Oliver's Quizzes Flashcards
1
Q
A 32 year old female presents to the GP complaining of blurry vision. When assessing her eye movements, you notice that she struggles to adduct her left eye and gets a few beats of nystagmus in that eye when she looks right. She is able to look left with no difficulty. Where is the lesion?
- a. Medial longitudinal fasciculus
- b. Oculomotor nucleus
- c. Abducens nucleus
- d. Paramedical pontine reticular formation
A
A 32 year old female presents to the GP complaining of blurry vision. When assessing her eye movements, you notice that she struggles to adduct her left eye and gets a few beats of nystagmus in that eye when she looks right. She is able to look left with no difficulty. Where is the lesion?
- a. Medial longitudinal fasciculus
- b. Oculomotor nucleus
- c. Abducens nucleus
- d. Paramedical pontine reticular formation
2
Q
People who lived in the UK for 6 months between January 1st 1980 - December 31st 1996 cannot give blood in Australia because of which disease?
- a. Variant Creutzfeldt Jakob Disease
- b. Kuru
- c. Gerstmann-Straussler-Scheinker Syndrome
- d. Fatal Familial Insomnia
A
People who lived in the UK for 6 months between January 1st 1980 - December 31st 1996 cannot give blood in Australia because of which disease?
- a. Variant Creutzfeldt Jakob Disease
- b. Kuru
- c. Gerstmann-Straussler-Scheinker Syndrome
- d. Fatal Familial Insomnia
3
Q
The lentiform nucleus consists of:
- a. Caudate nucleus and putamen
- b. Caudate nucleus and globus pallidus
- c. Putamen and subthalamic nucleus
- d. Putamen and globus pallidus
A
The lentiform nucleus consists of:
- a. Caudate nucleus and putamen
- b. Caudate nucleus and globus pallidus
- c. Putamen and subthalamic nucleus
- d. Putamen and globus pallidus
4
Q
How does dopamine affect the direct pathway?
- a. D2 receptors in the globus pallidus internus to decrease movement
- b. D1 receptors in the striatum to increase movement
- c. D1 receptors in the globus pallidus internus to increase movement
- d. D2 receptors in the striatum to increase movement
A
How does dopamine affect the direct pathway?
- a. D2 receptors in the globus pallidus internus to decrease movement
- b. D1 receptors in the striatum to increase movement
- c. D1 receptors in the globus pallidus internus to increase movement
- d. D2 receptors in the striatum to increase movement
5
Q
Which of the following statements is correct?
- a. Rigidity is velocity dependent and characteristic of pyramidal lesions
- b. Spasticity is velocity dependent and characteristic of extrapyramidal lesions
- c. Rigidity is velocity independent and characteristic of extrapyramidal lesions
- d. Spasticity is velocity independent and characteristic of pyramidal lesions
A
Which of the following statements is correct?
- a. Rigidity is velocity dependent and characteristic of pyramidal lesions
- b. Spasticity is velocity dependent and characteristic of extrapyramidal lesions
- c. Rigidity is velocity independent and characteristic of extrapyramidal lesions
- d. Spasticity is velocity independent and characteristic of pyramidal lesions
6
Q
Briefly outline the pathogenesis of prion diseases. (2.5 marks)
A
7
Q
What clinical features suggest a patient has a cerebellar lesion? (4 marks)
(8)
A
- Scanning speech/ataxic speech
- Nystagmus
- Dysmetria
- Dysdiadochokinesia
- Rebound phenomenon
- Abnormal heel-to-shin test coordination
- Hypotonia
- Wide based and/or staggering gait
8
Q
What are the clinical features of Parkinson’s disease? (4 marks)
A
9
Q
There are 4 main subtypes of motor neuron disease, list them and the neurons involved in each. (4 marks)
A
10
Q
A 60 year old male with a history of visual hallucinations, depression and cognitive decline is killed in a motor vehicle accident. At autopsy, tissue samples from his brain are stained and viewed by a neuropathologist. The following inclusion body was identified in a sample from the patient’s cortex. What is this inclusion body called and what protein(s) is it composed of? What disease did this patient have? (1.5 marks)
A
11
Q
Which of the following organisms is not a common cause of atypical pneumonia?
- a. Chlamydophila pneumoniae
- b. Legionella pneumophila
- c. Mycoplasma pneumoniae
- d. Moraxella catarrhalis
A
Which of the following organisms is not a common cause of atypical pneumonia?
- a. Chlamydophila pneumoniae
- b. Legionella pneumophila
- c. Mycoplasma pneumoniae
- d. Moraxella catarrhalis
12
Q
Where are peyer’s patches located?
- a. Duodenum
- b. Jejunum
- c. Ileum
- d. Colon
A
Where are peyer’s patches located?
- a. Duodenum
- b. Jejunum
- c. Ileum
- d. Colon
13
Q
Which of the following bacteria are able to replicate inside phagocytes?
- a. Streptococcus pneumoniae
- b. Legionella pneumophila
- c. Parainfluenza
- d. Haemophilus influenzae
A
Which of the following bacteria are able to replicate inside phagocytes?
- a. Streptococcus pneumoniae
- b. Legionella pneumophila
- c. Parainfluenza
- d. Haemophilus influenzae
14
Q
Which of the following is an example of a macrolide?
