Phase1 Year2: February2009

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Copyright@ 2009, UniversityCollege LondonMedical School

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MGQpaper- extendedmatchingsets

Onehouris allowedfor thispaper.

in thispaper.
Thereare80 questions
altogether
The questionsin this paperare arrangedin groupsof 5; eachgroupis headedby a themeor brief
clinicalscenario.
Thereis a list of possibleanswers,labelledA), B), G),etc for eachthemeor scenario:
Only one answeris correctfor eachnumberedquestion. lf you markmorethan one answerfor
any singlequestionyou scorezerofor that question.Thereis no negativemarking.
Someanswersfrom the list maybe usedmorethan once,somemay not be usedat all.
1 - 80 on the lineOfthecardthathasthe samenumber
numbered
Youshouldanswereachquestion
gdy!!93!Sggl
quesiion,
from
the list.
and
mark
the
as
You are advisedto mark your answerson this questionpaper,then transferyour answersto
card,usinqa Dencil.
the computer-readable
Makereasonablyfirm markson the card- thinhesitantmarkscannotalwaysbe readby the computer
scanner- butdo notpressso hardthatyouindentthroughthecard.
as possible,and enteryour
lf you make a mistake,eraseyour incorrectresponseas thoroughly
- the computerwill readthis
"score
response
through"
an
incorrecl
Do
not
answer
clearly.
revised
as vourresoonse.

Theme:evaluationof evidence

Possible
answers
are:
A) Validity
B) Testof heterogeneity
C) Relativerisk
D) Reliability
E) T{est
F) Confidence
interval
G) Responsiveness
H) P-value
l) Correlationcoefficient
J) Kappa
K) Noneof theabove
Fromthe abovelist,selecithe one statisticalvaluethat is bestdescribedby eachof thefollowing:

inter-rater
reliability
for a categorical
outcome.
1. Thequantity
usedto summarise
witha continuous
scale.
v_gliglity
of a measuring
instrument
2. Thequantity
usedto summarise
to change. \-.-sensitivity
3. The quantiiythatrefersto a measuringinstruments
scale.
of a measuringinstrumentwitha continuous
4, The quantityusedto summariserg_sllgBsivqgsE
abilityto correctlymeasurewhatit purports.
5. The quantitythatrefersto a measuringinstruments

Theme:ion movementsunderlyingelectricalphenomena
A) A net inwardmovementof calciumions
A netinwardmovement
of chlorideions
ions
A netinwardmovement
of potassium
of sodiumions
D) A netinwardmovement
movement
of calciumions
A netouhvard
F ) A netoutward
of chlorideions
movement
ions
of Dotassium
G) A netoutwardmovement
H) A net outvvard
movementof sodiumions
r) No netmovementof calciumionssinceionis closeto eouilibrium
of chlorideionssinceion is closeto equilibrium
J ) No netmovement
,K) No netmovement
ionssinceionis closeto equilibrium
of potassium
L) No netmovement
of sodiumionssinceionis closeto equilibrium
v;

thefluxthroughthechannels
selecttheonethatbestdescribes
Fromtheabovelistof ionmovements,
in a healtfry
beingthoseof a typicalmotoneurone
and conditions
listedbelow,all otherconditions
subject:
voltageis -70mV.
6. An openvoltageqatedsodiumchannelwhenthe membrane
sodiuT
when
the
membrane
voltageis +10mV.
7. An openi6iiElE-@teO
channel
pe!e.g!j_gm
the
membrane
voltage
is
An
channel
when
8.
open
-70 mV.
glutamatereceptorwhen the membranevoltageis equalto the potassium
9. An open ionotropic
voltage.
equilibrium
voltageis -20mV.
whenthe membrane
10.An openGABAreceptor

Y2 EMQ FEB09

Theme: dermatome distribution of lower limb

Possibleanswersare:

