These answers are compiled for sharing and peer learning purposes only.

It
is based on my own reading and hence is bound to have some mistakes.

Compiled by GC
Disclaimer: The answers provided are suggested answers. The following
information is solely to discuss questions, identify mistakes and facilitate
improvements among medical students about medical topics. NO OTHER
INTENTION IS IMPLIED. Thank you.

BA Paper 2 2022

1) 15 year old boy complained about redness and stringy discharge of left eye. What is
the part affected?

A. Cornea
-
B. Conjunctiva
C. Lacrimal duct
D. Sclera
E. Pupil Source: First Aid for the USMLE Step 1 2018

2) 24 year old women at risk of threatened miscarriage due to insufficient of progesterone.

Which area problem?

A. Chorion lavae
B. Chorion frondosum Fetal part of placenta
C. Corpus graviditatis
D.
- Decidua basalis Maternal part of placenta
E. Syncytiotrophoblast

3) The injury of the axillary nerve causes lost of rounded contour at the shoulder. This is
due to the paralysis of which muscle?

-
A. Deltoid
B. Subscapularis
C. Serratus anterior
D. Latissimus dorsi
E. Biceps brachii

4) 5 year old boy got injured at back of scalp and profuse bleeding. Which artery involved?

A. Posterior auricular
B. Superficial temporalis
C. Supratrochlear
D. Supraorbital
E.
- Occipital

5) Modified cardiac muscle which is smaller than other cardiac muscles but faster impulse
conduction. Which cardiac muscle?

A. Atrioventricular bundle
B. Right bundle branch
C. Left bundle branch
D. SA node
-
E. Purkinje fibres

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Source: Lecture - Cardiac Muscle
6) What muscle is associated with a positive Trendelenberg sign?

A. Gluteus maximus
-
B. Gluteus medius
C. Piriformis
D. Quadratus femoris
E. Superior gemellus

7) Experiencing weakness in left leg extending to left thigh. Diagnosed with piriformis
compartment syndrome. What nerve is associated with this condition?

A. Obturator
B. Femoral
-
C. Sciatic
D. Pudendal
E. Iliac
Source: Lecture - Bone and Cartilage
8) Which of the following is the first event that occurs in endochondral ossification?

-
A. Differentiation of mesenchymal cells into osteoblasts
B. Disintegration of chondrocytes in the centre region
C. Formation of subperiosteal bone collar
D. Penetration of blood vessel through the periosteal bud
E. Presence of primary ossification centre

9) A newborn was diagnosed with tetralogy of fallot. Which of the following leads to this
congenital defect?

-
A. anterior displacement of conotruncal septum
B. conotruncal ridge failure to fuse and descend
C. defect in membranous part of interventricular septum
D. failure in endocardial cushion to fuse
E. failure in conotruncal septum to descend spirally

10) Hemidiaphragm paralysis on chest x-ray. Which nerve is affected? Source: First Aid for the USMLE
Step 1 2018

-
A. Phrenic
B. Vagus
C. Intercostal
D. Subcostal
E. Sympathetic trunk

11) Dexamethasone injection is given to a pregnant woman in pre-labour. Which of the

following cell is affected due to dexamethasone by increasing alveolar surfactant?

A. Basal
B. Mucous
C. Goblet
D. Type 1 pneumocyte
E.
- Type 2 pneumocyte

2
12) 45 year old man died by hanging himself. Which bone is most likely fractured?

A. Atlas
B. Axis
C.
- Hyoid
D. Mandible
E. Maxilla

13) What artery passes through foramen transversarium? Source: Lecture - The Neck and Lower Back

A. anterior spinal
B. common carotid
C. external carotid
D. internal carotid
-
E. vertebral

14) Gout, what is the intermediary metabolite in degradation of purine to uric acid?

A. CMP
B. GMP
C.
- Hypoxanthine
D. IMP
E. PRPP

15) A 36 y/o male came in for regular check-up. Dr found out he has hyperuricemia. He
admitted to drinking excessively a few days ago. What is most likely causing his
condition?

A. Deficiency in xanthine oxidase

B. excess pyrimidine Source: PubMed
C. lack of PRPP for salvage pathway
D.
- Decreased excretion of uric acid
E. Lack of purine

16) Highest amount of voltage gated Na channel?

A. axon hillock
-
B. nodes of ranvier
C. dendrites
D. cell body
E. terminal bouton

17) End diastolic volume: 140ml co: 4.9L/min HR: 70 beat per min. what is the ejection
fraction?

