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150 Cards in this Set

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A male patient, aged 40, is being treated for ALL. Overnight he developed a painful foot. Walking to the bathroom he stubs his toe and screams with pain. On examination he is afebrile, the area around the first metatarsal phallangeal joint is red and swollen and light touch is excruciatinge FBE and CRP are unchanged.

Acute gout.

A male patient, aged 75 had a right hemi-colectomy 2 years ago and developed asymptomatic bone mets 3 months ago. He has had increasing pain in his left leg, much worse on weight bearing. On examination there is local tenderness and significant hip pain on rocking the femur, but the leg is not shortened nor externally rotated.

Impending pathological fracture.
A 49 year old male smoker develops a hoarse voice and bovine cough. He remarks it has been difficult to get a sweat-up at the gym. On examination, on the right side of his face he has a drooping eye-lid and constricted pupil.
Horner's syndrome due to pancoast tumour.
A 49 year old smoker develops weakness in his right hand and arm muscles. Sometimes his right arm experiences tingles. His right hand is colder than his left hand.
Pancoast tumour causing thoracic outlet syndrome.
A 49-year-old smoker presents with shortness of breath and facial oedema that is worst first thing in the morning and improves throughout the day. When you ask him to lift his hands above his head his face flushes and his head and neck veins become more prominent.
Superior vena cava syndrome due to pancoast tumour.
Pemberton's sign.
Injury is a major contributor to health carer costs in Australia. The type of injury causing the greatest cost to the Australian health care system is:
a) road traffic accident
b) accidental falls
c) adverse effects of medical treatment
d) intentional injuries
e) machinery injuries
A. Road traffic accident.
A 24 year old female university student has been sufferring from constipation, develops a burning pain on defecation associated with bright bleeding. A lo*** medical officer had prescribed and ointment which led to some improvement of her symptoms but caused severe headaches. She also notices a small lump at the anal opening.
Anal fissure.
A 24 year old female university student has been sufferring from constipation, develops a burning pain on defecation associated with bright bleeding. A lo*** medical officer had prescribed and ointment which led to some improvement of her symptoms but caused severe headaches. She also notices a small lump at the anal opening. What is the ointment?
Nitroglycerine ointment.
If systemically absorbed it can cause headaches.
A 44 year old male who cycles on weekends complains of a sudden onset of a painful swelling associated with a small amount of bleeding. The swelling makes it difficult for him to sit. Defecation is painful. He says his father had surgery for haemorrhoids.
External haemorrhoids.
(They originate below the dentate line and therefore are painful).
A 53 year old woman complains of recent onset of loose bowel actions over the last three months, though she has been regular most of her her life. She notices blood mixed with stools when she goes to flush the toilet and the feeling as though she has not complete a bowel action. There is no pain. Her mother died at the age of 75 in Croatia and the doctors told the family that she had cancer in the liver, though she had no surgery.
Rectal cancer.
An 80 year old war veteran present with intermittent rectal bleeding and mucous discharge from the rectum. There has also been a recent change in bowel habits, with a tendency towards diarrhoea. He had been prescribed digoxin for a myocardial failure and the recent tests by the family doctors revealed that the potassium level was well below the normal range and he was commenced on potassium replacement.
Villous adenoma (polyps) of the rectum.
An 80 year old war veteran present with intermittent rectal bleeding and mucous discharge from the rectum. There has also been a recent change in bowel habits, with a tendency towards diarrhoea. He had been prescribed digoxin for a myocardial failure and the recent tests by the family doctors revealed that the potassium level was well below the normal range and he was commenced on potassium replacement. Why was he hypokalaemic?
Both the mucous discharge and the digoxin lower the potassium levels in the blood.
With respect to examination of the abdomen, localised pain and involuntary guarding are due to?
a) distension of the visceral peritoneum
b) irritation of the somatic nerves running between external oblique and internal oblique
c) spasm or rectus abdominus in anticipation or painful stimuli
d) parasympathetic hyperstimulation
e) local irritation of the parietal peritoneum

