Internal medicine mcqs pdf

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Mcqs for Davidson - Ebook download as PDF File .pdf) or read book online . answers Core Clinical Cases in Medicine and Medical Specialties, Internal Medicine. The following are examples of items that you would find in a multiple-choice question (MCQ) exam. Model answers are included for your. Acute medicine specialty exam mcqs free haad mcqs general practitioner tricia joy haad exam mcqs physiotherapy pdf internal medicine is the medical specialty .

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1 Topographic Surface Anatomy. STUDY AIMS. At the end of your study, you should be able to: Identify the key landmarks. New York Chicago San Francisco Lisbon London Madrid Mexico City Milan. New Delhi San Juan Seoul Singapore Sydney Toronto. INTERNAL MEDICINE. Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug ther- apy are required.

Patent ductus arteriosus D. Amlodipine B. Non-sustained ventricular tachycardia E. Shortness of breath 2 A previously fit year-old man presents with unusual shortness of breath on exertion. Severe chest pain 26 D The most likely diagnosis, and the one that must be most urgently excluded, is an aortic dissection D. One clinical trial did appear to shown additional benefit for the omega-3 fatty acids E but this was in a population where few were receiving statins.

The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.

1000 MCQ for Medicine

In particular, but without limiting the generality of the preceding disclaimer every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized.

Joanna Koster Project Editor: Stephen Clausard Production Controller: Jonathan Williams Cover Design: Amina Dudhia Indexer: Or any other Hodder Arnold title? Please visit our website: Dedication To my parents and brother, who during the darkest nights have forever remained the brightest stars.

Sukhpreet S Dubb To my parents — thank you for your support and encouragement Kumaran Shanmugarajah To my family and friends, your priceless support and inspiration made this possible. This page intentionally left blank 7.

Foreword A continuing pursuance of clinical excellence can be a long and difficult path to follow. Nevertheless, it is something we all aspire to in order to use our best knowledge in serving our patients. But first, one has to pass the qualifying examination! This book helps to test your knowledge and aims to provide a question and answer format that closely follows the curriculum for Finals.

It reflects the clinical scenarios that medical students will encounter when they first start as doctors and also face in Finals. It follows the single best answer format; a format of questioning that is more like real life. The authors have given comprehensive and informative answers, as well as reasons for the choice of the correct answer. It is very readable. It is also refreshing to see that the authors have combined together to write this text from a wide range and level of knowledge — from a final year medical student to a professor.

They will all remember what Finals entailed, from the sheer anxiety to the excitement of getting the knowledge of medicine into focus. I am sure this book will be useful and enjoyable. Good luck for Finals!

This page intentionally left blank Preface Medical schools have undergone a number of changes in deciding upon the ideal format for testing clinical knowledge in examinations. Multiple choice questions MCQs in the past were the most common modality by which medical students were examined.

Although able to test a broad range of topics and being cost efficient for marking purposes, MCQs have largely been abandoned in favour of extending matching questions EMQs and more recently the single best answer SBA question format. EMQs and SBAs overcome the ambiguity that occurs in MCQ exams, as well as being able to provide more clinical question stems reflecting real-life situations.

The SBA format is highly favoured in examinations at both the undergraduate and postgraduate level since students must not only demonstrate their clinical knowledge and understanding but also make sound judgements which are more congruent with clinical practice. Each question not only provides an opportunity to apply clinical knowledge and correctly identify the single best answer to a question, but also to learn why the other answers are wrong, greatly increasing the clinical acumen and learning opportunity of the reader.

Questions 1. Myocardial infarction 3 2. Heart failure 1 3 3. Valve lesion signs 3 4.

