MCQ Medicine 2
"A 19-year-old female university student presents with fever and headache. On examination she is conscious but has neck stiffness. The cerebrospinal fluid Gram stain shows intracellular Gram-negative diplococci. The most probable diagnosis is? A. meningococcal meningitis B. Haemophilus influenzae meningitis C. Streptococcus pneumonia meningitis D. Listeria monocytogenes E. coli meningitis"
A
"A 20 year old woman with a history of smoking and mild asthma presents with sudden onset of sharp chest pain which on questioning is worse on inspiration. On examination her resting respiratory rate is 30 breaths/min and she is clearly distressed. What do you consider to be the most clinically valuable next step in examination or investigation? A. Determine if the trachea is midline B. Listen for decreased breath sounds C. Order an urgent chest X-ray D. Organise pulse oximetry E. test for hyper resonance on percussion"
A
"A 23-year-old man who lives with his male partner consults you for an opinion. He has suffered anal discharge and pruritis for the past 3 days. There are also some symptoms of dysuria. A urethral smear reveals intracellular diplococci. What is the most likely infective agent to fit with this clinical picture? A. neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. Herpes simplex-type 1 E. Herpes simplex-type 2"
A
"A 30-year-old man presents with an acute onset of pain and blurred vision of his right eye. On examination there is conjunctival injection and dendritic ulceration is seen on his cornea. What is the diagnosis? A. Herpes simplex virus keratitis B. Foreign body C. Candida keratitis D. Trachoma E. Glaucoma"
A
"A 32-year-old woman has just returned from a holiday in the Middle-East. She had to spend much of the flight in the toilet and has been brought by ambulance from the airport. On admission she is severely dehydrated and gives a history of passing voluminous watery stools that look like rice water, mixed with mucus and blood. blood testing reveals a raised haemoglobin, markedly raised urea and raised creatinine. blood glucose is measured at only 3. 1 mmol/l (normal 3. 0-6. 0). What diagnosis fits best with this clinic picture? A. Cholera B. Typhoid fever C. Shigella D. Salmonella E. Amoebic dysentery"
A
"A 33-year-old woman has returned from a holiday in Africa. She has been diagnosed as suffering from malaria due to Plasmodium falciparum. Which one of the following statements is FALSE? A. Following successful treatment, fever recurs due to persistence of the parasite in the liver B. Cough and mild diarrhoea are a common presentation C. Splenectomy increases the risk of infection D. Jaundice is usually due to haemolysis and hepatitis E. The fever has no particular pattern"
A
"A 36-year-old primary school teacher from the East End of London presents with increasing shortness of breath accompanied by sudden-onset, right-sided pleuritic chest pain. She gives a history of influenza for a few days before this acute presentation and also says she suffered a pulmonary embolus 2 years ago while taking the contraceptive pill and describes her pain as identical to that occasion. On further questioning it transpires that her mother had suffered from recurrent deep vein thrombosis. Arterial blood gases reveal a p(O2) of 7. 2 kPa on a re-breather mask, with a p(CO2) of 3. 2 kPa. Her chest X-ray reveals a wedge-shaped area of consolidation affecting her right middle and lower lobes. The white blood cell count is normal. Which diagnosis fits best with this clinical picture? A. recurrent pulmonary embolism B. Staphlyoccal pneumonia C. Pneumothorax D. Tuberculosis E. Bronchial carcinoma"
A
"A 45-year-old man of Sudanese origin is admitted with a history of low-grade fever for over 7 days. He migrated to the UK 1 year ago and has a past history of well-controlled asthma. His temperature chart shows that on some days there is a doubled rise in his temperature during 24 hours. Examination shows a massively enlarged spleen and mild hepatomegaly. His full blood count shows a mild microcytic and hypochromic anaemia along with granulocytopenia and thrombocytopenia. Which one of the following investigations will establish a diagnosis? A. Bone marrow aspirate B. Widal test C. Xenodiagnosis D. Examination of a wet blood film taken at night E. blood culture"
A
"A 56 year old man is brought into the Emergency Department following a car accident. When you assess his respiratory system you find that he has reduced chest expansion on the right with a midline trachea. The percussion note is dull on the right posteriorly and laterally but resonant on the left. He is very tender in the right axilla. Breath sounds are absent at the right base and generally vesicular with occasional crackles elsewhere. What is the most likely diagnosis based on these findings? A. Haemothorax on the right B. Simple pneumothorax on the right C. Right lower lobe aspiration pneumonitis D. Acute severe asthma E. Generalised lung contusions"
A
"A 60-year-old woman is convalescing in hospital following total right knee replacement surgery undertaken three weeks ago. She develops headache, chills and a fever of 39. 2°C. On examination the right knee is red, hot and very tender. Synovial fluid aspirate reports the growth of Gram-positive cocci. Which one of the following is the MOST likely organism? A. Staphylococcus epidermidis B. Pseudomona aeruginosa C. Streptococcus pneumoniae D. Staphylococcus aureus E. Haemophilus influenzae"
A
