SEAT NUMBER: ……….… ROOM:..……………….

FAMILY NAME:………….....………………………….
This question paper must be returned.
OTHER NAMES:……..…….…………………..……..
Candidates are not permitted to remove any part
of it from the examination room.
STUDENT NUMBER:…..…….………..……………..

FORMAL EXAMINATION PERIOD: SESSION 1, JUNE 2022

Unit Code: HLTH3302

Unit Name: Principles in Health and Disease 2

Duration of Exam 2h10min (the 10 min is reading time)

(including reading time if applicable):

Total No. of Questions: 47

Total No. of Pages 17

(including this cover sheet):

GENERAL INSTRUCTIONS TO STUDENTS:

• Students are required to follow directions given by the Final Examination Supervisor and must refrain from communicating in any way with another student once they have entered
the final examination venue.
• Students may not write or mark the exam materials in any way during reading time.
• Students may only access authorised materials during this examination. A list of authorised material is available on this cover sheet.
• All watches must be removed and placed at the top of the exam desk and must remain there for the duration of the exam. All alarms, notifications and alerts must be switched off.
• Students are not permitted to leave the exam room during the first hour (excluding reading time) and during the last 15 minutes of the examination.
• If it is alleged you have breached these rules at any time during the examination, the matter may be reported to a University Discipline Committee for determination.

EXAMINATION INSTRUCTIONS:

SECTION A: Multiple Choice Questions (45 marks)

Please use the MCQ answer sheet to answer all of the following questions. There are 45 questions, and
each is worth one mark.

SECTION B: CASE STUDIES (40 marks)

Please use the booklet provided to complete the two case studies. Each case study is followed by a number
of questions, and is worth 20 marks. Clearly indicate the case study number, and the question number
when you answer. Please write clearly and legibly. Please ensure all your details are on the front of the
booklet, and title it SECTION B: CASE STUDIES.

AIDS AND MATERIALS PERMITTED/NOT PERMITTED:

Dictionaries: No dictionaries permitted
Calculators: No calculators permitted
Other: Closed book – No notes or textbooks permitted

Copyright © Macquarie University. Copying or distribution of part or all of the contents in any form is prohibited.
SECTION A: Multiple Choice Questions (45 marks)
Please use the MCQ answer sheet to answer all of the following questions. There are 45
questions, and each is worth one mark.

Please choose the best single answer per question/ statement, and mark it clearly with pencil on
the answer sheet.

1. Which of the following terms best describes the origin and development of a disease,
and whether it is acute, chronic or recurrent?
A. Aetiology.
B. Pathophysiology.
C. Pathogenesis.
D. Prognosis.
E. Epidemiology.

2. Which of the following is the role of macrophages in the process of atherosclerosis?

A. Release of inflammatory cytokines.
B. Phagocytosis of oxidised LDLs.
C. Stimulation of the migration of smooth muscle cells into the intima.
D. Free radical production.
E. Macrophages have a role in all the processes described here.

3. Which of the following will increase the afterload on the heart:

A. Increased venous return to the heart.
B. Activation of the renin-angiotensin-aldosterone axis.
C. Arteriosclerosis.
D. Ischaemic heart disease.
E. Mitral valve regurgitation.

2
4. In coronary heart disease:
A. Oxygen supply cannot meet myocardial needs.
B. Myocyte necrosis has occurred, and the heart is in failure.
C. The myocardium is inflamed.
D. The myocardium has become enlarged, thick or rigid.
E. The valves are dysfunctional.

5. A 53-year-old female presents with angina. This pain would be called unstable angina if
the:
A. pain occurs under stress.
B. pain occurs when doing exercise and goes away at rest.
C. pain fluctuates.
D. pain is getting worse, and is occurring even at rest.
E. presentation is unusual e.g., it presents as indigestion.

6. The pathophysiology underlying an acute myocardial infarct is:

A. Necrosis of myocardium.
B. Heart arrhythmia.
C. Congestive heart failure.
D. Lactic acid accumulation causing angina.
E. Cessation of myocardial contraction and sudden death.

