Copperbelt University

MICHAEL CHILUFYA SATA SCHOOL OF MEDICINE

INTERNAL MEDICINE

September 19th 2018

4 TH YEAR [ 3 hours]
MCS 400 Paper 1 [9 hours hours]

NAMES: _______________________________________________________

STUDENT NUMBER: _______________________________________________

 SECTION A
Answer all stems [a, b, c, d, and e]. A wrong answer will attract a penalty of 0.25.

1. The following may be neurological presentations of HIV/Aids.[choose the most likely]

A. Mononeuritis multiplex T
B. Vacuolar degeneration of the cord T
C. Myelopathy associated with Tuberculosis, Syphilis T
D. Acute inflammatory demyelinating, polyradiculopathy T
E. All of the above T
F. None of the above F

2. In a patient suffering from HIV/Aids pruritus may be due to [ch

A. Sarcopteis scabies T
B. Psoriasis T
C. Eczema T
D. Primary biliary cirrhosis T
E. Neviraphine T
F. All of the above T
G. None of the above F

3. The following may be associated with Diabetes

A. Mononeritis Multiplex T
B. Hypoglycaemia T
C. Erythema nodosum T
D. Lactic acidosis T
E. All of the above T
F. None of the above F

4. The following are features of pericardial effusion

A. Cardiomegaly F
B. Pear shaped radiology T
C. Low voltage ECG T
D. Bronchial breathing behind the scapular T
E. All; of the above F
F. None of the above F

5. The following are features of mitral stenosis

A. Opening snap T
B. Facies T (Malar Rash)
C. Mid-diastolic ramble T
D. Basal Crackles of the above T
 E. All of the above T

6. The following are features of bronchial carcinoma

A. Clubbing of fingers T
B. Hypertrophic pulmonary osteparthropathy T
C. Coin lesion T
D. Hypoglycaemia T
E. All of the above T
F. None of the above F

7. The following are true of Rheumatoid arthritis

A. Monoarticular arthropathy of large joints T
B. Pleural effusions T
C. A symmetrical poly arthritis T
D. HIV/AIDS F
E. All of the above F
F. None of the above F

8. The following are causes of anasarca

A. Chronic Liver failure T
B. Malnutrition T
C. Chronic myeloid leukaemia T
D. Constrictive Pericarditis T
E. All of the above T
F. None of the above F

9. The following may be features of Aortic Regurgitation

A. Angina T
B. Austin Flint murmur T
C. Cardiomegaly T
D. Early diastolic murmur F
E. All of the above F
F. None of the above F

10. In the immune reconstitution and inflammatory syndrome

A. Pulmonary Tuberculosis is common T
B. Mycobacterium avium is a feature T
C. Syphilis can be a feature F
D. None of the above F
E. All of the above F

11. In HIV patients on ART

A. Lactic acidosis is a well known complication T
 B. Encephalopathy may be a presenting feature T
C. A hypochromic microcytic anaemia is a feature T
D. A normocytic normochromic anaemia may be a feature T

12. Altered immunity in HIV infection may be associated with the following
A. Rheumatoid arthritis F
B. Systemic Lupus Erythematosis F
C. Psoriasis T
D. Tinear corporis T

13. The following are true of bronchial asthma

A. Is due to a type 1 hypersensitivity reaction T
B. Immunoglobulin IgE is produced in excess T
C. Inability to talk indicates a serious asthma attack T
D. A silent chest indicates a serious attack T

14. The following are true

A. Streptococcus pnuemoniae is the most common pathogen in community acquired
pneumonia COPD T
B. In pneumonia commonly presents with fever, tachypnoea, tachycardia, signs of
consolidation T
C. Cavitation of the lungs is caused by Staphylococcus aureus, klebsiella pneumonia, and
Mycobacterium tuberculosis T
D. In patients with pneumonia an oxygen saturation of <90% indicates instability T

