Formatives Past Papers 1 Flashcards
1
Q
Which of the following is most correct about enzymes?
Enzymes are:
A. Biologically active carbohydrates.
B. Non-specific and are able to catalyse multiple metabolic reactions.
C. Released in response to changes in blood sugar levels.
D. Frequently found to contain co-factors.
E. Unaffected by changes in body temperature.
A
Enzymes are:
D. Frequently found to contain co-factors.
2
Q
Regarding physiological control of blood pressure, choose the most correct answer:
The lumen diameter of arterioles in the skin and GIT is decreased when:
A. sympathetic outflow is reduced.
B. patient has been exercising strenuously.
C. patient has suffered severe haemorrhage.
D. patient has just had a large meal.
E. patient has a fever of 390C.
A
The lumen diameter of arterioles in the skin and GIT is decreased when:
C. patient has suffered severe haemorrhage.
3
Q
Which one of the following statements is most correct about Hepatitis A?
A. Infection occurs via percutaneous transmission into the bloodstream
B. Infected individuals usually present with jaundice.
C. It is a vaccine preventable infection.
D. Up to 50% of 1-5 year olds infected with Hepatitis A will progress to chronic liver disease.
E. A serum marker of acute infection is HAV IgG antibody levels.
A
Which one of the following statements is most correct about Hepatitis A?
C. It is a vaccine preventable infection.
4
Q
The significance of the postulates of Henle and Koch lies in establishing, which one of the following?
A. whether a disease is transmissible or non-transmissible
B. unequivocally the causative agent of an infection
C. whether an animal model is representative of human infection
D. whether a pathogen can be grown in vitro
E. whether a host is susceptible to an infection
A
The significance of the postulates of Henle and Koch lies in establishing, which one of the following?
B. unequivocally the causative agent of an infection
5
Q
Regarding this trace of an arterial pressure wave, which statement is most correct?
A. “x” is the pulse pressure
B. “y” is measurable during diastole
C. “w” is the mean venous pressure
D. “w” is the sum of the diastolic pressure and the pulse pressure
E. “z” is the pulse pressure
A
Regarding this trace of an arterial pressure wave, which statement is most correct?
B. “y” is measurable during diastole
6
Q
In reference to the clinical information provided, which one of the following is most correct about Timothy?
A His lack of weight gain is concerning.
B. Most children Timothy’s age would be taller than him.
C. His weight has been incorrectly measured.
D. Most children Timothy’s age would weigh more than him.
E. You would expect him to have developmental delay.
A
10th percentile for weight but 90th percentile for length
D. Most children Timothy’s age would weigh more than him.
7
Q
Carbohydrates are broken down into simpler sugar units by the action of:
A. pepsin
B. protease
C. amylase
D. sugarase
E. lipase
A
Carbohydrates are broken down into simpler sugar units by the action of:
A. pepsin = proteins into smaller peptides
B. protease = catalyzes proteolysis, the breakdown of proteins into smaller polypeptides
C. amylase
D. sugarase = doesn’t exist
E. lipase = hydrolysis of fats
8
Q
A person with gall bladder disease will have problems with digestion and absorption of which one of the following?
A. protein
B. carbohydrates
C. nucleic acids
D. lipids
E. minerals
A
D. lipids
The gallbladder stores bile produced by the liver.
Bile breaks down fats (lipids) into fatty acids.
9
Q
According to the ‘Australian Guide to Healthy Eating’ carbohydrates in the recommended human diet should comprise:
A. simple sugars which easily raise blood the glucose level
B. very refined foods with little fibre
C. about 20% of the total food intake
D. plant products and complex carbohydrates with a low glycaemic index
E. none of the above.
A
D. plant products and complex carbohydrates with a low glycaemic index
10
Q
4 year old Sasha Bartlett has recently been diagnosed with cystic fibrosis (CF), her parents Jane & Roger, are understandably quite distraught as Jane is now 6 months pregnant with their second child.
They have found out in talking with Roger’s parents that their first child (his sister) died at age 4, probably due to cystic fibrosis.
Jane is an only child. There is no known family member with CF.
Jane and Roger ask you what the likelihood is that their unborn child will have cystic fibrosis, you reply;
A. There is a 50% chance that the baby will have cystic fibrosis
B. Only 1 in every 4 of their children will have cystic fibrosis.
C. There is a 25% chance that the baby will have cystic fibrosis.
D. The baby is more likely to have cystic fibrosis if it is another girl.
A
Jane & Roger = carriers
Cc x Cc = CC (non-carrier), Cc (carrier), Cc (carrier), cc (disease)
C. There is a 25% chance that the baby will have cystic fibrosis.
11
Q
The RNA responsible for bringing the amino acids to the “factory” site for protein formation is the
A. mRNA
B. rRNA
C. ssRNA
D. tRNA
E. eRNA
A
The RNA responsible for bringing the amino acids to the “factory” site for protein formation is the
D. tRNA
12
Q
The process of transcription:
A. produces mRNA from the DNA template
B. produces an amino acid chain from the mRNA template
C. occurs in the cytoplasm
D. forms new protein
E. forms DNA from the RNA template
A
The process of transcription:
A. produces mRNA from the DNA template
13
Q
Irreversible competitive antagonism exists,
A. when the antagonist binds with high affinity to the receptor
B. only when the antagonist is more potent than the agonist
C. when the dose-response curve is shifted to the right and the Emax is reduced D. when the antagonist acts through different but not independent receptors
E. when the agonist and the antagonist have affinit
A
Irreversible competitive antagonism exists,
C. when the dose-response curve is shifted to the right and the Emax is reduced
14
Q
In measuring test accuracy:
A. Sensitivity is the probability of a negative test in a diseased person
B. Specificity is the probability of a negative test in a non-diseased person
C. A sensitive test has a low rate of false positives
D. A specific test has a low rate of false negatives
E. A very sensitive test is usually very specific
A
In measuring test accuracy:
B. Specificity is the probability of a negative test in a non-diseased person
15
Q
Assume that the prevalence rate of H. Pylori infection in the population is 70%, the CLO (rapid urease) test sensitivity = 90% and specificity = 96%:
In a population of 1,000 people, there will be x people infected and y people not infected, therefore;
A. x = 800, y = 200
B. x = 900, y = 100
C. x = 700, y = 200
D. x = 700, y = 300
E. x = 900, y = 700
A
Assume that the prevalence rate of H. Pylori infection in the population is 70%, the CLO (rapid urease) test sensitivity = 90% and specificity = 96%.
In a population of 1,000 people, there will be x people infected and y people not infected, therefore;
D. x = 700, y = 300
16
Q
Assume that the prevalence rate of H. Pylori infection in the population is 70%, the CLO (rapid urease) test sensitivity = 90% and specificity = 96%:
Of these x people infected, what percentage will test positive for the CLO test?
A. 96%
B.70%
C. 100%
D. 10%
E.90%
A
Sensitivity = true positives = 90%
E.90%
17
Q
During periods of fasting the body requires an alternative source of glucose. Which one of the following is most correct regarding glucose homeostasis during fasting periods?
