Remembered Questions 2002

1
Patient with surgery for transposition of great vessels with surgery 20 years ago. ECG shown:

RBBB RVH Axis in degrees

a Present ? +140
b ? ? +120
c Present Present +240
d Absent ? +240

11
Population prevalence of renal disease in natives 30%. Specificity
80%, sensitivity 85% of predicting renal disease with dipstick urine test.
Reads protein 1+ in 50 yr old man with BP 140/90 and normal fasting glucose.
Next best investigation is:
A) MSU (urine miscroscopy)
B) 24 hr urine protein
C) Repeat fasting urine protein dipstick
D) Urine prot:cr ratio
E) renal biopsy

12
Pt with visual field defect who is an epileptic on meds. Which is
responsible for SE?
A) Gabapentin
B) Sodium valproate
C) Vigabatrine
D) Lamotrigine
E) Phenytoin

17:
Preamble about a drug. Then a curve is shown. This is a repeated Q. The curve is a
anticlockwise hysteresis e.g. digoxin. What is the reason for this behaviour:

a) Irreversible binding to its receptor

b) Bioavailability
c) The metabolites are not active
d) Down regulation of receptors
e) Delayed distribution of the drug to its site of action (Correct)

18:
A patient is admitted to hospital on an infusion of morphine at 4 mg/hr. You want to change this to
oral slow release morphine. The equivalent oral dose is:

a) 25mg BD
b) 50mg BD
c) 100mg BD
d) 200mg BD
e) 400mg BD
29
Which one of the following alleles best describe maternal “uniparental disomy”:
Maternal Paternal
(a) 0 0
(b) 1 1
(c) 1 2
(d) 2 0
(e) 2 1

30
25 year old man developed foot drop (didn’t state right, left, bilateral). Gives 2/7 history of
squatting while laying tiles on his verandah. What is the most likely diagnosis?
(a) multifocal motor neuropathy
(b) L5 root lesion
(c) acute inflammatory demyelinating neuropathy
(d) sciatic nerve lesion
(e) peroneal nerve lesion

49
Dendritic cells of langerhan are involved in antigen presentation. Which of the following is least
important in immune function of dendritic cells:
a) migration of langerhan cells to lymph nodes
b) upregulation of MHC I molecules
c) upregulation MHC II molecules
d) upregulation of costimulatory molecules.

50
What is the cause of excessive daytime sleepiness in a patient with obstructive sleep apnea:
a) fractionated sleep at night
b) reduced total slow wave sleep
c) poor quality of non REM sleep
d) day time hypercapnia.

51
Which of the following best describes the role of DNA polymerase in PCR:
a) splitting of single strand and primer
b) doubling of double stranded DNA

58
A middle aged man with bilateral acoustic neuromas
with a positive family history has them excised. The
following is a southern blot from the tumour and his
blood with a normal control for nf2 gene

normal blood tumour

__ __ __

__ __
__ __
__ __ __

This is best explained by

a Loss of abnormal allele from his blood
b Loss of abnormal allele from the tumour
c Doubling of the abnormal allele in the tumour
d Loss of normal allele from his blood
e Loss of normal allele form the tumour

59
When given an IV bolus of lignocaine, the plasma
concentration is lower than would be expected from the
elimination half life. Why?
a) Increased renal clearance
b) Self up regulation of metabolism
c) Rapid distribution to adipose tissue
d) Increased protein binding
e) First pass metabolism.

63
78 yr old lady with known breat cancer + bony mets. On slow release
morphine. Having increasing pain in left hip. Referred to hospital and
admitted for further investigation. In the meantime the best pain management
is
(a) Change morphine to tramadol
(b) Change morphine to oxycodone
(c) Increase morphine dose
(d) Decrease morphine and add panadeine
(e)??

64
I can't remember the exact wording for this question but it is a
repeat one about mode of action of B lactam...
(a) AUC/MIC
(b) Time/MIC
(c) AUC
(d) AUC/Time
(e) ??

