End of Phase (part 1)

1.

1 point

In regards to haemostasis, which of the following is most correct?

Intrinsic pathway is initiated by formation of factor X

Release of thromboxane A2 by injured endothelium causes vasoconstriction

Extrinsic pathway is initiated by factor III which complexes with factor VII and V

Platelet adhesion is prevented in healthy vessels by release of ADP

Prothrombin is the enzyme that catalases splitting of fibrinogen to form long fibrin fibres

2.

1 point

An audiogram showing a deficiency in hearing in the left ear at frequencies above 1000Hz is likely to be which of the following individuals?

A healthy 7 year old with difficulty hearing in the left ear and an upper respiratory tract infection

A normal person's hearing in the left ear

A 10 year old with bilateral sensorineural hearing loss from middle ear infection

A child with congenital sensorineural loss from maternal CMV

A 60 year old man who complained of hearing loss in his left ear, previously having worked as a construction worker

3.

1 point

Which of the following is most correct regarding the chemical thermogenesis f brown fat?

Thermogenin acts as an H+ channel across the internal mitochondrial membrane

Thermogenisis leads to increased ATP formation

ATP upregulates thermogenin

Adrenaline plays no role in chemical thermogenesis

Tri-thyrodine (T3) downregulates the uncoupling of thermogenin

4.

1 point

What enzyme does corticosteroids act on?

Stimulates the production of phospholipase A2

Prevents the induction of COX1 enzyme that inhibits the production of prostaglandins

Produces lipocortin, which inhibits the production of eicosanoids

5.

1 point

What is the mechanism of clomiphene in regard to infertility?

It binds to estrogen receptors in the anterior pituitary, lowering the levels of LH and FSH

It binds to the estrogen receptors in the hypothalamus and prevents the negative feedback of estrogen, thus increasing the levels of FSH

It binds to GnRH receptors in the hypothalamus and prevents the negative feedback of estrogen, thus increasing the levels of LH and FSH

6.

1 point

Which one of the following statements regarding the pharmacological treatment of Parkinson's disease is most correct?

Dopamine agonists are used as monotherapy in severe Parkinson's disease

Carbidopa acts centrally to reduce L-dopa metabolism

Selegiline acts peripherally to reduce L-dopa metabolism

Tolcapone is an effective COMT inhibitor

The actions of dopamine agonists are not dependent upon the survival of dopaminergic neurons

7.

1 point

Which one of the following features is inconsistent with breast carcinoma?

Stellate scar

Focal calcification

Spiculated border

Higher density than normal surrounding tissue

Well-circumscribed margin

8.

1 point

All of the following regarding the reduction of lipids are true, except:

Pharmacokinetics of ezetimibe means that it can be taken once daily

Statins inhibit cholesterol synthesis

Fibrates inhibit triglyceride production and increase triglyceride clearance

Niacin inhibits breakdown of lipids and enhances its synthesis in the liver

Cholestyramine inhibits absorption of dietary cholesterol and LDL production

9.

1 point

A 68 year old man presents with dull, central chest pain that worsens at rest. ECG shows ST elevation in the anterior chest leads. He also has high troponin-T levels. Which of the following pathopysiologies most reflects his clinical presentation?

Occlusive thrombus overlying a ruptured atheromatous plaque in the left anterior descending coronary artery

Mural thrombus overlying a ruptured atheromatous plaque in the right coronary artery

Mural thrombus overlying a ruptured atheromatous plaque in the left anterior descending coronary artery

Thromboembolism in the left main coronary artery

Occlusive thrombosis overlying a ruptured atheromatous plaque in the right coronary artery

10.

1 point

What does not pass through the posterior limb of the internal capsule?

Corticopontine tract

Corticobulbar tract

Medial lemniscus

Superior thalamic radiation

Corticospinal tract

11.

