QUESTIONNAIRE 2019

1. All of the following drugs may be associated with hepatotoxicity. Which is most likely to
produce a cholestatic (jaundice) picture?
a. Acetaminophaen
b. Allopurinol
c. Cyclosporine
d. Nifedipine
e. Zidovidine

2. A specific antidote for mgt in drug poisoning due to beta adrenoceptor blocking agent is
a. Ca gluconate
b. Na thiosulphate
c. Iv gluconate
d. Dicobalt edetate
e. Cacl (alongside atropine for CCB)

3. The safest anti htn med recommended in pregnancy is

a. Propranolol
b. Chlorhalidone
c. Alpha methyldopa
d. Lisinopril
e. Nifedipine

4. A 70 years old woman with a hx of dm, htn, and recurrent uti is admitted with fever and
pyuria. Her urine output is poor. Antibiotics and dopamine are administered; the dopamine
dose is progressively titrated from 3g/kg to 30g/kg. the patient complains of chest discomfort.
An electrocardiogram discloses changes compatible with ischaemia in the anterior precordial
leads.

What is the likely cause for these electrocardiographic changes?

a. Interaction with dopamine receptors in coronary arterioles
b. Peripheral conversion of dopamine to norepinephrine
c. Interaction with cardiac adrenergic receptors 1
d. Interaction with cardiac adrenergic receptor 2
e. Interaction with peripheral adrenergic receptors
5. A 50 yrs old htn who is also a known smoker without other comorbidities would have one of
these drugs as part of therapy
a. Atenolol
b. Amlodipine
c. Captopril
d. Frusemide
e. Minoxidil

6. Concerning septic shock, the following are true except

a. There is increased peripheral vascular resistance (There’s vasodilation)
b. Level of vasopressors and cathecolamines are increased
c. There is reduced o2 delivery due to myocardial depression
d. Blood lactate is increased
e. Nitric oxide and bradykinin contribute to hypotension

7. The following are paraneoplastic disorders except

a. Dermatomyositis (lung/upper GI Ca)
b. Psoriasis
c. Pemphigus vulgaris (NHL)
d. Thrombophlebitis migrans (aka trousseir syndrome – assoc with CA pancreas, stomach)
e. Erythema gyratum repens

8. Skin manifestations of dm include the following except

a. Acanthosis nigricans
b. Lichen planus
c. Necrobiosis lipoidica
d. Furunculosis
e. Eruptive xanthomas

9. Who is at least risk for severe malaria?

a. Children
b. Pregnant women
c. Non-immune
d. Holoendemic
e. Travelers
10. Which is not implicated in the pathophysiology of severe malaria?
a. Cyto-adherence
b. Resetting
c. Sequestration
d. All of the above
e. None of the above

11. Which of the following is true in alport syndrome?

a. The presence of hematuria is typically benign (seen in female carrier)
b. The disorder is generally inherited as an autosomal recessive disorder (X-linked recessive)
c. Most patients have mutations in a gene coding for collagen (85%)
d. Blue sclerae are a common finding
e. The syndrome is characterized by the presence of profound sensorineural deafness

12. A 24 years old retro viral disease patient present with reducing urinary output, some
peripheral edema and serum creatinine of 3.3g/dl. The following may be found on the
investigation of this patient except
a. Urine albumin >3.3g/day
b. Hematuria
c. Normal blood pressure
d. Focal segmental glomerulosclerosis
e. Membranous nephropathy

13. A 28 year old boy met with an accident and sustained severe crush injury. He is most likely
to develop
a. Cystinuria
b. Hypophosphatemia
c. Hypocalcemia
d. Hyperphosphataemia
e. Hypouricaemia

14. Plasma urea / creatinine ratio of 20:1 may be seen in

a. Rhabdomyolysis
b. Ureteric calculi
c. Aki from blood loss
d. Chronic glomerulonephritis
e. Hypertensive nephropathy
15. metabolic complication of CRF include all of the following except
a. Hyperkalemia
b. Hypophosphatemia
c. Hypocalcemia
d. Hypokalemia
e. Metabolic acidosis

16. cresentric glomerulonephritis may be seen in all of the following except

a. Post streptococcal glomerulonephritis
b. Henoch-schonlein purpura
c. Anti basement membrane disease
d. Alport disease
e. Good pasture syndrome