CHAD2 score 4 5. Chest pain 1 4 6. Shortness of breath 1 4 7. Murmurs 1 5 8. Chest pain 2 5 9. Chest pain management 5 Ventricular tachyarrhythmia 6 Jugular venous pressure 6 Heart failure 2 6 First degree heart block 7 Mitral stenosis 7 Hypertension 1 7 Palpitations 8 Murmurs 2 8 Postmyocardial infarction 1 8 Hypertension 2 9 Mid-systolic murmur 9 Ventral septal defect 9 Microscopic haematuria 10 Retrosternal chest pain 10 Pulmonary embolism management 10 Severe chest pain 11 Decrescendo diastolic murmur 11 Supraventricular tachycardia 12 Chest pain 3 12 Shortness of breath 2 12 Hypertension 3 13 Chest pain 4 13 Constrictive pericarditis 13 Visual disturbance 14 Weight loss 14 Postmyocardial infarction 2 14 Mitral valve prolapse complication 15 Mitral valve prolapse 15 Paroxysmal atrial fibrillation 15 Hypertension management 16 Answers 17 Myocardial infarction A year-old man presents with central crushing chest pain for the first time.

He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted. What are the most likely changes to have occurred on ECG during admission?

ST depression in leads V1—4 B. ST elevation in leads V1—6 C. ST elevation in leads V5—6 E. Heart failure 1 A year-old woman is admitted with heart failure.

The underlying cause is determined to be aortic stenosis. Which sign is most likely to be present? Pleural effusion on chest x-ray B. Raised jugular venous pressure JVP C. Bilateral pedal oedema D. Bibasal crepitations E. Atrial fibrillation 3. Valve lesion signs A patient is admitted with pneumonia.

A murmur is heard on examination. What finding points to mitral regurgitation? Murmur louder on inspiration B. Murmur louder with patient in left lateral position C. Murmur louder over the right 2nd intercostal space midclavicular line D. Narrow pulse pressure Cardiovascular 4. She is started on appropriate medication to reduce her cardiac risk. She is hypertensive, fasting glucose is normal and cholesterol is 5.

She is found to be in atrial fibrillation. What is the most appropriate treatment? Aspirin and clopidogrel B. Digoxin C. Cardioversion D. Aspirin alone E. Warfarin 5. Chest pain 1 A year-old man has just arrived in accident and emergency complaining of 20 minutes of central crushing chest pain. Which feature is most indicative of myocardial infarction at this moment in time? Inverted T waves B. ST depression C. ST elevation D. Q waves E. Raised troponin 6. Shortness of breath 1 A year-old woman presents to accident and emergency with a 2-day history of shortness of breath.

The patient notes becoming progressively short of breath as well as a sharp pain in the right side of the chest which is most painful when taking a deep breath. The patient also complains of mild pain in the right leg, though there is nothing significant on full cardiovascular and respiratory examination. Heart rate is 96 and respiratory rate is The patient denies any weight loss or long haul flights but mentions undergoing a nasal polypectomy 3 weeks ago.

The most likely diagnosis is: Muscular strain B. Heart failure C.

100 TOP MEDICINE Multiple Choice Questions and Answers pdf

Pneumothorax D. Angina E. Pulmonary embolism Questions 5 7. Murmurs 1 A year-old man presents for a well person check. A cardiovascular, respiratory, gastrointestinal and neurological examination is performed. No significant findings are found, except during auscultation a mid systolic click followed by a late systolic murmur is heard at the apex.

The patient denies any symptoms. Barlow syndrome B. Austin Flint murmur C. Patent ductus arteriosus D. Graham Steell murmur E. Carey Coombs murmur 8. Chest pain 2 A year-old man presents to accident and emergency with a 3-day history of increasingly severe chest pain. The patient describes the pain as a sharp, tearing pain starting in the centre of his chest and radiating straight through to his back between his shoulder blades. Myocardial infarction B. Myocardial ischaemia C.

Aortic dissection D. Pulmonary embolism E. Pneumonia 9. Chest pain management A year-old man is rushed to accident and emergency complaining of a minute history of severe, crushing chest pain. After giving the patient glyceryl trinitrate GTN spray, he is able to tell you he suffers from hypertension and type 2 diabetes and is allergic to aspirin.

