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MCQs in Medicine.

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1 Cardiovascular medicine 1.1 Regarding the jugular venous pulse (JVP): (a) 'a' wave is pronounced in atrial fibrillation. (b) 'a' wave is pronounced in pulmonary stenosis. (c) 'v' wave represents atrial filling against a closed tricuspid valve. (d) Normal range is + 5 to + 10 mmHg. (e) Right external jugular vein is the most reliable for assessing the JVP. 1.2 Collapsing (waterhammer) pulse is a sign of: (a) Aortic regurgitation. (b) Mitral stenosis. (c) Hyperthyroidism. (d) Anaemia. (e) Tricuspid regurgitation. 1.3 Amiodarone: (a) Has a half-life of 8 h. (b) Causes corneal microdeposits. (c) May cause a slate-grey discoloration of the skin. (d) May interfere with thyroid function. (e) Is a class IV antiarrhythmic agent. 1.4 Impotence is a recognized side-etTect of: (a) Atenolol. (b) Spironolactone. (c) Frusemide. (d) Nifedipine. (e) Digoxin. 1.5 Third heart sound: (a) Is normal at any age. (b) May occur with mitral regurgitation. (c) May occur with mitral stenosis. (d) Is due to decreased filling of the ventricle. (e) May occur if a ventricular septal defect is present. 2 Cardiovascular medicine: answers 1.1 (a) FALSE - 'a' wave is atrial systole and is absent. (b) TRUE (c) TRUE (d) FALSE - +3 cm measured with patient at 45° from sternal angle. (e) FALSE - Right internal jugular vein should be used as it does not traverse muscle. 1.2 (a) TRUE (b) FALSE (c) TRUE (d) TRUE (e) FALSE - Pulse character is usually normal but prominent systolic waves occur in the JVP. 1.3 (a) FALSE - Half-life of 20-100 days with chronic administration. (b) TRUE - Common. Rarely interferes with vision and are reversible on withdrawal of treatment. (c) TRUE - Also photosensitivity occurs in 10%. (d) TRUE - Hyper- or hypothyroidism may occur. (e) FALSE - It is a class III drug. 1.4 (a) TRUE (b) FALSE - Gynaecomastia is a side-effect. (c) FALSE - Impotence is a side-effect of thiazide not loop diuretics. (d) FALSE (e) FALSE 1.5 (a) FALSE - It is normal in children and adults up to 40 years of age. (b) TRUE - It is produced by increased ventricular filling. (c) FALSE (d) FALSE (e) TRUE - See (b). Cardiovascular medicine: questions 3 1.6 Maternal rubella in the first trimester of pregnancy may cause the following in the fetus: (a) Fallot's tetralogy. (b) Atrial septal defect. (c) Aortic stenosis. (d) Patent ductus arteriosus (PDA). (e) Coarctation of the aorta. 1. 7 A ventricular septal defect (VSD): (a) Is associated with Down's syndrome. (b) May result in Eisenmenger's syndrome. (c) Usually closes spontaneously if large. (d) May produce a diastolic murmur. (e) Predisposes to infective endocarditis. 1.8 Regarding an atrial septal defect (ASD): (a) An ostium primum ASD is the commonest type. (b) An ostium secundum ASD is associated with a high incidence of infective endocarditis. (c) Left bundle branch block is common. (d) It produces a systolic murmur due to increased pulmonary flow. (e) Chest X-ray shows pulmonary plethora. 1.9 Eisenmenger's syndrome: (a) Is due to a left to right shunt. (b) Results in central cyanosis. (c) Induces polycythaernia. (d) Is an indication for cardiac surgery. (e) Is associated with coarctation of the aorta. 1.10 Coarctation of the aorta: (a) Is usually distal to the origin of the left subclavian artery. (b) May produce a small volume femoral pulse. (c) Is commonly associated with a bicuspid aortic valve. (d) Results in hypotension. (e) Results in a double aortic knuckle on chest X-ray. 4 Cardiovascular medicine: answers 1.6 (a) TRUE (b) TRUE - Ventricular septal defects may also occur. (c) FALSE - Right-sided outflow obstruction; pulmonary valve, artery or branch stenosis. (d) TRUE (e) FALSE - 50% of fetuses are affected if infected in the first 1.7 trimester. The systemic syndrome also includes cataracts, deafness and mental retardation. (a) TRUE - Atrial septal defects are less common. (b) TRUE - Right to left shunting due to pulmonary hypertension. (c) FALSE - 50% of small defects close spontaneously in the first year. (d) TRUE - If large, a mitral diastolic flow murmur occurs as well as the pansystolic murmur of the VSD. (e) TRUE 1.8 (a) FALSE - Ostium secundum ASDs account for 70 %. (b) FALSE - Low incidence. Primum ASDs predispose to endocarditis and are usually associated with atrioventricular valve abnormalities. (c) FALSE - Right bundle branch block occurs. (d) TRUE - Flow through the ASD itself does not produce the murmur. (e) TRUE 1.9 (a) FALSE - It is due to a right to left, i.e. reversal of a left to right shunt, e.g. VSD, ASD, PDA. (b) TRUE (c) TRUE - Due to hypoxaemia. (d) FALSE - Lesion must be corrected before this serious condition develops. (e) FALSE 1.10 (a) TRUE - In 98% of cases. (b) TRUE (c) TRUE - In 70% of cases and may produce an aortic systolic murmur. (d) FALSE - It is a cause of hypertension in the young. (e) TRUE - Due to stenosis and poststenotic dilatation.