"A 70-year-old man known to have NIDDM was admitted with pain and swelling in the left ear and face. On examination the external ear is red, tender and swollen. There is a small amount of purulent discharge from the external auditory canal with crust covering the skin. The left side of the face is swollen, with tenderness over the left temporal bone. The primary microorganism most probably responsible for this infection is? A. Pseudomonas aeruginosa B. Staphylococcus aureus C. Streptococcus pneumoniae D. Listeria monocytogenes E. Haemophilus influenzae"
A
"A 75 year old woman brought into the Emergency Department by her daughter. Her daughter tells you she has become more confused over the last 2 days and she is normally independent and otherwise healthy woman. On examination she is afebrile, her heart rate is 100 beats per minute and her blood pressure is 160/90 mmHg. Pulse oximetry is 97 percent on room air. There are no focal findings on neurological examination and her chest is clear. What is the most likely cause of her confusion? A. Transient ischaemic attack B. Pneumonia C. Dementia D. Vitamin B12 deficiency E. Urinary tract infection"
A
"At the time of discharge of a 75-year-old non-smoker, with known COPD, it was decided that, according to the criteria, he should be having long-term oxygen therapy in home. What is not considered as a lone criterium for LTOT among the following options? A. Arterial blood gas showing pa(O2) 7. 5 kPa B. Cor pulmonale C. FEV1 < 1. 5 litres despite maximal treatment D. FVC < 2 litres despite maximal treatment E. Arterial blood gas showing pa(O2) 7. 8 kPa with pulmonary hypertension"
A
"Plasmodium vivax and Plasmodium ovale can relapse months or years after an initial infection. Which one of the following parasite stages is responsible for reactivation of malaria infection? A. Hypnozoite B. merozoite C. Trophozoite D. Sporozoite E. Gametocyte"
A
"Profound hypothyroidism in the elderly is likely to cause which of the following electrolyte disturbances? A. Hyponatraemia B. Hypernatraemia C. Hypokalaemia D. Hyperkalaemia E. Hypercalcaemia"
A
"Which of the following is the most sensitive investigation for pancreatitis? A. Lipase with levels > 3X normal B. Amylase if levels 3X normal C. Abdominal X-ray D. Computed Tomography (CT) scan E. Ultrasound"
A
"With regard to the use of antibiotics in cholera, which of the following statements is correct? A. They prevent the spread of infection in the community B. They reduce the risk of bacteraemia C. They reduce the production of the toxin D. They can shorten the duration of diarrhoea E. They reduce the likelihood of prolonged faecal sheddi"
A
"A patient with small-cell lung cancer has a serum sodium concentration of 121 mmol/l. Which of the following is the most likely cause? A. Sodium-restricted diet B. Sodium-reduced water drinking C. SIADH D. Liver metastases E. Bone metastases"
C
"A thin 45 year old alcoholic man presents 6 weeks after an admission for alcohol induced acute pancreatitis with a history of mild to moderate epigastric discomfort and a poor oral intake due to early satiety. Examination reveals he is afebrile and has an 8cm firm, round, slightly tender mass in the epigastrium. What is the most likely diagnosis? A. Distended stomach due to gastric outlet obstruction B. A pancreatic abscess C. A pancreatic pseudocyst D. A mucinous cystic tumour of the pancreas E. A pseudo-aneurysm of the splenic artery"
C
"An 18-year-old student presents to his GP with a 1-day history of rash, which has followed a 3-day history of cold-like symptoms and conjunctivitis. The rash began as a maculopapular eruption in the postauricular region, but has rapidly spread to his face and upper body. On examination white papules are visible inside his mouth. What diagnosis fits best with this clinical picture? A. Scarlet fever B. German measles C. measles D. Enterovirus infection E. Adenovirus infection"
C
"An 18-year-old woman complains of malaise, tiredness, headache and abdominal discomfort for the last 3-4 days. She was started on ampicillin 2 days ago and has developed a rash. She has lymphadenopathy and exudative tonsillitis. Her white cell count shows abnormal lymphocytosis. What is the most likely diagnosis? A. German measles B. Chickenpox C. Infectious mononucleosis D. Herpes simplex infection E. Cytomegalovirus infection"
C
"An HIV-positive patient recently returned from the tropics presents with severe diarrhoea (up to 30 times per day). What is the most likely cause? A. Escherichia coli B. Staphylococcus aureus C. Cryptosporidium D. Entamoeba histolytica E. Salmonella"
C
"As the medical SHO on call you are summoned to A&E to see a 25-year-old man whose condition has suddenly deteriorated. He arrived about 45 minutes earlier with a 2-hour history of central pleuritic-type chest pain and breathlessness. He collapsed while awaiting radiography. He is now agitated and cyanosed. His pulse is 128/min and BP 76/40 mmHg. Oxygen saturation is reading 76% with the patient breathing high-flow oxygen via a re-breathing mask. On respiratory examination you hear reduced breath sounds in the right lung field with deviation of the trachea towards the left. On percussion it is resonant bilaterally. What immediate course of action should you take? A. Contact the ITU for urgent mechanical ventilation B. Insert a large-bore needle into the left, second intercostal space C. Insert a large-bore needle into the right, second intercostal space D. Check his arterial blood gases and start nebulisation with salbutamol E. Ask for an urgent portable chest radiograph"
