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Respiratory Sciences Question 1 Deficiencies in medical knowledge are rarely the cause of errors in clinical reasoning but errors in diagnostic or management reasoning are common. Which of the following best defines "confirmation bias"? A. The tendency to do something (or seen to be doing something) even if intended actions are not supported by robust evidence and may do harm. B. The tendency to over-treat or under-treat in the hope that certain events will (or will not) happen, rather than acknowledge what is statistically most likely to happen. C. The tendency to opt for candidate diagnoses based on how the problem is perceived or framed according to past history, clinical setting, previous diagnostic labels, and other contextual factors. D. Selective seeking out of information that seems to confirm favoured diagnosis and ignoring data that are inconsistent with the diagnosis. E. The tendency to accept a diagnosis because of ease in recalling a past similar case rather than on the basis of prevalence or probability. Question 2 Which of the following is TRUE with regards to obstructive sleep apnoea (OSA)? A. Mandibular splints are 100% effective if OSA is the result of an orofacial abnormality. B. Tracheostomy is not effective as a sole procedure when there is an underlying specific abnormality. C. Continuous positive airway pressure (CPAP) is the most efficacious treatment, but compliance and correct use are issues. D. OSA is characterised by repeated lower airways obstruction during sleep. E. OSA is always symptomatic, and risk of developing increases with age, smoking and central obesity. Question 3 Which of the following is not a diagnostic criteria for obstructive sleep apnoea (OSA)? A. B. C. D. E. Excessive daytime sleepiness unexplained by other factors Choking during sleep Impaired concentration Unrefreshing sleep 2 or more apnoeas per hour of sleep Question 4 Which of the following is not commonly acknowledged to cause drug-induced (iatrogenic) interstitial lung disease (ILD)? A. Bleomycin B. Methotrexate C. Amiodarone D. Dapsone E. Nitrofurantoin Question 5 Which of the following is not a feature of interstitial lung disease (ILD)? A. B. C. D. E. Inspiratory wheeze Early productive cough Digital clubbing Inspiratory crackles All of the above are features of ILD Question 6 When spirometry is performed, some important measurements which can be reported include forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and the FEV1/FVC ratio.Which of the following spirometry results would be suggestive of interstitial lung disease (ILD)? A. B. C. D. E. Increased FEV1, decreased FVC and an increased FEV1/FVC ratio. Decreased FEV1, decreased FVC and an increased FEV1/FVC ratio. Decreased FEV1, decreased FVC and a decreased FEV1/FVC ratio. Increased FEV1, increased FVC and an increased FEV1/FVC ratio. Increased FEV1, decreased FVC and an increased FEV1/FVC ratio. Question 7 Which of the following is least useful for specific diagnosis of interstitial lung disease (ILD)? A. B. C. D. E. High-resolution computed tomography (CT) scan Spirometry Transbranchial biopsy and bronchoalveolar lavage (BAL) Autoimmune screen Histopathology Question 8 Which two drug classes are most commonly used to treat long-term, stable chronic obstructive pulmonary disease (COPD)? A. B. C. D. E. β-adrenoceptor agonists, anticholinergics. β-adrenoceptor agonists, corticosteroids. β-adrenoceptor agonists, theophylline. Anticholinergics, corticosteroids. Anticholinergics, theophylline. Question 9 Which of the following pathological changes in the lung is not generally characteristic of chronic obstructive pulmonary disease (COPD)? A. B. C. D. E. Mucous hyper-secretion. Pulmonary hypertension. Reduced lung compliance. Fibrosis of the small airways. Abnormal gas exchange in the alveoli. Question 10 Which of the following is an appropriate treatment for breathlessness in patients with chronic obstructive pulmonary disease (COPD)? A. B. C. D. E. Bronchodilator use. Participation in an exercise program. Supplemental oxygen therapy. Interventions to improve the patient's mood and self-efficacy. All of the above. Question 11 Which of the following statements is incorrect, regarding cystic fibrosis (CF)? A. CF is Australia’s most common genetically inherited disease. B. The average life expectancy at birth for people with CF is currently 37 years. C. CF is not a treatable condition, however with good management, disease progression can be slowed. D. Medications such as salmeterol, terbutaline and Inhaled corticosteroids can be used to manage CF. E. CF is an autosomal dominant disorder, and affected persons are usually identified at birth. Question 12 Which of the following is evidence against the traditional hypothesis about the pathogenesis of idiopathic pulmonary fibrosis (IPF)? A. There are usually signs of granulomas and increased amounts of lymphocytes. B. Over 35% of IPF patients have signs of caseating necrotic granulomas. C. Histologically, there are very few signs of inflammation and anti-inflammatory drugs don’t successfully treat the illness. D. Prognosis of IPF is too poor and at the moment, there are no available treatments other than those being tested in clinical trials. E. Some IPF is caused by hypersensitivity and as a result, fibroblast and myoblasts deposits type-1 collagen into extra-cellular matrix. Question 13 On a coronal CT of the head and neck displaying the cavernous sinus, within this sinus, which of the following structures are located immediately inferiorly to the oculomotor nerve (CN III)? A. The internal carotid artery B. C. D. E. The trochlear nerve (CN IV) Meckel’s Cave The opthalmic branch of the trigeminal nerve (CN V) The optic branch of the trigeminal nerve (CN V) Question 14 Which muscle is not innervated by the hypoglossal nerve (CN XII)? A. B. C. D. E. Palatoglossus Hypoglossus Genioglossus Styloglossus The intrinsic muscles of the tongue Question 15 Which of the following signs is consistent with a lesion of the hypoglossal nerve (CNXII)? A. B. C. D. E. Absent gag reflex Sense of taste is diminished Patient cannot shrug his shoulders Patient pokes out his tongue and it deviates to the unaffected side Patient pokes out his tongue and it deviates to the affected side Question 16 At the end of a normal (non-effortful) inspiration, what are the most likely pressures to be recorded in the intrapleural space and alveolar regions (assuming mouth pressure is 0 cmH2O)? A. B. C. D. E. Intrapleural pressure +5 cmH2O, alveolar -1 cmH2O Intrapleural pressure 0 cmH2O, alveolar 0 cmH2O Intrapleural pressure -8 cmH2O, alveolar 0 cmH2O Intrapleural pressure -5 cmH2O, alveolar -1 cmH2O Intrapleural pressure -8 cmH2O, alveolar -1 cmH2O Question 17 What is the first thing you should check and comment on when reading a chest X-ray (CXR)? A. Check the CXR was taken at full inspiration by counting and ensuring the 6th anterior rib is visible. B. Check that the trachea is mid-line and not deviated. C. Look for flattening in the diaphragm and the costo-phrenic angles. D. Note the patients name and date of birth. E. Look for lytic lesions in the bones. Question 18 Which of the following suggests a sufficient level of inspiration when viewing a chest x-ray (CXR)? A. B. C. D. E. You can view the 8th anterior rib at the mid-clavicular line. The diaphragm will be contracted and flattened. The diaphragm will be relaxed and even on both sides. You can view the 6th anterior rib at the mid-clavicular line. You will be able to see the air inside the lungs. Question 19 Which of the following is NOT generally a cause of low arterial oxygen levels (hypoxaemia)? A. B. C. D. E. Hyperventilation. Ventilation/perfusion mismatch. Diffusion defect across alveolar-endothelial wall. Right to left shunt. Breathing at altitude. Question 20 Which of the following is the least likely cause of type 2 respiratory failure (hypoxia with hypercapnia)? A. B. C. D. E. Obstructive lung diseases. Opioid overdose. Guillain-Barré syndrome. Kyphoscoliosis. Low ambient oxygen levels at altitude. Question 21 Varenicline is a smoking cessation therapy that functions via which of the following pharmacological mechanisms? (mAChR = Muscarinic Acetylcholine Recptor, nAChR = Nicotinic Acetylcholine Receptor) A. B. C. D. E. mAChR antagonist nAChR agonist nAChR antagonist nAChR partial agonist mAChR partial agonist Question 22 A patient presents with difficulty protracting their jaw and deviation of their jaw to the right side of their face. This is likely associated with a problem with which muscle(s)? A. B. C. D. The right temporalis muscle. The left temporalis muscle. The right medial and lateral pterygoid muscle. The left medial and lateral pterygoid muscles. E. The right buccinator muscle. Question 23 Which of the following is false, regarding emerging infectious diseases (EIDs)? A. B. C. D. E. EIDs are increasing in incidence. 30-40% originate from wildlife. Current incidence rates are sporadically distributed globally. Current incidence rates of non-zoonotic EIDs show an increasing trend. The peak number of cases of a zoonotic EID in wildlife will precede that of humans. Question 24 What are three effects of hypoxia-inducible factors (HIFs)? A. They increase levels of growth factors, erythrocyte generation and decrease the rate of lactate production. B. They increase rates of hydrogen sulfide production, increase levels of vascular endothelial growth factor (VEGF) and increase rates of angiogenesis. C. They decreased rates of hydrogen sulfide production, decrease levels of pyruvate dehydrogenase kinases and decrease the rate of angiogenesis. D. They cause increased cell survival and expansion, increased levels of vascular endothelial growth factor (VEGF) and decreased rates of lactate production E. They cause increased rates of lactate production, increased numbers of erythrocytes in blood and increased oxygen delivery to tissues. Question 25 What percentage of men with cystic fibrosis are also found to have CBAVD (congenital bilateral absence of the vas deferens)? A. B. C. D. E. 50-74% 75-89% 90-94% 95-99% 100% Question 26 In examining a patient's arterial blood gas results (obtained while breathing room air) you observe the following values: pO2 = 55 mmHg, pCO2 = 37 mmHg. What is the corresponding A-a DO2 (Alveolar - arterial gradient)? A. B. C. D. E. 44 mmHg 49 mmHg 58 mmHg 65 mmHg 69 mmHg Question 27 Which of the following most correctly describes the changes in electrical brain activity as you go from wake to sleep, as shown on EEG (electroencephalography)? A. B. C. D. E. Slowing and increased synchronisation. Slowing and increased α activity. Faster and increased α activity. The brain patterns slow. None of the above. Question 28 The "fight or flight" response, which encompasses many acute physiological responses to stress, is triggered by the arousal of which nervous system (specifically)? A. B. C. D. E. The autonomic nervous system. The sympathetic nervous system. The peripheral nervous system. The central nervous system. The para-sympathetic nervous system. Question 29 The currently accepted model of stress is the transactional model. This model regards...? A. B. C. D. E. Stress as a process of transaction between environment and person Stress as external to the person Stress as a focus on the behavioural response of the person Stress as concerned with dealing with symptoms, not response Stress as a "bad" thing Question 30 Most patients with emphysema usually have more damaged alveoli in the upper zones of the lungs, a reason for this is that... A. The upper zones of the lungs undergo more mechanical stress than in the lower zones. B. There are more pollutants trapped in the upper zones of the lungs. C. The upper zones of the lungs have less blood flow than the lower zones, therefore necrosis is more likely to occur. D. There is more surfactant coating on the alveoli in the upper zones of the lungs than in the lower zones. E. There is more gaseous exchange in the upper zones of the lungs than in the lower zones. Question 31 According to the incidence of age-standardised lung cancer for men and women over the last 30 years, how does the incidence rate compare in 2010 to the incidence rate in 1980? A. B. C. D. It was lower for both men and women. It was higher in men and lower in women. It was lower in men and showed no change in women. It was lower in men and higher in women. E. It showed no change in men and was higher in women. Question 32 What is not a risk factor for the development of OSA? A. B. C. D. E. Male Central obesity Genetics Hypothyroidism Narcolepsy Question 33 Which of the following is a feature of ILD? A. B. C. D. E. Increased lung compliance. Low forced expiratory volume to forced vital capacity ratio (FEV1/FVC ratio) Increased diffusing capacity. Reduced lung volume. Floppy lungs. Question 34 Which of the following is not commonly associated with COPD? A. B. C. D. E. Dyspnoea on exertion Wheeze Stridor Anorexia Ankle odemea Question 35 What is the principle mechanism of hypoxemia in patients with COPD? A. B. C. D. E. Hypoventilation Diffusion impairment VQ inequality Shunt Abnormal Haemoglobin Question 36 Posttraumatic stress disorder (PTSD) has been described as "the complex somatic, cognitive, affective, and behavioral effects of psychological trauma" Which of the following does NOT characterise PTSD? A. B. C. D. E. intrusive thoughts Nightmares and flashbacks Alcohol abuse Avoidance of reminders of trauma Hypervigilance Question 37 First-responders / rescuers to disasters are prone to experiencing PTSD. Which of the following is currently NOT a driver for experiencing PTSD? A. B. C. D. E. Exposure to mutilated bodies / injured people Feeling of helplessness Shame regarding post-traumatic symptoms Survivor Guilt Lack of Support from Authorities Question 38 Regarding chronic obstructive pulmonary disease (COPD), which of the following is FALSE? A. B. C. D. E. β2 antagonists can be used to reduce the symptoms of COPD with moderate effect. The disease process is different from asthma, with different cells involved. Lung function can never be returned to normal, even with medication. Onset is usually after 45 years of age. In advanced stages of the disease, Inhaled corticosteroids have no effect on the decline in lung function but they can reduce exacerbations of the disease. Question 39 Which of the following statements regarding the circadian system and disruption to this system is FALSE? A. The health effects of shift work include heart attacks, strokes, obesity and reduced immune function. B. The health effects of shift work include heart attacks, strokes, weight loss and reduced immune function. C. Risk factors for drowsy driving crashes include young adult males, late night/early morning periods and night shift workers. D. Body temperature is lower during the night and higher during the day. E. Higher melatonin levels during puberty can cause circadian disruption. Question 40 Which of the following statements about the organisation of the pulmonary hilum is FALSE? A. B. C. D. E. The pleural sleeve drapes inferiorly to create the pulmonary ligament. The pulmonary arteries are always posterior to the bronchi. The groove for the aortic arch lies behind the pulmonary hilum of the left lung. In the left and right hila, the veins are always the most anterior and inferior holes. The parietal and visceral pleura are continuous at the hilum. Question 41 Which of the following statements about vaccines is FALSE? A. Live vaccines may retain some pathogenicity and revert to virulence. B. C. D. E. Certain vaccines have been shown to increase the risk of developing autism. Live vaccines can lose their potency if they are exposed to heat. Maternal antibodies can interfere with the development of active immunity is a child. Live measles vaccine can be given to immunocompromised persons. Question 42 Which of the following statements regarding the use of a large volume spacer when taking asthma inhaler medications is FALSE? A. It reduces local side effects by minimising deposition of inhaled corticosteroids in the oropharynx. B. A spacer allows for more medication to be delivered to the lungs than an inhaler alone. C. It is easier to co-ordinate timing of activating the inhaler and inhalation. D. A spacer is not effective for bronchodilator delivery during emergency situations. E. None of the above. Question 43 Which of the following statements is FALSE? A. Meconium ileus is associated with cystic fibrosis. B. G551D is a mutation which causes reduced movement of chloride ions into the airway lumen. C. Pulmozyme aids in the clearance of mucous