All online Quiz Week 30-44 Flashcards
1
Q
Anthony is a 73 year-old man who presents to your general practice with shortness of breath. It has been present for 5-6 months and gradually worsening over that time. It is exacerbated by movement but is present to some degree, even at rest. It does not particularly bother him at night. He sleeps on 1 pillow. He coughs, particularly in the mornings. This is productive of yellow sputum and has been present for 4-5 years. He has had no fevers or night sweats and has not lost weight. There is no chest pain or tightness. He has no significant medical history. He is a Vietnam War veteran and has been smoking 20 cigarettes/day since age 20. He lives alone and avoids coming into town as much as possible. On examination, you notice a slim man. Jugular venous pressure is 3cm above the sternal notch at 45 degrees. His chest appears hyperinflated. Heart sounds are dual with no added sounds. There is widespread wheeze on examination of the lungs.
Which of the following is the most likely diagnosis?
A. Acute bronchitis
B. Acute coronary syndrome
C. Asthma
D. Chronic Obstructive Pulmonary Disease
E. Congestive heart failure
F. Pneumonia
A
Answer –> Chronic Obstructive Pulmonary Disease (COPD)
2
Q
What does the following blood results indicate?
Elevated: RBC HGB HCT
Lowered: Lymph
A
Answer –> Polycythaemia
3
Q
Increased numbers of red cells in Anthony’s blood are likely to reflect:
A. Excessive carbon monoxide exposure
B. Exogenous Erythropoietin administration
C. Haemoglobin chain abnormality
D. Peripheral endothelial dysfunction
E. Reduced pulmonary surface area for gas exchange
A
Answer –> Reduced pulmonary surface area for gas exchange
4
Q
Anthony is quite worried that his symptoms might be due to carbon monoxide exposure.He had a friend die of a workplace accident at BHP in 1988 due to this.
How does excessive carbon monoxide exposure cause death?
A. CO alters CO2diffusion in the lungs
B. CO alters endothelial function
C. CO binds to Hb with a higher affinity than oxygen
D. CO binds to the red cell membrane
E. CO increases peripheral tissue pH
A
Answer –> CO binds to Hb with a higher affinity than O2
5
Q
Sharon is a 52 year old woman with pernicious anaemia. On evaluation of her red blood cells, we notice a macrocytosis. The cause of this nuclear-cytoplasmic dyssynchrony is: A. Accelerated cytoplasmic maturation B. Accelerated nuclear maturation C. Decelerated cytoplasmic maturation D. Decelerated nuclear maturation E. Normal cytoplasmic maturation F. Normal nuclear maturation
A
Answer –> Decelerated nuclear maturation
6
Q
Akshay is a 42 year-old man who presents to your practice complaining of tiredness, gradually worsening over the last 6 weeks. There are no other symptoms. He says he sleeps well, is a lifelong vegetarian, works as an administration officer for the local council. He walks for exercise and is happily married. Examination is entirely unremarkable. Full blood count demonstrates a microcytic hypochromic anaemia but is otherwise normal.
What is the most important diagnosis not to miss?
A. Depression
B. Dietary iron deficiency
C. Gastrointestinal cancer
D. Pernicious anaemia
E. Roundworm infestation
A
Answer –> Gastrointestinal cancer
7
Q
Follow up iron studies confirm iron deficiency as the cause of Akshay’smicrocytic hypochromic anaemia. Why does iron deficiency cause a microcytic hypochromic anaemia? A. Accelerated cytoplasmic maturation B. Accelerated nuclear maturation C. Decelerated cytoplasmic maturation D. Decelerated nuclear maturation E. Normal cytoplasmic maturation F. Normal nuclear maturation
A
Answer –> Decelerated cytoplasmic maturation
8
Q
Use the Bradford Hill criteria to examine the following information on the association between smoking and lungcancer.Considertheevidence and tick those for which you believe the evidence supports a causal relationship.
A. Most research shows that people smoked before they developed lung cancer.
B. Most research shows that smokers were 20-30 times more likely to develop lung cancer than non-smokers.
C. Most research shows that higher levels of smoking are associated with more cases of lung cancer.
D. Most research found that the associate between smoking and lung cancer is seen in men and women as well as other social and ethnic groups.
E. The full biological basis for how tobacco may cause lung cancer is not known.
F. Research has found that reducing the consumption of cigarettes reduces the risk of lung cancer. Furthermore, animal studies have shown that tobacco is carcinogenic to animals.
G. Numerous other diseases are associated with smoking.
A
Answer –> A,B,C,D,F,
9
Q
What is the study design of:
Men and women who have had a heart attack are compared with those who have not had a heart attack and medical records are used to determine their use of anti-inflammatory medications.
A
Case-control study
10
Q
What is the study design of:
Is obesity more common in men and women with arthritis?In a population survey of men and women in the Hunter, information on weight and the existence of medical conditions (such as arthritis) was collected by questionnaire. This study showed that people with arthritis were more likely to be obese than those within the normal weight range.
A
Cross sectional study
11
Q
What is the study design of:
Does eating fish 3 or more times per week decrease the incidence of depression in men and women?
Men and women who eat fish 3 or more times per week are compared to those who consume less than this amount of fish. These people are followed for 5 years to determine if the incidence of depression is different between groups.
A
Cohort study
12
Q
What is the study design of:
Does zinc supplementation improve glucose tolerance in men and women with type 2 diabetes?
400 men and women with type-2 diabetes are divided into to two groups of 200 people to determine if zinc supplementation improves glucose tolerance over a 6-month period.
A
RCT
13
Q
You are a GP in Kotara, NSW. Baysan is a 19 year old woman referred in by her dentist following a planned wisdom tooth extraction that lead to persistent bleeding in the socket. The dentist is concerned that she may have a bleeding disorder. Baysan tells you she has always bruised easily but has never had bleeding into a joint as far as she’s aware. She’s never spoken to any doctors about her easy bruising before. She routinely experiences prolonged and heavy menstruation. On examination you notice widespread scattered petechiae.
Is the described pattern more likely to fit a:
A. Clotting factor disorder
B. Lack of skill of the dentist
C. Normal variant
D. Platelet disorder
E. Thrombotic disorder
A
Answer –> Platelet disorder
14
Q
Ethan is a 13 year old boy who has a history of hemarthroses and spontaneous haematomas.
Is this described pattern more likely to fit a:
A. Clotting factor disorder
B. Normal variant
C. Platelet disorder
D. Thrombotic disorder
A
Answer –> clotting factor disorder
15
Q
You are a gastroenterology registrar, monitoring the progress of Lucas, a 59 year old male inpatient with hepatic failure. His APTT and PT have recently become elevated, although his AST, ALT, GGT and ALP are stable. This is likely to reflect: A. Improving bone marrow function B. Improving liver function C. Deteriorating bone marrow function D. Deteriorating liver function E. Stable bone marrow function F. Stable liver function
A
Answer –> Deteriorating liver function
16
Q
Fu is a 79 year old man with B- blood type. Assuming he needed blood and by some disaster it was unavailable, theoretically which type would be an acceptable substitute? A. A- B. AB+ C. B+ D. O- E. O+
A
Answer –> O-
17
Q
Saanvi is a 15 year old girl who requires a plasma transfusion. She has a B+ blood type. Assuming B+ plasma was unavailable, which of the following would be an acceptable substitute? A. A- B. AB+ C. B- D. O- E. O+
A
Answer –> AB+
18
Q
What do AST and ALT measure in a liver function test?
