Cardiovascular Medicine

During ventricular systole, the AV valves are closed because:

a) The SL valves are open
b) The ventricles are contracting
c) Pressure in the ventricle exceeds that of the atria
a) Pressure in the atria exceeds that of the ventricles

Dromotropy refers to ______________ while chronotropy refers to __________________.

a) Contractility of contractile myocytes; rate of depolarisation of the SA node
b) Rate of action potential conduction through the AV node; rate of depolarisation of the SA
node
c) Rate of action potential conduction through the AV node; contractility of the contractile
myocytes
d) Rate of depolarisation of the SA node; contractility of the contractile myocytes
e) None of these options are correct

Identify the correct sequence of blood flow from the following options:
a) Lungs, right ventricle, left ventricle, right atrium, left atrium
b) Left ventricle, left atrium, lungs, right ventricle, right atrium
c) Left atrium, left ventricles, right ventricle, right atrium, lungs
d) Right ventricle, left ventricle, left atrium, lungs, right atrium
e) Right atrium, right ventricles, lungs, left atrium, left ventricle

A patient presents to hospital emergency and the following ECG is obtained. What type of rhythm is
this?

a) Atrial fibrillation
b) Ventricular escape rhythm
c) Sinus rhythm
d) Ventricular tachycardia
The left ventricular wall of the heart is thicker than the right wall in order to ________.
a) Expand the thoracic cage during diastole
b) Pump blood with greater pressure
c) Accommodate a greater volume of blood
d) Pump blood through a smaller valve

Which of the following best relates to Stroke Volume?

a) Increases proportionally with increased HR
b) Is a direct product of HR and ESV
c) Increases with increased inotropy
d) Increased with increased dromotropy

Which of the following is the Frank-Starling mechanism dependent on?

a) Venous return
b) Preload
c) Optical actin-myosin filament overlap
d) All of the above

What does the QT interval represent?

a) Conduction through the AV node
b) The time taken for ventricular depolarisation and repolarisation
c) The interval between ventricular depolarisation and repolarisation
d) Time for the impulse from the SA node to travel across the AV node to the ventricles

If a patient had a mean cardiac axis of -50 degrees, which frontal plane ECG lead would show the
largest R wave?
a) I
b) aVL
c) aVR
d) II
e) III

If the SA node or intermodal pathways are damaged:

a) Ventricular fibrillation will occur
b) The bundles of His and Purkinje fibres will assume command
c) The heart will stop
d) The AV node will assume command
e) The atria will not direct blood to the ventricles
Which of the following is true for aortic pressure in a healthy individual?
a) Is ~80𝑚𝑚𝐻𝑔 during isovolumic relaxtion
b) Inversely proportional to ventricular pressure
c) Remains relatively constant throughout the cardiac cycle
d) At peak ventricular contraction is ~𝟏𝟐𝟎𝒎𝒎𝑯𝒈

A patient’s lead II ECG trace looks like the following:

What is the most likely dysrhythmia she is experiencing?

a) Juntional escape rythym
b) Ventricular escape rythym
c) Sinus bradycardia
d) Second degree, type II heart block

Phase 0 of the action potential in a contractile myocyte is produced by _____________, which

________________ upon full depolarisation.

a) Voltage-gated L-type calcium channels; activate

b) Voltage-gated L-type calcium channels; inactivate
c) Voltage-gated fast sodium channels; activate
d) Voltage-gated fast sodium channels; inactivate

These channels activate upon repolarisation and permit a slow influx of cations, causing the resting
membrane potential to spontaneously depolarise in healthy myocytes.
a) Voltage-gated L-type calcium channels
b) Fast voltage-gated sodium channels
c) Slow If sodium channels
d) Voltage-gated potassium channels

The intrinsic rate of spontaneous depolarisation in AV node conductile myocytes is:

a) 0; the cells of the AV node do not spontaneously depolarise
b) 15-40 action potentials per minute at rest
c) 40-60 action potentials per minute at rest
d) 60-100 action potentials per minute at rest
A wave of repolarisation travelling directly toward the positive (recording) electrode will produce a
_________ deflection?
a) Positive
b) Negative
c) Biphasic
d) No deflection
e) Both a and b are correct

What structures attach directly to the atrioventricular valve flaps and aid their function?
a) Trabeculae carneae
b) Chordae tentineae
c) Papillary muscles
d) Auricles
e) Pectinate muscles

The vessels that empty into the right atrium have no valves to prevent backflow. True or false?
a) True
b) False

The large, positive R wave recorded by the Lead II ECG reflects which of the following cellular
events?
a) Depolarisation of the free wall by the base, radiating out from mid-myocardium in all
directions
b) Depolarisation of the septum from base to apex and left to right
c) Depolarisation of the atria
d) Depolarisation of the free wall of the ventricles from apex to base and endocardium to
epicardium
e) Depolarisation of the AV node (plus time for the atria to contract)

During contraction of heart muscle cells:

a) The action potential is initiated by the opening of slow voltage-gated calcium channels
b) The action potential is prevented from spreading from cell to cell by gap junctions
c) Calcium is prevented from entering cardiac fibers that have been stimulated
d) Calcium enters from the extracellular space and triggers calcium release from intracellular
stores

Which vessel drains blood DIRECTLY from the myocardium?

a) Superior vena cava
b) Inferior vena cava
c) Middle cardiac vein
d) Right coronary artery
e) Coronary sinus
A 63 year old woman comes to the clinic for a check-up. The attending physician notices that her
pulse is erratic, and decide to record her ECG to investigate further. The Lead II trace looks like the
following:

Which of the following dysrythmias is revealed by this ECG?

a) Sick sinus syndrome
b) First degree conduction block
c) Second degree conduction block Type I
d) Second degree conduction block Type II
e) Third degree conduction block

How many electrodes are required to record a 12 lead ECG?

a) 6
b) 8
c) 10
d) 12

A 56 year old male comes into Emergency. The triage nurse noticed his pulse is irregular. His Lead II
ECG looks like the following:

He is diagnosed as experiencing Torsades de Pointes. Which of the following mechanisms is most

likely to produce this dysrhythmia?
a) Failure of the SA node to produce action potentials
b) Inappropriate automaticity
c) Early after-depolarisation(s)
d) Delayed after-depolarisation(s)
e) Re-entry
True or False: Irreversible shock occurs when the cardiovascular system itself starts to deteriorate as
a consequence of side effects from compensatory measures to the severe hypotension.
a) True
b) False

Vasodilation is favoured by all of the following EXCEPT:

a) Increased potassium in the interstitial fluid.
b) Decreased oxygen in the blood
c) Increased carbon dioxide in the blood
d) A rise in blood pH
a) Increased adenosine concentration in blood

Which of the following DOES NOT OCCUR to compensate for a fall in blood pressure below normal?
a) Cardiac output is increased
b) Total peripheral resistance is decreased
c) Heart rate is increased
d) Venous vasoconstriction is decreased
e) Stroke volume is increased

Shock may develop:

a) From loss of blood
b) From low cardiac output
c) From anaphylaxis
d) Excess vasodilation
e) All of these answers

If the arterial blood pressure is recorded at 132/84, what is the mean arterial pressure (MAP)?
a) 100 mmHg
b) 93 mmHg
c) 108 mmHg
d) 48 mmHg
e) None of these answers

If your heart rate rises, but your mean arterial pressure remains the same then your:
a) Total peripheral resistance had decreased
b) End-diastolic volume has increased
c) Stroke volume has increased
d) Blood volume has increased
e) End-systolic pressure has decreased
True or False: As long as arterial blood pressure is 120/80 mmHg, local control of blood flow can
over-ride central nervous system control of blood pressure?
a) True
b) False

The lymphatic system ___________.

a) Does not have its own pump like the heart
b) Relies on the skeletal muscle pump to circulate lymph fluid
c) Empties the lymph vessels into the veins near the clavicles
d) Has lymph nodes positioned strategically where immunologically active cells interact with
the lymph
e) All of these

If capillary (plasma) hydrostatic pressure is 29 mmHg, the blood colloid osmotic pressure 20 mmHg
and the interstitial colloid and hydrostatic pressures are both 1 mmHg. What is the net hydrostatic
pressure?
a) 8 mmHg
b) 47 mmHg
c) 20 mmHg
d) 9 mmHg

For an otherwise healthy 70 year male, which of the following cardiovascular parameters is
INCORRECT?
a) Resting blood pressure may be 150/85 mmHg
b) A maximum heart rate during exercise of 150BPM
c) An increased heart weight compared to a 20 year old male
d) A decreased cardiac output at rest compared to a 20 year old male
e) An increased total peripheral resistance (TPR) at rest compared to a 20 year old male

The values obtained when taking a blood pressure, such as 120/80, __________.
a) Exactly match the pressures inside the ventricle during systole and diastole
b) Reflect the pressure in the major arteries during ventricular systole and diastole
c) Are the same on both the pulmonary and systemic circuits
d) Tend to decrease with age as the heart becomes weaker
e) When mathematically averaged give MAP (mean arterial pressure)
If the aortic valve of an elderly patient became stenotic, there would be a rapid acceleration in which
of the following age-associated adaptations of the heart?
a) Exercise intolerance
b) Cardiac structural remodelling (hypertrophy)
c) Risk arrhythmias
d) Development of hypertension
e) Progression of ischaemic heart disease (atherosclerosis)

Compared to a non-athlete at rest and during maximal exercise, which one of the following
parameters would show a greater change in a trained athlete under conditions of resting and
maximal exercise?
a) Stroke volume
b) Cardiac output
c) Heart rate
d) Blood pressure
e) Arterial PO2

Which of the following hormones is released when venous return increases?

a) Adrenaline (aka epinephrine)
b) Aldosterone
c) Angiotensin II
d) Antidiuretic hormone (ADH)
e) Atrial natriuretic peptide (ANP)

After moderate to severe haemorrhage all of the following are reduced EXCEPT:
a) Mean arterial pressure
b) Capillary pressure
c) Plasma protein concentration
d) Venous pressure
e) Flow of blood to non-vital organs

The resistance to flow of blood through a blood vessel varies:

a) Directly with the square of the radius
b) Directly with the cube of the radius
c) Inversely with the square of the radius
d) Inversely with the cube of the radius
e) Inversely with the fourth power of the radius

Angiotensin has a strong influence on arterioles and is also a hormone that helps regulate salt
balance. As far as controlling blood pressure is concerned, these two roles are ____, because
angiotensin leads to ____ salt retention and thus ____ blood volume, while it ____ arterioles.
a) Contradictory, increased, decreases, dilates
b) Contradictory, decreased, increases, constricts
c) Complimentary, increased, increases, constricts
d) Complimentary, decreased, decreases, dilates
e) Complimentary, decreased, decreased constricts
In the microvasculature, when pre-capillary sphincters are constricted:
a) Blood flows through the capillaries and takes part in exchange with tissue cells
b) The tissue being fed by the capillary bed receives no oxygen and nutrients at all
c) Blood flow stops at the metarteriole-thoroughfare channel
d) Most of the blood flows through the vascular shunt and bypasses the capillaries

The rapid increase in heart rate up to approximately 100 beats per minute at the onset of exercise is
mainly due to:
a) An increase in sympathetic outflow to the heart and the peripheral blood vessels
b) Increased venous return due to the activity of the skeletal muscle pump
c) Withdrawal of vagal outflow to the heart
d) A dramatic fall in total peripheral resistance

Cirrhosis of the liver (i.e. large amount of fibrous tissue throughout the liver and disruption of liver
cell function) can produce a generalized systemic oedema. One of the most likely contributing
factors to this oedema is:
a) Lack of plasma protein
b) Increased blood waste products
c) Increased blood pressure
d) Numerous small haemorrhages
e) Increased number of endothelial pores

Regarding the distribution of blood flow, which statement is NOT true?

a) At rest, approximately 2/3 of the cardiac output is routed to the digestive system, liver,
muscles and kidneys
b) Of the major organs, the kidneys receive the highest blood flow when at rest
c) During strenuous exercise, the skeletal muscles may receive up to 20% of the cardiac
output
d) Homeostatic reflexes and local control mechanisms work together to distribute blood to the
various tissues throughout the body
e) Total blood flow through all the systemic arterioles must equal cardiac output in a normal,
healthy individual

