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Group 2 Medical Posting MCQ

1) A 62 years old man presented with sudden onset of left sided chest pain of 30
min duration associated with palpitation. Clinically the BP was 140/90 , HR 125 ,
patient appeared tachypnoec with bilateral fine crepitations bibasally. ECG on
lead II showed new changes as below.

Rapid troponin T was 1.2 ug/L (N 0.1). Regarding this patient :


A. The diagnosis is acute coronary syndrome (ACS).
B. The thrombolytic therapy is indicated.
C. Cardioversion is more important than rate control.
D. Chordae tendineae rupture is a potential complication.
E. B-blocker is indicated for long term therapy.

2) In ventricular tachycardia ,
A. QRS complex is less than 0.12s.
B. Positive QRS concordance in chest lead.
C. The mode of cardioversion is Asynchrony.
D. Amiodarone is a drug of choice in stable patient.
E. Implantable defribillator is indicated if it occurs within 24 hours of acute
myocardial infarction.

3) Regarding rheumatic fever ,


A. Peak incidence is 15 to 20 years of age.
B. Caused by immunologic reaction post Group B streptococcal infection.
C. Acute attacks last an average of 3 months.
D. Aortic valve is the most common valve affected.

E. Secondary prophylaxis is required after recovery.


4) A 45 years old man seen in the clinic with progression dyspnoea over 4
months duration associated with cough productive of white sputum. Clinically ,
he was afebrile , barrel chested with end- expiratory rhonchi. Lung function was
as the following :
FEV1 : 0.8 & FVC : 1.6 ---------- Post bronchodilator FEV1 : 0.88 & FVC : 1.6
A. The diagnosis is asthma.
B. The most important step at this stage is initiation of inhaled corticosteroid.
C. Smoking is the most important risk factor.
D. Airways hyperresponsiveness is implicated.
E. Bronchodilators improved mortality.

5) A 42 years old man presented with 5 days history of fever associated with
cough productive of greenish sputum. Clinically the patient has a temperature of
38.7 C , BP of 140/90 mmHg , PR 105 beats per minute. Lung examination
revealed dullness on percussion and increased breath sound are heard.
Regarding this patients illness ,
A. Mycoplasma is 2nd most common causative organism.
B. Pseudomonas is the most common causative organism.
C. Fluroquinolone is the 1st line antibiotic of choice.
D. Blood cultures are negative in majority of cases.
E. It requires hospital admission.

6) Regarding chorea :
A. It is a large amplitude movement involving proximal muscles.
B. It is occasionally suppressible.
C. It is a non-rhythmic and fleeting movement.
D. It is jerky and purposeless movements.
E. It is brief , repeated and stereotyped movements.

7) Regarding multiple sclerosis.


A. Demyelination is caused by T-cell mediated immune response.
B. CSF showed oligoclonal band of Ig G on electrophoresis.
C. Normal evoked potentials.
D. Methylprednisolone improves prognosis.
E. Interferon is useful in reducing relapse.

8) A 58 years old gentleman , a heavy smoker with hypertension presented with


sudden onset of left arm weaknesses over 10 hours duration. On initial
examination he was alert , conscious with facial symmetry , but reduced power
on left side ; with power of 3/5 on UL and 4/5 on LL. CT brain at A&E showed no
bleed.
In the ward 4 hours later , his examination revealed an alert , conscious patient
with L facial asymmetry , left UL power of 2/5 and left LL power 2/5. Regarding
this patient :
A.
B.
C.
D.
E.

Aspirin is indicated.
IV Heparin is indicated.
Repeat CT brain is indicated.
His blood pressure of 170/95 need to be lowered immediately.
The diagnosis is stroke.

9) Hyperglycemic Hyperosmolar State (HHS) is characterized by :


A. Immediate requirement for insulin infusion therapy.
B. Altered conscious level
C. Hyponatraemia
D. Serum osmolality more than 340 mosmol/kg
E. Metabolic acidosis

10) Regarding ulcerative colitis.


A. It is an inflammatory disorder of colonic mucosa.
B. The disease usually favours terminal ileum and proximal colon.
C. Colonoscopy is preferred to barium enema to assess disease extent.
D. Intravenous antibiotic is used in disease exacerbation.
E. Salfasalazine is of proven benefit.

11) Regarding peptic ulcer disease.


