Y2S1 formative quiz

Question 1

A man presents following a fall onto his shoulder. An X-ray shows a fracture at the surgical neck of the humerus. You are concerned about possible neurological damage associated with the fracture.

Which of the following is the most appropriate clinical test?
A.	Active shoulder abduction
B.	Active shoulder flexion
C.	Passive shoulder abduction
D.	Sensation over deltoid
E.	Sensation over teres minor

Answer 1

D. Sensation over deltoid

Question 2

A 32 year-old male was prescribed oral penicillin for a throat infection. He has taken penicillin in the past. After commencing this current round, he began to feel light-headed, itchy and found it difficult to breathe.

What kind of reaction is he experiencing?
A. Type 1 hypersensitivity mediated by IgE
B. Type 1 hypersensitivity mediated by IgG
C. Type 2 hypersensitivity mediated by IgE
D. Type 2 hypersensitivity mediated by IgG

Answer 2

A. Type 1 hypersensitivity mediated by IgE

Question 3

In an observational study which of the following is likely to be true?
A. Bias can be eliminated
B. Confounders can be evenly distributed
C. Exposure can be controlled
D. Temporal associations can be confirmed

Answer 3

D. Temporal associations can be confirmed

Question 4

A 25 year-old man is playing a football game on a hot day and does not drink any water in the breaks. He is otherwise healthy and therefore his kidneys respond appropriately to the decrease in intravascular volume.

His kidneys do this by maximum reabsorption of:
A.	Creatinine and potassium
B.	Sodium and creatinine
C.	Sodium and urea
D.	Sodium, potassium and urea
E.	Urea and creatinine

Answer 4

C. Sodium and urea

Question 5

What is an example of an innate barrier to infection?
A. Agglutination by antibodies
B. Antibody-dependent cellular cytotoxicity
C. Opsonisation by antibodies
D. Phagocytosis
E. T cell cytotoxicity

Answer 5

D. Phagocytosis

Question 6

A 55 year-old woman presents to your practice with joint stiffness, joint pain and joint deformity. Your diagnosis is rheumatoid arthritis.

Which of the following would you expect regarding rheumatoid arthritis?
A.	A decrease in cytokines
B.	A decrease in osteoclast activity
C.	An increase in osteoblast activity
D.	An increase in osteoclast activity
E.	Type I hypersensitivity reaction

Answer 6

D. An increase in osteoclast activity

Question 7

A 41 year-old male presents to your practice for ongoing right sided low back, hip and knee pain for the past six months following jumping off a two-metre high roof and landing on his feet. Radiology investigations show an avascular necrosis of the right hip.

Which arteries are most likely to be involved?
A. Anterior and posterior obturator arteries
B. Lateral and medial circumflex femoral arteries
C. Median and lateral sacral arteries
D. Superficial and deep external pudendal arteries
E. Superior and inferior gluteal arteries

Answer 7

B. Lateral and medial circumflex femoral arteries

Question 8

A 55 year-old pianist has noted pain in his second and third distal interphalangeal joint of his right hand for several years. There is no joint swelling. He has noticed the pain gets worse during the day after playing the piano.

What is the most likely morphologic change in his joints?
A.	Bone marrow fibrosis
B.	Crystal deposition
C.	Loss of articular hyaline cartilage
D.	Synovitis
E.	Underlying osteomyelitis of bone

Answer 8

C. Loss of articular hyaline cartilage

Question 9

Maturation of collagen proteins requires multiple post-translational modifications. They are essential for the formation of collagen fibrils.

Which of the following is an example of one of these modifications?
A.	Acetylation
B.	Dehydroxylation
C.	Glycosylation
D.	Methylation
E.	Sulfurisation

Answer 9

C. Glycosylation

Question 10

A postmenopausal woman is prescribed Hormone Replacement Therapy (HRT) for osteoporosis following a fracture to the hip.

