Download 1 - Pass the FracP

1. Regarding oxalate renal stones, which statement is true:
(A)
(B)
(C)
(D)
(E)
Over 90% of oxalate comes from dietary absorption.
The amount of free calcium within the gut is a major determinant of oxalate absorption.
Low doses of ascorbic acid promote oxalate stone formation.
Fat malabsorption contributes to uric stones but not oxalate stones.
Hereditary hyperoxaluria is the most common cause of oxalate stones.
2. A 54 year old woman presents with a history of Raynaud’s phenomenon for many years, worsening
symptoms of indigestion, and mild shortness of breath on exertion. On examination she had thickening
of the skin over her fingers, extending to the metacarpophalygeal joints, with nailbed microangiopathy.
Her blood pressure was normal, as was the cardiorespiratory examination. Which of the following
statements is true:
(A)
(B)
(C)
(D)
(E)
Antitopoisomerase antibody is more likely to be positive than anti-centromere antibody.
Her chance of surviving for a further ten years is less than 20%.
She should be monitored for pulmonary hypertension.
She is at high risk of developing malignant hypertension in the future.
Treatment with D-pencillamine will prolong survival if respiratory complications develop.
3. A 50 year old woman has painless weakness of the shoulder girdle, hip girdle and trunk muscles.
Electromyography of the weak muscles is performed. This shows no spontaneous activity and full
motor recruitment patterns with many brief duration, highly polyphasic units. Which of the following
diagnoses is consistent with these features?
(A)
(B)
(C)
(D)
(E)
post-polio syndrome
limb girdle muscular dystrophy
myophosphorylase deficiency
acute polymyositis
motor neurone disease
4. A 62 year old farmer has the following biochemistry:
Creatinine 0.27 mmol/L
Calcium 3.12 mmol/L
Albumin 39 g/L
PTH 1.0 pmol/L
1,25 dihydroxyvitamin D 240 pmol/L
(0.06-0.12)
(2.20-2.55)
(39-48)
(1.7-7.0)
(40-140)
The likely diagnosis is:
(A)
(B)
(C)
(D)
(E)
metastatic malignancy
primary hyperparathyroidism
humoral hypercalcaemia of malignancy
Paget’s disease
Sarcoidosis
5. A 30 year old woman has the following results on biochemistry:
Bilirubin
8 umol/l
(<20)
ALP
350 U/L
(30-120)
ALT
260 U/L
(<40)
HBV surface antigen negative
Anti-mitochondrial antibody negative
Anti-smooth muscle antibody weakly positive
This would be consistent with all of the following except:
(A)
(B)
(C)
(D)
(E)
alcoholic hepatitis
autoimmune chronic active hepatitis
chronic hepatitis C infection
drug-induced cholestasis
delta agent acute hepatitis
6. Recognised associations of acromegaly include all of the following except:
(A)
(B)
(C)
(D)
(E)
sleep apnoea
colonic polyps
hyperalosteronism
hypercalciuria
hypertension
7. Which of these is not a feature of primary hypothyroidism:
(A)
(B)
(C)
(D)
(E)
dilutional hyponatreamia
U waves on electrocardiogram
pituitary enlargement
hyperprolactinanaemia
joint effusions
8. Which statement regarding diabetic amyotrophy incorrect:
(A)
(B)
(C)
(D)
(E)
The degree of diabetic control is often unrelated to onset of this problem
It is usually associated with intense pain, and often weight loss
There is a cellular pleocytosis on CSF analysis
Upper limb involvement is rare
The long-term prognosis is generally good
9. Which is true of drug interactions involving the mixed function oxidase system:
(A)
(B)
(C)
(D)
(E)
metronidazole induces phenytoin metabolism
carbemazepin inhibits phenytoin metabolism
phenytoin has little interaction with warfarin
both erythromycin and ciprofloxacin may inhibit theophylline metabolism
allopurinol acts via the P450 system to alter azathioprine metabolism
10. In a normal pregnancy all the following statements regarding physiological changes are true except:
(A) hypoalbuminaemia reflects significantly increased renal protein excretion
(B) cardiac output increases by 40% by the second trimester
(C) glomerular filtration rate increases by 50% due to increased glomerular pressure
(D) mild leucocytosis can occur
(E) mild respiratory alkalosis can occur
11. Which statement is always true about genetic polymorphism:
(A)
(B)
(C)
(D)
(E)
it is due to a variation in DNA sequence
polymerase chain reaction testing is invariably required for detection
it usually involves a clinically unimportant alteration in a gene
any polymorphism is helpful in linkage studies
tissues from two unrelated people can be distinguished using any polymorphism
12. A 32 year old man with Marfan’s syndrome presents with his wife who is pregnant, requesting
information regarding transmission of the disorder to their child. You advise them that:
(A)
(B)
(C)
(D)
(E)
There is a 25% chance the child will be affected
There is a 50% chance the child will be affected
The risk of transmission depends of the gender of the child
The risk of transmission depends on whether the father’s case is sporadic or inherited
The husband should be analysed for mutations in the fibrillin gene
13. A 35 year old woman is brought into the emergency department after a seizure. She has ptosis and
peripheral muscle weakness, with second degree AV block on ECG. She is diagnosed with KearnsSayre syndrome. Which feature in the family history would support this?
(A)
(B)
(C)
(D)
(E)
colonic cancer in the patient’s father
ancestral consanguinity
neuropsychiatric disease in the patient’s maternal relatives
the patient and her brother having different fathers
a strong family history of Parkinson’s disease
14. Two parents have a child born with severe neonatal hyperthyroidism. They are subsequently found
to have mildly elevated calcium levels. What is the mode of inheritance:
(A)
(B)
(C)
(D)
(E)
Multifactorial
Autosomal recessive
Autosomal dominant
X-linked
Mitochondrial
15. Regarding genetic definitions which is incorrect:
(A) Genetic anticipation refers to the progressively earlier appearance and increased severity of a
disease in successive generations.
(B) Heteroplasmy refers to the existence in the same cell of distinguishable (usually mutant and
normal) copies of the mitochondrial chromosome
(C) Imprinting is the differential expression of genes, depending on whether it has been inherited from
the mother or father
(D) Recombination is the reciprocal exchange or crossing over of genetic material between
homologous chromosomes during mitosis
(E) The amount of recombination between the loci estimates the genetic distance between these loci.
16. All of the following conditions classically result in nephrotic syndrome except:
(A)
(B)
(C)
(D)
(E)
HIV associated nephropathy
Focal segmental glomerulosclerosis
IgA nephropathy
Minimal change disease
Membranous nephropathy
17. Which is not associated with bladder carcinoma:
(A)
(B)
(C)
(D)
(E)
schistosomal infection
positive family history
dye exposure
cyclophosphamide therapy
cigarette smoking
18. Which of the following would occur in a compressive optic nerve lesion:
(A)
(B)
(C)
(D)
(E)
ataxic nystagmus
enlarged blind spot
normal visual evoked responses
unaffected colour vision in that eye
afferent pupillary defect
19. A 27 year old, otherwise fit man gives a history suggestive of recurrent tachyarrhythmias. During a
previous anaesthetic he apparently arrested and required DC cardioversion. He now presents for an
arthroscopy. His ECG is shown below.
