1
Q
A 56 year old male attends his GP 2 weeks post MI. His BMI is 22.8 and his cholesterol is high. What is the most effective dietary advice for secondary prevention of cardiovascular disease?
A. aim to reduce body weight by 5-10%
B. Increase intake of omega 3 fatty acids
C. Increase intake of trans fatty acids
D. Omit foods containing cholesterol such as eggs and prawns
E. Take a supplement containing anti-oxidant vitamins
A
B. increase omega 3 fatty acids
2
Q
Select one anatomical term that best fits the following descriptions:
- the thoracic duct drains into the left venous angle. This is the angle between which vein and the subclavian vein?
- Drains into the chamber of the heart in which the SA node is located.
- Intercostal veins from the anterior aspect of the intercostal spaces drains into this vein.
A. Azygous vein B. Brachiocephalic vein C. common iliac vein D. Gonadal Vein E. Hepatic portal vein F. Hepatic vein G. Inferior vena cava H. Internal jugular vein I. Internal thoracic vein J. Pulmonary vein
A
- H internal jugular vein
- G IVC
- I internal thoracic vein
3
Q
A woman is known to carry a mutation in the factor VIII gene that causes X linked haemophilia. She has experienced haemorrhage following surgery. Select the most likely mechanism from the options below:
A. an X-autosome translocation causing skewed X-inactivation
B. A coincidental mutation in the X-inactivation centre
C. Normal X-inactivation
D. She has a second mutation on her paternally inherited X chromosome
E. She also has Turner syndrome
A
C. Normal X-inactivation
4
Q
What type of shock is this? A 60 year old who been self medicating with diclofenac for back pain. He describes his stool as black and now feels dizzy on standing. A. Cardiogenic shock B. Hypovolaemic shock C. Anaphylactic shock D. Septic shock E. Neurogenic shock
A
B. Hypovolaemic shock due to GI blood loss
5
Q
A 56 year old non-smoking female with rheumatoid disease is breathless on exertion walking 200yds on flat ground, has finger clubbing and a CXR shows shrunken lungs with bilateral infiltrates. What is the most likely finding on spirometry?
A. low FEV1, low FVC, low FEV1/FVC, low PEF
B. low FEV1, low FVC, normal FEV1/FVC, normal PEF
C. low FEV1, low FVC, love FEV1/FVC, normal PEF
D. low FEV1, normal FVC, low FEV1/FVC, low PEF
E. low FEV1, normal FVC, normal FEV1/FVC, low PEF
A
B. low FEV1, low FVC, normal FEV1/FVC, normal PEF
Restrictive pattern with no obstruction to airflow
6
Q
For each of the following laboratory investigations used to aid the diagnosis of different diseases that are describes, select the option that best fits from the list below:
- Detection of plasma viral load (RNA) in a patient with HIV
- The measurement of T-lymphocyte subsets in blood
A. IgM antibody detection B. Light microscopy C. IgG antibody detection D. PCR E. Immunophenotyping F. Cytogenic analysis G. Cytochemistry H. MRI I. CT J. Scintigraphy
A
- D PCR
2. E immunophenotyping
7
Q
Which of the following statements is correct about resistance to blood flow in the CVS?
A. It is directly proportional to the radius of the blood vessel to the power of 4
B. It is inversely proportional to the viscosity of the blood
C. It is inversely proportional to the radius of the blood vessel to the power of 4
D. It is inversely proportional to the length of the blood vessel
E. It is not affected by the length of the blood vessel
A
C. It is inversely proportional to the radius of the blood vessel to the power of 4.
8
Q
Which of the following statements is true regarding haemoglobin?
A. Haemoglobin is a tetramer
B. All oxygen is transported bound to haemoglobin
C. The life-span of an erythrocyte is normally 50 days
D. Carbon dioxide does not bind to haemoglobin
E. Oxygen has a greater affinity for haemoglobin than carbon monoxide.
A
A. Hb is a tetramer
9
Q
During single rescuer cardiopulmonary resuscitation the rescuer should palpate the patient’s pulse to determine return of effective heart beat:
A. After every 10 breaths
B. After one minute of cardiopulmonary resuscitation
C. After five minutes of cardiopulmonary resuscitation
D. Only if the patient responds with purposeful movement
E. Never check a pulse
A
D. only if the patient responds with purposeful movement
10
Q
The germ layers are formed during which stage of embryogenesis? A. Cleavage B. Fertilisation C. Gastrulation D. Morphogenesis E. Organogenesis
A
C. Gastrulation
11
Q
For each of the following patients presenting with iron deficiency anaemia which test is the best to perform?
