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Medical MCQ Quiz 2022/2023

Total questions: 148

Worksheet time: 2hrs 46mins

Name
Class
Date
1.

Regarding adult polycystic kidney disease

a)

Inheritance is 100%

b)

Bleeding into cyst is a known complication

c)

Mitral valve prolapse is a recognized association

d)

Diverticular disease is a recognised extra renal manifestation

e)

Renal biopsy is indicated for diagnosis

2.

Below are TRUE regarding the symptoms of heart disease

a)

Pericarditis pain can be exacerbated by movement

b)

Grade 2 new york heart association (NYHA) grading of cardiac status involved a slightly compromised daily activity on severe exertion

c)

Wearing a tight collar may precipitate vasovagal type of syncope attack

d)

Fatigue is a symptoms of heart failure

e)

Stoke-adams attack is sudden loss of consciousness due to posture

3.

In thyrotoxicosis secondary to Grave’s disease, which of the following is true?

a)

Patients typically are above 40 years of age

b)

Biochemical results show elevated TSH with suppressed fT4

c)

Patients have diffuse goitre

d)

TSH receptor antibody is essential to come to the diagnosis

e)

It is an autoimmune disease

4.

Type 2 Myocardial infarction causes include

a)

Severe sepsis

b)

Shock

c)

Hypernatremia

d)

Severe anaemia

e)

Depression

5.

Regarding a 30 year old woman presenting with difficulty in climbing stairs and lifting objects overhead, diplopia towards evenings and a snarling smile:

a)

She is likely to have bilateral Babinski sign

b)

Her eye symptoms may have relief on placing ice pack on eyes

c)

Her tendon reflex will be normal

d)

Her disease is best diagnosed with a CT brain

e)

Her symptoms are likely to improve with pyridostigmine

6.

Regarding gastrointestinal and hepatobiliary causes of finger clubbing

a)

Cystic fibrosis

b)

Ulcerative colitis

c)

Hepatitis A

d)

Ascending cholangitis

e)

Cirrhosis of liver

7.

Causes of acute kidney injury include

a)

Acute pancreatitis

b)

Acute tubular necrosis

c)

Lupus nephritis

d)

Hepatitis A

e)

Tumour lysis syndrome

8.

The following are triggers for flare of systemic lupus erythematosus:

a)

Coffee

b)

Vaccination

c)

Infection

d)

Pollens

e)

Exercise

9.

24 years old lady presented to the emergency department with a sudden onset of shortness of breath and left sided chest pain. Her differential diagnoses would include:

a)

Left sided pneumothorax

b)

Left sided pleural effusion

c)

Pulmonary embolism

d)

Bronchial asthma

e)

Myocardial infarction

10.

A 28 years old IVDU was diagnosed of staphylococcus aureus bacteraemia. Potential complications include:

a)

Abscesses

b)

Hearing loss

c)

Intestinal perforation

d)

Glomerulonephritis

e)

Infective endocarditis

11.

You should order the following tests for a 50 years old man whose peripheral blood film showed Rouleaux formation and skull X ray showed multiple lytic lesions:

a)

Serum protein electrophoresis

b)

ECG

c)

Bone marrow aspiration

d)

Liver function test

e)

anti-HIV

12.

Regarding hyperkalemia

a)

Potassium level of more than 6.6 is life threatening

b)

Diuretics help to increase potassium loss through kidney

c)

Dietary potassium would not affect serum potassium level

d)

Most of the potassium in the body is present in the extracellular fluid

e)

Hypoaldosteronism can cause hyperkalemia

13.

The following features are suggestive of active rheumatoid arthritis

a)

Joint tenderness

b)

Joint deformity

c)

Morning stiffness

d)

Leukocytosis

e)

Raised C reactive protein

14.

Drugs causing hepatitis include

a)

Isoniazid

b)

Paracetamol

c)

Amiodarone

d)

Ethambutol

e)

Pyrazinamide

15.

A 50 year old farmer presented with cough associated with greenish sputum for 3 months. On examination, he had clubbing and coarse crepitation over both lungs. The causes of this condition include

a)

Smoking

b)

Tuberculosis

c)

Recurrent pneumonia

d)

Alpha 1 antitrypsin deficiency

e)

Cystic fibrosis

16.

Regarding a 75 years old man presenting with a masked face and shuffling gait

a)

His clinical signs will be typically asymmetrical

b)

He is likely to have bilateral ptosis towards evenings

c)

He is likely to have frequent falls from the early stage

d)

He is likely to have intention tremor

e)

He is likely to show symptomatic relief with levodopa

17.

Regarding pneumonia

a)

It leads to occlusion of the bronchi

b)

The CURB-65 scoring is used to guide hospitalisation

c)

Cavitation seen on the chest x ray is a characteristic feature

d)

Streptococcus pneumoniae causes atypical pneumonia

e)

Type 2 respiratory failure is a known complication

18.

Extra manifestations of inflammatory bowel disease include

a)

Uveitis

b)

Ankylosing spondylitis

c)

Erythema nodosum

d)

Erythema multiforme

e)

Primary sclerosing cholangitis

19.