[FIGURE REQUIRED]
The most likely diagnosis is:
(A)
(B)
(C)
(D)
(E)
Lown Ganong Levine syndrome
Prolonged QT syndrome
Wolff Parkinson White syndrome
Sick Sinus syndrome
Atrio-Ventricular (AV) nodal re-entrant tachycardia.
20. A fifty year old man suffers an acute myocardial infarction (MI). In which of the following
conditions is temporary transvenous pacing most clearly indicated?
(A)
(B)
(C)
(D)
(E)
First degree heart block
Mobitz type I second-degree AV block with normal haemodynamics
Mobitz type II second-degree AV block
Accelerated idioventricular rhythm
Bundle branch block known to exist before the acute MI.
21. In transfusion practice, which is false:
(A)
(B)
(C)
(D)
(E)
Fever is usually due to anti-leucocyte antibodies
Desmopressin (DDAVP) will raise levels of factor VIII in patients with mild haemophilia A
Haemolytic reactions may be delayed for up to one week
Severe anaphylaxis may be seen in IgA deficient individuals
Patients on immunosuppression never have transfusion reactions
22. Which is not true of Hepatitis E virus?
(A)
(B)
(C)
(D)
(E)
It is a 34 nm single stranded RNA virus
It is more common in IV drug abusers
It can produce epidemic waterborne infections
It will cause 10% of patients to develop chronic hepatitis.
It is a nonenveloped HAV like virus
23. Which of the following are incorrectly paired?
(A)
(B)
(C)
(D)
(E)
Conn’s syndrome and metabolic alkalosis
Uretero-colic anastomosis and hyperchloraemic acidosis
Shock and metabolic acidosis
Pancreatic fistula and metabolic acidosis
Salicyclate poisoning and normoacidaemia
24. Pleural calcification is not a recognised result of:
(A)
(B)
(C)
(D)
(E)
Tuberculosis
Chronic empyema
Asbestosis
Bagassosis
Pleural Haemothorax
25. A patient is suffering from dystrophia myotonica is likely to suffer from:
(A)
(B)
(C)
(D)
(E)
Progressive external ophthalmoplegia
Cataracts
Symptoms that begin in childhood
Fasiculations presenting in childhood
Tendon reflexes that are retained despite muscle wasting
26. An unconscious man is brought to hospital as an emergency. He is a known methylated spirit
drinker. If he is suffering from methyl alcohol poisoning, which is incorrect:
(A)
(B)
(C)
(D)
(E)
Kussmaul’s breathing (air hunger) would be expected as a prominent feature
Papilloedema would be consistent with the condition
The methyl alcohol would be metabolised to formaldehyde
The plasma bicarbonate would be very low
Heart block is possible.
27. Pulsus paradoxus is not found with:
(A)
(B)
(C)
(D)
(E)
Severe asthmatic attack
Severe left ventricular failure
Constrictive pericarditis
Cardiac amyloidosis
Cardiac sarcoidosis
28. A broad complex tachycardia is more likely to be supraventricular tachycardia with aberrant
conduction than ventricular tachycardia if:
(A)
(B)
(C)
(D)
(E)
Cannon waves are seen in the neck waves
Fusion beats are seen on the ECG
The tachycardia is abolished by carotid massage
There is a concordant pattern across the precordial leads
The QRS duration is > 160 msec.
29. Signs of posterior inferior cerebellar artery thrombosis do not include:
(A)
(B)
(C)
(D)
(E)
Ipsilateral 5th nerve sensory loss
Nystagmus to the side of the lesion
Contralateral loss of pain in limbs and trunk
Bulbar palsy
CN IX palsy
30. Which of the following is the LEAST likely cause of massive haemoptysis:
(A)
(B)
(C)
(D)
(E)
Tuberculosis
Bronchiectasis
Emphysema
Lung abscess
Carcinoma
31. A 17 year old male experiences easy fatiguability and cramping pain of muscles with exercise
during physical education classes. This condition does not improve with additional exercise, or with
anti-inflammatory medications. He does not have problems with the activities of daily living. The best
explanation is:
(A)
(B)
(C)
(D)
(E)
Duchenne muscular dystrophy
Myasthenia gravis
McArdle’s disease
Amyotrophic lateral sclerosis
Trichinosis
32. A 42 year old female complains of recent onset of easy bruising. The PT and PTT are normal, but
her platelet count is only 10,000/microlitre. A bone marrow biopsy reveal a normocellular marrow
with increased numbers of megakaryocytes. These findings most strongly suggest a diagnosis of:
(A)
(B)
(C)
(D)
(E)
Myeloproliferative disorder
Drug reaction to recent antibiotic therapy
Wiskott-Aldrich syndrome
Epstein-Baarr virus infection
Idiopathic thrombocytopenic purpura
33. Which of the following has an incubation period of less than 10 days?
(A)
(B)
(C)
(D)
(E)
Dengue fever
Yellow fever
Rickettsial infections
Plague
Leishmanisasis
34. Which of the following infectious diseases is incorrectly matched to its period of infectivity:
(A)
(B)
(C)
(D)
(E)
chicken pox: from appearance of rash until the last spot is crusted over
rubella: 7 days before onset of rash until 4 days after onset of rash
mumps: 3 days before until 7 days after salivary swelling
scarlet fever: from appearance of rash until completion of 1 day’s penicillin
measles: from onset of prodome until 4 days after onset of rash
35. which is false. Plasmodium falciparum
(A)
(B)
(C)
(D)
(E)
causes more severe disease in pregnancy
is associated with recurrent relapses after initial treatment because of liver hypnozoites
is the only malarial parasite causing greater than 20% parasitaemia
infection is typically associated with thrombocytopaenia
is the only cause of cerebral malaria
36. HIV positive patients may NOT receive:
(A)
(B)
(C)
(D)
(E)
Hepatitis B vaccination
TY21a (oral typhoid vaccine)
Hib vaccine
Pneumovax
Havrix (hepatitis A vaccine)
37. Allodynia is:
(A)
(B)
(C)
(D)
(E)
Pain caused by stimuli that are usually not painful
The “burning’ sensation of causalgia
Red flare with nerve damage
Due to reflex sympathetic dystrophy
Not associated with nerve damage
38. A celiac plexus block with alcoholwill probably not cause:
(A) Hypotension
(B)
(C)
(D)
(E)
Abdominal pain
Constipation
Paraplegia
Pleuritic chest pain
39. Statistics – which is false:
(A) Demonstrating that an intervention is beneficial when in reality it is not is an example of a type 1
error.
(B) Failure to reject a false null hypothesis is usually the result of small study size.
(C) 3 standard deviations above the mean should include 49.8% of observations.
(D) Variance is equal to the square root of the standard deviation.
(E) Blood groups are an example of nominal variables.
