Past year papers

Question 1

Constrictions of the oesophagus

Answer 1

C5/6 cricoid cartilage/origin of pharynx
T4/5 arch of aorta and left main bronchus
T10 eosophageal hiatus

Question 2

An apical lung tumour has eroded into and is affecting the autonomic nervous system of a patient.
The post-ganglionic fibres going to the heart and lungs are most significantly impacted here.
Where are the following locations of the pre-ganglionic cell bodies for these nerves going to the
heart and lungs?
A. Greater splanchnic nerve
B. Spinal cord S2-S4
C. Spinal cord T1-T4
D. Vagus nerve

Answer 2

C

apical lung tumour=pancoast tumour
affects SVC, sympathetic chain, c8/t1 brachial plexus, recurrent laryngeal nerve

• sympathetic trunk: thorocolumbar

Question 3

From the following list of options, please select the one that accurately completes the last
sentence.

After a prolonged bout of flu, a teacher develops a sharp stabbing pain in her chest and shoulders
when she breathes deeply. The patient’s GP diagnoses her with pleuritis. The pain in her
shoulders is MOST LIKELY due to inflammation of parietal pleura related closely to the…
A. apex of the lungs
B. central diaphragm
C. peripheral diaphragm
D. sternum

Answer 3

B

central diaphragm: phrenic nerve
peripheral diaphragm: intercostal nerve

phrenic nerve: c3,4,5
- dermatome to the shoulder

Question 4

In order to auscultate the superior lobe of the lungs, a medical student must recall the surface
anatomy of the lung fissures. The oblique fissure of the lung extends from…
A. T2 spinous process posteriorly to 6th costal cartilage anteriorly
B. T2 spinous process posteriorly to 8th costal cartilage anteriorly
C. T4 spinous process posteriorly to 2nd costal cartilage anteriorly
D. T4 spinous process posteriorly to 6th costal cartilage anteriorly

Answer 4

A

Question 5

During video-assisted thoracoscopic surgery to remove an upper lobe of the right lung affected by
bronchiectasis, the lung root was examined carefully by the attending surgeon. The root of the
right lung…
A. has the hemiazygos vein arching over it
B. has the main bronchus lying posterior to the pulmonary artery
C. has the vagus nerve passing anterior to it
D. lies opposite the bodies of the T2-T4 vertebrae

Answer 5

Answer B: has the main bronchus lying posterior to the pulmonary artery

D: lies opposite T5-T7

Question 6

A 50-year-old woman was diagnosed with a large and expanding posterior mediastinal tumour.
Which of the following structures is MOST LIKELY to be compressed in this patient?
A. Ascending aorta
B. Right recurrent laryngeal nerve
C. Thoracic duct
D. Trachea

Answer 6

C

trachea bifurcation is in posterior mediastinal but trachea is in superior

Question 7

A patient is undergoing surgery for rectal cancer. During this surgery, the surgeon needs to
eliminate risk of intra-operative bleeding of the rectum, as the superior portion of the rectum is
being removed.
What parent artery/arteries (which give rise to the superior rectal arteries) need to be ligated in
this patient?
A. Ileocolic artery
B. Inferior mesenteric artery
C. Sigmoid arteries
D. Superior mesenteric artery

Answer 7

B

Question 8

Which of the following types of nerves/functional components would be MOST LIKELY affected in
this patient, in addition to the visceral afferents?
A. Presynaptic (pre-ganglionic) and postsynaptic (post-ganglionic) parasympathetic fibres
from the vagus nerve
B. Presynaptic (pre-ganglionic) and postsynaptic (post-ganglionic) sympathethic fibres from
the greater and lesser splanchnic nerves
C. Presynaptic (pre-ganglionic) and postsynaptic (post-ganglionic) sympathethic fibres from
only the greater splanchnic nerve
D. Presynaptic (pre-ganglionic) parasympathetic fibres from the vagus nerve
E. Presynaptic (pre-ganglionic) sympathethic fibres from the greater and lesser splanchnic
nerves

