9 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.

A pulmonary contusion (A, D)

A.

Is most evident radiologically 1 to 2 days after an injury

B.

Does not usually resolve for 3 weeks

C.

Does not produce hypoxemia

D.

May require positive pressure ventilation

E.

Frequently presents with blood-stained copious watery sputum

The following statements about spontaneous pneumothorax are true (A, D, E)

A.

Breathlessness and pleuritic chest pain are usually present

B.

Bronchial breathing is audible over the affected hemithorax

C.

Absent peripheral lung markings on chest X-ray suggests tension

D.

Surgical referral is required if there is a bronchopleural fistula

E.

Pleurodesis should be considered for recurrent pneumothoraces

The following statements about pulmonary anatomy are true (B, C, D)

A.

The middle lobe lies posterior to the right upper lobe

B.

The left upper lobe lies anterior to the left lower lobe

C.

The ciliated epithelium extends down to terminal bronchioles

D.

The parietal and visceral pleura are continuous at the hilum

E.

The transverse fissure separates the right middle lobe from the right lower lobe

The following features suggest that a carcinoma of the left main bronchus is probably inoperable (A, C, D):
A.

a FEV1 OF 1.3 L

B.

A right recurrent laryngeal nerve palsy

C.

A wide, fixed carina at bronchoscopy

D.

Tumor within 1 cm of the main carina

E.

Hypercalcaemia with squamous cell carcinoma

Transfer factor (TCO), as measured using the single breath method, is (A, B, D, E):
A.

Greater in childhood than in adulthood

B.

Higher in males than females

C.

Reduced by exercise

D.

Increased in polycythaemia

E.

Reduced in chronic pulmonary sarcoidosis

The post-operative survival rate in lung cancer is reduced if (A, B, C, D, E):

A.

The patient is over 60 years old

B.

The tumor is of small-cell type

C.

There has been weight loss of over 10 lb approximately

D.

The tumor affects the left lung

E.

Pneumonectomy is undertaken

Features of primary pulmonary hypertension include (A, D):

A.

Angina pectoris

B.

Raised PaCO2

C.

Early diastolic murmur which is louder on expiration

D.

Giant a wave in jugular venous pulse

E.

Inverted P waves on electrocardiogram

A boy 18 years old has a moderately severe attack of asthma. One would expect to find (A, E)
A.

pO2 less than 60 mmHg

B.

pCO2 greater than 60 mmHg

C.

Raised plasma bicarbonate level

D.

Immediate relief by intravenous injection of hydrocortisone

E.

Dehydration

9.

10.

11.

12.

13.

14.

15.

16.

17.

Which of the following are characteristic features bronchial carcinoid tumors (C, D)
A.

Superior vena cava obstruction

B.

Radiological evidence of calcification

C.

Recurrent chest infection

D.

Hemoptysis with normal chest X-ray

E.

Weight loss

The following statements are correct (A, D)

A.

The normal pericardial fluid volume is 60-100 ml

B.

The coronary sinus drains into the superior vena cava

C.

The heart normally weighs 500 g

D.

The transverse cardiac diameter is normally less than 50% of the transthoracic diameter

E.

The right atrium normally indents the oesophagus

Tetralogy of Fallot (A, B, C)

A.

Is the most common cause of cyanotic heart diseases

B.

Is caused embriologically by the anterior displacement of the infundibular septum

C.

Is caused embriologically by the superior displacement of the infundibular septum

D.

Is caused embriologically by the posterior displacement of the infundibular septum

E.

Is caused embriologically by the inferior displacement of the infundibular septum

Cardiovascular changes in normal pregnancy include (B, C, D)

A.

Cardiac output increases by 150 % by 12 weeks

B.

Tachycardia, elevated JVP and third heart sound

C.

Reduction in systemic diastolic pressure

D.

Pulmonary systolic murmur

E.

Reduced blood coagulability post partum

An apical mid-diastolic murmur (A, B, C, E):

A.

Is produces by a left atrial myxoma

B.

Can be a Carey-Coombs murmur

C.

Can be associated with severe aortic regurgitation

D.

