A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. Wh

Make your own quiz Manage my Quizzes Plans / Features Guides and Help Contact Privacy & Security

A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. What is this most likely to be due to?

A. A median nerve injury

B. An ulnar nerve injury

C. A musculo-cutaneous nerve injury

D. An anxilliary nerve injury

E. A radial nerve injury

In the management of pneumothorax, what is the best indication that the intercostal catheter can be removed?

A. The size of the pneumothorax is less than 25% of the lung volume on chest x-ray

B. There is lack of bubbling in underwater seal drain with suction

C. There is lack of bubbles with cough in underwater seal drain

D. There is presence of swing and no bubbling in underwater seal drain

E. There is resolution of pleuritic chest pain

A 75 year old man, presents with painless loss of vision in the left eye one hour ago. VAR:6/9, VAL:light perception only. There is a left afferent pupil defect. He has been on an ACE inhibitor for hypertension. What do you see when you look into his left eye with a direct ophthalmoscope?

A. Signs of age-related macular degeneration

B. Some blot haemorrhages and hard exudates near the macula

C. A dense nuclear cataract makes the view of a probably normal optic disc and macula difficult

D. The macula has an orange/red spot and the surrounding retina looks pale, with marked attenuation of the retinal arterioles and segmentation of blood in the retinal veins

E. A swollen optic nerve and a normal retina

A 26 year old woman has a history of wheezing as a child. She has suffered from seasonal rhinitis in recent years. She is brought in by ambulance from a night club having developed severe shortness of breath. Which of the following findings is in keeping with a severe asthma attack?

A. Respiratory rate of 8/min

B. Blood pressure of 85/60 mmHg

E. Adjuvant chemotherapy is unsuitable for patients over 65 years of age

C. Inspiratory rhonchi on auscultation

D. Bilateral basal crackles on auscultation

E. 88 percent oxygen saturation on pulse oximetry

A 26 year old nurse has had wheezy bronchitis as a child. She went to a night club and suffered an attack of asthma. She is given nebulised salbutamol in the Emergency Department. Which of the following is the best explanation of why Salbutamol produces bronchodilation?

A. Antagonises muscarinic cholinergic receptors on airway smooth muscle

B. Increases cyclic AMP in airway smooth muscle cells

C. Inhibits the sodium channels in airway epithelial cells

D. Increases the firing rate of neurones in the brain stem respiratory centre

E. Antagonises beta adrenergic receptors on airway smooth muscle

A 25 year old man who sustains a clean, fairly superficial, 3cm long laceration to his left forearm on a piece of broken glass. Which one of the following statements about management is true?

A. Prophylactic antibiotics are required

B. Thorough cleansing with saline is the decontamination method of choice

C. Immediate tetanus prophylaxis is required as this is a tetanus-prone wound

D. X-ray is required even if the whole length and depth of the wound can be visualized

E. The wound should be closed in layers

Regarding the anatomy of the lungs, which of the following statements is correct?

A. The left lung is larger and heavier than the right

B. The lungs are supplied with oxygenated blood by the pulmonary arteries

C. The lungs are invested by parietal pleura

D. The middle lobe is the smallest lobe of the left lung

E. The apices of the lungs may pass above the thoracic inlet (1st rib)

A 30 year old woman, presents with a 2-day history of fever, vomiting and mild right-sided flank pain. She has evidence of right renal angle tenderness on examination. Urinalysis shows the presence of polymorphonuclear leucocytes and nitrates. What would be the next most appropriate investigation?

A. Abdominal ultrasound

B. Urine microscopy and culture

C. Intravenous pyelogram

D. Serum creatinine levels

E. Cystourethroscopy

Which of the following does the median nerve innervate?

A. All the muscles moving the thumb

B. Opponens pollicis

C. Adductor pollicis

D. The skin on the dorsum of the 5th digit

E. The medial two lumbricals

A 69 year old man presents to the doctor with an acutely swollen right knee. He has had previous episodes of acute pain and swelling in his big toes and ankles over the last 10 years. What is the most appropriate initial investigation to determine the diagnosis?

A. X-ray of the knee

B. Microscopy of synovial fluid

C. Full blood count

D. Serum uric acid

E. MRI of the knee

A 75 year old woman who presents with a six-month history of pain in her right knee, which is worse with prolonged walking. She has no relevant past history. Physical examination reveals a small effusion and crepitus on movement. Her body mass index is 32. You make a diagnosis of osteoarthritis Which of the following is the most important initial aspect of treatment?