C
"By definition, severe acute pancreatitis includes all EXCEPT which of the following complications? A. Acute renal failure B. Acute respiratory distress syndrome (ARDS) C. Acute bowel perforation D. Pancreatic pseudocysts E. Pancreatic necrosis"
C
"In an emergency setting for a patient with an unknown blood group, which is the most appropriate type of fresh frozen plasma (FFP) to administer? A. O negative B. O positive C. AB negative D. AB positive E. A negative"
C
"In which of the following is topical anaesthesia with lignocaine NOT effective? A. Cornea B. Posterior pharynx C. Auditory canal D. Urethra E. Nasal mucosa"
C
"What is the cause of myocarditis caused by diphtheria? A. Hypoxia B. Superinfection with streptococci C. Toxins D. Massive bacteraemia E. A virus"
C
"Which is the most common malignant neoplasm of the lung? A. Carcinoid tumour B. Squamous-cell carcinoma of the bronchus C. metastatic carcinoma D. Adenocarcinoma of the bronchus E. Oat-cell carcinoma"
C
"Which of the following statements about septic arthritis is correct? A. The infection is most commonly due to Escherichia coli B. The clinical features can be similar to gout C. It rarely presents as a monoarthritis D. It usually presents as a pyrexia of unknown origin E. The ankle is the most commonly involved joint"
C
"Which of the following statements describes the mechanism of action of statin therapy for lipid-modification? A. They predominantly reduce triglyceride levels B. Their major action is on intestinal cholesterol absorption C. They inhibit HMG CoA reductase D. They predominantly reduce HDL E. They inhibit lanosterol synthase"
C
"Which of the following treatments is most likely to be associated with a potential life threatening attack of asthma? A. Inhaled corticosteroids B. Inhaled corticosteroid plus a long acting beta agonist C. Multiple courses of oral corticosteroids for acute asthma D. Steroid nasal sprays for concurrent allergic rhinitis E. Topical steroids for concurrent atopic eczema"
C
"Which oral condition has the least association with Type 1 and Type 2 diabetes? A. Candidiasis B. Periodontitis C. Oral cancer D. Lichenoid reactions E. Implant failure"
C
"A 19-year-old student is admitted directly to emergency after being taken ill on a return flight from Central America. It is understood that he was on the last leg of a round-the-world ticket. His vaccination history is unavailable. He had suffered a flu-like illness around 10 days ago, from which he had recovered. On examination in emergency he is pyrexial at 39. 0°C, has extensive bruising, with bleeding around the gum line, and deep jaundice. What diagnosis fits best with this clinical picture? A. Malaria B. Influenza C. Weil's disease D. Yellow fever E. dengue fever"
D
"A 23-year-old woman presents to the sexual Health Clinic. She had unprotected sex after an office party 4 days ago. She is currently taking antibiotics for a respiratory tract infection. There is intense difficulty passing urine, accompanied by burning, itching and pain over her labia. On examination there is a crop of vesicles with ulceration. What diagnosis fits best with this clinical picture? A. Syphilis B. Herpes zoster infection C. Herpes simplex infection (HSV-1) D. Herpes simplex infection (HSV-2) E. Stevens-Johnson syndrome"
D
"A 24 year old man presents with a six month history of low back and buttock pain. His pain is worse in the morning and improves during the day. He has restriction of movement of his lumbar spine. His symptoms are helped by non-steroidal antiinflammatory drugs. Which of the following clinical features is he most likely to develop? A. Arthritis involving the small joints of the hands and feet B. Pulmonary fibrosis involving the lower lobes C. Aortic valve incompetence D. Acute iritis E. Ulcerative colitis"
D
"A 24-year-old thin man complains of constant daytime sleepiness. He mentions involuntary naps رغبة في النوم , often in the middle of activity, which occur suddenly and without warning. He also caused an accident when he fell asleep while driving home from work. The patient works as an office manager and has no history of exposure to chemicals. Which of the following treatments would be indicated? A. Nortriptyline B. Fluoxetine C. Diazepam D. Modafinil E. Continuous positive airway pressure-breathing device"
D
"A 25 year old man had a late night out drinking alcohol heavily. At 2 o'clock in the morning he vomited profusely. This was followed by an acute, severe pain in his chest radiating to his back and neck. What is the most likely diagnosis? A. Acute myocardial infarction B. Pulmonary embolus C. Peptic ulcer disease D. Oesophageal perforation E. Aortic dissection"
D
"A 25-year-old man presents with 4 days of fever, retro-orbital pain and severe myalgia following travel to the Indian subcontinent. He has red eyes and a faint, blanching, maculopapular rash. A peripheral smear for malarial parasites is negative and his white cell count and chest X-ray are normal. What is the most likely diagnosis? A. Malaria B. Typhoid fever C. Bubonic plague D. Dengue fever E. Tuberculosis"
D
"A 29-year-old Catholic priest returns from a trip to Brazil with fevers and deranged LFTs. He has an ALT of 2500 U/l and bilirubin of 75 mmol/l. He attended a travel clinic and was vaccinated prior to travel. He also took mefloquine malaria prophylaxis. What is the most likely diagnosis? A. Malaria B. Hepatitis A C. Hepatitis B D. Hepatitis E E. dengue fever"
D
