Summative S1 2018 Flashcards by Heath Cairns

Which of the following about the massive transfusion protocol is correct?
a. Can be adapted to local needs
b. Gathered from data collected from Australia, NZ and the UK
c. It is used in specific populations with major bleeding
d. Replaces the need for intervention from a haematologist/transfusion specialist
e. Provides guidance on monitoring of patients

c. It is used in specific populations with major bleeding

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A patient presents with a cut on their hand. They have numbness over the palmar surface of their thumb, index, middle finger and half of the ring finger. They also have weak pincer and pincer grip. They have weak wrist flexion, abduction and pronation. What nerve is affected?
a. Radial
b. Ulnar
c. Musculocutaneous
d. Median
e. Axillary

d. Median

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What causes thalassemia?
a. Globin synthesis dysfunction
b. Erythropoietin synthesis dysfunction
c. Problem with RBC DNA transcription

a. Globin synthesis dysfunction

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Which protein aggregation is in the picture of a lesion from Alzheimer’s disease?
a. Amyloid beta
b. Tau
c. Prion
d. Alpha synuclein

a. Amyloid beta

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Which immunoglobulin mediates the allergic reaction in anaphylaxis?
a. IgG
b. IgM
c. IgE
d. IgD
e. IgA

c. IgE

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What type of pain is the WHO pain management ladder used for?
a. Any pain
b. Neuropathic pain
c. Acute pain
d. Chronic pain
e. Cancer pain

a. Any pain

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What is the most common type of intracranial tumour?
a. Craniopharyngioma
b. Glioma
c. Meningioma
d. Metastatic cancer
e. Neuroblastoma

d. Metastatic cancer

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Why is metastatic brain cancer most common?

It is secondary cancer –> more common
Primary cancer in adults is meningiomas
Primary cancer in children is glioma

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Patient with emphysema and alveolar loss. What lung parameter would be decreased?
a. Alveolar dead space
b. Lung compliance
C. Diffusion capacity
D. Airway resistance
E. Total lung capacity

C. Diffusion capacity

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64 year old woman on warfarin, history of DVT. She is starting a new diet with green juices several times a day involving lots of leafy greens. What are you most concerned about?
a. Cognitive dysfunction
b. Increased risk of DVT
c. Increased risk of cerebral haemorrhage
d. Nausea and vomiting
e. Increased bruising

b. Increased risk of DVT

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Self-Reactive T cells are removed from the thymus during cell development. What name is given to the reduced effect on immune response?
a) Antigen modulation
b) Central tolerance
c) Immunological L.
d) Immunological anergy
e) Immunosuppression

b) Central tolerance

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Raised intracranial pressure can cause herniation of brain structures. Which type of herniation would cause brainstem compression?
a) Subfalcine
b) Supratentorial
c) Tonsillar
d) Transtentorial

c) Tonsillar

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What is the main impact of a trans tentorial herniation?

Pressure on particularly the midbrain

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What is the main impact of a tonsillar herniation?

Compression of the lower brainstem

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A 49 year old woman suffers an ischaemic stroke. What is the first line treatment?
a. Alteplase
b. Aspirin
c. Heparin
d. Warfarin

a. Alteplase

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What are the cytoplasmic inclusions in the substantia nigra in Parkinson’s Disease
a) Golgi Bodies
b) Lewy Bodies
c) NFTs
d) amyloid-beta aggregates

b) Lewy Bodies

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Liezel presents to your clinic with contact dermatitis. This is most likely to be a:
a. Type I Hypersensitivity Reaction
b. Type II Hypersensitivity Reaction
c. Type III Hypersensitivity Reaction
d. Type IV Hypersensitivity Reaction

d. Type IV Hypersensitivity Reaction

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What is an example of a Type 1 hypersensitivity?

Anaphylaxis or allergic rhino conjunctivitis (IgE)

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What is an example of a type 2 hypersensitivity?

Blood transfusions (IgG and IgM)

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What is an example of Type 3 hypersensitivity?

Immune complex mediated eg lupus (IgG)

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24 year old basketball player has a twisting injury of the knee. Swelling on medial aspect of knee, but full range of motion. Clicking, locking and pain on twisting motion. What is injured?
a. Anterior Collateral Ligament
b. Posterior Collateral Ligament
c. Medial collateral ligament
d. Lateral collateral ligament
e. Medial meniscus

e. Medial meniscus

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A sober alcoholic comes in with postural swaying. Which part of the brain is affected?
a. Cerebellar vermis
b. Lateral cerebellar hemispheres
c. Medullary olives
d. Primary motor cortex
e. Primary somatosensory cortex

a. Cerebellar vermis

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What is the role of the cerebellar vermis?