- a. Azithromycin
- b. Indomethacin
- c. Cephalexin
- d. Ciprofloxacin
A
Which of the following is an example of a macrolide?
- a. Azithromycin
- b. Indomethacin
- c. Cephalexin
- d. Ciprofloxacin
15
Q
A
= b. Lingula
16
Q
Claire is a 6 year old girl who presents to the emergency department with her mother with shortness of breath after she inhaled a small piece of a toy. A chest x-ray shows that one of her bronchi is obstructed with a foreign body. Which bronchus is most likely to be obstructed and why? (1 mark)
A
The right bronchus (0.5), it is wider and has a more vertical orientation (0.5)
17
Q
Explain why the surgical resection of a lobe of lung doesn’t cause a V/Q mismatch. (1.5 marks)
A
A V/Q mismatch occurs when either ventilation or perfusion changes whilst the other does not change proportionally (0.5). When a lobe of the lung is removed, the capacity for CO2 removal (i.e. ventilation) is decreased (0.5). However, because the whole lobe has been removed including the blood vessels there is a proportional change in perfusion (0.5) therefore there is no V/Q mismatch.
18
Q
What is Type II respiratory failure? Why does PCO2 increase when you give a patient with Type II respiratory failure high dose oxygen therapy? (2.5 marks)
A
Type II respiratory failure is caused by the failure of ventilation (0.5) which is characterised by increased PaCO2 and decreased or normal PaO2 (0.5). Giving O2 may fix hypoxaemia but the hypoxaemia is not the primary problem. Giving high dose O2 will increase the concentration of O2 in all alveoli, even the poorly ventilated alveoli (0.5). Increased O2 results in an increase in NO production which causes local vasodilation (0.5) which causes an increase in perfusion without a proportional increase in ventilation .’. worsening the V/Q mismatch → ↑ PaCO2 (0.5).
19
Q
Name and give a brief description of the pathophysiology of the 4 phases of lobar pneumonia. (4 marks)
A
Phases of Lobar Pneumonia
- *Phase 1: Congestion** (0.5)
- ↑ vascular permeability and blood flow (vascular congestion) → exudation of serum and fibrin and a small number of neutrophils (0.5)
- *Phase 2: Red Hepatisation** (0.5)
- Vascular congestion + RBCs (give the red colour) and neutrophils extravasate into the alveolar space (0.5)
- the exudate fills the alveolar sacs (consolidation) and the lung looks like the liver
- *Phase 3: Grey Hepatisation** (0.5)
- RBCs are broken down whilst neutrophils persist → consolidation becomes paler (i.e. why it’s grey hepatisation) (0.5)
- *Phase 4: Resolution** (0.5)
- The exudate is broken down enzymatically and removed by macrophages and by coughing (0.5)
20
Q
Outline the cough reflex. (3 marks)
A
21
Q
A
= b. Isoniazid
22
Q
A
= d. A TB granuloma and hilar lymphadenopathy
23
Q
A
= a. Ziehl-Nielson stain
24
Q
A
= D. Rifampicin
25
Haematogenous spread of mycobacterium tuberculosis results in:
* a. Miliary TB
* b. Tuberculous septicaemia
* c. Post-primary TB
* d. Secondary TB
Haematogenous spread of mycobacterium tuberculosis results in:
* **a. Miliary TB**
* b. Tuberculous septicaemia
* c. Post-primary TB
* d. Secondary TB
26
List 4 risk factors for TB. (2 marks)
27
What are the two things that are required for TB to be infectious? (1 mark)
The patient must have pulmonary TB (0.5) and they must have a positive smear (TB detected in the sputum) (0.5)
28
List 5 public health interventions to control TB (2.5 marks)
1. Treat patients with active TB (0.5)
2. Find cases (via contact tracing) and treat them before they become infectious (0.5)
3. Treat latent TB (0.5)
4. Isolate infectious cases (0.5)
5. Vaccination (not commonly done in Australia) (0.5)
29
Give 4 differential diagnoses for haemoptysis (2 marks).
30
Give 4 differential diagnoses for haemoptysis (2 marks).
31
Describe the immunopathogenesis of primary tuberculosis (10 marks)
**time and time again this year, my advice would be to use the year to brush up on it so you can handle any tough immuno questions that will inevitably come up]** If the APC secretes IL-12 (0.5), IL-18 (0.5) and IFNγ (0.5), the CD4 helper cells will differentiate into TH1 cells (0.5) (the types of cytokines released depend on the microenvironment that they are in i.e. rabbit hole material well beyond 2nd year). TH1 cells secrete IFNγ (0.5) which activates macrophages and enables them contain the MTb infection (0.5) by: stimulating the formation and maturation of the phagolysosome, production of reactive nitrogen intermediates and mobilises antimicrobial peptides (0.5). Activation of macrophages by IFNγ causes them to differentiate into epithelioid histiocytes that aggregate to form granulomas (0.5), some coalesce to form multinucleated giant cells (0.5). Other cytokines like TNFα attract other macrophages and immune cells (0.5) that contribute to the formation of a caseating granuloma surrounded by lymphocytes and fibrosis (0.5).
