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7 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.

Penetrating chest injures (C, D, E)


A.

Form only a small proportion of chest injures

B.Need an immediate thoracotomy


C.Need immediate sealing by any available method
D.

Produce mediastinal flap

E. Produce mediastinal shift


2.

3.

4.

5.

6.

The development of pleural effusion with a protein content of 50 G per litre would be compatible with (B, C, D)
A.

Congestive cardiac failure

B.

Pulmonary infarction

C.

Subphrenic abscess

D.

Pneumonia

E.

Nephrotic syndrome

Breath sounds are typically diminished or absent in (A, B, E)


A.

Pneumothorax

B.

Pleural effusion

C.

Bronchiectasis

D.

Consolidation due to pneumonia

E.

Collapse due to bronchial obstruction

The following are recognized pulmonary complications of acquired immune deficiency syndrome (AIDS) (A, B, D, E):
A.

Pneumocystis carinii pneumonia

B.

Kaposis sarcoma

C.

Pulmonary veno-occlusive disease

D.

Cytomegalovirus pneumonia

E.

Atypical mycobacterial infections

In normal pulmonary circulation (A, E):


A.

Pulmonary veins drain blood from both pulmonary and bronchial arteries

B.

The azygous vein drains into the left atrium directly

C.

The pulmonary artery supplies the capillary bed in the bronchial walls

D.

The pulmonary arterioles dilate in response to hypoxia

E.

In the erect position the upper zones are less well perfused than the mid or lower zones

An adolescent female with a history of chronic respiratory disease is found to have bronchiectasis. The following would be helpful in
establishing the etiology (A, C, D, E):

7.

8.

A.

A long-standing history of diarrhea with pale stools

B.

A positive precipitin reaction to Aspergillus fumigatus

C.

A history of a severe attack of whooping cough

D.

Dextrocardia

E.

Calcified bronchopulmonary lymph nodes on X-ray

Recognized association with pneumothorax include (A, C, D):


A.

Exposure to aluminium dust

B.

Acute pulmonary oedema

C.

Ehlers-Danlos syndrome

D.

Pulmonary tuberculosis

E.

Pleural mesothelioma

Bronchial carcinoids (C, D, E)


A.

Occurs more frequently in smokers

B.

Can usually be resected endoscopically

C.

May present with a lung abscess

D.

May give rise to valve lesions of the left side heart

E.

Can be locally invasive

9.

10.

11.

12.

13.

14.

15.

16.

17.

Recognized causes of bronchial carcinoma include (C)


A.

Cadmium exposure

B.

Pleural plaques

C.

Nickel exposure

D.

Chronic heroin abuse

E.

Retrovirus infection

The following are characteristic features of chronic constrictive pericarditis (B)


A.

Enlarged heart on chest X-ray

B.

Atrial fibrillation

C.

Pericardial friction rib

D.

Reduction of the jugular venous pressure with inspiration

E.

Pulsus paradoxus

Patients with patent ductus arteriosus are at risk of (F)


A.

Pulmonary hypertension

B.

Bacterial endocarditis

C.

Aortic aneurysm

D.

Pulmonary artery aneurysm

E.

Aortic dissection

In ventricular septum defect (B)


A.

Most defects are muscular

B.

Most defects are paramembranous

C.

Most defects are conal

D.

Most defects are inlet

E.

Most defects conal and inlet

Characteristic features of Eisenmengers syndrome complicating atrial septal defect include (B, C)
A.

Development before 20 years old

B.

Giant a waves

C.

Pulmonary incompetence

D.

Differential cyanosis

E.

Necessity of surgical correction

A third heart sound (S3) is a typical finding in (B, C, D, E)


A.

Mitral stenosis

B.

Healthy young athletes

C.

Constrictive pericarditis

D.

Tricuspid incompetence

E.

Left ventricular dyskinesia

The clinical features of mitral valve prolapse include (F)


A.

Mid-systolic click and late-systolic murmur

B.

Auscultatory finding which vary with posture

C.