Answer 8

B

Question 9

From the following list of options, please select the one that accurately completes the last
sentence.
A new-born baby is brought to the clinic because of repeated vomiting. Imaging reveals volvulus
due to Meckel’s diverticulum. The midgut is at risk for volvulus because it is…
A. intraperitoneal
B. retroperitoneal
C. secondarily retroperitoneal
D. A and C are both true

Answer 9

A

midgut is both secondarily and intra but then volvulus is to do with the vitelline duct not obliterating and instead, portion of the intestine twists upon itself bringing the mesentery with it –> intra

Question 10

Highly localised reciprocal inductive interactions between ureteric branch tips and metanephric
mesenchyme occurs during which of the following phases?
A. After birth in human babies born at term
B. Anterior region of the intermediate mesoderm at 22 days of gestation
C. During nephrogenesis which is complete by 36 weeks of gestation
D. Early 4th week of gestation in the cervical region, between the 2nd and 6th somites

Answer 10

C
week 5
D: sacral

Question 11

The morphological stages of nephron development (nephrogenesis) occur in which of the
following temporal order (sequence)?
A. Epithelial vesicle, comma-shaped body, mesenchymal cell condensate, S-shaped body
B. Epithelial vesicle, comma-shaped body, mesenchymal cell condensate, glomerulus,
S-shaped body
C. Mesenchymal cell condensate, epithelial vesicle, comma-shaped body, S-shaped body
D. Mesenchymal cell condensate, epithelial vesicle, glomerulus, lower limb of S-shaped body,
S-shaped body

Answer 11

C

Question 12

Surgical access to the kidneys posteriorly requires the operator to go through many layers.
Which of the following structures is the deepest layer immediately superficial to the kidney in this
posterior access?
A. Perirenal fat
B. Peritoneum
C. Renal capsule
D. Renal fascia

Answer 12

C

superficial
pararenal
renal fascia
perirenal
renal capsule
deep

kidneys have no peritoneum bc it is primarily retroperitonium

Question 13

Which of the following types of epithelium lines the urinary tract?
A. Simple columnar
B. Simple cuboidal
C. Simple squamous
D. Stratified squamous
E. Transitional

Answer 13

E

Question 14

From the following list of options, please select the one that accurately completes the following
sentence.
Diarrhoea is associated with…
A. increased water absorption in the colon
B. lactose intolerance resulting in decreased absorption of solutes in the jejunum
C. rectal prolapse and colonic obstruction
D. surgical removal of the parasympathetic pre-ganglionic innervation of the colon
(vagotomy)

Answer 14

b

Question 15

From the following list of options, please select the one that accurately completes the following
sentence.
The following hormones are synthesized in the hypothalamus EXCEPT…
A. endorphins
B. follicle-stimulating hormone
C. gonadotrophin releasing hormone
D. oxytocin

Answer 15

B

FSH and LH produced and released by anterior pituitary via stimulation by hypothalamus GnRH

Question 16

A 65-year-old man, who has been diabetic for many years, recently had insulin added on to his oral
hypoglycemic agents. He was doing well on the insulin for about 2 months but recently he noticed
he had gained weight and decided to increase his exercise and reduce his intake of carbohydrates.
However, he noticed that he was having frequent episodes of hypoglycemia.
Which of the following statements is TRUE with regard to this scenario?
A. He is experiencing increased insulin resistance.
B. He should be advised to eat more carbohydrates and reduce his exercise to prevent
hypoglycaemia.
C. He should be advised to reduce his insulin on days when he exercises and/or when he eats
less than usual.
D. Weight gain is unexpected in a patient on insulin therapy.