17. a patient present with hemoptysis and hematuria few weeks after respiratiory tract
infection, ANCA antibodies are present. Likely diagnosis is
a. Good pasture syndrome (pulmonary and renal involvement + ANCA)
b. IgA nephropathy
c. HIVAN
d. Post streptococcal glomerulonephritis
e. Renal tb

18. A 52 year old man present with renal failure. His father died of renal failure three years ago.
Fundoscopy reveals hard exudates and neovascularization. The likely renal diagnosis is
a. Autosomal dominant polycystic kidney
b. Autosomal recessive polycystic kidney disease
c. Alport’s syndrome
d. Diabetes nephropathy
e. Hypertension (cotton wool exudate)

19. Preferred method for determining microalbuminuria is

a. Urinary dipstick
b. 24 hour urinary protein collection (less expensive + others)
c. Urinary A/C ratio in a spot voided sample
d. Urinary A/C ratio in a 24 hour collection (reserved for detection of early stage of DM
nephropathy)
e. Urine microscopy

20. Recurrent gross hematuria is seen in

a. HIVAN
b. IgA nephropathy (hallmark is self limiting exacerbation with gross hematuria)
c. Focal segmented glomerulosclerosis
d. Membranous nephropathy
e. Minimal change disease

21. an 80 year old woman with severe osteoarthritis is wheelchair-bound. She develops a
pressure ulvrt on her right buttock that involves the dermis; however, subcutaneous tissue and
deeper structures do not appear to be involved. In addition to efforts to increase mobility and
to relieve pressure, the most appropriate therapy is
a. Surgical debridement
b. Dry dressings
c. Wet dressings changed when dry
d. Wet dressing changed when wet
e. Topical antibiotics

22. Trismus as an early feature is most likely due to poisoning from bite of what class of snake
a. Hydrophidae
b. Elapidae (flaccid paralysis)
c. Colubridae (non-venomous)
d. Viperidae (local necrosis)
e. Atractaspididae

23. Which of the following is not typical of sepsis

a. Azotaemia
b. Hyperhlycaemia
c. Hypoglycaemia
d. Metabolic alkalosis
e. Erythroderma

24. A 25 year old intravenous drug abuser with fever has blood cultures obtained and 24h later
a report from the microbiology laboratory indicates the presence of gram positive cocci in
clusters. The identification of the organism and sensitivities are pending. The most appropriate
antibiotics would be
a. Penicillin
b. Nafcillin
c. Vancomycin
d. TMP/SMZ
e. Ciprofloxacine
25. Concerning severe pulmonary oedema
a. Cardiogenic causes are usually indolent in onset
b. The incidence is higher among Caucasians compared to blacks
c. The commonest cause among blacks is dilated cardiomyopathy
d. The pathophysiology may be idiopathic
e. Multiple blood transfusion may result in cardiogenic pulmonary oedema

26. concerning dynamic exercise, the following are true except

a. walking, jogging, swimming, 30-45mins, 3-4 days per week
b. improves dyslipidaemia
c. contraindicated in patients with hypertension
d. it should be graded
e. prevents depression

27. The following are causes of sinus bradycardia except

a. Anorexia nervosa
b. Hypokalemia
c. Hypothermia
d. Raised intracranial pressure
e. Hypothyroidism

28. The immunological features of infective endocarditis include

a. Tender erythematous macules on the palms/soles
b. Non-tender nodes in the hands and feet
c. Chronic glomerulonephritis
d. Petechial hemorrhages soft palate, pharynx
e. Splinter hemorrhage with a clear center

29. Concerning arrhythmias

a. In a normal heart, it may be rate or rhythm related
b. In a structurally diseased heart, it is common, serious and life threatening
c. In tachyarrhythmia, the main mechanism is by re-entry
d. In bradyarrhythmia, the main mechanism is by triggered activity
e. Sinus arrhythmia is mediated by stimulation of the sympathetic nervous system
30. which of the following statement concerning acute rheumatic fever is true?
a. Migratory polyarthritis occurs in 10% of patients
b. Syndenham’s chorea typically occurs early in the course of the disease
c. Erythema marginatum is a common finding occurring in 50% of cases
d. Secondary prophylaxis should be initiated in order to decrease recurrent episode of rheumatic
fever
e. Group A streptococci can usually be recovered in the upper respiratory tract of patients with
rheumatic fever

