The Royal Australian College of
Physicians
2000 Written Examination
Paper 1 – Medical Sciences
Paper 2 – Clinical Applications
-1-
2 hours
3 hours
FRACP 2000
Infectious Disease
1.
PAPER 1 – MEDICAL SCIENCES
An 18-year-old male presented with fevers and myalgia for 1 week. Examination reveals
an inflamed throat an cervical lymphadenopathy. Paul-Bunnel test is negative on two
occasions one week apart. Blood film shows numerous atypical lymphocytes and
lymphocytosis. The most likely diagnosis:
a)
EBV
b)
CMV
c)
Toxoplasmosis
d)
HIV
e)
Staphylococcus
(a)
2
Which of the following is most likely to result in transmission of Hepatitis C virus
a)
Intravenous drug use
b)
Vaginal delivery in a HepC Ab positive, PCR negative mother
c)
Vaginal delivery in a HepC Ab positive, PCR positive mother
d)
Multiple sexual partners without protection
e)
Breast feeding with a HepC Ab positive, PCR negative mother
(?)
3.
Which is the most likely mechanism of Strep, pneumoniae resistance?
a)
Plasmid mediated βlactamase protein
b)
Chromosome mediated βlactamase protein
c)
Plasmid mediated penicillinase protein
d)
Altered permeability of cell membrane to drug
e)
Altered penicillin binding protein
(e)
4.
A patient has a lump removed from his forearm. (photograph of histology shown).
Histology shows central area of fibrinoid necrosis surrounded by pallisading histiocytes
and a chronic inflammatory cell infiltrate. The nodule is most likely due to:
a)
Sarcoid
b)
Tuberculosis
c)
Infected sebaceous cyst
d)
Rheumatoid nodule
e)
Gouty nodule
(d)
5.
A 78 year old man presents with community acquired prostatitis. The most likely causative
organism:
a)
Staph. Aureus
b)
E. coli
-2-
c)
d)
e)
Proteus mirabilis
Pseudomonas spp
Chiamydia
(a)
6.
The most important factor in the development of resistant herpes simplex virus is:
a)
prolonged acyclovir prophylaxis
b)
prolonged acyclovir treatment
c)
size of herpetic lesions
d)
degree if immunosupression
e)
subtherapeutic doses
(d)
7.
The organism most likely to cause nursing home acquired pneumonia:
a)
Streptococcus pneumoniae
b)
Haemophilus influenza
c)
Branhamelia catarrhalis
d)
Legionella pneumophilia
e)
Staphylococcus aureus
(a)
8.
The vaccine that is most likely to cause problems in an immunocompromised patient is:
a)
HAV
b)
HBV
c)
Polio (sabin)
d)
Tetanus toxoid
e)
Influenza
©
PAPER 2 - CLINICAL APPLICATIONS
9.
Patient with pancreatitis is on parenteral nutrition through a central line. He develops
persistent fevers. Candida knizei is grown on blood cultures. Best initial treatment is:
a)
Continue current treatment
b)
Start fluconazole and keep intravenous lines in
c)
Start fluconazole and remove lines
d)
Start amphotericin and keep lines in
e)
Start amphotericin and remove lines
(e)
10.
An 80-year-old female from nursing home presents to Accident and Emergency
department with a non-healing venous ulcer on the medial aspect of her leg. The ulcer is
clean with no surrounding cellulites. Her MSU shows >100 white cells, no red cells.
Urine culture grows E .coli > 105. What would you do for this woman’s urine result:
a)
treat with antibiotics
b)
treat with urinary alkalinisation
c)
cranberry juice
d)
no treatment
e)
long-term prophylactic antibiotics
(?)
-3-
11.
A 27-year-old male, visited Burma for 10 days, has been back for 2 days when he
presents to the emergency department with fever, rigors, headache, tachycardia, petechial
rash on legsand torso (photo shown). Hb 14, WCC 3,4, platelet 60. Temp 38.90C. HR
90/min. Next investigation most likely to give diagnosis:
a)
HIV Antibody
b)
Thick and thin blood film
c)
Dengue serology
d)
Stool culture
e)
Blood culture
(b)
12.
A 54-year-old male with a history of chronic renal failure and diabetes was admitted with
a perforated bowel secondary to diverticular disease. After laparotomy and lavage, blood
culture grew Enterobacter sensitive to ceftriaxone. He was commenced on ceftriaxonde
and metronidazole. Fevers pesisted and there was no improvement after 3 days. CT
abdo shows no collection or abscess. Repeat blood cultures grow Enterobacter again.
Next best action:
a)
Continue on same antibiotics
b)
Repeat laparotomy
c)
Change to meropenem
d)
Add vancomycin to existing regime
e)
Cease ceftriaxone and add ampicilin and gentamicin to metronidazole.
©
13.
A 46-year-old man presents with acute respiratory distress and has oral candidlasis. PO2
of 55 on ABG and diffuse bilateral pulmonary infiltrates on CXR. Sputum stains positive
on silver stain. Best initial treatment.
a)
IV ltraconazole
b)
IV ltraconazole and prednisone
c)
Amphotericin
d)
IV cotrimoxazole
e)
IV bactin(?) and prednisone
(e)
14.
A patient is admitted with community acquired bacterial meningitis. Culture sensitivity
is forthcoming. Ceftazidime and penicillin are started. Activity against which of the
following organisms is the rationale for the addition of penicillin:
a)
Pneumococcus
b)
Klebsiella
c)
Neiseria meningitis
d)
Listeria monocytogene
e)
E.coli
(?)
15.
A 31-year-old Cambodian man presents with the nephrotic syndrome. Albumin 23, urine
protein 7gm per day, serum creatinine 0.08. The investigation least likely to be helpful in
the diagnosis is:
a)
Hepatitis B antibody
b)
Syphilis serology
-4-
c)
d)
e)
Mantoux test
Malaria film
ANA
(?)
16.
A 38-year-old man presents with fever and rigors. He had just returned from a trip to
Africa 8 weeks ago. He took mefloquine for prophylaxis until two weeks after returning.
His peripheral blood film now shows Plasmodium vivax in 1% of the red cells. What is
the next best treatment?
a)
doxycycline for 3 days
b)
3 days of chloroquine followed by 7 days doxycycline
c)
one dose mefloquine followed by 14 days primaquine
d)
3 days choloroquine followed by 14 days primaquine
e)
doxycycline stat
(?)
