This Handbook of Multiple Choice Questions is the fourth in a series of publications that has been produced by the Australian Medical Council (AMC) to assist International Medical Graduates (IMGs) prepare for the AMC examinations. The AMC and the authors of this and earlier documents deserve considerable recognition for their insight, commitment and expertise in supporting IMGs’ entry into the Australian medical system, and for doing so in a manner which assures the Australian public about their competence. The introduction to this book lists the many clinicians who have contributed to its development. They are among the most respected doctors in Australia. These same clinicians devote many days each year to the development and review of materials for the AMC examinations and most have been doing so for many years. Their commitment to the AMC and its examinations underscores the respect they have and priority they assign to the AMC and its role and, more importantly, the quality of the assessment materials comprising the AMC examinations.
The examinations of the AMC are developed to assess competence at the level of a graduate from an Australian medical school, and assess competence relative to the requirements of safe, effective medical practice and health care in Australia. Effective this year, IMGs seeking general registration through the Standard Pathway must pass the AMC’s multiple choice question (MCQ) examination as a precondition to working in Australia. This latest publication serves IMGs well as an introduction and orientation to this examination. It has been over a decade since the AMC produced its first publication in this series. The first publication, like this current publication, addressed the needs of IMGs in their preparation for the AMC MCQ examination. A comparison of the first and fourth booklets identifies a remarkable evolution of the MCQ examination; from an emphasis on the assessment of an IMG’s knowledge base to one of testing their ability to make key clinical decisions underlying safe and effective clinical practice. This evolution is based on the recognition that, while possessing knowledge remains a cornerstone of clinical competence, the ability to apply that knowledge in the context of clinical problems is the real test of clinical competence, and that knowing alone is a necessary but not sufficient condition to being clinically competent.

Every person on this planet began life as one cell, about the same size as this period. Each one of us remained like this for about 24 hours before dividing in two—the first step toward creating the complex, multicellular organism that humans are today. It is an incredible and fascinating thought, that a human could have been contained in a single cell, and that, perhaps more remarkable still, that one basic unit of life knew what to do to next. To understand just how important cells are, consider the following. The total number of living things currently inhabiting our planet is unimaginably large (there are an estimated 8.7 million unique species, most of them numbering millions, billions, or trillions of individuals), and every last one of them, without exception, is made of one or more cells. Next, consider the incredible variety of processes and materials that occur in the natural world. The glow of a firefly, a plant bending toward the light, cancer, a 100-meter sprint, wood, mucus, elephant dung, a blue whale’s skeleton, body odor, the memory of the smell of ratatouille, the call of a howler monkey, houseplants, a hawk’s beak, a snake’s venom … all of these are the result of activity in cells. What is this life?
The difference between a living and a nonliving thing has always been difficult to define. Biologists generally agree that for something to be considered alive it must satisfy a set of criteria, including the use of energy to build complex molecules and organize its internal systems, and the ability to respond to its surroundings and to reproduce. Rhododendrons and ants satisfy all of these criteria—but only because they are made of cells, life’s building blocks. Cells are life, and to understand their behavior, their structure and their remarkable microscopic and submicroscopic machinery is to understand life itself. Chapter one outlines the history of that understanding (so far), and examines some of the tools and techniques that have nurtured it. A cell is just a mixture of molecules, a cocktail of chemicals, inside a little bag. Despite the unambitious simplicity of that description…

In our world there is no form of matter more astonishing than the living cell: tiny, fragile, marvelously intricate, continually made afresh, yet preserving in its DNA a record of information dating back more than three billion years, to a time when our planet had barely cooled from the hot materials of the nascent solar system. Ceaselessly re-engineered and diversified by evolution, extraordinarily versatile and adaptable, the cell retains a complex core of self-replicating chemical machinery that is shared and endlessly repeated by every living organism on the face of the Earth—in every animal, every leaf, every bacterium in a piece of cheese, every yeast in a vat of wine. Curiosity, if nothing else, should drive us to study cell biology; we need to understand cell biology to understand ourselves. But there are practical reasons, too, why cell biology should be a part of everyone’s education. We are made of cells, we feed on cells, and our world is made habitable by cells. The challenge for scientists is to deepen our knowledge of cells and find new ways to apply it.
All of us, as citizens, need to know something of the subject to grapple with the modern world, from our own health affairs to the great public issues of environmental change, biomedical technologies, agriculture, and epidemic disease. Cell biology is a big subject, and it has links with almost every other branch of science. The study of cell biology therefore provides a great scientific education. However, as the science advances, it becomes increasingly easy to become lost in detail, distracted by an overload of information and technical terminology. In this book we therefore focus on providing a digestible, straightforward, and engaging account of only the essential principles. We seek to explain, in a way that can be understood even by a reader approaching biology for the first time, how the living cell works: to show how the molecules of the cell—especially the protein, DNA, and RNA molecules—cooperate to create this remarkable system that feeds, responds to stimuli, moves, grows, divides, and duplicates itself.

