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Faculty of Life Sciences & Medicine GKT School of Medical Education

Stage 1 Formative Questions 2016/17 Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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For Stage 1 students: We have written a formative paper with questions of the same standard as your upcoming summative paper. We have provided the answers and learning outcomes to point you towards the relevant resources.

The answers to the questions will typically be apparent from the lecture notes/captures or other information presented on KEATS. However, if necessary you may also use the FAQs to contact faculty for clarity.

A good way to revise is to use the “cover test” where you cover the answers and try to answer the question from scratch. Then reveal the 5 possible answers – if your answer is not present, go back to the lecture. Use the questions as part of revision with friends or alone – the key is to be able to discuss WHY the answer is correct and the 4 other answers are wrong.

Have fun and good luck!

Stuart Knight

Phil Aaronson

Tushar Vince

Head of Stage 1

Chair P2 Assessment Sub-board

Formative Assessment lead

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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1. In the figure, which represents a sagittal section of the pelvis, what is the bony landmark labelled by the arrow?

A. 2 nd segment sacrum B. Anterior superior iliac spine C. Fifth lumbar vertebra D. Pubic symphysis E. Sacral promontory

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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2. In the figure, which represents a sagittal section of the pelvis, what is the structure labelled by the arrow?

A. Bulbourethral gland B. Descending colon C. Prostate D. Seminal vesicle E. Sigmoid colon

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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3. During insemination, parasympathetic fibres cause vasodilatation and increased blood flow. Which of the following fibres are responsible for emission and ejaculation respectively? A. Somatic and parasympathetic B. Somatic and visceral afferent C. Sympathetic and parasympathetic D. Sympathetic and somatic E. Visceral afferent and sympathetic

4. The pka’s of phosphoric acid are approximately 2.0, 6.8 and 10.5. What is the ratio of the predominant conjugate base to that of the predominant undissociated acid at pH 7.8, as calculated by the HendersonHasselbalch equation?

A. 1:1 B. 1:10 C. 1:100 D. 10:1 E. 100:1

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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5. With regard to the control of contraction, which feature is shared by cardiac and smooth muscle? A. In both types of muscle, relaxation is brought about by the re-uptake of Ca2+ into the sarcoplasmic reticulum via IP3 dependent channels B. They both contain T-tubules which couple sarcolemmal depolarisation to Ca2+ release C. They both rely on Ca2+ influx to initiate contraction D. They both rely on the phosphorylation of tropomysin to initiate crossbridge cycling E. They both rely on the release of noradrenaline from sympathetic nerves to initiate contraction

6. Which of the following combinations of group sizes (for each dose), primary end points and subject types are most appropriate for a Phase I study of a new drug for the treatment of hypertension. A. Group size 8-10; Primary end point, changes in diastolic blood pressure; hypertensive patients B. Group size 8-10; Primary end point, pharmacokinetics & pharmacodynamics; normal subjects C. Group size 8-10; Primary end point, safety & tolerability; normal male subjects D. Group size 200-300; Primary end point, all-cause cardiovascular mortality; hypertensive patients E. Group size 200-300; Primary end point, changes in diastolic blood pressure; hypertensive patients

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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7. A 60-year-old man is brought to A&E after a forceful blow to his perineum subsequent to falling on a metal beam. An emergency MRI is requested. The structure marked by an arrow on the MRI is ruptured.

Which of the following best describes the site at which fluid (blood or urine) is most likely to accumulate? A. In the deep perineal pouch B. In the ischioanal fossa C. In the pararectal fossa D. In the rectovesical pouch E. In the superficial perineal pouch

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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8. A man presents to his GP complaining of difficulty in urination and pain in the pelvis. The doctor performs a physical examination and requests some imaging. He was found to have hyperplasia of the structure indicated by the arrow below.

Which zone/lobe of the structure is the most commonly involved in this case? A. Anterior zone B. Inferolateral lobe C. Peripheral zone D. Superomedial lobe E. Transitional zone

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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9. Epithelial cells sit on a specialised extracellular matrix structure that separates them from an underlying connective tissue. What is it called? A. Adhesion layer B. Basement Membrane C. Collagen D. Fasicle E. Germinal layer

10. Where in cells do post-translational modifications take place? A. Golgi apparatus B. Lysosomes C. Mitochondria D. Plasma membrane E. Smooth endoplasmic reticulum

11. What is the function of the mitochondria? A. Generation of all the ATP in the cell B. Generation of ATP from the Krebs cycle C. Production of ATP under anaerobic conditions D. Regulation of the energy balance in the cell E. Removal of excess oxygen from the plasma

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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12. What is chromatin? A. DNA wrapped round the octamer nucleosome core B. Complex of DNA, histones and non-histone proteins C. Condensed DNA found in the nucleus during interphase D. Stained DNA that is only visible by electron microscope E. Histones that have been modified by acetylase enzymes

13. What type of receptor is the glucagon receptor? A. Catalytic serine / threonine kinase receptor B. G-protein coupled receptor linked to Gq/11 C. G-protein coupled receptor linked to Gi D. G-protein coupled receptor linked to Gs E. Steroid receptor