Which of the following best describes the mechanism of action of HRT on bone metabolism?
A. Activates transcription of RANKL in osteoblasts
B. Decrease osteoclast proliferation, differentiation and activation
C. Increase cytokine production, particularly interleukin-6
D. Increase osteoclast proliferation, differentiation and activation
E. Inhibits osteoclast apoptosis and increases osteoblast apoptosis

Answer 10

B. Decrease osteoclast proliferation, differentiation and activation

Question 11

Which of the following statements is true regarding the grading of ankle sprains?
A. A Grade 2 sprain indicates stretching of ligaments only
B. A Grade 3 sprain by definition involves a concurrent fracture
C. A Grade 3 sprain involves the complete tearing of one or more ligaments
D. A suspected Grade 1 sprain necessitates imaging
E. There is no difference in management between the grades of ankle sprain

Answer 11

C. A Grade 3 sprain involves the complete tearing of one or more ligaments

Question 12

In order to initiate an adaptive immune response, an antigenic peptide must be presented to antigen-specific T cells.

Which type of cell presents this antigen to T cells?
A.	Dendritic cell
B.	Epithelial cell
C.	Mast cell
D.	Neutrophil
E.	Plasma cell

Answer 12

A. Dendritic cell

Question 13

A 17-year-old male comes in having fallen over in a futsal game. History of falling onto an out-stretched hand, with a radially deviated wrist. He complains of pain when you apply pressure to the anatomical snuffbox.

What condition is he most likely to have?
A. Distal radius fracture
B. Extensor pollicis longus tendon sprain
C. Pisiform fracture
D. Scaphoid fracture

Answer 13

D. Scaphoid fracture

Question 14

What feature of cerebral vessels is responsible for the blood-brain barrier?
A. They are covered by myelin sheaths
B. They are surrounded by astrocyte perivascular end-feet
C. They have an additional layer of endothelial cells
D. They have substantially thicker basal lamina
E. They are covered by oligodendrocytes

Answer 14

B. They are surrounded by astrocyte perivascular end-feet

Question 15

A 28 year-old female presents to the Emergency Department after developing a widespread rash following a wasp sting. She has not experienced these symptoms with previous stings. She feels somewhat light-headed but is not short of breath. She is otherwise healthy and has no significant past medical history. No wheezing is audible on exam. A diffuse urticarial rash is present. Vital signs are T 37.4oC, BP 100/60 mmHg, HR 102 /min, RR 22 /min, O2 96% on room air.

Which of the following is the most appropriate first step in management?
A.	Intramuscular adrenaline
B.	Intravenous corticosteroids
C.	Intravenous fluids
D.	Oral antihistamine
E.	Oxygen mask

Answer 15

A. Intramuscular adrenaline

Question 16

Each cell type in the immune system has a distinct role in the immune response.

What type of pathogen do eosinophils primarily provide defence against?
A.	Bacteria
B.	Fungi
C.	Parasites
D.	Viruses

Answer 16

C. Parasites

Question 17

What term is appropriate to describe the fracture in this X-ray? (bony boi out of skin)
A.	Comminuted
B.	Compound
C.	Incomplete
D.	Pathological
E.	Salter-Harris

Answer 17

B. Compound

Question 18

Investigators conduct a case-control study to investigate potential associated factors with Non-Hodgkin’s lymphoma.

What is the most useful advantage of a case-control study in this situation?
A. Can investigate treatment efficacy
B. Can provide incidence rates of Non-Hodgkin’s lymphoma
C. Recall bias will be minimised
D. Useful in assessing rare outcomes

Answer 18

D. Useful in assessing rare outcomes

Question 19

A 45 year-old male patient is brought in by ambulance with massive vomiting of bright red blood and epigastric pain. On examination, you find the patient is clammy, has a dry mouth, is slightly drowsy and unable to give a comprehensive history. His pulse rate is 140 beats per minute and his blood pressure is 85/60 mmHg. He has marked splenomegaly.