32
Christopher, 72, is visiting Dr Hall for a follow up regarding his congestive heart failure. He tells the GP that he feels fine when he is watching the TV but struggles to keep up with the grandkids when they take the dog for a walk. He says that he feels breathless after about 10-15 minutes of walking. Dr Hall checks the New York Heart Association's classification system for assessing a patient with heart failure’s functional capacity. Christopher has:
* a. Class I heart failure
* b. Class II heart failure
* c. Class III heart failure
* d. Class IV heart failure
Christopher, 72, is visiting Dr Hall for a follow up regarding his congestive heart failure. He tells the GP that he feels fine when he is watching the TV but struggles to keep up with the grandkids when they take the dog for a walk. He says that he feels breathless after about 10-15 minutes of walking. Dr Hall checks the New York Heart Association's classification system for assessing a patient with heart failure’s functional capacity. Christopher has:
* a. Class I heart failure
* **b. Class II heart failure**
* c. Class III heart failure
* d. Class IV heart failure
33
Which of the following is not a possible cause of an NSTEMI:
* a. Embolisation of a thrombus into a small intramural vessel
* b. Partial occlusion of a coronary vessel
* c. Global hypotension
* d. Complete occlusion of a coronary vessel
Which of the following is not a possible cause of an NSTEMI:
* a. Embolisation of a thrombus into a small intramural vessel
* b. Partial occlusion of a coronary vessel
* c. Global hypotension
* **d. Complete occlusion of a coronary vessel**
34
Which of the following statements about concentric hypertrophy is correct?
* a. It occurs in response to volume overloading and new sarcomeres are created in parallel
* b. It occurs in response to volume overloading and new sarcomeres are created in series
* c. It occurs in response to pressure overloading and new sarcomeres are created in series
* d. It occurs in response to pressure overloading and new sarcomeres are created in parallel
Which of the following statements about concentric hypertrophy is correct?
* a. It occurs in response to volume overloading and new sarcomeres are created in parallel
* b. It occurs in response to volume overloading and new sarcomeres are created in series
* c. It occurs in response to pressure overloading and new sarcomeres are created in series
* **d. It occurs in response to pressure overloading and new sarcomeres are created in parallel**
35
What are the macroscopic features you would expect to find in the heart of a patient who was 8 days post-STEMI?
* a. A yellow-brown discolouration of the infarcted region with a hyperaemic border
* b. Grey-white fibrosis in the infarcted area
* c. Pallor of the infarcted region with some hyperaemia
* d. No gross changes or dark mottling of the infarcted area
What are the macroscopic features you would expect to find in the heart of a patient who was 8 days post-STEMI?
* **a. A yellow-brown discolouration of the infarcted region with a hyperaemic border**
* b. Grey-white fibrosis in the infarcted area
* c. Pallor of the infarcted region with some hyperaemia
* d. No gross changes or dark mottling of the infarcted area
36
A 25 year old athlete dies suddenly during basketball practice. What was the most likely cause of his sudden cardiac death?
* a. Dilated Cardiomyopathy
* b. Restrictive Cardiomyopathy
* c. Hypertrophic Cardiomyopathy
* d. Massive pulmonary embolism causing catastrophic right heart failure
A 25 year old athlete dies suddenly during basketball practice. What was the most likely cause of his sudden cardiac death?
* a. Dilated Cardiomyopathy
* b. Restrictive Cardiomyopathy
* **c. Hypertrophic Cardiomyopathy**
* d. Massive pulmonary embolism causing catastrophic right heart failure
37
Statins are one of the commonest drugs used to treat hyperlipidaemia. Outline their mechanism of action. (2.5 marks)
38
Interpret the following ECG (5 marks)
39
What are the signs and symptoms of left heart failure? (3 marks)
40
A patient has 120ml in their left ventricle after atrial systole. After ventricular systole, 40ml remains in the ventricle. Calculate the ejection fraction. (1 mark)
41
Elaine is a 54 year old smoker who has come to your practice for her yearly check up. You order a fasting blood glucose test and lipid studies. Her blood pressure is 149/92. Her blood glucose level is 6.8 mmol/L, total cholesterol is 6.7 mmol/L, LDL is 4.5 mmol/L and HDL is 0.9 mmol/L. Using the charts on the next page, calculate her 5-year cardiovascular risk. What would her risk be if she was not a smoker? (1.5 marks)
42
Coeliac disease is associated with:
* a. HLA-DQ2
* b. HLA-B27
* c. HLA-DR2
* d. HLA-DP8
Coeliac disease is associated with:
* **a. HLA-DQ2**
* b. HLA-B27
* c. HLA-DR2
* d. HLA-DP8
43
Guillain-Barre syndrome, acute inflammatory demyelinating polyradiculopathy, is commonly associated with diarrhoea caused by:
* a. Salmonella typhi
* b. Entamoeba histolytica
* c. Campylobacter jejuni
* d. Clostridium botulinum
Guillain-Barre syndrome, acute inflammatory demyelinating polyradiculopathy, is commonly associated with diarrhoea caused by:
* a. Salmonella typhi
* b. Entamoeba histolytica
* **c. Campylobacter jejuni**
* d. Clostridium botulinum
44
Haemolytic uraemic syndrome is strongly associated with which of the following species of E. coli?
* a. ETEC O104:H4
* b. EHEC O111
* c. EHEC O26
* d. EHEC O157:H7
Haemolytic uraemic syndrome is strongly associated with which of the following species of E. coli?
