MED2031 Mid Semester Practice Exam

MED2031 Mid Semester Practice Exam 2010

Respiratory Physiology1. Muscles used in passive expiration includea. Diaphragmb. External intercostalsc. Internal intercostalsd. No muscles are usede. Innermost intercostals

2. What is the residual volume in spirometry?a. Amount of air remaining in lungs after maximum expirationb. Amount of air that is exhaled when breathing with maximum forcec. Air inhaled or exhaled when breathing at restd. Total volume of air that can be breathed in and oute. Maximum amount of air that can be inhaled apart from that which is breathed in at rest

3. What is vital capacity?a. Amount of air remaining in lungs after maximum expirationb. Amount of air that is exhaled when breathing with maximum forcec. Air inhaled or exhaled when breathing at restd. Total volume of air that can be breathed in and oute. Maximum amount of air that can be inhaled apart from that which is breathed in at rest

4. What is inspiratory reserve volume?a. Amount of air remaining in lungs after maximum expirationb. Amount of air that is exhaled when breathing with maximum forcec. Air inhaled or exhaled when breathing at restd. Total volume of air that can be breathed in and oute. Maximum amount of air that can be inhaled apart from that which is breathed in at rest

5. What is tidal volume?a. Amount of air remaining in lungs after maximum expirationb. Amount of air that is exhaled when breathing with maximum forcec. Air inhaled or exhaled when breathing at restd. Total volume of air that can be breathed in and oute. Maximum amount of air that can be inhaled apart from that which is breathed in at rest

6. What is the anatomical dead space?a. About 2Lb. Volume in non-functioning alveolic. Volume of conducting airways, nasal cavity and pharynxd. Equal to physiological dead space if pathology presente. Space in lungs to which air cannot penetrate

7. What is the physiological dead space?a. Sum of anatomical dead space and volume in non-functioning alveolib. Volume in non-functioning alveolic. Volume of conducting airways, nasal cavity and pharynxd. Equal to anatomical dead space if pathology presente. Space in lungs to which air cannot penetrate

8. Obstructive lung disease isa. Reduced pulmonary complianceb. Reduced lung elasticityc. Can be caused by fibrosisd. Can be caused by asthmae. Decreased airway resistance

9. What is the equation for minute volume?a. Respiratory rate x tidal volumeb. Vital capacity x tidal volumec. Respiratory rate x (tidal volume anatomical dead space)d. Tidal volume x respiratory ratee. Respiratory rate x physiological dead space

10. What is the equation for alveolar ventilation?a. Respiratory rate x tidal volumeb. Vital capacity x tidal volumec. Respiratory rate x (tidal volume anatomical dead space)d. Tidal volume x respiratory ratee. Respiratory rate x physiological dead spaceVolume of air moved in alveoli in 1 minute

11. Factors affecting rate of gas diffusion include the following excepta. Thickness of membraneb. Surface area of membranec. Diffusion coefficient of gasd. Pressure difference across membranee. Amount of viable alveoli

12. The diffusion coefficient of oxygen is higher than that of carbon dioxidea. Trueb. False

13. The partial pressure of oxygen (PO2) in the alveolus is:a. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

14. The PO2 in the pulmonary veins isa. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

15. The PO2 in the blood leaving tissues is:a. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

16. The PCO2 in the alveoli isa. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

17. The PCO2 in the pulmonary veins isa. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

18. The PCO2 in the blood leaving tissues isa. 104mmHgb. 40mmHgc. 95mmHgd. 45mmHge. 23mmHg

19. Select the incorrect response. The Bohr effect a. Is a property of haemoglobinb. States that an increase in carbon dioxide decreases Hb saturation of oxygenc. Causes can increased amount of oxygen unloaded to tissuesd. Causes an increased oxygen uptake in alveolie. Is more pronounced when PO2 is higher

20. The utilisation coefficient of oxygen isa. About 25% and decreases during exerciseb. About 50% and increases during exercisec. About 25% and increases during exercised. About 50% and decreases during exercisee. 100% and increases during exercise

21. Carbon dioxide is transported in the blood in the following ways except:a. CO2b. HbCO2c. HCO3-d. O2.CO2e. D and A

22. Select the incorrect response. The Haldane effect:a. States that binding of O2 to Hb displaces CO2 from bloodb. Increases efficiency of movement of CO2 from blood to alveoli then external airc. Is due to OxyHb binding CO2 less strongly than dexoyhaemoglobind. Is due to increased acidity when OxyHb increasese. Reduces the amount of carbon dioxide removed from tissues