- A frail 82yo with altered bowel habit and severe arthritis
- A 55yo with anaemia, weight loss and early satiety
A. Ba enema B. Gastroscopy C. Colonoscopy D. Flexible sigmoidoscopy E. CT colonography F. Tissue transglutaminase G. Labelled red scan H. Capsule endoscopy I. Distal duodenal biopsy J. Glycocholate breath test
A
- E CT colonography as the patient is not mobile
2. B Gastroscopy
12
Q
A 62 year old woman has collapsed twice recently. Each time she lost consciousness but recovered quickly. She also complains of breathlessness on exertion. On examination her BP is 108/90 and she has an ejection systolic murmur. Which valvular abnormality is this patient most likely to have? A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis E. Tricuspid regurgitation
A
B. Aortic stenosis
13
Q
A 52 year old man is admitted to coronary care unit with chest pain. He is immediately managed with aspirin and sublingual glyceryl trinitrate. IV access is obtained and blood are taken. ECG shows ST elevation in leads V2-5. What is the most likely site of the infarct? A. anterior B. Anteroseptal C. Anterolateral D. Inferior E. Posterior
A
A. anterior
14
Q
Which one of the following anthropometric measurements is the best predictor of cardiovascular risk? A. hand grip dynamometry B. mid upper arm circumference C. Ulna length D. Triceps skinfold thickness E. Waist circumference
A
E. waist circumference
15
Q
Which of the following is the most likely pathology from the options below?
- A 50 year old man presents to his GP with heartburn which he has suffered from for many years and usually self controls with antacids. Recently his symptoms have worsened and are disrupting his sleep, He occasionally has difficulty swallowing.
- A 55 year old female presents to her GP with a sore stomach which is worse after eating. When asked where the pain is she points to her epigastrium. She also complains of bloating an difficulty swallowing, which is reducing her appetite. She has had a recent episode of black stools
- A 70 year old man presents to his GP with difficulty swallowing and pain on swallowing. He has a long history of Barrett’s oesophagus, but never attended review appointments. Doesn’t drink or smoke.
A. Plaque formation and inflammation of the central nervous system
B. Uncontrolled proliferation of epithelial cells in upper 2/3 of oesophagus
C. Metaplasia of squamous epithelium to columnar epithelium
D. Uncontrolled proliferation of epithelial cells in large airways of the lung
E. Constricted lower oesophageal sphincter
F. Uncontrolled proliferation of mucous glands in lower 1/3 of oesophagus
G. Uncontrolled proliferation of mucous gland cells in upper 2/3 oesophagus
H. Scar tissue leading to stricture formation
I. Gastric acid erosion of the gastric mucosa
J. Uncontrolled proliferation of epithelial cells in lower 1/3 of oesophagus.
A
- C Metaplasia of squamous epithelium to columnar epithelium
- I Gastric acid erosion of the gastric mucosa
- F Uncontrolled proliferation of mucous gland cells in the lower 1/3 of the oesophagus
16
Q
Systolic BP is recorded at the time of appearance of: A. Korotkoff 1st sound B. Korotkoff 2nd sound C. Korotkoff 3rd sound D. Korotkoff 4th sound E. Korotkoff 5th sound
A
A 1st sound
17
Q
Which of the following will cause left shift of the oxyhaemoglobin dissociation curve: A. Hyperthermia B. Hypercapnia C. Reduced 2,3 DPG D. Sickle cell disease E. Acidosis
A
C. Reduced 2, 3 DPG
18
Q
For each of the scenarios select the most likely diagnosis from the options below:
- A 65yo man complains of light-headedness on exertion. He has an ejection systolic murmur radiating to the neck.
- A 45yo woman complains of increasing SOB on exertion. She has a mid-diastolic murmur best heard at the apex of the heart with the patient in the left lateral position.
