Selection examination for the postgraduate diploma in elderly medicine – March 21st

2014.- Recall

1. Malabsorption is caused by
A. Whipple’s disease - T– Systemic infection by bacterium Trophoryma whipplei,
affects small intestine
B. Methotrexate - T– Damage to small intestine causes malabsorption and diarrhea
C. Crohns disease -T
D. Giardiasis -T
E.

2. Hypercalcaemia occurs in
A. Hypothyroidism – F, thyrotoxicosis is true
B. Sarcoidosis - T
C. Loop diuretic therapy - F
D. Immobility - T
E. Addison’s disease - T

3. Skin manifestations associated with diabetes mellitus

A. Lipoatrophy – Lipoatrophic DM is a variant
B. Lipohypertrophy – Complication of insulin injections
C. Pyoderma gangrenosum – associated with rheumatoid arthritis and IBD,
neoplasms
? data exists to suggest potential association with type 2 DM/metabolic syndrome
D. Erythema nodosum - F
E. Granuloma annulare – conflicting reports, ? latest case control study - no
association

4. Transmitted by a mosquito vector

A. Lymphatic filariasis
B. Visceral leishmaniasis – Sand fly
C. Onchocerciasis – Black fly
D. Myasis – (Maggots) fly
E. African trypanosomiasis – Tsetse fly

5. Causes polyuria
A. Heavy smoking – F, nothing to do with diuresis, but alcohol causes
B. Increased fluid intake - T
C. Early stage of chronic renal failure - T
D. Tubulointerstitial disease - T
E. Hyperglycaemia – T

6. Features of Graves disease

A. Weight loss - T
B. Galactorrhoea - F
C. Gynacomastia - F
 D. Diplopia - T
E. Carpel tunnel syndrome - T

7. Metformin
A. First line drug in type 2 diabetes mellitus -T
B. Can be used in pregnancy - T
C. Even in overdose does not cause hypoglycaemia – F, Causes lactic acidosis in
toxicity, can cause hypoglycaemia rarely and hyperglycaemia even more rarely
D. When given in the long term causes renal impairment – F, not a nephrotoxic drug
E. Should be avoided in mild renal impairment - F

8. Digoxin
A. Blocks Na-K ATPase pump- T
B. Delays AV nodal conduction - T
C. Has a positive inotropic effect- T
D. Toxicity is potentiated by hypokalaemia - T
E. Effect is enhanced by actacids – F, Constituents in antacids (particularly
magnesiem trisilicate) decrease the absorption of digoxin

9. Gastric transit time

A. 10 minutes for water
B. 6 hours for fat
C. Decreased by opioids – F, anticholinergics, narcotics, tricyclic antidepressants, and
calcium channel blockers, are known to delay gastric emptying
D. Increased by metoclorpromide - F
E.

10. Nerve supply of hands and wrist

A. Extensors of fingers are supplied by median nerve - F
B. Extensors of wrist are supplied by radial nerve - T
C. Majority of lumbricals are supplied by median nerve - F
D. Adductor policis is supplied by ulnar nerve - T
E. Opponens pollisis is supplied by median nerve - T

11. ECG changes of acute pulmonary embolism

A. Atrial fibrillation -T
B. Sinus tachycardia -T
C. S1Q3T3 pattern - T
D. RBBB – T, Complete or partial
E. T inversion in right leads –T, in leads III and aVF or leads V1 to V4
Right axis deviation, left axis deviation, p pulmonale

12. Cadiac arrest

A. Defibrillation should be done as early as possible -
B. im Adrenaline 0.5 mg should be given – F, iv 1 mg
C. Chest compressions should be given at a rate of 100 per minute - T
 D. Mouth to mouth breathing is essential - F
E. Drug of choice in ventricular fibrillation is atropine. - F

13. Peripheral neuropathy is caused by

A. Gentamicin - F
B. Metronidazole- T
C. Metformin- F
D. Rifampicin- F
E. Glibenclamide - F

14. Recognised consequences of head injury (Neuropsychiatric effects traumatic brain

injury)
A. Schizphrenia like psychosis - T
B. Impaired judgement - T
C. Emotional lability – T, common
D. Post traumatic amnesia - T
E. Social phobia

15. Multiple myeloma

A. Causes autonomic neuropathy
B. Causes renal failure - T
C. Causes bone pain - T
D. Causes normocytic anaemia - F
E.

16. Haemolytic anaemia

A. Pyruvate kinase deficiency is a cause- T
B. Beta thalassaemia is not a cause - F
C. Haptoglobulin level is low - T
D.
E.

