1. Psoriatic arthritis
(a) does not affect the axial skeleton
(b) can only be diagnosed if psoriasis is present
(c) is associated with nail pitting
(d) rarely occurs before 40
(e) often responds to weekly methotrexate therapy
2. Primary Osteoarthritis
(a) is commoner in women than in men
(b) usually spares the distal pharyngeal joints
(c) is associated with osteoporosis
(d) usually requires disease modifying treatment
(e) typically causes symptoms which are worse after use
3. In patients who present with sore throat:
(a) 70% are caused by beta-hemolytic streptococcal infection
(b) Penicillin V is effective in reducing non-suppurative complications
(c) More severe clinical features are indicative of bacterial infection
(d) Influenzae vaccination appears to reduce incidence
(e) Ibuprofen is of proven benefit
4. A 41 year old male with poorly controlled type 1 diabetes for 17 years and
recently treated hypertension complains of swollen feet and ankles. Possible
causes are:
(a) diabetic nephropathy
(b) autonomic neuropathy
(c) recurrent hypoglycemia
(d) insulin allergy
(e) treatment with calcium channel antagonists
5. In acute poisoning, the following are appropriate specific reversal agents:
(a) lead- Fuller’s earth
(b) Opiates-naloxone
(c) Benzodiazepines-flumazenil
(d) Warfarrin-red cell concentrate
(e) Digoxin-digoxin specific antibody fragments
6. The following are recognized causes of decompensation in patients with chronic
liver disease:
(a) hypoglycemia
(b) cefotaxime
(c) constipation
(d) pethidine
(e) lactulose
7. A 25 year old man presents with sore throat which had been present 4-5 days. On
examination his temperature was 38 degrees. His tonsils were enlarged and
inflamed. He had bilateral axillary, supraclavicular and inguinal
lymphadenopathy. His lymph nodes were tender. The following should be
included in the differential diagnosis:
(a) CML
(b) Infectious mononucleosis
(c) Acute taxoplasmosis
(d) Chickenpox
(e) HIV infection
8. The following are features of pernicious anemia
(a) gastric atrophy
(b) malabsorption syndrome
(c) mild icterus
(d) paresthesia with impaired vibration and position sense
(e) decreased MCV on routine hematological testing
9. In hereditary hemachromatosis
(a) inheritance is autosomal dominant
(b) chondrocalcinosis is a recognized feature
(c) bronze skin pigmentation is due to iron deposition
(d) cardiac failure may be a presenting feature
(e) hepatoma is an important complication
10. The following statements about atopic dermatitis are true
(a) At some time in their lives, approximately 15% of children develop it
(b) UVB is a relatively safe second line treatment
(c) Antecubital and popliteal fossae are typical sites
(d) Methotrexate may be useful in severe cases
(e) Restriction diets are of little proven value in most patients
11. Which of the following treatments are appropriate for the condition listed?
(a) Tar for psoriasis
(b) Topical steroids for atopic dermatitis
(c) Oral steroids for rosacea
(d) Cyclosporine for atopic dermatitis
(e) Systemic steroids for psoriasis
12. Patients with antibody deficiency syndromes typically present with:
(a) disseminated viral infections
(b) pyogenic bacterial infections
(c) bronchiectasis
(d) pneumocystis carinii
(e) hearing deficit
13. Patients who have undergone splenectomy or who are hyposplenic:
(a) are particulary predisposed to viral infections and therefore have influenza
immunization annually
(b) are particulary predisposed to overwhelming infections caused by
pyogenic encapsulated bacteria
(c) can withhold antibiotic prophylaxis provided their immunizations are
uptodate
(d) are predisposed to malaria infections
(e) often have a low white cell count
14. In malignant spinal cord compression
(a) pain is the initial symptom in more than 90% patients
(b) cervical spine is most commonly affected
(c) nerve root irritation produced unilateral or bilateral radicular pain
(d) normal plain xrays of the spine will outrule a diagnosis of spinal cord
compression
(e) initial management should ordinarily include high dose corticosteroids
15. In pagets disease of bone
(a) hypercalcemia is a frequent finding
(b) both increased osteoblastic and osteoclastic activity occur
(c) sarcoma of long bones is a complication
(d) bone pain responds to bisphosphonates
(e) renal calculi are a recognized problem
16. In a patient with a mitral stenosis and atrial fibrillation, the following clinical
features might be expected
(a) past history of chorea
(b) opening snap on auscultation
(c) mid diastolic murmur
(d) presystolic accentuation of the murmur
(e) loud S4
17. Factors predisposing to aortic dissection include
(a) primary hypertension
bicuspid aortic valve
(b) coarctation of the aorta
(c) mitral stenosis
(d) addison’s disease
18. In relation to thromboembolic disease
(a) a patient developing a spontaneous pulmonary embolus (PE) requires life
long anticoagulation
(b) a well patient found to have protein c deficiency during a family study
requires life long anticoagulation
(c) maximum risk period for thrombosis in a pregnant woman is first trimester
(d) desmopressin (DDAVP) may be used for prophylaxis
(e) there is less risk of bleeding complications with low molecular weight
heparin than with unfractionated heparin
19. The following features are consistent with a diagnosis of Horner’s syndrome in a
patient with a Pancoasts tumour:
(a) ipsilateral ptosis
(b) increased sweating on the affected side
