CHAPTER.1

Question 1. The following infections may be acquired by the following means
Tetanus-respiratory droplets or dust (False)
Explanation: Via wounds and abrasions
listeriosis-eating contaminated cheese (True)
Explanation: Can survive refrigeration
legionellosis-water aerosols (True)
schistosomiasis-via penetration of the skin (True)
leptospirosis-via rat urine (True)

Question 2. Diseases typically acquired from animals include
leptospirosis (True)
Explanation: From the urine of rats or dogs
Mycobacterium tuberculosis (False)
Explanation: Mycobacterium bovis
toxoplasmosis (True)
Explanation: From dog faeces
psittacosis (True)
Explanation: From birds
hepatitis A (False)
Explanation: Faecal-oral spread

Question 3. Live viruses are usually used for active immunisation against poliomyelitis (True)
Explanation: Inactivated vaccine also available
pertussis (False)
typhoid fever (False)
mumps, measles and rubella (True)
Explanation: Do not give to immunosuppressed patients
hepatitis B (False)

Question 4. Pyrexia of unknown origin is defined as a temperature of more than 37.5°C persisting for more than 2 weeks (True)
Explanation: Not elucidated by investigation in hospital
is due to infection in 75% of cases (False)
Explanation: In approximately 30% only
may be factitious (True)
Explanation: Suspect if ESR and CRP normal
can be caused by granulomatous hepatitis (True)
Explanation: And other forms of hepatitis
may be elucidated by bone marrow biopsy (True)
Explanation: May diagnose haematological malignancy

Question 5. The following statements about infectious mononucleosis are true
infection is usually attributable to the Epstein-Barr virus (EBV) (True)
presentation is with fever, headache and abdominal pain (True)
Explanation: And malaise and anorexia
sore throat suggests cytomegalovirus rather than EBV infection (False)
meningoencephalitis and pericarditis are recognised complications (True)
severe oropharyngeal swelling requires prednisolone therapy (True)
Explanation: Especially if there is dysphagia or breathing difficulty

Question 6. Typical features of toxoplasmosis include the following
infection is derived from cats, pigs and sheep (True)
Explanation: Immunocompromised patients are most at risk
peak age of onset is over 65 years of age (False)
Explanation: 25-35 years
congenital infection produces choroidoretinitis (True)
Explanation: And sometimes microcephaly
there is a positive heterophil antibody test (False)
Explanation: This is typically negative
pyrimethamine and sulfadiazine therapy is useful in immunocompromised patients (True)

Question 7. Recognised features of brucellosis include
a characteristically rapid response to penicillins (False)
Explanation: Typically doxycycline and streptomycin
fever, night sweats and back pain (True)
Explanation: And joint pains and anorexia
splenomegaly (True)
Explanation: But a non-specific finding
oligoarthritis and spondylitis (True)
Explanation: Due to localised granulomatous disease
thrombocytopenia (True)
Explanation: Due to hypersplenism

Question 8. The typical features of leptospirosis include
incubation period of 1-3 months (False)
Explanation: 7-14 days
exposure risk in abattoirs, farms and inland waterways (True)
fever, severe myalgia, headache and conjunctival suffusion (True)
Explanation: With abrupt onset
meningitis in Leptospira icterohaemorrhagiae rather than L. canicola infection (False)
Explanation: L. canicola infection is usually associated with aseptic meningitis
possible diagnosis by examination of the urine (True)
Explanation: Leptospires appear in the urine in the second week of illness

Question 9. The clinical features of Lyme disease include
infection with the tick-borne spirochaete Borrelia burgdorferi (True)
Explanation: Ixodes species of tick
an expanding erythematous rash (erythema chronicum migrans) (True)
Explanation: An annular red lesion
cranial nerve palsies (True)
Explanation: Or meningitis or radiculopathy
asymmetrical large joint recurrent oligoarthritis (True)
Explanation: Not in acute stages
response to tetracycline or penicillin therapy (True)
Explanation: And cephalosporins

Question 10. Features consistent with the diagnosis of Q fever include
exposure to sheep, cattle and unpasteurised milk (True)
Explanation: Especially butchers and abattoir workers
meningoencephalitis (True)
pneumonia in the absence of fever, headache or myalgia (False)
Explanation: Acute Q fever is an influenza-like illness
blood culture-negative endocarditis (True)
prompt clinical response to sulphonamide therapy (False)
Explanation: Responds to tetracyclines

Question 11. The typical features of erysipelas include
group A haemolytic streptococcal skin infection (True)
Explanation: Streptococcus pyogenes
absence of constitutional symptoms (False)
Explanation: Systemic upset is common
well-defined area of cutaneous erythema and oedema (True)
Explanation: The rash has a palpably raised edge
painless swelling (False)
Explanation: Typically painful
prompt response within 48 hours to benzylpenicillin (True)

Question 12. Clinical features of anthrax include
occupational exposure to animals and animal products (True)
Explanation: Farmers, butchers and dealers in wool, hides and bone meal
an incubation period of 1-3 weeks (False)
Explanation: 1-3 days
a painless cutaneous papule (True)
Explanation: Painless but itchy
gastroenteritis and bronchopneumonia (True)
multiple antibiotic resistance (False)
Explanation: The organism is widely sensitive

Question 13. The features of herpes simplex (HS) virus infections include
recurrent genital ulcers (True)
Explanation: Especially HS type 2
acute gingivostomatitis (True)
Explanation: HS type 1
encephalitis (True)
Explanation: HS type 1
shingles (False)
Explanation: Varicella zoster virus
paronychia (True)
Explanation: HS type 1-'herpetic whitlow'

Question 14. In a schoolchild with measles
infection is due to a paramyxovirus (True)
rhinorrhoea and conjunctivitis occur at the onset (True)
Explanation: The catarrhal phase
Koplik's spots appear at the same time as the skin rash (False)
Explanation: They precede the rash
the skin rash typically desquamates as it disappears (True)
infectivity is confined to the prodromal phase (False)
Explanation: Contact should be avoided for 7 days after the onset of the rash

Question 15. In patients with rubella infection
the RNA virus spreads by the faecal-oral route (False)
a prolonged fever is typical (False)
Explanation: Typically only on the first day of the rash
infectivity is present for 7 days before and after the rash (True)
sub-occipital lymphadenopathy is typical (True)
the risk of serious fetal damage is < 5% after the 16th week of pregnancy (True)
Explanation: Greatest risk is in the first 8 weeks

Question 16. The characteristic features of mumps include
infection with an RNA paramyxovirus by airborne spread (True)
high infectivity for 3 weeks after the onset of parotitis (False)
Explanation: Infectivity is generally low
presentation with an acute lymphocytic meningitis (True)
abdominal pain attributable to mesenteric adenitis (False)
Explanation: Pain suggests pancreatitis or oophoritis
orchitis which predominantly occurs prepubertally (False)
Explanation: It is usually unilateral and postpubertal

Question 17. The clinical features of amoebic dysentery include
an incubation period of 2-4 weeks (False)
Explanation: May develop many months after exposure
presentation with blood and mucus per rectum (True)
Explanation: Acute colitic symptoms often seen in the old
good response to metronidazole in intestinal disease (True)
characteristic appearances of the mucosa on sigmoidoscopy (True)
Explanation: Flask-shaped ulcers
antibodies detectable by immunofluorescence in only a small minority of patients (False)
Explanation: In 60-95%