from the airways in cystic fibrosis patients. D. Life expectancy for cystic fibrosis patients has increased over the last 30 years. E. Cystic fibrosis patients typically have a normal FEV1. Question 44 Which of the following is TRUE? A. Respiratory failure occurs when arterial oxygen pressure drops below 75 mmHg. B. At 80% arterial oxygen saturation, there is a risk of rapidly worsening respiratory failure. C. Arterial carbon dioxide is always increased in respiratory failure. D. Respiratory failure will result in an increased drive to breathe. E. Supplied oxygen will always improve respiratory failure to some extent. Question 45 In regards to management of sleep loss and circadian disruption, which of the following is TRUE? A. Prophylactic or preventative naps of a minimum of 30 minutes are recommended. B. Modafinil is a benzodiazepine drug that should be avoided. C. Administering exogenous melatonin in the morning will cause phase advancement in the sleep-wake cycle. D. Melatonin is contraindicated in adolescents, pregnant women and people with cardiovascular disease. E. Lorentin is a stimulant drug that has side effects of nausea and diarrhoea. Question 46 Which of the following about the lung is TRUE? A. B. C. D. E. Collagen fibres in the lung gives the lung its elasticity. The number of type III collagen fibres in the lung tissue decreases with age. A person's lung volume is determined by their race and height. Alveolar size is determined by a person's race and height. Lung elastic recoil is affected by a person's height and race. Question 47 Which of the following statements regarding the transport of oxygen in the respiratory system is TRUE? A. B. C. D. E. Oxygen moves the major airways by convection. Oxygen is at its highest partial pressure in the body when it is in the arteries. Oxygen moves across the alveolar-capillary membrane via convection. Oxygen is lost to anatomical dead space as it passes through the pulmonary vasculature. Oxygen undergoes diffusion across the terminal airways. Question 48 Which of the following statements about the diaphragm is TRUE? A. The oesophagus pierces the muscular diaphragm posterior to the central tendon at the level of thoracic vertebra 8. B. On expiration, the right dome is at the level of the 5th intercostal space. C. The left and right crus join to form the median arcuate ligament. D. The lateral arcuate ligaments span over the psoas major muscles. E. The inferior arterial blood supply comes from the thoracic aorta. Question 49 Which of the following statements regarding forced expiration is TRUE? A. A person's height does not affect their peak expiratory flow rate. B. Peak expiratory flow rate is limited by a person’s ‘flow limiting segment’, which is where the pressure inside the airway lumen has becomes the same as the pleural pressure. After this point, the airway lumen narrows. C. Peak expiratory flow rate is limited by a person’s ‘flow limiting segment’, which is where the pressure inside the airway lumen has becomes the same as the pleural pressure. After this point, the airway lumen widens. D. A person's peak expiratory flow rate increases with their age. E. The normal FEV1/FVC ratio (forced expiratory volume in 1 second to forced vital capacity) is 98%. Question 50 Which of the following statements about the cranial nerves is TRUE? A. The corneal reflex tests the integrity of pontine pathways. B. The motor fibres of the accessory nerve (CN XI) only innervate the trapezius muscle. C. Bell's palsy is only ever caused by an extra-cranial lesion. D. The olfactory (CN I) and optic nerves (CN II) are the only cranial nerves without motor fibres. E. The maxillary branch of the trigeminal nerve (CN V) passes through the superior orbital fissure. Question 51 Patients with classic cystic fibrosis have abnormally functioning ion channels on the apical surface of certain cells. Which of the following statements is TRUE? A. B. C. D. E. There is increased resorption of sodium in the sweat duct. There is decreased resorption of chloride in the sweat duct. There is increased secretion of sodium in the respiratory epithelium. There is decreased resorption of chloride in the respiratory epithelium. There is decreased water resorption in the respiratory epithelium. Question 52 Which of the following factors has been shown to have the greatest effect on incidence of CF? A. B. C. D. E. Maternal smoking during pregnancy Sex Ethnicity Premature birth Malnutrition during pregnancy Question 53 Which of the following is a not a goal of wholistic physiotherapy management of patients with CF? A. B. C. D. E. Maximise and maintain aerobic fitness, functional strength and muscle bulk Efficient sputum clearance Prevent and treat stress incontinence Advise patients on exercises to lose weight to assist sputum clearance Promote and maintain good posture Question 54 What is the most common mode of inheritance for CF? A. B. C. D. E. Autosomal dominant Autosomal recessive X-linked dominant X-linked recessive Complex inheritance Question 55 In describing lymph lode levels of the neck, what is the approximate location of neck level III? A. In the anterior triangle from the skull base to the inferior border of the hyoid bone. B. In the anterior triangle from the inferior border of the hyoid bone to the inferior border of the cricoid cartilage. C. In the anterior triangle from the inferior border of the hyoid bone to the clavicle. D. In the anterior triangle under the thyroid gland. E. In the posterior triangle. Question 56 A patient's arterial blood gas results are shown below. Which option correctly describes these results?pH = 7.35Partial pressure of oxygen: 70 mmHgPartial pressure of carbon dioxide: 60 mmHgBase excess = +12 mmol/L A. B. C. D. E. Uncompensated respiratory alkalosis. Compensated metabolic acidosis. Uncompensated respiratory acidosis. A normal alveolar-arterial (A-a) gradient. None of the above. Question 57 Which of the options correctly describes the arterial blood gas results listed below?pH: 7.54Partial pressure of oxygen: 126 mmHgPartial pressure of carbon dioxide: 17 mmHgBase excess: -3 mmol/L A. B. C. D. E. There is a pathological A-a gradient Overcompensated respiratory acidosis Uncompensated metabolic alkalosis Compensated respiratory alkalosis Uncompensated respiratory alkalosis Question 58 What is the most likely interpretation of the following arterial blood gas (ABG)? PaO2 = 119 mmHgPaCO2 = 21 mmHgpH = 7.55Base Excess = -4 mmol/L A. B. C. D. E. Respiratory alkalosis, partially compensated Metabolic alkalosis, partially compensated Respiratory alkalosis, uncompensated Metabolic alkalosis, uncompensated Respiratory alkalosis, fully compensated Question 59 Which of the options correctly describes the arterial blood gas results listed below?pH: 7.38Partial pressure of oxygen: 98 mmHgPartial pressure of carbon dioxide: 38 mmHgBase excess: -8 mmol/L A. Uncompensated respiratory alkalosis. B. C. D. E. Compensated metabolic acidosis. Compensated respiratory acidosis. A large A-a gradient. Uncompensated metabolic alkalosis. Question 60 In a forced expiration, what are the most likely pressures measured at each of the following structures or spaces: A) chest wallB) intrapleural spaceC) pulmonary elastic recoilD) alveolusNote: all measurements in cmH2O A. B. C. D. E. A) +5 B) -5 C) +8 D) +3 A) 0 B) 0 C) +8 D) +3 A) -7 B) +7 C) +9 D) +10 A) -5 B) +5 C) +8 D) +13 A) +5 B) +5 C) +8 D) +13 Question 61 Which statement is INCORRECT? A. Intense emotion can trigger an asthmatic attack. B. Epidemiologically, prevalence of atopic dermatitis tends to peak in the late teenage years. C. Chronic nasal blockage during childhood can bring about characteristics such as breathing through the mouth and distortion of growth in the central part of face (e.g. a wide nasal bridge) referred to as "allergic facies". D. Dust mites are an example of a perennial allergen. E. Allergic sensitisation to peanuts can come about before a child has ever consumed peanuts. Question 62 A consequence of chronic diurnal sleep restriction include all of the following, EXCEPT A. B. C. D. E. increased incidence of gastrointestinal distrubances Increased driving related accidents increased reaction/response time increased immune function increased risk of miscarriage Question 63 Asthma is an example of a A. B. C. D. E. Type 1 hypersensitivity Type 2 hypersensitivity Type 3 hypersensitivity Type 4 hypersensitivity Type 5 hypersensitivity Question 64 Which of the following is a modifiable risk factor for Obstructive Sleep Apnoea? A. B. C. D. E. Age Male gender Smoking Endocrine disorders Allergic disease Question 65 Cessation of airflow at the mouth needs to occur for how long to be classed as an apnoea? A. B. C. D. E. 2 or more seconds 3 or more seconds 5 or more seconds 10 or more seconds 15 or more seconds Question 66 Which of the following criteria MUST be fulfilled for a diagnosis of obstructive sleep apnoea? A. B. C. D. E. Recurrent nocturnal awakening Choking during sleep Excessive daytime sleepiness unexplained by other factors Demonstrated respiratory disturbance index >= 5/hour Sound recording and analysis of snoring Question 67 Which of the following is the main muscle is implicated in obstructive sleep apnoea? A. B. C. D. E. Tensor veli palatini Genioglossus Geniohyoid Thyrohyoid Levator veli palatini Question 68 Which of the following is NOT a commonly cited risk factor for obstructive sleep apnoea? A. B. C. D. E. Alcohol consumption Hypothyroidism Male Gender Obesity Growth hormone deficiency Question 69 Which of the following signs and symptoms is NOT consistent with a diagnosis of sleep apnoea? A. B. C. D. Excessive daytime sleepiness unexplained by other factors. Choking during sleep. Recurrent nocturnal wakening. Overnight monitoring demonstrates 5 or more apnoeas plus hypopnoeas per hour of sleep. E. Difficulty initiating sleep. Question 70 Which of the following groups of symptoms are all risk factors for sleep apnoea? A. B. C. D. E. Obesity, male gender and hypertension. Alcohol use, anatomically small airway and immune deficiency. Obesity, a history of hypothyroidism and a history of diabetes. Obesity, alcohol use and an anatomically small airway. Hypotension, alcohol use and a history of smoking. Question 71 Which of the following is the most appropriate definition of dyspnoea? A. B. C. D. E. A subjective awareness of discomfort related to the act of breathing. A subjective sensation of pain related to the act of breathing. A breathing rate greater than 20 breaths per minute. Deep, shallow breathing. Both A and C. Question 72 Which of the following strategies have led to a decrease in smoking prevalence in Australia? A. B. C. D. E. Anti-smoking advertisements Cigarette price Nicotine replacement therapy A and B A, B and C Question 73 Approximately what proportion of indigenous peoples live in "remote" and "very remote" communities in Australia? A. B. C. D. E. Less than 1% 9% 27% 50% 78% Question 74 Which of the following is NOT considered a parasomnia? A. B. C. D. E. Sleep terrors Nocturnal epilepsy Sleepwalking Confusional arousal Teeth grinding Question 75 Which of the following is correct with regards to insomnia? A. B. C. D. Insomnia is associated with sleep restriction. Prevalence of insomnia is higher in males. Insomnia can be treated with non-sedating antidepressants Behavioural treatments such as cognitive behavioural therapy (CBT), relaxation and circardian regulation are just as useful as pharmacologic treatments. E. Development of insomnia is more likely in younger populations. Question 76 What is sleep restriction and why is it used to treat insomnia? A. Restraining a patient in a bed and holding them still to bore them into sleeping. B. Preventing a patient from sleeping for 48 hours to 'reset' their circadian rhythm. C. Instructing a patient to sleep through a whole day to allow them to catch up on lost sleep. D. Instructing a patient to get up if they cannot get to sleep and return to bed when they are actually sleepy to prevent them from lying in bed stressing. E. Only being in bed for sleeping and restricting other activities in bed (ie. reading, eating) to associate good sleeping behaviours with being in bed. Question 77 Which of the following symptoms is NOT indicative of an "atypical" pneumonia? A. B. C. D. E. Non-purulent cough Upper respiratory tract symptoms Myalgia Sudden onset Arthralgia Question 78 Which of the following is a risk factor for severe pneumonia? A. B. C. D. E. Malignancy Immunosuppression Congestive Cardiac Failure Chronic Lung Disease All of the Above Question 79 Which of the following is characteristic of pneumonia? A. B. C. D. E. Stony dullness heard on percussion of the chest. Upper lobe hyperlucency on chest X-ray. Hyper-resonance on percussion. Increased tactile fremitus on palpation. Tracheal deviation towards the affected side of the lung. Question 80 Mrs Jones is a 63 year old who has presented to the emergency department with acute onset dyspnoea and productive cough, worsening over the last 3 days. She describes that recently she has been waking at night with drenching sweats and she feels very weak and lethargic.Mrs Jones is MOST likely to be infected with which bacteria? A. B. C. D. E. Pseudomonas aeruginosa Streptococcus pneumoniae Legionella pneumophila Staphylococcus aureus Chlamydia pneumoniae Question 81 The Bradford Hill criteria for causality are used to determine if an exposure causes a disease, for example, if smoking causes lung cancer.Which of the following is NOT one of the criteria? A. B. C. D. E. The exposure must precede the outcome. The association must have been replicated by at least three studies. The association is unlikely to be due to chance. The association is unlikely to be due to bias. The association is unlikely to be due to confounding. Question 82 Cystathionine γ-lyase (CSE) and Heme Oxygenase-2 are important enzymes in carotid body oxygen sensing. Which of the following species will increase with a shift from hypoxia to normoxia? A. B. C. D. E. Carbon monoxide Pyruvate Ammonia Hydrogen sulphide L-Cysteine Question 83 Which of the following is not an adaptive response to chronic hypoxia? A. Increase in ventilation B. Decreased peripheral blood flow C. Increased cardiac output D. Decreased cellular anaerobic metabolism E. Increased pulmonary arterial pressures Question 84 Peripheral oedema occurs in some patients with chronic obstructive pulmonary disease (COPD). What is the primary mechanism for this oedema? A. Failure of the left ventricle to maintan sufficient arterial pressure for adequate venous return. B. Increased thoracic pressures reducing cardiac output. C. Increased pulmonary arterial pressure causing right ventricular hypertrophy and failure. D. Cytokines released in lung damage processes increase peripheral vascular permeability. E. Decreased oxygen partial pressure causing peripheral vascular dilatation to ensure adequate tissue oxygenation. Question 85 Which of the following is not a feature of severe emphysema? A. B. C. D. E. Increased residual volume Increased diffusion capacity Possible reduction in vital capacity Increased total lung capacity Decreased FEV1/FVC ratio Question 86 Oskar is a 56 year old man who has been a pack-a-day smoker since he was 22. He has been complaining of a chronic cough and shortness of breath, and his doctor suspects he may have emphysema. Which of the following is most affected in emphysema? A. B. C. D. E. lung tissue upper airways pleura diaphragm pulmonary blood vessels Question 87 Which of the following changes occurs during the chronic stages of asthma? A. B. C. D. E. Decreased mucous production. Permanent airway widening due to destruction of the airway wall. Hyperplasia and hypertrophy of airway smooth muscle cells. Increased mucociliary clearance. Decrease in the number of submucosal glands. Question 88 Which of the following is NOT involved in the sensitisation and acute stages of asthma? A. B. C. D. E. Antigen presentation to Th1 cells. B cell class switching to produce IgE. Antibodies to sensitizing antigen bind to mast cells. Release of histamine, prostaglandins and leukotrienes. Recruitment of eosinophils. Question 89 Which one of the following is NOT an option for treatment of acute attacks or prevention in asthma? A. B. C. D. E. Methacholine Salbutamol Fluticasone Montelukast Salmeterol Question 90 Tracy is a 15 year old high school student who presents to you (her new GP) with a history of increasing shortness of breath following exercise. Lung function testing reveals bronchodilator reversibility and a provisional diagnosis of exercise-induced asthma is made. Which of the following would NOT be considered a risk factor for asthma? A. B. C. D. E. Tracy having atopic eczema in the first year of life. Tracy's mother and father both being asthma sufferers. Tracy having an acute viral infection early in life. Tracy's mother smoking cigarettes throughout her pregnancy. Mutations in the lymphotoxin-α (aka TNF-β) gene AND associated atopy. Question 91 Which of the following drugs is taken orally to treat asthma? A. B. C. D. E. Theophylline Salmeterol Tiotropium Glycopyrronium Montelukast Question 92 Classification of asthma - what are the characteristics of persistent asthma? A. B. C. D. E. Attacks < 6 weeks apart Use of β-agonists most days Nocturnal asthma may occur B and C A and B Question 93 Which of the following statements is FALSE regarding the smoking epidemic? A. B. C. D. Anti-smoking advertising and price had the greatest impact on reducing rates. Smoking is prohibited in high-roller casino rooms in NSW. The hardening hypothesis was disproved by the ImpacTeen study. Tobacco companies can still advertise indirectly through corporate social responsibility programs. E. In the late 19th century, a new fermentation process allowed for tobacco smoke to be less harsh.. Question 94 Which of the following antibiotics is an example of a ?