A complication of which of the following conditions would most likely be the cause of his presentation?
A.	Cirrhosis
B.	Crohn's disease
C.	Gastric cancer
D.	Gastric ulcer on greater curvature
E.	Helicobacter pylori infection

Answer 19

A. Cirrhosis

Question 20

A 25 year-old Asian woman presented to your clinic last week complaining of feeling consistently tired and unable to complete her daily chores. She also has some hair loss, mouth sores, rashes around her body and recent pain and swelling in both her hand and knee joints. Her blood results show an elevated erythrocyte sedimentation rate (ESR) and positive antinuclear antibodies (ANA).

Which one of the following is the most likely diagnosis?
A.	Fibromyalgia
B.	Hashimoto's disease
C.	Osteoarthritis
D.	Rheumatoid arthritis
E.	Systemic lupus erythematosus

Answer 20

E. Systemic lupus erythematosus

Question 21

Antibodies are key components of the adaptive humoral immune response.

Which of the following describes the production of antibodies by B cells?
A. Each B cell produces a single type of antibody with specificity for a single antigen
B. Each B cell produces a single type of antibody with specificity for multiple antigens
C. Each B cell produces multiple types of antibody with specificity for a single antigen
D. Each B cell produces multiple types of antibody with specificity for multiple antigens

Answer 21

A. Each B cell produces a single type of antibody with specificity for a single antigen

Question 22

What is the principal role of Schwann cells?
A. They facilitate inter-neuronal communication by releasing cytokines
B. They provide immune function including phagocytosis
C. They provide the myelin sheath to the axons resulting in faster axonal conduction
D. They take up neurotransmitters from synaptic terminals, preventing neurotoxicity

Answer 22

C. They provide the myelin sheath to the axons resulting in faster axonal conduction

Question 23

Your flatmate drank most of a bottle of scotch on Saturday night then fell asleep in the kitchen sprawled with his right arm over the back of a chair. This morning, his right hand is drooping as he is unable to extend it at the wrist. He also complains of numbness over the posterior arm and forearm and the back of his hand and fingers from his thumb to middle finger. His triceps reflex is absent.

What is the best explanation for his difficulties?
A. Axillary nerve palsy
B. Brachial plexus damage due to alcohol toxicity
C. Compression of brachial nerve
D. Musculocutaneous nerve palsy
E. Radial nerve palsy

Answer 23

E. Radial nerve palsy

Question 24

Hyperventilation may be used to treat raised intracranial pressure (ICP) in traumatic brain injury.

What is the means by which hyperventilation reduces ICP?
A. Increased oxygenation boosts brain metabolism
B. Increased respiratory rate results in higher cerebral blood flow
C. Resulting hypocapnia causes vasoconstriction
D. Resulting increase in carbon dioxide causes vasodilatation

Answer 24

C. Resulting hypocapnia causes vasoconstriction

Question 25

A 16 year-old boy comes to see you after a basketball game and complains of pain in his right knee. Examination elicits pain and tenderness over a swollen tibial tuberosity. X-rays are unremarkable.

Which of the following is the most likely diagnosis?
A.	Iliotibial band syndrome
B.	Inflammation of the patellar tendon
C.	Meniscal tear
D.	Popliteal cyst
E.	Posterior cruciate ligament injury

Answer 25

B. Inflammation of the patellar tendon

Question 26

What is the primary action of thrombin?
A. It activates cross-bridges between fibrin fibres
B. It causes conversion of fibrin monomer into fibrin fibres
C. It causes conversion of fibrinogen into fibrin monomer
D. It causes retraction of the blood clot

Answer 26

C. It causes conversion of fibrinogen into fibrin monomer

Question 27

What is the mechanism of bone mass increase in response to growth hormone (GH)?
A. Activates the formation of insoluble calcium phosphate salts
B. Activates the synthesis of insulin-like growth factor-1 (IGF-1, somatomedin) in liver
C. Directly activates osteoblasts
D. Directly inhibits osteoclasts

Answer 27

B. Activates the synthesis of insulin-like growth factor-1 (IGF-1, somatomedin) in liver

Question 28

Immunosuppressive therapies work through a variety of mechanisms.

