كتاب divedson's مع الحلول 2005

[cont78]

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.
(True)
(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)
(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)
(True)

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 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:
(a) Type I failure results in a partial pressure of oxygen (pO2) <8 kPa and a partial pressure of carbon dioxide (pCO2)
of >6.5 kPa. (False)
(b) In respiratory failure associated with chronic bronchitis, the level of carbon dioxide (CO2) determines the
respiratory rate. (False)
(c) Respiratory failure as defined in (a) would be an indication for ventilation in pure asthma. (True)
(d) Doxapram is a respiratory stimulant used in respiratory failure associated with chronic obstructive pulmonary
disease. (True)
(e) The main aim in type II failure is to keep the pO2 >7.0 kPa without worsening of the acidosis or pCO2. (True)

Question 16. Cushing's syndrome:
(a) May give rise to hypertension, diabetes, and truncal obesity. (True)
(b) Is usually diagnosed by estimation of the urinary free cortisol followed by an overnight dexamethasone suppression
test. (True)
(c) Could be associated with pigmentation. (True)
(d) The most common cause is probably iatrogenic. (True)
(e) Nelson's syndrome is a complication of bilateral adrenalectomy for pituitary-dependent Cushing's disease. (True)

Question 17. Leukaemia:
(a) The common presenting triad is infection, bleeding, and fatigue. (True)
(b) Acute myeloid leukaemia (AML) may result spontaneously or follow on from CML, polycythaemia rubra vera or
myelosclerosis. (True)
(c) The usual development of chronic lymphocytic leukaemia is a transformation to acute lymphoblastic leukaemia.
(False)
(d) A platelet count of 40 × 109/L would not normally give rise to spontaneous bleeding. (True)
(e) Bone marrow transplantation is a recognized treatment for AML. (True)

(a) An average diastolic blood pressure of >90 mmHg over prolonged observation is an indication for drug treatment in
uncomplicated hypertension. (False)
(b) Thiazide diuretics are the least effective antihypertensive drugs. (False)
(c) Thiazide diuretics work on the loop of Henle in the kidney. (False)
(d) Resistant hypertension is defined as a failure to control the blood pressure adequately with a good three-drug
regimen. (True)
(e) Thiazide diuretics are contraindicated in gout and diabetes. (True)

Question 19. Oral corticosteroids:
(a) Are an effective treatment for SLE. (True)
(b) In the long term may cause cataracts. (True)
(c) Should be avoided in sarcoidosis because they induce pulmonary oedema. (False)
(d) May be stopped abruptly after 2 weeks of 40 mg prednisolone daily in patients who are not exposed to repeated
courses. (True)
(e) May reveal that 15% of patients labelled as having chronic bronchitis, in fact have reversible airways disease.
(True)

Question 20. Paracetamol overdose:
(a) Ipecacuana followed by oral methionine is effective for most patients who are just over the treatment line. (False)
(b) Can cause renal failure. (True)
(c) Intravenous N-acetylcysteine frequently causes anaphylaxis. (False)
(d) The serum paracetamol level is of most value between 1 and 4 hours after ingestion. (False)
(e) In co-proxamol (distalgesic) overdose, sudden death is likely to be due to hypoglycaemia caused by paracetamol.
(False)

Question 21. Treatment of myocardial infarction:
(a) Aspirin and streptokinase are more effective than either alone after myocardial infarction. (True)
(b) Thrombolysis improves short-term complications but not mortality after myocardial infarction. (False)
(c) Tissue plasminogen activator and anistreplase are more effective than streptokinase but not used because they are
far more expensive. (False)
(d) ACE inhibitors improve outcome after myocardial infarction for patients with ventricular dysfunction. (True)
(e) HMGCo-A reductase inhibitor therapy is contraindicated for patients after myocardial infarction. (False)

Question 22. For self-poisoning:
(a) Gastric lavage is recommended for most drugs up to 12 hours after ingestion. (False)
(b) Naloxone is the specific antidote for benzodiazepine overdose. (False)
(c) Patients with tricyclic antidepressant overdose need cardiac monitoring for up to 48 hours. (True)
(d) All patients should be assessed by a qualified psychiatrist. (False)
(e) Pinpoint pupils could indicate opiate overdose. (True)

Question 23. Digoxin:
(a) Is the treatment of choice for ventricular extrasystoles. (False)
(b) May cause xanthopsia. (True)
(c) Is excreted by the kidneys. (True)
(d) Adverse effects are reduced by hypokalaemia. (False)
(e) Must not be coadministered with an ACE inhibitor. (False)