In severe mitral stenosis is associated with a loud S3

E.

Is accentuated after exercise

In the investigation of patients with cardiac failure (B, D, E)

A.

The cardiothoracic ratio (CTR) on chest X ray is usually > 0.6

B.

Pulmonary venous congestion is the earliest change on chest X ray

C.

Two-dimensional echocardiography can estimate cardiac output

D.

Doppler echocardiography can estimate pressure gradients

E.

Radionuclide myocardial scanning can identify areas of ischemia

Disorders typically producing the sudden onset of symptomatic mitral incompetence include (B, C, D, E)
A.

Marfans syndrome

B.

Acute myocardial infarction

C.

Acute rheumatic fever

D.

Infective endocarditis

E.

Diphtheria

Characteristic features of severe mitral stenosis include (A, C, D):

A.

A sternal heave

B.

A loud third heart sound

C.

No audible diastolic murmur

D.

Ascities

E.

A mean left atrial pressure of 15 mmHg

Cardiac involvement in rheumatoid arthritis (B, D, E)

A.

Is rare in the absence of a previous history of rheumatic fever

B.

Is usually apparent as pericarditis

C.

Is confined to the pericardium and endocardium

D.

Is seldom evident clinically but common at autopsy

E.

Results in constrictive pericarditis in some patients

18.

19.

20.

21.

22.

23.

24.

25.

26.

In infective endocarditis (A):

A.

Alpha-haemolytic streptococci are the commonest causative organisms

B.

Prophylactic tetracycline therapy is indicated prior to dental extraction

C.

Diffuse glomerulonephritis leads to irreversible renal failure

D.

Valve replacement is contraindicated until after at least 2 weeks of antibiotic therapy

E.

Blood cultures are best taken during peaks of pyrexia

Infective endocarditis is associated with (A, C, D, E):

A.

Arthralgias

B.

Ostium secundum rather than ostium primum atrial septal defect

C.

Normal leucocyte count

D.

Haematuria

E.

Negative blood cultures

Aortic regurgitation (A, B, C):

A.

Can cause left ventricular hypertrophy detectable on the electrocardiogram

B.

When severe can partially close the anterior mitral valve leaflet

C.

Is sometimes caused by a ventricular septal defect

D.

Is a cause of giant V waves in the jugular venous pulse

E.

Is often associated with Kussmauls sing

Technical difficulties during echocardiography can occur in (A, B, D):

A.

Patients with extreme obesity

B.

Emphysematous patients

C.

Patients who have had permanent pacemakers implanted

D.

Pectus excavatum

E.

Young children

Recognized causes of congestive cardiomyopathy include (A, B, D, E):

A.

Polymyositis

B.

Alcohol abuse

C.

Endomyocardial fibrosis

D.

Transfusion haemosiderosis

E.

Friedreichs ataxia

In the normal heart (D, E):

A.

The sinus node is situated in the inter-atrial septum

B.

The coronary sinus orifice opens into the right ventricle

C.

The foramen ovale is rarely patent after the first year of life

D.

The mitral anterior cusp is larger than posterior cusp

E.

The right coronary artery usually supplies the inferior surface of the left ventricle

Palpitation is a recognized feature of (A, B, C, D, E):

A.

Excessive coffee drinking

B.

Nebulised bronchodilatator treatment

C.

Hypoglycemia

D.

Carcinoid syndrome

E.

Wolff-Parkinson-White syndrome

Regarding PPH (A, B, C, E):

A.

A routine haematological screen may reveal polycythaemia

B.

The pulmonary artery is enlarged

C.

P waves may have a characteristic appearance

D.

T waves are usually hyperacute

E.

Cardiac catheterization

Serious conducting tissue disease requiring the implantation of a permanent pacemaker (C, D):
A.

Is commonly a result of viral illness

B.

Can occur following an attack of rheumatic fever

C.

Can occur as a result of ischemic heart disease

D.

May follow successful cardiac surgery

E.

Often does not show up on a resting electrocardiogram

27.

28.

29.

30.

31.

32.

33.

Absolute or relative contraindications to thrombolytic therapy include (A, B, C)

A.