1 point

Regarding the pharmacological treatment of congestive heart failure, what is the best sequence of treatment?
(ACE inhibitors, digoxin, hydrazine, loop diuretics)

Loop diuretic, angiotensin system drugs (ACE inhibitor or angiotensin II antagonist), beta-blocker (eg carvedilol), aldosterone antagonist, digoxin

Angiotensin system drugs (ACE inhibitor or angiotensin II antagonist), Carvedilol, dobutamine, aldosterone antagonist, loop diuretic

12.

1 point

Which of the following is most correct about buffers in the blood?

Oxyhaemoglobin takes up protons more readily than deoxyhaemoglobin

The main protein buffer in the blood is albumin

The pK of phosphate is less than that of bicarbonate

The pK of bicarbonate is closest to plasma pH

Proteins rich in histidine residues are good buffers

13.

1 point

Which of these groups are not at increased risk of having gestational diabetes mellitus?

Women with a family history of diabetes mellitus type 2

Indigenous Australians

Women over 40 years of age

Women who have previously had children with low birth weight

Women with polycystic ovarian syndrome

14.

1 point

All of these were part of the 8 measures outlined in the Alma Ata declaration, except:

Provision of water and sanitation

Decrease transmission/increase treatment of endemic diseases

Immunisation to major infectious diseases

Access to local hospital treatment

Provision of essential drugs

15.

1 point

Which of the following best explains the different properties of cellulose and glycogen?

One has a structural role and one has an information role

Different glycosidic bonds connect the subunits

One is a lipid and one is a carbohydrate

They are made of different sugar molecules

They are steriosomers of each other

16.

1 point

Which of the following is not routinely tested for in the first trimester of pregnancy?

Rubella

Chlamydia

Folate deficiency

Thalassaemias

HIV

17.

1 point

Damage to the subthalamic nucleus leads to:

Athetosis

Tremor

Hemiballismus

Chorea

Hypokinesia

18.

1 point

With regard to bacterial capsules, which of the following statements is most correct?

They allow an organism to evade phagocytosis

They only occur in gram positive bacteria

They are composed of a range of complex proteins

They are located just external to the plasma membrane

They assist in motility of bacteria

19.

1 point

With regard to the adrenal glands, which one of the following is most correct?

Has no capsule

Zona fasiculata has cuboidal cells arranged in columns

Medulla is arranged into three separate areas

Zona reticularis produces noradrenaline and adrenaline

Zona glomerulosa is closest to the medulla

20.

1 point

All of the following occur in excitotoxicity, except:

Ionotropic NMDA receptors enable flow of Na+ and Ca2+ into the cell

Glutamate acts on extrasynaptic NMDA receptors

Excitotoxic damage continues for hours after restoration of blood supply to the affected area

Decreased activation of NMDA receptors alters Ca2+ homeostasis

Initial ischaemia increases local glutamate concentration

21.

1 point

Regarding primary syphilis, which one of the following is correct?

It is associated with a widespread skin rash

Definitive diagnosis can be made using dark-field microscopy

The causative agent is gram positive

It is caused by Trichomonas vaginalis

22.

1 point

Which of the following is true regarding the mediastinum?

The pericardial sac is in the superior mediastinum

The trachea and oesophagus are in the middle mediastinum

The superior vena cava passes through the posterior mediastinum

The thoracic duct passes through the middle mediastinum

The thymus gland is in the anterior mediastinum

23.

1 point

All of the following are able to survive under adverse environmental conditions, apart from:

Histoplasma capsulatum

Bacillus anthracis

Clostridium perfringens

Mycoplasma tuberculosis

Neisseria gonorrhoea

24.

1 point

The mycobacterial species retains carbolfuschin when treated with acid alcohol. Which component of the bacteria is responsible for the retention of carbolfuschin?

Teichoic acid

Peptidoglycan

Mycolic acid

Outer membrane

Lipopolysaccharides

25.

1 point

Which of the following best explains the elimination of a pathogenic virus from the body?

Killed by helper T cells

Killed by B cells

Killed by cytotoxic T cells

Phagocytosed by macrophage

Killed by neutrophils

26.

1 point

Describe the lesion:
(flat, red, flaky lesions of irregular shapes)
From Foundations

Scaling papules

Excoriated erythematous nodules

Lichenified annular nodules

Scaling plaques

Flaking erythematous nodules

27.