A. Glucagon release activates the breakdown of glycogen stores in the liver.
B. Glycolysis results in the production of glucose from pyruvate.
C. Insulin release activates the process of gluconeogenesis.
D. Glucose-6-phosphate moves freely across the cell membrane into thebloodstream.
E. Low blood glucose levels increase phosphofructokinase activity.
A
A. Glucagon release activates the breakdown of glycogen stores in the liver.
18
Q
Regarding the labelled photograph below, which one of the following statements is most correct?
The femoral pulse is best felt a couple of centimetres below the inguinal ligament, half way along an imaginary line between the:
A. anterior superior iliac spine and the pubic tubercle
B. anterior superior iliac spine and the symphysis pubis
C. posterior iliac spine and the symphysis pubis
D. lateral border of sartorius and medial border of adductor longus
E. apex of femoral triangle and anterior superior iliac spine
A
B. anterior superior iliac spine and the symphysis pubis
19
Q
25 year old soccer playing Lucas, injured his knee following a fall 2 days ago, his knee is painful and swollen. His doctor has informed him that his knee is acutely inflamed.
A. His treatment will require hospitalisation and intravenous antibiotics.
B. Swelling is secondary to the efflux of plasma and cells into surrounding tissues.
C. The underlying histopathology would feature angiogenesis and fibrosis.
D. The inflammation in his knee is secondary to T-cell activation.
E. The acute inflammatory process is an example of adaptive immunity.
A
Acute Inflammation = Innate immunity
B. Swelling is secondary to the efflux of plasma and cells into surrounding tissues.
20
Q
When viewing an erect PA (postero-anterior) chest x-ray. Which one of the following statements is most correct?
A. The left hemi-diaphragm is higher than the right hemi-diaphragm due to gas in the underlying stomach.
B. The posterior costo-phrenic recess extends down to the level of thoracic vertebra 12 (T12).
C. The right hilum is higher than the left because of the course of the azygous vein.
D. The right heart border is mainly formed by the right ventricle.
E. The trachea usually deviates slightly to the left because of the position of the oesophagus.
A
A = false - right side is higher due to presence of liver
B = true - The posterior costo-phrenic recess extends down to the level of thoracic vertebra 12 (T12).
C = false - The left hilum is normally higher than the right becuase the left pulmonary artery is slightly higher than the right 97% of the time.
D = false - The right heart border is mainly formed by the right atrium not ventricle.
E = false - The trachea is always in the midline (pathological if deviated) and the oesophagus is posterior to the trachea.
21
Q
Regarding the diagram below, which one of the following statements is most correct?
A potentially deadly risk is the inhalation of food into the airway. The airway is protected by mechanisms such as:
A. sneeze & cough reflexes
B. micturition mechanism
C. glabella tap reflex
D. cremasteric reflex
E. yawn & hiccup reflexes
A
A. sneeze & cough reflexes
22
Q
Which one of the following is most correct? Drugs are subject to first-pass metabolism if given by:
A. intravenous injection
B. sublingual administration
C. intrathecal injection
D. oral administration
E. all of the above
A
D. oral administration
The first pass effect is a phenomenon of drug metabolism whereby the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation. It is the fraction of drug lost during the process of absorption which is generally related to the liver and gut wall.
23
Q
Which one of the following is most correct?
The amount of plasma protein binding of a drug may affect:
A. the concentration of unbound drug in plasma
B. the toxicity of another drug given at the same time
C. the amount available to bind to its site of action
D. the amount available for filtration through the kidneys
E. all of the above
A
The amount of plasma protein binding of a drug may affect:
A. the concentration of unbound drug in plasma
B. the toxicity of another drug given at the same time
C. the amount available to bind to its site of action
D. the amount available for filtration through the kidneys
E. all of the above
24
Q
Which is the most correct? Antibodies play a role in the:
A. Humoral response of the innate immune system.
B. Cell-mediated response of the innate immune system.
C. Cell-mediated response of the adaptive immune system.
D. Development of immunological memory
E. All of the above.
A
D. Development of immunological memory
25
Which one of the following is most correct?
A type of immunoglobulin that can cross the placenta is:
A. IgO
B. IgA
C. IgG
D. IgM
E. IgC
A type of immunoglobulin that can cross the placenta is:
A. IgO
B. IgA
**C. IgG**
D. IgM
E. IgC
26
Which of the following is most correct?
An epitope is:
A. The Fab region of an immunoglobulin.
B. The segment of an antigen recognised by an antibody.
C. The Fc region of an immunoglobulin.
D. The segment of an antibody that recognises an antigen.
E. None of the above.
An epitope is:
B. The segment of an antigen recognised by an antibody.
27
Which is most correct for antibiotics?
A. Penicillins inhibit bacterial nucleic acid synthesis
B. Sulfonamides inhibit folic acid synthesis
C. Macrolides inhibit bacterial cell wall synthesis
D. Aminoglycosides inhibit synthesis of DNA
E. Tetracyclines inhibit cell wall synthesis
A. Penicillins inhibit bacterial nucleic acid synthesis = false - Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, leading to cell lysis and death
**B. Sulfonamides inhibit folic acid synthesis**
C. Macrolides inhibit bacterial cell wall synthesis = false - interfere with protein synthesis
D. Aminoglycosides inhibit synthesis of DNA = false - interfere with protein synthesis
E. Tetracyclines inhibit cell wall synthesis = false - interfere with protein synthesis
28
In passing a needle into the pleural space to obtain pleural fluid for cytology, which one of the following anatomical structures would _normally_ be pierced?
A. visceral pleura
B. internal intercostal muscle
C. trachea
D. bronchioles
E. pulmonary artery
In passing a needle into the pleural space to obtain pleural fluid for cytology, which one of the following anatomical structures would _normally_ be pierced?
A. visceral pleura
**B. internal intercostal muscle**
C. trachea
D. bronchioles
E. pulmonary artery
29
A 45-year-old man presents with shortness of breath due to pleural fluid. On the erect Chest x-ray, the pleural fluid would be seen in the:
A. oblique fissure
B. horizontal fissure
C. costodiaphragmatic recess
D. costomediastinal recess
E. cardiac notch
On the erect Chest x-ray, the pleural fluid would be seen in the:
A. oblique fissure
B. horizontal fissure
**C. costodiaphragmatic recess**
D. costomediastinal recess
E. cardiac notch
30
Which one of the following statements is true regarding the structure of skin?
## Footnote
A. sebaceous glands are present in skin of all parts of body.
B. the epidermis has blood vessels and lymphatics.
C. the dermis is comprised of stratified squamous epithelium.
D. the dermis contains hair follicles.
Which one of the following statements is true regarding the structure of skin?
