Professional Documents
Culture Documents
Question 6. The following would help distinguish between a kidney and a spleen in the 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)
Question 7. Nystagmus:
(a) Vertical nystagmus usually indicates a lesion of the medulla oblongata. (False)
(b) Horizontal nystagmus is usually ipsilateral to an irritative 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 cerebellar vermis (the central part). (True)
By A. H.
MCQs VIA WEB 2005
(e) Pendular nystagmus may indicate partial blindness. (True)
Question 8. The following would suggest an upper rather than a lower motor neuron lesion:
(a) Fasciculation. (False)
(b) Increased tone. (True)
(c) An absent plantar reflex. (False)
(d) Clonus. (True)
(e) Relatively little wasting. (True)
By A. H.
MCQs VIA WEB 2005
(a) Type I failure results in a partial pressure of oxygen (pO2) <8 kPa and a partial pressure of carbon dioxide (pCO2)
of >6.5 kPa. (False)
(b) In respiratory failure associated with chronic bronchitis, the level of carbon dioxide (CO2) determines 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 obstructive 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)
By A. H.
MCQs VIA WEB 2005
(c) Tissue plasminogen activator and anistreplase are more effective than streptokinase but not used because they are
far more expensive. (False)
(d) ACE inhibitors improve outcome after myocardial infarction for patients with ventricular dysfunction. (True)
(e) HMGCo-A reductase inhibitor therapy is contraindicated for patients after myocardial infarction. (False)
Module 5 (Cardiology)
Question 2. The differential diagnosis for chest pain includes:
(a) Myocardial infarction. (True)
(b) Oesophagitis. (True)
(c) Pulmonary embolus. (True)
(d) Cholecystitis. (True)
(e) Aortic dissection. (True)
By A. H.
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 intake. (False)
(c) Female sex. (False)
(d) Hypercholesterolaemia. (True)
(e) Increasing age. (True)
Question 8. The following conditions require antibiotic prophylaxis before dental procedures:
(a) Prosthetic aortic valve. (True)
(b) Ventricular septal defect. (True)
(c) Floppy mitral valve with coexistent mitral regurgitation. (True)
(d) Enlarged left ventricle. (False)
(e) A history of infective endocarditis 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 tachycardia. (True)
(d) Lack of adequate tachycardic response to exercise. (True)
(e) Leg 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) Associated mitral stenosis. (True)
(c) Atrial fibrillation of more than 24 hours' duration. (True)
(d) A history of cerebral thromboembolism. (True)
(e) Associated left ventricular failure. (True)
By A. H.
MCQs VIA WEB 2005
(e) Atrial fibrillation. (False)
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 is enlarged. (True)
(c) It is thrusting in mitral stenosis. (False)
(d) It is thrusting in aortic regurgitation. (True)
(e) It is heaving in aortic stenosis. (True)
By A. H.
MCQs VIA WEB 2005
(e) Hypocalcaemia. (True)
Question 23. ECG changes due to myocardial infarction may include the following:
(a) ST elevation. (True)
(b) Sinus tachycardia. (True)
(c) Ventricular tachycardia. (True)
(d) Complete 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)
Module 6 (Neurology)
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)
By A. H.
MCQs VIA WEB 2005
(c) Raised CSF protein. (False)
(d) Oligoclonal bands in the CSF. (True)
(e) Periventricular white matter lesions on magnetic resonance imaging (MRI) of the brain. (True)
By A. H.
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. (True)
Question 13. A lesion to the common peroneal nerve at the fibular head causes:
(a) Weakness of eversion of the foot. (True)
(b) Decreased 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 18. The following clinical features may help differentiate between a syncopal attack and a seizure:
(a) Upright posture at the onset. (True)
(b) Convulsive movements of the limbs. (False)
(c) A bitten tongue. (True)
(d) Urinary incontinence. (True)
(e) Prolonged malaise after the attack. (False)
By A. H.
MCQs VIA WEB 2005
(e) Neck stiffness. (True)
Question 21. A lesion 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) Contralateral third nerve palsy. (False)
Question 22. The following may be seen in a patient 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 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. (True)
(e) Pain from the auditory meatus. (True)
Module 7 (Gastroeneterology)
Question 1. The following statements are true:
(a) Tylosis is associated with achalasia. (False)
(b) On barium swallow, a 'bird's beak' appearance is suggestive of squamous carcinoma. (False)
(c) Pneumatic 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)
By A. H.
MCQs VIA WEB 2005
(e) It is an indication for surveillance endoscopy. (True)
By A. H.
MCQs VIA WEB 2005
(e) Phenobarbitone. (False)
Question 13. The following is true of colon polyps and colon cancer:
(a) The larger the polyp, the greater the risk of carcinoma. (True)
(b) Malignant polyps can be successfully treated by colonoscopy and polypectomy alone. (True)
(c) Hyperplastic polyps have a higher malignant potential than villous polyps. (False)
(d) Polyps are most common in the ascending colon. (False)
(e) Colonic polyps are often recurrent. (True)
Question 14. The following gastrointestinal diseases are associated with the renal conditions listed:
(a) Crohn's disease and renal amyloidosis. (True)
(b) Hepatitis B and glomerulonephritis. (True)
(c) Gastric ulcer and nephrotic syndrome. (False)
(d) Pancreatic neuroendocrine tumours and polycystic kidney 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 lamblia. (True)
(d) It can be associated with Tropheryma whippelei. (True)
(e) When 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. (False)
(d) Bullous pemphigoid with pancreatitis. (False)
(e) Erythema nodosum with Crohn's disease. (True)
By A. H.
MCQs VIA WEB 2005
(e) Dysphagia due to abnormal peristalsis in the oesophagus. (True)
Question 21. The following are risk factors for gastric carcinoma:
(a) Pernicious anaemia. (True)
(b) Coeliac disease. (False)
(c) Partial gastrectomy. (True)
(d) Helicobacter pylori infection. (True)
(e) Ménétrière's disease. (True)
Question 24. The following is a risk factor for the Budd-Chiari syndrome:
(a) Oral contraceptive pill. (True)
(b) Malignancy. (True)
(c) Ascites. (False)
(d) Polycythaemia rubra vera. (True)
(e) Constrictive pericarditis. (False)
Question 25. The following 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. (False)
(c) Age of over 55 years usually has a good prognosis. (False)
(d) A low serum 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 relieved 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 candidiasis. (True)
Question 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 9. The following is true of risk factors for the development of hepatocellular carcinoma:
(a) Females are at greater risk than males. (False)
(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 12. The following GI conditions are associated with microcytic hypochromic anaemia:
(a) Acute duodenal ulceration. (False)
(b) Ankylostoma 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 conditions:
(a) 'Rice water' diarrhoea with cholera. (True)
(b) 'Anchovy sauce' discharge with amoebic dysentry. (False)
(c) 'Redcurrent jelly' and intussusception. (True)
(d) 'Apple core' lesion and diverticulitis. (False)
(e) 'Coffee grounds' and oesophageal varices. (False)
Question 14. The following is true of breath tests 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 hydrogen 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 autoantibodies are associated with the diseases listed:
(a) Antiendomyseal antibodies are associated with coeliac disease. (True)
(b) Anti-LKM antibodies are associated with Goodpasture syndrome. (False)
(c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True)
(d) Antiparietal cell antibodies are associated with Wilson's disease. (False)
(e) Antismooth muscle antibodies are associated with autoimmune chronic active hepatitis. (True)
By A. H.
MCQs VIA WEB 2005
(d) Ascites is a risk factor for bacterial peritonitis. (True)
(e) Ascites due to 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 21. The following drugs can be used for treatment of GORD:
(a) Metronidazole. (False)
(b) Amoxycillin. (False)
(c) Erythromycin. (False)
(d) Metoclopramide. (True)
(e) Omeprazole. (True)
Question 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)
By A. H.
MCQs VIA WEB 2005
(e) Paracetamol. (False)
Module 10 (Neurology)
Question 1. The following cranial nerves carry parasympathetic fibres:
(a) Oculomotor. (True)
(b) Trigeminal. (False)
(c) Facial. (True)
(d) Hypoglossal. (False)
(e) Vagus. (True)
Question 3. The causes of a mixed upper and lower motor neuron picture include:
(a) Guillain-Barré syndrome. (False)
(b) Multiple sclerosis. (False)
(c) Syringomyelia. (True)
(d) Motor neuron disease. (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 meningioma. (False)
Question 6. The following features suggest that increased tone is due to rigidity:
(a) Tone is increased equally in flexors and extensors. (True)
(b) Extensor plantar responses. (False)
(c) Associated pill-rolling tremor. (True)
(d) Clasp-knife reflex. (False)
(e) Tone increases with synkinesis. (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 multiple sclerosis. (False)
(e) It causes a delay in visual evoked potentials. (True)
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 15. The following are causes of acute transient visual impairment:
(a) Retinitis pigmentosa. (False)
(b) Amaurosis fugax. (True)
(c) Papilloedema. (True)
(d) Migrainous aura. (True)
(e) Glaucoma. (False)
By A. H.
MCQs VIA WEB 2005
(d) A receptive dysphasia. (False)
(e) A grasp reflex. (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 Geniculate ganglion. (False)
(e) The cavernous sinus. (True)
Question 24. Clinical features of a unilateral lesion of the cerebellopontine angle may be:
(a) Conductive deafness on the same side. (False)
(b) An ipsilateral hemiparesis. (False)
(c) Ipsilateral weakness of the lower face. (False)
(d) A pseudobulbar dysarthria. (False)
By A. H.
MCQs VIA WEB 2005
(e) Vertigo as a prominent early symptom. (False)
Question 2. Endocarditis:
· It is important to take blood cultures over at least 24 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, endocarditis can be ruled out if the patient is afebrile (False)
Explanation: Flucloxacillin (with gentamicin or rifampicin) is the medical 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 valve
endocarditis subsequently because of their continuing habit.
· Combination antibiotic therapy is almost always appropriate for endocarditis (True)
Explanation: For two reasons; first, the selected combinations are usually additive or synergistic. Second, to prevent the
development of resistance.
· If gentamicin is used for treatment, it should 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 symptoms of phaeochromocytoma include headache, sweating and palpitations (True)
By A. H.
MCQs VIA WEB 2005
· Addison's disease should be considered a possible cause in a hypertensive patient with hirsutism (False)
Explanation: Haemoptysis is also seen with dry bronchiectasis, chronic bronchial sepsis and with aspergillomas.