The most appropriate management is: Aspirin B. Morphine C. Heparin D. Clopidogrel E. Warfarin Cardiovascular Ventricular tachyarrhythmia While on call you are called by a nurse to a patient on the ward complaining of light headedness and palpitations.

When you arrive the patient is not conscious but has a patent airway and is breathing with oxygen saturation at 97 per cent. You try to palpate a pulse but are unable to find the radial or carotid. The registrar arrives and after hearing your report of the patient decides to shock the patient who recovers.

What is the patient most likely to have been suffering? Torsades de Pointes B. Ventricular fibrillation C. Sustained ventricular tachycardia D. Non-sustained ventricular tachycardia E. Normal heart ventricular tachycardia Jugular venous pressure A year-old man presents to accident and emergency with a 3-day history of shortness of breath. On examination you palpate the radial pulse and notice that the patient has an irregular heart beat with an overall rate of bpm. You request an electrocardiogram ECG which reveals that the patient is in atrial fibrillation.

Which of the following would you expect to see when assessing the JVP? Raised JVP with normal waveform B. Heart failure 2 A year-old woman is admitted to your ward following a 3-day history of shortness of breath and a productive cough of white frothy sputum. On auscultation of the lungs, you hear bilateral basal coarse inspiratory crackles. You suspect that the patient is in congestive cardiac failure. You request a chest x-ray. Which of the following signs is not typically seen on chest x-ray in patients with congestive cardiac failure?

Lower lobe diversion B. Cardiomegaly C. Pleural effusions D. Alveolar oedema E. Kerley B lines Questions 7 First degree heart block A year-old man presents to your clinic with symptoms of exertional chest tightness which is relieved by rest.

You request an ECG which reveals that the patient has first degree heart block. Which of the following ECG abnormalities is typically seen in first degree heart block? Mitral stenosis You see a year-old woman who presents with worsening shortness of breath coupled with decreased exercise tolerance. She had rheumatic fever in her adolescence and suffers from essential hypertension. On examination she has signs which point to a diagnosis of mitral stenosis. Which of the following is not a clinical sign associated with mitral stenosis?

Malar flush B. Atrial fibrillation C. Pan-systolic murmur which radiates to axilla D. Tapping, undisplaced apex beat E. Right ventricular heave Hypertension 1 A year-old woman has been diagnosed with essential hypertension and was commenced on treatment three months ago. She presents to you with a dry cough which has not been getting better despite taking cough linctus and antibiotics. Amlodipine B. Lisinopril C. Bendroflumethiazide D.

Frusemide E. Atenolol He has mild central chest discomfort but is not acutely distressed. He first noticed these about 3 hours before coming to hospital. As far as is known this is his first episode of this kind. Which of the following would you prefer as first-line therapy? Anticoagulate with heparin and start digoxin at standard daily dose B.

Attempt DC cardioversion C. Administer bisoprolol and verapamil, and give warfarin D. Attempt cardioversion with IV flecainide E. Wait to see if there is spontaneous reversion to sinus rhythm Murmurs 2 A year-old male is brought to accident and emergency after collapsing at home.

He has recovered within minutes and is fully alert and orientated. He says this is the first such episode that he has experienced, but describes some increasing shortness of breath in the previous six months and brief periods of central chest pain, often at the same time. On ECG there are borderline criteria for left ventricular hypertrophy. Which of the following might you expect to find on auscultation? Mid-diastolic murmur best heard at the apex B.

Crescendo systolic murmur best heard at the right sternal edge C. Diastolic murmur best heard at the left sternal edge D. Pan-systolic murmur best heard at the apex E. Pan-systolic murmur best heard at the left sternal edge Postmyocardial infarction 1 A year-old male was admitted to accident and emergency 2 days after discharge following an apparently uncomplicated MI.

