Mandus Hard MCQs Flashcards

1
Q

If the prevalence of a disease decreases, which of the following occurs?

  • a) Specificity decreases
  • b) Sensitivity increases
  • c) Negative predictive value does not change
  • d) Positive predictive value decreases
A

d) Positive predictive value decreases

D - as the prevalence of a disease decreases, the positive predictive value also decreases because the number of false positives will increase.

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2
Q

What is the best feature of a test for a disease that has low prevalence within a community?

a) A test with low sensitivity
b) A test with high sensitivity
c) A test with low specificity
d) A test with high specificity

A

What is the best feature of a test for a disease that has low prevalence within a community?

a) A test with low sensitivity
b) A test with high sensitivity
c) A test with low specificity

d) A test with high specificity

D - a test with high specificity will be able to rule out people without the disease who will make up most of the people that are tested. You want to be able to rule out people who are truly negative.

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3
Q

You are a doctor running a trial and find that the older a person is, the more likely they are to fall in nursing homes. However, after controlling for age, gender and medication use, you find that your correlation between age and falls is not significant. Which of the following is correct?

a) Age is not independently correlated with falls
b) You found these results by chance
c) There is no correlation
d) Other risk factors do not play a part in falls

A

You are a doctor running a trial and find that the older a person is, the more likely they are to fall in nursing homes. However, after controlling for age, gender and medication use, you find that your correlation between age and falls is not significant. Which of the following is correct?

a) Age is not independently correlated with falls

b) You found these results by chance
c) There is no correlation
d) Other risk factors do not play a part in falls

A - controlling for other factors shows that there were confounders that were leading you to an incorrect conclusion about the correlation between age and falls.

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4
Q

You conduct a study measuring the risk ratio of developing a new syndrome called RoryMichaelitis in people who drink VB vs people who don’t drink VB.

You produce the graph below showing the risk ratio with a 95% confidence interval of developing RoryMichaelitis in those who don’t drink VB (top line) and those who do (bottom line). What do you conclude?

  • a) There is an increased risk of developing RM in people who do drink VB but not in those who don’t
  • b) There is an increased risk of developing RM in people who don’t drink VB but not in those who do
  • c) There is an increased risk in both groups
  • d) There is no increased risk in either group
A

d) There is no increased risk in either group

D - while the risk ratio for each group is >1 indicating an increased risk, the confidence interval boundaries for both groups includes the risk ratio of 1 meaning that the neutral value is included in your estimate of uncertainty. You therefore cannot conclude that there is an increased risk because you could have easily found a risk ratio of 1 - no correlation.

Remember a confidence interval tells us the range of values that your risk ratio could be with 95% confidence. If you conducted your study 100 more times, the risk ratio would fall between those values. It’s impractical to do a study 100 times so a calculation of uncertainty allows you to show the range of all possible risk ratios that could have been generated.

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5
Q

What four factors differentiate between acceptable and non-acceptable sport injuries?

A

Intent - deliberate vs non-deliberate

Severity - minor and non-life threatening vs severe and disabling

Activity - intentional vs unintentional

Mechanism - regular or normal vs unnatural could be prevented.

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6
Q

A patient has just been told they have type 1 diabetes. What are some ways in which a chronic health condition can impact a person?

A
  1. Self esteem
  2. Role within society
  3. Quality of life
  4. Social and personal relationships
  5. Employment and education opportunities
  6. Financial cost
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7
Q

What are 4 outcomes that can be taken against a doctor who is impaired?

A
  1. No action taken
  2. Conditions placed on scope of practice
  3. Referred to another health practitioner for condition
  4. Suspension of license to practice
  5. Criminal proceedings
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8
Q

What is the difference between a disability and an impairment?

A

A disability is a condition that limits the scope of practice; however provisions are in place to ensure that the practitioner can still practice to an acceptable standard and therefore does not pose a risk to themselves or the public.

An impairment refers to a condition that is not being managed and the practitioner does pose a risk to the public.

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9
Q

What is the ABCD of palliative care?

A
  • A - Attitude
  • B - Behaviour
  • C - Compassion
  • D - Dialogue
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10
Q

What are the Bradford Hill criteria?

A
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11
Q

Well lit roads are which type of intervention in Haddon’s Matrix?

a) Pre event host
b) Post event environment
c) Pre event environment
d) Event vehicle
e) Event host

A

c) Pre event environment

C - ensuring that the environment is safe and prevents accidents from happening.

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12
Q

Which of the following is most beneficial to reduce someone’s risk of cardiovascular disease?

a) Using aggressive pharmacological therapy
b) Losing weight
c) Stopping smoking
d) Tackling 2 or more lifestyle factors
e) Reducing salt intake

A

d) Tackling 2 or more lifestyle factors

D - addressing more than one risk factor is more beneficial than addressing one single factor alone. Reducing multiple risk factors has a multiplicative effect on reducing someone’s risk of CVD.

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13
Q

Down syndrome is a chromosomal disorder that has been correlated to some predisposing factors. Which of the following is correct?

a) Maternal age is correlated to DS and more babies with DS are born from older women
b) Maternal age is correlated to DS but more babies with DS are born from younger women
c) Maternal age and regional status are both linked to DS with older, remote women giving birth to the most babies with DS
d) Maternal age and indigenous status are linked to DS and older, aboriginal women give birth to the most babes with DS.
e) Maternal age, aboriginal status and indigenous status are all linked to DS.

A

b) Maternal age is correlated to DS but more babies with DS are born from younger women

B - while maternal age is the most well documented risk factor for conceiving a child with down syndrome, more babies with down syndrome are born to younger women because younger women have more babies in total.

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14
Q

CF carrier frequency in population is around 1/2500. What is the likelihood that a woman with CF and a man who doesn’t know his genetic history will conceive a boy with CF.

