Formatives Past Papers 2

Question 1

Which one of the following statements is true regarding the structure of skin?

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.

Answer 1

A. sebaceous glands are present in skin of all parts of body = false - only present in dermis

B. the epidermis has blood vessels and lymphatics = false - only in dermis

C. the dermis is comprised of stratified squamous epithelium = false - epidermis is strat squam but dermis is made of dense, irregular CT that houses blood vessels, hair follicles, sweat glands, and other structures.

D. the dermis contains hair follicles.

Question 2

Carpal tunnel syndrome affects which of the following nerves?

A. Musculocutaneous

B. Ulnar

C. Radial

D. Median

E. Anterior interossous

Answer 2

Carpal tunnel syndrome affects which of the following nerves?

A. Musculocutaneous

B. Ulnar

C. Radial

D. Median

E. Anterior interossous

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.

Question 3

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.

Answer 3

C. The head of the ulna is distal while the head of the radius is proximal.

Ulnar is medial and Radius is lateral

Ulna head is distal - connects to wrist

Radius head is proximal - connects to humerus

Question 4

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.

Answer 4

Femoral Triangle - Lateral to Medial = NAV

D. femoral nerve, femoral artery, femoral vein.

Femoral Triangle - Medial to Lateral = VAN

Question 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.

Answer 5

Base of appendix surface landmark

B. The junction of the lateral third and middle third of a line between the umbilicus and right anterior superior iliac spine.

D. Half way between the pubic symphysis and anterior superior iliac spine. = mid-inguinal point = femoral pulse

Question 6

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 2^nd sternocostal junction.

E. The azygos vein enters the superior vena cava.

Answer 6

A. It is at the level of T2/T3 intervertebral disc = False - Sternal angle (Angle of Louis/Manubriosternal junction) = at T4-T5

Question 7

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. SVC

D. Right ventricle

E. Right subclavian artery

Answer 7

A. Right brachiocephalic vein.

Question 8

8. 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.

Answer 8

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.

Question 9

LEARN MUSCLE COMPARTMENTS OF ARM - innervation + functions

Answer 9

GO LEARN IT

Question 10

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

Answer 10

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

Question 11

10. 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

Answer 11

C. Psoas major tendon

Question 12

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 to 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.

Answer 12

A. The radial nerve runs along the spiral groove anteriorly = false -

B. The axillary nerve lies adjacent to the surgical neck.

C. The lesser tuberosity forms the lateral border of the bicipital groove = False - forms the medial

D. The greater tuberosity forms the medial border of the bicipital groove = False - forms the later border

Question 13

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.

Answer 13

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.

Question 14

Where is the ligamentum arteriosum and what does it connect?

Answer 14

The ligamentum arteriosum is the small fibrous 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.

Question 15

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 4^th part.

D. It lies over the second rib.

Answer 15

A. The scalenus anterior muscle divides it into 4 parts = False - The scalenus anterior muscle divides it into 3 parts (anterior, middle, posterior)

B. The scalenus anterior muscle is between the artery and the subclavian vein.

C. The axillary artery arises from the 4^th part = false - 3 parts only

D. It lies over the second rib = false - subclavian artery lies over the first rib, not the second

Question 16

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.

Answer 16

A. The great saphenous vein begins just below the lateral mallelolus = false - the great saphenous 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 = False - The great saphenous vein terminates by draining into the femoral vein immediately inferior to the inguinal ligament.

D. The short saphenous vein drains into the popliteal vein.

Question 17

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.

Answer 17

A. The right gonadal vein drains into the right renal vein = False - the right gonadal vein drains directly into the inferior vena cava.

Question 18

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.

Answer 18

Hilum of RIGHT lung:

A. The phrenic nerve passes behind it = false - passes anterior

B. The arch of the aorta is above it = false - aortic arch on left

C. The azygos vein is in front of it = false - It ascends within the posterior mediastinum to the level of T4 before it arches above the right pulmonary hilum.

D. The right pulmonary veins lie above the main bronchus.

E. The right pulmonary veins lie below the main bronchus.

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

Which one of the following structures is not found on the anterior surface of the heart?

A. Left ventricle

B. Left atrium

C. Right ventricle

D. Right atrium

Answer 21

Which one of the following structures is not found on the anterior surface of the heart?

A. Left ventricle

B. Left atrium

C. Right ventricle

D. Right atrium

Question 22

Which structures originate from embryonic ectoderm?

a) bones
b) heart
c) liver
d) spleen
e) spinal cord
f) dermis

Answer 22

e) Spinal cord

Ectoderm - differentiates to form epithelial (NOT dermis but epidermis) and neural tissues (spinal cord, peripheral nerves and brain). This includes the skin, linings of the mouth, anus, nostrils, sweat glands, hair and nails, and tooth enamel. Other types of epithelium are derived from the endoderm.

Endoderm = gut tube and its derived organs, including the cecum, intestine, stomach, thymus, liver, pancreas, lungs, thyroid and prostate.

Question 23

Dysfunction of which labeled surface can lead to development of acne vulgaris:

a) epidermis
b) sebacious gland
c) hair follicle
d) sweat gland
e) hypodermis

Answer 23

Dysfunction of which labeled surface can lead to development of acne vulgaris:

a) epidermis

b) sebacious gland

c) hair follicle
d) sweat gland
e) hypodermis

Question 24

The peripheral nervous system includes which of the following components?

a) Spinal nerves
b) Dura mater
c) Spinal Cord
d) CSF
e) Brain

Answer 24

The peripheral nervous system includes which of the following components?

a) Spinal nerves

b) Dura mater = Dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord.
c) Spinal Cord = CNS
d) CSF = exists in the surrounding spaces of CNS
e) Brain = CNS

Question 25

Which labelled structure has only sensory information? a) white matter of spinal cord b) posterior/dorsal rootlets c) grey matter d) anterior root e) spinal cord

Answer 25

Which labelled structure has only sensory information? a) white matter of spinal cord **b) posterior/dorsal rootlets** c) grey matter d) anterior (ventral) root = motor e) spinal cord

Question 26

Identify the structure labelled as ‘a’ a) left atrium b) right atrium c) left ventricle d) right ventricle e) oesophagus

Answer 26

Identify the structure labelled as ‘a’ a) left atrium b) right atrium c) left ventricle **d) right ventricle** e) oesophagus

Question 27

Post ganglionic sympathetic fibres innervating the dilator pupillae muscle begin in the...? a) Ciliary ganglion b) superior cervical ganglion c) brain d) trigeminal ganglion e) spinal cord (T1-L2)


Answer 27

Post ganglionic sympathetic fibres innervating the dilator pupillae muscle begin in the...? a) Ciliary ganglion **b) superior cervical ganglion** c) brain d) trigeminal ganglion e) spinal cord (T1-L2)


Question 28

All muscles innervated by deep fibular nerve...? a) Evert the foot b) invert the foot c) dorsiflex the foot d) plantar flex the foot e) medially rotate the foot

Answer 28

**c) dorsiflex the foot** The deep fibular nerve innervates the muscles in the anterior compartment of the leg, including: 1. Tibialis anterior. 2. Extensor hallucis longus. 3. Extensor digitorum longus. 4. Fibularis tertius. Anterior compartment of leg = all four perform dorsiflexion as one of their primary actions.

Question 29

Which part of the bowel becomes ischaemic if a large thrombus occluded the inferior mesenteric artery? a) 2nd part of the duodenum b) jejunum c) ilium d) ascending colon e) descending colon

Answer 29

Which part of the bowel becomes ischaemic if a large thrombus occluded the inferior mesenteric artery? **= e) descending colon** a) 2nd part of the duodenum - The distal segment of the duodenum is supplied by the superior mesenteric artery and the inferior pancreaticoduodenal artery. b) jejunum = jejunal arteries (branches of the superior mesenteric artery) c) ilium = The ileocolic artery is the most inferior branch of the superior mesenteric artery. d) ascending colon = superior mesenteric artery via the ileocolic and right colic arteries.

Question 30

Which of the following muscles are supplied by the musculocutaneous nerve? a) triceps brachii b) deltoid c) pec major d) brachialis e) trapezius

Answer 30

**d) brachialis** The musculocutaneous nerve innervates the 3 muscles of the _ANTERIOR_ compartment of the arm (flexors): 1. coracobrachialis 2. biceps brachii 3. brachialis. _POSTERIOR_ compartment arm = Radial nerve = extensor compartment

Question 31

What are the 3 muscles compartments of the leg? Innervation? Muscles? Function?