· Can usually be cured with oral antibiotics (False)
· May lead to pulmonary fibrosis (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Brain and heart. The CT/MR scan usually shows multiple ring-enhancing lesions, which are almost
diagnostic of toxoplasmosis in AIDS. CNS lymphomas are usually single. Cardiac toxoplasmosis is usually diagnosed
at postmortem.
· Cytomegalovirus retinitis can be treated with aciclovir (False)
Module 1 (trial2)
Question 1. In secondary diabetes:
· A patient can be assumed not to be ketosis-prone (False)
· A patient is more than 85% likely to have clinical pancreatic exocrine deficiency (False)
· Classical diabetic complications do not occur (False)
· Thiazide diuretics and beta-blockers can both impair insulin secretion (True)
Explanation: Secondary diabetes causes all the same complications as idiopathic diabetes.
· Most patients with acromegaly are diabetic (False)
Question 2. In hypoglycaemia:
· Insulin-dependent patients may recover from hypoglycaemic coma without treatment (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 always late symptoms of insulin-induced hypoglycaemia (False)
· Insulin-dependent patients may lose their warning symptoms of hypoglycaemia after many years of diabetes
(True)
Explanation: About 50% of patients who have had type 1 DM for 20 years or more develop 'hypoglycaemia
unawareness'.
· Metformin is responsible for as many cases of hypoglycaemia as sulfonylureas (False)
· The symptoms characteristically come on over hours rather than minutes (False)
By A. H.
MCQs VIA WEB 2005
Explanation: The condition of 'T3 toxicosis'.
Question 7. In gout:
· Tophi are an early sign (False)
· Allopurinol is used to treat the acute attack (False)
· Furosemide (frusemide) helps to increase urate excretion (False)
· Large joints are not affected (False)
· Raised serum urate makes the diagnosis certain (False)
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, the cardiac apex is the point where the heart beat can be felt most strongly (False)
Occlusion of the left anterior descending coronary artery causes infarction of the anterior wall of the left ventricle and
interventricular septum (True)
Explanation: Anterior myocardial infarction is caused by disease of the left anterior descending artery.
Question 3. Endocarditis:
It is important to take blood cultures over at least 24 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, endocarditis can be ruled out if the patient is afebrile (False)
Question 7. Hypertension:
Treatment is of no proven benefit in patients 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 stroke.
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 hypertensive patient with hirsutism (False)
By A. H.
MCQs VIA WEB 2005
Circulating antibodies to alveolar tissues (False)
Haemoptysis (False)
By A. H.
MCQs VIA WEB 2005
Most often occurs in the rectum and sigmoid (True)
Explanation: Metaplastic polyps have no malignant potential.
There are further polyps in most cases (False)
Involvement of local lymph nodes does not affect prognosis (False)
Obstruction is more common in right compared with left-sided lesions (False)
Question 21. In a ward with several patients where two of the nurses have had much vomiting and some diarrhoea over
a 48-hour period, you should:
Send the patients home (False)
Culture stools (and vomitus) for viruses (False)
Treat everyone with metronidazole (False)
Exclude visitors from the ward (True)
Explanation: To prevent further spread, unless necessary for, say, a dying patient.
Prevent the patients (affected or not) leaving the ward for investigations, physiotherapy, etc. (True)
Explanation: Unless the investigation was absolutely vital
By A. H.
MCQs VIA WEB 2005
Hepatitis C infection (True)
Explanation: A common 'early' abnormality.
Acute vitamin A poisoning (False)
An ultrasound artefact (False)
By A. H.
MCQs VIA WEB 2005
By A. H.
MCQs VIA WEB 2005
Question 11. In a young female with paraplegia, which of the following would suggest a diagnosis of multiple sclerosis:
Periventricular lesions seen on MR scanning (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 the 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)
Worsening of symptoms during the early morning (False)
Marked impairment of concentration (False)
By A. H.
MCQs VIA WEB 2005
Haemolysis, whatever the cause (False)
By A. H.
MCQs VIA WEB 2005
Explanation: This is true primarily of non-cardioselective beta-blockers
Question 24. The following are features of systemic lupus erythematosus (SLE)
Raynaud's phenomenon (True)
Explanation: Pain during mastication is a characteristic feature of temporal arteritis.
Mononeuritis multiplex (True)
Explanation: Pain during mastication is a characteristic feature of temporal arteritis.
Thrombocytopenia (True)
Explanation: This is one of the typical blood-associated dyscrasias.
Lymphopenia (True)
Explanation: As with thrombocytopenia
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 not give to immunosuppressed patients
hepatitis B (False)
By A. H.
MCQs VIA WEB 2005
Explanation: With abrupt onset
meningitis in Leptospira icterohaemorrhagiae rather than L. canicola infection (False)
Explanation: L. canicola infection is usually 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 13. The features of herpes simplex (HS) virus infections include
recurrent genital ulcers (True)
Explanation: Especially HS type 2
acute gingivostomatitis (True)
Explanation: HS type 1
encephalitis (True)
Explanation: HS type 1
By A. H.
MCQs VIA WEB 2005
shingles (False)
Explanation: Varicella zoster virus
paronychia (True)
Explanation: HS type 1-'herpetic whitlow'
Question 18. The following statements about the life cycle of plasmodia are true
sporozoites 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 cells 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 (False)
Explanation: Fertilisation occurs in the mosquito
By A. H.
MCQs VIA WEB 2005
absence of P. vivax infection in subjects lacking the Duffy blood group (True)
Explanation: West Africans and African Americans are protected
asymptomatic P. malariae parasitaemia persisting for years (True)
Explanation: With or without symptoms
enhanced risk of infection in splenectomised patients (True)
presentation with rigors, herpes simplex and haemolytic anaemia (True)
Explanation: Especially in P. vivax and P. ovale infection
excellent response to chloroquine (False)
Explanation: Widespread resistance-quinine preferred
Question 21. The following are possible causes of fever and a rash in a traveller returning from the tropics
paratyphoid fever (True)
leptospirosis (True)
meningococcal infection (True)
secondary syphilis (True)
HIV seroconversion (True)
By A. H.
MCQs VIA WEB 2005
generalised lymphadenopathy, hepatosplenomegaly and encephalitis (True)
good prognosis given prompt pentamidine or suramin therapy (True)
Explanation: Unless cerebral infection has developed
By A. H.
MCQs VIA WEB 2005
conjunctivitis, iritis and keratitis are characteristic (True)
ivermectin is the drug therapy of choice (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Macules occur, but sensation is retained
Question 35. The following are likely causes of splenomegaly in a patient with fever returning from the tropics
tuberculosis (False)
trypanosomiasis (True)
brucellosis (True)
visceral leishmaniasis (True)
infective endocarditis (True)
Question 37. Characteristic features of late (tertiary and quaternary) syphilis include
negative specific treponemal antigen tests (False)
Explanation: The tests are typically positive
destructive granulomas (gummas) in bones, joints and the liver (True)
sensory ataxia (True)
Explanation: Due to dorsal column spinal disease
aneurysms of the ascending aorta (True)
Explanation: Typically with calcification
poor response of gummas to antibiotic therapy (False)
By A. H.
MCQs VIA WEB 2005
a viral half-life of 1-2 hours in plasma (True)
a better prognosis in the presence of Kaposi's sarcoma (False)
Explanation: Prognosis is worse with Kaposi's sarcoma
By A. H.
MCQs VIA WEB 2005
characterised by copious sputum production (False)
Explanation: Dry cough and dyspnoea
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-ray (False)
Explanation: Normal chest radiograph is found in 15-20% of cases
By A. H.
MCQs VIA WEB 2005
Explanation: Hence less likely to disrupt bowel flora
Legionella pneumophila (True)
Mycoplasma pneumoniae (True)
Explanation: In appropriate dosage
Clostridium welchii (True)
Question 54. The following antiviral agents are active against the following viruses
ganciclovir-cytomegalovirus (True)
amantadine-orthomyxovirus (True)
Explanation: Used in prophylaxis of influenza A
ribavirin-respiratory syncytial virus (True)
Explanation: Also active in Lassa fever
zidovudine-retrovirus (True)
Explanation: Used in AIDS
famciclovir-herpes simplex and herpes zoster viruses (True)
Explanation: Like aciclovir, useful orally or parenterally
Module 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 given a placebo in a randomised controlled clinical trial (RCT). After 1 year of treatment 5
patients in the treatment group and 10 patients in the control group have suffered a stroke. Which of the following
statements are true?
the absolute risk reduction with treatment is 5% (False)
Explanation: 2.5%
the relative risk is 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)
Explanation: Can only be derived from continuing the RCT
By A. H.
MCQs VIA WEB 2005
Explanation: It increases the rate of gastric emptying
digoxin and verapamil compete for renal tubular secretion (True)
Explanation: Similarly, quinidine and amiodarone compete with digoxin for renal excretion
the effect of methotrexate is inhibited by NSAID therapy (False)
Explanation: Increased effect due to inhibition of renal tubular secretion of methotrexate
renal lithium excretion is inhibited by diuretics (True)
Explanation: Recommend a barrier method as well for patients on the contraceptive pill and taking antibiotics
Question 5. The actions of the following drugs are enhanced in liver disease
warfarin (True)
Explanation: Reduces the synthesis of clotting factors
metformin (True)
Explanation: Produces lactic acidosis
chloramphenicol (True)
Explanation: Induces bone marrow suppression
sulphonylureas (True)
Explanation: Increase the risk of hypoglycaemia
naproxen (True)
Explanation: Like other NSAIDs, increases the risk of gastrointestinal bleeding
Question 6. The following statements about drug prescribing in elderly patients are true
the error rate in patients taking prescribed drugs is similar to that found in younger adults (False)
Explanation: Error rates of up to 60% can be found in patients over the age of 60 years
adverse drug reactions are more likely to occur than in younger adults (True)
Explanation: Adverse drug reactions are 2-3 times more common
an increased proportion of body fat increases the accumulation of lipid-soluble drugs (True)
Explanation: Propranolol accumulation is also increased by reduced drug metabolism
drug excretion is typically increased due to impaired urinary concentrating ability (False)
Explanation: Impaired renal clearance associated with a reduced glomerular filtration rate is common
metabolism of paracetamol reduces with advancing age (True)
Explanation: As with other drugs (e.g. theophylline and sedative drugs) doses should be reduced
Question 7. The following are statutory requirements for the prescription of controlled drugs
prescriptions must be typewritten not 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 must specify the prescriber's name and address (True)
prescriptions must state the dosage in both words and numbers (True)
Explanation: Including the total quantity, number of doses, and form and strength of the drug
prescriptions must be signed and dated by the prescriber (True)
Module 3 (Chapter 3)
Question 1. The use of oral activated charcoal is indicated following poisoning with
paracetamol (True)
Explanation: More effective if given early
acetylsalicylic acid (True)
Explanation: More effective if given early and repeated 4-hourly ('gut dialysis')
ferrous 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 4. The following treatments are clinically useful in poisoning with the following agents
glucagons-â-blockers (True)
DMPS (dimercaprol)-heavy metal poisons (True)
Explanation: Useful in arsenic, gold and mercury poisoning
flumazenil-opioid analgesics (False)
Explanation: Used in benzodiazepine overdose
N-acetylcysteine-paracetamol (True)
Explanation: As indicated by plasma paracetamol concentrations post-ingestion
desferrioxamine-iron salts (True)
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 symptoms and signs within < 6 hours of poisoning (False)
Explanation: Usually < 24 hours
Module 4 (Chapter 4)
Question 1. The following statements about pulmonary artery wedge pressure (PAWP) monitoring are correct
PAWP provides an indirect measure of left atrial pressure (True)
the normal range is 15-20 mmHg (False)
Explanation: 6-12 mmHg
the PAWP is reduced in acute left ventricular failure (False)
Explanation: Increased, often > 35 mmHg
complications of monitoring include pulmonary artery rupture (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
oxygen saturation (SaO2) should be maintained in the range 75-85% (False)
Explanation: Maintain > 90%
the oxygenation index (PaO2/FIO2) is a useful measure of gas exchange (True)
Explanation: As is alveolar arterial oxygen gradient
end-tidal alveolar CO2 concentration measures the effectiveness of ventilation (True)
Explanation: As does PaCO2
By A. H.