"A 32-year-old Black woman presents with a 3-month history of a non-productive cough, dyspnoea and pleuritic chest pain, especially with climbing stairs. She reports intermittent fevers of up to 39°C and a 3. 5-kg weight loss. She complains of wrist and ankle pain that has interfered with her work. She smokes two packets of cigarettes per day. Her full blood count is normal and serum ANA is negative. On examination there are red nodules over her lower legs. What is the most likely diagnosis? A. Goodpasture's syndrome B. Adenocarcinoma of the lung C. Systemic lupus erythematosus D. Sarcoidosis E. Histoplasmosis"
D
"A 36-year-old woman presents complaining of a yellowish-green vaginal discharge that started 1 week ago. On examination her vagina is swollen and erythematous. What is the most sensitive diagnostic test? A. Colposcopy B. blood cultures C. serology D. Vaginal fluid microspcopy and culture E. Vaginal pH test"
D
"A 38-year-old man presents some 3 weeks after a stag party weekend in Prague. He has developed a painless ulcer on his penis. You suspect that he may have syphilis. Which of the following percentages is the best estimate of how many untreated syphilis patients go on to develop late-stage CNS or cardiovascular complications? A. 80% B. 90% C. 10% D. 30% E. 0%"
D
"A 40 year old man with a history of alcohol abuse presents with a one week history of shortness of breath, fever and lateral chest pain. His temperature is 39ºC and he is hypotensive. A chest X-ray shows a large D shaped collection posteriorly at the base of his right lung. Which of the following choices is the most appropiate next step? A. Ultrasound scan of the collection B. Computed tomography (CT) of the chest C. Diagnostic pleural tap and gram stain D. Intercostal drain insertion and gram stain E. ventilation perfusion lung scan"
D
"A 45-year-old Christian missionary returned from a tropical assignment in Central America 10 months ago. Since then he has undertaken no foreign travel. He presents with fever, malaise and rigors. On examination he has mild jaundice, liver tenderness and a palpable spleen. blood testing reveals that he is anaemic. What infective agent fits best with this clinical picture? A. Plasmodium falciparum B. Plasmodium malariae C. Tropical sprue D. Plasmodium vivax E. Plasmodium ovale"
D
"A 46-year-old patient has been chronically infected with the hepatitis B virus for the last 8 years. He has an increased risk of developing which disease? A. Coronary artery disease B. COPD C. Pancreatic cancer D. Hepatocellular cancer E. Malignant melanoma"
D
"A 49-year-old man presents with an episode of acute self-limiting hepatitis. Hepatitis A is diagnosed. What is the most likely mode of transmission? A. sexually B. blood transfusion C. needle-stick injury D. Contaminated food E. Mosquitoes"
D
"A 55-year-old man of no fixed address is admitted to the hospital because of self-neglect. A chest X-ray has shown bilateral apical cavitation and hyperinflated lung fields consistent with COPD. Sputum cultures have grown Mycobacterium avium complex (MAC). Which one of the following statements is correct? A. Patient should be treated with a standard 6 months of anti-tuberculosis drugs B. Patient should be notified within 1 week of diagnosis C. Patient should be barrier nursed for 2 weeks D. This organism is most likely to affect patients with pre-existing lung disease E. Surgery has no role in management"
D
"A 65-year-old man came to clinic with a history of proximal muscle weakness. He has had a cough for 8 weeks. There is associated pain in the small joints of the hands, and has small haemorrhages in the nail folds. He is apyrexic and on examination there is no lymphadenopathy or clubbing. Bibasal crackles can be heard and his chest X-ray reveals diffuse reticular infiltrates. Lung function tests show a restrictive pattern. What is the underlying cause of his interstitial lung disease? A. Cryptogenic fibrosing alveolitis B. SLE C. Ankylosing spondylitis D. Polymyositis E. Rheumatoid arthritis"
D
"A 75 year old man presents a year after sustaining a stroke. He complains of worsening urinary frequency, urgency and nocturnal enuresis. Which of the following statements is true? A. The most likely cause is benign prostatic hypertrophy B. The appropriate imaging investigation is computed tomography (CT) scan of the urinary tract C. Cystoscopy is mandatory D. The most likely cause is neurogenic overactive bladder E. A trial of antibiotic therapy is indicated"
D
"An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the most significant long-term risk following this infection? A. Coronary artery disease B. Endometriosis C. Infertility D. Cervical cancer E. Carcinoma of the endometrium"
D
"An 82-year-old man living alone in a bungalow came to the clinic complaining of feeling generally unwell for about the last 3-4 months and of losing about 9. 5 kg (21 lbs) in weight during this period. On further enquiry he said he had been having night sweats for the last month. He also has a past history of angina and arthritis and was on medication. On examination he did not look well. He was pyrexic and without lymphadenopathy. Bibasal crepitus on the lower zone was heard on chest auscultation. He had hepatosplenomegaly and clubbing. Investigations showed WBC 12. 3 x 106/l (neutrophils 52%, lymphocytes 39%), Hb 9. 1 g/dl, with all other routine investigations being normal. A chest X-ray showed 1-2 cm diameter miliary shadows all over the lung field. The Mantoux test was negative. No bacteria grew in a sputum culture. What is the probable cause of the illness and the X-ray finding? A. Sarcoidosis B. Mycoplasma pneumonia C. Staphylococcal pneumonia D. Miliary tuberculosis E. Bacterial endocarditis"
