4 VARIANT

Answer ALL of the following questions.

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

2.

3.

4.

5.

6.

7.

The airway of an unconscious patient (A, B, D)

A.

Is protected from aspiration of vomit in the semiphone position

B.

Is especially at risk in injures of the face and neck

C.

Can be effectively protected from vomit by an oropharyngeal tube

D.

Can be effectively protected from aspiration of vomit by a cuffed tracheal tube

E.

Should be protected by routine cricoid compression

Bronchial carcinoma (G)

A.

Is surgically resectable in approximately 30 %

B.

Can be excluded if the chest X-ray is normal

C.

Has a 50 % year survival after surgical resection

D.

Can only be diagnosed reliably bronchoscopy

E.

Associated with finger clubbing suggests a small cell histology

Finger clubbing is a typical finding in (B, C, D)

A.

Chronic bronchitis

B.

Bronchiectasis

C.

Primary biliary cirrhosis

D.

Fibrosing alveolitis

E.

Ventricular septal defect

The following statements are correct (A,C):

A.

There is 50 % greater resistance to breathing when breathing via the nose

B.

The main carina is normally quite fixed with no significant movement with respiration

C.

In the supine position there is a greater tendency to aspirate into the upper rather than the lower lobes

D.

Total airways resistance is greater in the small airways than in the trachea

E.

Type I pneumocytes secrete and store surfactant

Occupational exposure to the following materials cause the diseases listed (A, B, D):
A.

Asbestos causes peritoneal mesothelioma

B.

Coal workers may develop progressive massive fibrosis

C.

Fiberglass inhalation causes bronchial carcinoma

D.

Isocyanates cause asthma

E.

Tin oxide dust causes severe pulmonary fibrosis

During a moderately severe attack of acute asthma, the typical alterations in pulmonary function include (A, E):
A.

Decreased arterial PaO2

B.

Increased arterial PaCO2

C.

Decreased functional residual capacity (FRC)

D.

Raised serum bicarbonate concentration

E.

Decreased peak expiratory flow rate (PEFR)

A woman aged 30 years has previously suffered from red, tender nodules over her shins and now presents with a pyrexial illness. Chest Xray shows bilateral hilar enlargement and the tuberculin test is negative. Additional expected finding include (A, B, C, E):

8.

A.

Lacrimal gland enlargement

B.

Facial palsy

C.

Hypercalciuria

D.

Pleural effusion

E.

Elevated serum angiotensin-converting enzyme

Causes of finger clubbing include (C, D)

A.

Simple coal workers pneumoconiosis

B.

Chronic bronchitis

C.

Ulcerative colitis

D.

Addisons disease

E.

Mesothelioma of the pleura

9.

10.

11.

12.

13.

14.

15.

16.

17.

Conditions predisposing to bronchiectasis include (B, C)

A.

Rubella infection in childhood

B.

Hypohammaglobulinemia

C.

Kartageners syndrome

D.

Carbon monoxide poisoning

E.

Hypothyroidism

Recognized presentations of carcinoma of the bronchus include (A, B, C, E)

A.

An epileptic fit

B.

Increased pigmentation

C.

Collapse of a vertebral body

D.

Thyrotoxicosis

E.

Horners syndrome

Patients with atrial septal defect are at risk of (A, B, C)

A.

Atrial arrhythmias

B.

Right ventricular disfunction

C.

Congestive heart failure

D.

Aortic valve insufficiency

E.

Bacterial endocarditis

Typical clinical features of coarctation of the aorta include (A, C, D)

A.

An association with bicuspid aortic valve

B.

Cardiac failure developing in male adolescents

C.

Palpable collateral arteries around the scapulae

D.

Rib-notching on chest x-ray associated with weak femoral pulses

E.

Continuous murmur at the left upper sternal edge associated with a heaving and displaced apex beat

On assessing the heart sounds (A, C, E):

A.

A split S1 can often be physiological

B.

Reversed splitting of S2 is characteristic of an ostium secundum defect

C.