MCQs VIA WEB 2005
measurement of oxygen saturation requires arterial blood sampling (False)
Explanation: Finger or earlobe spectrophotometry is satisfactory in most instances
a decreasing cardiac output is likely to induce an abrupt fall in SaO2 (True)
Question 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 plasma (False)
Explanation: Hb carriage accounts for the majority
an increase in PaCO2 shifts the oxygen/haemoglobin dissociation curve to the right (True)
Explanation: Bohr effect-facilitates unloading of O2 to tissues
the optimum haemoglobin 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%
increasing 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 5. Diagnostic criteria for the systemic inflammatory response syndrome (SIRS) include
temperature > 38°C or < 36°C (True)
Explanation: Sepsis may cause hypothermia as well as fever
respiratory rate > 30/min (False)
Explanation: > 20/min
heart rate > 90/min (True)
white cell count > 12 000 or < 4000/mm2 (True)
PaCO2 < 4.3 kPa (True)
Question 7. Acute circulatory failure with an elevated central venous pressure are typical findings in
acute pancreatitis (False)
Explanation: Hypovolaemic shock occurs
massive pulmonary embolism (True)
Explanation: Acute right ventricular failure
ruptured ectopic pregnancy (False)
acute right ventricular infarction (True)
pericardial tamponade (True)
By A. H.
MCQs VIA WEB 2005
Question 10. The following statements about mechanical respiratory support are correct
cardiac output increases with positive end-expiratory pressure (PEEP) (False)
Explanation: Cardiac output often falls
PEEP helps correct V/Q mismatch (True)
Explanation: Improves oxygenation in atelectatic areas
continuous positive airways pressure (CPAP) requires intubation (False)
Explanation: A tightly fitting face or nasal mask can be used
the correct position of an endotracheal tube is 4 cm above the carina (True)
intermittent ventilation is useful in the transition to non-assisted ventilation (True)
Module 5 (Chapter 5)
Question 1. The histological features useful in distinguishing benign from malignant lesions include
a lower nuclear to cytoplasmic ratio (False)
Explanation: Increased
the presence of aberrations in nuclear morphology (True)
the number of cell mitoses (True)
Explanation: Increases with cell proliferation rate
the presence of cellular invasion into surrounding tissues (True)
Explanation: Evidence of metastatic spread
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 include
human chorionic gonadotrophin in testicular seminoma (False)
Explanation: Useful in testicular germ cell tumours
alpha fetoprotein in primary hepatocellular carcinoma (True)
Explanation: And testicular germ cell tumours
carcinoembryonic antigen in bronchial adenoma (False)
Explanation: Metastatic colorectal carcinoma
placental alkaline phosphatase in cervical carcinoma (False)
Explanation: There are no useful serum markers for cervical carcinoma
CA-125 in breast carcinoma (False)
Explanation: Useful in ovarian carcinoma
Question 3. The paraneoplastic syndromes listed below are typical of the following tumours
inappropriate ADH-adenocarcinoma of lung (False)
Explanation: Small-cell carcinoma
prothrombotic tendency-pancreatic carcinoma (True)
polymyositis-gastric carcinoma (True)
Explanation: And ovarian and nasopharyngeal carcinoma
myasthenia-like syndrome-small-cell anaplastic lung carcinoma (True)
Explanation: Lambert-Eaton syndrome
acanthosis nigricans-gastric carcinoma (True)
Explanation: And other gastrointestinal malignancy
Question 4. Malignant diseases that are potentially curable using combination chemotherapy include
cervical cancer (True)
squamous cell bronchial carcinoma (False)
Explanation: Refractory to chemotherapy
choriocarcinoma (True)
Explanation: Also testicular teratoma
oesophageal carcinoma (False)
Explanation: Resistant
soft tissue sarcoma (False)
Explanation: Resistant
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 regularly
NSAID therapy is particularly valuable in bone pain (True)
Explanation: Affects prostaglandin metabolism
controlled-release morphine has a 4-hour duration of action (False)
Explanation: 12 hours
respiratory depression is a common feature 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 agents may be more effective
Question 3. The following treatments may be of benefit in a patient with the following cancer-related symptoms
co-danthrusate-constipation (True)
gabapentin-nausea (False)
Explanation: Used for neuropathic pain
trazodone-insomnia (True)
Explanation: A sedating antidepressant
eicosapentanoic acid-anorexia (True)
Explanation: If combined with a high-protein diet
amitriptyline-neuropathic pain (True)
Module 7 (Chapter 7)
Question 1. Expected physiological changes associated with normal ageing include
decreased calcium phosphate content per 100 g bone (False)
Explanation: Bone mass declines (osteoporosis) but mineralisation is normal
increased tissue sensitivity to insulin (False)
Explanation: Reduced insulin sensitivity and glucose tolerance declines
reduced numbers of pacing cells within the sinoatrial node (True)
Explanation: Limits ability to mount a tachycardia
increased glomerular filtration rate (GFR) (False)
Explanation: Decreased number of nephrons, GFR and medullary function
increased chest wall rigidity (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Help reduce the risk of fall fractures
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 identified
parental loss or disharmony in childhood (True)
Explanation: Especially physical or sexual abuse
stressful life events and difficulties (True)
Explanation: E.g. bereavement, redundancy, retirement
chronic physical ill health (True)
Explanation: Also acute severe physical illness
social isolation (True)
Explanation: Particularly lack of a close relationship
By A. H.
MCQs VIA WEB 2005
Explanation: Rare-measure urinary catecholamines
Question 5. Factors associated with a higher suicide risk following attempted suicide include
females aged < 45 years (False)
Explanation: Older males
self-poisoning rather than more violent methods of self-harm (False)
Explanation: Self-poisoning 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: And drug or alcohol misuse
living alone and/or recently separated from partner (True)
Explanation: Or bereavement
By A. H.
MCQs VIA WEB 2005
Explanation: Typical somatic symptoms
claustrophobia and agoraphobia (False)
Explanation: Features of phobic anxiety states
Module 9 (Chapter 9)
Question 1. In a normal 65 kg man, the following statements are true
total body water is approximately 40 litres (True)
Explanation: Relatively constant in health
70% of the total body water is intracellular (True)
Explanation: Approximately 28 litres
75% of extracellular water is intravascular (False)
Explanation: 25% intravascular, 75% interstitial
sodium, bicarbonate and chloride ions are mainly intracellular (False)
Explanation: Extracellular
potassium, magnesium, phosphate and sulphate ions are mainly extracellular (False)
Explanation: Intracellular
By A. H.
MCQs VIA WEB 2005
cellular uptake of potassium is enhanced by adrenaline and insulin (True)
alkalosis predisposes to hyperkalaemia (False)
the normal dietary potassium intake is about 100 mmol per day (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Can produce mild acidosis
excessive liquorice ingestion (True)
Explanation: Due to excessive mineralocorticoid activity
diuretic therapy (True)
Explanation: And hypokalaemia
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)
Explanation: Reduction in total cholesterol of 10%
reduction in high-density lipoprotein cholesterol of 8% (False)
Explanation: Increases by 8%
Question 5. Drug therapies known to increase appetite and body weight include
orlistat (False)
Explanation: Has a role in promoting weight loss
fenfluramine (False)
Explanation: But side-effects preclude use
amitriptyline (True)
fluoxetine (False)
Explanation: Stimulates satiety and can help some patients lose weight
sibutramine (False)
Explanation: Can support weight loss
By A. H.
MCQs VIA WEB 2005
Explanation: Decrease plasma LDL and cholesterol
nicotinic acid increases lipolysis and lowers HDL (False)
Explanation: Decreases lipolysis and plasma triglycerides but increases plasma HDL
fibrates increase VLDL lipolysis (True)
Explanation: Decrease plasma triglycerides and plasma LDL and increase plasma HDL
colestipol diverts hepatic cholesterol synthesis into an increased bile acid production (True)
Explanation: Like colestyramine, it blocks bile acid reabsorption in the gut
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 peripheral neuropathy (True)
Explanation: Add to anti-tuberculosis regimens using isoniazid
pyridoxine-haemolytic anaemia (False)
Explanation: Sideroblastic anaemia may respond
riboflavin-angular stomatitis (True)
Explanation: And also nasolabial seborrhoea
riboflavin-cheilosis (True)
Explanation: Also seen in niacin deficiency
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)
Explanation: Incidence = 10%
DNA testing is useful in determining the presence of PKD1 mutations (False)
renal ultrasound after the age of 18 is the best screening test (True)
Explanation: Detects > 95% of individuals
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 disease-triplet repeat expansions (True)
Explanation: On 4p16
Down's syndrome-chromosomal deletion (False)
Explanation: Chromosomal aneuploidy (trisomy 21)
DiGeorge syndrome-chromosomal microdeletion (True)
Explanation: The commonest microdeletion syndrome
By A. H.