- A 52yo man has a displaced apex beat with a pan systolic murmur at the apex, radiating to the axilla
A. aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis E. Pulmonary regurgitation F. Pulmonary stenosis G. Tricuspid regurgitation H. Tricuspid stenosis I. VSD J. PDA
A
- B aortic stenosis
- D mitral stenosis
- C mitral regurgitation
19
Q
A 25yo professional footballer collapses during a match complaining of severe chest pain and SOB. Despite resuscitation attempts he dies on the way to hospital. He is a non-smoker, has no medical history and no family history of CV disease. What is the most likely cause of sudden death? A. WPW syndrom B. MI C. AF D. Hypertrophic cardiomyopathy E. Pulmonary embolism
A
D. hypertrophic cardiomyopathy
20
Q
Anti microbial protein(s) secreted by epitheilial cells at mucosal surfaces: A. defensin B. myeloperoxidase C. Lectin D. Immunoglobulin E. Secretin
A
A. defensin
21
Q
For each scenario select the most appropriate answer from the options below:
- Chronic agonist induced stimulation of airway beta 2 receptors results in…
- Sensitisation of airway smooth muscle by asthmatic inflammatory mediators results in…
A. airway remodelling and irreversible airway obstruction
B. Enhanced airway hyper-reactivity on bronchial challenge testing
C. reduced airway hyper-reactivity on bronchial challenge testing
D. beta 2 receptor up regulation and enhanced receptor coupling to G protein-adenylyl cyclase
E. beta 2 receptor down regulation and reduced receptor coupling to G protein-adenylyl cyclase
F. Increased pulmonary vascular resistance and RV afterload
G. Reduced pulmonary resistance and right ventricular afterload
H. alveolar cell hyperplasia
I. Alveolar cell desquamation
J. Alveolar wall fibrosis
A
- E beta 2 receptor down regulation and reduced receptor coupling to G protein-adenylyl cyclase
- B Enhanced airway hyper-reactivity on bronchial challenge testing
22
Q
The enzyme that transcribes genetic material is: A. ligase B. DNA polymerase C. RNA polymerase D. amino-acyl transferase E. DNA transcriptase
A
C. RNA polymerase
23
Q
For the following scenarios select the assessment from the options below that would help you differentiate between the two conditions:
- type 1 and 2 respiratory failure
- COPD and asthma
- Mild or moderate community acquired pneumonia
A. palpate trachea B. percuss chest C. Auscultate chest D. assess vocal resonance E. Measure peak flow F. measure oxygen saturations G. Measure respiratory rate F. look for finger clubbing I. perform spirometry J. Measure ABG
A
- J measure ABG
- I perform spirometry
- G measure respiratory rate
24
Q
For the following scenarios select the most likely underlying pathology:
- A 35yo woman presents with a dry cough that has been worsening over several months. She has red tender nodules on her shins and also reports fatigue, joint pain and weight loss in the same period. A chest x-ray shows hilar lymph adenopathy.
- A 65 yo man presents to his GP with a worsening cough for the last few months. On further questioning he admits that he has coughed up fresh blood and lost weight over the same period. Over the last couple of days he has developed a fever and is producing thick green sputum.
- A 15yo girl presents to A and E with severe breathlessness, wheeze and a cough. She has become increasingly breathless over the last few days but her mother reports she has refused to use her “puffers”.
A. uncontrolled proliferation of epithelial cells in the large airways of the lung
B. Idiopathic inflammation of alveoli with thickening of the alveolar walls
C. V/Q mismatch due to blockage of a pulmonary artery
D. reversible airway obstruction and bronchospasm
E. inflammation of the mucous membrane of the nasal cavity
F. Non-caseating granuloma formation
G. hypotonia of LOS leading to acid reflux
H. Chronic airway obstruction with air trapping
I. Caseating granuloma formation
J. Inflammation of the larynx, trachea and large bronchi.
A
- F non-caseating granuloma formation (sarcoidosis)
- A uncontrolled proliferation of epithelial cells in the large airways of the lung (squamous cell carcinoma)
- D reversible airway obstruction and bronchospasm (acute asthma attack)
25
```
Which one of the following is one of the most important human factors in the prevention of patient harm in health care?