Question 18. The following statements about the life cycle of plasmodia are true
sporozoites disappear from the blood within minutes of inoculation (True)
Explanation: Sporozoites enter the liver within 30 minutes
merozoites re-entering red blood cells undergo both sexual and asexual development (True)
all plasmodia multiply in the liver then subsequently in red blood cells (True)
Explanation: Duration of the pre-patent period varies
dormant hypnozoites remain within the liver cells in all species (False)
Explanation: Only P. vivax and P. ovale persist in this form
fertilisation of the gametocytes occurs in the human red blood cells (False)
Explanation: Fertilisation occurs in the mosquito

Question 19. Recognised clinical features of malaria include
absence of P. vivax infection in subjects lacking the Duffy blood group (True)
Explanation: West Africans and African Americans are protected
asymptomatic P. malariae parasitaemia persisting for years (True)
Explanation: With or without symptoms
enhanced risk of infection in splenectomised patients (True)
presentation with rigors, herpes simplex and haemolytic anaemia (True)
Explanation: Especially in P. vivax and P. ovale infection
excellent response to chloroquine (False)
Explanation: Widespread resistance-quinine preferred

Question 20. The features of typhoid fever include
faecal-oral spread of Salmonella typhi by food handlers (True)
Explanation: Usually asymptomatic carriers
presentation with constipation (True)
Explanation: But diarrhoea more common in children
onset with fever, headache and myalgia (True)
Explanation: And relative bradycardia
'rose spots' on the trunk and splenomegaly 7-10 days after onset (True)
development of carrier state in 50% of survivors (False)
Explanation: 5%

Question 21. The following are possible causes of fever and a rash in a traveller returning from the tropics
paratyphoid fever (True)
leptospirosis (True)
meningococcal infection (True)
secondary syphilis (True)
HIV seroconversion (True)

Question 22. In the diagnosis of the enteric fevers
blood cultures are usually positive 2 weeks after onset (False)
Explanation: Bacteraemia in the first week
stool cultures are usually positive within 7 days of onset (False)
Explanation: More likely in the second or third week
peripheral blood neutrophil leucocytosis is typically marked (False)
Explanation: Leucopenia is typical
the Widal reaction is typically positive within 7 days of onset (False)
Explanation: There are frequent false negatives
persistent fever despite antibiotics indicates resistant organisms (False)
Explanation: It may suggest a septicaemic focus

Question 23. Clinical features of dengue include
mosquito-borne infection with an incubation period of 2-7 days (True)
continuous or 'saddle-back' fever (True)
Explanation: Fever may remit on day 4-5 ('saddle-back')
rigors, headache, photophobia and backache (True)
Explanation: But non-specific
morbilliform rash and cervical lymphadenopathy (True)
Explanation: Rash starts peripherally
protection by vaccination every 10 years in endemic areas (False)
Explanation: No vaccine is available

Question 24. The typical features of African trypanosomiasis include
transmission of the parasite by the tsetse cattle fly (True)
an incubation period of 2-3 weeks (True)
Explanation: Occasionally longer in T. gambiense infections
onset with chancre-like skin lesion and local lymphadenopathy (True)
Explanation: At the site of the bite
generalised lymphadenopathy, hepatosplenomegaly and encephalitis (True)
good prognosis given prompt pentamidine or suramin therapy (True)
Explanation: Unless cerebral infection has developed

Question 25. Typical features of visceral leishmaniasis (kala-azar) include
spread of Leishmania donovani by sandflies from dogs and rodents (True)
Explanation: Also spread from infected blood transfusions
an incubation period of 1-2 weeks (False)
Explanation: 1 month to 10 years
rigors with hepatomegaly but no splenomegaly (False)
Explanation: Splenomegaly is characteristic
diagnosis confirmed on peripheral blood film (False)
Explanation: Diagnosis by examination of stained smears of bone marrow, spleen or liver
clinical response to pentavalent antimonials, e.g. stibogluconate (True)
Explanation: Amphotericin B is an alternative

Question 26. In diphtheria
heart block is a recognised complication (True)
Explanation: Although cardiac involvement usually causes no long-term problems
high fever is a typical early sign (False)
Explanation: Fever rarely dominant-insidious onset
isolation is usually unnecessary (False)
Explanation: Isolation is vital
paralysis of the soft palate, accommodation or ocular muscles may occur (True)
Explanation: Occasionally with peripheral polyneuritis
treatment is with antibiotics alone (False)
Explanation: Diphtheria antitoxin is also important

Question 27. The typical features of strongyloidiasis include
skin penetration with migration to the gut via the lungs (True)
Explanation: Producing an itchy rash
larval penetration of the duodenal and jejunal mucosa (True)
Explanation: With pain, diarrhoea, steatorrhoea and weight loss
abdominal pain, diarrhoea and malabsorption (True)
penetration of perianal skin producing a migrating linear weal (True)
Explanation: Intensely itchy
systemic spread in the immunosuppressed, resulting in pneumonia (True)
Explanation: Seen in HIV infection

Question 28. In infestation with the nematode Enterobius vermicularis
adult threadworms occur in great numbers in the small bowel (False)
Explanation: Seen in the colon
presentation with intense pruritus ani is typical (True)
Explanation: Worms may be visible
identifiable ova are found on the perianal skin (True)
malabsorption usually develops following heavy infestations (False)
Explanation: The small bowel is unaffected
all family members should take piperazine or mebendazole therapy (True)
Explanation: Cross-infection and autoinfection are common

Question 29. In onchocerciasis
larval infection is transmitted by the Simulium fly (True)
Explanation: A painful bite
worms mature over 2-4 weeks and persist for up to 1 year (False)
Explanation: Worms can live for over 15 years
cutaneous nodules and eosinophilia commonly develop (True)
Explanation: The nodules contain adult worms
conjunctivitis, iritis and keratitis are characteristic (True)
ivermectin is the drug therapy of choice (True)

Question 30. In schistosomal infection
painless haematuria may be the presentation (True)
Explanation: Due to bladder mucosal involvement
diagnosis can be made by finding cercariae in the urine and/or stool (False)
Explanation: Eggs are passed in urine and/or stool
the helminths mature in the portal vein (True)
peripheral neuropathy commonly causes lower limb weakness (False)
Explanation: But transverse myelitis may
praziquantel is the therapy of choice (True)
Explanation: Or oxamniquine or metrifonate

Question 31. Echinococcus granulosus infestation is usually associated with
contact with sheep, cattle and dogs (True)
Explanation: May be many years before clinical manifestations appear
acquisition of hydatid cysts in childhood (True)
Explanation: Usually an asymptomatic event
cysts in the liver, brain and lungs (True)
Explanation: Right lobe of the liver is the commonest site
absence of dissemination during liver aspiration (False)
Explanation: Care must also be taken during excision
prompt response to albendazole therapy if surgically inoperable (False)
Explanation: But further enlargement may be prevented

Question 32. Typical features of cutaneous leishmaniasis include
nasal and oral mucosal ulcers (True)
Explanation: Secondary to initial cutaneous ulceration
painful ulcers in the groins or axillae (False)
Explanation: Typically painless and not involving nodes
marked splenomegaly and lymphadenopathy (False)
Explanation: These occur in visceral leishmaniasis
ulcers which heal without scarring (False)
negative leishmanin skin test (False)
Explanation: Typically positive except in diffuse cutaneous leishmaniasis

Question 33. Characteristic features of leprosy include
an incubation period of 2-12 years (True)
growth of the organism on Löwenstein-Jensen medium after 2-3 months (False)
Explanation: The organism cannot be grown in artificial media
spread of the tuberculoid form by prolonged patient contact (False)
Explanation: There is no risk of infection in tuberculoid leprosy
thickened palpable peripheral nerves (True)
a cell-mediated immune response in the lepromatous form (False)
Explanation: Characteristic of the tuberculoid form