MCQs VIA WEB 2005
retinitis pigmentosa (True)
cystic fibrosis (True)
Explanation: Autosomal recessive
familial hypercholesterolaemia (True)
Explanation: Autosomal dominant
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 saturation at cardiac catheterisation suggests an intracardiac shunt (True)
Doppler echocardiography reliably assesses pressure gradients between cardiac chambers (True)
Explanation: Pressure gradients can be extrapolated from measuring intracardiac flow velocities
radionuclide blood pool scanning accurately quantifies left ventricular function (True)
Explanation: Ejection fraction is usually measured using this technique
Question 8. In the treatment of cardiac failure associated with acute pulmonary oedema
controlled oxygen therapy should be restricted to 28% oxygen in patients who smoke (False)
Explanation: High-flow oxygen in concentrations > 35% should be administered
morphine reduces vasoconstriction and dyspnoea (True)
furosemide (frusemide) therapy given intravenously reduces preload and afterload (True)
nitrates should be avoided if the systolic blood pressure < 140 mmHg (False)
Explanation: Can safely be used with systolic pressures > 110 mmHg
ACE inhibitors decrease the afterload but increase the preload (False)
Explanation: Both preload and afterload are reduced
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 side-effect of ACE inhibitors-probably due to bradykinin accumulation
first-dose hypotension occurs less commonly in patients pretreated with diuretics (False)
Explanation: Omitting diuretics pretreatment minimises risk
treatment is of no benefit until symptomatic left ventricular systolic dysfunction has developed (False)
By A. H.
MCQs VIA WEB 2005
renal artery stenosis (True)
Explanation: May also develop during follow-up
Question 16. The auscultatory findings listed below are associated with the following phenomena
third heart sound-opening of mitral valve (False)
Explanation: Occurs in mid-diastole due to rapid ventricular filling
varying intensity of first heart sound-atrioventricular dissociation (True)
Explanation: Due to variations in stroke volume
soft first heart sound-mitral stenosis (False)
Explanation: Typically loud in mitral stenosis
reversed splitting of second heart sound-left bundle branch block (True)
Explanation: Due to delayed closure of the aortic valve compared with the pulmonary valve
fourth heart sound-atrial fibrillation (False)
Explanation: Coincides with atrial contraction and hence cannot occur in atrial fibrillation
By A. H.
MCQs VIA WEB 2005
Explanation: QRS complexes are usually narrow
Question 23. The following statements about atrioventricular block are true
first-degree block is usually asymptomatic (True)
the PR interval is fixed in Mobitz type I second-degree block (False)
Explanation: Fixed PR = Mobitz type II; variable PR (Wenckebach's phenomenon) = Mobitz type I
decreasing PR intervals suggest Wenckebach's phenomenon (False)
Explanation: PR intervals gradually increase
irregular cannon waves in the jugular venous pressure suggest complete heart block (True)
Explanation: Due to AV dissociation
the QRS complex 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 true
class I agents inhibit the fast sodium channel (True)
Explanation: E.g. lidocaine (lignocaine)-like drugs
class II agents are â-adrenoceptor antagonists (True)
class III agents prolong the action potential (True)
Question 25. The cardiac drugs listed below are associated with the following adverse effects
digoxin-acute confusional state (True)
Explanation: And lidocaine (lignocaine) therapy
verapamil-constipation (True)
Explanation: Calcium channel-blocking effect on smooth muscle
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 28. The risk of developing clinical evidence of coronary artery disease is
increased by exogenous oestrogen use in postmenopausal females (False)
Explanation: Risk is decreased by oestrogen therapy
diminished by stopping smoking (True)
Explanation: Effect is measurable within 6 months of stopping
reduced by the moderate consumption of alcohol (True)
Explanation: Not more than 21 units per week
increased in hyperfibrinogenaemia (True)
increased by hypercholesterolaemia but not hypertriglyceridaemia (False)
Explanation: Both confer increased risk
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 33. Drug therapies which improve the long-term prognosis after myocardial infarction include
aspirin (True)
Explanation: Vascular events are reduced by 25%
nitrates (False)
calcium antagonists (False)
ACE inhibitors (True)
Explanation: Limit infarct expansion
â-blockers (True)
Explanation: Reduce mortality by 25%
Question 34. The following statements about the prognosis of acute myocardial infarction are true
50% of all deaths occur within the first 24 hours (True)
Explanation: Of which half occur within the first 20 minutes, often before help arrives
stress and social isolation adversely affect the prognosis (True)
Explanation: Rehabilitation programmes can be helpful
the 5-year survival is 75% for those who leave hospital (True)
late mortality is determined by the extent of myocardial damage (True)
Explanation: Limiting infarct size improves prognosis
in hospital mortality for those aged over 75 years is over 25% (True)
Explanation: Five times greater than < 55 years of age
By A. H.
MCQs VIA WEB 2005
By A. H.
MCQs VIA WEB 2005
left heart valves are more frequently involved than right heart valves (True)
normal cardiac valves are not affected (False)
Explanation: About 30% have no identifiable predisposing cardiac lesion
glomerulonephritis usually occurs due to immune complex disease (True)
a normal echocardiogram excludes the diagnosis (False)
Explanation: Vegetations may be too small to be detected
Question 42. Central cyanosis in infancy is an expected finding in the following congenital heart diseases
persistent ductus arteriosus (False)
Explanation: With a left to right shunt
transposition of the great arteries (True)
Explanation: Usually due to a shunt through a ventricular septal defect
coarctation of the aorta (False)
Explanation: No shunt
Fallot's tetralogy (True)
Explanation: Right to left shunt through a ventricular septal defect
atrial septal defect (False)
Explanation: Left to right shunt
Question 43. The following statements about persistent ductus arteriosus are true
blood usually passes from the pulmonary artery to the aorta (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
most patients are asymptomatic (True)
Explanation: Symptomless murmur is a frequent presentation
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
pleural friction rub (False)
Question 4. The following statements about pulmonary function tests are true
over 80% of vital capacity can normally be expelled in 1 second (False)
Explanation: More than 70% is normal
the transfer factor is measured using inspired oxygen (False)
Explanation: Carbon monoxide is used
residual volume is increased in chronic bronchitis and emphysema (True)
Explanation: The lungs are hyperinflated
analysis of flow volume curves is of value in suspected central airflow obstruction (True)
peak expiratory flow rates accurately reflect the severity of restrictive lung disorders (False)
Explanation: They measure obstructive ventilatory defects
By A. H.
MCQs VIA WEB 2005
Explanation: Another cause should be sought
bronchiectasis (True)
Explanation: May be massive
Goodpasture's syndrome (True)
Explanation: With associated renal disease
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
nephrotic syndrome (False)
Explanation: Severe hypoalbuminaemia produces transudates
Question 10. In the treatment of acute COPD exacerbations associated with type II respiratory failure
the inspired oxygen content should be at least 40% (False)
Explanation: Controlled oxygen therapy at about 24-28% is usual
nebulised doxapram improves 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 contraindicated (False)
Explanation: May help relieve bronchospasm
BIPAP may be valuable if pH falls (True)
Explanation: But not all patients are candidates for such support
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 contributes to tissue oxygenation in anaemia (True)
Explanation: Also in other situations when Hb is maximally saturated
oxygen toxicity in adults can produce retrolental fibroplasia (False)
Explanation: Occurs only in neonates
central cyanosis unresponsive to 100% oxygen indicates right-to-left shunting of > 20% (True) Explanation: Such
shunts may be extra- or intrapulmonary
Question 13. Typical findings in severe chronic obstructive pulmonary disease include
elevation of the jugular venous pressure (True)
Explanation: A feature of right heart failure
tracheal descent on inspiration (True)
Explanation: Tracheal 'tug' due to mediastinal descent
indrawing of the intercostal muscles (True)
Explanation: A sign of hyperinflation
contraction of the scalene muscles (True)
Explanation: And other accessory respiratory muscles
pursed lip breathing (True)
Explanation: Decreases air trapping
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: PaO2 < 8 kPa in life-threatening attacks
arterial PaCO2 = 5 kPa (True)
Explanation: PaCO2 may remain normal until the late stages
Question 17. The initial management of severe acute asthma should include
24% oxygen delivered by a controlled flow mask (False)
Explanation: High concentration, high flow should be used
salbutamol 5 mg by inhalation (True)
Explanation: Intravenous â2-adrenoceptor agonists can also be used
ampicillin 500 mg orally and sodium cromoglicate 10 mg by inhalation (False)
Explanation: Of no proven value in acute attacks
hydrocortisone 200 mg i.v. or prednisolone 40 mg orally (True)
Explanation: Maintain corticosteroid therapy for at least 7 days in severe attacks
arterial blood gas analysis and chest radiograph (True)
Explanation: Exclude pneumothorax and ventilatory failure
Question 20. In pneumonia, the following features are classically associated with the specific organisms noted
erythema nodosum and Mycoplasma pneumoniae (True)
hyponatraemia and Legionella pneumoniae (True)
contact with sick birds and Klebsiella pneumoniae (False)
Explanation: Chlamydia psittaci
abscess formation and Staphylococcus aureus (True)
haemolytic anaemia and Streptococcus pneumoniae (False)
Explanation: Mycoplasma
Question 21. A non-pneumococcal pneumonia should be considered if the clinical features include
respiratory symptoms preceding systemic upset by several days (False)
Explanation: The converse is typical of 'atypical' organisms
lobar consolidation (False)
By A. H.