40. Which of the following cranial nerves does not contain both sensory and motor fibres:
(A)
(B)
(C)
(D)
(E)
II
III
VII
IX
X
41. Typical features of REM sleep do not include:
(A)
(B)
(C)
(D)
(E)
Increased sympathetic activity
Recall of dreaming if awoke
Penile flaccidity
Increased tendon reflexes
Maximal loss of muscle tone
42. Neuropathological changes commonly seen in Alzheimer’s disease do not include:
(A)
(B)
(C)
(D)
(E)
Sulcal widening
Hirano Bodies
Astrocytosis
Thinning of corpus callosum
Reduced dendritic branching
43. Volume of distribution:
(A)
(B)
(C)
(D)
(E)
Is not a theoretical concept
Is equal to the mass of drug in the body at a given time divided by a person’s body weight
When increased in volume corresponds to a longer duration of drug action
Decreases with age
Can be affected by physical illness
44. A 75 year old lady presents with sudden breathlessness and palpitations. On examination, she was
observed to have an irregular heart beat with rate of 140 bpm, BP 150/84 and normal heart sounds. On
auscultation of the chest, fine basal crepitations are heard. An ECG confirms AF and an old inferior
MI. She is anticoagulated with heparin and given diuretics. Her heart rate remains rapid. What is the
most appropriate management of the lady’s AF.
(A) DCCV
(B)
(C)
(D)
(E)
IV amiodarone
IV betablocker
IV digoxin
Oral quinidine therapy
45. The term used to describe the genotype of a male for genes on the X chromosomes is:
(A)
(B)
(C)
(D)
(E)
homozygote
heterozygote
hemizygote
heteroplasmy
homogeneous
46. The Hardy-Weinberg principle can be used to calculate:
(A)
(B)
(C)
(D)
The new mutation rate of a disease in a population
The carrier frequency for an autosomal recessive disorder
The degree of consanguinity in a family
The risk that an offspring of a person affected with an autosomal dominant condition will be
affected by the disease
(E) The recombination fraction in a linkage study
47. The majority of cases of Down syndrome occur as a result of
(A)
(B)
(C)
(D)
(E)
non disjunction during maternal meiosis
mosaicism of normal and trisomic cell lines
unbalanced 14:21 translocations
end to end fusions of two chromosomes 21
non disjunction during paternal meiosis
48. The explanation thought to be the most likely for the high incidence of carriers for cystic fibrosis (1
in 20) in the Northern European populations is:
(A)
(B)
(C)
(D)
(E)
a high mutation rate in the CFTR gene
heterozygote resistance to chloride-secreting bacterial-induced diarrhoea
repeated invasions by Vikings
several separate loci for cystic fibrosis
the cystic fibrosis mutation altering the proportion of normal mutation containing gametes
49. Stimulation of cholinergic vagal fibres in the SA node decreases heart rate. Which of the following
statements most accurately describes the mechanism behind this?
(A) Cholinergic vagal fibres decrease the contractility of the heart
(B) Cholinergic vagal fibres increase the duration of the plateau phase of the action potential thereby
increasing the muscle cell refractory period
(C) Acetylcholine released from vagal fibres deactivates voltage-gated sodium channels in SA node
(D) Acetylcholine released from vagal fibres increases K+ conductance in SA node cells
(E) Non of the above
50. With respect to the human heart, which of the following statements is/are false?
(A) The spread of excitation through the walls of the ventricles is from the endocardial surface
outwards
(B) Vagal stimulation decreases the force of ventricular contraction
(C) Sympathetic stimulation increases the force of atrial contraction
(D) The non-conducting fibrous skeleton of the heart including the ventricular valves plays a
significant role in the electrical activity of the heart
(E) At rest, denervation of the heart would result in a rise in heart rate
51. Which is correct. The functional residual capacity (FRC) in the lungs of a healthy adult of average
size:
(A)
(B)
(C)
(D)
(E)
is about 1 litre
becomes smaller if airflow resistance increases
can be estimated using a helium dilution method
has the effect of increasing fluctuations of alveolar gas concentrations during the breathing cycle
is the volume at which some airways normally begin to close during expiration
52. In cancer of the cervix which is true
(A)
(B)
(C)
(D)
(E)
HSV has been identified as the aetiological agent
The “pap smear test” is used to stage early disease
Cells infected with HPV type 6 and type 11 have a high risk of progressing to cancer
The HPV L1 and L2 genes act as oncogenes in the development of cervical cancer
The HPV genome is often integrated into the cell’s chromosome
53. Which is incorrect. DNA
(A)
(B)
(C)
(D)
(E)
Contains the nucleotide bases adenine, cytosine, guanine and thymidine
Is replicated in a semi-conservative manner
Is replicated during the G2 phase of the cell cycle
Is converted to RNA during transcription
Is synthesised in a 5’ to 3’ direction
54. Which of the following are true of the tumour suppressor protein, p53
(A)
(B)
(C)
(D)
(E)
p53 is activated in response to DNA damage
Expression of the cyclin-dependent kinase inhibitor p21 is reduced when p53 is activated
The MDM2 protein is a viral protein which complexes with p53
The p53 gene is the second most commonly mutated gene in human cancers
Non of the above
55. Which subcellular compartment do the arrows point to in this electronmicrograph?
(A)
(B)
(C)
(D)
(E)
cytoplasm
rough endoplasmic cisterna
extracellular space
nuclear matrix
Non of the above
56. Which of the following are true of bacterial vaginosis:
(A)
(B)
(C)
(D)
(E)
It is always symptomatic
It is associated with a non-odorous discharge
Microscopy of the discharge shows “clue” cells
It is a proven sexually transmitted disease
It is not associated with post-partum endometritis
57. A 48 year old woman presented with a 10 day history of painful red nodules over her face, trunk,
and limbs which rapidly enlarged before developing central ulceration. She was otherwise well with no
complaints. She had received four days of oral flucloxacillin but otherwise was on no medication.
There was no past medical history of note. Examination revealed deep cutaneous ulcers with purplish
undermined edges and slough at the ulcer bases (fig 1). Ulcer swabs and blood cultures failed to grow
any organisms. Chest radiography, full blood count, and biochemical profile were normal, but the C
reactive protein was markedly raised at 380 mg/l. Complement C3 and C4 levels and IgG, IgA, and
IgM titres were normal. Antinuclear antibodies, DNA antibodies (single and double strand), and
neutrophil cytoplasmic antibodies were negative. Neutrophil function tests were normal (as assessed
by respiratory burst chemiluminescence). A skin biopsy showed a predominantly neutrophilic infiltrate
of the dermis with leucocytoclastic vasculitis. She was treated with 14 days of flucloxacillin and the
ulcers healed over the next month.
Two years later she developed diarrhoea after a chicken meal. After one week she again developed
cutaneous ulcers over her face, trunk, and limbs. She presented six weeks later with weight loss,
abdominal pains, multiple skin ulcers, and passing faeces through her vagina. On examination the skin
lesions were as before, there was tenderness in left iliac fossa, and the rectovaginal fistula was present.