Question 34. Typical features of lepromatous leprosy include
early and marked sensory loss (False)
Explanation: Late and limited
unlike the tuberculoid form, organisms are scanty in number (False)
Explanation: Is a multibacillary disease
blood-borne spread from the dermis throughout the body (True)
Explanation: No cell-mediated immune response
strongly positive lepromin skin test (False)
Explanation: Suggests tuberculoid disease
anaesthetic hypopigmented skin macules and plaques (False)
Explanation: Macules occur, but sensation is retained

Question 35. The following are likely causes of splenomegaly in a patient with fever returning from the tropics
tuberculosis (False)
trypanosomiasis (True)
brucellosis (True)
visceral leishmaniasis (True)
infective endocarditis (True)

Question 36. The following statements about syphilis are true
infection is usually caused by Treponema pertenue (False)
Explanation: Due to infection with Treponema pallidum
cardiac murmurs are a typical early feature of infection (False)
Explanation: A feature of late disease
the primary lesion at the site of infection is initially macular (True)
Explanation: But becomes papular, then chancrous
the incubation period for primary syphilis is typically 2-4 weeks (True)
Explanation: But may be up to 90 days
tertiary syphilis usually develops within 1 year of infection (False)
Explanation: Takes at least 2 years to develop

Question 37. Characteristic features of late (tertiary and quaternary) syphilis include
negative specific treponemal antigen tests (False)
Explanation: The tests are typically positive
destructive granulomas (gummas) in bones, joints and the liver (True)
sensory ataxia (True)
Explanation: Due to dorsal column spinal disease
aneurysms of the ascending aorta (True)
Explanation: Typically with calcification
poor response of gummas to antibiotic therapy (False)

Question 38. The typical clinical features of gonorrhoea include
an incubation period of 2-3 weeks (False)
Explanation: 2-10 days
anterior urethritis and cervicitis (True)
Explanation: Dysuria, discharge or no symptoms
right hypochondrial pain due to perihepatitis (True)
pharyngitis (True)
good response to ciprofloxacin therapy in penicillin allergy (True)
Explanation: Or spectinomycin

Question 39. Anogenital herpes simplex is typically associated with
type 2 herpes simplex infection only (False)
Explanation: Type 2 and type 1 equally
primary attacks more severe and prolonged than recurrent attacks (True)
Explanation: Healing is more rapid in recurrent attacks
fever with painful genital ulceration and lymphadenopathy (True)
sacral dermatomal pain and urinary retention (True)
absence of clinical response to oral aciclovir (False)
Explanation: Shortens first attacks and may prevent recurrence

Question 40. HIV infection is associated with
an RNA retrovirus (True)
heterosexual transmission in the majority of cases world-wide (True)
Explanation: Superseding homosexual and parenteral
involvement of CD4 lymphocytes (True)
a viral half-life of 1-2 hours in plasma (True)
a better prognosis in the presence of Kaposi's sarcoma (False)
Explanation: Prognosis is worse with Kaposi's sarcoma

Question 41. In HIV infection
80% of vertically transmitted infections are transplacental (False)
Explanation: Majority occur during parturition
a child born to an infected mother has a 90% chance of acquiring HIV (False)
Explanation: Under 50% chance
transmission can occur via breast milk (True)
Explanation: 10-20% additional risk for breast-fed babies
risk of fetal transmission is unaffected by pre-partum antiviral agents (False)
Explanation: HAART can reduce transmission rate
transmission risk after exposure to infected blood or blood products is over 90% (True)

Question 42. In the diagnosis of HIV infection
ELISA testing has a low false negative rate (True)
Explanation: ELISA testing therefore widely used as a screening test
seroconversion invariably occurs in under 4 weeks (False)
Explanation: 6-12 weeks or longer
antibody detection tests are particularly helpful in neonates (False)
Explanation: May have transplacentally acquired maternal antibody
HIV-RNA can be directly measured as a confirmatory test (True)
Explanation: Sometimes used as a confirmatory test
HIV-RNA is typically detected before anti-HIV antibodies (True)

Question 43. In the classification of HIV infection
group A = acute seroconversion simulating glandular fever (True)
Explanation: Also includes asymptomatic patients
group B = persistent generalised lymphadenopathy (False)
Explanation: Classed as group A infection
group C = constitutional symptoms and oral candidiasis (False)
Explanation: Group C includes conditions meeting CDC/WHO case definition
group A1/B1/C1 all have absolute CD4 count > 500/mm3 (True)
group B = asymptomatic infection (False)
Explanation: Group A are asymptomatic

Question 44. Presenting features of HIV infection include
hairy leucoplakia (True)
Explanation: Affects the tongue and mouth
atypical pneumonia (True)
Explanation: Especially Pneumocystis carinii
thrombocytopenic purpura (True)
pulmonary tuberculosis (True)
Explanation: Sometimes with atypical mycobacteria
candidiasis and cryptosporidiosis (True)

Question 45. Cryptosporidiosis in an HIV-positive patient is
an AIDS-defining diagnosis if chronic (True)
likely to present with painless profuse diarrhoea (False)
Explanation: Profuse diarrhoea, but usually with abdominal pain
likely to be self-limiting if the CD4 count is > 200 cells/mm3 (True)
preventable by the use of boiled tap water (True)
usually diagnosed on stool microscopy (True)

Question 46. Pneumocystis carinii infection in an HIV-positive patient is
the commonest cause of respiratory infection in African patients (False)
Explanation: Tuberculosis is more common
characterised by copious sputum production (False)
Explanation: Dry cough and dyspnoea
characterised by widespread fine pulmonary crackles (False)
Explanation: Crackles would be unusual
more likely to occur when the CD4 count is < 200/mm3 (True)
Explanation: In 95% of cases
excluded by the finding of a normal chest X-ray (False)
Explanation: Normal chest radiograph is found in 15-20% of cases

Question 47. In a patient with AIDS, cryptococcal meningitis is
the commonest cause of meningitis (True)
Explanation: Also causes pulmonary disease
characterised by abrupt onset of the classical features of a bacterial meningitis (False)
Explanation: Indolent onset
diagnosed by India ink stain of cerebrospinal fluid (CSF) (True)
Explanation: And serum/CSF culture
typically associated with negative CSF culture (False)
associated with deafness in survivors (True)
Explanation: And blindness

Question 48. In the treatment of HIV infection
all useful drugs work via inhibition of reverse transcriptase (False)
Explanation: Some are protease inhibitors
nucleoside reverse transcriptase inhibitors may cause peripheral neuropathy (True)
reverse transcriptase inhibitors prevent spread of infectious virus into uninfected cells (True)
Explanation: But not replication
drug-resistant strains of virus have not been recognised (False)
Explanation: As with zidovudine
monotherapy is preferred (False)
Explanation: Survival rates improve with combination regimens

Question 49. Antimicrobial therapy acts in the following ways
aminoglycosides disrupt bacterial protein synthesis (True)
Explanation: Via ribosomal binding
sulphonamides interrupt bacterial folate synthesis (True)
Explanation: And hence nucleic acid synthesis
penicillins disrupt bacterial protein synthesis (False)
Explanation: Affect cell wall synthesis
cephalosporins disrupt bacterial cell wall synthesis (True)
Explanation: As with penicillins
tetracyclines disrupt bacterial protein synthesis (True)
Explanation: Via ribosomal binding

Question 50. The following statements about penicillins are true
all penicillins are bactericidal (True)
Explanation: By interfering with their cell wall synthesis
like the cephalosporins, they contain a ß-lactam ring (True)
Explanation: Resistance by ß-lactamase-producing organisms is common
clavulanic acid inhibits bacterial ß-lactamase (True)
Explanation: Used in combination with amoxicillin as co-amoxiclav
they are all safe in pregnancy (False)
Explanation: Imipenem is not
they are synergistic with aminoglycosides (True)