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rigors (False)
the absence of a neutrophil leucocytosis (True)
Explanation: Leucopenia can occur in severe pneumococcal infection
palpable splenomegaly (True)
Explanation: Rare in pneumococcal disease
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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
bullous emphysema (False)
Explanation: No association
mycetoma (True)
Explanation: Usually in a tuberculous cavity
necrotising pneumonitis (True)
Explanation: A severe, rapidly progressive illness
bronchopulmonary eosinophilia (True)
Explanation: Typically with wheeze, pulmonary infiltrates and peripheral eosinophilia
extrinsic allergic alveolitis (False)
Explanation: Type III and IV immune responses
Question 30. The following are contraindications to surgical resection in bronchial carcinoma
distant metastases (True)
malignant pleural effusion (True)
FEV1 < 0.8 litres (True)
ipsilateral mediastinal lymphadenopathy (False)
Explanation: But contralateral nodes are a contraindication
oesophageal involvement (True)
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MCQs VIA WEB 2005
Explanation: Pulmonary apical mass
hiatus hernia (True)
Explanation: A retrocardiac opacity
neurofibroma (True)
Explanation: Can be multiple
Question 34. Clinical features compatible with a diagnosis of extrinsic allergic alveolitis include
expiratory rhonchi and sputum eosinophilia (False)
Explanation: Acute dyspnoea without wheeze is characteristic
dry cough, dyspnoea and pyrexia (True)
Explanation: Influenza-like symptoms may exist
end-inspiratory crepitations (True)
Explanation: Typically bilateral
FEV1/FVC ratio of 50% (False)
Explanation: Airway obstruction is absent
positive serum precipitin tests (True)
Explanation: May also be positive in healthy subjects
Question 35. The following statements about asbestos-related disease are true
pleural plaques usually progress to become mesotheliomas (False)
Explanation: Often calcify
pleural effusions are 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 typically decreased (False)
Explanation: A restrictive not an obstructive ventilatory defect
mesothelioma can only be reliably diagnosed at thoracotomy (False)
Explanation: Seldom necessary
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Explanation: Eosinophilia is necessary for the diagnosis
prominent asthmatic features (False)
Explanation: Wheeze may be absent
induction by exposure to drugs (True)
Explanation: Imipramine, phenylbutazone or others
opacities on chest radiograph (True)
Explanation: Pulmonary infiltrates and eosinophilia
Question 39. The following statements about spontaneous pneumothorax are true
breathlessness and pleuritic 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 markings on chest radiograph suggest tension (False)
Explanation: Mediastinal shift suggests tension
surgical referral is required if there is a bronchopleural fistula (True)
Explanation: Pleurectomy may also be necessary
pleurodesis should be considered for recurrent pneumothoraces (True)
Explanation: Particularly if bilateral
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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 capillaries are supplied by the afferent arterioles (True)
the kidney produces erythropoietin (True)
Question 5. The following findings would support a diagnosis of pre-renal rather than established acute renal failure
oliguria < 700 ml per day (False)
Explanation: Pre-renal acute failure is not always oliguric
urine/plasma urea ratio > 10:1 (True)
Explanation: Indicating preservation of renal medullary function
a urinary osmolality > 600 mOsm/kg (True)
Explanation: Indicating preservation of renal medullary function
a urinary sodium concentration < 20 mmol/l (True)
Explanation: Indicating preservation of renal medullary function
hypertension rather than hypotension (False)
Explanation: Suggests primary renal disease
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MCQs VIA WEB 2005
Goodpasture's disease (True)
IgA nephropathy (True)
Explanation: Including Henoch-Schönlein purpura
membranous glomerulonephritis (False)
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high-dose steroids usually control proteinuria (True)
immunosuppressant therapy is indicated for frequent relapses (True)
Explanation: E.g. cyclophosphamide
impaired renal function commonly develops in the long term (False)
Explanation: Rarely, even in relapsing disease
Question 16. The clinical features of adult polycystic renal disease include
an autosomal recessive mode of inheritance (False)
Explanation: Autosomal dominant
cystic disease of the liver and pancreas (True)
Explanation: But liver function tests are normal
renal angle pain and haematuria (True)
Explanation: And hypertension and urinary tract infection
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aortic and mitral regurgitation (True)
Explanation: Common but rarely severe
aneurysms of the circle of Willis (True)
Explanation: 10% will have a subarachnoid haemorrhage
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 epigastric pain
pyuria (True)
peritubular neutrophil infiltration (True)
loin pain and fullness in the flank (False)
Explanation: Suggest perinephric abscess
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MCQs VIA WEB 2005
elevated serum prostate specific antigen (False)
Explanation: Suggests prostatic carcinoma
hard, nodular prostatic enlargement on rectal examination (False)
Explanation: Suggests prostatic carcinoma
Question 2. The following statements about type 2 diabetes mellitus (NIDDM) are true
there is clear evidence of disordered autoimmunity in most patients with type 2 diabetes mellitus (False)
Explanation: In contrast to type 1 diabetes mellitus
monozygotic twins show almost 100% concordance for type 2 diabetes mellitus (True)
Explanation: Compare 35% concordance in monozygotic twins with type 1 diabetes mellitus
patients with type 2 diabetes mellitus typically exhibit hypersensitivity to insulin (False)
Explanation: Variable insulin resistance
obesity predisposes to type 2 diabetes mellitus in genetically susceptible individuals (True)
Explanation: Especially if combined with underactivity
hypertension, hypercholesterolaemia and hyperinsulinaemia often coexist (True)
Explanation: Syndrome X (Reaven's syndrome) associated with macrovascular disease
By A. H.
MCQs VIA WEB 2005
Explanation: Pancreatic fibrosis
primary hyperaldosteronism (True)
Explanation: Conn's syndrome produces a hypokalaemic alkalosis
pancreatic carcinoma (True)
Explanation: Islet cell destruction
thyrotoxicosis (True)
Explanation: Also occurs in phaeochromocytoma and acromegaly
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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 ideal method of monitoring intake (False)
Explanation: Not advocated as the method takes no account of glycaemic effects or fat intake
fat intake should not exceed 35% of total calorie intake (True)
Explanation: UK national diet tends to higher proportion of fat
in obese patients, calorie intake should not exceed 750 kcal/day (False)
Explanation: Calorie restriction of 500 kcal/day is more realistic and sustainable
Question 11. The following statements about other drug therapies in diabetes mellitus are true
Thiazolidinediones enhance endogenous insulin sensitivity (True)
Explanation: Activate peroxisome proliferator-activated receptor ã (PPARã agonists)
Thiazolidinediones produce hyperinsulinaemia and hypoglycaemia (False)
Explanation: Insulin sensitivity in adipose tissue is only increased in patients with insulin resistance
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 peripheral 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 true
Short-acting, regular insulin should be injected at least 30 minutes pre-prandially (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)
intermediate-acting isophane insulin action peaks at 1-3 hours (False)
Explanation: Isophane insulin action has an onset at 1-3 hours and lasts 7-14 hours
The standard UK solution strength is 100 units/ml (True)
Explanation: Different in other countries
Once absorbed, insulin has a plasma half-life of 2 hours (False)
Explanation: Plasma insulin has a half-life of 7 minutes
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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 normal 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 recognise
Question 15. Factors predisposing to frequent hypoglycaemic episodes in a diabetic patient include
Delayed meals (True)
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 possibility
Errors in drug administration (True)
Explanation: Inadvertent and occasionally even deliberate
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Explanation: Even in absence of infection due to acidosis
Question 20. The following statements about the long-term complications of diabetes are correct
cardiovascular disease accounts for 70% of all deaths associated with diabetes (True)
Explanation: Renal failure accounts for 10% of deaths associated with diabetes
the excess mortality associated with diabetes is mainly attributable to microvascular complications (False)
Explanation: Mainly macrovascular complications due to atherosclerosis
the frequency and severity of microvascular complications can be minimised by strict glycaemic control (True)
Explanation: Both in type 1 and type 2 diabetes
cardiovascular complications can be minimised by strict 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 diabetics at high risk from cardiovascular disease also benefit from angiotensin-
converting enzyme inhibitor therapy
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Question 2. Causes of hyperprolactinaemia include
oral contraceptive therapy (True)
Explanation: And pregnancy
chlorpromazine therapy (True)
Explanation: Dopamine antagonist like metoclopramide
primary hypothyroidism (True)
Explanation: High plasma TRH
hypothalamic disease (True)
Cushing's disease (True)
Explanation: High plasma ACTH
By A. H.
MCQs VIA WEB 2005
Question 11. The following statements about thyroid hormones are true
T3 and T4 are both stored in colloid vesicles as thyroglobulin (True)
Explanation: Thyroglobulin is synthesised within thyroid cells
T4 is metabolically more active than T3 (False)
Explanation: T4 should be regarded 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)
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MCQs VIA WEB 2005
Explanation: T4 is deiodinated in liver, muscle and kidney
conversion of T4 to T3 decreases in acute illness (True)
Explanation: Production of reverse T3 may increase
Question 12. The finding of reduced serum free T4 and thyroid-stimulating hormone (TSH) concentrations is
compatible with the following conditions
hypopituitarism (True)
Explanation: With secondary hypothyroidism
primary hypothyroidism (False)
Explanation: Serum TSH would be elevated
nephrotic syndrome (False)
Explanation: Free T4 is normal but total T4 is often increased (high thyroxine-binding globulin (TBG) concentrations)
pneumonia (True)
Explanation: Sick euthyroid 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)
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Explanation: And infertility and impotence
deafness and dizziness (True)
Explanation: Perhaps due to oedema of the middle ear
puffy eyelids and malar flush (True)
Explanation: And rarely alopecia, vitiligo and dry hair
absent ankle tendon reflexes (False)
Explanation: Reflexes preserved with delayed relaxation
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 on histology (False)
Explanation: Solitary parathyroid adenoma in 90%
osteitis fibrosa on bone radiographs at presentation (False)
Explanation: A relatively late feature
the complications of pseudogout and hypertension (True)
Explanation: And peptic ulceration and myopathy
nephrogenic diabetes insipidus (True)
Explanation: With characteristic polyuria
Question 24. The following statements about adrenal gland physiology are true
ACTH normally controls the adrenal secretion of aldosterone (False)
Explanation: Principally under control of angiotensin II
ACTH increases adrenal androgen and cortisol secretion (True)
Explanation: In the zona reticularis and zona fasciculata respectively
the plasma cortisol concentration normally peaks in the evening (False)
Explanation: Cortisol levels fall to a nadir at around midnight
hyperglycaemia increases the rate of cortisol secretion (False)
Explanation: Hypoglycaemia stimulates cortisol release
cortisol enhances gluconeogenesis and lipogenesis (True)
Explanation: Anti-insulin effects
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MCQs VIA WEB 2005
hypoglycaemic episodes (False)
Explanation: Impaired glucose tolerance
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Explanation: 90% are benign
presentation with hypertension and hypercalcaemia (True)
Explanation: Occurs in MEN type II syndrome
control of symptoms following propranolol therapy alone (False)
Explanation: Symptoms worsen due to unopposed á-adrenoceptor activity
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polycystic ovarian syndrome (PCOS) (True)
Explanation: PCOS is associated with obesity and infertility; plasma LH:FSH ratio > 2.5:1
Cushing's syndrome (True)
Explanation: Modest increase in adrenal androgen synthesis
autoimmune polyglandular syndrome (False)
Explanation: Primary adrenal, thyroid, parathyroid, gastric parietal and gonadal failure syndromes
ovarian tumour (True)
Explanation: Ectopic androgen production does not suppress with dexamethasone (unlike excessive androgen
production in congenital adrenal hyperplasia)
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MCQs VIA WEB 2005
Explanation: If this fails, Heller's myotomy may be indicated
By A. H.
