genreal practice 1990 exam

8/13/2019 genreal practice 1990 exam

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1990 EXAM PAPER

SIMPLE COMPLETION ITEMS

DIRECTIONS: Each of the questions or incomplete statements below is followed by five suggested answers or

completions. Write the appropriate letter in the space provided on the Answer Sheet.

1. In a cerebrovascular catastrophe, a distinction between haemorrhage and thrombosis may be made on which of

the following points

A. the progress of the clinical features !. the degree of loss of consciousness ". the abruptness of onset #. the presence or absence of headache E. none of the above

$. A 1%&year&old schoolboy athlete consults you with high left posterior thigh pain of si' days( duration. )ain and aclic* developed suddenly as he was competing in a one hundred metre sprint and prevented him from completingthe race. +e is still e'periencing considerable discomfort, is limping and unable to run.

Which of the following is most li*ely

A. slipped upper femoral epiphysis

!. iliopsoas tendon strain ". indirect in ury of the adductor group #. indirect in ury of the hamstring group E. sciatic nerve root irritation associated with an acute lumbar disc prolapse -. +untington(s "horea is an e'ample of

A. an &/or se'0 lin*ed condition

!. a recessive condition ". a dominant condition # a genetic mutation E. none of the above

. 2ou are called to see a 34&year&old woman with a three&month history of headaches and depressive symptoms. Sherelates that the vision of her right eye suddenly dimmed. 5wenty&four hours later, visual acuity in the right eye isrestricted to perception of hand movements only, compared with 676 in the left eye. She is not *nown to be diabeticand her blood pressure is only minimally elevated.

What possible cause of her visual loss would require immediate medical investigation and treatment to prevent

blindness in the other eye

A. detached retina !. central artery occlusion ". central vein occlusion #. acute glaucoma E. temporal arteritis

%. 5he most important clinical observation following head in ury is8

A. the e'amination of the fundi !. the state of the pupils ". the level of consciousness #. the plantar responses

E. the blood pressure


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6. Which of the following drugs used in the treatment of migraine has potentially the most serious adverse effects

A. methysergide !. propranolol ". arnitriptyline #. cyproheptadine

E. pi9otifen

3. An 4 year old child presents with a high fever. )hysical e'amination reveals a membranous tonsillar e'udate,generalised lymphadenopathy, hepato&splenomegaly and a faint macular rash. Which of the following would

be most li*ely to be found

A. raised AS:5 /antistreptolysin titre0 !. atypical lymphocytes in peripheral blood film ". bone marrow shows lymphatic leu*aemia #. cytomegalic inclusion bodies in cells from the urinary sediment E. positive Schic* test

4. 5he interossei of the hand are supplied by

A. the radial nerve !. the median nerve ". the ulnar nerve #. all of the above E. none of the above

;. A man presents with pain in the *nee when he stands out of bed in the morning. 5he most li*ely diagnosis is

A. osteoarthritis of the hip

!. rheumatoid arthritis of the hip ". crush fracture of


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A. chronic urinary infection in adulthood

!. repeated urinary infections in adulthood ". vesico&ureteric reflu' in childhood #. enuresis E. bacteriuria of pregnancy

1-. A % year old woman presents to her family doctor one month after her husband(s death complaining of feelingdepressed and lonely, inability to sleep well and of minor aches and pains. What is the first line of management

A. minor tranquillisers. and sedatives at night

!. ma or tranquillisers ". antidepressant medication #. referral to a psychiatrist E. encouraging her to tal* about her husband and her feelings about his death.

1 . Arthritis is common in

A. rubella !. mumps ". measles #. infectious mononucleosis E. varicella

1%. +irsutism in the adult female is most commonly due to

A. administration of androgens !. constitutional factors ". Stein&


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A. basilar artery insufficiency

!. anterior communicating artery aneurysm ". hypertensive encephalopathy #. pseudobulbar palsy

E. occlusion of the middle cerebral artery

$=. A 6 year old man suffered his first myocardial infarction. >ecovery was uneventful. 5wo days after admission tohospital, the patient(s fasting blood glucose was %.4 mmol7< /upper limits of normal 6.$ mmol7


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A. that he have an indwelling catheter inserted !. that anticoagulant therapy be commenced ". that physiotherapy be commenced to prevent hypostatic pneumonia #. that an intravenous drip be inserted to prevent dehydration E. that the nursing staff be as*ed to position him on alternate sides $ hourly

$3. Which of the following may be associated with renal failure A. erythema nodosum

!. iritis ". generalised pruritus #. generalised lymph gland enlargement E. herpes. 9oster $4. In adolescents, hematocrit values tend to correlate best with

A. body weight !. height ". se'ual maturity in boys #. chronologic age E. se'ual maturity in girls

$;. Wasting of the thenar muscles as an isolated sign is most li*ely due to

A. syringomyelia !. median nerve compression at the wrist

". motor neurone disease

#. ulnar nerve lesionE. "4&5I lesion

-=. Which of the following is the most desirable drug to use in the long term management of a patient with Addison(sdisease

A. cortisone

!. hydrocortisone ". prednisolone #. betamethasone E. de'amethasone -1. Which of the following changes is most li*ely to occur in '&irradiated s*in

A. telangiectasis !. melanoma ". *eloid formation #. e'cessive hair growth E. e'cessive sweating -$. Which of the following disorders is B:5 a pre&malignant condition

A. gastric atrophy !. colonic polyp ". cirrhosis

#. diverticulosis of the e unum E. ulcerative colitis


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--. 2ou recently thought on clinical grounds that )at @rey might have been thyroto'ic. +er 5 was elevated, butsubsequent evaluation of thyroid function showed her to be euthyroid. 5he reason for the elevation of the 5 assaylay in )at(s current therapeutic regime.

