Question 48

What is the most common cause of seizures in the elderly?

A.
B.
C.
D.
E.

Cerebral degeneration
Trauma
Infection
Tumor
Vascular disease

Question 49
Which of the following seizure types has little or no alteration in conscious
state?
A.
B.
C.
D.
E.

Petit mal
Complex partial
Simple partial
Temporal lobe
Febrile

Question 50
Which of the following medications is most appropriate for treatment in
stopping a grand mal seizure?
A.
B.
C.
D.
E.

Promethazine
Diazepam
Frusemide
Morphine
Prochlorperazine

Question 44.
Acute urinary retention maybe caused by all of the following EXCEPT
A.
B.
C.
D.
E.

Anticholinergic medication
Benign prostatic hypertrophy
Multiple sclerosis
Seizures
Sympathomimetic medication

Question 45
Increased bleeding tendancy in patients with end stage renal disease is
usually due to
A.
B.
C.
D.
E.

Decreased erythropoietin
Platelet dysfunction
Prolonged prothrombin time
Thrombocytopenia
Prolonged APTT

Question 46
A 72 year man has left sided headache, left temporal scalp tenderness and a
reduced temporal arterial pulse on palpation. Which pathologic test would be
most useful?
A.
B.
C.
D.
E.

Full blood count

Creatine kinase
Erythrocyte sedimentation rate
Glucose
Arterial blood gas

Question 47
What is the most common aetiology for seizures seen in adolescents?
A.
Idiopathic
B.
Infectious
C. Metabolic
D. Traumatic
E. Toxicologic

Question 40.
Which of the following is most reliable in suspected rhabdomyolysis?
A.
B.
C.
D.
E.

Creatine kinase
Low urea to creatinine ratio
Serum potassium
Proteinuria
Troponin I

Question 41
A 20 year woman presents to ED with urinary frequency and dysuria, the most
appropriate first test is
A.
B.
C.
D.
E.

Full blood count

Creatinine
Blood culture
Microurine
Urethral swab

Question 42
A urine dip stick test (urinalysis) may show a false positive result for blood in
which of the following conditions?
A.
B.
C.
D.
E.

Renal calculus
Rhabdomyolysis
Urinary tract infection
Prostatitis
Chronic kidney injury

Question 43.
A 70 year man with chronic kidney injury is found to have a sudden
deterioration in his renal function, which is the following medications is least
likely to contribute to this?
A.
B.
C.
D.
E.

Angiotensin converting enzyme inhibitors

Frusemide
Nitrate
Nonsteriodal anti-inflammatory medication
Amoxycillin

Question 38

The specimen shown here is from a nephrectomy done on a 5 year old child who
presented with abdominal pain for 3 months. An abdominal CT showed a mass
involving the left kidney. Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.

Wilms tumour.
Urothelial carcinoma.
Renal cell carcinoma.
Neuroblastoma.
Rhabdomyosarcoma.

Question 39
A 65 year old man presents with a urinary tract infection. Urinalysis revealed
leukocyte casts. The infection is within
A.
B.
C.
D.
E.

bladder.
urethra.
ureter.
kidney.
prostate.

Question 37

This is a cystic kidney from a young child. What is the most likely diagnosis?
A.
B.
C.
D.
E.

Acquired dialysis cystic disease.

Autosomal dominant polycystic kidney disease.
Autosomal recessive polycystic kidney disease.
Cystic dysplasia.
Medullary sponge kidney.

Question 35
Which is a risk factor for both renal cell carcinoma and transitional carcinoma of the
renal pelvis and bladder?
A.
B.
C.
D.
E.

Alcohol abuse.
Dye industry job.
Exposure to mercury.
Tobacco smoking.
Von Hippel-Lindau.

