Bofs in: Clinical sciences and statistics

Book: [MCQs for MRCP Part 1, GENERAL MEDICINE ]

By: [ MICHAEL J. FRD ! IAN ". #IL$IN%N ]
Edition: [ &HIRD EDI&IN '(() ]
Contribution by Dr. "a*er %ala+ member of the ,rc-"ofGro.-/0a+oo1ro.-s.co, '(()2(3214
( Regards to all member colleagues particularly the special man Dr. Azkar Baig )
1. In a -+ase 11 trial of a ne5 dr.1, '( o.t of 1(( -eo-le treated 5it+ t+e acti6e dr.1 died co,-ared 5it+ '7 o.t of
1(( -eo-le 1i6en t+e -lace8o. #+ic+ NE of t+e follo5in1 state,ents is &R9E:
A The relative risk reduction is 5%
" The number needed to treat to prevent 1 death is 20
C An analysis of variance (A!"A# is the most appropriate statistical test to apply to the data
D $andomi%ation for entry to the study is al&ays re'uired
E (tudent)s t*test &ould be an appropriate statistical tool to assess si+nificance
'. A scientist 5is+es to co,-are ser., as0,,etric di,et+0lar1inine le6els, an in+i8itor of nitric o;ide -rod.ction,
in t5o distinct 1ro.-s. #it+in eac+ 1ro.-, t+e ran1e of -las,a le6els e;+i8its a s*e5ed rat+er t+an a nor,al
distri8.tion. #+ic+ NE of t+e follo5in1 statistical tests 5o.ld 8e t+e ,ost a--ro-riate to assess differences
8et5een t+e ser., le6els 5it+in t+e t5o 1ro.-s:
A ,aired (tudent)s t*test
" -ilco.on rank sum test
C (pearman)s rank correlation
D /hi*s'uared test
E 0onferroni)s test
<. #+ic+ NE of t+e follo5in1 statistical -rocesses is LEA%& li*el0 to red.ce t+e -ossi8ilit0 of s0ste,atic errors
arisin1 fro, a clinical st.d0:
A 1o+arithmic transformation
" (tratification
C $andomi%ation
D $estricted entry criteria
E 1o+istic re+ression
). A dr.1 co,-an0 5is+es to cond.ct a rando,i=ed, -lace8ocontrolled st.d0 to in6esti1ate t+e effect of a no6el
dr.1 on t+e fre>.enc0 of +os-ital ad,issions in -atients 5it+ ast+,a. #+ic+ NE of t+e follo5in1 factors 5ill
N& affect t+e sa,-le si=e re>.ired for t+e st.d0:
A The anticipated rate of hospital admission in the control +roup
" The difference in admission rates bet&een the t&o +roups
C The desired level of statistical si+nificance
D 2ru+ tolerability
E The choice of post*hoc statistical analysis
7. #+ic+ NE of t+e follo5in1 state,ents 8est descri8es t+e arit+,etic ,ean of a series of ,eas.re,ents:
A The most commonly occurrin+ value
" The value intermediate bet&een the hi+hest and lo&est measurement
C T&ice the median
D The avera+e value of all the measurements
E The sum of values of measurement multiplied by the number of measurements
?. #+ic+ NE of t+e follo5in1 state,ents a8o.t nor,all0 distri8.ted data is &R9E:
A The data are likely to e.hibit considerable ske& of the values about the mean
" The mode and median coincide &ith the mean
C 35% of the area under the curve is represented by the mean plus or minus one standard deviation
D The standard error of the mean is the standard deviation of the mean multiplied by the s'uare of the number
of observations (#
E All people in the sample are normal
@. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e %t.dentAs t2test is FAL%E:
A 4t &as developed specifically for use by students
" 4t cannot be used to compare t&o normally distributed samples
C 4t re'uires reference tables for statistical assessment of the )t) value