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absence of symptoms prior to acute perforation (True
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volume replacement with colloids is preferable to crystalloids (True)
Explanation: Crystalloids rapidly redistribute to the extravascular space
monitoring central venous pressure and/or urine output is advisable (True)
Explanation: Facilitates restoration of optimal circulating volume
surgical intervention should be considered if rebleeding occurs despite ulcer sclerotherapy (True)
Explanation: Consider surgical options in all patients with continuing bleeding
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MCQs VIA WEB 2005
chronic hypochlorhydria (True)
Explanation: Pernicious anaemia and partial gastrectomy
Helicobacter pylori infection (True)
Explanation: H. pylori may account for 60% of gastric carcinoma
Ménétrier's disease (True)
Explanation: Hypertrophic gastritis with protein-losing enteropathy
alcohol and tobacco consumption (True)
Question 22. Causes of small bowel bacterial overgrowth (blind loop syndrome) include
diabetic autonomic neuropathy (True)
Explanation: Reduced small intestinal motility
chronic hypochlorhydria (True)
Explanation: E.g. long-term proton pump inhibitor therapy and pernicious anaemia
jejunal diverticulosis (True)
Explanation: Best demonstrated by barium meal
progressive systemic sclerosis (True)
Explanation: Reduced small intestinal motility
enterocolic fistula (True)
Explanation: E.g. Crohn's disease
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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 (True)
Explanation: And thiazides and corticosteroids
alcohol misuse (True)
Explanation: Common cause in the UK
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Explanation: Biliary tract disease is rarely the cause
Question 29. Features consistent with the diagnosis of chronic pancreatitis include
abdominal or back pain persisting for days (True)
Explanation: Sometimes relieved by crouching or leaning forward
chronic opiate dependency (True)
Explanation: In 20%
increased sodium concentration in the sweat (False)
Explanation: Occasionally in cystic fibrosis
abdominal pain induced and relieved by alcohol intake (True)
pancreatic calcification on plain radiograph or ultrasound (True)
Explanation: But insensitive diagnostic tests
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enterocutaneous and enteroenteric fistulae (False)
Explanation: Suggest Crohn's disease
Question 34. Ulcerative colitis (UC) differs from Crohn's colitis in that
UC occurs at any age (False)
Explanation: Both have a peak incidence at the age 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 ulcerative colitis
toxic dilatation only occurs in ulcerative colitis (False)
Explanation: 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
there is no involvement of the small bowel in UC (True)
Question 37. The typical clinical features of ileal Crohn's disease include
association with tobacco consumption (True)
Explanation: In contrast to ulcerative colitis
presentation with bloody diarrhoea (False)
Explanation: Usually pain rather than diarrhoea unless there is rectal involvement also
presentation with subacute intestinal obstruction (True)
Explanation: With episodes of colicky pain
segmental involvement of the colon and rectum (True)
Explanation: In contrast to ulcerative 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)
Explanation: Such symptoms suggest organic pathology
onset after the age of 45 years (False)
Explanation: Typically affects females aged 16-45 years
history of childhood 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 relieved 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 after a detailed clinical examination (True)
Explanation: Probably the most important therapeutic tools
barium enema and barium follow-through examinations in all patients (False)
Explanation: Investigations are important in older patients
evaluation of social and emotional factors (True)
Explanation: Anxiety and/or depression are often associated with refractory symptoms
referral for psychiatric assessment and therapy (False)
Explanation: Although occasionally psychiatric intervention may be necessary
dihydrocodeine for abdominal pain and diarrhoea (False)
Explanation: Use loperamide, a safer opioid that does not cross the blood-brain barrier
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MCQs VIA WEB 2005
likely to progress to carcinoma before the age of 40 years (True)
Explanation: Carcinoma is usually present when symptoms commence
associated with gastric and small bowel polyps (True)
Explanation: Also with lipomas, epidermoid cysts, osteomas and desmoid tumours
best treated with immunosuppressant therapy in patients aged < 20 years (False)
Explanation: Immunosuppressives have no role; prophylactic colectomy is warranted
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MCQs VIA WEB 2005
Question 5. In the investigation of suspected liver disease
ultrasonography reliably distinguishes solid from cystic masses (True)
ultrasonography reliably excludes liver disease (False)
Explanation: May appear normal in disease
normal liver function values exclude significant liver disease (False)
Explanation: May be normal in 10-15% of patients with cirrhosis
the mortality rate of percutaneous liver 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 concentration < 30 g/l = transudate
Question 9. The following features suggest extrahepatic cholestasis rather than viral hepatitis
a palpable gallbladder (True)
Explanation: E.g. pancreatic carcinoma
right hypochondrial tenderness (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
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MCQs VIA WEB 2005
Question 11. The typical features of type A viral hepatitis (HAV) include
picornavirus infection spread by the faecal-oral route (True)
an incubation period of 3 months (False)
Explanation: 2-4 weeks
a greater risk of acute liver failure in the young than in the old (False)
Explanation: But children are more frequently infected
right hypochondrial pain and tenderness (True)
Explanation: Non-specific findings of acute hepatitis
progression to cirrhosis if cholestasis is prolonged (False)
Explanation: Chronic hepatitis does not occur
Question 12. The following statements about type A viral hepatitis are true
persistent 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 virus is not usually transmitted via infected blood (True)
Explanation: But a recognised rarity
drug-induced acute hepatitis produces similar liver histology (True)
Explanation: Serological investigations should help distinguish
travellers given immune serum globulin are protected for 3 months (True)
Explanation: Some will have natural endogenous protection
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 exposure to unsafe sex or drug misuse (True)
Explanation: Or other exposure to blood or blood products
prodromal illness with polyrtharalgia (True)
Explanation: May cause serum sickness
hepatitic illness more severe than with type A virus (True)
Explanation: Hepatitis A is usually a mild illness
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MCQs VIA WEB 2005
absence of progression to chronic hepatitis (False)
Explanation: And hepatic cirrhosis also occurs
Question 16. The typical features of acute (fulminant) hepatic failure include
onset within 8 weeks of the initial illness (True)
Explanation: Without evidence of pre-existing liver disease
hepatosplenomegaly and ascites (False)
Explanation: Suggest chronic liver disease
encephalopathy and fetor hepaticus (True)
Explanation: With confusion and asterixis (liver flap)
nausea, vomiting and renal failure (True)
Explanation: Renal failure is an ominous development
cerebral oedema without papilloedema (True)
Explanation: Occurs late, if at all
Question 17. Typical liver function values in acute hepatic failure include
hypoalbuminaemia (False)
Explanation: Serum albumin has a long half-life
hypoglycaemia (True)
Explanation: Impaired hepatic gluconeogenesis
prolonged prothrombin time (True)
Explanation: Useful in determining prognosis
serum alkaline phosphatase > 6 times normal (False)
Explanation: Typically not so elevated, unlike the serum transaminases
peripheral blood lymphocytosis (False)
Explanation: May be a polymorphonuclear leucocytosis
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MCQs VIA WEB 2005
parotid gland enlargement (True)
Explanation: Particularly in alcoholic cirrhosis
central cyanosis (True)
Explanation: Hepatopulmonary syndrome associated with pulmonary telangiectasia
Question 21. Causes of ascites in the absence of intrahepatic liver disease include
congestive cardiac failure (True)
Explanation: Also constrictive pericarditis-transudate
nephrotic syndrome (True)
Explanation: Also protein-losing enteropathy-transudate
peritoneal tuberculosis (True)
Explanation: Also carcinomatosis-exudate
lymphatic obstruction (True)
Explanation: Chylous effusion
Budd-Chiari syndrome (True)
Explanation: Transudate associated with hepatic vein occlusion
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MCQs VIA WEB 2005
Explanation: Associated with hypergastrinaemia
hepatorenal failure (True)
Explanation: Associated with reduced renal blood flow
hepatic encephalopathy (True)
ascites (True)
Explanation: And hypersplenism
Question 25. In the management of acute variceal bleeding due to hepatic cirrhosis
the priority is to restore normovolaemia (True)
Explanation: Untreated, shock dramatically reduces liver blood flow and liver function
pharmacological therapy is more effective than variceal banding 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 trinitrate is given to reduce vasoconstriction
balloon tamponade is best undertaken after endoscopic confirmation of bleeding varices (True)
Explanation: Unless the patient is exsanguinating; 20% of patients are bleeding from non-variceal causes
transjugular intrahepatic portosystemic stent shunting (TIPSS) is contraindicated in hepatic failure (False)
Explanation: TIPSS is used when local measures fail and has replaced emergency shunt surgery
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MCQs VIA WEB 2005
Explanation: Sometimes accompanying an acute hepatitis in children
acute hepatitis and chronic hepatitis (True)
Explanation: Or acute hepatic failure or cirrhosis
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
By A. H.
MCQs VIA WEB 2005
By A. H.
MCQs VIA WEB 2005
whooping cough (False)
Explanation: Typically lymphocytosis
mesenteric infarction (True)
Explanation: And myocardial infarction
Question 3. Platelets
have a circulation lifespan of 10 hours in healthy subjects (False)
Explanation: 10-day lifespan
are produced and regulated under the control of thrombopoietins (True)
Explanation: By the megakaryocytes
contain small nuclear remnants called Howell-Jolly bodies (False)
Explanation: Found in red blood cells
decrease in number in response to aspirin therapy (False)
Explanation: May increase
release 5-hydroxytryptamine (5-HT, serotonin) and von Willebrand factor (vWF) (True)
Explanation: 5-HT (delta granules), and vWF and fibrinogen (alpha granules)
Question 4. The following statements about red blood cell morphology are true
hypochromia is pathognomonic of iron deficiency (False)
Explanation: Seen in other disorders of haemoglobin synthesis (e.g. thalassaemia)
polychromasia indicates active production of new red blood cells (True)
Explanation: Residual ribosomal material is stained faintly
poikilocytosis is invariably associated with anisocytosis (True)
Explanation: Sign of dyserythropoiesis
punctate basophilia is a typical feature of beta-thalassaemia (True)
Explanation: And lead poisoning
target cells are associated with hyposplenism and liver disease (True)
Explanation: And haemoglobinopathies
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Explanation: Typically a dimorphic red cell population
hypothyroidism (False)
Explanation: Typically macrocytic
beta-thalasaemia (True)
Explanation: And other thalassaemias
rheumatoid arthritis (True)
Explanation: Or a normochromic normocytic picture
Question 11. Folate and vitamin B12 deficiency both typically produce
subacute combined degeneration of the spinal cord (False)
Explanation: Feature of vitamin B12 deficiency only
intermittent glossitis and diarrhoea (True)
Explanation: Glossitis less common in folate deficiency
mild jaundice and splenomegaly (True)
Explanation: Mild haemolysis
peripheral neuropathy (True)
marked weight loss (True)
Explanation: Partially dependent on underlying cause
By A. H.
