2001a-Paper 1 – Medical Sciences

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Question 1 of 70

A 47-year-old woman with overt thyrotoxicosis is found to have aortic stenosis.
Which one of the following features, if present in this woman, is most likely to indicate the need for aortic valve replacement?

Select one of the following:

A. A peak systolic left ventricular aortic pressure gradient of 60 mmHg.
B. The presence of New York Heart Association (NYHA) class III angina.
C. A resting heart rate greater than 120/minute.
D. An aortic valve orifice area of 0.9 cm2.
E. The presence of concomitant moderate aortic regurgitation

Explanation

Question 2 of 70

The diagram below shows cumulative quantal dose-response curves for a hypothetical drug (drug X). The Y-axis represents the percentage of the population studied who: for curve (a) achieved the desired therapeutic effect at a given dose; and for curve (b) experienced the most important toxic effect at a given dose.
Based on this information, the best estimate of the therapeutic index of drug X is approximately:

Select one of the following:

A. 0.
B. 0.3.
C. 0.7.
D. 1.
E. 3.

Explanation

Question 3 of 70

The alveolar-arterial gradient for oxygen tension in arterial blood (PA-aO2) can be up to 15 mmHg in healthy young adults and as high as 30 mmHg in elderly people.
Which one of the following is considered to be the predominant physiological mechanism for a normal PA-aO2?

Select one of the following:

A. Variation in distribution of ventilation.
B. Variation in diffusion for oxygen.
C. Right to left shunt.
D. Ventilation/perfusion (V/Q) inequality.
E. Variation in distribution of pulmonary blood flow.

Explanation

Question 4 of 70

Significant intercurrent illness is commonly associated with disturbances of thyroid function (sick euthyroid syndrome).
Which one of the following is least likely to be present in a euthyroid patient with a severe illness?

Select one of the following:

A. Raised free thyroxine (free T4).
B. Raised free triiodothyronine (free T3).
C. Low free T3.
D. Low thyroid-stimulating hormone (TSH).
E. Raised TSH.

Explanation

Question 5 of 70

At 72 hours following a significant paracetamol overdose, which one of the following tests will allow the best prediction of death or need for liver transplantation?

Select one of the following:

A. Serum alanine transaminase (ALT).
B. Serum bilirubin.
C. Prothrombin time-international normalised ratio (PT-INR).
D. Serum gamma glutamyltranspeptidase (GGT).
E. Blood ammonia.

Explanation

Question 6 of 70

The most common cause of blindness in elderly Caucasians is:

Select one of the following:

A. glaucoma.
B. cataract.
C. macular degeneration.
D. diabetes mellitus.
E. retinal ischaemia.

Explanation

Question 7 of 70

Graft-versus-host disease is a major complication of allogeneic stem cell transplantation for haematological malignancy in adults.
Which one of the following has the least influence on the risk of developing graft-versus-host disease?

Select one of the following:

A. Age of recipient.
B. Donor-recipient ABO blood group incompatibility.
C. In vitro T cell depletion of the graft.
D. Type of HLA-matched donor (sibling versus unrelated).
E. Donor-recipient HLA mismatch.

Explanation

Question 8 of 70

Dendritic cells are distinguished by an exceptional ability to carry out which one of the following immune functions?

Select one of the following:

A. Phagocytosis.
B. Cytokine secretion.
C. Chemokine secretion.
D. Immunoglobulin secretion.
E. Antigen presentation

Explanation

Question 9 of 70

The most useful investigation for the diagnosis of multiple sclerosis is:

Select one of the following:

A. cerebrospinal fluid protein concentration.
B. visual evoked responses.
C. magnetic resonance imaging (MRI) scan of the brain.
D. serum oligoclonal bands.
E. cerebrospinal fluid microscopy

Explanation

Question 10 of 70

A mutation is located in the middle portion of a double-stranded DNA molecule 200 nucleotides long. At each end of the DNA molecule are sites at which short DNA primers for the polymerase chain reaction (PCR) bind to each strand.
In the figures shown below, five possible combinations of primer location and orientation relative to the mutation are shown. In each figure, the long pair of arrows represents the anti-parallel strands of the long DNA molecule and the short arrows represent each short single-stranded DNA primer binding to the closer of the two long strands. The mutation is located at position (II), the primers are located at positions (I) and (III), and the arrowhead on each DNA strand indicates the direction of DNA polymerisation (5’ to 3’).
Which one of the following combinations of primer location and orientation is required to amplify the mutation by PCR?