Question 24. Dementia may result from:
(a) Parkinson's disease. (True)
(b) Huntington's chorea. (True)
(c) Hypothyroidism. (True)
(d) Acquired immune deficiency syndrome (AIDS). (True)
(e) A cerebral tumour. (True)

Question 25. Oxygen:
(a) Should be administered with a high inspired concentration (>50%) in the treatment of type II respiratory failure.
(False)
(b) Should not be used at high concentration in patients with pulmonary embolism because respiration may be severely
impaired when the hypoxic drive is reduced. (False)
(c) Continuous long-term (domiciliary) oxygen improves survival in patients with respiratory failure caused by chronic
bronchitis and emphysema. (True)
(d) Is needed when respiratory failure is diagnosed by finding a pO2 of less than 11 kPa in an arterial blood sample.
(False)
(e) Comprises 21% of atmospheric air. (True)

Module 5 (Cardiology)
Question 2. The differential diagnosis for chest pain includes:
(a) Myocardial infarction. (True)
(b) Oesophagitis. (True)
(c) Pulmonary embolus. (True)
(d) Cholecystitis. (True)
(e) Aortic dissection. (True)

Question 3. The following are causes of acute life-threatening dyspnoea:
(a) Myocardial infarction. (True)
(b) Pulmonary embolus. (True)
(c) Pneumothorax. (True)
(d) Ventricular or supraventricular tachyarrhythmia. (True)
(e) Bacterial endocarditis. (True)

Question 4. The following are clinical signs found in infective endocarditis:
(a) Clubbing. (True)
(b) Haematuria. (True)
(c) Pyrexia. (True)
(d) Rashes. (True)
(e) Focal neurological defect. (True)

Question 5. The following are risk factors for ischaemic heart disease:
(a) Hypertension. (True)
(b) Moderate alcohol intake. (False)
(c) Female sex. (False)
(d) Hypercholesterolaemia. (True)
(e) Increasing age. (True)

Question 6. The following are classical features of cardiac syncope:
(a) Gradual onset. (False)
(b) Warning symptoms. (False)
(c) Rapid recovery. (True)
(d) Residual neurological deficit. (False)
(e) Precipitated by sudden turning of the head. (False)

Question 7. The following are causes of a pansystolic murmur:
(a) Mitral regurgitation. (True)
(b) Aortic regurgitation. (False)
(c) Tricuspid regurgitation. (True)
(d) Atrial septal defect. (False)
(e) Aortic stenosis. (False)

Question 8. The following conditions require antibiotic prophylaxis before dental procedures:
(a) Prosthetic aortic valve. (True)
(b) Ventricular septal defect. (True)
(c) Floppy mitral valve with coexistent mitral regurgitation. (True)
(d) Enlarged left ventricle. (False)
(e) A history of infective endocarditis in the past. (True)

Question 9. The following should be considered as possible signs of a positive exercise test:
(a) ST segment depression. (True)
(b) Exercise-induced hypotension. (True)
(c) Exercise-induced ventricular tachycardia. (True)
(d) Lack of adequate tachycardic response to exercise. (True)
(e) Leg pain at peak exercise. (False)

Question 10. The following are indications for anticoagulating a patient who has atrial fibrillation with warfarin:
(a) Age under 60 years. (False)
(b) Associated mitral stenosis. (True)
(c) Atrial fibrillation of more than 24 hours' duration. (True)
(d) A history of cerebral thromboembolism. (True)
(e) Associated left ventricular failure. (True)

Question 11. The following are true of ventricular tachycardia:
(a) It is a life-threatening condition. (True)
(b) It may be caused by myocardial ischaemia. (True)
(c) It may be caused by hypokalaemia. (True)
(d) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardia. (True)
(e) Acute ongoing ventricular tachycardia should be treated initially with drugs. (False)

Question 12. The following are signs of coarctation of the aorta:
(a) Radiofemoral delay in the pulses. (True)
(b) Rib notching. (True)
(c) Bruits heard over the scapula. (True)
(d) Ankle oedema. (False)
(e) Atrial fibrillation. (False)

Question 13. Functions of the recovery position include:
(a) To prevent the tongue from obstructing the airway. (True)
(b) To prevent neck injury. (False)
(c) To minimize the risk of aspiration of gastric *******s. (True)
(d) To maintain a straight airway. (True)
(e) To enable cardiopulmonary resuscitation to be carried out. (False)

Question 14. Complications of prosthetic heart valves are as follows:
(a) Thromboembolic events. (True)
(b) Dehiscence of the valve ring. (True)
(c) Increased risk of infective endocarditis. (True)
(d) Failure of the valve 5 years after placement. (False)
(e) Need for anticoagulation in patients who have porcine valves. (False)

