8 VARIANT

Answer ALL of the following questions.

Mark T, F, or D against each of responses (T = true, F = false, D = dont know).
Remember, marks are deducted only for wrong answers.
1.

Pleuritic chest pain is a characteristic feature of (F)

A.

Splenic infarction

B.

Hepatic infarction

C.

Pneumothorax

D.

Pericarditis

E.

Rib fracture

2.

Typical features of an empyema thoracic include (B, C, D)

A.

Bilateral effusions on chest X-ray

B.

A fluid level on chest X-ray suggests a bronchopleural fistula

C.

Persistent pyrexia despite antibiotic therapy

D.

Recent abdominal surgery

E.

Bacteriological culture of the organism despite antibiotic therapy

3.

In the normal adult (C, D)

A.

The trachea bifurcates at the level of the suprasternal notch

B.

The left main bronchus is more vertical than the right

C.

The right lung usually has ten bronchopulmonary segments

D.

The oblique fissure extends from the thoracic vertebral level Th3

E.

Pulmonary surfactant is secreted by Type I pneumocytes

4.

In bronchoalveolar lavage fluid (C):

A.

The finding of asbestos bodies is diagnostic of asbestosis

B.

Sarcoidosis is characterized by a preponderance of polymorphs

C.

There is an increase in total cell count in smokers

D.

Non-smokers have proportionately more macrophages and polymorphs

E.

The findings in sarcoidosis are a better guide to the diagnosis than bronchial and transbronchial biopsy

5.

Typical manifestations of ventilatory failure include (A, C, D, E):

A.

Drowsiness

B.

Cold extremities

C.

Papilloedema

D.

Flapping tremor

E.
6.

Muscle twitching
Radical surgical treatment for bronchial carcinoma is contraindicated by (B, C, D):

A.

Peripheral neuropathy

B.

Grossly widened carina on bronchoscopy

C.

Hoarseness with a bovine cough

D.

FEV 0.8 litre

E.
7.

Raised right hemidiaphragm which descends on sniffing

Recognized pulmonary manifestations of untreated rheumatoid arthritis include (A, D, E):

A.

Bronchiolitis obliterans

B.

Pulmonary eosinophilia

C.

Pulmonary infarction

D.

Rheumatoid nodules

E.

Pleural effusions

8.

In pulmonary alveolar proteinosis (A, D)

A.

Alveoli contain substance rich in phospholipids

B.

Hemoptysis is a recognized feature

C.

Pleural effusions occur

D.

Pulmonary lavage using several litres of fluid is helpful

E.

Steroids prevent deterioration in lung function

9.

Pulmonary granuloma are characteristic of (A, B, C, D)

A.

Histoplasmosis

B.

Berylliosis

C.

Histiocytosis

D.

Chung-Strauss syndrome

E.
10.

Goodpastures syndrome
Features of rejection of a heart transplantant include (A, B, C, E)

A.

Pyrexia

B.

Prolongation of the PR interval on ECG

C.

Increase in cardiac size on chest X-ray

D.

Chest pain

E.
11.

Reduction in the voltages of the QRS complex on ECG

Characteristic features of atrioventricular canal include (F)

A.

Atrial septum defect

B.

Ventricular septum defect

C.

Severe pulmonary hypertension

D.

Deficiency of atrioventricular valves

E.

Down syndrome

12.

In right to left shunt reversal (Eisenmengers syndrome) of congenital heart disease (A, C, D)
A.

Pulmonary arterial hypertension is usually present

B.

Prompt closure of the atrial septum defect or ventricular septum defect produces symptomatic relief

C.

Recurrent respiratory infections are characteristically present

D.

Most patients have central cyanosis and finger clubbing

E.

Shunt murmurs are prominent when polycythaemia is severe

13.

Oxygen therapy will significantly improve central cyanosis in (B, C, D)

A.

Transposition of the great vessels

B.

Mitral stenosis

C.

Pulmonary fibrosis

D.