7. A cardiac tamponade commonly occurs in:

A. Acute pericarditis.
B. Constrictive chronic pericarditis.
C. Rheumatic heart disease.
D. Cardiomyopathy.
E. Left heart failure.

3
8. Which of the following is NOT a typical clinical symptom or sign seen in myocarditis?
A. Dyspnoea when lying down.
B. Hypertension.
C. Fatigue.
D. Arrhythmias.
E. Chest pain or pressure.

9. Rheumatic fever:
A. Presents with a sore throat.
B. Is a hypersensitivity reaction to circulating toxin of a group A streptococcal
infection.
C. Causes damage to the endothelium of blood vessels, precipitating
atherosclerosis.
D. Is common in affluent populations.
E. Increases the afterload on the heart, and results in hypertrophy of the
myocardium.

10. A continuous systolic murmur can be heard in:

A. Mitral regurgitation.
B. Tricuspid stenosis.
C. Aortic stenosis.
D. Pulmonary regurgitation.
E. Aortic regurgitation.

11. Which of the following valvular lesions will NOT result in pulmonary oedema?
A. Mitral stenosis.
B. Mitral regurgitation.
C. Aortic stenosis.
D. Pulmonary stenosis.
E. Aortic regurgitation.

4
12. A 75-year-old male has cor pulmonale that has resulted in right heart failure. Which of
the following symptoms/signs are directly related to his right heart failure?
A. Significant oedema to both lower legs and feet.
B. Hypertension.
C. Decreased urine output.
D. Pulmonary venous congestion.
E. Barrel chest.

13. Which of the following valvular lesions will cause left ventricular hypertrophy?
A. Mitral regurgitation.
B. Aortic stenosis.
C. Mitral stenosis.
D. Both (a) and (c).
E. All the above will cause left ventricular hypertrophy.

14. A 65-year-old male presents with intermittent claudication relieved by rest. What other
symptoms or signs are likely in this patient?
A. Loss of peripheral pulses.
B. Varicose veins.
C. Deep vein thrombosis.
D. Pulmonary thromboembolus.
E. All of the above are likely in this patient.

15. Which of the following is NOT a risk factor for deep vein thrombosis?
A. Atherosclerosis.
B. Surgery.
C. Trauma.
D. Inherited hypercoagulability.
E. Polycythaemia.

5
16. An 80 year old male has atrophic gastritis and a chronic bleeding stomach ulcer. He is
anaemic with a low MCV and MCHC. The most likely type of anaemia he has is:
A. Haemolytic anaemia.
B. Pernicious anaemia.
C. Anaemia due to chronic disease.
D. Anaemia due to haemorrhage.
E. Iron deficiency anaemia.

17. A young male presenting with diarrhoea and vomiting for the past 24 hours was found
to have high concentrations of erythrocytes, leukocytes, and platelets in his full blood
count. The likely diagnosis is:
A. Polycythaemia rubra vera.
B. Acute lymphoblastic leukaemia.
C. Hodgkin’s lymphoma.
D. Relative polycythaemia due to haemoconcentration.
E. Multiple myeloma.

18. In Australia, the most common leukaemia in adults is:

A. Acute lymphoblastic leukaemia.
B. Chronic lymphocytic leukaemia.
C. Acute myeloblastic leukaemia.
D. Chronic myeloid leukaemia.
E. Multiple myeloma.

19. Which of the following is NOT true for lymphomas:

A. Lymphoma almost always starts in lymph nodes.
B. Lymphomas are cancers of the myeloid or lymphoid cell lines.
C. Most are B-cell lymphomas.
D. Multiple myeloma is a type of Non-Hodgkin’s lymphoma.
E. Men are more likely than women to develop lymphoma.

6
20. A 20 year old male presents with lymphadenopathy in the neck, fever, fatigue and night
sweats. A node biopsy reveals Reed-Sternberg cells. The most likely diagnosis is:
A. Acute lymphoblastic leukaemia.
B. Chronic myeloid leukaemia.
C. Hodgkin’s lymphoma.
D. Non-Hodgkin’s lymphoma.
E. Scleroderma.

