Y2S2 2011

Play an AI-generated podcast conversation about this lesson

Alice Smith, a 20-year-old secretary, presented to her GP with intermittent left-sided pricking chest pain of 1 day. This was associated with difficulty in breathing and dizziness. An ECG was done for her. What does it show?

Normal ECG (correct)

Right Bundle Branch Block

Right axis deviation

Sinus bradycardia

Hassan Abdullah, a 60-year-old man who complains of chest pain following a road traffic accident. He is also diabetic and hypertensive. An ECG was done for him. What does it show?

Acute anterior myocardial infarction

Acute inferior myocardial infarction (correct)

Acute lateral myocardial infarction

Atrial fibrillation

A 55-year-old woman with Type 2 Diabetes has been on insulin for the last 2 months using a mixed insulin in a disposable pen. She is now about to leave for Hong Kong on her first overseas trip since commencing the insulin and asks you about the care of her insulin whilst traveling.

Keep the current insulin pen in her handbag and place other supplies in her stowed luggage in a cooled thermal bag (not frozen) (correct)

Store the insulin however she likes as it is stable in hot or cold temperatures

Have her insulin before she goes and make sure she buys some more at the airport chemist so she knows it has been properly stored

Take syringes and ampoules rather than the disposable pens as the latter may not be legal in Hong Kong

All of the following effects of antipsychotic drugs are related to actions on dopamine receptors EXCEPT:

Dry mouth Signup and view all the answers

The human menstrual cycle is characterized by a proliferative phase followed by a secretory phase. The secretory phase of the human menstrual cycle is dependent upon:

Ovarian oestradiol secretion during the follicular phase of the ovarian cycle followed by ovarian oestradiol and progesterone from the luteal phase of the ovarian cycle Signup and view all the answers

During a vaginal examination, a doctor must be aware of the relations of the vagina. Which of the following relations or descriptions is INCORRECT?

The ovaries lie laterally to the lateral fornices Signup and view all the answers

A patient with acute right iliac fossa pain was found to have a calculus lodged where the lumen of her right ureter is at its narrowest diameter. Which of the following is the most likely site of the calculus?

At the right vesico-ureteric orifice Signup and view all the answers

The activated partial thromboplastin time (APTT) is prolonged in the following conditions or with the following medications:

Factor VIII deficiency Signup and view all the answers

Which of the following statements about human pregnancy and parturition is most accurate?

The signal for normal birth at term arises within the gravid uterus Signup and view all the answers

The metabolic response to starvation includes all of the following EXCEPT:

Absent urinary ketones Signup and view all the answers

A post-pubertal female-to-male transsexual is given testosterone to assist his change in body appearance. He comes to you because he recently had a fracture of a thoracic vertebra due to osteoporosis. Which of his problems is likely to be a result of the androgen administration?

His blood haemoglobin concentration Signup and view all the answers

With regard to the spleen, which one of the following is correct?

It is formed in the dorsal mesogastrium Signup and view all the answers

Which of the following hormones would fail to increase in response to acute hemorrhage?

Atrial natriuretic peptide Signup and view all the answers

Which of the following sexually transmissible infections does NOT match the etiological organism?

Chancre: Neisseria gonorrhoeae Signup and view all the answers

A 40-year-old man with terminal prostatic carcinoma is revealed to have numerous metastases in his lumbar spine. This is because the prostatic venous plexus communicates with the internal vertebral venous plexus MOST LIKELY via the:

Basivertebral veins Signup and view all the answers

A 26-year-old patient with Type 1 Diabetes calls her GP at 7:30 am indicating she vomited last night and is still nauseous. Her blood glucose was 12 mmol/L and urine ketones show a trace. What is the most appropriate action?

Reduce morning insulin to 6 units to provide basal requirement Signup and view all the answers

In a patient with Delayed Sleep Phase Syndrome, which of the following treatment protocols would be recommended based on circadian principles?

Melatonin administration an hour before desired bedtime and bright light therapy at desired wake time (morning) Signup and view all the answers

The currently accepted health benefits of hormone therapy after menopause include reduction in:

Urogenital and vasomotor symptoms of menopause Signup and view all the answers

The International Normalized Ratio (INR) is prolonged in each of these conditions EXCEPT:

Unfractionated heparin therapy Signup and view all the answers

A 70-year-old male has a carcinoma in the sigmoid colon. By which of the following routes are tumor cells most likely to be carried in blood draining from it?

To liver via portal venous system Signup and view all the answers

A 20-year-old motorcyclist was involved in a road traffic accident and sustained traumatic pancreatitis. He developed a collection of pancreatic secretion known as a pseudocyst. Where is this pseudocyst MOST LIKELY located?

Omental bursa Signup and view all the answers

Ms. Alana Bridge, a 22-year-old environmental scientist, has been on the combined oral contraceptive pill (COCP) for three years but often forgets to take it. She and her partner are planning to have children in about 3-4 years. What is the best contraceptive option for her?