Question 51. Erythromycin is active against the following microorganisms
Campylobacter jejuni (True)
Escherichia coli (False)
Explanation: Hence less likely to disrupt bowel flora
Legionella pneumophila (True)
Mycoplasma pneumoniae (True)
Explanation: In appropriate dosage
Clostridium welchii (True)

Question 52. Aminoglycoside drug therapy
is ototoxic and nephrotoxic (True)
Explanation: Especially in the elderly
is well absorbed orally (False)
Explanation: Negligible oral absorption
must be monitored using plasma drug concentrations (True)
Explanation: Serum levels and duration of therapy correlate with risk of toxicity
is effective against anaerobes and Streptococcus faecalis (False)
Explanation: No anti-anaerobic activity
is very effective against Gram-negative organisms (True)

Question 53. Ciprofloxacin is highly active against the following microorganisms
Escherichia coli (True)
Haemophilus influenzae (True)
Proteus mirabilis (True)
Explanation: Active against most of the enterobacteria
Streptococcus pneumoniae (False)
Explanation: Only moderate activity
Bacteroides fragilis (False)

Question 54. The following antiviral agents are active against the following viruses
ganciclovir-cytomegalovirus (True)
amantadine-orthomyxovirus (True)
Explanation: Used in prophylaxis of influenza A
ribavirin-respiratory syncytial virus (True)
Explanation: Also active in Lassa fever
zidovudine-retrovirus (True)
Explanation: Used in AIDS
famciclovir-herpes simplex and herpes zoster viruses (True)
Explanation: Like aciclovir, useful orally or parenterally


 CHAPTER - 2

Question 1. 200 patients with hypertension are treated with a new drug to prevent strokes and compared with 200 similar patients who are given a placebo in a randomised controlled clinical trial (RCT). After 1 year of treatment 5 patients in the treatment group and 10 patients in the control group have suffered a stroke. Which of the following statements are true?
the absolute risk reduction with treatment is 5% (False)
Explanation: 2.5%
the relative risk is 0.5 (True)
Explanation: 50% relative risk reduction
the number needed to treat is 200 (False)
Explanation: 40
all patients with hypertension will benefit from this treatment (False)
Explanation: Only patients similar to those in the trial
benefit can be expected to be similar in following years of treatment (False)
Explanation: Can only be derived from continuing the RCT

Question 2. Examples of pharmacokinetic interactions include the following
allopurinol inhibits the metabolism of azathioprine (True)
Explanation: And 6-mercaptopurine; both are metabolised by xanthine oxidase
metoclopramide delays gastric emptying and the rate of drug absorption (False)
Explanation: It increases the rate of gastric emptying
digoxin and verapamil compete for renal tubular secretion (True)
Explanation: Similarly, quinidine and amiodarone compete with digoxin for renal excretion
the effect of methotrexate is inhibited by NSAID therapy (False)
Explanation: Increased effect due to inhibition of renal tubular secretion of methotrexate
renal lithium excretion is inhibited by diuretics (True)
Explanation: Recommend a barrier method as well for patients on the contraceptive pill and taking antibiotics

Question 3. The following drugs should be avoided in severe renal failure
gentamicin (False)
Explanation: But reduce dose frequency and measure plasma concentrations daily
oxytetracycline (True)
Explanation: Induces protein catabolism and rapidly increasing uraemia
morphine (False)
Explanation: But reduce both dose and dose frequency
mesalazine (True)
Explanation: Like all NSAIDs, reduces renal blood flow by prostaglandin inhibition
metformin (True)
Explanation: Causes lactic acidosis

Question 4. The following drugs exhibit high rates of hepatic clearance
codeine phosphate (False)
Explanation: Similar to paracetamol in this respect
diazepam (False)
Explanation: Low rates of clearance during its first passage through the liver
simvastatin (True)
Explanation: Lidocaine (lignocaine) is also rapidly cleared during its first passage through the liver ('first-pass' effect)
propranolol (True)
warfarin (False)

Question 5. The actions of the following drugs are enhanced in liver disease
warfarin (True)
Explanation: Reduces the synthesis of clotting factors
metformin (True)
Explanation: Produces lactic acidosis
chloramphenicol (True)
Explanation: Induces bone marrow suppression
sulphonylureas (True)
Explanation: Increase the risk of hypoglycaemia
naproxen (True)
Explanation: Like other NSAIDs, increases the risk of gastrointestinal bleeding

Question 6. The following statements about drug prescribing in elderly patients are true
the error rate in patients taking prescribed drugs is similar to that found in younger adults (False)
Explanation: Error rates of up to 60% can be found in patients over the age of 60 years
adverse drug reactions are more likely to occur than in younger adults (True)
Explanation: Adverse drug reactions are 2-3 times more common
an increased proportion of body fat increases the accumulation of lipid-soluble drugs (True)
Explanation: Propranolol accumulation is also increased by reduced drug metabolism
drug excretion is typically increased due to impaired urinary concentrating ability (False)
Explanation: Impaired renal clearance associated with a reduced glomerular filtration rate is common
metabolism of paracetamol reduces with advancing age (True)
Explanation: As with other drugs (e.g. theophylline and sedative drugs) doses should be reduced

Question 7. The following are statutory requirements for the prescription of controlled drugs
prescriptions must be typewritten not written by hand (False)
Explanation: Prescriptions must be written entirely in the prescriber's own handwriting, in ink
prescriptions must specify the patient's name and address (True)
prescriptions must specify the prescriber's name and address (True)
prescriptions must state the dosage in both words and numbers (True)
Explanation: Including the total quantity, number of doses, and form and strength of the drug
prescriptions must be signed and dated by the prescriber (True)


 CHAPTER - 3

Question 1. The use of oral activated charcoal is indicated following poisoning with
paracetamol (True)
Explanation: More effective if given early
acetylsalicylic acid (True)
Explanation: More effective if given early and repeated 4-hourly ('gut dialysis')
ferrous sulphate (False)
Explanation: Not absorbed by activated charcoal
ethylene glycol (False)
Explanation: Not absorbed by activated charcoal
lithium carbonate (False)
Explanation: Not absorbed by activated charcoal

Question 2. Typical features 6-8 hours after paracetamol poisoning include
nausea and vomiting (True)
Explanation: Abdominal pain may develop
coma and internuclear ophthalmoplegia (False)
Explanation: Late features suggesting hepatic encephalopathy (after 3-5 days)
prolongation of the prothrombin time (False)
Explanation: Rare before 24 hours
metabolic acidosis and hypoglycaemia (False)
Explanation: Consequence of hepatic necrosis (after 36 hours)
prevention of liver damage with N-acetylcysteine therapy (True)
Explanation: But not useful beyond 15 hours

Question 3. Features of salicylate poisoning in an adult may include
metabolic acidosis (True)
Explanation: A poor prognostic sign
deafness, tinnitus and blurred vision (True)
Explanation: Common features
hypokalaemia and respiratory alkalosis (True)
Explanation: Due to hyperventilation
hyperventilation, sweating and restlessness (True)
peripheral vasodilatation (True)

Question 4. The following treatments are clinically useful in poisoning with the following agents
glucagons-ß-blockers (True)
DMPS (dimercaprol)-heavy metal poisons (True)
Explanation: Useful in arsenic, gold and mercury poisoning
flumazenil-opioid analgesics (False)
Explanation: Used in benzodiazepine overdose
N-acetylcysteine-paracetamol (True)
Explanation: As indicated by plasma paracetamol concentrations post-ingestion
desferrioxamine-iron salts (True)

