MCQ Basic Science Old

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"Cells that form the three primitive germ layers are derived from which of the following? A. Cytotrophoblast B. Epiblast C. Syncytiotrophoblast D. Hypoblast E. Yolk sac"

"Which one of the following viruses may be human tumor virus? A. Epstein-Barr virus (EBV) B. HIV C. Papillomavirus D. Varicella-zoster virus (VZV) E. Herpes simplex virus, type 2 (HSV)"

"Which of the following is the most prevalent microorganism in the vagina that may also be protective? A. α-hemolytic streptococci B. Lactobacillus C. S. epidermidis D. E. coli E. B. fragilis"

"Which of the following is a feature of the early asthma response? A- It occurs between 3-5 hours after an initial response to an allergen B- Eosinophils are particularly important C- Attraction of phagocytes is predominant D- Mast-cell degranulation is seen in response to the B-cell production of IgE E- Usually resolves spontaneously after 6-8 hours"

"Which of the following is a leading cause of pneumonia primarily in infants? A. Rabies B. Rhinovirus C. Cytomegalovirus D. respiratory syncytial virus E. Mumps"

"Which of the following is an acute porphyria? A- Congenital erythropoietic porphyria B- Erythropoietic protoporphyria C- Porphyria cutanea tarda D- Variegate porphyria E- None of the above"

"Which of the following is in direct contact with maternal blood in lacunae of the placenta? A. Cells of the cytotrophoblast B. Extraembryonic mesoderm C. Fetal blood vessels D. Cells of the syncytiotrophoblast E. Amniotic cells"

"Which of the following is the principal supply to the body and tail of the pancreas? A. Common hepatic artery B. Inferior phrenic artery C. left gastric artery D. Splenic artery E. Superior mesenteric artery"

"Which of the following may be the only detectable serological marker during the early convalescent phase of HBV infection (window phase)? A. HBeAg B. HBsAg C. HBcAg D. Anti-HBc E. HbeAb"

"You see a healthy 20-year-old man in your clinic. There is no significant past medical history and he plays rugby for Saracens rugby club. He tells you that his brother died at the age of seven years with cystic fibrosis. What are his chances of being a carrier? A- 1 in 4 (25%) B- 1 in 3 (33%) C- 1 in 2 (50%) D- 2 in 3 (67%) E- 3 in 4 (75%)"

"select an appropriate measure of frequency that describes the number of deaths in the first 28 days of life per 1000 live births in 1 year. A. Fetal mortality B. Infant mortality C. Perinatal mortality D. Neonatal mortality E. Post neonatal mortality"

"Meningitis is characterized by the acute onset of fever and stiff neck. Aseptic meningitis may be caused by a variety of microbial agents. During the initial 24 h of the course of aseptic meningitis, an affected person's cerebrospinal fluid is characterized by A. Decreased protein content B. Elevated glucose concentration C. Lymphocytosis D. Polymorphonuclear leukocytosis E. Eosinophilia"

"Which of the following is a feature of restriction fragment length polymorphisms (RFLPs)? A- They utilise restriction exonucleases B- They are infrequently used in linkage analysis C- They may be used to diagnose Huntington's disease D- They use Western blotting technique E- They are used in linkage which involves a difference of more than 1 million base pairs of DNA"

"Which of the following is the function of the large subunit of the ribosome? A. Bind messenger RNA (mRNA) B. Bind transfer RNA (tRNA) C. Catalyze peptide bond formation D. Link adjacent ribosomes in a polyribosome E. Initiate protein synthesis"

"Which of the following is true concerning complement activation? A- IgG and IgE are the main antibody classes involved in classical pathway activation B- C1q binds to the Fab regions of antigen-complexed IgG antibodies C- The alternative, but not the classical C3, convertase enzyme involves C3b D- Elevated serum C3dg is a good marker of complement activation E- The membrane-attack complex involves polymerisation of C7"

"Which of the following processes places the developing heart in the presumptive thoracic region cranial to the septum transversum? A. Gastrulation B. Lateral folding C. Cranial folding D. Neurulation E. Fusion of the endocardial heart tubes"

"A young man is admitted to the emergency room unconscious and hyperventilating. His breath smells of alcohol. Which of the following findings would suggest a specific cause for his condition? A- blood glucose concentration of 12 mmol/l B- Ketonuria C- Metabolic acidosis D- Serum calcium concentration (corrected) 1.62 mmol/l E- Serum sodium concentration 131 mol/l"

"Absent immune deposits on immunohistochemical analysis of renal tissue is characteristic of which one of the following renal disorders? A- Systemic lupus erythematosus B- Henoch-Schönlein nephritis C- Goodpasture's disease D- Wegener's granulomatosis E- Berger's disease"

"Among women aged 18 to 34 in a community, weight is normally distributed with a mean of 52 kg and a standard deviation of 7. 5 kg. What percentage of women will have a weight over 59. 5 kg? A. 2% B. 5% C. 10% D. 16% E. 32%"

"An 82-year-old woman, who is not on drug therapy, presents with a bullous skin rash on her arms. Which of the following tests is most likely to supply the definitive diagnosis? A- Search for anti-skin antibodies in blood B- Complement studies C- Antineutrophil cytoplasmic antibodies (ANCA) D- Skin biopsy for examination by immunofluorescence E- Immunoglobulins"

"An 85-year old woman comes into your family practice office because she says she is losing weight and she is having trouble chewing. Which of the following muscles is a pure elevator of the jaw? A. Buccinator muscle B. Geniohyoid muscle C. Lateral pterygoid muscle D. Medial pterygoid muscle E. Posterior fibers of temporalis muscle"

"An infant, seen in the ER, presents with a fever and persistent cough. Physical examination and a chest x-ray suggest pneumonia. Which of the following is most likely the cause of this infection? A. Rotavirus B. Adenovirus C. Coxsackievirus D. respiratory syncytial virus E. Rhinovirus"

"Analysis of a patient's stool reveals small structures resembling rice grains; microscopic examination shows these to be proglottids. The most likely organism in this patient's stool is A. Enterobius vermicularis B. Ascaris lumbricoides C. Necator americanus D. T. saginata E. Trichuris trichiura"

"Antibodies to which of the following are most frequently present in the serum of patients with type-1 diabetes at diagnosis? A- Cocksackievirus B- Glucagon C- Insulin D- Islet cells E- Cytomegalovirus"

"Based on the information given, which of the following laboratory tests would most rapidly assist you in making the diagnosis? A. Cold agglutinins B. Viral culture C. Complement fixation (CF) test D. Gram stain of sputum E. Culture of sputum"

"Certain parasites are found most commonly in particular body contents. A helminth that is naturally transmitted by ingestion of pork, bear, or walrus meat could be detected in A. Vaginal secretions B. Duodenal contents C. blood D. Biopsied muscle E. Sputum"

"Choose the type of measurement scale for Year of birth. A. Dichotomous scale B. Nominal scale C. Ordinal scale D. Interval scale E. Ratio scale"

"Delta hepatitis only occurs in patients who also have either acute or chronic infection with hepatitis B virus. The delta agent is A. An incomplete hepatitis B virus B. related to hepatitis A virus C. A hepatitis B mutant D. An incomplet E. Hepatitis C"

"Elevated estrogen levels during the menstrual cycle result in which of the following? A. Decrease LH levels B. Downregulate FSH receptors on granulosa cells C. Increase FSH levels D. Increase the ciliation of the epithelial cells of the oviduct E. Decrease synthesis and storage of glycogen in the vaginal epithelium"

"Endocytosis of low-density lipoprotein (LDL) differs from phagocytosis of damaged cells in which of the following? A. Use of membrane-enclosed vesicles in the uptake process B. Coupling with the lysosomal system C. Dependence on acidification D. Use of clathrin-coated pits E. Use of hydrolases"

"Erythema infectiosum (fifth disease), a self-limited disease of children, is caused by A. Measles B. Parvovirus C. Rubella D. Human herpesvirus type 6 E. Norwalk virus"

"Finding antibodies to HBsAg reflects A. Acute infection (incubation period) B. Acute infection (acute phase) C. Post infection (acute phase) D. Immunization E. HBV carrier state"

"Following a stroke, a patient is found to have a left homonymous inferior quadrantic visual field defect. Which one of the following structures is most likely to have been affected by the stroke? A- The left optical nerve B- The right occipital cortex C- The left frontal lobe D- The right parietal lobe E- The right internal capsule"

"German measles virus (rubella), a common cause of exanthems in children, is best described by which of the following statements? A. Measles (rubeola) and German measles (rubella) are caused by the same virus B. Incubation time is approximately 3 to 4 weeks C. vesicular rashes are characteristic D. Onset is abrupt with cough, coryza, and fever E. Specific antibody in the serum does not prevent disease"

"How is the Mantoux test administered? A- Intramuscular B- Subcutaneous C- Multiple subcutaneous places D- Intradermal E- Intravenous"

"Which of the following fluids would be the most appropriate to replace the fluid being lost in a patient with a paralytic ileus draining 2 litres of fluid a day through a nasogastric tube? A- Compound sodium lactate (Hartmann's solution) B- 5% dextrose C- 10% dextrose D- 0.18% sodium chloride with 4% dextrose ('dextrose saline') E- 0.9% sodium chloride ('normal saline')"

"Which of the following is a feature of the Sézary disease? A- B-cell lymphoma B- Macrophage disorder C- Natural killer cell deficiency D- Neutrophil disease E- T-cell malignancy"

"Which of the following is associated with the correct disease? A- HLA DR4 - ankylosing spondylitis B- HLA B27 - Behçet's disease C- HLA B5 - haemochromatosis D- HLA A3 - multiple sclerosis E- HLA Cw6 - psoriasis"

"Which of the following is available and effective for hepatitis A? A. Acyclovir B. Killed virus vaccine C. Inactivated virus vaccine D. Live virus vaccine E. recombinant viral vaccine"

"Which of the following is found exclusively in the renal medulla? A. Proximal convoluted tubules B. Distal convoluted tubules C. Collecting ducts D. Afferent arterioles E. Thin loops of Henle"

"Which of the following is independent of testosterone or other androgens? A. secretion from the prostatic epithelium B. The function of the prostatic glands C. Development of the penis from an indifferent phallus D. Spermatogenesis E. Fetal testis development from an indifferent gonad"

"Which of the following is the initial treatment of choice for the hyponatraemia in the majority of patients with the syndrome of inappropriate [secretion of] ADH (antidiuretic hormone, vasopressin)? A- Intravenous infusion of hypertonic saline B- Intravenous infusion of isotonic saline C- Oral demeclocycline D- Oral frusemide E- Restriction of water intake"

"Which of the following is the most important risk factor for developing cervical cancer? A. Coitarche before age 18 B. Herpes simplex virus infection C. Multiple sexual partners D. More than five years since the last Pap smear E. Human papillomavirus type 16"

"Which of the following is transmitted by the fecal-oral route; can be acquired from shellfish; and often causes acute jaundice, diarrhea, and liver function abnormalities? A. Rotavirus B. Adenovirus 40/41 C. Norwalk virus D. Astrovirus E. Hepatitis A virus"

"Which of the following organisms penetrates skin, is endemic in Africa and the Middle East, has large terminal spines on its eggs, and is found in urine samples? A. Paragonimus B. Clonorchis C. S. mansoni D. S. japonicum E. S. haematobium"

"Orchitis, which may cause sterility, is a possible manifestation of which of the following? A. Rabies B. Rhinovirus C. Cytomegalovirus D. respiratory syncytial virus E. Mumps"

"What is the mechanism of action of erythropoietin when used as a performance-enhancing drug? A- Improvement of renal function B- Increase in muscle mass C- Improvement of blood pressure control D- Improvement of exercise tolerance E- Reduction in pain"

"What the most appropriate specimen is for the detection of Adenovirus 40/41 A. Cervical tissue B. Synovial fluid C. blood D. Stool E. Cerebrospinal fluid"

"What the most appropriate specimen is for the detection of Varicella-zoster virus (VZV) A. Cervical tissue B. Synovial fluid C. blood D. Skin E. Cerebrospinal fluid"

"Where would you visualise the azygous lobe on an antero-posterior (A-P) chest X-ray? A- Left lower zone B- Left middle zone C- Left upper zone D- Right upper zone E- Right lower zone"

"Which enzyme in serum is increased in Gaucher's disease? A- Alkaline transferase (ALT) B- Aspartate transaminase (AST) C- Lactate dehydrogenase (LDH) D- Acid phosphatase E- Alkaline phosphatase (ALP)"

"A 25-year-old woman presents with primary hyperparathyroidism. It emerges that she has been treated previously for a prolactinoma. What is your diagnosis? A- Familial parathyroid hyperplasia B- Multiple endocrine neoplasia type 1 C- Neurofibromatosis type 1 D- Polyglandular autoimmune syndrome type 1 E- von Hippel-Lindau syndrome"

"A 25yearold man presents with blurred vision, dysphagia, and dry mouth. select the correct etiologic agent that match the descriptions above A. Clostridium botulinum B. Clostridium tetani C. Poliovirus D. Corynebacterium diphtheriae E. Haemophilus influenza B"

"Which of the following disorders may have an autosomal recessive mode of inheritance? A- Achondroplasia B- Glucose 6-phosphate dehydrogenase deficiency C- Huntington's disease D- Ehlers-Danlos syndrome Type IV E- Haemophilia A"

"The retinal pigment epithelium (RPE) is characterized by which of the following? A. The presence of the photoreceptor (rod and cone) perikarya B. Phagocytosis of worn-out components of photoreceptor cells C. Origin from the inner layer of the optic cup during embryonic development D. Presence of amacrine cells E. Synthesis of vitreous humor"

"The secretion of growth hormone is increased by? A- Hyperglycaemia B- Exercise C- Somatostatin D- Growth hormone E- Free fatty acids"

"In a 21-year-old female with systemic lupus erythematosus, which of the following investigations/statements is true? A- CRP is typically normal in non-infected patients with active disease B- Rheumatoid factor is positive in < 5% of patients C- Neutropenia is more common than lymphopenia D- The low-dose oral contraceptive pill and HRT are contraindicated E- Pulmonary fibrosis is a common disease complication"

"In a healthcare worker with a proven natural rubber/latex allergy, which of the following foods is most commonly associated with this condition? A- Bananas B- Melons C- Potatoes D- Tomatoes E- Chestnuts"

"In a patient developing anaphylaxis, which of the following is true? A- May be exacerbated by exercise B- Involves leukotriene A4 C- Initial symptoms include a sensation of coldness D- 20% of fatalities are due to respiratory complications E- Less than 10% of patients have a second episode within 24 hours"

"In an adult patient with cirrhosis, which of the following findings is the most reliably diagnostic of hereditary haemochromatosis as the cause? A- Liver biopsy B- Serum ferritin concentration C- Serum iron concentration D- Serum total iron-binding capacity E- Transferrin saturation"

"In patients with systemic lupus erythematosus which of the following statements is correct? A- Up to 80% of patients have anti-dsDNA antibodies B- Patients with anti-dsDNA antibodies are less likely to have renal disease C- 10% of patients can be antinuclear antibody-negative D- Ro positivity is associated with Raynaud's disease E- Beta-blockeres should be avoided in patients with SLE"

"Which of the following groups of risk factors has been associated with endometrial cancer? A. Hypertension, diabetes, and obesity B. Family history, obesity, and null parity C. Hypertension, oral contraceptives, and null parity D. Family history, early pregnancy, and diabetes E. Multiple pregnancies, obesity, and family history"

"Which of the following is not typically a cause of hypercalcaemia? A- Hyperparathyroidism B- Hypothyroidism C- Milk-alkali syndrome D- Sarcoid E- Squamous-cell carcinoma"

"A 27-year-old woman presents with worsening back pain. As a child, she and her sister had several admissions to hospital with bone fractures following minor trauma and she has recently developed bilateral hearing loss. Apart from some teeth discoloration and mild joint laxity, examination was normal. A vertebral X-ray showed partial collapse of L3. What is the most likely diagnosis? A- Osteogenesis imperfecta B- Early-onset osteoporosis C- Ehlers-Danlos syndrome D- Malignant bone metastases E- Multiple myeloma"

"A 28-year-old menstruating woman appeared in the emergency room with the following signs and symptoms: fever, 104°F (40°C); WBC, 16,000/μL; blood pressure, 90/65 mmHg; a scarlatiniform rash on her trunk, palms, and soles; extreme fatigue; vomiting; and diarrhea. The patient described in the case above most likely has A. Scalded skin syndrome B. Toxic shock syndrome C. Guillain-Barré syndrome D. Chickenpox E. Staphylococcal food poisoning"

"Which of the following is the most direct route for spread of infection from the paranasal sinuses to the cavernous sinus of the dura mater? A. Pterygoid venous plexus B. Superior ophthalmic vein C. Frontal emissary vein D. Basilar venous plexus E. Parietal emissary vein"

"A 36-year-old man presents to his GP with a feeling of numbness in his left leg. On examination, he has decreased position sense and light touch and vibration sensation affecting his left leg to the upper part of the thigh. No other neurological deficit is demonstrable. Which of the following is the most likely cause of this presentation? A- Left dorsal column lesion B- Left spinothalamic tract lesion C- Peripheral polyneuropathy D- Partial section of the spinal cord E- Sensory root compression"

"Which of the following is the primary regulator of salivary secretion? A. Antidiuretic hormone B. Autonomic nervous system C. Aldosterone D. Cholecystokinin E. secretin"

"Infection with hepatitis D virus (HDV; delta agent) can occur simultaneously with infection with hepatitis B virus (HBV) or in a carrier of hepatitis B virus because HDV is a defective virus that requires HBV for its replicative function. What serologic test can be used to determine whether a patient with HDV is an HBV carrier? A. HBsAg B. HBc IgM C. HBeAg D. HBs IgM E. HBs IgG"

"Osteoporosis is most reliably diagnosed by which one of the following techniques? A- Dual-energy X-ray absorptiometry (DEXA) B- Measurement of serum osteocalcin C- Measurement of urinary collagen telopeptides D- Quantitative computed tomography (CT) E- Quantitative ultrasonography"

"A 36-year-old man presents to his family doctor complaining of excessive sweating. thyroid function tests are performed: serum TSH concentration is normal, but the concentrations of both free thyroxine and free triiodothyronine are elevated. Which of the following is the most likely explanation for these results? A- A TSH-secreting pituitary tumour B- Graves' disease C- Self-administration of thyroxine D- The presence of heterophilic antibodies in the patient's serum E- thyroid hormone resistance"

"A 39-year-old man presents with recurrent episodes of early morning dizziness, which resolve rapidly when he has his breakfast. Which of the following metabolic pathways is most likely to be functioning abnormally? A- Gluconeogenesis B- Glycolysis C- Glycogen synthesis D- Ketogenesis E- The tricarboxylic acid cycle (citric acid cycle, Krebs' cycle)"

"Patients with xeroderma pigmentosum have a high risk of developing skin cancer.What kind of genetic deficiency do those patients have? A- Nucleotide excision repair B- Protein kinase C- Base excision repair D- Mismatch repair E- Ligase"

"Pulmonary gas exchange occurs under which of the following physiological principles? A- Gas exchange can occur in the final seven branches of the bronchoalveolar tree B- The first 12 branches of the bronchial tree are collectively known as the conducting zone C- The equilibration of gases takes about 2.5 s in the resting lung D- Only about 0.15% of oxygen is carried in solution in the plasma E- Carbon dioxide is less water-soluble than oxygen"

"Rabies, psittacosis, salmonellosis. select the most common described mode of transmission with the above disease A. Water or foodborne transmission B. Zoonoses C. Person to person direct contact transmission D. Airborne transmission E. Arthropodborne transmission"

"S. aureus has a distinctive appearance on which one of the following media? A. Sheep blood agar B. Löffler's medium C. Thayer-Martin agar D. Thiosulfate citrate bile salts sucrose medium E. Löwenstein-Jensen medium"

"Scabies is caused by a small mite that burrows into the skin. The disease is best described by which one of the following statements? A. It is caused by a species of Sarcoptes B. secondary bacterial infection is rare C. It is synonymous with Kawasaki's syndrome D. It is best diagnosed by biopsy of the inflammatory region around the mite bite E. Allergic (asthma-like) reactions to mites are rare"

"Some 4 hours after sustaining major trauma in a road traffic accident, a 22-year-old man, notknown to have diabetes, is found to have a high blood glucose concentration. Increased secretion of which of the following substances is most likely to be responsible? A- Adrenaline (epinephrine) B- Cortisol C- C-reactive protein D- Growth hormone E- Insulin"

"Susceptiblity to Pneumocystis jiroveci can be associated with high levels of: A- IgM B- IgG C- IgA D- IgE E- IgD"

"The 3' to 5' exonuclease activity possessed by some DNA polymerases that enables the enzyme to replace misincorporated nucleotide is called what? A- Proofreading B- Replication C- Recombination D- Retrotransposition E- Splicing"

"The accumulation of gangliosidic GM2 in the central nervous system of individuals with Tay-Sachs disease is attributed to: A- Decreased lysosomal hydrolysis B- Decreased Golgi stimulation C- Increased permeability of the blood-brain barrier D- Increased receptor-mediated endocytosis E- Increased synthesis in the endoplasmic reticulum"

"The antibiotic of choice for streptococcal pharyngitis is A. Penicillin B. Ampicillin C. Erythromycin D. Vancomycin E. Ceftriaxone"

"The asymmetry of the cell membrane is established primarily by which of the following? A. Membrane synthesis in the endoplasmic reticulum B. Membrane modification in the Golgi apparatus C. Presence of carbohydrates on the cytoplasmic surface D. The distribution of cholesterol E. Flipping proteins between the leaflets of the lipid bilayer"

"The cerebral cortex forms from which of the following? A. telencephalon B. Myelencephalon C. Metencephalon D. Mesencephalon E. Diencephalon"

"The clinical picture of arbovirus infection fits one of three categories: encephalitis, hemorrhagic fever, or fever with myalgia. One of the characteristics of arboviruses is that they A. Are transmitted by arthropod vectors B. Are usually resistant to ether C. Usually cause symptomatic infection in humans D. Are closely related to parvoviruses"

"The mean lower oesophageal sphincter pressure is reduced in which of the following situations? A- Grade III oesophagitis B- Grade IV oesophagitis post-laparoscopic Nissens fundoplication C- Achalasia D- Nutcracker oesophagus E- Diffuse oesophageal spasm"

"A 4-day-old boy weighing 7 lb, 6 oz is brought to the emergency room by his parents. The examining emergency room physician notes that his skin and sclerae are icteric. A blood test indicates elevated unconjugated bilirubin in the serum. The elevated bilirubin levels in this patient are most likely the result of which of the following? A. Deficiency of enzymes regulating bilirubin solubility B. Hepatocellular proliferation C. Decreased destruction of red blood cells D. Dilation of the common bile duct E. Increased hepatocyte uptake of bilirubin"

"A 42-year-old man with type-1 diabetes mellitus, which was diagnosed 23 years ago, is admitted to hospital with diabetic ketoacidosis. He is complaining of abdominal pain. Which of the following findings on admission would most suggest an acute event has preciptated his DKA? A- Serum amylase activity of 1244 U/l (upper limit of normal, 150 U/l) B- Serum creatinine concentration 140 m mol/l3- Serum lactate concentration 4.3 mmol/l C- Serum triglyceride concentration 12.2 mmol/l E- White cell count of 15 x 109/l"

"The most common portal of entry for C. tetani, the cause of tetanus, is the A. Skin B. Gastrointestinal tract C. respiratory tract D. Genital tract E. Nasal tract"

"The neural plate forms directly from which of the following? A. Ectoderm B. Endoderm C. Somatopleuric mesoderm D. Splanchnopleuric mesoderm E. Hypoblast"

"The oxygen-haemoglobin dissociation curve is shifted to the left by which of the following factors? A- Rise in pH B- Rise in 2,3-DPG (2,3-diphosphoglycerate) C- Rise in plasma temperature D- Rise in blood CO2 content E- Fall in plasma bicarbonate concentration"

"The substitution of the amino acid valine instead of the normal glutamic acid at position6 of the b-globin chain is the genetic abnormality encountered in which one of the following types of congenital haemolytic anaemia? A- Sickle cell anaemia B- β-Thalassaemia C- Hereditary spherocytosis D- Glucose-6-phosphate dehydrogenase (G6PD) deficiency E- Methaemoglobinaemia"

"The use of oral contracep tives will have the most impact on gynecological mortality by reduc ing the risk for which of the follow ing cancers? A. Ovarian B. Breast C. Cervical D. Vulvar D. Endometrial"

"Trachoma is one of the leading causes of blindness. Which of the following best typifies the disease? A. It is caused by C. trachomatis B. It is best treated with systemic cephalosporins and ophthalmic tetracycline C. It affects 400 million people in the Pacific Rim D. It is a form of chronic uveitis E. Chlamydial eye infection is a major veterinary problem"

"V. cholerae, the causative agent of cholera, is best described as A. "String-test"-positive isolate; three serotypes—Ogawa (AB), Inaba (AC), Hikojima (ABC) B. Human pathogen, halophilic, lactose-positive; produces heat-labile, extracellular toxin C. Human pathogen, halophilic, lactose-negative, sucrose-negative; causes gastrointestinal diseases primarily from ingestion of cooked seafood D. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at 42°C E. Urease-positive; cause of fetal distress in cattle"

"A 43-year-old man who recently returned from a trip to rural Peru presents with severe watery diarrhea, vomiting, and dehydration. He also has marked leg cramps and has lost 8 lb since his return from the trip. Fecal culture is positive for V. cholerae. How does this bacterium exert its effect? A. Activation of enterokinase on the brush border of epithelial cells B. Activation of cholecystokinin effects on pancreatic secretion C. Closure of chloride channels in the enterocyte cell membrane D. Inhibition of cyclic AMP in the enterocytes E. ADP-ribosylation of GS of the GTP-binding protein in enterocytes"

"A child has mononucleosis-like symptoms yet the test for mononucleosis and the EBV titers are negative. One of the causes of heterophilenegative mononucleosis is A. Cytomegalovirus B. Herpes simplex virus C. Varicella-zoster virus D. Adenovirus E. Coxsackievirus"

"A dental surgeon carries out a block of the inferior alveolar nerve by infiltrating local anaesthetic at the mandibular foramen. Which clinical feature may result from this procedure? A- Numbness of the lower lip on the injected side B- Ineffective block for the incisor teeth C- Numbness of the side of the tongue D- Inability of the patient to clench his jaws E- Transient weakness of the facial muscles on the injected side"

"What is the importance of the P1 receptor? A- Inducing apoptosis B- Increasing cytotoxic drug excretion from cells C- Increasing cytotoxic drug metabolite clearance D- Calcium channel activator E- Potassium channel activator"

"What is the main feature of DNA sequence polymorphisms that differentiates them from mutations? A- They are common in the population B- They often cause serious medical conditions C- They usually interfere with normal gene function D- They are not found in certain ethnic groups E- They are evenly spread throughout all genes"

"What the most appropriate specimen is for the detection of Cytomegalovirus A. Cervical tissue B. Synovial fluid C. blood D. Skin E. Cerebrospinal fluid"

"What the most appropriate specimen is for the detection of Human papillomavirus A. Cervical tissue B. Synovial fluid C. blood D. Skin"

"Which enzyme breaks base pairs in a double-stranded DNA molecule? A- Helicase B- Nuclease C- Phosphodiesterase D- Restriction endonuclease E- Telomerase"

"Which immunoglobulin can fix complement via the alternative pathway? A- IgA B- IgM C- IgG D- IgE E- IgD"