PAPER 1 - MEDICAL SCIENCES
Oncology:
1. A 48-year-old male on methotrexate for psoriasis received a course of co-trimoxazole for
a urinary tract infection. He develops mucositis. His FBC shows mild pancytopenia. He
is given folinic acid and he improves. The mechanism of folinic acid in this situation is:
a)
reduced protein binding
b)
inhibition of dihydrofolate reducatase
c)
provides source of reduced folate
d)
increased renal excretion of methotrexate
e)
increased intracellular concentration of methotrexate.
©
2.
Which is true regarding the G2 phase of the cell cycle?
DNA Replication
a)
b)
c)
d)
e)
Low
Low
Low
High
High
Microtubule
Production
Low
Low
High
High
High
Other Protein
Production
Low
High
High
Low
high
©
3. Which is antineoplastic agent is least toxic to bone marrow?
a)
Decreasing palatal oedema
b)
Increasing functional residual capacity
c)
Carboplatin
d)
Etoposide
e)
Vincristine
(?)
-5-
4.
In a post menopausal woman with carcinoma of the breast whish of the following is first
line hormonal treatment for breast cancer:
a)
oestrogen
b)
progesterone
c)
androgens
d)
anti-oestrogens
e)
aromatase inhibitors
(?)
PAPER 2 - CLINICAL APPLICATIONS
5.
A 71-year-old woman who lives alone presents to the emergency department following a
2 month history of increasing back pain. X-ray of thoracolumbar spine (shown) – crush
fracture of one thoracic vertebrae and osteophytic lipping on other vertebrae (which
appear very dense and opacified). Most likely diagnosis:
a)
Myeloma
b)
Breast cancer
c)
Lymphoma
d)
Pagets
e)
Osteoporosis
(b)
6.
The factor most associated with a poor prognosis in operable breast cancer is:
a)
her-2-neu mutation
b)
Hormone receptor status
c)
Tumour grade
d)
Nodal status
e)
Tumour size
(?)
7.
A change in which of the following protein or gene is responsible for drug resistance in
tumours?
a)
p-glycoprotein (MDR)
b)
p53
c)
Bc12
d)
Cytochrome P450
e)
Thiopurine S-menthyltransferase
(?)
8.
The reason for frequent follow up of a patient after complete locally excised melanoma is
for the early detection of which of the following:
a)
new primary lesion
b)
lymph node metastases
c)
recurrence at primary site
d)
systemic metastases
e)
??
(a)
-6-
PAPER 1 - MEDICAL SCIENCES
Gastroenterology
1.
The most efficacious drug to prevent a gastric ulcer whilst using an NSAID is:
a)
misoprostol
b)
omeprazole
c)
sucralfate
d)
ranitidine
e)
risprolol
(b)
2.
The most important mechanism/cause of reflux oesophagitis is:
a)
Sliding hiatus hernia
b)
Smoking > 20 cigarettes per day
c)
Increased frequently of transient lowering of oesophageal sphincter tone
d)
Decreased oesophageal motility
e)
Chronically decreased lower oesophageal sphincter tone
(?)
3.
NSAID’s that are COX-2 specific have the greatest reduction in which adverse reaction
compared to non-specific NSAID’s
a)
renal failure
b)
hypertension
c)
gastroduodenal ulceration
d)
rsh
e)
headache
©
4.
In the treatment of Hepatitis C with interferon-a which is the most predictive of a poor
response to treatment (defined as a persistent elevation of ALT)
a)
Age of patient
b)
Pre-treatment ALT level
c)
Presence of cirrhosis
d)
Viral genotype
e)
HCV RNA level (viral load)
(?)
5.
Best indicator of acute exacerbation of chronic hepatitis B infection:
a)
HepB SAg
b)
HepB Sab
c)
Hep B core 1gM
d)
Hep B e Antigen
e)
Hep B e Ab
(a)
PAPER 2 - CLINICAL APPLICATIONS
6
Young male intravenous drug user was found unconscious, hypotensive with a syringe
lying next to the bed. Resuscitated by ambulance officers with CPR and Naloxone and
brought to hospital in a stable condition. Two days later in hospital, LFT’s noted to be
abnormal:
-7-
bilirubin
37
ALP
251
AST
12653
ALT
11982
GGT
192
The most likely cause of the abnormal LFT’s?
a)
Acute hepatitis A
b)
Acute hepatitis C
c)
Ischaemic hepatitis
d)
Drug induced
e)
Liver abscess
©
7.
A middle aged man with past history of heavy alcohol intake. He has not taken alcohol
in the last two years. He presents with four weeks of increasing abdominal girth and leg
swelling. He is afebrile, icteric, confused, has adcites and leg oedema, and a metabolic
flap is present.
Bilirubin 35
ALT 90
Platelets 90
ALP 460
AST 85
INR 1.5
yGT 160
A CT of the liver is shown see NEXT PAGE:
What is the cause of his hepatic decompensation:
a)
Hepatitis
b)
Hepatocellular carcinoma
c)
Portal vein thrombosis
d)
Liver abscess
e)
Metastatic disease
(?)
8.
A 50-year-old male with epigastric pain. Abdominal ultrasound shows two large (3-4cm)
cystic lesions. Endoscopy shows gastritis and biopsy is positive for H. pylori. Treatment
with H2 antagonists fixes epigatric pain. LFT’s normal. Nil fevers, weight loss or RUO
tenderness. Abdominal CT shows two large hypodense lesions on liver and some smaller
ones peripherally. Most likely diagnosis:
a)
liver metastasis
b)
benign liver cysts
c)
haemangiomas
d)
liver abscesses
e)
hyhdatid disease
(?)
9.
A 36-year-old man with Crohn’s disease has 50 cm terminal ileum resected for iteitis. He
presents with watery diarrhoea usually occurring in the morning. There is no blood or
mucus with the stools. On examination there is no abdominal tenderness and stool
microscopy is normal. What is the most appropriate management?
a)
Metronidazole
b)
Predniso(lo)ne
c)
Azathioprine
d)
Cholestyramine
e)
Mesasal
(d)
-8-
10.
Which of the following is most likely to delay the need for liver transplantation in
primary biliary cirrhosis
a)
methotrexate
b)
surgery
c)
ursodeoxycholic acid
d)
Prednisone
©
11.
Which of the following is the most accurate description of Hepatitis E virus infection?
a)
Parenteral transmission, acute illness, no mortality
b)
Enteric transmission, acute illness, increased mortality in pregnancy
c)
Enteric transmission, chronic illness
d)
Parenteral transmission, high mortality
e)
Route of transmission unknown.
(?)
12.
A middle aged woman presents with watery diarrhoea for two years. She denies
laxatives use. There is no blood in the stools and no abdominal pain. There is no family
history of colonic polyps. Urinary Ko 50 mmol/L, serum K0 3.1. ESR normal, FBC
normal. (Colonoscopy shown; melanosis coli). What is the next appropriate step?
a)
upper gastrointestinal endoscopy and biopsy
b)
test stool and urine for laxative
c)
xylose C14 breath test
d)
antibiotics
e)
small bowel enema
(b)
13.
