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MCQs VIA WEB 2005 Medicine MCQS VIA Web Copyright © 2005 Elsevier Limited.

All rights reserved. Fles handbones is a registered trademark of Harcourt, Inc. in the United States and o ther jurisdictions, used under license These mcqs were donloaded By Ahmed Hakim TEST Module4 Question 1. The pulse: (a) In pulsus parad oxus the rate slows during inspiration. (False) (b) Pulsus alternans indicates a poorly functioning left ventricle. (True) (c) A tachycardia of 150 beats per mi nute in a resting patient usually implies an underlying cardiac arrhythmia. (Tru e) (d) A collapsing pulse may be noticed in thyrotoxicosis. (True) (e) Corrigan' s sign supports a diagnosis of aortic stenosis. (False) Question 2. Heart murmur s: (a) A low rumbling diastolic murmur with presystolic accentuation may be hear d in mitral stenosis accompanied by atrial fibrillation. (False) (b) Causes of a pansystolic murmur include mitral regurgitation and ventricular septal defect. (True) (c) A systolic murmur heard over the whole praecordium associated with a thrill usually indicates aortic stenosis. (True) (d) Left heart murmurs are best heard during expiration. (True) (e) An early blowing diastolic murmur at the le ft sternal edge indicates aortic incompetence. (True) Question 3. Pulsus paradox us: (a) The volume of the pulse increases in inspiration. (False) (b) Can be con firmed by detecting >10 mmHg difference in systolic pressure during the breathin g cycle. (True) (c) Is a sign of severe asthma. (True) (d) Is called paradoxus b ecause it is the opposite of what normally happens to the pulse. (False) (e) Can occur in cardiac tamponade. (True) Question 4. The jugulovenous pressure: (a) I s raised if it is 2 cm from the sternal angle with the patient seated at 45°. (Fal se) (b) Tall 'a' waves may be seen in pulmonary hypertension. (True) (c) Irregul ar cannon waves indicate complete heart block. (True) (d) Regular cannon waves m ay indicate a nodal rhythm. (True) (e) Giant 'v' waves and a pulsatile liver ind icate tricuspid stenosis. (False) Question 5. The physical signs of an uncomplic ated large pneumothorax include: (a) The trachea deviated to the opposite side. (False) (b) A clicking sound synchronous with the heart beat. (True) (c) Symmetr ical expansion of the chest. (False) (d) Increased breath sounds over the pneumo thorax. (False) (e) Increased percussion note over the pneumothorax. (True) Ques tion 6. The following would help distinguish between a kidney and a spleen in th e left upper quadrant: (a) Dull to percussion over the mass. (False) (b) A welllocalized notched lower margin. (False) (c) Moves with respiration. (False) (d) A ballottable mass. (True) (e) A family history of renal failure. (True) Questio n 7. Nystagmus: (a) Vertical nystagmus usually indicates a lesion of the medulla oblongata. (False) (b) Horizontal nystagmus is usually ipsilateral to an irrita tive lesion of the labyrinth. (False) (c) Ataxic nystagmus indicates a lesion of the medial longitudinal bundle. (True) (d) May be absent in a lesion of the cer ebellar vermis (the central part). (True) By A. H.

MCQs VIA WEB 2005 (e) Pendular nystagmus may indicate partial blindness. (True) Question 8. The fo llowing would suggest an upper rather than a lower motor neuron lesion: (a) Fasc iculation. (False) (b) Increased tone. (True) (c) An absent plantar reflex. (Fal se) (d) Clonus. (True) (e) Relatively little wasting. (True) Question 9. Hand si gns: (a) Clubbing may be caused by uncomplicated chronic bronchitis. (False) (b) Koilonychia usually indicates liver disease. (False) (c) Osler's nodes and Hebe rden's nodes both occur in osteoarthritis. (False) (d) Splinter haemorrhages are due to embolic rather than immunological phenomena. (False) (e) Psoriatic arthr itis affects most joints in the hand but usually spares the distal interphalange al (DIP) joints. (False) (True) Question 10. The face: (a) A malar flush may ind icate mitral valve disease or hypothyroidism. (True) (b) A butterfly rash in the face is seen in dermatomyositis. (False) (c) Bell's palsy can cause ptosis due to paralysis of orbicularis oculi. (False) (d) Herpes labialis may be associated with pneumococcal pneumonia. (True) (e) An expressionless face and drooling cou ld indicate Parkinson's disease. (True) Question 11. The electrocardiogram: (a) The PR interval is measured from the peak of the P wave to the start of the QRS complex. (False) (b) Right axis deviation is indicated by a QRS axis of -35°. (Fal se) (c) Q waves in S-II, S-III and aVf indicate a transmural inferior myocardial infarction. (True) (d) Left bundle branch block is suggested by broadening of t he QRS complex to 0.10 seconds (two and a half little squares), and positive RSR ' waves in V4-V6. (False) (e) P mitrale is suggested by a P wave taller than 2.5 mm. (False) Question 12. In the full blood count: (a) A haemoglobin of 10.0 g/d L would be considered normal in a premenopausal woman. (False) (b) Polycythaemia rubra vera is usually indicated by elevation not only of the haemoglobin but al so of the white cell count and platelets. (True) (c) A low platelet count could indicate a flare-up of systemic lupus erythematosus (SLE). (True) (d) High plate lets can be seen in gastrointestinal bleeding. (True) (e) A raised mean corpuscu lar volume is usual in significant alcohol excess. (True) Question 13. Heart fai lure: (a) The clinical features of left heart failure include: tachycardia, basa l crepitations, pulsus alternans and a raised JVP. (False) (b) Congestion of the pulmonary veins alone does not result in orthopnoea. (False) (c) Chronic conges tive heart failure leads to secondary hyperaldosteronism. (True) (d) Causes of h eart failure include ischaemic heart disease, hypertension, and thiamine deficie ncy. (True) (e) Clinical features of right heart failure include a raised JVP, a nkle oedema, and hepatomegaly. (True) Question 14. Stroke: (a) Cerebral haemorrh age accounts for more than 40% of acute strokes. (False) (b) In supratentorial s trokes with homonymous hemianopsia, patients cannot see on the hemiplegic side. (True) (c) Vertigo, vomiting, dysphagia, and Horner's syndrome indicate occlusio n of the vertebrobasilar circulation. (True) (d) Pinpoint pupils and bilateral u pgoing plantars could signal a brainstem stroke. (True) (e) Carotid endarterecto my should be considered for patients with more than 70% stenosis because this is more effective than medical treatment. (True) Question 15. Respiratory failure: By A. H.

MCQs VIA WEB 2005 (a) Type I failure results in a partial pressure of oxygen (pO2) <8 kPa and a pa rtial pressure of carbon dioxide (pCO2) of >6.5 kPa. (False) (b) In respiratory failure associated with chronic bronchitis, the level of carbon dioxide (CO2) de termines the respiratory rate. (False) (c) Respiratory failure as defined in (a) would be an indication for ventilation in pure asthma. (True) (d) Doxapram is a respiratory stimulant used in respiratory failure associated with chronic obstr uctive pulmonary disease. (True) (e) The main aim in type II failure is to keep the pO2 >7.0 kPa without worsening of the acidosis or pCO2. (True) Question 16. Cushing's syndrome: (a) May give rise to hypertension, diabetes, and truncal obe sity. (True) (b) Is usually diagnosed by estimation of the urinary free cortisol followed by an overnight dexamethasone suppression test. (True) (c) Could be as sociated with pigmentation. (True) (d) The most common cause is probably iatroge nic. (True) (e) Nelson's syndrome is a complication of bilateral adrenalectomy f or pituitary-dependent Cushing's disease. (True) Question 17. Leukaemia: (a) The common presenting triad is infection, bleeding, and fatigue. (True) (b) Acute myeloid leukaemia (AML) may result spontaneously o r follow on from CML, polycythaemia rubra vera or myelosclerosis. (True) (c) The usual development of chronic lymphocytic leukaemia is a transformation to acute lymphoblastic leukaemia. (False) (d) A platelet count of 40 × 109/L would not nor mally give rise to spontaneous bleeding. (True) (e) Bone marrow transplantation is a recognized treatment for AML. (True) Question 18. Hypertension: (a) An aver age diastolic blood pressure of >90 mmHg over prolonged observation is an indica tion for drug treatment in uncomplicated hypertension. (False) (b) Thiazide diur etics are the least effective antihypertensive drugs. (False) (c) Thiazide diure tics work on the loop of Henle in the kidney. (False) (d) Resistant hypertension is defined as a failure to control the blood pressure adequately with a good th ree-drug regimen. (True) (e) Thiazide diuretics are contraindicated in gout and diabetes. (True) Question 19. Oral corticosteroids: (a) Are an effective treatme nt for SLE. (True) (b) In the long term may cause cataracts. (True) (c) Should b e avoided in sarcoidosis because they induce pulmonary oedema. (False) (d) May b e stopped abruptly after 2 weeks of 40 mg prednisolone daily in patients who are not exposed to repeated courses. (True) (e) May reveal that 15% of patients lab elled as having chronic bronchitis, in fact have reversible airways disease. (Tr ue) Question 20. Paracetamol overdose: (a) Ipecacuana followed by oral methionin e is effective for most patients who are just over the treatment line. (False) ( b) Can cause renal failure. (True) (c) Intravenous N-acetylcysteine frequently c auses anaphylaxis. (False) (d) The serum paracetamol level is of most value betw een 1 and 4 hours after ingestion. (False) (e) In co-proxamol (distalgesic) over dose, sudden death is likely to be due to hypoglycaemia caused by paracetamol. ( False) Question 21. Treatment of myocardial infarction: (a) Aspirin and streptok inase are more effective than either alone after myocardial infarction. (True) ( b) Thrombolysis improves short-term complications but not mortality after myocar dial infarction. (False) By A. H.

(False) (d) ACE inhibi tors improve outcome after myocardial infarction for patients with ventricular d ysfunction. (True) (c) Pneumothora x. (False) (b) May cause xanthopsia. (True) (d) All patients should be assessed by a qualified p sychiatrist. (True) (b) Huntington's chorea. (True) (e) Bacter ial endocarditis. (True) Question 4. (True) Question 23.MCQs VIA WEB 2005 (c) Tissue plasminogen activator and anistreplase are more effective than strept okinase but not used because they are far more expensive. (Tr ue) (d) Adverse effects are reduced by hypokalaemia. The differential diagnosis fo r chest pain includes: (a) Myocardial infarction. For self-poisoning: (a) Gastric lavage is recommended for most drugs up to 12 hours after ingestion . (True) (c) Pyrexia. ( True) (d) Is needed when respiratory failure is diagnosed by finding a pO2 of le ss than 11 kPa in an arterial blood sample. Oxygen: (a) Should be administered with a high in spired concentration (>50%) in the treatment of type II respiratory failure. (Fa lse) (c) Patients with tricyclic antidepressant overdose need cardiac monitoring for up to 48 hours. (True) (e) A cerebr al tumour. (True) (b) Pulmonary embolus. (False) (e) Comprises 21% of atmosph eric air. H. (True) (e) HMGCo-A reductase inhibitor therapy is contraindicated fo r patients after myocardial infarction. Digoxin: (a) Is the treatment of choice for ventricular extrasystol es. (True) (d) Rashes. (False) (e) Must not be coa dministered with an ACE inhibitor. Dementia may result from : (a) Parkinson's disease. (True) (d) Cholecystitis. (False) Question 24. (False) (c) Continuous long-term (domiciliary) oxygen improves survival in patients with respiratory failure caused by chronic bronchitis and emphysema. (True) (e) Aortic dissection. The following are clinical signs found in i nfective endocarditis: (a) Clubbing. (True) (b) Oesophagitis. (True) (d) Acquired immune deficiency syndrome (AIDS). (True) Question 3. (True ) (c) Pulmonary embolus. (False) (b) Naloxone is the specific antidote for benzodiazepine overdose. (False) (e) Pinpoint pupils could indicate opiate overdose. (False) Question 22. (True) Module 5 (Cardiology) Question 2. (True) (c) Hypothyroi dism. (True) (b) Haematuria. (Fa lse) (b) Should not be used at high concentration in patients with pulmonary emb olism because respiration may be severely impaired when the hypoxic drive is red uced. (True) (c) Is excreted by the kidneys. (True) Question 25. . (True) (d) Ventricular or supraventricular tachyarrhythmia. (True) By A. The following are causes of acute life-threatening dyspnoea: (a) Myocardial infarction.

(True) (d) A history of cerebral thromboembolism. The following are signs of coarctation of the a orta: (a) Radiofemoral delay in the pulses. The following are classical features of cardiac syn cope: (a) Gradual onset. (True) (c) Exercise-induced ventricular tachyca rdia. (False) Question 10. (False) (b) Warning symptoms. H. (True) (d) Enlarged left ventricle. (True) (d) Residual neurological deficit. (False) (b) Associat ed mitral stenosis. The following are causes of a pansystol ic murmur: (a) Mitral regurgitation. (True) Question 9. (True) (e) Acute ongoing ventricular tachycardia should be treated initially with drugs. (False) (e) A history of infective en docarditis in the past. (False) Question 7. (False) (d) Hypercholesterolaemia. (True) (b) Rib notching. (False) By A. The following are true of ventricular tachycardia: (a) It is a life-threatening condition. The following conditions require antibiotic prophyl axis before dental procedures: (a) Prosthetic aortic valve. (False) Question 8. (True) (b) Moderate alcohol inta ke. (True) (b) Aortic regurgitation. (False) (c ) Tricuspid regurgitation. (True) (b) Ventricul ar septal defect. (True) (c) Bruits heard over the scapula.MCQs VIA WEB 2005 (e) Focal neurological defect. (True) (e) L eg pain at peak exercise. (False) (e) Precipitated by sudden turning of the head. (True) Question 11. (True) (d) Atrial septal defect. The following are risk factors for ischaemic heart disease: (a) Hypertension. (True) ( b) Exercise-induced hypotension. (True) Question 5. . (False) (c) Rapid recover y. (True) (b) It may be caused by myocardial ischaemia. (False) (c) Female sex. (True) (d ) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardi a. (False) Question 12. (True) Question 6. The following are indications for anticoagulating a patient who has atrial fibrillation with warfarin: (a) Age under 60 years. (False) (e) Aortic s tenosis. (True) (d) Ankle oedema. (True) (c) It may be caused by hypokalaemia. The following should be considered as possible signs of a positive exercise test: (a) ST segment depression. (True) (c) Atrial fibrillation of more than 24 hours' durati on. (True) (c) Floppy mitral valve with coexistent mitral regurgit ation. (True) (d) Lack of adequate tachycardic response to exercise. (True) (e) Increa sing age. (True) (e) Associated left ventricular failure.

Cardiac causes of clubbing are as follows: (a) Uncomplicated at rial septal defect. (False) (e) Need for anticoagulation in patients who have porcine valves . (Fal se) (e) II. The following statements are true of the apex beat: (a) It is the lowest and most lateral point at which the cardiac impulse can be felt. (True) (b) They may c ause gout.MCQs VIA WEB 2005 (e) Atrial fibrillation. (False) Question 14. (False) (d) Pregnancy. and V6. (False) Question 16. (True) (d) Hypokalaemia may occur. (False) Question 13. (False) (d) V1-V6. (False) (e) Empyema. (False) (c) AVR and V1. (True) (b) It is displaced downwards and laterally if the left ventricle i s enlarged. (True) (d) To maintain a straight airway. The following statements are true of thiazide diuretics: (a) They act at the level of the distal convoluted tubule. (True) (c) It is thrusting in mitral stenosis. (True) (c) Diabetic control may deteriorate. (True) (d) Failure of the valve 5 years after pla cement. (False) Question 15. Complications of prosthetic heart valves are as follows: (a) Thromb oembolic events. and AVF. (True) (e) It is heaving in aortic stenosis. (True) By A. Functions of the recovery position include: (a) To prevent the tongue from obstructing the airway. (False) (d) Dehydration. . (False) (c) To minimize the risk of aspiration of gastric co ntents. (True) Question 18. (True) (b) To p revent neck injury. V3. (True) (c) Hypertension. III. (T rue) (c) Hypothyroidism. H. The following are possible causes of electromechanical dissociation: (a) Pulmonary embolus. (False) Que stion 19. (False) (d) It is thr usting in aortic regurgitation. (True) (e) Arteriovenous malform ations. (True) (e) To enable cardiopul monary resuscitation to be carried out. The following are classified as high-output states: (a) Hypertension . (True) (c) Increased r isk of infective endocarditis. (True) Question 20. (False) (b) V2. and V4. (True) (b) Dehiscence of the valve ring. (True) (e) They cause ototoxicity. (False) (b) Chronic infective endocarditis. (False) (b) Sepsis. (True) (c) Atria l fibrillation. (True) (b) Tension pne umothorax. (False) (d) Acute endocarditis. AVL. (Tr ue) Question 17. The following leads represent the inferior myocardium: (a) I.

(False) Q uestion 25. (False) (e) The spinal cord ends at the level of the lower border of L3 in the adult. (True) (b) Renal cell carcinoma. The following drugs are used in the treatment of hypertension: (a) Atenolol. the following suggest a diagnosis of multiple sclerosis: (a) Delayed visual evoked potentials. (False) Module 6 (Neurolog y) Question 1. Concerning neuroanatomy: (a) The corticospinal tract decussates i n the pons. (True) (e) Gastrointestinal bleed. (True) (e) Oral contraceptive pill. Subdural haematomas can cause: (a) Dementi a. (True) (c) Cerebrovascular event. (False) (b) There may be an assoc iated pericardial effusion. (True) (b) Doxazocin. (True) Question 23. . In a young woman with a spastic paraparesis. (True) (d) The trochlear (fouth cranial) nerve supplies the lateral rec tus muscle. (True) (c) The pericardial rub may come and go. The following are characteristic of peric arditis: (a) The chest pain is dull in nature. (True) (b) Mitral regurgitation. (False) (c) Cushing's syndrome. (True) (e) Q waves.MCQs VIA WEB 2005 (e) Hypocalcaemia. ECG c hanges due to myocardial infarction may include the following: (a) ST elevation. (False) Question 2. (True) (d) Bendrofluazide. (False) Question 3. (False) (e) The ST elevation is concave. (True) Question 22. (Tru e) (d) The ECG usually shows regional ST elevation. (Tr ue) (d) Pregnancy. (True) (c) Bradycardia. (True) (c) The superior colliculus is found in the m idbrain. Secondary hypertension may be due to the following: (a) Renal arter y stenosis. (True) ( b) Fasciculations. (True) (d) M yocardial rupture. (True) (b) Pupillary change. ( True) (c) Enalapril. (True) (e) Nicorandil. (True) Question 21. (True) Question 24. (False) By A. (False) (b) The oculomotor nerve runs in close proximity to the post erior communicating artery. (True) (b) Sinus tachycardia. H. Complications of myocardial infarction include: (a) Cardiac failure. (True) (c) Ventricular tachycardia. (True) (d) Co mplete heart block. (True) (e) Blood-stained cerebrospinal fluid (CSF). (True) (d) Changing leve l of consciousness.

Concerning the brachial plexus: (a) In brachial neuritis. (True) (b) Myoclonus is a feature of subacute sclerosing panencephalitis. (False) (c) Erb's palsy is cause d by a lesion to C5/C6-derived regions of the brachial plexus. Unilateral facial weakness is a recognized feature of: (a ) Herpes zoster infection. The following are true about headaches: (a) The headache of raised intracrania l pressure is worst at the end of the day. (True) (e) It is a recognized featu re in Guillain-Barré syndrome. (True) (d) Neurological signs on examination rules out migraine as a diagnosis. Concerning the Brown-Séquard syndrome: (a) T here is ipsilateral corticospinal loss below the lesion. (False) (e) A central disc lesion at L3 would cause a Brown-Séquard syndrome i n the legs. (True) (b) Horner's syndrome. (False) (b) A normal CT scan rules ou t subarachnoid haemorrhage. (True) (e) M yasthenia gravis. (True) ( d) There is ipsilateral loss of pain and temperature below the level of the lesi on. (False) Question 11.MCQs VIA WEB 2005 (c) Raised CSF protein. (Tr ue) (d) Hypocalcaemia is a recognized cause. (False) (e) Alco hol reduces benign essential tremor. Concerning papilloedema: (a) There is loss of venous pulsation on funduscopy. (True) (e) Per iventricular white matter lesions on magnetic resonance imaging (MRI) of the bra in. (False) (c) Acoustic neuroma. (True) (b) There is ips ilateral loss of joint-position sense below the lesion. (True) (e) Haloperidol. (True) Question 9. (True) Question 6. The following drugs can produce parkinsonism: (a) Chlorproma zine. (True) (b) There may be en largement of the blind spot. severe pain around the shoulder precedes rapid wasting. (True) (b) Benzhexol. (True) By A. (Fa lse) (d) Chorea is commonly found in Cruetzfeldt-Jakob disease. (True) (c) There is ipsi lateral loss of two-point discrimination below the level of the lesion. (True) Question 8. (False) (d) Oculomotor nerve (third nerve) palsy. (True) Question 7. (False) (c) Bromocriptine. Concerning movement disorders: (a) Huntington's chorea presents with progressive dementia and chorea in middle age . Ptosis may be a feature of: (a) Myotonic dystrophy. (True) Question 4. (True) (c) Abducens nerve (six th nerve ) palsy. (False) (d) Metoclopramid e. (True) (b) Motor neuron disease. H. (False) (e) Cluster headaches are more common in men than in women. (True) Question 10. (True) (d) Cholesteatoma. (Tru e) (c) Infarction of the subthalamic nucleus causes ipsilateral hemiballism. . (True) (b) Kl umpke's paralysis causes proximal arm weakness. (False) Question 5 . (False) (d) Oligoclonal bands in the CSF. (False) (c) Amaurosis fugax may be caused by tempora l arteritis. (True) (e) Syringomyelia. (True) (c) Intracranial pressure may be normal.

(True) (c) Weakness of plantar flexion . (True) (c) The o ptic chiasm. A homonymous hemianopia may arise from a l esion of: (a) The optic tract. (True) (c) Renal failure. (True) (b) Decreas ed sensation over the dorsum of the foot. .MCQs VIA WEB 2005 (d) A brachial plexus lesion and an ipsilateral Horner's syndrome may indicate a Pancoast tumour. (False) (e) The optic radiation. (False) (d) The optic nerve. (True) (e) Vaccination may precipitate brachial neuritis. (True) (d) The basal gang lia. The following are features of a subarachnoid haemorrhage: (a) Fever. (False) Question 19. (True) (b) Convulsive movements of the limbs. (True) (e) Brisk ankle jerk. (True) (b) Gui llain-Barré syndrome. (False) (b) Absent corneal reflexes. (False) (c) The hypoglossal nerve. (True) (c) Dysphasia. (True) (c) Photophobia. (True) (e) The accessory nerve. (True) (d) P ositive Kernig's sign. (False) Question 13. The following are clin ical features of cerebellar dysfunction (a) Postural tremor. A lesion to the common peroneal nerve at t he fibular head causes: (a) Weakness of eversion of the foot. (True ) (b) Broca's area. (Tru e) Question 12. (False) (d) If long term. (True) (b) The occipital cortex. Brainstem death may be confirmed by: (a) Extensor re sponse of the limbs to painful stimuli. (False) (b) Hypoton ia. Dysarthria may result from a lesion of: (a) The cerebellum. (True) (d) Amyloid. (False) (d) A flat EEG. wasting of tibialis anterior. (False) (e) Absent 'doll 's eye' reflexes. (True) (e) Impaired rapid alte ring movements. The following clinical features may help dif ferentiate between a syncopal attack and a seizure: (a) Upright posture at the o nset. H. (False) (d) Titubation. (True) (e) Prolonged malaise after the attack. (True) (b) Thunderclap headache. (True) (e) Mul tiple sclerosis. (True) Question 18. (True) (d) Urinary incontinence. Causes of a polyneuropathy include: (a) Diabetes. (True ) Question 16. (False) Question 17. (Tr ue) (c) Absent tendon reflexes. (False) Question 14. (True) By A. (True) Question 15. (False) (c) A bitten tongue.

The following statements are true: (a) Tylosis is associated with achalasia. (False) (c) It is a premalignant condition. (True) (d) Sever e dysplasia is an ominous sign. (True) Question 20. a 'bird's beak' appearance is suggestive of squamous carcinoma. (True) (d) Reduced lower oesophageal sphincter pressure is a common feature of gastro-oesophageal reflux disease . A physiological tremor is: (a) Present a t rest. (False) Question 22. (True) (e) Contralate ral third nerve palsy. (True) Question 23 . (False) ( b) Diplopia. (True) (d) Altered perception of taste. (False) Question 24. A dissociated sensor y loss may be seen in: (a) Syringomyelia. . H. (True) (e) Familial. (False) Module 7 (Gastroeneterology) Question 1. (False) (d) Contralateral weakness of the tongue. (True) (c) Diplopia in all positions of gaze. (True) (c) Ipsilateral weakness of the palate. (False) (c) P neumatic dilatation is the treatment of choice for achalasia.MCQs VIA WEB 2005 (e) Neck stiffness. (False) Question 21. (True) (d) A history of alcohol abuse may be implicat ed in the aetiology. The following may be seen in a patie nt with a lesion of the third nerve or nucleus: (a) A fixed dilated pupil. (True) Question 25. (False) (c) Rombe rg's test may be positive. (False) (d) Improved by beta-blockers. A patient with herpes zoster infection of the geniculate ganglion may present with: (a) An upper motor neuron facial weakness. (True) By A. (True) (c) Improved by alcohol. (True) (b) The gait is characterized by 'scissoring' posture of the legs. (False) (b) Worsened by anxiety. (False) (e) Compression of the spinal cord by a prolapsed intervertebral disc. (True ) (b) Ptosis. (False) (d) Occlusion of a middle cerebral a rtery. The following is true of Barrett's oesophagus: (a) Columnar epithelium is replaced by squamous epithelium. (False) (b) On barium swallo w. (True) (e) Clonus may be elicited on examination of the leg s. (False) (c) Hyperacusis. A lesi on of the medulla on one side may give rise to : (a) An ipsilateral hemiparesis. (False) Quest ion 2. (False) (b) It appears in an antegrade (top to bottom) direction. (True) (b) Anterior spinal artery occl usion. (False) (b) A contralateral hemiparesis. (False) (c) A radiculopathy. (True) (d) A history of diabetes mellitus. (True) (e) A contralateral hemiplegia. (T rue) (e) Pain from the auditory meatus. (True) (e) Oesophageal pH is usually less than 4. In a patient with a sensory ataxia: (a) Vibration may be impaired.

(True) (e) Commonly presents with bloody diarrhoea. (True) (c) More commo nly occurs in smokers. (True) (c) I s a feature of generalized scleroderma (systemic sclerosis). The following drugs cause jaundice: ( a) Methotrexate. (True) (d) Occasion ally responds to erythromycin. (False) (b) Flucloxacillin. (False) (c) Diarrhoea requires treatment with metronidazole. (True) (d) Can result in vitamin B12 deficiency with a ne gative Schilling test. (False) (e) Hepatitis D occurs only in associat ion with hepatitis C. (False) (e) Diarrhoea commonly results in vitamin B12 deficiency. The following is true of giardiasis: (a) Diarrhoea abates with av oidance of dairy produce. The following is true of viral hepatitis: (a) Hepatitis C commonly presents w ith jaundice. (True) (e) Can convert urea to ammonia and carbon dioxide. (False) Question 5. (True) ( b) Causes Barrett's metaplasia in the oesophagus. (True) (b) Hypercalcaemia. (True) (b) Is a risk factor for gastro-oesophageal reflux disease. (False) Question 6. (True) (c) Metronidazole. (True) Question 4. Gastric hypomotility (gastroparesis): (a) Is commonly associated with diabetes mellitus. (Fals e) Question 7. H. (False) (c) It is occasionally co mplicated by carcinoma of the caecum. (False) (b) Hepatitis E is fatal particularly in pregnant women. The following is true of Crohn's disease: (a) The rectum is always affected. (True) Question 3. (False) (b) Small bowel barium enema is the best radi ological investigation for ulcerative colitis. (True) (d) Is often resistant to certain antibiotics. (True) Question 9. (False) (c) Is associated with hypergastrinaemia. (False) (b) Commonly affects the terminal ileum. (True) (d) Diarrho ea is usually accompanied by vomiting.MCQs VIA WEB 2005 (e) It is an indication for surveillance endoscopy. (False) Question 10. . The following are features of coeliac disease: (a) H ypocalcaemia. (True) (e) Is often secondary to duodenal ulcer d isease. (False) (e) It is sometimes complicated by iritis. Helicobacter pylori: (a) Causes ulceration in the duodenum. (False) (b) Diarrhoea abates with avoidance of gluten. (True) (d) It is commonly associated with thyroiditis. (True) (e) Positive antiparietal cell antibodies. (False) (d) Hypoalbuminaemia. (False) ( d) Isoniazid. (True) By A. (False) (c) Normocytic anaemia. (True) (d) Hepatitis A is a risk factor for hepatoma. ( True) (c) Hepatitis BeAg is a marker of viral replication. The following is true of inflammato ry bowel disease: (a) Increased liver enzymes in the serum usually indicate the complication of carcinoma. (False) Question 8.

it may cause a rise in serum folate. (True) (c) Vomiting associated with weight loss can b e indicative of malignant disease. (True) (c) It can be associated with Giardi la mblia. The following gastrointestinal diseases are associate d with the renal conditions listed: (a) Crohn's disease and renal amyloidosis. Scleroderma can produce the gastrointestinal complication s listed: (a) Diarrhoea due to bacterial overgrowth. Colonic carcinoma: (a) Mo st commonly occurs in the right side of the colon. (True) (b) Constipation due to gut hypomotility. . (True) (d) Vomiting usually precedes the pain of biliary colic. (False) (e) Vomiting can be a feature of myocardial infarctio n. (False) (e) Is the cause of carcinoid syndrome. (True) (d) It can be associated with Tropheryma whippelei. (False) (b) May present with iron deficiency anaemia in the absence of any gastrointestinal symptoms. the greater the risk of carcinoma. (False) (e) Liver cysts and glomerulosclerosis. (True) (b) It can be caused by tuberculosis. (True) (d) Gastric ulcer due to chronic gastritis. (False) (e) Can cause hypogon adism in the absence of cirrhosis. (True) (b) Pruritus with primary biliary cirrhosis. (False) (c) Diarrhoea which is unresponsive to a gluten-fr ee diet. (False) (b) Vomiting in association with headache is a feature of migraine. (False) Question 15. (True) Question 17. (False) (d) Pancreatic neuroendocrine tumours and polycystic kidn ey disease. (False) (b) Is a risk factor for the development of hepatoma. The following is true of colon polyps and colon cancer: (a) The larger the po lyp. (False) (d) Polyps a re most common in the ascending colon. ( True) (b) Hepatitis B and glomerulonephritis. (False) By A. (True Question 16. (Fal se) (d) Bullous pemphigoid with pancreatitis. (True) (c) Has an equal sex incidence but presents earlier in males than females . (True) Question 14. The following is true of villous atrophy in the small intestine: (a) If due to coeliac disease. (False) Question 1 3. (True) (d) Carries a 5-year survival of l ess than 10%. it should recover completely on a gluten-free diet. The following skin conditions are associated with the named GI diseases: (a) Dermatitis herpetiformis with coeliac disease. Haemochromatosis: (a) Is a genetic defect resulting in copper overl oad in the liver. (True) (c) Pyoderma gangrenosum with gastric carcinoma. H. The following statements are true in relati on to vomiting: (a) Vomiting occurring 12 hours after a suspicious meal is indic ative of Salmonella poisoning. (True) (d) Is treated by avoiding meat products. (True) (e) Whe n associated with bacteria. (True) (c) Gastric ulcer and nephr otic syndrome.MCQs VIA WEB 2005 (e) Phenobarbitone. (False) Question 11. (False) (e) Erythema nodosum with Crohn's disease. (True) (c) Commonly arises in colonic polyps. (False) (e) Colonic polyps are often recu rrent. (True) (b) Malignant polyps can be succe ssfully treated by colonoscopy and polypectomy alone. (True) Question 18. (True) Question 12. (True) (c) Hyperplastic po lyps have a higher malignant potential than villous polyps.

(False) (c) Fistula formation can be a feature of Whipple's disease. (True) (e) Constrictive pericarditis. (False) Question 23. (False) (b) A vacc ine is available for hepatitis C.MCQs VIA WEB 2005 (e) Dysphagia due to abnormal peristalsis in the oesophagus. (False) (d) Polycythaemia ru bra vera. The following are true of he patitis: (a) Hepatitis B is spread via the faecal-oral route. (True) Question 19. (True) (c) Ascites. (False) (b) Crypt abscesses are typical of coeliac disease. The followi ng are true regarding prognostic factors for acute pancreatitis: (a) A low pAO2 indicates a poor prognosis. (True) (b) Malignancy. (True) Question 21. (False) (e) Right iliac fossa pain is com mon with diverticular disease. H. (True) Module 9 (Gastroenterology) Question 1. Chronic pancreatitis: (a) Is a cause of diabetes mellitus. (True) (d) Can be diagnosed by a raised serum amy lase. . (True) (e) Abnormal clotting time has a poor prognosis. (True) (b) A high serum GGT has a poor prognosis. (True) (c) May be here ditary in a minority of cases. (False) (e) Is a cause of pancreas divisum. (True) (d) Helicobacter pylo ri infection. (True) By A. (True) (d) Hepatitis B is an RNA virus. (False) (d) Wh en it is due to diverticular disease. (True) Question 22. (False) (c) Partial gastrectomy. (False) (c) If it occurs in a patient with ulcer ative colitis. (True) (e) It may be caused by ingestion of aspirin. The following state ments are true: (a) Solitary rectal ulcers are commonly associated with Crohn's disease. (False) (b) It occurs more commonly in Crohn's dise ase than in ulcerative colitis. colectomy may be indicated to control it. (True) (b ) Coeliac disease. (False) (d) Anal fissu re predisposes to faecal incontinence. (F alse) (c) Age of over 55 years usually has a good prognosis. (False) (e) In terferon treatment is required for hepatitis E infection. (False) Question 24. it usually indicates that carcinoma has developed. (False) Question 25. (False) Question 20. (True) ( b) Can result from alcohol ingestion in moderate amounts. T he following is a risk factor for the Budd-Chiari syndrome: (a) Oral contracepti ve pill. (True) (c) It can be relie ved by glyceryl trinitrate. The follo wing is true of rectal bleeding: (a) In the absence of haemorrhoids. it is usual ly due to malignant disease. (True) (b) It can mimic the pain of a myocardial infarction. The fol lowing are risk factors for gastric carcinoma: (a) Pernicious anaemia. (False) (c) Incubation time for hepatitis A is approximately 2-3 weeks. (True) (e) Ménétrière's disease. (False) (d) A low s erum albumin indicates a poor prognosis. The following is true of oesophageal pain: (a) It can occur in the absence of heartburn.

(False) (b) It can be associated with ankylosing spondylitis . . (True) (c) It is a risk factor for toxic dilatation of the colon. (False) Question 4. (True) (e) Diarrhoea is commonly due to bacterial overgro wth. (True) (e) It often ca uses ischiorectal abscesses. (True) (d) Hepatitis A is a risk factor. (True) (c) Leiomyoma has a characteristic appearance at endo scopy. (True) (d) Anaemia associated with chron ic atrophic gastritis may respond to ascorbic acid supplements. (True) (b) The risk of gastric cancer in the long term is increased. (True) (b) Normal album in indicates remission. The following statements are true: (a) Iron absorptio n is reduced in hypochlorhydric states. The following is true of Crohn's disea se: (a) C-reactive protein mimics inflammatory activity. (True) (d) T he occurrence of abdominal tenderness is an ominous sign. (False) (d) A small bowel biopsy can be helpful in making the diagnosis. The following is true of risk factors for the developm ent of hepatocellular carcinoma: (a) Females are at greater risk than males. (True) (d) Is associated with pale-coloured stools. (False) Question 6. The following is true of neoplastic disease in the stoma ch: (a) Maltoma can occasionally respond to antibiotic treatment in combination with a proton pump inhibitor. (False) By A. (True) (b) Vitamin D absorption is often deficient in the presence of gastritis. (True) Question 7. (True) Question 3. The fo llowing is true of ulcerative colitis: (a) It commonly presents with pain in the right iliac fossa. The following is true of postgastrectomy syndromes: (a) The anaemia can be corrected with ascorbic acid supplements. The following clinical features are associated with coeliac disease: (a) Anaemia. (True) (b) Weight loss. (True) (c) Sweating and pa lpitations can be due to hypoglycaemia. (True) (c) Vomiting. (False) (e) It can be caused by cand idiasis. (False) (c) Large bowel barium enema is the most definit ive radiological test. (False) Question 9. (False) (b) Is a feature of Gilbert's disease. (True) (e) The most common gastric carcinoma is of squamous cell o rigin. (True) (d) Biliary gastritis in the gast ric remnant is common. (True) (e) Jaundice. (True) (c) Can occur in hereditary spherocytosis. (True) Question 2. (False) (c) Vitamin B12 supplements are often necessary following gastrectomy. H.MCQs VIA WEB 2005 (d) It is usually precipitated by exercise. (Fa lse) (b) Excess iron is a recognized risk factor. (True) (e) Intes tinal metaplasia in the stomach is a risk factor for gastric carcinoma. (True) (d) Gastric carcinoma produces abdominal pain that is often worse after eating. (True) Q uestion 5. (True) (e) A low blood urea is common. Acholuric jaundice without pain : (a) Is a common presentation of pancreatic carcinoma. (True) (b) Ménétrière's disease is due to metaplasia of the gastric mucosa. (False) (e) Is associated with prur itus. (False) (d) Diarrhoea. (True) (c) Aflatoxin is a risk factor. (False) Question 8.

(True) (b) Anti-LKM antibodies are associated wit h Goodpasture syndrome.MCQs VIA WEB 2005 (e) Risk factors generally only operate in the presence of cirrhosis. (False) Question 14. (True) Question 16. (False) (b) Is a risk factor for hepatorenal syndrome. Primary sclerosing cholangitis: (a) Occurs predominantly in middle-aged fem ales. (False) (b) Anky lostoma duodenale. (False) (c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True) (b) The 14C glycocholic acid breath test is used to detect bacterial overgrowth in the colon. (True) Question 10. (True) (b) 'Anchovy sauce' dischar ge with amoebic dysentry. . (True) (c) Caseating granulomas in the terminal ileum are diagnostic of Crohn's disease. (False) (d) Has been treated with ur sodeoxycholic acid. (T rue) (d) 'Apple core' lesion and diverticulitis. (True) Question 13. (True) (e) A 14C bile salt test can be used to identify bile duct obstruction. (False) (e) Encephalopathy occurs only if infection is present. (False) (c) 'Redcurrent jelly' and intussusception. The following autoantibodi es are associated with the diseases listed: (a) Antiendomyseal antibodies are as sociated with coeliac disease. The following GI conditions are associated with microcytic hypochromic anaemia: (a) Acute duodenal ulceration. ( False) (d) Colitis in a smoker is more likely to be Crohn's than ulcerative coli tis. The following is true of breath test s used for investigation of the gastrointestinal tract: (a) The 14C urea breath test detects Helicobacter pylori infection. (False) (b) Rectal sparing is characteristic of Crohn's colitis. (True) (d) Coagulopathy is corrected with administration of vitamin K. (False) (b) Is a major risk factor for cholangiocarcinoma. The followin g statements are true of colitis: (a) Granulomas are present in collagenous coli tis. (False) (b) Ascites resistant to d iuretics is characteristic of hepatic vein thrombosis. (True) By A. The following statements are true of ascites: (a) A high protein content in ascites is usual in alcoholic liver disease. (True) Question 12. (False) (e) 'Coffee grounds' an d oesophageal varices. (True) (d ) Partial gastrectomy. These gastronomic terms are associated with the following gastroenterological conditi ons: (a) 'Rice water' diarrhoea with cholera. (False) Question 11. Alcoholic hepatitis: (a) Recovers rapidly on cessation of drinking. (False) (c) A h ydrogen breath test following ingestion of lactulose is used to detect bacterial overgrowth in the small intestine. (True) (d) A lactose breath test is used to detect disaccharidase deficiency. (True) (e) May require insertion of an endoprosthesis for it s treatment. (True) (e) Pain is a characteristic feature of CMV colitis. (True) (c) Ascites is a feature. (True) (d) Antiparietal cell antibodies are asso ciated with Wilson's disease. (True) (e) Carcinoma of caecum. (True) (c) Occu rs in 50% patients with ulcerative colitis. (False) (e) Antismooth muscle antibodies are assoc iated with autoimmune chronic active hepatitis. H. (True) Question 17. (True) (c) Terminal ileitis due to Crohn's disease. (False) Question 15. (True) (c) Ascites is som etimes associated with a pleural effusion.

The fo llowing is true of pancreatic tumours: (a) Jaundice occurs only when carcinoma i s present in the tail of pancreas. (False) (b) Presence of diabetes mellitus ind icates that the tumour is of neuroendocrine origin. (True) Quest ion 22. (False) (d) When it occurs after repeated retching. (False) By A. (True) (e) Vitamin K. (False) Question 18. it is always due to oesophageal varices. The following drugs can be u sed for treatment of GORD: (a) Metronidazole. (False) (b) Amoxycillin. (False) (d) Vitamin D. (False) (c) Gastrointestinal bleeding.MCQs VIA WEB 2005 (d) Ascites is a risk factor for bacterial peritonitis. (True ) (d) Use of opioid drugs. (True) (d) They cause gastric erosions by stimulating gastric acid secretion. The following precipitate portasystemic encephalopathy: ( a) Infection. (False) ( c) Erythromycin. (True) (e) Omeprazole. (False) (b) Ison iazid. (True) (b) Pyrexia of unknown origin with normal liver enzymes. (True) (b) Diarrhoea. (False) (c) They are general ly unresponsive to chemotherapy. (False) Question 20. (True) (c) They can produce gastric erosions in elderly people causing occult blood loss. usually indicates malign ancy. (True) (d) Raised alkaline phosphatase in teenagers with acholuric jaun dice. (True) (c) When it occurs i n patients over 70 years of age who may have arthritis. (False) Question 25. (True) Question 19. it is suggestive of an oesophageal tear. H. Which of the following is dependent on bile salts for its absorption: (a ) Vitamin A. (True) (e) When it is caused by duodenal ulcer. The following drugs cause cholestatic jaundice: (a) Rifampicin. The following statements are true of non-steroidal anti-inflammatory drugs: (a) They can be given as suppositories to avoid gastrointestinal complications. (False) (d) Metoclopramide. (True) (b) Vitamin B. (True) (e) They occur with increased frequ ency in patients with ulcerative colitis. (False) (b) They may have a role in the prevention of colon cancer. (True) (d) Halothane. The following is true of haematemesis: (a) When it occurs in a patient with alcoholic liver disea se. (False) (b) A visible vessel seen a t gastroscopy is a risk factor for further bleeding. . (False) (c) Vitamin C. a partial gas trectomy is usually necessary. (False) (e) Abnormal liver enzymes in a patient with epilepsy on phenytoin . (True) (e) Ascites due t o constrictive pericarditis prevents pulsus paradoxus. (False) (e) They may exacerbate long-standing ulcerative colitis. (False) Question 21. (False) Question 24. (True) (e) Certain antibiotics. The following are indications for liv er biopsy: (a) Unexplained abnormal liver enzymes. (True) (d) They characteristically produce back pain when local invasion is present. (True) (c) Cirrhosis suspected on an ultrasou nd scan. (True) Question 23. (False) (c) Erythromycin.

Myasthenia gravis: (a) Is caused by antibodies to the acetylcholine receptor in the majority of cases. (True) (b) Guillain-Barré syndrome. Bilateral lower motor neuron facial weakness may occur in: (a) Sarcoidosis. (False) (c) Associated pill-rolling tremor. (True) Question 8. (True) (b) Trigeminal. (Fal se) (e) May present with ophthalmoplegia. (False) (c) Syringomyelia. (False) Question 6. (True) Question 2. Causes of a small pupil include: (a) Horner's syndrome. The following features suggest that increased tone is due t o rigidity: (a) Tone is increased equally in flexors and extensors. (True) (e) Parasagittal meningiom a. (False) (c) May show diurnal variation in symptom s. (Fal se) (b) Multiple sclerosis. (True) (b) Holmes-A die syndrome. (False) (e) Vagus. (Tr ue) (b) Causes muscle wasting. (False) (e) Tone increases with synkinesis. (True) Questio n 7. In idiopathic Parkinson's disease: (a) There is degenerat ion primarily of the cells of the globus pallidus. The following cranial nerves carry parasympath etic fibres: (a) Oculomotor. (False) (c) Tabes dorsalis. (False) (c) Facial. (True) (e) Treatment is aimed at reducing dopamine levels. . (True) (d) Motor neuron d isease. bradykinesia. (True) Question 3. (True) Question 4. (False) Question 5. (True) (c) Lyme disease. (True) (b) E xtensor plantar responses. (False) (b) The classical fea tures include tremor. (True) (e) Taboparesis. (True) (d ) Clasp-knife reflex. (False) Module 10 (Neurology) Question 1. (True) By A. (True) (d) Optic neuritis. and spasticity. (True) ( d) Hypoglossal. (True) (d) Is associated with an improvement in strength after exertion. (False) (c) There is an asso ciated vertical gaze palsy. (False) (b) White-matter abnormalities on MR imaging increase the likelihood of developing multiple sclerosis in the future. Concerning optic neuritis: (a) Visual loss is usually painless. (False) (e) Pilocarpine eye-drops. (True) (d) Lymphoma. The causes of a mix ed upper and lower motor neuron picture include: (a) Guillain-Barré syndrome. H. (False) (d) Anticholinergic drugs are most effective in relieving tremor.MCQs VIA WEB 2005 (e) Paracetamol.

