MCQs VIA WEB 2005

By A. H.

Medicine MCQS VIA WebCopyright 2005 Elsevier Limited. All rights reserved. Fleshandbones is a registeredtrademark of Harcourt, Inc. in the United States and other jurisdictions, used under licenseThese mcqs were donloaded By Ahmed Hakim ahmedhakim_227@yahoo.comTESTModule4Question 1. The pulse:(a) In pulsus paradoxus the rate slows during inspiration. (False)(b) Pulsus alternans indicates a poorly functioning left ventricle. (True)(c) A tachycardia of 150 beats per minute in a resting patient usually implies an underlying cardiac arrhythmia. (True)(d) A collapsing pulse may be noticed in thyrotoxicosis. (True)(e) Corrigan's sign supports a diagnosis of aortic stenosis. (False)

Question 2. Heart murmurs:(a) A low rumbling diastolic murmur with presystolic accentuation may be heard in mitral stenosis accompanied by

atrial fibrillation. (False)(b) Causes of a pansystolic murmur include mitral regurgitation and ventricular septal defect. (True)(c) A systolic murmur heard over the whole praecordium associated with a thrill usually indicates aortic stenosis.

(True)(d) Left heart murmurs are best heard during expiration. (True)(e) An early blowing diastolic murmur at the left sternal edge indicates aortic incompetence. (True)

Question 3. Pulsus paradoxus:(a) The volume of the pulse increases in inspiration. (False)(b) Can be confirmed by detecting >10 mmHg difference in systolic pressure during the breathing cycle. (True)(c) Is a sign of severe asthma. (True)(d) Is called paradoxus because it is the opposite of what normally happens to the pulse. (False)(e) Can occur in cardiac tamponade. (True)

Question 4. The jugulovenous pressure:(a) Is raised if it is 2 cm from the sternal angle with the patient seated at 45. (False)(b) Tall 'a' waves may be seen in pulmonary hypertension. (True)(c) Irregular cannon waves indicate complete heart block. (True)(d) Regular cannon waves may indicate a nodal rhythm. (True)(e) Giant 'v' waves and a pulsatile liver indicate tricuspid stenosis. (False)

Question 5. The physical signs of an uncomplicated large pneumothorax include:(a) The trachea deviated to the opposite side. (False)(b) A clicking sound synchronous with the heart beat. (True)(c) Symmetrical expansion of the chest. (False)(d) Increased breath sounds over the pneumothorax. (False)(e) Increased percussion note over the pneumothorax. (True)

Question 6. The following would help distinguish between a kidney and a spleen in the left upper quadrant:(a) Dull to percussion over the mass. (False)(b) A well-localized notched lower margin. (False)(c) Moves with respiration. (False)(d) A ballottable mass. (True)(e) A family history of renal failure. (True)

Question 7. Nystagmus:(a) Vertical nystagmus usually indicates a lesion of the medulla oblongata. (False)(b) Horizontal nystagmus is usually ipsilateral to an irritative lesion of the labyrinth. (False)(c) Ataxic nystagmus indicates a lesion of the medial longitudinal bundle. (True)(d) May be absent in a lesion of the cerebellar vermis (the central part). (True)

MCQs VIA WEB 2005

By A. H.

(e) Pendular nystagmus may indicate partial blindness. (True)

Question 8. The following would suggest an upper rather than a lower motor neuron lesion:(a) Fasciculation. (False)(b) Increased tone. (True)(c) An absent plantar reflex. (False)(d) Clonus. (True)(e) Relatively little wasting. (True)

Question 9. Hand signs:(a) Clubbing may be caused by uncomplicated chronic bronchitis. (False)(b) Koilonychia usually indicates liver disease. (False)(c) Osler's nodes and Heberden's nodes both occur in osteoarthritis. (False)(d) Splinter haemorrhages are due to embolic rather than immunological phenomena. (False)(e) Psoriatic arthritis affects most joints in the hand but usually spares the distal interphalangeal (DIP) joints. (False)(True)

Question 10. The face:(a) A malar flush may indicate mitral valve disease or hypothyroidism. (True)(b) A butterfly rash in the face is seen in dermatomyositis. (False)(c) Bell's palsy can cause ptosis due to paralysis of orbicularis oculi. (False)(d) Herpes labialis may be associated with pneumococcal pneumonia. (True)(e) An expressionless face and drooling could indicate Parkinson's disease. (True)

Question 11. The electrocardiogram:(a) The PR interval is measured from the peak of the P wave to the start of the QRS complex. (False)(b) Right axis deviation is indicated by a QRS axis of -35. (False)(c) Q waves in S-II, S-III and aVf indicate a transmural inferior myocardial infarction. (True)(d) Left bundle branch block is suggested by broadening of the QRS complex to 0.10 seconds (two and a half little

squares), and positive RSR' waves in V4-V6. (False)(e) P mitrale is suggested by a P wave taller than 2.5 mm. (False)

Question 12. In the full blood count:(a) A haemoglobin of 10.0 g/dL would be considered normal in a premenopausal woman. (False)(b) Polycythaemia rubra vera is usually indicated by elevation not only of the haemoglobin but also of the white cell

count and platelets. (True)(c) A low platelet count could indicate a flare-up of systemic lupus erythematosus (SLE). (True)(d) High platelets can be seen in gastrointestinal bleeding. (True)(e) A raised mean corpuscular volume is usual in significant alcohol excess. (True)

Question 13. Heart failure:(a) The clinical features of left heart failure include: tachycardia, basal crepitations, pulsus alternans and a raised JVP.

(False)(b) Congestion of the pulmonary veins alone does not result in orthopnoea. (False)(c) Chronic congestive heart failure leads to secondary hyperaldosteronism. (True)(d) Causes of heart failure include ischaemic heart disease, hypertension, and thiamine deficiency. (True)(e) Clinical features of right heart failure include a raised JVP, ankle oedema, and hepatomegaly. (True)

Question 14. Stroke:(a) Cerebral haemorrhage accounts for more than 40% of acute strokes. (False)(b) In supratentorial strokes with homonymous hemianopsia, patients cannot see on the hemiplegic side. (True)(c) Vertigo, vomiting, dysphagia, and Horner's syndrome indicate occlusion of the vertebrobasilar circulation. (True)(d) Pinpoint pupils and bilateral upgoing plantars could signal a brainstem stroke. (True)(e) Carotid endarterectomy should be considered for patients with more than 70% stenosis because this is more

effective than medical treatment. (True)

Question 15. Respiratory failure:

MCQs VIA WEB 2005

By A. H.

(a) Type I failure results in a partial pressure of oxygen (pO2) 6.5 kPa. (False)(b) In respiratory failure associated with chronic bronchitis, the level of carbon dioxide (CO2) determines the

respiratory rate. (False)(c) Respiratory failure as defined in (a) would be an indication for ventilation in pure asthma. (True)(d) Doxapram is a respiratory stimulant used in respiratory failure associated with chronic obstructive pulmonary

disease. (True)(e) The main aim in type II failure is to keep the pO2 >7.0 kPa without worsening of the acidosis or pCO2. (True)

Question 16. Cushing's syndrome:(a) May give rise to hypertension, diabetes, and truncal obesity. (True)(b) Is usually diagnosed by estimation of the urinary free cortisol followed by an overnight dexamethasone suppression

test. (True)(c) Could be associated with pigmentation. (True)(d) The most common cause is probably iatrogenic. (True)(e) Nelson's syndrome is a complication of bilateral adrenalectomy for pituitary-dependent Cushing's disease. (True)

Question 17. Leukaemia:(a) The common presenting triad is infection, bleeding, and fatigue. (True)(b) Acute myeloid leukaemia (AML) may result spontaneously or follow on from CML, polycythaemia rubra vera or

myelosclerosis. (True)(c) The usual development of chronic lymphocytic leukaemia is a transformation to acute lymphoblastic leukaemia.

(False)(d) A platelet count of 40 109/L would not normally give rise to spontaneous bleeding. (True)(e) Bone marrow transplantation is a recognized treatment for AML. (True)

Question 18. Hypertension:(a) An average diastolic blood pressure of >90 mmHg over prolonged observation is an indication for drug treatment in

uncomplicated hypertension. (False)(b) Thiazide diuretics are the least effective antihypertensive drugs. (False)(c) Thiazide diuretics work on the loop of Henle in the kidney. (False)(d) Resistant hypertension is defined as a failure to control the blood pressure adequately with a good three-drug

regimen. (True)(e) Thiazide diuretics are contraindicated in gout and diabetes. (True)

Question 19. Oral corticosteroids:(a) Are an effective treatment for SLE. (True)(b) In the long term may cause cataracts. (True)(c) Should be avoided in sarcoidosis because they induce pulmonary oedema. (False)(d) May be stopped abruptly after 2 weeks of 40 mg prednisolone daily in patients who are not exposed to repeated

courses. (True)(e) May reveal that 15% of patients labelled as having chronic bronchitis, in fact have reversible airways disease.

(True)

Question 20. Paracetamol overdose:(a) Ipecacuana followed by oral methionine is effective for most patients who are just over the treatment line. (False)(b) Can cause renal failure. (True)(c) Intravenous N-acetylcysteine frequently causes anaphylaxis. (False)(d) The serum paracetamol level is of most value between 1 and 4 hours after ingestion. (False)(e) In co-proxamol (distalgesic) overdose, sudden death is likely to be due to hypoglycaemia caused by paracetamol.

(False)

Question 21. Treatment of myocardial infarction:(a) Aspirin and streptokinase are more effective than either alone after myocardial infarction. (True)(b) Thrombolysis improves short-term complications but not mortality after myocardial infarction. (False)

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By A. H.

(c) Tissue plasminogen activator and anistreplase are more effective than streptokinase but not used because they arefar more expensive. (False)(d) ACE inhibitors improve outcome after myocardial infarction for patients with ventricular dysfunction. (True)(e) HMGCo-A reductase inhibitor therapy is contraindicated for patients after myocardial infarction. (False)

Question 22. For self-poisoning:(a) Gastric lavage is recommended for most drugs up to 12 hours after ingestion. (False)(b) Naloxone is the specific antidote for benzodiazepine overdose. (False)(c) Patients with tricyclic antidepressant overdose need cardiac monitoring for up to 48 hours. (True)(d) All patients should be assessed by a qualified psychiatrist. (False)(e) Pinpoint pupils could indicate opiate overdose. (True)

Question 23. Digoxin:(a) Is the treatment of choice for ventricular extrasystoles. (False)(b) May cause xanthopsia. (True)(c) Is excreted by the kidneys. (True)(d) Adverse effects are reduced by hypokalaemia. (False)(e) Must not be coadministered with an ACE inhibitor. (False)

Question 24. Dementia may result from:(a) Parkinson's disease. (True)(b) Huntington's chorea. (True)(c) Hypothyroidism. (True)(d) Acquired immune deficiency syndrome (AIDS). (True)(e) A cerebral tumour. (True)

Question 25. Oxygen:(a) Should be administered with a high inspired concentration (>50%) in the treatment of type II respiratory failure.