He complained of rapidly worsening shortness of breath over the previous 48 hours but no further chest pain. The jugular venous pressure was raised and a pan-systolic murmur was noted, maximal at the left sternal edge. Which of the following is the most likely diagnosis?

Mitral incompetence B. Ventricular septal defect C.

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Aortic stenosis D. Further myocardial infarction Questions 9 Hypertension 2 A year-old male is admitted complaining of headaches and blurring of vision. He had been known to be hypertensive for about five years and his blood pressure control had been good on three drugs. However, he had decided to stop all medication two months before this event.

Which of the following would be your preferred parenteral medication at this point? Glyceryl trinitrate B. Hydralazine C. Labetalol D. Sodium nitroprusside E. Phentolamine Mid-systolic murmur A year-old male is referred for assessment of hypertension. There is a mid-systolic murmur maximal at the aortic area, and radiating to the back. Clinical findings and the ECG are compatible with left ventricular hypertrophy. What is the most likely underlying pathology? Hypertrophic obstructive cardiomyopathy B.

Congenital aortic stenosis C. Coarctation of the aorta D. Patent ductus ateriosus E. Atrial septal defect Ventral septal defect A year-old boy is diagnosed with a small ventricular septal defect, having been screened by echocardiography because of a family history of hypertrophic obstructive cardiomyopathy.

He is entirely asymptomatic, plays several sports regularly and has no growth retardation. The echocardiogram also confirms a small left to right shunt, with pulmonary to systemic flow ratio only just above one.

Which of the following is the most likely to be a significant complication of his condition? Pulmonary hypertension B. Dysrhythmias D. Endocarditis E. Shunt reversal right to left flow Microscopic haematuria A 52 year-old woman has been treated for several years with amlodipine and lisinopril for what has been presumed to be primary hypertension.

She is seen by her GP having complained of persistent left loin pain. She is tender in the left loin and both kidneys appear to be enlarged. On urine dipstick testing, there is microscopic haematuria. Which of the following is likely to be the most appropriate investigation at this point? Urinary tract ultrasound B.

Abdominal and pelvic computed tomography CT scan C. Microscopy of the urine microbial and cytological D. Renal biopsy E. Intravenous urogram Retrosternal chest pain A year-old man presents with a 2-hour history of moderately severe retrosternal chest pain, which does not radiate and is not affected by respiration or posture. He complains of general malaise and nausea, but has not vomited.

Troponin levels are not elevated. He has already been given oxygen, aspirin and intravenous GTN; he is an occasional user of sublingual GTN and takes regular bisoprolol for stable angina. What would be the most appropriate next step in his management? IV low-molecular weight heparin B.

1000 Mcqs for Davidson

Thrombolysis with alteplase C. IV nicardapine D. Angiography with stenting E. Oral clopidogrel Pulmonary embolism management A year-old woman is referred for assessment after suffering a second pulmonary embolus within a year. She has not been travelling recently, has not had any surgery, does not smoke and does not take the oral contraceptive pill. She is not currently on any medication as the diagnosis is retrospective and she is now asymptomatic.

What should be the next step in her management? Initiation of warfarin therapy B. ECG C. Thrombophilia screen D. Insertion of inferior vena cava filter E. Duplex scan of lower limb veins and pelvic utrasound Questions 11 Mid-diastolic murmur A year-old woman attends her GP for a routine medical examination and is noted to have a mid-diastolic murmur with an opening snap.

She is entirely asymptomatic and chest x-ray and ECG are normal. What would be the most appropriate investigation at this point? ECG B. Anti-streptolysin O titre C. Cardiac catheterization D. Thallium radionuclide scanning E. Colour Doppler scanning Severe chest pain A year-old man develops sudden severe central chest pain after lifting heavy cases while moving house.

The pain radiates to the back and both shoulders but not to either arm. He is distressed and sweaty, but not nauseated. What would you consider the most likely diagnosis? Pneumothorax B. Pulmonary embolism D. Aortic dissection E. Musculoskeletal pain Decrescendo diastolic murmur A year-old woman presents with increasing shortness of breath on exertion developing over the past three months.