* a. ETEC O104:H4
* b. EHEC O111
* c. EHEC O26
* **d. EHEC O157:H7**
45
Which of the following statements is true?
* a. Flexible sigmoidoscopy is cannot be done without sedation
* b. Flexible sigmoidoscopy is both diagnostic and therapeutic
* c. Colonoscopy has a higher risk of perforation than flexible sigmoidoscopy
* d. Flexible sigmoidoscopy can reach the hepatic flexure
Which of the following statements is true?
* a. Flexible sigmoidoscopy is cannot be done without sedation
* b. Flexible sigmoidoscopy is both diagnostic and therapeutic
* **c. Colonoscopy has a higher risk of perforation than flexible sigmoidoscopy**
* d. Flexible sigmoidoscopy can reach the hepatic flexure
46
Which of the following stool tests might you use to investigate inflammatory bowel disease?
* a. Calprotectin and lactoferrin
* b. Lactoferrin and 5-HIAA
* c. 5-HIAA and lactoferrin
* d. Faecal elastase and calprotectin
Which of the following stool tests might you use to investigate inflammatory bowel disease?
* **a. Calprotectin and lactoferrin**
* b. Lactoferrin and 5-HIAA
* c. 5-HIAA and lactoferrin
* d. Faecal elastase and calprotectin
47
What are the 4 ways to block a tube? (2 marks)
1. Luminal
2. Mural
3. Extramural
4. Loss of function
48
What are the 5 broad pathophysiological mechanisms of diarrhoea? (2.5 marks)
1. Deranged motility associated diarrhoea
2. Osmotic diarrhoea
3. Malabsorption associated diarrhoea
4. Exudative/inflammatory diarrhoea
5. Secretory diarrhoea
(0.5 marks each, max 2.5 marks)
49
It is important to investigate rectal bleeding. What is the definition of melaena? What is the definition of haematochezia? What are the diagnostic implications of each?
| (1.5 mark)
Haematochezia means bright red (fresh) blood in the stool (0.5). Melaena means dark black tarry stools (0.5). Melaena is usually indicative of upper GI bleeding whilst haematochezia usually indicates lower GI bleeding. (0.5)
50
Germline mutations in tumour suppressor genes cause familial cancer syndromes. Give one (1) example of a familial cancer syndrome and it’s characteristic mutation that is often associated with colorectal cancer (1 mark)
1. Familial adenomatous polyposis - germline deletion of APC
2. Lynch syndrome/hereditary non-polyposis colorectal cancer - MLH1 and/or MSH2
3. Peutz-Jeghers syndrome - STK11
4. MYH-associated polyposis - MYH
(0.5 marks for the condition and 0.5 marks for the gene, max 1 mark)
51
Compare and contrast ulcerative colitis and Crohn’s disease. (8 marks)
52
Which of the following nerves goes through the parotid gland?
* a. Maxillary division of the Trigeminal nerve
* b. Facial nerve
* c. Glossopharyngeal nerve
* d. Hypoglossal nerve
Which of the following nerves goes through the parotid gland?
* a. Maxillary division of the Trigeminal nerve
* **b. Facial nerve**
* c. Glossopharyngeal nerve
* d. Hypoglossal nerve
53
Gastric cancer is associated with:
* a. Trousseau sign
* b. Russell’s sign
* c. Wellens’ sign
* d. Leser-Trélat sign
Gastric cancer is associated with:
* a. Trousseau sign
* b. Russell’s sign
* c. Wellens’ sign
* **d. Leser-Trélat sign**
54
Ingestion of alkaline substances causes
* a. Coagulative necrosis in the oesophagus and stomach
* b. Coagulative necrosis in the oesophagus but limited involvement of the stomach
* c. Liquefactive necrosis of the oesophagus but limited involvement of the stomach
* d. Liquefactive necrosis of the oesophagus and stomach
Ingestion of alkaline substances causes
* a. Coagulative necrosis in the oesophagus and stomach
* b. Coagulative necrosis in the oesophagus but limited involvement of the stomach
* **c. Liquefactive necrosis of the oesophagus but limited involvement of the stomach**
* d. Liquefactive necrosis of the oesophagus and stomach
55
Menetrier’s disease is caused by excessive secretion of
* a. Tumour Necrosis Factor α (TNF-α)
* b. Transforming Growth Factor α (TGF-α)
* c. Transforming Growth Factor β (TGF-β)
* d. Fibroblast growth factor (FGF)
Menetrier’s disease is caused by excessive secretion of
* a. Tumour Necrosis Factor α (TNF-α)
* **b. Transforming Growth Factor α (TGF-α)**
* c. Transforming Growth Factor β (TGF-β)
* d. Fibroblast growth factor (FGF)
56
Which of the following mediates an increase in the tone of the lower oesophageal sphincter?
* a. Protein
* b. Fat
* c. Chocolate
* d. Peppermint
Which of the following mediates an increase in the tone of the lower oesophageal sphincter?