Regarding nephrotic syndrome:

a)

Hypertension is a common feature

b)

Hyperlipidaemia is a known complication

c)

Salt restriction is important to control the oedema

d)

Hypercoagulopathy is a known complication

e)

Membranous glomerulonephritis is a recognized cause

20.

Disease manifestation of SLE

a)

Pancytopenia

b)

Renal stones

c)

Glomerulonephritis

d)

Achilles tendinitis

e)

Osteoporosis

21.

A 44-year-old farmer presented with fever and jaundice, what could be his diagnosis

a)

Viral hepatitis A

b)

Malaria

c)

Leptospirosis

d)

Measles

e)

HSV

22.

70 y/o man with known HPTN on treatment p/w sudden onset of right sided body weakness with dropping of his right face. The investigation of risk factor for his presentation would be

a)

Carotid Doppler US

b)

Echocardiogram

c)

Electrocardiogram

d)

Abdominal US

e)

Holter

23.

Diarrhoea caused by:

a)

Clostridium difficile

b)

Shigella sp

c)

Salmonella sp

d)

thyrotoxicosis

e)

hypoparathyroidism

24.

Clinical signs of haemolytic anaemia

a)

Hepatomegaly

b)

Splenomegaly

c)

Central cyanosis

d)

Sclera jaundice

e)

Positive murphys sign

25.

The following shows the murmur and its correct valve lesion

a)

Ejection systolic murmur - AS

b)

Early diastolic murmur - MS

c)

Mid systolic click with late systolic murmur – PS (in mitral valve prolapse)

d)

Pansystolic murmur – TR (mitral regurgitation)

e)

Austin Flint murmur – AR (is a rumbling diastolic murmur)

26.

20 yrs old man, came to ED with SOB. C-xray right sided pleural effusion...aspirate show transudate. What is differential diagnosis.

a)

Penumonia

b)

Connetive tissue disease

c)

Lung cancer

d)

CCF

e)

Hypothyroidism

27.

Features of multiple myeloma:

a)

Leukocytosis

b)

Immunoparesis

c)

Osteosclerotic lesions at skull

d)

Renal impairment

28.

A 58-year-old man was presented with polydipsia, polyuria, and weight loss of 5kg for 5 months. He also has a family history of Type 2 diabetes mellitus. What features did he had that helped to diagnose:

a)

HBA1c result of 5.6%. (>6.2)

b)

A single reading of fasting blood glucose 8mmol/L (>7.0)

c)

A single reading of random blood glucose 11.8mmol/L (>11.1)

d)

A capillary blood glucose of 5.6mmol/L

e)

Weight loss indicates insulin resistance

29.

A 35 year old woman, who presented with difficulty in walking, is found to have spastic right lower limb pain with hyperreflexia and positive babinski sign. Her upper limbs and cranial nerves were intact except for the relative afferent pupillary defect on the right side. There was also a past history of visual deficit in the right eye. Regarding her condition, select one or more:

a)

Both her pupils should constrict when light is shone in her left eye.

b)

Nerve conduction study will be useful for diagnosis of her condition.

c)

Her pupillary defect is suggestive of a third cranial nerve lesion

d)

She would need an MRI of the spine to look for white matter lesions

30.

Clinical feature of cirrhosis INCLUDE

a)

Cervical lymphadenopathy

b)

Testicular atrophy

c)

Splenomegaly

d)

Palmar erythema

e)

Hepatic bruit

31.

In the assessment of proteinuria in patients with underlying chronic kidney disease:

a)

The urine sample for albumin creatinine ration needs to be collected

b)

Urine albumin creatinine ratio sample should be first urine passed in the morning

c)

Protein creatinine ratio is more sensitve than albumin creatinine ratio

d)

Urine albumin creatinine ratio is not useful to detect microalbuminuria

e)

Women generally have higher albumin creatinine ratio than men

32.

A 52 year old man had bronchial asthma under polyclinic follow up for years. He was recently diagnosed of having hypertension and diabetes mellitus after a MI episode. He was started on treatment for these diseases. His cough, SOB and wheeze worsen after 2 weeks. Drugs that potentially worsen his airway symptoms includes

a)

ACI inhibitor

b)

Beta blocker

c)

Diuretic

d)

OHA

33.

Regarding cerebellar lesion:

a)

Visual filed defect is a presenting feature

b)

The clinical features manifest in contralateral limbs ipsilateral to the lesion site

c)

It is associated with a higher risk of brainstem compression compared to cerebral lesions

d)

Tendon reflexes are typically brisk

e)

CT scan is the ideal imaging study

34.

A 19-yo student was admitted to Emergency Department with septic shock. He had history of fever for 2 days. On examination, he is confused, had neck stiffness and generalised purpuric rashes were noted on his limbs and trunk.

a)

Gram stain of the skin scraping will reveal Gram negative diplococci

b)

Antibiotics must be given if blood cultures results is pending

c)

This patient need to be isolated

d)

Lumbar puncture is contraindicated if coagulopathy present

e)

Rifampicin needs to be given to close contacts

35.

Regarding pituitary adenoma

a)

Pituitary macroadenoma is defined as pituitary adenoma of more than 1.5cm

b)

Optic chiasma compression typically causes binasal hemianopia

c)

Patients with pituitary macroadenoma have risk of optic chiasm compression

d)

Patients with pituitary macroadenoma have higher risk of developing apoplexy compared to those with microadenoma

e)

The first line management of non-functioning pituitary macroadenoma is medical therapy

36.

