Download 2009 Mid Year Exam Questions - The Cabrini Code

MED EXAM 2009
A.
B.
C.
D.
E.
F.
G.
H.
I.
Basilar artery thrombosis
Calcified aortic arch atheroma
Dissection of aortic media
Fatty streak formation
Fragmentation of deep venous thrombus
Hyperplasia of intimal epithelium
Neurogenic arterial vasospasm
Ruptured atherosclerotic plaque
Weakened elastic media under atherosclerosis
1. A 64 year old man presents complaining of abdominal pain radiating to his back. Examination
reveals a pulsatile central abdominal mass
A.
B.
C.
D.
E.
F.
G.
H.
I.
Abundant blood in the pericardium and a ruptures myocardium
A focal area of haemorrhage in the anterior wall
A full thickness band of fibrosis of the anterior wall
A localised abscess in the ventricular septum
No visible change but palpable oedematous tissue in the anterior wall
No obvious change
Posterior left ventricular aneurysm formation
Thrombotic occlusion of the left atrium
Well defined area of necrosis in the anterior wall of the left ventricle
2. A 45 year old man with a longstanding hyperlipidaemia had an extensive myocardial infarction
with st elevation and Q wave changes on ECG three months previously. Since the infarction he has
had worsening cardiac failure and despite aggressive management he dies.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Acute myocardial infarction
Chest wall trauma
Dissecting thoracic aneurysm
Exertional angina
Gastro-oesophageal reflux
Metastatic bone disease
Pleurisy
Pulmonary embolus
Shingles
Unstable angina
3. A 60 year old woman with known cardiovascular disease presents to the ED after experiencing
severe central chest pain radiating to her back for a bout an hour. She is shocked bp 90/50, her
radial pulse is stronger in her left than her right arm though there is no change in ECG or cardiac
enzymes
4. A 55 year old business man who returned 10 days ago from a business trip to the US presents to
his GP complaining of the sudden onset of right sided chest pain that is worse with deep breathing.
His GP notes that he has a swollen left leg with marked distension of the veins of his foot
5. A 58 year old man with a history of peptic ulcer five years previously is a smoker with a recently
measured total cholesterol level of 6.5mmol/l He is admitted to a cardiac ward following several
weeks of increasingly severe episodes of dull central chest pain usually brought on during his daily
lunch break stroll to the sandw0ich shop. The episodes of pain have subsided quickly with rest.
However over recent days they have taken longer to settle and have occasionally come on whilst
resting. He has not previously sought medical advice for this problem but during the most recent
episode the pain began to spread down his left arm. He decided to visit the ED to see if his ulcer was
playing up again
A.
B.
C.
D.
E.
F.
Atrioventricular node
Bundle of his
Cardiac muscle
Left bundle branch
Right bundle branch
Sino-atrial node
6. You are evaluating MAVIS an elderly woman on no meds who has been bothered by dizziness and
fatigue. Her blood pressure is normal and the resting pulse is 60-85 and irregular. An ECG shows that
she has no p waves and an irregular rhythm
7. Mavis’ 92 year old sister comes to see you because you were such a help to mavis. She is planning
a trip to Rio DE Janeiro for Mardi gras and would like a ‘check-up’ before she goes. Her only
medications is a multivitamin tablet. An ECG shows sinus rhythm with a heart rate of 72bpm. The
only abnormality is that the PR interval progressively increases until a P wave fails to result in a QRS
complex indicative of second degree heart block.
A.
B.
C.
D.
E.
F.
Aldosterone antagonist
Alpha adrenergic agonist
ACE inhibitor
Beta blocker
Calcium channel blocker
Loop diuretics
8. A 72 year old man with chronic left ventricular failure due to ischaemic heart disease attends a
hospital general medical clinic and commences several new drugs. He also suffers from mild asthma.
He returns three months later complaining of breast enlargement and tenderness and you note that
serum potassium has risen to 5.8mmol
9. You recently prescribed a drug for the treatment of hypertension for a 44year old male who is a
regular patient in your practice. He comes back a few weeks later complaining of light headedness
when standing up and a dry irritating cough.
A.
B.
C.
D.
E.
F.
G.
ACE inhibitor
Alpha agonist
Beta blocker
Thiazide diuretics
Loop Diuretics
Nitrates
Thrombolytic therapy
10. A 68 year old obese male presents to his GP with persistent elevated blood pressure. He has had
hypertension for 6 months. After trying a range of lifestyle modifications his blood pressure remains
elevated he also has a history of angina.