The second heart sound is loud in coarctation of the aorta

D.

Wide reversed splitting of S2 occurs in right bundle branch block

E.

A loud S3 is heard in constrictive pericarditis

The following abnormalities of the jugular venous pulse are associated with the disorders listed below (C, D)
A.

Cannon waves = pulmonary hypertension

B.

Giant a waves = AV dissociation

C.

cv waves = tricuspid incompetence

D.

Prominent y descent = constrictive pericarditis

E.

Prominent x descent = tricuspid stenosis

Typical clinical features of mitral incompetence include (A, B, C)

A.

Pulmonary hypertention

B.

Right ventricular hypertrophy

C.

Atrial fibrillation

D.

Systemic hypertension

E.

Stroke

In congenital heart disease (B, C, D)

A.

Ostium secundum atrial septal defects (ASD) lie adjacent to the atrioventricular valves

B.

The ECG may show a prolonged PR interval in ostium primum ASD

C.

Ventricular septal defect (VSD) is the commonest congenital heart lesion

D.

Osteogenesis imperfecta is associated with aortic incompetence

E.

The recurrence risk in siblings of probands with VSD is 25%

Cannon waves in the jugular venous pulse are a recognized feature of (C, D, E)
A.

Atrial fibrillation

B.

Pericardial effusion

C.

Complete atrio-ventricular block

D.

Ventricular pacing

E.

Junctional (nodal) ectopic beats

18.

19.

20.

21.

22.

23.

24.

25.

26.

The following are helpful in the differential diagnosis of restrictive cardiomyopathy from constrictive pericarditis (B, C):
A.

A low volume pulse on clinical examination

B.

The presence of calcium on the chest X-ray

C.

An eosiniophilia

D.

Echocardiography

E.

Rapid atrial fibrillation an the electrocardiogram

Regarding patent ductus arteriosus in a full-term infant (D):

A.

Spontaneous closure may occur within one year of birth

B.

Males are more likely to be affected

C.

Right-to-left shunting occurs in 30 % of cases

D.

There is an association with maternal rubella infection

E.

The jugular venous pressure is elevated even if the duct is small

The murmur of mitral valve prolapse becomes louder during (C, D, E):
A.

Amyl nitrate inhalation

B.

The straining of the valsalva manoeuvre

C.

Standing from the supine position

D.

Acute anxiety

E.

An infusion of salbutamol

M-mode echocardiography reliably detects the presence of (B, C):

A.

Right coronary artery stenosis

B.

Mild mitral stenosis

C.

Hypertrophic cardiomyopathy

D.

Mild mitral reflux

E.

Libman-Sacks endocarditis

The left anterior descending coronary artery (B, C, D):

A.

Supplies the posterior left ventricular wall

B.

Occlusion results in anterior infarction

C.

Supplies the majority of inter-ventricular septum

D.

Supplies the left ventricular apex

E.

Runs in the posterior inter-ventricular groove

The first heart sound is loud in (B)

A.

First degree heart block

B.

Lown-Ganong-Levine syndrome

C.

Mitral stenosis with a heavily calcified valve

D.

Sinus bradycardia

E.

Hypertrophic obstructive cardiomyopathy

In patients with hyperlipoproteinaemia (A, B, D):

A.

The children of patients with familiar type 11a hyperlipoproteinaemia have a 50 % chance of inheriting the trait

B.

Chylomicrons consist primary of triglycerides

C.

Plasma cholesterol is reduces in the nephritic syndrome

D.

Long-term gemfibrosil therapy decreases the incidence of cardiac events

E.

Plasma cholesterol decreases with age

Recognized sequel of myocardial infarction include (B, C)

A.

Infective endocarditis

B.

Cerebral embolism

C.

Septal perforation

D.

Aortic aneurysm

E.

Horners syndrome

Reduction of risk factors in Coronary Artery Disease (CAD) include (F)

A.

Diet

B.

Weight loss

C.

Blood pressure control

D.

Cessation of tobacco use

E.

Lifestyle modulation

27.

28.

29.

30.