"A full-term male infant displays projectile vomiting 1 h after suckling. There is failure to gain weight during the first 48 hours. The vomitus is not bile-stained and no respiratory difficulty is evident. Examination reveals an abdomen neither tense nor bloated. Which of the following is the most probable explanation? A. Congenital hypertrophic pyloric stenosis B. Congenital absence of a kidney C. Patent ileal diverticulum D. Imperforate anus E. Tracheoesophageal fistula"

"A fur trapper complains of sore muscles, has swollen eyes, and reports eating bear meat on a regular basis. He is at risk for A. Trichinosis B. Schistosomiasis C. Toxoplasmosis D. Visceral larva migrans E. Giardiasis"

"A hospital worker is found to have hepatitis B surface antigen. Subsequent tests reveal the presence of e antigen as well. The worker most likely A. Is infective and has active hepatitis B. Is infective but does not have active hepatitis C. Is not infective D. Is evincing a biologic false-positive test for hepatitis E. Has both hepatitis B and C"

"A patient has been diagnosed with Marfan's syndrome. Which gene mutation is responsible for this condition? A- Fibrillin B- Mitochondria C- Cyclooxygenase D- Hexosaminidase E- Galactosidase"

"A patient has been investigated for loose joints. He also complains of reduced vision. On examination he has very thin extremities and arachnodactyly. What is the most likely diagnosis? A- Marfan's syndrome B- Tay-Sachs disease C- Fabry disease D- Gaucher disease E- Niemann-Pick disease"

"Which of following is true regarding gamma-glutamyl transferase (GGT)? A- It is increased in patients with fatty liver disease B- If elevated in prostate cancer it means liver metastases C- It is a better indicator of infectious hepatitis than of cholestasis D- It is only found in the liver E- It is elevated in pregnancy"

"Which of the following causes a fatal encephalitis for which a vaccine is available? A. Rabies B. Rhinovirus C. Cytomegalovirus D. respiratory syncytial virus E. Mumps"

"The serum of a newborn infant reveals a 1:32 cytomegalovirus (CMV) titer. The child is clinically asymptomatic. Which of the following courses of action would be advisable? A. repeat the CMV titer immediately B. Wait 6 months and obtain another titer on the baby C. Obtain a CMV titer from all siblings D. Obtain an anti-CMV IgM titer from the mother E. Obtain an anti-CMV IgM titer from the baby"

"The time interval between entry of an infectious agent into a host and the onset of symptoms is called A. The communicable period B. The incubation period C. The preinfectious period D. The noncontagious period E. The decubation period"

"A patient has her inferior laryngeal nerve inadvertently divided during a partial thyroidectomy. Which clinical features are likely to result from this? A- The larynx is anaesthetic inferior to the vocal cord on the affected side B- The larynx is totally anaesthetic on the affected side C- All the laryngeal muscles on the affected side are paralysed D- All the laryngeal muscles are paralysed on the affected side, apart from the posterior cricoarytenoid muscle E- At laryngoscopy, the affected cord is seen to lie paralysed in the midline"

"A patient has the following urea and electrolytes results: Sodium 140 mmol/l Potassium 4 mmol/l Chloride 105 mmol/l Bicarbonate 20mmol/l Calculate the anion gap. A- 19 meq/l B- 5 meq/l C- 10 meq/l D- 30 meq/l E- 0 meq/l"

"A patient presents with eczema, thrombocytopenia and recurrent infections. What is the most likely diagnosis? A- Wiskott-Aldrich syndrome B- Hyper-IgE syndrome C- Gaucher's disease D- IgA deficiency E- Malignancy"

"A patient presents with facial abnormalities that may include abnormal ears, a shortened philtrum, micrognathia and hypertelorism. Which cells is this patient lacking? A- T lymphocytes B- B lymphocytes C- Erythrocytes D- Melanocytes E- Leucocytes"

"The treatment of choice for a patient with C. jejuni enterocolitis is A. Erythromycin B. Ciprofloxacin C. Ampicillin D. Pepto-Bismol E. Campylobacter antitoxin"

"A patient presents with hypocalcaemic tetany. He has abnormal ears, hypertelorism and an absent thymus. What is the most likely diagnosis? A- DiGeorge syndrome B- Wiskott-Aldrich syndrome C- Gaucher's disease D- Tay-Sachs disease E- Ataxia-teleangiectasia"

"A patient presents with mononeuritis multiplex affecting the oculomotor nerve (III). What clinical feature is likely to be present on examination? A- Ptosis of the upper eyelid on the affected side B- Constricted pupil on the affected side C- Inability to laterally deviate the eye on that side D- Decreased sweating of the face on the affected side E- A light shone into the affected eye fails to produce constriction of the pupil on the opposite side"

"A pituitary adenoma is likely to result in which of the following? A. Cushing's syndrome B. Deficiency in T3 and T4 C. Diabetes insipidus D. Osteoporosis E. Stunted growth or dwarfism"

"A primary procedure for diagnosis of fecal parasites is a stained smear of feces. For some parasitic infections, however, other specimens may be more productive. G. lamblia is best diagnosed by A. Sigmoidoscopy and aspiration of mucosal lesions B. Baermann technique C. Dilution followed by egg count D. Enzyme immunoassay (EIA) E. Examination of a cellophane tape swab"

"Which of the following features applies to acetylcholine-mediated transmission at the motor endplate? A- The synaptic fusion complex is made of synaptobrevin, syntaxin and synaptosome-associated protein B- Syntaxin forms a SNAP complex, together with NSF, Ca2+ and other proteins C- Tetanus toxin (TeNT) cleaves specific sites of SNAP-25 D- Botulinum toxin type B (BoNT/B) cleaves syntaxin E- Botulinum toxin type A (BoNT/A) cleaves specific sites of synaptobrevin (VAMP)"

"Which of the following interventions is the most effective in the prevention and control of injuries? A. Education B. Economic incentives C. Law enforcement D. Engineering E. Emergency response"

"Which of the following is the function of the vestibular membrane? A. Maintain the gradient between the endolymph and the perilymph B. Maintain communication between the tympanic and vestibular cavities C. Transmit sound to the oval window D. Maintain the concentration gradient necessary for sensory transduction E. Dampen the action of the auditory ossicles"

"Which of the following is the most common cause of pediatric gastroenteritis? It is difficult to grow in cell culture but can be detected easily by immunologic methods (ELISA). A. Rotavirus B. Adenovirus 40/41 C. Norwalk virus D. Astrovirus E. Hepatitis A virus"

"Which of the following is the most cost-effective and safe public health measure today to prevent dental caries? A. Water fluoridation B. Proper nutrition C. regular dental visits D. Promotion of regular flossing E. Promotion of regular brushing"

"Which of the following is the most important causative factor in the development of obesity in the majority of patients? A- Energy intake in excess of expenditure B- Genetic predisposition C- Insulin resistance D- Intrauterine malnutrition E- Leptin deficiency"

"Which of the following is true concerning immunity to viruses? A- IgA can offer protection at mucosal surfaces B- Cytotoxic T cells are activated before natural killer cells during the course of infection C- Viruses stimulate the non-immune cells that they infect to produce interferong D- Non-enveloped viruses are susceptible to damage by complement E- Influenza virus can avoid antibody recognition by mutational changes in its nucleocapsid proteins"

"A survey of 100 healthy adults reveals that 80% have IgG antibodies to Toxoplasma. Which one of the following statements would help to explain this finding? A. The potential for Toxoplasma infection is widespread and the disease is mild and self-limiting B. Toxoplasmosis is caused by eating meat; therefore, all meat eaters have had toxoplasmosis C. A variety of parasitic infections induce the formation of Toxoplasma antibody D. The test for Toxoplasma antibodies is highly nonspecific E. The IgM test is more reliable than the IgG test for determination of past infections;retesting for IgM would show that most people do not have Toxoplasma antibody"

"A woman, recently returned from Africa, complains of having paroxysmal attacks of chills, fever, and sweating; these attacks last a day or two at a time and recur every 36 to 48 h. Examination of a stained blood specimen reveals ring-like and crescent-like forms within red blood cells. The infecting organism most likely is A. Plasmodium falciparum B. Plasmodium vivax C. Trypanosoma gambiense D. Wuchereria bancrofti E. Schistosoma mansoni"

"A young pregnant girl would like to know the risk of having a child with genetic abnormalities. Her father and two brothers are affected by haemophilia, which is inherited as an X-linked disease. She is herself completely asymptomatic. She knows from her last ultrasound test that her baby is a boy. What is the chance for her son to be genetically affected by the same condition? A- 1 in 2 B- 1 in 4 C- 1 in 6 D- 1 in 8 E- 1 in 16"

"A young woman is admitted to A&E having taken an aspirin overdose. The plasma concentration of salicylate is 550 mg/l (4.0 mmol/l). What clinical feature would most suggest that another drug has been taken in addition to aspirin? A- Coma B- Hyperventilation C- Sweating D- Tinnitus E- Vomiting"

"Which of the following locations is optimal for fertilization of an ovulated egg by sperm to occur? A. Ampulla of the oviduct B. Uterus C. Infundibulum of the oviduct D. Isthmus of the oviduct E. Cervical canal of the uterus"

"Which of the following measures is used frequently as a denominator to calculate the incidence rate of a disease? A. Number of cases observed B. Number of new cases observed C. Number of asymptomatic cases D. Personyears of observation E. Persons lost to follow up"

"Which of the following mycoplasmas has been implicated as a cause of nongonococcal urethritis (NGU)? A. Mycoplasma hominis B. M. pneumoniae C. M. fermentans D. M. mycoides E. Ureaplasma urealyticum"

"A young woman with known systemic lupus erythematosus, complicated by an autoimmune neutropenia, is referred for consideration of her therapeutic options. The initial choice of treatment would have been azathioprine; however, monitoring of the drug therapy is likely to be highly problematic since this patient is neutropenic. A cytotoxic agent selective for lymphocytes is therefore preferable, to circumvent such problems. Which agent best fits her requirements? A- Mycophenolate mofetil B- Sirolimus C- Chlorambucil D- Ciclosporin E- Thalidomide"

"Adults who have had varicella as children occasionally suffer a recurrent form of the disease, shingles. The agent causing these diseases is a member of which of the following viral families? A. Herpesvirus B. Poxvirus C. Adenovirus D. Myxovirus E. Paramyxovirus"

"Which of the following processes is responsible for fusion of the paired dorsal aortae? A. Lateral folding B. Craniocaudal folding C. Looping of the heart tube D. Neurulation E. Gastrulation"

"A 20-year-old man is referred to the endocrinology clinic because of delayed puberty. On examination, he has a preadolescent body habitus and no evidence of the development of secondary sexual characteristics. Serum testosterone, LH (luteinising hormone) and FSH (follicle-stimulating hormone) concentrations are all in the prepubertal range. The LH and FSH concentrations increase only slightly following a single injection of GnRH (gonadotrophin-releasing hormone) but a normal response iselicited after GnRH is given daily for seven consecutive days. Which of the following is most likely to be the cause of his delayed puberty? A- A hypothalamic disorder B- A pituitary disorder C- Klinefelter's syndrome D- Mumps orchitis in childhood E- Seminiferous tubular dysfunction"

"A 20-year-old man presents with mild jaundice following a flu-like illness. Following review by a gastroenterologist, he has been told that a diagnosis of Gilbert's syndrome is probable. Which of the following laboratory tests is most likely to confirm this diagnosis? A- Absence of bilirubin in the urine B- Decreased serum haptoglobin concentration C- Elevated serum aspartate aminotransferase (transaminase, AST) activity D- Increased reticulocyte count E- Increased urinary urobilinogen excretion"

"A 20-year-old woman complains of an immediate intense itching in her throat when eating apples, but says that she can eat cooked ones. She mentions that she has allergic rhinitis but the current symptoms occur in April and May and not the typical June/July period associated with grass pollen. What is the most likely diagnosis? A- Birch-associated oral allergy syndrome B- Food intolerance C- Allergy to the wax coating on apples D- Latex allergy E- Salicylate sensitivity"

"A 20-year-old woman presents with hypothyroidism. On further questioning it transpires she has primary amenorrhoea. She is also of relatively short stature compared to her sisters. What is the most likely diagnosis? A- Turner's syndrome B- Down's syndrome C- Noonan's syndrome D- XXX syndrome E- Achondroplasia"

"A 21-year-old college student complained of malaise, low-grade fever, and a harsh cough, but not of muscle aches and pains. An x-ray revealed a diffuse interstitial pneumonia in the left lobes of the lung. The WBC count was normal. The student has been ill for a week. Based on the information given, the most likely diagnosis is A. Mycoplasma pneumonia B. Pneumococcal pneumonia C. Staphylococcal pneumonia D. Influenza E. legionellosis"

"In a 20-year-old man, recurrent and/or severe infections with which of the following organisms would make you suspect immunodeficiency associated with hypogammaglobulinaemia? A- Haemophilus influenzae B- Chlamydia Psitacci C- Herpes simplex virus D- Candida spp E- Pneumocystis jiroveci"

"A 25-year-old man is admitted to hospital with persistent vomiting. He is clinically dehydrated and hypotensive. His serum sodium concentration is 124 mmol/l, potassium 4.9 mmol/l, urea 9.8 mmol/l, creatinine 96 m mol/l. Urine sodium concentration in a specimen passed on admission is 62 mmol/l. Which of the following is the most likely cause of the hyponatraemia? A- Adrenal failure B- Cerebral salt wasting C- Gastrointestinal fluid loss D- Low sodium intake E- Syndrome of inappropriate antidiuresis (SIAD)"

"A 25-year-old patient suffered recurrent deep vein thromboses and also one pulmonary embolism. She was extensively investigated and diagnosed with protein C deficiency. What pathological process is most likely to be responsible for her venous thromboembolisms? A- Reduced degradation of factors Va and VIIIa B- Reduced factor Xa complex C- Reduced inhibition of tissue-factor expression D- Reduced protein S E- Reduced synthesis of antithrombin III"

"A 16-year-old boy presented with absence of pubertal development. He had no other symptoms of note. On examination he was tall, his voice was unbroken, testes were undescended and there was only scanty pubic hair. The remainder of the examination was unremarkable. What is the most likely diagnosis? A- Klinefelter's syndrome B- Turner's syndrome C- Kallmann's syndrome D- Testicular feminisation E- Hypopituitarism"

"A 19-year-old man from a family of travellers presents to the Emergency department. He has suffered a sudden deterioration in vision. Additional past medical history of note includes bilateral shoulder dislocation. On examination he is tall and thin with a high arched palate. He appears to have suffered a lens dislocation. Which of the following genes is most likely to be abnormal? A- Fibrillin-1 B- Collagen Type II C- Collagen Type III D- Collagen Type IV E- Collagen Type V"

"A 19-year-old woman has been diagnosed as having acute intermittent porphyria. How is she most likely to have presented? A- Acute abdomen B- Hypertension C- Motor neuropathy D- Psychosis E- Sensory neuropathy"

"A 19-year-old woman is found in the desert following an accident 7 days earlier. She is severely dehydrated, drowsy and confused. On examination she looks very dry and has a BP of 90/65 mmHg. Investigations: Hb 14.9 g/dl, WCC 6.0 x 109/L, PLT 190 x 109/L, Na+ 145 mmol/l, K+ 5.4 mmol/l, Creatinine 198 μmol/l, Urea 21.0 mmol/l. Which of the following is the adaptive mechanism which has prevented her from dying from dehydration? A- Increase of aquaporin-2 in collecting duct B- Decrease in ADH C- Reduction in GFR D- Decrease in BP E- Increase in renal sodium excretion"

"A 20-year-old man is referred for investigation of hypogonadism and infertility. He went through normal puberty and there is no significant family history. On examination he is tall with gynaecomastia and small testes. He has a normal sense of smell. Which condition would be high on your list of differential diagnoses? A- Klinefelter's syndrome B- XYY syndrome C- Marfan's syndrome D- Kallmann's syndrome E- Fragile X syndrome"

"A 45-year-old woman with type-2 diabetes is making an apparently good recovery 7 days after a partial resection of the small intestine following trauma sustained in a stabbing incident. She is receiving parenteral nutrition with additional 'normal' saline and, because of a history of deep vein thrombosis some 10 years previously, is on prophylactic heparin. Before her admission she was well, with no ongoing medical problems and taking no regular medication. Serum electrolyte results are as follows: sodium 129 mmol/l, potassium 6.5 mmol/l, bicarbonate 24 mmol/l, urea 8.5 mmol/l, creatinine 120 mmol/l, glucose 10.2 mmol/l. Her potassium concentration has risen over the past 3 days. The potassium content of the parenteral feed has been reduced from 60 to 20 mmol/24 h during this period. Urine output is appropriate to her fluid input. Her red cell, white cell and platelet counts are all normal. What is the most likely cause of the hyperkalaemia? A- Heparin treatment B- Overprovision of potassium in the parenteral feed C- Primary adrenal failure (Addison's disease) D- Pseudohyperkalaemia E- Renal impairment"

"A 48-year-old man is referred by his GP with suspected acromegaly. Which of the following would be the most useful investigation to establish the diagnosis? A- Glucose tolerance test with measurement of growth hormone B- Measurement of serum basal growth hormone concentration C- Measurement of serum growth hormone concentration during sLEEP D- Measurement of serum insulin-like growth factor I (IGF-1, somatomedin C) E- Measurement of serum growth hormone concentration following exercise"

"A 49-year-old postmenopausal woman of Southern Asian origin complains of muscle weakness. She is found to have hypocalcaemia, and X-ray examination reveals two Looser's zones in her left upper femur. A defect in which of the following physiological processes is most likely to be the cause of her illness? A- Absorption of calcium from the gut B- Osteoblastic activity C- Osteoclastic activity D- Parathyroid hormone secretion E- Renal excretion of calcium"

"A 5-year-old boy sustains a tear in his gastrocnemius muscle when he is involved in a bicycle accident. regeneration of the muscle will occur through which of the following? A. Differentiation of satellite cells B. Dedifferentiation of myocytes into myoblasts C. Fusion of damaged myofibers to form new myotubes D. Hyperplasia of existing myofibers E. Differentiation of fibroblasts to form myocytes"

"A 50 year old woman comes for her periodical health examination. Her body mass index is 29 kg/m2. Her blood pressure is 120/80. She has no family history of cardiovascular disease. Her total cholesterol is 200 mg/dL (5. 2 mmol/L), her HDL is 35 mg/dL (0. 9 mmol/L), and her LDL is 100 mg/dL (2. 6 mmol/L). The most appropriate initial intervention for weight loss is A. Exercise B. Surgery C. Appetitesuppressive drugs D. Diet with less than 25% of total calories from fat E. restriction to three meals per day"

"A 52 year old man is being treated in hospitalfor digoxin toxicity. Which of the following biochemical abnormalities, if present, would be most likely to exacerbate the digoxin? A- Hypokalaemia B- Hypocalcaemia C- Hypomagnesaemia D- Hyponatraemia E- Hypophosphataemia"

"A 54-year-old woman presents with longstanding tinnitus and evidence of a unilateral fifth (trigeminal nerve) palsy. Her MRI scan shows evidence of an acoustic neuroma. Where is compression of the trigeminal nerve most likely to be occurring? A- Cerebellopontine angle B- Cavernous sinus C- Brainstem D- Skull base E- Trigeminal ganglion"

"A 55-year-old diabetic patient complains of soreness of his tongue, he has also noticed white plaques on his tongue. Which antibody in the saliva is the most important host defence in preventing further spreading of the disease? A- IgA B- IgG C- IgM D- IgD E- IgE"

"A 58-year-old man develops generalised oedema. He has heavy proteinuria and his serum albumin concentration is 24 g/l (35-50). Which of the following additional findings would most suggest a specific cause for this condition? A- Bence Jones protein in urine B- Decreased plasma antithrombin III concentration C- Elevated serum cholesterol concentration D- Increased beta-globulin band on serum protein electrophoresis E- Low serum 25-hydroxycholecalciferol concentration"

"A 64-year-old man is admitted with a severe haematemesis. Upper GI endoscopy identifies a posterior gastric ulcer. Bleeding is most likely to having occurred from which main vessel? A- Splenic artery B- Left gastroepiploic artery C- Inferior pancreaticoduodenal artery D- Oesophageal branch of the left gastric artery E- Gastroduodenal branch of the right gastric artery"

"A 75-year-old man with prostatism has a serum prostate-specific antigen (PSA) concentration of 15 ng/l. Which of the following statements is true with regard to this result? A- It could be explained by prostatitis B- It is diagnostic of malignancy C- It is likely to be invalidated if he underwent a digital rectal examination 48 h before the blood sample was taken D- It is prognostically highly significant E- It is unremarkable in a man of this age"

"A 76-year-old patient is admitted to the acute admission unit with septic shock. Pulse is 106 and BP 90/40 mmHg. Urinary catheterisation produces 75 ml of concentrated urine. Which of the following principles applies to the choice of an appropriate intravenous fluid for resuscitation? A- Certain intravenous solutions, which would be hypo-osmolar, have dextrose added to ensure they are iso-osmolar B- Hartmann's solution contains sodium, potassium, chloride, calcium and bicarbonate C- An advantage of crystalloid solutions is that relatively small volumes have to be infused to restore an intravascular volume deficit D- The normal colloid oncotic pressure is 70 mmHg E- Albumin is indicated"

"A bacterium is examined and is found to lack superoxide dismutase, catalase, and peroxidase. Which of the following statements best describes this bacterium? A. This bacterium is an anaerobe B. This bacterium will survive in an O2 environment C. This bacterium is more virulent than one containing the three enzymes D. This bacterium does not produce superoxide E. This bacterium does not produce peroxide"

"A cerebral angiogram is performed on a 37-year-old woman, following a suspected aneurysmal bleed. Which anatomical feature should be considered when interpreting the angiogram? A- The middle cerebral artery is the largest single component of the circle of Willis B- The posterior cerebral artery is clearly seen on a lateral carotid angiogram C- The vertebral arteries meet at the foramen magnum to form the basilar artery D- The middle cerebral artery courses over the lateral aspect of the temporal lobe of the cerebrum E- The middle meningeal artery is an extracranial branch of the internal carotid artery"

"An 82-year-old woman with atrial fibrillation develops a sudden arterial occlusion of her right arm due to a brachial embolism. Which statement pertaining to the arterial system of the upper limb best accords with usual clinical findings? A- The brachial artery bifurcates into the ulnar and radial arteries at the level of the head of the radius B- The brachial artery is crossed by the median nerve immediately above the elbow C- A large single brachial vein accompanies the artery on its medial side D- Profunda brachii arises from the brachial artery a hand's breadth above the elbow E- A brachial artery embolus is especially serious because of the poor collateral circulation around the elbow joint"

"An HIV-positive patient asks you if you can tell him the chances of him progressing to symptomatic AIDS. Which one of the following tests would be most useful? A. CD4 lymphocyte count B. HIV antibody test C. HIV RT PCR D. Neopterin E. HIV p24 antigen"

"An HIV-positive patient prior to being treated with AZT, DDI, and saquinavir has a CD4 lymphocyte count and an HIV RNA viral load test done. results are as follows: CD4: 50 CD4 lymphocytes per microliter, HIV RNA: 750,000 copies per ml. Which of the following statements best describes the above patient? A. This patient is no longer in danger of opportunistic infection B. The 5-year prognosis is excellent C. The patient's HIV screening test is most likely negative D. The patient is not infectious E. The viral load of 750,000 copies per ml suggests that the patient will respond to triple therapy"

"An overweight 32-year-old woman presents with a short history of painless jaundice. There is no previous history of illness and, apart from the jaundice, she has no signs of chronic liver disease. Initial investigations reveal a haemoglobin of 12.7 g/dl, MCV 105 fl, serum bilirubin 162 mmol/l, AST 145 U/l, alkaline phosphatase 224 U/l, gamma-glutamyltransferase 200 U/l. Which of the following is the most likely diagnosis? A- Alcoholic liver disease B- Autoimmune chronic hepatitis C- Carcinoma of the head of the pancreas D- Cholecystitis E- Hepatitis A infection"

"Broad-spectrum penicillin with antipseudomonas activity is A. Piperacillin B. Cefoperazone C. Ceftriaxone D. Ciprofloxacin E. Imipenem"

"C. trachomatis can be distinguished from C. psittaci by which of the following criteria? A. C. trachomatis is sensitive to sulfonamides B. C. trachomatis has a different lipopolysaccharide antigen C. C. trachomatis can be stained with Giemsa D. C. psittaci is an obligate prokaryotic parasite E. C. psittaci forms inclusions that contain glycogen"

"Comparison of the prevalence of hepatitis B surface antigen (HBsAg) in medical and dental students. select an appropriate statistical test to analyze the data that match above description A. Chi-square analysis B. Student t test C. Paired t test D. Analysis of variance E. Linear regression"

"Culture of the menstrual fluid in the case cited would most likely reveal a predominance of A. S. aureus B. S. epidermidis C. C. perfringens D. C. difficile E. Gardnerella vaginalis"

"Cytomegalovirus (CMV) infection is common. Which one of the following statements best characterizes CMV? A. It can be transmitted across the placental barrier B. While a common infection, CMV is almost always symptomatic C. The CMV can be cultured from red blood cells of infected patients D. Unlike other viral infections, CMV is not activated by immunosuppressive therapy E. There is no specific therapy for CMV"

"Degranulation of eosinophils allows which of the following cellular processes? A- Fusion of the lysosomal membrane with the plasma membrane B- Chemotaxis C- Ingestion within a phagosome D- Intracellular enzymatic degradation E- Endocytosis"

"During the last trimester, IgG is actively transported across the placenta to supply passive immunity to the fetus. Which disease occurring during pregnancy is most likely to lead to the neonate having low immunoglobulin levels and hence being prone to bacterial infections? A- Intestinal lymphangiectasia B- Systemic lupus erythematosus C- Myasthenia gravis D- Ulcerative colitis E- Prematurity"

"E. histolytica infection is best diagnosed by A. Sigmoidoscopy and aspiration of mucosal lesions B. Baermann technique C. Dilution followed by egg count D. Enzyme immunoassay (EIA) E. Examination of a cellophane tape swab"

"Fatty acids transported from adipose tissue to the muscle. Which enzyme is essential for this process? A- Carnitine acyltransferase I B- Xanthine oxidase C- Arginine hydroxylase D- Phosphoribosyl pyrophosphate synthetase E- Cyclooxygenase"

"Following an apparent transient ischaemic attack, a patient is demonstrated to have asmall left homonymous hemianopia with partial sparing of central vision. Which of the following is the most likely anatomical site of the lesion responsible? A- Right occipital cortex B- Left occipital cortex C- Right optic radiation D- Left optic radiation E- Optic chiasm"

"Haemolytic disease of the newborn is typically restricted to the presence of Rhesus antigens on red cells rather than ABO antigens. Predominantly, such anti-Rh antibodies cross the placenta during the third trimester. Which of the following statements best explains the background physiology? A- Antibodies to ABO blood groups are IgM, whereas antibodies to Rhesus antigens are IgG2- Antibodies to ABO blood groups are IgG, whereas antibodies to Rhesus antigens are IgM B- Antibodies to ABO blood groups are IgA, whereas antibodies to Rhesus antigens are IgG C- Antibodies to Rhesus antigens are IgD, whereas anti-ABO blood groups are IgM D- Antibodies to Rhesus antigens are IgE, whereas anti-ABO blood groups are IgG"

"Hepatitis E, a recently characterized hepatitis virus, is best described by which of the following statements? A. It is not a threat to the blood supply B. It is a major cause of blood-borne hepatitis C. It is prevalent in North America D. It is a single-stranded DNA virus E. The disease resembles hepatitis C"