11. Mr Davies, aged 54 years is admitted to the ED with chest pain, shortness of breath, profuse
sweating and dizziness which has been present for minutes. His ECG reveals ST elevation in the
inferior leads
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Clopidogrel
DDAVP
Dipyridamide
Factor 9
Factor 8
Heparin
LMW heparin
Tissue plasminogen activator
Warfarin
12. A 45 year old man has an x linked disorder of coagulation which has resulted in multiple bleeding
episodes including bleeding into joints. He receives a regular intravenous infusion of a drug to help
prevent ongoing bleeding
13. A 45 year old man with a recent embolic TIA has an Echo which reveals an enlarged left ventricle
associated with a large thrombus. He is admitted to hospital and placed on an intravenous drug
which interferes with the activity of thrombin and coagulation factors 7, 9 , 10 and 12
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
Abdominal x ray
Chest x ray
Doppler ultrasound
Carotid arteriogram
Coronary arteriogram
CT abdomen
CT brain
CT chest
CT neck
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CT pulmonary angiogram
Doppler venous ultrasound of the leg
Echo
ERCP
MRI BRAIN
MRI CHEST
MRI SPINE
Nuclear bone scan
Pulmonary arteriogram
Thallium cardiac scan
Thyroid nuclear scan
Ultrasound abdomen
Ultrasound neck
Ventricular perfusion nuclear scan
X ray skeletal survey
14. A 24 year old man present with the sudden onset of right shoulder pain made worse with deep
breathing and breathlessness. Physical examination reveals a temp of 36.6, resp rate of 22 and
decreased breath sounds and a resonant percussion note in his right upper chest
15. A 58 year old previously well man present to a large metro hospital with shortness of breath and
sharp, substernal chest pain that is relieved by sitting forward. Apart from tachycardia, his physical
examination reveals a rub on auscultation an ECG shows concave upwards ST elevation in anterior,
lateral and inferior chest leads and you are concerned that there may be fluid collection
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Asbestosis
Asthma
Bronchiectasis
Bronchogenic carcinoma
Centriacinar emphysema
Mesothelioma
Panacinar emphysema
16. A 27 year old woman with CF diagnosed in childhood undergoes bilateral lung transplantation.
The explanted lungs are submitted for pathological examination
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A bag and mask ventilation device
CPAP
Nasal prongs
Re-breather mask
Hudson mask
Venturi mask
17. A 72 year old female is admitted to your ward/unit with a diagnosis of right lower lobe
pneumonia. She has a history of longstanding chronic airways disease and her arterla blood gasses in
room air are as follows
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


Ph – 7.36
PCO2 70mmHG
PO2 50
SaO2 88%
18. A 73 year old male is admitted to the medical ward via the emergency department in respiratory
distress with a diagnosis of acute pulmonary oedema, secondary to congestive cardiac failure. The
initial management of his problem in the ED has not resolved his pulmonary oedema.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Asbestosis
Asthma
Bronchogenic carcinoma
Bronchopneumonia
COPD
Idiopathic pulmonary hypertension
Mitral stenosis
PE
Sleep apnoea
Type 1 hypersensitivity reaction
Mitral valve incompetence
Question 18, 19 and 20
19. A 62 year old woman presents to her GP with shortness of breath on exertion which has been
increasing in severity over several years. There is also a past history of rhematic fever as a child. She
now complains of fatigues has noticed increased swelling of her ankles and advisees that she wakes
at night feeling SOB and sleeps with three pillows. When asked she gives no history of chest pain.
Apart from digoxin each day for Afib she is on no other regular medications. Examination reveals
basal crackles on auscultation of the lungs and there is pitting oedema of both ankles. On
auscultation she has a loud first heart sound associated with a mid diastolic murmur, loudest at the
apex. Her pulse is irregular at 67bpm. JVP is raised to 4cm
20. Missed the question
A.
B.
C.
D.
E.
Acid fast bacilli
Gram negative cocci
Gram negative rods
Gram positive cocci
Gram positive rods
21. Siti is a 32 year old woman who arrived from Indonesia 3 months ago. She presents to ED with a
six week history of cough night sweats and weight loss. A chest x ray shows patchy opacification.
What would sputum examination show?
A.
B.
C.
D.
E.
Bronchiectasis
Lung consolidation
Pleural effusion
Pneumothorax
Pulmonary fibrosis
22. An elderly woman with a long history of smoking visits her GP because she has recently become
more SOB. over the past 3 weeks she has not felt like eating much and has lost 4kg. She has a
productive cough and on examination she is tachypnoeic RR 25 and has a tachycardia 98.