1 point

With regards to a picture of an oocyte (arrows pointing to polar bodies, pronuclei, and the zona pellucida), which is correct?

The pronuclei are of the spermatazoa and oocyte

Spermatazoa centriole

Zona pellucida

Polar bodies are from oocyte meiosis

28.

1 point

Which of the following regarding childhood vaccinations is incorrect?

Unvaccinated children benefit from high levels of vaccination in the population

Measles vaccine should be given as soon as possible after birth

The pneumococcal vaccine protects against meningitis

Rubella vaccination reduces the number of congenital defects in the population

Haemophilus influenzae type B is rare in Australia due to vaccination

29.

1 point

Regarding body temperature regulation in humans, which is the most correct?

Women have a higher basal temperature in the follicular phase

Human temperature varies around 2 degrees Celsius across normal circadian rhythm

The thermoneutral range for humans is 20 - 22 degrees Celsius

Preoptic nuclei in the hypothalamus mediate the shivering response

Chemical thermogenesis is an important energy source for infants

30.

1 point

Which of the following is most correct regarding intrauterine growth and fetal body composition?

There is an increase in the proportion of extracellular fluid during gestation

Placental weight keeps increasing throughout gestation

Epidemiological studies suggest that babies born at a lighter weight are more likely to have higher arterial blood pressures in adult life

Fetal growth is 6% per day during late gestation

Fat accumulation starts during week 26 of gestation

31.

1 point

Which of the following is correct regarding the ovary?

It has a free anterior surface

It is supplied by the external iliac artery

It is suspended by the mesovarium

It has a hilus on the posterior border

It is attached to the broad ligament of the uterus

32.

1 point

A 55 year old woman, who has B-cell lymphoma, is on Rituximab, a monoclonal antibody directed against anti-CD21. With regard to her immunity, which of the following is most correct?

Natural killer (NK) cells are depleted, but this has no clinical impact

Her serum antibody level is reasonably well-preserved, because anti-CD20 is not present on memory B cells

She is at risk of haeopoietic failure, because anti-CD20 is not present on T cells

She is at increased viral infection risk, because anti-CD20 is not present on T cells

33.

1 point

Which of the following is true about clavulanic acid?

Inhibits cell wall synthesis

Inhibits penicillin-binding protein

Inhibits transpeptidases and carboxypeptidases

Inhibits beta-lactamase

Alters the target receptor

34.

1 point

A 30 year old woman presents with a history of difficulty conceiving. She also complains of deep dyspareunia (pain on sexual intercourse) and dysmenorrhoea (painful periods). The most likely diagnosis is:

Submucous fibroid

Cervical stenosis

Endometriosis

Polycystic ovarian disease

35.

1 point

Which of the following is true regarding environmental air pollution?

Particulates are only harmful if they are >10 microns in diameter

Global burden of health due to air pollution has decreased from recent action taken by countries to reduce air pollution

Ozone release from aerosol cans causes significant damage to the environment

Helping to reduce the effects of climate change can have benefits to health by reducing air pollution

Disease occurs more from indoor pollution than outdoor pollution

36.

1 point

Which one of the following statements about body fluid compartments is most correct?

Most of the water in a person's body is found in their plasma

Movement between different fluid compartments involves crossing a cell membrane

Plasma is more like intracellular fluid than interstitial fluid

There is a higher concentration of K+ than Na+ in the intracellular fluid than the extracellular fluid

Osmolarity is usually different between intracellular and extracellular fluid

37.

1 point

With regard to pharyngitis, which one of the following statements is most correct?

It only occurs in childhood

It can lead to glomerulonephritis

Bacterial pharyngitis can be reliably distinguished from viral pharyngitis on clinical signs alone

Antibiotics are effective agents against viral pharyngitis

Streptococcus pyogenes is the only bacterial cause

38.

1 point

After his MI, the man then had severe progressive dyspnoea and palpitations. On examination, crepitations ('crackles') were audible in the bases of both lungs. What is this consistent with?