17. Guillain Barre syndrome

A. Associated with high CSF protein content with pleocyosis - F
B. AMSAN has a rapid recovery. – F, slow recovery and a poor prognosis, acute
ascending quadriparesis
C. Early involvement of bladder function should prompt considering other diagnosis-
T
D. Peak flow meter is used to measure respiratory muscle weakness - T
E. Back pain is common - T

18. Parkinson disease

A. Onset is usually unilateral - T
B. Tremor is worsened with action - F
C. Has a broad base gait - F
 D. Initially treated with antimuscarinics – T , most useful as monotherapy in patients
under age 70 with disturbing tremor who do not have significant akinesia or gait
disturbance. They also may be useful in patients with more advanced disease who
have persistent tremor despite treatment with levodopa or dopamine agonists. Their
use in older or demented individuals and those without tremor is strongly
discouraged.
E. associated with cognitive impairment - T

19. Hypercapnia is caused by

A. Central sleep apnoea - T
B. Motor neuron disease - T
C. Guillain Barre syndrome - T
D. Ankylosing spondilitis - T
E. Pnuemonia - F

20. Polycythaemia rubra vera

A. Splenomegaly is common - T
B. Strokes can occur - T
C. JAK 2 test is important in diagnosis - T
D. Causes peptic ulcers - T
E. Bone marrow is essential for diagnosis – F?

21. Features of decompensated chronic liver disease

A. Low albumin - T
B. Splenomegaly - T
C. Small liver span- T
D. High INR - T
E. high blood urea level - F

22. Investigations that can be useful to detect undernutrition in an under-weight patient

A. albumin - T
B. globulin - F
C. transferring – T, serum transferrin concentrations provides an index of severity in
severely malnourished children, and should prove useful in field assessments of
nutritional status
D. thyroid profile - F
E.

23. Regarding normal kidneys

A. Renin is produced by peritubular cells - F
B. Erythropeoitin is secreted by peritubular cells as a response to hypoxia - T
C. 90% of erythropoietin is secreted by the kidney – T, liver is the main extrarenal
site of Epo production
D. Prostaglandin is important in renal blood flow. - T
E. Conversion of 25- hydroxy-cholecaliciferol into its active form happens in kidney
– T, 1 alpha-hydroxylase is also expressed in a variety of extrarenal tissues
24. Body water
A. In a 6o kg man total body water is 4o l. - T
B. 70% of total body water is intracellular- T
C. Water moves between the compartments of the body by an active process. - F
D. 70% of extracellular water is in the intestitium. T
E. Total extracellular water is about 12l.- T

25. Clinical trials

A. Randomisation avoids selection bias -T
B. Randomisation ensures equal baseline characteristics in the two groups - F
C. Low sample size may lead to inconclusive results -T
D. Participants can not leave the trial due to personal reasons - F
E. Phase 1 trial involve healthy volunteers- T

26. Renal failure

A. Hypercalcaemia causes prerenal renal failure. - T
B. NSAIDs cause afferent arteriolar dilatation – F, NSAIDs inhibit the synthesis of
prostaglandins, and consequently vasoconstriction of the afferent arteriole leads to
lowering of the glomerular filtration rate (GFR)
C. ACEI can cause prerenal renal failure. – T, The most important drugs that cause
prerenal failure are NSAIDs, captopril and cyclosporine, cyclosporin causes
vasoconstriction of the afferent arteriole
D. Low urine Na is intrinsic renal failure – F, >40 mmol/l
E. Low urine specific gravity in intrinsic renal failure. – T, <1.010
In prerenal failure=Urine specific gravity - >1.016, Low urinary sodium - <20 mmol/l

27. Drugs causing hypothyroidism

A. Carbimazole - T
B. Phenytoin - T
C. Chlorpromazine
D.
E.

28. Causes of acute confusion in elderly

A. cystitis - T
B. myocardial infarction - T
C.
D.
E.

29. Risk factors for osteoporosis

A. Obesity - F
B. Osteoarthitis- F
C. Immobility - T
D.
 E.

30. Increased risk of fracture after minimal trauma

A. Male with high BMI- F
B. Premature gonadal failure - T
C. Rheumatoid arthritis - T
D.
E.

31. Regarding rheumatoid arthritis

A. associated with HLA- DR4 - T
B. Onset between 20-30 years is associated with poor prognosis
C. Coombs test is positive - ?F, can be positive in SLE, Antiglobulin test can be used
to detect red cells sensitized with IgG alloantibodies, Ig G autoantibodies or
complement components,
Two test, DAT (direct antiglobulin test) and IAT (indirect AT)
Coombs serum= Antihuman globulin

