1.

Amiodarone
Has a half-life of 8 h
Causes corneal microdeposits
May cause a slate grey discoloration of the skin
May interfere with thyroid function
Is a class IV antiarrhythmic agent
2. A ventricular septal defect (VSD):
Is associated with Downs syndrome
May result in Eisenmengers syndrome
Usually closes spontaneously if large
May produce a diastolic murmur.
Predisposes to infective endocarditis
3. Regarding an atrial septal defect
An ostium primum ASD is the common
An ostium secundum ASD is associated with a high incidence of infective endocarditis
Left bundle branch block is common
It produces a systolic murmur due to increased pulmonary flow
Chest X-ray shows pulmonary plethora
4. The following may be associated with aortic regurgitation:
Marfans syndrome
Right ventricular hypertrophy
Small volume pulse
Ankylosing spondylitis
Traubes sign
5. The following are characteristic signs of aortic stenosis:
Small pulse pressure
Early diastolic murmur
Arcus senilis
Ejection click in early systole
Left ventricular dilatation
6. The following are ECG features of hypokalaemia:
waves
Depressed ST segments
Flat T waves
Short PR interval
Peaked T waves
7. Finger clubbing may be associated with:
Chronic bronchitis
Bronchiectasis
Pulmonary fibrosis
Bronchial carcinoma
Asthma
8. Chronic bronchitis:
Is a diagnosis which is usually made on chest X-ray appearances
Is commoner in men
Is more prevalent in the USA than the UK
Results in an increased FEV1
May cause severe hypoxia during REM sleep
9. Emphysema:
Is a clinical diagnosis
Almost always is accompanied by right heart failure
Often results in purse-lip breathing
Causes an increased total lung capacity and reduced transfer factor
Results in copious sputum production
10. Regarding pneumonia:
Streptococcus pneumonia is the most common aetiological organism
If occurring during an influenza epidemic then klebsiella pneumonia is the usual cause
If caused by legionella pneumophila (Legionnaires disease) it is sometimes associated with myalgia and
renal failure
If caused by Mycoplasma pneumonia, high-dose intravenous benzyl-penicillin should be used
If staphylococcal, lung abscesses may occur
11. Miliary tuberculosis:
Most commonly follows primary infection
Is classically associated with lobar consolidation
May result in pancytopenia
May cause hepatosplenomegaly
Is difficult to diagnose in the elderly because of non-specific symptoms
12. Regarding a lung abscess:
It may complicate bronchial carcinoma
It may be a sequel to klebsiella pneumonia
Clubbing may develop
It usually presents incidentally as a cavity with a fluid level on a routine chest X-ray
Surgical excision is often required
13. The following characteristically produce a symmetrical polyarthritis:
Osteoarthritis
Rheumatoid arthritis
Systemic lupus erythematosus
Reiters syndrome
Crohns disease
14. Regarding systemic lupus erythematosus (SLE):
It is commoner in men
Photosensitivity may occur
Complement (C3 and C4) levels are increased
Renal involvement is a good prognostic feature
The antinuclear factor is usually negative
15. The following drugs may produce an SLE syndrome:
Hydralazine
Aspirin
Procainamide
Phenytoin
Ranitidine
16. The following may produce hyperuricaemia:
Pregnancy
Renal failure
Wilsons disease
Polycythaemia rubra vera
Obesity
17. Regarding polymyalgia rheumatica:
It is commoner in women
The ESR is usually less than 30mm/h
It is associated weakness of the limb girdle muscles
Weight loss may occur
There is a risk of blindness developing if untreated
18. Pseudogout:
Is more common in females than gout
Most commonly presents with arthralgia involving the ankle
Produces joint effusions which contain calcium pyrophosphate crystals
Is associated with calcification of joint cartilage
Is associated with haemochromatosis
19. Herpes simplex virus infection:
Can produce an encephalitis which runs a benign couse
Of the genitalia may be passed to the newborn with fatal consequences
Type 2 is implicated in cervical cancer
Causes chickenpox
Causes cold sores
20. The following are characterized by an erythematous maculopapular or petechial rash:
Meningococcal infection
Rubella
Chickenpox
Malaria
Scarlet fever
21. Scabies:
Has an incubation period of 3 months
Is transmitted by droplet infection
Produces a rash most commonly seen on the scalp
May be complicated by secondary infection
Is treated with 1% gamma benzene hexachloride
22. The following disease may be caused by the Epstein-Barr virus:
Nasopharyngeal carcinoma
Whooping cough
Glandular fever
Burkitts lymphoma
Dysentery
23. Regarding chickenpox:
It is associated with a papulovesicular rash which is peripherally distributed
The illness is milder in the adult
Vaccination is reducing the incidence
It may occur in the young after contact with a patient who has shigles
It may be complicated by encephalitis
24. Regarding bacterial meningitis:
Escherichia coli is the usual pathogen in the elderly
Kernigs sign is usually negative
Benzylpenicillin is the antibiotic of choice for Haemophilus influenza meningitis
Petechial rash commonly accompanies meningococcal meningitis
The CSF sugar is usually > 10 mmol/L
25. The following may cause a normochromic, normocytic anaemia:
B12 deficiency
Rheumatoid arthritis
Menorrhagia
Hypothyroidism
Folate deficiency
26. The following cause a macrocytosis (large red cell, MCV > 100 fl):
Alcoholism
Hypothyroidism
Chronic renal failure
Sideroblastic anaemia
Haemolysis
27. Heparin:
May be given orally
Inhibits clotting
