Question 48  What is the most common cause of seizures in the elderly?  

A. Cerebral degeneration B. Trauma C. Infection D. Tumor E. Vascular disease

     Question 49  Which of the following seizure types has little or no alteration in conscious state?  

A. Petit mal B. Complex partial C. Simple partial D. Temporal lobe E. Febrile

 Question 50  Which of the following medications is most appropriate for treatment in stopping a grand mal seizure?  

A. Promethazine B. Diazepam C. Frusemide D. Morphine E. Prochlorperazine

Question 44.  Acute urinary retention maybe caused by all of the following EXCEPT  

A. Anticholinergic medication B. Benign prostatic hypertrophy C. Multiple sclerosis D. Seizures E. Sympathomimetic medication

 Question 45 Increased bleeding tendancy in patients with end stage renal disease is usually due to  

A. Decreased erythropoietin B. Platelet dysfunction C. Prolonged prothrombin time D. Thrombocytopenia E. Prolonged APTT

       Question 46  A 72 year man has left sided headache, left temporal scalp tenderness and a reduced temporal arterial pulse on palpation. Which pathologic test would be most useful?  

A. Full blood count B. Creatine kinase C. Erythrocyte sedimentation rate D. Glucose E. Arterial blood gas

 Question 47  What is the most common aetiology for seizures seen in adolescents?  

A. Idiopathic B. Infectious C. Metabolic D. Traumatic E. Toxicologic

Question 40.  Which of the following is most reliable in suspected rhabdomyolysis?  

A. Creatine kinase B. Low urea to creatinine ratio C. Serum potassium D. Proteinuria E. Troponin I

     Question 41  A 20 year woman presents to ED with urinary frequency and dysuria, the most appropriate first test is  

A. Full blood count B. Creatinine C. Blood culture D. Microurine E. Urethral swab

 Question 42  A urine dip stick test (urinalysis) may show a false positive result for blood in which of the following conditions?  

A. Renal calculus B. Rhabdomyolysis C. Urinary tract infection D. Prostatitis E. Chronic kidney injury

 Question 43.  A 70 year man with chronic kidney injury is found to have a sudden deterioration in his renal function, which is the following medications is least likely to contribute to this?  

A. Angiotensin converting enzyme inhibitors B. Frusemide C. Nitrate D. Nonsteriodal anti-inflammatory medication E. Amoxycillin

 

Question 38  

 The specimen shown here is from a nephrectomy done on a 5 year old child who presented with abdominal pain for 3 months. An abdominal CT showed a mass involving the left kidney. Which of the following is the most likely diagnosis?  A. Wilms tumour. B. Urothelial carcinoma. C. Renal cell carcinoma. D. Neuroblastoma. E. Rhabdomyosarcoma.        Question 39  A 65 year old man presents with a urinary tract infection. Urinalysis revealed leukocyte casts. The infection is within  

A. bladder. B. urethra. C. ureter. D. kidney. E. prostate.

   Question 37  

 This is a cystic kidney from a young child. What is the most likely diagnosis?  A. Acquired dialysis cystic disease. B. Autosomal dominant polycystic kidney disease. C. Autosomal recessive polycystic kidney disease. D. Cystic dysplasia. E. Medullary sponge kidney.

Question 35  Which is a risk factor for both renal cell carcinoma and transitional carcinoma of the renal pelvis and bladder?  A. Alcohol abuse. B. Dye industry job. C. Exposure to mercury. D. Tobacco smoking. E. Von Hippel-Lindau.        Question 36  Which of the following is the major mechanism responsible for the anaemia of chronic renal disease?  A. Haemolysis occurring during dialysis

B. Reduced iron intake due to anorexia

C. Reduced erythropoietin synthesis

D. Chronic haematuria  E. Shortened red cell survival due to uremia

Question 32  A ten year old boy presents with several days history of malaise and fever. His mother says that he has only passed a small amount of dark urine in the last 24 hours. His face is noted to be puffy. On examination he is found to be mildly hypertensive. About ten days ago he had a sore throat.  What is the most likely diagnosis?  A. Nephrotic syndrome  B. Post-streptococcal glomerulonephritis  C. Acute renal failure secondary to dehydration  D. Urinary tract infection  E. Goodpasture syndrome

     Question 33  Which of the following features would suggest that renal failure is chronic rather than acute?

A. eGFR 15 mL/min/1.73m2

 B. Small kidneys demonstrated on ultrasound  C. Metabolic acidosis and hypercalcaemia  D. Polyuria > 3 l/day  E. Normochromic normocytic anaemia        Question 34  Which of the following would you expect in a patient with acute renal failure?  A. Haematuria  B. Polyuria  C. Proteinuria  D. Nocturia  

E Oliguria

Question 29  Which of the following is the congenital renal abnormality most commonly recognised antenatally?  A. Hydronephrotic kidney  B. Horseshoe kidney  C. Duplex kidney  D. Pelvic kidney  E. Polycystic kidney  Question 30  Acute tubular necrosis may be caused by which of the following?  