Aortic dissection

B.

Previous duodenal ulceration

C.

Ulcerative colitis

D.

Syndrome X

E.

Contraceptive pill

In the PA chest X-ray, the cardiac silhouette (C, D, E):

A.

Accurately identifies left atrial size

B.

Is usually increased in size in right ventricular hypertrophy

C.

Is within normal limits in chronic hypoadrenalism

D.

Correlates with the severity of hypertensive heart disease

E.

Shows a prominent pulmonary artery shadow in normal adolescents

In patients with hyperlipoproteinemia (A, B, D)

A.

The children of patients with familial type 11a hyperlipoproteinemia have a 50 % chance of inheriting the trait

B.

Chylomicrons consist primarily of triglycerides

C.

Plasma cholesterol is reduced in the nephrotic syndrome

D.

Long term gemfibrozil therapy decreases the incidence of cardiac events

E.

Plasma cholesterol decreases with the age

Raynauds phenomenon is recognized association of (A, B, C, D)

A.

Thromboangiitis obliterans (Buergers disease)

B.

Cryoglobulinemia

C.

Progressive systemic sclerosis

D.

Vibration trauma

E.

Giant cell arteritis

Symptoms associated with carotid bifurcation disease include (A)

A.

Aphasia

B.

Gait ataxia

C.

Nystagmus

D.

Drop attacks

E.

Dysarthria

Kink of carotid artery is (A, B, C, E)

A.

S-configuration of artery

B.

C-configuration of artery

C.

Circular configuration of artery

D.

Dilatation of artery

E.

Deviation of artery

Phaeochromocytoma (A, C, E):

A.

May be familial

B.

Is never malignant

C.

May cause sustained rather than episodic hypertension

D.

May cause hyperthyroidism

E.

Is associated with neurofibromatosis

34.

Ischemic colitis (B, C, D, E)

A.

Often presents with diarrhea

B.

Often presents with rectal bleeding

C.

Is commonly situated around the splenic flexure

D.

Is often effectively managed by non-surgical means

E.

May be associated with abdominal aorta aneurysm

35.

A dissecting aneurysm of the aorta (A, C, D, E)

A.

Usually starts around the aortic arch

B.

Is so-called because of the extensive mediastinal destruction it produces when it ruptures

C.

Is associated with pregnancy

D.

Is a feature of Marfans syndrome

E.

May present with acute lower limb ischemia

36.

37.

38.

39.

40.

41.

42.

43.

44.

In pulmonary embolism (A, B, E):

A.

A majority of the thrombi originate in the lower extremity

B.

Is the most common cause of an acute respiratory admission to hospital

C.

The venous volume of a thrombus in the pelvic is more than in the leg

D.

Thrombophlebitis does not lead to a pulmonary embolism

E.

Atrial fibrillation is the most common complicating arrhythmia

Pulmonary embolism (A, E)

A.

Can be demonstrated at postmortem in 60% of people over the age of 60 years

B.

Can usually be diagnosed by plain chest radiograph

C.

Typically produce prolongation of T waves on electrocardiogram

D.

Of the paradoxical variety has the red and white laminae of originating thrombus in the reverse of the normal order

E.

Can be effectively treated by infusion of streptokinase through a pulmonary artery catheter

Appendicitis (D)
A.

Is more common in females

B.

Is distributed evenly throughout the worlds population

C.

Is more likely to occur if the appendix is in the retrocaecal position

D.

Is commonly the result of appendicular obstruction

E.

Is frequently recurrent

Typical features of peptic ulcer dyspepsia include (B, C, E)

A.

Sharp stabbing epigastric pain

B.

Well-localised pain relieved by vomiting

C.

Pain-free remissions lasting many weeks

D.

Nausea and epigastric pain relieved by belching

E.

Noctural pain causing frequent night waking

Strangulation of the bowel (A, C, D, E)

A.

Commonly complicates closed loop obstruction

B.

Is difficult to distinguish from simple intestinal obstruction

C.

Is accompanied by bleeding into the affected bowel

D.

Frequently causes peritonitis

E.

