Professional Documents
Culture Documents
PAPER 1
COMPUTER NUMBER.
INSTRUCTIONS:
There are 100 multiple choice questions, please answer all the questions on the answer sheet provided.
NOTE: CORRECT ANSWER ONE MARK, WRONG ANSWER NEGATIVE HALF MARK, UNANSWERED ZERO
MARK
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1. The pulse:
a. In pulsus paradoxus the rate slows during inspiration.
b. Corrigans sign support a diagnosis of aortic stenosis.
c. A collapsing pulse may be noticed in thyrotoxicosis.
d. Pulsus alternans indicates a poorly functioning left ventricle.
3. The following would help distinguish between a kidney and a spleen in the left upper
quadrant:
a. Dull to percussion over the mass.
b. A well localized notched lower margin
c. Moves with respiration
d. A ballottable mass
4. The following would suggest an upper rather than a lower motor neuron lesion:
a. Fasciculation
b. Increased tone
c. An absent plantar reflex
d. Clonus
5. The face:
a. A malar flush may indicate mitral valve disease or hypothyroidism
b. A butterfly rash in the face is seen in dermatomyositis
c. An expressionless face and drooling could indicate Parkinsons disease
d. Bells palsy can cause ptosis due to paralysis of orbicularis oculi
6. Hand signs:
a. Clubbing may be caused by uncomplicated chronic bronchitis
b. Koilonychias usually indicates liver disease
c. Oslers nodes and Heberdens nodes both occur in osteoarthritis
d. Splinter hemorrhages are due to embolic rather than immunological phenomena
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7. Paracetamol overdose:
a. Ipecacuana followed by oral methionine is effective for most patients who are
just over the treatment line
b. Can cause renal failure
c. Intravenous N-acetylcysteine frequent causes anaphylaxis
d. Causes liver failure
8. Leukemia:
a. The common presenting triad is infection, bleeding, and fatigue
b. Acute Myeloid Leukemia (AML) may result spontaneously
c. The usual development of chronic lymphocytic leukemia is a transformation to
acute lymphoblastic leukemia
d. A platelet count of 40 109/L would not normally give rise to spontaneous
bleeding
9. For self-poisoning:
a. Gastric lavage is recommended for most drugs up to 12hours after ingestion
b. Naloxone is the specific antidote for benzodiazepine overdose
c. Patients with tricyclic antidepressant overdose need cardiac monitoring for up to
48 hours
d. Pinpoint pupils could indicate opiate overdose
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12. Cardiac causes of clubbing are as follows:
a. Uncomplicated atrial septal defect
b. Chronic infective endocarditis
c. Atrial fibrillation
d. Acute endocarditis
13. Ptosis may be a feature of:
a. Myotonic dystrophy
b. Horners syndrome
c. Abducens nerve palsy
d. Myasthenia gravis
16. Which of the following is dependent on bile salts for its absorption:
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
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18. Pleural aspiration is useful in the following situations:
a. Pleural tuberculosis
b. Empyema
c. In diagnosing mesothelioma
d. Viral pleurisy
20. Diagnostic criteria for the systemic inflammatory syndrome (SIRS) include:
a. Temperature > 380C or <360C
b. Respiratory rate >30/ min
c. Heart rate >90/min
d. White cell count >12 000
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24. In organophosphate poisoning,
a. RBCs transketolase activity can be useful in monitoring treatment
b. Fasciculation is a result of overwhelming muscarinic receptors response
c. Patient may present as Parkinsonism later in life
d. Death is due to respiratory failure
29. Which of the following on urinalysis is most likely in keeping with acute glomerulonephritis
a. Proteinuria
b. Erythrocyte casts
c. Granular casts
d. Hyaline cast
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30. A 32 year old man has trace proteinuria on dipstick urinalysis. Which of the following
statements concerning proteinuria is correct?
a. Persistent proteinuria should be investigated
b. Can be caused by fever
c. Always caused by tubular secretion
d. In systemic disease, it has no prognostic value
31. A 60 year old woman with heart failure and renal function has been on Lasix 60mg for 4
weeks with a very good diuretic response. She comes in with improved heart failure
symptoms, but has significant fatigue and muscle weakness. What are possible
explanations for her condition?
a. Dehydration
b. Hyperkalemia
c. Anemia
d. Hypokalemia
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35. Cushing syndrome:
a. Causes osteoporosis
b. The diagnosis is made by a high dose dexamethasone suppression tests
c. Serum adrenocorticotrophic hormone (ACTH) is important in diagnosing the
underlying cause
d. Can only be cured by bilateral adrenalectomy
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40. The following is true of viral hepatitis:
a. Hepatits C commonly presents with jaundice.
b. Hepatitis E is fatal particularly in pregnant women.
c. Hepatitis BeAg is a marker of viral replication.
d. Hepatitis A is a risk factor for hepatoma.
42. The following gastrointestinal disease are associated with the renal conditions listed:
a. Crohns disease and renal amyloidosis.
b. Hepatitis B and glomerulonephitis.
c. Gastric ulcer and nephritic syndrome.
d. Pancreatic neuroendocrine tumours and polycystc kidney disease.