A. accurate record keeping
B. Infection control
C. Patient safety audit
D. Reflection
E. Situational awareness
```
E. situational awareness
26
Mean arterial blood pressure equals:
A. systolic pressure-diastolic pressure
B. diastolic pressure + 2/3 (systolic-diastolic pressure)
C. Diastolic pressure + 1/3 (systolic-diastolic pressure)
D. Systolic pressure - 1/3 (systolic-diastolic pressure)
E. Systolic pressure + 1/3 (systolic-diastolic pressure)
C. Diastolic pressure + 1/3 (systolic-diastolic pressure)
27
For each of the following scenarios select the most appropriate treatment from the options below:
1. A 34yo male with mild intermittent asthma on no current treatment is seen by his GP with acute wheeze following exposure to a cat. His peak expiratory flow was 80% predicted, sats=98% on air, RR=15, HR=70. There is good air entry with minimal wheeze.
2. A 50 yo female persistent asthmatic taking beclametasone and salmeterol is seen by her GP. After a cold she becomes increasingly breathless and wheezy, despite taking multiple puffs of her reliever. She is afebrile and is not producing any sputum. Her peak flow is 60%, sats=95%, RR=25, HR=90. There is good air entry but marked wheeze and no crackles. After an initial nebulisation she begins to feel better and the GP decides to treat her at home with a 7 day course of appropriate oral therapy before returning to the nurse for review.
3. A 25yo female persistent severe brittle asthmatic prevents to the emergency departments with worsening breathlessness and wheeze following a recent episode of flu-like illness. She is afebrile, unable to complete sentences, drowsy and has poor air entry on both sides. She is using her accessory muscles and is clearly unable to perform peak expiratory flow. Sats=84% on air, RR= 35, HR=110. She is given high flow oxygen, repeated nebulisation and IV corticosteroid but she does not improve after 30 mins. You call the anaesthetist urgently. What other drug would you give the meantime to try and buy some waiting time?
```
A. oral cetirizine
B. IV aminophylline
C. Salbutamol via spacer device
D. Oral salbutamol
E. Oral montelukast
F. IV diazepam
G. Oral carbocistiene
H. Inhaled cromoglycate
I. Oral prednisolone
J. Oral amoxicillin
```
1. C salbutamol via spacer device
2. I oral prednisolone
3. B IV aminophylline
28
```
Which of the following is a malignant tumour?
A. pleomorphic adenoma
B. enchondroma
C. osteoid osteoma
D. squamous papilloma
E. cholangiocarcinoma
```
E. cholangiocarcinoma
29
For each of the following scenarios select the most appropriate response:
1. The most common cause of bacterial food poisoning diagnosed in UK laboratories.
2. Classically associated with food poisoning after eating rice which has been stored for too long at room temperature.
3. Infection with this organism may lead to haemolytic ureamic syndrome as a complication.
```
A. Bacillus cereus
B. Campylobacter
C. Clostridium botulinum
D. Clostridium difficile
E. Clostridium perfringens
F. Cryptosporidium
G. E. coli 0157
H. Salmonella enteritidis
I. Shigella sonnei
J. Staphylococcus aureus
```
1. B campylobacter
2. A bacillus cereus
3. G E. coli 0157
30
```
Where does fertilisation usually occur?
A. ampulla of uterine tube
B. infundibulum of uterine tube
C. Isthmus of uterine tube
D. Ovary
E. Uterus
```
A. ampulla
31
For each of the following scenarios, to help with rapid relief of symptoms, select the one best medication from the options below:
1. a 52yo man with hypertension wakes up suddenly during the night feeling short of breath. On examination he has bilateral basal crackles.
2. A 45yo woman complains of palpitations. Investigations confirm the diagnosis of thyrotoxicosis and AF with a ventricular rate of 110bpm.
3. A 57 year old man complains of central chest pain radiating to his left arm caused by exertion.
```
A. carbimazole
B. atorvastatin
C. IV furosemide
D. Bendroflumethiazide
E. Bisoprolol
F. Aspirin
G. Verapamil
H. Losartan
I. Ramipril
J. GTN spray
```
1. C
2. E
3. J
32
A 65 year old male is admitted to the Acute Medical Ward with sepsis.
Which of the statements below is true about sepsis?
