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
ahmedhakim_227@yahoo.com 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 well-
localized 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)
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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:
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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)
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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. (False) (d) ACE inhibi
tors improve outcome after myocardial infarction for patients with ventricular d
ysfunction. (True) (e) HMGCo-A reductase inhibitor therapy is contraindicated fo
r patients after myocardial infarction. (False) Question 22. For self-poisoning:
(a) Gastric lavage is recommended for most drugs up to 12 hours after ingestion
. (False) (b) Naloxone is the specific antidote for benzodiazepine overdose. (Fa
lse) (c) Patients with tricyclic antidepressant overdose need cardiac monitoring
for up to 48 hours. (True) (d) All patients should be assessed by a qualified p
sychiatrist. (False) (e) Pinpoint pupils could indicate opiate overdose. (True)
Question 23. Digoxin: (a) Is the treatment of choice for ventricular extrasystol
es. (False) (b) May cause xanthopsia. (True) (c) Is excreted by the kidneys. (Tr
ue) (d) Adverse effects are reduced by hypokalaemia. (False) (e) Must not be coa
dministered with an ACE inhibitor. (False) Question 24. Dementia may result from
: (a) Parkinson's disease. (True) (b) Huntington's chorea. (True) (c) Hypothyroi
dism. (True) (d) Acquired immune deficiency syndrome (AIDS). (True) (e) A cerebr
al tumour. (True) Question 25. Oxygen: (a) Should be administered with a high in
spired concentration (>50%) in the treatment of type II respiratory failure. (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. (False) (c) Continuous long-term (domiciliary) oxygen improves survival in
patients with respiratory failure caused by chronic bronchitis and emphysema. (
True) (d) Is needed when respiratory failure is diagnosed by finding a pO2 of le
ss than 11 kPa in an arterial blood sample. (False) (e) Comprises 21% of atmosph
eric air. (True) Module 5 (Cardiology) Question 2. The differential diagnosis fo
r chest pain includes: (a) Myocardial infarction. (True) (b) Oesophagitis. (True
) (c) Pulmonary embolus. (True) (d) Cholecystitis. (True) (e) Aortic dissection.
(True) Question 3. The following are causes of acute life-threatening dyspnoea:
(a) Myocardial infarction. (True) (b) Pulmonary embolus. (True) (c) Pneumothora
x. (True) (d) Ventricular or supraventricular tachyarrhythmia. (True) (e) Bacter
ial endocarditis. (True) Question 4. The following are clinical signs found in i
nfective endocarditis: (a) Clubbing. (True) (b) Haematuria. (True) (c) Pyrexia.
(True) (d) Rashes. (True)
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MCQs VIA WEB 2005
(e) Focal neurological defect. (True) Question 5. The following are risk factors
for ischaemic heart disease: (a) Hypertension. (True) (b) Moderate alcohol inta
ke. (False) (c) Female sex. (False) (d) Hypercholesterolaemia. (True) (e) Increa
sing age. (True) Question 6. The following are classical features of cardiac syn
cope: (a) Gradual onset. (False) (b) Warning symptoms. (False) (c) Rapid recover
y. (True) (d) Residual neurological deficit. (False) (e) Precipitated by sudden
turning of the head. (False) Question 7. The following are causes of a pansystol
ic murmur: (a) Mitral regurgitation. (True) (b) Aortic regurgitation. (False) (c
) Tricuspid regurgitation. (True) (d) Atrial septal defect. (False) (e) Aortic s
tenosis. (False) Question 8. The following conditions require antibiotic prophyl
axis before dental procedures: (a) Prosthetic aortic valve. (True) (b) Ventricul
ar septal defect. (True) (c) Floppy mitral valve with coexistent mitral regurgit
ation. (True) (d) Enlarged left ventricle. (False) (e) A history of infective en
docarditis in the past. (True) Question 9. The following should be considered as
possible signs of a positive exercise test: (a) ST segment depression. (True) (
b) Exercise-induced hypotension. (True) (c) Exercise-induced ventricular tachyca
rdia. (True) (d) Lack of adequate tachycardic response to exercise. (True) (e) L
eg pain at peak exercise. (False)
Question 10. The following are indications for anticoagulating a patient who has
atrial fibrillation with warfarin: (a) Age under 60 years. (False) (b) Associat
ed mitral stenosis. (True) (c) Atrial fibrillation of more than 24 hours' durati
on. (True) (d) A history of cerebral thromboembolism. (True) (e) Associated left
ventricular failure. (True) Question 11. The following are true of ventricular
tachycardia: (a) It is a life-threatening condition. (True) (b) It may be caused
by myocardial ischaemia. (True) (c) It may be caused by hypokalaemia. (True) (d
) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardi
a. (True) (e) Acute ongoing ventricular tachycardia should be treated initially
with drugs. (False) Question 12. The following are signs of coarctation of the a
orta: (a) Radiofemoral delay in the pulses. (True) (b) Rib notching. (True) (c)
Bruits heard over the scapula. (True) (d) Ankle oedema. (False)
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MCQs VIA WEB 2005
(e) Atrial fibrillation. (False) Question 13. Functions of the recovery position
include: (a) To prevent the tongue from obstructing the airway. (True) (b) To p
revent neck injury. (False) (c) To minimize the risk of aspiration of gastric co
ntents. (True) (d) To maintain a straight airway. (True) (e) To enable cardiopul
monary resuscitation to be carried out. (False)
Question 14. Complications of prosthetic heart valves are as follows: (a) Thromb
oembolic events. (True) (b) Dehiscence of the valve ring. (True) (c) Increased r
isk of infective endocarditis. (True) (d) Failure of the valve 5 years after pla
cement. (False) (e) Need for anticoagulation in patients who have porcine valves
. (False) Question 15. The following statements are true of thiazide diuretics:
(a) They act at the level of the distal convoluted tubule. (True) (b) They may c
ause gout. (True) (c) Diabetic control may deteriorate. (True) (d) Hypokalaemia
may occur. (True) (e) They cause ototoxicity. (False) Question 16. The following
are classified as high-output states: (a) Hypertension . (False) (b) Sepsis. (T
rue) (c) Hypothyroidism. (False) (d) Pregnancy. (True) (e) Arteriovenous malform
ations. (True) Question 18. 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) It is displaced downwards and laterally if the left ventricle i
s enlarged. (True) (c) It is thrusting in mitral stenosis. (False) (d) It is thr
usting in aortic regurgitation. (True) (e) It is heaving in aortic stenosis. (Tr
ue) Question 17. Cardiac causes of clubbing are as follows: (a) Uncomplicated at
rial septal defect. (False) (b) Chronic infective endocarditis. (True) (c) Atria
l fibrillation. (False) (d) Acute endocarditis. (False) (e) Empyema. (False) Que
stion 19. The following leads represent the inferior myocardium: (a) I, AVL, and
V6. (False) (b) V2, V3, and V4. (False) (c) AVR and V1. (False) (d) V1-V6. (Fal
se) (e) II, III, and AVF. (True) Question 20. The following are possible causes
of electromechanical dissociation: (a) Pulmonary embolus. (True) (b) Tension pne
umothorax. (True) (c) Hypertension. (False) (d) Dehydration. (True)
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MCQs VIA WEB 2005
(e) Hypocalcaemia. (True) Question 21. The following are characteristic of peric
arditis: (a) The chest pain is dull in nature. (False) (b) There may be an assoc
iated pericardial effusion. (True) (c) The pericardial rub may come and go. (Tru
e) (d) The ECG usually shows regional ST elevation. (False) (e) The ST elevation
is concave. (True)
Question 22. Secondary hypertension may be due to the following: (a) Renal arter
y stenosis. (True) (b) Renal cell carcinoma. (False) (c) Cushing's syndrome. (Tr
ue) (d) Pregnancy. (True) (e) Oral contraceptive pill. (True) Question 23. ECG c
hanges due to myocardial infarction may include the following: (a) ST elevation.
(True) (b) Sinus tachycardia. (True) (c) Ventricular tachycardia. (True) (d) Co
mplete heart block. (True) (e) Q waves. (True) Question 24. The following drugs
are used in the treatment of hypertension: (a) Atenolol. (True) (b) Doxazocin. (
True) (c) Enalapril. (True) (d) Bendrofluazide. (True) (e) Nicorandil. (False) Q
uestion 25. Complications of myocardial infarction include: (a) Cardiac failure.
(True) (b) Mitral regurgitation. (True) (c) Cerebrovascular event. (True) (d) M
yocardial rupture. (True) (e) Gastrointestinal bleed. (False) Module 6 (Neurolog
y) Question 1. Concerning neuroanatomy: (a) The corticospinal tract decussates i
n the pons. (False) (b) The oculomotor nerve runs in close proximity to the post
erior communicating artery. (True) (c) The superior colliculus is found in the m
idbrain. (True) (d) The trochlear (fouth cranial) nerve supplies the lateral rec
tus muscle. (False) (e) The spinal cord ends at the level of the lower border of
L3 in the adult. (False) Question 2. Subdural haematomas can cause: (a) Dementi
a. (True) (b) Pupillary change. (True) (c) Bradycardia. (True) (d) Changing leve
l of consciousness. (True) (e) Blood-stained cerebrospinal fluid (CSF). (False)
Question 3. In a young woman with a spastic paraparesis, the following suggest a
diagnosis of multiple sclerosis: (a) Delayed visual evoked potentials. (True) (
b) Fasciculations. (False)
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MCQs VIA WEB 2005
(c) Raised CSF protein. (False) (d) Oligoclonal bands in the CSF. (True) (e) Per
iventricular white matter lesions on magnetic resonance imaging (MRI) of the bra
in. (True) Question 4. Unilateral facial weakness is a recognized feature of: (a
) Herpes zoster infection. (True) (b) Motor neuron disease. (False) (c) Acoustic
neuroma. (True) (d) Cholesteatoma. (True) (e) Syringomyelia. (False) Question 5
. The following are true about headaches: (a) The headache of raised intracrania
l pressure is worst at the end of the day. (False) (b) A normal CT scan rules ou
t subarachnoid haemorrhage. (False) (c) Amaurosis fugax may be caused by tempora
l arteritis. (True) (d) Neurological signs on examination rules out migraine as
a diagnosis. (False) (e) Cluster headaches are more common in men than in women.
