Australasian Faculty of Rehabilitation Medicine

Sample Questions
(Module 1)

1 A 24 year old women, on tetracyclines for acne, presents with a three

month history of headaches and fleeting episodes of blurred vision. On
examination, she is obese and has severe papilloedema, but no other
neurological signs. A CT scan is normal.
Which of the following is the most appropriate initial investigation?
A.

MRI brain scan.

B.

Cerebral angiography.

C.

Hypercoaguability screen.

D.

Overnight dexamethazone suppression test.

E.

Lumbar puncture.

2 In rheumatoid arthritis the granulation tissue termed pannus is erosive

principally because of:
A.

Production of localised vasculitis

B.

Production of fibrinoid necrosis

C.

Procoagulant activity and capillary thrombosis

D.

Production of collagenase and other enzymes

E.

Presence of osteoclasts within the pannus

3 Levodopa is combined with carbidopa for the treatment of Parkinsons

disease. Carbidopa is added to:
A.

slow absorption of levodopa.

B.

reduce nausea caused by levodopa.

C.

reduce the required dose of levodopa.

D.

block chemoreceptor-trigger zone receptors.

E.

reduce the breakdown of levodopa by catechol-O-methyl transferase.

4 Which of the following antibiotics is the commonest cause of Clostridium

difficile colitis?
A.

Clindamycin.

B.

Metronidazole.

C.

Gentamicin.

D.

Amoxycillin.

E.

Doxycycline.

5 A 75 year old mildly demented man has carcinoma of the colon. He has
difficulties in the management of his financial affairs and has moved
from his home to a hostel. He has symptoms from his carcinoma but,
despite initial consent for treatment, he now refuses all treatment, and
permission for the diagnosis to be communicated to his family.
Which of the following is the most appropriate?
A.

The family should be asked to give consent.

B.

His refusal to consent cannot be challenged.

C.

A request for a guardianship order should be made.

D.

The initial consent remains valid.

E.

His capacity to consent must be reassessed.

6 A 65 year old male has a 3 year history of intermittent pain in both knees
and now presents with a 2 week history of pain and swelling in the right
knee. Examination reveals a small effusion of the knee.
The synovial fluid findings are as follows:
White cell count
700/mm3 [<100]
Mononuclear cells 90%
Neutrophils
10%
No crystals were seen.
X-ray of the knee is shown.
The most likely cause of the right knee pain is:
A.

Osteoarthritis.

B.

Ankylosing spondylitis.

C.

Pseudogout.

D.

Psoriatic arthritis.

E.

Rheumatoid arthritis.

7 With which one of the following clinical syndromes is Pseudomonas

aeruginosa most strongly associated?
A.

Osteomyelitis of the tarsal bones complicating foot infection in

diabetics.

B.

Osteomyelitis of the temporal bone complicating otitis externa in

diabetics.

C.

Haematogenous vertebral osteomyelitis in adults with urinary infection.

D.

Osteomyelitis of the phalanges following a cat bite.

E.

Osteomyelitis of the mandible complicating dental sepsis.

8 Which of the following is the commonest cause of bilateral lower motor

neurone Seventh nerve palsies?
A.

Sarcoidosis.

B.

HIV polyneuropathy.

C.

Acute inflammatory demyelinating neuropathy.

D.

Herpes zoster.

E.

Brainstem infarction.

9 A 72 year old man presents with acute onset of left sided weakness. On
examination he is drowsy, has a dense left hemiparesis and blood
pressure 200/100. CT scan of the head without contrast reveals a large
haemorrhage in the right parietal lobe. The patient deteriorates and
requires decompression.
The most likely pathology of the excised tissue is:
A.

Arteriovenous malformation.

B.

Berry aneurysm.

C.

Glioma.

D.

Beta A4 protein in vessel walls.

E.

Mycotic aneurysm.

10 When interpreting the results of bone mineral density scans, which of the
following parameters correlates best with the risk of future fractures?
A.

Absolute bone density.

B.

T-score.

C.

Z-score.

D.

Soft tissue density.

E.

Change in bone density.