(False) Question 14. (False) (d) Antibiotic therapy. (True) (c) Electro myography shows chronic partial denervation. (True) (d) May affect the shoulders in syringomyelia. Th e following are causes of acute transient visual impairment: (a) Retinitis pigme ntosa. (True) By A. (True) (e) Panco ast tumour. (True) (b) Social disinhibition. (True) (c) Papilloedema. (False) Question 12 . (False) Question 10. (False) (b ) There may be atrophy of the Betz cells in the motor cortex. (False) Question 16. (False) (c) Seizures. (True) (d) Migraino us aura. (True) Question 11. (False) (e) Lead poisoning. Hyposmia may arise sec ondary to: (a) A head injury. (True) (e) A frontal meningioma. (True) (e) Familial cases account for 50%. (True ) (d) Over 90% of patients with a history of optic neuritis go on to develop mul tiple sclerosis. (True) (d ) Brisk reflexes. The following may be features of frontal lobe dysfunction: (a) Depression. (True) (c) Motor neuron dis ease. (Tru e) Question 9. (False) (e) Gastric dilatation. (True) Question 15. (True) (b) Are often painful. (False) (c) May be ca used by neurosyphilis. (False) (c) Polyarteritis nodosa. The following typically occur within the first 24 hours of complete cervical cord transection: (a) Upgoing plantar responses. (True) (d) There should be no signs of sensory loss. Charcot joints: (a) May affect the feet in diabetes. (Tr ue) (e) Are usually hot and swollen. (False) (b) Amaurosis fugax. (True) (c) Loss of bladder control. (False) (e) It causes a delay in visual evoked potentials. (True) (b) Diabetes. H. (True) (d) Guillain-Barré sy ndrome.MCQs VIA WEB 2005 (c) After recovery. . (False) (d) Herniation of the uncus of the temporal lobe. ( True) (c) Apraxia of gait. Causes of a mononeuropathy include: (a) Diabetes. (True) Question 13. (True) (b) Migraine. ( False) (b) Fall in blood pressure. The following may cause a third nerve palsy: (a) Aneurysm of the posterior communicating artery. (True) (e) Glaucoma. In motor n euron disease: (a) Fasciculations are required to make the diagnosis. some impairment of red-green colour vision may remain. (True) (b) Hereditary motor sensory neuropathy.

(False) (b) Elderly patients. (False) (d) A pseudobulbar dysarthria. (False) (b) Sy ringobulbia. (True) (e) Otosclero sis. (True) (d) Te rminally ill patients taking morphine for analgesia. (False) By A. (True) Question 24. Nystagmus may be seen in: (a) A patient with an internucle ar ophthalmoplegia. (False) (b) Shock-like assymetrical and irregular. Facial sensory loss may occur with a lesion of: (a) The cerebellopontine angle. (False) (c) Brief. (False) (e) Rhythmical and oscillatory. (True) (d) An acoustic neuroma. (True) (c) Horner's syndrome. (False) (e) Multiple sclerosis. (True) (e) A lesion of the foramen magnum. (False) Question 20. (False) (d) Occlusion of the anter ior cerebral artery. (True) (b) The facial nerve. (False) (c) Huntington's chorea. (False) (c) Ipsilateral weakness of th e lower face. (True) (b) A lesion of the pons. (False) (e) A grasp reflex. (False) (c) Weakness of individual muscles. Sensorineura l deafness may occur secondary to: (a) Loud noise. (False) (b) An ipsilateral hemiparesis. (True) (c) A patient who is blind. (False) (d) Hypotonia. (False) Question 22. H. (True) (b) Gentamicin therapy . (True) Question 17. Choreic movements are: (a) Slow and writhing. (False) (b) Wasted muscles. (True) Question 23. (False) (e) Fatiguable muscle stre ngth. (True) (c) Ménière's disease. A small pupil may be seen in: (a) A lesion in the mid brain. The f ollowing may give rise to a pseudobulbar palsy (a) Poliomyelitis. (True) Question 18.MCQs VIA WEB 2005 (d) A receptive dysphasia. (True) (d) The Genicu late ganglion. (True) (e) A pontine lesion . (True) (d) A patient with cerebellar dysfunction. jerky and irregula r. . (False) (e) The cavernous sinus. (False) (c) The Gausserian ganglion. (True) (d) A sign of restlessness. Features of an upper motor neuron lesion are: (a) Brisk abdom inal and cremasteric reflexes. Clinical features of a unilateral lesio n of the cerebellopontine angle may be: (a) Conductive deafness on the same side . (True) Question 19. (F alse) Question 21.

(True) (e) Are spared following occlusion of the an terior spinal artery. (False) (c) Are affected in the deficiency of vitamin B12. Insertion of a prosthetic heart valve i nto a drug addict is very likely to lead to prosthetic valve endocarditis subseq uently because of their continuing habit. Second. Treatment of e ndocarditis: · Intravenous antibiotics for 6 weeks are necessary to cure viridans type streptococcal endocarditis (False) · Staphylococcal endocarditis on the tricu spid valve in a drug addict is treated with flucloxacillin and valve replacement (False) · Large vegetations are an indication for surgery (True) Explanation: Flu cloxacillin (with gentamicin or rifampicin) is the medical treatment of choice b ut valve replacement is not appropriate. (True) Available from Master Medicine Module 1 (trial1) Qu estion 1. particularly in the prevention of s troke. endocarditi s can be ruled out if the patient is afebrile (False) Question 3. Endocarditis: · It is important to take blood cultures over at least 2 4 hour period to make the diagnosis (False) · Transthoracic echocardiography is a sensitive means of making or confirming the diagnosis (False) · Most patients with Staphylococcus aureus bacteraemia have endocarditis (False) · Viral endocarditis leads to valvular abnormality (False) · In patients with a new stroke. · Oral treatment producing a fall in diastolic blood pressure of 20 mmHg over 24 h ours might be regarded as successful treatment of accelerated hypertension (True ) Explanation: There is well-proven benefit.MCQs VIA WEB 2005 (e) Vertigo as a prominent early symptom. there is left axis deviati on (True) · ST segment depression may be a sign of cardiac ischaemia (True) Explan ation: It may also be a digoxin effect. The ECG: · The T wave corresponds to atrial contraction (False) · If the S wave is greater than the R wave in lead I. Hypertension: · Treatment is of no proven benefit in patients over the age of 70 years (False) · The sympto ms of phaeochromocytoma include headache. The fibres of the dorsal column pathway: (a) Carry information abou t temperature perception. there is right axis deviation (True) · If the S wave is greater than the R wave in lead II. the selected combinations are usually additive or synergistic. (True) (d) When damaged may result i n a positive Romberg's test. · ACE inhibitors are the drugs of choice for hypertension in pregnancy (Fal se) By A. Question 2. · A tall R wave in V1 may be a sign of rig ht ventricular hypertrophy (True) Explanation: It may also be a digoxin effect. firs t. it shou ld not be used for more than 2 weeks (False) Question 4. · If gentamicin is used for treatment. H. · Combination antibiotic therapy is almo st always appropriate for endocarditis (True) Explanation: For two reasons. (False) (b) Decussate in the midbrain. sweating and palpitations (True) Expla nation: There is well-proven benefit. (False) Question 25. . particularly in the prevention of stroke. to pre vent the development of resistance.

Cardiac dysrhythmias: · Digoxin toxicity may cause supraventricular ta chycardia (True) Explanation: Typically. H.MCQs VIA WEB 2005 · Addison's disease should be considered a possible cause in a hypertensive patien t with hirsutism (False) Question 5. · A patien t with a completely irregular pulse of 180 beats/min is likely to be in atrial f ibrillation (True) Explanation: Typically. paroxysmal atrial tachycardia. · Is associated with a macrocytic a naemia (False) · Is best shown by barium enema (False) · Usually requires surgery (F alse) · Is a congenital lesion (False) Question 10. · Lo ng-chain triglycerides are transported from the gut in the lymph as chylomicrons (False) · There is no lymphatic tissue (False) · The entire mucosa is turned over e very 2-3 weeks (False) · Is the site of most nutrient absorption (True) Question 8 . paroxysmal atrial tachycardia. chronic bronchial sepsis and with aspergillomas. dif ficult-to-grow bacteria (False) · May lead to haemoptysis (True) Explanation: Haem optysis is also seen with dry bronchiectasis. Concerning HIV infection and A IDS: · Pneumocystis pneumonia is common in Africa (False) · Tuberculosis in AIDS pre sents like that in non-AIDS patients (False) · Oral candidiasis is a late feature of AIDS (False) · Toxoplasmosis is usually a cerebral disease (True) By A. micellar formation i s reduced (True) Explanation: Bile salts are essential for micelle formation. · Digoxin is effective in preventing paroxysms of atrial fibr illation (False) · A QRS width less than 3 small squares on the ECG indicates that a tachycardia is supraventricular (True) Explanation: Digoxin slows the ventric ular rate during paroxysms of atrial fibrillation but does not prevent them. · There are further polyps in most cases (False) · Involvement of lo cal lymph nodes does not affect prognosis (False) · Obstruction is more common in right compared with left-sided lesions (False) Question 9. sot alol or amiodarone may prevent them. Colorectal cancer: · May arise from a metaplastic polyp (False) · Most often occur s in the rectum and sigmoid (True) Explanation: Metaplastic polyps have no malig nant potential. · Can usually be cured with oral antibiotics (False) · May lead to pu lmonary fibrosis (True) Explanation: It produces a fibrotic reaction. Angiodysplasia of the colon: · Is more common in the caecum and ascending colon (True) Explanation: It usually occurs in the right side of the colon. Question 6. Question 7 . · Comple te heart block may be asymptomatic (True) Explanation: Particularly congenital c omplete heart block. . In the small intestine: · If there is bile salt deficiency. Chronic bronchial sepsis: · Is an uncommon feature of cystic fibrosis (False) · Typically is caused by unusual.

Cardiac toxoplasmosis is usually diagnosed at postmortem. Thyroid funct ion tests: · Serum thyroid-stimulating hormone (TSH) is a sensitive test of hypert hyroidism (True) Explanation: Suppression of TSH is the first biochemical sign o f hyperthyroidism. in secondary hypo thyroidism. · Hyperthyroid pa tients may have a raised serum triiodothyronine with a normal thyroxine (True) By A. In hypoglycae mia: · Insulin-dependent patients may recover from hypoglycaemic coma without trea tment (True) Explanation: The anti-insulin hormones can bring the patient round and the insulin which caused the coma can 'wear off'. it is low. · Insulin may sometimes be needed during short perio ds of illness in patients with type 2 DM (True) Explanation: These are signs of type 1 DM. In secondary diabetes: · A patient can be assumed not to be ketosis-pr one (False) · A patient is more than 85% likely to have clinical pancreatic exocri ne deficiency (False) · Classical diabetic complications do not occur (False) · Thia zide diuretics and beta-blockers can both impair insulin secretion (True) Explan ation: Secondary diabetes causes all the same complications as idiopathic diabet es. · Poor glycaemic control at conception increases the risk of congenital malformations (True) Explanation: Hyperglycaemia is teratogenic in early pregnancy. · Cy tomegalovirus retinitis can be treated with aciclovir (False) Module 1 (trial2) Question 1. · Serum triiodothyronine can be an unreliable test for hypo thyroidism (True) Explanation: Low triiodothyronine may result from intercurrent illness. · Most patients with acromegaly are diabetic (False) Question 2.MCQs VIA WEB 2005 Explanation: Brain and heart. which are almost diagnostic of toxoplasmosis in AIDS. TSH is high. · Serum TSH can distinguish primary from secondary hypothyroidi sm (True) Explanation: In primary hypothyroidism. · All patients on insulin should be discouraged from changing their dos es without first checking with the doctor or nurse (False) Question 4. CNS lymphomas are usually single. H. and can be misleading. · Sweating and shaking are a lways late symptoms of insulin-induced hypoglycaemia (False) · Insulin-dependent p atients may lose their warning symptoms of hypoglycaemia after many years of dia betes (True) Explanation: About 50% of patients who have had type 1 DM for 20 ye ars or more develop 'hypoglycaemia unawareness'. Diabetic pregnancy: · Insulin-dependent women should be advised not to contemplate pregnanc y (False) · Diabetes increases the risk of neural tube defects (True) Explanation: Neural tube defects are two to three times more common. . In insulin trea tment: · Pen injectors are reserved for the small minority who take four or more i njections per day (False) · Only patients who cannot be controlled with once-daily insulin should have two or more injections (False) · Insulin should be started wi thout delay in a thin hyperglycaemic patient with ketonuria (True) Explanation: These are signs of type 1 DM. · Metformin is responsible for as many cases of hypoglycaemia as sulfonylureas (False) · The symptoms characteristi cally come on over hours rather than minutes (False) Question 3. The CT/MR scan usually shows multiple ring-enhanci ng lesions. · There is a less than 10% chance that an ep isode of ketoacidosis will cause intrauterine death (False) · Sulfonylureas are th e treatment of choice for gestational diabetes (False) Question 5. major congenital malformation s are two to three times more common. particularly in elderly people.

Concerning osteomyelitis: · Debridement of infect ed bone is essential for cure in chronic bacterial osteomyelitis (True) Explanat ion: It is often difficult to remove all dead infected bone. · A distinctive feature of chronic osteomyelitis is a discharging sinus (True) Explanation: Although there are othe r causes of a sinus including actinomycosis. Rheumatoid factor is: · An antibody to sheep erythrocytes (False) · Pres ent when rheumatoid nodules are present (True) Explanation: Nodules are associat ed with high titres of rheumatoid factor. · It is usually chron ic and unremitting over 3-4 years (False) · Confidence in the diagnosis rests on g rowing a bacterium from stool or other sites (False) · NSAIDs are appropriate ther apy (True) Explanation: It is helpful if it can be done but failure does not rul e out the diagnosis. the left ventricle constitut es the apex and is felt under the fingers. Question 6. H. the left vent ricle lies under the sternum (False) On a postero-anterior (PA) chest radiograph . With regard to reactive arthritis: · It may be caused by both Salmonella and Campylobacter spp. · It is usually accom panied by a very high ESR (True) Explanation: Virtually always and it is a usefu l marker of response to treatment and relapse. In an ECG. disease of the interventri cular septum causes changes in chest leads V3-4 (True) By A. pleural or pericardial fluid (False) Question 7. · Rheumatic fever should be excluded (True) Module 1 (Master Medicine) Question 1. the left heart border is mostly formed by the left ventricle (True) Explanatio n: The right ventricle presses against the sternum. · Diagnostic of rheumatoid arthritis (Fa lse) · Usually is of the IgA subtype (False) · Is not found in rheumatoid synovial. In gout: · Tophi are an early sig n (False) · Allopurinol is used to treat the acute attack (False) · Furosemide (frus emide) helps to increase urate excretion (False) · Large joints are not affected ( False) · Raised serum urate makes the diagnosis certain (False) Question 8. . mycetoma (fungal soft tissue and bony infection of the leg in the tropic s). implanted foreign body (such as shr apnel). · Involves the proximal interphal angeal (PIP) (False) Question 9. · Is associated with the histocompatibility antigen HLA-DW3 (Fal se) · Is associated with pulmonary fibrosis (True) Explanation: It is associated w ith upper lobe fibrosis and aortic incompetence. The anatomy of the heart: If you stand on the patient's ri ght side with your right hand across the sternum and cardiac apex. · A positive culture from a sinus track is a good indication of the bacterial cause of the chronic osteomyelitis (False) · Usually 2 or 3 weeks' antibiotic ther apy is adequate for cure (False) Question 10. (True) Explanation: It usually occurs 3-12 weeks after the episode of diarrhoea.MCQs VIA WEB 2005 Explanation: The condition of 'T3 toxicosis'. Ankylo sing spondylitis: · Is more common in females (False) · May present as a severe olig oarthritis (True) Explanation: Commonly affects several joints and often present s with back pain.

Endocarditis: It is important to take blood cultures over at least 24 hour period to make the diagnosis (False) Transthoraci c echocardiography is a sensitive means of making or confirming the diagnosis (F alse) Most patients with Staphylococcus aureus bacteraemia have endocarditis (Fa lse) Viral endocarditis leads to valvular abnormality (False) In patients with a new stroke. endocarditis can be ruled out if the patient is afebrile (False) Qu estion 4. Acute aortic stenosis may occur (False) The patient may develop myocardial ischaemia (True) Explanation: The coronary ostia may be occluded by t he dissection Question 7. In acute dissection of the thor acic aorta: The operative mortality is about 30% (False) Spinal cord ischaemia m ay occur (True) Explanation: It is much higher. there is ri ght axis deviation (True) If the S wave is greater than the R wave in lead II. Question 2. Insertion of a prosthetic heart valve into a drug addict is very likely to lead to prosthetic v alve endocarditis subsequently because of their continuing habit. to prevent the development of resistance. Combination an tibiotic therapy is almost always appropriate for endocarditis (True) Explanatio n: For two reasons. Treatment of endocarditis: Intravenous antibiotics for 6 weeks are nec essary to cure viridans type streptococcal endocarditis (False) Staphylococcal e ndocarditis on the tricuspid valve in a drug addict is treated with flucloxacill in and valve replacement (False) Large vegetations are an indication for surgery (True) Explanation: Flucloxacillin (with gentamicin or rifampicin) is the medic al treatment of choice but valve replacement is not appropriate. the selected combinations are usually additive or syn ergistic. When examining the heart. The ECG: The T wave corresponds to atrial con traction (False) If the S wave is greater than the R wave in lead I. it should not be used for more than 2 weeks (False) Question 5. . H. sweating and palpitations (True) By A. A tall R wave i n V1 may be a sign of right ventricular hypertrophy (True) Explanation: It may a lso be a digoxin effect Question 3. Question 6. If gentamicin is use d for treatment. t here is left axis deviation (True) ST segment depression may be a sign of cardia c ischaemia (True) Explanation: It may also be a digoxin effect.MCQs VIA WEB 2005 Explanation: The right ventricle presses against the sternum. In acute myocardial infarction: The diagnosis should be questioned if the jugul ar venous pressure is not raised (False) Streptokinase should not be given until the diagnosis has been confirmed by two sets of raised cardiac enzymes (False) Dysrhythmias in the early hours after presentation carry a poor prognosis (False ) Lidocaine should routinely be given to prevent dysrhythmias (False) Rupture of the interventricular septum is an uncommon but serious complication (True) Expl anation: This is of no proven value. Second. first. Hypertension: Treatment is of no proven benefit in pat ients over the age of 70 years (False) The symptoms of phaeochromocytoma include headache. Hypertension should be treated a ggressively (True) Explanation: Nitroprusside or labetolol infusion is a recomme nded treatment. t he cardiac apex is the point where the heart beat can be felt most strongly (Fal se) Occlusion of the left anterior descending coronary artery causes infarction of the anterior wall of the left ventricle and interventricular septum (True) Ex planation: Anterior myocardial infarction is caused by disease of the left anter ior descending artery. the left ventricle constitutes the apex and is felt under the fingers.

Question 12. .MCQs VIA WEB 2005 Explanation: There is well-proven benefit.g. Question 1 0. In ischaemic heart disease: Preval ence is increased in chronic renal failure (True) Explanation: Cushing's syndrom e. paro xysmal atrial tachycardia. Complete heart block may be asymptomatic (True) Expla nation: Particularly congenital complete heart block. Oral treatment producing a fall in diastolic blood pressure of 20 mmHg over 24 hours might be regarded as successful treatment of accelerated hypertension (True) Explanation: There is well-proven benefit. A patient with a completely irregular pulse of 180 beat s/min is likely to be in atrial fibrillation (True) Explanation: Typically. particularly in the prevention of stroke. Hypoventilation occurs in the following: Central sleep apnoea syndrome (True) Explanation: Alveolar hypoventilation is a key feature. Cardiac dysrhythmias: Digoxin toxic ity may cause supraventricular tachycardia (True) Explanation: Typically. Severe kyphoscoliosis ( True) Explanation: Severe kyphoscoliosis can produce mechanical ventilation prob lems because of the changed curvature of the spine. Staph. Pneumothorax is a recognised complic ation of: Rib fracture (True) Explanation: Pneumothorax can occur secondary to t rauma. Digoxin is effective in pr eventing paroxysms of atrial fibrillation (False) A QRS width less than 3 small squares on the ECG indicates that a tachycardia is supraventricular (True) Expla nation: Digoxin slows the ventricular rate during paroxysms of atrial fibrillati on but does not prevent them. not Addison's disease. aureus) can lead to pneumothorax. Exercise (False) Question 11. Cyanosis in the early stages (False) By A. Untreated hypothyroidism predisposes to it (True) Expl anation: Hypothyroidism causes hypercholesterolaemia and atherosclerosis. Clubbing of the fingers in the m ajority of cases (True) Explanation: Clubbing occurs in about 60% of patients bu t is not essential for the diagnosis. Polycy thaemia may precipitate myocardial ischaemia (True) Explanation: By increasing b lood viscosity and impairing blood flow. paroxy smal atrial tachycardia. sotalol or amiodarone may prevent them. ACE inhibitors are the drugs of choice for hypertension in pregnancy (False) Addison's disease should be considered a possible cause in a hypertensi ve patient with hirsutism (False) Question 8. An alcohol intake of 18 units per week in a man increases the risk of ischaemic heart disease (False) A high plasma fib rinogen reduces the risk (False) Question 9. They are particularl y common in emphysema including á1-antitrypsin deficiency. Bullae can be single or multiple. The fo llowing are features of fibrosing alveolitis: Cough (True) Explanation: Patients usually present with cough and breathlessness. Kyphoscoliosis (False) Cystic fibrosis (False) Pneumocystis carinii pneumonia (True) Explanation: And l ung abscesses (e. H. particularly in the prevention of str oke. Anxiety (False) Benzodiazepi ne overdose (True) Explanation: Drugs such as benzodiazepines depress the respir atory centre. A bulla (True) Explanation: Any cavitating or cystic/bullous lung lesion can cause a pneumothorax.

Chronic bronchial sepsis: Is an uncommon feature of cystic fibrosi s (False) Typically is caused by unusual. transplant and hypogammaglobulinaemic pa tients. Pleural aspiration is useful in t he following situations: In diagnosing mesothelioma (False) Pleural tuberculosis (False) Viral pleurisy (False) Empyema (True) Explanation: An empyema will requ ire tube or surgical drainage for treatment. it may obs cure infection in patients treated before diagnosis considered. Relieving breathlessness in patient s with malignant effusions (True) Explanation: Drainage in malignant effusions i s often very helpful if litres of fluid are removed or a shunt can be inserted. H. Can usually be cured with oral antibiotics (False) May lead to pulmonary fibrosis (True) Explanation : It produces a fibrotic reaction Question 16. Ciprofloxacin (True) Expla nation: Ciprofloxacin is a useful agent. Question 17. Causes of life-threatening pneumonia or pneumonitis in adults include: Pneumocystis car inii (True) Explanation: Pneumocystis carinii infection is usually seen in AIDS. Staph. Useful drugs for tuberculosis include: Piperacillin (False) Isoniazid (True) Explanation: Isoniazid is a major. Long-chain triglycerides are transported from the gut in the lymph as c hylomicrons (False) There is no lymphatic tissue (False) The entire mucosa is tu rned over every 2-3 weeks (False) Is the site of most nutrient absorption (True) Explanation: The small intestine is the main area for the breakdown and absorpt ion of nutrients. first-line agent. but also in lymphoma. Amikacin (Tru e) Explanation: Amikacin is a useful i. difficult-to-grow bacteria (False) May lead to haemoptysis (True) Explanation: Haemoptysis is also seen with dry bronc hiectasis. aureus. pneumophilia pneumonia carries a high mortality if not treated appropriately. less active than rifampicin. In the small intestine: If there is bile salt deficiency. but second-line agent. second-line agent Question 14. e.g.v. Legionella pneumophila (True) Explanation: L. Question 18. steroid-treated. Question 15. . Ethambutol (True ) Explanation: Ethambutol is another major. Influenza A virus (True) Explanation: Primary influenzal pneumonia or co mplicated by bacteria. aureus pneumonia is often rapidly fa tal. chronic bronchial sepsis and with aspergillomas.MCQs VIA WEB 2005 Circulating antibodies to alveolar tissues (False) Haemoptysis (False) Question 13. especially following influenza. Colorectal cancer: May arise from a metaplastic p olyp (False) By A. Respiratory syncytial virus (False) S taphylococcus aureus (True) Explanation: S. micellar formation is reduced (True) Explanation: Bile salts are essential for micelle fo rmation.

A 'fatty liver' may represent: Simply an obese person (False) Alcoholism (True) Explanation: A common 'early' abnormality. unless necessary for. you should: Send the pati ents home (False) Culture stools (and vomitus) for viruses (False) Treat everyon e with metronidazole (False) Exclude visitors from the ward (True) Explanation: To prevent further spread. By A. but it is an uncommon cause. Hepatitis C is not a cause of hepa tocellular carcinoma (False) Hepatitis A is a cause of chronic liver disease (Fa lse) Hepatitis E can be acquired by sharing needles (False) A person with only a hepatitis B core IgG test positive is infectious for hepatitis B (False) Questi on 24. Caus es of acute pancreatitis include: Alcohol (True) Explanation: Most cases are ass ociated with gall stones or high alcohol intake. physiotherapy . with mostly blood a nd little stool and no fever. . The following are correct: Hepatitis B can be acquired from serous flui d from a wound (True) Explanation: This is the likely mode of horizontal transmi ssion among siblings in developing countries. a dying patient. The differential diagnosis of acute bloody diarrhoea includes: Amoebic dys entery (True) Explanation: This has much mucus and tenesmus. barley and rye (True) Explanation: All contain gluten Question 21. Question 20. H. There are further polyps in most cases (False) I nvolvement of local lymph nodes does not affect prognosis (False) Obstruction is more common in right compared with left-sided lesions (False) Question 19. The diagnosis is incorrect if a patient fails to respond to a gluten-free diet (False) Requir es a diet free from wheat. Hypocalcaemia (False) Hyperlipi daemia (True) Explanation: There is an association with hyperlipidaemia. say.MCQs VIA WEB 2005 Most often occurs in the rectum and sigmoid (True) Explanation: Metaplastic poly ps have no malignant potential. Traveller's diarrhoea (False) Cholera (False) Ques tion 23. Campylobacter enter itis (True) Explanation: The amount of blood is usually small. coli (True) Explanation: The classic cause. (True) Explanation: Unless the investigation was absolutely vital Questio n 22. Coeli ac disease: The patient will almost always have had symptoms since childhood (Fa lse) Is best diagnosed on colonic biopsy (False) Is associated with HLA-B8 (True ) Explanation: It is associated with HLA-B8 and HLA-DRW3 antigens. Haemorrhagic coli tis caused by E. Self poisoning with diazepam (False) Endoscopic retrograde cholangiopancreatography (ERCP) (True) Explanation: ERCP is used in the diagnos is of pancreatic disease but can precipitate an acute attack. In a ward with several patients where two of the nurses have had m uch vomiting and some diarrhoea over a 48-hour period. etc. Prevent t he patients (affected or not) leaving the ward for investigations.

Atherosclerosis (True) Explan ation: As a result of extrarenal or intrarenal obstruction to the renal arterial circulation. Treatment with beta-blockers (False) Rheumatoid arthritis (True) Expla nation: It may be caused by amyloid associated with rheumatoid arthritis or by d rugs used to treat the disease (gold or penicillamine). volume depletion. Renal cell carcinoma (False) By A. Rarely it is caused by a glomerulonephritis associated with the disease itself. Acute renal failure is a likely complication of the following: Sepsis (or sepsis syndrome) (True) Explanation: Commonly caused by prerenal factors such as sepsis syndrome. . The following may cause the nephrotic syndrome: Minimal change disease (True) Explanation: This is the characteristic disease associated with nephrotic syndrome. In patients with acute renal failure: Sodium bicarbonate should be given routinely (False) Most patients with acute renal failure need long-term dialysis (False) Skin turgor is a reliable guide to the need for i. Diabetes mellitus (True) Explanation: Although the full-blown nephrotic syndrome is a relatively uncommo n presentation of diabetic nephropathy. Polycystic kidney disease (False) Major arterial surgery (True) Explanation: Ma jor arterial surgery can cause renal ischaemia and acute tubular necrosis. Acute vi tamin A poisoning (False) An ultrasound artefact (False) Question 25. Analgesic abuse (True) Explanation: As a result of extrarenal or i ntrarenal obstruction to the renal arterial circulation. A neoplasm causing a classical 'lemon-on-sticks' appearance is > 25% l ikely to be small cell carcinoma of the bronchus (False) Can only be cured by bi lateral adrenalectomy (False) Module 2 (Master Medicine) Question 1. the kidneys are unable to excrete urea so the urinary urea concentration is low. particularly in children. Intravenous pyelography is the investigation of choice to exclude urinary obstruction (False) Question 3. Hypothyroidism (False) Question 4. Retro peritoneal tumours (False) Cardiogenic shock (True) Question 2.v. in which plasma urea is high but the kidney s retain the capacity to concentrate urinary urea.MCQs VIA WEB 2005 Hepatitis C infection (True) Explanation: A common 'early' abnormality. The diagnosis is made by a high-dose dexamethasone test (False) Serum adrenoco rticotrophic hormone (ACTH) is important in diagnosing the underlying cause (Tru e) Explanation: Patients with primary adrenal Cushing's have unmeasurably low se rum ACTH. The following are causes of chronic renal failur e: Gout (True) Explanation: In renal failure. for example. This distinguishes renal failure from. Cushing's syndrome: Causes osteoporosis (True) Explanation: Also cardiorespiratory disease . H. fluid therapy (False) Urinary catheterisa tion is sometimes needed to monitor the response to therapy (True) Explanation: It is important to measure urine flow in the fluid management of acute renal fai lure. Non-insulin-dependent d iabetes (True) Explanation: Both insulin-dependent and non-insulin-dependent dia betes cause renal failure.

The following are true: A cerebellar vermis lesio n will result in a marked intention tremor (False) Macular sparing is a characte ristic of lesions affecting the optic tract (False) In a patient with marked vis uo-spatial inattention. the lesion is most likely in the left cerebral hemispher e (False) Agnosia means inability to plan and execute motor tasks (False) Dyscal culia is a feature of Alzheimer's disease (True) Explanation: Remember other hig her cortical functions. Renal artery stenosis: Is invariably caused by atherosclerosis (False) May cause renal failure in patients given ACE (angiotensin-converting enzyme) inhib itor therapy (True) Explanation: Fibromuscular hyperplasia and radiation fibrosi s are two other pathologies which can cause renal artery stenosis. Diplopia worse on looking to the right (True) Explanation: Diplopia is maximal on looking in the direction of the primary action of the mu scle. though mostly the paralysis is only brought out when the eye is abducted. H. Features of a righ t sixth nerve palsy include: Convergent strabismus (True) Explanation: Complete paralysis of the lateral rectus leaves the medial rectus unopposed hence produci ng a convergent strabismus. False image parallel to the true image (True) Explanation: Unlike a superi or oblique palsy. Is a cause of hypertension (True) Explanation: Hypoperfusion causes reduction in renal siz e.g. Was ting of the hypothenar eminence occurs in the carpal tunnel syndrome (False) Abd uction of the thumb is impaired in an ulnar nerve lesion (False) The index finge r is hyperextended at the metacarpophalangeal (MCP) joint in an ulnar nerve lesi on (False) Sensation is lost over the whole of the back of the hand in radial ne rve damage (False) Question 8.MCQs VIA WEB 2005 Question 5. False image occurs further to the left than the true image (Fa lse) Images become increasingly separated on looking to the left (False) Questio n 10. perhaps reflecting anorexia and dehydration. The following are features of urinary infections in elderly people: Patients usually complain of dysuria (False) They may present with falls (True) They may present with constipation (True) Explanation: Or it may be coexistent. Can be reliably diagnosed by auscultat ing for renal bruits (False) May be seen on ultrasound as a unilateral small kid ney (True) Explanation: Hypoperfusion causes reduction in renal size. Tardive dyskinesia (False ) Intention tremor (False) Festinant gait (True) By A. e. . The following are true: There is weakness of elbow extension in a crutch palsy (True) Explanation: The triceps is affected in a crutch palsy. dyslexia. it does involve loss of dopam inergic neurons. Question 7. Questi on 6. Cogwheel rigidity (True) Explanation: Cogwheel rigidity is a su perimposed tremor on the 'lead pipe' increase in tone. dysphasia. Parkinson's disease is associated with: Loss of dopamine transmission (Tru e) Explanation: Although the mechanism is unclear. Question 9. Sterile pyuria is most likely cause d by tuberculosis (False) Estrogen supplements may reduce their frequency in pos tmenopausal women (True) Explanation: Elasticity of the urethra is reduced postm enopausally and this can lead to infection. although athe rosclerosis is the most common pathology. Local estrogen therapy helps.

With respect to lumbar puncture: Coagulopathy is a co ntraindication (True) Explanation: However. Furthermore about 5% of community-acquired cases are other organisms.g. haemophiliac) a nd the indication for lumbar puncture is strong enough. Mutism (False) Duration of symptoms less than 1 month (False) Wors ening of symptoms during the early morning (False) Marked impairment of concentr ation (False) Question 13. The following are more suggestive of dementia than of depression: Several episodes of antisocial behaviour (True) Explanation: Antisocial behaviour is more in keeping with the personality change of dementia.MCQs VIA WEB 2005 Question 11. therapy is necessary in meningitis. This is th e primary reason why i. MR scanning is the preferred imaging technique. In a young female with paraplegia. pneumoniae meningitis. which of the following would sug gest a diagnosis of multiple sclerosis: Periventricular lesions seen on MR scann ing (True) Explanation: Periventricular plaques would imply disease remote from the spinal cord. Development of ant ibiotic resistance during therapy (False) The causative organism (True) Explanat ion: Neisseria meningitidis has a lower mortality than S. such as L isteria monocytogenes. if correctable (e. Raised protein in cerebrospinal fluid (CSF) (False) Raised CSF globulin (True) Explanation: CNS immunology is disturbed in multiple sclerosis. the less likely coning is to occur (False) Postlumbar puncture headache is rel ated to the size of the needle used (False) Question 14. then it should be correc ted and the lumbar puncture carried out. Denervation of the muscles of th e leg (False) Episode of visual disturbance (True) Explanation: Disturbances of visual acuity are an early sign. The following statements are true: Hypocalcaemia causes prolongation of the pro thrombin time (False) The prothrombin time is a sensitive test of hepatocellular dysfunction (True) Explanation: Because hepatocellular dysfunction impairs the synthesis of vitamin K-dependent clotting factors. which are now the most common first line treatment for meningitis Question 15. The following m ay cause a microcytic anaemia: Sickle cell disease (False) The thalassaemias (Fa lse) Anaemia of chronic disease (False) Anticonvulsant therapy (False) By A. The effect of heparin is rev ersed by vitamin K (False) Deep venous thrombosis can be reliably diagnosed by m easuring fibrin degradation products (FDPs) (False) Question 16. Time to first administration of antibiotic (True) Explanation: Delays lead to increased mortality and morbidity. Outcome from bacterial meningitis relates to: Age of patient (True) Explanation: Mortality is highest i n elderly people. Papilloedema is an absolute contraindic ation (False) The procedure may cause meningitis (False) The less CSF is removed . Listeria is intrinsically resistant to all cephalosporins .v. CSF concentration of antibiot ic (True) Explanation: The CSF concentration of antibiotic needs to exceed by 20 -fold the minimum inhibitory concentration of the infecting organism. H. . Question 12. The activated partial thrombo plastin time (APTT) is prolonged by unfractionated heparin therapy (True) Explan ation: This is used as a measure of heparinisation.

o n the balance of available evidence. there was a noti ceable improvement in cardiovascular mortality (False) Good glycaemic control. Thiazide diuretics should not be use d in diabetes (False) Beta-blockers may increase the risk of severe hypoglycaemi a in insulin-treated patients (True) Explanation: This is true primarily of noncardioselective beta-blockers. can reduce cardiovascular mortality in both type 1 and type 2 DM (False) Even mildly 'impaired glucose tolerance' increases cardiovascular risk (True) Question 19. H. which increases the risk of cardiovascul ar disease up to 100-fold. Diabetic retinopathy: Characteristically causes arterio-venous nipping (False) Should be referred to an ophthalmologist only if the patient has visual symptoms (False) Inevitably causes blindness (False) May cause cotton wo ol spots (soft exudates) (True) Explanation: These may also occur in hypertensio n and other ischaemic retinopathies. whatever the cause (False) Question 17.MCQs VIA WEB 2005 Haemolysis. treatment with antibiotics should await the results of blood cult ure (False) Neutropenia is common in AIDS (False) Neutropenia can be caused by c arbimazole therapy (True) Explanation: Neutropenia occurs in 1:10000 patients tr eated with carbimazole for thyrotoxicosis. Is more likely to cause blindness in type 1 than in type 2 DM (False) Question 21. All patients o n insulin should be discouraged from changing their doses without first checking with the doctor or nurse (False) Question 22. In insulin treatment: Pen injectors are reserved for the small minority who take four or more injections per day (False) Only patients who cannot be controlled with once-daily insulin should have two or more injections (False) Insulin should be started without delay in a thin hyp erglycaemic patient with ketonuria (True) Explanation: These are signs of type 1 DM. . Prognosis of diabetes: C ardiovascular mortality is higher in diabetic than in non-diabetic people up to the age of 80 (True) Explanation: A threefold increase. The following statements are true: A neutrophil count of only 0. When sulfonylureas became available.1 × 109 cells/l neutrophil s and a fever. In secondary diabetes: A patient can be assumed not to be ketosis-prone (False) A patient is more than 85% likely to ha ve clinical pancreatic exocrine deficiency (False) Classical diabetic complicati ons do not occur (False) Thiazide diuretics and beta-blockers can both impair in sulin secretion (True) Explanation: Secondary diabetes causes all the same compl ications as idiopathic diabetes. Question 18. Insulin may sometimes be needed during short periods of illness in patients with type 2 DM (True) Explanation: These are signs of type 1 DM. Most patients with acromegaly are diabetic (Fal se) Question 20. Diabetic patients with p roteinuria have a higher cardiovascular risk than those without it (True) Explan ation: It is indicative of nephropathy.8 × 1 09 cells/l is a major risk for infection (False) A neutrophil count in a febrile patient of 25 × 109 cells/l reflects mostly the production of new neutrophils fro m the bone marrow (False) In a patient with less than 0. Hypertension in diabetes: Is more prevalent in type 1 than in type 2 (False) Its treatment slows the deterioratio n of nephropathy in type 1 DM (True) Explanation: Hypertension is associated wit h type 2 more strongly than with type 1 DM. Increases the risk of stroke in diabetes (True) By A.

MCQs VIA WEB 2005 Explanation: This is true primarily of non-cardioselective beta-blockers Question 23. The following are seen with NSAIDs: Improvement in renal function ( False) Increase in serum potassium (True) Explanation: The change in renal funct ion results in hyperkalaemia. Increased risk of peptic ulcer complications (True ) Explanation: There is a clear relationship between NSAID use and complications such as perforation, bleeding and death particularly in old people. Improved lo ng-term prognosis of rheumatoid arthritis (False) Improvement in coexistent asth ma (False) Question 24. The following are features of systemic lupus erythematos us (SLE) Raynaud's phenomenon (True) Explanation: Pain during mastication is a c haracteristic feature of temporal arteritis. Mononeuritis multiplex (True) Expla nation: Pain during mastication is a characteristic feature of temporal arteriti s. Thrombocytopenia (True) Explanation: This is one of the typical blood-associa ted dyscrasias. Lymphopenia (True) Explanation: As with thrombocytopenia Questio n 25. In primary osteoarthritis: The ESR is normal (True) Explanation: There are no haematological abnormalities. PIP joints are not usually affected (False) Ra diographs show characteristic erosions of articular margins (False) Morning stif fness usually lasts over 1 hour (False) First carpometacarpal joint involvement is a common finding (True) Explanation: This is common, resulting in 'squaring' of the hand Available from Davidson's Principles and Practice of Medicine Module 1 (Chapter 1) Question 1. The following infections may be acquired by the follo wing means tetanus-respiratory droplets or dust (False) Explanation: Via wounds and abrasions listeriosis-eating contaminated cheese (True) Explanation: Can sur vive refrigeration legionellosis-water aerosols (True) schistosomiasis-via penet ration of the skin (True) leptospirosis-via rat urine (True) Question 2. Disease s typically acquired from animals include leptospirosis (True) Explanation: From the urine of rats or dogs Mycobacterium tuberculosis (False) Explanation: Mycob acterium bovis toxoplasmosis (True) Explanation: From dog faeces psittacosis (Tr ue) Explanation: From birds hepatitis A (False) Explanation: Faecal-oral spread Question 3. Live viruses are usually used for active immunisation against By A. H.

MCQs VIA WEB 2005 poliomyelitis (True) Explanation: Inactivated vaccine also available pertussis ( False) typhoid fever (False) mumps, measles and rubella (True) Explanation: Do n ot give to immunosuppressed patients hepatitis B (False) Question 4. Pyrexia of unknown origin is defined as a temperature of more than 37.5°C persisting for more than 2 weeks (True) Explanation: Not elucidated by investigation in hospital is due to infection in 75% of cases (False) Explanation: In approximately 30% only may be factitious (True) Explanation: Suspect if ESR and CRP normal can be caus ed by granulomatous hepatitis (True) Explanation: And other forms of hepatitis m ay be elucidated by bone marrow biopsy (True) Explanation: May diagnose haematol ogical malignancy Question 5. The following statements about infectious mononucl eosis are true infection is usually attributable to the Epstein-Barr virus (EBV) (True) presentation is with fever, headache and abdominal pain (True) Explanati on: And malaise and anorexia sore throat suggests cytomegalovirus rather than EB V infection (False) meningoencephalitis and pericarditis are recognised complica tions (True) severe oropharyngeal swelling requires prednisolone therapy (True) Explanation: Especially if there is dysphagia or breathing difficulty Question 6 . Typical features of toxoplasmosis include the following infection is derived f rom cats, pigs and sheep (True) Explanation: Immunocompromised patients are most at risk peak age of onset is over 65 years of age (False) Explanation: 25-35 ye ars congenital infection produces choroidoretinitis (True) Explanation: And some times microcephaly there is a positive heterophil antibody test (False) Explanat ion: This is typically negative pyrimethamine and sulfadiazine therapy is useful in immunocompromised patients (True) Question 7. Recognised features of brucell osis include a characteristically rapid response to penicillins (False) Explanat ion: Typically doxycycline and streptomycin fever, night sweats and back pain (T rue) Explanation: And joint pains and anorexia splenomegaly (True) Explanation: But a non-specific finding oligoarthritis and spondylitis (True) Explanation: Du e to localised granulomatous disease thrombocytopenia (True) Explanation: Due to hypersplenism Question 8. The typical features of leptospirosis include incubat ion period of 1-3 months (False) Explanation: 7-14 days exposure risk in abattoi rs, farms and inland waterways (True) fever, severe myalgia, headache and conjun ctival suffusion (True) By A. H.

MCQs VIA WEB 2005 Explanation: With abrupt onset meningitis in Leptospira icterohaemorrhagiae rath er than L. canicola infection (False) Explanation: L. canicola infection is usua lly associated with aseptic meningitis possible diagnosis by examination of the urine (True) Explanation: Leptospires appear in the urine in the second week of illness Question 9. The clinical features of Lyme disease include infection with the tick-borne spirochaete Borrelia burgdorferi (True) Explanation: Ixodes spec ies of tick an expanding erythematous rash (erythema chronicum migrans) (True) E xplanation: An annular red lesion cranial nerve palsies (True) Explanation: Or m eningitis or radiculopathy asymmetrical large joint recurrent oligoarthritis (Tr ue) Explanation: Not in acute stages response to tetracycline or penicillin ther apy (True) Explanation: And cephalosporins Question 10. Features consistent with the diagnosis of Q fever include exposure to sheep, cattle and unpasteurised mi lk (True) Explanation: Especially butchers and abattoir workers meningoencephali tis (True) pneumonia in the absence of fever, headache or myalgia (False) Explan ation: Acute Q fever is an influenza-like illness blood culture-negative endocar ditis (True) prompt clinical response to sulphonamide therapy (False) Explanatio n: Responds to tetracyclines Question 11. The typical features of erysipelas inc lude group A haemolytic streptococcal skin infection (True) Explanation: Strepto coccus pyogenes absence of constitutional symptoms (False) Explanation: Systemic upset is common well-defined area of cutaneous erythema and oedema (True) Expla nation: The rash has a palpably raised edge painless swelling (False) Explanatio n: Typically painful prompt response within 48 hours to benzylpenicillin (True) Question 12. Clinical features of anthrax include occupational exposure to anima ls and animal products (True) Explanation: Farmers, butchers and dealers in wool , hides and bone meal an incubation period of 1-3 weeks (False) Explanation: 1-3 days a painless cutaneous papule (True) Explanation: Painless but itchy gastroe nteritis and bronchopneumonia (True) multiple antibiotic resistance (False) Expl anation: The organism is widely sensitive Question 13. The features of herpes si mplex (HS) virus infections include recurrent genital ulcers (True) Explanation: Especially HS type 2 acute gingivostomatitis (True) Explanation: HS type 1 ence phalitis (True) Explanation: HS type 1 By A. H.

ovale persist in this form fertilisation of the gametocytes occurs in the human red blood cells (Fals e) Explanation: Fertilisation occurs in the mosquito Question 19. The following statements about the life cycle of plasmodia are true sporo zoites disappear from the blood within minutes of inoculation (True) Explanation : Sporozoites enter the liver within 30 minutes merozoites re-entering red blood cells undergo both sexual and asexual development (True) all plasmodia multiply in the liver then subsequently in red blood cells (True) Explanation: Duration of the pre-patent period varies dormant hypnozoites remain within the liver cell s in all species (False) Explanation: Only P. H. .MCQs VIA WEB 2005 shingles (False) Explanation: Varicella zoster virus paronychia (True) Explanati on: HS type 1-'herpetic whitlow' Question 14. The clinical features of amoebic dysentery include an incubation period of 2-4 weeks (False) Explanation: May develop many months a fter exposure presentation with blood and mucus per rectum (True) Explanation: A cute colitic symptoms often seen in the old good response to metronidazole in in testinal disease (True) characteristic appearances of the mucosa on sigmoidoscop y (True) Explanation: Flask-shaped ulcers antibodies detectable by immunofluores cence in only a small minority of patients (False) Explanation: In 60-95% Questi on 18. In patients with rubella infection the RNA vir us spreads by the faecal-oral route (False) a prolonged fever is typical (False) Explanation: Typically only on the first day of the rash infectivity is present for 7 days before and after the rash (True) sub-occipital lymphadenopathy is ty pical (True) the risk of serious fetal damage is < 5% after the 16th week of pre gnancy (True) Explanation: Greatest risk is in the first 8 weeks Question 16. In a schoolchild with measles infe ction is due to a paramyxovirus (True) rhinorrhoea and conjunctivitis occur at t he onset (True) Explanation: The catarrhal phase Koplik's spots appear at the sa me time as the skin rash (False) Explanation: They precede the rash the skin ras h typically desquamates as it disappears (True) infectivity is confined to the p rodromal phase (False) Explanation: Contact should be avoided for 7 days after t he onset of the rash Question 15. Th e characteristic features of mumps include infection with an RNA paramyxovirus b y airborne spread (True) high infectivity for 3 weeks after the onset of parotit is (False) Explanation: Infectivity is generally low presentation with an acute lymphocytic meningitis (True) abdominal pain attributable to mesenteric adenitis (False) Explanation: Pain suggests pancreatitis or oophoritis orchitis which pr edominantly occurs prepubertally (False) Explanation: It is usually unilateral a nd postpubertal Question 17. Recognised cli nical features of malaria include By A. vivax and P.

vivax infection in subjects lacking the Duffy blood group (True) E xplanation: West Africans and African Americans are protected asymptomatic P. headache. In the diagnosis of th e enteric fevers blood cultures are usually positive 2 weeks after onset (False) Explanation: Bacteraemia in the first week stool cultures are usually positive within 7 days of onset (False) Explanation: More likely in the second or third w eek peripheral blood neutrophil leucocytosis is typically marked (False) Explana tion: Leucopenia is typical the Widal reaction is typically positive within 7 da ys of onset (False) Explanation: There are frequent false negatives persistent f ever despite antibiotics indicates resistant organisms (False) Explanation: It m ay suggest a septicaemic focus Question 23. H. head ache and myalgia (True) Explanation: And relative bradycardia 'rose spots' on th e trunk and splenomegaly 7-10 days after onset (True) development of carrier sta te in 50% of survivors (False) Explanation: 5% Question 21. The features of typhoid fever include faecal-oral spread of Salmonella typhi by food handlers ( True) Explanation: Usually asymptomatic carriers presentation with constipation (True) Explanation: But diarrhoea more common in children onset with fever. herpes simplex and haemolytic anaemia (True) Explanation: Especiall y in P. ma lariae parasitaemia persisting for years (True) Explanation: With or without sym ptoms enhanced risk of infection in splenectomised patients (True) presentation with rigors. photophobia and backache (True) Explanation: But non-sp ecific morbilliform rash and cervical lymphadenopathy (True) Explanation: Rash s tarts peripherally protection by vaccination every 10 years in endemic areas (Fa lse) Explanation: No vaccine is available Question 24. vivax and P.MCQs VIA WEB 2005 absence of P. ovale infection excellent response to chloroquine (False) E xplanation: Widespread resistance-quinine preferred Question 20. Clinical features of dengue include mosquito-borne infection with an incubation period of 2-7 days (True) continuous or 'saddle-back' fever (True) Explanation: Fever may remit on day 4-5 ('saddleback') rigors. gambiense infections onset with chancre-like skin lesion and local l ymphadenopathy (True) Explanation: At the site of the bite By A. The typical features of A frican trypanosomiasis include transmission of the parasite by the tsetse cattle fly (True) an incubation period of 2-3 weeks (True) Explanation: Occasionally l onger in T. The following are po ssible causes of fever and a rash in a traveller returning from the tropics para typhoid fever (True) leptospirosis (True) meningococcal infection (True) seconda ry syphilis (True) HIV seroconversion (True) Question 22. .