23. Which of the statements about ventilation is false?a. Ventilation = (Vt- dead space) x respiratory rateb. Is equal to perfusion in healthy peoplec. Is usually about 5L/mind. Is increased near base of lunge. Ventilation: perfusion ratio is equal in all areas of the lungs

24. Which of the following is false?a. In zone 1 the alveolar air pressure is greater than pulmonary capillary pressureb. Zone 1 is pathologicalc. In zone 2 there is intermittent blood flow through pulmonary capillaries during systoled. Zone 3 normally occurs 10 cm above heart when standinge. In zone 3 the capillary pressure is greater than the alveolar pressure

25. The alveoli at the apex contribute less to tidal volume than alveoli at base due to:a. Smaller alveoli which can be expanded more in the baseb. Gravityc. Increased perfusion near base of lungd. Increased pressure near base of lungse. Decreased ventilation: perfusion ratio at apex of lungs

26. Select the incorrect response. Hypoxic pulmonary vasoconstrictiona. Lowers efficiency of gas exchangeb. Is the opposite to what happens in tissuesc. Reduces blood flow to areas with low ventilationd. Helps to match V:Q ratioe. Increases V:Q ratio

27. Select the incorrect response. In emphysemaa. Lowered ventilationb. Lowered perfusionc. Enlargement of alveolid. Overall increase in V:Q ratioe. Manifests as pink puffers and blue bloaters

28. The dorsal respiratory group:a. Is in the ponsb. Contains inspiratory and expiratory neuronsc. Receives input from glossopharyngeal and vagal nervesd. Used in heavy breathinge. Regulates the shift from inspiration to expiration

29. Which of the following is false? The ventral respiratory groupa. Contains inspiratory and expiratory neuronsb. Used in heavy breathingc. Receives input from DRGd. Is activated when respiratory drive is increasede. Regulates shift from inspiration to expiration

30. Select the incorrect response. The pneumotaxic centrea. Is in the ponsb. Occurs in the nucleus ambiguous and nucleus retroambiguousc. Switches off inspiratory rampd. Controls duration of expiratione. Has low output to slow the respiratory rateNucleus parabrachialis is pneumotaxic centre.

31. Sensory receptors providing information to respiratory centres include the following except:a. Central chemoreceptors which response to pH changes in CSFb. Peripheral chemoreceptors which are found in the carotid arteries and aortac. Baroreceptors which respond to blood pressured. Stretch receptors are found in the smooth muscle of bronchi and bronchioles and visceral pleurae. Irritant receptors in the epithelial cells of airways

32. Carbon dioxide is the major factor controlling ventilation in the short terma. Trueb. False

33. Ventilation increases with exercise because:a. Brain sends collateral signals to respiratory centres at same time that it signals to muscles to commence exercisingb. Decreased O2 in bloodc. Increased CO2 in bloodd. Decreased pHe. Muscle and joint proprioceptor response

34. Other factors that control ventilation include the following except:a. Irritantsb. Drugsc. Brain damaged. J receptorse. Blood pressure changes

35. Acid production in the body:a. Only occurs via glucose breakdownb. Only occurs via amino acid breakdownc. Produces mainly respiratory acidd. Produces mainly metabolic acide. Is a product of renal outflow

36. A small change in pH equals a large change in [H+]a. Trueb. False

37. The normal pH of arterial blood isa. 7.35b. 7.4c. 7.2d. 0.7e. 8.138. The normal pH of venous blood isa. 7.35b. 7.4c. 7.2d. 0.7e. 8.1

39. The mechanisms for maintaining pH include the following except:a. Bufferingb. Diffusion c. Respirationd. Renal excretione. B and D

40. Select the incorrect response. A buffera. Sequesters H+b. Does not get rid of H+c. Works best if the pKa is equal to the pH of the fluid it is bufferingd. Includes HCO3-, haemoglobin, plasma proteins and phosphatee. Reduces pH

41. Normal CO2 pressure in arterial blood is:a. 40nmb. 40mmHgc. 45mmHgd. 24mMe. 7.4

42. Normal [H+]a. 40nMb. 40mmHgc. 45mmHgd. 24mMe. 7.4

43. Normal HCO3-a. 40nmb. 40mmHgc. 45mmHgd. 24mMe. 7.4

44. An increase in HCO3- will lead toa. Increased pHb. Decreased pHc. Alkalosisd. Acidosise. A and C

45. An increase in CO2 or decrease in O2 in the blood leads to the following excepta. Increase brain ECF [H+]b. Increase in central chemoreceptor firingc. Increase in peripheral chemoreceptors firingd. Increase in medullary inspiratory neurons firinge. Decrease in ventilation

