2010 Remembered Paper Part a Melbourne

2010 Remembered Paper Part A – Melbourne

Question 1: Which of the following antibiotics promotes biliary sludge formation? A. Ceftriaxone B. Clindamycin C. Erythromycin D. Metronidazole E. Cotrimoxazole

Q2. (Repeat 2008b Q95) A 13-year-old boy collapses while playing soccer. There is a brief period of loss of consciousness, but he is now awake, alert and oriented, although complaining of a severe headache. A computed tomography (CT) scan of his head is shown below.

A. Diffuse cerebral oedema. B. Extradural haemorrhage. C. Migraine. D. Subarachnoid haemorrhage. E. Subdural haemorrhage

Q3. What is the action of botulism neurotoxin at a cellular level? a) Inhibition of acetylcholine esterase at the synaptic junction b) Inhibition of acetylcholine uptake into nerve terminal c) Inhibition of acetylcholine release into synaptic junction d) Inhibition of pseudocholinesterase at synaptic junction e) Inhibition of anticholinesterase at the synaptic junction

4) The most severe outcome of midtrimester oligohydramnios is: a) Acute renal failure b) Amniotic band sequence c) Foetal compression syndrome d) Intrauterine Growth Retardation d) Pulmary hypolasia

5) Antibiotic prophylaxis is currently recommended to prevent bacterial endiocarditis in which of the following cardiac lesions? A) pulmonary valve stenosis B) aortic valve stenosis C) ASD D) VSD E) tetralogy of fallot

6) A 12 year old girl fell off the trampoline and through a plate glass window and has sustained the following injury

(photo similar to this, but didn't extend quite as far to the radial side) Which of the following structures would be LEAST likely to be affected? a) Radial artery b) Extensor pollicis longus c) Flexor carpi radialis d) Palmaris longus e) Ulnar Artery

7. What is the mechanism of action of Carbimazole? A block thyroid peroxidase B block release of preformed thyroid hormone C block formation of thyroglobulin D block peripheral action at receptor E block iodide concentration in thyroid gland

8. A couple meet at a Short Peoples’ Convention. The male partner has acondroplasia, and he is the only member of his family to have the disease. The female partner is of normal stature but her brother has acondroplasia. What is the chance that they will have a child with achondroplasia? a) <1% b) 25% c) 50% d) 75% e) 100%

9 Which clotting factor affects prothrombin time? A 8 B 9 C 10 D 11 E 12

10. Staph aureus superantigens worsens ectopic dermatitis by what mechanism? a. eosinophils activation b. T cell activation c. mast cell d. e.

11. UTI No UTI circumcision 4 96 no circumcision 5 95

What is the NNT to prevent 1 UTI ? a. 100 b. 200 c. 96 d. 90 e. 9

12. 15 year old boy with hunter syndrome and poor follow up presents with stridor and was given adrenaline nebuliser and dexamethasone. Blood gas Ph 7.08 CO2 101, O2 303 What does the blood gas show ? a. acute metabolic acidosis b. acute on chronic respiratory acidosis c. chronic resp acidosis d. chronic metabolic acidosis e.

13. A lesion in the prefrontal cortex causes which one of the following a) Antegrade Amnesia b) Executive functioning problems c) Expressive aphasia d) Personality changes e) Selective Mutism

14. The gram negative spectrum of first generation cephalosporins includes which one of the following? a) Bacteroides fragilis b) Enterobacter cloacae c) Klebsiella oxytoca d) Pseudomonas aeruginosa e) Serratia marcesnans

15. Which renal segment is the main site of action of Aldosterone a) Proximal convoluted tubule b) Descending loop of Henle c) Ascending loop of Henle d) Distal convoluted tubule e) Cortical collecting duct

16. Haemolytic crisis in patient with G6PD can be triggered by antibiotics used to treat UTI. Which of the following is the most likely to do this? a) Trimethoprim b) Norfloxacin c) Amoxycillin 17. A boy who was recently diagnosed with ALL and just finished induction treatment presents to ED with jaw and abdominal pain. His parents state he has not passed a bowel action in 3 days. Which of the following chemotherapeutic agents is likely to be responsible for his symptoms? a) Vincristine b) Methotrexate c) Cyclophosphomide d) Dexamethasone e) Asparaginase

19. Sucking and swallowing requires coordination. What gestational age would this be complete? A. 28 weeks B. 30 weeeks C. 32 weeks D. 34 weeks E. 36 weeks

20. A Type 1 diabetic on is on an IV infusion of insulin for DKA. Now stabilised and ready to start subcut insulin. When would you give first dose of actrapid/humalog insulin subcut in relation to stopping infusion? A. 2 hrs before B. Half hour before C. Same time D. half hour later E. 2 hrs after

21. Which chemotherapy associated with decreased fertility? A . Cyclophosphamide B. Dactinomycin C. Methothrexate D. Mercaptopurine E. Vincrisitine.

22 (Repeat from 2009) A 4 yo male presents after a fall from a trampoline. He is in considerable pain despite analgesia. You decide to perform a femoral nerve block. Which of the following best represents the anatomical structures from medial to lateral?