Question 15. The following statements are true of thiazide diuretics:
(a) They act at the level of the distal convoluted tubule. (True)
(b) They may cause gout. (True)
(c) Diabetic control may deteriorate. (True)
(d) Hypokalaemia may occur. (True)
(e) They cause ototoxicity. (False)

Question 16. The following are classified as high-output states:
(a) Hypertension . (False)
(b) Sepsis. (True)
(c) Hypothyroidism. (False)
(d) Pregnancy. (True)
(e) Arteriovenous malformations. (True)

Question 17. Cardiac causes of clubbing are as follows:
(a) Uncomplicated atrial septal defect. (False)
(b) Chronic infective endocarditis. (True)
(c) Atrial fibrillation. (False)
(d) Acute endocarditis. (False)
(e) Empyema. (False)

Question 18. The following statements are true of the apex beat:
(a) It is the lowest and most lateral point at which the cardiac impulse can be felt. (True)
(b) It is displaced downwards and laterally if the left ventricle is enlarged. (True)
(c) It is thrusting in mitral stenosis. (False)
(d) It is thrusting in aortic regurgitation. (True)
(e) It is heaving in aortic stenosis. (True)

Question 19. The following leads represent the inferior myocardium:
(a) I, AVL, and V6. (False)
(b) V2, V3, and V4. (False)
(c) AVR and V1. (False)
(d) V1-V6. (False)
(e) II, III, and AVF. (True)

Question 20. The following are possible causes of electromechanical dissociation:
(a) Pulmonary embolus. (True)
(b) Tension pneumothorax. (True)
(c) Hypertension. (False)
(d) Dehydration. (True)
(e) Hypocalcaemia. (True)

Question 21. The following are characteristic of pericarditis:
(a) The chest pain is dull in nature. (False)
(b) There may be an associated pericardial effusion. (True)
(c) The pericardial rub may come and go. (True)
(d) The ECG usually shows regional ST elevation. (False)
(e) The ST elevation is concave. (True)

Question 22. Secondary hypertension may be due to the following:
(a) Renal artery stenosis. (True)
(b) Renal cell carcinoma. (False)
(c) Cushing's syndrome. (True)
(d) Pregnancy. (True)
(e) Oral contraceptive pill. (True)

Question 23. ECG changes due to myocardial infarction may include the following:
(a) ST elevation. (True)
(b) Sinus tachycardia. (True)
(c) Ventricular tachycardia. (True)
(d) Complete heart block. (True)
(e) Q waves. (True)

Question 24. The following drugs are used in the treatment of hypertension:
(a) Atenolol. (True)
(b) Doxazocin. (True)
(c) Enalapril. (True)
(d) Bendrofluazide. (True)
(e) Nicorandil. (False)

Question 25. Complications of myocardial infarction include:
(a) Cardiac failure. (True)
(b) Mitral regurgitation. (True)
(c) Cerebrovascular event. (True)
(d) Myocardial rupture. (True)
(e) Gastrointestinal bleed. (False)

Module 6 (Neurology)
Question 1. Concerning neuroanatomy:
(a) The corticospinal tract decussates in the pons. (False)
(b) The oculomotor nerve runs in close proximity to the posterior communicating artery. (True)
(c) The superior colliculus is found in the midbrain. (True)
(d) The trochlear (fouth cranial) nerve supplies the lateral rectus muscle. (False)
(e) The spinal cord ends at the level of the lower border of L3 in the adult. (False)

Question 2. Subdural haematomas can cause:
(a) Dementia. (True)
(b) Pupillary change. (True)
(c) Bradycardia. (True)
(d) Changing level of consciousness. (True)
(e) Blood-stained cerebrospinal fluid (CSF). (False)

Question 3. In a young woman with a spastic paraparesis, the following suggest a diagnosis of multiple sclerosis:
(a) Delayed visual evoked potentials. (True)
(b) Fasciculations. (False)
(c) Raised CSF protein. (False)
(d) Oligoclonal bands in the CSF. (True)
(e) Periventricular white matter lesions on magnetic resonance imaging (MRI) of the brain. (True

Question 4. Unilateral facial weakness is a recognized feature of:
(a) Herpes zoster infection. (True)
(b) Motor neuron disease. (False)
(c) Acoustic neuroma. (True)
(d) Cholesteatoma. (True)
(e) Syringomyelia. (False)

