
- 96-99% reabsorbed
- Variations due to changes in GFR
- K+ reabsorbed in the proximal
tubule
- Secreted in distal tubule
- Rate is proportionate to flow of
tubular fluid – rapid flow
- Amount secreted = intake
- Mostly movement of K+ is passive
- K+ excretion decreases in
conjunction with reduced Na+ load
in the tubules, and when H+
secretion is increased
237
SUBJECT: PHYSIOLOGY
TOPIC: Buffers
Question Describe the role of buffers Marks

Points A buffer is a solution which can minimize
Required changes in H+ when acid or base is
added to it
Major buffer systems in the body
Extracellular
- Bicarbonate – major ECF buffer
against acid/base changes
- Haemoglobin is next major buffer for
H+ produced when HCO3- is
formed
- Plasma proteins
- Calcium bicarbonate in bone
- Urine – phosphate buffering
Intracellular
- proteins
- phosphates
- Hb
Henderson Hasselbach
pH = 6.1 + log10 [HCO3-]/PCO2x0.23
238
SUBJECT: PHYSIOLOGY
TOPIC: Calcium metabolism
Question Describe the hormones involved in the Marks

metabolism of calcium
Points Parathyroid hormone
Required - released in response to
hypocalcaemia
- acts on bone, kidney, gut
- causes increase in Ca2+
- Increased reabsorption in distal
tubule
- Increased calcitriol production
Calcitriol
- formed in the kidney, acts on bone
and gut
- increases intestinal absorption of
Ca2+
- increased osteoclast activity
- is the active form of vit D
Calcitonin
- lowers Ca2+
Distribution of Ca2+ in plasma

- free 50%
- bound 40-45%
- complexes 5-10%
239
Recalled ACEM I MCQs
Here is a collection of “recalled” MCQs, written by a variety of

people, from memory after past exams. There is no guarantee as to
the accuracy of these MCQs in terms of the actual questions asked
and the listed answers. Many of the stems themselves are not
complete, and may not have been remembered correctly. To get full
use from them, I suggest you revise around the stem topics, and
look up anything you are unsure of.
240
ANATOMY MCQ
1) Panniculosus adiposus
a) not well developed in man

b) is a thin layer of muscle
c) is unlike fat
d) contains nerves blood vessels and lymph
e)
2) Regarding the deep fascia which is FALSE
a) can provide attatchment for muscle

b) attatches to skin by thin fibrils
c) attatches to underlying bone
d) has no sensory supply
e) it is absent on the face
3) A dermatome is
a)
b) sperated from a discontinuous dermatome by an axial line
c)
d)
e)
4) Which is the CORRECT myotome
a) S1 supplies hip abduction

b)
c) L3,4 causes knee extension
d)
e) L5 supplies skin of dorsal 1st web space
5) An example of a synovial joint is ?
a) sacro-iliac joint
b) intervertebral joint
c) sterno manubrial joint
d) epiphyses
e)costal cartilages
6) Which is an example of a hyaline cartilage ?
a) knee meniscus
b) epiglottis
c) epiphyseal growth plate
d) intervertebral discs
e) articular surface of clavicle
7) An example of a secondary cartilaginous joint
a) costochondral joint
b) intervertebral disc
c) TMJ
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d) lambdoid suture
e) proximal tibial epiphysis
8) With respect to dermatomal nerve supply
a) the umbilicus is supplied by T12

b) C7 supplies the index finger
c) anterior axial line divides C6 and C7
d) T6 lies at level of the nipple
e) heel skin is supplied by S2
9) Myotomal supply includes
a) plantar flexion L4,5

b) shoulder abduction C5,6
c) ankle eversoin L 4
d) elbow extension C7,8
e) opponens pollicis C8
10) Diameter of a motor nerve fibre is
a) 1-2 micrometere
b) 10 millimetre
c) 12-20 micrometres
d) 5-7 millimetres
e) 20-50 micrometers
11) With regard to bone
a) nutrient artery supplies cortical bone predominantly

b) smallest channels are Haversian canals
c) trabecular network in cancellous bone is capable of considerable re-
arrangement with regard to fibre orientation
d)
e)
12) Loss of Greater tuberosity leads to loss of which movement?
a) Abduction and lateral rotation

b) Adduction and medial rotation
c) Abduction and medial rotation
d) Lateral rotation
e) Adduction and lateral rotation
13) Myotome of shoulder abduction?
a) C5
b) C5, 6
c) C5, 6, 7
d) C6, 7, 8
e) C6, 7
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14) Lateral rotation of the shoulder
a) is conducted by muscles supplied by C5

b)
c) is assisted by shoulder abduction
d)
e)
15) Which is false with respect to the lateral intermuscular septum ?
a) Origin of medial head of triceps

b) pierced by anterior branch profunda brachii artery
c) pierced by radial nerve
d) pierced by poterior branch profunda brachii artery
e) brachiradialis is anterior
16) Which does not pierce the clavipectoral fascia ?
a) lymphatics
b) cephalic vein
c) lateral pectoral nerve
d) medial pectoral nerve
e) thoracoacromial artery
17) Serratus anterior
a) Medially rotates the shoulder

b) Protracts the scapula
c) is unipennate
d) Arises from the upper 6 ribs
e) is supplied by the thoracodorsal artery
18) Latimus dorsi
a) arises from spinous processes of T2 to L5

b) externelly rotates humerus
c) inserts into lesser tuberosity of humerus
d) spirals around the upper border of teres major
e) arise from the iliac crest
19) Teres major
a) forms the lateral border of the triangular space

b) largely acts to extend the arm
c) forms the lower border of the quadrilangular space
d) is supplied by the axillary nerve
e) arises from the medial border of the scapula
20) The sternoclavicular joint
a) is supplied by nerve branches C8 and T1

b) contains two fibrocartilaginous discs
c) is the fulcrum of movements of the sterno-clavicular joint
d) is mostly stabilised by the costoclavicular ligament
e) communicates with the manubriosternal joint
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21) Which causes lateral rotation of the shoulder ?
a) subscapularis
b) teres minor
c) teres major
d) deltoid
e) serratus anterior
22) What stabilises the abducted shoulder ?
a) capsule
b) long head of triceps
c) glenohumeral ligament
d) coraco-acromial arch
e) gleno-humeral joint
23) Biceps brachii
a) the two heads merge in the upper arm

b) is supplied by the median nerve
c) is a supinator of the forearm
d) the short head arises from the acromion
e) the long head arises from the greater tuberosity of the humerus
24) The brachial artery
a) is a continuation of the subclavian artery

b) runs parallel but deep to the profunda brachii
c) is crossed posteriorly by the median nerve
d) lies anterior to the cephalic vein
e) lies lateral to the brachial plexus
25) Which nerve does not pass through the muscle shown
a) radial nerve and brachiradialis

b) posterior interosseous nerve and supinator
c) musculocutaneous and coracobrachials
d) ulna nerve and FDS
e) medin nerve and pronator teres
26) Injury to the middle trunk of the brachial plexus
a) will mean C8 sensation will be affected

b) will manifest in the medial chord
c) will affect the long thoracic nerve
d) will affect the median nerve
e) all of the above
27) Rotator cuff includes all the following EXCEPT
a) subscapularis
b) teres major
c) teres minor
d) infraspinatus
e) supraspinatus
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28) In the cubital fossa which of the following is lateral to the radial
artery
a)
b) brachial artery
c) median nerve
d) biceps tendon
e) posterior interosseus nerve
29) In the cubital fossa
a) nerve to pronator teres is derived from the radial nerve

b) radial nerve is medial to biceps tendon
c) the ulna artery lies superficial to the pronator teres
d) radial artery originates from brachial artery
e) the median nerve lies lateral to the brachial artery
30) Triceps
a) blood supply is posterior interosseus artery

b) is supplied by the radial nerve
c) only has two heads
d) stabilises the shoulder in adduction
e) often has it’s nerve supply compromised by humreal shaft
fractures
31) Deepest mid-forearm structure is
a) FPL
b) median nerve
c) basilic vein
d) radial artery
e) ulnar nerve
32) In the upper limb, which is CORRECT?
a) Upper arm recieves supply from T4

b) upper arm and forearm supplied by C3,4,5,6,7,8,T1
c) upper arm dermatomes are C4,5,8,T1
d) elbow flexion is C7,8
e) thumb dermatome is C8
33) The brachial plexus
a) there are 7 divisions of the trunks

b) the nerve to subclavius is the only trunk
c) the radial nerve is derived from C7,8,T1
d) the axillary nerve is derived from the lateral chord
e) the roots lie between the scalene muscles
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34) Which is FALSE regarding the carpal tunnel ?
a) Median nerve and flexor policis longus are superficial

b) Flexor policis longus has it’s own sheath
c) FDS and FDP tendons lie within the same sheath at the tunnel
d) FCR tendon may pierce the flexor retinaculum
e) FCU lies within the canal of Guyon
35) Of the Quadrilangular and triangular spaces, which is FALSE ?
a) both share the same medial border

b) circumflex humeral artery passes through quadrilangular
c) long head of triceps borders both spaces
d) Triangular space admits the radial nerve
e) teres minor does not form a border to either space
36) Radial nerve
a) Runs with profunda brachii in the radial groove

b) gives off the posterior interosseus in the spiral groove
c) contains only fibres of C 5,6,7
d) occupies the entire length of the radial groove
e) passes through the quadrilangular space
37) Lumbricals
a) oppose the action of introssei

b) arise from FDS
c) are all supplied by ulnar nerve
d) form proprioceptive bridges between flexors and extensors
e) aid flexion of terminal phalanx
38) Forearm muscles
a) pronator teres is the most powerful pronator

b) palmaris longus is absent in 30 % of cases
c) FPL is unipennate
d) FCR runs over whole length of flexor retinaculum
e) pronator quadratus arises from lower radius
39) Interossei
a) arise from flexor retinaculum

b) palmar cause abduction
c) palmar have two heads of origin
d) innervated by deep branch of ulnar nerve
e) combined palmer and dorsal causes abduction
40) Palmar interosseii
a)
b) have two heads
c) abduct the fingers
d) chiefly responsible for flexion MCPJ and extension PIPJ
e)
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41) Pectoralis major
a) is quadrilateral in shape
b) inserts to the medial lip of bicipital groove
c) is supplied by all 5 segments of the brachial plexus
d) lies between biceps and the humeral shaft
e) has a head arising from posterior surface clavicle
42) Ulna digital nerve supply
a) digital nerve branches lie superficial to the superficial palmar arch

b) digital nerve lies dorsal to the digital nerve along the fingers
c)
d)
e)
43) Midpalmar space
a)
b) extends into lumbrical canals distally
c)
d) is continuous with common carpal space
e) extends proximally to the origin of FDS
44) Flexor digitorum profundus
a) assists pronator quadratus in pronation

b) is supplied 10 % of the time purely by the median nerve
c) is the strongest muscle of the forearm
d) partly inserts into the flexor retinaculum
e) has it’s action enhanced by wrist flexion
45) Which is not a branch of the axillary artery ?
a) Thoraco-acromial
b) superior thoracic
c) posterior circumflex humeral
d) dorsal scapular
e) circumflex scapula
46) The axillary artery
a) arises from the vertebral artery

b) has no branches in it’s 3rd part
c) is clasped in it’s 3rd part by the chords of the brachial plexus
d) supplies the pectoral muscles via the superior thoracic artery
e) is divided into 3 parts by teres minor
47) In the forearm the ulna artery
a)
b)
c) has the ulna nerve lying medial to it
d)
e)
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48) The ulna artery
a)
b) has the ulna nerve lying lateral to it
c) supplies deep palmar arch
d) has common interosseus as it’s major branch
e)
49) The flexor retinaculum attaches to all bones except
a) tarpezium
b) hamate
c) pisiform
d) scaphoid
e) capitate
50) Which of the following bones is attached to flexor and extensor

retinaculum
a) scaphoid
b) hamate
c) pisiform
d) trapezium
e) triquetral
51) The anatomical snuff box
a) has trapezoid palpable at it’s base

b) has EPL on it’s ulna side
c) contains the posterior interosseus artery
d) lies between EPLand APL
e) is most obvious with the thumb abducted
52) The radial artery
a) in it’s middle third has the radial nerve medial to it

b) lies on brachioradialis in the upper arm
c) passes between the tendons of EPB and APL
d) forms both the anterior an dposterior carpal arches
e) all of the above
53) Acromio-clavicular joint which is FALSE
a) is a complex joint with fibrocartilage intracapsular disc

b)
c) coraco-clavicular ligament is not a stabilising factor
d) all movements are passive
e) is innervated by the cervical plexus
54) The deltoid
a)
b) is supplied by the axillary nerve
c) has a multipennate arrangement for maximal range of movement
d)
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e) inserts into the bicipital groove
55) All drain into the great saphenous vein except
a) superficial epigastric
b) superficial circumflex iliac
c) deep external pudendal
d) superficial external pudendal
e) deep circumflex iliac
56) All are tributaries of the femoral artery except
a) deep circumflex iliac

b) medial femoral circumflex
c) superficial circumflex iliac
d) superficial external pudendal
e) deep external pudendal
57) Adductor canal
a) vein is medial to the artery throughout

b) adductor longus forms the roof
c) lateral border is vastus lateralis
d) femoral artery lies between the saphenous nerve and femoral vein at all
times
e) nerve to vastus lateralis passes through the canal
58) Which passes through the lesser sciatic foramen
a) inferior gluteal artery

b) superior gluteal artery
c) internal pudendal artery
d) piriformis
e) pudendal nerve
59) Which statement concerning the femoral triangle is FALSE
a) adductor longus is a medial boundary

b) anterior division of obturator nerve is on adductor brevis?
c) femoral vein receives the great saphenous
d) lateral border is medial border of sartorius
e) lateral and medial circumflex femorals leave femoral artery ?
60) Which does not attach to the greater trochanter
a) piriformis
b) gluteus maximus
c) obturator internus
d) obturator externus?
e) gemelli
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61) Which is not in the 3rd layer of the sole
a) part of the transverse arch

b) flexor hallucis brevis
c) adductor hallucis
d) flexor digiti minimi brevis
e) peroneus longus
62) Regarding the deltoid ligament of the ankle
a) strengthens the lateral aspect of the ankle

b) has three layers
c) superficial part is triangular
d)
e)
63) Regarding the layers of the foot
a) long flexor tendons lie in the 2nd layer

b) plantar aponeurosis is in the 4th layer
c) it consists of three layers
d)
e)
64) Regarding the medial side of the ankle
a) deltoid ligament is continuous with the spring ligament

b) great saphenous vein runs posterior to the malleolus
c) anterior talo-fibular ligament strengthens the joint
d) posterior tibial artery runs anterior to malleolus
e) short plantar ligament strengthens medial arch
65) All make up the medial arch EXCEPT
a) metatarsals 1,2,3
b) calcaneum
c) talus
d) navicular
e) cuboid
66) Plantar aponeurosis
a) Covers the abductors of the big and little toe

