RACPpastpapers Flashcards by Aisha Yaseen

2023

Hyperorality is a feature of which form of dementia?

Frontotemporal
Dementia with lewy body
Alzheimers
Vascular

A- Frontotemporal

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2023

The National Institute of Mental Health Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus panel has recently defined five negative symptoms: blunted affect, alogia, asociality, avolition. What is the 5th negative symptom?

A- Alexithymia
B- Anhedonia
C- Anxiety
D- Autism

B- Anhedonia

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2023

Young woman with PE, HR 90, SBP 110, Echo shows Right ventricular dilatation, which of the following is most likely to improve her mortality

A- Anticoagulation
B- IVC filter
C- Catheter directed thrombolysis

A- anticoagulation

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2023
What thyroid disorder is most likely to result in a euthyroid state post successful treatment with radioactive iodine therapy?

A) Graves’ disease
B) Nontoxic goitre
C) Autonomous nodule
D) Thyroid cancer

C) autonomous nodule

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2023
An 85 year old male sees you in an outpatient setting. He is interested in reducing his pill burden. His medical background is significant for chronic renal impairment, atrial fibrillation, treated bladder cancer, chronic urinary retention with a permanent IDC, previous R MCA stroke and hypertension. His current medications include Frusemide, warfarin, atorvastatin, metoprolol, prazosin and enalapril. What is the first medication you would cease?

A) Frusemide
B) Warfarin
C) Atorvastatin
D) Prazosin

D) Prazosin

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2023

32 year old female with severe acute pancreatitis, triglycerides 32, has been treated with IV Fluids, Insulin, triglycerides remain elevated, what is next treatment

A) Apheresis
B) Dialysis
C) Fibrates
D) PCSK9 inhibitor

A) Apheresis

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2023

What is the most appropriate starting dose of prednisone for a 72 year old female with PMR who weighs 75 kg

A) 5 mg
B) 15 mg
C) 50 mg
D) 75 mg

B) 15 mg

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2023

69m with erectile dysfunction. Found to have low testosterone and then high prolactin

Prolactin 77000
Testosterone 5
Other indices normal
Mrib showing compression of pituitary stalk. No compression of optic chiasm
What is the treatment?

A) External beam radiation
B) Surgery
C) Somatostatin analogue
D) Dopamine agonist

D) Dopamine agonist

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2023

Nanging is a recreational activity teenagers engage in where they inhale nitrous oxide (LOL). Which vitamin does nanging deplete?

A) B1
B) B6
C) B12
D) Vitamin C

C) B12

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2023

A 37 year old man who has a family history of autosomal dominant polycystic kidney disease wishes to
donate a kidney to his sister, who has end stage renal failure.
Genetic testing for autosomal polycystic kidney disease is expensive and time-consuming. In order to preserve
resources and for the best planning for the future of the organ donation for this family, who should be tested for
polycystic kidney disease?

A. The man
B. His sister
C. His mother
D. His father

A) The man

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2023

20F receiving CART therapy for ALL. Develops myalgias fevers and headache, and deteriorates despite empiric antibiotics. You suspect cytokine release syndrome. Which of these do you target for treatment?

A) IL10
B) TFN
C) IL6
D) IFN gamma

C) IL6

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2023

What finding on EMG is most consistent with axonal nerve injury?

A) Increased F wave latency
B) Increased distal latency
C) Decreased amplitude
D) Reduced velocity of wave

C) Decreased amplitude

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2023

Sodium valproate at therapeutic doses is not dialysable. However in acute overdose, sodium valproate is very effective in dialysis. What is the reason for this discrepancy?

A) Hepatotoxicity causing reduced valproate metabolism

B) Higher concentration of toxic metabolites of valproate that is easily dialysed

C) High valproate concentrations caused by saturated protein binding, meaning more valproate is dialysable when not protein bound

D) Hyperammonamia with metabolic acidosis affecting volume of distribution

C) High valproate concentrations caused by saturated protein binding, meaning more valproate is dialysable when not protein bound

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2023

What is 4mg of dexamethasone equivalent to in terms of hydrocortisone?

A. 20
B. 40
C. 80
D. 100

D. 100

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2023

A 46F with Sjogren’s syndrome develops the following rash on her legs. She has the following blood tests:
ANA 1:640 speckled
RF 300 (<15)
Anti-CCP 8 (<12)
C3 0.3 (low)
C4 0.1 (very low)
Anti-Ro positive
pANCA positive
MPO negative
PR3 negative
Urinalysis: red cell casts

A) Hypocomplementaemic urticarial vasculitis
B) Cryoglobulinaemic vasculitis
C) Microscopic polyangitis
D) Rheumatoid vasculitis

B) Cryoglobulinaemic vasculitis

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2023

An elderly lady presents with an L1 compression fracture after lifting groceries. Which of her medications is most likely to contribute to decreased BMD?

A) bisoprolol
B) isosorbide mononitrate
C) metformin
D) pioglitazone

D) pioglitazone

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2023

A 64 year old male presents to you with a Hb of 185 and a Haematocrit of 0.55. He has tested positive for the JAK2 V617F mutation. In addition to regular venesection, what is the most appropriate treatment?

a) Aspirin
b) Hydroxyurea
c) Aspirin and Hydroxyurea
d) Aspirin and Ruxolitinib

c) Aspirin and Hydroxyurea

<60 and no mutation –> observe
<60 + mutation –> aspirin
>60 and no mutation –> aspirin +/- hydroxyurea
>60 + mutation –> aspirin + hydroxyurea

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2023

Which medication is used as first line therapy in the prophylaxis of idiopathic cyclical vomiting syndrome

A) Amitryptiline
B) Levetiracetam
C) Propanolol
D) Topiramate

A) Amitryptiline

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2023

What pathology is suggested by painless asymmetric wasting of the thenar eminence and first dorsal interosseus, with sparing of the hypothenar eminence, in the absence of sensory changes?

A) ALS
B) Multifocal motor neuropathy
C) C8 radiculopathy
D) Median nerve palsy at the wrist

A) ALS

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2023

The size of a positive skin prick test clinically correlates to:

A) The likelihood of a reaction
B) Cross reactivity
C) The expected severity of a reaction
D) The patient having has a recent bad reaction

A) The likelihood of a reaction

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2023

A man presents with headache and epistaxis. Protein 110, IgM 55 what is the most rapid way to treat?

A) Apheresis
B) Bendamustine
C) Continuous veno veno dialysis
D) High dose methylprednisone

A) Apheresis

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2023

A 30 year old woman presents to the Emergency Department with drug overdose. The following is her arterial blood gas analysis (ABG):
pH 7.62
Partial pressure of carbon dioxide 20
Bicarbonate 17
Base excess -4
Sodium 135
Potassium 5.8
Chloride 98

Which drug in overdose is most likely responsible for this metabolic derangement?

A. Gamma hydroxybutyrate (GHB) acid
B. Paracetamol
C. Salicylate
D. Tricyclic antidepressant

C. Salicylate

Combined metabolic acidosis and respiratory alkalosis which is specific for salicylate poisoning
High anion gap metabolic acidosis

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2023

32 year old gentleman with long-standing T1DM symptoms presents with nausea, vomiting and early satiety. He has prominent micro vascular complications. He has a normal endoscopy. Next best investigation to confirm gastroparesis?

A) Gastroduodenal Manometry
B) 13C breath test
C) Gastric emptying scintigraphy
D) Barium swallow

C) Gastric emptying scintigraphy

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2023

What is the best medication to reduce hyperandrogenism in pcos in a girl who does not want pregnancy?