Answer 31

Leg - 3 muscle groups: * **Anterior** – dorsiflexes the foot * Innervation = deep fibular nerve * 3 Muscles = tibialis anterior, extensor digitorum longus and extensor hallucis longus. * **Posterior** – plantarflexes the foot * Innervation = tibial nerve. * 7 Muscles = gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus and flexor hallucis longus. * **Lateral** **compartment** – everts the foot and is * Innervation = superficial fibular nerve. * 2 Muscles = fibularis longus and fibularis brevis.

Question 32

“Wrist drop” is a clinical condition denoting the inability to extend the wrist, caused by damage to which nerve? a) radial b) ulnar c) median d) musculocutaneous e) long thoracic

Answer 32

**a) radial** Posterior compartment = Radial nerve = Wrist + hand EXTENSORS

Question 33

A 64 year old female presents with a pulmonary thromboembolism. Track the appropriate course of the blood clot to the obstructed artery. a) inferior vena cava -\> right atrium -\> mitral valve -\> right ventricle -\> pulmonary trunk -\> left pulmonary artery b) inferior vena cava -\> left atrium -\> mitral valve -\> left ventricle -\> pulmonary trunk -\> left pulmonary artery c) inferior vena vaca -\> right atrium -\> tricuspid valve -\> right ventricle -\> pulmonary trunk -\> left bronchial artery d) coronary sinus -\> right atrium -\> tricuspid valve -\> right ventricle -\> pulmonary trunk -\> left pulmonary artery e) inferior vena cava -\> right atrium -\> tricuspid valve -\> right ventricle -\> pulmonary trunk -\> left pulmonary artery

Answer 33

pulmonary thromboembolism (obstruction of a pulmonary artery due to a blood clot). e) inferior vena cava -\> right atrium -\> tricuspid valve -\> right ventricle -\> pulmonary trunk -\> left pulmonary artery

Question 34

Consider that the inferior gluteal nerve is severed by a knife just as the nerve emerges from the greater sciatic foramen. Which of the following statements is true? a) the adductor part of the adductor magnus muscle would be affected b) abduction of the thigh would be eliminated c) muscles in the posterior compartment of the leg would be paralysed d) extension of the thigh would be the action most affected e) adduction of the thigh would be eliminated

Answer 34

**d) extension of the thigh would be the action most affected** **Inferior gluteal nerve** (L4–S1) - supplies the gluteus maximus, obturator internus, gemelli, and quadratus muscles. It contributes to extension of the thigh at the hip and to outward rotation (abduction) of the thigh. * ***Abduction*** = moving away from the midline * ***Adduction*** = coming towards the midline

Question 35

The first branch of the subclavian artery is: 1. Superior thoracic artery 2. Vertebral artery 3. Internal thoracic artery 4. Thyrocervical trunk 5. Axillary artery

Answer 35

The first branch of the subclavian artery is: 1. Superior thoracic artery 2. **Vertebral artery** 3. Internal thoracic artery 4. Thyrocervical trunk 5. Axillary artery The subclavian arteries give off five major arteries each: the vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk, and the dorsal scapular artery.

Question 36

The median nerve supplies which of the following muscles 1. Flexor carpi radialis 2. Flexor carpi ulnaris 3. FDS 4. Pronator teres 5. Palmaris Longus

Answer 36

The median nerve supplies which of the following muscles 1. **Flexor carpi radialis** 2. Flexor carpi ulnaris 3. **FDS** = Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. 4. **Pronator teres** 5. Palmaris Longus The anterior forearm compartment is split into 3 categories: superficial, intermediate and deep. In general, muscles in the anterior compartment of the forearm perform flexion at the wrist and fingers, and pronation. Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand.

Question 37

The deep peroneal (fibular) nerve supplies which of the following muscles 1. Peroneus Longus 2. Peroneus Brevis 3. Tibialis posterior 4. Tibialis anterior 5. Flexor digitorum longus

Answer 37

The deep peroneal (fibular) nerve supplies which of the following muscles 1. Peroneus Longus 2. Peroneus Brevis 3. Tibialis posterior 4. **Tibialis anterior** 5. Flexor digitorum longus deep peroneal (fibular) nerve = Anterior compartment of leg = Dorsiflexion 1. Tibialis anterior 2. Extensor hallucis longus 3. Extensor digitorum longus 4. Fibularis tertius

Question 38

Damage to which of the structures below will lead to faecal incontinence: 1. Bulbospongiosus muscle 2. Puborectalis muscle 3. Internal anal sphincter muscle 4. Deep transverse perineal muscle 5. External anal sphincter

Answer 38

Damage to which of the structures below will lead to faecal incontinence 1. Bulbospongiosus muscle 2. **Puborectalis muscle** = a muscular sling that wraps around the lower rectum as it passes through the pelvic floor. It serves an important role in helping to maintain fecal continence and also has an important function during the act of having a bowel movement. 3. Internal anal sphincter muscle 4. Deep transverse perineal muscle 5. External anal sphincter

Question 39

What is the function of the Bulbospongiosus muscle?

Answer 39

**Bulbospongiosus** **muscle** - acts to expel remaining urine from the urethra after the bladder has completed its emptying.

Question 40

What does the Deep transverse perineal muscle do?

Answer 40

**Deep transverse perineal muscle** lies in the perineum, a part of the pelvic floor. * Innervation = pudendal nerve. * Functions = fixation of the perineal body (central tendon of perineum), support of the pelvic floor, expulsion of semen in males and last drops of urine in both sexes. Also superficial transverse perineal muscle

Question 41

The pelvic floor is made up of the following muscle 1. Pubococcygeous, puborectalis & illiococcygeous, coccygeus 2. Levator ani & obturator internus 3. Levator ani obturator internus and piriformis 4. Obturator internus and the piriformis muscle 5. Obturator internus and the piriformis muscle & coccygeous

Answer 41

The pelvic floor is made up of the following muscles: 1. Pubococcygeous 2. Puborectalis 3. lliococcygeous 4. Coccygeus **Levator ani muscles** (largest component) = The levator ani is a broad sheet of muscle. It is composed of three separate paired muscles; pubococcygeus, puborectalis and iliococcygeus + **Coccygeus muscle.**

Question 42

An operation on the right parotid gland has causes the patient’s right face to droop. In this situation, which one of the following is likely to be true: 1. The patient should be able to raise both eyebrows fully and equally 2. The right pupil will be dilated 3. The left pupil will be dilated 4. The right eyelid will be ptsosed (will droop) 5. The patient will be unable to puff out the cheeks properly

Answer 42

**e. The patient will be unable to puff out the cheeks properly** The facial nerve (cranial nerve VII), gives rise to five terminal branches within the parotid gland - innervate muscles of facial expression. Oculomotor nerve (III) is responsible for the control of the pupil (constriction) via parasympathetic fibres (this is opposed by dilator tone controlled by sympathetic pathways). Eyelid = Occulomotor

Question 43

Which of the following is the most likely complication of a fracture of the neck of the humerus: 1. Numbness of the skin over the humeral attachment of the deltoid 2. Winging of the scapula 3. Inability to extent the wrist 4. Inability to flex the wrist 5. Weakness of abduction of the little finger

Answer 43

Fracture of the neck of the humerus - Damage to Axilary nerve = supplies deltoid 1. **Numbness of the skin over the humeral attachment of the deltoid** 2. Winging of the scapula = long thoracic nerve + serratus anterior muscle. 3. Inability to extent the wrist 4. Inability to flex the wrist 5. Weakness of abduction of the little finger = Abductor digiti minimi + Lateral plantar nerve

Question 44

A blockage of the right coronary artery at its origin, in the majority of cases, is most likely to cause: 1. Damage to the SA node but not AV node 2. Damage to the AV node but not the SA node 3. Damage to both SA and AV node 4. Damge to neither SA or AV node 5. No damage to the left ventricle

Answer 44

A blockage of the right coronary artery at its origin, in the majority of cases, is most likely to cause: 1. Damage to the SA node but not AV node 2. Damage to the AV node but not the SA node 3. **Damage to both SA and AV node** 4. Damge to neither SA or AV node 5. No damage to the left ventricle

Question 45

At lumbar puncture, the needle is unknowingly passed through the T12-L1 interspace. At this level, the needle is reasonably likely to: 1. Damage the conus medularis of the spinal cord 2. Pass through the filum terminale 3. Be too high to enter the extradural space 4. Be too high to enter the subdural space 5. Be too high to enter the subarachnoid space

Answer 45

1. **Damage the conus medularis of the spinal cord = T12-L1** 2. Pass through the filum terminale = 3. Be too high to enter the extradural space 4. Be too high to enter the subdural space 5. Be too high to enter the subarachnoid space

Question 46

At which level would a spinal cord injury NOT effect bladder function? 1. T12 2. T4 3. S1 4. C7 5. S4

Answer 46

At which level would a spinal cord injury NOT effect bladder function? 1. T12 2. T4 3. S1 4. C7 5. **S4** The sacral micturition center is located at the S2-S4 levels and is responsible for bladder contraction.