Repeat question on patient who needs radiolabelled hepatic scan.
14.
A patient with Crohn’s disease presents with fever and abdominal discomfort. He takes
sulindac 1 gm bd and prednisone 10 mg daily. On examination there is right iliac fossa
tenderness.
CT shown below
What is the next appropriate management:
a)
IV hydrocortisone and IV antibiotics
b)
IV antibiotics
c)
Increase dose of Sulindac
d)
Laparotomy
e)
Increase Prednisone dose
(?)
-9-
15.
A 63-year-old man has a 4-month history of low abdominal pain, increasing constipation
and bright red bleeding. Double contrast barium enema shown – diverticular disease
descending colon and narrow, irregular segment – 10 cm of sigmoid colon.
a)
Ultrasound
b)
CT scan
c)
Colonscopy
d)
High fibre diet and antispasmodics
e)
Surgery
(?)
16.
A 52-year-old lady presents with symptoms of gastritis. Endoscopy shows evidence of
MALT lymphoma. H. pylori positive. Physical examination, CT chest/abdo/pelvis and
galliumscan normal. Best initial treatment?
a)
Combination chemotherapy
b)
H. pylori eradication
c)
Single agent chemotherapy
d)
Irradiation
e)
Gastrectomy
(b)
PAPER 1 - MEDICAL SCIENCES
Pharmacology
1.
With the treatment of Chlamydia trachomatis, doxycycline for 7 days is used, but a single
dose of azithromycin is used because of:
a)
lower bacterial concentration in serum
b)
high serum level
c)
long intracellular half life
d)
post dosage effect
e)
lower renal clearance
©
2.
Concerning a medication, which has been, commenced a once daily medication dose,
with an elimination half-life of 48 hours. The drug will continue to accumulate for:
a)
2 days
b)
4 days
c)
10 days
d)
16 days
e)
indefinitely
©
3.
A drug is cleared 80% in the kidneys and 20% is metabolized in the liver. If the usual
dose is 100 mg what dose should be given to a patient with 25% of renal function:
a)
80 mg
b)
20 mg
c)
40 mg
d)
25 mg
e)
60 mg
©
- 10 -
4.
A patient is clinically stable on a fixed dose of Lithium carbonate. Which of the
following is most likely to cause an increase in the lithlum level?
a)
Cimetidine
b)
Probenecid
c)
Bendrofluozide
d)
NSAID’s
e)
Erythromycin
©
5.
Five drugs with different log concentration and effect
Which drug has the most potency?
a)
drug
b)
drug B
c)
drug C
d)
drug D
e)
drug E
(a)
6.
Which of the following NSAID’s is most likely associated with haemorrhagic cystitis:
a)
Sulindac
b)
Naprosyn
c)
Ketoprofen
d)
Tiaprofenic acid
e)
Piroxicam
(d)
7.
Which causes the least reduction of protein binding of phenytoin?
a)
Pregnancy
b)
Chronic renal failure
c)
Chronic liver failure
d)
Warfarin
e)
Carbamazepine
(e)
9. In a 70 kg person, which has the slowest clearance from plasma, given that:
DRUG
Amiloride
Amiodarone
Dapsone
Tolbutamide
Trimethoprim
a)
Amiloride
b)
Amiodarone
c)
Dapsone
d)
Tolbutamide
e)
Trimethoprim
Vd (L)
1190
4620
70
7
126
T½ (h)
21
600
22
6
11
(b)
PAPER 2 - CLINICAL APPLICATIONS
- 11 -
10.
A 53-year-old woman collapsed and was resuscitated by ambulance officers. She had a
history of hay fever. She was started on Erythromicin four days ago for treatment of an
upper respiratory tract infection. On arrival in the Emergency department an ECG
showed prolonged QT interval. The Interaction with which of the following drug is the
most likely cause of her collapse.
a)
Asthma
b)
Pulmonary embolus
c)
Diastolic dysfunction
d)
Myocardial ischaemia
e)
Interstitial pulmonary fibrosis
©
11.
An inadequately small response to codeine phosphate is likely due to which of the
following phenotypes of polymorphic drug metabolizing enzymes?
a)
Slow acetylator (N-acetyl transerase deficiency)
b)
Poor metaboliser (cytochrome P450 2D6 deficiency)
c)
Inadequate hydroxylation of mephenytoin
d)
Atypical anticholinesterase
e)
Rapid metaboliser (multiple copies of gene coding for cytochrome P450 2D6).
(b)
12.
The reason why elderly people are more prone to adverse drug reactions compared to the
young is due t which one of the following:
a)
Altered pharmacokinetics
b)
Altered phrmacodynamics
c)
Reduced homeostatic mechanisms
d)
Other co-morbidities
e)
Polypharmacy
(e)
PAPER 1 - MEDICAL SCIENCES
Cardiology
1.
The most specific finding for hypertrophic cardiomyopathy on M-mode echo is:
a)
delayed closure of the aortic valve
b)
anterior systolic mitral valve motion
c)
ratio of the thickness of the septum to the posterior ventricular wall of greater
than 1.3:1
d)
LVOT obstruction
e)
Reduced E-A ratio
©
2.
What is the commonest complication related to coronary angiography
a)
myocardial infarction
b)
ventricular fibrillation
c)
arterial false aneurysm
d)
stroke
e)
contrast reaction
© or (e)
- 12 -
3.
Which of the following interventions would be least helpful in lowering blood pressure:
a)
Weight reduction
b)
Reduction in salt intake
c)
A daily exercise program
d)
Smoking cessation
e)
Reducing ethanol consumption to less than 10 grams a day.
(d)
PAPER 2 – CLINICAL APPLICATIONS
4.
A 35-year-old man presents with central chest pain worse on inspiration. BP 130/80:
Temperature 37.80 C. JVP not elevated. No murmurs, no pleural rub. ECG shown
opposite.
What is the likely diagnosis:
a)
AMI
b)
Pericarditis
c)
Pulmonary embolism
d)
Acute dissection
e)
Pneumonia
(?)
6. A 62-year-old woman with history of essential hypertension has increasing exertional
dyspnoea. She has no wheeze and respiratory examination is normal. Pulses are regular
at 80/min. BP 170/90 mmHg, JVP not elevated, no oedema. Echo shows normal LV
systolic function with mild left ventricular hypertrophy. Which of the following is the
likely cause of her dyspnoea.
a)
Asthma
b)
Pulmonary embolus
c)
Diastolic dysfunction
d)
Myocardial ischaemia
e)
Interstitial pulmonary fibrosis
(?)