"High titres of antithyroid microsomal and antithyroglobulin antibodies would suggest which of the following diagnoses in a patient presenting with a complaint of tiredness? A- Hashimoto's thyroiditis B- Reidel's thyroiditis C- Grave's disease D- Hypoparathyroidism E- Idiopathic hypothyroidism"

"IgM antibody to the viral particle is the method of choice for laboratory diagnosis of which one of the following hepatitis viruses? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E"

"Which of the following respiratory physiology tests would be consistent with a diagnosis of moderately established cryptogenic fibrosing alveolitis? A- Diffusion capacity decreased, FEV1/FVC normal, total lung capacity reduced B- Diffusion capacity increased, FEV1/FVC normal, total lung capacity increased C- Diffusion capacity normal, FEV1/FVC reduced, total lung capacity reduced D- Diffusion capacity decreased, FEV1/FVC normal, total lung capacity normal E- Diffusion capacity decreased, FEV1/FVC increased, total lung capacity increased"

"Which of the following structures is located in the anterior mediastinum on computed tomography (CT)? A- Thymus B- Oesophagus C- Aorta D- Heart E- Trachea"

"Which one of the following is higher at the apex of the lung than at the base when a person is standing? A- V/Q ratio B- Ventilation C- paCO2 D- Compliance E- blood flow"

"Which one of the following markers is closely associated with HBV infectivity and DNA polymerase activity? A. HBeAg B. HBsAg C. HBcAg D. Anti-HBc E. HBeAb"

"Which one of the following would be the treatment of choice for HSV infection? A. Acyclovir B. Killed virus vaccine C. Herpes immune globulin D. Azythromycin E. recombinant viral vaccine"

"You are asked to review a 17-year-old who suffers from leprachaunism. You understand that this occurs due to a mutation associated with the insulin receptor. Where is the insulin receptor located? A- Cell membrane B- Nucleus/nuclear membrane C- Cytoplasm D- Endoplasmic reticulum E- Chromatin"

"You are examining some strategies for research into a possible metabolic defect. You think this involves an abnormality of pyruvate kinase. In which of the following processes is pyruvate kinase the rate limiting step? A- Glycolysis B- Hydrolysis C- Hydroxylation D- Carbonation E- Dehydrogenation"

"You are working in the Emergency Department and notice that a tall and thin 19 year old student has attended for the second time with spontaneous pneumothorax. He displays clear signs of hyperflexibility and on further questioning it appears he has also had problems with shoulder dislocation. He also has a reduced upper to lower body segment ratio. You suspect he may have Marfan's. Which of the following correctly describes the mutation associated with Marfan's syndrome? A- Fibrillin-1 (FBN-1) gene mutation B- PLOD-1 gene mutation C- COL-3A1 gene mutation D- ADAMST-2 gene mutation E- COL-5A1 gene mutation"

"You have performed a liver biopsy, and shortly after the procedure the patient develops pain on the tip of his right shoulder. Which nerve is most likely to be responsible for his pain? A- Right phrenic nerve B- Axillary nerve C- Right vagus D- Right sympatheticus E- Intercostobrachial nerve"

"You identify an IgAk paraprotein in an elderly male and need to decide whether this is part of an underlying malignancy such as myeloma, or a monoclonal gammopathy of underdetermined significance. Which of the following tests most supports a malignant process? A- Kappa light chains in the urine (Bence Jones protein) B- Normal IgG and IgM C- Reduced plasma viscosity D- Elevated b 2-glycoprotein-1 E- Elevated serum creatinine"

"You review a 19-year-old man who is referred to the clinic with recurrent nose bleeds. On examination you notice that he has multiple telangiectases on his body and you are concerned that he may have an underlying genetic disorder. On further questioning you understand that one relative had a similar skin appearance and unfortunately died of a GIhaemorrhage, and another suffered from a stroke. What is the likely mode of inheritance for this condition? A- Autosomal dominant B- Autosomal recessive C- Polysomal D- X-linked recessive E- X-linked dominant"

"Treating a pregnant woman infected with syphilis. select the most appropriate level of prevention that match with description above. A. Primary prevention B. secondary prevention C. tertiary prevention D. Primary and tertiary prevention E. Primary and secondary prevention"

"Using condoms during sexual intercourse. select the most appropriate level of prevention that match with description above. A. Primary prevention B. secondary prevention C. tertiary prevention D. Primary and tertiary prevention E. Primary and secondary prevention"

"Vaccination for this hepatic disease is with viral surface antigen and usually provides immunity. A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis"

"What would be consistent with femoral nerve damage in a patient with pelvis trauma? A- Preserved knee reflex B- Loss of sensation over the anterior-lateral aspect of the thigh C- Loss of power in the biceps femoris muscle D- Loss of power in the peroneus muscle E- Reduced power on adduction"

"Which of the following is true of the Churg-Strauss syndrome?Which of the following is true of the Churg-Strauss syndrome? A- Granuloma formation is uncommon B- It is likely to be associated with a history of asthma and atopy over a few years before the diagnosis is made C- May be characterised by basophilia D- Is associated with polyneuritis E- pANCA is positive in > 80% of cases"

"Which of the following is typically the earliest lesion to develop in diabetic retinopathy? A- Blot haemorrhages B- Dot haemorrhages C- Hard exudates D- Macular oedema E- Soft exudates"

"Which of the following markers is usually the first viral marker detected after hepatitis B infection? A. HBeAg B. HBsAg C. HBcAg D. Anti-HBc E. HbeAb"

"Which of the following occurs in diabetic retinopathy? A. reduction in the thickness of the basal lamina of small retinal vessels B. Microaneurysms C. Decreased capillary permeability D. Increased retinal blood flow E. Loss of phagocytic ability of the pigmented epithelium"

"Which of the following organisms may be ingested with raw fish, affects the liver, and has an operculated egg? A. Paragonimus B. Clonorchis C. S. mansoni D. S. japonicum E. S. haematobium"

"Which of the following physiological characteristics relates to the lining of the respiratory tract? A- About 1 litre of mucus is produced every day B- The cilia are under the control of a physiological motor, dynein C- The mucociliary escalator moves at 0.2 cm/minute D- The bronchioles have cartilage in their wall E- The bronchioles have diameters up to 5 mm"

"Which of the following should be considered in the management of haemophilia A? A- The infant is protected at birth due to maternal transfer of factor VIII B- Desmopressin may be useful C- A factor VIII concentration < 10% causes severe disease D- Most cases are the result of new mutations E- von Willebrand factor levels are reduced"

"Which of the following findings would most suggest that fluid loss from the body was primarily hypotonic (water depletion) rather than isotonic (sodium depletion)? A- Hyponatraemia B- Increased haematocrit C- Postural hypotension D- Production of a highly concentrated urine E- Tachycardia"

"Which of the following forms from paraxial mesoderm? A. Adrenal cortex B. Adrenal medulla C. Humerus D. Biceps brachii E. Masseter"

"Which of the following immunoglobulin isotypes has the highest concentration in serum? A- IgA B- IgD C- IgE D- IgG E- IgM"

"Which of the following statements is most consistent with the Crigler-Najjar syndrome? A- Autosomally inherited, severe conjugated hyperbilirubinaemia B- Autosomally inherited, severe unconjugated hyperbilirubinaemia C- Autosomal-recessive, mild unconjugated hyperbilirubinaemia D- X-linked, severe conjugated hyperbilirubinaemia E- X-linked, severe unconjugated hyperbilirubinaemia"

"When planning the radiotherapy dosage for solid tumours, it has to be remembered that the division of cells is governed by the cell cycle, the mechanism of which is disrupted by radiation. Which of the following is true concerning the cell cycle? A- M represents the phase of premitotic DNA synthesis B- G1 is a gap phase under the influence of the p53 gene C- S is the mitotic phase D- G2 is a gap phase when cells contain half as much DNA as non-dividing cells E- In normal tissues, cells with significant damage to their DNA are arrested at the M phase"

"Where does RNA splicing occur? A- Ribosome B- Nucleus C- Golgi D- Proteasome E- Peroxisome"

"Which of the following is a cause of mild gastroenteritis? It can be transmitted by the fecal-oral route but not by food consumption. A. Rotavirus B. Adenovirus 40/41 C. Norwalk virus D. Astrovirus E. Hepatitis A virus"

"Which of the following definitely excludes IgG subclass deficiency? A- Normal serum immunoglobulins B- Good IgG antibody responses to immunisations C- The presence of existing antibody responses to past infections D- Normal IgG subclasses E- Normal peripheral blood lymphocyte subpopulations"

"A 36-year-old woman with an eight month history of Raynaud's phenomenon presents to the emergency room with new onset precordial chest pain. Physical examination reveals a pericardial friction rub and her CPK is elevated 5 times above the upper normal limit, but the MB isoenzyme is negative. The immunology profile reveals a positive ANA test at 1:640 with a speckled staining pattern. The MOST appropriate immunology test at this stage is? A- Parasagittal cerebral rheumatoid nodule B- Anti-ribonucleoprotein (anti-RNP antibody) C- Anti-centromere antibody D- Rheumatoid factor E- Anti-neutrophil cytoplasmic antibody (ANCA)"

"A 54-year-old man with a long history of excessive alcohol ingestion develops a blistering skin eruption. His urine tests positive for porphyrins. What is the most likely diagnosis? A- Acute intermittent porphyria B- Cutaneous hepatic porphyria C- Hepatoerythropoietic porphyria D- Hereditary coproporphyria E- Variegate porphyria"

"A 56-year-old woman sustains a myocardial infarction. ST elevation and Q waves are present in leads V4-V6 , I and AVL. Which of the following aspects of the heart is most likely to have been involved in the infarct? A- Anterior B- Anterolateral C- Anteroseptal D- Inferior E- Lateral"

"A 56-year-old woman with known metastatic breast cancer presents to A&E with a calcium concentration of 3.22 mmol/l. Which of the following is the most appropriate initial management? A- Intravenous hydrocortisone B- Intravenous infusion of 0.9% sodium chloride ('normal saline') C- Intravenous infusion of sodium phosphate D- Oral bisphosphonate E- Oral thiazide diuretic"

"A 61-year-old patient who suffered a humeral fracture after falling off a ladder presents for review after being in a cast for the past 8 weeks. He presents with weakness in the deltoid, and sensory loss over the deltoid region. Which of the following is the most likely underlying lesion? A- Brachial plexus injury B- Axillary nerve injury C- Radial nerve injury D- Ulnar nerve injury E- Neuralgic amyotrophy"

"A 65-year-old smoker with a history of transient ischaemic attacks presents with loss of co-ordination of his right side. On examination there is decreased skin sensation in the right half of his face and the left half of his body. In addition he has a right Horner syndrome. Which vessel is most likely to be involved? A- Basilar artery B- Posterior inferior cerebellar artery C- Middle cerebral artery D- Internal carotid artery E- Posterior cerebral artery"

"A patient with liver cirrhosis develops metabolic alkalosis.What is the most likely pathological mechanism? A- Bicarbonate loss due to ascites B- Reduced urea synthesis C- Increased gastric acid production D- Reduced bicarbonate secretion from the pancreas E- Reduced lactate formation in skeletal muscle"

"Human plague can be bubonic or pneumonic. The primary epidemiologic difference between the two clinical forms of plague is A. season of the year B. Route of infection C. Age of the patient D. Health of the animal vector E. Geographic location of the animal vector"

"Ideally, an antibiotic should focus on a microbial target not found in mammalian cells. By this standard, which of the following antibiotic agents would be expected to be most toxic to humans? A. Penicillin B. Mitomycin C. Cephalosporin D. Bacitracin E. Vancomycin"

"In Duchenne's muscular dystrophy, which of the following statements applies? A- Serum creatinine kinase is elevated in 30% of cases B- Exon deletion or duplication in the dystrophin gene occurs in 60% of patients C- Prenatal diagnosis involves analysis of restriction fragment length polymorphisms (RFLPs) D- The genetic defect affects mainly skeletal muscle E- The majority of cases are due to new mutations"

"In a patient with suspected hereditary angio-oedema (HAE), which of the following is most likely to be helpful in identifying this clinical condition? A- Persistently low C3 levels, including between attacks B- Persistently low C4 levels, including between attacks C- Search for a paraprotein D- Drug history of taking ACE inhibitors E- Presence of urticaria with angio-oedematous swellings"

"In an elderly patient found to have a large IgM-kappa paraprotein, which of the following helps to decide that it is related to Waldenstrom's macroglobulinaemia? A- Light chains in the urine B- No isotype suppression (normal IgG and IgA levels) C- Recurrent infections D- Hyperviscosity E- Thrombocytosis"

"A 25-year-old man is referred to a dermatologist with fleshy nodules on the backs of his elbows. He also has yellow linear deposits in his palmar creases. His fasting serum lipids are: cholesterol 14.2 mmol/l, triglycerides 16 mmol/l. Fasting plasma glucose and thyroid function tests are normal. In addition to dietary and lifestyle advice, what would be the most appropriate treatment? A- A bile-acid sequestrant B- A fibrate C- A statin D- Nicotinic acid E- Omega-3 fish oils"

"A 28 year old man, who is a keen bodybuilder, presents with a short history of left upper limb discomfort and difficulty in moving his shoulder. On examination he is noticed to have winging of the left scapula. There is no wasting of the shoulder girdle muscles. With stabilisation of th scapula, he has a full range of movement and is able to elevate the shoulder. Sensory testing is normal, as are upper limb reflexes. What is the likely anatomical origin of his problem? A- C3,4 nerve root B- Long thoracic nerve C- Diffuse left brachial plexus injury D- Spinal accessory nerve (cranial nerve XI) E- C5,6 nerve root"

"A 32-year-old man is referred to a dermatologist with soft, fleshy lumps over his elbows. Examination also reveals that he has yellow fat deposits in his palmar creases. His (fasting) serum cholesterol concentration is 12.4 mmol/l, triglyceride 14.2 mmol/l. Which of the following groups of lipoprotein particles is likely to be present in excess? A- Chylomicrons B- Intermediate-density lipoproteins (IDL) C- Lipoprotein (a) D- Low-density lipoproteins (LDL) E- Very low-density lipoproteins (VLDL)"

"In dislocation of the jaw, displacement of the articular disk beyond the articular tubercle of the temporomandibular joint results from spasm or excessive contraction of which of the following muscles? A. Buccinator B. Lateral pterygoid C. Medial pterygoid D. Masseter"

"A 32-year-old, 6 ft 7 inch (2.01 m) man is admitted via ambulance from Heathrow airport after a flight from Australia. He is ataxic with double vision and complains of facial numbness. On examination there is left-sided facial numbness, nystagmus, ataxia and Horner 's syndrome. There appears to be some loss of pain and temperature sensation on the right-hand side. Which artery is most likely to be occluded in this case? A- Middle cerebral artery B- Posterior inferior cerebellar artery C- Anterior inferior cerebellar artery D- Labyrinthine artery E- Posterior communicating artery"

"A 32yearold farmer presents to the emergency room with a crushing injury of the index finger and thumb that occurred while he was working with machinery in his barn. records show that he received three doses of Td in the past, and that his last dose was given when he was 25 years old. In addition to proper wound cleaning and management, which of the following is the most appropriate prevention intervention? A. No additional prophylaxis B. Administration of tetanus toxoid C. Administration of tetanus immunoglobulin only D. Administration of tetanus toxoid and immunoglobulin E. Administration of tetanus and diphtheria toxoid"

"The primary neurochemical disturbance in idiopathic Parkinson's disease involves A- Noradrenaline B- Dopamine C- Gamma-aminobutyric acid (GABA) D- Substance P E- Adrenaline"

"A 19-year-old teenager is brought to the emergency room after a single-car accident just 20 minutes earlier in which she lost control of her car on black ice and hit a retaining column of an overpass at about 45 miles per hour. She was wearing a seat belt but looks pale, has tachycardia and positional hypotension, is extremely nauseated, and is lying in the fetal position due to increasingly severe abdominal pain. She has no fractures and a cranial nerve test is normal. You order an abdominal CT because you suspect which of the following? A. Lacerated kidney B. Ruptured spleen C. Ruptured gallbladder D. Diverticulitis E. Hemorrhoids"

"A 19-year-old woman is referral to you with a blood pressure of 180/130 mmHg. On examination she has cafè-au-lait patches and some axillary freckling. She required surgery for scoliosis as a child. What is the most likely underlying diagnosis? A- Marfan's syndrome B- Neurofibromatosis type 1 C- Hypertrophic cardiomyopathy D- Tuberous sclerosis E- Cushing's disease"

"A 20yearold patient presents to the office for contraception counseling. Her history reveals no past medical problems. Her physical and pelvic examination is normal. She is sexually active with the same partner for 9 months. Which of the following contraceptive methods would be most appropriate? A. Barrier method B. Combined oral contraceptives C. Pro-gestinonly contraceptives D. Intrauterine device (IUD) E. Barrier method and combined oral contraceptives"

"A 21-year-old male medical student who has been feeling non-specifically unwell for several days is noticed to have slightly icteric sclerae by his girlfriend and has liver function tests performed. The results of these are normal apart from a serum bilirubin concentration of 44 mmol/l (3-17). His urine does not contain bilirubin. Which of the following is the most likely diagnosis? A- Dubin-Johnson syndrome B- Gilbert's syndrome C- Hereditary spherocytosis D- Infectious mononucleosis E- Rotor syndrome"

"A 21-year-old man is alarmed to find that his urine has become unusually dark 2 days before he is to leave on a backpacking holiday in South-East Asia . He consults his GP, who observes that he is slightly jaundiced. Deficiency of which of the following enzymes could best explain these clinical features? A- Bilirubin glucuronyltransferase B- Glucose 6-phosphate dehydrogenase C- Glucose 6-phosphatase D- Hydroxymethylbilane synthase E- Pyruvate kinase"

"A 21-year-old man takes advantage of his employer's health benefits and undergoes a private health screen. Urinalysis is positive for protein on two occasions, once at the health screen and a later repeated sample at the GP. His serum urea and creatinine concentrations are normal.Which of the following would be the most important investigations to perform next? A- Creatinine clearance B- Measurement of urine protein immediately on getting out of bed in the morning C- Mid-stream urine for culture and sensitivity D- Urine protein electrophoresis E- 24-hour urine protein excretion"

"A 22-year-old woman with partial lipodystrophy presents with a 3- month history of increasing swelling of her legs, which is now up to her knees. Urinalysis shows heavy proteinuria but no haematuria. A diagnosis of nephrotic syndrome is therefore made. Which investigation is most likely to help in the definition of the underlying renal pathology? A- Serum immunoglobulins B- Complement studies C- Antineutrophil cytoplasmic antibodies (ANCA) D- Antiglomerular basement membrane antibodies (anti-GBM) E- Antistreptolysin titre (ASOT)"

"A 24-year-old, unconscious man is admitted to A&E. No history is available. The results of arterial blood gas analysis are: [H+] 80 nmol/l (pH 7.1), p(CO2) 7.0 kPa, p(O2) 8.2 kPa, [HCO3-] 17.1 mmol/l. These results indicate which one of the following acid-base disturbances? A- Metabolic acidosis with respiratory compensation B- Mixed metabolic and respiratory acidosis C- Respiratory acidosis D- Respiratory acidosis with metabolic alkalosis E- Uncompensated metabolic acidosis"

"A 25-year-old adopted man consults for review. He is interested in having children and is concerned about the possibility of inheritance of genetic disease. Which of the following is most prevalent in northern Caucasians? A- Cystic fibrosis B- α1-antitrypsin deficiency (A1AT) C- Congenital hypothyroidism D- Sickle cell disease E- Phenylketonuria"

"A 25-year-old man is found to have a fasting serum triglyceride concentration of 4.2 mmol/l at a routine examination for life insurance. His serum cholesterol concentration is 5.4 mmol/l; liver function tests are normal apart from a g-glutamyltransferase activity of 74 U/l (upper limit of normal, 55 U/l). He claims to be in good health but has a history of epilepsy for which he is taking sodium valproate. His body mass index is 24 kg/m2.What is the most likely cause of the abnormal findings? A- Familial combined hyperlipidaemia B- Hepatic steatosis secondary to alcohol C- Non-alcoholic steatohepatitis D- Remnant hyperlipidaemia (familial dysbetalipoproteinaemia, broad beta disease) E- Valproate treatment"

"A 38-year-old builder's labourer sustained a severe fracture of his left elbow, which damaged the ulnar nerve behind the medial epicondyle of the humerus. A month later, he still has a total ulnar nerve paralysis. Which clinical sign is most likely to be present on examination? A- Sensory loss over the ulnar 3آ½ digits on the ulnar side of the hand B- Inability to grip a sheet of paper between his fingers when the hand is placed flat on the table C- Excessive sweating over the ulnar border of the left hand D- Index and middle fingers on the affected side are held in the claw position E- Marked wasting of the thenar eminence"

"A 38-year-old woman with type-1 diabetes reports at her regular clinic review that she has been experiencing frequent episodes of hypoglycaemia during the previous 6 months, despite reducing her overall dose of insulin by almost 50%. Her Hb A1c in the clinic is 5.6%, having been 6.8 % a year previously. She also says she has lost some weight and that her periods are becoming scanty and irregular, and wonders if she is having an early menopause. Gonadotrophin concentrations are in the normal early follicular range. What is the most likely cause of the reduction in her insulin requirement? A- Addison's disease B- Hypopituitarism C- Increased exercise D- Spontaneous regression of diabetes E- Weight loss"

"A 40-year-old man presents with a purpuric rash on his lower limbs. You request cryoglobulin screening. The report indicates a moderate amount of a mixed cryoglobulin, having both a monoclonal and a polyclonal component. With what are these typically associated? A- Hepatitis B B- Hepatitis C C- Chronic lymphocytic leukaemia D- Chronic myeloid leukaemia E- Active SLE"

"A 41-year-old man has a body mass index of 38 kg/m2. He is normotensive and a non-smoker. A fasting blood glucose concentration is normal. His mortality in comparison with an otherwise comparable individual of normal body weight is increased primarily because of an increased risk of which one of the following? A- Carcinoma of colon B- Cardiovascular disease C- Chronic respiratory disease D- Hypertension E- Type-2 diabetes mellitus"

"A 45-year-old man presents with prognathism and interdental separation. Which of the following is the most appropriate investigation? A- Fasting glucose test including growth hormone measurement B- Glucose tolerance test including growth hormone measurement C- Basal growth-hormone measurement D- Serum prolactin measurement E- thyroid function test"

"A 48-year-old man went up in a hot air balloon without sufficient clothes to keep him warm. In the evening he presents with acute renal failure and a purpuric/vasculitic rash on his legs. Which of the following investigations is likely to be most helpful in identifying the process leading to the above? A- Cold agglutinins B- Cryoglobulins C- Cryofibrinogens D- Plasma viscosity E- Paroxysmal cold haemoglobinuria"

"A 48-year-old woman presents to the clinic complaining that her left foot drags and gets caught when she tries to climb the steps athome. On examination there is weakness of the foot and ankle dorsiflexors and she has a so-called steppage gate. She has sensory loss over the lateral portion of the leg extending onto the dorsum of the foot. Which of the following is the most likely location of neurological injury? A- Femoral nerve injury B- Common peroneal nerve injury C- Tibial nerve injury D- L3 nerve lesion E- L4 nerve lesion"

"A 49-year-old woman has been complaining of a tingling feeling in her right hand at night and is under the impression that her hand is swollen although there is no obvious oedema. In the last few days she has noticed numbness in her right index finger and the tip of her thumb, especially while working. Which nerve is most likely to be responsible for her symptoms? A- Ulnar nerve B- Median nerve C- Radial nerve D- Nerve root C7 E- Nerve root C8"

"A 50 year old woman comes for her periodical health examination. Her body mass index is 29 kg/m2. Her blood pressure is 120/80. She has no family history of cardiovascular disease. Her total cholesterol is 200 mg/dL (5. 2 mmol/L), her HDL is 35 mg/dL (0. 9 mmol/L), and her LDL is 100 mg/dL (2. 6 mmol/L). This patient is at highest risk for developing which of the following conditions? A. Stroke B. Coronary artery disease C. Noninsulin dependent diabetes D. Pulmonary embolism E. Hypertension"

"A 50 year old woman comes for her periodical health examination. Her body mass index is 29 kg/m2. Her blood pressure is 120/80. She has no family history of cardiovascular disease. Her total cholesterol is 200 mg/dL (5. 2 mmol/L), her HDL is 35 mg/dL (0. 9 mmol/L), and her LDL is 100 mg/dL (2. 6 mmol/L). This patient's weight increases the risk for which of the following cancers? A. Breast, pancreas, and ovary B. Endometrium, breast, and colon C. Ovary, cervix, and colon D. Cervix, ovary, and breast E. Colon, endometrium, and ovary"

"A 50-year-old man is referred by his GP with general ill health. An autoimmune screen reveals high titres of anti-smooth muscle antibodies. Which of the following conditions is suggested by this autoantibody profile? A- Fibrosing alveolitis B- Autoimmune hepatitis C- EBV infection D- Hepatitis A E- Hypothyroidism"

"A 50-year-old man with a long-standing history of alcohol abuse was admitted to hospital because he was difficult to rouse. On examination he is confused and ataxic. Examination of the eyes reveals nystagmus and ophthalmoplegia. Deficiency of which vitamin is most likely to have caused his symptoms? A- Vitamin A B- Vitamin B1 C- Vitamin B6 D- Vitamin B12 E- Folic acid"

"A 50-year-old woman, who is a non-smoker, presents with bilateral claudication of her arms when performing tasks such as using a paint-roller when decorating. She is noted to have absent radial pulses and be normotensive. Investigations reveal a raised ESR of 80 mm/h and a CRP of 30 mg/l. What is the most likely diagnosis? A- Antiphospholipid antibody syndrome (APLS) B- Takayasu's arteritis C- Giant-cell arteritis D- Polyarteritis nodosa (PAN) E- Berger's disease"

"A 54-year-old Afro-Caribbean man consults his family doctor because of the chest discomfort he first noticed 4 days ago after a session digging in his garden, but which he says is now resolving. He has previously been well, but is being treated with a statin for hypercholesterolaemia, and a thiazide and a calcium-channel antagonist for hypertension. Serum creatine kinase activity is 425 U/l (normal up to 150 U/l); serum troponin-T concentration is normal. What is the most likely explanation for the elevated creatine kinase? A- Myocardial infarction B- Racial variant C- Recent exercise D- Statin treatment E- Thiazide treatment"

"A 68-year old man undergoes a routine health check-up, which includes various laboratory investigations. He has abnormal results as follows: fasting blood glucose 5.6 mmol/l; urea 7.2 mmol/l; alkaline phosphatase activity 176 U/l (upper limit of reference range 150); TSH 9.1 mU/l; creatinine clearance (calculated) 70 ml/min. Which one of the following parameters can be regarded as a normal result of ageing? A- Fasting blood glucose concentration B- Glomerular filtration rate C- Alkaline phosphatase activity D- Urea concentration E- TSH (thyroid-stimulating hormone) concentration"

"A 7-year-old boy who came from India presented with fever, maculopapular rash and pharyngitis with greyish membranes surrounding the tonsils. There is regional lymphadenopathy. What is the most likely diagnosis? A- Infectious mononucleosis B- Diphtheria C- Rubella D- Measles E- Streptococcus pyogenes"

"A 71-year-old man presents with fatigue and breathlessness. The results of initial investigations include a serum creatinine concentration of 654 mmol/l. Which of the following best suggests a specific cause for his renal failure? A- Anaemia B- Bence Jones proteinuria C- Hyperuricaemia D- Hypocalcaemia E- Metabolic acidosis"