D. the dermis contains hair follicles.
31
2. Carpal tunnel syndrome affects which of the following nerves?
## Footnote
A. Musculocutaneous
B. Ulnar
C. Radial
D. Median
E. Anterior interossous
2. Carpal tunnel syndrome affects which of the following nerves?
## Footnote
D. Median
32
3. In the forearm, which of the following statements is true?
A. The head of the ulna is proximal while the head of the radius is distal.
B. Both the head of the ulna and the head of the radius are proximal.
C. The head of the ulna is distal while the head of the radius is proximal.
D. Both the head of the ulna and the head of the radius are distal.
3. In the forearm, which of the following statements is true?
C. The head of the ulna is distal while the head of the radius is proximal.
33
4. In what order to the structures run in the femoral triangle (from lateral to medial)?
A. femoral artery, femoral vein, femoral nerve
B. femoral vein, femoral artery, femoral nerve
C. greater saphenous vein, femoral artery, femoral nerve
D. femoral nerve, femoral artery, femoral vein.
4. In what order to the structures run in the femoral triangle (from lateral to medial)?
D. femoral nerve, femoral artery, femoral vein.
(medial + lateral = VAN)
34
5. A patient is complaining of abdominal pain which you suspect is caused by appendicitis. Which surface landmarks would you use to palpate over the base of the appendix?
A. The junction of the lateral third and middle third of a line between the umbilicus and greater trochanter of the femur
B. The junction of the lateral third and middle third of a line between the umbilicus and right anterior superior iliac spine.
C. Two third of the distance between the umbilicus and the left anterior superior iliac spine.
D. Half way between the pubic symphysis and anterior superior iliac spine (mid-inguinal point)
Which surface landmarks would you use to palpate over the base of the appendix?
B. The junction of the lateral third and middle third of a line between the umbilicus and right anterior superior iliac spine.
35
6. Which one of the following statements about the sternal angle is false?
A. It is at the level of T2/T3 intervertebral disc
B. It is where the trachea bifurcates into two primary bronchi.
C. It is the level of T4/5 intervertebral disc.
D. It is the level of the 2nd sternocostal junction.
E. The azygos vein enters the superior vena cava.
6. Which one of the following statements about the sternal angle is false?
A
The sternal ange is at the level of T4/T5.
36
An 18 year old is brought to the ED after being stabbed in the chest. He is bleeding profusely. Examination shows a horizontal knife wound in the first right intercostal space, immediately lateral to the manubrium, 5 cm deep. Which one of the following structures is most likely to be injured?
A. Right brachiocephalic vein.
B. Ascending aorta
C. Superior vena cava
D. Right ventricle
E. Right subclavian artery
First right intercostal space, immediately lateral to the manubrium, 5 cm deep =
A. Right brachiocephalic vein.
37
A 9 year old child presents to the ED with a painful swelling of the left elbow after having fallen onto the outstretched left hand while playing football.. The child is unable to flex his index finger or make a circle with the index finger and thumb. An X ray shows a supracondylar fracture. The nerve most likely to be injured is the:
A. Ulnar nerve.
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve.
E. Axillary nerve.
B. Median nerve
Explanation: The radial nerve supplies posterior of arm - triceps, posterior forearm muscles and they are all extensors so a radial nerve injury - patients can’t extend fingers so their hands are curved. If it’s a radial nerve injury, extension is the problem not flexion.
The axillary nerve supplies deltoid and arm area (not forearm). The musculocutaneous nerve supplies anterior compartment of arm (upper bit, not forearm). The lateral side of the hand is supplied by the median nerve and the medial side of the hand is supplied by the ulnar nerve. In an ulnar nerve injury, the patient will have trouble flexing the last two digits.
38
9. At which stage of development does a fertilized ovum undergo implantation?
A. Blastocyst
B. 4-cell stage
C. 2-cell stage
D. Morula
E. Gastrula
9. At which stage of development does a fertilized ovum undergo implantation?
**A. Blastocyst**
B. 4-cell stage
C. 2-cell stage
D. Morula
E. Gastrula
39
Which of the following structures pass under the inguinal ligament?
A. Genital branch of the genitofemoral nerve.
B. The long saphenous vein.
C. Psoas major tendon
D. Superficial epigastric vein.
E. Sciatic nerve
Which of the following structures pass under the inguinal ligament?
C. Psoas major tendon
40
Regarding the humerus, which one of the following is true?
A. The radial nerve runs along the spiral groove anteriorly.
B. The axillary nerve lies adjacent ot the surgical neck.
C. The lesser tuberosity forms the lateral border of the bicipital groove.
D. The greater tuberosity forms the medial border of the bicipital groove.
Regarding the humerus, which one of the following is true?
B. The axillary nerve lies adjacent ot the surgical neck.
41
Regarding the arch of the aorta, which one of the following is true?
A. The ligamentum arteriosum connects the aorta to the pulmonary vein.
B. The right common carotid artery arises from the braciocephalic trunk.
C. The right common carotid artery arises from the right subclavian artery.
D. The left subclavian artery arises from the brachiocephalic trunk.
Regarding the arch of the aorta, which one of the following is true?
## Footnote
**B. The right common carotid artery arises from the braciocephalic trunk.**
42
What does the ligamentum arteriosis connect?
The ligamentum arteriosum = a remnant of the fetal ductus arteriosum, located between and connecting the proximal left pulmonary artery and the undersurface of the junction of the aortic arch and descending aorta, at the aortic isthmus.
43
Regarding the subclavian artery, which one of the following is true?
A. The scalenus anterior muscle divides it into 4 parts.
B. The scalenus anterior muscle is between the artery and the subclavian vein.
C. The axillary artery arises from the 4th part.
D. It lies over the second rib.
B. The scalenus anterior muscle is between the subclavian artery and the subclavian vein.
The scalenus anterior muscle divides it into 3 parts and it lies over the first rib, not the second.
44
Regarding the venous drainage of the lower limb, which one of the following is true?
A. The great saphenous vein begins just below the lateral mallelolus.
B. The great saphenous vein begins behind the medial malleolus
C. The great saphenous vein drains into the popliteal vein.
D. The short saphenous vein drains into the popliteal vein.
Regarding the venous drainage of the lower limb, which one of the following is true?
A. The great saphenous vein begins just below the lateral mallelolus = False - begins just above the medial malleolus
B. The great saphenous vein begins behind the medial malleolus
C. The great saphenous vein drains into the popliteal vein.
**D. The short saphenous vein drains into the popliteal vein.**
45
Which one of the following statements is false?
A. The right gonadal vein drains into the right renal vein.
B. The left gonadal vein drains into the left renal vein.
C. The left gastric vein drains into the portal vein.
D. The left renal vein receives the left suprarenal (adrenal) vein.
E. The common iliac veins drain directly into the inferior vena cava.
Which one of the following statements is false?
**A. The right gonadal vein drains into the right renal vein** = False - The right gonadal vein usually drains into the IVC while the left gonadal vein drains into the left renal vein.
B. The left gonadal vein drains into the left renal vein.
C. The left gastric vein drains into the portal vein.
D. The left renal vein receives the left suprarenal (adrenal) vein.
E. The common iliac veins drain directly into the inferior vena cava.
46
Regarding the hilum of the right lung which one of the following is true?
