2023 Y2 Sem 2 Paper 1.pdf

2023 Y2 Sem 2 Paper 1 1. A patient with chronic kidney disease is treated with erythropoietin. Which of the following statements is TRUE regarding erythropoietin? A. A patient with iron deficiency anemia can safely receive erythropoietin injection. B. Eryth...

2023 Y2 Sem 2 Paper 1 1. A patient with chronic kidney disease is treated with erythropoietin. Which of the following statements is TRUE regarding erythropoietin? A. A patient with iron deficiency anemia can safely receive erythropoietin injection. B. Erythropoietin stimulates neutrophil growth factors. C. Adrenal medulla produces sufficient erythropoietin. D. Erythropoietin can cause thrombus formation by increasing viscosity of blood. 2. Select which of the following STIs can cause oral, anal and cervical cancer A. HPV B. HIV C. HSV D. HBV 3. Which of the following signs on examination would be most suggestive of PCOS as the cause of her symptoms. A. BMI of 19.5kg/m2 B. Tremor C. Plethoric facies D. Coarse, dark hair on the upper lip 4. Patients comes with a bruised knee after basketball with no trauma. Blood results show abnormal APTT corrected with a mixing test. Which factor levels should be tested? A. X and X1 B. VIII and IX (ans) C. V and X D. VII and VIII 5. Defecation involves a complex interplay of autonomic and somatic innervation. Which of the following nervous modalities constrict the anal sphincter and relaxes the wall of the rectum to store feces? A. Somatic efferent B. Somatic afferent C. Sympathetic efferent D. Parasympathetic afferent 6. The Doctor Performed a Digital Rectal Exam (DRE) on a patient whose histology cross section is given below The Doctor is most like is papating which portion of the tissue sample provided A. Boggy Mass B. Median Sulcus C. Cord-like tube D. Pulsatile mass 7. Partial gastrectomy was done for Jane, she experienced megaloblastic anemia, which statement best explains the cause of her anemia? A. Vegan diet B. Lack of intrinsic factor C. Lack of iron D. Require B12 supplements 8. Jill went for motivational interview for lifestyle changes due to her uncontrolled T2DM, however Jill find the advices difficult to be integrated into her lifestyle. Select which statement best explains the barrier for her health changes? A. Lack of time B. Lack of resources  C. Patient compliance D. Lack of financial support 9. At 20 weeks’ gestation, Sherry has a routine ultrasound. A decreased growth rate of the foetus is observed. Further testing showed increased protein levels in Sherry’s urine. Select the maternal condition that is LIKELY to be the cause of these findings. Select one: A. Gestational diabetes B. Endometriosis C. Preeclampsia D. Placenta praevia 10. Which of the following preventable STI could cause all oral, anal and cervical cancer? A. Hepatitis B virus (HBV) B. Human papillomavirus (HPV) C. Herpes simplex virus (HSV) D. Human immunodeficiency virus (HIV) 11. Which vaccine is given through the intramuscular route? A. DTP B. BCG C. Cholera D. Rotavirus 12. Which of the following statements is true regarding vaccine coverage? A. DTP coverage is often used as the indicator of global immunization coverage B. Global immunization coverage is 55%, unchanged since 2000. C. Immunization coverage is indicated by the number of children receiving compulsory vaccines D. Immunization coverage is indicated by the number of vaccines provided by clinicians in an area. 13. 12-month-old girl has due vaccinations. She has received all of her previous vaccinations. However recently, her mother scheduled an appointment with the GP to discuss if she should continue with her vaccines. She is significantly concerned of the risks discussed in her mothers’ group. What category does her mother fall into? A. Refusal B. Hesitant C. Cautious acceptor D. Selective vaccinator 14. According to a consensus in scientific literature, which is the major factor contributing to the rise in global temperature?  A. Car B. Pharmaceutical industry C. Human D. Nuclear power plant 15. Which of the following is the major anthropological contributor for increase in atmospheric CO2? A. Bush fire B. Burning of fossil fuels C. Volcano eruptions D. Fluctuation in solar radiation 16. Clinical Breast examination (Sensitivity = 55%, Specificity = 90%) A. False positive rate = 55% B. True negative rate = 10% C. Among those with breast cancer, 55% of them are incorrectly identified as not having breast cancer D. Among those without breast cancer, 90% of them are correctly identified as not having breast cancer. 