D
"Charlie Springer is a 25 year old man who has had a motor bike accident. On arrival at the Emergency Department, his vital signs are heart rate is 130/minute, blood pressure of 90/60 mmHg, respiratory rate of 32/minute, temperature is 36°C. His peripheral oxygen saturation is 97 percent on room air. What would be your initial order for IV fluids? A. Two packs of O negative blood over half an hour B. A litre of normal saline over 2 hours C. A litre of 4 percent dextrose and 0. 18 percent saline over an hour D. A litre of normal saline over half an hour E. A litre of Hartmans solution over 2 hours"
D
"Infection with which virus is the most frequent cause of blindness in patients with AIDS? A. Herpes simplex virus B. Varicella zoster virus C. Epstein-Barr virus D. Cytomegalovirus E. Papillomavirus"
D
"The 18-year-old son of an immigrant from Bangladesh who recently came to the UK has been complaining of tiredness, weight loss and generally not feeling well for the last month. He presents to his GP because of haemoptysis, especially in the morning. What is the most likely diagnosis? A. Pneumothorax B. Pulmonary embolism C. Lung cancer D. Pulmonary tuberculosis E. Asthma"
D
"Which of the following most accurately describes the ECG abnormality seen with a delay in AV node conduction? A. A QRS duration of >0.16 seconds B. A PR interval of >0.12 seconds C. A QT interval of 420 milliseconds D. A PR interval of >0.20 seconds E. A QRS complex duration of 0.08 seconds"
D
"You are asked to review a 54-year-old asylum seeker from Eastern Europe. He has suffered a cough and weight loss of some 14 kg over the past few months. He admits to occasional night sweats. He is a heavy smoker of some 40 cigarettes per day. blood testing reveals that he is HIV-positive. Chest X-ray reveals multiple calcified lymph nodes, fibrosis and hilar retraction. Initial sputum culture is unremarkable. What is the most likely diagnosis in this case? A. Bronchial carcinoma B. Sarcoidosis C. Silicosis D. Pulmonary tuberculosis E. Histoplasmosis"
D
"regarding unstable angina pectoris, which of the following statements is true? A. A normal ECG and normal serial troponins makes the diagnosis very unlikely B. The absence of cardiac risk factors excludes the disease C. Pain commonly radiates to the back D. It is treated with thrombolysis or percutaneous coronary intervention E. beta blockers have been shown to reduce mortality"
D
"A 17-year-old young woman is undertaking a summer placement at a nursery school before applying to study medicine. She has received a full programme of childhood vaccinations. Her main complaints are difficulty swallowing, sore throat, malaise and fever. On examination she has 5-10 grey ulcers on her buccal mucosa. There is also a vesicular rash affecting her hands and feet. What is the most likely cause of this clinical picture? A. Erythema multiforme B. Herpes simplex infection C. Gonorrhoea D. Pemphigus E. Coxsackievirus infection"
E
"A 19-year-old athlete was admitted to hospital after having been found wandering around in a confused state. His girlfriend is concerned that his behaviour has been very odd during the day. No illicit drugs are found on him. Clinically, he is disoriented and vague about his history but does admit to headaches. Histemperature is high at 38. 3°C. On review by the medical team, his level of consciousness deteriorated, his Glasgow Coma Score (GCS) being 11 out of 15. A CT scan of his head was normal. His CSF was clear, but the opening pressure was raised at 23 cmH2O. His CSF protein concentration was 0. 9 g/l and the glucose level was normal. The CSF showed 300 white cells, mainly lymphocytes. No organisms were seen on Gram stain. The results of CSF PCR is awaited. Which one of the following treatments would you start immediately? A. Intravenous benzylpenicillin B. Anti-tuberculous therapy C. Intravenous anti-fungal therapy D. Intravenous steroid therapy E. Intravenous aciclovir"
E
"A 19-year-old student visits you complaining of fevers and headaches over the past week or two. She has just started university after a world tour during her gap-year. There is also complaint of muscle ache, a sore throat, general malaise and of a general lack of appetite and vague abdominal pain. She remembers a short period of diarrhoea a couple of weeks ago. On examination there are a few faint maculopapular blanching lesions on the chest. What diagnosis fits best with this clinical picture? A. Malaria B. Tuberculosis C. Brucellosis D. Amoebic liver abscess E. Typhoid fever"
E
"A 26 year old woman, presents with a 7 month history of abdominal pain. Investigations reveal her to have Crohn's disease affecting a short segment of the terminal ileum. There is no evidence of disease elsewhere, and she remains systemically well. Of the following, which would be the most appropriate initial therapy? A. Oral olsalazine B. Local resection C. Oral azathioprine D. Oral cyclosporine E. Oral budesonide"
E
"A 32-year-old man from Uganda is referred to hospital with a high eosinophil count by his GP following routine blood tests. He is entirely asymptomatic and has no past medical history of note. Which of the following organisms is LEAST likely to be responsible? A. Strongyloides stercoralis B. Wuchereria bancrofti C. Schistosoma mansoni D. Schistosoma haematobium E. Entamoeba histolytica"