* **a. Protein**
* b. Fat
* c. Chocolate
* d. Peppermint
57
Describe the regulation of acid secretion during the cephalic and gastric phases (4 marks)
58
What are the clinical features of GORD? (2 marks) = 7
1. Burning retrosternal discomfort
2. Regurgitation
3. Belching
4. Dysphagia/Odynophagia (caused by reflux oesophagitis or strictures in long-standing disease)
5. Hypersalivation
6. Globus sensation
7. Nausea
59
What histological feature of the wall of the gastrointestinal tract is absent in the walls of the thoracic oesophagus, ascending and descending colon and rectum? (1 mark)
(0.5 marks each, max 1 mark)
The rest of the gastrointestinal tract is lined by a layer of mesothelium called the serosa (the visceral peritoneum) (0.5) The thoracic oesophagus, ascending and descending colon and rectum are only covered by an adventitia (connective tissue layer) (0.5).
This has implications for local invasion and metastasis
60
List 3 causes of reactive gastropathy (1.5 marks)
(0.5 marks each, max 1.5 marks)
1. Bile reflux
2. NSAIDs
3. Uraemia
61
Briefly outline the events of the oral phase of deglutition? (2 marks)
1. Mastication and salivation leads to formation of a bolus (0.5)
2. Extrinsic muscles of the tongue elevate the tongue (0.5) and the intrinsic muscles form a central trough for the bolus to sit in (0.5)
3. Bolus is pushed up against the palatoglossal arch (0.5)
(0.5 marks each, max 2 marks)
62
Variations in the length of menstrual cycle are due to changes in the length of the:
* a. Luteal phase
* b. Menstrual phase
* c. Ovulatory phase
* d. Follicular phase
Variations in the length of menstrual cycle are due to changes in the length of the:
* a. Luteal phase
* b. Menstrual phase
* c. Ovulatory phase
* **d. Follicular phase**
63
Oncogenic HPVs produce the E7 protein which acts to:
* a. Inhibit apoptosis by binding to and inhibiting p53
* b. Binding to pRb to induce S-phase entry
* c. Increase expression of cyclin D to drive the G1/S phase transition
* d. Inhibit apoptosis by inactivating caspase enzymes
Oncogenic HPVs produce the E7 protein which acts to:
* a. Inhibit apoptosis by binding to and inhibiting p53
* **b. Binding to pRb to induce S-phase entry**
* c. Increase expression of cyclin D to drive the G1/S phase transition
* d. Inhibit apoptosis by inactivating caspase enzymes
64
Which of the following statements about oestrogens is most correct?
* a. Oestrogen synthesis takes place in the granulosa and theca cells
* b. Oestrone is more potent than oestriol but less potent than oestradiol
* c. Oestrogen production in males only occurs via peripheral aromatase conversion
* d. Estetrol is only produced during puberty
Which of the following statements about oestrogens is most correct?
* a. Oestrogen synthesis takes place in the granulosa and theca cells
* **b. Oestrone is more potent than oestriol but less potent than oestradiol**
* c. Oestrogen production in males only occurs via peripheral aromatase conversion
* d. Estetrol is only produced during puberty
65
Extramammary Paget’s disease is characterised by:
* a. Malignant epithelial cells in the epidermis of the vulva
* b. Hyperplasia of the vulvar squamous epithelium
* c. Thinning of the epidermis and fibrosis of the dermis
* d. Hyperkeratosis, hypergranulosis, acanthosis and lymphocytic infiltration of the dermal-epidermal junction
Extramammary Paget’s disease is characterised by:
* **a. Malignant epithelial cells in the epidermis of the vulva**
* b. Hyperplasia of the vulvar squamous epithelium
* c. Thinning of the epidermis and fibrosis of the dermis
* d. Hyperkeratosis, hypergranulosis, acanthosis and lymphocytic infiltration of the dermal-epidermal junction
66
Which of the following is not one of the eligibility criteria for a self collection HPV test?
* a. The patient is older than 30
* b. The patient hasn’t had a cervical screening test in more than 2 years
* c. The patient refuses a speculum examination
* d. The patient has been previously vaccinated against HPV
Which of the following is not one of the eligibility criteria for a self collection HPV test?
* a. The patient is older than 30
* b. The patient hasn’t had a cervical screening test in more than 2 years
* c. The patient refuses a speculum examination
* **d. The patient has been previously vaccinated against HPV**
67
Outline the International Federation of Gynaecology and Obstetrics (FIGO) system for classifying the **causes** of abnormal uterine bleeding? (4.5 marks)
= PALM COEIN
* Polyps
* Adenomyosis
* Leiomyoma
* Malignancy
* Coagulopathy
* Ovulatory
* Endometrial
* Iatrogenic
* Not otherwise classified
68
What are the signs and symptoms of invasive cervical cancer (2 marks)
69
Why is bleeding more prolonged in anovulatory cycles? (2 marks)
70
What are the cells seen on the right of this slide called and what are they pathognomonic of? (1 mark)
They are koilocytes (0.5)
Koilocytes are pathognomonic of HPV infection (0.5)
71
72
When is Haemophilus influenzae type B vaccinated for in Australia?
* a. 2, 4 and 6 months
* b. 4, 6 and 18 months
* c. 4, 6, 12 and 18 months
* d. 2, 4, 6 and 18 months
When is Haemophilus influenzae type B vaccinated for in Australia?