(True) Question 6. The following drugs can produce parkinsonism: (a) Chlorproma
zine. (True) (b) Benzhexol. (False) (c) Bromocriptine. (False) (d) Metoclopramid
e. (True) (e) Haloperidol. (True) Question 7. Concerning movement disorders: (a)
Huntington's chorea presents with progressive dementia and chorea in middle age
. (True) (b) Myoclonus is a feature of subacute sclerosing panencephalitis. (Tru
e) (c) Infarction of the subthalamic nucleus causes ipsilateral hemiballism. (Fa
lse) (d) Chorea is commonly found in Cruetzfeldt-Jakob disease. (False) (e) Alco
hol reduces benign essential tremor. (True) Question 8. Concerning papilloedema:
(a) There is loss of venous pulsation on funduscopy. (True) (b) There may be en
largement of the blind spot. (True) (c) Intracranial pressure may be normal. (Tr
ue) (d) Hypocalcaemia is a recognized cause. (True) (e) It is a recognized featu
re in Guillain-Barré syndrome. (True) Question 9. Ptosis may be a feature of: (a)
Myotonic dystrophy. (True) (b) Horner's syndrome. (True) (c) Abducens nerve (six
th nerve ) palsy. (False) (d) Oculomotor nerve (third nerve) palsy. (True) (e) M
yasthenia gravis. (True) Question 10. Concerning the Brown-Séquard syndrome: (a) T
here is ipsilateral corticospinal loss below the lesion. (True) (b) There is ips
ilateral loss of joint-position sense below the lesion. (True) (c) There is ipsi
lateral loss of two-point discrimination below the level of the lesion. (True) (
d) There is ipsilateral loss of pain and temperature below the level of the lesi
on. (False) (e) A central disc lesion at L3 would cause a Brown-Séquard syndrome i
n the legs. (False) Question 11. Concerning the brachial plexus: (a) In brachial
neuritis, severe pain around the shoulder precedes rapid wasting. (True) (b) Kl
umpke's paralysis causes proximal arm weakness. (False) (c) Erb's palsy is cause
d by a lesion to C5/C6-derived regions of the brachial plexus. (True)
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MCQs VIA WEB 2005
(d) A brachial plexus lesion and an ipsilateral Horner's syndrome may indicate a
Pancoast tumour. (True) (e) Vaccination may precipitate brachial neuritis. (Tru
e) Question 12. Causes of a polyneuropathy include: (a) Diabetes. (True) (b) Gui
llain-Barré syndrome. (True) (c) Renal failure. (True) (d) Amyloid. (True) (e) Mul
tiple sclerosis. (False) Question 13. A lesion to the common peroneal nerve at t
he fibular head causes: (a) Weakness of eversion of the foot. (True) (b) Decreas
ed sensation over the dorsum of the foot. (True) (c) Weakness of plantar flexion
. (False) (d) If long term, wasting of tibialis anterior. (True) (e) Brisk ankle
jerk. (False) Question 14. Brainstem death may be confirmed by: (a) Extensor re
sponse of the limbs to painful stimuli. (False) (b) Absent corneal reflexes. (Tr
ue) (c) Absent tendon reflexes. (False) (d) A flat EEG. (False) (e) Absent 'doll
's eye' reflexes. (True) Question 15. A homonymous hemianopia may arise from a l
esion of: (a) The optic tract. (True) (b) The occipital cortex. (True) (c) The o
ptic chiasm. (False) (d) The optic nerve. (False) (e) The optic radiation. (True
) Question 16. Dysarthria may result from a lesion of: (a) The cerebellum. (True
) (b) Broca's area. (False) (c) The hypoglossal nerve. (True) (d) The basal gang
lia. (True) (e) The accessory nerve. (False) Question 17. The following are clin
ical features of cerebellar dysfunction (a) Postural tremor. (False) (b) Hypoton
ia. (True) (c) Dysphasia. (False) (d) Titubation. (True) (e) Impaired rapid alte
ring movements. (True) Question 18. The following clinical features may help dif
ferentiate between a syncopal attack and a seizure: (a) Upright posture at the o
nset. (True) (b) Convulsive movements of the limbs. (False) (c) A bitten tongue.
(True) (d) Urinary incontinence. (True) (e) Prolonged malaise after the attack.
(False) Question 19. The following are features of a subarachnoid haemorrhage:
(a) Fever. (True) (b) Thunderclap headache. (True) (c) Photophobia. (True) (d) P
ositive Kernig's sign. (True)
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MCQs VIA WEB 2005
(e) Neck stiffness. (True) Question 20. A physiological tremor is: (a) Present a
t rest. (False) (b) Worsened by anxiety. (True) (c) Improved by alcohol. (False)
(d) Improved by beta-blockers. (True) (e) Familial. (False) Question 21. A lesi
on of the medulla on one side may give rise to : (a) An ipsilateral hemiparesis.
(False) (b) A contralateral hemiparesis. (True) (c) Ipsilateral weakness of the
palate. (False) (d) Contralateral weakness of the tongue. (True) (e) Contralate
ral third nerve palsy. (False) Question 22. The following may be seen in a patie
nt with a lesion of the third nerve or nucleus: (a) A fixed dilated pupil. (True
) (b) Ptosis. (True) (c) Diplopia in all positions of gaze. (True) (d) A history
of diabetes mellitus. (True) (e) A contralateral hemiplegia. (True) Question 23
. In a patient with a sensory ataxia: (a) Vibration may be impaired. (True) (b)
The gait is characterized by 'scissoring' posture of the legs. (False) (c) Rombe
rg's test may be positive. (True) (d) A history of alcohol abuse may be implicat
ed in the aetiology. (True) (e) Clonus may be elicited on examination of the leg
s. (False) Question 24. A patient with herpes zoster infection of the geniculate
ganglion may present with: (a) An upper motor neuron facial weakness. (False) (
b) Diplopia. (False) (c) Hyperacusis. (True) (d) Altered perception of taste. (T
rue) (e) Pain from the auditory meatus. (True) Question 25. A dissociated sensor
y loss may be seen in: (a) Syringomyelia. (True) (b) Anterior spinal artery occl
usion. (False) (c) A radiculopathy. (False) (d) Occlusion of a middle cerebral a
rtery. (False) (e) Compression of the spinal cord by a prolapsed intervertebral
disc. (False) Module 7 (Gastroeneterology) Question 1. The following statements
are true: (a) Tylosis is associated with achalasia. (False) (b) On barium swallo
w, a 'bird's beak' appearance is suggestive of squamous carcinoma. (False) (c) P
neumatic dilatation is the treatment of choice for achalasia. (True) (d) Reduced
lower oesophageal sphincter pressure is a common feature of gastro-oesophageal
reflux disease . (True) (e) Oesophageal pH is usually less than 4. (False) Quest
ion 2. The following is true of Barrett's oesophagus: (a) Columnar epithelium is
replaced by squamous epithelium. (False) (b) It appears in an antegrade (top to
bottom) direction. (False) (c) It is a premalignant condition. (True) (d) Sever
e dysplasia is an ominous sign. (True)
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MCQs VIA WEB 2005
(e) It is an indication for surveillance endoscopy. (True)
Question 3. Helicobacter pylori: (a) Causes ulceration in the duodenum. (True) (
b) Causes Barrett's metaplasia in the oesophagus. (False) (c) Is associated with
hypergastrinaemia. (True) (d) Is often resistant to certain antibiotics. (True)
(e) Can convert urea to ammonia and carbon dioxide. (True) Question 4. Gastric
hypomotility (gastroparesis): (a) Is commonly associated with diabetes mellitus.
(True) (b) Is a risk factor for gastro-oesophageal reflux disease. (True) (c) I
s a feature of generalized scleroderma (systemic sclerosis). (True) (d) Occasion
ally responds to erythromycin. (True) (e) Is often secondary to duodenal ulcer d
isease. (False) Question 5. The following are features of coeliac disease: (a) H
ypocalcaemia. (True) (b) Hypercalcaemia. (False) (c) Normocytic anaemia. (False)
(d) Hypoalbuminaemia. (True) (e) Positive antiparietal cell antibodies. (False)
Question 6. The following is true of Crohn's disease: (a) The rectum is always
affected. (False) (b) Commonly affects the terminal ileum. (True) (c) More commo
nly occurs in smokers. (True) (d) Can result in vitamin B12 deficiency with a ne
gative Schilling test. (True) (e) Commonly presents with bloody diarrhoea. (Fals
e) Question 7. The following is true of giardiasis: (a) Diarrhoea abates with av
oidance of dairy produce. (False) (b) Diarrhoea abates with avoidance of gluten.
(False) (c) Diarrhoea requires treatment with metronidazole. (True) (d) Diarrho
ea is usually accompanied by vomiting. (False) (e) Diarrhoea commonly results in
vitamin B12 deficiency. (False) Question 8. The following is true of inflammato
ry bowel disease: (a) Increased liver enzymes in the serum usually indicate the
complication of carcinoma. (False) (b) Small bowel barium enema is the best radi
ological investigation for ulcerative colitis. (False) (c) It is occasionally co
mplicated by carcinoma of the caecum. (True) (d) It is commonly associated with
thyroiditis. (False) (e) It is sometimes complicated by iritis. (True) Question
9. The following is true of viral hepatitis: (a) Hepatitis C commonly presents w
ith jaundice. (False) (b) Hepatitis E is fatal particularly in pregnant women. (
True) (c) Hepatitis BeAg is a marker of viral replication. (True) (d) Hepatitis
A is a risk factor for hepatoma. (False) (e) Hepatitis D occurs only in associat
ion with hepatitis C. (False) Question 10. The following drugs cause jaundice: (
a) Methotrexate. (False) (b) Flucloxacillin. (True) (c) Metronidazole. (False) (
d) Isoniazid. (True)
By A. H.
MCQs VIA WEB 2005
(e) Phenobarbitone. (False)
Question 11. Haemochromatosis: (a) Is a genetic defect resulting in copper overl
oad in the liver. (False) (b) Is a risk factor for the development of hepatoma.
(True) (c) Has an equal sex incidence but presents earlier in males than females
. (True) (d) Is treated by avoiding meat products. (False) (e) Can cause hypogon
adism in the absence of cirrhosis. (True) Question 12. Colonic carcinoma: (a) Mo
st commonly occurs in the right side of the colon. (False) (b) May present with
iron deficiency anaemia in the absence of any gastrointestinal symptoms. (True)
(c) Commonly arises in colonic polyps. (True) (d) Carries a 5-year survival of l
ess than 10%. (False) (e) Is the cause of carcinoid syndrome. (False) Question 1
3. The following is true of colon polyps and colon cancer: (a) The larger the po
lyp, the greater the risk of carcinoma. (True) (b) Malignant polyps can be succe
ssfully treated by colonoscopy and polypectomy alone. (True) (c) Hyperplastic po
lyps have a higher malignant potential than villous polyps. (False) (d) Polyps a
re most common in the ascending colon. (False) (e) Colonic polyps are often recu
rrent. (True) Question 14. The following gastrointestinal diseases are associate
d with the renal conditions listed: (a) Crohn's disease and renal amyloidosis. (
True) (b) Hepatitis B and glomerulonephritis. (True) (c) Gastric ulcer and nephr
otic syndrome. (False) (d) Pancreatic neuroendocrine tumours and polycystic kidn
ey disease. (False) (e) Liver cysts and glomerulosclerosis. (False) Question 15.
The following is true of villous atrophy in the small intestine: (a) If due to
coeliac disease, it should recover completely on a gluten-free diet. (True) (b)
It can be caused by tuberculosis. (True) (c) It can be associated with Giardi la
mblia. (True) (d) It can be associated with Tropheryma whippelei. (True) (e) Whe
n associated with bacteria, it may cause a rise in serum folate. (True Question
16. The following skin conditions are associated with the named GI diseases: (a)
Dermatitis herpetiformis with coeliac disease. (True) (b) Pruritus with primary
biliary cirrhosis. (True) (c) Pyoderma gangrenosum with gastric carcinoma. (Fal
se) (d) Bullous pemphigoid with pancreatitis. (False) (e) Erythema nodosum with
Crohn's disease. (True) Question 17. 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. (False) (b) Vomiting in association with headache
is a feature of migraine. (True) (c) Vomiting associated with weight loss can b
e indicative of malignant disease. (True) (d) Vomiting usually precedes the pain
of biliary colic. (False) (e) Vomiting can be a feature of myocardial infarctio
n. (True) Question 18. Scleroderma can produce the gastrointestinal complication
s listed: (a) Diarrhoea due to bacterial overgrowth. (True) (b) Constipation due
to gut hypomotility. (False) (c) Diarrhoea which is unresponsive to a gluten-fr
ee diet. (True) (d) Gastric ulcer due to chronic gastritis. (False)
By A. H.
MCQs VIA WEB 2005
(e) Dysphagia due to abnormal peristalsis in the oesophagus. (True)
Question 19. Chronic pancreatitis: (a) Is a cause of diabetes mellitus. (True) (
b) Can result from alcohol ingestion in moderate amounts. (True) (c) May be here
ditary in a minority of cases. (True) (d) Can be diagnosed by a raised serum amy
lase. (False) (e) Is a cause of pancreas divisum. (False) Question 20. The follo
wing is true of rectal bleeding: (a) In the absence of haemorrhoids, it is usual
ly due to malignant disease. (False) (b) It occurs more commonly in Crohn's dise
ase than in ulcerative colitis. (False) (c) If it occurs in a patient with ulcer
ative colitis, it usually indicates that carcinoma has developed. (False) (d) Wh
en it is due to diverticular disease, colectomy may be indicated to control it.