Select one of the following:

Explanation

Question 11 of 70

A number of patients in a ward have been found to be colonised with vancomycin-resistant enterococci. What would be the best laboratory test to determine if transmission from one patient to another has occurred?

Select one of the following:

A. Comparison of antibiotic susceptibility (antibiogram).
B. Polymerase chain reaction (PCR) for the van A and van B genes.
C. Enterococcal serology.
D. Pulse-field gel electrophoresis.
E. Speciation (e.g. faecalis vs. faecium).

Explanation

Question 12 of 70

A 35-year-old woman with hypertrophic cardiomyopathy presents with chest pain and palpitations. Her heart rate is 155/minute and irregular, and her blood pressure is 130/80 mmHg.
What is the most appropriate initial therapy?

Select one of the following:

A. Beta-adrenergic blocker.
B. Nitroglycerine.
C. Amiodarone.
D. Frusemide.
E. Digoxin.

Explanation

Question 13 of 70

In a patient with cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis), the finding on bronchoalveolar lavage of an elevated proportion of which one of the following cell types is associated with a better response to therapy?

Select one of the following:

A. Eosinophils.
B. Lymphocytes.
C. Macrophages.
D. Mast cells.
E. Neutrophils.

Explanation

Question 14 of 70

A bioavailability study has been performed to compare a proposed new generic capsule, in a strength of 50 mg, with a marketed tablet preparation in a strength of 100 mg. The active ingredient is a drug with linear kinetics. A cross-over design was used, with each subject receiving, in random order and with an adequate wash-out period, a single oral dose of one tablet on one occasion and one capsule on the other. The mean results for the area under the plasma concentration versus time curve (AUC) are 300 mg.h/L for the capsule, and 500 mg.h/L for the tablet.
The best estimate of the relative bioavailability of the capsule with respect to the tablet is:

Select one of the following:

A. 0.3.
B. 0.6.
C. 1.2.
D. 1.7.
E. 3.3.

Explanation

Question 15 of 70

A 25-year-old woman presents to the emergency department with renal colic and macroscopic haematuria. She reports having had several previous episodes treated at another hospital.
The least likely diagnosis is:

Select one of the following:

A. IgA disease.
B. warfarin use.
C. narcotic abuse.
D. Goodpasture’s syndrome.
E. polycystic kidney disease.

Explanation

Question 16 of 70

The COX-2 isoform of cyclo-oxygenase is most strongly expressed in which one of the following tissues?

Select one of the following:

A. Platelets.
B. Established scar tissue.
C. Synovium from osteoarthritic joint.
D. Gastric mucosa.
E. Rheumatoid synovium.

Explanation

Question 17 of 70

Which one of the following is the most potent inhibitor of aldosterone secretion in a healthy individual?

Select one of the following:

A. Elevated plasma potassium.
B. Elevated plasma angiotensin II.
C. Elevated plasma atrial natriuretic peptide.
D. Elevated adrenocorticotrophic hormone.
E. Dietary sodium restriction.

Explanation

Question 18 of 70

A 45-year-old man develops stage C cancer of the caecum. There is a strong family history of bowel cancer in the absence of polyps and there is no history of colitis.
The most likely underlying inherited genetic abnormality is in:

Select one of the following:

A. the ras gene.
B. the DNA mismatch repair (MMR) gene.
C. the p-glycoprotein (MDR1) gene.
D. the adenomatous polyposis coli (APC) gene.
E. the deleted in colon cancer (DCC) gene.

Explanation

Question 19 of 70

A 19-year-old woman presents with recent-onset of right leg swelling and pleuritic chest pain and is found to have iliofemoral thrombosis on Doppler ultrasound examination. Results of a ventilation-perfusion lung scan indicate a high probability for pulmonary emboli. She had been taking the oral contraceptive pill for the last three years but has now ceased. She is a non-smoker. There is no significant medical history and no known family history of venous thromboembolism.
Which one of the following investigations for an underlying hypercoagulable state is most likely to be affected by the presence of the extensive thrombosis?

Select one of the following:

A. Antiphospholipid antibody screen.
B. Antithrombin level.
C. Factor V and prothrombin genotype assessment.
D. Activated partial thromboplastin time (APTT).
E. Full blood count including blood film.

Explanation

Question 20 of 70

Which one of the following is associated with the highest risk of NSAID (non-steroidal anti-inflammatory drug)-induced gastric ulceration?

Select one of the following:

A. Concomitant use of steroids.
B. Infection with Helicobacter pylori.
C. Higher therapeutic dose of NSAID.
D. Advanced age.
E. Concomitant use of anticoagulants.