Compared to arteries, the velocity of flow of the blood through the capillaries is:
a) At least 10 times faster
b) At least twice as fast
c) About the same
d) Much slower
e) Impossible to predict without more information
 Haematological & Renal Medicine

Degenerative products of inflamed tissues cause chemotaxic of cells towards the inflamed area.
Which of these cells is attracted most towards the inflamed area?
a) Lymphocytes
b) Mast cells
c) Eosinophils
d) Neutrophils
e) Basophils

f) Which one of the following haemoglobin is due to an abnormal heme?

a) HbA2
b) HbA1
c) HbF
d) HbS
e) Methemoglobin

Which of the following drug is used in the setting of acute thrombosis?

a) Hirudin
b) Aspirin
c) Desmopressin
d) Warfarin
e) Streptokinase

The fibrinogen group of clotting factors are:

a) I, II, V, and X
b) II, VII, IX, and X
c) I, VIII, V, and XIII
d) II, IX, XI, and X
e) XI, XII, XIII, and Ca2+

A 50 year old patient presents with acute myocardial infarction and he is treated with tissue
plasminogen activator. Which of the following steps in the coagulation pathway is affected by this
treatment?
b) Blockage of the primary haemostatic plug formation
c) Activation of the extrinsic pathway
d) Activation of the intrinsic pathway
e) Blockage of the common pathway
f) Activation of the fibrinolytic pathway
The below image is from a 34 year-old male patient who presented with acute onset of anaemia
following hypertension treatment. What is the most likely type of anaemia?

a) Iron deficiency anaemia

b) Megaloblastic anaemia
c) Acute blood loss
d) Haemolytic anaemia
e) Anaemia of chronic disease

Which of the following protein is in higher concentration in plasma?

a) Immunoglobulin
b) Transport globulin
c) Albumin
d) Fibrinogen
e) Prothrombin

Bleeding time done on a patient reads as 12 min. This indicates which of the following?
a) Defect in intrinsic coagulation pathway
b) Defect in extrinsic coagulation pathway
c) Defect in common coagulation pathway
d) Thrombocytopenia
e) Thrombocytosis

All the blood cells are produced from hematopoietic stem cells in the bone marrow. During
hematopoiesis, which of the following blood cells are formed first?
a) Monocyte
b) Lymphocyte
c) Neutrophils
d) Erythrocytes
e) Platelets
This is the image from a 68 year-old female patient who is on a vegan diet. On history taking she
admits to be suffering from Coeliac disease. Now she presents with tiredness and dizziness. Her FBC
shows low haemoglobin. What is the type of anaemia?

a) Iron deficiency anaemia

b) Megaloblastic anaemia
c) Acute blood loss
d) Haemolytic anaemia
e) Anaemia of chronic disease

Blood plasma is mostly:

a) Water
b) Blood cells
c) Proteins
d) Organic molecules
e) Ions

25 year old woman gets an accidental cut injury in her finger while working in the kitchen. She
washes her finger and applies firm pressure which stops her bleeding after a while. Which of the
following is involved in the primary haemostatic plug?
a) Platelet vWF
b) Factor XII
c) Factor VII
d) Fibrin
e) RBCs
What is the possible diagnosis in a 27 year-old patient with the following FBC result: Hb:8.8gm,
MCV:107 fl, MCH:39, MCHC:34 Reticulocytes:2.8%?
a) Iron deficiency anaemia
b) Megaloblastic anaemia
c) Acute blood loss
d) Haemolytic anaemia
e) Anaemia of chronic disease

A haemoglobin molecule is composed of:

a) Two protein chains
b) Three protein chains
c) Four protein chains and two haem groups
d) Four protein chains and four haem groups
e) Four haem groups and two protein chains

Intrinsic and the extrinsic pathway of the coagulation cascade merge to form the common pathway
at which of the following?
a) Factor VIII
b) Factor VII
c) Factor X
d) Factor V
e) Factor II

Which of the following is the most correct statement regarding iron deficiency anaemia?
a) Macrocytes are commonly present in the blood film
b) The platelet count is usually reduced
c) Serum ferritin levels are raised
d) The total iron-binding capacity (TIBC) is decreased
e) Red blood cells are hypochromic

Which of the following cell count in circulation is a good indicator of hemopoietic activity?
a) Neutrophil
b) Reticulocyte
c) Haemocytoblast
d) Megakaryocyte
e) Lymphocyte
Few days after birth, a pre-term infant presented with bleeding around the umbilical cord stump.
The mother states that an injection was given and the bleeding stopped. This injection is most likely
to contain which of the following?
a) Platelets
b) Recombinant Factor VIII concentrate
c) Donor Factor IX concentrate
d) Fat soluble vitamin
e) Water soluble vitamin

A 13-year-old male has less than 1% factor VIII activity in the plasma. If he does not receive
transfusion of factor VIII concentrate, which of the following manifestations of this deficiency, he is
likely to develop?
a) Splenomegaly
b) Conjunctival petechiae
c) Haemolysis
d) Haemochromatosis
e) Haemarthosis

Blood platelets assist in the homeostasis mechanism by all of the following mechanisms except:
a) Releasing factors promoting blood clotting
b) Adhering together to form plugs when exposed to collagen
c) Releasing high concentrations of calcium
d) Releasing vasoconstrictor agents
e) Binding to vonWillebrand Factor through GpIb

This circulating factor regulates growth and maturation of megakaryocyte in the bone marrow:
a) Erythropoietin
b) Thyroxine
c) Thrombopoietin
d) Vitamin B12
e) Testosterone

A 45-year old male visits clinical laboratory to check his serum cholesterol level and his blood was
collected in a glass test tube and was allowed to clot to separate the serum. Which of the following
clotting factor is most essential for final common pathway of blood clotting?
a) Fibrinogen
b) Factor VIII
c) Factor XII
d) Tissue Factor
e) Factor V
A 69 year-old previously healthy woman has been feeling increasingly tired and weak for the last 4
months. On examination, she is afebrile. There is no hepatosplenomegaly or lymphadenopathy.
Laboratory studies show haemoglobin of 93 g/L with normal range platelets and white cells. The
differential count is normal. The appearance of the peripheral blood smear is shown in the below
image. Which of the following conditions should be suspected as the most likely cause of these
findings?