"A 72-year-old man presents to A&E with acute retention of urine. He has a serum creatinine concentration of 522 mmol/l. Which of the following features, if present, would help most to identify possibleaetiologies for his renal failure and suggest that it is longstanding? A- Anaemia B- Small kidneys on ultrasound examination C- High serum parathyroid hormone concentration D- Hypotension E- Hyperuricaemia"

"A 72-year-old woman is found to have a serum calcium concentration of 3.12 mmol/l.Which of the following clinical features, if present, would most direct you towards a specific cause? A- Bone pain B- Hilar lymphadenopathy C- Polyuria D- Short QT interval E- Ureteric colic"

"A 74-year-old man receives an acyclovir shingles treatment pack from his GP. He is a retired chemist and is interested in asking you about how acyclovir works. Which of the following best describes the step required for acyclovir activation? A- Conversion to diphosphate form by viral thymidine kinase B- Conversion to monophosphate form by viral thymidine kinase C- Metabolism by intracellular phosphatases D- Reverse transcriptase activation E- Viral protease activity"

"A broad-spectrum antibiotic in the general class of thienamycins is A. Piperacillin B. Cefoperazone C. Ceftriaxone D. Ciprofloxacin E. Imipenem"

"A dental practice nurse is admitted for an elective operation. During induction with a general anaesthetic she develops tachycardia, rash and diffuse wheeze. She had mentioned that she has had rashes when assisting with anaesthetics at work. What is the likely diagnosis? A- Systemic mastocytosis B- Anaphylaxis C- Pseudoallergy D- Serum sickness E- Contact dermatitis"

"A hypertensive, heavy smoking, 73-year-old man suffers a massive cardiac infarct following occlusion of his anterior interventricular artery, (anterior descending artery). Angiography is performed to demonstrate the coronary vessels.Which anatomical relationship of these vessels should be borne in mind? A- The anterior interventricular artery arises above the left posterior aortic cusp B- The anterior interventricular artery supplies almost all of the left ventricle C- There is a rich collateral circulation between the right and left coronary arteries D- The circumflex artery is the major branch of the right coronary artery E- The posterior interventricular artery is a branch of the circumflex artery"

"A man who has autosomal recessively inherited common variable immunodeficiencywould like to start a family. His partner does not have the disease. What is the percentage that his children will inherit his disease? A- 100% B- <5% C- 25% D- 50% E- 0%"

"A medical SHO is required to give a blood sample to check his HepB status. He received a course of vaccinations nine months ago. What is his blood test likely to show? A- Anti-HBeAb B- Anti-HBsAb C- Anti-HBsAb + anti-HBcAb D- HBsAg + HBcAg E- IgM to HBcAg"

"A middle-aged woman is referred to you by her GP with a 6-month history of increasing breathlessness on exertion. Her son is affected with Duchenne's muscular dystrophy, as was her brother. What would you be concerned about in her? A- Bronchiectasis B- Cardiomyopathy C- Emphysema D- Respiratory muscle failure E- Pericardial effusion"

"A motor cyclist involved in a road traffic accident sustained an injury to the brachial plexus on the right side. He is found to have weakness of right shoulder abduction and forearm flexion, as well as some sensory loss over the lateral aspect of his upper arm. The right biceps and brachioradialis reflexes are absent. What is the likely level of maximal plexus injury? A- C4,5 root B- C5,6 root C- C6,7 root D- C7,8 root E- C8, T1 root"

"A new test for chlamydial infections of the cervix is introduced. Half of the women who are tested have a positive test. Compared with the gold standard of careful cultures, 45% of those with a positive test are infected with chlamydia, and 95% of those with a negative test are free of the infection. Match with the correct percentage with the epidemiologic terms, Prevalence of chlamydial infection in that community. A new test for chlamydial infections of the cervix is introduced. Half of the women who are tested have a positive test. Compared with the gold standard of careful cultures, 45% of those with a positive test are infected with chlamydia, and 95% of those with a negative test are free of the infection. Match with the correct percentage with the epidemiologic terms, Predictive value of a positive test. A. 25% B. 45% C. 63% D. 90% E. 95%"

"A patient has arthralgia, a rash, lymphadenopathy, pneumonia but no fever. Which of the following diseases is most likely based on these symptoms? A. Dengue fever B. St. Louis encephalitis C. Infectious mononucleosis D. Hepatitis E. HIV infection"

"A patient with AIDS develops Pneumocystis jiroveci pneumonia. He is deficient of what immunological component? A- Complement B- T cells C- B cells D- IgM E- IgA"

"A patient with hypoalbuminaemia is suspected of having a protein-losing enteropathy.Measurement of which of the following in a sample of faeces would be most appropriate to prove this? A- Albumin B- α1-antitrypsin C- Calmodulin D- Calprotectin E- Elastase"

"A patient with type 1 diabetes presents to clinic for review and says he has read about cloning as a cure for diabetes mellitus. He asks you about the mechanism. Which of the following best describes the mechanism currently used for cloning? A- An enucleated adult cell is fused with the nucleus from a donor cell B- An enucleated oocyte is fused with the nucleus from a donor cell C- An enucleated adult cell is fused with the nucleus from an oocyte D- Genes are transfected into a donor oocyte using a retrovirus E- Oocytes are harvested from the donor and fused with adult cells from the donor"

"A research team wishes to investigate a possible association between smokeless tobacco and oral lesions among professional baseball players. At spring training camp, they ask each baseball player about current and past use of smokeless tobacco, cigarettes, and alcohol, and a dentist notes the type and extent of the lesions in the mouth. What type of study is this? A. Case control B. Cross sectional C. Prospective cohort D. Clinical trial E. retrospective cohort"

"A student from Phnom Penh has had abdominal pain for 2 years; he is used to swim in sekong/Stung Treng river. Which of the following should you be in your differential diagnosis? A. Trichinosis B. Schistosomiasis C. Toxoplasmosis D. Visceral larva migrans E. Giardiasis"

"A vaccine is available for one of the most common causes of infantile gastroenteritis. However, it has recently been recalled. The virus is A. Cytomegalovirus B. Rotavirus C. Varicella-zoster virus D. Adenovirus E. Papillomavirus"

"A young man with severe learning difficulties and congenital heart disease is referred to you for a cardiac assessment. He is accompanied by his carer who says he has a chromosome abnormality. What type of abnormality is most likely to cause such a severe phenotype? A- Balanced autosomal translocation B- Unbalanced autosomal translocation C- Pericentric inversion D- Paracentric inversion E- Sex chromosome aneuploidy"

"Amebae that are parasitic in humans are found in the oral cavity and the intestinal tract. Which one of the following statements best describes these intestinal amebae? A. They are usually nonpathogenic B. They can cause peritonitis and liver abscesses C. They are usually transmitted as trophozoites D. They occur most abundantly in the duodenum E. Infection with Entamoeba histolytica is limited to the intestinal tract"

"Analysis of the metabolites produced by an organism's fermentation of glucose reveals small amounts of 6-phosphogluconic acid. This fermentation organism is most likely to be A. Enterobacter B. Escherichia C. leuconostoc D. Enterococcus faecalis E. Streptococcus lactis"

"Antibodies to which of the following are found in patients with myasthenia gravis? A- Acetylcholine esterase B- Acetylcholine receptors C- Myelin D- Striated muscle E- Tensilon"

"Atypical lymphocytosis is most likely to be found in which one of the following diseases? A. Encephalitis caused by herpes simplex virus (HSV) B. Mononucleosis induced by Epstein-Barr virus C. Parvovirus infection D. Chronic hepatitis C E. Rotavirus gastroenteritis"

"By which process are particles moved along a concentration gradient across a selectively permeable membrane? A- Endocytosis B- Diffusion C- Exocytosis D- Osmosis E- Phagocytosis"

"C. diphtheriae may be difficult to isolate from the nasopharynx without the use of special media. The medium of choice is A. Sheep blood agar B. Löffler's medium C. Thayer-Martin agar D. Thiosulfate citrate bile salts sucrose medium E. Löwenstein-Jensen medium"

"Choose the type of measurement scale for Type of medical specialty. A. Dichotomous scale B. Nominal scale C. Ordinal scale D. Interval scale E. Ratio scale"

"Death occurs in 10% of cases of meningococcal meningitis. Choose statement below that match rate above. A. secondary attack rate B. Case fatality rate C. Morbidity rate D. Age adjusted mortality E. Crude mortality"

"E. coli causes disease by a variety of different methods. Which one of the following E. coli types is characterized by the presence of LT (heat-labile) and ST (heat-stable) proteins? A. Enteroinvasive (EIEC) B. Enterotoxigenic (ETEC) C. Enterohemorrhagic (EHEC) D. Enteropathogenic (EPEC) E. Enterohemolytic (EHEEC)"

"Fetal blood from the placenta is about 80% oxygenated. However, mixture with unoxygenated blood at various points reduces the oxygen content. Which of the following fetal vessels contains blood with the highest oxygen content? A. Abdominal aorta B. Common carotid arteries C. Ductus arteriosus D. Pulmonary artery E. Pulmonary vein"

"Finding HBsAg positive, HBeAg positive, and IgM core antibody positive reflects A. Acute infection (incubation period) B. Acute infection (acute phase) C. Post infection (acute phase) D. Immunization E. HBV carrier state"

"Gallbladder pain often presents as epigastric pain that then migrates towards the patient's right side and can even wrap around to the posterior. The referred pain is not the site of the problem. Anatomically where is the gallbladder located? A. Between the left and caudate lobes of the liver B. Between the right and quadrate lobes of the liver C. In the falciform ligament D. In the lesser omentum E. In the right anterior leaf of the coronary ligament"

"Genomic imprinting is seen in which of the following conditions? A- Neurofibromatosis B- Prader-Willi syndrome C- Huntington's chorea D- Hurler's syndrome E- Marfan's syndrome"

"Hepatitis C (HCV) is usually a clinically mild disease, with only minimal elevation of liver enzymes. Hospitalization is unusual. Which one of the following statements best characterizes HCV? A. Few cases progress to chronic liver disease B. It often occurs in post transfusion patients C. HBV but not HCV infections occur in IV drug abusers D. It is a DNA virus E. blood products are not tested for antibody to HCV"

"Human infection with the beef tapeworm, Taenia saginata, usually is less serious than infection with the pork tapeworm, T. solium, because A. Acute intestinal stoppage is less common in beef tapeworm infection B. Larval invasion does not occur in beef tapeworm infection C. Toxic by-products are not given off by the adult beef tapeworm D. The adult beef tapeworms are smaller E. Beef tapeworm eggs cause less irritation of the mucosa of the digestive tract"

"In estimating the physiological clearance of 10 ml of an intravenous substance which has been administered at 10 mg/ml, the plasma concentration at equilibration is 15 mg/litre, the urine concentration is 150 mg/litre and the subject produces 1440 ml of urine during aIn estimating the physiological clearance of 10 ml of an intravenous substance which has been administered at 10 mg/ml, the plasma concentration at equilibration is 15 mg/litre, the urine concentration is 150 mg/litre and the subject produces 1440 ml of urine during a24h collection. The substance is not actively secreted or absorbed by the kidney. What is the clearance of the substance? A- 1 ml/min B- 10 ml/min C- 0.1 ml/min D- 100 ml/min E- Cannot say from the information given"

"In the clinical examination of the chest, accurate knowledge of the surface markings of the lungs is essential. Which of the following corresponds to the clinical situation? A- The apex of the lung corresponds precisely to the upper border of the medial third of the clavicle B- The oblique fissure of the lung corresponds to the medial border of the scapula when the arm is fully abducted C- The transverse (horizontal) fissure of the right lung corresponds to the right fifth intercostal space D- The lower border of the lung on each side corresponds to the tenth rib in the mid-axillary line E- The lower border of the lung reaches the twelfth rib posteriorly"

"In the developing embryo, the edge of the ectoderm is continuous with which of the following? A. Chorion B. Amniotic membrane C. Yolk sac lining D. Extraembryonic mesoderm E. Adventitia of the umbilical vessels"

"In the developing human embryo/fetus, most of the internal organs begin to form in which month? A. First B. second C. Fourth D. Sixth E. Ninth"

"Inhalation of fungal spores can cause primary lung infections. Of the following organisms, which one is most likely to be associated with this mode of transmission? A. C. immitis B. S. schenckii C. C. albicans D. T. tonsurans E. Candida tropicalis"

"Malaria is a significant worldwide public health problem. Which one of the following control methods for malaria is currently effective? A. A vaccine B. Chemoprophylaxis C. Antibiotics D. White clothing E. Tick repellents"

"Multiple members from a large family suffer from an autosomal-dominant disorder. Although the gene for the condition is known, a mutation has not been found in the family. One of the family members wants to know if he will develop the disease as his father is affected. blood samples are available from both affected and unaffected members. Which molecular technique is most useful in this situation? A- DNA sequence analysis B- Linkage analysis C- Southern blotting D- Microarray analysis E- Chromosome analysis"

"Mycoplasmas differ from chlamydiae in that they are A. Susceptible to penicillin B. Able to grow on artificial cell-free media C. Able to cause urinary tract infection D. Able to stain well with Gram's stain E. Able to cause disease in humans"

"One of the most common sexually transmitted diseases that may lead to cervical carcinoma is caused by which of the following viruses? A. Cytomegalovirus B. Papillomavirus C. Epstein-Barr virus D. Herpes simplex virus E. Adenovirus"

"Regarding the clinical physiology of the adrenal gland in Cushing's disease, which of the following pertains? A- The zona glomerulosa of the cortex is predominantly responsible for sex steroid production B- The zona fasciculata is predominantly controlled by ACTH and is often hypertrophied C- The zona reticularis is predominantly responsible for mineralocorticoid production D- About 15% of glucocorticoid production takes place in the adrenal medulla E- The zona fasciculata is primarily responsible for mineralocorticoid production"

"Shigellosis is common in travelers to developing countries. Infection is commonly acquired through the A. Skin B. Gastrointestinal tract C. respiratory tract D. Genital tract E. Nasal tract"

"The adrenal cortex influences the secretion of the adrenal medulla by means of which of the following? A. secretion of aldosterone into the intra-adrenal circulation B. secretion of glucocorticoids into the intra-adrenal circulation C. Autonomic neural connections D. secretion of monoamine oxidase into the portal circulation E. secretion of androgens into the intrarenal circulation"

"The best method for the detection of Strongyloides larvae is A. Sigmoidoscopy and aspiration of mucosal lesions B. Baermann technique C. Dilution followed by egg count D. Enzyme immunoassay (EIA) E. Examination of a cellophane tape swab"

"The direction in which vestibular hair cell stereocilia are deflected is important for which of the following reasons? A. Differentiates between type I and type II hair cells B. Determines whether cells are depolarized or hyperpolarized C. Determines whether linear or angular acceleration is detected D. Determines the direction of blood flow in the stria vascularis E. Is determined by the frequency of the sound"

"The incidence of H. influenzae meningitis in the general population is less than 1%. If during an epidemic the incidence rose to 3%, the negative predictive value of the LA test would A. Increase B. Decrease C. remain the same D. Be impossible to calculate E. Vary as a function of the specificity of the LA test"

"The incidence rate of lung cancer is 120/100,000 person years for smokers and 10/100,000 person years for nonsmokers. The prevalence of smoking is 20% in the community. What is the relative risk of developing lung cancer for smokers compared with nonsmokers? A. 5 B. 12 C. 50 D. 100 E. 120"

"The intercostal neurovascular bundle is particularly vulnerable to injury from fractured ribs because it is found in which of the following locations? A. Above the superior border of the ribs, anteriorly B. Beneath the inferior border of the ribs C. Between external and internal intercostal muscle layers D. Deep to the posterior intercostal membrane E. Superficial to the ribs, anteriorly"

"The most sensitive test for the diagnosis of herpes simplex (HSV) meningitis in a newborn infant is A. HSV IgG antibody B. HSV polymerase chain reaction (PCR) C. HSV culture D. Tzanck smear E. Cerebrospinal fluid (CSF) protein analysis"

"The primary function of intermediate filaments is which of the following? A. Generate movement B. Provide mechanical stability C. Carry out nucleation of microtubules D. Stabilize microtubules against disassembly E. Transport organelles within the cell"

"Which of the following statements is true concerning immunity to bacteria? A- Antibodies to secreted bacterial products play no protective role B- Bacteria opsonised by antibodies and complement are more effectively phagocytosed than those opsonised by antibodies alone C- Humoral rather than cellular immunity is predominant in protection against all types of bacteria D- Phagocytes cannot engulf bacteria in the absence of antibodies E- Endotoxin induces shock mainly through the activation of T cells"

"Which of the following takes place during inspiration? A- The diaphragm drops by 10 cm during normal breathing B- A negative pressure of 1-3 mmHg is created C- The rib cage recoils D- Abdominal muscles contract E- Accessory muscles relax"

"Which of the following tumour-associated antigens is linked with the correct cancer? A- CA-125: Testicular teratoma B- CA 19-9: Pancreatic cancer C- Alpha-fetoprotein: Ovarian cancer D- CEA: Hepatocellular carcinoma E- HCG: Breast cancer"

"Which of the following types of cancer is the most frequent cause of gynecologic cancer deaths? A. Ovarian B. Cervical C. Endometrial D. Vaginal E. Vulvar"

"Which of the following vaccines is contraindicated during pregnancy? A. Hepatitis B vaccine B. Varicella vaccine C. Influenza vaccine D. tetanus toxoid E. Rabies vaccine"

"Which one of the following features in an adult patient presenting with porphyrinuria would most suggest lead poisoning rather than acute intermittent porphyria as a cause? A- Abdominal pain B- Anaemia C- Foot drop D- Hypertension E- Seizures"

"Which one of the following inherited diseases is due to mutation in mitochondrial DNA? A- Alport's syndrome B- Leber's optic neuropathy C- Noonan's syndrome D- Fabry's disease E- Marfan's syndrome"

"Which one of the following organisms normally inhabits the healthy human oral cavity? A. M. hominis B. M. orale C. M. pneumoniae D. M. fermentans E. U. urealyticum"

"Which one of the following statements BEST describes a patient with Wilson's disease? A- The primary defect is believed to be enhanced intestinal absorption of copper B- An alternative diagnosis should be considered if chorea occurs with no evidence of Kayser-Fleischer rings C- Chronic liver disease and autoimmune haemolytic anaemia are recognised features D- Raised serum copper levels evident at birth E- Siblings with biochemical evidence of the disease are treated only when they become symptomatic"

"Which one of the following statements best applies to renal tubular acidosis type 4? A- It is an inherited condition B- It is a recognised complication of diabetes mellitus C- It is associated with hypokalaemia D- It is due to decreased renal bicarbonate reasborption E- Renal calculi are a common presentation"

"Which protein defect is responsible for Marfan's syndrome? A- Elastin B- Fibrillin C- Myosin D- Actin E- Collagen"

"Which structure is most susceptible to unintentional damage during a hysterectomy? A. Uterine artery B. Ureter C. Urinary bladder D. Urethra E. Kidney"

"You are asked to assess the cardiovascular risk status of a man with the insulin-resistance syndrome. Which of the following pathophysiological changes are most strongly associated with increased insulin resistance? A- Hypotension B- Increased levels of Plasminogen activator inhibitor-1 PAI-1 C- Decreased platelet aggregation D- Improved endothelial function E- Increased HDL levels"

"You are asked to review a 45-year-old obese woman who is jaundiced. Which of the following best fits the metabolism of bile acids? A- Concentration in the gall-bladder is around 500 mmol/l B- Their production is catalysed by cholesterol 7a-hydroxylase C- Around 30% of the bile acid pool is lost in faeces each day D- 80% of bile salts are reabsorbed during each cycle E- The total bile salt pool in the liver is around 10 g"

"You are asked to review a young man with short stature, short fifth metacarpals, subcutaneous calcification, intellectual impairment and hypocalcaemia. Given the likely clinical diagnosis, mutation resulting in the dysfunction of what structure is most likely? A- An ion-channel linked to the PTH receptor B- A G-protein linked to the PTH receptor C- A tyrosine kinase receptor D- A tyrosine phosphatase receptor E- A serine kinase receptor"

"You are asked to see a 45-year-old man who is haemodynamically compromised and plan to insert a right subclavian line. He has a body mass index (BMI) of 38, where is the correct position for central venous cannulation? A- 1 cm under the mid-point of the clavicle and 0.5 cm laterally B- 2 cm under the mid-point of the clavicle and 1 cm laterally C- 2.5 cm under the mid-point of the clavicle and 2 cm laterally D- 0.5 cm under the mid-point of the clavicle and 1 cm laterally E- 1 cm under the mid-point of the clavicle and 1 cm laterally"

"You are asked to see a patient who had a chest drain removed 4 days ago. There appears to be some infection. What are the stages in the cell biology of normal wound healing? A- Demolition is the first phase B- Maturation and remodelling can continue for up to a year C- Acute inflammation usually lasts for 6-12 hours D- Epithelial cell proliferation is the hallmark of the demolition phase E- Collagen deposition is the key process during demolition"

"You are investigating a 24-year-old woman with pyrexia of unknown origin, and a diagnosis of systemic lupus erythematosus (SLE) may need to be excluded. What negative test virtually excludes the condition? A- Negative double-stranded DNA antibodies (dsDNA) B- Negative ANA and negative anti-Ro antibodies C- Negative ANA and anti-dsDNA antibodies D- Negative ANA and Sm antibodies E- Negative Sm antibodies"

"You are researching a new agent for the management of hypoxia related to acute pneumonia. Part of the assessment includes changes in the pulmonary vasculature in response to hypoxia. When considering acute hypoxia, which of the following is true of the pulmonary vasculature? A- An area of lung affected by pneumonia is likely to experience vasodilatation B- An area of lung unaffected by pneumonia is likely to experience vasodilatation C- An area of lung unaffected by pneumonia is likely to experience vasoconstriction D- Increased cardiac output promotes pulmonary vasoconstriction E- Hypothermia promotes pulmonary vasoconstriction"

"You are reviewing a 45-year-old woman whois suffering from multiple sclerosis and are considering prescribing beta-interferon for her. Which of the following best describes the action of beta-interferon? A- It increases MHC class-II expression on antigen-presenting cells B- It leads to increased MHC class-I expression C- It is used in the treatment of hepatitis B D- It may be used as an adjunct in atypical mycobacterial disease E- It activates macrophage and neutrophil intracellular killing"

"You are reviewing a man who has paid privately for HLA tissue typing. He is found to be HLA B5-positive on typing.Which of the following diseases is most closely associated with HLA B5? A- Dermatitis herpetiformis B- Behçet's syndrome C- Grave's disease D- Addison's disease E- Sjögren's syndrome"

"You are reviewing a young woman who presents with intermittent abdominal pain, depression and anxiety. She has a diagnosis of acute intermittent porphyria. Which of the following statements best fits the production of haem? A- Increased haem levels increase the activity of delta-ALA synthetase B- Protoporphyrin is formed as the penultimate step before haem formation C- Defects of uroporphyrinogen co-synthetase cause acute intermittent porphyria D- Defects of ferrocheletase cause variegate porphyria E- Protoporphyrinogen oxidase catalyses the production of haem"

"You review a 16-year-old boy who has a history of Type 1 diabetes. He is doing a project at his school on aspects of the human immune system and asks about the function of T lymphocytes and how they interact with other cells in the body. Which of the following fits best with the action of the immune system? A- CD4 T cells interact with macrophages via MHC class I B- CD4 T cells interact with B cells via MHC class II C- CD8 T cells interact with any cell via MHC class II D- CD8 T cells only interact with detritic cells via MHC class I E- Only cells of the immune system express MHC class I"

"You review a 21-year-old man with albinism. He is from Central/ South America and you believe that he has Hermansky-Pudlak syndrome (HPS). You believe that this is due to a defect in the transport of glycoproteins from the Golgi body. Which of the following best fits the position of the Golgi body within the cell? A- In the nucleus B- Adjacent to the endoplasmic reticulum C- Moves within the cytoplasm D- Sits across the cell membrane E- Just inside the cell membrane"

"You review a 28-year-old man with a family history of early thyroid carcinoma and phaeochromocytoma. Your patient has been searching on the internet and has found information about the RET proto-oncogene. The proto-oncogene RET causes which thyroid cancer? A- Papillary B- Medullary C- Follicular D- Anaplastic E- Lymphoma"

"edema, neuropathy, and myocardial failure. select the dietary deficiency that match each set of symptoms and signs. A. Vitamin A deficiency B. Thiamine deficiency C. Vitamin C deficiency D. Vitamin D deficiency E. Niacin deficiency"

"select an appropriate measure of frequency that describes the number of deaths under the age of 1 year per 1000 live births in 1 year. A. Fetal mortality B. Infant mortality C. Perinatal mortality D. Neonatal mortality E. Post neonatal mortality"

"When is a gene mutation causing a particular genetic disorder said to be highly penetrant? A- It affects a large number of the population B- Affected individuals with the same mutation have a very similar phenotype C- Individuals with the mutation invariably develop the phenotype D- The disorder only manifests early in life E- It affects both sexes equally"

"Which of the following features most reliably suggests that a patient presenting with diabetes has type 1? A- Family history of diabetes B- Hypertriglyceridaemia C- History of recent weight loss D- Onset below 20 years of age E- Retinopathy"

"A 49-year-old woman presents to her gynaecologist with CIN-3 changes. She has been reading on the Internet about how the human papillomavirus interferes with the programmed death of defective cells and may predispose to cancers. Which of the following protein names best identifies the DNA-binding protein with which the papillomavirus interferes? A- p52 B- p51 C- p53 D- p54 E- p55"

"Which of the following is a common cause of epidemic gastroenteritis, particularly aboard cruise ships and in summer camps? It may be detected by ELISA methods or electron microscopy. A. Rotavirus B. Adenovirus 40/41 C. Norwalk virus D. Astrovirus E. Hepatitis A virus"

"A 50-year-old woman presents with symptoms and signs of cerebellar ataxia and an abdominal mass that on ultrasound is suggestive of ovarian cancer. You consider the possibility of a paraneoplastic syndrome and request some immunological investigations. Which antibody test would best support your clinical diagnosis? A- Anti-Hu antibodies B- Anti-intrinsic factor antibodies C- Anti-Yo antibodies D- Antinuclear antibodies (low titre) E- Antiendomysial antibodies"

"select the most effective or principal means of control for tetanus. A. Rat control B. Sanitation C. Immunization D. vector control E. Deer control"

"A 26-year-old woman is in her last trimester of a normal pregnancy. Synthesis of milk by her mammary glands specifically requires which of the following? A. Oxytocin from the neurohypophysis B. Prolactin from the corpus luteum C. The influence of vasopressin D. Placental lactogen E. Neurohumoral reflexes"

"A 52 year old woman presents to your office for her annual gynecological examination. She stopped menstruating about 6 months ago and is getting some hot flashes. Her history reveals that she drinks one glass of wine per day and smokes about 10 cigarettes per day. She does not exercise much and is overweight. Her most important risk factor for developing osteoporosis is A. Smoking B. Alcohol use C. Lack of physical activity D. Age E. Obesity"

"Chicken pox is a common disease of childhood. It is caused by which of the following viruses? A. Cytomegalovirus B. Rotavirus C. Varicella-zoster virus D. Adenovirus E. Papillomavirus"

"35yearold woman presents to your office complaining of hair loss, bone pain, and dryness and fissures of the lips. She tells you that she has been taking large amount of vitamins in hopes of pre venting cancer and infections. Her symptoms are most likely caused by an excess of A. Vitamin A B. Vitamin E C. Vitamin C D. Vitamin D E. Vitamin K"

"A "parasite" that may be a fungus is the initial clinical manifestation in up to 60% of patients with AIDS. This organism is A. Microsporidium B. Cryptosporidium C. Pneumocystis D. Blastocystis E. Blastomyces"