e) local irritation of the parietal peritoneum

A 26-year-old woman complains of acne, hirsutism, easy bruising and amenorrhoea. Examination reveals proximal weakness, purple striae on her upper thighs, a blood pressure of 155/90. Full ward test of urine shows 2+ glycosuria. A fasting blood glucose is 12 mmol (normal range < 5.5 mmol/L).
Cushing's syndrome
A 55 year old alcoholic man with known cirrhosis of the liver presents with 3 months of thirst, polyuria and 3kg of wieght loss. He gives a history or recurrent abdominal pain over the last four years. Full ward test of the urine shows 1+ ketones, 2+glucose. Fasting blood glucose is 14mmol/L. Plain abdominal X-rays show patchy areas of calcification in the epigastric region. Transferrin saturation is 32% (normal range 22 - 46%).
Chronic pancrea***is.
An obese 30 year old woman presents with recurrent genito-urinary thrush. Examination also shows velvety pigmented areas on her upper back in both axillae. She has a long standing history of oligomenorrhoea. Her mother and grandmother both had diabetes treated with oral agents. Full ward test of the urine shows 2+ glucose, no ketons and fasting laboratory glucose is 14mmol/L.
Type II diabetes.
A 60 year old smoker complains of nocturia twice a night. He also has pedal oedema in the afternoons and struggles to play his usual 9 holes of golf because of exertional dyspnoea. Examination revelas a JVP of 5cm, loud P2 and pitting oedema of both ankles. Rectal examination is normal. Urea and electrolytes are normal and fasting blood glucose is 6.5 mmol/L.
Congestive cardiac failure.
A 50 year old woman complains of nocturia twice a night. She has been previously wally and denies taking medication. BP is 160/95 and she has some proximal weakness. Examination is otherwise normal. Fasting blood glucose if 5.9 mmol/L and electrolytes are normal apart from a serum potassium of 3.2 mmol/L (normal 3.5 - 5 mmol/L).
Primary hyperaldosteronism.
A 65 year old man complains of nocturia twice a night. He had been previously well and denies taking medication, apart from Viagra to help him during intercourse. He also complains initial hesitancy and a poor stream. His last PSA was within normal limits. On DRE, you feel a uniformly enlarged prostate.
Benign prostatic hypertrophy.
A 65-year-old schizophrenic man complains of nocturia twice a night and excessive thirst. He was found drinking from other patients cups. He complains of a headache and nausea and seems more confused than usual. On examination, you notice he is hyporeflexic. His electrolytes are normal apart from a serum sodium of 110 mmol/L (normal 135 - 145 mmol/L).
Psychogenic polydipsia.
Due to phenothiazine component of chlorpromazine.
Patient feels as though they have a dry mouth and so drinks excessive amount of water.
A 50-year-old man who had surgery to biopsy a pituitary lesion 2 weeks ago complains of excessive thirst and frequent need to void large amounts of urine. Investigations reveal low urine osmolality, high serum osmolality, high serum sodium concentration.
Diabetes insipidus.
(Central diabetes insipidus due to defective release of ADH from the hypothalamic pituitary axis).
A 60 year old male smoker presents with dyspnoea, haemoptysis and weight loss. On examination he is afebrile, trachea is deviated to the right side, chest expansion is reduced in the right upper zones, percussion note dull at the right apex and breath sounds softened in the upper zones on the right side. JVP is clearly visible at 3cm.
Right upper lobe collapse.
An 80 year old man presents with progressive dyspnoea over recent months. He is afebrile, trachea is midline, chest expansion reduced on the right side, percussion note stony dull at the right base and breath sounds absent at the right base. JVP is 2cm.
Pleural effusion.
A 25 year old man presents with sudden onset dyspnoea. He is a lean man, afebrile with trachea midline and reduced chest expansion on the right. Percussion not is resonant thought but breath sounds soft over the whole right lung field. JVP is not visible.
Pneumothorax.
A 65 yeard old woman presents with cold sweats, dizziness, sudden onset of shortness of breath. On examination she is afebrile, blood pressure 140/80 mmHg, pulse 90 bpm, RR 30/min. Cardiovascular, respiratory, abdominal examination are all normal.

Acute myocardial infarction.

