MCQ – SINGLE RESPONSE QUESTIONS

1. A 76 year- old man develops an acute kidney injury 2 days after an elective knee replacement.
His past medical history includes mild chronic obstructive pulmonary disease and
hypertension (controlled with an angiotensin-converting enzyme (ACE) inhibitor). He is
hypotensive (80/50 mmHg), oliguric and has urea of 18 mmol/L (50.4 mg/dL), creatinine of
165 μmol/L (1.87 mg/dL), potassium of 5.1 mmol/L and a normal bicarbonate level. He has
received 30 mL/kg of intravenous fluids over the past 2 hours.
Which will be the most efficacious measure to improve his renal outcome?

A. Commence renal replacement therapy

B. Further fluid therapy
C. Intravenous dopamine infusion
D. Intravenous noradrenaline infusion

Answer :

2. A 25 year -old man presents to the emergency department with a 4-day history of chest pain
and mild shortness of breath. He feels that the pain is worse on lying flat, coughing and deep
breathing; it is relieved by sitting forwards and has improved with ibuprofen. He has no
significant past medical history but was recently unwell with a non-specific viral infection. An
ECG shows widespread saddle ST elevation.
What is the most likely cause of the chest pain?

A. Aortic dissection
B. Pericarditis
C. Myocardial infarction
D. Pulmonary embolism

Answer:

3. For which of these conditions is non-invasive ventilation (bi-level positive airway pressure;
BiPAP) the first-line respiratory treatment?

A. Acute epiglottitis
B. H1N1 Influenza
C. Severe pneumonia
D. Acute exacerbation of COPD

Answer :

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4. You assess a 62 year old woman 2 days after treatment for anterior myocardial infarction. On
examination she is tachycardic and tachypnoeic, and has a harsh systolic murmur radiating
to the axilla. There are fine inspiratory crepitations audible at the lung bases. What is the
most likely explanation for these findings?

A. Aortic Incompetence
B. Papillary muscle rupture and mitral incompetence
C. Post infarction pericarditis
D. Intraventricular septal rupture and VSD

Answer:

5. A 60-year-old female patient is admitted to the neurosurgical unit with subarachnoid

hemorrhage secondary to a ruptured intracranial aneurysm.
Which of the following is the most serious complication that could occur during the
subsequent 3 days?

A. Re- bleeding
B. Cerebral vasospasm
C. Hypertension
D. Pulmonary edema

Answer :

6. A pulmonary embolus is suspected in a patient in the ICU. He is hemodynamically stable.

Which investigation is the most useful for the diagnosis of pulmonary embolus in this patient?

A. CT pulmonary angiogram
B. Transesophageal echocardiography
C. 12 lead ECG
D. Blood D-Dimer

Answer :

7. A 75-year-old man is admitted to HDU following an episode of severe chest pain and collapse
with transient loss of consciousness. On admission he is conscious but complaining of chest
pain radiating into his back. Blood pressure measured in the right arm is 210/110. The left
radial pulse is absent and there are signs of a left hemiparesis. What is the most likely
diagnosis?

A. Acute pulmonary embolism

B. Acute myocardial infarction with stroke
C. Dissecting aneurysm of thoracic aorta
D. Rupture of mycotic aneurysm.

Answer :

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8. A 56-year-old female patient with type II DM has undergone trans-sphenoidal excision of
pituitary adenoma. During the immediate post- operative period she develops polyuria with a
urine output of 600 ml over 2 hours. The urine osmolality is 324 mosmol /Kg and the specific
gravity is 1.001.
Which is the most appropriate treatment for her?

A. Intravenous normal saline

B. Intravenous 5% glucose
C. Intravenous insulin
D. Subcutaneous vasopressin

Answer :

9. An 83 -year old woman presents with acute pulmonary edema, BP 180/100 and a SaO2 of 85
% Which of the following treatment is UNLIKELY to helpful in this setting?

A. Inj furosemide
B. IV Dobutamine
C. IV infusion of NTG
D. Non invasive ventilation

Answer :

10. A 75- year old presents to her family physician with 24- hour history of rapid irregular
palpitation accompanied by fatigue. In an elderly patient, what is the most likely cause of
palpitations?

A. Atrial premature beats

B. Supraventricular tachycardia
C. Atrial fibrillation
D. Ventricular fibrillation

Answer :

11. Post Dural puncture headache

A. Occipital headache
B. Slow leak of CSF
C. Relieved by analgesic
D. Prevented by pencil cut needle

Answer :

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12. The term orthopnea refers to breathlessness (dyspnea) in a particular situation. Which
answer below describes that situation?

A. Lying flat on the bed

B. Sitting upright
C. After several hours of sleep
D. Due to bronchial asthma

Answer :A

13. A-75 year- old woman with history of palpitation presents with a painful left leg. On
examination, pulse rate 80/mt irregularly irregular, BP 170/96 mm of Hg. Left leg is pale cold
and sensations reduced. The popliteal, posterior tibial and dorsalis pedis pulse not palpable.
Her only medication is tab Asparin and clopidogrel. What is the most likely diagnosis?

A. Deep vein thrombosis

B. Calf muscle tear
C. Ischemic limb
D. Cellulitis following surgery

Answer :

14. Which of the following physical signs is associated with left ventricular failure?

A. A gallop rhythm with fourth heart sound

B. A gallop rhythm with 3rd heart sound
C. A loud 2nd heart sound
D. Fixed split of 2nd heart sound

Answer :

15. In the general medical setting, what is the earliest and most sensitive sign of clinical
deterioration?

A. Heart rate
B. Blood pressure
C. Respiratory rate
D. Core temperature

Answer=
16. In the context of cardiac physiology, which of the following, is stroke volume dependent on?

A. Cardiac index
B. Pre load and contractility
C. Hemoglobin and O2 saturation
D. Jugular venous pressure

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Answer :

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