b) Is inserted to all 5 metatarsals
c) Does not attach to skin
d) Arises from talus
e) Covers half length of sole
67) Regarding the femoral triangle
a) lateral circumflex femoral seperates superficial and deep branches of femoral

nerve
b)
c)
d)
e)
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68) The skin over the femoral triangle is supplied by
a) ilio-inguinal nerve
b) obturator nerve
c) medial femoral cutaneous nerve
d) lateral femoral cutaneous
e) genito-femoral nerve
69) The great saphenous vein
a) is a continuation of the lateral marginal vein of the foot

b) runs between the two heads of gastrocnemius
c) pierces the cribriform fascia
d) can be found immediately below and lateral to the pubic tubercle
e) does not communicate with the superficial vein varicosities
70) Movement at the mid-tarsal joint includes
a) inversion/eversion
b) dorsiflexion / plantarflexion
c)
d)
e)
71) Which is not a branch of the common peroneal
a) superior genicular nerve

b) lateral cutaneous nerve of the calf
c) inferior genicular nerve
d) recurrent genicular
e) sural nerve
72) All of the following structures pass deep to the superior retinaculum
EXCEPT
a) deep peroneal nerve

b) anterior tibial artery
c) superficial peroneal nerve
d) peroneus tertius
e) extensor digitorum longus
73) Regarding the ankle joint
a) the capsule is attached anteriorly to the neck of the talus

b) it has a fixed axis of rotation
c) in full plantarflexion, a significant amount of inversion and eversion is
possible at the ankle joint
d) the lateral ligament is made up of three separate bands that all insert into
the talus
e) the weight bearing surfaces are the upper facet of the talus, the inferior
facet of the tibia and the medial and lateral malleoli
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74) In the lateral compartment of the leg
a) the muscles are supplied by the deep peroneal nerve

b) the peroneus longus arises only from the fibula
c) the blood supply is anterior tibial
d) peroneal muscle tendons share same muscle sheath at the lateral malleolus
e) peroneal muscle tendons are bound at the lateral malleolus by the inferior
peroneal retinaculum
75) Popliteus
a) does not attach to lateral meniscus

b) causes lateral rotation of femur on fixed tibia
c)
d)
e)
76) Popliteus
a) arise from the tibia above the condyles

b) slopes upwards and medially
c) inserts into the lateral meniscus
d) acts to lock the knee in full extension
e) is innervated by a branch of the common peroneal nerve
77) Regarding the cruciate ligament
a)
b)
c) PCL is attached to the medial condyle of the femur
d)
e)
78) By Hilton’s law which nerve does not supply the hip joint
a) nerve to rectus femoris

b) obturator nerve
c) femoral nerve
d) sciatic nerve
e) gluteal nerve
79) Medial lymph nerves DO NOT drain
a) anal canal
b) scrotal skin
c) testicles
d) urethra
e) anterior skin distal to umbilicus and above inguinal ligament
80) Muscle of the lower leg which can initiate dorsiflexion and inversion
a) tibialis posterior
b) tibialis anterior
c) peroneus tertius
d) peroneus longus
e) peroneus brevis
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81) With respect to the ossification times in the foot
a) metatarsals have two ossification centres

b) 5th metatarsal has three ossification zones
c)
d)
e)
82) With respect to the inguinal canal
a) the inguinal nerve does not pass through the deep ring
b)
c)
d)
e)
83) The femoral artery
a) is separated from the hip joint capsule by fat only

b) is crossed by the femoral vein from medial to lateral as it descends
c) enters the adductor canal by piercing sartorius
d) is found at the mid-inguinal point
e) gives off the medial femoral cutaneous as it’s major branch
84) Gluteus maximus
a) is the deepest of the gluteal muscles

b) is supplied by L5, S1
c) medially rotates and extends the hip
d) forms the skin crease of the gluteal fold
e) all of the above
85) The hip joint
a) is flexed largely by sartorius and rectus femoris

b) is limited in full extension by the pubofemoral ligament
c) is only supplied by the obturator and sciatic nerves
d) has the ischiofemoral as it’s strongest ligament
e) derives it’s stability largely from it’s articular surfaces
86) In the popliteal fossa
a) the popliteal artery runs vertically

b) the inferomedial border is soleus
c) the popliteal vein lies between popliteal artery and tibial nerve
d) the roof is formed by biceps femoris
e) the sural nerve branches from the common peroneal nerve
87) With regard to the knee joint
a) the lateral meniscus is more ‘c’ shaped

b) the tendon of popliteus is intra-articular
c) the medial collateral ligament is extra-articular
d) the medial collateral extends 8 cm beyond the joint line
e) all of the above
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88) Tibialis anterior
a) dorsiflexes and everts the foot

b) arises from the upper two thirds of the fibula
c) inserts into the medial cuneiform
d) shares it’s site of insertion with peroneus tertius
e) is supplied by L5, S1
89) Under the extensor retinaculum the most lateral structure is
a) sural nerve
b) dorsalis pedis artery
c) EHL
d) EDL
e) Peroneus tertius
90) With regard to cutaneous innervation of the lower limb
a) Branches of the tibial nerve supply most of the dorsum of the foot
b) The medial plantar nerve supplies a greater area than the lateral
c) Deep peroneal nerve supplies the 3rd digital cleft
d) Sural nerve supplies the medial malleolus
e) Superficial peroneal nerve supplies the 1st inter-digital cleft
91) The dermatome supplying the great toe is usually
a) L3
b) S1
c) L5
d) S2
e) L4
92) In the chest wall
a) the neurovascular bundle lies between the external and internal intercostals
b) the transversus muscle lies between the internal and external intercostals
c) the intercostal artery lies between the nerve and vein
d) the intercostal artery is more superficial than the vein
e) all of the above
93) The oesophageal opening in the diaphragm is at
a) T6
b) T8
c) T10
d) T12
e) L1
94) The trachea
a) drains to axillary lymph nodes

b) is supplied by glossopharyngeal nerve
c) is marked at it’s lower end by the sternal angle
d) enters the thoracic inlet slightly to the left
e) commences below the cricoid at the level of C5
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95) The most superficial structure in the thoracic inlet is the
a) vagus nerve
b) superior vena cava
c) right subclavian artery
d) left subclavian artery
e) thoracic duct
96) The diaphragm
a) has the oesophageal opening opposite the T8 vertebrae

b) is supplied by C4, 5, 6
c) has a major role in expiration
d) has a vena caval opening at T10
e) has an aortic opening opposite T12
97) Which passes through the diaphragm with the oesophagus
a) azygous vein
b) right vagus
c) sympathetic trunks
d) thoracic duct
e) phrenic nerves
98) With regard to the coronary arteries
a) right arises from the posterior coronary sinus

b) left supplies the conducting system in most patients
c) right supplies the posterior descending branch in most patients
d) there are no arteriolar anastomoses between left and right
99) Regarding broncho-pulmonary segments, which is FALSE
a) There are approximately 10 segments in each lung

b) The lingula is divide into upper and lower segments
c)
d)
e)
100) Which muscle is NOT used in forced expiration
a) transversus abdominis
b) rectus abdominis
c) diaphragm
d) external oblique
e) internal oblique
101) Which vessel passes directly behind the right hilum
a) right phrenic nerve

b) right vagus nerve
c) azygous vein
d) internal mammary artery
e) hemi-azygous vein
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102) Which lymph nodes drain the lower anal canal
a) superficial inguinal
b) external iliac
c) deep inguinal
d) para-aortic
e) internal iliac
103) Superior pancreaticoduodenal vein drains into
a) left gastric vein

b) portal vein
c) splenic vein
d) superior mesenteric vein
e) IVC
104) All the following are veins which drain the stomach EXCEPT
a) gastroepiploic
b) gastroduodenal
c) right gastric
d) left gastric
e) short gastric
105) Which is not true of the stomach
a) completely invested by peritoneum

b) cardia situated at T12
c) pyloric opening at L1
d) aorta to the left of lesser curve
e) supplied by branches of the coeliac trunk
106) Which DOES NOT pass through the transpyloric plane
a) splenic vein
b) tips of the 9th costal cartilages
c) lower border of L1
d) spleen
e) superior mesenteric artery
107) Appendix
a) usually lies retrocaecal in health

b) drains to inguinal nodes
c) has no mesentry
d) has a tip constant in relation to the caecum
e) opens into the caecum 2 cm below the ileocaecal valve
108) The duodenum
a) is a retro-peritoneal structure
b) is 25cm in length
c) lies between the levels of L2-L4
d) in it’s 4th part lies to the right of the aorta
e) all of the above
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109) The highest branch of the abdominal aorta is the
a) right suprarenal artery

b) coeliac trunk
c) left renal artery
d) left gonadal artery
e) superior mesenteric artery
110) The main vessel supplying the body of the pancreas is the
a) superior pancreaticoduodenal artery

b) splenic artery
c) left gastric
d) left gastroepiploic
e) inferior pancreaticoduodenal
111) Regarding the abdominal aorta
a) renal arteries originate at T12

b) splenic vein crosses the aorta just below superior mesenteric artery origin
c) surface marking from a point just above the transpyloric plane to a point
just to the left of the umbilicus
d)
e)
112) Regarding the testicular blood supply
a) division of the testicular artery results in testicular infarction

b) testicular artery has numerous anastamoses with the cremateric artery
c) pampiniform plexus is a superficial plexus surrounding the testicular artery
d)
e)
113) Which of the following the appendix is UNTRUE
a) it has a base constant in relation to the caecum

b) it has it’s own mesentery
c) it is formed by teneae coli convergence
d) varies in length between 2 and 25 cm
e) it always lies retro-ileal in prescence of disease
114) The ureters
a) widest in diameter at the PUJ

b) innervated by sympathetic nerves T12-L1
c) lie lateral to the tips of the lumbar transverse processes
d) depend on innervation from the pelvis for peristalsis
e) none of the above are true
115) The ureters
a) cross the gonadal vessels

b) cross over the vas deferens
c) are crossed by the genitofemoral nerve
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d) pass under the cover of the psoas muscle peritoneum

e) lie lateral to the lumbar transverse processes
116) All the following are branches of the external carotid EXCEPT
a) lingual artery
b) facial artery
c) ascending pharyngeal artery
d) hypoglossal artery
e) superior thyroid artery
117) All the following are branches of the ophthalmic division of the trigeminal nerve
EXCEPT
a) lacrimal nerve
b) infraorbital nerve
c) supraorbital nerve
d) infratrochlear nerve
e) supratrochlear nerve
118) Which of the following is a branch of the mandibular nerve
a) infraorbital nerve
b) external nasal nerve
c) zygomaticofacial nerve
d) auriculotemporal nerve
e) zygomaticotemporal nerve
119) Which of the following is a branch of the maxillary nerve
a) zygomaticotemporal nerve
b)
c)
d)
e)
120) The alar ligaments connect the
a) bodies of the axis to foramen magnum

b) dens to foramen magnum
c) adjacent vertebral bodies posteriorly
d) tips of adjacent spinous processes
e) adjacent laminae
121) All the following are boundaries of the named triangle EXCEPT
a) mandible and submental triangle

b) mandible and anterior triangle
c) mandible and digastric triangle
d) sternocleidomastoid and carotid triangle
e) sternocleidomastoid and anterior triangle
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122) All the following are contents of the posterior triangle EXCEPT
a) accessory nerve
b) cervical plexus
c) inferior belly of omohyoid
d) transverse cervical vessels
e) occipital lymph nodes
123) The afferent path of the sneeze reflex is mediated by the
a) ophthalmic nerve
b) maxillary nerve
c) mandibular nerve
d) vagus nerve
e) glossopharyngeal nerve
124) Which of the following enters into the inferior meatus of the nose
a) frontal sinus
b) ethmoidal sinus
c) maxillary sinus
d) nasolacrimal duct
e) auditory tube
125) A fracture through the roof of the maxillary sinus might result in
sensory loss to the
a) tympanic membrane
b) lacrimal gland
c) upper molar teeth
d) upper incisors and canine teeth
e) skin overlying the zygomatic bone
126) All the following structures pass through the jugular foramen EXCEPT
a) jugular vein
b) glossopharyngeal nerve
c) hypoglossal nerve
d) accessory nerve
e) vagus nerve
127) The motor nuclei of the facial nerve are found in the
a) pons
b) midbrain
c) medulla oblongata
d) cerebellum
e) floor of the 3rd ventricle
128) The midbrain
a) is largely in the middle cranial fossa

b) is supplied by the anterior inferior cerebellar artery
c) lies between pons and upper spinal cord
d) contains the occulomotor nuclei
e) contains the trigeminal nuclei
259
129) Cerebrospinal fluid communicates with the subarachnoid space via the
a) 4th ventricle
b) 3rd ventricle
c) subarachnoid granulations
d) choroid plexus
e) tela choroidia
130) Which of the following pathways is not concerned with posture and
movement
a) spinocerebellar
b) vestibulospinal
c) tractus solitarius
d)
e)
131) The posterior column transmits which of the following
a) afferent pain and temperature

b) afferent tendon stretch impulses
c) motor tracts
d) none
132) The infratrochlear nerve supplies the
a) upper incisors
b) labial gum
c) bridge over the nose
d) upper lip
e) skin of the lower eyelid
133) Which nerve supplies the vertex of the scalp
a) greater occipital
b) third occipital
c) auriculotemporal
d) supraorbital
e) supratrochlear
134) Corneal sensation synapses in which ganglion
a) pterygopalatine
b) geniculate
c) otic
d) ciliary
e) trigeminal
135) Which is true of swallowing ?
a) It is entirely voluntary
b) The oropharyngeal portion is voluntary
c) Peristalsis speeds as the bolus descends
d) The voluntary stage commences as food enters the oesophagus
e) It is initially voluntary then involuntary
260
136) Which muscle controls vocal cord abduction
a) aryepiglotic
b) transverse arytenoid
c) lateral cricoarytenoid
d) posterior cricoarytenoid
e) cricothyroid
137) Where does the superior cerebral vein lie
a) deep in the sulci

b) between the dura and the skull
c) in the arachnoid mater
d) in the margins of the falx
e) with the superior cerebral artery
138) What exits the stylomastoid foramen
a) middle meningeal artery

b) accessory nerve
c) facial nerve
d) artery to stapedius
e) hypoglossal nerve
139) Regarding the circle of Willis
a) posterior cerebral is a branch of the internal carotid

b) anterior cerebral is the largest branch of the internal carotid
c) middle cerebral supplies motor but not sensory cortex
d) internal carotid gives off ophthalmic artery
e) anterior communicating unites middle and anterior cerebral
140) Regarding the speech centres
a) Broca’s area is on the left side in most left handed people