A. Cyproterone
B. Metformin
C. Oestrogen and progestin
D. Spironolactone

C. Oestrogen and progestin

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2023 Where is the lesion where anosognosia is a potential symptom of stroke? A. Left cinguate gyrus B. Left frontal lobe C. Right parietal lobe D. Right frontal lobe

C. Right parietal lobe

2023 In cognitive assessments, the testing of verbal fluency something (such as naming multiple words starting with P) and ? fluency (such as drawing an object such as with four lines), is testing the function of which lobe? A. Frontal B. Occipital C. Temporal D. Parietal

A. Frontal

2023 During the COVID-19 pandemic, there was increased reporting of functional tic-like disorders on social media (termed "TikTok tics"). It can be hard to distinguish between genuine tic disorders and functional tic-like disorders on presentation. Which of the following is most effective for both conditions? A. Clonidine B. Cognitive behavioural therapy C. Rapid eye desensitisation reprogramming D. Risperidone

B. Cognitive behavioural therapy

2023 What are the most common precursor to lung abscess? A) Aspiration B) Septic emboli C) Empyema D) Obstructive lesion

A) Aspiration

2023 A 30 year old male with Marfan's syndrome has asthma that is significantly exacerbated by beta-blockers. He has hypertension to 150/90 mmHg and a heart rate of 98 bpm. Which medication should be prescribed for management of his hypertension? A. If (funny channel) blocker B. Angiotensin receptor blocker C. Calcium channel blocker D. Thiazide diuretic

B. Angiotensin receptor blocker (use losartan) recall, IF funny channel is ivabradine

2023 What is the most prevalent mutation in patients with heritable thrombophilia? A. Factor V Leiden B. Protein C Deficiency C. Protein S deficiency D. Antithrombin III mutation

A. Factor V Leiden

2023 Which of the following medications is best option for woman with bipolar disorder who is trying to become pregnant A) Antipsychotic B) Antidepressant C) Lithium D) Valproate

A) Antipsychotic

2023 Which is the following safest option to do ECT in pregnancy: A) First trimester B) First and second trimester C) Second and third trimester D) All trimesters

D) All trimesters

2023 Which has the highest risk of VTE? A) Clozapine B) Olanzapine C) Quetiapine D) Risperidone

B) Olanzapine

2023 Which of the following is correct about prescription of HIV post exposure prophylaxis A) No benefit if started >24 hrs, needs to be taken for 2 weeks B) No benefit if started >24 hrs, needs to be taken for 4 weeks C) No benefit if started after 72 hrs, needs to be taken for 2 weeks D) No benefit if started after 72 hrs, needs to be taken for 4 weeks

D) No benefit if started after 72 hrs, needs to be taken for 4 weeks

2023 3 year old female long standing splenomegaly and bony pain. No history of lymphadenopathy, weight loss or fevers. She was born in Australia with no recent travel. Blood film shows abnormal cells with fibrillar material in the cytoplasm. X-ray of the distal femur shows Erlenmeyer flask abnormality. What is the diagnosis? A) Fabry’s disease B) Gaucher disease C) Glycogen storage D) Hemophagocytic lymphohistiocytosis

B) Gaucher disease

2023 A 37 year old lady presents acutely to the Emergency Department with palpitations. A previous baseline ECG and an ECG captured during her palpitations are shown below Baseline ECG - (normal 12 lead ECG in SR) ECG during palpitations - (narrow complex regular tachycardia with HR 150, flutter waves most obvious in V1) Which of the following is the rhythm represented by the ECG captured during her palpitations? A. Sinus tachycardia B. AVNRT C. Atrial flutter D. Multifocal atrial tachycardia

C. Atrial flutter

2023 What causes a capture beat on an ECG showing VT? A. Sinus and ventricular activity fuse to form a hybrid complex B. The distance from QRS to nadir S wave >100s C. Sinus node firing causes ventricle to produce a normal QRS D. A rabbit ear RSR shape where left ear larger than right ear

C. Sinus node firing causes ventricle to produce a normal QRS

2023 A coagulation profile includes APTT, Fibrinogen, Prothrombin Time (PT) and Thrombin Time (TT). Which of these will be altered by the therapeutic level of Rivaroxaban? A) APTT B) Fibrinogen C) Prothombin Time D) Thrombin Time

C) Prothombin Time

2023 In addition to trauma based cognitive therapy (CBT) which additional non pharmacological therapy has the best evidence in the treatment of post traumatic stress disorder (PTSD)? A) Mobilisation Therapy B) Risperidone C) Rapid eye movement and reprocessing therapy D) Mindfulness based therapy

C) Rapid eye movement and reprocessing therapy

2023 A 65 year old women with a 60 pack year history presents and an ECOG of 1 with the symptoms of SVC obstruction including Pemberton's sign and distended anterior chest veins. She has a biopsy of an enlarged supraclavicular lymph node. Which histology would make you choose urgent up-front chemotherapy for treatment? A. Neuroendocrine B. Adenocarcinoma C. Small cell D. Squamous cell

C. Small cell

2023 What is the predominant cell on bronchoalveolar lavage? A) Neutrophils B) Eosinophils C) Macrophages D) Lymphocytes

C) Macrophages

2023 Nephrogenic diabetes insipidus due to chronic lithium use and urine output of 6L. What to do prior to commencing therapy? A) Amilioride B) Salt restriction C) Thiazide D) Water restriction

B) Salt restriction 1) Low salt 2) Amiloride 3) HCT 4) Desmopressin

2023 Which organ system is most commonly affected in type 1 cryoglobulinemia? A. Dermatologic B. Nervous C. Pulmonary D. Renal

A. Dermatologic

2023 A 70 year old woman with rheumatoid arthritis has been on Methotrexate 20mg weekly, Prednisolone 5mg daily and Atorvastatin 40mg daily for the last 4 years. She reports fatigue and pain in her hips and also has pain and difficulty with standing up. She drinks 3 standard drinks of alcohol a day. She has 3/5 weakness bilaterally in the hips, pain on hip rotation but no synovitis in the hand or foot joints. Blood tests reveal ALT 120 and AST 450. FBE and other LFTs are otherwise normal. What is the next most appropriate investigation? A. Creatine Kinase B. CRP and ESR C. Hip Joint US D. Liver US

?A- CK

2023 VITS is a rare prothrombotic complication for people receiving COVID vaccine. Which platelet factor is involved? A) GP 1b-ix B) GP IIa/IIIb C) PF4 D) vWF

C) PF4

2023 Which of the following is the minimum amount of plasma cells in bone marrow required for a diagnosis of multiple myeloma A) 5% B) 10% C) 15% D) 20%

B) 10%

2023 48 year old gentleman with Child Pugh B cirrhosis presents with ascites and back pain. He is on the following medications: Ibuprofen 400mg tds Panadol 1g bd Oxycodone SR 10mg bd Pregabalin 75mg bd Which medication should be stopped in light of his cirrhosis? A) Ibuprofen B) Oxycodone C) Pregabalin D) Paracetamol

A) Ibuprofen

2023 Resistance to which antibiotic differentiates VanA VRE from VanB VRE? A) Daptomycin B) Linezolid C) Teicoplanin D) Tigecycline

C) Teicoplanin

2023 20 year old patient with cystic fibrosis has a 6 week history of increased production of green sputum without haemoptysis. Pancreatic function and bowel function are normal. They have bilateral upper cylindrical bronchiectasis on CT imaging. They also have new severe iron deficiency. Infection by what organism accounts for this presentation? A. Aspergillosis fumigates B. Klebsiella oxytocin C. Mycobacterium avium complex D. Pseudomonas aeruginosa

D. Pseudomonas aeruginosa

2023 A 28 year old man is seen in the medical oncology clinic post-orchidectomy. Biopsy of specimen shows a pT1 pure seminoma. He has abnormal tumour markers prior. Besides LDH, which of the following are expected to be abnormal? A) AFP B) b-hcg C) CA15.3 D) CEA

B) b-hcg

2023 Venetoclax is a chemotherapeutic used in AML and CLL. Which protein does venetoclax inhibit? A) BCL-2 B) P-53 C) BTK D) PD-1

A) BCL-2

2023 Chylothorax post thoracic surgery draining 200ml daily for the previous 48hrs. Which would reduce the chance of having to have surgical correction? A Atorvastatin B Corticosteroids C Imatinib D Octreotide

D Octreotide

2023 In a patient with idiopathic pulmonary fibrosis, lung function tests were performed. Saturations after 6 minute walk test 86% DLCO 45% Percent predicted forced vital capacity 50% Right heart catheter mean pulmonary arterial pressure 18mmHg Which result is an indication for flagging for lung transplant? A) 6MWT B) DLCO C) ppFVC D) RHC PAP

A) 6MWT Look at FVC, DLCO, 6MWT 6MWT <88% *10% decline in FVC in 6 months * 15% decline in DLCO over 6 months * O2 sats of less than 88% on 6MWT, distance less than 250m or decline in distance by 50m over 6 months, pulmonary HTN, worsening of CT findings But percent predicted forced vital capacity <80

2023 45F otherwise healthy executive presents for review. History of preeclampsia. Nyha 1, asymptomatic. sBP 150. TC 5.8, LDL 4. She is worried about the risks of taking long-term statins What test is best to predict her long-term atherosclerostic cardiovascular disease? A. Myocardial perfusion scan B. CT coronary arteries C. Coronary calcium score D. Exercise Stress Echocardiogram