Question 47

Left versus right-sided dominance of the heart is determined b; 1. The location of the apex beat 2. The SA node 3. Whichever ventricle is largest 4. The blood supply laying in the posterior interventricular groove 5. The person’s dominant hand

Answer 47

Left versus right-sided dominance of the heart is determined b; 1. The location of the apex beat 2. **The SA node** 3. Whichever ventricle is largest 4. The blood supply laying in the posterior interventricular groove 5. The person’s dominant hand

Question 48

Which of the following muscles is NOT innervated by CN VII 1. Stapedius 2. Frontalis 3. Obicularis Occuli 4. Masseter 5. Orbicularis Oris

Answer 48

Which of the following muscles is NOT innervated by CN VII = Facial nerve 1. Stapedius 2. Frontalis 3. Obicularis Occuli 4. **Masseter =** It receives its motor innervation from the mandibular division of the trigeminal nerve (CNV) 5. Orbicularis Oris

Question 49

A 17 year old male presents to ED with an elbow # shown on the x-ray. Which structure may be injured in this patient? 1. Median nerve 2. Radial nerve 3. Ulnar nerve 4. Musculocutaneous nerve 5. Brachial artery

Answer 49

A 17 year old male presents to ED with an elbow # shown on the x-ray. Which structure may be injured in this patient? 1. Median nerve 2. Radial nerve 3. **Ulnar nerve** 4. Musculocutaneous nerve 5. Brachial artery

Question 50

Which of the following statements is correct: 1. The femoral artery is medial to the femoral nerve and lateral to the femoral vein 2. The femoral vein is medial to the femoral nerve and lateral to the femoral artery 3. The femoral nerve is lateral to the femoral vein and medial to the femoral artery 4. The femoral canal is medial to the femoral vein and lateral to the femoral artery

Answer 50

**a. The femoral artery is medial to the femoral nerve and lateral to the femoral vein** Medial --\> Lateral = VAN (vein, artery, nerve)

Question 51

An avulsion fracture of the hamstring muscle would commonly involve which part of the hip bone? 1. Inferior pubic rams 2. Ischial spine 3. Ischial ramus 4. Ischial tuberosity 5. Illiac crest

Answer 51

Avulsion injury occurs when the hamstring muscle tendon completely tears away from the bone. Hamstring muscle tendon - insertion = ischial tuberosity (sit bone). 1. Inferior pubic rams 2. Ischial spine 3. Ischial ramus 4. **Ischial tuberosity** 5. Illiac crest

Question 52

The 6^th cranial nerve (abducent) exits the skull via the; 1. Optic canal 2. Foramen ovale 3. Foramen rotundum 4. Inferior orbital fissure 5. Superior orbital fissure

Answer 52

The 6^th cranial nerve (abducent) exits the skull via the; 1. Optic canal - CNII 2. Foramen ovale - CNV3 3. Foramen rotundum - CNV2 4. Inferior orbital fissure - no such thing 5. **Superior orbital fissure** - CNIII, CNIV, CNV1, CNV1

Question 53

A thrombus causes a major occlusion of the inferior mesenteric artery. Which of the following structures may become ischaemic? 1. The liver 2. The third part of the duodenum 3. The ascending colon 4. The transverse colon 5. The descending colon

Answer 53

Inferior mesenteric artery supplies: 1. The liver 2. The third part of the duodenum 3. The ascending colon 4. The transverse colon 5. **The descending colon**

Question 54

In the supine position the deepest part of the adomino-pelvic cavity is the: 1. Hepatorenal recess 2. Rectovesical pouch 3. Omental bursa 4. Subphrenic recess 5. Epiploic foramen

Answer 54

Supine position = lying flat on back In the supine position the deepest part of the adomino-pelvic cavity is the: 1. Hepatorenal recess 2. **Rectovesical pouch** 3. Omental bursa 4. Subphrenic recess 5. Epiploic foramen

Question 55

A lesion to the optic tract on the left side would produce? 1. Blindness in the left eye 2. Blindness in the right eye 3. Contralateral homonymous hemianopia 4. Ipsilateral homonymous hemianopia 5. Central scotoma

Answer 55

A lesion to the optic tract on the left side would produce? 1. Blindness in the left eye 2. Blindness in the right eye 3. **Contralateral homonymous hemianopia** 4. Ipsilateral homonymous hemianopia 5. Central scotoma **Contralateral**: Of or pertaining to the other side. The opposite of **ipsilateral** (the same side). **Homonymous hemianopia** = a visual field loss on the left or right side of the vertical midline.

Question 56

Which statement regarding the nerve supply to the tongue is correct? 1. Taste sensation to the anterior 2/3 is supplied by the glossopharyngeal nerve 2. Taste sensation to the anterior 2/3 is supplied by the trigeminal nerve 3. Taste sensation to the posterior 1/3 is supplied by the facial nerve 4. Temperature sensation the anterior 2/3 is supplied by the facial nerve 5. Temperature sensation to the posterior 2/3 is supplied by the glossopharyngeal nerve

Answer 56

Which statement regarding the nerve supply to the tongue is correct? **e. Temperature sensation to the posterior 2/3 is supplied by the glossopharyngeal nerve** TASTE: 1. Facial nerve (CN VII) = anterior 2/3rds 2. Glossopharyngeal nerve (CN IX) = posterior 1/3rd 3. Vagus nerve (CN X) = epiglottis region.

Question 57

Which of the following statement regarding the innervation of the tongue is FALSE 1. The motor innervation of the tongue is via the hypoglossal nerve 2. The touch sensation of the posterior third of the tongue is via the glossopharyngeal nerve 3. The taste sensation of the posterior third of the tongue is via the glossopharyngeal nerve 4. The touch sensation of the anterior 2/3 of the tongue is via the trigeminal nerve 5. **The taste sensation of the anterior two thirds of the tongue is via the trigeminal nerve**

Answer 57

**e. The taste sensation of the anterior two thirds of the tongue is via the trigeminal nerve** = FALSE - taste sensation of anterior 2/3rds tongue = chorda tympani nerve, a branch of the facial nerve (CN VII).

Question 58

What is the name of the main legislative instrument that governs the conduct of medical practitioners in NSW? (1 mark)

Answer 58

The Health Practitioner Regulation National Law (NSW) 86A

Question 59

Under The Health Practitioner Regulation National Law (NSW) 86A a medical practitioner has a duty to render medical services within a reasonable time to a person if the practitioner has reasonable cause to believe the person is in need of urgent attention by a medical practitioner. Under what circumstance, in this legislation is a practitioner excused from this duty? (2 marks)

Answer 59

If the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time.