a) Pernicious anaemia
b) Iron deficiency anaemia
c) Aplastic anaemia
d) Beta-thalassemia major
e) Autoimmune haemolytic anaemia

A 45-year old woman was evaluated for a prolonged prothrombin time result obtained before she
underwent right total hip arthroplasty. Which of the following blood coagulation factor deficiency
increases prothrombin time?
a) Antihaemophilic factor
b) Fibrin stabilizing factor
c) Christmas factor
d) Calcium
e) Fibrinogen

The filtration fraction is the fraction of renal plasma flow in relation with:
a) Renal blood flow
b) Volume of glomerular filtrate
c) Urine volume
d) Tubular load
e) Cardiac output
The macula densa is a part of:
a) Afferent arteriole
b) Distal tubule
c) Proximal tubule
d) Glomerulus
e) Bowmans capsule

Which of these unite to open into the pelvis of the ureter?

a) Ducts of Bellini
b) Major calyces
c) Minor calyces
d) Collecting tubules
e) Collecting ducts

Laboratory analysis of cord blood of an infant suffering from haemolytic disease of the newborn will
demonstrate which combination of the following characteristics: RhD (-) red cells; anaemia with high
reticulocyte count; negative Direct Coombs test; positive Direct Coombs test; high levels of serum
bilirubin.
a) RhD (-) red cells, anaemia with high reticulocyte count, negative Direct Coombs test, high
levels of serum bilirubin
b) Anaemia with high reticulocyte count, negative Direct Coombs test, positive Direct Coombs
test, high levels of serum bilirubin
c) RhD (-) red cells, anaemia with high reticulocyte count, high levels of serum bilirubin
d) Anaemia with high reticulocyte count, positive Direct Coombs test, high levels of serum
bilirubin
e) RhD (-) red cells, negative Direct Coombs test, high levels of serum bilirubin

The osmolality of the glomerular filtrate is:

a) 1200 mosm/Kg
b) 800 mosm/Kg
c) 300 mosm/Kg
d) 600 mosm/Kg
e) 50 mosm/Kg

An 85-year-old woman presents with fever and hypovolemic hypotension. Her renal function test
was done and Inulin and PAH clearance were measured. PAH clearance would indicate:
a) Renal blood flow
b) Filtration fraction
c) Tubular maximum
d) Urine osmolality
e) Glomerular filtration rate
Antidiuretic hormone binds to this receptor to increase water reabsorption in the collecting duct:
a) V1 receptor
b) V2 receptor
c) V3 receptor
d) M2 receptor
e) Alpha receptor

Renal clearance measures the efficiency of the kidney. Which of the following clearances would be
zero?
a) Glucose clearance in normal person
b) Glucose clearance in uncontrolled diabetes mellitus
c) Sodium clearance in person on low salt diet
d) Free water clearance in a normally hydrated person
e) Bicarbonate clearance in alkalosis

The renal pyramid is:

a) The outermost layer of kidney tissue
b) A conical-shaped structure that is located in the renal medulla
c) An internal cavity lined by the fibrous capsule and located in the area of the hilus
d) A large branch of the renal pelvis
e) A knot of capillaries that lies within the renal corpuscle

Which type of blood group cells are used for antibody screening tests?
a) Group A, Rh positive
b) Group AB, Rh positive
c) Group O, Rh positive
d) Group AB, Rh negative
e) Group O, Rh negative

The most important force causing glomerular filtration is:

a) Colloidal osmotic pressure in the capillaries
b) Hydrostatic pressure in the Bowman’s capsule
c) Colloidal osmotic pressure in the capillaries
d) Hydrostatic pressure in the capillaries
e) Colloidal osmotic pressure in the peritubular capillaries

Which of the following is true regarding Rh blood group system?

a) The term Rh-positive means that the individual has no agglutinogen
b) The Rh-negative individual forms the anti-D agglutinin when injected with D-positive cells
c) The Rh typin serum used in routine blood typing in D serum
d) 85% of Caucasians are not having D antigen in their blood
e) D antigens are IgM type, which cannot cross the placental barriers
A 55 year old man presents with back pain, fatigue, confusion. X-ray of spine, skull & all limbs
showed numerous lytic lesions. Laboratory results showed hypoalbuminemia, mild anaemia,
thrombocytopenia with Hyper gammaglobulinemia & A monoclonal Igκ peak on serum protein
electrophoresis. What is the most likely diagnosis?
a) Chronic lymphocytic leukaemia
b) Multiple myeloma
c) Chronic myeloid leukaemia
d) Stage 4 Hodgkins lymphoma
e) High grade non-Hodgkins lymphoma

The fluid in the glomerular (Bowman's) capsule is similar to plasma except that it does not contain a
significant amount of ________.
a) Glucose
b) Hormones
c) Electrolytes
d) Plasma proteins
e) Bicarbonates

A 35-year-old male was admitted with hypertension and oliguria. A CT scan of the abdomen revealed
hydronephrosis of left kidney. A change in arterial pressure exerts much less of an effect on urine
volume, because:
a) Renal auto-regulation prevents large changes in GFR
b) There is increased angiotensin II secretion
c) Sodium reabsorption in proximal tubule increases
d) Increased renin secretion
e) Constriction of efferent arterioles by increased pressure

A decline in the number of neutrophils in the peripheral blood is called:

a) Thrombocytopaenia
b) Neutrophilia
c) Neutropaenia
d) Pancytopaenia
e) Lymphocytosis

The endothelial lining of the glomerular capillaries is:

a) Fenestrated
b) Continuous
c) Sieved
d) Tubular
e) Discontinuous

Which of the following parts of the nephron reabsorbs glucose maximally under normal conditions?
a) Collecting ducts
b) Thick ascending limb of Loop of Helne
c) Distal tubule
d) Proximal convoluted tubule
e) Collecting tubule
A 23 year old woman develops a skin rash if she spends prolonged periods outdoors. She has an
allergy to dust mites. She also has seasonal asthmatic bronchitis when exposed to dust. Which of the
following finding is most likely to be demonstrated by a WBC differential count?
a) Eosinophilia
b) Neutrophilia
c) Monocytosis
d) Lymphocytosis
e) Thrombocytosis