A. The phrenic nerve passes behind it.
B. The arch of the aorta is above it.
C. The azygos vein is in front of it.
D. The right pulmonary veins lie above the main bronchus.
E. The right pulmonary veins lie below the main bronchus.
Regarding the hilum of the right lung which one of the following is true?
A. The phrenic nerve passes behind it.
B. The arch of the aorta is above it.
C. The azygos vein is in front of it.
D. The right pulmonary veins lie above the main bronchus.
**E. The right pulmonary veins lie below the main bronchus.**
47
Which one of the following muscles is not part of the rotator cuff?
A. Teres minor
B. Teres major
C. Supraspinatus
D. Infraspinatus
E. Subscapularis
Which one of the following muscles is not part of the rotator cuff?
A. Teres minor
**B. Teres major**
C. Supraspinatus
D. Infraspinatus
E. Subscapularis
48
Which of the following structures is not found within the free edge of the lesser omentum?
## Footnote
A. The portal vein.
B. The common bile duct.
C. The hepatic artery.
D. The inferior vena cava
Which of the following structures is not found within the free edge of the lesser omentum?
A. The portal vein.
B. The common bile duct.
C. The hepatic artery.
**D. The inferior vena cava**
The free border of the lesser omentum between the porta hepatis and the duodenum contains the hepatic artery, the portal vein, the common bile duct, lymph glands, lymph vessels, and nerves, forming the hepatic hilum.
49
In which Australian population group was the highest rate of Down syndrome notified between 1998 and 2003?
A. Aboriginal and Torres Strait Islander infants
B. Non-Aboriginal Australian infants
C. Infants born to mothers who usually reside in major cities
D. Infants born to mothers who usually reside in regional areas
E. Infants born to mothers who usually reside in remote and very remote areas
In which Australian population group was the highest rate of Down syndrome notified between 1998 and 2003?
D. Infants born to mothers who usually reside in regional areas = 13.4
50
Which one of the following types of study is most appropriate to answer a clinical question about whether the use of antibiotics reduces the severity of symptoms in children aged under five years with otitis media?
A. Ecological study
B. Case-control study
C. Cohort study
D. Systematic review
E. Economic analysis
D. Systematic review
51
Massie et al (2010) found that the live-population prevalence of cystic fibrosis in Victoria declined by 17% after the introduction of genetic screening. The most likely reason for this reduction is:
A. Decrease in the prevalence of the carrier state in the population
B. Decrease in the incidence of the carrier state in the population
C. Increase in the incidence of cystic fibrosis in live births
D. Decrease in the incidence of cystic fibrosis in live births
E. Decrease in the incidence of cystic fibrosis in all pregnancies
D. Decrease in the incidence of cystic fibrosis in live births
52
Which one of the following is the sensitivity of the test?
## Footnote
A. (100/10,000) x 100 = 1%
B. (100/1,000) x 100 = 10%
C. (100/500) x 100 = 20%
D. (8600/9500) x 100 = 90.5%
E. (900/10,000) x 100 = 9%
Sensitivity = true positives/all those with the disease
C. (100/500) x 100 = 20%
53
Hepatitis A is a notifiable disease in all Australian States and Territories. In New South Wales from 2002-2006, which one of the following population groups accounted for the largest number of notifications of hepatitis A infection?
A. Plumbers
B. Prison inmates
C. Men who have sex with men D. Preschoolers
E. Overseas travellers
E. Overseas travellers
54
Internationally 240 million people live with chronic hepatitis B virus infection and 150 million people are chronically infected with hepatitis C virus. These are measures of which one of the following?
A. Attributable risk
B. Incidence
C. Prevalence
D. Relative risk
E. Risk factor
C. Prevalence
55
In some parts of Australia, recorded hospitalisation rates for hepatitis A are more than 50 times higher for Aboriginal and Torres Strait children compared with non-Indigenous children. This comparative measure is best described as which one of the following?
A. Attributable risk
B. Incidence
C. Prevalence
D. Relative risk
E. Risk factor
Attributable risk = Given a group of people exposed to a risk, it's the fraction who develop a disease or condition.
Prevalence = Prevalence refers to proportion of persons who have a condition at or during a particular time period, whereas incidence refers to the proportion or rate of persons who develop a condition during a particular time period.
**D. Relative risk** = the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group.
56
Sally Dunstan is planning a research project to investigate patterns of injury among skateboarders in NSW, and has Human Ethics Committee approval to review the records at all Emergency Departments in the State. Although Sally will be able to report the number of patients seen with skateboard-related injury, she will not be able to calculate an incidence rate for injury among skateboarders because there is no:
A. unique identifier used in all EmergencyDepartments
B. accurate count of skateboarders in NSW
C. ICD-10AM code for skateboarding
D. licensing system for skateboarders
E. national collection of ED attendance data
B. accurate count of skateboarders in NSW
57
The citizens of Erehwon (population 2500) are concerned about the number of young people from their community who die or are seriously injured on the roads each year.
Which one of the following strategies is most likely to reduce the number of motor vehicle crashes and reduce the severity of injury?
A. All young people required to sign a ‘good behaviour’ pledge before being allowed to drive
B. Regular reports about the dangers of driving on rural roads in the local newspaper
C. Annual police visit to the Erehwon High School to demonstrate driving skills
D. Enforcement of the road safety legislation such as speed restrictions, alcohol limits and seat belt use
E. Discounted fuel prices for customers of specified fast-food outlets in the community
D. Enforcement of the road safety legislation such as speed restrictions, alcohol limits and seat belt use
58
Graduated driver licensing has been an effective population-level intervention to reduce the incidence and impact of severe injury from road traffic crashes. In terms of its positive impact on driver ability, which cell of the Haddon’s matrix does this example fit best?
A. Pre-event host
B. Pre-event physical environment
C. Event vehicle
D. Event physical environment
E. Post-event social environment
A. Pre-event host
59
The Chief Health Officer of NSW has asked you as Director of a Public Health Unit to ascertain the incidence of tuberculosis in your area. What type of study would be the best research method to obtain this information?
A. Surveillance of the entire population for a defined period of time
B. A case-control study in which cases are patients admitted to hospitals within the Local Health Network and controls are recruited from the population fromwhich cases are derived
C. A series of cases identified from the medical records from all hospitals within the Local Health Network
D. A health survey on a random sample selected from the population residing within the Local Health Network
E. A randomized controlled trial
A. Surveillance of the entire population for a defined period of time
60
Which one of the following is true of a patient who refuses treatment?
## Footnote
A. Every patient can refuse any treatment
B. A 14-year-old girl may give valid consent to some procedures but may be overruled by a court if she refuses treatment essential to her welfare
C. A promiscuous mentally impaired 15-year-old girl can be sterilized if both parents and two doctors agree that it is necessary, even if the girl refuses
D. You cannot give an emergency blood transfusion to a 10-year-old child of Jehovah’s witnesses if the parents refuse permission
E. You do not need permission to amputate a leg that is obviously gangrenous
B. A 14-year-old girl may give valid consent to some procedures but may be overruled by a court if she refuses treatment essential to her welfare
61
A 36-year-old man has been seeing his GP for reduced libido and suspected impotence. Physical examination and initial investigations are normal. In the following week, his partner telephones the GP, and expresses her concern about his health. She is genuinely anxious and asks if he is “keeping secrets from” her.