D 4t does not re'uire calculation of the standard error of the differences bet&een t&o medians
E 4t uses the concepts of de+rees of freedom and confidence limits
3. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e c+i2s>.are test is &R9E:
A The test makes comparisons bet&een +roups
" The test is more useful if small numbers are present
C The test re'uires prior calculation of the potency ratio
D A probability ,5 061 indicates statistical si+nificance
E The test compares actual values rather than proportions or number of occurrences
4. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e incidence of a disease is &R9E:
A 4t is the number of cases of disease present at any +iven time in the sample under study
" 4t is a measure of only clinical rather than subclinical cases
C The incidence of a chronic disease is typically less than its prevalence
D 4t is a useful measure in determinin+ the cause of a disease
E 4t is best determined from postmortem data
1(. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e trans,itter nitric o;ide is &R9E:
A 4t is synthesi%ed from 1*citruiline
" 4t is a potent vasoconstrictor
C 4t increases plasma cyclic A7,
D 4t is stored in vesicles for release
E 4t is soluble in blood
11. #+ic+ NE of t+e follo5in1 state,ents a8o.t atrial natri.retic -e-tide is &R9E:
A 4t is secreted mainly by the kidney
" 4t increases the production and release of renin
C /yclic 87, is the main second messen+er in si+nal transduction
D 4t increases blood pressure
E 4t induces vasopressin secretion by the posterior pituitary
1'. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e ne.ronal action -otential is &R9E:
A 7yelination decreases nerve conduction velocity
" 1ar+e fibres conduct more slo&ly than small fibres
C 4nactivation of potassium channels causes the refractory period
D Tetrodoto.in blocks volta+e +ated sodium channels
E 2epolari%ation results from inhibition of sodium entry durin+ potassium efflu.
1<. A 7)20ear2old ,an is ad,itted se,i2conscio.s 5it+ a nor,al 8lood -ress.re 8.t e6idence of -eri-+eral c0anosis.
9rinal0sis s+o5ed no e6idence of *eton.ria and arterial 8lood 1ases s+o5ed a -H ?.4, PaC' '.( $Pa, Pa '
1'.@ $Pa, HC2 <.( ,,olBL. "lood 1l.cose 5as ?.1 ,,olBL and t+e anion 1a- 5as '3 ,,olBL 5it+ a -las,a
lactate 1@.( ,,olBL. #+ic+ NE of t+e follo5in1 dia1noses is ,ost consistent 5it+ t+ese findin1s:
A 2iabetic ketoacidosis
" 4n+estion of e.cess ammonium chloride
C /hronic renal failure
D 4n+estion of ethylene +lycol
E ,rimary hyperaidosteronism
1). #+ic+ NE of t+e follo5in1 state,ents a8o.t -rostac0clin CPGI'D is &R9E:
A 4t is synthesi%ed by smooth muscle cells
" 4t is formed from arachidonic acid by the action of lipo.y+enase
C 4t is a potent vasoconstrictor
D 4t inhibits platelet a++re+ation
E 4t causes uterine contraction in the non*pre+nant state
17. #+ic+ NE of t+e follo5in1 s.1ars is a ,onosacc+aride:
A 8alactose
" 1actose
C (ucrose
D 7altose
E (tarch
1?. In 5+ic+ NE of t+e follo5in1 1enetic disorders is t+e ,eta8olis, of a,ino acids nor,al:
A ,henylketonuria
" Albinism
C 8aucher)s disease
D 9omocystinuria
E 7aple syrup urine disease
1@. #+ic+ NE of t+e follo5in1 state,ents a8o.t +ae,o1lo8in is &R9E:
A :ach haemo+lobin molecule comprises t&o haem +roups
" :ach haem +roup binds four molecules of o.y+en
C -ithin the haem +roup; iron is in the ferric state (<el=#
D 8lobin consists of t&o polypeptide chains
E 9aemo+lobin A2 contains both alpha and delta chains
13. #+ic+ NE of t+e follo5in1 factors is li*el0 to s+ift t+e o;01en dissociation c.r6e to t+e ri1+t:
A 7ethaemo+lobinaemia
" Alkalosis
C 2ecreased blood 2;> diphospho+lycerate levels
D A fall in body temperature
E 2ecreased arterial partial pressure of carbon dio.ide
14. #+ic+ NE of t+e follo5in1 ,eta8olic actions is associated 5it+ adrenaline Ce-ine-+rineD:
A 8lyconeo+enesis
" 2ecreased fatty acid utili%ation by muscle
C 2ecreased lipolysis in adipocytes
D 2ecreased ketone body production by the liver
E 4nhibition of adenyl cyclase via alpha*adrener+ic receptors
'(. #+ic+ NE of t+e follo5in1 state,ents a8o.t 6ita,in deficienc0 states is &R9E:
A $iboflavin deficiency causes dryness of the mouth and +enitalia
" ,yrido.ine deficiency causes pro.imal myopathy
C "itamin A deficiency causes e.foliative dermatitis
D iacin deficiency causes con+estive cardiomyopathy
E <olic acid deficiency causes +lossitis but not stomatitis
'1. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e en=0,e 1.an0l0 c0clase is &R9E:
A The en%yme is inhibited by isosorbide mononitrate
" 4t inhibits the effect of natriuretic peptides
C 4t catalyses the formation of cyclic 87, from 8T,
D 4ts activity is enhanced by phosphodiesterases
E The en%yme contains a haem +roup &hich binds nitric o.ide
''. #+ic+ -art of t+e renal ,ed.lla is res-onsi8le for t+e ,aEorit0 of renal t.8.lar rea8sor-tion of 8icar8onate in
nor,al -+0siolo1ical states:
A 2istal convoluted tubules
" Thick ascendin+ loop of 9enle
C /ollectin+ ducts
D ,ro.imal convoluted tubules
E 4nner medullary collectin+ ducts
'<. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e cranial fora,ina is &R9E:
A The ?u+ular foramen contains the cranial nerve @44
" The hypo+lossal foramen contains the cranial nerve @
C The stylomastoid foramen contains the cranial nerve "
D The foramen lacerum contains the internal carotid artery
E The foramen ma+num contains the cranial nerve "ill
'). #+ic+ NE of t+e follo5in1 actions is ,ediated 80 8eta2' adrener1ic rece-tors:
A 0ronchoconstriction
" "asoconstriction
C Aterine contraction
D 2ecreased s&eat +land secretion
E 4nsulin secretion
'7. #+ic+ NE of t+e follo5in1 ,.scles is inner6ated 80 t+e ,edian ner6e:
A :.tensor pollicis lon+us
" <le.or carpi ulnaris
C Abductor pollicis
D The medial t&o lumbricals
E :.tensor pollicis brevis
'?. #+ic+ NE of t+e follo5in1 ions is -resent in +i1+er concentrations in t+e intracell.lar fl.id co,-art,ent t+an
t+e e;tracell.lar fl.id co,-art,ent:
A (odium
" 7a+nesium
C /hloride
D 0icarbonate
E /alcium
'@. A )@20ear2old 5o,an co,-lains of t+e recent onset of s+ortness of 8reat+. &+e -ast ,edical +istor0 incl.ded
l.n1 s.r1er0 for an .ne;-lained ,ass on t+e c+est F2ra0 5+ic+ later -ro6ed to 8e a 8eni1n t.,o.r. Isoto-e l.n1
scannin1 re6ealed a lo5 6entilation to -erf.sion CGB(D ratio. #+ic+ NE of t+e follo5in1 disorders 5o.ld 8est
e;-lain t+ese findin1s:
A A ri+ht*to*left shunt of blood
" ,neumothora.