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MCQs in Medicine

, MCQs in Medicine


Debra King MB, MRCP (UK),
Senior Registrar in Geriatric Medicine,
Royal Liverpool University Hospital.

Susan J. Benbow MB, MRCP (UK),
Clinical Research Fellow,
Department of Medicine,
University of Liverpool.


With a Foreword by

Michael Lye MD, FRCP




CHAPMAN &. HALL MEDICAL
London· Glasgow· New York· Tokyo· Melbourne· Madras

,Published by Chapman & Hall, 2-6 Boundary Row, London SE18HN

Chapman & Hall, 2-6 Boundary Row, London SEI 8HN, UK
Blackie Academic & Professional, Wester Cleddens Road, Bishopbriggs,
Glasgow G64 2NZ, UK
Chapman & Hall Inc., One Penn Plaza, 41st Floor, New York NY 10119,
USA
Chapman & Hall Japan, Thomson Publishing Japan, Hirakawacho Nemoto
Building, 6F, 1-7-11 Hirakawa-cho, Chiyoda-ku, Tokyo 102, Japan
Chapman & Hall Australia, Thomas Nelson Australia, 102 Dodds Street,
South Melbourne, Victoria 3205, Australia
Chapman & Hall India, R. Seshadri, 32 Second Main Road, CIT East,
Madras 600 035, India

First edition 1994
© 1994 Debra King and Susan J. Benbow
Typeset in 9.5/llpt Times by Mews Photosetting

ISBN-J3: 978-1-4684-6478-8 e-ISBN-J3: 978-1-4684-6476-4
DOl: 10.1007/978-1-4684-6476-4
Apart from any fair dealing for the purposes of research or private study, or
criticism or review, as permitted under the UK Copyright Designs and Patents
Act, 1988, this publication may not be reproduced, stored, or transmitted, in
any form or by any means, without the prior permission in writing of the
publishers, or in the case of reprographic reproduction only in accordance
with the terms of the licences issued by the Copyright Licensing Agency in
the UK, or in accordance with the terms of licences issued by the appropriate
Reproduction Rights Organization outside the UK. Enquiries concerning
reproduction outside the terms stated here should be sent to the publishers at
the London address printed on this page.
The publisher makes no representation, express or implied, with regard to
the accuracy of the information contained in this book and cannot accept any
legal responsibility or liability for any errors or omissions that may be made.
A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication data
King, Debra.
MCQS in medicine / Debra King, Susan J. Benbow: with a foreword
by Michael Lye. - 1st ed.
p. cm.
Includes index.
ISBN-J3: 978-1-4684-6478-8
I. Internal medicine - Examinations, questions, etc. I. Benbow,
Susan J. II. Title.
[DNLM: I. Medicine - examination questions. W IS K52m 1994]
RC5S.K56 1994
616' .OO76-dc20
DNLM/DLC
for Library of Congress 93-34658
eIP
8 Printed on permanent acid-free text paper, manufactured in accordance
with the proposed ANSIINISO Z39.48-1992 and ANSI/NISO Z39.4S-J984
(Permanence of Paper).

, Contents

Foreword vii
Acknowledgements ix
Introduction xi
1 Cardiovascular medicine 1
2 Respiratory medicine 25
3 Rheumatology 49
4 Infectious diseases 73
5 lIaematology 97
6 Endocrinology and metabolic diseases 121
7 Renal medicine 145
8 Gastroenterology 169
9 Neurology 193
10 Dermatology 217

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