A) L1
B) L2
D) L4
F) 51
\].f

Dz

r) s4
Foreachpartof the bodydescribedbelow,choosethe one nerverootthat suppliesthatareafromthe
abovelistof oplions.Eachoptionmaybe usedonce,morethanonce,or notat all.
I 1. The soleof the foot
12.Themedialaspectof the anteriorlgleg (calf)andbigtoe.
13.Theposterior
aspectof the upperleg(thigh)
14.Theposterior
aspectof the lowerleg(calf)
15.Thelower-medial
aspectof theanterior
upperleg (thigh)

Theme:Treatmentof Psychosis
A young man was prescribeda drug to controlhis schizophrenia.Howeverhe then sufferedfrom
involuntary
musclemovements,
tremorandrigidity.
Thedrugwas thenchangedto anotherin orderto
reducehismovement
disorders.
Possible
answersare:
A) Amantadine
B) Bromocriptine
C) Chlorpromazine
D) Clozapine
E) Dopamine
D1receptors
F) DopamineD2receptors
G) Dopamine
D3receptors
H) Muscarinic
receotors
l) Oestrogen
J) Progesterone
K) Prolactin
L) Selegiline
Foreachof thefollowing
statements
or questions
selecttheonemostappropriate
answerfromthe list
above:
16.Theblockade
of thesereceptors
is thoughtto be responsible
for the involuntary
muscle
movements,
tremorandrigidity.
17.Thefirstdrugthatwas prescribed
causeda highdegreeof sedation
as it alsoblockshistamine
receptors.Whichdrugis it?
18.Bothdrugsleadto a highcirculating
concentration
of a hormone,
reducing
fertilityin women.
Whichhormoneis elevatedin response
to thesedrugs?
19.Theseconddrugthatwasprescribed
causesagranulocytosis.
Whichdrugis it?
20.Themovement
disorders
causedby thefirstdrugcanbe prevented
by prescribing
an additional
drugthat blocksa differentreceptorsystem.However,thiscausesa dry mouth.Whichreceptor
systemis blockedby thisadditional
drug?

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Theme:Pain
periodhe was
post-operative
A middle-aged
man has undergone
a herniarepair.In the immediate
giventwo drugsthat relievehis pain.He recoveredwell and returnedto workbut severalmonthslater
pain.He is givena different
drug.
hasnumbness,
burningpainandtouch-evoked
Possible
answersare:
A) Glutamate
B) Prostaglandins
C) lbuprofen
D) Diazepam
E) Substance
P
F) Morphine
G) Calciumchannels
pain
H) Neuropathic
I) GABA
J) cabaDentin
(SSRls)
serotonin
reuptake
inhibitors
K) Selective
(5-HT;Serotonin)
L) 5-hydroxytryptamine

Ut/

answerfromthe list
or questions,selectthe one mostappropriate
Foreachof the followingstatements
ADOVC:

in spinaltransmission
of bothpainst!!tqs?
21.Whattransmitter
is likelyto be involved
p6in.
22.Nameonedrugthatwouldbe usedas thefirstlinefor theposfoperative
pain.
23.Nameanotherdrugthatalsowouldbe usedfor post-operative
24.Whatdrugwashe givenfor thedelayedchronicpain
thisdrug
siteof action.6f
25.Whatis the pharmacological

Theme:Adrenal

\t

Possibleanswersare:
A) Adrenalartery
B) Adrenalcapsule
C) Adrenalcortex- Fetalzone
D) Adrenalcortex- Zonafasciculata
E) Adrenalcortex- Zonaglomerulosa
F) Adrenalcortex- Zonagranulosa
G) Adrenalcortex- Zonareticularis
H) Adrenalcortex- Zonareticulata
l) Adrenalmedulla
J) Adrenalvein
Fromthe abovelist of regionsin the adrenalgland,selectthe majorsite of synthesisfor each of the
following:
26."Adrenalandrogens"
27.Adrenaline
28.Cortisol
29. 16-Hydroxy-androstenediol
30.Mineralocorticoids