Which one of the following is the most appropriate response from the GP?
A. As she is his partner, reassure her that his investigation results were all normal and he had not kept any secret away.
B. Make an appointment to see her the following day to discuss the issue.
C. Thank her for expressing the concern, explain the issue on confidentiality, and politely decline to answer her question.
D. Invite both to come in for a joint interview to discuss the investigation results and offer management of their concern.
E. Acknowledge her concern and pass her on to the nurse to arrange for faxing his investigation results to her.
C. Thank her for expressing the concern, explain the issue on confidentiality, and politely decline to answer her question.
62
Antibiotics are not effective in the treatment of the common cold. By not prescribing antibiotics for a patient with a cold, even when they demand you to do so, you are applying which one of the following ethical principles?
A. Beneficence
B. Informed consent
C. Non-maleficence
D. Competence
E. Autonomy
Antibiotics are not effective in the treatment of the common cold. By not prescribing antibiotics for a patient with a cold, even when they demand you to do so, you are applying which one of the following ethical principles?
A. Beneficence
B. Informed consent
**C. Non-maleficence**
D. Competence
E. Autonomy
63
A 29-year-old man arrives in Emergency on a ventilator after an accident. He is brain dead by all criteria. He has an organ donor card in his wallet indicating his desire to donate. The organ donor team contacts the family. The family refuses to agree to the donation of the organs.
Which one of the following is the most appropriate next step for the hospital administrator doctor?
A. Remove the organs anyway
B. Wait for the patient’s heart to stop, then remove the organs
C. Stop the ventilator and remove the organs
D. Seek a court order to overrule the family
E. Honour the wishes of the family: no donation
E. Honour the wishes of the family: no donation
64
To satisfy the requirement for _capacity_ to consent to a specific procedure, the patient must be able to:
A. Consent without duress, pressure, coercion, fraud, deceit or drugs
B. Understand what is involved in the proposed procedure or treatment
C. Recognise the terminology
D. Know that the consent is limited to the particular procedure
E. Understand everyone has a right to choose what occurs to his or her own body
B. Understand what is involved in the proposed procedure or treatment
65
During an operation on a patient under a general anaesthetic, a surgeon identifies that it is desirable that an additional medical procedure should be performed, even though the patient did not consent to this additional procedure. If the surgeon performs the procedure with reasonable care and skill then the patient may be able to successfully sue the doctor for which one of the following?
A. Assault
B. False imprisonment
C. Negligence
D. Battery
E. Nuisance
D. Battery
66
You can withhold information about the material risks of treatment in which one of the following situations:
A. The incidence of the risk is rare.
B. The information will upset the patient and cause anxiety.
C. The information will prevent the patient from proceeding with a life-saving treatment.
D. The doctor judges on reasonable grounds that patient’s health might be seriously harmed by the information.
E. A carer has requested that the information be withheld.
**Material** **risk** = A significant potential for harm that a reasonable person would want to consider when making a decision about undergoing a medical or surgical treatment.
D. The doctor judges on reasonable grounds that patient’s health might be seriously harmed by the information
67
A 10-year-old child is very seriously ill. Her sister Hariata, aged seven, is the only family member with compatible tissue typing. Hariata is able to understand the process of tissue and organ donation and transplant.
In NSW, which one of the following tissues or organs can Hariata legally donate to her sister, provided her parents give informed consent and Hariata agrees to the procedure?
A. Kidney
B. Bone marrow
C. Lobe of lung
D. Part of small intestine
E. All of the above
B. Bone marrow
68
The internal sphincter of the bladder is kept closed by which one of the following?
A. Alpha-neurones arising from sacral nerve roots S2,3,4
B. Voluntary neural pathways from the brainstem
C. Inhibitory neural pathways from the brainstem
D. Sympathetic innervation via the hypogastric nerve
E. Parasympathetic innervation via the pudendal nerve
The internal sphincter of the bladder is kept closed by which one of the following?
A. Alpha-neurones arising from sacral nerve roots S2,3,4
B. Voluntary neural pathways from the brainstem
C. Inhibitory neural pathways from the brainstem
**D. Sympathetic innervation via the hypogastric nerve**
E. Parasympathetic innervation via the pudendal nerve
69
The RNA responsible for bringing the amino acids to the ribosomes for protein formation is the:
A. mRNA
B. rRNA
C. ssRNA
D. tRNA
E. eRNA
The RNA responsible for bringing the amino acids to the ribosomes for protein formation is the:
A. mRNA
B. rRNA
C. ssRNA
**D. tRNA**
E. eRNA
70
Which one of the following medications is used in a sweat test for cystic fibrosis?
A. Milocarpine
B. Acetylcholine
C. Pirenzepine
D. Atropine
E. Pilocarpine
Which one of the following medications is used in a sweat test for cystic fibrosis?
A. Milocarpine
B. Acetylcholine
C. Pirenzepine
D. Atropine
**E. Pilocarpine =** muscarinic cholinergic agonist
71
The oxygen dissociation curve is obtained by exposing blood to a number of partial pressures and measuring how much of its total O2 carrying capacity is occupied.
Which one of the following statements best states the changes that occur in this curve?
A. A shift to the right means that less oxygen is available in the tissues
B. A decrease in pH will shift the curve to the left
C. Local acidosis at the tissue level will shift the curve to the right
D. DPG reacts with HbO2 and shifts the curve to the left
E. The curve relates to the changes in cardiac output
C. Local acidosis at the tissue level will shift the curve to the right
72
When a B cell encounters an antigen to which it is targeted, it interacts with T cells and divides rapidly and differentiates into which of the following cells?
A. Macrophages
B. Plasma cells
C. T lymphocytes cells
D. Natural killer cells
E. Memory cells
**B. Plasma cells**
## Footnote
Plasma cells develop from B lymphocytes (B cells), a type of white blood cell that is made in the bone marrow. Normally, when bacteria or viruses enter the body, some of the B cells will change into plasma cells. The plasma cells make antibodies to fight bacteria and viruses, to stop infection and disease.
73
A 23-year-old woman who was infected with a virus cleared the infection in two weeks. Six months later, she was infected by the same virus and cleared the infection in 5 days.
Which feature of the adaptive immunity is best illustrated in this example?
A. Antigen specificity
B. Active memory
C. Receptor-mediated antigen recognition
D. Distinguishing self vs.non-self
E. Primary response
B. Active memory
74
Children with trisomy 21 are at increased risk for gastro-intestinal tract anomalies.
The strongest association occurs with:
A. Coeliac disease
B. Duodenal atresia
C. Hirschsprung disease
D. Annular pancreas
E. Gastro-oesophagealreflux
A. Coeliac disease
75
The greatest change in blood pressure occurs across:
A. arterioles
B. capillaries
C. venules
D. veins
E. anastomoses
The greatest change in blood pressure occurs across:
**A. arterioles**
B. capillaries
C. venules
D. veins
E. anastomoses
76
Which of the following are clinical features of severe shock?