15. The following are true

A. Oral candidiasis is diagnostic of HIV F
B. Herpes Simplex is common and is diagnostic of HIV F
C. In the CDC category B Kaposi’s Sarcoma is a feature F
D. In the CDC category D Cryptococcal Meningitis is a feature T

16. Among the features of nephrotic syndrome are as follows

A. Sodium retention is universal and early feature F
B. Upper limbs and face may be oedematous T
C. Pleural effusions do occur T
D. Oedema may be unilateral and none-pitting F
E. May be associated with Quartan Malaria T

17. The following are features of lactic acidosis

A. Symptoms of an acute abdomen T
B. Hypothermia T
C. Kussmauls breathing T
D. All of the above T
E. None of the above F
18. Blood cultures are usually required in cases of
A. Typhoid T
B. Meningococal meningitis T
C. Pneumococcal pneumonia T
D. Rheumatic fever F
E. All of the above F
F. None of the above F

19. Useful drugs in fungal infections are

A. Ribavirin F
B. Amantidine F
C. Nystatin T
D. Fluconazole T
E. All of the above F

20. Streptococus Pnuemonia

A. Is common aetiological agent in meningitis T
B. Is invariably sensitive to penicillin T
C. Infections can be prevented by vaccination F
D. On Gram staining appears in Gram positive T
E. None of the above F

21. Diabetic autonomic neuropathy is characterized by

A. Nocturnal diarrhoea T
B. Postural hypotension T
C. Gastroparesis T
D. Hyperhydrosis T
E. All of the above T

22. The following conditions are associated with insulin-dependent diabetes mellitus
A. Pernicious anaemia T
B. Coeliac disease T
C. Pernicious anaemia T
D. Thyroid Disease T
E. None of the above F

23. The following are causes of hepatosplenomegaly

A. Chronic Myeloid Leukaemia T
B. Malaria T
C. Typhoid T
D. Hodgkin’s lymphoma T
E. All of the above T
24. The following are causes of high output cardiac failure
A. Beriberi T
B. Anaemia T
C. Thiamine deficiency T
D. Thyroid disease T

25. The following are true of a pleural effusion

A. Aegophony T
B. Bronchial breathing T
C. Dullness to percussion T
D. Whispering pectriloquay T

26. In HIV/Aids the following are complications of repeated blood transfusions

A. Hepatitis C T
B. Haemosiderosis T
C. Haemolytic uremic Syndrome F
D. Disseminated intravascular coagulation T

27. The following are true of cryptococal meningitis

A. It only occurs at CD 4 of 50 cell or less F
B. It may present as a subacute illness with no signs of meninges T
C. Typical CSF findings may show a lymphocyte – predominant pleocytosis T
D. A Confusional state indicates a poor prognosis T

28. The following may be closely associated with HIV/Aids

A. Sero-positive Rheumatoid arthritis F
B. Systemic Lupus Erythomatosus F
C. Reiter’s Disease T
D. None of the above F

29. The following are none-metastatic manifestation of bronchial carcinoma

A. Syndrome of inappropriate secretion of anti-diuretic hormone [SIADH] T
B. Hypercalcaemia T
C. Hypoglycaemia F
D. None of these F

30. The following may be manifestations of HIV/Aids

A. Dysphagia T
B. Dysarthria T
C. Odynophagia T
D. Eczema T
E. All of the above T
F. None of the above F
31. In acute myocardial infarction
A. The troponin measurement may be normal T
B. ST segment elevation is always present F
C. Unstable angina can only be diagnoses by ECG F
D. Q waves develop during 24 hours F
E. The ST segment returns to normal within 2 to 3 days T

32. The following are features of aortic stenosis

A. A tall stature F (aortic reg)
B. An Austin Flint murmur F (aortic reg)
C. A high arched palate F (aortic reg)
D. Cardiomegaly T