Pulmonary thromboembolus

Viral interstitial pneumonia

Bacterial bronchopneumonia

Ischaemic cardiac fibrosis

Cardiogenic shock

39.

1 point

In terms of the classical model of long-term potentiation, which receptor is important for the expression of LTP in excitatory neurotransmission?

Metabotropic glutamate receptor

GABA-A receptor

AMPA glutamate receptor

Muscarinic acetylcholine receptor

NMDA glutamate receptor

40.

1 point

All of the following regarding the pars compacta of the substantia nigra are correct, except:

It contains dopaminergic neurons which project to the globus pallidus

Its neurons degenerate in Parkinson's disease

It has an excitatory effect on the direct loop of the basal ganglia

It is located in the cerebral peduncles of the midbrain

It has an inhibitory effect on the indirect loop of the basal ganglia

41.

1 point

Which of the following is lowest in the hierarchy of evidence?

Meta-analysis

Case control

A systematic review

Cohort

An RCT

42.

1 point

Jessie is a 17 year old girl presenting to her GP. She is worried about her height as she seems to have stopped growing. She was average height in her class at 12 years, however, she is now below average. Physical examination was normal, breast development/pubic hair was Tanner 5/5. Growth chart was shown with menarche at 10 years, plateau from 14 years onwards.
Which one of the following is the most likely cause of her short stature?

Malabsorption

Hypothyroidism

Early puberty

Growth hormone deficiency

Undiagnosed eating disorder

43.

1 point

All of the following statements regarding adverse effects of pharmacological treatments use in hypertension are correct, except:

Angiotensin converting enzyme inhibitors can cause a reduction in blood potassium

Beta-adrenoreceptor antagonists are associated with bronchospasm

Prazosin can cause postural hypotension

Dihydropyridines such as nifedipine may cause headache

Diuretics are associated with electrolyte imbalance

44.

1 point

Which is the most correct regarding blood entering the left atrium?

oxygenated blood from the pulmonary veins

deoxygenated blood from the pulmonary artery

deoxygenated blood from the pulmonary veins

oxygenated blood from the pulmonary artery

oxygenated blood from the superior and inferior vena cava

45.

1 point

Which of the following is true?

Dizygotic twins are identical

Monochorionic and monoamniotic twins are always identical

Dichorionic and diamniotic twins are always non-identical

Dizygotic twins are created when two ova are fertilised by one sperm

46.

1 point

Which of the following tests would be done to determine tumour staging after a diagnosis of breast cancer?

Ultrasound of contralateral breast

Full blood count

HER2 receptor status of the tumour

Whole body bone scan

Pap smear

47.

1 point

Sam is a 72 year old man with benign prostatic hyperplasia (BPH) that is waking him up a few times a night. He also has low blood pressure and has had a few fainting spells. What would be the most appropriate drug to teach his BPH?

Alpha1 non-selective antagonist (prazosin)

Alpha 1a-selective antagonist (tamulosin)

Alpha1-non-selective agonist (phenylepiphrine)

Beta1 selective antagonist (metaprolol)

Beta1 selective agonist (dobutamine)

48.

1 point

A 66 year old man presents with right-sided weakness, predominantly affecting the lower half of the face and arm. A CT scan of his brain 24 hours after his initial symptoms is shown below:
(CT cross section image of a left MCA infarction)
What clinical presentation will he most likely have?

Dysphasia

Left homonymous hemianopia

Ptosis of right eye

Sensory loss of the right side of the face

Dysarthria

49.

1 point

With regards to healing by primary intention, which is most correct?

It is a process of regeneration

It is characterised by epithelial proliferation

It is delayed by inadequate opposition of edges

It is delayed in the very young and elderly

It involves replacement with substantial granulation tissue

50.

1 point

Which is correct regarding HIV treatment?

Clinical efficacy requires high concentration at the site of infection, including inside of affected cells

The most effective drugs have many sites of action at different viral proteins

Single critical amino acid substitution cannot confer resistance

HAART requires two different drugs from two different classes