Which of the following agents was )at ta*ing

A. lasi' /frusemide0 !.. prednisolone ". a combined /oestrogen7progestogen0 contraceptive #. potassium iodide supplements E. insulin - . 5he commonest source of fatal pulmonary embolism is

A. iliofernoral veins !. subclavian veins ". calf veins #. pelvic veins E. none of the above -%. #uring tetracycline treatment absorption is impaired with concurrent administration of

A. ascorbic acid !. oral penicillin ". oral ferrous sulphate #. frusemide E. sulphadimidine -6. Atrio&ventricular heart bloc* may be treated with which of the following

A. an artificial pacema*er !. isoprenaline hydrochloride /Isuprel0 ". ephedrine sulphate

#. all of the above E. none of the above -3. A 1 year old boy presents with a long history of recurrent upper respiratory tract infections and chronic

diarrhoea. Although these respiratory infections respond to anti&microbial therapy, they recur soon after treatmentis ceased. :ther than suffering recurrent allergic rhinitis and vernal con unctivitis /spring catarrh0, he is well.

What immune deficiency is the li*ely cause

A. IgA

! IgD ". IgD$ #. IgE E. IgC -4. A woman with Carfan(s syndrome has ectopia lentis, long body habitus, dorsal scoliosis, and arachnodactyly. She

should be discouraged from having children because

A. there is a $% ris* that her children will be similarly affected !. affected progeny will have more severe manifestations of the disorder than she has ". there is an obstetric ris* of maternal mortality #. she will be too handicapped by her condition to loo* after children

E. uterine inertia may occur during labour

-;. 5rimethoprirn&sulpharnetho'a9ole /!actrim, Septrin0 combinations e'ert their bacteriostatic effect by

A. interrupting cell wall synthesis

!. disturbing protein metabolism ". inhibiting folic acid metabolism #. interrupting transport across the cell membrane


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E. none of the above =. Which of the following is most effective in preventing migraines

A. methysergide !. propranolol

". amitriptyline #. cyproheptadine E. pi9otifen 1. 5he commonest arrhythmia associated with thyroto'icosis is

A. sinus tachycardia

!. atrial fibrillation ". atrial flutter #. atrial ectopics E. first degree heart bloc* $. A child presented to you with mild pharyngitis. A throat swab was ta*en. 5he mother was reassured that it was

probably viral, and paracetamol was prescribed. 5wo days later the laboratory reports a profuse growth of Strep.)yogenes /


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3. 5he drug of choice for treatment of erysipelas is

A penicillin!. methicillin". ampicillin

#. tetracycline

E. none of the above 4. )hysical signs( of a patient with moderate obstructive pulmonary emphysema would include all of the following

E "E)5

A. distant heart sounds . !. a prominent pulmonary second sound ". a narrow intercostal angle

#. prolonged e'piration E. hyperresonance to pulmonary percussion,

;. +ow quic*ly do migraine preventatives appear to wor* once the correct dose is found for each patient

A. within twenty&four hours!. from one to seven days afterwards

". from one to two wee*s afterwards #. from two to four wee*s afterwards E. from one to three months afterwards %=. All of the following drugs are useful in the treatment of moderately severe dysmenorrhoea EXCEPT

A. )onstan !. Baprosyn ". Aspirin #. !rufen E. Indocid %1. )ost prandial epigastric pain occurs in = to %= of patients with

A. peptic ulcer !. gall bladder disease ". non ulcer dyspepsia #. irritable bowel E. all of the above %$. Each of the following is characteristic of adult rheumatoid arthritis EXCEPT

A. morning stiffness of oints lasting longer than an hour !. soft tissue swellings ". +eberden(s nodes #. subcutaneous nodules at pressure points E. symmetrical oint involvement %-. Which of the following postural states places the most stress on the inter&vertebral discs of the lumbar vertebrae

A. sitting and leaning forward !. standing

". standing and leaning forward #. sitting E. lying curled up in bed


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% . In e'amination of movements of the lumbar spine in a patient with bac* pain due to disc in ury which of thefollowing spinal movements is usually free from pain

A. fle'ion

!. rotation

". hypere'tension #. lateral fle'ion E. e'tension %%. 5he E.S.>. is not increased in which one of the following conditions

A. systemic lupus erythematosus !. multiple myeloma ". polycythaemia vera #. disseminated malignancy E. bacterial infections

%6. Bumerous spider haemangiomata often are found in association with another physical sign. 5his is

A. blue spots on the buccal mucosa! .redness of the thenar and hypothenar eminences". dilated nec* veins

# (spoon( nails E. acrocyanosis %3. In a patient with aundice, a high serum al*aline phosphatase level suggests

A. cholangitis !. hepato&cellular damage, but can sometimes be misleading ". haemolytic, anaemia #. biliary obstruction

E. metastatic carcinoma of the prostate %4. Appro'imately what percentage of patients presenting with acute bac* pain would you e'pect to have significantly

recovered after si' wee*s of conservative treatment only

A ;; !. ;% " 4% #. 3%

E. %=

%;. 5he upper limit of normal for the period of apnoea following a baby(s delivery is

A. -= seconds !. % seconds ". 6= seconds #. $ minutes E. % minutes 6=. )atent ductus arteriosus is associated with all the following statements EXCEPT

A. it occurs frequently as an isolated phenomenon !. , it is more common in males ". it is associated with maternal rubella in pregnancy #. there is a wide pulse pressure E. there are usually no symptom(s

61. 5o prevent >hesus iso&immunisation, anti&>h/#0 gamma globulin should be given after delivery to A. an >h/#0 negative mother with anti antibodies with an >h/#0 negative infant


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!. an >h/#0 negative mother without anti antibodies with an >h/#0 negative infant ". an >h/#0 negative mother with anti antibodies with an >h/#0 positive infant #. an >h/#0 negative mother without anti antibodies with an >h/#0 positive infant

E. an >h/#0 negative mother in all cases 6$. #iverticular disease of the colon is

A. associated with hypertrophy of circular smooth muscle !. most prominent in the right half of the colon ". often complicated by carcinoma #. usually congenital in origin E. not associated with any of the above