Explanation

Question 21 of 70

T lymphocytes expressing both CD4 and CD8 on the cell surface are most likely to be found in which one of the following anatomical locations in healthy individuals?

Select one of the following:

A. Bone marrow.
B. Thymus.
C. Peripheral blood.
D. Lymph nodes.
E. Spleen.

Explanation

Question 22 of 70

In treating constipation, which one of the following agents administered over an extended period of time is most likely to lose its effectiveness?

Select one of the following:

A. Docusate sodium (Coloxyl).
B. Lactulose.
C. Senna.
D. Psyllium husk powder (Metamucil).
E. Epsom salts.

Explanation

Question 23 of 70

An 18-year-old woman presents with a two-week history of cervical lymphadenopathy, fever, fatigue and myalgia. A Paul-Bunnell test (heterophile antibody) has been negative on two occasions, a week apart. Full blood examination reveals a lymphocytosis with many atypical lymphocytes.
The most likely diagnosis is acute:

Select one of the following:

A. Epstein-Barr virus (EBV) infection.
B. streptococcal pharyngitis.
C. toxoplasmosis.
D. cytomegalovirus (CMV) infection.
E. human immunodeficiency virus (HIV) infection.

Explanation

Question 24 of 70

The picture below shows a computed tomography (CT) scan of the heart.
Which one of the following is the most likely diagnosis?

Select one of the following:

A. Metastatic tumour in the pericardium.
B. Left atrial myxoma.
C. Ruptured myocardial papilla.
D. Cor triatriatum.
E. St. Jude mitral valve prosthesis.

Explanation

Question 25 of 70

Vertigo which occurs with neck extension is most likely due to:

Select one of the following:

A. cervical spondylosis.
B. benign paroxysmal positional vertigo.
C. kinking of the vertebral artery.
D. endolymphatic hydrops.
E. Chiari 1 malformation.

Explanation

Question 26 of 70

Allopurinol precipitates azathioprine toxicity by which one of the following mechanisms?

Select one of the following:

A. Displacement of azathioprine from protein-binding sites.
B. Impairment of the renal excretion of azathioprine.
C. Promotion of gastrointestinal absorption of azathioprine.
D. Prolongation of the half-life of the biologically active azathioprine metabolite.
E. Inhibition of hydrolysis of azathioprine.

Explanation

Question 27 of 70

Which one of the following mutations in a gene is most likely to disrupt the production of a protein?

Select one of the following:

A. Splicing defect.
B. Missense change.
C. Nucleotide transversion.
D. Nonsense change.
E. A three base pair deletion.

Explanation

Question 28 of 70

In a patient with a severe exacerbation of asthma, the use of a peak-flow meter may underestimate the severity of airflow limitation compared to the use of spirometry and measurement of the forced expiratory volume in 1 second (FEV1).
Which one of the following is mainly responsible for this reduction in the accuracy of the peak-flow meter?

Select one of the following:

A. The hyperinflation of severe asthma.
B. The effort-independent component of the forced expiratory manoeuvre.
C. The effort-dependent component of the forced expiratory manoeuvre.
D. Narrowing of small airways.
E. Narrowing of large airways.

Explanation

Question 29 of 70

The most important rationale for using adjuvant chemotherapy soon after surgery for cancer (rather than deferring chemotherapy until the cancer has recurred) is that after surgery:

Select one of the following:

A. cancer volume is smaller.
B. there is no resistance to cytotoxic agents.
C. there are fewer cells in cell cycle.
D. drug penetration into the tissues is reduced.
E. cancer growth is slower.

Explanation

Question 30 of 70

Which one of the following is the best predictor of outcome in a patient with colorectal cancer?

Select one of the following:

A. Tumour stage.
B. Degree of microsatellite instability.
C. Ethnic background.
D. Strong family history.
E. Sporadic occurrence.

Explanation

Question 31 of 70

A 32-year-old woman, who has recently migrated from India, is breastfeeding her third child and presents with lethargy and a history of recurrent chest infection. She has a vegetarian diet. Physical examination shows her to be anaemic with no site of blood loss clinically evident and no other abnormalities.
Investigations show:
Full blood count
haemoglobin 64 g/L [120-155]
mean corpuscular volume (MCV) 68 fL [80-95]
white cell count 7.4 x 109/L [3.5-9.5]
differential normal
platelet count 412 x 109/L [130-330]
Blood film is shown below.
With respect to the patient’s anaemia, which one of the following laboratory results has the most diagnostic value?