[X-ray showing distal femoral shaft fracture, though not required to answer question.]

a) Artery, nerve, vein b) Artery, vein, nerve c) Nerve, artery, vein d) Vein, artery, nerve e) Vein, nerve, artery.

23) In an unconscious patient, which of the following parameters on EEG is most in keeping with a post-anoxic encephalopathy a. Diffuse fast (beta) activity b. Diffuse slow (delta) activity c. Focal left slow (delta) activity d. Periodic spike and wave e. Rhythmic trisphasic.

24) Which one of the following pharmacokinetic parameters is most important in the optimal prescribing of beta- lactam antibiotics? A. The peak concentration/minimum inhibitory concentration (MIC) ratio. B. Area under the plasma concentration versus time curve (AUC). C. The AUC/MIC ratio. D. Time above the MIC. E. Both AUC/MIC ratio and peak concentration/MIC ratio.

25) Rituximab is being used increasingly as a treatment for autoimmune diseases and certain malignancies. What is the mechanism by which it works? a. Anti CD3 antibody b. Anti CD4 antibody c. Anti CD8 antibody d. Anti CD 10 antbody e. Anti CD20 antibody

26) When fluorescent in situ hybridization (FISH) is used for antenatal diagnosis, which genetic abnormality is most likely to be detected? a. Aneuploidy b. Deletions c. Duplications d. Mosaicism e. Translocations

27) The parents of a child with persistent asthma are reluctant to use steroids for control and ask instead about monteleukast. What is the mechanism of montelukast? a. Leukotriene receptor antagonist b. Phospholipase A2 inhibitor c. Mast cell stabilizer

28) Nephrogenesis is completed cloest to which of the following age: A. 28 week gestation B. 34 week gestation C. 40 week gestation D. 6 week E. 1 year of age

Q29 (repeat from 2009) Asperger syndrome is associated with which type of language disorder? A. Articulation B. Expressive C. Pragmatic D. Receptive E. Voice production

30) What is the mechanism of action of anti-influenza (aseltamivir) A. Destruction of sialic acid receptors B. Haemogglutination C. Ion channel D. Neuraminidase Inhibitors E. Proteolytic clearance of haemoglutinin Q 31 – A patient is having induction for ALL is monitored for tumour lysis syndrome. Which of the following is NOT likely to happen? A. Hyperglycaemia B. Hyperkalaemia C. Hyperphosphataemia D. Hyperuricaemia E. Hypocalcaemia

Q 32 - 7yo girl with mild intellectual difficulty who is short and obese presents with tingling around her mouth. Serum Calcium 1.7 Serum Phosphate 2 Parathyroid Hormone 10 25-Vit D 40 The most likely cause of her symptoms is? A. Hyperparathyroidism B. Hypoparathyroidism C. Hyperventilation D. Pseudohypoparathyroidism E. Vitamin D Deficiency

Q 33 - You are using volume assist ventilation on a term infant. What is the ideal volume setting (ml/kg) A. 0.5-2 B. 3-5 C. 6-8 D. 9-11 E. 12-15

Q37 Which is a cause of decreased chest wall compliance? a. Achondroplasia b. Duchenne muscular dystrophy c. Infancy d. Sleep e. Sedation

38) By what age 90% of children develop neat pincer grip? a. 3 months b. 6 months c. 9 months d. 12 months e. 15 months

Q39 What is the commonest recognised immunodeficiency? a. CVID b. Selective IgA deficiency c. Hyper IgM d. X-linked agammaglobulinaemia e. SCID

40) Which of the following defines a grade 3 intraventricular haemorrhage? A. Associated parenchymal bleed B. Bleed into 30% of the lateral ventricles C. Bleed into 50% of the lateral ventricles D. Dilation of the lateral ventricles E. Dilation of the third ventricle

41) Azole antifungal medications such as voriconazole increase the toxicity of which of the following cytotoxic medications? A. Cyclophosphamide B. Cytarabine C. Doxorubicin D. Methotrexate E. Vincristine

42) Vasopressin acts to regulate water homeostasis by acting on the renal vasopressin V2 receptor. This receptor increases collecting duct permeability by which of the following mechanisms: A. increasing aldosterone secretion via phosphatidyl pathways B. increasing the synthesis of sodium channels in the apical membrane C. inserting aquaporins into the apical membrane of the collecting duct D. mobilising intracellular calcium via phosphatidyl pathways E. increasing vasodiation via nitric oxide synthase

43. Stem talks of a 4 yo boy with DIC going to theatre. FFP will not replace: a. Factor VIII b. Factor IX c. Prothrombin d. cryoprecipitate e. fibrinogen

44. Stem referred to left atrial enlargement secondary to dilated cardiomyopathy. This is most likely to compress which of the following structures: a. recurrent laryngeal nerve b. distal trachea c. L) main bronchus d. phrenic nerve e. oesophagus

45. Growth hormone is used in chronic renal disease. What is the mechanism of GH deficiency in chronic renal disease? a. decreased GHRH b. decreased growth hormone binding proteins c. decreased secretory bursts d. GH receptor resistance e. increased metabolic rate