(True) (e) It may be caused by ingestion of aspirin. (True) Question 21. The fol
lowing are risk factors for gastric carcinoma: (a) Pernicious anaemia. (True) (b
) Coeliac disease. (False) (c) Partial gastrectomy. (True) (d) Helicobacter pylo
ri infection. (True) (e) Ménétrière's disease. (True) Question 22. The following state
ments are true: (a) Solitary rectal ulcers are commonly associated with Crohn's
disease. (False) (b) Crypt abscesses are typical of coeliac disease. (False) (c)
Fistula formation can be a feature of Whipple's disease. (False) (d) Anal fissu
re predisposes to faecal incontinence. (False) (e) Right iliac fossa pain is com
mon with diverticular disease. (False) Question 23. The following are true of he
patitis: (a) Hepatitis B is spread via the faecal-oral route. (False) (b) A vacc
ine is available for hepatitis C. (False) (c) Incubation time for hepatitis A is
approximately 2-3 weeks. (True) (d) Hepatitis B is an RNA virus. (False) (e) In
terferon treatment is required for hepatitis E infection. (False) Question 24. T
he following is a risk factor for the Budd-Chiari syndrome: (a) Oral contracepti
ve pill. (True) (b) Malignancy. (True) (c) Ascites. (False) (d) Polycythaemia ru
bra vera. (True) (e) Constrictive pericarditis. (False) Question 25. The followi
ng are true regarding prognostic factors for acute pancreatitis: (a) A low pAO2
indicates a poor prognosis. (True) (b) A high serum GGT has a poor prognosis. (F
alse) (c) Age of over 55 years usually has a good prognosis. (False) (d) A low s
erum albumin indicates a poor prognosis. (True) (e) Abnormal clotting time has a
poor prognosis. (True) Module 9 (Gastroenterology) Question 1. The following is
true of oesophageal pain: (a) It can occur in the absence of heartburn. (True)
(b) It can mimic the pain of a myocardial infarction. (True) (c) It can be relie
ved by glyceryl trinitrate. (True)
By A. H.
MCQs VIA WEB 2005
(d) It is usually precipitated by exercise. (False) (e) It can be caused by cand
idiasis. (True) Question 2. The following is true of postgastrectomy syndromes:
(a) The anaemia can be corrected with ascorbic acid supplements. (True) (b) The
risk of gastric cancer in the long term is increased. (True) (c) Sweating and pa
lpitations can be due to hypoglycaemia. (True) (d) Biliary gastritis in the gast
ric remnant is common. (True) (e) Diarrhoea is commonly due to bacterial overgro
wth. (True) Question 3. 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. (True) (b) Ménétrière's disease is due to metaplasia of
the gastric mucosa. (True) (c) Leiomyoma has a characteristic appearance at endo
scopy. (True) (d) Gastric carcinoma produces abdominal pain that is often worse
after eating. (True) (e) The most common gastric carcinoma is of squamous cell o
rigin. (False) Question 4. The following statements are true: (a) Iron absorptio
n is reduced in hypochlorhydric states. (True) (b) Vitamin D absorption is often
deficient in the presence of gastritis. (False) (c) Vitamin B12 supplements are
often necessary following gastrectomy. (True) (d) Anaemia associated with chron
ic atrophic gastritis may respond to ascorbic acid supplements. (True) (e) Intes
tinal metaplasia in the stomach is a risk factor for gastric carcinoma. (True) Q
uestion 5. The following clinical features are associated with coeliac disease:
(a) Anaemia. (True) (b) Weight loss. (True) (c) Vomiting. (False) (d) Diarrhoea.
(True) (e) Jaundice. (False) Question 6. The following is true of Crohn's disea
se: (a) C-reactive protein mimics inflammatory activity. (True) (b) Normal album
in indicates remission. (False) (c) Large bowel barium enema is the most definit
ive radiological test. (False) (d) A small bowel biopsy can be helpful in making
the diagnosis. (True) (e) A low blood urea is common. (True) Question 7. The fo
llowing is true of ulcerative colitis: (a) It commonly presents with pain in the
right iliac fossa. (False) (b) It can be associated with ankylosing spondylitis
. (True) (c) It is a risk factor for toxic dilatation of the colon. (True) (d) T
he occurrence of abdominal tenderness is an ominous sign. (True) (e) It often ca
uses ischiorectal abscesses. (False) Question 8. Acholuric jaundice without pain
: (a) Is a common presentation of pancreatic carcinoma. (False) (b) Is a feature
of Gilbert's disease. (True) (c) Can occur in hereditary spherocytosis. (True)
(d) Is associated with pale-coloured stools. (False) (e) Is associated with prur
itus. (False) Question 9. The following is true of risk factors for the developm
ent of hepatocellular carcinoma: (a) Females are at greater risk than males. (Fa
lse) (b) Excess iron is a recognized risk factor. (True) (c) Aflatoxin is a risk
factor. (True) (d) Hepatitis A is a risk factor. (False)
By A. H.
MCQs VIA WEB 2005
(e) Risk factors generally only operate in the presence of cirrhosis. (True)
Question 10. Alcoholic hepatitis: (a) Recovers rapidly on cessation of drinking.
(False) (b) Is a risk factor for hepatorenal syndrome. (True) (c) Ascites is a
feature. (True) (d) Coagulopathy is corrected with administration of vitamin K.
(False) (e) Encephalopathy occurs only if infection is present. (False) Question
11. Primary sclerosing cholangitis: (a) Occurs predominantly in middle-aged fem
ales. (False) (b) Is a major risk factor for cholangiocarcinoma. (True) (c) Occu
rs in 50% patients with ulcerative colitis. (False) (d) Has been treated with ur
sodeoxycholic acid. (True) (e) May require insertion of an endoprosthesis for it
s treatment. (True) Question 12. The following GI conditions are associated with
microcytic hypochromic anaemia: (a) Acute duodenal ulceration. (False) (b) Anky
lostoma duodenale. (True) (c) Terminal ileitis due to Crohn's disease. (True) (d
) Partial gastrectomy. (True) (e) Carcinoma of caecum. (True) Question 13. These
gastronomic terms are associated with the following gastroenterological conditi
ons: (a) 'Rice water' diarrhoea with cholera. (True) (b) 'Anchovy sauce' dischar
ge with amoebic dysentry. (False) (c) 'Redcurrent jelly' and intussusception. (T
rue) (d) 'Apple core' lesion and diverticulitis. (False) (e) 'Coffee grounds' an
d oesophageal varices. (False) Question 14. 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. (True) (b) The 14C glycocholic acid
breath test is used to detect bacterial overgrowth in the colon. (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) A 14C bile salt test can be used to
identify bile duct obstruction. (False) Question 15. The following autoantibodi
es are associated with the diseases listed: (a) Antiendomyseal antibodies are as
sociated with coeliac disease. (True) (b) Anti-LKM antibodies are associated wit
h Goodpasture syndrome. (False) (c) Antimitochondrial antibodies are associated
with primary biliary cirrhosis. (True) (d) Antiparietal cell antibodies are asso
ciated with Wilson's disease. (False) (e) Antismooth muscle antibodies are assoc
iated with autoimmune chronic active hepatitis. (True) Question 16. The followin
g statements are true of colitis: (a) Granulomas are present in collagenous coli
tis. (False) (b) Rectal sparing is characteristic of Crohn's colitis. (True) (c)
Caseating granulomas in the terminal ileum are diagnostic of Crohn's disease. (
False) (d) Colitis in a smoker is more likely to be Crohn's than ulcerative coli
tis. (True) (e) Pain is a characteristic feature of CMV colitis. (True) Question
17. The following statements are true of ascites: (a) A high protein content in
ascites is usual in alcoholic liver disease. (False) (b) Ascites resistant to d
iuretics is characteristic of hepatic vein thrombosis. (True) (c) Ascites is som
etimes associated with a pleural effusion. (True)
By A. H.
MCQs VIA WEB 2005
(d) Ascites is a risk factor for bacterial peritonitis. (True) (e) Ascites due t
o constrictive pericarditis prevents pulsus paradoxus. (False) Question 18. The
following statements are true of non-steroidal anti-inflammatory drugs: (a) They
can be given as suppositories to avoid gastrointestinal complications. (False)
(b) They may have a role in the prevention of colon cancer. (True) (c) They can
produce gastric erosions in elderly people causing occult blood loss. (True) (d)
They cause gastric erosions by stimulating gastric acid secretion. (False) (e)
They may exacerbate long-standing ulcerative colitis. (True) Question 19. 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. (False) (c) They are general
ly unresponsive to chemotherapy. (True) (d) They characteristically produce back
pain when local invasion is present. (True) (e) They occur with increased frequ
ency in patients with ulcerative colitis. (False) Question 20. The following is
true of haematemesis: (a) When it occurs in a patient with alcoholic liver disea
se, it is always due to oesophageal varices. (False) (b) A visible vessel seen a
t gastroscopy is a risk factor for further bleeding. (True) (c) When it occurs i
n patients over 70 years of age who may have arthritis, usually indicates malign
ancy. (False) (d) When it occurs after repeated retching, it is suggestive of an
oesophageal tear. (True) (e) When it is caused by duodenal ulcer, a partial gas
trectomy is usually necessary. (False) Question 21. The following drugs can be u
sed for treatment of GORD: (a) Metronidazole. (False) (b) Amoxycillin. (False) (
c) Erythromycin. (False) (d) Metoclopramide. (True) (e) Omeprazole. (True) Quest
ion 22. Which of the following is dependent on bile salts for its absorption: (a
) Vitamin A. (True) (b) Vitamin B. (False) (c) Vitamin C. (False) (d) Vitamin D.
(True) (e) Vitamin K. (True) Question 23. The following are indications for liv
er biopsy: (a) Unexplained abnormal liver enzymes. (True) (b) Pyrexia of unknown
origin with normal liver enzymes. (True) (c) Cirrhosis suspected on an ultrasou
nd scan. (True) (d) Raised alkaline phosphatase in teenagers with acholuric jaun
dice. (False) (e) Abnormal liver enzymes in a patient with epilepsy on phenytoin
. (False) Question 24. The following precipitate portasystemic encephalopathy: (
a) Infection. (True) (b) Diarrhoea. (False) (c) Gastrointestinal bleeding. (True
) (d) Use of opioid drugs. (True) (e) Certain antibiotics. (False) Question 25.
The following drugs cause cholestatic jaundice: (a) Rifampicin. (False) (b) Ison
iazid. (False) (c) Erythromycin. (True) (d) Halothane. (False)
By A. H.
MCQs VIA WEB 2005
(e) Paracetamol. (False)
Module 10 (Neurology) Question 1. The following cranial nerves carry parasympath
etic fibres: (a) Oculomotor. (True) (b) Trigeminal. (False) (c) Facial. (True) (
d) Hypoglossal. (False) (e) Vagus. (True) Question 2. Myasthenia gravis: (a) Is
caused by antibodies to the acetylcholine receptor in the majority of cases. (Tr
ue) (b) Causes muscle wasting. (False) (c) May show diurnal variation in symptom
s. (True) (d) Is associated with an improvement in strength after exertion. (Fal
se) (e) May present with ophthalmoplegia. (True) Question 3. The causes of a mix
ed upper and lower motor neuron picture include: (a) Guillain-Barré syndrome. (Fal
se) (b) Multiple sclerosis. (False) (c) Syringomyelia. (True) (d) Motor neuron d
isease. (True) (e) Taboparesis. (True) Question 4. Bilateral lower motor neuron
facial weakness may occur in: (a) Sarcoidosis. (True) (b) Guillain-Barré syndrome.
(True) (c) Lyme disease. (True) (d) Lymphoma. (True) (e) Parasagittal meningiom
a. (False) Question 5. In idiopathic Parkinson's disease: (a) There is degenerat
ion primarily of the cells of the globus pallidus. (False) (b) The classical fea
tures include tremor, bradykinesia, and spasticity. (False) (c) There is an asso
ciated vertical gaze palsy. (False) (d) Anticholinergic drugs are most effective
in relieving tremor. (True) (e) Treatment is aimed at reducing dopamine levels.
(False) Question 6. The following features suggest that increased tone is due t
o rigidity: (a) Tone is increased equally in flexors and extensors. (True) (b) E
xtensor plantar responses. (False) (c) Associated pill-rolling tremor. (True) (d
) Clasp-knife reflex. (False) (e) Tone increases with synkinesis. (True) Questio
n 7. Causes of a small pupil include: (a) Horner's syndrome. (True) (b) Holmes-A
die syndrome. (False) (c) Tabes dorsalis. (True) (d) Optic neuritis. (False) (e)
Pilocarpine eye-drops. (True) Question 8. Concerning optic neuritis: (a) Visual
loss is usually painless. (False) (b) White-matter abnormalities on MR imaging
increase the likelihood of developing multiple sclerosis in the future. (True)
By A. H.