Which of the following drug actions will promote immunosuppression?
A. Enhanced presentation of antigen
B. Inhibition of glucocorticoid production
C. Inhibition of interleukin production
D. Promotion of cytokine gene expression
E. Promotion of purine breakdown

Answer 28

C. Inhibition of interleukin production

Question 29

A 48 year-old male is four days post motor vehicle accident. He sustained multiple long bone fractures resulting in anaemia from significant blood loss. He required surgery and fluid resuscitation, however he did not require a blood transfusion.

What would you expect his blood examination to show?
A. Hypochromic, microcytic red cells with normal reticulocyte count
B. Normochromic, normocytic red cells with decreased reticulocyte count
C. Normochromic, normocytic red cells with increased reticulocyte count
D. Normochromic, normocytic red cells with normal reticulocyte count

Answer 29

C. Normochromic, normocytic red cells with increased reticulocyte count

Question 30

A 29 year-old male patient was stabbed in the antecubital fossa. A tourniquet has been applied by ambulance officers due to unstoppable bleeding and IV fluids commenced. Five minutes later, on arrival at hospital, his hand and forearm are pale and pulses are not present at his wrist. When the tourniquet is removed brisk bleeding resumes and his pulses are still not palpable.

Damage to which vessel most accounts for these findings?
A.	Brachial artery
B.	Brachial vein
C.	Median cubital vein
D.	Radial artery
E.	Ulnar artery

Answer 30

A. Brachial artery

Question 31

A woman undergoing an emergency caesarean section experiences excessive blood loss for which tranexamic acid has been administered.

How does tranexamic acid act to increase thrombosis?
A. Activates thrombin leading to the production of fibrin
B. Binds to heparin leading to the activation of clotting factors
C. Inhibits plasminogen activation and prevents fibrinolysis
D. Is used by vitamin K reductase in the activation of clotting factors

Answer 31

C. Inhibits plasminogen activation and prevents fibrinolysis

Question 32

Which cells are responsible for releasing calcium into the blood stream in response to parathyroid hormone?
A.	Osteoblasts
B.	Osteoclasts
C.	Osteocytes
D.	Osteogenic cells
E.	Osteophytes

Answer 32

C. Osteocytes

Question 33

A 45 year-old woman with anaemia resulting from iron deficiency is otherwise well.

What finding would be expected from her iron studies?
A.	Low serum ferritin
B.	Low serum transferrin
C.	Low soluble transferrin receptor
D.	Low total iron binding capacity

Answer 33

A. Low serum ferritin

Question 34

A 6 month-old infant, presents with recurrent severe infections, poor growth rate and chronic diarrhoea. Lab results indicate low T cell numbers and very low antibody concentrations in the blood.

Which type of immunodeficiency is most likely to explain these symptoms and lab results?
A.	Cancer-induced
B.	Drug-induced
C.	Genetically-determined
D.	Infection-induced

Answer 34

C. Genetically-determined

Question 35

A 72 year-old female tripped and fell against the back of a kitchen chair. Her right anterior upper arm is bruised where the back of the chair broke her fall. There is redness, swelling and tenderness anteriorly over her right upper arm. She rates the pain in her arm as 10 out of 10 with 10 being most severe. Pain is worse on passive extension of the elbow.

Which upper limb muscle is at risk of permanent damage?
A.	Biceps brachii
B.	Brachioradialis
C.	Flexor carpi ulnaris
D.	Flexor digitorum profundus
E.	Triceps brachii

Answer 35

A. Biceps brachii

Question 36

Which of the following mechanisms is exploited by medications used to reduce the risk of thromboembolism?
A. Activation of glycoprotein IIb/IIIa receptors
B. Increased cyclooxygenase activity
C. Inhibition of cAMP production
D. Inhibition of platelet phosphodiesterase
E. Thromboxane A2 receptor agonism

Answer 36

D. Inhibition of platelet phosphodiesterase

Question 37

A 20 year-old male twisted his knee playing soccer. He thinks he heard a ‘pop’ at the time. You find a moderately swollen knee and you are able to move the tibia forward unopposed on the femur.