-lactam antibiotic? A. B. C. D. E. Quinupristin Clindamycin Levofloxacin Meropenem Vancomycin Question 95 Which structures can be seen in the masticator space of the head? A. B. C. D. E. The pharyngeal venous plexus and the maxillary artery. The parotid duct and gland. Tensor veli palatini, levator veli palatini and the mastoid process. Masseter, and the lateral and medial pterygoid muscles. The common carotid artery, jugular vein and vagus nerve (CN X). Question 96 You have just informed a young female patient that she has acute leukaemia. This is the lady's first visit to you and she is present with a number of her family members. You wish for her to stay at the hospital and immediately undergo chemotherapy but she remains quiet and does not answer. Some of her family members aggressively ask you questions. How do you respond to ensure that her decision making is not compromised? A. Order her family to leave the room to ensure she decides autonomously and independently. B. Leave the room and allow them to make a decision whichever way they see fit. C. Stay in the room, carefully see if their interactions seem to put pressure on the girl, but allow them to make a decision as a group. D. Stay in the room, carefully see if their interactions seem to put pressure on the girl, but ensure that the final decision is made wholly by the girl. E. Make the best decision for her based on your own clinical knowledge. Question 97 In pharmacology, drugs are often released in different formulations. Glycopyrronium bromide is currently prescribed as an inhaler to treat obstructive respiratory diseases, and is also used intravenously during anaesthesia. What class of drug is glycopyrronium bromide and for what pharmacological effects is it used? A. B. C. D. E. Anticholinergic; Bronchodilation, increasing secretions. β-adrenergic agonist; Bronchodilation, hypertension. Anticholinergic; Bronchodilation, reducing secretions. β-adrenergic agonist; Bronchodilation, reducing secretions. Phosphodiesterase (PDE) inhibitor; Bronchodilation, increasing secretions. Question 98 Which of the following is cell-mediated rather than antibody-mediated? A. B. C. D. E. Type I hypersensitivity Type II hypersensitivity Type III hypersensitivity Type IV hypersensitivity Type V hypersensitivity Question 99 Which of the follow is most likely to cause otitis media in a child? A. B. C. D. E. Streptococcus pneumoniae Staphylococcus aureus Staphylococcus epidermidis Streptococcus pyogenes Pseudomonas aeruginosa Question 100 Mr Smith is has a chronic cough and you suspect he may have a vocal fold problem.Which nerve supplies sensation to the vocal fold? A. B. C. D. E. Vagus nerve Superior laryngeal nerve Recurrent laryngeal nerve Hypoglossal nerve C1 through hypoglossal nerve Question 101 In the young adult/teenage population within Australian indigenous communities, there is an increasing burden of metabolic syndrome and youth alienation (self harm, violence, substance abuse and mental abuse). Which of the following key changes to health policy fails to address this trend? A. B. C. D. E. Gaining informed advice from community representatives and health workers. Combining effort, rigour and resources to achieve the outcome. Clearly identifying these issues and deciding on strategy. Increased corporate investment. Suppressing bureaucratic and ideological rhetoric aimed at these issues. Question 102 Which of the following is TRUE about the respiratory system's response to increased partial pressure of carbon dioxide in arterial blood? A. Peripheral chemoreceptors in the medulla sense an increase in the partial pressure of carbon dioxide in arterial blood. B. Conditions of hypoxia increase the sensitivity of the ventilatory response to hypercapnia. C. Alcohol increases the sensitivity of the ventilatory response to hypercapnia. D. The peripheral chemoreceptors are more sensitive to changes in arterial partial pressure of carbon dioxide, rather than to changes in arterial partial pressure of oxygen. E. Increased partial pressure of carbon dioxide in arterial blood above the normal range stimulates hypoventilation in the subject. Question 103 Which of the following will most likely result in the greatest increase in partial pressure of oxygen in blood? A. B. C. D. E. Increasing the inspired oxygen pressure in a normal subject. Increasing the inspired oxygen pressure in a patient with shunt. Hyperventilation by a patient with a ventilation-perfusion mismatch. Supplying oxygen to a cyanotic patient. Increasing tidal volume in a patient with chronic obstructive pulmonary disease (COPD). Question 104 Which of the following are atypical pneumoniae? A. B. C. D. E. Pseudomonas aeruginosa. Legionella species. Haemophilus influenzae. Chlamydia pneumoniae. Klebsiella pneumoniae. Question 105 You are the doctor in charge of a rural hospital. A young male patient has come to you in a worryingly bad state. If you do not treat, he is likely to die within the week. You request that he return the following morning but he does not return the next day, or the day after. What should your response be? A. Respect his right to choose his treatment for himself. B. Enquire with nurses whether there was any reason for his absence, but do not contact him directly as this goes against the privacy of the patient. C. Ring the police and force the young man to return to hospital. D. Ring the young man's home and family to see how he is doing and whether he understands the gravity of the situation. E. Read through the man's records to see if there was any reason for his absence, but do not contact him. Question 106 During swallowing, which muscle helps in opening the Eustachian tube? A. B. C. D. E. Levator veli palatini Tensor veli palatini Tensor tympani Stapedius Glossopharyngeus Question 107 Which of the following is TRUE with regard to airway resistance? A. Forced expiratory volume in one second (FEV1) provides an absolute measure of airways resistance. B. Airways resistance can be influenced by local reflex changes in arterial partial pressure of carbon dioxide in order to maintain ventilation-perfusion matching. C. Release of inflammatory mediators such as histamine causes smooth muscle relaxation in small airways resulting in increased airways resistance. D. Airways resistance is higher in the smaller airways due to higher total cross-sectional area and laminar airflow. E. With laminar flow, airways resistance is related to the radius of the airway to the fourth power (r4). Question 108 In what order does the respiratory system divide? A. Trachea, lobar bronchi, principal bronchi, segmental bronchi, terminal bronchioles, respiratory bronchioles, alveoli. B. Trachea, principal bronchi, lobar bronchi, segmental bronchi, terminal bronchioles, respiratory bronchioles, alveoli. C. Trachea, primary bronchi, segmental bronchi, tertiary bronchioles, alveoli. D. Trachea, principal bronchi, segmental bronchi, terminal bronchioles, alveoli. E. Trachea, primary bronchi, secondary bronchi, terminal bronchioles, alveoli. Question 109 What are the structural changes in the lung with age A. B. C. D. E. Decrease in elastic fibres Increase in type 3 collagen Decrease in number of alveoli Increase in size of alveolar ducts All of the above Question 110 Which of the following degenerative changes occur in the alveolar sacs as they age? A. B. C. D. E. Elasticity decreases, compliance decreases and radial traction increases. Elasticity increases, compliance increases and radial traction increases. Elasticity decreases, compliance increases and radial traction decreases. Elasticity increases, compliance decreases and radial traction increases. Elasticity decreases, compliance increases and radial traction increases. Question 111 Which of the following physiotherapy techniques/interventions is designed to help prevent airway collapse and blockage? A. B. C. D. E. Postural drainage Percussion Hypertonic saline via nebuliser Active Cycle of Breathing Bubble PEP Question 112 How does dimethyloxaloylglycine (DMOG) from the liver compensate for hyperoxiainduced retinal damage? A. It negatively regulates prolyl hydroxylase which inhibits hypoxia-inducible factors, leading to increased angiogenesis in the retina. B. It enhances HIF production directly, leading to increased angiogenesis. C. It positively regulates prolyl hydroxylase which inhibits hypoxia-inducible factors, leading to increased angiogenesis in the retina. D. It increases levels of glutathione, leading to oxidation of reactive oxygen species and less retinal damage. E. it negatively regulates glutathione levels, leading to increased levels of reactive oxygen species and less retinal damage. Question 113 a1-antitrypsin deficiency is a known genetic risk factor for developing chronic obstructive pulmonary disease (COPD). ?1-antitrypsin utilises which mechanism to protect the lung tissue from damage? A. Inhibiting release of proteases by neutrophils by binding to a receptor on the neutrophil cell wall. B. Binding to neutrophil-released proteases directly and forming an inactive complex. C. Inhibiting IL-8 signalling to block neutrophil infiltration of lung tissue. D. Secreting neutrophil inhibitory factor preventing neutrophil adhesion to fibrinogen. E. Suppressing IL-2 activation of alveolar macrophages. Question 114 The two intraembryonic layers to differentiate during gastrulation are the: A. ectoderm and endodern B. C. D. E. epiblast and mesoderm mesoderm and endoderm ectoderm and hypoblast epiblast and hypoblast Question 115 A 55-year-old man with a history of peripheral vascular disease, who presents with a complaint of a left foot ulcer and pain when walking short distances, is found to have a popliteal stenosis and admitted for re-vascularisation. Four days after admission, on postoperative day 3, he develops shortness of breath, hypoxia, and a productive cough. Auscultation of his chest reveals decreased breath sounds at the lower aspect of the right side of his chest. His morning leukocyte count is slightly higher than the day before at 11,000 cells/mL. An anterior-posterior bedside chest X-ray reveals right lower lobe opacity.Which diagnosis will be most probable? A. B. C. D. E. Hospital-acquired pneumonia. Atypical pneumonia. Community-acquired pneumonia. Atelectasis. Lung cancer. Question 116 Which muscle is able to retract the mandible? A. B. C. D. E. Masseter Stylohyoid Lateral pterygoid Temporalis Medial pterygoid Question 117 John complains of being excessively sensitive to everyday noises. Which muscles do you suspect are responsible? A. B. C. D. E. The helicis muscles Stapedius Tensor tympani The helices muscles or stapedius Stapedius or tensor tympani Question 118 Which of the following structures is not connected to the hyoid bone by a muscle? A. B. C. D. Mandible Scapula Styloid process Sphenoid bone E. Thyroid cartilage Question 119 The parotid duct passes through which facial muscle? A. B. C. D. E. Masseter Digastric Medial Pterygoid Lateral Pterygoid Buccinator Question 120 What is the function of the Zygomaticus major muscle? A. B. C. D. E. Lower the lip Pull mouth together Elevate mouth angle Elevate the eyebrows Tense the neck Question 121 Which cranial nerve supplies motor function to the lateral rectus muscle? A. B. C. D. E. Abducens nerve (CN VI) Oculomotor nerve (CN III) Hypoglossal nerve (CN XII) Facial nerve (CN VII) Trochlear nerve (CN IV) Question 122 What is a typical condition associated with the collapse of iridocorneal angle? A. B. C. D. E. Glaucoma Cataract Conjunctivitis Impaired pupillary reflex Vitreous detachment Question 123 Which of the following are determinants of lung volume? A. B. C. D. E. Age Sex Height Race All of the above Question 124 In a patient with severe interstitial lung disease, what happens to their diffusing capacity and residual volume? A. B. C. D. E. Diffusing capacity is low and residual volume is low Diffusing capacity is low and residual volume remains the same Diffusing capacity is low and residual volume increases Diffusing capacity is the same and residual volume decreases Diffusing capacity is the same and residual volume increases Question 125 Which of these structures should be visible when using an otoscope to observe a healthy tympanic membrane? A. B. C. D. E. Internal acoustic meatus Ampulla Malleus Round window Stapes Question 126 Which of the following anti-fungal drugs does NOT act by disrupting the phospholipid bilayer of the cell membrane? A. B. C. D. E. Amphotericin B Caspofungin Fluconazole Itraconazole Voriconazole Question 127 Which is the most common cause of infertility in men with a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene? A. B. C. D. E. Decreased sperm motility. Congenital absence of the vas deferens. Low sperm count. Development of autoantibodies to sperm which block movement and egg binding. Hormonal disturbances resulting in low testosterone levels and hence infertility. Question 128 The three steps to appraising an observational study are A. B. C. D. E. bias, selection, confounding relevance, validity, results relevance, validity and bias blinding control statistical control Question 129 The physiological pH of blood is 7.4 (range 7.35-7.45). How do the intracellular pH levels compare? A. B. C. D. They are more acidic to facilitate removal of metabolic bases. They are more acidic to facilitate removal of metabolic acids. They are within the same range. They are more alkaline to facilitate transport of metabolic acids to the intra-cellular fluid. E. They are more alkaline to facilitate transport of metabolic bases to the intra-cellular fluid. Question 130 Which of the following is the preferred position for a child to be in during a simple, minimally invasive procedure? A. B. C. D. E. Supine surrounded by lots of smiling people. Therapeutic position where the child is sitting on his or her parent's lap. On their side, in recovery position with a teddy bear. Upright in a sturdy chair. Gently fastened to the bed so that they cannot wriggle away. Question 131 What is open disclosure? A. B. C. D. E. An apology or expression of regret for a mistake in health care. An opportunity for the patient, and their family and carers, to relate their experiences. An explanation for why an adverse event occured in health care. A and C. A, B, and C. Question 132 Which of the following statements is most correct about the normal sleep structure? A. B. C. D. E. A sleep cycle is between 150 to 180 minutes long. Deep sleep occurs during the later stages of sleeping. Rapid eye movement (REM) sleep phases become longer at the end of a period of sleep. Deep sleep occurs throughout a period of sleeping. Light and deep sleep occur intermittently throughout a period of sleep. Question 133 Mr. Jones is a 35 year old male brought in by ambulance overnight after falling over due to a dizzy spell. Upon further questioning, he mentions that he has a general tingling sensation on his face along with difficulty blinking. Upon examination, you find out that he is unable to raise his left eyebrow and unable to bare his teeth. Which cranial nerve is most likely affected in Mr. Jones' case? A. B. C. D. E. V1 V2 V3 VII XII Question 134 In Australia, there is a large increase in the number of road traffic injuries when drivers transition from learner permits to probationary licences. What is the most significant factor contributing to this increase? A. B. C. D. E. Increased consumption of