Question 60

In considering the vulnerability of patients and their safety in a health care setting, list four groups of patients who are recognised as being the most vulnerable: (0.5 mark each, max 2 marks)

Answer 60

**Vulnerable patient groups:** 1. The very young 2. The elderly 3. Patients from Culturally and linguistically diverse backgrounds 4. Patients with mental illness 5. (Patient with chronic illness who are transitioning the health system)

Question 61

List the four main elements that must be satisfied in order for a consent to a medical procedure to be valid: (1 mark each, max 4 marks)

Answer 61

**Components of Valid Consent** 1. The patient must be competent / have capacity 2. The patient must be informed of the procedure including the material risks 3. The consent must be obtained without duress 4. The consent must be specific to the procedure undertaken

Question 62

List the four main reasons why a medical practitioner owes a duty of care to a patient: (1 mark each, max 4 marks)

Answer 62

**Why Drs owe Duty of Care to patients:** 1. The Practitioner’s special knowledge and skill 2. Patient vulnerability and the degree of influence exercised by the practitioner 3. The Practitioner’s assumption of responsibility 4. Patient reliance on advice given by the Practitioner

Question 63

The Cancer Council of Australia estimates that approx. 1.5 million Australians, engaged in 51 different industries, have been identified as potentially exposed to carcinogens in the course of their normal work. List six environmental carcinogens to which Australian workers are potentially exposed: (0.5 mark each, max 3 marks)

Answer 63

Environmental carcinogens to which Australian workers are potentially exposed: 1. UV radiation 2. Ionising radiation 3. Asbestos 4. Silica 5. Sawdust 6. Metals/arsenic/chromium/nickel

Question 64

Over a six-month period, 7 young people aged under 18 years from the small rural community of Erewhon died in motor vehicle crashes, and 6 young people are still recovering from severe injuries. Surveillance data show that these incidents all occurred on Friday or Saturday nights, on the road between Erewhon and the nearest town about 40 kilometres away. Coronial inquests determined that alcohol, excessive speed and inexperience were factors in all incidents. Interviews with community members found that private motor vehicles are the only form of transport in the community, and that it is easy for young people to buy cheap cars from a local ‘wrecker’. Using the information above, identify and briefly describe two actions the Erewhon community could implement to reduce the incidence and severity of road traffic injury among young people in their community.

Answer 64

1. **Organise affordable safe transport from Erewhon to town on weekend nights** 2. **Increase enforcement of speed limits on local roads** 3. Enforce law on sale of alcohol to minors 4. Enforce blood alcohol limits for drivers on local roads/ increase random breath testing on local roads 5. Community program to reduce access of young people to alcohol 6. Develop appropriate and attractive youth services and activities in Erewhon to reduce need to travel

Question 65

In March 2009 communicable disease surveillance system of the Government of Mexico identified several cases of influenza-like illness in otherwise healthy young adults, with a rapid rise in the number of cases over the next month. The viruses in this outbreak had not been previously detected in pigs or humans. Identify four population-level actions that could be taken to control the spread of this disease. (1 mark each, max 4 marks)

Answer 65

1. Quarantine human source of infection (or affected individuals) 2. Promote influenza immunisation as there may be cross-protection 3. Diagnose and treat infected persons to prevent secondary spread 4. Control of disease vectors * Public education about hygiene (e.g. handwashing, masks) * Encourage symptomatic people to remain at home (not to go to work) * Maintain open communication at all times

Question 66

Complete the following table in terms of myotomes: (0.5 mark each, max 3 marks)

Answer 66

Question 67

Describe three typical signs or symptoms of acute leukaemia, and explain their underlying pathophysiology. (0.5 mark each, max 3 marks)

Answer 67

Question 68

For a person with a stroke volume (SV) of 80 ml/beat and a cardiac output (CO) of 4.0 L/min, calculate the heart rate (HR) showing working of the answer and including the correct units. (2 marks)

Answer 68

**CO = HR x SV** 4000 = HR x 80 HR = 4000/80 HR = 50bpm

Question 69

Inhalation and micro-aspiration deliver potential pathogens to the respiratory tract. What are the mechanisms of host defence against these pathogens? (1.5 marks)

Answer 69

_Respiratory Tract - Host Defences_ 1. **Nasal Clearance** * **​​**Sneezing, blowing, and swallowing (0.5) 2. **Tracheobronchial clearance** * **​​**mucociliary transport action) / mucociliary escalator (0.5) 3. **Alveolar** **clearance** * (alveolar macrophages) (0.5)

Question 70

List three factors that perturb the respiratory tract defence mechanisms and may predispose to pneumonia: (0.5 mark each, max 1.5 marks)

Answer 70

1. Age \> 50 / increasing age 2. Harmful levels of alcoholism 3. Smoking * Manoeuvred airways (e.g. asthma and COPD) * Very young age / aged less than 6 weeks * Malnutrition * Cystic fibrosis

Question 71

Provide four clinical signs expected in a patient with hypovolaemic shock: (0.5 mark each, max 2 marks)

Answer 71

**Clinical signs of Hypovolaemic shock** 1. The appearance to be pale 2. Low BP 3. Tachycardia 4. The respiratory rate to be elevated / increased/ tachypnea * The urine output to be low * Cold, clammy hands / cool peripheries * Sweating * Delayed capillary return

Question 72

What is the fundamental problem that characterizes progressive shock?

Answer 72

**Characteristic of Progressive Shock** Persistent reduction in mean arterial pressure results in reduced perfusion of vital organs (heart, kidney) that would otherwise mediate compensatory responses to the shock. The compensatory mechanisms begin failing to meet tissue metabolic needs, and the shock cycle is perpetuated. **=** w/o intervention the patient’s condition will get progressively worse and result in death. ‘The shock itself breeds more shock’ = positive feedback

Question 73

Meiosis and mitosis are both processes that involve nuclear division. They result in cells with differing chromosome numbers. Explain the differences between the two processes. (2 marks)

Answer 73

1. No of chromosomes * Mitosis is nuclear division which ultimately leads to diploid somatic cells. * Meiosis is nuclear division which ultimately leads to haploid gametes (half no. of chromosomes) 2. No of cells * Mitosis: generation of 2 identical daughter cells * Meiosis: generation of one to four non-identical gametes sperm or ova

Question 74

A 56-year-old man was admitted to hospital with pneumonia. The bacterium responsible for the pneumonia was thought to be resistant to antibiotics. The clinician asked for sensitivity tests against a range of antibiotics. Define “Minimum inhibitory concentration” (MIC) levels.

Answer 74

**Minimum inhibitory concentration (MIC) levels** = Lowest concentration (1) of antibiotic which inhibits visible growth (0.5) in broth or agar after overnight incubation of standard inoculum. (0.5)

Question 75

The complement system is important in host defence against infection, list three important functions of the complement system. (1 mark each, max 3 marks)

Answer 75

**Functions of the Complement System** 1. Lysis of cells (bacteria/viruses) 2. Opsonisation (covering of pathogen leads to phagocytosis particulate antigens) 3. Activation of Inflammatory Response 4. Clearance of Immune Complexes (deposition spleen/liver)

Question 76

What clinical features of the skin help you to identify a skin problem as acne? (0.5 mark each, max 1.5 marks)

Answer 76

**Clinical features of skin - Acne Diagnosis** 1. Open and closed comedones 2. Papules 3. Pustules * Nodules * Cysts

Question 77

Explain the role of Proprionibacterium acnes in the pathogenesis of acne. (0.25 mark each max 1.5 marks)

Answer 77

**Pathogenesis of acne - role of *Proprionibacterium acnes*** P acnes is skin normal flora (0.25). It resides in the follicular duct (0.25). It is able to produce lipase (0.25) which acts on sebum (0.25) whose production is increased by the androgen (0.25) increase associated with puberty. Lipase breaks down sebum and these products have an inflammatory effect (0.25) on the skin

Question 78

A 16-year-old old rugby player is brought to the ED after a heavy tackle. He is complaining of back pain and is tender near the left lumbar region but there is no other sign of injury. You note that he is pale, sweaty, has a rapid pulse and low BP. Your registrar instructs you to insert an intravenous (IV) line. Give two possible reasons for needing an IV line in place. (1 mark each, max 2 marks)

Answer 78

1. Patient may need IV fluids because he is in shock 2. Patient may need blood transfusion because he is bleeding internally  Patient may need IV analgesia because of pain

Question 79

Outline the site and mechanism of action of H2-receptor antagonists used in the management of peptic ulcer disease.

Answer 79

H2 receptor antagonists are competitive inhibitors (0.5) of histamine (0.5) at the parietal cell H2 (0.5) receptor. They reduce secretion of hydrochlonic acid (0.5) by the parietal cell.

Question 80

Name 3 classes of drugs that could be used for reflux.