A. Henoch-Schonlein purpure B. Nonketotic hyperosmolar coma C. Prostatitis D. Scleroderma E. Renal vein thrombosis

     Question 31  The sensations of bladder fullness and the desire to micturate are conveyed centrally by the  A. lateral spinothalamic tracts. B. anterior spinothalamic tracts. C. fasciculus cuneatus. D. fasciculus gracilis. E. spinoreticular tracts.

Question 26  Which of the following should be suspected in patients with bilateral Bell’s palsy?  

A. Embolic lesions B. Mercury poisoning C. Sarcoidosis D. Syphilis E. Tuberculosis

 Question 27  Which of the following terms best describes the mechanism by which fluid is removed by peritoneal dialysis?  A. Passive diffusion  B. Clearance  C. Countercurrent flow  D. Convection  E. Ultrafiltration        Question 28  A 35 year old man presents to the Emergency Department in great distress with severe left loin pain of sudden onset. He has no past history of note. He is restless and sweaty, and complains of nausea. On testing, blood is found in his urine.  Which of the following is the most likely diagnosis?

A. Ureteric calculus

B. Glomerulonephritis  C. Polycystic kidney disease  D. Urinary tract infection  E. Renal cell carcinoma

Question 23  Destruction of the right optic tract between the optic chiasma and the lateral geniculate nucleus results in  A. blindness in the right eye.  B. blindness in the right visual field of both eyes.  C. blindness in the left visual field of the right eye and the left visual field of the left eye.  D. blindness in the right visual field of the right eye and the left visual field of the left eye.  E. blindness in the left visual field of the right eye and the right visual field of the left eye.        Question 24  Opening of the upper eyelid occurs via the following muscle-nerve combination.  A. Levator muscle - cranial nerve VII (facial nerve) B. Levator muscle - cranial nerve III (oculomotor) C. Levator muscle - cranial nerve V (trigeminal nerve) D. Orbicularis muscle - cranial nerve VII (facial nerve) E. Orbicularis muscle - cranial nerve V (trigeminal nerve)

     Question 25  Which of the following is inconsistent with a diagnosis of Bell’s Palsy?  

A. Gaze paralysis B. Hyperacusis C. Loss of taste D. Loss of lacrimation E. Facial numbness

Question 21  Autopsy brain specimen showing a lesion in the circle of Willis.  

This would be likely to produce a  A. Duret haemorrhage. B. epidural haemorrhage. C. subarachnoid haemorrhage. D. subdural haemorrhage. E. subependymal haemorrhage.

     Question 22  Fine-needle aspiration biopsy has found its greatest usefulness in the examination of  A. adrenal incidentalomas. B. brain tumours. C. pituitary masses. D. suspected phaeochromocytoma. E. thyroid nodules.

Question 20  

 The best description for this lesion is a  A. Duret haemorrhage. B. epidural haematoma. C. haemorrhagic infarct. D. subarachnoid bleed. E. subdural haematoma.

 

Question 19  A 65-year-old man developed a progressively worsening headache and seizure attacks. A CT scan of the brain showed a tumour in the right parietal lobe. The pathology report is that of a tumour with an infiltrating edge, necrosis and vascular endothelial cell proliferation.  What is the MOST likely diagnosis for this lesion?  

A. Ependymoma.

B. Glioma.

C. Glioblastoma.  

D. Metastatic carcinoma.

E. Oligodendroglioma.

Question 16  A young man is brought into the Emergency Department by ambulance with a GCS of 8 (E2 V2 M4), BP 145/75, HR 135, Sats 95% RA and Temp 39.1.  Which of the following investigations is most likely to reveal the cause of this presentation?  A. ECG  B. Blood sugar level  C. Chest X-ray  D. Lumbar puncture

E. Full blood count

Question 17

Which of the following does NOT apply to multiple sclerosis?  

A. There is demyelination in the grey matter.  

B. Affects mainly women from about 20-50 years of age.      

C. Neurological symptoms and signs are variable.

D. May present with sudden impairment of vision.

 E. Symptoms usually disappear within days or weeks only to recur at a later time.

     Question 18  The pathological features of Alzheimer Disease does NOT include  

A. neuritic plaques.  

B. neurofibrillary tangles.  

C. narrowing of the cerebral sulci.  

D. amyloid deposition in blood vessels.

E. ventricular enlargement.

Question 14  A 52 year old woman presents with severe unilateral face and head pain. She describes it as excruciating stabbing pain triggered by cold air, or by simply washing her face. Which of the following tests would it be most appropriate to perform first?  

