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Page 1


By A. H.

Medicine MCQS VIA Web
Copyright © 2005 Elsevier Limited. All rights reserved. Fleshandbones is a registered
trademark of Harcourt, Inc. in the United States and other jurisdictions, used under license
These mcqs were donloaded By Ahmed Hakim [email protected]
Question 1. The pulse:
(a) In pulsus paradoxus the rate slows during inspiration. (False)
(b) Pulsus alternans indicates a poorly functioning left ventricle. (True)
(c) A tachycardia of 150 beats per minute in a resting patient usually implies an underlying cardiac arrhythmia. (True)
(d) A collapsing pulse may be noticed in thyrotoxicosis. (True)
(e) Corrigan's sign supports a diagnosis of aortic stenosis. (False)

Question 2. Heart murmurs:
(a) A low rumbling diastolic murmur with presystolic accentuation may be heard in mitral stenosis accompanied by

atrial fibrillation. (False)
(b) Causes of a pansystolic murmur include mitral regurgitation and ventricular septal defect. (True)
(c) A systolic murmur heard over the whole praecordium associated with a thrill usually indicates aortic stenosis.

(d) Left heart murmurs are best heard during expiration. (True)
(e) An early blowing diastolic murmur at the left sternal edge indicates aortic incompetence. (True)

Question 3. Pulsus paradoxus:
(a) The volume of the pulse increases in inspiration. (False)
(b) Can be confirmed by detecting >10 mmHg difference in systolic pressure during the breathing cycle. (True)
(c) Is a sign of severe asthma. (True)
(d) Is called paradoxus because it is the opposite of what normally happens to the pulse. (False)
(e) Can occur in cardiac tamponade. (True)

Question 4. The jugulovenous pressure:
(a) Is raised if it is 2 cm from the sternal angle with the patient seated at 45°. (False)
(b) Tall 'a' waves may be seen in pulmonary hypertension. (True)
(c) Irregular cannon waves indicate complete heart block. (True)
(d) Regular cannon waves may indicate a nodal rhythm. (True)
(e) Giant 'v' waves and a pulsatile liver indicate tricuspid stenosis. (False)

Question 5. The physical signs of an uncomplicated large pneumothorax include:
(a) The trachea deviated to the opposite side. (False)
(b) A clicking sound synchronous with the heart beat. (True)
(c) Symmetrical expansion of the chest. (False)
(d) Increased breath sounds over the pneumothorax. (False)
(e) Increased percussion note over the pneumothorax. (True)

Question 6. The following would help distinguish between a kidney and a spleen in the left upper quadrant:
(a) Dull to percussion over the mass. (False)
(b) A well-localized notched lower margin. (False)
(c) Moves with respiration. (False)
(d) A ballottable mass. (True)
(e) A family history of renal failure. (True)

Question 7. Nystagmus:
(a) Vertical nystagmus usually indicates a lesion of the medulla oblongata. (False)
(b) Horizontal nystagmus is usually ipsilateral to an irritative lesion of the labyrinth. (False)
(c) Ataxic nystagmus indicates a lesion of the medial longitudinal bundle. (True)
(d) May be absent in a lesion of the cerebellar vermis (the central part). (True)

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By A. H.

(e) Pendular nystagmus may indicate partial blindness. (True)

Question 8. The following would suggest an upper rather than a lower motor neuron lesion:
(a) Fasciculation. (False)
(b) Increased tone. (True)
(c) An absent plantar reflex. (False)
(d) Clonus. (True)
(e) Relatively little wasting. (True)

Question 9. Hand signs:
(a) Clubbing may be caused by uncomplicated chronic bronchitis. (False)
(b) Koilonychia usually indicates liver disease. (False)
(c) Osler's nodes and Heberden's nodes both occur in osteoarthritis. (False)
(d) Splinter haemorrhages are due to embolic rather than immunological phenomena. (False)
(e) Psoriatic arthritis affects most joints in the hand but usually spares the distal interphalangeal (DIP) joints. (False)

Question 10. The face:
(a) A malar flush may indicate mitral valve disease or hypothyroidism. (True)
(b) A butterfly rash in the face is seen in dermatomyositis. (False)
(c) Bell's palsy can cause ptosis due to paralysis of orbicularis oculi. (False)
(d) Herpes labialis may be associated with pneumococcal pneumonia. (True)
(e) An expressionless face and drooling could indicate Parkinson's disease. (True)