46. Respiratory acidosisa. Arises through low plasma CO2b. pH> 7.45c. paCO2> 45mmHgd. increase in H+ or HCO3- not of respiratory origine. may be a result of hyperventilation

47. Respiratory acidosis can occur in the following ways except:a. Exaggerated V:Q ventopnoeab. Acute lung diseases like pneumonia or asthmatic episodesc. Chronic lung diseases like COPD or cystic fibrosisd. Alteration to central drive for respiration like a head injurye. Neural linkage to respiratory muscles like polio or MS

48. PAO2> PaO2a. Is normalb. Suggests pathologyc. Indicates V:Q mismatchd. Indicates hypoxemia is due to ventilation and not underlying lung disordere. B and C

49. Sleep is important for the following excepta. Memoryb. Steroid productionc. Growthd. Immune functione. Protein synthesis

50. Darkness decreases melatonin releasea. Trueb. False

51. Sleep deprivation can lead to the following excepta. Heart failureb. Infection riskc. Decreased vascular reactivityd. Increase sleep latencye. Hypotension

52. Sleep apnoea increases risk of the following excepta. Arrhythmiasb. Hypotensionc. Neuropsychological damaged. Strokee. Heart failure

53. Which of the following about sleep apnoea is false?a. Obstructive sleep apnoea is due to upper airway dysfunctionb. Obstructive sleep apnoea may be the cause of left ventricular failurec. Central sleep apnoea is due to respiratory control dysfunctiond. Central sleep apnoea may be the result of left ventricular failuree. Central sleep apnoea is more likely to occur in obese snorers

54. Treatment of sleep apnoea includes the following excepta. Lifestyle factors like sleep hygiene, weight loss and reduced alcohol intakeb. Upper airway surgery like UPPP or tonsil and adenoid removalc. Bariatric surgeryd. Mouth splints to widen the maxillae. Positive airway pressure

55. The pros of non-invasive ventilation like CPAP include the following except:a. Avoidance of invasive procedures like tracheal intubation which have complicationsb. Keeps upper airway intact which is important in immune defence, swallowing and speechc. Less sedationd. Increased patient comforte. Potential for abrupt deterioration

56. Indications for NIVa. Tachypnoeab. Acidotic (pH< 7.35)c. Hypercapnicd. Heart failuree. All of the above

57. Acclimatisation to lack of oxygen include the following excepta. Hyperventilationb. Polycythemiac. Increased diffusing capacity of lungsd. Pulmonary vasoconstrictione. Decreased tissue capillarity

58. Symptoms of acute mountain sickness include the following excepta. Headache/dizziness/nauseab. Cerebral oedemac. Peripheral oedemad. Increased blood viscosity due to increased RBC mass and haematocrite. Hypoxic pulmonary vasoconstriction

59. Effects of high partial pressures on body includea. Nitrogen narcosisb. Oxygen toxicityc. Hypercapniad. Pulmonary fixatione. A and B

60. To avoid decompression sickness, drop hyperbaric pressure back to normal pressure immediatelya. Trueb. FalseRenal physiology61. Without functioning kidneys, the following could occur excepta. Hypotensionb. Anaemiac. Osteoporosisd. Metabolic acidosise. Hyperkalemia

62. Functions of the kidneys include the following excepta. Regulation of water and electrolyte volume/osmolarityb. Acid-base regulationc. Excretion of metabolic wastesd. Secretion of hormonese. Glycolysis

63. The percentage of total body water which is interstitial fluid isa. 10%b. 40%c. 60%d. 30%e. 1%

64. The volume of which compartment is regulated?a. Plasmab. Interstitial fluidc. Intracellular fluidd. Transcellular fluide. Extracellular fluid

65. What receptor does not monitor changes in ECF volume and composition?a. Low pressure baroreceptorsb. Osmoreceptors in hypothalamusc. Renal baroreceptors which leads to renin released. Adrenal cortexe. Mechanoreceptors

66. The composition of ICF and ECF is identical except fora. Ion concentrationb. Protein contentc. Water concentrationd. Pressuree. Osmolarity

67. What is Starlings Law?a. Fluid moves in direction of sum of forces on each side of membraneb. Equivalent to net driving pressurec. Takes into account colloid osmotic pressure and hydrostatic pressured. A and Be. A, B and C

68. Blood flow to kidneys is what percentage of cardiac output?a. 20-25%b. 10-20%c. 30-50%d. 60%e. 5%

69. Filtration fraction isa. Volume of plasma filtered per minuteb. Glomerular filtration ratec. GFR/renal plasma flowd. Amount of plasma filtered during single pass through kidneye. C and D