14. What terminates the action of a heterotrimeric G protein once it has been activated? A. Dephosphorylation by a protein phosphatase B. Dissociation of the alpha subunit from the beta/gamma subunits C. Hydrolysis of GTP bound to the G protein D. Phosphorylation by a protein kinase E. Rebinding of the G protein to the receptor following dissociation of the agonist

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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15. Which cell type is responsible for the synthesis of the extracellular materials of connective tissue? A. Adipocyte cells B. Fibroblasts C. Macrophages D. Mast cells E. Osteoclasts

16. What would be the consequence of inhibiting the carnitine shuttle which transports fatty acids into the mitochondria? A. Accumulation of glycogen in liver and muscle B. High levels of long chain free fatty acids in the blood C. Increase in blood glucose concentration D. Increase in fatty acid synthesis in the liver E. Increased production of acetyl CoA by the liver

17. Glycogen is degraded by the action of which type of enzyme? A. A decarboxylase B. A phosphodiesterase C. A phosphorylase D. A thiolase E. An oxidase

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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18. What effect on mitochondria would an uncoupler of oxidative phosphorylation be most likely to have? A. Inability of the electron transport chain to oxidise NADH B. Inability to produce heat by the operation of the electron transport chain C. Inhibition of the electron transport chain D. Operation of the electron transport chain without ATP production E. The requirement for ADP in order for the electron transport chain to function

19. The release of insulin leads to lowering of blood glucose. What is an important mechanism in achieving this effect? A. Increased deamination of amino acids B. Increased ketogenesis C. Increased lipolysis D. Increased proteolysis E. Inhibition of gluconeogenesis in the liver

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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20. What is the mechanism by which insulin inhibits hormone sensitive lipase? A. It causes a Ras-dependent stimulation of mitogen-activated protein kinase (MAPK) B. It causes an Akt-dependent phosphorylation of glycogen synthase kinase C. It causes an Akt-mediated stimulation of cyclic AMP phosphodiesterase (PDE) D. It inhibits phosphatidyl inositol 3-kinase (PI3 kinase), leading to dephosphorylation of phospholipase C E. It reduces the cellular cyclic AMP concentration by inhibiting adenylate cyclase

21. Where are hydrogen bonds responsible for structural stability located in the alpha helix region of a protein? A. Between adjacent alpha helical polypeptide molecules B. Between parts of the peptide bonds within the same alpha helix C. Between side chains on every fourth amino acid residue D. Between the electro-negative residues and the water molecules E. Within the non-structural loop structures of the peptide

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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22. What is the nature of the interaction between aspartic acid and lysine residues in adjacent regions of protein at physiological pH? A. Electrostatic interaction B. Hydrogen bonding C. Hyrdrophobic interactions D. Van der Waals forces E. Weak covalent bonding

23. What is the function of the autonomic nervous system? A. Involuntary regulation of somatic function B. To gather sensory input from the skin C. To initiate the beating of the heart D. To stimulate skeletal muscle E. Unconscious regulation of visceral function

24. Which is an example of a body function that is oppositely affected by the sympathetic and parasympathetic nervous systems? A. Glucose release from the liver B. Insulin release from the pancreas C. Production of tears by the lacrimal glands D. Storage of urine by the bladder E. Visual accommodation

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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25. What effect would blocking nicotinic cholinergic receptors have on the autonomic nervous system? A. The entire ANS would be stimulated due to de-repression of ganglionic inhibitory pathways B. The entire ANS would stop working C. The parasympathetic branch of the ANS would stop working while the sympathetic branch would continue to function D. The release of adrenaline from the adrenal glands would cease, but otherwise the ANS would function normally E. The sympathetic branch of the ANS would stop working while the parasympathetic branch would continue to function

26. Transpulmonary pressure is calculated as: A. Alveolar pressure minus intrapleural pressure B. Barometric pressure minus alveolar pressure C. Intrapleural pressure minus alveolar pressure D. Intrapleural pressure minus barometric pressure E. Mouth pressure minus alveolar pressure

27. Tidal volume in a healthy 70kg young man breathing at rest is typically: A. 50 ml B. 500 ml C. 1500 ml D. 2000 ml E. 5000 ml

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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28. Arteries and arterioles are said to autoregulate. What is the meaning of this term? A. Autoregulation refers to the ability of arteries to maintain a constant blood pressure over a range of flow rates B. Autoregulation refers to the ability of arteries to maintain a constant diameter over a range of flow rates C. Autoregulation refers to the ability of arteries to maintain a constant flow of blood over a range of pressures D. Autoregulation refers to the ability of arteries to maintain a constant level of vascular tone over a range of pressures E. Autoregulation refers to the ability of arteries to regulate their diameter in response to both intrinsic and extrinsic stimuli

29. The majority of CO2 added to the blood as it passes through the tissues is carried as: A. Bicarbonate B. Carbamino compounds C. Carbonic anhydrase D. Dissolved CO2 E. Lactate

30. A specific safety concern with the anti-platelet drug aspirin is: A. Increased risk of anaphylaxis B. Increased risk of haemorrhage C. Increased risk of hepatic toxicity D. Increased risk of stomach ulcers E. Increased risk of thrombocytopaenia