Question 11. The electrocardiogram:
(a) The PR interval is measured from the peak of the P wave to the start of the QRS complex. (False)
(b) Right axis deviation is indicated by a QRS axis of -35°. (False)
(c) Q waves in S-II, S-III and aVf indicate a transmural inferior myocardial infarction. (True)
(d) Left bundle branch block is suggested by broadening of the QRS complex to 0.10 seconds (two and a half little

squares), and positive RSR' waves in V4-V6. (False)
(e) P mitrale is suggested by a P wave taller than 2.5 mm. (False)

Question 12. In the full blood count:
(a) A haemoglobin of 10.0 g/dL would be considered normal in a premenopausal woman. (False)
(b) Polycythaemia rubra vera is usually indicated by elevation not only of the haemoglobin but also of the white cell

count and platelets. (True)
(c) A low platelet count could indicate a flare-up of systemic lupus erythematosus (SLE). (True)
(d) High platelets can be seen in gastrointestinal bleeding. (True)
(e) A raised mean corpuscular volume is usual in significant alcohol excess. (True)

Question 13. Heart failure:
(a) The clinical features of left heart failure include: tachycardia, basal crepitations, pulsus alternans and a raised JVP.

(b) Congestion of the pulmonary veins alone does not result in orthopnoea. (False)
(c) Chronic congestive heart failure leads to secondary hyperaldosteronism. (True)
(d) Causes of heart failure include ischaemic heart disease, hypertension, and thiamine deficiency. (True)
(e) Clinical features of right heart failure include a raised JVP, ankle oedema, and hepatomegaly. (True)

Question 14. Stroke:
(a) Cerebral haemorrhage accounts for more than 40% of acute strokes. (False)
(b) In supratentorial strokes with homonymous hemianopsia, patients cannot see on the hemiplegic side. (True)
(c) Vertigo, vomiting, dysphagia, and Horner's syndrome indicate occlusion of the vertebrobasilar circulation. (True)
(d) Pinpoint pupils and bilateral upgoing plantars could signal a brainstem stroke. (True)
(e) Carotid endarterectomy should be considered for patients with more than 70% stenosis because this is more

effective than medical treatment. (True)

Question 15. Respiratory failure:

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peak expiratory flow (PEF) rate = < 70% of expected (False)
Explanation: Usually < 50% of expected PEF
pulsus paradoxus (True)

Explanation: But may diminish in severe attacks
arterial PaO2 = 14 kPa while breathing air (False)

Explanation: PaO2 < 8 kPa in life-threatening attacks
arterial PaCO2 = 5 kPa (True)

Explanation: PaCO2 may remain normal until the late stages

Question 17. The initial management of severe acute asthma should include
24% oxygen delivered by a controlled flow mask (False)
Explanation: High concentration, high flow should be used
salbutamol 5 mg by inhalation (True)

Explanation: Intravenous â2-adrenoceptor agonists can also be used
ampicillin 500 mg orally and sodium cromoglicate 10 mg by inhalation (False)

Explanation: Of no proven value in acute attacks
hydrocortisone 200 mg i.v. or prednisolone 40 mg orally (True)

Explanation: Maintain corticosteroid therapy for at least 7 days in severe attacks
arterial blood gas analysis and chest radiograph (True)

Explanation: Exclude pneumothorax and ventilatory failure

Question 18. Typical clinical features of bronchiectasis include
chronic cough with scanty sputum volumes (False)
Explanation: Copious sputum production
recurrent pleurisy (True)

Explanation: Recurrent pneumonia
haemoptysis (True)

Explanation: Secondary to inflammatory bronchial change
finger clubbing (True)
crepitations on auscultation (True)

Explanation: In the presence of large amounts of secretions

Question 19. Cystic fibrosis is associated with
an incidence of 1 in 2500 live births (True)
Explanation: The commonest severe autosomal recessive disorder in Caucasians
a decreased sweat sodium concentration (False)

Explanation: Increased sweat sodium concentration
male infertility (True)