70. Which of the following about nephrons is false?a. We are born with the number of nephrons we will have for the rest of our lifeb. Nephrons have a filtration component and a tubular componentc. Nephrons are found in the pelvis of the kidneyd. Nephrons can cross the medulla and cortex of the kidneye. Nephrons are the functional unit of the kidney

71. The cortex contains the Bowmans capsule and convoluted tubulesa. Trueb. False

72. The glomerulus isa. The drainage tubes of the kidneyb. Interconnected specialised capillariesc. The filtration unit of the kidneyd. Contain straight and convoluted tubulese. B and C

73. The tubular system contains the following excepta. Proximal tubulesb. Loop of Henlec. Renal pelvisd. Collecting ducte. Distal tubule

74. What are the steps in urine formation and where do they occur?

75. Name the renal blood supply from the renal artery to the peritubular capillary network

76. The epithelial layer of the glomerular capillaries are made froma. Mesangial cellsb. Simple squamous cellsc. Cuboidal cellsd. Podocytese. Connective tissue

77. The parietal layer of Bowmans capsule is made froma. Simple squamous cellsb. Podocytesc. Capillariesd. Capillary endotheliume. Mesangial cells

78. Fenestrae are found in __________ and are required for ___________a. Podocytes; particle movementb. Endothelial cells; expansionc. Mesangial cells; structure maintenanced. Endothelial cells; particle movemente. Podocytes; expansion

79. Mesangial cells are required for:a. Structure and support of glomerulusb. Diffusion of particlesc. Changing surface area of capillariesd. A and Ce. A and B

80. Nephrin is expressed bya. Podocytesb. Mesangial cellsc. Endothelial cellsd. A and Be. A, B and C

81. Filtration slits exist between ___________ which are found at the end of ____________ which are extensions from the cell body of ____________a. Fenestrations; capillary extensions; endothelial cellsb. Foot processes; pedicles; podocytesc. Fenestrations; pedicles; endothelial cellsd. Foot processes; capillary extensions; podocytese. Aquaporins; ADH; anti naturietic peptide

82. The glomerulus filtration barrier is composed of:a. Endothelial fenestraeb. Glomerular basement membranec. Filtration slit diaphragmsd. A and Be. A, B and C

83. Select the incorrect response. The juxtaglomerular apparatus:a. Consists of a macula densa, juxtaglomerular cells, extraglomerular mesangial cellsb. Monitor salt balancec. Produces renin and thus regulates glomerular filtration and reabsorption of Na+ and waterd. Is responsible for majority of water reabsorptione. Is found at the vascular pole of a renal corpuscle84.

85. What are the forces controlling glomerular filtration rate?a. Glomerular hydrostatic pressureb. Glomerular osmotic pressurec. Bowmans space fluid pressured. All of the abovee. None of the above

86. Glomerular filtration rate is given bya. (PGC PBS - GC ) x Kfb. NFP x Kfc. Hydraulic conductivity x glomerular capillary surface area x NFPd. A and Be. A, B and C

87. In liver diseasea. GFR decreasesb. GFR increasesc. Plasma proteins decreasedd. Plasma proteins increasede. B and C

88. In dehydration, GFR decreasesa. Trueb. False

89. GFR is increased and renal blood flow is maintained bya. Decreased afferent arteriolar pressure and decreased efferent arteriolar pressureb. Increased afferent arteriolar pressure and decreased efferent arteriolar pressurec. Decreased afferent arteriolar pressure and increased efferent arteriolar pressured. Increased afferent arteriolar pressure and increased efferent arteriolar pressuree. All of the above

90. Select incorrect responsea. GFR must be kept relatively constant or changes in reabsorption occurb. GFR is controlled via autoregulationc. The myogenic mechanism of GFR control causes vasoconstriction in efferent arterioles in response to increase blood pressured. The juxtaglomerular apparatus responds to blood pressure by changes in renin releasee. Autoregulation only occurs between arterial pressure of 70-150mmHg

91. What is the definition of renal clearance?

92. The equation for clearance is given by:a. (V x Us)/Psb. V/Psc. (V x Ps)/Usd. Us/Pse. Ps/( V x Us)

93. Which of the following is the most widely used clinically to measure GFRa. Inulinb. Creatininec. Glucosed. Ureae. Para-aminohippurate

94. Which of the following gives the most accurate measurement for GFR?a. Inulinb. Creatininec. Glucosed. Ureae. Para-aminohippurate