Answer 80

**Classes of drugs used for reflux** 1. Proton pump inhibitor 2. Antacids 3. H2 receptor antagonists

Question 81

You are examining a patient who has a red, swollen and painful area on the skin of the lower limb. List four major causes of acute inflammatory reaction that could give rise to the finding. (1 mark each, max 4 marks)

Answer 81

**Causes of Acute Inflammation of Skin** 1. Trauma 2. Infection (bacterial / fungal / viral) 3. UV light/radiation 4. Chemical or thermal burn / scald * all causes of necrotic cell death (e.g. ischaemia) * disorder of immunity (e.g. hypersensitivity) * radiation therapy

Question 82

A 78-year-old man presents to the clinic because of difficulty passing urine at night. After a brief history, your provisional diagnosis is benign prostatic hyperplasia (BPH). List four common symptoms of BPH.

Answer 82

**Common Symptoms of BPH** 1. Hesitancy (difficult initiation) 2. Urgency 3. Poor stream/decrease flow, stream/spraying /splitting 4. Frequency / nocturia = frequent urination at night 5. Incomplete emptying 6. Terminal dribbling of urine 7. Strangury = a condition caused by blockage or irritation at the base of the bladder, resulting in severe pain and a strong desire to urinate. 8. Pis-en-deux (double voiding) = the need to go again right after you have gone 9. Overflow incontinence

Question 83

Briefly outline why the prostate enlarges with age. (2 marks) Prostate is an endocrine dependent tissue Respond to dihydro-testosterone by hyperplasia  Estrogen at physiological male levels potentates hyperplasia by inducing androgen receptors

Answer 83

**Reasons prostates enlarge with age** 1. Prostate is an endocrine dependent tissue - endocrine function reduces with age 2. Respond to dihydro-testosterone by hyperplasia 3. Estrogen at physiological male levels potentates hyperplasia by inducing androgen receptors

Question 84

# Fill in the blanks - In a plain radiograph of the abdomen... 1. Gas is ....... in colour 2. Calcium is ....... in colour 3. Soft tissue is ....... in colour 4. Fat is ....... in colour (0. 5 mark each, max 2 marks)

Answer 84

# Fill in the blanks - In a plain radiograph of the abdomen... 1. Gas is **Black** in colour 2. Calcium is **White** in colour 3. Soft tissue is **Grey** in colour 4. Fat is **Dark** **Grey** in colour (0. 5 mark each, max 2 marks)

Question 85

A 30-year-old chef presents with jaundice and malaise. A diagnosis of Hepatitis A is made. Nominate four principles of containing the spread of the infection. (1 mark each, max 4 marks)

Answer 85

**Hep A Transmission Prevention** 1. Maintaining effective hygiene / hand washing / faecal oral route transmission measures 2. Home isolation / absence from work 3. Contact tracing / restaurant cleaning / education 4. Future Hep A vaccination

Question 86

A 15-year-old girl visited her GP a month ago with symptoms of a urinary tract infection (UTI). Urine culture grew Esherischia coli (E.coli), sensitive to trimethoprim. The GP prescribed trimethoprim for her, and recommended her to increase her fluid intake. Describe the appearance and Gram staining characteristics of E.coli?

Answer 86

**Appearance and Gram staining characteristics of E.coli** Gram –ve (0.5) rod (0.5) = PINK stain

Question 87

Explain why E.coli is a pathogen commonly found in UTI. (2 marks)

Answer 87

E.coli is a pathogen commonly found in UTI because: 1. Normal flora in gastrointestinal tract 2. Contamination of urinary tract from intestinal flora

Question 88

What are the anatomical landmarks for the porta hepatis, and what are its contents (5)?

Answer 88

_Porta Hepatis (hilum of liver)_ **Anatomical landmarks:** The porta hepatis is a tranverse fissure located on the posteroinferior surface between the caudate and quadrate lobes through which structures supplying and draining the liver enter and leave. **Contents:** 1. Portal vein 2. Right + Left hepatic ducts 3. Right + Left hepatic arteries 4. Hepatic nerve plexus 5. Lymph vessels

Question 89

What structures do lymphatics (components of the lymphatic system) usually accompany?

Answer 89

Lymph vessels tend to accompany veins, with superficial lymphatics accompanying superficial veins and deep lymphatics accompanying deep veins.

Question 90

What is unusual about the lymph vessels in areas drained by the portal venous system (intestinal lymphatics)?

Answer 90

Intestinal lymphatics DO NOT accompany veins. Instead, lymph vessels will follow unpaired branches of the aorta and drain into the intestinal lymph trunk.

Question 91

The branch of medicine known as epidemiology is transitioning from a black box analysis to a system approach variously analogous to ‘Chinese boxes’ or ‘Russian dolls’. ## Footnote Black box epidemiology is the study of: A. Anthropometry and lifestyle factors B. Exposures and outcomes C. Fertility and life expectancy D. Eco-socio-cultural factors influencing health E. Incidence of disease in rural vs urban settings

Answer 91

Black box epidemiology is the study of: A. Anthropometry and lifestyle factors **B. Exposures and outcomes** C. Fertility and life expectancy D. Eco-socio-cultural factors influencing health E. Incidence of disease in rural vs urban settings

Question 92

The life expectancy of the most well-known group of people with intellectual disability since childhood, people with Down Syndrome, has risen significantly internationally from 15 years in the 1950s to 25 years in the 1980s and 50 years in the year 2000. This has been notable in Australia at a population level, with accommodation ‘normalization’, as well as with health measures such as a trend to prioritizing surgical intervention for cardiac abnormalities in this group. Notably some people with the ‘mosaic’ form of Down Syndrome are living into their 80s (similar to the general population). However the incidence of Down Syndrome live births in Australia has remained constant for the past decade, at about 300 live births per year, thought to be due to the availability of termination of pregnancy. If this situation continues it could be predicted that the prevalence of people with Down Syndrome, over the next 30 years A. Will rise for the next 30 years. B. Will be dependent on the percentage of live births who have a mosaic chromosomal abnormality. C. Will be dependent on the prevalence of live births in specific socioeconomic groups. D. Will be dependent on the rate of live births compared with the impact of lifestyle on the rate of death. E. Will be dependent on the quality of accommodation support for adults with Down Syndrome no longer living with their parents.

Answer 92

If this situation continues it could be predicted that the prevalence of people with Down Syndrome, over the next 30 years: D. Will be dependent on the rate of live births compared with the impact of lifestyle on the rate of death.

Question 93

The following histograms outline the Australian experience of harm from alcohol use between 2010 and 2013. Between 2010 and 2013 the prevalence in the population of people who reported being victims of physical abuse from recent drinkers: A. Dropped from 2% to 1% of the population B. Rose from 400,000 to 500,000 people C. Did not rise significantly D. Rose from 8% to 9% of the population E. Declined from 1.7M to 1.5M people

Answer 93

Between 2010 and 2013 the prevalence in the population of people who reported being victims of physical abuse from recent drinkers: A. Dropped from 2% to 1% of the population B. Rose from 400,000 to 500,000 people C. Did not rise significantly - *cannot say what is significant* **D. Rose from 8% to 9% of the population** E. Declined from 1.7M to 1.5M people

Question 94

The two viral liver infections for which there are no vaccines available in Australia are A. Hep A and Hep B B. Hep B and Hep D C. Hep C and Hep D D. Hep A and Hep D E. Hep C and HepE

Answer 94

The two viral liver infections for which there are no vaccines available in Australia are A. Hep A and Hep B B. Hep B and Hep D C. Hep C and Hep D D. Hep A and Hep D **E. Hep C and Hep E** Hep A, Hep B (Hep D = secondary to Hep B) = all have vaccines

Question 95

The thalassaemias are the commonest single gene disorders in the world’s population and are a common cause of hereditary anaemia. The global prevalence of the carrier state is approximately 7%, and 1.7% of the population has one of these disorders. In Australia it is estimated that there are approximately 500 people with a thalassaemia, and they are mostly people with a Mediterranean background. However we are increasingly seeing migration of people carrying the genetic abnormality and there is an expectation that the numbers of children born with the disorder in Australia will continue to grow. The main group of people from areas where the thalassaemias are common, who are migrating to Australia, are those from: A. Russia B. India C. Canada D. SouthPacific E. SouthAmerica

Answer 95

The main group of people from areas where the thalassaemias are common, who are migrating to Australia, are those from: A. Russia **B. India** C. Canada D. SouthPacific E. SouthAmerica

Question 96

A disease is said to be endemic if it is continuously present in a particular region or population, as measured by regional surveillance systems. Which one of the following disease-region combinations is an example of an endemic situation? A. Ross River virus infection in several states of Australia B. Dengue in WA and Southern QLD C. Histoplasmosis in the NT D. Malaria in Northern QLD E. Barmah Forest Virus infection in SA

