Internal Medicine MCQ
True/False
1. What is associated with Trisomy 13 / ‘Patau’ Syndrome?
(Abel)
A. Polydactyly
B. Simian crease
C. Scalp defects
D. Hypotonia
E. Cleft lips and palate
2. The following are signs of RHF
A. Raised JVP
B. Bilateral basal crepitations in lungs
C. Hepatosplenomegaly
D. 3rd heart sounds
E. Ankle edema
3. Complication below best represent the following condition (is this OBA or T/F?)
A. RVH- coarctation of aorta
B. ? cant read writing
C. Pulmonary infarct- varicose vein
D. Intravascular hemolysis- hereditory spherocytosis
E. Subdural hematoma- berry aneurysm
4. Deep vein thrombosis
A. Describes thrombosis in popliteal veins
B. is associated with cancer
C. is usually unilateral
D. can be dissolved by anticoagulant
E. Can lead to pulmonary embolism
5. Causes of Nephrotic syndrome (Mezhen)
A. Multiple Myeloma
B. Diabetes Mellitus
C. Henoch Schelein Purpura
D. Amyloidosis
E. SLE
6. The following statements are true about osteoarthritis of knee
(Esther)
A. Creps felt over the joint
B. Synovial thickening
C. Xray shows loss of joint space
D. Chondrocalcinosis is a feature
E. Bony nodules found in tendon
7. 34 y/o Chinese female who complain of pain in the loin. Renal punch is positive
bilaterally. The following investigation finding is most compatible:
A. FBC shows lymphocytes
B. Ultrasound shows bilaterally shrunken kidney
C. UFEME shows gross proteinuria
D. Renal function test show hypokalemia
E. AXR show renal stones
8. Folate deficiency results in:
A. Macrocytic anemia
B. Hypersegmented neutrophils
C. Thrombocytosis
D. Reticulocytopenia
E. Chronic hemolysis
9. Addison’s disease clinical manisfestation:
A. Vomiting
B. Abdominal Striae
C. Hypotension
D. Glucose intolerance
E. Hyperpigmentation
10. Which of the following are true about ABG?
A. In hypoglycemia, there will be increased HCO3
B. In hysteria, there will be increased pH
C. In metabolic acidosis, there will be a high base
D. In chest cage injury, there will be increased PCO2
E. ?
11) Severe aortic stenosis
A. Systolic BP low
B. Pulse pressure wide
C. Second heart sound soft
D. Louder systolic murmur indicate tighter stenosis
E. Rheumatic fever is an important cause
12. Causes of clubbing (Woh Wei)
A. COAD
B. PTB
C. Lung ca
D. Bronchiectasis
E. Recurrent pulmonary embolism
13.Expiratory ronchi
(Marina)
A. Acute CHD
B. Acute pneumocitis
C. Acute asthmatic attack
D. Pneumothorax
E. Acute exacerbation of chroic bronchitis
14. Glasgow Coma Scale
(Simran)
A. Minimum score is 0
B. Pupil responds is 4 points
C. Spontaneous eye opening scores 4 points
D. Appropriate motor reflex to speech is 6 points
E. Best response towards stimulus is recorded
One Best Answer
15. Elderly women going for operation of suspected Colorectal Ca, what is the important
pre-operative test? (Abel)
A. CT abdomen & pelvis
B. Colonoscopy
C. Biopsy
D. ECG
E. Weight reduction
16) 65y/o Chinese female with SOB and jaundice. Pleural fluid shows protein 6g/dL (
Serum protein 28g/dL) Cytology shows occasional leucocytes and no malignant cells.
Pleural fluid culture is pending.
What is the likely diagnosis?
A. TB
B. CCF
C. Chronic liver disease
D. Nephrotic syndrome
E. Fungal infection
17) 26y/o Malay man presents with high grade fever with chills of 2 weeks duration. He
is an active IVDU. On examination he is febrile, increased JVP with giant V-wave,
bibasal crepts are noted in lungs and there is a pansystolic murmur in the left sternal
edge. The following statement is true?