In onchocerciasis larval infection is transmitted by the Simulium f ly (True) Explanation: A painful bite worms mature over 2-4 weeks and persist fo r up to 1 year (False) Explanation: Worms can live for over 15 years cutaneous n odules and eosinophilia commonly develop (True) Explanation: The nodules contain adult worms By A. In infestation with the nematode Enterobius vermicularis adult threadworms occur in great numbers in the small bowel (False) Explanation: Seen in the colon presentation with intense pruritus ani is typical (True) Explanatio n: Worms may be visible identifiable ova are found on the perianal skin (True) m alabsorption usually develops following heavy infestations (False) Explanation: The small bowel is unaffected all family members should take piperazine or meben dazole therapy (True) Explanation: Cross-infection and autoinfection are common Question 29. stibogluconate (True) Explanation: Amph otericin B is an alternative Question 26. accommodation or ocu lar muscles may occur (True) Explanation: Occasionally with peripheral polyneuri tis treatment is with antibiotics alone (False) Explanation: Diphtheria antitoxi n is also important Question 27. diarrhoea. The typical features of strongyloidiasis includ e skin penetration with migration to the gut via the lungs (True) Explanation: P roducing an itchy rash larval penetration of the duodenal and jejunal mucosa (Tr ue) Explanation: With pain. Typical features of visceral leishma niasis (kala-azar) include spread of Leishmania donovani by sandflies from dogs and rodents (True) Explanation: Also spread from infected blood transfusions an incubation period of 1-2 weeks (False) Explanation: 1 month to 10 years rigors w ith hepatomegaly but no splenomegaly (False) Explanation: Splenomegaly is charac teristic diagnosis confirmed on peripheral blood film (False) Explanation: Diagn osis by examination of stained smears of bone marrow. resulting in pneumonia (True) Explanation: Seen in HIV infect ion Question 28. steatorrhoea and weight loss abdominal pa in. hepatosplenomegaly and encephalitis (True) good pro gnosis given prompt pentamidine or suramin therapy (True) Explanation: Unless ce rebral infection has developed Question 25. H. .MCQs VIA WEB 2005 generalised lymphadenopathy. diarrhoea and malabsorption (True) penetration of perianal skin producing a migrating linear weal (True) Explanation: Intensely itchy systemic spread in the immunosuppressed.g. spleen or liver clinical r esponse to pentavalent antimonials. e. In diphtheria heart block is a recogni sed complication (True) Explanation: Although cardiac involvement usually causes no long-term problems high fever is a typical early sign (False) Explanation: F ever rarely dominant-insidious onset isolation is usually unnecessary (False) Ex planation: Isolation is vital paralysis of the soft palate.

Typical features of leproma tous leprosy include early and marked sensory loss (False) Explanation: Late and limited unlike the tuberculoid form. brain and lungs (True) Explanation: Right lobe of the liver is the commonest site absence of dissemination during liver a spiration (False) Explanation: Care must also be taken during excision prompt re sponse to albendazole therapy if surgically inoperable (False) Explanation: But further enlargement may be prevented Question 32. Characteristic features of leprosy include an incubation period of 2-12 yea rs (True) growth of the organism on Löwenstein-Jensen medium after 2-3 months (Fal se) Explanation: The organism cannot be grown in artificial media spread of the tuberculoid form by prolonged patient contact (False) Explanation: There is no r isk of infection in tuberculoid leprosy thickened palpable peripheral nerves (Tr ue) a cell-mediated immune response in the lepromatous form (False) Explanation: Characteristic of the tuberculoid form Question 34. iritis and keratitis are characteristic (True) ivermectin is the drug therapy of choice (True) Question 30. . H. In schistosomal infection painless h aematuria may be the presentation (True) Explanation: Due to bladder mucosal inv olvement diagnosis can be made by finding cercariae in the urine and/or stool (F alse) Explanation: Eggs are passed in urine and/or stool the helminths mature in the portal vein (True) peripheral neuropathy commonly causes lower limb weaknes s (False) Explanation: But transverse myelitis may praziquantel is the therapy o f choice (True) Explanation: Or oxamniquine or metrifonate Question 31.MCQs VIA WEB 2005 conjunctivitis. organisms are scanty in number (False) Exp lanation: Is a multibacillary disease blood-borne spread from the dermis through out the body (True) Explanation: No cell-mediated immune response strongly posit ive lepromin skin test (False) Explanation: Suggests tuberculoid disease anaesth etic hypopigmented skin macules and plaques (False) By A. Echinoco ccus granulosus infestation is usually associated with contact with sheep. Typical features of cutaneous leishmaniasis include nasal and oral mucosal ulcers (True) Explanation: Secondar y to initial cutaneous ulceration painful ulcers in the groins or axillae (False ) Explanation: Typically painless and not involving nodes marked splenomegaly an d lymphadenopathy (False) Explanation: These occur in visceral leishmaniasis ulc ers which heal without scarring (False) negative leishmanin skin test (False) Ex planation: Typically positive except in diffuse cutaneous leishmaniasis Question 33. cattl e and dogs (True) Explanation: May be many years before clinical manifestations appear acquisition of hydatid cysts in childhood (True) Explanation: Usually an asymptomatic event cysts in the liver.

HIV infection is associated with an RNA retrovirus (True) heterosexual transmis sion in the majority of cases world-wide (True) Explanation: Superseding homosex ual and parenteral involvement of CD4 lymphocytes (True) By A. H. The following statements about syphilis are true infection is usually ca used by Treponema pertenue (False) Explanation: Due to infection with Treponema pallidum cardiac murmurs are a typical early feature of infection (False) Explan ation: A feature of late disease the primary lesion at the site of infection is initially macular (True) Explanation: But becomes papular. but sensation is retained Question 35. di scharge or no symptoms right hypochondrial pain due to perihepatitis (True) phar yngitis (True) good response to ciprofloxacin therapy in penicillin allergy (Tru e) Explanation: Or spectinomycin Question 39. Chara cteristic features of late (tertiary and quaternary) syphilis include negative s pecific treponemal antigen tests (False) Explanation: The tests are typically po sitive destructive granulomas (gummas) in bones. then chancrous the in cubation period for primary syphilis is typically 2-4 weeks (True) Explanation: But may be up to 90 days tertiary syphilis usually develops within 1 year of inf ection (False) Explanation: Takes at least 2 years to develop Question 37. The typical clinical fe atures of gonorrhoea include an incubation period of 2-3 weeks (False) Explanati on: 2-10 days anterior urethritis and cervicitis (True) Explanation: Dysuria. . Anogenital herpes simplex is typic ally associated with type 2 herpes simplex infection only (False) Explanation: T ype 2 and type 1 equally primary attacks more severe and prolonged than recurren t attacks (True) Explanation: Healing is more rapid in recurrent attacks fever w ith painful genital ulceration and lymphadenopathy (True) sacral dermatomal pain and urinary retention (True) absence of clinical response to oral aciclovir (Fa lse) Explanation: Shortens first attacks and may prevent recurrence Question 40.MCQs VIA WEB 2005 Explanation: Macules occur. The following are likely causes of splenomegaly in a patient with f ever returning from the tropics tuberculosis (False) trypanosomiasis (True) bruc ellosis (True) visceral leishmaniasis (True) infective endocarditis (True) Quest ion 36. joints and the liver (True) sen sory ataxia (True) Explanation: Due to dorsal column spinal disease aneurysms of the ascending aorta (True) Explanation: Typically with calcification poor respo nse of gummas to antibiotic therapy (False) Question 38.

H. . Cryptosporidiosis in an HIV-positive patient is an AIDS-defining diagnosis if chronic (True) likely to present with painless profuse diarrhoea (False) Explanation: Profuse diarrhoea. Presenting features of HIV infection include hairy leucoplakia (T rue) Explanation: Affects the tongue and mouth atypical pneumonia (True) Explana tion: Especially Pneumocystis carinii thrombocytopenic purpura (True) pulmonary tuberculosis (True) Explanation: Sometimes with atypical mycobacteria candidiasi s and cryptosporidiosis (True) Question 45. but usually w ith abdominal pain likely to be self-limiting if the CD4 count is > 200 cells/mm 3 (True) preventable by the use of boiled tap water (True) usually diagnosed on stool microscopy (True) Question 46. In the diagnosis of HIV infection ELISA testing has a low false negative rate (True) Explanation: ELISA testing therefore widely used as a screening test seroconversion invariably occurs in under 4 weeks (False) Explan ation: 6-12 weeks or longer antibody detection tests are particularly helpful in neonates (False) Explanation: May have transplacentally acquired maternal antib ody HIV-RNA can be directly measured as a confirmatory test (True) Explanation: Sometimes used as a confirmatory test HIV-RNA is typically detected before antiHIV antibodies (True) Question 43. Pneumocystis carinii infection in an HIV-po sitive patient is the commonest cause of respiratory infection in African patien ts (False) Explanation: Tuberculosis is more common By A. In HIV infection 80% of vertically transmitted infections are transplacental (False) Explanation: Majority occur during parturition a child bo rn to an infected mother has a 90% chance of acquiring HIV (False) Explanation: Under 50% chance transmission can occur via breast milk (True) Explanation: 10-2 0% additional risk for breast-fed babies risk of fetal transmission is unaffecte d by pre-partum antiviral agents (False) Explanation: HAART can reduce transmiss ion rate Question 42.MCQs VIA WEB 2005 a viral half-life of 1-2 hours in plasma (True) a better prognosis in the presen ce of Kaposi's sarcoma (False) Explanation: Prognosis is worse with Kaposi's sar coma Question 41. In the classification of HIV infection group A = acute seroconversion simulating glandular fever (True) Explanation: Also inc ludes asymptomatic patients group B = persistent generalised lymphadenopathy (Fa lse) Explanation: Classed as group A infection group C = constitutional symptoms and oral candidiasis (False) Explanation: Group C includes conditions meeting C DC/WHO case definition group A1/B1/C1 all have absolute CD4 count > 500/mm3 (Tru e) group B = asymptomatic infection (False) Explanation: Group A are asymptomati c Question 44.

Erythromycin is active again st the following microorganisms Campylobacter jejuni (True) Escherichia coli (Fa lse) By A. they contain a â-lactam ring (True) Explanation: Resistance by â-lactamase-producing organisms is common clavulanic acid inhibits bacterial â-l actamase (True) Explanation: Used in combination with amoxicillin as co-amoxicla v they are all safe in pregnancy (False) Explanation: Imipenem is not they are s ynergistic with aminoglycosides (True) Question 51. cryptococcal meningitis is the commonest cause of meningitis (True) Explanation: Also causes pulmonary disease characterised by abrupt onset of the classical features of a bacterial meningitis (False) Explan ation: Indolent onset diagnosed by India ink stain of cerebrospinal fluid (CSF) (True) Explanation: And serum/CSF culture typically associated with negative CSF culture (False) associated with deafness in survivors (True) Explanation: And b lindness Question 48. The following statements about penicillins are true all penicillins are b actericidal (True) Explanation: By interfering with their cell wall synthesis li ke the cephalosporins. In a patient with AIDS.MCQs VIA WEB 2005 characterised by copious sputum production (False) Explanation: Dry cough and dy spnoea characterised by widespread fine pulmonary crackles (False) Explanation: Crackles would be unusual more likely to occur when the CD4 count is < 200/mm3 ( True) Explanation: In 95% of cases excluded by the finding of a normal chest X-r ay (False) Explanation: Normal chest radiograph is found in 15-20% of cases Ques tion 47. H. Antimicrobial therapy acts in the following ways amino glycosides disrupt bacterial protein synthesis (True) Explanation: Via ribosomal binding sulphonamides interrupt bacterial folate synthesis (True) Explanation: And hence nucleic acid synthesis penicillins disrupt bacterial protein synthesis (False) Explanation: Affect cell wall synthesis cephalosporins disrupt bacteria l cell wall synthesis (True) Explanation: As with penicillins tetracyclines disr upt bacterial protein synthesis (True) Explanation: Via ribosomal binding Questi on 50. . In the treatment of HIV infection all useful drugs work vi a inhibition of reverse transcriptase (False) Explanation: Some are protease inh ibitors nucleoside reverse transcriptase inhibitors may cause peripheral neuropa thy (True) reverse transcriptase inhibitors prevent spread of infectious virus i nto uninfected cells (True) Explanation: But not replication drug-resistant stra ins of virus have not been recognised (False) Explanation: As with zidovudine mo notherapy is preferred (False) Explanation: Survival rates improve with combinat ion regimens Question 49.

5% the relative risk i s 0.5 (True) Explanation: 50% relative risk reduction the number needed to treat is 200 (False) Explanation: 40 all patients with hypertension will benefit from this treatment (False) Explanation: Only patients similar to those in the trial benefit can be expected to be similar in following years of treatment (False) E xplanation: Can only be derived from continuing the RCT Question 2. H. both are metabo lised by xanthine oxidase metoclopramide delays gastric emptying and the rate of drug absorption (False) By A. Examples of pharmacokinetic interactions include the following allopurinol inhibits the meta bolism of azathioprine (True) Explanation: And 6-mercaptopurine. 200 patients with hypertension are treated with a new drug to prevent strokes and compared with 200 similar patients who are give n a placebo in a randomised controlled clinical trial (RCT). . Aminoglycoside drug therapy is ototoxic and nephroto xic (True) Explanation: Especially in the elderly is well absorbed orally (False ) Explanation: Negligible oral absorption must be monitored using plasma drug co ncentrations (True) Explanation: Serum levels and duration of therapy correlate with risk of toxicity is effective against anaerobes and Streptococcus faecalis (False) Explanation: No anti-anaerobic activity is very effective against Gram-n egative organisms (True) Question 53. The following antiviral agents are active against the following viruses ganciclovir-cytomegalovirus (True) amantadine-orthomyxovi rus (True) Explanation: Used in prophylaxis of influenza A ribavirin-respiratory syncytial virus (True) Explanation: Also active in Lassa fever zidovudine-retro virus (True) Explanation: Used in AIDS famciclovir-herpes simplex and herpes zos ter viruses (True) Explanation: Like aciclovir. useful orally or parenterally Mo dule 2 (Chapter 2) Question 1. Ciprofloxacin is highly active against the following microorganisms Escherichia coli (True) Haemophilus influenzae (True) Proteus mirabilis (True) Explanation: Active against most of the enterobacteria Streptococcus pneumoniae (False) Explanation: Only moderate activity Bacteroides fragilis (False) Question 54. After 1 year of tre atment 5 patients in the treatment group and 10 patients in the control group ha ve suffered a stroke.MCQs VIA WEB 2005 Explanation: Hence less likely to disrupt bowel flora Legionella pneumophila (Tr ue) Mycoplasma pneumoniae (True) Explanation: In appropriate dosage Clostridium welchii (True) Question 52. Which of the following statements are true? the absolute r isk reduction with treatment is 5% (False) Explanation: 2.

H. The f ollowing drugs exhibit high rates of hepatic clearance codeine phosphate (False) Explanation: Similar to paracetamol in this respect diazepam (False) Explanatio n: Low rates of clearance during its first passage through the liver simvastatin (True) Explanation: Lidocaine (lignocaine) is also rapidly cleared during its f irst passage through the liver ('first-pass' effect) propranolol (True) warfarin (False) Question 5. .g. The following d rugs should be avoided in severe renal failure gentamicin (False) Explanation: B ut reduce dose frequency and measure plasma concentrations daily oxytetracycline (True) Explanation: Induces protein catabolism and rapidly increasing uraemia m orphine (False) Explanation: But reduce both dose and dose frequency mesalazine (True) Explanation: Like all NSAIDs. The actions of the following drugs are enhanced in liver di sease warfarin (True) Explanation: Reduces the synthesis of clotting factors met formin (True) Explanation: Produces lactic acidosis chloramphenicol (True) Expla nation: Induces bone marrow suppression sulphonylureas (True) Explanation: Incre ase the risk of hypoglycaemia naproxen (True) Explanation: Like other NSAIDs. The following are statutory requiremen ts for the prescription of controlled drugs prescriptions must be typewritten no t written by hand (False) Explanation: Prescriptions must be written entirely in the prescriber's own handwriting. quinidine and am iodarone compete with digoxin for renal excretion the effect of methotrexate is inhibited by NSAID therapy (False) Explanation: Increased effect due to inhibiti on of renal tubular secretion of methotrexate renal lithium excretion is inhibit ed by diuretics (True) Explanation: Recommend a barrier method as well for patie nts on the contraceptive pill and taking antibiotics Question 3. reduces renal blood flow by prostaglandin i nhibition metformin (True) Explanation: Causes lactic acidosis Question 4. The following statemen ts about drug prescribing in elderly patients are true the error rate in patient s taking prescribed drugs is similar to that found in younger adults (False) Exp lanation: Error rates of up to 60% can be found in patients over the age of 60 y ears adverse drug reactions are more likely to occur than in younger adults (Tru e) Explanation: Adverse drug reactions are 2-3 times more common an increased pr oportion of body fat increases the accumulation of lipid-soluble drugs (True) Ex planation: Propranolol accumulation is also increased by reduced drug metabolism drug excretion is typically increased due to impaired urinary concentrating abi lity (False) Explanation: Impaired renal clearance associated with a reduced glo merular filtration rate is common metabolism of paracetamol reduces with advanci ng age (True) Explanation: As with other drugs (e. in ink By A. in creases the risk of gastrointestinal bleeding Question 6.MCQs VIA WEB 2005 Explanation: It increases the rate of gastric emptying digoxin and verapamil com pete for renal tubular secretion (True) Explanation: Similarly. theophylline and sedative d rugs) doses should be reduced Question 7.

nystagmus and drowsiness (True) severe systemic hypotension and respiratory depression (F alse) Explanation: Severe cardiorespiratory depression is rare nausea. dysarthria. . tinnitus and blurred vision (True) Explana tion: Common features hypokalaemia and respiratory alkalosis (True) Explanation: Due to hyperventilation hyperventilation.MCQs VIA WEB 2005 prescriptions must specify the patient's name and address (True) prescriptions m ust specify the prescriber's name and address (True) prescriptions must state th e dosage in both words and numbers (True) Explanation: Including the total quant ity. Typical f eatures following benzodiazepine poisoning include ataxia. The following treatments are clinically useful in poisoning with the following agents glucagons-â-blockers (True) DMPS (dimercaprol)-heavy metal poiso ns (True) Explanation: Useful in arsenic. Typical fea tures 6-8 hours after paracetamol poisoning include nausea and vomiting (True) E xplanation: Abdominal pain may develop coma and internuclear ophthalmoplegia (Fa lse) Explanation: Late features suggesting hepatic encephalopathy (after 3-5 day s) prolongation of the prothrombin time (False) Explanation: Rare before 24 hour s metabolic acidosis and hypoglycaemia (False) Explanation: Consequence of hepat ic necrosis (after 36 hours) prevention of liver damage with N-acetylcysteine th erapy (True) Explanation: But not useful beyond 15 hours Question 3. sweating and restlessness (True) peri pheral vasodilatation (True) Question 4. and form and strength of the drug prescriptions must be si gned and dated by the prescriber (True) Module 3 (Chapter 3) Question 1. Features of salicylate poisoning in an adult may include metabolic acidosis (True) Explanat ion: A poor prognostic sign deafness. vomiting and diarrhoea (False) By A. gold and mercury poisoning flumazenilopioid analgesics (False) Explanation: Used in benzodiazepine overdose N-acetylc ysteine-paracetamol (True) Explanation: As indicated by plasma paracetamol conce ntrations post-ingestion desferrioxamine-iron salts (True) Question 5. H. The use of oral activated charcoal is indicated following poisoning with paracetamol (T rue) Explanation: More effective if given early acetylsalicylic acid (True) Expl anation: More effective if given early and repeated 4-hourly ('gut dialysis') fe rrous sulphate (False) Explanation: Not absorbed by activated charcoal ethylene glycol (False) Explanation: Not absorbed by activated charcoal lithium carbonate (False) Explanation: Not absorbed by activated charcoal Question 2. number of doses.

headache and confusion marked central cyanosis ( False) Explanation: Usually skin pallor. patients may appear 'pink' due to carbo xyhaemoglobin hypotension and myocardial ischaemia (True) Explanation: Especiall y in patients whose coma is prolonged cognitive impairment and personality chang es following recovery (True) Explanation: Due to the effects of cerebral oedema and cerebral anoxia parkinsonian features following recovery (True) Explanation: Neuropsychiatric sequelae occur in 10% 2-4 weeks following recovery Module 4 (C hapter 4) Question 1. vomiting (False) Explanation: Com mon features include agitation. The following statements about pulmonary artery wedge pres sure (PAWP) monitoring are correct PAWP provides an indirect measure of left atr ial pressure (True) the normal range is 15-20 mmHg (False) Explanation: 6-12 mmH g the PAWP is reduced in acute left ventricular failure (False) Explanation: Inc reased.MCQs VIA WEB 2005 Explanation: Suspect mixed overdose convulsions. The following are true of cocaine poisoning hypothermia is a typic al feature (False) Explanation: Hyperthermia or pyrexia cerebellar signs may occ ur (True) Explanation: As may convulsions myocardial infarction occurs only in t he presence of abnormal coronary arteries (False) Explanation: They may be norma l activated charcoal is of benefit within 1 hour of ingestion (True) a dose of o ver 10 mg would usually be regarded as potentially fatal (False) Explanation: Ov er 1 g Question 7. The following statements about monitoring of pulmonary function are correct oxyg en saturation (SaO2) should be maintained in the range 75-85% (False) Explanatio n: Maintain > 90% the oxygenation index (PaO2/FIO2) is a useful measure of gas e xchange (True) Explanation: As is alveolar arterial oxygen gradient end-tidal al veolar CO2 concentration measures the effectiveness of ventilation (True) Explan ation: As does PaCO2 By A. muscle spasms and papilloedema (False) Explanation: Suspect alternative or mixed overdose resolution of symptom s and signs within < 6 hours of poisoning (False) Explanation: Usually < 24 hour s Question 6. H. vomiti ng and pallor (True) coma with widely dilated pupils (False) Explanation: Pinpoi nt pupils hypoventilation and respiratory arrest (True) hypotension and hypother mia (True) Explanation: Use naloxone non-cardiac pulmonary oedema (True) Explana tion: Characteristic and the commonest mode of death Question 8. sepsis and arrhythmias the optimum PAWP in acute circulatory failure is 12-15 mmHg (True) Question 2. air embolism. . often > 35 mmHg complications of monitoring include pulmonary artery rup ture (True) Explanation: Also pneumothorax. Typical feature s of carbon monoxide poisoning include nausea. Typical features of morphine poisoning include nausea.

Acute circulatory failure with an elevated central venous pressure are typical findings in acute pancreat itis (False) Explanation: Hypovolaemic shock occurs massive pulmonary embolism ( True) Explanation: Acute right ventricular failure ruptured ectopic pregnancy (F alse) acute right ventricular infarction (True) pericardial tamponade (True) By A.5 kPa. the peripheries are characteristically warm (Fa lse) Explanation: Peripheral cyanosis is characteristic massive pulmonary emboli sm typically presents with shock (True) Explanation: Due to central vessel obstr uction anaphylactic shock is associated with profound allergen-induced systemic vasoconstriction (False) Explanation: Vasodilatation occurs arteriovenous shunti ng is a significant contributory factor in septic shock (True) Explanation: Capi llary damage and vasodilatation also occur Question 7. H. Diagnostic criteria for the systemic inf lammatory response syndrome (SIRS) include temperature > 38°C or < 36°C (True) Expla nation: Sepsis may cause hypothermia as well as fever respiratory rate > 30/min (False) Explanation: > 20/min heart rate > 90/min (True) white cell count > 12 0 00 or < 4000/mm2 (True) PaCO2 < 4. approximately 10% of the haemoglobin will be saturated (False) Explanation: Around 50% increas ing the haemoglobin concentration of the blood will increase its oxygen content but not its partial pressure of oxygen (True) Explanation: Hb concentration and saturation are major determinants of O2 content Question 4.3 kPa (True) Question 6. a source of blood/ fluid loss is invariably apparent clinically (False) Explanation: Bleeding may b e internal in cardiogenic shock.MCQs VIA WEB 2005 measurement of oxygen saturation requires arterial blood sampling (False) Explan ation: Finger or earlobe spectrophotometry is satisfactory in most instances a d ecreasing cardiac output is likely to induce an abrupt fall in SaO2 (True) Quest ion 3. . The following statem ents about oxygen consumption are correct VO2 (global oxygen consumption) can be calculated from the PaO2 and the PaCO2 (False) Explanation: Calculated from ins piratory/expiratory gas analysis mixed venous oxygen saturation (SvO2) is the pu lmonary arterial oxygen saturation (True) Explanation: Equates to DO2 (oxygen de livery) . The following statements about oxygen transport in the blood are correct the amount of oxygen carried by haemoglobin is equal to that dissolved in the pl asma (False) Explanation: Hb carriage accounts for the majority an increase in P aCO2 shifts the oxygen/haemoglobin dissociation curve to the right (True) Explan ation: Bohr effect-facilitates unloading of O2 to tissues the optimum haemoglobi n concentration in a critically ill adult male is 15 g/dl (False) Explanation: 7 -10 g/dl to minimise hyperviscosity problems at a PaO2 = 3. The following stateme nts about shock syndromes are correct in severe hypovolaemia.VO2 (global oxygen consumption) SvO2 reflects the amount of oxygen not consumed by the tissues (True) oxygen saturation of venous blood from differing tissues is identical (False) Explanation: Varies depending on metabolic rate VO 2 rises 10-15% for every 1°C rise in body temperature (True) Explanation: Sepsis a nd trauma also increase VO2 Question 5.

In the management of raised intracranial pressure (ICP) normal ICP is < 15 mmHg (True) Explanation: A sustained pressure > 30 mmHg suggests a poor pr ognosis cerebral perfusion pressure = mean systemic arterial pressure minus intr acranial pressure (True) Explanation: Should be > 70 mmHg modest hyperglycaemia facilitates a decrease in ICP (False) Explanation: Glycaemic control should be s trict temporary hyperventilation reduces ICP (True) Explanation: Target (PaCO2 o f 4 kPa for 24 hours the patient should be nursed with 30° head-up tilt (True) Exp lanation: And avoid excessive neck flexion Module 5 (Chapter 5) Question 1. The expected effe cts of the following vasoactive drugs include nitroprusside-reduction in systemi c vascular resistance (True) Explanation: Blood pressure typically falls epopros tenol (prostacyclin)-increased pulmonary vascular resistance (False) Explanation : Reduces PVR isoprenaline-sinus tachycardia (True) Explanation: And moderate in crease in myocardial contractility dopamine-sinus bradycardia (False) Explanatio n: Usually tachycardia adrenaline (epinephrine)-increased splanchnic blood flow (False) Explanation: Typically declines Question 10. The histological features useful in distinguishing benign from malignant lesions inc lude a lower nuclear to cytoplasmic ratio (False) Explanation: Increased the pre sence of aberrations in nuclear morphology (True) the number of cell mitoses (Tr ue) Explanation: Increases with cell proliferation rate the presence of cellular invasion into surrounding tissues (True) Explanation: Evidence of metastatic sp read the number of mitochondria in the cell cytoplasm (False) By A. . The acute respiratory distress syndrome (ARDS) is characterised by m aintenance of a normal PaO2 despite profound dyspnoea (False) Explanation: Hypox aemia is a cardinal feature increased pulmonary compliance (False) Explanation: Compliance decreases a normal chest radiograph (False) Explanation: Diffuse infi ltrates are typical greatly elevated pulmonary artery wedge pressure (False) Exp lanation: Typically normal or slightly elevated elevated right heart pressure (T rue) Explanation: Pulmonary hypertension is common Question 9. The following statements ab out mechanical respiratory support are correct cardiac output increases with pos itive end-expiratory pressure (PEEP) (False) Explanation: Cardiac output often f alls PEEP helps correct V/Q mismatch (True) Explanation: Improves oxygenation in atelectatic areas continuous positive airways pressure (CPAP) requires intubati on (False) Explanation: A tightly fitting face or nasal mask can be used the cor rect position of an endotracheal tube is 4 cm above the carina (True) intermitte nt ventilation is useful in the transition to non-assisted ventilation (True) Qu estion 11.MCQs VIA WEB 2005 Question 8. H.

g .MCQs VIA WEB 2005 Question 2. The fol lowing statements about chemotherapy are true methotrexate is an antifolate-bloc king nucleotide synthesis (True) Explanation: An antimetabolite vincristine is a n alkylating agent blocking DNA transcription (False) Explanation: A mitotic spi ndle poison doxorubicin is a plant alkaloid which disrupts mitotic spindles (Fal se) Explanation: An antibiotic anticancer drug which acts primarily as a topoiso merase antagonist taxanes act as mitotic spindle poisons (True) Explanation: E. Useful serum tumour markers associated with the following diseases i nclude human chorionic gonadotrophin in testicular seminoma (False) Explanation: Useful in testicular germ cell tumours alpha fetoprotein in primary hepatocellu lar carcinoma (True) Explanation: And testicular germ cell tumours carcinoembryo nic antigen in bronchial adenoma (False) Explanation: Metastatic colorectal carc inoma placental alkaline phosphatase in cervical carcinoma (False) Explanation: There are no useful serum markers for cervical carcinoma CA-125 in breast carcin oma (False) Explanation: Useful in ovarian carcinoma Question 3. . docetaxel melphalan is an alkylating agent which blocks DNA replication (True) Explanation: And also blocks DNA transcription Module 6 (Chapter 6) Question 1. Malignant diseases that are potentially curable using co mbination chemotherapy include cervical cancer (True) squamous cell bronchial ca rcinoma (False) Explanation: Refractory to chemotherapy choriocarcinoma (True) E xplanation: Also testicular teratoma oesophageal carcinoma (False) Explanation: Resistant soft tissue sarcoma (False) Explanation: Resistant Question 5. The paraneoplas tic syndromes listed below are typical of the following tumours inappropriate AD H-adenocarcinoma of lung (False) Explanation: Small-cell carcinoma prothrombotic tendency-pancreatic carcinoma (True) polymyositis-gastric carcinoma (True) Expl anation: And ovarian and nasopharyngeal carcinoma myasthenia-like syndrome-small -cell anaplastic lung carcinoma (True) Explanation: Lambert-Eaton syndrome acant hosis nigricans-gastric carcinoma (True) Explanation: And other gastrointestinal malignancy Question 4. In the management of pain in patients with malignant diseases analgesia is best prescribed on an 'as required' basis (False) Explanation: Should be given regul arly NSAID therapy is particularly valuable in bone pain (True) Explanation: Aff ects prostaglandin metabolism controlled-release morphine has a 4-hour duration of action (False) Explanation: 12 hours respiratory depression is a common featu re of prolonged opiate use (False) Explanation: But can occur in acute dosing By A. H.

The following drugs have clinically useful a ntiemetic properties haloperidol (True) domperidone (True) Explanation: Blocks d opaminergic receptors ondansetron (True) Explanation: 5HT3 receptor antagonist d examethasone (True) Explanation: Given parenterally with chemotherapy etoposide (False) Explanation: Chemotherapeutic agent which causes nausea and vomiting Que stion 3. The following treatments may be of benefit in a patient with the follow ing cancer-related symptoms co-danthrusate-constipation (True) gabapentin-nausea (False) Explanation: Used for neuropathic pain trazodone-insomnia (True) Explan ation: A sedating antidepressant eicosapentanoic acid-anorexia (True) Explanatio n: If combined with a high-protein diet amitriptyline-neuropathic pain (True) Mo dule 7 (Chapter 7) Question 1. . The following interventions may be of va lue in a patient with falls oral fludrocortisone (True) Explanation: May help po stural hypotension occupational therapy home visit (True) Explanation: To improv e environmental safety programme of exercise training (True) soft cervical colla r (False) Explanation: May help vertebrobasilar insufficiency oral calcium and v itamin D (True) By A.MCQs VIA WEB 2005 opiates are of no value in neuropathic pain (False) Explanation: But other agent s may be more effective Question 2. GFR and medullary function increased chest wall rigidity (True) Question 2 . Expected physiological changes associated with no rmal ageing include decreased calcium phosphate content per 100 g bone (False) E xplanation: Bone mass declines (osteoporosis) but mineralisation is normal incre ased tissue sensitivity to insulin (False) Explanation: Reduced insulin sensitiv ity and glucose tolerance declines reduced numbers of pacing cells within the si noatrial node (True) Explanation: Limits ability to mount a tachycardia increase d glomerular filtration rate (GFR) (False) Explanation: Decreased number of neph rons. Likely causes of recurrent falls in the elderly include accidental slips and t rips (True) Explanation: Exacerbated by poor mobility postural hypotension (True ) Explanation: Often drug-induced vasovagal syncope (False) Explanation: More co mmon in the young Parkinson's disease (True) Explanation: Multiple factors invol ved acute myocardial infarction (False) Explanation: May present with a single f all but not recurrent falls Question 3. H.

Diseases mimicking anxiety disorders include alcohol withdrawal (True) Explanation: Delirium may also occur hyperthyroidism (True) Explanation: Exclud e biochemically hypoglycaemia (True) Explanation: Measure blood glucose temporal lobe epilepsy (True) Explanation: EEG may be necessary phaeochromocytoma (True) By A. memory and orientation Question 3. In the frailty syndrome the following domains are impaired musculosk eletal function (True) aerobic capacity (True) cognitive function (True) integra tive neurological function (True) nutritional status (True) Module 8 (Chapter 8) Question 1. bereavement. i llusions and hallucinations cognitive function (True) Explanation: Concentration . suicidal ide ation speech and thought content (True) Explanation: Paranoid.g. Important factors in the assessment of mental state include appearance and behaviour (True) Explanati on: Including motor retardation mood state (True) Explanation: E. H. grandiose or depr essive abnormal perceptions and beliefs (True) Explanation: Depersonalisation. firmly held.MCQs VIA WEB 2005 Explanation: Help reduce the risk of fall fractures Question 4. redundancy.g. a single gene disorder is ide ntified parental loss or disharmony in childhood (True) Explanation: Especially physical or sexual abuse stressful life events and difficulties (True) Explanati on: E. The following psychiatric definitions are t rue delusions-abnormal perceptions of normal external stimuli (False) Explanatio n: Illusions illusions-unreasonably persistent. retirement chronic physical ill health (True) Explanation: Also acute severe physical illness social isolation (True) Explanat ion: Particularly lack of a close relationship Question 2. . Aetiological factors in psychiatric illness include family history of psychiatric illness (True) Explanation: Rarely. false beliefs (Fals e) Explanation: Delusions hallucinations-abnormal perceptions without external s timuli (True) Explanation: Suggest psychosis depersonalisation-perception of alt ered reality (True) Explanation: Often with derealisation phobia-abnormal fear l eading to avoidance behaviour (True) Explanation: Typical pattern in neurosis Qu estion 4.

Factors associated with a higher suicide risk following attempted su icide include females aged < 45 years (False) Explanation: Older males self-pois oning rather than more violent methods of self-harm (False) Explanation: Self-po isoning is frequently parasuicidal absence of a suicide note or previous suicide attempts (False) Explanation: Suicide note often left and usually a history of previous attempts chronic physical or psychiatric illness (True) Explanation: An d drug or alcohol misuse living alone and/or recently separated from partner (Tr ue) Explanation: Or bereavement Question 6. Cardinal elements in cognitive thera py include restructuring psychological conflicts and behaviour (False) Explanati on: Undertaken in psychotherapy identification of negative patterns of automatic thoughts (True) Explanation: E. mood and behaviour (True) Explanation: Altering thoughts may alter b ehaviour reorientation of negative views of the past. self-esteem and hope (True) Explanat ion: 'Anhedonia'-loss of sense of enjoyment loss of energy. H. dizziness.g. sweating and palpitation (True) By A. The typical features of alcohol dependence include expansion of the drinking reperto ire (False) Explanation: Narrowing of choices of alcoholic beverages increasing tolerance of alcohol (False) Explanation: Decreasing tolerance subjective compul sion to drink (True) use of alcohol to relieve withdrawal symptoms (True) Explan ation: Classical recurrent withdrawal symptoms (True) Question 8. present and future (True) Explanation: And development of positive views personality assessment and transa ctional analysis (False) Explanation: Features of psychotherapy Question 7. libido and interest (True) Explanation: Perhaps with other somatic symptoms psychomotor retardation and suicidal thoughts (True) Explanation: With delusions of worthlessness Questi on 9. The typical fe atures of depression include depressed mood for most of the day (True) Explanati on: But diurnal variation may occur insomnia or hypersomnia (True) Explanation: Or early morning wakening loss of pleasure. Clinical features of generalised anxiety disorders include feelings of wor thlessness and excessive guilt (False) Explanation: Suggest depression depersona lisation and derealisation (True) Explanation: May be seen in affective disorder s feelings of apprehension and impending disaster (True) Explanation: With irrit ability breathlessness. in depression awareness of connections betwee n thoughts.MCQs VIA WEB 2005 Explanation: Rare-measure urinary catecholamines Question 5. .

Typical features of ano rexia nervosa include only adolescent girls are affected (False) Explanation: Ei ther sex. In a normal 65 kg man. phosphate and sulphate ions are mainly extracellular (False) Explanation: Int racellular Question 2. bicarbonate and chloride ions are mainly intracellular (False) Explanation: Extracellular potassium. . 75% interstitial sodium. Typical causes of hyponatraemia include diabetes insipidu s (False) Explanation: But may be seen in the syndrome of inappropriate antidiur etic hormone (ADH) secretion hepatocellular failure (True) Explanation: Water re tention exceeds sodium retention psychogenic polydipsia (True) Explanation: Incr eased total body water Cushing's syndrome (False) Explanation: But seen in adren ocortical insufficiency diuretic drug therapy (True) Explanation: Salt loss exce eds water loss Question 3. The following statements about potassium balance ar e true 85% of the daily potassium intake is excreted in the urine (True) intrace llular potassium ion concentrations are about 150 mmol/l (True) Explanation: Com pared with extracellular concentrations of about 4 mmol/l By A. magnesiu m. the following statements are true t otal body water is approximately 40 litres (True) Explanation: Relatively consta nt in health 70% of the total body water is intracellular (True) Explanation: Ap proximately 28 litres 75% of extracellular water is intravascular (False) Explan ation: 25% intravascular. H. rarely non-adolescent amenorrhoea or loss of libido > 3 months (True) Explanation: With avoidance of high-calorie foods weight loss > 25% or weight < 25% below normal (True) Explanation: In contrast to bulimia nervosa normal perce ption of body weight and image (False) Explanation: Emaciation is unrecognised b y the patient progression to death in 20% (False) Explanation: In 5% Module 9 (C hapter 9) Question 1.MCQs VIA WEB 2005 Explanation: Typical somatic symptoms claustrophobia and agoraphobia (False) Exp lanation: Features of phobic anxiety states Question 10. Predominant water depletion is a recognised complicat ion of primary hyperparathyroidism (True) Explanation: Renal tubular insensitivi ty to ADH toxic confusional states (True) Explanation: Inadequate intake oesopha geal carcinoma (True) Explanation: Inadequate intake lithium therapy (True) Expl anation: Renal tubular insensitivity to ADH enteral feeding (True) Explanation: High solute load Question 4.

excretion increased cardiac failure (True) Explanation: Secondary hyperaldosteronism corticosteroid treatment (True) Explan ation: Mineralocorticoid-like effect renal tubular acidosis (True) Explanation: Primary or secondary tubular defect. H. Metabolic acidosis woul d be an expected finding in chronic alveolar hyperventilation (False) Explanatio n: Chronic respiratory alkalosis acute insulin deficiency (True) Explanation: Di abetic ketoacidosis acute inflammatory polyneuropathy (Guillain-Barré syndrome) (F alse) Explanation: Acute respiratory acidosis due to alveolar hypoventilation fa ilure of distal renal tubular hydrogen ion secretion (True) Explanation: Distal (type I) renal tubular acidosis methanol poisoning (True) Question 9.MCQs VIA WEB 2005 cellular uptake of potassium is enhanced by adrenaline and insulin (True) alkalo sis predisposes to hyperkalaemia (False) the normal dietary potassium intake is about 100 mmol per day (True) Question 5.26% sodiu m bicarbonate i. . Recognised causes o f potassium depletion include metabolic alkalosis (True) Explanation: Renal tubu lar cell K+ concentration increased. Hyperkalaemia is a recognised finding in severe untreated diabetic ketoacidosis (True) Explanation: Insulin promotes m ovement into the cells primary hypoadrenalism (True) Explanation: Impairment of secretion in the distal nephron rhabdomyolysis (True) Explanation: Increased tis sue breakdown prostaglandin inhibitor therapy in renal impairment (True) Explana tion: Especially if given with an ACE inhibitor angiotensin-converting enzyme (A CE) inhibitor therapy (True) Explanation: Avoid concurrent supplementation Quest ion 6. The emergency treatment of severe hyperkalaemia should include dietary re striction of coffee and fruit juices (False) Explanation: But may be necessary t o prevent recurrence parenteral dextrose and glucagon therapy (False) Explanatio n: Give parenteral dextrose and insulin parenteral calcium gluconate therapy (Tr ue) Explanation: Cardioprotective effect restoration of sodium and water balance (True) Explanation: Also correct metabolic acidosis if present with 1. Metabolic alkalosis may be caused by hyperventilation (False) Explanation: Respiratory alk alosis aspiration of gastric contents (True) Explanation: Or vomiting mineraloco rticoid deficiency (False) By A.v. Calcium Resonium orally and/or rectally (True) Explanation: T he resin binds potassium in exchange for calcium Question 7. also occurs with activation of renin and an giotensin amiloride diuretic therapy (False) Explanation: Causes hyperkalaemia b y an effect on the distal convoluted tubules Question 8.

A healthy daily diet for a slim man with a physical job should include 1500 kcal (8.5 MJ or 600 kcal deficit/day = 17.5 MJ (6 00 kcal) per day achieve a theoretical weight loss of at least 2 kg per week (Fa lse) Explanation: 0.5 MJ (600 k cal) per day (False) Explanation: Aim to reduce intake by no more than 2. cessation of smo king reduce carbohydrate intake much more than total fat intake (False) Explanat ion: Fat restriction < 50 g/day (calorific values fat = 38 KJ or 9 kcal/g.3 MJ (2700 kcal) 60% of total energy requirements as carbohydrat e (True) Explanation: 55-75% no less than 10 g salt per day (False) Explanation: No more than 6 g/day 35 g of dietary fibre (True) Explanation: 27-40 g/day no m ore than 10% of total energy requirements as fat (False) Explanation: 15-30% Que stion 2.6 kg human tissue) aim to achieve a weight loss of 10% (True) Explanation: Sufficient to achieve a significant improvement in health be part of a multiple risk factor intervention (True) Explanation: E. H. The benefits of a sustained 10 kg weight reducti on in the obese include fall in the blood pressure of 10 mmHg (systolic) and 20 mmHg (diastolic) (True) By A.4 MJ) (False) Explan ation: About 11. Magnesium deficiency is a cause of confu sion.MCQs VIA WEB 2005 Explanation: Can produce mild acidosis excessive liquorice ingestion (True) Expl anation: Due to excessive mineralocorticoid activity diuretic therapy (True) Exp lanation: And hypokalaemia Question 10.15 MJ or 4200 kcal/week = 0. Recognised medical complications of weight gain include osteoporosis (F alse) Explanation: Bone density increases rheumatoid arthritis (False) Explanati on: Osteoarthritis gallstones (True) Explanation: Often asymptomatic type 2 diab etes mellitus (True) Explanation: With insulin resistance hyperlipidaemia (True) Explanation: And coronary artery disease Question 3. Ideal weight-reducing diet s in the treatment of moderate obesity should provide no more than 2. depression and epilepsy (True) Explanation: And tremor and choreiform move ments usually due to prolonged vomiting and diarrhoea (True) Explanation: Also f rom chronic diuretic therapy found in uncontrolled diabetes mellitus and alcohol ism (True) Explanation: Excess losses in the urine found in primary hyperparathy roidism and hyperaldosteronism (True) Explanation: Including secondary hyperaldo steronism best treated with oral magnesium sulphate (False) Explanation: Very po orly absorbed orally Module 10 (Chapter 10) Question 1. CHO = 17 KJ or 4 kcal/g) Question 4.g.5 kg per week (2. .

