SGH MCQ Library 2004 (Collated by William Ng) Edited with Answers!!!By Prof. Andrew Jordan,

Legend: Assoc. Prof Ming-Celine Dubosq,1. K-Code has the following choices Evil Intern Alan Ma

a) If 1, 2 and 3 are correct. At the Ron Dunbier Instituteb) If 1 and 3 are correct. For cramming, anally retentivec) If 2 and 4 are correct. 6th year Medical Studentsd) If 4 only is correct. Liverpool Inc.e) If all are correct. 2004

NB Most questions with choices from 1-4 are K-code unless otherwiseindicated.

5 weeks to go til exams!!!!3 weeks til elections!!!!

2. If questions have been repeated, they will not be fully redisplayed. Aaaargh!!!3. My editions are in square brackets [x]. Please ignore my commentswhich are for my own follow-up.

Mummy!!!

4. No answers that were scribbled on the original photocopies wereincluded.

A Short Read-me from Will Ng, Med VI 2004:

The motivation and the reason for me in writing these questions upis the bible quote that has appeared on every page. I must risk thesake of boring you and say again that it is because of God’s greatlove for me in Jesus that I do anything and everything, thoughnever with equal import or benefit, for my neighbours, friends,fellow students and, in the future, patients. I too hope that you willfind that first love in Him inspiring, transforming and real for you.

Thanks Will, you’re a CHAMP!!!!!!!!!Yours, Will (bachnwill@hotmail.com)

MCQ Lot #21. Instability with difficulty maintaining fracture reduction is a feature of which of the followingfractures?

No idea aboutorthopaedics!!!!

a) Fractured calcaneus.b) 3º Pott’s fracture.c) Fractured metacarpal.d) Impacted fracture of the neck of femur.e) Crush fracture of a lumbar vertebra.

2. Phenylketonuria is an important metabolic disorder, the harmful effects of which can beprevented by early diagnosis. Which of the following about PKU is FALSE?

a) PKU is due to a metabolic block in converting phenylalanine to tyrosine. Right!b) In untreated PKU, skin, hair and eyes are usually pale. Yeah!c) The children of untreated female PKUs are severely retarded. If phenylalanine levels

aren’t controlled ‡microcephaly anddefects in the kid!

d) PKU occurs in 20:10000 ppl in NSW. No. 1:10000e) The Guthrie test for PKU depends on a differential growth potential of b. subtilis. Yes that’s right.

3[wn1]. A man aged 48y has experienced 3 episodes of severe vertigo and nausea lastingm 1-48h during the past 2y. The attacks are associated with tinnitus and a feeling of fullness in left ear. There is some left-sided hearing loss to whispered voice and Weber’s test lateraliseshe left. Air conduction of the tuning fork sound is better than bone conduction bilaterally. Thest likely diagnosis is

These signs don’tseem to fit…

a) Meniere’s disease Yep!!!???b) Recurrent vestibular neuronitisc) Left acoustic neuromad) Vertebrobasilar insufficiencye) Chronic otitis media

4. A 65yo non-diabetic male presents with a 1y history of intermittent claudication due to aleft superficial femoral artery occlusion. He has taken his doctor’s advice to stop smoking andto exercise regularly. What are the chances of his circulation deteriorating to an extent thatbelow knee amputation will be necessary?

below knee amputation will be necessary?a) 0-10% Yep!! V. low chance.b) 0-20%c) 0-30%d) 0-40%e) 0-50%

5. Over 3d, a patient has developed increasing pain to the left side of the anus and into thebuttock. Examination reveals he is febrile (T38.2ºC) and there is a tender red swelling 5cmbehind the anus to the left of the midline. Rectal examination is painless and normal. Themost likely cause is

a) Perianal haematoma No. it’s thrombosedpile.

b) Pilonidal abscess Usually midlinec) Ischiorectal abscess Painful and palpable

on PRd) Perianal abscess OKEEDOKEE!!e) Infected sacral haematoma No way

6. In the treatment of an acute attack of ulcerative colitis, all of the following are useful excepta) Corticosteroid Yep!b) Oral anticholinergic drug No role in acute

attacks. Only inchronic diarrhoeawhen acute state isover.

c) Sulphasalazine Important in proctitisd) Blood transfusion May be important in

severe blood losse) Potassium supplements Yes!