MCQs VIA WEB 2005
(c) After recovery, some impairment of red-green colour vision may remain. (True
) (d) Over 90% of patients with a history of optic neuritis go on to develop mul
tiple sclerosis. (False) (e) It causes a delay in visual evoked potentials. (Tru
e) Question 9. The following may cause a third nerve palsy: (a) Aneurysm of the
posterior communicating artery. (True) (b) Diabetes. (True) (c) Motor neuron dis
ease. (False) (d) Herniation of the uncus of the temporal lobe. (True) (e) Panco
ast tumour. (False) Question 10. The following typically occur within the first
24 hours of complete cervical cord transection: (a) Upgoing plantar responses. (
False) (b) Fall in blood pressure. (True) (c) Loss of bladder control. (True) (d
) Brisk reflexes. (False) (e) Gastric dilatation. (True) Question 11. In motor n
euron disease: (a) Fasciculations are required to make the diagnosis. (False) (b
) There may be atrophy of the Betz cells in the motor cortex. (True) (c) Electro
myography shows chronic partial denervation. (True) (d) There should be no signs
of sensory loss. (True) (e) Familial cases account for 50%. (False) Question 12
. Causes of a mononeuropathy include: (a) Diabetes. (True) (b) Hereditary motor
sensory neuropathy. (False) (c) Polyarteritis nodosa. (True) (d) Guillain-Barré sy
ndrome. (False) (e) Lead poisoning. (True) Question 13. Charcot joints: (a) May
affect the feet in diabetes. (True) (b) Are often painful. (False) (c) May be ca
used by neurosyphilis. (True) (d) May affect the shoulders in syringomyelia. (Tr
ue) (e) Are usually hot and swollen. (False) Question 14. Hyposmia may arise sec
ondary to: (a) A head injury. (True) (b) Migraine. (False) (c) Seizures. (False)
(d) Antibiotic therapy. (True) (e) A frontal meningioma. (True) Question 15. Th
e following are causes of acute transient visual impairment: (a) Retinitis pigme
ntosa. (False) (b) Amaurosis fugax. (True) (c) Papilloedema. (True) (d) Migraino
us aura. (True) (e) Glaucoma. (False) Question 16. The following may be features
of frontal lobe dysfunction: (a) Depression. (True) (b) Social disinhibition. (
True) (c) Apraxia of gait. (True)
By A. H.
MCQs VIA WEB 2005
(d) A receptive dysphasia. (False) (e) A grasp reflex. (True) Question 17. The f
ollowing may give rise to a pseudobulbar palsy (a) Poliomyelitis. (False) (b) Sy
ringobulbia. (False) (c) Huntington's chorea. (False) (d) Occlusion of the anter
ior cerebral artery. (False) (e) Multiple sclerosis. (True) Question 18. Facial
sensory loss may occur with a lesion of: (a) The cerebellopontine angle. (True)
(b) The facial nerve. (False) (c) The Gausserian ganglion. (True) (d) The Genicu
late ganglion. (False) (e) The cavernous sinus. (True) Question 19. Sensorineura
l deafness may occur secondary to: (a) Loud noise. (True) (b) Gentamicin therapy
. (True) (c) Ménière's disease. (True) (d) An acoustic neuroma. (True) (e) Otosclero
sis. (False) Question 20. Choreic movements are: (a) Slow and writhing. (False)
(b) Shock-like assymetrical and irregular. (False) (c) Brief, jerky and irregula
r. (True) (d) A sign of restlessness. (False) (e) Rhythmical and oscillatory. (F
alse) Question 21. Features of an upper motor neuron lesion are: (a) Brisk abdom
inal and cremasteric reflexes. (False) (b) Wasted muscles. (False) (c) Weakness
of individual muscles. (False) (d) Hypotonia. (False) (e) Fatiguable muscle stre
ngth. (False) Question 22. A small pupil may be seen in: (a) A lesion in the mid
brain. (False) (b) Elderly patients. (True) (c) Horner's syndrome. (True) (d) Te
rminally ill patients taking morphine for analgesia. (True) (e) A pontine lesion
. (True) Question 23. Nystagmus may be seen in: (a) A patient with an internucle
ar ophthalmoplegia. (True) (b) A lesion of the pons. (True) (c) A patient who is
blind. (True) (d) A patient with cerebellar dysfunction. (True) (e) A lesion of
the foramen magnum. (True) Question 24. Clinical features of a unilateral lesio
n of the cerebellopontine angle may be: (a) Conductive deafness on the same side
. (False) (b) An ipsilateral hemiparesis. (False) (c) Ipsilateral weakness of th
e lower face. (False) (d) A pseudobulbar dysarthria. (False)
By A. H.
MCQs VIA WEB 2005
(e) Vertigo as a prominent early symptom. (False)
Question 25. The fibres of the dorsal column pathway: (a) Carry information abou
t temperature perception. (False) (b) Decussate in the midbrain. (False) (c) Are
affected in the deficiency of vitamin B12. (True) (d) When damaged may result i
n a positive Romberg's test. (True) (e) Are spared following occlusion of the an
terior spinal artery. (True) Available from Master Medicine Module 1 (trial1) Qu
estion 1. The ECG: · The T wave corresponds to atrial contraction (False) · If the S
wave is greater than the R wave in lead I, there is right axis deviation (True)
· If the S wave is greater than the R wave in lead II, 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. · A tall R wave in V1 may be a sign of rig
ht ventricular hypertrophy (True) Explanation: It may also be a digoxin effect.
Question 2. 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, endocarditi
s can be ruled out if the patient is afebrile (False) Question 3. 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. 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. · Combination antibiotic therapy is almo
st always appropriate for endocarditis (True) Explanation: For two reasons; firs
t, the selected combinations are usually additive or synergistic. Second, to pre
vent the development of resistance. · If gentamicin is used for treatment, it shou
ld not be used for more than 2 weeks (False) Question 4. Hypertension: · Treatment
is of no proven benefit in patients over the age of 70 years (False) · The sympto
ms of phaeochromocytoma include headache, sweating and palpitations (True) Expla
nation: There is well-proven benefit, particularly in the prevention of 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, particularly in the prevention of s
troke. · ACE inhibitors are the drugs of choice for hypertension in pregnancy (Fal
se)
By A. H.
MCQs VIA WEB 2005
· Addison's disease should be considered a possible cause in a hypertensive patien
t with hirsutism (False)
Question 5. Cardiac dysrhythmias: · Digoxin toxicity may cause supraventricular ta
chycardia (True) Explanation: Typically, paroxysmal atrial tachycardia. · 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. · Comple
te heart block may be asymptomatic (True) Explanation: Particularly congenital c
omplete heart block. · 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; sot
alol or amiodarone may prevent them. Question 6. Chronic bronchial sepsis: · Is an
uncommon feature of cystic fibrosis (False) · Typically is caused by unusual, dif
ficult-to-grow bacteria (False) · May lead to haemoptysis (True) Explanation: Haem
optysis is also seen with dry bronchiectasis, chronic bronchial sepsis and with
aspergillomas. · Can usually be cured with oral antibiotics (False) · May lead to pu
lmonary fibrosis (True) Explanation: It produces a fibrotic reaction. Question 7
. In the small intestine: · If there is bile salt deficiency, micellar formation i
s reduced (True) Explanation: Bile salts are essential for micelle formation. · 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
. 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. · 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. 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. · 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. 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. H.
MCQs VIA WEB 2005
Explanation: Brain and heart. The CT/MR scan usually shows multiple ring-enhanci
ng lesions, which are almost diagnostic of toxoplasmosis in AIDS. CNS lymphomas
are usually single. Cardiac toxoplasmosis is usually diagnosed at postmortem. · Cy
tomegalovirus retinitis can be treated with aciclovir (False) Module 1 (trial2)
Question 1. 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. · Most patients with acromegaly are diabetic (False) Question 2. 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'. · 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'. · 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. 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. · 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. · All patients on insulin should be discouraged from changing their dos
es without first checking with the doctor or nurse (False) Question 4. 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. · Poor glycaemic control
at conception increases the risk of congenital malformations (True) Explanation:
Hyperglycaemia is teratogenic in early pregnancy; major congenital malformation
s are two to three times more common. · 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. 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. · Serum TSH can distinguish primary from secondary hypothyroidi
sm (True) Explanation: In primary hypothyroidism, TSH is high; in secondary hypo
thyroidism, it is low. · Serum triiodothyronine can be an unreliable test for hypo
thyroidism (True) Explanation: Low triiodothyronine may result from intercurrent
illness, particularly in elderly people, and can be misleading. · Hyperthyroid pa
tients may have a raised serum triiodothyronine with a normal thyroxine (True)
By A. H.
MCQs VIA WEB 2005
Explanation: The condition of 'T3 toxicosis'.
Question 6. 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. · Diagnostic of rheumatoid arthritis (Fa
lse) · Usually is of the IgA subtype (False) · Is not found in rheumatoid synovial,
pleural or pericardial fluid (False) Question 7. 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. 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. · 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. · Involves the proximal interphal
angeal (PIP) (False) Question 9. 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. · 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. · A distinctive feature of chronic
osteomyelitis is a discharging sinus (True) Explanation: Although there are othe
r causes of a sinus including actinomycosis, implanted foreign body (such as shr
apnel), mycetoma (fungal soft tissue and bony infection of the leg in the tropic
s). · 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. With regard to reactive arthritis:
· It may be caused by both Salmonella and Campylobacter spp. (True) Explanation:
It usually occurs 3-12 weeks after the episode of diarrhoea. · 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. · Rheumatic fever should be excluded (True) Module 1 (Master
Medicine) Question 1. 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, the left vent
ricle lies under the sternum (False) On a postero-anterior (PA) chest radiograph
, the left heart border is mostly formed by the left ventricle (True) Explanatio
n: The right ventricle presses against the sternum; the left ventricle constitut
es the apex and is felt under the fingers. In an ECG, disease of the interventri
cular septum causes changes in chest leads V3-4 (True)
By A. H.
MCQs VIA WEB 2005
Explanation: The right ventricle presses against the sternum; the left ventricle
constitutes the apex and is felt under the fingers. When examining the heart, 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. Question 2. The ECG: The T wave corresponds to atrial con
traction (False) If the S wave is greater than the R wave in lead I, there is ri
ght axis deviation (True) If the S wave is greater than the R wave in lead II, 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. 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. 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. 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. 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. Combination an
tibiotic therapy is almost always appropriate for endocarditis (True) Explanatio
n: For two reasons; first, the selected combinations are usually additive or syn
ergistic. Second, to prevent the development of resistance. If gentamicin is use
d for treatment, it should not be used for more than 2 weeks (False) Question 5.
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. Question 6. 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. Hypertension should be treated a
ggressively (True) Explanation: Nitroprusside or labetolol infusion is a recomme
nded treatment. 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. Hypertension: Treatment is of no proven benefit in pat
ients over the age of 70 years (False) The symptoms of phaeochromocytoma include
headache, sweating and palpitations (True)
By A. H.