A
largely measure inflammatory processes within the liver
19
Q
What do GGT and ALP measure in a liver function test?
A
a measure of liver obstruction.
20
Q
What is the universal donor for blood?
A
O-
21
Q
What is the universal donor for plasma?
A
AB+
22
Q
Why is AB+ the universal plasma donor?
A
Plasma contains antibodies to cell surface markers not expressed by the donor. This is thought to be due to cross-reactivity with intestinal flora surface markers. The plasma of an AB+ person will not contain antibodies to either A, B, or the rhesus factor
E.g. –> A blood will contain antibodies to B, B to A, and O to both A and B. Negative rhesus factor donors will have antibodies to the Rhesus factor.
23
Q
Which Immunoglobulin, present in secretions, is thought to coat microbes to prevent epithelial cell adherence, neutralise toxins and dampen inflammatory pathways that could otherwise lead to autoimmune processes? A. IgA B. IgD C. IgE D. IgG E. IgM
A
Answer –> IgA
24
Q
Carly, aged 12 months, is receiving her scheduled vaccinations.
Which Immunoglobulin provides immediate response in response to the antigen stimuli?
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
A
Answer –> IgM
25
```
Which Immunoglobulin provides a long term protection against the given antigen, and can be used to measure immunity against the antigen?
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
```
Answer --> IgG
26
```
Which immunoglobulin is classically implicated in the pathogenesis of anaphylaxis?
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
```
Answer --> IgE
27
```
Adrian is a 32 year old man who lives in Australia and who has just been diagnosed with community acquired pneumonia.
When the organism is identified, which of the following would be considered unusual?
A. Group A Steptococci
B. Haemophilus inlfuenza
C. Moxarella catarrhalis
D. Pneumocystis jiroveci
E. Streptococcus pneumonia
F. Staphylococcus aureus
```
Answer --> Pneumocystis jiroveci
28
Rocco, a 12 year old boy presents to the ED after a crash on his BMX bike, where he landed on the handlebars. He is complaining of abdominal pain and on exam he has a handlebar tattoo (see image). He has the following vital signs:
HR 120 BP 110/70 RR 20 T 37.1
What is the appropriate triage category for this boy?
A. 1
B. 2
C. 3
D. 4
E. 5
Answer --> 3 --> but most Eds would give a 2 because of the probable underlying injury
29
```
Which of the following internal organs is Rocco most likely to have injured?
A. Liver
B. Spleen
C. Large intestine
D. Left kidney
E. Small intestine
```
Answer --> Spleen
30
```
An elevated serum lipase would raise suspicion of what kind of injury?
A. Kidney
B. Liver
C. Pancreas
D. Spleen
```
Answer --> Pancreas
31
Which of the following findings would most clearly indicate a hollow viscus (vs solid organ) injury had occurred?
A. Free peritoneal fluid on FAST scan (focused assessment with sonography for trauma)
B. Crepitus in the soft tissues around the site of injury
C. Rebound tenderness in all four abdominal quadrants
D. Radiolucent rim between the ribs and liver on lateral decubitus x-ray
Answer --> Radiolucent rim between the ribs and liver on lateral decubitus x-ray
32
Half an hour after Rocco’s arrival his vital signs are deteriorating. He has a HR of 145 and a BP of 100/50. You suspect intraperitoneal bleeding from a ruptured spleen.
How would Rocco’s cardiovascular system first detect acute loss of intravascular volume?
A. Decreased firing of baroreceptors
B. Decreased delivery of sodium to the distal tubule
C. Increased firing of baroreceptors
D. Increased levels of CO2 in peripheral tissues
Answer --> Decreased firing of baroreceptors
33
Rocco can increase his cardiac output by: (check all that apply)
A. Decreasing vagal nerve input to his heart
B. Increasing preload by venoconstriction
C. Increasing afterload by arteriolar constriction
D. Direct sympathetic nerve stimulation of the SA node
E. Release of circulating adrenaline from the adrenal medulla
Answer --> A,B,D,E
34
Vasoconstriction is accomplished by: (check all that apply)
A. Activation of sympathetic nerves innervating vasculature
B. Local response to increasing CO2 levels
C. Release of circulating adrenaline from the adrenal medulla
D. Withdrawal of parasympathetic nerve signals to vasculature
Answer --> A,C
35
Is there parasympathetic innervation of the vasculature?
No --> there is only sympathetic
36
Rocco is able to shift some fluid from the interstitial space to the intravascular space because: (check all that apply)
A. Decreasing capillary hydrostatic pressure alters the balance of starling force
B. Increasing capillary permeability allows free flow between the spaces
C. Increasing capillary oncotic pressure alters the balance of starling force
D. Sympathetic nerves activate a sodium-potassium ATPase in the capillary wall
Answer --> Decreasing capillary hydrostatic pressure alters the balance of starling force
37
Despite all these compensatory measures, perfusion to Rocco’s peripheral tissues becomes inadequate. As his cells are deprived of oxygen, what vital cellular process is unable to proceed? (check all that apply)
A. Utilisation of glucose via glycolysis
B. Reduction of NAD to NADH+
C. Conversion of pyruvic acid to lactic acid
D. Final reaction of electron transport chain
Answer --> D
38
No blood is available, so you replace Rocco’s lost volume with normal saline. His blood pressure returns to normal, however you have caused his haemoglobin to drop from 13.1 g/dL to 9.9 g/dL, thus reducing his oxygen carrying capacity.
Would giving 100% oxygen make up for this haemoglobin deficit?
A. Completely
B. Mostly
C. Only a bit
D. It's a toxic waste of time
Answer --> It's a toxic waste of time
39
Rocco is taken to theatre for an exploratory laparotomy. He is found to have a more extensive injury to the spleen than initially suspected, and the surgeon has no choice other than to perform a splenectomy.
When considering the long term consequences of splenectomy for Rocco, infection with which of the following organisms would be a particular concern?
A. Cryptosporidium
B. Influenza virus
C. Mycoplasma pneumonia
D. Streptococcal pneumonia
Answer --> Streptococcal Pneumonia
40
The spleen is normally involved with removing old worn out RBCs from the circulation. Rocco’s liver and lymph nodes will try to take up the slack, but patients without a spleen (or with a non-functioning spleen from something like sickle cell disease) have characteristic findings on their peripheral smear.