Congestive cardiomyopathy

E.
14.

Methemoglobinemia
The following statements about cardiac murmurs are true (B, D)

A.

Diastolic murmurs are a recognised feature of normal pregnancy

B.

Ventricular septal defects produce pansystolic murmurs

C.

An early high-pitched diastolic murmur suggests mitral stenosis

D.

Late-systolic murmurs suggest mitral valve prolapse

E.

Mitral diastolic murmurs are best heard at the apex with the patient leaning forwards and the breath held in expiration

15.

Recognised features of chronic mitral incompetence include (A, B, D)

A.

Soft first heart sound and short mid-diastolic murmur

B.

Onset associated with congestive cardiomyopathy

C.

Afterloud reduction increases the severity of regurgitation

D.

Pansystolic murmur and heaving, displaced apex beat

E.

Atrial fibrillation requiring anticoagulation

16.

Typical features of primary pulmonary hypertension include (A):

A.

Chest pain

B.

Onset of symptoms in infancy

C.

An ejection systolic murmur at the pulmonary area

D.

A soft pulmonic component of the second heart sound

E.
17.

Left ventricular hypertrophy on the electrocardiogram

Features of chronic constrictive pericarditis include (D, E)

A.

A rise in systolic blood pressure on inspiration

B.

A fall in venous pressure on inspiration

C.

Pulsus alternans

D.

Ascites

E.

A low pulse pressure

18.

The following are congenital acyanotic cardiac diseases without a shunt (A, B, E):
A.

Ostium primum defect

B.

Coronary arteriovenous fistula

C.

Pulmonary stenosis with ventricular septum defect

D.

Pulmonary arteriovenous fistula

E.
19.

Aortopulmonary window
Aortic stenosis (B, C):

A.

Causes fixed splitting of the second heart sound

B.

Often produces a thrill in the supra sternal notch

C.

Is likely to be severe if there is considerable left ventricular hypertrophy with a strain pattern on the electrocardiogram

D.

Is unlikely to be severe if the blood pressure is normal

E.
20.

Is most commonly associated with a previous history of rheumatic fever in patients

Pulmonary hypertension (B, C, D, E):

A.

Causes the pulmonary and aortic components of the second heart sound to be further apart

B.

Is a cause of a Graham-Steel murmur

C.

Can cause peripheral cyanosis

D.

Is a cause of atrial fibrillation

E.

Gives rise to giant A waves in the jugular venous pressure

21.

Transoesophageal echocardiography is superior to transthoracic echocardiography in the following situations (A, B, C, D, E):
A.

In patients with advanced chronic obstructive airway disease

B.

In cases of left atrial thrombus

C.

Evaluation of prosthetic mitral valve function

D.

Monitoring patients during operative procedures

E.
22.

Examination of the thoracic aorta

Significant risk factors for the development of the ischemic heart disease include (B, E):

A.

Elevated plasma HDL-cholesterol concentration

B.

Family history of type 2 diabetes

C.

Low factor VIIIc plasma concentration

D.

Obsessional personality

E.
23.

Smoking five cigarettes daily for 10 years

The following factors are associated with a poor prognosis following acute myocardial infarction (A, C, E)

A.

Previous myocardial infarction

B.

Female sex

C.

Psychosis

D.

Transient complete heart block in inferior myocardial infarction

E.

Creatinine kinase greater than 2000 international units

24.

Indications for the implantation of a permanent pacemaker include (B, C, D):

A.

Syncope of undetermined cause

B.

Congenital symptomatic atrio-ventricular block

C.

Carotid sinus hypersensitivity complicated by symptomatic bradycardia

D.

Symptomatic long pauses in a patient with atrial fibrillation

E.
25.

Bifasicular block
Physical sings suggesting PPH include (B, C, E):

A.

Left ventricular hypertrophy

B.

Pulmonary incompetence

C.

Systolic clicks

D.

Left-sided fourth heart sound

E.
26.

Enlarged liver
Clinical presentation of CAD include (F)

A.

Angina pectoris

B.