The following statements are TRUE on infective endocarditis

a)

Surgical intervention should be considered in cases complicated with myocardial abscess

b)

Erythema marginatum is one of the diagnostic criteria Revised Jone Criteria

c)

Jones criteria is used as diagnostic criteria Modified Duke 's criteria

d)

In case of infective endocarditis due to Stapylococcus aureus, erythromycin is used as the alternative antibiotic if a patient is allergic to cloxacillin

e)

Transoesophageal echocardiography can be used to look for vegetations

37.

A 45 year old women with history of ESRD on CAPD presented to Emergency Department complaining abdominal pain and fever. Her last dialysis bag appeared cloudy. Which of these organisms are likely to be responsible?

a)

Enterococcus sp.

b)

Klebsilla pneumoniae

c)

Staphyloccocus aureus

d)

Staphylococcus epidermidis

e)

Escherichia coli

38.

Causes of hypercalcemia include

a)

Multiple myeloma

b)

Hypoparathyroidism

c)

Lung carcinoma

d)

Liver failure

e)

Diuretic use

39.

A 47 year old man presented with fever, jaundice and pain in right hypochondrium for 10 days. Physical examination also revealed tender hepatomegaly. Possible causes of his condition INCLUDE

a)

Dengue fever

b)

Meliodosis

c)

Liver abscess

d)

Pancreatitis

e)

Alcoholic hepatitis

40.

A 40 yo lady presented with SOB for a week. Chest Xray showed meniscus sign over right lung. Pleural tapping was haemoserous in color with protein of 40g/L, LDH of 500 U/L (Reference range for serum protein 60-80g/L and serum LDH is 125-220 U/L). Possible differential diagnosis includes

a)

Connective tissue disease

b)

Tb

c)

Hypothyroidism

d)

Parapneumonic effusion

e)

Congestive heart failure

41.

Common feature of myelodysplastic syndrome INCLUDE

a)

Anaemia

b)

Thrombocytopenia

c)

Prolonged APTT

d)

Huge splenomegaly

e)

Leukopenia

42.

The following statements regarding cardiac investigations are TRUE

a)

ST depression in lead V1 is an ECG feature of posterior ST elevation MI

b)

ECG changes of inferior ischaemia are found on V1-V2

c)

The normal cardiothoracic ratio on a chest xray (PA) is less than 50% 0.42 - 0.50

d)

Dissection of ascending aorta is seen as mediastinum widening on the chest xray

e)

A QT interval of 0.6s is a normal ECG finding

43.

Regarding ECG

a)

posterior leads V7-9 placed from left posterior axillary line to the left paraspinal region

b)

right sided chest leads indicated for inferior MI

c)

posterior STEMI shows ST depression on lead V1-3

d)

shortened PR intervals is one of JONES criteria for acute rheumatic fever

e)

prolonged PR interval is seen in infective endocarditis complicated with aortic root abscess

44.

Regarding heart failure,

a)

preserved ejection fraction HF is defined as EF>50%

b)

third heart sound is a feature of HF

c)

CKMB is a sensitive tool for HF

d)

enalapril reduces mortality rate in HF

e)

ventricular fibrillation is a possible complication of reduced EF HF

45.

45 year sold woman presented with SOB on exertion for 1 year,dry cough, and Velcro fine crepitations bibasally. Possible underlying dx

a)

Alpha-1-antitrypsin deficiency

b)

Scleroderma

c)

SLE

d)

Cystic fibrosis

e)

Bronchogenic carcinoma

46.

Causes of false positive hematuria on urine dipstick

a)

Renal calculi

b)

Myoglobinuria

c)

Haemoglobinuria

d)

Glomerulonephritis

47.

Regarding Bell’s palsy,

a)

Lesions at pons

b)

UMN plus LMN

c)

Present with deafness

d)

Caused by varicella zoster infection

e)

Complication is corneal damage

48.

Elderly gentlemean with underlying HPT of 10 yrs&hx of MI 2 years ago presented with right hemiplegia with speech problems.Dx is TACI. Which of the following statements are true for this patient?

a)

Speech problem is aphasia

b)

Likely to have homonymous hemianopia

c)

CT brain shows well-defined infarct,it’s too late for thrombolysis

d)

No need ng tube since brainstem is unlikely affected

49.

Regarding Graves dx:

a)

No family hx

b)

Autoimmune dx

c)

Untreated pts have higher risk of developing atrial fibrillation

d)

Anti-thyroid medication needs to be taken atleast 36 months to reach remission

e)

Patient relapse after remission,treatment of choice is surgery

50.

Causes of nephritic syndrome

a)

PSGN

b)

Membranous glomerulonephritis

c)

MCD

d)

IgA nephropathy

e)

Anti-GBM dx

51.

Followin causes of liver cirrhosis and their features correctly match:

a)

alpha-1-antitrypsin deficiency-emphysema

b)

Hemochromatosis-slate grey and diabetes

c)

Wilson dx-Kay Fischer ring

d)

Primary biliary cirrhosis-Xanthelasma

e)

Autoimmune hepatitis-Anti smooth muscle antibody

52.