A. the circulating blood volume is increased in the septic patient
B. The HR is lover than normal in the septic patients
C. The circulating blood volume is decreased in the septic patient
D. Sepsis is easily treated with antibiotics
E. Blood clotting remains normal in the septic patient
C. the circulating blood volume is decreased in the septic patient
33
Hexokinase I in red blood cells and Glucokinase in the liver and pancreas both catalyse the phosphorylation of glucose to glucose-6-phosphate. Hexokinase I has a Km of glucose of 0.05mM, while glucokinase has a Km for the same substrate of 5-6mM. What can you deduce from this information?
A. Both enzymes are almost fully saturated at normal fasting glucose levels.
B. Hexokinase I is regulated by allosteric interactions
C. Hexokinase I has a higher affinity for glucose than Glucokinase
D. Glucokinase can convert glucose to glucose-6-phosphate at a higher rate than Hexokinase I.
E. Glucokinase is inhibited by a competitive inhibitor
C. Hexokinase I has a higher affinity for glucose than Glucokinase
34
For each of the following scenarios select the most appropriate management option from the list below:
1. A 45yo man with intermittent dysphagia for solids and heartburn goes for an upper GI endoscopy. He is shown to have grade C oesophagitis.
2. A 44yo man with vomiting and dysphagia to solids. A tight, benign peptic stricture is seen at endoscopy.
3. A 20yo woman could not be endoscoped because her gullet was full of food after an overnight fast. She had a barium swallow, which showed a dilated oesophagus and a bird's beak appearance at the gastro-oesophageal junction.
```
A. PPI
B. Ballooon oesophageal dilatation
C. Oesophageal bougie dilatation
D. Metal oesophageal stenting
E. Oesophagectomy
F. Metoclopramide
G. Monteleukast
H. Percutaneous endocopic gastrostomy tube
I. Radiologically inserted gastrostomy tube
J. Heller's Cardiomyotomy
```
1. A PPI
2. B balloon oesophageal dilatation
3. J Heller's Cardiomyotomy
35
Which of the statements below is true of streptococcus?
A. These appear as gram negative cocci in chains on gram film
B. The coagulase test is important in the classification of this genus
C. These appear as gram negative cocci in clusters on gram stain
D. Haemolysis is important in the classification of this genus
E. These appears as gram negative bacilli on gram stain
D. Haemolysis is important in the classification of this genus.
36
Select one anatomical term from the options list that best fits the following descriptions:
1. A layer which lies immediately superficial to (external to) the myocardium.
2. A layer most closely associated (anatomically) with the route of the phrenic nerve through the chest.
```
A. Costal parietal pleura
B. Endometrium
C. Fibrous pericardium
D. Mesentery
E. Parietal serous pericardium
F. Thoracolumbar fascia
G. Transversalis fascia
H. Visceral serous pericardium
I. Visceral peritoneum
J. Visceral pleura
```
1. H Visceral serous pericardium
| 2. C Fibrous pericardium
37
```
A 62 yo woman has been diagnosed with chronic congestive heart failure secondary to ischaemic disease. Which of the following medications improve survival in chronic congestive heart failure?
A. calcium channel blockers
B. Loop diuretics
C. Statins
D. ACE inhibitors
E. nitrates
```
D. ACE Diuretics
38
```
The rate of rescue breathing in an adult with a respiratory arrest should be :
A. 5 times per minute
B. 10 times per minute
C. 13 times per minute
D. 16 times per minute
E. 20 times per minute
```
B. 10 times per minute
39
```
Which of the following factors increases the venous return to the heart?
A. increasing the pressure in the RA.
B. Decreasing the blood volume
C. dilatation of the veins
D. Decreasing the venomotor tone
E. Increasing skeletal muscle activity
```
E. Increasing skeletal muscle activity
40
From the list below, select the best option which completes each of the following statements:
1. Phase 0 is mainly caused by:
2. Phase 2 is mainly caused by:
3. Phase 3 is mainly caused by:
A. Increased sodium influx
B. Increased sodium efflux
C. Decreased potassium efflux superimposed in slow sodium influx
D. Increased calcium influx
E. Increased sodium and potassium influx
F. Decreased sodium and potassium efflux
G. Increased sodium efflux superimposed in slow potassum influx
H. Increased calcium efflux
I. Increased potassium efflux
J. Increased potassium influx
1. A increased sodium influx
2. D Increased calcium influx
3. I Increased potassium efflux
41
```
Which of the following is one of the key medical ethical principles as defined by Beauchamp and Childress?