Explanation: Due to failure of development of the vas deferens
abnormal lung function at birth (False)

Explanation: It is normal; hence prospect for gene therapy
recurring pneumococcal pulmonary infections (False)

Explanation: Pseudomonas and staphylococcal sepsis

Question 20. In pneumonia, the following features are classically associated with the specific organisms noted
erythema nodosum and Mycoplasma pneumoniae (True)
hyponatraemia and Legionella pneumoniae (True)
contact with sick birds and Klebsiella pneumoniae (False)

Explanation: Chlamydia psittaci
abscess formation and Staphylococcus aureus (True)
haemolytic anaemia and Streptococcus pneumoniae (False)

Explanation: Mycoplasma

Question 21. A non-pneumococcal pneumonia should be considered if the clinical features include
respiratory symptoms preceding systemic upset by several days (False)
Explanation: The converse is typical of 'atypical' organisms
lobar consolidation (False)

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rigors (False)
the absence of a neutrophil leucocytosis (True)

Explanation: Leucopenia can occur in severe pneumococcal infection
palpable splenomegaly (True)

Explanation: Rare in pneumococcal disease

Question 22. The following features suggest a poor prognosis in pneumonia
diastolic blood pressure of 90 mmHg (False)
Explanation: < 60 mmHg
confusion (True)
respiratory rate of 20 breaths per minute (False)

Explanation: > 30/min
blood urea of 9 mmol/l (True)

Explanation: > 7 mmol/l
white cell count of 3000 × 109/l (True)

Explanation: < 4000 × 109/l
Question 23. Typical features of primary tuberculosis include
a sustained pyrexial illness (False)
Explanation: Typically symptomless
caseation within the regional lymph nodes (True)

Explanation: Mediastinal, cervical or mesenteric nodes are most frequently involved
bilateral hilar lymphadenopathy on chest radiograph (False)

Explanation: Suggests sarcoidosis
erythema nodosum (True)

Explanation: Can also accompany pulmonary sarcoid
pleural effusion with a negative tuberculin skin test (False)

Explanation: A hypersensitivity phenomenon typically associated with positive tuberculin test

Question 24. Recognised complications of post-primary tuberculosis include
aspergilloma (True)
Explanation: Superinfection of a cavity
amyloidosis (True)

Explanation: Associated with chronic immune stimulation
massive haemoptysis (True)
bronchiectasis (True)

Explanation: Suggested by chronic productive cough
paraplegia (True)

Explanation: Due to vertebral or paraspinal abscess formation

Question 25. In the treatment of post-primary pulmonary tuberculosis
combination drug therapy is always indicated (True)
Explanation: Minimises resistance and reduces duration of treatment
sputum remains infectious for at least 4 weeks after the onset of therapy (False)

Explanation: Patients can be regarded as non-infectious after 2 weeks of therapy
at least 12 months' daily therapy is required for 100% effectiveness (False)

Explanation: 6- and 9-month regimes are of proven efficacy
isoniazid and pyrazinamide do not cross the blood-brain barrier (False)

Explanation: Hence their great value in the treatment of tuberculous meningitis
treatment failure is invariably due to multiple drug resistance (False)

Explanation: More often due to non-compliance

Question 26. Recognised adverse reactions to antituberculous drugs include
streptomycin-renal failure (False)
Explanation: Causes vestibular disturbance and deafness
isoniazid-hypothyroidism (False)

Explanation: Polyneuropathy

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anterior spinal artery thrombosis (True)
Explanation: Sudden onset typically
spinal neurofibromas and gliomas (True)

Explanation: Intradural pathology accounts for 20% of cases of cord compression

Question 54. The typical features of syringomyelia include
slow insidious progression of the disease (True)
Explanation: Onset in third or fourth decade
dissociate sensory loss with normal touch and position sense (True)

Explanation: Leading to trophic ulceration
loss of one or more upper limb tendon reflexes is invariable (True)

Explanation: Damage to anterior horn cells
wasting of the small muscles of the hands (True)

Explanation: A common early feature
hyperreflexia of the lower limbs and extensor plantar responses (True)

Explanation: Pyramidal tract damage

Question 55. Recognised features of neurofibromatosis include
autosomal dominant inheritance (True)
Explanation: Central and peripheral forms occur
café-au-lait spots (True)