alcohol. Increased driving in rural and remote areas. Poor road design. Inexperienced drivers now driving unsupervised. Intentional risk taking by young drivers. Question 135 Which of the following are a form of interstitial lung disease? A. B. C. D. E. Asthma Hypersensitivity pneumonitis Idiopathic pulmonary fibrosis Pulmonary hypertension Chronic obstructive pulmonary disease (COPD) Question 136 A stapedectomy is a surgical procedure generally performed to treat which ear disease? A. B. C. D. E. Cholesteatoma. > 3 episodes of acute otitis media in 6 months. Sensory hearing loss. Otosclerosis. Traumatic perforation of the tympanic membrane. Question 137 Which of the following lung irritants is the most common cause of chronic obstructive pulmonary disease? A. B. C. D. E. Pollen Air pollution Cigarette smoke Microbes All of the above Question 138 What is the FIRST step in the management of a tension pneumothorax with signs of haemodynamic compromise? A. B. C. D. E. Needle thoracotomy in the 2nd intercostal space at the mid-clavicular line. Chest X-ray to confirm clinical diagnosis. Surgery to repair the damage to the pleura. Chest drain in the 4th/5th intercostal space at the mid-axillary line. Intubation to secure an airway. Question 139 According to the International Agency for Research on Cancer, for which of the following cancers is there insufficient evidence that smoking is a cause? A. B. C. D. E. Cervical cancer Bladder cancer Stomach cancer Liver cancer All of the above have sufficient evidence linking their incidence to smoking as a risk factor. Question 140 If a patient presents with dyspnoea, which of the following symptoms is associated with a cardiac cause? A. B. C. D. E. Sputum Wheeze Cough Haemoptysis Palpitations Question 141 The experience of trauma has unique features in particular sub-populations. Amongst refugees, post-traumatic stress disorder (PTSD) is particularly prevalent because A. Refugees lack the resilience and capacity to absorb the effects of normal hardship B. PTSD is not particularly prevalent in refugee populations, because they experience survivor elation C. Refugees fear persecution and vilification in the countries into which they have fled D. Refugees are unable to seek help because their experience of torture or persecution was often enabled by medical professionals in their home country. E. They are biologically predisposed to the development of PTSD in the face of normal stressors. Question 142 Mary Smith is a 70-year-old woman who has been admitted to hospital with an acute exacerbation of airflow limitation on a long-standing background of chronic obstructive pulmonary disease (COPD). She is commenced on oxygen therapy. Her arterial blood gases on room air are measured and the results are as follows:pH 7.3Partial pressure of carbon dioxide: 70 mmHgPartial pressure of oxygen: 60 mmHgBicarbonate concentration: 30 mmol/LWhat do these results demonstrate? A. B. C. D. E. Moderate hypoxemia and a partially-compensated respiratory acidosis. Primary metabolic alkalosis with secondary respiratory acidosis. The effects of alveolar hyperventilation. The effects of low volumes of physiological dead space. Uncompensated respiratory acidosis. Question 143 What does the Abducens nerve (CNVI) innervate? A. B. C. D. E. Superior Oblique Medial Rectus Lateral Rectus Superior Rectus Levator Palpebrae Superior Question 144 What is the sensory nerve supply to the anterior 2/3 of the tongue? A. B. C. D. E. CN V3 - Mandibular branch of Trigeminal Nerve CN VII - Facial Nerve CN IX - Glossopharyngeal Nerve CN X - Vagus Nerve CN XII - Hypoglossal Nerve Question 145 Which of the following statements concerning the ventilation-perfusion ratio (V/Q ratio) is true? A. B. C. D. E. If ventilation is kept constant and perfusion is increased, the V/Q ratio will increase. If ventilation is increased and perfusion is increased, the V/Q ratio will stay constant. If ventilation is decreased and perfusion is decreased, the V/Q ratio will decrease. If ventilation is increased and perfusion is kept constant, the V/Q ratio will increase. If ventilation is decreased and perfusion is increased, the V/Q ratio will stay constant. Question 146 Which of the following statements regarding the oxyhaemoglobin dissociation curve is true? A. A right shift of the curve indicates an increase in the oxygen affinity for haemoglobin at a fixed partial pressure.. B. The curve shows that the amount of oxygen bound to haemoglobin is directly proportional to the partial pressure of oxygen. C. A left shift of the curve indicates a decrease in the oxygen affinity for haemoglobin at a fixed partial pressure. D. The curve shows that the amount of oxygen carried by haemoglobin drops suddenly at an oxygen concentration of 85 mmHg. E. The steep lower portion of the curve shows that diffusion of oxygen into tissues is possible with only small changes in oxygen partial pressure. Question 147 Which of the following is true? A. The invention of the cigarette-rolling machine dramatically increased the consumption of cigarettes. B. Cigarette rationing in the World Wars led to a greater increase in tobacco consumption in men than women C. The invention of ecigarettes has reduced tobacco use in young women D. Less than half the retail price of cigarettes in Australia is due to tax E. Plain packaging laws prohibit retailers from displaying cigarettes on open cabinets Question 148 Which of the following statements regarding Cystic Fibrosis (CF) is most true? A. Some heterozygous carriers of a CF gene can be found to have significant reduction of CFTR activity, but not enough to warrant diagnosis of CF B. Both ataluren and lumacaftor have been shown in trials to "chaperone" produced CFTR to the cell membrane C. Females with CF should be strongly encouraged to get assessed for their fertility D. Carrying one severe mutation and one mild mutation will leave an individual to suffer severe CF E. Newborn screening helps to detect CF in over 95% of affected babies Question 149 Ms Yee has a left parotid gland tumour, compressing the parotid gland and the structures within it. Which clinical symptom might you expect Ms Yee have? A. B. C. D. E. A numb tongue. Ptosis of the left eye. A lop-sided smile. An atrophied left temporalis muscle. Tingling and pain on her forehead. Question 150 Sally is a 5 year old girl who has come into ED complaining of breathlessness and wheeze on a history of asthma. She has been given salbutamol and her breathlessness and wheeze has since lessened.Which of the following is Sally also most likely to have? A. B. C. D. Alveolar inflammation Anaphylaxis Urticaria Vasculitis E. Butterfly rash Question 151 For which of the following would treatment with corticosteroids and/or immunosuppressive therapy be least effective? A. B. C. D. E. Idiopathic pulmonary fibrosis Cryptogenic organising pneumonia Respiratory bronchiolitis - interstitial lung disease Granulomatous interstitial lung disease Nonspecific interstitial pneumonia Question 152 A pharyngeal sinus or fistula may develop due to improper development of which pharyngeal groove? A. B. C. D. E. The first pharyngeal groove The second pharyngeal groove The third pharyngeal groove The fourth pharyngeal groove The fifth pharyngeal groove Question 153 Which of the following is not supplied by oculomotor nerve? A. B. C. D. E. The superior rectus muscle. The levator palpebral superior muscle. The ciliary body. The lateral rectus muscle. Sphincter pupillae. Question 154 All of the following can be seen during a physical examination of a patient with interstitial lung disease, with the EXCEPTION of: A. B. C. D. E. Inspiratory crackles Wheezes Clubbing Pulmonary Hypertension Hyper-resonant sounds Question 155 A lung function test on a patient with interstitial lung disease will show a decrease in all of the following parameters with the EXCEPTION of: A. TLC B. FVC C. FEV1/FVC D. DLCO E. RV Question 156 What is the soft palate comprised of? A. The muscles: Palatoglossus, Palatopharyngeus, Tensor veli palatini and Levator veli palatini. The uvula and the palatine bone. B. The muscles: Palatoglossus, Palatopharyngeus, Tensor veli palatini and Levator veli palatini. The uvula, the palatoglossal arch and the palatopharyngeal arch. C. The muscles: Palatoglossus, Palatopharyngeus and Styloglossus. The uvula, the palatoglossal arch and the palatopharyngeal arch. D. The muscles: Palatoglossus, Palatopharyngeus and Styloglossus. The uvula, the palatoglossal arch, palatopharyngeal arch, the maxilla and palatine bones. E. The muscles: Palatoglossus, Palatopharyngeus, Tensor veli palatini and Levator veli palatini. The palatoglossal arch and the palatopharyngeal arch. Question 157 Which of the following is not a primary cause of clubbing? A. B. C. D. E. Interstitial Lung Disease Infective Endocarditis Chronic obstructive pulmonary disease (COPD) Mesothelioma Cirrhosis Question 158 A variety of anatomical and physiological changes occur in the ageing lung. Which of the follow is NOT an effect of ageing. A. B. C. D. E. Lung elastic recoil decreases Airway closure decreases Intrapleural pressures decrease in magnitude The gradient between apical and basilar intrapleural pressures is maintained Ventilation becomes decreasingly heterogeneous Question 159 During inspiration the elastic tendency of the lungs to recoil pulls back against inflation more strongly as overall lung volume increases. During upright normal breathing in a healthy person the intrapleural pressure at all stages of breathing at the base of the lungs is less negative than at the apex. What will be the consequences of the specific interplay between these two forces during standing normal tidal breathing? A. The bronchioles in apex of the lung will be open at rest and will ventilate more upon inspiration. B. The base of the lung will be held less inflated at rest and will have more capacity to ventilate upon inspiration. C. The surface tension in the alveoli at the base of the lung will be lower than in the apex. D. The airflow in the base of the lung will be faster than the airflow in the apex. E. The bloodflow at the apex of the lung will be greater than at the base. Question 160 Which of the following explains the mechanism for expiration in normal, quiet breathing? A. Use of abdominal muscle to depress ribs, creating a positive pressure in lungs and causing air to leave lungs. B. Diaphragm contracts, creating negative pressure in lungs and causing air to enter lungs. C. Use of internal intercostal muscles to depress ribs, creating a positive pressure in lungs and causing air to leave lungs. D. Use of accessory muscles such as sternocleidomastoid to create a negative pressure in lungs, causing air to enter lungs. E. Elastic recoil of lungs creating a positive pressure in lungs, causing air to leave lungs. Question 161 Which of the following pathological changes in the lungs does NOT result from smoking? A. B. C. D. E. Paralysis of the mucociliary escalator. Inhibition of α1-antritrypsin in the lung parenchyma. Squamous metaplasia of the airway epithelium. Hyperplasia of airway wall goblet cells. Lesions containing pronounced fibroblastic proliferation. Question 162 Which of the following strategies would be most effective in decreasing public health costs due to smoking? A. B. C. D. E. Selling lighter or milder cigarettes. Advising people to only smoke twice in the day. Education people's family and friends on throwing out their cigarettes. Advise them to quit straight away. Advise them to plan about quitting before they quit. Question 163 Which of the following describes the hardening hypothesis for smoking? A. Smoke that contains higher quantities of hard PCAHs is likely to be more detrimental to health. B. Increasing emphasis on denormalisation laws will ultimately reduce the prevalence of smoking. C. Of the populations with a lower prevalence of smoking, the remaining smokers are relatively dependent and less likely to quit. D. Substituting for cigarettes with lower nicotine quantities will simply result in the smoker taking "harder" drags. E. None of the above. Question 164 Which of the following is not caused by smoking? A. B. C. D. E. Anhedonia Bronchitis Lung cancer Type II Diabetes Emphysema Question 165 Regarding deaf children (with no other disability) who receive a cochlear implant before the age of 18 months, what percentage learn to communicate using speech and receive regular schooling? A. B. C. D. E. 20% 50% 90% 95% 100% Question 166 Salbutamol is a short-acting β-adrenergic agonist (SABA) whilst salmeterol is a long-acting β-adrenergic agonist (LABA). Both produce bronchodilation. Which of the following explains why salmeterol is longer acting? A. Salmeterol is a larger molecule with a long lipid soluble tail so it takes longer to be metabolized. B. Salmeterol diffuses into the cell so it can't be metabolized by extracellular enzymes. C. Salmeterol is typically given in higher doses so its bronchodilation effect lasts longer. D. Salmeterol has a long lipid soluble tail which sits in the cell membrane, while the head of the molecule activates the receptor. E. Salmeterol is typically administered in combination with an inhaled corticosteroid so its perceived effect is greater. Question 167 A patient comes into your clinic and wishes to have her eye tested. If you ask her to abduct her eye and look up, what muscle would you be testing? A. B. C. D. E. Superior oblique muscle Inferior rectus muscle Superior rectus muscle Inferior oblique muscle Medial rectus muscle Question 168 In the presence of hypoxia, a wide alveolar-arterial (A-a) gradient would possibly indicate which of the following? A. B. C. D. E. Pulmonary shunt. Presence of interstitial lung disease. Presence of chronic obstructive pulmonary disease (COPD) Atelectasis. All of the above. Question 169 Narcolepsy is most typically described as excessive daytime sleepiness, combined with which of the following? A. Sleep onset in less than eight minutes, with rapid onset of deep (Stage N3) sleep. B. Sleep onset in less than eight minutes, with rapid onset of rapid eye movement (REM) sleep. C. Sleep onset when excited, resulting in collapsing. D. Inability to sleep at night, only able to sleep during the day. E. Sleep onset less than eight minutes, with slowing and cessation of breathing. Question 170 Grommets are a surgical treatment for which of the following? A. B. C. D. E. Ear wax build-up. Acute otitis media. Otitis media with effusion. Perforated tympanic membrane. Cholesteatoma. Question 171 Spirometry assesses which of the following? A. B. C. D. E. Total lung capacity Forced vital capacity Tidal breath Functional residual capacity Residual volume Question 172 In the context of surgery, smoking causes all except which of the following? A. B. C. D. E. Post-operative nausea and vomiting. Delayed bone healing times. Delayed wound healing times. Increased wound infections. Increased risk of anaesthesia. Question 173 There are four parts to the "structure of smoking" that contribute to its addictive power. These include all but which of the following? A. B. C. D. E. The context in which smoking occurs. The ritual of smoking. The sensory input obtained from smoking (i.e sound, taste, smell). Nicotine stimulation. The number of cigarettes smoked. Question 174 In interstitial lung diseases (ILD), lung function tests most often show which of the following? A. B. C. D. E. Reduced carbon monoxide diffusing capacity (DLCO) Increased total lung capacity (TLC) Airflow obstruction Elevated arterial partial pressure of carbon dioxide A decrease in the FEV1 to FVC ratio (forced expiratory volume in one second to forced vital capacity) Question 175 Which of the following muscles arises from the first pharyngeal arch? A. B. C. D. E. Stylohyoid Stylopharyngeus Mylohyoid Palatopharyngeus Levator veli palatini Question 176 According to the Haddon Matrix, effective and timely emergency response is an example of what type of factor for the prevention of road traffic injury and death? A. B. C. D. E. Post-crash environmental. Post-crash social. Pre-crash human. Crash vehicle. Crash environmental. Question 177 Which of the following is false regarding the influences of spirituality on health? A. B. C. D. E. It is a core domain in assessing the quality of life in patients with cancer It could interfere in a patient's acceptance of clinical information It can contribute to longevity in patients with cancer It can contribute to expectations of health staff Empirical evidence suggests that spirituality is too subjective to be supported as having protective effects on health Question 178 Which of the following pathologies cannot be distinguished