A. 0.4
B. 0.45
C.
- 0.5
D. 0.55
E. 0.6

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18) Hypoxic hypoxia drives respiration by stimulating?

A. Central chemoreceptor Only responds to hypercapnia.

-
B. Chemoreceptor at carotid body
C. Low pressure baroreceptor
D. Pontine respiratory neuron
E. Pulmonary mechanoreceptor

19) Which of the following describe the release of neurotransmitter from the hair cells
during sound conduction in cochlea?

-
A. Bending of hair cells (stereocilia)
B. Efflux of K+ into the endolymph
C. Rapid vibration hair cells
D. Efflux of Na+ into endolymph
E. Influx of Cl- into perilymph

20) Which of the following best describes the relationship between blood pressure and its
determinants?

A. BP = CO ÷ TPR
-
B. BP = CO × TPR
C. BP = SV + HR
D. BP = SV × HR
E. BP = SV × End Systolic Volume

21) Lowest Left Ventricle Pressure?

-
A. 0
B. 25
C. 80
D. 100
E. 120

22) The increase in the slope of the pacemaker potential following sympathetic activation
is mainly due to the increase in?

A. Ca2+ efflux from the L-type channels

B. Ca2+ influx from the T-type channels
C. K+ efflux from the voltage-gated channels
-
D. Na+ influx from the funny sodium channels
E. Na+ influx from the voltage-gated channels

23) Defect in Cystic Fibrosis Transmembrane Receptor (CFTR) channel expression

causes an increase in airway luminal?

A. Chloride concentration
B. Fluid pH
C. Fluid volume
D.
- Mucous viscosity
E. Sodium concentration

4
24) Mrs X presented with COPD and heart failure. She was given a drug to reduce the AV
node rate. and to increase cardiac output.

A. Ivabradine Only reduces HR does not affect CO

B. Propanolol
C. Captopril
D. Spironolactone
E.
- Digoxin

25) A 60y/o man has HF was given diuretics. He later developed AF. He was then given
digoxin for the dysrhythmia. He then developed digoxin toxicity suspected due to
hypokalaemia. Which diuretic is the cause?

A. Amiodarone
-
B. Frusemide Loop diuretics
C. Metanazole
D. Hydrochlorothiazide
E. Spironolactone

26) 60yo female was admitted due to ARDS and undergo endotracheal tube procedure.
Before the procedure she was given a neuromuscular blocking agent and she had
uncontrolled muscle contraction. What is the drug given?

A. Atracurium
B. d-tubocurarin
C. mivacurium
D. rocuronium
-
E. suxamethonium Rapid sequence induction

27) In general, individuals with renal failure will have a change in their pharmacokinetic
profile of drugs. What is the change that can be seen in the individual?

A. Area under the curve (AUC) decrease

B. Clearance of the drug increase
C. Elimination rate constant of the drug increase
-
D. Half life of the drug increase Slow excretion of the drug
E. Volume of distribution of the drug decrease

28) 78 year old female presents with red swollen joints, a scan showed rhomboid shaped
crystals with positive birefringence in polarised light. What are the crystals made out
of?

-
A. calcium pyrophosphate
B. uric acid Needle-shaped, negatively birefringent
C. sodium
D. potassium
E. sodium chloride

5
29) 60 year old male presents with pain in lower abdomen, examination reveals non tender
pulsatile mass, CT scan shows fusiform mass associated with abdominal aorta just
below the level of the origin of the renal arteries. Which of these is most commonly
associated with this condition?

-
A. Artherosclerosis Atherosclerotic abdominal aortic aneurysm
Source: First Aid for the USMLE Step 1 2018
B. Hypertension
C. Obesity
D. Diabetes Mellitus
E. Smoking

30) A 60y/o man was recently diagnosed with severe aortic stenosis. His other heart valves
are normal. Which is the most likely cause of this abnormality?

-
A. Bicuspid aortic valve
B. Chronic rheumatic valve disease Mitral stenosis
C. Congenital aortic stenosis
D. Infective endocarditis
E. Myxomatous degeneration Mitral valve prolapse → mitral valve regurgitation

31) Female,62, known HTN, come for follow up and complain of persistent headache.

A. Excessive salt intake

B. Alcohol
C. Hormone replacement therapy
-
D. Pheochromocytoma
Source: First Aid for the USMLE Step 1 2018
E. Analgesics such as paracetamol

32) Which of the following is true regarding hypertension?