The actions of the lipid-lowering drugs include the following the statins inhibit HMG CoA reductase and reduce cholesterol synthesis (True) Explanation: I ncrease LDL catabolism the statins increase plasma LDL and triglycerides (False) By A.MCQs VIA WEB 2005 reduction in total mortality of 20-25% (True) reduction in fasting glucose of 15 % (False) Explanation: 50% reduction in total cholesterol of 50% (False) Explana tion: Reduction in total cholesterol of 10% reduction in high-density lipoprotei n cholesterol of 8% (False) Explanation: Increases by 8% Question 5. not present in the normal fasting plasma very lowdensity lipoprotein transports endogenous triglycerides (True) Explanation: VLDL is synthesised in the liver and is the precursor of LDL low-density lipoprotein transports cholesterol (True) Explanation: Generated from VLDL in the blood str eam high-density lipoprotein transports cholesterol from the peripheral tissues to the liver (True) low-density lipoprotein is important for the excretion of ch olesterol and is cardioprotective (False) Explanation: HDL aids cholesterol excr etion and is cardioprotective Question 7. the following findings are typical chylomicronaem ia in types I and V (True) Explanation: Risk of pancreatitis with both types I a nd V but no atherogenic risk hypertriglyceridaemia in types III. Drug therap ies known to increase appetite and body weight include orlistat (False) Explanat ion: Has a role in promoting weight loss fenfluramine (False) Explanation: But s ide-effects preclude use amitriptyline (True) fluoxetine (False) Explanation: St imulates satiety and can help some patients lose weight sibutramine (False) Expl anation: Can support weight loss Question 6. In the class ification of hyperlipidaemias. Common causes of secondary hyperlipida emia include chronic renal failure (True) Explanation: Increases triglycerides a nd VLDL but decreases HDL diabetes mellitus (True) Explanation: Increases trigly cerides and VLDL but decreases HDL hyperthyroidism (False) Explanation: Hypothyr oidism increases cholesterol and LDL alcohol misuse (True) Explanation: Increase s triglycerides. III and IV (True) Explanation: And all are associated wi th increased atherosclerosis tendon xanthomata in type IIa hypercholesterolaemia (True) Explanation: And premature coronary atherosclerosis defective LDL catabo lism and receptor binding in type V hyperlipidaemia (False) Explanation: Defecti ve LDL receptor gene is typical of type II familial hypercholesterolaemia Questi on 9. The function of the main lipoprotei ns include the following chylomicrons transport mainly cholesterol (False) Expla nation: Mainly triglycerides. . IV and V (True) Explanation: Triglycerides variably abnormal in all except type IIa hypercholes terolaemia in types II. VLDL and HDL thiazide diuretics (True) Question 8. H.

bradycardia is the rule Question 11. Vitamin A is a fat-soluble vitamin (True) Explanation: A. E . N. hair loss and covert infection (True) Explanation: Adolescents may maintain hair growth cerebral atrophy and sinus tachycardia (False) Explanat ion: Brain weight is preserved. . cold intoleran ce and diarrhoea (True) Explanation: And weakness.B. amenorrhoea or impotence skin depigmentation. stoma titis and anorexia in marasmus (False) Explanation: Features of kwashiorkor asso ciated zinc deficiency in kwashiorkor (True) Explanation: Contributing to dermat osis Question 12.MCQs VIA WEB 2005 Explanation: Decrease plasma LDL and cholesterol nicotinic acid increases lipoly sis and lowers HDL (False) Explanation: Decreases lipolysis and plasma triglycer ides but increases plasma HDL fibrates increase VLDL lipolysis (True) Explanatio n: Decrease plasma triglycerides and plasma LDL and increase plasma HDL colestip ol diverts hepatic cholesterol synthesis into an increased bile acid production (True) Explanation: Like colestyramine. and K are the fat-soluble vitamins present as retinol in carrots and certain g reen vegetables (False) Explanation: Occurs as retinol in animal produce and as carotene in plants the treatment of choice in xerophthalmia and keratomalacia (T rue) Explanation: Both conditions are the result of vitamin A deficiency and lea d to blindness associated with teratogenicity if administered in pregnancy (True ) present in high concentrations in fish liver oils (True) Explanation: Present as retinol Question 13. B MI is calculated from the formula weight (kg) ÷ height2 (m) oedema in the absence of hypoalbuminaemia (True) Explanation: 'Famine oedema' nocturia. Deficiency of the following B vitamins is associated with the disorders listed below niacin-pellagra (True) By A. H. The clinica l features of protein-energy malnutrition in children include marked muscle-wast ing and abdominal distension in marasmus (True) Explanation: And absence of oede ma weight loss more than growth retardation in marasmus (True) Explanation: Weig ht < 60% standard for age hepatic steatosis and hypoproteinaemic oedema in kwash iorkor (True) Explanation: With low plasma lipids desquamative dermatosis. Vitamin D is present in high concentrations in dairy pro ducts (False) Explanation: Some margarines are fortified is non-essential in the diet given adequate sunlight exposure (True) Explanation: But less efficiently produced in old age like vitamin A is stored mainly in the liver (False) Explana tion: But metabolism partly occurs in the liver is converted from cholecalcifero l to 1.25-dihydroxycholecalciferol (True) Explanation: 1-alpha hydroxylation occ urs in the kidney and 25-hydroxylation in the liver enhances calcium absorption by the induction of specific enterocyte transport proteins (True) Explanation: A nd stimulates osteoclast proliferation Question 14. it blocks bile acid reabsorption in the gut Question 10. D. Clinical features of protein-energy malnutrition in adults incl ude a body mass index of between 20 and 22 (False) Explanation: BMI < 16.

In the chromosomal disorders ane uploidy is the addition or loss of a chromosome (True) Explanation: The most com mon form of numerical chromosome aberration deletions arise from the loss of a s egment of a chromosome (True) the majority of affected conceptions result in mis carriage (True) Explanation: Liveborn frequency is 0. diarrhoea and dementia pyridoxine-isoniazid-induced per ipheral neuropathy (True) Explanation: Add to anti-tuberculosis regimens using i soniazid pyridoxine-haemolytic anaemia (False) Explanation: Sideroblastic anaemi a may respond riboflavin-angular stomatitis (True) Explanation: And also nasolab ial seborrhoea riboflavin-cheilosis (True) Explanation: Also seen in niacin defi ciency Question 15. In polycystic kidney disease By A. Disorders associated with amyloid deposition includ e familial Mediterranean fever (True) Explanation: Reactive (AA) amyloidosis bro nchiectasis (True) chronic haemodialysis (True) Alzheimer's disease (True) Expla nation: Also the spongiform encephalitides rheumatoid arthritis (True) Explanati on: Reactive AA amyloidosis Module 11 (Chapter 11) Question 1. In humans somatic cell nuclei contain 22 pairs of homologous autosomes (True) Explanation: In add ition there are 2 X chromosomes in females and 1 X and 1 Y in males gamete nucle i are haploid with a single X or Y chromosome (True) Explanation: In contrast to somatic cell nuclei which are diploid the haploid male cell (sperm) contains 22 autosomes and a Y chromosome (False) Explanation: The haploid male cell (sperm) may contain an X or a Y chromosome the long and short arms of a chromosome meet at the telomere (False) Explanation: Centromere both X chromosomes in females a re genetically active (False) Explanation: One X chromosome is inactive and appe ars as the Barr body in the nucleus Question 2.6% identical deletions prod uce the same effects whether inherited from father or mother (False) Explanation : Gene expression can be affected by the parental origin of the abnormal chromos ome translocation is the exchange of segments between chromosomes (True) Explana tion: No genetic material is lost Question 3. H.MCQs VIA WEB 2005 Explanation: Dermatitis. . In the classification of acute and non-acute porphyrias ä-amin olaevulinic acid synthetase activity is increased in all porphyrias (True) Expla nation: Rate-limiting step in biosynthesis of haem porphobilinogen deaminase act ivity is reduced in acute porphyrias (True) Explanation: Porphobilinogen accumul ates neuropsychiatric features are typical of the non-acute porphyrias (False) E xplanation: Typical of acute porphyria photosensitivity is typical of the acute porphyrias (False) Explanation: Typical of the non-acute porphyrias variegate po rphyria and coproporphyria are mixed porphyrias (True) Explanation: Both are hep atic porphyrias Question 16.

MCQs VIA WEB 2005 inheritance is commonly autosomal dominant (True) hepatic cysts commonly coexist (True) intracranial aneurysms are present in 70% of patients (False) Explanatio n: Incidence = 10% DNA testing is useful in determining the presence of PKD1 mut ations (False) renal ultrasound after the age of 18 is the best screening test ( True) Explanation: Detects > 95% of individuals Question 4. The karyotype of a n ormal male is 45. +21 male with Klinefelter's syndrome is 47. -21 (False) Explanation: 47. Given a husband with haemophilia and his unaffected wife none of their sons w ill be affected (True) Explanation: Absence of male to male transmission is a ke y feature of all X-linked inheritance all of their daughters will carry the haem ophilic gene (True) a daughter with Turner's syndrome may also have haemophilia (True) Explanation: If the X chromosome is inherited from the father all of his sisters will be carriers (False) Explanation: 50% of his sisters will be carrier s and 50% normal his maternal grandfather could have had haemophilia (True) Expl anation: All the female children of an affected grandfather would carry the gene Question 8. XY. H. +18 (False) Explanation: 47. In autosomal dominant inheritance affected individua ls are usually heterozygotes (True) affected individuals rarely have an affected parent (False) Explanation: Parent is almost always affected male offspring are more likely to be affected than female (False) Explanation: An equal chance una ffected children of an affected parent have a 50% chance of transmitting the con dition (False) Explanation: Unaffected children are free of the mutant gene clin ical disease is always found in genetically affected individuals (False) Explana tion: Some affected individuals are clinically normal-'non-penetrance' Question 7. The following disorders are caused by single gene disorders cleft l ip (False) Explanation: Multifactorial disorder sickle-cell anaemia (True) Expla nation: Autosomal recessive By A. XX. XXY (True) female with Turner's syndrome is 45. XX. XY (False) Explanation: 46. XX. XO (True) male with trisomy 18 (Edwards' syndrome) is 47. . The following conditions arise as a result of the noted genetic abnormality haemochromatosis-DNA point mutation (True) Explanation: HFE gene cystic fibrosis -DNA point mutation (False) Explanation: Three base-pair deletion Huntington's d isease-triplet repeat expansions (True) Explanation: On 4p16 Down's syndrome-chr omosomal deletion (False) Explanation: Chromosomal aneuploidy (trisomy 21) DiGeo rge syndrome-chromosomal microdeletion (True) Explanation: The commonest microde letion syndrome Question 6. +18 Question 5. XY female with Down's syndrome is 46.

In the normal ECG depolarisation proceeds from epicardium to e ndocardium (False) Explanation: Proceeds from endocardium to epicardium depolari sation away from the positive electrode produces a positive deflection (False) E xplanation: Produces a negative deflection depolarisation of the interventricula r septum is recorded by the Q wave in V5 and V6 (True) Explanation: Absent in le ft bundle branch block (BBB) the aVR lead = right arm positive with respect to t he other limb leads (True) Explanation: Hence the predominant S wave as depolari sation moves away from aVR voltage amplitudes vary with the thickness of cardiac muscle (True) Explanation: An aid to the diagnosis of left ventricular hypertro phy Question 5. pros taglandins and nitric oxide Question 3. In the normal electrocardiogram (ECG) th e PR interval is measured from the end of the P wave to the beginning of the R w ave (False) Explanation: Measured from the start of the P wave to the start of t he R wave each small square represents 40 milliseconds at a standard paper speed of 25 mm/sec (True) the heart rate is 75 per minute if the R-R interval measure s 4 cm (True) Explanation: Heart rate = 1500/R-R interval (mm) or 300/R-R interv al (cm) R waves become progressively larger from leads V1-V6 (True) Explanation: Reflecting the electrical dominance of the left ventricle the P wave represents sinoatrial node depolarisation (False) Explanation: Represents atrial depolaris ation Question 4. With regard to cardiovascular physiology cardiac output is appro ximately 10 l/min at rest (False) Explanation: Measured in l/min (70/min × 700 ml = 5 l/min) coronary blood vessels are innervated only by the parasympathetic ner ves (False) Explanation: Also by sympathetic-both have dominant vasodilating eff ect intracoronary acetylcholine provokes vasoconstriction if atheroma is present (True) Explanation: But endothelial-derived relaxing factor (EDRF)-mediated vas odilatation occurs in normal vessels an atheromatous coronary lesion restricts b lood flow during exercise if > 40% (False) Explanation: Must be > 70% bradykinin is an endogenous vasodilator (True) Explanation: Others include adenosine.5 By A.75 (False) Explanation: The CTR should not be > 0. In the investigation of patients with suspected heart disease th e normal upper limit for the cardiothoracic ratio (CTR) on chest radiograph is 0 . .MCQs VIA WEB 2005 retinitis pigmentosa (True) cystic fibrosis (True) Explanation: Autosomal recess ive familial hypercholesterolaemia (True) Explanation: Autosomal dominant Module 12 (Chapter 12) Question 1. H. In the normal human heart the atrioventricular (AV) node is usually supplied by the left circumflex coronary artery (False) Explana tion: Supplied by the right coronary artery in 90% â1-adrenoceptors mediate chrono tropic responses (True) Explanation: These receptors also mediate inotropic resp onses pulmonary artery systolic pressure normally varies between 90 and 140 mmHg (False) Explanation: Varies between 15 and 30 mmHg in health the annulus fibros us aids conduction of impulses from the atria to the ventricles (False) Explanat ion: Restricts electrical connections between the atria and ventricles to the AV node cardiac output is the product of heart rate and ventricular end-diastolic volume (False) Explanation: The product of heart rate and ventricular stroke vol ume Question 2.

In a patient with central chest pain at rest intrasc apular radiation suggests the possibility of aortic dissection (True) Explanatio n: As does a tearing quality postural variation in pain suggests the possibility of pericarditis (True) Explanation: As does variation with respiration chest wa ll tenderness is a typical feature of Tietze's syndrome (True) Explanation: The syndrome is a form of costochondritis relief of pain by nitrates excludes an oes ophageal cause (False) Explanation: And oesophageal pain may also be precipitate d by exercise features of autonomic disturbance are specific to cardiac pain (Fa lse) Explanation: May occur in severe pain from any cause Question 8. weight gain due to oedema is more common epigastric pain (True) Explanation: Due to hepatic and gastrointestinal congest ion nocturia (True) Explanation: Diuresis is induced by adopting the supine posi tion nocturnal cough (True) Explanation: A manifestation of pulmonary congestion Question 10. With regard to angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors reduce the conversion of angiotensinogen to angiotensin I (False) Exp lanation: Angiotensin I to angiotensin II By A. arms or back rarely lasts longer than 10 seconds after resting (False) Explanation: Rapid res olution is atypical-pain usually lasts for minutes is easily distinguished from oesophageal pain (False) Explanation: Oesophageal pain may mimic angina-precipit ation by swallowing may be useful invariably worsens as exercise continues (True ) Explanation: Can disappear as exercise continues-'second wind' effect ('walk t hrough' angina) Question 7. The pain of myocardial ischaemia is typically in duced by exercise and relieved by rest (True) Explanation: Typical chest pain oc curring at rest does not exclude myocardial ischaemia radiates to the neck but n ot the jaw (False) Explanation: May also radiate to the shoulders. Recognised features of severe cardiac failure include tiredness (T rue) Explanation: Due to severe reduction in cardiac output weight loss (True) E xplanation: 'Cardiac cachexia'-however. . H. In the tre atment of cardiac failure associated with acute pulmonary oedema controlled oxyg en therapy should be restricted to 28% oxygen in patients who smoke (False) Expl anation: High-flow oxygen in concentrations > 35% should be administered morphin e reduces vasoconstriction and dyspnoea (True) furosemide (frusemide) therapy gi ven intravenously reduces preload and afterload (True) nitrates should be avoide d if the systolic blood pressure < 140 mmHg (False) Explanation: Can safely be u sed with systolic pressures > 110 mmHg ACE inhibitors decrease the afterload but increase the preload (False) Explanation: Both preload and afterload are reduce d Question 9.MCQs VIA WEB 2005 a negative exercise ECG excludes the diagnosis of ischaemic heart disease (False ) Explanation: False negative tests occur in 15-20% a 'step-up' in oxygen satura tion at cardiac catheterisation suggests an intracardiac shunt (True) Doppler ec hocardiography reliably assesses pressure gradients between cardiac chambers (Tr ue) Explanation: Pressure gradients can be extrapolated from measuring intracard iac flow velocities radionuclide blood pool scanning accurately quantifies left ventricular function (True) Explanation: Ejection fraction is usually measured u sing this technique Question 6.

MCQs VIA WEB 2005 enalapril has a longer half-life than lisinopril (False) Explanation: Converted to enalaprilat in the liver cough is a less common side-effect of ACE inhibitors than angiotensin II antagonists (False) Explanation: Cough is a more common sid e-effect of ACE inhibitors-probably due to bradykinin accumulation first-dose hy potension occurs less commonly in patients pretreated with diuretics (False) Exp lanation: Omitting diuretics pretreatment minimises risk treatment is of no bene fit until symptomatic left ventricular systolic dysfunction has developed (False ) Question 11. irregularity and tortuosity are detectable aortic dissection ( True) renal artery stenosis (True) Explanation: Hypertension predisposes to athe roma formation lacunar strokes of the internal capsule (True) subdural haemorrha ge (False) Explanation: Hypertension predisposes to intracerebral and subarachno id haemorrhage Question 13. H. Recognised causes of secondary hypertension include persistent ductus arteriosus (False) Explanation: In contrast to coarctation of the aorta primary hyperaldosteronism (True) Explanation: Conn's syndrome acromeg aly (True) oestrogen-containing oral contraceptives (True) Explanation: And preg nancy thyrotoxicosis (True) Question 14. In the management of chronic heart failure ACE inhibitor therapy reduces subsequent hospitalisation rates (True) Explanation: And reduces mortali ty coagulation is impaired and thromboembolic risk therefore declines (False) Ex planation: Other factors favouring thromboembolism outweigh this effect salt res triction may be beneficial (True) â-adrenoceptor antagonists (â-blockers) should alw ays be avoided (False) Explanation: There is evidence that they reduce mortality in some patients digoxin is only of benefit if atrial fibrillation coexists (Fa lse) Explanation: Reduces need for hospitalisation Question 12. Complications of systemic hypertension include retinal microaneurysms (False) Explanation: Arter iolar thickening. In the treatment of systemic hypertensi on treatment has more effect on the risk of stroke than the risk of coronary hea rt disease (CHD) (True) Explanation: 30% reduction in stroke. . Important explanations for hypertension refractory to medical therapy include poor compliance with drug therapy (True) inadequate drug therapy (True) Explanation: Common particularly in asymptomatic patients phaeoc hromocytoma (True) Explanation: But rare primary hyperaldosteronism (True) Expla nation: Conn's syndrome is suggested by a hypokalaemic alkalosis By A. 20% in CHD thresho lds for treatment are higher in the elderly (False) Explanation: Absolute risk i s higher treatment is less likely to be of benefit if cardiac or renal disease i s present (False) there are no proven benefits of therapy in patients aged over 70 years (False) Explanation: Good evidence of efficacy in the elderly moderatio n of alcohol consumption is likely to improve blood pressure control (True) Expl anation: Excessive consumption of alcohol is a significant factor in 10-15% of h ypertensives Question 15.

3:1 or variable an atrial rate of 300/min (False) Explanati on: Atrial rate is 140-220/min presence of P waves identical to those found duri ng sinus rhythm (False) Explanation: An ectopic atrial focus with abnormal P wav es digoxin toxicity and intracellular potassium depletion (True) bizarre broad Q RS complexes on ECG (False) By A. a common finding in elderly patients Question 19. The auscultatory findings listed below are associated with the followin g phenomena third heart sound-opening of mitral valve (False) Explanation: Occur s in mid-diastole due to rapid ventricular filling varying intensity of first he art sound-atrioventricular dissociation (True) Explanation: Due to variations in stroke volume soft first heart sound-mitral stenosis (False) Explanation: Typic ally loud in mitral stenosis reversed splitting of second heart sound-left bundl e branch block (True) Explanation: Due to delayed closure of the aortic valve co mpared with the pulmonary valve fourth heart sound-atrial fibrillation (False) E xplanation: Coincides with atrial contraction and hence cannot occur in atrial f ibrillation Question 17.MCQs VIA WEB 2005 renal artery stenosis (True) Explanation: May also develop during follow-up Ques tion 16. H. In cardiac arrest a sharp blow to the praecordium may be useful (True) Explanation: In witnessed arrest only asystole is the commonest finding on ECG (False) Expla nation: Ventricular fibrillation is the commonest underlying arrhythmia a normal ECG may suggest profound hypovolaemia (True) Explanation: A cause of 'electrome chanical' dissociation if cardioversion fails. Syncope followed by facial flushing suggests a tachyarr hythmia (False) Explanation: Suggests episodic bradycardia.5% a common presenting feature of the sick sinus syndrome (True) Explanation: Episodes of sinus bradycardia or sinus arrest may coexist making drug therapy difficult usually associated with a ventricular rate < 100/min before treatment (False) Explanation: Indicates con comitant AV nodal disease. Atrial tachycardia is typically associated with 1:1 AV conduction (Fals e) Explanation: 2:1. .Adams-Stokes attacks without warning suggests a vasovagal episode (False) Explanation: Nausea and li ghtheadedness typically precede vasovagal attacks on exercise is a typical featu re of mitral regurgitation (False) Explanation: Exertional syncope is a feature of severe aortic stenosis can sometimes be treated by â-blockers (True) may be a f eature of Parkinson's disease (True) Explanation: Due to severe postural hypoten sion Question 18. Atrial fibrillation (AF) is present in 10% of the elderly popu lation over the age of 75 years (True) usually readily converted to permanent si nus rhythm using DC cardioversion (False) Explanation: Underlying structural hea rt disease is common and promotes the recurrence of AF associated with an annual stroke risk of 5% if structural heart disease is present (True) Explanation: Wa rfarin therapy reduces the annual risk to about 1. intracardiac adrenaline (epinephr ine) should be given (False) Explanation: Adrenaline (epinephrine) should be giv en intravenously the compression to ventilation ratio should be 15:2 (True) Ques tion 20.

sotalol and amiodarone Question 25.g. the following statements are t rue class I agents inhibit the fast sodium channel (True) Explanation: E. variable PR (Wenckebach's phenomenon) = Mobitz type I decreas ing PR intervals suggest Wenckebach's phenomenon (False) Explanation: PR interva ls gradually increase irregular cannon waves in the jugular venous pressure sugg est complete heart block (True) Explanation: Due to AV dissociation the QRS comp lex in complete heart block is always broad and bizarre (False) Explanation: Can be narrow if the escape rhythm arises from within the bundle of His Question 24 .g. In ventricular tachycardia (VT) underlyi ng cardiac disease is usually present (True) Explanation: Often ischaemic heart disease amiodarone is useful in the prevention of recurrent episodes (True) Expl anation: A class III agent a shortened QT interval on ECG predisposes to recurre nt episodes (False) Explanation: A prolonged QT interval predisposes to recurren t VT carotid sinus massage usually slows the cardiac rate transiently (False) Ex planation: No effect on cardiac rate complicated by acute cardiac failure. nifedipine many anti-arrhythmic agents have actions in more than one cl ass (True) Explanation: E. H. ve rapamil.g. amiodar one class IV agents inhibit the slow calcium channel (True) Explanation: E.g. The following statements about atrioventricu lar block are true first-degree block is usually asymptomatic (True) the PR inte rval is fixed in Mobitz type I second-degree block (False) Explanation: Fixed PR = Mobitz type II.MCQs VIA WEB 2005 Explanation: QRS complexes are usually narrow Question 21. . cardi oversion should be avoided (False) Explanation: The treatment of choice in acute heart failure with VT Question 23. Typical features of the Wolff-Parkinson-White (WPW) syndrome includ e tachyarrhythmias resulting from re-entry phenomenon (True) Explanation: Re-ent rant circuit includes AV node and the accessory bundle ventricular pre-excitatio n via an accessory AV pathway (True) atrial fibrillation with a ventricular resp onse of > 160/min (True) Explanation: Consider WPW in young patients with episod es of atrial fibrillation ECG between bouts showing prolonged PR interval with n arrow QRS complexes (False) Explanation: PR interval is shortened and a delta wa ve is seen in the QRS complex useful therapeutic response to verapamil or digoxi n (False) Explanation: Differential effects on the normal and anomalous pathways can increase cardiac rate Question 22. The cardiac dru gs listed below are associated with the following adverse effects digoxin-acute confusional state (True) Explanation: And lidocaine (lignocaine) therapy verapam il-constipation (True) Explanation: Calcium channel-blocking effect on smooth mu scle amiodarone-photosensitivity (True) propafenone-corneal microdeposits (False ) Explanation: An adverse effect of amiodarone therapy By A. In the classification of anti-arrhythmic drugs. lido caine (lignocaine)-like drugs class II agents are â-adrenoceptor antagonists (True ) class III agents prolong the action potential (True) Explanation: E.

The risk of developing clinical evidence of coronary artery disease is increased by exogenous oestrogen use in postmenopausal females (False) Explanati on: Risk is decreased by oestrogen therapy diminished by stopping smoking (True) Explanation: Effect is measurable within 6 months of stopping reduced by the mo derate consumption of alcohol (True) Explanation: Not more than 21 units per wee k increased in hyperfibrinogenaemia (True) increased by hypercholesterolaemia bu t not hypertriglyceridaemia (False) Explanation: Both confer increased risk Ques tion 29. . In the treatment of patients with angina pectoris aspirin reduces t he frequency of anginal attacks (False) Explanation: But it improves the prognos is glyceryl trinitrate is equally effective when swallowed as when taken subling ually (False) Explanation: Extensive first-pass hepatic metabolism calcium antag onists may cause peripheral oedema (True) Explanation: Common adverse effect tis sue levels of nitrates must be consistently high for maximum therapeutic effect (False) Explanation: A nitrate-free period should be achieved By A. In the investigation of suspected angina pectoris the resting ECG is us ually abnormal (False) Explanation: Usually normal exercise-induced elevation in blood pressure indicates significant ischaemia (False) Explanation: Fall in blo od pressure suggests significant ischaemia a normal ECG during exercise excludes angina pectoris (False) Explanation: False negatives may occur coronary angiogr aphy is only indicated if an exercise tolerance test (ETT) is abnormal (False) E xplanation: Useful in patients with convincing history but normal ETT physical e xamination is of no clinical value (False) Explanation: Important to exclude ana emia and valvular stenosis Question 30. Amiodarone therapy prolongs the plateau phase of the action potenti al (True) Explanation: In common with other class III drugs potentiates the effe ct of warfarin (True) is useful in the prevention of ventricular but not suprave ntricular tachycardia (False) Explanation: Effective in both may cause corneal d eposits (True) Explanation: But no effect on vision has a significant negative i notropic action (False) Explanation: Can be safely used in heart failure Questio n 27.MCQs VIA WEB 2005 lidocaine (lignocaine)-convulsions (True) Question 26. Digoxin shortens the refractory period of conducting tissue (False) Explan ation: Prolongs the refractory period of conducting tissue. H. shortens it in cardi ac muscle usually converts atrial flutter to sinus rhythm (False) Explanation: O ften converts atrial flutter to atrial fibrillation is excreted primarily by the kidney (True) is a class II anti-arrhythmic (False) is a recognised cause of ve ntricular arrhythmias (True) Explanation: Increases myocardial excitability Ques tion 28.

The clinical features of acute myocardial infarction include nausea and vomi ting (True) Explanation: Due to activation of the autonomic nervous system breat hlessness and angor animi (True) hypotension and peripheral cyanosis (True) Expl anation: Suggest a large infarct sinus tachycardia or sinus bradycardia (True) a bsence of any symptoms or physical signs (True) Explanation: 15% of infarcts are believed to be clinically 'silent' Question 32. nitrate therapy has no effect on the ea rly mortality rate mobilisation should be deferred until cardiac enzymes normali se (False) Explanation: Mobilisation should begin on day 2 in the absence of car diac failure Question 33. In the treatment of acute myoca rdial infarction aspirin given within 6 hours of onset reduces the mortality (Tr ue) Explanation: 30% reduction in short-term mortality streptokinase therapy red uces infarct size and mortality by > 25% (True) Explanation: The earlier thrombo lysis is given.MCQs VIA WEB 2005 â-blockers are more effective than other anti-anginal agents (False) Explanation: Nitrates. often be fore help arrives stress and social isolation adversely affect the prognosis (Tr ue) Explanation: Rehabilitation programmes can be helpful the 5-year survival is 75% for those who leave hospital (True) late mortality is determined by the ext ent of myocardial damage (True) Explanation: Limiting infarct size improves prog nosis in hospital mortality for those aged over 75 years is over 25% (True) Expl anation: Five times greater than < 55 years of age Question 35. The following statements about the prognosis of acut e myocardial infarction are true 50% of all deaths occur within the first 24 hou rs (True) Explanation: Of which half occur within the first 20 minutes. Drug therapies which improve the long-term prognosis a fter myocardial infarction include aspirin (True) Explanation: Vascular events a re reduced by 25% nitrates (False) calcium antagonists (False) ACE inhibitors (T rue) Explanation: Limit infarct expansion â-blockers (True) Explanation: Reduce mo rtality by 25% Question 34. H. In intermittent claudication due to atherosclerosis pain is typically relieved by rest and eleva tion of the leg (False) Explanation: Rest relieves but elevation worsens pain th e commonest cause of death is lower limb gangrene (False) Explanation: Myocardia l infarction or stroke pedal pulses are often still palpable (False) Explanation : Anaemia or diabetes may produce claudication without loss of the pulses exerci se which causes pain should be avoided (False) Explanation: Exercise promotes gr owth of the collateral circulation the risk of progression is lessened by warfar in (False) Explanation: Anticoagulation is unhelpful By A. the better the results diamorphine is better given intravenously than by any other route (True) Explanation: Intramuscular injections predispose to haematoma immediate calcium channel blocker therapy reduces the early mortal ity rate (False) Explanation: Similarly. calcium antagonists and â-blockers are all equally efficacious Question 31. .

In infective endocarditis streptococci and staphylococci account for over 80% of cases (True) Explanation: Streptococcus viridans alone a ccounts for 30-40% of cases By A. H. Clinical featur es suggesting aortic stenosis include late systolic ejection click (False) Expla nation: Early systolic click implies the stenosis is valvular narrow pulse press ure (True) heaving apex beat (True) Explanation: Implies left ventricular hypert rophy syncope associated with angina (True) loud second heart sound (False) Expl anation: Quiet S2 if the valve is heavily calcified and immobile Question 40. Characteristic features of aortic dissection include haemopericardi um (True) Explanation: Type A aneurysms acute paraparesis (True) Explanation: Du e to infarction of the spinal cord interscapular back pain (True) Explanation: T he pain is often described as 'tearing' early diastolic murmur (True) Explanatio n: Type A aneurysms pleural effusion (True) Explanation: Haemothorax Question 37 . In patients with significant mitral stenosis the mitral valve orifice is reduc ed from 5 cm2 to about 1 cm2 (True) Explanation: First symptoms appear at valve areas of around 2 cm2 a history of rheumatic fever or chorea is elicited in over 90% of patients (False) Explanation: Only in 50% of patients left atrial enlarg ement cannot be detected on the chest radiograph (False) Explanation: Produces a double right heart border and an enlarged left atrial appendage the risk of sys temic emboli is trivial in sinus rhythm (False) Explanation: Embolic risk over 1 0 years is 10% compared with 35% if atrial fibrillation is present mitral balloo n valvuloplasty is not advisable if there is also significant mitral regurgitati on (True) Explanation: Mitral regurgitation is a contraindication Question 38. Di sorders associated with aortic regurgitation include ankylosing spondylitis (Tru e) Explanation: Also Reiter's disease and psoriatic arthritis Marfan's syndrome (True) Explanation: Due to cystic medial necrosis syphilitic aortitis (True) Exp lanation: Typically affects the ascending aorta persistent ductus arteriosus (Fa lse) Explanation: Produces the 'machinery murmur' congenital bicuspid aortic val ve (True) Question 41. . R ecognised features of chronic mitral regurgitation include soft first heart soun d and loud third heart sound (True) presentation with signs of right ventricular failure (True) Explanation: Due to pulmonary hypertension left ventricular dila tation (True) a pansystolic murmur and hyperdynamic displaced apex beat (True) a trial fibrillation requiring anticoagulation (True) Question 39.MCQs VIA WEB 2005 Question 36.

. H. In atrial septal defect the lesion is usually of secund um type (True) Explanation: Due to a patent fossa ovalis the initial shunt is ri ght to left (False) Explanation: Occurs late. In small ventricular septal defects the murmur is confined to late systole (False) By A.MCQs VIA WEB 2005 left heart valves are more frequently involved than right heart valves (True) no rmal cardiac valves are not affected (False) Explanation: About 30% have no iden tifiable predisposing cardiac lesion glomerulonephritis usually occurs due to im mune complex disease (True) a normal echocardiogram excludes the diagnosis (Fals e) Explanation: Vegetations may be too small to be detected Question 42. Central cyanosis in infancy is an expected finding in the following congenital heart di seases persistent ductus arteriosus (False) Explanation: With a left to right sh unt transposition of the great arteries (True) Explanation: Usually due to a shu nt through a ventricular septal defect coarctation of the aorta (False) Explanat ion: No shunt Fallot's tetralogy (True) Explanation: Right to left shunt through a ventricular septal defect atrial septal defect (False) Explanation: Left to r ight shunt Question 43. Typical clinical features of coarctation of th e aorta include an association with a bicuspid aortic valve (True) Explanation: Frequently coexists cardiac failure developing in male adolescents (False) Expla nation: Cardiac failure is more likely to develop in infancy palpable collateral arteries around the scapulae (True) Explanation: A useful but unusual finding r ib notching on chest radiograph associated with weak femoral pulses (True) Expla nation: Rib notching is due to enlarged collateral vessels ECG showing right ven tricular hypertrophy (False) Explanation: Left (not right) ventricular hypertrop hy develops Question 45. and rarely splitting of the second heart sound increases in expiration (False) Explanation: Splitting is fixed and wide the ECG typically shows right bundle branch block (True) Explanation: In p rimum defect there may be left axis deviation surgery should be deferred until s hunt reversal occurs (False) Explanation: Surgery is indicated when the pulmonar y/systolic flow ratio is > 3:2 Question 46. The following statements about persistent ductus arterio sus are true blood usually passes from the pulmonary artery to the aorta (False) Explanation: This only happens if the shunt reverses the onset of heart failure usually occurs in early infancy (False) Explanation: Typically presents with a murmur in an otherwise healthy infant a systolic murmur around the scapulae is t ypical (False) Explanation: Continuous 'machinery' murmur is typical (systolic a nd diastolic) shunt reversal is indicated by cyanosis of the lower limbs (True) Explanation: A rare sign prophylactic antibiotic therapy to prevent endocarditis is indicated (True) Question 44.

. H. Typical chest findings in a large right pleural effusion includ e normal chest expansion (False) Explanation: Expansion is reduced on the affect ed side By A. Dilated (congestive) cardiomyopathy is usually idiop athic (True) associated with pathognomonic ECG changes (False) Explanation: ECG changes are non-specific a recognised complication of HIV infection (True) assoc iated with chronic alcohol misuse (True) caused by Coxsackie A infection (True) Explanation: And influenza.MCQs VIA WEB 2005 Explanation: It is pansystolic the heart is usually enlarged (False) Explanation : No cardiomegaly there is a risk of infective endocarditis (True) Explanation: Prophylaxis is indicated surgical repair before adolescence is usually indicated (False) Explanation: Surgery is only indicated if right-sided pressures rise mo st patients are asymptomatic (True) Explanation: Symptomless murmur is a frequen t presentation Question 47. In pericardial tamponade high amplitude QRS complexes are a typi cal ECG feature (False) Explanation: Low amplitude the systemic arterial pressur e falls dramatically on inspiration (True) Explanation: This is pulsus paradoxus echocardiography is the definitive investigation (True) an effusion > 250 ml mu st be present before detrimental haemodynamic effects ensue (False) Explanation: As little as 75-100 ml a normal chest radiograph excludes the diagnosis (False) Explanation: But the cardiac shadow usually appears globular Module 13 (Chapter 13) Question 1. Clinical features compat ible with hypertrophic cardiomyopathy include family history of sudden death (Tr ue) Explanation: 50% of cases are autosomal dominant angina pectoris and exertio nal syncope (True) Explanation: Mimicking aortic stenosis jerky pulse and heavin g apex beat (True) murmurs suggesting both aortic stenosis and mitral regurgitat ion (True) Explanation: Left ventricular outflow obstruction and secondary mitra l regurgitation soft or absent second heart sound (False) Explanation: Suggests calcific aortic stenosis Question 49. HIV and others Question 48. Typical features of acute pericarditis inc lude chest pain identical to that of myocardial infarction (False) Explanation: Sharp pain worsened by posture and movement a friction rub that is best heard in the axilla in mid-expiration (False) Explanation: Localisation and character va ry greatly ST elevation on the ECG with upward concavity (True) Explanation: In contrast to ischaemia elevation of the serum creatine kinase (False) Explanation : May occur in pericarditis complicating acute myocardial infarction ECG changes that are only seen in the chest leads (False) Explanation: Widespread ECG chang es Question 50.

Hypercapnia is a typical feature of pulmona ry embolism (False) Explanation: Hyperventilation unless embolism is massive sev ere chest wall injury (True) Explanation: With type II respiratory failure salic ylate intoxication (False) Explanation: Hyperventilation pulmonary fibrosis (Fal se) Explanation: Hyperventilation and type I failure severe chronic bronchitis ( True) Explanation: Type II respiratory failure may ensue Question 3. The following statements about pulmonary function tests are true over 80% of vit al capacity can normally be expelled in 1 second (False) Explanation: More than 70% is normal the transfer factor is measured using inspired oxygen (False) Expl anation: Carbon monoxide is used residual volume is increased in chronic bronchi tis and emphysema (True) Explanation: The lungs are hyperinflated analysis of fl ow volume curves is of value in suspected central airflow obstruction (True) pea k expiratory flow rates accurately reflect the severity of restrictive lung diso rders (False) Explanation: They measure obstructive ventilatory defects Question 5. . Typical che st findings in right lower lobe collapse include decreased chest expansion (True ) Explanation: On the affected side stony dull percussion note (False) Explanati on: Implies effusion bronchial breath sounds (False) Explanation: Diminished or absent breath sounds decreased vocal resonance (True) Explanation: As for vocal fremitus crepitations (False) Explanation: No specific added sounds Question 4. In a patient with severe acute breathlessness a normal arterial PaO2 invaria bly suggests psychogenic hyperventilation (False) Explanation: The patient may h ave a metabolic acidosis pulsus paradoxus is pathognomonic of acute asthma (Fals e) Explanation: Also found in pericardial tamponade a normal chest radiograph ex cludes pulmonary embolism (False) Explanation: Although subtle changes are frequ ently present the extremities are typically cool and sweaty in left ventricular failure (True) Explanation: With basal pulmonary crepitations left bundle branch block is strongly suggestive of pulmonary embolism (False) Explanation: Right b undle branch block or S1Q3T3 pattern Question 6.MCQs VIA WEB 2005 dull percussion note (False) Explanation: Stony dull absent breath sounds (True) vocal resonance decreased (True) Explanation: As is tactile vocal fremitus pleu ral friction rub (False) Question 2. H. The following are recognised ca uses of haemoptysis tuberculosis (True) chronic obstructive pulmonary disease (F alse) By A.

A pleural effusion with a pleural fluid:serum protein ratio of > 0. H. The following statements about oxygen are true at sea level. In the treatment of acute COPD exacerbations associated with type II respirato ry failure the inspired oxygen content should be at least 40% (False) Explanatio n: Controlled oxygen therapy at about 24-28% is usual nebulised doxapram improve s small airways obstruction (False) Explanation: A central respiratory stimulant flapping tremor is a sensitive indicator of hypercapnia (False) Explanation: It may be absent-blood gases are vital corticosteroid therapy is usually contraind icated (False) Explanation: May help relieve bronchospasm BIPAP may be valuable if pH falls (True) Explanation: But not all patients are candidates for such sup port Question 11. The sleep apnoea syndrome is associated with obesity (True) Expla nation: Found in two-thirds of patients and may be associated with alcohol misus e an increased risk of road traffic accidents (True) Explanation: Increased thre efold due to day-time sleepiness nocturnal restlessness apparent to the patient (False) a good response to inhaled bronchodilator therapy administered at bedtim e (False) Explanation: Ineffective.5 would be typical of congestive cardiac failure (CCF) (False) Explanation: Transudate in CCF renal failure (False) subphrenic abscess (True) Explanation: Most frequently on the right pneumonia (True) Explanation: With polymorphonuclear leucocytes ne phrotic syndrome (False) Explanation: Severe hypoalbuminaemia produces transudat es Question 8.MCQs VIA WEB 2005 Explanation: Another cause should be sought bronchiectasis (True) Explanation: M ay be massive Goodpasture's syndrome (True) Explanation: With associated renal d isease mitral stenosis (True) Explanation: With pulmonary hypertension Question 7. t he pressure of oxygen in inspired air is approximately 20 kPa (True) Explanation : PaO2 declines with altitude By A. The following disorders characteristically produce type I respiratory failure kyphoscoliosis (False) Explanation: Typically type II failu re Guillain-Barré polyneuropathy (False) Explanation: Respiratory muscle paralysis causes type II failure acute respiratory distress syndrome (ARDS) (True) Explan ation: Arterial PCO2 is typically normal extrinsic allergic alveolitis (True) Ex planation: Ventilatory drive is usually maintained inhaled foreign body in a maj or airway (False) Explanation: Causes acute type II failure-asphyxia Question 10 . . continuous positive airway pressure (CPAP) m ay be effective nocturnal hypotension (False) Explanation: Typically episodic hy pertension Question 9.

In the managemen t of chronic obstructive pulmonary disease influenza immunisation should only be offered once (False) Explanation: Immunisation should be offered yearly long-te rm antibiotic treatment decreases the frequency of exacerbations (False) Explana tion: This encourages drug resistance regular inhaled steroids are of no proven value (True) supplemental oxygen during air travel is necessary if the resting P aO2 < 9 kPa (True) Explanation: PaO2 will be < 7 kPa in such a patient at altitu de long-term controlled oxygen therapy improves symptoms but not the prognosis ( False) Explanation: Survival has been demonstrated to improve Question 13.or intrapulmonary Question 12. In the management of chronic persis tent asthma inhaled â2-agonist use more than once per day is an indication for inh aled steroid therapy (True) Explanation: Typically low-dose steroids sodium crom oglicate therapy is often useful as an alternative to inhaled steroids in adults (False) Explanation: But may be valuable in childhood patients taking high dose s of inhaled steroids should use a large-volume spacer device (True) Explanation : Reduces oropharyngeal and gastric deposition leukotriene antagonists are valua ble substitutes for inhaled steroids (False) Explanation: Use in addition to ste roids and â2-agonist anticholinergic agents should be avoided (False) Explanation: May be valuable Question 16. Features compatible with severe acute asthma inclu de pulse rate = 120 per minute (True) Explanation: But bradycardia may occur in life-threatening attacks By A. .3 breathing air dissolved oxygen contribu tes to tissue oxygenation in anaemia (True) Explanation: Also in other situation s when Hb is maximally saturated oxygen toxicity in adults can produce retrolent al fibroplasia (False) Explanation: Occurs only in neonates central cyanosis unr esponsive to 100% oxygen indicates right-to-left shunting of > 20% (True) Explan ation: Such shunts may be extra. Typical pathological features of asthma include eo sinophilic bronchial infiltrate (True) Explanation: And T lymphocytes increased airway macrophages (True) mucus gland hyperplasia (True) Explanation: May contri bute to development of fixed airways obstruction epithelial shedding (True) Expl anation: A recognised feature in fatal asthma in particular T lymphocyte activat ion and cytokine release (True) Question 15. H. Typic al findings in severe chronic obstructive pulmonary disease include elevation of the jugular venous pressure (True) Explanation: A feature of right heart failur e tracheal descent on inspiration (True) Explanation: Tracheal 'tug' due to medi astinal descent indrawing of the intercostal muscles (True) Explanation: A sign of hyperinflation contraction of the scalene muscles (True) Explanation: And oth er accessory respiratory muscles pursed lip breathing (True) Explanation: Decrea ses air trapping Question 14.MCQs VIA WEB 2005 chronic domiciliary oxygen therapy is indicated only when PaO2 is < 6 kPa (False ) Explanation: Indicated when PaO2 < 7.

or prednisolone 40 mg orally (True) Explanation: Maintain corticoster oid therapy for at least 7 days in severe attacks arterial blood gas analysis an d chest radiograph (True) Explanation: Exclude pneumothorax and ventilatory fail ure Question 18. In pneumonia. . Typical clinical features of bronchiectasis include chronic cou gh with scanty sputum volumes (False) Explanation: Copious sputum production rec urrent pleurisy (True) Explanation: Recurrent pneumonia haemoptysis (True) Expla nation: Secondary to inflammatory bronchial change finger clubbing (True) crepit ations on auscultation (True) Explanation: In the presence of large amounts of s ecretions Question 19. The initial manage ment of severe acute asthma should include 24% oxygen delivered by a controlled flow mask (False) Explanation: High concentration. hence prospect for gene therapy recurring pneumoc occal pulmonary infections (False) Explanation: Pseudomonas and staphylococcal s epsis Question 20. Cystic fibrosis is associated with an incidence of 1 in 2 500 live births (True) Explanation: The commonest severe autosomal recessive dis order in Caucasians a decreased sweat sodium concentration (False) Explanation: Increased sweat sodium concentration male infertility (True) Explanation: Due to failure of development of the vas deferens abnormal lung function at birth (Fal se) Explanation: It is normal. H.v. high flow should be used salb utamol 5 mg by inhalation (True) Explanation: Intravenous â2-adrenoceptor agonists can also be used ampicillin 500 mg orally and sodium cromoglicate 10 mg by inha lation (False) Explanation: Of no proven value in acute attacks hydrocortisone 2 00 mg i. A non-pneumococcal pneumonia sho uld be considered if the clinical features include respiratory symptoms precedin g systemic upset by several days (False) Explanation: The converse is typical of 'atypical' organisms lobar consolidation (False) By A. the following features are classically associat ed with the specific organisms noted erythema nodosum and Mycoplasma pneumoniae (True) hyponatraemia and Legionella pneumoniae (True) contact with sick birds an d Klebsiella pneumoniae (False) Explanation: Chlamydia psittaci abscess formatio n and Staphylococcus aureus (True) haemolytic anaemia and Streptococcus pneumoni ae (False) Explanation: Mycoplasma Question 21.MCQs VIA WEB 2005 peak expiratory flow (PEF) rate = < 70% of expected (False) Explanation: Usually < 50% of expected PEF pulsus paradoxus (True) Explanation: But may diminish in severe attacks arterial PaO2 = 14 kPa while breathing air (False) Explanation: P aO2 < 8 kPa in life-threatening attacks arterial PaCO2 = 5 kPa (True) Explanatio n: PaCO2 may remain normal until the late stages Question 17.