Which component of the knee joint is most likely to be damaged?
A.	Anterior cruciate ligament
B.	Lateral collateral ligament
C.	Medial collateral ligament
D.	Posterior cruciate ligament

Answer 37

A. Anterior cruciate ligament

Question 38

A 55 year-old woman had recurrent joint pain and joint effusions. A biopsy of the knee joint was performed. The pathology report described “proliferative synovitis, chronic inflammation and vascular proliferation”.

What is the most likely diagnosis?
A.	Ankylosing spondylitis
B.	Osteoarthritis
C.	Paget's disease
D.	Rheumatoid arthritis
E.	Systemic lupus erythematosus

Answer 38

D. Rheumatoid arthritis

Question 39

You are asked to see a 9 month-old male infant at the hospital outpatient clinic. His mother complains that his cheeks are “red and scaly.” She’s concerned that they are uncomfortable, since she’s noticed him scratching them. The rash has worsened since winter started, otherwise he is healthy. You diagnose him with atopic dermatitis.

Which one of the following conditions could also be part of his atopic syndrome?
A.	Food intolerance
B.	Hay fever
C.	Nut allergy
D.	Seborrheic dermatitis
E.	Urticaria

Answer 39

B. Hay fever

Question 40

Which of the following history features is most useful for determining risk of lower limb deep vein thrombosis (DVT)?
A.	Family history of cancer
B.	Major surgery two years ago
C.	Previously documented DVT
D.	Recent swelling of both legs
E.	Smoking status

Answer 40

C. Previously documented DVT

Question 41

Which of the following is a hallmark of the humoral immune response?
A.	Antibody antigen binding
B.	Antigen presentation
C.	Cell lysis by T cells
D.	Interferon production
E.	Phagocytosis

Answer 41

A. Antibody antigen binding

Question 42

Dual energy X-ray absorptiometry (DEXA) scans are often used when osteoporosis is suspected. Following a DEXA scan, a T-score is generated.

What is the T-score?
A. A measure of bone density, reported as mg Ca++ per cubic centimetre
B. A measure of the hardness of bone, reported as a ratio compared to the hardness of concrete
C. A standardised measure of bone density, reported in standard deviation units
D. A standardised measure of the risk of bone density, reported as a risk ratio

Answer 42

C. A standardised measure of bone density, reported in standard deviation units

Question 43

A 60 year-old farmer presents to your practice with a skin lesion. Your provisional diagnosis is a melanoma.

Which of the following clinical manifestations will support your diagnosis?
A. Asymmetrical lesion with irregular borders < 4 mm in diameter with a smooth surface
B. Asymmetrical lesion with irregular borders > 6 mm in diameter with bleeding on the surface
C. Symmetrical lesion with irregular border > 6 mm in diameter without bleeding on the surface
D. Symmetrical lesion with irregular borders < 4 mm in diameter with a smooth surface

Answer 43

B. Asymmetrical lesion with irregular borders > 6 mm in diameter with bleeding on the surface

Question 44

A 59 year-old woman, post-menopausal, who complains of feeling general fatigue and weakness over the past few months. She does not have a fever, denies any altered bowel habits and claims to eat a balanced diet. Her full blood count, blood smear and iron studies suggest iron deficiency anaemia.

Which of the following options is the most appropriate investigation to perform?
A. Blood and liver function tests to identify the presence of malarial parasites
B. Blood test and serology for autoantibodies and small bowel biopsy to identify coeliac disease
C. Faecal occult blood testing
D. Microscopic investigation of a stool sample to search for hookworm eggs and larvae

Answer 44

C. Faecal occult blood testing

Question 45

Maximal oxygen uptake (VO2 max) is a measure of aerobic fitness.

What VO2 max might be expected in an elite cross country skier?
A.	10 ml/kg/min
B.	30 ml/kg/min
C.	50 ml/kg/min
D.	80 ml/kg/min
E.	100 ml/kg/min

Answer 45

D. 80 ml/kg/min

Question 46

Different immune strategies are taken, based on the type of pathogen present.