A. Paracetamol

B. Non-steroidal anti-inflammatory drugs

C. Arthroscopy plus lavage

D. Avoidance of walking

E. Weight loss

Mrs Betty Smith is a 75 year old woman with osteoarthritis for whom you prescribe diclofenac. Which one of the following statements about diclofenac sodium is correct?

A. It inhibits both Cox I and Cox II isoenzymes

B. It does not affect platelet aggregation

C. It does not reduce renal blood flow in normal kidneys

D. It has no analgesic properties

E. It does not affect prostaglandin-mediated protection of the gastric mucosa

A 22 year old woman who is an active intravenous drug user presents to her general practitioner, six weeks pregnant. On investigation she is found to be positive for anti-hepatitis C virus (HCV). Her hepatitis A and B and HIV serology are negative. What advice is most appropriate for this patient at this point?

A. The risk of transmission of Hepatitis C to the fetus is > 80%

B. She should be vaccinated against hepatitis A and B unless she is already immune

C. She should commence antiviral treatment

D. She can expect to develop symptoms of hepatitis as her pregnancy progresses

E. She should reduce her alcohol consumption

What is the most important direct action of the hormone 1,25 Dihydroxyvitamin D?

A. Decrease bone resorption

B. Reduce urine phosphate losses

C. Reduce urine calcium losses

D. Potentiate the action of parathyroid hormone

E. Increase gut calcium absorption

With regard to the pathology of rheumatoid arthritis, which of the following statements is correct?

A. Rheumatoid arthritis involves amphiarthroses (fibrocartilagenous joints)

B. Pannus destroys articular cartilage and underlying bone

C. Rheumatoid erosions are typically subchondral

D. Rheumatoid nodules are typically caseating granulomas

E. Rheumatoid arthritis is typically associated with periarticular sclerosis

A 28 year old man, is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from a wound. Which of the following is the correct terminology to describe his fracture?

A. Greenstick fracture

B. Pathological fracture

C. Stress fracture

D. Impacted fracture

E. Compound fracture

A 28 year old man, is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from an anterior wound. Which of the following is the most likely early complication?

A. Femoral artery injury

B. S1 nerve root injury

C. Ruptured bladder

D. Pulmonary embolus

E. L5 nerve root injury

Soft tissue healing is an ordered process. Which of the following is NOT a stage in this type of wound healing?

A. Acute inflammatory reaction

B. Formation of fibrous tissue

C. Granuloma formation

D. Formation of the coagulum

E. Angiogenesis

A 28 year old man is travelling in Thailand when he is involved in a motor vehicle accident. He is taken to a local hospital with visible bone protruding from a wound in his mid-thigh. He undergoes transfusion with multiple units of whole blood as part of his immediate treatment. Six weeks later he develops jaundice. He undergoes a series of tests to investigate his jaundice. Which of the results suggests that his jaundice is likely to be related to his blood transfusion?

A. The presence of Anti-Hepatitis C Virus antibody

B. Elevated Alanine amino-transferase

C. The presence of Anti-Hepatitis B Surface Antigen antibodies

D. Elevated gamma-glutamyl transferase

E. Elevated aspartate amino-transferase

A 54 year old asthmatic woman, presents for a routine check up and isfound to have a blood pressure of 150/90mmHg. Examination reveals she is moderately overweight (BMI 28 kg/m²), in sinus rhythm with a heart rate of 80 beats per minute and has an audible fourth heart sound. Which one of the following clinical features is NOT relevant to the possible causation of hypertension in this patient?

A. A history of snoring

B. The detection of a carotid bruit

C. The detection of an abdominal bruit

D. A history of regular alcohol consumption

E. A history of chronic oral steroid use for severe asthma

Gail Tran is a 39 year old woman who is 20 weeks pregnant. You have just received her amniocentesis result which shows: 47 XY Trisomy 21. What is the most common cause of a left to right cardiac shunt in an infant with Trisomy 21?

A. Ventricular septal defect

B. Atrial septal defect

C. Tetralogy of Fallot

D. Atrial septal defect with pulmonary hypertension

E. Transposition of the great vessels

Regarding the blood supply to the heart, which of the following statements is correct?

A. The left and right coronary arteries arise from the arch of the aorta

B. The left and right coronary arteries are usually of equal length

C. The anterior interventricular artery is a branch of the right coronary artery

D. The right coronary artery descends on the heart between the right atrium and ventricle

E. The left coronary artery usually supplies the atrioventricular (AV) node

Regarding the anatomy of the heart, which one of the following statements is most correct?

