1 F GIVEN a Patient Is Receiving a Total of 120Mg Morphine by Mouth for Cancer Pain Each
PROGRESS TEST JUNE 1998
GENERAL
1 F GIVEN A patient is receiving a total of 120mg morphine by mouth for cancer pain each
day. He becomes unable to swallow and you decide to prescribe subcutaneous
diamorphine
QUESTION The correct dose is 60mg daily
2F If a dying patient cannot swallow an intravenous infusion should be started
3T The daily requirement for fluid and electrolytes of an adult weighing 70Kg is 25003000mi
of water, 150mmol of sodium and 60mmol of potassium
4T GIVEN A locum general practitioner confirms the fact of death in a patient expected to die
of cancer. The locum has never seen the patient before
QUESTION The patient's usual general practitioner is permitted to issue a Death
Certificate without seeing the body
5F A Coroner's inquest will on:y be held if death occurred before the usual age of retirement
6T A standardised mortality ratio (SMR) can only be estimated if the age distribution of the
population is known
HEART, LUNGS AND BLOOD
717M Thiazide diuretics decrease renal HC03 excretion
8FM The "c" wave of the jugular venous pulse is due to opening of the tricuspid valve
9FM Staphylococcus aureus is frequently implicated in an acute exacerbation of chronic bronchitis
10FM Nicotinecontaining chewing gum is available on NHS prescriptions
11FM Cuses of a pleural effusion with a protein content of 50g11 include cardiac failure
12T GIVEN: A 26 year old man is known to have bronchial asthma. A peak flow measurement is taken, and is found to be less than 50% of the subject's usual peak flow measurement
QUESTION: Oral steroid therapy should be given
13FM Magnetic resonance imaging is of value in assessment of severity of pulmonary emphysema
14FM Prostacyclin (PG12) is synthesised in mast cells
15FM A paradoxical embolus is one which arises as a thrombus in the area of greatest flow in the aorta
16T Some of the muscles of the anterior abdominal wall are supplied by intercostal nerves
17T Haemosiderin consists of aggregates of ferritin molecules
18T The inferior vena cava lies to the right of the abdominal aorta
19T Macrophages are antigenpresenting cells
20T GIVEN The renal clearance of benzylpenicillin is greater than that of gentamicin QUESTION Benzylpenicillin has a shorter plasma concentration halftime than gentamicin
21F Atrial systole is responsible for 80% of the blood flow into the left ventricle of the heart
22F Plasmin is essential for normal thrombus retraction
23F In a normal subject, sitting upright, apical and basal regions of the lungs receive approximately equal blood flows
24T Neutrophil polymorphonuclear leucocytes are typically seen at the site of acute inflammation
25F GIVEN Cardiomegaly and pulmonary congestion are characteristic radiological features of cardiac failure
QUESTION These findings indicate that the patient has heart muscle disease (cardiomyopathy)
26F GIVEN A patient presents to the Accident and Emergency Department with a history of central crushing chest pain for a period of two hours
QUESTION A normal electrocardiogram excludes myocardial infarction
27T GIVEN The incidence of myocardial infarction increases in women following the menopause
QUESTION Hormone replacement therapy (HRT) can be regarded as a form of primary prevention for coronary artery disease
28F Dilated pupils are an important prognostic sign immediately after cardiac arrest
29T One dose of aspirin may prolong the bleeding time for some days
30T GIVEN A patient with pernicious anaemia will show red cell macrocytosis caused, indirectly, by a deficiency of intrinsic factor and consequent Vitamin B12 malabsorption
QUESTION Intrinsic factor and Vitamin B12 given together by mouth will correct the anaemia and macrocytosis
31T GIVEN Vitamin K is a fat soluble vitamin and is required for the manufacture of certain fully functional coagulation factors
QUESTION Obstructive jaundice potentially causes prolongation of prothrombin time which can be corrected by Vitamin K treatment
32T GIVEN A woman of 63 years reports to her general practitioner that she has been hoarse for 4 weeks
QUESTION She should be referred to hospital for investigations
33F GIVEN Histological verification of lung cancer is usually by bronchoscopy and biopsy QUESTION Bronchoscopy is poorly tolerated, and therefore contraindicated, in patients over 70 years of age
34T Benzodiazepines can be used to alleviate dyspnoea in terminally ill patients
35F GIVEN An adult with a known allergy to nuts suddenly has a rash and difficulty in breathing QUESTION It is appropriate to treat with 1 mg of adrenaline by rapid intravenous injection
36T For anything other than the treatment of a lifethreatening condition, a general anaesthetic should not be administered within six months of acute myocardial infarction
37F GIVEN Hypertension represents an increased perioperative risk. Before routine surgery, you are clerking a patient with known hypertension, for which he is receiving medication. You find that his blood pressure is 210/105mmHg