Y2 EMQ FEB09

Theme:Musclecontraction
Possibleanswersare:
A) Actin
B) Bloodglucose
C) Calciumions
D) Hydrolysis
of ATP
E) Muscleglycogen
gravis
F) Myasthenia
G) Myosin
H) Plasmanon-esterified
fattyacids(nefa)
l) Releaseof ADP
J) Thickfilament
K) Thinfilament
ions
L) Potassium
For eachof the following,selectthe one correctanswerfromthe IistA - L above:
(sarcoplasmic)
increased
to cholinergic
stimulation
at
concentration
in response
31. Intracellular
junctions.
neuromuscular
whichis a productof sometoxic
32.Theproteinthatis thetargetfor the cyclicpeptidephalloidin,
musnrooms.
: 02 consumed)
indicates
thatthisis the majorfuelbeing
33.A fallin the RQ (ratioof CO2produced
usedby muscle.
kinaseby calcium
34. Increasedbreakdownin responseto activationof phosphorylase
35.The regionof striated
musclewheremyosinis the majorprotein.

Theme:the hip joint

by a number.
termto placein eachof the spaceswherea wordis replaced
Selectthe mostsuitable
Eachanswermaybe usedonce,morethanonceor notat all.
A)
B)
C)
D)
E)
F)
G)
H)
l)
J)
K)

'

the femoralnerve
the obturatornerve
the hamstrings
the superiorglutealnerve
the iliopsoas
muscle
tensorfasciaelatae
internus
obturator
glutealnerve
the inferior
the sciaticnerve
the genitofemoral
nerve
gluteusminimusandmedius

is produced
by L361, supplied
andmuscles.
Extension
by strongligaments
The hipjointis siabilized
suppliedby L37l andis limitedto about15"by the
by the sciaticnerve,andgluteusmaximus,
andabduction
areproduced
by L38l andtensorfasciaelatae,
iliofemoral
ligament.
Medialrotation
throughthe actionof iliopsoas
whicharesuppliedby [_391.60oof activeflexionof thehipis possible,
andrectusfemoris.Thelatteris suppliedby L401.

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I
Theme:
thedevelopins
eye

Possible
answers
are:
A) Theyare derivedfromthe outerlayerof the invaginated
opticcup.
B) Theyare derivedfromthe surfaceectodermof the head.
C) Theirdensityis the maindeterminant
of iriscolour.
D) Mostof themdegenerate
duringfetallife.
E) Theyarederivedfromtheanteriorepithelium
of thelensvesicle.
F) Theyare amongthe laststructuresin the eye to begintheirdifferentiation.
G) Theyinvadethe developingvitreousbody.
H) Someof themcontaina greenpigment.
l) Theyarederivedfromthe mesenchyme
thatsurrounds
theopticcup.
J) Theypassthroughthe choroidfissureof the opticcup.
Choosethe onedescription
fromthe listabovethat bestmatcheseachof the followingstructures:

lL

41. Primarylensfibres
42. Retinalpigmentepithelial
cells
43. Ciliatymusclecells
44. Retinalganglion
cellaxons
45. Photoreceotor
cells

Theme:the pituitarygland
Selectthe mostsuitableterm (A - L) to placein eachof the spaceswherea wordis replacedby a
number.Eachanswermaybe usedonce,morethanonceor notat all.
A)
B)
C)
D)
E)
F)
G)
H)
l)
J)
K)
L)

the anteriorcranialfossa
thebodyof thesphenoid
bone
thecavernous
sinus
the posteriorcerebralartery
thesellaturcica
thesuperior
sagittalsinus
the anteriorcerebralartery
theopticchiasm
djrectbranchesof the internalcarotidartery
theinferior
sagittalsinus
themammillary
bodies
the posteriorcranialfossa

glandis locatedin L461, directlyaboveL471, whichis filledby an airsinus.Thegland

Thepituitary
receivesits arterialbloodsupplyfrom L481. Venousdrainageis into L49J, whichdrainsultimately
jugularvein.Anteriosuperior
to the sigmoidsinusandinternal
io theglandis [_50J,whichmaybe
damagedby enlargements
of the gland.