  • a) 4%
  • b) 0.4%
  • c) 2%
  • d) 0.2%
  • e) 0.004%
A
  • a) 4%
  • b) 0.4%
  • c) 2%
  • d) 0.2%
  • e) 0.004%
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15
Q

Three researchers conduct an ecological study comparing alcohol use in Australia and Germany. What they find is that alcohol use is higher in women in Australia overall but in Germany, alcohol use is higher in people aged 60 for both genders.

Which of the following conclusions is an example of the ecological fallacy? (multiple answers)

a) Tighter laws around alcohol contribute to its lower use in Australia.
b) Younger people in Germany are more influenced by advertising against alcohol.
c) Germans have more permissive attitudes to alcohol.
d) Alcohol is more readily available in Germany

A

B and C - these two conclusions are assuming about the causation of the factors on the outcome of alcohol use by inferring from the results.

Both A and D are making conclusions about the factors that contribute to alcohol use and are not making assumptions about the populations being studied.
The ecological fallacy is when you take aggregate group data and apply it to the individual. Aggregate group data fails to control for multiple factors that show trends or correlation at the individual level. In this example, it is taking the outcome of all people aged over 60 and saying that they all drink too much whereas it may be only a small percentage of people who do and have pushed the average consumption rate in Germany above the average consumption rate in Australia. It could be that more Australians >60 drink more than they should but have been overshadowed by some serious drinkers in Germany.

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16
Q

Week 19
A woman presents and believes she is pregnant as her period is 3 weeks late. She believes she is pregnant. She discloses that wants to keep the baby and get a check up to ensure she can carry the pregnancy to term. What test would you not carry out?

a) Cervical screening
b) Blood test for immune status
c) Glucose tolerance test
d) Urinalysis
e) B-hcg test
f) Take vitals
g) Measure weight

A

c) Glucose tolerance test

C - this is the most inappropriate test to perform. Gestational diabetes will develop later in the pregnancy and is usually tested with the glucose tolerance test during week 24 - 28 of pregnancy, sometimes earlier. The reason that women develop gestational diabetes is because the placenta produces hormones to increase glucose in the blood for maternal tissues to metabolise and create energy. However, some women are unable to produce enough insulin to maintain normal blood glucose levels and become hyperglycaemic.

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17
Q

Which of the following is a cause of central cyanosis?

a) Cold temperature
b) Polycythemia
c) Vagal stimulation
d) Left ventricular heart failure
e) Pulmonary embolism

A

b) Polycythemia

B - polycythemia will result in a total amount of oxygenated haemoglobin circulating because the total number of RBCs available to oxygenate has increased. Therefore the percentage of oxy-haemoglobin that leaves the heart is decreased.

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18
Q

Which of the following cells is least associated with the pathophysiology of asthma?

a) Dendritic cells
b) Mast cells
c) Monocytes
d) Eosinophils
e) Plasma cell

A

C - Monocytes are non-mature pre-macrophage cells that circulate in the blood before they move into tissues and mature. They may link RSV and asthma but this link is not clear.

Dendritic cells sample the allergen and display it to Th2 cells which are responsible for cytokine production. IL-4 + IL-13 recruit plasma cells to produce IgE which bind to mast cells which degranulate upon binding to the antigen. Eosinophils are recruited by IL-5 which release histamine and other mediators when exposed to the antigen.

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19
Q

Which of the following results in an increase in bronchiole diameter?

a) Decreased O2
b) Increased CO2
c) Increased O2
d) Decreased CO2
e) AandB

A

b) Increased CO2

B - the control of V/Q is different to that of the systemic circulation.

● Increased alveolar air PCO2 => dilate bronchioles and dilate systemic arterioles

● Decreased PCO2 => constrict bronchioles and constrict systemic arterioles

● Increased PO2 => dilate pulmonary arterioles and constrict systemic arterioles

● Decreased PO2 => constrict pulmonary arterioles and dilate systemic arterioles

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20
Q

Which of the following regarding normal pulmonary pressures is correct?

a) Transpulmonary pressure is always negative
b) Transpulmonary pressure is always positive
c) Intrapulmonary pressure is always positive
d) Intrapulmonary pressure is always negative

A

b) Transpulmonary pressure is always positive

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21
Q

Which of the following regarding normal pulmonary pressures is correct?

a) Transpulmonary pressure is always negative
b) Transpulmonary pressure is always positive
c) Intrapulmonary pressure is always positive
d) Intrapulmonary pressure is always negative

A

b) Transpulmonary pressure is always positive

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22
Q

The macula densa is responsible for:

a) Releasing renin
b) Sensing ultrafiltrate NaCl concentration
c) Contracting the smooth muscle around the afferent arteriole
d) Releasing noradrenaline
e) Sensing aldosterone levels

A

b) Sensing ultrafiltrate NaCl concentration

B - the macula densa senses salt concentration and to a lesser extent the rate of fluid flow (they are ciliated cells). They then secrete adenosine or ATP to the juxtaglomerular granular cells to secrete renin.

They also secrete prostaglandins to increase afferent arteriole vasoconstriction and efferent arteriole vasodilation.

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23
Q

Which of the following is the correct pair?

a) Intra-renal AKI - high FeNa (fractional

excreted sodium)

b) Pre-renal AKI - low BUN/Cr ratio
c) Intra-renal AKI - high urine osmolarity
d) Oliguric phase of AKI - hypokalemia
e) Diuretic phase - low urine volume

A

a) Intra-renal AKI - high FeNa (fractional excreted sodium)

A - is correct. During an intra-renal cause of AKI, the tubules are damaged (by drugs, toxins or ischaemia) meaning that the transporters and exchangers are absent or not working optimally. In the proximal tubule especially, a decrease in their functioning means that much of the ultrafiltrate cannot be reabsorbed. This results in more of the ultrafiltrate forming part of the urine and therefore more sodium being excreted.