A. S. aureus is the most common agent
B. He needs at least 4-6weeks of oral antibiotics
C. The murmur is most likely a tricuspid stenosis
D. absence of vegetation on transthoracic ECHO rules out IE
E. Congenital heart failure is an indication for surgery
18) 72 y/o Malay male c/o weight loss and sudden onset of backache, physical findings
are unremarkable. FBC showed leukoerythroblastic anemia. Serum protein
electrophoresis does not show any M band.
Which of the following is most likely to be encountered?
A. Spine x-ray show lumbar sacral osteoarthritis
B. Raised in PSA
C. Normal ALP
D. Bone marrow showed extensive fibrosis
E. CT scan showed obstructive uropathy
19) 56y/o male, pre employment medical check up. Loss of weight despite good appetite,
no significant PMH or FH and no other abnormalities. Which is the most compatible
findings. (Woh Wei)
A. Normal ESR
B. Decreased TSH
C. Apical cavity
D. Positive mammogram
E. Positive pap smear
20) 40y/o Indian female presented with epigastric pain radiate to the back and worsen
when lying down, relieved slightly when intake of milk. There was no loss of appetite.
What diagnosis is most appropriate?
A. Perforated peptic ulcer
B. Acute appendicitis
C. Acute cholecystitis
D. Acute pancreatitis
E. ?
21) 17 y/o Indian female SOB, dizziness, ABG normal O2 tension, low bicarbonate and
mildly increased pH
A. Type 1 DKA
B. hysteria conversion
C. Myasthenia gravis
D. CRF
E. Salicylate poisoning
22. 43 year old woman complains of lethargy. Radial pulse is irregular at 88bpm, apex
beat 143bpm. Heart sounds normal with no murmurs.
A. SLE
B. Henoch Scholein purpura
C. Hyperthyroid
D. VSD
E. Conn’s Syndrome
23. 15 year old Indian male admitted to hospital due to sudden onset of chest pain &
breathlessness. On examination, revealed right chest hyper resonant on percussion with
decreased chest expansion. Physical signs compatible with:
(Esther)
A. Tracheal shifted to right
B. Apex beat lateral to mid clavicular line
C. Increased Tactile Fremitus in right chest
D. Absence of breath sounds on right
E. Crepitations in right
24. A 26 year old Chinese female presented with pallor, jaundice, dark colour urine. On
examination, liver is enlarged and spleen is palpable. Liver enzymes are normal. What is
the most compatible findings?
A. Ovalocytosis in blood
B. Reticulocytosis
C. Hugh serum haptoglobin
D. Hemosiderosis
E. Positive direct coombs test
25. 48/C/Male, Alcoholic. Epigastric pain for 4 days worsen within last 24 hours.
Associated with vomiting & diarrhoea, guarding. Erect X-ray found crescenteric
transluscency between diaphragm and gastric bubble. (Marina)
A. Perforated peptic ulcer
B. Acute alcoholic hepatitis
C. Acute pancreatitis
D. Dissecting aortic aneurysm
E. Splenic rupture
26. 56 year old Malay male, presents with hemoptysis. Past history of TB, fully treated.
He has bilateral finger clubbing, dull percussion note over basal regions. Afebrile. What
is your diagnosis?
(Qian Hui)
A. Pulmonary TB
B. Bronchiectasis
A. Bronchogenic carcinoma
B. Aspergilosis
C. Chronic bronchitis
27. 35 year old Male with RUQ pain and fever. Murphy's sign +ve. What is the most
appropriate investigation. (Mezhen)
A. LFT
B. FBC
C. US Abdomen
D. ECG
E. ?
EMQ
Question 1 (Qian Hui)
1) 16y/o, lost of balance when asked to stand on both feet with eyes close.
2) 24y/o, lower limb weakness, urinary retention and sacral numbness
3) Resting tremor and difficulty getting up from chair
4) Neck pain and wasting of hand muscle
5) nystagmus and broad gait
A. Mononeuropathy
B. Mononeuritis multiplex?
C. Radiculopathy
D. Proximal myopathy
E. Sensory Ataxia
F. Spinal Cord Compression
G. Cauda Equina syndrome
H. Extrapyramidal lesion
I. Gait apraxia
J. Cerebellar lesion
Question 2 (Tharveen)
Acute glomerunephritis
Acute Tubular Necrosis
Acute Urinary Retention
Pre renal Failure
Nephrotic
Obst Uropathy
Hydronephrosis