Excretion of dilute urine requires _______.

a) Relative permeability of the distal tubule to water
b) Impermeability of the collecting tubule to water
c) Transport of sodium and chloride ions out of the descending nephron loop
d) The presence of ADH
e) The presence of urea in the collecting duct

Most nephrons are located within the renal:

a) Pelvis
b) Calyces
c) Medulla
d) Pyramids
e) Cortex

Which of the following substances is used to measure glomerular filtration rate?

a) PAH
b) Mannitol
c) Creatinine
d) Urea
e) Insulin

The total volume of glomerular filtration per day for both kidneys is:
a) 125 mL
b) 180 L
c) 180 mL
d) 5 L
e) 1200 mL
Which one of the following terms describes the location of the kidneys?
a) Suprarenal
b) Retroperineal
c) Adrenal
d) Intraperitoneal
e) Retroperitoneal

A 60-year old man has fever, malaise, weight loss and enlarged lymph nodes in inguinal, axillary and
cervical region. The nodes are firm and non-tender. Given below is the image of the biopsy of the
lymph nodes. What is the likely diagnosis based on history and biopsy?

a) Hodgkin’s lymphoma
b) Chronic leucocytic leukaemia
c) Non-Hodgkin’s lymphoma
d) Chronic myeloid leukaemia
e) Reactive lymphadenitis
 Respiratory Medicine

The diaphragm:
a) Is pierced by the oesophagus at the level of T4
b) Is supplied by the phrenic nerve
c) Divides the thorax from the pelvis
d) Is supplied by the vagus nerve
e) Sits higher on the left side due to the presence of the stomach

The vagus nerve passes anterior to the root of the lung. True or False?
a) True
b) False

Chronic pulmonary disease results in reduced alveolar ventilation and hypoxia. As a result
pulmonary vascular resistance (PVR) _______________ and the afterload on the right ventricle (RV)
_______________. This increases__________________ pressure and results in _____________
oedema.
a) Increases, decreases, capillary osmotic, pulmonary
b) Increases, increases, capillary hydrostatic, peripheral
c) Decreases, decreases, interstitial hydrostatic, peripheral
d) Increases, increases, capillary osmotic, pulmonary
e) Decreases, decreases, interstitial osmotic, peripheral

The ___________ circulation branches off the ___________. It supplies nutrients to the airways and
is part of the __________________ circulation.
a) Bronchial, pulmonary artery, pulmonary
b) Pulmonary, pulmonary artery, pulmonary
c) Bronchial, pulmonary vein, pulmonary
d) Pulmonary, pulmonary vein, pulmonary
e) Bronchial, aorta, systemic
f) Bronchial, aorta, pulmonary
g) Bronchial, pulmonary vein, pulmonary
h) Bronchial, pulmonary artery, systemic

____________temperature, _____________PaCO2, __________________pH and/or

_______________2,3-DPG will cause a rightward shift in the oxyhaemoglobin curve.
a) Decreasing, increasing, decreasing, increasing
b) Decreasing, decreasing, increasing, decreasing
c) Increasing, decreasing, decreasing, decreasing
d) Increasing, increasing, decreasing, increasing
e) Increasing, increasing, increasing, increasing
What happens to the V/Q relationship when moving from the top of the lung to the bottom of the
lung?
a) Lung
b) Does not change
c) Decreases

In which zone is Pa > Pv > PA?

a) Zone 1
b) Zone 2
c) Zone 3

Haemoglobin in the Tense (T) state expresses _________oxygen affinity and would be found
predominantly leaving the _____________.
a) Low, tissues
b) Low, lungs
c) High, tissues
d) High, lungs

Foreign body aspiration is common in young children. Which main bronchus is a foreign object more
likely to lodge in, right or left?
a) Left
b) Right

The rings of cartilage in the airways are:

a) Are complete (ie, like the letter O)
b) Are made of fibrocartilage
c) Are made of elastic cartilage
d) Maintain the airways open
e) Are functionally irrelevant

A leftward shit in the oxyhaemoglobin curve indicates an increased haemoglobin affinity for oxygen.
True or false?
a) True
b) False

Hypoxia causes ______________ in the pulmonary circulation and ______________ in the systemic
circulation.
a) Vasodilation, vasodilation
b) Vasodilation, vasoconstriction
c) Vasoconstriction, vasodilation
d) Vasoconstriction, vasoconstriction
The costal cartilages join the ribs to the sternum. True or false?
a) True
b) False

Under normal conditions at rest, what % of metabolic rate goes to the respiratory muscles?
a) 1
b) 3
c) 7
d) 11
e) 15

The lungs:
a) Are supplied by somatic nerves
b) Receive deoxygenated blood via bronchial arteries
c) Are within the mediastinum
d) Receive deoxygenated blood from the pulmonary artery
e) Are drained by the azygous system of veins

The costal margin is formed by which of the following ribs and associated costal cartilages?
a) 6-8
b) 6-12
c) 5-10
d) 7-10
e) 9-12

What is normal tidal volume?

a) 150mL
b) 300mL
c) 500mL
d) 650mL
e) 800mL

What method can be used to measure total lung volume?

a) Spirometry
b) Closed circuit Helium dilution
c) Pnemuotachography
d) Peak flow

The collateral intercostal nerves run in the costal groove. True or False?
a) True
b) False
A patient with stiff lungs will have ___________ lung compliance and require a __________ inflation
pressures to maintain the same tidal volume.
a) Low, lower
b) Low, higher
c) High, lower
d) High, higher

Which of the following is the only muscle that abducts the vocal cords?
a) Cricothyroid muscle
b) Transverse arytenoids
c) Oblique arytenoids
d) Posterior cricoarytenoid

Cells and molecules involved in the pathogenesis of atopic asthma include: eosinophils; increased
number of TH2 lymphocytes; IgE; IgM; Histamine; Theophylline.
a) True, false, true, false, true, false
b) True, true, true, false, true, false
c) False, false, true, false, false, true
d) False, true, false, true, false, true
e) True, false, false, true, true, false

In chronic respiratory acidosis with partial renal compensation, you would expect to find the
following changes, _________ urinary excretion of NH4+; __________ plasma HCO3- concentration;
_____________ and ___________ urine pH.
a) Increased, increased, decreased
b) Increased, decreased, decreased
c) No change in, increased, decreased
d) No change in, no change in, decreased
e) Increased, no change in, increased

Fill in the blanks.