Question 5. The following are true about headaches:
(a) The headache of raised intracranial pressure is worst at the end of the day. (False)
(b) A normal CT scan rules out subarachnoid haemorrhage. (False)
(c) Amaurosis fugax may be caused by temporal arteritis. (True)
(d) Neurological signs on examination rules out migraine as a diagnosis. (False)
(e) Cluster headaches are more common in men than in women. (True)

Question 6. The following drugs can produce parkinsonism:
(a) Chlorpromazine. (True)
(b) Benzhexol. (False)
(c) Bromocriptine. (False)
(d) Metoclopramide. (True)
(e) Haloperidol. (True)

Question 7. Concerning movement disorders:
(a) Huntington's chorea presents with progressive dementia and chorea in middle age. (True)
(b) Myoclonus is a feature of subacute sclerosing panencephalitis. (True)
(c) Infarction of the subthalamic nucleus causes ipsilateral hemiballism. (False)
(d) Chorea is commonly found in Cruetzfeldt-Jakob disease. (False)
(e) Alcohol reduces benign essential tremor. (True)

Question 8. Concerning papilloedema:
(a) There is loss of venous pulsation on funduscopy. (True)
(b) There may be enlargement of the blind spot. (True)
(c) Intracranial pressure may be normal. (True)
(d) Hypocalcaemia is a recognized cause. (True)
(e) It is a recognized feature in Guillain-Barré syndrome. (True)

Question 9. Ptosis may be a feature of:
(a) Myotonic dystrophy. (True)
(b) Horner's syndrome. (True)
(c) Abducens nerve (sixth nerve ) palsy. (False)
(d) Oculomotor nerve (third nerve) palsy. (True)
(e) Myasthenia gravis. (True)

Question 10. Concerning the Brown-Séquard syndrome:
(a) There is ipsilateral corticospinal loss below the lesion. (True)
(b) There is ipsilateral loss of joint-position sense below the lesion. (True)
(c) There is ipsilateral loss of two-point discrimination below the level of the lesion. (True)
(d) There is ipsilateral loss of pain and temperature below the level of the lesion. (False)
(e) A central disc lesion at L3 would cause a Brown-Séquard syndrome in the legs. (False)

Question 11. Concerning the brachial plexus:
(a) In brachial neuritis, severe pain around the shoulder precedes rapid wasting. (True)
(b) Klumpke's paralysis causes proximal arm weakness. (False)
(c) Erb's palsy is caused by a lesion to C5/C6-derived regions of the brachial plexus. (True)

(d) A brachial plexus lesion and an ipsilateral Horner's syndrome may indicate a Pancoast tumour. (True)
(e) Vaccination may precipitate brachial neuritis. (True)

Question 12. Causes of a polyneuropathy include:
(a) Diabetes. (True)
(b) Guillain-Barré syndrome. (True)
(c) Renal failure. (True)
(d) Amyloid. (True)
(e) Multiple sclerosis. (False)

Question 13. A lesion to the common peroneal nerve at the fibular head causes:
(a) Weakness of eversion of the foot. (True)
(b) Decreased sensation over the dorsum of the foot. (True)
(c) Weakness of plantar flexion. (False)
(d) If long term, wasting of tibialis anterior. (True)
(e) Brisk ankle jerk. (False)

Question 14. Brainstem death may be confirmed by:
(a) Extensor response of the limbs to painful stimuli. (False)
(b) Absent corneal reflexes. (True)
(c) Absent tendon reflexes. (False)
(d) A flat EEG. (False)
(e) Absent 'doll's eye' reflexes. (True)

Question 15. A homonymous hemianopia may arise from a lesion of:
(a) The optic tract. (True)
(b) The occipital cortex. (True)
(c) The optic chiasm. (False)
(d) The optic nerve. (False)
(e) The optic radiation. (True)

Question 16. Dysarthria may result from a lesion of:
(a) The cerebellum. (True)
(b) Broca's area. (False)
(c) The hypoglossal nerve. (True)
(d) The basal ganglia. (True)
(e) The accessory nerve. (False)

Question 17. The following are clinical features of cerebellar dysfunction
(a) Postural tremor. (False)
(b) Hypotonia. (True)
(c) Dysphasia. (False)
(d) Titubation. (True)
(e) Impaired rapid altering movements. (True)

Question 18. The following clinical features may help differentiate between a syncopal attack and a seizure:
(a) Upright posture at the onset. (True)
(b) Convulsive movements of the limbs. (False)
(c) A bitten tongue. (True)
(d) Urinary incontinence. (True)
(e) Prolonged malaise after the attack. (False)