Recognised adverse reactions to antituberculous drugs include streptomycin-renal failure (False) Ex planation: Causes vestibular disturbance and deafness isoniazid-hypothyroidism ( False) Explanation: Polyneuropathy By A. cervical or mesenteric nodes are most freq uently involved bilateral hilar lymphadenopathy on chest radiograph (False) Expl anation: Suggests sarcoidosis erythema nodosum (True) Explanation: Can also acco mpany pulmonary sarcoid pleural effusion with a negative tuberculin skin test (F alse) Explanation: A hypersensitivity phenomenon typically associated with posit ive tuberculin test Question 24.and 9-month regimes are o f proven efficacy isoniazid and pyrazinamide do not cross the blood-brain barrie r (False) Explanation: Hence their great value in the treatment of tuberculous m eningitis treatment failure is invariably due to multiple drug resistance (False ) Explanation: More often due to non-compliance Question 26. . In the treatment of post-primary pulmonary tuberculosis c ombination drug therapy is always indicated (True) Explanation: Minimises resist ance and reduces duration of treatment sputum remains infectious for at least 4 weeks after the onset of therapy (False) Explanation: Patients can be regarded a s non-infectious after 2 weeks of therapy at least 12 months' daily therapy is r equired for 100% effectiveness (False) Explanation: 6.MCQs VIA WEB 2005 rigors (False) the absence of a neutrophil leucocytosis (True) Explanation: Leuc openia can occur in severe pneumococcal infection palpable splenomegaly (True) E xplanation: Rare in pneumococcal disease Question 22. The following features sug gest a poor prognosis in pneumonia diastolic blood pressure of 90 mmHg (False) E xplanation: < 60 mmHg confusion (True) respiratory rate of 20 breaths per minute (False) Explanation: > 30/min blood urea of 9 mmol/l (True) Explanation: > 7 mm ol/l white cell count of 3000 × 109/l (True) Explanation: < 4000 × 109/l Question 23 . H. Typical features of primary tuberculosis include a sustained pyrexial illness (False) Explanation: Typically symptomless caseation within the regional lymph n odes (True) Explanation: Mediastinal. Recognised complications of post-primary tuberc ulosis include aspergilloma (True) Explanation: Superinfection of a cavity amylo idosis (True) Explanation: Associated with chronic immune stimulation massive ha emoptysis (True) bronchiectasis (True) Explanation: Suggested by chronic product ive cough paraplegia (True) Explanation: Due to vertebral or paraspinal abscess formation Question 25.

Non-metastatic manifestations of bronchial carcinoma incl ude cerebellar degeneration (True) Explanation: With ataxia and nystagmus myasth enia (True) Explanation: Eaton-Lambert syndrome gynaecomastia (True) Explanation : Usually bilateral polyneuropathy (True) Explanation: Usually distal sensorimot or dermatomyositis (True) Explanation: Skin rash and proximal myopathy Question 30. adenocarcinoma 30% is associated with asb estos exposure (True) Explanation: As is mesothelioma is 40 times more common in smokers than in non-smokers (True) Explanation: Smoking is the major aetiologic al factor Question 29. rapidly progressive illness bronchopulmonary eosinophilia (True) Explanatio n: Typically with wheeze. The following are contraindications to surgical resection in bronchial carci noma distant metastases (True) malignant pleural effusion (True) FEV1 < 0. pulmonary infiltrates and peripheral eosinophilia extr insic allergic alveolitis (False) Explanation: Type III and IV immune responses Question 28. . Bronchial carcinoma accounts for 10% of all male deaths from cancer (False) Explanation: 50% of all male deaths from malignant disease typically pr esents with massive haemoptysis (False) Explanation: Streaking of sputum with bl ood in a smoker is more typical histology reveals adenocarcinoma in 50% of patie nts (False) Explanation: Squamous 35%.8 litr es (True) ipsilateral mediastinal lymphadenopathy (False) Explanation: But contr alateral nodes are a contraindication oesophageal involvement (True) Question 31 . Mediastinal opacification on the chest radiograph is a typical feature of thym oma (True) Explanation: May be associated with myasthenia gravis retrosternal go itre (True) Explanation: Anterior superior mediastinum Pancoast tumour (False) By A.MCQs VIA WEB 2005 rifampicin-optic neuritis (False) Explanation: Ethambutol causes optic neuritis pyrazinamide-hepatitis (True) Explanation: And rifampicin ethambutol-vestibular neuronitis (False) Explanation: Streptomycin causes this Question 27. H. Pulmonary infection with Aspergillus fumigatus is a recognised cause of the following bull ous emphysema (False) Explanation: No association mycetoma (True) Explanation: U sually in a tuberculous cavity necrotising pneumonitis (True) Explanation: A sev ere.

MCQs VIA WEB 2005 Explanation: Pulmonary apical mass hiatus hernia (True) Explanation: A retrocard iac opacity neurofibroma (True) Explanation: Can be multiple Question 32. TB) are associated with cavi tation the tuberculin tine test is usually positive (False) Explanation: Typical ly negative erythema marginatum is a characteristic finding (False) Explanation: Erythema nodosum is the typical skin lesion spontaneous resolution is unusual ( False) Explanation: The normal course in stage I and stage II disease hypercalca emia suggests skeletal involvement (False) Explanation: Due to increased vitamin D sensitivity Question 33. Clinical features compatible with a diagnosis of extrinsic allergic a lveolitis include expiratory rhonchi and sputum eosinophilia (False) Explanation : Acute dyspnoea without wheeze is characteristic dry cough. Typical features of cryptogenic fibrosing alveolitis include hypercapnic respiratory failure (False) Explanation: Typically type I r espiratory failure positive antinuclear and rheumatoid factors (True) Explanatio n: With or without evidence of connective tissue disease finger clubbing (True) recurrent wheeze and haemoptysis (False) Explanation: Dyspnoea. . The fo llowing statements about sarcoidosis are true pulmonary lesions typically cavita te (False) Explanation: Caseating granulomata (e. The following sta tements about asbestos-related disease are true pleural plaques usually progress to become mesotheliomas (False) Explanation: Often calcify pleural effusions ar e always malignant (False) Explanation: But malignancy should be excluded finger clubbing and basal crepitations suggest pulmonary asbestosis (True) Explanation : Although cryptogenic fibrosing alveolitis is possible the FEV1/FVC ratio is ty pically decreased (False) Explanation: A restrictive not an obstructive ventilat ory defect mesothelioma can only be reliably diagnosed at thoracotomy (False) Ex planation: Seldom necessary Question 36. Characteristic features of pulmonary eo sinophilia include an association with ascariasis and microfilariasis (True) Exp lanation: And Toxocara infestation eosinophilic pneumonia without peripheral blo od eosinophilia (False) By A. dry cough and cr ackles increased carbon monoxide transfer factor (False) Explanation: Reduced Qu estion 34.g. H. dyspnoea and pyrexi a (True) Explanation: Influenza-like symptoms may exist end-inspiratory crepitat ions (True) Explanation: Typically bilateral FEV1/FVC ratio of 50% (False) Expla nation: Airway obstruction is absent positive serum precipitin tests (True) Expl anation: May also be positive in healthy subjects Question 35.

II a nd aVL on ECG (False) Explanation: Classical ECG pattern is S1. Typical features of an empyema thoracis include bilateral effusions on chest radiograph (False) Explanation: Typically unilateral a fluid level on chest rad iograph suggesting a bronchopleural fistula (True) Explanation: Or a recent diag nostic aspiration persistent pyrexia despite antibiotic therapy (True) Explanati on: Suggests lung abscess. The following statements about renal physiology i n health are correct each kidney comprises approximately 1 000 000 nephrons (Tru e) the kidneys receive approximately 5% of the cardiac output (False) By A. Q3. phenylbutazone or others opacities on chest radio graph (True) Explanation: Pulmonary infiltrates and eosinophilia Question 37. The following are causes of an elevated hemidiaphragm recurrent laryngeal nerve paralysis (False) Explanation: Phrenic nerve paralysis surgical lobectomy (True) subphrenic abscess (True) severe pleuritic pain (True) Explanat ion: But underlying pathology should be sought chronic severe asthma (True) Modu le 14 (Chapter 14) Question 1. . The follow ing statements about spontaneous pneumothorax are true breathlessness and pleuri tic chest pain are often present (True) Explanation: A small pneumothorax may be asymptomatic bronchial breathing is audible over the affected hemithorax (False ) Explanation: Diminished or absent breath sounds absent peripheral lung marking s on chest radiograph suggest tension (False) Explanation: Mediastinal shift sug gests tension surgical referral is required if there is a bronchopleural fistula (True) Explanation: Pleurectomy may also be necessary pleurodesis should be con sidered for recurrent pneumothoraces (True) Explanation: Particularly if bilater al Question 40. antibiotic resistance or hypersensitivity recent abdo minal surgery (True) Explanation: Perhaps complicating subphrenic infection bact eriological culture of the organism despite preceding antibiotic therapy (False) Explanation: Frequently sterile post-antibiotic therapy Question 39. H.MCQs VIA WEB 2005 Explanation: Eosinophilia is necessary for the diagnosis prominent asthmatic fea tures (False) Explanation: Wheeze may be absent induction by exposure to drugs ( True) Explanation: Imipramine. Cl inical features characteristic of massive pulmonary embolism include central and peripheral cyanosis (True) Explanation: With profound hypoxaemia pleuritic ches t pain and haemoptysis (False) Explanation: Suggests pulmonary infarction breath lessness and syncope (True) Explanation: Non-specific tachycardia and elevated j ugular venous pressure (True) Explanation: Non-specific Q waves in leads I. T3 Question 38.

H.5 g/day hypertension and poly uria (False) Explanation: But may occur in chronic renal failure urinary sodium concentration > 50 mmol/l (False) Explanation: Marked sodium retention-urinary s odium < 10 mmol/l Question 5.5 g/day is invariably due to glomerular disease (True) E xplanation: Often with oedema and hypoalbuminaemia is greater in the night than during the day (False) Explanation: Greater when the person is upright-'orthosta tic proteinuria' can be assessed by the albumin/creatinine ratio in a single sam ple (True) Explanation: Easier to undertake than 24-hour collection in early dia betic nephropathy typically comprises albumin predominantly (True) Explanation: Microalbuminuria is a sensitive predictor Question 4. The following findings would support a diagnosis o f pre-renal rather than established acute renal failure oliguria < 700 ml per da y (False) Explanation: Pre-renal acute failure is not always oliguric urine/plas ma urea ratio > 10:1 (True) Explanation: Indicating preservation of renal medull ary function a urinary osmolality > 600 mOsm/kg (True) Explanation: Indicating p reservation of renal medullary function a urinary sodium concentration < 20 mmol /l (True) Explanation: Indicating preservation of renal medullary function hyper tension rather than hypotension (False) Explanation: Suggests primary renal dise ase Question 6. chronic non-steroidal anti-inflammatory d rug (NSAID) misuse and alcoholism membranous glomerulonephritis (False) Explanat ion: Typically proteinuria infective endocarditis (True) Explanation: Associated with a mesangiocapillary glomerulonephritis renal infarction (True) Explanation : May be frank haematuria Question 3. Typical features of the ne phrotic syndrome include bilateral renal angle pain (False) Explanation: Typical ly painless generalised oedema and pleural effusions (True) Explanation: Transud ates hypoalbuminaemia and proteinuria > 3. Microscopic haematuria would be an expected finding in urinary tract infection (True) renal papillary necrosis (True) Explanation: R isk factors include diabetes mellitus.MCQs VIA WEB 2005 Explanation: 25% of the cardiac output variations in the calibre of afferent and efferent arterioles control the filtration pressure (True) the glomerular capil laries are supplied by the afferent arterioles (True) the kidney produces erythr opoietin (True) Question 2. Urinary protein excretion in Bence Jones p roteinuria is readily detectable by stick tests (False) Explanation: Immunoelect rophoresis required > 3. .5 g/day (True) Explanation: Serum albu min concentration < 30 g/l and urinary protein > 3. Typical causes of rapidly progressive glomerulonephritis include post-infectious glomerulonephritis (True) systemic vasculitis (True) Explanatio n: Causes focal necrotising glomerulonephritis By A.

Complications of chronic renal failure include macrocytic anaemia (False) Exp lanation: Typically normocytic or microcytic peripheral neuropathy (True) Explan ation: Can improve with haemodialysis bone pain (True) Explanation: Renal osteod ystrophy with osteomalacia pericarditis (True) Explanation: Even haemorrhagic pe ricarditis with tamponade metabolic alkalosis (False) Explanation: Chronic metab olic acidosis Question 9. urinary diluting ability also impaired Question 8. accounts for 25% of nephrotic syndrome in adults marked mesangial cell prolifer ation on renal biopsy (False) Explanation: Minor or absent nephrotic syndrome wi th unselective proteinuria (False) Explanation: Selective proteinuria hypertensi on and microscopic haematuria (False) Explanation: Suggest an alternative cause progression to chronic renal failure in patients not responding to corticosteroi d therapy (False) Explanation: Renal function is otherwise unimpaired Question 1 1.MCQs VIA WEB 2005 Goodpasture's disease (True) IgA nephropathy (True) Explanation: Including Henoc h-Schönlein purpura membranous glomerulonephritis (False) Question 7. Characteristic features of minimal change nephropathy are occurrence in adults usually follows an acute infection (False) Explanation: Usually children. . In the treatment of minimal change nephropathy therapy should be deferred pen ding renal biopsy in childhood (False) Explanation: Diagnosis in children rarely requires histological confirmation diuretics should be avoided to minimise the risk of renal impairment (False) Explanation: Useful in management of oedema By A. The features of Alport's syndrome include an autosomal dominant mode of inheritance (False) Explanation: Autosomal recessive and X-lin ked modes degeneration of the glomerular basement membrane (True) mutation of ge nes encoding type IV collagen (True) Explanation: Located at Xq22 association wi th progressive chronic renal failure (True) Explanation: Second most common inhe rited form of chronic renal failure association with high-tone deafness (True) E xplanation: Characteristic feature preceding severe sensorineural deafness Quest ion 10. H. Typical bioc hemical features of chronic renal failure include polycythaemia (False) Explanat ion: Anaemia is atypical hypophosphataemia (False) Explanation: Hyperphosph atae mia hypercalcaemia (False) Explanation: Hypocalcaemia metabolic acidosis (True) Explanation: Resulting in hyperpnoea impaired urinary concentrating ability (Tru e) Explanation: Hence polyuria.

penici llin or naproxen Question 14. Typical features of acute interstitial nephritis (AIN) include skin rashes. Causes of chronic interstitial nephritis include S jögren's syndrome (True) Explanation: Also associated with sarcoidosis and systemi c lupus erythematosus Wilson's disease (True) Explanation: And other heavy metal poisoning sickle-cell nephropathy (True) chronic transplant rejection (True) an algesic misuse (True) Explanation: Resulting in medullary ischaemia Question 15.g.MCQs VIA WEB 2005 high-dose steroids usually control proteinuria (True) immunosuppressant therapy is indicated for frequent relapses (True) Explanation: E. Typical features of acute post-infec tious glomerulonephritis include subendothelial immune deposits on the glomerula r basement membrane (True) bacterial rather than viral infections (True) Explana tion: Especially haemolytic streptococci. rare in the UK diffuse glomerular invo lvement (True) recurrent haemoptysis (False) Explanation: Suggests Goodpasture's disease a poor prognosis when the disease occurs in childhood (False) Explanati on: Usually resolves spontaneously. The clinical feature s of adult polycystic renal disease include an autosomal recessive mode of inher itance (False) Explanation: Autosomal dominant cystic disease of the liver and p ancreas (True) Explanation: But liver function tests are normal renal angle pain and haematuria (True) Explanation: And hypertension and urinary tract infection By A. especially in children Question 13. Chronic pyelonephritis in adults accounts for the majority of patients with chr onic renal failure (CRF) in the UK (False) Explanation: Diabetes mellitus is the commonest cause is usually attributable to vesicoureteric reflux in childhood ( True) Explanation: Other aetiological factors may also be important has pathogno monic histopathological features on renal biopsy (False) Explanation: Similar to chronic interstitial nephritis is usually associated with demonstrable ureteric reflux (False) Explanation: Reflux is often no longer demonstrable in adulthood producing hypotension should be treated with oral sodium salts (True) Explanati on: As a result of a 'salt-losing' nephropathy Question 16. . cyclophosphamide imp aired renal function commonly develops in the long term (False) Explanation: Rar ely. H. arthralgia a nd fever (False) Explanation: Less than 30% of patients with drug-induced AIN ha ve features of generalised hypersensitivity peripheral blood eosinophilia (False ) Explanation: Eosinophilia occurs in 30% in the peripheral blood and 70% in the urine renal biopsy evidence of an eosinophilic interstitial nephritis (True) Ex planation: And neutrophil or monocytic infiltrate renal impairment typically fol lows withdrawal of the drug (False) Explanation: Typically resolves onset follow ing antibiotic or anti-inflammatory drug therapy (True) Explanation: E.g. even in relapsing disease Question 12.

The typical f eatures of benign prostatic hypertrophy include peak incidence in the age-group 40-60 years (False) Explanation: Aged over 60 years acute urinary retention and haematuria (True) Explanation: Sometimes precipitated by urinary tract infection a response to á-adrenoceptor blocker therapy in > 50% of patients (True) By A. Characteristic features of renal tubular acidosis (RTA) include normal anion gap (True) Explanation: Anion gap = plasma (Na+ + K+) . rigors and renal angle tenderness (True) Explanation: With loin or epi gastric pain pyuria (True) peritubular neutrophil infiltration (True) loin pain and fullness in the flank (False) Explanation: Suggest perinephric abscess Quest ion 19. The typical features of acute pyelonephritis in adult females include normal anatomy of the urinary tract (True) Explanation: But ureteric obstruction may be a predisposing factor vomiting. Recognised features of renal carcinoma include persistent f ever (True) Explanation: Occurs in 20% and is due to increased interleukin relea se bone metastases (True) Explanation: Typically osteolytic metastases haematuri a (True) Explanation: Due to blood clot or direct tumour obstruction of ureter p olycythaemia (True) Explanation: Erythropoietin secretion serum alphafetoprotein in high titre (False) Explanation: Suggests hepatoma Question 21. In the treatment of renal calculi anuria indicates the need for urgent s urgical intervention (True) Explanation: Suggests total obstruction the urine sh ould be alkalinised if the stone is radio-opaque (False) Explanation: Acidificat ion with ammonium chloride may benefit bendroflumethiazide (bendrofluazide) incr eases urinary calcium excretion (False) Explanation: Decreases urinary calcium e xcretion by 30% in hypercalciuric patients allopurinol increases urinary urate e xcretion in gouty patients (False) Explanation: Decreases urinary urate and may reduce oxalate stone formation renal pelvic stones require removal at open surge ry (False) Explanation: Fragmentation by lithotripsy and endoscopic removal is p ossible Question 20. H.4 (True ) Explanation: Even in presence of systemic acidosis decreased glomerular filtra tion rate (GFR) (False) Explanation: GFR is normal normocytic normochromic anaem ia (False) Explanation: No features of uraemia Question 18.(C l. .MCQs VIA WEB 2005 aortic and mitral regurgitation (True) Explanation: Common but rarely severe ane urysms of the circle of Willis (True) Explanation: 10% will have a subarachnoid haemorrhage Question 17.+ HCO3-) normally < 15 mmol/l hyperchloraemic acidosis (True) Explanation: in creased chloride preserves anion gap inappropriately high urinary pH > 5.

nodular prostatic enlargement on rectal examination (False) Exp lanation: Suggests prostatic carcinoma Question 22. Type 1 insulin-dependent diabetes mellit us (IDDM) is associated with 'insulitis'-T lymphocyte infiltrate of the islets o f Langerhans (True) Explanation: Patchy distribution in pancreas feeding of cows ' milk in early infancy (True) Explanation: Cross-reactivity of antibodies to bo vine serum albumin destruction of over 70% of pancreatic beta cells (True) Expla nation: Symptoms occur only when 70-90% of beta cells have been destroyed concor dance rates in monozygotic twins of 35% (True) Explanation: Indicating the impor tance of environmental factors possession of HLA antigens DR3 and DR4 (True) Exp lanation: Linkage with HLA-DQA1 and DQB1 genes encoded on the short arm of chrom osome 6 Question 2. S econdary diabetes mellitus is associated with thiazide diuretic therapy (True) E xplanation: Hypokalaemic alkalosis impairs insulin secretion haemochromatosis (T rue) By A. hypercholesterolaemia and hyperinsulinaemia often coexist (True) Explanation: Sy ndrome X (Reaven's syndrome) associated with macrovascular disease Question 3. The following statements about type 2 diabetes mellitus (NID DM) are true there is clear evidence of disordered autoimmunity in most patients with type 2 diabetes mellitus (False) Explanation: In contrast to type 1 diabet es mellitus monozygotic twins show almost 100% concordance for type 2 diabetes m ellitus (True) Explanation: Compare 35% concordance in monozygotic twins with ty pe 1 diabetes mellitus patients with type 2 diabetes mellitus typically exhibit hypersensitivity to insulin (False) Explanation: Variable insulin resistance obe sity predisposes to type 2 diabetes mellitus in genetically susceptible individu als (True) Explanation: Especially if combined with underactivity hypertension.MCQs VIA WEB 2005 elevated serum prostate specific antigen (False) Explanation: Suggests prostatic carcinoma hard. H. Typical features of prostati c carcinoma include slowly progressive obstructive uropathy (True) Explanation: As also benign prostatic disease presentation with urinary frequency and nocturi a (True) Explanation: Or haematuria preservation of the normal anatomy on digita l rectal examination (False) Explanation: Hard with obliteration of median furro w local spread along the lumbosacral nerve plexus (True) Explanation: And may in volve ureters osteolytic rather than osteosclerotic bone metastases (False) Expl anation: Osteosclerotic metastases Question 23. .a nd chemosensitive (True) Explanation: Chemotherapy is given if disease is widesp read Module 15 (Chapter 15) Question 1. Characteristic features of testi cular tumours include testicular pain in seminoma of the testis (False) Explanat ion: Typically painless secretion of alphafetoprotein and chorionic gonadotrophi n by teratomas (True) Explanation: Helps in the assessment of treatment response absence of distant metastases (False) peak incidence after the age of 60 years (False) Explanation: Peak incidence aged 25-34 years seminomas are both radio.

. H. In the diagnosis of diabetes mellitus glycated haemoglobin (Hb Alc) is a sensitive screening test (False) Explanation: Too insensitive to detec t all cases absence of glycosuria excludes diabetes (False) Explanation: Renal t hreshold may be high glycosuria is usually due to a reduced renal threshold in y oung patients (True) Explanation: But it should never be assumed to be so 2% of patients have significant diabetic complications at presentation (False) Explana tion: 20% have significant diabetic complications random plasma glucose concentr ations > 11 mmol/l are diagnostic (True) Explanation: When symptoms suggest diab etes Question 7. Typical presentations of diabetes mellitus include weight loss (True) Explanation: Catabolism balanitis or pruritus vulvae (True) Explanation: Predisposition to monilial infection nocturia (True) Explanation: Osmotic diures is limb pains with absent ankle reflexes (True) Explanation: Small vessel diseas e and neuropathy asymptomatic glycosuria in the elderly (True) Explanation: Ofte n detected on routine urine testing Question 8. The physiological effects of in sulin include increased glycolysis (True) decreased glycogenolysis (True) increa sed lipolysis (False) Explanation: Decreased lipolysis and ketogenesis increased gluconeogenesis (False) Explanation: Decreased gluconeogenesis increased protei n catabolism (False) Explanation: Decreased protein catabolism Question 5. In de compensated diabetes mellitus thirst results from the increased osmolality of gl omerular filtrate (True) Explanation: And produces an increase in plasma osmolal ity hyperpnoea is the result of acidosis due to increased lactic and ketoacid pr oduction (True) Explanation: Resulting in a metabolic acidosis negative nitrogen balance results from the increased protein catabolism (True) Explanation: Insul in deficiency increases protein degradation lipolysis increases as a result of r elative insulin deficiency (True) Explanation: More profound ketogenesis occurs in type 1 diabetes mellitus insulin deficiency inhibits the peripheral utilisati on of ketoacids (False) Explanation: Insulin deficiency increases ketoacid produ ction Question 6. In the dietary management of dia betes mellitus 90% of patients also require hypoglycaemic drug therapy (False) E xplanation: 50% of new diabetics can be controlled on diet alone By A.MCQs VIA WEB 2005 Explanation: Pancreatic fibrosis primary hyperaldosteronism (True) Explanation: Conn's syndrome produces a hypokalaemic alkalosis pancreatic carcinoma (True) Ex planation: Islet cell destruction thyrotoxicosis (True) Explanation: Also occurs in phaeochromocytoma and acromegaly Question 4.

regular insulin should be injected at least 30 minutes pre-pra ndially (True) Explanation: Onset of effect at least 30 minutes after injection the duration of action of short-acting regular insulin is 4-8 hours (True) inter mediate-acting isophane insulin action peaks at 1-3 hours (False) Explanation: I sophane insulin action has an onset at 1-3 hours and lasts 7-14 hours The standa rd UK solution strength is 100 units/ml (True) Explanation: Different in other c ountries Once absorbed. Sulphonylurea drug therapy in diabetes mellitus ca uses less weight gain than biguanide therapy (False) Explanation: Causes more we ight gain increases hepatic gluconeogenesis (False) Explanation: Stimulates panc reatic insulin secretion decreases the number of peripheral insulin receptors (F alse) Explanation: Such an action would produce insulin resistance decreases hep atic glycogenolysis (True) Explanation: Also decreases hepatic gluconeogenesis t o reduce hyperglycaemia causes alcohol-induced flushing (True) Explanation: Disu lfiram-like reaction Question 10. Biguanide drug therapy in diabetes mellitus is more likely to cause weight loss than weight gain (True) Explanation: Sometimes a useful adjunct to calorie-restricted diets Increases plasma immunoreactive in sulin concentration (False) Explanation: Hence does not cause hypoglycaemia in n on-diabetics Decreases pancreatic glucagon release (False) Explanation: Increase s the sensitivity of peripheral insulin receptors Inhibits hepatic glycogenolysi s (True) Explanation: Thus limiting hyperglycaemia Causes troublesome constipati on (False) Explanation: Causes diarrhoea which may limit drug compliance Questio n 11. insulin has a plasma half-life of 2 hours (False) Explan ation: Plasma insulin has a half-life of 7 minutes Question 13. The following statements about insulin therapy are t rue Short-acting. calorie intake should not exceed 750 kc al/day (False) Explanation: Calorie restriction of 500 kcal/day is more realisti c and sustainable Question 9. . Typical symptoms of hypoglycaemia in diabetic patients include By A.MCQs VIA WEB 2005 carbohydrate should provide 50% of the total calorie intake (True) Explanation: Higher than that in the average UK diet 10 g carbohydrate exchanges provide an i deal method of monitoring intake (False) Explanation: Not advocated as the metho d takes no account of glycaemic effects or fat intake fat intake should not exce ed 35% of total calorie intake (True) Explanation: UK national diet tends to hig her proportion of fat in obese patients. The following statements about other drug therapies in diabetes mellitus a re true Thiazolidinediones enhance endogenous insulin sensitivity (True) Explana tion: Activate peroxisome proliferator-activated receptor ã (PPARã agonists) Thiazol idinediones produce hyperinsulinaemia and hypoglycaemia (False) Explanation: Ins ulin sensitivity in adipose tissue is only increased in patients with insulin re sistance Thiazolidinediones are best prescribed in combination with biguanides. sulphonylureas or insulin (True) Explanation: Glitazones promote weight gain and fluid retention similar to sulphonylureas and insulin Meglitinides increase per ipheral insulin sensitivity (False) Explanation: Stimulate postprandial insulin secretion Alpha-glucosidase inhibitors induce carbohydrate malabsorption (True) Explanation: Selectively inhibit intestinal disaccharidases producing flatulence and diarrhoea Question 12. H.

weight loss and nocturia should signal the p ossibility Errors in drug administration (True) Explanation: Inadvertent and occ asionally even deliberate Question 16. . nightmares and convulsions (True) Explanation: Nocturnal hypoglycaemia may be difficult to reco gnise Question 14. diplopia and confusion (True) Explanation: Neuroglycopenia Abnormal behaviour despite a norma l plasma glucose (False) Explanation: But plasma glucose concentration does not mirror cerebrospinal fluid glucose perfectly Nocturnal sweating. Expected findings in moderately severe diabetic ketoacidosis include water deficit of at least 6 litres (True) Explanation: Average deficit = 6 l (50% intracellular + 50% extracellular) sodium and potassium deficits of at least 400 mmol (True) Explanation: Chloride deficit similar plasma bicarbonate less than 12 mmol/l (True) Explanation: Check the arterial blood pH and PaCO2 ab sence of ketones in the urine (False) Explanation: Absence of ketonuria suggests another cause for the metabolic acidosis peripheral blood leucocytosis (True) By A. palpitation and dizziness ( True) Explanation: Sympathetic nervous system activation Headache. The typical clinical features of diabetic ketoacidosis include Abdominal pain and air hunger (True) Explanation: Due to t he acidosis Rapid. weak pulse and hypotension (True) Explanation: Due to dehydra tion and acidosis Profuse sweating with skin pallor (False) Explanation: Suggest s hypoglycaemia-skin is typically dry with loss of turgor in diabetic ketoacidos is Vomiting and constipation (True) Explanation: Due to ketosis and dehydration coma with focal neurological signs (False) Explanation: Suggests severe hypoglyc aemia Question 17.MCQs VIA WEB 2005 Feelings of faintness and hunger (True) Explanation: But 50% of long-term type 1 diabetes mellitus patients have no symptoms Tremor. H. In the treatment of severe hypoglycaemia in a diabetic patien t patients should be taught to self-administer 50 ml of 50% glucose intravenousl y (False) Explanation: Defined as hypoglycaemia requiring the assistance of anot her person for recovery glucagon should be given intramuscularly (True) Explanat ion: Diabetics and close family members should be taught the technique the patie nt is more likely to have been taking metformin therapy alone rather than a sulp honylurea (False) Explanation: Hypoglycaemia does not occur with biguanides reve rsal of cognitive impairment is complete within 30 minutes of the restoration of normoglycaemia (False) Explanation: Can take 60-90 minutes after normoglycaemia is restored cerebral oedema should be considered if consciousness is not rapidl y restored (True) Explanation: Other possibilities include stroke. hypoglycaemia -induced seizures and alcohol intoxication Question 15. Factors predisposing to frequent hypoglycaemic episodes in a diabetic patient include Delayed meals (Tru e) Explanation: Or inadequate size of meal unusual exercise (True) Explanation: Often unanticipated Excessive alcohol intake (True) Explanation: A problem with patients on sulphonylurea drugs Development of hypoadrenalism (True) Explanation : Increased sensitivity to insulin.

monito r urine output and central venous pressure Question 19. dopamine antagonists and TRH both stimulate prolactin release somato statin-growth hormone (False) Explanation: Somatostatin inhibits growth hormone release thyrotrophin-releasing hormone (TRH)-thyroid-stimulating hormone (TSH) a nd prolactin (True) Explanation: In vivo significance of effect on prolactin is uncertain gonadotrophin-releasing hormone (GnRH)-luteinising hormone (LH) and fo llicle-stimulating hormone (FSH) independently (True) Explanation: Gonadal stero ids and inhibin modify GnRH effects corticotrophin-releasing hormone (CRH)-â-lipot rophic hormone (LPH) and adrenocorticotrophic hormone (ACTH) (True) Explanation: Arginine vasopressin also effects ACTH release By A. In the management of diabetic ketoacidosis intracellular water defi cit is best restored using half-strength saline (0.0 (H+ concentration > 100 nmol/l) 5% dextrose solution should b e avoided unless hypoglycaemia supervenes (False) Explanation: Dextrose is used to correct intracellular fluid depletion and if blood glucose < 15 mmol/l periph eral circulatory failure requires rapid volume replacement initially (True) Expl anation: Give plasma expander if blood pressure does not improve rapidly. i. The hypothalamic releasing factors listed below stimulate the pituitary gland to secrete the foll owing hormones dopamine-prolactin (False) Explanation: Dopamine inhibits prolact in release. H. hard exudat es indicate plasma leakage retinal haemorrhages (True) Explanation: Appearance o f haemorrhages corresponds with their site in the layers of the retina microaneu rysms (True) Explanation: Major risk factor for macrovascular disease Question 2 0.45% saline) (False) Explanati on: Use isotonic solutions. .5 mmol/l bicarbonate infusion is rarely necessary in the absence of renal failure (True) Explanation: Or in severe acido sis.e. The clinical features of diabetic retinopathy include arteriolar spasm with arteriovenous nipping (False ) Explanation: Suggests hypertensive change venous dilatation and increased veno us tortuosity (True) Explanation: Sausage-like venous 'beading' soft and hard ex udates (True) Explanation: Soft exudates indicate retinal ischaemia. change to 5% dextrose when blood glucose falls below 15 mmol/l potassium should be given immediately anticipating a low serum potass ium concentration (False) Explanation: Avoid until the serum K+ result is availa ble and do not give if the serum K+ > 5. pH < 7.MCQs VIA WEB 2005 Explanation: Even in absence of infection due to acidosis Question 18. The following statements about the long-term complications of diabetes are co rrect cardiovascular disease accounts for 70% of all deaths associated with diab etes (True) Explanation: Renal failure accounts for 10% of deaths associated wit h diabetes the excess mortality associated with diabetes is mainly attributable to microvascular complications (False) Explanation: Mainly macrovascular complic ations due to atherosclerosis the frequency and severity of microvascular compli cations can be minimised by strict glycaemic control (True) Explanation: Both in type 1 and type 2 diabetes cardiovascular complications can be minimised by str ict control of the blood pressure (True) Explanation: Both in type 1 and type 2 diabetes diabetic patients with hypercholesterolaemia and cardiovascular disease benefit from statin therapy (True) Explanation: Both type 1 and type 2 diabetic s at high risk from cardiovascular disease also benefit from angiotensinconverti ng enzyme inhibitor therapy Module 16 (Chapter 16) Question 1.

cabergoline and quinagolide Question 4. Causes of hyperprolactinaemia include oral contraceptive therapy (Tr ue) Explanation: And pregnancy chlorpromazine therapy (True) Explanation: Dopami ne antagonist like metoclopramide primary hypothyroidism (True) Explanation: Hig h plasma TRH hypothalamic disease (True) Cushing's disease (True) Explanation: H igh plasma ACTH Question 3. .MCQs VIA WEB 2005 Question 2. GH normally falls during the GTT decreased serum prolactin (False) Explanation: Increased se rum prolactin occurs in 30% increased serum insulin-like growth factor (IGF-1) ( True) abnormality of the pituitary fossa on plain radiograph (False) Explanation : Rarely abnormal-MR scanning is used for preoperative assessment tumour shrinka ge in response to octreotide therapy (False) Explanation: Somatostatin analogues reduce GH secretion but not tumour size Question 6. skin changes do not occur dilutional hyponatraemia (True ) Explanation: Due to increased ADH release and ADH sensitivity induced by hypot ension and cortisol deficiency-ADH deficiency occurs if there is posterior pitui tary damage By A. Typical results of investigations in a patient with acromegaly include failur e of the plasma growth hormone (GH) to rise during a glucose tolerance test (GTT ) (False) Explanation: Failure to suppress plasma GH-may even rise. Typical features of anterio r pituitary hormone deficiency in adults include loss of growth hormone function before luteinising hormone (True) Explanation: Then loss of ACTH and finally lo ss of TSH hypertension due to ACTH deficiency (False) Explanation: Hypotension d ue to the effects of cortisol deficiency on the vascular bed and kidneys skin pi gmentation (False) Explanation: Striking pallor due to the effects of â-LPH defici ency on melanocytes myxoedema due to TSH deficiency (False) Explanation: Unlike primary hypothyroidism. The clinical features of hyperprolactinaemia include hypogonadism and galactorrhoea (True) Explanation: Unilateral galactorrhoea sug gests a breast tumour infertility associated with secondary amenorrhoea (True) E xplanation: Typical an increased likelihood of macroadenoma in males (True) bite mporal hemianopia associated with microadenomas (True) Explanation: Pressure eff ects are only associated with macroadenomas prompt response to dopamine agonist therapy (True) Explanation: E.g. The cli nical features of acromegaly include arthropathy and myopathy (True) Explanation : Also carpal tunnel syndrome hypertension and impaired glucose tolerance (True) Explanation: Both occur in 25% goitre and cardiomegaly (True) Explanation: Visc eromegaly and hepatomegaly increased sweating and headache (True) Explanation: T he commonest of all the symptoms skin atrophy and decreased sebum secretion (Fal se) Explanation: The skin is thickened with increased sebum production Question 5. H.

001 (False) Explanation: Severe hypernatraemia only w hen water access denied increased polyuria following corticosteroid therapy for hypopituitarism (True) Explanation: Glucocorticoid insufficiency may mask diabet es insipidus onset following basal meningitis or hypothalamic trauma (True) Expl anation: Or secondary to pituitary tumours or sarcoid decreased renal responsive ness to ADH following carbamazepine therapy (False) Explanation: Carbamazepine s timulates ADH release unlike psychogenic polydipsia. diabet es mellitus. H. Causes of hypopituitarism include Kallmann's syndrome (True) Explana tion: GnRH deficiency associated with hypogonadotrophic hypogonadism and anosmia craniopharyngioma (True) Explanation: Any tumour close to the pituitary fossa i ncluding meningiomas head injury (True) Explanation: Including radiotherapy Shee han's syndrome (True) Explanation: Post-partum necrosis of the pituitary gland s arcoidosis (True) Explanation: Also tuberculosis causing chronic basal meningiti s Question 8. The insulin tolerance test is mandatory to confirm the diagnosis of hypopituitarism (False) Explanation: An ACTH stimulation test is often the more appropriate test best terminated as soon as the plasma glucose falls below 2. Causes of diabetes insipidus (DI) include congenital sex-linked re cessive disorder (True) Explanation: Nephrogenic DI. optic atrophy and deafness severe hypocalcaemia (False) Explanation : Severe hypokalaemia and hypercalcaemia sarcoidosis (True) Explanation: Also tu berculosis causing chronic basal meningitis Question 9.MCQs VIA WEB 2005 Question 7. The following statements abo ut thyroid hormones are true T3 and T4 are both stored in colloid vesicles as th yroglobulin (True) Explanation: Thyroglobulin is synthesised within thyroid cell s T4 is metabolically more active than T3 (False) Explanation: T4 should be rega rded as a prohormone T3 and T4 are mainly bound to albumin in the serum (False) Explanation: Bound to thyroxine-binding globulin and also to pre-albumin 85% of the circulating T3 arises from extra-thyroidal T4 (True) By A. The typical features of cranial diabetes insipidus include serum sodium concentration > 150 mmol/l with urine specific gravity < 1. also congenital cranial DIautosomal dominant craniopharyngioma (True) Explanation: Any tumour or radiother apy close to the pituitary fossa DIDMOAD syndrome (True) Explanation: DI.4 mmol/l (True) Explanation: Or if severe hypoglycaemic symptoms develop contraindicated in ischaemic heart disease (True) Explanation: Needs an adequate hypoglycaemic stimulus and runs the risk of hypoglycaemia contraindicat ed in severe hypopituitarism (True) Explanation: Plasma cortisol at 0800 hrs < 1 80 nmol/l an unreliable test of hypothalamic function (False) Explanation: Test of hypothalamic-pituitary-adrenal axis Question 11. . the response to ADH is inva riably normal (True) Explanation: An effect of long-term overhydration in psycho genic polydipsia Question 10.

MCQs VIA WEB 2005 Explanation: T4 is deiodinated in liver. . muscle and kidney conversion of T4 to T 3 decreases in acute illness (True) Explanation: Production of reverse T3 may in crease Question 12. total T4 is often increased (high TBG concentrations) Que stion 13. The following statements about thyrotoxicosis are true most patients h ave Graves' disease (True) Explanation: 75% of cases multinodular goitre is more common than uninodular goitre (True) Explanation: 15% multinodular. The clinical features of thyrotoxicosis include atrial fibrillation with a collapsing pulse (True) Explanation: Or persisting r esting sinus tachycardia weight loss and oligomenorrhoea (True) Explanation: App etite is maintained peripheral neuropathy (False) Explanation: Muscular weakness may occur proximal myopathy and exophthalmos (True) Explanation: Occasionally w ith ophthalmoplegia decreased insulin requirements in type 1 diabetes mellitus ( False) Explanation: Insulin requirements may increase Question 15. 5% single n odule amiodarone treatment should be considered as a possible cause (True) Expla nation: May also cause hypothyroidism the thyroid gland is diffusely hyperactive in Graves' disease (True) Explanation: A goitre is therefore usually present th ere is an increased prevalence of HLA-DR3 in Graves' disease (True) Explanation: And HLA-B8 and DR2 Question 14. The finding of reduced serum free T4 and thyroid-stimulating hormone (TSH) concentrations is compatible with the following conditions hypopi tuitarism (True) Explanation: With secondary hypothyroidism primary hypothyroidi sm (False) Explanation: Serum TSH would be elevated nephrotic syndrome (False) E xplanation: Free T4 is normal but total T4 is often increased (high thyroxine-bi nding globulin (TBG) concentrations) pneumonia (True) Explanation: Sick euthyroi d syndrome-total and free T4 may be reduced pregnancy (False) Explanation: Free T4 and TSH are normal. H. a re non-specific cold sensitivity and menorrhagia (True) By A. however. The clinical features of primary hypothyroidism include c arpal tunnel syndrome and proximal myopathy (True) Explanation: Both. In the treatm ent of thyrotoxicosis propranolol should not be given in atrial fibrillation (Fa lse) Explanation: Controls ventricular response rate carbimazole blocks the secr etion of T3 and T4 by the thyroid (False) Explanation: Inhibits the iodination o f tyrosine persistent suppression of the serum TSH is an indication for surgery (False) Explanation: TSH measurement alone should not guide therapy serum TSH re ceptor antibodies usually persist despite carbimazole (False) Explanation: But t itres correlate poorly with disease activity surgery is more likely to be necess ary in young men than in women (True) Explanation: Especially patients with larg e goiters Question 16.

The development of a goitre is as sociated with Coxsackie B viral infection (False) Explanation: May cause painful thyroiditis with transient hypothyroidism dietary iodine deficiency (True) Expl anation: Hypothyroidism if iodine deficiency is severe excess dietary calcium in take (False) Explanation: No association cranial irradiation (True) Explanation: Secondary hypothyroidism lithium carbonate therapy (True) Explanation: Inhibits release of thyroid hormones Question 19. . normal after correction for serum albumin pyloric stenosis (False) Explanati on: But metabolic alkalosis decreases the level of ionised calcium carcinomatosi s (True) Explanation: Due to bone metastases (often microscopic) hypoparathyroid ism (False) Explanation: Decreases serum calcium levels chronic sarcoidosis (Tru e) Explanation: Increased vitamin D synthesis with decreased PTH concentration Q uestion 21. Thyroid carcinoma of lymphomatous type usually presents as a single 'hot' thyroid nodule (False) Explanation: 'Hot' no dules are almost always benign anaplastic type is usually cured by local radioth erapy (False) Explanation: Radiotherapy provides brief symptomatic relief only f ollicular type is best treated by 131I radio-iodine therapy alone (False) Explan ation: Total thyroidectomy. H. The serum calcium concentration is typically increased in hypoalbuminaemia (False) Explanation: 40% of calcium is protein-bou nd.MCQs VIA WEB 2005 Explanation: And infertility and impotence deafness and dizziness (True) Explana tion: Perhaps due to oedema of the middle ear puffy eyelids and malar flush (Tru e) Explanation: And rarely alopecia. Typical clinical features of primary hyperparathyroidism include By A. radio-iodine and long-term thyroxine papillary type should be treated with total thyroidectomy (True) Explanation: Papillary tumours are the most common cell type medullary type secretes calcitonin causing severe hypocalcaemia (False) Explanation: Rare despite high calcitonin levels. carcino id syndrome can occur Question 20. vitiligo and dry hair absent ankle tendon r eflexes (False) Explanation: Reflexes preserved with delayed relaxation Question 17. Biochemical findings in primary hypothyroidism include decreased serum free T4 and decreased serum TSH concentration (False) Explanation: Decreased serum f ree T4 and increased serum TSH concentration increased serum prolactin concentra tion (True) Explanation: Rarely causing galactorrhoea inappropriate ADH secretio n (True) Explanation: Producing hyponatraemia increased serum alkaline phosphata se concentration (False) Explanation: Serum lactate dehydrogenase and creatine k inase may be elevated increased serum cholesterol concentration (True) Explanati on: And serum triglyceride levels Question 18.