A. Thirst and high urine output
B. Thirst and low urine output
C. Increased heart rate and increased blood pressure
D. Increased heart rate and reduced respiratory rate
E. Pallor and reduced respiratory rate
B. Thirst and low urine output
77
Haemopoeisis:
A. is the process of formation of leucocytes in the adult bone marrow
B. is the process of formation of red blood cells, white blood cells and platelets
C. is a process that can occur in the spleen, liver and kidneys
D. occurs in the yolk sac, liver and renal tissues in the embryo
E. occurs in the thymus and adrenal gland
Haemopoeisis:
B. is the process of formation of red blood cells, white blood cells and platelets
78
Aspirin as a NSAID (non-steriodal anti-inflammatory drug) has which one of the following actions?
A. Inhibition of cyclooxygenase (COX)
B. Increases thromboxane production
C. Decreases gastric acid secretion
D. Increases stomach mucous secretion
E. Increases platelet aggregation by binding to ADP receptor
Aspirin as a NSAID (non-steriodal anti-inflammatory drug) has which one of the following actions?
**A. Inhibition of cyclooxygenase (COX)**
B. Increases thromboxane production
C. Decreases gastric acid secretion
D. Increases stomach mucous secretion
E. Increases platelet aggregation by binding to ADP receptor
79
Which one of the following is the correct definition of autophagy? A process during which cells:
A. become senescent and stop replicating
B. catabolise cellular components for replication
C. initiate anabolic self-division for replication
D. become cytotoxic and stop replicating
E. become multi-nucleated and increase replication
B. catabolise cellular components for replication
80
A key muscle involved in abduction of the shoulder in the rotator cuff is the:
* A. Teresmajor
* B. Deltoid
* C. Supraspinatus
* D. Trapezius
* E. Latissimusdorsi
**C. Supraspinatus**
Rotator cuff muscles are:
1. Supraspinatus
2. Infraspinatus
3. Teres Minor
4. Subscapularis
81
Which one of the following proteins is a tumor suppressor?
* A. p16
* B. E2F
* C. ATP
* D. CAK
* E. PK-C
Which one of the following proteins is a tumor suppressor?
* **A. p16**
* B. E2F
* C. ATP
* D. CAK
* E. PK-C
82
Innervation of the urinary bladder is dependent on:
A. sympathetic fibres reaching the bladder from S2,3,4
B. parasympathetic fibres reaching the bladder from L 1,2
C. the pudendal nerve innervation of the external sphincter
D. the detrusor muscle and external sphincter being supplied by the hypogastric nerve
E. voluntary control of the internal sphincter of the bladder
Innervation of the urinary bladder is dependent on:
A. sympathetic fibres reaching the bladder from S2,3,4 = False - Sympathetic = L1-L3 (Hypogastric nerves)
B. parasympathetic fibres reaching the bladder from L 1,2 = False = S2-S4 (Pelvic splanchnic nerves)
**C. the pudendal nerve innervation of the external sphincter =** True (Somatic S2-S4)
D. the detrusor muscle and external sphincter being supplied by the hypogastric nerve
E. voluntary control of the internal sphincter of the bladder
83
The pancreas secretes enzymes for the digestion of protein, carbohydrates and fat. Which one of the following stimuli is responsible for the bulk of pancreatic enzyme secretion?
A. Acid in the duodenum
B. Cholecystokinin
C. Distension of the stomach
D. Secretin
E. The sight, smell and taste of food
Which one of the following stimuli is responsible for the bulk of pancreatic enzyme secretion?
A. Acid in the duodenum
**B. Cholecystokinin**
C. Distension of the stomach
D. Secretin
E. The sight, smell and taste of food
84
A 75-year-old man presents with a history of dysuria, dribbling after micturition, and inability to void urine completely at micturition. Digital examination of the prostate reveals a 90g enlarged non-tender prostate with smooth edges.
Which one of the following is the most likely diagnosis?
A. Acute prostatitis
B. Nephrotic syndrome
C. Carcinoma of the prostate
D. Benign prostatic hyperplasia
E. Diabetes insipidus
D. Benign prostatic hyperplasia
85
Staphylococcus aureus is carried in the nose and/or in the saliva by some 30% of the population, and at higher percentages in health care workers.
Which one of the following is the most important intervention against transmission of this organism?
A. Vaccination against this bacterium
B. Face mask, and hygienic nose-blowing
C. Well-trimmed moustaches and nasal hair
D. Correct hand hygiene
E. Cleaning of surfaces in the home and hospital
D. Correct hand hygiene
86
The flow of which substance in the liver or gallbladder would be most impacted by a deficit in CCK (cholecystokinin) production?
A. Bicarbonate
B. Bile
C. Lymph
D. Acid
E. Blood
**B. Bile**
The presence of cholecystokinin causes the release of digestive enzymes and bile from the pancreas and gallbladder, respectively, and also acts as a hunger suppressant.
87
Which one of the following is the most effective prevention against tetanus?
A. Immunisation with the toxin, as it causes the disease
B. Antibiotics, as the organism grows when inoculated into wounds
C. Immunisation with toxoid that cannot cause the disease
D. Administration of anti-toxin to children, as antibodies protect against the disease
E. Immunisation of mothers, so that maternal antibodies are passed to children
C. Immunisation with toxoid that cannot cause the disease
88
Enterohepatic circulation refers to:
A. The flow of blood from intestinal capillaries to the liver
B. The secretion of liver proteins into blood that are transported to the gut
C. The chemical transformation in the liver of drugs absorbed by the gut
D. The flow of various substances from the liver to the gastro-intestinal tract then back to the liver
E. The synthesis of urea by the liver that is removed by the kidney
Enterohepatic circulation refers to:
D. The flow of various substances from the liver to the gastro-intestinal tract then back to the liver
89
Which one of the following is the correct definition of cholera?
A. A toxin-driven, non-inflammatory gastroenteritis
B. An invasion of the enterocytes by Vibrio cholerae
C. A food intoxication producing symptoms rapidly after ingestion of food
D. A food intoxication associated with a delayed vomiting reaction
E. An allergy driven, inflammatory gastroenteritis
B. An invasion of the enterocytes by Vibrio cholerae
90
Which one of the following is the correct dermatological term for a rash whose distribution follows that of a cutaneous nerve?
A. Serpiginous
B. Zosteriform
C. Reticulated
D. Confluent
E. Papulosquamous
A. Serpiginous = having a wavy margin
**B. Zosteriform**
C. Reticulated = net-like pattern.
D. Confluent = Joining or running together
E. Papulosquamous = a condition which presents with both papules and scales, or both scaly papules and plaques.
91
ESCAPPM isolates have an inducible antimicrobial resistance that will likely cause treatment failure in a therapy with which one of the following?