A. The coronary arteries are the first branches of the arch of the aorta

B. Papillary muscles are located in the atria and the ventricles of the heart

C. The coronary sinus drains directly into the right atrium

D. The openings of the pulmonary veins into the left atrium are usually guarded by valves

E. The pulmonary valve has 2 cusps

SOK, aged 63, is in left ventricular failure following a myocardial infarct. Which of the following is the most appropriate to maximise life expectancy?

A. Digoxin - to increase the force of cardiac contraction

B. ACE inhibitors - to inhibit the renin-angiotensin system

C. Beta-adrenoreceptor agonists - to increase the force of cardiac contraction

D. Alpha-adrenoreceptor antagonists - to reduce systemic vascular resistance

E. Diuretics - to reduce ventricular preload

A 36 year old woman who presents with palpitations and is found to have significant mitral stenosis. Which of the following arrhythmias is the most likely cause of her palpitations?

A. Atrial fibrillation

B. Ventricular fibrillation

C. Atrial tachycardia

D. Ventricular tachycardia

E. Ventricular bradycardia

Where should the normal apex beat be palpated whilst undertaking a cardiovascular examination?

A. Left 5th intercostal space, anterior anxillary line

B. Left 5th intercostal space, mid-clavicular line

C. Left 6th intercostal space, mid-clavicular line

D. Left 6th intercostal space, anterior axillary line

E. Left parasternal edge, 5th intercostal space

Mr Wong, a 53 year old office worker, is found by his General Practitioner to have a blood pressure of 150/95mmHg. Which one of the following findings is most likely?

A. Normal renal function

B. A renal artery bruit

C. An elevated adrenocorticotropic hormone (ACTH) level

D. An elevated adrenaline level

E. An elevated noradrenaline level

Which one of the following is the specific treatment for paracetamol overdose?

A. Activated charcoal

B. Naloxone

C. Celecoxib

D. Frusemide

E. N-acetyl cysteine

The cranial nerves IX, X, XII are characterised by the fact that they all emerge from which one of the following structures?

A. Midbrain

B. Pons

C. Medulla

D. Thalamus

E. Spinal cord

Which one of the following statements about the skeleton is true?

A. The ulna is lateral to the radius

B. The metacarpals are numbered from 1 to 5 from the medial side

C. The metatarsals are numbered from 1 to 5 from the medial side

D. There are 14 phalanges in the hand and 13 phalanges in the foot

E. The elbow joint is an articulation between two bones

A 30 year old woman presents with polyuria and is diagnosed with diabetes mellitus. She has a blood glucose level of 24 mmol/L. Which of the following is the strongest indication to commence insulin treatment immediately?

A. Her very high blood glucose level

B. Her age

C. Her symptomatic hyperglycaemia

D. Presence of moderate blood ketones

E. Vaginal candidiasis

Macrocytosis refers to enlarged red cells while the term megaloblastosis refers to a specific morphological appearance observed in haemopoietic cells forming in the absence of adequate amounts of either vitamin B12 or folate. Which of the following morphological features in a peripheral blood smear indicates megaloblastic haemopoiesis?

A. Hypersegmented neutrophils

B. Target cells

C. Platelet clumps

D. Reduced neutrophil granulation

E. Eosinophilia

Which one of the following is the correct order of tissues lining the gastrointestinal tract from the lumen (inside) outwards?

A. Epithelium, lamina propria, muscularis mucosa, submucosa, muscularis externa

B. Epithelium, muscularis mucosa, lamina propria, submucosa, muscularis externa

C. Epithelium, lamina propria, muscularis externa, submucosa, muscularis mucosa

D. Epithelium, lamina propria, muscularis mucosa, muscularis externa, submucosa

E. Epithelium, muscularis externa, submucosa, muscularis mucosa, lamina propria

Which of the following is true regarding surgical therapy for colorectal cancer?

A. Adjuvant therapy is indicated for all patients with colorectal cancer

B. The goal of adjuvant therapy is to improve the chances of cure

C. Adjuvant radiotherapy is indicated for patients with colon cancer

D. Adjuvant chemotherapy for colon cancer should continue for at least 12 months

E. Adjuvant chemotherapy is unsuitable for patients over 65 years of age

What is the laryngeal prominence (Adam's apple) in the neck formed by?