(c) exophthalmos
(d) tongue deviation to the contralateral side
(e) ipsilateral miosis
20. Motor neuron disease
(a) is progressive, neurodegenerative disoreder involving mainly the
spinothalamic tracts
(b) is predominantly a disease affecting females
(c) respiratory muscle involvement is unusual
(d) is typically associated with progressive cognitive impairment
(e) prognosis is usually in the order of 3-5 years survival
21. The following drugs are used in the treatment of angina
(a) Aspirin
(b) ACE-inhibitors
(c) Nitrates
(d) Calcium antagonists
(e) Streptokinase
22. The following statements are true for the management of a diabetic patient
(a) exercise reduces insulin requirement
(b) because renal involvement is common, ACE inhibitors are contraindicated
(c) Urinary albumin excretion is an important prognostic indicator
(d) High fasting blood sugar levels can be an indicator of nocturnal
hypoglycemia
(e) Beta-blockers enhance awareness for hypoglycemia
23. In the management of hypertension, the following statements are correct:
(a) non-pharmacological approaches are of value only in mild hypertension
(b) a beta-blocker is usually the drug of choice in a diabetic patient
(c) a thiazide diuretic is often particularly suitable for the elderly patient
(d) a calcium channel blocking agent is contra-indicated in a patient with
hyperlipidemia
(e) treatment is more effective in reducing the risk of heart attack than of
stroke
24. The conditions listed are matched with the appropriate treatment
(a) post-partum thyroiditis
carbimazole
(b) lithium-induced hypothyroidism
thyroxine
(c) hirsutism
spironolactone
(d) acromegaly
octreotide
(e) hyperprolactinemia
chlorpromazine
25. Regarding celiac disease
(a) anemia due to iron and folic acid deficiency is a common presentation
(b) gastrointestinal symptoms may be absent
(c) dermatitis herpetiformis is an associated condition
(d) Howell-Jolly bodies from associated hyposplenism may be seen on a
peripheral blood film
(e) The distal rather than the proximal small bowel is more frequently
affected
26. The following physical signs and conditions are associated
(a) Absent v-wave on JVP
Atrial fibrillation
(b) Pulsus alternans
Heart failure
(c) Pulsus paradoxus
pericardial effusion
(d) plateau pulse
aortic regurgitation
(e) pulsatile liver
tricuspid regurgitation
27. plasmapharesis is a therapeutically useful option in the following situations
(a) hyperviscosity syndrome associated with a paraprotein
(b) cell mediated immune disorders
(c) if a rhesus (D) negative woman is accidentally transfused with several
units of rhesus (D) positive blood
(d) to obtain platelets for therapeutic use
(e) in patients with thrombotic thrombocytopenic purpura
28. In relation to thromboembolic disease
(a) a patient developing a spontaneous pulmonary embolus requires life long
treatment
(b) a healthy patient found to have protein C deficiency during a family study
requires life long anticoagulation
(c) the maximum risk period for thrombosis in a pregnant woman is the first
trimester
(d) DDAVP (Desmopressin) may be used for prophylaxis
(e) There is less risk of bleeding complications with low MW heparin than
with unfractionated heparin
29. In the treatment of a patient with obstructive sleep apnea
(a) stopping smoking may be helpful
(b) overweight patients should initiate a weight reducing diet
(c) nasal CPAP (continuous positive airway pressure) is NOT beneficial
(d) Surgery of the para-nasal sinuses is essential
(e) Inhaled nasal steroids may be useful
30. A 60 year old non-smoking farmer presents with a history of dyspnea on exertion
for three months. Physical examination reveals finger clubbing, central cyanosis
and bilateral crackles on chest auscultation. The following are realistic diagnostic
possibilities:
(a) eosinophilic granuloma of lung
(b) crytogenic fibrosing alveolitis
(c) extrinsic allergic alveolitis
(d) lymphangiomyomatosis
(e) idiopathic pulmonary hemosiderosis
31. A 32 year old former IV drug user presents with a several week old history of low
grade fever, night sweats and shortness of breath. The following diagnoses are
likely
(a) pneumocystis carinii pneumonia
(b) crytospiridosis
(c) pneumococcal pneumonia
(d) toxoplasmosis
(e) pulmonary TB
32. A 24 year old student present with jaundice three weeks after returning from a
holiday in Mexico. The following make a diagnosis of Hepatitis A likely:
(a) sharing needles
(b) foreign travel
(c) Incubation period
(d) Recent blood transfusion
(e) Extrahepatic manifestation
33. A 61 year old male patient presents with renal colic and the following
biochemistry results: Na+ 135 mmol/L, K+ 3.7 mmol/L, Urea 10 mmol/L, Ca++
2.9 mmol/L, Total protein 95 g/L, albumin 28 g/L. The following are the most
likely diagnoses:
(a) Hypercalcemia of malignancy
(b) Nephritic syndrome
(c) Multiple myeloma
(d) Sarcoidosis
(e) Hyperparathyroidism
34. A 72 year old woman presents with recent chest pain, an uninformative ECG and
an elevated troponin level. This indicates
(a) unstable angina
(b) dermatomyositis
(c) crush injury
(d) induction by exercise
(e) myocardial infarct
35. Tuberculous cavitation on CXR:
(a) Is usually multiple
(b) Is usually thick walled
(c) May contain Nocardia
(d) Is usually in the mid/lower lobes
(e) Is low in bacteria count
36. A 55 year old black US male has radicular chest pain. Serum Na+ is 122 mmol/L
and ESR is 96 mm/hr. Which of the following are the likely diagnosis?