6-. 5he most sensitive prognostic indicator of >h disease of pregnancy is

A. the antibody titre !. the past history ". an amniocentesis #. the presence of maternal to'emia E. the presence of foetal movements

6 . A $ &year old woman whose uvenile diabetes mellitus has been *ept under reasonable control with insulin for 1=years has ust married. She wants to *now what her chances are of having normal children. She should be told

A. if her diabetes is not *ept under good control during pregnancy, her child will have a higher ris* of developing

diabetes !. if her husband is also an insulin&dependent diabetic, any diabetes in their child will be more severe

". if she is under poor diabetic control during pregnancy, the ris* of severe congenital malformations is muchhigher

#. if she becomes pregnant, her diabetic treatment should be changed from insulin to oral hypoglycemic agents E. her chances of having normal children are so remote she should be offered sterili9ation

6%. A healthy si' year old child without cyanosis or dyspnoea on e'ercise is e'amined for migration to F.S.A. +is pulse is 4 per minute, !.). 1==76=, radial pulse and ugular venous pressure normal and there is no evidence of cardiomegaly. :n auscultation in the $ nd left intercostal space the 1 st and $ nd heart sounds are audible with fi'edsplitting of the $ nd heart sound. A medium pitched rough grade $ systolic murmur is present and is not transmitted

elsewhere. 5he most li*ely diagnosis is

A. pulmonary stenosis!. atrial septal defect

". innocent pulmonary e ection murmur #. ventricular septal defect E. patent ductus arteriosus 66. 5he single most common causative organism in epididymitis is

A. mumps virus !, E. "oli ". clamydia #. neisseria gonococcus E. E. Strep, faecalis 63. 5he initial management of a spontaneous pneumothora' in a patient without dyspnoea at rest and a uniform $ cm

separation of the lung from the chest wall on a radiograph should consist of

A. observation !. single needle aspiration ". positive pressure respiration #. underwater drainage

E. underwater drainage with suction


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64. !etabloc*ers should be avoided in which of the following conditions

A. heart bloc* !. cardiac failure ". peripheral vascular disease #. history of asthma

E. all of the above

6;. 5he best long&term results in treating depression are achieved using

A. tranquillisers ! , counselling " medication and counselling # E"5 E. beta bloc*ers 3=. A patient has a stab wound in the left fourth intercostal space in the mid&clavicular line. Indications for immediate

aspiration are

A. rising blood pressure !. pericardial friction rub ". hyperventilation with hypercapnoea #. falling blood pressure with increased venous pressure E. bradycardia 31. 5he most rapid and accurate diagnostic procedure in gout of

A. '&ray of the *nee !. serum uric acid ". blood count #. ES>

E. oint fluid microscopy

3$. 5he blood urea nitrogen is 1% mmol7


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3%. Surviving premature infants may be e'pected to lag behind other children of the same age in physicalaccomplishments during the first

A $ years of life !. years of life ". 4 years of life #. 6 months of life E. 1$ months of life 36. 5he initial investigation of a cyanotic infant should be

A. a +b estimation and blood grouping !. a "oomb(s test ". a chest &ray #. the arterial o'ygen saturation E. the p"=$ /plasma carbon dio'ide concentration0 33. 5o confirm the diagnosis of trichomoniasis, the organism is most li*ely to be identified by

A. cytological e'amination of a cervical smear ! direct microscopic e'amination of a drop of vaginal secretion ". stained smear of vaginal secretion #. culture of vaginal secretion

E. response to treatment

34. Which of the following is the most useful observation to EXCLUDE the diagnosis of fracture of the hip

A. normal buttoc* contour !. quadriceps tone ". absence of local tenderness of the hip oint

#. absence of crepitus of the hip E. normal range of movement in the hip 3;. An 14 month old boy presents with a history of anore'ia and recurrent upper respiratory tract infections. )hysical

e'amination reveals pallor and splenornegaly. +is blood picture showed a hypochromic, microcytic anaemia withnumerous target cells and nucleated red cells.

Which of the following diagnoses is most li*ely

A. thalassaernia ma or

!. iron deficiency anaemia ". glucose&6&phosphate dehydrogenase deficiency #. sideroblastic anaemia E. sic*le cell anaemia 4=. Increased catecholamines in the urine are diagnostic of

A. "ushing(s syndrome !. carcinoid syndrome ". hyperparathyroldism #. phaeochromocytoma E.( hyperaldosteronism

41. 5he greatest defect in artificial limbs for upper limb amputees is


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. A. cosmetic ! lac* of sensory feed&bac* " lac* of motor effectiveness # weight of the prosthesis E. none of the above

4$. 5he p"=$ is an inde' of A. ventilation

!. acid&base balance ". ano'aernia #. dyspnoea E. *etosis

4-. A three year old child who has swallowed *erosene is brought immediately to casualty. 2our management wouldinclude which of the following

A. gastric lavage

!. an emetic ". chest '&ray #. intravenous saline E. methicillin 4 . 5he GbenignG aundice that occasionally occurs in the third trimester of pregnancy is probably most closely related to

A. high progesterone level !. a specific defect in glucuronide con ugation ". autoimmune process #.( high oestrogen level E. the use of diuretics in this stage of pregnancy 4%. 5he defect in visual fields most commonly associated with a pituitary tumour is

A. crossed homonymous hemianopia !. central scotoma ". bitemporal hernianopia # total blindness in one field E. peripheral concentric constriction and enlargement of the blind spot 46. =yr old ietnamese who arrived in +ong Hong 6 wee*s ago presents with % days of headache, fever and malaise.

Which of the following is the most li*ely diagnosis

A. malaria !. typhoid fever ". dengue fever #. filariasis E. meningococcal meningitis 43. Which of the following would be most helpful in distinguishing cerebral infarction from cerebral neoplasm

A. history of headache !. herniplegia " chronology of development #. carotid bruit E. focal abnormality on electroencephalogram

44. A $ year old child presents with a - wee* history of cough and whee9e. 5he most important diagnosis to e'clude is

A. whooping cough

!. inhaled foreign body ". mycoplasma pneumoniae infection #. cystic fibrosis


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E. bronchial asthma 4;. A seven year old boy passes a large bloody stool. 5he most li*ely cause is

A. Cec*el(s diverticulurn !. duodenal ulcer

". polyps of the colon #. diverticulitis of the colon E. intussusception ;=. A patient with a severe hemi&cranial nocturnal headache lasting for 6= minutes and occurring regularly for -

wee*s with a bloc*ed nose and watering eye probably has

A. tension headache !. migraine ". sinusitis #. cluster headache, E. trigeminal neuralgia ;1. In hypothyroidism, which of the following characterises the nature of the an*le refle'es

A. bris* !. diminished ". delayed rela'ation #. pendular E. absent ;$. Intestinal sugar malabsorption may be suspected if the child has

A. vomiting each time a particular sugar is eaten !. stool p+ 6 ". salmonella in the faeces #. glycosuria and e'cess of sugar in the faeces

E. diarrhoea

;-. 5he main long&term ha9ard of a fractured patella is

A. osteoarthritis of the *nee oint !. recurrent dislocation of the patella ". chondromalacia patellae #. osteochondritis dessicans E. none of the above

; . 5om )atric*, a $ year old, fit business e'ecutive runs an average -& *m every second day. +e is an'ious to participate in the "ity to Surf @un >un so he begins to increase his running to 6 *m five days a wee*. +e is in hisusual state of health when he starts out one morning in the second wee* of his new running programme. 5he first

part of his run is uneventful, but during the latter part, he notices the sudden onset of pain in his left *nee for noapparent reason. It rapidly increases in severity, so that by the time he finishes he can only wal* y with a painfullimp. +e has to see you because of the severe pain and disability and you find a warm tense effusion in the involved*nee. :therwise, clinical e'amination is normal.

Which of the following is the most li*ely

A. osteoarthritis

!. acute pseudo&gout ". acute gout & #. septic arthritis E. rheumatoid arthritis ;%. Car* >ogers has been a ogger for twelve months and recently decided to enter a marathon run. +e presents

frustrated that his training for the event has been hampered in recent days by the development of pain on the inner border of his right lower leg. +is pain commences early in his training runs and prevents him continuing8 itdisappears with rest but recurs when he runs again.


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Which one of the following conditions is the most li*ely cause of his symptoms

A. a stress fracture of the tibia

!. an anterior compartment syndrome( ". a sub&periosteal haematoma

#. shin splints , E. a tibial osteoma ;6. A diabetic patient *nown to have been receiving 4= units of 9inc protamine insulin daily, is found unconscious.

5he blood pressure is 11=13= mm +g, the pulse rate 1== per minute, the pupils are equal and dilated, the fundishow occasional small micro& aneurysms and the plantar responses are e'tensor. 5he patient had been incontinentof urine and a G"linisti'G, pressed against the patient(s urine&soac*ed clothing, indicates the presence ofglyocosuria. Initial management should consist of

A. commencing an intravenous drip of =.; solution of sodium chloride

!. administering %=g of %= glucose intravenously ". administering 1== units of soluble insulin hypodermically #. see*ing evidence of barbiturate overdosage E. arranging an urgent blood sugar estimation and "=$ content

;3. 5he most frequent cause of iron deficiency anaemia is

A. dietary deficiency !. malabsorption ". chronic DI5 blood loss #. menstruation E. idiopathic ;4. 5he causes of primary dysmenorrhoea include

A. pelvic inflammatory disease

!. fibroids ". endometriosis #. I.F.".#. E. none of the above ;; In what percentage of women between the ages of 1% and % does dysmenorrhoea occur

A. -= !. = ". %= #. 6= E.3=

1==. Which of the following statements about routine immunisation is true

A. if more than - months elapses between triple antigen in ections the series should be restarted to obtainadequate immuni9ation

!. the first triple antigen in ection should always be 17$ dose /l7$ ml0 to reduce allergic reactions ". when a convulsion occurs as a triple antigen reaction, further immunisations should e'clude pertussis vaccine #. tetanus booster in ections should be repeated every three years

E. measles vaccine should be given at 6 months of age to protect the child as soon as possible

1=1. A %&year&old man presents to you with a one&year history of progressive an*le swelling, difficulty with spea*ingdue to an enlarged tongue, pain J paraesthesiae in the forearm and hand, particularly at night, and easy bruising.

Which of the following is the most li*ely diagnosis

A. membranous nephritis !. allergic reaction


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". chronic leu*aemia #. amyloidosis E. carcinoma of the lung 1=$. 5he most appropriate management of a stress fracture of the calcaneum of one wee*(s duration would be

A. see* an orthopaedic opinion !. refer to a physiotherapist for ultrasound ". resume running m one wee* using a heel cushion #. refrain from running and re&'&ray in four wee*s E. in ect the site of ma'imum tenderness with a glucocorticosteroidal agent 1=-. >on >owe, an otherwise well, -=&year&old "ommonwealth Dames rower,suddenly develops persistent, dull upper

left chest pain, not related to e'ertion, of several hours duration. 5he pain, although not related to respiration,causes mild restriction in breathing. 5here were no related respiratory or cardiac symptoms? the patient was notdistressed and was afebrile.

:f the following, which one should NOT be considered as a possible diagnosis

A. spontaneous pneumothora'

!. functional chest pain /an'iety neurosis0 ". costo&chondral syndrome #. muscle strain, E pleurodynia /!omhohn(s disease0 1= . In the investigation of hypertension, an endocrine cause is li*ely if

A. the serum potassium is low !. the serum potassium is high ". the serum bicarbonate is high #. the serum bicarbonate is low E. the serum calcium is high

1=%. A patient aged -; years presents with a 6 months( history of prolonged and frequent periods.5he most usualhistological appearance of pre&menstrual curettings would be

A. hyperplastic proliferative endometnum !. secretory endometrium, ". atypical endometrial hyperplasia #. atrophic endometrium E. none of the above

1=6. 5he nephrotic syndrome can be caused by all of the following EXCEPT

A. pyelonephritis !. amyloidosis ". lupus erythematosus #. penicillamine E. renal vein thrombosis 1=3. 5he erythrocyte sedimentation rate is raised in all of the following e'cept

A. the puerperium !. polycythaemia ". infancy #. pregnancy E. chronic hepatitis 1=4. !lood&stained discharge from the nipple of a % year old woman is most li*ely due to

A. gynaecomastia !. duct papilloma


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". )aget(s disease of the nipple #. fibroadenoma E. none of the above 1=;. A % year old man presents with glycosuria. +e has drun* heavily all his life. :n e'amination he is diffusely

pigmented and has a firm, regular enlarged liver. 5here is also testicular atrophy and cardiomegaly. What is the

most li*ely diagnosis A. congestive cardiac failure

!. beri beri heart disease ". infectious hepatitis #. secondary haemochromatosis E. chronic renal disease 11=. Which of the following is the most common event preceding the formation of a false aneurysm

A. myocardial infarction !. in ury to the arterial wall ". treatment of a dissecting aneurysm with a beta&bloc*er #. thrombosis of a saccular aneurysm E. erosion of a saccular aneurysm by tumour 111. Which one of the following is NOT characteristic of an upper motor neurone lesion

A. clonus!. e'tensor plantar response

". intact superficial #. increased tone E. hyperactive tendon refle'es 11$. A man aged %% begins to develop progressive dementia and is admitted to hospital because of a convulsive episode.

:n e'amination the patient has wea*ness of the right side of his body and a positive grasp refle' on the same side.5he most li*ely diagnosis is

A. left carotid artery stenosis ! & left middle cerebral artery thrombosis ". left vertebral artery stenosis #. a temporal lobe tumour on the left side E. a pre&frontal tumour on the left side 11-. In motor neurone disease /amyotrophic lateral sclerosis0, one often finds

A. a long history of remissions and e'acerbations !. sensory loss of dermatomal distribution ". focal epilepsy #. a positive family history E. none of the above 11 . Inorganic lead poisoning is associated with all of the following EXCEPT

A. basophilic stippling !. abdominal pain ". peripheral neuropathy #. microcytic anaemia E. ulceration of the mouth and pharyn' 11%. An elderly patient with rheumatoid arthritis has been on prednisone in a dose of 1$.% mg daily for 4 years. After a

fall, she complains of severe pain over her lower thoracic spine and is found to be very tender over 51 1 and 51$thoracic vertebral spines. A radiograph shows Gcod&fishG vertebrae, with generalised radiolucency of bones andcollapse of two vertebral bodies. E'amination of her serum is most li*ely to show

A. high calcium, low phosphate, raised al*aline phosphatase !. low calcium, high phosphate, normal al*aline phosphatase


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". low calcium, low phosphate, raised al*aline phosphatase #. low calcium, normal phosphate, normal al*aline phosphatase E. normal calcium, normal phosphate, normal al*aline phosphatase

116. A male infant, birth weight $. *g. and product of a normal labour, becomes aundiced at 1$ hours of age. Which

of the following would be the most li*ely cause of the aundice A. grain negative septicaemia

!. aundice of prematunty ". biliary atresia #. physiological aundice E. >h incompatibility 113. 5he most sensitive inde' of fluid retention is

A. ugular venous pressure !. urinary output ". increase in body weight #. pitting oedema E. increasing tightness of ring on finger

114. 5he following statements are frequently made about the management of acute rheumatoid arthritis. Which one ismost clearly established

A. aspirin should be ta*en in low dosage because it causes gastric erosion

!. the oints should be *ept actively moving to prevent stiffness even when painful, hot and swollen ". splintage of actively inflamed oints leads to an*ylosis and has no place in treatment #. manipulation and massage are useful for the treatment of nec* pain in rheumatoid arthritis E. bed rest is an essential part of the management

11;. Subcutaneous emphysema in the suprastenal notch in a vomiting patient with acute epigastric pain, epigastricguarding, laboured respiration and slight cyanosis should suggest the presence of a

A. fractured rib penetrating the lung !. ruptured diaphragm ". spontaneous pneumothora' #. ruptured oesophagus E. ruptured trachea

1$=. Which of the following is of LEAST value in assessing the level inflammation /Gdisease activityG0 in rheumatoidarthritis

A. duration of morning stiffness

!. presence or absence of tiredness, malaise and weight loss ". height of the erythrocyte sedimentation rate /E.S.>.0 #. presence or absence of rheumatoid factor in the blood E. strength of hand grip

1$1. In which of the following conditions is the face unli*ely to be affected

A. contact ec9ema !. seborrhoeic dermatitis ". pityriasis rosea #. lupus erythematosus E. secondary syphilis

1$$. Severe pruritus is common in any of the following E "E)5


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A. +odg*in(s disease !. polycythaernia vera ". chronic renal insufficiency #. haemolytic aundice E. drug sensitivity

1$-. A man of $1 years complains of sudden shortness of breath and e'amination his chest reveals on one sidedecreased chest movement, hyper&resonant percussion note J decreased breath sounds. 5he most li*ely diagnosisis

A. lobar pneumonia

!. pneumothora' ". asthma #. bronchopneumonia E. emphysema with bullae 1$ . A reliable guide to early ".".@. is

A. increased ugular venous pressure !. a cardiac arrhythmia ". a low pulse pressure #. a tapping ape' beat E. an increased cardiac rate

1$%. Citral regurgitation is associated with

A. pan&systolic basal cardiac murmur !. late diastolic basal cardiac murmur ". accentuation of the second heart sound #. pan&systolic apical cardiac murmur E. mid&systolic basal cardiac murmur

MULTIPLE COMPLETIONS

DIRECTIONS 8 @or each of the questions or incomplete statements below, ONE or MORE of the answers or completions

given is correct. :n the Answer Sheet write the appropriate letter in the space provided.