Question 5. Typical features following benzodiazepine poisoning include
ataxia, dysarthria, nystagmus and drowsiness (True)
severe systemic hypotension and respiratory depression (False)
Explanation: Severe cardiorespiratory depression is rare
nausea, vomiting and diarrhoea (False)
Explanation: Suspect mixed overdose
convulsions, muscle spasms and papilloedema (False)
Explanation: Suspect alternative or mixed overdose
resolution of symptoms and signs within < 6 hours of poisoning (False)
Explanation: Usually < 24 hours

Question 6. The following are true of cocaine poisoning
hypothermia is a typical feature (False)
Explanation: Hyperthermia or pyrexia
cerebellar signs may occur (True)
Explanation: As may convulsions
myocardial infarction occurs only in the presence of abnormal coronary arteries (False)
Explanation: They may be normal
activated charcoal is of benefit within 1 hour of ingestion (True)
a dose of over 10 mg would usually be regarded as potentially fatal (False)
Explanation: Over 1 g

Question 7. Typical features of morphine poisoning include
nausea, vomiting and pallor (True)
coma with widely dilated pupils (False)
Explanation: Pinpoint pupils
hypoventilation and respiratory arrest (True)
hypotension and hypothermia (True)
Explanation: Use naloxone
non-cardiac pulmonary oedema (True)
Explanation: Characteristic and the commonest mode of death

Question 8. Typical features of carbon monoxide poisoning include
nausea, vomiting (False)
Explanation: Common features include agitation, headache and confusion
marked central cyanosis (False)
Explanation: Usually skin pallor; patients may appear 'pink' due to carboxyhaemoglobin
hypotension and myocardial ischaemia (True)
Explanation: Especially in patients whose coma is prolonged
cognitive impairment and personality changes following recovery (True)
Explanation: Due to the effects of cerebral oedema and cerebral anoxia
parkinsonian features following recovery (True)
Explanation: Neuropsychiatric sequelae occur in 10% 2-4 weeks following recovery


CHAPTER - 4

Question 1. The following statements about pulmonary artery wedge pressure (PAWP) monitoring are correct
PAWP provides an indirect measure of left atrial pressure (True)
the normal range is 15-20 mmHg (False)
Explanation: 6-12 mmHg
the PAWP is reduced in acute left ventricular failure (False)
Explanation: Increased, often > 35 mmHg
complications of monitoring include pulmonary artery rupture (True)
Explanation: Also pneumothorax, air embolism, sepsis and arrhythmias
the optimum PAWP in acute circulatory failure is 12-15 mmHg (True)

Question 2. The following statements about monitoring of pulmonary function are correct
oxygen saturation (SaO2) should be maintained in the range 75-85% (False)
Explanation: Maintain > 90%
the oxygenation index (PaO2/FIO2) is a useful measure of gas exchange (True)
Explanation: As is alveolar arterial oxygen gradient
end-tidal alveolar CO2 concentration measures the effectiveness of ventilation (True)
Explanation: As does PaCO2
measurement of oxygen saturation requires arterial blood sampling (False)
Explanation: Finger or earlobe spectrophotometry is satisfactory in most instances
a decreasing cardiac output is likely to induce an abrupt fall in SaO2 (True)

Question 3. The following statements about oxygen transport in the blood are correct
the amount of oxygen carried by haemoglobin is equal to that dissolved in the plasma (False)
Explanation: Hb carriage accounts for the majority
an increase in PaCO2 shifts the oxygen/haemoglobin dissociation curve to the right (True)
Explanation: Bohr effect-facilitates unloading of O2 to tissues
the optimum haemoglobin concentration in a critically ill adult male is 15 g/dl (False)
Explanation: 7-10 g/dl to minimise hyperviscosity problems
at a PaO2 = 3.5 kPa, approximately 10% of the haemoglobin will be saturated (False)
Explanation: Around 50%
increasing the haemoglobin concentration of the blood will increase its oxygen content but not its partial pressure of oxygen (True)
Explanation: Hb concentration and saturation are major determinants of O2 content

Question 4. The following statements about oxygen consumption are correct
VO2 (global oxygen consumption) can be calculated from the PaO2 and the PaCO2 (False)
Explanation: Calculated from inspiratory/expiratory gas analysis
mixed venous oxygen saturation (SvO2) is the pulmonary arterial oxygen saturation (True)
Explanation: Equates to DO2 (oxygen delivery) - VO2 (global oxygen consumption)
SvO2 reflects the amount of oxygen not consumed by the tissues (True)
oxygen saturation of venous blood from differing tissues is identical (False)
Explanation: Varies depending on metabolic rate
VO2 rises 10-15% for every 1°C rise in body temperature (True)
Explanation: Sepsis and trauma also increase VO2

Question 5. Diagnostic criteria for the systemic inflammatory response syndrome (SIRS) include
temperature > 38°C or < 36°C (True)
Explanation: Sepsis may cause hypothermia as well as fever
respiratory rate > 30/min (False)
Explanation: > 20/min
heart rate > 90/min (True)
white cell count > 12 000 or < 4000/mm2 (True)
PaCO2 < 4.3 kPa (True)

Question 6. The following statements about shock syndromes are correct
in severe hypovolaemia, a source of blood/fluid loss is invariably apparent clinically (False)
Explanation: Bleeding may be internal
in cardiogenic shock, the peripheries are characteristically warm (False)
Explanation: Peripheral cyanosis is characteristic
massive pulmonary embolism typically presents with shock (True)
Explanation: Due to central vessel obstruction
anaphylactic shock is associated with profound allergen-induced systemic vasoconstriction (False)
Explanation: Vasodilatation occurs
arteriovenous shunting is a significant contributory factor in septic shock (True)
Explanation: Capillary damage and vasodilatation also occur

Question 7. Acute circulatory failure with an elevated central venous pressure are typical findings in
acute pancreatitis (False)
Explanation: Hypovolaemic shock occurs
massive pulmonary embolism (True)
Explanation: Acute right ventricular failure
ruptured ectopic pregnancy (False)
acute right ventricular infarction (True)
pericardial tamponade (True)

Question 8. The acute respiratory distress syndrome (ARDS) is characterised by
maintenance of a normal PaO2 despite profound dyspnoea (False)
Explanation: Hypoxaemia is a cardinal feature
increased pulmonary compliance (False)
Explanation: Compliance decreases
a normal chest radiograph (False)
Explanation: Diffuse infiltrates are typical
greatly elevated pulmonary artery wedge pressure (False)
Explanation: Typically normal or slightly elevated
elevated right heart pressure (True)
Explanation: Pulmonary hypertension is common

Question 9. The expected effects of the following vasoactive drugs include
nitroprusside-reduction in systemic vascular resistance (True)
Explanation: Blood pressure typically falls
epoprostenol (prostacyclin)-increased pulmonary vascular resistance (False)
Explanation: Reduces PVR
isoprenaline-sinus tachycardia (True)
Explanation: And moderate increase in myocardial contractility
dopamine-sinus bradycardia (False)
Explanation: Usually tachycardia
adrenaline (epinephrine)-increased splanchnic blood flow (False)
Explanation: Typically declines

Question 10. The following statements about mechanical respiratory support are correct
cardiac output increases with positive end-expiratory pressure (PEEP) (False)
Explanation: Cardiac output often falls
PEEP helps correct V/Q mismatch (True)
Explanation: Improves oxygenation in atelectatic areas
continuous positive airways pressure (CPAP) requires intubation (False)
Explanation: A tightly fitting face or nasal mask can be used
the correct position of an endotracheal tube is 4 cm above the carina (True)
intermittent ventilation is useful in the transition to non-assisted ventilation (True)