33. In the immune reconstitution and inflammatory syndrome

A. Pulmonary Tuberculosis is always a feature F
B. Syphilis may be a manifestation T
C. Diabetes may be a feature T
D. All of the above F
E. None of the above F

34. .The following statements are true of Anti Retroviral Treatment

A. Efavirenz is a nucleotide analogue F
B. Nevirapine is none nucleoside analogue T
C. Nevirapine may cause a severe Stephenson Syndrome which may be fatal T
D. ATRIPLA has no nephrotoxicity F
E. None of the above F

35. The following statements are true

A. Lactic acidosis may occur during the treatment of diabetes with glibenclameide F
B. Hiccups may occur during treatment with ATRIPLA T
C. Neuropsychiatry complications are unusual F
D. None of the above F

36. The following may occur in a state of altered immunity

A. Rheumatoid arthris F
B. Gout T
C. Chondrocalcinosis (pseudogout) T
D. Systemic Lupus Erythematosus F
E. Rheumatic Fever T

37. The following are well known dematological manifestations of Diabetes

A. Necrobiosis diabeticorum T
B. Psoriasis T
C. Tinear Corporis T
 D. Oral thrush T
E. Acanthosis nigricans T

38. The following will be true of people who frequent Hungry Lion outlet
A. An increased waist line T
B. Raised triglycerides T
C. A random blood sugar of 11mmol T
D. A systolic blood pressure greater that 150 mm Hg T
E. MODY mature onst diabetes of the young F

39. Useful drugs in fungal infections are

F. Ribavirin F
G. Amantidine F
H. Nystatin T
I. Fluconazole T

40. Streptococus Pnuemonia

F. Is common aetiological agent in meningitis T
G. Is invariably sensitive to penicillin T
H. Infections can be prevented by vaccination T
I. On Gram staining appears in Gram positive cocci T

41. Diabetic autonomic neuropathy is characterized by

F. Nocturnal diarrhoea T
G. Postural hypotension T
H. Gastroparesis T
I. Hyperhydrosis T

42. The following conditions are associated with insulin-dependent diabetes mellitus
F. Pernicious anaemia T
G. Coeliac disease T
H. Pernicious anaemia T
I. Thyroid Disease T

43. The following are causes of hepatosplenomegaly

F. Chronic Myeloid Leukaemia T
G. Malaria T
H. Typhoid T
I. Hodgkin’s lymphoma T

44. The following are causes of high output cardiac failure

E. Beriberi T
F. Anaemia T
 G. Thiamine deficiency T
H. Thyroid disease T

45. The following are true of a pleural effusion

E. Aegophony T
F. Bronchial breathing T
G. Dullness to percussion T
H. Whispering pectriloquay T

46. In HIV/Aids the following are complications of repeated blood transfusions

E. Hepatitis C T
F. Haemosiderosis T
G. Haemolytic uremic Syndrome T
H. Disseminated intravascular coagulation T

47. The following are true of cryptococal meningitis

E. It only occurs at CD 4 of 50 cell or less F
F. It may present as a subacute illness with no signs of meninges T
G. Typical CSF findings may show a lymphocyte – predominant pleocytosis T
H. A Confusional state indicates a poor prognosis T

48. The following may be closely associated with HIV/Aids

E. Sero-positive Rheumatoid arthritis F
F. Systemic Lupus Erythomatosus F
G. Reiter’s Disease T
H. None of the above F

49. The following are none-metastatic manifestation of bronchial carcinoma

E. Syndrome of inappropriate secretion of anti-diuretic hormone [SIADH] T
F. Hypercalcaemia T
G. Hypoglycaemia F
H. None of these F

50. The following may be manifestations of HIV/Aids

G. Dysphagia T
H. Dysarthria T
I. Odynophagia T
J. Eczema T

‘
 SECTION B

Write short Notes on the following

1. Nephritic Syndrome
2. Constrictive pericarditis
3. Quartan Malaria Nephropathy
4. Glasgow coma scale
5. Viral Hepatitis