2 VARIANT

Answer ALL of the following questions.

Mark T, F, or D against each of responses (T = true, F = false, D = dont know).
Remember, marks are deducted only for wrong answers.
1.

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4.

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8.

The complications of a tracheostomy include (B, C, D)

A.

Laryngeal stenosis

B.

Erosion of the brachiocephalic artery

C.

Erosion of the innominate vein

D.

Tracheo-oesophageal fistula

E.

Persistent hypocapnia

Typical features of bronchial adenoma include (B, C, D, E)

A.

Occurrence in elderly females

B.

Carcinoid syndrome if liver metastases are present

C.

Recurrent haemoptysis

D.

Lobar emphysema

E.

Recurrent pneumonia

Sputum consisting only of blood is an expected finding in (A, B, C)

A.

Pulmonary infarction

B.

Bronchiectasis

C.

Pulmonary tuberculosis

D.

Acute asthma

E.

Aortic stenosis

The following reduce total pulmonary compliance (A, C, D, E):

A.

Fibrosing alveolitis

B.

Emphysema

C.

Mitral stenosis of long standing

D.

Ankylosing spondylitis

E.

Adult respiratory distress syndrome

The following are indications for the mandatory use of steroids in sarcoidosis (B, D)
A.

Bilateral hilar lymphadenopathy

B.

Ocular involvement

C.

Erythema nodosum

D.

Cerebral involvement

E.

Arthralgia

Miliary calcification of the lung is a recognized feature of (A, C):

A.

Histoplasmosis

B.

Asbestosis

C.

Chickenpox

D.

Carcoidosis

E.

Silicosis

Characteristic radiological finding in cryptogenic fibrosing alveolitis include (B, D):

A.

Hyperinflation

B.

A honeycomb pattern

C.

Pleural plaques

D.

Bilateral involvement

E.

Hilar lymphadenopathy

Characteristic features of infective endocarditis in the heroin addict include (A, C, D, E)

A.

Immune complex nephritis

B.

Dental caries

C.

Rigors

D.

Splenomegaly

E.

Lung abscesses

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In emphysema the following parameters of lung function are reduced (A, C, E)

A.

Ratio of forced expiratory volume in 1 second to forced vital capacity

B.

Residual volume

C.

Peak flow rate

D.

Lung compliance

E.

Transfer factor for carbon monoxide (TLCO)

Recognized features of carcinoma of the bronchus include (C, E)

A.

Hypokalemic acidosis

B.

Hypernatremia

C.

Peripheral neuropathy

D.

Hypocalcemia

E.

Hypertrophic pulmonary osteoarthropathy

Trisomy-13 (A, B, E)
A.

Due to atrial septal defect

B.

Due to ventricular septal defect

C.

Due to coarctation of the aorta

D.

Due to pulmonary arterys stenosis

E.

Due to persistent ductus arteriosus

Central cyanosis in infancy is an expected finding in the following congenital heart diseases (B, D)
A.

Persistent ductus arteriosus

B.

Transposition of the great arteries

C.

Coarctation of the aorta

D.

Fallots tetralogy

E.

Atrial septal defect

Aortic stenosis (B, D):

A.

Is likely to be subvalvular when a click is audible

B.

Caused a low blood pressure and narrow pulse pressure

C.

Is a cause of giant A waves in the jugular venous pulse

D.

Causes paradoxical splitting of S2

E.

Often causes a left parasternal heave

On palpation of the precordium (C, D, E):

A.

The apex beat is usually laterally displaced in severe mitral stenosis

B.

The second heart sound is usually palpable as a tapping apex beat in mitral stenosis

C.

There is sometimes a double apical impulse with a left ventricular aneurysm

D.

The apex beat can be laterally displaced in the presence of an early diastolic murmur

E.

A left parasternal heave can be associated with a palpable pulmonary component of the second heart sound

Complications of aortic stenosis (A, B, C, D)

A.

Angina pectoris

B.

Miocardial infarction

C.

Syncope

D.

Stroke

E.

Hypertension

Typical features of severe cardiac failure include (A, B, C, E)

A.

Tiredness

B.

Nocturia

C.

Anorexia and epigastric pain

D.

Hyperpnoea

E.

Noctural cough

Which of the following statements concerning artificial heart valves are true (A, C, E)?
A.

Residual gradients occur across artificial valves

B.

Embolic problems are more likely to be associated with aortic than with mitral valves

C.

Antibiotic cover is required during cystoscopy

D.

Anticoagulation is not required with a Starr Edwards valve

E.

Haemolitic anemia has been reported as a complication of normally functioning valves

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The following are associated with aortic regurgitation (A, B, C, D, E)

A.

Coarctation of the aorta

B.

Relaping polychondritis

C.

Hypertension

D.

Takayasys disease

E.