6.
What is the least likely finding with proximal aortic dissection:
ST-T changes on ECG
a) Aortic regurgitation
b) Chest pain
c) Hypotension
d) Difference in brachial blood pressures
7.
The following cardiac Doppler flow pattern in the left ventricular outflow tract is
due to which of the following:
(?)
a)
b)
Mitral stenosis
Aortic insufficiency
- 13 -
c)
d)
e)
Aortic stenosis
Aortic regurgitation and aortic stenosis
Aortic stenosis and mitral regurgitation
(?)
8.
A 57-year.old has exertional chest on moderate activity. He is hypertension
which is treated with Captopril, and he takes ibuprofen for osteoarthritis. His
body mass index is 30. W:H ratio 1.1. total cholesterol 6.0 triglyceride 2.0.
HDL 0.7. LDE 4.0. random blood glucose 6.5. creatlinine 0.09. What is the next
appropriate management?
a) Hypocaloric diet with weight loss of 2 kg. per week
b) Hypocaloric diet with weight loss of 0.5 kg per week
c) Reduced sucrose, reduced cholesterol diet
d) Low cholesterol with low intensity aerobic activity
e) Low cholesterol, hypocaloric diet with resistance exercises
9.
A 60-year-old man is admitted to the surgical ward for a cholecystectomy. He
has no symptoms attributed to cardiac diseases. You are asked to see him because
his preoperative ECG was abnormal
The next most appropriate step is:
a) No further investigation
b) Exercise stress test
c) Dobutamine echo
d) Thallium scan
e) Coronary angiography
(a)
Respiratory
Paper 1 - Medical Sciences
1.
In a patient with idiopathic pulmonary fibrosis, which of the following cell types
when found to predominate in the bronchioalveolar lavage, will be associated with
the best response to treatment ?
a) CD8 lymphocytes
b) Macrophages
c) Neutrophils
d) CD4 lymphocytes
e) Eosinophils
2
A 67-year-old woman with severe COAD has an overnight sleep study. There is no
evidence of obstructive sleep apnoea, but there are three episodes of recurrent
desaturation of oxyhaemoglobin. The most likely cause:
a) SWS (slow wave sleep) related upper airway narrowing
b) REMS related increase in ventilation-perfusion mismatching
c) SWS related reduction in cardiac output
d) REMS related reduction in respiratory drive
3.
What is the mechanism of nasal CPAP for obstructive sleep apnoea?
(d)
(e)
- 14 -
a)
b)
c)
d)
e)
Decreasing palatal oedema
Increasing functional residual capacity
Augmenting the genioglossus muscle
Pneumatic splinting of the upper airway
Reducing the closure of the epiglottis
(d)
Paper 2 - CLINICAL APPLICATIONS
4.
The next best management:
a) Volume infusion
b) Increase PEEP
c) Increase F102
d) Transfusion of packed red blood cells
e) Increase ventilation rate
(a)
5
A 43-year-old woman presents with increasing dyspnoea and wheeze. Spirometry
shows limitation of flow during inspiration with a plateau effect on the inspiratory
phase. (No spirometry shown). What is the likely cause?
e)
Variable extrathoracic obstruction
f)
Variable intrathoracic obstruction
g)
Fixed intrathoracic obstruction
h)
Fixed extrathoracic obstruction
i)
Widespread intrapulmonary obstruction.
10.
A 38-year-old woman presents with increasing shortness of breath while
vacuuming. She arrived on a flight from London one week ago. Her spirometry
FEV1 FVX 80%, (CXR shown: plate atelectasis right lower zone). ABG pH 7, 46,
Pco2 28, PO2 8.
Ventilation- perfusion lung scan
High resolution chest CT
Lung function tests
Bronchoscopy
Echocardiogram
(?)
11.
12.
13.
14.
15.
(a)
7. A 54-year-old man presents with a history of jfever an haemoptysis. The CXR shows
right midzone and upper zone patchy opacification. No organisms are cultured from
the sputum. What is the next appropriate step:
a) CT scan of the chest
b) Bronchoscopy
c) ZN stain of the sputum
d) Sputum culture
©
- 15 -
Paper 1 – Medical Sciences
Renal Medicine:
1. Which of the following least affects water resorption in the collecting tubules of the
kidney?
16. ADH
17. Mineralocorticoid receptors
18. G protein
19. Aquaporin
20. Adenyl cyclase
2. A 25-year-old female presents to the Accident and Emergency Department with leftsided renal colic and macroscopic haematuria. She has had several similar
presentations to other hospitals. On examination she has a temperature of 37.50C and
there is left loin tenderness. Which of the following is least likely to cause this
condition.
a) Goodpasture’s syndrome
b) Polycystic kidney disease
c) Narcotic abuse
d) LgA disease
e) Warfarin
?
3. In a pregnant woman which of the following best differentiate chronic hypertension
from pre-eclampsia
a) proteinuria
b) BP less than 160 systolic
c) Onset of hyperiension before 15 weeks of pregnancy
d) Family history of hypertension
e) Haematuria
(?)
4. What is least likely to be seen in the renal pathology of Wegener’s granulomatosis?
a) Crescents
b) Focal necrosis
c) LgG
d) Lymphocytes
e) Macrophages
(?)
5. A patient with pancreatic insufficiency refuses to take pancreatic supplements. He
later presents with renal calculi. Increased excretion of which of the following is the
most likely cause of the renal calculi?
a) urate
b) phosphate
c) bicarbonate
d) oxalate
e) cysteine
(d)
Paper 2 - Clinical Applications
- 16 -
6. Previously person was found to have a BP of 170/105 on a routine insurance check
up. He is on no medication and a normal diet. Serum K* 2.8, serum Na* 145, Cr
0.09, (Bicarb not given). Serum aidosterone 800. Serum renin 150. This clinical
picture is most consistent with the following diagnosis:
a) essential hypertension
b) renovascular hypertension
c) Cushing’s syndrome
d) Conn’s syndrome
e) Licorice induced hypertension
(?)
7. A 46-year-old male presents to Accident and Emergency Department with right-sided
abdominal pain. Several years ago he had a nephrectomy on the left side because of
a staghom calculus. He has passed very little urine over the last twelve hours. His
temperature is 37.40C, he is tender on the right side of the abdomen and right flank.
