2005a_Paper 1 – Medical Sciences

Question 1

A study is comparing the bioavailability of a new oral preparation of a drug (100 mg tablet) with the marketed intravenous preparation (50 mg in 2 mLs). In this crossover study, healthy volunteers were given in random order one 100 mg tablet or 50 mg intravenously (IV). The drug has linear kinetics within the range of concentrations studied. The mean results are as follows:
Which of the following is the best estimate of the oral bioavailability of the tablet?

Accepted Answer

D. 90%.

Answer

A. 12.5%.

Answer

B. 40 %.

Answer

C. 50%.

Answer

E. 96%.

Question 2

Which one of the following is the predominant stimulus to gastric acid secretion in a healthy individual?

Accepted Answer

B. Gastrin.

Answer

A. Acetylcholine.

Answer

C. Histamine.

Answer

D. Calcium.

Answer

E. Somatostatin.

Question 3

With which of the following viruses is cancer of the cervix most strongly associated?

Accepted Answer

C. Human papilloma virus (HPV).

Answer

A. Epstein-Barr virus (EBV).

Answer

B. Cytomegalovirus (CMV).

Answer

D. Human immunodeficiency virus (HIV).

Answer

E. Herpes simplex virus (HSV).

Question 4

Diabetic neuropathic arthropathy is most likely to affect which of the following areas?

Accepted Answer

B. Mid-foot.

Answer

A. Knee.

Answer

C. 1st metatarsophalangeal joint.

Answer

D. Elbow.

Answer

E. Ankle.

Question 5

In a patient with IgA nephropathy who has a serum creatinine in the normal range, which of the following is the best predictor of developing end-stage renal failure?

Accepted Answer

D. Level of proteinuria.

Answer

A. Urine red cell count.

Answer

B. Serum IgA level.

Answer

C. Creatinine clearance.

Answer

E. Blood pressure.

Question 6

Which of the following mechanisms best describes the mode of action of the sulphonylurea class of drugs?

Accepted Answer

C. Stimulates insulin secretion.

Answer

A. Stimulates insulin synthesis.

Answer

B. Enhances insulin binding to the beta cell insulin receptor.

Answer

D. Stimulates conversion of proinsulin to insulin and C-peptide.

Answer

E. Stimulates beta cell proliferation

Question 7

The relationship of the left ventricular pressure to volume throughout a single cardiac cycle (Pressure-Volume Loop) is recorded on two occasions in an intact anaesthetised animal, before (control) and during an intravenous infusion of a pharmacological agent (treatment). The results are shown below.
Which of the following agents is most likely to have been infused?

Accepted Answer

A. Noradrenaline.

Answer

B. Glyceryl trinitrate.

Answer

C. Metoprolol.

Answer

D. Isoprenaline.

Answer

E. Metaraminol.

Question 8

Headache, blindness and jaw claudication secondary to end-organ ischaemia are common clinical manifestations of temporal arteritis (giant cell arteritis). Which of the following most accurately describes the common pathophysiologic mechanism of end-organ ischaemia in this condition?

Accepted Answer

A. Luminal occlusion secondary to concentric intimal hyperplasia.

Answer

B. Thrombotic occlusion of medium arteries.

Answer

C. Spasm of medium and large arteries.

Answer

D. Aneurysm formation, haemorrhage and rupture.

Answer

E. Arterial dissection, haemorrhage and rupture.

Question 9

Which of the following transfusion-related events is most frequently reported (episodes/unit transfused) with transfusion of unmodified red cells?

Accepted Answer

B. Febrile non-haemolytic transfusion reaction.

Answer

A. Acute haemolytic transfusion reaction.

Answer

C. Transmission of hepatitis B.

Answer

D. Graft-versus-host disease.

Answer

E. Transfusion-associated acute lung injury.

Question 10

Which of the following anticonvulsant drugs is most likely to cause weight gain in young women?