(False)(b) Should not be used at high concentration in patients with pulmonary embolism because respiration may be severely

impaired when the hypoxic drive is reduced. (False)(c) Continuous long-term (domiciliary) oxygen improves survival in patients with respiratory failure caused by chronic

bronchitis and emphysema. (True)(d) Is needed when respiratory failure is diagnosed by finding a pO2 of less than 11 kPa in an arterial blood sample.

(False)(e) Comprises 21% of atmospheric air. (True)

Module 5 (Cardiology)Question 2. The differential diagnosis for chest pain includes:(a) Myocardial infarction. (True)(b) Oesophagitis. (True)(c) Pulmonary embolus. (True)(d) Cholecystitis. (True)(e) Aortic dissection. (True)

Question 3. The following are causes of acute life-threatening dyspnoea:(a) Myocardial infarction. (True)(b) Pulmonary embolus. (True)(c) Pneumothorax. (True)(d) Ventricular or supraventricular tachyarrhythmia. (True)(e) Bacterial endocarditis. (True)

Question 4. The following are clinical signs found in infective endocarditis:(a) Clubbing. (True)(b) Haematuria. (True)(c) Pyrexia. (True)(d) Rashes. (True)

MCQs VIA WEB 2005

By A. H.

(e) Focal neurological defect. (True)

Question 5. The following are risk factors for ischaemic heart disease:(a) Hypertension. (True)(b) Moderate alcohol intake. (False)(c) Female sex. (False)(d) Hypercholesterolaemia. (True)(e) Increasing age. (True)

Question 6. The following are classical features of cardiac syncope:(a) Gradual onset. (False)(b) Warning symptoms. (False)(c) Rapid recovery. (True)(d) Residual neurological deficit. (False)(e) Precipitated by sudden turning of the head. (False)

Question 7. The following are causes of a pansystolic murmur:(a) Mitral regurgitation. (True)(b) Aortic regurgitation. (False)(c) Tricuspid regurgitation. (True)(d) Atrial septal defect. (False)(e) Aortic stenosis. (False)

Question 8. The following conditions require antibiotic prophylaxis before dental procedures:(a) Prosthetic aortic valve. (True)(b) Ventricular septal defect. (True)(c) Floppy mitral valve with coexistent mitral regurgitation. (True)(d) Enlarged left ventricle. (False)(e) A history of infective endocarditis in the past. (True)

Question 9. The following should be considered as possible signs of a positive exercise test:(a) ST segment depression. (True)(b) Exercise-induced hypotension. (True)(c) Exercise-induced ventricular tachycardia. (True)(d) Lack of adequate tachycardic response to exercise. (True)(e) Leg pain at peak exercise. (False)

Question 10. The following are indications for anticoagulating a patient who has atrial fibrillation with warfarin:(a) Age under 60 years. (False)(b) Associated mitral stenosis. (True)(c) Atrial fibrillation of more than 24 hours' duration. (True)(d) A history of cerebral thromboembolism. (True)(e) Associated left ventricular failure. (True)

Question 11. The following are true of ventricular tachycardia:(a) It is a life-threatening condition. (True)(b) It may be caused by myocardial ischaemia. (True)(c) It may be caused by hypokalaemia. (True)(d) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardia. (True)(e) Acute ongoing ventricular tachycardia should be treated initially with drugs. (False)

Question 12. The following are signs of coarctation of the aorta:(a) Radiofemoral delay in the pulses. (True)(b) Rib notching. (True)(c) Bruits heard over the scapula. (True)(d) Ankle oedema. (False)

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By A. H.

(e) Atrial fibrillation. (False)

Question 13. Functions of the recovery position include:(a) To prevent the tongue from obstructing the airway. (True)(b) To prevent neck injury. (False)(c) To minimize the risk of aspiration of gastric contents. (True)(d) To maintain a straight airway. (True)(e) To enable cardiopulmonary resuscitation to be carried out. (False)

Question 14. Complications of prosthetic heart valves are as follows:(a) Thromboembolic events. (True)(b) Dehiscence of the valve ring. (True)(c) Increased risk of infective endocarditis. (True)(d) Failure of the valve 5 years after placement. (False)(e) Need for anticoagulation in patients who have porcine valves. (False)

Question 15. The following statements are true of thiazide diuretics:(a) They act at the level of the distal convoluted tubule. (True)(b) They may cause gout. (True)(c) Diabetic control may deteriorate. (True)(d) Hypokalaemia may occur. (True)(e) They cause ototoxicity. (False)

Question 16. The following are classified as high-output states:(a) Hypertension . (False)(b) Sepsis. (True)(c) Hypothyroidism. (False)(d) Pregnancy. (True)(e) Arteriovenous malformations. (True)

Question 18. The following statements are true of the apex beat:(a) It is the lowest and most lateral point at which the cardiac impulse can be felt. (True)(b) It is displaced downwards and laterally if the left ventricle is enlarged. (True)(c) It is thrusting in mitral stenosis. (False)(d) It is thrusting in aortic regurgitation. (True)(e) It is heaving in aortic stenosis. (True)

Question 17. Cardiac causes of clubbing are as follows:(a) Uncomplicated atrial septal defect. (False)(b) Chronic infective endocarditis. (True)(c) Atrial fibrillation. (False)(d) Acute endocarditis. (False)(e) Empyema. (False)

Question 19. The following leads represent the inferior myocardium:(a) I, AVL, and V6. (False)(b) V2, V3, and V4. (False)(c) AVR and V1. (False)(d) V1-V6. (False)(e) II, III, and AVF. (True)

Question 20. The following are possible causes of electromechanical dissociation:(a) Pulmonary embolus. (True)(b) Tension pneumothorax. (True)(c) Hypertension. (False)(d) Dehydration. (True)

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By A. H.

(e) Hypocalcaemia. (True)

Question 21. The following are characteristic of pericarditis:(a) The chest pain is dull in nature. (False)(b) There may be an associated pericardial effusion. (True)(c) The pericardial rub may come and go. (True)(d) The ECG usually shows regional ST elevation. (False)(e) The ST elevation is concave. (True)

Question 22. Secondary hypertension may be due to the following:(a) Renal artery stenosis. (True)(b) Renal cell carcinoma. (False)(c) Cushing's syndrome. (True)(d) Pregnancy. (True)(e) Oral contraceptive pill. (True)

Question 23. ECG changes due to myocardial infarction may include the following:(a) ST elevation. (True)(b) Sinus tachycardia. (True)(c) Ventricular tachycardia. (True)(d) Complete heart block. (True)(e) Q waves. (True)

Question 24. The following drugs are used in the treatment of hypertension:(a) Atenolol. (True)(b) Doxazocin. (True)(c) Enalapril. (True)(d) Bendrofluazide. (True)(e) Nicorandil. (False)

Question 25. Complications of myocardial infarction include:(a) Cardiac failure. (True)(b) Mitral regurgitation. (True)(c) Cerebrovascular event. (True)(d) Myocardial rupture. (True)(e) Gastrointestinal bleed. (False)

Module 6 (Neurology)

Question 1. Concerning neuroanatomy:(a) The corticospinal tract decussates in the pons. (False)(b) The oculomotor nerve runs in close proximity to the posterior communicating artery. (True)(c) The superior colliculus is found in the midbrain. (True)(d) The trochlear (fouth cranial) nerve supplies the lateral rectus muscle. (False)(e) The spinal cord ends at the level of the lower border of L3 in the adult. (False)

Question 2. Subdural haematomas can cause:(a) Dementia. (True)(b) Pupillary change. (True)(c) Bradycardia. (True)(d) Changing level of consciousness. (True)(e) Blood-stained cerebrospinal fluid (CSF). (False)

Question 3. In a young woman with a spastic paraparesis, the following suggest a diagnosis of multiple sclerosis:(a) Delayed visual evoked potentials. (True)(b) Fasciculations. (False)

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(c) Raised CSF protein. (False)(d) Oligoclonal bands in the CSF. (True)(e) Periventricular white matter lesions on magnetic resonance imaging (MRI) of the brain. (True)

Question 4. Unilateral facial weakness is a recognized feature of:(a) Herpes zoster infection. (True)(b) Motor neuron disease. (False)(c) Acoustic neuroma. (True)(d) Cholesteatoma. (True)(e) Syringomyelia. (False)

Question 5. The following are true about headaches:(a) The headache of raised intracranial pressure is worst at the end of the day. (False)(b) A normal CT scan rules out subarachnoid haemorrhage. (False)(c) Amaurosis fugax may be caused by temporal arteritis. (True)(d) Neurological signs on examination rules out migraine as a diagnosis. (False)(e) Cluster headaches are more common in men than in women. (True)

Question 6. The following drugs can produce parkinsonism:(a) Chlorpromazine. (True)(b) Benzhexol. (False)(c) Bromocriptine. (False)(d) Metoclopramide. (True)(e) Haloperidol. (True)

Question 7. Concerning movement disorders:(a) Huntington's chorea presents with progressive dementia and chorea in middle age. (True)(b) Myoclonus is a feature of subacute sclerosing panencephalitis. (True)(c) Infarction of the subthalamic nucleus causes ipsilateral hemiballism. (False)(d) Chorea is commonly found in Cruetzfeldt-Jakob disease. (False)(e) Alcohol reduces benign essential tremor. (True)

Question 8. Concerning papilloedema:(a) There is loss of venous pulsation on funduscopy. (True)(b) There may be enlargement of the blind spot. (True)(c) Intracranial pressure may be normal. (True)(d) Hypocalcaemia is a recognized cause. (True)(e) It is a recognized feature in Guillain-Barr syndrome. (True)

Question 9. Ptosis may be a feature of:(a) Myotonic dystrophy. (True)(b) Horner's syndrome. (True)(c) Abducens nerve (sixth nerve ) palsy. (False)(d) Oculomotor nerve (third nerve) palsy. (True)(e) Myasthenia gravis. (True)

Question 10. Concerning the Brown-Squard syndrome:(a) There is ipsilateral corticospinal loss below the lesion. (True)(b) There is ipsilateral loss of joint-position sense below the lesion. (True)(c) There is ipsilateral loss of two-point discrimination below the level of the lesion. (True)(d) There is ipsilateral loss of pain and temperature below the level of the lesion. (False)(e) A central disc lesion at L3 would cause a Brown-Squard syndrome in the legs. (False)

