Date posted: October 22, 2011

Based on all the chapters of  Davidson’s Medicine- Fleshandbones
Candidates  preparing for competitive examinations are recommended to read the appropriate chapters from the text books  and then to asses themselves using these questions.  Otherwise it seems to be difficult .Try to record your reasoning before checking the correct answer.


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


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)


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


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


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


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)


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)


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%


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


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 1,25-dihydroxycholecalciferol (True)
  • Explanation: 1-alpha hydroxylation occurs in the kidney and 25-hydroxylation in the liver
  • enhances calcium absorption by the induction of specific enterocyte transport proteins (True)
  • Explanation: And stimulates osteoclast proliferation

Question 14. Deficiency of the following B vitamins is associated with the disorders listed below

  • niacin-pellagra (True)
  • Explanation: Dermatitis, diarrhoea and dementia
  • pyridoxine-isoniazid-induced peripheral neuropathy (True)
  • Explanation: Add to anti-tuberculosis regimens using isoniazid
  • pyridoxine-haemolytic anaemia (False)
  • Explanation: Sideroblastic anaemia may respond
  • riboflavin-angular stomatitis (True)
  • Explanation: And also nasolabial seborrhoea
  • riboflavin-cheilosis (True)
  • Explanation: Also seen in niacin deficiency

Question 15. In the classification of acute and non-acute porphyrias

  • d-aminolaevulinic acid synthetase activity is increased in all porphyrias (True)
  • Explanation: Rate-limiting step in biosynthesis of haem
  • porphobilinogen deaminase activity is reduced in acute porphyrias (True)
  • Explanation: Porphobilinogen accumulates
  • neuropsychiatric features are typical of the non-acute porphyrias (False)
  • Explanation: Typical of acute porphyria
  • photosensitivity is typical of the acute porphyrias (False)
  • Explanation: Typical of the non-acute porphyrias
  • variegate porphyria and coproporphyria are mixed porphyrias (True)
  • Explanation: Both are hepatic porphyrias

Question 16. Disorders associated with amyloid deposition include

  • familial Mediterranean fever (True)
  • Explanation: Reactive (AA) amyloidosis
  • bronchiectasis (True)
  • chronic haemodialysis (True)
  • Alzheimer’s disease (True)
  • Explanation: Also the spongiform encephalitides
  • rheumatoid arthritis (True)
  • Explanation: Reactive AA amyloidosis

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