Accepted Answer

C. Sodium valproate.

Answer

A. Topiramate.

Answer

B. Lamotrigine.

Answer

D. Carbamazepine.

Answer

E. Phenytoin.

Question 11

The mechanism by which specific information encoded by viral DNA is transferred to messenger RNA (mRNA) is:

Accepted Answer

B. transcription.

Answer

A. translation.

Answer

C. reverse transcription.

Answer

D. transduction.

Answer

E. conjugation.

Question 12

Which intervention has been best demonstrated to extend maximal life span in animals?

Accepted Answer

D. Caloric restriction.

Answer

A. Exercise.

Answer

B. Antioxidants.

Answer

C. Hormonal replacement.

Answer

E. Immunisation.

Question 13

In patients with a certain genetic disorder, more than 95% of the abnormal genes have the same mutation. Analysis of a highly polymorphic locus in an intron of the gene shows similar allele frequencies in patients as in the general population.
Which one of the following genetic mechanisms is least likely to account for the predominance of one mutation in patients with this disorder?

Accepted Answer

B. Founder effect (i.e. a historical population “bottleneck”).

Answer

A. Gene conversion involving a related pseudogene.

Answer

C. Selective advantage for carriers with the mutation.

Answer

D. Gene rearrangements due to repetitive sequences flanking an exon.

Answer

E. Highly mutable DNA sequence at one point in the gene.

Question 14

A 60-year-old male presents with worsening dysphagia for solid and liquid food. Manometry is shown above (reference normal on left, patient tracing on right). The most likely diagnosis is:

Accepted Answer

C. achalasia.

Answer

A. hiatus hernia.

Answer

B. gastroesophageal reflux.

Answer

D. distal oesophageal malignancy.

Answer

E. presbyoesophagus.

Question 15

A 58-year-old male is referred with breathlessness on exercise. He has smoked 20 cigarettes/day since the age of 13. He completed his electrician's apprenticeship at a naval dockyard, and worked in the construction industry until sustaining a back injury and retiring at the age of 50 years. A chest X-ray is reported as abnormal and a thoracic computed tomography (CT) scan (shown opposite) is performed.
The CT scan appearances are most characteristic of which one of the following conditions?

Accepted Answer

B. Asbestos-related pleural disease.

Answer

A. Emphysema.

Answer

C. Pulmonary fibrosis.

Answer

D. Silicosis.

Answer

E. Asbestosis.

Question 16

A test has a sensitivity of 95% and a specificity of 90%. It is used to screen the general population for a rare condition that has a prevalence of 1 in 100,000.
What will the positive predictive value be nearest to?

Accepted Answer

A. 0.01%.

Answer

B. 0.05%.

Answer

C. 0.1%.

Answer

D. 0.5%.

Answer

E. 1%.

Question 17

In addition to decreased gastrointestinal calcium absorption, by which of the following mechanisms is prednis(ol)one most likely to cause net bone loss in a 65-year-old man?

Accepted Answer

D. Direct suppression of osteoblast function.

Answer

A. Increased renal calcium loss.

Answer

B. Reduced 1,25 (OH)2 vitamin D formation.

Answer

C. Reduced testosterone production.

Answer

E. Reduced adrenal androgen production.

Question 18

A 67-year-old woman develops symptomatic anaemia and jaundice nine days after subtotal colectomy for adenocarcinoma of the colon, at the time of which she received a transfusion of 3 units of red cells. She is on therapy (which includes sulfasalazine) for ulcerative colitis.
Review of the pre-operative antibody screen shows this to be negative for red cell alloantibodies.
Her current full blood examination includes the following:
haemoglobin 82 g/L [120-155]
mean cell volume 99 fL [80-97]
reticulocyte count 162 x 109/L [8-104]
Her blood film is shown below.
The most likely cause of her anaemia is:

Accepted Answer

D. delayed haemolytic transfusion reaction.

Answer

A. iron deficiency.

Answer

B. peri-operative blood loss.

Answer

C. red cell aplasia.

Answer

E. megaloblastosis.

Question 19

A patient with aortic regurgitation has the following haemodynamic measurements:
cardiac output (CO) 7.5 L/minute
heart rate (HR) 75/minute
left ventricular end-diastolic volume (LVEDV) 200 mL
left ventricular end-systolic volume (LVESV) 50 mL
The regurgitant fraction is defined as the ratio of the regurgitant volume to the total volume flowing through the valve with each beat.
The regurgitant fraction in this patient is:

Accepted Answer

B. 33%.

Answer

A. 25%.

Answer

C. 50%.

Answer

D. 67%.

Answer

E. 75%.

Question 20

Which of the following best describes the antiviral effect of zanamivir on the influenza virus?