Y2 EI\,IQFEB09

Theme:intracranial
sinuses
selectthemostsuitable
termto placein eachof the spaceswherea wordis replaced
by a number.
Eachanswermaybe usedonce,morethanonceor notat all.
A)
B)
C)
D)
E)
F)
G)
H)
l)
J)
K)
L)

thesigmoidsinus
thesuperiorpetrosal
sinus
thefalxcerebri
theinferiorDetrosal
sinus
thecavernous
sinus
thetentorium
cerebelli
a transverse
sinus
thefalxcerebelli
thediaphragma
sellae
thesuperior
sagittalsinus
thegreatcerebral
vein
plexus
thepterygoid

Themeninges
surround
thecentralnervoussystem.Withinthecranialcavitytwolargefoldsof dura
stabilise
thebrain.Onefold,L511, formsa sheetundertheoccipital
lobes,preventing
rotation
of the
brainarounda transverse
axis.In itsfjxedmarginon eachsideis foundL52_1.Theothergreatfoldof
meninges,
thecerebral
hemispheres.
In itsfixedmarginlies1541, which
L53-J,extendsbetween
endsby dralningintoa transverse
sinus.In themiddlecranialfossatheduracoversI 55 I at thesroe
of thepituitary
fossa(orsellaturcica).

Theme:poliomyelitis
Possible
answersare:
A) amoeba
B) DNAvirus

Gram+vebacterium
D) Gram-vebacterium

nematodeworm
F) RNAvirus
G) infection
resulting
in the appearance
of antibodies
butno detectable
symptoms
H) infection
of non-human
Drimates

r)

J)

K)
L)
M)
N)

o)
P)

mildfeverthat is overby 6 daysafterinfectionwithno furthersymptoms

mutation
of an attenuated
to a virulent
strain
post-polio
syndrome
in adults
significant
deathof motorneurones
in thespinalcord
significant
deathof Purkinje
cellsin thecerebellum
significant
deathof pyramidal
cellsin themotorcortex
significant
deathof sensoryneurones
in the dorsalrootganglia
sjgnificant
deathof skeletalmusclefibres

Fromthelistabove,choosethe objector phenomenon

bestdescribed
by eachofthefollowing:
56.Theresultof polioinfection
in the majority
(>90%)of cases.
57.Thatthisdoesnotoccuris oneofthe reasons
whyeradication
possible.
of poliois considered
58.Theprimarylesionthatcauseslimbweakness
andparalysis
in peoplewhocatchpolio.
59.A phenomenon
thatcancauseriskto parentsof childreninoculated
withSabin(OPV)vaccine.
60.Thelnfectious
agentin polio.

Y2 EMQ FEB09

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II
Theme:archesand nervesofthe embryonicpharynx

Possible
answersare:
A) thefirst pharyngealarch
B) thesecondpharyngeal
arch
C) thethirdpharyngeal
arch
D) thefourthpharyngeal
arch
E) the fifth pharyngealarch
F) thesixthpharyngeal
arch
G) thetrigeminal
nerve
H) thefacialnerve
l) theglossopharyngeal
nerve
J) thevagusnerve
K) the hypoglossal
nerve
Choosethe one itemfromthe listabovethat bestmatcheseachof thefollowingdescriptions:

v,
-'

61. lt containsa vesselthatwillbe majorconduitof oxygento thebrain.

62. lt neverhasan independent
identity
in humanembryos.
63. lt innervates
thearchthroughwhichtheaortawillrun.
64. lt passesthroughseveralarchesbutthecellsit innervates
originated
fromnoneof them.
65. Someof its fibr-esinnervatetastebudsbut otherssubservegeneralsensation.

Theme:Neuromuscular
transmission
A patientis givena skeletalmuscle"relaxant"
drugto aidtrachealintubation
in preparation
for surgery,
andthengivenanotherskeletalmuscle"relaxant"
drugto aidsurgery.

