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DIRECTIONS: Each of the questions or incomplete statements below is followed by five suggested answers or completions.
Write the appropriate letter in the space provided on the Answer Sheet.
12. Which of the following is the most common event preceding the formation of a false aneurysm?
A. myocardial infarction
B. injury to the arterial wall
C. treatment of a dissecting aneurysm with a beta-blocker
D. thrombosis of a saccular aneurysm
E. erosion of a saccular aneurysm by tumour
13. Whilst on weekend duty you review a child who is having amoxycillin for otitis media. Your partner who
prescribed this has specifically told the child's mother that he can take Amoxil with food.
A. broad spectrum
B. acid stability-
C. food does not affect absorption
D. different side chain
E. all of the above
14. In which of the following conditions of the colon is malignant change most like to occur?
A. adenomatous polyp
B. melanosis coli
C. diverticulitis
D. familial intestinal polyposis
E. ulcerative colitis
16. Which of the following is the most desirable drug to use long term management of a patient with Addison's disease?
A cortisone
B. hydrocortisone
C. prednisolone
D. betamethasone
E. dexamethasone
18. You recently thought on clinical grounds that Pat Frey might have been thyrotoxic. Her T4 was elevated, but
subsequent evaluation of thyroid function showed her to be euthyroid. Reason for the elevation of the T4 assay
lay in Pat's current therapeutic regime.
A. Lasix (frusemide)
B. prednisolone
C. a combined (oestrogen/progestogen) contraceptive
D. potassium iodide supplements
E. insulin
19. A four year old child is brought to you by the kindergarten teacher. She states that the child was not well that
morning and has vomited once and has complained of central abdominal pain She has found the child's
temperature to be 39 degrees C. clinical examination is most likely to reveal
20 The most satisfactory results in the treatment of infertility are obtained when the cause is
A. azo-spermia
B. Stein-Leventhal syndrome
C. tubal occlusion
D. pelvic tuberculosis
E. Turner's syndrome
A. colitis
B. rectal polyp
C. intussusception
D. fissure-in-ano
E. peptic ulcer
22. Elevation of the ST segment in an electrocardiogram may be associated with all of the following EXCEPT
23. Numerous spider haemangiomata often are found in association with another physical signs. This is
24. A 55 year old woman develops frequency and dysuria. Microscopic examination of her centrifuged urine shows
100 leucocytes per high power field and numerous organisms. Therapy with su1phamethizole (Urolucosil) is
begun in a dose of 1g six hourly. 48 hours later, the patient's symptoms are relieved, but the result of the initial
urine culture is to hand revealing a heavy growth of E. coli sensitive to all. antibiotics except the sulphonamides.
The next step should therefore be
A. sebaceous cyst
B. basal cell carcinoma
C. carbuncle
D. squamous cell carcinoma
E. granuloma fissuratum
27. A 10 month old infant is admitted with a wheeze and rapid respiratory rate following 2 days of
rhinorrhoea and irritable cough. A chest X-ray shows hyper-inflated lungs but is otherwise normal.
28. Among the following drugs stimulation of cardiac contraction. is achieved with least vasoconstrictor effect by
A. adrenaline
B. isoprenaline
C. pitressin
D. ephedrine
E. noradrenaline
29. Mr. Chris Roberts, aged 20, presented on a Tuesday morning complaining of 10 days cough He was producing a
small amount of yellowish sputum. He had mild exertional dyspnoea and was a ‘bit wheezy’ the night before. He
smoked 10--15 cigarettes per day. He had no past history of respiratory illness. Examination: Afebrile, Pulse 80,
BP 125/80, Cardiovascular system normal. Chest resonant with scattered wheeze.
A . ‘flu’