69
Randomized controlled trial for COPD patients to stop smoking. Intention to treat analysis bias
due to:

a) bias which overestimates effect

b) bias which underestimates effect
c) selection bias
d) bias secondary to outcome studied
e) known and unknown confounding factors

A 35 year old man admitted with malena. All bloods normal except Hb 64. Transfused 3U RBCs.
After 5 minutes of 3rd unit feels unwell with chills, rigors, fever and hypotension. Most likely
cause:

a) bacterial contamination of blood

b) transfusion related graft versus host reaction
c) citrate toxicity
d) reaction to citrate in transfusion bag

4
Forty two year old woman, type 2 diabetes for four years, on oral hypoglycaemics. Treated H
pylori ulcer (according to serology). Acute vomiting. Erect AXR (air fluid level in stomach only)
Air through to rectum.

a) gastroparesis
b) volvulus
c) small bowel obstruction
d) perforation

5
Woman with Alzheimers on Danpezil. Which will be LEAST likely effect

a) improvement in memory
b) improvement in ADLs
c) improvement in visuospatial
d) improvement in social interaction
e) no improvement past three months

9
The mechanism of antibiotic resistance by Vancomycin resistant Enterococci is:
a) altered cell wall binding of Vancomycin
b) increased production of beta lactamases
c) increrased metabolism of Vancomycin
d) induced cell pump decreasing intracellular Vancomycin concentration

10
Regarding cancer patients in a trial of a new drug. The reason informed consent is important is
a) Nonmalificence
b) Beneficence
c) Autonomy
d) Justice
e) Egalatariansim

19
The most specific for SLE is
(a) Anti RNP
(b) Anti Sm
(c) Anti dsDNA
(d) Anti centromere
(e) Anti Ro

20
A 54 yr old man who presented to his GP for routine investigation and
was found to have platelets of 78. Asymptomatic. Physical examination was
normal except for an enlarged spleen. No lymphadenopathy was noted. Other
bloods FBC/U+Es/LFTs/Coags normal.
2 cuts of CT abdomen shown. Don't really know what it showed...a few of us
seem to think there was some funny calcification kinda on the right,
anterior to the liver. Liver looks normal. Spleen enlarged but normal
echogeneity. Bowel also looks normal. Pancreas also normal?

Further little hx about this man...beaten up when he was a child. Admitted

to hospital for few days and was old that he had some "pancreatic problem"

Most likely diagnosis is

(a) SLE
(b) CML
(c) Splenic vein thrombosis
(d) Budd Chiari
(e) Pancreatic pseudocyst

21
Another repeat question. Long story about 55 yr old man who presented
with petechiae rash and gum bleeding. Etc etc Blood film very clearly showed
Auer rod. Best treatment is
(a) Chorambucil
(b) Chemotherapy
(c) Hydroxyurea
(d) ATRA
(e) Prednisone

28
Picture of R hand Xray. Middle-aged diabetic man presents with arthritis R hand.

a) haemochromotosis
b) gout
c) osteoarthritis
d) rheumatoid arthritis
e) hyperparathyroidism

29
Man with colonic Crohn’s disease on Prednisone. Which of the following would maintain in
remission:

a) prednisone
b) azathioprine
c) sulfasalazine
d) cyclosporin

30
Middle-aged woman referred with abnormal blood tests. Her mother had hypercalcaemia not
cured with parathyroidectomy. Bloods: Ca 2.5, Parathormone n, Phosphate n. Next best
investigation:

a) Sestimibi scan
b) Bone scan
c) 24 Urine Ca levels
d) Parathyroid scan / neck scan

43
What is the role of naltroxane in the treatment of opoid addiction:
a) reduces opiate induced euphoria
b) increases toxic effect of opiates
c) decreases tolerance
d) improve withdrawal symptoms
44
55 yo male wheat farmer with recurrent calcium oxalate stones. Normal serum creatinine,
calcium, urea and oxalate. Hyperuricosuria, huypercalciuria. Which is the least likely form of
treatment to be of benefit?
a) Low calcium diet
b) Allopurinol
c) Increased fluid intake
d) Thiazide diuretic
e) Alkalinising urine.