A. Epiglottis

B. Hyoid bone

C. Thyroid cartilage

D. Cricoid cartilage

E. Thyroid gland

E. Adjuvant chemotherapy is unsuitable for patients over 65 years of age

What is the most useful guide to the likely post-operative opioid requirements of a patient undergoing a laparotomy?

A. The weight of the patient

B. The estimated lean body mass of the patient

C. The gender of the patient

D. The age of the patient

E. The magnitude of the surgery

A 55 year old woman, presents to the Emergency Department with a 24 hour history of right upper quadrant pain, passing dark coloured urine and a fever of 38.7ºC. Abdominal ultrasound shows multiple gallstones in the gallbladder and adilated common bile duct of 1.5 cm. What is the most likely diagnosis?

A. Acute appendicitis

B. Acute pancreatitis

C. Acute cholecystitis

D. Acute cholangitis

E. Acute hepatitis

Which of the following statements about the autonomic nervous system is most accurate?

A. The cell bodies of sympathetic preganglionic neurons are located in the ventral horn of the thoracic and lumbar segments of the spinal cord

B. In response to stress, sympathetic nerves regulating different effectors tend to be activated simultaneously

C. Sympathetic preganglionic neurons receive direct inputs from primary afferent nerves that enter the spinal cord at the same segmental level

D. Most sympathetic and parasympathetic ganglia are remote from their target organs

E. In quadriplegic patients, an increase in blood pressure evokes a reflex change in heart rate

A 19 year old girl presents to the Emergency Department with a one day history of drowsiness, headache, fever and photophobia. There is no history of trauma, and she doesn't have a rash. Which of the following is the most appropriate next step in managing this patient?

A. Prescribe opioids to treat her headache

B. Administer intravenous antiobiotics urgently after blood cultures

C. CT scan of the brain

D. Lumbar puncture with CSF sampling

E. Await results of full blood count and other inflammatory markers

Radiotherapy with or without chemotherapy can be used to cure (without surgery) all of the cancers listed EXCEPT which of the following below?

A. Lymphoma

B. Anal cancer

C. Colon cancer

D. Cervix cancer

E. Laryngeal cancer

Which of the following pharmacological agents used in the management of type 2 diabetes is NOT associated with significant weight gain?

A. Metformin

B. Sulphonylureas

C. Short acting insulin

D. Thiazolidinediones

E. Biphasic insulin

Which of the following is NOT a recognised side effect of non-steroidal antiinflammatory drugs (NSAIDs)?

A. Peptic ulceration

B. Bleeding

C. Renal impairment

D. Aggravation of asthma in some patients

E. Squamous cell carcinoma of the skin

A patient with Parkinson's disease has been treated successfully for several years with a levodopa based medication. He has recently developed prominent involuntary writhing movements of the limbs. Which of the following terms describes this phenomenon?

A. Hypokinesia

B. Akinesia

C. Bradykinesia

D. Dyskinesia

E. Hyperkinesia

A 64 year old female presents with a two-year history of perianal itching and irritation more noticeable in the past month. Inspection of the perineum shows an area of hyperkeratosis, leucoplakia and an associated large irregular ulcer on the anal verge in the mid-line posteriorly. What should be the next step in her management?

A. Perform a wide local excision

B. Prescribe a steroid cream

C. Patient to apply rectogesic ointment 5 percent (nitroglycerin-base)

D. Perform an internal anal sphincterotomy

E. Perform an incisional biopsy

Which of the following is the least important factor contributing to Total lung capacity (TLC)?

A. Age

B. Height

C. Lung elastic recoil

D. Chest wall recoil

E. Gender

Which of the following has the least effect on the diffusing capacity for carbon monoxide of the lung at rest?

A. The physical properties of carbon monoxide

B. Pulmonary capillary blood volume

C. Thickness of the blood-gas barrier

D. Haemoglobin level in the blood

E. Area of the blood gas interface

A 45 year old man is involved in a motor vehicle accident. He presents 2 weeks later with pain involving the right shoulder, scapula and upper limb. What sensory findings would be suggestive of a C6 radiculopathy?

A. Numbness in a patch over the deltoid

B. Parasthesia over the upper trapezius

C. Numbness in the axilla

D. Paraesthesia of the index finger and thumb

E. Numbness of the little and ring fingers

Which of the following joints are affected most commonly by osteoarthritis?

A. Metacarpophalangeal joint

B. Ankle joint

C. Elbow joint

D. Distal interphalangeal joint

E. Shoulder joint

How does chronic suppurative otitis media most commonly present?