b) Broca’s area is posterior
c) Wernicke’s area controls motor response
d) Damage to Broca’s area produces motor aphasia
e) Damage to Wernicke’s area produces expressive aphasia
141) Regarding the optic pathways
a) combined inferior rectus and superior oblique gives lateral gaze

b) Abducent paralysis makes eye turn down and out
c) Superior rectus makes eye turn up and out
d) Trochlear paralysis, eye cannot look downwards when turned out
e) Combined superior rectus and inferior oblique causes vertical upward gaze
142) Regarding the blood supply of the cerebral cortex
a) middle cerebral is contralateral arm, leg and speech areas

b) anterior cerebral is contralateral leg, micturition and defacation
c) middle cerebral is ipsilateral arm, face and vision
d) posterior cerebral is ipsilateral vision
e) anterior cerebral is contralateral leg, auditory and speech
261
143) Which vessel supplies a branch which passes through the foramen spinosum
a)
b)
c) maxillary artery((((for middle meningeal)))))
d)
e)
262
1. D
2. D
3. B
4. C
5. A
6. C
7. B
8. B
9. D
10. C
11. C
12. D
13. A
14. A
15. D
16. D
17. B
18. E
19. C
20. D
21. B
22. B
23. C
24. – (B)
25. D
26. D
27. B
28. D (E)
29. D
30. B
31. E (A)
32. C
33. E
34. E
35. E
36. A
37. D
38. C
39. D
40. D
41. C
42. –
43. –
44. C
45. D
46. – (D)
47. C
48. D (?C)
49. E
50. C
51. B
52. D
53. C (+E)
54. B
55. E
56. A
57. D
58. C&E
59. B&E
60. B
61. E
62. C
63. A
64. E (A)
65. E
66. B (?C)
263
67. A
68. E
69. C
70. A
71. E
72. C
73. A
74. D
75. B
76. D (C)
77. C
78. E
79. C
80. B
81. A
82. A
83. D
84. D (B)
85. E
86. C
87. E
88. C
89. E
90. B
91. C
92. C
93. C
94. C
95. B
96. E
97. B
98. C
99. B
100. C
101. C
102. A
103. B
104. B
105. B
106. D
107. E
108. B
109. B
110. B
111. C
112. C
113. E
114. E
115. –
116. D
117. B
118. D
119. A
120. B
121. A
122. E (B)
123. A (B)
124. E(B)
125. E (D)
126. C
127. A
128. D
129. A
130. C
131. –
132. C
264
133. A
134. D
135. E
136. D
137. C
138. C
139. D
140. D
141. D
142. B
143. C
144. -
265
PATHOLOGY MCQ
1) Hypertrophy
a) occurs after partial hepatectomy

b) increases function of an organ exponentionally
c) is triggered by mechanical and trophic chemicals
d) occurs after dennervation
e) is usually pathological
2) All the following are features of apoptosis EXCEPT
a) cell swelling
b) chromatin condensation
c) formation of cytoplasmic blebs
d) lack of inflammation
e) phagocytosis of apoptotic bodies
3) Dystrophic calcification
a) is formed only in coagulative necrosis

b) does not occur on heart valves
c) rarely causes dysfunction
d) is rarely found on mitochondria
e) is formed by crystalline calcium phosphate mineral
4) Irreversible cell injury is characterised by
a) dispertion of ribosomes
b) cell swelling
c) nuclear chromatin dumping
d) lysosomal rupture
e) cell membrane defects
5) Metaplasia
a) can be caused by vitamin B12 deficiency

b) preserves mucus secretion in the respiratory tract
c) is typically an irreversible process
d) is the process that occurs in Barrett’s oesophagitis
e) is an increase in the number and size of cells in a tissue
6) Smooth endoplasmic reticulum
a) is the site a cell steroid production

b) is the site of cell protein synthesis
c)
d)
e) is the site of cellular cytochrome oxidases
266
7) Pinocytosis
a) adds to the cell membrane

b)
c)
d)
e) involves the uptake of soluble macromolecules
8) Examples of hyperplasia include
a)
b)
c)
d) glandular epithelium of pubertal breasts
e)
9) Ribosomes
a) have 3 subunits
b) have 30% DNA
c) synthesise haemoglobin
d)
e)
10) Which of the following is not associated with atrophy
a) decreased smooth endoplasmic reticulum

b) decreased rough endoplasmic reticulum
c)
d)
e) decreased autophagic vacuoles
11) In acute inflammation which event occurs first
a) arteriolar dilatation
b) arteriolar constriction
c) oedema
d) leucocyte migration
e) blood flow stasis
12) The first vascular response to injury is
a) slowing of the circulation

b) venular dilation
c) recruitment of vascular beds
d) capillary engorgement
e) arteriolar vasoconstriction
13) Leucocytes move into the tissues from the vasculature (extravasation )
a) by the action of actin and myosin

b) predominantly as monocytes on the first day post injury
c) in response to C3b
d) in response to the Fc fragment of IgG
267
e) largely in the arterioles
14) Regarding chemical mediators of inflammation
a) histamine is derived from plasma

b) C3b is within macrophages
c) The kinin system is activated in platelets
d) Nitric oxide is preformed in leukocytes
e) Seretonin is preformed in mast cells
15) Chronic inflammation is
a) always preceded by acute inflammation

b) characterised by hyperemia, oedema and leukocyte infiltration
c) most frequently results in resolution
d) the factors underlying monocyte infiltration are the same as for acute
inflammation
e)
16) In the triple response the reactive hyperemia is due to
a) blushing
b) excersise
c) arteriolar dilation
d) inflammatory mediators
e) still present after sympathectomy
17) Vascular hyperemia
a) is caused by inflammatory mediators

b) results in cyanosis
c) results in oedema
d) results in brown induration
e)
18) Platelets
a) contain alpha and beta granules

b) are biconcave discs
c) contain a nucleus
d) are found in the plasma at levels of 200-500 per microlitre
e) are the main source of thrombin
19) Macrophages may secrete
a) histamine
b) seretonin
c) prostaglandins
d) oxygen free radicals
e)
20) Which of the following cells cannot phagocytose
a) neutrophils
b) eosinophils
c) macrophages
d) T-cells
268
e)
21) The most common peripheral circulating lymphocyte is
a) B-cell
b) T-cell
c)
d)
e)
22) Granulocytes
a)
b)
c)
d)
e)
23) Oncogenes
a)
b)
c)
d)
e)
24) Dysplasia
a) is a feature of mesenchymal cells

b) inevitably progresses to cancer
c) is characterised by cellular pleomorphism
d) is the same as carcinoma in situ
e) is not associated with architectural abnormalities
25) Metastasis
a) unequivocally prove malignancy

b) is the most common presentation of melanoma
c) is proven by lymph node enlargement adjacent to a tumor
d) of breast is usually to supraclavicular nodes
e) all of the above
26) Mast cell
a) may discharge independent of IgE

b) release lysosymes
c)
d)
e)
27) Non-inflammatory oedema
a) has a high protein content

b) has a SG of greater than 1.012
c) is caused by low levels aldosterone
d) is caused by elevated oncotic pressure
269
e) is associated with elevated levels of ANP
28) Metastatic calcification occurs in
a) old lymph nodes

b) gastric mucosa
c) atherosclerotic vessels
d) damaged heart valves
e)
29) Regarding chronic inflammation all of the following are true EXCEPT
a) it can be caused by persistent infections

b) it primarily involves tissue destruction
c) it may contribute to the formation of atherosclerosis
d) it involves mononuclear inflammatory cells
e) it can be caused by exposure to toxic agents
30) Macrophages are derived from
a) monocytes
b) T-cells
c) B-cells
d) Eosinophils
e) Plasma cells
31) White infarcts occur in
a) small intestine
b) oesophagus
c) lung
d) kidney
e) sigmoid colon
32) Concerning the repair of a well opposed, clean surgical incision
a) dermal appendages destroyed by the incision usually recover

b) new collagen begins to accumulate after the first week
c) granulation tissue does not occur
d) there is an initial inflammatory response
e) 15% of original tissue strength is attained after 1 week
33) Pulmonary congestion is associated with
a)
b)
c) haemosiderin deposition in macrophages
d)
e)
34) Regarding oedema
a) infection does not cause pulmonary oedema

b) hereditory angioneurotic oedema involves skin only
c) facial oedema is a prominent component of anasacra
d) hepatic cirrhosis is the most common cause of hypoprotenemia
270
e) hypoprotenemia is the most common cause of systemic oedema
35) With respect to wound healing
a)
b)
c) neutrophils proliferate at the wound margins at the same time as epitheleal
proliferation occurs
d)
e)
36) Which occurs first in fracture healing
a) neutrophil invasion
b) procallus formation
c) woven bone ossification
d) lamellar bone ossification
e) collagen deposition
37) Subchondral necrosis
a) is rarely idiopathic
b) associated with diving injuries
c) rarely involves ischaemia
d)
e)
38) In bone fracture healing
a) woven bone forms in the periosteum of the medullary cavity

b) osteoblasts lay down woven bone over the procallous to repair the fracture
line
c) PTH acts directly on osteoclasts to increase absorption
d) Haematoma at the fracture site plays little role in the development of
procallous
e) Inadequate immobilisation aids the formation of normal callous
39) In healing by primary intention
a) there is a large tissue defect

b) the tissue defect cannot be reconstituted
c) it involves excessive granulation tissue
d) an epitheleal spur forms on the first day
e)
40) The process of blood coagulation involves
a) prothrombin activator converting fibrinogen to fibrin

b) alpha 2 macroglobulin
c) the action of antithrombin 3 to promote clotting
d) the action of plasmin on fibrin
e) the removal of peptides from each fibrinogen molecule
271
41) DIC is associated with
a) thrombocytosis
b) a bleeding diathesis presentation in a patient with malignancy
c)
d)
e)
42) With respect to the clotting cascade
a) the alternative pathway is stimulated by Ag-Ab interaction

b) C3bBb inhibits the final common pathway
c) As
d) As
e) C5a initiates arachadonic acid metabolite release from neutrophils
43) With regard to embolism
a) arterial emboli most often lodge in the viscera

b) pulmonary emboli are rarely multiple
c) amniotic fluid emboli are associated with the highest mortality
d) all emboli consist of either gas or solid intravascular mass
e) most pulmonary emboli produce signs of respiratory distress
44) Regarding the veins of the lower limb
a) thrombosis in the superficial veins is a common source of emboli

b) phlegmasia alba dolens is associated with iliofemoral vein thrombosis
c) dermatitis is a common consequence of Buergers disease
d) varicosity development has no genetic component
e) 20% of venous thrombi commence in superficial veins
45) Post mortem features of clot include
a) adherence to vascular walls

b) absence of red cells in supernatant
c)
d) lines of Zahn
e)
46) Air embolism
a) is fatal as air is non-compressible so does not leave the heart

b)
c)
d) 200 ml is the lethal dose
e)
47) Amniotic fluid embolism
a) is associated with a greater than 80 % mortality

272
b)
c)
d)
e)
48) Fat embolism syndrome is assocoated with
a)
b)
c) mortality of greater than 20 %
d)
e) petechial rash, non-thrombocytopenic
49) T lymphocytes
a) contain CD3 proteins

b) are the basis for type 2 hypersensitivity
c) differentiate into antibody producing plasma cells
d) are capable of cytotoxic activity
e) are activated in the presence of soluble antigens
50) In transplant rejection the hyperacute rejection is
a) cell mediated
b) prevented largely by cross-matching blood
c) controlled by immunosuppressive drugs
d)
e)
51) All the following are type 1 hypersensitivity primary mast cell
mediators EXCEPT
a) histamine
b) tryptase
c) heparin
d) platelet activating factor
e) eosinophil chemotactic factor
52) Type 2 hypersensitivity
a) involve cell mediated immune responses

b) explain the tuberculin skin test
c) involve IgE on mast cells
d) explain many transfusion reactions
e) include serum sickness as an example
53) A man with type B blood
a) has the commonest blood type

b) cannot have a child with type O blood
c) cannot have a child with type AB blood
d) cannot have a child with type A blood
e) none of the above
54) Passive immunity is achieved by administering

273
a) live virus
b) attenuated virus
c) adsorbed toxin
d) activated T-cells
e) all of the above
55) The majority of AIDS cases are reported from
a) homosexual males
b) IV drug abusers
c) Haemophilliacs
d) Heterosexual contact
e) Recipients of blood products
56) The following are opportunistic AIDS infections EXCEPT
a) PCP
b) Atyoical mycobacterium
c) CMV
d) Mycoplasma pneumonia
e)
57) HIV is associated with
a)
b)
c)
d) polyclonal hypergammaglobulinemia
e)
58) Staph aureus
a) has enterotoxins which stimulate emetic receptors in the abdominal viscera

b) has a lipase which degrades lipids on the skin surface
c) has a capsule that allows it to attach to artificial materials
d) has receptors on it’s surface which allow binding to host endothelial cells
e) all of the above
59) Staph aureus can cause all of the following EXCEPT
a) food poisoning
b) osteomyelitis
c) carbuncles
d) scarlet fever
e) scalded skin syndrome
60) Which of the following is NOT a DNA virus

274
a) HSV
b) HBV
c) HIV
d) EBV
e) VZV
61) With respect to streptococcal infection
a)
b)
c) may result in glomerulonephritis 3 weeks post infection
d)
e)
62) Non-thrombocytopenic purpura is associated with
a) aplastic anemia
b) SLE
c) Meningococcemia
d) HIV
e) EBV
63) With hepatitis B infection
a)
b)
c) HbeAg is associated with viral replication
d)
e)
64) In hepatitis B
a) Anti-HBs appears soon after HbsAg

b) Infection does not play a role in hepatocellular carcinoma
c) HbsAg appears soon after overt disease
d) The majority of cases of persistent infection result in cirrhosis
e) Acute infection causes sub-clinical disease in 65% of cases
65) Hepatitis C
a) is acquired by faecal-oral transmission

b) has it’s highest prevelance in heamodialysis patients
c) transmission by sexual contact is at a high rate
d) exposure confers effective immunity to subsequent infection
e) causes chronic hepatitis at a higher rate than hepatitis B
66) With hepatitis C infection