17. TRIPS within members of what organization? A. FDA B. UN C. WTO D. WHO 18. Which one of the following is the correct step from the 5A’s of the SNAP guidelines that follows “Ask”? A. Alleviate stress B. Allocate a specialist clinician C. Aim to reduce risk factor D. Assess readiness of behavioral change 19. Which of the following is a correct action area of the Ottawa Charter? A. Strengthening community action B. Reorienting health service towards a single disease C. Primary health care for all D. Health in all policy 20. Ali is pre-diabetic, she finds it hard to integrate life changes recommended by the doctor. Which of the following is the most important barrier to health promotion in her case? A. Lack of time B. Lack of resources C. Patient compliance D. Poor access to infrastructure 21. Which of the following is an important international agreement on climate change? A. Accra Action for Advocacy B. Bangkok Protocol C. Glasgow Pact D. Abuja 22. What is the best test to quantify T lymphocytes? A. Bone marrow B. Flow cytometry C. Total white blood cell count D. Total lymphocyte count 23. Which immunosuppressant is correctly paired to its function? A. Anakinra = Stimulate IL-1 B. Sirolismus = block m-TOR C. Cyclosporin = stimulate IL-2 D. Rituximab = block T cell 24. Which drug is least likely to cause pancytopenia? A. Lefluonamide B. Aziothioprine C. Methotrexate D. Cyclosporin 25. Which will cause cervical, anal, oral cancer? A. HSV B. HPV C. Chlamydia D. Treponema pallidum 26. Which organism is primarily diagnosed with serology detecting antibodies A. Treponema pallidum B. HSV C. HPV D. Chlamydia 27. Gram negative diplococci detected. Which of the following is the most likely organism? A. Neisseria B. Chlamydia C. HPV D. HSV 28. Perineal laceration during labour. Muscles repaired. However a week later presented with faecal incontinence. Which muscle is not repaired? A. Bulbospongiosus B. Gluteus maximus C. Transverse perineal muscle D. Internal anal sphincter 29. Right-sided conductive hearing loss. A. Rinne positive, Weber louder sound on right ear. B. Rinne positive, Weber softer sound on right ear. C. Rinne negative, Weber louder sound on right ear. D. Rinne negative, Weber softer sound on right ear. 30. Which statement is true?  A. Chancre is painless and infectious. B. HSV cause genital warts. C. Syphilis is caused by flagellated protozoa. D. Chlamydia infections in woman majorly presented with foul-smell discharged. 31. Which is correctly paired. A. Health in all policies, 4 pairs B. Universal Health Coverage 32. Female presented to ED with 4kg weight loss, fever, sweating. Blood test showed increased neutrophils, eosinophils, basophils. RBC (drop 1 actually), platelets (drop 1 actually), and lymphocytes normal count. Also left shift showing immature myeloblasts. A. Severe bacterial infection B. Chronic myeloid leukaemia. 33. 4-month history without menstruation. Menarche at 13 y/o. Normal flow. Each cycle lasts between 30-35 days. No pain. A. Primary amenorrhea B. Secondary amenorrhea C. Dysmenorrhea D. Oligomenorrhea 34. Amenorrhea, weight loss, agitated, proptosis on both eyes, goitre. A. Graves B. Hashimoto C. De Quervain D. Multiple toxic nodules 35.Homonymous hemianopia A. Right visual field loss on both eyes. B. Upper visual field loss on both eyes. C. Nasal visual field loss on both eyes. D. Lateral visual field loss on both eyes. 36. Iron absorption correct statement. A. Ferrin better absorbed than ferrous salt. B. Iron absorbed at terminal ileum. C. Absorption of iron increased with Vitamin C intake. D. Absorption of iron increased with phosphate intake. 37. A 15-year-old patient assigned female at birth has not attained menarche. Her mother is concerned and has brought her to consult their family General Practitioner. On examination, the patient’s height is on the 3rd centile for age. She has no evidence of breast development, pubic or axillary hair growth. Her blood test results are shown below. FSH: normal LH: normal Oestrogen: low Select which of the following structures of the gonadal axis is abnormal in this patient. a. Pituitary b. Ovary c. Uterus d. Hypothalamus 38. Following a surgical repair of an inguinal hernia, the patient presents with localized pain in the groin/iliac region that extends into the anterior aspect of the scrotum. Select which of the following nerves is now suspected of being entrapped by the surgical repair. Select one: a. Pudendal nerve b. Dorsal genital nerve c. Ilioinguinal nerve d. Lateral femoral cutaneous nerve 39. A pregnant woman attends a routine ultrasound. There is reduced growth of the fetus, and upon urine exam there is protein. Which maternal condition will cause this? A. Placentae previa B. Preeclampsia C. Gestational diabetes 40. In vitro fertilization involves allowing an ovum and a sperm to fuse in a petri dish or test tube. Sperm extracted from the ejaculate and placed directly with an ovum will not be able to penetrate the outer coating of the ovum immediately but will need to be co-incubated for several hours before fertilization can occur. Select which of the following options BEST explains this observation. Select one: a. Additional proteins need to be attached to the spermatic head to facilitate binding to ovum. b. Capacitation of sperm needs to occur. c. The ovum needs additional time to express receptors to sperm.  