Answer 96

_Example of an Endemic_ ## Footnote **A. Ross River virus infection in several states of Australia** B. Dengue in WA and Southern QLD C. Histoplasmosis in the NT D. Malaria in Northern QLD E. Barmah Forest Virus infection in SA

Question 97

During her clinical attachment in a GP practice, a first-year medical student observed a consultation with a four-year-old child with otitis media. The GP did not recommend antibiotics for this patient. The student decided to search medical literature to learn more about this situation. Which one of the following types of publication 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. Randomised controlled trial

Answer 97

D. Systematic review

Question 98

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

Answer 98

D. Decrease in the incidence of cystic fibrosis in live births

Question 99

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

Answer 99

E. Overseas travellers

Question 100

The following data refer to the performance of a screening test for cancer X. Which one of the following is the sensitivity of the test? 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%

Answer 100

Which one of the following is the sensitivity of the test? Sensitivity = true positives = test positive/all who have disease 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%

Question 101

Internationally 240 million people have chronic hepatitis B virus infection and 150 million people have chronic hepatitis C virus infection. These are measures of which one of the following? A. Attributable risk B. Incidence C. Prevalence D. Relative risk E. Risk factor

Answer 101

C. Prevalence

Question 102

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. Riskfactor

Answer 102

D. Relative risk

Question 103

Cancer Council Australia has recognised many agents, exposure to which have a heightened risk for development of cancer. Which one of the following habits has a known association with the development of cancer in adult humans? A. Drinking excessive amounts of alcohol B. Using artificial sweeteners containing Aspartame C. Packaging of food with material containing Bisphenol A D. Use of amalgam in dental procedures E. Using cosmetics containing sodium lauryl sulfate

Answer 103

A. Drinking excessive amounts of alcohol

Question 104

The sensitivity for Test A is 99% and the specificity of Test A is 67%. Which one of the following statements about false positive or negative rates is most correct for test A? It has a: A. low false positive rate B. low false negative rate C. high false negative rate D. medium false negative rate E. medium false positive rate

Answer 104

**B. low false negative rate** Sensitivity = true positives = 99% - so 1% will be false negatives Specificity = true negatives = 67% - so 33% false positives

Question 105

“Absence of fidgety movements” at age 3 months is a clinical sign that is 100% sensitive for a later diagnosis of cerebral palsy when assessed by trained health professionals in a high-risk infant population. Which of the following statements is most correct about sensitivity of 100% in the relationship between this clinical sign and the condition of cerebral palsy? A. All babies with the clinical sign will develop cerebral palsy B. The clinical sign is a necessary cause of cerebral palsy C. All babies who later develop cerebral palsy have the clinical sign D. The clinical sign is a sufficient cause of cerebral palsy E. Babies without the clinical sign are in a latent phase of cerebral palsy

Answer 105

C. All babies who later develop cerebral palsy have the clinical sign

Question 106

The Campylobacter-Like-Organism (rapid urease) test sensitivity = 90% and specificity = 96% in a population with a prevalence rate of H. Pylori infection in the population of 70%. In 1,000 people in this population, there will be x people infected and y people not infected. Which of the following combinations is correct? A. x=960, y=40 B. x=900, y=100 C. x=800, y=200 D. x=700, y=300 E. x=40, y=960

Answer 106

D. x=700, y=300

Question 107

During fasting several hormones are activated. Which of the following hormone/effects is characteristic of the fasting state? A. Thyroid hormone levels rise/promoting glycolysis B. Glucagon levels rise/promoting glycogenolysis C. Cortisol levels rise/promoting lipogenesis D. Growth hormone levels rise/promoting lipogenesis E. Insulin levels rise/promoting gluconeogenesis

Answer 107

**B. Glucagon levels rise/promoting glycogenolysis** **Glucagon** = a peptide hormone, produced by alpha cells of the pancreas. It raises concentration of glucose and fatty acids in the bloodstream, and is considered to be the main catabolic hormone of the body. **Glycogenolysis** = the breakdown of the molecule glycogen into glucose - occurs when fasting + sugar needed from stores

Question 108

A key muscle of the rotator cuff involved in abduction of the shoulder is: A. Teres major B. Deltoid C. Supraspinatus D. Trapezius E. Latissimus dorsi

Answer 108

**C. Supraspinatus** Four muscles make up the rotator cuff: 1. Subscapularis 2. Teres minor 3. Supraspinatus 4. Infraspinatus.

Question 109

Innervation of the urinary bladder involves: A. sympathetic fibres reaching the bladder from S2,3,4 B. parasympathetic fibres reaching the bladder from L1,2 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

Answer 109

A. sympathetic fibres reaching the bladder from S2,3,4 = False - Sympathetic = L2-4 B. parasympathetic fibres reaching the bladder from L1,2 = = False - S2-4 **C. the pudendal nerve innervation of the external sphincter** D. the detrusor muscle and external sphincter being supplied by the hypogastric nerve = False - detrusor (paras. - pelvic splanchnic nerves + symp - inferior hypogastric plexus) E. voluntary control of the internal sphincter of the bladder = False - internal sphincter is involuntary + External sphincter is voluntary.

Question 110

A femoral hernia occurs more frequently in females because: A. Women have more omental fat B. Child birth causes femoral nerve compression against the inguinal ligament C. The pelvis angle in women contributes to a larger gap D. Child birth in the lithotomy position causes sciatic neuropathy E. Women are more likely to have had inguinal hernia repairs

Answer 110

C. The pelvis angle in women contributes to a larger gap

Question 111

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. Diabetes insipidus B. Nephrotic syndrome C. Carcinoma of the prostate D. Benign prostatic hyperplasia E. Acuteprostatitis

Answer 111

D. Benign prostatic hyperplasia

Question 112

Your patient’s X-ray of the abdomen is reported as having normal bowel gas in the large intestine. What of the following X-ray findings distinguishes large intestine from small intestine? A. Central location of the bowel gas B. Valvulae conniventes C. Mucosal folds stretching partway around the diameter of bowel loops D. Plicae circulares E. Mucosal folds stretching fully around the diameter of bowel loops

Answer 112

A. Central location of the bowel gas B. Valvulae conniventes **C. Mucosal folds stretching partway around the diameter of bowel loops** = haustra D. Plicae circulares E. Mucosal folds stretching fully around the diameter of bowel loops The small bowel's mucosal folds are known as valvulae conniventes (plicae circulares) and are visible across the full width of the bowel. The large bowel wall features pouches or sacculations that protrude into the lumen, known as haustra. The haustra are thicker than the valvulae conniventes of the small bowel and typically do not appear to completely traverse the bowel.

Question 113

Compound X is an inhibitor of Phosphoenolpyruvate Carboxykinase (PEPCK). Administration of compound X to a patient will: A. Increase the rate of glycogenolysis B. Decrease the rate of gluconeogenesis C. Increase the rate of glycogen synthesis D. Decrease the rate of glycogen synthesis E. Decrease the rate of glycolysis

Answer 113

**B. Decrease the rate of gluconeogenesis** ## Footnote **Gluconeogenesis** = a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates. **Phosphoenolpyruvate Carboxykinase (PEPCK)** = an enzyme used in the metabolic pathway of gluconeogenesis. It converts oxaloacetate into phosphoenolpyruvate and carbon dioxide. Compound X inhibits PEPCK so PEPCK cannot continue gluconeogenesis + form glucose

Question 114

Which of the following molecules are involved in the intrinsic pathway of apoptotic cell death? A. perforin B. granzymes C. pro-caspase-9 D. pro-caspase-8 E. lysozyme

Answer 114

**C. pro-caspase-9**

Question 115

What reaction is catalysed by a β-lactamase enzyme? A. The final cross-linking reaction to split the bacterial wall B. The hydrolysis of the acyl side ring from penicillin structures C. The transesterification reaction with a carboxylic acid group D. The hydrolysis of the four-membered ring present in penicillins E. The breakdown of the penicillin structure into amino acids valine and cysteine

Answer 115

**D. The hydrolysis of the four-membered ring present in penicillins** **β-lactamases** = enzymes produced by bacteria that provide multi- resistance to β-lactam antibiotics such as penicillins, cephalosporins. **β-lactam** = four-atom ring