* a. 2, 4 and 6 months
* b. 4, 6 and 18 months
* c. 4, 6, 12 and 18 months
* **d. 2, 4, 6 and 18 months**
73
Which of the following statements is most correct?
* a. Fever in a child may be caused by teething
* b. Febrile seizures may occur when the core temperature changes suddenly
* c. A fever in a child should always be investigated with throat swabs for MC&S
* d. Superficial skin infections are the most common cause of fever in a child
Which of the following statements is most correct?
* a. Fever in a child may be caused by teething
* **b. Febrile seizures may occur when the core temperature changes suddenly**
* c. A fever in a child should always be investigated with throat swabs for MC&S
* d. Superficial skin infections are the most common cause of fever in a child
74
The cranial vault and brain of a patient are examined at autopsy. The subarachnoid space is occupied by a fibrinous exudate that primarily involves the base of the brain. There are small discrete white “spots” seen scattered in the leptomeninges. The patient suffered from
* a. Neuroborreliosis (Lyme disease)
* b. Neurosyphilis
* c. Tuberculous meningoencephalitis
* d. Cryptococcal meningoencephalitis
The cranial vault and brain of a patient are examined at autopsy. The subarachnoid space is occupied by a fibrinous exudate that primarily involves the base of the brain. There are small discrete white “spots” seen scattered in the leptomeninges. The patient suffered from
* a. Neuroborreliosis (Lyme disease)
* b. Neurosyphilis
* **c. Tuberculous meningoencephalitis**
* d. Cryptococcal meningoencephalitis
75
Which of the following statements about Waterhouse-Friderichsen syndrome (WFS) is correct:
* a. It only occurs in patients with meningococcal disease
* b WFS is associated with disseminated intravascular coagulation
* c. Affects adults more frequently than children
* d. All of the above
Which of the following statements about Waterhouse-Friderichsen syndrome (WFS) is correct:
* a. It only occurs in patients with meningococcal disease
* **b WFS is associated with disseminated intravascular coagulation**
* c. Affects adults more frequently than children
* d. All of the above
76
= A) Progressive Multifocal Leukoencephalopathy
77
What are the clinical features of meningitis (3 marks)
78
List 3 virulence factors of *Neisseria meningitidis* and explain their function (3 marks)
79
What are the functions of CSF? (2 marks)
80
What structures are traversed during a lumbar puncture (4.5 marks)
81
82
Which intracranial neoplasm is associated with drop metastases?
* a. Pilocytic astrocytoma
* b. Choroid plexus papilloma
* c. Craniopharyngioma
* d. Medulloblastoma
Which intracranial neoplasm is associated with drop metastases?
* a. Pilocytic astrocytoma
* b. Choroid plexus papilloma
* c. Craniopharyngioma
* **d. Medulloblastoma**
83
Which of the following, if mutated, confers a better prognosis for patients with glioblastoma?
* a. Isocitrate Dehydrogenase
* b. Neurofilament
* c. Ki67
* d. Glial Fibrillary Acidic Protein
Which of the following, if mutated, confers a better prognosis for patients with glioblastoma?
* **a. Isocitrate Dehydrogenase**
* b. Neurofilament
* c. Ki67
* d. Glial Fibrillary Acidic Protein
84
Which intracranial neoplasm is associated with perivascular pseudorosettes?
* a. Medulloblastoma
* b. Oligodendroglioma
* c. Ependymoma
* d. Anaplastic astrocytoma
Which intracranial neoplasm is associated with perivascular pseudorosettes?
* a. Medulloblastoma
* b. Oligodendroglioma
* **c. Ependymoma**
* d. Anaplastic astrocytoma
85
Which of the following medications is relatively contraindicated in patients with migraines with auras?
* a. Sumatriptan
* b. Combined oral contraceptive pill
* c. Propranolol
* d. Valproate
Which of the following medications is relatively contraindicated in patients with migraines with auras?
* a. Sumatriptan
* **b. Combined oral contraceptive pill**
* c. Propranolol
* d. Valproate
86
Gladys, a 72 year old retired bank manager, presents to your general practice complaining of headaches. She states that they are throbbing in nature and occur on the left side of her forehead. She also complains of jaw pain that comes and goes. Which of the following diseases do 50% of patients with her type of headache syndrome have:
* a. Giant cell arteritis
* b. Amaurosis fugax
* c. Polymyalgia rheumatica
* d. Rheumatoid arthritis
Gladys, a 72 year old retired bank manager, presents to your general practice complaining of headaches. She states that they are throbbing in nature and occur on the left side of her forehead. She also complains of jaw pain that comes and goes. Which of the following diseases do 50% of patients with her type of headache syndrome have:
* a. Giant cell arteritis
* b. Amaurosis fugax
* **c. Polymyalgia rheumatica**
* d. Rheumatoid arthritis
87
What are the clinical features of Horner’s syndrome? How do you differentiate it from a third nerve palsy? (3 marks)
88
Define Thunderclap Headache (1 mark)
A thunderclap headache is a sudden onset severe headache (0.5) that reaches maximum intensity within 1 minute of onset (0.5)
Subarachnoid haemorrhage is a type of thunderclap headache, it is really important that you learn the proper definition of terminology that you use and you don’t just use them as buzzwords. Learning medicine is like learning another language and you have to use words appropriately to accurately convey what you mean.