C (ur+ical removal of a lun+
D 1obar pneumonia
E <ibrosin+ alveolitis
'3. #+ic+ NE of t+e follo5in1 conditions is associated 5it+ increased 1astric ,otilit0:
A Anore.ia nervosa
" 8astrinoma
C "estibular neuronitis
D Acute intermittent porphyria
E ,artial +astrectomy
'4. #+ic+ NE of t+e follo5in1 1astrointestinal ne.ro-e-tides increases colonic ,otilit0:
A ,eptide BB
" :ntero+luca+on
C /alcitonin +ene*related peptide
D (omatostatin
E eurotensin
<(. In 5+ic+ NE of t+e follo5in1 disorders is a.toso,al do,inant in+eritance t+e ,ost co,,on ,ode of
in+eritance:
A 8ilbert)s syndrome
" 1imb +irdle muscular dystrophy
C /ystic fibrosis
D (pinal muscular atrophy
E 0eta*thalassaemia
<1. In 5+ic+ NE of t+e follo5in1 disorders is a.toso,al recessi6e in+eritance t+e ,ost co,,on ,ode of
in+eritance:
A 9ereditary haemorrha+ic telan+iectasia
" 9ereditary spherocytosis
C -ilson)s disease
D <amilial hypercholesterolaemia
E ,seudohypoparathyroidism
<'. &+e fa,il0 +istor0 s.11ests an F2lin*ed recessi6e disorder. #+ic+ NE of t+e follo5in1 state,ents is &R9E:
A 9alf of the sons of a female carrier are carriers
" 9alf of the dau+hters of affected males are carriers
C All of the sons of an affected male are normal
D There is a 1 in 2 chance of a child of a female carrier bein+ affected
E 9etero%y+ous females are likely to be affected by the disorder
<<. #+ic+ NE of t+e follo5in1 state,ents a8o.t acet0l coen=0,e A is &R9E:
A 4t is converted into formic acid in the tricarbo.ylic acid cycle (Creb)s cycle#
" 4ts production from pyruvate is controlled by positive feedback
C 4t inhibits +lucose*D*phosphate production from fructoseD*phosphate in the cell
D /onversion to fatty acids is an ener+y*consumin+ action
E 4ts production from citrate is the result of o.idative phosphorylation
<). #+ic+ NE of t+e follo5in1 is t+e MAJR constit.ent of 6er02lo52densit0 li-o-rotein CGLDLD:
A Triacyl+lyceride
" Apolipoprotein A*11
C /holesterol
D ,hospholipid
E ,rotein
<7. #+ic+ NE of t+e follo5in1 tests is 8ased on an i,,.nofl.orescent tec+ni>.e:
A <actor "444 assay in haemophilia
" The $ose*-aaler test in rheumatoid arthritis
C The T,9A test in syphilis
D 4dentification of tumour*specific anti+ens in sera
E 2etection of tissue immuno+lobulins
<?. #+ic+ NE of t+e follo5in1 state,ents a8o.t i,,.no1lo8.lins is &R9E:
A They are secreted by transformed T lymphocytes
" The lamina propria of the +ut produces predominantly 4+8
C 4+7 and 4+A cross the placenta
D 4+2 is found on the surface of immature 0 lymphocytes
E 4+: is predominantly involved in immune comple. formation
<@. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e co,-le,ent s0ste, is &R9E:
A !nly the classical path&ay produces both /> and /5 convertase
" /omponents of the classical path&ay are mainly beta+lobulins
C The classical path&ay is tri++ered by bacterial endoto.in
D The alternative path&ay is tri++ered by platelet a++re+ation
E /l esterase e.cess produces an+io*oedema
<3. #+ic+ NE of t+e follo5in1 is an e;-ected -+0siolo1ical c+an1e associated 5it+ t+e nor,al a1ein1 -rocess:
A 2ecreased calcium phosphate content per 100 + bone
" 4ncreased tissue sensitivity to insulin
C $educed numbers of pacin+ cells &ithin the sino*atrial node
D 4ncreased +lomerular filtration rate
E 4ncreased suppressor T cell function
<4. #+ic+ NE of t+e follo5in1 factors in +ealt+0 elderl0 indi6id.als is M%& res-onsi8le for t+e increase in
s.sce-ti8ilit0 to +0-ot+er,ia:
A An increased core*skin temperature +radient
" 4ncreased ability to detect small chan+es in room temperature
C An impaired ability to shiver effectively in response to coolin+
D 4mpaired cellular responses to thyroid hormones
E Thermore+ulation &hich is not altered by autonomic function
)(. #+ic+ NE of t+e follo5in1 factors is M%& res-onsi8le for t+e increased ris* of falls in elderl0 s.8Eects
co,-ared 5it+ 0o.n1er indi6id.als:
A A reduced variability of step len+th
" An increased step fre'uency
C An increased step &idth
D An increased step len+th
E A reduced antero*posterior s&ay in &omen than men
)1. #+ic+ NE of t+e follo5in1 state,ents a8o.t +ae,o-+ilia A is &R9E:
A 9alf of the sons of a female carrier are carriers
" All dau+hters of an affected male &ill be carriers
C All sons of an affected male &ill be carriers
D 1 in 2 of all the children of a female carrier &ill be affected
E 9omo%y+ous females are unaffected
)'. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e +.,an 1eno,e is &R9E:
A (omatic cell nuclei contain 2> pairs of homolo+ous autosomes
" 8amete nuclei are diploid &ith a sin+le @ or B chromosome
C The @ chromosome is smaller than the B chromosome
D An < body in somatic cell nuclei represents a B chromosome
E A 0arr body is a +enetically inactive @ chromosome
)<. #+ic+ NE of t+e follo5in1 cell.lar e6ents occ.rs in t+e c0to-las, rat+er t+an 5it+in t+e cell n.cle.s:
A Transcription to 7$A precursor
" 2A replication
C Translation of 7$A to +ene product
D :.cision of introns and splicin+ of e.ons
E /ontrol of +ene e.pression
)). #+ic+ NE of t+e follo5in1 is an essential a,ino acid:
A 1eucine
" 8lycine
C 9ydro.ylysine
D Ar+inine
E 8lutamine
)7. #+ic+ NE of t+e follo5in1 cell rece-tors acti6ates aden0late c0clase:
A 4nsulin
" Alpha*2 adrenoceptor
C 9istamine 1
D Thrombo.ane A2
E Thyroid*stimulatin+ hormone
)?. #+ic+ NE of t+e follo5in1 t.,o.rs is associated 5it+ t+e -roto2onco1ene c2,0c:
A /olon carcinoma
" 0reast carcinoma
C /ervical carcinoma
D (mall*cell lun+ carcinoma
E 0urkitt)s lymphoma
)@. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e release of free fatt0 acid fro, adi-ose tiss.e is &R9E:
A 4t is increased by noradrenaline (norepinephrine#
" 4t is increased by insulin
C 4t is decreased by +lucocorticoids
D 4t is decreased by +ro&th hormone
E 4t is dependent on activated pancreatic lipase
)3. #+ic+ NE of t+e follo5in1 state,ents a8o.t nor,al cere8ros-inal fl.id is &R9E:
A /(< is under less hydrostatic pressure than the venous sinuses of brain
" /(< is present &ithin the subdural space
C 1ateral ventricles communicate &ith the third ventricle via the foramen of 7unro
D The total /(< volume is appro.imately 500 ml
E /(< is produced by the arachnoid villi
)4. A '420ear2old ,an is ad,itted 5it+ a fe6er 5it+o.t locali=in1 si1ns. "lood c.lt.res 0ield a Gra,2ne1ati6e
di-lococc.s. #+ic+ NE of t+e follo5in1 is t+e li*eliest infectin1 or1anis,:
A Neisseria meningitides
" Streptococcus pneumoniae
C Corynebacterium diphtheria
D Staphylococcus aureus
E Borrelia burgdorferi
7(. #+ic+ NE of t+e follo5in1 state,ents a8o.t t+e s-inal cord is &R9E:
A The dorsal columns predominantly convey pain and temperature sensation
" (pinothalamic fibres from the sacral se+ments lie innermost
C The cauda e'uina be+ins at the level of the first sacral vertebra
D The anterior spinal artery supplies the sensory compartments
E The dorsal root +an+lion lies &ithin the subarachnoid space