7. Which of the following is INCORRECT regarding cutaneous herpes simplex infection?a) Eruptions are commonly precipitated by exposure to sunlight. Yeah!b) Atopic individuals are at particular risk from disseminated skin lesions. Yep!c) Pain is rare in the prodrome of an eruption. WRONG. It’s

COMMON!!d) Genital herpes may be transmitted to the foetus during parturition. Yep!e) Widespread or systemic involvement is mainly a feature of the 1st infective episode. Yep!

8. A thin 18yo man presents with a 1mth history of polyuria, thirst and blurred vision…A: he has pneumoniaB: He has syphilisC: He has diabetes insipidusD: He has maturity-onset-diabetes of the youngE: He has diabetes mellitus

Hmm…

9. A 64yo man presenting with lassitude but no history of blood loss, is found to have Fedeficiency anaemia. Gastroscopy, sigmoidoscopy and barium enema reveal noabnormality…

10. Given that haemoglobin values in a population have a normal distribution, then one canpredict, if the mean is 15g/100mL and the standard deviation is 1.5g/100mL, that

a) The Hb value ranges from 13.5-16.5. Nob) There is 95% accuracy within the range 13.5-16.5. Noc) There is a 5% error outside 13.5-16.5. Nod) About 2/3 of Hb values in the population lie between 13.5 and 16.5. Yeahe) More than _ of the Hb values lie between 13.5 and 16.5. ???!

11. A left homonymous hemianopia is likely to be associated witha) Normal visual acuity. Yeah!b) Right hemiplegia. No, LEFT!c) Nominal aphasia. No, LEFT!d) Unequal pupils. No relation!e) None of the above. Nope.

12. Which of the following is true concerning renal cell carcinoma (Grawitz tumour)?a) Always presents with haematuria. No

b) 5year survival is greater than 90% Noc) Daughter tumours can occur on bladder mucosa. Noped) Can be mistaken for a renal cyst on IVP. Yeah baby!!e) Responds well to irradiation and chemotherapy. No way

13. A 4th heart sound is commonly heard in1) Mitral stenosis No2) Severe aortic stenosis Yes3) Constrictive pericarditis No4) Acute myocardial infarction Yes!

14. Hydatid disease may be acquired by man by which of the following means? Echinococcusgranulosus. Lives indog gut‡ hangs abog‡ infects sheep(or human) who aresecondary hosts

1) Eating inadequately cooked lamb’s fry. Wrong. At Kempseyhospital…maybe…

2) Contact with the contents of hydatid cysts in the abattoir or on the farm. Wrong. You need toingest the dogpoo!

3) Contact with hydatid cysts in a dog. Wrong. Need thedogpoo!

4) Ingestion of parasite ova from an infested dog. Yes! Via the faecal-oral route!! Yumm…

15. Which of the following about coeliac disease is/are true?1) Small bowel biopsy is the most useful diagnostic tool. Indeed it is!2) Scrupulously maintained gluten free diet will avoid malignant complications. You still get the risk…3) Symptoms correlate poorly with degree of abnormality of small bowel histology. WRONG! The degree

of symptomsCORRELATES withhistopath!

4) The most frequently malignant complication is carcinoma of the stomach. Nope!

16. Myelofibrosis is characterised by1) Massive splenomegaly Yah!2) Marked poikilocytosis You get teardrop cells

and macro andmicrocytes…yes!!

3) Hepatomegaly Yep!4) Massive lymphadenopathy Very uncommon.