Question 36
Which of the following is the major mechanism responsible for the anaemia of
chronic renal disease?
A. Haemolysis occurring during dialysis
B. Reduced iron intake due to anorexia
C. Reduced erythropoietin synthesis

D. Chronic haematuria
E. Shortened red cell survival due to uremia

Question 32
A ten year old boy presents with several days history of malaise and fever. His
mother says that he has only passed a small amount of dark urine in the last
24 hours. His face is noted to be puffy. On examination he is found to be
mildly hypertensive. About ten days ago he had a sore throat.
What is the most likely diagnosis?
A. Nephrotic syndrome
B. Post-streptococcal glomerulonephritis
C. Acute renal failure secondary to dehydration
D. Urinary tract infection
E. Goodpasture syndrome

Question 33
Which of the following features would suggest that renal failure is chronic
rather than acute?
A. eGFR 15 mL/min/1.73m2
B. Small kidneys demonstrated on ultrasound
C. Metabolic acidosis and hypercalcaemia
D. Polyuria > 3 l/day
E. Normochromic normocytic anaemia

Question 34
Which of the following would you expect in a patient with acute renal failure?
A. Haematuria
B. Polyuria
C. Proteinuria
D. Nocturia
E Oliguria

Question 29
Which of the following is the congenital renal abnormality most commonly
recognised antenatally?
A. Hydronephrotic kidney
B. Horseshoe kidney
C. Duplex kidney
D. Pelvic kidney
E. Polycystic kidney
Question 30
Acute tubular necrosis may be caused by which of the following?
A.
B.
C.
D.
E.

Henoch-Schonlein purpure
Nonketotic hyperosmolar coma
Prostatitis
Scleroderma
Renal vein thrombosis

Question 31
The sensations of bladder fullness and the desire to micturate are conveyed
centrally by the
A.
B.
C.
D.
E.

lateral spinothalamic tracts.

anterior spinothalamic tracts.
fasciculus cuneatus.
fasciculus gracilis.
spinoreticular tracts.

Question 26
Which of the following should be suspected in patients with bilateral Bells
palsy?
A.
B.
C.
D.
E.

Embolic lesions
Mercury poisoning
Sarcoidosis
Syphilis
Tuberculosis

Question 27
Which of the following terms best describes the mechanism by which fluid is
removed by peritoneal dialysis?
A. Passive diffusion
B. Clearance
C. Countercurrent flow
D. Convection
E. Ultrafiltration

Question 28
A 35 year old man presents to the Emergency Department in great distress with
severe left loin pain of sudden onset. He has no past history of note. He is restless
and sweaty, and complains of nausea. On testing, blood is found in his urine.
Which of the following is the most likely diagnosis?
A. Ureteric calculus

B. Glomerulonephritis
C. Polycystic kidney disease
D. Urinary tract infection
E. Renal cell carcinoma

Question 23
Destruction of the right optic tract between the optic chiasma and the lateral
geniculate nucleus results in
A. blindness in the right eye.
B. blindness in the right visual field of both eyes.
C. blindness in the left visual field of the right eye and the left visual field of the left
eye.
D. blindness in the right visual field of the right eye and the left visual field of the left
eye.
E. blindness in the left visual field of the right eye and the right visual field of the left
eye.

Question 24
Opening of the upper eyelid occurs via the following muscle-nerve
combination.
A. Levator muscle - cranial nerve VII (facial nerve)
B. Levator muscle - cranial nerve III (oculomotor)
C. Levator muscle - cranial nerve V (trigeminal nerve)
D. Orbicularis muscle - cranial nerve VII (facial nerve)
E. Orbicularis muscle - cranial nerve V (trigeminal nerve)

Question 25
Which of the following is inconsistent with a diagnosis of Bells Palsy?
A.
B.
C.
D.
E.

Gaze paralysis
Hyperacusis
Loss of taste
Loss of lacrimation
Facial numbness

Question 21
Autopsy brain specimen showing a lesion in the circle of Willis.