Urea is 32 mmol/L K* 5.1 mmol/L Bicarb 21 mmol/L
Creatinine 0.41 mmo/L Na* 128 mmol/L
Ultrasound of the right kidney shows a calculus in the pelvi-ureteric junction with
dilated pelvicalyceal system. What is the next appropriat e management:
a) haemodialysis
b) retrograde cytoscopy and pyelogram
c) intravenous pyelogram
d) urgent percutaneous nephrostomy
e) lithotripsy
(d)
8. Woman with history of SLE and progressive glomerulonephritis, commenced on
prednisone and cyclophospamide. One month after treatment commenced a painful
rash develops.
The suppressed immunological effector function responsible is:
a)
NK cell
b)
Complement
c)
Cell mediated immunity
d)
Antibody
e)
Phagocytic function
©
9. A 50-year-old male with a 5-year history of nephrolihiasis presents with a
renal stone, which is composed of calcium oxalate. The serum Calcium 2.35,
- 17 -
phosphate 1.4, urate 0.32, creatinine 0.08. Urine shows hypercalciuria and
hyper uricaemia. Treatment least likely to help:
a) Low calcium diet
b) Thiazide diuretic
c) Allopurinol
d) High fluid intake
e) Alkalinisation of urine
(a)
10. A 23-year-old pregnant woman presents with a blood pressure of
145/90mmHg at 32 weeks gestation. Her prepregnancy BP was 125/70.
Currently Cr normal. LFT normal, electrolytes normal, FBC normal,
Urinalysis ***protein. She is otherwise well. Best management:
a) Chlorothiazide
b) Bed rest
c) Irbesartan
d) Enalapril
e) Methyidopa
(?)
11. Persistent depression of C3 is associated with which type of
glomerulonephritis
12. MCGN
13. Membranous GN
14. SLE
15. Post infectious GN
16. IgA nephropathy
(?)
12. A 48-year-old man presents with increasing generalized oedema and
proteinuria of 8g/24 hrs. He was previously treated for nephrotic syndrome
with initially some response to steroid therapy. A renal biopsy was
performed . (note trichrome stain)
What is the diagnosis?
a) Focal segmental glomenilosclerosis
b) Membranous
c) Post infectious?
d) IgA nephropathy
e) Amyhloid?
(?)
13.
The least likely feature of cyclosporin induced renal disease:
a)
Interstitial fibrosis
b)
Arterial endothelial injury
- 18 -
c)
d)
e)
Reduced uric acid excretion
Altered potassium secretion
Glomerulopathy.
Paper 1 – Medical Sciences
Immunology:
1.
When a T-helper cell interacts with an APC an important mechanism of costimulation is binding of B7 to CD28. In the absence of this co-stimulatory
signal what is the least likely response of the lymphocyte:
a)
apoptosis of the T cell
b)
activation of B lymphocytes
c)
anergy
d)
produce Th1 cytokines
e)
produce Th2 cytokines
(b)
2. The large granular cells seen in the early response to virally infected cells are:
a) Naïve T cells
b) B lymphocytes
c) Memory CD4 cells
d) Memory CD8 cells
e) Natural killer cells
(e)
3. Cytokine regulation (especially IL-2) is least likely to be affected by:
a) Prednisone
b) Mycophenolate mofetil
c) Cyclosporin A
d) Tacrolimus
e) Rapamycin
(b)
4.
Which of the following best distinguishes Th2 from Th1
a)
IL-3 production
b)
IL-5 production
c)
Response to antigen by macrophages
d)
Surface expression of MHC II
e)
Surface expression of CD4
(b)
5.
Which of the following is least important in the killing of gram-positive pyogenic
infection:
a)
complement mediated C3a C5a anaphylatoxin
b)
opsonisation
c)
complement mediated leukocytosis
d)
C3a and C5a mediated chemotaxis
e)
C5-9 membrane attack complex
- 19 -
(?)
6.
The class or subclass of immunoglobulin which binds weakly in early response to
Pneumococcal polysaccharide is:
a)
IgE
b)
IgG1
c)
IgG3
d)
IgM
e)
IgA
(d)
Paper 2 – Clinical Applications
13. Two photographs shown.
14. Picture of foot with large blisters, surrounding erythema:
15. Immunoflourescence stain of skin biopsy showing line of C3 immunoflourescence at
interface between dermis and epidermis. Which one of the following is involved in the
pathogenesis of this condition:
a)
immunoglobulin
b)
CD4 + T cells
c)
CD 8 + T cells
d)
Masts cells
e)
Monocytes
(a)
16. 35-year-old male with a fever, bilateral lower limb rash, bilateral ankle arthralgia.
ESR raised
CRP raised
Most likely cause?
a)
Sarcold
b)
TB
c)
Lymphoma
d)
Reither’s disease
e)
SLE
(a)
17. The most useful test to prove anaphylaxis after dental surgery where penicillin was given
prophylactically:
a)
RAST
b)
Serum tryptase
c)
Skin testing
d)
??
e)
??
(b)
18. A 50-year-old man has a long history of chronic asthma and fleeting infiltrates in his
lung. He presents with worsening of his asthma, fever and left foot drop. And…
WCC 18.0
IgE 1250 (0 – 2550)
Eosinophils 3.6 (0.05 – 0.25)
- 20 -
He responded poorly to predniso(lo)ne but improved after the addition of
cyclophosphamide. The most likely diagnosis is:
a)
allergic bronchopulmonary aspergillosis
b)
chronic eosinophillic pneumonia
c)
extrinsic allergic alveolitis
d)
exacerbation of asthma
e)
Churg-Strauss syndrome
(?)
19. A 64-year-old lady has symptoms of painful, blue fingers in cold weather. X-ray shown
calcinosis in pulps of fingers. Which of the following test is most likely to be positive?
a)
Anti RNP
b)
Anti pm SCL
c)
Anti-centromere
d)
Anti topoisomerase (SCL 70)
e)
Anti filaggrin
(?)
20. A 31-year-old man with HIV on zidovudine, smoker since the age of 17, denies asthma.
He develops left sided chest pain and dyspnoea. PR 120, RR 28. Temp. 38.5 SaO2 96*,
CXR 45% pneumothorax on the left. Most likely cause?
a)
Smoking related disease
b)
HIV related
c)
Strep. Pneumoniae
d)
Pneumocystis carinli
e)
Antiretroviral therapy
Paper 1 – Medical Sciences
Neurology:
1.
Strongest independent risk factor for stroke
a)
age
b)
hypertension
c)
cigarette smoking
d)
obesity
e)
sedentary lifestyle
2.
A 20-year-old female presents with two days of reduced visual acuity in the left
eye. A visual evoked response was performed with the following result.
(a)
What is the diagnosis?
a)
retinal artery occlusion
b)
retinal detachment
c)
optic neuritis
- 21 -
d)
e)
retinal migraine
cortical stroke
(?)
3.