Possible
answersare:
A) cr-adrenoceotors
B) atrooine
C) dopamine
receptors
D) dyflos
E) edrophonium
F) hemicholinium
G) hexamethonium
H) muscarinlcreceptors
l) neostigmine
J) nicotinic
receptors
K) oancuronium
L) suxamethonium
Foreachof thefollowing
statements
or questions,
selecttheonemostappropriate
response
fromthe
listabove:
66.Thefirstmuscle"relaxant"
(fasciculation).
drugusedcausedtransient
muscletwitches
Whichdrug
was it?
67.Whichdrugwouldbe usedto reversethe effectsof the secondskeletalmuscle"relaxant"drugthat
wasused?
68. Bothmuscle"relaxant"drugsact on the samereceptortypeand interference
withthis receptorcan
Whichreceptor
alsocausea fallin bloodpressure.
typeis involved?
gravisareabnormally
withmyasthenia
69.Patients
sensitive
to oneof thedrugslistedabove.Which
drugis it?
gravis?
70.Whichof the drugslistedaboveis usedto diagnose
myasthenia

Y2 EMQ FEB09

Theme:the actionpotential.
Possible
answersare:
A) A largeinwardcurrentis carriedby potassium
ions.
B) Thecellis depolarized
fromthe restingstate.The inwardcurrentthroughvoltagegatedsodium
channels
is greaterthantheoutwardcurrentthroughpotassium
channels.
C) The cell is depolarized
fromthe restingstate.The inwardcurrentthroughvoltagegatedsodium
channels
is equalto theoutwardcurrentthroughpotassium
channels.
D) Thecellis depolarized
fromthe restingstate.Theoutwardcurrentthroughpotassium
channels
is greaterthantheinwardcurrentthroughvoltagegatedsodiumchannels.
E) Thenetcurrentaerossthe plasmamembrane
is zero.Mostof thevoltagegatedsodium
channels
arein thereadyto openstate,that is,theywouldopenif thecellweredepolarized.
F) The numberof voltagegatedsodiumchannels
thatareopenis lessthanin the restingcell.
G) Thesodium/potassium
ATPase(= thesodiumpump)hasceasedto functionat thistime.
Eachof thefollowing
fivegraphsrepresents
a plotof membrane
voltageagainsttimefor an excitable
Foreachof lines71 - 75 selectthe one mostappropriatedescription
of the stateof an excitablecellat
thetimepointshownbythethickcircleon thegraph,fromthelistabove.

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Y2 EMQ FEB 09

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Theme:Depression
A 40 yearoldwomanhasbeendepressed
afterlosingherhusbandsixmonthsago.Shewasgivena
drugand afterthreeweeksher moodhad improvedsignificantly.
However,becauseof sideeffects.
shewasthengivena differentdrug.
Possible
answers
are:
A) s-HTuotakeinhibition
B) 5-HT2receptorantagonism
C) cocaine
D) diazeoam
E) monoamine
releasing
agent
F) fluoxetine
G) imiDramine
H) monoamine
oxidaseinhibition
l) mianserin
J) muscarinicreceptors
K) reserpine
L) o2-adrenoceptors
Foreachof the followingstatementsor questions,selectthe one mostappropriate
responsefor the
list above:

76. The firstdrugshewas prescribedcausedblurredvisionand constipation.

Whichdrugwas it?
77. Bothdrugsthatshewas prescribedhavethesamemechanismof action:whatis this mechanism
of action?
78.Whichof thedrugslistedaboveis notan antidepressant,
buthasa similarmechanism
of actionto
the two drugsthatthis patientwas prescribed?
79. She hearsthatthereis anothergroupof antidepressant
drugs,but certainfoodscannotbe eaten
whentheyare beingtaken.Whatis the mechanismof actionof thisgroupof drugs?
80.Whichof thedrugslistedabovecancausedepression
in patients?

ENDOF PAPER

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