Question 11. Concerning the brachial plexus:(a) In brachial neuritis, severe pain around the shoulder precedes rapid wasting. (True)(b) Klumpke's paralysis causes proximal arm weakness. (False)(c) Erb's palsy is caused by a lesion to C5/C6-derived regions of the brachial plexus. (True)

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(d) A brachial plexus lesion and an ipsilateral Horner's syndrome may indicate a Pancoast tumour. (True)(e) Vaccination may precipitate brachial neuritis. (True)

Question 12. Causes of a polyneuropathy include:(a) Diabetes. (True)(b) Guillain-Barr syndrome. (True)(c) Renal failure. (True)(d) Amyloid. (True)(e) Multiple sclerosis. (False)

Question 13. A lesion to the common peroneal nerve at the fibular head causes:(a) Weakness of eversion of the foot. (True)(b) Decreased sensation over the dorsum of the foot. (True)(c) Weakness of plantar flexion. (False)(d) If long term, wasting of tibialis anterior. (True)(e) Brisk ankle jerk. (False)

Question 14. Brainstem death may be confirmed by:(a) Extensor response of the limbs to painful stimuli. (False)(b) Absent corneal reflexes. (True)(c) Absent tendon reflexes. (False)(d) A flat EEG. (False)(e) Absent 'doll's eye' reflexes. (True)

Question 15. A homonymous hemianopia may arise from a lesion of:(a) The optic tract. (True)(b) The occipital cortex. (True)(c) The optic chiasm. (False)(d) The optic nerve. (False)(e) The optic radiation. (True)

Question 16. Dysarthria may result from a lesion of:(a) The cerebellum. (True)(b) Broca's area. (False)(c) The hypoglossal nerve. (True)(d) The basal ganglia. (True)(e) The accessory nerve. (False)

Question 17. The following are clinical features of cerebellar dysfunction(a) Postural tremor. (False)(b) Hypotonia. (True)(c) Dysphasia. (False)(d) Titubation. (True)(e) Impaired rapid altering movements. (True)

Question 18. The following clinical features may help differentiate between a syncopal attack and a seizure:(a) Upright posture at the onset. (True)(b) Convulsive movements of the limbs. (False)(c) A bitten tongue. (True)(d) Urinary incontinence. (True)(e) Prolonged malaise after the attack. (False)

Question 19. The following are features of a subarachnoid haemorrhage:(a) Fever. (True)(b) Thunderclap headache. (True)(c) Photophobia. (True)(d) Positive Kernig's sign. (True)

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(e) Neck stiffness. (True)

Question 20. A physiological tremor is:(a) Present at rest. (False)(b) Worsened by anxiety. (True)(c) Improved by alcohol. (False)(d) Improved by beta-blockers. (True)(e) Familial. (False)

Question 21. A lesion of the medulla on one side may give rise to :(a) An ipsilateral hemiparesis. (False)(b) A contralateral hemiparesis. (True)(c) Ipsilateral weakness of the palate. (False)(d) Contralateral weakness of the tongue. (True)(e) Contralateral third nerve palsy. (False)

Question 22. The following may be seen in a patient with a lesion of the third nerve or nucleus:(a) A fixed dilated pupil. (True)(b) Ptosis. (True)(c) Diplopia in all positions of gaze. (True)(d) A history of diabetes mellitus. (True)(e) A contralateral hemiplegia. (True)

Question 23. In a patient with a sensory ataxia:(a) Vibration may be impaired. (True)(b) The gait is characterized by 'scissoring' posture of the legs. (False)(c) Romberg's test may be positive. (True)(d) A history of alcohol abuse may be implicated in the aetiology. (True)(e) Clonus may be elicited on examination of the legs. (False)

Question 24. A patient with herpes zoster infection of the geniculate ganglion may present with:(a) An upper motor neuron facial weakness. (False)(b) Diplopia. (False)(c) Hyperacusis. (True)(d) Altered perception of taste. (True)(e) Pain from the auditory meatus. (True)

Question 25. A dissociated sensory loss may be seen in:(a) Syringomyelia. (True)(b) Anterior spinal artery occlusion. (False)(c) A radiculopathy. (False)(d) Occlusion of a middle cerebral artery. (False)(e) Compression of the spinal cord by a prolapsed intervertebral disc. (False)

Module 7 (Gastroeneterology)Question 1. The following statements are true:(a) Tylosis is associated with achalasia. (False)(b) On barium swallow, a 'bird's beak' appearance is suggestive of squamous carcinoma. (False)(c) Pneumatic dilatation is the treatment of choice for achalasia. (True)(d) Reduced lower oesophageal sphincter pressure is a common feature of gastro-oesophageal reflux disease . (True)(e) Oesophageal pH is usually less than 4. (False)

Question 2. The following is true of Barrett's oesophagus:(a) Columnar epithelium is replaced by squamous epithelium. (False)(b) It appears in an antegrade (top to bottom) direction. (False)(c) It is a premalignant condition. (True)(d) Severe dysplasia is an ominous sign. (True)

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(e) It is an indication for surveillance endoscopy. (True)

Question 3. Helicobacter pylori:(a) Causes ulceration in the duodenum. (True)(b) Causes Barrett's metaplasia in the oesophagus. (False)(c) Is associated with hypergastrinaemia. (True)(d) Is often resistant to certain antibiotics. (True)(e) Can convert urea to ammonia and carbon dioxide. (True)

Question 4. Gastric hypomotility (gastroparesis):(a) Is commonly associated with diabetes mellitus. (True)(b) Is a risk factor for gastro-oesophageal reflux disease. (True)(c) Is a feature of generalized scleroderma (systemic sclerosis). (True)(d) Occasionally responds to erythromycin. (True)(e) Is often secondary to duodenal ulcer disease. (False)

Question 5. The following are features of coeliac disease:(a) Hypocalcaemia. (True)(b) Hypercalcaemia. (False)(c) Normocytic anaemia. (False)(d) Hypoalbuminaemia. (True)(e) Positive antiparietal cell antibodies. (False)

Question 6. The following is true of Crohn's disease:(a) The rectum is always affected. (False)(b) Commonly affects the terminal ileum. (True)(c) More commonly occurs in smokers. (True)(d) Can result in vitamin B12 deficiency with a negative Schilling test. (True)(e) Commonly presents with bloody diarrhoea. (False)

Question 7. The following is true of giardiasis:(a) Diarrhoea abates with avoidance of dairy produce. (False)(b) Diarrhoea abates with avoidance of gluten. (False)(c) Diarrhoea requires treatment with metronidazole. (True)(d) Diarrhoea is usually accompanied by vomiting. (False)(e) Diarrhoea commonly results in vitamin B12 deficiency. (False)

Question 8. The following is true of inflammatory bowel disease:(a) Increased liver enzymes in the serum usually indicate the complication of carcinoma. (False)(b) Small bowel barium enema is the best radiological investigation for ulcerative colitis. (False)(c) It is occasionally complicated by carcinoma of the caecum. (True)(d) It is commonly associated with thyroiditis. (False)(e) It is sometimes complicated by iritis. (True)

Question 9. The following is true of viral hepatitis:(a) Hepatitis C commonly presents with jaundice. (False)(b) Hepatitis E is fatal particularly in pregnant women. (True)(c) Hepatitis BeAg is a marker of viral replication. (True)(d) Hepatitis A is a risk factor for hepatoma. (False)(e) Hepatitis D occurs only in association with hepatitis C. (False)

Question 10. The following drugs cause jaundice:(a) Methotrexate. (False)(b) Flucloxacillin. (True)(c) Metronidazole. (False)(d) Isoniazid. (True)

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(e) Phenobarbitone. (False)

Question 11. Haemochromatosis:(a) Is a genetic defect resulting in copper overload in the liver. (False)(b) Is a risk factor for the development of hepatoma. (True)(c) Has an equal sex incidence but presents earlier in males than females. (True)(d) Is treated by avoiding meat products. (False)(e) Can cause hypogonadism in the absence of cirrhosis. (True)

Question 12. Colonic carcinoma:(a) Most commonly occurs in the right side of the colon. (False)(b) May present with iron deficiency anaemia in the absence of any gastrointestinal symptoms. (True)(c) Commonly arises in colonic polyps. (True)(d) Carries a 5-year survival of less than 10%. (False)(e) Is the cause of carcinoid syndrome. (False)

Question 13. The following is true of colon polyps and colon cancer:(a) The larger the polyp, the greater the risk of carcinoma. (True)(b) Malignant polyps can be successfully treated by colonoscopy and polypectomy alone. (True)(c) Hyperplastic polyps have a higher malignant potential than villous polyps. (False)(d) Polyps are most common in the ascending colon. (False)(e) Colonic polyps are often recurrent. (True)

Question 14. The following gastrointestinal diseases are associated with the renal conditions listed:(a) Crohn's disease and renal amyloidosis. (True)(b) Hepatitis B and glomerulonephritis. (True)(c) Gastric ulcer and nephrotic syndrome. (False)(d) Pancreatic neuroendocrine tumours and polycystic kidney disease. (False)(e) Liver cysts and glomerulosclerosis. (False)

Question 15. The following is true of villous atrophy in the small intestine:(a) If due to coeliac disease, it should recover completely on a gluten-free diet. (True)(b) It can be caused by tuberculosis. (True)(c) It can be associated with Giardi lamblia. (True)(d) It can be associated with Tropheryma whippelei. (True)(e) When associated with bacteria, it may cause a rise in serum folate. (True

Question 16. The following skin conditions are associated with the named GI diseases:(a) Dermatitis herpetiformis with coeliac disease. (True)(b) Pruritus with primary biliary cirrhosis. (True)(c) Pyoderma gangrenosum with gastric carcinoma. (False)(d) Bullous pemphigoid with pancreatitis. (False)(e) Erythema nodosum with Crohn's disease. (True)

Question 17. The following statements are true in relation to vomiting:(a) Vomiting occurring 12 hours after a suspicious meal is indicative of Salmonella poisoning. (False)(b) Vomiting in association with headache is a feature of migraine. (True)(c) Vomiting associated with weight loss can be indicative of malignant disease. (True)(d) Vomiting usually precedes the pain of biliary colic. (False)(e) Vomiting can be a feature of myocardial infarction. (True)

Question 18. Scleroderma can produce the gastrointestinal complications listed:(a) Diarrhoea due to bacterial overgrowth. (True)(b) Constipation due to gut hypomotility. (False)(c) Diarrhoea which is unresponsive to a gluten-free diet. (True)(d) Gastric ulcer due to chronic gastritis. (False)

MCQs VIA WEB 2005

By A. H.