Accepted Answer

B. Inhibition of viral neuraminidase.

Answer

A. Inhibition of M2 ion channel activity.

Answer

C. Competitive blocking of surface haemagglutinins.

Answer

D. Inhibition of reverse transcriptase.

Answer

E. Inhibition of DNA polymerase.

Question 21

A 60-year-old man with a five-year history of type 2 (non-insulin-dependent) diabetes mellitus presents for a routine checkup. The most appropriate screening test for the presence of diabetic nephropathy is:

Accepted Answer

D. spot urine albumin/creatinine ratio.

Answer

A. serum creatinine level.

Answer

B. spot urine albumin concentration.

Answer

C. 24 hour urine protein excretion.

Answer

E. 12 hour urinary albumin excretion rate.

Question 22

A patient is taking Drug A for a chronic condition. Drug B is added for a period of time and then stopped. The half-life of both drugs is between 6 and 12 hours. The following graph shows the total and free concentrations of Drug A: before Drug B is added, over the time Drug B is added, and after Drug B is ceased.
The most likely mechanism for the interaction is:

Accepted Answer

A. protein binding displacement.

Answer

B. induction of metabolism.

Answer

C. inhibition of metabolism.

Answer

D. binding in gut.

Answer

E. decreased hepatic blood flow.

Question 23

Which one of the following is the most important consideration in optimising treatment outcome from combination chemotherapy?

Accepted Answer

A. Use drugs partially effective as single agents.

Answer

B. Use drugs with similar toxicity profiles.

Answer

C. Use drugs with similar schedules.

Answer

D. Use drugs with similar treatment free intervals.

Answer

E. Minimise interaction between drugs.

Question 24

A 54-year-old man presents with neck pain. Examination reveals a limited range of movement of the neck. Which feature on the X-ray shown above best explains the limited range of movement?

Accepted Answer

A. Zygoapophyseal joint fusion.

Answer

B. Diffuse disc degeneration.

Answer

C. Upper cervical spine instability.

Answer

D. Calcification of the posterior longitudinal ligament.

Answer

E. Diffuse idiopathic skeletal hyperostosis.

Question 25

Which of the following is most characteristic of healthy ageing muscle?

Accepted Answer

B. Type 2 fiber atrophy.

Answer

A. Type 1 fiber atrophy.

Answer

C. Decreased capillary density.

Answer

D. Decreased oxidative capacity.

Answer

E. Intramuscular lipid accumulation.

Question 26

Which one of the following best explains the mechanism of trigeminal neuralgia?

Accepted Answer

B. Microvascular compression.

Answer

A. Herpes virus ganglionitis.

Answer

C. Central demyelination.

Answer

D. Vascular steal phenomena.

Answer

E. Trigeminal neuroma.

Question 27

Consider the portion of an exon shown below. The DNA sequence is presented as nucleotide triplets, reflecting the reading frame of the gene. A numbering system for the nucleotides is shown below the sequence.
Which one of the following mutations is least likely to have an effect on the amino acid sequence of the protein encoded by this gene?

Accepted Answer

C. Substitution of the nucleotide at position 6.

Answer

A. Substitution of the nucleotide at position 4.

Answer

B. Substitution of the nucleotide at position 5.

Answer

D. Substitution of the nucleotides at positions 5, 6, and 7.

Answer

E. Substitution of the nucleotides at positions 6, 7, and 8.

Question 28

Which of the following is the strongest predictor of mortality in patients on haemodialysis for chronic renal failure?