She has no chest pain or cough, and has noticed no ankle swelling. There is a decrescendo diastolic murmur at the left sternal edge. What is the most likely diagnosis? Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis E.

Tricuspid regurgitation Supraventricular tachycardia A year-old man is on his way home from a party when he experiences the sudden onset of rapid palpitations. He feels uncomfortable but not short of breath and has no chest pain. Carotid sinus massage produced transient reversion to sinus rhythm, after which the tachycardia resumed.

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What would be the next step in your management? Repeat carotid sinus massage B. IV verapamil C. IV propranolol D. IV adenosine E. Synchronized DC cardioversion Chest pain 3 A year-old woman attends her local accident and emergency department with a history of at least six months of frequent central chest pain in the early morning or during the night.

She had no chest pain on exertion. This had been a particularly severe attack, lasting over 2 hours. Subsequent coronary angiography is normal. Stable angina C.

Unstable angina D. Anxiety E. Variant angina Shortness of breath 2 A previously fit year-old man presents with unusual shortness of breath on exertion. At times, this is also associated with central chest pain. On examination there is a loud mid-systolic murmur at the left sternal edge. Heart rate and blood pressure are normal and there is no oedema. The ECG shows left axis deviation and the voltage criteria for left ventricular hypertrophy and the echocardiogram reveals a significant thickened interventricular septum, with delayed ventricular filling during diastole.

There is a family history of sudden death below the age of Which of the following would be your initial therapy? Digoxin B. Long-acting nitrates C. Beta-blockers D. Rate-limiting calcium channel blockers E.

Partial excision of the septum Questions 13 Hypertension 3 A year-old woman presents with episodes of headaches, associated with anxiety, sweating and a slow pulse rate. Which of the following would be your initial diagnostic procedure? Magnetic resonance imaging MRI scans of the abdomen and pelvis B. Measurement of random plasma catecholamines C. Measurement of urinary metanephrines over several 24 hour periods D. Glucose tolerance test E. Pharmacological provocation using clonidine Chest pain 4 A year-old man presents to the accident and emergency department with a 2-hour history of central chest pain radiating to the left arm.

He is anxious, nauseated and sweaty. The troponin level is significantly raised. This is certainly acute MI. Which is the most likely coronary vessel to be occluded? Circumflex artery B. Left anterior descending artery C. Right coronary artery D. Left main coronary artery E. Posterior descending artery Constrictive pericarditis A year-old woman complains of increasing shortness of breath on exertion, as well as orthopnoea, for the previous 3—4 months.

She had apparently recovered from pericarditis about a year earlier. On ECG there is low voltage, especially in the limb leads, and the chest x-ray shows pericardial calcification. The presumptive diagnosis is constrictive pericarditis. Which of the following physical signs would be consistent with this? Increased jugular distention on inspiration B. Third heart sound C. Fourth heart sound D. Rales at both lung bases E. Loud first and second heart sounds Visual disturbance A year-old man is being treated for congestive heart failure with a combination of drugs.

He complains of nausea and anorexia, and has been puzzled by observing yellow rings around lights. Which of the following medications is likely to be responsible for these symptoms? Lisinopril B. Spironolactone C.

Digoxin D. Furosemide E. Bisoprolol Weight loss A year-old woman goes to see her GP complaining of fatigue and palpitations. She says she has also lost weight, though without dieting. There are no added cardiac sounds. The ECG confirms the diagnosis of atrial fibrillation. What would you suggest as the most useful next investigation. Chest x-ray D. Full blood count E. Fasting blood sugar Postmyocardial infarction 2 A year-old man has made an excellent functional recovery after an anterior MI.