C. Coronary calcium score

2023 What is the most common cause of acute tubulointerstitial nephritis? A. Viral infection B. Bacterial infection C. Medication exposure D. Immune complex

C. Medication exposure

2023 EC50 and EMAX

2023 Man comes in with reduced BMD. Which of the following drugs causes a reduced BMD A) Beta blocker B) Pantoprazole C) Pioglitazone

C) Pioglitazone

2023 80 year old male with postural hypotension confirmed on 20 mm Hg drop in systolic pressure captured during ward/inpatient measurements associated with syncope/symptoms. Past medical history includes AF, non-ischaemic rate-driven cardiomyopathy. Postural hypotension persists despite salt supplementation and compression stockings. Which is preferred medication A) Midodrine B) Fludrocortisone

A) Midodrine

2023 What cell is primarily deficient in leukocyte adhesion deficiency? A) NK B) B1 C) Eosinophils D) Neutrophils

D) Neutrophils involves integrins

2023 62y F with a history of orthotropic liver transplant reports diarrhoea. Current meds are amlodipine, mycophenolate, tacrolimus, prednisolone and valganciclovir. Colonoscopy demonstrates mild erythema. Biopsy demonstrates colitis but with culture neg for CMV. Which agent is responsible for the diarrhoea? A. Prednisone B. Mycophenolate C. Tacrolimus D. Valganciclovir

B. Mycophenolate

2023 Which of the following medications is likely to prevent a biphasic reaction in anaphylaxis if administered promptly? A) Adrenaline (Epinephrine) B) Cetirizine C) Montelukast D) Prednisone

A) Adrenaline (Epinephrine)

2023 Urea cycle disorders can present at any age. Which of the following are most likely to be abnormal? A) Ammonia B) Creatine Kinase C) Creatinine D) Urea

A) Ammonia

2023 A 48 year old male with cirrhosis presents with fluid overload. There is evidence of ascites, gross peripheral oedema and has been having worsening dyspnoea over the last few months. He has gained 7kg of weight over the last two months. His blood tests are as follows: FBC majority normal. EGFR > 90. Cr 110. Urea slightly elevated. Na 128 (low). Potassium normal. Albumin 19 (low). Protein 40 (low). Diuresing these patients with frusemide often causes an AKI. What is the physiological mechanism for the AKI in his situation? A) Hepatorenal syndrome B) Intravascular depletion C) Interstitial nephritis D) Tubular toxicity

B) Intravascular depletion

2023 A 76 year old woman who is otherwise well presents for review of her blood tests. Her TFTs are found to be abnormal during routine review, with minimal change since her bloods tests three months ago. Her blood tests Now vs 3 months ago are as follows: What is the appropriate management step? a) Commence selenium b) Thyroid ultrasound c) Commence thyroxine d) Annual TFT monitoring

d) Annual TFT monitoring

2023 In the management of herpes simplex, valaciclovir is dosed at 1g TDS, whereas aciclovir is 800mg five times per day. What is the reason for the more frequent dosing of aciclovir? A. The elimination half life of valaciclovir is twice that of aciclovir B. The oral bioavailability of valaciclovir is three times that of aciclovir C. HSV is more sensitive to valaciclovir than aciclovir D. The volume of distribution of valaciclovir is smaller than aciclovir.

A. The elimination half life of valaciclovir is twice that of aciclovir

2023 Eosinophilic oesophagitis treated with budesonide and PPI. Ongoing symptoms but no strictures on repeat endoscopy. Next step in management? A. Diet modification B. Montelukast C. Mepolizumab D. Balloon dilatation

A. Diet modification

2023 80yo male with major depression, with prominent features of anorexia and insomnia. Difficult to control BP, and history of electrolyte derangements when acutely unwell. Recurrent falls. History of bleeding peptic ulcer within the last year. Which is best to manage insomnia and anorexia? A. Citalopram B. Mirtazapine C. Nortriptyline D. Venlafaxine

B. Mirtazapine

2023 Prostate cancer with hypercalcaemia, bone mets. Ca 2.82, PTH 7.5 (ULN 7.3), Urine Ca to Cr ratio 0.41 (<0.61). What is the likely cause of the hypercalcaemia? A. Bony erosion B. Extra renal Vit D C. HyperPTH D. PTHrp driven

C. HyperPTH

2023 In a premenopausal woman who needs endocrine therapy for breast cancer, why would you add a GNRH antagonist to an aromatase inhibitor? A. Reduce ovarian production of aromatase substrates B. Increase ovarian production of aromatase substrates C. Reduce androgenic side effects D. Prevent menstrual bleeding

A. Reduce ovarian production of aromatase substrates

2023 Sleep is divided into both REM and non-REM sleep. REM sleep is characterised by which of the following? A. Atonia B. Fibrillations C. Myotonia D. Periodic limb movements

A. Atonia

2023 What is the dose of adrenaline used in anaphylaxis? A) 1mL of 1:1000 B) 1mL of 1:10000 C) 0.5mL of 1:1000 D) 0.5mL of 1:10000

C) 0.5mL of 1:1000

2023 A 56 year old female is newly diagnosed with non Hodgkin’s lymphoma and planned to commence treatment with cyclophosphamide, doxorubicin, vincristine, prednisolone and rituximab. Her hepatitis serology is as follows: Hepatitis B surface antibody positive Hepatitis surface antigen negative Hepatitis B core antibody positive Hepatitis B viral load undetectable Which of the following steps is most appropriate? A) Commence antiviral therapy B) Check hepatitis E antigen C) Commence chemotherapy and monitor LFTs D) Give hepatitis B vaccination

A) Commence antiviral therapy

2023 85 lady presents with new acute rash over R arm covering her back and trunk. She had a UTI 2 weeks ago treated with trimethoprim. She has right red eye and arthalgias and myalgias. On examination no weakness, no erythema or signs of arthritis. Biopsy showed dense neutrophilic infiltrate. Picture of rash - A) Agep B) Sweet syndrome C) Lupus D) Reactive arthritis

B) Sweet syndrome

2023 A 76-year-old lady admitted for elective left hip revision with a background of hypertension, T2DM and OA of the spine. On admission to rehab she is noted to have a left foot drop. Her upper limbs examine normally. She has normal hip and knee flexion and extension bilaterally. Her left foot plantarflexion power is 5/5, dorsiflexion 2/5, inversion and eversion 3/5. She has a reduced left ankle jerk reflex with subjective sensory loss at the dorsum of the left foot. EMG testing 10 days after the operation showed denervation of tibialis anterior and tibialis posterior. Where is the site of her injury? A. Common peroneal nerve B. L5 radiculopathy C. Lumbosacral plexus injury D. Sciatic nerve injury

? B. L5 radiculopathy However known ankle reflex is from S1

2023 An 85-year old man has left facial droop with paraesthesias. 6 months ago he had a lacunar stroke with transient facial droop. His family report a recent slowing of cognition. CT brain shows a small amount of subarachnoid blood in the right central sulcus close to the vertex. What is the most likely cause of his subarachnoid bleed? A. Amyloid angiopathy B. Hypertension C. Reversible cerebral vasoconstriction syndrome D. Trauma

A. Amyloid angiopathy

2023 A 23 year old woman presents with rapid onset myalgia, rigors, fever and conjunctival suffusion 3 days after swimming in a freshwater lake for a triathlon in Malaysia. What is the most likely causative organism? A. Aeromonas Aeurginosa B. Entamoeba Histolytica C. Leptospira D. Vibro Vulnificus

C. Leptospira

2023 Which of the following personality disorders matches the following A 50 year old man has no friends outside of his family. He wants a relationship but says 'I've tried in the past, women don't want to be with me' A) Histrionic B) Borderline C) Paranoid D) Schizoid E) Schizotypal F) Narcisstic G) Avoidant

G) Avoidant

2023 A 40 year old woman has no friends and can not hold down a job. She thinks she has a divine gift to see the future, and says she can not make friends with anyone as "I know more than them" A) Histrionic B) Borderline C) Paranoid D) Schizoid E) Schizotypal F) Narcisstic G) Avoidant

E) Schizotypal

2023 Which immunodeficiency is associated with infection with catalase positive bacteria A. C5 deficiency B. CVID C. X linked agammaglobulinemia D. SCID E. Chronic granulomatous disease F. Isolated CD4 deficiency G. Wiskott-Aldrich syndrome H. Interferon deficiency

E. Chronic granulomatous disease

2023 What is associated with neisseria infections? A. C5 deficiency B. CVID C. X linked agammaglobulinemia D. SCID E. Chronic granulomatous disease F. Isolated CD4 deficiency G. Wiskott-Aldrich syndrome H. Interferon deficiency Cellular something