Select one of the following:

A. A lower than normal serum iron level.
B. A lower than normal serum ferritin level.
C. A higher than normal serum transferrin level.
D. A negative urinary haemosiderin test.
E. A normal plasma haemoglobin A2 leve

Explanation

Question 32 of 70

A 28-year-old woman presents with galactorrhoea. She has been treated for hypothyroidism for five years with thyroxine 0.1 mg/day. She is also receiving lithium carbonate for depression and her serum lithium levels are in the mid-therapeutic range. She takes diazepam 5 mg nocte for insomnia and metoclopramide 10 mg as required for nausea. Her serum prolactin concentration is 1800 mU/L [<600].
From this history, which one of the following factors is most likely to be responsible for her hyperprolactinaemia and galactorrhoea?

Select one of the following:

A. Use of metoclopramide.
B. History of hypothyroidism.
C. Treatment with thyroxine.
D. Use of lithium.
E. Use of diazepam.

Explanation

Question 33 of 70

In renal transplant biopsies, which one of the following features of acute rejection has the worst prognostic implication?

Select one of the following:

A. Glomerular T cell infiltrate.
B. Dense interstitial mononuclear infiltrate.
C. Increased expression of HLA-DR on graft cells.
D. Vascular injury.
E. Tubulitis due to CD8+ T cells.

Explanation

Question 34 of 70

Which one of the following biologically active components of the complement cascade is most directly responsible for the formation of transmembrane channels leading to cell lysis?

Select one of the following:

A. C3a.
B. C3b.
C. C4a.
D. C5a.
E. C5-9.

Explanation

Question 35 of 70

Which one of the following is the most common association of the abnormality shown in the X-ray above?

Select one of the following:

A. Haemochromatosis.
B. Hypomagnesaemia.
C. Old age.
D. Hyperparathyroidism.
E. Osteoporosis.

Explanation

Question 36 of 70

A young man presents with breathlessness and ankle swelling. He had a ventricular septal defect (VSD) repaired at the age of three years. He is centrally cyanosed and has a prominent right ventricular heave on palpation of the chest.
The most likely finding is:

Select one of the following:

A. pulmonary hypertension.
B. blood oxygen saturation of 95%.
C. left ventricular hypertrophy.
D. left to right shunt.
E. normal haemoglobin.

Explanation

Question 37 of 70

The principal aim of a phase 1 trial of a cytotoxic agent is to:

Select one of the following:

A. maintain the patient’s hope that treatment is possible.
B. determine the best schedule of administration.
C. define tumour response rate.
D. measure progression-free survival.
E. establish the maximum tolerated dose (MTD).

Explanation

Question 38 of 70

A 67-year-old woman with severe chronic obstructive pulmonary disease undergoes an all-night respiratory sleep study. The study reveals no evidence of obstructive sleep apnoea but there are three periods of repeated falls in oxyhaemoglobin saturation (SaO2).
Which one of the following is the most likely explanation for the falls in SaO2?

Select one of the following:

A. SWS (slow wave sleep)-related upper airway narrowing.
B. REMS (rapid eye movement sleep)-related increase in nasal resistance.
C. REMS-related increase in ventilation-perfusion mismatching.
D. SWS-related reduction in cardiac output.
E. REMS-related reduction in respiratory drive.

Explanation

Question 39 of 70

Which one of the following is the strongest independent risk factor for stroke?

Select one of the following:

A. Hypertension.
B. Cigarette smoking.
C. Physical inactivity.
D. Age.
E. Hypercholesterolaemia.

Explanation

Question 40 of 70

The diagram below shows cumulative quantal concentration-response curves for a hypothetical drug (drug X) which has linear kinetics. The Y-axis represents the percentage of the population studied who: for curve (a) achieved the desired therapeutic effect at a given plasma concentration; and for curve (b) experienced the most important toxic effect at a given plasma concentration.
If a patient with no evidence of toxicity who has not achieved the desired therapeutic response has a measured concentration of 40 mg/L, the best response would be to:

Select one of the following:

A. check compliance with no change in dose.
B. increase the dose by 25%.
C. increase the dose by 50%.
D. increase the dose by 75%.
E. increase the dose by 100%.

Explanation

Question 41 of 70

A patient undergoes a Schilling test because of vitamin B12 deficiency. The following results are obtained:
The most likely pathology is:

Select one of the following:

A. small bowel bacterial overgrowth.
B. pernicious anaemia.
C. partial (Billroth II) gastrectomy.
D. terminal ileal Crohn’s disease.
E. short bowel syndrome.