Answer as follows #irections summarised8

A. if only 1, $ and - are correct A&1,$,- !. if only 1 and - are correct !&1,- ". if only $ and are correct "&$, #. if only is correct #& E. if all are correct E&all correct

1$6. @actors which contribute significantly to the persistence of pain, irrespective of the original precipitating event are

1. social withdrawal and inactivity $. antagonistic attitudes to drugs for pain relief -. depression . lac* of sympathy and attention 1$3. 5he wrist is susceptible to in ury with falls on the outstretched hand. Which of the following statements regarding

wrist in ury is7are correct

1. other than the scaphoid, carpal bones are seldom fractured $. serious dislocation of the carpal bones may be misdiagnosed


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-. a fractured scaphoid produces little swelling and bruising . scaphoid fractures have a high incidence of non&union 1$4. 5he following are true of epiphysitis of the tibial. tuberosity

1 symptoms initially occur after vigorous effort

$. swelling subsides quic*ly with initial rest -. increased blood supply to the area accounts for the raised temperature . the condition occurs at 1 years of age

1$;. Severe, left ventricular failure with a near&normal cardiac silhouette may be found in

1 acute myocardial infarction $. acute bacterial endocarditis -. thyroto'icosis . constrictive pericarditis

1-=. In the following conditions direct pupil response will be diminished

1 retinal detachment $. optic neuropathy -. vitreous haemorrhage . retinal artery occlusion

1-1. Which of the following would a person with manic symptoms be e'pected to show

1 . restlessness $. suicidal thoughts

-. dis ointed speech with a rapid change of ideas . a loss of se'ual drive

1-$. Which of the following conditions may cause tiredness as a significant presenting complaint

1. diabetes mellitus $. hyperthyroidism -. hypo*alaernia . hyperparathyroidism

1--. Which of the following statements about inhaled foreign bodies in children is7are correct

1. they usually lodge in the laryn' $. sudden coughing and cho*ing followed by a whee9e is a common cause of presentation -. the commonest ob ect inhaled is a small coin .films ta*en in e'piration and inspiration are essential to localise small radio& translucent ob ects 1- . Adolescent acne is

1.better in summer$.aggravated by a high fat diet-.strongly related to emotional stress.made worse by hot soapy water

1-%. In #own(s syndrome

1. education is of little value as severe intellectual impairment is present $. affected children have single transverse palmar creases


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-. there is no increased ris* of #own(s syndrome in subsequent siblings .intrauterine diagnosis can often be made by amniocentesis at 1 wee*s gestation 1-6. "ollapse of the lung with a patent bronchus will produce

1. dullness on percussion

$. decreased air entry -. diminished vocal resonance . absent breath sounds 1-3. 5he patient with a painful nec* should be advised to

1. wear a collar $. use heat and massage on the painful area

-. sleep on a high firm pillow . sleep with the painful side on the pillow 1-4. Which of the following conditions cause vertigo

1 change of barometric pressure $. :tosclerosis -. "holesteatoma .#iabetes mellitus & 1-;. Which of the following auriscopic findings would be significant in establishing an aural cause of vertigo

1. fluid in the middle ear

$. otitis e'terna, -. perforation of the tympanic membrane . wa' in the ear 1 =. +ealing of a peptic ulcer may be adversely affected by concurrent

1. corticosteroids $. cigarette smo*ing -. analgesic drugs . stress 1 1. In the case of a simple bone cyst

1. females are affected twice as frequently as males

$. the lesion occurs generally in long bones & -.periosteal new bone formation is frequently found

. the lesion originates from the metaphysis

1 $. Erythema multiforme may be precipitated by

1. viral infections $. mycoplasma infections -. fungal infections . drug administration 1 -. In


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$.S*in pigmentation may occur with their use-. they may produce sleep disturbances. any complicating retinopathy is reversible with drug withdrawal

1 %. Where no obvious cause is present for generalised pruritus the following investigations may be necessary

1. &ray chest$. full blood e'amination

- e'amination of stools for ova and parasites . multiple biochemical analysis

1 6. Which of the following drugs can cause orthostatic hypotension

1 #igo'in $. )ropranolol -. Indomethacin . Cethyldopa 1 3. )ain in the arm causing wa*ing at night is characteristically caused by

1. cervical rib syndrome $. cervical disc lesion -. carpal tunnel syndrome . lateral epicondylitis /tennis elbow0

1 4. Which of the following conditions can cause the supraspinatus syndrome

1.inflammation of the tendon $. incomplete tearing of the tendon -. acute calcification of the tendon

. degeneration of the tendon 1 ;. In +enoch&Schorflein purpura

1. the condition may follow an upper respiratory tract infection $. arthralgia is an uncommon finding -. typically the condition begins with headache, fever and malaise . episodes generally last for about 1= days

1%=. Which of the following are features of psychoneurotic8 giddiness

1. the attac*s are paro'ysmal $. wal*ing causes little difficulty -. there are no visual symptoms . the aetiology is similar to that of the hyperventilation syndrome 1%1. "ommon causes of visual loss in the 3= year old include

1. cataract $. macular degeneration -. diabetic retinopathy . chronic simple glaucoma 1%$. 5he following are true in relation to semen collection for analysis

1. 4 hours of abstinence before collecting the specimen is necessary

$. the specimen must be collected by masturbation-. the specimen should be ta*en to the laboratory without delay. the specimen should be *ept chilled during transportation