Pulmonary surfactant is synthesis by alveolar type 2 cells or type 2 cells and stored in lamellar
bodies. It is made up of 90% lipids or phospholipids. Its major functional role is to reduce surface
tension.
Cystic fibrosis is an autosomal dominant condition (True/False), is linked to a gene mutation on the
long arm of chromosome 11 (True/False) and results in a defect in the CFTR Chloride channel
(True/False).
a) True, true, true
b) True, false, true
c) False, true, false
d) False, false, true
e) False, false, false

Which of the following limits the duration of inspiration and increases respiratory rate?
a) Apneustic centre
b) Doral respiratory group
c) Nucleus of the tractus solitaries
d) Pneumotaxic centre
e) Ventral respiratory group

Transection of the neurons between the medulla and spinal cord results in:
a) An irregular breathing pattern
b) Inability to cough
c) Inability to breathe while asleep
d) Inability to hold their breath
e) Inability to breathe

The following are treatments for chronic asthma – true or false?

Low dose inhaled steroids are the first line treatment for mild asthma.
Long acting B2-agonsits should only be used if short acting B2-agonists are ineffective.
A patient with moderate asthma should take regular oral steroid medication.
Once good control is achieved, no further changes should be made to the medication.
a) True, true, true, true
b) True, true, false, false
c) False, true, false, true
d) False, true, false, false
e) False, false, false, false

A 21 year old man with gastroenteritis developed severe vomiting with a loss of stomach acids. A
metabolic alkalosis is present. Which of the following is most likely to occur?
a) The plasma bicarbonate concentration will decrease
b) H+ will move from the plasma into the cells
c) Peripheral chemoreceptors will stimulate pulmonary ventilation
d) Renal H+ excretion will decrease
The brain’s respiratory centre receives input regarding ventilation from several different sources. Fill
in the boxes 1-4 with one of the following: spinal cord; cerebral cortex, pneumotaxic centre (pons);
midbrain; medullary respiratory centre.

a) 1 = spinal cord, 2 = pneumotaxic centre (pons), 3 = cerebral cortex, 4 = medullary respiratory

centre
b) 1 = medullary respiratory centre, 2 = cerebral cortex, 3 = midbrain, 4 = spinal cord
c) 1 = cerebral cortex, 2 = pneumotaxic centre (pons), 3 = medullary respiratory centre, 4 =
spinal cord
d) 1 = midbrain, 2 = cerebral cortex, 3 = pneumotaxic centre (pons), 4 = medullary respiratory
centre
e) 1 = pneumotaxic centre (pons), 2 = cerebral cortex, 3 = medullary respiratory centre, 4 =
midbrain

65 year old man has a heart attack and experiences cardiopulmonary arrest while being transported
to the emergency room. The following laboratory arterial blood gases were obtained
ph = 7.12
PaCO2 = 60mmHg
HCO3- = 19 mEq/L
Which of the following laboratory results would be expected, compared to normal?
a) Increased renal excretion of HCO3-
b) Decreased urinary titratable acid
c) Increased urine pH
d) Increased plasma lactate level
The diagram below shows three different compliance curves (S, T and U) for isolated lungs subjected
to various pressures. Which of the following best describes the relative compliances for the three
curves?

a) S<T<U
b) S<T>U
c) S=T=U
d) S>T<U
e) S>T>U

A key difference between chronic bronchitis and emphysema is/are?

a) Lung diffusion capacity
b) FEV1/FVC
c) Measured VC/ predicted VC
d) Airway obstruction
e) Airway surface liquid
f) Mucus glands
g) Both A and F
h) A, E and F
i) All of the above

A restrictive pulmonary disease will demonstrate a:

a) Increase in TLC
b) Decrease in VC
c) Decrease in FEV1/FVC
d) Increased RV
e) Increased FRV

A 34-year old man sustains a bullet wound to the chest that causes a pneumothorax. Which of the
following best describes the changes in lung volume and thoracic volume in this man, compared to
normal?
a) Lung volume decreased, thoracic volume decreased
b) Lung volume decreased, thoracic volume increased
c) Lung volume decreased, thoracic volume no change
d) Lung volume increased, thoracic volume decreased
e) Lung volume increased, thoracic volume increased
f) Lung volume no change, thoracic volume no change
Patients with pulmonary fibrosis who are tested for pulmonary function will have a decreased
FEV1/FVC true or false?
a) True
b) False

In cystic fibrosis, there is increased Na+ reabsorption by epithelial cells (True/False), reduced Cl-
excretion into the airways (True/False), a reduction in the viscosity of airway secretions (True/False)
and a low Na+ concentration in sweat (True/False)
a) True, true, true, true
b) True, false, false, false
c) True, true, false, false
d) False, true, false, false
e) False, false, true, true

The maximum expiratory flow-volume curves shown in the diagram above were obtained from a
healthy patient (A) and a 57-year old man who complains of shortness of breath (B). Which of the
following disorders is most likely present in this man (B)?

a) Asbestosis
b) Emphysema
c) Kyphosis
d) Scoliosis
e) Silicosis
f) Tuberculosis

During pregnancy which of the following parameters would be normal?

a) Residual volume
b) Expiratory reserve volume
c) Inspiratory reserve volume
d) Function residual capacity
e) Vital capacity
Concerning the carotid bodies:
They are important peripheral chemoreceptors (true/false)
They are rich in dopamine (true/false)
They respond to hypoxia (true/false)
They have a slow response time (true/false)
a) True, true, true, true
b) True, true, true, false
c) True, false, true, false
d) False, false, true, false
e) True, false, true, false