95. Which of the following is used to measure renal plasma flow?a. Inulinb. Creatininec. Glucosed. Ureae. Para-aminohippurate

96. How much sodium and how much water is reabsorbed usually?a. 99.5%, >99%b. 90%, 90%c. 99%, 99%d. >99.5%, >99%e. None of the above

Pharmacology98. Rhinosinusitis:a. Is caused by bacteriab. Is treated with antibioticsc. Is treated symptomaticallyd. Is commonly diagnosed via blood culturese. All of the above

99. Pharyngitis and tonsillitisa. Can be caused by strep pyogenesb. Can be caused by viruses like adenovirusc. Can be complicated by peritonsillar abscessesd. Are treated symptomatically and via antibioticse. All of the above

100. Select incorrect response. Otitis externaa. Is caused by bacteria and fungib. Includes symptoms like discharge and itchinessc. Is treated by dry aural toiletd. Is treated with topical antibiotics and steroidse. Is prevented using prophylactic antibiotics

101. Otitis mediaa. Is usually self limitingb. Is caused by viruses or bacteriac. Can present with reddening of tympanic membraned. Treatment is symptomatic usually or amoxycillin if persistent and fever occurse. All of the above

102. Select incorrect response. Sinusitisa. Causes severe facial painb. Causes tenderness over sinusesc. Treatment is valaciclovir given intravenouslyd. Treatment is symptomatice. Usually caused by viruses or allergies not bacteria

103. Croup is caused bya. Haemophilus influenzaeb. Parainfluenza virusc. Rhinovirusd. Adenoviruse. RSV

104. Influenza is treated witha. Vaccinationb. Oseltamivirc. Amoxycillind. Cefaclore. Doxycycline

105. Select incorrect response. Pertussis a. Caused by Bordetella pertussisb. Includes symptoms such as paroxysmal coughing, inspiratory whoop, post-tussive vomitingc. Treated with antibiotics to prevent spreadd. Prevented with vaccinatione. Secondarily caused by Haemophilus pertussis

106. Factors predisposing to fungal infections includea. Moisture and warmthb. Diabetesc. Immunosuppressiond. Obesitye. Broad spectrum antibiotics

107. Sites of action of fungal infection treatment include the following excepta. Cell membrane synthesisb. Nucleic acid synthesisc. Cell membrane integrityd. mRNA synthesise. Cell wall synthesis

108. Clotrimazolea. Affects cell membrane integrityb. Is narrow spectrumc. Is applied topicallyd. Inhibits fungal cell divisione. Has no side effects

109. First line treatment for aspergillosis isa. Terbinafineb. Amphotericinc. Ketoconazoled. Capsofungine. Griseofulvin

110. A major side effect of azoles isa. Renal toxicityb. Allergenic reactionsc. Inhibition of P450 enzymesd. Conversion of lanosterol to ergosterole. Immunosuppression

111. Asthma is caused bya. Inflammationb. Mucus secretionc. Bronchoconstrictiond. All of the abovee. None of the above

112. Intrinsic asthma is caused bya. Hyper-responsive airwaysb. NSAIDsc. Allergic responsed. Degranulation of mast cellse. Antibody release

113. First line treatment for asthma area. Short-acting beta agonistsb. Long-acting beta agonistsc. Steroidsd. Symptom controllerse. Preventers

114. Terbutaline isa. Leukotriene antagonistb. Short-acting beta agonistc. Long-acting beta agonistd. Steroide. Mast cell stabiliser

115. Low dose inhaled corticosteroids or mast cell stabilisers are used for asthmaa. As first line treatmentb. As second line treatmentc. As third line treatmentd. As fourth line treatmente. Are not used

116. Long acting beta agonists are used for asthmaa. As first line treatmentb. As second line treatmentc. As third line treatmentd. As fourth line treatmente. Are not used

117. The drugs classes used to treat angina includea. Nitratesb. Calcium antagonistsc. Beta-antagonistsd. All of the abovee. None of the above

118. Select the incorrect response. Glycerol trinitrate a. Is also called nitroglycerineb. Is extremely volatilec. Lasts less than 30mins if given sublinguallyd. Lasts less than 6 hours if given transdermallye. Is used to cause vasodilation

119. Side effects of nitrates include the following excepta. Hypotensionb. Reflex tachycardiac. Toleranced. Bradycardiae. None of the above

120. Contraindications for nitrates area. Beta blockersb. Calcium antagonistsc. Sildenafild. Amiodaronee. Diuretics

121. Which of the following calcium antagonists is most cardio selective and thus most useful for supraventricular tachycardia?a. Nifedipineb. Amlodopinec. Verapamild. Diltiazeme. Digoxin