Question 11. In the management of raised intracranial pressure (ICP)
normal ICP is < 15 mmHg (True)
Explanation: A sustained pressure > 30 mmHg suggests a poor prognosis
cerebral perfusion pressure = mean systemic arterial pressure minus intracranial pressure (True)
Explanation: Should be > 70 mmHg
modest hyperglycaemia facilitates a decrease in ICP (False)
Explanation: Glycaemic control should be strict
temporary hyperventilation reduces ICP (True)
Explanation: Target (PaCO2 of 4 kPa for 24 hours
the patient should be nursed with 30° head-up tilt (True)
Explanation: And avoid excessive neck flexion


 CHAPTER - 5

Question 1. The histological features useful in distinguishing benign from malignant lesions include
a lower nuclear to cytoplasmic ratio (False)
Explanation: Increased
the presence of aberrations in nuclear morphology (True)
the number of cell mitoses (True)
Explanation: Increases with cell proliferation rate
the presence of cellular invasion into surrounding tissues (True)
Explanation: Evidence of metastatic spread
the number of mitochondria in the cell cytoplasm (False)

Question 2. Useful serum tumour markers associated with the following diseases include
human chorionic gonadotrophin in testicular seminoma (False)
Explanation: Useful in testicular germ cell tumours
alpha fetoprotein in primary hepatocellular carcinoma (True)
Explanation: And testicular germ cell tumours
carcinoembryonic antigen in bronchial adenoma (False)
Explanation: Metastatic colorectal carcinoma
placental alkaline phosphatase in cervical carcinoma (False)
Explanation: There are no useful serum markers for cervical carcinoma
CA-125 in breast carcinoma (False)
Explanation: Useful in ovarian carcinoma

Question 3. The paraneoplastic syndromes listed below are typical of the following tumours
inappropriate ADH-adenocarcinoma of lung (False)
Explanation: Small-cell carcinoma
prothrombotic tendency-pancreatic carcinoma (True)
polymyositis-gastric carcinoma (True)
Explanation: And ovarian and nasopharyngeal carcinoma
myasthenia-like syndrome-small-cell anaplastic lung carcinoma (True)
Explanation: Lambert-Eaton syndrome
acanthosis nigricans-gastric carcinoma (True)
Explanation: And other gastrointestinal malignancy

Question 4. Malignant diseases that are potentially curable using combination chemotherapy include
cervical cancer (True)
squamous cell bronchial carcinoma (False)
Explanation: Refractory to chemotherapy
choriocarcinoma (True)
Explanation: Also testicular teratoma
oesophageal carcinoma (False)
Explanation: Resistant
soft tissue sarcoma (False)
Explanation: Resistant

Question 5. The following statements about chemotherapy are true
methotrexate is an antifolate-blocking nucleotide synthesis (True)
Explanation: An antimetabolite
vincristine is an alkylating agent blocking DNA transcription (False)
Explanation: A mitotic spindle poison
doxorubicin is a plant alkaloid which disrupts mitotic spindles (False)
Explanation: An antibiotic anticancer drug which acts primarily as a topoisomerase antagonist
taxanes act as mitotic spindle poisons (True)
Explanation: E.g. docetaxel
melphalan is an alkylating agent which blocks DNA replication (True)
Explanation: And also blocks DNA transcription


 CHAPTER - 6

Question 1. In the management of pain in patients with malignant diseases
analgesia is best prescribed on an 'as required' basis (False)
Explanation: Should be given regularly
NSAID therapy is particularly valuable in bone pain (True)
Explanation: Affects prostaglandin metabolism
controlled-release morphine has a 4-hour duration of action (False)
Explanation: 12 hours
respiratory depression is a common feature of prolonged opiate use (False)
Explanation: But can occur in acute dosing
opiates are of no value in neuropathic pain (False)
Explanation: But other agents may be more effective

Question 2. The following drugs have clinically useful antiemetic properties
haloperidol (True)
domperidone (True)
Explanation: Blocks dopaminergic receptors
ondansetron (True)
Explanation: 5HT3 receptor antagonist
dexamethasone (True)
Explanation: Given parenterally with chemotherapy
etoposide (False)
Explanation: Chemotherapeutic agent which causes nausea and vomiting

Question 3. The following treatments may be of benefit in a patient with the following cancer-related symptoms
co-danthrusate-constipation (True)
gabapentin-nausea (False)
Explanation: Used for neuropathic pain
trazodone-insomnia (True)
Explanation: A sedating antidepressant
eicosapentanoic acid-anorexia (True)
Explanation: If combined with a high-protein diet
amitriptyline-neuropathic pain (True)


 CHAPTER - 7

Question 1. Expected physiological changes associated with normal ageing include
decreased calcium phosphate content per 100 g bone (False)
Explanation: Bone mass declines (osteoporosis) but mineralisation is normal
increased tissue sensitivity to insulin (False)
Explanation: Reduced insulin sensitivity and glucose tolerance declines
reduced numbers of pacing cells within the sinoatrial node (True)
Explanation: Limits ability to mount a tachycardia
increased glomerular filtration rate (GFR) (False)
Explanation: Decreased number of nephrons, GFR and medullary function
increased chest wall rigidity (True)

Question 2. Likely causes of recurrent falls in the elderly include
accidental slips and trips (True)
Explanation: Exacerbated by poor mobility
postural hypotension (True)
Explanation: Often drug-induced
vasovagal syncope (False)
Explanation: More common in the young
Parkinson's disease (True)
Explanation: Multiple factors involved
acute myocardial infarction (False)
Explanation: May present with a single fall but not recurrent falls

Question 3. The following interventions may be of value in a patient with falls
oral fludrocortisone (True)
Explanation: May help postural hypotension
occupational therapy home visit (True)
Explanation: To improve environmental safety
programme of exercise training (True)
soft cervical collar (False)
Explanation: May help vertebrobasilar insufficiency
oral calcium and vitamin D (True)
Explanation: Help reduce the risk of fall fractures

Question 4. In the frailty syndrome the following domains are impaired
musculoskeletal function (True)
aerobic capacity (True)
cognitive function (True)
integrative neurological function (True)
nutritional status (True)


 CHAPTER - 8

Question 1. Aetiological factors in psychiatric illness include
family history of psychiatric illness (True)
Explanation: Rarely, a single gene disorder is identified
parental loss or disharmony in childhood (True)
Explanation: Especially physical or sexual abuse
stressful life events and difficulties (True)
Explanation: E.g. bereavement, redundancy, retirement
chronic physical ill health (True)
Explanation: Also acute severe physical illness
social isolation (True)
Explanation: Particularly lack of a close relationship

Question 2. Important factors in the assessment of mental state include
appearance and behaviour (True)
Explanation: Including motor retardation
mood state (True)
Explanation: E.g. suicidal ideation
speech and thought content (True)
Explanation: Paranoid, grandiose or depressive
abnormal perceptions and beliefs (True)
Explanation: Depersonalisation, illusions and hallucinations
cognitive function (True)
Explanation: Concentration, memory and orientation

Question 3. The following psychiatric definitions are true
delusions-abnormal perceptions of normal external stimuli (False)
Explanation: Illusions
illusions-unreasonably persistent, firmly held, false beliefs (False)
Explanation: Delusions
hallucinations-abnormal perceptions without external stimuli (True)
Explanation: Suggest psychosis
depersonalisation-perception of altered reality (True)
Explanation: Often with derealisation
phobia-abnormal fear leading to avoidance behaviour (True)
Explanation: Typical pattern in neurosis