(a) dissecting aneurysm
(b) bony metastatic manifestation
(c) multiple myeloma
(d) spinal plasmacytoma
(e) sickle cell crisis
37. In a patient presenting with dermatitis of the face and a previous history of atopic
dermatitis, the appropriate therapy would include:
(a) dermovate
(b) emollients
(c) synalar
(d) betnovate
(e) hydrocortisone
38. The following conditions should be treated with topical steroids
(a) Contact dermatitis
(b) Rosacea
(c) Acne
(d) Lichen planus
(e) Eczema herpeticum
39. In a 47 year old lady with disseminated breast carcinoma, dyspnea may be caused
by:
(a) Lymphangitis carcinomatosa
(b) Pericardial effusion
(c) Massive ascites
(d) Superior vena cava obstruction
(e) Tamoxifen therapy
40. A 48 year old dentist complains of fatigue for three months, and is found to have
markedly elevated serum transaminase and bilirubin levels. Serum alkaline
phosphatase is marginally elevated. The differential diagnosis includes:
(a) Gilbert’s syndrome
(b) Hepatitis C
(c) Drug induced hemolysis
(d) Primary biliary cirrhosis
(e) Biliary cholelithiasis
41. The following associations are correct:
(a) Primary hyperparathyroidism and high phosphate
(b) Primary hyperparathyroidism and MEN
(c) Secondary hyperparathyroidism and hypocalcemia
(d) Secondary hyperparathyroidism and hypophosphatemia
(e) Tertiary hyperparathyroidism and anemia
42. Alport’s syndrome
(a) Is the most common hereditary nephritis
(b) Is due to a defect in the alpha-7 chain of type IV collagen
(c) Is a Y-linked disease
(d) Is associated with anterior lenticonus
(e) Is a contraindication to renal transplantation
43. The following are features of mitral stenosis
(a) A loud first heart sound
(b) Prominently displaced apex beat
(c) An opening snap soon after the heart sound suggests severe disease
(d) Graham-Steell murmur
(e) Giant v waves
44. Cystic Fibrosis
(a) Results from a mutation in the CF transmembrane regulator
(b) Is characterized by a reduced transepithelial potential difference
(c) Shows significant clinical response to N-acetyl-cysteine
(d) Causes death prematurely principally from gastrointestinal complications
(e) In managed with aerosolized tobramycin to delay pulmonary
exacerbations
45. In Ulcerative Colitis
(a) Men and women are equally affected
(b) The rectum is generally spared
(c) The presence of pyoderma gangrenosum relates to disease activity
(d) There is an increased incidence of both large bowel and biliary carcinoma
(e) Elemental diets have a significant therapeutic benefit in acute relapse
46. Renal artery stenosis
(a) Is found in up to 50% of patients undergoing peripheral angiography
(b) Should be suspected if there is >0.5cm difference in kidney size on
ultrasonography
(c) Typically presents with “flash” pulmonary edema when unilateral
(d) Is associated with hypokalemia
(e) Nearly always progresses to complete occlusion
47. The following statements on heart sounds are correct
(a) A loud S1 in mitral stenosis suggests a rigid mitral valve
(b) Splitting of S2 occurs normally during inspiration
(c) Left bundle branch block results in P2 preceding A2
(d) A2 is normally louder than P2
(e) S3 occurs at the termination of atrial contraction
48. The following are recognized complications of ulcerative colitis
(a) Sclerosing cholangitis
(b) Aphthous ulceration
(c) Erythema marginatum
(d) Pyoderma gangrenosum
(e) Large bowel lymphoma
49. In patients with chronic liver disease
(a) An elevated serum sodium is typical
(b) The incidence of hepatoma is reduced
(c) Treatment with porto-caval shunt increases the likelihood of
encephalopathy
(d) GI bleeding may precipitate encephalopathy
(e) There is an increased clotting tendency
50. The following drugs are paired with common indications for their use
(a) ACE inhibitors
left heart failure
(b) Beta-blockers
asthma
(c) N-acetyl cysteine
TCA overdose
(d) Verapamil
Ventricular tachycardia
(e) Bisphosphonates
Hypercalcemia of malignancy
51. The following may cause falls in the elderly
(a) Inappropriate footwear
(b) Diminished visual acuity
(c) Autonomic neuropathy
(d) Treatment with benzodiazepines
(e) Osteoporosis
52. On examination of the chest
(a) A dull percussion note indicates hyperinflation
(b) Wheeze represents alveolar pathology
(c) Bronchial breathing is commonly heard above a pleural effusion
(d) Inspiratory stridor is caused by an intrathoracic obstruction
(e) A pneumothorax may cause tracheal deviation away from the side of the
lesion
53. Immediately following an ischemic stroke
(a) Hypertension should be aggressively treated
(b) The patient may have a flaccid paralysis
(c) An ECG should always be performed
(d) An absent gag reflex is an indication for PEG insertion