Ankylosing spondilitis

Prominence of the main pulmonary arteries on chest X-ray may be seen in (A, B, D, E)
A.

Ventricular septal defect

B.

Valvular pulmonary stenosis

C.

Fallots tetralogy

D.

Severe mitral stenosis

E.

Multiple pulmonary emboli

The jugular venous pulse (B, C, D):

A.

Inspection of the normal adult normally reveals A, C and V waves

B.

The X descent results from downward displacement of the AV valves during ventricular systole

C.

The V wave results from atrial filling during ventricular systole

D.

The Y descent begins with opening of the AV valves

E.

The physiological third sound may be heard synchronous with the X descent

Acute rheumatic fever (D, E):

A.

Is generally a very rare disease

B.

Over the last 10 years has been produced or associated with penicillin resistant streptococci

C.

May cause erythema marginatum which may remain pruritic for several days

D.

May cause nodules which appear over tendons and bony prominences

E.

May present as Sydenhams Chorea which can have a latent period of up to six months after the streptococcal infection

On examining a hypertensive patient (A, D, E):

A.

Atrial flutter may be associated with hypertensive heart disease

B.

Retinal microaneurysms indicate grade three hypertensive retinopathy

C.

Renal bruits are often present

D.

Moon shaped facies may be relevant

E.

Very large hands may be aetiologically important

The right coronary artery (A, C, E):

A.

Can be involved in acute aortic dissection

B.

Provides a posterior descending branch which runs in the atrio-ventricular groove

C.

Usually provides an atrio-ventricular nodal branch

D.

Occlusion result in anterior infarction

E.

Occlusion can result in right ventricular infarction

Atrial fibrillation is a recognized complication of (B, E)

A.

Aortic stenosis

B.

Carcinoma of the bronchus

C.

Tricuspid regurgitation

D.

Non-toxic goiter

E.

Ischemic heart disease

In atrial tachyarrhythmias (A, B, C, E):

A.

The delta wave in Wolf-Parkinson-White syndrome is due to myocardial activation via an additional conduction pathway

B.

Atrial pacing can control atrial tachycardias

C.

Atrial fibrillation is a recognized complication of the Wolf-Parkinson-White syndrome

D.

Polyuria suggests a ventricular rather than supraventricular focus

E.

Atrial tachycardias usually arise from a re-entry mechanism when the electrocardiogram is otherwise normal

Pulsus alternans (B, C, E):

A.

Is best recognized on the electrocardiogram

B.

Indicates bad prognosis

C.

Is associated with diastolic gallop

D.

Is seen with restrictive pericarditis

E.

Causes an additional sound in diastole

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Coronary artery disease is recognized feature of (B, D)

A.

Chagas disease

B.

Kawasaki disease

C.

Elevation of HDL-cholesterol

D.

Pseudoxanthoma elasticum

E.

Kartageners syndrome

Doppler echocardiography can be used to (A, B, C, D, E):

A.

Differentiate innocent from pathological murmurs

B.

Evaluate prosthetic valve function

C.

Estimate cardiac output

D.

Estimate intra-cardiac pressures

E.

Detect and quantify stenotic valvular lesions

In the treatment of patients with angina pectoris (D)

A.

Lowering a high plasma cholesterol has no effect on survival

B.

Regular exercise should be avoided if angina occurs daily

C.

Nitrate-induced tachycardia usually persists despite beta blocade

D.

Nifedipine is a potent systemic and coronary anteriolar dilator

E.

Cardio-selective beta blockers are more effective then non-selective beta blockers especially in variant angina

Chronic arterial occlusion of the lower limbs results in (A, B, C)

A.

Muscle atrophy

B.

Brittle nails

C.

Ischemic nerve pain

D.

Paradoxical warmth in the foot

E.

Osteoarthritic changes of the knee

Typical causes of cerebrovascular disease include (A, B, C, D)

A.

Atherosclerosis

B.

Takayasus arteritis

C.

Fibromuscular dysplasia

D.

Thoracic Outlet syndrome

E.

Temporal arteritis

Diagnostic criteria for Temporal Arteritis (A, D, E)

A.

Age at onset > 50 years

B.

Age at onset < 50 years

C.

Erythrocyte sedimentation rate > 30 mm in first hour

D.

Abnormal artery biopsy

E.

Temporal artery abnormality

The superior mesenteric artery supply (B, C, D, E)

A.

Liver

B.

Stomach

C.

Duodenum

D.

Small intestine

E.

The colon from the ligament of Trietz to the splenic flexure

Symptoms of acute mesenteric ischemia include (F)

A.

Pain

B.

Vomiting

C.

Diarrhea

D.

Weight loss

E.

Peritonitis

Most of the atherosclerotic stenosis is located at (C)

A.

The ostia of renal artery

B.

The first third of renal artery

C.

The ostia and the first third of renal artery

D.