Which of the following conditions is electromyography /nerve conduction studies
least useful?
a)
radial nerve daisy
b)
deep branch of the ulnar nerve palsy
c)
sciatica
d)
polymyositis
e)
carpal tunnel syndrome
4.
Concerning DNA testing for Huntington’s disease, the best clinical value of the
test is
a)
to investigate a child
b)
to investigate someone presenting with a tremor
c)
to predict the age of onset
d)
to investigate before clinical symptoms become evident
e)
if it only involves the collection of a blood test.
5.
An abnormality of which of the following tests would confirm the diagnosis of
motor neuron disease?
a)
Sural nerve biopsy
b)
MRI of brain and spinal cord
c)
EMG
d)
Nerve conduction study
e)
CSF for protein concentration
6.
A 21-year-old student presents with right wrist drop. The most likely cause is
damage to:
a)
Left internal capsule
b)
Right brachial plexus
c)
Left C7 cervical nerve root
d)
Right radial nerve
e)
Left extensor digitorum comminis muscle
(?)
(?)
(?)
(?)
Paper 2 – Clinical Applications
7.
A 28-year-old male develops an acute demyelinating polyneuropathy. Two
weeks prior to this he had an episode of diarrhoea in which Campylobacter was
isolated from the stool. The most likely relationship between Campylobacter and
polyneruopathy:
a)
coincidental
b)
Campylobacter toxin
c)
Molecular mimicry between Campylobacter antigen and myelin
- 22 -
d)
e)
Direct damage to neural tissue by Campylobacter
Spinal abscess
(?)
8.
A 65-year-old male has had a left sided transient ischaemic attack. Carotid
dopplers reveal an 80% stenosis in the left internal carotid artery. Next best
treatment is:
a)
Carotid angioplasty
b)
Carotid endarterectomy
c)
IPA to carotid artery
d)
Warfarin
e)
Commence Ticlopidine
9.
Predniso(lo)ne is not a recognized treatment of which of the following:
a)
Myasthaenia gravis
b)
Polymyositis
c)
Guillain-Barre syndrome
d)
Temporal arteritis
e)
Multiple sclerosis
10.
A 16-year-old woman presents with several blank spells. The
electroencephalogram shows right temporal lobe sharp waves. (ECG described,
not shown) What is the drug of choice in the treatment of this condition?
a)
Carbemazepine
b)
Phenytoin
c)
Lamotrigine
d)
Vigabatrin
e)
Ethosuxamide
10.
A 24-year-old male had had epilepsy for nine years attends a neurology clinic in
January 2000 because he has had three seizures in the last week. He currently
takes Phenytoin after failing a trial of Carbemazepine due to gastrointestinal side
effects. He works as a barman, drinks 5 to 6 standard drinks a day, and smokes
15 cigarettes a day. He also uses marijuana on a recreational basis.
(?)
(?)
(?)
Phenyhtoin
Dose
September5, 1999
September 26, 1999
360mg
360mg
October 11, 1999
December 14, 1999
January 6, 2000
400mg
330mg
330mg
- 23 -
Phenytoin
Level
Well
Seizures, presented to ED:
Dose
Normal
Low
Vertigo, nausea
Well
seizures
High
Normal
What is the cause of the pattern shown above:
a)
excessive alcohol intake
b)
cigarette smoking
c)
illicit drug use inducing hepatic enzymes
d)
noncompliance
e)
reduced gastrointestinal absorption secondary to antacids
(?)
12.
A 23-year-old female presents with a tremor, worse on movement. Her thyroid
function tests are normal. Which of the following is least likely to be associated
with her condition?
a)
Improvement with a beta blocker
b)
Improvement with alcohol
c)
Family history
d)
Improvement with L-dopa
e)
Worsening with anxiety.
(d)
Paper 1 – Medical Sciences
Endocrinololgy:
1.
Which one of the following is least likely to be raised in the third trimester of
pregnancy?
a)
Total iron binding capacity
b)
FT4
c)
Protactin
d)
Cortisol
e)
Alkaline phosphatase
2.
Which of the following best describes relationship between insulin resistance and
ischaemic heart disease?
a)
confined to hypertension
b)
confined to diabetes
c)
confined to obesity
d)
independent of cholesterol
e)
only if low HDL
3.
Concerning the sick euthyroid syndrome. The least likely finding in a patient
who is critically ill and euthyroid is:
a)
Raised FT4
b)
Low T3
c)
Raised T3
d)
Low TSH
e)
High TSH
(?)
(?)
- 24 -
(?)
4.
Which of the following biochemical changes is most associated with obesity:
a)
decreased leptin
b)
increased C-peptide
c)
increased LDL
d)
reduced insulin receptor sensitivity
e)
increased blood glucose level
5.
Which of the following has the least direct effect on the parathyroid hormone
production:
a)
parathyroid hormone
b)
phosphate
c)
ionized calcium
d)
1.25 Vit DOH
e)
calcium receptor
(?)
(?)
6. A 28-year-old woman present with galactorrhoea. She has a history of
hypothyroidism and takes 0.1mg Thyroxine a day. She also takes lithium
carbonate for bipolar disorder and has levels in mid-normal range. She takes
Metoclopramide 10mg for nausea and Diazepam 5 mg at night. Serum
prolactin 1,8000 (N<600). What is the most likely cause of her
hyperprolactinaemia and galactorrhoea?
a) history of hypothyroidism
b) Metoclopramide
c) Lithium carbonate therapy
d) Diazepam
e) Thyroxine therapy
(?)
Paper 2 – Clinical Applications
7.
A 45-year-old male presents with visual impairment for two weeks. He is found
to have 6/12 visual acuity on both sides with bitemporal hemianopla Low
tetosterone, low gonadotrophins, normal TSH, low cortisol, low T4, serum
protactin 210,000 (N>600). He was given hydrocortisone and thyroxine.
Next best management:
a)
transphenoidal pituitary resection
b)
transfrontal pituitary resection
c)
bromocriptine
d)
testosterone
e)
radiotherapy
- 25 -
(?)
8.
A patient presents with calcium of 2.7 mmol/L following a routine blood test. He
is asymptomatic. A 24 hour urinary calium excretion is low. PTH is within the
normal range; 24-hr urinary creatinine clearance is normal. Renal ultrasound is
normal. What is the next best test?
a)
1.25 vitamin D
b)
test the urinary calcium of first degree relatives
c)
bone scan
d)
ultrasound of the neck
e)
PTHrP
9.
A 78-year-old female presents with several months of malaise and fatigue. There
is a palpable 4 cm nodule in right upper pole of thyroid. Scan shown – toxic
MNG with patchy uptake (? Cold predominant nodule in right upper pole.