A. Beneficence
B. Maleficence
C. Independence
D. Righteousness
E. Rightfulness
```
A
42
```
A 24 yo female asthmatic becomes increasingly breathless and wheezy and requires her reliever 4 times in most days and on at least 3 nights a week with coughing. She is taking salbutamol only. Peak flow shows 30% diurnal variability. What regular treatment would you consider prescribing?
A. Treatment with ICS
B. Treatment with ICS + LABA
C. Treatment with LABA
D. Treatment with oral theophylline
E. Treatment with oral mucolytic alone
```
A. ICS
43
Select from below the most appropriate assessment for the following situations in a patient with a chest infection.
1. Performed initially when undertaking a systematic patient assessment.
2. To indicate a problem with the patient's peripheral circulation.
```
A. blood pressure
B. blood sugar levels
C. Capillary refill time
D. ECG
E. Heart rate
F. AVPU
G. Oxygen saturation levels
H. Patency of airway
I. Respiratory rate
J. Review of medical notes
```
1. H patency of airway
| 2. C cap refill
44
```
Transcription and translation of a gene composed of 30 nucleotides would for a protein containing no more than _____ amino acids.
A. 10
B. 15
C. 30
D. 60
E. 90
```
A. 10
45
```
A change from one mature cell type to another is known as:
A. metaplasia
B. Dysplasia
C. Neoplasia
D. hyperplasia
E. Hyperplasia
```
A. metaplasia
46
For each of the following statements select the most appropriate CV structure from the options below:
1. Blood from the spleen and bowel, which has been processed by the liver, is transported by this vessel to the inferior vena cava?
2. This vessel is the most inferior of the paired anterolateral branches of the abdominal aorta.
3. The common hepatic, splenic and left gastric arteries arise directly from this vessel.
```
A. SMA
B. Portal vein
C. Adrenal artery
D. Hepatic artery
E. Common iliac vein
F. IVC
G. gonadal artery
F. Coeliac trunk
I. RA
J. IMA
```
1. D hepatic vein
2. G Gonadal artery
3. H coeliac trunk
47
```
A 46yo man visits his GP as he is worried he may have high blood pressure because his brother has just started on medication for high blood pressure. His BP on two separate occasions was 142/98 mmHg and 144/95mmHg. What is the next most appropriate step to diagnose hypertension?
A. Reassess in 1 month
B. Reassess in 3 months
C. Reassess every year
D. Ambulatory blood pressure monitoring
E. Home blood pressure monitoring
```
D. Ambulatory blood monitoring
48
In a female patient whose mother was affected by breast caner at the age of 48 and has no other family history, how would you describe your patient's risk of developing breast cancer?
A. 0
B. below population risk
C. population risk
D. slightly increased above population risk
E. Much higher than population risk
D. slightly increased above population risk
49
For each description select the antibody that best fits from the options below:
1. The most abundant antibody type
2. The antibody-type that exists as a dimer in breast milk, saliva and tears
3. The antibody-type that exists as a pentameric molecule
```
A. IgG
B. Hyper IgE
C. IgM
D. IgD
E. IgE
F. membrane attack complex
G. IgA
H. IgH
```
1. A IgG
2. G IgA
3. C IgM
50
For each scenario select the most appropriate answer from the options below:
1. This acts on the post junctional muscarinic end plate receptor on airway smooth muscle to mediate constriction.
2. This acts on the membrane bound beta-2 adrenoceptor on airway smooth muscle to mediate and relax.
3. Metabolite of the arachadonic acid pathway released from eosinophils and mast cells which mediates airway smooth muscle constriction, increased vascular permeability and mucous secretion.
```
A. noradrenaline
B. Interleukin 5
C. Leukotriene D4
D. Prostaglandin D2
E. Adrenaline
F. Leukotriene A4
G. Histamine
H. Bradykinin
I. Acetylcholine
J. Cyclic AMP
```
1. I acetylcholine
2. E prostaglandin D2
3. C Leukotriene D4
51
SBAR stands for :
A. Safe, bold, assertive, reflective
B. SEW score, BP, allergies, RR
C. Situation, background, assessment, recommendation
D. Situation, background, analysis, registration
E. Symptoms, blood analysis, assessment, refinement
C
52
```
Which of the following protein components of the inner mitochondrial membrane transfers energy associated with the proton motive force into high energy phosphate bonds found in ATP?