A. C5 deficiency

Which of the following is the most likely cause of hyponatraemia in the following: Elderly lady with HTN, cardiovascular disease, diabetes on aspirin and a combination statin and anti-hypertensive A) Chronic Liver Disease B) Nephrotic syndrome C) Hypoadrenalism D) Hypothyroidism E) Salt depletion F) Psychogenic polydipsia G) Loop diuretics H) Thiazide diuretics

H) Thiazide diuretics

2023 Which of the following is the most likely cause of hyponatraemia in the following: 40 year old male with schizophrenia who has been on a depot for 12y A) Chronic Liver Disease B) Nephrotic syndrome C) Hypoadrenalism D) Hypothyroidism E) Salt depletion F) Psychogenic polydipsia G) Loop diuretics H) Thiazide diuretics

F) Psychogenic polydipsia Antipsychotics usually cause SIADH

2023 A. Calcium B. Sodium C. Potassium D. Chloride

A. Calcium

2023 What nerve is responsible for the pain experienced in pericarditis? A) Cardiac plexus B) Phrenic nerve C) Recurrent laryngeal nerve D) Vagus nerve

B) Phrenic nerve

2023 Mechanism of action of levosimendan A. Influx of calcium B. A C. Increase release of calcium from sarcoplasmic reticulum D. Increased sensitivity of membrane to calcium

D. Increased sensitivity of membrane to calcium

2023 SGLT2 inhibitors (flozins) have been shown to improve cardiovascular outcomes. Which of the following best represents their effects on weight, blood pressure and LDL-C? A) Weight gain, BP increase, LDL-C reduces B) Weight loss, BP decrease, LDL-C increases C) Weight neutral, BP increase, LDL-C reduces D) Weight loss, BP decrease, LDL-C reduces

B) Weight loss, BP decrease, LDL-C increases

2023 The secretion of which hormone by the anterior pituitary is controlled by tonic inhibition? A. Adrenocorticotropic hormone B. Growth hormone C. Prolactin D. Thyroid stimulating hormone

C. Prolactin

2023 Clomiphene works in male hypogonadism by blocking what? A. Oestrogen B. LH C. GnRH D. Androgens

A. Oestrogen

2023 What is the Non classical congenital adrenal hyperplasia enzyme deficiency? A) Corticosterone to esterone B) 17oh progesterone to 11 deoxycortisol C) 11 deoxycortisol to cortisol D) Androsterone to esterone

B) 17oh progesterone to 11 deoxycortisol Congenital adrenal hyperplasia: 21-hydroxylase deficiency Non-classical adrenal hyperplasia , partial deficiency of 21-hydroxylase, encoded by CYP21A2 gene

2023 A patient on PDL1 for metastatic melanoma develops intractable diarrhea which does not improve with steroids. Which of the following will help as next line therapy? A) Mycophenolate B) Infliximab C) Azathioprine D) Colectomy

B) Infliximab

2023 Lactose is broken down into glucose and what other product? A. Galactose B. Glucose C. Fructose D. Maltose

A. Galactose

2023 What adrenergic receptors does midodrine agonise? A) Alpha 1 B) Alpha 2 C) Alpha 1 and 2 D) Beta

A) Alpha 1

2023 What is the most common transmission route of Hepatitis E? A) Vertical transmission B) Via the blood C) Faecal oral route D) Sexual transmission

C) Faecal oral route

2023 In addition to the splenic flexure, where else in the colon is a watershed infarct area and thus susceptible to ischaemia? A) Hepatic flexure B) Caecum C) Ascending colon D) Rectosigmoid junction

D) Rectosigmoid junction

2023 Which of the following mutations in GBM does adjuvant chemotherapy provide the greatest benefit? A) TP53 deletion B) EGFR mutant C) IDH mutant D) MGMT hypermethylated

D) MGMT hypermethylated This is associated with a better response to temozolomide (TMX).

2023 What is the mechanism for hyperkalaemia in type 4 RTA? A) Hypermagnesaemia B) Hyperreninaemia C) Hypo aldosteronism D) Hypochloraemia

C) Hypo aldosteronism

2023 Pressure area staging - partial loss of dermis and no slough A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

B. Stage 2

2023 Multiple medications are used for BPH including finasteride. What is its mechanism of action? A: 5-alpha reductase inhibitor B: Adrenergic receptor antagonist C: Beta-3 adrenergic agonists D: PDE5 inhibitor

A: 5-alpha reductase inhibitor Beta-3 adrenergic agonists- mirabegron PDE5 inhibitor- sildenafil

2023 Which genetic test is appropriate when diagnosing Huntington disease? A) CGH B) Sanger sequence C) PCR and allele expansion

C) PCR and allele expansion

2023 In which compartment of the cell does protein folding occur? A) Endoplasmic reticulum B) Golgi body C) Lysosome D) Peroxisome

A) Endoplasmic reticulum

2023 Adults may be deemed to lack decision making capacity with regards to refusing medical treatment if they cannot understand the relevant information, or if what A - they cannot appreciate the information in its context B - they cannot SOMETHING C - they cannot paraphrase the information D - they cannot use the information to weigh up the decision

D - they cannot use the information to weigh up the decision

2023 In normal ageing, which of the following stages of sleep has the greatest percentage decrease? A) REM B) Stage 1 C) Stage 2 D) Stage 3

D) Stage 3 The most significantly reduced stage in older adults. Slow-wave sleep (N3) decreases dramatically with age, often nearly disappearing in very elderly individuals. This stage is crucial for physical restoration and memory consolidation.

2023 Which anticoagulant causes hyperkalaemia by inducing hypoaldosteronism? A) Warfarin B) Heparin C) Rivaroxaban D) Dabigatran

B) Heparin

2023 Dupilumab is an IL4 receptor subunit alpha antagonist. What also is blocked? A. IL5 B. IL17 C. IL22 D IL13

D) IL13

2023 What is the most common cause of familial hypocalcuric hypercalcaemia? A Gain of function mutation of GANAB B. Loss of function mutation of GANAB C. Gain of function of calcium sensing receptor D. Loss of function of calcium sensing receptor

D. Loss of function of calcium sensing receptor

2023 What is the mechanism of action of ivacaftor in cystic fibrosis? A) CFTR potentiator B) Improves CFTR transport C) Increases CFTR concentrations D) Prevents CFTR breakdown

A) CFTR potentiator

2023 What is the penetrance of disease related to iron overload (e.g. liver disease, arthropathy) in male patients with C282Y homozygosity HFE gene mutation? A. >90% B. 60-80% C. 20-40% D. < 10%

C. 20-40%

2023 A 23 year old woman with a childhood history of atopic dermatitis presents with a 2 month history of redness and itchiness over her earlobes. On further questioning, she has similar symptoms on her abdomen around where it comes into contact with her jean stud. A diagnosis of nickel allergy is suspected. How is this type of hypersensitivity mediated? A. Cytotoxic B. Cell mediated C. IgE D. Immune complex

B. Cell mediated

2023 Other than 14-3-3, what is a protein marker in CJD? A) Amyloid B) S100 C) Tau D) Dystrophin

C) Tau

2023 When interpreting an antinuclear antibody (ANA) testing, what is the significance of a positive dense fine specked pattern with positive DFS70 on confirmatory testing? A) False negative DsDNA result is likely B) Further testing with myositis specific autoantibodies is indicated C) The ANA result is likely a false positive due to positive antimitochondrial antibodies D) Underlying autoimmune connective tissue is unlikely

D) Underlying autoimmune connective tissue is unlikely

2023 Trimethoprim increases creatinine clearance without decreasing eGFR. What is the mechanism behind this? A. Decreased secretion of creatinine B. Increased reabsorption of creatinine C. Rhubarb D. Increase rhabdomyolysis

A. Decreased secretion of creatinine

2023 There has been an outbreak of Japanese encephalitis in some areas of Australia. Which of the following virus families foes Japanese encephalitis belong to? A. Togavirus B. Rhabdovirs C. Flavivirus D. Adenovirus

C. Flavivirus

2023 Immunotherapy has helped in the management of colorectal cancer. In which of the following circumstances is cetuximab most helpful A. KRAS mutant, R) sided colon cancer B. KRAS mutant, L) sided colon cancer C. KRAS wild type, R) sided colon cancer D. KRAS wild type, L) sided colon cancer

