2008
Question 6.
At a site of localised reduction in arterial vessel diameter of a flowing vessel:
a) blood pressure increases
b) blood velocity increases
c) vessel wall tension decreases
d) blood flow is unlikely to become turbulent
e) the intima is the most likely layer to be abnormal, if the cause of the diameter
reduction is structural.
(2.5 marks)
Question 9.
The Angiotensin Converting Enzyme (ACE) inhibitors:
a) produce sustained inhibition of ACE activity
b) increase the risk of new-onset heart failure
c) increase the secretion of aldosterone from the adrenal gland
d) reduce the activity of the sympathetic nervous system
e) induce sexual dysfunction in about 25% of patients
(2.5 marks)
Question 10
Carotid baroreceptors:
a) are located in the external carotid artery wall
b) exert a beat-to-beat control of blood pressure
c) directly control the synthesis and secretion of aldosterone
d) are tonically controlled by cells located in the macula densa
e) modulate peripheral vascular resistance
(2.5 marks)
QUESTION 19
(a) Describe the correct procedure of blood pressure measurement:
(6 marks)
(b) Describe the physiological basis of Korotkoff sounds.
(6 marks)
2007
Question 1.
Describe the biosynthesis, mechanism(s) of action and main roles of angiotensin II in cardiovascular
system regulation.
(10 marks)
Question 8.
Beta-blockers
a) selectively block the β2-receptors in the peripheral vasculature, thus causing vasodilatation.
b) are better than ACE inhibitors in preventing stroke in patients with essential hypertension.
c) are contraindicated in patients with ischaemic heart disease.
d) increase the risk of new onset diabetes in patients with hypertension.
e) induce sexual dysfunction in approximately 35% of male patients.
(2.5 marks)

2006
Question 1.
Describe the synthesis, mechanism(s) of action and main role(s) of endothelial nitric oxide in
cardiovascular system regulation.
(10 marks)
Question 2.
Heterozygous Familial Hypercholesterolemia:
a) Explain the abnormality of lipoprotein metabolism that gives rise to heterozygous familial
hypercholesterolemia.
(4 marks)
b) How is a high LDL-cholesterol atherogenic?
(4 marks)
c) How do statin drugs lower LDL-cholesterol?
(2 marks)
Question 3.
Choose ONE of the following physiological situations, and describe the normal cardiovascular
responses, which occur as a consequence. Give two examples where the 'normal' response does not
occur in your chosen situation.
a) horizontal to upright tilt (over 3-5 seconds)
b) valsalva manoeuvre
c) haemorrhage (of approximately 1 litre over approximately 30 min)
(10 marks)
Question 5.
At a site of localised reduction in blood vessel diameter of a flowing blood vessel:
a) blood velocity decreases because vessel radius is less
b) blood pressure increases
c) blood flow is more likely to become turbulent
d) the lateral component of blood pressure decreases
e) the kinetic component of blood pressure decreases
(2.5 marks)
Question 8.
The Angiotensin Converting Enzyme (ACE) inhibitors:
a) induce sexual dysfunction in about 25% of patients
b) increase the risk of new-onset heart failure
c) increase the secretion of aldosterone from the adrenal gland
d) reduce the activity of the sympathetic nervous system
e) produce sustained inhibition of ACE activity
(2.5 marks)

2005
Question 1
Outline the changes in blood systolic, diastolic and pulse pressures that occur with advancing age,
and the likely mechanisms believed to be responsible for these changes.
(10 marks)
Question 6
Carotid baroreceptors:
a) directly control the synthesis and secretion of aldosterone
b) exert a beat-to-beat control of blood pressure
c) are located in the external carotid artery wall
d) are tonically controlled by cells located in the macula densa
e) modulate peripheral vascular resistance
(2.5 marks)
Question 7
Calcium channel blockers
a) exert their antihypertensive effects primarily by reducing cardiac contractility
b) can cause bilateral ankle oedema
c) are subdivided into four sub-classes according to their pharmacologic characteristics
d) have beneficial effects in patients with both hypertension and ischaemic heart disease
e) do not cause hypokalemia
(2.5 marks)

Initial Patient Presentation:
Beverley Jones, a 63-year-old lady, is worried that she may have high blood pressure. She is
currently well, but incidentally discovered high blood pressure values when she checked her blood
pressure via her husband’s home monitor. In March 2002, she arranged an appointment with her
GP in Noarlunga.
Question 10
List and justify the key history questions you suggest the GP should ask this patient.
(10 marks)
Question 11
What key specific investigations and/or clinical examination(s) should be undertaken to exclude
/confirm the presence of target organ damage in this patient. Explain how each investigation /
clinical examination you mention would confirm / exclude target organ damage.
(6 marks)
Question 12
(a) Describe the correct procedure of blood pressure measurement in the normal GP’s office
setting.
(5 marks)
(b) Describe the physiological basis of Korotkoff sounds.
(5 marks)
The GP undertook a complete physical examination and arranges a series of tests for Mrs Jones,
who was booked for a second visit in 7 days time.
History Information from the GP’s initial consultation with Mrs Jones:
• She is generally well and reports no specific symptoms
• Reliable home blood pressure recordings vary between 160-180 systolic, 90-100 diastolic.
• Non-smoker
• She has a family history of ischaemic heart disease (brother died of heart attack aged 52) and
cerebrovascular disease (mother died of stroke age 69)
• Post-menopausal for 11 years
• Not known to be diabetic
• Overweight (BMI = 34)
Clinical Examination
• Pulse regular, BP 169/96 after resting, equal in both arms
• Cardio-respiratory examination unremarkable
• Abdominal examination unremarkable
• Urinalysis shows no proteinura, and no glycosuria
Further Information from a subsequent consultation of the GP’s with Mrs Jones, in Sept 2002 (6
months later):
After 6 months monitored treatment with a non-pharmacological protocol,
• BP remains elevated
• Mrs Jones remains significantly overweight (BMI = 32)
Question 13
List and comment briefly on at least 4 lifestyle modifications you consider the GP should have
advised this patient about during these past 6 months.
(8 marks)
The GP plans to start tablet treatment to control her BP. However, Mrs Jones is wary of tablet
treatment for a problem that is not currently causing her any symptoms; she wants to know why she
should take a table on a regular basis.
Question 14
What specific point(s) should the GP stress about the patient commencing on a course of antihypertensive
drug therapy at this time?
(5 marks)
Question 15
At what time(s) after commencing drug therapy, or after a drug dosage change, should the GP
monitor the effect of treatment? Explain.
(3 marks)
The GP plans to use a thiazide diuretic regimen (hydrochlorothiazide, 12.5 mg/day).
Question 16
(a) By what mechanism(s) do thiazide diuretics exert their antihypertensive effects?
(5 marks)
(b) List 4 clinical and metabolic side effects of this treatment that might be anticipated.
(5 marks)
From results of her investigations, Mrs Jones was found to have essential hypertension (ie no
obvious caused identified).
By June 2005, after three years on diuretic therapy only, Mrs Jones had developed congestive heart
failure.
Question 17
In this situation identify and comment briefly on 2 additional drugs that have been shown to control
blood pressure and halt the progression of heart failure.
(4 marks)