A. FiFoATPase
B. Complex I
C. Complex II
D. Complex III
E. Complex IV
```
A. FiFoATPase
53
Select the one anatomical term from the options list that best fit the following descriptions:
1. The numeral used to represent the cranial nerve whose function it is to supply somatic sensory nerve fibres to the skin of the face.
2. The numeral used to represent the cranial nerve which allows you to raise your eyebrows.
3. The numeral used to represent the nerve that has a branch that innervated muscles that cause adduction of the vocal cords.
```
A. I
B. II
C. III
D. IV
E. V
F. VI
G. VII
H. VIII
I. IX
J. X
```
1. E V
2. G VII
3. J X
54
```
At risk drinking for men is the regular consumption of:
A. more than 2 units per day
B. More than 2 pints per day
C. More than 3 units per day
D. More than 3 pints per day
E. More than 28 units per week
```
A. more than 2 units per day
55
A 68 year old female long standing smoker presents with 3 exacerbations in the past 12 months, progressive SOB, productive cough and wheeze. What would the most likely findings on spirometry be?
A. low FEV1, normal FVC, low FEV1/FVC, low PEF
B. low FEV1, low FVC, normal FEV1/FVC, normal PEF
C. low FEV1, low FVC, low FEV1/FVC, normal PEF
D. low FEV1, low FVC, low FEV1/FVC, low PEF
E. Low FEV1, normal FVC, low FEV1/FVC, normal PEF
A
56
```
Which of the following can reactivate from a latent state to cause disease?
A. Rabies virus
B. HPV
C. Herpes simplex virus
D. Adenovirus
E. Influenza A virus
```
C. Herpes simplex virus
57
What is the reducing agent in the following reaction?
Pyruvate + NADH + H+ -> Lactate + NAD+
```
A. oxygen
B. NADH
C. lactate
D. Pyruvate
E. NAD+
```
B. NADH
58
Rapidly contracting human muscle cells start producing lactic acid. Which of the following statements best explains this finding?
A. the cells have to convert NADH into NAD+
B. lactic acid acts as a substitute for gluconeogenesis
C. Lactic acid is oxidised in the Kreb's cycle
D. Most cells utilise lactic acid as an energy source
E. Lactic acid is a normal waste product of aerobic metabolism
A. The cells have to convert NADH into NAD+
59
```
Which of the following is associated with the epiblast layer of the bilaminar embryo?
A. amniotic cavity
B. Chorionic cavity
C. Syncytiotrophoblast
D. Trophoblast lacunae
E. Yolk sac
```
A. amniotic cavity
60
A 39yo non-smoking male asthmatic with cough and wheeze who has had 2 exacerbations in the past 6mnths which have responded rapidly to oral corticosteroids has a bronchial biopsy performed. What is the most likely pathology finding?
A. chronic eosinophilic mucosal inflammation
B. Chronic neutrophilic mucosal inflammation
C. Chronic granulomatous mucosal inflammation
D. squamous metaplasia
E. Squamous carcinoma
A. chronic eosinophilic mucosal inflammation
61
Which of the following statements about mental health and physical health are true?
A. 10% of patients with diabetes mellitus have an eating disorder
B. 1 in 5 patients presenting to their GP with mental illness require referral to the community mental health team
C. Most patients with dementia in the general hospital are in the medicine for the elderly ward
D. 20% of patients who have a MI develop depression in the subsequent months
E. It is not necessary to examine the peripheral neurological system in patients presenting with moderate depression and no focal neurological symptoms
D. 20% of patients who have an MI develop depression in the subsequent months
62
Which of the statements below is true of the gram positive cell wall?
A. when the structure breaks up, endotoxin is released which accelerates the process of sepsis
B. This structure is an intracytoplasmic DNA that is easily transferred from one bacterium to another and ma carry genes for antibiotic resistance
C. This structure has a thin layer of peptidoglycan and stains pink with gram stain
D. This structure has a thick layer of peptidoglycan and stains purple with gram stain
E. This structure consists solely of a phospholipid bilayer
D. This structure has a thick layer of peptidoglycan and stains purple with gram stain.
63
According to the resuscitation council when performing chest compressions on an adult the heel of the hand should be placed?