Clinical picture of dengue 5th day fever.Low BP,low WBC,plt is 45,Hematocrit is 42,NS-1 negative

a)

Dengue excluded

b)

Admit for IV hydration

c)

Currently is defervescence phase

d)

FBC daily if no admission

e)

Gum bleed is warning sign

53.

56y/o man,fever 3wks,no other focal symptoms,no LOW.Mild hepatosplenomegaly,leukocytosis.Normal RPand LFT.Us-liver and spleen shows multiple abscess.

a)

Drain abscess

b)

Empirical abx while awaiting blood culture result

c)

Mantoux test to help dx

d)

Causative organism is gram -ve

e)

CT scan needed to look at occult abscess

54.

The following are the typical investigation findings for the stated condition/dx:

a)

Absolute neutrophil<0.5x10-Neutropenic fever

b)

Presence of JAK2 mutation-polycythemia rubra vera

c)

Macrocyti anemia-warm autoimmune hemolytic anemia

d)

Microangiopathic hemolytic anemia-DIVC

e)

Isolated leucopenia-Aplastic anemia

55.

Schistocytes on PBF can be found in:

a)

Evans syndrome

b)

TTP

c)

HELLP

d)

Catastrophic APS

e)

DIVC

56.

25 y/o female,known case of SLE with history of recurrent miscarriage.Which lab findings suggest atiphospholipid syndrome?

a)

Prolonged aPTT

b)

Reduced C3&C4

c)

Increased plt count

d)

+ve anticardiolipin antibodies

e)

Raised ESR

57.

30-year-old woman presented with fever and athralgia for 2 weeks.She has history of painful finers upon exposure to cold for 2 months. Likely underlying exposure INCLUDES

a)

osteoathritis

b)

systemic sclerosis

c)

SLE

d)

viral infection

e)

psoriatic arthropathy

58.

The following are known case of Alzheimer’s dx:

a)

Apolipoprotein E3

b)

Fam hx

c)

Mutation of amyloid precursor protein gene

d)

Low education

e)

Trisomy 21

59.

Regarding genital wart

a)

Caused by herpes simplex virus type 2

b)

Screeing of HV is not indicated

c)

Biopsy of skin lesion indicated for the dx

d)

Anal canal should be examined

e)

Transmission is predominantly sexually

60.

Risk stratification for chest pain

a)

Gender

b)

Age

c)

Current use of aspirin

d)

Crepitation

e)

ECG ST changes

61.

Fever,Erbs point diastolic murmur,roth spots seen on fundoscopy,nail streaks

a)

Mycotic aneurysm

b)

Aortic root abscess

c)

Lung abscess

d)

Thromboembolic stroke

e)

3rd degree heart block

62.

22 year old, SOB late night and due to cold. Also has allergic rhinitis. Which med suitable for her?

a)

Inhaled saba

b)

Inhaled sama

c)

Inhaled corticosteroid

d)

Oral leukotriene receptor antagonist

e)

Oral theophylline

63.

50+ y/old male farmer presented with sob & cough. Ix is done.

a)

FEV/FVC:0.6, positive reversible test- COAD

b)

FEV/FVC:0.5, negative reservible test - AEBA

c)

FEV/FVC: 0.8, FVC:50% - ILD

d)

CXR: Trem-line - Bronchiectasis

e)

CXR: Unilateral loss of pulmonary marking - Pneumothorax

64.

Subarachnoid haemorrhage:

a)

Hemiplegia is the most common presentation.

b)

White in sulci on ct brain for diagnosis

c)

Known complications of adpkd

d)

Has worse morta0lity rate than ischemic stroke

65.

What test have to regularly performed to assess chronic diabetes mellitus complication?

a)

CT brain

b)

urine albumin

c)

fundoscopy

d)

liver function test

e)

monofilament test

66.

Causes of positive urine dipstick ketone include:

a)

Metformin toxicity

b)

DKA

c)

severe volume depletion

d)

starvation

e)

Chronic Kidney Disease

67.

Regarding nephrotic syndrome

a)

Oval fat body is uncommon finding

b)

Malnutrition is known complication

c)

HPT is common clinical features

d)

Hypercoagulability causing recurrent infection

e)

Renal vein thrombosis causing AKI

68.

Boy coming with 20 times loose stool, sign u look for ;

a)

sunken eyes

b)

dry tongue

c)

confusion

d)

polyuria

e)

lack of skin elasticity

69.

Regarding hepatitis B prevention

a)

should have barrier method when with partner

b)

do not share toothbrush

c)

get the partner to take vaccination if has -ve HBsAg

d)

should not donate blood

e)

can donate sperm

70.

17 y/o female NKMI p/w fever, flu, sore throat a/w vomiting, diarrhea for 2 days. She noted rash on the face, spreading progressively to the neck, trunk amd limbs. No h/o similar contact or travelling.

a)

Ns1 antigen is negative

b)

She does not need to be isolated

c)

Oophoritis is a complication

d)

Treatment is antiviral such as acyclovir

e)

Koplik spot would be absent

71.

25 years old student presented with fever, arthralgia and myalgia for 5 days. There is recent fogging. What criteria to admit him?

a)

Abdominal pain

b)

Confusion

c)

Wide pulse pressure

d)

Spontaneous gum bleeding

e)

Diarrhea more than 3 times/day

72.