(e) Patients with atrial fibrillation should be anticoagulated
54. The following associations are correct
(a) Fracture of the middle cranial fossa
(b) Fracture of the anterior cranial fossa
(c) Subdural hematoma
(d) Extradural hematoma
Battle’s sign
Raccoon eyes
hydrocephalue
middle meningeal artery hemorage
55. Ulcerative colitis
(a) Occurs most commonly in females
(b) Is associated with malignant change
(c) Can affect the small intestine
(d) Exhibits transmural inflammation
(e) Is associated histologically with crypt abscess formation
56. Breast carcinoma
(a) May be diagnosed on fine needle aspiration (FNA)
(b) Is predominantly lobular carcinoma
(c) Paget’s disease is benign
(d) Commonly metastasizes to bone
(e) Less than 10% arise in the upper outer quadrant
57. Abdominal pain may be caused by
(a) Myocardial infarction
(b) Mesenteric infarction
(c) Porphyria
(d) Pneumonia
(e) Ureteric calculi
58. Groin lymphadenopathy may occur with
(a) Anus carcinoma
(b) Uterine cervical carcinoma
(c) Testicular neoplasm
(d) Lower limb cellulitis
(e) Lymphoma
59. In a patient who has pulsus arternans
(a) The pulse is irregular
(b) Digitalis intoxication is the most likely cause
(c) The pulse waves are unequal in size
(d) It is most easily observed when taking the blood pressure
(e) The pulse rate varies with respiration
60. A pericardial rub is a recognized feature of
(a) Hypertensive cardiac failure
(b) Extrarenal uremia
(c) Terminal uremia
(d) Minority of cases of myocardial infarction
(e) Atrial flutter
61. In active pulmonary TB
(a) Physical signs are always present on careful examination of the chest
(b) Clubbing of the fingers is common
(c) In most cases, the ESR is raised
(d) Radiological changes are commonest in the lung apex
(e) Pneumothorax occurs in about 10% of cases
62. The following factors influence the rate of emptying the stomach through the
pylorus:
(a) Acid in the duodenum
(b) Fatty meal
(c) Volume of the gastric contents
(d) Presence of bile in the intestine
(e) Integrity of the vagus nerve
63. Vitamin B12 absorption is usually or always associated with
(a) Total gastrectomy
(b) Celiac disease
(c) Megaloblastic anemia
(d) Tropical sprue
(e) Proximal small bowel resection
64. CNIII palsy characterized by
(a) Constricted pupil on the affected side
(b) Divergent squint
(c) Ptosis on the affected side
(d) Loss of corneal reflex
(e) All of the above
65. Chronic subdural hematoma is a condition in which
(a) There is usually blood in CSF
(b) Patient commonly elderly
(c) The onset is insidious with no definite history of head injury
(d) Hypertension is a common cause
(e) Conservative management is indicated
66. In nephritic syndrome
(a) The urinary 24 hour protein is usually in the range of 0.5 to 2.5 grams
(b) Hypertension is present in the majority of cases
(c) Blood urea is often normal
(d) Chronic pyelonephritis is not a common cause
(e) Diabetes mellitus may be a cause
67. Hypoglycemic coma is characterized by
(a) Cold dry skin
(b) Tachycardia
(c) Pin-point pupils
(d) Deep respiration
(e) Sweating
68. In hypothermic coma
(a) Pancreatitis is a recognized complication
(b) The prognosis is better in hypothyroidism than in “accidental
hypothermia”
(c) Sheehan syndrome is likely is body hair is present
(d) Phenothiazine medication may be a causative factor
(e) Cardiac complications are common
69. These conditions cause a polymorphonuclear leucocytosis
(a) Acute blood loss
(b) Malignant infiltration of the bone marrow
(c) Acute brucellosis
(d) Chronic pyelonephritis
(e) Acute pyelonephritis
70. The following statements are correct
(a) Hip joint disease may present as pain in the knee
(b) Normal joints contain so little synovial fluid that the clinical examination
of fluid in a joint always implies abnormality
(c) Joint disease alone is seldom a cause of gross muscle wasting
(d) Positive patellar tap is a sign of patello-femoral arthritis
(e) Carpal tunnel syndrome typically remits during pregnancy
71. Characteristic features of typhoid fever include
(a) Incubation period of about 4 weeks
(b) Polymorph leucocytosis in the early stages of the illness
(c) Macular rash on the trunk
(d) Profuse watery diarrhea in the first week of the fever
(e) Resolution of fever within 3-4 days of starting chloramphenicol in
appropriate dosage
72. The following drugs may cause or aggravate gastrointestinal ulceration
(a) Paracetamol (panadol)
(b) Codeine phosphate
(c) Ibuprofen (brufen)
(d) Indomethacin (indocid)
(e) Enteric-coated potassium chloride
73. Harmful results are not infrequent when working with
(a) Asbestos
(b) Emulsion paint
(c) beryllium
(d) Coarse sand
(e) Cotton dust