Question 116

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

Answer 116

_Normal skin commensal_ **A. Staphylococcus epidermidis** B. Staphylococcus pyogenes C. Streptococcus pneumoniae D. Escherichia coli E. Campylobacter jejuni

Question 117

There are now several opioid receptors described and several sites in the body are receptive to the actions of opioid analgesics. Opioid analgesics are sometimes associated with the production of pulmonary disease. The most common pulmonary complication after oral ingestion is: A. Interstitial fibrosis B. Pulmonary calcification C. Pulmonary oedema D. Bronchoconstriction E. Pleural effusion

Answer 117

**Pulmonary complication of Opioid analgesic** C. Pulmonary oedema

Question 118

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

Answer 118

**Characteristics of malignant neoplasms:** 1. More rapid increase in size 2. Less differentiation (or lack of differentiation, called anaplasia) 3. Tendency to invade surrounding tissues 4. Ability to metastasize to distant tissues **Cytologic features of malignant neoplasms:** 1. Increased nuclear size (with increased nuclear/cytoplasmic ratio--N/C ratio). 2. Variation in nuclear or cell size (pleomorphism). 3. Lack of differentiation (anaplasia). 4. Increased nuclear DNA content with subsequent dark staining on H and E slides (hyperchromatism). 5. Prominent nucleoli or irregular chomatin distribution within nuclei. 6. Mitoses (especially irregular or bizarre mitoses).

Question 119

Respiration involves inspiration and expiration. The primary muscle of respiration during quiet breathing is the diaphragm. The accessory muscles recruited for forceful expiration include: A. Sternocleidomastoid B. Scalenes C. Serratus anterior D. Internal intercostals E. Pectoralis minor

Answer 119

**D. Internal intercostals** * **Primary inspiratory muscles** = diaphragm + external intercostals. * **Relaxed normal expiration** = a passive process, happens because of the elastic recoil of the lungs and surface tension. * **Forceful expiration** = internal intercostals, intercostalis intimi, subcostals and the abdominal muscles.

Question 120

A 55-year-old man visited a doctor with a complaint of fatigue. He had a 3-year history of diabetes mellitus, performed appropriate diet, regularly took glibenclamide 5 mg before breakfast and metformin 500 mg after breakfast and dinner. He was obese and sedentary. Laboratory examination revealed fasting and 2 hours post prandial glucose levels of 160 mg/dl (normal: 70-100) and 250 mg/dl (normal: \<140), respectively. ## Footnote What is the most likely cause of hyperglycemia in this case? A. The decrease of pancreatic beta cell function B. The increase of pancreatic beta cell function C. Gluconeogenesis D. The increase of lipolysis E. Insulin resistance

Answer 120

E. Insulin resistance

Question 121

Which two nerves conduct the impulses for the flexion of the elbow 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

Answer 121

**C. Musculocutaneous and radial** * _Flexion (bending) of elbow_ = biceps brachii, brachioradialis and the brachialis = Musculocutaneous * _Extension (straightening the arm) of elbow_ = triceps = Radial nerve * _Extension of wrist_ = Extensor carpi radialis longus = Radial nerve

Question 122

Oxidation of fatty acids in liver mitochondria may directly contribute to gluconeogenesis by: A. Leading to ATP synthesis B. Contributing 2-carbon fragments toward glucosesynthesis C. Contributing FADH2 and NADPH D. Transporting carnitine into the mitochondrion E. Decreasing the dependence of energy generation on oxygen consumption

Answer 122

A. Leading to ATP synthesis

Question 123

A 45-year-old man with untreated diabetes presents with symptoms of thirst, frequent urination, weight loss, hyperventilation, and fatigue. Blood analysis reveals above normal glucose levels and below normal bicarbonate levels, pH, and partial pressure of carbon dioxide (PCO2). Which of the following metabolic pathways is most active in the liver of this patient? A. Gluconeogenesis B. Glycolysis C. Glycogenesis D. Fatty acid synthesis E. Lipolysis

Answer 123

**A. Gluconeogenesis** = reverse of glycolysis = formation of glucose from The patient is hyperglycaemic - high blood glucose levels because insulin not working and cannot move glucose from blood to cells --\> cells think they're starving = triggers **Glycogenesis** = the formation of glycogen from sugar.

Question 124

Which one of the following is a secondary immunodeficiency? A. Hodgkin’s disease B. IgA deficiency C. X-linked agammaglobulinaemia D. Severe combined immunodeficiency E. Leukocyte adhesion deficiency

Answer 124

**A. Hodgkin’s disease** = a type of lymphoma (blood cancer) that starts in the lymphatic system **4 groups of primary immunodeficiencies:** 1. Antibody deficiencies - eg. X-linked agammaglobulinaemia 2. Combined immunodeficiencies - eg. SCID 3. Complement deficiencies 4. Phagocytic cell deficiencies **Causes of secondary immunodeficiencies:** 1. severe burns. 2. chemotherapy. 3. radiation. 4. diabetes. 5. malnutrition.

Question 125

In which layer of the gut is the Meissner plexus of ganglion cells located? A. Mucosa B. Muscularis externa C. Serosa D. Submucosa E. Muscularis mucosae

Answer 125

**D. Submucosa** The myenteric plexus controls primarily motility; the Meissner (submucosal) plexus controls primarily fluid secretion and absorption.

Question 126

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

Answer 126

Possible consequence of iron overload? **A. liver fibrosis** - due to iron deposition in the liver B. kidney failure - iron does get filtered by very little is excreted C. anaemia - low Hb levels can be due to Fe deficiency not overload D. skin depigmentation - would cause skin pigmentation (deposits) E. thalassemia - Hb deficiency = unable to make RBCs = blood transfusions = iron overload - need chelating agent

Question 127

Blast cells are: A. killer immune cells B. effete RBCs C. polymorphonuclear leucocytes D. old WBCs E. haemopoietic precursor cells

Answer 127

Blast cells are: A. killer immune cells B. effete RBCs = non-functional RBCs C. polymorphonuclear leucocytes D. old WBCs **E. haemopoietic precursor cells**

Question 128

Which immunoglobulin plays the dominant role in immunity for the mucosal surfaces of the respiratory and gastrointestinal tract? A. IgA B. IgD C. IgE D. IgG E. IgM

Answer 128

**A. IgA** The immunoglobulin A (IgA) is the predominant antibody isotype in the mucosal immune system - GIT, resp tract, vaginal tract, tears, saliva, and colostrum.

Question 129

Which amino acid is deleted from Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) in people with Cystic Fibrosis? ## Footnote A. Phenylalanine B. Valine C. Glycine D. Alanine E. Leucine

Answer 129

**A. Phenylalanine** CF mutation = deletion of phenylalanine 508 (F508del) in the cystic fibrosis transmembrane conductance regulator (CFTR). The amino acid is in the first nucleotide-binding domain (NBD) of CFTR. This mutation leads to defective channel processing and gating problems.

Question 130

Which type of joint allows the least movement of adjacent structures? A. Amphiarthrosis B. Synovial joint C. Diarthrosis D. Fibrous joint E. Cartilaginous joint

Answer 130

Which type of joint allows the least movement of adjacent structures? A. Amphiarthrosis - limited mobility B. Synovial joint - between bones that move against each other C. Diarthrosis - a freely moveable joint. **D. Fibrous joint =** connected by dense CT consisting mainly of collagen - also called fixed or immovable joints because they do not move. Fibrous joints have no joint cavity and are connected via fibrous connective tissue. - eg. skull bones are connected by fibrous joints called sutures. E. Cartilaginous joint - allow more movement than fibrous joints but less movement than synovial joints.