Answer 16

C

Question 17

The administration of Angiotensin Converting Enzyme (ACE) Inhibitor agents can…
A. decrease the glomerular filtration rate (GFR) by reducing the afferent arteriolar resistance
in the kidney
B. decrease the glomerular filtration rate (GFR) by reducing the efferent arteriolar resistance
in the kidney
C. increase the glomerular filtration rate (GFR) by increasing the efferent arteriolar resistance
in the kidney
D. increase the glomerular

Answer 17

B

ACEi, ARBs affect efferent arteriole
antihypertensive –> to reduce BP, so reduced BF to kidneys, decreasing GFR by decreasing efferent arteriole resistance

Question 18

Which of the following statements is FALSE regarding autoregulation of glomerular capillary
pressure and therefore glomerular filtration?
A. ACE inhibitors inhibit vasoconstriction of the efferent arteriole.
B. Constriction of the efferent arteriole increases glomerular filtration.
C. Dilatation of the afferent arteriole increases glomerular filtration.
D. NSAIDs cause dilatation of the afferent arteriole.
E. NSAIDs inhibit vasodilation of the afferent arteriole.

Answer 18

D

NSAIDs inhibit production of PGs.
PGs vasodilate the afferent arteriole
thus NSAIDs inhibit vasodilation, not cause vasodilation

Question 19

Which of the following conditions BEST DESCRIBES the prognosis for bladder function following a
spinal cord injury at L1?
A. Disruption of the sensory input to the brain is lost but voiding can be encouraged by
tapping on the bladder wall which activates the abundant stretch receptors.
B. Dysfunction can be controlled by drugs, especially those that influence parasympathetic
nerve function.
C. Function is poor and almost impossible to restore.
D. Urination will be minimally disrupted because the process is entirely controlled by robust
local reflexes.

Answer 19

C

Spinal cord injury: everything below it affected
L1: above sacral level –> (loss of PSNS inhibition by PSC) urge incontinence
At sacral level
= (pudendal nerve) stress incontinence
= (pelvic splanchnics to detruser) overflow incontinence

Question 20

A 70-year-old male patient with a history of hepatitis C and liver cirrhosis presents to the General
Practitioner with tiredness, weakness, and loss of appetite for the past two weeks. Further history
and physical examination findings were suggestive of portal hypertension.
Which of the following physical examination findings, elicited by the General Practitioner, is MOST
LIKELY to be present in patients with portal hypertension?
A. Flat abdomen
B. Inverted umbilicus
C. Splenomegaly
D. Visible peristalsis

Answer 20

C

Question 21

A 60-year-old female patient with a 20-year history of uncontrolled type 2 diabetes mellitus
presents to the General Practitioner with progressive tiredness, nausea, and loss of appetite for
the past two months. Further history and physical examination findings were suggestive of chronic
kidney disease.
Which of the following physical examination findings is MOST LIKELY to be present in this patient?
A. Murphy’s sign
B. Non pitting oedema
C. Pitting nails
D. Shifting dullness

Answer 21

D
Fluid buildup

Question 22

A 55-year-old female patient presents to General Practitioner with a 2-month history of
constipation.
Which of the following history and physical examination findings are MOST LIKELY to suggest that
this patient has hypothyroidism?
A. A hoarse voice and hearing loss
B. Excessive sweating and clubbing
C. Polyphagia and pitting oedema
D. Rectal bleeding and jaundice

Answer 22

A

Question 23

A 40-year-old woman has suffered a Pulmonary Embolism two days post-surgery for a ruptured
Achilles tendon.
Which of the following symptoms was she MOST LIKELY to have described at that time?
A. A bark-like cough
B. A cough productive of pink frothy sputum
C. A sharp chest pain when breathing in
D. A whistling noise throughout her chest

Answer 23

c

Question 24

A 57-year-old accountant has been on losartan and hydrochlorothiazide for two years to control
his hypertension. A few weeks ago, he started experiencing pain in his finger joints. His wife, who
has a long history of arthritis, gave him several doses of the ibuprofen tablets she has been taking
for pain relief. He is now likely to experience…
A. fluid retention
B. frequent urination
C. hypokalemia
D. increased appetite
E. mental alertness