MCQs VIA WEB 2005
Explanation: There is well-proven benefit, particularly in the prevention of str
oke. 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, particularly in the prevention
of stroke. 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. In ischaemic heart disease: Preval
ence is increased in chronic renal failure (True) Explanation: Cushing's syndrom
e, not Addison's disease. Untreated hypothyroidism predisposes to it (True) Expl
anation: Hypothyroidism causes hypercholesterolaemia and atherosclerosis. Polycy
thaemia may precipitate myocardial ischaemia (True) Explanation: By increasing b
lood viscosity and impairing blood flow. 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. Cardiac dysrhythmias: Digoxin toxic
ity may cause supraventricular tachycardia (True) Explanation: Typically, paroxy
smal atrial tachycardia. A patient with a completely irregular pulse of 180 beat
s/min is likely to be in atrial fibrillation (True) Explanation: Typically, paro
xysmal atrial tachycardia. Complete heart block may be asymptomatic (True) Expla
nation: Particularly congenital complete heart block. 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; sotalol or amiodarone may prevent them. Question 1
0. Hypoventilation occurs in the following: Central sleep apnoea syndrome (True)
Explanation: Alveolar hypoventilation is a key feature. Severe kyphoscoliosis (
True) Explanation: Severe kyphoscoliosis can produce mechanical ventilation prob
lems because of the changed curvature of the spine. Anxiety (False) Benzodiazepi
ne overdose (True) Explanation: Drugs such as benzodiazepines depress the respir
atory centre. Exercise (False) Question 11. Pneumothorax is a recognised complic
ation of: Rib fracture (True) Explanation: Pneumothorax can occur secondary to t
rauma. A bulla (True) Explanation: Any cavitating or cystic/bullous lung lesion
can cause a pneumothorax. Bullae can be single or multiple. They are particularl
y common in emphysema including á1-antitrypsin deficiency. Kyphoscoliosis (False)
Cystic fibrosis (False) Pneumocystis carinii pneumonia (True) Explanation: And l
ung abscesses (e.g. Staph. aureus) can lead to pneumothorax. Question 12. The fo
llowing are features of fibrosing alveolitis: Cough (True) Explanation: Patients
usually present with cough and breathlessness. 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. Cyanosis in the early stages (False)
By A. H.
MCQs VIA WEB 2005
Circulating antibodies to alveolar tissues (False) Haemoptysis (False) Question
13. Useful drugs for tuberculosis include: Piperacillin (False) Isoniazid (True)
Explanation: Isoniazid is a major, first-line agent. Ciprofloxacin (True) Expla
nation: Ciprofloxacin is a useful agent, less active than rifampicin; it may obs
cure infection in patients treated before diagnosis considered. Ethambutol (True
) Explanation: Ethambutol is another major, but second-line agent. Amikacin (Tru
e) Explanation: Amikacin is a useful i.v. second-line agent Question 14. Causes
of life-threatening pneumonia or pneumonitis in adults include: Pneumocystis car
inii (True) Explanation: Pneumocystis carinii infection is usually seen in AIDS,
but also in lymphoma, steroid-treated, transplant and hypogammaglobulinaemic pa
tients. Influenza A virus (True) Explanation: Primary influenzal pneumonia or co
mplicated by bacteria, e.g. Staph. aureus. Respiratory syncytial virus (False) S
taphylococcus aureus (True) Explanation: S. aureus pneumonia is often rapidly fa
tal, especially following influenza. Legionella pneumophila (True) Explanation:
L. pneumophilia pneumonia carries a high mortality if not treated appropriately.
Question 15. Chronic bronchial sepsis: Is an uncommon feature of cystic fibrosi
s (False) Typically is caused by unusual, difficult-to-grow bacteria (False) May
lead to haemoptysis (True) Explanation: Haemoptysis is also seen with dry bronc
hiectasis, chronic bronchial sepsis and with aspergillomas. Can usually be cured
with oral antibiotics (False) May lead to pulmonary fibrosis (True) Explanation
: It produces a fibrotic reaction Question 16. 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. 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.
Question 17. In the small intestine: If there is bile salt deficiency, micellar
formation is reduced (True) Explanation: Bile salts are essential for micelle fo
rmation. 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. Question 18. Colorectal cancer: May arise from a metaplastic p
olyp (False)
By A. H.
MCQs VIA WEB 2005
Most often occurs in the rectum and sigmoid (True) Explanation: Metaplastic poly
ps have no malignant potential. 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. Caus
es of acute pancreatitis include: Alcohol (True) Explanation: Most cases are ass
ociated with gall stones or high alcohol intake. Hypocalcaemia (False) Hyperlipi
daemia (True) Explanation: There is an association with hyperlipidaemia, but it
is an uncommon cause. 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. Question 20. 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. The diagnosis
is incorrect if a patient fails to respond to a gluten-free diet (False) Requir
es a diet free from wheat, barley and rye (True) Explanation: All contain gluten
Question 21. In a ward with several patients where two of the nurses have had m
uch vomiting and some diarrhoea over a 48-hour period, 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, unless necessary for, say, a dying patient. Prevent t
he patients (affected or not) leaving the ward for investigations, physiotherapy
, etc. (True) Explanation: Unless the investigation was absolutely vital Questio
n 22. The differential diagnosis of acute bloody diarrhoea includes: Amoebic dys
entery (True) Explanation: This has much mucus and tenesmus. Campylobacter enter
itis (True) Explanation: The amount of blood is usually small. Haemorrhagic coli
tis caused by E. coli (True) Explanation: The classic cause, with mostly blood a
nd little stool and no fever. Traveller's diarrhoea (False) Cholera (False) Ques
tion 23. 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. 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. A 'fatty liver' may represent: Simply an obese person (False) Alcoholism
(True) Explanation: A common 'early' abnormality.
By A. H.
MCQs VIA WEB 2005
Hepatitis C infection (True) Explanation: A common 'early' abnormality. Acute vi
tamin A poisoning (False) An ultrasound artefact (False) Question 25. Cushing's
syndrome: Causes osteoporosis (True) Explanation: Also cardiorespiratory disease
. 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. 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. 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.
Polycystic kidney disease (False) Major arterial surgery (True) Explanation: Ma
jor arterial surgery can cause renal ischaemia and acute tubular necrosis. Retro
peritoneal tumours (False) Cardiogenic shock (True) Question 2. 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.v. 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. Intravenous pyelography is the investigation of choice to exclude urinary
obstruction (False) Question 3. The following are causes of chronic renal failur
e: Gout (True) Explanation: In renal failure, the kidneys are unable to excrete
urea so the urinary urea concentration is low. This distinguishes renal failure
from, for example, volume depletion, in which plasma urea is high but the kidney
s retain the capacity to concentrate urinary urea. Atherosclerosis (True) Explan
ation: As a result of extrarenal or intrarenal obstruction to the renal arterial
circulation. Analgesic abuse (True) Explanation: As a result of extrarenal or i
ntrarenal obstruction to the renal arterial circulation. Non-insulin-dependent d
iabetes (True) Explanation: Both insulin-dependent and non-insulin-dependent dia
betes cause renal failure. Hypothyroidism (False) Question 4. The following may
cause the nephrotic syndrome: Minimal change disease (True) Explanation: This is
the characteristic disease associated with nephrotic syndrome, particularly in
children. 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). Rarely it is caused by a
glomerulonephritis associated with the disease itself. Diabetes mellitus (True)
Explanation: Although the full-blown nephrotic syndrome is a relatively uncommo
n presentation of diabetic nephropathy. Renal cell carcinoma (False)
By A. H.
MCQs VIA WEB 2005
Question 5. 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,
perhaps reflecting anorexia and dehydration. 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. Local estrogen therapy helps. Questi
on 6. 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, although athe
rosclerosis is the most common pathology. 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. Is a cause
of hypertension (True) Explanation: Hypoperfusion causes reduction in renal siz
e. Question 7. The following are true: There is weakness of elbow extension in a
crutch palsy (True) Explanation: The triceps is affected in a crutch palsy. 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. 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, e.g. dysphasia, dyslexia. Question 9. 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, though mostly the paralysis is only brought out when
the eye is abducted. 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. False image parallel to the true image (True) Explanation: Unlike a superi
or oblique palsy. 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. Parkinson's disease is associated with: Loss of dopamine transmission (Tru
e) Explanation: Although the mechanism is unclear, it does involve loss of dopam
inergic neurons. Cogwheel rigidity (True) Explanation: Cogwheel rigidity is a su
perimposed tremor on the 'lead pipe' increase in tone. Tardive dyskinesia (False
) Intention tremor (False) Festinant gait (True)
By A. H.
MCQs VIA WEB 2005
Question 11. In a young female with paraplegia, 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. MR scanning is the preferred imaging technique. Raised protein
in cerebrospinal fluid (CSF) (False) Raised CSF globulin (True) Explanation: CNS
immunology is disturbed in multiple sclerosis. Denervation of the muscles of th
e leg (False) Episode of visual disturbance (True) Explanation: Disturbances of
visual acuity are an early sign. Question 12. 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. 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. With respect to lumbar puncture: Coagulopathy is a co
ntraindication (True) Explanation: However, if correctable (e.g. haemophiliac) a
nd the indication for lumbar puncture is strong enough, then it should be correc
ted and the lumbar puncture carried out. Papilloedema is an absolute contraindic
ation (False) The procedure may cause meningitis (False) The less CSF is removed
, the less likely coning is to occur (False) Postlumbar puncture headache is rel
ated to the size of the needle used (False) Question 14. Outcome from bacterial
meningitis relates to: Age of patient (True) Explanation: Mortality is highest i
n elderly people. Time to first administration of antibiotic (True) Explanation:
Delays lead to increased mortality and morbidity. 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. This is th
e primary reason why i.v. therapy is necessary in meningitis. Development of ant
ibiotic resistance during therapy (False) The causative organism (True) Explanat
ion: Neisseria meningitidis has a lower mortality than S. pneumoniae meningitis.
Furthermore about 5% of community-acquired cases are other organisms, such as L
isteria monocytogenes. Listeria is intrinsically resistant to all cephalosporins
, which are now the most common first line treatment for meningitis Question 15.
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. The activated partial thrombo
plastin time (APTT) is prolonged by unfractionated heparin therapy (True) Explan
ation: This is used as a measure of heparinisation. 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. The following m
ay cause a microcytic anaemia: Sickle cell disease (False) The thalassaemias (Fa
lse) Anaemia of chronic disease (False) Anticonvulsant therapy (False)
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MCQs VIA WEB 2005
Haemolysis, whatever the cause (False)
Question 17. The following statements are true: A neutrophil count of only 0.8 × 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 0.1 × 109 cells/l neutrophil
s and a fever, 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. Question 18. 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. Diabetic patients with p
roteinuria have a higher cardiovascular risk than those without it (True) Explan
ation: It is indicative of nephropathy, which increases the risk of cardiovascul
ar disease up to 100-fold. When sulfonylureas became available, there was a noti
ceable improvement in cardiovascular mortality (False) Good glycaemic control, o
n the balance of available evidence, can reduce cardiovascular mortality in both
type 1 and type 2 DM (False) Even mildly 'impaired glucose tolerance' increases
cardiovascular risk (True) Question 19. 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. Most patients with acromegaly are diabetic (Fal
se) Question 20. 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. Is more likely to cause blindness in type 1
than in type 2 DM (False) Question 21. 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. 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. All patients o
n insulin should be discouraged from changing their doses without first checking
with the doctor or nurse (False) Question 22. 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. 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 non-
cardioselective beta-blockers. Increases the risk of stroke in diabetes (True)
By A. H.
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)
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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
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MCQs VIA WEB 2005
shingles (False) Explanation: Varicella zoster virus paronychia (True) Explanati
on: HS type 1-'herpetic whitlow' Question 14. 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. 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. 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. 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. 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. vivax and P. 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. Recognised cli
nical features of malaria include
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MCQs VIA WEB 2005
absence of P. vivax infection in subjects lacking the Duffy blood group (True) E
xplanation: West Africans and African Americans are protected asymptomatic 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, herpes simplex and haemolytic anaemia (True) Explanation: Especiall
y in P. vivax and P. ovale infection excellent response to chloroquine (False) E
xplanation: Widespread resistance-quinine preferred Question 20. 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, 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 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 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. 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 ('saddle-
back') rigors, headache, 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. 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. gambiense infections onset with chancre-like skin lesion and local l
ymphadenopathy (True) Explanation: At the site of the bite
By A. H.
MCQs VIA WEB 2005
generalised lymphadenopathy, hepatosplenomegaly and encephalitis (True) good pro
gnosis given prompt pentamidine or suramin therapy (True) Explanation: Unless ce
rebral infection has developed Question 25. 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, spleen or liver clinical r
esponse to pentavalent antimonials, e.g. stibogluconate (True) Explanation: Amph
otericin B is an alternative Question 26. 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, 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. 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, diarrhoea, steatorrhoea and weight loss abdominal pa
in, diarrhoea and malabsorption (True) penetration of perianal skin producing a
migrating linear weal (True) Explanation: Intensely itchy systemic spread in the
immunosuppressed, resulting in pneumonia (True) Explanation: Seen in HIV infect
ion Question 28. 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. 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. H.