May have its effects reversed by protamine
Has a half-life of 24h
May cause alopecia
28. Regarding sideroblastic anaemia:
The ring sideroblast is seen in the peripheral blood
Bone marrow iron stores are depleted
It may respond to pyridoxine
It may be caused by isoniazid
The red cells are normochromic
29. The following are clinical features of multiple myeloma:
Bone pain
Hypocalcaemia
Polycythaemia
Renal failure
Bleeding tendency
30. Regarding polycythaemia rubra vera:
The total red cell volume is decreased
It is commoner in women
Pruritus may occur
Headaches may occur
Splenomegaly is a common finding
31. Expected findings in cranial diabetes insipidus include:
Polyuria
A sex-linked recessive mode of inheritance
Urine with low specific gravity
Hypotonic urine following the administration of desmopressin (vasopressin)
An increase in weight during a water deprivation test
32. Characteristic features of Addisons disease include:
Hyperpigmentation
Hypertension
Loss of body hair in males
Hypoglycaemia
Family history of autoimmune disease
33. The following are recognized feature of Cushings disease (pituitary dependent Cushings syndrome):
Hypertension
Distal limb weakness
Menstrual irregularity
Osteomalacia
Depression
34. In Conns syndrome:
Hypertension is a recognized finding
Hyperkalaemia occurs
Serum renin levels are increased
Tetany may occur
Polyuria is common
35. In Grave disease:
Men and women are equally affected
Thyroid gland is typically nodular
Exophthalmos is found
Weight loss is inevitable
Pre-tibial myxedema may occur
36. Recognized causes of a goiter include:
Lithium
Cough linctus
Pregnancy
Pendreds syndrome
Hashimotos disease
37. Recognized causes of proteinuria include:
Chronic pyelonephritis
E. coli urinary tract infection
Heavy exercise
The Fanconi syndrome
Subacute bacterial endocarditis
38. Causes of dark coloured urine include:
Metronidazole therapy
Obstructive jaundice
Methaemoglobinuria
Ingestion of tomatoes
Acute intermittent porphyria
39. The following can cause hyperkalaemia:
A combination of potassium supplements and ACE inhibitors
Addisons disease
Acute renal failure
Metabolic alkalosis
Secondary aldosteronism
40. Metabolism acidosis is characteristically associated with:
Vomiting
Chronic renal failure
Salicylate overdose
Ethanol ingestion
Severe diarrhoea
41. Pre-renal failure is a recognized complication of:
Myocardial infarction
Septicaemic shock
Burns
Retroperitoneal fibrosis
Polyarteritis nodosa
42. Causes of sterile pyuria include:
Myeloma
Renal tuberculosis
Herpetic urethritis
Chronic prostatitis
Amyloidosis
43. Gilberts syndrome:
Can be precipitated by fasting
Is a sex-linked recessive condition
Reduces life expectancy by approximately 10 years
Results in a raised serum conjugated bilirubin
Results in an abnormal liver biopsy
44. Chronic constipation is a recognized association of:
Gastrectomy
Hyperthyroidism
Hypokalaemia
Iron salts
Hirschprungs disease
45. Expected findings in idiopathic haemochromatosis are:
Diabetes mellitus
An increased incidence in females
Raised serum ferritin
Hepatomegaly
Primary hepatoma in 90% of cases
46. Recognized complications of ulcerative colitis include:
Erythema nodosum
Leg ulcers
Sclerosing cholangitis
Iritis
Arthropathy
47. In irritable bowel syndrome:
Altered bowel habit may occur
Males are more commonly affected than females
Iron deficiency anaemia is present in 10-20% of cases
C-reactive may respond to bulking agents
48. Recognized causes of malabsorption are:
Primary biliary cirrhosis
Acute pancreatitis
Crohns disease
Systemic sclerosis
Tropical sprue
49. Possible causes of sudden blindness include:
Hypoparathyroidism
Temporal arteries
Retinal detachment
Bells palsy
Retinal artery obstruction
50. Characteristic features of a Horners syndrome are:
Partial ptosis
Enophthalmos
Dilated pupil
Increased sweating
Abducted eye
51. Characteristic features of Bells palsy are:
Hyperacusis
Complete recovery in 20% of cases
Loss of taste in the posterior one-third of the tongue
Paralysis of the lower half of the face only
Ptosis
52. In trigeminal neuralgia:
Symptoms characteristically start in patients age 30-40 years
Pain typically lasts for <1 min, then abates
Carbamazepine is the treatment of first choice
Surgical treatment is almost never indicated
Trigger zone is often found in the precipitation of pain
53. Recognized causes of a peripheral polyneuropathy are:
Amyloidosis
Sarcoidosis
Uraemia
Metronidazole
Systemic lupus erythematosus (SLE)
54. Recognized treatment for Parkinsons disease are:
Selegiline
Amantadine
Levodopa
Tetrabenazine
Propranolol
55. The following typically occur with a parietal lobe lesion:
Deja-vu phenomenon
Anosmia
Grasp reflex
Sensory inattention
Some forms of apraxia
56. Recognized causes of leg ulcers include:
Psoriasis
Rheumatic fever
Sickle-cell anaemia
Tabes dorsalis
Pyoderma gangrenosum
57. The following may cause a diffuse increase in skin pigmentation:
Wilsons disease
Pellagra
Systemic sclerosis
Tuberose sclerosis
Acromegaly
58. The following drugs are recognized to cause photosensitivity:
Cotrimoxazole
Chlorpromazine
Ferrous sulphate
Cephradine
Amiodarone
59. Mucosal ulceration is typical of the following conditions:
Herpes zoster
Pernicious anaemia
Behcets disease
Stevens-Johnson syndrome
Eczema
60. Characteristic features of pityriasis rosea are:
Scaling of the lesion
Predominance of lesions on the feet and hands
Pustular rash
Herald patch
Mortality in 5-10% of patients within 2 years