Question 19. The following are features of a subarachnoid haemorrhage:
(a) Fever. (True)
(b) Thunderclap headache. (True)
(c) Photophobia. (True)
(d) Positive Kernig's sign. (True)
(e) Neck stiffness. (True)

Question 20. A physiological tremor is:
(a) Present at rest. (False)
(b) Worsened by anxiety. (True)
(c) Improved by alcohol. (False)
(d) Improved by beta-blockers. (True)
(e) Familial. (False)

Question 21. A lesion of the medulla on one side may give rise to :
(a) An ipsilateral hemiparesis. (False)
(b) A contralateral hemiparesis. (True)
(c) Ipsilateral weakness of the palate. (False)
(d) Contralateral weakness of the tongue. (True)
(e) Contralateral third nerve palsy. (False)

Question 22. The following may be seen in a patient with a lesion of the third nerve or nucleus:
(a) A fixed dilated pupil. (True)
(b) Ptosis. (True)
(c) Diplopia in all positions of gaze. (True)
(d) A history of diabetes mellitus. (True)
(e) A contralateral hemiplegia. (True)

Question 23. In a patient with a sensory ataxia:
(a) Vibration may be impaired. (True)
(b) The gait is characterized by 'scissoring' posture of the legs. (False)
(c) Romberg's test may be positive. (True)
(d) A history of alcohol abuse may be implicated in the aetiology. (True)
(e) Clonus may be elicited on examination of the legs. (False)

Question 24. A patient with herpes zoster infection of the geniculate ganglion may present with:
(a) An upper motor neuron facial weakness. (False)
(b) Diplopia. (False)
(c) Hyperacusis. (True)
(d) Altered perception of taste. (True)
(e) Pain from the auditory meatus. (True)

Question 25. A dissociated sensory loss may be seen in:
(a) Syringomyelia. (True)
(b) Anterior spinal artery occlusion. (False)
(c) A radiculopathy. (False)
(d) Occlusion of a middle cerebral artery. (False)
(e) Compression of the spinal cord by a prolapsed intervertebral disc. (False)

Module 7 (Gastroeneterology)
Question 1. The following statements are true:
(a) Tylosis is associated with achalasia. (False)
(b) On barium swallow, a 'bird's beak' appearance is suggestive of squamous carcinoma. (False)
(c) Pneumatic dilatation is the treatment of choice for achalasia. (True)
(d) Reduced lower oesophageal sphincter pressure is a common feature of gastro-oesophageal reflux disease . (True)
(e) Oesophageal pH is usually less than 4. (False)

Question 2. The following is true of Barrett's oesophagus:
(a) Columnar epithelium is replaced by squamous epithelium. (False)
(b) It appears in an antegrade (top to bottom) direction. (False)
(c) It is a premalignant condition. (True)
(d) Severe dysplasia is an ominous sign. (True)

(e) It is an indication for surveillance endoscopy. (True)

Question 3. Helicobacter pylori:
(a) Causes ulceration in the duodenum. (True)
(b) Causes Barrett's ****plasia in the oesophagus. (False)
(c) Is associated with hypergastrinaemia. (True)
(d) Is often resistant to certain antibiotics. (True)
(e) Can convert urea to ammonia and carbon dioxide. (True)

Question 4. Gastric hypomotility (gastroparesis):
(a) Is commonly associated with diabetes mellitus. (True)
(b) Is a risk factor for gastro-oesophageal reflux disease. (True)
(c) Is a feature of generalized scleroderma (systemic sclerosis). (True)
(d) Occasionally responds to erythromycin. (True)
(e) Is often secondary to duodenal ulcer disease. (False)

Question 5. The following are features of coeliac disease:
(a) Hypocalcaemia. (True)
(b) Hypercalcaemia. (False)
(c) Normocytic anaemia. (False)
(d) Hypoalbuminaemia. (True)
(e) Positive antiparietal cell antibodies. (False)

Question 6. The following is true of Crohn's disease:
(a) The rectum is always affected. (False)
(b) Commonly affects the terminal ileum. (True)
(c) More commonly occurs in smokers. (True)
(d) Can result in vitamin B12 deficiency with a negative Schilling test. (True)
(e) Commonly presents with bloody diarrhoea. (False)

Question 7. The following is true of giardiasis:
(a) Diarrhoea abates with avoidance of dairy produce. (False)
(b) Diarrhoea abates with avoidance of gluten. (False)
(c) Diarrhoea requires treatment with metronidazole. (True)
(d) Diarrhoea is usually accompanied by vomiting. (False)
(e) Diarrhoea commonly results in vitamin B12 deficiency. (False)