B - In pre-renal AKI, urea cannot be filtered so stays high and is therefore incorrect.

C - Intra-renal AKI is a problem with reabsorption and the urine is unable to be concentrated.

D - during the oliguric phase of AKI, potassium is retained and not filtered.

E - diuretic phase of AKI is when high volumes of urine are produced and can lead to hypokalemia and hyponatremia.

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24
Q

Which of the following is diagnostic of hypertension?

a) 120/80
b) 129/35
c) 140/80
d) 140/90
e) None of the above

A

D - 140/90 over three consecutive visits.

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25
Q

Which of the following layers are affected first in an ischaemic heart episode?

a) Epicardium
b) Outer myocardium
c) Inner myocardium
d) None of the above

A

C - the inner myocardium is furthest from the arteries and will hence become ischaemic before the better perfused outer layers.

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26
Q

Which of the following is not a site of action of PTH?

a) Kidney tubule
b) Bone
c) GI tract
d) Thyroid

A

d) Thyroid

D - The thyroid does not respond to PTH and secretes its own hormone in calcium regulation - calcitonin.

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27
Q

Which of the following is the cause of primary type I osteoporosis?

a) Old age
b) Menopause
c) Drug induced
d) Lack of sunlight

A

B - the primary cause of osteoporosis is the absence of estrogen which represses the action of IL-6. IL-6 upregulates RANKL expression on osteoblasts which subsequently activates osteoclast maturation.

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28
Q

Which of the following injuries would cause Trendelenburg’s Sign?

a) Posterior column damage
b) Cerebellar damage
c) Damage at the fibular head
d) Damage at L4-S1
e) Damage at L3-L4

A

D - damage at L4-S1 would injure the superior gluteal nerve which weakens the abductor muscles (gluteus medius and minimus). Weakness of the abductors shows a contralateral hip drop.

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29
Q

What changes would a posterolateral L4 disc herniation cause?

a) Changes to the knee jerk reflex
b) Changes to the ankle jerk reflex
c) Changes to the tone on the external sphincter
d) Changes to the bladder reflex
e) None of the above

A

E - none of the above. L4 disc herniation would cause a L5 compression which does not participate in any reflexes.

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30
Q

What changes would a posterolateral L4 disc herniation cause?

a) Changes to the knee jerk reflex
b) Changes to the ankle jerk reflex
c) Changes to the tone on the external sphincter
d) Changes to the bladder reflex
e) None of the above

A

E - none of the above. L4 disc herniation would cause a L5 compression which does not participate in any reflexes.

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31
Q

What is the type of wave present on an EEG during light sleep?

a) Alpha
b) Beta
c) Gamma
d) Delta
e) Theta

A

What is the type of wave present on an EEG during light sleep?

a) Alpha
b) Beta = concentration
c) Gamma = higher cortical functions
d) Delta = deep sleep

e) Theta

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32
Q

Which of the following is not a phase of wound healing?

a) Haemostasis
b) Exudative
c) Inflammatory
d) Proliferation
e) Maturation

A

B - exudate is formed during haemostasis.

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33
Q

Decreased ability for a patient to feel touch and vibration on the left leg is a result of what lesion?

a) Damage to lateral corticospinal tracts on the right
b) Damage to the spinocerebellar tracts on the right
c) Damage to the DCLM on the right
d) Damage to the DCLM on the left
e) Damage to the lateral spinothalamic tracts

A
  • D - the dorsal column medial lemniscus pathway is responsible for fine touch, crude touch, vibration and conscious proprioception (know your arm is next to your body).
  • The corticospinal pathways are for transmitting motor signals to the spinal cord.
  • The spinocerebellar is responsible for transmitting unconscious proprioception (quite important in the joint capsule).
  • Spinothalamic is responsible for transmitting pain and temperature.
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34
Q

Which one of the following occurs as a result of the ischaemic cascade?

a) Increased GABA synthesis
b) Increase rates of alanine breakdown
c) Excess glutamate release
d) Increased activity of ATP synthase
e) Decreased substrate level phosphorylation

A

c) Excess glutamate release

C - the decrease of oxygen results in decreased ATP. This decrease in cellular energy raises the level of depolarisation within the cell and results in calcium influx and glutamate release. This leads to excitotoxicity within the brain.

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35
Q

Which of the following is not given to a patient presenting with altered mental status?

a) Glucose
b) Naloxone
c) Thiamine
d) Carbamezapine
e) Flumazenil

A

d) Carbamezapine

D - the ‘coma cocktail’ includes thiamine (Vit B1), glucose in the case of hypoglycaemia, naloxone an opioid antagonist, and flumazenil a gaba antagonist to block the effects of benzodiazepines.

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36
Q

Which of the following would cause internuclear ophthalmoplegia and be seen as horizontal nystagmus?

a) Damage to the optic nerve
b) Damage to the cochlear nerve
c) Damage to the medial longitudinal fasciculus
d) Damage to the occipital lobe
e) Damage to the pretectal area

A

C - the medial longitudinal fasciculus is responsible for coordinating sideway movements of the eyes when somebody turns their head. When you turn your head to the left, both eyes turn to the right. For this to occur the medial rectus and lateral rectus have to coordinate. The medial longitudinal fasciculus is the pathway for the signals to move between the abducens and oculomotor nuclei.

The semicircular canals in the inner ear send signals to the pons area which then coordinates the abducens nuclei on the ipsilateral side to activate. This abducens nucleus causes a contraction of the lateral rectus on the contralateral side and sends signal via the medial longitudinal fasciculus to the ipsilateral oculomotor nucleus to contract so that both eyes rotate to the same side. Think about it for a second.

When the MLF is damaged, you will have uncoordinated sideways movement of the eyes called horizontal nystagmus.