275
a) Associated with sexual transmission primarily

b) More than 50 % become chronic
c) Transmission increases in pregnancy
d)
e)
67) With hepatitis E infection
a) it is transmitted primarily parenterally

b) it accounts for a greater than 20 % mortality in pregnant mothers
c)
d)
e)
68) Clostridium species
a) are all spore producing

b) C.tetani produces an endotoxin which causes muscle spasm
c) Vaccination against C.tetani has not significantly reduced the incidence of
tetanus
d) C.botulinum toxin blocks seretonin and dopamine receptors
e) C.perfringens causes wound infections 10 days post operatively
69) All the following infections are associated with splenomegaly EXCEPT
a) leprosy
b) toxoplasmosis
c) tuberculosis
d) typhoid fever
e) CMV
70) Bacterial endotoxin
a) is exemplified by streptokinase
b) si the cause of the severe form of diptheria
c) is the cause of gas gangrene
d) induces the production of TNF
e) is the outer cell wall of gram positive bacteria
71) In aseptic meningitis
a) the glucose in the CSF is raised

b) the most commonly identified agent is an enterovirus
c) there is a more fulminant course than bacterial meningitis
d) there is no brain swelling
e) microscopically there is a large infiltration of leukocytes
72) In infectious disease
a) bacterial endotoxin is inner cell wall mucoprotein

b) exotoxin molecular mechanisms are mostly unknown
c) microbes propagating in the gut lumen are accessible to IgA antibodies
d) macrophages in bronchi play a major role in protecting the lungs from
infection
e) bacterial adhesins which bind bacteria to host cells have a broad range of
host cell specificity
276
73) In malaria
a) plasmodium vivax causes severe anemia

b) parasites mature in red blood cells
c) innoculated sporozites immediately invade the spleen
d) plasmodium falciparum initially causes hepatomegaly
e) cerebral malaria is caused by parasites invading grey matter
74) Ricketsial infection
a)
b)
c)
d) principally affects the endothelium
e)
75) Which of the following tissues is the most susceptible to radiation

injury
a) GI mucosa
b) CNS
c) Lymph and haemopoetic
d) Bone
e) Lungs
76) With electrical injury
a) death is always due to thermal burn

b) dry skin is a good electrical conductor
c) ampage of the current is important
d) all body tissues conduct electricity
e)
77) Which of the following is an anti-oxidant
a) vitamin D
b) vitamin B12
c) vitamin E
d) vitamin K
e) vitamin B6
78) Which deficiency causes diarrohea, dermatitis and dementia
a) pyridoxine
b) vitamin A
c) riboflavin
d) vitamin B1
e) niacin
277
79) Decreased levels of B12 are associated with all the following EXCEPT
a) autoimmune gastritis
b) crohns disease
c) subacute combined degeneration of the cord
d)
e)
80) Regarding Iron which of the following is INCORRECT
a) absorption is increased by vitamin C

b) most is found in myoglobin
c) most is absorbed in the duodenum
d) women have smaller iron stores than men
e) transferrin is usually 33% saturated
81) Which is true of the pituitary gland
a) anterior-LH-basophils
b) posterior-vasopressin-basophils
c) anterior-GH-basophils
d)
e)
82) Pituitary adenoma may cause
a) graves disease
b) hypothyroidism
c) acromegaly
d)
e)
83) Which is true of the pituitary
a) posterior-prolactin-acidophils
b) posterior-vasopressin-basophils
c) anterior-LH-basophils
d)
e)
84) The type of emphysema associated with smoking is
a) panacinar
b) centriacinar
c) distal acinar
d) irregular
85) Squamous cell lung carcinoma
a) has a 5 year survival rate of 60%

278
b) is most commonly associated with smokers

c) is commonest peripherally
d) is commonest in females
e)
86) Intrinsic asthma is commonly triggered by
a)
b)
c) viral infections
d)
e)
87) TB pathogenicity is due to
a)
b)
c)
d)
e)
88) Lobar pneumonia
a) is more common in the young and the elderly

b) involves morphological changes of red to grey hepatisation
c) not usually associated with a productive cough
d) is associated with immunosuppression
e) rarely caused by streptococcus
89) Chronic bronchitis is characterised by
a) smooth muscle hypertrophy

b) leucocyte infiltration
c) mucus gland hypertrophy
d) increased size of goblet cells
e)
90) All the following cause compressive atelectasis EXCEPT
a) pneumothorax
b) asthma
c) CCF
d) Peritonitis
e) Pleural effusion
91) Which is not true of bronchogenic cysts
a) they may become dysplastic

b) they occasionally cause pneumothorax
c) they have an epithelial layer
d) they may contain mucus
e) they are often associated with bronchioles
92) Chronic bronchitis major morphological change involves

279
a) leukocyte infiltration
b) decreased goblet cell number
c) smooth muscle hypertrophy
d) increased mucosal gland depth ( REID index)
e)
93) In males the relative risk of cigarette smoking causing a cancer is

highest for
a) lung
b) larynx
c) oesophagus
d) pancreas
e) lip, oral, and pharynx
94) Cessation in cigarette smoking causes a prompt reduction in the risk of
a) lung cancer
b) stroke
c) cancer of the bladder
d) MI
e) COPD
95) Regarding bronchogenic carcinoma
a) it most often arises around the hilum of the lung

b) distant spread occurs solely by lymphatic spread
c) metastasis are most common to the liver
d) small cell carcinoma is the most common type
e) surgical resection is often effective for small cell carcinoma
96) In emphysema
a) a deficiency of alpha 1 antitrypsin is protective

b) centriacinar destruction leads to obstructive overinflation
c) the protease-antiprotease mechanism is the most plausible explanation of
the disease
d) smokers have an increased number of macrophages in the bronchi
e) elastase activity is unaffected by oxygen free radicals
97) In chronic bronchitis
a) the hallmark is hypersecretion of mucus in the large airways

b) there is a marked increase in goblet cells in the main bronchi
c) infection is a primary cause
d) cigarette smoke stimulates alveolar leukocytes
e) dysplasia of the epitheleum leads to emphysema
98) In bronchial asthma

280
a) extrinsic asthma is initiated by diverse non-immune mechanisms

b) sub-epitheleal vagal receptors in respiratory mucosa are insensitive to
irritants
c) IgG plays a role
d) Bronchial wall smooth muscle is atrophic
e) Primary mediators include eosinophilic and neutrophilic chemotactic factors
99) In bacterial pneumonia
a) patchy consolidation of the lung is the dominant feature of

bronchopneumonia
b) a lobar distribution is a function of anatomical variations
c) Klebsiella pneumonia is a common virulent agent
d) Alveolar clearance of bacteria is achieved by lymphocytes
e) The nasopharynx is inconsequential in defending the lung against infection
100) Smoking is associated with all the following diseases EXCEPT
a) spontaneous abortion
b) atherosclerosis
c) bladder carcinoma
d) chronic liver disease
e)
101) Smoking is associated with
a)
b)
c)
d) particle deposition in alveolar macrophages
e)
102) In pulmonary tuberculosis
a) the Ghon complex is a parenchymal peri-hilar lesion

b) bacilli establish themselves in sites of low oxygen tension
c) liquefactive necrosis precedes granuloma formation
d) Langhans cells occur in coalescent granulomas
e) Primary TB causes more damage to lungs than secondary TB
103) The commonest site of primary TB lesion in lung is
a) apex
b) base
c) hilum
d) lower zone of upper lobe
e) peripherally
104) Regarding the changes to myocardium after MI
a) pallor at 24 hours
b) wavy fibres are found centrally
281
c) decreased contractility after 5 minutes

d) liquefactive necrosis is typical
e) sarcoplasm is resorbed by leukocytes
105) In compensated cardiac hypertrophy changes include
a) diffuse fibrosis
b) hyperplasia
c) decreased sarcomeres
d) increased capillary density
e) increased capillary/myocyte ratio
106) In atherosclerosis the cells at the centre of the plaque are
a) macrophages
b) foam cells
c) leukocytes
d) smooth muscle cells
e)
107) All of the following are major risk factors for atherosclerosis EXCEPT
a) obesity
b) hyperlipidemia
c) smoking
d) hypertension
e) diabetes
108) Endocarditis in IV drug abusers typically
a) involves the mitral valve

b) is caused by candida albicans
c) does not cause fever
d) has a better prognosis than other types of endocarditis
e) is caused by staph aureus
109) The commonest cause of fungal endocarditis is
a) actinomycosis
b) as
c) as
d) candida
e) blatomycosis
110) With regard to MI
a) gross necrotic changes are present within 3-5 hours

b) irreversible cell injury occurs in less than 10 minutes
c) fibrotic scarring is completed in less than 2 weeks
d) death occurs in 20 % of cases in less than 2 hours
e) is most commonly caused by occlusion of the left circumflex coronary artery
282
111) Septic shock may cause all of the following EXCEPT
a) myocardial depression
b) vasoconstriction
c) DIC
d) ARF
e) ARDS
112) Regarding pericarditis
a) constrictive pericarditis only rarely follows suppurative pericarditis

b) primary pericarditis is usually bacterial in origin
c) serous pericarditis may be due to ureamia
d) haemorrhagic pericarditis is most commonly due to Klebsiella infection
e) fibrinous pericarditis is due to TB until proven otherwise
113) Shock results in
a)
b)
c)
d) decreased capillary hydrostatic pressure
e)
114) Patient who has a normal blood pressure post MI must have
a) increased cardiac output

b) increased systolic filling pressure
c) increased right atrial pressure
d)
e)
115) Acute endocarditis
a) has a less than 20 % mortality

b) is caused by virulent micro-organisms
c) 30 % is caused bacteria
d)
e)
116) Congestive cardiac failure may be caused by
a) vitamin A deficiency
b) niacin deficiency
c) vitamin D deficiency
d) thiamine deficiency
e) vitamin C deficiency
117) Following myocardial infarction
a) ATP is down to 50% at 10 minutes

b) Irreversible cell injury occurs within 5 minutes
c) ATP depletion begins at 2 minutes
d) Microvascular injury occurs within 30 minutes
e) Wavy fibres are present within 20 minutes
283
118) Thromboctopenia
a) occurs commonly in HIV

b) causes spontaneous bleeding at levels of less than 90,000/mm
c) occurs with hyposplenism
d) is related to platelet survival in paroxysmal nocturnal haemoglobinuria
e) is not associated with megaloblastic anaemia
119) A young man presents with central chest pain presumed to be

associated with vasoconstriction. The most likely cause of the pain is
local
a) hypoxia
b) decreased ATP
c) increased CO2
d) catecholamines acting on alpha 1 receptors
e) acetylcholine stimulation
120) An adult male with an ejection fraction of 80 % could be due to
a) myocardial ischaemia
b) arrhythmia
c) thiamine deficiency
d)
e)
121) Which risk factors have the greatest association with atherosclerosis
a) hypertension, diabetes, smoking , hyperlipidemia

b) hypertension, male, family history
c) hypertension, obesity, sedentary lifestyle
d) hypertension, female, OCP
e) age, family history, sex
122) Central pathophysiological feature of shock
a) hypotension
b) decreased blood volume
c) cellular hypoxia at a tissue level
d) infection
e) cardiac failure
123) Malignant hypertension
a) 75 % recover with no loss of renal function

b) is associated with abnormal renin levels
c)
d)
e) affects 1 to 5 % of sufferers
284
124) The cause of fluid retention peripherally with congestive cardiac failure
is
a) increased renin
b) increased GFR
c) increased angiotensin 2
d) increased aldosterone
e)
125) Rheumatic carditis is associated with
a) Curschmann spirals
b) Ito cells
c) Aschoff bodies
d) Nutmeg cells
e) Reed-sternberg cells
126) Bradykinin
a) causes smooth muscle dilatation

b) kallikrein causes prohormone degredation to produce bradykinin
c)
d)
e)
127) Diabetes is associated with
a) carbuncles
b) mucormycosis
c)
d)
e) all of the above
128) Pathogenesis of type 1 diabetes is associated with
a) decreased insulin sensitivity

b) abnormal glucokinase activity
c) no antibodies found at diagnosis
d) auto-immune insulitis
e) twin concordance greater than 70 %
129) Which of the following is characteristic of type 11 diabetes
a) early insulinitis
b) not affected by pregnancy
c) decreased peripheral receptor sensitivity
d) less than 50 % concordance in twins
e) 90 % of patients displaying antibodies to insulin receptors within 1 year of
diagnosis
130) Type 11 diabetes is characterised by
a) onset in early adulthood

b) 50 % concordance in twins
c) severe beta cell depletion
d) islet cell antibodies
e) normal or increased blood insulin levels
285
131) In type 1 diabetes
a) associated organ-specific auto-immune disorders are common

b) a genetic susceptibility is not supported by evidence
c) Finnish children have a 70 fold increase compared with Korean children
d) Influenza and varicella viruses are suspected as initiators of the disease
e) Children who ingest cows milk early in life may have a lower incidence
132) Regarding pancreatitis
a) the second most common cause is infectious agents

b) trypsin is implicated as an activator of the kinin system
c) the chronic form is usually due to gallstones
d) duct obstruction is not the mechanism in alcoholic pancreatitis
e) elastase is the only pancreatic enzyme that acts to limit pancreatitis
133) In acute pancreatitis
a) fat necrosis occurs in other intra-abdominal fatty deposits

b) trauma is the precipitating cause in 30 % of cases
c) alcohol is directly toxic to the Islets of Langerhans
d) Kallikrein converts trypsin to activate the complement system
e) Erythromycin has been implicated in severe cases
134) With regards to jaundice
a) Conjugated bilirubin causes kernicterus in adults

b) Unconjugated bilirubin does not colour sclera
c) Unconjugated bilirubin is tightly bound to albumin
d) Unconjugated bilirubin produces bilirubin in urine
e) Conjugated bilirubin is tightly bound to albumin
135) In cirrhosis
a) fibrosis is confined to the delicate bands around central veins

b) nodularity is uncommon
c) vascular architecture is preserved
d) the Ito cell is a major source of excess collagen
e) the left lobe of the liver is most affected
136) Cirrhosis is associated with
a)
b) reorganised liver vasculature with scarring
c)
d)
e)
137) Oesophageal varices
a) occur in one third of all cirrhosis patients

b) account for more than 50 % of episodes of haematemesis
c) are most often associated with hepatitis C cirrhosis
d) have a 40 % mortality during the first episode of rupture
e) lie primarily in the middle portion of the oesophagus
286
138) Concerning acute tubular necrosis
a) cephalosporins are not a causative agent

b) nephrotoxic causes are associated with a poor prognosis
c) casts are found in the loop of Henle
d) rhabdomyolysis is not a cause
e) ischaemic tubular necrosis is uncommon after haemorrhagic shock
139) Regarding acute tubular necrosis
a) it is associated with hyperkalemia not hypokalemia in recovery

b) non-oliguric has a better recovery
c) it is associated with ischaemic cortical cells
d) 80 % are associated with anuria
e)
140) Ischaemic tubular necrosis is associated with
a) maintenance stage with polyuria