A female patient, aged 72, has a long history of hypertension and presents with gradually increasing dyspnoea. On examination her pulse is 96 per minute and of low volume, and respiratory rate is 18 per minute. She has bilateral basal crackles and auscultation of the praecodium reveals a gallop rhythm.
Congestive cardiac failure.
Recently arrived by plane 36 hours ago from the United Kingdom, a 62 year old retired banker presents with sudden onset shortness of breath and syncope. He now complains of associated central chest pain but examinatin of the chest is normal.r
Pulmonary embolism.
A 52 year old unemployed woman on the invaled pension presents complianing of chronic shortness of breath on exertion. She is a nonsmoker and has long standing NIDDDM presently controlled on oral hypoglycaemics. Examination reveals that she is afebrile, pulse is 80 and regular, BP is 140/85 mmHg, height is 156cm and weight is 90 kg. She does not seem to have any major respiratory signs.
Ischaemic heart disease.
A male 55 year old factory worker and heavy smoker presents with increasing shortness of breath. He also noticed increasing cough. Examination reveals symmetrically reduced chest expansion, hyperresonant percussion note and decreased breath sound bilaterrally.
COPD
Bill is a first year university student who is feeling overwhelmed and stressed by an upcoming exam. The night before the exam Bill goes to the moves with some friends. Which of the following best describes Bill's coping style?
A) Problem-focussed coping.
B) Emotion-focussed coping.
C) Denial-focussed coping.
D) Problem-Emotion focussed coping.
E) This is not a coping style and can only make his situations worse.
B) Emotion-focussed coping.
Emotion-focused coping involves trying to reduce the negative emotional responses associated with stress such as embarrassment, fear, anxiety, depression, excitement and frustration. Strategies include ignoring the problem, distracting yourself, keeping yourself busy so you don't think about the problem.
Bill is a first year university student who is feeling overwhelmed and stressed by an upcoming exam. The night before the exam Bill makes a check-list of the information he still doesn't know and prioritises is according to importance. Which of the following best describes Bill's coping style?
A) Problem-focussed coping.
B) Emotion-focussed coping.
C) Denial-focussed coping.
D) Problem-Emotion focussed coping.
E) This is not a coping style and can only make his situations worse.
A) Problem-focussed.
Bill is a first year university students who hates the sight of blood. He has to get his blood tested as a course requirement. When the nurse takes his blood, Bill looks away and pretends this isn't happening. Which best describes Bill's coping style?
A) Problem-focussed coping.
B) Emotion-focussed coping.
C) Denial-focussed coping.
D) Problem-Emotion focussed coping.
E) This is not a coping style and can only make his situations worse.
D) Denial-focussed.
The appraisal-focussed strategies are those coping mechanisms which involve the change of mindset or a revision of thoughts. Denial is the most common coping mechanism under this category.
Klaus believes that if he doesn't get high distinctions in all of his courses, this means he is a personal failure. This is an example of the kind of cognitive distortion called.
A) Magnification
B) Personalisation
C) All or nothing thinking
D) Mental filtering
E) Overgeneralisation
C) All-or-nothing thinking.
Conception in absolute terms, like "always", "every", "never", and "there is no alternative".
Klaus believes that his father's abuse of him as a child was his own personal fault, as he was an ugly child.
A) Magnification
B) Personalisation
C) All or nothing thinking
D) Mental filtering
E) Overgeneralisation
B) Personalisation.
Klaus is five minutes late to his psychologist appointment. He is very tearful on arrival and apologises profusely for being so, so, so late and for all the inconvenience he must have caused the psychologist.
A) Magnification
B) Personalisation
C) All or nothing thinking
D) Mental filtering
E) Overgeneralisation
A) Magnification.
Klaus achieved 19/20 on his psychiatry assignment Despite getting the highest mark in the year, all he can think of is the 1 mark that he lost.
A) Magnification
B) Personalisation
C) All or nothing thinking
D) Mental filtering
E) Overgeneralisation
D) Mental filtering.
Klaus failed his pathology quiz. He now believes he willl always fails any test that he sits and he must be a complete failure and loser.
A) Magnification
B) Personalisation
C) All or nothing thinking
D) Mental filtering
E) Overgeneralisation
E) Overgeneralisation.
A 25 year old man with down syndrome and a moderate intellectual disability presents to your practice. He is accompanied by a support worker from his home. The house staff are concerned at his aggressive outbursts. He has lived in the house about 12 months. At first he was was cheerful and took great pleasure from joining in with the house social activities. Over the last month he has become non compliant, no longer joins in with activities and refused to do chores around the house. Last week he hit a staff member who was trying to get him out of bed in the morning.
Depression.
A 60 year old woman with an intellectual disability of unknown cause spent much of her early life in Kew Residential Services and recently moved into a Community Residential Unit in your practice area. She is first brought to see you late on a Friday afternoon with a laceration to her forehead sustained when she feel at home. Staff report that she is tripping more frequently and has a had a number of falls recently, but has not injured herself significantly before now. She used to enjoy watching TV and looking through magazines but these activities seem to no longer be of interest to her. She is a cheerful, socially engaging woman who enjoys outings with other residents from her home. She is generally independent in her personal care.
Vision impairment.
A 35 year old woman is planning for pregnancy. Her history reveals she is a smoker. What issues would you raise with her?
A) smoking reduces the chance of conception
B) smoking reduces the chance of miscarriages
C) Smoking reduces the chance of prmature birth
D) Smoking increases the growth of the foetus
E) Smoking reduces the risk of SIDS
A) Smoking reduces the chance of conception
A 35 year old woman with a previous history of gestational diabetes asks your advice about subsequent pregnancies. What advice can you give her?
A) GDM occurs in 25% of pregnancies.
B) GDM may recur in subsequent pregnancies.
C) GDM is always associated with preeclampsia.
D) GM if treated improves maternal survival.
E) GDM occurs less frequently in women with a higher BMI before pregnancy.
B) GDM may recur in subsequent pregnancies.
A female patient is worried about having a premature delivery. You advise her that the preterm birth is most commonly associated with:
A) Vitamin C use
B) PAst history of CIN 1
C) Reduced foetal movements
D) OP position of foetus
E) RDS
RDS
A 57 year old postmenopausal woman is concerned about the SE of HRT. What is the most common start-up SE of hromone therapy that you should warn her about?