"A 13-year-old boy of Spanish descent has suffered from recurrent sinus infections for the past 2 years and has a history ofintermittent diarrhoea. As an infant he had many episodes of otitis media and at the age of 10 years was hospitalised with tonsilitis. His mother has coeliac disease and his sister autoimmune haemolytic anaemia. His full blood count is normal. What is his most likely diagnosis? A- Coeliac disease B- Systemic lupus erythematosus C- Selective IgA deficiency D- X-linked agammaglobulinaemia E- Wiskott-Aldrich syndrome"

"A 15-year-old boy presents with fever, rash and arthralgia. He has ++ protein and + blood on urinalysis. Investigations reveal the following: erythrocyte sedimentation rate 32; C-reactive protein 12; full blood count normal; and U+Es normal. Antistreptolysin-O titres are raised. What immunological phenomenon is taking place? A- Type-I hypersensitivity reaction B- Type-II hypersensitivity reaction C- Type-III hypersensitivity reaction D- Type-IV hypersensitivity reaction E- Cryoglobulinaemia"

"A 16-year-old girl presents to the Emergency Department complaining of an urticarial skin rash. There is a history of recent ingestion of peanut butter, although she is not known to be allergic to peanuts. Measurement of peanut specific IgE on RAST testing is in the normal range. Which of the following fits best with this clinical situation? A- Diagnosis of peanut allergy can be made on history alone B- Negative RAST testing rules out peanut allergy C- Skin prick testing may be useful D- Food provocation is the next most appropriate investigation E- Complement testing is the most useful next investigation"

"A 19-year-old man is admitted by ambulance after falling into a river. He is pulled out by two friends but is thought to have inhaled a significant quantity of water. On examination in the Emergency room his saturation is 90% on O2 by mask. He is drowsy but conscious, with bradycardia and a temperature of 34.8oC. Auscultation of his chest reveals wheeze and crackles consistent with fluid inhalation. Which of the following is the most likely biochemical imbalance to be seen? A- Alkalosis on ABG measurement B- Low Urea C- Acidosis on ABG measurement D- Hypokalaemia E- Hyponatraemia"

"A 19-year-old man presents with clinical features suggestive of malabsorption. Which of the following investigations has the potential to indicate a single cause for this? A- Breath hydrogen measurement B- Faecal fat excretion C- Lactose tolerance test D- Pancreolauryl test (comparison of the absorption of fluorescein and fluorescein dilaurate) E- Xylose tolerance test"

"A 19-year-old patient presents with gradual worsening myopia and decreased night vision. On examination there is atrophy of the retina. What enzyme deficiency is this patient most likely to have? A- Lipoprotein lipase B- Acetyl-coenzyme A acetyltransferase C- Ornithine aminotransferase D- Argininosuccinic acid synthetase E- Glutathione synthetase"

"A 2-year-old child was admitted to the hospital with acute meningitis. The Gram stain revealed Gram-positive short rods, and the mother indicated that the child had received "all" of the meningitis vaccinations. What is the most likely cause of the disease? A. N. meningitidis, group A B. N. meningitidis, group C C. Listeria D. S. pneumoniae E. H. influenzae"

"A 24-year-old woman attends the neurological clinic for review of multiple sclerosis, diagnosed 2 years before. She had presented with blurring of vision and mild pain in her left eye, which had resolved over a period of 3 months and had not recurred. On examination now, the following observations are made: light shone in the left eye causes constriction of the left and right pupils; light shone into the right eye causes constriction of the right and left pupils but when the light is shone back into the left eye, the left pupil dilates slightly. Which of the following is the most likely site of the lesion responsible? A- Left ciliary ganglion B- Left oculomotor nerve C- Left optic nerve D- Right ciliary ganglion E- Right optic nerve"

"A 24-year-old woman is admitted with dysarthria, tremor and parkinsonian symptoms. On examination you notice yellow brown rings on examination of the eyes, seen at the limbus of the corneae. Given the most likely diagnosis, which part of the brain is predominantly affected by her underlying condition? A- Cerebral cortex B- Frontal lobes C- Basal ganglia D- Brainstem E- Cerebellum"

"A 24-year-old woman undergoes resection of the terminal ileum with fashioning of an ileostomy for Crohn's disease. Some 2 weeks after surgery, she is making a good recovery, and is eating a high-energy, low-residue diet, but has a high ileostomy volume, necessitatingintravenous fluid replacement. Her serum calcium concentration is 1.82 mmol/l, phosphate 1.28 mmol/l, alkaline phosphatase 82 U/l (normal < 150), albumin 30 g/l, creatinine 80 m mol/l. Prior to surgery, her serum calcium concentration was 2.18 mmol/l, albumin 36 g/l. What is the most likely cause of her hypocalcaemia? A- Formation of insoluble calcium salts in the intestine B- Hypoalbuminaemia C- Hypomagnesaemia D- Malabsorption of calcium E- Malabsorption of vitamin D"

"A 24-year-old woman visits her GP complaining that she is tired and lethargic. He arranges some routine blood tests including FBC, U&E, LFT, TFT, viscosity and immunoglobulins. The only abnormality is elevated IgE levels to 1.2 times the upper limit of normal. Raised IgE levels are a normal finding in what % of the population? A- 2% B- 5% C- 2.5% D- 1.25% E- 10%"

"A 25-year-old accountant is admitted to hospital with severe abdominal pain, vomiting and postural hypotension. She has had similar attacks in the past. A mid-stream urine sample shows the presence of high levels of aminolaevulinic acid (ALA) and porphobilinogen (PBG). What is the most likely diagnosis? A- Hereditary coproporphyria B- Porphyria cutanea tarda C- Acute intermittent porphyria D- Erythropoietic protoporphyria E- Variegate porphyria"

"A 25-year-old man, previously rather sedentary in his habits but alarmed by his increasing weight, is persuaded by his girlfriend to join a gym, and begins an exercise programme. Although there are several similar people enrolled in the programme, he finds that he is unable to keep up with them because of muscle pain, particularly in his legs. Within a few minutes of resting, however, the pains resolve. Investigation revealed a slight fall in blood lactate concentration during exercise. Which of the following is most likely to be the cause of his complaint? A- Decreased muscle glucose uptake B- Decreased hepatic glycogenolysis C- Decreased muscle glycogenolysis D- Impaired hepatic gluconeogenesis E- Premature atherosclerosis"

"A 25-year-old patient presents with anaemia and jaundice. A blood film showspolychromasia, bite cells, reticulocytosis and Heinz bodies. What is the most probable diagnosis? A- Haemolytic uraemic syndrome B- Autoimmune haemolytic anaemia C- Glucose-6-phosphate dehydrogenase deficiency D- Hereditary spherocytosis E- Paroxysmal nocturnal haemoglobinuria"

"A 25-year-old patient presents with yellow papules on the extensor surfaces of the arms, legs, buttocks and back. His triglycerides are grossly elevated. On questioning he admits that there is a family history. What kind of deficiency is the patient most likely to have? A- Apolipoprotein A B- Apolipoprotein B48 C- Lipoprotein lipase D- LDL receptor E- Acetyl-coenzyme A acetyltransferase (ACAT)"

"A 27-year-old Jewish man attends the clinic with his wife. They are keen to start a family but are worried because his brother developed jaundice during teenage years and was given a diagnosis of Dubin Johnson syndrome. He asks for advice as to the chance of his children inheriting the condition. Which of the following most accurately represents the mode of inheritance for Dubin Johnson syndrome? A- X-linked recessive B- Autosomal dominant C- Autosomal recessive D- X-linked dominant E- Occurs by new mutation only"

"A 32-year-old woman on nasogastric aspiration for paralytic ileus following surgery develops a metabolic alkalosis. Which of the following intravenous fluids would be the preferred treatment for the alkalosis? A- 5% dextrose B- Dextrose saline C- Normal (0.9%) saline D- Ringer's lactate E- Twice normal (1.8%) saline"

"A 35-year-old man presents with severe hypertension and is found to have a unilateral phaeochromocytoma. His father died from metastatic renal-cell carcinoma aged 48 and previously had surgery for a brain tumour. What is the most likely underlying genetic condition? A- Neurofibromatosis type 1 B- Multiple endocrine neoplasia type 2A C- von Hippel-Lindau syndrome D- Hereditary haemorrhagic telangiectasia E- Neurofibromatosis type 2"

"A 36-year-old male office worker comes to the clinic complaining of general weakness and shortness of breath. He also relates a rapid, throbbing pulse after climbing a flight of stairs. Cardiac auscultation reveals a diastolic rumbling murmur attributable to the mitral valve. The mitral valve is best heard where? A. left side adjacent to the sternum in the second intercostal space B. left side adjacent to the sternum in the fifth intercostal space C. left side in the midclavicular line in the fifth intercostal space D. Right side adjacent to the sternum in the second intercostal space E. Right side adjacent to the sternum in the fourth intercostal space"

"A 38-year-old woman is sent as an emergency to you with an acute-onset headache and deteriorating conscious level. Her husband mentions that her brother has recently had a kidney transplant, although he is not sure why. What condition may be running in the family? A- von Hippel-Lindau disease B- Hereditary haemorrhagic telangiectasia C- Polycystic kidney disease D- Alport's syndrome E- Tuberous sclerosis"

"A 40-year-old man comes to see you because he is worried about his family history of Huntington's disease. His 45-year-old sister is known to be affected and has been given a molecular diagnosis, but neither parent is affected and both have had a normal gene test. What is the most likely reason for this inheritance pattern? A- Anticipation B- A new mutation in the sister C- Non-paternity D- Females are more often affected E- Non-penetrance in the parents"

"A 40-year-old woman patient has been referred to hospital with jaundice. On examination there is hepatosplenomegaly. She does not take any medication nor drinks alcohol. Her sister, who is 10 years older, had similar problems. Following serum testing, antibodies to which antigen are most likely to be detected in her serum? A- Double-stranded DNA B- Proteinase 3 C- Mitochondria D- T cells E- Immunoglobulins"

"A 44-year-old woman presents complaining that she has trouble opening jars and holding a pencil. On examination she has weakness of the adductor pollicis muscle. There is also sensory loss over the volar surface of the hypothenar eminence. Which of the following is the likely site of the lesion which has caused this clinical picture? A- Median nerve B- Radial nerve C- Ulnar nerve D- T7 E- Anterior interosseous nerve"

"A 55-year-old, chronic heavy smoker is brought to A&E with a 2-day history of polyuria, polydipsia, nausea and altered sensorium. On examination, he is lethargic and confused. A chest X-ray shows a round shadow in the right mid-zone with enlarged hilar lymph nodes on the right side. An ECG is normal except for a narrowed QT interval. What is the most likely metabolic abnormality in this case? A- Hypernatraemia B- Hyperkalaemia C- Hypercalcaemia D- Hyperphosphataemia E- Hypokalaemia"

"A 55-year-old-woman presents with the clinical features of Cushing's syndrome. She is on no medication. The results of routine biochemical investigations are normal. Her 0900-h cortisol concentration is 800 nmol/l (normal 150-650) and ACTH 80 ng/ml (normal < 50). Following dexamethasone 1 mg theprevious evening, a repeat 0900-h cortisol concentration is 720 nmol/l. Which of the following is the most likely diagnosis? A- Adrenal adenoma B- Adrenal carcinoma C- Cushing's disease (pituitary adenoma) D- Depression E- Ectopic ACTH secretion"

"A 58-year-old female patient goes into anaphylactic shock in the operating theatre soon after induction. She has been previously patch tested for severe asthma, and was found to be allergic to cats, dogs, trees and pollens. She received vecuronium and propofol on induction. Which of the following is the most likely cause? A- Latex allergy B- C1-esterase deficiency C- Vecuronium D- Propofol E- Nitrous oxide"

"A 58-year-old man presents with progressively worsening indigestion and weight loss. His GP can feel an epigastric mass and arranges upper gastrointestinal (GI) endoscopy. Biopsy of a suspicious lesion in the stomach reveals numerous signet ring cells. Which of the following is the most likely underlying diagnosis? A- Gastric lymphoma B- Oesophageal carcinoma C- Gastric adenocarcinoma D- Gastric leiomyoma E- Gastrinoma"

"A 62-year-old man presents with lower back pain radiating into the posterior part of the tops of both legs. He also reports trouble with difficulty starting and stopping his stream of urine and difficulty making it to the toilet when he wants to pass stool. On examination he has local tenderness to palpation over the lower back. There is diminished light touch in the perianal region and decreased anal tone. Where is the most likely cause of his symptoms? A- Conus medullaris lesion B- L1 disc lesion C- Cauda equina syndrome D- T10 disc lesion E- Spinal meningioma"

"A 65-year-old man consults his family doctor complaining of feeling 'tired all the time'. His haemoglobin is 11.5 g/dl (13-17); mean cell volume (MCV) is 105 fl (82-102). Bone marrow examination does not indicate megaloblastic changes.Which of the following investigations is most important to determine the cause of the anaemia? A- Measurement of red cell folate concentration B- Measurement of serum ferritin concentration C- Measurement of serum TSH (thyroid-stimulating hormone) concentration D- Measurement of serum Vitamin B12 concentration E- Reticulocyte count"

"A 68yearold man with controlled hypertension complains of gradual impairment of vision. His history further reveals that he was recently diagnosed with mild adult onset diabetes that is also well controlled. He is a retired fisherman. The most likely cause of his visual impairment is A. Glaucoma B. Cataract C. Diabetic retinopathy D. Macular degeneration E. Xerophthalmia"

"A 70-year-old patient has become more forgetful, in that he has lost his day-to-day memory and is unable to learn new tasks. What kind of pathological deposits are most likely to be present in his brain? A- b2-Microglobulin B- Transthyretin C- Amyloid D- Immunoglobulins E- Acute-phase proteins"

"A 71-year-old man with known chronic obstructive pulmonary disease is admitted to A&E with severe shortness of breath. blood gas analysis shows: arterial [H+] 55 nmol/l (pH 7.26), p(CO2) 9.4 kPa, p(O2) 9.1 kPa, derived [HCO3-] 31 mmol/l.Which of the following types of acid-base disturbance is most likely? A- Acute respiratory acidosis B- Chronic, compensated respiratory acidosis C- Exacerbation of chronic respiratory acidosis D- Mixed respiratory acidosis and metabolic alkalosis E- Severe metabolic acidosis"

"A 72-year-old man presents with weight loss, low-grade fever, mononeuritis and hypertension. You consider the diagnosis of polyarteritis nodosa (PAN) and request certain immunological investigations. Which one of the following would best support your clinical diagnosis? A- Positive c-ANCA B- Positive p-ANCA C- ANCA-negative D- Positive ANA E- Positive thyroid microsomal antibodies"

"A 75-year-old man is given a routine health check by his family doctor. He has no specific complaints and is not on any regularmedication. Biochemical tests reveal a serum alkaline phosphatase activity of 550 U/l (upper limit of normal (ULN) 150 U/l); serum creatinine concentration is 132 mmol/l, calcium 2.42 mmol/l, phosphate 1.21 mmo l/l, albumin 41 g/l. Which of the following is the most likely cause of the high alkaline phosphatase? A- Osteomalacia B- Osteoporosis C- Paget's disease of bone D- Primary hyperparathyroidism E- Renal osteodystrophy"

"A 77-year-old man presents with a history of vomiting undigested food. Routinebiochemistry shows a serum bicarbonate concentration of 38 mmol/l. Which of the following findings would most strongly suggest that he had a chronic metabolic alkalosis? A- Alkaline urine B- Base excess 18 mmol/l C- Elevated arterial p(CO2) D- Hypokalaemia E- Hypomagnesaemia"

"A butcher, who is fond of eating raw hamburger, develops chorioretinitis; a Sabin-Feldman dye test is positive. This patient is most likely infected with A. Trichinosis B. Schistosomiasis C. Toxoplasmosis D. Visceral larva migrans E. Giardiasis"

"A colleague asks for your help in designing a new diagnostic molecular assay where small amounts of DNA need to be accurately amplified and analysed. Which would be your technique of choice? A- Southern blotting B- Immunoprecipitation C- Polymerase chain reaction (PCR) D- Western blotting E- Enzyme-linked immunoabsorbant assay (ELISA)"

"A male patient age 33 presents with depression, weight loss and choreiform movements. He informs you that his father had similar symptoms aged 50, his grandfather at aged 75, and both deteriorated in terms of mobility and mental state and eventually died. What is the phenomenon described here known as? A- Increased penetrance B- Autsomal dominance C- Anticipation D- X-linked dominant characteristics E- Mitochondrial characteristics"

"Children between the ages of 1 and 5 have an average of eight colds per year. Choose statement below that match rate above. A. secondary attack rate B. Case fatality rate C. Morbidity rate D. Age adjusted mortality E. Crude mortality"

"A man in his mid-60s is referred to you because he is worried about his family history of ischaemic heart disease. His father was a non-smoker and died of a myocardial infarction aged 39 years. His maternal grandfather and a paternal uncle both had myocardial infarcts in their 40s. What is his history most suggestive of? A- Hyperhomocysteinaemia B- Homocystinuria C- Familial hypercholesterolaemia D- Factor V Leiden deficiency E- Haemochromatosis"

"A man presents with an eczematous rash on his hands suggestive of contact dermatitis, possibly related to wearing latex gloves at work. He requests confirmatory tests. Which of the following tests is most likely to be helpful establishing the diagnosis? A- Atopy patch testing B- Skin-prick testing C- Patch testing D- Intradermal testing E- Direct exposure tests to gloves"

"A parasite resembling malaria that infects both animals and humans and is carried by the same tick that transmits B. burgdorferi (the bacterium that causes Lyme disease) would most likely be observed in A. Vaginal secretions B. Duodenal contents C. blood D. Biopsied muscle E. Sputum"

"A patient collapses during induction with a general anaesthetic. Which of the following investigations will be most useful in subsequently establishing an IgE-mediated process (anaphylactic mechanism)? A- Elevated serum tryptase at approximately 1 hour after collapse B- Total serum IgE level C- Skin-prick tests to anaesthetic agents D- Serum/plasma C3 and C4 levels E- Specific IgE to latex"

"A patient with familial hypercholesterolaemia has a total cholesterol concentration of 10.2 mmol/l, LDL-cholesterol 8.1 mmol/l, HDL-cholesterol 1.2 mmol/l and fasting triglycerides 1.9 mmol/l. He has a strong family history of premature myocardial infarction. He is a non-smoker and normotensive. He is given lifestyle and dietary advice and prescribed a statin. Some 2 months after being on the maximum dose of the statin, his total cholesterol concentration is 6.8 mmol/l, LDL-cholesterol 5.2 mmol/l, HDL-cholesterol 1.3 mmol/l and fasting triglycerides 1.0 mmol/l. What would be the most appropriate next step in his management? A- Adding a bile-acid sequestrant to his medication B- Adding a fibrate to his medication C- Adding ezetimibe to his medication D- Adding nicotinic acid to his medication E- Continuing on the present medication with review in a further 2 months"

"A pregnant woman in her second trimester presents with a recent onset of a bullous rash on her lower anterior abdominal wall. She has no other clinical features. Which of the following bullous conditions is the most likely diagnosis? A- Pemphigus B- Pemphigoid foliaceus C- Pemphigoid gestationis D- Drug-associated rash E- Flea bites"

"A teenager presents with excess hair and amenorrhoea. She is normotensive. Her prolactin levels are normal but she has a raised 17a-hydroxyprogesterone level. What is her diagnosis? A- Complete 21-hydroxylase deficiency B- Complete 11b-hydroxylase deficiency C- Partial 21-hydroxylase deficiency D- Partial 11b -hydroxylase deficiency E- None of the above"

"An 18-year-old suffers recurrent, proven bacterial chest infections requiring regular antibiotic treatment. Which of the following is the best way to exclude antibody deficiency? A- Serum immunoglobulins B- Immunoglobulin subclasses C- Specific antibodies to haemophilus and pneumococci D- Complement levels E- Mannan-binding protein"

"An 18-year-old woman presents with mild polyuria and polydipsia; her fasting blood glucose concentration is 14 mmol/l. Her father and two of her three sisters have diabetes. She responds well to treatment with insulin, and is stabilised on a total dose of 14 units per 24 h. A mutation in which of the following is likely to be responsible for her condition? A- Glucokinase B- Glutamic acid decarboxylase C- Hepatic nuclear factor-1a D- Insulin E- Insulin promoter factor-1"

"An 8-year-old child is admitted to hospital having ingested some of her mother's iron tablets (ferrous fumarate) 4 hours earlier. Her serum iron concentration is 182 mmol/l. Plain abdominal X-ray is unremarkable. What would be the most useful therapeutic measure? A- Gastric lavage with desferrioxamine B- Induction of vomiting C- Intravenous infusion of desferrioxamine D- Oral activated charcoal E- Whole bowel irrigation"

"An elderly man with a history of prostatism presents with acute retention of urine. His serum creatinine concentration is 520 mmol/l. Which of the following additional abnormal serum biochemistry test results is most suggestive of a chronic component to his renal failure? A- Hyperkalaemia B- Hyperuricaemia C- Hypocalcaemia D- Hyponatraemia E- Low serum bicarbonate concentration"

"An immunocompromised patient is suspected of having an infection with A. fumigatus. Which of the clinical conditions is most likely to occur? A. Wound infection B. Urinary tract infection C. Invasive aspergillosis causing thrombosis and infarction D. Thrush E. Superficial rash"

"Anti-Ro antibodies in isolation (negative ANA) occur in which of the following conditions? A- Sjögren's syndrome B- Sicca syndrome C- Systemic lupus erythematosus (SLE) D- Scleroderma E- Polymyositis"

"Ascaris are best observed in human specimens by which one of the following? A. Sigmoidoscopy and aspiration of mucosal lesions B. Baermann technique C. Dilution followed by egg count D. Enzyme immunoassay (EIA) E. Examination of a cellophane tape swab"

"Benign prostatic hypertrophy results in obstruction of the urinary tract. Patients present with weak urine flow, increased difficulty initiating urination, and increase frequency of urination since the bladder often is not fully emptied. Benign prostatic hypertrophy is associated with enlargement of which of the following? A. Entire prostate gland B. Lateral/posterior lobes C. Mucosal and submucosal regions D. Anterior region"

"Cells from a patient with severe combined immunodeficiency disease (SCID) lack the adenosine deaminase enzyme. This will have a direct effect on? A- synthesis of deoxynucleoside diphosphates (dNDPs) B- degradation of guanine nucleotides C- purine salvage D- de novo synthesis of purine nucleotides E- degradation of adenine nucleotides"

"Concerning monoclonal free light chains, which of the following statements is true? A- They are usually found in association with Waldenstrom's macroglobulinaemia B- They are commonly found in the serum of myeloma patients with normal renal function C- They are found in isolation in 20-30% of cases of myeloma D- They are not associated with IgE- or IgD-secreting myelomas E- They are rarely associated with renal tubular damage"

"During the assessment of a stroke, a middle-aged man undergoes detailed neurological examination. Which of the following physical signs would most suggest a pyramidal lesion? A- Weakness of forearm flexion B- Weakness of hip extension C- Weakness of knee flexion D- Weakness of ankle plantar flexion E- Weakness of wrist flexion"

"Each individual of the total group has an equal chance of being selected. Select the correct term that match above description of a sampling procedure. A. Systematic sampling B. Paired sampling C. Simple random sampling D. Stratified sampling E. Cluster sampling"

"Eastern equine encephalitis virus is associated with a high fatality rate. Control of the disease could be possible by eradication of A. Horses B. Birds C. Mosquitoes D. Fleas E. Ticks"

"Excluding influenza, which one of the following viruses is a common cause of acute respiratory disease? A. Cytomegalovirus B. Rotavirus C. Varicella-zoster virus D. Adenovirus E. Papillomavirus"

"Flukes (trematodes) have a great impact on worldwide public health, causing both morbidity and mortality. Which of the following organisms penetrates skin, is endemic in Africa and Latin America, and has a large lateral spine on its eggs? A. Paragonimus B. Clonorchis C. S. mansoni D. Schistosoma japonicum E. Schistosoma haematobium"

"Following a rock-climbing accident in which a foothold gave way, leaving him suspended by one arm, a young man develops weakness of his right hand. He can manoeuvre his arm into any position but cannot use the hand effectively. What structure is most likely to have been damaged in this accident? A- The C6 nerve root B- The C7 nerve root C- The T1 nerve root D- The ulnar nerve E- The radial nerve"

"Gluten-sensitive enteropathy (GSE) can be associated with low levels of: A- IgM B- IgG C- IgA D- IgE E- IgD"

"In a patient presenting acutely with severe abdominal pain presumed to be related to previously diagnosed hereditary angioneuritic oedema, which of the following treatment strategies would be optimal? A- Start/increase the dose of danazol B- Start tranexamic acid C- Give an intravenous C1-inhibitor concentrate D- Give intravenous fresh-frozen plasma E- Give intramuscular adrenaline (epinephrine), 0.3 or 0.5 mg"

"In metabolic alkalosis associated with prolonged nasogastric aspiration in postoperative ileus, what is the most important cause of the acid-base disturbance? A- Hypoventilation B- Increased renal bicarbonate reabsorption C- Loss of gastric acid D- Potassium depletion E- Secondary aldosteronism"

"In performing a lumbar puncture, the operator needs to be familiar with the anatomy involved. Which anatomical feature is relevant to this procedure? A- In the newborn baby, the spinal cord occupies the full length of the dural sac B- The dural sac in the adult terminates at the lower end of the sacral canal C- The spinal cord in the normal adult terminates anywhere from opposite the body of T12 to the body of L3; however, the commonest level is at the disc space between L1 and L2 D- The spinal cord in the average male is 12 inches (30 cm) in length E- The extradural space comprises a thin layer of avascular connective tissue"

"In the investigation of a woman presenting with jaundice and itching, which one of the following would most strongly support the diagnosis of primary biliary cirrhosis (PBC)? A- Raised serum IgM B- Positive antinuclear antibodies C- Antimitochondrial antibodies (M2 pattern) D- Raised serum IgA E- Anti-smooth muscle antibodies"

"In which of the following genetic diseases is DNA analysis useful? A- Adult polycystic kidney disease B- Down's syndrome C- Huntington's disease D- Hyperobstructible coronary myopathy E- Klinefelter's syndrome"

"In which of the following hereditary conditions will affected males have a significant risk of fathering affected sons? A- Duchenne's muscular dystrophy B- Cystic fibrosis C- Myotonic dystrophy D- MELAS (myopathy, encephalopathy, lactic acidosis, stroke) E- Haemophilia type A"

"Infection with herpes simplex virus, a common human pathogen, is best described by which of the following statements? A. The CNS and visceral organs are usually involved B. It rarely recurs in a host who has a high antibody titer C. It can be reactivated by emotional disturbances or prolonged exposure to sunlight D. Initial infection usually occurs by intestinal absorption of the virus E. Infection with type 1 virus is most common"

"Insulin binds to a 400-kDa glycoprotein, which straddles the cell membrane of many cells and exerts much of its peripheral effects through action at this receptor. The expression of which glucose transporter (GLUT) is upregulated by insulin binding at this receptor site? A- GLUT-1 B- GLUT-2 C- GLUT-4 D- GLUT-5 E- GLUT-3"

"Intervertebral disc prolapse in the lumbar spine most often affects the L4/l5 and L5/S1 discs. In a man presenting with acute back pain following an episode of lifting a heavy weight, reduced force of which of the following movements would most suggest an L5/S1 (L5 root) rather than an L4/5 disc lesion (L4 root)? A- Ankle plantar flexion B- Eversion of the foot C- Extension of great toe D- Inversion of the foot E- Knee extension"