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37
Q

What is not a common pathogen of middle ear infections?

a) Pseudomonas aeruginosa
b) Moraxella catarrhalis
c) Streptococcus pneumoniae
d) Haemophilus influenzae

A

A and D - the three common pathogens are listed. Pseudomonas is more common in external ear infections

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38
Q

The Trendelenburg Sign is indicative of what pathology?

a) Superior Vena Cava syndrome

B) Splenomegaly

C) Weakness of hip extensor (gluteus Maximus)

D) Weakness of hip abductors (gluteus medius and minimus)

A

The Trendelenburg Sign is indicative of what pathology?

a) Superior Vena Cava syndrome = positive Pemberton’s sign

B) Splenomegaly = inferred from a positive Castell’s sign.

C) Weakness of hip extensor (gluteus Maximus)

D) Weakness of hip abductors (gluteus medius and minimus)

The answer is D. Trendelenberg’s sign is found in people with weak of paralysed abductor muscles of the hip. The test is used to assess hip stability. Note A positive sign is elicited when the pelvis tilts down on the side contralateral to the weakness during stance

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39
Q

A 77 year old male presents to your GP practice complaining of erectile dysfunction. Which of the following is a NOT likely cause of his ED?

A) Stress

B) Obesity

C) Hypergonadism

D) Hypertension

E) Atherosclerosis

A

C) Hypergonadism

A is incorrect because mental state plays a big part in sexual arousal leading to erection.
B is incorrect because obesity lowers the amount of testosterone that can be produced in an older system which is already low in the androgen, hence leading to ED.

D is incorrect because prolonged hypertension can damage blood vessel wall lining leading to issues with tumescence for erections.
E is incorrect as atherosclerosis hardens blood vessels making it harder to obtain an erection

C is the correct answer. Hypogonadism would contribute to erectile dysfunction

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40
Q

A 77 year old male presents to your GP practice complaining of erectile dysfunction. Which of the following is NOT part of the deadly quartet, increasing the risk of erectile dysfunction?

A) Diabetes

B) Hypogonadism

C) Obesity

D) Hypertension

E) Dyslipidaemia

A

B) Hypogonadism

The deadly quartet refers to 4 conditions that constitute a metabolic syndrome which place a patient at a high risk of erectile dysfunction.

These are: Diabetes, Obesity, Hypertension Dyslipidaemia.

Therefore, the answer is B. Hypogonadism is a contributing factor ED, however it is not a part of the deadly quartet.

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41
Q

A 77 year old male presents to your GP practice complaining of erectile dysfunction. Which of the following is NOT part of the deadly quartet, increasing the risk of erectile dysfunction?

A) Diabetes

B) Hypogonadism

C) Obesity

D) Hypertension

E) Dyslipidaemia

A

B) Hypogonadism

The deadly quartet refers to 4 conditions that constitute a metabolic syndrome which place a patient at a high risk of erectile dysfunction.

These are: Diabetes, Obesity, Hypertension Dyslipidaemia.

Therefore, the answer is B. Hypogonadism is a contributing factor ED, however it is not a part of the deadly quartet.

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42
Q

In patients with obstructive lung disease, spirometry would most likely reveal a _______ FEV1:FVC ratio and a ________FVC.

A) normal; elevated

B) normal; reduced

C) decreased; normal/elevated

D) decreased; normal/reduced

A

In patients with obstructive lung disease, spirometry would most likely reveal a decreased FEV1:FVC ratio and a normal/reduced FVC.

Patients with obstructive lung disease exhibit the characteristic ‘scooped out’ spirometry curve with significantly decreased FEV1 but relatively normal, if not slightly reduced, FVC. Although air can be drawn in the same volume, there is a smaller airway for air to be forced out of and so it can’t move out as quickly.

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43
Q

In patients with restrictive lung disease, spirometry would most likely reveal a _______ FEV1:FVC ratio and a ________FVC.

A) normal; elevated

B) normal; reduced

C) decreased; normal/elevated

D) decreased; normal/reduced

A

In patients with restrictive lung disease, spirometry would most likely reveal a normal FEV1:FVC ratio and a reduced FVC.

Patients with restrictive lung disease demonstrate a smaller curve on spirometry that is proportional to the normal/expected curve. They have a loss of elasticity of the lung parenchyma and hence are unable to take in nor expel air fast enough leading to a relatively normal FEV1:FVC ratio but reduced values of FEV1 and FVC.

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44
Q

A 23 year old man presents to the ED with an acute exacerbation of asthma. Which of the following clinical signs would NOT be indicative of a severe asthma attack?

A) Low pulse rate
B) Silent chest
C) Speaks in only words
D) Low O2 saturation
E) Physical exhaustion with paradoxical chest movement

A

A) Low pulse rate
The answer is A as we would expect a high pulse rate (>120bpm) in this presentation.

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45
Q

A 63-year old man presents for a routine check-up. His BP is 165/85 mmHg (sitting) and 155/80 mmHg (standing). His BMI is 31 kg/m2.

Which option is NOT a common cause of secondary hypertension?

A) Coarctation of the aorta

B) Renal Artery Stenosis

C) Hyperaldosteronism

D) Cushing’s Syndrome

E) Obesity

A

E) Obesity

Although obesity may be correlated with patients who have hypertension or may set up pathophysiological states which lead to hypertension, it itself is not directly the cause of the hypertension. This is more a risk factor for primary/essential/idiopathic hypertension.

46
Q

When interpreting an ECG, what does the P wave represent?

A) Ventricular repolarisation

B) Atrial depolarisation

C) Ventricular depolarisation

D) Atrial repolarisation

A

P wave = B) Atrial depolarisation

47
Q

When interpreting an ECG, what does the P wave represent?

