M5 Medicine end of posting test – 11 Feb 2003
M5 Medicine end of posting test – 11 Feb 2003 ( 10 OSCE mcqs & 60 mcqs)
Special thanks to the people who made this possible, Cg G and H 2003, Aaron, Wei Min and Chun How,
Typed by Reuben Soh, updated by Shang Zhe.
OSCEs
1. Fundoscopy with flame haemorrhages, papilloedema, macula exudates
2. Psoriasis
3. Thyrotoxicosis with eye signs
4. CXR with dark lucency on the left and a sharp left longitudinal line (widened mediastinum?)
5. VI nerve palsy, question on diplopia
6. non-contrast CT head, shift of mediastinum with bleed intracranially
7. ECG, infero lat infarct
8. Slide of sputum with gram positive cocci and man has multiple abscess in lung – staph aureus
9. Lesion on nose with vesicles on the chin – herpes zoster
10. DM foot. Treatment options are the following except oral antibiotics and daily dressing
MCQs
1. The following are seen in uncomplicated mitral stenosis EXCEPT
a) loud S1
b) Weak pulse
c) LVH on ECG
d) pulmonary hypertension signs on CXR
e) parasternal heave
2. Complications of NSAIDs are the following EXCEPT
a) Hypertension
b) Hypokalemia
c) Renal failure
d) Interstitial nephritis
e) Papillary necrosis
3. The following drugs can be given intrathecally EXCEPT
a) methotrexate
b) Amphotericin B
c) Cytoarabine
d) Vincristine
e) Benzylpenicillin
4. The following are true for osteoporosis EXCEPT
A) more common in females than males
B) can be prevented by HRT initiated at the start of menopause
C) fluoride can decrease the incidence of hip fractures
D) leanness predisposes to osteoporosis
E) weight bearing exercises are useful in preventing osteoporosis
5. The following are found in HSP except:
a) erythema nodosum
b) abdominal pains
c) arthralgia
d) hematuria
e) purpura
6. Glycosuria is present in all EXCEPT
a) thyrotoxicosis
b) acromegaly
c) amyloidosis
d) cushings
e) pregnancy
7. The most common cause of ascites is
a) Peritoneal TB
b) Carcinomatosis peritonei
c) Liver cirrhosis
d) Hepatoma
e) Perforated bowel
8. Iron therapy is useful in the following conditions EXCEPT
a) thalassemia minor
b) Chronic iron deficiency
c) Anaemia in pregnancy
d) Peptic ulcer disease
e) Chronic intestinal malabsortion
9. In cerebral metastases, the least likely is
a) papilloedema is commonest presenting sign
b) headache is the commonest presenting symptom
c) corticosteroid therapy has a rapid clinical response
d) MRI is the most sensitive investigation
e) Commonest primary malignancy in men is lung cancer
10. Prothrombin Time is normal in
a) Chronic intestinal malabsortion
b) Disseminated intravascular coagulation
c) Fulminant hepatitis
d) Von Willebrand’s disease
e) Patients on adequate dose of warfarin
11. Features of DIVC are all EXCEPT
a) generalized bleeding tendency
b) increased in fibrin degradation products
c) prolonged clotting time
d) normal platelets in more than 50% of individuals
e) red cell fragmentation in blood smear
12. Dengue fever is associated with all EXCEPT
a) depression
b) moderate splenomegaly
c) headaches
d) maculopapular rash
e) bone pain
13. Which of the following is not a feature of the lateral medullary syndrome
a) contralateral facial sensory loss
b) ipsilateral cerebellar signs
c) ipsilateral Horners syndrome
d) dysphagia
e) vertigo
14. Proteinuria of >2g in 24 hours can be caused by all EXCEPT
a) Postural proteinuria
b) Diabetes mellitus
c) Myelomatosis
d) Acute GN
e) Renal vein thrombosis
15. A patient on long term therapy for complex generalised epilepsy who has developed neutropenia. Most likely caused by:
a) Primidone
b) Carbamazepine
c) Clonazepam
d) Sodium valproate
e) Phenobarbitone
16. Warfarin significantly interacts clinically with the following EXCEPT
a) combined OCP
b) Phenobarbitone
c) Co-trimoxazole
d) Alcohol
e) Frusemide
17. Generalised pruritus is seen in the following EXCEPT
a) Polycythemia rubra vera
b) Pellagra
c) Hodgkin’s lymphoma
d) Chronic Renal Failure
e) Primary biliary cirrhosis
18. Oral glucose tolerance test may be abnormal in
a) hyperparathyroisdism
b) thyrotoxicosis
c) TB
d) Diabetes insipidus
e) Phenylketonuria