d. External membrane of the spermatic head needs to dissolve before it can penetrate the ovum. 41. Following a prolonged and difficult delivery, the patient sustains an extensive perineal laceration which is repaired. Upon review a week later, she complains of faecal incontinence. Select which of the following key muscles may have been missed in the repair. Select one: a.Bulbocavernosus b.Internal anal sphincter c.Gluteus maximus d.Transverse perineal muscles 42. From the following list of options, please select the one that accurately completes the final sentence below. Craig’s lab recently generated mice that express inactive forms of inhibin A and inhibin B. The consequence of inhibin inactivation in these mice will be: Select one: a. a decreased follicle stimulating hormone (FSH)/increased luteinizing hormone (LH) leading to decreased follicle survival but increased ovulation b. an increased follicle stimulating hormone (FSH)/decreased luteinizing hormone (LH) leading to increased follicle survival but decreased ovulation c. a decreased follicle stimulating hormone (FSH), decreased follicle survival and decreased ovulation d. an increased follicle stimulating hormone (FSH), increased follicle survival and increased ovulation 43. The process of birth requires significant modifications in the maternal physiology to transition from the quiescent phase of fetal development to the phase of parturition. Select which of the following hormones is the MOST central to triggering the onset of parturition. Select one: a. Estrogen  b. Prolactin c. Corticotrophin releasing hormone d. Oxytocin 44. In vitro fertilization involves allowing an ovum and a sperm to fuse in a petri dish or test tube. Sperm extracted from the ejaculate and placed directly with an ovum will not be able to penetrate the outer coating of the ovum immediately but will need to be co-incubated for several hours before fertilization can occur. Select which of the following options BEST explains this observation. Select one: a. External membrane of the spermatic head needs to dissolve before it can penetrate the ovum. b. Capacitation of sperm needs to occur. c. Additional proteins need to be attached to the spermatic head to facilitate binding to ovum. d. The ovum needs additional time to express receptors to sperm. 45. Uná has been rushed to hospital due to probable preterm labour. Select, from the options, the drug that could be administered to delay delivery. Select one: a. Antenatal glucocorticoid b. Estrogen agonist c. Prostaglandin d. Oxytocin receptor antagonist 46. Pat is electing to undergo a vaginal hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, uterine tubes and ovaries via the vagina) as management for endometriosis that has failed to respond to conservative treatments. Select which of the following structure(s) would need to be cut and ligated for Pat to have their uterus removed completely. Select one: a. Round ligament (cut), Uterine and ovarian vessels (ligated) b. Uterine tubes (cut), Uterine and ovarian vessels (ligated) c. Uterine tubes (cut), Internal Iliac vessels (ligated) d. Round ligament (cut), Internal Iliac vessels (ligated) 47. A 48-year-old patient with chronic renal failure has been treated with erythropoietin. Select which of the following statements is CORRECT regarding erythropoietin. Select one: a. Erythropoietin can cause thrombosis by increasing blood viscosity. b. Erythropoietin stimulates neutrophil progenitors in bone marrow. c. A patient presenting with iron deficiency anaemia can safely use erythropoietin. d. Adrenal medulla produces sufficient amounts of erythropoietin. 48. Listed below are several statements (that are TRUE or FALSE) regarding the benefits of investment in health promotion. 1. Investment in health promotion can save health spending. 2. Investment in health promotion has minimal impact on mental health. 3. Investment in health promotion reduces the burden of chronic diseases. 