Explanation

Question 42 of 70

Which one of the following antibiotics is least active against pathogenic anaerobic bacteria (e.g. Bacteroides fragilis, Clostridium perfringens)?

Select one of the following:

A. Ticarcillin plus clavulanate.
B. Metronidazole.
C. Clindamycin.
D. Ceftriaxone.
E. Chloramphenicol.

Explanation

Question 43 of 70

A 22-year-old woman has been on a stable dose of anticonvulsant for three years. She has recently experienced difficulties in seeing at night. A formal ophthalmological assessment demonstrates visual field constriction.
For which one of the following anticonvulsants is it important to monitor visual fields?

Select one of the following:

A. Carbamazepine.
B. Gabapentin.
C. Lamotrigine.
D. Valproate.
E. Vigabatrin.

Explanation

Question 44 of 70

A 64-year-old woman undergoes a dual-energy X-ray absorptiometry scan. The report is shown below.
According to World Health Organisation (WHO) definitions, the patient's lumbar spine bone density is:

Select one of the following:

A. high normal.
B. normal.
C. osteopenic.
D. osteoporotic.
E. severely osteoporotic.

Explanation

Question 45 of 70

A 48-year-old previously well man is receiving a transfusion of four units of packed red cell concentrate via a peripheral intravenous line after presenting with melaena secondary to a bleeding duodenal ulcer. He has not been previously transfused. Admission biochemistry (including urea, electrolytes and creatinine) is normal and pre-transfusion blood counts are normal apart from anaemia (haemoglobin 64 g/L [135-170]). Less than five minutes after transfusion of the third unit of blood is commenced, he complains of feeling very unwell and abruptly develops fever, chills, rigors and profound hypotension.
In the absence of ABO, Rhesus or minor blood group donor-recipient incompatibility, the most likely diagnosis is:

Select one of the following:

A. bacterial contamination of the transfused blood.
B. transfusion-associated graft-versus-host disease.
C. electrolyte disturbance.
D. citrate toxicity.
E. reaction to plasticiser in infusion bag.

Explanation

Question 46 of 70

The following pharmacokinetic data (normalised to a 70 kg individual) are provided for five drugs.
Which one of the following drugs is most likely to have the slowest rate of clearance from plasma?

Select one of the following:

A. Amiloride.
B. Amiodarone.
C. Dapsone.
D. Tolbutamide.
E. Trimethoprim.

Explanation

Question 47 of 70

A non-consanguineous family with a rare genetic disease has been identified. The pedigree is shown below.
What is the most likely mode of inheritance?

Select one of the following:

A. Mitochondrial.
B. X-linked.
C. Autosomal dominant.
D. Autosomal recessive.
E. Polygenic.

Explanation

Question 48 of 70

Which one of the following findings during a stress exercise ECG test is most predictive of angiographically significant multivessel or left main coronary artery disease?

Select one of the following:

A. Late-onset of ST-segment depression.
B. Return to normal of ST-segment changes early in recovery phase.
C. ST-segment elevation in lead aVR.
D. Multifocal premature ventricular contractions.
E. Failure to increase systolic blood pressure by at least 10 mmHg.

Explanation

Question 49 of 70

At the onset of infection or inflammation, the level of which one of the following acute phase proteins rises most rapidly and by the highest percentage over background?

Select one of the following:

A. Fibrinogen.
B. Haptoglobin.
C. Transferrin.
D. C-reactive protein.
E. Complement component 3 (C3).

Explanation

Question 50 of 70

A 40-year-old woman presents with progressive breathlessness on exertion. She is a non-smoker. Physical examination and chest X-ray reveal no significant abnormality. Pulmonary function tests show the following results:
Which one of the following is the most likely explanation for this woman's pulmonary function test results?

Select one of the following:

A. Pulmonary vascular disease.
B. Pulmonary fibrosis.
C. Small airway disease.
D. Inadequate effort during the tests.
E. Hyperventilation syndrome.

Explanation

Question 51 of 70

For an 82-year-old nursing home resident who experiences recurrent falls, which one of the following is least likely to prevent hip fracture?

Select one of the following:

A. Oestrogen replacement therapy.
B. Bisphosphonates.
C. Calcium supplements.
D. Balance and muscle strengthening exercises.
E. Hip protectors.

Explanation

Question 52 of 70

The manometric feature most characteristic of achalasia is:

Select one of the following:

A. lack of peristalsis in the oesophageal body.
B. high resting tone of the lower oesophageal sphincter.
C. failure of lower oesophageal sphincter relaxation with swallowing.
D. poor propagation of oesophageal contraction waves.
E. diffuse spasm in the oesophageal body.