19. Most common presentation of carcinoma of the caecum is
a) mass in abdomen
b) perforation
c) positive fecal occult blood
d) blood mixed with stools
e) Iron deficiency anaemia
20. Chronic alcoholism is least likely to have the following EXCEPT
a) PUD
b) Impotence
c) Suicide
d) Hyperlipoproteinemia
e) Hypercalcaemia
21. 35 year old woman, previously well, underwent health screen because of worry and the following results were noted:
total chol: 6.7 mmol/L
total TG: 2.6 mmol/L
LDL 4.7 mmol/L
HDL 1.3 mmol/L
Her recommended plan is to have
a) fenofibrate
b) simvastatin
c) niacin
d) exercise
e) diet modification
22. The following is true about Rheumatoid Arthritis
a) Usually progress to deformity
b) affects the DIPJ
c) is often associated with a normochromic, normocytic anaemia
d) treatment is rest in bed
e) males affected outnumber females
23. In acute pulmonary edema
a) I/V morphine is life-saving
b) Decreased lung compliance
c) Increased Chest compliance
d) Due to decreased lymphatic clearance
e) Treat by raising the legs
24. Patient with massive GI bleed, now hypotensive, in hypovolemic shock, your next step is to
a) Resuscitate
b) Urgent laparotomy
c) Urgent OGD
d) Erect and supine x-ray
e) 4-hourly parameters
25. VF is best treated by
a) I/V lignocaine
b) I/V adrenaline
c) Pacing
d) defibrillation
e) Verapamil
26. The commonest organism in IE is
a) staph aureus
b) staph epidermidis
c) strep viridans
d) strep hemolyticus
e) enterococcus faecalis
27. Neuropathic ulcer of the foot does not occur in
a) syringomyelia
b) DM
c) Syphillis
d) Leprosy
e) Subacute degeneration of the spinal cord
28. Hypoglycaemia does not occur in
a) insulinoma
b) thyrotoxicosis
c) Addison’s
d) Liver failure
e) Oral hypoglycemic therapy
29. Hyperkalemia does not occur in
a) Cushing’s syndrome
b) Addison’s disease
c) CRF
d) Acidosis
e) Therapy with spironolactone
30. Most common cause of post transfusion hepatitis
a) HAV
b) HBV
c) HCV
d) HDV
e) CMV hepatitis
31. Uveitis is seen in the following EXCEPT:
a) sarcoidosis
b) ankylosing spondylitis
c) Ulcerative colitis
d) Reiter’s disease
e) dermatomyositis
32. The most important prognostic indicator in SLE is
a) ANA titre
b) Lupus anticoagulant
c) Extent of renal involvement
d) Sex of the patient
e) Severe arthritis
33. ARF is caused by all except
a) sulphasalazine
b) gentamicin
c) amphotericin B
d) neomycin
e) metronidazole
34. Chronic SDH can cause the following except
a) headache
b) pupillary changes
c) sensory ataxia
d) dementia
e) fits
35. Migraine can be the cause of the following except
a) scintillating flashes of light
b) unilateral headache
c) Homonymous hemianopia
d) Horner’s syndrome
e) Nausea
36. Rapid injection of 120 mg/kg frusemide can cause
a) Heart failure
b) ARF
c) Reversible deafness
d) Convulsions
37. 56 year old lady, previously well, presents to the EMD with transient loss of vision, transient hemiparesis, likely diagnosis is
a) Carotid artery insufficiency
b) Vertebrobasilar insufficiency
c) Normal response of a tense individual
d) Hypoglycaemia
e) glaucoma
38. The following are seen in leptospirosis except
a) Leucopenia
b) Hepatitis
c) Jaundice
d) Increasing serum urea
e) Neck stiffness
39. All reflexes are absent in brain death except
a) corneal reflex
b) gag reflex
c) oculocephalic reflex
d) deep tendon reflex
e) pupillary reflex
40. TB of the urinary tract is
a) an ascending infection
b) will lead to CRF
c) does not involve the bladder
d) the only cause of sterile pyuria
e) may present with hematuria as the only symptom
41. A patient with type 2 DM, with nephropathy, proteinuria >2g/24hrs, Creatine Clearance is 30mls/min, Hb 9g/dL. All of the following are true to slow the progression of proteinuria/renal deterioration EXCEPT
a) good glycaemic control
b) aggressive hypertension treatment
c) May need moderate dietary protein restriction
d) Can be started on captopril
e) Should be started on Erythropoietin to treat anemia
42. In atrial fibrillation
a) it’s a benign condition
b) it’s rare in the elderly
c) can be treated with cardioversion with low energy shock
