1 Given: A patient has ingested 10g of paracetamol
Question: Gastric lavage is essential
2 Given: A man is admitted after head injury; he has a Glasgow Coma Scale score of 15
Question: He requires an urgent CT brain scan
3 Progression of Alzheimer’s disease is halted by donepezil (Aricept)
4 Temazepam is a useful hypnotic for the treatment of early wakening
5 Hyponatremia is a recognised complication following head injury.
6 A normal magnetic resonance imaging (MRI) brain scan excludes a diagnosis of multiple sclerosis
7 Given: A patient with carotid stenosis develops cerebral infarction
Question: The most likely mechanism is restriction of blood flow through the stenotic segment
8 The ulnar nerve supplies sensation to the little finger
9 Inflammatory joint disease such as rheumatoid arthritis rarely affects the hands
10 Patients with radial nerve palsy cannot extend the fingers
11 Malignant spinal cord compression is an emergency
12 The stage of family role identification extends from 2 to 6 years of age
13 Major depressive illness may be induced by corticosteroids
14 All phenothiazine drugs have adverse extra-pyramidal effects
15 Topical corticosteroids can safely be prescribed for undiagnosed ‘red eye’
16 Metabolic alkalosis is a consequence of aspirin overdose
17 The overall suicide rate in the United Kingdom has increased in the last 5 years
18 Before referring a case to the Coroner, a Certificate of the Cause of Death must be completed and given to the family
19 Congenital heart block is a recognised consequence of maternal systemic lupus erythematosus
20 Haloperidol is a dopamine D2 receptor antagonist
21 Given: Schizophrenia is a natural disease
Question: Death following self-harm is a recognised complication of schizophrenia, and need not be referred to the Coroner
22 Cognitive behaviour therapy improves the prognosis of schizophrenia
23 Intravenous antibiotics are the most important way of preventing osteomyelitis in open contaminated fractures of bone
24 Woven bone, formed during fracture repair, is generally converted to lamellar bone
25 In suspected septic monoarthritis, both blood and synovial fluid cultures must be taken
26 Astrocytoma is a tumour that arises from neurones
27 Regular monitoring with full blood count and liver function tests is necessary for patients prescribed sulphasalazine
28 Given: A 60 year old myopic lady presents with pain in the right eye, especially on reading, and has a red eye with a small pupil
Question: Acute angle-closure glaucoma is the most likely diagnosis
29 Rheumatoid arthritis causes synovial hypertrophy
30 Chronic alcoholic brain disease involves permanent damage to the mamillary bodies
31 Glioblastoma multiforme arises from astrocytes
32 Secondary brain tumours are more frequent than primary brain tumours
33 Given: A 20 year old student has a tonic-clonic convulsion after having a blood test
Question: He probably suffers from epilepsy
34 Multiple sclerosis can give rise to vertigo
35 Given: An elderly patient complains of slowing down, and examination reveals unilateral tremor and bradykinesis
Question: The likely diagnosis is Parkinson’s disease
36 Bisphosphonate treatment may control the symptoms of Paget’s disease
37 Hypocalcaemia is common in osteoporosis
38 After femoral neck fracture, the three-month mortality rate is about 5%
39 Eburnation of the joint surface is a feature of osteoarthritis
40 Lysergic acid diethylamide (LSD) acts on 5HT receptors
41 Lithium carbonate has a narrow therapeutic window
42 Carpal tunnel syndrome requires no investigation before surgical treatment
43 Given: A 64 year old man with repeated attacks of right amaurosis fugax undergoes Doppler ultrasound studies of his carotid vessels and is found to have a 50% stenosis of the left internal carotid artery
Question: He should undergo a left carotid endarterectomy as soon as possible
44 Cerebral haemorrhage is a complication of streptokinase therapy
45 A facial paralysis getting progressively worse over a period of one month is likely to be Bell’s palsy
46 Gentamicin is more vestibulotoxic than cochleotoxic
47 Air conduction of sound is better than bone conduction
48 Hearing loss in Meniere’s disease is characteristically for low frequency sounds
49 Otitis media is the commonest cause of persistent deafness in young children
50 People with alcohol dependency syndrome are usually unaware of their addiction
51 Benzodiazepines are effective antidepressants
52 Oesophageal bleeding is a complication of portal hypertension
53 Suicide is more common in men than women
54 The annual incidence of agranulocytosis in patients taking clozapine is 1 to 2%
55 Postnatal depression often requires inpatient psychiatric care
56 Section 3 of the Mental Health Act can only be used by the patient’s own consultant
57 Sexual dysfunction occurs in approximately 10 to 15% of patients treated with selective serotonin reuptake inhibitors (SSRIs)
58 The symptom of hopelessness is associated with suicide
59 Antipsychotics must be discontinued during pregnancy
60 Depressive symptoms occur in about 50% of people with bulimia nervosa
61 Most subjects with autism have a diagnosable physical disorder
62 The most common cause of poor attendance at school is truancy
63 The mortality rate from female breast cancer in the United Kingdom is decreasing
64 Depressive disorder is less common in childhood than in adolescence
65 An infant is clinging strongly to its mother, and so a diagnosis of physical abuse can be excluded
66 Given: MMR vaccine is a live virus vaccine
Question: MMR vaccine should not be given to children being treated with systemic steroids