A. Recurrent painless aural discharge

B. Acute aural discharge accompanied by pain

C. Hearing loss

D. Facial palsy

E. An incidental finding of a perforated ear drum

Mary is a 17 year old student who presents complaining of recurrent nasal discharge, irritation and sneezing. What is the most likely cause of her complaint?

A. Deviated nasal septum

B. Infective sinusitis

C. Nasal foreign body

D. Allergic rhinitis

E. Rhinitis medicamentosa

Which of the following not an indication for tracheotomy?

A. Acute air way obstruction

B. Prolonged ventilation

C. Recurrent bronchial toilet

Moderate sleep apnea

Major head and neck cancer resection

Chandra, a 50 year old Indian migrant, presents with a two week history of high spiking fever and right upper quadrant pain. A CT scan of the abdomen shows features of a liver abscess. Ultrasound guided aspiration of the collection shows fluid that looks like anchovy sauce. What is the most likely diagnosis?

A. Staphylococcus liver abscess

B. Amoebic liver abscess

C. Hydatid liver abscess

D. Tuberculous liver abscess

E. E. Coli liver abscess

A 17 year old girl, presents with a 1-day history of central abdominal pain that then localises to the right lower quadrant of the abdomen. This is associated with nausea, decreased appetite and a temperature of 37.8°C. What is the most appropriate initial management of this patient?

A. β HCG

B. Pelvic ultrasound

C. Urgent O&G review to exclude pelvic inflammatory disease

D. Laparoscopy

E. Start broad spectrum antibiotics

A 24 year old student, presents at the Emergency Department with sudden onset of a cough and high fever. Chest X-ray shows a left lower lobar consolidation and further history reveals frequent sinus infections requiring antibiotics, and two episodes of lobar pneumonia in the past 5 years. Which of the following organisms is most likely to be responsible for his repeated infections?

A. Haemophilus influenza

B. Streptococcus pneumonia

C. Moraxella catarrhalis

D. Pneumocystis jiroveci

E. Pseudomonas aeruginosa

Type I diabetes mellitus is caused by an auto-immune process.

A. Anti-insulin antibodies

B. Anti-glutamic acid decarboxylase antibodies

C. Infiltrate of islets by CD4+ and CD8+ T cells

D. Ant-islet cell antibodies

E. Complement mediated damage of the islets

A 39 year old receptionist with a history of chronic asthma, has her blood pressure checked by her GP. It is found to be 165/95 mmHg. The patient’s body mass index is 32 kg/m² (NR: 20 -25kg/m 2 ) and the remainder of the physical examination is normal. Urinalysis is negative for blood and protein. Which of the following anti-hypertensive agents is contraindicated in this case?

A. Perindopril

B. Atenolol

C. Nifedipine

D. Hydrochlorothiazide

E. Prazosin

An 85 year old woman comes to see you, her local doctor, with her daughter. Her daughter tells you that her mother has become increasingly confused over the last week. She has also developed increasing generalised weakness, poor mobility and her overall ability to carry out her activities of daily living has deteriorated. Which of the following investigations would you perform first?

A. Electrolytes

B. Computed tomography (CT) scan of the brain

C. Full blood count

D. Dipstick urine analysis

E. Creatinine kinase

What is the main vein draining the brain?

A. Internal jugular vein

B. External jugular vein

C. Internal carotid vein

D. External carotid vein

E. Vertebral vein

Which of the following micro-organisms is the commonest cause of communityacquired pneumonia?

A. Haemophilus influenzae

B. Staphylococcus aureus

C. Streptococcus pneumoniae

D. Pseudomonas aeruginosa

E. Klebsiella pneumonia

How is an "open" fracture defined?

A. There is a full thickness break of the bone

B. Requires surgical (open) reduction

C. Requires antibiotic therapy

D. Requires internal (surgical) fixation

E. Associated with a breach in the overlying skin

Which of the following is NOT a stage in normal soft tissue wound healing?

A. Acute inflammatory reaction

B. Formation of fibrous tissue

C. Granuloma formation

D. Formation of the coagulum

E. Haemostasis

Which of the following is the main risk factor for ischaemic heart disease in men and women older than 75?

A. Hypertension

B. Age

C. Cholesterol

D. Smoking

E. Obesity

Which of the following tests is most likely to establish a definitive microbiological diagnosis in a patient with community-acquired pneumonia?

A. Gram stain of sputum

B. Bacterial culture of sputum

C. Bacterial culture from a throat swab

D. Blood cultures

E. Serological assays

Which of the following investigations is useful in the monitoring of rheumatoid arthritis?