58
An old lady falls over and gives her self a subdural.
They plan to take her to theatre for evacuation of the
clot. She is on warfarin for AF and an un-named
antibiotic.
Blood results
FBC and UE normal
INR 6.0
APTT 58 I think, it was definitely above normal range
Fib 2.6
As well as vit k she should have
A FFP
B Cryoglobulin
C F VIII concentrate
D Platelets
E packed RBC

59
A 20 something man with tonsillitis. T 38.7. Given
erythromyin. Next day he is noted to be mildly
jaundiced. Abdo exam is unremarkable.
His bloods show
FBC wcc 18.7 normal differentiation
HB and platelets normal
U&E normal
LFT bili 78 otherwise all within normal range Not
given coags.
Most likely cause is
A EBV
B Erythromycin
C Haemolysis
D Wilson's
E Gilbert's

70
25 year old man presenting with malaise and epistaxis. No history of recent infection or trauma.
Not on any medications and no exposure to toxins.
O/E: pale, not icteric, no lymphadenopathy. There are ecchymoses and a purpuric rash. No
organomegaly.
Investigations: Hb 67, MCV 102, plt 12, WBC 1.4, neutrophils 0.2 (and low lymphocytes and
eosinophils)
Tests for B12 and folate are normal. Bone marrow aspirate is a bloody tap. Trephine (picture)
shows hypoplastic/aplastic marrow. Which one of the following treatments modalities carries the
best prognosis for this patient?
(a) chlorambucil
(b) allogeneic bone marrow transplant with HLA matched sibling
(c) antithymocyte globulin
(d) ?cyclosporine
(e) high dose cyclophosphamide

71
Which of the following features best differentiate inclusion body myositis from polymyoisitis:

a) wasting of deltoids
b) quadriceps wasting
c) bilateral ptosis
d) trunk weakness
e) weakness of long finger flexors

76
57 year old female, no previous history. One hour chest pain.
ECG1: 6mm ST elevation inferior and lateral leads, given streptokinase, further pain with repeat
ECG at 2 hours:
ECG2: ST elevation as above with extension to reciprocal anterior lead ST depression.
O/E: BP 75/60, UO 10mLs/hr. What will improve survival?

a) IV fluids
b) Coronary stent
c) TPA
d) G2b/3a inhibitor
e) Intra-aortic balloon pump

82;
A 58 year old man with a 20 year history of sleep disordered breathing (?) undergoes a sleep
study. He has a BMI of 38 kg/m2.
On the study 82 hypopneas/apnoes are recorded and 75 arousals noted (This data is given in
words). He is more at risk than a normal member of the population without this disorder of:

a) Stroke
b) Motor vehicle accident
c) MI
d) Hypertension
e) Hypothyroidism

83: repeated question

A 60 year old man with chronic history of gout on warfarin INR 2.5. He has recently had an
increase of his allopurinol to 200mg OD. He presents with acute synovitis in his left ankle.
His serum urate is 0.49 and his creatinine is 0.16 (chronic).

What is the most appropriate management:

a) Stop the allopurinol and start colchicine at 0.5mg TDS

b) Continue the allopurinol and commence prednisone 20mg OD
c) Reduce the dose of the allopurinol and commence a COX II inhibitor
d) Continue the Allopurinol and start a NSAID (indomethacin 25 mg TDS)
e) Stop the allopurinol and commence prednisone.