b) predominantly proximal necrosis
c) intact basement membranes
d) tubular cast obstruction
e) distal necrosis only
141) Hypertensive renal disease
a)
b) 60 % of renovascular hypertension is due to fibromuscular hyperplasia
c) malignant hypertension only arises if previous hypertension
d) onion skinning correlates with degree of renal failure
e)
142) The morphology of renal failure includes
a)
b)
c)
d)
e)
143) Regarding the hepatorenal syndrome
a) it is irreversible
b) one loses the ability to concentrate urine
c) urine has a high sodium concentration
d) the urine is hyperosmolar
e) the favoured theory of it’s generation involves increased renal blood flow
144) Urolithiasis
a) presence of hypercalcemia implies renal insufficiency

b) a patient with leukemia is likely to make cystine calculi
c) calcium is the major component of 35% of calculi
d) struvite stones are made up of magnesium-ammonium-phosphate
e) the commonest cause of calcium oxalate stones is hypercalciuria
287
145) In pyelonephritis
a) 85 % of infections are caused by G-ve bacteria

b) uretral obstruction makes haematogenous infection less likely
c) uretral obstruction allows bacteria to ascend the ureter into the pelvis
d) infection is less likely during pregnancy
e) papillary necrosis and perinephric abscess are common seqelae
146) Cushing syndrome is associated with
a) osteoporosis
b) general obesity
c) hypotension
d)
e)
147) Macrocytic anaemia is associated with all the following except
a) Hyperthyroidism
b) Neoplasm
c) Folate and B12 deficiency
d) Pregnancy
e) EBV
148) Myositis ossificans
a) Morphologically resembles osteosarcoma

b) Resembles the repair process following a muscle tear
c)
d)
e)
149) Internal carcinoma is associated with which of the following skin

disorders
a)
b)
c)
d) acanthosis nigricans
e)
150) Hypothyroidism is associated with all of the following EXCEPT
a) cretinism
b)
c)
d) decreased hair growth
e) cold intolerance
151) Which of the following reactions is cell mediated
a) SLE
b) Arthus reaction
c) Anaphylaxis
d) Graft rejection
e) Goodpastures
288
152) Myelefibrosis
a) causes decreased megakaryocytes

b) stimulates erythropoetin production
c) causes leukoerythroblastic anaemia
d)
e)
153) The commonest cause of thyroid carcinoma is
a) medullary
b) follicular
c) papillary
d) anaplastic
e) squamous
154) Stress fractures
a) do not incite a paracortical reaction

b)
c)
d)
e) result from repetitive stresses or abnormal axial loading
289
1. E (C)
2. A
3. E
4. E
5. D
6. A
7. E
8. D
9. C
10. E
11. B
12. E
13. B (A)
14. D (E)
15. D
16. C&E
17. C
18. A ?E
19. D
20. D
21. B
22. –
23. –
24. C
25. A ?E
26. A
27. E?
28. B
29. – (B)
30. A
31. D
32. D
33. C
34. C
35. C
36. A
37. B
38. B (A)
39. D
40. E
41. B
42. E
43. C
44. B
45. A
46. - ?D
47. A
48. E
49. A (D)
50. –
51. D
52. D
53. E
54. D
55. A (D)
56. D
57. D
58. E
59. D
60. C
61. C
62. C
63. C
64. E
65. E
66. B
290
67. B
68. A
69. A
70. D
71. B
72. D (E)
73. B
74. D
75. C
76. C,D
77. C
78. E
79. A
80. B
81. A
82. B,C
83. C
84. B
85. B
86. C
87. –
88. B
89. C
90. B
91. A
92. D
93. E
94. A (D)
95. A
96. C
97. A
98. E
99. A
100.D
101.D
102.D
103.E
104.A
105.A
106.B
107.A
108.E
109.D
110.D
111.A (B)
112.C
113.D
114.B
115.B
116.D
117.D (A)
118.A
119.A
120.C
121.A,E (A)
122.A,C
123.E
124.D
125.C
126.B
127.E
128.D
129.B (?C)
130.– (E)
131.C
132.B
291
133.A
134.C
135.D
136.B
137.D
138.C
139.B
140.D
141.–
142.–
143.D
144.D
145.A
146.A
147.E
148.A
149.D
150.D
151.D
152.C
153.C
154.E
292
PHARMACOLOGY MCQ
1) The volume of distribution
a) is calculated by dividing the amount of drug by it’s clearance

b) if high suggests homogeneous distribution throughout tissues
c) if low suggests homogeneous distribution throughout tissues
d) of aspirin is greater than pethidine
e) of midazolam is greater than warfarin
a) is proportional to half life

b) is inversely proportional to clearance
c) is used to work out maintenance dose
d) is measured in mg/L
e) is high in warfarin
3) Calculate the half life of digoxin in a patient with a renal clearance of 8.4L/min and
Vd of digoxin of 5 L/Kg in a 70 Kg man
a) 8 hours
b) 14 hours
c) 29 hours
d) 36 hours
e) 44 hours
4) The half life of lignocaine is
a) 1 minute
b) 5 minutes
c) 10 minutes
d) 30 minutes
e) 120 minutes
a) is less than 70 L for fluoxeteine

b) is calculated by dividing rate of elimination by concentration
c) is inversely proportional to half life
d) is about 5L/kg for pethidine
e) is effected by the route of drug administration
6) The bioavaliability of a drug
a) must be 100% if given by inhalation

b) is typically 75 % if given intravenously
c) is high if the drug is hydrophillic
d) is equal to 1 - the extraction ratio
e) is 70% for orally administered digoxin
293
7) Type 1 biotransformation reactions include
a) methylation
b) acetylation
c) oxidation
d) glucuronidation
e) sulphonation
8) The half life of narcan is
a) 1-2 minutes
b) 2-4 minutes
c) 40-60 minutes
d) 60-90 minutes
e) more than 2 hours
9) 5 ml of 2% wv is equal to
a) 10 mg
b) 100 mg
c) 200 mg
d) 20 mg
e) 40 mg
10) With regard to a drug
a) LD50 is 50 % of the dose necessary to kill experimental animals

b) Efficacy is the maximum response produced by a drug
c) Spare receptors are present if Kc 50 is the same as EC 50
d) Potency is the same as affinity
e) TD50 is the concentration of a drug necessary to produce toxic effects 50 %
of the time
11) Regarding fibrinolytics
a) all thrombolytics act to convert free plasminogen to plasmin

b) urokinase is a human product
c) tPA and APSAC lack the streptococcal antigen
d) tPA does not occur naturally
e) raections to tPA and antistrepalase are preparation related
12) In a patient on warfarin which of the following drugs cause an

increased INR
a) cholestyramine
b) barbituates
c) benzodiazepines
d) rifampicin
e) amiodorone
294
13) Which is not true of warfarin
a) it has 100% bioavailability

b) it is reversed by FFP
c) it is 99% protein bound
d) it affects vitamin K synthesis
e) Half life is 6 hours
14) Streptokinase
a) is a complex lipopolysaccharide
b) is synthesised by the human kidney
c) binds to the proactivator plasminogen
d) activates the plasminogen that is bound to fibrin
e) is more dangerous than tPA in those over 75 years of age
15) Heparin induced mild thrombocytopenia is caused by
a) release of lipoprotein lipase

b) platelet aggregation
c) thrombosis
d) anti-platelet antibodies
16) With respect to the pharmacokinetics of warfarin. All the following

cause altered INR EXCEPT
a) cephalosporins
b) benzodiazepines
c) barbituates
d)
e)
17) All of the following are known to potentiate the effects of oral
anticoagulants EXCEPT
a) cimetidine
b) ceftriaxone
c) rifampicin
d) metronidazole
e) trimethoprim
18) Heparin
a) decrease the rate of conversion of VII to VIIa

b) decreases th erate of fibrinogen to fibrin
c) slows the rate of prothrombin to thrombin
d) inhibits the action of antithrombin III
e) inhibits the action of protein C
295
19) Regarding heparin
a) dose reduction is necessary in the elderly

b) LMW fractions have more effect on thrombin than HMW fractions
c) It may cause alopecia
d) It inhibits antithrombin III
e) Protamine is a competitive antagonist of heparin
20) Ticlodipine
a)
b)
c)
d) inhibits ADP induced platelet aggregation
e)
21) Warfarin
a) is completely broken down in the duodenum

b)
c)
d) decreases levels of thromboplastins
e)
22) Regarding fibrinolytics
a) TIMI trial showed increased incidence of GI bleed as the major side effect of
administration
b) Aminocaproic acid inhibits fibrinolysis
c)
d)
e)
23) Macrolide antibiotics
a) are usually active against neisseria species

b) are bacteriostatic but not bactericidal
c) bind at the 30 s ribosome sub-unit
d) are unaffected by plasmid mediated resistance
e) enhance metabolism by cytochrome pathways
24) Which of the following is a second generation cephalosporin
a) cefaclor
b) ceftazidime
c) cephalexin
d) cefotaxime
e) cephalothin
25) The cephalosporin with the highest activity against G +ve bacteria is:
a) cefuroxime
b) cefotaxime
c) cefaclor
d) cefipime
e) cephalothin
296
26) Which of the following antibiotics does not possess a beta-lactam ring
a) penicillins
b) cephalosporins
c) fluoroquinolones
d) carbapenams
e) monobactams
27) Which of the following drugs does not exert its action by inhibiting cell
wall synthesis
a) vancomycin
b) erythromycin
c) penicillin
d) ceftriaxone
e) imipenem
28) Erythromycin
a) has a large cross-reactivity with the penicillins

b) is bacteriostatic only
c) is ineffective against G +ve organisms
d) is inactivated by beta-lactamases
e) binds to the 50 s sub-unit of the bacterial ribosome
29) Erythromycin
a)
b)
c)
d) is effective against campylobacter jejuni
e)
30) Metronidazole
a) inhibits alcohol dehydrogenase

b) is effective for vaginal trichomoniasis
c) does not cause a metallic taste in th emouth
d) turns urine green
e)
31) Penicillins reach high concentrations in
a) vitreous humour
b) CSF with normal meninges
c) Proximal tubular fluid in kidneys
d)
e)
32) Zidovudine ( AZT)
a) has a short half life

b) inhibits viral thymidine kinase
c) has no activity against retroviruses
d)
e)
297
33) The antiviral drug which acts on reverse transcriptase is:

a) Acyclovir
b) zidovudine
c) ganciclovir
d) vidarabine
e) all of the above
34) Regarding metronidazole which is not true
a) it is used to trae giardiasis

b) it inhibits alcohol dehydrogenase
c) it causes a metallic taste in the mouth
d) it is used to treat gardenella
e) it is useful against trichomonas vaginalis
35) Acyclovir is active against all the following EXCEPT
a) HSV
b) CMV
c) HZV
d) Varicella
e) None of the above
36) Acyclovir
a) is commonly given in doses of 10-20 mg TDS

b) si used to treat CMV
c) is a guanosine analogue
d) acts to inhibit viral entry into cells
e) is only available intravenously
37) Amantadine
a) is an antiviral drug
b) produces insomnia not sedation
c) causes acute psychosis
d) potentiates dopaminergic function
e) all of the above
38) Doxycycline
a) acts to inhibit nucleic acid synthesis

b) may cause photosensitivity
c)
d)
e)
39) Metronidazole
a) may cause a disulfiram-like reaction

b)
c)
d) is only available intravenously
e)
298
40) All of the following inhibit nucleic acid synthesis except
a) norfloxacin
b) trimethoprim
c) rifampicin
d) sulfasalazine
e) chloramphenicol
41) Gentamicin
a) is not nephrotoxic
b) increases the effect of neuromuscular junction blocking drugs
c)
d)
e)
42) Gentamicin
a)
b) may be given orally
c) enters cells by an oxygen dependent influx
d) has a large theraputic index
e)
43) Which of the following is not true of trimethoprim
a) it is useful in the treatment of UTI

b) it is bactericidal
c) it is an anti-folate anti-metabolite drug
d)
e)
44) Which of the following drugs causes methaemaglobinemia
a) lignocaine
b) prilocaine
c) bupivicaine
d) benzocaine
e) cocaine
45) Which of the following drugs can cause alopecia
a) warfarin
b) heparin
c) verapamil
d) ticlodopine
e) digoxin
46) Which of the following drugs DOES NOT cause constipation
a) verapamil
b) digoxin
c) imipramine
d) codeine
e) chlorpromazine
299
47) Which of the following drugs can cause hypothrombinemia
a) cefuroxime
b) cefotetan
c) cefazolin
d) cefaclor
e) ceftriaxone
48) Which of the following drugs does not cause the same effect
a) muscarine
b) acetylcholine
c) hyoscine
d) carbachol
e) methacholine
49) Which of the following side effects for given drugs is wrong
a) phenytoin and gum hypertrophy

b) phenobarbitol and enzyme induction
c) carbemazepine and ataxia
d) ethosuximate and hirsutism
e) valpraote and idiosyncratic hepatic toxicity
50) A man presents with dilated pupils, confusion, hyperpyrexia. Which of the
following drugs would not account for this
a) atropine OD
b) morphine
c) datura
d)
e)
51) A healthy young man recieves a normal dose of a drug which induces
midriasis and increased systolic blood pressure . The drug could be
a) adrenaline
b) acetylcholine
c)
d)
e)
52) Characteristics of propranolol include all EXCEPT
a) lipid solubility
b) local anaesthetic action
c) half life of 3-6 hours
d) bioavaliability of 30 %
e) beta sympathetic selectivity
300
53) A patient arrives in the DEM staggering, agitated, hyperthermic with

dilated pupils. Which is least likely to produce this effect
a) atropine OD
b) amphetamine OD
c) aspirin OD
d) tricyclic OD
e) angels trumpet
54) A young man is injected with an iv drug. He shows a resultant

tachycardia, midriasis, normal blood pressure and reduced sweating.
The most likely drug is
a) nicotinic antagonist
b) muscarinic antagonist
c) cholinomimitic
d) adrenergic agonist
e) adrenergic antagonist
55) A woman is hypertensive with a potassium of 6.7. which of the

following is LEAST likely to cause this
a) potassium supplements
b) frusemide
c) ACE inhibitor
d) Suxamethonium
e) Spironalactone
56) The major side effect of benztropine is
a) miosis
b) confusion
c) diarrohea
d) GIT haemorrhage
e) Bronchorrhea
57) Coronary artery dilation occurs with
a) adenosine
b) high potassium
c) propranolol
d) enalapril
58) Regarding adenosine
a) its receptors are ion channels

b) it increases AV nodal conduction
c) it enhances potassium conductance
d) it is the drug of choice in VT
e) it has a half life of 2 minutes
301
59) Which does not prolong the refractory period of normal cells
a) amiodorone
b) lignocaine
c) quinidine
d) sotalol
e) procainamide
60) Verapamil
a) is a positive inotrope
b)
c) inhibits activated and inactivated sodium channels
d) is a dihydropyridone
e)
61) The calcium channel blocker with the most rapid onset of action when
given orally is
a) diltiazem
b) nifedipine
c) verapamil
d) felodopine
e) nicardipine
62) Sodium nitroprusside
a) increases cGMP by release of nitric oxide

