via practice paper 2010

7/23/2019 Via Practice Paper 2010

1/26

MED 2042

MEDICINE

PRACTICEASSESSMENT

VIA Practice Paper

Monday , 20th October 2010

Read ing t ime: 10 mins

Wri ting t ime: 80 m ins

Feedback answers : 25 mins

The aim of this practice Vertically Integrated Assessment is to give you an indication of the types of

questions that may be asked in the VIA. We will display the correct responses after completion of

the paper to give you an indication of your performance. There are few SAQs in the paper due to

time constraints. Theme I and II content is somewhat under represented.

Please indicate your answers on this paper by circling the correct response. You will mark your paper

based on the correct answers provided.

It is unlikely that any of the questions in this paper will feature in summative assessments. Never the

less we require that you return the paper to us on exit from the lecture theatre.

Score out of 75 /_

Borderline Score = 37.4 (49.8)

Page

of

25


2/26

MCQ 1

A 50-year-old man is diagnosed with ischaemia of the ascending colon. The artery involved is

most likely to be a branch of the:

a.

Left colic artery

b. Inferior mesenteric artery

c. Superior mesenteric artery

d. Upper sigmoid arteries

e. Coeliac trunk

Scenario Two

Christy, aged 24, was aware from the time of her ultrasound examination at 18 weeks gestation that

her baby was lacking some neural arches and would probably be affected by a spinal defect but,

after counselling, she decided to continue with the pregnancy. Now, 17 weeks later, she is having

labour pains but her obstetrician tells her the baby's head has enlarged to the extent that a vaginal

delivery will not be possible. Christy is admitted to hospital immediately and her uterine activity is

monitored. The next day, her uterine activity has increased and her obstetrician delivers the 3 kg

baby by caesarian section. The baby has a bulge over the lumbar spine but the skin is intact.

SAQ1

2 marks

What is the likely cause of the baby's head enlargement? Give the name ofthe condition and

identify what has accumulated excessively and where it is mainly located.

Page 2 of

25


3/26

SAQ2

3 m ark s

How would you maximise the understanding and retention of information provided to Christy and

her husband? (List

TH RE E 3

points)

Page 3 of

25


4/26

Using the image above, match the most appropriate labels to the following descriptions:

MCQ 2. Has appendices epiploicae

MCQ 3. Has circular folds

MCQ 4. Has the falciform ligament attached to it

Page 4 of 5


5/26

MCQ

5. A 50 year-old man presents with left hypochondria I pain. Examination reveals an enlarged

spleen. Of the following, the most l ikely diagnosis is:

a. Left heart failure

b. Coeliac trunk obstruction

c. Superior mesenteric vein obstruction

d. Portal hypertension

e. Thoracic duct obstruction

MCQ 6 A fit and well 80 year-old woman presents with central abdominal discomfort, but no pain.

Examination reveals marked lumbar lordosis with a pulsatile midline mass in the umbilical region.

The mass is most l ikely:

a. An abdominal aortic aneurysm

b. A renal artery aneurysm

c. A superior mesenteric artery aneurysm

d. Tortuous normal aorta

e. Lumbar spine metastases

MCQ

7

A

25

year-old known intravenous drug user presents with fever and shortness of breath.

Bacterial endocarditis (heart valve infection) is diagnosed. The jugular venous pulse shows large

svstolic waves that are palpable. This indicates that the most likely diagnosis is:

a.

Pulmonary stenosis

b. Tricuspid stenosis

c. Pulmonary embolus

d. Tricuspid regu rgitation

e. Pulmonary regurgitation

Page of 25


6/26

MCQ 8. When examining the second heart sound, the best method to use is:

a. The bell at the mid-left sternal edge

b. The bell at the mid-right sternal edge

c. The diaphragm at the mid-left sternal edge

d. The diaphragm at the mid-right sternal edge

e. Either the bell or diaphragm at the mid-right sternal edge

MCQ 9. A 50 year-old man presents with drooping of the left upper eyelid. On examination, the pupil

is contracted on that side. Palpation reveals dry skin on the left side of the face, which also appears

slightly flushed. The pathology causing these symptoms is most l ikely to be discovered by examining

the:

a. Third, fourth

sixth cranial nerves

b. Fifth cranial nerve

c. Seventh cranial nerve

d. Cranial cavity

e. Thorax

MCQ 10. A 60 year-old woman presents with shortness of breath. On examination, vocal resonance

is increased. This is most consistent with:

a. Pneumonia

b. Cardiac failure

c.

Apical tumour

d.

Pneumothorax

e.

