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Paper 1 Questions CUM1 2/15/05 4:33 PM Page 3 QUESTIONS 1 Paper 1 Questions MCQs [1] Concerning cardiac failure . (c) Dressler’s syndrome (a) valvular disease is the most common cause in the UK (d) electromechanical disociation (b) raised levels of atrial natriuretic peptide (ANP) are (e) left ventricular aneurysm thought to be beneficial in heart failure (c) a third heart sound is a common finding on [5] The following cardiac events are matched correctly ausculation to the corresponding ECG changes . .. (d) the heart looks small on plain postero-anterior (a) inferior infarct Æ ST-segment depression in leads chest radiograph II,III and aVF (e) all diuretics used in treatment of cardiac failure (b) pericarditis Æ downward-sloping ST-segment potentially cause hypokalaemia depression in all anterior chest leads (c) atrial fibrillation Æ irregularly irregular P-waves [2] Concerning hypertension . (d) first degree heart block Æ broad QRS complexes (a) approximately 50% of all cases of hypertension are (e) ventricular aneurysm Æ persistent ST-segment caused by renal dysfunction elevation in chest leads (b) patients with Conn’s syndrome usually have a raised [6] In peripheral arterial occlusive disease... serum potassium level (a) the relationship between radius of artery and flow (c) hypothyroidism does not cause hypertension within it is described by the Fick principle (d) the ‘Cushing reflex’is an increase in systolic blood (b) claudication means ‘cramping’in Latin pressure that occurs secondary to Cushing’s (c) Leriche syndrome is arterial occlusive disease below syndrome the popliteal trifurcation (e) malignant hypertension can be diagnosed on (d) ‘rest pain’commonly occurs in the feet and fundoscopy alone metatarsal heads (e) arterial ulcers are usually painless [3] Acute myocardial infarction . (a) causes chest pain not relieved by glyceryl trinitrate [7] Concerning aortic stenosis... (GTN) (a) all aortic valve murmurs are heard best with the (b) can be entirely painless in elderly diabetic patients patient on their left side with breath held in end- (c) should prompt administration of intramuscular expiration morphine to relieve pain (b) it causes hypertrophy of only the left ventricle (d) can be diagnosed on the history alone (c) it causes a ‘Waterhammer’character in the radial (e) first shows on ECG in the form of‘Q’waves pulse (d) it causes an ‘ejection systolic’murmur [4] The following are recognized complications of (e) it is a common cause of atrial fibrillation acute MI... (a) Sheehan’s syndrome [8] Concerning atrial fibrillation (AF)... (b) acute aortic regurgitation (a) it is commonly caused by dehydration 3 CUM1 2/15/05 4:33 PM Page 4 4 Paper 1 MCQs (b) when caused by high levels of circulating thyroid (e) it causes ‘bat’s wing’pulmonary oedema,upper lobe hormone,it is always accompanied by thyroid eye diversion and Kerley-B lines on chest radiograph signs (c) no P waves are present on the ECG [13] Concerning asthma... (d) the QRS complex is broad (a) airway limitation is uniformly reversible in asthma QUESTIONS 1 (e) class Ic antidysrhythmics (e.g.flecainide) are safe to (b) typical asthma attacks occur during exercise give to most patients with atrial tachyarrhythmias (c) ACE inhibitors should not be given to asthmatic subjects [9] Concerning the respiratory organs of the body . (d) symptoms of asthma are usually worse at night (a) the right main bronchus lies more vertically than (e) b2 adrenoceptor antagonists are commonly used in the left treatment of asthma (b) the lung is an organ with a single blood supply (i.e. the pulmonary artery) [14] Tuberculosis... (c) the alveolar lining of the lungs comprises mainly (a) is caused by the Gram-negative bacillus type I pneumocytes M. tuberculosis (d) only the right lung has an oblique fissure (b) is a recognized cause of apical lung fibrosis (e) in healthy subjects,the strongest stimulator of (c) is classically associated with the presence of ventilation is an increase in the arterial partial non-caseating granulomas pressure of CO2 (PaCO2) (d) is diagnosed using one test with two different names: Heaf and Mantoux [10] On examination of the chest of a patient with a (e) is a recognized cause of erythema nodosum unilateral tension pneumothorax . (a) chest wall movements are decreased on both sides [15] Concerning palpation of the abdomen . (b) the mediastinum is pulled towards the affected (a) in healthy,slim individuals,the liver is normally side palpable in the right upper quadrant in deep (c) the percussion note may be hyperresonant inspiration (d) breath sounds may be decreased or absent on the (b) the normal liver extends superiorly to the 3rd affected side intercostal space (e) tactile vocal resonance will be increased on the (c) hepatic enlargement usually proceeds toward the affected side left iliac fossa (d) in healthy,slim individuals,the spleen is normally [11] Concerning chronic obstructive pulmonary palpable