A) Irregular bleeding
B) Breast tenderness
C) Breast cancer
D) Weight gain
E) Bloating
In the first 2-3 months the woman may experience oestrogenic side effects, therefore B or A most likely.
A 2 year old girl is brought for a check up her neurodevelopment. You determine that she is able to wave, play ball and drink from a cup. She bangs two blocks together, has a pincer grip and places a block in a cup. She is able to crawl, pull to stand and walk holding on. She can say four words including Mum and Dad. You *****s her developmental level as:
A) age appropriate
B) six month level
C) nine month level
D) 12 month level
E) 18 month level
D) 12 month level.
A 7 year old girls is brought to see you as the school teacher and her parents are concerned with her behaviour. She has previously been of good health but her behviour has always been difficult. She has poor concentration, temper tanrtums, aggressive behaviour, intensely like changes of routine, prefers to play alone and is very focussed and knowledge about dinosaurs and dolls. She has flapping hand movements, speaks with an odd accent and is sensitive to loud noises and being touched.
Autism spectrum disorder.
A 4 year old known asthmatic boy presents with RR of 49 per minute, pulse rate 130 per minute. He is afebrile and oximetry is 85% RA. He has had a recent URTI. The appropriate management is:
A) give a salbutamol inhalation and recommend four houly salbutamol inhalations at home.
B) Commence four hourly salbutamole and ipratropium inhalations, plus oral pred and review in 24 hours.
C) commence four hourly salbutamol inhlations and oral amoxycillin. Review in 24 hours.
D) Refer for admission for salbutamole and ipratropium inhalation.
E) Give oxygen and continuous salbutamol inhalations and transfer to hospital by ambulance.
E) Give oxygen and continuous salbutamol inhalations and transfer to hospital by ambulance
A 5 year old boy has developed a swollen right knee and is febrile 3 days after a fall in the schoolyard. On examination the right knee is swollen and red. The child screams with pain when the affected joint is moved.
Septic arthritis.
A previously well 2 year old girl presents with a 3 week history of bruising, lethargy and irritability. On examination, she has numerous bruises of different ages and has an easily palpable liver and spleen. A FBE reveals:
Hb 76 g/L (105 - 140 g/L)
MCV 79 fl (70 - 86 fl)
WCC 1.3 x 10^9/L (5 - 15 x 10^9/L)
Platelets 26 x 10^9/L (150 - 450 x 10^9/L)
Which one of the following Ix is the most appropriate next step?
A) Serum anti-platelet antibodies
B) Serum ANF and anti-DSDNA antibodies
C) serum iron, iron binding capacity, transferrin saturation
D) Serum Factor VIII and vWF levels.
E) Bone marrow aspirate and trephine.
E) Bone marrow aspirate and trephine.
--> leukaemia
2 year old child with persistent day and night cough. His weight is on the 10th centile and his height on the 25th. He was on the 90th centile for weight at birth and on the 50th centile for weight at one year of age. On examination of his chest there is generalised wheeze and coarse crepitations. He is developmentally normal.
What is the most appropriate diagnosistc test?
A) Lung function test
B) Bronchoscopy
C) Inspiratory and expiratory CXR
D) Sweat chloride test
E) Duodenal biopsy
D) Sweat chloride.
---> CF
A 6 month old infant presents with mild cyanosis and a mid-systolic murmur. He has cardiac catheterisation for possible congenital heart disease. The following results of oxygen saturation and heart chamber pressures while breathing air were obtained:
RA PO2 65 (N 67%)
RA mean BP 8 (NR -2 - 6)
RV PO2 78 (N 69%)
RV mean BP 80 (NR 14 - 38)
PA PO2 78 (N 69%)
LA PO2 98 (N >95%)
LV PO2 78 (N >95%)
Aorta PO2 80 (N >95%)
What is the diganosis?
TOF
A 3 month old baby boy is brought to you because of noisy breathing. This was first noted within the first three weeks of life. The baby has been well and feeds normally and has gained 240g per week. Examination reveals a well infant but there is a marked respiratory crowing noise on inspiration. He has suprasternal retraction and intercostal recession. This is worse when he is crying and settles when he is asleep.
Laryngotracheomalacia.
A nine year old boy presents with a long history of asthma. In the past year he had 5 acute attacks of cough, wheeze, breathelessness each lasting about one week. He has had no interval symptoms. You see him one month after his most recent attack. He is completely well. You perform spirometry. What is his expected lung function result?
Normal FEV1, FVC and FEV1/FVC ratio.
A 13 year old girl is brought to you by her mother after the teacher complained that her coughing is so bad it disrupts the class and she has to be sent outside. Her coughing is harsh and croaky and not associated with sputum. The cough stops her from exercises. She does not cough at night.
Psychogenic cough.
A 70 year old man presents with weight loss. He has lost 8kg in the last 3 months. He is icteric but anodminal exertion is otherwise unremarkable. Urinalysis shows glycosuria nd bilirubinuria.
Carcinoma of the head of the pancreas.
A 60 year old man presents with anorexia, wight loss of 7kg over 3 months, lethargy and vague right hypochondrial discomfort. On examination he is jaundiced, and has 5 fingerbreadths of palpable liver below the right costal margin. A firm 2cm LN is palpable in the left supraclavicular fossa.
Metastatic liver adenocarcinoma.
An 18 year old student has infrequent episodic asthma associated with exercise, usually playing or training for basketball, twice a week. Spirometry shows normal lung function. Management?
Inhaled short acting beta2agonist as required.
A 42 year old storeman has moderate persistent asthma since childhood. He has never required hospital admissions but has had a couple of presentations to ED with acute asthma. He has been on maintenance inhaled budesonide 400 mcg twice daily for 5 years and in combination with formoterol 12 mcg twice daily for last year. A recent chest infection has lead to increased wheeze and SOB with daily activity as well as night time waking. Management?
Oral prednisolone.
(Budesonide + formoterol = ICS + LABA = symbicort).
Give oral prednisolone for exacerbations.
A 25 year old lawyer has mild asthma and peanut allergy since early childhood. He usually takes inhaled salbutamol as required which is about once a month. This evening, he was at a restaurant, and ate an entrée with satay sauce. Within minutes he developed lip and tongue itching and swelling associated with wheeze and chest tightness. He presents sweaty, short of breath, thready pulse and a blood pressure of 90 mmHg systolic. Management?
Intravenous adrenaline.
A 25-year-old lawyer has had mild asthma an peanut allergies since early childhood. He develops a respiratory tract infection with cough, increased sputum volume and change in colour. He has been commenced on Abx but is still SOB and wheezy despite frequent salbutamol. Management?
Inhaled corticosteroids.
Which of the following statements is incorrect?
A) Thiazide diuretics can cause hyponatremia.
