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YDR.Org.

uk
BOF: 61
An elderly lady has features of osteoporosis. She appears to have lost height due to
osteoporoti ollapse of the verte!rae !ut she does not kno" "hat her for#er height "as.
$hih #easure#ent "ill give an indiation of her for#er height%
a& 'ength of #anu!riu# sterni
!& Distane !et"een the ostal #argin and the ilia rest
& Dia#eter of the ri! age
d& $aist #easure#ent
e& Ar# span
Ans"er:
e&
(n an adult the ar# span and height are appro)i#ately e*ual. (n osteoporoti ollapse of
the verte!rae+ the ar# span !eo#es greater than the height.
Osteoporosis
BOF: 6,
(n osteoporoti ollapse of the verte!ra:
a& -he a!sene of preipitating stress #akes it less likely
!& -he a!sene of severe pain "ill #ake the diagnosis less likely
& -he pain is very "ell loalised and the a!sene of this sy#pto# "ill e)lude the
diagnosis
d& -he verte!rae are tender to perussion and the a!sene of this sign "ill e)lude
the diagnosis
e& Fre*uently ours "ithout sy#pto#s
Ans"er:
e&
Osteoporoti ollapse of the verte!rae fre*uently ours "ithout sy#pto#s
Osteoporosis
BOF: 6.
-he three #ain sites at "hih osteoporoti fratures our are:
a& /erte!rae+ pelvis+ fe#oral nek
!& /erte!rae+ fe#oral nek+ forear#
& /erte!rae+ forear#+ pelvis
d& /erte!rae+ fe#oral nek+ hu#erus
e& /erte!rae+ forear#+ ri!s
Ans"er:
!&
-he o##onest sites of osteoporoti frature are verte!rae+ fe#oral nek+ forear#
Osteoporosis
BOF: 60
(n ontrast to other for#s of osteoporosis+ steroid indued osteoporosis affets the:
a& Skull
!& Forear#
& /erte!rae
d& 1elvis
e& Fe#oral nek
Ans"er:
a&
Osteoporosis is thought not to affet the skull e)ept in steroid indued osteoporosis.
Osteoporosis
BOF: 62
A 023year3old fe#ale is ad#itted "ith a su!arahnoid hae#orrhage. She initially+ #akes
satisfatory progress !ut 2 days later her level of onsiousness !egins to deteriorate. -he
#ost likely ause of the deterioration is:
a& Baterial #eningitis o#pliating lu#!ar punture
!& 4ere!ral a!sess
& 4oning of the #edulla
d& Aute hydroephalus
e& Dural sinus thro#!osis
Ans"er:
d&
Organised !lood in the su!arahnoid spae #ay ause o!strution to the flo" of
ere!rospinal fluid and result in hydroephalus.

BOF: 66
A 653year3old #an presents "ith a history of falls. 6e has diffiulty in reading and
o#ing do"n stairs. 6e has dysarthria+ and akinesia and rigidity an !e de#onstrated.
1o"er of the #usles is nor#al+ refle)es are !risk. $hat physial sign "ill help to #ake
the diagnosis%
a& 7a" 8erk
!& Ro#!erg9s sign
& -ande# "alking
d& :ye #ove#ents
e& 1lantar response
Ans"er:
d&
-he patient has progressive supranulear palsy and de#onstration of i#pair#ent of
voluntary ga;e "ill allo" one to #ake a diagnosis
BOF: 65
A ,23year3old fe#ale has reently had a foreps delivery. She o#plains of pain in the
groin and on e)a#ination she has "eakness of addution and internal rotation of the hip.
-here is sensory i#pair#ent over the #edial aspet of the thigh. -he affeted nerve is
the:
a& Fe#oral nerve
!& Siati nerve
& 'ateral utaneous nerve of the thigh
d& -i!ial nerve
e& O!turator nerve
Ans"er:
e&
-he o!turator nerve supplies grailis+ addutor longus and !revis+ addutor #agnus+
o!turator e)ternus and the skin over the lateral aspet of the thigh
BOF: 6<
A ,=3year3old #ale presents "ith "asting and "eakness of the #usles of the pelvi
girdle. -here is evidene of generalised #usular hypertrophy. 6is #aternal grandfather
had a si#ilar disorder. -he #ode of inheritane is
a& Autoso#al do#inant
!& Autoso#al reessive
& >3linked reessive
d& 1olygeni inheritane
e& >3liked do#inant
Ans"er:
&
-he patient has !enign )3liked #usular dystrophy ?Beker type&
BOF: 6@
Ayotonia aggravated !y old is a feature of:
a& Ayotonia dystrophia
!& Ayotonia ongenita
& 4hondrodystrophi #yotonia
d& 1ara#yotonia
e& 6ypothyroidis#
Ans"er:
d&
Ayotonia appearing on e)posure to old ours in 1ara#yotonia. 4hondrodystrophi
#yotonia auses hoking on old drinks.