D. KRAS wild type, L) sided colon cancer

2023 45F with metastatic breast cancer complains of anticipatory emesis when attending day center for her anthracycline chemotherapy. What class of medications would be best to treat her anticipatory emesis? A. 5HT3 Receptor Antagonist B. Benzodiazepines C. Glucocorticoids D. NK-1 receptor blocker

B. Benzodiazepines

2023 What happens to minute ventilation, tidal volume and FRC during pregnancy A. Minute ventilation up, tidal volume down, FRC same B. Minute ventilation down, tidal volume down, FRC up C. Same as A D. Minute ventilation up, tidal volume up, FRC down

D- FRC down

2023 What is the main mechanism of renal injury in antiphospholipid antibody syndrome A. ATN B. Immune complex deposition C. AIN D. Vascular thrombosis

D. Vascular thrombosis

2023 Vit D is associated with vascular calcium deposits in chronic kidney disease. What other Vitamin is associated with this? A. A B. C C. E D. K

D. K

2023 In FSGS with proteinuria, what do you give to reduce proteinuria / preserve renal function (?alongside RAAS inhibition)? Corticosteroid SGLT2i

? steroid

2023 Which of the following is the typical response to addition of allopurinol to azathioprine? A) Increase MMP, increase 6TGN B) Increase MMP, decrease 6TGN C) Decrease MMP, increase 6TGN D) Decrease MMP, decrease 6TGN

C) Decrease MMP, increase 6TGN

2023 Winging of the scapula is caused by weakness of a muscle innervated by which of the following: A. Axillary B. Dorsal scapular C. Long thoracic D. Suprascapular?

C. Long thoracic

2023 Which is the major inhibitory neurotransmitter in the brain? A) Glycine B) GABA C) Acetylcholamine D) Glutamate

B) GABA

2023 What is the main transmitter implicated in narcolepsy with cataplexy? A) GABA B) Glutamate C) Orexin D) Serotonin

C) Orexin

2023 A patient is commenced on ciprofloxacin. Which of the patient’s other medications should be ceased? A) Atorvastatin B) Magnesium C) Omeprazole D) Paroxetine

B) Magnesium Magnesium directly reduces ciprofloxacin absorption, leading to subtherapeutic antibiotic levels and treatment failure. This is an immediate and significant concern, unlike the theoretical additive QT prolongation risk with paroxetine.

2023 Deposition and aggregation of which of the following proteins is central to the pathogenesis of progressive supranuclear palsy? A. Alpha synuclein B. Lipofuscin C. Tau D. Beta amyloid

C. Tau

2023 Which of the following receptors is the main target of dexmedetomidine? A. 5HT2A B. Alpha 2 C. Glutamate (NMDA) D. Glycine

B. Alpha 2

2023 Prochlorperazine is used to treat nausea. Which receptor does prochlorperazine predominantly antagonise to exert its antiemetic effect? A. Acetylcholine B. Dopamine C. Histamine D. Serotonin

B. Dopamine

2023 What is the treatment of Pagets disease in a patient with normal renal function? A. Weekly PO bisphosphonate B. Calcitonin C. Single dose IV zoledronic acid D. 3 years of annual zoledronic acid

C. Single dose IV zoledronic acid calcitonin if renal impairment

2023 Which of the following molecules may be a possible target for the management of Granulomatosis with polyangiitis A) C5a B) IL-6 C) TNF D) Phosphodiesterase type 5

A) C5a noted avacopan approved!

2023 Where do thiazide diuretics work? A. Na-Cl cotransporter at the proximal convoluted tubule B. Na-Cl cotransporter at the distal convoluted tubule C. Na-K cotransporter at the proximal convoluted tubule D. Na-K cotransporter at the distal convoluted tubule

B. Na-Cl cotransporter at the distal convoluted tubule

2023 A researcher wants to set up a study using an online survey, what kind of bias is this at risk of? A) Participation B) Detection C) Attrition D) Selection E) Reporting F) Publication

A) Participation

2023 A guy is doing an audit of a hospital protocol but knows that only stastically significant results tend to get published, so favours including statistically significant results only. A) Participation B) Detection C) Attrition D) Selection E) Reporting F) Publication

E) Reporting

2023 Which of the following structures is associated with: molecules around which DNA is wrapped A. DNA B. RNA C. Ribosome D. mRNA E. tRNA F. Ribosomal RNA G. Centromere H. Histone

H. Histone

2023 Which of the following structures is associated with: molecules to which amino acids are bound then transport to the ribosome A. DNA B. RNA C. Ribosome D. mRNA E. tRNA F. Ribosomal RNA G. Centromere H. Histone

E. tRNA

2024 2. Which IL does Tacrolimus work on. a. IL2 b. IL10 c. IL5 d. IL4

a. IL2

2024 3. Young male treated with Augmentin for a chest infection. 4 days later develops bloody diarrhea, raised WCC, fever and raised CRP. Treat by ceasing the augmentin and starting metronidazole. stool culture/c diff toxin negative. he gets better, what is the cause a. Antibiotic induced diarrhea b. Antibiotic associated haemhorrhagic colitis c. Diverticultis d. Toxin negative c diff

b. Antibiotic associated haemhorrhagic colitis

2024 4. 60-70y/o Lady with R thigh pain, gets XR and see an incomplete fracture line just below trochanter. what is most likely cause a. Vit D b. Phosphate c. Calcium d. Iron

d. Iron

2024 PRRT (Peptide receptor nuclide therapy) new modality of treatment for phaeo + paraganglioma - what receptor are they targeting a. Dopamine b. Somatostatin c. Tyrosine kinase d. Adrenergic

b. Somatostatin

2024 In recurrent cushings syndrome, what selective antagonist at the GCC receptor can be used for symptom control? a. Ketoconazole b. Metyrapone c. Mifepristone d. Osildrostat

c. Mifepristone Binds to progesterone and glucocorticoid receptors in cells The rest inhibit 11b hydroxylase

2024 7. What proportion of people with an immediate Type 1 hypersensitivity reaction to penicillin that occurred 10 years ago will still have an allergy now? a. <5% b. 20% c. 50% d. 80%

b. 20% The time elapsed since the last reaction is important because penicillin-specific IgE antibodies decrease over time, and therefore, patients with recent reactions are more likely to be allergic than patients with distant reactions [63-65]: Approximately 50 percent of patients with IgE-mediated penicillin allergy have lost the sensitivity 5 years after their last reaction. Approximately 80 percent of patients with IgE-mediated penicillin allergy have lost the sensitivity after 10 years. (uptodate)

2024 8. What feature can help differentiate epileptic seizures from PNES? a. Pelvic thrusting b. Ictal forced eye closure

b. Ictal forced eye closure

2024 14. Patient admitted to ICU. Found to have candida glabrata. First line therapy. a. Caspfungin b. Amphotericin c. Fluconazole d. Voriconazole

a. Caspfungin

2024 20. Post stroke depression with prolonged qtc to 480ms. Which SSRI has the most qtc prolonging effect a. Fluoxetine b. Citalopram c. Paroxetine d. Sertraline

b. Citalopram

2024 23. Chasdvasc in male 64 , BP 127, no previously history, overweight. Smoker and has gout. Management of new AF. a. Aspirin b. No treatment c. DOAC d. Warfarin

b. No treatment

2024 24. Herniation causing ipsilateral pupil dilation a. Subfalcine b. Uncal c. Tonsilar d. Transcavarial

b. Uncal

2024 26. Mineral to treat graves orbitopathy a. Iron b. Selenium c. Copper d. Iodine

b. Selenium

29. Leptospirosis - what is a distinguishing feature a. Red spots b. strawberry tongue c. Conjunctival suffusion

c. Conjunctival suffusion note- red spots seen in typhoid strawberry tongue seen in Kawasaki disease, toxic shock syndrome, yersinia, vit b12

2024 30. Toxoplasmosis diagnosis in HIV a. Biopsy b. LP CSF PCR c. Serum PCR d. Serum serology

b. LP CSF PCR

2024 31. Young man with UC. Receives hydrocort 100 QID for 3 days. Ongoing 10 bowel motions a day. CRP 80. eGFR 25. Next step? a. Infliximab b. Cyclosporine c. Methylprednisolone d. Refer for colectomy

a. Infliximab

2024 32. flawless RCT. hypothesis is that trial drug is the same as the other drug. p value 0.04 interpretation a. accepting hypothesis that both drugs have similar efficacy, the probability of obtaining similar or more. extreme result is 4% b. probability that trial drug is better than other drug is 4% c. Rhubarb d. probability that results of both drugs having similar efficacy by chance is 4%

d. probability that results of both drugs having similar efficacy by chance is 4%