Pursed lipped breathing is used by COPD patients. It:

a) Increases the time for expiration
b) Moves the Equal Pressure Point into smaller airways
c) Promotes negative transmural pressures in the bronchioles
d) Increases elastic recoil
e) Increases gas trapping in the lungs

Increasing progesterone levels during pregnancy:

a) Promotes airway mucosal oedema
b) Increases blood volume
c) Stimulates mucus gland hypertrophy
d) Sensitises the central chemoreceptors

Airway proliferation is mostly completed in which stage of lung development?

a) Embryonic
b) Pseudoglandular
c) Canalicular
d) Saccular
e) Alveolar

What measurement/calculation is the most useful to demonstrate airway calibre constriction in

asthma?
a) FEV1
b) FEV1/FVC
c) FVC
 Rural, Remote, Indigenous & Tropical Health

The Aboriginal health worker always leaves the consulting room when certain members of the
community visit the clinic. What would be a cultural reason to explain why the health worker leaves
the room?
a) Family dispute
b) Skin group relationship
c) Age difference
d) Fear of infection
e) Client from another community

Of the total Aboriginal and Torres Strait Islander population in Australia, around what percentage
live in remote and very remote areas?
a) 90%
b) 25%
c) 50%
d) 5%
e) 10%

Lynette is a 10 year old girl from a remote Aboriginal community recently discharged from the
regional base hospital after an attack of acute rheumatic fever. Which of the following strategies is
LEAST effective in making sure Lynette receives regular penicillin prophylaxis?
a) Involve the local Aboriginal Health Worker
b) Schedule monthly appointments at the Regional Base Hospital
c) Involve Lynette’s family
d) Have a systematic recall system
e) Engage the local school

Hookworm has a lifecycle involving transmission via eggs in faeces, through which of the following
stages to reach the adult stage in the intestine?
a) Soil, ingestion, stomach, small intestine
b) Soil, ingestion, small intestine, lungs, large intestine
c) Soil, inhalation, coughed and swallowed, large intestine
d) Perianal skin, lymphatics, lungs, coughed and swallowed, small intestine
e) Soil, skin penetration, lungs, coughed and swallowed, small intestine
 Box 2

What type of rural index is used in the graph in Box 2?

a) Accessibility, Remoteness Index of Australia (ARIA)
b) Australian Health Access Indices (AHAI)
c) Australian Standard Geographical Classification (ASGC)
d) Rural, Remote and Metropolitan Areas (RRMA)
e) Statistical Local Areas (SLA)

In Box 2, above, which of the following does NOT explain the relationship between numbers
diagnosed and percentage dying of breast cancer in rural areas?
a) Less than optimal treatment choices are made to allow earlier return home
b) Poorer access to oncology clinical trials in rural areas
c) Breast cancer is less common in rural areas
d) Rural areas experience later diagnosis of more advanced disease
e) Rural areas have lower rates of breast cancer early detection (mammography)

Complete missing words: Leptospirosis is a zoonosis transmitted by contact of__________________

with the ________of infected animals.
a) Skin
b) Mucous membrane
c) Urine
Look at the two graphs below. What would change in the graph showing cardiovascular mortality if
the data had NOT been age standardised?

a) Major city mortality lower, very remote mortality higher

b) Major city mortality unchanged, very remote mortality unchanged
c) Major city mortality higher, very remote mortality higher
d) Major city mortality unchanged, very remote mortality lower
e) Major city mortality lower, very remote mortality lower

Acute rheumatic fever is a complication of infection of which organ with Group A strep?
a) Kidney
b) Tonsils
c) Endocardium
d) Mitral valve
e) Synovial lining

The opening of a nearby mine will strongly effect the local community. These effects commonly
include:
a) Increased employment opportunities
b) Affordable housing
c) High exposure to pollutants
d) Higher education achievement
e) Reduces pressure of the local health service
What best describes the epidemiological pattern of acute rheumatic fever in Australia?
a) Common in Australia in 1900 but does not exist today
b) Disease of poverty and brought to Australia from poor countries
c) Cases are only seen in Northern Territory
d) Eliminated from rural and remote areas due to improvements in socio-economic and
environmental conditions
e) Common cause of childhood hospitalisation in 1940s and most often seen today in remote
Indigenous communities

According to ACRRM, rural medical practice is characterised by:

a) Lack of contact with other health professionals
b) Wider range of clinical skills used
c) Independent practice without any support or backup
d) Demanding, difficult patients
e) Focus on acute care rather than prevention

Of the total Aboriginal and Torres Strait Islander population in Australia, what percentage lives
outside the major Australian cities?
a) 90%
b) 70%
c) 50%
d) 30%
e) 10%

Which of the following natural disasters exposes people to the greatest risk of contracting
leptospirosis?
a) Floods
b) Drought
c) Bushfire
d) Earthquake
e) Landslide

In traditional communication norms among Aboriginal and Torres Strait Islander people minimising
eye contact during conversation indicates
a) A desire to hide something
b) Lack on manners
c) Normal behaviour
d) Lack of interest
e) Nervousness
About what percentage of Australians live outside major cities?
a) 10%
b) 20%
c) 30%
d) 40%
e) 50%

Sydenhams chorea is a symptom of which disease/problem?

a) Rheumatic heart disease
b) Acute rheumatic fever
c) Rheumatoid arthritis
d) Parkinsons disease
e) Neuroleptic drug side-effect

Melioidosis is more likely in a person who:

a) Has drug allergies
b) Lives in the wet tropics
c) Is pregnant
d) Has recently returned from the Middle-East
e) Has not been immunized

The left hand side is the population pyramid for Qld. The right hand side is most likely to represent:

a) A remote indigenous community such as Palm Island

b) A regional centre such as Townsville
c) A major city such as Brisbane
d) A rural farming town such as Ingham
e) A mining town such as Moranbah

As well as fever, presenting symptoms of rheumatic fever commonly include

a) Tremor
b) Cough and shortness of breath
c) Abdominal pain
d) Migratory joint pain
e) Frontal headache
Signs of severe dehydration according the WHO definition:
a) Dry mouth; tachycardia
b) Skin pinch goes back very slowly; unable to drink
c) Unable to drink; low blood pressure
d) Low blood pressure; skin pinch goes back very slowly
e) Thirsty; dry mouth