He is entirely asymptomatic and there is no abnormality on physical examination. Which of the following would you not recommend as part of his secondary prevention planning? Simvastatin D. Bisoprolol E. Omega-3 fatty acids Questions 15 Mitral valve prolapse complication A year-old woman with known mitral valve prolapse develops a low grade fever, malaise and night sweats within a couple of weeks of a major dental procedure.

Which investigation is most likely to provide a definitive diagnosis? Full blood count B. Autoantibody screen D. Blood culture E. Coronary angiography Mitral valve prolapse An asymptomatic year-old woman has been referred for cardiological assessment. After her ECG she was told that she had mitral valve prolapse and would like further information on this condition. Which of the following statements is correct?

Beta-blocker therapy is indicated B. Angiotensin-converting enzyme ACE inhibitor therapy is indicated C. One or both leaflets of the mitral valve are pushed back into the left atrium during systole D. Significant mitral regurgitation will eventually develop E. Exercise should be restricted Paroxysmal atrial fibrillation A year-old woman complains of intermittent palpitations, lasting several hours, which then stop spontaneously.

She also suffers from asthma. Holter monitoring confirms paroxysmal atrial fibrillation. Which of the following statements is correct regarding the management of this patient?

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Digoxin effectively prevents recurrence of the arrhythmia B. Anticoagulation is not necessary C. Sotalol may be effective D. Amiodarone should be avoided E. Flecainide orally may be an effective as-needed treatment to abort an attack Electrolytes and physical examination have been, and remain, normal.

Which of the following would be your next stage in his management? Arrange for his medication to be given under direct observation B. Add spironolactone to his medication C. Arrange urinary catecholamine assays D. Request an adrenal CT scan E. Add verapamil to his medication The angiogram shows that the left circumflex artery is occluded, resulting in a lateral infarct. This area is represented by leads V5—6 D. V1—4 represents the territory of the left anterior descending artery.

If the entire left mainstem had been occluded, changes would have shown throughout leads V1—6 B. Structure your knowledge for success in medical exams, Cavaye, with permission. Cardiovascular The location of the changes tells you which part of the heart is affected as shown in the diagrams.

These depict: Putting all of these together will allow you to pinpoint the location of the lesion. Posterior descending branch Heart failure 2 D Aortic stenosis will first result in left ventricular failure as a result of increased ventricular pressure as the ventricle tries to pump blood across a narrowed valve. Initially the pressure load will cause a backlog of blood into the lungs, resulting in pulmonary oedema — the first sign of which will be bibasal crepitations D before enough fluid accumulates as pleural effusions visible on chest x-ray A.

Earlier signs of pulmonary oedema include upper lobe blood diversion and Kerley B lines as fluid infiltrates the interstitium. If the backlog continues back into the right heart, eventually signs of right-sided heart failure will be evident including raised JVP B and bilateral pedal oedema C. Atrial fibrillation E may coexist with aortic stenosis, however it is more commonly associated as a result of mitral stenosis as the enlarged atrium disrupts the normal electrical pathways.

Valve lesion signs 3 B A murmur heard loudest on inspiration A points to a right-sided valve lesion. The right intercostal space midclavicular line C is the anatomical landmark for the aortic valve.

The mitral area is over the apex. A murmur louder with the patient in the left lateral position B as opposed to leaning forward is associated with mitral lesions. If heard, you should determine whether the murmur radiates to the axilla. A narrow pulse pressure E is a sign of aortic stenosis. There is no indication for hypoglycaemics at present. There is no indication that this is acute atrial fibrillation and she does not seem to be compromised in a female of this age, cardioversion C is unlikely to be successful.

She should be rate-controlled but the beta blockade is more appropriate in light of her ischaemic heart disease. Whether to start anticoagulation A is a decision that has to be tailor-made for each individual patient. The CHAD2 score is a quick and dirty but very useful way of predicting risk of subsequent stroke as a result of atrial fibrillation and helps guide the prescription of prophylactic antiplatelets or anticoagulants. Other factors, such as ease of taking and monitoring warfarin, risk of falls and important risk factors, such as vascular disease, should be taken into account.