A. on the intermammary line
B. Two fingers breadth above the xiphisternum
C. In line with the patient's nipples
D. on the xiphoid process
E. In the centre of the patient's chest
E. in the centre of the patient's chest
64
For the following scenario select the most appropriate investigation from the options below:
A 20yo female recently returned from a three month stay in Malawi. She wants you to check for GI parasites.
A. Stool for antigen detection
B. Stool for culture
C. Stool for microscopy
D. Stool for PCR
E. Stool for toxin detection
C. Stool microscopy
65
For each of the following descriptions select the most likely microbe from the options below:
1. A microbe discovered in 2001 and shown to be a common cause of bronchiolitis.
2. A microbe with the potential to cause pandemics.
3. A cause of pneumonia that's associated with sheep contact.
```
A. Influenza A virus
B. Influenza B virus
C. Influenza C virus
D. Metapneumovirus
E. Respiratory syncytial virus
F. Rhinovirus
G. Coxiella burnetii
H. Mycoplasma pneumoniae
I. Chlamydophila psittaci
J. Streptococcus pneumoniae
```
1. D metapneumovirus
2. A influenza A
3. G coxiella burnetti
66
```
A man with X-linked muscular dystrophy has a daughter. What is the likelihood that she is a carrier of this condition?
A. 0%
B. 25%
C. 33%
D. 50%
E. 100%
```
E. 100%
67
```
A 20yo university student presents with lethargy, headache, fever nausea and abdominal pain for 4 days. He has no rash. He returned from backpacking in india about 4 weeks ago. His friends noticed his eyes are yellow. What is the most likely infection to cause this?
A. hep A
B. hep C
C. EBV
D. HIV
E. Dengue fever
```
A. hepatitis A
68
For each of the following scenarios presenting to primary care select the most appropriate oral antibiotic from the options below:
1. A 75yo male long standing smoker with COPD and an infective exacerbation during the winter presents with a wheeze and cough productive of purulent sputum. He has no known allergies and is considered well enough to be treated at home.
2. A 61 yo female non-smoker with an exacerbation of bronchiectasis has already been to treated by her GP with two different oral antibiotics in the past month. The GP then sends off a sputum culture which grows pseudomonas aeruginosa which is resistant to beta-lactams and tetracyclines.
3. A 35yo male non-smoker previously well presents with community acquired pneumonia. His GP thinks he is well enough to be treated at home. He is known to be allergic to penicillin.
```
A. clindamycin
B. Gentamicin
C. Amoxicillin
D. Penicillin V
E. Aciclovir
F. Penicillin G
G. Chloramphenicol
H. Doxycycline
I. Metronidazole
J. Ciprofloxacin
```
1. C amoxicillin
2. J ciprofloxacin
3. H doxycycline
69
What is the most appropriate initial management for each of the following scenarios:
1. a 56yo man with history of alcohol excess presents to hospital complaining for the first time of abdominal pain with a tense distended abdomen and shifting dullness.
2. A 47yo female primary school teacher presents for the first time with itch. Investigation reveals she has PBC.
3. A 19yo female student with a history of autoimmune hepatitis presents with a raised alanine aminotransferase at routine clinic review.
```
A. spironalactone
B. Terlinpressin
C. Neomycin
D. co-trimethazole
E. paracentesis
F. TIPSS
G. Banding
H. Low sodium diet
I. Prednisolone
J. Uresodeoxycholic acid
```
1. E paracentesis
2. J Urseodeoxycholic acid
3. I Prednisolone
70
```
A patient who is thought to be suffering shock from substantial blood loss would have which if the following pulse rated:
A. fast
B. slow
C. bounding
D. normal
E. no pulse
```
A. fast
71
```
Which of the following caused the rising phase of depolarisation in contractile ventricular muscle cells?
A. Fast sodium efflux
B. Voltage gated calcium influx
C. fast sodium influx
D. potassium influx
E. potassium efflux
```
C. fast sodium influx
Year 1
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