Question 8. The following is true of inflammatory bowel disease:
(a) Increased liver enzymes in the serum usually indicate the complication of carcinoma. (False)
(b) Small bowel barium enema is the best radiological investigation for ulcerative colitis. (False)
(c) It is occasionally complicated by carcinoma of the caecum. (True)
(d) It is commonly associated with thyroiditis. (False)
(e) It is sometimes complicated by iritis. (True)

Question 9. The following is true of viral hepatitis:
(a) Hepatitis C commonly presents with jaundice. (False)
(b) Hepatitis E is fatal particularly in pregnant women. (True)
(c) Hepatitis BeAg is a marker of viral replication. (True)
(d) Hepatitis A is a risk factor for hepatoma. (False)
(e) Hepatitis D occurs only in association with hepatitis C. (False)

Question 10. The following drugs cause jaundice:
(a) Methotrexate. (False)
(b) Flucloxacillin. (True)
(c) Metronidazole. (False)
(d) Isoniazid. (True)

(e) Phenobarbitone. (False)

Question 11. Haemochromatosis:
(a) Is a genetic defect resulting in copper overload in the liver. (False)
(b) Is a risk factor for the development of hepatoma. (True)
(c) Has an equal sex incidence but presents earlier in males than females. (True)
(d) Is treated by avoiding meat products. (False)
(e) Can cause hypogonadism in the absence of cirrhosis. (True)

Question 12. Colonic carcinoma:
(a) Most commonly occurs in the right side of the colon. (False)
(b) May present with iron deficiency anaemia in the absence of any gastrointestinal symptoms. (True)
(c) Commonly arises in colonic polyps. (True)
(d) Carries a 5-year survival of less than 10%. (False)
(e) Is the cause of carcinoid syndrome. (False)

Question 13. The following is true of colon polyps and colon cancer:
(a) The larger the polyp, the greater the risk of carcinoma. (True)
(b) Malignant polyps can be successfully treated by colonoscopy and polypectomy alone. (True)
(c) Hyperplastic polyps have a higher malignant potential than villous polyps. (False)
(d) Polyps are most common in the ascending colon. (False)
(e) Colonic polyps are often recurrent. (True)

Question 14. The following gastrointestinal diseases are associated with the renal conditions listed:
(a) Crohn's disease and renal amyloidosis. (True)
(b) Hepatitis B and glomerulonephritis. (True)
(c) Gastric ulcer and nephrotic syndrome. (False)
(d) Pancreatic neuroendocrine tumours and polycystic kidney disease. (False)
(e) Liver cysts and glomerulosclerosis. (False)

Question 15. The following is true of villous atrophy in the small intestine:
(a) If due to coeliac disease, it should recover completely on a gluten-free diet. (True)
(b) It can be caused by tuberculosis. (True)
(c) It can be associated with Giardi lamblia. (True)
(d) It can be associated with Tropheryma whippelei. (True)
(e) When associated with bacteria, it may cause a rise in serum folate. (True

Question 16. The following skin conditions are associated with the named GI diseases:
(a) Dermatitis herpetiformis with coeliac disease. (True)
(b) Pruritus with primary biliary cirrhosis. (True)
(c) Pyoderma gangrenosum with gastric carcinoma. (False)
(d) Bullous pemphigoid with pancreatitis. (False)
(e) Erythema nodosum with Crohn's disease. (True)

Question 17. The following statements are true in relation to vomiting:
(a) Vomiting occurring 12 hours after a suspicious meal is indicative of Salmonella poisoning. (False)
(b) Vomiting in association with headache is a feature of migraine. (True)
(c) Vomiting associated with weight loss can be indicative of malignant disease. (True)
(d) Vomiting usually precedes the pain of biliary colic. (False)
(e) Vomiting can be a feature of myocardial infarction. (True)

Question 18. Scleroderma can produce the gastrointestinal complications listed:
(a) Diarrhoea due to bacterial overgrowth. (True)
(b) Constipation due to gut hypomotility. (False)
(c) Diarrhoea which is unresponsive to a gluten-free diet. (True)
(d) Gastric ulcer due to chronic gastritis. (False)
(e) Dysphagia due to abnormal peristalsis in the oesophagus. (True)

Question 19. Chronic pancreatitis:
(a) Is a cause of diabetes mellitus. (True)
(b) Can result from alcohol ingestion in moderate amounts. (True)
(c) May be hereditary in a minority of cases. (True)
(d) Can be diagnosed by a raised serum amylase. (False)
(e) Is a cause of pancreas divisum. (False)

