1 VARIANT

Answer ALL of the following questions.

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

1.

2.

3.

4.

5.

6.

7.

8.

The indications for tracheostomy include (A, B, C, D)

A.

Sputum retention

B.

An inadequate tidal volume

C.

A flail chest

D.

Tetanus

E.

Acute head injures

The following statements about bronchial obstruction are true (A, C, D)

A.

Emphysema develops in the presence of partial obstruction

B.

Mediastinal displacement is always towards the affected side

C.

Infection is inevitable especially in partial obstruction

D.

A collapsed right middle lobe is best defected radiologically

E.

Inhaled foreign bodies usually lodge in the left main bronchus

The following sputum characteristics are associated with (C, D)

A.

Rusty-coloured-staphylococcal pneumonia

B.

Watery consistency chronic asthma

C.

Foul-smelling lung abscess

D.

Pink and frothy pulmonary oedema

E.

Black chronic bronchitis

The following may cause an increase in transfer factor (TF, DLCO) (A, D, E):
A.

Athletic training

B.

Emphysema

C.

The ventricular septal defect with right-to-left shunt

D.

Polycytaemia

E.

Pulmonary haemorrhage

The following are true of spontaneous pneumothorax (A, B, C, E):

A.

It is associated with Ehlers-Danlos syndrome

B.

May be associated with auscultatory clicks

C.

Is associated with Positive End Expiratory Pressure (PEEP) during Intermittent Positive Pressure Ventilation (IPPV)

D.

Causes an obstructive defect on pulmonary function

E.

May occur in tuberculosis

A lateral chest X-ray which reveals a mass posteriorly overlying the spine suggests the possibility of a (B, E):
A.

Thymoma

B.

Tuberculous abscess

C.

Pericardial cyst

D.

Bronchogenic cyst

E.

Neuroblastoma

Characteristic features of Legionnaires disease include (A, C, E):

A.

Confusion

B.

Lymphocytosis

C.

Hypophosphatemia

D.

Hypernatremia

E.

Diarrhea

Hypertrophic pulmonary osteo-arthropathy (A, B, E):

A.

Occurs in association with gynaecomastia

B.

Is associated with pleural effusion

C.

Can involve the small joints of the spine

D.

Is usually associated with small-cell carcinoma of the bronchus

E.

Regress following vagotomy or tumor resection

9.

10.

11.

12.

13.

14.

15.

16.

17.

Features of occupational asbestos exposure include (A, C, E)

A.

A restrictive lung defect

B.

More severe lung disease when many asbestos bodies are found in the sputum

C.

Non-malignant pleural effusion

D.

Lung nodules

E.

Calcified pleural plaques

Hemoptysis is a recognized manifestation of (B, D, E)

A.

Emphysema

B.

Pulmonary aspergilloma

C.

Extrinsic allergic alveolitis

D.

Bronchial adenoma

E.

Mitral stenosis

Trisomy-18 (B, D, E)
A.

Due to atrial septal defect

B.

Due to ventricular septal defect

C.

Due to coarctation of aorta

D.

Due to pulmonary arterys stenosis

E.

Due to persistent ductus arteriosus

Typical clinical features of pulmonary hypertension include (B, D, E)

A.

Male preponderance

B.

Exertional syncope

C.

Systemic arterial emboli

D.

Giant A waves in the JVP and right parasternal heave

E.

Loud second heart sound and early diastolic murmur

Components of the jugular venous pulse are explained on the basis of the following physiological events (B, D, E)
A.

c wave = closure of the tricuspid valve

B.

a wave = atrial systole

C.

v wave = onset of ventricular systole

D.

x descent = atrial relaxation

E.

y descent = ventricular diastole and tricuspid valve opening

An ejection systolic murmur (A, B, D):

A.

Is heard in aortic stenosis

B.

Is a common finding in a young person with pyrexial illness

C.

Is present at the lower left sternal edge in tricuspid regurgitation

D.

Is heard in the presence of an atrial septal defect

E.

Is caused by ventricular septal defects

Complications of mitral stenosis include (F)

A.

Atrial fibrillation

B.

Stroke

C.

Miocardial infarction

D.

Hematuria

E.

Hypertension

Indications of severe aortic stenosis include (G)

A.

Pulse pressure of 50 mmHg

B.

Third heart sound

C.

Austin Flint murmur

D.

Left ventricular ejection fraction 0f 50%

E.

Giant a wave

Pulmonary valve closure (A, D, E):

A.

Is accentuated in pulmonary hypertension

B.

Occurs early during inspiration

C.

Is accentuated in right bundle branch block

D.

Is delayed in right bundle branch block

E.
18.

19.

20.

21.

22.

23.

24.

25.

26.

May occur before aortic valve closure in left bundle branch block

The following features are characteristic of Fallots tetralogy (E):

A.

A loud pansystolic murmur

B.

A loud first heart sound is commonly heart

C.

There is a fixed splitting of the heart sound

D.

Atrial fibrillation is seen in 75 % of cases

E.