11 A 45 year old man presents with pneumonia. He is found to have IgG

multiple myeloma.
His routine biochemistry finds:
sodium
143 mmol/L
potassium
4.5 mmol/L
chloride
101 mmol/L
HCO3
28 mmol/L
glucose
5.5 mmol/L
urea
18 mmol/L
creatinine
250 mmol/L
albumin
35 g/L
protein
70 g/L
calcium
2.3 mmol/L
PO4
1.0 mmol/L
alkaline phosphatase 100 U/L

[134-146]
[3.4-5.3]
[95-105]
[24-31]
[3.5-6.5]
[3-8]
[60-120]
[35-50]
[60-80]
[2.1-2.6]
[0.8-1.50]
[35-135]

The most likely cause of this renal impairment is:

A.

myeloma cast nephropathy.

B.

Acute tubular necrosis.

C.

Amyloid.

D.

Plasma cell infiltration.

E.

Proliferative glomerulonephritis.

12 A 17 year old girl notices swelling of her ankles and breathlessness.

Examination shows pitting oedema, blood pressure is 150/95 mmHg and
urine contains ++protein, +++ blood. Microscopy of the urine shows
cellular casts and crenated and fragmented red cells.
Serum Creatinine
Complement

105 mmol/L [50-120]

C3 0.4g/L [0.751.50]
C4 0.23g/L [0.16-0.56]

The most likely diagnosis is:

A.

Minimal change disease.

B.

Focal and segmental glomerulosclerosis.

C.

Systemic lupus erythematosis.

D.

Membranous glomerulonephritis.

E.

Post infectious glomerulonephritis.

13 An asymptomatic 40 year old male who jogs regularly has two episodes
of transient light headedness at rest. There is no history of smoking or
diabetes and no family history of premature vascular disease. BP is
150/70. Other examination is unremarkable. His ECG is illustrated.
The next most appropriate step is:
A.

reassurance.

B.

Holter monitoring.

C.

trial of treatment with anticholinergics.

D.

myocardial biopsy.

E.

permanent pacing.

14 A 36 year old man who was admitted to the Intensive Care Unit 3 weeks
ago with multiple injuries sustained in a motor vehicle accident is
intubated and breathing spontaneously. He has a Swan Ganz catheter
which was inserted 10 days ago and is receiving total parenteral nutrition
via a multilumen central venous catheter. For the last week he has had
bilateral alveolar shadowing on chest X-ray but his oxygenation has been
stable whilst receiving intravenous ceftriaxone. He suddenly develops a
high fever (40.3oC PO) and becomes haemodynamically unstable;
clinical examination fails to reveal a likely source of infection and chest
X-ray is unchanged. Intial investigation results include the following:
haemoglobin
109 g/L
white cell count
15.7x109/L
neutrophils
11.6x109/L
lymphocytes
3.0x109/L
monocytes
0.7x109/L
platelets
150x10 9/L
film comment : band forms + +; toxic granulation + +;

[130 - 170]
[4 - 10]
[2.0 - 7.5]
[1.5 - 4.0]
[0.2 - 0.8]
[150 - 400]

After obtaining cultures from blood and urine, which of the following is
the most appropriate next diagnostic step?
A.

Whole body gallium scan.

B.

Culture of endotracheal aspirate.

C.

Removal of indwelling lines for culture.

D.

Bronchoscopy with transbronchial biopsy.

E.

Echocardiogram.

15 Which of the following conditions is the major contraindication for an

older person to be involved in an exercise programme?
A.

Alzheimers dementia.

B.

Unstable angina pectoris.

C.

Atrial fibrillation.

D.

Stroke.

E.

Chronic obstructive pulmonary disease.

16 A 19-year-old male complains of intermittent breathlessness and

wheezing. Which of the following lung function abnormalities is most
specific for a diagnosis of asthma?
A.

A ratio of the forced expiratory volume in one second to forced vital

capacity (FEV1/FVC) of less than 0.7.

B.

An increase in the forced expiratory volume in one second (FEV1) of

15% following inhalation of 400 mcg salbutamol.

C.

A ratio of residual volume to total lung capacity (RV/TLC) greater than

120% of predicted.

D.

A concentration of inhaled methacholine causing a 25% fall in the

forced expiratory volume in one second (FEV1) of 1 mg/ml.

E.

An increase in the carbon monoxide diffusing capacity to 125% of

predicted.