25-dihydroxych olecalciferol concentration hypercalciuria and hyperphosphaturia (True) Explanat ion: Predisposing to stone formation increased serum alkaline phosphatase with b ony involvement (True) Explanation: Indicating osteoblastic activity increased s erum calcium and PTH concentrations (True) Explanation: Serum chloride concentra tion is usually elevated Question 23. The following statements about adrenal gland physiology are true ACTH normally controls the a drenal secretion of aldosterone (False) Explanation: Principally under control o f angiotensin II ACTH increases adrenal androgen and cortisol secretion (True) E xplanation: In the zona reticularis and zona fasciculata respectively the plasma cortisol concentration normally peaks in the evening (False) Explanation: Corti sol levels fall to a nadir at around midnight hyperglycaemia increases the rate of cortisol secretion (False) Explanation: Hypoglycaemia stimulates cortisol rel ease cortisol enhances gluconeogenesis and lipogenesis (True) Explanation: Antiinsulin effects Question 25. Typical biochemical findings in pr imary hyperparathyroidism include increased serum calcium and phosphate concentr ations (False) Explanation: Phosphate is usually low decreased serum 1.25-dihydr oxycholecalciferol concentration (False) Explanation: Increased 1. .MCQs VIA WEB 2005 recurrent acute pancreatitis and renal colic due to calculi (True) Explanation: But 50% of patients are asymptomatic hyperplasia of all the parathyroid glands o n histology (False) Explanation: Solitary parathyroid adenoma in 90% osteitis fi brosa on bone radiographs at presentation (False) Explanation: A relatively late feature the complications of pseudogout and hypertension (True) Explanation: An d peptic ulceration and myopathy nephrogenic diabetes insipidus (True) Explanati on: With characteristic polyuria Question 22. H. Causes of hypercalcaemia include bone meta stases (True) Explanation: Often via production of osteoclast-activating factors carcinomas secreting PTH-like peptides (True) Explanation: Undetectable using s tandard PTH assays severe Addison's disease (True) Explanation: Increased vitami n D synthesis with low PTH concentration severe hypothyroidism (False) Explanati on: Hyperthyroidism is a rare cause chronic sarcoidosis (True) Explanation: Incr eased vitamin D production with low PTH concentration Question 24. The typical clinical features of Cushing's syndrome include generalised osteoporosis (True) Explanation: Protein catabolism in bone systemic hypotension (False) Explanation: Hypertension may occur hirsutism and amenorrhoea (True) Explanation: Impotence in men proximal myopathy (True) Explan ation: Muscle protein catabolism By A.

Causes of primary adrenocortical insufficiency include haemochromatosis (True) Explanation: Rare cause autoimmune adrenalitis (True) Explanation: Commonest cause amyloidosis (True) Explanation: Rare sarcoid osis (False) Explanation: May cause hypercalcaemia tuberculosis (True) Explanati on: Now a rare cause Question 29. c auses day-night reversal of biorhythms Question 27. The typical feature s of phaeochromocytoma include predominantly adrenaline rather than noradrenalin e secretion (False) Explanation: Noradrenaline is a precursor of adrenaline epis odic nausea with sweating and marked skin pallor (True) Explanation: Catecholami ne secretion underlying malignant tumour in the majority (False) By A. In primary hyperaldosteronis m (Conn's syndrome) peripheral oedema is usually marked (False) Explanation: Unl ike oedema in patients with secondary hyperaldosteronism proximal myopathy is du e to hypokalaemia (True) Explanation: Rarely hypokalaemic paralysis polyuria and polydipsia are characteristic (True) Explanation: Hypertension and hypokalaemia are also characteristic diabetes mellitus is often present (False) Explanation: Type 2 diabetes mellitus is. weight loss and diarrhoea (True) Explanation: All f eatures of glucocorticoid insufficiency pigmentation of scars from surgery prece ding hypoadrenalism (False) Explanation: Only new scars become pigmented vitilig o. associated with primary hypoadrenalism hy pertension is associated with hyperreninaemia (False) Explanation: Associated wi th renin suppression Question 28. . Adverse effects of oral corticosteroid therapy include peptic ulceration (Tr ue) Explanation: Decreases mucosal resistance hypertension (True) Explanation: I ncreased renal sodium reabsorption avascular bone necrosis (True) Explanation: P articularly likely to affect the femoral heads pseudogout (False) Explanation: S ometimes used to treat severe pseudogout insomnia (True) Explanation: Typical. Typical features of primary adrenocortical ins ufficiency include anorexia.MCQs VIA WEB 2005 hypoglycaemic episodes (False) Explanation: Impaired glucose tolerance Question 26. however. H. weakness and hypotension (True) Explanation: Vitiligo is seen in 10-20% of pa tients increased insulin requirements in diabetic patients (False) Explanation: Increased insulin sensitivity with hypoglycaemia amenorrhoea and loss of body ha ir (True) Explanation: Loss of adrenal androgen Question 30.

Causes of gynaecomastia include androgen defic iency and/or excessive oestrogen production (True) Explanation: E.g. Causes of secondary amenorrhoea include pituitary microprolactinoma (True ) Explanation: Suppression of LH and FSH secretion by prolactin anorexia nervosa (True) Explanation: Failure of gonadotrophin secretion Cushing's syndrome (True ) Explanation: Associated with hyperprolactinaemia renal failure (True) Explanat ion: Or other severe systemic disease Stein-Leventhal syndrome (True) Explanatio n: Polycystic ovary disease Question 34. In cryptorchidism with ingui nal testes in a child the individual is usually otherwise normal (True) Explanat ion: Chromosomal abnormalities are rare hypogonadotrophic hypogonadism should be excluded (True) Explanation: Occurs in the minority the seminiferous tubules ar e typically normal (False) Explanation: Sterility follows if bilateral testicula r interstitial cell function is usually normal (True) Explanation: Secondary sex ual characteristics are preserved treatment with chorionic gonadotrophin or GnRH is contraindicated (False) Explanation: Testicular descent ensues in 40% Questi on 33.g.g. cyproterone) By A. The typical features of the menopause i nclude decreased plasma LH and FSH concentrations (False) Explanation: Gonadotro phins elevated hirsutism and clitoral hypertrophy (False) Explanation: Features of androgen excess bone fractures due to osteomalacia (False) Explanation: Osteo porosis develops prematurely superficial dyspareunia and dysuria (True) Explanat ion: Due to oestrogen deficiency normal age at onset 40 years (False) Explanatio n: Normal menopause occurs at age 50-55 years Question 35. . cyproterone + GnRH analogues) haemochromatosis (True) Explanation: Hypergonadotrophic hypogo nadism human chorionic gonadotrophin-secreting tumour (True) Explanation: Rare c ause of excessive oestrogen production Question 32.MCQs VIA WEB 2005 Explanation: 90% are benign presentation with hypertension and hypercalcaemia (T rue) Explanation: Occurs in MEN type II syndrome control of symptoms following p ropranolol therapy alone (False) Explanation: Symptoms worsen due to unopposed á-a drenoceptor activity Question 31. hypogonadis m or chronic liver failure microprolactinoma or macroprolactinoma (True) Explana tion: Inhibition of LH/FSH secretion caused by prolactin cimetidine therapy (Tru e) Explanation: Also spironolactone and anti-androgen therapy (e. Causes of hirsutism i nclude idiopathic familial hirsutism (True) Explanation: Commonest cause and tre ated with anti-androgens (e. H.

plasma LH:FSH ratio > 2. H. Reiter's syndrome Crohn's disease (True) Explanation: And ulcerative colitis lichen planus (True) Explana tion: And pemphigoid and pemphigus adverse drug reaction (True) Explanation: Ste vens-Johnson syndrome due to either drugs or infections herpes simplex (True) Ex planation: Aphthous mouth ulcers are usually idiopathic rather than viral-induce d Question 2. parathyroid. thyroid. Causes of salivary gland enlargement include alcoholic liver disea se (True) Explanation: Also associated with malnutrition and autoimmune hepatiti s Sjögren's syndrome (True) Explanation: Associated with dry mouth and keratoconju nctivitis sicca (dry eyes) bacterial infection (True) Explanation: May be associ ated with calculi in the parotid duct sarcoidosis (True) Explanation: Uveoparoti d fever (Heerfordt's syndrome) measles (False) Explanation: Associated with mump s Question 3. Beh[sfgr ]et's syndrome.MCQs VIA WEB 2005 polycystic ovarian syndrome (PCOS) (True) Explanation: PCOS is associated with o besity and infertility. typically worse with fluids than with solids achalasia (True) Explanation: Best diagnosed on oesophageal manometry Question 4. . Causes of mouth ulcers include gluten enteropathy (True) Explanation: And systemic lupus erythematosus. Recognised causes of dysphagia include iron deficiency anaemia (Tr ue) Explanation: Via formation of an oesophageal web-'sideropenic dysphagia' pha ryngeal pouch (True) Explanation: May also be associated with regurgitation and recurrent aspiration Barrett's oesophagus (False) Explanation: Asymptomatic unle ss complicated by malignancy myasthenia gravis (True) Explanation: More commonly caused by stroke.5:1 Cushing's syndrome (True) Ex planation: Modest increase in adrenal androgen synthesis autoimmune polyglandula r syndrome (False) Explanation: Primary adrenal. Typical featur es of oesophageal achalasia include recurrent pneumonia (True) Explanation: Due to regurgitation and aspiration spasm of the lower oesophageal sphincter (LOS) ( False) Explanation: Failure to relax the LOS with loss of ganglion cells in Auer bach's plexus on histology heartburn and acid reflux (False) Explanation: Acid r eflux is prevented by the non-relaxing LOS predisposition to oesophageal carcino ma (True) Explanation: Even if the obstruction is treated symptomatic response t o pneumatic balloon dilatation (True) By A. gastric p arietal and gonadal failure syndromes ovarian tumour (True) Explanation: Ectopic androgen production does not suppress with dexamethasone (unlike excessive andr ogen production in congenital adrenal hyperplasia) Module 17 (Chapter 17) Questi on 1.

H. Gastro-oesophageal reflux disease is associated with the following f actors decreased intra-abdominal pressure (False) Explanation: Associated with i ncreased intra-abdominal pressure (e.MCQs VIA WEB 2005 Explanation: If this fails. pain rarely lasts > 2 hours By A. Typical features of peptic ulcer dyspepsia include pain relieved by ea ting (True) Explanation: Hunger pain well-localised pain relieved by vomiting (T rue) Explanation: Perhaps with the 'pointing sign' pain-free remissions lasting many weeks (True) Explanation: Pain is characteristically periodic nausea and ep igastric pain (False) Explanation: More suggestive of biliary colic. Fac tors associated with chronic peptic ulcer disease include oral contraceptive the rapy (False) non-steroidal anti-inflammatory drug therapy (True) Explanation: Pl ays a role in gastric ulcer pernicious anaemia (False) Explanation: Associated w ith achlorhydria-'no acid. Heller's myotomy may be indicated Question 5.g. liver and/or mediastinal spread overall survival rates at 5 years of ap proximately 50% (False) Explanation: 5-year survival is about 5% Question 8. no ulcer' Helicobacter pylori . pregnancy) delayed gastric emptying (Tru e) prolonged oesophageal transit time (True) Explanation: Delayed oesophageal cl earance is more common in the elderly increased lower oesophageal sphincter tone (False) Explanation: Associated with decreased lower oesophageal sphincter tone presence of a hiatus hernia (True) Question 6. .associated gastritis (True) Explanation: Implicated in > 90% of instances tobacco consumption (True) Explanation: Associated with both gastric and duodenal ulcer recurrence rates Qu estion 9. Oesophageal carcinoma in the UK is associated with gluten enteropathy (True) Explanation: Squamous rather than a denocarcinoma more likely to be due to adenocarcinoma than squamous carcinoma (F alse) Explanation: 80-90% are squamous cell associated with Barrett's oesophagus (True) Explanation: Adenocarcinoma is associated with chronic oesophagitis more likely to arise in the upper third rather than the lower third of the oesophagu s (False) Explanation: 90% are in the lower two-thirds associated with alcohol a nd tobacco consumption (True) Explanation: And betel nut chewing in the East Que stion 7. Typical features of oesophageal carcinoma at presentation include acid reflux and odynophagia (False) Explanation: More suggestive of reflux with oesop hagitis and stricture formation painless obstruction to the passage of a food bo lus (True) Explanation: Painless due to destruction of the mucosal innervation n ausea and weight loss (True) Explanation: Weight loss relates to poor food intak e metastatic spread in the majority of patients (True) Explanation: 75% have lym ph node.

H. aluminium-containing antacids caus e constipation bismuth compounds should not be used for maintenance therapy (Tru e) Explanation: Due to potential accumulation of bismuth. pylori gastritis than gastric ulcers occurring in patients no t taking NSAIDs (True) Explanation: 30% of gastric ulcers are not associated wit h H. . In the investigation and treatment of chronic dyspepsia most patien ts aged < 55 years have an underlying peptic ulcer (False) Explanation: Only abo ut 20%.MCQs VIA WEB 2005 absence of symptoms prior to acute perforation (True Question 10. When acute gastroduodenal haemorrhage is suspected a pulse rate > 100/min is most likely to be due to anxiety (False) Explanation: A sign of hyp ovolaemia hypotension without a tachycardia suggests an alternative diagnosis (F alse) Explanation: Bradycardia may occur in profound blood loss or in the elderl y the absence of anaemia suggests the volume of blood loss is modest (False) Exp lanation: Haemoglobin concentration remains unaltered until haemodilution occurs nasogastric aspiration provides an accurate estimate of blood loss (False) Expl anation: Monitoring the urine output as a measure of perfusion is important endo scopy is best deferred pending blood volume replacement (True) Explanation: Pati ents should first be haemodynamically stable if possible Question 14. acid-lowering drugs ar e preferable gastric ulcers associated with NSAID therapy are less likely to be associated with H. varices < 5% associated with a 5% mortality when due to chronic peptic ulceration (True) Explanation: Higher mortality in the elderl y and especially in patients who rebleed a recognised complication of severe hea d injury (True) Explanation: Cushing's stress ulcers best investigated by endosc opy (True) Explanation: Diagnostic yield reduces with time post-admission signif icantly associated with anti-inflammatory drug therapy (True) Explanation: 75% o f patients with gastrointestinal bleed have recently taken NSAIDs (only 50% of ' controls') Question 12. In resusci tating a patient with an acute gastrointestinal bleed oxygen should be administe red if there are signs of hypovolaemia (True) Explanation: Especially in patient s with shock transfusion requires whole blood rather than packed red cells (Fals e) Explanation: Colloid infusion and packed red cells are adequate for volume re placement By A. pylori has not been eradicated magnesium-containing antacids produce const ipation (False) Explanation: Cause diarrhoea. Typical features of major acute gastroduodenal haemorrha ge include severe abdominal pain (False) Explanation: Typically pain-free angor animi and restlessness (True) Explanation: Sympathetic activation syncope preced ing other evidence of bleeding (True) Explanation: Particularly in older patient s elevated blood urea and creatinine concentrations (False) Explanation: Blood u rea but not creatinine rises due to digestion of the blood in the gut peripheral blood microcytosis (False) Explanation: Only present if preceding iron deficien cy Question 13. pylori (NSAID-induced ulcers) Question 11. Gastroduodenal haemorrhage in th e UK is more often due to peptic ulcer than to oesophageal varices (True) Explan ation: Peptic ulcer 35-50%. most have reflux dyspepsia or functional dyspepsia 25% of duodenal ulcer s relapse unless H. pylori has been eradicated (False) Explanation: 85% relapse if H.

patients may feel like eating immediately after v omiting absent gastric peristalsis (False) Explanation: Often prominent gastric peristalsis and a succussion splash Question 17. H. .MCQs VIA WEB 2005 volume replacement with colloids is preferable to crystalloids (True) Explanatio n: Crystalloids rapidly redistribute to the extravascular space monitoring centr al venous pressure and/or urine output is advisable (True) Explanation: Facilita tes restoration of optimal circulating volume surgical intervention should be co nsidered if rebleeding occurs despite ulcer sclerotherapy (True) Explanation: Co nsider surgical options in all patients with continuing bleeding Question 15. Complications of partial gastre ctomy include early satiety (True) Explanation: Smaller stomach and loss of vaga lly mediated gastric relaxation iron deficiency anaemia (True) Explanation: Mala bsorption is common and can produce folate. Carcinoma of the stomach is ass ociated with adenomatous gastric polyps (True) By A. Chara cteristic features of gastric outlet obstruction include metabolic acidosis (Fal se) Explanation: Hypokalaemic metabolic alkalosis bile vomiting (False) Explanat ion: Suggests more distal obstruction urinary pH < 5 (True) Explanation: Paradox ical aciduria due to renal tubular mechanisms symptomatic relief after vomiting (True) Explanation: Unusually. The typical features of non-ulcer dyspepsia include onset under the age of 40 y ears (True) Explanation: Women are more commonly affected than men nausea and bl oating (True) Explanation: Dysmotility state weight loss and anaemia (False) Exp lanation: Features suggesting serious underlying disease constipation with pelle ty stools (True) Explanation: Often associated with an irritable bowel syndrome symptoms of anxiety and depression (True) Explanation: Often associated with str essful life events and difficulties Question 19. Pe rforation of a peptic ulcer is typically associated with acute rather than chron ic ulcers (False) Explanation: 25% occur in acute ulcers duodenal more often tha n gastric ulcers (True) Explanation: Especially anterior wall ulcers abdominal p ain radiating to the shoulder tip (True) Explanation: Diaphragmatic pain referre d to one or both shoulder tips the absence of nausea and vomiting (False) Explan ation: Vomiting is common symptomatic improvement several hours following onset (True) Explanation: But abdominal rigidity typically persists Question 16. B12 and vitamin D deficiency weight loss (True) Explanation: Most patients will lose at least 5 kg reactive hypoglyc aemia (True) Explanation: Late dumping syndrome with exaggerated insulin release vomiting and diarrhoea soon after meals (True) Explanation: Early dumping syndr ome with the exaggerated release of upper gastrointestinal hormones Question 18.

MCQs VIA WEB 2005 chronic hypochlorhydria (True) Explanation: Pernicious anaemia and partial gastr ectomy Helicobacter pylori infection (True) Explanation: H. pylori may account f or 60% of gastric carcinoma Ménétrier's disease (True) Explanation: Hypertrophic gas tritis with protein-losing enteropathy alcohol and tobacco consumption (True) Qu estion 20. flushing and wheezing constipation (False) Explanation: Diarrhoea is char acteristic intestinal ischaemia (True) Explanation: Due to mesenteric infiltrati on and/or vasospasm tricuspid valve dysfunction (True) Explanation: And pulmonar y stenosis late occurrence of metastatic disease (False) Explanation: Typically associated with widespread liver metastases Question 24. Causes of acute pancrea titis include By A. Crohn's disease Question 23. H. Typical features of gastric carcinoma in the UK include progression t o involve the duodenum (False) Explanation: Extraordinary but true origin within a chronic peptic ulcer (False) Explanation: But may present as a malignant ulce r overall 5-year survival rate of 50% (False) Explanation: 10% 5-year survival f olate deficiency anaemia on presentation (False) Explanation: Iron deficiency an aemia is typical supraclavicular lymphadenopathy (True) Explanation: Virchow's n ode Question 21. Clinical features suggesting the carcinoid synd rome include facial blanching and sweating (False) Explanation: Facial telangiec tasia.g.g. . Causes of small bowel bacterial overgrowth (blind loop syndrome) includ e diabetic autonomic neuropathy (True) Explanation: Reduced small intestinal mot ility chronic hypochlorhydria (True) Explanation: E. long-term proton pump inh ibitor therapy and pernicious anaemia jejunal diverticulosis (True) Explanation: Best demonstrated by barium meal progressive systemic sclerosis (True) Explanat ion: Reduced small intestinal motility enterocolic fistula (True) Explanation: E . In gluten enteropathy (coeliac disease) the peak at onset is 11 -19 years (False) Explanation: Peak incidence in the age groups 1-5 years and 40 -59 years there is a predisposition to gut lymphoma and carcinoma (True) Explana tion: Symptoms return without dietary indiscretion the toxic agent is the polype ptide á-gliadin (True) Explanation: A component of the gluten protein gluten-free diets improve absorption but not the villous atrophy (False) Explanation: Villou s atrophy should resolve serum anti-endomysium IgA antibody titres are character istically elevated (True) Explanation: Also antigliadin IgA antibody titres Ques tion 22.

Adverse prognostic factors in acute pancreatitis inclu de arterial hypoxaemia with a PaO2 < 8 kPa (True) Explanation: Administer high-f low oxygen therapy leucopenia with white blood cell count < 5 × 109/l (False) Expl anation: Poorer prognosis indicated by white blood cell count > 15 × 109/l serum a lbumin < 30 g/l and serum calcium < 2 mmol/l (True) Explanation: Reflect extent of peritoneal reaction hypoglycaemia < 2.3 mmol/l (False) Explanation: Hyperglyc aemia > 10 mmol/l blood urea > 16 mmol/l after rehydration (True) Question 27. H. The following are characteristic of acu te pancreatitis abdominal guarding develops soon after the onset of pain (False) Explanation: Guarding occurs relatively late normal serum amylase concentration in the first 4 hours after onset (False) Explanation: Serum amylase rises and f alls rapidly persistent serum hyperamylasaemia suggests a developing pseudocyst (True) Explanation: Or pancreatic abscess or non-pancreatic cause hypercalcaemia 5-7 days after onset (False) Explanation: Hypocalcaemia hyperactive loud bowel sounds (False) Explanation: Bowel sounds usually absent or diminished due to par alytic ileus Question 26.MCQs VIA WEB 2005 measles (False) Explanation: Mumps and Coxsackie B viral infections hypothermia (True) Explanation: And hyperlipidaemia choledocholithiasis (True) Explanation: 50% of cases are associated with biliary tract disease azathioprine therapy (Tru e) Explanation: And thiazides and corticosteroids alcohol misuse (True) Explanat ion: Common cause in the UK Question 25. . I n the management of acute pancreatitis early laparotomy is advisable to exclude alternative diagnoses (False) Explanation: Diagnostic laparotomy is rarely requi red opiates should be avoided because of spasm of the sphincter of Oddi (False) Explanation: Effective pain relief is important intravenous fluids are unnecessa ry in the absence of a tachycardia (False) Explanation: Heart rate alone is a po or guide to volume losses the urine output and PaO2 should be monitored (True) E xplanation: Shock and respiratory failure are serious complications persistent e levation in the serum amylase suggests pancreatic duct obstruction (True) Explan ation: Resulting in pancreatic pseudocyst Question 28. In the investigation of c hronic pancreatic disease glucose tolerance is typically normal in pancreatic ca rcinoma (False) Explanation: Typically impaired glucose tolerance test (GTT) duo denal ileus is a characteristic feature of chronic pancreatitis (False) Explanat ion: Occurs in acute pancreatitis transabdominal ultrasound scanning is more sen sitive than CT (False) Explanation: Pancreatic visualisation is superior with CT endoscopic retrograde cholangiopancreatography (ERCP) can reliably distinguish carcinoma from chronic pancreatitis (False) Explanation: Surgery may be necessar y pancreatic calcification suggests alcohol as the cause (True) By A.

MCQs VIA WEB 2005 Explanation: Biliary tract disease is rarely the cause Question 29. H. Features consistent with the diagnosis of chronic pancreatitis incl ude abdominal or back pain persisting for days (True) Explanation: Sometimes rel ieved by crouching or leaning forward chronic opiate dependency (True) Explanati on: In 20% increased sodium concentration in the sweat (False) Explanation: Occa sionally in cystic fibrosis abdominal pain induced and relieved by alcohol intak e (True) pancreatic calcification on plain radiograph or ultrasound (True) Expla nation: But insensitive diagnostic tests Question 30. Typical causes of chronic pancreatitis include annular pancreas (False) Explanation: Associated with pancr eas divisum alcoholism (True) Explanation: Accounts for 70-80% of instances gall stones (False) Explanation: Common but not the cause of chronic pancreatitis cys tic fibrosis (True) mumps (False) Question 31. The typical features of pancreatic carcinoma include adenocarcinomatous histol ogy (True) Explanation: The vast majority origin in the body of the pancreas in 60% of patients (False) Explanation: Head of pancreas is the origin in 60% of pa tients presentation with diabetes mellitus (True) Explanation: Indicating advanc ed disease back pain and weight loss indicate a poor prognosis (True) Explanatio n: Even in the absence of metastatic spread presentation with painless jaundice (True) Explanation: Usually due to a tumour in the head of pancreas Question 33. Typical complications of chronic pancreatitis include pancreatic pseudocyst formation (True) Explanation: Also as sociated with acute pancreatitis obstructive jaundice (True) Explanation: Due to stricture of the common bile duct as it passes the head of the pancreas portal vein thrombosis (True) Explanation: And splenic vein thrombosis leading to gastr ic varices diabetes mellitus (True) Explanation: Occurs in 30% overall opiate dr ug dependence (True) Explanation: May occur in up to 20% of patients Question 32 . Characteristic features of ulcerative colitis include invariable involvement of the rectal mucosa (True) Explanation: Proctitis is a typical finding segmental involvement of the colon and rectum (False) Explanation: Suggests Crohn's diseas e pseudopolyposis following healing of mucosal damage (True) Explanation: Due to oedema and hyperplasia inflammation extending from the mucosa to the serosa (Fa lse) Explanation: Affects mucosa and submucosa only By A. .

MCQs VIA WEB 2005 enterocutaneous and enteroenteric fistulae (False) Explanation: Suggest Crohn's disease Question 34. Ulcerative colitis (UC) differs from Crohn's colitis in tha t UC occurs at any age (False) Explanation: Both have a peak incidence at the ag e of about 20 years cessation of smoking is likely to reduce activity of Crohn's disease (True) Explanation: Smoking exacerbates Crohn's disease but not ulcerat ive colitis toxic dilatation only occurs in ulcerative colitis (False) Explanati on: Also occurs in severe Crohn's colitis there is no association with aphthous mouth ulcers in UC (unlike Crohn's disease) (False) Explanation: Occur in both t here is no involvement of the small bowel in UC (True) Question 35. Recognised c omplications of ulcerative colitis include pyoderma gangrenosum (True) Explanati on: Also occurs in Crohn's disease and rheumatoid arthritis pericholangitis (Tru e) Explanation: Suggested by abnormal liver function tests amyloidosis (True) Ex planation: Induced by many chronic inflammatory diseases colonic carcinoma (True ) Explanation: Long-standing disease (> 10 years) enteropathic arthritis (True) Question 36. Characteristic features of Crohn's disease include familial associa tion with ulcerative colitis (True) Explanation: And vice versa onset after the age of 70 years (False) Explanation: Early adult life most commonly disease conf ined to the terminal ileum and colon (False) Explanation: Affects any part of th e alimentary tract predisposition to biliary and renal calculi (True) Explanatio n: Bile acid malabsorption and hyperoxaluria giant cell granulomata on histopath ology (True) Explanation: Crohn's granulomata are non-caseating unlike those of tuberculosis Explanation: Large joints especially, or spondyloarthritis Question 37. The typical clinical features of ileal Crohn's disease include association with tobacco consumption (True) Explanation: In contrast to ulcerative colitis p resentation with bloody diarrhoea (False) Explanation: Usually pain rather than diarrhoea unless there is rectal involvement also presentation with subacute int estinal obstruction (True) Explanation: With episodes of colicky pain segmental involvement of the colon and rectum (True) Explanation: In contrast to ulcerativ e colitis inflammatory changes confined to the mucosa on histopathology (False) Explanation: Inflammation is transmural Question 38. The typical features of the irritable bowel syndrome include nocturnal diarrhoea and weight loss (False) Ex planation: Such symptoms suggest organic pathology onset after the age of 45 yea rs (False) Explanation: Typically affects females aged 16-45 years history of ch ildhood abdominal pain (True) Explanation: Many also have dyspeptic and urinary symptoms By A. H.

MCQs VIA WEB 2005 right iliac fossa pain and urinary frequency (True) Explanation: Pain may be rel ieved by defaecation abdominal distension, flatulence and pellety stools (True) Explanation: May be tenesmus, mucus PR and diarrhoea Question 39. The management of the irritable bowel syndrome should include explanation and reassurance afte r a detailed clinical examination (True) Explanation: Probably the most importan t therapeutic tools barium enema and barium follow-through examinations in all p atients (False) Explanation: Investigations are important in older patients eval uation of social and emotional factors (True) Explanation: Anxiety and/or depres sion are often associated with refractory symptoms referral for psychiatric asse ssment and therapy (False) Explanation: Although occasionally psychiatric interv ention may be necessary dihydrocodeine for abdominal pain and diarrhoea (False) Explanation: Use loperamide, a safer opioid that does not cross the blood-brain barrier Question 40. Typical features of colonic diverticulosis include predomin ant involvement of the right hemicolon (False) Explanation: Sigmoid colon is mos t commonly involved predisposition to the development of colonic carcinoma (Fals e) Explanation: No causative association complications are more common in patien ts receiving NSAID therapy (True) Explanation: Especially bleeding and perforati on reduction in the number of diverticula with a high-fibre diet (False) Explana tion: But symptoms may be improved the absence of symptoms in the absence of com plications (True) Explanation: Such as acute diverticulitis Question 41. Typical features of colonic diverticulitis include severe rectal bleeding (True) Explan ation: Exclusion of malignancy may be necessary chronic iron deficiency anaemia (False) Explanation: But this may be a feature of chronic diverticulosis septica emia and paralytic ileus (True) Explanation: With or without perforation right i liac fossa pain (False) Explanation: Left iliac fossa or hypogastric pain is typ ical vesicocolic fistula (True) Explanation: Or enterocolic or colovaginal Quest ion 42. Typical features of pseudomembranous colitis include onset within two we eks of antibiotic therapy (True) Explanation: Occurs from 4 days to 6 weeks post -antibiotics normal appearance of the rectal mucosa (False) Explanation: Usually appears as a non-specific proctitis Clostridium difficile toxin in the stool (T rue) presentation with abdominal pain and diarrhoea (True) Explanation: And even bloody diarrhoea clinical relapse despite prompt treatment (True) Explanation: Treated with metronidazole or vancomycin Question 43. Familial adenomatous polyp osis is inherited as an autosomal recessive trait (False) Explanation: Autosomal dominant with a prevalence of 1 in 14 000 usually clinically apparent before th e age of 10 years (False) Explanation: Typically presents in the age group 20-40 years By A. H.

MCQs VIA WEB 2005 likely to progress to carcinoma before the age of 40 years (True) Explanation: C arcinoma is usually present when symptoms commence associated with gastric and s mall bowel polyps (True) Explanation: Also with lipomas, epidermoid cysts, osteo mas and desmoid tumours best treated with immunosuppressant therapy in patients aged < 20 years (False) Explanation: Immunosuppressives have no role; prophylact ic colectomy is warranted Module 18 (Chapter 18) Question 1. Bilirubin is derive d exclusively from the breakdown of haemoglobin (False) Explanation: Also from c atabolism of other haem-containing proteins (e.g. myoglobin) bound in the unconj ugated form to plasma â-globulin (False) Explanation: Bound to albumin conjugated in the microsomes of the hepatocytes (True) Explanation: By enzymes of the smoot h endoplasmic reticulum reabsorbed in the small bowel as bilirubin diglucuronide (False) Explanation: Only reabsorbed after metabolism to stercobilinogen normal ly excreted as stercobilinogen in the faeces and as urobilinogen in the urine (T rue) Explanation: And as the oxidation products stercobilin and urobilin Questio n 2. The concentration of conjugated bilirubin in the serum in haemolytic anaemi a is typically increased (False) Explanation: Unconjugated hyperbilirubinaemia u rine of healthy subjects is typically undetectable (True) Explanation: As almost all bilirubin is unconjugated and albumin-bound serum normally constitutes most of the total serum bilirubin (False) Explanation: Most of the serum bilirubin i s unconjugated serum in Gilbert's syndrome is typically increased (False) Explan ation: Unconjugated bilirubin is increased urine in viral hepatitis parallels th at of urobilinogen (False) Explanation: Urobilinogen is an unreliable indicator of hepatobiliary disease Question 3. The serum alanine aminotransferase (ALT) co ncentration is derived from a microsomal enzyme specific to hepatocytes (False) Explanation: Neither ALT nor AST is specific to the liver typically more than si x times normal in alcoholic hepatitis (False) Explanation: Not usually > three t imes normal usually normal in both obstructive and haemolytic jaundice (False) E xplanation: May be elevated in either likely to rise and fall in parallel with t he serum bilirubin in viral hepatitis (False) Explanation: Changes in serum ALT precede changes in the serum bilirubin likely to increase in response to enzymeinducing drug therapy (False) Explanation: Only the gamma-glutamyl transferase l evels increase Question 4. The serum alkaline phosphatase concentration is deriv ed from the liver, bone, small bowel and placenta (True) Explanation: Therefore not specific to liver disease typically increased to more than six times normal in viral hepatitis (False) Explanation: Not usually > 2.5 times normal derived m ainly from hepatic sinusoidal and canalicular membranes (True) Explanation: Exce ss synthesis in cholestasis of particular prognostic value in chronic liver dise ase (False) Explanation: No prognostic value increased more in extrahepatic than in intrahepatic cholestasis (False) Explanation: No site-specific pattern By A. H.

MCQs VIA WEB 2005 Question 5. In the investigation of suspected liver disease ultrasonography reli ably distinguishes solid from cystic masses (True) ultrasonography reliably excl udes liver disease (False) Explanation: May appear normal in disease normal live r function values exclude significant liver disease (False) Explanation: May be normal in 10-15% of patients with cirrhosis the mortality rate of percutaneous l iver biopsy is about 5% (False) Explanation: Approximately 0.05% ascitic protein concentrations > 25 g/l are compatible with a diagnosis of carcinomatosis (True ) Explanation: And tuberculosis and hepatic vein obstruction; protein concentrat ion < 30 g/l = transudate Question 6. Characteristic features of Gilbert's syndr ome include an autosomal recessive mode of inheritance (False) Explanation: Typi cally autosomal dominant decreased hepatic glucuronyl transferase activity (True ) Explanation: Causing failure of bilirubin conjugation unconjugated hyperbiliru binaemia < 100 µmol/l (True) Explanation: And no abnormality of other liver functi on tests serum bilirubin concentration increased by fasting (True) Explanation: Sometimes used as a diagnostic test increased serum bile acid concentrations (Fa lse) Explanation: Unconjugated hyperbilirubinaemia is the sole abnormality Quest ion 7. Characteristic features of cholestatic jaundice include dark green stools (False) Explanation: Typically pale stools-steatorrhoea dark brown urine (True) Explanation: Due to conjugated bilirubinuria unconjugated hyperbilirubinaemia ( False) Explanation: Conjugated hyperbilirubinaemia serum alkaline phosphatase co ncentration > 2.5 times normal (True) Explanation: Diagnostic feature increased serum bile acid concentrations (True) Question 8. Typical causes of extrahepatic cholestatic jaundice include sclerosing cholangitis (False) Explanation: Intrah epatic primary biliary cirrhosis (False) Explanation: Intrahepatic cystic fibros is (True) Explanation: Common bile duct obstruction from chronic pancreatitis al coholic cirrhosis (False) Explanation: Intrahepatic non-alcoholic steatohepatiti s (False) Explanation: Rarely causes jaundice Question 9. The following features suggest extrahepatic cholestasis rather than viral hepatitis a palpable gallbla dder (True) Explanation: E.g. pancreatic carcinoma right hypochondrial tendernes s (False) Explanation: Also common in acute hepatitis serum alkaline phosphatase concentration > 2.5 times normal (True) pruritus and rigors (True) Explanation: Suggests obstruction with cholangitis peripheral blood polymorph leucocytosis ( True) Explanation: Sometimes relative lymphocytosis in viral hepatitis By A. H.

MCQs VIA WEB 2005 Question 10. The typical causes of macrovesicular steatosis include alcohol misu se (True) Explanation: Often asymptomatic pregnancy (False) Explanation: Microve sicular steatosis Reye's syndrome (False) Explanation: Microvesicular steatosis severe malnutrition (True) Explanation: Steatohepatitis (macrovesicular steatosi s with hepatocyte necrosis) can be serious diabetes mellitus (True) Explanation: Common and benign Question 11. The typical features of type A viral hepatitis ( HAV) include picornavirus infection spread by the faecal-oral route (True) an in cubation period of 3 months (False) Explanation: 2-4 weeks a greater risk of acu te liver failure in the young than in the old (False) Explanation: But children are more frequently infected right hypochondrial pain and tenderness (True) Expl anation: Non-specific findings of acute hepatitis progression to cirrhosis if ch olestasis is prolonged (False) Explanation: Chronic hepatitis does not occur Que stion 12. The following statements about type A viral hepatitis are true persist ent viraemia produces the post-hepatitis syndrome (False) Explanation: Viraemia is only transient in hepatitis A relapsing hepatitis usually indicates a poorer prognosis (False) Explanation: Spontaneous recovery is the typical outcome the v irus is not usually transmitted via infected blood (True) Explanation: But a rec ognised rarity drug-induced acute hepatitis produces similar liver histology (Tr ue) Explanation: Serological investigations should help distinguish travellers g iven immune serum globulin are protected for 3 months (True) Explanation: Some w ill have natural endogenous protection Question 13. Circulating hepatitis B surf ace antigen (HBsAg) is detectable during the prodrome of acute type B hepatitis (True) Explanation: A reliable marker of hepatitis B infection a DNA viral parti cle transmissible in all body fluids (True) Explanation: A DNA hepadna virus lik ely to persist in about 50% of adults following acute type B hepatitis (False) E xplanation: Chronic carriage occurs in 5-10% of adults invariably present in a p atient with jaundice attributable to type B hepatitis infection (False) Explanat ion: Alternative serological evidence of infection should be sought commoner in asymptomatic subjects in the Western rather than the Eastern hemisphere (False) Explanation: Carriage rates are highest in the Middle East and Far East Question 14. The typical features of type B viral hepatitis (HBV) include an incubation period of 1 month (False) Explanation: Average incubation 3 months history of ex posure to unsafe sex or drug misuse (True) Explanation: Or other exposure to blo od or blood products prodromal illness with polyrtharalgia (True) Explanation: M ay cause serum sickness hepatitic illness more severe than with type A virus (Tr ue) Explanation: Hepatitis A is usually a mild illness By A. H.

Typical liver function values in a cute hepatic failure include hypoalbuminaemia (False) Explanation: Serum albumin has a long half-life hypoglycaemia (True) Explanation: Impaired hepatic glucone ogenesis prolonged prothrombin time (True) Explanation: Useful in determining pr ognosis serum alkaline phosphatase > 6 times normal (False) Explanation: Typical ly not so elevated. vomiting and renal failure (True) Explanation: Renal f ailure is an ominous development cerebral oedema without papilloedema (True) Exp lanation: Occurs late. anorexia and jaundice spider telangiectasia and hepatosplenomegal y (True) Explanation: And other signs of chronic liver disease Cushingoid facies . The typical featur es of acute (fulminant) hepatic failure include onset within 8 weeks of the init ial illness (True) Explanation: Without evidence of pre-existing liver disease h epatosplenomegaly and ascites (False) Explanation: Suggest chronic liver disease encephalopathy and fetor hepaticus (True) Explanation: With confusion and aster ixis (liver flap) nausea. hirsutism and acne (True) Explanation: Altered steroid hormone metabolism Ques tion 19. In hepatitis C (HCV) a chronic carriage rate of > 50% is the rule (True) Explanation: With varying degrees of severity the infec ting agent is an RNA flavivirus (True) the disease does not progress to chronic hepatitis (False) Explanation: Hepatitis C may progress to chronic disease most patients experience the symptoms of acute hepatitis (False) Explanation: Most pa tients are asymptomatic.MCQs VIA WEB 2005 absence of progression to chronic hepatitis (False) Explanation: And hepatic cir rhosis also occurs Question 15. unlike the serum transaminases peripheral blood lymphocytosi s (False) Explanation: May be a polymorphonuclear leucocytosis Question 18. incubation period is 2-26 weeks the virus is responsibl e for 90% of all post-transfusion hepatitis (True) Explanation: Although serolog ical screening methods have greatly reduced this Question 16. if at all Question 17. H. The typical features of hepatic cirrhosis include a small shrunken live r (True) Explanation: Liver size reduces as disease progresses painful splenomeg aly (False) Explanation: Painless splenomegaly due to portal hypertension periph eral blood macrocytosis (True) Explanation: Particularly in alcoholic liver dise ase By A. The clinical features of autoimmune hepatitis include an association with autoimmune thyroiditis (True) Explanation: Type I autoimmune liver disease is associated w ith Graves' disease and Hashimoto's thyroiditis acute onset simulating viral hep atitis in 25% of patients (True) Explanation: Occurs in 25% of patients but symp toms and signs then persist arthralgia. fever and amenorrhoea (True) Explanation : And fatigue. .

H. Typical features of hepatic encephalopathy include disordered sleep and loss of concentration (True) Explanation: Grade 1 aggressive behaviour and personality change (True) Explanation: Grade 2 yawning and hiccuping (True) Explanation: And asterixis (hepatic flap) drowsiness and di sorientation (True) Explanation: Grade 3 confusion progressing to coma (True) Ex planation: Grade 4 Question 21. . In the management of ascites due to hepatic cirrhos is the dietary sodium intake should be restricted to 140 mmol/day (False) Explan ation: Restriction < 40 mmol/day is usually required paracentesis and parenteral albumin replacement improve the survival rate (False) Explanation: A palliative . stomal and rectal varices congestive gastropathy (True) By A. symptomatic measure with no prognostic value the daily calorie intake should b e restricted to 1500 calories (False) Explanation: Calorie restriction is neithe r required nor desirable diuretic therapy should achieve a daily weight loss of at least 2. also sarcoidosis abdom inal trauma (True) Explanation: Extrahepatic pre-sinusoidal (portal vein thrombo sis) hepatic vein obstruction (Budd-Chiari syndrome) (True) Explanation: Extrahe patic post-sinusoidal Question 24.MCQs VIA WEB 2005 parotid gland enlargement (True) Explanation: Particularly in alcoholic cirrhosi s central cyanosis (True) Explanation: Hepatopulmonary syndrome associated with pulmonary telangiectasia Question 20. Complications of portal hypertension include variceal haemorrhage (True) Explanation: Oesophageal. Causes of ascites in the absence of intrahepatic liver disease include congestive cardiac failure (True) Explanation: Also const rictive pericarditis-transudate nephrotic syndrome (True) Explanation: Also prot ein-losing enteropathy-transudate peritoneal tuberculosis (True) Explanation: Al so carcinomatosis-exudate lymphatic obstruction (True) Explanation: Chylous effu sion Budd-Chiari syndrome (True) Explanation: Transudate associated with hepatic vein occlusion Question 22.5 kg (False) Explanation: Daily weight loss > 1 kg may precipitate re nal impairment and/or encephalopathy the protein intake should be at least 40 g/ day unless encephalopathy is suspected (True) Explanation: Restriction may be ne cessary to control encephalopathy Question 23. gastric. Causes of portal hypertension inc lude alcoholic cirrhosis (True) Explanation: Intrahepatic parenchymal myeloproli ferative disease (True) Explanation: Intrahepatic pre-sinusoidal hepatic schisto somiasis (True) Explanation: Intrahepatic pre-sinusoidal.