b) decreases vascular resistance but increases blood pressure
c) is a complex of calcium and cyanide groups
d) is predominantly an arteriodilator
e) has its onset of action in 10-15 minutes
63) Methyldopa
a)
b)
c)
d) is a potent vasoconstrictor
e) can cause Coombs positive test after prolonged use
64) ACE inhibitors
a) cause a concomitant reduction in bradykinin

b) directly inhibit angiotensin receptors
c) work predominantly by venodilation
d) can cause angioneurotic oedema
e) are only available intravenously
65) Digoxin
a)
b)
c)
d) is a positive inotrope
e)
302
66) All of the following may increase the effect of digoxin EXCEPT
a) amiodorone
b) frusemide
c) carbamazepine
d) verapamil
e) quinidine
67) Diazoxide. Which of the following is NOT true ?
a) is used to treat severe hypertension

b) acts by direct smooth muscle relaxation
c) causes salt and water retention
d)
e) is a thiazide derivative
68) Hydralazine
a) Causes an abrupt but transient fall in blood pressure

b) Displays a biphasic blood pressure response
c)
d)
e)
69) The most lipid soluble beta blocker is
a) propranolol
b) atenolol
c) metopralol
d) pindolol
e) sotalol
70) Propranolol
a) is a highly selective beta receptor antagonist

b) is poorly lipid soluble
c) has sodium channel blocking action
d) has intrinsic sympathomimetic activity
e) has an oral bioavaliability of > 50 %
71) Nitrates
a) increase collateral blood flow

b) demonstrate tolerance
c) demonstrate physical dependence
d)
e)
72) The CAST trial highlighted the adverse effects of
a) metoprolol
b) verapamil
c) sotalol
d) flecanide
e) bretylium
303
73) Losartan differs from enalapril in:
a) its selective action on angiotensin type one receptors

b) its enhanced effect on bradykinin metabolism
c) its prolonged half life
d) its higher incidence of drug related angioedema
e) its increased incidence of cough
74) All of the following anti-hypertensives act directly on vascular smooth

muscle EXCEPT
a) felodipine
b) nitroprusside
c) indapamide
d) prazosin
e) hydralasine
75) Which of the following is an aldosterone antagonist
a)
b)
c)
d) spironolactone
e)
76) An example of an ADH antagonist is
a) ethanol
b) amiloride
c) lithium
d) aldosterone
e) triamterene
77) Carbonic anhydrase inhibitors
a) were developed from early antibiotics

b) are closely related to thiazide diuretics
c) cause metabolic acidosis
d) decrease the pH of CSF
e) all of the above
78) Which is NOT true of diuretics
a) loop diretics can be used to treat hypercalcemia

b) frusemide is used in the prophylaxis of acute mountain sickness
c) cirrhotic patients respond to spironolactone
d) they may enhance the effect of ACE inhibitors
e) hydrochlorothiazide is useful in treating diabetes insipidus
79) Which is not the correct site of action
a) Spironolactone and the collecting duct

b) Triamterene and the ascending loop of Henle
c) Thiazides and the proximal part of the distal tubule
d) Acetazolamide and the collecting tubule
e) Frusemide and the ascending loop of Henle
304
80) All of the following cause DIRECT bronchodilation EXCEPT
a) atropine
b) adrenaline
c) salbutamol
d) theophylline
e) disodium cromoglycate
81) Salbutamol may cause all except
a) hyperkalemia
b) decreased PO2 initially
c) skeletal muscle tremor
d) nervousness
e) weakness
82) Ipratropium
a) causes miosis
b) is well absorbed orally
c) inhibits mast cells
d) readily enters the CNS
e) onset of effect within 10 minutes
83) Cromolyn reduces bronchial reactivity chiefly by
a) relaxing smooth muscle cells

b) inhibiting eosinophil chemotactic factor
c) direct bronchodilation
d) inhibiting IgE mediated mast cell degranulation
e) inhibiting basophil mediator release
84) Which of the following is a direct serotonin agonist
a) fluoxeteine
b) amitryptiline
c) moclobemide
d) ondansotron
e) sumatriptan
85) Regarding SSRI’s
a)
b)
c)
d) they are preferred in the treatment of obsessive compulsive disorders over
TCA’s
e)
86) Barbituates act by
a)
b)
c) opening GABA chloride ion channels
d)
e)
305
87) Which of the following regarding carbemazepine is FALSE
a) it is greater than 50 % protein bound

b) it has active metabolites
c) it induces p450 liver cytochromes
d)
e) all true
88) Carbemazepine is closely related to
a) vigabatrin
b) quinidine
c) sodium valproate
d) metoprolol
e) imipramine
89) The drug that acts by MAO inhibition is
a) paroxetine
b) sertraline
c) trazodone
d) moclobemide
e) clomipramine
90) The most dangerous drug in overdose is
a) imipramine
b) moclobenide
c) sertraline
d) trazodone
e) paroxeteine
91) Fluoxeteine
a) has minimal drug interactions

b) is associated with seretonin syndrome with muscle weakness, hyperpyrexia
and confusion
c)
d) none
e) induces hepatic p450 enzymes
92) Patient on phenytoin is found to have a low blood phenytoin level.
Which of the following is LEAST likely to cause this
a) carbemazepime
b) non-compliance
c) disulfiram
d) erythromycin
e) hypoalbuminemia
93) Carbemazepime
a) enhances sodium channel conductance

b) causes seizures in overdose
c) inhibits cytochrome p450
d) has active metabolites
e) is not a tricyclic
306
94) Regarding SSRI
a) They are safe in OD due to minimal drug interactions

b) Can cause malignant hyperpyrexia
c) Are readily removed by dialysis
d) May cause seizures in OD
e) May be associated with seretonin syndrome with muscle weakness,
hyperpyrexia and confusion
95) The opiate associated with seizures when given in high dose to
patients with renal failure is
a) morphine
b) pethidine
c) methadone
d) fentanyl
e) codeine
96) Regarding neurotransmitters in the brain
a) strychnine stimulates glycine receptors

b) atropine antagonises GABA receptors
c) butyrophenones stimulate dopamine receptors
d) ondansotron antagonises seretonin receptors
e) atenolol stimulates noradrenaline receptors
97) Buspirone relieves anxiety without sedation by:
a) direct GABA stimulation

b) indirect GABA stimulation
c) direct noradrenaline receptor stimulation
d) indirect noradrenaline stimulation
98) The most potent sedative is
a) diazepam
b) midazolam
c) temazepam
d) phenobarbitone
e) chloral hydrate
99) The drug used as an antipsychotic most likely to cause extrapyramidal

effects is
a) chlorpromazine
b) lorazepam
c) risperidone
d) haloperidol
e) clozapine
307
100) A high degree of tolerance can be expected to all these effects of

morphine EXCEPT
a) miosis
b) nausea
c) cough supression
d) analgesia
e) respiratory depression
101) Methadone is used in the treatment of narcotic addiction because
a) it does not produce constipation

b) it is a phenylpiperadine class narcotic agonist
c) it produces a short withdrawl when ceased
d) it produces predictable effects when given orally
e) it is a less efficacious analgesic than morphine
102) What do kappa receptors mediate
a) supraspinal analgesia and euphoria

b) truncal rigidity
c) hallucinations and dysphoria
d) respiratory depression and dependence
e) spinal analgesia and miosis
103) Cannabinoids
a) produce tachycardia
b) have an antipsychotic action
c) act on a number of non-specific receptors
d) constrict the pupils
e) all of the above
104) Pralidoxime
a) cleaves organophosphate from acetylcholinesterase

b) inhibits presynaptic acetylcholine release
c)
d)
e)
105) Pentamidine
a)
b)
c)
d) is toxic to pancreatic beta cells
e)
106) Which is an ester local anaesthetic
a) tetracaine
b) lignocaine
c) bupivicaine
d) etidocaine
e) prilocaine
308
107) Metformin
a)
b)
c) does not require functioning pancreatic beta cells for its action
d)
e)
108) Which of the following statements are FALSE regarding vecuronium
a) it has minimal cardiovascular effects

b) it is predominantly renally excreted
c) it has a significantly longer duration of action than pancuronium
d)
e)
109) Which is true of neuromuscular blockers
a) atracurium causes hypotension in volume depleted patients

b) pancuronium causes histamine release
c) vecuronium is an isoquinolone derivative
d) gallium is eliminated by the liver
e) gentamicin increases their efficacy
110) The cholinesterase inhibitor with the shortest duration of action is
a) physostigmine
b) edrophonium
c) neostigmine
d) parathion
e) malathion
111) Ketamine is closely chemically related to
a) phencyclidine
b) LSD
c) Propofol
d) Thiopentone
e) Enflurane
112) All of the following are amide local anaesthetics EXCEPT
a) lignocaine
b) bupivicaine
c) benzocaine
d) prilocaine
e) etidocaine
113) The muscle relaxant most commonly associated with tachycardia is low
dose
a) Suxamethonium
b) Atracurium
c) Vecuronium
d) Pancuronium
e) Tubocurare
309
114) The most potent mineralocorticoid is
a) hydrocortisone
b) prednisolone
c) methylprednisolone
d) dexamethasone
e) betamethasone
115) Which of the following drugs is the most safe to give in pregnancy
a) heparin
b) lithium
c) phenytoin
d) captopril
e) gentamicin
116) Cisapride
a) slows gastric emptying

b) delays oesophageal clearance
c) raises lower oesophageal sphincter pressure
d) increases pancreatic secretions
e) increases gastric secretions
117) In an overdose of paracetamol
a)
b)
c)
d) metabolism of paracetamol requires glutathione
e)
118) Paracetamol
a) has anti-inflammatory properties

b)
c)
d) is highly protein bound
e)
119) Dextropropoxyphene
a)
b)
c)
d)
e) is structurally related to methadone
120) Allopurinol
a)
b)
c)
d) is metabolised by xanthine oxidase
e)
310
121) Prochlorperazine
a)
b)
c)
d) can cause neuroleptic malignant syndrome
e)
122) Local anaesthetics
a) act on the most rapidly firing neurones

b)
c)
d) have an increased effect on large fibre diameter
e)
123) On administration of an anti-histamine which of the following effects

are caused by receptors other than histamine receptors
a) sedation
b) postural hypotension
c) nausea and vomiting
d) LA
e) All of the above
124) The effects of ethyl alcohol on the body!!!!
a)
b)
c)
d)
e)
125) Which skin antiseptic is commonly used
a) ethyl alcohol 70%

b) ethanol 30%
c) isopropyl alcohol 10%
d) formaldehyde
e) boric acid
126) Regarding drugs in the elderly
a) the dose of lithium should be increased

b) phase II biotransformation is much poorer
c) they have an increased lean body mass
d) side effects are proportional to the amount of medication
e) they have higher serum albumin
127) Which of the following is a live virus vaccine
a) typhoid
b) tetanus
c) HBV
d) Rabies
e) Measles
311
128) Which is an effect of methylxanthines
a) weak anti-diuresis
b) increased strength of muscle contraction
c) negative inotropic effect
d) medullary depression
e) stimulation of cell surface adenosine receptors
129) Methanol intoxication
a) is partly due to inhibition of aldehyde dehydrogenase

b) is due to formation of oxalic acid
c) is treated in part with activated charcoal
d) produces renal damage due to crystal formation
e) can be treated with 4 methylpyrazole
130) The MAC is greatest for
a) nitrous oxide
b) halothane
c) isoflurane
d) methoxyflurane
e) ketamine
131) All the following are anaesthetic agents EXCEPT
a) midazolam
b) glycopyrolate
c) propofol
d) fentanyl
e) etomidate
132) A patient complains of pain post-operatively. This is most likely to be due

to
a) propfol
b) isoflurane
c) suxamethonium
d) atracurium
e) ketamine
133) The muscle relaxant with the longest duration of action is
a) atracurium
b) mivacurium
c) pancuronium
d) vecuronium
e) rocuronium
312
134) All of the following are NSAID’s EXCEPT
a) sulindac
b) piroxicam
c) gemfibrozil
d) ketorlac
e) diflusinal
135) A patient with impetigo would be most likely to respond to
a) streptomycin
b) kanamycin
c) metronidazole
d) cephalexin
e) phenoxymethylpenicillin
136) With regard to oral hypoglycaemics
a)
tolbutamide and glipizide are sulphonylureas
b)
chlorpropramide has a half life of 4-6 hours
c)
metformin is more effective once weight is controlled
d)
glipizide has one of the longest half lives
e)
lactic acidosis is more common with metformin than phenformin
137) Which of the following has its metabolism inhibited by limiting liver
blood flow
a) verapamil
b) lignocaine
c) labetalol
d) trimethoprim
e) propoxyphene
138) The most common adverse effect of procainamide is
a) bradycardia
b) pulmonary infiltrates
c) fever
d) hypotension
e) anaphylaxis
139) Theophyline
a) is a positive chronotrope
b) reduces GFR
c) si thought to increase blood viscosity
d) is less potent than aminophlline
e) has a Vd of 10L/kg
140) The Beta 2 sympathomimetic with the longest duration of action is
a) salbutanol
b) salmeterol
c) sotalol
d) terbutaline
e) isoprotenerol
313
1. E
2. A
3. –
4. E
5. D
6. E
7. C
8. D
9. B
10. E
11. B
12. E
13. E
14. C
15. B
16. B
17. C
18. C
19. C
20. D
21. D
22. B
23. A
24. A
25. E
26. C
27. B
28. E
29. D
30. B
31. C
32. A
33. B
34. B
35. B
36. C
37. E
38. B
39. A
40. E
41. B
42. C
43. B
44. B
45. B
46. B
47. B
48. C
49. D
50. B
51. A
52. – (E)
53. C
54. B
55. B
56. B
57. A
58. C
59. B
60. C
61. B
62. A
63. E
64. D
65. D
66. C
314
67. D
68. A
69. A
70. C
71. B
72. D
73. A
74. C
75. D
76. A (C)
77. E
78. E (B)
79. B, D
80. E
81. A
82. E ?A
83. D
84. E
85. D
86. C
87. – (?B)
88. E
89. D
90. A
91. B
92. C
93. D
94. E
95. A (B)
96. D
97. E
98. D (B)
99. D
100. A
101. D
102. E
103. A
104. A
105. D
106. A
107. C
108. C
109. E
110. B
111. A
112. C
113. D
114. E (A)
115. A
116. C
117. D
118. –
119. E
120. D
121. D
122. A
123. E
124. –
125. B
126. D
127. E
128. B
129. D (E)
130. A
131. B
132. C
315
133. C
134. C
135. D
136. A
137. A,B,C,E
138. D
139. A
140. B
316
PHYSIOLOGY MCQ
1)Total body water
a) increases with age