Examination of her chest reveals bronchial breath sounds in the right base and a dull percussion
note and enhanced vocal resonance over the right base
23. A 20 year old man with a history of CF presents with a history of productive yellow sputum and
recurrent episodes of fever and tiredness. On examination you note clubbing and coarse crackles
over the bases of both lungs
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Aspergillus
Candida
Cytomegalovirus
Herpes
Mucormycosis
Mycobacterium tuberculosis
Ditto avium intracellular
Nocardia
Staph SP
Strep SP
24. A 45 year old HIV positive male with a moderately low CD4 count presents with pain on
swallowing. Biopsies of the oesophagus show budding pseudohyphae in the acutely inflamed
squamous epithelium
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
Abdominal pain
Chest x ray
Doppler ultrasound
Carotid arteriogram
Coronary arteriogram
CT abdomen
CT B?RAIN
CT chest
CT neck
CT pulmonary angiogram
Doppler ultrasound
Echo
ERCP
MRI BRAIN
MRI CHEST
MRI SPINE
Nuclear bone scan
Pulmonary arteriogram
Thallium cardiac scan
Thyroid nuclear scan
Ultrasound abdomen
V. Ultrasound neck
W. Ventilation perfusion nuclear scan
X. X-ray skeletal survey
25. A 59 year old male present with severe central abdominal pain radiating through to the back. His
bp is 90/70 and a tender pulsatile central abdominal mass is palpable
26. A 49 year old woman who underwent cholycystectomy 7 years ago presents with colicky right
upper quadrant abdominal pain. On examination she is found to be slightly jaundiced and there is
right upper quad tenderness
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




Appendix only
Diffuse involvement of duodenum and jejunum
Diffuse involvement of rectum and colon
Rectum only
Segmental involvement of terminal ileum and ascending colon
Sigmoid colon only
27. A year 12 student visits his GP complaining of bloody diarrhoea often passing 5-6 loose stools per
day each containing blood and mucus. He is referred to a gastroenterologist but before his
appointment he presents to the ED with lower abdo pain increasing stool frequency up to 10 times
and feeling hot. On examination his temp is 38.9 and heart rate is 120. Investigations reveal a raised
ESR and microcytic anaemia
28. A 45 year old woman reports abdominal bloating and foul smelling bowel actions, associated
with tiredness. There is no history of abdo pain. Investigations show a mild macrocytic anaemia and
serology shows a high titre of anti endomysial antibodies. Her symptoms improve markedly on a
gluten free diet.
A.
B.
C.
D.
E.
F.
G.
H.
I.
Atypical mitoses
Caseous necrosis
Complete villous atrophy
Diffuse acute inflammation limited to the mucosa
Eosinophils in lamina propria
Foreign body type giant cells
Numerous apoptic cells in crypts
Transmural inflammation with granulomas
Tubulovillous adenoma
29. A 25 year old woman presents to ED with colicky central abdo pain, nausea and vomiting, on
background of several months of lethargy and 8kg weight loss. On examination her abdo is
distended and bowel sounds are increased. Scattered aphthous ulcers are noted in her mouth. Pr
examination is exquisitely painful and a deep anal fissure is associated with a large anal skin tag and
fistulas.
A. Chemical gastritis
B. Congenitally short oesophagus
C.
D.
E.
F.
G.
Gastric adenocarcinoma
Gastric heterotopias
Gord
Helicobacter pylori gastritis
Peptic ulcer disease
30. A 57 year old man presents with recurrent episodes for post prandial epigastric discomfort,
endoscopic examination of the oesophagus and stomach are performed and biopsies are taken. No
peptic ulcers are found. The histo-pathological findings detailed in the subsequent path reports are
as follows.
Oesophagus biopsy – section shows glandular mucosa composed of tall columnar epithelial cells
with interspersed goblet cells. (use answers below)
A.
B.
C.
D.
E.
F.
G.
H.
Autoimmune gastritis
Chemical gastritis
Congenitally short oesophagus
Gastric adenocarcinoma
Gastric heterotopias
GORD
Helicobacter pylori gastritis
Peptic ulcer disease
31. A 60 year old woman who does not drink any alcohol presents with a history of epigastric
discomfort over several years. She also complains of increasing fatigue and a persistent tingling
sensation in her feet. There is no history of abdominal surgery a full blood examination and iron
studies is performed.