Question 20. The following is true of rectal bleeding:
(a) In the absence of haemorrhoids, it is usually due to malignant disease. (False)
(b) It occurs more commonly in Crohn's disease than in ulcerative colitis. (False)
(c) If it occurs in a patient with ulcerative colitis, it usually indicates that carcinoma has developed. (False)
(d) When it is due to diverticular disease, colectomy may be indicated to control it. (True)
(e) It may be caused by ingestion of aspirin. (True)

Question 21. The following are risk factors for gastric carcinoma:
(a) Pernicious anaemia. (True)
(b) Coeliac disease. (False)
(c) Partial gastrectomy. (True)
(d) Helicobacter pylori infection. (True)
(e) Ménétrière's disease. (True

Question 22. The following statements are true:
(a) Solitary rectal ulcers are commonly associated with Crohn's disease. (False)
(b) Crypt abscesses are typical of coeliac disease. (False)
(c) Fistula formation can be a feature of Whipple's disease. (False)
(d) Anal fissure predisposes to faecal incontinence. (False)
(e) Right iliac fossa pain is common with diverticular disease. (False)

Question 23. The following are true of hepatitis:
(a) Hepatitis B is spread via the faecal-oral route. (False)
(b) A vaccine is available for hepatitis C. (False)
(c) Incubation time for hepatitis A is approximately 2-3 weeks. (True)
(d) Hepatitis B is an RNA virus. (False)
(e) Interferon treatment is required for hepatitis E infection. (False)

Question 24. The following is a risk factor for the Budd-Chiari syndrome:
(a) Oral contraceptive pill. (True)
(b) Malignancy. (True)
(c) Ascites. (False)
(d) Polycythaemia rubra vera. (True)
(e) Constrictive pericarditis. (False)

Question 25. The following are true regarding prognostic factors for acute pancreatitis:
(a) A low pAO2 indicates a poor prognosis. (True)
(b) A high serum GGT has a poor prognosis. (False)
(c) Age of over 55 years usually has a good prognosis. (False)
(d) A low serum albumin indicates a poor prognosis. (True)
(e) Abnormal clotting time has a poor prognosis. (True)


Question 2. The following is true of postgastrectomy syndromes:
(a) The anaemia can be corrected with ascorbic acid supplements. (True)
(b) The risk of gastric cancer in the long term is increased. (True)
(c) Sweating and palpitations can be due to hypoglycaemia. (True)
(d) Biliary gastritis in the gastric remnant is common. (True)
(e) Diarrhoea is commonly due to bacterial overgrowth. (True)


Question 3. The following is true of neoplastic disease in the stomach:
(a) Maltoma can occasionally respond to antibiotic treatment in combination with a proton pump inhibitor. (True)
(b) Ménétrière's disease is due to ****plasia of the gastric mucosa. (True)
(c) Leiomyoma has a characteristic appearance at endoscopy. (True)
(d) Gastric carcinoma produces abdominal pain that is often worse after eating. (True)
(e) The most common gastric carcinoma is of squamous cell origin. (False)


Question 4. The following statements are true:
(a) Iron absorption is reduced in hypochlorhydric states. (True)
(b) Vitamin D absorption is often deficient in the presence of gastritis. (False)
(c) Vitamin B12 supplements are often necessary following gastrectomy. (True)
(d) Anaemia associated with chronic atrophic gastritis may respond to ascorbic acid supplements. (True)
(e) Intestinal ****plasia in the stomach is a risk factor for gastric carcinoma. (True)


Question 5. The following clinical features are associated with coeliac disease:
(a) Anaemia. (True)
(b) Weight loss. (True)
(c) Vomiting. (False)
(d) Diarrhoea. (True)
(e) Jaundice. (False

Question 6. The following is true of Crohn's disease:
(a) C-reactive protein mimics inflammatory activity. (True)
(b) Normal albumin indicates remission. (False)
(c) Large bowel barium enema is the most definitive radiological test. (False)
(d) A small bowel biopsy can be helpful in making the diagnosis. (True)
(e) A low blood urea is common. (True)


Question 7. The following is true of ulcerative colitis:
(a) It commonly presents with pain in the right iliac fossa. (False)
(b) It can be associated with ankylosing spondylitis. (True)
(c) It is a risk factor for toxic dilatation of the colon. (True)
(d) The occurrence of abdominal tenderness is an ominous sign. (True)
(e) It often causes ischiorectal abscesses. (False)


Question 8. Acholuric jaundice without pain:
(a) Is a common presentation of pancreatic carcinoma. (False)
(b) Is a feature of Gilbert's disease. (True)
(c) Can occur in hereditary spherocytosis. (True)
(d) Is associated with pale-coloured stools. (False)
(e) Is associated with pruritus. (False)