Accepted Answer

A. Serum albumin.

Answer

B. Pre-dialysis serum urea.

Answer

C. Urea reduction ratio.

Answer

D. Serum phosphate.

Answer

E. Serum parathyroid hormone.

Question 29

A 22-year-old male presents with his fourth episode of pancreatitis. A computed tomography (CT) scan of the pancreas is shown above. He has two first degree relatives with chronic pancreatitis. There is no other significant family history.
The most likely explanation for his episodes is:

Accepted Answer

D. hereditary pancreatitis.

Answer

A. cystic fibrosis.

Answer

B. alcoholic pancreatitis.

Answer

C. hyperparathyroidism.

Answer

E. haemochromatosis.

Question 30

A 20-year-old male student is referred by his general practitioner with difficulty concentrating and a disturbed sleep pattern. He finds it difficult to stay awake during classes, often needing catnaps during the day, and has to get up at 5 a.m. to complete his course work. His body mass index (BMI) is 31 kg/m2 [18-26]. A polysomnographic sleep study result is shown below.
What is the most likely diagnosis?

Accepted Answer

B. Obstructive sleep apnoea syndrome.

Answer

A. Obesity-hypoventilation syndrome.

Answer

C. Narcolepsy.

Answer

D. Periodic leg movement disorder.

Answer

E. Cataplexy.

Question 31

Which one of the following cells of the immune system is most reliant on its release of mediators into the extracellular fluid surrounding the organism in order to carry out its role in eradication of foreign organisms?

Accepted Answer

B. Eosinophils.

Answer

A. Neutrophils.

Answer

C. Macrophages.

Answer

D. Cytotoxic T lymphocytes.

Answer

E. Natural killer cells.

Question 32

Which of the following findings is most specific for a diagnosis of pernicious anaemia?

Accepted Answer

E. A positive intrinsic factor antibody.

Answer

A. A low serum vitamin B12 level.

Answer

B. An elevated fasting homocysteine level.

Answer

C. An elevated serum gastrin level.

Answer

D. A positive gastric parietal cell antibody.

Question 33

A 36-year-old woman has a very strong family history of premature coronary disease. Physical examination is normal. Fasting lipid profile reveals:
total cholesterol 9.5 mmol/L [2.5-5.2]
high-density lipoprotein (HDL) cholesterol 1.5 mmol/L [0.9-1.8]
triglycerides 2.00 mmol/L [0.10-1.85]
Which abnormality is most likely to be present?

Accepted Answer

D. Low-density lipoprotein (LDL) receptor defect.

Answer

A. apoB 3500 mutation.

Answer

B. Cholesteryl ester transfer protein (CETP) deficiency.

Answer

C. Hypoalphalipoproteinaemia.

Answer

E. Lecithin:cholesterol acetyltransferase (LCAT) deficiency.

Question 34

The most common mechanism for malignant ascites is:

Accepted Answer

C. obstruction of abdominal lymphatics.

Answer

A. cardiac failure.

Answer

B. hypoalbuminaemia.

Answer

D. portal hypertension.

Answer

E. portal vein thrombosis.

Question 35

Drugs A and B have the following properties in healthy individuals:
In such healthy individuals, haemodialysis shortens the half-life of drug A much more than it shortens the half-life of drug B. This difference is best explained by which of the following characteristics of drug B?

Accepted Answer

A. Higher volume of distribution.

Answer

B. Much higher renal clearance.

Answer

C. Higher plasma protein binding.

Answer

D. Higher molecular weight.

Answer

E. Lower hepatic clearance

Question 36

In a patient with unilateral facial weakness, which one of the following findings on physical examination most strongly suggests a peripheral cause for the facial weakness?

Accepted Answer

C. Loss of taste.

Answer

A. Frontalis weakness.

Answer

B. Associated lateral rectus weakness.

Answer

D. Facial numbness.

Answer

E. Nystagmus.

Question 37

Which of the following best describes the changes in regional deposition of adipose tissue that occur with ageing?
Key to symbols: ↓ = decrease
↑ = increase