A) Ventricular repolarisation

B) Atrial depolarisation

C) Ventricular depolarisation

D) Atrial repolarisation

E) Period between end of ventricular depolarisation and repolarisation

A

P wave = B) Atrial depolarisation

48
Q

When interpreting an ECG, what does the T wave represent?

A) Ventricular repolarisation

B) Atrial depolarisation

C) Ventricular depolarisation

D) Atrial repolarisation

E) Period between end of ventricular depolarisation and repolarisation

A

T wave = A) Ventricular repolarisation

49
Q

When interpreting an ECG, what does the QRS complex represent?

A) Ventricular repolarisation

B) Atrial depolarisation

C) Ventricular depolarisation

D) Atrial repolarisation

E) Period between end of ventricular depolarisation and repolarisation

A

C) Ventricular depolarisation = QRS

50
Q

When interpreting an ECG, what is the ST segment?

A) Ventricular repolarisation

B) Atrial depolarisation

C) Ventricular depolarisation

D) Atrial repolarisation

E) Period between end of ventricular depolarisation and repolarisation

A

ST segment = E) Period between end of ventricular depolarisation and repolarisation

51
Q

When listening for heart sounds and murmurs, which option correctly identifies where you would auscultate the tricuspid area?

A) Left, 5th intercostal space, mid clavicular line

B) Right, 2nd intercostal space, parasternally

C) Left, 2nd intercostal space, parasternally

D) Left, 5th intercostal space, parasternally

A

D) Left, 5th intercostal space, parasternally

A few mnemonics:

  • APTM 2255 (ie Apartment 2255)
52
Q

Which of the following options correctly identifies Virchow’s Triad of Thrombosis?

A) Stasis, hypercoagulability of blood, vessel wall injury

B) Stasis, atherosclerosis, vessel wall injury

C) Hypercoagulability of blood, stasis, dysfunctional venous valves

D) Stasis, hypercoagulability of blood, excess platelets

A

A) Stasis, hypercoagulability of blood, vessel wall injury

53
Q

Regarding a plain radiograph of the abdomen, which is INCORRECT?

A) Gas is black in colour

B) Calcium is white in colour

C) Soft Tissue is grey in colour

D) Fat is lighter grey in colour

A

D) Fat is lighter grey in colour

Fat would appear as a darker shade of grey than soft tissue as it is less dense than soft tissue hence creates less obstruction to the passage of X Rays (more radiolucent).

54
Q

Which of the following represents a correct match between the cranial nerve and its respective test?

A) Olfactory; gag reflex

B) Facial; clench jaw

C) Oculomotor; close eye under resistance

D) Spinal Accessory; turn head to side against resistance

E) Vagus; protrude tongue

A

D) Spinal Accessory; turn head to side against resistance

55
Q

Which of the following represents a correct match between the cranial nerve and its respective test?

A) Olfactory; gag reflex

B) Facial; clench jaw

C) Oculomotor; close eye under resistance

D) Spinal Accessory; turn head to side against resistance

E) Vagus; protrude tongue

A

D) Spinal Accessory; turn head to side against resistance

56
Q

What forms the afferent arm of the cremaster reflex?

a) Genitofemoral nerve
b) Obturator nerve
c) Medial cutaneous nerve of the thigh
d) Ilioinguinal nerve
e) Sciatic nerve

A

Afferent cremaster reflex = d) Ilioinguinal nerve

57
Q

Which layer is not pierced during an emergency needle decompression?

a) Innermost intercostals
b) Parietal pleura
c) External intercostals
d) Internal intercostals
e) None of the above

A

e) None of the above

E - all layers of the thoracic wall need to be pierced to access the intrapleural space in order to remove the air from this space.

58
Q

Between which layers do you find the pericardial cavity?

a) Visceral and parietal layers
b) Parietal and fibrous layers
c) Visceral and fibrous layers
d) Myocardial and epicardial layers

A

a) Visceral and parietal layers

A - the visceral and parietal layers are the two serous pericardial layers that secrete fluid which prevents friction during heart contractions

59
Q

Which of the following is not part of the arterial distribution of the right coronary artery?

a) Part of the left ventricle
b) Right ventricle
c) Anterior interventricular septum
d) Right lateral surface
e) SA and AV node

A

c) Anterior interventricular septum

C - the posterior 1⁄3 of the interventricular septum is supplied by the right coronary artery.

60
Q

Which of the following is not part of the arterial distribution of the right coronary artery?

a) Part of the left ventricle
b) Right ventricle
c) Anterior interventricular septum
d) Right lateral surface
e) SA and AV node

A

c) Anterior interventricular septum

C - the posterior 1⁄3 of the interventricular septum is supplied by the right coronary artery.

61
Q

Damage of the facial nerve at the level of the stylomastoid foramen will mean that someone will not be able to:

a) Taste from the anterior 2⁄3 of the tongue
b) Masticate
c) Open their eye fully
d) Puff out their cheeks
e) Lacrimate

A

D - the buccinator muscle is innervated by the facial nerve and responsible for puffing the cheeks.

A - Damage at the stylomastoid foramen is distal to the chorda tympani and will preserve taste sensation.
B - Mastication is done by the mandibular nerve C - ptosis is caused by damage to either the sympathetic cervical ganglia or the oculomotor nerve
E - the greater petrosal nerve is a branch of the acial which innervates the lacrimal gland. Again damage at the stylomastoid foramen is distal to this and will preserve its function

62
Q

Which of the following spaces are natural or true anatomical spaces? (multiple answers)

a) Extradural space
b) Spinal epidural space
c) Subdural space
d) Subarachnoid space

A

B and D - there is no naturally occurring space between the periosteal layer of the dura mater and the cranium. Any space created here is a pathological space and not natural.