B) A potassium sparing diuretic can cause cardiac arrythmias if combined with an ACE-I.
C) Spironolactone can cause gynaecomostia.
D) Loop diuretics commonly cause increased magnesium levels.
E) Thiazide and loop diuretics can cause weakness.
D)
Loop diuretics can cause decreased magnesium levels.
Which of the folllowing statements is incorrect?
A) Initial treatment of type 2 DM can include diet and exercise without the use of drugs.
B) The biguanide metformin stimulates beta cells of the pancreas to produce more insulin.
C) Metformin can cause lactic acidosis.
D) Sulphonyureas can cause hypoglycaemia.
E) Glucocorticoids can precipitate or exacerbate diabetes.
B)
Metformin is not an insulin secratagogue.
Which of the following is incorrect in relation to chemotherapy?
A) Chemotherapy has its greate chest when applied aggressively aginst small, high growth rate tumours.
B) Drugs are generally chosen on the bases of previous success against that cancer.
C) Appropriate combination of drugs with diferent mechanisms of action and toxicities are often used.
D) Therapy should be intermittent so that normal, dividing cells have a chance to recover.
E) Cytotoxic drugs include hormones such as GnRH.
E)
Pretty sure GnRH is not used to fight cancer.
A 17 year old girl, living in a medium sized rural twon works part time at the supermarket and shares a unit with a girlfirend. She is having trouble making ends meet and over the past month or so has been feeling more stressed, calling ill at works and being generally irritable with everyone. She was hoping to solve her problems with her boyfriend but has has announced that he has been seeing someone else and wants to move in with her. She presents to ED this evening after an ipsode of self-harm in the context of drinking half a bottle of scotch.
Adjustment disorder.
A 17 year old patient has taken her grandmother's digoxin. What is the most important feature to look for on physical exam?
Nausea, disturbance in colour vision, slowing of AV conduction.
A 17 year old patient has taken a packet of paracetamol. What is the most important feature to look for on physical exam?
Nausea and liver failure.
Within what period of time do you expect to see a response to antidepressant medication?
6 weeks.
A. 20 year old female.
B. 20 year old male.
C. 30 year old female.
D. 30 year old male.
E. 45 year old female.
F. 45 year old male.
G. 60 year old female.
H. 60 year old male.
I. 70 year old female.
J. 70 year old male.
Which of the following is most likely to present with non lethal self harm?
Which of the following is most likely to present with lethal self harm?
A. 20 year old female.
H. 60 year old male.??
A 45 year old man tried to lift a heavy weight today and although he denies and pain at the time, now complains of a numb sensation of the sole of his right foot. On examination he has brisk knee jerks bilaterally and a reduced ankle jerk on the right side. Which nerve roots are most likely to be affected?
L5, S1.
A young woman often thinks that she sees her mother out of the corner of her eye in the evening. Her mother sits there in the corner, watching TV and knitting socks the way she used to. The young woman misses her mother terribly since she died last month.
What is the component on the MSE most relefvant?
Illusion.
Note - visual hallucination was not an option, only auditory hallucination.
A 25 year old man insists on wearing the same pair of underpants every time he plays baseball. He was wearing them when he pitched a perfect game last seaons and always plays better when he wears them. This is despite him regularly misfielding during the game when he checks to make sure that he is wearing them.
obsession
A 4 year old boy presents to the emergency department at an outer urban hospital. His parents say that he has been unable to walk since the previous night when he fell down the stairs at home. Family history is unremarkable. His past medical records show he presented a year ago with a pulled elbow after a fall. His pulse is 100 per minute, BP 80/40 mmHg, temperature 36.4 degrees.
On examination his leg is laterally rotated, there is minimal thigh swelling and he is unable to lift his leg.
Fracture of the femoral neck.
The four year old boy is to be admitted to hospital. He refuses to let you listen to his chest and screams every time you try to lift up his shirt. When you listen to his chest over his shirt he yells as if you are hurting him. A chest x-ray is ordered and shows multiple healing fractures of different ages. What diagnosis would you need to consider?
Child abuse.
When the metabolic activity of an organ increases, blood flow through the arterioles supply that organ increases. This response is referred to as active hyperemia and occurs because...?
A) cardiac output has been increased in anticipation of the increased metabolic demand.
B) there is an increase in activity in the sympathetic nerves which innervate the arterioles.
C) the smooth muscle of the arterioles relaxes in response to local chemical factors.
D) the capillaries within the organ dilate.
E) the veins leaving the organ dilate, allowing more blood to enter them.
C)
An elderly woman presents complaining of swollen feet and ankles. This is most likely the direct result of?
A) A decrease in the volume of blood in her veins.
B) An increase in her total peripheral resistance.
C) A high degree of constriction of the capillaries in her feet and ankles.
D) an increased plasma osmotic pressure resulting from an expanded volume.
E) an increase in filtration of water and small solutes from the blood into the inters***ial fluid due to increased capillary hydrostatic pressure in her feet and ankles.
E)
In a healthy concious person a sudden drop in arterial blood pressure would be expected to lead to:
A) a corresponding decreased in heart rate
B) pooling of blood in the veins of the legs
C) an increase in sympathetic nerve activity to arterioles
D) an increase in the rate of firing of arterial baroreceptors
E) all of the above.
C)
When a knife penetrates the chest wall and the pleural cavity is punctured, the throacic cage adopts a...?
A) Deflated (contracted) position because the intrapleural pressure is more negative than normal.
B) Hyperinflated (expanded) position because the intrapleural pressure is more negative than normal.
C) Hyperinflated position because the intrapleural pressure is higher than normal.
D) Deflated position because the intrapleural pressure is higher than normal.
E) Hyperinflated position because the intrapulmonary pressure is higher than normal.
C)
ph 7.46 (7.38 - 7.42)
paCO2 47 (37 - 42)
HCO3- 34 (23 - 26)
What is the acid-base state?
Metabolic alkalosis
ph 7.16 (7.38 - 7.42)
paCO2 70 (37 - 42)
HCO3- 25 (23 - 26)
What is the acid-base state?
Respiratory acidosis
A) sciatic nerve
B) gluteus medius and minimus
C) gluteus maximus
D) femoral nerve
E) rectus femoris
F) acetabular labrum
G) femur
H) greater trochanter
I) obturator nerve
J) hamstrings
K) pubic symphysis
L) femoral and sciatic nerves
M) femoral artery
N) superior gluteal artery
O) superior gluteal nerve
P) iliacus (iliopsoas)
Q) branches of the trochanteric anastomosis
R) L5 spinal nerve