Since the early 1970s, when recombinant DNA technology was first developed, there has been a veritable explosion of knowledge in the biological sciences. Since that time, with the advent of PCR, chemical DNA synthesis, DNA sequencing, monoclonal antibodies, directed mutagenesis, genomics, proteomics, and metabolomics, our understanding of and ability to manipulate the biological world have grown exponentially. When the first edition of Molecular Biotechnology: Principles and Applications of Recombinant DNA was published in 1994, nearly all of the transgenic organisms that were produced included only a single introduced gene. Just 15 years later, it is not uncommon for researchers to engineer organisms by modifying both the activity and the regulation of existing genes while at the same time introducing entire new pathways. In 1994, only a handful of products produced by this new technology were available in the marketplace. Today, molecular biotechnology has given us several hundred new therapeutic agents, with many more in the pipeline, as well as dozens of transgenic plants. The use of DNA has become a cornerstone of modern forensics, paternity testing, and ancestry determination. Several new recombinant vaccines have been developed, with many more on the horizon. The list goes on and on. Molecular biotechnology really has lived up to its promise, to all of the original hype.
It has been estimated that worldwide there are currently several thousand biotechnology companies employing tens of thousands of scientists. When the exciting science being done at universities, government labs, and research institutes around the world is factored in, the rate of change and of discovery in the biological sciences is astounding. This fourth edition of Molecular Biotechnology, building upon the fundamentals that were established in the previous three editions, endeavors to provide readers with a window on some of the major developments in this growing field in the past several years. Of necessity, we have had to be highly selective in the material that is included in this edition. Moreover, the window that we are looking through is moving. This notwithstanding, we both expect and look forward to the commercialization of many of these discoveries as well as to the development of new approaches, insights, and discoveries.

The science of genetics has been evolving rapidly. The DNA of genomes, even large ones, can now be analyzed in great detail; the functions of individual genes can be studied with an impressive array of techniques; and organisms can be changed genetically by introducing alien or altered genes into their genomes. The ways of teaching and learning genetics have also been changing. Electronic devices to access and transmit information are ubiquitous; engaging new media are being developed; and in many colleges and universities, classrooms are being redesigned to incorporate “active learning” strategies. This edition of Principles of Genetics has been created to recognize these scientific and educational advances. Goals Principles of Genetics balances new information with foundational material.
In preparing this edition, we have been guided by four main goals:
• To focus on the basic principles of genetics by presenting the important concepts of classical, molecular, and population genetics carefully and thoroughly. We believe that an understanding of current advances in genetics and an appreciation for their practical significance must be based on a strong foundation. Furthermore, we believe that the breadth and depth of coverage in the different areas of genetics— classical, molecular, and population—must be balanced, and that the ever-growing mass of information in genetics must be organized by a sturdy—but flexible— framework of key concepts.
• To focus on the scientific process by showing how scientific concepts develop from observation and experimentation. Our book provides numerous examples to show how genetic principles have emerged from the work of different scientists. We emphasize that science is an ongoing process of observation, experimentation, and discovery.
• To focus on human genetics by incorporating human examples and showing the relevance of genetics to societal issues. Experience has shown us that students are keenly interested in the genetics of their own species. Because of this interest, they find it easier to comprehend complex concepts when these concepts are illustrated with human examples. Consequently, we have used human examples to illustrate genetic principles wherever possible. We have also included discussions of the Human Genome Project, human gene mapping, genetic disorders, gene therapy, and genetic counseling throughout the text.