What changes would you observe in Brody’s RBCs on a peripheral blood smear? (check all that apply)
A. Poikilocytosis
B. Howell Jolly Bodies
C. Target cells
D. Acanthocytes
Answer --> A,B,C,D
41
Despite significant blood loss during surgery, Rocco recovers well and is keen to get back on his bike. He received perioperative IV iron during surgery, but when you see him for follow up you would like to check if his iron stores have been adequately replenished.
Which of the following would indicate adequacy of iron stores?
A. Decreased TIBC (total iron binding capacity)
B. Normal serum iron
C. Increased soluble transferrin receptor
D. Normal serum ferritin
E. Normal haemoglobin
Answer --> Normal serum ferritin
42
```
You are a GP working in Jewells, NSW. Matilda Pryzbylski is a 17 year old girl who presents with her father, Sam. She’s developed an intensely itchy rash around her wrist. The rash has been gradually getting worse over the last few days. It’s never happened before. The distribution is limited to what you see in the picture, plus bilateral earlobes. It’s pruritic but not painful. She hasn’t tried new soaps, creams or sunscreen. She does wear earrings and a watch daily, and has had the same ones for several years. There is no other useful information on history. What is the pathogenesis of this rash most likely to be do you think?
Image shows a rash localised under watch band
A. Allergic contact dermatitis
B. Atopic dermatitis
C. Bacterial infection
D. Fungal infection
E. Irritant contact dermatitis
F. Viral infection
```
Answer --> Allergic contact dermatitis
43
```
Which type of hypersensitivity reaction is allergic contact dermatitis?
A. I
B. II
C. III
D. IV
```
Answer --> IV (4)
44
Should Matilda continue wearing her watch and earrings?
A. Maybe, the choice is up to her
B. No, she is likely to develop anaphylaxis to repeated exposure
C. No, the reaction is unlikely to dissipate
D. Yes, it should dissipate with time
E. Yes, with some treatment to reduce the inflammation she can continue
Answer --> No, the reaction is unlikely to dissipate
45
```
Tony is a 23 year old man who comes to see you as his GP. He has developed skin lesions on his trunk and extensor surfaces of his limbs in the last fortnight. They are mildly itchy. He is otherwise well.
Image displays thick, red, bumpy patches covered with silvery scales.
Is this likely to be:
A. Allergic contact dermatitis
B. Atopic dermatitis
C. Psoriasis
D. Scarlet fever
E. Urticaria
```
Answer --> Psoriasis
46
Tony’s Dad, Cameron, aged 70, is your next patient. He’s had this mark on his face for the last 3 months. It’s not itchy or painful, and hasn’t got better. He thinks it might be gradually getting bigger.
Image shows circular Raised erythematous border with hyperpigmented centre.
Is this most likely to be:
A. Infectious dermatosis
B. Inflammatory dermatosis
C. Malignant dermatosis
D. Self inflicted injury
Answer --> Malignant dermatosis
47
Hunter is a 11 year old boy brought by ambulance to the Emergency Department, where you are an intern. He was playing at a friend’s house when he became unwell, having difficulty breathing. His friend’s Mum called the ambulance. Hunter has a history of both asthma and anaphylaxis to peanuts.
Which of the following will help you distinguish between asthma and anaphylaxis?
A. Dual heart sounds, no murmur
B. Poor air entry
C. Reduced blood pressure
D. Widespread wheeze
E. Vomiting
Answer --> Vomiting
48
You are a GP in Jesmond, NSW. Yvette is a 40 year old woman who presents to you with the following rash. Rash displays erythematous distribution over cheeks and nose
Would you say that this distribution reflects:
A. Allergy
B. Melanoma
C. Photosensitivity
D. Psoriasis
E. Urticaria
Answer --> photosensitivity
49
You ask Yvette if she has sore joints. Arthritis or arthralgias are present in over 90% of patients with SLE.
If she has joint symptoms, are they likely to be:
A. Monoarticular
B. Morning stiffness which resolves with movement
C. Stiffness which gradually progresses as they day goes on
D. Unilateral
Answer --> Morning stiffness which resolves with movement
50
```
Her husband, Ray, has booked the next appointment. He shows you his feet below. He says it began overnight. The intense pain affects the erythematous area in the picture. He thinks it is hot too and he finds it painful to walk. This has never happened to him before. He has no significant medical history and apart from this, feels quite well.
Image displays two feet --> one which is oedematous and erythematous, more red near big toe joint with a medial growth/protrusion
Is this likely to be:
A. Gout
B. Osteoarthritis
C. Pseudogout
D. Rheumatoid Arthritis
E. Septic Arthritis
```
Answer --> Gout
51
```
Gout is caused by:
A. Deposition of crystals of calcium pyrophosphate dihydrate
B. Hyperuricaemia
C. Hypouricaemia
D. Xanthine oxidase inhibition
E. Xanthine oxidase potentiation
```
Answer --> Hyperuricaemia
52
```
Rheumatic Fever and Rheumatoid Arthritis have names which sound similar and they both occur in humans. Are they pathophysiologically similar conditions?
A. No
B. Sometimes
C. Unsure
D. Yes
```
Answer --> No
53
Many of the diseases you learned about last year resulted from immunologic processes gone wrong. Match the disease with the (oversimplified!) description of the primary pathologic process associated with it.