74. Low fibre diet is at present commonly believed to be a major factor in the
causation of
(a) Diverticular diseases of the colon
(b) Crohn’s disease
(c) Varicose veins
(d) Colonic carcinoma
(e) Cancer of the esophagus
75. The following are recognized complications of blood transfusion
(a) Pyrexia
(b) Hemoglobinura
(c) Myoglobinuria
(d) Acute tubular necrosis
(e) Raynauds phenomenon
76. Infectious mononucleosis
(a) Spleen is palpable in almost all cases
(b) Epstein barr virus is the cause
(c) Sore throat is often the presenting feature
(d) Paul-Bunnell test may remain positive for 3-6 months
(e) LFTs may be abnormal
77. Mitral incompetence
(a) Is associated with a loud first heart sound
(b) Is better heard in expiration than inspiration
(c) Does not radiate to the axilla
(d) May be associated with a gallop rhythm
(e) May be due to rupture of the chordae tendinae
78. The following are well recognized complications of therapy with ACE inhibitors
(a) Hypotension especially after the first dose
(b) Dry cough
(c) Depression
(d) Increased serum lipids
(e) Increased blood glucose
79. The following drugs and their side effects are correctly paired
(a) Gold
Exfoliative dermatitis
(b) Chloramphenicol
Megaloblastic anemia
(c) Phenytoin
Osteomalacia
(d) Metoclopramide
Dystonic reactions
(e) Propranolol
Bronchospasm
80. The following are known associations of rheumatoid disease
(a) Stiffness, worse in the evening
(b) Pericardial friction rub
(c) Subcutaneous nodules on flexor surfaces of elbow
(d) Painful scleritis
(e) Right sided stony dullness to percussion
81. Sjogrens syndrome
(a) Is associated with a dry mouth
(b) Recurrent respiratory infection is common
(c) Hair loss is associated
(d) Tests for rheumatoid arthritis will usually be negative
(e) Keratoconjunctivitis results from atrophy of tear ducts
82. Non-thrombocytopenic purpura and bruising may be caused by
(a) Kala-azar
(b) Platelet storage pool disorder
(c) Hereditary hemorrhagic telangiectasia
(d) Scurvy
83. Diabetes
(a) A patient of NIDDM is more likely to have a family member who suffers
from diabetes than an IDDM patient
(b) The commonest cause of death is coronary artery disease
(c) Patients with DM who are ill for 24 hours should discontinue insulin for
24 hours
(d) Lipohypertrophy at site of injection implies allergy to insulin
(e) Loss or warning of impending hypoglycemia may be a sign of autonomic
neuropathy
84. Hypoglycemia in insulin dependent patient may occur
(a) With alcohol
(b) With thiazide diuretics
(c) With influenza
(d) With unaccustomed exercise
(e) With injections at intermuscular rather than subcutaneous by mistake
85. Farmers lung
(a) Is more common than asthma in farmers
(b) Shows non-caseating granulomas on transbronchial biopsy
(c) Commonly shows perihilar lymphadenopathy
(d) May have antibodies without symptoms
(e) Responds to steroid in the early stages
86. Asthma is characterized by
(a) Continuous variation in PEFR
(b) Continuous variation in FRC
(c) Increase in FEV-1 after bronchodilator
(d) Decreased transfer factor
87. Case history: female, urea=22, creatinine=356 (chronic renal failure)
(a) Needs 2-2.5 litres per day to excrete solute
(b) Should not be protein restricted as it is meddlesome
(c) If the underlying cause is DM, will need renal replacement within 6-18
months
(d) If the underlying cause is DLE, will need renal replacement within 6-18
months
88. The following are associated with Reiter’s syndrome
(a) Uveitis
(b) Pain and stiffness of low back especially in the morning
(c) HLA-B27
(d) Symmetrical involvement of small muscles of the hand
(e) Increased lumbar lordosis
89. The following are true of hyperthyroidism
(a) If eyes are affected, it is likely to be due to Graves
(b) Eye signs may worsen with treatment of thyrotoxicosis
(c) Atrial fibrillation may respond well with digoxin
(d) Atrial fibrillation may disappear with treatment of thyrotoxicosis
(e) The gland is always palpably enlarged
90. The following associations are true
(a) Goodpastures
(b) Addisons
(c) Hyperparathyroidism
(d) Progressive membranoproliferative GN
(e) Malignant hyperthermia
Mononeuritis complex
Hyperkalemia
Hypophosphatemia
Malignant hypertension
Hypernatremia
91. The following are associated with inflammatory bowel disease
(a) Carcinoma of biliary tract
(b) Pyoderma gangrenosum
(c) Renal calculi
(d) Seropositive arthritis
(e) Seronegative arthritis
92. Case history: male, heavy smoker, weight loss, cough, presents with weakness of
quadriceps and anterior tibial muscles, absent knee and ankle jerk, flexor plantar
responses, sensory loss in the saddle area, poor anal tone and weakness of knee
extension. The likely diagnosis is:
(a) Transverse myelitis
(b) S.A.C.D.C.