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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31. A stem cell that is able to divide to produce all the differentiated cells of an organism is described as: A. Omnipotent B. Multipotent C. Pluripotent D. Totipotent E. Unipotent

32. A particular characteristic of eosinophils is: A. Eosinophils have a polymorphonuclear nucleus B. Eosinophils are highly motile C. Eosinophils are involved in the extracellular killing of parasites D. Eosinophils are associated with airway inflammation in patients with asthma E. Eosinophils contain cationic proteins in their granules

33. Which is an example of an organ specific autoimmune disease? A. Chronic granulomatous disease B. Perennial rhinitis C. Rheumatoid arthritis D. Systemic lupus erythematosus E. Type1 diabetes

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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34. Based on their morphological characteristics, some bacteria are considered pleomorphic. What does this mean? A. That they are long and helical-shaped B. That they are shaped like bent rods C. That they can grow into stalked structures D. That they do not have just one shape E. That they have spherical shape

35. Why do gram-positive cells appear purple when using the Gram stain? A. Have a periplasmic space that retains the crystal violet stain B. Have a thick capsule that retains the crystal violet stain C. Have a thin layer of peptidoglycan that is stained by safranin D. Have an outer membrane that retains the crystal violet stain E. Have multiple layers of peptidoglycan that retain the crystal violet stain

36. At the population level, the success of a vaccination programme depends on: A. Herd immunity B. Favourable environmental conditions C. Immunity transferred by administration of antibodies D. Natural active immunity E. Natural passive immunity

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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37. What family of human viruses have a complex capsid? A. Bacteriophages B. dsRNA viruses C. Naked viruses D. Poxviruses E. ssRNA viruses

38. At what stage does a child develop the concept of object permanence? A. 0-2 years B. 2-6 years C. 6-11 years D. 12+ years E. Prenatal

39. According to Piaget's classification of developmental stages, what characterises the period of Concrete Operations? A. Abstract thinking B. Conservation C. Egocentricity D. Insecure attachment E. Object permanence

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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40. A 13 month old child is distressed when their primary care giver leaves them alone with a stranger. When their primary care giver returns they are comforted. What type of attachment does this child have with their care giver? A. Affective attachment B. Insecure anxious/avoidant attachment C. Insecure anxious/resistant attachment D. Insecure disorganised attachment E. Secure attachment

41. The term ‘somatosensation’ refers to which sensory modalities? A. Head motion, Taste, Smell, Proprioception, non-painful Visceral sensation B. Head motion, Touch, Itch, Proprioception, Pain C. Touch, Proprioception, Pain, Itch, non painful Visceral sensation D. Vision, Hearing, Head motion, Taste, Smell E. Vision, Hearing, Touch, Pain, Itch

42. The two points perceptual threshold (i.e. the smallest distance between two points that still results in the perception of two distinct stimuli) is smallest: A. On the back B. On the fingertips C. On the foot D. On the forehead E. On the upper lip Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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43. Mr Thomson has come to his second appointment at the diabetes clinic. At his last appointment Mr Thomson had agreed to change his diet however he states that he was not successful in doing so. What technique from theory of planned behaviour could best help Mr Thomson achieve this behaviour change? A. Implementation intentions B. Emotion focused coping C. Fear appraisal D. Information giving via a leaflet E. Classical conditioning

44. According to the Theory of Planned behaviour, attitudes toward the behaviour, subjective norms and perceived behavioural control directly predicts what? A. Adherence B. Behaviour change C. Compliance D. Coping E. Intention to change behaviour

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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45. Miss Williams has a progressive form of multiple sclerosis (MS). She has recently had a flare in her symptoms which have further reduced her physical functioning. She is currently coping by making adjustments to her home to make it wheelchair accessible. What is the umbrella term for the type of coping Miss Williams is engaging in? A. Illness perceptions B. Future focused coping C. Goal setting and action planning D. Problem focused coping E. Psychological coping

46. You have asked a patient how they are getting on with their asthma preventer medication. The patient has replied that they are getting on fine and in fact they don’t seem to need to take it as much as you had recommended. Rather than taking the medication preventer twice a day, as agreed in their previous consultation, they have been taking the preventer only when they have had a tight chest. What is this behaviour described as? A. A drug holiday B. Illness delay C. Intentional non-adherence D. Non-persistence E. Unintentional non-adherence

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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47. Miss Murphy has poorly controlled asthma, meaning she uses her reliever medication more than four times a day. You discover that Miss Murphy is using her reliever to treat symptoms such as headache which are not biologically associated with asthma. What illness perception would it be important to address in the consultation with Miss Murphy to correct this overuse of medication? A. Perceived cause B. Perceived consequences C. Perceived control D. Perceived identity E. Perceived timeline

48. Which mode of inheritance does Huntingdon’s disease result from? A. Autosomal recessive B. Autosomal dominant C. X-linked D. Imprinted E. Common complex

Owned by: Head of Stage 1 Maintained by: Senior Assessment Officer Last updated: 24.03.2017

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