Myocardial infarction (MI)

C.

Heart failure

D.

Arrhythmia

E.

Sudden death

27.

Cigarette smoking is associated with (A, B, D)

A.

Decreased heart rate

B.

Increased threshold to ventricular fibrillation

C.

Increased platelet adhesion

D.

Decreased HDL-cholesterol

E.
28.

Decreased hematocrit
A poorer prognosis after acute myocardial infarction is associated with (A, C, D):

A.

Transient pulmonary oedema

B.

Ventricular fibrillation within 12 hours of onset of infarction

C.

Left ventricular ejection fraction in range 20-30 %

D.

Patients aged 75 or over

E.
29.

Inferior rather than an anterior infarction

The following are clinical features of pulmonary embolism (A, B, C, E)

A.

Chest pain

B.

Tachypnoe

C.

Normal chest X-ray

D.

Matched ventilation and perfusion defects on radio-isotope scan

E.

Apprehension

30.

Takayasus disease (C, D, E)

A.

Is caused by an abnormal sensitivity of skin vessels to cold

B.

Usually progresses to necrotic changes of the fingertips

C.

Was originally described by a Japanese opthalmologist

D.

Classically involves the branches of the aortic arch

E.

Is a panarteritis

31.

Symptoms associated with carotid bifurcation disease include (A, B)

A.

Sensory or motor deficit affecting the contralateral face, arms or legs

i.

Alteration in higher cortical dysfunction

ii.

Dysarthria

iii.

Diplopia

iv.

Drop attacks

32.

Indications for shunting during Carotid Endarterectomy (CEA) (A, B, C, E)

A.

Retrograde stamp pressure < 40 mm Hg

B.

Contralateral carotid occlusion

C.

Contralateral high-grade carotid stenosis

D.

Contralateral carotid stenosis

E.

Contralateral carotid stenosis and vertebral stenosis

33.

The inferior mesenteric artery supply (C, D, E)

A.

Small intestine

B.

The colon from the ligament of Trietz to the splenic flexure

C.

The descending colon

D.

The sigmoid colon

E.

The rectum

34.

Ischemic colitis (B, C )

A.

Commonly involves the hepatic flexure

B.

May present with late strictures

C.

Often present with fresh rectal bleeding

D.

Is typified by pseudopolyposis

E.

Produces a diffuse granular proctitis

35.

Abdominal aortic aneurysms (C, E)

A.

Arise from an atheromatous vessel in approximately 50% of cases

B.

Characteristically produce epigastric pain

C.

Are associated with duodenal ulceration

D.

Which are asymptomatic are relatively benign conditions and should not usually be resected

E.

May rupture into the inferior vena cava

36.

Secondary lymphoedema (A, D)

A.

May be caused by Wuchereria bancrofti

B.

Of the arm in post-masrectomy patients undergoes lymphosarcomatous changes in 10% of patients

C.

Is characterised by an increased number of lymphatics

D.

Is characterised by dermal backflow

E.

May be caused by Milroys disease

37.

The incidence of postoperative venous thrombosis can be reduced (B, C, D)

A.

By raising the foot of the operation table during surgery

B.

By passive calf contractions during an operation

C.

By the intravenous administration of 500 ml of low molecular weight dextran during operation and on the first 2 postoperative days

D.

By the priphylactic use of subcutaneus heparin

E.

By the contraceptive pill

38.

Acute appendicitis (C, D)

A.

Is most common in the 30 to 40 year age group

B.

Characteristically presents with a high temperature

C.

Is often associated with painful extension of the right hip

D.

May produce haematuria and pyuria

E.

Can be excluded if the patient has diarrhoea

39.

Abdominal pain is a characteristic feature of (B, C, D)

A.

Intestinal spirochaetosis

B.

Lead poisoning

C.

Acute intermittent porphyria

D.

Diabetic ketoacidosis

E.

Tricyclic antidepressant poisoning

40.

Emergency treatment of a mechanical obstruction of the large bowel may include (A, B, D, E)
A.