31. which of the following agents has been shown to reduce mortality in patients with
congestive heart failure?
a. Digitalis
b. Furosemide
c. Ramipril (ACEI)
d. Procainamide
e. Aspirin

32. What is the most common cause of pulseless electrical activity

a. Acidosis
b. Hypovolemia
c. Tension pneumothorax
d. Pericardial tamponade
e. Severe pulmonary embolism

33. Syncope
a. Followed by facial flushing suggests a tachyarrhythmia (vasovagal)
b. Without warning suggests a vasovagal episode (has an aura)
c. Occurring on exercise is a typical feature of mitral regurgitation (aortic stenosis, HOCM)
d. Is not treated by alpha blockers (alpha agonist used)
e. Is a feature of parkinson’s disease

34. In the investigation of suspected angina pectoris

a. The resting ECG is usually normal
b. Exercise induced elevation is blood pressure indicates significant ischaemia
c. A normal ECG during exercise exclude angina pectoris
d. Coronary angiography is only indicated if an exercise test(ETT) is abnormal
e. Physical examination is of no clinical value

35. Cerebral ischemia occurs when cerebral blood flow is less than:
a. 10ml/100g/mins
b. 20ml/100g/mins
c. 40ml/100g/mins
d. 50ml/100g/mins
e. 100ml/100g/mins

36. Bradykinesia, a decreased ability to initiate voluntary movement, as well as sustain

impedance to the examiner’s effort to extend the arm would most likely be due to lesion in
which of the following structures?
a. Anterior horn cell of the spinal cord
b. Descending corticospinal fibers
c. Basal ganglia
d. Internal capsule
e. Cerebral cortex

37. Which of the following would help exclude the diagnosis of seizure in a patient with sudden
loss of consciousness?
a. A brief period of tonic-clonic movements at the time of falling
b. An aura of a strange of or before falling
c. Sudden return to normal mental function upon awakening though with feeling of physical
weakness
d. Urinary incontinence
e. Laceration of the tongue

38. A thirty-five-year-old female has proximal weakness of muscles, ptosis and easy fatigability.
The most sensitive test to suggest the diagnosis is:
a. Muscle biopsy
b. CPK levels
c. Endrophonium test
d. EMG
e. MRI

39. A 45 years male presents with hypertension. He has sudden abnormal flinging movement in
right upper and lower limbs. Most likely site of haemorrhage is:
a. Substantia nigra
b. Caudate nuclei
c. Pons
d. Subthalmic nuclei
e. Lateral ventricle
40. Neurotransmitter deficiency or dysfunction has been found to play key role in pathogenesis
of some disorders. Which of these pairs illustrate this
a. Dopamine=migraine
b. Acetylcholine=Alzheimer disease
c. Glycine= guillian barre’s syndrome
d. Glutamine=myasthenia gravis
e. Serotonine=epilepsy

41. A physiological tremor is

a. Present at rest
b. Worsened by anxiety
c. Improved by beta-agonists
d. Familial
e. improved by alcohol

42. In the examination of the cerebrospinal fluid the following are true except
a. Opening pressure in adults is 250 to 300mmh2o f
b. Xanthochromic in subarachnoid hemorrhage
c. Cyto-albuminogenic dissociation is seen in guillian-barre syndrome
d. Glucose level less than two-third of plasma concentration is typical of viral meningitis
e. Cells predominate in fungal meningitis

43. One of these is a non-motor feature of parkinson’s disease

a. Dementia (cognitive non motor)
b. REM sleep behavior disorder (prodromal premotor symptom)
c. Constipation (prodromal premotor symptom)
d. Dyskinesia (motor)

44. Which of these is most likely to cause deviation of the trachea

a. A left basal pneumonia
b. A small right pleural effusion
c. Previous tuberculosis of the right upper lobe
d. Idiopathic fibrosing alveolitis (tracheal deviates towards lesion)
e. Pulmonary oedema
45. Transudative pleural effusion is caused by
a. Tuberculosis
b. Subphrenic abscess
c. Nephrotic syndrome
d. Pneumonia
e. None of the above