C Congestive heart failure 1 H Hypertension: A score of 1 is moderate risk 3 per cent annual stroke risk and either warfarin or aspirin D is indicated according to the individual. Chest pain 5 C Acute coronary syndrome is a spectrum of cardiac ischaemia-infarction determined by the presence of two out of three factors: Depending on these results, patients will fall into one of the following categories: ST elevation, Q waves and raised troponin are indicative of infarction.

ST elevation C is a very good predictor of imminent infarction positive troponin. However, if this patient is treated quickly enough with thrombolysis or primary PCI, infarction can be avoided. Patients most often complain of shortness of breath, pleuritic chest pain and haemoptysis. Clinical signs can include a pleural rub, coarse crackles and atrial fibrillation. In massive pulmonary embolism there can be a raised JVP, respiratory rate, heart rate and hypotension.

The Geneva scoring system see below is useful for predicting the risk of a pulmonary embolism: Muscular strain A typically occurs on movement and is not associated with shortness of breath or leg pain and there is usually an indicator of injury or a preceding stressor. Heart failure B is unlikely due to the acute presentation of symptoms which tend to occur more insidiously and can be associated with bilateral leg oedema, murmurs, orthopnoea or hepatomegaly, among others.

A pneumothorax C can present with a similar pleuritic chest pain that occurs in an embolism, however, there is no association with limb pain and a respiratory examination is likely to reveal hyper-resonance.

Angina D is typically described as a dull or crushing chest pain in the centre of the chest, patients have risk factors such as diabetes, hyperlipidaemia, obesity, smoking and hypertension.

Answers 21 Murmurs 7 A This patient is suffering from a mitral valve prolapse Barlow syndrome, click murmur syndrome A. A mid-systolic click followed by a late systolic murmur is heard at the apex as the thickened mitral valve leaflet is displaced into the left atrium during systole.

An Austin Flint murmur B produces a low pitched, mid-diastolic rumble at the apex. Classically, mitral valve displacement as well as aortic turbulence due to regurgitation qualifies as an Austin Flint murmur. A patent ductus arteriosus C produces a constant machinery murmur. A Graham Steell murmur D is typically heard best at the left sternal edge, second intercostals space during inspiration.

A high pitched early diastolic murmur is heard associated with pulmonary hypertension. A Carey Coombs murmur E is a short, mid-diastolic rumble heard best at the apex due to turbulent blood flow over a thickened mitral valve, most often due to rheumatic fever.

Chest pain 8 C All of the answer options can present as central chest pain, however the patient describes a very typical description of an aortic dissection C , usually a severe, tearing pain that radiates toward the back though this can be to the jaw depending on the location of the dissection.

An MI A is typically described as severe, crushing chest pain with an acute onset, this patient has been suffering from a 3-day history of chest pain which makes an infarction unlikely. Although myocardial ischaemia B , i.

A pulmonary embolism D typically presents with pleuritic chest pain, cough and haemoptysis which are not present in this patient, or preceding risk factors such as long haul travel or surgery. Pneumonia E is associated with fever and productive coughing.

Since the patient has had an adequate response to GTN spray, further pain relief in the form of morphine B is unnecessary. In patients who are not allergic, mg of aspirin is recommended and ideally should be given in the ambulance. Although heparin C and warfarin E would provide good anticoagulant cover, they are slower to act and current guidance advises clopidogrel monotherapy D in those patients allergic to aspirin.

Cardiovascular Ventricular tachyarrhythmia 10 B This patient is suffering from a life-threatening ventricular tachyarrhythmia of which there are two types, sustained ventricular tachycardia and ventricular fibrillation. In ventricular fibrillation B the patient is pulseless and cardioversion is required.