It is associated with increased maternal age

The intensity of a murmur (B, C, E)

A.

From the right side of the heart is increased by expiration

B.

Of aortic stenosis is increased by amyl nitrate

C.

Of hypertrophic obstructive cardiomyopathy is increased by Valsalva manoeuvre

D.

Of mitral stenosis is proportional to severity

E.

Of aortic incompetence is increased by hand-grip exercise

In the normal cardiac cycle (B, E):

A.

Mitral valve opening occurs simultaneously with aortic closure

B.

Left ventricular filling is largely complete before atrial systole

C.

The aortic valve opens simultaneously with mitral valve closure

D.

The aortic valve opens at peak left ventricular pressure

E.

The diastolic notch on the arterial pressure wave form is simultaneous with aortic valve closure

In acute pericarditis (B, D):

A.

Pain is unaffected by posture

B.

Pain is often pleuritic in nature

C.

Is associated with concave upwards ST segment elevation in the anterior chest leads but not in the standard leads of the ECG

D.

Anticoagulants are contra-indicated

E.

In viral pericarditis, viral culture of pericardial fluid usually positive

Type of hearts supply include (A, B, D)

A.

Left

B.

Right

C.

Middle

D.

Mixes

E.

Anterior

Which of these are risk factors for ischemic heart disease (B, C, D)
A.

Coal mining

B.

Hypertension

C.

Hypercholesterinemia

D.

Diabetes mellitus

E.

Asthma

The following drugs may be used to control the ventricular rate in atrial fibrillation (B, C, D)
A.

Quinidine

B.

Sotalol

C.

Amiodarone

D.

Digoxin combined with verapamil

E.

Atenolol combined with verapamil

In hypertension (A, D, E):

A.

Electrocardiography changes of left ventricular hypertrophy improve with lowering of blood pressure

B.

Treatment with prazosin unmasks diabetes mellitus

C.

Anxiety increases the pulse pressure but does not increase the systolic pressure

D.

Salt restriction lowers blood pressure in most individuals

E.

Hypertension is aggravated by oestrogen therapy

Are the following significant finding, on routine examination of a fit thirty year old man (C, D, E):
A.

Extrasystoles

B.

Early, short systolic bruit at left sternal edge

C.

Early, short diastolic bruit at left sternal edge

D.

Bundle-branch block

E.
27.

28.

29.

30.

31.

32.

33.

34.

35.

Split heart sound at mitral area

A diagnosis of myocardial infarction may be excluded if (D)

A.

The electrocardiogram is normal

B.

There is the left bundle branch block

C.

The patient is asymptomatic

D.

The level of MB isoenzyme of creatine phosphokinase remains normal in the first 24-48 hours

E.

The patient has no risk factors for coronary artery disease

Recognized postoperative complications of coronary artery bypass grafting include (A, C, D, E):
A.

Stroke

B.

Endocarditis

C.

Atrial fibrillation

D.

Heart block

E.

Pericardial effusion

In the investigation of suspected angina pectoris (G)

A.

The resting ECG is usually abnormal

B.

Exercise-induced elevation in BP indicates significant ischemia

C.

A normal ECG during exercise excludes angina pectoris

D.

Coronary angiography is indicated if an exercise test is normal

E.

Coronary artery bypass improves survival in asymptomatic patients with triple vessel disease

In chronic arterial occlusion of the lower limbs (B, D)

A.

Claudication usually starts in the shin

B.

Buttock claudication is suggestive of arterial occlusion above the inguinal ligament

C.

Skin ulceration most commonly occurs along the medial border of the foot

D.

Which is severe, there be venous guttering on elevation of the legs

E.

There is usually an associated peripheral neuropathy

There is a major risk of cerebral embolism associated with (B, C, D)

A.

Calf vein thrombosis

B.

Atrial fibrillation
1.

Atrial myxoma

2.

Infective endocarditis

3.

Acute rheumatic fever

Typical causes of stroke include (A, B, C)

A.

High-grade stenosis of carotid artery

B.

High-grade stenosis of vertebral artery

C.

Occlusion of carotid artery

D.

Subintimal haemorrhag

E.

Thromboembolism

The celiac artery supply (A, C, E)

A.

Stomach

B.

Small intestine

C.

Spleen

D.

The sigmoid colon

E.

Duodenum

Mesenteric emboli account for (D)

A.

10-20 % of acute mesenteric ischemia

B.

20-30 % of acute mesenteric ischemia

C.

30-40 % of acute mesenteric ischemia

D.

Approximately 50 % of acute mesenteric ischemia

E.

More then 50 % of acute mesenteric ischemia

Uncommon causes of renal artery occlusive disease are (C, D, E)

A.

Atherosclerosis

B.

Fibromuscular dysplasia

C.

Congenital aortic malformation

D.

Arterial dissection

E.
36.

37.

38.

39.

40.

41.

42.

43.

44.

Renal artery emboli

Symptoms of abdominal aortic aneurysms rupture to duodenum include (A, D, E)

A.

Pain

B.

Peritonitis

C.

Diarrhea

D.