Pleural effusion

Page 6 of 25


7/26

MCQ 11

A 60 year-old administrative assistant presents with a lcm lump in her left inguinal region.

Statistically, this is most likely to be a:

a. Femoral hernia

b. Direct inguinal hernia

c. Indirect inguinal hernia

d. Saphena varix (dilation of the great saphenous vein)

e. Lymph node

MCQ 12

You are the night intern on call. A 60 year-old woman (whom you are not familiar with) is recovering

from a hip operation and she would like to know what operation was performed and why. The pre-

operative films are not available, just a post-operative film (above). Of the following, the best

answer to her questions would be to explain to her (in simple terms) that she has had a femoral

head replacement due to a femoral fracture that was:

a. Subcapital

b. Impacted

c. Trochanteric

d.

Subtrochanteric

e. Undisplaced

P age 7

of

25


8/26

MCQ 13 A patient presents with ischaemic foot ulcers and is found to have absent foot pulses. An

angiogram is performed (see image). The artery that is obstructed is the:

a. Femoral

b. Popliteal

c. Anterior tibial

d. Posterior tibial

e. Peroneal

MCQ14

Page 8 of

5


9/26

A 60 year-old smoker is sent to Emergency by her GP. She saw the doctor for her shortness of

breath. The patient has brought the above x-ray with her. The percussion note that you would

expect to find when examining the abnormal area is:

a. Stony dullness

b. Moderate dullness

c. Normal

d. Moderately increased resonance

e. Hyper-resonance

MCQ 15. A 65 year-old woman with hypertension has signs of a stroke. Her speech is non-fluent,

enunciation poor and words are produced with great effort. Sentences are short and she omits

words such as the and and . However, she understands much of what she is asked.

Which ofthe following diagnoses is

most consistent

with her speech problem?

a. Cerebellar ataxia.

b. Expressive aphasia

c. Wernicke's aphasia

d. Sensory aphasia

e. Parkinson's disease

MCQ 16. It is noticed that the patient whose history is given above, also has facial weakness on the

right with obvious muscle drooping.

Which of the following components of the motor system is most likely to be the cause her facial

weakness?

a. Facial nerve

b. Basal ganglia

c. Cerebellum

d. Motor relay nuclei of the thalamus

e. Primary motor cortex

Page 9 of 25


10/26

MCQ 17.

In a patient with speech difficulties and facial weakness, the artery most

likely

affected is

the:

a. Anterior cerebral

b. Middle cerebral

c. Posterior cerebral

d. Internal carotid

e. Basilar

MCQ 18.

An eighty year-old woman with known left hip osteoarthritis has an abnormal

Trendelenberg test. This is most likely due to pain inhibiting the action of the:

a.

Left gluteus maximus

b. Right gluteus maximus

c.

Left iliopsoas

d.

Right iliopsoas

e. Left gluteus medius

MCQ 19.

A 65 year-old woman is diagnosed with a venous (stasis) ulcer on her left ankle. Of the

following, these ulcers

most l ikely

occur due to:

a. Increased arterial pulsation and flow

b. Poor transfer from deep to superficial veins.

c. Thrombophlebitis

d. Incompetent perforator veins

e. Lack of gravity

Page

1 o f 25


11/26

MCQ 20. An 80 year-old woman has had to stop ballroom dancing because of the pain of

osteoarthritis in her hip. She has vivid dreams about dancing, and feels wonderful until she wakes

up. Her dreams:

a. indicate that she suffers from an ongoing psychological illness

b. are a good example of abnormal illness behaviour

c. would be considered as 'parasitic modes' in Freudian (Psychoanalytic) theory

d. are most likely to occur during paradoxical or

R

sleep

e. probably result from altered consciousness produced by her medications.

MCQ 21. Complete the following sentence. The amygdala is crucial in the activation of the stress

response because:

a. It stores memory.

b. It regulates decision-making.

c. It initiates the fear response.

d. It releases oxytocin.

e. It regulates the adrenal gland.

MCQ 22. The main reason that chronic stress can lead to poor resistance to infection is because of:

a. An increase in gamma interferon levels.

b. A reduction in immune cell numbers.

c. An increase in interleukins.

d. A reduction in immune cell function.

e. An increase in cytokines.