A. C- reactive protein

B. Anti DNA antibodies

C. X-rays of the lumbar spine

D. Serum uric acid level

E. Serum creatinine

A 45 year old woman presents with a 3 month history of arthritis. Physical examination reveals tender swollen metacarpo-phalangeal joints in a symmetrical pattern. What is the most likely diagnosis?

A. Rheumatoid arthritis

B. Systemic lupus erythematosis

C. Reactive arthritis

D. Gout

E. Psoriatic arthritis

A 58 year old man is treated with diuretics for his mild essential hypertension. His blood gas results are shown below: PaO2 = 92 mmHg (normal range: 80-100 mmHg) PaCO2 = 44 mmHg (normal range: 35-45 mmHg) pH = 7.50 (normal range: 7.35-7.45) BE = +10 mmol/L (normal range: -2-+2 mmol/L) Which of the following best describes this picture?

A. Compensated metabolic acidosis

B. Uncompensated metabolic alkalosis

C. Compensated respiratory acidosis

D. Uncompensated respiratory alkalosis

E. Compensated respiratory alkalosis

Acob Butler is an 18 year old motorcyclist who is brought to hospital by ambulance following a single-vehicle crash. He has a compound fracture of the right femur and is agitated and disorientated. Which of the following is NOT an immediate priority?

A. Assess air-entry and position of the trachea

B. Check upper airways to ensure patency

C. Urgent full blood count

D. Urgent blood sugar level

E. Establish intravenous access

Hyperalgesia is defined as which of the following?

A. Loss of sensitivity to pain

B. Increased sensitivity to touch

C. Increased sensitivity to pain

D. Pain response to non-noxious stimulus

E. Increased numbers of nociceptors

Regarding the uterine tubes, which of the following statements is NOT correct?

A. They have smooth muscle in their wall

B. They connect to the junction of body and fundus of uterus

C. They are most dilated at the isthmus

D. They are located in the upper part of the broad ligament

E. They open laterally into the peritoneal cavity

Regarding the scapula, which one of the following statements is correct?

A. It helps form the acromioclavicular joint

B. It is not involved in force transfer from the upper limb to the thorax

C. The suprascapular notch transmits the radial nerve

D. Only two of the musculotendinous cuff muscles attach to it

E. The spine of the scapula is at the level of thoracic vertebra seven

Which of the following terms best describes the usual response of cardiac myocytes to hypertension?

A. Atrophy

B. Metaplasia

C. Hyperplasia

D. Hypertrophy

E. Dysplasia

During pregnancy, which one of the following infectious diseases has the lowest risk of causing congenital infection?

A. Toxoplasmosis

B. Syphilis

C. Rubella

D. Listeriosis

E. Tuberculosis

Which of the following statements about right-sided heart failure is true?

A. The most frequent cause is left-sided cardiac failure

B. Pulmonary oedema is a consequence

C. When the disorder is a result of lung disease, left ventricular hypertrophy is likely

D. The liver compensates with cirrhosis and shrinkage

E. Pitting oedema of dependent parts is a common sign

Maternal cardiovascular changes during pregnancy include which one of the following?

A. A decrease in cardiac output

B. Systemic vasoconstriction

C. Vasoconstriction of the renal arterioles

D. A decrease in red blood cell production

E. An increase in blood volume

Regions that are innervated by the ulnar nerve include which of the following?

A. The lateral epicondyle of the humerus

B. Skin over the palmar surface of the thumb

C. The 1st and 2nd (lateral) lumbrical muscles

D. Skin over the palmar surface of the little (5th) finger

E. The thenar muscles

In the context of drug use, which one of the following statements best describes the difference between addiction and dependence?

A. Dependence is the diagnostic term

B. There is no difference between the terms

C. A withdrawal syndrome is always present in addiction

D. Addiction is an antiquated term which has been replaced with dependence

E. Dependence and addiction refer to the physical attributes of drug and alcohol problems

Regarding genital chlamydial infections, which of the following statements is FALSE?

A. It is frequently asymptomatic

B. It can be treated with a single dose of an antibiotic

C. It can lead to pelvic inflammatory disease (PID) in females

D. Polymerase chain reaction (PCR) assays are useful for diagnosis

E. The period of infectivity is 7-14 days after infection

If a patient has an isolated iron deficiency, which of the following sets of results would you expect to find?