Explanation

Question 53 of 70

Cytokine regulation (especially involving interleukin 2) is least affected by which one of the following immunosuppressive drugs?

Select one of the following:

A. Prednis(ol)one.
B. Mycophenolate.
C. Cyclosporin.
D. Tacrolimus (FK506).
E. Rapamycin.

Explanation

Question 54 of 70

The mechanism of penicillin resistance in pneumococcal infections is most likely to be due to which one of the following?

Select one of the following:

A. Plasmid-mediated beta lactamase production.
B. Chromosome-mediated beta lactamase production.
C. Plasmid-mediated penicillinase production.
D. Decreased affinity of penicillin-binding proteins.
E. Altered permeability to penicillin.

Explanation

Question 55 of 70

The most important application of carcinoembryonic antigen (CEA) measurements in patients with colon cancer is:

Select one of the following:

A. testing of relatives.
B. detection of resectable relapse.
C. determining prognosis of stage III disease.
D. identification of patients who require adjuvant chemotherapy.
E. monitoring during adjuvant treatment.

Explanation

Question 56 of 70

In complex partial seizures of temporal lobe type, the most common finding at surgery for the epilepsy is:

Select one of the following:

A. mesial temporal sclerosis.
B. neuronal migration disorder.
C. old infarction.
D. normal brain.
E. cavernous angioma.

Explanation

Question 57 of 70

The diagram below shows the relationship between the plasma concentration of a drug and the effect of that drug over time in a single individual given one dose of the drug. The direction of change over time is shown by the arrows. The relationship is described by an anti-clockwise hysteresis loop. The numbers on the loop indicate the number of hours after the dose was given.
The best explanation of this phenomenon is that:

Select one of the following:

A. the drug is binding irreversibly to its target receptor.
B. the drug is active itself but has no active metabolites.
C. there is a delay in the absorption of the drug from the gastrointestinal tract.
D. there is down-regulation of the drug’s target receptor over time.
E. there is a delay in the distribution of the drug from plasma to its site of action

Explanation

Question 58 of 70

Genetically determined variation in which one of the following cell surface molecules is capable of conferring the greatest resistance to human immunodeficiency virus (HIV) infection?

Select one of the following:

A. Mannose-binding lectin.
B. Chemokine receptor CCR5.
C. Chemokine receptor CXCR4.
D. Human leucocyte antigen (HLA) class I.
E. Human leucocyte antigen (HLA) class II.

Explanation

Question 59 of 70

Deficiency of which one of the following enzymes is most likely to cause severe hyperuricaemia?

Select one of the following:

A. Xanthine oxidase.
B. Adenosine deaminase.
C. Phosphoribosyl pyrophosphate (PRPP) synthetase.
D. Hypoxanthine-guanine phosphoribosyl transferase (HGPRTase).
E. Hexosaminidase

Explanation

Question 60 of 70

Which one of the following physical findings would be least expected in association with the chest X-ray shown above?

Select one of the following:

A. A soft pulmonary component of the second heart sound (P2).
B. Prominent "v" wave in the jugular venous pressure.
C. Right ventricular lift.
D. Ejection click.
E. Early diastolic murmur

Explanation

Question 61 of 70

Which feature of glomerular pathology is least consistent with the diagnosis of Wegener's granulomatosis?

Select one of the following:

A. Focal necrosis.
B. Crescents.
C. IgG deposition.
D. T cell infiltrate.
E. Macrophage infiltrate.

Explanation

Question 62 of 70

A 62-year-old man on weekly oral methotrexate for psoriatic arthritis inadvertently receives a course of oral trimethoprim-sulfamethoxazole therapy for urinary infection. He becomes ill with mucositis, fever and bruising and is found to have moderately severe pancytopenia.
Folinic acid (in the form of calcium folinate) is administered intravenously as an antidote for presumed methotrexate toxicity.
The principal mode of action of folinic acid is:

Select one of the following:

A. enhanced renal excretion of methotrexate.
B. reduced intracellular accumulation of methotrexate.
C. conversion of methotrexate to an inactive metabolite.
D. activation of the enzyme dihydrofolate reductase.
E. provision of reduced folates for nucleic acid synthesis

Explanation

Question 63 of 70

A young woman presents with thirst and polyuria. Following overnight water deprivation, which one of the following is the best indicator that she has partial (and central) diabetes insipidus rather than psychogenic polydipsia?