MCQs VIA WEB 2005
Explanation: Typically 45-65 years
gastric parietal cell and intrinsic factor antibodies in the serum (True)
Explanation: Found in 90% and < 50% respectively
increased serum bilirubin and lactate dehydrogenase concentrations (True)
Explanation: 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
By A. H.
MCQs VIA WEB 2005
Question 17. Typical features of hereditary spherocytosis include
splenomegaly (True)
Explanation: Also pigment gallstones
intravascular haemolysis (False)
Explanation: Red blood cell destruction occurs in the spleen
decreased red blood cell osmotic fragility (False)
Explanation: Osmotic fragility is increased
transient aplastic anaemia (True)
Explanation: Often in association with parvovirus infection
deficiency of red cell spectrin (True)
Explanation: Red blood cell membrane protein
Question 19 In patients with sickle-cell disease, acute painful crises are likely to be precipitated by
high altitude (True)
Explanation: Decreased PaO2
pregnancy (True)
Explanation: May present as pseudo-toxaemia syndrome
dehydration (True)
Explanation: Rehydration is an essential component of therapy
systemic infection (True)
Explanation: Treat promptly to prevent sickle-cell crises
hypoxia (True)
By A. H.
MCQs VIA WEB 2005
Explanation: Chronic lymphatic leukaemia, lymphoma and also systemic lupus erythematosus
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 leucocyte alkaline phosphatase (LAP) score (False)
Explanation: Usually decreased LAP score
transformation to acute leukaemia (True)
Explanation: Transformation results to either ALL (30%) or acute myeloid leukaemia (AML) (70%)
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)
Explanation: Mild thrombocytopenia with urate usually normal
hypogammaglobulinaemia (True)
Explanation: Associated with a paraproteinaemia in 5%
peripheral blood lymphocytosis in the absence of lymphoblasts (True)
Explanation: Total WCC typically 50-200 × 109/l
positive Coombs test (True)
Explanation: May be associated with haemolysis
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 myelofibrosis
severe aplastic anaemia (True)
alpha-thalassaemia (True)
Explanation: All severe thalassaemias
severe combined immunodeficiency disorder (True)
chronic lymphocytic leukaemia (False)
Explanation: But useful in most other acute and chronic leukaemias
Question 30. The presence of lymphadenopathy and splenomegaly would be expected findings in
multiple myeloma (False)
Explanation: Neither is characteristic
chronic lymphocytic leukaemia (True)
Explanation: Mild splenomegaly, generalised lymphadenopathy
chronic myeloid leukaemia (False)
Explanation: Moderate to massive splenomegaly, no lymphadenopathy
infectious mononucleosis (True)
Explanation: Usually both mild
myelofibrosis (False)
Explanation: Splenomegaly without lymphadenopathy
By A. H.
MCQs VIA WEB 2005
increased serum calcium, urate and blood urea (True)
Explanation: All of which may be asymptomatic
Question 32. In differentiating multiple myeloma from a benign monoclonal gammopathy, the following findings
would favour the diagnosis of multiple myeloma
monoclonal gammopathy with normal serum immunoglobulin levels (False)
Explanation: Myeloma produces suppression of the other serum immunoglobulins
bone marrow plasmacytosis of > 20% (True)
Explanation: A diagnostic prerequisite
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 normal isotope bone scan
By A. H.
MCQs VIA WEB 2005
prolongation of the bleeding time (True)
Explanation: Other clotting tests normal
splenomegaly (False)
Explanation: Suggests other causes of thrombocytopenia
prompt response to corticosteroid therapy (True)
Explanation: Particularly in children
Question 38. The activated partial thromboplastin time (APTT) is typically prolonged in
disorders of the extrinsic pathway (False)
Explanation: The intrinsic pathway
factor VII deficiency (False)
Explanation: Detected by prothrombin time
factor VIII or X deficiency (True)
Explanation: Factor X also influences prothrombin time
factor XIII deficiency (False)
Explanation: Specific assay to measure
factor IX, XI or XII deficiency (True)
Explanation: Initial factors in the intrinsic system
Question 41. The following statements 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 not apparent until the age of 6 months
activated partial thromboplastin time and prothrombin time are both prolonged (False)
Explanation: Only the activated partial thromboplastin time is prolonged
factor VIII has a biological half-life of about 12 days (False)
Explanation: Half-life is 12 hours
desmopressin therapy increases factor VIII concentrations (True)
Explanation: Desmopressin (DDAVP) therapy is useful to limit exposure to blood products
Question 42. The following statements about von Willebrand's disease are true
the disorder is inherited in an X-linked recessive mode (False)
Explanation: Autosomal dominant-gene locus on chromosome 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 protein which is bound to factor VIII (True)
deficiency of vWF is best treated by desmopressin (True)
Explanation: Desmopressin (DDAVP) therapy increases vWF concentrations
Question 43. Thrombophilia with a predisposition to recurrent venous thromboses is associated with
the antiphospholipid antibody syndrome (True)
Explanation: May present with recurrent spontaneous abortion
antithrombin deficiency (True)
Explanation: Decreased inactivation of factors IIa, VIIa, IXa, Xa, XIa, causing 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 deficiency-reduced inactivation of factors Va and VIIIa
By A. H.
MCQs VIA WEB 2005
Explanation: Delayed haemolytic transfusion reaction occurs 5-7 days after the transfusion
rigors and fever (True)
Explanation: Stop the transfusion immediately
chest and back pain (True)
sudden loss of consciousness (False)
Explanation: Unlikely in the absence of other premonitory changes
development of hypotension and shock (True)
Explanation: May be problematic in anaesthetised patients
Explanation: And systemic lupus erythematosus, dermatomyositis and progressive systemic sclerosis
fibrosing alveolitis (True)
Explanation: And autoimmune hepatitis and sarcoidosis
ankylosing spondylitis (False)
Explanation: And, by definition, all the seronegative spondyloarthritides
Question 2. The biochemical features listed below characterise the following metabolic bone disorders
increased serum calcium, serum phosphate and serum alkaline phosphatase-osteoporosis (False)
Explanation: All three are normal in osteoporosis
normal serum calcium and serum phosphate but increased serum alkaline phosphatase-Paget's disease (True)
Explanation: Occasionally the serum calcium may be elevated if immobilisation is prolonged
normal serum calcium and serum alkaline phosphatase but decreased 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 phosphate, and high serum alkaline phosphatase
decreased serum calcium and serum phosphate but increased serum alkaline phosphatase-osteomalacia (True)
Explanation: But all three may be normal
By A. H.
MCQs VIA WEB 2005
Question 5. The following features of backache suggest mechanical or radicular pain 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 pathology
localised tenderness over the greater sciatic notch (True)
Explanation: Suggests lumbar nerve root compression
gradual mode of onset in an elderly patient (False)
Explanation: Suggests significant pathology even if there are no physical signs
back pain and stiffness exacerbated by resting (False)
Explanation: Suggests inflammatory disease
By A. H.
MCQs VIA WEB 2005
septic arthritis (True)
Explanation: And any joint previously traumatised
haemochromatosis (True)
Explanation: Also chondrocalcinosis and Wilson's disease
Perthes' disease (True)
Explanation: And most hip dysplasias
Ehlers-Danlos syndrome (True)
Explanation: Also other causes of hypermobility
Question 14. The typical pattern of synovial disease in rheumatoid arthritis includes
early involvement of the sacroiliac joints (False)
Explanation: More suggestive of a seronegative spondyloarthritis such as ankylosing spondylitis
symmetrical peripheral joint involvement (True)
Explanation: Characteristic pattern of onset
spindling of the fingers and broadening of the forefeet (True)
Explanation: Involvement of the proximal interphalangeal and metatarsophalangeal joints respectively
distal interphalangeal joint involvement of fingers and toes (False)
Explanation: More suggestive of osteoarthrosis or psoriatic arthritis
atlantoaxial joint involvement (True)
Explanation: Often not obvious clinically but can produce cord compression
Question 15. The following statements about rheumatoid arthritis are true
joint pain and stiffness are typically aggravated by rest (True)
Explanation: Early morning stiffness is a characteristic feature of all inflammatory arthritides
By A. H.
MCQs VIA WEB 2005
the rheumatoid factor test is positive in about 70% of patients (True)
Explanation: May be absent at disease onset and is not specific to rheumatoid arthritis
joint involvement is additive rather than flitting (True)
Explanation: The usual pattern; in palindromic arthritis flitting episodes are typical
associated scleromalacia typically produces painful red eyes (False)
Explanation: Scleromalacia is a painless wasting of the sclera unlike the rarer scleritis
sicca syndrome suggests the presence of an alternative diagnosis (False)
Explanation: Common in rheumatoid arthritis
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
enthesitis 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 aortic regurgitation
By A. H.
MCQs VIA WEB 2005
Question 25. In Reiter's disease
a peripheral blood monocytosis is commonly found (False)
Explanation: Polymorphonuclear leucocytosis is typical in the acute phase
sacroiliitis and spondylitis develop in most patients (False)
Explanation: Occur in only 15% of patients
Salmonella or Shigella species can be cultured from joint aspirates (False)
Explanation: Organisms cause the preceding dysenteric illness
calcaneal spurs are not apparent radiologically (False)
Explanation: Appear on radiograph as a periostitis
arthritis resolves within 3-6 months of onset (False)
Explanation: 10% of patients have chronic active arthritis 20 years after onset
By A. H.
MCQs VIA WEB 2005
Explanation: Increased purine turnover
therapy with loop diuretic agents (True)
Explanation: Diminished renal excretion of uric acid
By A. H.