Question 38

A 40-year-old woman with a 20-year history of systemic lupus erythamatosus (SLE) presents with severe anterior chest pain, dyspnoea and nausea.
Her SLE has manifested previously as arthritis, rash, mucosal ulceration and focal proliferative glomerulonephritis. She has had two miscarriages and delivered two normal children. Treatment has included hydroxychloroquine, prednis(ol)one in doses of 7.5 mg to 100 mg daily, intermittent cyclophosphamide and azathioprine. At presentation she is taking prednis(ol)one 7.5 mg daily and hydroxychloroquine.
Physical examination reveals obesity, pulse rate of 105/minute, blood pressure of 105/75 mmHg, normal heart sounds, and clear lung fields. The jugular venous pulse and pressure are obscured by fat.
Laboratory results show:
haemoglobin 124 g/L [115-165]
white cell count 3.4 x109/L [3.5-11.0]
lymphocytes 0.9 x109/L [1.5 – 4.0]
erythrocyte sedimentation rate (ESR) 35 mm/hr [0-20]
ECG shows ST-segment elevation in the anterior chest leads and sinus tachycardia. During the assessment, the patient develops ventricular fibrillation and dies. Which of the following is the most likely cause of her death?

Accepted Answer

D. Coronary atherosclerosis.

Answer

A. Vasculitis involving the coronary arteries.

Answer

B. Libman-Sacks endocarditis with coronary artery embolisation.

Answer

C. Viral myocarditis.

Answer

E. Pericardial effusion with tamponade.

Question 39

A 35-year-old man presents with several weeks of generalised unwellness, epigastric pain, vomiting and headaches. He has no past medical history of note. He has a smoking history of 15 pack years and uses daily cannabis. He has been holidaying at the beach for the summer and is tanned. He is mildly dehydrated. The rest of the physical examination is unremarkable.
Blood tests show:
sodium 139 mmol/L [138-145]
potassium 5.4 mmol/L [3.5-5.2]
corrected calcium 3.10 mmol/L [2.15-2.57]
phosphate 1.50 mmol/L [0.87-1.45]
urea 10.4 mmol/L [3.5-8.0]
creatinine 0.32 mmol/L [0.05-0.12]
parathyroid hormone 0.6 pmol/L [1.6-6.2]
His chest X-ray is shown below.
What mechanism best explains the hypercalcaemia?

Accepted Answer

C. Increased 1,25(OH)2-vitamin D synthesis.

Answer

A. Secretion of parathyroid hormone-related peptide (PTHrP).

Answer

B. Increased bone resorption.

Answer

D. Reduced renal clearance of calcium.

Answer

E. Mineralocorticoid deficiency.

Question 40

Which of the following is most likely to cause predominantly zone 1 (periportal) rather than zone 3 (centrilobular) liver pathology?

Accepted Answer

E. Primary biliary cirrhosis.

Answer

A. Alcohol.

Answer

B. Paracetamol.

Answer

C. Morbid obesity.

Answer

D. Budd-Chiari syndrome.

Question 41

During normal haemostasis, von Willebrand factor (vWF) plays a role in platelet adhesion/aggregation. During this process, which of the following is the primary binding site of vWF to platelets?

Accepted Answer

B. Platelet glycoprotein Ib-IX-V.

Answer

A. Collagen receptor.

Answer

C. Adenosine diphosphate receptor.

Answer

D. Platelet glycoprotein IIb-IIIa.

Answer

E. Ristocetin.

Question 42

Which of the following is the most effective therapy for hyperphosphataemia associated with chronic renal failure?

Accepted Answer

B. Oral phosphate binders.

Answer

A. Low phosphate diet.

Answer

C. Parathyroidectomy.

Answer

D. Vitamin D analogues.

Answer

E. Low protein diet.

Question 43

Many familial disorders are due to mutations in genes for transcription factors. Which of the following statements is the best description of the role of a transcription factor? It:

Accepted Answer

E. regulates the binding of RNA polymerase

Answer

A. generates an RNA template.

Answer

B. is a component of the ribosome.

Answer

C. regulates the binding of DNA polymerase.

Answer

D. regulates the polyadenylation of messenger RNA (mRNA).

Question 44

Which of the following most accurately reflects the mechanism of complement consumption induced by complement component 3 (C3) nephritic factors?