In the management of ac ute variceal bleeding due to hepatic cirrhosis the priority is to restore normov olaemia (True) Explanation: Untreated. females may be protected by menstruation and pregnancy hepatic cirrhosis and diabetes mellitus (True) Explanation: 'Bronzed diabetes' congestive cardiomyopathy (True) Explanat ion: May be a congestive cardiomyopathy grey skin pigmentation due to ferritin d eposition (False) Explanation: Melanin not iron deposition Question 29. The typical features of primary h aemochromatosis include association with an autosomal dominant pattern of inheri tance (False) Explanation: Inherited as an autosomal recessive gene located on c hromosome 6 male predominance (True) Explanation: 90% are males. Prevention of recurrent vari ceal bleeding is achievable using somatostatin (octreotide) therapy (False) Expl anation: Somatostatin may be useful in acute bleeds TIPSS (True) Explanation: Al so used in acute variceal bleeding â-adrenoceptor antagonist (â-blocker) treatment ( True) Explanation: â-blockers reduce portal pressure variceal banding (True) Expla nation: Better than sclerotherapy in the elective situation sclerotherapy (True) Explanation: Easier than banding in the emergency situation Question 27.MCQs VIA WEB 2005 Explanation: Associated with hypergastrinaemia hepatorenal failure (True) Explan ation: Associated with reduced renal blood flow hepatic encephalopathy (True) as cites (True) Explanation: And hypersplenism Question 25. In pri mary biliary cirrhosis middle-aged males are affected predominantly (False) Expl anation: Middle-aged females pruritus is invariably accompanied by jaundice (Fal se) Explanation: May precede jaundice by months or years osteomalacia and osteop orosis both occur as the disease progresses (True) Explanation: Vitamin D malabs orption and hepatic osteodystrophy rigors and abdominal pain are presenting feat ures (False) Explanation: Suggests obstruction of large bile duct smooth muscle antibodies are present in high titres in the serum (False) Explanation: High tit res of antimitochondrial antibody Question 28. The typi cal features of Wilson's disease include haemolytic anaemia (True) By A. . glyceryl trinitrat e is given to reduce vasoconstriction balloon tamponade is best undertaken after endoscopic confirmation of bleeding varices (True) Explanation: Unless the pati ent is exsanguinating. shock dramatically reduces liver blood fl ow and liver function pharmacological therapy is more effective than variceal ba nding or sclerotherapy (False) Explanation: Local measures stop bleeding in 80% of patients somatostatin (octreotide) and vasopressin both reduce portal venous pressure (True) Explanation: Constrict splanchnic arterioles. H. 20% of patients are bleeding from non-variceal causes tra nsjugular intrahepatic portosystemic stent shunting (TIPSS) is contraindicated i n hepatic failure (False) Explanation: TIPSS is used when local measures fail an d has replaced emergency shunt surgery Question 26.

weight loss and abdo minal pain (True) Explanation: Abdominal pain and a cirrhotic liver suggest hepa toma ascites and intra-abdominal bleeding (True) Explanation: Tumours are vascul ar and spread locally arterial bruit over the liver (True) Explanation: There ma y also be a hepatic rub rising serum á-fetoprotein titre (True) Explanation: Rises in 90% of cases surgically resectable disease in 50% of patients (False) Explan ation: Only 10% are suitable for surgery Question 32. H.MCQs VIA WEB 2005 Explanation: Sometimes accompanying an acute hepatitis in children acute hepatit is and chronic hepatitis (True) Explanation: Or acute hepatic failure or cirrhos is parkinsonian syndrome and hepatic cirrhosis (True) Explanation: A variety of extrapyramidal syndromes may be seen Kayser-Fleischer rings (True) Explanation: Kayser-Fleischer rings are an important diagnostic clue renal tubular acidosis ( True) Explanation: Copper is deposited in the liver and kidneys Question 30. Pyogenic liver abscess is a recognised complication of ascending cholangitis (True) Explanation: Secondary to biliary obstruction Crohn's disease (True) Explanation: Secondary to portal pyaemia pancreatitis (True) Explanation: Acute pancreatitis septicaemia (True) E xplanation: Infection via hepatic artery subphrenic abscess (True) Explanation: Direct local spread Question 33. The typical features of alcoholic liver disease include microvesicular steatosis (F alse) Explanation: Macrovesicular steatosis is the earliest stage when abstinenc e will achieve a good prognosis acute hepatitis and chronic hepatitis (True) Exp lanation: 33% mortality if liver dysfunction is severe hepatic cirrhosis (True) Explanation: 50% 5-year survival after the initial presentation if abstinent cho lestatic jaundice (True) Explanation: Often associated with tender hepatomegaly and abdominal pain alcohol intake > 30 g/day for > 5 years (True) Explanation: U sually associated with at least 50 g/day for at least 10 years Question 31. anaerobes and streptococci pres ent in pus (True) Explanation: Multiple organisms in one-third of cases By A. especially in ascending cholangitis (True) Explanation: Single lesions are more common in the right liver Escherichia coli. The typical features of pyogenic liver abscess include obstructive jaundice and pruritus (False) Explanation: Jaundice is usual ly mild and not often obstructive tender hepatomegaly without splenomegaly (True ) Explanation: Splenomegaly suggests coexistent pathology pleuritic pain and ple ural effusion (True) Explanation: May be right shoulder tip pain multiple absces ses. . The typical features of hepatocellular carcinoma include fever.

increases at delivery By A. The post-cholecystectomy syndrome is characteris tically associated with patients with previous acalculous cholecystitis (True) E xplanation: Less common in patients with previous typical biliary colic and gall stones females with a history of abdominal pain > 5 years in duration (True) Exp lanation: Associated with the irritable bowel syndrome and functional dyspepsia retained stones in the common bile duct (True) Explanation: Hence the need to in vestigate this possibility dysfunction of the sphincter of Oddi (False) Explanat ion: This abnormality may not be causal and may in fact result from cholecystect omy early postoperative complications (True) Explanation: Suggest the possibilit y of a biliary stricture Module 19 (Chapter 19) Question 1. Peripheral blood neutrophil leucocytosis would be an expected findi ng in connective tissue disease (True) Explanation: Or may be neutropenia in sys temic lupus erythematosus corticosteroid therapy (True) Explanation: And lithium therapy pregnancy (True) Explanation: Variable. . Peripheral blood lym phocytosis would be an expected finding in brucellosis (True) Explanation: Often with neutropenia pneumococcal pneumonia (False) Explanation: Polymorphonuclear leucocytosis measles and rubella (True) Explanation: Non-specific feature of man y viral infections Hodgkin's disease (False) Explanation: Non-Hodgkin's lymphoma chronic lymphatic leukaemia (True) Explanation: Predominantly small lymphocytes Question 2. nausea and vomiting (False) Explanation: Jaundice occurs in less than 20% even in the absence of stones (Mirizzi's syndrome) coli cky abdominal pain in spasms lasting about 5 minutes (False) Explanation: Pain i s typically continuous for up to 6 hours right hypochondrial tenderness worse on inspiration (True) Explanation: Murphy's sign air in the biliary tree on plain radiograph (False) Explanation: May follow passage of a gallstone into intestine or biliary surgery peripheral blood leucocytosis (True) Explanation: May be abs ent in the elderly Question 36.MCQs VIA WEB 2005 Question 34. Gallstones are a recognised complication of obesity (True) Explanat ion: Increased hepatic cholesterol secretion pregnancy (True) Explanation: Incre ased hepatic cholesterol secretion and impaired gallbladder motility chronic hae molytic anaemia (True) Explanation: Pigment stones terminal ileal disease (True) Explanation: Pigment stones rapid weight loss (True) Explanation: Increased hep atic cholesterol secretion Question 35. H. The typical clinical features of acute c holecystitis include jaundice.

and vWF and fibrinogen (alpha granules) Question 4. H. bleeding or poor compliance maximal reticulo cyte count usually develops within 1-2 days (False) Explanation: Peak reticulocy te count at 7-10 days parenteral iron is usually more effective than oral iron ( False) Explanation: Oral iron is usually effective Question 7. . thalassaemia) polychromasia indicates active production of new red blood cells (True) Explanation: Residual ribosomal material is staine d faintly poikilocytosis is invariably associated with anisocytosis (True) Expla nation: Sign of dyserythropoiesis punctate basophilia is a typical feature of be ta-thalassaemia (True) Explanation: And lead poisoning target cells are associat ed with hyposplenism and liver disease (True) Explanation: And haemoglobinopathi es Question 5. hypochromia is due to microcytosis Howell-Jolly bodies (False) Explanation: Suggests hyposplenism thrombocytosis (True) Explanation: Thrombocytosis occurs even in the absence of bleeding Question 6. In the treatment of iron deficiency anaemia with iron folic acid should also be given if the anaemia is severe (False) Explanation: Only if coexistent deficiency demonstrated treatment is stopped as soon as haemoglobin normalises (False) Explanation: Continue for 3 months to replenish stores haemog lobin should rise by 1 g/l every 7-10 days (False) Explanation: 10 g/l every 10 days unless there is malabsorption.g. Hypochromic micro cytic anaemia is a recognised finding in haemolytic anaemia (False) Explanation: Macrocytic with polychromasia myelodysplastic syndrome (True) By A. Peripheral blood findings in dietary iron deficiency include micr ocytosis (True) Explanation: Microcytosis is the first sign ovalocytosis (True) Explanation: Sometimes poikilocytosis mean corpuscular haemoglobin concentration < 50% of normal (False) Explanation: Only in severe anaemia. The fo llowing statements about red blood cell morphology are true hypochromia is patho gnomonic of iron deficiency (False) Explanation: Seen in other disorders of haem oglobin synthesis (e. serotonin) and von Willebrand factor (vWF) (True) Explanation: 5 -HT (delta granules). Platelets have a cir culation lifespan of 10 hours in healthy subjects (False) Explanation: 10-day li fespan are produced and regulated under the control of thrombopoietins (True) Ex planation: By the megakaryocytes contain small nuclear remnants called Howell-Jo lly bodies (False) Explanation: Found in red blood cells decrease in number in r esponse to aspirin therapy (False) Explanation: May increase release 5-hydroxytr yptamine (5-HT.MCQs VIA WEB 2005 whooping cough (False) Explanation: Typically lymphocytosis mesenteric infarctio n (True) Explanation: And myocardial infarction Question 3.

. Characteristic f eatures of Addisonian pernicious anaemia include onset before the age of 20 year s (False) By A. with microcytic population myelodysplastic syndrom e (True) Explanation: But variable red cell morphology Question 10. Folate and vitamin B12 deficiency both typically produce subacute combi ned degeneration of the spinal cord (False) Explanation: Feature of vitamin B12 deficiency only intermittent glossitis and diarrhoea (True) Explanation: Glossit is less common in folate deficiency mild jaundice and splenomegaly (True) Explan ation: Mild haemolysis peripheral neuropathy (True) marked weight loss (True) Ex planation: Partially dependent on underlying cause Question 12. Typical haem atological findings in megaloblastic anaemia include pancytopenia and oval macro cytosis (True) Explanation: Commonly due to vitamin B12 deficiency neutrophil le ucocyte hypersegmentation (True) Explanation: Shift to the right in the nuclear segmentation count (Arneth count) anisocytosis and poikilocytosis (True) Explana tion: And red cell fragmentation reticulocytosis and polychromasia (False) Expla nation: Features of bleeding or haemolysis excess urinary urobilinogen and bilir ubinuria (False) Explanation: Bilirubinuria is not a feature of any anaemia Ques tion 11. Macrocytic anaemia is a typical finding in folic acid deficiency (True) Explanation: With megaloblasti c marrow haemolytic anaemia (True) Explanation: With polychromasia alcohol misus e (True) Explanation: With or without cirrhosis primary sideroblastic anaemia (F alse) Explanation: Dimorphic. H. Normocytic normochromic anaemia is an expected feature of alcoholic liver disease (False) Explanation: Typically macrocytic chronic renal failure (True) Explanation: Erythropoietin deficiency rheumatoid arthritis (Tru e) Explanation: Typically macrocytic kwashiorkor (True) Explanation: Protein-ene rgy malnutrition strict vegetarianism (False) Explanation: Anaemia is rare in mo dest reductions of dietary vitamin B12 intake Question 9.MCQs VIA WEB 2005 Explanation: Typically a dimorphic red cell population hypothyroidism (False) Ex planation: Typically macrocytic beta-thalasaemia (True) Explanation: And other t halassaemias rheumatoid arthritis (True) Explanation: Or a normochromic normocyt ic picture Question 8.

H.g. Laboratory features suggesting haemolytic anaemia include increased serum lactate dehydrogenase (LDH) concentration (True) Explanation: Red cells are ric h in LDH conjugated hyperbilirubinaemia and bilirubinuria (False) Explanation: U nconjugated hyperbilirubinaemia and excess urobilinogen in the urine peripheral blood neutrophil leucocytosis (True) Explanation: Also red cell abnormalities (e . Characteristic features of primary aplastic anaemia include peak incidence in the elderly (False) Explanation: Peak s about 30 years of age normocytic normochromic anaemia with thrombocytosis (Fal se) Explanation: Thrombocytopenia bone marrow trephine is required to confirm th e diagnosis (True) Explanation: Diagnosis cannot be made on peripheral blood fil m alone splenomegaly indicating extramedullary erythropoiesis (False) Explanatio n: Splenomegaly occurs in under 10% of cases pancytopenia (True) Explanation: Ty pical Question 15. Causes of folic acid deficiency inc lude vegetarian diet (False) Explanation: Caused by inadequate vegetable intake gluten enteropathy (True) Explanation: Characteristic finding pregnancy (True) E xplanation: Increased requirements haemolytic anaemia (True) Explanation: Increa sed requirements antibiotic therapy (False) Explanation: Methotrexate and phenyt oin may cause folate deficiency Question 14. spherocytes) peripheral blood polychromasia and macrocytosis (True) Explanat ion: Reflects reticulocytosis bone marrow erythroid hyperplasia (True) Explanati on: With megaloblastic change if folate deficiency is also present By A.MCQs VIA WEB 2005 Explanation: Typically 45-65 years gastric parietal cell and intrinsic factor an tibodies in the serum (True) Explanation: Found in 90% and < 50% respectively in creased serum bilirubin and lactate dehydrogenase concentrations (True) Explanat ion: Mild haemolysis occurs four-fold increase in the risk of developing gastric carcinoma (True) Explanation: Associated gastric atrophy Schilling test usually reverts to normal with intrinsic factor (True) Explanation: Failure to correct suggests terminal ileal disease Question 13. Typical features suggesting intravascular haemolysis include bilirubinuria and haemoglobinuria (False) Explanation: Bilirubin is unconjugated therefore not found in urine methaemalbuminaemia and haemosiderinuria (True) Ex planation: The latter always indicating intravascular haemolysis increased serum haptoglobin concentration (False) Explanation: Decreased serum haptoglobin incr eased plasma haemoglobin concentration (True) Explanation: Most is bound to seru m haptoglobin splenomegaly (True) Explanation: Often with reticulocytosis Questi on 16. .

Typical features of hereditary spherocytosis include splenomegaly ( True) Explanation: Also pigment gallstones intravascular haemolysis (False) Expl anation: Red blood cell destruction occurs in the spleen decreased red blood cel l osmotic fragility (False) Explanation: Osmotic fragility is increased transien t aplastic anaemia (True) Explanation: Often in association with parvovirus infe ction deficiency of red cell spectrin (True) Explanation: Red blood cell membran e protein Question 18. The typical features of the beta-thalassaemias include ma crocytic anaemia (False) Explanation: Typically hypochromic microcytic anaemia h epatosplenomegaly (True) Explanation: In the 'major' (homozygous) form pigment g allstones (True) Explanation: Pigment gallstones can be associated with chronic haemolysis neonatal haemolytic anaemia (False) Explanation: Not until HbF synthe sis declines bone infarcts (False) Explanation: Unlike sickle cell disease Quest ion 21. . acute painful crises ar e likely to be precipitated by high altitude (True) Explanation: Decreased PaO2 pregnancy (True) Explanation: May present as pseudo-toxaemia syndrome dehydratio n (True) Explanation: Rehydration is an essential component of therapy systemic infection (True) Explanation: Treat promptly to prevent sickle-cell crises hypox ia (True) Question 20. splenic and mesenteric infarcts (True) Explanation: Causing pleuritic pain and also renal infarcts sple nomegaly with hypersplenism (False) Explanation: Splenic atrophy and functional hyposplenism bone necrosis and osteomyelitis (True) Explanation: Painful bone in farcts Question 19 In patients with sickle-cell disease. H. The typical clinical features of sickle-cell anaemia incl ude haemolytic and aplastic crises (True) Explanation: Often precipitated by vir al infection neonatal spherocytic haemolytic anaemia (False) Explanation: Not un til HbF levels fall after the age of 3 months pulmonary. cold usually IgM association with lymphoproliferative disease (True) By A. The typical features of autoimmune haemolytic anaemia include peripheral blood spherocytosis and splenomegaly (True) Explanation: Characteristic haemogl obinuria and haemosiderinuria (True) Explanation: Suggesting intravascular haemo lysis increased serum haptoglobin concentration (False) Explanation: Decreased s erum haptoglobin concentration positive Coombs test (True) Explanation: Warm usu ally IgG.MCQs VIA WEB 2005 Question 17.

lymphoma and also systemic lupus eryth ematosus Question 22. The typical features of polycythaemia rubra vera include p eak prevalence aged > 40 years (True) splenomegaly. pruritus and pepti c ulcer dyspepsia (True) Explanation: But may be asymptomatic decreased leucocyt e alkaline phosphatase score (False) Explanation: A feature of chronic myeloid l eukaemia increased blood viscosity associated with vascular disease (True) Expla nation: E. Acute lymphoblastic leukaemia (ALL) has a peak prevalence in patients aged 20-30 years (False) Explanation: P eaks in childhood typically produces cytoplasmic Auer rods in blast cells (False ) Explanation: Acute myeloblastic leukaemia (AML) has a median survival of 30 mo nths with chemotherapy (True) Explanation: AML has a 40% 5-year survival with ch emotherapy is the most common of all acute leukaemias (False) Explanation: AML i s four times more common than ALL is a typical complication of multiple myeloma (False) Explanation: May complicate myelofibrosis Question 24. Clinical features of chronic myeloid leukaemia (CML) include painful splenomegaly (True) Explanat ion: Splenomegaly in 90% of cases gout and arthralgia (True) Explanation: Hyperu ricaemia is often asymptomatic generalised lymphadenopathy (False) Explanation: Atypical feature tendency to bleeding and bruising (True) Explanation: Variable platelet dysfunction median survival of 15 years with chemotherapy (False) Expla nation: Median survival 5 years Question 25. eosinophilia and basophilia (True) chromosomal translocation q-22/q+9 (True) Explanation: Philadelphia chromosome increased neutrophil leuco cyte alkaline phosphatase (LAP) score (False) Explanation: Usually decreased LAP score transformation to acute leukaemia (True) Explanation: Transformation resu lts to either ALL (30%) or acute myeloid leukaemia (AML) (70%) Question 26. H.g.MCQs VIA WEB 2005 Explanation: Chronic lymphatic leukaemia. leucocytosis and thrombocyto sis (True) Explanation: And elevated red cell mass headaches. . increased risk of stroke Question 23. The typical laboratory findings in chronic myeloid leukaemia include leucoerythroblastic anaemia and thrombocytosis (True) Explanation: Platelet count falls after blast transformation peripheral blood neutrophilia. Typi cal features of chronic lymphocytic leukaemia include onset in younger patients than in chronic myeloid leukaemia (False) Explanation: Peak age 65 years develop ment of autoimmune haemolytic anaemia (True) Explanation: Typically warm antibod y presentation with massive hepatosplenomegaly (False) Explanation: Mild organom egaly only lymphadenopathy associated with recurrent infections (True) Explanati on: Bacterial more than viral By A.

The typical laboratory features in chronic lymphocytic leukaemia include hyperuricaemia and thrombocytosis (False) Explanat ion: Mild thrombocytopenia with urate usually normal hypogammaglobulinaemia (Tru e) Explanation: Associated with a paraproteinaemia in 5% peripheral blood lympho cytosis in the absence of lymphoblasts (True) Explanation: Total WCC typically 5 0-200 × 109/l positive Coombs test (True) Explanation: May be associated with haem olysis transformation to acute leukaemia (False) Explanation: Transformation is rare Question 28. . no lymphadenopathy infectious mononucleosis (True) Explanation: Us ually both mild myelofibrosis (False) Explanation: Splenomegaly without lymphade nopathy Question 31. especially with viruses and atypical micro organisms infertility (True) Explanation: Important given the age of many of the patients pneumonitis (True) malignant disease during long-term follow-up (True) Question 30. H. Complications of allogeneic bone marrow transp lantation include acute graft-versus-host disease (True) Explanation: Usually oc curs 2-3 weeks after the graft and is associated with infection severe infection (True) Explanation: A major problem. Allogeneic bone marrow transplantation is particularly useful in the treatment of multiple myeloma (True) Explanation: Also useful in acute my elofibrosis severe aplastic anaemia (True) alpha-thalassaemia (True) Explanation : All severe thalassaemias severe combined immunodeficiency disorder (True) chro nic lymphocytic leukaemia (False) Explanation: But useful in most other acute an d chronic leukaemias Question 29. The presence of lymphadenopathy and splenomegaly would be expected findings in multiple myeloma (False) Explanation: Neither is characteristic chro nic lymphocytic leukaemia (True) Explanation: Mild splenomegaly. generalised lym phadenopathy chronic myeloid leukaemia (False) Explanation: Moderate to massive splenomegaly.MCQs VIA WEB 2005 median survival of 15 years following chemotherapy (False) Explanation: Overall median survival 6 years Question 27. Recognised clinical features of multiple myeloma include pe ak incidence between the ages of 30 and 50 years (False) Explanation: Peak preva lence in males aged 60-70 years secondary amyloidosis (True) Explanation: Amyloi dosis occurs in 10% of cases median survival > 10 years with chemotherapy (False ) Explanation: Median survival of 40 months recurrent infections and pancytopeni a (True) Explanation: Reduction of normal plasma cells causes immunodeficiency By A.

In differentiating multiple myeloma from a benig n monoclonal gammopathy. . urate and blood urea (True) Explanation: All of which m ay be asymptomatic Question 32. H. Typical characteristics of non-Hodgkin's lymphoma include low-grade lymphomas rapidly produce symptoms due to high cell proliferation rat es (False) Explanation: Indolent and often asymptomatic course with low cell pro liferation rates bone marrow and splenic involvement are present from the onset (True) Explanation: Typically extranodal at diagnosis isolated involvement of ga stric mucosa associated with Helicobacter pylori infection (True) Explanation: M ALToma may be cured by H.and age-dependent Question 35. or secondary to superimpo sed infections disseminated intravascular coagulation (True) Explanation: Increa sed peripheral consumption of platelets von Willebrand's disease (False) Explana tion: The platelet count is normal aspirin therapy (True) Explanation: Also many commonly used drugs including heparin and â-blockers Question 36. The clinical features of Hodgkin's disease incl ude painless cervical lymphadenopathy (True) Explanation: Usually painless anaem ia due to bone marrow involvement (False) Explanation: Unlike non-Hodgkin's lymp homa impaired T-cell function in the absence of lymphopenia (True) Explanation: Lymphopenia suggests poor prognosis fever and weight loss (True) Explanation: St age B median survival > 10 years (True) Explanation: Dependent on staging at pre sentation Question 34. Recognised causes of thrombocytopenia i nclude megaloblastic anaemia (True) Explanation: Often with leucopenia acquired immunodeficiency syndrome (True) Explanation: Primary. the following findings would favour the diagnosis of mu ltiple myeloma monoclonal gammopathy with normal serum immunoglobulin levels (Fa lse) Explanation: Myeloma produces suppression of the other serum immunoglobulin s bone marrow plasmacytosis of > 20% (True) Explanation: A diagnostic prerequisi te bilateral carpal tunnel syndrome (True) Explanation: Amyloidosis also causes a restrictive cardiomyopathy Bence Jones proteinuria (True) Explanation: But the serum paraprotein may be undetectable multiple osteolytic lesions on radiograph (True) Explanation: Malignant infiltration is typically associated with a norma l isotope bone scan Question 33.MCQs VIA WEB 2005 increased serum calcium. pylori eradication the majority are T-cell rather than B-cell in origin (False) Explanation: 70% are B-cell tumours better prognosis i n high-grade rather than low-grade lymphomas (True) Explanation: Prognosis is al so stage. Typical feature s of idiopathic thrombocytopenic purpura include IgG-mediated thrombocytopenia ( True) Explanation: Can therefore be transmitted transplacentally peak prevalence in patients aged > 60 years old (False) Explanation: Usually the young and comm oner in females By A.

. The bleeding time is characteristically prolonged in ascorbic a cid deficiency (False) Explanation: Bleeding time is normal but petechial haemor rhages may occur thrombocytopenia (True) Explanation: Irrespective of its cause haemophilia (False) Explanation: No vessel wall or platelet defect warfarin ther apy (False) von Willebrand's disease (True) Explanation: Secondary decrease in f actor VIII level with a qualitative platelet defect Question 41. The prothrombin time is typically prolonged in disorders of th e intrinsic pathway (False) Explanation: The extrinsic pathway factor X deficien cy (True) Explanation: The Stuart-Prower factor factor VII deficiency (True) Exp lanation: First factor in extrinsic pathway factor V deficiency (True) Explanati on: Also affects the activated partial thromboplastin time factor XII deficiency (False) Explanation: Disorder of the intrinsic pathway Question 38. H.MCQs VIA WEB 2005 prolongation of the bleeding time (True) Explanation: Other clotting tests norma l splenomegaly (False) Explanation: Suggests other causes of thrombocytopenia pr ompt response to corticosteroid therapy (True) Explanation: Particularly in chil dren Question 37. D isseminated intravascular coagulation is a complication of amniotic fluid emboli sm (True) Explanation: Initiated by thromboplastin incompatible blood transfusio n (True) Explanation: An unusual complication hypovolaemic and anaphylactic shoc k (True) Explanation: Endothelial injury septicaemic shock (True) Explanation: E xogenous endotoxins carcinomatosis (True) Explanation: Commonly bronchial carcin oma Question 40. The activat ed partial thromboplastin time (APTT) is typically prolonged in disorders of the extrinsic pathway (False) Explanation: The intrinsic pathway factor VII deficie ncy (False) Explanation: Detected by prothrombin time factor VIII or X deficienc y (True) Explanation: Factor X also influences prothrombin time factor XIII defi ciency (False) Explanation: Specific assay to measure factor IX. The following s tatements about severe haemophilia A are true the disorder is inherited in an Xlinked recessive mode (True) Explanation: Prenatal diagnosis is possible By A. XI or XII defic iency (True) Explanation: Initial factors in the intrinsic system Question 39.

factor II Leiden increases plasma prothrombin levels polycythaemia rubra vera (True) Explanation: And chronic myeloid leukaemia-both are associated with thrombocytosis protein C deficiency (True) Explanation: And protein S defi ciency-reduced inactivation of factors Va and VIIIa Question 44. XIa. IXa.0-4. The hazards of blood transfusion include urticar ia (True) Explanation: Allergic reaction cardiac failure (True) Explanation: Vol ume overload-in patients with previous CCF. H. Xa. give prophylactic diuretic therapy d evelopment of Rhesus antibodies in a Rhesus-negative patient (True) Explanation: Particularly important in women of child-bearing age fever (True) Explanation: Allergic reaction to one or more of the constituents of the transfusion acute in travascular haemolysis (True) Explanation: Major ABO incompatibility is the like liest cause Question 46.MCQs VIA WEB 2005 recurrent haemarthroses and haematuria are typical (True) Explanation: Usually n ot apparent until the age of 6 months activated partial thromboplastin time and prothrombin time are both prolonged (False) Explanation: Only the activated part ial thromboplastin time is prolonged factor VIII has a biological half-life of a bout 12 days (False) Explanation: Half-life is 12 hours desmopressin therapy inc reases factor VIII concentrations (True) Explanation: Desmopressin (DDAVP) thera py is useful to limit exposure to blood products Question 42. Clinical features suggesting an acute transfusion react ion include onset within an hour of starting the transfusion (True) By A. VIIa. Thrombophilia with a predisposition to recurrent venous t hromboses is associated with the antiphospholipid antibody syndrome (True) Expla nation: May present with recurrent spontaneous abortion antithrombin deficiency (True) Explanation: Decreased inactivation of factors IIa. The following stat ements about von Willebrand's disease are true the disorder is inherited in an X -linked recessive mode (False) Explanation: Autosomal dominant-gene locus on chr omosome 12 it is characterised by a prolonged bleeding time (True) Explanation: And secondary reduction in factor VIII levels the von Willebrand factor (vWF) is synthesised by both platelets and endothelial cells (True) vWF is a carrier pro tein which is bound to factor VIII (True) deficiency of vWF is best treated by d esmopressin (True) Explanation: Desmopressin (DDAVP) therapy increases vWF conce ntrations Question 43.0 arterial embolism (True) Explan ation: Less effective in non-embolic peripheral vascular disease myocardial infa rction (False) Explanation: Unless associated with mural thrombus atrial fibrill ation (True) Explanation: Reduces the risk of arterial embolism mechanical prost hetic heart valves (True) Explanation: Reduces the risk of embolic clots and pos sibly endocarditis Question 45. c ausing heparin resistance factor V Leiden (True) Explanation: Prolonged factor V activation. Indications for warfarin anticoagulation include venous thromboembolism (True) Explanation: Mai ntain the prothrombin ratio in the range 2. .

MCQs VIA WEB 2005 Explanation: Delayed haemolytic transfusion reaction occurs 5-7 days after the t ransfusion rigors and fever (True) Explanation: Stop the transfusion immediately chest and back pain (True) sudden loss of consciousness (False) Explanation: Un likely in the absence of other premonitory changes development of hypotension an d shock (True) Explanation: May be problematic in anaesthetised patients Module 20 (Chapter 20) Question 1. streptococci and staphylococ ci in adults joint aspiration should be avoided given the risk of septicaemia (F alse) Explanation: Early joint aspiration is vital if the diagnosis is not to be delayed By A. but less so in the elderly or the immunocompromised pre-exis ting arthritis is a recognised predisposing factor (True) Explanation: Also occu rs after trauma or surgery small peripheral joints are involved more often than larger joints (False) Explanation: Large joints are most frequently affected Hae mophilus influenzae is the commonest causative organism in adults (False) Explan ation: H. . dermatomyositis an d progressive systemic sclerosis fibrosing alveolitis (True) Explanation: And au toimmune hepatitis and sarcoidosis ankylosing spondylitis (False) Explanation: A nd. serum phosphate and serum alkaline phosphatase-osteop orosis (False) Explanation: All three are normal in osteoporosis normal serum ca lcium and serum phosphate but increased serum alkaline phosphatase-Paget's disea se (True) Explanation: Occasionally the serum calcium may be elevated if immobil isation is prolonged normal serum calcium and serum alkaline phosphatase but dec reased serum phosphate-osteomalacia (False) Explanation: All three may be normal (see E) decreased serum calcium. normal or low p hosphate.g. The following diseases are associated with antinucle ar and/or rheumatoid factor antibodies infective endocarditis (True) Explanation : Chronic infections (e. leishmaniasis and schistosomiasis) auto immune thyroiditis (True) Explanation: Also found in myasthenia gravis Sjögren's s yndrome (True) Explanation: And systemic lupus erythematosus. serum phosphate and serum alkaline phosphatase -metastatic bone disease (False) Explanation: Increased calcium. tuberculosis. all the seronegative spondyloarthritides Question 2. The following statements about infe ctive arthritis are true the onset is typically insidious (False) Explanation: O nset usually acute. and high serum alkaline phosphatase decreased serum calcium and serum phosphate but increased serum alkaline phosphatase-osteomalacia (True) Explanati on: But all three may be normal Question 3. influenzae is the main cause in children. H. by definition. Presentation with acute monoarthriti s suggests the possibility of crystal arthritis (True) Explanation: Gout and pse udogout trauma (True) Explanation: Trauma usually obvious bacterial infection (T rue) rheumatoid arthritis (False) Explanation: Usually polyarticular in onset en teropathic arthritis (True) Explanation: Reactive arthritis following entericall y or sexually acquired infection Question 4. The bioc hemical features listed below characterise the following metabolic bone disorder s increased serum calcium.

The clinical features of primary (nodal) osteoarthrosis include joint pain aggravated by rest and reliev ed by activity (False) Explanation: More suggestive of an inflammatory arthritis such as rheumatoid arthritis proximal interphalangeal and metacarpal-phalangeal joint involvement (False) Explanation: Typically distal interphalangeal joint i nvolvement involvement of the hip. Shoulder pain is a recognised feature of myocardial ischae mia (True) Explanation: Either alone or associated with central chest pain supra spinatus tendonitis (True) Explanation: With characteristic painful arc on shoul der abduction bronchial carcinoma (True) Explanation: Suggests extra-pleural spr ead or bony metastases pneumococcal pneumonia (True) Explanation: Classically du e to diaphragmatic irritation secondary to pleurisy cervical spondylosis (True) Explanation: Due to cervical nerve root compression Question 8. sp ontaneous resolution (False) Explanation: Often very chronic musculoskeletal pai n without local tenderness (False) Explanation: Multiple tender points are chara cteristic Question 7. The following features of backache suggest mechanical or radicular p ain rather than inflammatory pain radiation of pain down the back of one leg to the ankle (True) Explanation: Suggests lumbar nerve root compression an elevated C-reactive protein (CRP) (False) Explanation: Suggests an active inflammatory p athology localised tenderness over the greater sciatic notch (True) Explanation: Suggests lumbar nerve root compression gradual mode of onset in an elderly pati ent (False) Explanation: Suggests significant pathology even if there are no phy sical signs back pain and stiffness exacerbated by resting (False) Explanation: Suggests inflammatory disease Question 6. . H. knee and spinal apophyseal joints (True) a st rong family history of Heberden's nodes (True) microfractures of subchondral bon e (True) Question 10. Causes of secondary osteoarthritis include acromegaly (Tru e) By A.MCQs VIA WEB 2005 Question 5. The typical findings in fibromyalgia i nclude elevation of the ESR (False) Explanation: A high ESR suggests another dia gnosis symptoms of fatigue and an irritable bowel (True) Explanation: Typical of most psychosomatic disorders coexistent anxiety and depression (True) rapid. rheumatoid arthritis is excluded as a possible diagnosis (False) Explanation: Rheumatoid arthritis ty pically involves atlantoaxial articulations Question 9. In a patient wit h neck pain aggravation by sneezing suggests cervical disc prolapse (True) Expla nation: Disc prolapse may also produce upper or lower limb neurological signs ra diation to the occiput suggests disease affecting the upper cervical vertebrae ( True) Explanation: Common in tension headache associated bilateral arm paraesthe siae suggest angina pectoris as the most likely diagnosis (False) Explanation: S uggest cervical radiculopathy and otherwise normal joints.

Criteria for the diagnosis of rheumatoid arthritis include morning stiffness lasting more tha n 1 hour (True) Explanation: American Rheumatism Association criteria (1998) art hritis in both hip joints (False) Explanation: Arthritis affecting three or more joint areas the presence of rheumatoid nodules (True) Explanation: Pathognomoni c symmetrical polyarthritis (True) Explanation: Diagnosis of RA requires four or more of the criteria radiological changes (True) Explanation: In significant ti tres Question 12. The following statements about rheumatoid arthritis are tr ue joint pain and stiffness are typically aggravated by rest (True) Explanation: Early morning stiffness is a characteristic feature of all inflammatory arthrit ides By A. The typical pattern of synovial disease in rheumatoid arthritis includes early i nvolvement of the sacroiliac joints (False) Explanation: More suggestive of a se ronegative spondyloarthritis such as ankylosing spondylitis symmetrical peripher al joint involvement (True) Explanation: Characteristic pattern of onset spindli ng of the fingers and broadening of the forefeet (True) Explanation: Involvement of the proximal interphalangeal and metatarsophalangeal joints respectively dis tal interphalangeal joint involvement of fingers and toes (False) Explanation: M ore suggestive of osteoarthrosis or psoriatic arthritis atlantoaxial joint invol vement (True) Explanation: Often not obvious clinically but can produce cord com pression Question 15. making diagnosis difficult macrocytic anae mia (False) Explanation: Anaemia is classically normochromic and normocytic ante rior uveitis (False) Explanation: Anterior uveitis is specifically associated wi th the seronegative spondyloarthritides thrombocytopenia (False) Explanation: Mo dest elevation in platelet count is common generalised lymphadenopathy (True) Ex planation: Most obvious in nodes draining actively inflamed joints Question 14. Typical features of active rheumatoid arthritis include fever and weight loss (True) Explanation: These al so occur with minimal joint symptoms. Common extra-articular manifestations of rheumatological disor ders include episcleritis and keratoconjunctivitis sicca in rheumatoid arthritis (True) erythema nodosum in enteropathic arthritis (True) enthesitis in ankylosi ng spondylitis (True) Explanation: And Reiter's disease alopecia in systemic lup us erythematosus (True) Explanation: Also photosensitive skin rashes retinitis p igmentosa in psoriatic arthritis (False) Question 13.MCQs VIA WEB 2005 septic arthritis (True) Explanation: And any joint previously traumatised haemoc hromatosis (True) Explanation: Also chondrocalcinosis and Wilson's disease Perth es' disease (True) Explanation: And most hip dysplasias Ehlers-Danlos syndrome ( True) Explanation: Also other causes of hypermobility Question 11. . H.

Typical features of seronegative spondyloarthritis include as ymmetrical oligoarthritis (True) By A. A po orer prognosis in rheumatoid arthritis is associated with insidious onset of rhe umatoid arthritis (True) Explanation: An explosive onset confers a relatively be tter prognosis high titres of rheumatoid factor early in the course of the disea se (True) Explanation: Especially within 12 months of onset early development of subcutaneous nodules and erosive arthritis (True) Explanation: Indicates seropo sitive disease extra-articular manifestations (True) onset with palindromic rheu matism (False) Explanation: The presence of periods of remission is a favourable sign Question 20. . The clinical features of Felty&apos. in palindromic arthritis flitting episodes are typical associated scler omalacia typically produces painful red eyes (False) Explanation: Scleromalacia is a painless wasting of the sclera unlike the rarer scleritis sicca syndrome su ggests the presence of an alternative diagnosis (False) Explanation: Common in r heumatoid arthritis Question 16. proteinuria and marrow suppression) azathioprine (True) Expl anation: Reserved for life-threatening or unresponsive disease Question 19.s syndrome include peak prevalence in the age group 20-30 years (False) Explanation: Peak p revalence in the age group 50-70 years previous long-standing rheumatoid arthrit is (True) negative rheumatoid factor test (False) Explanation: Positive rheumato id factor test lymphadenopathy and splenomegaly (True) Explanation: Characterist ic recurrent infections and leg ulcers (True) Explanation: Characteristic Questi on 17.MCQs VIA WEB 2005 the rheumatoid factor test is positive in about 70% of patients (True) Explanati on: May be absent at disease onset and is not specific to rheumatoid arthritis j oint involvement is additive rather than flitting (True) Explanation: The usual pattern. penicillamine and immunosuppressants Question 18. H. In the treatment of rheumatoid arthritis bed rest should be avoided becau se of bony ankylosis (False) Explanation: Bed rest is of great value and without risk of bony ankylosis splinting of the affected joints reduces pain and swelli ng (True) Explanation: Reduces joint pain and may reduce contractures associated anaemia responds promptly to oral iron therapy (False) Explanation: Not usually iron-deficient and reflects disease activity systemic corticosteroids are contr aindicated (False) Explanation: Low-dose steroids may lessen disease progression with only a small risk of side-effects non-steroidal anti-inflammatory drugs re tard disease progression (False) Explanation: Not disease-modifying drugs.g. unlik e gold. Disease-modifying anti rheumatic drugs (DMARD) in rheumatoid arthritis include sulfasalazine (True) Exp lanation: 50% of patients respond in 3-6 months naproxen (False) Explanation: No ne of the NSAIDs are DMARDs D-penicillamine (True) Explanation: Benefit may not be apparent for 3 months sodium aurothiomalate (True) Explanation: Adverse effec ts are common (e.

frequency and supr apubic discomfort symmetrical small joint polyarthritis (False) Explanation: Art hritis is asymmetrical. however. Features su ggesting ankylosing spondylitis include early morning low back pain radiating to the buttocks (True) Explanation: Due to sacroiliitis and sometimes mistaken for lumbar disc disease persistence of lumbar lordosis on spinal flexion (True) Exp lanation: Lumbar lordosis may be lost in advanced disease chest pain aggravated by breathing (True) Explanation: Due to involvement of the costovertebral joints 'squaring' of the lumbar vertebrae on radiograph (True) Explanation: Leading to the 'bamboo' spine appearance erosions of the symphysis pubis on radiograph (Tr ue) Explanation: Involvement of cartilaginous joints is a hallmark of the diseas e Question 23. The typical features of reactive arthritis in clude the development of anterior uveitis more often than conjunctivitis (False) Explanation: Conjunctivitis is the classical ocular manifestation non-specific urethritis and prostatitis (True) Explanation: Cause dysuria. involvement is rare in seropositive arthritides enth esitis of tendinous insertions (True) Explanation: Achilles tendonitis scleritis and episcleritis (False) Explanation: Typical ocular problem is acute anterior uveitis mitral valve disease (False) Explanation: An aortitis usually causing ao rtic regurgitation Question 21.g. In the treatment of ankylosing spondylitis systemic corticosteroi d therapy is contraindicated (False) Explanation: Can be invaluable in acute iri tis prolonged bed rest accelerates functional recovery (False) Explanation: In c ontrast to rheumatoid arthritis. be discordant for the disease faecal carriage of specific Klebsiella species (True) Explanation: Klebsiella ca rry an antigen similar to HLA-B27. suggesting a possible aetiology family histor y of psoriatic arthritis and Reiter's syndrome (True) Explanation: Familial aggr egation of overlapping seronegative spondyloarthritides Question 22. the patient with ankylosing spondylitis stiffen s with bed rest spinal radiotherapy modifies the course of the disease (False) E xplanation: Only to improve symptoms spinal deformity is minimised with physioth erapy (True) Explanation: Education regarding appropriate back exercises is vita l hip joint involvement augurs a poorer prognosis (True) Explanation: As does ex tra-articular disease Question 24. Features associated with ankylosing spondylitis include peak onset in the second and third decades (True) subcutaneous nodules ( False) Explanation: Nodules suggest seropositive arthritis. only 10% of cases present with a peripheral arthritis involvement of cartilaginous joints (True) Explanation: E.MCQs VIA WEB 2005 Explanation: Axial joints are involved initially. especially rheumatoi d arthritis HLA-B27 in at least 90% of affected patients (True) Explanation: Ide ntical twins homozygous for HLA-B27 may. H. the sacroiliac joints. . involving large or small joints onset 1-3 weeks followin g bacterial dysentery (True) Explanation: Similar delay following sexually acqui red infections keratoderma blenorrhagica and nail dystrophy (True) Explanation: Similar to psoriatic skin and nail disease By A.

Psoriatic arthritis is usually preceded by the development of psoriasis (True) Explanation: Occasionally there is no evidence of skin disea se at onset likely to develop in 25% of patients with psoriasis (False) Explanat ion: Occurs in around 7% of patients commoner in patients with psoriatic nail ch anges (True) Explanation: Such as pitting and onycholysis associated with a poor er prognosis than rheumatoid arthritis (False) Explanation: Except for patients with arthritis mutilans likely to respond to hydroxychloroquine (False) Explanat ion: Should be avoided due to precipitation of an exfoliative dermatitis Questio n 27.MCQs VIA WEB 2005 Question 25. . DR17 and OQ2 but not HLA-B27 ulcerati ve colitis (True) Explanation: Arthritis may precede evidence of ulcerative coli tis or Crohn's disease Behçet's disease (True) Explanation: Suggested by orogenita l ulceration and iritis (more common in Japan) Question 29. Recognised patterns of psoriatic arthritis include asymmetrical oligoarthr itis of the fingers and toes (True) Explanation: Occurs in 40% of patients dista l interphalangeal joint involvement with nail dystrophy (True) Explanation: Occu rs in 15% of patients sacroiliitis and spondylitis (True) Explanation: Develops in 15% of patients-may be indistinguishable from ankylosing spondylitis rheumato id-like symmetrical small joint arthritis (True) Explanation: Occurs in 25% of p atients arthritis mutilans with telescoping of the digits (True) Explanation: Oc curs in 5% of patients Question 28. Factors predisposing to hyperuricaemia and gout include hypothyroidism (True) Explanation: Diminishe d renal excretion of uric acid severe exfoliative psoriasis (True) Explanation: Increased purine turnover chronic renal failure (True) Explanation: Diminished r enal excretion of uric acid polycythaemia rubra vera (True) By A. Diseases associated with seronegative spondy loarthritis include Sjögren's syndrome (False) Explanation: Either as a primary di sorder or in association with some connective tissue diseases Whipple's disease (True) Explanation: Rare condition coeliac disease (False) Explanation: An assoc iation between coeliac disease and HLA-B8. H. In Reiter's disease a peripheral blood monocytosis is commonly foun d (False) Explanation: Polymorphonuclear leucocytosis is typical in the acute ph ase sacroiliitis and spondylitis develop in most patients (False) Explanation: O ccur in only 15% of patients Salmonella or Shigella species can be cultured from joint aspirates (False) Explanation: Organisms cause the preceding dysenteric i llness calcaneal spurs are not apparent radiologically (False) Explanation: Appe ar on radiograph as a periostitis arthritis resolves within 3-6 months of onset (False) Explanation: 10% of patients have chronic active arthritis 20 years afte r onset Question 26.

In pyro phosphate arthropathy calcium pyrophosphate dihydrate crystals are deposited in the synovial cells (False) Explanation: Crystals are deposited in articular cart ilage then shed into the joint space haemochromatosis is a recognised predisposi ng factor (True) the clinical appearances are similar to acute gout (True) Expla nation: Hence 'pseudogout' the findings on synovial aspiration are indistinguish able from acute gout (False) Explanation: Characteristic appearances of calcium pyrophosphate dihydrate (CPPD) crystals under polarising light microscopy intraarticular corticosteroid injections are contraindicated (False) Explanation: Suc h injections are often highly effective Question 33. In the treatment of gout NSAID t herapy increases urinary urate excretion (False) Explanation: Uricosuric drugs i nclude probenecid. sulfinpyrazone and the NSAID azapropazone salicylates control symptoms and accelerate resolution of the acute attack (False) Explanation: Asp irin may worsen an acute attack by reducing renal urate excretion allopurinol in hibits xanthine oxidase and hence urate production (True) tophi should resolve w ith control of hyperuricaemia (True) allopurinol or probenecid should be given w ithin 24 hours of onset of the acute attack (False) Explanation: Delay hypourica emic therapy unless concomitant colchicine therapy is given Question 32. tenosynovitis a nd bursitis (True) Explanation: Non-articular signs may predominate the abrupt o nset of severe joint pain and tenderness (True) Explanation: Onset may be explos ively sudden serum urate levels fall during an acute attack (False) Explanation: Serum urate is usually elevated but may be normal loin pain and haematuria (Tru e) Explanation: Urate urolithiasis Question 31. . Osteoporosis is usually ass ociated with normal serum calcium. phosphate and alkaline phosphatase (True) Exp lanation: Serum alkaline phosphatase may rise if fractures occur more likely to occur if menopause is early (True) Explanation: Accelerated bone loss occurs wit h oestrogen withdrawal commonly asymptomatic (True) Explanation: Pain only occur s after fracture a typical complication of untreated Addison's disease (False) E xplanation: Occurs in states of corticosteroid excess more common in patients wi th chronic high alcohol intake (True) Explanation: Also associated with cigarett e smoking Question 34. Risk factors for osteoporosis include gluten enteropathy (True) Explanation: All causes of malabsorption including liver disease rheumato id arthritis (True) Explanation: And ankylosing spondylitis hyperparathyroidism (True) Explanation: Multifactorial By A. H.MCQs VIA WEB 2005 Explanation: Increased purine turnover therapy with loop diuretic agents (True) Explanation: Diminished renal excretion of uric acid Question 30. The clinical f eatures of gout include precipitation of an acute attack by allopurinol (True) E xplanation: Enzyme induction induces an acute attack cellulitis.

especially in elderly patients (False) Explanation: Insidio us asymptomatic progression. Typical features of Paget's disease of bone include onset befo re the age of 40 years (False) Explanation: Onset usually over the age of 60 yea rs increased serum alkaline phosphatase and urinary hydroxyproline excretion (Tr ue) Explanation: Increased bone turnover and osteoblast activity presentation wi th severe bone pain. an drogen and oestrogen therapy are both effective Question 36. H. In osteomalacia the finding of a proximal myopathy suggests an alternative diagnosis (False) Explan ation: Characteristic. Therapies useful in p reventing recurrent vertebral fractures in osteoporosis include regular exercise (True) Explanation: Excessive exercise may be associated with low body weight a nd osteoporosis oral phosphate supplementation (False) Explanation: Unless the p atient is hypophosphataemic from severe malnutrition etidronate (True) Explanati on: Bisphosphonate therapy is the most effective and best evaluated vitamin D an d calcium supplementation (True) Explanation: But this is less effective than bi sphosphonate therapy corticosteroid (False) Explanation: Causes osteoporosis. I n a male patient with prostate cancer and widespread metastatic bone disease ost eolytic deposits are characteristic (False) Explanation: Prostatic secondaries a re typically osteosclerotic the plasma parathyroid hormone (PTH) concentration i s typically elevated (False) Explanation: Serum PTH is usually normal even when the serum calcium is high bone pain is invariably present (False) Explanation: A symptomatic disease may be detected coincidentally on radiograph the alkaline ph osphatase is only elevated if pathological fracture occurs (False) Explanation: Serum alkaline phosphatase is frequently elevated due to osteoblast activation c yproterone acetate retards progress of the disease (True) Explanation: Androgen deprivation therapy is of proven value in prostatic cancer Question 39. with nerve root and spinal cord compression delayed healing of fractures (False) Explanation: Fractures occur more commonly but usu ally heal normally risk of development of osteogenic sarcoma (True) Explanation: Rare complication suggested by bony expansion and localised pain Question 38. 25-hydroxychol ecalciferol therapy is recommended (False) Explanation: Give 1-á-hydroxycholecalci ferol. patients may have difficulty in standing up or in climbin g stairs bone involvement is characteristically painless (False) Explanation: Pa in may be generalised and severe Chvostek's sign indicates that the underlying d iagnosis may be hyperparathyroidism (False) Explanation: Hypocalcaemia increases neuromuscular excitability (latent tetany) due to renal disease.MCQs VIA WEB 2005 anorexia nervosa (True) Explanation: Multifactorial hypogonadism (True) Explanat ion: Improved by androgen replacement therapy Question 35. renal 1-á-hydroxylation is impaired pseudofractures on radiograph are patho gnomonic (True) Explanation: Looser's zones are translucent bands seen on radiog raph Question 37. . Typical features of systemic lupus erythematosus (SLE) include a higher prevalence in Ca ucasian than in African women (False) Explanation: Afro-Caribbean females are pa rticularly susceptible onset usually in the fourth and fifth decades (False) By A.