The middle third of renal artery

E.

The distal third of renal artery

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Concerning acute dissection of the aorta (A, B, C):

A.

CT scanning is more likely than echocardiography to be diagnostic

B.

Urgent surgical correction is more commonly needed in type I than type III

C.

Associated aortic valve incompetence commonly develops at some time during this condition

D.

Characteristically the pain produced radiates anteriorly and up to the left shoulder

E.

During repair it is essential to identify the re-entry site of the dissection before surgery can be attempted

The protein content of the lymph (A, B, C, E)

A.

From the liver is over 5 g/100 ml (50 g/l)

B.

From the periphery is 2 g/100 ml (20 g/l)

C.

From the gastrointestinal tract is 3 to 5 g/100 ml (30 to 50 g/l)

D.

In the thoracic duct is 8 g/100 ml

E.

Rises distal to lymphatic obstruction

A perforated duodenal ulcer (A, D)

A.

Usually lies on the anterior or superior surface of the duodenum

B.

Usually presents with the acute onset of severe back pain

C.

Produces radiological evidence of free gas in the peritoneum in over 90 % of the patients

D.

Is usually treated surgically by simple closure of the perforation

E.

Should, if detected within the first 4 hours, be treated by famotidine

In the differential diagnosis of appendicitis in an infant it is important to consider (A, B, C)

A.

Ileo-ilial intussception

B.

Basal pneumonia

C.

Henoch-Schoenlein purpura

D.

Torsion of ovarian cyst

E.

Testicular torsion

The following factors are known to be significantly associated with gastric ulcer disease (A, B, E)
A.

Duodeno-gastric reflux

B.

Tobacco consumption

C.

Gastric hypersecretion

D.

Pernicious anemia

E.

Anti-inflammatory drug therapy

Meconium ileus (D, E)

A.

Is the presenting feature in the majority of patients with cystic fibrosis

B.

May occur at any time in the first year of life

C.

Is associated with achlorhydria

D.

Presents with a distended abdomen and bilious vomiting

E.

May be effectively treated with acetylcysteine

There is an association of gastric cancer with (A, B, C, E)

A.

Achlorhydria of the stomach

B.

Athrophic gastritis

C.

Adenomatous gastric polyps

D.

Duodenal ulceration

E.

A history of gastric cancer in first degree relatives

The following are characteristic of acute pancreatitis (C)

A.

Abdominal guarding develops soon after of pain

B.

Normal serum amylase concentration in the first 4 hours after unset

C.

Persistent serum hyperamylaseamia suggests a developing pseudocyst

D.

Hypercalcaemia develops 5-7 days after onset

E.

Hyperactive loud bowel sounds

Ulcerative colitis differs from Crohns colitis in that (B)

A.

The disease can occur at any age

B.

Tobacco consumption is not associated with ulcerative colitis

C.

Toxic dilatation only occurs in ulcerative colitis

D.

Aphthous stomatitis is less common than in Crohns disease

E.

Colonic strictures do not occur in ulcerative colitis

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50.

The management of functional bowel disorders should include (C, D)

A.

Antispasmoidic and laxative drugs

B.

Extensive investigations of aged < 30 years

C.

Explanation and reassurance after a full examination

D.

Evaluation of social and emotional factors

E.

Referral for psychiatric assessment and therapy

In the initial management of acute bleeding oesophageal varices associated with hepatic cirrhosis (A, C, D)
A.

There is a 50 % mortality rate

B.

Oesophageal sclerotherapy is not indicated

C.

Intravenous vasopressin reduces portal venous pressure

D.

Ballon tamponade is better deferred pending endoscopy

E.

Oesophageal transection is contraindicated in hepatic failure

Hernias in the umbilical region (G)

A.

Are always acquired in origin

B.

Usually occur in males

C.

Usually require surgical repair in infants

D.

Rarely strangulate

E.

Should be treated by a surgical corset

Bile (B)
A.

Is secreted by the liver following the stimulus of the ingestion of food

B.

Is secreted into the gastrointestinal tract following the stimulus of food ingestion

C.

Is secreted at the rate of 200 to 400 ml per day

D.

Secretion is reduced after cholecystectomy

E.

Contains cholecystokinin

In severe jaundice diagnostic evidence of an extrahepatic obstruction of the biliary tract may be gained by (B, C, D, E)
A.

Intravenous cholangiography

B.

A barium meal

C.

Ultrasonography

D.

Endoscopic retrograde cholangiography

E.

Percutaneous transhepatic cholangiography

The typical features of Wilsons disease include (A, B, C, E)

A.

Acute haemolitic anaemia

B.

Acute hepatitis and chronic active hepatitis

C.

Parkinsonian syndrome and hepatic cirrhosis

D.

Osteomalacia and raised serum cooper concentration

E.

Renal tubular acidosis and Kayser-Fleischer rings

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