Compared to random donor platelet transfusion, apheresis platelet is better because it can reduce the risk of reaction

a)

AHTR

b)

FNHTR

c)

TRALI

d)

Graft vs Host disease

e)

Circulatory overload

73.

28 y/o with known SLE, presented with bilateral limb weakness. Power 4/5 Muscle tone, muscle reflex amd coordination is normal. Plantar reflex is downgoing. The most likely caused of her symptoms is

a)

cortocosteroid

b)

hydroxy

c)

Polymyosistis

d)

Cervical myeopathy

e)

Vitamin D

74.

Regarding environmental measure for delirium

a)

Overstimulation is required

b)

Family care not required

c)

Sleep not important

d)

ambulation is not important

e)

Avoid Sensory deprivation

75.

Regarding leprosy

a)

Thickening of peripheral nerve is a feature

b)

Tuberculoid with numerous skin lesion

c)

Tuberculoid with inflammatory nerve Tube

d)

Lepromatous leprosy positive skin slit biopsy

e)

Lepromatous leprosy treatment should be 6 months

76.

48 yo man dx with hypertension, on amlodipine, but bp still high, 170/90. Wat is the choice of add on drugs

a)

ACE inhibitor

b)

ARB

c)

Beta blocker

d)

Non dihyropyridine CCB

e)

Potassium sparing diuretics

77.

which of the followings support the initiation of anticoagulants?

a)

Heart failure

b)

Valvular disease

c)

Htn

d)

Dm

e)

Hyperthyroidism

78.

54 year old lady, p/w sudden onset of SOB & left sided chest pain especially on deep inspiration. Examination: lungs clear but spo2 85% on room air and BP 90/50mmHg. What are relevant immediate investigations?

a)

Chest x-ray

b)

Spirometry

c)

Electrocardiogram

d)

D dimer

e)

Cardiac enzymes

79.

66 year old gentleman p/w fever, cough, greenish sputum, sob. CXR revealed cavitation at right upper lobe.

a)

PTB

b)

VIRAL PNEUMONIA

c)

FUNGAL LUNG INFECTION

d)

LUNG TUMOUR

e)

KLEBSIELLA PNEUMONIA

80.

Match correctly

a)

MG- autoimmune process causing neuromuscular junction

b)

GBS- ischemic of nerve root

c)

Multiple sclerosis- dysfunction of anterior horn cell

d)

Parkinson- degeneration of substantial nigra

e)

Alzhemier - degradation of basal ganglia

81.

Regarding stroke,

a)

hemorrhagic stroke more common than ischemic stroke

b)

contralateral 7 th cranial nerve if lesion in internal capsule

c)

TACI poorer prognosis than Lacunar stroke

d)

if 9th and 10 th cranial nerve involve, it is likely brain stem stroke

e)

cerebellar stroke is part of anterior circulation

82.

Which of the following cause hypothyroidism ?

a)

Autoimmune

b)

Radioactive Iodine

c)

Post pituitary surgery

d)

Primary hypogonadism

e)

Post partum thyroiditis

83.

Which of the following statement is true regarding serum TSH?

a)

It is low in subclinical hyperthyroidism

b)

It is normal in subclinical hypothyroidism

c)

It suppresses T3 toxicosis

d)

It needs to be monitored in hypothyroidism patient whom on L-thyroxine therapy

e)

It is the first to be affected in thyroid disorder

84.

Hyperkalemia ECG changes

a)

Tall tented T wave

b)

Presence of u wave

c)

Tall P

d)

Wide QRS interval

e)

ST elevation

85.

Anemia in ESRF

a)

Iron deficiency common

b)

Hypochromic microcytic

c)

Erythropoietin at Hb<13

d)

IV Fe is indicated for absolute iron deficiency

86.

Causes of cirrhosis

a)

Chronic Hep B

b)

Hep D

c)

Wilson

d)

Autoimmune hepatitis

e)

Alcohol

87.

Regarding autoimmune hepatitis

a)

associated with autoimmune haemolytic anaemia

b)

it is a cause of cirrhosis

c)

infertility is a complication

d)

anti-smooth muscle antibody is present

e)

can be treated with cholestyramine

88.

45yo man, prison warden, heavy smoker, type 2 DM, p/w fever, cough, night sweat, LOW. He also noted abdominal distension. On examnation, abdomen soft, positive shifting dullness. Hb 10.6 g/dL, ESR 102mm/h.

a)

Echocardiogram

b)

Blood culture

c)

Abdominal paracentesis

d)

Anti-nuclear antibody

e)

HbA1C

89.

  1. Regarding pneumothorax

a)

  • It would cause reversible atelectasis to the lungs.

b)

  • It would further decrease the intrapleural pressure.

c)

  • Marfan syndrome is a known risk factor.

d)

  • Spirometry is to confirm the diagnosis.

e)

  • Chest water seal drainage is used as treatment.

90.

  1. Regarding UTI:

a)

  • Females have a higher risk.

b)

  • UTI in male needs to be investigated for structural abnormalities.

c)

  • Acute kidney injury is a potential complication.

d)

  • Pyelonephritis presents with dysuria.

e)

  • Indwelling catheter is a known risk factor.