This would be likely to produce a

A.
B.
C.
D.
E.

Duret haemorrhage.
epidural haemorrhage.
subarachnoid haemorrhage.
subdural haemorrhage.
subependymal haemorrhage.

Question 22
Fine-needle aspiration biopsy has found its greatest usefulness in the
examination of
A.
B.
C.
D.
E.

adrenal incidentalomas.
brain tumours.
pituitary masses.
suspected phaeochromocytoma.
thyroid nodules.

Question 20

The best description for this lesion is a

A.
B.
C.
D.
E.

Duret haemorrhage.
epidural haematoma.
haemorrhagic infarct.
subarachnoid bleed.
subdural haematoma.

Question 19
A 65-year-old man developed a progressively worsening headache and seizure
attacks. A CT scan of the brain showed a tumour in the right parietal lobe.
The pathology report is that of a tumour with an infiltrating edge, necrosis and
vascular endothelial cell proliferation.
What is the MOST likely diagnosis for this lesion?
A.

Ependymoma.

B.

Glioma.

C.

Glioblastoma.

D.

Metastatic carcinoma.

E. Oligodendroglioma.

Question 16
A young man is brought into the Emergency Department by ambulance with a
GCS of 8 (E2 V2 M4), BP 145/75, HR 135, Sats 95% RA and Temp 39.1.
Which of the following investigations is most likely to reveal the cause of this
presentation?
A. ECG
B. Blood sugar level
C. Chest X-ray
D. Lumbar puncture
E. Full blood count
Question 17

Which of the following does NOT apply to multiple sclerosis?

A.

There is demyelination in the grey matter.

B.

Affects mainly women from about 20-50 years of age.

C.

Neurological symptoms and signs are variable.

D.

May present with sudden impairment of vision.

E. Symptoms usually disappear within days or weeks only to recur at a later

time.
Question 18
The pathological features of Alzheimer Disease does NOT include
A. neuritic plaques.
B. neurofibrillary tangles.
C. narrowing of the cerebral sulci.
D. amyloid deposition in blood vessels.
E. ventricular enlargement.

Question 14
A 52 year old woman presents with severe unilateral face and head pain. She
describes it as excruciating stabbing pain triggered by cold air, or by simply
washing her face. Which of the following tests would it be most appropriate to
perform first?
A. ESR
B. MRI brain

C. Plain XR skull
D. Lumbar puncture
E. Temporal artery biopsy

Question 15
A 22 year old boy presents to the Emergency department with a mild head
injury after an assault on the streets. CT head shows an extradural hematoma.
Which one of the following approaches is known to have the best prognosis?
A. Anticoagulation
B. Craniotomy
C. Conservative
D. Lumbar puncture
E. Focal radiotherapy

Question 12
A 66 year old man presents with severe headache.
Which of the following features indicates that urgent management is needed?
A. Severe nausea and vomiting
B. Watery eye
C. Abnormal neurological signs
D. Unilateral localisation
E. Sleep disturbance

Question 13
Which of the following patients is MOST at risk of a cerebral embolus?
A. A young man with congenital pulmonary stenosis
B. A patient with cancer and thrombophlebitis in the leg
C. Young woman on the OCP, after a long flight
D. A 45 year old man with rheumatic tricuspid regurgitation
E. A 68 year old man with a prosthetic aortic valve

Question 10
A 23 year old woman presents complaining of blurred vision since waking that
morning. She had a similar incident the previous year, but it resolved
spontaneously after a couple of hours. She is well otherwise, and has no
headache. On questioning she admits to having had one bout of bladder
problems (urgency and hesitancy) a few months ago, but says no bacteria
were found in her urine.
Which of the following is the most likely cause of her symptoms?
A. Pituitary adenoma
B. Cerebellar astrocytoma
C. Sub-acute combined degeneration of the cord
D. Multiple sclerosis
E. Chronic viral encephalitis.