(0.5 marks each, max 1 mark)
89
What are the signs and symptoms of raised intracranial pressure? (3 marks)
1. Cushing’s Triad: irregular breathing (0.5), bradycardia (0.5) and widening pulse pressure (0.5)
2. Headache (0.5)
3. Nausea and vomiting (0.5)
4. ↓ level of consciousness (0.5)
5. Papilloedema (0.5)
6. Diplopia (sometimes) (0.5)
7. Signs and symptoms specific to a herniation syndrome (0.5)
(0.5 marks each, max 3 marks)
90
Angela, a 68 year old right-handed accountant, is brought to the emergency department by her daughter who reports that her mother has suddenly and progressively developed unilateral weakness. An emergency non-contrast CT is ordered and shows the following.
What clinical features would you expect to see in a patient with this lesion? (3 marks)
91
Derrick, a 49 year old real estate agent, presents to the emergency department following a blackout after being tackled during a social rugby game. His teammates report that he was unconscious for 30 seconds or so before coming to and he was fine for 30 minutes or so before we started to get a bad headache which brought them to the emergency department. What type of intracranial haemorrhage do you need to exclude? In this type of haemorrhage, what vessel is the source of the blood? What would you expect to see on a non-contrast CT? (1.5 marks)
92
What is the formula for plasma osmolality?
* a. 2x[Na+] + [K+] + [Glucose]
* b. 2x[Na+] + [Glucose]
* c. 2x[Na+] + [Glucose] + [Urea]
* d. 2x[Na+] + [K+] + [Glucose] + [Urea]
What is the formula for plasma osmolality?
* a. 2x[Na+] + [K+] + [Glucose]
* b. 2x[Na+] + [Glucose]
* **c. 2x[Na+] + [Glucose] + [Urea]**
* d. 2x[Na+] + [K+] + [Glucose] + [Urea]
93
Ischaemic strokes do not affect consciousness unless the _______ is/are involved.
* a. Brainstem
* b. Prefrontal cortex
* c. Hypothalamus
* d. Cerebral peduncles
Ischaemic strokes do not affect consciousness unless the _______ is/are involved.
* **a. Brainstem**
* b. Prefrontal cortex
* c. Hypothalamus
* d. Cerebral peduncles
94
Which of the following would cause a sympathomimetic toxidrome?
* a. Withdrawal of benzodiazepines
* b. Methamphetamine
* c. Cocaine
* d. All of the above
Which of the following would cause a sympathomimetic toxidrome?
* a. Withdrawal of benzodiazepines
* b. Methamphetamine
* c. Cocaine
* **d. All of the above**
95
Claire is started on duloxetine for her generalised anxiety. Duloxetine is a:
* a. NaSSA
* b. SSRI
* c. SARI
* d. SNRI
Claire is started on duloxetine for her generalised anxiety. Duloxetine is a:
* a. NaSSA
* b. SSRI
* c. SARI
* **d. SNRI**
96
What is the antidote for a patient that has overdosed on paracetamol?
* a. Naloxone
* b. Physostigmine
* c. N-acetylcysteine
* d. Flumazenil
What is the antidote for a patient that has overdosed on paracetamol?
* a. Naloxone
* b. Physostigmine
* **c. N-acetylcysteine**
* d. Flumazenil
97
What are the four components of consciousness? (2 marks)
1. Self-awareness
2. Access to memories
3. Ability to manipulate abstract ideas
4. Ability to focus attention/arousal
98
Part of the advanced life support (ALS) algorithm is to identify and correct reversible causes of cardiac arrest. They are sometimes referred to as the H’s and T’s of ACLS. List these reversible conditions: (4.5 marks)
99
What is the mechanism of action of MDMA? (2.5 marks)
1. The primary mode of action of MDMA is as an indirect serotonergic agonist, increasing the amount of serotonin released into the synapse
2. MDMA hijacks the serotonin transporter (SERT) and is transported into the axon terminal
3. Increases serotonin release by reverse transport through the serotonin transporter (transporter-mediated exchange)
4. Interferes with the storage of serotonin within the vesicles → more serotonin available to be released
5. MDMA is also able to enhance release of dopamine and noradrenaline via a similar mechanism
6. MDMA inhibits monoamine reuptake and breakdown via monoamine oxidase (MAO)
7. Might also act on 5-HT2 receptors, α2-adrenergic receptors and M1 muscarinic cholinergic receptors
100
What are the clinical features of the opioid toxidrome? (4 marks)
101
Amanda, a 27 year old bricklayer, presents to your clinic for wound dressing after injuring her left forearm during a night out. Last weekend, Amanda was brought to the emergency department at Royal Perth Hospital at 3am with a large laceration sustained during a fall in the street after leaving a club. Her friends report that she consumed more than 10 standard drinks that they know of and they are concerned by her alcohol usage. They also report that she gets angry when they mention her alcohol usage to her. What questions would you ask to quickly screen Amanda for alcohol use disorder? (2 marks)
102
Which of the following is a cortical area of the limbic system?
* a. Septal area
* b. Amygdala
* c. Hippocampus
* d. Parahippocampal gyrus
Which of the following is a cortical area of the limbic system?