A. Duodenal ulcers are 4 times more common than gastric ulcers.
B. H. pylori is implicated in about 80 to 90 percent of cases.
C. H2 antagonist is the most effective drug therapy.
D. Smoking increased relapse rate in duodenal ulcer.
E. Somatostatin analogue have a role in arresting bleeding.

12) 55 years old female presented with lethargy over 4 months and frequent
vomiting over 5 days. She has history of osteoarthritis and on regular pain
reliever for 5 years , otherwise no other illnesses. Clinically she is pale ,
hypertensive , sallow complexion with bilateral pedal oedema ; creatinine is 1060
umol/L , urea 55 mmol/L , corrected serum Ca 1.98 mmol/L , PO 4 2.6 mmol/L.
Regarding this patient :
A. Serum bicarbonate is usually normal.
B. Ultrasound would show a normal sized kidney.
C. She requires urgent dialysis.
D. Long term dialysis is not yet indicated.
E. Renal transplantation is an option.

13) A 42 years old male presented with fever and dysuria of 6 days. Clinically the
temperature is 38.2 C , the rest of examination were unremarkable. Urine
dipstick and microscopy showed :
Leucocyte 100
RBC 150
Protein ++
Nitrate ++
Casts : Hyaline casts seen.
A.
B.
C.
D.
E.

The diagnosis is acute glomerulonephritis.


Antibiotic is indicated for 2 weeks.
Cystoscopy is indicated.
Renal biopsy is indicated.
The underlying condition is usually self limiting.

14) Regarding myeloproliferative disorders.


A. In essential thrombocytopenia , platelet is usually 400 X 109.
B. In polycythemia rubra vera , red blood cell mass is elevated.
C. In myelofibrosis , teardrop RBCs are characteristic.
D. Massive splenomegaly is a shared feature.
E. In chronic myeloid leukemia , the absence of Philadelphia chromosome confers
worse prognosis.

15) Regarding bleeding disorders.


A. Osler-Weber-Rhendu syndrome is one of the cause.
B. Platelet dysfunction manifests as low platelet count.
C. In DIC , INR , APTT and bleeding time are all prolonged.
D. Vitamin K deficienct is characterized by prolonged INR.
E. Haemophilia A is due to factor IX deficiency.

16) In type 2 diabetes ,


A. Endogenous insulin secretion is deficient.
B. Elevated fasting blood sugar is a marker of peripheral insulin resistance.
C. Basal insulin therapy is aimed at controlling fasting blood sugar.
D. Diabetic ketoacidosis is not a feature.
E. Medical nutritional therapy has no role in advance disease.

17) In secondary hypoparathyroidism ,


A. Serum calcium is high.
B. Occurs in chronic kidney disease.
C. Osteoclastic stimulation occurs in subligamentous area.
D. Serum phosphate is elevated.
E. Parathyroid hormone stimulates osteoclastic activity.

18) A 22 years old lady presented with 3 months history of multiple joints pain
particularly right wrist , left elbow and left MCPs associated with constitutional
symptoms. Examination revealed rash over the face , oral ulcers and tenderness
over the affected joints with reduced range of movements. Investigations are as
follow :
FBC : Hb 9.0 g/dL , WCC 8 X 109 , Platelet 160 X 109 , MCV 80 fL , Retics 2.5%
BUSE/Cr : Na 137 mmol/L , K 3.8 mmol/L , Urea 6 mmol/L , Creat 85 umol/L
Urine : Protein 2+
Regarding this patient.
A.
B.
C.
D.
E.

The diagnosis is Systemic Lupus Erythromatous.


Treatment with high dose steroid is indicated.
Both ESR and CRP are usually elevated in active disease.
Men who present with similar scenario have a better prognosis.
ANA is useful for monitoring disease activity.

19) The following are the features of lichen planus.

A. non itchy
B. flat topped
C. Wickhams stria
D. leukoplakia
E. genitalia is one of the affected site

20) In describing skin lesions ,


A. Macule is a raised flat-topped lesion 1 cm in diameter.
B. Papule is a small solid elevation of skin 1 cm in diameter.
C. Scales is a flakes arising from abnormal stratum corneum.
D. Pustules is a fluid filled lesion 1 cm in diameter.
E. Papule is a fluid filled lesion 1 cm in diameter.

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