Page

of 25


12/26

MCQ 23. Which of the following is a risk factor for the later development of dementia?

a. Physical exercise

b. Diverse leisure activities

c. Passive leisure activities

d. Marriage

e. Intellectually challenging work

From the following list of findings on Mental State Examination select the most appropriate

alternative for the description given.

a. auditory hallucination

b. compulsion

c. magical thinking

d. confabulation

e. obsession

f. delusion

g. depersonalisation

h. depressed mood

EMQ 24. Despite the fact that you are a locum and have not seen him before, Jack greets you like an

old friend. He enthusiastically asks what you have been doing since last Saturday when he saw you

at the Pub and you had a few drinks after the football.

EMQ 25. Michael insists on wearing the same pair of underpants every time he plays baseball. He

was wearing them when he pitched a perfect game last season and he always plays better when he

wears them. This is despite him regularly misfielding when he checks to make sure that he is wearing

them.

Page

of

5


13/26

MCQ

26. Which of the following management options should be avoided in the treatment of

migraine?

a. Opioid agents

b. Aspirin

c. Anti-emetics e.g. metociopramide

d. SHTld receptor agonists

e. Ergot type compounds

MCQ 27

Pain is best understood as:

a. a medical diagnosis assessed by appropriate investigations

b. Being able to be graded by objective means from examination of the patient

c. easily managed as there is a range of analgesic agents

d. a well understood mechanism

e. being determined and graded by what the patient feels

MCQ 28. Which ofthe following suggests nociceptive pain?

a.

Allodynia

b. Hyperalgesia

c. Dysaesthesia

d. Phantom limb pain

e. Pain worse during day

MCQ 29

Which of the following would increase pain fibre traffic?

a. Presynaptic opioid receptor stimulation

b. Release of endogenous endorphins from inhibitory neurons in the dorsal horn

c. Descending NA SHT pathways that stimulate inhibitory neurons in the dorsal horn

d. Adjacent sensory fibres that stimulate inhibitory neurons in the dorsal horn

e. Activation of NMDA receptors on 2nd order sensory neurons

Page

13

of

25


14/26

MCQ 30. Spina bifida can be best diagnosed in pregnancy by

a. Villus sampling

b. Maternal serum screening test

c. Amniocentesis

d. 1st trimester ultrasound

e. 2

nd

trimester ultrasound

MCQ 31. Frequency of birth defects is in the order of

a 1:3

b 1:30

c

1:300

d 1:3000

e

1:30 000

MCQ 32.0ne of the assumptions of the life-span perspective is that development is multidirectional.

This means that:

a. Development is caused by any number of factors and determining which cause is most

influential can't be done

b. Developmental changes are universal across most people

c. Developmental changes are DNA driven

d. Developmental outcomes can never be predicted

e. Development at all ages consists of gains and losses plus abilities that remain the same

MCQ

33. Barrett's oesophagus is characterised by transformation of the oesophageal mucosa into:

a. stratif ied squamous epithelium

b. simple cuboidal epithelium

c. columnar epithelium (intestinal metaplasia)

d. pseudo-stratif ied ciliated columnar epithelium

e. a fibrous connective tissue scar

Page

4 o f 5


15/26

MCQ 34. The gold standard for diagnosis of coeliac disease is:

a. Full blood examination

b. Bone density study

c. Clotting time/INR

d. Small bowel biopsy

e. Antibody tests (anti-endomysial, anti-gliadin IgG

IgA, anti-tissue transglutaminase

f. Liver function tests

MCQ 35. Choose the food from the list below that should be avoided by a person with coeliac

disease

a. legumes

b.

mushrooms

c. sausages

d. fruit

e. rice

MCQ 36. Of the following, the factor most important in reducing the incidence of colorectal cancer

is:

a. eating barbecued meat

b. high calorie diet

c. smoking

d.

exercising regularly

e. obesity

Match the following blood glucose readings (rnmol/l) to the scenarios below.

a 2

b

4 5

c

7

d

9

e 1 1 1

f 1 5

Page

15

o f

25


16/26

MCQ 37. The level considered consistent with normal blood glucose.

MCQ 38. The lowest level for a fasting blood glucose that would be consistent with diabetes

mellitus.

MCQ 39. The lowest level for a random blood glucose that would be consistent with diabetes

mellitus.

