MCQs
- 1.Meckel's diverticulum most commonly presents as:
- A.
Gastrointestinal bleeding.
- B.
Obstruction.
- C.
Diverticulitis.
- D.
Intermittent abdominal pain
- 2.Patients with established, complete, simple, distal small bowel obstruction usually have the following findings on plain and upright abdominal radiographs:
- A.
Distended small bowel identifiable by the valvulae conniventes and . multiple air-fluid levels.
- B.
Modest amount of gas in the pelvis.
- C.
Peripheral, rather than central, distribution of gas.
- D.
Prominent haustral markings.
- E.
Free air.
- 3.A 42-year-old man with acute renal failure is confused. His serum potassium is 8.1 mEq/L . The most likely abnormal ECG finding is
- A.
T wave inversion
- B.
PR interval of 300ms
- C.
QT interval of 0.4s
- D.
U wave
- E.
Tall tented T waves test
- 4.75 year old woman presents with severe headaches.What is the most likely diagnosis?
- A.
Takayasu arteritis
- B.
Giant cell arteritis
- C.
Aortic dissection
- D.
Polyarteritis nodosa
- E.
Wegener's granulomatosis
- 5.25 year old woman has several episodes of gastrointestinal bleeding of unclear source with muscle pains. What is the most likely diagnosis?
- A.
Takayasu arteritis
- B.
Giant cell arteritis
- C.
Aortic dissection
- D.
Polyarteritis nodosa
- E.
Wegener's granulomatosis
- 6.Autopsy findings of a 57 year old woman are as follows: Multiple 2-4 mm vegetations were found on an otherwise normal mitral valve. the vegetations were made of fibrin on histological section, and the underlying valve was essentially normal. What would be the most likely history when you get her clinic chart:
- A.
Long history of intravenous drug abuse with recent history of fevers to 104 degree F
- B.
Pancreatic carcinoma being treated on an experimental protocol for chemotherapy
- C.
History of rheuthmatic fever at age nine with long term mitral stenosis and recent onset of fevers to 103 degree F
- D.
Long history of systemic lupus erythematosis (SLE)
- 7.Which of the following is not likely to see in mitral valve prolapse
- A.
Stroke
- B.
Arrhythmias
- C.
Infective endocarditis
- D.
Mitral stenosis
- E.
Embolism of leaflet thrombi
- 8.Disorders predisposing to cor pulmonale include all of the following except:
- A.
Cystic fibrosis
- B.
Chronic obstructive pulmonary disease
- C.
Left-sided heart failure
- D.
Kyphoscoliosis
- E.
Pulmonary embolism
- 9.Which of the following is less likely to be a manifestations of ischemic heart disease
- A.
Myocardial infarction
- B.
Chronic ischemic heart disease
- C.
Sudden cardiac death
- D.
Myocarditis
- E.
Angina pectoris
- 10.A 44 year old builder presents with weakness over the past 48 hours. A neurological exam reveals the following (N=normal) Upper Limbs Lower Limbs Right Left Right Left Tone N reduced N N Power (MRC) 4/5 4/5 3/5 4/5 Coordination N N N N Sensation Fine touch Proprioception N N N N N N N N Reflexes Biceps triceps supinator - (absent) - (absent) + - (absent) - (absent) + with reinforcement Knee Ankle Plantar - (absent) - (absent) down - (absent) - (absent) down Which of the following is the most likely diagnosis?
- A.
Polio
- B.
Multiple Sclerosis
- C.
Myasthenia Gravis
- D.
Stroke
- E.
Guillian Barre
- 11.A 64 year old man presents to hospital with his first epileptic seizure whilst sat reading a newspaper at home. Drug history - Nil A clinical examination reveals the following:
- Temp 37˚
- BP 182/102
- O2 Saturation 99% on room air
- GCS 15
- HGT 3.9mmol/l
- No jaudince, pallor, cyanosis, clubbing, lymphadenopathy.
- CVS – NAD
- Chest – NAD
- GI – NAD
- A.
Brain metastasis
- B.
Hypercalcemia
- C.
Syndrome of inappropriate ADH secretion (SIADH)
- D.
Idiopathic epilepsy
- 12.An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis. She tells you she drinks 42 units of alcohol a week. Her blood results are as follows Albumin 32 (35-50) Alk Phos 456 (<110) ALT 88 (<40) Bilirubin 120 (<20) INR 1.6 GGT 400 (0-70) What’s the most likely diagnosis?
- A.
Gallstones
- B.
Paracetamol Overdose
- C.
Pancreatic cancer
- D.
Alcoholic Hepatitis
- E.