2024 33. Pancreatitis with ventilation requirement and oligoanuric. High AST and rasied CK.Low Ca high phos. a. Rhubarb b. Rhabdomyolysis c. Ischaemic Hepatitis d. ARDS with RHF

b. Rhabdomyolysis

2024 34. What respiratory complication of cirrhosis has the feature of intra-pulmonary shunts? a. Thrombus b. Porto-pulmonary hypotension c. Hepatopulmonary syndrome d. Hepatic hydrothorax

c. Hepatopulmonary syndrome

2024 35. Middle aged woman. Smoker. Nil other significant history. Someone with irregular cysts in lung - upper and middle zone, heterogenous, thin walled. Also appearance of small nodules on CT. 5% eosinophils 10% lymphoocytes. Stain showed CD1a and CD206 positivity. a. Sarcoidosis b. Lymphocytic interstitial pheumonia c. Langerhans cell histiocytosis d. PLAM

c. Langerhans cell histiocytosis

2024 36. Lady with metastatic breast cancer to liver and bones. Now presenting with ongoing nausea, headache, progressive deafness, and diplopia. Unsteady gait. Nil significant neuro findings on exam. CT non contrast brain is reported as normal. What is dx? a. Leptomeningeal b. CVST (cerebral venous sinus thrombosis) c. Chemo neuropathy d. Autoimmune

a. Leptomeningeal

2024 37. Bullous pemphigoid histology a. Granular IgA b. Linear IgA c. Granular IgG d. Linear IgG

d. Linear IgG

2024 38. pathophysiology of immune TTP a. inhibitor of ADAMTS13 b. Activating ADAMTS13 c. inhibitor of vWF d. inhibitor of thrombomodulin

a. inhibitor of ADAMTS13

2024 39. Which cardiac amyloidosis has highest mortality a. ATTR b. AL c. AA d. Beta-2 macroglobulin

b. AL

2024 40. Carpal tunnel syndrome, heart failure, positive PYP (pyrophosphate) a. AL b. ATTR c. AA d. Beta-2-macroglobulin

b. ATTR carpal tunnel syndrome - amyloid deposits in connective tissues such as the flexor retinaculum heart failure- restrictive cardiomyopathy, leading to diastolic heart failure. positive PYP scan- A technetium-99m pyrophosphate scan is highly sensitive and specific for ATTR cardiac amyloidosis. It can differentiate ATTR from AL amyloidosis, as AL does not usually show significant uptake.

2024 41. Yesinia pestis vector a. Rhubarb b. Fleas c. Rats d. Ticks

b. Fleas

2024 42. APLS. Most common skin manifestation a. Levidoreticularis b. Purpura

a. Levidoreticularis

2024 43. Acanthosis nigricans. which malignancy most suspected/associated a. Gastric adenocarcinoma b. Oesophageal Adenocarcinoma c. Lung SCC d. Renal cell carcinoma

a. Gastric adenocarcinoma

2024 44. Peson has triple AAA repair, somthing about possible damage to Adam of Wickowitz artery , what neurology is likely preserved a. Proprioception b. Autonomic bladder c. voluntary movement d. Temperature sensitisation

a. Proprioception

2024 45. Eosinophilic oesophagitis, trialled PPI/budesonide, next step a. Elimination diet b. Mepolizumab c. Diltation

a. Elimination diet

2024 46. Enteric TB most likely to affect which area a. Ileocaecal b. Jejunum c. Duodenum d. Peritoneum

a. Ileocaecal

2024 47. Which chemo gives cold insensitivity and PN a. Taxane b. Oxaliplatin c. 5FU

b. Oxaliplatin note, taxane does cause peripheral neuropathy but does not cause cold insensitivity

2024 48. pH 7.63, CO2 20 , bicarb 30s , obtunded cooked patient. overdose of what most likely a. Salicylate poisoning b. paracetamol overdose c. TCA d. GABA butyric acid

a. Salicylate poisoning

2024 50. Man presents with broad based gait , no resting tremor. Slow blink. no vertical gaze palsy. Mild symmetrical bradykinesia. Walking around with knees and thighs in fixed extension a. Idiopathic Parkinsons b. Cerebellar degeneration (some rememb corticobasal degeneration) c. PSP d. Normal pressure hydrocephalus

c. PSP

2024 51. DMARD most assoc with Herpes zoster infection a. IL6 b. TNF c. JAK d. Rhubarb

c. JAK

2024 52. anaphylaxis to what is contraindication to Pfizer mRNA COVID vaccine. a. Latex b. Nuts c. Eggs d. Polyethylene glycol

d. Polyethylene glycol

2024 53. Neuro condition with AD inheritance pattern. parents no phenotype. dad has same mutation low level 10% in blood. Both Children have the condition with same mutation as dad . reason? a. Rhubarb b. non-paternity c. Mosaicism d. Anticipation

c. Mosaicism

2024 54. Grandma immunosuppressed, grandson getting live vaccine. What precutions needed? a. Distance if rash develops b. Avoid for X weeks c. no need to take precaution

a. Distance if rash develops

2024 56. This antiepileptic has glucoridation metabolism. A glucoridinated metabolite is reduced by 50-90% when this carbapenem is on board. Which antiepileptic is affected by carbapanem in this way? a. Phenytoin b. Sodium valproate c. Lacosamide d. Rhubar

B- sodium valproate

2024 58. Heart attack with high uric acid. (question regarding urate lowering therapy recommendations) a. Losartan b. Allopurinol c. Febuxostat d. Probenecid

b. Allopurinol

2024 60. Pregnancy safe antiepileptic other than lamotrigine a. Topiramate b. Carbamazepine c. Levetiracetam

c. Levetiracetam

2024 62. Nurse recurrent syncope. Is a sportsperson. Echo features of pulm HTN with high RSVP that normalised with diuresis. Picture of lung biopsy with polarised a. Hypersensitivity pneumonitis b. Pulmonary amyloidosis c. organising pneumonia d. Talc granulomatosis

B. pulmonary amyloidosis

2024 64. Mediastinal lymph nodes at 4R. how best to obtain sample a. CT guided biopsy b. EBUS c. Endoscopic US d. Mediastinoscopy

b. EBUS

2024 65. idiopathic myositis characteristically least responsive to immunotherapy a. Dermatomyositis b. Inclusion body c. Anti-synthetase d. Polymyositis

b. Inclusion body

2024 66. Patient with new finding of bence jones proteinuria and CKD. PCR 0.15. No features of anaemia or bony pain. Reports that bone marrow biospy <10% plasma cells. elevated KFLC without giving FLC ratio. What is diagnosis? a. MGUS b. MRUS ??MGRS c. MM d. AL amylod

b. MRUS ??MGRS

2024 67. Colorectal cancer risk with polyps a. Pseudopolyps b. tubuloVillous adenoma with dysplasia c. Tubular adenoma with dysplasia d. With dysplasia/inflammation

b. tubuloVillous adenoma with dysplasia Villous histology (villous > tubulovillous > tubular). Polyp size (>1 cm). High-grade dysplasia.

2024 68. 21M with diabetes, sister is on oral hypoglycaemics for past 5 years, paternal granddad and dad on insulin. Paternal grandfather and dad has renal cysts. a. GCK b. HNF1a c. HNF1b d. KCNJ11

c. HNF1b

2024 69. Worst mesothelioma subtype a. Epitheloid b. Sarcomatoid c. Desmoplastic d. Mixed

b. Sarcomatoid

2024 70. Middle aged man. smoker. Headache and pruritis, low EPO, Hb 160, hct 0.48, WCC 12, plt 600 a. ET b. PCV c. Reactive thrombocytosis d. Haemoglobinapathy

b. PCV key features of PCV: headache, pruritis, low EPO, raised Hb and hct ET would have isolated raised platelets

2024 71. Patient on pembrolizumab, now quitting smoking - which med to change dose a. Clozapine b. Sertraline c. Pembrolizumab d. Rhubarb

a. Clozapine Smoking is a CYP1A2 inducer

2024 72. Neuroendocrine tumour undergoing resection. Give which medication to prevent perioperative carcinoid crisis? a. Octreotide b. Alpha blocker c. Beta blocker d. Rhubarb

a. Octreotide

2024 73. Young 23 year old female, CK with exercise . rests and able to resume at low intensity a. CMT2 disease b. Gaucher c. Kennedy d. McArdle

d. McArdle CPT2 and MCardle are metabolic CPT2 is fatty acid metabolism and Mcardle is issue with glycogen phosphorylase in acute strenuous exercise, uses anaerobic metabolism. here we need glycogen. so if issue with high intensity --> Mcardle in low intensity fatty acid reliant

2024 74. Men with the gene for Asian flushing syndrome (genetic variant in the ALDH2 enzyme) is associated with what malignancy when they drink ETOH a. Head and neck b. Oesophageal c. Stomach d. Liver

b. Oesophageal

2024 75. RA on methotrexate has pleural effusion pH 7.3 Hct 30 cholesterol 5. Low trigs. a. Empyema b. Haemothorax c. Pseudochylothorax d. Malignant

c. Pseudochylothorax Often seen in patients with rheumatoid arthritis, this type of pleural effusion is characterized by low triglycerides, high cholesterol, and low pH.

