Candidate Number -

Candidate Number -

MBChB 1 Examination
Paper 1
May 22nd 2012
9.30 a.m. – 11.30 a.m.

This paper is in two parts

• Part A Modified Essay Question 60 minutes

• Part B Short Notes 60 minutes

Instructions to Candidates

Two hours will be allowed to complete this exam.

This examination is in two parts.

The examiners recommend that students divide their time between the parts as
follows:

Part A Modified Essay Question 60 minutes

Part B Short Notes 60 minutes

Part A Modified Essay Question

1. One hour is recommended for the completion of Part A.

2. This part carries 60 marks.

3. DO NOT read through this booklet before starting.

4. On each page of the exam, information is provided about a developing scenario.

Read through the information at the top of the page then answer the question(s)
on that page. You should write short, succinct answers but if you need more
space please use the back of the sheet.

5. If you are asked to answer a question by drawing a diagram, you must do this to
earn the marks.

6. Each page should be labelled clearly with your registration number and candidate
number.

7. Each page will be marked by a different examiner therefore do not assume that
the examiner marking any one page will be aware of anything you have written on
a previous page. Try to make each answer “free-standing”.

8. The time you should spend on each answer and the time remaining is indicated
on each page. Try to keep to the suggested timings.

9. The number of marks for each section is indicated on each page.

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Part A Modified Essay Question

An Evening Surgery

Dr Buchanan is doing his evening surgery in the Health Centre. His next patient is
Mrs Young (55 years) who has a long history of a troublesome cough and spit. She
has smoked since she was a teenager. Dr Buchanan asks her what the problem is
and she tells him that she is “getting awful short of breath”.

What is the most likely diagnosis?

1 mark

Dr Buchanan decides to examine Mrs Young’s chest.

List the steps required in examining the chest.

3 marks

Marks Awarded = 4 marks Time Remaining = 56 minutes

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The GP uses his stethoscope to listen to Mrs. Young’s breathing.

Describe the mechanism of normal breathing.

7 marks

Marks Awarded = 7 marks Time Remaining = 49 minutes

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Mrs Young then says that for the last two weeks she has had a sharp pain in her
chest when she breathes deeply. Dr Buchanan localises the painful area to the
posterior left chest.

Suggest a likely explanation for this pain.

2 mark

Dr Buchanan decides to send Mrs Young for a chest X-ray.

Name the following structures seen on the normal chest x-ray below:
3 marks
A. D.

B. E.

C. F.

B F

Marks Awarded = 5 marks Time Remaining = 44 minutes

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Mrs Young returns to see Dr Buchanan in 2 weeks when he has the X-ray report
from the hospital. The report reads:

“PA chest X-ray shows an area of consolidation in the left lower lobe associated with
a distinct opacity approximately 2 cm in diameter at the upper end of the lobe. The
appearances are highly suggestive of a primary lung tumour.”

What is the PA view and why is this the standard view?

2 marks

Marks Awarded = 2 marks Time Remaining = 42 minutes

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Dr Buchanan arranges for Mrs Young to be seen at the local Chest Clinic, where a
bronchoscopy is arranged.

What specimens might be taken at bronchoscopy?

2 marks

The pathology and cytology reports are sent to Dr Mohammed the Consultant Chest
Physician.

The following terms were used in the laboratory reports. Explain what each term
means. 5 marks

1. pleomorphic (1 mark)
2. high nuclear-cytoplasmic ratio (1 mark)
3. squamous carcinoma (2 marks)
4. primary origin (1 mark)

Marks Awarded = 7 marks Time Remaining = 35 minutes

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Dr Buchanan has received a letter from the chest clinic about Mrs Young, indicating
that she has lung cancer.

At the regular practice meeting on Wednesday afternoon, Dr Buchanan discusses

with his colleagues the results from Mrs Young’s investigations. Miss Patel, a 1st year
medical student on a practice visit, is surprised by the result as she thinks that lung
cancer is much more common in men than in women.

Dr Buchanan shows her the following graph.

Lung Cancer: Incidence Rates per 100,000 Population, by Sex, UK

Explain the terms incidence and prevalence making clear the difference between the
two terms.
4 marks

Marks Awarded = 4 marks Time Remaining = 31 minutes

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Smoking is the major risk factor for lung cancer. When the cancer risks of smoking
were first discovered, doctors imagined that warning people about the dangers of
smoking would result in them giving up. However, this did not happen immediately.