Muscle tone for posture

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What is the role of the lateral cerebellar hemispheres?

Involved in ataxia as well as gait (finger- nose, alternating movements etc)

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What is the role of the medullary olives?

Motor movement learning and auditory perception

19. Which of the following is characteristic of innate immunity? a. Memory b. Highly specific c. No specificity d. Rapid response e. Slow response

d. Rapid response

20. Old man who is a painter comes in with hypertension, hypercholesterolemia and diabetes. He describes an episode yesterday when he was painting where he suddenly felt weak in his right arm and leg and couldn’t hold his paintbrush anymore. He recovered in about one hour. What has most likely occurred? a. Cerebral anoxia b. Cerebral hypoxia c. Partial cerebral occlusion from atherosclerosis d. Complete cerebral occlusion from sickle cell disease

c. Partial cerebral occlusion from atherosclerosis

21. Which of these is involved in the “early phase” of the allergic reaction development? a. Eosinophil activation via IL-5 b. Mast cell degranulation by IgE c. Antigen-presenting cell activation by IgE d. Th2 activation by TCR

d. Th2 activation by TCR

22. A 31 yr old woman presents with a history of fatigue. Her blood test results show decreased red blood cells and haemoglobin and increased mean corpuscular volume. What is the most likely diagnosis for her condition? a. Folic acid deficiency b. Iron deficiency anaemia c. Hereditary spherocytosis d. Thalassemia

a. Folic acid deficiency

What are some features of blood with folic acid deficiency?

Fatigue Decreased RBC Decreased Haemoglobin Increased MCV

What are some features of blood with iron deficiency anaemia?

Fatigue Decreased RBC Decreased Haemoglobin (hypochromic) Microcytic

24. A patient got stabbed in the chest in the 5th intercostal space to the left of the sternum. Which structure is damaged? a. Aorta b. Left Ventricle c. Right ventricle d. Trachea bifurcation e. Left atrium

c. Right ventricle

25. What pathogen causes rheumatic fever? a. Golden Staph b. Group A Streptococcus c. HIV d. Campylobacter

b. Group A Streptococcus

28.A neurosurgeon does an electrical stimulation test on the right hemisphere of the brain in a specific part of the motor area. What effect will you see? a. Complete body movement b. Twitching on the left side c. Twitching on right side d. Complex movement on left e. Complex movement on right

b. Twitching on the left side

29. What changes would be seen on xray for a grade 2 sprain on ankle? a. Changes to bony outline at ankle joint b. Bone deformity at ankle joint c. Soft tissue mass in calf d. Soft tissue swelling only e. Widening of the joint space

d. Soft tissue swelling only

30. How do antihistamines cause vasoconstriction? a. Histamine H2 receptor antagonist b. Reduce NO mobilisation c. Reduce kinase activity d. Act on nerve endings

b. Reduce NO mobilisation

31. What is the mutation involved in early onset Alzheimer’s dementia? a. Tau b. Amyloid precursor protein (APP) c. Alpha synuclein d. Prion

b. Amyloid precursor protein (APP)

32. A patient had a previous respiratory infection. Her symptoms persist long after the infection clears. This is because self-reactive cells cross-react with bacteria. What is this a result of? a. Molecular mimicry b. Bystander immune cell activation c. Release of sequestered antigens d. Cytokine activation

a. Molecular mimicry

33. Alvin presents with cholethiasis. His FBC shows he has small densely stained blood cells, low HgB, high MCHC. What is the cause of this? a. Folate Deficiency b. Iron deficiency c. Spherocytosis d. Thalassaemia

c. Spherocytosis

What is cholethiasis?

Gallstone disease

35. Which of the following best describes the function and structure of the Golgi tendon apparatus? a. Muscle stretch and arranged in parallel with muscle fibres b. Muscle stretch and arranged in series with muscle fibres c. Muscle tension and arranged in parallel with muscle fibres d. Muscle tension and arranged in series with muscle fibres

d. Muscle tension and arranged in series with muscle fibres

36. A 74 year old man has a stroke. What signs would mean that is was a cortical cerebral stroke? a. Impaired respiration b. Weak facial muscles c. Impaired coordination d. Impaired thermoregulation e. Impaired ability to understand speech

e. Impaired ability to understand speech

38. Sharon had bowel surgery. After 2 weeks, she has painful, swollen right leg which she cannot walk on. On doppler ultrasound you find a DVT from peroneal vein to common femoral vein. It is non-compressible. What is the next step? a. CT Scan b. Therapeutic anticoagulants c. Urgent referral to vascular surgeon d. Surveillance e. MRI