E
"A 33-year-old man has recently returned from a holiday in Pakistan. He is complaining of episodes of abdominal spasms followed by loose stools containing blood and mucus. Which one of the following pathogens is not likely to be causative of his disorder? A. Entaemoeba histolytica B. Shigella dysenteriae C. Salmonella typhi D. Campylobacter jejuni E. Schistosoma mansoni"
E
"A 46-year-old meat-factory worker is found to have Q fever pneumonia. Which of the following statements is correct? A. He requires high-dose penicillin for his treatment B. His occupation is not important for the diagnosis C. There is no long-term sequel of the disease D. The organism responsible is Coxiella pneumoniae E. The organism is usually inhaled from infected dust"
E
"A patient with tuberculosis was initially treated with streptomycin, which was later changed to a combination of isoniazid, rifampicin, pyrazinamide and ethambutol. Abnormal liver functions are noted on this, his follow-up, visit. Which drug is most likely to be responsible? A. Streptomycin B. Ethambutol C. Rifampicin D. Pyrazinamide E. Isoniazid"
E
"A72 year old woman, presents with 2 days of melaena on the background of a 2 month history of burning epigastric pain relieved by food. An upper endoscopy demonstrates a gastric ulcer in the prepyloric region. Urease test is positive, indicating the presence of H. pylori. She is treated with standard triple therapy for H. pylori infection, followed by omeprazole for a further 2 months, with good relief of her symptoms. She presents for follow up. Which of the following would represent the most appropriate management? A. Check H. pylori eradication with faecal culture B. Check H. pylori eradication with anti H. pylori antibody assay C. Check H. pylori eradication with urea breath test D. Continue omeprazole indefinitely E. repeat upper endoscopy"
E
"An HIV-positive patient attends clinic. He is on his first antiretroviral regimen, which includes stavudine, DDI and nevirapine. He is well but complains of wasting of his temporal areas and arms with an increase in the size of his abdomen. You do some screening tests, the results of which are shown below: U&E normal; LFT normal; glucose 7. 9 mmol/l; amylase 80 U/l; cholesterol 8. 8 mmol/l; TGs 12. 7 g/l; FBC normal; CD4 count 870 cells/mm3; HIV viral load < 50 copies/ml. Which advice is the most appropriate? A. Stop the antiretroviral therapy and start atorvastatin 40 mg B. Arrange a glucose tolerance test and start atorvastatin 40 mg C. Switch the stavudine to abacavir and start atorvastatin 40 mg D. Switch the nevirapine to nelfinavir and start pravastatin 10 mg E. Switch the stavudine to abacavir and start pravastatin 10 mg"
E
"An epidemic of diarrhoea and vomiting has broken out on the elderly care wards. Your catering suppliers assure you that their food is unlikely to be responsible as they follow the strictest hygiene procedures. A total of 15 patients on the ward have become unwell with a sudden onset of diarrhoea and vomiting. Patients infected earlier have recovered with rehydration therapy after about 48 h. Examination of faeces by electron microscopy has revealed circular virus particles with radiating spokes. Which virus is most likely to be responsible for this outbreak? A. Enteric adenovirus B. Small, round-structured virus C. Norwalk virus D. Astrovirus E. Rotavirus"
E
"Cholinesterase inhibitors have NOT been associated with which of the following potential adverse effects? A. Tachycardia B. Diarrhoea C. Muscle cramps D. Vivid dreams E. Pancreatitis"
E
"Haematemesis is NOT a feature of which of the following? A. Barrett's oesophagus B. Dieulafoy lesion C. Duodenal ulcer D. Gastrointestinal stromal tumour of the stomach E. Jejunal angiodysplasia"
E
"Which one of the following statements is true with regard to legionnaires' disease? A. legionella pneumophila is a Gram-positive rod B. The urinary antigen test for legionella species has low sensitivity and is not particularly specific C. The infection is generally confined to immunocompromised patients D. The beta-lactam group of drugs are now regarded as the drug of choice against legionella species E. Hyponatraemia occurs significantly more often in legionnaires' disease than in other pneumonias"
E
"A 10-year-old boy is complaining of pain in his right leg. He is pyrexial and a diagnosis of osteomyelitis has been made. Which of the following is the most likely pathogen? A. Streptococcus viridans B. Staphylococcus aureus C. Cornybacterium diphtheriae D. Neisseria meningitides E. Brucellosis"
B
"A 19-year-old student presented to his university GP complaining of a severe sore throat, headache and malaise. On examination there was a severe exudative pharyngitis with grossly enlarged inflamed tonsils. There was some evidence of cervical lymphadenopathy. He was diagnosed with a streptococcal infection and received a course of ampicillin. Unfortunately he re-presents to the GP with a maculopapular rash, still feeling unwell. blood testing reveals a relative lymphocytosis with atypical lymphocytes. What is the most likely cause of this clinical picture? A. Stevens-Johnson syndrome B. Epstein-Barr virus (EBV) C. Toxoplasmosis D. Cytomegalovirus E. Streptococcal pharyngitis"
B
"A 22-year-old farm worker is admitted to hospital with a 2-day history of headache, fever, severe myalgia and a petechial rash. He is known to suffer from mild asthma, which is well controlled by inhaled steroids. He is jaundiced, has a tachycardia and has not passed urine for over 14 hours. His urea level is raised and liver function tests indicate hepatocellular damage. What is the most likely diagnosis? A. Brucellosis B. Weil's disease C. Lyme disease D. Rat-bite fever E. septicaemic shock"