(e) Dysphagia due to abnormal peristalsis in the oesophagus. (True)

Question 19. Chronic pancreatitis:(a) Is a cause of diabetes mellitus. (True)(b) Can result from alcohol ingestion in moderate amounts. (True)(c) May be hereditary in a minority of cases. (True)(d) Can be diagnosed by a raised serum amylase. (False)(e) Is a cause of pancreas divisum. (False)

Question 20. The following is true of rectal bleeding:(a) In the absence of haemorrhoids, it is usually due to malignant disease. (False)(b) It occurs more commonly in Crohn's disease than in ulcerative colitis. (False)(c) If it occurs in a patient with ulcerative colitis, it usually indicates that carcinoma has developed. (False)(d) When it is due to diverticular disease, colectomy may be indicated to control it. (True)(e) It may be caused by ingestion of aspirin. (True)

Question 21. The following are risk factors for gastric carcinoma:(a) Pernicious anaemia. (True)(b) Coeliac disease. (False)(c) Partial gastrectomy. (True)(d) Helicobacter pylori infection. (True)(e) Mntrire's disease. (True)

Question 22. The following statements are true:(a) Solitary rectal ulcers are commonly associated with Crohn's disease. (False)(b) Crypt abscesses are typical of coeliac disease. (False)(c) Fistula formation can be a feature of Whipple's disease. (False)(d) Anal fissure predisposes to faecal incontinence. (False)(e) Right iliac fossa pain is common with diverticular disease. (False)

Question 23. The following are true of hepatitis:(a) Hepatitis B is spread via the faecal-oral route. (False)(b) A vaccine is available for hepatitis C. (False)(c) Incubation time for hepatitis A is approximately 2-3 weeks. (True)(d) Hepatitis B is an RNA virus. (False)(e) Interferon treatment is required for hepatitis E infection. (False)

Question 24. The following is a risk factor for the Budd-Chiari syndrome:(a) Oral contraceptive pill. (True)(b) Malignancy. (True)(c) Ascites. (False)(d) Polycythaemia rubra vera. (True)(e) Constrictive pericarditis. (False)

Question 25. The following are true regarding prognostic factors for acute pancreatitis:(a) A low pAO2 indicates a poor prognosis. (True)(b) A high serum GGT has a poor prognosis. (False)(c) Age of over 55 years usually has a good prognosis. (False)(d) A low serum albumin indicates a poor prognosis. (True)(e) Abnormal clotting time has a poor prognosis. (True)

Module 9 (Gastroenterology)Question 1. The following is true of oesophageal pain:(a) It can occur in the absence of heartburn. (True)(b) It can mimic the pain of a myocardial infarction. (True)(c) It can be relieved by glyceryl trinitrate. (True)

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By A. H.

(d) It is usually precipitated by exercise. (False)(e) It can be caused by candidiasis. (True)

Question 2. The following is true of postgastrectomy syndromes:(a) The anaemia can be corrected with ascorbic acid supplements. (True)(b) The risk of gastric cancer in the long term is increased. (True)(c) Sweating and palpitations can be due to hypoglycaemia. (True)(d) Biliary gastritis in the gastric remnant is common. (True)(e) Diarrhoea is commonly due to bacterial overgrowth. (True)

Question 3. The following is true of neoplastic disease in the stomach:(a) Maltoma can occasionally respond to antibiotic treatment in combination with a proton pump inhibitor. (True)(b) Mntrire's disease is due to metaplasia of the gastric mucosa. (True)(c) Leiomyoma has a characteristic appearance at endoscopy. (True)(d) Gastric carcinoma produces abdominal pain that is often worse after eating. (True)(e) The most common gastric carcinoma is of squamous cell origin. (False)

Question 4. The following statements are true:(a) Iron absorption is reduced in hypochlorhydric states. (True)(b) Vitamin D absorption is often deficient in the presence of gastritis. (False)(c) Vitamin B12 supplements are often necessary following gastrectomy. (True)(d) Anaemia associated with chronic atrophic gastritis may respond to ascorbic acid supplements. (True)(e) Intestinal metaplasia in the stomach is a risk factor for gastric carcinoma. (True)

Question 5. The following clinical features are associated with coeliac disease:(a) Anaemia. (True)(b) Weight loss. (True)(c) Vomiting. (False)(d) Diarrhoea. (True)(e) Jaundice. (False)

Question 6. The following is true of Crohn's disease:(a) C-reactive protein mimics inflammatory activity. (True)(b) Normal albumin indicates remission. (False)(c) Large bowel barium enema is the most definitive radiological test. (False)(d) A small bowel biopsy can be helpful in making the diagnosis. (True)(e) A low blood urea is common. (True)

Question 7. The following is true of ulcerative colitis:(a) It commonly presents with pain in the right iliac fossa. (False)(b) It can be associated with ankylosing spondylitis. (True)(c) It is a risk factor for toxic dilatation of the colon. (True)(d) The occurrence of abdominal tenderness is an ominous sign. (True)(e) It often causes ischiorectal abscesses. (False)

Question 8. Acholuric jaundice without pain:(a) Is a common presentation of pancreatic carcinoma. (False)(b) Is a feature of Gilbert's disease. (True)(c) Can occur in hereditary spherocytosis. (True)(d) Is associated with pale-coloured stools. (False)(e) Is associated with pruritus. (False)

Question 9. The following is true of risk factors for the development of hepatocellular carcinoma:(a) Females are at greater risk than males. (False)(b) Excess iron is a recognized risk factor. (True)(c) Aflatoxin is a risk factor. (True)(d) Hepatitis A is a risk factor. (False)

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By A. H.

(e) Risk factors generally only operate in the presence of cirrhosis. (True)

Question 10. Alcoholic hepatitis:(a) Recovers rapidly on cessation of drinking. (False)(b) Is a risk factor for hepatorenal syndrome. (True)(c) Ascites is a feature. (True)(d) Coagulopathy is corrected with administration of vitamin K. (False)(e) Encephalopathy occurs only if infection is present. (False)

Question 11. Primary sclerosing cholangitis:(a) Occurs predominantly in middle-aged females. (False)(b) Is a major risk factor for cholangiocarcinoma. (True)(c) Occurs in 50% patients with ulcerative colitis. (False)(d) Has been treated with ursodeoxycholic acid. (True)(e) May require insertion of an endoprosthesis for its treatment. (True)

Question 12. The following GI conditions are associated with microcytic hypochromic anaemia:(a) Acute duodenal ulceration. (False)(b) Ankylostoma duodenale. (True)(c) Terminal ileitis due to Crohn's disease. (True)(d) Partial gastrectomy. (True)(e) Carcinoma of caecum. (True)

Question 13. These gastronomic terms are associated with the following gastroenterological conditions:(a) 'Rice water' diarrhoea with cholera. (True)(b) 'Anchovy sauce' discharge with amoebic dysentry. (False)(c) 'Redcurrent jelly' and intussusception. (True)(d) 'Apple core' lesion and diverticulitis. (False)(e) 'Coffee grounds' and oesophageal varices. (False)

Question 14. The following is true of breath tests used for investigation of the gastrointestinal tract:(a) The 14C urea breath test detects Helicobacter pylori infection. (True)(b) The 14C glycocholic acid breath test is used to detect bacterial overgrowth in the colon. (False)(c) A hydrogen breath test following ingestion of lactulose is used to detect bacterial overgrowth in the small intestine.

(True)(d) A lactose breath test is used to detect disaccharidase deficiency. (True)(e) A 14C bile salt test can be used to identify bile duct obstruction. (False)

Question 15. The following autoantibodies are associated with the diseases listed:(a) Antiendomyseal antibodies are associated with coeliac disease. (True)(b) Anti-LKM antibodies are associated with Goodpasture syndrome. (False)(c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True)(d) Antiparietal cell antibodies are associated with Wilson's disease. (False)(e) Antismooth muscle antibodies are associated with autoimmune chronic active hepatitis. (True)

Question 16. The following statements are true of colitis:(a) Granulomas are present in collagenous colitis. (False)(b) Rectal sparing is characteristic of Crohn's colitis. (True)(c) Caseating granulomas in the terminal ileum are diagnostic of Crohn's disease. (False)(d) Colitis in a smoker is more likely to be Crohn's than ulcerative colitis. (True)(e) Pain is a characteristic feature of CMV colitis. (True)

Question 17. The following statements are true of ascites:(a) A high protein content in ascites is usual in alcoholic liver disease. (False)(b) Ascites resistant to diuretics is characteristic of hepatic vein thrombosis. (True)(c) Ascites is sometimes associated with a pleural effusion. (True)

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By A. H.

(d) Ascites is a risk factor for bacterial peritonitis. (True)(e) Ascites due to constrictive pericarditis prevents pulsus paradoxus. (False)

Question 18. The following statements are true of non-steroidal anti-inflammatory drugs:(a) They can be given as suppositories to avoid gastrointestinal complications. (False)(b) They may have a role in the prevention of colon cancer. (True)(c) They can produce gastric erosions in elderly people causing occult blood loss. (True)(d) They cause gastric erosions by stimulating gastric acid secretion. (False)(e) They may exacerbate long-standing ulcerative colitis. (True)

Question 19. The following is true of pancreatic tumours:(a) Jaundice occurs only when carcinoma is present in the tail of pancreas. (False)(b) Presence of diabetes mellitus indicates that the tumour is of neuroendocrine origin. (False)(c) They are generally unresponsive to chemotherapy. (True)(d) They characteristically produce back pain when local invasion is present. (True)(e) They occur with increased frequency in patients with ulcerative colitis. (False)

Question 20. The following is true of haematemesis:(a) When it occurs in a patient with alcoholic liver disease, it is always due to oesophageal varices. (False)(b) A visible vessel seen at gastroscopy is a risk factor for further bleeding. (True)(c) When it occurs in patients over 70 years of age who may have arthritis, usually indicates malignancy. (False)(d) When it occurs after repeated retching, it is suggestive of an oesophageal tear. (True)(e) When it is caused by duodenal ulcer, a partial gastrectomy is usually necessary. (False)

Question 21. The following drugs can be used for treatment of GORD:(a) Metronidazole. (False)(b) Amoxycillin. (False)(c) Erythromycin. (False)(d) Metoclopramide. (True)(e) Omeprazole. (True)

Question 22. Which of the following is dependent on bile salts for its absorption:(a) Vitamin A. (True)(b) Vitamin B. (False)(c) Vitamin C. (False)(d) Vitamin D. (True)(e) Vitamin K. (True)

Question 23. The following are indications for liver biopsy:(a) Unexplained abnormal liver enzymes. (True)(b) Pyrexia of unknown origin with normal liver enzymes. (True)(c) Cirrhosis suspected on an ultrasound scan. (True)(d) Raised alkaline phosphatase in teenagers with acholuric jaundice. (False)(e) Abnormal liver enzymes in a patient with epilepsy on phenytoin. (False)

Question 24. The following precipitate portasystemic encephalopathy:(a) Infection. (True)(b) Diarrhoea. (False)(c) Gastrointestinal bleeding. (True)(d) Use of opioid drugs. (True)(e) Certain antibiotics. (False)

Question 25. The following drugs cause cholestatic jaundice:(a) Rifampicin. (False)(b) Isoniazid. (False)(c) Erythromycin. (True)(d) Halothane. (False)

MCQs VIA WEB 2005

By A. H.