on a lateral X-ray of the head and neck? A. B. C. D. E. Airway narrowing. Sella turcica enlargement. A blocked right maxillary sinus. Sclerosis of the mastoid process. Fracture of the mandible. Question 179 Which structure is a boundary to both the anterior and posterior triangles of the neck? A. B. C. D. E. Angle of the mandible. Sternocleidomastoid muscle. Posterior belly of the digastric muscle. Common carotid artery. Clavicle. Question 180 Which of the following activities improve children and families' experience in hospital? A. B. C. D. E. Continuous opportunities for play. Self-esteem reinforcement. Opportunities to express themselves with art. Stress management techniques. All of the above. Question 181 The stimulus based model of stress proposes that stress is external to the person, who experiences a reaction to the stress. Which of the following is NOT a weakness/limitation of this model? A. B. C. D. It treats the person as a passive respondent to a stressful event. It does not recognise the person's role in creating the stressful event. It undervalues the person's ability to moderate their response with effective coping. It implies an internal locus of control whereby the person is unable to change the situation. E. It does not suggest an avenue to prevent the event occurring. Question 182 Doubling alveolar ventilation will: A. B. C. D. E. double the PaO2 cause respiratory acidosis have no effect halve the PACO2 induce fainting Question 183 Where does the mandibular branch of the Trigeminal nerve (CNV3) exit the skull? A. B. C. D. E. Foramen Ovale Foramen Rotundum Superior Orbital Fissue Jugular Foramen Internal Acoustic Meatus Question 184 Which of the following is an important difference between salbutamol and salmeterol? A. B. C. D. E. Salbutamol and salmeterol act on different receptors. Salmeterol has a slower speed of onset. Salmeterol causes fewer systemic side effects. Only salmeterol improves mucociliary clearance. Only salmeterol inhibits the release of contractile mediators. Question 185 Which of the following does not belong to the conducting zone of the respiratory system? A. B. C. D. E. The alveoli The bronchioles The nose The pharynx The mouth Question 186 What is the innervation of the diaphragm? A. B. C. D. E. Through the phrenic nerve from the posterior rami of C3-C5 spinal levels. Through the phrenic nerve from the anterior rami of C3-C5 spinal levels. Through the vagus nerve. Through the intercostal nerve. Through the phrenic nerve from anterior rami of C1-C2 spinal levels. Question 187 A 35 year old man is presenting to your clinic with acute onset of fever, night sweats and productive cough with rusty sputum and mild chest pain. A culture and Gram stain of his sputum shows the presence of a Gram-positive organism. Which antibiotic you will most likely prescribe to him? A. B. C. D. E. Doxycycline Azithromycin Ciprofloxicin Amoxycillin Penicillin V Question 188 When listening to the chest of a patient, bronchial or vesicular breath sounds may be heard. In a patient with healthy lungs, what sort of breath sounds should be heard when auscultating lung tissue, and which part of the lungs do the sounds originate from? A. B. C. D. E. bronchial, bronchi and large bronchioles bronchial, small bronchioles and alveolar ducts vesicular, trachea vesicular, bronchi and large bronchioles vesicular, small bronchioles and alveolar ducts Question 189 A very large tumour of the parotid space will most likely impact upon the parapharyngeal space by which mechanism? A. Disrupting the junction of the parapharyngeal space with the danger space, B. Projecting into the posterior aspect of the parapharyngeal space. C. Invasion of the parotid-parapharyngeal border and subsequent compression of the Vagus nerve (CN X). D. Displacing the parapharyngeal space anteriorly into the carotid space. E. Displacing the parapharyngeal space posteriorly into the masticator space. Question 190 Which of the following is true in relation to the mediastinum? A. B. C. D. E. The pulmonary veins exit the lungs inferior to the pulmonary arteries. The aorta arches posteriorly over the right main bronchus. The pulmonary veins enter the hila at the level of the sternal angle. The azygos vein arches over the right hilum, emptying into the superior vena cava. The bronchi enter the left hilum anteriorly, because of the position of the heart. Question 191 How many pairs of ribs attach solely to the manubrium of the sternum? A. B. C. D. E. 0 1 2 3 4 Question 192 Which of the following is not a part of the contents in the mediastiunum? A. B. C. D. The thymus. The phrenic nerves. The vocal folds. The common carotid artery. E. The carina of the trachea. Question 193 With regard to health and health care, which of the following provides the most correct reason why Indigenous children in Australian remote communities are severely disadvantaged compared to non-Indigenous children? A. 30% of the Indigenous population live urban/city centres. B. They carry a high burden of infectious diseases, including respiratory illness, gastroenteritis, ear infections and skin diseases. C. They carry a high burden of chronic disease including diabetes mellitus, hypertension, renal disease and vascular disease. D. Growing antibiotic resistance has led to loss of efficient treatment for infectious disease. E. There is no breast or cervical cancer screening. Question 194 A 50 year old man visits his GP concerned about where or not he should undertake a PSA screen for prostate cancer. You give him decision aids presenting evidence for the outcomes of the PSA screen. Decision aids are most beneficial in: A. B. C. D. E. directing patients towards the right decision improving patient knowledge reducing consultation time length better selecting who is more appropriate to screen encouraging paternalistic decision making Question 195 Caitlin is a 5 year old girl brought into the ED by her mother with shortness of breath and audible wheeze. Her mother tells you that this has never happened before, but that her older brother had a similar episode when he was 5 years of age that was discovered to be asthma. What findings would allow for a potential diagnosis of asthma in Caitlin? A. Positive sputum culture. B. Increased forced vital capacity (FVC). C. Decreased FEV1 to FVC ratio (forced expiratory volume in one second to forced vital capacity). D. More than 25% improvement in forced expiratory volume in one second (FEV1) following bronchodilator inhalation. E. Increased breath sounds on auscultation. Question 196 What cranial nerve carries preganglionic autonomic fibres which synapse in the otic ganglion? A. Oculomotor nerve (CN III) B. Trigeminal nerve (CN V) C. Facial nerve (CN VII) D. Glossopharyngeal nerve (CN IX) E. Vagus nerve (CN X) Question 197 Which of the following are important issues in medical certification? A. B. C. D. E. Patient honesty Doctor honesty Patient privacy The doctor-patient relationship All of the above Question 198 Which of the following will be best corrected by hyperventilation? A. B. C. D. E. Shunt Alkalosis A defect in diffusion capacity A reduced inspired oxygen percentage Ventilation/perfusion mismatch Question 199 The two main pathological features of asthma, bronchoconstriction and airway inflammation are treated pharmacologically with different drugs. These include shortacting β-adrenergic agonists (SABA), long-acting β-adrenergic agonists (LABA), phosphodiesterase (PDE) inhibitors, inhaled corticosteroids and anticholinergic drugs.Which of the following are appropriate drug classes to treat: i) bronchoconstriction and ii) inflammation. A. B. C. D. E. i) SABA ii) inhaled corticosteroid i) SABA ii) PDE inhibitor i) inhaled corticosteroid ii) anticholinergic i) SABA ii) anticholinergic i) LABA ii) PDE inhibitor Question 200 There are a number of causes of bacterial pneumonia. Which of the following is preventable through vaccination? A. B. C. D. E. Staphylococcus aureus Klebsiella pneumoniae Escherichia coli Streptococcus pneumoniae Legionella longbeachae Question 201 What is not part of the primary survey for trauma examination? A. B. C. D. E. Circulation Airway and C Spine Blood glucose level Breathing Liver Function Tests Question 202 What is the best explanation of sensitisation? A. An allergen leaches through the epithelium, where antigen presenting cells pick up the antigen, migrate to the nearest lymph node and are recognised by B cells, signalling class switching to IgE antibodies B. An allergen leaches through the epithelium, whereby a resident mast cell is stimulated through the cross linking of antigens onto IgE antibodies, which then stimulates the release of preformed and newly formed mediators. C. An allergen leaches through the epithelium, which is then phagocytosed by resident macrophages, mounting a local inflammatory response. D. An allergen leaches through the epithelium, where antigen presenting cells pick up the antigens and migrate to the nearest lymph node whereby T helper cells are activated and encourage class switching in B cells to produce IgE antibodies. E. None of the above Question 203 You are a GP working in a busy practice. A patient, who you have seen for several years, comes to see you and asks for a medical certificate. It is clear, however, that the patient is not sick and it appears that she wants the certificate to avoid an exam. According to ethical and professional guidelines, which of the following is the best course of action? A. B. C. D. Write a certificate to preserve the patient's trust in you. Write a certificate so that you can attend to other patients who may need your help. Decline to write a certificate. Enquire about her reasons for wanting the certificate and see if there are alternative solutions to her problems. Explain that you cannot sign the certificate because of the importance you place on honesty and the possible legal implications. E. Refer her to a specialist. Question 204 Which of the following nerve lesions is correctly listed with it's associated loss of function? A. Damage to the glossopharyngeal nerve (CN IX) may cause loss of sensation in the laryngopharynx. B. Damage to the vagus nerve (CN X) may impair the ability to equalise pressure of the auditory (eustachian) tube. C. Damage to the glossopharyngeal nerve (CN IX) will impair the ability to abduct the vocal folds. D. Damage to the glossopharyngeal nerve (CN IX) is the most likely cause of dysphagia. E. Damage to the recurrent laryngeal nerve (a branch of the vagus nerve; CN X) will impair the ability to tense the vocal folds. Question 205 Which of the following is correct in regards to exocrine secretion? A. All exocrine secretion is by a merocrine or apocrine mechanism. B. The faster fluid flows through a reabsorption duct, the greater the reabsorption of ions from the fluid. C. The potassium concentration in sweat is highest under low flow rates. D. Reabsorption of ions takes place predominantly in the acinus of a sweat gland. E. Tight junctions between cells restrict all ion flow between them. Question 206 A 8 year old girl with cystic fibrosis has been in the hospital for the last week following a chest infection. She has been very anxious during procedures. You are trying to complete a procedure on her but she is uncooperative. Which of the following is the most appropriate intervention? A. B. C. D. E. Leave her now and try again in an hour once she has calmed down Coach her in stress management techniques Do the procedure in her hospital bed Have the parent restrain the child from moving Give her a puzzle to assemble during the procedure Question 207 Select the most correct option: A. Spirituality may be beneficial to the patient on a personal level, but is not beneficial in the health care setting as it has no impact on the patients physical state of health (cardiovascular health, pain, etc).. B. 'Suffering' refers to only physical and emotional pain experienced and the consequences of this physical and emotional pain. C. Spirituality can have a negative effect on health when it presents itself as an obstacle to appropriate health care. D. There is no link between spirituality/religion and health, and spirituality cannot improve the physical health of patients. E. Suffering is an all-encompassing societal and community experience which may then have physical, emotional, psychological and other negative effects on an individual. Question 208 Which of the following statements is INCORRECT regarding shift work and circadian disruption? A. Shift workers are more likely to experience weight loss due to increased disruption in their eating habits. B. Shift workers can experience reproductive difficulties such as decreased fertility and increased risk of miscarriage. C. Consequences of shift work and circadian disruption include impaired concentration and reaction times. D. The number of fatigue-related car crashes in Australia is similar to that of alcoholrelated car crashes. E. Shift work sleep disorder is characterised by difficulty sleeping during the day, and difficulty staying awake at night. Question 209 Which of the following is considered the strongest treatment for circadian disruption? A. B. C. D. E. Bright light exposure Low temperature Caffeine Orally administered melatonin Dim light exposure Question 210 In patients with chronic obstructive pulmonary disease (COPD), which volume increases the most in relative proportion? A. B. C. D. E. Total lung capacity. Vital capacity. Tidal volume. Residual volume. Functional residual capacity. Question 211 Ben is a medical intern who is working night shift. In order to delay the onset of tiredness and sleepiness, what would you recommend Ben do? A. B. C. D. E. He should take a nap before his night shift, of 30-60 minutes duration. He should take regular naps during his shift as required. He should drink coffee before his shift starts. He should take a nap before his shift, of less than 30 minutes duration. He should take melatonin supplements before his shift starts. Question 212 You are working in a rural Chinese community for an elective. Which of the following is becoming a greater cause of death today in developing countries such as China compared to 20 years ago? A. B. C. D. Lower respiratory tract infections Malnutrition Preterm birth complications Ischemic Heart Disease E. Tuberculosis Question 213 In fibrosis of the lung there may be excessive radial traction on the airways. This leads to A. B. C. D. E. collapse of the small airways enlarged airway calibre related to lung volume increased forced vital capacity low FEV1/FVC ratio all of the above Question 214 Which of the following statement most correctly describes developmental changes in sleep? A. B. C. D. E. In the first year of life, sleep often starts with non-rapid eye movement (NREM) sleep. Rapid eye movement (REM) sleep stages emerge over first 2 - 6 months of life. Slow wave sleep (SWS) develops in young chidren and increases with age. Arousals increase in frequency with age, so sleep is less consolidated. Less wake after sleep onset (WASO) as age increases. Question 215 From which of the following structures does the external auditory canal develop? A. B. C. D. E. The 1st branchial groove. The 2nd branchial groove. The 3rd branchial groove. None of the above. All of the above. Question 216 Which cranial nerve is responsible for sensory innervation of the middle ear? A. B. C. D. E. The mandibular nerve (CN V3) The abducens nerve (CN VI) The facial nerve (CN VII) The oculomotor nerve (CN VIII) The glossopharyngeal nerve (CN IX) Question 217 A 20year old female patient with Cystic Fibrosis is admitted to hospital with an acute infective exacerbation. On your multidisciplinary ward round, she asks the physiotherapist in your team about the long term efficacy of airway clearance techniques. You have recently read the Pryor 2006 and McIlwaine 2003 studies looking at this question and tell her that most of the interventions have no significant difference in exacerbations except for one. Which physiotherapy intervention has been associated with a significant increase in exacerbations compared to the others over 1 year? A. B. C. D. E. Positive expiratory pressure High frequency chest wall oscillation vest Autogenic Drainage Flutter device Active Cycle of Breathing technique Question 218 Iron (Fe) deficiency (serum ferritin A. B. C. D. E. Narcolepsy Obesity hypoventilation syndrome (hypercapnic OSA) REM behaviour disorder Restless legs syndrome (RLS) Insomnia Question 219 If you are an unaffected sibling of a child who has cystic fibrosis (CF) then what are the chances that you are a carrier? A. B. C. D. E. 0 (No chance) 1/4 1/2 2/3 1 (Certain) Question 220 Opening of the vocal folds is essential for allowing normal and forced respiration. Which muscle and associated nerve are responsible for opening the vocal folds in this manner? A. B. C. D. E. Lateral cricoarytenoideus and the superior laryngeal nerve. Posterior cricoarytenoideus and the superior laryngeal nerve. Lateral cricoarytenoideus and the recurrent laryngeal nerve. Posterior cricoarytenoideus and the recurrent laryngeal nerve. Cricothyroideus and the superior laryngeal nerve. Question 221 What is the sensory, motor and taste nerve supply to the tongue? Pick the correct answer. A. Sensory is V3 (mandibular) anteriorly, IX (Glossopharyngeal) posteriorly. Motor is XII (hypoglossal) except palatoglossus X (vagus). Taste is XII hypoglossal B. Sensory is V3 (mandibular) anteriorly, IX (Glossopharyngeal) posteriorly. Motor is XII (hypoglossal). Taste is VII anteriorly (facial) and IX posteriorly (Glossopharyngeal) C. Sensory is V3 (mandibular) anteriorly, IX (Glossopharyngeal) posteriorly. Motor is XII (hypoglossal) except palatoglossus X (vagus). Taste is VII anteriorly (facial) and IX posteriorly (Glossopharyngeal) D. Sensory is XII anteriorly (hypoglossal) and IX (glossopharyngeal) posteriorly. Motor is XII (hypoglossal) except palatoglossus X (vagus). Taste is XII hypoglossal E. Sensory is XII anteriorly (hypoglossal) and IX (glossopharyngeal) posteriorly. Motor is XII (hypoglossal). Taste is XII hypoglossal anteriorly and IX posteriorly (glossopharyngeal). Question 222 The ethmoid bone contains which concha? Select the most correct answer. A. B. C. D. E. superior concha middle concha superior, middle and inferior concha middle and inferior concha superior and middle concha Question 223 A 60 year old man presents with a 2-year history of right knee pain. He has been prescribed a non-selective NSAID, which he takes regularly but has not helped with his pain and he has become very distressed. You recommend a knee arthoscopy, knowing there is no evidence for the treatment, but in hopes that it will provide him relief. This is an example of what type of cognitive error? A. B. C. D. E. Anchoring heuristic Commision bias Outcome bias Latent error Error in execution Question 224 Many molecules are released from mast cells during an immune response. A number of these molecules are derived from a membrane phospholipid precursor and therefore synthesised de novo when the mast cell is activated. Which of the following molecules is NOT derived from a membrane phospholipid precursor? A. B. C. D. E. Prostaglandin D2 (PG D2) Leukotriene B4 (LT B4) Platelet Activating Fator (PAF) Leukotriene C4 (LT C4) Eosinophil Chemotactic Factor (ECF) Question 225 A patient presents to you with obstructive airway disease. They are unable to fully expire to a normal residual volume, and their lungs are constantly hyperinflated. They are still able to breathe in a normal tidal volume using their inspiratory reserve volume however they are showing signs of severe peripheral and central hypoxia. What is the most likely reason for this to occur? A. The air is only ventilating the most superior lobes of the lungs which have poorer blood flow. B. The air will not make it past the conducting dead spaces into the alveoli, and thus blood is not oxygenated. C. The higher intrathoracic pressure will prevent venous return to the heart from the inferior vena cava. D. The higher intrathoracic pressure will push on the heart and prevent it from beating fully. E. The higher intrathoracic pressure will push on the pulmonary arteries and prevent perfusion of the lungs. Question 226 Short acting ?-agonists (SABAs), which are used to alleviate an acute exacerbation of asthma, have a number of physiological effects within the airways. Which of the following is the most clinically relevant mechanism of action of SABAs? A. B. C. D. E. They directly inhibit mast cell mediator release. They improve mucociliary clearance by increasing frequency of cilia beating. They relax airway smooth muscle to increase airway latency. They decrease hypersensitivity of airways. All of the above actions are equally important. Question 227 Which of the following are not smokefree areas? A. B. C. D. E. Restaurants Workplaces Public transport Casino high-roller rooms None of the above Question 228 A 55 year old male smoker presents to the emergency room with wheezing and shortness of breath. He explains that he was at his work as a spray painter, and he removed his mask and forgot to put it back on before beginning to paint again in a small enclosed space. You give him bronchodilators and he improves immensely. What do you think he has? A. B. C. D. E. Occupational induced asthma caused by sensitisation Pneumonia, which was exacerbated by the irritant exposure Occupational induced asthma caused by irritants COPD, this is probably an exacerbation of his long term symptoms due to smoking Asbestosis, he has probably been exposed at work to asbestosis for a long time Question 229 A patient comes to the emergency room with broken ribs due to falling off her bike. You take a chest X-ray and notice, as well as the broken ribs, fibrotic nodular appearance on the upper zones of her X-ray and enlarged hilar nodes. She tells you upon questioning that she works as a sandblaster. What do you think she has? A. B. C. D. Asbestosis, this X-ray is typical of a patient with asbestosis Silicosis, however it is abnormal that she has had no respiratory symptoms Silicosis, it is not unusual that she has had no respiratory symptoms Lung cancer, this very rarely presents with respiratory symptoms until very late in the disease and is associated with a poor prognosis E. Metal fume fever, the fever probably contributed to her becoming unbalanced and falling off her bike Question 230 You're following an intern around at clinical school during rounds. Afterwards they mention they're worried that their registrar is often quick to accept a suggested diagnosis and regularly fails to complete any form of physical exam. It is possible this is due to a cognitive bias in the registrar's diagnostic reasoning. Which of the following best describes this type of bias? A. B. C. D. E. Premature closure Omission bias Outcome bias Anchoring heuristic Availability heuristic Question 231 An 'anchoring heuristic' is identified as a type of cognitive error in diagnostic reasoning. It relates to a tendency to fixate on first impressions and selected symptoms or signs or simple investigation results are used as predictors of specific diagnosis.Which of the following is the best strategy to minimise this form of bias? A. Verify prevalence based on proper statistics. B. Think beyond the most favoured diagnosis; reconsider in light of new data or unexpected course of illness. C. Consider the worst case scenario that may result from inaction. D. Be realistic in expectations for therapeutic success; do not offer treatment in futile or near futile situations. E. Ask "Am I treating the patient, or myself?"efer her to a specialist. Question 232 Which of the following is an example of an appropriate use of antibiotics? A. They are continued when viral aetiology is confirmed and bacterial infection is unlikely. B. They are given in dosages which produce low levels in blood long enough to eradicate the bacteria. C. Broad-spectrum antibiotics are used for the shortest duration. D. Use of narrow spectrum β-lactam antibiotics for a lung infection. E. Prescribing β-lactams for an infection by an atypical microbe. Question 233 Which of the following is not an explanation for the current increase in demand for emergency health services? A. Australia's ageing population B. The convenience of presenting to the emergency department C. The opportunity for patients to be referred following admission to the emergency department D. Staff in the emergency department tend to work faster and more effectively than primary care physicians E. The increasing prevalence of chronic diseases Question 234 Children, particularly infants, have a number of differences in their respiratory system compared to adults. Which of the following is NOT one of those differences? A. B. C. D. E. A softer trachea. A relatively large tongue compared to the size of their mouth. Breathing which predominantly occurs using abdominal muscles. Less compliant chest walls. All are differences noted in the respiratory system of children. Question 235 Which of the following is true in regards to the Pharyngeal arches? A. There are 4 main arches with the fifth and sixth arches being rudimentary. B. The first arch gives rise to the incus, malleus, maxilla, zygomatic, vomer, mandible, temporal (squamous part) bones. C. Only the third arch gives rise to the hyoid bone. D. A and B. E. A, B and C. Question 236 How do prolyl hydroxylases act in response to reactive oxygen species? A. They act to promote the production of glutathione, which is oxidised in order to protect cells from reactive oxygen species. B. They are negatively regulated by dimethyloxaloylglycine (DMOG), which leads to decreased stability of hypoxia-inducible factors (HIFs). C. They decrease the stability of hypoxia-inducible factors (HIFs), negatively regulating this pathway. D. They increase the stability of hypoxia-inducible factors (HIFs), positively regulating this pathway. E. They inhibit pyruvate dehydrogenase, leading to the conversion of pyruvate to lactic acid. Question 237 Which of the following is not a widely used way of reporting outcomes from prognostic studies? A. B. C. D. E. % outcome at a point in time e.g. 5 year survival rates medial survival survival curves e.g. Kaplan Meier relative risk Hazard ratio Question 238 Polio is still endemic to which of the following countries? A. B. C. D. E. China Australia Ethiopia Afghanistan Papua New Guinea Question 239 Which of the following is an example of a passive safety measure for the prevention of road traffic injuries? A. B. C. D. E. A public awareness campaign encouraging drivers to take frequent breaks. Increased penalties for driving offences during holiday periods. Speed cameras on busy roads. Random breath testing by police. Installation of air bags in all new cars. Question 240 Pulmonary rehabilitation is one of the most effective strategies for long term management of chronic obstructive pulmonary disease (COPD). This includes exercise training, which is associated with improved exercise capacity and decreased dyspnoea. Which of the following describes one of the changes which occurs in exercising skeletal muscles? A. B. C. D. E. Increased oxidative enzyme concentration. Decreased density of mitochondria. Increased myoglobin. A and C. A, B and C. Question 241 What is the function of the transversus thoracis muscles? A. B. C. D. E. To raise the ribs during inspiration. To pull the sternum back during inspiration. To depress the ribs during expiration. To support the posterior thoracic wall. To pull the sternum back during expiration. Question 242 Which of the following is the least likely explanation for swollen ankles? A. B. C. D. E. Pregnancy Pleural effusion Pulmonary oedema Cirrhosis of the liver Hypothyroidism Question 243 What are the 4 main asbestos related diseases? A. B. C. D. E. Lung cancer, Asthma, COPD , Hypersensitivity pneumononitis Asbestosis, Pneumonia, COPD, Lung cancer Asthma, Lung cancer, Asbestosis, COPD Mesothelioma, Lung cancer, Benign pleural disease, Asbestosis Asbestosis, Mesothelioma, Asthma, Lung cancer Question 244 Which of the following conditions would be considered most urgent for triage purposes? A. B. C. D. E. An 80 year old female with suspected Stage IV pancreatic cancer. A 22 year old male with a distal phalanx dislocation. A 42 year old female with a blood glucose of 1.9 mM. A 18 year old who passed out and has a GCS of 8. A 33 year old who inhaled a tic tac with slight wheeze. Question 245 The semicircular canals connect to the vestibule by how many openings? A. B. C. D. E. 2 3 4 5 6 Question 246 What constitutes the respiratory zone of the lungs? A. B. C. D. E. The area from the primary bronchi to the alveolar sacs. The area from the trachea to the terminal bronchioles. The area from the terminal bronchioles to the alveolar sacs The area from the respiratory bronchioles to the avleolar sacs The area from the alveolar ducts to the alveolar sacs Question 247 Which of the following is correct regarding perfusion and gas transfer in the lungs? A. Diffusing capacity of the lung is affected primarily by its elastic recoil. B. Simple spirometry can be used to calculate a person's total lung capacity. C. Carbon dioxide is a suitable gas to be used when measuring gas diffusion within the lungs because it is more soluble in blood than oxygen is. D. Methane or helium are suitable gases to be used when measuring gas diffusion in the lungs because they do not diffuse into the alveolar capillaries. E. Methane or helium are NOT suitable gases to be used when measuring gas diffusion in the lungs because they do not diffuse into the alveolar capillaries. Question 248 The MOST likely cause of a spontaneous pneumothorax in an otherwise healthy 17 year old male is: A. B. C. D. E. Emphysema Blunt trauma α1-antitrypsin deficiency Rupture of an apical bleb Cystic fibrosis Question 249 The foramen caecum of the adult tongue is: A. the site of embryonic evagination of the thyroid gland B. the point of division of the tongue into the anterior two-thirds and the posterior onethird C. the site of embryonic evagination of the thymus gland D. never observed in an adult human E. a pathology of thyroid development Question 250 The primitive streak is: A. B. C. D. E. derived as an extension of the cloacal membrane formed by the folding of the hypoblast the notochord which extends rostrally during gastrulation formed during gastrulation due to epiblast cell movement to form the mesoderm initiated by neural plate signalling Question 251 The most common mutation in cystic fibrosis is ?F508, which affects the transporter called cystic fibrosis transmembrane conductance regulator (CFTR). How does it do this? A. B. C. D. E. By preventing initial synthesis of the transporter. By inhibiting processing of the protein into a mature transporter. By affecting regulation of the transporter. By altering the conductance of the transporter. By reducing synthesis of the transporter. Question 252 Which of the following findings would be most expected in advanced silicosis? A. Pleural plaques on a chest X-ray. B. Increased rheumatoid factor measured in the blood. C. An FEV1 to FVC ratio of 50% (forced expiratory volume in one second to forced vital capacity). D. Fibrotic nodules with concentric collagen and birefringent particles within the lungs. E. A family history of atopy. Question 253 A patient presents with fine inspiratory crackles. What is one likely differential diagnosis? A. B. C. D. E. Asthma A cold Pulmonary fibrosis Cancer Consolidation Question 254 A patient presents to you with dyspnoea. On examination, breath sounds are absent in the left lung base, there is reduced vocal resonance on the left side and stony dullness is heard on percussion. What is one likely diagnosis? A. B. C. D. E. Consolidation of the lung Pleural effusion Chronic obstructive pulmonary disease (COPD) Interstitial lung disease Pneumothorax Question 255 A 56-year-old male patient presents with breathlessness and bilateral basal crepitations on auscultation. Lung function tests reveal a decrease in total lung capacity and a decrease in diffusing capacity for carbon monoxide (DLCO). Which of the following is the most likely diagnosis? A. B. C. D. E. Chronic bronchitis Idiopathic pulmonary fibrosis Cystic fibrosis Allergic bronchopulmonary aspergillosis Chronic obstructive pulmonary disease (COPD) Question 256 A 40 year old woman is seen in the office complaining of shortness of breath in climbing a flight of stairs, which has been progressive over the past four months. Her physical examination is unremarkable. Her chest X-rays show bilateral hilar lymphadenopathy, with a mild diffuse infiltrate in the lung fields. Which of the following is the most likely diagnosis? A. B. C. D. E. Interstitial pulmonary fibrosis (IPF) Sarcoidosis Wegener's granulomatosis Asbestosis Tuberculosis Question 257 A 43-year-old woman with xerostomia, and keratoconjunctival and vaginal sicca (mouth, eye, and vaginal dryness). She is complaining of shortness of breath, dry cough, and fine crackles upon auscultation. She has low levels of oxygen saturation on examination. Further investigations show that her total lung capacity is less than 80%. High-resolution computed-tomography scanning shows symmetrical, lower-lobe, ground glass