4. Health promotion is a major component of routine government health spending. Identify, from the options listed, the CORRECT set of statements from the above. Select one: a. 1 and 3 b. 2 and 4 c. 1, 2 and 3 d. 1, 3 and 4 49. Which of the following increase chances of breast cancer? A. Early menopause B. Nullipara C. Fibrous adenoma 50. A patient’s visual acuity was tested using the Snellen chart. His visual acuity on both eyes is 6/9. Which of the following is true? A. One eye can see at 6m and the other at 9m B. Can see what a person with normal acuity can see at 6m he can see at 9m C. Can see what a person with normal acuity can see at 9m he can see at 6m D. Can see at 15m when both eyes combined 51. Homonimous hemianopia A. Top half of both eyes B. Bottom half of both eyes C. Nasal half of both eyes D. Right side of both eyes 52. A patient underwent a surgery for inguinal hernia and came back a few days later with loss of sensation in his groin/iliac region which extended to the anterior part of his scrotum. Which of the following nerves was affected? a. Lateral femoral cutaneous nerve b. Ilioinguinal nerve c. Pudendal nerve d. Genital nerve 53. Organ X can be felt in a digital rectal examination. Which of the following is a normal finding of organ X? a. Median sulcus b. Boggy mass c. Cord-like tube d. Pulsatile mass 54. For a hysterectomy, which of the following arteries need to be ligated to prevent excessive bleeding? a. Superior vesical artery b. Vaginal artery c. Ovarian artery d. Uterine artery 55. Which of the following is a feature of neoliberalisation? a. Increased funds to the public sector b. Privatisation c. Increased government spending d. Increased public health spending 56. Patient presents with septicaemia and purpuric rash and petechiae. Laboratory findings: High neutrophils Low platelets APTT - prolonged PT - prolonged TT - prolonged Which of the following laboratory tests need to be done to diagnose the condition? a. Platelet function b. Factor X c. D-dimer d. Thrombin 57. Mother brings her son to the clinic with bleeding in his joints after a football match in which he sustained no injuries. His father also has similar problems. Which of the following tests would narrow down the diagnosis? a. Factor V and Factor VIII b. Factor XI and Factor XII c. Factor VIII and Factor IX d. Von Willebrand factor 58. Patient presents with recurrent infections. Laboratory findings: Neutrophils - very high Eosinophils - high Basophils - high Platelets - slightly reduced Lymphocytes - normal What is the diagnosis?  a. Allergy b. CML c. Aplastic anaemia d. Acute lymphocytic leukaemia 59. Defect in hematopoiesis in early myeloid cell lineage. a. ALL b. CML c. AML d. Polycythemia vera 60. A 30 year old female patient has been diagnosed with an estrogen secreting granulosa cell tumour in her right ovary. Her plasma levels of estrogen are markedly elevated. Select which of the following is MOST LIKELY to be TRUE in this patient. Select one: a. The endometrium will have thickened, coiled spiral arteries as a dominant feature. B. Examination of her uterine lining will show endometrial hyperplasia. C. Plasma levels of follicle stimulating hormone (FSH) will be significantly elevated. D. Plasma levels of progesterone will be markedly elevated. 61. The process of birth requires significant modifications in the maternal physiology to transition from the quiescent phase of fetal development to the phase of parturition. Select which of the following hormones is the MOST central to triggering the onset of parturition. Select one: a. Oxytocin b. Corticotrophin releasing hormone c. Estrogen d. Prolactin 62. Select which of the following sexually transmitted infections uses serological detection of antibodies as the PRIMARY tool for its diagnosis: a. Human Papillomavirus (HPV) b. Treponema pallidum c. Chlamydia Trachomatis d. Herpes Simplex Virus 63. A 70-year-old patient was found on routine blood tests to have a very elevated haemoglobin. Select which of the following underlying conditions may be associated with this finding: e. Thalassemia minor f. Chronic Obstructive Pulmonary Disease g. Chronic Renal failure h. Type 2 Diabetes Mellitus 64. A 50 yo male patient presented to the GP with 3-day/week/month (sorry can’t remember oops) old tiredness. Physical examination findings showed conjunctival pallor, glossitis and koilonychia. Which of the following tests confirms a diagnosis of iron deficiency, as a cause of the anaemia? A. Ferritin B. Total red blood cells C. Haemoglobin A2 D. Haemoglobin A 65. From the 4 options below, select which show benefits of investment in health promotion. 1. Investment in health promotion saves health spending. 2. Investment in health promotion has a minimal impact on mental health. 3. Investment in health promotion reduces the burden of chronic disease. 