67 Pyloric stenosis is associated with hyperchloraemic alkalosis
68 Given: A 6 week old infant presents with fever, drowsiness and poor feeding.
Question: Antibiotics should only be started once bacterial cultures have been shown to be positive
69 Given: The father of a 2 year old boy has been recently been diagnosed with tuberculosis
Question: The child is at a higher risk of developing fulminant tuberculosis than is his mother
70 Given: A 6 year old girl bleeds excessively after sustaining small cuts and abrasions
Question: The most likely diagnosis is anti-haemophilic globulin deficiency
71 Rotavirus is the most common cause of gastroenteritis in infants and young children
72 Coeliac disease may present with small intestinal lymphoma
73 Mental health problems are rare in childhood epilepsy
74 There is a genetic contribution to the development of schizophrenia
75 Family therapy can be an effective form of treatment for some childhood disorders
76 Separation anxiety is a normal part of childhood development
77 Hallucinations can occur in non-psychotic conditions
78 The average age for a child to first walk unaided is 24 months
79 The iron content of breast milk is higher than that in standard formula milk
80 The benefits of breast milk include protection from infections
81 Breast feeding increases conjugated bilirubin levels in the neonatal period
82 Wheeze, hyperinflation and hepatomegaly are features of bronchiolitis associated with respiratory syncytial virus infection
83 Irritability and absent breath sounds are a poor prognostic sign in an attack of asthma
84 Early and intensive physiotherapy improves survival in cystic fibrosis
85 In a child, a bradycardia of 60/minute during sleep indicates severe cardiac disease
86 In measles, the cutaneous rash precedes the appearance of Koplik’s spots
87 For iron to be absorbed, it needs to be in the ferrous form
88 More girls than boys develop urinary tract infections
89 Gram positive cocci are the commonest organisms causing urinary infections in childhood
90 In girls, breast development starts before pubic hair grows significantly
91 The risk of developing ovarian cancer is less in women taking the combined contraceptive pill
92 A correctly-placed copper intrauterine contraceptive device will be effective for five years or more
93 Raised blood pressure is a contraindication to the combined oral contraceptive pill
94 Antibiotic therapy renders the emergency contraceptive (‘morning after’) pill ineffective
95 Healthy children have higher erythrocyte counts than adults
96 Iron deficiency anaemia in pregnancy is associated with preterm labour
97 Urticaria and sneezing, occurring together, is highly suggestive of anaphylaxis
98 In the antenatal detection of Down's syndrome. the maternal serum level of human chorionic gonadotrophin is the most powerful predictive factor
99 Antenatal screening for beta-thalassaemia need only be carried out in women of Mediterranean origin.
100 Amniocentesis carries a risk of abortion of 5% in excess of the background spontaneous abortion rate.
101 Pulmonary embolism is the commonest cause of post partum collapse
102 Respiratory distress syndrome is more likely to occur in babies born of diabetic mothers, compared to non-diabetic mothers
103 Late decelerations are those which occur late in labour
104 Entonox is a mixture of oxygen and nitrous oxide in the ratio of 30:70
105 Ergometrine is contraindicated in women with cardiac disease.
106 Oxytocin has an antidiuretic effect equivalent to that of vasopressin.
107 Vaginal breech delivery should not be permitted in primigravidae.
108 The drug of choice to suppress lactation is stilboestrol.
109 Breast fed babies are less likely to be obese.
110 Breast abscesses are best treated by the administration of a broad spectrum antibiotic.
111 Laparoscopy should be performed if an ectopic pregnancy is suspected.
112 Breast cancer is less common in women who have breast fed their babies.
113 Hot flushes can occur before menopause
114 The mean age of the menopause in the United Kingdom is 45 years.
115 The commonest cause of post menopausal bleeding is endometrial carcinoma.
116 The national cervical screening programme recommends that screening should begin at 16 years of age in sexually active women.