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46. The following are features of urinary infections in elderly people:
a. Patients usually complains of dysuria
b. They may present with falls
c. They may present with constipation
d. Estrogen supplements may reduce their frequency in post-menopausal women
a. Infection
b. Diarrhoea.
c. Gastrointestinal bleeding
d. Use of opioid drugs.
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52. The following may cause the nephrotic syndrome;
a. Minimal change disease
b. Treatment with beta- blockers
c. Rheumatoid arthritis
d. Diabetic mellitus
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57. In insulin treatment;
a. Pen injectors are reserved for the small minority who take four or more injections
per day
b. Only patients who cannot be controlled with once- daily insulin should have two
or more injections
c. Insulin should be started without delay in a thin hyperglycaemic patient with
ketonuria
d. Insulin may sometimes be needed during short periods of illness in patients with
type 2 DM.
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62. Disorders of coagulation leading to bleeding may occur in,
a. Vitamin K intoxication
b. Factor IX deficiency
c. Protein S deficiency
d. Factor VIII deficiency
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68. About Parkinsonism,
a. Mainly result from reduction of dopaminergic transmission within the basal ganglia
b. Intentional tremor and akinesia help in diagnosis
c. Family history is a risk factor
d. Neuropsychiatry symptoms might be present
70. A 70 year old woman complains of sudden onset of weakness of left arm and leg,
she also experiences difficulties in speech and loss of vision in one eye. Although
these symptoms were frightening, they improved within 10 hours and she was
feeling well she came to the clinic. What is the likely diagnosis
a. Patient has a minor stroke
b. Patient has Motor neurone disease
c. Patient has Parkinsons disease
d. Patient has Transient Ischaemic attack
71. A young lady of 35 complains of dizziness and fainting attacks on several occasions.
She also complains of palpitation and gets tired very easily. She has noticed that her
monthly periods are prolonged and heavy in recent months. What could be the
problem?
a. The patient has anaemia
b. The patient may have fibroids
c. The patient has psychosis
d. The patient has neurofibromatosis
72. A 17 year old female patient presents with very severe bone pain. She is sweating
profusely. Her pulse rate is 108 beats per minute. Her BP id 90/60 mm Hg. This is the
third episode experienced in the past 6 months. Her sibling sister experiences similar
attacks. What could be the diagnosis?
a. Patient has Parkinsons disease
b. Patient has Hepatoma
c. Patient is in Sickle cell crisis
d. Patient has Myocardial Infarction
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73. A 58 year old male nurse is admitted to Levy Mwanawasa general hospital
complaining of sudden onset of severe headache. He has nausea and has vomited
several times on his way to the hospital. He also had a seizure just before arriving at
the hospital. On examination he is found to be delirious, photophobic and has
temperature of 39 degrees Celcius, He has neck stiffness and positive kernigs sign.
What could be the cause?
a. Patient has cerebral malaria
b. Patient has subarachnoid haemorrhage
c. Patient Pontine haemorrhage
d. Patient has bacterial meningitis
75. In vascular injury, the main process that contribute to bleeding arrest are
a. Vasoconstriction
b. Gap plugging by platelets
c. Nitric oxide production
d. Coagulation cascade
77. In meningitis,
a. Diastolic hypertension is an early sign
b. Reduced pulse rate may signify increased intracerebral pressure
c. Petechiae rash may suggest meningococcus
d. Non infective meningitis may be caused malignant cells
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78. Aseptic meningitis may be due to
a. viral infection
b. TB
c. Partly treated bacterial infection
d. Lyme disease
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84. In the evaluation of a confused patient, following should be considered
a. Motor neurone disease
b. Drug intoxication
c. Cerebral Malaria
d. Post-Seizure event
88. A pleural effusion with a pleural fluid: serum protein ration of >0.5 would be typical
of
a. Congestive cardiac failure (CCF)
b. Renal failure
c. Pneumonia
d. Nephrotic syndrome
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90. A non-pneumococcal pneumonia should be considered if the clinical features include
a. Respiratory symptoms preceding systemic upset by several days
b. Lobar consolidation
c. The absence of a neutrophil leucocytosis
d. Palpable splenomegaly
94. Pulmonary infection with Aspergillus fumigatus is a recognised cause of the following
a. Bullous emphysema
b. Mycetoma
c. Necrotising pneumonitis
d. Bronchopulmonary eosinophilia
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96. The following statements about thyroid hormones are true
a. T3 and T4 both stored in colloid vesicles as thyroglobulin
b. T4 is metabolically more active than T3
c. T3 and T4 are mainly bound to albumin in the serum
d. 85% of the circulating T3 arises from extra-thyroidal T4
97. The finding of reduced serum free T4 and thyroid-stimulating hormone (TBG)
concentrations is compatible with the following conditions
a. Hypopituitarism
b. Primary hypothyroidism
c. Nephrotic syndrome
d. Pneumonia
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