Question 131

Human rhinovirus infections commonly occur in autumn and winter and are spread by respiratory droplets and person-to-person contact. They have to ability to: A. Replicate faster in healthy people than in immunocompromised people B. Replicate in the gastrointestinal tract C. Replicate at 33 ̊C D. Replicate at 37.9 ̊C E. Replicate at different temperature ranges

Answer 131

C. Replicate at 33 ̊C

Question 132

Which one of the following processes initiates the onset of a new acne lesion? A. Inflammation of the hair follicle B. Increased sebum production C. Obstruction of the pilo-sebaceous unit D. Vasodilation of dermal blood vessels E. Infection by pathogenic bacteria

Answer 132

Which one of the following processes initiates the onset of a new acne lesion? A. Inflammation of the hair follicle B. Increased sebum production **C. Obstruction of the pilo-sebaceous unit** D. Vasodilation of dermal blood vessels E. Infection by pathogenic bacteria

Question 133

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 10cm D. Few in number E. Presence of faeces

Answer 133

Which one of the following is a characteristic feature of loops of small bowel on abdominal X-ray? A. Peripher allocation = true but not do to with loops **B. Valvulae conniventes (plicae circulares)** C. Diameter between 5 and 10cm = false - approx 1.5cm diameter, large intestine = 6-7cm D. Few in number = false E. Presence of faeces = not in the small intestine

Question 134

Which one of the following enzymes is predominantly found in the biliary tract? A. Aspartate transaminase (AST) B. Alanine transaminase (ALT) C. Alkaline phosphatase (ALP) D. Creatine kinase (CK) E. Acid phosphatase

Answer 134

Which one of the following enzymes is predominantly found in the biliary tract? A. Aspartate transaminase (AST) B. Alanine transaminase (ALT) **C. Alkaline phosphatase (ALP) = i**ntrinsic to the bile duct D. Creatine kinase (CK) E. Acid phosphatase

Question 135

To confer mucosal immunity, IgA dimers in the lumen of the GIT are protected from proteolytic digestion by which of the following components? A. Kappa light chains B. J-chains C. Alpha heavy chains and kappa light chains D. Secretory molecules E. Alpha heavy chains

Answer 135

D. Secretory molecules

Question 136

Which one of the following can be a consequence of lactose intolerance? A. Osmotic diarrhoea B. Inflammatory bowel disease C. Irritable bowel syndrome D. Constipation E. Mouth ulcers

Answer 136

**A. Osmotic diarrhoea =** Osmotic diarrhea occurs when too many solutes (components of the food you eat) stay in your intestine and water can't be absorbed properly. This excess water causes your bowel movements to be loose or more liquid than solid. **Lactose Intolerance** = The inability to fully digest sugar (lactose) in dairy products.

Question 137

Inorganic fluoride inhibits enolase. In an anaerobic system that is metabolizing glucose as a substrate, which one of the following compounds would increase in concentration following the addition of fluoride? A. 2-Phosphoglycerate B. Glucose C. Glyoxylate D. Phosphoenol pyruvate E. Pyruvate

Answer 137

**Enolase** (phosphopyruvate hydratase) = a metalloenzyme responsible for the catalysis of the conversion of 2-phosphoglycerate to phosphoenol pyruvate, the ninth and penultimate step of glycolysis. If Enolase is inhibited = build up of **A. 2-Phosphoglycerate**

Question 138

Which of the following statements concerning the pancreas is true? The A. pancreas receives part of the arterial supply from the left gastric artery B. main pancreatic duct opens into the third part of the duodenum C. common bile duct lies anterior to the head of the pancreas D. uncinate process of the pancreas projects from the head of the pancreas E. transverse mesocolon is attached to the posterior border of the pancreas

Answer 138

D. uncinate process of the pancreas projects from the head of the pancreas

Question 139

What is the arterial supply of the pancreas?

Answer 139

The pancreas is supplied by the ***pancreatic branches*** of the ***splenic*** ***artery***. The head is additionally supplied by the ***superior*** ***and*** ***inferior*** ***pancreaticoduodenal*** ***arteries*** which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.

Question 140

Where does the main pancreatic duct drain into?

Answer 140

Major pancreatic duct = duct of Wirsung - joins the pancreas to the common bile duct. The pancreatic duct joins the common bile duct just prior to the ampulla of Vater, after which both ducts perforate the medial side of the _second_ portion of the duodenum at the ***major duodenal papilla***. Accessory pancreatic duct drains into 2nd part of duodenum - minor duodenal papilla.

Question 141

What is the Ampulla of Vater?

Answer 141

**Ampulla of Vater** = a conical structure at the confluence of the common bile duct and the main pancreatic duct. It is an important landmark halfway along the 2nd part of the duodenum that marks the anatomical transition from foregut to midgut. **Foregut** = Celiac trunk **Midgut** = Superior mesenteric artery **Hindgut** = Inferior mesenteric artery

Question 142

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

Answer 142

**D. sympathetic innervation via the hypogastric nerve** * The internal sphincter is involuntary. * Nerve Sympathetic fibers from T10-L2 through the inferior hypogastric plexus then vesical nervous plexus

Question 143

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

Answer 143

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**

Question 144

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

Answer 144

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

Question 145

Which one of the following relationships determines the flow rate of blood through a vessel? A. Volume x Heart rate B. Pressure/Resistance C. Heart rate/Resistance D. Resistance/Pressure E. Pressure x Resistance

Answer 145

Flow rate through a blood vessel ## Footnote **B. Pressure/Resistance**

Question 146

Which of the following gastrointestinal hormone combinations stimulate an increase in the muscle tone of the pyloric sphincter? A. Peptide YY and Gastric Inhibitory Peptide (GIP) B. Gastrin and peptide YY C. Secretin and cholecystokinin (CCK) D. Gastrin and Gastric Inhibitory Peptide (GIP) E. Ghrelinand Vasoactive Intestinal Peptide (VIP)

Answer 146

**C. Secretin and cholecystokinin (CCK)** **Secretin** = hormone released by duodenum - also inhibits the secretion of gastrin, which triggers the initial release of hydrochloric acid into the stomach, and delays gastric emptying. **Gastrin** = peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric motility. **CCK** = improves digestion by slowing down the emptying of food from the stomach and stimulating the production of bile in the liver as well as its release from the gall bladder. **The pyloric sphincter** = a valve that regulates the flow of partially digested food from the stomach to the duodenum. Increased muscle tone of pyloric sphincter = closes it = stops gastric emptying into duodenum

Question 147

Sometimes a gene pair will interact so as to control the expression of a second gene pair in an interaction called: A. dominance B. gene regulation C. recessiveness D. pleiotropy E. epistasis

Answer 147

A. dominance = relationship between alleles, in which one allele masks the effect of the other in influencing some trait. B. gene regulation = the process of turning genes on and off C. recessiveness = failure of one allele in pair to express itself in an observable manner because of the greater influence (dominance) of its opposite-acting partner. D. pleiotropy = 1 gene affects multiple characteristics E. **epistasis** = a gene pair will interact so as to control the expression of a second gene pair in an interaction

Question 148

A young woman decides to conduct a three-day detoxification and confines herself to a liquid diet with minimum calories. Which of the following metabolic processes in the liver would be most likely after 4-5 hrs? A. Increased glycogenesis in liver B. Increased glycogenolysis in liver C. Decreased glycogenolysis in liver D. Decreased glycogenesis in liver E. Increased gluconeogenesis in liver

Answer 148

**B. Increased glycogenolysis in liver** **Glycogenolysis** = Breakdown of glycogen into glucose **Glycogenesis** = Forming glucogen from glucose **Gluconeogenesis** = Forming glucose from non-carbohydrate source - occurs beyond approx. 8 hours of fasting when liver glycogen stores start to deplete and an alternative source of glucose is required.

Question 149

A 10-year-old boy with gastroenteritis presents to the Emergency Department. He is assessed as MODERATELY (5-8%) dehydrated. Which of the following signs is most likely to be found? A. Decreased level of consciousness B. Collapsed veins C. Postural hypotension D. Tachycardia E. Sunken eyes

Answer 149

**D. Tachycardia -** reduced blood volume = reduced SV = increased HR to increase CO

Question 150

The ductus arteriosus in the developing heart links the circulation between the: A. Right and left atria B. Right atrium and right ventricle C. Umbilical vein and inferior vena cava D. Left and right ventricles E. Pulmonary artery and aorta

Answer 150

The ductus arteriosus in fetus connnects: A. Right and left atria = ***Foramen ovale*** - blood bypasses lungs/pulmonary circulation (not needed) B. Right atrium and right ventricle C. Umbilical vein and inferior vena cava = ***Ductus Venosus*** - shunts a portion of umbilical vein blood flow directly to the IVC. Thus, it allows oxygenated blood from the placenta to bypass the liver. D. Left and right ventricles **E. Pulmonary artery and aorta = Ductus Arteriosus -** lungs not used for gas exchange yet so can bypass the fetal lungs and go straight to aorta.