17. Which of the following measurements of lung function show a gradual reduction related toageing?

18. Bloody diarrhoea in a person travelling can be due to…

19. An increased incidence of thrombosis is found in persons with1) Sickle cell anaemia True2) Hemiplegia Yes. Cos of

immobilization3) Carcinoma of the pancreas Yes! Must think

pancreatic cancer4) Chronic myeloid leukaemia Yes, but not very

common.

20. A traveller eating uncooked salad vegetables in Indonesia runs a risk of acquiring whichof the following parasites?

1) Ascaris lumbricoides Faecal oral!!Contaminated soil orusing human manureas fertiliser will affectthis!

2) Entamoeba histolytica Comes fromcontaminated water!

3) Giardia lamblia That’s from water, ifthey wash it!

4) Wuchereria bancrofti Filariasis! It’s frommozzies baby!!

21. Which of the following is/are true of the most common variety of atrial septal defect?1) The lesion results from failure of growth of the atrial septum secundum. Yah2) The intracardiac shunt is almost always left-right. Yah3) Surgery is not indicated in the presence of a right-left shunt. Cos

EISENMENGER’SSYNDROME ah! Verybad lah!

4) Uncorrected, the lesion frequently results in heart failure in early childhood. Usually older lah

22. Following a car accident an asthmatic patient is noted on CXR to have surgicalemphysema over the left chest wall but no apparent pneumothorax. If assisted ventilationbecomes necessary (positive pressure), you would first

a) Prescribe salbutamolb) Insert a left intercostal drain Yes!~c) Insert an endotracheal tubed) Perform a repeat chest X-raye) Ensure humidification of inspired air

23. Which one of the following is/are correct for infective endocarditis?a) Staphylococcus aureus is the most common causative organism.b) The disease is often the result of dissemination of infection in rheumatic fever.c) The arterial endothelium is the commonest site of lesions.d) When complicating congenital heart disease [exist] it frequently is associated with

auricular fibrillation.e) Vasculitis is a manifestation of the disease. Yes!!

24. Which of the following statements is/are true of digoxin therapy?1) It is effective in controlling the ventricular rate in atrial fibrillation. Yes2) The presence of hypokalaemia may potentiate the effects of digoxin. Yes3) The presence of hypercalcaemia may potentiate the effects of digoxin. Yes4) Atrial fibrillation is a frequent toxic effect. No!!

25. Which of the following is/are true in relation to renovascular hypertension?

26. Which of the following is/are true of paroxysmal atrial tachycardia? It’s paroxysmalsupraventricular tachy

1) It is common in younger people, often in the absence of heart disease. Yes!2) The onset is usually preceded by atrial ectopic beats. Yes!3) A re-entry mechanism is usually responsible. Yes! The VAST

majority, e.g. WPW4) The QRS complexes are usually normal. Yes!!

27. A 60yo man complains of angina. Full physical examination reveals only generalisedpallor. A blood count reveals an Hb of 10.5g/dL and hypochromic microcytic RBC. You wouldfirstly

a) Prescribe oral iron and a _-blocker and see in 1mth’s time. No!b) Request a sigmoidoscopy and barium enema. No!c) Request a barium meal. No!d) Perform an endoscopy of the upper GIT.e) Give a blood transfusion. He is symptomatic

with mangina!!

28. Hepatic encephalopathy is likely to be aggravated by which of the following?

29. A 50yo woman, who does not admit to drinking in excess, complains of recent swelling ofthe abdomen. She has jaundice, ascites and hepatomegaly. The urine contains a trace ofprotein. Serum values are as follows:Bilirubin 80µM ALP 150U/LProtein 68g/L Albumin 25g/LALT 24U/LWhat is the likely diagnosis?

a) Cirrhosis Yeah…b) Metastatic disease with liver involvement No…c) Congestive cardiac failure Nod) Chronic active hepatitis Noe) Continuing or persistent hepatitis No

30. An alcoholic man is admitted with a 10d history of epigastric pain and vomiting. He hasminimal tenderness and rigidity in the epigastrium. The blood WCC is 13000 with 90%neutrophils and the serum amylase is 650U/L (normal <300) days after admission a mass inthe left of the epigastrium is palpable. Which of the following investigations would yourecommend to establish the cause of the mass?

a) Repeat WCC and amylase. Nob) A plain abdominal X-ray. Not very goodc) Barium meal. Stoopid?!d) An ERCP. No way!e) An US-scan of the epigastrium. Yeah – tell if

solid/cystic mass!