Inflammatory markers were raised but ulcer, stool, and blood cultures were sterile.
Which skin condition is not associated with the Gastrointestinal disease with which this patient suffers
(A)
(B)
(C)
(D)
(E)
Pyoderma gangrenosum
Erythema nodosum
Sweets syndrome
Psoriasis
None of the above
58. A 53 year old man complained of intermittent blurring of vision confined to the left eye over a
period of 12 months. It did not stop him from reading or driving. There was no history of visual loss,
eye pain or double vision. He had recently been diagnosed with hypertension and
hypercholesterolaemia, for which he was treated with felodipine (5 mg once daily) and fluvastatin (40
mg once daily) respectively.
He attended his optician who performed a visual field test (suprathreshold static perimetry, see figure
below), on the basis of which referral to a neurologist was recommended.
Clinical examination showed an uncorrected visual acutiy of 6/9 left, 6/6 right. Reading
pseudoisochromatic (Ishihara) plates he scored 2/17 left, 14/17 right. Confrontation testing of the
visual fields showed no field loss to stationary or moving targets, but a red pin appeared less read in the
left temporal field compared with the left nasal field; no such temporal desaturation to red was noted on
the right. There was no relative afferent pupillary defect and fundoscopy was normal. There was no
neglect of visual stimuli. The rest of the neurological examination was normal. Ophthalmological
examination showed normal appearances of the ocular media, retina and optic nerve, and the
intraocular pressures were normal.
What is the neuroanatomical correlate of this clinical finding?
(A) Prechiasmal lesion
(B) Postchiasmal lesion
(C) Occipital lesion
(D) Retinal lesion
(E) Non of the above
59. A 16 year old girl was admitted because of low grade fever, headache, and nuchal rigidity. She
complained of galactorrhoea during the preceding year and irregular menstruation since menarche at 13
years old. Physical examination was unremarkable except for the galactorrhoea.
The diagnostic work-up for meningitis was negative. Cranial computed tomography and subsequent
magnetic resonance imaging showed a large, possibly cystic, pituitary lesion (fig 1). The laboratory
work-up showed a mild elevation of basal prolactin levels, 1.05 IU/l; evaluation of pituitary reserve
showed normal thyrotrophin, luteinising hormone, and follicle stimulating hormone responses after
stimulation. The α-subunit levels were 0.1 mIU/ml. Mild bilateral superior constriction was found on
Goldman visual field examination. There were no findings suggestive of sarcoidosis (normal chest
radiography, normal serum angiotensin converting enzyme levels).
The most common condition associated with the above clinical picture is:
(A)
(B)
(C)
(D)
(E)
Primary hypophysitis
Secondary Hypophysitis
Pituitary Adenoma
Lymphoma
Craniopharyngioma
60. A 40 year old man, a non-smoker, was referred to us on account of chest radiograph abnormalities
that had been discovered during the preoperative evaluation before an Achilles tendon repair. He had
no respiratory complaints or significant past medical history. He had been working as a silver polisher
for the last 20 years.
His routine blood investigations were normal. The chest radiograph (fig 1) and the high resolution
computed tomography (HRCT) lung scan (fig 2) are shown. Spirometry and arterial blood gases were
normal.
The most likely diagnosis is
(A) Siderosis
(B) Sarcoidosis
(C) Hypersensitive pneumonitis
(D) Tuberculosis
(E) Vasculitis
61. A 24 year old woman was admitted to our hospital for a massive haemoptysis with abrupt onset.
The average amount of blood expectorated was 200-250 ml in 24 hours. She was a non-smoking
housewife living in a rural area. Her medical history was unremarkable except for the presence of
recurrent oral and genital ulcers for three years, and skin lesions consistent with erythema nodosum had
occurred one year previously. Her vital signs on admission were as follows: temperature 37°C, blood
pressure 110/70 mm Hg, pulse rate 120 beats/min, and respiratory rate 28 breaths/min. Physical
examination of the chest was normal. Admission laboratory values were as follows: leucocyte count
9.3 x 109/l, haemoglobin concentraion 120 g/l, packed cell volume 0.34, platelet count 42 x 10 9/l,
erythrocyte sedimentation rate 44 mm/hour, alanine aminotransferase 48 IU/l (normal range 0-40 IU/l),
aspartate aminotransferase 34 IU/l (normal range 0-40 IU/l). Serum electrolytes, renal function,
urinalysis, prothrombin time, and activated partial thromboplastin time were all in the normal ranges.
Her chest radiograph showed two rounded opacities bilaterally with fine margins with an average size
of 3 x 5 cm (fig 1). Purified protein derivative by Mantoux testing was 17 mm.
What is the most likely diagnosis?
(A) Neoplasm
(B) Hydatid disease
(C) Fungal Infection
(D) Behcets Disease
(E) Tuberculosis
62. A 53 year old woman was referred to the general medical outpatient clinic. She
had no relevant past medical history. Her main complaints were those of numbness
and burning over her entire right forearm and hand. She felt that a recent cough had
exacerbated the pain. In addition, she had burnt her right hand twice in the last month
without even noticing. She denied any history of neck pain or stiffness and there was
no history of spinal trauma.
On examination she looked well and undistressed. There was nil of note on examination of the
cardiorespiratory system or the abdomen. There were no palpable breast lumbs or lymphadenopathy.
Examination of the cranial nerves and lower limbs was unremarkable and in particular there were no
long tract signs. The left upper limb was normal from a neurological point of view.
On neurological examination of the right upper limb, both the biceps and supinator jerks were absent.
In addition there was grossly impaired sensation of pain over the C3-T2 dermatones. Light touch and
vibration sense were preserved over this area. There was early wasting of the intrinsic hand muscles
with an associated reduction in distal power. The tone was normal.
MRI scan shown below
What is the likely diagnosis?
(A) Syringomyelia
(B) Motor Neuron Disease
(C) Cervical Spondylosis
(D) Multiple Sclerosis
(E) Intrinsic Spinal Cord Neoplasm
63. A 38 year old man presented with a history of episodic lower limb weakness lasting a few hours.
The weakness was predominantly proximal and was preceded by cramps in the affected muscles.
There were two such attacks separated by a one month period. He was perfectly normal between
episodes. The weakness was unrelated to exertion or meals. The upper limbs, eyes, face, tongue,
pharynx, larynx, diaphragm, and sphincters were spared. There were no sensory abnormalities. He did
not have vomiting or diarrhoea, nor was he on any medication. He had had no major illness in the past.
No other family member had a similar illness. His appetite was good and there was no change in his
weight in recent years. His sleep was normal, so were his bowel and bladder habits. He did not have
any addictions. On physical examination, the patient was afebrile and nervous. He had a heart rate of
120 beats/min and a blood pressure of 170/70 mm Hg.