Bloody vomiting

E.

Profuse bloody diarrhea

The treatment of acute lymphangitis in a limb should include (C)

A.

Active mobilisation to allow the muscle pump to maintain lymph flow

B.

Incision of any associated inflamed areas

C.

The use of an appropriate antibiotics

D.

Lymphangiography

E.

Venography

A patient with generalised peritonitis (A, C, E)

A.

Usually has an elevated temperature and pulse rate

B.

Characteristically complains of spasmodic severe pain which causes him to be restless

C.

Characteristically vomits

D.

Will usually have a rapid and deep respiratory pattern

E.

May require paracentesis for diagnosis of the condition

Obstruction of the lumen of the appendix may lead to (A, B, C)

A.

Mucosal ulceration

B.

Gangrenous appendicitis

C.

A perforated appendix

D.

Intissusception of the appendix

E.

Athrophy in the appendix

The following factors are known to be significantly associated with chronic duodenal ulcer disease (D, E)
A.

Oral contraceptive therapy

B.

Duodeno-gastric reflux

C.

Pernicious anemia

D.

Helicobacter pyloris infection

E.

Tobacco consumption

Childhood intussusception (A, C, D)

A.

Usually presents during the first year of life

B.

Is frequently caused by congenital gastrointestinal tract abnormalities

C.

Is frequently ileocolic

D.

Can usually be diagnosed without radiological examination of the abdomen

E.

Rarely requires surgical treatment

Gastric cancer is (C, E)

A.

Most common in the fundus of the stomach

B.

Most commonly a squamous cell carcinoma

C.

Frequently metastasises via the bloodstream

D.

Most frequently an ulceration lesion

E.

Frequently multifocal

Typical features of acute pancreatitis include (A, C, E)

A.

Peripheral circulatory failure

B.

Persistent diarrhea

C.

Pain radiating to the back

D.

Pain relieved by vomiting

E.

Obstructive jaundice

Characteristic features of ulcerative colitis include (C)

A.

Invariable involvement of the rectal mucosa

B.

Segmental involvement of the colon and rectum

C.

Pseudo-polyposis following healing of mucosal damage

D.

Inflamation extending from the mucosa to the serosa

E.
45.

46.

47.

48.

49.

50.

Entero-cutaneous and entero-enteritic fistulae

The typical features of the irritable bowel syndrome include (C, D, E)

A.

Nocturnal diarrhea and weight loss

B.

Onset after the age of the 40 years

C.

History of abdominal pain in childhood

D.

Right iliac fossa pain and urinary frequency

E.

Abdominal distention, flatulence and pellety stools

Liver failure (A, B, C)

A.

Is most common cause of death in patients who present with bleeding oesophageal varices

B.

May be precipitated by diuretics in cirrhotic patients

C.

May present with personality changes

D.

Can be effectively treated on a temporary basis by haemodialysis

E.

Commonly results from prolonged hypotension

Incisional hernias are related to (A, C, D, E)

A.

Wound infections

B.

Anaemia and malnutrition

C.

Obesity

D.

The use of absorbable suture materials

E.

Failure of surgical technique

The spleen (A, B)

A.

Is the commonest abdominal organ to be injured

B.

Is subject to delayed rupture following blunt trauma

C.

Can usually be preserved after blunt injury

D.

Which is injured produces buttock pain

E.

Is protected from injury by its posterior position

Oral cholecystography (A, B, C)

A.

May not opacity the gallbladder when gallstones are present

B.

Is frequently unsatisfactory if intestinal absorbtion is diminished

C.

Will only opacity the gallbladder when the serum bilirubin is less than 3 mg/100 ml (51 mmol/l)

D.

Demonstrates evidence of cholelithiasis in less than 70 % of affected patients

E.

Is the preferred method of confirming the presence of gallstones

The typical features of pancreatic carcinoma include (A, D)

A.

Adenocarcinomatous history

B.

Origin in the body of the pancreas in 60 % of cases

C.

Abdominal pain when arising in the ampulla of Vater

D.

Back pain and weight loss indicate a poor prognosis

E.

Gallbladder enlargement when associated with gallstones

ANSWERS
1
A, B, C, D
11
B, D, E
21
B, D
31
B, C, D
41
A, C, D

2
A, C, D
12
B, D, E
22
A, B, D
32
A, B, C
42
C, E

3
C, D
13
B, D, E
23
B, C, D
33
A, C, E
43
A, C, E

4
A, D, E
14
A, B, D
24
B, C, D
34
D
44
C

5
A, B, C, E
15
F
25
A, D, E
35
C, D, E
45
C, D, E

6
A, B, E
16
G
26
C, D, E
36
A, D, E
46
A, B, C

7
A, C, E
17
A, D, E
27
D
37
C
47
A, C, D, E

8
A, B, E
18
E
28
A, C, D, E
38
A, C, E
48
A, B

9
A, C, E
19
B, C, E
29
G
39
A, B, C
49
A, B, C

10
B, D, E
20
B, E
30
B, D
40
D, E
50
A, D