Question 11
Drugs are avoided in Parkinsons disease until clinically necessary. Which of
the following statements best describes the rationale for this strategy?
A. Drugs do not alter the natural course of the disease.
B. Distressing side effects such as nausea, vomiting, confusion and
hallucinations are common, appear early, and affect compliance.
C. Medication is not subsidised by the PBS and the cost is a serious limiting
factor for many patients in the age group.
D. Stereotactic surgery is less successful in patients who have used medication
for Parkinsons disease for a number of years.

E. Efficacy falls off and major distressing and irreversible side effects can appear
after several years treatment.

Question 8.
The organism most commonly isolated from burn wounds is
A. Staphyloccus aureus
B. Pseudomonas aeroginosa
C. Streptococcus pyrogenes
D. Bacteroides fragilis

E. Proprionibacterium acnes

Question 9
A young man is brought into the Emergency Department by ambulance with a
GCS of 8 (E2 V2 M4), BP 145/75, HR 135, Sats 95% RA and Temp 39.1.
Which of the following investigations is most likely to reveal the cause of this
presentation?
A. ECG
B. Blood sugar level
C. Chest X-ray
D. Lumbar puncture
E. Full blood count

Question 5
Which of the following organisms would be MOST likely to be considered a
contaminant if grown from a blood culture?
A. Coagulase negative staphylococci
B. Corynebacterium spp
C. Bacillus spp
D. Proprionibacterium acnes
E. Enterococcus faecalis

Question 6
Why would infections of the scalp give rise to encephalitis?
A. Skin in the scalp is thin.
B. Abundant sebaceous glands on the scalp.
C. Presence of emissary veins in the scalp.

D. The epicranial aponeurosis lacks a bony attachment.

E. The pericranium is fused with the sutures between the skull bones.

Question 7
Shock in burn patients is primarily due to
A. Neurogenic factors
B. Hypovolemia
C. Acute haemolysis
D. Myocardial depression
E. Associated haemorrhagic injuries

Question 3
The resistance of various strains of bacteria to beta-lactam drugs is of
increasing concern due to the lack of efficacy of a number of antibiotic drugs
in treating the diseases they cause. A mechanism through which bacteria DO
NOT acquire and exhibit resistance to beta-lactams is
A. acylation of the beta-lactam ring caused by an overexpression of bacterial
beta-lactamases.
B. changes in bacterial cell wall porins which alter drug influx.
C. expression of a bacterial enzyme which modifies the pentapeptide involved in
cell wall peptide cross-linking.
D. production of modified penicillin binding proteins with poor affinity to betalactams.
E. acquisition of a bacterial plasmid via conjugation from a neighbouring resistant
bacterial cell of a different strain.
Question 4
A patient suffering from a serious cryptococcal meningitis infection is
administered a lipid formulation of amphotericin B. The molecular actions of
this drug on target fungal cells involve
A. increased expression of toxic sterols following binding to fungal cell
membrane porins.
B. formation of pores in fungal cell membranes leading to leakage of intracellular
contents.
C. direct inhibition of squalene epoxidase, thereby reducing intracellular
lanosterol concentrations .
D. blockade in the formation of ergosterol by inhibition of cytochrome P450 51.
E. preferential binding to fungal cell membranes which causes cell clumping and
cell death.

Question 1
Which of the following organisms would be LEAST likely to be considered a
contaminant if grown from a blood culture?
A. Coagulase negative staphylococci
B. Corynebacterium spp
C. Bacillus spp
D. Proprionibacterium acnes
E. Enterococcus faecalis
Question 2
With respect to the structure of the spleen, which of the following is correct?
A. The white pulp is the myeloid component of the spleen and is responsible for
immune function.
B. The germinal centre is composed of numerous T lymphocytes and rare B
lymphocytes.
C. The red pulp is composed of vascular sinuses and is responsible for the
filtration function.
D. The mantle zone is composed predominantly of T-lymphocytes.
E. The marginal zone is composed of B-cells only, and is the site of antigen
trapping.