47. A 5 year-old boy presents with collapse and wheeze post IV contrast during a CT scan. The child is resuscitated and recovered. What investigation would confirm the cause of his reaction to IV contrast? A. Histamine level B. IgE level C. Eosinophil count D. Triptase E. C3

48) Taking into account cytochrome p450 which one of the following drugs has an unpredictable analgesia response? A-Paracetamol B-Ibuprofen C-sucrose D-Morphine E - Codeine

49) HSV PCR on CSF is a test that is very useful in modern clinical practice because of its good sensitivity and specificity. Which of the following reasons could explain a false negative result with this test? A. 24h of antibiotics given prior to CSF obtained B. Contamination by other Herpes viruses C. Storing sample in fridge at 4 degrees celsius overnight D. Storing sample in room temperature overnight E. CSF taken 24 hours before symptoms

50) In children with Prader Willi Syndrome, what is the problem with giving growth hormone therapy? A. Fear of needles B. Increases their blood glucose levels C. Reduced response to growth hormone with time D. Causes obstructive sleep apnoea

52) Accodring to Erickson stages, what are adolescents? a. Identity vs confusion b. Initiative vs Guilt c. Autonomy vs shame and doubt d. Industry vs inferiority e. Intimacy vs isolation

53)What is the pathophysiology of type 1 vWD? A: no von Willebrand Factor produced B: abnormal vWF produced C: decreased production of normal von Willebrand Factor D: reduced amount abnormal vWF E: defective platelet aggregation

54) What is the frequency of epilepsy in classical autism? A: 2% B: 5% C: 10% D: 30% E: 50%

55) What's the aim of phase I of clinical trials? A. adverse events of the trialled medication B. efficacy of treatment C. efficacy of the treatment related to the standard treatment D. pharmacology and metabolic effects of trialled med 56) Apart from wheat, what else will contain gluten and needs to be avoided in Celiac disease? A. Barley B. Maize C. Oats D. Yeast E. Hops

57) "Lupus anticoagulant" is a cause of prolonged APTT. What's the most common condition leading to this in children? A. drug reaction B. Juvenile arthritis C. SLE D. recent viral illnes E. HIV

58. A 25/40 baby boy is born weighing 740g. On day 3 he develops a grade 2 IVH which does not progress. He later develops mild heart failure secondary to a PDA which is subsequently closed surgically at 5 weeks old. He has a small oxygen requirement at 11 weeks old, which has resolved by 14 weeks old when he is discharged. His neurodevelopmental outcome is most influenced by: a) Chronic lung disease b) Gender c) Gestational age d) IVH e) PDA surgery

59. A drug is given IV - dose given is 40mg. The area under the curve is 200. The same drug is given orally at a dose of 80mg, and the AUC is 300. What is the oral bioavailability of this drug? a) 35% b) 50% c) 60% d) 66% e) 75%

60. Widened splitting of the pulmonary and the aortic components of the second heart sounds during inspiration is an auscultatory feature of: a) ASD b) Pulmonary hypertension c) Severe aortic valve stenosis d) (?severe) pulmonary valve stenosis

61. A 9yo boy presents with a history of fever, diarrhoea and abdominal cramps. Stool MCS positive for white cells and red cells. Abdominal USS shows evidence of mesenteric adenitis and thickened terminal ileum. Which of the following organisms best explains this clinical presentation? A. Giardia B. Shigella C. Salmonella D. Yersinia enterolithica E. Enterobacter

62. Where is the lesion in SMA? a) Anterior horn cells b) Peripheral nerve c) Neuromuscular junction d) Muscle e) Cerebral cortex

64 Rotavirus vaccine commonly used in Australia and NZ. What is the efficacy of the two vaccines (Rotateq and Rotavic) in preventing rotavirus gastroenteritis of any severity? a) 30% b) 50% c) 70% d) 90% e) 95%

65 Atomoxitine is used as a treatment for ADHD. What is its mechanism of action? a) Dopamine and NA reuptake inhibitor b) Dopamine blockade c) NA blockade d) NA reuptake inhibitor e) Serotonin reuptake inhibitor

66. Which of the following coagulation factors is most likely to be relatively lower in the healthy newborn compared with the older infant? a) V b) VII c) VIII d) Fibrinogen e) Prothrombin

67: At what age do the frontal sinuses show air space a 6m b 12m c 4-5yr d 7-8yr e 12-13yr

68: Haemofiltration is a process best described by which of the following: a Diffusion b. Solute Drag c. Ultrafiltration d. Osmotic pressure e. Hydrostatic pressure

69: Delayed Umbilcal stump separation after birth is attributable to which of the following mediators a t cells b B cells c. Complement d. phagocytes

Question 70. Stevens-Johnsons syndrome is a well recognised side effect of lamotrigine. Which of the following interacts with lamotrigine and increases the chance of this occurring? A. Carbamazepine B. Phenytoin C. Sodium valproate D. Topiramate E. Vigabatrin

BITS OF OTHER PAPER A QUESTIONS Which of the following has activity against gram negative organisms – cephalexin was the answer Which of the following is an osmotic laxative? What is the mechanism of carbimazole?