(e) Paracetamol. (False)

Module 10 (Neurology)Question 1. The following cranial nerves carry parasympathetic fibres:(a) Oculomotor. (True)(b) Trigeminal. (False)(c) Facial. (True)(d) Hypoglossal. (False)(e) Vagus. (True)

Question 2. Myasthenia gravis:(a) Is caused by antibodies to the acetylcholine receptor in the majority of cases. (True)(b) Causes muscle wasting. (False)(c) May show diurnal variation in symptoms. (True)(d) Is associated with an improvement in strength after exertion. (False)(e) May present with ophthalmoplegia. (True)

Question 3. The causes of a mixed upper and lower motor neuron picture include:(a) Guillain-Barr syndrome. (False)(b) Multiple sclerosis. (False)(c) Syringomyelia. (True)(d) Motor neuron disease. (True)(e) Taboparesis. (True)

Question 4. Bilateral lower motor neuron facial weakness may occur in:(a) Sarcoidosis. (True)(b) Guillain-Barr syndrome. (True)(c) Lyme disease. (True)(d) Lymphoma. (True)(e) Parasagittal meningioma. (False)

Question 5. In idiopathic Parkinson's disease:(a) There is degeneration primarily of the cells of the globus pallidus. (False)(b) The classical features include tremor, bradykinesia, and spasticity. (False)(c) There is an associated vertical gaze palsy. (False)(d) Anticholinergic drugs are most effective in relieving tremor. (True)(e) Treatment is aimed at reducing dopamine levels. (False)

Question 6. The following features suggest that increased tone is due to rigidity:(a) Tone is increased equally in flexors and extensors. (True)(b) Extensor plantar responses. (False)(c) Associated pill-rolling tremor. (True)(d) Clasp-knife reflex. (False)(e) Tone increases with synkinesis. (True)

Question 7. Causes of a small pupil include:(a) Horner's syndrome. (True)(b) Holmes-Adie syndrome. (False)(c) Tabes dorsalis. (True)(d) Optic neuritis. (False)(e) Pilocarpine eye-drops. (True)

Question 8. Concerning optic neuritis:(a) Visual loss is usually painless. (False)(b) White-matter abnormalities on MR imaging increase the likelihood of developing multiple sclerosis in the future.

(True)

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By A. H.

(c) After recovery, some impairment of red-green colour vision may remain. (True)(d) Over 90% of patients with a history of optic neuritis go on to develop multiple sclerosis. (False)(e) It causes a delay in visual evoked potentials. (True)

Question 9. The following may cause a third nerve palsy:(a) Aneurysm of the posterior communicating artery. (True)(b) Diabetes. (True)(c) Motor neuron disease. (False)(d) Herniation of the uncus of the temporal lobe. (True)(e) Pancoast tumour. (False)

Question 10. The following typically occur within the first 24 hours of complete cervical cord transection:(a) Upgoing plantar responses. (False)(b) Fall in blood pressure. (True)(c) Loss of bladder control. (True)(d) Brisk reflexes. (False)(e) Gastric dilatation. (True)

Question 11. In motor neuron disease:(a) Fasciculations are required to make the diagnosis. (False)(b) There may be atrophy of the Betz cells in the motor cortex. (True)(c) Electromyography shows chronic partial denervation. (True)(d) There should be no signs of sensory loss. (True)(e) Familial cases account for 50%. (False)

Question 12. Causes of a mononeuropathy include:(a) Diabetes. (True)(b) Hereditary motor sensory neuropathy. (False)(c) Polyarteritis nodosa. (True)(d) Guillain-Barr syndrome. (False)(e) Lead poisoning. (True)

Question 13. Charcot joints:(a) May affect the feet in diabetes. (True)(b) Are often painful. (False)(c) May be caused by neurosyphilis. (True)(d) May affect the shoulders in syringomyelia. (True)(e) Are usually hot and swollen. (False)

Question 14. Hyposmia may arise secondary to:(a) A head injury. (True)(b) Migraine. (False)(c) Seizures. (False)(d) Antibiotic therapy. (True)(e) A frontal meningioma. (True)

Question 15. The following are causes of acute transient visual impairment:(a) Retinitis pigmentosa. (False)(b) Amaurosis fugax. (True)(c) Papilloedema. (True)(d) Migrainous aura. (True)(e) Glaucoma. (False)

Question 16. The following may be features of frontal lobe dysfunction:(a) Depression. (True)(b) Social disinhibition. (True)(c) Apraxia of gait. (True)

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By A. H.

(d) A receptive dysphasia. (False)(e) A grasp reflex. (True)

Question 17. The following may give rise to a pseudobulbar palsy(a) Poliomyelitis. (False)(b) Syringobulbia. (False)(c) Huntington's chorea. (False)(d) Occlusion of the anterior cerebral artery. (False)(e) Multiple sclerosis. (True)

Question 18. Facial sensory loss may occur with a lesion of:(a) The cerebellopontine angle. (True)(b) The facial nerve. (False)(c) The Gausserian ganglion. (True)(d) The Geniculate ganglion. (False)(e) The cavernous sinus. (True)

Question 19. Sensorineural deafness may occur secondary to:(a) Loud noise. (True)(b) Gentamicin therapy. (True)(c) Mnire's disease. (True)(d) An acoustic neuroma. (True)(e) Otosclerosis. (False)

Question 20. Choreic movements are:(a) Slow and writhing. (False)(b) Shock-like assymetrical and irregular. (False)(c) Brief, jerky and irregular. (True)(d) A sign of restlessness. (False)(e) Rhythmical and oscillatory. (False)

Question 21. Features of an upper motor neuron lesion are:(a) Brisk abdominal and cremasteric reflexes. (False)(b) Wasted muscles. (False)(c) Weakness of individual muscles. (False)(d) Hypotonia. (False)(e) Fatiguable muscle strength. (False)

Question 22. A small pupil may be seen in:(a) A lesion in the midbrain. (False)(b) Elderly patients. (True)(c) Horner's syndrome. (True)(d) Terminally ill patients taking morphine for analgesia. (True)(e) A pontine lesion. (True)

Question 23. Nystagmus may be seen in:(a) A patient with an internuclear ophthalmoplegia. (True)(b) A lesion of the pons. (True)(c) A patient who is blind. (True)(d) A patient with cerebellar dysfunction. (True)(e) A lesion of the foramen magnum. (True)

Question 24. Clinical features of a unilateral lesion of the cerebellopontine angle may be:(a) Conductive deafness on the same side. (False)(b) An ipsilateral hemiparesis. (False)(c) Ipsilateral weakness of the lower face. (False)(d) A pseudobulbar dysarthria. (False)

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By A. H.

(e) Vertigo as a prominent early symptom. (False)

Question 25. The fibres of the dorsal column pathway:(a) Carry information about temperature perception. (False)(b) Decussate in the midbrain. (False)(c) Are affected in the deficiency of vitamin B12. (True)(d) When damaged may result in a positive Romberg's test. (True)(e) Are spared following occlusion of the anterior spinal artery. (True)

Available from Master MedicineModule 1 (trial1)

Question 1. The ECG: The T wave corresponds to atrial contraction (False) If the S wave is greater than the R wave in lead I, there is right axis deviation (True) If the S wave is greater than the R wave in lead II, there is left axis deviation (True) ST segment depression may be a sign of cardiac ischaemia (True)Explanation: It may also be a digoxin effect. A tall R wave in V1 may be a sign of right ventricular hypertrophy (True)Explanation: It may also be a digoxin effect.

Question 2. Endocarditis: It is important to take blood cultures over at least 24 hour period to make the diagnosis (False) Transthoracic echocardiography is a sensitive means of making or confirming the diagnosis (False) Most patients with Staphylococcus aureus bacteraemia have endocarditis (False) Viral endocarditis leads to valvular abnormality (False) In patients with a new stroke, endocarditis can be ruled out if the patient is afebrile (False)Question 3. Treatment of endocarditis: Intravenous antibiotics for 6 weeks are necessary to cure viridans type streptococcal endocarditis (False) Staphylococcal endocarditis on the tricuspid valve in a drug addict is treated with flucloxacillin and valve

replacement (False) Large vegetations are an indication for surgery (True)Explanation: Flucloxacillin (with gentamicin or rifampicin) is the medical treatment of choice but valve replacement isnot appropriate. Insertion of a prosthetic heart valve into a drug addict is very likely to lead to prosthetic valveendocarditis subsequently because of their continuing habit. Combination antibiotic therapy is almost always appropriate for endocarditis (True)Explanation: For two reasons; first, the selected combinations are usually additive or synergistic. Second, to prevent thedevelopment of resistance. If gentamicin is used for treatment, it should not be used for more than 2 weeks (False)Question 4. Hypertension: Treatment is of no proven benefit in patients over the age of 70 years (False) The symptoms of phaeochromocytoma include headache, sweating and palpitations (True)Explanation: There is well-proven benefit, particularly in the prevention of stroke. Oral treatment producing a fall in diastolic blood pressure of 20 mmHg over 24 hours might be regarded as

successful treatment of accelerated hypertension (True)

Explanation: There is well-proven benefit, particularly in the prevention of stroke. ACE inhibitors are the drugs of choice for hypertension in pregnancy (False)

MCQs VIA WEB 2005

By A. H.