31.

32.

33.

34.

35.

Cardiomyopathy is a recognized feature of (A, C, D, E)

A.

Tuberculosis

B.

Pancreatitis

C.

Chagas disease

D.

Sarcoidosis

E.

Pregnancy

Anatomical indications for Coronary Artery Bypass Graft (A, B, D, E)

A.

Left main stenosis > 60 %

B.

Three-vessel disease with impaired LV function

C.

Three-vessel disease with impaired LV function but with inducible ischemia on physiological testing

D.

Positive physiological studies or significant coronary stenosis before major cardiac or noncardiac surgery

E.

Congenital coronary anomalies associated with sudden death

In a patient with suspected heart disease (G)

A.

Stabbing inframammary pain is likely to be cardiac in origin

B.

Effort dyspnoea is anequivocal evidence of cardiac failure

C.

Palpitation disappearing on exertion suggests an ischemic origin

D.

The absence of symptoms excludes serious disease

E.

Central cyanosis is indicative of a reduced cardiac output

In the neuropathy of the diabetic foot (B, C, D)

A.

The autonomic nervous system is usually spared

B.

The fine medullated nerve fibres are first affected

C.

Motor paralysis is commonly of the small muscles of the foot

D.

Ulceration commonly occurs over the lateral border of the foot

E.

The longitudinal arch of the foot is accentuated

The carotid siphon is (C)

A.

The intracavernous segment

B.

The supraclinoid segment

C.

The intracavernous and supraclinoid segments

D.

The intrapetrosal segment

E.

The intracavernous, supraclinoid and intrapetrosal segments

In a patient with tachycardia of 170 beats per minute likely results of carotid sinus massage are (C, D
A.

Return to sinus rhythm if the original rhythm was rapid atrial fibrillation

B.

Gradual slowing towards normal if the original rhythm was ventricular tachycardia

C.

Temporary slowing if the original rhythm was sinus tachycardia

D.

Return to sinus rhythm if the original rhythm was paroxysmal atrial tachycardia

E.

No effect if the original rhythm was atrial flutter

Recognized features of pheochromocytoma include (A, B, C, D, E)

A.

Anxiety

B.

Glucosuria

C.

Chest pain

D.

Raynauds phenomenon

E.

Headache

A very uncommon cause of intestinal ischemia (D)

A.

Acute embolic occlusion

B.

Acute thrombotic occlusion

C.

Nonocclusive mesenteric ischemia

D.

Mesenteric vein thrombosis

E.

Compression of mesenteric arteries

Lesions of renal artery by renovascular hypertension (F)

A.

Stenosis

B.

Aneurysm

C.

Arteriovenous fistula

D.

Kink

E.

Emboli

36.

37.

38.

39.

40.

41.

42.

43.

44.

In dissection of the aorta (A, D, E):

A.

Aortic incompetence is common

B.

The pain increases gradually over several hours

C.

It is essential to identify the re-entry site of the dissection by angiography

D.

CT scanning of thorax is helpful in the diagnosis

E.

Hemopericardium is common

Varicose veins (G)

A.

Are common throughout the world

B.

Are frequently congenital

C.

Are the commonest cause of venous ulceration

D.

Are associated with an increased risk of pulmonary embolism

E.

Have a reduced number of valves

Acute peritonitis (A)

A.

Complicating appendicitis is typically caused by Esch. coli

B.

Carries an overall mortality rate < 1%

C.

Due to tuberculosis is usually blood-borne of pulmonary origin

D.

Is invariably due to infection

E.

Causes increasing abdominal rigidity as paralytic ileus develops

Abdominal distension in mechanical intestinal obstruction is produces in part by (A, C, D)

A.

Swallowed air

B.

Carbon dioxide produced in the bowel

C.

Increased intestinal secretions proximal to the obstruction

D.

Decreased intestinal absorption proximal to the obstruction

E.

Peritoneal exudate

The treatment of chronic peptic ulceration (D, E)

A.

Sodium bicarbonate is the most efficacious of all antacids

B.