31. Which of the following is most characteristic of pyloric stenosis due to chronic duodenalulceration?

a) Vomiting immediately after eating. Not immediatelyb) Vomiting approximately 1h after eating. Yes! Is most

common?!c) Abdominal distension. Yesd) Heartburn due to oesophageal reflux. yese) Vomiting large amounts once a day. Yes. Is common.

32. A 50yo man complains of weight loss and tiredness. In the past he has been a heavydrinker. He is not anaemic but has a palpably enlarged liver and spleen. Serum values are:Bilirubin 10µM ALP 80U/LProtein 70g/L Albumin 40g/LALT 20U/LWhich of the following is true?

a) These results rule out cirrhosis. No way!b) Cirrhosis is the likely diagnosis. More likely in an

alcoholicc) Metastatic liver disease is the likely diagnosis. Not commond) A lymphoma is the likely diagnosis. Not commone) Chronic leukaemia is the likely diagnosis. Not common. Not

anaemic.

33. Which of the following is/are true regarding diagnostic tests for viral hepatitis?1) The presence of anti-HBsAg indicates past infection with hepatitis B. Indicates vaccination!!2) There is currently no diagnostic test for non-A/non-B hepatitis. No!!3) The presence of “e” antigen in HBsAg positive patients denotes potentially greater

infectivity.Yah!!!!

4) The appropriate antibody for recent hep A infections is IgM. Yes!!!

34. A 50yo man presents with 2y history of burning pains in the feet, pins and needles in thefingers and toes and weakness and unsteadiness of the legs. There is distal wasting andweakness in all limbs, glove and stocking sensory loss to all modalities and areflexia. Themost likely diagnosis is

a) Polymyositis Nob) Hereditary sensory motor neuropathy (Charcot-Marie-Tooth disease). Noc) Diabetic neuropathy Yes!!!!d) Acute post-infectious polyneuropathy (Guillain-Barre syndrome). Noe) Diabetic amyotrophy. Muscle – no!

35. Myoclonic jerks are associated with which of the following?1) Epilepsy Yes!!!!2) Normal sleep Yes!3) Subacute encephalitis Yes4) Uraemia Yes!

36. Which of the following is NOT true concerning Parkinson’s disease?

a) It frequently commences on one side. Yep!b) It causes postural hypotension. Yesc) It causes falls without loss of consciousness. Yesd) It causes involuntary stopping whilst walking. Yes.e) The tremor persists during sleep. No it doesn’t!!!

39. A 40yo lady presents with sudden onset of severe, global, throbbing headache, withnausea, photophobia, marked mental confusion and tachycardia. The most likely diagnosis is

a) Migraineb) Subarachnoid haemorrhage Bingo!!!!c) Meningitisd) Sagittal sinus thrombosise) Herpes simplex encephalitis

40. Which of the following is LEAST characteristic of meningococcal meningitis?a) Comab) Disseminated intravascular coagulationc) Purulent pharyngitis Not characteristic

baby!!d) Purpuric rashe) Adrenal haemorrhage

41. A 60yo man presents with increasing weakness in his legs over a 6mth period. He haswasting, weakness and fasciculations in UL mm especially the small muscles of the handand he has spastic paraparesis of and absent vibratory sense and proprioception in the LL.The most likely diagnosis is

a) Motor neurone diseaseb) Multiple sclerosisc) Cervical spondylosis with cervical myelopathy Yes, as we said

before, Craigy babytold us so

d) Subacute combined degeneration of the cord Noooooe) Alcoholic peripheral neuropathy

45. A 59yo man with chronic obstruction to airflow suffers an exacerbation of dyspnoea andis found to have RHF. Auscultation reveals expiratory rhonchi. The ABG has PaO2 of57mmHg and PaCO2 of 43mmHg. Which of the following could precipitate this?