"Like all endocrine glands, the thyroid is highly vascular. The thyroid gland normally receives its blood supply, in part, from branches off which of the following? A. Internal carotid artery B. Lingual artery C. Subclavian artery D. Transverse cervical artery E. vertebral artery"

"Malaise and fatigue with increased "atypical" lymphocytes and a reactive heterophil antibody test is most commonly caused by A. Toxoplasma B. Borrelia burgdorferi C. Epstein-Barr virus D. Parvovirus E. Rubella virus"

"Measles, tuberculosis, influenza. select the most common described mode of transmission with the above disease A. Water or foodborne transmission B. Zoonoses C. Persontoperson direct contact transmission D. Airborne transmission E. Arthropodborne transmission"

"Parents of a boy with suspected peanut allergy want answers to many questions, including prediction of the severity of future reactions and whether he will grow out the allergy. Which of the following is a valid statement? A- The weal size resulting from the skinprick test is a good indicator for the severity of the next anaphylactic reaction B- The amount of plasma-specific IgE to peanuts/treenuts is a good indicator for the severity of the next anaphylactic reaction C- The weal size resulting from the skinprick test is an excellent predictor of a positive food challenge to peanuts D- A negative skinprick is insufficient evidence to definitely exclude peanut allergy E- More than 50% of peanut allergic individuals will outgrow these allergies"

"Pathogenic mechanisms involved in tuberculosis can be primarily attributed to which of the following? A. Toxin production by the mycobacteria B. Specific cell adhesion sites C. Cell-mediated hypersensitivity D. Humoral immunity E. Clogging of alveoli by large numbers of acid-fast mycobacteria"

"Patients should be vaccinated annually for influenza with which of the following vaccines? A. Immune serum globulin B. Killed virus vaccine C. Inactivated virus vaccine D. Live virus vaccine E. recombinant viral vaccine"

"Public health efforts to pre vent injuries have been particularly successful in reducing deaths from A. Firearms B. Fire C. Motor vehicle accidents D. Falls E. Hypothermia"

"Schistosomiasis is a disease characterized by granulomatous reactions to the ova or to products of the parasite at the place of oviposition. Clinical manifestations include which one of the following? A. Bladder wall hyperplasia B. Pulmonary embolism C. Splenomegaly D. Cardiac abnormalities E. Arthropathies"

"Selective IgA deficiency is often discovered incidentally in the investigation of a patient, however you will need to explain to the patient the clinical significance of such a finding. Hence which of the following statements is relevant? A- Predisposition to Staphylococcus aureus infection B- An increased risk of colonic carcinoma C- IgG2 deficiency leading to recurrent bacterial infections D- A reduced risk of allergy E- An increased risk of viral infections"

"The first (S1, or "lub") heart sound and the second (S2, or "dup") heart sound originate, respectively, from which of the following? A. Closure of the pulmonary valve followed by closure of the aortic valve B. Closure of the tricuspid valve followed by closure of the mitral valve C. Closure of the atrioventricular valves followed by closure of the semilunar valves D. Closure of the atrioventricular valves followed by opening of the semilunar valves E. Opening of the atrioventricular valves followed by closure of the atrioventricular valves"

"The life cycle of this parasite consists of two stages: the cyst and the trophozoite, as shown in the figure below. The most likely identification of this organism is A. Entamoeba B. Clonorchis C. Giardia D. Trichomonas E. Pneumocystis"

"The major venous return system of the heart, the coronary sinus, empties into which of the following structures? A. Inferior vena cava B. left atrium C. Right atrium D. Right ventricle E. Superior vena cava"

"The most common way in which tuberculosis is acquired is via the A. Skin B. Gastrointestinal tract C. Respiratory tract D. Genital tract E. Nasal tract"

"The primordial germ cells that eventually form the oogonia and spermatogonia originate in which of the following? A. Dorsal mesentery of the hindgut B. Gonadal ridge C. Endodermal lining of the yolk sac D. Primary sex cords of the developing gonad E. Chorion"

"The vaccine for measles is best characterized as a A. Bacterin B. Killed virus vaccine C. Inactivated virus vaccine D. Live virus vaccine E. recombinant viral vaccine"

"There are millions of cases of leprosy (Hansen's disease) worldwide, but predominately in Asia and Africa. The clinical spectrum of Hansen's disease is best characterized by A. Immunologic energy B. Chronic pneumonitis C. Peripheral neuritis D. Bacilli in lesions that digest tissues E. Erythematous lesions resembling concentric circles"

"There is considerable overlap of signs and symptoms seen in congenital and perinatal infections. In a neonate with "classic" symptoms of congenital cytomegalovirus (CMV) infection, which one of the following tests would be most useful in establishing a diagnosis? A. CMV IgG titer on neonate's serum at birth B. CMV IgG titer on mother's serum at birth of infant C. CMV IgM titer on neonate's serum at birth and at 1 month of age D. Total IgM on neonate's serum at birth E. Culture of mother's urine"

"Third-generation cephalosporin with good activity against Borrelia burgdorferi is A. Piperacillin B. Cefoperazone C. Ceftriaxone D. Ciprofloxacin E. Imipenem"

"Third-generation cephalosporin with primary activity against Pseudomonas aeruginosa is A. Piperacillin B. Cefoperazone C. Ceftriaxone D. Ciprofloxacin E. Imipenem"

"This virus belongs to the family of flaviviruses and its reservoir is strictly human. Transmission is blood-borne so the blood supply is routinely screened for this virus. A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E"

"This virus is the leading cause of bronchiolitis and communityacquired pneumonia in infants. A. Measles virus B. Influenza virus C. respiratory syncytial virus D. Parainfluenza virus E. Adenovirus"

"To isolate specific bacteria from clinical specimens, it is necessary to use a variety of artificial media, some of which is selective, others of which are nonselective. N. gonorrhoeae is a fastidious pathogen and found in sites often contaminated with normal flora. The best medium for isolation is A. Sheep blood agar B. Löffler's medium C. Thayer-Martin agar D. Thiosulfate citrate bile salts sucrose medium E. Löwenstein-Jensen medium"

"What is the most likely diagnosis in a 30-year-old man with tall stature, gynaecomastia and azoospermia? A- Cystic fibrosis B- Homocystinuria C- Klinefelter's syndrome D- Marfan's syndrome E- XYY syndrome"

"What the most appropriate specimen is for the detection of Enterovirus A. Cervical tissue B. Synovial fluid C. blood D. Skin E. Cerebrospinal fluid"

"Which of the following statements is most accurate with regards to the chemoreceptor control of breathing? A- The aortic body is located in the root of the aorta B- When the CO2 concentration of plasma falls, the central chemoreceptors stimulate the inspiratory area of the brain C- Central chemoreceptors are sensitive to the H+ content of the CSF D- The carotid bodies are located on the external carotid artery E- Central chemoreceptors are sensitive to the O2 content of the CSF"

"Which of the following statements regarding the eukaryotic cell cycle is correct? A- M phase signifies meiosis B- DNA is made in the G1 phase C- DNA is made in the S phase D- G2 phase commences as G1 finishes E- G2 determines variability in the length of the cell cycle in humans"

"Which of the following viruses causes an acute febrile rash and produces disease in immunocompetent children but has been associated with transient aplastic crises in persons with sickle cell disease? A. Rubeola B. Varicella-zoster C. Parvovirus D. Rubella E. Herpes simplex"

"Which of these are well-recognised late complications of trisomy 21 (Down's syndrome)? A- Ischaemic heart disease B- Addison's disease C- Alzheimer's dementia D- Glioblastoma E- Cataracts"

"Which one of the following is MOST likely to increase during exercise? A- Peripheral vascular resistance B- Pulmonary vascular resistance C- Stroke volume D- Diastolic pressure E- Venous compliance"

"Which one of the following organisms causes primary atypical pneumonia in humans? A. M. hominis B. M. orale C. M. pneumoniae D. M. fermentans E. U. urealyticum"

"Which one of the following viruses is the leading cause of congenital malformations? A. Rabies B. Rhinovirus C. Cytomegalovirus D. respiratory syncytial virus E. Mumps"

"Which organ lies anterior in direct contact with the left kidney without separation by visceral peritoneum? A- Spleen B- Left suprarenal C- Tail of the pancreas D- Left psoas muscle E- Splenic flexure"

"Which pair of venous structures contributes to the confluence of dural sinuses on the interior surface of the occipital bone? A. Sigmoid and transverse sinuses B. Inferior sagittal and cavernous sinuses C. Occipital and straight sinuses D. Transverse and inferior petrosal sinuses E. Superior petrosal and occipital sinuses"

"Which virus is the leading cause of the croup syndrome in young children and, when infecting mammalian cells in culture, will hemabsorb red blood cells? A. Group B coxsackievirus B. Rotavirus C. Parainfluenza virus D. Adenovirus E. Rhinovirus"

"Whilst treating a diabetic patient who is controlled with insulin you perform fundoscopy and find new vessel disease in the macula lutea. Which of the following is true of ocular physiology? A- The macula is rich in rods B- This corresponds with the optic papilla C- The central portion of the macula is known as the fovea centralis D- As it corresponds with the blind spot, retinopathy will have less functional effect on acuity E- There is a direct relationship between proliferative retinopathy and the frequency of cataracts"

"You are asked to help identify whether the child of a woman with a neuromuscular disorder is affected by the condition. A specific DNA sequence associated with the mutation which causes the disorder has been identified. Which of the following methods is a technique to identify a particular DNA sequence? A- Northern blot B- Eastern blot C- Southern blot D- Western blot E- South-Western blot"

"You are called to see a 56-year-old man 2 h after a cardiac catheterisation. He is actively bleeding from his catheter site and his dressings and bedclothes are soaked with blood. Which of the following statements is true? A- Grade I shock applies with up to a 20% loss of circulating blood volume B- Loss of 2 litres of blood is consistent with normal systolic blood pressure C- The pulse can remain normal in patients with grade I shock D- Anuria is pathognomonic of grade III shock E- Grade IV shock is seen with a 30% loss of circulating blood volume"

"You are reviewing an 18-year-old woman with cystic fibrosis. How would the genetic inheritance of this condition best be described? A- It has an autosomal-dominant mode of inheritance B- It has an X-linked dominant mode of inheritance C- It has an autosomal-recessive mode of inheritance D- It has an X-linked recessive mode of inheritance E- It is a chromosomal disorder"

"You are trialing a new antihypertensive agent, 'Wonderone'. As part of the drug-development programme you must assess the half-life of Wonderone. Some results are sent to you for calculation of the half-life: 15 mins after iv injection - Wonderone level 150, 2 h 15 mins after iv injection -Wonderone level 37.5, 4 h 15 mins after iv injection - Wonderone level 9.4. Which of the following stems fits best with the half-life of this agent? A- 90 min B- 15 min C- 1 h D- 2 h E- 3 h"

"You review a 54-year-old man with a history of alcoholism; you are concerned that there may be evidence of portal hypertension. Which of the following stems best describes blood flow to the liver? A- The hepatic artery supplies 75% of the total liver blood flow B- The normal portal vein pressure is 8-12 mmHg C- The portal vein supplies 75% of liver blood flow D- The caudate lobe of the liver does not have it's own branch of the hepatic vein E- Only the portal vein enters the liver via the porta hepatis"

"You suspect that a 48-year-old man is suffering from Cushing's syndrome. At what time of day is a random cortisol test most likely to be abnormal? A- 0900 h B- 1200 h C- 2400 h D- 1700 h E- 2000 h"

"blood is circulated through the arteries by which of the following physiological mechanisms? A- Suction during cardiac diastole B- Negative pressure during inspiration C- Maintenance of diastolic pressure in the arteries and arterioles D- Contraction of external muscles E- Residual pressure from blood flow through the capillaries"

"lethargy, malaise, and fatigue are observed in a patient 2 weeks after eating raw hamburger at a restaurant. The most likely infectious cause is A. Toxoplasma B. Cytomegalovirus C. E. coli D. Salmonella E. Clostridium"

"select the most effective or principal means of control for Typhoid fever. A. Rat control B. Sanitation C. Immunization D. vector control E. Deer control"

"A woman has von Willebrand's disease and so does her partner. They wish to have childrenand seek genetic counselling. How would the risk of disease transmission to her offspring be best described? A- All the children will have the disease B- All the children will be carriers C- Half the children will be carriers D- Three-quarters of the children will have the disease E- All the sons will be affected"

"A woman presented with diarrhoea that has persisted up to 2 weeks after cholecystectomy. What is the most likely cause of the diarrhoea? A- Salmonella spp. B- Yersinia C- Campylobacter D- Bile acid malabsorption E- Lactose malabsorption"

"A 40 year old woman, who is under investigation in the medical out-patient department for symptoms of fatigue, proves to have weakly positive serum anti-nuclear antibodies (ANAs). Other blood tests are all normal. Which of the following is the most likely explanation for her ANA positivity? A- Ankylosing spondylitis B- Primary antiphospholipid antibody syndrome (APL) C- Chronic fatigue syndrome D- Age-related E- Myasthenia gravis"

"A 70-year-old Irish man is diagnosed with haemochromatosis. Subsequently, his son is also diagnosed with the condition. Both are homozygous for the common Northern European mutation. What is the most likely explanation? A- Autosomal-dominant inheritance B- Mitochondrial inheritance C- Non-paternity D- Pseudo-dominant inheritance E- X-linked inheritance"

"A patient who had a myocardial infarction 6 months ago is diagnosed as having gingival hypertrophy. Which drug is most likely to be responsible for this? A- Atorvastatin B- Isosorbide mononitrate C- Aspirin D- Amlodipine E- Atenolol"

"A patient with colon cancer presents with cafè au lait spots around the nose and mouth, hand and feet and within the oral cavity. What is the most likely diagnosis? A- Fanconi's anaemia B- Neurofibromatosis type 1 C- Neurofibromatosis type 2 D- Peutz-Jeghers' syndrome E- Tuberous sclerosis"

"A person who contracts gonorrhea is most likely to have acquired it via the A. Skin B. Gastrointestinal tract C. respiratory tract D. Genital tract E. Nasal tract"

"A teenager who works in a dog kennel after school has had a skin rash, eosinophilia, and an enlarged liver and spleen for 2 years. The most likely cause of this infection is A. Trichinosis B. Schistosomiasis C. Toxoplasmosis D. Visceral larva migrans E. Giardiasis"

"V. cholerae, the causative agent of cholera, is best isolated using A. Sheep blood agar B. Löffler's medium C. Thayer-Martin agar D. Thiosulfate citrate bile salts sucrose medium E. Löwenstein-Jensen medium"

"A 27-year-old woman presents with global weakness, lethargy and numbness of her extremities, which has worsened over the past 6 weeks. She admits to intermittent diarrhoea. On examination in the Emergency Department she is markedly underweight with a body mass index (BMI) of only 19. blood testing reveals hypokalaemia, raised chloride levels, low serum bicarbonate and pH of 7.31. Which of the following diagnoses seems most likely in this case? A- Bartter's syndrome B- Liddle's syndrome C- Gitelman's syndrome D- Laxative abuse E- Diuretic abuse"

"A 29-year-old man is referred to you with lethargy, constipation and generalised bone pain. Some 5 years ago he had pituitary surgery for a prolactinoma. He mentions that his father had required surgery to his parathyroid a few years ago and his brother is currently in hospital with kidney stones. What is the most likely diagnosis? A- Pseudohypoparathyroidism B- Hypophosphataemia C- Familial hypocalciuric hypercalcaemia D- Multiple endocrine neoplasia type 1 E- Multiple endocrine neoplasia type 2"

"A 30-year-old man is found to have 3 adenomatous polyps in the sigmoid colon at colonoscopy. He mentions that his father died at 45 with colon cancer, his paternal aunt was treated for rectal cancer at 45 and his paternal grandfather was treated for colon cancer at 50. What is the most likely diagnosis? A- Familial adenomatous polyposis (FAP) B- Cowden syndrome C- Gardner syndrome D- Hereditary non-polyposis colon cancer (HNPCC) E- Peutz-Jeghers' syndrome"

"A 30yearold patient presents to your office for contraceptive counseling. She is divorced and has just started a new relationship. She wishes to use oral contraceptives because of their effectiveness. Her examination is normal. Which of the following factors would be considered a contraindication to their use? A. Tobacco use B. Vaginal bleeding C. History of gestational hypertension D. Polycystic breast disease E. Migraines"

"A 32-year-old woman with a history of Sjögren's syndrome gives birth to her second child. On examination the baby is noted to be bradycardic at 65 beats per minute during birth checks carried out by the on-call midwife. The baby's ECG shows that she appears to be in a junctional rhythm. Which of the following antibodies is most likely to be responsible for the child's heart block? A- Anti-nuclear B- Anti-mitochondrial C- Anti-smooth muscle D- Anti-ro E- Rheumatoid factor"

"A 22-year-old golfer presents for review. He has noticed a decrease in his grip strength over the past few weeks and pain over his elbow. On examination he has pain over his elbow which is worse on wrist flexion and resisted forearm pronation. There is weakness of the adductor policis muscle and loss of pinch grip and loss of sensation over the lateral fingers of the hand. Which of the following is the most likely cause for his injury? A- Lateral epicondylitis B- Radial neuropathy C- Median neuropathy D- Medial epicondylitis E- Brachial plexus injury"

"A 22-year-old man presents with a long history of intermittent abdominal discomfort and diarrhoea. On examination, he has a body mass index of 19 kg/m2 and is clinically anaemic. Coeliac disease is suspected. Which of the following investigations will most reliably diagnose this condition? A- Detection of antigliadin antibodies in serum B- Detection of endomysial antibodies in serum C- Detection of tissue transglutaminase antibodies in serum D- Microscopic examination of a small bowel biopsy specimen E- Xylose absorption test"

"A 22-year-old woman presents to Accident & Emergency with an acute hereditary angioedema involving the larynx. What is the optimum immediate management? A- Antihistamines B- IV hydrocortisione C- Fresh frozen plasma D- C1 inhibitor concentrate E- Recombinant C1 inhibitor"

"A 35-year-old man presents with a one-year history of choreiform movements, personality changes and mild memory loss. His father died with similar problems at the age of 50. What is the most likely diagnosis? A- Alzheimer's disease B- Creutzfeldt-Jakob disease C- Hallervorden-Spatz disease D- Huntington's disease E- Wilson's disease"

"A 24-year-old man is being provided with long-term parenteral nutrition for Crohn's disease. His energy requirement is estimated to be approximately 597 J (2500 kcal)/24 h. Which of the following combinations of lipid emulsion and dextrose solutions would bemost appropriate to provide his energy requirements? A- Dextrose 50% 500 ml, lipid emulsion 20% 500 ml B- Dextrose 50% 500 ml, lipid emulsion 20% 750 ml C- Dextrose 50% 500 ml, lipid emulsion 20% 1000 ml D- Dextrose 50% 750 ml, lipid emulsion 20% 500 ml E- Dextrose 50% 1000 ml, lipid emulsion 20% 500 ml"

"A 25-year-old woman is referred to you for treatment of her asthma. She is otherwise well and there is no significant previous medical history. During the consultation it transpires that her sister died of cystic fibrosis and she is worried about having a child affected with the same disease. Her chest X-ray is normal. Assuming a population carrier frequency of 1 in 25, what is the chance of her having an affected child? A- 1 in 10 B- 1 in 50 C- 1 in 100 D- 1 in 150 E- 1 in 200"

"A 25-year-old woman with systemic lupus erythematosus (SLE) has dsDNA antibodies and a grade III glomerulonephritis. Which is the most likely immunopathological process? A- Activation of the alternative complement pathway B- Type-II hypersensitivity reaction C- Type-I hypersensitivity reaction D- Activation of the classical complement pathway E- A complement deficiency"

"A 17-year-old adolescent complains of intermittent face swelling. It varies in severity but sometimes he has difficulty breathing. His brother has similar symptoms. What protein is most likely to be responsible for his condition? A- Interleukin-1 B- Interferon-gamma C- Complement C3 D- C1 esterase inhibitor E- Interleukin-6"

"A 17-year-old boy with a history of type 1 diabetes mellitus, sensorineural high tone deafness and colour blindess presents for review in the genetics clinic. You learn from his mother that other members of the family are affected, including a daughter aged 21 who also suffers from Type 1 diabetes. Which of the following represents the usual mode of inheritance for the likely genetic syndrome? A- Autosomal dominant B- X-linked C- X-linked recessive D- Autosomal recessive E- Chromosomal non-dysjunction"

"A 2-year-old infant is brought to the emergency room with hemolytic uremic syndrome and thrombocytopenia. Which one of the following bacteria would most likely be isolated from a stool specimen? A. Shigella B. Salmonella C. Aeromonas D. E. coli 0157/H7 E. Enterobacter"

"A 20-year-old female presents with the following blood gases: pH 7.48 p(CO2) 3.9 mmHg HCO3- 22 mmol/l H+ 35mmol/l. What is the most likely reason for these results? A- Amitriptyline B- Cushing's syndrome C- Hepatic failure D- Pregnancy E- Diazepam overdose"

"A 20-year-old man presents with pes cavus, distal weakness and wasting of his leg muscles, absent knee and ankle jerks and reduced sensation to touch and vibration in his feet and legs. His father is said to havesimilar problems. Nerve conduction studies show absent sensory potentials from his sural nerve and reduced motor nerve conduction velocities in his common peroneal nerve. What is the most likely diagnosis? A- Autosomal dominant cerebellar ataxia B- Dejerine-Sottas syndrome C- Friedreich's ataxia D- Hereditary sensory and motor neuropathy type 1 (HMSN1) E- Hereditary neuropathy with liability to pressure palsies (HNPP)"

"A 40-year-old man is referred to you with breathlessness and bradycardia. During the consultation you notice that he has a bilateral ptosis. He is estranged from his family and never knew his father, but he does know that his sister has a muscle problem and lost a child in infancy. What diagnosis might you suspect in this man? A- Duchenne's muscular dystrophy B- Facioscapulohumeral dystrophy C- Becker's muscular dystrophy D- Myotonic dystrophy E- Spinal muscular atrophy"

"A 41-year-old patient complains of tinnitus. Which of the following statements is correct regarding the clinical physiology of the ear? A- High-frequency waves are detected in the scala tympani B- Low-frequency waves are detected in the scala vestibuli C- The scala media is filled with perilymph D- The scala media contains the organ of Corti E- Normal hearing frequency only ranges from 20 to 2000 Hz"

"A 42-year-old Afro-Caribbean man sustains a myocardial infarction. He is discharged from hospital 4 days later. His medication is aspirin, simvastatin and a β-blocker. A month later, he is well and has routine blood tests in the outpatient clinic. His serum creatine kinase(CK) activity is reported as being 400 U/l. His CK 24 h after admission had been 620 U/l and had fallen to 415 U/l after a further 48 h. Which of the following is the most likely cause of the high CK when he was reviewed in outpatients? A- Effect of simvastatin B- Further myocardial infarction C- Heavy exercise D- Racial variant E- Undiagnosed hypothyroidism"

"A 42-year-old man consulted his family doctor because of a 2-3 month history of lethargy and feeling generally unwell. The history was otherwise unremarkable. His urine tested positive for glucose, and a random venous plasma glucose concentration was 8.3 mmol/l. The family doctor arranged an oral glucose tolerance test: glucose concentration at baseline 5.6 mmol/l, 9.3 mmol/l at 120 minutes. Which of the following statements is correct? A- Diabetes could have been diagnosed on the random glucose value alone B- The combination of the random glucose and glycosuria are diagnostic of diabetes3- The result of the OGTT confirms a diagnosis of diabetes D- The result of the OGTT indicates impaired glucose tolerance E- The result of the OGTT indicates that he is at increased risk of microvascular disease"

"A 42-year-old man with a history of road traffic accident and injury to his back and neck presents with global muscle wasting of the left hand. Which is the nerve or nerve root most likely to be involved? A- Radial nerve B- Median nerve C- Ulnar nerve D- T1 nerve root E- C7 nerve root"

"A 44-year-old pharmacist presents with a history of recurrent episodes of faintness, sweating and tremor, occurring particularly in the late morning or late afternoon. An insulinoma is suspected. The patient is admitted for 3 days' consecutive overnight fasting with blood glucose measurements in the morning. She remains asymptomatic during her admission and the lowest blood glucose concentration is 4.4 mmol/l. On discharge from hospital, she reports that her symptoms have recurred. What would be the most useful investigation to establish the diagnosis? A- Measurement of plasma b -hydroxybutyrate B- Measurement of glycated haemoglobin (Hb A1c) C- Prolonged glucose tolerance test D- Simultaneous measurement of glucose and C-peptide when symptomatic E- Simultaneous measurement of glucose and insulin when symptomatic"

"A 45-year-man sustains a myocardial infarction. His serum cholesterol concentration is 9.6 mmol/l. Which of the following physical signs would most suggest a diagnosis of familial hypercholesterolaemia? A- Arcus senilis B- Eruptive xanthomas C- Palmar xanthomas D- Tendon xanthomas E- Xanthelasmas"

"A 49-year-old man presents with an acutely red and painful eye. Following ophthalmalogical assessment, a diagnosis of anterior uveitis is made. Further investigations are to be undertaken to examine the possible underlying systemic cause. Which of the following underlying diagnoses would the least likely in his case? A- Tuberculosis B- HLA B27 associated arthritis C- Behçet's disease D- T-cell lymphoma E- Sarcoid"

"A 50-year-old woman has a suspected right renal artery stenosis. A transfemoral aortogram has been performed. Which one of the following is likely to be correct? A- The femoral artery at the groin is situated halfway between the anterior superior iliac spine and the pubic tubercle B- The catheter passes through the common femoral artery into first the external iliac artery and then the aorta at its bifurcation C- The right renal artery also gives off the right ovarian and suprarenal arteries D- The right and left renal arteries lie in the transpyloric plane at the level of the first lumbar vertebra E- The aorta passes through the diaphragm at the level of the tenth thoracic verteb"

"A 52-year-old woman undergoes investigation for jaundice. She first noticed this symptom 2 months ago, but for 4 months prior to that, she had been experiencing generalised pruritus. The results of liver function tests are as follows: serum bilirubin 325 mmol/l, aspartate aminotransaminase 55 U/l (15-42), alkaline phosphatase 436 U/l (80-150),gamma-glutamyltransferase 82 U/l (11-51), albumin 36 g/l, total protein 82 g/l. Which of the following is the most likely diagnosis? A- Alcoholic cirrhosis B- Carcinoma of the head of the pancreas C- Cholangiocarcinoma D- Primary biliary cirrhosis E- Primary sclerosing cholangitis"

"A 52yearold patient with chronic cough and shortness of breath is diagnosed with chronic obstructive lung disease. Which of the following factors is the most important contributor to this finding? A. Tobacco use B. Deficiency of α antitrypsine C. Asthma D. repeated childhood respiratory tract infections E. Occupation"

"A 60-year-old man presents to the emergency team with dramatic swelling of his tongue and lips. He has hypertension and type-2 diabetes mellitus. His drug therapy has been unchanged for 5 years and comprises lisinopril, low-dose aspirin and metformin. Which of the following diagnoses is most likely? A- Acquired angioedema related to a paraprotein B- Idiopathic angioedema C- Hereditary angioedema D- ACE inhibitor-associated angioedema E- Salicylate-induced angioedema"