4. Health promotion is a major component of routine government health spending. A. 1,2,4 B. 1,3,4 C. 1 & 3 D. 2 & 4 66. From the following list of options, please select the one that accurately completes the following sentence: Polycythemia vera is a myeloproliferative neoplasm that results in hematopoietic stem cell proliferation, which in turn causes: Select one: a. A decrease of erythrocytes b. A decrease of neutrophils c. An increase of erythrocytes d. An increase of basophils 67. A female patient presents to the GP and her hormone levels are taken. Based on her results, she had decreased FSH and LH, increased estrogen and progesterone. Her HCG levels were also undetected. She is: a. Pregnant b. About to undergo ovulation c. Undergoing early follicular phase d. In her mid-luteal phase 68. What is best test to quantify T-cell? a. lymphocytes of FBC b. flow cytometry c. Bone marrow smear d. Leukocyte count 69. What occurs in order for a strong rhythmic contraction during labor? a. Downregulation of estrogen receptors b. Breakdown of connexins c. Increased expression of oxytocin receptors d. Reduced sensitivity of progesterone 70. In severe combined immunodeficiency, there is marked decrease in mature T lymphocytes (T cells), deficiency cell mediated immunity and defective humoral immunity that id due to: a. Lack of antibody production b. Immature lymphocyte being unable to proliferate c. B lymphocyte (B cells) being unable to proliferate d. A lack of plasma cell production 71. A GP has a specialist interest in sexual health and wellbeing. When educating patients about their anatomy, he often includes a description of the ways in which the erectile tissues of the perineum are similar in people with either a clitoris or penis. Select, from the options, the correct pairing of the part of the clitoris or penis that is affected to the ischiopubic rami, and the type of erectile tissue involved. a. Glans, cavernous erectile tissue b. Bulbs, spongy erectile tissue c. Crura, cavernous erectile tissue d. Bodies, spongy erectile tissue 72. Which of the following changes of systemic hormone during menopause is correct? a. Increase in progesterone and LH b. Increase in progesterone and estrogen c. Decrease in estrogen and inhibin d. Decrease in estrogen but increase in inhibin. 73. A 43 year old female presented with bleeding after her first coitus. Examination finding shows that the bleeding is from lacerated hymen. Which of the arteries account for the bleeding? a. Internal pudendal artery b. External iliac artery c. Middle rectal artery d. Obturator artery 74. During a prostatectomy, the surgeon endeavours to protect prostatic plexus of nerves which contains nerve fibers that innervate erectile tissue. From which of the following nerves do these plexus fibers originate? a. Genitofemoral b. Pelvic splanchnic c. Dorsal nerve of the penis  d. Pudendal 75. S wanted to get a vasectomy, which is a procedure where the vas deferens is cut and the tubes are ligated. Which structure will have spermatozoa when S goes to the GP 3 months later? a. Epididymis b. Prostate c. Seminal vesicle d. Ejaculatory duct 76. Crolg’s lab recently generated mice that express inactive form of inhibin A and B. The consequence of inhibin inactivation in these mice will be: a. Increased FSH, decreased LH leading to increased follicle survival but decreased ovulation b. Decreased FSH, decreased follicle cervical and decreased ovulation c. Decreased FSH, increased LH leading to decreased follicle survival but increased ovulation d. Increased FSH, increased follicle survival and increased ovulation 77. Following surgical repair of inguinal hernia, the patient presents with localised pain on the groin/iliac region that extends into anterior aspect of the scrotum. Select which of the following nerves is now suspected of being entrapped by the surgical repair. a. Pudendal b. Dorsal genital c. Ilioinguinal d. Lateral femoral cutaneous 78. Select which of the following is a feature of neoliberalism. A) Privatization B) Minimizing free trade C) Increase public sector resources D) Increase government control over the economy 79. Select of the sexually transmitted infections uses serology detection of antibodies as the primary tool of its diagnosis. A) Herpes simplex virus B) Human papillomavirus C) Chlamydia trachomatis D) Treponema pallidum 80. A 25-year-old woman presents to the doctor with a complaint of amenorrhea for 6 months. Clinical examination and blood test were inconclusive, and the doctor is next considering a biopsy of the ovary. Select which of the following structures is correctly matched with it histological description, if an ovarian biopsy was done. A. Antral follicle: only two layers of granulosa cells without any cavities B. Secondary follicle: a single later of granulosa cells and the oocyte half its mature size C. Primary follicle: several layers of granulosa cells and the oocyte has begun to grow D. Graafian follicle: several layers of granulosa cells with corona radiata, and the oocyte is of mature size