An association in young adults with embolic stroke

D.

Predisposition to tachyarrhythmias

E.

Predisposition to infective endocarditis

Cor pulmonale is a well recognized complication of the following conditions (A, B, C, E):
A.

Asthma

B.

Schistosomiasis

C.

Multiple pulmonary oedema

D.

Carcinoma of the lung

E.

Appetite suppressing drugs

On clinical examination (E)


A.

The first heart sound is typically increased in aortic stenosis

B.

The second heart sound is usually diminished in severe mitral stenosis

C.

A blood pressure of 180/100 mmHg in a 70 year old man excludes significant aortic stenosis

D.

The intensity of the diastolic murmur is a reliable guide to severity in aortic incompetence

E.

The murmur of tricuspid stenosis becomes louder during deep inspiration

18.

19.

20.

21.

22.

23.

24.

Infective endocarditis (C, D)


A.

Is a notifiable disease

B.

is rare on prosthetic valves

C.

Commonly affects the mitral valve

D.

May cause microscopic hematuria

E.

Can be excluded if no cardiac murmur is heard

In infective endocarditis (B, D, E):


A.

Echocardiography is the best diagnostic aid

B.

Alpha-haemolytic streptococci are the most common causative organisms

C.

Prophylactic tetracycline is indicated prior to dental treatment

D.

Acute surgery of a severely affected valve may be a life saving procedure

E.

It is sometimes seen to occur on a completely normal heart valve

The chest X-ray in rheumatic heart disease may reveal (B, C, D, E):
A.

Cardiomegaly more commonly in mitral stenosis than in mitral regurgitation

B.

Cardiomegaly in aortic regurgitation

C.

Elevation of the left main bronchus in mitral stenosis

D.

Oligaemic lung fields in pulmonary stenosis

E.

A double right heart border in mitral regurgitation

2D echocardiography (A, B, C):


A.

Can visualize the proximal portions of coronary arteries

B.

Can detect left ventricular aneurysms

C.

Can detect ventricular septal defects

D.

Can effectively exclude bacterial endocarditis

E.

Cannot detect valve ring abscesses

In considering the insertion of a permanent cardiac pacemaker (C, D, E):


A.

DDD is optimal for atrial fibrillation with atrioventricular block

B.

Asymptomatic pauses of less than 2 seconds on Holter monitoring merit a VVI pacemaker

C.

Dual-chamber pacing is useful when lelf ventricular function is poor

D.

VVI are more likely than DDD pacemakers to produce the pacemaker syndrome

E.

Sinus node disease with normal atrioventricular conduction merit AAI pacemakers

In atrial fibrillation (C, D, E)


A.

Cardiac output is reduced by approximately 10 %

B.

Atria contract at a rate of 350-600 per minute

C.

The ventricular rate is regular if there is coexistent complete heart block

D.

The sick sinus syndrome is a precipitating cause

E.

The intensity of the first heart sound is variable

Thrombolysis in acute myocardial infarction (E):


A.

Thrombolytic therapy reduces mortality only if given within six hours of the onset of symptoms

B.

Because APSAC is derived from recombinant human protein, it can be given if streptokinase has been prescribed in the previous six
months

25.

26.

C.

A lack of cardiac enzyme rise after treatment suggests that successful reperfusion has occurred

D.

rtPA can be given if there is history of active peptic ulceration

E.

Recent stroke is a contraindication to thrombolytic therapy

Indications for 24 hour ambulatory Holter monitoring include (A, C, D, E):


A.

Syncope and dizziness

B.

General fatigue and lethargy

C.

Chest pains possibly due to myocardial ischemia

D.

Asymptomatic hypertrophic cardiomyopathy

E.

Monitoring the effect and use of anti-arrhythmic drugs

Coronary artery bypass surgery has been shown to improve prognosis in patients with (A, B):
A.

Significant left main stem disease

B.

Proximal three vessel disease

C.

Single vessel disease

D.

Two vessel disease without involvement of the proximal left anterior descending coronary artery

E.

