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Created: 15/2/2005
51. A middle-aged man presents with painless rectal haemorrhage. The following is indicated:

a) barium meal
b) fibreoptic colonoscopy
c) a prothrombin time
d) an intravenous pyelogram
e) blood gas analysis

52. A patient has the following electrolyte results: Na+ 127 mEq/L, K+6.7 mEq/L. This could be caused by:

a) oliguric renal failure
b) hyperaldosteronism
c) pituitary insufficiency
d) Cushing's disease
e) Meig’s syndrome

53. In a patient with thyrotoxicosis:

a) atrial fibrillation is common
b) diabetes insipidus is a common complication
c) a hoarse voice is not uncommon
d) premedication with pethidine 50 mg, atropine 0.6 mg is the method of choice
e) hypertensive heart disease is a common association

54. In Crohn's disease:

a) the risk of subsequent malignant change is greater than in ulcerative colitis
b) anal lesions are infrequent
c) folate disturbances commonly cause megaloblastic anaemia
d) controlled trials have demonstrated steroids to be the medical treatment of choice
e) the eye signs are indistinguishable from ulcerative colitis

55. An increase in pulmonary vascular resistance is seen in:

a) shock
b) response to vasodilator therapy
c) acidosis
d) head injury
e) hypocapnia

56. Pruritus is seen in association with:

a) miconazole
b) uraemia
c) morphine overdose
d) scabies
e) pancreatitis

57. Carbon dioxide narcosis is associated with:

a) papilloedema
b) raised jugular venous pressure
c) thready pulse
d) cool periphery
e) muscle twitching

58. After major abdominal surgery (e.g. abdomino-perineal resection), the following metabolic changes would be expected to occur in the first 4 postoperative days:

a) an increased utilisation of glucose
b) a reduction in the amount of sodium excreted in the urine
c) a decrease in the free fatty acid concentration
d) an increase in the amount of potassium in the urine
e) an increase in the oxygen consumption per kg body weight

59. Jaundice due primarily to intrahepatic biliary obstruction (cholestatic jaundice) is a recognised complication of treatment with:

a) monamine oxidase inhibitors
b) C17-substituted testosterones
c) erythromycin estolate (Ilosone)
d) phenothiazines
e) alkylating agents

60. In Crohn’s disease:

a) the risk of subsequent malignant change of the mucosa is greater than in ulcerative colitis
b) anal tensions are infrequent
c) the demonstration of vitamin B12 malabsorption indicates involvement of the jejunum
d) eye signs indistinguishable from those complicating ulcerative colitis are found
e) controlled trials have found steroids to be helpful

61. Complications from using a central venous pressure (CVP) catheter for CVP measurement include:

a) a high incidence of thrombosis and phlebitis
b) a high incidence of predominantly fungal infections
c) abnormal readings of CVP
d) myocardial perforation of pericardial effusion
e) pneumothorax, if the subclavian vein is used

62. Carcinoma of the large intestine:

a) mostly originates in the ascending colon
b) mostly develops from a single polyp
c) may show signet ring features histologically
d) characteristically metastasises to the liver before the lymph nodes
e) is amenable to chemotherapy

63. Finger clubbing is a recognised feature of:

a) asbestosis
b) chronic bronchitis
c) fibrosing alveolitis
d) fibrocaseous tuberculosis
e) empyema

64. Carcinoma of the female breast:

a) is less common than carcinoma of the cervix
b) is unrelated to cystic hyperplasia of the breast
c) when intraductal in type may be associated with Paget’s disease of the nipple
d) carries a worse prognosis when auxiliary lymph nodes show proliferation of histiocytes and plasma cells
e) is prone to metastasis to the internal mammary lymph nodes

65. The following are characteristic of adrenal insufficiency:

a) hypotension
b) small heart
c) hyperkalaemia
d) increased fatiguability of striated muscle
e) hypoglycaemia

66. Regarding blood transfusions:

a) they are associated with an incidence of viral hepatitis of 1% or lower
b) an incompatible transfusion will cause a fall in fibrinogen
c) 1 unit of blood will raise the Hb value by 10% in 24 hours
d) they may result in pulmonary oedema
e) they are responsible for most cases of hepatitis C

67. Hypokalaemia is recognised as a complication of:

a) Zollinger-Ellison syndrome
b) small bowel fistula
c) treatment with bumetanide
d) Cushing’s syndrome
e) infestation with round worms

68. Paroxysmal atrial tachycardia can be controlled by:

a) carotid sinus pressure
b) beta-blocking drugs
c) atropine
d) intravenous bolus of lidocaine
e) stellate ganglion blockade

69. Radiologically, a large pulmonary artery on a chest X-ray is associated with:

a) infundibular pulmonary stenosis
b) atrial septal defect
c) Fallot’s tetralogy
d) pulmonary valve stenosis
e) Eisenmenger syndrome

70. A man of 50 years of age presents with a left-sided pneumonia. The following is indicated:

a) doxapram infusion at 2 mg/kg/h
b) blood culture
c) bronchoscopy
d) hydrocortisone infusion
e) physiotherapy with the Bird ventilator

71. A patient undergoing anaesthesia develops a blood pressure of 240/140 mmHg during the procedure. The initial treatment should include:

a) digitalisation
b) urinary vanillyl mandelic acid levels
c) IV guanethidine
d) diazoxide
e) phenoxybenzamine

72. A woman, aged 30 years, who has suffered from asthma suddenly becomes increasingly breathless. The following investigations are particularly useful:

a) ECG
b) peak expiratory flow
c) eosinophil count
d) serum glucose
e) clinical examination of sputum

73. Calcification on the chest X-ray in a single lesion is a feature of:

a) bronchial carcinoma




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