QUESTION His operation should be cancelled immediately
38F A patient who has had a coronary artery bypass graft should be advised to inform their dentist that they will require antibiotic cover for surgical procedures
39T In patients with asthma, a fall in the peak expiratory flow rate (PEFR) to 60% of their bi~st value is an indication for oral steroid therapy
40T Theophylline toxicity can be precipitated by erythromycin
41 F In an adult, acute breathlessness occurring at night is most commonly due to left ventricular failure
42T On testing for pitting oedema, indentation lasting more than 30 seconds is suggestive of hypoproteinaemia
43F Expiratory crackles are typically heard in fibrosing alveolitis
44T Atenolol is less likely than propranolol to produce unpleasant dreams
45F Vitamin B12 'Slikely to be necessary for the treatment of anaemia after pregnancy
46T Pleural biopsy is the best method o f diagnosing pleural tuberculosis
47F GIVEN An unconscious 60 year old man is brought into the Accident and Emergency Department
QUESTION A chest xray should be performed to exclude pneumothorax
48T GIVEN A patient with chronic obstructive airways disease suffers cardiac arrest QUESTION Oxygen should be prescribed at the highest possible delivery rate
49T Hyperventilation can compensate for mild metabolic acidosis
50F Patients travelling to malarious areas should not be given mefloquine
51F GIVEN The worldwide prevalence of tuberculosis is increasing, and resistance to antituberculous chemotherapy is increasing
QUESTION Quadruple therapy is advised for the initial therapy of tuberculosis, pending susceptibility testing results
52F Pyrexia of unknown origin is defined as a fever of 3M or more on two occasions over three days, with a negative blood culture
53F The murmur of aortic incompetence is low pitched and therefore best heard using the bell of the stethoscope
54F Abdominal aortic aneurysm often presents with symptoms of peripheral embolism
55F Sickle cell anaemia causes splenomegaly in adults
56T A pigmented skin lesion should be removed if depigmentation occurs
57F Haemophilus influenzae type A is the commonest cause of postinfluenzal pneumonia
58T The blood in glandular fever characteristically shows atypical lymphocytes
59F Infection with papilloma virus can be reliably detected on examination of a cervical smear
60T In a normal menstrual cycle the secretory phase of the cycle is of constant length
61 F Xlinked Duchenne muscular dystrophy presents as floppiness at birth
62F Karyotype 46XX is present in testicular feminisation
63F The UK National Breast Cancer Screening Programme is less likely to detect slowly growing tumours than rapidly growing tumours
64F Children with sickle cell disease are usually symptomatic in early infancy
65T GIVEN Iron within the heme molecule needs to be in the reduced form to bind oxygen QUESTION Haemoglobin containing ferric iron is ineffective in oxygen transport
NUTRITION, METABOLISM AND EXCRETION
66FM Type 1 hypersensitivity is classically seen in tuberculosis
67FM In untreated diabetes mellitus, urine is usually alkaline
68FM Dopamine receptors in the renal vasculature mediate vasoconstriction
69TM Glomerular filtration rate increases when renal afferent arterioles dilate
70FM Intercurrent infection typically precipitates hypoglycaemic episodes in a diabetic patient
71 FM Secondary hype rpa rathyroid ism is a cause of hypercalcaemia
72FM The absorption of a drug taken by mouth is most likely to be complete when the drug molecule is soluble in water
73TM Clostridium difficileassociated diarrhoea may be confirmed by detecting toxin in faeces
74FM A patient's urine output is a satisfactory guide to the apparent volume of distribution of a drug
75FM Gastric carcinoma is a frequent complication of chronic gastric ulcer
76FM The majority of dietary iron is absorbed
77TM Pain complicating cancer may be reduced by nonsteroidal antiinflammatory drugs
78TM Gold injections (sodium aurothiomalate) are potentially nephrotoxic when given to a patient with normal renal function ,
79TM In England and Wales the incidence of prostatic cancer is increasing
80FM In acute appendicitis in adults, vomiting usually precedes the onset of pain
81TM In a jaundiced patient, percutaneous transhepatic cholangiography should be delayed until a coagulation screen has been completed
82T The action of insulin is mediated by membrane receptors which function as tyrosine
kinases
83T Growth hormone increases blood glucose concentration
84F Triiodothyronine is formed mainly in plasma
85T The ability of the kidney to concentrate urine depends on the osmolality of renal medullary interstitial fluid
86F The initial action of the oral hypoglycaemic drug tolbutamide is to increase the synthesis of insulin
87T Vomiting in adults involves an increase in intraabdominal pressure
88F Glucocorticosteroids unmask latent diabetes mellitus because they inhibit the secretion of insulin
89F Pancreatic juice contains maltase