b. Therapeutic anticoagulants

39. How do the majority of seizure medications work? a. Increase refractory period of Na+ channels b. Degrade GABA c. Increase glutamate release d. Increase sodium excretion during latent period

a. Increase refractory period of Na+ channels

40. 31 year old woman presents with fatigue and amenorrhea. Thyroid tests show low T3, low t4 and very low TSH. What is the most appropriate next test? a. Thyroid antibodies test b. Thyroid ultrasound c. Thyroid iodine uptake scan d. MRI of pituitary gland e. Monitor 24 hour iodine excretion

d. MRI of pituitary gland

What is amenorrhea?

Absence of menstrual periods

41. What's the best way to take an image of the head while minimising ionising radiation and maximising image definition? a. Ultrasound b. MRI c. CT d. X ray

b. MRI

42. Endothelial cells regulate thrombus formation. How does it do this? a. Releases zygomen inhibitors b. Releases nitric oxide c. Activation of thrombin d. Releases plasminogen inhibitors

c. Activation of thrombin

43. John, 70, presents with eye trouble. He has 6/6 acuity with glasses. His eyes feel heavy and he gets double vision after an hour of reading. His eyes recover after short rest but get worse after shorter and shorter rest times. No other tiredness is noted. What disease is likely? a. Degeneration of CNS b. Demyelination c. Inflammatory polyneuropathy d. Disease of the NMJ

d. Disease of the NMJ

44. A young girl has ORIF surgery for a fractured ulna/radius. Six hours after her surgery she is still in severe pain. The registrar fears compartment syndrome. What is a late sign of compartment sign? a. Pain b. Pallor c. Pulselessness d. Palpable mass e. Paraesthesia

c. Pulselessness

What is ORIF surgery?

Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken ankle

What is Paraesthesia?

an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves.

45. Where are neurofibrillary tangles first found in Alzheimer’s Disease? a. Dentate gyrus b. Entorhinal cortex c. Hippocampus d. Neocortex e. Substantia nigra

b. Entorhinal cortex

46. Therapeutic hyperventilation is used to treat increased intracranial pressure. What is the mechanism behind this? a. Hypocapnia causes vasoconstriction b. Hypercapnia causes vasodilation c. Increases heart rate causing vasoconstriction d. Increases O2

a. Hypocapnia causes vasoconstriction

47. There is an RCT that wants to assess the effects of different types of exercise in 2 groups over a 6 month period. What is the best way in which individuals could be randomised between the 2 groups? a. Random numbers generated by a computer b. Using the date of births of the individuals c. Pre-selecting the groups by student number d. Sequential order e. Self-selection

a. Random numbers generated by a computer

50. The famous neurosurgery patient ‘HM’ underwent surgery for his epilepsy which resulted in anterograde amnesia. This indicated the importance of this area in declarative memory formation. Which area of the brain was affected? a. Diencephalon b. Dorsolateral prefrontal cortex c. Medial temporal lobe d. Medial prefrontal cortex e. Right parietal lobe

c. Medial temporal lobe

52. Indigenous male presents with double vision when both eyes are open. You notice his left eye is slightly medially deviated and he has trouble abducting his left eye. He has diabetes. Which cranial nerve is likely to be causing this? a. Abducens b. Facial c. Oculomotor d. Trigeminal e. Trochlear

a. Abducens

What eye related movements does the facial nerve do?

Closes the eyes --> via the orbicularis oculi muscle

What eye related movements does the oculomotor nerve do?

Opens the eye --> via elevator palpebrae Elevates the eyeball Depresses eyeball Adducts eyeball (outwards) Lateral rotation

What eye related movements does the trochlear do?

Innervates the superior oblique to depress and intort the eyeball.

What does the abducens do in the eye?