A. It is well controlled in most patients

B.
- It is common among elderly
C. Ambulatory BP can be used for diagnosis
D. No effect on ECHO
E. It is congenital

33) Which best describe jugular venous pressure (JVP)?

-
A. a rise of 3cm is normal
B. it is measured from sternal notch to jugular venous pulsation Sternal angle
C. measured when patient recumbent 45 degrees
D. It is usually visible
E. It shows left atrium involvement Right atrium

34) An 18 year old girl with no medical abnormalities presented with syncope. Her friend
claimed that it was transient and there were no salivation. She was standing under the
hot sun while the incident happened.

A. cardiogenic syncope
B.
- vasovagal syncope
C. stroke
D. situational syncope
E. seizure

6
35) A 18 year old obese teenager complained of excessive daytime sleepiness. His mother
reported that he is watching FIFA World Cup recently and frequently wake up late. His
mother also noted he kicks and shout during his sleep. What is the cause of his
symptoms?

-
A. Delayed sleep phase syndrome
B. Narcolepsy
C. Obstructive sleep apnea
D. Periodic limb movement disorder
E. Substance or medication use

36) Mr X has interstitial lung disease, atrial fibrillation and congestive heart disease. His
CXR showed bilaterally consolidation: Which of the drug cause interstitial lung
disease?

A. Amiodarone
-
B. Aspirin
C. Digoxin
D. Spironolactone
E. Warfarin

37) Which method is the best to diagnose active pulmonary tuberculosis?

A. chest radiograph
B. chest ct scan
C. Tuberculin skin test Latent
D. Sputum gram stain culture for mycobacterium tuberculosis
-
E. Sputum acid fast bacilli stain

38) The spirometry result shown below for man with breathlessness FEV1- 0.7L (55%
predicted) FVC- 1.5L (65% predicted) RV- 1.4L (160% predicted) TLC- 2.9L (150%
predicted) High RV and TLC due to hyperinflation

-
A. bronchial asthma FEV1/FVC ratio = 0.7/1.5 < 0.7 - obstructive lung disease
-
B. COPD
C. covid-19 pneumonia
D. interstitial fibrosis
E. silicosis

39) 55 year old man came in for emergency laparotomy due to perforated bowel. He has
acute kidney disease with potassium level 55mmol. Use what muscle relaxant?

A. Atracurium
B. Cis atracurium
C. Pancurorium
D. Rocurorium
-
E. Succinylcholine

7
40) Closed left hip fracture, closed bilateral femur fractures, closed right tibial fracture.

-
A. Hypovolemic shock Due to internal bleeding
B. Cardiogenic shock
C. Obstructive shock
D. Neurogenic shock
E. Septic shock

41) What is the commonest manifestation of cutaneous psoriasis?

A. Erythrodermic psoriasis
-
B. Plaques at the extensor surfaces of knee and ankle
C. Pustules at the soles and palms
D. Scaling scalp and hyperkeratosis
E. Flexural plaques

42) 35 yo man, unwell for a month. He describes himself as a workaholic, perfectionist,

and is constantly under stress. He has family history of hypertension, bmi 28,
presented slightly anxious. Upon checking, he has hypertension. What is the factor
that cause him to have this symptom?

-
A. Type A personality
B. Borderline personality trait
C. Sedentary lifestyle
Source: Robbins Basic Pathology 10e
D. Obesity
E. Family history

43) 25 y/o Man, Healthy, non-smoker, went for blood pressure screening. Father has
history of hypertension. First bp - 140/96, Second bp - 144/90, BMI - 28 , Glucose - 5.
What the best management?

A. Annual screening
B. anti-hypertensive drug
-
C. modification of lifestyle
D. hospitalisation
E. allow patient to go home

44) A 40 y/o woman with gestational diabetes delivered a term baby girl.Which of the
following supports the diagnosis of Down Syndrome during newborn examination?

A. cleft palate
-
B. hypotonia
C. large tongue
D. presence of cardiac murmur
E. small head

45) During exercise, cardiac output

Source: Lecture - Down syndrome
A. Increase prior to exercise due to adrenaline acting on AV node
B. No direct relationship with exercise intensity
C. Will sudden increase after exercise session stop
D. Will have sharp reduction below resting level towards rest from exercise
-
E. Plateau during steady state exercise

8
46) Which of the following is the abnormality of Rapid Eye Movement (REM) sleep?