During the attack, there was a flaccid paraparesis with depressed tendon jerks. In the interattack
period, strength was normal and the reflexes were brisk. His serum potassium concentration during the
attack was 3.2 mmol/l, and after recovery 4.40 mmol/l (reference range 3.5-5.0 mmol/l). The
concentration in urine was normal. Other electrolyte values were within normal limits. What further
studies should be performed to establish the aetiology.
(A)
(B)
(C)
(D)
(E)
Serum diuretic level
Aldosterone level
Renin level
Thyroid Function tests
Genetic screen for periodic paralysis
64. A 50 year old woman was admitted with complaints of swelling and stiffness of right shoulder for
three months. There was no history of trauma, fever, or any local injections. She did not drink alcohol
and there was no history of any steroid intake. There was no past history of diabetes or syphilis. The
swelling was minimally painful and only extremes of shoulder movements were painful. The swelling
was fluctuant. There was no neurological deficit. Radiographic examination of the shoulder was done
(fig1) followed by magnetic resonance imaging (MRI) of the cervical spine (fig 2).
Given the changes shown in the above figures what is the most likely diagnosis
(A) Charcots joints
(B) Tuberculous arthritis
(C) Septic arthritis
(D) Metastatic Tumour
(E) Vanishing Bone Disease (Gorhans Disease)
65. A 78 year old women was admitted to hospital with collapse and sudden onset left sided
hemiplegia and a right sided ptosis. On admission she was drowsy. She had a left hemiplagia and
right ptosis. When the right upper eyelid was passively raised, there was a fixed outward deviation
of the right eye. Both pupils were of equal size and reacting to light. No diplopia or sensory signs
were noted at presentation.
Which is not true
(A) Figures 1 and 2 show right sided partial ptosis and a divergent squint
(B) Ipsilateral limb weakness is demonstrated
(C) The diagnosis is that of a crossed hemiplegia involving the pons (3 rd CN and corticospinal tract at
the level of the cerebral peduncles)
(D) When the 4th nerve is involved in addition this may result in the patient being misdiagnosed with
torticollis
(E) The 3rd nerve nucleus (Motor nucleus and Edinger-Westphal) is located in the midbrain
66. A 23 year old man has had chronic diarrhoea, bloating and a 15 pound weight loss over the past
year. His diarrhoea is improved by fasting and is worsened by eating fatty foods. He has no significant
medical history. He takes no medications. The review of systems is remarkable for a skin rash over
the extensor surface of his elbows and forearms.
The patient’s vital signs are normal. He is 6 feet tall and weighs 68 kg (152 pounds). His skin is loose,
with apparent loss of subcutaneous fat. He has an erythematous, serpiginous, scaling rash over the
extensor surface of his right elbow. The abdominal examination is normal. He has no adenopathy.
Evaluation shows normal electrolytes, an albumin of 3.1 g/dL, normal aminotransferases, amylase,
lipase, and creatinine. The haemoglobin is 12 g/dL, with a mean corpuscular volume of 80 fL. The
leukocyte count is 4500/μL. A 72 hour faecal fat collection shows 12 g of fat per 24 h on a 100 g fat
diet.
The most appropriate approach is:
(A)
(B)
(C)
(D)
(E)
Secretin test
Small bowel biopsy
Low fat diet supplemented with medium chain triglycerides
Systemic corticosteroid therapy
A course of broad spectrum antibiotic therapy
67. A 54 year old asymptomatic man volunteers to donate blood and is found to have elevated serum
aminotransferase levels. He has no known medical problems and no history of hepatitis. He drinks no
alcohol, takes no medications, and has not seen a physician in more than 10 years. He is active, works
as a truck driver, and has noted no change in his physical condition. He has no family history of liver
disease.
The physical examination is remarkable for obesity. He is 5 feet 10 inches tall and weighs 100 kg.
Laboratory studies
Complete blood count
Normal
Aspartate aminotransferase
45 U/L (NL = <35 U/L)
Alanine aminotransferase
85 U/L (NL = <35 U/L)
Alkaline phosphatase
90 U/L (NL = <36-92 U/L)
Gamma-Glutamyltransferase
125 U/L (NL = 5-40 U/L)
Hepatitis serologies
(anti-hepatitis A, hepatitis B
surface antigen and antibody,
anti-hepatitis B core antibody,
and hepatitis C antibody)
Negative
Erythocyte sedimentation rate
Normal
Antinuclear antibody
Negative
Anti-smooth-muscle antibody
Negative
Total cholesterol
260 mg/dL (NL = <200 mg/dL)
Low-density lipoprotein
225 mg/dL (NL = <130 mg/dL)
Cholesterol
Triglycerides
830 mg/dL (NL = <250 mg/dL)
A liver biopsy specimen shows large droplet steatosis without a significant inflammatory reaction and
no fibrosis. Ultrasonography shows a mildly enlarged fatty liver.
The appropriate management of this patient would be:
(A)
(B)
(C)
(D)
(E)
Interferon therapy for presumed chronic non-B, non-C hepatitis
Alcohol rehabilitation and counselling
Weight loss and therapy for hyperlipidemia
ERCP to evaluate the biliary tree
Corticosteroid therapy
68. An 84 year old woman with a 10 year history of dementia is transferred from a nursing home to the
hospital for evaluation of a new fever. She is being fed through a gastronomy tube, and she requires
both an indwelling bladder catheter and a diaper. She has no known allergies. She has had three prior
episodes of fever in the last six months. When she had a fever in the nursing home, she was given
ciprofloxacin through the gastronomy tube. She has no advance directive, and her grandson, who has
durable power of attorney, insists on full medical measures. On physical examination in the emergency
room, the patient has a temperature of 38.8°C, pulse rate of 84/min, respiration rate of 24/min, and
blood pressure of 94/48 mm/Hg. She is unresponsive. Her neck is supple, and her lungs are clear.
There is an S4 gallop but no significant murmurs. The abdomen is soft and non-tender, with no masses
or organomegaly. The extremities are warm but not swollen or red. Rectal examination is normal, and
the stool is brown and negative for occult blood. The Foley catheter is filled with cloudy urine. In
urinalysis and urine culture reports available from two days earlier, urinalysis showed trace protein,
large leukocyte esterase, many leukocytes, rare erythrocytes, and copious bacteria, and urine culture
showed Klebsiella pneumoniae. The susceptibility report was limited and indicated that the organism
was susceptible to cefotaxime and resistant to ceftazidime, ciprofloxacin, tobracmycin, and
tetracycline.
Which of the following antimicrobial agents would be most likely to be effective for this woman?
(A)
(B)
(C)
(D)
(E)
Cefotaxime
Aztreonam
Imipenem
Gentamicin
Levofloxacin
69. A 34 year old man is evaluated because of a 4 day history of sore throat. He is able to swallow but
indicates that the pain is significant. He has taken analgesics inconsistently. He has no febrile
sensation or cough. On examination, he is afebrile. His pharynx is erythematous, but no plaques are
visible, and he has no tender enlarged cervical lymph nodes. He is concerned about strep because he
has small children, and they currently have symptoms of upper respiratory infection, including sore
throat and fever.
What would be the next appropriate step in managing this patient?