Aluminium containing antacids produce diarrhea

C.

Magnesium containing antacids produce constipation

D.

Bismuth compounds should not be used for maintenance therapy

E.

Oesophagitis heals less readily than duodenitis

Acute gastric dilatation (A, C, D)

A.

May follow spinal injures

B.

Rarely follows abdominal surgery

C.

May cause dehydration and hypovolaemia

D.

May cause haemorrhagic ulceration

E.

Requires urgent surgical treatment

Surgical treatment of gastric cancer (B, C)

A.

Should preferably be by a total gastrectomy

B.

Gives overall 5-year survival figures of 5 to 10 %

C.

Includes excision of the tumor as a palliative measure

D.

Should be advised for all diagnosed cases

E.

Is not more effective when it includes radical excision of the regional lymph nodes

Recognised complications of Crohns disease include (B, C, D)

A.

Pernicious anemia

B.

Erythema nodosum

C.

Enteropathic arthritis

D.

Aphthous mouth ulcers

E.

Small bowel lymphoma

In the treatment of severe acute ulcerative colitis (B, C, E)

A.

Antibiotic therapy is mandatory if the patient is febrile

B.

Codeine phosphate increases the risk of toxic dilatation

C.

Systemic corticosteroids induce a remission in the majority

D.

Hypoproteinaemia indicates the need for albumin infusion

E.

Failure of medical therapy indicates the need for surgery

45.

46.

47.

48.

49.

50.

Gastroduodenal haemorrhage (F)

A.

Is more often due to the chronic gastric ulcer than oesophageal varices

B.

Has a 10 % mortality when due to peptic ulceration

C.

Is a recognased complication of severe head injury

D.

Is best investigated by endoscopy within 24 hours of admission

E.

Is significantly associated with anti-inflammatory drug therapy

In primary biliary cirrhosis (C, D)

A.

Middle-aged males are affected predominantly

B.

Pruritis is invariably accompanied by jaundice

C.

Osteomalacia and osteoporosis are often present

D.

Lipid infiltration produces peripheral neuropathy

E.

Serum smooth muscle antibodies are present in high titres

An exomphalos (B, E)
A.

Is a congenital defect of the urethra

B.

Is a congenital defect of the anterior abdominal wall

C.

Results from a patient vitello-intestinal duct

D.

Is otherwise known as gastroschisis

E.

Needs urgent surgical treatment if the sac has ruptured

A patient with chronic liver failure frequently exhibits (A, B, C, E)

A.

Tremors

B.

Disorders of consciousness

C.

Palmar erythema

D.

A cold collapsed peripheral circulation

E.

Gynaecomastia

Carcinoma of the gallbladder (D, E)

A.

Is usually a squamous cell neoplasm

B.

Is more common in men

C.

Is most common in the middle age

D.

Is usually associated with gallstones

E.

Has a pure prognosis

Typical complications of hepatocellular carcinoma include (A, C)

A.

Polycythaemia

B.

Hyperglycaemia

C.

Porphyria cutanea tarda

D.

Hypocalcaemia

E.

Cushings syndrome

ANSWERS
1
A, B, D
11
A, B, C
21
B, C

2
G
12
A, C, D
22
B, C, D

3
B, C, D
13
A, C, E
23
B

4
A, C
14
C, D
24
A, B, D

5
A, B, D
15
A, B, C
25
B, C

6
A, E
16
B, C, D
26
A, B, C, D,

7
A, B, C, E
17
C, D, E
27
A, C, D, E

8
C, D
18
B, C
28
A, B, D, E

9
B, C
19
D
29
G

10
A, B, C, E
20
C, D, E
30
B, C, D

31
C

32
C, D

33
A, B, C, D,

34
D

35
A, B, C, D,

E
36
A, D, E

37
G

38
A

39
A, C, D

40
D, E

41
A, C, D

42
B, C

E
43
B, C, D

44
B, C, E

E
45
A, B, C, D,

46
C, D

47
B, E

48
A, B, C, E

49
D, E

50
A, C