(c) Radiculoneuropathy
(d) Conus of the cord
(e) Lesion of the cauda equine
93. In the valvular disease of the aortic valve
(a) The least common congenital abnormality is bicuspid valve
(b) The more severe the stenosis becomes, the louder the murmur becomes
(c) The aortic valve is at risk of bacterial endocarditis
(d) The most likely cause of significant stenosis is rheumatic fever in early
life
(e) Sudden death may occur in aortic stenosis
94. Which of the following are true of chest pain within the last 6 hours
(a) A man presenting with chest pain, less than 15 minutes duration, pressing
pain, with normal ECG can be assured it is non-cardiac in origin
(b) A man presenting with chest pain, 30 minutes, pressing pain, radiating to
jaw and arm, with ST elevation on ECG, needs to be admitted to coronary
care unit with view to thrombolysis
(c) A man presents with chest pain, 30 seconds, pressing pain, with ST
elevation on ECG, needs to be admitted to coronary care unit and given
prophylactic lidocaine
(d) He needs hospital admission
95. Myelofibrosis is characterized by:
(a) Increased B12
(b) Often unproductive marrow aspirate
(c) Decreased neutrophil alkaline phosphatase
(d) Leukoerythroblastic anemia
(e) Folate deficiency is common
96. The following are true of duodenal ulcer
(a) Relapse rate is higher with campylobacter colonization
(b) H2 blockers are only used short term
(c) High dose antacids may heal ulcers
(d) H2 blockers have been superceded by oxyprenolone
97. The following are characterized by pustules
(a) Psoriasis vulgaris
(b) Rosacea
(c) DLE
(d) Dermatitis herpetiformis
(e) Erythema marginatum
98. The following are worsened by sunlight
(a) Vitiligo
(b) Rosacea
(c) DLE
(d) Psoriasis vulgaris
(e) Seborrheic dermatitis
99. The following are true of HLA-DR3
(a) It is most specific for Graves disease
(b) It is of no value for connective tissue disorders
(c) It is characteristic of celiac disease
(d) It increased the relative risk of IDDM
(e) It is associated with NIDDM
100.
(a)
(b)
(c)
(d)
(e)
Myotonic dystrophy is characterized by
facial weakness
frontal baldness
cataract
hypertrophic sternomastoids
proximal muscle weakness
(a)
(b)
(c)
(d)
(e)
Bloody diarrhea is characteristic of
Cholera
Enteric (typhoid) fever
Amoebic dysentery
Schistosomiasis mansoni
Tropical sprue
101.
102.
The following are associated with normal small bowel villous appearances
on biopsy
(a) Gluten sensitive enteropathy
(b) Irritable bowel syndrome
(c) Post-gastrectomy steatorrhea
(d) Tropical sprue
(e) Pyloric stenosis
103.
(a)
(b)
(c)
(d)
(e)
Pneumothorax
Causes fever
Causes chest pain
Causes blood stained sputum
May be of sudden onset
May cause cyanosis
(a)
(b)
(c)
(d)
(e)
Polymyalgia rheumatica
Causes shoulder girdle pain
Is associated with raised ESR
Steroids are often helpful
Patients rarely die of the disease
Can only be diagnosed on muscle biopsy
(a)
(b)
(c)
(d)
The following are typical presentations
Toxoplasmosis
Choroiditis
Q-fever
endocarditis
Leptospirosis
Renal failure
Paget’s disease
heart failure
104.
105.
106.
(a)
(b)
(c)
(d)
(e)
Third nerve palsy
Is associated with small pupil
May be viral
Is characterized by inability to look down and out
May be caused by a lesion of posterior cerebral artery
Is associated with diabetes
107.
The following are associated with their possible
complications/associations
(a) Bronchial carcinoma
cerebellar ataxia
(b) Brucellosis
allergic alveolitis
(c) Bronchiectasis
proteinuria and hepatomegaly
(d) Bullous emphysema
jaundice+abnormal serum electrophoresis
(e) Fibrosiing alveolitis
prominent a-wave on JVP
108.
Features of brucellosis include
(a) Phylectenular conjunctivitis
(b) Allergic alveolitis
(c) Lymphadenopathy
109.
(a)
(b)
(c)
(d)
(e)
Hypothermia (accidental) in the elderly
Is frequently assicated with shivering
T3 should be used
Rectal thermometer should be used
Rapid rewarming is advised
Is associated with bradycardia
(a)
(b)
(c)
(d)
(e)
The following abolish paroxysmal atrial tachycardia
Valsalva manoevre
Carotid massage
Eyeball pressure
Digoxin
Beta blocker
110.