FBE
Hb
MCV
WCC
Plts
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
97
120
3x109
90x109
(f115-165, m130-180) Iron Studies
(76-96)
(4-11x109)
(150-400x109)
Acute cholecystitis
Acute pancreatitis
Acute appendicitis
Gastritis
Incarcerated inguinal hernia
Obstructing reanl cancer
Pelvic inflammatory disease
Perforated duodenal ulcer
Pylenophriritis
Ruptured abdo aortic aneurism
Sigmoid diverticulutiis
Sigmoid volvulus
Small bowel obstruction
Ureteric calculi
Serum iron
Transferrin
ferritin
20
3
120
(11-30)
(1.8-3.2)
(20-300)
32. An 18 year old man presents with what began as vague central abdominal pain 6 hours ago but
has just moved to the right iliac fossa in the last hour. The pain is constant and is worse with
movement and coughing. It is associated with anorexia and nausea. He has a temp of 38 a pulse of
120 and is very tender when examined in the right iliac fossa even feeling pain there when the left
hand side of the abdomen is pressed.
33. A 45 year old woman with rheumatoid arthritis present with sudden onset of epigastric pain 2
hours ago. Now unable to move because pain is so severe. Routing obs show febrile (38.5) with
pulse rate of 120 beats/min and BP of 85/65. Examination reveals rigid abdomen with no bowel
sounds. The abdominal x-ray and chest x-ray demonstrate free gas under the diaphragm. (use
answers above)
34 A 42 year old member of parliament presents with central abdo pain radiating into the back, and
nausea and vomiting. On examination the upper abdomen is tender. The serum amylase was found
to be greatly elevated. On direct questioning the patient confirmed a long history of excessive
alcohol intake. (use answers above)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
Gastro haemorrhage
Acute diverticulitis
Acute peptic ulcer
Amoebic dysentry
Anal fissure
AV malformation
Carcinoma of sigmoid colon
Crohns disease
Gastritis
Haemorrhoids
Mallory weiss tear
Meckel’s diverticulum
Oesophageal varices
Ulcerative colitis
35. A 58 year old man presents with a change in his bowel habit. He previously passed stool every
day but over the past few weeks he notices that he is only passing stool every 203 days. Associated
with this he has lost 10kg in weight and he has occasionally notes some bright blood mixed in his
stool. His haemoglobin is 90 and MCV is 65
36. A 74 year old alcoholic woman presents following a large bright fresh haematemesis. On
examination her abdomen is grossly distended with ascites and she has a caput medusa. She has
multiple purpura and spider naevi.
37. A 21 year old man present with bright PR bleeding with blood streaking on his stool on the paper
and in the toilet bowl. He has considerable pain on defection and he reports that his anus is
exquisitely tender. There has been no change in his weight or bowel habits.
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
38. Mr Jones is a 78 year old man who undergoes surgery for carcinoma of the colon. Prior to
surgery a CT of the abdo is performed. The CT scan is normal. At surgery a section of the bowel is
removed along with adjacent nodes. Pathological investigations reveals tumour confined to the
mucosa with no regional node involvement.
39. Mrs smith is 83 years old and undergoes surgery for carcinoma of the colon. CT is normal.
A.
B.
C.
D.
E.
F.
G.
H.
I.
Breast cancer
Fibrocystic change
Ductal carcinoma in situ
Infiltrating duct carcinoma
Lactating adenoma
Lipoma
Leukaemia
Metastatic melanoma
Fibroadenoma
40. Missed the question
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Abdo xray
Chest xray
Doppler ultrasound
Carotid arteriogram
Coronary arteriogram
CT abdomen
CT brain
CT chest
CT neck
CT pulmonary angiogram
Doppler ultrasound
ECHO
ERCP
MRI BRAIN
MRI Chest
MRI SPINE
Nuclear bone scan
Pulmonary arteriogram
Thallium cardiac scan
Thyroid nuclear scan
Ultrasound
Ultrasound neck
Ventilation perfusion nuclear scan
Xray skeletal survey
Cervical spine imagine
41. A 61 year old woman presents to her doctor at a metropolitan clinic with a four week history of
increasing headache worse in the morning and sometimes associated with vomiting. Physical
examination reveals left-sided papilloedema and increased tone in the right biceps brachii muscle.
Head CT with contrast was inconclusive.
42. A 22 year old woman is brought to the ED of a major regional hospital, having collapsed
immediately after complaining of sudden onset of severe headache at work. She is afebrile but has
evidence of meningismus and photophobia. Her blood pressure is 190/110
A.
B.
C.
D.
E.
F.
G.
H.
I.
Brown Sequard Syndrome
Cauda equine lesion
Common peroneal nerve injury
Lateral cutaneous nerve of thigh injury
Median nerve injury
Radial nerve injury
Syringomyelia C5-T2
Total transection of the spinal cord at T11
Ulnar nerve injury
43. Angelo present to the ED department four days after falling from his motorbike. He felt bruised
and stiff after the fall and has rested at home for a few days. Since he has been out of bed he feels
he is inclined to trip. He thinks his foot is dragging. On examination he has weak eversion and
dorsiflexion of his right foot and a patch of numbness on the dorsum of his right foot
44. Ruth aged 30 years present to the ED with severe back pain after falling heavily on her but.
Examination reveals loss of sensation in the bum. Further she reports after going to the toilet to pass
urine. Urinary was still flowing when she stood up.