122. In angina, beta blockers are used toa. Vasoconstrict skeletal muscles vasculatureb. Vasodilate vasculature in skinc. Decrease heart rated. Decrease paine. Increase water excretion

123. B1 antagonists includea. Atenololb. Metoprolol c. Propranolold. A and Be. A, B and C

124. The drug classes used to treat arrhythmias includea. Calcium channel blockersb. Potassium channel blockersc. Beta-blockersd. Sodium channel blockerse. All of the above

125. An example of a sodium channel blocker isa. Amiodaroneb. Bretyliumc. Sotalold. Flecainidee. Verapamil

126. Which of the following reduce pro-arrhythmic effects of adrenaline and NAa. Metoprololb. Amiodaronec. Lignocained. Diltiazeme. Digoxin

127. A common side effect of beta-blockers isa. Dry coughb. Nauseac. Impotenced. Hypertensione. Immunosuppression

128. Contraindications for beta-blockers include the following excepta. Asthmab. Bradycardiac. Calcium antagonistsd. Dry coughinge. All of the above

129. Drug which prolongs the refractory period to stop arrhythmias includesa. Amiodaroneb. Lignocainec. Dobutamined. Carvedilole. Isoprenaline

130. The drug which converts an arrhythmic heart immediately to sinus rhythm isa. Digoxinb. Adenosinec. Dobutamined. Nifedipinee. Sotalol

131. Which of the following is not given for atrial fibrillation?a. Digoxinb. Ca+ channel blockerc. Beta-blockerd. Adenosinee. Warfarin

132. Which of the following is not given for bradycardia?a. Isoprenalineb. Atropinec. Adrenalined. Metoprolol e. All of the above are given

EMQa) Captoprilb) Losartanc) Carvedilold) Atenolole) Propranololf) Indapamide g) Digoxinh) Dobutaminei) Nitrovasodilators133. Angiotensin II receptor blocker

134. Limited IV use due to desensitisation and decreased beta 1 receptors

135. Used if ACE inhibitors, ARBs and diuretics contraindicated

136. Contraindicated with digoxin

137. Common side effect of this drug is dry cough

138. Has long half life thus must be given with high loading dose

139. Slows heart rateAnatomy140. Where do ribs fracture?a. Anywhere according to traumab. At angle of ribc. Point of greatest curvatured. Lateral border of erector spinaee. Clinical paravertebral linef. All of the above

141. Where is an intercostal catheter usually inserted?a. 2nd ICS paravertebral lineb. 5th ICS anywherec. 2nd ICS mid clavicular lined. 5th ICS anterior to mid axillary linee. C and D

142. Select the incorrect response. Which site is used to insert the intercostal catheter and why?a. Bottom of ICS to avoid bleedingb. Mid clavicular line to avoid internal thoracic arteryc. Mid axillary line for easier accessd. Paravertebral line as there are no vessels here which can bleede. No incorrect response, all of the above are used

143. Why does an intercostal nerve block have to be performed at the lateral limit of erector spinae?a. No reason, just traditionb. Easiest accessc. Dermatomal overlapd. To anaesthetise lateral branche. No intercostal arteries or veins in this area so fewer complications

144. The danger zones of the pleura include the following excepta. Left costoxiphisternal angleb. Right costoxiphisternal anglec. Above lung apicesd. Inferior to left 12th ribe. Inferior to right 12th rib

145. Pleural aspiration is performeda. Usually around 9th/10th ICSb. Anywhere according to clinical investigationc. Lateral border of erector spinaed. A and Be. A, B and C

146. Why do foreign bodies lodge in the right main bronchus more often than left?a. Left; more vertical, shorter, narrowerb. Right; more vertical, shorter, widerc. Left; more horizontal, longer, narrowerd. Right more horizontal, longer, widere. Right; more vertical, longer, wider

147. Where does pneumonia from aspirated fluid most commonly occur?a. Basal segment lower lobe left lungb. Basal segment upper lobe right lungc. Apical segment lower lobe right lungd. Apical segment upper lobe left lunge. Apical segment middle lobe right lung

148. Which of the following about pneumothoraces is correct?a. Pneumothorax is air filling the lungsb. Tension pneumothorax is usually the most dangerous of pneumothoracesc. Spontaneous pneumothoraces commonly occur in short, old womend. Iatrogenic pneumothorax is of unknown origine. Pneumothoraces are treated using pleural aspiration

149. The ligamentum arteriosum is a landmark used to find the branch of the nerve which innervates what in the thoracic region?a. Heartb. Intercostalsc. Pericardiumd. Parietal pleurae. None of the above