21. The abnormal Philadelphia chromosome is found in 95% of:

A. Hodgkin’s lymphoma.
B. Polycythaemia rubra vera.
C. Acute myeloblastic leukaemia.
D. Chronic myeloid leukaemia.
E. Chronic lymphocytic leukaemia.

22. Which of the following conditions can occur with a non-secreting pituitary adenoma?
A. Proportional dwarfism.
B. Cushings syndrome.
C. Gigantism or acromegaly.
D. Hyperthyroidism.
E. Gynaecomastia and galactorrhoea in males.

23. Which of the following conditions carries an increased risk for type 2 diabetes mellitus?
A. Gigantism.
B. Acromegaly.
C. Cushing’s disease.
D. Metabolic syndrome.
E. All the above carry an increased risk for type 2 diabetes mellitus.

7
24. Characteristic physical features of individuals with Cushing’s syndrome include:
A. Weight loss.
B. Muscle atrophy.
C. Pallor and swollen tongue.
D. Depigmented skin.
E. Exophthalmos.

25. True or false: Both the ACTH and cortisol levels are elevated in Cushing’s disease.
A. True
B. False

26. True or false: Both TSH and thyroid hormone levels are elevated in Grave’s disease.
A. True
B. False

27. Toxic nodular goitre is due to:

A. Autoantibody stimulation of sections of the thyroid gland, causing nodules.
B. An additional stress like an infection in partially treated Grave’s disease .
C. Medications that block thyroid hormone production such as
propylthiouracil.
D. Irreversible change in some follicular cells following a period of increased
thyroid stimulation by TSH.
E. Iodine deficiency.

8
28. J.F. Kennedy presents with low blood pressure, hypoglycaemia and dehydration. The
most likely diagnosis is:
A. Addison’s disease.
B. Diabetes insipidus.
C. Conn’s syndrome.
D. Hashimoto’s disease.
E. Thyroiditis.

29. A 62 year old female with Cushing’s disease has had repeated skin infections and
prolonged wound healing. She now presents with polyuria, polydipsia and pain in her
feet and hands. Which one of the following blood tests is most needed to establish the
underlying cause of her present condition?
A. ACTH levels.
B. Cortisol levels.
C. Fasting glucose levels.
D. ADH levels.
E. Aldosterone levels.

30. A 30-year-old female with Graves’ disease is admitted to your hospital unit for the
surgical removal of her thyroid gland. During the postoperative period, you note that her
serum calcium is low. She should be observed for which of the following
signs/symptoms?
A. Hypoglycemia and change in consciousness.
B. Laryngeal spasms and painful carpopedal cramps.
C. Constipation and abdominal pain.
D. Muscle weakness and bradycardia.
E. Headache, anorexia, nausea and vomiting

9
31. A 65 year old male presents with chest pain and significant weight loss. He has suffered
from acid reflux for many years, and says he has had difficulty swallowing for the last 3
months. Which of the following would be number one in your differential diagnosis?
A. Stomach cancer.
B. Peptic ulcer.
C. Coronary heart disease.
D. Oesophageal cancer.
E. Chronic gastritis.

32. Which of the following is NOT a risk factor for gastric cancer?
A. Exposure to benzene products.
B. Helicobacter pylori growth in the stomach.
C. Smoking.
D. High intake of salted and preserved foods.
E. Family history of gastric cancer.

33. A patient with colorectal cancer has liquid faeces and complains of pain in the abdomen.
The most likely location of his cancer is in the:
A. Ascending colon.
B. Transverse colon.
C. Descending colon.
D. Rectum.
E. Tissues adjacent to the colon i.e., it has spread beyond the colon.

10
34. A 20-year-old female presents with recurrent abdominal cramping pain, frequent
diarrhoea, and bloody stools. Examination revealed a cobblestone appearance to
sections of her small and large intestine. Which of the following is the most likely
diagnosis?
A. Crohn’s disease.
B. Irritable bowel syndrome.
C. Colonic cancer.
D. Ulcerative colitis.
E. Coeliac disease.