MCQ 40. The best way to diagnose reflux (GORD) in a 40 year old person with typical symptoms is:

a. by a therapeutic trial of double dose proton pump inhibitor therapy for 2 weeks

b. by endoscopy

c. by a barium meal (patient tilted head down to promote reflux)

d. by 24 hour oesophageal pH monitoring

e. by 24 hour oesophageal manometry

MCQ 41. The best way to investigate reflux (GORD) in a 40 year old person with alert/alarm

symptoms is:

a. by a therapeutic trial of double dose proton pump inhibitor therapy for 2 weeks

b. by endoscopy

c. by a barium swallow and meal (patient tilted head down to promote reflux)

d. by 24 hour oesophageal pH monitoring

e. by 24 hour oesophageal manometry

MCQ 42. A 12 year-old girl is diagnosed with a fractured radial neck. If the nerve closest to the neck

is injured, then examination will most likely reveal:

a. Numbness over the anatomical snuffbox

b. Numbness over the dorsum of the hand

c. Numbness over the palm

d. Weakness of wrist flexion

e. Weakness of wrist extension

Page 16 of 25


17/26

MCQ 43. A patient with a torn anterior cruciate ligament is to have the ligament replaced with a

local tendon. The surgeon needs to choose a relatively superfluous long tendon that is inserted

closest to the tibial attachment of the ACL The best tendon to choose would be:

a. Semimembranosus

b. Semitendinosus

c. Plantaris

d. Soleus

e. Plantaris

MCQ 44. A patient twists an ankle and is diagnosed with a tear of the ankle medial collateral

ligament. This is relatively unusual as the medial ligament: is

a. One strong broad band

b. Two moderately sized bands

c. Three narrow bands

d.

A

strong accessory ligament

e. Is reinforced by the cervical ligament

Page

17

o f

25


18/26

MCQ 45. A suicidal patient stabs at his wrist. The wound is indicated above. The tendon

most

likely

to have been cut in this patient is:

a. Flexor carpi ulnaris

b. Flexor digitorum superficialis

c. Palmaris longus

d. Flexor carpi radialis

e. Brachioradialis

MCQ 46. Consider again the image presented above. The nerve most at risk is the:

a. Deep branch of ulnar

b. Superficial branch of ulnar

c.

Superficial radial

d.

Deep radial

e. Median

Page

8

of

5


19/26

MCQ 47. A patient suffers a stab wound to the neck that severs the thoracodorsal nerve.

Considering the above image, which is the muscle that would be paralysed?

MCQ 48. A patient suffers a stab wound to the axilla that severs the lateral pectoral nerve.

Considering the image, which is the muscle that

most

likely would be paralysed?

Page

19

of

25


20/26

MCQ 49. A patient has an intramuscular injection to the right buttock. A large (non-pulsatile)

haematoma develops and the patient has particularly painful (and restricted) hip extension.

Considering the image, the structure most likely affected would be:

MCQ s A patient has ovarian carcinoma with adhesions to the lateral pelvic wall. The structure

most likely to be affected is:

MCQ 51. A patient is diagnosed with an acoustic neuroma (benign tumour) at the entrance to the

internal acoustic meatus. The nerve most likely affected is the vestibulocochlear, but the other

cranial nerve most likely to be affected is the:

a. Fourth

b Fifth

c. Sixth

d. Seventh

e. Eighth

Page 20 of 25


21/26

MCQ 52. A cavernous sinus thrombosis has eroded the internal carotid artery. Considering this

information, the most l ikely extra-ocular muscle to show signs of palsy is the:

a. Superior oblique

b. Inferior oblique

c.

Superior rectus

d. Inferior rectus

e. Lateral rectus

MCQ 53. A patient has a base of skull fracture passing through the foramen spinosum. The structure

most likely to be affected is the:

a. Ophthalmic nerve

b. Maxillary nerve

c. Mandibular nerve

d. Internal carotid artery

e. Middle meningeal artery

MCQ 54. The gastrointestinal tract normally has outer longitudinal and inner circular muscle layers.

There is an extra layer in the:

a. oesophagus

b. stomach

c. jejunum

d. ileum

e. colon

MCQ 55. In GORD (gastro-oesophageal reflux disease) there is weakness of the lower oesophageal

sphincter. Factors contributing to weakness of this sphincter mechanism include:

a. Decreased intra-abdominal pressure

b. Increased number of mucosal folds

c. More acute fundo-oesophageal angle

d. Diaphragmatic spasm

e. Decreased muscle tone

Page 21 of 25


22/26

MCQ

56. A 28 yr old man is stabbed in the left chest in full expiration. The knife passes horizontally

into the 9

th

intercostal space in the mid axillary line. He is MOST LIKELY to have a penetrating injury

to his

a. spleen

b. lung

c. kidney

d. stomach

e.

colon

MCQ 57

Wendy, a 75 year-old woman, presented with sudden onset of abdominal pain and

bleeding per rectum. A CT scan showed ischaemic changes of the sigmoid colon.

Which artery is MOST LIKELY to be affected?

a. Right gastric

b.

Right gastroepiploic

c.