Recognised features of primary Sjögren's syndrome include an increased incidence of lymphoma (True) dryne ss of the eyes. specific to SLE alo pecia (True) Explanation: Occurs in at least 50% of patients an erythematous pho tosensitive facial rash (True) Explanation: Characteristic absence of renal comp lications (False) Explanation: Renal involvement is not infrequent and heralds a poor prognosis neuropsychiatric symptoms (True) Explanation: Especially depress ion and organic psychosis Question 41. mouth and vagina (True) reduced lacrimal secretion rate (True) E xplanation: Demonstrable with the Shirmer test more males affected than females (False) Explanation: More females than males a positive IgM rheumatoid factor in over 80% of patients (True) Explanation: Not diagnostic of primary Sjögren's (sic ca) syndrome Question 43. .MCQs VIA WEB 2005 Explanation: Most commonly in the second and third decades impaired function of suppressor T lymphocytes (True) Explanation: Associated with polyclonal B lympho cyte activation increased prevalence in women compared with men (True) Explanati on: Genetic factors appear to be of importance in aetiology presentation with Ra ynaud's phenomenon in young men rather than young women (True) Explanation: And in women aged > 30 years Question 40. In polymyositis a normal serum creatine kinase does not exclude the diagnosis (True) Explanation: Especially co mmon in juvenile myositis By A. In the management of systemic lupus eryth ematosus. atrophy and su bcutaneous calcification of the fingertips (True) Explanation: 'Sausaging' of th e fingers and sclerodactyly are also seen anti-DNA antibodies and decreased seru m complement levels (False) Explanation: ANA only in 50%. however. then red uced to as low a dose as possible on remission of disease plasmapheresis for imm une complex disease (True) Explanation: Especially when combined with immunosupp ressant drugs hydroxychloroquine for skin and joint involvement (True) Explanati on: Beware retinal complications long-term corticosteroid therapy during periods of remission to prevent relapse (False) Explanation: Little evidence to suggest that this improves the long-term prognosis Question 42. the following are of proven value NSAIDs for renal involvement (False) Explanation: NSAIDs may worsen renal function corticosteroid therapy for cerebr al involvement (True) Explanation: High doses are often used initially. The clinical features of progressive systemic sclerosi s include presentation with Raynaud's phenomenon (True) Explanation: Raynaud's m ay precede other features by years reflux oesophagitis and dysphagia (True) Expl anation: Gastrointestinal tract is involved in most patients fibrosing alveoliti s (True) Explanation: Occurs in the majority of cases ulceration. H. anti-DNA antibodies ar e not seen and complement is normal Question 44. Characteristic clinical features of SLE in clude Raynaud's phenomenon (True) Explanation: Not.

Features of giant cell arteritis include a predominance in f emales > 60 years of age (True) pain in the jaw during eating (True) Explanation : Due to claudication of the masseters confluent involvement of affected arterie s (False) Explanation: Histological involvement is characteristically patchy dif ficulty in rising from the seated position (False) Explanation: Suggests proxima l myopathy weight loss with normochromic anaemia and high ESR (True) Question 46 . elbows. The following statements about the skin are true the surface area of an adult is approximately 2 m2 (True) Expl anation: Comprising the epidermis. . The fe atures of classical polyarteritis nodosa include increased prevalence in males ( True) Explanation: Male to female ratio is 2:1 an association with circulating i mmune complexes containing hepatitis B virus (True) Explanation: HBV markers may only become apparent on follow-up involvement of small arteries and arterioles (False) Explanation: Systemic vasculitis affecting medium-sized arteries multipl e peripheral nerve palsies (True) Explanation: Due to arteritis of the vasa nerv orum severe hypertension (True) Explanation: Especially in association with rena l involvement Module 21 (Chapter 21) Question 1. knees and face is typi cal (True) Explanation: Cutaneous features suggest dermatomyositis (Gottron's pa pules) Question 45. H. In the t erminology of skin lesions papules are solid skin elevations > 20 mm in diameter (False) Explanation: Papules < 5 mm in diameter nodules are solid skin masses > 5 mm in diameter (True) Explanation: Larger than papules vesicles are fluid-con taining skin elevations > 5 mm in diameter (False) By A. keratinocytes synthesise vitamin D eccrine sweat glands ar e innervated by the parasympathetic nervous system (False) Explanation: They are innervated by cholinergic fibres of the sympathetic system Question 2.MCQs VIA WEB 2005 antinuclear (DNA) antibodies are characteristically absent (True) Explanation: S imilarly in polyarteritis nodosa electromyography is helpful in differentiation from peripheral neuropathy (True) underlying malignancy is usually present if we ight loss is marked (False) Explanation: Weight loss may occur in the absence of malignancy an erythematous rash on the knuckles. In polymyalgia rheumatica antinuclear and rheumatoid factor antibodies are pre sent in high titre (False) Explanation: This finding would suggest an alternativ e diagnosis temporal artery biopsy usually confirms the diagnosis (False) Explan ation: Biopsy is positive in < 40% of patients response to oral corticosteroids typically occurs within 7 days (True) Explanation: No such response should promp t a review of the diagnosis corticosteroid therapy should be Question 47. dermis and subcutis layers the predominant ce ll of the dermis is the fibroblast (True) keratinocytes comprise 10% of the epid ermal cell mass (False) Explanation: They comprise 95% of epidermal cells Langer hans cells synthesise vitamin D in the epidermis (False) Explanation: These are modified macrophages.

MCQs VIA WEB 2005 Explanation: Vesicles < 5 mm in diameter petechiae are pinhead-sized macules of blood within the skin (True) Explanation: They are not palpable macules are smal l raised areas of skin of altered colour (False) Explanation: Macules are flat. Typical features of malignant mela noma include changing appearance of a preceding melanocytic naevus (True) Explan ation: 30-50% develop in this way diameter of the lesion > 5 mm (True) Explanati on: But smaller lesions may be malignant irregular colour. . H. Characteristic features of eczema include epidermal oedema and intra-epidermal vesicles (True) Explanation: Epidermal oedema (spongi osis) and epidermal thickening (acanthosis) delayed hypersensitivity reaction in seborrhoeic eczema (False) Explanation: This is a feature of allergic contact e czema increased serum IgA concentration in discoid eczema (False) Explanation: S erum IgE concentrations are elevated eyelid and scrotal oedema in allergic conta ct eczema (True) Explanation: The initial eruption occurs at the contact site oc currence in the flexures of the elbows and knees in pompholyx (False) Explanatio n: Occurs on palms and plantar surfaces of hands and feet Question 6. The following are recognised causes of leg u lcers leprosy (True) Explanation: Typically painless sickle-cell disease (True) Explanation: And also cryoglobulinaemia diabetes mellitus (True) By A. hairy nodules (False) Explanation: Not hairy and are macular intradermal naevi are circular brown macules < 10 mm in diameter (False) Explanation: They a re nodular 30% life-time risk of malignant transformation (False) Explanation: 6 % in congenital melanocytic naevi Question 4. The follow ing blistering eruptions are typically associated with mucosal involvement derma titis herpetiformis (False) Explanation: An intensely itchy rash without oral mu cosal involvement bullous pemphigoid (False) pemphigus (True) Explanation: Often erosive and with mucosal involvement toxic epidermal necrolysis (True) porphyri a cutanea tarda (False) Question 7. expanding. papillom atous. Typical features of melanocytic naevi include the following usually present from birth (False) Explanation: Most appear in early childhood development after the age of 40 years (False) Explana tion: Should raise suspicion of malignancy junctional naevi are smooth. subungual area of pigmentation (True) Explanation: Characterist ically painless Question 5. border and elevation (True) Explanation: Typically asymmetrical personal or family history of melanom a (True) Explanation: Risk is also increased with fair skin and blonde hair pain less. with altered skin colour or texture Question 3.

The following cause alopecia with scarring tinea capitis (False) alopecia areata (False) discoid lupus erythematosus (True) Explanation: Typically patchy teloge n effluvium (False) androgenetic alopecia (False) Explanation: Male-pattern bald ness Question 9. Typi cal features of psoriasis include well-defined erythematous plaques with adheren t silvery scales (True) Explanation: Typically on the elbows. face and neck (False) Explanation: The scalp is frequently involved guttate psoriasis usually affects the elderly (Fals e) Explanation: Usually seen in children nail changes with pitting and onycholys is (True) Explanation: Also subungual hyperkeratosis oligoarthritis particularly associated with nail changes occurring in 5% of cases (True) Explanation: Perha ps mimicking rheumatoid arthritis red non-scaly skin areas in the natal cleft an d submammary folds (True) Explanation: Axillary folds may be similarly affected Question 12. The characteristic clinical features of psoriasis in clude sparing of the skin over the head. H. The typical features of acne vulgaris include involvement of pilose baceous glands and their ducts (True) Explanation: Ducts may be obstructed distr ibution over the face and upper torso (True) Explanation: Lesions elsewhere sugg est an alternative diagnosis infection with the skin commensal Propionibacterium acnes (True) Explanation: Antibiotics are helpful increased sebum production co ntaining excess free fatty acids (True) By A. With regard to psoriasis a child with one affected parent has a 50% chance of developing the disease (False) Explanation: 15% if there is one a ffected parent the cellular infiltrate is typically lymphocytic (True) Explanati on: Of helper type in the dermis guttate psoriasis may be preceded by â-haemolytic streptococcal infection (True) Explanation: Typically throat infection nail pit ting is associated with distal interphalangeal arthropathy (True) Explanation: A nd onycholysis about 5% of patients develop arthropathy (True) Question 10. . knees and lower ba ck epidermal thickening and nucleated horny layer cells (parakeratosis) (True) E xplanation: Also a dermal T lymphocyte infiltrate induction of plaques by local trauma (True) Explanation: Including surgical wounds (Köbner phenomenon) an associ ation with HLA Cw6 (True) Explanation: Inheritance is probably polygenic exacerb ation by propranolol and lithium carbonate therapy (True) Explanation: Also anti malarial drugs Question 11.MCQs VIA WEB 2005 Explanation: Arterial and neuropathic aetiology pyoderma gangrenosum (True) Expl anation: Associated with inflammatory bowel disease syphilis (True) Question 8.

inflammatory papules. The characteristic features of rosacea include predominantly aff ects adolescents (False) Explanation: Commonest in middle age increased secretio n of sebum (False) Explanation: Sebum secretion is normal facial erythema. telan giectasia. H. nodules and cysts (True) Explanation: Seborrhoea (greasy skin) is ofte n present also Question 13.MCQs VIA WEB 2005 Explanation: Largely hormonally mediated open and closed comedones. conjunctivitis and keratitis (True) non-responsive to oral tetracycline therapy (False) Explanation: Repeated courses may be necessary Question 15. Skin diseases associated with marked pruritus include cutaneous vasculitis (False) Explanation: The rash is non-pruritic lichen planus (True) Ex planation: Usually intensely itchy atopic eczema (True) Explanation: Classically pruritic seborrhoeic keratosis (False) Explanation: Non-pruritic dermatitis her petiformis (True) Explanation: Associated with coeliac disease Question 17. Therapies of proven value in acne vulgaris include o ral tetracycline or erythromycin therapy (True) Explanation: For a minimum of 3 months topical preparations of benzoyl peroxide and retinoic acid (True) Explana tion: Antibacterials such as chlorhexidine may also help oral contraceptive pill (False) Explanation: Unless given with cyproterone acetate cyproterone acetate (True) Explanation: Anti-androgen therapy often in combination with an oestrogen oral isotretinoin (True) Explanation: Reduces sebum secretion. Medical conditions that cause pruritus in clude oral contraceptives and pregnancy (True) hypothyroidism and hyperthyroidis m (True) Explanation: Also caused by biliary obstruction lymphoproliferative and myeloproliferative diseases (True) iron deficiency anaemia (True) Explanation: Also caused by chronic renal failure opiate and antidepressant drug therapy (Tru e) Question 16. pustules and papules (True) rhinophyma. . highly teratogen ic Question 14. Skin diseases associated with blistering eruptions include erythema multiforme (True ) Explanation: Perhaps with target lesions dermatitis herpetiformis (True) Expla nation: Typically on extensor surfaces pemphigoid (True) Explanation: Tense bloo d-filled lesions pemphigus vulgaris (True) Explanation: Superficial flaccid lesi ons guttate psoriasis (False) By A.

pearly edge unresponsive to radiotherapy (F alse) Explanation: Radiosensitive but surgery is preferred Question 22.MCQs VIA WEB 2005 Explanation: Small scaly raised lesions Question 18. Recognised causes of erythema nodosum include sarcoidosis (Tr ue) Explanation: Also brucellosis â-haemolytic streptococcal infection (True) Expl anation: Also mycoplasmal and chlamydial infections inflammatory bowel disease ( True) Explanation: Also leukaemias and Hodgkin's disease tuberculosis (True) Exp lanation: Also leprosy contraceptive drug therapy (True) Explanation: Erythema n odosum can also be caused by some other drugs. H. mouth or genitalia (True) Explanation: Or actinic keratosis on the skin By A. Recog nised causes of erythema multiforme include herpes simplex infection (True) Expl anation: Also orf and other viruses mycoplasmal pneumonia (True) Explanation: Cl assical sulphonamide therapy (True) Explanation: Also penicillins and barbiturat es systemic lupus erythematosus (True) Explanation: And other connective tissue disorders bronchogenic carcinoma (True) Explanation: And especially post-radioth erapy Question 20. The typical features of basal cell carcinoma include the following pr edominantly affects the elderly (True) Explanation: Rare in young adults metasta tic spread to the lungs if untreated (False) Explanation: Spread by local invasi on occurrence in areas exposed to light or X-irradiation (True) Explanation: Typ ically on the face or head papule with surface telangiectasia or ulcerated nodul e (True) Explanation: With a rolled. Skin diseases associated wi th photosensitivity include variegate and hepatic porphyrias (True) Explanation: Disordered haem metabolism atopic eczema (True) Explanation: Perhaps progressin g to chronic actinic dermatitis drug reactions to phenothiazine.g.g. e. The typi cal features of squamous cell carcinoma include occurrence in areas exposed to l ight or X-irradiation (True) Explanation: Typically in Caucasians living in equa torial regions association with chronic immunosuppressant drug therapy (True) Ex planation: E. following organ transplantation preceded by leucoplakia on the l ips. thiazide and te tracycline (True) Explanation: And also to amiodarone and enalapril therapy pyod erma gangrenosum (False) Explanation: Associated with inflammatory bowel disease pityriasis rosea (False) Explanation: Unaffected by sunlight Question 19. . iodides and sulphonamides Qu estion 21.

.MCQs VIA WEB 2005 metastatic spread to the liver and lungs (False) Explanation: Haematogenous diss emination is rare unresponsive to radiotherapy (False) Explanation: Radiosensiti ve but surgery is preferred Module 22 (Chapter 22) Question 1. The predominant s egmental innervation of the following tendon reflexes is biceps jerk-C5 (True) s upinator jerk-C6 (True) Explanation: Same as the biceps jerk triceps jerk-C7 (Tr ue) Explanation: Finger flexion jerk-C8 knee jerk-L4 (True) ankle jerk-S1 (True) Question 2. H. Features suggesting a 3rd cranial nerve palsy include paralysis of abduction (False) Explanation: Suggests 6th cranial n erve palsy absence of facial sweating (False) Explanation: Occurs in Horner's sy ndrome complete ptosis (True) Explanation: Paralysis of levator palpebrae superi oris pupillary dilatation (True) Explanation: Impaired parasympathetic flow abse nce of the accommodation reflex (True) Explanation: And direct light response im paired Question 4. Paralysis of the 6th cranial nerve produces impaired adductio n of the eye (False) Explanation: Impaired abduction produces enophthalmos (Fals e) Explanation: May be a feature of Horner's syndrome is a characteristic featur e of Wernicke's encephalopathy (True) By A. A right homonymous hemianopia would be an expected finding in disor ders of the left optic tract (True) Explanation: The optic tract runs between op tic chiasm and lateral geniculate body left optic radiation (True) Explanation: Upper fibre damage causes lower field defect optic chiasm (False) Explanation: M idline lesions cause bitemporal hemianopia right lateral geniculate body (False) Explanation: Left lateral geniculate body left optic nerve (False) Explanation: Left monocular visual loss Question 3. Paralysis of the 4th cranial nerve produces weakness of the i nferior oblique muscle (False) Explanation: Superior oblique pupillary dilatatio n (False) Explanation: No pupillary change impaired downward gaze in adduction ( True) Explanation: May be difficult to detect clinically elevation and abduction of the eye (True) Explanation: Head may tilt towards normal side nystagmus more marked in the abducted eye (False) Explanation: Suggests internuclear ophthalmo plegia Question 5.

Drooping of the upper eyelid results from a lesion of the levator palpe brae superioris (True) Explanation: Partial or complete ptosis 3rd cranial nerve (True) Explanation: With pupillary dilatation cervical sympathetic outflow (Tru e) Explanation: With pupillary constriction 7th cranial nerve (False) Explanatio n: Orbicularis oculi may be affected abducens nucleus (False) Explanation: No pt osis. perhaps other ocular nerves also involved result s from disease of the upper pons (True) Explanation: Infarction. Features of an intracranial lower motor neuron lesion of the facia l nerve include inability to wrinkle the forehead (True) Explanation: Frontalis weakness increased lacrimation on the affected side (False) Explanation: Decreas ed due to involvement of nervus intermedius upward deviation of the eye on attem pted eyelid closure (True) Explanation: Bell's sign deafness due to loss of the nerve to the stapedius muscle (False) Explanation: Produces hyperacusis loss of taste over the anterior two-thirds of the tongue (True) Explanation: Involvement of the chorda tympani Question 9. . Absence of pupillary constriction in either eye on shining a light into the right pupil suggests bilateral Argyll Robertson pupils (True) Explanation: Accommodation preserved bilateral Holmes-Ad ie pupils (True) Explanation: Defect is probably in the ciliary ganglia right op tic nerve lesion (True) Explanation: An afferent defect right oculomotor nerve l esion (False) Explanation: Reaction in right eye only is impaired bilateral Horn er's syndrome (True) Explanation: Both pupils may be small but response preserve d Question 8. 12th nerve absence of the jaw jerk (Fa lse) Explanation: Jaw jerk is typically brisk Question 10. Characteristic features of pseudobulbar palsy include dysarthria (True) Explanation: With dysphonia dysphagia (True) Explanat ion: Often with aspiration emotional lability (True) Explanation: Particularly i n cerebrovascular disease wasting and fasciculation of the tongue (False) Explan ation: Suggest lower motor neuron lesion. haemorrhage or demyelination typically is a recognised feature of posterior fossa tumour (True) Explanation: May be 'false localising sign' in raised intracranial pressure Que stion 6. H.MCQs VIA WEB 2005 Explanation: Usually bilateral. just a lateral rectus palsy Question 7. The following stateme nts about bladder innervation are correct sacral cord lesions usually produce ur inary retention (True) Explanation: Parasympathetic innervation impaired By A.

H. Typical features of prefrontal lo be lesions include positive grasp reflex (True) Explanation: And other 'primitiv e' reflexes astereognosis (False) Explanation: Suggests a parietal lobe lesion s ensory dysphasia (False) Explanation: Posterior temporo-parietal lesion (Wernick e's area) olfactory hallucinations (False) Explanation: Temporal lobe sign socia l disinhibition (True) Explanation: Perhaps with antisocial behaviour Question 1 4.7 kPa preservation of the cough and gag reflexes (False) Explanatio n: All brain-stem reflexes absent Question 13. Typical features of posterior parietal lobe lesions include lower homonymous quadrantanopia (False) Explanation: Contralateral to lesion constructional aprax ia (False) Explanation: Non-dominant hemisphere sensory inattention (False) Expl anation: Perhaps with sensory neglect motor dysphasia (True) Explanation: Broca' s area in the inferior frontal lobe agnosia and acalculia (False) Explanation: G erstmann's syndrome of the dominant angular gyral region By A. The diagnosis of brain death is supported by pin-point pupils (False) Explanation: Dilated and unreactive to lig ht absent corneal reflexes (True) Explanation: A brain-stem reflex absent vestib ulo-ocular responses to caloric testing (True) Explanation: 20 ml ice-cold water into each ear in turn absence of spontaneous respiration (True) Explanation: Wi th PaCO2 > 6. The following statements about the Glasgow coma scale are correct th e best response to an arousal stimulus should be measured (True) Explanation: Te st at least twice appropriate motor responses to verbal commands = score 6 (True ) Explanation: No response to pain = 1 spontaneous eye opening = score 4 (True) Explanation: No eye opening = 1 verbal responses with normal speech and orientat ion = score 5 (True) Explanation: No speech = 1 the minimum total score = 3 (Tru e) Explanation: Maximum score = 15 Question 12.MCQs VIA WEB 2005 thoracic cord lesions produce urinary urge incontinence (True) Explanation: And incomplete bladder emptying pelvic nerve parasympathetic stimulation causes blad der emptying (True) Explanation: Internal sphincter relaxation and detrusor cont raction pudendal nerve lesions produce automatic bladder emptying (False) Explan ation: Feature of spinal cord lesions the L1-L2 segment sympathetic outflow medi ates bladder relaxation (True) Explanation: And internal sphincter contraction Q uestion 11. .

In the evaluation of a patient with headache thunderclap headache i s invariably associated with subarachnoid haemorrhage (False) Explanation: Only associated in 1 in 8 patients patients with viral meningitis invariably display meningism (False) Explanation: Meningism less common than in bacterial infection the presence of concurrent focal limb weakness excludes migraine (False) Explan ation: Migrainous hemiparesis is well recognised improvement with simple analges ia suggests tension headache (False) Explanation: Tension headaches are typicall y poorly responsive headache on waking suggests raised intracranial pressure (Tr ue) Explanation: As does morning vomiting Question 16.MCQs VIA WEB 2005 Question 15. Features suggesting vasova gal faint rather than epilepsy in a patient with a blackout include an olfactory aura (False) Explanation: But many patients are aware that something is about t o happen confusion following the event (False) headache following the event (Fal se) Explanation: Also absence of injury or tongue-biting memory loss surrounding the event (False) tongue-biting (False) Explanation: Also pallor rather than ce ntral cyanosis suggests fainting Question 19. In the analysis of gait circumduct ion of a leg suggests pyramidal weakness (True) Explanation: Often with dragging of the affected foot a high-stepping gait suggests foot drop (True) Explanation : Perhaps with slapping steps inability to walk heel-to-toe suggests cerebellar disease (True) Explanation: Classically of the vermis difficulty negotiating doo rways suggests parkinsonism (True) Explanation: Associated with festination a wa ddling gait suggests proximal muscle weakness (True) Explanation: Usually myopat hic in nature By A. Migrainous neuralgia (clu ster headache) is more common in females than in males (False) Explanation: Male to female ratio is 5:1 the commonest form of migraine (False) Explanation: 10-5 0 times less common associated with Horner's syndrome in some patients (True) Ex planation: And unilateral lacrimation likely to be cured by prophylactic propran olol treatment (False) Explanation: Prophylaxis may not be helpful likely to res pond well to sumatriptan therapy (True) Question 17. In the evaluation of a pati ent with true vertigo short-lived symptoms favour a labyrinthine cause (True) Ex planation: Persistent vertigo is more often central the presence of nystagmus ex cludes viral labyrinthitis (False) Explanation: Often present although transient associated paroxysmal tinnitus suggests Ménière's disease (True) Explanation: Exclu de acoustic neuroma positional vertigo fatigues rapidly when due to central caus e (False) Explanation: Tends to persist temporal lobe epilepsy should be conside red (True) Explanation: But a rare cause Question 18. H. .

Typical featu res of generalised epilepsy include loss of consciousness accompanied by symmetr ical EEG discharge (True) Explanation: May follow focal EEG abnormality and symp toms-partial seizures invariable presence of an aura (False) Explanation: Often absent lesion demonstrable on CT of the brain (False) Explanation: Usually no ob vious abnormality induction by photic stimulation (True) Explanation: TV or comp uter games may induce fits By A. carbamazepine Question 22. Jerking nystagmus that changes in direction with the direction of g aze is compatible with cerebellar hemisphere disease (True) Explanation: Maximal on gaze towards lesion if cerebellar disease is unilateral indicative of a brai n-stem disorder (True) Explanation: May be more marked in the abducting eye (ata xic nystagmus) compatible with a vestibular nerve lesion (False) Explanation: Ty pically present only when looking away from side of lesion typically accompanied by vertigo and tinnitus (False) Explanation: Suggests vestibulocochlear disease likely to continue following closure of the eyes (True) Explanation: Demonstrab le using electronystagmography Question 21.MCQs VIA WEB 2005 Question 20. nausea and vomiting (True) Explanati on: May be disabling progressive sensorineural deafness and tinnitus (True) Expl anation: Usually unilateral jerking nystagmus and ataxic gait (True) Explanation : Typically during attacks nystagmus usually persists between attacks (False) Ex planation: Suggests benign positional vertigo restoration of hearing following e ffective treatment (False) Explanation: May delay progression but cannot restore auditory loss Question 23. The characteristic features of trige minal neuralgia include pain lasting several hours at a time (False) Explanation : Lancinating paroxysms lasting a few seconds pain precipitated by touching the face and/or chewing (True) Explanation: 'Trigger areas' may exist absence of the corneal reflex (False) Explanation: No abnormal signs predominance in young fem ales (False) Explanation: Occurs in elderly subjects response to anticonvulsants (True) Explanation: E. H. . Typical causes of vertigo include cardiac arrhythmia (False) Explanation: Postural instability and syncopal symptoms acoustic neurom a (True) Explanation: Or other pathology of the 8th nerve vestibular neuronitis (True) Explanation: Usually associated with vertebral artery ischaemia gentamici n drug therapy (True) Explanation: And other ototoxic drugs otitis media (True) Explanation: With secondary labyrinthine inflammation Question 24.g. The typical features of Ménière 's disease include sudden onset of vertigo.

MCQs VIA WEB 2005 induction by hyperventilation (True) Explanation: Often used during the recordin g of an EEG Question 25. . A patient with seizures in the UK can drive a pr ivate car following a single seizure after 1 year free of recurrence (True) hold a heavy goods vehicle licence if all seizures occurred before the age of 5 year s (True) Explanation: Providing no potentially epileptogenic brain lesion identi fied drive a private car during the withdrawal of anticonvulsant therapy (False) Explanation: Should stop driving for 6 months after their withdrawal drive a he avy goods vehicle only if seizure-free for 5 years (False) Explanation: 10 years drive a private car if seizures have only occurred during sleep in the previous 3 years (True) Question 29. The clinical features of tonic clonic seizures include prodromal phase lasting hours or days (True) Explanation: With vague irritabilit y or lethargy onset with an audible cry due to the aura (False) Explanation: Aud ible cry may occur at the onset of the tonic phase sustained spasm of all muscle s lasting 30 seconds (True) Explanation: Tonic phase interrupted jerking movemen ts lasting 1-5 minutes (True) Explanation: Clonic phase flaccid post-ictal state with bilateral extensor plantars (True) Explanation: Variable duration Question 26. H. mostly in fir st 2 months trigger factors for epilepsy include sleep deprivation and physical exhaustion (True) Explanation: Also febrile illnesses and metabolic disturbances the lifetime risk of a single seizure is 20% (False) Explanation: 5% sharp wave s on EEG are highly specific for epilepsy (True) Explanation: Only one in 1000 a re false positives Question 28. The following statements about epilepsy are correct treatment should be started following a single witnessed seizure (False) Explan ation: Await evidence of recurrent seizures 25% of patients will have a further seizure within 1 year of a first seizure (False) Explanation: 70%. The typical features of absence (petit mal) seizures include loss of consci ousness lasting up to 10 seconds (True) Explanation: Sometimes with loss of post ure onset around age 25-30 years (False) Explanation: Typically in childhood syn chronous three per second spike and wave activity on EEG (True) Explanation: May be detected inter-ictally later development of tonic clonic seizures in 40% of patients (True) Explanation: May not occur until adulthood sleepiness lasting se veral hours post-ictally (False) Explanation: Rapid recovery although may occur very frequently Question 27. The following statements about anticonvulsants are correct plasma level monitoring is particularly useful in sodium valproate thera py (False) Explanation: Phenytoin and carbamazepine primidone is likely to cause sideroblastic anaemia (False) Explanation: Megaloblastic anaemia clonazepam is the first-line treatment of absence seizures (False) Explanation: Ethosuximide s odium valproate is the first-line treatment in primary generalised tonic clonic seizures (True) By A.

speech disturbance atrial fibrillation (True) Explanation: Bilateral events may occur hypotension (True) Explanation: Associated with standing intracerebell ar haemorrhage (False) Explanation: Fixed deficit stroke intracerebral tumour (F alse) Explanation: Slowly progressive typically Question 34. H. . Clinical features of raised intracranial pressure include tachycardia and hyp otension (False) Explanation: Bradycardia and hypertension dizziness and lighthe adedness (True) Explanation: And vomiting headache aggravated by bending and str aining (True) Explanation: And coughing behavioural and personality changes (Tru e) Explanation: And impairment of conscious level 6th or 3rd cranial nerve palsi es (True) Explanation: 'False localising signs' Question 32. Clinical features s uggesting lacunar stroke include homonymous hemianopia (False) Explanation: The optic pathway is only affected by larger lesions motor or sensory dysphasia (Fal se) Explanation: Suggests cortical damage facial weakness and arm monoparesis (T rue) By A. Typical causes of transient cerebral ischaemic attacks includ e carotid artery stenosis (True) Explanation: Usually contralateral motor. especially in the elderly eye-witness account of sustained jerking movements during the attack (True) Explanation: Som e jerking movements are common in simple faints attacks aborted by lying supine (False) Explanation: Suggests vasovagal syncope attacks confined to the sleeping hours (True) Explanation: May occur in blackouts due to bradycardias Question 3 1. The following state ments about primary brain tumours are correct meningiomas are the most common ty pe in the middle-aged (True) Explanation: 20% of all cerebral tumours gliomas ar e the most common type in childhood (False) Explanation: 40% of all cerebral tum ours most childhood brain tumours arise within the posterior fossa (True) Explan ation: They are usually cerebellar tumours presentation with adult-onset partial seizures is typical (True) Explanation: Indication for CT acoustic neuromas usu ally present in the 6th and 7th decades (False) Explanation: Fourth and fifth de cades Question 33. senso ry. Features suggesting epilepsy rather than a simple faint as the cause of blackouts include impairment of vision heralding th e attack (False) Explanation: Suggests syncopal episode tongue-biting during the attack (True) Explanation: Not specific.MCQs VIA WEB 2005 carbamazepine is a recognised cause of hyponatraemia (True) Explanation: Particu larly in older patients Question 30.

Clinical featur es suggesting intracerebral haemorrhage include abrupt onset of severe headache followed by coma (True) Explanation: Headache is not specific to haemorrhage 3rd cranial nerve palsy (True) Explanation: In midbrain haemorrhage retinal haemorr hages and/or papilloedema (True) Explanation: With subhyaloid retinal haemorrhag e vomiting and neck stiffness (True) Explanation: Raised ICP tinnitus. vomiting and confusion (True) Explanation: With focal hemispheric signs posit ive blood and CSF cultures (False) Explanation: Lumbar puncture may be hazardous Question 39.MCQs VIA WEB 2005 Explanation: Internal capsule lacuna isolated hemiparesis or hemianaesthesia (Tr ue) Explanation: Internal capsule lacuna history of hypertension or diabetes mel litus (True) Explanation: Account for > 80% of lacunar strokes Question 35. The typical features of adult tuberculous meningitis include heada che and vomiting (True) Explanation: And general malaise By A. Intracerebral abscess is a typical complication of infective endocarditis (Tru e) Explanation: Often streptococcal in origin bronchiectasis (True) Explanation: Usually staphylococcal in origin frontal sinusitis (True) Explanation: Typicall y affects the frontal lobe otitis media (True) Explanation: Cerebellar or tempor al head injury (True) Explanation: Typically staphylococcal in origin Question 3 8. The typical features of an intracerebral abscess include high fever. H. deafness and vertigo (False) Explanation: Suggest peripheral 8th nerve lesion Question 37 . . weight l oss and peripheral blood leucocytosis (False) Explanation: Usually there is no s uggestion of infection epilepsy persisting after successful treatment of the abs cess (True) Explanation: Prophylactic anticonvulsants should be considered brady cardia and papilloedema (True) Explanation: Raised intracranial pressure headach e. The following statements about stroke are correct 65% of completed strokes are due t o cerebral infarction (False) Explanation: 85% most strokes are complete in < 6 hours (True) Explanation: Minority 'stutter' over a longer period 20% of cerebra l infarcts are secondary to cardiogenic embolism (True) Explanation: Another 20% are lacunar infarcts following an ischaemic stroke. aspirin reduces the risk of death or further stroke by 25% (True) Explanation: 75-150 mg daily 20% of patie nts with carotid territory symptoms have a major (> 70%) stenosis (True) Explana tion: Carotid endarterectomy may then be beneficial Question 36.

Typical features of adul t viral encephalitis include acute onset of headache and fever (True) Explanatio n: Usually no prodrome partial epilepsy and coma rapidly ensue (True) Explanatio n: Occasionally a mild impairment of consciousness decreased CSF glucose concent ration (False) Explanation: Suggests pyogenic infection temporal lobe EEG abnorm alities are pathognomonic of herpes simplex infection (False) Explanation: Other viruses may cause this meningism (True) Explanation: In 75% of patients Questio n 43. pneumococci and Haemophilus antibiotic therapy should not be given before CSF analysis has been undertaken (False) Explanation: Start therapy if the diagnosis is likely. Recognised causes of viral meningitis include herpes simplex (True) Explanat ion: Sometimes with encephalitis poliomyelitis (True) Explanation: With subseque nt anterior horn cell infection arenavirus (True) Explanation: Lymphocytic chori omeningitis Coxsackie viruses (True) Explanation: Common cause in UK mumps virus (True) Explanation: Usually self-limiting Question 42. In the treatment of adult pyo genic meningitis penicillin therapy should be given intrathecally initially (Fal se) Explanation: Intrathecal penicillin is both unnecessary and dangerous chlora mphenicol therapy should be considered for penicillin-allergic patients (True) E xplanation: Covers meningococci. H. . given the mortality and morbidity par enteral fluid therapy should be instituted immediately (True) Explanation: Septi caemic shock often complicates the disease the onset of a purpuric rash suggests drug allergy is likely (False) Explanation: Suggests meningococcaemia Question 41. frequency and incontinence (True) Explanation: In spinal involvement epilepsy. The typical features of multiple sclerosis include invariable progression with relapses and remission (False) Explanation: Only 25% of cases have a chroni cally progressive course onset often occurs before the age of puberty (False) Ex planation: Rare in childhood choreoathetosis and parkinsonism (False) Explanatio n: No extrapyramidal features urinary urgency. dysphasia or hemiplegia (False) Ex planation: Epilepsy and hemiplegia are unusual By A.MCQs VIA WEB 2005 fever associated with neck stiffness (True) Explanation: Fever often low-grade c ranial nerve palsies associated with coma (True) Explanation: Cranial nerve lesi ons in 25% of cases miliary tuberculosis is often present (True) Explanation: Us ual source of infection CSF cell count > 400 neutrophil leucocytes per ml (False ) Explanation: Lymphocytic meningitis Question 40.

Useful investigations in diagnosing multiple sclerosis include visu al and somatosensory evoked potentials (True) Explanation: Can detect clinically silent lesions in 75% of patients magnetic resonance brain scanning (True) Expl anation: MRI more sensitive than CT CSF analysis for oligoclonal IgG bands (True ) Explanation: Occurs in 70-90% of patients between attacks electroencephalograp hy (False) Explanation: Non-specific abnormalities electromyography (False) Expl anation: Test of lower motor neuronal disease Question 45.MCQs VIA WEB 2005 Question 44. do not cause confusion (False) Explanation: Neuropsychiatric problems occu r with both types of therapy dyskinesia is a frequent dose-limiting side-effect of levodopa (True) Explanation: Sustained-release preparations sometimes help Qu estion 48. Clinical findings consistent with the diagnosis of idiopathic Parkinson's d isease include unilateral onset of the disorder (True) Explanation: Typically ar m tremor emotional lability (False) Explanation: Suggests underlying cerebrovasc ular disease oculogyric crises (False) Explanation: Suggests drug-induced extrap yramidal disease extensor plantar responses (False) Explanation: Suggests multis ystems atrophy (MSA) impaired voluntary eye movements (False) Explanation: Impai rment of conjugate eye movements suggests progressive supranuclear palsy Questio n 47. H. The characteristic features of Huntington's disease include autosomal recessive inheritance (False) Explanation: Autosomal dominant transmission clin ical onset before the age of puberty (False) Explanation: Onset in middle-aged s ubjects progress of dementia arrested with tetrabenazine therapy (False) Explana tion: May help chorea choreiform movements of the face and arms particularly (Tr ue) Explanation: But become generalised cardiomyopathic changes on echocardiogra phy (False) By A. The typical features of idiopathic parkinsonism include hypokinesia (True) Explanation: Impaired fine finger movements early-onset dementia (False) Explanation: Cognitive impairment develops in about 30% of patients as the disease progresses intention tremor (F alse) Explanation: Resting tremor 'leadpipe' rigidity (True) Explanation: Also ' cogwheel' rigidity if a tremor is prominent normal eye movements (True) Question 46. In the management of Parkinson's disease anticholinergic therapy is the be st first-line therapy for hypokinesis (False) Explanation: Principally useful fo r tremor levodopa should be introduced as soon as the diagnosis is made (False) Explanation: Early introduction means earlier waning of effect hypersalivation i nvariably indicates overuse of levodopa (False) Explanation: May be a sign of un dertreatment causing hypokinesis dopamine receptor agonists. . unlike anticholiner gics.

. Typical features of cervical radiculopathy include pathognomonic radiograph abnormalities of the cervical spine (False) Explanation: Changes are usually degenerative and non-specific radicular pain in the arm and shoulder (Tr ue) Explanation: Follows the distribution of nerve root(s) painful limitation of movements of the cervical spine (True) Explanation: Only if due to disc prolaps e or destructive pathology C5-C7 sensory and/or motor loss in the upper limb (Tr ue) Explanation: C5-C7 involvement with appropriate reflex loss neurosurgical in tervention is often required (False) Explanation: Conservative management is usu ally adequate Question 52. The different ial diagnosis in MND includes syringomyelia (True) Explanation: But no sensory s igns in MND diabetic amyotrophy (True) Explanation: Look for evidence of diabete s mellitus cervical myelopathy (True) Explanation: Treatment may limit progressi on paraneoplastic syndrome (True) Explanation: Protean manifestations of a numbe r of tumours meningovascular syphilis (True) Explanation: Check syphilis serolog y Question 51. The clinical features of motor neuron disease (MND) include insidious onset in elderly males (True) Expla nation: Prevalence of 4 per 100 000 progressive distal muscular atrophy (True) E xplanation: Typically with absent reflexes progressive bulbar palsy (True) Expla nation: Particularly tongue fasciculation upper motor neuron signs in the lower limbs (True) Explanation: Or in the upper limbs lower motor neuron signs in the upper limbs (True) Explanation: Or in the lower limbs Question 50.MCQs VIA WEB 2005 Explanation: Suggests Friedreich's ataxia Question 49. H. The following statements about spinal cord compressio n are correct metastatic disease is a more common cause than primary tumour (Tru e) Explanation: Usually extradural deposits the CSF protein concentration is lik ely to be normal (False) Explanation: Typically elevated with xanthochromia (Fro in's syndrome) local spinal pain and tenderness usually precede motor weakness ( True) Explanation: Pain may follow nerve root distribution urinary urgency is co mmonly the presenting feature (False) Explanation: A late feature myelography is the best and most appropriate investigation (True) Explanation: MRI is now inva luable Question 53. Recognised causes of paraplegia include intracranial parasag ittal meningioma (True) Explanation: Important to remember if spinal investigati ons are normal vitamin B12 deficiency (True) Explanation: Rare in UK in this sev erity tuberculosis of the thoracic spine (True) Explanation: Associated with ver tebral collapse (Pott's disease) By A.

B6. phaeochromocytoma intraspinal and intracranial neuromas and meningiomas (True) Explanation: At almost any site nerve deafness (True) Explanation: Acous tic neuroma Question 56. also cause mononeuritis multiplex vita min B12 deficiency and folate deficiency (True) Explanation: Also vitamin B1. Recognised causes of a generalised polyneuropathy include bronchial c arcinoma (True) Explanation: Typically sensory rheumatoid arthritis (True) Expla nation: And systemic lupus erythematosus.MCQs VIA WEB 2005 anterior spinal artery thrombosis (True) Explanation: Sudden onset typically spi nal neurofibromas and gliomas (True) Explanation: Intradural pathology accounts for 20% of cases of cord compression Question 54. Recognised features of neurofibromatosis include autosomal dominant inheritance (True) Explanation: Cen tral and peripheral forms occur café-au-lait spots (True) Explanation: And axillar y skin freckling association with multiple endocrine neoplasias (True) Explanati on: E. A and E deficiency amiodarone therapy (True) Explanation: And numerous dru gs diabetes mellitus (True) Explanation: And myxoedema Question 58. The typical features of syring omyelia include slow insidious progression of the disease (True) Explanation: On set in third or fourth decade dissociate sensory loss with normal touch and posi tion sense (True) Explanation: Leading to trophic ulceration loss of one or more upper limb tendon reflexes is invariable (True) Explanation: Damage to anterior horn cells wasting of the small muscles of the hands (True) Explanation: A comm on early feature hyperreflexia of the lower limbs and extensor plantar responses (True) Explanation: Pyramidal tract damage Question 55. B2 . H. The following statements about dementia are correct 20% of the population aged over 80 years suffer a dementing illness (True) Explanat ion: Most commonly Alzheimer's disease inheritance of the apolipoprotein å4 allele is associated with multi-infarct dementia (False) Explanation: Risk of Alzheime r's increased four-fold cerebral acetylcholinesterase inhibitors arrest progress ion of the disease (True) Explanation: Particularly in Alzheimer's Alzheimer's d isease is characterised by the presence of neurofibrillary tangles (True) Explan ation: And amyloid-rich plaques associated parkinsonism suggests possible Lewy b ody disease (True) Explanation: Patients often made worse by levodopa therapy Qu estion 57. Clinical fea tures typical of the following polyneuropathies include predominantly motor loss -lead poisoning (True) Explanation: Look for haematological clues predominantly sensory loss-post-inflammatory polyneuropathy (False) By A. .g.

Recurrent dizziness in the elderly is likely to be the result of an adverse drug reaction (True) Explanation: Especially if associated with post ural hypotension postural hypotension (True) Explanation: Absence of attacks whe n lying in bed is suggestive Ménière's disease (True) Explanation: Rare in the absen ce of hearing loss vertebrobasilar insufficiency (True) Explanation: Common and may be reproduced by head movements sick sinus syndrome (True) Explanation: Dizz iness is more likely to occur with bradycardias than tachycardias Downloaded By Ahmed Hakim By A. . Typical causes of proximal myopathy include hypothyroidism (True) Explanation: And also hyperthyroidism. Acute confusion in the elderly is likely to be the r esult of an adverse drug reaction (True) Explanation: E.MCQs VIA WEB 2005 Explanation: Motor weakness predominates painful sensory impairment-alcohol misu se (True) Explanation: Also autonomic neuropathy with local sympathetic neural d ysfunction sparing of the cranial nerves-sarcoidosis (False) Explanation: The 7t h nerve especially is commonly involved in neurosarcoid prominent postural hypot ension-diabetes mellitus (True) Explanation: Suggests autonomic involvement Ques tion 59.g. opiates. The typical features of Guillain-Barré polyneuropathy include onset withi n 4 weeks of an acute infective illness (True) Explanation: 1-4 weeks. levodopa hyp othermia (True) Explanation: Check core temperature with a low-reading thermomet er bronchopneumonia (True) Explanation: Consider the possibility of meningitis m yocardial infarction (True) Explanation: More often asymptomatic in the elderly cerebral infarction (True) Explanation: CT to exclude subdural haematoma or tumo ur Question 62. cell count i s normal Question 60. usually a fter viral infection peripheral paraesthesiae (True) Explanation: Paraesthesiae spread proximally ascending flaccid paralysis with areflexia (True) Explanation: Muscle wasting is usually absent sparing of the respiratory and facial nerves ( False) Explanation: Cranial nerves involved in 30-40% normal CSF protein concent ration and cell count (False) Explanation: CSF protein is elevated. H. both resolve with treatment type 1 diabetes mellitus (False) Explanation: Causes a variety of different periphera l nerve disorders Cushing's syndrome (True) Explanation: And also acromegaly per nicious anaemia (False) Explanation: Causes a peripheral neuropathy and spinal c ord degeneration chronic alcohol misuse (True) Explanation: Often with a periphe ral neuropathy Question 61.