35. A 25-year-old male presents with chronic intermittent pain in the epigastric area what is
relieved by eating. He says the pain is worst at night and when his stomach is empty.
Which of the following is the most likely diagnosis?
A. Chronic gastritis.
B. Chronic pancreatitis.
C. Gastric carcinoma.
D. Gastric ulcer.
E. Duodenal ulcer.

36. A 3-year-old female has developed rickets. On examination she is anaemic and
malnourished. Her stools are pale, greasy and foul smelling. Her mother says her
daughter failed to thrive especially after the introduction of cereals into her diet. Which
of the following is the most likely diagnosis?
A. Crohn’s disease.
B. Hypoparathyroidism.
C. Pancreatitis.
D. Coeliac disease.
E. Cholecystitis.

11
37. True or false: alcohol abuse is a common cause of pancreatitis.
A. True
B. False

38. True or false: hepatitis B can cause liver cancer and cirrhosis.
A. True
B. False

39. A 54-year-old male complains that he has been vomiting blood. His skin is yellow, his
palms are red, and he has lost a lot of weight. On examination, his spleen is enlarged,
and he has ascites. What is the most likely cause of his condition?
A. Thrombosis in the spleen.
B. Cirrhosis of the liver.
C. Haemolytic anaemia.
D. Protein malnutrition.
E. Renal artery stenosis.

40. A 55-year-old female has general symptoms of gallstones but also has jaundice.
Intravenous cholangiography would most likely reveal that the gallstones are obstructing
the:
A. Intrahepatic bile canaliculi.
B. Gallbladder.
C. Cystic duct.
D. Common bile duct.
E. Common hepatic duct.

12
41. The airway obstruction in asthma is caused by:
A. Extensive damage to the alveolar-capillary membrane and decreased
surfactant.
B. Alveolar fibrosis and pulmonary oedema.
C. Mucous secretion, bronchoconstriction and airway oedema.
D. Collapse of the cartilaginous rings in the bronchi.
E. Destruction of elastic tissue, alveolar walls and capillary beds.

42. Which of the following correctly distinguishes chronic bronchitis from emphysema?
A. Infections are more common in chronic bronchitis.
B. Dyspnoea is more severe in chronic bronchitis.
C. Cyanosis is less common in chronic bronchitis.
D. A barrel chest is more common in chronic bronchitis.
E. Wheezing is more common in chronic bronchitis.

43. Restrictive lung disease typically has:

A. A normal or increased TLC.
B. A decreased FEV1 compared to the FVC.
C. A preserved or increased ratio of FEV1 to FVC.
D. An increased FVC.
E. A decreased ratio of FEV1 to FVC.

44. Which of the following lung cancers tends to grow at a rapid rate, metastasis early and
can produce ectopic cortisol?
A. Adenocarcinoma.
B. Large cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
E. Adrenal carcinoma.

13
45. A 1-year-old child with cystic fibrosis would demonstrate disordered membrane
transport of which of the following?
A. Potassium.
B. Chloride.
C. Inflammatory cytokines.
D. Mucus.
E. Fatty acids.

SECTION B
CASE STUDIES (40 marks)
Please use the booklet provided to complete the two case studies below. Each case study is
followed by a number of questions, and is worth 20 marks. Clearly indicate the case study
number, and the question number when you answer. Please write clearly and legibly. Please
ensure all your details are on the front of the booklet, and title it SECTION B: CASE STUDIES.

If you complete more than one booklet, please name your booklets SECTION B PART 1 AND
SECTION B PART 2, and again be sure all your details are on each of the booklets.