Explanation: And axillary skin freckling
association with multiple endocrine neoplasias (True)

Explanation: E.g. phaeochromocytoma
intraspinal and intracranial neuromas and meningiomas (True)

Explanation: At almost any site
nerve deafness (True)

Explanation: Acoustic neuroma

Question 56. The following statements about dementia are correct
20% of the population aged over 80 years suffer a dementing illness (True)
Explanation: Most commonly Alzheimer's disease
inheritance of the apolipoprotein å4 allele is associated with multi-infarct dementia (False)

Explanation: Risk of Alzheimer's increased four-fold
cerebral acetylcholinesterase inhibitors arrest progression of the disease (True)

Explanation: Particularly in Alzheimer's
Alzheimer's disease is characterised by the presence of neurofibrillary tangles (True)

Explanation: And amyloid-rich plaques
associated parkinsonism suggests possible Lewy body disease (True)

Explanation: Patients often made worse by levodopa therapy

Question 57. Recognised causes of a generalised polyneuropathy include
bronchial carcinoma (True)
Explanation: Typically sensory
rheumatoid arthritis (True)

Explanation: And systemic lupus erythematosus; also cause mononeuritis multiplex
vitamin B12 deficiency and folate deficiency (True)

Explanation: Also vitamin B1, B2, B6, A and E deficiency
amiodarone therapy (True)

Explanation: And numerous drugs
diabetes mellitus (True)

Explanation: And myxoedema

Question 58. Clinical features typical of the following polyneuropathies include
predominantly motor loss-lead poisoning (True)
Explanation: Look for haematological clues
predominantly sensory loss-post-inflammatory polyneuropathy (False)

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Explanation: Motor weakness predominates
painful sensory impairment-alcohol misuse (True)

Explanation: Also autonomic neuropathy with local sympathetic neural dysfunction
sparing of the cranial nerves-sarcoidosis (False)

Explanation: The 7th nerve especially is commonly involved in neurosarcoid
prominent postural hypotension-diabetes mellitus (True)

Explanation: Suggests autonomic involvement

Question 59. The typical features of Guillain-Barré polyneuropathy include
onset within 4 weeks of an acute infective illness (True)
Explanation: 1-4 weeks, usually after viral infection
peripheral paraesthesiae (True)

Explanation: Paraesthesiae spread proximally
ascending flaccid paralysis with areflexia (True)

Explanation: Muscle wasting is usually absent
sparing of the respiratory and facial nerves (False)

Explanation: Cranial nerves involved in 30-40%
normal CSF protein concentration and cell count (False)

Explanation: CSF protein is elevated, cell count is normal

Question 60. Typical causes of proximal myopathy include
hypothyroidism (True)
Explanation: And also hyperthyroidism; both resolve with treatment
type 1 diabetes mellitus (False)

Explanation: Causes a variety of different peripheral nerve disorders
Cushing's syndrome (True)

Explanation: And also acromegaly
pernicious anaemia (False)

Explanation: Causes a peripheral neuropathy and spinal cord degeneration
chronic alcohol misuse (True)

Explanation: Often with a peripheral neuropathy

Question 61. Acute confusion in the elderly is likely to be the result of
an adverse drug reaction (True)
Explanation: E.g. opiates, levodopa
hypothermia (True)

Explanation: Check core temperature with a low-reading thermometer
bronchopneumonia (True)

Explanation: Consider the possibility of meningitis
myocardial infarction (True)

Explanation: More often asymptomatic in the elderly
cerebral infarction (True)

Explanation: CT to exclude subdural haematoma or tumour

Question 62. Recurrent dizziness in the elderly is likely to be the result of
an adverse drug reaction (True)
Explanation: Especially if associated with postural hypotension
postural hypotension (True)

Explanation: Absence of attacks when lying in bed is suggestive
Ménière's disease (True)

Explanation: Rare in the absence of hearing loss
vertebrobasilar insufficiency (True)

Explanation: Common and may be reproduced by head movements
sick sinus syndrome (True)

Explanation: Dizziness is more likely to occur with bradycardias than tachycardias
Downloaded By Ahmed Hakim

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