Question 4. Diseases mimicking anxiety disorders include
alcohol withdrawal (True)
Explanation: Delirium may also occur
hyperthyroidism (True)
Explanation: Exclude biochemically
hypoglycaemia (True)
Explanation: Measure blood glucose
temporal lobe epilepsy (True)
Explanation: EEG may be necessary
phaeochromocytoma (True)
Explanation: Rare-measure urinary catecholamines

Question 5. Factors associated with a higher suicide risk following attempted suicide include
females aged < 45 years (False)
Explanation: Older males
self-poisoning rather than more violent methods of self-harm (False)
Explanation: Self-poisoning is frequently parasuicidal
absence of a suicide note or previous suicide attempts (False)
Explanation: Suicide note often left and usually a history of previous attempts
chronic physical or psychiatric illness (True)
Explanation: And drug or alcohol misuse
living alone and/or recently separated from partner (True)
Explanation: Or bereavement

Question 6. Cardinal elements in cognitive therapy include
restructuring psychological conflicts and behaviour (False)
Explanation: Undertaken in psychotherapy
identification of negative patterns of automatic thoughts (True)
Explanation: E.g. in depression
awareness of connections between thoughts, mood and behaviour (True)
Explanation: Altering thoughts may alter behaviour
reorientation of negative views of the past, present and future (True)
Explanation: And development of positive views
personality assessment and transactional analysis (False)
Explanation: Features of psychotherapy

Question 7. The typical features of alcohol dependence include
expansion of the drinking repertoire (False)
Explanation: Narrowing of choices of alcoholic beverages
increasing tolerance of alcohol (False)
Explanation: Decreasing tolerance
subjective compulsion to drink (True)
use of alcohol to relieve withdrawal symptoms (True)
Explanation: Classical
recurrent withdrawal symptoms (True)

Question 8. The typical features of depression include
depressed mood for most of the day (True)
Explanation: But diurnal variation may occur
insomnia or hypersomnia (True)
Explanation: Or early morning wakening
loss of pleasure, self-esteem and hope (True)
Explanation: 'Anhedonia'-loss of sense of enjoyment
loss of energy, libido and interest (True)
Explanation: Perhaps with other somatic symptoms
psychomotor retardation and suicidal thoughts (True)
Explanation: With delusions of worthlessness

Question 9. Clinical features of generalised anxiety disorders include
feelings of worthlessness and excessive guilt (False)
Explanation: Suggest depression
depersonalisation and derealisation (True)
Explanation: May be seen in affective disorders
feelings of apprehension and impending disaster (True)
Explanation: With irritability
breathlessness, dizziness, sweating and palpitation (True)
Explanation: Typical somatic symptoms
claustrophobia and agoraphobia (False)
Explanation: Features of phobic anxiety states

Question 10. Typical features of anorexia nervosa include
only adolescent girls are affected (False)
Explanation: Either sex, rarely non-adolescent
amenorrhoea or loss of libido > 3 months (True)
Explanation: With avoidance of high-calorie foods
weight loss > 25% or weight < 25% below normal (True)
Explanation: In contrast to bulimia nervosa
normal perception of body weight and image (False)
Explanation: Emaciation is unrecognised by the patient
progression to death in 20% (False)
Explanation: In 5%


 CHAPTER - 9

Question 1. In a normal 65 kg man, the following statements are true
total body water is approximately 40 litres (True)
Explanation: Relatively constant in health
70% of the total body water is intracellular (True)
Explanation: Approximately 28 litres
75% of extracellular water is intravascular (False)
Explanation: 25% intravascular, 75% interstitial
sodium, bicarbonate and chloride ions are mainly intracellular (False)
Explanation: Extracellular
potassium, magnesium, phosphate and sulphate ions are mainly extracellular (False)
Explanation: Intracellular

Question 2. Typical causes of hyponatraemia include
diabetes insipidus (False)
Explanation: But may be seen in the syndrome of inappropriate antidiuretic hormone (ADH) secretion
hepatocellular failure (True)
Explanation: Water retention exceeds sodium retention
psychogenic polydipsia (True)
Explanation: Increased total body water
Cushing's syndrome (False)
Explanation: But seen in adrenocortical insufficiency
diuretic drug therapy (True)
Explanation: Salt loss exceeds water loss

Question 3. Predominant water depletion is a recognised complication of
primary hyperparathyroidism (True)
Explanation: Renal tubular insensitivity to ADH
toxic confusional states (True)
Explanation: Inadequate intake
oesophageal carcinoma (True)
Explanation: Inadequate intake
lithium therapy (True)
Explanation: Renal tubular insensitivity to ADH
enteral feeding (True)
Explanation: High solute load

Question 4. The following statements about potassium balance are true
85% of the daily potassium intake is excreted in the urine (True)
intracellular potassium ion concentrations are about 150 mmol/l (True)
Explanation: Compared with extracellular concentrations of about 4 mmol/l
cellular uptake of potassium is enhanced by adrenaline and insulin (True)
alkalosis predisposes to hyperkalaemia (False)
the normal dietary potassium intake is about 100 mmol per day (True)

Question 5. Hyperkalaemia is a recognised finding in
severe untreated diabetic ketoacidosis (True)
Explanation: Insulin promotes movement into the cells
primary hypoadrenalism (True)
Explanation: Impairment of secretion in the distal nephron
rhabdomyolysis (True)
Explanation: Increased tissue breakdown
prostaglandin inhibitor therapy in renal impairment (True)
Explanation: Especially if given with an ACE inhibitor
angiotensin-converting enzyme (ACE) inhibitor therapy (True)
Explanation: Avoid concurrent supplementation

Question 6. The emergency treatment of severe hyperkalaemia should include
dietary restriction of coffee and fruit juices (False)
Explanation: But may be necessary to prevent recurrence
parenteral dextrose and glucagon therapy (False)
Explanation: Give parenteral dextrose and insulin
parenteral calcium gluconate therapy (True)
Explanation: Cardioprotective effect
restoration of sodium and water balance (True)
Explanation: Also correct metabolic acidosis if present with 1.26% sodium bicarbonate i.v.
Calcium Resonium orally and/or rectally (True)
Explanation: The resin binds potassium in exchange for calcium

Question 7. Recognised causes of potassium depletion include
metabolic alkalosis (True)
Explanation: Renal tubular cell K+ concentration increased, excretion increased
cardiac failure (True)
Explanation: Secondary hyperaldosteronism
corticosteroid treatment (True)
Explanation: Mineralocorticoid-like effect
renal tubular acidosis (True)
Explanation: Primary or secondary tubular defect; also occurs with activation of renin and angiotensin
amiloride diuretic therapy (False)
Explanation: Causes hyperkalaemia by an effect on the distal convoluted tubules

Question 8. Metabolic acidosis would be an expected finding in
chronic alveolar hyperventilation (False)
Explanation: Chronic respiratory alkalosis
acute insulin deficiency (True)
Explanation: Diabetic ketoacidosis
acute inflammatory polyneuropathy (Guillain-Barré syndrome) (False)
Explanation: Acute respiratory acidosis due to alveolar hypoventilation
failure of distal renal tubular hydrogen ion secretion (True)
Explanation: Distal (type I) renal tubular acidosis
methanol poisoning (True)

Question 9. Metabolic alkalosis may be caused by
hyperventilation (False)
Explanation: Respiratory alkalosis
aspiration of gastric contents (True)
Explanation: Or vomiting
mineralocorticoid deficiency (False)
Explanation: Can produce mild acidosis
excessive liquorice ingestion (True)
Explanation: Due to excessive mineralocorticoid activity
diuretic therapy (True)
Explanation: And hypokalaemia