Graves disease
Hashimoto thyroiditis
Coeliac disease
Post-streptococcal glomerulonephritis
Allergic asthma
Type 1 diabetes mellitus
Antibody-receptor interaction resulting in activation of receptor
Immune complex (IgG, IgM and C3) deposition in tissue with associated inflammation
IgE mediated reaction to environmental trigger
T-cell mediated autoimmune process resulting in complete destruction of a specific cell type
Multiple autoantibodies causing generalized tissue inflammation usually progressing to loss of function
Autoimmune response triggered by environmental antigen resulting in reversible tissue damage
Answers:
Antibody-receptor interaction resulting in activation of receptor = Graves
```
Immune complex (IgG, IgM and C3) deposition in tissue with associated inflammation
IgE mediated reaction to environmental trigger =Post-streptococcal glomerulonephritis
```
IgE mediated reaction to environmental trigger = Allergic asthma
T-cell mediated autoimmune process resulting in complete destruction of a specific cell type = Type-1 diabetes mellitus
Multiple autoantibodies causing generalized tissue inflammation usually progressing to loss of function = Hashimotos thyroiditis
Autoimmune response triggered by environmental antigen resulting in reversible tissue damage = Coeliac disease
54
Match the following patient presentations to consistent diagnosis:
Graves disease
Hashimotos thyroiditis
Coeliac disease
Post-streptococcal glomerulonephritis
Allergic Asthma
Type 1 diabetes mellitus
12 yo girl with shortness of breath, prolonged expiration with wheeze
32 yo woman with weight loss, shortness of breath on exertion, frequent bowel movements and anxiety
32 yo woman with weight gain, fatigue and constipation
12 yo girl with a swollen face, shortness of breath, widespread crackles on lung exam
32 yo woman with weight loss, fatigue and diarrhoea
12 yo girl with weight loss and excessive thirst
Answers
12 yo girl with shortness of breath, prolonged expiration with wheeze = allergic asthma
32 yo woman with weight loss, shortness of breath on exertion, frequent bowel movements and anxiety = Graves disease
32 yo woman with weight gain, fatigue and constipation = Hashimotos thyroiditis
12 yo girl with a swollen face, shortness of breath, widespread crackles on lung exam = Post-streptococcal glomerulonephritis
32 yo woman with weight loss, fatigue and diarrhoea = Coeliac disease
12 yo girl with weight loss and excessive thirst = Type 1 diabetes mellitus
55
```
Match the disease with the most commonly used confirmatory diagnostic test:
Graves disease
Hashimotos thyroiditis
Coeliac disease
Post-streptococcal glomerulonephritis
Allergic Asthma
Type 1 diabetes mellitus
Tissue biopsy
Positive Streptozyme
Anti-TPO antibodies
Presence of TSI immunoglobulin (anti TSH receptor)
Immune testing not usually required with consistent clinical presentation
Skin testing with suspected antigens
```
Answers:
Tissue biopsy = Coeliac disease
Positive Streptozyme = post- streptococcal glomerulonephritis
Anti-TPO antibodies = Hashimotos thyroiditis
Presence of TSI immunoglobulin (anti TSH receptor) = graves disease
Immune testing not usually required with consistent clinical presentation = type 1 diabetes
Skin testing with suspected antigens = Allergic Asthma
56
Match the causes of swelling in the following diseases:
Graves disease
Unrecognized coeliac disease
Post-streptococcal glomerulonephritis
Anaphylaxis
increased hydrostatic pressure due to volume overload
deposition of hyaluronic acid in skin tissue
increased capillary permeability
decreased plasma oncotic pressure
Answers:
increased hydrostatic pressure due to volume overload = Post-streptococcal glomerulonephritis
deposition of hyaluronic acid in skin tissue = Graves disease
increased capillary permeability = Anaphylaxis
decreased plasma oncotic pressure = Unrecognised Coeliac disease
57
In your working problem, Gulshan Behrooz was being treated for pharyngitis and had a reaction to penicillin. She became severely hypotensive. What type of shock did she have?
a. cardiogenic
b. distributive
c. septic
d. hypovolemic
e. obstructive
Answer --> distributive
58
If after admission to the ICU, Gulshan was noted to have decreased urine output, what serious renal complication would you be most worried about?
a. Post strep GN
b. Nephrolithiasis
c. Nephrotic syndrome
d. ATN (acute tubular necrosis)
Answer --> ATN (acute tubular necrosis)
59
Which of the following would be reassuring, that Gulshan’s low urine output was simply an appropriate response to hypotension rather than an indication of renal damage?
a. High urea/creatinine ration (>20:1)
b. Fractional excretion of sodium greater than 2%
c. Granular casts on urinalysis
d. Lack of urine output in response to fluid bolus
Answer --> High urea/creatinine ration (>20:1) (as urea retention is a reasonable response to hypovolaemic shock
60
Gulshan’s kidneys do sustain some damage and recover slowly. What blood test would give the best estimate of glomerular filtration rate?
a. Albumin
b. Creatinine
c. Urea
d. Potassium
Answer --> Creatinine
61
What properties are crucial for an intravascular molecule (like the one in your answer above) to be useful for estimation of GFR? (check all that apply!)
a. Lipid solubility
b. Consistent rate of production
c. Consistent rate of active transport at Loop of Henle
d. Free movement between intravascular space and Bowman’s space
e. Free movement between intravascular space and medullary interstitium
f. Lack of tubular reabsorption
g. Lack of tubular secretion
Answer --> B,D,F,G
62
Many patients with arthritis take over the counter NSAIDs. What are the common adverse effects? (check all that apply)
a. Increased risk of peptic ulcer disease
b. Decreased renal function
c. Osteoporosis
d. Elevation of blood pressure
e. Increased risk of myocardial infarction
f. Increased risk of fatal GIH (gastrointestinal haemorrhage)
g. Exacerbation of asthma
Answer --> A,B,D,E,F,G
63
How do NSAIDs affect the stomach? (check all that apply)
a. Decreased epithelial blood flow
b. Increased activity of proton pump
c. Decreased secretion of mucin
d. Decreased secretion of bicarbonate
e. Decreased production of protective PGE
f. Increased secretion of pepsin
g. Direct irritant effect in mucosal epithelial cells
h. Decreased epithelial cell proliferation
Answer --> A,C,D,E,G,H
64
How do NSAIDs cause a decrease in GFR?
a. Loss of vasoconstriction of afferent arteriole
b. Loss of vasoconstriction of efferent arteriole
c. Loss of vasodilation of afferent arteriole
d. Loss of vasodilation of efferent arteriole
Answer --> Loss of vasodilation of afferent arteriole
65
What is the likely direction of glenohumeral dislocations?
Anterior
66
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Shoulders are more likely to dislocate anteriorly than posteriorly. This is due to the shape and angle of the:
A. Acromio-clavicular joint
B. Axilla
C. Cubital fossa
D. Glenoid fossa
E. Sterno-clavicular joint
```
Answer --> Glenoid fossa
67
Rory is a 14 year old girl who tells you she has tingling and numbness in her right hand in the distribution fitting the green area in the picture below.
Shows area of dorsal and ventral sides of medial hand (pinky finger side)
Is this distribution likely to be the:
A. Deltoid nerve
B. Median nerve
C. Radial nerve
D. Ulnar nerve
Answer --> Ulnar nerve
68
Which movements of Rory's hand are most likely to be negatively affected?
A. Finger abduction
B. Opposition of thumb and 5th finger
C. Thumb and finger extension
Answer --> Finger abduction --> ulna nerve role is finger abduction, median nerve opposes thumb and 5th finger, radial nerve does thumb, finger and wrist extension
69
Luba, a 30 year old woman, presents to the emergency department with a 5-day history of worsening abdominal pain, nausea, and vomiting. She has had intermittent gastrointestinal discomfort for several years but has never had any investigation of the cause. Which of the following in her history would most increase the likelihood that small bowel obstruction was causing her symptoms?
A. Ulcerative colitis treated with steroids
B. Recurrent cholelithiasis
C. Coeliac disease
D. Gastro-oesophageal reflux
E. Pregnancy with caesarean delivery
Answer --> Pregnancy with caesarean delivery
70
```
What is the most common effect of hypothyroidism on the gastrointestinal tract?
A. Decreased motility
B. Hyposecretion of mucus
C. Villous atrophy
D. Malabsorption
```
Answer --> Decreased motility
71
Thyroxine, free (free T4), ng/dL 1.25 0.60-1.60
Thyroid stimulating hormone, μIU/mL 11.83 (H) 0.34-5.60
Would you expect Luba to have clinical signs of hypothyroidism?