A. ESR  

B. MRI brain      

C. Plain XR skull  

D. Lumbar puncture E. Temporal artery biopsy

       Question 15  A 22 year old boy presents to the Emergency department with a mild head injury after an assault on the streets. CT head shows an extradural hematoma.  Which one of the following approaches is known to have the best prognosis?  A. Anticoagulation  B. Craniotomy  C. Conservative  D. Lumbar puncture  E. Focal radiotherapy

Question 12  A 66 year old man presents with severe headache.  Which of the following features indicates that urgent management is needed?  A. Severe nausea and vomiting  B. Watery eye  C. Abnormal neurological signs  D. Unilateral localisation  E. Sleep disturbance        Question 13  Which of the following patients is MOST at risk of a cerebral embolus?  A. A young man with congenital pulmonary stenosis  B. A patient with cancer and thrombophlebitis in the leg  C. Young woman on the OCP, after a long flight  D. A 45 year old man with rheumatic tricuspid regurgitation  E. A 68 year old man with a prosthetic aortic valve

Question 10  A 23 year old woman presents complaining of blurred vision since waking that morning. She had a similar incident the previous year, but it resolved spontaneously after a couple of hours. She is well otherwise, and has no headache. On questioning she admits to having had one bout of bladder problems (urgency and hesitancy) a few months ago, but says no bacteria were found in her urine. Which of the following is the most likely cause of her symptoms?  

A. Pituitary adenoma  

B. Cerebellar astrocytoma      

C. Sub-acute combined degeneration of the cord  

D. Multiple sclerosis  

E. Chronic viral encephalitis.      Question 11  Drugs are avoided in Parkinson’s disease until clinically necessary. Which of the following statements best describes the rationale for this strategy?  

A. Drugs do not alter the natural course of the disease.  

B. Distressing side effects such as nausea, vomiting, confusion and hallucinations are common, appear early, and affect compliance.

     

C. Medication is not subsidised by the PBS and the cost is a serious limiting factor for many patients in the age group.

 D. Stereotactic surgery is less successful in patients who have used medication

for Parkinson’s disease for a number of years.      

E. Efficacy falls off and major distressing and irreversible side effects can appear after several years’ treatment.

Question 8.  The organism most commonly isolated from burn wounds is  

A. Staphyloccus aureus  

B. Pseudomonas aeroginosa

C. Streptococcus pyrogenes

D. Bacteroides fragilis

E. Proprionibacterium acnes      Question 9  A young man is brought into the Emergency Department by ambulance with a GCS of 8 (E2 V2 M4), BP 145/75, HR 135, Sats 95% RA and Temp 39.1.  Which of the following investigations is most likely to reveal the cause of this presentation?  A. ECG  B. Blood sugar level  C. Chest X-ray  D. Lumbar puncture  E. Full blood count

   Question 5  Which of the following organisms would be MOST likely to be considered a contaminant if grown from a blood culture?  

A. Coagulase negative staphylococci  

B. Corynebacterium spp  

C. Bacillus spp  

D. Proprionibacterium acnes  

E. Enterococcus faecalis      Question 6  Why would infections of the scalp give rise to encephalitis?  

A. Skin in the scalp is thin.  

B. Abundant sebaceous glands on the scalp.

C. Presence of emissary veins in the scalp.

D. The epicranial aponeurosis lacks a bony attachment.  

E. The pericranium is fused with the sutures between the skull bones.      Question 7  Shock in burn patients is primarily due to  

A. Neurogenic factors  

B. Hypovolemia  

C. Acute haemolysis  

D. Myocardial depression  

E. Associated haemorrhagic injuries

 

Question 3  The resistance of various strains of bacteria to beta-lactam drugs is of increasing concern due to the lack of efficacy of a number of antibiotic drugs in treating the diseases they cause. A mechanism through which bacteria DO NOT acquire and exhibit resistance to beta-lactams is  

A. acylation of the beta-lactam ring caused by an overexpression of bacterial beta-lactamases.

 B. changes in bacterial cell wall porins which alter drug influx.

 C. expression of a bacterial enzyme which modifies the pentapeptide involved in cell wall peptide cross-linking.

 D. production of modified penicillin binding proteins with poor affinity to beta- lactams.

 E. acquisition of a bacterial plasmid via conjugation from a neighbouring resistant bacterial cell of a different strain.

 Question 4  A patient suffering from a serious cryptococcal meningitis infection is administered a lipid formulation of amphotericin B. The molecular actions of this drug on target fungal cells involve  

A. increased expression of toxic sterols following binding to fungal cell membrane porins.

 B. formation of pores in fungal cell membranes leading to leakage of intracellular contents.

 C. direct inhibition of squalene epoxidase, thereby reducing intracellular lanosterol concentrations .

 D. blockade in the formation of ergosterol by inhibition of cytochrome P450 51.

 E. preferential binding to fungal cell membranes which causes cell clumping and cell death.

Question 1  Which of the following organisms would be LEAST likely to be considered a contaminant if grown from a blood culture?  

A. Coagulase negative staphylococci  

B. Corynebacterium spp  

C. Bacillus spp  

D. Proprionibacterium acnes  

E. Enterococcus faecalis  Question 2  With respect to the structure of the spleen, which of the following is correct?  

A. The white pulp is the myeloid component of the spleen and is responsible for immune function.

 B. The germinal centre is composed of numerous T lymphocytes and rare B lymphocytes.

 C. The red pulp is composed of vascular sinuses and is responsible for the filtration function.

 D. The mantle zone is composed predominantly of T-lymphocytes.

 E. The marginal zone is composed of B-cells only, and is the site of antigen trapping.