B
"A 23-year-old man presents to his GP complaining of fevers, headache, malaise and muscle pain. Shortly after his return to the UK last week from a walking trip in the United States, he says he used a cigarette to burn off a tick on his leg. On examination he has a rash on the palms and soles of his feet. What diagnosis fits best with this clinical picture? A. Infectious mononucleosis B. Rocky Mountain spotted fever C. reiter's syndrome D. Influenza E. Typhoid fever"
B
"A 25-year-old homosexual man complains of a 9-day history of mucopurulent anal discharge, anal bleeding and pain while opening his bowels. What is the most likely diagnosis? A. Candidiasis B. Gonorrhoea C. Crohn's disease D. Salmonella infection E. Chancroid"
B
"A 29-year-old homosexual man has been complaining of anal warts for the last 6 months. They have gradually increased in size and he has also noticed some fresh blood when opening his bowels. On examination there are grey lesions, approximately 5 mm in size, around his anus. What is the most likely cause for these lesions? A. Human papillomavirus B. Neisseria gonorrhoea C. Candida albicans D. Human immunodeficiency virus E. Chlamydia trachomatis"
B
"A 30-year-old man presents with an acute onset of pain and blurred vision of his right eye. On examination there is conjunctival injection and dendritic ulceration is seen on his cornea. Given the likely diagnosis, what is the most important treatment? A. Topical steroids B. Topical aciclovir C. Ampicillin ointment D. Topical nystatin E. Oral fluconazole"
B
"A 31-year-old man has just returned from a holiday to recuperate after the death of his partner. He has been suffering night sweats, a chronic cough and shortness of breath on exercise. Over the past 6 months he has lost a few kilograms in weight and suffered from intermittent diarrhoea. On auscultation the lung fields appear relatively clear. Laboratory testing reveals a relative lymphopenia, with the CD4 lymphocyte subfraction reduced at only 85/ mm3 (normal 200-800). There is desaturation on blood gas monitoring associated with exercise. Other blood tests reveal a raised lactate dehydrogenase level. Chest X-ray reveals diffuse pulmonary infiltrates. What diagnosis fits best with this clinical picture? A. Tuberculosis B. Pneumocystis jiroveci pneumonia C. Histoplasmosis D. Cryptococcosis E. Mycoplasma pneumonia"
B
"A 33-year-old homosexual patient who is HIV positive but in the stable phase of the disease is best monitored with which biomarker? A. C-reactive protein B. CD4 lymphocyte count C. Erythrocyte sedimentation rate D. Polymerase chain reaction E. blood cultures"
B
"A 34-year-old coronary care nurse accidentally stabs himself with a used needle from a patient infected with the hepatitis C virus. He attends the occupational health department and asks for advice. Which would be the most appropriate next step suggested by the occupational health doctor? A. Monthly hepatitis C antibody testing B. Monthly hepatitis C PCR testing C. 6 months' ribavirin therapy D. 6 months' lamivudine therapy E. 6 months of weekly interferon therapy"
B
"A 36-year-old woman presents complaining of a yellowish-green vaginal discharge that started 1 week ago. On examination her vagina is swollen and erythematous. What is the most likely diagnosis? A. Candidiasis B. Trichomoniasis C. AIDS D. Papillomavirus infection E. Lactobacilli infection"
B
"A 50 year old woman presents with painless rectal bleeding on defaecation. There is no family history of bowel cancer, no weight loss and no change in bowel habits. What is the recommended investigation? A. Haemoccult testing B. Colonoscopy C. Flexible sigmoidoscopy D. Proctoscopy and haemoccult test E. Small bowel series"
B
"A 65-year-old man with severe rheumatoid arthritis (RA) is admitted with a right pleural effusion. He has been complaining of dyspnoea on exertion for the last three months. He has never smoked and has not worked for over 20 years when he was diagnosed to be suffering from rheumatoid arthritis. Which of the following is true? A. Pleural effusions with rheumatoid arthritis occur in over 50% of patients B. A glucose level in pleural fluid of < 1. 6 mmol/l is characteristic of a rheumatoid pleural effusion C. Pleural effusions associated with RA have low levels of cholesterol D. The most appropriate treatment is chemical pleurodesis E. Bilateral pleural effusions do not occur in RA"
B
"A regarding analgesic doses of ketamine, which of the following statements is correct? A. It should be given carefully to asthmatics as it may worsen bronchospasm B. It is likely to cause nausea and vomiting C. It antagonises the effects of opiates D. It is unlikely to cause respiratory depression E. It may worsen neuropathic pain"
B
"A young homosexual man contacts his GP complaining of a short episode of lethargy, fever and swollen neck glands. HIV infection is diagnosed. Which is the most likely cell receptor through which the virus infects the body? A. CD13 B. CD4 C. CD8 D. CD2 E. CD28"
B
"Aminoglycosides (e. g. gentamycin) cause deafness by damaging which of the following? A. Basilar membrane B. vestibular nerve C. Cochlear hair cells D. Cochlear duct E. vestibular aqueduct"
B