MCQs VIA WEB 2005
conjunctivitis, iritis and keratitis are characteristic (True) ivermectin is the
drug therapy of choice (True) Question 30. 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. Echinoco
ccus granulosus infestation is usually associated with contact with sheep, 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, 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. 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. 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. Typical features of leproma
tous leprosy include early and marked sensory loss (False) Explanation: Late and
limited unlike the tuberculoid form, 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)
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MCQs VIA WEB 2005
Explanation: Macules occur, but sensation is retained
Question 35. 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. 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, 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. 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, 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. 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, 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. 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.
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.
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 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. 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 anti-
HIV antibodies (True) Question 43. 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. 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. 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, 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. 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. H.
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. In a patient with AIDS, 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. 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. 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. 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, 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. Erythromycin is active again
st the following microorganisms Campylobacter jejuni (True) Escherichia coli (Fa
lse)
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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. 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. 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. 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. 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). After 1 year of tre
atment 5 patients in the treatment group and 10 patients in the control group ha
ve suffered a stroke. Which of the following statements are true? the absolute r
isk reduction with treatment is 5% (False) Explanation: 2.5% 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. Examples of
pharmacokinetic interactions include the following allopurinol inhibits the meta
bolism of azathioprine (True) Explanation: And 6-mercaptopurine; both are metabo
lised by xanthine oxidase metoclopramide delays gastric emptying and the rate of
drug absorption (False)
By A. H.
MCQs VIA WEB 2005
Explanation: It increases the rate of gastric emptying digoxin and verapamil com
pete for renal tubular secretion (True) Explanation: Similarly, 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. 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, reduces renal blood flow by prostaglandin i
nhibition metformin (True) Explanation: Causes lactic acidosis Question 4. 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. 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, in
creases the risk of gastrointestinal bleeding Question 6. 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.g. theophylline and sedative d
rugs) doses should be reduced Question 7. 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, in ink
By A. H.
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, number of doses, and form and strength of the drug prescriptions must be si
gned and dated by the prescriber (True) Module 3 (Chapter 3) Question 1. 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. 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. Features of
salicylate poisoning in an adult may include metabolic acidosis (True) Explanat
ion: A poor prognostic sign deafness, tinnitus and blurred vision (True) Explana
tion: Common features hypokalaemia and respiratory alkalosis (True) Explanation:
Due to hyperventilation hyperventilation, sweating and restlessness (True) peri
pheral vasodilatation (True)
Question 4. 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, gold and mercury poisoning flumazenil-
opioid 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. Typical f
eatures following benzodiazepine poisoning include ataxia, dysarthria, nystagmus
and drowsiness (True) severe systemic hypotension and respiratory depression (F
alse) Explanation: Severe cardiorespiratory depression is rare nausea, vomiting
and diarrhoea (False)
By A. H.
MCQs VIA WEB 2005
Explanation: Suspect mixed overdose convulsions, 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. 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. Typical features of morphine poisoning include nausea, 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. Typical feature
s of carbon monoxide poisoning include nausea, vomiting (False) Explanation: Com
mon features include agitation, 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. 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, often > 35 mmHg complications of monitoring include pulmonary artery rup
ture (True) Explanation: Also pneumothorax, air embolism, sepsis and arrhythmias
the optimum PAWP in acute circulatory failure is 12-15 mmHg (True) Question 2.
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. H.
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 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 = 3.5 kPa, 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. 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) - 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. 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 < 4.3 kPa (True) Question 6. The following stateme
nts about shock syndromes are correct in severe hypovolaemia, a source of blood/
fluid loss is invariably apparent clinically (False) Explanation: Bleeding may b
e internal in cardiogenic shock, 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. 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. H.
MCQs VIA WEB 2005
Question 8. 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 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 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. 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
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. H.
MCQs VIA WEB 2005
Question 2. 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. 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. 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 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.g
. docetaxel melphalan is an alkylating agent which blocks DNA replication (True)
Explanation: And also blocks DNA transcription Module 6 (Chapter 6) Question 1.
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.
MCQs VIA WEB 2005
opiates are of no value in neuropathic pain (False) Explanation: But other agent
s may be more effective Question 2. 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. 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, GFR and medullary function increased chest wall rigidity (True) Question 2
. 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. 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. H.
MCQs VIA WEB 2005
Explanation: Help reduce the risk of fall fractures
Question 4. 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. Aetiological factors in psychiatric illness include family history
of psychiatric illness (True) Explanation: Rarely, 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.g. bereavement, redundancy, 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. Important factors in
the assessment of mental state include appearance and behaviour (True) Explanati
on: Including motor retardation mood state (True) Explanation: E.g. suicidal ide
ation speech and thought content (True) Explanation: Paranoid, grandiose or depr
essive abnormal perceptions and beliefs (True) Explanation: Depersonalisation, i
llusions and hallucinations cognitive function (True) Explanation: Concentration
, memory and orientation Question 3. The following psychiatric definitions are t
rue delusions-abnormal perceptions of normal external stimuli (False) Explanatio
n: Illusions illusions-unreasonably persistent, firmly held, 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. 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. H.
MCQs VIA WEB 2005
Explanation: Rare-measure urinary catecholamines
Question 5. 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.g. in depression awareness of connections betwee
n thoughts, mood and behaviour (True) Explanation: Altering thoughts may alter b
ehaviour reorientation of negative views of the past, present and future (True)
Explanation: And development of positive views personality assessment and transa
ctional analysis (False) Explanation: Features of psychotherapy Question 7. 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. 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, self-esteem and hope (True) Explanat
ion: 'Anhedonia'-loss of sense of enjoyment loss of energy, libido and interest
(True) Explanation: Perhaps with other somatic symptoms psychomotor retardation
and suicidal thoughts (True) Explanation: With delusions of worthlessness Questi
on 9. 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, dizziness, sweating and palpitation (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Typical somatic symptoms claustrophobia and agoraphobia (False) Exp
lanation: Features of phobic anxiety states Question 10. Typical features of ano
rexia nervosa include only adolescent girls are affected (False) Explanation: Ei
ther sex, 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. In a normal 65 kg man, 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, 75% interstitial sodium, bicarbonate and chloride ions
are mainly intracellular (False) Explanation: Extracellular potassium, magnesiu
m, phosphate and sulphate ions are mainly extracellular (False) Explanation: Int
racellular Question 2. 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. 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. 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. H.
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. 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 1.26% sodiu
m bicarbonate i.v. Calcium Resonium orally and/or rectally (True) Explanation: T
he resin binds potassium in exchange for calcium Question 7. Recognised causes o
f potassium depletion include metabolic alkalosis (True) Explanation: Renal tubu
lar cell K+ concentration increased, 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; 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. 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. 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. H.
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. Magnesium deficiency is a cause of confu
sion, 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. A healthy daily diet for
a slim man with a physical job should include 1500 kcal (8.4 MJ) (False) Explan
ation: About 11.3 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. 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 2.5 MJ (600 k
cal) per day (False) Explanation: Aim to reduce intake by no more than 2.5 MJ (6
00 kcal) per day achieve a theoretical weight loss of at least 2 kg per week (Fa
lse) Explanation: 0.5 kg per week (2.5 MJ or 600 kcal deficit/day = 17.15 MJ or
4200 kcal/week = 0.6 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.g. 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, CHO =
17 KJ or 4 kcal/g) Question 4. 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. H.
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. 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. The function of the main lipoprotei
ns include the following chylomicrons transport mainly cholesterol (False) Expla
nation: Mainly triglycerides; not present in the normal fasting plasma very low-
density 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. 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, VLDL and HDL thiazide diuretics (True) Question 8. In the class
ification of hyperlipidaemias, 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, IV and V (True)
Explanation: Triglycerides variably abnormal in all except type IIa hypercholes
terolaemia in types II, 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 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. H.
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, it blocks bile acid reabsorption in the
gut Question 10. Clinical features of protein-energy malnutrition in adults incl
ude a body mass index of between 20 and 22 (False) Explanation: BMI < 16. N.B. B
MI is calculated from the formula weight (kg) ÷ height2 (m) oedema in the absence
of hypoalbuminaemia (True) Explanation: 'Famine oedema' nocturia, cold intoleran
ce and diarrhoea (True) Explanation: And weakness, amenorrhoea or impotence skin
depigmentation, hair loss and covert infection (True) Explanation: Adolescents
may maintain hair growth cerebral atrophy and sinus tachycardia (False) Explanat
ion: Brain weight is preserved; bradycardia is the rule Question 11. 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, 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. Vitamin A is a fat-soluble vitamin (True) Explanation: A, D, E
, 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. 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. Deficiency of the following
B vitamins is associated with the disorders listed below niacin-pellagra (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Dermatitis, 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 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. 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. 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 0.6% 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. In polycystic kidney disease
By A. H.
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, XY (False) Explanation: 46, XY female with Down's syndrome is
46, XX, -21 (False) Explanation: 47, XX, +21 male with Klinefelter's syndrome is
47, XXY (True) female with Turner's syndrome is 45, XO (True) male with trisomy
18 (Edwards' syndrome) is 47, XX, +18 (False) Explanation: 47, XY, +18 Question
5. 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. 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. 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. 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. H.
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. 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. 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, 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. 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. In the investigation of patients with suspected heart disease th
e normal upper limit for the cardiothoracic ratio (CTR) on chest radiograph is 0
.75 (False) Explanation: The CTR should not be > 0.5
By A. H.
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. 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, 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. 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. 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. 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, 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. H.
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. 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, 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. 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 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, 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. 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. H.
MCQs VIA WEB 2005
renal artery stenosis (True) Explanation: May also develop during follow-up Ques
tion 16. 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. Syncope followed by facial flushing suggests a tachyarr
hythmia (False) Explanation: Suggests episodic bradycardia- 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 1.5% 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, a common finding in elderly patients Question 19. 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, 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. Atrial tachycardia is typically associated with 1:1 AV conduction (Fals
e) Explanation: 2:1, 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. H.
MCQs VIA WEB 2005
Explanation: QRS complexes are usually narrow
Question 21. 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. 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, cardi
oversion should be avoided (False) Explanation: The treatment of choice in acute
heart failure with VT Question 23. 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; 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
. In the classification of anti-arrhythmic drugs, the following statements are t
rue class I agents inhibit the fast sodium channel (True) Explanation: E.g. lido
caine (lignocaine)-like drugs class II agents are â-adrenoceptor antagonists (True
) class III agents prolong the action potential (True) Explanation: E.g. amiodar
one class IV agents inhibit the slow calcium channel (True) Explanation: E.g. ve
rapamil, nifedipine many anti-arrhythmic agents have actions in more than one cl
ass (True) Explanation: E.g. sotalol and amiodarone Question 25. 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. H.
MCQs VIA WEB 2005
lidocaine (lignocaine)-convulsions (True)
Question 26. 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. Digoxin shortens the refractory period of conducting tissue (False) Explan
ation: Prolongs the refractory period of conducting tissue; 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 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 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. 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. H.
MCQs VIA WEB 2005
â-blockers are more effective than other anti-anginal agents (False) Explanation:
Nitrates, calcium antagonists and â-blockers are all equally efficacious Question
31. 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. 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, 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, 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. 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. 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, 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. 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. H.
MCQs VIA WEB 2005
Question 36. 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. 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. 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. 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. 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.
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. 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. 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. 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, 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. In small ventricular septal defects
the murmur is confined to late systole (False)
By A. H.
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. 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, HIV and others Question 48. 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. 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. 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. 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. H.
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. 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. 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.
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. 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. The following are recognised ca
uses of haemoptysis tuberculosis (True) chronic obstructive pulmonary disease (F
alse)
By A. H.
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. A pleural effusion with a pleural fluid:serum protein ratio of > 0.5 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. 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; continuous positive airway pressure (CPAP) m
ay be effective nocturnal hypotension (False) Explanation: Typically episodic hy
pertension Question 9. 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
. 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 following statements about oxygen are true at sea level, t
he pressure of oxygen in inspired air is approximately 20 kPa (True) Explanation
: PaO2 declines with altitude
By A. H.
MCQs VIA WEB 2005
chronic domiciliary oxygen therapy is indicated only when PaO2 is < 6 kPa (False
) Explanation: Indicated when PaO2 < 7.3 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- or intrapulmonary Question 12. 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. 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. 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. 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. H.