2024 77. GvHD first organ affected a. Skin b. GIT c. Liver d. CNS

a. Skin

2024 79. Neurocysticerosis a. Schistosomiasis b. Toxoplasmosis c. Taeni solium d. Rhubarb

c. Taeni solium

2024 80. Metastatic lung cancer NSCLC IIIb on durvalumab. Has had 2 cycles of durva. Had definitive treatment with chemoradiation. now has a cerebellar met. (Imaging showing single lesion) No other mets on CTCAP. Lung primary has stable appearance on CT. Best therapy for met a. Resection b. Stereotactic c. Best supportive care d. continue immunotherapy and close radiograph surveillance

b. Stereotactic

2024 81. RCHOP. Hep B core positive a. Nothing b. Lamivudine c. Rhubarb d. Entecavir/Tenofovir

d. Entecavir/Tenofovir

2024 82. Man with CKD. Has evidence of interstitial fibrosis. Found to have adenine phosphoribosyltransferase deficiciency. How should this be managed? a. urosuric agent b. Xanthine oxidase inhibitor c. urosuric agent d. Thiazide

b. Xanthine oxidase inhibitor adenine phosphoribosyltransferase deficiciency can cause radiolucent nephrolithiasis and can lead to kidney failure.

2024 MOA entecavir a. Stop new virions formation and release in liver b. DNA polymerase c. Glycoprotein fusion inhibition d. Rhubarb

b. DNA polymerase

2024 2. SCAD histology (spontaneous coronary artery dissection) a. atherosclerotic plaque rupture b. adventitial fat inflammation c. Intramural haematoma

Intramural haematoma

2024 Watershed area other than splenic flexure a. Rectosigmoid b. Caecum c. Hepatic flexure

a. Rectosigmoid

2024 Lactulose mechanism of action a. undigested in the gut absorbing more water b. increase stool bulk c. increase gut motiliy

A) undigested in the gut absorbing more water

2024 Most common reason for acquired complement deficiencies a. Reduced hepatic production b. Consumption due to immune complexes c. increased renal clearance d. somatic gene mutation causing disruption in production

b. Consumption due to immune complexes

2024 sarcoidosis heart - most common presentation a. HF b. Heart block c. valvular heart disease

b. Heart block

2024 9. Every 10 years, 1000 people are selected from a population and surveyed - lifestyle and health outcomes a. Case control b. Case cohort c. Repeat cross sectional d. Prospective cohort

c. Repeat cross sectional

2024 10. common cardiac presentation in patient with sle a. myocarditis b. pericarditis c. Endocarditis

b. pericarditis

2024 12. RHC with positive NO test . which treatment to be considered first a. CCB b. Endothelin c. Progestin d. NO

a. CCB

2024 13. Difference between central and obstructive apnoea a. High index arousal b. cessation of airflow for more than 10sec c. respiratory effort throughout apnoea

c. respiratory effort throughout apnoea

2024 14. Pt has a 50% pretest probability of disease. The test has sensitivity of 80% and specificity of 60%. what will be the post test probability? a. 66% b. 50% c. 60% d. 80%

a. 66%

2024 18. Familial hypercholestoleramia and LDL elevated a. Apoliprotein increase b. Increase LDL C receptor catabolism c. Increase LDL production d. Reduced lipoprotein lipase function

b. Increase LDL C receptor catabolism

2024 19. Hepatitis from azathioprine - what substrte causes this a. 6TG b. 6MMP c. 6MP d. 6GTN

b. 6MMP

2024 21. patient with CRT-D. ECG with pacing spikes for a few seconds in limb leads. hard to tell not many other features a. Biventricular pacing b. V pacing c. A pacing

a. Biventricular pacing

2024 22. Orexigenic peptide acting centrally on AgRP a. Insulin b. Ghrelin c. Leptin d. GLP-1

b. Ghrelin

2024 24. What are the features of tetralogy of fallot? a. overriding aorta, R ventricular hypertrophy, RVOT, VSD b. overriding pulmonary artery, R ventricular hypertrophy, RVOT, VSD c. overriding aorta, L ventricular hypertrophy, RVOT, VSD d. overriding aorta, L ventricular hypertrophy, LVOT, VSD

a. overriding aorta, R ventricular hypertrophy, RVOT, VSD

2024 26. Tranxemic Acid MOA a. Inhibits Plasminogen b. direct inibition of plasmin interaction with fibrin c. activates tissue plasminogen activator causing plasmin breakdown

a. Inhibits Plasminogen

2024 27. Carvedilol - vasodilatory effect by blocking which receptor a. Alpha 1 b. Beta 1 c. Alpha 2 d. Beta 2

a. Alpha 1

2024 28. Magnesium MOA in COPD a. Voltage gated calcium channel b. type 2 taste receptor c. G protein coupled receptor

a. Voltage gated calcium channel The possible mechanism(s) of action of MgSO4 in offering benefit in COPD exacerbations may be calcium antagonism via calcium channel and counteraction of calcium-mediated smooth muscle contraction

2024 29. Metaraminol MOA a. alpha 1 agonist b. alpha 2 agonist c. beta 2 agoist d. beta 1 agonist

a. alpha 1 agonist

2024 30. HITTS criteria - what feature will result in highest likelihood of HITTS. Each answer a combo of decrease + nadir AND onset time a. 50 percent decrease and nadir >20 b. 30 percent decrease OR nadir <10 c. onset 5-10 days d. onset 1-4 days

a. 50 percent decrease and nadir >20

2024 31. PNH piga gene affects what protein a. glycosylphosphatidyl-inositol b. CD59 c. CD19

A. glycosylphosphatidyl-inositol In paroxysmal nocturnal hemoglobinuria (PNH), mutations in the PIGA (phosphatidylinositol glycan anchor biosynthesis, class A) gene disrupt the synthesis of GPI anchors, which are critical for attaching certain proteins to the cell membrane. The loss of GPI-anchored proteins, such as CD55 (decay-accelerating factor) and CD59 (membrane inhibitor of reactive lysis), leads to the complement-mediated hemolysis characteristic of PNH.

2024 33. Lady with cancer on Cyclophosphamide needs to preserve fertility. There is no time to do oocyte preservation. What do u use a. GNRH b. Progesterone c. Aromatase inhibitor d. SERM

a. GNRH

2024 34. F5U and Capecitabine metabolism a. DPD (Dihydropyrimidine Dehydrogenase) b. UMP (Uridine monophosphate) c. DP

a. DPD (Dihydropyrimidine Dehydrogenase)

2024 1. patient with bilateral gynecomastia on finernone - why does this have less anti-androgen effect compared to spironolactone a. Less aromatase action b. less effect on androgen receptors c. Finasteride has less active metabolites and shorter half live d. less able to cross into testicular cells

b. less effect on androgen receptors

2024 37. Nocardia a. Gram positive coccobacilli b. Gram positive branching rod c. Gram negative cocci d. Gram negative rod

b. Gram positive branching rod

2024 38. Efgartigimod MOA a. IgG recycling b. CD19

a. IgG recycling Efgartigimod binds to the neonatal Fc receptor and inhibits its interaction with IgG, thereby reducing IgG recycling and increasing degradation of IgG and pathological autoantibodies, without altering other immunoglobulins and albumin levels

2024 39. Anti-GBM what is first line treatment for induction a. Ritux + PLEX b. Cyclophosphamide + PLEX c. Cyc mono d. PLEX alone

b. Cyclophosphamide + PLEX

2024 40. Riociguat (c-GMP?) mechanism of action a. Endothelin b. NO c. Progestin d. TGF

b. NO Endothelin receptor antagonist (ambrisentan) Nitric oxide – cGMP enhancers: o Phosphodiesterase 5 inhibitor (tadalafil, sildenafil) o Guanylate cyclate stimulant (roiciguat) Prostacyclin receptor agonist (selexipag, treprostinil)

2024 41. FMF cytokine involved a. IL1 b. TNF c. IL6

a. IL1

2024 44. Buproprion MOA

Noradrenaline and dopamine reuptake inhibitor Vareniciline: Partial agonist at nicotinic acetylcholine receptors (alpha4beta4)- stimulates dopamine release  reduces nicotine cravings and withdrawal symptoms

2024 45. Malignancy- NXP2, what other antibody is predictive of cancer a. Rhubarb b. TIF-1 gamma c. MI-2 d. Jo

b. TIF-1 gamma

2024 51. Guy with alzheimers, which type of memory is lost first a. Implicit b. Semantic c. Procedural d. Episodic

d. Episodic episodic memory (the ability to recall specific events and experiences from one's life) is typically the first type of memory affected. This is due to early pathological changes in the medial temporal lobe, particularly the hippocampus, which plays a critical role in episodic memory.