b) is typically 45% of bodyweight
c) is typically 63 % of body weight
d) is greater in men than women
e) is composed largely of interstitial fluid
2) With the addition of 1 litre of 5% dextrose intravenously to which

compartment is it mainly distributed
a) intracellular
b) interstitial
c) extracellular
d) transcellular
e) vascular
3) Regarding the composition of ECF versus ICF . ECF has
a) decreased magnesium
b) increased phosphate
c) increased potassium
d) decreased sodium
e)
4) ECF compared to ICF has
a) increased potassium
b) decreased phosphate
c) increased phosphate
d) decreased sodium
e)
5) A fit healthy 20 y/o male lose 1 litre of blood
a) the haematocrit falls immediately

b) this is a 35 % blood loss
c) plasma protein synthesis is not increased
d)
e)
6) Anion gap is
a) sodium + potassium - bicarbonate

b) due to organic protein ions and phosphate ions
c) increased in hyperchloremic metabolic alkalosis
d)
e)
317
7) Ratio of HCO3- ions to carbonic acid at pH of 7.1 is
a) 1
b) 10
c) 0.1
d) 100
e) 0.01
8) With the loss of 1 litre of blood
a) haematocrit falls immediately

b) iron resorption is not increased
c) this equals 35 % plasma volume loss
d) baroreceptors increase parasympathetic output
e) red cell mass normalises within 2 weeks
9) What is the hydrogen ion concentration at a pH of 7.4
a) 0.0001meq/L
b) 0.00004 meq/L
c) 0.0004 meq/L
d) 0.0002 meq/L
e) 0.00002 meq/L
10) Regarding basic physiological measures all of the following are true
EXCEPT
a) osmolarity is the number of osmoles per litre of solution

b) pH is the log to the base 10 of the reciprocal of hydrogen ion concentration
c) carbon has a molecular mass of 12 dalton
d) osmolarity is measured by freezing point depression
e) one equivalent of Na+ is 23g/L
11) With regards to membrane potential
a) the Donan effect relies on non-diffusable ions

b) the exterior of the cell is negative with respect to the interior
c) the membrane potential tends to push chloride ions out of the cell
d) potassium leaks out against a concentration gradient
e) it can be derived by measuring the chloride concentration and using the
Nernst equation
12) Na+/K+ ATPase
a) hydrolyses ADP to ATP

b) extrudes 3 Na+ from the cell for every 2 K+ in
c) consists of an alpha, beta and gamma sub-unit
d) lies on the ECF side of the membrane
e) is potentiated by the drug ouabain
318
13) With regard to the action potential of a neuron with an RMP of -70mV
a) the firing level is likely to be-30mV

b) the overshoot will not extend much past 0mV
c) the absolute refractory period occupies only 10% of repolarisation
d) chloride influx will restore the membrane potential
e) increasing the external chloride ion concentration increases the RMP
14) In skeletal muscle
a) the immediate energy source for contracting is GTP

b) troponin T inhibits the interaction with myosin
c) the myosin is contained entirely within the A band
d) the heads of actin contain the ATP hydrolysis site
e) tropomysin is made up of 3 sub-units
15) In smooth muscle the alternating sinusoidal RMP is due to
a) calcium influx
b) sodium influx
c) potassium influx
d) chloride influx
e) potassium efflux
16) The special feature of the contraction of smooth muscle is that
a) actin is not involved

b) myosin is not involved
c) calcium is not involved
d) ATP is not the energy source
e) The membrane potential is unstable
17) With respect to the cardiac action potential
a) unlike nerve action potential there is no overshoot

b) plateau and repolarisation may be 200 times larger than depolarisation
phase
c) the resting membrane potential is -90mV
d) sodium channels are progressively inactivated in phase 2
e) it is usually 20 ms in duration
18) Upon stretching intestinal smooth muscle
a) it hyperpolarises
b) the tension is due to elastic forces only
c) it depolarises
d) relaxation occurs
e) it is an example of a multi-unit smooth muscle
19) Upon skeletal muscle contraction
a) the H zone increases

b) the I zone decreases
c) the A zone decreases
d) the A and I zone increase
319
20) Which of the following is the largest
a) fibrinogen
b) haemoglobin
c) albumin
d) gamma globulin
e) alpha 1 antitrypsin
21) The liver synthesises all of the following EXCEPT
a) albumin
b) fibrinogen
c) gamma globulins
d) complement
e) erythropoetin
22) The part of the cardiovascular system with the largest cross sectional surface area
is
a) arteries
b) capillaries
c) large veins
d) aorta
e) vena cava
23) All of the following are true of skeletal and cardiac muscle EXCEPT
a) they both have striations

b) they have high resistance gap junctions
c)
d)
e)
24) With respect to smooth muscle, calmodulin
a) acts to curtail contraction

b) acts to stimulate contraction
c) acts to limit relaxation
d) acts to stimulate relaxation
e)
25) The R wave of the ECG is due to
a) calcium influx
b) chloride influx
c) sodium influx
d) potassium efflux
e) chloride efflux
26) Which statement concerning iron is FALSE
a) iron is absorbed in the duodenum

b) it is the major component of myoglobin
c) excess can de associated with diabetes
d)
e)
320
27) Regarding iron
a) it is absorbed in the duodenum

b) 70 % is present in myoglobin
c) a deficiency can cause diabetes
d) the amount absorbed ranges between 10-20%
e) mobilferin binds less iron in iron deficiency
28) Haemoglobin
a) the globin portion is a porphyrin

b) the difference between haemoglobin and myoglobin is haeme
c) foetal haemoglobin has no beta chains
d)
e)
29) With a fall in systemic blood pressure
a) GFR falls more than renal plasma flow

b) There is efferent arteriolar constriction
c) The filtration fraction falls
d) There is no efferent arteriolar constriction
e) GFR does not change
30) What is the filtration fraction of the kidney ( GFR/RBF )
a) 0.1
b) 0.2
c) 0.3
d) 0.4
e) 0.5
31) The osmolarity of the pyramidal papilla is
a) 400
b) 800
c) 1200
d) 1600
e) 2000
32) What is the major stimulus for the secretion of ADH
a)
b)
c)
d)
e) hyperosmolarity
33) Hypokalemic metabolic alkalosis is associated with
a) carbonic anhydrase inhibition

b) diuretic use
c) chronic diarrohea
d)
e)
321
34) Which of the following would be best used for measuring GFR
a) radiolabelled albumin
b) inulin
c) deuterium oxide
d) tritium oxide
e) mannitol
35) Given the following values calculate the GFR
Plasma PAH 90: Urine PAH 0.3: Plasma inulin 35: urine inulin 0.25: Urine flow 1 ml/
min: Hct 40%
a) 120
b) 140
c) 180
d) 240
e) 400
36) Where in the renal tubules does the intratubular and interstitial osmolality hold
the same values
a) thick ascending loop of Henle

b) thin descending loop of Henle
c) distal convoluted tubule
d) collecting duct
37) With respect to the GFR
a) it can be equated to creatinine clearance

b)
c)
d)
e)
38) With respect to the renal handling of potassium
a)
b)
c)
d) potassium is reabsorbed actively in the proximal tubule
e)
39) In the kidneys sodium is mostly reabsorbed with
a) chloride
b) bicarbonate
c) glucose
d) potassium
e) calcium
322
40) In chronic acidosis the major adaptive buffering system in the urine is
a) carbamino compounds
b) bicarbonate
c) ammonium
d) histidine residues
e) phosphate
41) The following blood gases represent pH 7.32, pCO2 31mmHg and HCO3-
20mmol/L
a) primary metabolic acidosis

b) primary respiratory alkalosis
c) a picture consistent with diuretic abuse
d) mixed respiratory acidosis, metabolic acidosis
e) partly compensated metabolic acidosis
42) The following gases are associated with
PCO2 45 pH 7.57 HCO3- 30
a) acetazolamide treatment
b) diuretic use
c) diarrhoea
d)
e)
43) The absorption of sodium in the proximal tubule
a) reabsorbs 60% of the filtered sodium

b) causes increasing hypertonicity
c) is powered by Na+/H+ ATPase
d) shares a common carrier with glucose
e) all of the above
44) With regard to osmotic diuresis
a) urine flows are much less than in a water diuresis

b) vasopressin secretion is almost zero
c) the concentration of the urine is less than plasma
d) increased urine flow is due to decreased water reabsorption in the proximal
tubule and loop of Henle
e) osmotic diuresis can only be produced by sugars such as mannitol
45) Renal acid secretion is affected by all the following EXCEPT
a) PaCO2
b) K+ concentration
c) Carbonic anhydrase
d) Aldosterone
e) Calcium
323
46) Glucose reabsorption in the kidney is
a) a passive process
b) closely associated with potassium
c) the same in all nephrons
d) occurs predominantly in the distal tubule
e) resembles glucose reabsorption in the intestine
47) Which of the following is the most permeable to water
a) thin ascending loop of Henle

b) distal convoluted tubule
c) thin descending loop of Henle
d) cortical portion of collecting tubule
e) thick ascending limb of the loop of Henle
48) With regard to urea
a) it moves actively out of the proximal tubule

b) it plays no part in the establishment of an osmotic gradient in the medullary
pyramids
c) all of the tubular epithelium is impermeable to urea except the inner
medullary portion of the collecting duct
d) a high protein diet reduces the ability of the kidney to concentrate urine
e) vasopressin has no effect on the movement of urea across tubular
epithelium
49) In a patient with a plasma pH of 7.1 the HCO3-/H2CO3 ratio is
a) 20
b) 10
c) 1
d) 0.1
e) 0.2
50) Which of the following best describes the changes found in uncompensated
respiratory alkalosis
a) decreased pH, HCO3- and PaCO2

b) increased pH and lowHCO3- and PaCO2
c) decreased pH and HCO3- and normal PaCO2
d) increased pH low HCO3- and normal PaCO2
e) decreased pH increased HCO3- and normal PaCO2
51) Pulmonary vascular resistance
a) increases as venous pressure rises

b) is increased at both low and high lung volumes
c) is decreased by histamine
d) increases with recruitment
e) is increased by muscular pulmonary arterioles which regulate flow to various
regions of the lungs
324
52) Compliance of the lung is reduced by all the following EXCEPT
a) fibrosis
b) consolidation
c) emphysema
d) alveolar oedema
e) high expanding pressures
53) In control of ventilation the medullary chemoreceptors respond to

decreased
a) O2 tension
b) CO2 tension
c) H+ concentration
d) H+ conc and CO2 tension
e) H+conc, CO2 tension and PO2
54) Laplaces law
a) explains the observed elastic recoil of the chest

b) explains the tendency of small alveoli to collapse
c) determines the change in volume per unit change in pressure
d) tells us the pressure is inversely proportional to tension
e) all of the above
55) The Haldane effect refers to
a) the shape of the CO2 dissociation curve

b) the carriage of O2 according to Henrys law
c) the chloride shift that maintains electrical neutrality
d) the dissociation constant for the bicarbonate buffer system
e) the increased capacity for deoxygenated blood to carry CO2
56) The systemic circulation peripherally has
a) decreased red cell size

b) decreased pH
c) increased chloride
d) decreased HCO3-
e)
57) The major mechanism for transporting CO2 in the blood is
a) carboamino groups
b) dissolved in blood by Henrys law
c) haemoglobin
d) bicarbonate
58) The haemoglobin dissociation curve moves up and to the left with
a) increased H+ concentration
b) hypothermia
c) increased 2,3 DPG
d) hypercarbia
e) all of the above
325
59) With regard to the distribution of pulmonary blood flow
a) typically there is a zone at the apex which is not perfused

b) the mean pulmonary arterial pressure is 8 mmHg
c) hypoxia leads to pulmonary dilation
d) the net balance of the Starling forces keep the alveoli dry
e) in some areas flow is determined by the arterial/alveolar pressure difference
60) With regard to pulmonary gas exchange
a) transfer of nitrous oxide is perfusion limited

b) diffusion is inversely proportional to the partial pressure gradient
c) the diffusion rate for CO2 is double that of O2
d) at altitude the profound systemic hypoxemia favours oxygen diffusion
e) transfer of O2 is diffusion limited
61) Which of the following is associated with the least increase in airway
pressure
a) forced expiration
b) nasal breathing
c) very low lung volumes
d)
e)
62) Surfactant
a) increases compliance
b) is produced by type 1 pneumocytes
c)
d)
e)
63) A permanent inhabitant at 4,500 feet
a) has a high alveolar PO2

b) has a decreased 2,3, DPG
c) is highly sensitised to the effects of hypoxia
d) shows increased ventilation
e) may have a normal HCO3-
64) What is the PO2 of alveolar air with a CO2 of 64 and a respiratory
quotient of 0.8
a) 35
b) 52
c) 69
d) 72
e) 80
326
65) What is the compliance of a lung if a balloon is blown up with 500ml of air with a
pressure change from -5 to -10
a) 0.1
b) 1
c) 10
d) 100
e) 200
66) When walking at a steady pace the increase in respiratory rate is due to
a) decreased PO2
b) increased CO2
c) increased pH
d) increased pH CSF
67) Which of the following are a cause of increased pulmonary vascular

resistance
a) altitude
b) forced expiration
c)
d)
e)
68) What is the maximal volume left in the lung after maximal forced
expiration
a) 0.5
b) 1.0
c) 2.0
d) 3.0
e) 3.5
69) Compliance is
a)
b)
c)
d) dependent on lung volume
e)
70) Carotid body stimulation occurs with
a) decreased blood pressure

b) decreased PaO2
c) increased PaO2
d) increased arterial pH
e) increased blood pressure
327
71) Permanent high altitude is associated with all of the following EXCEPT
a) increased arterial blood HCO3-

b) increased arterial blood 2,3 DPG
c) increased pulmonary artery pressure
d) increased alveolar ventilation
e) could have a normal PaCO2
72) Increased 2,3 DPG occurs with all the following EXCEPT
a) chronic hypoxia
b) acidosis
c) androgens
d) thyroid hormones
73) The anatomic dead space
a) varies with minute ventilation

b) is typically 150 mls
c) will increase in COPD
d) is alveolar minus the physiological dead space
e) all of the above
74) EDRF
a) shares a similar mechanism of action to GTN

b) activates adenyl cyclase
c) is the common pathway in the action of adenosine and histamine
d) antagonises the action of thromboxane
e) is synthesised by a magnesium dependent enzyme
75) All of the following explain venous blood flow EXCEPT
a) oncotic pressure gradient

b) smooth muscle contraction
c) skeletal muscle contraction
d) the pumping of the heart
e) intrathoracic pressure variations
76) All capillaries have
a) a diameter of 10-20 mm
b)
c)
d)
e) a basement membrane
77) Regarding Poiseuille-Hagen flow in vessels, the flow in a vessel is