9OF Glomerular filtration rate (GFR) decreases when plasma protein concentration decreases
91F T lymphocytes are the source of lgM in the plasma
92F GIVEN Thyroxine is a cardiac stimulant
QUESTION Thyrotoxicosis does not cause cardiac failure
93T Core temperature can effect the response to defibrillation
94F Thyroid swellings often cause dysphagia for solids
95F GIVEN A patient present with clinically malignant lymph nodes in the neck
QUESTION The primary tumour is most probably in the head and neck region
96F A hard lump in the anterior triangle of the neck could be a cervical rib
97F Clinical features will usually distinguish between a benign and malignant tumour of the parotid
98T Salivary calculi are most common in the submandibular gland
99F Radioactive iodine therapy is contraindicated in young women as it may lead to infertility
100T Screening tests for Cushing=s syndrome may be abnormal in alcoholism
101F Hypoglycaemia is uncommon in well controlled diabetes mellitus
102F Obese patients with type 2 diabetes are ideally treated with a sulphonylurea in the first instance
103F The visual disturbance usually associated with a pituitary tumour is a homonymous
hemianopia
104T Patients with Cushings syndrome may complain of difficulty in climbing stairs
105T The insulin tolerance test can be used to diagnose cortisol deficiency
106T Osteoporosis is a consequence of hypogonadism in men
107F GIVEN A fit young person presents with a one week history of cough
QUESTION The presence of purulent sputum is an indication that antibiotics should be
prescribed
108T Bisphosphonate drugs are effective in correcting malignant hypercalcaemia
109T GIVEN Thiazide diuretics reduce urinary calcium excretion
QUESTION Thiazides can be used to prevent renal stones in men with hypercalciuria
11OF All type 11 diabetic patients taking oral hypoglycaemic agents and due to have an operation under general anaesthesia should be switched to soluble insulin preoperatively
111F Catheterisation of the bladder is a safe way to obtain urine samples for microbiology from elderly patients
112T Acute pyelonephritis may be treated with ciprofloxacin
113F Chlamydia trachomatis is sensitive to amoxycillin
1 14T Dentures are the most common predisposing factor to oral candidal infection
115F Recurrent aphthous ulceration usually indicates an underlying haematological problem
116F GIVEN A patient aged 30 years presents with diarrhoea of six weeks duration.
Hepatomegaly is found on examination
QUESTION Crohn=s disease is the most likely diagnosis
117F Carcinoma of the lower rectum is typically a squamous cell carcinoma
118F In the treatment of peptic ulceration, omeprazole is less effective than cimetidine in suppressing gastric acid production
119T Uterine prolapse is associated with urinary incontinence
120F GIVEN An unconscious elderly lady is brought into the Accident and Emergency
Department. The core body temperature is WC
QUESTION One litre of warm normal saline should be given intravenously over a period of
10 minutes
121 T Water fluoridation gives reductions in dental caries of the order of 50%
122F Mouth pigmentation is a frequent accompaniment of alcoholic liver disease
123F Features of paralytic ileus which help to distinguish it from mechanical intestinal obstruction include severe electrolyte depletion
124T Anal fissure is associated with Crohn=s disease
125F Digoxin is potentially nephrotoxic when given to a patient with normal renal function
126T The product of the normal p53 gene promotes apoptosis
127F Postparturn hypopituitarism is associated with thick coarse skin
128T Constipation is a common cause of abdominal pain in childhood
FAMILIES AND CHILDREN
129FM Congenital hypertrophic pyloric stenosis causes bile stained vomitus
130FM Karyotype 46XX is present in a patient with Turner's syndrome
131 FM Physiological jaundice in the newborn is associated with a positive Coombs test
132TM Duchenne's muscular dystrophy is inherited in an Xlinked recessive manner
133TM Emotional deprivation is a cause of short stature
134TM Polyhydramnios is associated with fetal renal agenesis
135FM AntiD antibody is present in plasma of Rh negative blood from infancy
136TM The incubation period of rotavirus infection is less than a week
1 37TM Acute osteomyelitis can present with a complaint of limb paralysis
138TM Haematemesis is an important toxic effect when ferrous gluconate is accidentally ingested by a child
139TM In England and Wales childhood accidental injury is commonest amongst children of social class V
140FM School refusal is more common in children from social classes 1 and 11
141 FM Puerperal breast infection is best treated by aspiration
142FM In labour normal uterine contractions increase placental blood flow
143TM Sodium cromoglycate is poorly absorbed after oral administration
144T Foveal function determines the level of visual acuity
145T Ageing causes reduction in pupil size
146F The sympathetic supply of the pupil is activated by pilocarpine eye drops