Why is there a greater risk of motor vehicle death in rural and remote Australia?
a) Higher proportion of young men in the population; faster driving
b) Long distances and fatigue; more likely to be distracted by mobile phone
c) More likely to be distracted by mobile phone; more drink driving
d) Longer times to emergency care; higher proportion of young men in the population
e) Poorer roads; longer times to emergency care

Which of the following most accurately describes acute rheumatic fever?

a) Group A Strep infects connective tissue of the joint and heart valves
b) Group A Strep attaches to the connective tissue of heart valves damaging them
c) Group A Strep triggers an aberrant immune response which attacks connective tissue
a) Group A Strep triggers rheumatoid arthritis

Which of the following risk factors for chronic disease is NOT at a higher rate in rural populations?
a) Smoking
b) Risky levels of alcohol intake
c) Diet low in fruit and vegetables
d) Lack of exercise
e) Obesity

The commonest symptoms associated with tuberculosis are:

a) Loss of appetite and jaundice
b) Cough, fever and loss of weight
c) Persistent diarrhoea and loss of weight
d) Shortness of breath and wheeze
e) Chest pain and palpitations

Ross River virus clinical symptoms:

a) Usually last 30-60 days
b) Very severe headache and muscle pain
c) Relapse intermittently for years
d) Occasionally lead to death
e) Eventually result in rheumatoid arthritis
The NT Intervention involved all EXCEPT:
a) Compulsory child health checks
b) Compulsory adult STI checks
c) Quarantining of social security payments
d) Greater police presence in communities
e) Ceasing the Community Development Employment Program

The most common vector of RRV is:

a) Anopheles
b) Aedes aegypti
c) Sandflies
d) Marchflies
e) Culex annulirostris

The local RFDS base has just received a call asking for help: a young man has fallen from his horse
and is unconscious, but breathing normally. The RFDS doctor will FIRST:
a) Call an ambulance
b) Find out the exact location of the incident
c) Reassure the caller that the young man will be OK
d) Ask them to put the patient into the coma position
e) Obtain a phone number and promise to call them back when the plane is on its way

The diagnosis of malaria is usually made from:

a) Thick blood smear
b) Thin blood smear
c) Blood culturing
d) PCR testing
e) Serology

A rural generalist is a doctor:

a) With s skill set designed to meet the needs or rural practice, usually including a procedural
skill
b) Who can turn his/her hand to anything
c) Who is only accredited to work in rural hospitals
d) Who has completed the FRACGP
e) Who trained overseas and is working in a rural town in Australia
Strategies aimed at solving rural doctor shortages include all EXCEPT:
a) Medicare incentive to practice in rural areas
b) Better use of staff like ambulance officers or physicians assistants
c) Training more general surgeons and physicians
d) More rural training posts for junior doctors
e) Changing from undergraduate to more postgraduate medical courses

Which of the following is NOT a strategy for controlling dengue fever?

a) Avoiding mosquito bites from dawn till dusk
b) Spraying swamps to kill adult Aedes aegypti
c) Surveillance and reporting of cases
d) Reducing the number of domestic rain water tanks
e) Reduction in the breeding sites in outdoor vessels holding water

When should you book an interpreter? (select all that apply)

a) If the patient is not a native English speaker
b) If the patient shows difficulty in understanding and communicating in English
c) The patient prefers to speak in a language other than English
d) If the patient requests one

Where does Aedes aegypti breed?

a) Artificial containers with standing water
b) Rivers
c) Brackish swamps
d) Coastal plains
e) Tidal inlets

Who is most at risk of death from malaria?

a) Infant with P. Falciparum
b) An adult from highly endemic area with P. Falciparum
c) Adult living in endemic area with P. Vivax
d) Adults who have had another type of malaria in the past
e) Tourist infected with P. Vivax

One reason for the NT intervention was a report of high rates of child sexual abuse. In relation to
child sexual abuse what is a positive outcome of the intervention?
a) Raised awareness of child sexual abuse and more local action
b) Medical detection of many cases
c) A focus on Aboriginal people as sex offenders
d) An increase in children attending school
e) A marked decrease in alcohol and drug consumption
Which of the following is NOT a vector borne disease?
a) Dengue fever
b) Japanese B encephalitis
c) Malaria
d) Meliodosis
e) Filiariasis

The PTSS (patient travel subsidy scheme):

a) Is funded by local councils
b) Covers the cost of ambulance transport within Queensland
c) Reimburses actual travel expenses, when referred to a tertiary hospital clinic
d) Subsidises travel to specialist appointments more than 50Km away when referred by a
doctor
e) Is a special subsidy made available to people in declared disaster areas

Which of the following statements are true about an interpretation process to ensure the process is
as successful as possible?
a) Allow more time than would be needed for a unilingual appointment
b) Address the interpreter directly
c) Maintain eye contact with the interpreter during interpretation

During an outbreak of Ross River virus, some personal protection is gained by:
a) Wearing dark coloured clothing
b) Wearing mosquito repellent
c) Avoiding sandfly bites
d) Vaccination
e) Prophylactic medication

What type of microorganism is malaria?

a) Arbovirus
b) Bacteria
c) Helminth
d) Protozoa
e) Retrovirus

Where do most imported cases of dengue into Australia currently come from?
a) East Timour
b) Indonesia
c) PNG
d) Thailand
e) Cambodia
Severe dengue presents with:
a) Signs of plasma leakage
b) Fever > 39oC
c) Failure to respond to penicillin
d) Severe anaemia
e) Diarrhoea and vomiting

Which of the following is NOT a strategy for preventing dengue fever?

a) Remove and empty water containers around human habitation
b) Drain swampy areas
c) Prevent insect bites
d) Spray to kill adult mosquitoes
a) Wear light coloured clothing to cover skin

The rise in Non communicable disease (NCD) is having important longterm effects on health systems
globally and in Australia through:
a) Reduced need for primary health care because infectious disease is less prevalent
b) The trend to increasing subspecialisation in medicine
c) Delegated practice models such as physician assistants
d) Maldistribution of the health workforce
e) Greatly increased costs of caring for large populations with chronic disease