Accepted Answer

D. Stabilisation of the C3 convertase, C3bBb.

Answer

A. Activation of the classical complement pathway.

Answer

B. Stabilisation of the membrane attack complex, C5-9.

Answer

C. Amplification of C3 “tickover”.

Answer

E. Inhibition of the complement regulator, Factor I.

Question 45

Which of the following is the most important reason for not recommending gentamicin for the treatment of coliform central nervous system (CNS) infections?

Accepted Answer

C. It has poor CNS penetration.

Answer

A. It is not active in an acidic environment.

Answer

B. It is not active in a low oxygen tension environment.

Answer

D. It may precipitate seizures.

Answer

E. Ototoxicity risk is accentuated

Question 46

An asymptomatic 45-year-old male with no risk factors for coronary artery disease (CAD) is sent by his general practitioner to have an exercise ECG. At peak exercise, the heart rate is 160/minute and there is 0.7 mm of horizontal ST depression. The relationship between pre-test and post-test probability of significant coronary artery disease is shown below according to the ECG changes occurring at maximal exercise.
What is the probability that this man has significant CAD?

Accepted Answer

E. 1-10%.

Answer

A. 41-50%.

Answer

B. 31-40%.

Answer

C. 21-30%.

Answer

D. 11-20%.

Question 47

The most common identifiable cause of epilepsy in the elderly is:

Accepted Answer

A. cerebrovascular disease.

Answer

B. traumatic injury.

Answer

C. Alzheimer’s disease.

Answer

D. tumours.

Answer

E. alcohol.

Question 48

A 40-year-old woman treated for Hodgkin’s disease in her early twenties with mantle radiotherapy is at highest risk of which of the following cancers?

Accepted Answer

A. Breast.

Answer

B. Lung.

Answer

C. Thyroid.

Answer

D. Lymphoma.

Answer

E. Sarcoma.

Question 49

A 47-year-old male presents with haemoptysis on a background of a 47 pack year smoking history. A chest X-ray shows an irregular mass lesion in the right lower lobe, and sputum examination reveals large undifferentiated malignant cells.
Which of the following is the most sensitive method of determining if the mediastinal lymph nodes are involved with the disease?

Accepted Answer

E. Positron emission tomography (PET).

Answer

A. Gallium scan.

Answer

B. Standard thoracic computed tomographic (CT) scanning.

Answer

C. High resolution computed tomographic (CT) scanning.

Answer

D. Magnetic resonance imaging (MRI).

Question 50

The deterioration in glycaemic control over time seen in patients with type 2 (non-insulin-dependent) diabetes mellitus is primarily due to:

Accepted Answer

D. decreasing insulin secretion.

Answer

A. medication non-compliance.

Answer

B. increasing insulin resistance.

Answer

C. increasing obesity.

Answer

E. reduced energy expenditure.

Question 51

In a study of polymorphisms in the gene encoding the β2-adrenergic receptor, 20% of people were heterozygous for a polymorphism at codon 16 and 22% were heterozygous for a polymorphism at codon 27.
18% of the population were heterozygous at both loci.
Which one of the following statements is the best explanation for this observation?

Accepted Answer

A. Linkage disequilibrium between the two polymorphisms.

Answer

B. Low frequency of recombination between the two polymorphisms.

Answer

C. Co-inheritance of the two polymorphisms providing a selective advantage.

Answer

D. Intragenic cross-over between the two codons.

Answer

E. Variable triplet repeat expansion between the two codons.

Question 52

A test is used to screen for a target disorder.
The best definition of the specificity of the test is “the proportion of individuals:

Accepted Answer

B. without the target disorder who have a negative result”.

Answer

A. with the target disorder who have a positive test result”.

Answer

C. with a positive test result who have the target disorder”.

Answer

D. with a negative test result who do not have the target disorder”.

Answer

E. with or without the target disorder who have a correct result”.

Question 53

Of the following conditions, which has the greatest contraindication to therapy with bupropion (Zyban) for smoking cessation?

Accepted Answer

C. Epilepsy.

Answer

A. Depression.

Answer

B. Anxiety.

Answer

D. Peptic ulceration.

Answer

E. Ischaemic heart disease.

Question 54

With advancing age, there is an increase in collagen content in the wall of the aorta associated with fragmentation of elastin fibres. These structural changes are thought to have an important influence on the aortic pulse, systemic pressure, and ventricular performance. The table below provides a selection of possible changes in aortic function.
Which changes are most commonly seen with advancing age?
Key: Change (with advancing age): ⇔ = no change; ⇑ = increase; ⇓ = decrease.