Left gastroepiploic

d. Superior mesenteric

e. Inferior mesenteric

MCQ 58. A direct inguinal hernia is a hernia whose contents enter the inguinal canal through the:

a. Deep inguinal ring

b. Posterior wall of the inguinal canal

c. Superficial inguinal ring

d. Internal oblique hiatus

e. External oblique hiatus

MCQ

59. Following surgery Mrs. Clarke develops a winged (abnormally prominent) scapula on the

right side. The nerve

MOST LIKELY

to have been damaged during surgery is the

a. suprascapular nerve

b.

lower subscapular nerve

c.

upper subscapular nerve

d. thoracodorsal nerve

e. long thoracic nerve

Page

o f

5


23/26

MCQ 60. Breast carcinoma commonly spreads to the vertebral bodies. This is MOST LIKELYdue to:

a. Venous spread

b. Lymphatic spread

c.

Trans-coelomic spread

d. Direct invasion

e. Arterial spread

MCQ 61. A patient is suffering from Bell's palsy, a condition in which inflammation disrupts function

of the facial nerve on one side. Which one of the following symptoms would this patient experience

on the affected side?

a. inability to open the eye

b. excessive salivation

c. loss of lacrimation

d. loss of the sense of smell

e.

loss of tactile sensation

MCQ 62. A patient complains of epigastric pain. At gastroscopy multiple gastric ulcers are observed

which are in danger of eroding through arteries supplying the stomach. The blood supply of the

stomach is derived

a. from the celiac axis

b. from the superior mesenteric artery

c. from bilateral branches of the aorta

d. from splenic artery branches along the lesser curvature

e. from the azygos system

MCQ 63. A 35 year old pregnant woman presents with nocturnal tingling in the hands; a diagnosis of

carpal tunnel syndrome is made. The usual distribution of altered sensation is the anterior aspect of:

a. lateral3Yz digits including the thenar eminence

b. lateral

Y z

digits sparing the thenar eminence

c. lateral Y z digits including thenar eminence

d. medial Y z digits sparing hypothenar eminence

e. medial Y z digits including hypothenar eminence

Page

23 o f 25


24/26

MCQ 64. A twenty-two year old female swimmer presents to your clinic complaining of right

shoulder pain. She has pain predominantly on initiation of shoulder abduction with a relatively free

range of motion otherwise. You determine she most likely has a tear of:

a.

Infraspi natus

b.

Subscapularis

c. Teres minor

d. Teres major

e. Supraspi natus

MCQ 65. A man presents to the emergency following a fall onto his shoulder. An X-ray shows a

fracture of the surgical neck of his humerus. You are concerned about his neurological function. The

MOST AP PROPR IAT E examination would be to assess:

a. Active shoulder abduction

b. Active shoulder flexion

c. Sensation over pectoralis major

d. Sensation over deltoid

e. Passive shoulder abduction

MCQ

66

A 40 year old man collapses at home following a myocardial infarct, and is found to have an

arrhythmia related to a sinoatrial node block. Which of the coronary arteries is MOST LIK ElY to be

involved?

a. Left main coronary artery

b. Right coronary artery

c. Left anterior descending (or anterior interventricular) coronary artery

d. Left circumflex coronary artery

e. Posterior interventricular artery

Page 24 of 25


25/26

MCQ 67

AIi is a 72 year-old male with a history of liver cirrhosis. He has been diagnosed with

secondary portal hypertension. Which one of the following sites of porto-systemic anastomoses is

the

MOST

clinically important?

a. Lower oesophagus

b. Anorectal junction

c. Bare area of liver

d. Posterior abdominal wall

e. Periumbilicus

MCQ 68

Matthew, an 11 year-old boy, presented to the Emergency Department with a painful right

inguinal swelling. Investigations showed the lump was an indirect inguinal hernia containing small

intestine. Where would the visceral pain be referred to?

a. Epigastric region

b. Umbil ical region

c. Hypogastric region

d. Right inguinal region

e. Right lumbar region

MCQ 69

A posteriorly perforating ulcer in the stomach would M OST L IK EL Y leak into the

a. greater sac

b.

left sub-hepatic space

c.

lesser sac (omental bursa)

d. left sub-phrenic space

e. paracolic gutter

MCQ 7 Which of the following statements is CORRECT?

Veins feature:

a. a thick tunica media

b. a stratified squamous endothelium

c. an external covering of flattened epithelial cells

d. a thicker wall than accompanying arteries to inhibit excessive dilation

e. a larger lumen than that if the accompanying artery

Page

25

of

25


26/26

via practice paper 2010

Documents