150. Normal sites of oesophageal narrowing include the following excepta. C6b. T4c. T5d. T6e. T12

151. This abnormal narrowing site is commonly caused bya. Right ventricle hypertrophyb. Left ventricle hypertrophyc. Right atrium hypertrophyd. Left atrium hypertrophye. None of the above

152. A clinical sign that may indicate lung carcinoma seen on an x-ray isa. Enlarged subcarinal lymph nodesb. Widened carinac. Diffuse fibrosisd. Fluid meniscuse. Consolidated lobe

153. Aortic coarctation may present clinically witha. Notching of inferior border of ribsb. Radio-femoral delayc. Notable pulsations in ICSd. A, Be. B, C

154. What complication of a pterion fracture shows up on a head CT?a. Crescent shaped haemorrhageb. Lens shaped haemorrhagec. Spidery, ventricle filling haemorrhaged. Temporal region contusion

155. Scalp lacerations bleed heavily due to:a. Arteries pulled apart by dense connective tissueb. Emissary veins being laceratedc. Superficial veins in skind. Highly vascularised durae. Aponeurosis resting tone pulling layers apart

156. Possible signs of cavernous sinus thrombosis include the following excepta. Eye is fully abducted and depressedb. Ptosisc. Reduced pupillary reflexd. Eye is fully adductede. Miosis

157. Why can subdural haemorrhages be more dangerous than extradural haemorrhages?a. Easy to misdiagnoseb. Can cause coning of brainstemc. Faster onset of symptomsd. Subdural haemorrhages are arterial bleeds whereas extradural haemorrhages are venouse. Unable to see subdural haemorrhages on head CT

158. An enlarged pituitary can causea. Loss of sight in one eyeb. Complete blindness (loss of sight in both eyes)c. Binasal hemianopiad. Bitemporal hemianopiae. ScotomaCranial regions and brain physiology159. Which of the following about motor neurons is incorrect?a. Upper motor neurons originate in cortex or brainstemb. Upper motor neurons control voluntary movementc. Alpha motor neurons directly innervate musclesd. Lower motor neurons subserve both reflex and voluntary actionse. Lateral motor pathways control posture and locomotion

160. Which of the following about the lateral corticospinal tract is false?a. Originates from motor cortexb. Controls distal muscles and fractionated movementsc. Decussates in medullary pyramidsd. Controls facial musclese. Terminates in dorsolateral region of ventral horns

161. Lesion of upper motor neurons in the brain leads to the following except:a. Hyper-reflexiab. Hypertoniac. Partial recoveryd. Impaired voluntary power in musclese. Contralateral paresis/paralysis

162. Which of the following about areas of the cortex controlling movement is false?a. The posterior parietal cortex project to area 4 (primary motor cortex)b. The primary motor cortex (area 4) generates the impulses which execute movementc. The PMA in area 6 is responsible for sensory guidance of movement and proximal/trunk muscle controld. The SMA in area 6 plans motor actions guided from memorye. Pre-SMA lesions cause inability to perform complex but not simple movements

163. The cerebellum:a. Refines/coordinating sequences of muscle contractionsb. Evaluates disparities between intention and actionc. Has inputs from spinal cord, motor cortex, somatosensory cortex and visual cortexd. Has outputs to motor systems in cortex and brain stem but not directly to alpha motor neuronse. All of the above

164. Which of the following about parts of the cerebellum is false:a. Vestibulocerebellum contains the flocculonodular lobeb. Spinocerebellum is made of vermis and intermediate parts of hemispheresc. Vestibulocerebellum is responsible for balance and receives input from vestibular/visual systemsd. Spinocerebellum receives somatosensory information from limbs and controls distal musclese. Cerebrocerebellum only receives input from thalamusMicrobiology 165. Which of the following about infective endocarditis is false?a. Infection of endocardium of heartb. Usually bacterial but sometimes fungalc. Self-limitingd. Can enter through oral cavity or breach in skine. Can occur due to endocardial abnormalities like valve defects

166. Clinical features of infective endocarditis include the following except:a. Feverb. Splinter haemorrhagesc. Petechiaed. Oslers nodese. Spleen shrinkage

EMQa) Otitis externab) Acute bronchiolitisc) Influenzad) Pneumoniae) SARSf) Tuberculosisg) Common coldh) Pharyngitis and tonsillitis

167. Which disease occurs more commonly in children who have viral infections, is mostly caused by strep pneumoniae but also caused by Haemophilus influenzae?