B bronchitis
C asthma
D. mycoplasma
E. sinusitis
A. haematuria
B. dysuria
C. backache
D. nocturia
E. oliguria
A. limb survival is generally greater when arteries of the upper extremity are acutely occluded than when
arteries of the lower extremity are so involved
B. delay in treatment of acute arterial occlusion adversely affects limb survival
C. a limb acutely deprived of arterial circulation should be positioned below the level of the heart
D. the main reason that ischaemic skin is vulnerable to injury is because of loss of pain perception
E. the larger the artery that is acutely occluded. the greater the mortality and the more often the loss of limb
A. administration-of androgens
B. constitutional factors
C. Stein-Leventhal syndrome
D. virilizing tumours of the ovary or adrenal gland
E. none of the above
34. Which of the following drugs has been shown to be of value in the treatment of herpes zoster?
A. protamide
B. vitamin B12 (cyanocobalamin)
C. hydrocortisone
D. pituitary extract
E. none of the above
A. 24 hours
B. 2-4 days
C. 5-8 days
D. 10-60 da
E. 1 year
36. A seven year old boy passes a large bloody stool. The most likely cause is
A. Meckel’s diverticulum
B. duodenal ulcer
C. polyps of the colon
D. diverticulitis of the colon
E. intussusception
A. precipitate delivery
B. persistent occipito-posterior position
C. forceps delivery
D. failure to cut an episiotomy
E. large baby
A. inverted nipples
B. cracked nipples
C. engorged breast
D. infection in a breast
E. none of the above
39. The greatest defect in artificial limbs for upper limb amputees is
A. cosmetic
B. lack of sensory feed--back
C. lack of motor effectiveness
D. weight of the prosthesis
E. none of the above
41. A 30 year old housewife complains of' intermittent muscular weakness for 6 months, and has experienced double
vision after prolonged reading. There was a vague history also of difficulty in swallow. On physical examination
the woman has an expressionless facies, unequal palpebral fissures and facial weakness. Further neurological
examination is negative except for generalised diminution in deep tendon reflexes. Routine laboratory
investigations are all normal.
A. thyrotoxic myopathy .
B. acute ascending polyneuritis
C. multiple sclerosis
D. myasthenia gravis
E, muscular dystrophy
42. A 2 year old child presents with a 3 week history of cough and wheeze. The most important diagnosis to exclude
is
A. whooping cough
B. inhaled foreign body
C. mycoplasma pneumoniae infection
D. cystic fibrosis
E. bronchial asthma
44. In differentiating chronic congestive heart failure from cirrhosis of the liver, which of the following is the most
useful single physical sign?
A. blood pressure
B. ascites
C. jaundice
D. raised jugular venous pressure
E. oedema of the ankles
A. loud second heart sound, opening snap and mid-diastolic murmur at the apex
B. loud first heart sound, opening snap and pansystolic murmur at the apex
C. loud first heart sound. opening snap and mid-diastolic murmur at the apex
D. loud second heart sound. opening snap and pansystolic murmur at the apex
E. none of the above
.
46. A 40 year old labourer who smokes two packets of cigarettes daily has a rapidly history of bilateral calf and
thigh pain that forces him to stop walking after approximately, 100 metres. He has a history strongly suggestive
of angina pectoris. Even before examining this patient you can surmise that he probably has one of the following
47. Partial occlusion of either the coeliac axis or the superior mesenteric artery may lead to
A. Ludwig's angina
B. xangina pectoris
C. Vincent Is angina
D. status anginosus
E. abdominal angina
48. Surviving premature infants may be expected to lag behind other children of the same age, in physical
accomplishments during the first
A 2 years of life
B. 4 years of life
C. 8 years of life
D. 6 months of life
E. 12 months of life
49. A 36 year old female presents with chronic pe1vic pain menorrhagia deep dyspareunia and secondary infertility.
Examination reveals bilateral tender adnexial swelling. A hysterosalpingogram shows both fallopian tubes to be
patent.
A. chronic salpingo-oophoritis
B. uterine fibromyomata
C. pelvic tuberculosis
D. endometriosis
E. carcinoma of the ovary
50. Silent myocardial infarction can be expected to occur most commonly in patients with
A. polycythemia vera
B. hypertension
C. diabetes mellitus
D. hypercholesterolaemia
E. alcohol dependence
51. Internal version and breech extraction is least dangerous when performed for
A. placenta praevia
B. delivery of the second twin
C. prolapse of the cord
D. transverse lie with cervix fully dilated
E. brow presentation with cervix fully dilated
52. Which is the best indication of successful treatment of the nephrotic syndrome?
A. loss of oedema
B. a normal blood urea
C. absence of urinary protein .
D. massive diuresis
E. normal blood pressure
53. A 65 year old man presents with the complaint that he experiences attacks of numbness of the left side of his
body accompanied by poor vision of his right eye. The most likely diagnosis is
A. meningioma
B. parietal lobe neoplasm
C. posterior cerebral artery insufficiency
D. arteriovenous malformation
E internal carotid artery insufficiency
A. mental retardation
B. emotional deprivation
C. paediatric psychiatric disorders
D. specific learning difficulties
E. none of the above
55. A 35 year old homosexually active man presents with a two week history of intermittent watery diarrhoea.
Physical examination including sigmoidoscopy is normal. Your next step in management should be
56. In X-ray of the feet, the os trigonum is most common mistaken for a fracture of
A. cuboid
B. tibia
C. fifth metatarsal
D. ta1us
E. calcaneum
57. The blood urea nitrogen is 1.5 mmol/L; blood sugar level normal; C02 combining power 39 mmol/L (N 24-29);
serum sodium normal; serum potassium 2.4 mmol/L.