List and briefly discuss the factors that led in time to a reduction in smoking
prevalence.
4 marks

The graph that Dr. Buchanan showed to Miss Patel shows an increasing incidence of
lung cancer in females which reflects patterns of smoking in younger females.

What explanations account for relatively high rates of smoking continuing in younger
females?
2 marks

Marks Awarded = 6 marks Time Remaining = 25 minutes

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Explain the mechanisms by which smoking causes lung cancer.

6 marks

Marks Awarded = 6 marks Time Remaining = 19 minutes

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Mrs Young is admitted to hospital for treatment for her tumour. She is going to have
surgery to remove the lobe of lung affected by the tumour. The surgeon, Mr Major,
shows her a diagram of her lungs, to explain what he is going to do.

Label the following structures on the diagrams of the lungs and chest wall below.
3 marks

A. right main bronchus D. carina

B. oblique fissure of left lung E. visceral pleura
C. left lower lobe F. parietal pleura

The respiratory epithelium of the lung is populated by Type 1 and Type 2

pneumocytes and alveolar macrophages.

For each of these cell types, describe its specific function(s).

3 marks

Marks Awarded = 6 marks Time Remaining = 13 minutes

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Mrs Young recovers well from her surgery and Mr Major is able to tell her after a few
days that she had a localised tumour with no apparent spread to the lymph nodes
and that he was able to completely excise it within the specimen.

However, 3 days post-operatively Mrs Young develops a painful swollen right calf.

What does this symptom indicate/signify?

1 mark

Outline the mechanism of blood coagulation using a diagram to explain your answer.
4 marks

From your knowledge of the factors affecting coagulation, what measures are
normally put in place to reduce the risk of this complication of surgery?

2 marks

Marks awarded =7 marks Time remaining = 6 minutes

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Mrs Young is successfully treated and the pain and swelling go. She is able to leave
the hospital after another 8 days.

However, nine months later Mrs Young goes to see Dr Buchanan, complaining of
back pain and increasing breathlessness. Further investigations confirm that the
tumour has recurred and has metastasised to the spine.

How are adjacent (superior-inferior) vertebrae articulated with each other?

2 marks

What structure lies between two vertebral bodies? What is its function?
2 marks

How are the ribs connected to the vertebral column?

2 marks

Marks awarded = 6 marks Time remaining = 0 minutes

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Part B Short Notes

1. One hour is allowed for the completion of part B.

2. Each short note is worth 12 marks (60 marks in total for part B).

3. Answer all the questions in this section.

4. All answers should be written on the paper in the space below the
question. Use the continuation sheet if you need more room.

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Part B Short Note Questions

Each Short Note is worth 12 marks

1. The cell cycle is defined as the time from one cell division to the next.
Describe the various stages of the cell cycle (5 marks) and describe how it is
normally regulated (7 marks).

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Question 1 – Answer Continued

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2. a. Describe the underlying immune mechanisms in someone who suffers an

allergic response to their pet cat and any medication they may be prescribed
to carry (5 marks). How does the medication work? (1 mark)

b. Multidrug resistant strains of Mycobacterium tuberculosis have resulted in

an increase in reported cases of Tuberculosis (TB). Briefly describe the host
response which develops in an attempt to contain infection with this
intracellular organism. (6 marks)

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Question 2 – Answer Continued

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3. A healthy individual consumes a large sugary drink. Describe at the

cellular/molecular level the physiological changes which occur over the
following 2 hours in order to maintain blood glucose homeostasis (10 marks).
Which responses are different in an individual with type 1 diabetes, who is
under appropriate medical supervision (2 marks)?

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Question 3 – Answer Continued

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4. The nervous system is involved in regulating all of the functions of the body
with many cell types involved in this process.

a. Pick 4 different cell types present in the nervous system and describe
their function. (4 marks)

b. Describe the function of a dermatome

(2 marks)

c. Draw a simple diagram of the spinal cord showing where afferent and
efferent information enters and exits.
(6 marks)

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Question 4 – Answer Continued

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5. a. Describe the organisation and histological structure of skeletal muscle

(6 marks).
b. Briefly describe the function of skeletal muscle (2 marks).
c. Explain the basic features of the cross-bridge cycle (4 marks).

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Question 5 – Answer Continued

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