A. Yes, significant elevation of TSH is usually accompanied by symptoms
B. No, any non-specific symptoms are probably unrelated
C. Possibly, but not severe given a normal T4
Answer --> Possibly, but not severe given a normal T4
72
After dismissing the TSH result as an explanation for Luba s symptoms, you notice the high calcium. What additional signs/symptoms might you look for that would commonly be seen with hypercalcemia?
A. Anxiety or agitation
B. Evidence of neuromuscular excitability (such as positive Chvostek s sign)
C. Positive Trousseau sign
D. Polyuria and polydipsia
Answer --> Polyuria and polydipsia (increased urination and thirst)
73
Hypercalcemia can be associated with symptoms such as nausea and vomiting. What is the most likely mechanism?
A. Intraluminal calcification and obstruction
B. Stimulation of gastric acid secretion
C. Decreased smooth muscle motility
D. Smooth muscle spasm
Answer --> decreased smooth muscle motility
but HYPERcalcemia actually causes muscles and nerves to QUIT working. In hypercalcemia the gut can become atonic, and the resulting distention (functional obstruction?) would cause abdominal pain, nausea and vomiting.
74
When you see Luba's total calcium result, you also order an ionized calcium (even though it is more expensive and technically more difficult!). This is because:
A. A large portion of blood calcium is bound to sodium
B. Ionized calcium is the biologically active fraction
C. Only albumin-bound calcium is biologically active
Answer --> Ionized calcium is the biologically active fraction
75
Luba's ionized calcium is quite elevated so you decide to measure PTH levels as well to determine cause
Calcium (ionized) mmol/L 2.21 (H) 1.12 – 1.32
Parathyroid hormone (PTH), intact, pg/ml 4 (L) 12 - 88
Based on these results, which of the following diagnoses can be ruled out? (check all that apply)
A. Primary hyperparathyroidism
B. Paraneoplastic hypercalcemia
C. Secondary hyperparathyroidism
D. Primary hypoparathyroidism
E. Vitamin D toxicity
Answer --> A,C,D
76
Which two of the following would be most useful in ruling out hypercalcaemia related to malignancy? (check two answers)
A Serum levels of PTH related protein (PTHrP)
B. Skeletal survey
C. Urinary calcium
D. Breast examination
E. Whole body PET/CT
Answer --> A,E
77
What is the active form of vitamin D and where is it produced?
A. cholecalciferol, produced in the skin
B. calcidiol, produced in the liver
C. calcitriol, produced in the kidney
Answer --> Calcitriol produced in the kidney
78
Taking large doses of oral vitamin d supplements (usually cholecalciferol) can lead to hypercalcaemia, as happened to Luba. Let s do a bit more vitamin D review. Where are vitamin D receptors located? (hint: calcitriol is fat soluble)
A. Extracellular, associated with ion channels
B. Extracellular, associated with intramembrane G proteins
C. Intracellular, associated with DNA
D. Intracellular, associated with endoplasmic reticulum
Answer --> Intracellular, associated with DNA
79
What are the known and postulated actions of calcitriol? (check all that apply)
A. Stimulates expression of calcium transporters in intestinal epithelium
B. Stimulates renal reabsorption of calcium
C. Induces differentiation of osteoclasts
D. Maintains healthy bone mineralization
Answer --> A,B,C,D
80
Some people are deficient in CYP24A1 activity, a cytochrome p450 enzyme. CYP24A1 is a 24-hydroxylase that acts on vitamin D both endogenous and xenobiotic. It catabolises calcitriol to calcitroic acid. What would be a possible consequence of this deficiency?
A. Vitamin D deficiency
B. Vitamin D sensitivity
C. Renal failure
Answer --> Vitamin D sensitivity
81
```
Which of the following vitamins, like vitamin D, have a higher potential for toxicity, due to their fat solubility? (check all that apply)
A. Vitamin A
B. B vitamins
C. Vitamin C
D. Vitamin D
E. Vitamin E
F. Vitamin K
G. Folic Acid
```
Answer --> A,D,E,F (ADEK)
82
Luba was treated with rehydration and administration of zoledronic acid and calcitonin. Zoledronic acid is a bisphosphonate. Why would a bisphosphonate be used?
A. They inhibit bone resorption by osteoclasts
B. They inhibit calcium absorption from the GIT
C. They stimulate osteoblast activity
D. They promote calcium excretion in kidney
Answer --> They inhibit bone resorption by osteoclasts
83
What is calcitonin? (Does anyone really care?)
A. Peptide hormone produced by thyroid gland
B. Steroid hormone produced by the parathyroid gland
C. Structural molecule that stabilizes the bony matrix
D. Regulatory protein in calcium transport
Answer --> Peptide hormone produced by thyroid gland
84
```
Which of the following is vitamin D claimed to do (by sellers of supplements)?
A. Improve your prostate
B. Make your muscles stronger
C. Treat autoimmune conditions
D. Prevent you from getting influenza
E. Reduce cancer
F. Cure heart disease
```
Answer --> All of them
85
```
What are the two most common causes of hypercalcaemia (accounting for greater than 90% of cases)? (pick two)
A. Dietary excess
B. Hypercalcaemia of malignancy
C. Primary hyperparathyroidism
D. Secondary hyperparathyroidism
E. Thiazide diuretics
F. Vitamin D toxicity
```
Answer --> B,C
86
Rohan is a 41 year-old man who has a background of Type 2 diabetes mellitus (diagnosed 20 years ago), 55 pack-year history of smoking, hypertension and hypercholesterolaemia. He presents to ED in an ambulance with his wife with an acutely painful right leg. You notice it is pale and cool to the touch with delayed capillary refilling when compared with the right leg at the same level. He says he can't move it or feel it much (except for the pain). You are unable to palpate his peripheral pulses. The limb is not oedematous.
```
Which arterial pulse are you attempting to palpate?
A. Femoral
B. Profunda femoris
C. Dorsalis pedis
D. Medial plantar
E. Anterior tibia
```
Answer --> Dorsalis pedis
87
Rohan is a 41 year-old man who has a background of Type 2 diabetes mellitus (diagnosed 20 years ago), 55 pack-year history of smoking, hypertension and hypercholesterolaemia. He presents to ED in an ambulance with his wife with an acutely painful right leg. You notice it is pale and cool to the touch with delayed capillary refilling when compared with the right leg at the same level. He says he can't move it or feel it much (except for the pain). You are unable to palpate his peripheral pulses. The limb is not oedematous.
```
Does this group of symptoms suggest to you a problem with his:
A. Arterial supply
B. Nerve supply
C. Venous drainage
D. Lymphatic drainage
```
Answer --> Arterial supply
88
Kerry is a 63 year old woman who, 10 years ago, had a complete left axilllary lymph node clearance as part of her surgery for breast cancer. You are an intern at the Calvary Mater Newcastle hospital. She is a patient on your ward for an unrelated issue, and requires a cannula.