Addison's disease should be considered a possible cause in a hypertensive patient with hirsutism (False)

Question 5. Cardiac dysrhythmias: Digoxin toxicity may cause supraventricular tachycardia (True)Explanation: Typically, paroxysmal atrial tachycardia. A patient with a completely irregular pulse of 180 beats/min is likely to be in atrial fibrillation (True)Explanation: Typically, paroxysmal atrial tachycardia. Complete heart block may be asymptomatic (True)Explanation: Particularly congenital complete heart block. Digoxin is effective in preventing paroxysms of atrial fibrillation (False) A QRS width less than 3 small squares on the ECG indicates that a tachycardia is supraventricular (True)Explanation: Digoxin slows the ventricular rate during paroxysms of atrial fibrillation but does not prevent them; sotalolor amiodarone may prevent them.

Question 6. Chronic bronchial sepsis: Is an uncommon feature of cystic fibrosis (False) Typically is caused by unusual, difficult-to-grow bacteria (False) May lead to haemoptysis (True)Explanation: Haemoptysis is also seen with dry bronchiectasis, chronic bronchial sepsis and with aspergillomas. Can usually be cured with oral antibiotics (False) May lead to pulmonary fibrosis (True)Explanation: It produces a fibrotic reaction.

Question 7. In the small intestine: If there is bile salt deficiency, micellar formation is reduced (True)Explanation: Bile salts are essential for micelle formation. Long-chain triglycerides are transported from the gut in the lymph as chylomicrons (False) There is no lymphatic tissue (False) The entire mucosa is turned over every 2-3 weeks (False) Is the site of most nutrient absorption (True)Question 8. Colorectal cancer: May arise from a metaplastic polyp (False) Most often occurs in the rectum and sigmoid (True)Explanation: Metaplastic polyps have no malignant potential. There are further polyps in most cases (False) Involvement of local lymph nodes does not affect prognosis (False) Obstruction is more common in right compared with left-sided lesions (False)Question 9. Angiodysplasia of the colon: Is more common in the caecum and ascending colon (True)Explanation: It usually occurs in the right side of the colon. Is associated with a macrocytic anaemia (False) Is best shown by barium enema (False) Usually requires surgery (False) Is a congenital lesion (False)Question 10. Concerning HIV infection and AIDS: Pneumocystis pneumonia is common in Africa (False) Tuberculosis in AIDS presents like that in non-AIDS patients (False) Oral candidiasis is a late feature of AIDS (False) Toxoplasmosis is usually a cerebral disease (True)

MCQs VIA WEB 2005

By A. H.

Explanation: Brain and heart. The CT/MR scan usually shows multiple ring-enhancing lesions, which are almostdiagnostic of toxoplasmosis in AIDS. CNS lymphomas are usually single. Cardiac toxoplasmosis is usually diagnosedat postmortem. Cytomegalovirus retinitis can be treated with aciclovir (False)Module 1 (trial2)Question 1. In secondary diabetes: A patient can be assumed not to be ketosis-prone (False) A patient is more than 85% likely to have clinical pancreatic exocrine deficiency (False) Classical diabetic complications do not occur (False) Thiazide diuretics and beta-blockers can both impair insulin secretion (True)Explanation: Secondary diabetes causes all the same complications as idiopathic diabetes. Most patients with acromegaly are diabetic (False)

Question 2. In hypoglycaemia: Insulin-dependent patients may recover from hypoglycaemic coma without treatment (True)Explanation: The anti-insulin hormones can bring the patient round and the insulin which caused the coma can 'wearoff'. Sweating and shaking are always late symptoms of insulin-induced hypoglycaemia (False) Insulin-dependent patients may lose their warning symptoms of hypoglycaemia after many years of diabetes

(True)Explanation: About 50% of patients who have had type 1 DM for 20 years or more develop 'hypoglycaemiaunawareness'. Metformin is responsible for as many cases of hypoglycaemia as sulfonylureas (False) The symptoms characteristically come on over hours rather than minutes (False)Question 3. In insulin treatment: Pen injectors are reserved for the small minority who take four or more injections per day (False) Only patients who cannot be controlled with once-daily insulin should have two or more injections (False) Insulin should be started without delay in a thin hyperglycaemic patient with ketonuria (True)Explanation: These are signs of type 1 DM. Insulin may sometimes be needed during short periods of illness in patients with type 2 DM (True)Explanation: These are signs of type 1 DM. All patients on insulin should be discouraged from changing their doses without first checking with the doctor

or nurse (False)

Question 4. Diabetic pregnancy: Insulin-dependent women should be advised not to contemplate pregnancy (False) Diabetes increases the risk of neural tube defects (True)Explanation: Neural tube defects are two to three times more common. Poor glycaemic control at conception increases the risk of congenital malformations (True)Explanation: Hyperglycaemia is teratogenic in early pregnancy; major congenital malformations are two to three timesmore common. There is a less than 10% chance that an episode of ketoacidosis will cause intrauterine death (False) Sulfonylureas are the treatment of choice for gestational diabetes (False)Question 5. Thyroid function tests: Serum thyroid-stimulating hormone (TSH) is a sensitive test of hyperthyroidism (True)Explanation: Suppression of TSH is the first biochemical sign of hyperthyroidism. Serum TSH can distinguish primary from secondary hypothyroidism (True)Explanation: In primary hypothyroidism, TSH is high; in secondary hypothyroidism, it is low. Serum triiodothyronine can be an unreliable test for hypothyroidism (True)Explanation: Low triiodothyronine may result from intercurrent illness, particularly in elderly people, and can bemisleading. Hyperthyroid patients may have a raised serum triiodothyronine with a normal thyroxine (True)

MCQs VIA WEB 2005

By A. H.

Explanation: The condition of 'T3 toxicosis'.

Question 6. Rheumatoid factor is: An antibody to sheep erythrocytes (False) Present when rheumatoid nodules are present (True)Explanation: Nodules are associated with high titres of rheumatoid factor. Diagnostic of rheumatoid arthritis (False) Usually is of the IgA subtype (False) Is not found in rheumatoid synovial, pleural or pericardial fluid (False)Question 7. In gout: Tophi are an early sign (False) Allopurinol is used to treat the acute attack (False) Furosemide (frusemide) helps to increase urate excretion (False) Large joints are not affected (False) Raised serum urate makes the diagnosis certain (False)Question 8. Ankylosing spondylitis: Is more common in females (False) May present as a severe oligoarthritis (True)Explanation: Commonly affects several joints and often presents with back pain. Is associated with the histocompatibility antigen HLA-DW3 (False) Is associated with pulmonary fibrosis (True)Explanation: It is associated with upper lobe fibrosis and aortic incompetence. Involves the proximal interphalangeal (PIP) (False)Question 9. Concerning osteomyelitis: Debridement of infected bone is essential for cure in chronic bacterial osteomyelitis (True)Explanation: It is often difficult to remove all dead infected bone. It is usually accompanied by a very high ESR (True)Explanation: Virtually always and it is a useful marker of response to treatment and relapse. A distinctive feature of chronic osteomyelitis is a discharging sinus (True)Explanation: Although there are other causes of a sinus including actinomycosis, implanted foreign body (such asshrapnel), mycetoma (fungal soft tissue and bony infection of the leg in the tropics). A positive culture from a sinus track is a good indication of the bacterial cause of the chronic osteomyelitis

(False) Usually 2 or 3 weeks' antibiotic therapy is adequate for cure (False)Question 10. With regard to reactive arthritis: It may be caused by both Salmonella and Campylobacter spp. (True)Explanation: It usually occurs 3-12 weeks after the episode of diarrhoea. It is usually chronic and unremitting over 3-4 years (False) Confidence in the diagnosis rests on growing a bacterium from stool or other sites (False) NSAIDs are appropriate therapy (True)Explanation: It is helpful if it can be done but failure does not rule out the diagnosis. Rheumatic fever should be excluded (True)Module 1 (Master Medicine)Question 1. The anatomy of the heart:If you stand on the patient's right side with your right hand across the sternum and cardiac apex, the left ventricle liesunder the sternum (False)On a postero-anterior (PA) chest radiograph, the left heart border is mostly formed by the left ventricle (True)

Explanation: The right ventricle presses against the sternum; the left ventricle constitutes the apex and is felt under thefingers.In an ECG, disease of the interventricular septum causes changes in chest leads V3-4 (True)

MCQs VIA WEB 2005

By A. H.

Explanation: The right ventricle presses against the sternum; the left ventricle constitutes the apex and is felt under thefingers.When examining the heart, the cardiac apex is the point where the heart beat can be felt most strongly (False)Occlusion of the left anterior descending coronary artery causes infarction of the anterior wall of the left ventricle and

interventricular septum (True)Explanation: Anterior myocardial infarction is caused by disease of the left anterior descending artery.

Question 2. The ECG:The T wave corresponds to atrial contraction (False)If the S wave is greater than the R wave in lead I, there is right axis deviation (True)If the S wave is greater than the R wave in lead II, there is left axis deviation (True)ST segment depression may be a sign of cardiac ischaemia (True)

Explanation: It may also be a digoxin effect.A tall R wave in V1 may be a sign of right ventricular hypertrophy (True)

Explanation: It may also be a digoxin effect

Question 3. Endocarditis:It is important to take blood cultures over at least 24 hour period to make the diagnosis (False)Transthoracic echocardiography is a sensitive means of making or confirming the diagnosis (False)Most patients with Staphylococcus aureus bacteraemia have endocarditis (False)Viral endocarditis leads to valvular abnormality (False)In patients with a new stroke, endocarditis can be ruled out if the patient is afebrile (False)

Question 4. Treatment of endocarditis:Intravenous antibiotics for 6 weeks are necessary to cure viridans type streptococcal endocarditis (False)Staphylococcal endocarditis on the tricuspid valve in a drug addict is treated with flucloxacillin and valve replacement

(False)Large vegetations are an indication for surgery (True)

Explanation: Flucloxacillin (with gentamicin or rifampicin) is the medical treatment of choice but valve replacement isnot appropriate. Insertion of a prosthetic heart valve into a drug addict is very likely to lead to prosthetic valveendocarditis subsequently because of their continuing habit.Combination antibiotic therapy is almost always appropriate for endocarditis (True)

Explanation: For two reasons; first, the selected combinations are usually additive or synergistic. Second, to prevent thedevelopment of resistance.If gentamicin is used for treatment, it should not be used for more than 2 weeks (False)

Question 5. In acute myocardial infarction:The diagnosis should be questioned if the jugular venous pressure is not raised (False)Streptokinase should not be given until the diagnosis has been confirmed by two sets of raised cardiac enzymes (False)Dysrhythmias in the early hours after presentation carry a poor prognosis (False)Lidocaine should routinely be given to prevent dysrhythmias (False)Rupture of the interventricular septum is an uncommon but serious complication (True)

Explanation: This is of no proven value.