111.
A patient on an open ward demonstrates tubercle bacilli on several sputa.
The following should be done
(a) Transfer patient to single room
(b) Incinerate all personal clothes
(c) Tell family it is unlikely they are infected
(d) Arrange skin tests and CXR for family contact
(e) Commence drug therapy before TB culture results available
112.
(a)
(b)
(c)
(d)
(e)
The following are complications of polycythemia rubra vera
Acute gout
Budd-chiari syndrome
Stroke
Hypercapnia
Uveitis
(a)
(b)
(c)
(d)
(e)
The following have hematuria (microscopic/macroscopic)
Steroid-sensitive but recurrent minimal change GN
IgA nephropathy
Nephropathy associated with diabetes
Infective endocarditis
Acute papillary necrosis
113.
114.
A 55 year old woman is thought likely to have osteoporosis
(a) History of alcoholism would support the diagnosis
(b) History of thyrotoxicosis would support the diagnosis
(c) AP and lateral Xrays of spine are a sensitive indicator of disease
progression
(d) Bone loss is mainly cortical rather than trabecular
(e) Vitamin D replacement is mandatory
115.
(a)
(b)
(c)
(d)
(e)
Psoriasis may cause
Thimble pitting of nails
Arthritis of distal interphalangeal joints
Permanent scarring alopecia
Cataracts
Steatorrhea and malabsorption
(a)
(b)
(c)
(d)
(e)
Endogenous eczema of the atopic type
Itches in the majority of patients
May cause weeping of the skin
Often responds to topical corticosteroids
Is often associated with hayfever and/or asthma
Often involves limb flexures
(a)
(b)
(c)
(d)
(e)
Seborrheic eczema (seborrheic dermatitis) commonly involves
Scalp
Elbows and knees
Sacrum
Sternum and between scapulae
Face
116.
117.
118.
Griseofulvin is indicated in the treatment of:
(a) Candida infection of the nails
(b) Dermatophyte infection (trichophyton rubrum nail infection, tinea
capitis/scalp ringworm)
(c) Paronychia
(d) Tinea versicolor
(e) Porphyria
119.
(a)
(b)
(c)
(d)
(e)
120.
(a)
(b)
(c)
(d)
(e)
Carcinoma of the lip
More often affects the lower lip than the upper lip
Metastasizes early to the internal jugular lymph nodes
Affects men more often than women
Has a poor prognosis if it occurs at the angle of the mouth
Is best treated by surgical excision
Malignant disease of
The tonsil most commonly arises in lymphoid tissue
The tongue can cause pain radiating to ear
Nasopharynx may present with deafness
The floor of the mouth is most commonly an ulcerating squamous
carcinoma
The buccal mucosa can arise in a patch of leukoplakia
121.
Recognized metabolic changes in patients with chronic duodenal
unceration leading to “pyloric stenosis” include
(a) Alkalosis due to loss of hydrogen ions in the vomit
(b) Compensatory increased renal excretion of sodium bicarbonate
(c) An acid urine, even in the presence of advanced alkalosis
(d) A fall in the concentration of calcium ions in the plasma
(e) Increased renal excretion of chloride ions in the plasma
122.
(a)
(b)
(c)
(d)
(e)
The metabolic effect of hyperparathyroidism include
Hypercalciuria
Hypophosphaturia
Raised serum alkaline phosphatase
Metabolic alkalosis
Increased renal excretion of chloride leading to uremia
(a)
(b)
(c)
(d)
(e)
Facial nerve paralysis is demonstrated by:
Asking the patient to protrude the tongue
Testing the reaction of the pupil to light
Testing the reaction of the pupil to accommodation
Testing the pin prick sensation on the fact
Asking the patients to show the teeth
123.
124.
(a)
(b)
(c)
(d)
(e)
In acute mastoiditis
Inspection from behind may reveal pinna pushed forward
Conductive deafness is present
Perceptive deafness present
Moving pinna up and back is painful
Patient is a child
(a)
(b)
(c)
(d)
(e)
Which of the following are true of the varieties of nasal sinusitis
Frontal sinusitis is a disease of the aged
Frontal sinusitis is a disease of the young
Ethmoiditis is largely confined to infants and young children
Maxillary sinusitis is found only before the twelth year
Maxillary sinusitis is only found at and after adolescence
(a)
(b)
(c)
(d)
(e)
The characteristics of a thyroglossal cyst are
Seldome fluctuates
Usually transilluminates
Moves upwards on swallowing
Moves upwards on extruding tongue
Usually to one side of midline
125.
126.
127.
In reaching a decision whether an external hernia is strangulated or merely
irreducible, which two of the following are most important?