If stable, patients can be cardioverted with amiodarone, if unstable, electrocardioversion is required. Torsades de pointes A presents with irregular QRS complexes and prolonged QT interval, a non-sustained ventricular tachycardia D is defined by more than five consecutive heart beats within 30 seconds, while a normal heart ventricular tachycardia E is a benign tachyarrhythmia.

Answers A , D and E are not shockable rhythms. Jugular venous pressure 11 D The JVP provides clinicians with information regarding right atrial pressures and filling. It mainly consists of five wave forms: A raised JVP with normal waveform pattern A is usually seen in fluid overload and right heart failure.

Large v waves B are usually seen in patients with tricuspid regurgitation. Heart failure 12 A Cardiomegaly B , bilateral pleural effusions C , alveolar oedema D and Kerley B lines E representing interstitial oedema are all features that can be seen in a chest x-ray in patients with congestive cardiac failure.

Father has Autosomal dominant disease. Mother is normal with no family history of the disease. Dominant trait expresses in a homozygous state b heterozygous state c both homo and heterozygous state d males. All of the following are autosomal dominant disorders except a tuberous sclerosis b polyposis coli c cystic fibrosis d myotonic dystonia. Achondroplasia is inherited as a autosomal dominant b autosomal recessive c x-linkeddonlinant d x-linked recessive.

All are Autosomal recessive except a -Cystic fibrosis b Hypercholesterolemia c Wilsons disease d Sickle cell anemia. Pick out product manufactured at present by genetic engineering a Interferons b Rabies vaccine c Gammaglobulin d Tuberous sclerosis.

All of the following are autosomal recessive except a Albinism b Alkaptonuria c Cystic fibrosis d Tuberous sclerosis. Which is not X-recessive? Commonest chromosomal anomaly a fragile b trisomy 21 c trisomy 13 d trisomy Mode of action of actinomycin — D is to prevent: The most important investigation for diagnosis would be: Chemoprophylaxis is used in all except a Malaria b Typhoid c Meningococcal meningitis b gram negative enterobacteriae.

Endotoxic shock is due to a gram positive bacteria b gram negitive entrobacteriae c viruses d gas gangrene Ans: The endotoxin which leads to endotoxic shocks is actually a Lipoprotein b Lipopolysaccharide c Polysaccharide d Polyamide.

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Probenecid excretion is increased by a penicillin b cephalosporin c NaHC d tetracycline. Immunoglobulin administration is life saving in one of the following conditions: True statement regarding Ciprofloxacin is a Excreted mainly through bile b Antacid when given with, facilitates absorption c It can be given only orally d Belongs to Fluroquinolones group.

The antibiotic which is acid labile is a Ampicillin b Cloxacillin c Gentamicin d Methicillin. Drug of choice in pseudomonas septicemia is: The half life of chloroquine is: Which of the following combination is not synergistic a Penicillin and streptomycin in endocarditis b Amphotericin B and flucytosine in cryptococcal meningitis c Penicillin and chlortetracycline in pneumococcal meningitis d Sulphamethoxazole and trimethoprim in UT1.

Nosocomial pneumonia is caused most commonly by a streptococcal b mycoplasma c gram negative bacteria d viruses. The persistence of one of the following clinical feature indicates very poor prognosis in a case of endotoxin shock: Treatment of travellers diarrhoea is a sulfaguanidine b Diphenoxylate and atropine c metronidazole d Chloromycetin and Streptomycin. The following are characteristic of central fever except a No diurnal variation b No sweating c decreased response to External cooling d Resistant to antipyretics.

Ampicillin is used in all except a Pseudomonas b Proteus c Streptococci d Staphylococci. First generation cephalosporins are not effective in… infection a Pseudomonas b Proteus c Streptococci d Staphylococci. Which of the following is a useful bedside test in septicemia assessment? Drug choice for pseudomonas septicemia are a carbenicillin b Gentamicin c tobramycin plus ticarcillin d Histoplasma.

Prognosis is related to incubation period in a Cholera b Rabies c Tetanus d Diphtheria.