opacity, and signs of traction bronchiectasis, with no honeycombing. Her serum tests positive for extractable nuclear antigens (ENA), anti-nuclear antibodies (ANA) and rheumatoid factor (RF).Which of the following is the most likely diagnosis? A. B. C. D. E. Idiopathic pulmonary fibrosis Sarcoidosis Connective tissue disease Non-specific intersitial pneumonia Lymphocytic interstitial pneumonia Question 258 Rinne and Weber tests are performed on an patient with suspected hearing loss. The results are as follows:RinneRight ear: air conduction exceeds bone conductionLeft ear: air conduction exceeds bone conductionWeber: Sound is heard better in the right ear.What is the most likely diagnosis? A. B. C. D. E. Sensorineural hearing loss in the right ear. Sensorineural hearing loss in the left ear. Conductive hearing loss in the right ear. Conductive hearing loss in the left ear. Normal hearing. Question 259 Rinne and Weber tests are performed on a patient with suspected hearing loss. The results are as follows:RinneRight ear: bone conduction exceeds air conductionLeft ear: air conduction exceeds bone conductionWeber: Sound is heard more clearly in the right earWhat is the most likely diagnosis? A. B. C. D. Sensorineural hearing loss in the right ear. Sensorineural hearing loss in the left ear. Conductive hearing loss in the right ear. Conductive hearing loss in the left ear. E. Normal hearing. Question 260 Which of the following conditions is not seen with Cystic fibrosis? A. B. C. D. E. Nasal polyposis Focal biliary cirrhosis Xerostomia Cholestasis Meconium ilieus Question 261 Which of the following characteristics do NOT contribute to disease in Cystic fibrosis? A. B. C. D. E. decrease in airway Cl secretion due to impaired Calcium dependent Cl channel Increase in Sodium reabsorption Increase in production of pro-inflammatory cytokine decrease in muco-ciliary clearance increase in mucous production and viscosity Question 262 Your long-term patient Friedrich has just died from a respiratory infection associated with his cystic fibrosis. Which of the following respiratory pathogens is responsible for the highest mortality from lung infections in adults with cystic fibrosis? A. B. C. D. E. Staphylococcus aureus Pseudomonas aeruginosa Haemophilus influenzae Methicillin-resistant Staphylococcus aureus Burkholderia cenocepacia Question 263 Which one of the following is not a pathogen that commonly infects patients with cystic fibrosis? A. B. C. D. E. Staphylococcus aureus Bacillus anthracis Haemophilus influenzae Burkholderia cepacia Pseudomonas aeruginosa Question 264 What type of lung crackles are you most likely to hear on auscultation of a patient with asbestosis? A. Fine crackles on early inspiration and expiration B. Course crackles on early to mid inspiration C. Course crackles on late inspiration D. Fine crackles on mid to late expiration E. Fine crackles on mid to late inspiration Question 265 Hypoxia-inducible factors (HIFs) mediate the body's response to inadequate oxygenation. In the absence of enough oxygen to meet demand, which of the following enzymes directly facilitates the switch from aerobic respiration to glycolysis? A. B. C. D. E. Prolyl hydroxylase Asparagine hydroxylase Pyruvate dehydrogenase Pyruvate dehydrogenase kinase Glutathione Question 266 When viewing a chest X-ray you notice hyper-expanded lung fields and flat hemidiaphragms. What would you consider the best diagnosis based on these signs? A. B. C. D. E. Lung cancer Bronchiectasis Emphysema Tuberculosis Interstitial lung disease Question 267 Which of the following scenarios would most likely cause respiratory alkalosis to be diagnosed after appropriate investigations? A. B. C. D. E. A patient investigated after 5 minutes of hypoventilation. A patient with a hepatocarcinoma causing hyper-secretion of bicarbonate. A patient investigated after 5 minutes of hyperventilation. A patient with chronic obstructive pulmonary disease (COPD). A patient with Bowen's disease. Question 268 What is the most common CF mutation in caucasian populations? A. B. C. D. E. p.F508Δ p.G542X p.G551D p.R117H p.A445E Question 269 Jenny is 2 days old and was born premature. She has a rare genetic condition in which she is unable to produce Prolyl Hydroxylase and Asparagine Hydroxylase. Her mother comes to you worried and asks if Jenny will end up with any vision problems from the high-flow oxygen therapy you have given her.Considering only their roles in oxygen sensing, what will you tell Jenny's mother regarding her mutations? A. She will be fine because we are also treating her with dimethyl oxaloylglycine (DMOG). B. Prolyl hydroxylase and Asparagine hydroxylase serve to deactivate hypoxia-inducible factors (HIF) so angiogenesis will not be retarded. C. Hypoxia-inducible factors (HIF) will retard angiogenesis in the absence of prolyl hydroxylase and asparagine hydroxylase D. Prolyl hydroxylase and asparagine hydroxylase liberate Nrf2 which is protective against reactive oxygen species (ROS), so this will result in ROS damage of her retinas. E. In the absence of prolyl hydroxylase and asparagine hydroxylase, NADPH oxidase will become hyperactive, producing damaging reactive oxygen species. Question 270 What two muscles make up the faucial arches and what are their innervations? A. B. C. D. E. Palatoglossus and Palatopharyngeus (CNIX and CNX respectively) Tensor veli palatini and Palatoglossus (CNV3 and CNX respectively) Palatopharyngeus and Levator veli palatini (both supplied by Vagus [CNX]) Tensor veli palatini and Levator veli palatini (CNV3 and CNX respectively) Palatoglossus and Palatopharyngeus (both supplied by Vagus [CNX]) Question 271 Which of the following is FALSE regarding antimicrobial therapy in lung infections? A. β-lactam resistance in Streptococcus pneumoniae is incremental. B. Mycoplasma sp. do not have cell walls and are therefore not destroyed by β-lactam antibiotics. C. β-lactam resistance in Haemophilus influenzae is incremental relative to levels of βlactamase the microbe produces. D. Aminoglycosides are most useful for aerobic gram negative bacteria. E. The 'societal' approach to antibiotic prescription is one that favours narrow spectrum therapy. Question 272 Nail clubbing is NOT associated with which of the following conditions? A. B. C. D. E. Idiopathic pulmonary fibrosis Mesothelioma Cystic fibrosis Chronic obstructive pulmonary disease Asbestosis Question 273 What histological findings of the lung would you expect to see for a individual presenting with chronic shortness of breath and was a sand-blaster for many years? A. Well formed alveoli with minimal interstitial fibrosis. B. Small stellate shaped scars around alveoli containing collagen fibres and dark coloured macrophages. C. Nodular lesions with concentric layers of collagen and birefringence under polarised light. D. Noncaseating granulomas with numerous giant cells around lymphatics and bronchi. E. Diffuse interstitial fibrosis with golden beaded rods. Question 274 Which of the following are correct with regards to sleep disorders? A. Narcolepsy presents more often in the elderly, and presents with persistent daytime sleeping. B. Cataplexy can be treated with medications that suppress rapid eye movement (REM) sleep, like tri-cyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors. C. Idiopathic hypersomnolence is an important differential for narcolepsy, and presents with mild EDS (excessive daytime sleepiness). D. Rapid eye movement (REM) sleep behaviour disorder is strongly associated with Parkinson's disease, and is characterised by decreased muscle activity during REM sleep. E. Patients with Restless Legs Syndrome have worsening symptoms by night that cannot be improved by moving around. Question 275 Which of the following conditions is NOT associated with a higher incidence in smokers? A. B. C. D. E. Atherosclerosis. Rheumatoid arthritis. Age-related macular degeneration. Oral cancer. Cystic fibrosis. Question 276 Gas exchange in the lungs happens by which of the following process: A. B. C. D. E. Osmosis Diffusion Exocytosis Active Transport Ion channels Question 277 Under normal conditions, the rate of sweat secretion from a sweat gland is driven by calcium in the secretory coil. Which family of chloride channels will be activated through this process? A. The volume-activated chloride channels. B. C. D. E. The ClC family. The TMEM16a family. The CFTR family. None of the above. Question 278 Which of these groups of symptoms are NOT consistent with prolonged wakefulness? A. B. C. D. E. Fall in body temperature, blurred vision and mood changes. Fall in body temperature, slurred speech and ataxia. Fall in body temperature, mood changes and visual hallucinations. Mood changes, memory lapses and weight loss. Mood changes, impaired concentration and irritability. Question 279 Which of the following most adequately describes the physiological requirements for exercise without breathlessness? A. B. C. D. E. Air must go in and out of the respiratory system. Air and blood must meet. Oxygen must be available to muscle. Muscle must be strong enough to allow movement. All of the above. Question 280 Stress regarded as 'a reciprocal process between the environment and the person', is the central tenant of which model of stress? A. B. C. D. E. The willingness model The cognitive dynamic model The response based model The transaction model The stimulus based model Question 281 Barry, a 75yo retired carpenter, comes to your clinic. He tells you that he's started to find he's having trouble hearing what his wife is saying while they watch TV, and sometimes his daughter complains that he doesn't respond when she's talking to him. He tells you that about 5 years ago, he went to the doctor after a loud noise from a piece of machinery caused a ringing in his ear, and he was told he had a small hole in his eardrum - the hole was about 20% of the total surface. He is very worried that this is the cause of his current hearing loss. Which of the following is the most likely cause for his hearing loss? A. B. C. D. The previous trauma to his eardrum. A subsequent trauma to his eardrum. Age-related degradation of the inner row of hair cells of his inner ear. Age-related degradation of the outer row of hair cells of his inner ear. E. None of the above. Question 282 Childhood trauma can be particularly difficult with children lacking the emotional resilience of adults. Which of the following manifestations of trauma are more characteristic in children that adults? A. B. C. D. E. Altered Arousal Repetitive Behaviours Negative Cognitions and Mood Avoidance of Stimuli Associated with Trauma Re-experiencing the Trauma Question 283 Which of the following is TRUE with regards to ?-agonists? A. B. C. D. E. They cause relaxation of airway smooth muscle leading to bronchodilation. They inhibit the release of histamine and leukotrienes. They increase the beat frequency of cilia within the upper airways. They cause a reduction in the levels of acetylcholine acting on the smooth muscle cells. All of the above. Question 284 Which muscle needs to relax during swallowing to allow food to go down the oesophagus? A. B. C. D. E. Palatopharyngeus Salpingopharyngeus Thyropharyngeus Cricopharyngeus Stylopharyngeus Question 285 A patient's blood gases reveal the following:pH 7.39Partial pressure of oxygen: 44 mmHgPartial pressure of carbon dioxide: 67 mmHgBase Excess +10 mmol.How would you classify their acid/base status? A. B. C. D. E. Their pH is normal so they are neither acidotic or alkalotic. A primary respiratory alkalosis which is compensated. A primary respiratory acidosis which is compensated. A primary metabolic alkalosis which is compensated. A primary metabolic acidosis which is compensated. Question 286 Patients with Cystic Fibrosis are affected by abnormal transport of chloride across an epithelium due to a mutation on the CFTR gene. In sweat glands, this means that chloride is not reabsorbed, and thus they produce salty sweat. Under experimental conditions, betaagonists can be used to promote secretions to discover a defect in the CFTR gene. What effect of ?-agonists activates CFTR chloride channels and consequently enables investigators to observe a defect? A. β-agonists increases concentration of calcium to activate CFTR chloride channels. B. β-agonists cause Protein Kinase A activation and hence cyclic AMP (cAMP) production, which activates CFTR chloride channels. C. β-agonists increase the flow rate of sweat secretion and therefore promote CFTR chloride channel activation. D. β-agonists promote osmosis by increasing the leakage of CFTR chloride channels. E. None of the above. Question 287 Which of the following is not a measure of effect? A. B. C. D. E. relative risk relative risk reduction odds ratio absolute risk reduction hazard risk Question 288 Which of the following regarding exocrine glands is correct? A. Examples of discrete exocrine glands include sweat glands, salivary glands and the kidneys. B. They are derived from epithelial cells. C. They characteristically have sodium-potassium ATPase transporters on their apical surface. D. Deficient exocrine function is a leading cause of interstitial lung disease. E. Cystic fibrosis is due to a congenital absence of exocrine glands. Question 289 Mast cells are vital in the acute response to antigen in asthma.Which of the following concerning mast cells in asthma and subsequent mast cell responses is correct? A. Leukotrienes are pre-formed mediators released from mast cells during degranulation B. Sodium cromoglycate is a suicide inhibitor of mast cells, inducing mast cell apoptosis C. Cross-linking of IgEs on the surface of mast cells by antigen stabilises the cells and inhibits degranulation events D. A mannitol challenge causes a reduction in mucosal cell osmolarity, eventually leading to mast cell-mediated bronchial smooth muscle contraction E. Nedocromil has a direct effect on mast cells to reduce the % fall in FEV1 in response to an antigen challenge in the bronchial tree Question 290 In regards to the effect of light in the regulation of sleep and wakefulness, which statement is correct A. B. C. D. E. Light increases melatonin secretion Light shifts the timing of the circadian system Has a slow, gradual effect on alertness and performance Blind people cannot synchronise to the light/dark cycle Light stimulates the suprachiasmatic nucleus (SCN) in the amygdala Question 291 Which of the following is incorrect? A. Central chemoreceptors respond to changes in blood gas levels slower than peripheral chemoreceptors. B. Peripheral chemoreceptors are both in the carotid bodies and aortic bodies. C. Central chemoreceptors are located in the medulla. D. Peripheral chemoreceptors detect changes in both arterial PO2 and PCO2. E. Central chemoreceptors can detect changes in PO2, PCO2 and pH. Question 292 Which of the following statements about primary and secondary surveys is incorrect? A. Ensuring a patent airway is of utmost concern in emergency medicine. B. A thorough head-to-toe examination should be performed in all secondary surveys to identify all injuries. C. Primary survey includes initial trauma radiological examinations – lateral c-spine, chest and pelvic x-rays and a bedside ultrasound examination where the mechanism, signs or symptoms suggest internal injuries. D. The secondary survey is a review of the patient and all investigation results which is undertaken approximately 24 hours after the initial trauma. E. Testing for neurological disability should initially be limited to GCS, pupillary response and limb power, sensation and reflexes Question 293 Oscar is a 13 year old boy who presents to you, his local GP with complaints of more frequent attacks of dyspnoea and wheezing related to his asthma caused by house dust mite exposure. Currently, the only medication he uses to treat his asthmatic symptoms is Ventolin (salbutamol). Due to the increased frequency of Oscar's attacks, you consider prescribing inhaled corticosteroids (ICS). Which of the following regarding ICS treatment is incorrect? A. ICS treatment may act to reduce the circulating numbers of eosinophils and mast cells in asthmatic patients B. Fixed dose combinations of ICS and long acting β-agonists are available for asthma treatment C. ICS doses may be tapered off once the asthamtic patient reports improvement in nocturnal symptoms D. A patient on ICS treatment will require exposure to more triggering antigen to produce an equal % fall in FEV1 compared to if the patient was not on ICS treatment E. Budesonide, fluticasone and beclomethasone are all approved ICSs for the treatment of asthma Question 294 Which of the following is one