ESA 2 Feedback Selected Questions from ESA 2 Papers 2008

Q1 A 43 year old woman reports that her previously regular menses have become more erratic and sometimes very heavy over the past year. a State the anatomic pre-requisites of menstruation. (1 mark for each; max 3 marks)

b List the sequence of events in the ovarian cycle from a pre-ovulatory follicle to a corpus luteum. (1 mark for each; 6 marks)

c This patient’s friend has told her she probably has fibroids. What is a fibroid? (2 marks)

d The patient is more concerned about possible cancer. List TWO types of cancer that might explain her symptoms. Use correct terms to indicate site and cell type.

e This patient finally has a hysterectomy. List THREE ligaments that need to be identified and ligated to enable the uterus to be removed from the abdomen.

f A year after recovering from her surgery this patient reports hot flushes despite still retaining her ovaries. Briefly explain why this has occurred. (2 marks)

Q2 A 72 year old man is a keen golfer. He now reports severe crampy pain in his right calf when he is on the golf course. The pain subsides when he sits in his golf cart.

a i) What is the likely diagnosis, given the history outlined above? (1 mark) ii) What is the likely cause? (1 mark)

bi) List TWO factors that may cause the pain felt during exercise. (1 mark for each up to a maximum of 2 marks) ii) What effect will these factors have locally on blood vessel diameter? (1 mark)

ci) Name the muscle(s) in his calf. i) (5 marks) ii) How are the muscles of the calf innervated? (1 mark) iii) Which arteries supply the musculature of the calf ? (1 mark)

di) Explain how the resistance of blood vessels changes with a change in vessel radius in laminar flow? (1 mark) ii) Whose law summarises the relationship between radius and resistance? (1 mark)

e i) What are the FOUR characteristics of the pulse? (0.5 marks for each) ii) How would the pulse change in the area affected in this patient? iii) Where would you elicit it?

f Give TWO modifiable or treatable factors that increase the risk of peripheral vascular disease. (1 mark for each; max 2)

Q3 A 82 year old woman with Type 2 diabetes mellitus falls and sustains a fracture of the neck of the left femur at the hip joint.

a Describe the TWO major types of fracture of the neck of the femur and the TWO types of fracture in each group (1 mark for each correct part)

b Describe the clinical appearance of the leg in this situation. Both required for 1 mark

C The adductor muscles of the thigh are in spasm as she is lying. (i) Describe the nerve supply of the adductor magnus muscle (2 Marks) (ii) Which muscle of the medial compartment of the thigh has an attachment distal to the femur? (1 mark) (iii) Name TWO muscles which ABDUCT the femur when the hip is EXTENDED. (2 Marks)

d) Name TWO hormones associated with the stress response that counter regulate the action of insulin. (2 marks)

e) Give FOUR long term complications of poorly controlled Type 2 diabetes. (4 marks)

F Give TWO lifestyle changes and TWO different pharmacological strategies that can be used as treatment of Type 2 diabetes. (1 mark each; max 2) Pharmacological strategies (2 marks)