A. Cotrimoxazole
B. Bacteriostatic antibiotic
C. DNA gyrase and topoisomerase inhibitor
D. β-lactam
E. Ribosomeinhibitor
D. β-lactam
ESCAPPM or ESCHAPPM is a mnemonic for the organisms with inducible beta-lactamase activity that is chromosomally mediated.
Intrinsic resistance to Beta lactam antibiotics
92
Which one of the following is a risk factor for atherosclerosis?
A. Female gender
B. Diabetes
C. Hypolipidaemia
D. Low blood pressure
E. Vegan diet
Which one of the following is a risk factor for atherosclerosis?
A. Female gender
**B. Diabetes**
C. Hypolipidaemia
D. Low blood pressure
E. Vegan diet
93
Which one of the following bacteria is found commonly as a normal skin commensal?
A. Staphylococcus epidermidis
B. Staphylococcus pyogenes
C. Streptococcus pneumoniae
D. Escherichia coli
E. Campylobacter jejuni
Which one of the following bacteria is found commonly as a normal skin commensal?
**A. Staphylococcus epidermidis**
B. Staphylococcus pyogenes
C. Streptococcus pneumoniae
D. Escherichia coli
E. Campylobacter jejuni
94
The clinical sign of dark urine is due to an excess of which one of the following substances in the plasma?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Biliverdin
D. Urobilinogen
E. Beta-carotene
The clinical sign of dark urine is due to an excess of which one of the following substances in the plasma?
**A. Conjugated bilirubin**
B. Unconjugated bilirubin
C. Biliverdin
D. Urobilinogen
E. Beta-carotene
95
Which one of the following is the pulse that is felt just lateral to the extensor hallucis longus tendon in the foot?
A. Posterior tibial artery
B. Popliteal artery
C. Anterior interosseous artery
D. Posterior interosseous artery
E. Dorsalis pedis artery
Which one of the following is the pulse that is felt just lateral to the extensor hallucis longus tendon in the foot?
A. Posterior tibial artery
B. Popliteal artery
C. Anterior interosseous artery
D. Posterior interosseous artery
**E. Dorsalis pedis artery**
96
A 27-year-old man presents to the Emergency Department after a fall landing on his right elbow. A radiograph of his right elbow demonstrates a fracture of the medial epicondyle of the humerus.
Which one of the following nerves is likely to be damaged?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Antecubital nerve
E. Digital nerve
B. Ulnar nerve
97
Which one of the following is true regarding a reaction catalysed by an enzyme?
A. The enzyme is one of the substrates of the reaction
B. The enzyme is converted into the products of the reaction
C. The tertiary structure of the enzyme determines its specificity
D. Each enzyme molecule can participate as a catalyst only once
E. The enzyme usually increases the speed of the reaction by 1000 fold
C. The tertiary structure of the enzyme determines its specificity
98
Which of the following are specialist phagocytic cells:
A. leukocytes and erythrocytes
B. hepatocytes and stellate cells
C. macrophages and neutrophils
D. endothelial and epithelial cells
E. neutrophils and erythrocytes
Which of the following are specialist phagocytic cells:
A. leukocytes and erythrocytes
B. hepatocytes and stellate cells
**C. macrophages and neutrophils**
D. endothelial and epithelial cells
E. neutrophils and erythrocytes
99
A 40-year-old woman was diagnosed with carcinoma of the breast. On histological examination of the tumor, which one of the following histological findings is characteristic for a malignant neoplasm?
A. High degree of differentiation
B. Circumscribed margin
C. Pigmented nuclei
D. Invading adjacent tissue
E. Bounded by basement membrane
Histological findings characteristic for a malignant neoplasm:
A. High degree of differentiation
B. Circumscribed margin
C. Pigmented nuclei
**D. Invading adjacent tissue**
E. Bounded by basement membrane
100
Rate of gastric emptying decreases with:
A. An increase in intragastric volume
B. A decrease in intraduodenal volume
C. An increase in acidity in the stomach
D. An increase in osmolarity in the duodenum
E. An increase in glucose concentration in the oral cavity
Rate of gastric emptying decreases with:
A. An increase in intragastric volume
B. A decrease in intraduodenal volume
C. An increase in acidity in the stomach
**D. An increase in osmolarity in the duodenum**
E. An increase in glucose concentration in the oral cavity
101
In the treatment of hypovolaemic shock, the most appropriate IV fluid for increasing the circulating blood volume is:
A. Glucose 5%
B. Glucose 10%
C. Normal saline 0.9%
D. Normal saline 0.9% with 30 mmol potassium
E. 4% Dextrose and 1/5 normal saline
In the treatment of hypovolaemic shock, the most appropriate IV fluid for increasing the circulating blood volume is:
A. Glucose 5%
B. Glucose 10%
**C. Normal saline 0.9%**
D. Normal saline 0.9% with 30 mmol potassium
E. 4% Dextrose and 1/5 normal saline
102
A medical student stops at a roadside accident. A young woman is bleeding from her leg. She is breathing but is confused and mumbling. Her skin is pale and clammy. He has called for help. The most effective intervention at this point is to:
A. elevate her legs to 45 degrees
B. lay her flat in a supine position
C. give an intravenous infusion of normal saline
D. compress the site of bleeding
E. start cardiac massage
D. compress the site of bleeding
103
Which one of the following is most likely to occur acutely in tissue distal to a vascular obstruction?
A. Dilation
B. Calculi
C. Atrophy
D. Infarction
E. Hypertrophy
**D. Infarction**
= death of tissue resulting from a failure of blood supply, commonly due to obstruction of a blood vessel by a blood clot or narrowing of the blood-vessel channel.
104
Bacterial endospores are epidemiologically important because they:
A. encode virulence genes
B. enable survival of heat treatment
C. facilitate attachment to mucosae
D. preventen gulfment by neutrophils
E. scavenge and sequester iron for growth
Bacterial endospores are epidemiologically important because they:
A. encode virulence genes = plasmid
**B. enable survival of heat treatment**
C. facilitate attachment to mucosae = pili and Fimbria
D. prevent engulfment by neutrophils =
E. scavenge and sequester iron for growth
105
Hypoglycemia will cause which of the following clinical signs and symptoms:
A. Trembling, sweating, fever
B. Weight loss, sweating, abdominal pain
C. Trembling, sweating, tachycardia
D. Pallor, sweating, hypotension
E. Polyuria, abdominal pain, fever
C. Trembling, sweating, tachycardia
106
Which one of the following is an exocrine product of the liver?
A. Albumin
B. Bile acids
C. Fibrinogen
D. Lipoprotein
E. Prothrombin
**B. Bile acids**
* **Exocrine**: Pertaining to the secretion of a substance out through a duct. The exocrine glands include the salivary glands, sweat glands and glands within the gastrointestinal tract. Exocrine is as opposed to endocrine which refers to the secretion of a substance (a hormone) into the bloodstream.
* Bile Secretion occurs via bile ductules draining into the hepatic duct, the gallbladder, the cystic duct, the common bile duct and, finally, into the duodenum.
* Endocrine functions include the release of substances produced by liver cells into blood, including albumin, lipoprotein, globulins, liver glycogen, and T3 (thyroid hormone).