Question 9. The following is true of risk factors for the development of hepatocellular carcinoma:
(a) Females are at greater risk than males. (False)
(b) Excess iron is a recognized risk factor. (True)
(c) Aflatoxin is a risk factor. (True)
(d) Hepatitis A is a risk factor. (False)
(e) Risk factors generally only operate in the presence of cirrhosis. (True)


Question 10. Alcoholic hepatitis:
(a) Recovers rapidly on cessation of drinking. (False)
(b) Is a risk factor for hepatorenal syndrome. (True)
(c) Ascites is a feature. (True)
(d) Coagulopathy is corrected with administration of vitamin K. (False)
(e) Encephalopathy occurs only if infection is present. (False)


Question 11. Primary sclerosing cholangitis:
(a) Occurs predominantly in middle-aged females. (False)
(b) Is a major risk factor for cholangiocarcinoma. (True)
(c) Occurs in 50% patients with ulcerative colitis. (False)
(d) Has been treated with ursodeoxycholic acid. (True)
(e) May require insertion of an endoprosthesis for its treatment. (True)



Question 12. The following GI conditions are associated with microcytic hypochromic anaemia:
(a) Acute duodenal ulceration. (False)
(b) Ankylostoma duodenale. (True)
(c) Terminal ileitis due to Crohn's disease. (True)
(d) Partial gastrectomy. (True)
(e) Carcinoma of caecum. (True)


Question 13. These gastronomic terms are associated with the following gastroenterological conditions:
(a) 'Rice water' diarrhoea with cholera. (True)
(b) 'Anchovy sauce' discharge with amoebic dysentry. (False)
(c) 'Redcurrent jelly' and intussusception. (True)
(d) 'Apple core' lesion and diverticulitis. (False)
(e) 'Coffee grounds' and oesophageal varices. (False)


Question 14. The following is true of breath tests used for investigation of the gastrointestinal tract:
(a) The 14C urea breath test detects Helicobacter pylori infection. (True)
(b) The 14C glycocholic acid breath test is used to detect bacterial overgrowth in the colon. (False)
(c) A hydrogen breath test following ingestion of lactulose is used to detect bacterial overgrowth in the small intestine.
(True)
(d) A lactose breath test is used to detect disaccharidase deficiency. (True)
(e) A 14C bile salt test can be used to identify bile duct obstruction. (False)


Question 15. The following autoantibodies are associated with the diseases listed:
(a) Antiendomyseal antibodies are associated with coeliac disease. (True)
(b) Anti-LKM antibodies are associated with Goodpasture syndrome. (False)
(c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True)
(d) Antiparietal cell antibodies are associated with Wilson's disease. (False)
(e) Antismooth muscle antibodies are associated with autoimmune chronic active hepatitis. (True)


Question 15. The following autoantibodies are associated with the diseases listed:
(a) Antiendomyseal antibodies are associated with coeliac disease. (True)
(b) Anti-LKM antibodies are associated with Goodpasture syndrome. (False)
(c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True)
(d) Antiparietal cell antibodies are associated with Wilson's disease. (False)
(e) Antismooth muscle antibodies are associated with autoimmune chronic active hepatitis. (True)


Question 16. The following statements are true of colitis:
(a) Granulomas are present in collagenous colitis. (False)
(b) Rectal sparing is characteristic of Crohn's colitis. (True)
(c) Caseating granulomas in the terminal ileum are diagnostic of Crohn's disease. (False)
(d) Colitis in a smoker is more likely to be Crohn's than ulcerative colitis. (True)
(e) Pain is a characteristic feature of CMV colitis. (True)


Question 17. The following statements are true of ascites:
(a) A high protein ******* in ascites is usual in alcoholic liver disease. (False)
(b) Ascites resistant to diuretics is characteristic of hepatic vein thrombosis. (True)
(c) Ascites is sometimes associated with a pleural effusion. (True)
(d) Ascites is a risk factor for bacterial peritonitis. (True)
(e) Ascites due to constrictive pericarditis prevents pulsus paradoxus. (False)


Question 18. The following statements are true of non-steroidal anti-inflammatory drugs:
(a) They can be given as suppositories to avoid gastrointestinal complications. (False)
(b) They may have a role in the prevention of colon cancer. (True)
(c) They can produce gastric erosions in elderly people causing occult blood loss. (True)
(d) They cause gastric erosions by stimulating gastric acid secretion. (False)
(e) They may exacerbate long-standing ulcerative colitis. (True)

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