(A)
(B)
(C)
(D)
(E)
Get a rapid strep test and is positive start antibiotics
Treat symptoms only
Send off a throat culture and treat with antibiotics until result comes back
Treat him and his children with antibiotics
None of the above
70. With respect to infection with the human immunodeficiency virus which of these is incorrect:
(A) Antiviral use in pregnancy and neonatally, elective caesarean delivery and avoidance of breast
feeding have been effective interventions reducing vertical transmission.
(B) Genetic susceptibility, not only to infection and progression, but to drug resistance, has been
identified.
(C) Methadone levels are unaffected by antiretroviral therapy.
(D) Changes in body fat distribution (lipodystrophy syndrome) can induce buffalo hump, breast
enlargement, abdominal paunch, face atrophy, and extremity wasting.
(E) Levels of atorvastatin can increase six times with Lopinavir/Ritonavir (Kaletra).
71. After the introduction of highly active antiretroviral therapy (HAART) patients can develop an
immune reconstitution syndrome. Which of these is incorrect:
(A) The syndrome includes focal MAC, cryptococcal meningitis with marked CSF pleocytosis, mild
herpes zoster, PML and CMV vitritis
(B) HCV reactivated hepatitis and cryoglobulinaemia can result.
(C) HAART should be stopped if PML manifests (MRI changes of enhancement).
(D) MAC manifesting with focal adenitis should be treated with MAC specific therapy and perhaps
steroids
(E) Progression of TB can result.
72. Coeliac Disease or gluten sensitive enteropathy is characterised by malabsorption resulting from
inflammatory injury to the mucosa of the small intestine after ingestion of wheat gluten or related
proteins. In the autoimmune model of Coeliac Disease the environmental antigen, gliadin, in a
genetically susceptible patient sets off an inflammatory process. Initially gliadin and transglutaminase
form a complex; gliadin is deaminated and has increased avidity binding to DQ2. APC then present
gliadin and gliadin-tissue transglutaminase complexes. Which is not true:
(A) Coeliac Disease is related to an inappropriate T cell mediated response against ingested gluten in
genetically predisposed people.
(B) Only 50% of patients with Coeliac Disease have HLA DQ2.
(C) α gliadin IgA antibodies are neither as specific nor sensitive as IgA antiendiomysial antibodies.
(D) False negatives can occur in the setting of IgA deficiency.
(E) Immunodeficiency is more common in patients with Coeliac Disease
73. The CXR shown is from a patient with scleroderma. Which is true:
(A) This patient will probably not have anticentromere specific antibodies.
(B) This patient will not respond to Prostacylin analogues or Bosentan.
(C) This patient may have normal lung volumes with disproportionately reduced gas trasfer (↓DLCO)
corrected for alveolar volume.
(D) The degree of impairment of gas transfer is of no prognostic importance.
(E) The problem is benign and of no clinical significance
74. The monitoring of patients with HIV includes both T cell subset and viral load analysis. Which is
true:
(A)
(B)
(C)
(D)
(E)
The normal range for CD4 count is 300-1400/ml.
CD4, CD8 and viral load are all independent predictors of clinical progression and survival.
CD4 response generally mirroring RNA decay curve.
CD4 cell count alone is used in the decision making process regarding antiviral treatment
After achieving complete viral suppression with HAART for one year usually there is no further
increase in CD4 count.
75. Behcet’s Disease is an inflammatory disorder of unknown cause characterised by recurrent
aphthous ulcers, genital ulcers, uveitis and skin lesions. Which is not true:
(A)
(B)
(C)
(D)
(E)
Involvement of the GIT, CNS or large vessels can be life-threatening.
Cases cluster along the ancient Silk Road and Turkey has the highest prevalence.
Pathergy test can help the diagnosis.
Erythema nodosum and superficial migratory thrombophlebitis are pathognomonic.
Despite therapeutic intervention 25% of patients with ocular lesions eventually become blind.
76. Anthrax has three main clinical presentations:
- cutaneous
- inhalational
- gastrointestinal
Which is not true:
(A)
(B)
(C)
(D)
(E)
Anthrax is a gram-positive, spore-forming organism.
Growth from blood culture is the most useful test for inhalational anthrax.
Doxycydine and ciprofloxacin are effective agents for both prophylaxis and treatment.
With respect to inhalational anthrax the usual clinical presentation is a pneumonitis.
A widened mediastinum on CXR is a pathognomonic feature of inhaltional anthrax.
77. The diagnosis of common variable immunodeficiency (CVID) should be considered if either a male
or female patient has a marked decrease in 2/3 major isotypes (IgM/C/A). Which is not true:
Most patients with CVID are diagnosed in the 2nd-4th decade of life after several pneumonias.
Viral, fungal and parasitic infections can be problematic.
There is an association with autoimmunity and malignancy.
The majority of patients have normal BtK gene, but reduced numbers of B cells and T cell
functional abnormalities.
(E) The hypogammaglobulinaemia of CVID is not easily distinguished from the
hypogammaglobulinaemia associated with chronic lymphocytic leukaemia, penicillamine
treatment and the immunodeficiency caused by hypercatabolsim of immunoglobulins.
(A)
(B)
(C)
(D)
78. With respect to the clinical utility of ANA/ENA, which is not true:
(A) Anticentromere antibody is associated with the limited cutaneous variant of scleroderma.
(B) Scl 70 detected by EIA, Immunoblot or CIEP is specific for DNA topoisomerase 1, has greater
than 90% specificity but only 40% sensitivity for diffuse scleroderma.
(C) The presence of Ribosomal P Antibody is reported to be associated with neuropsychiatric
manifestations of SLE.
(D) Anti-Smith (Sm) Antibodies are highly sensitive for SLE and are used to monitor disease activity.
(E) ANAs are a screening tool for autoimmune connective tissues but of no use alone for prognosis
and disease monitoring.
79. With respect to cryoglobulins and HCV which of the following is not true:
(A) HCV is associated with type II and III cryoglobulinaemia.
(B) HCV-associated cryoglobulins are associated with a vasculitis manifested as cutaneous lesions,
peripheral neuropathy and mesangiocapillary glomerulonephritis.
(C) Can cause hyperviscosity that responds to Inteferon α.
(D) Can cause Raynaud’s phenomena.
(E) Can induce immune complexes with HCV as the antigen, polyclonal anti-HCV antibodies and
monclonal antibodies specific for IgG.
80. Raynaud’s phenomenon represents an episodic event of vasoconstriction of digital arteries,
precapillary arterioles and cutaneous arteriovenous shunts. Which is not true:
(A) Raynaud’s can be a primary or secondary phenomenon distinguished by such things as symmetry,
necrosis/ulceration/gangrene, other clinical findings of a connective tissue disease, ANA, ESR, and
nailfold capillaroscopy.
(B) The median age of onset of primary Raynaud’s phenomenon is 14 years and a quarter have a
family history.
(C) 15-20% of patients with Raynaud’s phenomenon who have autoantibodies and abnormal nailfold
capillaroscopy but do not initially meet the diagnostic criteria of a well defined connective tissue
disease will ultimately do so, usualy with two years.