46. The following can cause cavities in the lungs except

a. Klebsiella pneumonia
b. Wegenner’s granulomatosis
c. Tuberculosis
d. Pulmonary infarction
e. None of the above

47. Which of these features suggest that a crackling sound is more likely due to a pleural friction
rub than crackles?
a. More prominent in expiration
b. Alters with coughing
c. No pain over the area
d. Clubbing
e. More prominent over the sternum

48. The initial management of severe acute asthma should not include
a. Salbutamol 5mg by inhalation
b. Arterial blood gas analysis and chest radiograph
c. 24% oxygen delivered by a controlled flow mask
d. Hydrocortisone 200mg iv
e. Oral prednisolone 40mg orally

49. Which of these option is not recognized as a cause of chronic cough?

a. Gastro-oesophageal reflux disease
b. Angiotensin converting enzyme inhibitors
c. Long-term smoking
d. Sodium valproate
e. Tuberculosis

50. Bronchial breathing is characterized by

a. Inspiratory component louder and longer with a gap between expiration and inspiration
b. Expiratory component louder and longer with a gap between inspiration and expiration
c. Inspiratory component louder and longer with a gap between inspiration and expiration
d. Expiratory component louder and longer with a gap between expiration and inspiration

51. The following suggest a poor prognosis in pneumonia

a. Diastolic blood pressure of 90mmhg
b. Systolic blood pressure of 110mmhg
c. Confusion
d. Respiratory rate of 20 cycles/min
e. Urea 40mg/dl

52. Typical features of primary tuberculosis include

a. Sustained pyrexial illness
b. Bilateral hilar lymphadenopathy on chest radiograph
c. Erythema nodosum
d. Pleural effusion with negative tuberculin skin test
e. None of the above

53. Which statement concerning malaria is correct

a. Malaria caused by each of the four plasmodium species can relapse after the initial illness
b. Red cell with the duffy blood group antigen are resistant to plasmodium vivax
c. Renal impairment is a grave prognostic sign in falciparum malaria
d. P.falciparium causes immune mediated nephropathy
e. Massive splenomegaly can result from repeated bouts of infection

54. Which statement concerning the pathogenesis of fever is correct?

a. Aspirin inhibits the production of endogenous pyrogens
b. The major endogenous pyogens in human include IL-4 and TGF
c. Endogenous pyrogens are produced by bacteria, protozoa, and fungi
d. Endogenous pyrogens raise body temperature through their effect on skeletal muscle bed
e. Endogenous pyrogens play a role in the cachexia of chronic infection

55. Which of the following statements correctly characterize tetanus?

a. Neonatal tetanus develops after passage through a contaminated birth canal
b. Human tetanus immune globulin can modify the course of disease significantly once symptoms
develop.
c. Tetanus does not recur because lasting immunity develops
d. Trismus occurs in 10% of those infected
e. In a patient who is uncertain about his or her immunization status, both tetanus toxoid and
immune globulin should be given for serious wound.
56. A patient with scleral icterus and a positive reaction for bilirubin by urine dipstick testing
could have which of the following disorders?
a. Autoimmune hemolytic anemia
b. Dubin-johnson syndrome
c. Crigler-najjar type 2 disorder
d. Thalassemia intermedia
e. Gilbert’’s syndrome

57. A 66 year old man presents with fatigue and tea colored urine. Physical examination reveals
icteric sclerea but is otherwise unremarkable. Which of the following condition is least likely to
account for these findings?
a. Pancreatic cancer
b. Gallbladder cancer
c. Primary biliary cirrhosis
d. Autoimmune hemolytic anaemia
e. Viral hepatitis

58. A 75 year old woman with ahistory of aspirin induced gastritis 5 years ago now has severe
knee and hip pain that is thought to be due to osteoarthritis. She requires treatment with
nonsteroidal anti-inflammatory agents. Which of the following agents would be most helpful
for prophylaxis against recurrent gastrointestinal bleeding?
a. Omeprazole
b. Misoprostol
c. Nizatidine
d. Sucralfate
e. Atropine