(The answers are not absolutely correctly remembered, and past versions differ except for the
stem and the lab values. Therefore just be primed for the case with best treat scenario)
88
Which is most likely to lead to suicidal ideation in an elderly person
with cancer?
A) Advanced stage of disease
B) Poor family support
C) Pain
D) Current major depression
E) Past psychiatric history

89
36 yr old female with 3 month history of L arm weakness and gradual
speech disturbance presents with following CT head scan: (Non-contrast scan
showing large white round mass in R frontal area with central dark area).
This is likely to be:
A) Astrocytoma
B) Oligodendrocytoma
C) Glioblastoma multiforme
D) Meningioma
E) Primitive neuroectodermal tumour (PNET)

90
A 25 year old man. No previous history of ill health. Presents following episode of nausea and 1x
vomit of fresh haematemesis. No other symptoms. Smokes 10-15 cigarettes/ day and alcohol
120g/day. PR examination reveals soft brown stool. No blood. The most likely diagnosis is:
a) Mallory-Weiss tear
b) Gastric Ulcer
c) Duodenal Ulcer
d) Oesophageal Varices

91
The most common sign with Bechets syndrome is:
a) recurrent mucositis
b) recurrent genital ulcers
c) anterior uveitis
d) skin rash
e) Pathergy

100
A 63 year old man presents with 2 month history of dry non-productive cough. He has a
background of heart disease and medicines include propanalol, aspirin, amiodarone, simvistatin.
ESR 105. Examination : bilateral creps, JVP +2cm, Lung function tests show decreseld DL CO.
CXR: ?bilateral interstitial change. Most likely cause is:
a) Amiodarone toxicity
b) CFA
c) Heart failure
d) Lung cancer

Repeated questions / stems from 2001 remembered papers

What is the best measure of success of a cancer surveillance program?

a) increased case detection rates

b) improved cancer-specific survival
c) improved survival duration post diagnosis
d) improved community awareness of the cancer

A Doppler echo tracing is shown, indicating that it is across the mitral valve. What does it
represent?

a) MS
b) MR
c) AR
d) AS
e) Severe pulmonary hypertension

A 60 year old man with a 20 year history of type 2 diabetes and hypertension for ten years, now
presents with a CN palsy with the pupil spared and a mild increase in the ESR. Diagnosis is most
likely to be?

a) Diabetic third nerve palsy

b) Giant cell arteritis
c) Midbrain infarct

A 54 year old man presents with dyspnoea which has been a grumbling subacute problem. He
also had surgery for grommet placement. His CXR is shown. There are multiple densities within
both lung fields, which appear to be cavitating. Next step in management would be:

a) ZN
b) ANCA
c) FNAB of one of the lesions
d) HRCT chest

A 55 year old woman presents with back pain. She had been carrying the bags of sand again.
Xray reveals fracture and lyticl lesions of vertebral body. Serum EPG negative. What is the next
appropriate investigation?

a) Bone scan
b) Urine EPG
c) Biopsy
d) FSH

A long history if given related to an elderly male who has had increasing confusion and visual
disturbance. He is found to have Hb 68 and a kappa paraproteinaemia of 60g/L. Fundoscopy
reveals engorged retinal veins. He needs:

a) transfusion of red packed cells

b) plasma exchange
c) prednisone and melphalan
d) observation
e) fludarabine

Who is most likely to become a chronic HBV carrier when given no immunization?
a) 2 year old bitten by carrier
b) baby who is infected vertically
c) needlestick to a medical student
d) 50 year old who acquired Hep B from sexual contact

A concept which surfaces in studies is that of the number needed to treat. In a study of
asthmatics, there is a 50% improvement in the study group who learns to self treat at home: 10%
of the control group and 5% of the treatment group require hospitalization. What is the NNT?

a) 1
b) 2
c) 20
d) 50
e) 100

A 30 year old woman with bipolar disorder on Li and corrected hyperthyroidism. Galactorrhoea
and amenorrhoea evident. She takes thyroxine, metaclopramide prn, lithium. Blood test: high
prolactin. What is the most likely cause of the high prolactin?

a) Lithium
b) Hypothyroidism
c) Oral contraceptive
d) Metaclopramide
e) Pitiuitary adenoma

A girl on antiepileptics can’t see as well as before. Which drug is she maybe on?

a) Lamotrigine
b) Vigabatrin
c) Carbamezapine
d) Gabapentin
e) Valproate

COX-2 activity is greatest in...