(D) The DD can include cold agglutinins, cryoglobulinaemia and thoracic outlet syndrome.
(E) Treatments include Calcium Channel and  Blockers, Angiotensin II receptor antagonists, GTN
and Prostastandin analogues.
81. Many patients are infected with both HIV and HBV. With respect to the management of HIV and
Hepatitis B co-infection, which drugs would you predict to be effective in antiretroviral naïve patients
for both viruses:
(A)
(B)
(C)
(D)
(E)
Zidovudine and Lamivudine
Zidovudine and Efavirenz
Tenofavir and Lamivudine
Tenofavir and Efavirenz
None of the above
82. Non-alcoholic Fatty Liver Disease is no longer considered a benign process and may progress to
end-stage liver disease. Which is incorrect:
(A) Obesity, insulin-resistant Type 2 Diabetes Mellitus, hyperlipidaemia and a family history of
steatohepatitis are risk factors.
(B) Often there are no symptoms or signs of liver disease and mild to moderately elevated levels of
AST and ALT are the most common and often only laboratory abnormality.
(C) The AST/ALT ration is usually less than one.
(D) Histologically liver biopsies are distinct from liver damage resulting from alcohol abuse with
steatosis, mixed inflammatory cell infiltrate, kepatocyte necrosis, Mallory’s hyaline and fibrosis.
(E) The management is difficult but steps towards weight loss, improved serum glucose and lipid
levels are important.
83. Periodic Fevers are defined as recurrences of fever that last from a few days to a few weeks
separated by symptom-free periods. Many disorders including those inflammatory and neoplastic in
nature can cause such fevers but recent interest has increased in the hereditary syndromes such as
Familial Mediterranean Fever (FMF), Hyper IgD syndrome and the Tumour Necrosis Factor (TNF)
receptor associated with periodic syndrome.
Which is incorrect:
(A) FMF can have associated serositis, scrotal involvement and erythema.
(B) The genetic mutation associated with FMF (encoding the Pyrin gene) can be detected and helps
with the diagnosis.
(C) Colchicine has been shown to be of no benefit for patients with FMF.
(D) With long term untreated patients with FMF and TNF receptor associated with periodic syndrome,
the potential development of amyloidosis is a concern.
(E) Hyper IgD syndromes can be associated lymphadenopathy, erythematous macules, abdominal
pain, vomitting and arthralgias.
84. Peanut allergy in recent years has been of increased concern in the general community. Which is
incorrect:
(A) Early symptoms of food-induced anaphylaxis often include oral pruritis and tingling, pharyngeal
pruritis, a sensation of tightening of the airways, abdominal pain, nausea, vomiting, flushing,
urticaria and angioedaemia.
(B) Biphasic reactions can occur in up to a third of patients with near fatal reactions.
(C) Cross reactions can occur between other legumes and to tree nuts.
(D) Treatment of an acute reaction includes intramuscular adrenaline.
(E) Patients with a strong history of an allergy following the ingestion of a peanut product and
evidence of peanut specific IgE (Skin Prick Test or RAST) should always have the diagnosis
confirmed by oral challenge.
85. Thrombophyllias can adversely effect many pregnancy outcomes. Anticoagulation has been shown
to be of benefit at least in some settings. Which is not true:
(A) Although Warfarin is teratogenic between 6 and 12 weeks gestation, heparins do not cross the
placenta.
(B) Therapeutic doses of low molecular weight heparin contraindicate the use of regional anaesthesia
and a switch to IV unfractionated heparin before delivery should be considered.
(C) Aspirin can reduce the incidence of recurrent pre-eclampsia.
(D) Antiphospolipid syndrome (thrombosis, recurrent miscarriage, antiphospholipid antibody
positivity) is associated with venous thrombosis and often is associated with thrombocytosis.
(E) Women with antiphospholipid antibodies have increased risk of uteroplacental insufficiency and
pre-eclampsia.
(F) Pregnancy outcomes in women with recurrent miscarriage associated with antiphospholipid
syndrome are improved if aspirin and clexane are used
86. Lupus nephritis is a prototype of immune complex glomerulonephritis. Which is incorrect:
(A) Within each of the WHO classes of lupus nephritis highly pleomorphic histological changes
affecting the glomeruli tubules are observed.
(B) Treatment of severe nephritis includes pulses with methylprednisolone, oral prednisone and
cyclophosphamide.
(C) Mycophenolate mofetil (a selective and reversible inhibitor of inosine monophosphate
dehydrogenase – key enzyme in the de novo purine synthetic pathway) has been used for both
initial treatment and as part of maintenance therapy.
(D) Depressed serum complements and elevated titres of double-stranded DNA specific antibodies can
alert physicians of renal involvement and should lead to careful review of a patient’s urinalysis.
(E) ANA titres parallel the activity of lupus nephritis.
87. Mannose binding lectin (MBL) is a collagenous lectin found in serum. It binds to mannose and Nacetyl glucosamine residues when presented in the orientations and densities commonly found on
micro-organisms. On binding it activates the complement system independently of antibodies. Which
is incorrect:
(A) MBL deficiency seems to have an important influence on the duration of febrile neutropenic
episodes in children with malignancy.
(B) Some variant alleles of MBL are associated with increased risk of HIV infection either directly or
indirectly because of increased susceptibility to co-infections.
(C) MBL is an acute phase protein that increases 2-3 fold after an inflammatory stimulus.
(D) MBL appears to be an ancient mechanism of innate host defence. MBL-like systems seem to have
been established for at least 300 million years.
(E) Genetic deficiency in MBL is associated with resistance to meningococcal disease.
88. An orally absorbed drug is administered with grapefruit juice. As a result the area under
concentration time curve (AUC) is increased. Which of the following is false:
(A)
(B)
(C)
(D)
(E)
The half-life of the drug is increased.
The Cmax of the drug is increased.
The drug is metabolised by cytochrome P450 3A4.
First-pass metabolism is reduced.
Co-administration of St John’s Wort may counteract some of the increase in AUC.
89. 60 patients are randomised to placebo or Wonder Treatment X to determine whether the new
treatment is effective. The trial finds that the survival rate increases from 20 to 25% at one year
(p=0.1). Which of the following is the best answer:
(A)
(B)
(C)
(D)
(E)
The new treatment should be rejected because the result is not statistically significant.
This result is unlikely to have occurred by chance.
There is a 9 in 10 chance that the difference in survival is real.
The trial probably had sufficient power to detect a statistically significant difference at 5%.
The trial has demonstrated the new treatment to be 5% better than placebo alone.
90. Regarding chemotherapy-induced toxicity, which of the following is false:
(A)
(B)
(C)
(D)
(E)
The side effects of 5-fluorouracil are schedule dependent.
The haematologic toxicity of carboplatin can be predicted by renal function.
Anthracycline cardiac toxicity is related to cumulative dose.
Peripheral neuropathy is a side-effect of gemcitabine.