There is no natural, true or anatomical space at the dura-arachnoid mater level. A space is only formed when there is trauma or blood pooling for cortical vein shearing during a fall in the elderly.

63
Q

Where does the maxillary sinus open in the nasal cavity?

a) Super nasal meatus
b) Middle nasal meatus
c) Inferior nasal meatus
d) Within the nasolacrimal duct
e) Sphenoethmoid recess

A

B - the maxillary sinus opens into the middle nasal meatus along with the anterior and middle ethmoid air cells and the frontal sinus.

The posterior ethmoidal cells open into the superior nasal meatus and the frontonasal duct opens into the inferior nasal meatus. The sphenoid sinus opens in the sphenoethmoid recess.

64
Q

The inner surface of the tympanic membrane is innervated by which nerve?

a) Facial nerve
b) Mandibular nerve
c) Trigeminal nerve
d) Vagus nerve
e) Glossopharyngeal nerve

A

E - the inner surface is innervated by the glossopharyngeal nerve.

65
Q

Which of the following describes the correct flow of blood out of the brain?

a) Superior sagittal sinus > transverse sinus > confluence of sinuses > sigmoid sinus > IJV
b) Transverse sinus > confluence of sinuses > superior sagittal sinus > sigmoid sinus > IJV
c) Superior sagittal sinus > confluence of sinuses > transverse sinus > sigmoid sinus > IJV
d) IJV > sigmoid sinus > confluence of sinuses > superior sagittal sinus > transverse sinus

A

c) Superior sagittal sinus > confluence of sinuses > transverse sinus > sigmoid sinus > IJV

66
Q

The teres major is innervated by the:

a) Musculocutaneous nerve
b) Lower subscapular nerve
c) Axillary nerve
d) Thoracodorsal nerve
e) Circumflex scapular nerve

A

b) Lower subscapular nerve

67
Q

Which muscle sits between the two gemelli muscles?

a) Obturator externus
b) Obturator internus
c) Piriformis
d) Quadratus femoris
e) Pectineus

A

b) Obturator internus

68
Q

The renal fascia is found between which structures?

a) The perirenal fat and the capsule
b) The perirenal fat and the muscles
c) The perirenal fat and the pararenal fat
d) The pararenal fat and the muscle
e) Deep to the renal capsule

A

c) The perirenal fat and the pararenal fat

69
Q

The lymphatic drainage of the superficial thorax is to which lymph nodes?

a) Cervical
b) Axillary
c) Supraclavicular
d) Parasternal
e) Cisterna chyli

A

b) Axillary

70
Q

Which part of the urinary tract must be damaged to cause a swollen scrotum?

a) Spongy urethra
b) Membranous urethra
c) Prostatic urethra
d) Intravesicular
e) Ureter

A

a) Spongy urethra

A - damage here is usually caused by saddle injury or catheterisation and will allow for semen and fluid to leak into the superficial perineal pouch and down into the scrotum via the genital hiatus. Fluid will also accumulate in the superficial abdomen.

Damage above this level at B, C, D, E will allow for fluid to leak into the subperitoneal space which is closed off from accessing the scrotum via the thick perineal fascia which forms the roof of the deep perineal pouch.

71
Q

The inferior mesenteric vein usually joins which vein?

A - IVC

B - left renal

C - portal

D - splenic

E - superior mesenteric

A

D - splenic

IMC -> splenic vein and SMV unite to drain into the portal vein.
IVC and left renal veins are caval veins and do not drain the gut.

72
Q

The vagus nerve passes into the abdomen by passing through the:

A - aortic hiatus

B - Esophageal hiatus

C - caval foramen

D - Lateral arcuate ligament

E - Medial arcuate ligament

A

B - Esophageal hiatus

73
Q

While performing a hysterectomy, the surgeon must ligate the uterine artery. To avoid iatrogenic injury, to the ureters, they must be aware that the ureter passes ____ the artery at the level of the ____.

A - over, cervix

B - over, fundus of the uterus

C - over, pelvic brim

D - under, cervix

E - under, pelvic brim

A

D - the ureter passes under the uterine artery to the inferior portion of the mesometrium near the cervix.

74
Q

An agonist is a drug which

  1. Has both affinity and intrinsic activity (efficacy)
  2. Must be taken orally to achieve a therapeutic effect
  3. Can combine with many different types of receptors
  4. Generally binds irreversibly with a receptor
  5. Has affinity but no intrinsic activity (efficacy)
A
75
Q
  1. Drugs are subject to first pass metabolism when administered by which one of the following routes of administration?

A. Sublingual

B. Oral

C. Intramuscular

D. Rectal

E. Intravenous

A
76
Q
  1. Which of the following drugs is a competitive antagonist at beta adrenergic receptors?

A. Acetylcholine

B. Noradrenaline

C. Adrenaline

D. Propranolol

E. Naloxone

A
77
Q
  1. The rate of absorption of a drug following oral administration is increased if

A. The drug remains in the stomach

B. The drug is in the ionised form

C. The drug is administered as a sustained release product

D. The drug enters the duodenum/small intestine

E. The drug is a large water-soluble molecule

A
78
Q
  1. Passive diffusion is when a drug

A. Moves across the cell membrane against a concentration gradient

B. Moves across the cell membrane with the expenditure of energy

C. Moves across the cell membrane without the need for energy expenditure

D. Moves across the cell membrane by pinocytosis

E. Is actively pumped across the cell membrane using ATP as an energy source

A
79
Q
  1. Pantoprazole is useful in the treatment of duodenal ulcers because it

A. Acts as a competitive antagonist at histamine H2 receptors

B. Increases bicarbonate ion secretion

C. Neutralises excessive gastric acid

D. Binds to H+/K+ ATPase and inhibits the proton pump

E. Inhibits the enzyme cyclooxygenase 1 (COX 1)

A
80
Q
  1. The therapeutic index of a drug gives an indication of A. The amount of drug absorbed

A. The amount of drug that needs to be administered

B. The safety margin of the drug

C. The amount of drug which reaches the site of action

D. Whether the drug interacts with other drugs

A
81
Q
  1. In the treatment of bacterial infections which of the following drugs inhibits the bacterial enzyme dihydrofolate reductase?