Which immune cell type recognises virus-infected cells, based on the presence of virus antigen in Major Histocompatibility Complex 1 (MHC-1) molecules on the cell surface?
A.	Cytotoxic T cells (CTLs)
B.	Innate lymphoid cells (ILCs)
C.	Natural killer (NK) cells
D.	T helper (TH) cells

Answer 46

A. Cytotoxic T cells (CTLs)

Question 47

A 72 year-old male is brought into the Emergency Department by his wife because she is concerned that he has become confused. She describes frequent falls over the last few months. He started taking rivaroxaban (anticoagulant) for atrial fibrillation six months ago. Lately, he has also been clumsy when holding things with his left hand. You suspect an intracranial haemorrhage and arrange for a CT scan of the brain.
What sort of haemorrhage is most likely?
A.	Epidural
B.	Intraventricular
C.	Subarachnoid
D.	Subdural

Answer 47

D. Subdural

Question 48

Which of the following anticoagulation mechanisms is initiated directly as a result of damage to the vascular wall?
A. Release of endothelin
B. Release of noradrenaline (norepinephrine)
C. Release of serotonin
D. Release of thromboxane A2

Answer 48

A. Release of endothelin

Question 49

What is the mechanism of action of antihistamines?
A.	Full agonist
B.	Inverse agonist
C.	Neutral agonist
D.	Partial agonist

Answer 49

B. Inverse agonist

Question 50

What process follows formation of the bony callus in fracture repair?
A. Bone remodelling to convert to compact bone
B. Fibrocartilaginous callus formation
C. Formation of granulation tissue
D. Haematoma formation
E. Protein release from the callus

Answer 50

A. Bone remodelling to convert to compact bone

Question 51

A clot in which of the following would not be considered a deep vein thrombus (DVT)?
A.	Common femoral vein
B.	Great saphenous vein
C.	Popliteal vein
D.	Profunda femoris vein

Answer 51

B. Great saphenous vein

Question 52

What is the effect of hepcidin in the regulation of iron homeostasis?
A. It converts insoluble ferric (3+) iron into a soluble ferrous (2+) form to enable absorption by enterocytes
B. It increases the rate of haematopoiesis and RBC maturation in the bone marrow
C. It inhibits ferroportin resulting in reduced export of iron from enterocytes into circulation
D. It up-regulates transferrin receptor expression resulting in increased total iron binding capacity

Answer 52

C. It inhibits ferroportin resulting in reduced export of iron from enterocytes into circulation

Question 53

Antihistamines reduce allergic symptoms through a number of mechanisms.
Which action of antihistamines is most important in reducing vasodilatation?
A. Histamine 2 (H2) receptor antagonism
B. Reduced kinase activation
C. Reduced nitric oxide release
D. Reduced recruitment of immune cells

Answer 53

C. Reduced nitric oxide release

Question 54

Which of the following should raise a suspicion of primary immunodeficiency in an adult with no history of recent overseas travel?
A. A history of two upper respiratory tract infections in the previous year
B. An episode of cellulitis requiring intravenous antibiotics
C. An episode of pneumonia in the previous year
D. Three episodes of food poisoning in the previous year
E. Two episodes of ear infection in the previous year

Answer 54

B. An episode of cellulitis requiring intravenous antibiotics

Question 55

Which of the following pathologies is most likely to result in an extradural haemorrhage?
A. Disruption to a bridging vein between dura and arachnoid mater
B. Haemorrhage of the middle cerebral artery
C. Parenchymal injury
D. Rupture of a meningeal artery
E. Rupture of an aneurysm in the Circle of Willis

Answer 55

D. Rupture of a meningeal artery

Question 56

Intramuscular vitamin K given shortly after birth has been shown to prevent haemorrhage in the neonatal period for some infants at risk.
What underlying condition is being treated by vitamin K?
A. Endothelial fragility
B. Inactive prothrombin
C. Low Factor VIII levels
D. Low fibrinogen
E. Platelet dysfunction

Answer 56

B. Inactive prothrombin