Select one of the following:

A. Severe thirst.
B. Failure to reach normal urinary concentrations.
C. Low serum osmolality.
D. Increased urine osmolality in response to injected vasopressin.
E. Increased blood urea.

Explanation

Question 64 of 70

In the pedigree shown below, the man indicated by an arrow has been shown to have an autosomal recessive biochemical disorder with complete penetrance. The causative gene has not been identified. His parents are obligate carriers and do not exhibit any biochemical abnormalities. His sister also has normal biochemical studies. The carrier frequency in this population is 10%.
In the absence of consanguinity, what is the risk of the sister having a child with the biochemical abnormality?

Select one of the following:

A. 1 in 40.
B. 1 in 60.
C. 1 in 80.
D. 1 in 100.
E. 1 in 120.

Explanation

Question 65 of 70

In a patient with oropharyngeal dysphagia following a stroke, which one of the following would be the strongest indicator of increased risk of aspiration?

Select one of the following:

A. Facial weakness with drooling.
B. Refusal to eat.
C. Moist vocal quality and weak cough.
D. Bilateral absent gag reflex.
E. Dysarthria.

Explanation

Question 66 of 70

Which one of the following pharmacokinetic parameters is most important in the optimal prescribing of beta-lactam antibiotics?

Select one of the following:

A. The peak concentration/mean inhibitory concentration (MIC) ratio.
B. Area under the plasma concentration versus time curve (AUC).
C. The AUC/MIC ratio.
D. Time above the MIC.
E. Both AUC/MIC ratio and peak concentration/MIC ratio.

Explanation

Question 67 of 70

Drug X is given intravenously, using two different regimens, to the same patient on two different occasions. On both occasions, there is no measurable amount of the drug in plasma prior to its administration. On both occasions, the volume of distribution of X is 0.85 L/kg and the plasma half-life is six hours.
Regimen A: continuous intravenous infusion of 10 mg/kg/h, with no loading dose.
Regimen B: a loading dose of 50 mg/kg given rapidly intravenously, then a continuous intravenous infusion of 10 mg/kg/h.
Using Regimen A, the plasma concentration of X after 48 hours was 100 mg/L.
Using Regimen B, the plasma concentration of X after 48 hours would most closely approximate:

Select one of the following:

A. 50 mg/L.
B. 75 mg/L.
C. 100 mg/L.
D. 125 mg/L.
E. 150 mg/L.

Explanation

Question 68 of 70

A 25-year-old man dislocates his right shoulder while playing football. This is reduced in the emergency department and he is discharged after observation. After removal of his sling he has problems with abduction of the arm. Examination shows weakness of abduction at the shoulder and sensory loss on the lateral aspect of his upper arm.
The nerve involved is the:

Select one of the following:

A. accessory nerve.
B. axillary nerve.
C. musculocutaneous nerve.
D. radial nerve.
E. suprascapular nerve.

Explanation

Question 69 of 70

In a randomised controlled trial of an intervention to stop smoking in patients with chronic obstructive pulmonary disease (COPD), the use of an intention-to-treat analysis is most likely to cause which one of the following?

Select one of the following:

A. Bias that overestimates the efficacy of the intervention.
B. Bias that underestimates the efficacy of the intervention.
C. Bias due to selection of subjects.
D. Bias due to measurement of the outcome.
E. Bias due to known and unknown confounders.

Explanation

Question 70 of 70

Which one of the following histopathological features is least likely to be seen in cranial (temporal) arteritis?

Select one of the following:

A. Thickening of the intima.
B. Fragmentation of the internal elastic lamina.
C. Panarteritis.
D. Presence of giant cells.
E. Aneurysmal dilatation.

Explanation

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	Created by Jeku Jacob over 8 years ago

2001 FRACP Written Examination Adult Medicine Paper 1 – Medical Sciences

2001a-Paper 1 – Medical Sciences

Question 1 of 70

A 47-year-old woman with overt thyrotoxicosis is found to have aortic stenosis. Which one of the following features, if present in this woman, is most likely to indicate the need for aortic valve replacement?

Select one of the following:

Explanation

Question 2 of 70

Select one of the following:

Explanation

Question 3 of 70

The alveolar-arterial gradient for oxygen tension in arterial blood (PA-aO2) can be up to 15 mmHg in healthy young adults and as high as 30 mmHg in elderly people. Which one of the following is considered to be the predominant physiological mechanism for a normal PA-aO2?

Select one of the following:

Explanation

Question 4 of 70

Significant intercurrent illness is commonly associated with disturbances of thyroid function (sick euthyroid syndrome). Which one of the following is least likely to be present in a euthyroid patient with a severe illness?