of the margins of the thoracic inlet? A. B. C. D. E. The clavicles anteriorly The first pair of ribs laterally The apices of the lungs The sternocleidomastoid muscle laterally The C7 vertebra posteriorly Question 295 If someone watches TV late at night for three nights in a row, what effect will this have on their sleep pattern on the fourth night? A. Their sleep drive will be reduced, therefore they will go to bed later and wake up later. B. Light into the suprachiasmatic nucleus (SCN) will maintain the release of melatonin, meaning they will feel sleepier later. C. Light into the suprachiasmatic nucleus (SCN) will inhibit the release of melatonin, meaning they will feel sleepier later. D. Their homeostatic drive to sleep will build up, meaning they will be tired earlier. E. None of the above. Question 296 Claire gave birth to her first child, Robert, 2 years ago. Robert was born with cystic fibrosis. Claire has brought him to your clinic because he has symptoms consistent with a lung infection. Which of the following organisms is most likely the causative agent? A. B. C. D. E. Pseudomonas aeruginosa Staphylococcus pneumoniae Haemophilus influenzae Candida albicans Staphylococcus aureus Question 297 Which of the following is NOT an important factor when writing a medical certificate for a patient? A. B. C. D. E. A judgement of the patient's actions. Observation of the patient's privacy. Treatment of the cause of the presenting complaint. Education of the patient regarding how to prevent recurrence. Maintaining integrity as a medical practitioner. Question 298 As a first year intern, you accidentally administer pure oxygen for a prolonged period of time to a patient with otherwise normal lung function. What biochemical process would you expect NOT to occur within this patient? A. Oxidation of thioredoxin leading to dissociation of apoptosis signal-related kinase 1. B. Enhanced expression of pyruvate dehydrogenase kinase restricting entry of pyruvate into the citric acid cycle. C. Lower rates of glutathione conversion to an oxidised form. D. Increased serum pH. E. The activation of antioxidant response enzymes. Question 299 A patient's blood gases reveal the following:pH: 7.55Partial pressure of oxygen: 117 mmHgPartial pressure of carbon dioxide: 21 mmHgBase Excess: -4 mmol.They are breathing room air in the Emergency Department of RPA Hospital, Sydney (assume sea level). What is the alveolar-arterial (A-a) gradient for this patient? A. B. C. D. E. -21.75 -6.75 6.75 21.75 30.75 Question 300 Many genetic and environmental factors have been found to predispose an individual towards the development of asthma. Which of the following HAVE NOT been found to be positively associated with subsequent asthma development? A. B. C. D. E. Early childhood infections, especially viral. Maternal smoking during pregnancy High omega-6 intake, and low omega-3 intake Antibiotic use under the age of 2 Environmental pollutants such as sulphur dioxide. Question 301 John, a 24-year-old medical student, comes into your clinic complaining of reduced hearing. You perform Rinne and Weber testing using a tuning fork. The results are as follows:Rinne left ear: air conductance better than bone conductanceRinne right ear: air conductance worse than bone conductanceWeber: sound is heard more strongly in the right earWhat do you think is the most likely mechanism behind his hearing impairment? A. B. C. D. E. Sensorineural hearing impairment in right ear. Sensorineural hearing impairment in left ear. Conductive hearing loss in right ear. Conductive hearing loss in left ear. None of the above. Question 302 You are seeing an Indigenous patient in a rural clinic in Alice Springs who has come to you for the first time. On what knowledge base are you going to rely most to tailor your clinical understanding and to ensure that you give this patient the most effective treatment? A. A randomised control study that was conducted with a sample base purely from the North Shore of Sydney. B. An isolated case involving the same disease that you remember a colleague telling you about. C. A newspaper report on the condition of health care in Alice Springs. D. A detailed history of the patient's diet, living conditions, social history and cultural preferences E. Cultural training that you have completed for a specific Indigenous nation, one from which you are unsure your patient originates. Question 303 Elisa is a 14-year-old girl with cystic fibrosis. You have recently diagnosed her with a lung infection and identified the causative organism as methicillin-sensitive Staphylococcus aureus (MSSA). Which of the following specifically relating to MSSA infections is important to consider before beginning treatment? A. B. C. D. MSSA is resistant to antibiotics and can only be treated with anti-staphylococcal agents. Antibiotic treatment may increase the risk of antibiotic resistance developing. MSSA is an intracellular pathogen, and can therefore evade the actions of antibiotics. 14 year old girls do not get infected with MSSA. There was likely a problem with the investigation which identified MSSA as the causative organism. E. Treatment with anti-staphylococcal agents may predispose her to colonisation with P. aeruginosa. Question 304 Which of the following is NOT an element of open disclosure following an adverse event? A. B. C. D. E. An apology and expression of regret. A factual explanation of what happened. An opportunity for the patient do discus their thoughts. An explanation that the cause of the event is unknown and shouldn't happen again. An explanation of steps taken to prevent a further adverse event. Question 305 Which of the following anatomical landmarks is not at the level of the xiphisternal joint? A. B. C. D. E. The inferior limit of the thoracic cavity. The central tendon of diaphragm. The inferior limit of the liver. The inferior border of the heart. The superior limit of the liver. Question 306 Homeostatic drive increases as we're awake, circadian drive compliments the homeostatic drive in the beginning so as to maintain wakefulness. Once the homeostatic drive reaches a critical point later in the evening, we become ready for sleep.According to the statement above, which of the following best characterizes the relationship between homeostatic drive and circadian drive before the homeostatic drive reaches the critical point? A. Circadian drive tends to wane in the evening while the homeostatic drive keeps accumulating. B. Circadian drive tends to increase in the evening while the homeostatic drive keeps accumulating. C. Circadian drive tends to wane as the homeostatic drive wanes in the evening. D. Circadian drive tends to increase in the evening while the homeostatic drive wanes. E. Both the circadian drive and the homeostatic drive wane as the day passes. Question 307 Why might a baby be admitted to hospital for RSV infection, whereas an adult would not? A. B. C. D. Babies are more likely to be exposed to RSV from other children. Adults are immunized against RSV and generally do not become infected. Babies suffer more severe diarrhea from RSV than adults. The standard adult treatment for RSV is antibiotics which have side effects too strong for babies. E. Babies has smaller airway structure and weaker respiratory muscles that make breathing with RSV difficult. Question 308 Management of obstructive sleep apnoea can involve the following except: A. B. C. D. E. Nasal continuous positive airway pressure. Oral temazepam. Oral prosthesis. Weight reduction. Avoidance of alcohol. Question 309 Which of the following describes a lung affected with Emphysema best? A. B. C. D. E. The lungs are more elastic, more compliant and lung volumes are greater. The lungs are less elastic, more compliant and lung volumes are smaller. The lungs are less elastic, more compliant and lung volumes are greater. The lungs are more elastic, less compliant and lung volumes are greater. None of the above. Question 310 On the fourth day heel prick tests are conducted on neonates. Which of the following is not true about the heel prick test? A. It measures the Na/Cl ions for CF B. C. D. E. It tests for hypothyroidism it tests for phenyalanine it tests for galactasemia it also tests for rare metabolic conditions Question 311 Which of the following is true with respect to the blood supply of the thorax? A. B. C. D. E. The bronchial arteries arise from the pulmonary arteries. The internal thoracic arteries branch off the arch of the aorta. The intercostal arteries run superior to their corresponding veins. The accessory hemiazygos vein run along the left side of the vetebral column. The azygos vein drains into the inferior vena cava. Question 312 Which of the following is NOT a possible clinical sign of a tension pneumothorax? A. B. C. D. E. A deviated trachea. Hyperresonance on percussion. Hypoexpanded chest that moves dynamically with respiration. Decreased breath sounds. Decreased tactile fremitus. Question 313 What is not a potential result of a tension pneumothorax? A. B. C. D. E. CNS hypoxia CV collapse Clubbing Tracheal displacement Mediastinal compression Question 314 Your patient is suffering from dysphagia following a stroke.Which cranial nerve(s) are responsible for the gag reflex? A. The vagus nerve (CN X). B. Sensory fibres of the mandibular nerve (CN V3) and motor fibres of the vagus nerve (CN X). C. Sensory fibres from the glossopharyngeal nerve (CN IX) and motor fibres from the vagus nerve (CN X) D. Sensory fibres from the vagus nerve (CN X) and motor fibres from the glossopharyngeal nerve (CN IX) E. Sensory fibres from the mandibular nerve (CN V3) and motor fibres from the glossopharyngeal nerve (CN IX) Question 315 Which of the following does NOT make up the contours of the mediastinum on a frontal chest X-ray? A. B. C. D. E. Aortic knuckle Right ventricle Left ventricle Superior vena cava Left atrial appendage Question 316 Mandibular advancement splints assist breathing in obstructive sleep apnoea by: A. B. C. D. E. Opening the mouth to let more air in. Pushing down the tongue to prevent the patient from swallowing it. Gently widening the airway over a long time, like the actions of braces. Pushing the jaw forwards to pull open the pharynx antero-posteriorally. Pumping air into the lungs to keep the larynx and small airways open upon expiration. Question 317 On a T2 weighted median plane MRI of the head and neck, the greatest signal intensity will be produced by A. B. C. D. E. Cerebrospinal fluid Grey matter of the nervous system White matter of the nervous system Adipose tissue Cranial sinuses Question 318 Central sleep apnoea is accompanied by A. B. C. D. E. an absence of diaphragm EMG and thoraco-abdominal wall movement continued or raised diaphragm EMG and thoraco-abdominal wall movement continued or raised diaphragm EMG, but not thoraco-abdominal wall movement paradoxical thoraco-abdominal wall movement none of the above Question 319 Which of the following is CORRECT regarding cessation of smoking and its effects on life expectancy? A. B. C. D. E. Cessation of smoking at 20 years old adds approximately 90 years to life expectancy. Cessation of smoking at 30 years old adds approximately 20 years to life expectancy. Cessation of smoking at 40 years old adds approximately 15 years to life expectancy. Cessation of smoking at 50 years old adds approximately 5-6 years to life expectancy. Cessation of smoking at 60 years old adds approximately 1-2 years to life expectancy. Question 320 Nicotine is the primary addictive drug in cigarettes. Which of the following is NOT a direct effect of nicotine on the body? A. B. C. D. E. Increased sympathetic activity. Increased heart rate and blood pressure. Peripheral vasoconstriction. Binds to haemoglobin causing decreased oxygen content in blood. Can result in premature births and low birth weight. Question 321 Kerley B lines are a sign of which pathology? A. B. C. D. E. Pulmonary embolism Pneumonia Pulmonary oedema Pulmonary fibrosis Pleuritis Question 322 'Kerley B lines' are a sign that most likely indicate which respiratory pathology? A. B. C. D. E. Pulmonary embolism. Pulmonary oedema. Pneumonia. Pulmonary fibrosis. Emphysema. Question 323 The respiratory quotient describes the relationship between the amount of CO2 produced by a process and the amount of O2 consumed. For the metabolism of sugars and fats, the respiratory quotient is approximately: A. B. C. D. E. 0.8 1 0.5 0.1 0.5 Question 324 Which of the following is the LEAST significant contributor to the shorter life expectancy in Indigenous people (as compared to non-Indigenous people) living in the Northern Territory? A. B. C. D. E. Cardiovascular disease Injury Chronic respiratory conditions Diabetes mellitus Melanoma Question 325 Which of following lung volumes capacities can not be measured directly using spirometry? A. B. C. D. E. Expiratory reserve volume Functional residual volume Inspiratory reserve volume Tidal volume Vital capacity Question 326 Which of the following has contributed to the rise of the smoking epidemic at the turn of the 20th century? A. B. C. D. E. Introduction of the Bosnack cigarette rolling machine. Invention of the safety match. Mass marketing campaigns. A, B and C. A and C only. Question 327 Which of the following is NOT a symptom commonly associated with Narcolepsy? A. B. C. D. E. Excessive daytime sleepiness Periodic movements in sleep Sleep paralysis Cataplexy Sleep hallucinations Question 328 What makes up Vital Capacity? A. B. C. D. The total lung capacity (TLC) minus the expiratory reserve volume (ERV) The total lung capacity (TLC) minus the functional residual capacity (FRC). The inspiratory capacity (IC) plus the functional residual capacity (FRC). The inspiratory capacity (IC) plus the expiratory reserve volume (ERV) plus the tidal volume (Vt) E. The inspiratory capacity (IC) plus the expiratory reserve volume (ERV). Question 329 In a patient with muscular dystrophy, what happens to their residual volume and diffusing capacity? A. B. C. D. E. Residual volume and diffusing capacity remains the same Residual volume increases and diffusing capacity decreases Residual volume increases and diffusing capacity remains the same Residual volume decreases and diffusing capacity decreases Residual volume decreases and diffusing capacity remains the same Question 330 With regards to obstructive airway disease, which of the following is FALSE?Note that FEV1 stands for forced expiratory volume in one second, and FVC stands for forced vital capacity. A. Patients with emphysema suffer a grossly reduced FEV1 compared to normal subjects. B. The ratio of FEV1 to FVC in patients with obstructive airway disease is decreased below 80%. C. Use of a bronchodilator in patients suffering from airways obstruction due to asthma will return their FEV1 and FVC values back to normal. D. Use of a peak flow meter by patients suffering from asthma is a useful way of monitoring airways obstruction and response to asthma treatment at home. E. In emphysema, expiratory flow rates are reduced due to loss of pulmonary elastic recoil. Question 331 Which of the following is not a Bradford Hill absolute criterion for causality? A. B. C. D. E. The exposure precedes the outcome. The outcome precedes the exposure. The association is unlikely to be due to chance. The association is unlikely to be due to bias. The association is unlikely to be due to confounding variable. Question 332 A patient is brought into the emergency department, following a motor vehicle accident (MVA), which of the following is of the highest priority? A. B. C. D. E. Assess gross motor control to check for neurological damage. Palpate the trachea for deviation to assess for tension pneumothorax. Perform an X-ray of chest, head and abdomen to check for occult bleeds. Assess blood pressure to monitor shock and blood loss. Strip the patient and perform a log roll to ensure no wounds have been missed. Question 333 The calculation known as attributable risk provides an estimate of what quantity? A. The incidence of a disease that is due to a certain exposure. B. The ratio of the probability of developing a disease among those exposed to a risk factor, compared with the probability of developing the outcome if the risk factor is not present. C. The odds of the experimental group showing positive (or negative) effects of an intervention or exposure, in comparison to the control group. D. The risk of developing some new condition within a specified period of time. E. All of the above. Question 334 Which of the following mediators is NOT found in type I hypersensitivity? A. B. C. D. E. Prostaglandin D2 Histamine Leukotriene B4 TNFa Leukotriene E4