D. Splenomegaly is seen in Felty’s syndrome. - T

E. Causes juxta articular osteoporosis - T

32. Chronic immune thrombocytopenic purpura

A. Commonly causes splenomegaly- F
B.
C.
D.
E. Bone marrow is essential for diagnosis - F

33. Causes of fever with low platelet count

A. Leptospirosis - T
 B. Plasmodium vivax malaria – T, thrombocytopenia as an early indicator for acute
vivax malaria; a finding that is frequent and present even before anaemia and
splenomegaly set in. Occurs in faciparum malaria too, The incidence of
thrombocytopenia was similar in vivax and falciparum malaria, Finding of
thrombocytopenia is of diagnostic help as it raises the suspicion of malaria.
C. Typhoid – T, can be the presenting feature
D. Mycoplasma pneumonia – ? F, commonly cause thrombocytosis, In Community
acquired pneumonias, Q fever and mycoplasma cause thrombocytosis, while
cytomegalovirus, human parainfluenza virus type 3, 2009 influenza A(H1N1),
influenza A(H5N1), severe ARDS, Hantavirus pulmonary syndrome cause
thrombocytopenia: But Mycoplasma can rarely cause Immune thrombocytopenia
E. Infectious mononucleiosis – T, due to transient bone marrow suppression

34. Antipsychotic medications

A. Olanzapine causes metabolic syndrome - T
B. Haloperidol does not cause akathisia- F
C. Clozapine is given in the first episode of schizophrenia -F
D. Resperidone in given to reduce agitation in demented patients -
E.

35. Diabetes mellitus

A. Random blood sugar value of more than 11.1mmol/l on 2 or more occasions is
diagnostic - F
B. Glycosylated haemoglobin is not used for diagnosis - F
C. Fasting blood sugar of more than 6.9mmol/l (130mg) on one occasion is diagnostic
-T
D.
E.

36. Microalbuminuria
A. A value between 30-300mg in 24 hour urine collection – T,
Albuminuria can be measured in several ways
1) measurement of albumin-to-creatinine ratio (ACR) in a random or first morning
spot collection,
2) 24-h urine collection with measurement of creatinine to verify adequacy of the
collection, and
3) timed (4-h or overnight) urine collections
B.
C. Initial finding of incipient nephropathy. T
D. Not necessary to perform if urine dipstick is positive for microalbumin- F
E. Persistent microalbuminuria is associated with atherosclerosis – T,
Microalbuminuria was as potent a risk factor for cardiovascular events as a previous
history of actual cardiovascular disease
The presence of albuminuria is a powerful predictor of renal and cardiovascular risk
in patients with type 2 diabetes and hypertension.
 Physicians should measure urinary albumin excretion in patients with type 2 diabetes
and hypertension routinely and be as aggressive in treating this modifiable risk factor
as they do blood pressure, cholesterol, or blood glucose.

37. Pleural fluid analysis

A. Adenosine deaminase indicates tuberculosis – T, More than 100 IU/L was
exclusively seen in tubercular pleural effusion.
B. Pleural fluid: serum protein >0.5 indicates an exudate - T
C. Pleural fluid: serum LDH <0.6 indicates an exudates- F
D. Pleural glucose <60mg/dl indicates malignancy – ?T, If glucose is <60mg/dl =
Complicated parapneumonic effusion or empyema, tuberculosis (20%), malignancy
(< 10%), rheumatoid arthritis
E. Serum pleural fluid albumin gradient >3.1g/dl indicates transudate – F, albumin
gradient of 1.2 g/dl or less to indicate exudates and greater than 1.2 g/dl to indicate
transudates

38. Long term complications of rheumatoid arthritis

A. Gross proteinuria – T (nephrotic syndrome)
B.
C.
D.
E.

39. An elderly patient sustained head injury and has swelling of the right temporal region.
He became unconscious and his blood pressure is 200/120mmHg, pulse rate is 50/min
and respiratory rate is 36 per minutes. The following are likely in this patient
A. He has Cushings reflex -T
B. He has raised intracranial pressure -T
C. He has an extradural haematoma. -T
D. He has a dilated right pupil. -T
E. His PaCO2 is less than 35mmHg. -T

40.
A.
B.
C.
D.
E.