The cannula in her right hand has failed and fluid has extravasated into her tissues.
Which system will Kerry's body primarily use to remove this fluid?
A. Arterial
B. Capillary
C. Lymphatic
D. Nervous
E. Venous
Answer --> Lymphatics
89
Should you insert a cannula into her left hand?
A. Maybe
B. No
C. Yes, it's been 10 years, it should be fine
D. Yes, the surgery is irrelevant to this issue
Answer --> No
90
```
The major determinant as to whether a drug will cross the blood-brain barrier is its:
A. Albumin bound percentage
B. Lipid solubility
C. Plasma solubility
D. Platelet bound percentage
E. Red cell bound percentage
```
Answer --> lipid solubility
91
India is a 24 year old woman who presents to ED with a severe headache. The onset was over 6-12 hours, she is febrile 39.0 degrees C, BP, HR, RR, oxygen saturations are all within normal limits. She has neck stiffness, photophobia and is a bit drowsy.
In this clinical situation, we can conclude that India's neck stiffness is likely to relate to:
A. Kernig's sign
B. Meningism
C. Musculoskeletal strain
D. Non-significant
Answer --> Meningism
92
Shoushan is a 32 year old man who has suffered an epidural haematoma. He has signs of raised intracranial pressure. You are concerned he may develop “coning”, where his brain contents may herniate through skull foramina.
Classically, which skull foramen is most likely to be associated with coning?
A. Foramen magnum
B. Foramen of cribriform plate
C. Greater palatine foramen
D. Infraorbital foramen
E. Supraorbital foramen
Answer --> Foramen magnum
93
```
Leigh is a 66 year old woman who presents with a numb right arm. It’s been “a bit funny on and off” for a few days. You gather that it has been variably numb for a few days. Today it is entirely numb, affecting the whole limb. She can move it well. She is a bit worried about what’s going on but is otherwise fine.
Is this a:
A. Anterior cerebral artery syndrome
B. Lacunar stroke syndrome
C. Middle cerebral artery syndrome
D. Posterior cerebral artery syndrome
E. Vertebrobasilar artery syndrome
```
Answer --> Lacunar stroke syndrome
94
Colin a a 69 year-old man with diabetes and cardiovascular disease.
Diabetes contributes to the development of artherosclerosis.
The pathological mechanism for this is:
```
A. Dyslipidaemia
B. Increased angiotensin 2 concentration
C. Mitochondrial DNA damage
D. Promotion of leucocyte adherence to endothelium
E. Tissue factor activation
```
Answer --> Dyslipidaemia
95
```
You auscultate Colin’s neck blood vessels and notice a bruit on both sides. Is this likely to be:
A. A non-significant finding
B. Carotid atheroma
C. Jugular venous atheroma
D. Mitral valve regurgitation
E. Patent foramen ovale
```
Answer --> Carotid atheroma
96
```
Jayne is an 83 year old woman with a DVT. She develops a cardioembolic stroke.
How is this possible?
A. Aortic stenosis
B. Inferior vena caval obstruction
C. Patent foramen ovale
D. Pulmonary hypertension
E. Right-sided heart failure
```
Answer --> Patent foramen ovale
97
```
Jasmin is a 29 year old woman who has just given birth to her 3rd baby. She had epidural anaesthesia during labour and delivery for pain relief. She has unfortunately developed a CSF leak through the hole used for the epidural. Her CSF pressure is reduced compared with normal.
Are her arachnoid villi:
A. Closed
B. Indeterminate
C. Open
D. Unrelated
```
Answer --> Closed
98
Genetic analysis revealed that Feona was homozygous for a mutation in the LDL receptor, and you diagnose her with Familial Hypercholesterolaemia (FH). What molecules on the surface of LDL allow hepatic LDL-receptors to recognize and bind to LDL?
a. Carbohydrate moieties
b. Cholesterol esters
c. Apolipoproteins
d. MHC surface markers
Answer --> Apolipoproteins
99
LDL receptor mutations are usually expressed in an autosomal dominant fashion, though the phenotype is less severe in heterozygotes (early CAD but not this early). Knowing this, what would you expect to find in Feona’s family history?
a. Frequent early CAD in siblings only
b. Frequent early CAD on both maternal and paternal sides
c. Frequent early CAD on either maternal or paternal side only
d. Unlikely to be any significant family history
e. Slight increase in likelihood of early CAD in first degree relatives
Answer --> Frequent early CAD on both maternal and paternal sides
100
And just to keep the terminology straight (or cause more confusion!), Feona was diagnosed with familial hypercholesterolemia. What is the most common form of inherited dyslipidemia?
a. Familial Combined Hyperlipidemia
b. Familial Hypercholesterolemia
c. Familial hypertriglyceridemia
Answer --> Familial Combined Hyperlipidemia
101
Feona was treated with weekly apheresis to remove LDL (pretty drastic but so is having heart attacks in your 20’s). Medication is less effective in homozygotes, but her mother was started on a potent statin and ezetimibe. How do statins work?
a. Inhibits HMG CoA reductase
b. Reduces cholesterol absorption from intestine
c. Sequesters bile acids
d. Displaces cholesterol from mixed micelles
Answer --> Inhibits HMG CoA reductase
102
Headaches are a common adverse effect of GTN (remember that is why Samuel Gilles in week 9 last year didn’t take his angina meds). What is the commonly attributed (though possibly inaccurate) mechanism?
a. nitric oxide induced sensitization of vascular nociceptors
b. nitric oxide induced sensitization of trigeminal neurones
c. nitric oxide induced vasodilation of cerebral vasculature
Answer --> Nitric oxide induced vasodilation of cerebral vasculature
103
What are the two mechanisms by which GTN relieves angina and lessens likelihood of critical ischaemia in patients with coronary artery disease? (pick two)
a. Decreased preload from venodilation
b. Decreased mycocardial contractility
c. Decreased heart rate
d. Vasodilation of coronary arteries
Answer -->
Decreased preload from venodilation
Vasodilation of coronary arteries
104
What is a cardioembolic stroke?
Stroke from the heart to the brain
105
What are the roles of arachnoid villi?
Arachnoid villi act as one-way valves for the flow of CSF into venous blood, and hydrostatic pressure is the main stimulus that causes these valves to open.
106
What is the role of VLDL?
synthesized by the liver, delivers triacylglycerol to body cells for energy production
107
What is the role of Chylomicron?
synthesized by enterocytes, delivers triacylglycerol to body cells for energy production
108
What is the role of Micelle?
delivers monoglycerides and fatty acids to intestinal enterocytes
109
What is the role of Emulsification droplets?
allows pancreatic lipase to access triacylglycerol
110
What is the role of LDL?
delivers cholesterol to body cells for use in membranes and steroidogenesis
111
What is the role of HDL?
returns excess cholesterol from tissues to the liver for excretion in bile
112
What transports fat from the intestines during digestion?
Lymphatics full of chylomicrons
113
What does HMG CoA reductase (statins target)?