17 Of the following statements, pick the one that best relates to axial
skeletal involvement in rheumatoid arthritis.
A.

sacro-iliac joints are involved early in the course of the disease

B.

involvement of the lumbar spine in characteristic

C.

cervical spondylosis is a significant radiological finding

D.

axial involvement is usually limited to the upper cervical spine

E.

low back pain is one of the commonest symptoms in rheumatoid

arthritis

18 Apart from nausea, what is the most common side effect of the class of
medications that include citalopram, ecitalopram, sertraline, paroxetine
and fluvoxamine?
A.

Akathisia.

B.

Sexual dysfunction.

C.

Diarrhoea.

D.

Mania.

E.

Seizures.

19 Which of the following best determines whether an ascitic fluid sample is

a transudate or an exudate?
A.

Ascitic pH.

B.

Ascitic lactic dehydrogenase activity.

C.

Serum to ascitic fluid albumin gradient.

D.

Ascitic neutrophil count.

E.

Ascitic protein concentration.

20 The prevalence of alcohol related morbidity in a community is best

predicted by the:
A.

mean alcohol consumption of the members of the community.

B.

overall prevalence of alcoholism.

C.

number of malnourished alcoholics in the community.

D.

prevalence of abusive drinking among young males.

E.

amount of alcohol consumed by the highest decile of alcohol

consumers.

21 Which of the following drugs newly prescribed to a patient with stable

and therapeutic lithium levels is most likely to produce an increase in his
serum lithium?
A.

Fluoxetine.

B.

Theophylline.

C.

Captopril.

D.

Hydrochlorothiazide.

E.

Aspirin.

22 The following results are obtained from a 40 year old man prior to
elective hernia surgery who gives a history of excessive bleeding after
dental extraction.
Bleeding time
Prothrombin time
International normalised prothrombin ratio (INR)
Activated partial thromboplastin time (APTT)
Fibrinogen

6 mins`
12 secs`
1.0
48 secs
2.4g/L

[2-9]
[12-14]
[0.1-1.2]
[25-38]
[1.8-4.0]

Mixing the patients plasma with an equal volume of normal plasma

normalises the APTT.
Which of the following is the most likely diagnosis?
A.

factor VII deficiency

B.

Recent aspirin ingestion

C.

antiphospholipid antibody syndrome

D.

Von Willebrands disease

E.

haemophilia B

23 Which of the following is the most critical issue when using DNA
analysis for presymptomatic (predictive) testing in Huntingtons
disease?
A.

Blood has to be collected in a specific way.

B.

A neurological assessment is mandatory.

C.

The test is only conducted if the individual is at risk.

D.

There must be a living affected relative.

E.

Appropriate counselling must be given.

24 The muscle pair which most importantly assists in elevating the arm
above the head is the:
A.

trapezius and pectoralis minor

B.

levator scapulae and serratus anterior

C.

rhomboid major and serratus anterior

D.

rhomboid major and levator scapulae

E.

trapezius and serratus anterior

25 Which of the following physiological responses is NOT integrated within

the medulla oblongata?
A.

swallowing

B.

sneezing

C.

temperature regulation

D.

gagging

E.

vomiting

26 A lesion of the left cerebral hemisphere involving the motor cortex is

most likely to result in paralysis of the muscles of the face in its
A.

right half

B.

left half

C.

right upper quadrant

D.

right lower quadrant

E.

right and left lower quadrants

27 The motorneurones responsible for the knee-jerk are located mainly in

spinal cord segments
A.

L1,L2

B.

L2,L3

C.

L3,L4

D.

L4,L5

E.

L5,S1

28 The best single indicator of the adequacy of restoration of fluid volume

after injury is
A.

Blood volume

B.

Haematocrit

C.

Blood gases

D.

Urine output

E.

Rise in blood pressure

29 The annular ligament prevents dislocation of the

A.

distal end of the clavicle from the acromion process

B.

head of the humerus from the glenoid cavity

C.

head of the ulna from the triquetrum

D.

head of the radius from the radial notch of the ulna

E.

head of the third metacarpal from the base of the proximal phalanx

30 The most important factor increasing blood flow through an active

muscle is
A.

adrenaline release during exercise

B.

activation of sympathetic dilator fibres

C.

reduced constrictor tone in the arterioles of the muscle

D.

local action of metabolites on vessels in the muscles

E.

the muscle pump action

ANSWERS TO SAMPLE QUESTIONS (MODULE 1)

QUESTION

ANSWER

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.

E
D
B
D
E
A
B
C
D
B
A
E
E
C
B
D
D
B
C
A
D
E
E
E
B
D
C
D
D
D