Clinically euthyroid. Blood tests reveal TSH 0.02 (low). FT4 23 (upper limit
19). Most likely diagnosis:
a)
Thyroidities
b)
Thyroid cysts
c)
Thyroid cancer
d)
Toxic multinodular goiter
e)
Autonomous nodule
10.
A 63-year-old woman has three weeks of fatigue, palpitations, tremulousness and
weight loss of 2 kg. She has had no recent exposure to iodine. On examination
she is thin, BP 150/86 mmHg. Pulse 80/min and regular. Respiratory,
cardiovascular, and abdominal examination is normal. There is proximal
weakness. Hb 130, platelets 236, WCC 3.5, TSH <0.03, free T4 31, T3 5.9.
Anti-thyroid peroxidase is negative, TSH receptor Ab is negative. The
radiosotope thyroid scan is shown (diffusely poor uptake). What is the next
appropriate treatment ?
a)
Propranolol
b)
Carbimazole
c)
Radiolodine
d)
Perchlorate
e)
Predniso(lo)ne
11.
A 72-year-old diabetic presents with a 3 month history of midtarsal foot pain
bilaterally. HbA1c 7.6%, ESR 22, uric acid 0.38. X-ray shown – bilateral midtarsal joint destruction. Most likely diagnosis is:
a)
osteoarthritis
b)
rheumatoid arthritis
c)
septic joint
d)
neuropathic arthropathy
e)
gout
(?)
(?)
(e)
(?)
- 26 -
Paper 1 – Medical Sciences
Rheumatology:
1.
In a patient on long-term treatment of Pagets disease which of the following
bisphosphonates is most likely to result in defective bone mineralisation?
a)
Alendronate
b)
Pamidronate
c)
Clodronate
d)
Tiludronate
e)
Etidronate
2.
The following is dual energy Xray absorptiometry result in a 70-year-old with
rheumatoid arthritis:
(?)
Hip
Lumbar spine
T-score
(std day from mean of
young normals)
-2
1.3
Z-score
(std day from mena of
age matched controls)
-3
1.0
What is the best explanation for the discrepancy between hip and lumbar spine?
a)
technical error
b)
Pagets disease
c)
Spondylosis
d)
Synovitis in hip joint
e)
Spinal metastases
(?)
Paper 2 – Clinical Applications
3.
90-year-old female complaining of right hip pain, worse on lying on her right and
crossing her right leg over the left, the most likely cause is:
a)
osteoarthritis
b)
Meralgia paraesthetica
c)
Trochanteric bursitis
d)
Sciatica
e)
Fractured neck of femur
4.
A 31-year-old presents with a malar rash on her face and arms, mild arthralgra
and malaise. Blood tests basically normal except for a strongly positive ANA.
Next best treatment is:
a)
Paracetamol
b)
Naproxen
(?)
- 27 -
c)
d)
e)
Prednisone 15mg daily
Hydroxychloroquine
Methotrexate
(?)
5.
A 6 0-year-old male presents with cough and haemoptysis. There is a long
history of smoking. Clinically euvolemic and on no medications. Serum sodium
11g, C1, K, Cr, Ur normal. Next best treatment:
a)
Demeclocyline
b)
Fluid restriction
c)
Hypertonic saline
d)
Isotonic saline
e)
Inhaled ADH
6.
A 36-year-old woman presents with pain in the right wrist along the radial
styloid. Examination reveals no obvious swelling but tenderness is present over
the distal radius. On flexing the right wrist medially with the thumb in the
extended position from the palmar surface there is exacerbation of the pain over
the radial styloid. What is the likely diagnosis?
a)
Osteoarthritis of the first metatarsophalyngeal joint
b)
Avascular necrosis of the distal radius
c)
Rheumatoid arthritis
d)
DeQuervain’s tenosynovitis
e)
??
7.
A 72-year-old woman presents with shoulder girdle and pelvic girdle pain. The
ESR is 126mm/Hr and the CRP is 35. The most likely diagnosis:
a)
Polymyalgia rheumatica
b)
Polymyositis
c)
Inclusion body myositis
d)
Temporal arteritis
e)
??
8.
A 58-year-old man has intermittent pain in the left wrist and right knee. On
examination there is mild tenderness in the affected joints, but there is no
effusion or erythema. X-ray of right knee shown (periosteal reaction). The next
best test is:
a)
Joint aspiration
b)
Bone scan
c)
CXR
d)
Serum calcium and PTH
e)
??
9.
A 58-year-old woman with long-standing rheumatoid arthritis presents with right
groin pain radiating to the knee.
(b)
(?)
(a)
©
- 28 -
What is the cause of the pain
a)
synovitis
b)
purple villonodular synovitis
c)
osteoarthritis
d)
ankylosing spondylitis
e)
avascular necrosis
(?)
10.
A 72-year-old woman with presents with shoulder girdle and pelvic girdle pain.
The ESR is 126mm/Hr and the CRP is 35. The most likely diagnosis:
a)
Polymyalgia rhematica
b)
Polymyositis
c)
Inclusion body myositis
d)
Temporal arteritis
e)
??
f)
A 44-year-old man presents with a four-day history of painful right knee. He has
a 10-year history of fleeting pains in his ankle, wrist… On examination he has a
tender, warm, swollen right knee with an effusion. He also has tenderness of his
wrist, left elbow, right ankle and forefoot. A previous x-ray of his right foot is
shown
(?)
The most likely cause of his symptoms is:
5. rheumatoid arthritis
6. gout
7. chondrocalcinosis
8. seronegative arthritis
9. septic arthritis
(b)
Paper 1 – Medical Sciences
Clinical Trials:
1.
In a randomized controlled trial of smoking cessation in chronic obstructive
airway disease. If an intention to treat analysis is used which of the following
can occur:
a)
selection bias
b)
overestimation of benefit
c)
underestimation of benefit
d)
failure to account for confounders
e)
outcome bias
©
- 29 -
Paper 1 - Medical Sciences
Haematology:
1.
32-year-old male who has fatigue and splenomegaly of 20 cm, WCC of 480, has
a bone marrow biopsy consistent with chronic myeloid leukaemia in the chronic
phase. The best treatment that improve long-term that will improve long-term
disease free survival is:
a)
Interferon
b)
Interferon and cytarabine
c)
Hydroxyurea
d)
Autologuous bone marrow transplant
e)
Allogenelc bone marrow transplant
2.
Which of the following cell type in bone marrow is the largest proportion of cells
in active cell cycle
a)
pluripotent stem cell
b)
myelocytes
c)
myeloblasts
d)
metamyelocytes
e)
granulocyte reserve pool
3.