Question 6. In acute dissection of the thoracic aorta:The operative mortality is about 30% (False)Spinal cord ischaemia may occur (True)

Explanation: It is much higher.Hypertension should be treated aggressively (True)

Explanation: Nitroprusside or labetolol infusion is a recommended treatment.Acute aortic stenosis may occur (False)The patient may develop myocardial ischaemia (True)

Explanation: The coronary ostia may be occluded by the dissection

Question 7. Hypertension:Treatment is of no proven benefit in patients over the age of 70 years (False)The symptoms of phaeochromocytoma include headache, sweating and palpitations (True)

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By A. H.

Explanation: There is well-proven benefit, particularly in the prevention of stroke.Oral treatment producing a fall in diastolic blood pressure of 20 mmHg over 24 hours might be regarded as successful

treatment of accelerated hypertension (True)Explanation: There is well-proven benefit, particularly in the prevention of stroke.ACE inhibitors are the drugs of choice for hypertension in pregnancy (False)Addison's disease should be considered a possible cause in a hypertensive patient with hirsutism (False)

Question 8. In ischaemic heart disease:Prevalence is increased in chronic renal failure (True)Explanation: Cushing's syndrome, not Addison's disease.Untreated hypothyroidism predisposes to it (True)

Explanation: Hypothyroidism causes hypercholesterolaemia and atherosclerosis.Polycythaemia may precipitate myocardial ischaemia (True)

Explanation: By increasing blood viscosity and impairing blood flow.An alcohol intake of 18 units per week in a man increases the risk of ischaemic heart disease (False)A high plasma fibrinogen reduces the risk (False)

Question 9. Cardiac dysrhythmias:Digoxin toxicity may cause supraventricular tachycardia (True)Explanation: Typically, paroxysmal atrial tachycardia.A patient with a completely irregular pulse of 180 beats/min is likely to be in atrial fibrillation (True)

Explanation: Typically, paroxysmal atrial tachycardia.Complete heart block may be asymptomatic (True)

Explanation: Particularly congenital complete heart block.Digoxin is effective in preventing paroxysms of atrial fibrillation (False)A QRS width less than 3 small squares on the ECG indicates that a tachycardia is supraventricular (True)

Explanation: Digoxin slows the ventricular rate during paroxysms of atrial fibrillation but does not prevent them; sotalolor amiodarone may prevent them.

Question 10. Hypoventilation occurs in the following:Central sleep apnoea syndrome (True)Explanation: Alveolar hypoventilation is a key feature.Severe kyphoscoliosis (True)

Explanation: Severe kyphoscoliosis can produce mechanical ventilation problems because of the changed curvature ofthe spine.Anxiety (False)Benzodiazepine overdose (True)

Explanation: Drugs such as benzodiazepines depress the respiratory centre.Exercise (False)

Question 11. Pneumothorax is a recognised complication of:Rib fracture (True)Explanation: Pneumothorax can occur secondary to trauma.A bulla (True)

Explanation: Any cavitating or cystic/bullous lung lesion can cause a pneumothorax. Bullae can be single or multiple.They are particularly common in emphysema including 1-antitrypsin deficiency.Kyphoscoliosis (False)Cystic fibrosis (False)Pneumocystis carinii pneumonia (True)

Explanation: And lung abscesses (e.g. Staph. aureus) can lead to pneumothorax.

Question 12. The following are features of fibrosing alveolitis:Cough (True)Explanation: Patients usually present with cough and breathlessness.Clubbing of the fingers in the majority of cases (True)

Explanation: Clubbing occurs in about 60% of patients but is not essential for the diagnosis.Cyanosis in the early stages (False)

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By A. H.

Circulating antibodies to alveolar tissues (False)Haemoptysis (False)

Question 13. Useful drugs for tuberculosis include:Piperacillin (False)Isoniazid (True)

Explanation: Isoniazid is a major, first-line agent.Ciprofloxacin (True)Explanation: Ciprofloxacin is a useful agent, less active than rifampicin; it may obscure infection in patients treatedbefore diagnosis considered.Ethambutol (True)

Explanation: Ethambutol is another major, but second-line agent.Amikacin (True)

Explanation: Amikacin is a useful i.v. second-line agent

Question 14. Causes of life-threatening pneumonia or pneumonitis in adults include:Pneumocystis carinii (True)Explanation: Pneumocystis carinii infection is usually seen in AIDS, but also in lymphoma, steroid-treated, transplantand hypogammaglobulinaemic patients.Influenza A virus (True)

Explanation: Primary influenzal pneumonia or complicated by bacteria, e.g. Staph. aureus.Respiratory syncytial virus (False)Staphylococcus aureus (True)

Explanation: S. aureus pneumonia is often rapidly fatal, especially following influenza.Legionella pneumophila (True)

Explanation: L. pneumophilia pneumonia carries a high mortality if not treated appropriately.

Question 15. Chronic bronchial sepsis:Is an uncommon feature of cystic fibrosis (False)Typically is caused by unusual, difficult-to-grow bacteria (False)May lead to haemoptysis (True)

Explanation: Haemoptysis is also seen with dry bronchiectasis, chronic bronchial sepsis and with aspergillomas.Can usually be cured with oral antibiotics (False)May lead to pulmonary fibrosis (True)

Explanation: It produces a fibrotic reaction

Question 16. Pleural aspiration is useful in the following situations:In diagnosing mesothelioma (False)Pleural tuberculosis (False)Viral pleurisy (False)Empyema (True)

Explanation: An empyema will require tube or surgical drainage for treatment.Relieving breathlessness in patients with malignant effusions (True)

Explanation: Drainage in malignant effusions is often very helpful if litres of fluid are removed or a shunt can beinserted.

Question 17. In the small intestine:If there is bile salt deficiency, micellar formation is reduced (True)Explanation: Bile salts are essential for micelle formation.Long-chain triglycerides are transported from the gut in the lymph as chylomicrons (False)There is no lymphatic tissue (False)The entire mucosa is turned over every 2-3 weeks (False)Is the site of most nutrient absorption (True)

Explanation: The small intestine is the main area for the breakdown and absorption of nutrients.

Question 18. Colorectal cancer:May arise from a metaplastic polyp (False)

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By A. H.

Most often occurs in the rectum and sigmoid (True)Explanation: Metaplastic polyps have no malignant potential.There are further polyps in most cases (False)Involvement of local lymph nodes does not affect prognosis (False)Obstruction is more common in right compared with left-sided lesions (False)

Question 19. Causes of acute pancreatitis include:Alcohol (True)Explanation: Most cases are associated with gall stones or high alcohol intake.Hypocalcaemia (False)Hyperlipidaemia (True)

Explanation: There is an association with hyperlipidaemia, but it is an uncommon cause.Self poisoning with diazepam (False)Endoscopic retrograde cholangiopancreatography (ERCP) (True)

Explanation: ERCP is used in the diagnosis of pancreatic disease but can precipitate an acute attack.

Question 20. Coeliac disease:The patient will almost always have had symptoms since childhood (False)Is best diagnosed on colonic biopsy (False)Is associated with HLA-B8 (True)

Explanation: It is associated with HLA-B8 and HLA-DRW3 antigens.The diagnosis is incorrect if a patient fails to respond to a gluten-free diet (False)Requires a diet free from wheat, barley and rye (True)

Explanation: All contain gluten

Question 21. In a ward with several patients where two of the nurses have had much vomiting and some diarrhoea overa 48-hour period, you should:Send the patients home (False)Culture stools (and vomitus) for viruses (False)Treat everyone with metronidazole (False)Exclude visitors from the ward (True)

Explanation: To prevent further spread, unless necessary for, say, a dying patient.Prevent the patients (affected or not) leaving the ward for investigations, physiotherapy, etc. (True)

Explanation: Unless the investigation was absolutely vital

Question 22. The differential diagnosis of acute bloody diarrhoea includes:Amoebic dysentery (True)

Explanation: This has much mucus and tenesmus.Campylobacter enteritis (True)

Explanation: The amount of blood is usually small.Haemorrhagic colitis caused by E. coli (True)

Explanation: The classic cause, with mostly blood and little stool and no fever.Traveller's diarrhoea (False)Cholera (False)

Question 23. The following are correct:Hepatitis B can be acquired from serous fluid from a wound (True)Explanation: This is the likely mode of horizontal transmission among siblings in developing countries.Hepatitis C is not a cause of hepatocellular carcinoma (False)Hepatitis A is a cause of chronic liver disease (False)Hepatitis E can be acquired by sharing needles (False)A person with only a hepatitis B core IgG test positive is infectious for hepatitis B (False)

Question 24. A 'fatty liver' may represent:Simply an obese person (False)Alcoholism (True)

Explanation: A common 'early' abnormality.

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By A. H.

Hepatitis C infection (True)Explanation: A common 'early' abnormality.Acute vitamin A poisoning (False)An ultrasound artefact (False)

Question 25. Cushing's syndrome:Causes osteoporosis (True)Explanation: Also cardiorespiratory disease.The diagnosis is made by a high-dose dexamethasone test (False)Serum adrenocorticotrophic hormone (ACTH) is important in diagnosing the underlying cause (True)

Explanation: Patients with primary adrenal Cushing's have unmeasurably low serum ACTH.A neoplasm causing a classical 'lemon-on-sticks' appearance is > 25% likely to be small cell carcinoma of the bronchus

(False)Can only be cured by bilateral adrenalectomy (False)

Module 2 (Master Medicine)Question 1. Acute renal failure is a likely complication of the following:Sepsis (or sepsis syndrome) (True)Explanation: Commonly caused by prerenal factors such as sepsis syndrome.Polycystic kidney disease (False)Major arterial surgery (True)

Explanation: Major arterial surgery can cause renal ischaemia and acute tubular necrosis.Retroperitoneal tumours (False)Cardiogenic shock (True)

Question 2. In patients with acute renal failure:Sodium bicarbonate should be given routinely (False)Most patients with acute renal failure need long-term dialysis (False)Skin turgor is a reliable guide to the need for i.v. fluid therapy (False)Urinary catheterisation is sometimes needed to monitor the response to therapy (True)

Explanation: It is important to measure urine flow in the fluid management of acute renal failure.Intravenous pyelography is the investigation of choice to exclude urinary obstruction (False)

Question 3. The following are causes of chronic renal failure:Gout (True)Explanation: In renal failure, the kidneys are unable to excrete urea so the urinary urea concentration is low. Thisdistinguishes renal failure from, for example, volume depletion, in which plasma urea is high but the kidneys retain thecapacity to concentrate urinary urea.Atherosclerosis (True)

Explanation: As a result of extrarenal or intrarenal obstruction to the renal arterial circulation.Analgesic abuse (True)Explanation: As a result of extrarenal or intrarenal obstruction to the renal arterial circulation.Non-insulin-dependent diabetes (True)

Explanation: Both insulin-dependent and non-insulin-dependent diabetes cause renal failure.Hypothyroidism (False)

Question 4. The following may cause the nephrotic syndrome:Minimal change disease (True)Explanation: This is the characteristic disease associated with nephrotic syndrome, particularly in children.Treatment with beta-blockers (False)Rheumatoid arthritis (True)

Explanation: It may be caused by amyloid associated with rheumatoid arthritis or by drugs used to treat the disease(gold or penicillamine). Rarely it is caused by a glomerulonephritis associated with the disease itself.Diabetes mellitus (True)

Explanation: Although the full-blown nephrotic syndrome is a relatively uncommon presentation of diabeticnephropathy.Renal cell carcinoma (False)

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By A. H.