A.
B.
C.
D.
E.
Basal ganglion
Cerebellum
Left cerebral cortex
Midbrain brainstem
Right cerebral cortex
45. A 65 year old male with a history of heavy alcohol use presents with difficulty walking. He has
problems with finger nose testing and dysdiadokinesia
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Facet joint arthritis
Metastatic cancer
Multiple sclerosis
Osteomyelitis
Peripheral vascular disease
Retroperitoneal haematoma
Ruptured vascular disease
Retroperitoneal haematoma
Ruptured abdo aortic aneurysm
Spondylosis
K. Tuberculolosis
L. Vertebral disc prolapsed
46. A 30 year old male Cricketer presents to the ED with acute onset of lower back pain radiating to
his right buttock. He complains of pain in his back when he laughs and on flexion of his right hip. On
examination there is some spasm of his para-vertebral muscles but no neuro abnormalities
47. A 74 year old male with a history of hypertension presents to the ED with a 12 hour history of
back pain and a 60 minute history of dizziness. On examination his pulse is 100bpm an his blood
pressure is 80/50. On examination he is sweaty and distressed by his pain. His abdomen appears
distended and a pulsatile tender epigastric mass is palpable
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Amoxycillin
Iv benzyl/penicillin
Clotrimazole
Doxycycline
Flucoxacillin
Ketoconazole
Metronidazole
Phenoxymethyl penicillin
Roxithromycin
Trimethroprim
48. A 21 year old male female presents to the ED with a 12 hour history of increasing headache and
neck stiffness. She has no allergies on examination you note that she is agitated, has a temperatures
of 38 degrees, is photophobic and has a positive kernig’s sign. You also note she has a purpuric rash
on her hands and feet.
49. 23 year male severe sore throat 48 hours associated with difficulty swallowing and dribbling of
saliva. On examination has a temp of 38.4. enlarged, tender cervical lymph nodes and enlarged
reddened tonsils covered with white exudates. From the notes you recognise he has previously
presented with fine macular rash after being given penicillin.
A.
B.
C.
D.
E.
F.
G.
H.
I.
Bacillus cereus
Campylobacter jejuni
Clostridium botulinum
Clostridium difficile
Clostridium perfringens
E Coli
Salmonella enteritis
Shigella Species
Staph aureus
50. A 40 year old man presents to the ED during the evening a few hours after eating rice salad at a
summer barbeque. He is experiencing frequent diarrhoea and vomiting.
51. A 75 year old man received intravenous antibiotics as treatment for a severe post operative
wound infection, which resolved completely. Two weeks later he developed watery diarrhoea
52. Jon is a 21 year old medical student who travelled to Mexico during the vacation. He has had
increasing colicky abdominal pain and loose bowel actions with some blood visible in the stools for 2
days. He feels tired and feverish and is having about 5 bloody bowel actions each day. His
temperature is 37.5 PR 90, and his abdomen is tender without any other signs. Rectal examination is
normal. His blood tests are normal and faecal microbiology shows leucocytes.
A.
B.
C.
D.
E.
F.
Candidiasis
Cellulitis
Disseminated gonococcal infection
Herpes simplex
Herpes zoster
Scabies
53. A 40 year old man who has recently had a renal transplant complains of a sore mouth. The
buccal mucosa appears inflamed with a patchy white exudates
54. A young woman is undergoing chemotherapy for Hodgkins disease and experiencing severe right
upper abdo pain and tenderness. Subsequently a vesicular rash develops over the right upper abdo
quadrant
55. An elderly man who lives in an aged care hostel is noticed to be scratching his hands. Red
papules are evident in the web spaces.
A.
B.
C.
D.
E.
F.
G.
H.
I.
Ductal carcinoma in situ
Fibroadenoma
Fibrocystic change
Intraductal papilloma
Invasive ductal carcinoma
Invasive lobular carcinoma
Paget’s disease of the breast
Phylloides tumour
Pseudolipoma
56. Angela is a 40 year old woman who has noticed a lump in her right breast. On examination it is
15mm in diameter, firm with an irregular surface. Mammography shows dense breast tissue with a
possible stellate deformity, but this seems to resolve on further views. US shows a suspicious lesion
and fine needle aspirate cytology is inconclusive
57. Elaine is a 67 year old woman who presents with a 2 month history of left nipple changes. She is
well apart from the treatment for hypertension. A routine screening mammogram performed two
months ago was reported as normal. Examination reveals no breast lump, but the nipple is red and
scaly with a normal areolar margin
58. Julie is 45 woman who has had an excision biopsy of a left breast lump. She is aware of some
cyclical breast pain, worse before her period. A lump was found in her left breast a few months ago.