Mirena (hormonal IUD) Signup and view all the answers

Mrs. Antonia Jane, a 37-year-old married magazine editor, has smoked since her late teens and has heavy, regular periods. She has three children and does not plan to have any more but hasn’t completely ruled it out. What is the best contraceptive option for her?

Mirena (hormonal IUD) Signup and view all the answers

A 30-year-old lady presented with signs and symptoms of small intestinal obstruction. The radiological feature seen in an erect abdominal radiograph that would BEST support the diagnosis would be:

Multiple air-fluid levels Signup and view all the answers

Exercise training increases insulin sensitivity by all of the following mechanisms EXCEPT:

Increased intramyocellular lipid Signup and view all the answers

Which of the following is used as a general anesthetic by intravenous route?

Ketamine Signup and view all the answers

A man has a selective increase in inhibin production and secretion. What abnormalities of hypothalamic and pituitary hormone secretion would you expect to see?

Unchanged LH, decreased FSH, and unchanged GnRH secretion Signup and view all the answers

The effect of aging on human body composition includes all of the following EXCEPT:

Decreased extracellular water Signup and view all the answers

A patient has a twelve-month history of weight gain, hypertension, abdominal striae, proximal muscle weakness, and diabetes. A presumptive diagnosis of Cushing’s Syndrome is made. Which of the following observations would be most consistent with an adrenal adenoma?

High cortisol concentrations, low ACTH concentrations with an enlarged left adrenal on abdominal CT scan Signup and view all the answers

The mechanism of action of bisphosphonates (e.g., alendronate) in the treatment of osteoporosis relates to their ability to:

Inhibit osteoclast activity Signup and view all the answers

A 25-year-old woman presents with medial thigh pain almost on a monthly basis. This is MOST LIKELY explained by the ovary’s direct relationship to the:

Obturator nerve Signup and view all the answers

Which of the following is most likely to be located one-third of the way along a line between the right anterior superior iliac spine and the umbilicus?

Tip of appendix Signup and view all the answers

The most important ethical problem in performing a focus group on people’s experience of depression is that:

There is a risk of causing emotional distress during the focus group Signup and view all the answers

The human ovarian cycle has the mid-cycle surge of luteinizing hormone (LH) as a prominent feature that results in ovulation. The major endocrine signal leading to the mid-cycle LH surge is:

Positive feedback from ovarian oestradiol secretion on the release of LH from the anterior part of the pituitary gland Signup and view all the answers

Tricyclic antidepressants are known to produce all of the following adverse effects EXCEPT:

Extrapyramidal effects Signup and view all the answers

Mrs. Janet Peckham is a 49-year-old teacher who presents with amenorrhea for 3 months. What is the MOST IMPORTANT test to perform?

B-HCG Signup and view all the answers

Which of the following statements about the Masters & Johnson model of human sexual response is the most accurate?

It describes the experience of most men better than that of most women Signup and view all the answers

All of the following occur in the context of genetic counseling EXCEPT:

Telling people what to do about their risks Signup and view all the answers

An elderly farmer went for a laparoscopic inguinal hernia repair. Name the landmark used by the laparoscopic surgeon during surgery to differentiate between a direct and an indirect inguinal hernia:

Lateral umbilical ligament Signup and view all the answers

On calculation, it was found that surgical management yields 19.46 life years. A similar calculation for drug treatment yields:

18.38 life years Signup and view all the answers

A woman has a regular 28-day menstrual cycle, and she wishes to find out if she is ovulating. Which of the following would you advise as the most reliable method to determine if she has ovulated?

Measure blood progesterone concentrations on day 21 of her cycle Signup and view all the answers

A 55-year-old man with a BMI of 28 is having an annual checkup with his GP. He reports difficulty obtaining and maintaining an erection. Which of the following treatment options will best preserve his erectile capacity in the long term?

An exercise regime Signup and view all the answers

The potency of an inhalational general anaesthetic is generally related to its:

Lipid solubility Signup and view all the answers

A patient presents with weakness of the adductor muscles of the thigh and loss of sensation on the inner surface of the upper thigh after a pelvic operation. The nerve which was most likely damaged in the procedure passes through which opening?

Obturator canal Signup and view all the answers

A 42-year-old male presents with problems including abnormal glucose tolerance, obesity, and proximal muscle weakness. His condition is localized to the pituitary gland. A defect in the secretion of which hormone is most likely?

ACTH Signup and view all the answers

A patient’s arterial blood sample shows: pH 7.55, PCO2 52 mm Hg, HCO3 40 mmol/L. What is the underlying disorder?

Compensated metabolic alkalosis Signup and view all the answers

A climber reaches an altitude of 5000 meters where PO2 is half the value at sea level. What will happen to his arterial PCO2 and pH?

The pH will rise and PCO2 will fall Signup and view all the answers

An elderly female presented with severe acute suprapubic pain from an infarct to a segment of gastrointestinal tract by an arterial embolus. Which of the following arteries is most likely to have been occluded?