Poor left ventricular function (left ventricular ejection fraction less than 30 %)

27.

28.

29.

30.

31.

32.

33.

34.

35.

Cardiac after load is reduced by (A, B, C, E)


A.

Phentolamine

B.

Nifedipine

C.

Prazosin

D.

Morphine

E.

Minoxidil

In the electrocardiogram (A, B, E):


A.

Hypokalaemia produces flattened T waves

B.

Right ventricular hypertrophy causes clockwise rotation

C.

Pathological Q waves are usually the first sing of infarction

D.

A QT interval of 500 milliseconds is normal

E.

Mobitz type II atrioventricular block does not show progressive lengthening of the PR interval

The following may be associated with a congestive type of cardiomyopathy (B,C,D)


A.

Methotrexate

B.

Ethanol

C.

Fabrys disease

D.

Acromegaly

E.

Hyperphosphataemia

Thromboangitis obliterans (G)


A.

Was originally described by a Japanese opthalmologist

B.

Classically involves the branches of the aortic arch

C.

Is a panarteritis

D.

Is seen more frequently in young women

E.

Is associated with a raised ESR

Typical localization of cerebrovascular atherosclerotic disease (B, C)


A.

Common carotid artery

B.

Carotid bifurcation

C.

Carotid siphon

D.

Vertebral artery

E.

Subclavian artery

Complications of Arteriography (F)


A.

False aneurysm

B.

Tromboembolism

C.

Renal disfunction

D.

Contrast reaction

E.

Intimal dissecting

In unilateral renal artery stenosis (E)


A.

Angiotensin converting enzyme inhibitors are contraindicated

B.

Arterial reconstructive surgery is the treatment of choice

C.

The affected kidney is usually larger than the unaffected one

D.

The contralateral kidney may develop amyloid

E.

An audible bruit is often absent

Recognized causes of high blood pressure include (A, D, E)


A.

Cerebral hemorrhage

B.

Sodium losing enteropathy

C.

Patent ductus arteriosis

D.

Adenoma of the zona glomerulosa

E.

Renal artery stenosis

Characteristic features of dissecting aortic aneurysm include (A, B, C)


A.

Haemopericardium

B.

Acute flaccid paraparesis

C.

Interscapular back pain

D.

Cardiogenc shock

E.

Normal peripheral pulses

36.

37.

38.

39.

40.

41.

42.

43.

44.

The lymph nodes (B, C, D)


A.

Of the axilla number up to 20

B.

Of the parotid group drain the inner ear and external auditory meatus

C.

Of the left supraclavicular fossa are commonly implicated in gastrointestinal malignancy

D.

Are responsible for the production of plasma cells

E.

Of the umbilicus occasionally present with metastatic disease

Risk factors in deep venous thrombosis include (A, C, E)


A.

Hip surgery

B.

Aspirin therapy

C.

Malignant disease

D.

Extreme exercise

E.

Previous history of thrombosis

In the diagnosis and treatment of acute appendicitis (C)


A.

Non-specific mesenteric adenitis often progresses to appendicitis

B.

Recurrent abdominal pain suggests chronic appendicitis is likely

C.

Rigors soon after the onset of pain make the diagnosis unlikely

D.

Surgery should be avoided if the patient is pregnant

E.

Immediate surgery is mandatory if an appendix mass is palpable

The pain associated with peptic oesophagitis (B, D)


A.

Responds poorly to antacid therapy

B.

Is aggravated by swallowing hot liquids

C.

Is easily distinguishable from ischemic chest pain

D.

Is aggravated by bending and relieved by standing

E.

Can be differentiated from duodenal ulcer dyspepsia by the fact that noctural pain is exceptional in oesophagitis

In the treatment of intestinal obstruction (A, B)


A.

Nasogastric suction should be instituted preoperatively

B.

Intravenous fluid replacement is essential

C.

Abdominal girth measurements allow one to decide when surgical intervention is required

D.

Immediate surgery is essential

E.