Answer 24

A

CKD: fluid retention, kidneys don’t work

Question 25

A patient presents with symptoms consistent with Graves’ disease, including tachycardia,
palpitations, agitation and tremor. Which of the following drugs will provide immediate short
term relief of these symptoms?
A. Iodine
B. Propranolol, a non-selective beta adrenoceptor antagonist
C. Propylthiouracil, a thionamide
D. Radioactive iodine

Answer 25

B

Question 26

A patient is referred for a colonoscopy. To prepare the bowel for examination, he is prescribed
polyethylene glycol, which is a/an…
A. bulk laxative
B. faecal softener
C. osmotic laxative
D. stimulant laxative

Answer 26

C

Question 27

A 24-year-old man with recurrent tonsillitis presents to his doctor with a 3-day history of sore
throat and fever. Examination reveals right-sided peritonsillar swelling and enlarged cervical lymph
nodes.
Which of the following organisms is the MOST LIKELY causative bacteria?
A. Corynebacterium diphtheriae
B. Haemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
E. Streptococcus pyogenes

Answer 27

E

peritonsillar swelling = quincy
–> strep pyogenes

Question 28

A female presents to her GP complaining of fatigue for the last two weeks following an episode of
viral fever. On examination, the GP finds a mass in the left hypochondrium.
Which of the following findings would suggest that the mass is the spleen rather than the kidney?
A. It has a notch on its anterior border.
B. The mass enlarges inferiorly.
C. The mass is ballotable.
D. The upper border is palpable.

Answer 28

A

Question 29

A 20-year-old female presents to her GP with a one-month history of intermittent epigastric
discomfort and three episodes of melena.
Which of the following history elements would this patient be MOST LIKELY to additionally report?
A. Coffee-ground vomitus
B. Consumption of statins
C. Past history of hepatitis A infection
D. Presence of haemorrhoids

Answer 29

A
- peptic ulcer

statins is referring to something to do with the gallbladder (hypercholestermia?)

Question 30

A 55-year-old woman attends her General Practitioner for a general check-up. She had some
bloods tests done as part of a workplace medical service last week and has brought these in for
the GP to review. She has a history of COPD and uses a daily steroid puffer. She has smoked a
packet of cigarettes per day since she moved to Australia from Vietnam 20 years ago. Her BMI is
29. She reports no significant symptoms.
The basic bloods test revealed the following result:

Full Blood Examination – Normal
Liver Function Tests (LFT) – AST↑, ALT↑, GTT ↑↑↑, ALP↑
Glucose - Normal
Lipids - Mild hyperlipidaemia

Which of the following is the MOST LIKELY to explain her LFT results? She has…
A. alcoholic liver disease
B. asymptomatic gallstones
C. undiagnosed Hepatitis B
D. undiagnosed pancreatic cancer

Answer 30

A

Alcoholic liver disease: only GGT highly elevated

Question 31

A 70-year-old man is in a palliative care ward with end stage renal failure secondary to Polycystic
Kidney Disease. Which of the following combination of signs is MOST LIKELY to be seen on his
examination?
A. Asterixis, hiccups, pale conjunctiva, palpable kidneys
B. Bruising, leukonychia, plethoric complexion, pitting oedema
C. Caput medusa, a fishy odour, hypertension, tachypnoea
D. Dehydration, palmar erythema, sallow appearance, scratch marks

Answer 31

A

asterixis: toxic buildup in kidneys
hiccups: uremia (build up of urea on skin)
pale conjunctiva: anaemia

b: plethoric complexion: cushings syndrome
c: caput medusa: portal hypertension
D: CKD wont have dheydration, fluid retention instead

Question 32

An 85-year-old male patient is admitted to hospital following a fall that resulted in a fractured pelvis and right neck of femur. A pre-operative chest x-ray has been requested and an antero-
posterior (AP) view was taken given that the patient was unable to stand.

Which of the following chest x-ray findings requires a postero-anterior (PA) view in order to be
RELIABLY diagnosed in this patient?
A. A pneumothorax
B. An aortic arch aneurysm
C. An upper lobe consolidation
D. Cardiomegaly

Answer 32

D