on deep inspiration in the left disease (COPD)... hypochondrium (a) the airway obstruction is entirely irreversible (e) splenic enlargement occurs obliquely,toward the (b) chronic bronchitis is believed to be due mainly to right iliac fossa mucous gland hypertrophy (c) patients commonly demonstrate asterixis [16] The following are recognized gastrointestinal (d) ‘cor pulmonale’is defined as lung disease secondary causes of finger clubbing... to ventricular hypertrophy (a) fibrosis (e) it mainly leads to type II respiratory failure (b) coeliac disease (c) Plummer–Vinson syndrome [12] Concerning respiratory failure . (d) gastrointestinal lymphoma (a) PaCO2 is,by definition,elevated in all types of (e) cystic fibrosis respiratory failure (b) the commonest cause of type II respiratory failure is [17] The following are recognized medical causes of pneumonia abdominal pain... (c) pulsus paradoxus is a sign commonly associated (a) diabetic ketoacidosis with respiratory failure (b) myocardial infarction (d) it always presents with dyspnoea (c) Addison’s disease CUM1 2/15/05 4:33 PM Page 6 6 Paper 1 EMQs EMQs Question 1 (a) Mitral stenosis (b) Mitral regurgitation Match the following examination findings to the most QUESTIONS 1 (c) Aortic regurgitation accurate diagnosis: (d) Aortic sclerosis with atrial fibrillation (e) Aortic regurgitation with left ventricular failure (1) JVP Normal (f) Mitral stenosis with atrial fibrillation Apex ‘Tapping’in character,not (g) Mitral regurgitation and stenosis displaced laterally (h) Aortic stenosis Auscultation Grade 3 mid-diastolic murmur (i) Aortic sclerosis at apex,no pre-systolic (j) Mitral regurgitation with diastolic flow murmur accentuation (k) None of these Chest Clear BP 155/82 mmHg Question 2 (2) JVP Elevated Match the following case histories to the best diagnosis Apex Displaced laterally,and ‘thrust- given in the list below. ing’in character Auscultation Pan-systolic murmur at apex (1) A 47-year-old woman presents with a history of re- Chest Bi-basal end expiratory current headaches over 5 years. The pain is described as crepitations unilateral, behind the eye and severe. She is well between BP 143/65 mmHg episodes. There is no vomiting although she feels nau- seated and has abdominal discomfort. The onset is typi- (3) JVP Normal cally sudden. She occasionally has ‘hazy’ disturbance of Apex ‘Tapping’in character,not her vision. There are no abnormal features on systemic displaced review. In the past she has had hypertension, but is cur- Auscultation Grade 3 mid-diastolic murmur rently not taking treatment.She has three children.There at apex,pre-systolic are no regular medications. On examination she has a accentuation BMI of 29 and a BP recording of 170/95 mmHg. Other- Chest Clear wise a full neurological examination was normal,includ- BP 162/73 mmHg ing fundoscopy. (4) JVP 8 cm (2) A 15-year-old girl presents with a 5-week history of Apex Displaced,thrusting in character persistent headaches. These are described as ‘all over the Auscultation Short early diastolic murmur head’.There is associated episodic blurring of vision and Chest Few bi-basal crepitations dizziness. There is no history of head injury. These BP 180/62 mmHg headaches occur throughout the day. There have been several episodes of vomiting. In the past she has been fit (5) JVP Normal and well. Her mother and sister have both suffered Apex ‘Heaving’in character and episodes of migraine since childhood. She takes the oral displaced laterally contraceptive pill as her only medication. On examina- Auscultation Grade 3 crescendo-decrescendo tion she is obese and has a BMI of 32. She is normoten- systolic murmur over whole sive. Cranial nerve examination is normal. Fundoscopy precordium,not heard in reveals bilateral blurring of the optic disc margins. carotid area There are no abnormal findings in the peripheral nerv- Chest Few bi-basal crepitations ous system. BP 110/93 mmHg CUM1 2/15/05 4:33 PM Page 7 Paper 1 EMQs 7 QUESTIONS 1 (3) A 52-year-old patient attends complaining of (e) Giant cell arteritis episodic bouts of headache. He has no previous history (f) Space occupying lesion of headaches. The pain is described as burning and se- (g) Chronic subdural haematoma vere.The pain occurs behind the right eye, and is associ- (h) Epilepsy ated with lacrimation, and running of the nostril on the (i) Cavernous sinus thrombosis same side.Each episode lasts approximately 1 h and then (j) Viral meningitis subsides. In the past he has suffered from diabetes and (k) Benign intracranial hypertension angina. He smokes 20 cigarettes per day. His current (l) Cluster headache medication includes metfomin and GTN spray for occa- (m)Referred pain sional use. You happen to see him during an acute (n) Hypertensive encephalopathy episode. He has conjunctival injection on the side of the (o) Acute encephalitis pain. Cranial nerve examination and fundoscopy find- (p) None of these ings are normal.
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