A. Penicillin

B. Cephalexin

C. Doxycycline

D. Gentamicin

E. Trimethoprim

A

E. Trimethoprim

82
Q
  1. In the treatment of bacterial infections which of the following drugs inhibits the bacterial enzyme dihydrofolate reductase?

A. Penicillin

B. Cephalexin

C. Doxycycline

D. Gentamicin

E. Trimethoprim

A

E. Trimethoprim

83
Q
  1. In the treatment of cancer cyclophosphamide acts primarily by

A. Inhibiting human epidermal growth factor receptor 2 (HER2)

B. Imbibing the reproduction of the Epstein Barr virus

C. Forming covalent bonds across the strands of DNA to produce intrastrand links and interstrand cross links

D. Inhibiting the aromatase enzyme and reducing the conversion of androgens into oestrogens

E. Reducing the effects of ultraviolet light on the skin

A
84
Q
  1. Which of the following medications may be of benefit in the treatment of a paracetamol overdose?

A. Naloxone

B. Acetylcysteine

C. Celecoxib

D. Diclofenac

E. Prostaglandin E

A

Naloxone

Acetylcysteine

Celecoxib

Diclofenac

Prostaglandin E

85
Q
  1. In patients taking long term opioid therapy, tolerance seldom develops to

A. Analgesia

B. Constipation

C. Nausea and vomiting

D. Cough suppression

E. Sedation

A

B. Constipation

86
Q
  1. Which of the following drug combinations may produce the Serotonin Syndrome?

A. Propanol and amlodipine

B. Diazepam and codeine

C. Pantoprazole and salbutamol

D. Sertraline and tramadol

E. Methotrexate and ibuprofen

A

D. Sertraline and tramadol

87
Q
  1. Acetylcholine produces bradycardia by stimulating
  • H2 receptors
  • α1 receptors
  • β2 receptors
  • AT1 receptors
  • M2 receptors
A
  1. Acetylcholine produces bradycardia by stimulating
  • H2 receptors
  • α1 receptors
  • β2 receptors
  • AT1 receptors
  1. Acetylcholine produces bradycardia by stimulating
  • H2 receptors
  • α1 receptors
  • β2 receptors
  • AT1 receptors
  • M2 receptors
88
Q
  1. Which of the following drugs is a corticosteroid used as a preventer medicine in the treatment of asthma?

A. Salbutamol

B. Eformoterol

C. Fluticasone

D. Ipratropium

E. Montelukast

A
89
Q
  1. Mrs James recently commenced taking medication to treat high blood pressure and she has now developed peripheral (ankle) oedema. Which of the following drugs is most likely to cause this effect?

A. Amlodipine

B. Enalapril

C. Candesartan

D. Hydrochlorothiazide

E. Metoprolol

A
90
Q
  1. Ramipril exerts its effects by

A. Competitively antagonizing angiotensin II type one receptors

B. Reducing the formation of angiotensin II by inhibiting angiotensin converting enzyme

C. Inhibiting the effects of noradrenaline on beta1 receptors in the heart

D. Inhibiting the release of renin from the juxtaglomerular apparatus in the kidneys

E. Inhibiting calcium entry into the cell by blocking voltage-gated L type calcium channels

A
91
Q
  1. Ramipril exerts its effects by

A. Competitively antagonizing angiotensin II type one receptors

B. Reducing the formation of angiotensin II by inhibiting angiotensin converting enzyme

C. Inhibiting the effects of noradrenaline on beta1 receptors in the heart

D. Inhibiting the release of renin from the juxtaglomerular apparatus in the kidneys

E. Inhibiting calcium entry into the cell by blocking voltage-gated L type calcium channels

A
92
Q
  1. In the treatment of STEMI, which of the following drugs acts to degrade the thrombus?

A. Warfarin

B. Aspirin

C. Alteplase

D. Glyceryltrinitrate

E. Heparin

A

C. Alteplase

93
Q
  1. Which of the following drugs is included Pregnancy Category X?

A. Atenolol

B. Atorvastatin

C. Candesartan

D. Isotretinoin

E. Trimethoprim

A

D. Isotretinoin

94
Q
  1. Ethyl alcohol is metabolised by alcohol dehydrogenase to

A. Acetic acid

B. Acetyl-CoA

C. Acrylicacid

D. Acetone

E. Acetaldehyde

A

E. Acetaldehyde

95
Q
  1. Benzodiazepines exert their effects on the central nervous system by

A. Blocking the opening of the GABAA receptor chloride ion channel by competitively inhibiting the effects of GABA on the GABAA receptors

B. Increasing the frequency of opening of the GABAA receptor chloride ion channel

C. Increasing the duration of the opening of the GABAA receptor chloride ion channel

D. Directly acting on the GABAA receptor chloride ion channel to block the entrance of chloride ions

E. Increasing both the frequency and the duration of the opening of the GABAA receptor chloride ion channel

A

B. Increasing the frequency of opening of the GABAA receptor chloride ion channel

96
Q

You find the following prescription below

a) Identify the drug class of this medication
b) Identify TWO indications of this drug class
c) Identify TWO adverse effects of this drug class
d) Is the dose appropriate?Justify your answer
e) Identify ONE drug used in the reversal of this drug following an overdose

A

a) Identify the drug class of this medication

Benzodiazepine

b) Identify TWO indications of this drug class

Anxiolytic / for anxiety

Hypnotic/ for insomnia

c) Identify TWO adverse effects of this drug class

Drowsiness

Memory impairment

d) Is the dose appropriate?Justify your answer.