MCQs VIA WEB 2005
anorexia nervosa (True)
Explanation: Multifactorial
hypogonadism (True)
Explanation: Improved by androgen replacement therapy
Question 35. Therapies useful in preventing recurrent vertebral fractures in osteoporosis include
regular exercise (True)
Explanation: Excessive exercise may be associated with low body weight and osteoporosis
oral phosphate supplementation (False)
Explanation: Unless the patient is hypophosphataemic from severe malnutrition
etidronate (True)
Explanation: Bisphosphonate therapy is the most effective and best evaluated
vitamin D and calcium supplementation (True)
Explanation: But this is less effective than bisphosphonate therapy
corticosteroid (False)
Explanation: Causes osteoporosis; androgen and oestrogen therapy are both effective
Question 38. In a male patient with prostate cancer and widespread metastatic bone disease
osteolytic deposits are characteristic (False)
Explanation: Prostatic secondaries are typically osteosclerotic
the plasma parathyroid hormone (PTH) concentration is typically elevated (False)
Explanation: Serum PTH is usually normal even when the serum calcium is high
bone pain is invariably present (False)
Explanation: Asymptomatic disease may be detected coincidentally on radiograph
the alkaline phosphatase is only elevated if pathological fracture occurs (False)
Explanation: Serum alkaline phosphatase is frequently elevated due to osteoblast activation
cyproterone acetate retards progress of the disease (True)
Explanation: Androgen deprivation therapy is of proven value in prostatic cancer
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 lymphocyte activation
increased prevalence in women compared with men (True)
Explanation: Genetic factors appear to be of importance in aetiology
presentation with Raynaud's phenomenon in young men rather than young women (True)
Explanation: And in women aged > 30 years
Question 41. In the management of systemic lupus erythematosus, the following are of proven value
NSAIDs for renal involvement (False)
Explanation: NSAIDs may worsen renal function
corticosteroid therapy for cerebral involvement (True)
Explanation: High doses are often used initially, then reduced to as low a dose as possible on remission of disease
plasmapheresis for immune complex disease (True)
Explanation: Especially when combined with immunosuppressant drugs
hydroxychloroquine for skin and joint involvement (True)
Explanation: 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
By A. H.
MCQs VIA WEB 2005
antinuclear (DNA) antibodies are characteristically absent (True)
Explanation: Similarly in polyarteritis nodosa
electromyography is helpful in differentiation from peripheral neuropathy (True)
underlying malignancy is usually present if weight 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 typical (True)
Explanation: Cutaneous features suggest dermatomyositis (Gottron's papules)
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 small raised areas of skin of altered colour (False)
Explanation: Macules are flat, with altered skin colour or texture
Question 6. The following blistering eruptions are typically associated with mucosal involvement
dermatitis herpetiformis (False)
Explanation: An intensely itchy rash without oral mucosal involvement
bullous pemphigoid (False)
pemphigus (True)
Explanation: Often erosive and with mucosal involvement
toxic epidermal necrolysis (True)
porphyria cutanea tarda (False)
By A. H.
MCQs VIA WEB 2005
Explanation: Arterial and neuropathic aetiology
pyoderma gangrenosum (True)
Explanation: Associated with inflammatory bowel disease
syphilis (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 often present also
By A. H.
MCQs VIA WEB 2005
Explanation: Small scaly raised lesions
Question 21. The typical features of basal cell carcinoma include the following
predominantly affects the elderly (True)
Explanation: Rare in young adults
metastatic spread to the lungs if untreated (False)
Explanation: Spread by local invasion
occurrence in areas exposed to light or X-irradiation (True)
Explanation: Typically on the face or head
papule with surface telangiectasia or ulcerated nodule (True)
Explanation: With a rolled, pearly edge
unresponsive to radiotherapy (False)
Explanation: Radiosensitive but surgery is preferred
By A. H.
MCQs VIA WEB 2005
metastatic spread to the liver and lungs (False)
Explanation: Haematogenous dissemination is rare
unresponsive to radiotherapy (False)
Explanation: Radiosensitive but surgery is preferred
By A. H.
MCQs VIA WEB 2005
Explanation: Usually bilateral, perhaps other ocular nerves also involved
results 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
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-Adie pupils (True)
Explanation: Defect is probably in the ciliary ganglia
right optic nerve lesion (True)
Explanation: An afferent defect
right oculomotor nerve lesion (False)
Explanation: Reaction in right eye only is impaired
bilateral Horner's syndrome (True)
Explanation: Both pupils may be small but response preserved
Question 8. Features of an intracranial lower motor neuron lesion of the facial nerve include
inability to wrinkle the forehead (True)
Explanation: Frontalis weakness
increased lacrimation on the affected side (False)
Explanation: Decreased due to involvement of nervus intermedius
upward deviation of the eye on attempted 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 10. The following statements about bladder innervation are correct
sacral cord lesions usually produce urinary 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 bladder emptying (True)
Explanation: Internal sphincter relaxation and detrusor contraction
pudendal nerve lesions produce automatic bladder emptying (False)
Explanation: Feature of spinal cord lesions
the L1-L2 segment sympathetic outflow mediates bladder relaxation (True)
Explanation: And internal sphincter contraction
Question 11. The following statements about the Glasgow coma scale are correct
the best response to an arousal stimulus should be measured (True)
Explanation: Test 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 orientation = score 5 (True)
Explanation: No speech = 1
the minimum total score = 3 (True)
Explanation: Maximum score = 15
By A. H.
MCQs VIA WEB 2005
Question 15. In the evaluation of a patient with headache
thunderclap headache is 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)
Explanation: Migrainous hemiparesis is well recognised
improvement with simple analgesia suggests tension headache (False)
Explanation: Tension headaches are typically poorly responsive
headache on waking suggests raised intracranial pressure (True)
Explanation: As does morning vomiting
Question 18. Features suggesting vasovagal 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 to happen
confusion following the event (False)
headache following the event (False)
Explanation: Also absence of injury or tongue-biting
memory loss surrounding the event (False)
tongue-biting (False)
Explanation: Also pallor rather than central cyanosis suggests fainting
By A. H.
MCQs VIA WEB 2005
Question 20. Jerking nystagmus that changes in direction with the direction of gaze is
compatible with cerebellar hemisphere disease (True)
Explanation: Maximal on gaze towards lesion if cerebellar disease is unilateral
indicative of a brain-stem disorder (True)
Explanation: May be more marked in the abducting eye (ataxic nystagmus)
compatible with a vestibular nerve lesion (False)
Explanation: Typically 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: Demonstrable using electronystagmography
By A. H.
MCQs VIA WEB 2005
induction by hyperventilation (True)
Explanation: Often used during the recording of an EEG
Question 26. The typical features of absence (petit mal) seizures include
loss of consciousness lasting up to 10 seconds (True)
Explanation: Sometimes with loss of posture
onset around age 25-30 years (False)
Explanation: Typically in childhood
synchronous 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 several hours post-ictally (False)
Explanation: Rapid recovery although may occur very frequently
By A. H.
MCQs VIA WEB 2005
carbamazepine is a recognised cause of hyponatraemia (True)
Explanation: Particularly in older patients
Question 30. Features suggesting epilepsy rather than a simple faint as the cause of blackouts include
impairment of vision heralding the 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: Some 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 32. The following statements about primary brain tumours are correct
meningiomas are the most common type in the middle-aged (True)
Explanation: 20% of all cerebral tumours
gliomas are the most common type in childhood (False)
Explanation: 40% of all cerebral tumours
most childhood brain tumours arise within the posterior fossa (True)
Explanation: They are usually cerebellar tumours
presentation with adult-onset partial seizures is typical (True)
Explanation: Indication for CT
acoustic neuromas usually present in the 6th and 7th decades (False)
Explanation: Fourth and fifth decades
By A. H.
MCQs VIA WEB 2005
Explanation: Internal capsule lacuna
isolated hemiparesis or hemianaesthesia (True)
Explanation: Internal capsule lacuna
history of hypertension or diabetes mellitus (True)
Explanation: Account for > 80% of lacunar strokes
By A. H.
MCQs VIA WEB 2005
fever associated with neck stiffness (True)
Explanation: Fever often low-grade
cranial nerve palsies associated with coma (True)
Explanation: Cranial nerve lesions in 25% of cases
miliary tuberculosis is often present (True)
Explanation: Usual source of infection
CSF cell count > 400 neutrophil leucocytes per ml (False)
Explanation: Lymphocytic meningitis
By A. H.
MCQs VIA WEB 2005
Question 44. Useful investigations in diagnosing multiple sclerosis include
visual and somatosensory evoked potentials (True)
Explanation: Can detect clinically silent lesions in 75% of patients
magnetic resonance brain scanning (True)
Explanation: MRI more sensitive than CT
CSF analysis for oligoclonal IgG bands (True)
Explanation: Occurs in 70-90% of patients between attacks
electroencephalography (False)
Explanation: Non-specific abnormalities
electromyography (False)
Explanation: Test of lower motor neuronal disease
Question 46. Clinical findings consistent with the diagnosis of idiopathic Parkinson's disease include
unilateral onset of the disorder (True)
Explanation: Typically arm tremor
emotional lability (False)
Explanation: Suggests underlying cerebrovascular disease
oculogyric crises (False)
Explanation: Suggests drug-induced extrapyramidal disease
extensor plantar responses (False)
Explanation: Suggests multisystems atrophy (MSA)
impaired voluntary eye movements (False)
Explanation: Impairment of conjugate eye movements suggests progressive supranuclear palsy
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)
Explanation: Prevalence of 4 per 100 000
progressive distal muscular atrophy (True)
Explanation: Typically with absent reflexes
progressive bulbar palsy (True)
Explanation: 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 52. The following statements about spinal cord compression are correct
metastatic disease is a more common cause than primary tumour (True)
Explanation: Usually extradural deposits
the CSF protein concentration is likely to be normal (False)
Explanation: Typically elevated with xanthochromia (Froin's syndrome)
local spinal pain and tenderness usually precede motor weakness (True)
Explanation: Pain may follow nerve root distribution
urinary urgency is commonly the presenting feature (False)
Explanation: A late feature
myelography is the best and most appropriate investigation (True)
Explanation: MRI is now invaluable
By A. H.
MCQs VIA WEB 2005
anterior spinal artery thrombosis (True)
Explanation: Sudden onset typically
spinal neurofibromas and gliomas (True)
Explanation: Intradural pathology accounts for 20% of cases of cord compression
By A. H.
MCQs VIA WEB 2005
Explanation: Motor weakness predominates
painful sensory impairment-alcohol misuse (True)
Explanation: Also autonomic neuropathy with local sympathetic neural dysfunction
sparing of the cranial nerves-sarcoidosis (False)
Explanation: The 7th nerve especially is commonly involved in neurosarcoid
prominent postural hypotension-diabetes mellitus (True)
Explanation: Suggests autonomic involvement
By A. H.