Select one of the following:

Explanation

Question 5 of 70

At 72 hours following a significant paracetamol overdose, which one of the following tests will allow the best prediction of death or need for liver transplantation?

Select one of the following:

Explanation

Question 6 of 70

The most common cause of blindness in elderly Caucasians is:

Select one of the following:

Explanation

Question 7 of 70

Graft-versus-host disease is a major complication of allogeneic stem cell transplantation for haematological malignancy in adults. Which one of the following has the least influence on the risk of developing graft-versus-host disease?

Select one of the following:

Explanation

Question 8 of 70

Dendritic cells are distinguished by an exceptional ability to carry out which one of the following immune functions?

Select one of the following:

Explanation

Question 9 of 70

The most useful investigation for the diagnosis of multiple sclerosis is:

Select one of the following:

Explanation

Question 10 of 70

Select one of the following:

Explanation

Question 11 of 70

A number of patients in a ward have been found to be colonised with vancomycin-resistant enterococci. What would be the best laboratory test to determine if transmission from one patient to another has occurred?

Select one of the following:

Explanation

Question 12 of 70

A 35-year-old woman with hypertrophic cardiomyopathy presents with chest pain and palpitations. Her heart rate is 155/minute and irregular, and her blood pressure is 130/80 mmHg. What is the most appropriate initial therapy?

Select one of the following:

Explanation

Question 13 of 70

In a patient with cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis), the finding on bronchoalveolar lavage of an elevated proportion of which one of the following cell types is associated with a better response to therapy?

Select one of the following:

Explanation

Question 14 of 70

Select one of the following:

Explanation

Question 15 of 70

A 25-year-old woman presents to the emergency department with renal colic and macroscopic haematuria. She reports having had several previous episodes treated at another hospital. The least likely diagnosis is:

Select one of the following:

Explanation

Question 16 of 70

The COX-2 isoform of cyclo-oxygenase is most strongly expressed in which one of the following tissues?

Select one of the following:

Explanation

Question 17 of 70

Which one of the following is the most potent inhibitor of aldosterone secretion in a healthy individual?

Select one of the following:

Explanation

Question 18 of 70

A 45-year-old man develops stage C cancer of the caecum. There is a strong family history of bowel cancer in the absence of polyps and there is no history of colitis. The most likely underlying inherited genetic abnormality is in:

Select one of the following:

Explanation

Question 19 of 70

Select one of the following:

Explanation

Question 20 of 70

Which one of the following is associated with the highest risk of NSAID (non-steroidal anti-inflammatory drug)-induced gastric ulceration?

Select one of the following:

Explanation

Question 21 of 70

T lymphocytes expressing both CD4 and CD8 on the cell surface are most likely to be found in which one of the following anatomical locations in healthy individuals?

A 47-year-old woman with overt thyrotoxicosis is found to have aortic stenosis.
Which one of the following features, if present in this woman, is most likely to indicate the need for aortic valve replacement?

The alveolar-arterial gradient for oxygen tension in arterial blood (PA-aO2) can be up to 15 mmHg in healthy young adults and as high as 30 mmHg in elderly people.
Which one of the following is considered to be the predominant physiological mechanism for a normal PA-aO2?

Significant intercurrent illness is commonly associated with disturbances of thyroid function (sick euthyroid syndrome).
Which one of the following is least likely to be present in a euthyroid patient with a severe illness?

Graft-versus-host disease is a major complication of allogeneic stem cell transplantation for haematological malignancy in adults.
Which one of the following has the least influence on the risk of developing graft-versus-host disease?

A 35-year-old woman with hypertrophic cardiomyopathy presents with chest pain and palpitations. Her heart rate is 155/minute and irregular, and her blood pressure is 130/80 mmHg.
What is the most appropriate initial therapy?

A 25-year-old woman presents to the emergency department with renal colic and macroscopic haematuria. She reports having had several previous episodes treated at another hospital.
The least likely diagnosis is:

A 45-year-old man develops stage C cancer of the caecum. There is a strong family history of bowel cancer in the absence of polyps and there is no history of colitis.
The most likely underlying inherited genetic abnormality is in:

The picture below shows a computed tomography (CT) scan of the heart.
Which one of the following is the most likely diagnosis?

A young man presents with breathlessness and ankle swelling. He had a ventricular septal defect (VSD) repaired at the age of three years. He is centrally cyanosed and has a prominent right ventricular heave on palpation of the chest.
The most likely finding is: