Download 1 - UCC

1.
d.
e.
Pure mitral stenosis:
tends to cause a loud first heart sound
produces displacement of the apex beat
Produces a diastolic murmus, the duration of which, rather then the intensity,
determines degree of stenosis
Is better heard with the diaphragm than the bell of the stethoscope
Is louder on inspiration
a.
b.
c.
d.
e.
The following may cause sinus tachycardia
anemia
atropine
atrial flutter
thyrotoxicosis
carotid sinus massage
a.
b.
c.
d.
e.
Signs of aortic regurgitation include
anacrotic pulse
wide pulse pressure
corrigans neck pulsation
durozier’s sign
Austin-flint murmur
a.
b.
c.
2.
3.
4.
a.
b.
c.
d.
e.
A third heart sound may be heard in:
cardiac failure
mitral incompetence
systemic HTN with normal ECG
pure mitral stenosis
contrictive pericarditis
5.
a.
b.
c.
d.
e.
Recognized features of acromegaly include
loss of libido
reduced fields of vision
arterial HTN
hydronephrosis
enlargement of the tongue
6.
a.
b.
c.
d.
e.
Nephrotic syndrome is a well recognized feature of
chronic pyelonephritis
renal papillary necrosis
thrombosis of renal veins
proliferative glomerulonephritis
disseminated lupus erythematosis
7.
a.
b.
c.
d.
e.
Excretion urography can be diagnostic in
chronic pyelonephritis
acute glomerulonephritis
renal artery stenosis
polycystic kidney disease
nephritic syndrome
8.
a.
b.
c.
d.
e.
Hemolytic anemia is a feature of
malaria
tropical sprue
hookworm disease
thalassemia
brucellosis
9.
a.
b.
c.
d.
e.
peripheral neuropathy is a recognized complication of
diphtheria
leprosy
snake bite
weil’s disease
typhus
10.
The following associations are correct
a. Early morning waking and depression
b. Morning headache and depression
c. SLE and psychosis
d. Late pregnancy and Down’s syndrome
e. Right sided endocarditis and drug addiction
11. Regarding pernicious anemia:
a. Hypersegmentation of neutrophils is a common finding
b. Glossitis may be seen
c. Platelets are usually normal
d. Low serum B12 levels are diagnostic
e. Histamine-fast achlorhydia is usual
12. In rheumatoid arthritis
a. ESR is good index of disease activity
b. Renal lesions commonly occur
c. Amyloidosis may develop
d. Nodules may occur over bony prominences
e. Osteoporosis is a common radiological finding adjacent to the affected joint
13. Gynecomastia may occur with
a. Adrenal tumors
b. Renal tumors
c. Cirrhosis of liver
d. Myxoedema
e. Digitalis treatment
14. Sacro-iliac involvement is commonly found in the arthropathy of:
a. ankylosing spondylitis
b. Reiter’s syndrome
c. Gout
d. Rheumatoid arthritis
e. Ulcerative colitis
15. Hypokalemia can be associated with
a. Administration of insulin
b. Conn’s disease
c. Addison’s
d. Diarrhea
e. Terminal stages renal failure
16. A 75 year old male patient with gross painless hematuria
a. Should have a rectal examination
b. May have TB
c. Should be reassured if JVP normal
d. Should be given Vitamin K
e. Is likely to have renal stones
17. Fibrosis of the left upper lobe
a. TB is likely cause
b. Trachea is deviated to the right
c. Tactile vocal fremitus increased in the left apex
d. Apex displaced left
e. Hamman’s sign
18. Clinical features of acute hepatitis include
a. Dislike of cigarettes
b. Splenomegaly
c. Glycosuria
d. Anorexia
e. Bilirubinemia
19. Following statements are correct
a. Carpal tunnel syndrome is commonest in middle aged women
b. Pretibial myxoedema is seen in thyrotoxicosis
c. Cushing’s syndrome in females usually gives rise to amenorrhea
d. Acromegaly may give rise to HTN
e. Calcified ascending aorta on Xray suggests syphilis
20. Diuretic therapy
a. May precipitate hepatic encephalopathy
b. may cause secondary gout
c. May cause collapse in elderly patients
d. Should not be prescribed for patients with diabetes mellitus
21. Erythema multiforme
a. May have associated oral lesions
b. Is a vasculitic eruption seen in rheumatic fever
c. May be very toxic and require steroid therapy
d. Is frequently seen in amyloidosis
e. May be fatal
22. Acute myocarditis
a. Is usually viral in origin
b. May be produced by steroid therapy
c. Produces T-wave abnormality on ECG
d. May result in ventricular dysrhythmias
e. Frequently exhibits Bell’s sign
23. Rheumatoid disease
a. May lead to impotence
b. Usually requires steroid therapy
c. May involve temporomandibular joint
d. Occasionally causes hypersplenism
e. May affect the lungs
24. Acute nephritis is a recognized feature of:
a. Brucellosis
b. Ankylosing spondylitis
c. Polyarteritis nodosa
d. Polyposis coli
e. Bacterial endocarditis
25. In sarcoidosis
a. Pleural effusions are common
b. Hypocalcemia can occur
c. Liver biopsy is often helpful in diagnosis
d. Spontaneous remission commonly occurs
e. Treatment with steroids or ACTH is mandatory
26. Tetanus
a. Is caused by an anaerobic spore-forming organism, which produces tissue destroying
enzymes
b. Is commoner in underdeveloped countries
c. Does not cause sequelae in those who recover
d. Confers a high degree of immunity against a second attack
e. May resemble strychnine poisoning
27. Neoplasms of the esophagus
a. Are usually adenocarcinomas
b. Are commoner in males
c. Are more prevalent in patients with achalasia
d. Usually present with retrosternal pain
e. If respectable, have a good prognosis
28. Complications of Ulcerative colitis include:
a. cirrhosis
b. colon cancer
c. arthritis
d. thyroiditis
e. pleural effusion
29. Patients suffering from regional enteritis have a tendency to develop
a. fistulae
b. low serum iron
c. vitamin B12 insufficiency
d. cholelithiasis
e. recurrence of disease after surgery
30. The following are causes of hypercalcemia:
a. Milk-alkali syndrome
b. Paget’s disease of bone
c. Sarcoidosis
d. Multiple myeloma
e. Rickets
31. The following drugs are know to give rise to lesions of the eighth cranial nerve
a. chloramphenicol
b. kanamycin
c. cyclophosphamide
d. salicylates
e. streptomycin
32. Gout
a. Is characterized by deposits of sodium urate in joints and other structures
b. Causes symmetrical arthritis
c. May lead to renal dysfunction
d. may be exacerbated by diuretics
e. An acute attack usually responds to allopurinol
33. CO2 retention is a feature of
a. status asthmaticus
b. coma associated with barbiturate intoxication
c. Acute PE
d. Bronchopneumonia
e. Respiratory muscle involvement in myasthenia gravis
34. In bronchiectasis
a. Hemoptysis is common
b. Clubbing of fingers is rare
c. CXR commonly confirms the diagnosis
d. Coarse crepitations may be heard over the involved area
e. Surgery is eventually necessary in most patients
35. Characteristic features of subacute bacterial endocarditis include
a. Heberden’s nodes
b. Proteinuria
c. Osler’s nodes
d. Thrombocytopenia
e. Conjunctival hemorrages
36. Recognized causes of amyloid disease include:
a. Osteoarthritis
b. Cirrhosis of the liver
c. Osteomyelitis
d. TB
e. Rheumatic valvular disease
37. In CLL:
a. Children are affected more commonly than adults
b. Immune response is enhanced
c. Spleen is characteristically extremely large
d. Sternal marrow biopsy reveals an excess of myelocytes
e. Cyclophosphamide is the drug of choice
38. In pneumonic consolidation the following statements are correct:
a. The percussion note is characteristically stony dull
b. Breath sounds are bronchial
c. Kerley’s lines are seen on CXR during resolution
d. Sputum contains Curshmann’s spirals
e. Cavitation suggests staphylococcal aetiology
39. Characteristic features of aortic incompetence include:
a. Atrial fibrillation
b. Heaving apex impulse
c. Right ventricular hypertrophy
d. BP 145/110
e. Diastolic murmur heard in carotid arteries
40. Recognized causes of hypokalemia include:
a. Conn’s syndrome
b. Diuretic therapy
c. purgatives
d. metabolic acidosis
e. Cushing’s syndrome
41. Hemolytic anemia
a. Excess urobilniogen is present in the urine
b. Itching is a feature
c. Coombs test may be positive
d. Red cell fragility may be increased
e. Feces are pale
42. Right homonymous hemianopia found in
a. Retinal detachment
b. Pituitary neoplasms
c. Optic nerve glioma
d. Left cerebral infarct
e. Right occipital tumour
43. The findings of weakness, spasticity, and impairment of sensations are compatible
with:
a. Polymyositis
b. Spinal cord compression
44. Manifestations of ankylosing spondylitis include
a. Aortic incompetence
b. Proteinuria
c. Blood uric acid level of 9mg/100mL
d. Narrowing of sacroiliac joint space
e. Punched out lesions in vertebral bodies
45. In rheumatoid arthritis
a. There is an association with HLA-B27
b. Bony erosions occurring early in the disease imply an adverse prognosis
c. Gold therapy may cause fatal pancytopenia
d. Carpel tunnel syndrome may be a complication
e. Rheumatoid factor is usually negative if subcutaneous nodules are present
46. Red cells may be found in the urine of patients with:
a. Acute pyelonephritis
b. Post streptococcal acute glomerulonephritis
c. Acute tubular necrosis
d. Subacute bacterial endocarditis
e. prerenal uremia
47. Postural hypotension occurs in
a. Hemolytic anemia
b. Addison’s disease
c. Autonomic neuropathy
d. Salt depletion
e. Hypercalcemia
48. AIDS:
a. Occurs exclusively in homosexuals
b. Is uniformly fatal in less than two years
c. Is commonly complicated by pneumocystis carini pneumonia
d. The latent period after exposure is short, usually less than two months
e. Responds to treatment with interferon
49. Hookworm disease
a. Causes iron deficiency anemia
b. Causes megaloblastic anemia
c. Causes liver abscess
d. Is treated with penicillin
e. Is common in Africa
50. The following are frequently seen in systemic sclerosis (scleroderma)
a. Raynaud’s phenomenon
b. Ulcers on fingers
c. Dysphagia
d. Peripheral neuritis
e. Hemiplegia
51. Abdominal pain relieved by defecation and associated with loose bowel motions is a
feature of:
a. Irritable bowel syndrome
b. Anorexia nervosa
c. Peptic ulcer of stomach
d. Gall stones
e. Crohn’s disease of colon
52. The following have hematuria
a. Steroid sensitive but recurrent minimal change GN
b. IgA nephropathy
c. Nephropathy associated with diabetes
d. Infective endocarditis
e. Acute papillary necrosis
53. A 50 year old woman is thought likely to have osteoporosis
a. A history of alcoholism would suppose the diagnosis
b. A history of thyrotoxicosis would support the diagnosis
c. A-P and lateral xrays of spine are sensitive indicator of disease progression
d. Bone loss is mainly cortical, not trabecular
e. Vitamin D replacement is mandatory
54. Characteristic features of sarcoidosis include:
a. fatigue
b. hypocalcemia
c. erythema marginatum
d. positive mantoux test
e. Uric acid stones
55. With regards to acute stroke, the following statements are true
a. cerebral ischemia is readily differentiated from cerebral hemorrhage from clinical signs
b. early CT scanning always demonstrates the lesion
c. Infarction of the cerebral cortex is commonly associated with dysphagia
d. cerebellar hemorrhage often requires surgical intervention
e. patients with A.fib should be anticoagulated immediately
56. With regards to hemochromatosis, the following statements are true
a. It is an autosomal recessive condition
b. Patients may present with glycosuria
c. The condition may be complicated by hepatoma development
d. Therapy usually involves desferrioxamine
e. A genetic screen is available to aid diagnosis
57. The following are causes of secondary hyperlipidemia
a. Loop diuretics
b. Chronic renal failure
c. Hypothyroidism
d. High alcohol intake
e. Obstructive jaundice
58. With regards to Atrial fibrillation
a. Commonly occurs in patients with a structurally normal heart
b. May be precipitated by alcohol excess
c. tends to be asymptomatic in patients with hypertrophic cardiomyopathy
d. On careful auscultation, a fourth heart sound can be heard
e. a-waves are often visible in JVP
59. In primary hyperparathyroidism
a. Most patients present with urinary tract calculi
b. Serum calcium is always higher than normal
c. PTH is usually within normal limits
d. Chloride:phosphate ratio is elevated
60. Which of the following suggests that a thyroid swelling is malignant
a. Thyrotoxicosis
b. Hoarseness
c. Palpable lymph glands
d. Increased uptake of iodine
61. The following are recognized complications of Crohns disease
a. Iritis
b. Ascending cholangitis
c. Sclerosing cholangitis
d. Erythema nodosum
62. Pancreatic pseudocysts
a. Are developmental in origin
b. Usually arise in the lesser peritoneal sac
c. May be effectively treated by internal drainage
d. Occur following pancreatic abscess
63. Acute protrusion of L4/L5 or L5/S1 intervertebral disc
a. Is usually associated with lumbar scoliosis
b. Causes reduction in straight leg raising
c. Commonly causes loss of knee tendon reflex
d. May be associated with sensory change at the lateral border of the foot
64. The following are features of Horner’s syndrome
a. Unilateral enophthalmos
b. Atrophy of the hand muscles
c. Miosis
d. Loss of sweating on one side of face
65. Diagnosis of insulinoma is suggested by the following
a. Fasting hypoglycemia
b. hypoglycemia relieved by meals
c. Hypoglycemia coming 1-2 hours after meals
d. Hepatic disease in an alcoholic
e. Hypoglycemia with very low plasma insulin
66. The following are true of ankylosing spondylitis
a. It is commonest in females over 40
b. Can be associated with arthritis of the hip joint
c. It may present with sciatica
67. A 70 year old lady presented with a cough. She is also anorexic of late. The following
should be performed immediately?
a. ESR
b. CXR
c. Psychiatric evaluation
d. Sedate her, send her home and review in a week
e. Examine sputum for AFB
68. Subdural hematoma is suggested by the following:
a. Change of personality
b. Brain spinal tap
c. History of trauma
d. Central scotoma
69. The following investigations are indicated in a patient with bilateral hilar
lymphadenopathy.
a. Mantoux test
b. Kveim test
c. Serum calcium
d. CT scan
e. Lung biopsy
70. Complications of Diabetes mellitus include
a. LOAD
b. Liver cysts
c. Proteinuria
d. Raynaud’s phenomenon
e. Neovascularization of the retina
71. An alcoholic presents with hepatosplenomegaly and hematemesis
a. The bleeding can be assume to be esophageal varices
b. Vitamin K will reverse all clotting defects
c. The presence of blood in the GIT may be harmful
d. Lactulose, magnesium sulphate and neomycin may all be useful
e. The features of encephalopathy include altered consciousness
72. Polycystic kidney
a. Is transmitted autosomal dominant
b. Often presents in childhood
c. Causes hypertension
d. Is associated with cystic liver disease
73. Extraintestinal manifestations of IBD:
a. Sacroiliitis
b. Erythema nodosum
c. Syndenhams’s Chorea
d. Pyoderma gangrenosum
e. Entrapment neuropathy.
74. An 80 year old female presented in an acute confusional state with very aggressive
behavior. Immediate steps in her management include:
a. Acute psychiatric admission
b. Review for drug therapy if any
c. Physical examination to exclude focus of infection
d. Start broad spectrum antibiotic
e. Isolate and review in a week
75. Multiple blood transfusions increase the risk of
a. Malaria
b. Hepatitis A
c. Non-A Non-B Hepatitis
d. Chicken pox pneumonia
e. AIDS
76. The following attach both skin and mucosal surfaces
a. Erythema multiforme
b. Lichen planus
c. Granuloma annulare
d. Discoid lupus
e. Herpes simplex
77. Causes of gynecomastia include
a. Puberty
b. Klinefelters syndrome
c. Spironolactone therapy
d. Untreated essential hypertension
e. decreased thyroid function
78. The following are features of LVF
a. Basal creps
b. Gallop rhythm
c. Pulsus alternans
d. Peripheral edema
e. Elevated pulsatile JVP
79. A 23 year old man with 6/12 history of treatment of frequent bowel motions with
release of blood and mucus PR.
a. A perianal fistula would suggest Crohns
b. A barium enema may aid diagnosis
c. You would expect anemia and low serum iron
d. A barium follow through may be needed
e. An infective cause would be likely
80. A 60 year old man presents with bilateral ptosis. Diplopia is worse in the evenings.
Pupils are equal and reactive to light and accommodation. Bedrest improved ocular
movements. The most likely diagnosis is:
a. Myasthenia gravis
b. Ocular myopathy
c. Myotonic dystrophy
d. Endocrine exopthalmic exopthalmoplegia
e. Midbrain vascular lesion
81. The following murmurs are correctly associated:
a. Mitral stenosis: mid diastolic murmur
b. Pulmonary stenosis: pansystolic murmur
c. Mitral regurgitation: pansystolic murmur
d. Aortic stenosis: ejection murmur
e. Aortic regurgitation: pan-diastolic murmur
82. The following are suggestive of carcinoma in a patient with hoarseness:
a. Unilateral recurrent laryngeal nerve palsy
b. Myxedematous thickening of the vocal cord
c. Cervical lymphadenopathy
d. Single nodule in the thyroid gland
e. Sudden enlargement of???
83. In Cor pulmonale
a. Digoxin in the best treatment
b. Diuretics are indicated
c. The 5 year survival rate exceeds 75%
d. Hypoxia causes reduced pulmonary vascular resistance
e. Home oxygen has little or no place in the treatment
84. Heberdens nodes:
a. Occur at the base of the terminal phalanges
b. Occur in subacute bacterial endocarditis
c. Are commoner in fat people than in thin people
85. A teacher, asthmatic, with a 2month history of epigastric pain. Barium meal is
negative. She is currently taking theophylline and a B12 stimulant. No other medications.
Three days later she is complaining of nausea. What is the single most appropriate action
to take?
a. Repeat barium meal
b. Measure theophylline levels
c. Gastric acid stimulation test
d. Gastroscopy
e. FOB
86. Cerebellar ataxia may be caused by:
a. Folate deficiency
b. Thiamine
c. Phenytoin
d. Alcohol
e. Carbamazepine
87. A young man presents with rigors, dysuria and pyrexia. What do you do?
a. MSU, differential wcc, blood culture
b. IVP before starting treatment
c. Do not treat with antibiotics before getting cultures
d. Oral penicillin is the first line treatment
88. Mitral valve prolapse:
a. Is found in 5-10% of the population
b. Presents with a mid-late systolic cluck and late systolic murmur
c. Presents with chest pain and palpitations
d. Patients should receive antibiotic prophylaxis
e. Patients have a higer incidence of endocarditis
89. The following statements are correct:
a. Amiodarone causes corneal microdeposits and pulmonary fibrosis
b. Amiodarone causes a peripheral neuropathy
c. Adenosine is contraindicated in complete heart block
d. Aortic incompetence is best heard with the patients sitting forward and on inspiration
e. A collapsing pulse is a feature of aortic incompetence
90. During cardio-pulmonary resuscitation
a. External cardiac massage must be discontinued during inflation of the lungs
b. Intubation should be attempted immediately
c. PEA should be treated with IV adrenaline
d. 50 mL of 8.4% sodium bicarbonate should be given as soon as central access is
established
e. Ventricular fibrillation associated with hypotension is best treated with IV Lignocaine
91. Ototoxicity is an important adverse effect
a. Salicylates
b. Nitrofurantoin
c. Aminogycoside drugs
d. Furosemide
e. Atropine
92. The following cardiovascular phenomena are paried with a relevant underlying
condition
a. JVP cannon waves: atrial flutter
b. Mid systolic murmus in the 2nd left interspace: Tetralogy of Fallot
c. 2nd heart sound of varying intensity: Complete heart block
d. Fixed splitting of the 2nd heart sound: ASD
e. Bifid p waves on ECG: Mitral incompetence
93. The following statements regarding chronic alcoholism are correct:
a. It is commoner in males than females
b. Hallucinations during DTs are characteristically of the visual kind
c. After having been abstinent for one year, 50% are able to resume social drinking under
supervision
d. It may be associated with another psychiatric illness such as depression
e. The prognosis is worse in males than females
94. A 41 year old man presents with DM, pigmentation and hepatomegaly. The following
suggest a diagnosis of idiopathic hemachromatosis:
a. History of heavy smoking
b. Serum K+ 6.2 mmol/L, Serum Na+ 119 mmol/L
c. Spinal arthropathy
d. Cardiac enlargement
e. Thrombocytosis
f. Cardiac arrhythmias
g. Impotence
h. Hypertension
95. The adult respiratory distress syndrome (ARDS)
a. May complicate incompatible blood transfusions
b. May feature combined hypoxia and hypocapnia
c. Is accompanied by raised pulmonary capillary wedge pressures
d. Benefits from the application of PEEP
96. The finding of red cell casts in the urinary sediment is consistent with:
a. Polycystic kidney disease
b. Subacute bacterial endocarditis
c. Acute glomerulonephritis
d. Goodpastures syndrome
e. IgA nephropathy
97. The following conditions are paired with an appropriate therapy:
a. Salicylate poisoning: Forced acid diuresis
b. Heparin overdose: IV Vitamin K
c. Morphine Overdose: IV Naloxone
d. Active Myasthenia Gravis: Atropine
e. Glaucoma: Beta blocker eye drops.
98. Long term steroid therapy is indicated where the patient develops
a. Hypercalcemia
b. Deteriorating pulmonary function
c. Complete heart block
d. Hilar adenopathy and erythema nodosum
e. Anterior uveitis
99. Verapamil:
a. Inhibits Na+/K+ ATPase
b. Causes hyperkalemia
c. May be used to treat ventricular tachycardia at an arrest
d. Is a negative inotrope
e. Should be given IV quickly for maximum therapeutic effect
100. Ventricular tachycardia (acute)
a. If the patient is normotensive, best treatment is by DC cardioversion
b. Beta blockers convert the patient to sinus rhythm
c. It the patient is hypotensive, treat with Amiodarone
d. May be due to underlying MI
e. ACE Inhibitor may be beneficial.
101. Regarding renal transplantation:
a. Cardiovascular disease is the single biggest cause of mortality
b. CMV disease is treated by ganciclovir
c. ADPKD recurs in the graft
d. Azathioprine levels need to be monitored on a regular basis
e. Gout may occur in up to 50% of patients
102. The following ECG changes occur with hyperkalemia
a. Peaked p waves
b. Tall tented T waves
c. Broadened QRS
d. Absent p waves
e. Sine wave
103. Hypothermia
a. J wave on ECG
b. Causes pancreatitis
c. Patient must be rewarmed slowly
d. Increased risk of arrhythmias as you approach normal body temperature
e. Hyperthyroid patients are at an increased risk of developing hypothermia
104. Anaphylactoid purpura (Henoch Schonlein purpura)
a. Can be caused by some drugs
b. Can be caused by streptococcus
c. Usually start on upper half of body
d. Can cause abdominal pain
e. Can effect kidneys
105. Erysipelas:
a. Is caused by Staphylococcus aureus
b. Is caused by Streptococcus
c. Should be treated with corticosteroids
d. Should be treated with IM Penicillin in patients not allergic
e. Is likely to occur in a lymphoedematous limb and to produce lymphoedema after
repeated episodes.
106. Multiple Sclerosis
a. Shows equal sex incidence
b. Immunoelectrophoresis with the finding of oligoclonal gammaglobulin is diagnostic
c. Optic neuritis is usually unilateral and may cause abnormal papillary reactions
d. Does not always result in severe disability
e. Hot baths may make symptoms worse
107. In Dystrophia Myotonica (myotonic dystrophy):
a. Inheritance is Xlinked
b. Only males are affected
c. Testicular atrophy occurs
d. Cardiac abnormalities occur
e. Muscular weakness is initially marked in the distal muscles of the limbs
108. Diarrhea and weight loss are features of:
a. Duodenal ulcer
b. Crohns disease of small intestine
c. Whipples disease
d. Choledolithiasis
e. Gastritis
109. Jaundice with bilirubinemia may be due to:
a. Cystic duct stenosis
b. Gilberts disease
c. Hepatitis C
d. Carcinoma of pancreatic head
e. Duodenal ulcer
110. Treatment of hepatic encephalopathy in acute liver failure includes:
a. Oral loperamide
b. IV neomycin
c. Control cerebral edema
d. Bowel wash outs
e. Oral lactulose
111. Portal HTN is a feature of
a. Liver cirrhosis
b. Portal vein thrombosis
c. Budd Chiari syndrome
d. Alcoholic hepatitis
e. Propranolol therapy
112. Steatorrhea is present in:
a. Pancreatic insufficiency
b. Bile duct obstruction
c. Stagnant loop syndrome
d. Ulcerative colitis
e. Uremia
113. A 30 year old has jaundice and AST level of 1500 (Normal<40)
a. U/S exam is likely to show dilated intrahepatic ducts and normal common bile ducts.
b. Hep A byt not Hep C could be responsible
c. Reinfection with delta agent (Hep D) could be responsible in a chronic Hep B carrier
d. Paracetamol OD could be responsible
e. Previous anesthetic with halothane could be responsible
114. The following are correctly matched:
a. A raised serum sodium and SIADH
b. Raised serum potassium and hypoadrenalism
c. Raised urea and hypoadrenalism
d. Reduced TSH and primary hypothyroidism
e. Normal diurnal variationj of plasma cortisol and Cushings syndrome
115. A displaced apex beat is found in:
a. Classical mitral stenosis
b. Aortic incompetence
c. Pectus excavatum
d. Atelectasis of left lower lobe
e. Scoliosis
116. Severe mitral valve stenosis is often associated with
a. Mid diastolic murmur at apex
b. Reduced first heart sound at apex
c. Opening snap
d. hemoptysis
e. Atrial fibrillation
117. Severe aortic valve incompetence is characterized by
a. Visible carotid pulsation in the neck
b. Mid systolic ejection murmur in the aortic area
c. Normal first heart sound in aortic area
d. Dilated left ventricle
e. Susceptibility to subacute bacterial endocarditis
118. Mitral regurgitation is associated with:
a. MI
b. Marfans
c. HCOM
d. Thyrotoxicosis
e. Syphilitic carditis
119. In aortic stenosis:
a. Fainting attacks may occur on exertion
b. A cardiac thrill is uncommon
c. The aortic 2nd sound is accentuated
d. Angina may occur in the presence of normal coronary arteries
e. Echocardiography shows dense echoes in the aortic root
120. A patient with a pulse rate of 48/min may
a. be a well-trained athlete
b. Have fT4 of 2 umol/L
c. Have a complete heart block
d. Have digoxin toxicity
e. Have pulsus Bigemini
121. Subacute bacterial endocarditis:
a. rarely occurs with valvular abnormality
b. Is caused in 75% of cases by hemolytic streptococci
c. Is associated with Heberden’s nodes
d. Is associated with Roth spots on fundoscopy
e. Is associated with glomerulonephritis
122. Diminished movement of the chest wall on one side may be associated with:
a. Pneumonia in upper and lower lobers
b. Tension pneumothorax
c. Diffuse pulmonary fibrosis
d. Emphysema
e. Acute bronchitis
123. In a patient with a pneumothorax the following signs may be present:
a. Displacement of trachea towards side of lesion
b. Impaired percussion note
c. Diminished or absent breath sounds
d. Increased vocal resonance
e. Tinkling crepitations when fluid is present.
124. Sarcoidosis in a young adult:
a. Most commonly presents with erythema nodosum and bilateral gland enlargement
b. Always requires treatment with corticosteroids
c. Never remits spontaneously
d. May cause a restrictive defect of pulmonary function
e. Is usually associated with hypercalcemia
125. In status asthmaticus
a. Disodium cromoglycate should be given in high doses
b. Pulse rate of 140/minute is an indication for hospital admission of an adult
c. Beta-blockers are useful for controlling the tachycardia
d. Sedation with diazepam, 5mg IM is safe
e. PaO2 may be reduced
126. In a patient with COPD, the presence of hypercapnia implies
a. Reduced alveolar ventilation
b. Presence of emphysema
c. Increased dead space
d. Decreased activity of respiratory center
e. Presence of impaired gas transfer
127. Features of acromegaly include
a. Enlargement of hands and feet
b. Excessive sweating
c. Hypokalemia
d. Hypertension
e. Abnormal glucose tolerance test
128. Which of the following might be the cause of hypokalemia?
a. Treatment with Spironolactone
b. Treatment with captopril
c. Treatment with thiazide diuretic
d. Carcinoma of the lung
e. Adrenal adenoma
129. With respect to the Hepatitis D (Delta) virus:
a. Hep D requires Heb B to replicate
b. Hep B is spread by the fecal/oral route
c. Hep C is associated with chronic liver disease
d. Hep A is associated with chronic active hepatitis
e. Hep B is associated with chronic active hepatitis
130. Opioid treatment is associated with
a. nausea and vomiting
b. Diarrhea
c. Urinary incontinence
d. myoclonal myopathy
e. pruritus
131. Rheumatoid arthritis disease modifying drugs include
a. gold
b. steroids
c. cyclosporine
d. methotrexate
e. nyprostyn
132. Clubbing is associated with which of the following
a. severe asthma
b. chronic bronchitis
c. bronchiectasis
d. cirrhosis
e. pulmonary fibrosis
133. Radioiodine treatment for hyperthyroidism
a. can be given in an outpatient clinic
b. is the treatment of first choice in the elderly
c. The results of this treatment can be seen in 2-3 weeks
d. Is absolutely contraindicated in women who are lactating
e. Is absolutely contraindicated in women planning a future pregnancy
134. Collapsing pulse is associated with:
a. aortic stenosis
b patent ductus arteriosus
c. fever
d. anemia
e. aortic regurgitation
135. Features of an innocent murmur are
a. diastolic rhythm
b. loud S1
c. Normal S2 in expiration
d. Radiation throughout precordium
e. PR interval 0.12-0.2 seconds
136. Features of a pleural effusion
a. bronchial breaths
b. increased vocal fremitus
c. Increased vocal resonance
d. Dullness on percussion
e. Crackles
137. Thrombocytosis is a feature of
a. Post operatively
b. Post-splenectomy
c. Malignancy
d. SLE
e. After blood transfusion
138. Crackles can be a sign of:
a. Cryptogenic fibrosing alveolitis
b. Extrinsic allergic alveolitis
c. Sarcoidosis
d. Pulmonary fibrosis
e. TB
139. The following are true about hypertension
a. Thiazide diuretics are treatment of choice in elderly
b. There is more of a chance of finding a cause for the more severe malignant form than
from the more common benign form
c. Headache and dizziness are signs/symptoms of mild or moderate hypertension
d. Systolic hypertension alone requires no treatment
140. A woman presents with a facial rash of four weeks
a. History is compatible with a diagnosis of acne rosacea
b. Psoriasis could be a cause
c. Oral steroids trial is advised
d. H2 blockers could be a cause of the rash
e. Photosensitive rash is a possible diagnosis
141. A 45 year old man, non smoker, presents to casualty with chest pain of 3 hours, no
history of hypertension
a. IV analgesics are indicated
b. PO aspirin advised
c. IV thrombolytic therapy is not contraindicated
d. Monitoring of BP and ECG is necessary
e. Patient is allowed home to return in 24 hours for ECG
142. Anemia of chronic disorders is associated with
a. Low ESR
b Reduced serum iron
c. Reduced utilization of iron
d. No response to oral iron
e. Reduced serum transferring
143. Low serum potassium could be from:
a. Diuretic therapy
b. Digoxin therapy
c. Addison’s disease
d. Phaeochromocytoma
e. Acute renal failure
144. A 64 year old smoker presents with left pleuritic chest pain, cough and hemoptysis.
On examination, clubbing was noticed. A reasonable differential diagnosis would include
a. Pulmonary TB
b. Mycoplasma pneumonia
c. Cancer of bronchus
d. CFA
e. Left Upper Lobe Strep pneumonia
145. Tests on the above man should include
a. Sputum for regular cytology and serology
b. Sputum for PCP and H+E
c. MRI thorax
d. Mantoux test
e. Videooptic bronchoscopy
146. A 45 year old man presents with a 10 year history of tremor which is worse on
picking up a glass. The patient says his father and sister also had the tremor
a. Tremor decreases during sleep
b. Propranolol is drug of choice
c. Diagnosis is likely to be familial parkinsonism
d. Amantadine is next drug of choice
e. Tremor is thought to be a disorder of the red nucleus
147. A 40 year old man presents to casualty in a confused state
a. Alcohol may be a cause
b. Confabulation is a feature of Korsakoff’s syndrome
c. Ophthalmaplegia and ataxia are indications for pyramine
d. Foeter and liver flap indicate hepatic encephalopathy
e. Chlordiazepoxide is used for treatment of DTs
148. In a patient who has pulsus alternans
a. The pulse is irregular
b. Digitalis intoxication is the most likely cause
c. The pulse waves are unequal in size
d. It is most easily observed when taking BP
e. Pulse rate varies with respiration
149. Pericardial rub is a recognized feature of:
a. Hypertensive cardiac failure
b. Extrarenal uremia
c. Terminal uremia
d. Minority of cases of MI
e. Atrial flutter
150. In active pulmonary TB:
a. Physical signs are always present on careful examination of the chest
b. Clubbing is common
c. In most cases ESR is raised
d. Radiological changes are commonest in the apex of the lung
e. Pneumothorax occurs in about 10% of cases
151. Mitral stenosis
a. Is more likely to develop SBE than incompetence
b. Always give antibiotic prophylaxis
c. Systolic murmur
d. Give anticoagulation
e. Presents with sudden death
152. A 35 year old Indian vegetarian presents with difficulty getting out of a chair and
parasthesia; useful tests include
a. Calcium
b. Alkaline phosphatase
c. ACTH
d. bilirubin
e T4
153. A student tested Mantoux positive after contact with TB; CXR normal and there
were no signs but sputum was not available for testing
a. Discharge her saying she will never get TB
b. Discharge her saying come back only if pregnant
c. Tell her to miss college for 3 months
d. Three month prophylaxis with rifampicin and streptomycin
e. Six month prophylaxis with rifampicin and streptomycin
154. A 40 year old male who worked in Saudi, presented with dyspnea, slight wheeze. He
had a history of smoking and alpha-1 anti-trypsin deficiency. The likely findings are:
a. Enlarged lung fields on CXR
b. Diagnosis of asthma
c. Diagnosis of emphysema
d. Reduced FEV1/FVC
e. Improvement with bronchodilators
155. Gout:
a. Commoner in females than males
b. Treat an acute attack with allopurinol
c. Initial attacks are commonly a polyarthritis
d. May occur with a normal serum uric acid
e. Tophi are an early feature of disease
156. These conditions cause a polymorphonuclear leucocytosis
a. Acute blood loss
b. Malignant infiltration of the bone marrow
c. Acute brucellosis
d. Chronic pyelonephritis
e. Acute pyelonephritis
157. The following statements are correct
a. Hip joint disease may present as pain in the knee
b. A normal joint contains as little synovial fluid that the clinical demonstration of fluid
in a joint always implies an abnormality
c. Joint disease alone is seldom a cause of gross muscle wasting
d. A positive “patellar tap” test is a sign of patello-femoral arthritis
e. Carpal tunnel syndrome typically remits during pregnancy
158. Characteristics of typhoid fever include:
a. Incubation period of 4 weeks
b. Polymorph leucocytosis in the early stages of the illness
c. Macular rash on the trunk
d. Profuse watery diarrhea in the first week of fever
e. Resolution of the fecter within 3-4 days of starting chloramphenicol in appropriate
dosage
159. The following drugs may aggravate or cause GI ulceration
a. Paracetamol
b. Codeine phosphate
c. Ibuprofen
d. Indomethacin
e. Enteric-coated potassium chloride
160. Impaired elimination of the following drugs occurs in advanced renal failure and
will necessitate dosage reduction when they are used in this situation
a. Chlorpropamide
b. Warfarrin
c. Streptomycin
d. Morphine
e. Benzylpenicillin
161. Harmful results are not infrequent when working with
a. Asbestos
b. Emulsion paint
c. Beryllium
d. Coarse sand
e. Cotton dust
162. Low fibre diet is at present commonly believed to be a major factor in the causation
of
a. Diverticular disease of the colon
b. Crohn’s disease
c. Varicose veins
d. Colon cancer
e. Esophageal cancer
163. Hypernatremia is an expected finding in the following disorders
a. Acute renal failure caused by abruption placentae
b. Dehydration complicating renal tubular acidosis
c. Dehydration in an elderly confused man being treated with chlorpromazine
d. Non-ketotic hyperglycemic coma
e. Dehydration complicating diuretic therapy
164. The following are characteristic hematological findings in the named systemic
disorders
a. Leucopenia in active SLE
b. Leucopenia in active PAN
c. Lymphocytosis in acute leptospirosis
d. Lymphopenia in acute sarcoidosis
e. Lymphpenia in HIV infection
165. Hypophosphatemia is associated with
a. Osteomalacia due to celiac disease
b. Parathyroid adenoma-associated hypercalcemia
c. Rickets due to progressive chronic renal failure
d. Osteoporosis associated with exogenous steroid therapy
e. Sarcoidosis associated hypercalcemia
166. The following are frequently found in association
a. Chronic ulcerative colitis and membranous glomerulonephritis
b. Acute-on-chronic renal failure and prolonged bleeding time
c. Pericarditis and sarcoidosis
d. Spironolactone treatment and gynecomastia
e. Thrombocytopenia with renal failure caused by the HUS
167. The following may be of value in the treatment of hirsutism
a. Regular waxing
b. Cyproterone acetate
c. Minoxidil
d. Spirolactone
e. Low dose dexamethasone at night
166. Regarding hypoglycemia
a. When insulinoma is suspected this is best diagnosed by a glucose tolerance test
b. It is not a clinical problem in diabetic patients if they have diminished awareness of
their symptoms
c. May be precipitated in insulin-dependent patients by unaccustomed exercise
d. Does not occur in diabetic patients treated with oral hypoglycemics
e. Is rarely a cause of death in insulin-dependent diabetics
167. In the jaundiced patient
a. A palpable gallbladder suggests gallstones
b. Pruritus suggests obstructive jaundice
c. With hemolytic anemia, the urine is of normal color but contains urobilinogen
d. Carcinoma of the head of the pancreas typically causes “boring” back pain
e. Xanthelasmata are usually found in jaundiced patients with chronic active hepatitis
168. In a patient with a pleural effusion
a. Bronchial breathing may be heard above the effusion
b. Protein content of 40g/L suggests heart failure may be the cause
c. Pleural effusion may occur in the patient with an ovarian tumor
d. Atypical pneumonia is a classical cause of a pleural effusion
e. Acute pancreatitis may cause a left-sided pleural effusion and ascites
169. In the patient with mitral stenosis
a. History of rheumatic fever almost always obtained
b. Loud first heart sound and opening snap suggests the valve is calcified
c. A “p” mitrale may be seen on ECG
d. Bacterial endocarditis is an uncommon complication of mitral stenosis
e. Mitral stenosis may cause hoarseness
170. A 65 year old man is found to have hypercalcemia
a. Diarrhea and itching would be expected symptoms
b. Serum electrophoresis would be a relevant investigation
c. Fluid restriction is the first line of treatment
d. Thiazide diuretics may be a cause
e. If he has a lung tumor, it is likely to be a squamous cell carcinoma
171. In Irritable Bowel Syndrome
a. Nocturnal diarrhea is typical
b. Daily stool weight is normal
c. Symptoms typically develop in late middle life
d. Rectal biopsy is diagnostic
e. Carcinoma of the colon is a late complication
172. A 25 year old female is found to have microscopic hematuria on routine insurance
exam. The following statements are correct:
a. The finding is compatible with IgA nephropathy
b. The finding is consistent with Alport’s nephropathy
c. The finding is compatible with a residuum from an episode of minimal change
nephrosis eight months previously
d. The finding is compatible with a residuum from an episode of post-streptococcal
nephritis eight months previously
e. If the patients has insulin-dependent diabetes mellitus of 12 years standing, the finding
is likely to indicate the early phase of diabetic nephropathy
173. Erythema nodosum may be associated with:
a. OCP
b. Streptococcal sore throat
c. Sarcoidosis
d. Pemphigus
e. Diabetes Mellitus
174. The following are true in rheumatoid disease:
a. Rheumatoid nodules are tender
b. Proximal interphalangeal joints are commonly affected
c. Presence of swan-neck deformities is a good guide to current disease activity
d. Rheumatoid nodules are usually located on the dorsum of the hand
e. Charcots joints are a complication
175. Mark the following True or False
a. In Iron deficiency anemia, mean corpuscular volume is frequently 65-75 fL
b. Poor dietary B12 is the main cause of pernicious anemia
c. Celiac disease frequently causes folic acid deficiency
d. Normal isotope bone scan is typical of multiple myeloma
e. Hemolytic anemia causes increased conjugated bilirubinemia
176. The following are recognized associations
a. Hypothyroidism: pretibial myxoedema
b. thyrotoxicosis: Proximal myopathy
c. Cushings disease: hypoglycemia
d. Addisons disease: hypertension
e. Acromegaly: Homonymous hemianopia
177. The following disorders and findings on examination are correctly paired:
a. Pulmonary fibrosis: fine end inspiratory crepitations
b. Emphysema: increased intensite of breath sounds
c. Pleural effusion: reduced tactile and vocal fremitus
d. Right upper lobe collapse: trachea deviated to right
e. Left apical lung tumor: Left horners syndrome
178. True or false:
a. In pulmonary TB, the presence of acid fast bacilli on a sputum smear indicated
infectivity
b. Treatment of TB is with combination chemotherapy for a 2 month period
c. Mycoplasma pneumoniae is a common cause of community acquired pneumonia
d. In meningococcal meningitis, gram+ diplococci are seen in CSF
e. IN Meningococcal meningitis, CSF neutrophilia is seen
179. The following skin manifestations and systemic diseases are correctly paired
a. Neurofibromatosis: Café-au-lait patches
b. Diabetes Mellitus: Livedo Reticularis
c. Chronic liver disease: Spider naevi
d. Erythema nodosum: IBD
e. Polyarteritis nodosa: telangiectasia
180. The following conditions are correctly paired with an accurate description of typical
symptoms:
a. MI: central anterior chest tightness
b. Unstable angina: central anterior chest tightness
c. Pericarditis: pain exacerbated by sitting forward
d. Psoriasis: itch
e. Subarachnoid hemorrhage: frontal headache
181. The following occupations are correctly paired with a recognized occupational
hazard
a. Asbestos insulation: pleural mesothelioma
b. Pottery worker: silicosis
c. Animal laboratory worker: asthma
d. Pneumatic drill operator: Raynaud’s phenomenon
e. Deep sea diver: bony infarction
182. The following nail findings are correctly paired with underlying disease states:
a. Spoon shaped nails: B12 deficiency
b. Leuconychia: chronic liver disease
c. Splinter hemorrages: infective endocarditis
d. Nail pitting: Steven-Johnson syndrome
e. Finger clubbing: chronic liver disease
183. The following are recognized complications of diabetes mellitus:
a. Impotence
b. Postural hypotension
c. Charcot’s joint
d. 3rd nerve palsy
e. Pneumothorax
184. Subacute bacterial endocarditis can manifest itself as:
a. Cerebrovascular accident
b. Anemia
c. Hematuria
d. Hypertension
e. Vasculitis
185. In TB meningitis
a. There is usually a high polymorph cell count in CSF
b. Blood glucose is usually low
c. CSF protein is usually low
d. Presentation can be with inappropriate ADH secretion (SiADH)
e. Cranial nerve palsies may occur
186. Vasculitis lesions can be found in:
a. Polyarteritis nodosa
b. Drug reactions
c. Hypertension
d. Rheumatoid arthritis
e. Hepatitis A
187. Mycoplasma pneumoniae
a. Occurs in young adults
b. Can have CNS manifestations
c. Can be accompanied by skin rash
d. Responds to treatment with penicillin
e. Can show a significant titre of cold agglutinins
188. In a patient with harsh ejection systolic murmur at the precordial base, the following
might indicate aortic stenosis
a. History of syncope
b. Large volume pulse
c. ECG showing left ventricular hypertrophy and strain
d. Doppler echocardiography showing a large pressure gradient across the aortic valve
e. A mid-systolic click at left sternal edge
189. Regarding hypercholesterolemia
a. Fasting sample is necessary for screening
b. May be due to a decrease in LDL receptors
c. Total cholesterol and LDL cholesterol are usually closely associated
d. Increased HDL cholesterol is associated with an increased risk of cardiovascular
disease.
e. Reduction of total cholesterol has been shown to significantly reduce cardiovascular
risk.