Which bony structure is most likely to be damaged in posterior dislocation of the hip?
H) Greater trochanter
A) sciatic nerve
B) gluteus medius and minimus
C) gluteus maximus
D) femoral nerve
E) rectus femoris
F) acetabular labrum
G) femur
H) greater trochanter
I) obturator nerve
J) hamstrings
K) pubic symphysis
L) femoral and sciatic nerves
M) femoral artery
N) superior gluteal artery
O) superior gluteal nerve
P) iliacus (iliopsoas)
Q) branches of the trochanteric anastomosis
R) L5 spinal nerve

Concerned about the risk of infection after multiple hip surgery the woman's surgeon prescribes antibiotics by IM injection. The graduated nurse is surprised at ther extensive complaints of pain following administration of antibiotics via deep IM injection at the line joining the PSIS to the greater trochanter. What is the likely cause of this pain?
O) Superior gluteal nerve
A) sciatic nerve
B) gluteus medius and minimus
C) gluteus maximus
D) femoral nerve
E) rectus femoris
F) acetabular labrum
G) femur
H) greater trochanter
I) obturator nerve
J) hamstrings
K) pubic symphysis
L) femoral and sciatic nerves
M) femoral artery
N) superior gluteal artery
O) superior gluteal nerve
P) iliacus (iliopsoas)
Q) branches of the trochanteric anastomosis
R) L5 spinal nerve