She and her doc decided to have the lump removed because her maternal aunt was diagnosed with
breast cancer at 50 .. Preoperative imagine showed no abnormality and FNA cytology had
insufficient cells for diagnosis. The pathology report is of the epithelial hyperplasia without atypia
with microcysts and fibrosis.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Adrenocortical carcinoma
Adrenal cortical adenoma
Anaplastic Thyroid carcinoma
Follicular adenoma of thyroid
Follicular carcinoma of thyroid
Graves disease
Hashimotos thyroiditis
Medullary carcinoma of thyroid
Multinodular thyroid
Papillary carcinoma of thyroid
Parathyroid carcinoma
Phaeochromocytoma
59. A 45 year old female on your unit has a 20mm lesion in her thyroid, detected on ultrasound. A
fine needle aspirate of her nodule shows papillae lined by epithelial cells with evident psammoma
bodies
60. Missed it
A.
B.
C.
D.
E.
F.
G.
H.
I.
Dequervain’s thyroiditis
Follicular adenoma
Graves disease
Multinodular goitre
Primary hypothyroidism
Reidels’ thyroiditis
Secondary hyperthyroidism
Simple goitre
Thyroid carcinoma
61. A 37 year old mother of three and a part time pilates instructor presents with a six month history
of menorrhagia and tiredness. Investigations show: (missed it)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
AMI
Diabetic ketoacidosis
Hyperosmolar coma
Hypoglycaemia
Nephropathy
Peripheral neuropathy
Peripheral vascular disease
Retinopathy
Skin ulcers/infections
Stroke
62. A 20 year old male presents to ED with hypotension, tachycardia, decreased mental state, rapid
shallow respiration, recent onset of polyuria and thirst. He is a known diabetic whose diabetes is
generally well controlled. He has been away camping with friends recently and a number of the
group have contracted a respiratory infection
63. a 24 year old male with Type 1 diabetes has recently joined the university gymnasium. His
diabetes has been well controlled unless he ‘eats the wrong thing’. After a training session he is
stopped by the police as he is leaving the uni campus because he is noticed to be driving erratically
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
B12 deficiency
Cold type haemolytic anaemia
Drug induced haemolytic anaemia
Folate deficiency
G6PD deficiency
Hereditary elliptocytosis
Hereditary spherocytosis
Iron deficiency anaemia
Microangiopathic acquired haemolytic anaemia
Post infective haemolytic anaemia
Pyruvate kinase deficiency
Sideroblastic anaemia
Thallasaemia
Transfusion reaction
Warm type haemolytic anaemia
64 Mary is a 40 year old woman. She visits you complaining of tiredness. On examination you note
that she is pale and tachycardia and has some apparently hypo-pigmented patches on her skin.
There is no other significant history except her mother had some sort of thyroid problem. A FBE
reveals an anaemia of HB 78 associated with an increase
65 Missed it
66. John is a 52 year old executive who exercises vigorously, presented with a six month history of
increasing tiredness. He is generally well but gets quite frequent headaches which he attributes to
stress and for which he takes a NSAID purchased at the pharmacy. His diet is normal, although
sometimes he gets indigestion and intermittently takes a white liquid the pharmacist is suggested to
relieve his symptoms. Clinical examination is normal. Full blood examination is as follows
Hb
79
MCV 70
Platelets
470x109
Wcc
6x109
A.
B.
C.
D.
E.
Acute lymphocytic leukaemia
Acute myeloid leukaemia
Amyloidosis
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Gauchers disease
Infectious mononucleosis
Infective endocarditis
Hodgkin’s lymphoma
Malaria
Myelofibrosis
Non hodkins lymphoma
Portal hypertension
Thalassaemia
Tuberculosis
67. A 21 year old woman presents with a 3 week history of increasing tiredness associated with a
sore throat and tender cervical lymph nodes. Atypical mononuclear cells were found in a peripheral
blood sample, and she developed a fine rash after being given amoxicillin for her sore throat. Her
spleen is palpable 1cm below the costal margin and is soft
68. a 56 year old university lecturer presents to his local doctor because he felt a fullness and
swelling in his left upper quadrant. Over the last siz months he has developed diabetes, symptoms of
hypo-gonadism and a bronze colour of his skin. And he has also noticed he tires and bruises easily.