As the daughter of a NASA scientist I was raised to have an analytical mind. A part of me craves method, data, and evidence. I started journaling at the age of seven, carrying my notebooks everywhere. I filled them with charts, graphs, observations, and plans concerning everything from what I ate that day to what to rent at the video store. I was a curious child, constantly asking, “Why?” My parents would send me to the trusty encyclopedia to look up the answer. At the same time, I have always been artistic, creative, and interested in spirituality. My notebooks are also filled with elaborate stories, poetry, and colorful drawings. My undergraduate studies in art led to burnout. Like many people, I came to yoga hoping to relieve stress and anxiety during a difficult time—with the added bonus of staying fit. I didn’t expect that yoga would transform me in an ineffable, seemingly magical way. When I started practicing, I aimed to make the pictureperfect poses. I slowly realized that yoga isn’t about performing the pose “perfectly,” but instead about being perfectly okay with my body and mind in the moment. Now I know that many of the most profound effects of poses transcend my anatomy of muscles and bones to shape my neurology, psychology, and energetic body.
I vividly remember lying on my mat at the end of a yoga class with my eyes wide open, looking impatiently around when I was supposed to be relaxing. I thought “What a waste of time; I have work to do!” With practice, I started to enjoy the way relaxation and meditation practices made me feel. Now, through reading research, I know that when I meditate, I am literally reshaping my brain. Ultimately, I am impacting every single system of my body, and optimizing function. What more important work could I possibly do? My shifting mindset drew me to the Himalayas to study yoga, massage, and healing arts. My teacher, Yogi Sivadas, renewed my interest in science. I returned to the US and completed the pre-medicine courses, in pursuit of understanding how and why yoga works in such life-changing ways. I will never forget the first time I held a human brain in the cadaver lab. The experience was neither antiseptic nor clinical, but deeply spiritual. That three-pound folded gray mysterious mass once both computed mathematics and felt the depths of love. Holding that brain, I knew that the mind-body connection was a key mechanism behind yoga’s benefits.

The American College of Surgeons (ACS) was founded to improve the care of surgical patients, and it has long been a leader in establishing and maintaining the high quality of surgical practice in North America. In accordance with that role, the ACS Committee on Trauma (COT) has worked to establish guidelines for the care of injured patients. Accordingly, the COT sponsors and contributes to the continued development of the Advanced Trauma Life Support (ATLS) Program. The ATLS Student Course does not present new concepts in the field of trauma care; rather, it teaches established treatment methods. A systematic, concise approach to the early care of trauma patients is the hallmark of the ATLS Program. This Ninth Edition was developed for the ACS by members of the ATLS Committee and the ACS COT, other individual Fellows of the College, members of the international ATLS community, and nonsurgical consultants to the Committee who were selected for their special competence in trauma care and their expertise in medical education. (Please see the listing at the end of the Preface and the Acknowledgements section for names and affiliations of these individuals.) The COT believes that those individuals who are responsible for caring for injured patients will find the information extremely valuable. The principles of patient care presented in this manual may also be beneficial for the care of patients with nontrauma-related diseases. Injured patients present a wide range of complex problems. The ATLS Student Course presents a concise approach to assessing and managing multiply injured patients. The course presents providers with knowledge and techniques that are comprehensive and easily adapted to fit their needs. The skills described in this manual represent one safe way to perform each technique. The ACS recognizes that there are other acceptable approaches. However, the knowledge and skills taught in the course are easily adapted to all venues for the care of these patients. The ATLS Program is revised by the ATLS Committee approximately every four years to respond to changes in available knowledge and incorporate newer and perhaps even safer skills. ATLS Committees in other countries and regions where the Program has been introduced have participated in the revision process, and the ATLS Committee appreciates their outstanding contributions. National and international educators review the educational materials to ensure that the course is conducted in a manner that facilitates learning. All of the course content is available in other resources, such as textbooks and journals.

This book helps doctors and students to arrive at a diagnosis, and to explain and to justify their reasoning, especially when seeing patients with new problems that lie outside their personal range of experience. This will happen very frequently to students, frequently to house officers, but will still happen regularly to very experienced senior hospital doctors and general practitioners. The book adopts the approach used by experienced diagnosticians, by focusing on the finding with the shortest differential diagnosis (i.e. the best diagnostic lead). It describes the differential diagnoses of such findings that may be encountered by a reader in the history, examination and usual preliminary tests and how the diagnoses can be confirmed. It describes what tactics to adopt in order to find better leads, while not losing sight of the patient’s original concern. The probability and set theory of this process is explained in Chapter 3. The entries on each page of the book resemble a traditional past medical history with multiple diagnoses.
The reader scans down the page to see which of the diagnoses with its findings match the patient’s findings so far. The compatible findings can then be used as evidence for the diagnosis and treatment, to be shared with the patient and other members of the multidisciplinary team, such as nurses, pharmacists, physiotherapists, and other professionals allied to medicine. It can be used to create high-quality discharge or handover summaries. Patients or their carers may wish to share in the diagnostic and decision-making process. In order to do this, they need to know what problems have been identified and the tests and treatments being proposed. They will need to know which of these diagnoses explain each problem and treatment. They may also need to know which findings are being used to confirm each diagnosis, and to choose its treatments and to mark the outcome. The book describes how this information can be provided in writing. The patient or carer will then be in a position to explain all this to another doctor, if necessary.