BOF: 5=
(n #yasthenia gravis the tendon refle)es are:
a& Brisk
!& A!sent
& Depressed
d& Delayed
e& 1endular
Ans"er:
a&
(n #yasthenia gravis the tendon refle)es are harateristially !risk. (f the refle)es are
depressed or a!sent one should think of :aton3'a#!ert syndro#e.
BOF: 51
A ,23year3old #ale "ho is kno"n to have ankylosing spondylitis presents "ith a painful+
ahing+ photopho!i red eye. :)a#ination sho"s ells floating in the anterior ha#!er
and preipitated on the !ak of the ornea. (n this patient treat#ent should !e o##ened
"ith:
a& 6igh dose oral steroids
!& Broad spetru# anti!iotis
& 'oal steroids
d& 'oal steroids and dilator
e& 'oal steroids and a onstritor
Ans"er:
d&
-he patient has anterior uveitis. -reat#ent should !e "ith loal steroids and a dilator to
!reak adhesions to the lens and allo" the iris to re#ain #o!ile.
Ankylosing Spondylitis
BOF: 5,
(n dia!etes #ellitus eye. o#pliations that do not result in visual i#pair#ent are:
a& 4atarat
!& 'ipae#ia retinalis
& Ru!eosis iridis
d& Retinal vein olusion
e& Dia!eti retinopathy
Ans"er:
!&
'ipae#ia retinalis is seen in assoiation "ith hypertriglyeridae#ia and reverses "ith
#eta!oli ontrol. All other o#pliations i#pair vision. Ru!eosis iridis an result in
glauo#a !y neovasularistion of the drainage hannels of the a*ueous in the anterior
ha#!er.
BOF: 5.
A ,5 year old fe#ale presents "ith a!do#inal pain+ "eight loss+ diarrhoea and #outh
ulers. On linial e)a#ination apart fro# #outh ulers no a!nor#ality is deteted. Full
!lood ount reveals nor#oyti nor#ohro#i anae#ia+ infla##atory #arkers are
raised+ and !iohe#ial investigation reveals a raised alkaline phosphatase. Bariu#
follo" through sho"s ter#inal ileal infla##atory disease. (n this patient long ter#
re#ission #ay !e #aintained !y the use of:
a& 'o" dose prednisolone
!& Aesala;ine
& A;athioprine
d& (nfli)i#a!
e& :le#ental diet
Ans"er:
&
-he patient has 4rohn9s disease. (ndution of re#ission of 4rohn9s disease #ay !e
ahieved !y the use of steroids+ ele#ental diet+ surgery or (nfli)i#a!. Aesala;ine #ay
#aintain re#ission if indution has !een ahieved !y surgery and if an <3"eek ourse of
#etronida;ole is ad#inistered. (n other ases the #ost useful drug to #aintain re#ission
is a;athioprine.
4rohnBs Disease
BOF: 50
An <=3year3old #an has had a stroke and has a poor s"allo". 6e keeps pulling his
nasogastri tu!e out and is not ade*uately nourished. 6e develops diarrhoea. Stools "ere
e)a#ined and sho" the presene of 4lostridiu# diffiile to)in. 6e has not !een treated
"ith anti!iotis. (n this patient the ne)t ourse of ation should !e:
a& Arrange a olonosopy
!& Arrange a !ariu# ene#a
& -reat "ith #etronida;ole
d& -reat "ith 'opera#ide
e& -reat "ith 4holestyra#ine
Ans"er:
&
(nfetion "ith 4lostridiu# diffiile is usually esta!lished upon e)posure to anti!iotis.
6o"ever+ it #ay also our in de!ilitated patients "ho have not !een e)posed to
anti!iotis.
BOF: 52
A 2=3year3old #ale presents "ith hae#ate#esis and #elaena. 6e gives a history of
alohol a!use of several years duration. On e)a#ination he has !ilateral parotid
enlarge#ent+ spider naevi+ Dupuytren9s ontrature+ 8aundie and asites. $hilst a"aiting
endosopy the initial #anage#ent of this patient should !e:
a& Ad#inistration of intravenous pantopra;ole
!& Ad#inister terlipressin
& (nsert a Sengstaken tu!e
d& Casogastri tu!e and aspiration to deo#press the sto#ah
e& Ad#inister suralfate
Ans"er:
!&
-he patient has linial evidene of irrhosis of the liver ?features of portal hypertension
and features of hepatoellular failure&. -he likely ause of the hae#ate#esis and #elaena
is !leeding oesophageal varies. Dntil endosopy and definitive treat#ent one should
atte#pt to redue portal venous pressure "ith terlipressin.
