peermedics practice questions mcqs for 2nd years: options: a. 95% confidence interval b. statistical...

PeerMedics Practice questions Year 2

PeerMedics MCQs for 2nd Years:

Options:

a. 95% confidence interval b. statistical measure of dispersion of continuous data c. hypothesis test for categorical data d. statistical power- ability of study to find what you want to find e. type I error f. type II error g. statistical significance level

This would be illustrated by:

1. The failure to detect a true difference 2. The Chi-squared test 3. The statistical assessment of a statement formulated in the negative, such as “there is

no association between osteoarthritis and nutrition” 4. Illustrated by looking at the difference between the 5th and the 95th centile of a set of

blood pressure measurements in millimetres of mercury 5. A measure of the precision of an estimated proportion of patients on an orthopaedic

waiting list who are likely to be over 65 years old

Options:

a. sample size calculation b. calculation of odds c. calculation of a relative risk d. surveillance e. calculation of an odds ratio f. minimizing bias in a cohort study g. matching


6. illustrated by comparing incidence between exposed and non-exposed groups 7. illustrated by a school health service implementing an ongoing system of hearing tests at

school entry 8. illustrated by focusing on ‘loss to follow-up’ 9. a way of adjusting for confounders 10. crucial for deciding whether a study has the power to detect a particular difference

Options:

a. undertaking record linkage: bringing two pieces of information together b. population screening: opportunistic / targeting high risk pops c. Surveillance: regular / continuous d. undertaking a case-control study e. matching: e.g. making sure that two groups in case control are as similar apart

form disease f. undertaking a service evaluation study g. reporting a case study


11. estimating point prevalence regularly for disease control purposes 12. publishing about an episode of adverse reaction to a new oral contraceptive 13. checking regularly the weight of pregnant women 14. offering a test for Down’s syndrome to all older pregnant women 15. checking childhood immunization uptake using a continuous system 16. checking the blood pressure of all women of child-bearing age whenever they consult a

general practitioner

17. A malignant tumour is damaging the patient's glossopharyngeal nerve. They will experience…

a. loss of taste over the anterior two-thirds of the tongue b. loss of somaesthetic sensation over the anterior two thirds of the tongue c. loss of taste and somaesthetic sensation over the posterior third of the tongue d. paralysis of the muscles of the tongue

18. A patient is stabbed in the neck. You suspect damage to the accessory nerve in the

posterior triangle. You would test nerve function by asking the patient to… a. extend their neck against resistance b. extend their neck without impairment c. lift their shoulders against resistance d. lift their shoulders without impairment

19. Loss of somatic sensation over the anterior two-thirds of the tongue indicates damage to

the… a. lingual branch of the mandibular trigeminal nerve. b. chorda tympani branch of the facial nerve. c. lingual branch of the glossopharyngeal nerve. d. hypoglossal nerve

20. Examination of a patient indicates that they have a medially directed strabismus (squint). This could be due to damage to the

a. oculomotor nerve. b. trochlear nerve. c. ophthalmic trigeminal nerve. d. abducens nerve.

21. A patient suffers damage to the orbit in a road traffic incident resulting in damage to the

third cranial nerve. Which of the following signs will be present? a. Pupillary constriction and a medial strabismus b. Pupillary dilatation and a medial strabismus c. Pupillary constriction and a lateral strabismus d. Pupillary dilatation and a lateral strabismus

22. Which of the following statements is true of the pupillary light reflex?

a. Its efferent limb is carried in the optic nerve b. It is mediated by the inferior colliculi in the midbrain c. It is a consensual reflex d. Its afferent limb is carried in the oculomotor nerve

23. The seventh cranial nerve supplies…

a. taste buds on the posterior third of the tongue. b. muscles of the soft palate. c. muscles of the lower lip. d. the parotid salivary gland.

24. A 40 year old man is brought to A&E with a severe headache. On examination he has papiloedema and fundal haemorrhages. His BP is 220/145mmHg. What is the most likely diagnosis?

a. Cushing’s syndrome b. Conn’s syndrome c. Malignant hypertension d. Phaeochromocytoma e. Renal artery stenosis

25. A 65 year old woman is found to have a BP persistantly over 160/90 mmHg during a 2

month assessment period by her GP. Lifestyle advice has been provided on several occasions and she is otherwise fit, well and asymptomatic. What is the most appropriate management?

a. Ambulatory BP monitoring b. Lifestyle advice c. ACE inhibitor therapy d. CCB therapy e. Thiazide diuretic

26. A 60 year old businessman complains of central crushing chest pain radiating to both arms after running to catch a bus. Pain was relieved by rest and his ECG recording 1 hour later was unremarkable. What is the most likely cause?

a. PE b. Tietze Syndrome c. Infective Endocarditis d. GORD e. Angina f. STEMI g. AF h. Pneumothorax

27. A 60 year old businessman complains of central crushing chest pain radiating to both

arms after running to catch a bus. Pain was not relieved by rest and his ECG recording 1 hour later showed ST elevation. What is the most likely cause?

a. PE b. Tietze Syndrome c. Infective Endocarditis d. GORD e. Angina f. STEMI g. AF h. Pneumothorax

28. An 85 year old man with pneumonia complains of palpitations. ECG shows absent P

waves. What is the most likely diagnosis? a. Hyperkalaemia b. Normal ECG c. AF d. Right bundle branch block e. Left bundle branch block f. Ventricular tachycardia

29. On examination of a 50 year old man who presented with fever, weight loss and lethargy you

notice small red lesions below his fingernails and the presence of a new murmur. What is the most likely diagnosis?

a. Aortic stenosis b. Mitral regurgitation c. AF d. Mobitz type II heart block e. Bacterial endocarditis f. Rheumatic fever

30. This serological marker is used to measure immunity following hepatitis B immunisation.

a. α-Fetoprotein

b. Alanine aminotransferase

c. Hepatitis B core antibody (HBcAB) d. Hepatitis B core antigen (HBcAg) e. Hepatitis B e antigen (HBeAg) f. Hepatitis B surface antibody (HBsAb) g. Hepatitis B surface antigen (HBsAg) h. Hepatitis B RNA titre.

31. This serological marker is the first to indicate acute hepatitis B infection a. α-Fetoprotein

b. Alanine aminotransferase

c. Hepatitis B core antibody (HBcAB) d. Hepatitis B core antigen (HBcAg) e. Hepatitis B e antigen (HBeAg) f. Hepatitis B surface antibody (HBsAb) g. Hepatitis B surface antigen (HBsAg) h. Hepatitis B RNA titre.

32. This serological marker would indicate chronic hepatitis B infection if detected 6 months after the original infection

a. α-Fetoprotein b. Alanine aminotransferase c. Hepatitis B core antibody (HBcAB) d. Hepatitis B core antigen (HBcAg) e. Hepatitis B e antigen (HBeAg) f. Hepatitis B surface antibody (HBsAb) g. Hepatitis B surface antigen (HBsAg) h. Hepatitis B RNA titre.

33. This serology marker indicates high infectivity in a chronic hepatitis B carrier


34. This serological marker, if high would indicate low infectivity in a chronic hepatitis B carrier


35. A 32 year old man has recently returned from a holiday in India, where he stayed with

locals and dined with them. 2 weeks later, he presents with jaundice and lethargy. Liver function tests reveal a massively raised ALT and a significantly raised bilirubin. What is the most likely diagnosis?

a. Paracetamol overdose b. Hepatitis C c. Haemolytic anaemia d. Biliary obstruction e. Hepatitis A f. Autoimmune hepatitis g. Hepatitis B

36. A 29 year old man is admitted to the emergency department with sudden onset, severe abdominal pain radiating to the back and vomiting. On examination there is tenderness and guarding in the epigastrium. His pulse is 118 and his BP is 96/68mmHg. What is the most appropriate investigation? What is the most likely diagnosis?

a. CT scan b. Erect chest x-ray c. Faecal elastase level d. Laparoscopy e. Mesenteric angiography f. Serum amylase g. Supine chest X-ray h. Troponin levels i. Urgent laparotomy

37. A 45 year old woman presents to the emergency department with severe right upper

quadrant abdominal pain. She is found to have significantly raised ALP and bilirubin levels. ALT and AST are only mildly raised. What is the most likely diagnosis?

a. Biliary tract obstruction b. Gilbert’s syndrome c. Hepatocellular carcinoma d. GORD e. Paracetamol overdose f. Short term alcohol abuse g. Hepatitis B infection h. Perforated peptic ulcer

38. A 38 year old woman presents with a 48 hour history of right upper quadrant pain,

nausea and vomiting. On examination she is clinically jaundiced and her temperature is 38.5°C. An abdominal ultrasound shows multiple stones in the gallbladder and common bile duct. What is the most likely diagnosis?

a. Acute cholecystitis b. Ascending cholangitis c. Biliary colic d. Chronic cholecystitis e. Gallstone ileus f. Empyema of the gallbladder g. Choledocholithiasis

39. An 18 year old woman is seen with a 48 hour history of lower abdominal pain, vomiting

and diarrhoea. On examination there is tenderness and guarding in the right iliac fossa and no masses are palpable. A routine β-hCG test is positive. What is the most likely diagnosis?

a. Acute appendicitis b. Acute pancreatitis c. Diverticulitis d. Ectopic pregnancy e. IBS f. Perforated peptic ulcer

40. An 80 year old man has developed poorly localised lower abdominal pain over 5 days. There is no nausea or vomiting. He has not had a bowel movement for 2 days and before this he has had loose stools. Examination shows him to be apyrexial and to have a soft abdomen with a palpable, slightly tender left lower abdominal mass. What is the most likely diagnosis?

a. Perforated peptic ulcer b. Appendicitis c. Bowel obstruction d. Kidney stone e. Strangulated hernia f. Ruptured ectopic pregnancy g. Abdominal aneurysm h. Mesenteric adenitis i. Carcinoma of the colon j. Endometriosis k. Pancreatitis l. Diverticulitis

41. A 73 year old man is admitted to the surgical assessment unit with left iliac fossa pain

and a small amount of PR bleeding mixed with the stools for the last 2 days. His abdomen is soft with mild left iliac fossa tenderness and guarding. Bloods reveal a raised WCC and CRP. What is the most likely diagnosis?

a. Rectal cancer b. Crohn’s disease c. Ulcerative colitis d. Haemorrhoids e. Anal fissures f. Diverticulitis

42. A 24 year old man presents with right lower abdominal pain. The pain came on gradually

over 24 hours and was initially in the centre of his abdomen. He has nausea but has not vomited. He has not opened his bowels for 24 hours. Examination shows a temp of 37.6°C and a right lower abdominal tender mass. What is the most likely diagnosis?

a. Perforated peptic ulcer b. Appendicitis c. Kidney stone d. Bowel obstruction e. Strangulated hernia f. Ruptured ectopic pregnancy g. Abdominal aneurysm h. Mesenteric adenitis i. Carcinoma of the colon j. Endometriosis k. Pancreatitis l. Diverticulitis

43. A 68 year old woman with a history of osteoarthritis presents with acute, severe abdominal pain and vomiting. On examination the abdomen is rigid and bowel sounds are absent. What is the most likely diagnosis?

a. Acute appendicitis b. Acute pancreatitis c. Chronic pancreatitis d. Diverticulitis e. Ectopic pregnancy f. IBS g. Pelvic abscess h. Pelvic inflammatory disease i. Perforated peptic ulcer

Options:

a. Acute MI b. Cerebrovascular accident c. Dissecting aortic aneurysm d. Drug allergy e. First-dose hypertension f. Left ventricular failure g. Ruptured aortic aneurysm h. Stable angina i. Stokes-Adams attack j. SVT k. Vasovagal syndrome l. Ventricular rupture m. Wolff-Parkinson-White syndrome

44. A 45 year old woman collapses during a church service in summer. Her husband states

that she turned pale and collapsed shortly after standing up. She did not jerk or lose urinary continence. She denies chest pain, shortness of breath and palpitations. She recovered after 30 seconds and now feels back to her usual self. All observations including blood tests, ECG and lying and standing blood pressure are normal. What is the most likely diagnosis?

45. A 75 year old woman is brought to the emergency department after collapsing. On examination her heart rate is 80 bpm and irregular, with a BP of 150/90 mmHg. She has difficulty in moving her left arm and leg.

46. A 67 year old man presents to the emergency department following a collapse. He has a history of ischaemic heart disease and has been diagnosed with hypertension only last week. He remembers feeling dizzy when he got out of his chair to go to the toilet before fainting. He regained consciousness almost immediately and had fully recovered within 5 minutes.

47. A 57 year old man is found collapsed at work. On arrival at the emergency department, he is complaining of mild epigastric discomfort that started at rest. He appears pale and sweaty and has vomited once. He is on insulin for type 1 diabetes mellitus.

48. Mrs Smith is a 67 year old lifelong smoker. She presents to the medical outpatients clinic complaining of pain and swelling in her left arm, and increasing breathlessness on climbing the stairs. She has also recently noticed a 'gravelly' quality to her voice. On examination her GP had noticed a small pupil in the left eye, and referred her for a chest X-ray (below). What is the most likely diagnosis?

a. Pancoast tumour b. Heart failure c. Pneumonia d. COPD exacerbation e. Small cell lung cancer f. Non-small cell lung cancer g. Lobar collapse h. TB

49. Mr Smith is a 56 year old bus driver, ex-smoker. Recently, he has found work increasingly difficult and in the last 2 days has found it impossible to sleep due to breathlessness when lying down. He is distressed when you see him in the emergency department. Previous medical history includes lumbar pain and sciatica which he has tolerated for years with conservative treatment. He mentions recent increasing thoracic back pain which he has found less tolerable but which is reasonably well controlled with anti-inflammatories. Having examined him you request a chest X-ray (below). What is the most likely diagnosis?

a. Heart failure b. Pneumonia c. Lung metastasis d. Asthma e. COPD f. Primary lung cancer g. PE h. TB

50. Ben Johanssen is a tall and thin 23 year old lifelong non-smoker with no significant medical history. He presented to the emergency department with a short history of unilateral chest pain, shortness of breath and is tachycardic on examination. He has absent breath sounds in the left upper lobe and hyperresonance on percussion but the trachea is central. What is the most likely diagnosis?

a. PE b. Pneumonia c. Primary lung cancer d. Tension pneumothorax e. Heart failure f. Non-tension pneumothorax g. MI h. GORD

51. Patrick Smith is a 76 year old lifelong smoker. He presented with worsening shortness of breath over several weeks, a more recent history of a cough productive of green sputum, and left-sided pleuritic chest pain. Blood tests show a raised white cell count and C-reactive protein.

a. Primary lung cancer b. TB c. COPD d. Pneumonia e. Pancoast tumour f. PE g. MI h. Heart failure i. Pneumothorax

52. Barry Barnhill is a 43 year old homeless man who presents to A&E after an episode of haemoptysis. On questioning he reports he has had difficulty sleeping because he is woken up sweating. On examination he appears thin, breathless and has a temperature of 38.6°C. You send him for an x-ray and the results are below. What is the most likely diagnosis?


53. James Denver is a 86 year old with a history of ischaemic heart disease. He presents to his GP with increasing lethargy and reduced exercise tolerance. During the consultation he mentions that he has had difficulty sleeping, often waking up breathless and is having to sleep with more and more pillow. He has also had 2 episodes of pink frothy sputum. to his GP with increasing lethargy and reduced exercise tolerance. During the consultation he mentions that he has had difficulty sleeping, often waking up breathless and is having to sleep with more and more pillow. He has also had 2 episodes of pink frothy sputum. You send him for a chest x-ray and the results are below. What is the most likely diagnosis?


Options:

a. Bell’s palsy b. Guillain-Barré syndrome c. Mononeuritis multiplex d. Epilepsy e. Poliomyelitis f. Myasthenia gravis g. Motor neuron disease h. Multiple sclerosis i. Cerebrovascular accident j. TIA k. Spinal cord compression l. Radial nerve palsy m. Ulnar nerve palsy n. Median nerve palsy o. Common peroneal nerve palsy p. Parkinson’s disease q. Huntington’s disease

54. A 32 year old woman presents to the GP with a sudden pain behind her right eye associated

with blurred vision. Last month she experienced sudden loss of the use of her left arm but this resolved spontaneously within 48 hours. On examination there was no limb weakness or sensory loss.

55. An 81 year old woman is unable to get out of bed one morning because she is weak in her right arm and leg. You notice that she has trouble understanding what you ask her although she can speak comprehensively. After 24 hours symptoms are still present.

56. A 65 year old man presents to his GP with a tremor. He explains that the tremor is absent when he reaches for and holds his cup of tea. His wife also comments that while doing the shopping she has noticed he is much slower when walking around. On examination you notice he speaks very quietly and while assessing his tone you observe led pipe rigidity. When you ask him to play the piano in the air you notice his movements are slow.

57. Simon is a 28 year old man. He falls asleep in a chair with his arm compressed against the bar edge after an afternoon of heavy drinking. The next morning he presents to his GP. On examination he is unable to extend the wrist upward when the hand is palm down and has numbness of the back of the hand and wrist, specifically over the first web space.

58. A 57 year old woman falls and fractures her right elbow. On examination of her right hand it appears claw like with curling of the small (5th) and ring (4th) finger accompanied by numbness in the 5th finger, along the half of the 4th finger.

59. A 62 year old man with a 10 year history of poorly controlled type2 diabetes presents to his GP with difficulty walking. On examination he is unable to dorsiflex his foot and has sensory loss to the dorsal surface of the foot and portions of the anterior lower-lateral leg. He has a high stepping gait.

Options:

a. Abducens b. Accessory c. Facial d. Glossopharyngeal e. Hypoglossal f. Oculomotor g. Olfactory h. Optic i. Trigeminal j. Trochlear k. Vagus l. Vestibulocochlear

60. This nerve supplies the muscles of the tongue 61. This nerve supplies the muscle that moves the eye laterally 62. This nerve supplies the sternocleidomastoid muscle 63. This nerve supplies the muscles of mastication 64. This nerve supplies taste sensation to the anterior 2/3 of the tongue

65. Mrs X is an 80 year old woman with a history of ischaemic heart disease. She presents to

the emergency department with a 3 month history of worsening shortness of breath associated with swollen ankles. Her ECG demonstrates no abnormality, but you suspect that she has heart failure. What blood test could you do to exclusively rule out heart failure in this patient?

a. Brain-type natriuretic peptide b. Myoglobin c. FBC d. U&E e. Troponin I f. TFTs g. Echocardiography

Options: a. Ventricular tachycardia b. Ventricular fibrillation c. Atrial fibrillation d. Brady cardia e. ST elevation MI f. Non-ST elevation MI g. Asystole h. Pulseless electrical activity

66. A 64 year old man with a past history of MI presents to A&E with chest pain and palpitations.

The nurse assesses his vital signs and notes a reducing conscious level and hypotension. You conduct an ECG and the results are shown below. What is the most likely diagnosis?

67. An 85 year old man with pneumonia complains of palpitations. His ECG is shown below. What is the most likely diagnosis?

68. A 72 year old lady is found collapsed on the ward. She is unresponsive with no pule so you begin chest compressions. An ECG is conducted and results are shown below. What is the most likely diagnosis?

69. During a routine pre-operative assessment you conduct an ECG on a 32 year old

professional cyclist. The ECG results are shown below. What is the most likely diagnosis?

70. An 85 year old overweight man complains epigastric pain while out shopping accompanied with nausea, sweating and feeling fant. He was rushed to A&E and an ECG was conducted and is shown below. What is the most likely diagnosis?

Options:

a. Rheumatoid arthritis b. Osteoarthritis c. Gout d. Pseudogout e. Ankylosing spondylitis f. Psoriatic arthritis g. Reactive arthritis h. Septic arthritis

71. A 56 year old woman presents with pain in her hands and swelling of the fingers. The pain is mainly in the distal interphalangeal joints. She has morning stiffness and the pain in her hands is better with use. On inspection of her hands you notice ulnar deviation, z thumbs and swan neck deformities.

72. A 65 year old man with a history of heart failure and obesity presents with a red, painful and swollen right hallux. Joint aspiration is performed and shows needle-shaped negatively birefringent crystals.

73. A 63 year old overweight man presents with a 2 year history of worsening pain in his knees. The pain is worse when he walks. He is otherwise well. X-rays of his knees show narrowing of the joint space, subchondral sclerosis, cyst formation and osteophytes.

74. A 24 year old man presents with difficulty walking on his left leg because of pain. On examination his left ankle is red, hot, swollen and tender. His temperature is 38.6°C.

75. A 75 year old woman presents with sudden onset pain in her right knee. On examination the knee is swollen, red and painful. She has a temperature of 36.8°C. A joint aspiration is performed and demonstrates positively birefringent brick shaped crystals.

Options:

a. Acute renal failure b. Chronic renal failure c. BPH d. Hypovolaemia e. Prostate cancer f. Renal artery stenosis g. Renal calculi h. Cystitis i. Acute pyelonephritis j. Diabetes mellitus type 2

76. A 76 year old man presents to the emergency department unable to pass urine. This is

preceded by a 2 month history of increased hesitancy, urgency and frequency in passing urine. On examination his bladder is palpable to the umbilicus and on rectal examination a uniformly enlarged smooth prostate is noted.

77. A 34 year old woman presents to GP with lower abdominal pain, urinary frequency and gross haematuria for the past 2 days. Today she has developed sudden onset left sided loin pain and an uncontrollable shiver. On examination she has a temperature of 38.6°C and there is pain when balloting the left kidney.

78. A 56 year old business man presents to GP with irritation and redness of his penis. The GP correctly diagnoses genital candidiasis. During the consultation he mentions he has been urinating more at night and that his wife has said that he is drinking much more water than he normally does.

79. A 45 year old woman presents to her GP with lower abdominal pain, frequency of urination and pain when passing urine. She describes her urine as dark and offensive. Urine dipstick shows leucocytes, nitrites and blood.

Options:

a. Crohn’s disease b. Appendicitis c. Infective colitis d. Ischaemic colitis e. Biliary obstruction f. Colorectal cancer g. Ulcerative colitis h. Ectopic pregnancy i. Diverticulitis j. Haemorrhoids

80. A 23 year old man presents to GP with painful ulceration in his mouth accompanied with

general malaise and anorexia. He also complains of recent episodes of diarrhoea with abdominal pain. A colonoscopy is conducted and transmural granulomatous inflammation is noted particularly around the terminal ileum with the presence of skip lesions.

81. A 30 year old woman presents to GP with bloody diarrhoea a week after quitting smoking. She has had accompanying crampy abdominal pain with increased bowel movement frequency. Stool culture is negative and a colonoscopy is conducted a week later. The

colonoscopy showed the presence of pseudopolyps with ulceration confined to the distal

colon and rectum which was limited to the mucosal layer.

Answers:

1. f 2. c 3. c 4. b 5. a 6. c 7. d 8. f 9. g 10. a 11. c 12. g 13. c 14. b 15. c 16. b 17. c 18. c 19. a 20. d 21. d 22. c 23. c 24. c 25. d 26. e 27. f 28. c 29. e 30. f 31. g 32. g 33. e 34. c 35. e 36. f 37. a 38. b 39. d 40. i 41. f 42. b 43. i 44. k 45. b 46. e 47. a 48. a

49. c 50. f 51. d 52. b 53. h 54. h 55. i 56. p 57. l 58. m 59. o 60. e 61. a 62. b 63. i 64. c 65. a 66. a 67. c 68. h 69. d 70. e 71. a 72. c 73. b 74. h 75. d 76. c 77. i 78. j 79. h 80. a 81. g

peermedics practice questions mcqs for 2nd years: options: a. 95% confidence interval b. statistical...

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