Primary billiary cirrhosis
- 13.A 37 year old intravenous drug user is referred by his GP for a suspected Bells Palsy. On examining his inner ear there are a number of vesicles visible on his ear drum. His cranial nerve examination reveals a weakness of the whole of the left side of his face. The most likely diagnosis is:
- A.
Steven Johnson Syndrome
- B.
HIV
- C.
Stroke
- D.
Ramsay Hunt Syndrome
- E.
Bells Palsy
- 14.A 45 year old female presents to A&E with mild pleuritic right sided chest pain. A Chest X ray reveals a small (<1cm) ring of air outside the lung at the apex. What is the correct management?
- A.
Chest drain (Seldinger technique)
- B.
Aspiration under ultrasound guidance
- C.
Aspiration without ultrasound
- D.
Observation initially
- E.
Chest drain (trochar technique)
- 15.A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him "dying " as a result of the AF. PMHx: Hypertension (treated), Mild COPD. Nil else of note. DHx Verapamil (as treatment for AF) Amlodipine Simvastatin PRN inhalers SHx Lives alone. Independent. Can carry out all ADL's (activities of daily living) What is the anticoagulation schedule you would recommend to prevent stroke?
- A.
Clopidrogel
- B.
Warfarin
- C.
Aspirin
- D.
No anticoagulation
- E.
Warfarin and Aspirin
- 16.A 42 year old man develops a sore throat. He does not consult his local health centre but takes some over the counter painkillers and an anti-inflammatory. 1 week later he has a non itchy rash starting on his feet then spreading to his trunk. The rash has the appearance of tiny teardrops. He is correctly diagnosed with guttate psoriasis. The patient is put on penicillin orally 250mg QDS for 1 week. He then starts passing small volumes of urine. His urine is described as "orangey brown" . He continues taking a non steroidal anti inflammatory drug (ibuprofen 800mg TDS). What is the most likely explanation for this?
- A.
Post infective glomerulonephritis
- B.
Rheumatic fever
- C.
Secondary to penicillin
- D.
Interstitial nephritis secondary to anti inflammatory medication
- E.
None of the listed answers
- 17.A 27 year old female presents with a headache. She has had it for 3 days. She has no other symptoms. She has a normal CT brain. Her lumbar puncture shows the following. CSF Opening Pressure (10-20cm H20) 42 Macroscopic appearance Clear Bottle 1 Bottle 3 RBC 150 mm3, WCC 0mm3 RBC 0mm3,WCC 0mm3 Gram stain Negative MCS No growth Glucose 4.5 Xanthochromia negative What is the most likely diagnosis?
- A.
Benign Intracranial Hypertension
- B.
Tension headache with traumatic Lumbar Puncture
- C.
Sub arachnoid haemarrage missed on CT
- D.
TB Meningitis
- E.
Sub Arachnoid Haemorrage
- 18.Which of these symptoms of hypoadrenalism will distinguish between primary adrenal failure and secondary (pituitary) adrenal insufficiency?
- A.
Postural Hypotension
- B.
Weight Loss
- C.
Fatigue
- D.
Hypoglycaemia
- E.
Skin Pigmentation
- 19.A 63 year old male who was previously fit and well presents with easy bruising and profusely bleeding gums when he cleans his teeth. He has had the symptoms for 5 weeks. On examination he has numerous ecchymoses and purpura. You can feel no palpable lymph nodes. His wife arrives in the clinic late. She explains that he’s a forgetful chap and forgot to tell you he’s taking warfarin for atrial fibrillation. She also tells you he has recently been prescribed some antibiotics for a sore throat. She shows you his INR book with the readings from the previous 6 weeks Date INR 3 days ago 2.0 3 weeks ago 2.1 5 weeks ago 2.3 7 weeks ago 1.8 13 weeks ago 2.6 What is the most likely explanation for his symptoms?
- A.
Cranberry juice ingestion
- B.
Antibiotics affecting warfarin
- C.
Accidental overdosing of warfarin
- D.
None of the above
- 20.A 62 year old man presents with a swollen right calf 3 weeks after undergoing a total left hip replacement. He is known to have rheumatoid arthritis. An Emergency Department doctor tells you that he feels the patient can be discharged. He tells you this because he shows you the D-Dimer result, which is “negative”. The result is shown below. D-Dimer 0.08 (Normal range 0-0.18) Which of the following statements is true about D-Dimer testing in general patients with a suspected DVT?
- A.
Following a clinical assessment, clinicians should not rely on the test as a basis to 'discharge' or 'investigate'
- B.
It is of no use in patients who have had recent surgery (e.g. within the last 12 weeks)
- C.
It is of no clinical use in patients with malignancy and secondary metastases
- D.
It can be used to discharge patients based on their underlying estimated clinical risk score
- E.
None of the listed answers are correct
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