168. Which disease is caused 75% of the time by RSV and often in children under 2 years old?

169. Which disease is caused by the coronavirus, spread via droplets and results in high fever?

170. Which disease is most commonly caused by the rhinovirus?

171. Which diseases are commonly caused by adenoviruses but if caused by strep pyogenes can lead to peritonsillar abscess?

172. Caused by pseudomonas aeruginosa, staph aureus, strep pyogenes, Proteus and Klebsiella and in immunosuppressed patients can cause base of skull osteomyelitis.

Pathology173. The roadway of injury includes the following excepta. Cellular swellingb. Cytoplasmic swellingc. Nuclear changesd. Crisis point tissue deathe. Loss of membrane integrity

174. Limitations of the coronary arteries include the following except:a. Coronary arteries only fill during diastoleb. Hypertrophy of myocardium results in inadequate blood supply to extra musclec. Small calibre of vessels means any narrowing leads to poor flowd. Anatomical end arteries- no anastomoses to provide collateral supply if occlusion occurse. None of the above- all are limitations

175. AMIs commonly occur in/due to ischaemia in which region of the heart?a. Right atriumb. Left atriumc. Right ventricled. Left ventriclee. In all areas equally

176. Acute myocardial infarction can be diagnosed which of the following:a. Troponinb. Creatine kinasec. ECG changesd. All of the abovee. None of the above

177. The following are all consequences of infarction except:a. Cardiac failureb. Pericarditisc. Thrombus formationd. Muscle rupture 7-10 days after infarcte. Large scale growth of new cardiomyocytes

178. Which of the following about AMI diagnostic protein markers is false?a. Creatine kinase is found in 3 isoformsb. CKMB is most common in the heartc. Troponin has 3 typesd. Tn T is most commonly used as it is only manufactured by the hearte. Myoglobin is the most specific and sensitive of all cardiac markersHealth Promotion179. Name the 5 CM modalities and give an example of each

180. Which of the following regarding CM and conventional therapy is false?a. More out-of-pocket money is spent on CM than on PBSb. Doctors who practice CM are expected to exhibit same level of skills of any other practising doctorc. Lack of evidence for an effect of treatment is not evidence for lack of effectd. 72% of patients using both CM and conventional treatment do not tell their doctor they are using CMe. The evidence supporting CM is equivalent to the evidence supporting conventional medicine181. The Ottawa Charter includes the following points except:a. Building health public policyb. Creating hostile and competitive environmentsc. Strengthening community actiond. Developing personal skillse. Re-orientation of health care services towards disease prevention

182. Which of the following about the HP cycle is true?a. Implementation determines effectiveness of process or outcomeb. Evaluation measures outcome against specific aims of interventionc. Development may use the BASK modeld. Implementation makes use focus groups and surveyse. Evaluation delivers an intervention

183. Which of the following is not a criterion for a screening test?a. Condition should be common and contribute significantly to burden of diseaseb. Test should detect condition earlier than detection without screeningc. Test should have high sensitivity and specificityd. Test should be able to detect more than one diseasee. Test should have solid evidence base for efficacy

184. Listening to emo music is associated with youth suicide. True or False?a. Trueb. False

Clinical skills185. The steps of looking at an ECG include the following except:a. Rate and rhythmb. Calculating PR interval and QRS complex durationsc. Analysing the cardiac axisd. Checking for abnormalities in QRS complexes, ST segments and T wavese. Checking for discrepancies between leadsThere will be discrepancies between leads as they are measuring different areas of the heart

EMQ (q 191-196)a) 0.06-0.10sb) 0.12-0.20s c) 100/mind) 60/mine) 75/minf) 25/ming) Irregular rhythmh) Sinus rhythmi) 200msj) 300msk) 150msl) Left axis deviationm) Right axis deviationn) Normal axiso) Left bundle branch blockp) Right bundle branch blockq) Ischaemiar) Acute myocardial infarction

186. The normal length of the PR segment is?

187. The normal length of the QRS complex is?

188. The rate is?

189. The rhythm is?

190. The PR interval is?

191. The cardiac axis shows?

192. Which of the following is not a common symptom of CV disease?a. Chest pain/anginab. Dyspnoea- paroxysmal, exertional, orthopneac. Ankle or back oedemad. Palpitationse. Myocardial infarction

193. Which of the following is not a risk factor for CV disease?a. Family history of CV diseaseb. Past history of CV diseasec. Hypotension d. Smokinge. Diabetes mellitus

194. Which of the following is not a common symptom in respiratory disease?a. Coughb. Sputum productionc. Dyspnoead. Syncopee. Post nasal dripRadha RamananPage 18