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. The initial manage
ment of severe acute asthma should include 24% oxygen delivered by a controlled
flow mask (False) Explanation: High concentration, 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.v. 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. 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. 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; hence prospect for gene therapy recurring pneumoc
occal pulmonary infections (False) Explanation: Pseudomonas and staphylococcal s
epsis Question 20. In pneumonia, 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. 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. H.
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
. Typical features of primary tuberculosis include a sustained pyrexial illness
(False) Explanation: Typically symptomless caseation within the regional lymph n
odes (True) Explanation: Mediastinal, 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. 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. 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- 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. 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. H.
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. 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, rapidly progressive illness bronchopulmonary eosinophilia (True) Explanatio
n: Typically with wheeze, 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%, 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. 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. The following are contraindications to surgical resection in bronchial carci
noma distant metastases (True) malignant pleural effusion (True) FEV1 < 0.8 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. H.
MCQs VIA WEB 2005
Explanation: Pulmonary apical mass hiatus hernia (True) Explanation: A retrocard
iac opacity neurofibroma (True) Explanation: Can be multiple Question 32. The fo
llowing statements about sarcoidosis are true pulmonary lesions typically cavita
te (False) Explanation: Caseating granulomata (e.g. 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. 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, dry cough and cr
ackles increased carbon monoxide transfer factor (False) Explanation: Reduced Qu
estion 34. 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, 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. 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. 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, phenylbutazone or others opacities on chest radio
graph (True) Explanation: Pulmonary infiltrates and eosinophilia Question 37. 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, II a
nd aVL on ECG (False) Explanation: Classical ECG pattern is S1, Q3, T3 Question
38. 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, 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. 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. 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 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. H.
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. Microscopic haematuria would be an expected finding
in urinary tract infection (True) renal papillary necrosis (True) Explanation: R
isk factors include diabetes mellitus, 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. Urinary protein excretion in Bence Jones p
roteinuria is readily detectable by stick tests (False) Explanation: Immunoelect
rophoresis required > 3.5 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. 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 > 3.5 g/day (True) Explanation: Serum albu
min concentration < 30 g/l and urinary protein > 3.5 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. 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. Typical causes of rapidly progressive glomerulonephritis include
post-infectious glomerulonephritis (True) systemic vasculitis (True) Explanatio
n: Causes focal necrotising glomerulonephritis
By A. H.
MCQs VIA WEB 2005
Goodpasture's disease (True) IgA nephropathy (True) Explanation: Including Henoc
h-Schönlein purpura membranous glomerulonephritis (False) Question 7. 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; urinary diluting ability also impaired Question
8. 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. 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. Characteristic features of minimal change nephropathy are occurrence in
adults usually follows an acute infection (False) Explanation: Usually children;
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. 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. H.
MCQs VIA WEB 2005
high-dose steroids usually control proteinuria (True) immunosuppressant therapy
is indicated for frequent relapses (True) Explanation: E.g. cyclophosphamide imp
aired renal function commonly develops in the long term (False) Explanation: Rar
ely, even in relapsing disease Question 12. 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, especially in children Question 13. Typical
features of acute interstitial nephritis (AIN) include skin rashes, 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. penici
llin or naproxen Question 14. 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.
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. 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. H.
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. Characteristic features of renal tubular acidosis (RTA)
include normal anion gap (True) Explanation: Anion gap = plasma (Na+ + K+) - (C
l- + HCO3-) normally < 15 mmol/l hyperchloraemic acidosis (True) Explanation: in
creased chloride preserves anion gap inappropriately high urinary pH > 5.4 (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. 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, 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. 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. 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. 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. H.
MCQs VIA WEB 2005
elevated serum prostate specific antigen (False) Explanation: Suggests prostatic
carcinoma hard, nodular prostatic enlargement on rectal examination (False) Exp
lanation: Suggests prostatic carcinoma Question 22. 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. 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- a
nd chemosensitive (True) Explanation: Chemotherapy is given if disease is widesp
read Module 15 (Chapter 15) Question 1. 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. 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,
hypercholesterolaemia and hyperinsulinaemia often coexist (True) Explanation: Sy
ndrome X (Reaven's syndrome) associated with macrovascular disease Question 3. S
econdary diabetes mellitus is associated with thiazide diuretic therapy (True) E
xplanation: Hypokalaemic alkalosis impairs insulin secretion haemochromatosis (T
rue)
By A. H.
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. 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 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. 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. H.
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, 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. 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. 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. The following statements about insulin therapy are t
rue Short-acting, 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, insulin has a plasma half-life of 2 hours (False) Explan
ation: Plasma insulin has a half-life of 7 minutes Question 13. Typical symptoms
of hypoglycaemia in diabetic patients include
By A. H.
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, palpitation and dizziness (
True) Explanation: Sympathetic nervous system activation Headache, 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, nightmares and
convulsions (True) Explanation: Nocturnal hypoglycaemia may be difficult to reco
gnise Question 14. 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; weight loss and nocturia should signal the p
ossibility Errors in drug administration (True) Explanation: Inadvertent and occ
asionally even deliberate Question 16. 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. 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. H.
MCQs VIA WEB 2005
Explanation: Even in absence of infection due to acidosis
Question 18. In the management of diabetic ketoacidosis intracellular water defi
cit is best restored using half-strength saline (0.45% saline) (False) Explanati
on: Use isotonic solutions; 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+ > 5.5 mmol/l bicarbonate infusion is rarely
necessary in the absence of renal failure (True) Explanation: Or in severe acido
sis, i.e. pH < 7.0 (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; monito
r urine output and central venous pressure Question 19. 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; 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. 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. 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; 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. H.
MCQs VIA WEB 2005
Question 2. 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. 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. cabergoline and quinagolide Question 4. 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. 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; 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. 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, 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. H.
MCQs VIA WEB 2005
Question 7. 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. Causes of diabetes insipidus (DI) include congenital sex-linked re
cessive disorder (True) Explanation: Nephrogenic DI; also congenital cranial DI-
autosomal dominant craniopharyngioma (True) Explanation: Any tumour or radiother
apy close to the pituitary fossa DIDMOAD syndrome (True) Explanation: DI, diabet
es mellitus, optic atrophy and deafness severe hypocalcaemia (False) Explanation
: Severe hypokalaemia and hypercalcaemia sarcoidosis (True) Explanation: Also tu
berculosis causing chronic basal meningitis Question 9. The typical features of
cranial diabetes insipidus include serum sodium concentration > 150 mmol/l with
urine specific gravity < 1.001 (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, the response to ADH is inva
riably normal (True) Explanation: An effect of long-term overhydration in psycho
genic polydipsia Question 10. 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 2.4 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 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. H.
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. 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; 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, 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 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. 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 clinical features of primary hypothyroidism include c
arpal tunnel syndrome and proximal myopathy (True) Explanation: Both, however, a
re non-specific cold sensitivity and menorrhagia (True)
By A. H.
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, 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. 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. 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, 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. The serum calcium concentration is typically
increased in hypoalbuminaemia (False) Explanation: 40% of calcium is protein-bou
nd; 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. Typical clinical features of primary hyperparathyroidism include
By A. H.
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. 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 1,25-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. 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 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: Anti-
insulin effects Question 25. 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. H.
MCQs VIA WEB 2005
hypoglycaemic episodes (False) Explanation: Impaired glucose tolerance Question
26. 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; c
auses day-night reversal of biorhythms Question 27. 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, however, associated with primary hypoadrenalism hy
pertension is associated with hyperreninaemia (False) Explanation: Associated wi
th renin suppression Question 28. 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. Typical features of primary adrenocortical ins
ufficiency include anorexia, 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, 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. 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. H.
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. Causes of gynaecomastia include androgen defic
iency and/or excessive oestrogen production (True) Explanation: E.g. 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.g. 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. 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. 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. 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. Causes of hirsutism i
nclude idiopathic familial hirsutism (True) Explanation: Commonest cause and tre
ated with anti-androgens (e.g. cyproterone)
By A. H.
MCQs VIA WEB 2005
polycystic ovarian syndrome (PCOS) (True) Explanation: PCOS is associated with o
besity and infertility; plasma LH:FSH ratio > 2.5:1 Cushing's syndrome (True) Ex
planation: Modest increase in adrenal androgen synthesis autoimmune polyglandula
r syndrome (False) Explanation: Primary adrenal, thyroid, parathyroid, 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. Causes of mouth ulcers include gluten enteropathy (True) Explanation: And
systemic lupus erythematosus, Beh[sfgr ]et's syndrome, 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. 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. 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; typically worse with fluids than with solids achalasia (True)
Explanation: Best diagnosed on oesophageal manometry Question 4. 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. H.
MCQs VIA WEB 2005
Explanation: If this fails, Heller's myotomy may be indicated
Question 5. 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.g. 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. 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, 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. 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, no ulcer' Helicobacter pylori - 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. 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; pain rarely
lasts > 2 hours
By A. H.
MCQs VIA WEB 2005
absence of symptoms prior to acute perforation (True
Question 10. 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%; 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. pylori has not been eradicated magnesium-containing antacids produce const
ipation (False) Explanation: Cause diarrhoea; aluminium-containing antacids caus
e constipation bismuth compounds should not be used for maintenance therapy (Tru
e) Explanation: Due to potential accumulation of bismuth, acid-lowering drugs ar
e preferable gastric ulcers associated with NSAID therapy are less likely to be
associated with H. pylori gastritis than gastric ulcers occurring in patients no
t taking NSAIDs (True) Explanation: 30% of gastric ulcers are not associated wit
h H. 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%, 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. 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. 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. 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. 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. 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. 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, patients may feel like eating immediately after v
omiting absent gastric peristalsis (False) Explanation: Often prominent gastric
peristalsis and a succussion splash Question 17. 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, 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.
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. Carcinoma of the stomach is ass
ociated with adenomatous gastric polyps (True)
By A. H.
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. 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. 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. 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.g. 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
.g. Crohn's disease Question 23. Clinical features suggesting the carcinoid synd
rome include facial blanching and sweating (False) Explanation: Facial telangiec
tasia, 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. H.
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. 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. 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. 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. H.
MCQs VIA WEB 2005
Explanation: Biliary tract disease is rarely the cause
Question 29. 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. 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
. 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.
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. H.
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 enzyme-
inducing 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.
MCQs VIA WEB 2005
absence of progression to chronic hepatitis (False) Explanation: And hepatic cir
rhosis also occurs Question 15. 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; 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. 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, vomiting and renal failure (True) Explanation: Renal f
ailure is an ominous development cerebral oedema without papilloedema (True) Exp
lanation: Occurs late, if at all Question 17. 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, unlike the serum transaminases peripheral blood lymphocytosi
s (False) Explanation: May be a polymorphonuclear leucocytosis Question 18. 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, anorexia and jaundice spider telangiectasia and hepatosplenomegal
y (True) Explanation: And other signs of chronic liver disease Cushingoid facies
, hirsutism and acne (True) Explanation: Altered steroid hormone metabolism Ques
tion 19. 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. H.
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. 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. 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. 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
, 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 2.5 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. 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; 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. Complications of portal hypertension include
variceal haemorrhage (True) Explanation: Oesophageal, gastric, stomal and rectal
varices congestive gastropathy (True)
By A. H.
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 the management of ac
ute variceal bleeding due to hepatic cirrhosis the priority is to restore normov
olaemia (True) Explanation: Untreated, 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; 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; 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. 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. 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 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; 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 typi
cal features of Wilson's disease include haemolytic anaemia (True)
By A. 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. 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. The
typical features of hepatocellular carcinoma include fever, 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. 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 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, especially in ascending cholangitis (True) Explanation: Single lesions are
more common in the right liver Escherichia coli, anaerobes and streptococci pres
ent in pus (True) Explanation: Multiple organisms in one-third of cases
By A. H.
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. The typical clinical features of acute c
holecystitis include jaundice, 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. 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 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. 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, increases at delivery
By A. H.