A. Low serum iron, normal serum transferrin and low serum ferritin

B. Low serum iron, high serum transferrin and low serum ferritin

C. Low serum iron, high serum transferrin and normal serum ferritin

D. Low serum iron, low serum transferrin and high serum ferritin

E. Normal serum iron, low serum transferrin and low serum ferritin

Which of the following is a feature of the inferior vena cava?

A. It is formed by the union of brachiocephalic veins

B. It travels behind the spleen

C. It drains the lower lobe of the lungs

D. It is formed by the union of portal and superior mesenteric veins

E. It empties blood into the right atrium

Smoking is a known risk factor for a number of cancers. Smoking cessation can modify a person’s risk of these cancers. Despite this, smoking cessation has NOT been shown to reduce the risk of which of the following?

A. Oesophageal cancer

B. Pancreatic cancer

C. Colon cancer

D. Lung cancer

E. Cervical cancer

Which of the following agents/devices used in the treatment of pulmonary embolism is associated with the highest risk of serious bleeding?

A. Unfractionated heparin

B. Low molecular weight heparin

C. Tissue plasminogen activator (TPA)

D. Inferior vena caval filters

E. Warfarin

An obese 65 year old female with renal failure has had a laparotomy. On day five post operative she develops copious serous ooze from her midline abdominal wound. She is afebrile. This is likely to be due to which of the following?

A. Wound abscess

B. Wound dehiscence

C. Normal wound healing

D. Allergic reaction to the sutures

E. Bowel fistula

A 15 year old male presents with central periumbilical pain, a low grade temperature and nausea. Over the next couple of hours, the pain shifts to the right iliac fossa. Which of the following is the most likely diagnosis?

A. Mesenteric lymphadenitis

B. Acute appendicitis

C. Crohn's disease

D. Pelvic inflammatory disease

E. Meckel's diverticulitis

What is an advantage of tramadol over morphine?

A. Fewer interactions with antidepressants compared with morphine

B. Less respiratory depression

C. Less likely to cause seizures

D. Less diarrhea

E. Easily reversed with flumazenil

Sara presents to the Emergency Department with 5 days of cough, 2 days of fever and increased lethargy. Her oxygen saturation is 90 percent, blood pressure is 90/50 mmHg, heart rate 120/min and temperature is 38.5°C. On examination, she has bronchial breathing at her right lung base. What is the most likely diagnosis?

A. Bronchitis

B. Pneumonia

C. Pulmonary embolism

D. Pulmonary haemorrhage

E. Respiratory tract infection

How do you calculate the Mean Arterial Pressure (or MAP)?

A. Diastolic BP + systolic BP

B. (Diastolic BP / 3) + systolic BP

C. Diastolic BP + 1/3 (systolic BP - diastolic BP)

D. Diastolic BP + 1/3 (systolic BP + diastolic BP)

E. (Diastolic BP + systolic BP) / 2

Sara, a 25 year old woman, presents to the Emergency Department with 5 days of cough, 2 days of fever and increased lethargy. Her oxygen saturation on air is 90%, blood pressure is 90/50 mmHg, heart rate is 120 bpm and temperature is 38.5ºC. On examination, she has bronchial breathing at her right lung base. You have assessed Ms Jones and have decided to give her IV fluids. How much fluid will you give before reassessing her?

A. 1 litre normal saline rapidly

B. 1 litre 5% glucose rapidly

C. 1 litre normal saline over 2 hours

D. 1 litre 5% glucose over 1 hour

E. 500 mls of 5% glucose rapidly

Anna is a 50 year old woman who is brought to the Emergency Department after collapsing at home while standing at the sink. She says that she remembers feeling hot and nauseated before developing tunnel vision and then passing out. She is usually well and takes a single anti-hypertensive agent. On physical examination, she is now well. There are no significant cardiovascular findings and no focal neurological deficits. What is the most likely cause for her syncopal episode?

A. Vasovagal syncope

B. Transient ischaemic attack

C. Orthostatic hypotension

D. Ventricular tachycardia

E. Ventricular fibrillation

Susan is a 35 year old woman who is brought into the Emergency Department by ambulance after being found lying in the gutter. She is able to speak but is unable to give coherent answers to questions. Her initial vital signs are as follows: heart rate 120 bpm, blood pressure 80/40 mmHg, temperature 38ºC and respiratory rate 28bpm. What would be your first step on reaching her bedside?