(a) Long history
(b) Tenderness over hernia
(c) Raised white blood cell count
(d) Vomiting
(e) Anxious patient
(a)
(b)
(c)
(d)
(e)
Pancoast’s syndrome consists of
Neck vein distension
Face swelling
Horner’s syndrome
Pain in arm
Lower brachial plexus lesion
(a)
(b)
(c)
(d)
(e)
Physical signs of carpal tunnel syndrome are
Wasting of hypothenar eminence
Wasting of thenar eminence
Hyperaesthesia in median nerve distribution
Median nerve palpable above flexor retinaculum
Phalen’s sign positive
128.
129.
(a)
(b)
(c)
(d)
(e)
Galeazzi’s fracture involves
The fibula
The talus
The radius
The scapula
The ankle
(a)
(b)
(c)
(d)
(e)
The physical signs of osteoarthritis of the hip joint are
Apparent shortening at an early stage
Real shortening at an early stage
Trandelenburge sign is commonly positive
Early limitation of flexion
Early limitation of abduction
(a)
(b)
(c)
(d)
Which of the following are common to all median nerve injuries?
Wasting of thenar eminence
Wasting of hypthenar eminence
The benediction attitude
Ochener’s test positive
(a)
(b)
(c)
(d)
(e)
In myocardial infarction
Pericardial friction rub may occur
Ventricular extrasystole may occur
ST segment elevation is usually evident on ECG
Prolonged bed rest is essential
Use of digitalis may be dangerous
(a)
(b)
(c)
(d)
(e)
Penicillin is the antibiotic of choice in
Lobar pneumonia
Typhoid carriers
Streptococcal tonsillitis
Staphylococcal septicemia
Dental extraction in patients with mitral valve disease
(a)
(b)
(c)
(d)
(e)
Aseptic meningitis may be a feature of
Ulcerative colitis
Leptospirosis
Influenze
Tuberculosis
Gastric Carcinoma
130.
131.
132.
133.
134.
135.
136.
(a)
(b)
(c)
(d)
(e)
Hypercalcemia
May be present with polyuria
Is an indication for steroid therapy in sarcoidosis
May occur in myeloma
Causes QT interval prolongation on ECG
May require treatment with mithramycin
(a)
(b)
(c)
(d)
(e)
Diabetes mellitus may give rise to
Silent myocardial infarction
Acute abdomen
Renal papillary necrosis
Chronic hepatitis
Polyarthritis
(a)
(b)
(c)
(d)
(e)
The signs of hypopituitarism
Hypotension
Absent pubic and axillary hair
Alopecia
Extreme emaciation
Small stature
(a)
(b)
(c)
(d)
(e)
Coronary artery disease may result from
Syphilis
Excessive iron therapy
Temporal arteritis
Pancreatic insufficiency
Diphtheria
137.
138.
139.
140.
In the following circumstances, the physician should be aware of the
possible presence of malignancy:
(a) Polyposis coli
(b) Ulcerative colitis
(c) Diverticular disease
(d) Pernicious anemia
(e) Hypertrophic pulmonary osteoarthropathy
141.
(a)
(b)
(c)
(d)
(e)
A 75 year old male patient with gross painless hematuria
Should have a rectal examination
May have tuberculosis
Should be reassured if JVP normal
Should be given vitamin K
Is likely to have renal stones
142.
(a)
(b)
(c)
(d)
(e)
In fibrosis of the left upper lobe
TB is the likely cause
Trachea is deviated to the right
Tactile vocal fremitus increased in the left apex
Apex usually displaced to left
Hartman’s sign is diagnostic
(a)
(b)
(c)
(d)
(e)
The clinical features of acute hepatitis include
Dislike of cigarettes
Splenomegaly
Glycosuria
Anorexia
Bilirubinuria
(a)
(b)
(c)
(d)
(e)
The following statements are true
Carpal tunnel syndrome is commonest in middle aged females
Pretibial myxoedema is seen in thyrotoxicosis
Cushing’s syndrome in females usually gives rise to amenorrhea
Acromegaly may give rise to hypertension
Calcified ascending aorta on Xray suggests syphilis
(a)
(b)
(c)
(d)
Diuretic therapy
May precipitate hepatic encephalopathy
May cause secondary gout
May cause collapse in elderly patients
Should not be prescribed for patients with diabetes mellitus
(a)
(b)
(c)
(d)
(e)
Erythema multiforme
May have associated oral lesions
Is a vasculitic eruption seen in rheumatic fever
May be very toxic and require steroid therapy
Is frequently seen in amyloidosis
May be fatal
(a)
(b)
(c)
(d)
(e)
Acute myocarditis
Is usually viral in origin
May be produced by steroid therapy
Produces T-wave abnormalities on ECG
May result in ventricular dysrhythmias
Frequently shows Bell’s sign
143.
144.
145.
146.
147.
148.
(a)
(b)
(c)
(d)
(e)
Rheumatoid disease
May lead to impotence
Usually requires steroid therapy
May involve temperomandibular joints
Occasionally leads to hypersplenism
May affect the lungs
(a)
(b)
(c)
(d)
(e)
Acute nephritis is a recognized feature of the following disease
Brucellosis
Ankylosing spondylitis
Polyarteritis nodosa
Polyposis coli
Bacterial endocarditis
149.