d) Benign in WPW syndrome
e) Associated with thromboembolism
43. A man, with a past history of asthma, is admitted to the EMD with BP 220/136mmHg, complains of visual blurring, and on examination has papilloedema, treatment entails
a) I/V nitroprusside
b) I/M hydralazine
c) I/V labetalol
d) I/V metoprolol
e) I/V verapamil
44. Prognostic indicator in completed myocardial infarction are all EXCEPT
a) normal exercise stress test
b) LVEF>50%
c) The degree of S-T elevation during acute phase of MI
d) Overt cardiac failure in the acute phase
e) Recurrent angina in the early post MI period
45. DM neuropathy gives rise to the following EXCEPT
a) nocturnal diarrhoea
b) impotence
c) deafness
d) postural hypotension
e) mononeuritis multiplex
46. Panhypopituitarism has all of the following features except
a) loss of axillary and pubic hair
b) hypokalemia
c) hypotension
d) decreased serum GH
e) suprasellar lesion seen on lateral skull x-ray
47. Mouth ulcers appear in all of the following except
a) Psoriasis
b) Lichen planus
c) Herpes simplex infection
d) Secondary syphilis
e) Behcet’s disease
48. The following are true of hepatitis A infection EXCEPT:
a) it may have a cholestatic phase
b) it may present as an influenza-like illness
c) about 10% of patients with acute hepatitis A infection become carries
d) seldom causes fulminant hepatitis
e) IgM anti-HAV titre is used for the serological diagnosis of acute hepatitis A infection
49. The following have malignant potential except
a) adenomatous polyp in colon
b) familial adenomatous polyposis
c) villous adenoma
d) long standing ulcerative colitis
e) diverticulosis
50. Liver abscesses classically have the following signs except
a) Jaundice
b) Tenderness
c) Fever
d) Ascites
e) Hepatomegaly
51. Hypercalcaemia is seen in the following except
a) small cell cancer of lung
b) renal cell carcinoma
c) parathyroid adenoma
d) squamous cell cancer of lung
e) multiple myeloma
52. The following may be found in DKA except
a) pH 30mmol/L
c) serum osmolalaity >340 osm
d) HCO3 > 30 mmol/L
e) Ketones 4+
53. The MOST appropriate initial management of febrile neutropenia in a patient
on cytotoxic chemotherapy should be:
A. observe for spontaneous recovery of white cell count
B. leukocyte transfusion
C. carry out cultures of blood and urine and wait for results before commencing specific antibiotics
D. immediate empirical antibiotics after obtaining specimens for culture
E. administration of growth factors
54. A patient from Thailand with severe malaria complicated by acute renal failure should be started on this regiment consisting:
A) IV quinine and pyrimethamine-sulphadoxine (fansidar)
B) IV quinine and oral tetracycline
C) IV chloroquine and oral tetracycline
D) mefloquine and oral tetracycline
E) dapsone-pyrimethamine and primarquine
55. Which of these is least likely to present with diffuse lymph node enlargement?
a) TB
b) Myelomatosis
c) Secondary syphilis
d) Hodgkins lymphoma
e) Infectious mononucleosis
56. Which of the following drugs should be used to treat a patient who has severe systemic Candidiasis?
a) Nystatin
b) Ketoconazole
c) Amphotericin B
d) Miconazole
e) Clotrimazole
57. In a patient with spinal cord compression caused by metastases, the immediate management should be:
A) decompression laminectomy
B) high dose dexamethasone
C) radiotherapy
D) chemotherapy
E) observation for spontaneous recovery
58. Pneumocystis carinii pneumonia can be diagnosed by EXCEPT:
A) open biopsy
B) sputum culture
C) endotracheal brushing
D) complement fixation test
E) immunofluorescence antibody testing
59. Which of the following anti diabetic drugs have the longest duration of action?
a) Tolbutamide
b) Glibenclamide
c) Glicazide
d) Chlorpropamide
e) Metformin
60. The following are true for small cell lung cancer EXCEPT:
a) it is associated with smoking
b) is is associated with Cushing’s syndrome
c) the treatment of choice is wide surgical excision of the primary with adequate clear margins
d) systemic spread widely/early
e)
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