* a. Septal area
* b. Amygdala
* c. Hippocampus
* **d. Parahippocampal gyrus**
103
The cell bodies of serotonergic neutrons are found in the:
* a. Locus coeruleus
* b. Raphe nuclei
* c. Basal nucleus of meynert
* d. Ventral tegmental area
The cell bodies of serotonergic neutrons are found in the:
* a. Locus coeruleus
* **b. Raphe nuclei**
* c. Basal nucleus of meynert
* d. Ventral tegmental area
104
Which of the following is an example of a NaSSA?
* a. Venlafaxine
* b. Reboxetine
* c. Mirtazapine
* d. Sertraline
Which of the following is an example of a NaSSA?
* a. Venlafaxine
* b. Reboxetine
* **c. Mirtazapine**
* d. Sertraline
105
Hypertensive crises when a patient consumes foods containing tyramine may occur if a patient is taking:
* a. MAOi
* b. Amitriptyline
* c. Paroxetine
* d. Nefazodone
Hypertensive crises when a patient consumes foods containing tyramine may occur if a patient is taking:
* **a. MAOi**
* b. Amitriptyline
* c. Paroxetine
* d. Nefazodone
106
Which of the following is not a type of disordered thought form?
* a. Thought blocking
* b. Circumstantial
* c. Tangential
* d. Word salad
Which of the following is not a type of disordered thought form?
* **a. Thought blocking**
* b. Circumstantial
* c. Tangential
* d. Word salad
107
What are the diagnostic criteria for major depressive disorder? (5 marks)
108
Define emotional expression and emotional experience. (1 mark)
**Emotional Expression**: a set of physiological responses when the brain detects positively or negatively charged stimulus (0.5)
**Emotional Experience:** the conscious experience of somatic and cognitive changes (0.5)
109
What is the monoamine theory of depression and upon what evidence is it based? (1 mark)
Depression is the result of the depletion in the levels of serotonin, noradrenaline, and/or dopamine (the monoamines) in the central nervous system (0.5)
It is based on the evidence that drugs that increase the levels of monoamines (e.g. SSRIs, SNRIs etc) relieve the symptoms of depression (0.5)
110
What are the clinical features of a manic episode? (4 marks)
111
What are the clinical features of a panic attack? (5 marks)
112
What is the most common cause of psychosis in the elderly?
* a. Depression
* b. Delirium
* c. Dementia
* d. Medications
What is the most common cause of psychosis in the elderly?
* a. Depression
* b. Delirium
* **c. Dementia**
* d. Medications
113
Neuroleptic malignant syndrome and serotonin syndrome share all of the following features except:
* a. Mydriasis
* b. Hypertension
* c. Tachycardia
* d. Hyperthermia
Neuroleptic malignant syndrome and serotonin syndrome share all of the following features except:
* **a. Mydriasis**
* b. Hypertension
* c. Tachycardia
* d. Hyperthermia
114
Which of the following motor side effects of antipsychotic use are often not fully reversible?
* a. Acute dystonia
* b. Bradykinesia
* c. Akathisia
* d. Tardive dyskinesia
Which of the following motor side effects of antipsychotic use are often not fully reversible?
* a. Acute dystonia
* b. Bradykinesia
* c. Akathisia
* **d. Tardive dyskinesia**
115
Which of the following occurs with antipsychotic use?
* a. Prolongation of the PR interval
* b. Prolongation of the QT interval
* c. Prolongation of the PR segment
* d. Prolongation of the QT segment
Which of the following occurs with antipsychotic use?
* a. Prolongation of the PR interval
* **b. Prolongation of the QT interval**
* c. Prolongation of the PR segment
* d. Prolongation of the QT segment
116
Which rare but potentially fatal side effect of clozapine is monitored for by taking serial FBCs?
* a. Megaloblastic crisis
* b. Haemolytic crisis
* c. Agranulocytosis
* d. Granulocytosis
Which rare but potentially fatal side effect of clozapine is monitored for by taking serial FBCs?
* a. Megaloblastic crisis
* b. Haemolytic crisis
* **c. Agranulocytosis**
* d. Granulocytosis
117
Define delusions. (1.5 marks)
Fixed, false beliefs based on incorrect inference about external reality (0.5), firmly held despite evidence to the contrary (0.5), out of keeping with the patient's cultural background (0.5).
(0.5 marks each, max 1.5 marks)
118
What are the criteria for an involuntary inpatient treatment order as per the WA Mental Health Act 2014? (3 marks)
119
What is Folie Deux? (1 mark)
When a patient develops a similar delusion (0.5) to a person that they are close with that already has an established delusion (0.5)
(0.5 marks each, max 1 mark)
120
Briefly describe the neurodevelopmental model. (1.5 marks)
Mental illness is the product of abnormal neurodevelopmental processes (0.5) that started years before the onset of the illness (0.5)
Chemical, physical or psychological insults in utero and throughout neurodevelopment in childhood and adolescence cause phenotypic changes that result in mental illness (0.5)
(0.5 marks each, max 1.5 marks)
121
What are some poor prognostic indicators in schizophrenia? (4 marks)
1. Male
2. Early onset, insidious
3. Long period of untreated psychosis
4. Poor premorbid function
5. Single
6. Structural brain abnormalities
7. Severe negative Sx
8. Neurological soft signs
9. Neurocognitive deficits
(0.5 marks each, max 4 marks)