Question 5. The following are features of urinary infections in elderly people:Patients usually complain of dysuria (False)They may present with falls (True)They may present with constipation (True)

Explanation: Or it may be coexistent, perhaps reflecting anorexia and dehydration.Sterile pyuria is most likely caused by tuberculosis (False)Estrogen supplements may reduce their frequency in postmenopausal women (True)

Explanation: Elasticity of the urethra is reduced postmenopausally and this can lead to infection. Local estrogen therapyhelps.

Question 6. Renal artery stenosis:Is invariably caused by atherosclerosis (False)May cause renal failure in patients given ACE (angiotensin-converting enzyme) inhibitor therapy (True)

Explanation: Fibromuscular hyperplasia and radiation fibrosis are two other pathologies which can cause renal arterystenosis, although atherosclerosis is the most common pathology.Can be reliably diagnosed by auscultating for renal bruits (False)May be seen on ultrasound as a unilateral small kidney (True)

Explanation: Hypoperfusion causes reduction in renal size.Is a cause of hypertension (True)

Explanation: Hypoperfusion causes reduction in renal size.

Question 7. The following are true:There is weakness of elbow extension in a crutch palsy (True)Explanation: The triceps is affected in a crutch palsy.Wasting of the hypothenar eminence occurs in the carpal tunnel syndrome (False)Abduction of the thumb is impaired in an ulnar nerve lesion (False)The index finger is hyperextended at the metacarpophalangeal (MCP) joint in an ulnar nerve lesion (False)Sensation is lost over the whole of the back of the hand in radial nerve damage (False)

Question 8. The following are true:A cerebellar vermis lesion will result in a marked intention tremor (False)Macular sparing is a characteristic of lesions affecting the optic tract (False)In a patient with marked visuo-spatial inattention, the lesion is most likely in the left cerebral hemisphere (False)Agnosia means inability to plan and execute motor tasks (False)Dyscalculia is a feature of Alzheimer's disease (True)

Explanation: Remember other higher cortical functions, e.g. dysphasia, dyslexia.

Question 9. Features of a right sixth nerve palsy include:Convergent strabismus (True)Explanation: Complete paralysis of the lateral rectus leaves the medial rectus unopposed hence producing a convergentstrabismus, though mostly the paralysis is only brought out when the eye is abducted.Diplopia worse on looking to the right (True)

Explanation: Diplopia is maximal on looking in the direction of the primary action of the muscle.False image parallel to the true image (True)

Explanation: Unlike a superior oblique palsy.False image occurs further to the left than the true image (False)Images become increasingly separated on looking to the left (False)

Question 10. Parkinson's disease is associated with:Loss of dopamine transmission (True)Explanation: Although the mechanism is unclear, it does involve loss of dopaminergic neurons.Cogwheel rigidity (True)

Explanation: Cogwheel rigidity is a superimposed tremor on the 'lead pipe' increase in tone.Tardive dyskinesia (False)Intention tremor (False)Festinant gait (True)

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By A. H.

Question 11. In a young female with paraplegia, which of the following would suggest a diagnosis of multiple sclerosis:Periventricular lesions seen on MR scanning (True)

Explanation: Periventricular plaques would imply disease remote from the spinal cord. MR scanning is the preferredimaging technique.Raised protein in cerebrospinal fluid (CSF) (False)Raised CSF globulin (True)

Explanation: CNS immunology is disturbed in multiple sclerosis.Denervation of the muscles of the leg (False)Episode of visual disturbance (True)

Explanation: Disturbances of visual acuity are an early sign.

Question 12. The following are more suggestive of dementia than of depression:Several episodes of antisocial behaviour (True)Explanation: Antisocial behaviour is more in keeping with the personality change of dementia.Mutism (False)Duration of symptoms less than 1 month (False)Worsening of symptoms during the early morning (False)Marked impairment of concentration (False)

Question 13. With respect to lumbar puncture:Coagulopathy is a contraindication (True)Explanation: However, if correctable (e.g. haemophiliac) and the indication for lumbar puncture is strong enough, thenit should be corrected and the lumbar puncture carried out.Papilloedema is an absolute contraindication (False)The procedure may cause meningitis (False)The less CSF is removed, the less likely coning is to occur (False)Postlumbar puncture headache is related to the size of the needle used (False)

Question 14. Outcome from bacterial meningitis relates to:Age of patient (True)

Explanation: Mortality is highest in elderly people.Time to first administration of antibiotic (True)

Explanation: Delays lead to increased mortality and morbidity.CSF concentration of antibiotic (True)

Explanation: The CSF concentration of antibiotic needs to exceed by 20-fold the minimum inhibitory concentration ofthe infecting organism. This is the primary reason why i.v. therapy is necessary in meningitis.Development of antibiotic resistance during therapy (False)The causative organism (True)

Explanation: Neisseria meningitidis has a lower mortality than S. pneumoniae meningitis. Furthermore about 5% ofcommunity-acquired cases are other organisms, such as Listeria monocytogenes. Listeria is intrinsically resistant to allcephalosporins, which are now the most common first line treatment for meningitis

Question 15. The following statements are true:Hypocalcaemia causes prolongation of the prothrombin time (False)The prothrombin time is a sensitive test of hepatocellular dysfunction (True)

Explanation: Because hepatocellular dysfunction impairs the synthesis of vitamin K-dependent clotting factors.The activated partial thromboplastin time (APTT) is prolonged by unfractionated heparin therapy (True)

Explanation: This is used as a measure of heparinisation.The effect of heparin is reversed by vitamin K (False)Deep venous thrombosis can be reliably diagnosed by measuring fibrin degradation products (FDPs) (False)

Question 16. The following may cause a microcytic anaemia:Sickle cell disease (False)The thalassaemias (False)Anaemia of chronic disease (False)Anticonvulsant therapy (False)

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By A. H.

Haemolysis, whatever the cause (False)

Question 17. The following statements are true:A neutrophil count of only 0.8 109 cells/l is a major risk for infection (False)A neutrophil count in a febrile patient of 25 109 cells/l reflects mostly the production of new neutrophils from the

bone marrow (False)In a patient with less than 0.1 109 cells/l neutrophils and a fever, treatment with antibiotics should await the results of

blood culture (False)Neutropenia is common in AIDS (False)Neutropenia can be caused by carbimazole therapy (True)

Explanation: Neutropenia occurs in 1:10000 patients treated with carbimazole for thyrotoxicosis.

Question 18. Prognosis of diabetes:Cardiovascular mortality is higher in diabetic than in non-diabetic people up to the age of 80 (True)Explanation: A threefold increase.Diabetic patients with proteinuria have a higher cardiovascular risk than those without it (True)

Explanation: It is indicative of nephropathy, which increases the risk of cardiovascular disease up to 100-fold.When sulfonylureas became available, there was a noticeable improvement in cardiovascular mortality (False)Good glycaemic control, on the balance of available evidence, can reduce cardiovascular mortality in both type 1 and

type 2 DM (False)Even mildly 'impaired glucose tolerance' increases cardiovascular risk (True)

Question 19. In secondary diabetes:A patient can be assumed not to be ketosis-prone (False)A patient is more than 85% likely to have clinical pancreatic exocrine deficiency (False)Classical diabetic complications do not occur (False)Thiazide diuretics and beta-blockers can both impair insulin secretion (True)

Explanation: Secondary diabetes causes all the same complications as idiopathic diabetes.Most patients with acromegaly are diabetic (False)

Question 20. Diabetic retinopathy:Characteristically causes arterio-venous nipping (False)Should be referred to an ophthalmologist only if the patient has visual symptoms (False)Inevitably causes blindness (False)May cause cotton wool spots (soft exudates) (True)

Explanation: These may also occur in hypertension and other ischaemic retinopathies.Is more likely to cause blindness in type 1 than in type 2 DM (False)

Question 21. In insulin treatment:Pen injectors are reserved for the small minority who take four or more injections per day (False)Only patients who cannot be controlled with once-daily insulin should have two or more injections (False)Insulin should be started without delay in a thin hyperglycaemic patient with ketonuria (True)

Explanation: These are signs of type 1 DM.Insulin may sometimes be needed during short periods of illness in patients with type 2 DM (True)

Explanation: These are signs of type 1 DM.All patients on insulin should be discouraged from changing their doses without first checking with the doctor or nurse

(False)

Question 22. Hypertension in diabetes:Is more prevalent in type 1 than in type 2 (False)Its treatment slows the deterioration of nephropathy in type 1 DM (True)

Explanation: Hypertension is associated with type 2 more strongly than with type 1 DM.Thiazide diuretics should not be used in diabetes (False)Beta-blockers may increase the risk of severe hypoglycaemia in insulin-treated patients (True)

Explanation: This is true primarily of non-cardioselective beta-blockers.Increases the risk of stroke in diabetes (True)

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By A. H.

Explanation: This is true primarily of non-cardioselective beta-blockers

Question 23. The following are seen with NSAIDs:Improvement in renal function (False)Increase in serum potassium (True)

Explanation: The change in renal function results in hyperkalaemia.Increased risk of peptic ulcer complications (True)

Explanation: There is a clear relationship between NSAID use and complications such as perforation, bleeding anddeath particularly in old people.Improved long-term prognosis of rheumatoid arthritis (False)Improvement in coexistent asthma (False)

Question 24. The following are features of systemic lupus erythematosus (SLE)Raynaud's phenomenon (True)Explanation: Pain during mastication is a characteristic feature of temporal arteritis.Mononeuritis multiplex (True)

Explanation: Pain during mastication is a characteristic feature of temporal arteritis.Thrombocytopenia (True)

Explanation: This is one of the typical blood-associated dyscrasias.Lymphopenia (True)

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