Superior mesenteric artery Signup and view all the answers

Severe and recurrent depression causes a greater burden of disease and Disability Adjusted Life Years (DALYs) than advanced dementia because:

Depression tends to affect people earlier in life Signup and view all the answers

Which of the following is the first in the sequence of sperm production?

Spermatogonium Signup and view all the answers

Which of the following has selective anti-anxiety effects without sedative or anticonvulsant activity?

Buspirone Signup and view all the answers

Fiona Bell is a 52-year-old female housewife who presents to the GP with dyspnoea and fatigue for 2 months. On clinical examination, Fiona has a rounded face, hirsutism, and truncal obesity with relatively slender arms and legs. The dexamethasone suppression test result indicated adrenal neoplasm or ectopic ACTH syndrome. Which of the following dexamethasone suppression test results would indicate adrenal neoplasm or ectopic ACTH syndrome?

Failure to suppress cortisol on dexamethasone 8 mg/day Signup and view all the answers

If the concentration of thyroid hormone binding proteins increases, a normal subject will show the following alteration after a new steady-state is reached:

Increased total hormone concentration Signup and view all the answers

Antipsychotic drugs like phenothiazines or haloperidol are likely to exhibit pharmacological effects on all of the following systems EXCEPT:

Pulmonary system Signup and view all the answers

A 53-year-old woman presents with increasing tiredness, depression, lethargy, dry skin, constipation, and cold intolerance. Which of the following is the most appropriate first single investigation?

Estimation of plasma TSH concentration Signup and view all the answers

Sarcopenia (reduced muscle mass):

Occurs normally in aging adults Signup and view all the answers

A 60-year-old woman with hypothyroidism on thyroxine therapy is found to be overmedicated. What sign might you expect to see?

Fine tremor Signup and view all the answers

A 32-year-old woman experiences numbness and tingling in her hands and feet following thyroid surgery. Trousseau’s and Chvostek’s signs are positive. What is the likely cause?

Diminished parathyroid hormone secretion Signup and view all the answers

Pharmacokinetic drug interactions can result from all of the following except:

Competition for a common receptor binding site Signup and view all the answers

The following changes occur at birth:

The vitellointestinal duct may persist as Meckel’s diverticulum Signup and view all the answers

Which of the following factors influencing the increase in childhood obesity is not a socio-environmental factor?

The calorie content of energy-dense foods Signup and view all the answers

Which of the following is correct regarding the prevention of birth defects?

All women should take folate pre-pregnancy and during the first trimester Signup and view all the answers

A 20-year-old male was stabbed in the right side through the 10th intercostal space just behind the mid-axillary line. Which of the following is most likely to have been penetrated by the point of the blade?

Right lung Signup and view all the answers

Prolonged glucocorticoid excess leads to:

Easy bruising, thinning of bones, and susceptibility to infection Signup and view all the answers

A patient presents with neurological symptoms that the doctor believes are due to piriformis syndrome. He must recall that piriformis can compress the sciatic nerve:

As it exits the greater sciatic foramen Signup and view all the answers

The doctor suspects that a patient’s symptoms may be related to excessive production of thyroid hormones. Which of the following statements about thyroid hormones is TRUE?

Deiodination of T4 to reverse T3 (rT3) presents a mechanism to decrease the biological activity of thyroid hormone Signup and view all the answers

During a laparoscopic cholecystectomy, the surgeon must locate the bile duct. He must recall that it:

Lies in the free margin of the lesser omentum anterior to the portal vein Signup and view all the answers

Which of the following is associated with increased plasma AVP (vasopressin) concentrations?

Decreased blood volume associated with increased plasma osmolality Signup and view all the answers

A 30-year-old female with acute appendicitis had pain that shifted to the right iliac fossa. Which of the following is the most likely afferent nerve fiber path carrying this sensation from the irritated parietal peritoneum?

Somatic nerves on right to L1 spinal segment Signup and view all the answers

6-year-old boy presented with short stature, with his height measuring 4.26 standard deviations below the mean. His bone age was equivalent to 3 years, and his serum cortisol was decreased. What is the most likely underlying diagnosis?

Pituitary aplasia Signup and view all the answers

Consumption of grapefruit juice may cause important drug interactions with medications such as statins or calcium channel blockers. This is primarily due to:

Down-regulation of the liver enzyme CYP3A4 Signup and view all the answers

With regard to genital development:

The testes and ovaries descend from their original position at the tenth thoracic level Signup and view all the answers

Which one of the following would suggest that a breast mass may be sinister?

Palpable lymph nodes Signup and view all the answers

If excess aldosterone is produced autonomously by an adenoma of the adrenal cortex, the typical findings in plasma are:

Renin low, potassium low Signup and view all the answers

In the management of drug exposure in pregnancy, you may consider all of the following factors EXCEPT:

evidence of a normal ultrasound examination Signup and view all the answers

One of the following statements for controlling infection is TRUE:

Handwashing is the most effective method of preventing transmission of hospital-acquired infection Signup and view all the answers