"A 65-year-old male presents with jaundice for 2-3 weeks, fatigue and increasing epigastric pain. He has no history of peptic ulcers and says the pain does not relate to eating in anyway. His epigastric pain is midline and he has had some recent back pain. His urinary bilirubinogen and serum bilirubin are elevated (serum bilirubin 5. 8 mg/dl). Helical CT reveals a suspicious mass in the head of the pancreas adjacent to the descending duodenum. The gallbladder is significantly enlarged. Which of the following is the likely cause of the elevated bilirubin? A. Viral hepatitis B. Blocked cystic duct C. Open hepatic duct D. Blocked duodenal papilla E. Gilbert syndrome"

"A 70-year-old man presents in an acute confusional state. His plasma sodium concentration is 108 mmol/l, his creatinine is 106 micromol/l, urea of 5.0 mmol/l. Which of the following findings would be most suggestive of the hyponatraemia being due to inappropriate secretion of vasopressin (antidiuretic hormone, ADH)? A- Plasma osmolality of 230 mmol/kg B- Plasma urea concentration 2.5 mmol/l C- Urine sodium concentration of 50 mmol/l D- Urine osmolality 510 mosmol/kg E- Plasma albumin concentration of 28 g/l"

"A 70-year-old man with symptoms of prostatism has a serum prostate specific antigen (PSA) concentration of 20 mg/l (normal value, < 4 mg/l). Which one of the following statements about the clinical importance of this result is the most likely? A- It could be elevated because a digital rectal examination was performed 48 h before the blood sample was taken B- It could be elevated because of cancer elsewhere in the urinary tract C- It is diagnostic of prostatic cancer D- It is more likely to reflect prostatic cancer than benign prostatic hypertrophy E- It is normal for a man of this age"

"A 74-year-old-man is seen in the preoperative assessment clinic prior to a right total hip replacement scheduled in eight weeks time. He had a recent chest infection and suffered chronic joint pain and prostatism for many years. On examination there were few chest signs and the musculoskeletal examination revealed evidence of severe arthritis in the right hip and base of the thumb. The prostate is firm and enlarged. It was thought that he was fit to have the operation. However, the blood tests showed raised immunoglobulins and the immune electrophoresis identified an M-protein of the IgG type at 2.5 g/dl. Further tests reveal no lytic bone lesions on skeletal survey and no Bence-Jones proteinuria. The bone profile and the prostate specific antigen were within normal limits. The MOST likely underlying disease is? A- Carcinoma of the prostate B- Multiple myeloma C- Rheumatoid arthritis D- Monoclonal gammopathies of undetermined significance (MGUS) E- Waldenstrom's macroglobulinaemia"

"A 75-year-old man has gangrene of the left hallux. There are no pulses to feel below the rather weak femoral pulse on that side. A duplex scan reveals a block in the superficial femoral artery. Which statement pertaining to the arterial system of the lower limb best accords with usual clinical findings? A- The common femoral artery divides into its superficial and profunda branches a hand's breadth below the inguinal ligament B- The femoral vein lies on the lateral side of the common femoral artery at the groin C- The femoral artery passes into the popliteal fossa, as the popliteal artery, by passing between the adductor longus and magnus D- The popliteal artery lies against the popliteal surface of the femur deep to the popliteal vein, which itself lies deep to the tibial nerve E- The pulse of the posterior tibial artery is felt behind the lateral malleolus"

"A 75-year-old woman undergoes total gastrectomy for carcinoma of stomach. With which of the following nutrients is she most likely to require parenteral replacement? A- Ascorbic acid B- Folic acid C- Iron D- Vitamin B12 E- Vitamin D"

"A 78-year-old man had poliomyelitis as a child, which left him with total paralysis of the left deltoid muscle. Which feature is most likely to be present on clinical examination? A- Anaesthesia over the 'epaulette' region of the left shoulder B- The acromion process of the scapula forms the most lateral bony landmark of the left shoulder C- Drooping of the left shoulder compared to the right side D- Detectable weakness in drawing the arm forward and internally rotating the shoulder when this is compared with the right side E- Abduction of the shoulder to 60o is likely to be preserved due to action of the intact supraspinatus muscle on the left side"

"A carcinoma in the medial portion of the lower lip is most likely to first metastasize via which of the following lymph nodes? A. Submandibular B. Parotid C. Superficial cervical D. Submental E. Buccal"

"A couple attends genetic screening for an inherited condition that has been observed in the husband's family. More severe cases of so-called 'anticipation' have been observed. What is the most likely condition? A- Achondroplasia B- Haemophilia B C- Marfan's syndrome D- Myotonic dystrophy E- Polycystic kidney disease"

"A patient has all the gastrointestinal symptoms of infection with hepatitis A virus (HAV), yet all the tests for HAV-IgG and HAV-IgM are nonreactive. A possible cause of this infection is A. Hepatitis B surface antigen B. Hepatitis C C. Hepatitis D D. Hepatitis E E. Rotavirus"

"A patient in the intensive care unit following liver transplant surgery has a metabolic alkalosis. Which of the following biochemical abnormalities is most specifically indicative of this? A- Acidic urine B- High arterial blood pH (low hydrogen-ion concentration) C- High arterial partial pressure of carbon dioxide p(CO2) D- High plasma bicarbonate concentration E- Hypochloraemia"

"A patient on enteral nutrition develops constipation.What could explain the underlying clinical physiology? A- Hyperosmolar feed B- Bacterial contamination C- Low feed temperature D- Inadequate fluid replacement E- Reduced intestinal absorptive capacity"

"A patient on total parenteral nutrition (TPN) regimen presents with drowsiness and abnormal serum electrolytes. What is the most likely cause? A- Hypocalcaemia B- Hypercalcaemia C- Hypernatraemia D- Hypophosphataemia E- Hypomagnesaemia"

"A patient receives too many infusions after an operation resulting in a 20% increase in hisblood volume. What is the physiological process that is most likely to correct this abnormality? A- Reduced activity of arterial pressure sensors B- Increased activity of renal sympathetic nerves C- Aldosterone release D- Atrial natriuretic peptide (ANP) release E- Venous dilatation"

"A patient undergoes excision of the left submandibular salivary gland for sialectasia. Unfortunately, his hypoglossal (XII) nerve on that side is damaged. What is the most likely outcome? A- There is numbness of the posterior one-third of the tongue B- On protruding the tongue, it deviates towards the right C- The uvula deviates towards the left D- All the intrinsic muscles of the left side of the tongue are paralysed E- The genioglossus muscle is spared"

"In a patient with chronic hyponatraemia (sodium concentration 112 mmol/l), which of the following findings would most suggest a diagnosis of the syndrome of inappropriate [secretion of] antidiuretic hormone (SIADH)? A- Normal cortisol response to ACTH B- Plasma albumin concentration 28 g/l C- Plasma osmolality 248 mOsmol/kg D- Urinary osmolality 350 mOsmol/kg E- Urinary sodium concentration < 20 mmol/l"

"In a study of the cause of lung cancer, patients who had the dis ease were matched with controls by age, sex, place of residence, and social class. The frequency of cigarette smoking was then compared in the two groups. What type of study was this? A. Prospective cohort B. retrospective cohort C. Clinical trial D. Casecontrol E. Correlation"

"In order to recognize abnormal bacteria, it is necessary to know which bacteria are predominant normal flora of certain body sites. The bowel contains many microorganisms but the most prevalent bacterium is A. α-hemolytic streptococci B. Lactobacillus C. S. epidermidis D. E. coli E. B. fragilis"

"In people who have sickle cell anemia, osteomyelitis usually is associated with which of the following organisms? A. Micrococcus B. Escherichia C. Pseudomonas D. Salmonella E. Streptococcus"

"In relation to the nutritional physiology of patients, which of the following would represent appropriate nitrogen requirements (g N/kg per day) and calorie requirements (kcal/kg per day)? A- Reduced food intake: nitrogen requirement 0.3 g N/kg per day, calorie requirement 35 kcal/kg per day B- Moderate injury: nitrogen requirement 0.15 g N/kg per day, calorie requirement 25 kcal/kg per day C- Moderate sepsis: nitrogen requirement 0.3 g N/kg per day, calorie requirement 15 kcal/kg per day D- Severe injury: nitrogen requirement 0.3 g N/kg per day, calorie requirement 35 kcal/kg per day E- Severe sepsis: nitrogen requirement 0.2 g N/kg/day, calorie requirement 15 kcal/kg/day"

"In the selection of an optimum agent to prevent rejection postrenal transplantation, which of the following cell biological principles is correct? A- Daclizumab blocks the de novo pathway of purine synthesis B- Mycophenolate mofetil is a monoclonal antibody against IL-2 C- Basiliximab inhibits inosine monophosphate dehydrogenase D- Tacrolimus is a calcineurin inhibitor E- Sirolimus is a calcineurin inhibitor"

"Infectious mononucleosis, a viral disorder that can be debilitating, is Characterized by which of the following statements? A. It is most prevalent in children less than 14 years old B. It is caused by a rhabdovirus C. The causative pathogen is an Epstein-Barr virus D. Affected persons respond to treatment with the production of heterophil antibodies E. Ribavirin is the treatment of choice"

"Pain referred to the right side of the neck and extending laterally from the right clavicle to the tip of the right shoulder is most likely to involve which of the following? A. Cervical cardiac accelerator nerves B. Posterior vagal trunk C. Right intercostal nerves D. Right phrenic nerve E. Right recurrent laryngeal nerve"

"Phase 0 of the cardiac action potential relates to a: A- Rapid efflux of calcium B- Rapid influx of calcium C- Rapid influx of potassium D- Rapid influx of sodium E- None of the above"

"Quinolone antibiotic with broad Gram-negative and Gram-positive activity is A. Piperacillin B. Cefoperazone C. Ceftriaxone D. Ciprofloxacin E. Imipenem"

"Regarding B cells and plasma cells, which of the following is true? A- B cells and plasma cells have surface-bound IgG B- B cells and plasma cells have surface MHC class II C- Plasma cells can undergo somatic hypermutation D- B cells can undergo isotype switching E- Plasma cells can undergo isotype switching"

"Structure(s) that normally transit the diaphragm by way of the esophageal hiatus include which of the following? A. Azygos vein B. Hemiazygos vein C. Azygos and hemiazygos veins D. Anterior and posterior vagal trunk E. Thoracic duct"

"Symptoms of C. botulinum food poisoning include double vision, inability to speak, and respiratory paralysis. These symptoms are consistent with A. Invasion of the gut epithelium by C. botulinum B. secretion of an enterotoxin C. Endotoxin shock D. Ingestion of a neurotoxin E. Activation of cyclic AMP"

"The antibiotic of choice for pneumococcal pneumonia is A. Penicillin B. Ampicillin C. Erythromycin D. Vancomycin E. Ceftriaxone"

"The course of the vertebral arteries is best described by which of the following statements? A. They arise from the common carotid artery on the left and the arachiocephalic artery on the right B. They enter the cranium via the anterior condylar canals C. They enter the cranium via the posterior condylar canals D. They pass through the transverse processes of several cervical vertebrae E. They directly give rise to the posterior cerebral arteries"

"The diagnostic characteristics of Plasmodium falciparum are best described by which one of the following statements? A. A period of 72 h is required for the development of the mature schizont, which resembles a rosette with only 8 to 10 oval merozoites B. An important diagnostic feature is the irregular appearance of the edges of the infected red blood cell C. The signet-ring-shaped trophozoite is irregular in shape with ameboid extensions of the cytoplasm D. Except in infections with very high parasitemia, only ring forms of early trophozoites and the gametocytes are seen in the peripheral blood E. Schüffner stippling is routinely seen in red blood cells that harbor parasites"

"The stability and arrangement of actin filaments as well as their properties and functions depend on which of the following? A. The structure of the actin filaments B. Microtubules C. Intermediate filament proteins D. Actin-binding proteins E. Motor molecules, such as kinesin"

"The therapy of choice for pseudomembranous enterocolitis is A. Penicillin B. Ampicillin C. Erythromycin D. Vancomycin E. Ceftriaxone"

"This hepatitis virus is a defective virus in that it cannot replicate independently without the presence of hepatitis B virus. A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E"

"Traditional vaccination for the common cold is virtually impossible because there are multiple serotypes of which one of the following viruses? A. Rabies B. Rhinovirus C. Cytomegalovirus D. respiratory syncytial virus E. Mumps"

"Which of the following mechanisms is used to establish the mitochondrial electrochemical gradient? A. The action of ATP synthase B. Transfer of electrons from NADH to O2 in the intermembrane space C. Pumping of protons into the mitochondrial matrix by respiratory chain activity D. Proton-translocating activity in the inner membrane E. Transport of ATP out of the matrix compartment by a specific transporter"

"Which of the following organisms penetrates skin, is endemic in Asia, and has a small lateral spine on its eggs? A. Paragonimus B. Clonorchis C. S. mansoni D. S. japonicum E. S. haematobium"

"Which of the following statements about prostaglandin synthesis is correct? A- It is activated by glucocorticoids B- It is produced by lipoxygenase C- It is activated by aspirin D- It is mediated by cyclooxygenase E- It causes vasoconstriction"

"Which of the following statements concerning hyperacute rejection after renal transplantation is correct? A- Occurs at least three days after surgery B- Is successfully treated with ciclosporin A C- Is caused by ciclosporin A D- Is mediated by preformed circulating antibodies E- Is largely a B-cell-mediated respons"

"Which of the following statements is true concerning kinins? A- They are lipids B- They promote vasoconstriction C- They decrease the permeability of blood vessels D- They are proteins that attract phagocytes E- They perforate invading bacteria"

"Which of the following statements is true in the epidemiology of disease associated with a-1-antitrypsin deficiency? A- Smoking is not a major risk factor B- There is an increased incidence of hyper-reactive airways in adult life C- It is an autosomal dominant disorder with low penetrance D- The disorder is an indication for liver transplantation in a child E- Most cases present during the neonatal period"

"Which of the following statements pertains to a resting neurone? A- It is uncharged B- It is depolarised C- It is negatively charged externally D- It is positively charged externally E- It is unable to conduct impulses"

"Which of the following types of diets may reduce the risk of developing cancer? A. Low fiber diet B. High protein diet C. High fat diet D. Diet rich in vitamin C and βcarotene E. Diet rich in vitamin E"

"Which one of the following groups of people may be at increased risk for HIV infection? A. Members of a household in which there is a person who is HIV-positive B. receptionists at a hospital C. Factory workers whose coworkers are HIV-positive D. Foreign service employees who are hospitalized in Zaire for bleeding ulcers E. Homosexual females"

"Which one of the following organisms normally inhabits the female genital tract but may cause acute respiratory illness? A. M. hominis B. M. orale C. M. pneumoniae D. M. fermentans E. U. urealyticum"

"Which one of the following porphyrias can be both acquired and inherited? A- Acute intermittent porphyria B- Congenital erythropoietic porphyria C- Erythropoietic protoporphyria D- Porphyria cutanea tarda (cutaneous hepatic porphyria) E- Variegate porphyria"

"Which one of the following viruses would be most likely to establish a latent infection? A. Adenovirus B. Measles virus C. Influenza virus D. Parvovirus E. Coxsackievirus group B"

"You are asked to review an 80-year-old woman who has suffered previous neurological damage. You note that she has a lower homonymous quadrantanopia affecting the temporal side of the left visual field and the nasal side of the right visual field. Where is the most likely site of her brain lesion? A- Optic chiasm B- Temporal lobe C- Left parietal lobe D- Right parietal lobe E- Optic nerve"

"You are consenting a 19-year-old man, who is thought to have a congenital neurological degenerative disorder, for collection of genetic material. He tells you he has heard about the human genome project. Which of the following statements is true concerning the project? A- 10,000 genes have been identified B- The project was completed in 2006 C- 95% of the gene containing part of the human DNA sequence was examined D- 3.7 million human single nucleotide polymorphisms (SNPs) were mapped E- 10,000 full length human cDNAs were identified"

"You are reviewing a man with familial hypertriglyceridaemia who has presented to the surgeons with pancreatitis. He asks about why he suffers from this condition. Which of the following best describes the metabolism of VLDL (predominant triglyceride) particles? A- They are synthesised postprandially in the small intestine B- They are formed from IDL particles C- They bind to the hepatic LDL receptor D- They are synthesised continuously in the liver E- They take up cholesterol from cells"

"You are reviewing a man with significant early arterial disease. The brachial artery response postocclusion is severely diminished and confirms a diagnosis of endothelial dysfunction.The successful production of which compound is best linked to vascular smooth muscle cell relaxation? A- Angiotensin II B- Nitrous oxide C- Endothelin I D- Nitric oxide E- Serotonin"

"You are working on your PhD project into the underlying basis for an inherited neurological condition. Part of your project involves identifying a protein expressed in an abnormal cell line. Which of the following is the appropriate method for identifying such a protein? A- Northern blot B- Southern blot C- Eastern blot D- Western blot E- RT-PCR"

"You review a 39-year-old sportsman who complains of knee pain. Arthroscopy reveals damage to the cartilage. Which of the following stems best describes a property of hyaline cartilage? A- It has a blood supply from small arterioles B- It is rich in type 1 collagen C- Chondrocytes secrete collagen only D- It is avascular E- Pressure from normal joint loading accelerates damage to cartilage"

"You review a young man with hypocalcaemia and notice on review of his hands that he has a shortened fourth and fifth digit on each hand. You wonder if he may have pseudohypoparathyroidism, caused by a G-protein abnormality. Which of the following best describes the location of G-proteins? A- In the nucleus B- In the nuclear membrane C- In the nucleolus D- In the cytoplasm E- In the cell membrane"

"A 35-year-old woman is referred by her GP because she has been feeling unwell and has pain, stiffness and tenderness in her joints which have gradually worsened over the last 6 months. She has a detectable rheumatoid factor. What is the most likely structure that these antibodies are targeted against? A- Double-stranded DNA B- Tumour necrosis factor-alpha C- Complement D- Interleukin E- Fc portion of immunoglobulins"

"A 40-year-old lady presents with numbness and tingling in little finger of her right hand, and a diagnosis of ulnar neuropathy is made. Which muscle of her hand is most likely to be affected? A- Extensor digiti minimi B- Lateral 2 lumbricals C- Flexor pollicis longus D- Flexor pollicis brevis E- Adductor pollicis"

"A 40-year-old man develops jerky movements affecting various parts of his body. His fatherdied at the age of 55 and had been diagnosed as having Huntington's disease. Which of the following genetic abnormalities is responsible for this condition? A- Frame-shift mutation B- Point mutation C- Splicing mutation D- Termination mutation E- Triplet-repeat mutation"

"A 42-year-old, atopic, health-care worker presents with red weals and itchy hands within 20 minutes of wearing latex gloves. Which of the following mechanisms is most likely to be relevant? A- Contact dermatitis B- Complement-mediated C- Immune complex-mediated D- Delayed-type hypersensitivity E- IgE-mediated sensitivity"

"Which of the following diseases is correctly matched to the immunodeficiency? A- Ataxia-telangiectasia - absent NBT (neutrophil nitroblue tetrazolium) reduction B- Bruton's disease - impaired phagocytosis C- Chronic granulomatous disease (CGD) - hypogammaglobulinaemia D- Chèdiak-Higashi - reduced IgA levels E- DiGeorge syndrome - absent T-cell function"

"A 45-year-old lady is referred to you with a diagnosis of renal cell carcinoma. She tells you that she had surgery for phaeochromocytoma at the age of 25 years. What is the most likely diagnosis? A- Familial paraganglioma B- Multiple endocrine neoplasia type 1 C- Multiple endocrine neoplasia type 2A (MEN2A) D- Neurofibromatosis type 1 (Nf1) E- Von Hippel-Lindau disease"

"A 45-year-old man has severe pulmonary emphysema. A diagnosis of α1-antitrypsin deficiency is being considered. What is the genotype most typically associated with this condition? A- PiMM B- PiMZ C- PiSS D- PiSZ E- PiZZ"

"A patient undergoes a radical parotidectomy for a malignant parotid tumour, at which time it is found necessary to perform a total division of the left facial (VII) nerve. Postoperatively, which is the most likely sequel? A- Preservation of left sided frown in all cases B- Numbness over the cheek on the left side C- Ptosis of the upper eyelid on the left side D- Loss of taste sensation over the anterior two-thirds of the tongue on the left side E- Tendency for food and fluids to collect in the buccal sulcus after meals"

"A patient undergoes respiratory function tests. Which of the following are normal readings for a 70-kg man? A- Peak expiratory flow of 376 l/min B- Total lung capacity of 3.5 litres C- Functional residual capacity of 3.5 litres D- Tidal volume of 250 ml E- Inspiratory reserve volume of 2 litres"

"A 28-year-old man presents with a septic cavernous sinus thrombosis, with high fever, orbital oedema and proptosis. The primary source of infection would most likely arise from which site? A- The chin B- The occipital region C- The skin over the parotid gland D- The pinna of the ear E- The upper lip"

"A 3-year-old child presents at the physician's office with symptoms of coryza, conjunctivitis, low-grade fever, and Koplik's spots. The causative agent of this disease belongs to which group of viruses? A. Adenovirus B. Herpesvirus C. Picornavirus D. Orthomyxovirus E. Paramyxovirus"

"A 34-year-old immigrant of African origin is prescribed ciprofloxacin for an infection. He suffers problems with acute haemolysis. You suspect G6PD deficiency. Given this, what is the likely underlying cause of haemolysis? A- Increased levels of NADPH B- Decreased levels of NADP C- A defect on chromosome 29 D- Reduced levels of ATP E- Reduced levels of NADPH"

"A regimen that includes appropriately administered gamma globulin may be contraindicated in which one of the following diseases? A. Hepatitis A B. Hepatitis B C. Rabies D. Poliomyelitis E. Infectious mononucleosis"

"A tissue-dwelling trematode that may be found in feces can also be detected in A. Vaginal secretions B. Duodenal contents C. blood D. Biopsied muscle E. Sputum"

"A young boy has his second episode of Neisseria meningitis. You suspect he may have complement deficiency.Which of the following deficient complement factors is particularly associated with Neisseria infection? A- C1 B- C2 C- C3 D- C4 E- C5"

"A 34-year-old woman with a body mass index of 44 kg/m2 seeks medical help for her obesity. Which one of the following treatments offers her the highest probability of achieving a long-term reduction in weight? A- An energy-deficient diet (600 kcal/day (~ 143 J/day) less than requirements) for 6 months B- Jaw-wiring and milk feeding for 3 months C- Treatment with orlistat for 12 months D- Treatment with sibutramine for 12 months E- Vertical banded gastroplication"

"A 35-year-old man is referred to you with altered bowel habit and weight loss. One of his sisters had a hysterectomy for uterine cancer aged 42, another sister had colorectal cancer aged 44 and his father died from colorectal cancer in his fifties. Colonoscopy shows a few polyps and a caecal mass. Which genetic condition might be running in the family? A- Familial adenomatous polyposis B- Peutz-Jeghers' disease C- Neurofibromatosis type 1 D- von Hippel-Lindau disease E- Hereditary non-polyposis colorectal cancer"

"A 15-year-old youth with haemophilia A has suffered recurrent bleeding episodes into his joints. As a consequence he has arthropathies in his knees, elbows and wrists. What is the most likely coagulation deficiency causing his bleeding tendency? A- Thromboxane B- Factor X C- Protein C D- Factor IX E- Factor VIII"

"A 16-year-old girl presents with primary amenorrhoea. On examination, her height is 145 cm and weight 45 kg. What is the most likely diagnosis? A- Crohn's disease B- Cystic fibrosis C- McCune-Albright syndrome D- Iron deficiency anaemia E- Turner's syndrome"

"A 16-year-old youth presents with lethargy and abdominal bloating. He has lost 5 kg in weight over the last 6 months. Examination confirms a thin teenager with obvious pallor. Which is the most appropriate serological test to investigate possible malabsorption? A- IgG antireticulin antibodies B- IgG antiendomysial antibodies C- IgA antigliadin antibodies D- IgA enterocyte antibodies E- IgA antiendomysial antibodies"

"A 17-year-old phenotypic female with no clinical evidence of dysmorphism is referred to the Endocrine Clinic for the investigation of primary amenorrhoea. On examination, breast development is normal, the external genitalia are normal female in appearance but pubic hair is sparse. Her karyotype is found to be 46XY. A defect in which of the following hormonal processes is most likely to be the abnormality causing this presentation? A- Conversion of testosterone to dihydrotestosterone B- FSH (follicle-stimulating hormone) secretion C- Prolactin secretion D- Testosterone secretion E- The androgen receptor"

"A 20-year-old woman presents with tremor and dysarthria, she is also noticed to be slightly jaundiced; clinically, Wilson's disease is considered to be the most likely diagnosis. Which of the following investigations will most reliably confirm this diagnosis? A- Identification of a mutation in the HFE gene B- Measurement of copper in a liver biopsy C- Serum ceruloplasmin concentration D- Serum copper concentration E- Urinary copper excretion after penicillamine challenge"

"A 20-year-old woman, who was prescribed the oral contraceptive pill a week earlier, develops central abdominal pain, vomiting and weakness in both lower limbs. blood tests show an elevated white cell count. What is the most probable diagnosis? A- Guillain-Barrè syndrome B- Polyarteritis nodosa C- Sarcoidosis D- Diabetic ketoacidosis E- Acute intermittent porphyria"

"A 23-year-old woman with a natural menstrual cycle is nearing ovulation. The oocyte of a mature follicle will be induced to undergo the first meiotic division as a result of which of the following hormonal stimuli? A. The cessation of progesterone secretion B. The gradual elevation of follicle-stimulating hormone (FSH) titers C. The low estrogen titers associated with the maturing follicle D. The slow elevation of progesterone produced by luteal cells E. The surge of luteinizing hormone (LH) initiated by high estrogen titers"

"A 24-year old man was a passenger in an automobile broadsided by another vehicle. Although he was wearing a seat belt he felt "terrible," and had left sided abdominal, flank, and shoulder pain. During the ambulance ride into the emergency room his blood pressure kept dropping, he appeared pale, had a rapid heartbeat, with otherwise normal lung and heart sounds. Intravenous saline was started en route. Which of the following abdominal organs is most likely damaged? A. Stomach B. Duodenum C. Pancreas D. left kidney E. Spleen"

"A 24-year-old man, a new immigrant to the UK from Eastern Europe, who had worked in his own country as a demolition contractor, undergoes a medical examination and is found to have glycosuria. His blood lead concentration is high. Which of the following findings would suggest that he has a generalised disorder of proximal tubular function? A- Albuminuria B- Hyperkalaemia C- Increased serum urea concentration D- Inability to acidify the urine E- Metabolic acidosis"

"A 26-year-old teacher of Ashkenazi Jewish descent presents with long-standing bone pain. On examination there is marked hepatosplenomegaly. Which genetic disorder should be included in the list of differential diagnoses? A- Tay-Sachs disease B- Canavan's disease C- Niemann-Pick's disease type A D- Galactosaemia E- Gaucher's disease"

"A 47-year-old man with a long history of alcohol abuse is admitted to hospital with acute abdominal pain and is diagnosed clinically as having acute pancreatitis. This is confirmed by finding a high serum amylase activity and by the results of an ultrasound scan. He has not had a similar illness before. His serum is seen to be lipaemic: serum triglyceride concentration is 26 mmol/l. Which of the following is the most likely cause of the hypertriglyceridaemia? A- Decreased pancreatic lipase secretion B- Deficiency of apolipoprotein C-II C- Deficiency of LDL (low-density lipoprotein) receptors D- Deficiency of lipoprotein lipase E- Increased synthesis of VLDL (very low-density lipoprotein)"

"A 48-year-old woman with known renal disease presents to A&E, and admission biochemistry profile shows a serum potassium concentration of 5.9 mmol/l. Her ECG is abnormal. Which ECG abnormality is most likely to have occurred earliest as her hyperkalaemia developed? A- Prolonged PR interval B- Prominent U wave C- Reduced P wave D- Sine-wave pattern E- Tall, tented T wave"