BOF: 56
-he ardinal #anifestation of aute hepati failure is:
a& 7aundie
!& 1rolonged prothro#!in ti#e
& 6epati enephalopathy
d& Asites
e& :levated A'-
Ans"er:
&
4ere!ral distur!ane ?hepati enephalopathy& is the ardinal #anifestation of aute
hepati failure.
BOF: 55
A 023year3old fe#ale "ho is kno"n to have autoi##une hepatitis+ "hih has progressed
to irrhosis of the liver dou#ented on liver !iopsy+ o#plains of !reathlessness. -he
!reathlessness is !etter "hen she lies do"n and gets "orse "hen she is upright. 6er
arterial o)ygen saturation is redued on standing. -he ondition that this patient suffers
fro# is an:
a& (ndiation for treat#ent "ith arvedilol
!& (ndiation for treat#ent digo)in
& (ndiation for liver transplantation
d& (ndiation for ho#e o)ygen treat#ent
e& (ndiation for oral !eta agonists
Ans"er:
&
Breathlessness on standing relieved !y lying do"n ?platypnoea& together "ith dereased
arterial o)ygen saturation on standing ?orhtodeo)ia& are features of the hepato3pul#onary
syndro#e "hih is an indiation for liver transplantation
BOF: 5<
A ,63year3old fe#ale "ho has !een on the ontraeptive pill presents "ith a!do#inal
pain and distension of 2 days duration. On e)a#ination she has no stig#ata of hroni
liver disease. She has distended veins over the anterior a!do#inal "all "ith flo" of
!lood in a audal to ephali diretion .She also has asites+ an enlarged tender liver "ith
a!sent hepato38ugular reflu). 6er lo"er li#!s are oede#atous.
(n this patient the oede#a of the lo"er li#!s is due to:
a& 6ypoal!u#inae#ia
!& 6epato3renal syndro#e
a& (nferior vena ava thro#!osis
!& 1ortal venous thro#!osis
& 'y#phati o!strution
Ans"er:
&
Budd34hiari syndro#e is thro#!osis of the hepati veins. 'o"er li#! oede#a ould
our due to assoiated thro#!osis of the inferior vena ava.
BOF: 5@
A 0=3year3old #ale presents "ith a history of inter#ittent+ !ut slo"ly progressive
dysphagia for !oth solids and li*uids. 6e e)perienes pain on s"allo"ing and has
regurgitation of food s"allo"ed several hours earlier. 6e has no heart!urn !ut has
anore)ia and "eight loss.
Ba s"allo" de#onstrates pro)i#al dilatation of the oesophagus and failure of rela)ation
of the lo"er oesophageal sphinter.
(n this patient good #ediu# to long ter# relief of sy#pto#s #ay !e o!tained !y:
a& Oesophageal #yoto#y
!& A#yl nitrite
& A#lodipine
d& (ntrasphinteri !otulinu# to)in
e& Oesophageal !ouginage
Ans"er:
a&
-he patient has ahalasia of the ardia+ "hih is a funtional o!strution at the lo"er
oesophageal sphinter aused !y a failure of rela)ation. Oesophageal #yoto#y ?6eller9s
operation& and !alloon dilatation give good #ediu# to long3ter# results. Bouginage is
not used. Drug therapy does not ahieve #ediu# to long3ter# relief.
BOF: <=
A ,,3year3old fe#ale of (rish desent has !een ad#itted under the are of the surgeons
"ith a history of a!do#inal pain. -hey have onluded that the patient has non3speifi
a!do#inal pain+ "hih they define as a!do#inal pain that annot !e treated !y an
operation. Co a!nor#ality has !een deteted linially or !y routine investigation. -hey
"ish to disharge the patient !ut "ould "elo#e your opinion. You agree to see the
patient in lini follo"ing disharge !ut re*uest that they perfor# an investigation prior
to disharge. -his investigation "ould !e:
a& B1, and folate levels
!& Drine for porphyrins
& AC4A sreen
d& Aesenteri angiogra#
e& Anti gliaden and anti endo#ysial anti!odies
Ans"er:
e&
4oelia disease presents "ith a!do#inal pain and a oelia sreen "ould !e a good
sreening test for this ondition