proportional to
a) pressure difference between the two ends

b) radius
c) viscosity
d)
e)
328
78) Which of the following have a specific beta effect on smooth muscle contraction
a) adrenaline
b) noradrenaline
c) isoprenaline
d)
e)
79) With respect to isovolumetric contraction of the ventricle it is associated with
a) decreasing aortic pressure

b) aortic back flow
c) open mitral and tricuspid valves
d) open aortic and pulmonary valves
80) The heat lost by the body at 21 degrees is due to
a) sweating
b) defecation
c) urination
d) radiation/conduction
e)
81) The Poiseuille-Hagen formula tells us that
a) longer tubes can sustain higher flow rates

b) flow is directly proportional to resistance
c) flow will be doubled by a 20 % increase in vessel diameter
d) turbulent flow is predicted in high velocity vessels
e) why the venous capacitance is important in cardiac output
82) The greatest percentage of the circulating volume is contained within
a) capillaries
b) large arteries
c) pulmonary circulation
d) the heart
e) venules and veins
83) Which of the following organs receive the largest amount of the bloods
circulation per kg of tissue
a) heart
b) kidney
c) brain
d) liver
e) adrenal
84) With regards to CSF composition
a)
b)
c)
d)
e) it is similar to the ECF of the brain
329
85) Myocardial contractility is decreased by all of the following EXCEPT
a) acidosis
b) barbituates
c) hypercarbia
d) bradycardia
e) glucagon
86) Cardiac output is decreased by
a) sleep
b) excersise
c) pregnancy in the first trimester
d) sitting from a lying position
e) all of the above
87) With regard to the cardiac cycle
a) phase 1 represents atrial systole

b) the aortic valve opens at the beginning of phase 2
c) the T wave of the ECG occurs during phase 4
d) the second heart sound is due to mitral valve closure
e) the c wave is due to tricuspid valve opening
88) With regard to the 12 lead ECG
a) lead 11 is at 90 degrees for vector analysis

b) V2 is placed in the 3rd left interspace
c) Septal Q waves are predictable in V2
d) +130 degrees is still a normal axis
e) the standard limb leads record the potential difference between 2 limbs
89) With regard to cardiac action potentials
a) cholinergic stimulation increases the slope of the pre-potential

b) the resting membrane potential is increased by vagal stimulation
c) phase 0 and phase1 are steepest in the AV node
d) the Twave is the surface ECG manifestation of phase 1
e) the action potential in the AV node is largely due to calcium fluxes
90) The most rapid conduction of electrical impulses occurs in the
a) AV node
b) Atrial pathways
c) Bundle of His
d) Purkinje system
e) Ventricular system
91) Which of the following are not part of the compensatory mechanism
activated by haemorrhage
a) increased erythropeitin
b) increased insulin secretion
c) increased vasopressin secretion
d) increased glucacorticoid secretion
e) increased renin secretion
330
92) Cardiac output is affected by all of the following EXCEPT
a) exercise
b) eating
c) sleep
d)
e)
93) A young fit man goes from sitting to running with full exertion. His stroke
volume will increase by
a) 400%
b) 700%
c) 2000%
d) less than 200%
e) 1000%
94) With respect to the cardiac cycle
a)
b)
c)
d) isovolumetric contraction phase immediately follows the phase of atrial
systole
e)
95) Which of the following is a compensatory response to shock
a) decreased ADH
b)
c)
d) increased thoracic pumping
e)
96) With regard to the renin-angiotensin system
a) prorenin has 50% the action of renin

b) renin secretion will be increased by propranolol
c) angiotensinogen is secreted by the liver
d) angiotensin 1 is a potent vasoconstrictor
e) angiotensin 11 acts at receptors at the nucleus
97) Atrial natriuretic peptide
a) stimulates the secretion of ADH

b) secretion will be decreased by scuba diving
c) is a typical dual chain helix structure
d) stimulates erythropoeitin production
e) has generally the opposite actions to angiotensinII
331
98) During the valsalva manoeuvre bradycardia occurs
a) at the onset of straining

b) as the intrathoracic pressure reaches a maximum
c) as the result of an initial increase in cardiac output
d) when the glottis is opened and intrathoracic pressure returns to normal
e) if the patient has autonomic insufficiency
99) The ‘c’ wave of the jugular pulse is due to
a) atrial systole
b) atrial contraction against a closed tricuspid valve in complete block
c) the increase in intrathoraci pressure during expiration
d) transmitted pressure due to tricuspid bulging in isovolumetric contraction
e) the rise in pressure before the tricuspid valve opens in diastole
100) All of the following produce vasodilation EXCEPT
a) local K+ accumulation
b) systemic hypoxia
c) lactate
d) increased CO2 tension
e) decreased pH
101) Under basal conditions the percentage of the hearts caloric needs met
by fat is
a) 70%
b) 60%
c) 50%
d) 40%
e) 30%
102) Baroreceptors
a)
b)
c)
d)
e)
103) Bradykinin
a) is named after it’s effect on the heart

b) stimulates cutaneous smooth muscle constriction
c) stimulates GI smooth muscle constriction
d)
e)
104) With respect to absorption in the gut
a)
b)
c)
d) vitamins A, D and K are absorbed in the small intestine
e)
332
105) With regards to cholesterol which of the following is FALSE
a) it is present in animals
b) plants contain cholesterol
c) it is essential to the structure of the cell membrane
d) it is a precursor to bike acids
e)
106) Concerning pancreatic secretions
a) the pancreas secretes gastrin

b) pH is 6.0
c) it contains anti-trypsin molecules
d) it contains an enzyme converting polysaccharides to monosaccharides
e)
107) Gastric emptying
a) takes 1-3 hours

b)
c)
d)
e)
108) The majority of water ingested or secreted in the bowel is usually

absorbed in the
a) stomach / duodenum
b) jejenum
c) ileum
d) ascending colon
e) descending colon
109) With regard to the parasympathetic nerve supply of the gut it is
a) essential
b) non-essential
c) modulatory
d) passive
e)
110) Which of the following does not utilise the same receptor in its mechanism of
action
a) insulin
b) glucagon
c) PTH
d) ACTH
e) They all have the same mechanism of action
333
111) Anterolateral dissection of the spinal cord is associated with loss of
a) ipsilateral loss of pain

b) ipsilateral loss of temperature
c) ipsilateral hyperreflexia
d) contralateral vibration loss
e)
112) Which of the following is a nutritionally essential amino acid
a) glycine
b) histidine
c) tryptophan
d) tyrosine
e) cysteine
113) With regard to adrenal physiology
a) glucocorticoids exert their action by cGMP activation

b) cortisol has negligible mineralocorticoid activity
c) the largest steroid molecules are the oestrogens
d) dopamine is secreted by the adrenal medulla
e) the only glucocorticoid secreted in significant amounts is cortisol
114) Insulin secretion is stimulated by all of the following EXCEPT
a) mannose
b) glucagon
c) noradrenaline
d) leucine
e) acetylcholine
115) Insulin
a) is secreted by the A cells in the islets of Langerhans

b) is a triple helical polypeptide
c) is synthesised as a prohormone
d) binds at cytoplasmic receptor sites
e) causes K+ to leak out of cells
116) Lymph
a) Has an increased protein content compared with plasma

b) Has a differing protein in different areas
c) Fats cannot enter lymph
d) Has no lymphocytes
e) Contains no clotting factors
117) The hypothalamus is essential for
a)
b)
c)
d) renal function
e)
334
118) With regard to thyroid physiology
a) T3 and T4 are metabolised in the spleen and bone marrow

b) T3 and T4 bind and act at the same cell membrane receptor
c) T4 is synthesised from tyrosine held in thyroglobulin
d) T4 is more active than T3
e) T3 is bound to a complex polysaccharide in the plasma
119) A deficiency of parathyroid hormone is likely to lead to
a) hypophos phatemia
b) the formation of kidney stones
c) a self limiting illness
d) neuromuscular hyperexcitability
e) cystic bone disease
120) Alpha 1 stimulation will lead to
a) contraction of bladder trigone and sphincter

b) bronchial smooth muscle contraction
c) pupillary constriction
d) increased AV conduction
e) skeletal muscle vasodilation
121) The sensation for cold
a) is relayed by the thalamus

b) is transmitted by the dorsal columns
c) is an uncrossed sensory modality
d) is mediated by substance P fluxes
e) is mediated by A alpha fibres
122) MAO breaks down
a) seretonin
b) tryptophan
c) glycine
d) GABA
e) Glutamate
123) In the formation of adrenaline
a) COMT produces adrenaline from noradrenaline

b) Phenylalanine is converted to tyrosine
c) Seretonin is a vital intermediate step
d) Dopamine is two noradrenaline molecules side by side
e) Dopa is formed from dopa decarboxylase
124) (True) acetylcholinesterase
a) forms acetylcholine from acetate

b) is produced by the liver
c) functions only in nerve endings
d) is involved in GABA metabolism
335
125) All the following are neurotransmitters EXCEPT
a) serotonin
b) glutamate
c) adenosine
d) insulin
e) glucagon
126) Inhibitory neurotransmitters increase the post synaptic conductance to
a) sodium
b) chloride
c) sodium and magnesium
d) magnesium
e) all of the above
127) Intrinsic factor
a)
b)
c)
d) is produced by the gastric parietel cells
e)
128) Protein digestion
a) Commences upon activation of saliva

b)
c)
d)
e) is largely completed by the small intestine
129) The major inhibitory substance of the spinal cord is
a) GABA
b) Glutamate
c) Aspartate
d) Glycine
e) None of the above
130) Within the bladder
a) the first urge to void is at 400 mls

b) intravesical pressures can remain constant over a range of volumes
c) voiding reflex is dependent on sympathetic control
d) parasympathetic reflex controls external urethral sphincter
e)
131) Regarding glucagon
a) it is secreted by the pancreatic B cells

b) it increases glycogen formation
c) it has a half life 30 minutes
d) secretion is stimulated glucose
e) it stimulates insulin secretion
336
132) Which cells secrete intrinsic factor
a) G cells
b) Chief cells
c) Parietal cells
d) K cells
e) S cells
133) Where are the vitamins A, D, E and K absorbed
a) stomach
b) proximal small bowel
c) colon
d) distal small bowel
e) ileum
134) Regarding insulin
a) it increases protein catabolism in muscle

b) secretion is inhibited by somatostatin
c) secretion is stimulated by phenytoin
d) it causes decreased K+ uptake into adipose tissue
e) it causes decreased protein synthesis
135) Which is true of faeces
a) 50 ml is produced per day on average

b) it is chiefly formed from protein breakdown products
c) solids form 75% of its composition
d) the solid portion contains 30% bacteria
e) the brown colour is due to melanin
337
1. D
2. A
3. A
4. B
5. –
6. B
7. B
8. B
9. B
10. D
11. C (A)
12. B
13. B (D)
14. C
15. E
16. E
17. C
18. C
19. B
20. A
21. C
22. B
23. B
24. B
25. C
26. B
27. A
28. C
29. B
30. B
31. C
32. E
33. B
34. B
35. –
36. B
37. A
38. D
39. A
40. C
41. E
42. B
43. D
44. D
45. E
46. E
47. C
48. C
49. B
50. B
51. E (B)
52. C
53. C
54. B
55. E
56. B
57. D
58. B
59. E
60. A
61. C
62. A
63. E
64. C
65. A (D)
66. E
338
67. A
68. B
69. D
70. B
71. A
72. B
73. B
74. A
75. B (A)
76. E
77. A
78. C
79. E
80. D
81. C
82. E
83. B
84. E
85. E
86. D
87. A
88. E
89. E
90. D
91. B
92. C
93. D
94. D
95. D
96. C
97. E
98. D
99. D
100. B
101. B
102. –
103. C
104. D
105. B
106. C
107. A
108. B
109. B
110. A
111. C
112. B
113. D
114. C
115. C
116. B
117. D
118. C
119. D
120. A
121. A
122. A
123. B
124. C
125. D
126. B
127. D
128. E
129. A
130. B
131. E
132. C
339
133. E
134. B
135. D

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1

Prog. Outline 8-9

Weekly study plan 10-29

Exam checklist 30-31

Pathology summaries 38-49

Physiology Ganong table references 50-52

Viva topic frequency analysis 53-77

ACEM I Vivas 78-238

Recalled Past MCQs 239-339

Exam Specific Preparation

Weekly Study Sessions

Clinically Oriented Anatomy (5th Edition)

Atlas of Human Anatomy: With Netteranatomy.com (Netter Basic Science)

McMinn's Color Atlas of Human Anatomy (Paperback)

Robbins & Cotran Pathologic Basis of Disease, Seventh Edition

Pocket Companion to Robbins and Cotran Pathologic Basis of Disease (Paperback)

Pathology Secrets (Paperback)

Review of Medical Physiology (Paperback)

Textbook of Medical Physiology: (Textbook of Medical Physiology) (Hardcover)

Respiratory Physiology: The Essentials (Respiratory Physiology: The Essentials

Vander's Renal Physiology (Lange Physiology) (Paperback)

The Physiology Viva: Questions & Answers

Basic & Clinical Pharmacology (Basic and Clinical Pharmacology) (Paperback)

Katzung and Trevor's Pharmacology (Katzung & Trevor's Pharmacology:

The Pharmacology of Common Drugs in Emergency Medicine

ACEM PART I PROGRAM

Week Pharmacology Physiology Anatomy Pathology

6 CV Diuretics CVS – Control – Upper limb – Wrist/ Infectious Disease

15 Analgesic Absorption & Head & Neck Mouth, Pancreas

Week Pharmacology Physiology Anatomy Pathology

Pathology Normal Cell Robbins • Definitions of hypertrophy, hyperplasia, atrophy,

Physiology Resp IV Ganong • Describe the different sensors involved in

Anatomy Head & Neck Moore • Describe innervation of tongue

Anatomy Abdomen I Moore • Abdominal wall and peritoneum – structures –

Anatomy Abdomen II Moore • Stomach/Small bowel/Large bowel

Week 20 Bringing it All Together

Physiology Integration AMK books • Inter-relations of CVS/Lung/Central control

Anatomy Transitional AMK books • Triangles of neck

Week 23 – EXAM WEEK

Accommodation & Flights

Suit/Formal Viva clothing

The Night Before

I wish you the very best of luck.

1. Anatomy key facts

3. Physiology – Ganong table and figure references

4. ACEM I Viva statistics (Dr. J Stevens)

5. ACEM Viva Questions

6. ACEM I Recalled MCQs

Anatomy Key Facts

Anterior triangle of neck

Posterior triangle of neck

Greater sciatic foramen

Lesser sciatic foramen

Layers for surgical airway – tracheostomy

Layers for chest drain

Layers for lumbar puncture

Irreversible Cell injury

Physiology Table & Figure References

Figure 1-27 Electrolyte composition of human body fluids. Page 30

Table 2-1, Nerve fiber types in mammalian nerve, Page 61