He knows that some sort of liver disease has been diagnosed in his two male cousins, but his 45 year
old sister is well. He drinks about 4 glasses of red wine each week. His abdomen is slightly distended
and the spleen is palpable 4cm below the costal margin.
A.
B.
C.
D.
E.
F.
Ankylosing spondylitis
Crohns/ulcerative colitis, arthritis
Osteoarthritis
Psoriatic arthritis
Reiters syndrome
Rheumatoid arthritis
69 A 65 year old woman presents to her Gp with painful hands. On examination she is found to have
firm nodules at the distal interphalangeal and proximal interphalangeal joints. She says her hands
are starting to look like her own mothers did.
70 a 55 year old female presents to her Gp with warm and tender joints of her hands. On
examination she has ulnar deviation of metacarpal phalangeal joints, Z deformity of her thumb and
deformity oat the proximal interphalangeal joints
A.
B.
C.
D.
E.
F.
G.
H.
I.
Angina/AMI
Bicipital tendonitis
Cervical spine dysfunction
Herpes Zoster
Infraspinatus tendonitis
Neoplasia
Osteoarthritis
Polymyalgia Rheumatica
Rheumatoid arthritis
J.
K.
L.
M.
Septic arthritis
Subchromal bursitis
Subscapularis tendonitis
Supraspinatus tendonitis
71 A 40 year old netball player presents with a painful shoulder. While she can move her arm a little,
abduction becomes painful over about 60 degrees with the scapula fixed. She is able to internally
rotate, adduct and flex her shoulder
72 a 45 year old male cricketer (bowler) presents to his GP with pain in his left shoulder. This pain is
of dull quality is most prominent at the front of the shoulder and radiates down this arm. The pain is
made worse by elbow flexion
A.
B.
C.
D.
E.
F.
G.
H.
Acute osteoarthritis
Gout
Effusion caused by cardiac failure
Haemarthrosis
Rheumatoid arthritis
Ross river virus
Septic arthritis
Systemic lupus erhythematosus
73 A 75 year old man is in hospital with left ventricular failure treated with diuretics. He develops
spontaneous onset of pain in the left knee. On examination his temperature is 37.2 degrees and his
knee is red, swollen, hot and tender with a positive patellar tap. Fluids from his swollen knee is
aspirated and negatively birefringent crystals identified under polarised light microscopy
74 A 25 year old woman twists her knee while playing hockey. She is carried from the field and is
noted to have a swollen extremely tender knee and is unable to weight bear
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Apical dominant centrilobulbar emphysema
Basal pan acinar emphysema
Bronchiectasis
Diffusely thickened pleura bilaterally
Infiltrating grey white peribronchial lesion
Intra luminal bronchial adenoma
Severe anthracosis
Single lesion containing numerous neutrophils
Three well defined numerous neutrophils
Three well defined round 10mm white nodules
Widespread fibrotic nodules
75. A 35 year old man with a family history of alpha 1 antitrypsin deficiency has a lung transplant.
His explants (native) lung is examined. What would it show?
A. Dural based 20mm firm grey nodular lesion
B. Five well defined 10mm brown lesions based at he grey white interface
C. Ill defined grey white lesion in the pons
D.
E.
F.
G.
H.
I.
Ill defined lesion expanding the entire corpus callosum, compressing the ventricles
Localised collection of thick walled blood vessels
Multiple abscesses
No evident macroscopic path
Single cystic lesion in the cerebellum
Single fleshy white 30mm basal ganglia
76. ?
A.
B.
C.
D.
E.
F.
G.
H.
Crohns disease
UC
Colonic adenocarcinoma
Tubular adenoma
Familial polyposis coli
Phlegmenous colitis
Infective colitis
Diverticular disease
77. Frequent out pouching of the sigmoid colon lined by normal colonic mucosa
A.
B.
C.
D.
E.
F.
G.
H.
I.
Staphlyoccus aureus
Haemophilus influenza
Strep pneumonia
Meningititis
E coli
Candida albicans
Mycoplasma pneumonia
Herpes
Epstein barr virus
79. A 30 year old woman presents with several days of fever and irritability and more recent onset of
confusion associated with an inability to express her. Prior to this presentation she has otherwise
been well apart from the occurrence of labial cold sore in the last week
80. An xx year old man presents with confusion and a UTI.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Atorvastatin
Adrenalin
Ateplase
Amitripyline
Amithrombin 3
Aspirin
Bradykinin
Fluoxetine
Heparin
Histamine
Impramme
L.
M.
N.
O.
P.
Q.
R.
S.