107
Which one of the following is the correct dermatological descriptive term for a circumscribed palpable elevation, less than 1 cm in diameter?
A. Purpura
B. Plaque
C. Petechiae
D. Pustule
E. Papule
Which one of the following is the correct dermatological descriptive term for a circumscribed palpable elevation, less than 1 cm in diameter?
A. Purpura
B. Plaque
C. Petechiae
D. Pustule
**E. Papule**
108
Which two nerves conduct the impulses for the flexion of the arm and extension of the wrist respectively?
A. Radial and ulnar
B. Radial and median
C. Musculocutaneous and radial
D. Musculocutaneous and ulnar
E. Musculocutaneous and median
**C. Musculocutaneous and Radial**
## Footnote
Musculocutaneous = flexion of the arm
Radial = extension of the wrist
109
Which one of the following is a characteristic feature of loops of small bowel on abdominal X-ray?
A. Peripher allocation
B. Valvulae conniventes
C. Diameter between 5 and 10 cm
D. Few in number
E. Presence of faeces
B. Valvulae conniventes = plicae ciculares
= small bowel folds, the mucosal folds of the small intestine, starting from the second part of the duodenum, they are large and thick at the jejunum and considerably decrease in size distally in the ileum to disappear entirely in the distal ileal bowel loops.
110
Proteins form the basic structural material of the body. They:
A. Compose 70% of the cell mass
B. Contain only carbon hydrogen and oxygen
C. Form enzymes and some hormones
D. Are made up of amino acids, 1/10 of which are essential in the body
E. All of the above
Proteins form the basic structural material of the body. They:
A. Compose 70% of the cell mass
B. Contain only carbon hydrogen and oxygen
**C. Form enzymes and some hormones**
D. Are made up of amino acids, 1/10 of which are essential in the body
E. All of the above
111
A 50-year-old man presents with right upper quadrant abdominal pain for 1 week. Which one of the following symptoms is characteristic of a complete biliary obstruction?
A. Pale coloured urine
B. Pale coloured stool
C. Worsening of pain after fatty meal
D. Pale sclera
E. Abdominal swelling
B. Pale coloured stool
112
Which one of the following is a risk factor for hepatitis B infection?
A. Poor sanitation
B. Blood donation before 1992
C. Sharing needles during intravenous drug use
D. Chronic alcoholism
E. Born to a woman with a hepatitis infection
C. Sharing needles during intravenous drug use
113
What is the key mechanism of polyuria in insulin-dependent diabetes?
A. Increased glucose filtration by kidneys due to hyperglycaemia and the associated osmotic effect
B. Chronic renal failure, which is a complication of uncontrolled diabetes
C. Increased intake of fluid, due to increased thirst
D. An irritation of the bladder lining due to increased glucose concentration in the urine
E. A genetic abnormality of the kidney tubules, which is frequently inherited with the gene for diabetes, and causes decreased reabsorption of water
A. Increased glucose filtration by kidneys due to hyperglycaemia and the associated osmotic effect
114
The least likely of the following compounds could serve as the starting material(s) for the synthesis of glucose via gluconeogenesis in the liver is:
A. Glycerol
B. Lactate
C. Oxaloacetate
D. Glycogen
E. Pyruvic acid
**D. Glycogen**
115
If a patient with colicky abdominal pain has gallstones, which region of abdomen is more likely to be tender in physical examination?
A. Right hypochondrium
B. Left hypochondrium
C. Right Iliac fossa
D. Left iliac fossa
E. Hypogastrium
A. Right hypochondrium
116
Which one of the following is the first measureable immunoglobulin response from the cell mediated immunity after vaccination against pertussis?
A. Increased IgG
B. Decreased IgG
C. Increased IgM
D. Decreased IgM
E. Increased IgE
**C. Increased IgM**
**IgM** = first antibody to appear in the response to initial exposure to an antigen.
**IgG** = most abundant Ab - many functions; enhancing phagocytosis in macrophages and neutrophils, neutralizing toxins + inactivating viruses and killing bacteria; can cross placenta.
**IgE** = bound to mast cells and basophils, which circulate in blood = a mediator of allergic reactions.
117
Which cyclin-dependent kinase (CDK) is activated by cyclin D?
A. CDK1
B. CDK2
C. CDK4
D. CAK
E. pro-caspase-8
**C. CDK4**
Cyclin-dependent kinases (CDKs) are the families of protein kinases first discovered for their role in regulating the cell cycle. They are also involved in regulating transcription, mRNA processing, and the differentiation of nerve cells.
118
Which one of the following is a possible consequence of iron overload?
A. liver fibrosis
B. kidney failure
C. anaemia
D. skin depigmentation
E. thalassemia
Which one of the following is a possible consequence of iron overload?
**A. liver fibrosis**
B. kidney failure
C. anaemia
D. skin depigmentation
E. thalassemia
119
Blast cells are:
A. killer immune cells
B. effetered blood cells
C. polymorphonuclear leucocytes
D. old white blood cells
E. haemopoietic precursor cells
Blast cells are:
A. killer immune cells
B. effetered blood cells
C. polymorphonuclear leucocytes
D. old white blood cells
**E. haemopoietic precursor cells**
In biology and in medicine, the suffix "-blast" refers to immature cells known as precursor cells or stem cells.
120
In the regulation of gastrointestinal function:
A. the neurons responsible for the “short/local reflexes” have their cell bodies in the sacral region of the spinal cord
B. receptors in the gastrointestinal tract include ones that respond to temperature
C. parasympathetic stimulation results in increased digestive activity
D. all gastrointestinal reflexes are exclusively autonomic
E. motility is principally mediated by the somatic motor system
C. parasympathetic stimulation results in increased digestive activity
121
The absorption of vitamins A, D, E and K is facilitated by which one of the following?
A. Water
B. Intrinsic factor
C. Iron
D. Glucose
E. Micelles
**E. Micelles**
Vitamins A, D, E and K = fat soluble
122
A 45-year-old woman burns her arm on the stove. The Emergency Physician explains to you that:
A. Cell injury by burning is always irreversible
B. Burns result in cell death by programmed apoptosis
C. Cell injury is mediated by phosphates undergoing chemical changes
D. Apoptosis is always due to a pathological processes
E. Cell death by necrosis in this instance has arisen from an external cause.
E. Cell death by necrosis in this instance has arisen from an external cause.
123
Which one of the following is the correct definition of glycolysis? The reactions that:
A. Occur in the mitochondria
B. Convert glucose to ATP
C. Manufacture NADPH
D. Convert glucose to pyruvate
E. Produce FADH
Which one of the following is the correct definition of glycolysis? The reactions that:
A. Occur in the mitochondria = false - occurs in cytoplasm
B. Convert glucose to ATP = 'false' - 1st step of cellular respiration
C. Manufacture NADPH = false - glycolysis produces 2 NADH
**D. Convert glucose to pyruvate**
E. Produce FADH = false - citric acid cycles produces 2 FADH2