Twelve months after her traumatic dislcation of the right hip she presents with pain in her right knee. Her doctor notes her history and orders a plain XR which shows extensive osteoarthritis of the hip. The doctor explains that the pain in the knee is related to the hip pathology and referred via stimulation of which structure?
I) Obturator nerve
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Medial pectoral nerve
E. C5 spinal nerve
F. Supraspinatus
G. Deltoid
H. Infraspinatus
I. Trapezius
J. Rotator cuff

Having recovered from her multiple hip injuries the 70 year old woman is coming down the stairs in her unit when she falls on the bottom step. She places her arm out straight to soften the fall. She immediately experiences acute pain and is unable to move her shoulder. On XR the shoulder joint is found to be dislocated.
Before reducing her dislocation the orthopaedic registrar expresses concern about brachial plexus damage. He examines cutaneous sensation over deltoid and notes reduced sensation over a small area. What structure is likely to have been damaged?
A) Axillary nerve
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Medial pectoral nerve
E. C5 spinal nerve
F. Supraspinatus
G. Deltoid
H. Infraspinatus
I. Trapezius
J. Rotator cuff

On recover she has marked weakness in abduction at the shoulder joint past 15 degrees. Which muscle is likely to be involved?
G) Deltoid
The spinal cord in an adult normally ends at what level?
L1/L2
A 20 year old male patient is in ICU. The ICU staff would be concerned if his potassium level rose to 7 mmol/L (normal range 3.5 - 5.0 mmol/L) because it would...?
A) indicated that he needed more IV fluids
B) show that alcohol has affected his liver
C) predispose him to cardiac arrythmias
D) affect his brainstem function temporarily
E) act to suppress his immune system
C)
A 50 year old male patient presents with acute chest pain. The attending registrar orders an ECG. There is ST segment elevation in leads II, III, and aVF.
Acute inferior myocardial infarction.
A 50 year old male patient presents with acute chest pain. The attending registrar orders an ECG. There is ST segment elevation with Q wave formation in leads V1 - V6 and reciprocal ST depression in leads III and aVF.
Acute anterior myocardial infarction.
A 50 year old male patient presents with acute chest pain. The attending registrar orders an ECG. There is ST segment elevation with Q wave formation in leads V1 - V6 and reciprocal ST depression in leads III and aVF. Which artery is blocked?
Left anterior descending artery causing acute anterior myocardial infarction.
A 50 year old male patient presents with acute chest pain. The attending registrar orders an ECG. There is ST segment elevation in leads I, aVL and V5 - 6 and reciprocal ST depression in leads III and aVF.
Acute lateral myocardial infarction.
An echocardiogram performed on a 40 year old male suggested he had aortic stenosis. On physical examination and auscultation of his heart, what finding would you expect?
An ejection systolic murmur maximal in the 2nd RICS adjacent to the sternum.
A 24 year old woman with a 5 year history of anorexia nervosa and chronic fatigue syndrome comes to the clinic. She feels her heart is racing and has occasional chest pain. Her pulse rate is 130. What pathology would you expect her ECG to show?
Torsades de pointes.
A 42 year old previously well woman presents with a flutter on her chest which makes her catch her breath. It lasts for a few seconds.
Paroxysmal atrial tachycardia.
A 28 year old man has hyperglycaemia. He is a basketball player, and has recently had pains in his hands and needed to get his wedding ring resized. He has also had carpal tunnel surgery. What is the likely cause of his hyperglycaemia?
Acromegaly.
A 39 year old female comes to the clinic with double vision. On examination, she is unable to look down when the eye is abducted. This is likely due to injury to which nerve?
Trochlear nerve.
Superior oblique palsy.
Which part of the loop of Henle is impermeable to water?
Ascending loop.
A 14-year-old girl comes to the clinic complaining of needing to go to the toilet 10 times per day. She has been drinking lots of water. She has lost 5kg of weight over the past month.
Diabetes I
A schizophrenic man with poor compliance has had 3 relapses while being medicated on olanzapine. What would be a suitable depot?
Risperidone consta.
A 15 year old girl has been diagnosed with oppositional defiant disorder. Her poor mother is finding it difficult to cope. What would be an appropriate treatment for the mother?
Parent therapy.
A 80-year-old woman is lying flat on her bed and eating mashed potato. She accidentally chokes on some of the mash. Which segment of the lung would the material travel to?
superior segment of the lower lob.
A 20-year-old man fell off the motorbike and feels he may have "broken his arm." An XR reveals a fractured humerus. You are worried he may have injured the axillary nerve. Where should you test?
Skin over the deltoid.
Regimental patch.
A 60-year-old obese many presents with longstanding moderate hypertension. What is the expected cellular response from cardiac myocytes?
Hypertrophy.
A muslim man, 30 years old, is a keen athlete. He is incidentally yellow. This is worse during fasting and exercise.
Gilbert's syndrome.
A man chisels his finger. Ouch. What would his injured blood vessels release in response to this injury?
Tissue factor.
A man is prescribed valium by his unwise GP to help control his anxiety. What is the mechanism of action of valium?
Valium = diazepam.
Agonist effect on the y-aminobutyric acid type A (GABA) receptor complex.
What is the most sensitive stimulus for the control of inspiration in the brain?
CO2
A patient cannot use the facial muscles of expression on the R side of their face. When asked, they cannot wrinkle their forehead on the R side. Where is the lesion?
LMN - facial nerve
A 50 year old man comes in with central crushing chest pain. He is found to have an anterior STEMI. What could you give him to break down the blockage in the artery?
TPA
A 75-year-old lady comes to your clinic with a nose bleed. She has been stressed recently due to the death of her husband. She has not had her health care checked for a number of years.
Undiagnosed hypertension.
A patient cannot abduct or adduct their fingers and cannot adduct the thumb either. Which nerve roots are damaged?
C8, T1
A 50-year-old known alcoholic presents to you with an unbalanced gait. He has been drinking a lot of late but is not drunk when he comes to see you. His unbalanced gait is due to damage to which structure in the cerebellum?
Cerebellar vermis.
A 24 year old female comes to you with cervical lymphadenopathy. A biopsy of the axillary lymphadenopathy reveals small cells which were on population of CD20. The bone marrow has similair findings. What is this?
Follicular lymphoma.
Non-Hodgkins.
What happens to the fluid compartments of the body when you drink one litre of water?
The water moves between compartments and balances out the tonicity.
What is the last step in preparing clean instruments? As in the machine...
Autoclave.
What is the most common side-effect of levodopa?
Nausea.
Seriously, what a dumb question.
A 2 year old child has not been feeling well for one week. He is refusing to weight-bare on his R leg and has pain at the distal femur. The XR appears normal. His CRP/ESR are raised.
Transient synovitis...
But why the pain at the distal femur? Referred?
A 28-year-old lady presented with confusion, incoordination and memory problems. Over the last few years she had episodes of proximal muscle weakness and paraesthesia. Sometimes her legs would give way. She has also had episodes of optic neuritis and nystagmus.
Multiple sclerosis.
A 25-year-old woman has been trying for 1 year to fall pregnant and has been unsuccessful. When questioning her about her menstrual cycle, she describes her periods as normal but the pain as excruciating.
Endometriousis.
A 65-year-old man presents with changes in his vision. When testing his visual fields you note homonymous hemianopia with sparing of the fovea (macular sparing). Where is the lesion?
Occipital lobe.
A 65-year-old man presents with changes in his vision. When testing his visual fields you note homonymous hemianopia with sparing of the fovea (macular sparing). Why is the macular spared?
Dual blood supply of occipital lobe.
PCA main supply BUT MCA gives small branch to the area which represents the macula topographically.
A 65-year-old man presents with changes in his vision. On testing his visual fields you notice right homonymous superior quadrantinopia. Where is the lesion?
Optic radiations.
A) Gamma benzene hexchloride
B) Erythromycin
C) Prednisolone
D) Miconazole

Rx for scabies infection.
A) Gamma benzene hexachloride. Rub into the lesions, leave for 8 - 12 hours, wah off thoroughly.
A) Gamma benzene hexchloride
B) Erythromycin
C) Prednisolone
D) Miconazole

Rx for tinea.
D) Miconazole.
A) Varicella
B) HSV
C) Verrucae
D) Allergic reaction
E) Mollus*** contagiosum

4 year old girl has itchy lesions on her chest wall. Skin in other areas appears normal. Lesions are typical pearly nodules with umbilication.
E) mollus*** contagiousum
A) Varicella
B) HSV
C) Verrucae
D) Allergic reaction
E) Mollus*** contagiosum

4 year old girl has widespread itchy lesions. A boy at her play-group had similair lesions. The lesions are vesicles with are teardrop in appearance and polymorphic in evolution with surrounding erythema.
A) Varicella - chicken pox.
A) Varicella
B) HSV
C) Verrucae
D) Allergic reaction
E) Mollus*** contagiosum

4 year old girl has itchy lesions on her chest wall. The lesions are small blisters which are closely grouped and show some ulceation.
B) HSV
A) Moisture and wet dressing
B) Hot bathing
C) Oral steroids
D) Tar cream
E) Salicylic acid cream

First-line Rx for flexural eczema.
a) Moisture and wet dressing.
A) Moisture and wet dressing
B) Hot bathing
C) Oral steroids
D) Tar cream
E) Salicylic acid cream

First-line but least patient compliant Rx for psoriasis.
D) Tar cream
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration

A 47 year old aboriginal complains of blurring of vision. His blood pressue is normal, he smokes 40 cigarettes per day and drinks 100g of alcohol per day. On fundoscopy you find a mixture of hard and soft exudates and focal haemorrhages.
D) DM
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration

A 47 year old man comlains of blurring of vision. He has long-standing and poorly treated hypertension. On fundoscopy you find the fundal vessels show silver wiring and nipping. There are haemorrhages and hard exudates.
A) Previous HTN
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration

A 45 year old man presents with blurred vision. He is a known alcoholic. He has 6/12 vision in his right eye and 6/18 in his left eye. Further testing reveals a thiamine deficiency.
B) Alcoholic amblyopia. Due to toxic effect of alcohol on optic nerve.
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration

A 65 year old man complains of recent misty vision on sunny days. His vision, when tested, is 6/18 right and left.
C) Cataract.
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration
A 65 year old man complains of difficulty reading the newspaper. His daughter said that she saw him at the supermarket yesterday but he didn't notice her waving at him. You show him an amsler grird and he says the line are wavy. He has smoked one pack per day for the past 20 years.
H) Macular degneration
A) Previous HTN
B) Alcohol amblyopia
C) Secondary cerebral tumour
D) DM
E) Chronic simple glaucoma
F) Myopia
G) Cataract
H) Macular degeneration
A 65 year old man complains of loss of vision. His daughter says that she has to be directly infront of his face to get his attention. He believes his vision has been getting gradually worse over the lats four years. He has never had any pain or redness in the eyes or noticed rings around lights.
E) Chronic simple glaucoma
A palpable and solitary nodule in the thyroid is most commonly?
A a solitary cyst
B part of a multinodular goitre
C an adenoma of the thyroid
D a thyroid carcinoma
E localised Hashimoto disease
B
Most palpable and apparently solitary nodules are dominant modules in a goitre, with the other nodules not being readily palpable.
A known 60-year-old alcoholic man who lives on the streets comes to the emergency department in a confused state. You do a cranial neve exam and notice he has nystagmus and abducens nerve palsy.
Wernicke's encephalopathy.
(Triad for WE: distrubance in gait, confusion, opthalmaplegia).
A spinal cord
B corticospinal pathways
C cerebellum
D basal ganglia
E internal capsule

Lesions here cause decreased muscle tone.
C Disorders of the cerebellum restult i reduced ulce tone, possible due to decreased activity of gamma efferents. There is also suppressed reflexes.
A spinal cord
B corticospinal pathways
C cerebellum
D basal ganglia
E internal capsule

Lesions here cause rigid muscle tone.
D Basal ganglia
A immediate carotid endarterectomy
B carotid endarterectomy after 2 months
C aspirin 100mg per day
D warfarin
E intracarotid streptokinase infusion

A 60 year old male has three episodes of transient left monocula blindness and right hemianethesia. There is a soft bruit in the neck on the left and Doppler studies show a 25% stenosis of the ICA at the bifucation.
C aspirin, 100mg each day
< 30% risks outweight benefits
A immediate carotid endarterectomy
B carotid endarterectomy after 2 months
C aspirin 100mg per day
D warfarin
E intracarotid streptokinase infusion

A 60 year old male has three episodes of transient left monocula blindness and right hemianethesia. There is a soft bruit in the neck on the left and Doppler studies show a 55% stenosis of the ICA at the bifucation.
A carotid endarterectomy after 2 months
> 30% benefits outweigh risks
A 50 year old woman experiences and episode of shimmering light which spread over her left visual field during a 10 minute period leaving her with blured vision that resolves after 30 minutes.
Migrainous aura
A 65-year-old man presents with sudden, peristing monocular visual loss. There is a history of continual ipilateral headache for the past 12 months. He has a markedly raised ESR.
Temporal arteritis.
A 16-year-old boy is knocked to the ground during a fight. He has tenderness around his right eye and you suspect a periorbital fracture. When he is examined it is found that the right pupil is dilated and does not react to light. The left pupil reacts to light shone into the left eye but not light shone into the right eye. This is due to injury to the?
right optic nerve - direct
right third nerve - consensual
A 50 year old man has a 12 month history of episodes of severe vertigo and vomiting; between episodes he is symptomatic. he hs noticed progressively increasing deafness in his right ear with mild tinnitus. Examination reveals that, except for a nerve deafness in one ear, there are no abnormalities in the third, fouth, fifth, sixth or seventh cranil nerves during an acute attack of vertigo.
Meniere's disease.
A 40-year old woman presents complaining with difficulty of swallowing. Examination shows she has nasal speech, weakness of facial and neck muscles, receding hairline and a weak and slow hand grip.
Muscular dystonica.
A 40-year old woman presents complaining with difficulty of swallowing. Examination shows she has nasal speech and diplopia. She has a younger daughter who she is able to pick-up at the start of the day, but struggles to pick her up at the end of the day.
Myasthenia gravis
A 50-year-old man presents with a 2 year history of burning pains in the feet, pins and needles in the fingers and toes and weakness and unsteadiness of the legs. There is distal wasting and weakness in all limb, areflexia and glove and stocking sensory loss to all modalities.
Diabetic neuropathy.
What is used to treat pain in post-herpetic neuralgia?
Amitryptilline.
A 35-year old woman develops weakness of te legs over a period of 7 days. On examination the only abnormalities are generalised weakness of the legs and suppressed reflexes.
Guillain-Barre syndrome.
A 64 year old man complains of 6 months of inceasing stiffness in his legs and difficulty with walking. On examination there is wasting of the right biceps brachii with depression of the tendon reflex, spasticity in both legs with weakness of hip flexion and bilateral brisk lower limb tendon reflexes.
Cervical spondylosis
bilateral spasticity, brisk reflexes and weak flexion in LL - consistent with lesion higher than L2.
Wasting or biceps brachii and hyporeflexia - lesion at C5-6.
Pyramidal involvement due to compression of the anterior spinal artery.
60-year-old woman who has had rheumatoid arthritis for 35 yeasr and has been managed on corticosteroid fo the past ten years now complains of sudden onset of pain and swelling in the right knee which is warm and very tender.
Septic arthritis.