A. acute nephritis
B vomiting
C. dehydration
D. diabetes mellitus
E. chronic renal failure
A. delerium
B. coma
C. hyperventilation.
D. hyperpyrexia
E. convulsions
59. A patient presents with acute gout but has a normal serum uric acid. Which of the following drugs can be
responsible for a low reading?
A. colchicine
B. prednisolone
C. indomethacin
D. naproxyn
E. salicylates
60. Following delivery which was induced at 38 weeks because of materna hydramnios, an infant is noted to have
excessive salivation. When fed at 6 hours the infant went blue. What is the most probably diagnosis?
A. meningitis
B. hypoglycaemia
C. duodenal atresia
D. tracheo-oesophageal fistula
E. pneumonia
61. When the doctor is convinced his patient is evasive to the point of lying to him the best course is to
63. Patent ductus arteriosus is associated with all the following statements EXCEPT
64. Which of the following is the sequence of events usually seen in acute small bowel obstruction?
A. 1g of carbohydrate
B. 5g of carbohydrate
C. 10g of carbohydrate
D. 15g of carbohydrate
E. 20g of carbohydrate
66. A 2 year old child has had a cold for a few days and has been crying on and off for the past three hours.
Examination reveals a rectal temperature of 39 degrees C. a "running nose" & bilateral bulging and reddened
tympanic membranes. You prescribe analgesics and ephedrine nasal drops. In addition, you should:
A. advise the parents that the most likely cause is a virus and that the inflammation will shortly resolve
B. reassure the parents and review the child's progress in 24 hours
C. prescribe antihistamines
D. prescribe amoxycillin syrup and review within 3
E. prescribe amoxycillin and arrange for a myringotomy
67. The initial management of a spontaneous pneumothorax in a patient without dyspnoea at rest and a uniform 2
cm separation of the lung from the chest wall on a radiograph should consist of
A observation-
B. single needle aspiration
C. positive pressure respiration
D. underwater drainage
E. underwater drainage with suction
68. A 3 year old boy presents because he can say a few words and tends to communicate by gesticulation. Physical
examination including auroscopic examination is normal. The most likely reason for his presentation is
A. mental deficiency
B. dyslexia
C. behavioural disorder
D. deafness
E. variation of normality
69. Which of the following is the most sensitive test of renal function?
A. .I.V.P.
B. blood urea
C. serum creatinine
D. blood urea nitrogen
E urinary specific gravity
70. In a twin pregnancy after the first twin is delivered and the cord tied. The next step in management is to
A. the physical findings depend upon the position of the caecum and the relation of the appendix to the caecum.
B. the illopsoas test and obturator test are never positive in the pelvic variety
C. the abdominal findings may be perfectly normal in pelvic appendicitis
D. localised tenderness is a very reliable physical sign
E. anorexia and vomiting are common symptoms
72. Which of the following family situations would lead to the highest recurrence risk for future children
73. A ten month old infant presents with extreme pallor but is otherwise well nourished and healthy. Haemoglobin is
6.5g/dl (N 9.5-14.0) and serum iron 25 umol/L (N 10-27) occult blood is negative on several stool examinations.
A. occupation
B. nutritional status
C. sex
D. smoking habit
E. age
75. A50 year old man who suffers from rheumatoid arthritis and who has been treated with prednisolone for 3 years
developed peripheral neuropathy of the lower extremities. This neuropathy is most likely due to
A. arsenic poisoning
B. thiamine deficiency
C. development of necrotising arteritis
D. ruptured intervertebral disc
E. vitamin B12 deficiency
A. atopic eczema
B. lichen planus
C. Hodgkin's disease
D. secondary syphilis
E. scabies
77 A 46 Year old man suffered his first myocardial infarction. Recovery was uneventful. Two days after admission
to hospital, the patient's fasting blood glucose was 5.8 mmol/L (upper limits of normal 6.2 mmol/L); a 2 hr
postprandial blood glucose was 8.3 mmol/L. Four weeks later an oral glucose tolerance test was performed with
the following results - fasting 6.5 mmol/L. 1 hr. 9.0 mmol/L, 2 hr. 7.2 mmol/L. Blood glucose values in this
patient indicate
78. In which spinal cord segments are the motor neurones responsible for the knee jerk located?
A. S1
B. S1, 2
C. L2. 3. 4
D. L4. 5
E. L5, S1
79. An infant at one minute after birth is deeply cyanosed in body and limbs, makes no reaction to a catheter
inserted into the nose, is limp but takes an occasional gasp.- What is the apgar score?
A. 0
B. 1
C. 2
D. 3
E. insufficient data
81. The sister of a boy with cystic fibrosis is married to a man whose nephew has cystic fibrosis. The couple want to
know whether cystic fibrosis will appear in a child of theirs. They should be told that
A. sweat chloride tests will show whether they are both carriers for the cystic fibrosis gene.
B. they should have no children. because there is a 33% risk of cystic fibrosis affecting their child.
C. prenatal diagnostic tests will reliably detect an affected foetus. which can then be aborted
D. they need not be concerned about having a child with cystic fibrosis because it can be detected reliably in the
newborn.
E. their risk of having a child with cystic fibrosis is less than 10%
82. During a home visit to a rather confused 78 year old woman the doctor is asked whether all her five prescribed
drugs can be taken with meals.
A. digoxin (Lanoxin)
B. frusemide (Lasix)
C. potassium chloride (Slow-K)
D. phenytoin (Dilantin)
E. glibenclamide ( Daonil)
83. A typical finding at cardiac catheterisation in mitral stenosis of moderate severity would be
84. In a patient with bronchogenic carcinoma, which one of the following most strongly suggests inoperability
A. brachial neuritis
B. hypertrophic pulmonary osteoarthropathy
C. hypercalcaemia
D. Horner's syndrome
E. Cushing's syndrome
A. worms
B. malabsorption
C. dietary_
D. peptic ulceration
E. occult blood loss from a Meckel’s diverticulum
A. 2%
B 5%
C 10%
D 20%
E 50%
88. In a patient with symptoms of bronchial asthma, it is characteristically found that the
A. vital capacity is increased. but the forced expiratory volume in 1 second (F.E.V.1) is normal
B . vital capacity is normal. but F.E.V.1 is reduced
C. vital capacity is increased but F.E.V.1 is reduced
D. vital capacity is reduced but F.E.V.1 is normal
E. vital capacity is reduced and F.E.V.1 is reduced .
89. Wasting of the thenar muscles as an isolated sign is most likely due to
A. syringomyelia
B. median nerve compression at the wrist
C. motor neurone disease
D. ulnar nerve lesion
E. C7-T1 lesion
90. In which one of the following is the combination of sallow skin colouration and hyperventilation most likely to be
seen
A. Addison's disease
B. hypoglycaemia
C. haemochromatosis
D. renal failure
E. pneumothorax
91. A three year old child who has swallowed kerosene is brought immediately to casualty., Your management
would include which of the following
A gastric lavage
B. an emetic
C. chest x-r,ay
D. intravenous saline
E. methicillin
92. In making a diagnosis of myocardial infarction from an ECG tracing , the most significant finding is
93. A 35 year old multigravida who has experienced an uncomplicated pregnancy presents at 40 weeks with the
head above the pelvic brim. Your next step in management should be to arrange
A. pelvimetry
B. caesarean section
C. ultrasonography
D. an oxytocin infusion
E. review at 41weeks
94. Ischiorectal abscess is commonly followed by
A. anal carcinoma
B. stricture
C, anal fissure
D anal fistula
E. haemorrhoids
95. The daily fluid requirement of a healthy 4.5 Kg infant in a temperate climate is
97 A 20 year old man was admitted to hospital because of the sudden onset of intense headache and neck stiffness.
For the past 4 years, the patient had had occasional focal motor seizures on the right side of the body.
98. In severe alveolar hypoventilation causing respiratory failure the arterial blood will have (with thepatient
breathing air).
99. Which of the following would be most helpful in distinguishing cerebral infarction from cerebral neoplasm
A history of headache
B. hemiplegia
C. chronology of development
D. carotid bruit
E. focal abnormality on electroencephalogram
1. D 21. D 41 D 61 C 81 E
2. E 22. E 42 E 62 D 82 E
3. B 23. B 43 B 63 B 83 B
4. A 24 D 44 D 64 D 84 D
5. C 25 C 45 C 65 C 85 C
6. A 26 D 46 D 66 D 86 D
7. D 27 E 47 E 67 A 87 B
8. B 28 B 48 A 68 D 88 E
9. C 29 C 49 D 69 C 89 B
10. E 30 D 50 C 70 E 90 D
11. A 31 C 51 B 71 B 91 C
12. B 32 D 52 C 72 C 92 B
13. C 33 B 53 E 73 E 93 E
14. D 34 E 54 D 74 E 94 D
15. E 35 D 55 B 75 C 95 C
16. A 36 A 56 D 76 D 96 D
17. D 37 D 57 B 77 B 97 E
18. C 38 E 58 C 78 C 98 D
19. D 39 B 59 E 79 E 99 C
20. B 40 D 60 D 80 D 100 D