Accepted Answer

B

Answer

A

Answer

C

Answer

D

Answer

E

Question 55

In therapy with immunosuppressive drugs (the relevant drugs are shown in brackets), knowledge of which of the following genotypes is most likely to be useful in preventing serious adverse drug events?

Accepted Answer

A. Thiopurine methyltransferase (azathioprine).

Answer

B. CYP3A4 (cyclosporin).

Answer

C. Dihydrofolate reductase (methotrexate).

Answer

D. Type II glucocorticoid receptor (prednis(ol)one).

Answer

E. Plasma cholinesterase (cyclophosphamide).

Question 56

Carbimazole acts predominantly by inhibiting which of the following mechanisms?

Accepted Answer

B. Thyroid peroxidase activity.

Answer

A. Sodium/iodide (Na/I) symporter.

Answer

C. Binding of thyroxine to thyroid binding globulin.

Answer

D. Thyroglobulin synthesis.

Answer

E. 5’-deiodinase activity.

Question 57

A 57-year-old male presents with progressive breathlessness on exercise over five years. His lung function tests are shown above.
What is the most likely diagnosis from the lung function tests?

Accepted Answer

C. Emphysema.

Answer

A. Chronic bronchitis.

Answer

B. Pulmonary fibrosis.

Answer

D. Bronchiectasis.

Answer

E. Asthma.

Question 58

Liberation of dietary cobalamin from R-proteins would be most likely to be adversely affected by:

Accepted Answer

B. pancreatic insufficiency.

Answer

A. ileal resection.

Answer

C. coeliac disease.

Answer

D. Crohn’s disease.

Answer

E. Helicobacter pylori chronic gastritis.

Question 59

The most common cause of chronic incontinence in the elderly is:

Accepted Answer

C. urge.

Answer

A. stress.

Answer

B. overflow.

Answer

D. urinary infection.

Answer

E. delirium.

Question 60

Intravenous infusion of which of the following blood components is most likely to be associated with a septic transfusion reaction?

Accepted Answer

D. Platelet concentrate.

Answer

A. Red cell concentrate.

Answer

B. Fresh frozen plasma.

Answer

C. Pooled gammaglobulin.

Answer

E. Cryoprecipitate.

Question 61

In the treatment of hepatitis C infection with interferon and ribavirin, which one of the following is the best predictor of sustained virological response?

Accepted Answer

B. Viral genotype.

Answer

A. Serum bilirubin.

Answer

C. Gender.

Answer

D. Viral load.

Answer

E. Portal fibrosis.

Question 62

Efalizumab is a humanized monoclonal antibody active against an adhesion molecule (CD11a) and is used in the treatment of psoriasis. Which of the following is the best explanation for the therapeutic effect of efalizumab?

Accepted Answer

A. Interference with extravasation of circulating T lymphocytes into skin.

Answer

B. Depletion of peripheral blood T lymphocyte numbers.

Answer

C. Inhibition of cytokine secretion by phagocytes.

Answer

D. Inhibition of chemokine secretion by epithelial cells.

Answer

E. Interference with danger signals released from inflamed skin.

Question 63

Which one of the following patterns of electrolyte changes is most consistent with tumour lysis?
Key to symbols: ↓ = decrease
↑ = increase

Accepted Answer

D

Answer

A

Answer

B

Answer

C

Answer

E

Question 64

A 24-year-old is noted to have persistent microscopic haematuria following an insurance examination. Which one of the following factors provides the strongest indication for a renal biopsy?

Accepted Answer

C. Proteinuria 0.9 g/day [<0.12].

Answer

A. 90 glomerular red cells/μl in the urine [<10].

Answer

B. Blood pressure 145/80 mmHg.

Answer

D. Serum creatinine 105 μmol/L [60-120].

Answer

E. Male gender.

2005a_Paper 1 – Medical Sciences

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