59. A 45 year old man presents with sharp epigastric pain relieved by antacids and food. Barium
study of the upper gastrointestinal tract reveals a crater in the proximal portion of the
duodenal bulb. Which of the following statements concerning therapeutic alternatives is
correct?
a. Atropine or related anticholinergic agents are effective in improving the symptoms
b. Sucralfate is effective in eradicating helicobacter pylori colonization
c. Cimetidine or other H2 receptor antagonists are more effective than sucralfate in promoting
healing
d. Sucralfate can significantly reduce the bioavailability of fluoroquinolone antibiotics
e. Omeprazole, a specific inhibitor of parietal cell HK-ATPase, is contraindicated in routine
situations because of its carcinogenic potential
60. As a consequence of severe liver damage, hepatic amino acid handling is deranged. In this
situation, plasma levels of which of the following are likely to be lower than normal?
a. Ammonia
b. Ammonium
c. Alanine
d. Urea
e. Glycine

61. Chronic active hepatitis is most reliably distinguished from reliably distinguished from
chronic persistent hepatitis by the presence of
a. Extrahepatic manifestations
b. Hepatitis B surface antigen in the serum
c. Antibody to hepatitis B core antigen in the serum
d. A significant titer of anti-smooth-muscle antibody
e. Characteristic liver histology

62. Which of the following statement regarding delta hepatitis virus is correct?
a. HDV is a defective DNA virus
b. HDV can infect only persons infected with hepatitis B virus
c. The HDV genome is partially homologous with HBV DNA
d. HDV infection has been found only in limited areas of the world
e. Simultaneous infection with HDV and HBV results in an increased risk of the development of
chromic hepatits

63. A patient with scleral icterus and a positive reaction for bilirubin by urine dipstick testing
could have which of the following disorders?
a. Autoimmune hemolytic anemia
b. Dubin Johnson syndrome
c. Crigler najjar type 2 disease
d. Thalassaemia intermedia
e. Gilbert’s syndrome

64. Which one of the following statements about hepatitis B is accurate

a. HBeAg can be detected in the sera of patients ill with acute hepatits B
b. The presence of HBeAg in the serum is correlated with infectivity
c. Absence of HBeAg in the serum rules out chronic infection caused by hepatitis B
d. HBeAg is immunologically distinct from HBsAg but is genetically related to HBsAg
e. The disappearance of HBeAg from the serum may be a

65. Which of the following condition does not cause secretory diarrhea?
a. Medullary carcinoma of the thyroid
b. Resection of the distal ileum
c. Zollinger Ellison syndrome
d. Somatostinoma
e. Carcinoid tumors

66. Concerning cushing syndrome

a. Overnight dexamethasone stimulation test with 1mg of dexamethasone is a useful screening
test T
b. The commonest exogenous cause is pituitary adenoma(70-80%)
c. ACTH dependent causes include adrenal adenoma T
d. Ectopic ACTH syndrome may present with hyperpigmentation (T-only seen in ACTH dependent)
e. It is easily differentiated from pseudo-cushing’s syndrome by careful bedside examination and
biochemical confirmation of hypercortisolaemia

67. The diagnosis of dm is certain in which of the following situation?

a. Abnormal oral glucose tolerance in a 24 year old woman who has been dieting
b. Successive fasting plasma glucose concentration of 8, 9, and 8.5mmol/l in an asymptomatic,
otherwise healthy business woman
c. A serum glucose level of 7.8mmol/l (140mg/dl) in a woman in her twenty fifth week of
gestation after a 50g oral glucose load
d. Persistent asymptomatic glycosuria in a 30 year old woman
e. Persistently elevated non fasting serum glucose level

68. Characteristics of hyperosmolar coma include

a. The presence of ketoacids
b. Marked elevation of serum free fatty acids
c. Association with thrombosis and bleeding from disseminated intravascular coagulopathy
d. Markedly elevated serum sodium level
e. Best initial therapeutic response with large volumes of free water and large loss of insulin
69. Causes of fasting hypoglycemia that are due primarily to overutilization of glucose include
a. Acromegaly
b. Hepatoma
c. Alcohol ingestion
d. Congestive heart failure from cor pulmonale
e. Hypopituitarism

70. Concerning endocrine disorders, which of the option is not correct

a. 10 excess high target organ hormones; low trophic hormones
b. 10 deficiency low target organ hormone; high trophic hormone
c. 20 excess high trophic hormone and hormones of target gland
d. 20 deficiency low trophic hormone and hormones of the target gland
e. 20 deficiency low trophic hormone and high hormones of the target gland