"What is the significance of the finding of localised tenderness and guarding on abdominal examination? A. The patient's pain is severe B. There is an inflammatory process involving the parietal peritoneum C. There is intraperitoneal free fluid D. There is haemorrhage within a hollow viscus E. There is infarction of a hollow viscus"
B
"Which pulmonary function test may be altered to a similar degree in both restrictive lung disease and obstructive lung disease? A. residual volume B. Tidal volume C. Total lung capacity D. Forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio E. Forced expiratory volume in 1 second (FEV1)"
B
"regarding adult basic life support in cardiac arrest, which of the following is correct? A. The ratio of compressions to ventilations may be altered depending on the number of rescuers B. The recommended compression: ventilation ratio is 30:2 C. Five initial rescue breaths should be given D. A radial pulse should be checked before commencing chest compressions E. Cardiopulmonary resuscitation should not be commenced if there is abnormal or irregular breathing"
B
"A 22-year-old man has returned from a period travelling, during which he visited central/sub-Saharan Africa. He presents to the GP complaining of urinary frequency, perineal itching and inflammation and also of painless haematuria. What diagnosis fits best with this clinical picture? A. Infection with Schistosoma mansoni B. Infection with Schistosoma japonicum C. Infection with Schistosoma haematobium D. Syphilis E. Gonorrhoea"
C
"A 25-year-old homosexual man complains of a 9-day history of mucopurulent anal discharge, anal bleeding and pain while opening his bowels. What is the next step in the diagnosis? A. Colonoscopy B. Erythrocyte sedimentation rate C. Stained specimen microscopy D. Specimen culture E. C-reactive protein"
C
"A 32-year-old farmer's wife presents with fever and malaise, feeling generally 'washed-out' and off her food. She has recently been helping out with lambing on the farm. On examination there is generalised lymph node swelling and a palpable liver edge. Her white blood cell count is just below the normal range. What diagnosis fits best with this clinical picture? A. Tuberculosis B. Subacute bacterial endocarditis C. Brucellosis D. Amoebic liver abscess E. Mixed connective tissue disease"
C
"A 36-year-old woman presents complaining of a yellowish-green vaginal discharge that started 1 week ago. On examination her vagina is swollen and erythematous. Given the likely diagnosis, what is the most appropriate treatment? A. Ampicillin B. Nystatin C. metronidazole D. Fluconazole E. Erythromycin"
C
"A 45 year old man presents having had a large haematemesis and melaena. He had four forceful vomits containing old food and bile prior to the episode of haematemesis. What is the most likely cause of the haematemesis? A. Duoenal ulcer B. Gastric ulcer C. Mallory-Weiss tear D. Oesophageal varicies E. Aortic aneurysm"
C
"A 45-year-old business traveller noticed some moderate diarrhoea 3 days after he arrived inKorea. The diarrhoea lasted for 4 days. What is the most likely cause for his diarrhoea? A. Legionella B. Staphylococcus C. Enterotoxic Escherichia coli D. Giardia lamblia E. Entamoeba histolytica"
C
"A 48-year-old woman is admitted with a couple of days' history of fever with rigors and breathlessness. On examination she looks extremely unwell and is confused, cyanosed, has a respiratory rate of 36/min and a systolic blood pressure of 86 mmHg. There is dullnesson percussion and bronchial breathing at her right base. The chest radiograph reveals consolidation. Which of the following would be the most appropriate antibiotic regimen to use? A. Oral amoxicillin B. Oral amoxicillin and oral clarithromycin C. Intravenous cefotaxime and intravenous clarithromycin D. Intravenous ceftazidime and intravenous vancomycin E. Intravenous amoxicillin and intravenous clarithromycin"
C
"A 65-year-old man known to have COPD presented with progressive respiratory failure. He was treated in ITU with mechanical ventilation and improved. After extubation he was transferred to the ward. On the second day on the ward, his temperature spiked and he developed a productive cough with a yellow-greenish sputum. blood results showed leucocytosis. A chest X-ray revealed a right-sided middle and lower lobe pneumonia. What is the most probable cause of his pneumonia? A. Pneumococcal pneumonia B. Aspiration pneumonia C. Pseudomonas pneumonia D. Staphylococcal pneumonia E. Haemophilus pneumonia"
C
"A 67-year-old woman has been diagnosed as suffering from bronchiectasis on a high-resolution computed tomography (HRCT) scan of the lung. Which one of the following statements is NOT true? A. She is at risk of developing a pneumothorax B. She is at risk of developing a brain abscess C. Massive haemoptysis is the commonest cause of death in her age group D. recurrent chest infections are likely at her age E. Her immunoglobulin levels should be checked"
C
"A 74 year old man with advanced chronic obstructive pulmonary disease (COPD) presents to his family doctor with increasing exertional dyspnoea. This problem has slowly evolved over the previous 2-3 years. He is now having difficulty walking around the shopping centre and can no longer do the gardening. Investigations suggest his symptoms are due to progression of the COPD. Which of the following management strategies is NOT appropriate to consider in this patient? A. Inhaled corticosteroid and long acting bronchodilator therapy B. Domiciliary oxygen C. Lung transplantation D. Pulmonary rehabilitation program E. Immunisation against influenza"
C