Abducts

53. What is the critical function of astrocytes? a. Generating neural stem cells b. Initiating inflammatory response in CNS c. Insulate axons to increase conduction d. Helps make a semi permeable barrier between fluid filled compartments in CNS e. Recycle neurotransmitters and secrete neurotrophic substances

e. Recycle neurotransmitters and secrete neurotrophic substances

54. The relative risk reduction of disease X by intervention Y is 1.6 times greater than no intervention. This means that Y reduces the risk of X by 160% compared to no intervention. The 95% confidence interval is 0.8-2.4. Which of the following is the correct interpretation of these results? a. The findings are statistically significant but not clinically significant. b. The findings are statistically significant because the confidence interval does not include 0 c. The risk of X is reduced by 80-240% d. Findings may indicate an increased or decreased risk reduction in developing the outcome

d. Findings may indicate an increased or decreased risk reduction in developing the outcome

56. Which of the following is the main outcome of the citric acid cycle? a. 6 chain carbon converted to 3 chains carbon b. NAD+ reduced to NADH c. Citrate is regenerated at the end of the cycle d. Oxygen used and Carbon Dioxide produced

b. NAD+ reduced to NADH

57. Intramuscular vitamin K injections are commonly given to neonates to prevent haemorrhage. Which of the following is Vitamin K given for? a) Platelet deficiency b) Prothrombin inactivity (II) c) Factor VIII deficiency d) Endothelial fragility e) Fibrinogen deficiency

b) Prothrombin inactivity (II)

60. What is a characteristic of Alzheimer’s disease? a. Neurofibrillary tangles (tau) and senile plaques (amyloid beta) Amyloid beta mutation

a. Neurofibrillary tangles (tau) and senile plaques (amyloid beta)

62. Neostigmine is used for myasthenia gravis. What is its mode of action? a. Inhibitor of acetylcholinesterase b. Releases more ACh from presynaptic terminals

a. Inhibitor of acetylcholinesterase

63. A mother brings in her 5 year old daughter who is tired all the time. On blood pathology, blood count is normal and RBCs are normocytic and normochromic. Serum iron is normal, transferrin is normal, transferrin saturation is high and ferritin is low. What does this indicate? a. Haemochromatosis b. Iron deficiency anaemia c. Iron deficiency d. Normocytic anaemia

c. Iron deficiency

64. Mel, a 30 year old woman, presents with pain in her right knee. The pain is there on twisting, and sometimes her knee locks. Sometimes she is unable to fully extend her knee. She reports a twisting injury one week ago. Where is the pathology most likely located? a. Along the lateral fibular head b. At the attachment of the tibial tuberosity c. At the attachment of the joint capsule d. In the joint space e. In the quadriceps tendon

d. In the joint space

66. A man comes in after hitting a pole which he claims he didn’t see. He has deficits in both of his temporal fields. What is the cause of this? a. Damage to the LGN/thalamus b. Macula degeneration c. Damage to the optic cortex d. Damage to the optic tract e. Pituitary adenoma

e. Pituitary adenoma

67. Janine, a 23 year old, suffers a haemorrhage after giving birth. In preparation for immediate fluid resuscitation, you place a cannula and collect blood for matching to a blood donor. What abnormalities would her blood sample show? a. Low Hb b. Low Hct c. Low RBC d. No abnormalities

d. No abnormalities

68. The myelin sheath surrounding central nervous system nerves are made from which cell type? a. Microglia b. Oligodendrocytes c. Satellite cells d. Schwann cells

b. Oligodendrocytes

69. You can get lesions that display deficits on the same side of the body or the opposite side depending on where the lesion is. Where would a lesion occur giving you ipsilateral motor deficits? a. Midbrain b. Primary motor cortex c. Somatosensory cortex d. Spinal cord e. Thalamus

d. Spinal cord

70. 76 year old female has a history of hypertension, hyperlipidaemia and a carotid endarterectomy with 99% stenosis that was diagnosed after several TIA attacks. 12 months ago, her family noticed some sudden memory loss. She has no other sensory disturbances. No personality changes. What’s the most likely diagnosis? a. Lewy body dementia b. CJD c. Alzheimer's Disease d. Vascular Dementia e. Frontotemporal Dementia

d. Vascular Dementia

71. Jade is a 23 y/o female who suffered from acute blood loss following a traumatic labour. 3 days later, she did a follow-up FBC test and was given 2L of saline and 300ml of whole blood at the time. Which of the following will be shown on her FBC? a. Decreased MCH b. Decreased MCV c. Increased RDW d. Increased Hct

c. Increased RDW

What is RDW for blood tests?

Red cell distribution width (range of RBC size)

72. A man comes to ED after a drunken brawl. His left shoulder is anteriorly dislocated. Paraesthesia on left lateral upper arm is noted. What nerve is damaged? a. Axillary b. Radial c. Musculocutaneous d. Suprascapularis e. Median

a. Axillary

What area does the axillary nerve sensory innervate?

Lateral upper arm

What area does the radial nerve sensory innervate?

lateral lower arm Posterior surface of the arm A strip of skin down the middle of the posterior forearm

What does the musculocutaneous nerve sensory innervate?