Case Study One (20 marks)

Adult Damien is a 28-year-old chemical engineer. He has been feeling unwell for the past 2
weeks and has gone to see his doctor. He presents with fatigue, fever, night sweats and
bruising. Damien's doctor decides to request a full blood count. The blood sample is sent to
a haematology laboratory — the laboratory report that comes back shows that Damien has
normocytic-normochromic anaemia, marked leucocytosis and marked thrombocytopenia. A
blood film was made from Damien's sample and examined microscopically. The report
states that numerous blast cells were present in the blood film (50% of the white cells in
Damien's blood film are blast cells).
Craft JA et al (2018) Understanding Pathophysiology ANZ, 3rd Edition, Elsevier Australia

14
Questions
1. Explain the terms normocytic-normochromic anaemia, marked leucocytosis and marked
thrombocytopenia. (2 marks)

2. Give 4 possible causes of a normocytic-normochromic anaemia. (2 marks)

3. In a normocytic-normochromic anaemia, the MCHC and MCV are normal in a full blood
count. What do these acronyms stand for, and define exactly they measure? (2 marks)

4. Give 3 pathophysiological responses to a sympathetic outflow in response to the

hypoxaemia of anaemia, which will result in an increase in blood pressure. (3 marks)

5. 50% of the white cells in Damien's blood film are blast cells. What is a blast cell? (1 mark)

6. What is the diagnostic significance of the number of blast cells in Damien’s blood film?
(1 mark)

7. Explain whether the laboratory findings are consistent with Damien’s symptoms. (4
marks)

8. Describe how a chronic form of this disease would present clinically (give 6 main points).
(3 marks)

9. Name the two stem cell lines from which this disease can be derived. (1 mark)

10. Which stem cell line do you think is likely involved in Damien’s disease? Give reasoning
for your answer (1 mark)

15
Case Study Two (20 marks)
Helena is an 82-year-old woman living in a granny flat in her daughter Gina's home. She has
no significant medical history and is on a cholesterol-lowering medication only. Over several
weeks her daughter notices Helena has lost her appetite, complains of nausea and
constipation but is thirsty and regularly visits the bathroom to ‘pass water’. This normally
happy and sociable woman appears to be mildly confused, is unusually sad and is unsteady
on her feet. Late one night Helena is found on the bathroom floor, confused and holding her
right hand which is swollen at the wrist. An ambulance is called because Helena is too
confused and weak to get up. In the emergency department the clinical examination shows
she has a right wrist fracture, is mildly dehydrated but regularly wants to pass urine. Her
urine is noted to be clear and dilute. She has proximal weakness and complains of bone
pain. Her temperature is 37°C, blood pressure 168/96mmHg, pulse 64bpm. Her
electrocardiogram shows sinus rhythm. Her blood calcium once hydrated is 2.95 (2.15–
2.55 mmol/L).
Adapted from: Craft JA et al (2018) Understanding Pathophysiology ANZ, 3rd Edition, Elsevier Australia

Questions
1. Give 3 causes of polyuria and polydipsia, and in each case, in one sentence, briefly
describe the pathophysiology. (3 marks)

2. What endocrine condition is the most common cause of hypercalcaemia? In your answer
also say which hormone is elevated in this condition, and what is the most likely cause of
this elevation? (2 marks)

3. Multiple myeloma can also cause hypercalcaemia. Explain the physiological mechanism
that causes the hypercalcaemia in this condition. (2 marks)

4. Explain what is causing Helena’s muscle weakness, bradycardia and constipation (1.5
marks).

5. Suggest why Helena fell (0.5 marks)

16
6. Explain what likely has led to Helena’s wrist fracture consequent upon her fall (hint:
there are two possible reasons) (2 marks).

7. What is the possible reason for Helena’s generalised bone pain? (1 mark)

8. Helena’s condition can also lead to kidney stones. Explain the pathophysiology behind
the formation of these calcium phosphate stones (3 marks).

9. Proximal muscle weakness is also observed in Grave’s disease. Explain the

pathophysiology of muscle weakness in this condition (2 marks)

10. Helena’s condition can also occur secondary to insufficient sunlight.

a. Explain how insufficient sunlight can cause a rise in the same hormone that is
high in Helena’s blood? (2 marks)
b. Explain why the blood calcium levels will not be elevated in this secondary form
of the condition (1 mark).

17