An important part of the cholesterol synthesis pathway
114
Cruz is a 3 year old boy who presents to his GP with his parents. They’re concerned that he seems to have these “pauses” whereby he just stops what he’s doing and stares for several seconds, and then resumes playing or talking like nothing is wrong.
What kind of seizure are they describing?
A. Complex partial
B. Generalised absence
C. Simple partial
D. Tonic clonic
Answer --> Generalised absence
115
Harry is an 18 month old boy who is brought in by ambulance with his very worried father. They were out for a walk this morning when his father, Simon, stopped the pram to point out something. Harry looked a bit unwell, then Simon noticed he was “blue in the face” and started “shaking all over at the same time”. The seizure felt to Simon that it lasted “forever, but it was probably only a few minutes”. A bystander called the ambulance.
What kind of seizure is Simon describing?
A. Complex partial
B. Generalised absence
C. Simple partial
D. Tonic clonic
Answer --> Tonic clonic
116
```
Which of the following diagnoses is the most likely?
A. Other
B. Primary brain tumour
C. Secondary brain tumour
D. Systemic illness
```
Answer --> Systemic illness
117
What are the components of the Glasgow Coma Scale?
A. Time, Person, Place
B. Eyes, Pain, Motor
C. Eyes, Verbal, Motor
Answer --> Eyes, Verbal, Motor
118
Which of the following arrangements of steps per component is correct?
A. Eyes 4 Verbal 5 Motor 6
B. Eyes 5 Verbal 4 Motor 6
C. Eyes 5 Verbal 5 Motor 5
Answer --> Eyes 4 Verbal 5 Motor 6 (4,5,6 EASY)
119
```
A 22yo man is admitted to hospital after being assulted. He appears drowsy but upon calling his name, he opens his eyes to look at you. How would you score his eye response on the GCS?
A. 1
B. 2
C. 3
D. 4
```
Answer --> 3
120
The same 22yo man as the previous question is next asked his name, location and the date. He replies Lionel, car park, Wednesday (it is Saturday). What would you score his verbal response on the GCS?
```
A. 1
B. 2
C. 3
D. 4
E. 5
```
Answer --> 4
121
```
We are interrupted by anther emergency in the ED. When we return to complete the motor component of the 22yo man's GCS we find he is unable to follow verbal commands. You decide to apply supraorbital pressure and his hand moves up to his face and towards your hand. What would you score his motor response on the GCS?
A. 2
B. 3
C. 4
D. 5
E. 6
```
Answer --> 5
122
What is viral exanthum?
Viral exanthem, also known as non-specific viral rash, is a rash caused by a viral infection.
Not normally itchy
Person can be reasonably well
123
Kathryn is a 37 year old woman with tremor, palpitations, weight loss and heat intolerance. You test her thyroid and find the following results:
TSH --> Less than 0.01 --> reference 0.4-4mU/L
Free T4 --> 37.8 --> reference 10-20pmol/L
```
Has Kathryn got:
A. Euthyroidism
B. Functioning pituitary adenoma
C. Hyperthyroidism
D. Hypothyroidism
E. Non-functioning pituitary adenoma
```
Answer --> Hyperthyroidism
124
```
Jim is a 64 year old man with difficulty moving. His limbs are stiff and he has a "pill rolling tremor". He has no trouble with his memory or remembering where thing are. He has not had hallucinations. He has fallen a few times, which he thinks is due to difficulty lifting his feet when walking.
Is Jim most likely to have:
A. Alzheimer's Disease
B. Delirium
C. Dementia with Lewy Bodies
D. Frontotemporal Dementia
E. Parkinson's Disease
```
Answer --> Parkinson's Disease
125
```
Meghan is a 77 year old woman with short term memory loss who struggles to find her way home from the shops (3 blocks in a straight line when walking). She has no hallucinations and no difficulty moving around.
Is Meghan most likely to have:
A. Alzheimer's Disease
B. Delirium
C. Dementia with Lewy Bodies
D. Frontotemporal Dementia
E. Parkinson's Disease
```
Answer --> Alzheimer's Disease
126
```
Eric is a 68 year old man with fluctuating cognition and difficulty moving. Sometimes he is quite confused, or unexpectedly falls asleep during the middle of the day for several hours. You find his limbs are stiff and note the presence of cogwheel rigidity. He has had visual and auditory hallucinations.
Is Eric most likely to have:
A. Alzheimer's Disease
B. Delirium
C. Dementia with Lewy Bodies
D. Frontotemporal Dementia
E. Parkinson's Disease
```
Answer --> Dementia with Lewy Bodies
127
```
Emmaline, aged 78, presents with her partner, who tells you that Emmaline has become "rude" to others, talking often and laughing at things that others don't find funny. She has stopped showering unless strongly and repeatedly encouraged, has been "playing with" objects in the home, moving them around and has been sexually inappropriate.
Is Emmaline most likely to have:
A. Alzheimer's Disease
B. Delirium
C. Dementia with Lew Bodies
D. Frontotemporal Dementia
E. Parkinson's Disease
```
Answer --> Frontotemporal Dementia
128
True story: Lexington, Ky, 1991. Delmar, a previously well three year old boy, presented to an ED after a brief tonic-clonic generalized seizure. His temperature in triage was 40.3.
What percent of children will have a seizure during a febrile illness at some point in their childhood?
a. <1%
b. 2-5%
c. 10-20%
d. 20-30%
Answer --> 2-5%
129
(3 year old presenting with temp 40 and after tonic-clinic seizure) His mother reported he had been a bit grumpy since waking up that morning. He did not eat or drink much through the day, but had no other obvious symptoms. On exam he was lying listlessly in his mother’s lap but became irritable with attempted examination. Physical examination: HR 150, BP 100/70, RR 30. No rash or neck stiffness. Heart, lung, ENT and abdo exam were unremarkable.
What diagnosis are you most worried about?
a. Influenza
b. Leukemia
c. Meningitis
d. Sepsis
e. Urinary tract infection
Answer --> Sepsis
130
The ED doc proceeded with a fever work up including a full blood count:
WBC 15.7 5.0 – 17.00 × 109/L
RBC 5.61 3.9 – 5.3 × 1012/L
HGB 132 115 – 135 g/L
HCT 0.480 0.34 – 0.40
PLT 390 150 – 400 × 109/L
Neut 7.0 1.5 – 8.5 × 109/L
Lymph 4.2 1.5 - 9.5 × 109/L
Mono 0.7 0.2 – 1.2 × 109/L
Eos 0.09 <0.81 × 109/L
Baso 0.00 <0.11 × 109/L
Bands 3.7 H < 0.0 × 109/L
What is the most likely process to have caused this abnormality?
a. Demargination of neutrophils from the vascular endothelium
b. Folate deficiency interfering with nuclear development in neutrophils
c. Malignant transformation of a white cell line
d. Stimulation of release of neutrophils from the bone marrow
Answer --> Stimulation of release of neutrophils from the bone marrow
Bands are immature neutrophils released early from the bone marrow, which can happen in response to infection.