Lithium
Moclobemide
Prostacyclin
Salbutamol
Streptokinase
Tranyclypromine
Venlafaxin
Warfarin
81. A 60 year old man presents to you, his local GP for a well man check up. On reviewing his results,
the only significant finding is a total cholesterol of 7.8 mmol/L. He has a significant family history of
ischaemic heart disease and of stroke. His doctor commence treatment with atorvastatin and
commences an additional therapy as prophylaxis against stroke
82. A 46 year old man presents to ED with a history of a swollen leg after a transpacific plane flight.
He has evidence of a DVT on Doppler study and VQ scan shows moderate likelihood of pulmonary
embolus, although he has no resp symptoms, initial treatment uses a drug which may be
administered intravenously or in different form subcut, but which is not available orally
83. A 70 year old woman is diagnosed with atrial fibrillation. The rate is controlled but she remains in
AF. Her long term risk of stroke due to atrial thrombus can be reduced by the prophylactic use of a
drug
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Carbon monoxide
Chlorinated Hydrocarbon
Glycophasphate
Isocynate
Metal fume
Methane
Organic solvent
Organophosphate
Oxides of nitrogen
Ozone
84. A 25 year old man was gluing rubber strips to the inner wall of a metal pipe of 1.5 m diameter.
He wore no resp protection and the odour was strong and mildly irritating. After about 40 mins he
began to feel nauseated and very light headed as if he’d been drinking alcohol.
86. A 35 year old woman was working outdoors in a small recently constructed corrugated iron
booth selling tickets to a farming display. The day was cold so to keep warm she gathered scraps of
timber and lit a small fire in her booth. It was smoky but better than shivering. After an hour she
developed a severe headache and nausea and was taken for medical attention where she was found
to have rapid breathing and pulse rate, but no wheeze or evidence of cyanosis
87. A 38 year old man was removing old, unlabelled drums of chemical from a store. One of the
smaller drums leaked onto his hand and forearm. He became sweaty, tearful and kept having to
wipe his mouth. He developed griping abdo pains and vomited and his vision blurred. When he
reached medical attention the doc noted he had pin-point papules
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Hypercalcaemia
Hyperchloraemia
Hyperkalaemia
Hypermagnesaemia
Hypernatraemia
Hypocalcaemia
Hypochloraemia
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
88. A 46 year old female with end stage renal failure, secondary to diabetes mellitus, presents to ED
complaining that she caught gastro from her son. She felt nauseated vomited once and has been
unable to eat or drink for 24 hours. ECG in emergency department shows tall T waves and widened
QRS complex. Several minutes later she has a cardio-respiratory arrest
A.
B.
C.
D.
E.
F.
G.
H.
Bladder tumour
Malignant hypertension
Polycystic renal disease
Pyelonephritis
Renal calculi
Glomerulonephritis
Renal trauma
Urinary tract infection
89. A 70 year old man who has smoked cigs for many years presents to his local doctor after an
episode of painless macroscopic haematuria. He has not experienced any nocturia
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Acute interstitial nephritis
Acute tubular necrosis
Adult polycystic kidney disease
Analgesic nephropathy
Crystal nephropathy
Hepato-renal syndrome
Nephrotic syndrome
Reflux nephropathy
Renal tubular acidosis
Sickle cell nephropathy
90. A 25 year old meat packer has been sent home by his supervisor due to swelling of his legs and
tiredness. He is passing dark, frothy urine. On examination there is oedema of his legs and genitalia.
He has severe proteinuria (urinary albumin 6g/day) and the serum albumin is 27g/l
91. A 72 year old man has had surgery for a ruptured abdominal aortic aneurysm. He was admitted
to hospital hypotensive and his blood pressure has fallen to a mean of 60 several times
postoperatively, but is now stable. However his urine output has remained low and his blood tests
show that he has acute renal failure
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
CT abdomen
DMSA scan
DTPA scan
IV urogram
Micturating cystourethrography
MRI abdomen
Plain abdo xray
Renal arteriogram
Renal biopsy
Renal ultrasound
92. A 43 year old woman is referred by her GP to the outpatient clinic at her local metro hospital
after developing hypertension which has been unresponsive to treatment. Her history is
unremarkable. Except for frequent urinary tract infections between ages of 14-19 years. No other
abnormalities are found.
93. A 30 year old woman presents to ED in the evening with a history of severe abdo pain for 60
minutes. On investigation, urinalysis shows +++blood, but is negative for glucose and protein. Her
vital signs are normal, but she seems to be having trouble getting comfortable
94. A 26 year old woman. Has had recent bone marrow transplant. Develops a skin rash. Biopsy
report is graft vs host disease. Which cell type is responsible for epidermal cell death seen in biopsy?
(didn’t get answer list – just the answer on the answer sheet)