A. Perform a neurological examination

B. Remove her clothing, looking for signs of injury

C. Ask for an urgent 12 lead electrocardiogram (ECG)

D. Auscultate her chest

E. Insert an intravenous cannula

Which device would deliver oxygen at a concentration close to 100 percent?

A. High flow nasal prongs with an oxygen flow at 15L/min

B. Simple face mask with oxygen flow at 15L/min

C. Venturi device set at 50% and oxygen flow at 30L/min instead of the usual 15L/min

D. Loose fitting mask that has an oxygen reservoir bag with a one-way valve and oxygen flow at 15L/min

E. Self-inflating bag- valve- mask device with reservoir and oxygen flow at 15L/min

A 45 year old morbidly obese male presents with a two day history of pain in the left calf and swelling of the ankle. Which of the following is the correct management?

A. Elastic stockings and aspirin with a review in 5 days

B. Bed rest with elevation of the left leg

C. Venous duplex ultrasound scan of the left leg

D. Subcutaneous heparin for 6 days

E. Plain X-ray of the left ankl

Which of the following is most useful for identifying the cause of syncope?

A. Electroencephalogram (EEG)

B. Electrocardiogram (ECG)

C. Cerebral Computerised Tomography (CT)

D. History from patient

E. History from a witness

Management of atrial fibrillation of onset within 4 hours of presentation includes all of the following EXCEPT:

A. Urgent cardioversion to prevent systemic embolisation

B. Rate control with IV anti-arrhythmic drugs

C. Anticoagulation with heparin

D. Commencement of continuous ECG monitoring

E. Echocardiography

A 20 year old university student presents to you with a one week history of fatigue, fevers, night sweats and poor appetite. He was well prior to this episode. Examination reveals multiple tender lymph nodes in the cervical and axillary areas and splenomegaly palapable 3cm below the costal margin. What would most appropriate initial management include?

A. Perform a monospot and viral serology

B. Referral for abdominal (staging) CT scan

C. Referral for excision biopsy of a lymph node

D. Referral for a fine needle lymph node aspiration biopsy

E. Treat with amoxycillin and review in one week

Red cell fragments (schistocytes) are commonly seen in which of the following conditions?

A. Acute pulmonary embolism

B. Autoimmune haemolytic anaemia

C. Disseminated intravascular coagulation

D. Falciparum malaria

E. Gastrointestinal haemorrhage

Multiple myeloma is characterised by plasma cell infiltration of which of the following organs?

A. Lymph nodes

B. Spleen

C. Kidneys

D. Bone marrow

E. Soft tissue

Which of the following statements regarding the use of diagnostic ultrasound for medical imaging is correct?

A. A fizzy drink is the best preparation for an ultrasound of the upper abdomen

B. The higher the frequency of the ultrasound used the better the spatial resolution obtained

C. The use of ultrasound in women of child bearing age is not recommended because of radiation concerns

D. The use of ultrasound for guidance of percutaneous procedures is decreasing as CT scans and MRI units become more widely available

E. For vascular problems ultrasound imaging is primarily useful for demonstrating anatomy, while flow is assessed by other means

Which of the following is most likely to cause damage to cardiac muscle?

A. Cyclophosphamide

B. Methotrexate

C. 5-fluorouracil

D. Doxorubicin

E. Cisplatin

A 24 year old man admitted to the Emergency Department following a motor vehicle accident. He has a contused chest wall and is in respiratory distress. His left chest is resonant on percussion and no breath sounds can be heard on auscultation. His trachea is deviated to the right. What is the most likely diagnosis?

A. Acute Respiratory Distress Syndrome (ARDS)

B. Pulmonary embolism

C. Spontaneous pneumothorax

D. Haemothorax

E. Tension pneumothorax

Alex is a 25 year old woman who presents to the Emergency Department with sharp central chest pain. You make a provisional diagnosis of pericarditis. Which of the following is TRUE of this condition?

A. It has a high fatality rate in young people

B. It is sometimes associated with pulsus paradoxus

C. It commonly presents with a pleuritic pain, worse on sitting up

D. It commonly presents with ECG changes such as PR elevation

E. It is usually managed as an outpatient in people aged less than 30 years old

{"name":"A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. Wh", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. What is this most likely to be due to?, In the management of pneumothorax, what is the best indication that the intercostal catheter can be removed?, A 75 year old man, presents with painless loss of vision in the left eye one hour ago. VAR:6\/9, VAL:light perception only. There is a left afferent pupil defect. He has been on an ACE inhibitor for hypertension. What do you see when you look into his left eye with a direct ophthalmoscope?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}