a) platelets
b) OA knee
c) Rheumatoid knee
d) Stomach
e) Endothelium

Which is the most potent stimulus to aldosterone secretion?

a) ACTH
b) High K+
c) High ANP
d) High ATII
e)
Long preamble on the origin of T lymphocytes. Where would you find the most cells that are both
CD4+ and CD8+?

a) lymph nodes
b) blood
c) bone marrow
d) spleen
e) thymus

The main cause of death more than six months post transplant?

a) CAD
b) Rejection
c) Opportunistic infection
d) CCF
e) Neoplasia

AXR with dilated loops, worse on the right. Air in rectum and SI, likely diagnosis:

a) Pseudo obstruction
b) Sigmoid volvulus
c) Ca at splenic flexure
d) Faecal loading

What is the least likely renal pathology to occur with Cyclosporin use?

a) tubulitis
b) vasoconstriction
c) glomerular pathology

A table is given in which the volume of distribution and half life is given of 5 drugs. You can
determine the most rapid clearance.

An old fellow with a history of prostatic carcinoma has PSA of 576 and a bone scan is shown with
a million mets. Best treatment?

a) Total androgen deprivation

b) Panadol
c) NSAID
d) Pamidronate not given as option

A Thai woman has menorrhagia and her plumbing checks out OK. She still has a low Hb 110,
and MCV 70, with ferritin and serum iron at the low end of normal. HbA2 is normal and a film
shows HbH inclusions. Most likely diagnosis:

a) Iron deficient
b) Homozygous for alpha nought
c) Beta thalassemic
Other 2002 recalls
Ankylosing spondylitis, first change in spine:

a) Thoracic
b) Thoracolumbar
c) Cervical
d) Lumbar

Patient with sepsis, treated with antibiotics, oliguric, urine output less than 5mls per hour,
hypotensive. Next best step:

a) Frusemide
b) Dopamine at renal doses
c) Adrenaline
d) Hydrocortisone

Indigenous man, middle-aged, from population with 30% renal disease, BP high, no diabetes,
proteinuria + (sensitivity and specificity 83%). Next step:

a) 24 hour urinary protein

b) renal biopsy
c) albumin: Creatinine ratio
d) urinary microscopy
e) repeat the test

Most common cause for suicidal ideation in terminal Cancer patient

a) pain
b) depression due to Cancer
c) past psych history
d) cancer
e) poor carer support

40 year old man presenting with chest pain. ECG to be interpreted: wide complex tachycardia,
irregular, (AF with aberrancy vs VF ?) BP 90/60 ?Treatment

a) Amiodarone
b) Cardioversion
c) Thrombolysis

Young girl with “fits” on waking up in mornings on no medications, and her ECG is opposite, at
time of attack. ECG: brady 30 bpm ?QT prolongation, not WPW. Separate rhythm strip showed
wide complex : ? Torsades des Pointes. How to treat:

a) Implantable defibrilator
b) Amiodarone
c) Beta blocker
d) Atrial Pacemaker

Man with tonic clonic seizure. Has had two month history of deja vu (description of partial or
absence seizures ? ). EEG to interpret: (?spikes in frontal region bilaterally). What is the
diagnosis:
a) Temporal lobe epilepsy with cavernous hemangioma
b) Temporal lobe epilepsy with abcess
c) Frontal lobe epilepsy

Patient is pregnant, her sister had child with congenital heart block. Which test would you
perform:

a) Anti Cardiolipin antibodies

b) Anti endomysial antibodies (Ro)
c)

Peritoneal Dialysis patient, on 4.5% Dextrose bags, c/o abdominal pain, JVP not elevated, how to
check adequacy of dialysis.

a) sCreatinine
b) sPotassium
c) CAPD bag adequacy exchange test !!