Question 10. Magnesium deficiency is
a cause of confusion, depression and epilepsy (True)
Explanation: And tremor and choreiform movements
usually due to prolonged vomiting and diarrhoea (True)
Explanation: Also from chronic diuretic therapy
found in uncontrolled diabetes mellitus and alcoholism (True)
Explanation: Excess losses in the urine
found in primary hyperparathyroidism and hyperaldosteronism (True)
Explanation: Including secondary hyperaldosteronism
best treated with oral magnesium sulphate (False)
Explanation: Very poorly absorbed orally


 CHAPTER - 10

Question 1. A healthy daily diet for a slim man with a physical job should include
1500 kcal (8.4 MJ) (False)
Explanation: About 11.3 MJ (2700 kcal)
60% of total energy requirements as carbohydrate (True)
Explanation: 55-75%
no less than 10 g salt per day (False)
Explanation: No more than 6 g/day
35 g of dietary fibre (True)
Explanation: 27-40 g/day
no more than 10% of total energy requirements as fat (False)
Explanation: 15-30%

Question 2. Recognised medical complications of weight gain include
osteoporosis (False)
Explanation: Bone density increases
rheumatoid arthritis (False)
Explanation: Osteoarthritis
gallstones (True)
Explanation: Often asymptomatic
type 2 diabetes mellitus (True)
Explanation: With insulin resistance
hyperlipidaemia (True)
Explanation: And coronary artery disease

Question 3. Ideal weight-reducing diets in the treatment of moderate obesity should
provide no more than 2.5 MJ (600 kcal) per day (False)
Explanation: Aim to reduce intake by no more than 2.5 MJ (600 kcal) per day
achieve a theoretical weight loss of at least 2 kg per week (False)
Explanation: 0.5 kg per week (2.5 MJ or 600 kcal deficit/day = 17.15 MJ or 4200 kcal/week = 0.6 kg human tissue)
aim to achieve a weight loss of 10% (True)
Explanation: Sufficient to achieve a significant improvement in health
be part of a multiple risk factor intervention (True)
Explanation: E.g. cessation of smoking
reduce carbohydrate intake much more than total fat intake (False)
Explanation: Fat restriction < 50 g/day (calorific values fat = 38 KJ or 9 kcal/g, CHO = 17 KJ or 4 kcal/g)

Question 4. The benefits of a sustained 10 kg weight reduction in the obese include
fall in the blood pressure of 10 mmHg (systolic) and 20 mmHg (diastolic) (True)
reduction in total mortality of 20-25% (True)
reduction in fasting glucose of 15% (False)
Explanation: 50%
reduction in total cholesterol of 50% (False)
Explanation: Reduction in total cholesterol of 10%
reduction in high-density lipoprotein cholesterol of 8% (False)
Explanation: Increases by 8%

Question 5. Drug therapies known to increase appetite and body weight include
orlistat (False)
Explanation: Has a role in promoting weight loss
fenfluramine (False)
Explanation: But side-effects preclude use
amitriptyline (True)
fluoxetine (False)
Explanation: Stimulates satiety and can help some patients lose weight
sibutramine (False)
Explanation: Can support weight loss

Question 6. The function of the main lipoproteins include the following
chylomicrons transport mainly cholesterol (False)
Explanation: Mainly triglycerides; not present in the normal fasting plasma
very low-density lipoprotein transports endogenous triglycerides (True)
Explanation: VLDL is synthesised in the liver and is the precursor of LDL
low-density lipoprotein transports cholesterol (True)
Explanation: Generated from VLDL in the blood stream
high-density lipoprotein transports cholesterol from the peripheral tissues to the liver (True)
low-density lipoprotein is important for the excretion of cholesterol and is cardioprotective (False)
Explanation: HDL aids cholesterol excretion and is cardioprotective

Question 7. Common causes of secondary hyperlipidaemia include
chronic renal failure (True)
Explanation: Increases triglycerides and VLDL but decreases HDL
diabetes mellitus (True)
Explanation: Increases triglycerides and VLDL but decreases HDL
hyperthyroidism (False)
Explanation: Hypothyroidism increases cholesterol and LDL
alcohol misuse (True)
Explanation: Increases triglycerides, VLDL and HDL
thiazide diuretics (True)

Question 8. In the classification of hyperlipidaemias, the following findings are typical
chylomicronaemia in types I and V (True)
Explanation: Risk of pancreatitis with both types I and V but no atherogenic risk
hypertriglyceridaemia in types III, IV and V (True)
Explanation: Triglycerides variably abnormal in all except type IIa
hypercholesterolaemia in types II, III and IV (True)
Explanation: And all are associated with increased atherosclerosis
tendon xanthomata in type IIa hypercholesterolaemia (True)
Explanation: And premature coronary atherosclerosis
defective LDL catabolism and receptor binding in type V hyperlipidaemia (False)
Explanation: Defective LDL receptor gene is typical of type II familial hypercholesterolaemia

Question 9. The actions of the lipid-lowering drugs include the following
the statins inhibit HMG CoA reductase and reduce cholesterol synthesis (True)
Explanation: Increase LDL catabolism
the statins increase plasma LDL and triglycerides (False)
Explanation: Decrease plasma LDL and cholesterol
nicotinic acid increases lipolysis and lowers HDL (False)
Explanation: Decreases lipolysis and plasma triglycerides but increases plasma HDL
fibrates increase VLDL lipolysis (True)
Explanation: Decrease plasma triglycerides and plasma LDL and increase plasma HDL
colestipol diverts hepatic cholesterol synthesis into an increased bile acid production (True)
Explanation: Like colestyramine, it blocks bile acid reabsorption in the gut

Question 10. Clinical features of protein-energy malnutrition in adults include
a body mass index of between 20 and 22 (False)
Explanation: BMI < 16. N.B. BMI is calculated from the formula weight (kg) ÷ height2 (m)
oedema in the absence of hypoalbuminaemia (True)
Explanation: 'Famine oedema'
nocturia, cold intolerance and diarrhoea (True)
Explanation: And weakness, amenorrhoea or impotence
skin depigmentation, hair loss and covert infection (True)
Explanation: Adolescents may maintain hair growth
cerebral atrophy and sinus tachycardia (False)
Explanation: Brain weight is preserved; bradycardia is the rule

Question 11. The clinical features of protein-energy malnutrition in children include
marked muscle-wasting and abdominal distension in marasmus (True)
Explanation: And absence of oedema
weight loss more than growth retardation in marasmus (True)
Explanation: Weight < 60% standard for age
hepatic steatosis and hypoproteinaemic oedema in kwashiorkor (True)
Explanation: With low plasma lipids
desquamative dermatosis, stomatitis and anorexia in marasmus (False)
Explanation: Features of kwashiorkor
associated zinc deficiency in kwashiorkor (True)
Explanation: Contributing to dermatosis

Question 12. Vitamin A is
a fat-soluble vitamin (True)
Explanation: A, D, E, and K are the fat-soluble vitamins
present as retinol in carrots and certain green vegetables (False)
Explanation: Occurs as retinol in animal produce and as carotene in plants
the treatment of choice in xerophthalmia and keratomalacia (True)
Explanation: Both conditions are the result of vitamin A deficiency and lead to blindness
associated with teratogenicity if administered in pregnancy (True)
present in high concentrations in fish liver oils (True)
Explanation: Present as retinol

Question 13. Vitamin D
is present in high concentrations in dairy products (False)
Explanation: Some margarines are fortified
is non-essential in the diet given adequate sunlight exposure (True)
Explanation: But less efficiently produced in old age
like vitamin A is stored mainly in the liver (False)
Explanation: But metabolism partly occurs in the liver
is converted from cholecalciferol to 1