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1%-. Which of the following antibiotics penetrates the middle ear poorly

1. trirnethoprim 7sulpharnetho'a9ole$. tetracycline.-. amo'ycillinin

. erythromycin

1% . "auses of renal hypertension include

1 sub&capsular renal haematoma $. coarctation of the aorta - renal vein thrombosis ,

. pyelonephritis

1%%. Which of the following are features of postural /orthostatic0 hypotension

1. it is uncommon in elderly and frail patients$. it is usually accompanied by visual disturbance

-. it causes vertigo . it is best managed by instruction on how to assume the upright position 1%6. Deneralised pruritus may be associated with

1. lymphorna

$. polycythaemia rubra vera-. leu*aemia . hyperthyroidism

1%3. In the investigation of infertility which of the following are true about the *eeping of a temperature chart

1. a new chart should be started with each menstrual cycle $ the days of bleeding should be documented & -. the days of intercourse should be mar*ed on the chart . the temperature may be ta*en at any time during the day

1%4. Which of the following statements is /are0 true of essential hypertension

1. Symptomless hypertension does not require treatment$. the older the patient, the less beneficial the treatment will be

-. once anti&hypertensive treatment has commenced, cerebral or coronary insufficiency is rare . generally, women have a better prognosis than men

1%;. Which of the following symptoms in a patient with acute frontal sinusitis would indicate spread of the infection beyond the frontal sinus

1 an increase in the fever and vomiting

$. oedema of the eyelids -.convulsions

. reduction in mental alertness


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16=. In pregnancy associated with essential hypertension1.

1. a fall in blood pressure is common in the early months of regnancy$. a successful pregnancy is less li*ely with a blood urea above 4.- mmol71

-. pre&eclamptic to'aemia is much more common

. adrenergic neurone bloc*ing drugs such as methyldopa0 cannot be used

161. In the carpal tunnel syndrome

1. pain pro'imal to the wrist may occur . $. wea*ness of the abductor pollicis brevis may occur -. sensory signs are often minimal . the patient may e'perience pain in all fingers

16$. A %6 year old patient whose essential hypertension is being treated with metoprolol /!etaloc0 presents for review.Which of the following complaints is7are li*ely to be caused by his medication

1 KI get whee9y in my chest especially when I e'ert myself(

$. GCy hands and feet go cold and white especially on cold morningsG -. KI get very short of breath when 1 wal* up the street . KI have developed a painful swelling in my left big toeG

16-. Which of the following statements about schi9ophrenia is /are0 true

1 suicide is more common than with depressive patients $. most people develop the illness in the $nd and -rd decades -. it occurs more commonly in professional and white collar groups . the patient has a distinct difficulty in thin*ing clearly

16 . #ysuria in females may be due to

1. herpes $. gonorrhoea -. candida . F5I

16%. 5he following are present in acute con unctivitis

1. normal vision $. clear cornea -. normal tension . small pupil

166. @actors increasing the ris* of women developing osteoporosis include

1 . loss of ovarian function $. family history -. cigarette smo*ing . pre&e'isting s*eletal disease

163. @eatures of peripheral vascular insufficiency in diabetes include 1. neurotrophic changes


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$. lymphangitis -. smooth, shiny s on the lower legs . loss of hair on the lower legs

164. #amaging factors in the development of a peptic ulcer include

1 & ingested drugs $. alcohol -. smo*ing . reflu'ed bile 16;. estrictive airways disease is characterised by

1 normal vital capacity $. a reversible component

-. evidence of air trapping. reduced flow rates

131 .A $4 year old woman, Cartha Cayer, comes to see you because her periods have not returned since stopping oralcontraceptives 1$ months ago. Cartha is rather concerned because she is *een to start a family. +er menarche wasat 1 years of age and her periods were irregular /up to si' wee*ly0 before starting (the pill(. While ta*ing oralcontraceptives, she had three to four days of withdrawal bleeding every four wee*s. +er last period was ust afterfinishing her last pac*et of pills. :therwise she has been in good health, is under no undue emotional stress and

her weight has not changed significantly. Which of the following causes of secondary amenorrhoea, need to be e'cluded

1. pituitary tumour

$. thyroid disease -. premature menopause . stress related amenorrhoea,

13$. :n E"D, ventricular premature e'trasystoles have which features

1. bi9arre L>S configuration $. no related preceeding ). wave -. prematurity . a constant coupling interval

13-. 5he peripheral neuropathy of chronic alcoholism

1. is multiple and symmetrical $. is predominantly or e'clusively sensory is -. more prominent in the lower limbs . will resolve with some wee*s. abstinence from alcohol

13 . +aemoptysis may occur in


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1. pulmonary tuberculosis $. bronchial adenoma -. bronchiectasis . mitral stenosis

13%. 5he following have confidently been shown to have an increased incidence in obese sub ects. 1. diabetes

$.atherosclerosis -. pedestrian accidents & osteoarthritis

136.


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14$. Cartha, an apparently rebellious 1% year old, comes to see you on her own. She complains of a vaginal dischargeand has a history of unprotected intercourse.

Which of the following are probable causes of the discharge

1. Dardnerella vaginalis 1 $ "hlarnydia trachomatis - Beisseria gonorrhoea . Syphilis 14- . A three month history of dysphagia occurring only with solid foods and not liquids is suggestive of

1. oesophagitis with stricture$. achalasia-. oesophageal carcinoma. oesophagial dysrhythmia

14 . "auses of male infertility include

1. varicocoele $. bladder nec* incompetence -. therapy with sulphasala9ine . therapy with chlorothia9ide

14%. All patients presenting with recurrent or multiple renal calculi should have the following performed.