Antero-lateral forearm

What does the suprascapularis nerve sensory innervate?

Acromioclavicular joint | Glenohumeral joint

What does the median nerve sensory innervate?

Lateral aspect of the palm + fingers (3 and a half digits) Lateral back of the hands (only fingertips of 3 and a half digits)

What nerve is impacted by carpal tunnel?

Median nerve

73. Child with a bee sting, has an anaphylactic reaction. Why does a bee sting swell? a. chemical modulation causes adhesion and activation of inflammatory cells b. Chemical modulation causes local vasodilation and increased blood vessel permeability c. vasoconstriction causes increased hydrostatic pressure d. Loss of fluid causes viscosity

b. Chemical modulation causes local vasodilation and increased blood vessel permeability

74. A 23 year old male has had a deep vein thrombosis (DVT) and has a family history of DVT and pulmonary embolisms (PE). You decide to check for an inherited clotting disorder. Which of these would indicate a genetic clotting problem? a) Factor IX deficiency b) Factor VIII increased c) Factor V Leiden mutation d) thrombin doesn't work e) Increased amount of S protein

c) Factor V Leiden mutation

75. What type of antineoplastic drug would be used to treat non-small cell lung cancer dependant on Epidermal Growth Factor Receptor? a) Alkylating Agents b) Antimetabolites c) Kinase Inhibitors d) Hormonal Agents

c) Kinase Inhibitors

76. Which of the following are involved in the formation of a primary platelet plug? a. Fibrinogen activation b. Serine protease amplification in the intrinsic cascade pathway c. Platelet mediators like ADP and TXA2

c. Platelet mediators like ADP and TXA2

81. 23 year old female presents with pain on the lateral aspect of her elbow extending down the posterior aspect of her arm. On palpation she was tender on the lateral epicondyle. She felt pain on resisted extension of her wrist and elbow. Where is the likely cause of her issue? a. Insertion of Biceps Brachii b. Insertion of extensor carpi radialis brevis c. Origin of the common extensor tendon d. Origin of the common flexor tendon e. Insertion point of pronator teres

c. Origin of the common extensor tendon

82. What established the resting membrane potential in neurons? a. Concentration gradient of calcium ions b. Concentration gradient of sodium c. Concentration gradient of potassium d. Movement of potassium and calcium ions

c. Concentration gradient of potassium

83. A 48 year old man with hypertension is on Hydrochlorizide (a diuretic) however his blood pressure is still high at 155/95. He is then also put on Ramipril (an ACE inhibitor). He then develops Acute Kidney Injury. What is the mechanism behind this? a. Acute interstitial nephritis b. Hypotension (sys <90) causing a decrease in renal perfusion c. Dilation of afferent arteriole causing a decrease in GFR d. Dilation of afferent arteriole causing an increase in GFR e. Dilation of efferent arteriole causing a decrease in GFR

