RACPpastpapers Flashcards
2023
Hyperorality is a feature of which form of dementia?
Frontotemporal
Dementia with lewy body
Alzheimers
Vascular
A- Frontotemporal
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
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
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
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
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
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
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
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
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
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
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
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
2023
What is 4mg of dexamethasone equivalent to in terms of hydrocortisone?
A. 20
B. 40
C. 80
D. 100
D. 100
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
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
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
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
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
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
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
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
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
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
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
- Which IL does Tacrolimus work on.
a. IL2
b. IL10
c. IL5
d. IL4
a. IL2
2024
- 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
- 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
- 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
- What feature can help differentiate epileptic seizures from PNES?
a. Pelvic thrusting
b. Ictal forced eye closure
b. Ictal forced eye closure
2024
- Patient admitted to ICU. Found to have candida glabrata. First line therapy.
a. Caspfungin
b. Amphotericin
c. Fluconazole
d. Voriconazole
a. Caspfungin
2024
- 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
- 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
- Herniation causing ipsilateral pupil dilation
a. Subfalcine
b. Uncal
c. Tonsilar
d. Transcavarial
b. Uncal
2024
- Mineral to treat graves orbitopathy
a. Iron
b. Selenium
c. Copper
d. Iodine
b. Selenium
- 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
- Toxoplasmosis diagnosis in HIV
a. Biopsy
b. LP CSF PCR
c. Serum PCR
d. Serum serology
b. LP CSF PCR
2024
- 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
- 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
- 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
- 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
- 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
- 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
- Bullous pemphigoid histology
a. Granular IgA
b. Linear IgA
c. Granular IgG
d. Linear IgG
d. Linear IgG
2024
- pathophysiology of immune TTP
a. inhibitor of ADAMTS13
b. Activating ADAMTS13
c. inhibitor of vWF
d. inhibitor of thrombomodulin
a. inhibitor of ADAMTS13
2024
- Which cardiac amyloidosis has highest mortality
a. ATTR
b. AL
c. AA
d. Beta-2 macroglobulin
b. AL
2024
- 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
- Yesinia pestis vector
a. Rhubarb
b. Fleas
c. Rats
d. Ticks
b. Fleas
2024
- APLS. Most common skin manifestation
a. Levidoreticularis
b. Purpura
a. Levidoreticularis
2024
- Acanthosis nigricans. which malignancy most suspected/associated
a. Gastric adenocarcinoma
b. Oesophageal Adenocarcinoma
c. Lung SCC
d. Renal cell carcinoma
a. Gastric adenocarcinoma
2024
- 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
- Eosinophilic oesophagitis, trialled PPI/budesonide, next step
a. Elimination diet
b. Mepolizumab
c. Diltation
a. Elimination diet
2024
- Enteric TB most likely to affect which area
a. Ileocaecal
b. Jejunum
c. Duodenum
d. Peritoneum
a. Ileocaecal
2024
- 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
- 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
- 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
- DMARD most assoc with Herpes zoster infection
a. IL6
b. TNF
c. JAK
d. Rhubarb
c. JAK
2024
- anaphylaxis to what is contraindication to Pfizer mRNA COVID vaccine.
a. Latex
b. Nuts
c. Eggs
d. Polyethylene glycol
d. Polyethylene glycol
2024
- 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
- 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
- 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
- Heart attack with high uric acid. (question regarding urate lowering therapy recommendations)
a. Losartan
b. Allopurinol
c. Febuxostat
d. Probenecid
b. Allopurinol
2024
- Pregnancy safe antiepileptic other than lamotrigine
a. Topiramate
b. Carbamazepine
c. Levetiracetam
c. Levetiracetam
2024
- 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
- Mediastinal lymph nodes at 4R. how best to obtain sample
a. CT guided biopsy
b. EBUS
c. Endoscopic US
d. Mediastinoscopy
b. EBUS
2024
- idiopathic myositis characteristically least responsive to immunotherapy
a. Dermatomyositis
b. Inclusion body
c. Anti-synthetase
d. Polymyositis
b. Inclusion body
2024
- 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
- 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
- 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
- Worst mesothelioma subtype
a. Epitheloid
b. Sarcomatoid
c. Desmoplastic
d. Mixed
b. Sarcomatoid
2024
- 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
- 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
- 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
- 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
- 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
- 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
- GvHD first organ affected
a. Skin
b. GIT
c. Liver
d. CNS
a. Skin
2024
- Neurocysticerosis
a. Schistosomiasis
b. Toxoplasmosis
c. Taeni solium
d. Rhubarb
c. Taeni solium
2024
- 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
- RCHOP. Hep B core positive
a. Nothing
b. Lamivudine
c. Rhubarb
d. Entecavir/Tenofovir
d. Entecavir/Tenofovir
2024
- 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
- 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
- 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
- common cardiac presentation in patient with sle
a. myocarditis
b. pericarditis
c. Endocarditis
b. pericarditis
2024
- RHC with positive NO test . which treatment to be considered first
a. CCB
b. Endothelin
c. Progestin
d. NO
a. CCB
2024
- 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
- 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
- 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
- Hepatitis from azathioprine - what substrte causes this
a. 6TG
b. 6MMP
c. 6MP
d. 6GTN
b. 6MMP
2024
- 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
- Orexigenic peptide acting centrally on AgRP
a. Insulin
b. Ghrelin
c. Leptin
d. GLP-1
b. Ghrelin
2024
- 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
- 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
- Carvedilol - vasodilatory effect by blocking which receptor
a. Alpha 1
b. Beta 1
c. Alpha 2
d. Beta 2
a. Alpha 1
2024
- 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
- Metaraminol MOA
a. alpha 1 agonist
b. alpha 2 agonist
c. beta 2 agoist
d. beta 1 agonist
a. alpha 1 agonist
2024
- 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
- 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
- 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
- F5U and Capecitabine metabolism
a. DPD (Dihydropyrimidine Dehydrogenase)
b. UMP (Uridine monophosphate)
c. DP
a. DPD (Dihydropyrimidine Dehydrogenase)
2024
- 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
- Nocardia
a. Gram positive coccobacilli
b. Gram positive branching rod
c. Gram negative cocci
d. Gram negative rod
b. Gram positive branching rod
2024
- 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
- 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
- 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
- FMF cytokine involved
a. IL1
b. TNF
c. IL6
a. IL1
2024
- 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
- 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
- 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
- Lung mechanics in pregnancy - what are the physiological changes that decrease during pregnancy
a. FEV1
b. DLCO
c. FVC
d. FRC
d. FRC
2024
- 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
- Leukocyte adhesion deficiency
a. Integrin
b. Selectin
c. Leukoadhesin
d. Cadherin
a. Integrin
2024
- 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
- 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
- 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
- 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
- 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
- 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
- Man presents with miosis and ptosis . Most appropriate first line investigation
a. Carotid angiogram
b. CTB
c. CXR
d. MRI
a. Carotid angiogram
2024
- 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
- Bicuspid aortic valve, no risk factors - aortic diameter required for repair
a. 45mm
b. 50mm
c. 55mm
d. 65mm
c. 55mm
2024
- 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
2024
- 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
- 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
- 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
2024
- 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
likely pulmonary amyloidosis as it responds to diuresis and shows birefringent polarised light
2024
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- MOA erythromycin on gut . Prokinetic ?B
a. GLP1
b. Motilin
c. 5HT3
d. Dopamine
b. Motilin
2024
- 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
- 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
- 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
- PTSD - 2nd line non-pharm after CBT
a. ECT
b. trauma psychotherapy
c. Rapid eye desensitisation
d. Rhubarb
b. trauma psychotherapy