117 In cervical cytology, an adequate sample includes endocervical cells.
118 In cervical cytology screening programmes, the false negative rate is less than 1%.
119 Insulin resistance is associated with the polycystic ovarian syndrome
120 Urinary incontinence is more common in women than men
121 Surgery alone is usually curative of ovarian cancer
122 Progestogens are highly effective in the treatment of dysfunctional uterine bleeding
123 Physiotherapy is an effective treatment for detrusor instability
124 Ectopic pregnancy can be a consequence of chlamydial infection
125 In the United Kingdom, pelvic inflammatory disease is most commonly due to gonorrhoea
126 Given: Hyperkalaemia is noted during the investigation of a patient who has recently presented with hypertension
Question: Conn’s syndrome is the most likely diagnosis
127 Given: A hypertensive patient presents with headaches, palpitations and sweating
Question: The symptoms are consistent with a diagnosis of phaeochromocytoma
128 Given: A 52 year-old patient with essential hypertension on full-dose atenolol and lisinopril has a blood pressure of 162/94mmHg
Question: Adding a thiazide diuretic would be an appropriate action
129 Given: A 52 year old man collapses suddenly and unexpectedly in the bus queue. There is no previous history
Question: The most likely diagnosis is pulmonary thrombo embolism
130 Patients treated with captopril for essential hypertension have a higher risk of developing diabetes mellitus than do patients treated with atenolol
131 Spironolactone has been shown to reduce the mortality in patients with heart failure
132 Given: The relative risks of a smoker developing coronary heart disease and cancer of the larynx, compared with a non-smoker, are 2 and 15 respectively
Question: This shows that smoking causes more cases of cancer of the larynx than of coronary heart disease
133 ACE inhibitors should not be given to patients with moderately severe renal failure
134 Osteosclerotic secondary tumours are associated with carcinoma of the prostate
135 Patients with renal failure caused by diabetes mellitus characteristically have small kidneys
136 In chronic systemic hypertension, the kidneys are usually large
137 Hyperglycaemia during the acute phase of myocardial infarction is an adverse prognostic marker
138 Beta blockers are the therapy of choice in patients with heart failure
139 Thiazide diuretics are contraindicated in the treatment of hypertension in subjects with diabetes mellitus
140 Beta blockers exacerbate psoriasis
141 In a clinical study, the main purpose of randomisation is to ensure that there are an equal number of subjects in each group
142 Given: A 45 year old nursing assistant in an endoscopy unit presents with recent onset of asthma
Question: She should be removed from her working environment
143 There is no correlation between the incidence of ischaemic heart disease and the number of cigarettes smoked
144 The left main bronchus is more vertical than the right main bronchus
145 The Fc component of immunoglobulin binds to macrophages
146 Diminution of the R wave is an early feature in acute myocardial infarction
147 High protein diets slow the progression of renal failure
148 Treatment with intravenous sodium bicarbonate may help to control the hyperkalaemia of renal failure
149 Most patients with hairy cell leukaemia have considerable splenomegaly
150 Sputum coughed up by patients with pneumonia associated with Klebsiella pneumoniae is often visibly coloured with iron-containing pigment
151 Carcinoid syndrome causes high output cardiac failure
152 Smoking is associated with bladder cancer
153 Most myocardial infarcts occur in the wall of the right ventricle
154 Multiple myeloma is a disease of myocytes
155 Reed-Sternberg cells are diagnostic of lymphoma
156 Most non-Hodgkin’s lymphomas are of B-cell type
157 Folic acid deficiency causes megaloblastic anaemia
158 The Philadelphia chromosome is associated with acute lymphoblastic leukaemia
159 A low grade fever is a feature of iron deficiency anaemia
160 Sickle cell anaemia is usually inherited by an autosomal recessive mechanism
161 Given: A patient with chronic obstructive pulmonary disease has become slightly more breathless, is producing a little yellow sputum and feels ill
Question: Amoxycillin is an appropriate treatment
162 Given: A patient has a bicuspid aortic valve, and develops a fever. A blood culture grows Enterococcus faecalis
Question: High dose penicillin is the best treatment
163 Mycobacterium tuberculosis showing resistance to both isoniazid and rifampicin is becoming more common
164 Given: A patient has a PaO2 of 65mmHg (8.7 kPa), a PaCO2 of 65 mmHg (8.7 kPa), a pH of 7.5 and a HCO3- of 40mmol/l
Question: This is respiratory acidosis
165 Depression in the medically ill often goes undetected
166 Chronic fatigue syndrome is classified as a functional somatic disorder