2024 53. Lung mechanics in pregnancy - what are the physiological changes that decrease during pregnancy a. FEV1 b. DLCO c. FVC d. FRC

d. FRC

2024 57. MOA of omeprazole a. Irreversible H+, K(+)-ATPase inhibitor b. irreversible H2 inhibitor c. reversible H+, K(+)-ATPase inhibitor d. reversible H2 inhibitor

A) Irreversible H+, K(+)-ATPase inhibitor

2024 59. Leukocyte adhesion deficiency a. Integrin b. Selectin c. Leukoadhesin d. Cadherin

a. Integrin

2024 60. what is biosimiar definition

Identical structure and function to the original structure and function, no clinically meaningful differences in efficacy, safety, and immunogenicity

2024 what is the best description of quorom sensing

Quorum sensing is a process used by bacteria to coordinate their behavior based on the density of their population. It involves the production, release, and detection of small signaling molecules called autoinducers. When the concentration of these molecules reaches a certain threshold, bacteria can collectively regulate gene expression, enabling them to coordinate activities such as biofilm formation, virulence factor production, and antibiotic resistance.

2024 63. citrate is commonly used as anticoagulation during apheresis. what is most common SE a. bleeding b. symptomatic hypocalcaemia c. symptomatic hypokalaemia

b. symptomatic hypocalcaemia

2024 1. 26 M Covid vaccine. Urticarial rash two days later which is intermittent and ongoing for several weeks. Previous hx of similar with other vaccines and other meds. What would you advise? ?? still couldn’t reach final answer a. Next vaccine when asymptomatic b. Avoid mRNA vaccine c. Skin prick testing prior to next dose d. Take antihistamines prior to next dose

Unsure d. Take antihistamines prior to next dose

2024 9. Someone's mother has rheumatoid. She has Raynauds. Which sign is most likely indicative to have a systemic rheumatological disorder. a. Positive ANA b. Family Hisotory c. Nailfold capilloroscopy d. Raynauds

c. Nailfold capilloroscopy

2024 11. Male, Headache 30 mins long, happens at night, associate with autonomic symptoms. Banging head. ?? UNSURE a. Cluster b. Hypnic c. Paroxysmal hemicrania d. SUNCT

unsure. A vs C

2024 12. Pregnant lady first trimester, symptoms of hyperthyroidism. Goitre with Chemosis. Values given (T3 and T4 upper limit of normal, TSH <0.01, BHCG 3000) What would you do? a. Observe b. PTU c. Carbimazole d. Steroids

a. Observe

2024 15. Man presents with miosis and ptosis . Most appropriate first line investigation a. Carotid angiogram b. CTB c. CXR d. MRI

a. Carotid angiogram

2024 16. Man on large dose of clozapine (nocte 125mg?) Is admitted and misses two doses. Then restarted at nocte 12.5mg. What side effect does this avoid? a. Orthostatic hypotension b. Myocarditis c. Agranulocytosis d. Seizures

a. Orthostatic hypotension

2024 18. Bicuspid aortic valve, no risk factors - aortic diameter required for repair a. 45mm b. 50mm c. 55mm d. 65mm

c. 55mm

2024 19. Obese diabetic with TIA. on appropriate antiplatelet. Currently on metformin monotherapy with hba1c 86 mmol. microalbuminuria and eGFR ~63 - which medication to add to reduce future stroke risk a. GLP-1 b. Insulin c. SGLT-2 d. Rhubarb

a. GLP-1

a. Leptomeningeal

2024 55. fabry- particular pathogenic mutation in a deep intronic segment. a. FISH b. WGS c. Sanger- looks at exons and introns around exomes d. WES

b. WGS exons are coding segments also with sanger sequencing, it looks at exons and the introns around it

2024 57. A patient with trigeminal neuralgia has developed a dvt. She is on pregabalin, paracetamol and Carbamazepine. What is the most appropriate anticoagulant to prescribe? a. Clexane bridge and then warfarin b. Dabigatran c. Rivaroxaban d. Heparin BD

a. Clexane bridge and then warfarin

likely pulmonary amyloidosis as it responds to diuresis and shows birefringent polarised light

2024 63. Women forgets insulin on PD . gaining weight with peripheral oedema despite adherent to her bag changes 4%dextrose bags. What is the likely reason for this? a. Constipation b. Ultrafiltration

b. Ultrafiltration

95. Extended MCQ: GH deficiency test?

insulin tolerance test a. Short synacthen- ACTH deficiency, cortisol deficiency b. Insulin tolerance test- GH deficiency c. saline suppression- diabetes insipiditus , primary hyperaldosterolism d. clonidine suppression test- e. high dose dex test- high cortisol f. glucose TT- acromegaly g. metyrapone suppression test- congenital adrenal hyperplasia

2024 4. Neurogenic syncope. which neurotransmitter is deficient? a. Serotonin b. Adrenaline- main hormone c. Noradrenaline d. Acetylcholine

c. Noradrenaline main neurotransmitter . noradrenaline gets converted to adrenaline

2024 8. Targeted radionuclide therapy is a treatment option for patients with metastatic paragangliomas and phaeochromocytomas. What receptor must be present on the tissue for this therapy to work? a. Adrenergic b. Dopamine c. Somatostatin d. Tyrosine kinase

UNCLEAR!! A vs C targeted radionuclide therapy is either 131-1 MIBG or peptide receptor radionuclide therapy (PRRT) PRRT is for somatostatin and 131-1MIBG is analogue for norepinephrine

2024 17. Patient with bee allergies, Chronically elevated tryptase >18 on screening, about to start bee immunotherapy - what does the baseline elevated tryptase influence? Is it B??? a. inc risk of Localised reaction b. inc risk of severe systemic reaction c. Low efficacy of immunotherapy tx d. high efficacy of immunotherapy tx

b. inc risk of severe systemic reaction

2024 11. Monitoring osteoporosis - which one is catabolic marker a. P1NP b. CTX c. TRAP

b. CTX P1NP: marker of bone formation, indication of osteoblast) CTX: measure this at 3 months (usually this decreases when bone turnover is suppressed by a bisphosphonate, this is catabolic marker and looks at osteoclasts)

2024 32. Gym freak overdosing on pre-work out what is the effect on ingestion a. Mitochondrial b. Krebs cycle c. Urea cycle d. Rhubarb

b. Krebs cycle

2024 35. MOA erythromycin on gut . Prokinetic ?B a. GLP1 b. Motilin c. 5HT3 d. Dopamine

b. Motilin

2024 48. Mixing studies - Patient with bilateral thrombosis - APTT 70 , mixing studies done and APTT 60, normal PT/fibrinogen/TT - what is the cause a. Lupus anticoagulant b. Factor VIII c. Heparin d. Rhubarb

a. Lupus anticoagulant

2024 49. Emicizumab mechanism a. Factor VIII and IX b. Factor IX and X c. Factor X and XII

b. Factor IX and X Emicizumab is a bispecific monoclonal antibody that bridges activated factor IX (FIXa) and factor X (FX), mimicking the cofactor function of factor VIII (FVIII) in the coagulation cascade. It is used for the prophylaxis of bleeding in patients with hemophilia A, including those with inhibitors to factor VIII.

2024 55. guy has problems backing car out, forgetting things, personality changes - what feature is most likely to predict Alzheimer disease a. Executive dysfunction b. Visuospatial dysfunction c. Forgetfullness d. Personality

c. Forgetfullness

2024 58. PTSD - 2nd line non-pharm after CBT a. ECT b. trauma psychotherapy c. Rapid eye desensitisation d. Rhubarb

b. trauma psychotherapy