e. Dilation of efferent arteriole causing a decrease in GFR

Does afferent or efferent enter the kidney first?

``` Afferent = in Efferent = out ```

What is the affect on GFR for a dilation of the afferent?

Increased GFR

What is the affect on GFR for a dilation of the efferent?

Decreased GFR

87. Post translational modifications are important in the production of collagen. Which of the following modifications occur to make collagen fibrils? a. Methylation b. Alkylation c. Sulfuration d. Dehydroxylation e. Glycosylation

e. Glycosylation

93.The posterior pituitary releases which of the following hormones? a. Growth hormone b. Luteinising hormone c. Oxytocin d. Thyroid stimulating hormone

c. Oxytocin

94. A woman has hypercalcaemia which you decide to treat with bisphosphonates. What is the mode of action of bisphosphonates? a. Ingestion by osteoclasts inducing osteoclast apoptosis and leading to decreased bone resorption b. Antagonise RANKL causing decreased bone resorption by osteoclasts c. Stimulate osteoblasts promoting calcium deposition d. Inhibit calcium release from bones into bloodstream

a. Ingestion by osteoclasts inducing osteoclast apoptosis and leading to decreased bone resorption

96. Which neurotransmitter system contributes to the generation of seizures? a. Noradrenaline b. Epinephrine c. GABA d. Glutamate e. Dopamine

d. Glutamate

97. What runs under the inguinal ligament most laterally. a. Femoral Nerve b. Femoral Artery c. Femoral Vein d. Femoral Canal e. Femoral Duct

a. Femoral Nerve

99. George, a 50 year old male, presents with forgetfulness and is worried about having Alzheimer’s disease because his father developed it at 75 years of age. He has no other family history of Alzheimer’s disease. What is the most appropriate first step in investigating whether George has dementia? a. Brain MRI to investigate brain volume b. Clinical assessment of cognitive function c. Genotyping of ApoE4 protein d. PET scan e. Something about hippocampus

b. Clinical assessment of cognitive function

100. Rebecca, aged 15, presents with a history of heavy menstrual bleeding and complains of fatigue. Blood tests and iron studies show that she has mild iron deficiency anaemia. You prescribe short-term oral iron tablets. Why should Rebecca take vitamin C (ascorbic acid) with the iron tablets? a. Ascorbic acid breaks down the inhibitors of haem and non-haem iron absorption. b. Ascorbic acid chelates the inhibitors of haem and non-haem iron absorption. c. Ascorbic acid chelates the inhibitors of non-haem iron absorption. d. Ascorbic acid enhances the absorption of haem and non-haem iron absorption e. Ascorbic acid enhances the absorption of non-haem iron absorption.

e. Ascorbic acid enhances the absorption of non-haem iron absorption.

101. A man presents to the ED with neck pain and right arm pain. His right triceps reflex is absent. Which spinal level is likely affected? a) C4 b) C5 c) C6 d) C7 e) T1

d)C7

What spinal level controls the triceps muscle?

What nerve innervates the triceps?

Radial nerve

102. There are 2 major arteries that supply the brain. They exist on both sides of the brain. The internal carotid artery supplies one section of the brain. What is the other artery that supplies the brain? a. Subclavian b. Circle of Willis c. Vertebral d. External carotid e. Middle cerebral artery

c. Vertebral

104. What cell type is found in connective tissue proper? a. Chondrocytes b. Endothelial cells c. Epithelial cells d. Glial cells e. Mast cells

e. Mast cells

105. A patient presents with a torn medial collateral ligament of knee. What sign might you see? a. Abnormal lateral rotation of the knee during extension b. Abnormal passive abduction of the knee when extended c. Posterior tibial displacement d. Inability to fully extend knee e. Anterior tibial displacement

b. Abnormal passive abduction of the knee when extended

107. What triggers the initial endocytosis of LDL in early stages of atherosclerosis? a. Endothelial cell b. Epithelial cell c. Macrophage d. Foam cells e. Smooth muscle cells

c. Macrophage

110. A 46 year old man presents with new onset of a hoarse voice. On examination, he has weakness of the his left soft palate and pharynx when testing the gag reflex. When asked to cough, it is moist and inefficient. Which cranial nerve is most likely involved? a. Accessory b. Facial c. Hypoglossal d. Trigeminal e. Vagus

e. Vagus

111. Which of the following is the most important cause of non-melanoma skin cancer a. Chronic sunburn resulting in increased melanin activity in the skin b. Chronic UVB exposure disrupting DNA in keratinocyte c. Chemical exposure decreasing skin desmosomes d. Immunosuppression resulting in increasing risk of HPV infections e. Ionising radiation resulting in keratinocyte apoptosis

b. Chronic UVB exposure disrupting DNA in keratinocyte

114. In which disease can you find alpha synuclein in the substantia nigra? a. Huntington’s disease b. Creutzfeldt Jakob’s Disease c. Alzheimer’s Disease d. Parkinson’s Disease

d. Parkinson’s Disease

115. A 14 year old girl had been having migraines and was given Sumatriptan (a serotonin agonist). What is the mechanism of the serotonin agonist? a. PKG b. Inhibits Adenylate Cyclase → inhibits NO-mediated calcium influx c. PKA → calcium influx

c. PKA → calcium influx

116.What happens 10 days - 3 weeks after an ischaemic stroke? a. Infiltration of macrophages b. Infiltration of neutrophils c. Oedema with raised ICP d. Degeneration of axons distal to infarction site e. Proliferation of capillaries at the border of the infarct

d. Degeneration of axons distal to infarction site

117. A 26 year old man had a motorcycle accident and sustained a compound fracture. What structure is most at risk? a. Dorsalis pedis artery b. Posterior tibial artery c. Peroneal artery d. Fibular vein e. Lesser saphenous vein

b. Posterior tibial artery

118. A 54 year old male has a long history of migraines with renal failure. Which medication is most likely to cause this? a. Alniditan, a 5HT1D agonist b. Methysergide, a 5HT2 antagonist c. Pizotifen, a 5HT2 antagonist d. Sumatriptan, a 5HT1D agonist

d. Sumatriptan, a 5HT1D agonist

120. Benzodiazepines are used for status epilepticus. What is the mode of action of benzodiazepine in absence seizures? a. Blocks T type calcium channels b. Enhanced GABA inhibitory effects c. Blocks sodium channels

b. Enhanced GABA inhibitory effects