71. The following are secondary causes of hyperlipidaemia except

a. Hypothyroidism
b. Nephrotic syndrome
c. Nevirapine
d. Anorexia nervosa
e. Obstructive liver disease

72. Which of the following statement is incorrect concerning dyslipidaemia

a. Treatment must be individualized for each patient
b. Cardiovascular risk should be assessed for all patients with dyslipidaemia before therapy
c. Life style measure for all patient is beneficial
d. Statin therapy is more beneficial for patients with high cardiovascular risk
e. Combination therapy with lipid lowering agents from different classes is the norm

73. Which of the following is the least likely symptom of hyperthyroidism in a 77 year old man?
a. Atrial fibrillation
b. Confusion
c. Tremor
d. Weakness
e. Syncope

74. A strain of obese mice homozygous for a mutation in the ob gene has a failure to elaborate
normal amount of the peptide leptin. Which of the following statements about leptin is
correct?
a. Leptin is secreted by cells in the hypothalamus
b. Overproduction causes increased energy expenditure.
c. Aberrant leptin physiology has never been shown to be a cause of obesity in human
d. Obese people have normal level of leptin
e. Patients with non-genetic causes of obesity do not respond to exogenous leptin

75. A 32 year old obese woman presents to you for advice regarding weight loss. She has no
significant medical problems at this time. She requests a pill to help her lose weight. You should
a. Tell her that a low calorie diet and exercise are the best ways to lose weight
b. Prescribe phentermine
c. Prescribe fenfluramine
d. Prescribe a combination of orlistat andfenfluramine
e. Prescribe L-thyroxine

76. Which of the following is least likely to be seen in sjogren’s syndrome?

a. Dental caries
b. Corneal ulceration
c. Renal tubular acidosis
d. Lymphoma
e. Cardiac fibrosis

77. Which of the following systemic manifestations is least characteristic of early adult
rheumatoid arthritis?
a. High fever
b. Weight loss
c. Muscle wasting
d. Vague musculoskeletal symptoms
e. Fatigue

78. Which of the following is the least common immunologic manifestation of HIV infection
a. Cutaneous reactions to drugs
b. Anaphylactic reactions to drugs
c. Anticardiolipin antibodies
d. Oligoarticular arthritis
e. Fibromyalgia

79. Concerning spondyloarthritides

a. Female preponderance
b. Back pain associated with stiffness
c. Polyarthropathy small joints uppr limbs
d. Poor response to non-steroidal anti-inflammatory drugs
e. Intermittent claudication

80. Which of the following inflammatory arthropathy is matched with the cause
a. Infection-reiter’s syndrome
b. Crystal induced- pseudogout
c. Immune mediated-neisseria gonorrhea
d. Idiopathic-rheumatiod arthritis
e. Reactive- mycobacterium tuberculosis
81. Disease mimicking anxiety disorders include the following except
a. Alcohol withdrawal
b. Hyperthyroidism
c. Hypoglycaemia
d. Temporal lobe epilepsy
e. None of the above

82. A psychopathological phenomenon in which the individual experiences sensation of insect

crawling under the skin is known as
a. Olfactory hallucination
b. Formication
c. Gustatory hallucination
d. Archnophobia
e. Claustrophobia

83. The misinterpretation of misperception of a real percept is called

a. Delusion
b. Illusion
c. Psychotic ideas
d. Hallucination
e. Delirium

84. An episode of intense anxiety with autonomic hyper arousal is known as

a. Agoraphobia
b. Phobia
c. Panic attack
d. Stress
e. Psychostressor

85. The pit vipers and rattle snake are usually absent in
a. South Asia
b. Europe
c. North America
d. Africa
e. South America
86. The first immediate medication to be administered to a patient with anaphylaxis with an
adverse reaction to intramuscular injection of penicillin
a. Antihistamine
b. Hydrocortisone
c. Adrenaline
d. Glucagon
e. Aminophylline