Started on ACE-I, Cr 0.09 to Cr 0.1? (slightly abnormal), how to monitor renal function:

a) serum Creatinine
b) Creatinine clearance
c) Renal ultrasound
d) Renal biopsy

Mutation most likely to cause disruption in protein production

a) Mis-sense
b) Nonsense
c) Transversion
d) Splice-site

Old man with flare of gout, renal impairment Cr 0.16 to 0.18 while on Allopurinol 200mg od, also
therapeutic on Warfarin. Uric acid 0.49

a) Same Allopurinol plus Prednisone 20mg od

b) Decrease Allopurinol to 100mg od plus add COX-2 inhibitor
c) ? Allopurinol plus Colchicine
d) Increase Allopurinol
e) Indomethacin

Most sensitive way to detect gallstones:

a) ERCP, Dye study

b) MRI
c) CT
d) Ultrasound
e) Xray
Question – repeated Pharmacology
Morphine (4mg per hour), convert to oral, old question

Question – repeated Pharmacology

Phenytoin loading dose, how long to steady state?

Question – repeated Pharmacology

Warfarin with Erythromycin added, what happens to Warfarin re bioavailability and clearance

Brain abcess. How to treat?

a) Vancomycin and Rifampicin

b) Ceftriaxone and Metronidazole
c)

Bee Sting allergy immunotherapy, what is least likely to happen:

a) IL 10
b) Produces blocking antibodies to Bee sting venom

repeated
A couple want to have a baby but are both known to have thalassemia in the family. What would
be the most favourable combination of genes ot have with regards to fetal outcome?

a) no betas
b) a beta with an e
c) an alpha-0 with a beta
d) no alphas

Known Rheumatoid arthritis on Methotrexate and Prednisone 7.5mg od, came for review with
swelling or MCP joints and early erosions in 2nd and 3rd PIPJs. Xray now (both shown, not much
change, no dislocation or progression of erosions). Options for treatment:

a) Increase Prednisone to 15mg od

b) Decrease Prednisone to 5mg
c) Add Lefunamide

Woman with cancer, CT slice for interpretation: large pericardial + R sided pleural effusion
(small). Treatment:

a) Pericardial tap
b) Pleural tap

Why use Leukocyte depleted red cell transfusions: reduces likelihood of:

a) CMV
b) Hepatitis B
c) Malaria
d) Anaphylaxis

Man with bone marrow transplant from brother. Eight days or weeks later has abnormal LFTs. ?
cause

a) GvH disease

Man with NSCLC. Renal impairment. Surgery. PCA with pethidine. Develops twitching,
seizures.

a) Stroke
b) Secondaries
c) Hypercalcaemia
d) Pethidine metabolites

NSCLC stage 3a. Treatment options including

a) Chemo before surgery

b) Pneumonectomy

Patient with IHD going for PTCA, his creatinine is 0.18, what is the
most helpful measure to avoid deterioration of his renal function?

a) Postpone the procedure.

b) B-IV saline.
c) C- frusemide

32 years old pregnant women developed RUQ abdominal pain. on examination

she has an enlarged liver, her LFT are all raised, MSU ++ proteins, what is
the most likely cause?.

a) Acute fatty liver of pregnency.

b) B- Preeclampsia.
c) C- Cholestatic hepatitis

Hand Xray. Calcification of the triangular ligament. Dialysis patient. Cr 0.49. Most likely
diagnosis?

a) amyloidosis
b) hyperparathyroidism
c) old age
d) OA

Which vessel is Takyaschu’s (vasculitis) most likely to affect?

a) aorta
b) coeliac axis
c) cerebral circulation
d) coronary arteries

Most common cause of impotence in 70 year-old males?

a) psychological
b) testosterone deficiency
c) vascular
d) neurological

Patient with IHD going for PTCA, creatinine is 0.18, what is the most helpful measure to avoid
deterioration of his renal function?

a) Postpone the procedure

b) IV saline
c) frusemide

32 year-old pregnant women developed RUQ abdominal pain. O/E: hepatomegaly. LFTs all
elevated. MSU ++ protein. What is the most likely cause?

a) Acute fatty liver of pregnancy

b) Preeclampsia.
c) Cholestatic hepatitis