A 42-year-old woman with no clinical risk factors for deep vein thrombosis
presents with an above knee DVT on the right and probable pulmonary
embolism. The most likely cause to be found on investigation of thrombophilia
is:
a)
Protein C deficiency
b)
Protein S deficiency
c)
Dysfibrinogenaemia
d)
Factor V Leiden
e)
Lupus anticoagulani
4.
A 58-year-old with myelodysplasia requires recurrent transfusions of packet red
cells for anaemia. While having a transfusion he has a non-haemolytic febrile
episode. The use of a filter during transfusion will benefit the patient by which
of the following mechanism.
a)
Removal of donor cytokines
b)
Removal of donor leukocytes
c)
Isohaemagglutination of the donor’s red cells
d)
Removal of plasma proteins
e)
Reducing transfusion associated viral infection
(?)
©
(?)
(?)
Paper 2 – Clinical Applications
- 30 -
5.
60-year-old male with a past medical history of COAD and osteoarthritis is
admitted with bleeding gums and severe bruising. He is on nebulised salbutamol
and piroxicam to joint pain. (Peripheral film shown).
D-dimer < 0.19
INR 1.0
APTT 32
PT 15
Platelets 65
Urea 28
Creatinine 0.36
What is the likely diagnosis?
a)
Gram negative sepsis
b)
Thrombocytopenic thrombotic purpura
c)
Disseminated intravascular coagulation
d)
Piroxicam toxicity
e)
Drug effect
(?)
6.
Elederly lady, increased bilirubin 51, increased LDH 750, C3b +++, MCV 115,
macrocytic anaemia, platelets 456. Most likely to see on blood film:
a)
target cells
b)
RBC agglutination
c)
RBC fragmentation
d)
Heinz bodies
e)
?
7.
A 75-year-old man with a background of IHD and previous heavy smoker has a
hip fracture and is waiting internal fixation in the next three days. ECG shows
left bundle branch block. Blood tests reveal Hb 219, Hct 0.69, WCC 113 with
mild neutrophilia, platelets 412, electrolytes and renal function normal. Serum
erythropoeitin will not be back for 6 weeks. The best initial treatment is:
a)
venesection
b)
alpha interferon
c)
hydroxyurea
d)
therapeutic anticoagulation
e)
radioactive phosphorus
8.
A 35-year-old woman presents with spontaneous bruising. INR 1.0. Platelet
count 19. What is the next appropriate management?
a)
Danazol
b)
Prednisone
c)
Intravenous Gammaglobulin
d)
Platelet transfusion
e)
Tranexamic acid
(?)
(?)
(?)
- 31 -
9.
A 42-year-old woman with several weeks of lethargy. On clinical examination
she is anaemic and mildly icteric. She has a normal varied diet and is on no
medication. Investigations:
Haemoglobin 67 g/L
Monocytes 0.7 x 109
MCV 129
Eosinophils 0.5 x 109
9
Leukocytes 3.1 x 10 (4-11)
Basophils 0.2 x 109
9
Neutrophils 1.4 x 10 (1.5Platelets 98 x 109(130-330)
9
Lymphocytes 0.9 x 10
Reticulocytes 4 (8-108)
Her blood film is shown
The most likely diagnosis is:
a)
Evans syndrome (thrombocytopaenia and autoimmune haemolytic
anaemia)
b)
Aplastic anaemia
c)
Pemicious anaemia
d)
Hypothyroidism
e)
Alcoholic liver disease
(?)
Paper 1 – Medical Sciences
Geriatrics:
1.
The best indicator of aspiration in a patient with stroke and oropharyngeal
dysphagia is:
a)
facial weakness and drooling
b)
dysarthria
c)
absent bilateral gag reflex
d)
moist vocal sounds and weak cough
e)
refusal to eat
2.
Which of the following is the least likely cause of constipation in the elderly in a
nursing home
a)
poor dietary habit
b)
sedentary habits
c)
decrease in gastrointestinal transit time
d)
laxative abuse
e)
polypharmacy
(d)
(?)
Paper 2 – Clinical Applications
3.
An 85-year-old woman presents with urinary incontinence on exertion. She has a
past history of congestive cardiac failure, hypertension, and osteoarthritis.
- 32 -
Examination reveals a cystocoele 2 cm below urethra which appears with
straining, followed by incontinence. Best treatment:
a)
Oxybutinin
b)
Intravaginal ring
c)
Pelvic floor exercises
d)
Gynaecological surgical repair
e)
Pelvic floor exercises and bladder training
(?)
4.
Which of the following is least likely to be associated with dementia:
a)
motor neurone disease
b)
Huntington’s disease
c)
multiple sclerosis
d)
stroke
e)
Parkinson’s disease
5.
An 80-year-old woman with recent onset depression responds in 4 months to
standard antidepressant therapy and behavioural cognitive therapy. What is the
best way of continue management:
a)
half dose antidepressant
b)
full dose antidepressant
c)
social network – counseling
d)
half dose antidepressant and counseling
e)
full dose antidepressant and counseling
6.
An 83-year-old woman is brought to you by her son. She has been increasingly
forgetful, not looking after herself or eating well noticeable weight loss. She is
otherwise in general good health and is on no medication. A CT scan of her
brain is normal. The next most helpful test is:
a)
Perform an MRI scan of her brain
b)
Perform an electroencephalogram
c)
Test cognitive and psychological function
d)
Test 812 and folate levels
e)
Perform thyroid function tests
(?)
(?)
(?)
Paper 2 – Clinical Applications
RS (RESP – unsure if these questions are part of respiratory)
1.
A 65-year-old man with a 28 pack-year history of smoking presents with
increasing shortness of breath and exercise intolerance. On examination there is
reduced chest expansion, increased percussion note and reduced breath sounds
bilaterally. Resting SaO2 90%. Spirometry results: FEV, 0.9L/s, FVC 2.1 L/s.
Post bronchodilator: FEV, 1.1 / FVC 3.0. DLCO 50%. What is the least likely
to improve following an exercise rehabilitation program:
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a)
b)
c)
d)
e)
Lung function tests
Exertional dyspnoea
Exercise tolerance
Quality of life
Exacerbation of CAL
(?)
2.
A 17-year-old farm worker presents with right sided chest pain. He is afebrile,
not tachypnoeic and not tachycardic. CXR shows large right-sided lung
opacification in the lower zone with and air-fluid leved. What is the best
treatment:
a)
albendazole
b)
intravenous amoxycillin and metronidazole
c)
intercostals chest catheter
d)
intravenous lmipenem, Flagyl, and Gentamicin
e)
Rifampicin, isoniazid, Ethambutol, Pyrazinamide
(a)
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