No. This is because with long-term use, tolerance and dependence can occur.

e) Identify ONE drug used in the reversal of this drug following an overdose.

Flumazenil

97
Q
  1. You find a box with the following pharmacy label below.

Identify TWO drugs that can interact with this medication and identify the name of this interaction.

A

Diuretics and NSAIDs. Known as Triple Whammy.

98
Q
  1. Note the following extract from a prescription. Assume that it has been written intentionally and with no grammatical mistakes.
    a) Identify ONE adverse effect of this medication
    b) If this medication has been prescribed for an autoimmune disease,is the dose appropriate?
A
  1. Note the following extract from a prescription. Assume that it has been written intentionally and with no grammatical mistakes.
    a) Identify ONE adverse effect of this medication

Alopecia (hair loss)

b) If this medication has been prescribed for an autoimmune disease,is the dose appropriate?

No (should only be taken once weekly on same day of week)

99
Q
  1. Note the following bottle of vitamin E capsules found.
    a) List ONE claimed benefit of this vitamin
    b) List ONE reported adverse event with its long-term use
    c) Identify the classification of this vitamin according to the Australian Register of Therapeutic Goods (ARTG)
    d) What does this ARTG classification mean for this product?
A
100
Q

Which of the following is not an intrinsic control mechanism of blood vessel diameter?

A. Myogenic

B. Metabolite control

C. SNS activation

A

Which of the following is not an intrinsic control mechanism of blood vessel diameter?

A. Myogenic

B. Metabolite control

C. SNS activation

101
Q

Identify a component of the pulmonary circuit:

  • The abdominal aorta
  • Superior vena cava
  • Inferior vena cava
  • Left ventricle
  • Right ventricle
A

Identify a component of the pulmonary circuit:

  • The abdominal aorta
  • Superior vena cava
  • Inferior vena cava
  • Left ventricle
  • Right ventricle
102
Q

Why are AV nodal cells NOT responsible for determining heart rate?

  • As depolarisation initiated in the SA node reaches the AV node, it leaves AV node in refractory state
  • The AV node is connected to the SA node but not to other conducting fibres in the heart
  • They depolarise faster than all other conducting fibres
  • They depolarise slower than all other conducting fibres
  • They are non-responsive to catecholamines
A

Why are AV nodal cells NOT responsible for determining heart rate?

  • As depolarisation initiated in the SA node reaches the AV node, it leaves AV node in refractory state
  • The AV node is connected to the SA node but not to other conducting fibres in the heart
  • They depolarise faster than all other conducting fibres
  • They depolarise slower than all other conducting fibres
  • They are non-responsive to catecholamines
103
Q

Mitotic spindles attach to which part of the chromosome to pull them apart?

  • Centromere
  • Centrosome
  • Chromatid
  • Kinetochore
  • Cohesin Protein
A

Mitotic spindles attach to which part of the chromosome to pull them apart?

  • Centromere
  • Centrosome
  • Chromatid
  • Kinetochore
  • Cohesin Protein
104
Q

When a chromosome fails to separate during Meiosis II, what is the likelihood of the gamete being aneuploidic?

A. 12.5%

B. 25%

C. 50%

D. 75%

E. 100%

A

When a chromosome fails to separate during Meiosis II, what is the likelihood of the gamete being aneuploidic?

A. 12.5%

B. 25%

C. 50%

D. 75%

E. 100%

105
Q

Which enzyme is rate-limiting in glycolysis?

A. Hexokinase

B. Glucokinase

C. Phoshofructokinase-1

D. Pyruvate kinase

A

Which enzyme is rate-limiting in glycolysis?

A. Hexokinase

B. Glucokinase

C. Phoshofructokinase-1

D. Pyruvate kinase

106
Q

Which one of the following is not a barrier in the respiratory tract to protect against colonisation?

  • Alveolar macrophages
  • Mucociliary apparatus
  • Commensal bacteria
  • Complement system
A

Which one of the following is not a barrier in the respiratory tract to protect against colonisation?

  • Alveolar macrophages
  • Mucociliary apparatus
  • Commensal bacteria
  • Complement system
107
Q

Which of the following is not a mechanism of gene transfer between bacteria?

A. Induction

B. Transformation

C. Transduction

D. Conjugation

A

Which of the following is not a mechanism of gene transfer between bacteria?

A. Induction

B. Transformation

C. Transduction

D. Conjugation

108
Q

Melanocytes are found in which layer of the epidermis?

  • Stratum basale
  • Stratum spinosum
  • Stratum granulosum
  • Papillary layer
A

Melanocytes are found in which layer of the epidermis?

  • Stratum basale
  • Stratum spinosum
  • Stratum granulosum
  • Papillary layer
109
Q

Which of the following is not a virulence factor of H. Pylori?

A. Flagella
B. Urease
C. CagA
D. Collagenase
E. Acid Inhibitory Protein

A

Which of the following is not a virulence factor of H. Pylori?

A. Flagella
B. Urease
C. CagA
D. Collagenase
E. Acid Inhibitory Protein

110
Q

Which of the following is not a common pathological feature of giardia infection?

  • Steatorrhoea
  • Abdominal cramping
  • Tachycardia
  • Nausea
A

Which of the following is not a common pathological feature of giardia infection?

  • Steatorrhoea
  • Abdominal cramping
  • Tachycardia
  • Nausea
111
Q

The Cori cycle describes which process?

  • The conversion of lactate to a-ketoglutarate for ammonia production.
  • The recycling of lactate for glucose production
  • The production of aspartate for amino acid synthesis.
  • The conversion of glucose to ribose for NADPH production.
  • The conversion of glutamate to glutamine for beta oxidation
A

The recycling of lactate for glucose production