91.

  1. About IBD

a)

  • Backwash ileitis in ulcerative colitis.

b)

  • Stricture and intestinal obstruction in ulcerative colitis.

c)

  • Increased risk of venous thrombosis in IBD.

d)

  • Ileal bladder fistula in Crohn disease.

e)

  • Risk of colon carcinoma higher in Crohn disease.

92.

  1. Regarding bronchial asthma

a)

  • It is a disease of lung parenchyma.

b)

  • Atopy is an association.

c)

  • Worsens in the early morning.

d)

  • PEFR is used to confirm the diagnosis.

93.

  1. Which of the following should be routinely monitored during follow up of a patient with T2DM?

a)

  • Lipid profiles.

b)

  • Blood pressure.

c)

  • Oral glucose tolerance test.

d)

  • Body mass index.

e)

  • Urine for protein.

94.

  1. Modified Duke Criteria include

a)

  • Persistent bacteremia.

b)

  • Vascular phenomena.

c)

  • Echocardiographic evidence of vegetation.

d)

  • Dextrocardia.

e)

  • Hypothermia.

95.

  1. Polydipsia polyuria

a)

  • Cranial diabetes insipidus.

b)

  • SIADH.

c)

  • DM.

d)

  • Hypocalcemia.

e)

  • Primary polydipsia.

96.

35 years old man presented with fever and heart murmur. What is the supportive evidence to diagnose infective endocarditis?

a)

  • Palmar erythema

b)

  • Retinal haemorrhage

c)

  • Splenomegaly

d)

  • Microscopic haematuria

e)

  • Haemolysis

97.

A woman presented with polyuria and polydipsia for 4 years. Likely diagnosis? (hypercalcaemia, chronic renal insufficiency, hyperaldosteronism, pyelonephritis)

a)

  • Diabetes insipidus

b)

  • Diabetes mellitus type 2

c)

  • Prolactinoma

d)

  • Hypoparathyroidism

e)

  • Diuretic usage

98.

Intermittent fever for 2 months

a)

  • SLE

b)

  • Melioidosis

c)

  • TB

d)

  • Lymphoma

e)

  • Pneumonia

99.

35 years old woman with 1 month history of fever, multiple joint pain, painful discolouration of fingers on exposure to cold. She noticed her fingers become very pale, then turn blue, then red. Possible underlying cause: (Raynaud’s phenomenon)

a)

  • Rheumatoid Arthritis

b)

  • SLE

c)

  • Rheumatic fever

d)

  • Septic Arthritis

e)

  • Systemic sclerosis

100.

Tumour Lysis Syndrome

a)

  • Usually after chemotherapy

b)

  • Characterised by hypercalcemia, hyperkalemia & hyperuricaemia

c)

  • High risk in DM

d)

  • Invariably cause permanent renal failure

e)

  • Diagnosed by renal ultrasound

101.

The following correlate with each other

a)

  • Multiple myeloma – reduced ESR

b)

  • JAK 2 mutation – chronic myeloid leukemia

c)

  • Hereditary spherocytosis – microcytic hypochromic anemia

d)

  • Liver cirrhosis – macrocytic anemia

e)

  • Myelodysplastic syndrome – pancytopenia

102.

40 years old presented with low back pain for 3 months. Diagnosis with AS

a)

  • Back pain relieved by rest

b)

  • Raised calcium level

c)

  • Urinalysis – haematuria

d)

  • History of sexual promiscuity

e)

  • Patient can’t touch the toe bending forward

103.

65 years old lady with rheumatoid arthritis presented with left knee swelling 2 days ago. Currently on methotrexate and sulfasalazine

a)

  • Osteoarthritis needs to be considered as differential diagnosis

b)

  • Normal WCC in blood culture can rule out septic arthritis

c)

  • Joint aspiration is indicated

d)

  • Intra-articular corticosteroid is first line of treatment

104.

Regarding mini mental state examination, the following component and brain part is correctly matched

a)

  • Serial 7 and WORLD

b)

  • Copy pentagon – parietal lobe

c)

  • Learning and delayed recall – parietal

d)

  • Calculation – parietal lobe

e)

  • Verbal fluency – parietal lobe

105.

Rheumatological disease with AR

a)

  • Systemic sclerosis

b)

  • Gout

c)

  • Rheumatoid arthritis

d)

  • Ankylosing spondylitis

e)

  • Reactive arthritis

106.

Complication of IE

a)

  • Mycotic aneurysms

b)

  • Thromboembolic stroke

c)

  • Lung abscess

d)

  • Aortic root abscess

e)

  • Third degree heart block

107.

50-year-old man with cough and wheezing for 2 months, spirometry done FEV1=21, FVC=31. What is the diagnosis?

a)

  • CCF

b)

  • Asthma

c)

  • COPD

d)

  • ILD

e)

  • Obstructive sleep apnea

108.

Cranial nerve and manifestation correctly match

a)

  • Left CN 2: absent consensual light reflex in right eye

b)

  • Left CN 4: head tilted to the right

c)

  • Right CN 7: drop of the right upper lip

d)

  • Right CN 8: Weber lateralised to the left

e)

  • Right CN 12: Tongue deviated to the left

109.

