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