1) Pneumothorax Yah!2) Myocardial infarction Yah!3) Increased airways obstruction Yah!4) Pulmonary embolism Yah!

46. Which of the following ABG data are the most consistent with an acute pulmonaryembolus?

Hyperventilate!

a) PaO2 60 PaCO2 40 BE -10 pH 7.30b) PaO2 55 PaCO2 35 BE -8 pH 7.4c) PaO2 55 PaCO2 30 BE +2 pH 7.52 Yes!!!!!!!d) PaO2 60 PaCO2 60 BE -8 pH 7.38e) PaO2 80 PaCO2 35 BE -15 pH 7.28

49. Patients suffering from infectious mononucleosis are likely to exhibit all of the followingEXCEPT

a) A positive Paul Bunnell test. Yes!b) A rising heterophil antibody titre against sheep red cells. Baaaah!!c) IgG red cell antibody. No. sounds weirdd) Abnormal large lymphocytes in peripheral blood. Yes!!e) Peripheral blood lymphocytosis. Yes!!!

50. Fever following a blood transfusion is most likely to be due to which of the following?

51. A 62yo man is admitted for repair of an inguinal hernia. Routine preoperative blood countreveals haemoglobin of 9.5g/dL, WBC of 50000/mm3. Differential WCC is as follows:neutrophils 10%, lymphocytes 89% & monocytes 1%. The platelet count is 160000mm3.Which of the following are likely to be found?

1) Positive Hess test.

2) Positive direct Coomb’s test.3) Elevated IgM levels.4) Generalised lymphadenopathy and splenomegaly. Yes. Sounds weird

like some weird bloodthing happening.

54. A 22yo lady presents for investigation of anaemia. She has a history of menorrhagia,easy bruising and prolonged bleeding after tooth extraction. Her father and 1brother are saidto be “bleeders”. Preliminary investigations reveal Hb of 9.0g/dL, with hypochromic andmicrocytic RBC. Bleeding time is 15 minutes (normal 3-7). The most likely diagnosis is

a) Haemophiliab) Factor XII deficiencyc) Christmas diseased) Von Willebrand’s disease Yep!e) Hypofibrinogenaemia

55. The Problem Oriented Medical record does nota) Enable quick data recallb) Present an up-to-date description of all the patient’s problemsc) Facilitate transfer of clinical data to professional colleaguesd) Provide a comprehensive list of differential diagnoses No!!e) Present a whole profile of the patient

56. In analgesic nephropathy1) Na and HCO3

- wastage by the kidney is often seen. Salt wasters!2) Severe hypertension may occur. Yes3) Acute renal failure may be obstructive. Yes. Slough papillae!4) Oedema is a prominent feature. No.

59. Which of the following is/are true in the treatment of Hypertension?1) The incidence of stroke and renal failure has been shown to be reduced. Yes2) Only the diastolic reading is of importance. No3) Adrenergic beta-blockers are relatively contraindicated in patients with obstructive

airways disease of peripheral vascular disease.Yes

4) K+ supplements are always necessary when a thiazide diuretic is used. no

60. A 74yo man presenting with a 2mth history of severe headache, weight loss, anorexia,pain and stiffness in pelvic and shoulder girdle musculature and ESR of 106mm/h is mostlikely to have

a) Dermatomyositisb) Rheumatoid arthritisc) Polyarteritis nodosad) Giant cell arteritis Yes!!!! Andrew has

stayed up til 1151pmto do this question.What a champ!!! He’snever been up thislate before!! Give thatman a medal!!

e) Metastatic carcinoma