Delirium

a)

  • Progressive over the weeks

b)

  • The symptoms frequently fluctuate over the days

c)

  • May mimic dementia

d)

  • Anti-acetylcholine esterase is a drug of choice

e)

  • Restraint is recommended in delirious patient

110.

Choose appropriate sign with conditions

a)

  • Gum hypertrophy (Severe aplastic anemia)

b)

  • Murphy sign (hereditary spherocytosis)

c)

  • Hemiplegia (polycythaemia vera)

d)

  • Positive shifting dullness (haemochromatosis)

e)

  • Splenomegaly (undertransfused thalassemia major)

111.

50 y/o with coarse facial features, bitemporal hemianopia, elevated IGF-1 & non-suppressible GH. Investigation to screen for complications

a)

  • Water deprivation test

b)

  • Echocardiogram

c)

  • MRI adrenal

d)

  • Colonoscopy

e)

  • Bone mineral density scan

112.

Features of Parkinson’s disease

a)

  • Asymmetrical is typical feature

b)

  • Finger-to-nose test makes it worse

c)

  • Levodopa is able to arrest the disease progression

d)

  • Vertical gaze is characteristically affected

e)

  • Deep brain stimulation is one of the treatment options

113.

Causes for increased urea production

a)

  • GI bleeding

b)

  • Trauma

c)

  • Pregnancy

d)

  • Liver failure

e)

  • Corticosteroid therapy

114.

Signs & symptoms of uremia

a)

  • Pallor

b)

  • Flapping tremor

c)

  • Halitosis breath

d)

  • Pericarditis

e)

  • Vomiting

115.

Causes of constipation

a)

  • Hypercalcemia

b)

  • Hyperkalemia

c)

  • Low fibre intake

d)

  • Dehydration

e)

  • Hypothyroidism

116.

Drugs that increase liver enzymes

a)

  • Ethambutol

b)

  • Rifampicin

c)

  • Isoniazid

d)

  • Pyrazinamide

e)

  • Streptomycin

117.

47 y/o logging camp worker with fever, jaundice, hepatomegaly – severe manifestation

a)

  • Serum HCO3 (VBG) 10

b)

  • RBC 12

c)

  • Urine output 15 ml/hr

d)

  • Oral temp 40°C

e)

  • Hb 11

118.

25 y/o lupus nephritis treated, now with confusion – likely causes

a)

  • Stroke

b)

  • Encephalitis

c)

  • Sepsis

d)

  • Side effect of prednisolone

e)

  • Hyponatremia

119.

Non-valvular atrial fibrillation – risk factors for cardio-embolic stroke

a)

  • Smoking

b)

  • Family history

c)

  • Hypertension

d)

  • Diabetes mellitus

e)

  • Male sex

120.

50 y/o with mitral valve surgery, fever, systolic murmur – next step

a)

  • Stop warfarin while on antibiotics

b)

  • IV Ceftriaxone as preliminary antibiotics

c)

  • S. aureus most likely organism

d)

  • Prosthetic valve indicates poor prognosis

e)

  • 3 sets of blood culture should be taken

121.

Regarding atrial fibrillation

a)

  • Dabigatran is not indicated in severe mitral stenosis

b)

  • Rhythm control is not indicated in young patients with normal echocardiogram

c)

  • Rate and rhythm control does not affect mortality

d)

  • CCF worsens at the risk of stroke

122.

Pulmonary embolism risk factors

a)

  • Anaemia

b)

  • Occult malignancy

c)

  • Thrombocytosis

d)

  • Nephrotic syndrome

e)

  • Hyperlipidemia

123.

Risk factor – organism pairing

a)

  • DM – Klebsiella

b)

  • IVDU – Staph aureus

c)

  • Water heating system exposure – E. coli

d)

  • Aspiration pneumonia – Anaerobes

e)

  • Bronchiectasis – Pseudomonas

124.

Regarding seizure

a)

  • Seizure caused by postural hypotension due to brain ischemia

b)

  • Generalized tonic-clonic due to focal seizure

c)

  • Driving restriction is warranted

d)

  • Carbamazepine is the first choice in generalized tonic-clonic seizure

e)

  • Focal seizure is cortical lesion

125.

Fever, jaundice, diarrhoea, conjunctival suffusion – investigation

a)

  • Hep A serology

b)

  • BFMP

c)

  • Creatinine phosphokinase

d)

  • Hep C serology

e)

  • Melioidosis serology

126.

Multiple thyroid nodules, hoarseness, euthyroid – true statements

a)

  • Anti-hyperthyroid can be given as treatment

b)

  • Thyroid scan reveals cold nodule

c)

  • Follicular thyroid carcinoma is commonest

d)

  • Ultrasound shows hypoechoic nodule

127.

Possible causes of nephritic syndrome

a)

  • IgA

b)

  • Focal segmental glomerulosclerosis

c)

  • Minimal change disease

d)

  • Alport syndrome

e)

  • Membranous glomerulonephritis

128.

35 y/o nephrotic syndrome, IF shows C3 & IgG – management

a)

  • Hepatitis serology should be done

b)

  • Immunosuppressants

c)

  • Corticosteroids

129.

Factors precipitating porto-systemic encephalopathy

a)

  • Constipation

b)

  • GI haemorrhage

c)

  • Transjugular intrahepatic portosystemic shunt

d)

  • Diuretics

e)

  • High carbohydrate diet

130.