-
A. Acting out the dreams
B. Associated with the dreams
C. Recur throughout the night
D. Leg muscles are paralysed
E. Lasts around half an hour

47) A man presented with 1 month and 2 weeks of fever and night sweats. Chest
radiograph shows cavitating opacity at the upper left lobe. What is the likely diagnosis?

A. Bronchiolitis
B. Pneumonia
C. Lung abscess
D. Lung cancer
-
E. Tuberculosis

48) A 12-month old baby went to the clinic for his regular checkup. Which immunisation is
he given?

A. BCG
B. Diphteria, pertussis, tetanus, polio, Hib
-C. MMR
D. Hep B
E. Oral Polio

49) What is the primary prevention for diabetes?

A. Community health screening of fasting sugar blood Secondary prevention

B. Community service for foot cleaning
-
C. Exercise in university
D. App message for adherence to diabetes medication
E. YouTube for complications of diabetes

50) Which of the following virus caused a major outbreak in 2003?

A. H1N1
B. H1N5
C. Influenza B
D. MERS
E.
- SARS

51) What is the environmental factor of development of asthma?

A. Gender
B. Genetic
C. Atopic history
D. Obesity
-
E. Tobacco smoke

9
EMQ

A. Brachioradialis
B. extensor indicis
C. extensor pollicis brevis
D. extensor pollicis longus
E. flexor carpi ulnaris
F. flexor carpi radialis
G. flexor digitorum
H. palmaris longus

52) Paralysis of this muscle will cause weakness of abduction of wrist joint. F

53) This muscle has a short belly long tendon and is often used for grafting. H

A. Obturator fossa
B. Greater sciatic foramen
C. Iliac crest
D. Ischial spine
E. Ischial tuberosity
F. Lesser sciatic foramen
G. Obturator foramen
H. Posterior superior iliac spine
Source: Wikipedia
54) Proximal attachment of tensor fasciae latae. C

55) When sitting, most of the body weight is transferred to this bony part. E

A. Eponychium
B. Hyponychium
C. Nail bed
D. Nail root
E. Nail matrix
F. Lunula
G. Nail plate
H. Nail fold

56) Removal of this part during manicure and pedicure can cause inflammation of
surrounding tissues. A

57) Injury to this part cause permanent loss of nail. E

10

Source: Lecture - Histology of Skin

A. Aneurysmal bone cyst
B. Chondroblastoma
C. Chondrosarcoma
D. Ewing sarcoma
E. Giant cell tumour
F. Multiple Myeloma
G. Osteochondroma
H. Chondrosarcoma

58) Blood filled cyst at metaphysis and diaphysis. A Source: First Aid for the USMLE Step 1 2018

59) Lytic bone lesion associated with Bence-Jones protein with raised M protein. F

A. Adenocarcinoma
B. Diffuse large B cells carcinoma
C. Lymphoma
D. Hamartoma
E. Large cell carcinoma
F. Bronchioaveolar carcinoma
G. Neuroendocrine tumors
H. Squamous cell carcinoma Source: Robbins Basic Pathology 10e

60) Cancer strongly associated with smoking and usually located at centre and hilar region. H

61) Which type of neoplasia produces hormones that causes paraneoplastic syndrome? G

A. STEMI
B. non STEMI
C. stable angina pectoris
D. unstable angina
E. pulmonary embolism
F. pneumothorax
G. pericarditis
H. pulmonary edema

62) A 23 year old women with no medical illness came to the hospital for chest pain for 2
days. The pain is central and has no radiation. It was described as sharp and constant.
She also had cough and runny nose associated with fever for one week. The chest
pain is worsened when lying down and relieved when sitting. Electrocardiogram shows
saddle shaped ST segment elevation. G

11
A. alpha 1 antitrypsin deficiency
B. bronchial asthma
C. bronchiectasis Source: First Aid for the USMLE Step 1 2018
D. COPD
E. hypersensitivity pneumonitis
F. idiopathic pulmonary fibrosis
G. lung cancer
H. pneumonia

63) Chronic smoker withe FEV1/FVC ratio value below 0.7 D

Question memorised wrongly? Liver disease?

64) Patient with family history of renal disease. He doesn’t smoke but complains of
breathlessness. A

A. Make a report to the hospital management

B. Make a report to Malaysian Medical Council
C. Make a police report
D. Sue the surgeon in the law of contract
E. Sue the surgeon in the tort of negligence

65) A 42 year old woman sustained a significant deformity of her nose from the cosmetic
surgery done on it. She wants financial compensation from the surgeon. What is the
best option for her under Malaysian legal system? E

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