MCQs VIA WEB 2005
whooping cough (False) Explanation: Typically lymphocytosis mesenteric infarctio
n (True) Explanation: And myocardial infarction Question 3. 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, serotonin) and von Willebrand factor (vWF) (True) Explanation: 5
-HT (delta granules), and vWF and fibrinogen (alpha granules) Question 4. 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.g. 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. 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; 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, 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. Hypochromic micro
cytic anaemia is a recognised finding in haemolytic anaemia (False) Explanation:
Macrocytic with polychromasia myelodysplastic syndrome (True)
By A. H.
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. 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. 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, with microcytic population myelodysplastic syndrom
e (True) Explanation: But variable red cell morphology Question 10. 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. 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. Characteristic f
eatures of Addisonian pernicious anaemia include onset before the age of 20 year
s (False)
By A. H.
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. 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. 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. 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. 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
.g. 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. H.
MCQs VIA WEB 2005
Question 17. 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 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, 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, 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. 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. 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, cold usually IgM association with lymphoproliferative disease (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Chronic lymphatic leukaemia, 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, leucocytosis and thrombocyto
sis (True) Explanation: And elevated red cell mass headaches, 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.g. increased risk of stroke Question 23. 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. The typical laboratory findings in
chronic myeloid leukaemia include leucoerythroblastic anaemia and thrombocytosis
(True) Explanation: Platelet count falls after blast transformation peripheral
blood neutrophilia, 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. 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. H.
MCQs VIA WEB 2005
median survival of 15 years following chemotherapy (False) Explanation: Overall
median survival 6 years Question 27. 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. 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. 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, 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. 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, no lymphadenopathy infectious mononucleosis (True) Explanation: Us
ually both mild myelofibrosis (False) Explanation: Splenomegaly without lymphade
nopathy Question 31. 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. H.
MCQs VIA WEB 2005
increased serum calcium, urate and blood urea (True) Explanation: All of which m
ay be asymptomatic Question 32. In differentiating multiple myeloma from a benig
n monoclonal gammopathy, 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. 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. 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. 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- and age-dependent Question 35. Recognised causes of thrombocytopenia i
nclude megaloblastic anaemia (True) Explanation: Often with leucopenia acquired
immunodeficiency syndrome (True) Explanation: Primary, 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. 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. 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. 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. 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, XI or XII defic
iency (True) Explanation: Initial factors in the intrinsic system Question 39. 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 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 following s
tatements about severe haemophilia A are true the disorder is inherited in an X-
linked recessive mode (True) Explanation: Prenatal diagnosis is possible
By A. H.
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. 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. 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, VIIa, IXa, Xa, XIa, c
ausing heparin resistance factor V Leiden (True) Explanation: Prolonged factor V
activation; 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. Indications for
warfarin anticoagulation include venous thromboembolism (True) Explanation: Mai
ntain the prothrombin ratio in the range 2.0-4.0 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. The hazards of blood transfusion include urticar
ia (True) Explanation: Allergic reaction cardiac failure (True) Explanation: Vol
ume overload-in patients with previous CCF, 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. Clinical features suggesting an acute transfusion react
ion include onset within an hour of starting the transfusion (True)
By A. H.
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. The following diseases are associated with antinucle
ar and/or rheumatoid factor antibodies infective endocarditis (True) Explanation
: Chronic infections (e.g. tuberculosis, leishmaniasis and schistosomiasis) auto
immune thyroiditis (True) Explanation: Also found in myasthenia gravis Sjögren's s
yndrome (True) Explanation: And systemic lupus erythematosus, dermatomyositis an
d progressive systemic sclerosis fibrosing alveolitis (True) Explanation: And au
toimmune hepatitis and sarcoidosis ankylosing spondylitis (False) Explanation: A
nd, by definition, all the seronegative spondyloarthritides Question 2. The bioc
hemical features listed below characterise the following metabolic bone disorder
s increased serum calcium, 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, serum phosphate and serum alkaline phosphatase
-metastatic bone disease (False) Explanation: Increased calcium, normal or low p
hosphate, 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. 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 following statements about infe
ctive arthritis are true the onset is typically insidious (False) Explanation: O
nset usually acute, 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. influenzae is the main cause in children, 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. H.
MCQs VIA WEB 2005
Question 5. 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. 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, sp
ontaneous resolution (False) Explanation: Often very chronic musculoskeletal pai
n without local tenderness (False) Explanation: Multiple tender points are chara
cteristic Question 7. 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. 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, rheumatoid arthritis
is excluded as a possible diagnosis (False) Explanation: Rheumatoid arthritis ty
pically involves atlantoaxial articulations Question 9. 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, 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. H.
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. 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. 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. Typical features of active
rheumatoid arthritis include fever and weight loss (True) Explanation: These al
so occur with minimal joint symptoms, 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.
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. 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. H.
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; 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. The clinical features of Felty&apos;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. 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, unlik
e gold, penicillamine and immunosuppressants Question 18. 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.g. proteinuria and marrow suppression) azathioprine (True) Expl
anation: Reserved for life-threatening or unresponsive disease Question 19. 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. Typical features of seronegative spondyloarthritis include as
ymmetrical oligoarthritis (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Axial joints are involved initially; only 10% of cases present with
a peripheral arthritis involvement of cartilaginous joints (True) Explanation:
E.g. the sacroiliac joints; 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. Features associated with ankylosing spondylitis
include peak onset in the second and third decades (True) subcutaneous nodules (
False) Explanation: Nodules suggest seropositive arthritis, especially rheumatoi
d arthritis HLA-B27 in at least 90% of affected patients (True) Explanation: Ide
ntical twins homozygous for HLA-B27 may, however, 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. 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. 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, 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. 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, frequency and supr
apubic discomfort symmetrical small joint polyarthritis (False) Explanation: Art
hritis is asymmetrical, 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. H.
MCQs VIA WEB 2005
Question 25. 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. 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. 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. 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, 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. 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. 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, 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. 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. 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 intra-
articular corticosteroid injections are contraindicated (False) Explanation: Suc
h injections are often highly effective Question 33. 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
anorexia nervosa (True) Explanation: Multifactorial hypogonadism (True) Explanat
ion: Improved by androgen replacement therapy Question 35. 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; an
drogen and oestrogen therapy are both effective Question 36. In osteomalacia the
finding of a proximal myopathy suggests an alternative diagnosis (False) Explan
ation: Characteristic; 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, 25-hydroxychol
ecalciferol therapy is recommended (False) Explanation: Give 1-á-hydroxycholecalci
ferol; 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 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, especially in elderly patients (False) Explanation: Insidio
us asymptomatic progression; 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. 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. 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. H.
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. Characteristic clinical features of SLE in
clude Raynaud's phenomenon (True) Explanation: Not, however, 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. In the management of systemic lupus eryth
ematosus, 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, 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. Recognised features of
primary Sjögren's syndrome include an increased incidence of lymphoma (True) dryne
ss of the eyes, 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. 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, 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%; anti-DNA antibodies ar
e not seen and complement is normal Question 44. In polymyositis a normal serum
creatine kinase does not exclude the diagnosis (True) Explanation: Especially co
mmon in juvenile myositis
By A. H.
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, elbows, knees and face is typi
cal (True) Explanation: Cutaneous features suggest dermatomyositis (Gottron's pa
pules) Question 45. 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
. 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. 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. The following statements about
the skin are true the surface area of an adult is approximately 2 m2 (True) Expl
anation: Comprising the epidermis, 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; 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. 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. H.
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,
with altered skin colour or texture Question 3. 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, papillom
atous, 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. 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, 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, expanding, subungual area of pigmentation (True) Explanation: Characterist
ically painless Question 5. 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 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. 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. H.
MCQs VIA WEB 2005
Explanation: Arterial and neuropathic aetiology pyoderma gangrenosum (True) Expl
anation: Associated with inflammatory bowel disease syphilis (True) Question 8.
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. 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. Typi
cal features of psoriasis include well-defined erythematous plaques with adheren
t silvery scales (True) Explanation: Typically on the elbows, 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. The characteristic clinical features of psoriasis in
clude sparing of the skin over the head, 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 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. H.
MCQs VIA WEB 2005
Explanation: Largely hormonally mediated open and closed comedones, inflammatory
papules, nodules and cysts (True) Explanation: Seborrhoea (greasy skin) is ofte
n present also Question 13. 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; highly teratogen
ic Question 14. 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, pustules and papules (True) rhinophyma, conjunctivitis and keratitis
(True) non-responsive to oral tetracycline therapy (False) Explanation: Repeated
courses may be necessary Question 15. 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. 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. 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. H.
MCQs VIA WEB 2005
Explanation: Small scaly raised lesions Question 18. 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, 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. 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. 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, e.g. iodides and sulphonamides Qu
estion 21. 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, pearly edge unresponsive to radiotherapy (F
alse) Explanation: Radiosensitive but surgery is preferred Question 22. 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.g. following organ transplantation preceded by leucoplakia on the l
ips, mouth or genitalia (True) Explanation: Or actinic keratosis on the skin
By A. H.
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. 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. 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 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. 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. H.
MCQs VIA WEB 2005
Explanation: Usually bilateral, perhaps other ocular nerves also involved result
s from disease of the upper pons (True) Explanation: Infarction, 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. 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, just a lateral rectus palsy Question 7. 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. 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. 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, 12th nerve absence of the jaw jerk (Fa
lse) Explanation: Jaw jerk is typically brisk Question 10. 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.
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. 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. 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 > 6.7 kPa preservation of the cough and gag reflexes (False) Explanatio
n: All brain-stem reflexes absent Question 13. 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. 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. H.
MCQs VIA WEB 2005
Question 15. 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. 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. 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. H.
MCQs VIA WEB 2005
Question 20. 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. 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.g. carbamazepine Question 22. The typical features of Ménière
's disease include sudden onset of vertigo, 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. 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. 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. H.
MCQs VIA WEB 2005
induction by hyperventilation (True) Explanation: Often used during the recordin
g of an EEG Question 25. 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. 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 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%, 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. 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 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. H.
MCQs VIA WEB 2005
carbamazepine is a recognised cause of hyponatraemia (True) Explanation: Particu
larly in older patients Question 30. 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, 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. 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. 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. Typical causes of transient cerebral ischaemic attacks includ
e carotid artery stenosis (True) Explanation: Usually contralateral motor, senso
ry, 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. 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. H.
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
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. 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, deafness
and vertigo (False) Explanation: Suggest peripheral 8th nerve lesion Question 37
. 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, 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, vomiting and confusion (True) Explanation: With focal hemispheric signs posit
ive blood and CSF cultures (False) Explanation: Lumbar puncture may be hazardous
Question 39. The typical features of adult tuberculous meningitis include heada
che and vomiting (True) Explanation: And general malaise
By A. H.
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. 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, pneumococci and Haemophilus antibiotic therapy
should not be given before CSF analysis has been undertaken (False) Explanation:
Start therapy if the diagnosis is likely, 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. 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. 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. 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, frequency and incontinence (True)
Explanation: In spinal involvement epilepsy, dysphasia or hemiplegia (False) Ex
planation: Epilepsy and hemiplegia are unusual
By A. H.
MCQs VIA WEB 2005
Question 44. 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. 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. 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. 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, 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. 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. H.
MCQs VIA WEB 2005
Explanation: Suggests Friedreich's ataxia Question 49. 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. 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. 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 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. H.
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. 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. 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.g. phaeochromocytoma intraspinal and intracranial neuromas and meningiomas
(True) Explanation: At almost any site nerve deafness (True) Explanation: Acous
tic neuroma Question 56. 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. Recognised causes of a generalised polyneuropathy include bronchial c
arcinoma (True) Explanation: Typically sensory rheumatoid arthritis (True) Expla
nation: And systemic lupus erythematosus; also cause mononeuritis multiplex vita
min B12 deficiency and folate deficiency (True) Explanation: Also vitamin B1, B2
, B6, A and E deficiency amiodarone therapy (True) Explanation: And numerous dru
gs diabetes mellitus (True) Explanation: And myxoedema Question 58. 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. H.
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. The typical features of Guillain-Barré polyneuropathy include onset withi
n 4 weeks of an acute infective illness (True) Explanation: 1-4 weeks, 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, cell count i
s normal Question 60. Typical causes of proximal myopathy include hypothyroidism
(True) Explanation: And also hyperthyroidism; 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. Acute confusion in the elderly is likely to be the r
esult of an adverse drug reaction (True) Explanation: E.g. opiates, 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. 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. H.