Irinotecan-related diarrhoea may be ameliorated by atropine.
91
Regarding genetic polymorphisms and drug metabolism, which of the following is true:
(A) Polymorphisms are unstable genetic variations with a frequency of >1%.
(B) Rapid metabolisers of codeine have inadequate pain control due to a polymorphism of CYP 2D6.
(C) A polymorphism of thiopurine methyltransferase increases the risk of complications from
azathioprine.
(D) 50% of Asians are slow acetylators.
(E) Gene polymorphisms present in the population as a part of a normal distribution of gene variants.
92 A middle aged male presents with diarrhoea, flushing and wheeze and is found after extensive
investigation to have malignant carcinoid. Which of the following is true:
(A)
(B)
(C)
(D)
(E)
He should be started on depot intramuscular octreotide to control his symptoms.
The most likely cause of his wheeze is tricuspid incompetence.
He should be started on subcutaneous octreotide to control his symptoms.
Octreotide use will prolong his survival.
Malabsorption is this syndrome is due to octreotide administration.
93
With respect to HER-2/neu oncoprotein, which is false:
(A)
(B)
(C)
(D)
(E)
It is overexpressed in 10-40% of human breast cancers.
In tumours that are ER positive, the likelihood of response to a hormonal agent is reduced.
In tumours that are ER positive, the duration of response to a hormonal agent is reduced.
It does not have tyrosine kinase activity.
It has similarity to the epidermal growth factor receptor.
94 With respect to BRCA 1/2 mutations, which is false:
(A)
(B)
(C)
(D)
(E)
Germline prevalence is 0.1-0.2% in the population.
They account for 10% of all cases of ovarian cancer.
They account for 70% of cases diagnosed in women younger than 40.
Carriers of either BRCA1 or 2 have a 50-85% lifetime risk of breast cancer.
BRCA2 carriers have a higher risk of ovarian cancer than BRCA1.
95 The most important prognostic feature of a local malignant breast mass is:
(A)
(B)
(C)
(D)
(E)
size
fixation
location
ulceration
hormone status
96 Which of the following is false regarding Pamidronate:
(A)
(B)
(C)
(D)
(E)
Can be associated ARF
Can induce a fever
Is standard of care for metastatic breast cancer with bony metastases
Is standard of care for metastatic prostate cancer
Can be associated with first dose “flu-like” illness
97 Which of the following is a tumour suppressor gene:
(A)
(B)
(C)
(D)
(E)
p53
c-myc
c-erbB2
ras
fos
98 Regarding hormonal therapy and cancer, which of the following is TRUE?
a) Tamoxifen acts by blocking the membrane bound oestrogen receptor
b) Anastrazole acts by blocking the membrane bound oestrogen receptor
c) A flare of bone pain due to the use of goserelin to treat metastatic
prostate cancer is due to the partial agonist effect of goserelin at the
androgen receptor
d) Failure to induce amennorhoea is an important predictor of relapse in
pre-menopausal women who receive chemotherapy for early breast cancer
e) Aromatase inhibition results in oestadiol levels being increased through
negative feedback.
99 A 29 year old man with a 12 pack a year history of smoking presents with sharp pleuritic chest
pains. On auscultation the chest sounds clear and there are no other signs on examination. His chest
CT scans and serial lung function measurements are shown below.
A.
B.
C.
D.
E.
He should be reassured that his condition will resolve spontaneously.
The smoking history, presentation and CT findings are typical of histiocytosis X.
His presentation, progress and CT findings are typical of bronchoalveolar cell carcinoma.
He should be treated with a combination of prednisone and cyclophosphamide.
The presence of hypercalciuria will help determine the need for treatment.
100. A 45 year old accountant presents with sinusitis, chronic asthma and cough with expectoration of
mucus plugs. His CXR and CT scans are shown below.
Which of the following statements is false:
A. He worked with a jack hammer for 6 months when aged 18 and has developed silicosis with
progressive massive fibrosis.
B. The differential diagnosis of his CT and CXR findings would include tuberculosis.
C. The treatment of choice is a course of oral prednisone
D. His serum IgE is likely to be elevated.
E. This condition is frequently seen in patients with cystic fibrosis.
101. A 39 year old woman presented 4 years ago with a chronic cough. She had a history of winter
bronchitis for some years and chronic sinusitis with no history of allergies, snoring or reflux. She is a
non-smoker who is married but has no children because of infertility. She has a family history of
breast cancer and colon cancer but no family history of respiratory disease. On examination she was
not clubbed and her saturation were 98 % on room air. She had bibasal inspiratory coarse crackles
nasal airflow. She has the following CT scan.
The diagnostic test most likely to yield a positive result is:
A.
B.
C.
D.
E.
CF genotype testing
A test of cilial function
ANCA and serum immunoglobulins
A CT of the sinuses
A sweat test
102 A 17 year old schoolboy presents complaining of an inability to stay awake in class. He is
overweight with a BMI of 30kg/m2. He reports occasional episodes of sleep-wake paralysis but denies
cataplexy. His parents report intermittent snoring which is worse when he lies on his back. On
examination he has a red swollen uvula and oedematous posterior pharynx and large prominent tonsils.
Which of the following statements is false:
A. The absence of cataplexy does not exclude a diagnosis of narcolepsy.
B. He should be booked for a diagnostic sleep study followed the next day by a multiple sleep latency
test (MSLT).
C. A maintenance of wakefulness test (MWT) will help exclude the diagnosis of narcolepsy.
D. The most likely diagnosis is obstructive sleep apnoea exacerbated by his obesity and large tonsils/
E. People with narcolepsy commonly present in their teens.
103. A 62 year-old man who is a retired boilermaker presents with the following CT scan and lung
function. In retirement he is working four days a week as tennis coach and personal trainer.
FEV1
FVC
FEV1/VC%
KCO
TLC
3.16 L 101% predicted
3.92 L 98% predicted
80% predicted
92% predicted
5.87 L 89% predicted
Which of the following statements is true?
A.
B.
C.
D.
E.
He has asbestosis.
He is compensable under the Dust Diseases Act.
He has developed mesothelioma.
He has asbestos related pleural disease.
It is likely that he had trivial exposure to asbestos during his working life.
104. A 52 year old female presents with breathlessness. She has the following lung function tests.
FEV1
FVC
FEV1/VC%
PEFR (L/sec)
2.90 L 98% predicted
3.26 L 98% predicted
88% predicted
7.8
113% predicted
KCO
2.5
TLC
VC (slow)
Inspiratory capacity
Functional residual cap
Residual volume
47% predicted
80% predicted
89% predicted
66% predicted
93% predicted
63% predicted
Which of the following statements is true?
A.
B.
C.
D.
E.
Kyphoscoliosis with marked chest wall deformity could account for these lung function results.
She requires tests of respiratory muscle strength.
The next most helpful test would be a CT pulmonary angiogram.
The next most helpful test is a high resolution CT scan with prone and supine view.
These findings are consistent with diagnosis of chronic asthma with hyperinflation.