"A 4yearold girl presents with sore throat, fever, hoarseness, and drooling. select the correct etiologic agent that match the descriptions above A. Clostridium botulinum B. Clostridium tetani C. Poliovirus D. Corynebacterium diphtheriae E. Haemophilus influenza B"

"A 52-year-old hypertensive man presents with a right hemisphere stroke. Neuroimaging demonstrates the presence of a recent infarction of the right internal capsule. Which anatomical features of this region should be borne in mind? A- The anterior limb of the internal capsule lies between the tail of the caudate nucleus and the lentiform nucleus B- Medial to the posterior limb lies the septum lucidum C- The lentiform nucleus itself comprises an outer globus pallidus and an inner putamen D- The junction of the anterior and posterior limbs of the internal capsule is termed 'the crus' E- The internal capsule receives its arterial supply from the lenticulostriate vessels derived from the roots of the middle and anterior cerebral arteries"

"A 54-year-old woman has undergone some blood tests as part of an employment health screen. She reports she is in good health and, being very health conscious, takes regular vitamin and mineral supplements. She is taking bendrofluazide 2.5 mg for hypertension and her blood pressure is 132/82 mmHg. The only abnormality is a serum calcium concentration of 2.94 mmol/l. Which of the following is the most likely cause? A- Diuretic treatment B- High dietary calcium intake C- High dietary vitamin D intake D- Occult malignancy E- Primary hyperparathyroidism"

"A 55-year-old woman arrives at the emergency room the day after St. Patrick's Day coughing up bright red blood. She has frequented your emergency room before. History includes excessive alcohol consumption. Using abdominal percussion you determine that her liver extends 5 cm below the right costal margin at the midclavicular line. You call in a gastroenterologist because you suspect that the bright red blood is most likely the result of which of the following? A. Hemorrhoids B. Colon cancer C. Duodenal ulcer D. Gastric ulcer E. Esophageal varices"

"A 55-year-old woman is diagnosed with type 2 diabetes mellitus. Her weight is 76 kg, body mass index 34 kg/m2. After 3 months' trial of dietary modification, she has lost 2 kg in weight, but her Hb A1c, which was 10.2% at diagnosis, is 9.6%. The most appropriate treatment would now be which of the following? A- Acarbose B- A sulphonylurea C- A thiazolidinedione D- Insulin E- Metformin"

"A 62-year-old woman with type-2 diabetes being treated with a thiazide, β-blocker and ACE inhibitor for hypertension is found to have a serum potassium concentration of 3.1 mmol/l. Her blood pressure is 156/94 mmHg; serum creatinine concentration is 115 mmol/l. What is the most likely cause of the hypokalaemia? A- Low dietary potassium intake B- Primary aldosteronism C- Renal tubular acidosis type 4 D- The ACE inhibitor E- The thiazide diuretic"

"A 68-year-old man is admitted to hospital for elective femoral angioplasty. On examination, he is found to have widespread lymphadenopathy. blood is taken for 'group and save'. His cells are not agglutinated by either anti-A or anti-B; his serum does notcause agglutination of cells of blood group A or B. Based on these data, which of the following is most likely to be his genotype? A- AB B- AO C- BB D- BO E- OO"

"A 71-year-old-man is given a health check by his doctor. He has no complaints, apart from pain in his hip, which he attributes to arthritis. He has blood taken for a panel of routine biochemical and haematological tests. The only abnormality is a serum alkaline phosphatase activity of 822 U/l. Which of the following is the most likely cause of this abnormality in his case? A- Metastatic carcinoma B- Osteoarthritis C- Osteomalacia D- Osteoporosis E- Paget's disease"

"A 75-year-old woman is being followed by her GP for suspected developing primary hypothyroidism. Which of the following biochemical changes would you most expect to occur first? A- Fall in serum free thyroxine B- Fall in serum thyroxine-binding globulin C- Fall in serum free triiodothyronine D- Fall in serum total triiodothyronine E- Increase in serum TSH"

"A couple aged in their early 30s come to the genetics clinic. They have one 6-year-old son who has gross obesity and mild mental impairment, diagnosed as Prader Willi syndrome and they are concerned about the possibility of further children being affected. Which of the following most accurately describes the mode of inheritance of Prader Willi? A- Autosomal recessive B- Autosomal dominant C- X-linked recessive D- X-linked dominant E- Non-mendelian"

"A patient has been diagnosed with a fast-growing pituitary adenoma. Magnetic resonance image (MRI) scanning reveals suprasellar extension. Which structure is most likely affected? A- Abducens nerve B- Hypothalamus C- Oculomotor nerve D- Third ventricle E- Optic chiasm"

"A patient presents with distal weakness and muscle wasting. Myotonic dystrophy is confirmed by which investigation? A- Nerve conduction studies B- CT scan C- ECG D- Muscle biopsy E- Genetic testing"

"A young man is admitted to A&E having taken an overdose of an unknown drug. On examination, he is hyperventilating and has a tachycardia. Results of arterial blood gas analysis (breathing room air) are: [H+] 30 nmol/l (pH 7.56); p(CO2) 3.5 kPa; p(O2) 14.2 kPa; [HCO3-] 21 mmol/l. Which of the following drugs is he most likely to have taken? A- A benzodiazepine B- A tricyclic antidepressant C- Cocaine D- Paracetamol (acetaminophen) E- Theophylline"

"A young man sustains a skull-base fracture at the middle cranial fossa which injures his right abducent (VI) nerve. Which signs are most likely to be present on clinical examination? A- There is ptosis on the right side B- The pupil on the right side is constricted and fails to respond to light C- The right eyelid is numb D- The patient is unable to deviate his right eye medially E- The patient is unable to deviate his right eye laterally"

"An 18-year-old army recruit undergoes preliminary health screening and is found to have a haemoglobin of 11.5 mg/dl (13-17). Spherocytes are present in the peripheral blood film. Investigation of his siblings reveals that one of his two brothers also has spherocytic anaemia. A defect in which of the following is most frequently responsible for this condition? A- Actin B- Ankyrin C- Glucose-6-phosphate dehydrogenase D- Protein 4.1 E- Spectrin"

"An 18yearold sexually active college student presents with complaints of lower abdominal pain and irregular bleeding for five days. She has no fever. She uses oral contraceptives as method of birth control. Upon examination, the cervix is friable; there is cervical motion tenderness and adnexal tenderness. The pregnancy test is negative. Which is the most likely etiologic agent responsible for these findings? A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. Herpes simplex virus type 2 E. Mycoplasma hominis"

"An 81-year-old, nursing-home resident is admitted to hospital in an unconscious state. His blood sugar is measured as 1.5 mmol/l (normal 3-6 mmol/l). You administer glucagon. Which of the following best describes one of the main actions of glucagon? A- Decreased ketone body production from fatty acids B- Increased lipogenesis in adipose tissue C- Decreased glycogenolysis D- Decreased gluconeogenesis E- Increased glycogenolysis and gluconeogenesis"

"An 84-year-old man had his left sciatic nerve completely transected just inferior to the buttock crease by a piece of shrapnel during the D-day landings in 1944. Which sign is likely to be present on current neurological examination? A- Complete anaesthesia below the knee B- Spastic paralysis of the lower limb, with increased ankle jerk C- Plantar flexed and everted foot D- Paralysed quadriceps femoris E- Unimpaired hip abduction"

"An anaesthetist performs a successful block of the median nerve at the elbow. Which neurological sign is likely to be present on examination? A- Inability to flex the fingers B- An obvious wrist drop deformity C- The palm of the hand is totally anaesthetised D- Inability to abduct and adduct the fingers E- Inability to abduct the thumb"

"An immunocompromised person with history of seizures had an MRI that revealed a temporal lobe lesion. Brain biopsy results showed multinucleated giant cells with intranuclear inclusions. The most probable cause of the lesion is A. Hepatitis C virus B. Herpes simplex virus C. Listeria monocytogenes D. Coxsackievirus E. Parvovirus"

"An otherwise well, 62-year-old woman with hypertension is referred to an outpatient clinic for assessment. Despite treatment with a thiazide diuretic, a beta-adrenergic antagonist (beta-blocker) and an angiotensin-converting enzyme (ACE) inhibitor, her blood pressure is 158/92 mmHg. Investigations show serum sodium concentration is 138 mmol/l, serum potassium concentration 3.2 mmol/l, serum creatinine concentration 108 mmol/l. What is the most likely cause of the hypokalaemia? A- A low dietary potassium intake B- Excessive secretion of aldosterone C- The ACE inhibitor D- The beta-adrenergic antagonist E- The thiazide diuretic"

"Angelman's and Prader-Willi syndromes both involve defects in the same chromosome region. What is the best molecular explanation for differences in the phenotypes in these two conditions? A- It is sex-linked with the Prader-Willi syndrome, occurring mainly in boys B- It is due to anticipation, with successive generations becoming more severely affected C- It is related to the degree of X chromosome inactivation D- It is due to modifying genes on other chromosomes E- It is due to the differential expression of genes depending on parental origin"

"Approximately 9 people die each year in a country for every 1000 estimated to be alive. Choose statement below that match rate above. A. secondary attack rate B. Case fatality rate C. Morbidity rate D. Age adjusted mortality E. Crude mortality"

"Botulinum toxin has which of the following features? A- It is produced by a Gram-positive, aerobic bacillus B- The bacillus has 15 serotypes C- Its main activity is at the presynaptic membrane D- It may be used in the treatment of myasthenia gravis E- It may be used in the treatment of blepharospasm"

"Cholera is a toxicogenic dysenteric disease common in many parts of the world. In the treatment of patients who have cholera, the use of a drug that inhibits adenylcyclase would be expected to A. Kill the patient immediately B. Eradicate the organism C. Increase fluid secretion D. reduce intestinal motility E. Block the action of cholera toxin"

"Choose the type of measurement scale for Birth Weight. A. Dichotomous scale B. Nominal scale C. Ordinal scale D. Interval scale E. Ratio scale"

"Concerning the respiratory cell biology of an asthmatic individual, which of the following is true? A- Monocytes are granular and static B- Eosinophils are agranular and mobile C- Basophils are granular and their mode of action is phagocytosis D- B cells are mobile and their mode of action is phagocytosis E- T cells are mobile and contribution to asthma is via cytokine production"

"Dermatitis, diarrhea, and delirium. select the dietary deficiency that match each set of symptoms and signs. A. Vitamin A deficiency B. Thiamine deficiency C. Vitamin C deficiency D. Vitamin D deficiency E. Niacin deficiency"

"Only IgE-mediated allergic reactions can be formally tested by skinprick testing. Adverse reactions to which of the following substances can be tested in this manner? A- Morphine B- Radiocontrast media C- Scombrotoxins D- Colloid plasma expanders E- Latex"

"During a visit to her gynecologist, a patient reports she received vitamin A treatment for her acne unknowingly during the first 2 months of an undetected pregnancy. Which of the following organ systems in the developing fetus is most likely to be affected? A. The digestive system B. The endocrine organs C. The respiratory system D. The urinary and reproductive systems E. The skeletal and central nervous systems"

"During the physical exam of a 52-year-old man you note internal hemorrhoids. He complains of blood in his stool. Which of the following arteries could be the source of his rectal bleeding? A. Superior rectal artery off the inferior mesenteric artery B. Middle rectal artery off the internal iliac artery C. Inferior rectal artery off the internal pudendal artery D. Both B and C E. A, B, and C"

"Eighty percent of susceptible household contacts of a child with chicken pox develop this disease. Choose statement below that match rate above. A. secondary attack rate B. Case fatality rate C. Morbidity rate D. Age adjusted mortality E. Crude mortality"

"Environmental tobacco smoke (ETS) is a major public health issue, particularly for children. Which of the following conditions is most affected by ETS? A. Low birth weight B. Middle ear infection C. Bronchitis or pneumonia D. Asthma E. Lung cancer"

"Finding HBsAg positive and HBeAg positive reflects A. Acute infection (incubation period) B. Acute infection (acute phase) C. Post infection (acute phase) D. Immunization E. HBV carrier state"

"Glucokinase exists in brain, pancreas and liver, and responds differently in different locations. In the brain, response is governed merely by different glucose levels, while in liver glucokinase activity increases after meals. Downregulation of glucokinase activity in the liver is an example of which of the following? A- Affinity B- Specificity C- Co-activation D- Stereoisomerism E- Co-repression"

"Households are selected at random, and every person in each household is included in the sample. select the correct term that match above description of a sampling procedure. A. Systematic sampling B. Paired sampling C. Simple random sampling D. Stratified sampling E. Cluster sampling"

"Hypercalcaemia in malignant disease secondary to the secretion of parathyroid hormone-related peptide by the tumour ismost frequently associated with which one of the following? A- Carcinoid tumours B- Lymphoma C- Multiple myeloma D- Small-cell carcinoma of the bronchus E- Squamous-cell carcinoma of the bronchus"

"Immunoglobulin structure - which of the following regions forms the antigen binding site? A- The heavy chain B- The light chain C- The constant region of one heavy and one light chain D- The hinge region E- The variable region of one heavy and one light chain"

"Immunological investigations in a patient with renal disease are important in the diagnostic work-up, which of the following statements is correct? A- Henoch-Schönlein purpura is associated with IgG in the mesangium B- SLE is typically associated with sparse deposits of IgG and complement in the glomeruli C- C3 nephritic factor is associated with mesangiocapillary glomerulonephritis type I D- Minimal-change glomerulonephritis is associated with hypocomplementaemia E- Antiglomerular basement-membrane antibodies are associated with Goodpasture's disease"

"In a patient with diabetes mellitus of 30 years' duration, complications related to kidney function may include which of the following? A. Enhanced selectivity of the filtration barrier B. Decreased permeability to plasma proteins C. Increased glomerular filtration rate D. Decreased secretion of aldosterone E. Glycation of proteins in the basal lamina"

"In a patient with nickel-associated contact dermatitis which of the following statements is true? A- Mediated by mast cells B- Mediated by IgE C- Skinprick testing is the best way to establish the sensitising antigen D- Systemic cytokine release induces skin inflammation E- Elimination of the responsible agent is the most important goal"

"In nine families surveyed, the numbers of children per family were 4, 6, 2, 2, 4, 3, 2, 1, and 7. The mean, median, and mode numbers of children per family are, respectively, A. 3. 4, 2, 3 B. 3, 3. 4, 2 C. 3, 3, 2 D. 2, 3. 5, 3 E. 3. 4, 3, 2"

"In patients with severe oral and genital ulceration, therapy with agents having clinically significant anti-TNF- a activity can bebeneficial, which of the following is used for this indication? A- Cyclophosphamide B- Dapsone C- Methotrexate D- Pentoxifylline E- Thalidomide"

"In the study of the cause of a disease, the essential difference between an experimental study and an observational study is that in the experimental investigation A. The study is prospective B. The study is retrospective C. The study and control groups are of equal size D. The study and control groups are selected on the basis of history of exposure to the suspected causal factor E. The investigators determine who is and who is not exposed to the suspected causal factor"

"Influenza can be treated; therefore, specific detection of the virus becomes much more important. Which of the following would be best for detection of influenza? A. Detection of specific antigen in urine B. Cold agglutinin test C. Electron microscopy of sputum D. Detection of antigen in respiratory secretions E. Culture of respiratory secretions on monkey kidney cells"

"M. tuberculosis can be found in the sputum of patients with tuberculosis. After digestion of the sputum, isolation is best accomplished using A. Sheep blood agar B. Löffler's medium C. Thayer-Martin agar D. Thiosulfate citrate bile salts sucrose medium E. Löwenstein-Jensen medium"

"Monozygotic twins arise by means of which of the following? A. Fusion of the embryonic blastomeres from two zygotes B. Fertilization of two oocytes by two sperm C. Fertilization of one oocyte by two sperm D. Division of the inner cell mass (embryoblast) into two embryonic primordia E. Extra cleavage divisions of the zygote induced by the presence of a double chorion"

"Mumps virus accounts for 10 to 15% of all cases of aseptic meningitis in the United States. Infection with mumps virus A. Is apt to recur periodically in many affected persons B. Will usually cause mumps orchitis in postpubertal males C. Is maintained in a large canine reservoir D. Usually produces severe systemic manifestations E. Is preventable by immunization"

"Patients with Cushing's syndrome often show osteoporotic changes. Which of the following is involved in the etiology of osteoporosis induced by Cushing's syndrome? A. Decreased glucocorticoid levels that result in decreased quality of the bone deposited B. Excess deposition of osteoid C. Stimulation of intestinal calcium absorption D. Decreased PTH levels E. Bone fragility resulting from excess bone resorption"

"Perilymph is located in which of the following structures? A. Utricle B. Saccule C. semicircular canals D. Scala media E. Scala tympani"

"Periodic fever can be associated with high levels of: A- IgM B- IgG C- IgA D- IgE E- IgD"

"Sickle-cell anaemia is characterised by which of the following? A- Occurrence due to the substitution of alanine for valine on position 6 of the globin gene B- Presence of 70-90% HbS, 5-10% HbA and 2-20% HbF on electrophoresis C- Resistance to falciparum malaria D- Absent reticulocytosis E- Vaso-occlusive crises"

"Some 24 hours after sustaining severe skeletal and soft tissue trauma in a road traffic accident, a 19-year-old man becomes oliguric. Which of the following would be LEAST likely to present if acute tubular necrosis were the likely diagnosis? A- Glycosuria B- Hyperkalaemia C- Hyperuricaemia D- Urinary osmolality less than 250 mmol/kg E- Urinary sodium concentration less than 10 mmol/l"

"The association between low birth weight and maternal smoking during pregnancy can be studied by obtaining smoking histories from women at the time of the first prenatal visit and then subsequently assessing and assigning birth weight at delivery according to smoking histories. What type of study is this? A. Clinical trial B. Crosssectional C. Prospective cohort D. Casecontrol E. retrospective cohort"

"The ectoderm is derived directly from which of the following? A. Hypoblast B. Epiblastic cells that undergo gastrulation C. Mesoderm D. Endoderm E. Nongastrulated epiblast"

"The medical evaluation of a 25yearold intravenous drug user reveals elevated liver enzymes and a positive antiHBsAg. The most likely cause of the abnormal liver profile is hepatitis A. A B. B C. C D. D E. E"

"The polymerase chain reaction (PCR) is becoming widely used in both research and clinical medicine. Which of the following statements is correct? A- The Taq polymerase used is of viral origin B- After approximately 30 cycles, a million cDNA copies can theoretically be made from a single target copy C- Cycling of the reaction-mixture temperature enables sequential extension, annealing and denaturation D- Specific sense and antisense primers that bind to part of the downstream target sequence are used as the starting point of the polymerase E- Reverse transcriptase-PCR (RT-PCR) is able to identify the transcripts of a given gene by detecting the messenger (m) RNA coding for the gene"

"The presence of Negri inclusion bodies in host cells is characteristic of A. Mumps B. Infectious mononucleosis C. Congenital rubella D. Aseptic meningitis E. Rabies"

"This hepatitis virus is a calicivirus. The reservoir is in pigs, and humans acquire it via the fecal-oral route. A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis"

"This is a double-stranded DNA virus. It is responsible for 15% of pediatric respiratory infections and 10 to 15% of acute diarrhea in children. A. Measles virus B. Influenza virus C. respiratory syncytial virus D. Parainfluenza virus E. Adenovirus"

"This virus may be detected by the polymerase chain reaction (PCR) in a variety of cells of patients with nasopharyngeal carcinoma. A. Measles B. Mumps C. Rubella D. Parvovirus E. Epstein-Barr virus"

"Trypanosoma cruzi initially penetrates through the mucous mem branes on the skin and then multiplies in a lesion known as a chagoma. In the chronic stage of the disease, the main lesions are often observed in the A. Spleen and pancreas B. Heart and digestive tract C. Liver and spleen D. Digestive tract and respiratory tract E. Heart and liver"

"What is the medical treatment of choice for the majority of patients with carcinoid syndrome? A- Conventional chemotherapy B- Cyproheptadine C- Interferon-a D- Methysergide E- Octreotide"

"When taking a history from a 61-year-old woman with disseminated sclerosis, you ascertain that she is intermittently incontinent for liquid stools. Which of the following pertains to the clinical physiology of faecal continence? A- Voluntary faecal continence is controlled by the internal anal sphincter B- Involuntary faecal continence is controlled by the external anal sphincter C- Anal ultrasound is widely used to assess sphincter function D- The commonest cause of sphincter weakness is pudendal neuropathy E- Incontinence may be associated with rectal prolapse"

"When taking a history from a patient with suspected vasculitis, clinical determination of the size of vessel involved is important in the identification of the underlying vasculitic condition. Which of the following statements is true? A- Takayasu's arteritis mainly affects small blood vessels B- Churg-Strauss syndrome mainly affects large blood vessels C- Wegener's granulomatosis mainly affects large blood vessels D- Classical polyarteritis nodosa only affects small arteries E- Behçet's disease is a postcapillary venulitis"

"Where is the antibody targeted in Lambert-Eaton syndrome? A- Anticholinesterase B- Mitochondria C- Sodium channels D- Potassium channels E- Voltage-gated calcium channels"

"Where is the immune defect in chronic lymphocytic leukaemia situated? A- Complement B- Immunoglobulin G (IgG) C- Macrophages D- Mast cells E- B cells"

"Which of the following acts as a cofactor in duodenal ulcer? A. Cigarette smoking B. Alcohol use C. NSAID use D. blood group O E. Helicobacter pylori"

"Which of the following adverse food reactions is mediated by IgE-dependent mechanisms and hence can be ascertained by skinprick testing? A- Monosodium glutamate in Chinese food B- Scombroid fish poisoning C- Sulphites on prepacked salads D- Salicylate-induced urticaria E- Kiwi fruit"

"Which of the following best describes the presently available vaccine for hepatitis B? A. Synthetic peptide vaccine B. Killed virus vaccine C. Inactivated virus vaccine D. Live virus vaccine E. recombinant viral vaccine"

"Which of the following patterns of serum lipids is most characteristic of diabetes mellitus? A- Elevated LDL-cholesterol, elevated HDL-cholesterol, elevated triglycerides B- Elevated LDL-cholesterol, elevated HDL-cholesterol, normal triglycerides C- Elevated LDL-cholesterol, low HDL-cholesterol, normal triglycerides D- Normal LDL-cholesterol, elevated HDL-cholesterol, elevated triglycerides E- Normal LDL-cholesterol, low HDL-cholesterol, elevated triglycerides"

"Which of the following public health interventions has been the most successful in preventing initiation of smoking or reducing the prevalence of smoking? A. Media campaigns against smoking B. Prohibiting the sale of tobacco to minors C. restrictions on indoor smoking D. Lawsuits against the tobacco industry E. Increases in cigarette prices through taxes"

"Which of the following statements applies to the physiology of the normal menstrual cycle? A- The luteal stage lasts from day 1 to day 14 of the menstrual cycle B- The follicular stage lasts from day 18 to day 28 of the menstrual cycle C- Rising levels of progesterone occur during the follicular stage D- There is a large fall in GnRH just before ovulation E- There is a large rise in GnRH just before ovulation"

"Which of the following statements best characterises low-density lipoproteins (LDL)? A- 50% of their fat content is triglyceride B- Their concentration is highly correlated with dietary cholesterol content C- They are involved in reverse cholesterol transport D- They are synthesised de novo in the liver E- They contain apolipoprotein B-100"

"Which of the following statements in relation to skin disease is true? A- Eye involvement is unusual in benign mucous membrane pemphigoid B- The rash of herpes gestationis most commonly affects the chest C- Pemphigus is associated with subepidermal bullae D- Epidermolysis bullosa acquisita is strongly associated with HLA-DR4 E- Nasal swabs should be routinely checked in patients with recurrent staphylococcal abscesses"

"Which of the following statements is true about the matrix metalloproteinases, which play a major role in pathological processes, including rheumatoid arthritis, periodontitis, vascular disease as well as tumour invasion and metastasis? A- All are controlled by specific tissue stimulators of the metalloproteinases B- All contain an iron atom C- Each is involved in the synthesis of at least one component of the extracellular matrix, basement membrane proteins and bioactive mediators D- All are secreted as a proenzyme, which in each case is activated by cleavage of defined glycoprotein sequences E- All share sequence homologies"

"Which one of the following organisms is associated with nongonococcal urethritis in humans? A. M. hominis B. M. orale C. M. pneumoniae D. M. fermentans E. U. urealyticum"

"Which patient is most likely to become a chronic carrier following an acute episode of hepatitis B? A. A newborn B. A 20yearold female following vaginal sexual transmission C. A 50yearold male following rectal sexual transmission with a partner positive for HBeAg D. A 30yearold health care worker following a percutaneous injury E. A 40yearold HIVinfected male with a CD4 cell count of 200"

"Why can trinucleotide repeat disorders become worse in successive generations? A- Modifying genes exacerbate the phenotype B- The phenotype is worse if the expansion is inherited by a male C- There is ascertainment bias with younger family members diagnosed earlier D- There is variable gene penetrance from generation to generation E- The repeat can expand from one generation to the next"

"Y. enterocolitica, formerly a Pasteurella, is best described by which of the following statements? A. Commonly inhabits the canine respiratory tract and is an occasional pathogen for humans; strongly urease-positive B. Pits agar, grows both in carbon dioxide and under anaerobic conditions, and is part of the normal oral cavity flora C. Typically infects cattle, requires 5 to 10% carbon dioxide for growth, and is inhibited by the dye thionine D. Typically is found in infected animal bites in humans and can cause hemor rhagic septicemia in animals E. Manifests different biochemical and physiologic characteristics, depending on growth temperature, and causes a spectrum of human disease, most commonly mesenteric lymphadenitis"

"You are asked to review a 15-year-old boy with abnormal weight gain and learning difficulties. As part of your assessment you arrange for an assessment of peptide hormones to assess if a deficiency may be involved in the pathogenesis of his condition. Elevated levels of which of the following may be involved in the pathogenesis of his condition? A- Leptin B- Somatostatin C- CCK D- Secretin E- Gherelin"

"You are asked to see a 19-year-old man who has had recurrent pneumothoraces. He is tall with pes planus and has an increased arm span to height ratio and upper segment to lower segment body ratios. Which other feature would be most helpful in making a diagnosis of Marfan's syndrome? A- Joint hypermobility B- High arched palate C- Mid-systolic click D- Arachnodactyly E- Early diastolic murmur"

"You are preparing a report to present to the MoH on the declining rates of gonorrhea in your province in both men and women over the last 10 years. Which type of graph would best illustrate the data? A. Bar chart B. Histogram C. Pie chart D. Frequency polygon E. Line graph"

"You are reviewing a 52-year-old man who has suffered a myocardial infarction. You suspect occlusion of the posterior descending coronary artery. In this case, which region of myocardium would you expect to be most affected? A- The right atrium B- The right ventricle C- The anterior septum D- The anterior left ventricular wall E- The posterior portion interventricular septum and the posterior left ventricular wall"

"You are teaching molecular biology to a group of medical students, and one asks you about how reverse transcriptase works. How does reverse transcriptase work? A- It amplifies segments of DNA B- It cleaves specific portions of DNA C- It is involved in protein synthesis D- It transcribes RNA from DNA E- It transcribes DNA from RNA"

"select an appropriate measure of frequency that describes the number of deaths between the ages of 28 days and 11 months per 1000 live births in 1 year. A. Fetal mortality B. Infant mortality C. Perinatal mortality D. Neonatal mortality E. Post neonatal mortality"

"Which of the following hematopoietic tissues or organs develops from endoderm? A. Thymus B. Tonsils C. Bone marrow D. Spleen E. blood islands"

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