Enemata

B.

Radiological examination by contrast enema

C.

Exeriorisation of the lesion with a colostomy

D.

A transverse colostomy

E.

An ileo-transverse colostomy

41. A ruptured ovarian cyst (C, D)

A.

Most frequently occurs premenstrually

B.

Is more common in those on aral contraceptives

C.

May cause peritonitis

D.

Most commonly occurs in young women

E.

Requires no surgical treatment

42.

Recognised indications for elective peptic ulcer surgery include (C, E)

A.

Reccurent ulcer despite previous peptic ulcer surgery

B.

Chronic gastric ulcer persisting after 6 weeks medical therapy

C.

Gastric outlet obstruction

D.

Asymptomatic hour-glass deformity of the stomach

E.

Persistently troublesome symptoms despite medical therapy

43.

Patients with Crohns disease often presents with (A, C, D, E)

A.

Colicky abdominal pain

B.

Constipation

C.

Nutritional deficiencies

D.

Rectal bleeding

E.

Tender abdominal masses

44.

Multiple polyposis (C, D)

A.

Is inherited as an autosomal recessive trait

B.

Is usually clinically apparent before the age of 10 years

C.

Left untreated, progresses to carcinoma before the age of 40 years

D.

Is associated with gastric and small bowel polyps

E.

Under the age of 20 is best treated with azathioprine

45.

Acute haemorrhage from the upper gastrointestinal tract (B)

A.

Requires an urgent barium meal examination

B.

Requires an urgent gastroscopy

C.

Should be treated surgically as soon as the diagnosis is made

D.

Indicates the presence of a chronic duodenal ulcer

E.

Should be treated with H2 blockade

46.

Diseases associated with hepatic vein obstruction include (F)

A.

Oral contraceptive therapy

B.

Polycythaemia vera

C.

Constrictive pericarditis

D.

Hypernephroma

E.

Aplastic anaemia

47.

Indication of a serious intra-abdominal injury in a comatose patient may be gained by (A, B, C, E)

A.

Abdominal paracentesis

B.

The observation of pattern bruising on the abdominal wall

C.

Falling haemoglobin values

D.

The presence of diarrhea

E.

A falling blood pressure

48.

Hydatid cysts of the liver (A, B, C, D)

A.

Are frequently asymptomatic

B.

Are common in Australia

C.

Require surgical removal

D.

May produce jaundice and fever

E.

Are less common than pulmonary hydatid cysts

49.

Cancer of the pancreas (A, D)

A.

Occurs commonly in the head of the pancreas

B.

Is decreasing in incidence in the Western world

C.

Is not related to diabetes mellitus

D.

Is related to cigarette smoking

E.

Is usually treated by radical surgery

50.

Failure to opacify the gallblader on an oral cholecystogram is a recognised occurrence (F)

A.

Gastric outflow obstruction

B.

Diarrhoea

C.

Normal subjects

D.

Jaundice

E.

Malabsorption

ANSWERS
1
A, B, C, D,

2
B, C, D

3
C, D

4
C

5
A, C, D, E

6
B, C, D

7
A, D, E

8
A, D

9
A, B, C, D

10
A, B, C, E

E
11
A, B, C, D,

12
A, C, D

13
B, C, D

14
B, D

15
A, B, D

16
A

17
D, E

18
A, B, E

19
B, C

20
B, C, D, E

E
21
A, B, C, D,

22
B, E

23
A, C, E

24
B, C, D

25
B, C, E

26
A, B, C, D,

27
A, B, D

28
A, C, D

29
A, B, C, E

30
C, D, E

E
31
A, B
41
C, D

32
A, B, C, E
42
C, E

33
C, D, E
43
A, C, D, E

34
B, C
44
C, D

35
C, E
45
B

E
36
A, D
46
A, B, C, D,

37
B, C, D
47
A, B, C, E

38
C, D
48
A, B, C, D

39
B, C, D
49
A, D

40
A, B, D, E
50
A, B, C, D,