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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