``` A 6 year old girl with a clinical grade 1 ankle sprain presents to your clinic. What would you do? a. Bone scan b. CT c. MRI d. X-ray e. No imaging ```

e. No imaging

1. What does Vitamin D deficiency in children affect? a. Calcification of bony matrix b. Involved in bone collagen formation c. Bone formation by osteoblasts d. Bone resorption by osteoclasts

a. Calcification of bony matrix

1. Which antineoplastic drug is most likely to cause myelosuppression? a. Alkylating agents b. Immunotherapy c. Monoclonal antibodies d. Kinase inhibitor

a. Alkylating agents

What is myelosuppression?

Bone marrow activity is decreased

1. Man jumped from a 2 metre height and landed on his feet. He now has avascular necrosis of his right hip. Which artery is most likely to be affected? a. Lateral and medial femoral circumflex artery b. Sacral artery c. Superficial and deep pudendal artery d. Superior and inferior gluteal artery e. Obturator artery

a. Lateral and medial femoral circumflex artery

1. An EEG is performed on someone with insomnia. During deep sleep, what does an EEG show? a. Delta and beta b. Beta c. High amplitude Theta waves d. Slow delta waves

d. Slow delta waves

1. A patient who gets tonic clonic seizures is taking sodium valproate. This is not effective. You consider adding carbamazepine to try to better control their seizures. What would concern you about combining sodium valproate and carbamazepine? a. Carbamazepine and sodium valproate are metabolised by the same enzyme -potentially toxic effects b. Carbamazepine and sodium valproate together produce a toxic synergistic effect c. Carbamazepine induces the metabolism of valproate, leading to decreased effect

c. Carbamazepine induces the metabolism of valproate, leading to decreased effect

1. A child presents with an inversion ankle injury which is a grade 2 ankle sprain. Two weeks later, she is still in pain and can’t stand on the bad leg. Which ligament is most likely damaged? a. Anterior talofibular ligament b. Posterior talofibular ligament c. Calcaneofibular ligament d. Deltoid ligament e. Tibiofibular ligament

a. Anterior talofibular ligament

1. A 4 year old boy presents with failure to thrive and developmental delay. He has splenomegaly and hepatomegaly. Normal iron, LFTs. FBC showed microcytic, hypochromic cells. He had an elevated unconjugated bilirubin. What is this indicative of? a. Malaria b. Thalassaemia minor c. Sickle cell disease

b. Thalassaemia minor

1. A patient has pain in their right neck and arm. Their triceps reflex is absent. Which nerve root elicits the triceps reflex? a. C4 b. C5 c. C6 d. C7 e. T1

d. C7

1. A patient presents to the ED with stabbing pain above their knee. They say it came on suddenly earlier that day when sprinting. On examination, they have an absent knee jerk reflex and trouble extending their knee. What is the problem? a. Tear of adductor magnus b. Tear in quads c. Biceps femoris d. Tear in quad tendon e. PCL tear

d. Tear in quad tendon

1. What is the mode of action of adrenaline? a. Targets a1 and b2 adrenoreceptors to cause vasoconstriction and bronchodilation b. Targets a1 and a2 adrenoceptors c. Targets a1 and b1 adrenoceptors to cause vasoconstriction and increase HR and contractility

a. Targets a1 and b2 adrenoreceptors to cause vasoconstriction and bronchodilation

1. A truck driver presents with a rash on his legs after walking through a bush. You decide to give him second generation antihistamines. What is the benefit of second generation antihistamines? a. They are less likely to cause sedation b. They do not cause blurred vision c. They are generally more effective in mild rashes

a. They are less likely to cause sedation

1. What does connective tissue proper consists of? a. Cells, fibres and ground substance b. Cells, water and extracellular matrix (ECM) c. Collagen, cells and extracellular matrix (ECM) d. Fibroblasts, mast cells and ground substance

a. Cells, fibres and ground substance

1. What is the most important cause of non-melanoma skin cancer? a. HPV b. Ultraviolet (UV-B) causing DNA damage in keratinocytes c. Sunlight causing pigment production from melanocytes d. Chemical exposure

b. Ultraviolet (UV-B) causing DNA damage in keratinocytes

1. A patient has a history hepatitis B that was treated with antivirals and _____(?). They have a history of opiate addiction but have abstained for a year. They notice blood filled blisters on their legs. What could this be? a. Polyarteritis nodosa b. Allergic vasculitis c. Opioid withdrawals d. Hepatitis A

a. Polyarteritis nodosa

1. What is the major inhibitory neurotransmitter in the CNS? a. GABA b. Glutamate c. Dopamine

a. GABA

1. What is the major neurotransmitter in migraine pathophysiology? a. Serotonin b. Noradrenaline c. Glutamate d. Dopamine

a. Serotonin

What is the mechanism of action of tranexamic acid?