23 y/o from Matang with myalgia, arthralgia, hepatomegaly, thrombocytopenia & leukopenia

a)

  • Gram negative with similar presentation

b)

  • Melioidosis serology must be done

c)

  • IV bolus hydration

d)

  • Persistent vomiting is a warning sign

e)

  • Antiviral can be given

131.

Regarding Hep B

a)

  • It is a DNA virus

b)

  • It is transmitted via blood products

c)

  • Hepatitis B is transmitted by IVDU

d)

  • HBs antigen is positive 1 week after exposure

e)

  • Anti-HBs alone indicates vaccination

132.

Standard treatment for the diagnosis

a)

  • TTP – Platelet transfusion

b)

  • IDA – Blood transfusion

c)

  • Anaemia of chronic disease – Hematinic

d)

  • Immune thrombocytopenia – Prednisolone

e)

  • G6PD deficiency – Cholestyramine

133.

Lab findings – diagnosis

a)

  • Rouleaux formation – Multiple myeloma

b)

  • BCR-ABL1 – Chronic myeloid leukemia

c)

  • Macrocytic anemia – ESRF

d)

  • MAHA – DIC

e)

  • Pancytopenia – APML

134.

Diagnosis – features match

a)

  • RA – Chronic asymmetrical arthritis

b)

  • SLE – Chronic symmetrical polyarthritis

c)

  • AS – Chronic sacroiliitis

d)

  • Septic arthritis – Acute monoarticular arthritis

e)

  • Psoriatic arthritis – Acute symmetrical polyarthritis

135.

50 y/o with chronic gout, pallor, BP 190/100, Hb 8.5 – next step

a)

  • Digital rectal examination

b)

  • Bone marrow aspiration

c)

  • Iron study

d)

  • BUSE

e)

  • Hb electrophoresis

136.

Pertaining osteoporosis

a)

  • It is a painful condition

b)

  • Secondary causes include corticosteroid therapy

c)

  • Stop smoking is part of management

d)

  • Post-menopausal fragility fracture is a cause of secondary osteoporosis

e)

  • Skull is a common

137.

Regarding multibacillary leprosy:

a)

  • More than 5 skin lesions

b)

  • Thickened nerve lesion or regional nerve

c)

  • Deformities of toes and fingers

d)

  • Skin biopsy shows tuberculoid granuloma with positive lepra bacilli

e)

  • Treatment includes dapsone and rifampicin for one month

138.

Aortic valve endocarditis

a)

  • Complete heart block is a known complication

b)

  • Emboli to coronary artery is a known complication

c)

  • Septic emboli is a complication

d)

  • Surgical if fungal endocarditis

e)

  • Low diastolic BP

139.

Regarding MI

a)

  • CXR is necessary before starting treatment

b)

  • Definitive treatment can’t be started till diagnosis is confirmed by troponin

c)

  • Nasal prong oxygen indicated

d)

  • Thrombolysis is indicated

140.

Life-threatening asthma

a)

  • Tachycardia

b)

  • Hypotension

c)

  • High grade fever

d)

  • Confusion

e)

  • Rhonchi

141.

FEV1 = 1.5 L & FVC = 1.8 (ratio 0.83, restrictive)

a)

  • Asthma

b)

  • COPD

c)

  • Lung fibrosis

d)

  • CCF

e)

  • Bilateral pleural effusion

142.

Parkinson’s disease features

a)

  • Asymmetrical

b)

  • Falls in early stage

c)

  • CT brain showed no lesion

d)

  • Inability to move up and down

e)

  • Bilateral Babinski sign

143.

Myasthenia gravis

a)

  • Anti-acetylcholine esterase antibody is indicated

b)

  • Repeated nerve stimulation confirms diagnosis

c)

  • Thymectomy is curable

d)

  • Anticholinergic is useful

e)

  • Ice pack is helpful in making diagnosis

144.

Investigation of complication of primary hyperparathyroidism

a)

  • Renal ultrasound

b)

  • Bone mineral density

c)

  • Visual field

d)

  • Colonoscopy

e)

  • Echocardiogram

145.

Investigations at clinic visit for patient with hypopituitarism on testosterone and cortisol

a)

  • Serum testosterone

b)

  • FBC

c)

  • PSA

d)

  • LH

e)

  • FSH

146.

HUS

a)

  • Generally occurs in adults

b)

  • Due to E. coli O157

c)

  • Linear Ig on immunofluorescence is hallmark of renal biopsy

d)

  • Majority result is ESRF

147.

True statements regarding gastric acid secretion

a)

  • Sight, smell stimulates gastric acid secretion from vagal stimulation

b)

  • Gastrin stimulates acid from parietal cells

c)

  • Somatostatin inhibits acid secretion

d)

  • Stomach secretion increases pH

e)

  • Ghrelin stimulates acid secretion

148.

True associations

a)

  • Anti-GBM – Whipple’s disease

b)

  • Liver kidney microsomal – Autoimmune hepatitis

c)

  • Anti-mitochondrial – Primary biliary cirrhosis

d)

  • ANA – Crohn’s disease

e)

  • Anti-dsDNA – Ulcerative colitis

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