1. mid&stream urine for microscopy, chemistry and culture serum $. serum creatinine, urea and electrolyte levels

-. serum calcium, phosphate, al*aline phosphatase, uric acid and protein levels . $ &hour urinary calcium and creatinine e'cretion

. 146. Which of the following statements about diagnostic ultrasound is correct

1.ultrasound can distinguish a hydatid cyst from a capillary haemangioma of the liver $. ultrasound can distinguish between chronic pancreatitis and carcinoma of the pancreas -. ultrasound can accurately detect a sub&phrenic abscess . scan quality is unimpaired in the presence of obesity or abdominal scars

143. +epatitis ! can be transmitted

I . by blood transfusion $. by se'ual intercourse -. by tattooing . from mother to foetus

144. In cases of chronic mucocutaneous candidiasis the following conditions should be e'cluded

1. hypoparathyroidism $. Addison(s disease -. hypothyroidism . diabetes

14;. #rug/s0 of choice in


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1. amo'ycillin

$. tetracyclines -. penicillin . erythromycin

1;=. @ingers are vulnerable to in ury during all sporting activity, but especially football. Inconsidering such in uries, which of the following statements would you regard as correct

1. internal fi'ation is the treatment of choice in the management of fractures of the phalangeal shaft

$. to avoid non&union, all finger movement should be prevented by firm splinting -. fractured phalanges should be splinted in e'tension to prevent subsequent deformity . the prognosis is frequently dependent on associated soft tissue damage

1;1. Which of the following drugs are effective in the treatment of adolescentacne

1. tetracycline $. do'ycycline -. erythromycin . penicillin

1;$. Which of the following statements is7are true of sarcoidosis

1. it is usually fatal $. erythema nodosurn is a common presentation -. renal involvement is common . some form of biopsy is usually necessary to diagnose it

1;-. Which of the following neurological signs give a correct description of the classic clinical

presentation of an intrinsic lesion of the spinal cord such as cervical syringomyelia 1. light touch is intact

$. pain perception is abolished -. temperature perception is abolished . two point discrimination /%mm on fingers0 is abolished

1; . >eported as possible ha9ards of increasing consumption of polyunsaturated fat is7are

1 increased incidence of stro*e $. increased incidence of rheumatoid arthritis -. increased incidence of diabetic *etoacidosis . increased incidence of cancer

1;%. 5he following are true in relation to blood transfusion

1.blood transfusion is seldom indicated where blood loss is less than 1= per cent of the circulating blood volume $.if blood loss is acute, initial transfusion should consist of two units of pac*ed cells -.a microfilter should be considered if the anticipated transfusion requirement of stored blood e'ceeds two litres .where blood loss is not acute and transfusion is necessary, whole blood should be used from the onset

1;6. 5he principles of emergency resuscitation for the near drowned adult or child include

1 . maintain an airway and begin e'pired air resuscitation $. drain all water from the lungs -. begin e'ternal cardiac compression if there is no carotid pulse


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. rewarming

1;3. +ead louse infestation is commoner in

1. urban than in rural schools

$. children with long hair than children with short hair -. girls than boys . si' to nine&year&olds than younger children 1;4. 5he child with abdominal pain is li*ely to have an organic basis for the pain if

1. threadworms are discovered $. he points to the umbilicus -. there is a history of over&reaction to stress . the pain wa*es him at night

1;;. Which of the following statements is true

1. married men report more psychosocial problems than single men $. single men report greater satisfaction with life than married men -. single women report more psychosocial problems than married men

. married women report less satisfaction with life than single women

$==. In which of the following situations is coronary angiography not indicated

1 a man under 6= with mild angina and a strongly positive e'ercise test$. where there are complications of myocardial infarct such as ventricular aneurysm, mitral

regurgitation or ventricular septal defect -. variant /)rin9metal0 angina . a man under %= whose mild angina responds well to medical treatment

ANSWERS TO 1990 EXAM

1. E $6 A %1 E 36 " 1=1 # 1$6 ! 1%1 E 136 A$. # $3 " %$ " 33 ! 1=$ # 1$3 E 1%$ A 133 E-. " $4 " %- A 34 E 1=- E 1$4 A 1%- # 134 ". E $; ! % ! 3; A 1= A 1$; E 1% E 13; #%. " -= A %% " 4= # 1=% A 1-= " 1%% " 14= A6. A -1 A %6 ! 41 ! 1=6 A 1-1 ! 1%6 E 141 E3. ! -$ # %3 # 4$ A 1=3 ! 1-$ E 1%3 A 14$ A4. " -- " %4 " 4- " 1=4 ! 1-- " 1%4 " 14- !;. A - A %; " 4 # 1=; # 1- ! 1%; E 14 A1=. # -% " 6= ! 4% " 11= ! 1-% E 16= A 14% E11. ! -6 # 61 # 46 A 111 " 1-6 A 161 E 146 !1$. " -3 A 6$ A 43 " 11$ E 1-3 " 16$ A 143 E1-. E -4 " 6- " 44 ! 11- E 1-4 E 16- " 144 E1 . A -; " 6 " 4; A 11 E 1-; ! 16 E 14; "1%. ! = A 6% ! ;= # 11% E 1 = A 16% A 1;= #16. ! 1 A 66 " ;1 " 116 E 1 1 " 166 E 1;1 A13. " $ " 63 A ;$ E 113 " 1 $ E 163 E 1;$ "14. # - # 64 E ;- A 114 E 1 - A 164 E 1;- A1;. A " 6; " ; " 11; # 1 A 16; A 1; #$=. ! % ! 3= # ;% # 1$= # 1 % E 13= # 1;% !$1. " 6 ! 31 E ;6 ! 1$1 " 1 6 " 131 E 1;6 !

$$. " 3 A 3$ ! ;3 " 1$$ # 1 3 A 13$ E 1;3 #$-. " 4 " 3- " ;4 E 1$- ! 1 4 E 13- A 1;4 #$ . A ; # 3 " ;; # 1$ A 1 ; ! 13 E 1;; #


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$%. " %= " 3% A 1== " 1$% # 1%= " 13% E $== #

genreal practice 1990 exam

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