131
What is the likely reason for positive ketones in Delmar’s urine? (fever, toic clonic seizure, listless in mums lap, heart lung and abdo unremarkable)
a. Anorexia and dehydration
b. Diabetes
c. Toxic ingestion
d. Hepatic involvement in infection
Answer --> anorexia and dehydration
132
Nitrites have a reputation for being a specific indicator of urinary tract infection. What is the source of urinary nitrites?
a. Bacterial metabolism of urinary nitrates
b. By product of leukocytes killing bacteria
c. Leaked contents of damaged bladder epithelial cells
Answer --> Bacterial metabolism of urinary nitrates
133
Because of continued lethargy, a lumbar puncture was done and the CSF obtained was noted to be clear (with normal microscopic examination and no evidence of meningeal infection). However, upon withdrawal of the needle from Delmar’s back, he had a sudden massive explosion of watery stool (which showered both nurse and resident doctor).
What is the most common cause of gastroenteritis in children?
a. Norovirus
b. Rotavirus
c. RSV
d. Salmonella
Answer --> Norovirus
134
Which of the following findings would MOST raise your suspicion of a bacterial cause of Delmar’s diarrhoea?
a. Fever >39 degrees
b. Green colour of stool
c. Blood in stool
d. White cells in stool
Answer --> blood in stool --> but green stool (rotavirus) and many white cells sometimes
135
What are the four most common causes of bacterial enteritis in Australia (in previously healthy people not on antibiotics) (pick four --obviously)
a. Campylobacter
b. Clostridium difficile
c. E Coli
d. Klebsiella
e. Pseudomonas
f. Salmonella
g. Shigella
h. Staphylococcus
Answer --> a,c,f,g
136
```
With regard to the pupils of the eye, does the term “miosis” refer to:
A. A non-circular pupil
B. Equally sized pupils
C. Excessive constriction of a pupil
D. Excessive dilatation of a pupil
E. Mismatched size of pupils
```
Answer --> Excessive constriction of a pupil
137
```
With regard to the pupils of the eye, does the term “mydriasis” refer to:
A. A non-circular pupil
B. Equally sized pupils
C. Excessive constriction of a pupil
D. Excessive dilatation of a pupil
E. Mismatched size of pupils
```
Answer --> Excessive dilatation of a pupil
138
Zachary is a 56 year old man who presents to you for his type 2 diabetes check-up. You wish to examine him for diabetic retinopathy. Do you give him a:
A. Systemic anticholinergic (eg. Atropine)
B. Systemic beta blocker (eg. Propranolol)
C. Topical anticholinergic (eg. Atropine)
D. Topical beta blocker (eg. Timolol)
E. Topical cholinergic agent (eg Pilocarpine)
Answer --> Topical anticholinergic (eg. Atropine)
139
54yo woman with a past history of treated breast cancer presents with isolated atrophy of left side of her tongue. This is associated with tongue weakness and muscle fasciculation on that side. There are no other findings on physical examination.
```
Which nerve is responsible for most motor innervation of the tongue?
A. Trigeminal Nerve
B. Facial Nerve
C. Glossopharyngeal nerve
D. Vagus Nerve
E. Hypoglossal Nerve
```
Answer --> Hypoglossal Nerve
140
54yo woman with a past history of treated breast cancer presents with isolated atrophy of left side of her tongue. This is associated with tongue weakness and muscle fasciculation on that side. There are no other findings on physical examination.
Is this an upper or lower motor neuron lesion?
A. Upper Motor Neuron Lesion
B. Lower Motor Neuron Lesion
Answer --> LMN
141
54yo woman with a past history of treated breast cancer presents with isolated atrophy of left side of her tongue. This is associated with tongue weakness and muscle fasciculation on that side. There are no other findings on physical examination.
Which foramen does the hypoglossal nerve traverse.?
```
A. Foramen Ovale
B. Foramen Rotundum
C. Jugular Foramen
D. Hypoglossal Canal
E. Internal Acoustic Meatus
```
Answer --> Hypoglossal Canal
142
You are an intern in the Emergency Department at Belmont Hospital. Your next patient is Alan, aged 55, who has a 4cm vertical laceration to his anterior right lower leg following a “lawn mower incident” (his words) this morning. Subcutaneous fat is visible at the bottom of it, but it doesn’t seem to have cut into the tibialis anterior muscle beneath.
What is the most likely complication of this injury?
A. Bleeding
B. Fracture
C. Infection
D. Nerve injury
E. Shin splints
Answer --> Infection
143
```
You are concerned at the possibility of nerve injury. In assessing Alan’s foot you notice its pink colour, that it has a capillary refill time of 2 seconds and has palpable dorsalis pedis and posterior tibial pulses.
Is this indicative of:
A. Arterial injury
B. Nerve injury
C. Normal findings
D. Venous injury
```
Answer --> Normal findings
144
In assessing Alan’s foot you notice that there is some small passive ankle joint mobility but overall it is fixed in a position of plantar flexion. Active movements are limited due to pain around his wound site.
Is this likely to be related to:
A. Injury of the deep peroneal nerve
B. Injury of the L3-L4 nerve root
C. Injury of the superficial peroneal nerve
D. Sciatica
E. Unrelated condition
Answer --> Unrelated condition
145
```
Alan tells you he’s had “tight muscles at the back there all my life”. You notice he is unable also to fully extend his knee. He has brisk ankle jerk reflexes.
Is this likely to an:
A. Lower motor neuron lesion
B. Neuromuscular junction blockade
C. Normal anatomical variation
D. Upper motor neuron lesion
```
Answer --> Upper motor neuron lesion
146
```
You notice that the other side is exactly the same. Alan tells you its “just my cerebral palsy. I sometimes have botox for it, you know”. Botulinum toxin blocks acetylcholine release at the neuromuscular junction.
Is this likely to cause:
A. Increased signal transmission
B. Reduced signal transmission
C. Normal signal transmission
D. Psychological distress
E. Psychological relief
```
Answer --> Reduced signal transmission
147
Rosie is a 22 year old woman. When performing the Rhomberg test, she consistently falls to the left.
The 3 main factors to maintain balance include proprioception, vestibular function and intact:
A. Autonomic nervous system
B. Parasympathetic nervous system
C. Sympathetic nervous system
D. Tympanic membrane
E. Vision
Answer --> E
148
```
The function of the cerebellum include:
A. Co-ordination of movement
B. Integration of auditory inputs
C. Maintenance of consciousness
D. Modulation of visual input
```
Answer --> Co-ordination of movement
149
```
Damage to the small hairs in the cochlea causes:
A. Conductive hearing loss
B. Impaired balance
C. Impaired proprioception
D. No hearing loss
E. Sensorineural hearing loss
```
Answer --> Sensorineural hearing loss
150
Which artery supplies blood directly to the cerebellum?
superior cerebellar artery