87. one of the earliest clinical features of carbon monocide poisoning is

a. hypoventilation
b. hyperreflexia
c. hypertension
d. convulsion
e. lethargy

88. a 55 year old man who recently underwent hip surgery develops a pulmonary embolism
and is placed on unfractionated heparin. After 3 days of therapy, his platelet count (previously
normal) is now 50000L. what is the mechanism of the thrombocytopenia in this case?
a. The induction of and anti-platelet antibody
b. Platelet-heparin binding causing platelet aggregation
c. Splenomegaly causing platelet aggregation
d. Heparin-induced bone marrow suppression
e. Platelet aggregation due to the formation of a heparin-platelet factor iv antibody complex

89. A 28 year old man presents with chest pain. Chest x-ray reveals a large mediasternal mass.
The testes, is negative. Mediastinoscopic biopsy reveals poorly differentiated carcinoma. Which
of the following laboratory tests would most likely be positive?
a. Prostate-specific antigen
b. Beta human chorionic gonadotropin
c. Carcinoembryonic antigen
d. CA-125
e. CA19

SECTION B: For questions 90-93 please select the best answers from the options provided below
a. Radiofemoral delay
b. Pan-systolic murmur
c. Systolic blood pressure of 220mmhg
d. Tapping apex beat
e. Chest pain eased by glyceryl trinitrate in 5 minutes
f. Third heart sound
g. Splinter haemorrhages
h. Chest pain eased by leaning forward
i. Slow-rising carotid pulse
j. Bradycardia with pulse rate 20 per minute
k. Chest pain eased by glyceryl trinitrate after an hour

The patients described below have come to see you. Which of these clinical features are they
most likely to demonstrate?
F 90. A 70-year-old man had a myocardial infarction two years ago. He is now admitted with
gradually increasing breathlessness worse on lying flat with crepitation in the lung bases
E 91. The patient is a 60 year old man who smokes 20 per day. He comes to clinic complaining
of a tight pain in the centre of his chest which comes on when he walks uphill
C 92. A young man was admitted with complaints of headaches, vomiting and recently noted
to have become restless
H 93. A 45year old man diagnosed with chronic kidney disease stage 5, complaining of chest
pain

For question 94-97 please select the best answers from the options provided below:
a. Heartburn
b. Biliary colic
c. Renal colic
d. Pancreatitis
e. Peritonitis
f. Intestinal obstruction
g. Peptic ulcer
h. appendicitis
i. diverticulitis
j. acute pyelonephritis
k. irritable bowel syndrome
l. urinary tract infection
m. diabetic ketoacidosis

J 94. a 68 year old man has suffered chronic urinary frequency for over a year. Over the last 2
days, he has suffered bouts of severe right loin pain radiating to his groin. He has been off his
food and felt nauseous, urinalysis shows blood +++ and protein ++
E 95. a 42year old man present to A&E with diffuse abdominal pain. He has had indigestion for
the last 6 weeks. He looked ill, pale clammy and in extreme discomfort. Examination of the
abdomen is limited because of pain and the board-like rigidity of it
96. a 52 year old man who is a chief executive of a local hospital trust presents to his GP with a
burning pain that radiates up his sternum and into the rest of his neck. He found milk of
magnesis and gaviscon relieved the pain at first but now they are only partially effective. He
has found hot tea aggravates the pain
M 97. a semi-conscious 24year old is admitted to the medical admission unit. He had been
complaining of vague central abdomen pain. He has been thirsty and has had urinary frequency
and his urine dipstick shows protein +, a trace of blood, glucose +++, ketones+++

For question 98 to 100, please select the best answer from the options provided below:
a. acromegaly
b. pagets disease of bone
c. goirte
d. horner’s syndrome
e. exophthalmos
f. jaundice
g. cushing’s syndrome
h. hypothyroidism
i. spider naevi
j. systemic lupus erythematosus
k. parkinson’s disease
l. hereditary haemorrhagic telangiectasia

K 98. an elderly man goes to his GP complaining of declining mobility and generally slowing
down. His face is impassive and expressionless and you notice him drooling. Also there is a
short-lived tremor of his right hand
E 99. a young woman who appears anxious is seen in clinic with loose stools and weight loss.
Even though she is anxious her eyes seem to have a greater staring quality than would be
expected
I 100. a 32year old man has been admitted to a general medical ward. He has been falling a lot
and admits to drinking heavily over the years. He is covered in bruises and it is noticeable that
there are red blebs on his face, neck, and upper chest. You wonder what the red blebs are.