May results in Gram-negative septicaemia

Biliary colic typically (C, D)

A.

Occurs 3 to 4 hours after meals

B.

Lasts 5 to 20 minutes

C.

Radiates from the upper abdomen to the right subscapular region

D.

Is made worse by deep inspiration

E.

Is followed by jaundice

Acute perforation of a peptic ulcer is typically associated with (B, E)

A.

Acute rather than chronic ulcers

B.

Duodenal more often than gastric ulcers

C.

Abdominal pain unrelated to the extent of peritoneal soiling

D.

The absence of nausea and vomiting

E.

Symptomatic improvement several hours following onset

Systemic manifestations of Crohns disease include (A, B, C, E)

A.

Arthralgia

B.

Finger clubbing

C.

Growth retardation

D.

Alopecia

E.

Pyoderma gangrenosum

The following statements about colonic carcinoma are true (A, C)

A.

It is the commonest of all gastrointestinal carcinomas

B.

The majority of carcinomas arise in the right hemicolon

C.

After resection, there is a recognised risk of second carcinoma

D.

Dukes A classifies tumor extending to the serosa only

E.

Only a minority of rectal tumors are palpable per rectum

45.

46.

47.

48.

49.

50.

The anemia associated with chronic liver disease may be due to (A, B, C)
A.

Gastrointestinal bleeding

B.

Decreased red cell survival

C.

Hypersplenism

D.

Deficiency of intrinsic factor

E.

Decreased iron absorption

The typical features of primary biliary cirrhosis include (A, C)

A.

Xanthomata of the palmar creases and eyelids

B.

Poor prognosis even in asymptomatic patients

C.

Hepatomegaly precending splenomegaly

D.

Dilated bile ducts on ultrasonography

E.

Improved survival rate with immunosuppressant therapy

Penetrating wounds of the abdomen (C)

A.

Can be adequately explored and their depth determined by a probe

B.

Frequently result in acquired abdominal wall herniae

C.

May be managed by careful observation, laparotomy being indicated only if signs of peritonitis or blood loss occur

D.

Demand an urgent laparotomy

E.

Can be treated conservatively if the weapon is less than 3 cm long

Liver cancer (A, B, D)

A.

Is commoner in patients with cirrhosis

B.

Often presents with ascites

C.

Has an increased incidence in sheep farmers

D.

Produces measurable serum levels of a fetal protein

E.

Has been associated with the contraceptive pill

In the investigation of chronic pancreatic disease (E)

A.

Glucose tolerance is typically normal in pancreatic carcinoma

B.

Duodenal ileus is a characteristic feature of chronic pancreatitis

C.

Stool microscopy is more helpful in adults than children

D.

ERCP can reliably distinguish carcinoma from chronic pancreatitis

E.

Pancreatic calcification suggests that chronic pancreatitis is the result of alhogol abuse rather than biliary tract disease

Gallstones (E)
A.

Occur more frequently in black Africans and Indians than Caucasians

B.

Are demonstrable in over 75 % patients > 60 years of age

C.

Comprise cholesterol stones in 75 % of gallstones

D.

Are usually cholesterol stones in hepatic cirrhosis

E.

Are usually the result of reduced hepatic bile acid secretion

ANSWERS
1
A, D

2
A, D, E

3
B, C, D

4
A, C, D

5
A, B, D, E

6
A, B, C, D,

7
A, D

8
A, E

9
, D

10
A, D

11
A, B, C
21
A, B, D

12
B, C, D
22
A, B, D, E

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

14
B, D, E
24
A, B, C, D,

15
B, C, D, E
25
A, B, C, E

E
16
A, C, D
26
C, D

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

18
A
28
C, D, E

19
A, C, D, E
29
A, B, D

20
A, B, C
30
A, B, C, D

31
A
41
C, D

32
A, B, C, E
42
B, E

33
A, C, E
43
A, B, C, E

E
34
B, C, D, E
44
A, C

35
A, C, D, E
45
A, B, C

36
A, B, E
46
A, C

37
A, E
47
C

38
D
48
A, B, D

39
B, C, E
49
E

40
A, C, D, E
50
E