Surgery should be restricted to those cases where strangulation is diagnosed

Acute salpingitis (B, D)


A.

Usually occurs in the first month pregnancy

B.

Is frequently associated with vomiting

C.

Often presents with vaginal discharge

D.

Presents with uterine tenderness

E.

Is usually caused by Staphylococcus aureus

Chronic duodenal ulcers may be treated by (A, B, C, D)


A.

Histamine H2-receptor antagonists

B.

Sub-total gastrectomy

C.

Vagotomy and gastric drainage

D.

Highly selective vagotomy

E.

Non-steroidal anti-inflammatory drugs

Crohns disease (G)


A.

Is confined to the small and large bowel

B.

Has an infective etiology

C.

Is limited to the bowel mucosa

D.

Does not produce mucosal ulceration

E.

Is characterised by the absence of fibrous tissue in the affected inflamed bowel

The following statements about colonic polyps are true (B, C, D)


A.

75 % of polyps occur in the right hemicolon

B.

The typical histology is that of tubular adenoma

C.

Polyps > 2 cm in diameter are usually malignant

D.

Intussusception is a recognised complication

E.

Presentation with constipation is typical

45.

46.

47.

48.

49.

50.

In resuscitating a patient with major gastroduodenal bleeding (B, C)


A.

Sedation is best avoided if the patient is hypotensive

B.

Whole blood is preferable to packed red blood cells

C.

Volume replacement with colloids is preferable to crystalloids

D.

Monitoring the central venous pressure is unnecessary

E.

Surgical intervention should be deferred in younger patients

The typical features of hepatic vein obstruction include (C, D)


A.

Predisposing disease in 75 % patients

B.

Slow insidious onset of ascites

C.

Abdominal pain and tender hepatomegaly

D.

Hepatic venous obstruction on hepatic ultrasonography

E.

Good response to anticoagulation

Car seat belts (lap diagonal) when properly adjusted (B)


A.

Prevent injures to the abdominal viscera

B.

May cause small bowel injures

C.

Do not reduce the incidence of head injuries amongst car passengers involved in a road traffic accident

D.

Protect the cervical spine during sudden acceleration

E.

Often do not prevent thoracic injuries

A liver abscess (F)


A.

Is commonly associated with gallstones

B.

Typically produces a firm enlarged tender liver

C.

Is usually accompanied by jaundice

D.

Commonly produces a right-sided pleural effusion

E.

May be treated by percutaneous drainage

The Zollinger-Ellison syndrome (A, C, D)


A.

Is the result of hypergastrinaemia

B.

Is produced by parietal cell neoplasma

C.

Includes diarrhea and malabsorption among its presenting features

D.

Is most effectively treated by total gastrectomy

E.

Requires removal of the pancreatic tumor

The typical features of pyogenic liver abscess include (B, C, D, E)


A.

Obstructive jaundice and weight loss

B.

Tender hepatomegaly without splenomegaly

C.

Pleuritic pain and pleural effusion

D.

Multiple abscess especially in ascending cholangitis

E.

Esch. coli., anaerobes and streptococci present in pus

ANSWERS
1
C, D, E
11
A, B, C, D,

2
B, C, D
12
B

3
A, B, E
13
B, C

4
A, B, D, E
14
B, C, D, E

5
A, E
15
A, B, C, D,

6
A, C, D, E
16
A, B, C, E

7
A, C, D
17
E

8
C, D, E
18
C, D

9
C
19
B, D, E

10
B
20
B, C, D, E

E
21
A, B, C
31
B, C

22
C, D, E
32
A, B, C, D,

23
C, D, E
33
E

24
E
34
A, D, E

E
25
A, C, D, E
35
A, B, C

26
A, B
36
B, C, D

27
A, B, C, E
37
A, C, E

28
A, B, E
38
C

29
B, C, D
39
B, D

30
G
40
A, B

41
B, D

E
42
A, B, C, D

43
G

44
B, C, D

45
B, C

46
C, D

47
B

48
A, B, C, D,

49
A, C, D

50
B, C, D, E