Inhibits plasminogen and inhibits fibrinolysis

1. What is a unique characteristic of an upper motor neuron lesion? a. Increased reflexes b. Babinski downgoing c. Weakness d. Fasciculations

a. Increased reflexes

1. HM is a patient who had anterograde amnesia. What is an important structure in the brain that maintains declarative memory? a. Medial temporal lobe b. Dorsolateral prefrontal cortex c. Medial prefrontal cortex d. Diencephalon e. Right parietal lobe

a. Medial temporal lobe

1. Patient cannot move eyes in all directions. Patient has incomplete ptosis. Patient has lack of sensation in eye region and scalp. Where is the lesion? a. Superior orbital fissure b. Internal acoustic meatus c. Foramen ovale d. Pons e. Midbrain

a. Superior orbital fissure

1. Patient presents with constricted pupils bilaterally. Neither eye reacts/constricts to light, however accommodation is normal (constriction occurs). There are no other abnormal signs. What is the problem? a. Optic nerve/optic neuritis b. Bilateral oculomotor nerve palsy c. Light-near dissociation response d. Recent opioid use

c. Light-near dissociation response

1. Which of the following is correct about rods and cones? a. Colour vision best peripherally, seen with cones b. Both Rods and Cones are needed for colour vision c. Red green colour-blindness mutations are on the X chromosome d. Rods have three photopigments to detect colour vision e. Rods allow colour vision to be best at night-time

c. Red green colour-blindness mutations are on the X chromosome

1. A patient presents with a tension pneumothorax. A tube is inserted at the 5th intercostal space midaxillary line. What structure could be affected? a. Intercostal vessels b. Internal thoracic vessels c. Lower brachial plexus d. Upper lobe of liver

a. Intercostal vessels

1. A patient is given 2L of normal saline and 300ml blood transfusion 3 days ago after massive haemorrhage after labour. What would her blood results show now? a. Increase haematocrit b. Increase in RDW c. Decrease haemoglobin

b. Increase in RDW

1. Where is pro-collagen formed? a. Cytosol b. Nucleus c. Endoplasmic Reticulum d. Golgi Apparatus e. Extra-cellular space

c. Endoplasmic Reticulum

1. Woman with non-small-cell lung cancer has activated growth factor receptors. Which drug should be used for targeted therapy? a. Alkylating drugs b. Anti-hormones c. Anti-metabolites d. Kinase inhibitors

d. Kinase inhibitors

1. Question about GLUT1 receptors? - i think it was about defiency of GLUT 1 and effects? This question was talking about a child with GLUT1 deficiency who had seizures as a result of it, and something to do with the mechanism. a. Present in astrocytes b. Present in endothelial cells c. Present in neurons

b. Present in endothelial cells

Where are GLUT1 found?

Endothelial cells and astrocytes

What GLUT is in astrocytes?

GLUT1

What GLUT is in neurons?

GLUT3

1. Patient with left arm and leg problems and deviates to the left when walking? Where is the problem? a. Right lateral cerebellar b. Right lateral cerebellar and vermis c. Left lateral cerebellar d. Left lateral cerebellar and vermis e. The vermis only

c. Left lateral cerebellar

1. Which is the targeted outcome in treatment for someone with congestive heart failure? a. Increase pre-load b. Increase afterload c. Decrease intravascular volume d. Decrease contractility

c. Decrease intravascular volume

34. How is the majority of CO2 transported in blood? a. Bicarbonate b. Carboxyhemoglobin c. Carb-amino haemoglobin d. Dissolved gas

a. Bicarbonate

35. Tender lateral epicondyle and painful resisted wrist extension. Where is damage? a. Common extensors of arm origin b. Carpi radialis brevis point of attachment c. Common flexors of arm origin d. Pronator teres

a. Common extensors of arm origin

36. IgG attached to bacteria, how is it cleared? a. By phagocytosis by neutrophils b. By cytotoxic t cell activation c. By eosinophilic something granules

a. By phagocytosis by neutrophils

37. Something about which type of dementia has mutated tau proteins? a. Parkinsons b. Early onset AD Mutated amyloid beta protein c. FTLD d. prion one

c. FTLD