1. Answer: a) reduction in thromboxane A2 synthesis. Aspirin blocks the synthesis of COX1 and COX2 enzymes. This leads to a reduction in PGG2, PGH2 TXA2 synthesis leads to platelet aggregation. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 1 of 37 (Guessed: 0 | Skipped: 1 | Bookmarked: 0 ) Time taken: 15s Cardiology questions [id:0050] A man with mild bleeding disorder is being considered for aspirin for acute coronary syndrome. Which one of the effects of aspirin is beneficial in coronary artery disease? A. Reduction in thromboxane A2 synthesis nmlkj B. Increase in the prostaglandins nmlkj C. Glycoprotein IIB IIIA receptor inhibition nmlkj D. ADP receptor antagonism nmlkj E. Increase in COX enzymes nmlkj Do question later! nmlkji Exit Test

2. Answer: b) increased sodium reabsorption in the distal tubules of the kidneys. Sodium and water retension is the most important factor leading to the development of ascites. Sodium absorption in the distal tubules of the nephron is particularly stimulated by aldosterone, hence spironolactone is commonly used to treat ascites in liver disease (thiazide diuretics can also help when fluid is difficult to shift). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 2 of 37 (Guessed: 0 | Skipped: 2 | Bookmarked: 0 ) Time taken: 8s Cardiology questions [id:0593] A 39 year old man has a previous history of hepatitis C infection. He has gained weight over the past 4 months and has shifting dullness in the abdomen on examination. Which is the likely process contributing to the development of ascites? A. Lymphoedema nmlkj B. Increased sodium reabsorption in the distal tubules of the kidneys nmlkj C. An albumin of 23 g/l nmlkj D. Right sided cardiac failure nmlkj E. Portal hypertension nmlkj Do question later! nmlkji Exit Test 3. Answer: b) rheumatic fever. This patient has polyarthritis, carditis (2 major criteria), fever and raised inflammatory markers (2 minor criteria). The history is consistent with rheumatic fever ( haemolytic strep Group A) infection. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 3 of 37 (Guessed: 0 | Skipped: 3 | Bookmarked: 0 ) Time taken: 6s Cardiology questions [id:0064] A 23 year old lady has a 6 month history of fever and pains in her elbows, wrist and knee joints. There is a soft systolic murmur and a pericardial rub on auscultation. Her bloods reveal Hb 12.0 g/dl, WCC 10 x 10^9/l, platelets 280 x 10^9/l, urea 5 mol/l, creatinine 70 mol/l, sodium 138 mmol/l, potassium 3.8 mmol/l, bilirubin 18 mol/l, AST 18 U/l, ALP 180 U/l, albumin 35 g/l, ESR 100 mm/hr, CRP 140 mg/l. What is the likely diagnosis? A. Viral pericarditis nmlkj B. Rheumatic fever nmlkj C. Subacute bacterial endocarditis nmlkj D. Atrial myxoma nmlkj E. Polyarteritis nodosa nmlkj Do question later! nmlkji Exit Test 4. Answer: e) bisoprolol. The CIBIS trial showed that bisoprolol showed improvement in functional status and reduced hospitalisation. Mortality however, was not decreased on bisoprolol in this trial. There are other trials which have shown a small mortality benefit for beta blockers in heart failure. Other B blockers which can be used are metoprolol (MERIT HF study) and carvedilol. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 4 of 37 (Guessed: 0 | Skipped: 4 | Bookmarked: 0 ) Time taken: 8s Cardiology questions [id:0049] A 75 year old man has become progressively more breathless. On examination he has a displaced cardiac apex and a third heart sound. Chest XR confirms cardiomegaly. An echocardiogram shows Left ventricle size of 6.5 cm ( 180 mmHg systolic, and unstable angina are all contraindications towards ETT. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 9 of 37 (Guessed: 0 | Skipped: 9 | Bookmarked: 0 ) Time taken: 4s Cardiology questions [id:0039] A 55 year old man presented to hospital with chest pains. His troponin I is negative at 12 hours. Following this an exercise test is recommended. In which of the following situations is it safe to perform an exercise test? A. Aortic stenosis with a gradient of 50mmHg nmlkj B. Pericarditis nmlkj C. Trifascicular heart block nmlkj D. Blood pressure of 220/100 nmlkj E. Dynamic ST changes with chest pain nmlkj Do question later! nmlkji Exit Test 10. Answer: b) hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy which is familial, can present with presyncopal episodes as described above. ECG would typically achieve LVH voltage criteria (Sokolov criteria is described above). Supravalvular aortic stenosis is found in William's syndrome (mental impairment, pulmonary stenosis). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 10 of 37 (Guessed: 0 | Skipped: 10 | Bookmarked: 0 ) Time taken: 4s Cardiology questions [id:0057] A 40 year old man has episodes of lightheadness and collapses on one occasion whilst running for the bus. His ECG shows large QRS complexes with V1 and V6 leads achieving voltage criteria of >35 mm. Which of the following is most likely? A. Alcohol related cardiomyopathy nmlkj B. Hypertrophic cardiomyopathy nmlkj C. Ventricular fibrillation nmlkj D. Aortic stenosis nmlkj E. Dilated cardiomyopathy nmlkj Do question later! nmlkji Exit Test 11. Answer: d) ruptured papillary muscle. Following an MI, ruptured papillary muscle or interventricular septum is most likely to cause the combination of pulmonary oedema and new murmur (either mitral regurgitation or due to VSD). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 11 of 37 (Guessed: 0 | Skipped: 11 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0062] A 55 year old patient had myocardial infarction 6 days ago. He suddenly develops dyspnoea, cough and frothy sputum. For the first time a harsh systolic murmur is heard over the praecordium. This sequence of events might be caused by: A. Pulmonary embolism nmlkj B. Aortic dissection nmlkj C. Tricuspid regurgitation nmlkj D. Ruptured papillary muscle nmlkj E. Ruptured aortic cusp nmlkj Do question later! nmlkji Exit Test 12. Answer: d) heavy calcification of the mitral valve. The contraindications towards valvuloplasty are heavy MV calcification, thrombus in the left atrial appendage on transoesophageal echocardiography and severe mitral regurgitation. These patients are indicated for mitral valve surgery instead. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 12 of 37 (Guessed: 0 | Skipped: 12 | Bookmarked: 0 ) Time taken: 2s Cardiology questions [id:0007] A patient who has rheumatic mitral stenosis is considered for percutaneous mitral valvuloplasty. Which of the following would contraindicate this procedure? A. Dilated left atrium nmlkj B. Atrial fibrillation nmlkj C. Aortic regurgitation nmlkj D. Heavy calcification of the mitral valve nmlkj E. Long history of mitral stenosis nmlkj Do question later! nmlkji Exit Test 13. Answer: c) systemic arterial embolus from mural thrombus. This man has features indicating that he has an enlarged left ventricle from previous anterior myocardial infarction in the LAD artery territory. Poor LV function also causes his symptoms of heart failure. He is at risk of developing mural thrombus with embolus to the arterial circulation. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 13 of 37 (Guessed: 0 | Skipped: 13 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0045] A 70 year man has been short of breath for 1 year. An electrocardiogram shows T wave inversion and q waves in the anterolateral leads at rest. He has cardiomegaly on the chest X ray. Clinical examination shows a third heart sound, a soft systolic murmur in the mitral area and also bilateral inspiratory crepitations in his lungs. Which of the following is he at risk of? A. Deep vein thrombosis nmlkj B. Pulmonary embolus nmlkj C. Systemic arterial embolus from mural thrombus nmlkj D. Venous thrombosis due to mural thrombus nmlkj E. Coronary artery thrombus due to mural thrombus nmlkj Do question later! nmlkji Exit Test 14. Answer: c) verapamil. All are useful agents which can be used in conjunction cautiously for VT except for Verapamil. Verapamil is contraindicated in VT because it can cause the blood pressure to drop drastically due to negative ionotropic action. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 14 of 37 (Guessed: 0 | Skipped: 14 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0008] A 50 year old man presents with broad complex tachycardia and has a BP of 100/70. The duty medical registrar is considering administration of antiarrhythmics. Which one of the following medications is contraindicated in sustained ventricular tachycardia? A. Magnesium nmlkj B. Amiodarone nmlkj C. Verapamil nmlkj D. Procainamide nmlkj E. Lignocaine nmlkj Do question later! nmlkji Exit Test 15. Answer: c) frusemide. The likely cause of the arrhythmias is hypomagnesaemia and hypokalaemia, which is most commonly associated with diuretic use. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 15 of 37 (Guessed: 0 | Skipped: 15 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0073] A 50 year man presents with lightheadness. He has frequent nonsustained ventricular tachycardia on the ECG and cardiac monitor. His bloods show a Hb 13.0 g/dl, WCC 7 x 10^9/l, platelets 230 x 10^9/l, urea 11mol/l, creatinine 80mol/l, sodium 134 mmol/l, potassium 3.2 mmol/l, serum magnesium of 0.6 mmol/l (0.75). Which one of following is likely to be responsible for his arrhythmias? A. Poor diet nmlkj B. Alcoholism nmlkj C. Frusemide nmlkj D. Diarrhoea nmlkj E. Hyperphosphataemia nmlkj Do question later! nmlkji Exit Test 16. Answer: a) restrictive cardiomyopathy. In this scenario, there symptoms can be caused by any form of cardiomyopathy. The rise in JVP with inspiration suggests either constrictive or restrictive cardiomyopathy. Echocardiography showing no pericardial effusion and stiffness suggests restrictive rather than constrictive cardiomyopathy. The transmitral dopplers on the echo may show E/A wave reversal and high velocities which may suggest restrictive picture. This may be due to infiltration due to haemochromatosis, endomyocardial fibrosis, sarcoidosis, myeloma, lymphoma or connective tissue disease. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 16 of 37 (Guessed: 0 | Skipped: 16 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0068] A 55 year old patient presented with breathlessness and ankle oedema. The blood pressure is 135/80 mmHg. On examination, her JVP rises with inspiration. She has a soft systolic murmur and a third heart sound. Blood tests reveal Hb 10.5 g/dl WCC 7.5 x 10^9/l Platelets 150x 10^9/l sodium 136 mmol/l potassium 3.5 mmol/l creatinine 140 mol/l urea 6 mol/l ECG shows poor R wave progression. An echocardiogram shows no pericardial effusion, the ventricles are stiff and systolic function is mildly impaired. Which of the following is the likely diagnosis? A. Restrictive cardiomyopathy nmlkj B. Dilated cardiomyopathy nmlkj C. Constrictive pericarditis nmlkj D. Ischaemic cardiomyopathy nmlkj E. Pulmonary embolus nmlkj Do question later! nmlkji Exit Test 17. Answer: c) myocarditis. Pyrexia, chest pain (pleuritic), raised troponin, T wave changes on the ECG would be suggestive of myocarditis. Pericarditis usually causes saddle shaped ST elevation on ECG. Coxsackie B is the commonest cause. Other causes are HIV, diphtheria, Chagas disease, Lyme disease, SLE and arsenic poisoning. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 17 of 37 (Guessed: 0 | Skipped: 17 | Bookmarked: 0 ) Time taken: 3s Cardiology questions [id:0072] A 33 year old man presents with chest pains and fatigue for several days. His observations show a temperature of 38C, pulse 100 bpm, BP 100/7 mmHg. ECG shows T wave inversion in the anterior and inferior leads. The troponin I is 3 ng/mL (170 beats per minute. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 37 of 37 (Guessed: 0 | Skipped: 37 | Bookmarked: 0 ) Time taken: 2s Cardiology questions [id:0002] A 50 year old lady has palpitations. Her ECG shows a broad complex tachycardia. Which of these features suggests that the tachycardia is more likely to be of ventricular origin? A. QRS of 150 ms nmlkj B. Left bundle branch block and left axis deviation nmlkj C. P wave for every QRS complex nmlkj D. History of atrial fibrillation nmlkj E. Heart rate of 150 nmlkj Do question later! nmlkji Exit Test 38. Answer: c) extrinsic allergic alveolitis. Out of these causes, EAA is the most likely to cause upper zone lung fibrosis. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 1 of 35 (Guessed: 0 | Skipped: 1 | Bookmarked: 0 ) Time taken: 8s Respiratory Medicine [id:0114] A 60 year old woman who is breathless has a CXR for assessment. This shows linear fibrotic changes in the upper zones of the lungs bilaterally. Which one of these conditions causes upper zone lung fibrosis? A. Cryptogenic fibrosing alveolitis nmlkj B. Rheumatoid arthritis nmlkj C. Extrinsic allergic alveolitis nmlkj D. Systemic sclerosis nmlkj E. Systemic lupus erythematosus nmlkj Do question later! nmlkji Exit Test 39. Answer: c) hilar lymphadenopathy and erythema nodosum. The sarcoid subset of Lofgren's syndrome as described here, is self limiting. It consists of the triad of fever, bilateral hilar lymphadenopathy and erythema nodosum. Therefore, the prognosis is good and steroids are not required. Bilateral hilar lymphadenopathy Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 2 of 35 (Guessed: 0 | Skipped: 2 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0094] A 50 year old Afro-Caribbean man has a cough. He also has generalised arthralgia. There is an eruption of tender red areas on his shin. Which of the following is important to determine whether this condition is self limiting? A. Hilar lymphadenopathy and eosinophilia nmlkj B. Response to Kveim test nmlkj C. Hilar lymphadenopathy and erythema nodosum nmlkj D. Serum calcium levels nmlkj E. Serum ACE levels nmlkj Do question later! nmlkji Exit Test 40. Answer: d) silica. Slate workers, stonemasons and miners are exposed to silica dust. Silicosis impairs macrophage function, and in particular, predisposes to TB infection. Silicosis Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 3 of 35 (Guessed: 0 | Skipped: 3 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0095] A 60 year old miner has been in the occupation for 20 years. He presents with a cough and breathlessness. Chest XR shows diffuse interstitial shadowing. A sputum sample is positive for acid fast bacilli. Which of the following dusts is most likely to have predisposed the patient to tuberculosis? A. Beryllium nmlkj B. Cadmium nmlkj C. Coal nmlkj D. Silica nmlkj E. House dust nmlkj Do question later! nmlkji Exit Test 41. Answer: b) Loeffler's syndrome. Hypereosinophilic syndrome is a rare condition where there is an idiopathic eosinophil count of > 15 x 10^9/dl. It is associated with Loeffler's syndrome which is a transient pulmonary reaction with nodular or reticular shadowing (diffuse, fanshaped shadowing) on chest radiology and eosinophilia. Hypereosinophilic syndrome generally affects young men ages 20-50. Thrombotic tendency, neurological involvement and restrictive cardiomyopathy occur. There is response to steroids. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 4 of 35 (Guessed: 0 | Skipped: 4 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0099] A 30 year old man has breathlessness and wheeze. Investigations show: Neutrophils 6 (2-7.5) x 10^9/l Lymphocytes 3 (1.3-3.5) x 10^9/l Eosinophils 19 (0.04-0.44) x 10^9/l CXR shows reticulonodular shadowing What is the likely diagnosis? A. Tuberculosis nmlkj B. Loeffler's syndrome nmlkj C. Sarcoidosis nmlkj D. Pulmonary embolism nmlkj E. Wegener's granulomatosis nmlkj Do question later! nmlkji Exit Test 42. Answer: d) staphylococcus. Following a viral infection, patients are predisposed to staphylococcal infection. The chest XR changes suggest staphlococcus rather than streptococcus (which would cause lobar consolidation). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 5 of 35 (Guessed: 0 | Skipped: 5 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0106] A 40 year old lady was admitted to hospital with fevers and cough productive of sputum. Chest X-ray shows diffuse patchy consolidation around the left lung. She has had a flu like illnes 4 weeks ago, and has a past medical history of asthma. She also smokes. Which organism is likely to be responsible? A. Mycoplasma nmlkj B. Pseudomonas nmlkj C. Klebsiella nmlkj D. Staphylococcus nmlkj E. Tuberculosis nmlkj Do question later! nmlkji Exit Test 43. Answer: c) tuberculosis. Multinucleated giant cells are very large epidermis cells that have multiple nuclei. They can be present in viral infections (e.g. herpes), TB or lymphoma. Granulomatous disease suggests either sarcoid, TB or Wegener's granulomatosis. A multinucleated giant cell Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 6 of 35 (Guessed: 0 | Skipped: 6 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0120] A 55 year old smoker has a history of breathlessness and a dry cough. He has several nodules present in the perihilar region. His serum calcium is normal. A bronchoscopy and transbronchial biopsy is done. This shows non necrotic granulomas and multinucleated giant cells. Which of the following is likely? A. Histoplasmosis nmlkj B. Aspergillosis nmlkj C. Tuberculosis nmlkj D. Small cell carcinoma nmlkj E. Silicosis nmlkj Do question later! nmlkji Exit Test 44. Answer: e) Aspergilloma. Haemoptysis can be caused by pulmonary embolus, tuberculous infection, aspergilloma, bronchial carcinoma, Goodpasture's syndrome and Wegener's granulomatosis. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 7 of 35 (Guessed: 0 | Skipped: 7 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0108] A 60 year old man presents with haemoptysis of small amounts. he does not have pleuritic chest pains and has normal oxygen saturations. In considering the potential diagnosis, haemoptysis can occur with which one of the following diagnosis? A. Pulmonary fibrosis nmlkj B. Melanoma nmlkj C. Goitre nmlkj D. Thymoma nmlkj E. Aspergilloma nmlkj Do question later! nmlkji Exit Test 45. Answer: d) extrinsic allergic alveolitis. Extrinsic allergic alveolitis causes a neutrophilia due to cell mediation but eosinophil count is normal. Bronchoalveolar lavage shows lymphocytes and mast cells. EAA is a delayed hypersensitivity reaction which may be immune complex (III) mediated or cell mediated (type IV) in chronic disease. Precipitins to micropolyspora faeni in farmers lung or aspergillus are seen. Upper zone fibrosis causes crackles which can be heard. Symptoms are typically of breathlessness but not wheeze. EAA causing upper zone fibrosis Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 8 of 35 (Guessed: 0 | Skipped: 8 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0076] A 65 year old farmer has breathlessness. During investigation he was found to have raised serum precipitins to micropolyspora faeni. What is the diagnosis? A. Tuberculosis nmlkj B. Wegener's granulomatosis nmlkj C. Churg Strauss syndrome nmlkj D. Extrinsic allergic alveolitis nmlkj E. Pulmonary eosinophilia nmlkj Do question later! nmlkji Exit Test 46. Answer: b) iv magnesium 2g. According to BTS guidelines, single dose Magnesium of 2g IV should be instituted in cases of acute severe asthma following administration of conventional therapy. Aminophylline is no longer recommended as the second line treatment in most trusts. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 9 of 35 (Guessed: 0 | Skipped: 9 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0104] An 18 year old girl with severe difficulty in breathing to A+E. She has had a history of asthma with two previous ITU admissions. Her peak flow is currently 100. She is unable to say more than a few words. She was given nebulised salbutamol and iv hydrocortisone 200mg by the paramedics.Which treatment should she now have? A. Further iv hydrocortisone 200 mg nmlkj B. Iv magnesium 2g nmlkj C. Intubation and ventilation nmlkj D. Iv salbutamol nmlkj E. Iv ipatropium nmlkj Do question later! nmlkji Exit Test 47. Answer: c) re-infection. The diagnosis is pulmonary TB. Infections in the elderly usually occur due to re-activation rather than a new infection. Right upper zone fibrosis (TB) Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 10 of 35 (Guessed: 0 | Skipped: 10 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0089] A 75 year old man has consolidation on his Chest XR. Sputum AFB is positive. Upon reviewing his notes an old chest x ray report showed upper zone fibrosis. What is the likely cause of tuberculous infection? A. New infection nmlkj B. Undertreatment nmlkj C. Re-infection nmlkj D. Inaccurate lab test nmlkj E. Infection with a non tuberculous organism nmlkj Do question later! nmlkji Exit Test 48. Answer: d) reduce inspired oxygen concentration. This lady with COPD has blood gases showing type II respiratory failure with acidosis. Her respiratory drive is suppressed by too much oxygen inspired, and hence reduction to a lower concentration (e.g. 2 litres) to maintain a PO2 above 8.5kPa is recommended. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 11 of 35 (Guessed: 0 | Skipped: 11 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0118] A 60 year man has been a long standing smoker of 20 a day. He has a cough and difficulty in breathing. Arterial blood gases show: pH 7.25 P02 16 kPa PCO2 8.2 kPa What should be the next management step? A. Non invasive ventilation nmlkj B. Intravenous antibiotics nmlkj C. Intubation and ventilation nmlkj D. Reduce inspired oxygen concentration nmlkj E. Increase oxygen concentration nmlkj Do question later! nmlkji Exit Test 49. Answer: c) serial peak flow measurements. The best diagnostic test for asthma would be demonstration of variable airways obstruction with serial peak flow measurements. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 12 of 35 (Guessed: 0 | Skipped: 12 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0115] An 13 year old male has recent onset breathlessness. He wheezes particularly during the summer when the pollen count is high. Which of these tests would help to confirm the diagnosis? A. Trial of inhaled corticosteroids nmlkj B. Trial of anticholinergics nmlkj C. Serial peak flow measurements nmlkj D. Lung function tests nmlkj E. Chest X ray nmlkj Do question later! nmlkji Exit Test 50. Answer: d) sleep study. The diagnosis of obstructive sleep apnoea can be made with a sleep study. In sleep apnoea, there is gross obesity and airways obstruction, occasionally leading to type II respiratory failure. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 13 of 35 (Guessed: 0 | Skipped: 13 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0096] A 55 year old gentleman has pickwickian syndrome. He has poor exercise tolerance and often feels lethargic at work. Which of the following is the best investigation? A. Echocardiography to assess cor pulmonale nmlkj B. CT scan of the chest nmlkj C. Blood gas nmlkj D. Sleep study nmlkj E. Exercise tolerance test nmlkj Do question later! nmlkji Exit Test 51. Answer: b) beryllium. The diagnosis is asthma. Isocyanates are used to make polymers for foams, varnish and paints. Isocyanates, flour (bakeries), platinum salts, and soldering flux are occupational causes of asthma. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 14 of 35 (Guessed: 0 | Skipped: 14 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0087] A 40 year old man who was well during childhood has become progressively wheezy and breathless. He has reduced peak flows and an obstructive picture on the lung function test. Which of the following is a recognised occupational cause of the condition? A. Tar nmlkj B. Isocyanates nmlkj C. Methanol nmlkj D. Paraffin nmlkj E. Gold nmlkj Do question later! nmlkji Exit Test 52. Answer: c) kyphoscoliosis. In this scenario, the lung function indicates that the surface area for exchange are inadequate (low TLCO) hence suggesting that lung expansion is reduced. However, cardiac output is increased to compensate, and henced KCO is increased. Kyphoscoliosis would restrict lung expansion, or a neuromuscular disorder (eg spina bifida) could cause this. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 15 of 35 (Guessed: 0 | Skipped: 15 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0093] A 40 year old man has been breathless and is undergoing investigations for the cause. She has a previous history of being a smoker and has a dry cough as well. Her ABGs show a pO2 of 9kPa and pCO2 of 5 kPa. Lung function tests show reduced vital capacity, reduced TLCO but increased KCO. Which of the following are most likely? A. COPD nmlkj B. Bronchial obstruction from a tumour nmlkj C. Kyphoscoliosis nmlkj D. Obstructive sleep apnoea nmlkj E. Fibrosing alveolitis nmlkj Do question later! nmlkji Exit Test 53. Answer: b) chronic obstructive pulmonary disease. This patient has type II respiratory failure, without an acidosis, suggesting chronic CO2 retention. He also is a heavy smoker and has polycythaemia, making COPD most likely. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 16 of 35 (Guessed: 0 | Skipped: 16 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0097] A 75 year old heavy smoker presents to the hospital with breathlessness and a cough with yellow sputum. He has the following investigations : Hb 18 g/dl, WCC 12 x 10^9/l, ABGs show a pH of 7.38, pO2 of 8.5 kPa, pCO2 of 7 kPa. Which of the following is most likely? A. Bronchiectasis nmlkj B. Chronic obstructive pulmonary disease nmlkj C. Mesothelioma nmlkj D. Tuberculosis nmlkj E. Cryptogenic fibrosing alveolitis nmlkj Do question later! nmlkji Exit Test 54. Answer: d) inhaled corticosteroids. Diurnal PEFR variation points towards a diagnosis of asthma. Patients who do not respond to B agonists should be treated with inhaled steroids. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 17 of 35 (Guessed: 0 | Skipped: 17 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0086] A 35 year old man has significant wheezing and breathlessness. Recordings of peak flows shows diurnal variation. He was prescribed with salbutamol but continues to have frequent wheezy episodes. What is the next step in management? A. Phosphodiesterase inhibitors nmlkj B. Leukotriene antagonists nmlkj C. Oral antibiotics nmlkj D. Inhaled corticosteroids nmlkj E. Oral steroids nmlkj Do question later! nmlkji Exit Test 55. Answer: c) cryptogenic fibrosing alveolitis. KCO (transfer factor) is reduced in fibrotic lung disease, such as cryptogenic fibrosing alveolitis. It is also reduced in pulmonary oedema, lung infiltration, emphysema and asthma. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 18 of 35 (Guessed: 0 | Skipped: 18 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0102] A 40 year old man has a low KCO on the lung function test. FEV1 /FVC ratio is increased. Echocardiogram showed normal left ventricular function. Which one of the following diagnosis is likely? A. Aspergilloma nmlkj B. Guillain-Barre syndrome nmlkj C. Cryptogenic fibrosing alveolitis nmlkj D. Asthma nmlkj E. Congestive cardiac failure nmlkj Do question later! nmlkji Exit Test 56. Answer: a) dry cough. In extrinsic allergic alveolitis, haemoptysis and wheeze are uncommon. Dry cough and breathlessness are common features. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 19 of 35 (Guessed: 0 | Skipped: 19 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0091] A 45 year old woman has progressive shortness of breath. On examination she has O2 sats of 93% on air and finger clubbing was noticed. In assessing the potential diagnosis, which one of the following is a typical feature of cryptogenic fibrosing alveolitis? A. Dry cough nmlkj B. Haemoptysis nmlkj C. Haematuria nmlkj D. Wheeze nmlkj E. Abdominal pain nmlkj Do question later! nmlkji Exit Test 57. Answer: b) sodium cromoglycate. Sodium cromoglycate stabilises mast cell activity and reduces degranulation / histamine release Aminophylline is a phosphodiesterase inhibitor. Monteleukast is a leukotriene antagonist. Atrovent (ipatropium bromide) is an anticholinergic bronchodilator. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 20 of 35 (Guessed: 0 | Skipped: 20 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0013] A 25 year old patient has poorly controlled asthma and is prescribed a medication which reduces mast cell degranulation and histamine release. Which is the most likely medication ? A. Aminophylline nmlkj B. Sodium cromoglycate nmlkj C. Salbutamol nmlkj D. Monteleukast nmlkj E. Ipatropium bromide nmlkj Do question later! nmlkji Exit Test 58. Answer: d) adult respiratory distress syndrome. Respiratory distress syndrome is associated with profound hypoxia and increased vascular permeability (causing a V/Q mismatch). A normal PCWP differentiates the condition from pulmonary oedema. It does not respond to steroids. ARDS Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 21 of 35 (Guessed: 0 | Skipped: 21 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0103] A 55 year old man who had two episodes of hemorrhagic shock due to intestinal hemorrhage and post-operative secondary hemorrhage, was admitted to intensive care unit. During the following weeks this was followed by bronchopneumonia with symptoms of sepsis persisting over several weeks. Chest x ray showed progressive changes in the interstitial tissues and he became more significantly hypoxic. Pulmonary capillary wedge pressure was 13 mmHg. What is the diagnosis? A. Congestive cardiac failure nmlkj B. Pneumocystis pneumonia nmlkj C. Pulmonary embolism nmlkj D. Adult respiratory distress syndrome nmlkj E. Community acquired pneumonia nmlkj Do question later! nmlkji Exit Test 59. Answer: d) thoracoscopy and biopsy. This patient probably has a malignant effusion. As he is symptomatic, the best option would be to drain the fluid as well as confirm a diagnosis simultaneously. A video assisted thoracoscopy would help to do this Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 22 of 35 (Guessed: 0 | Skipped: 22 | Bookmarked: 0 ) Time taken: 4s Respiratory Medicine [id:0116] A 65 year old man has had 5 kg weight loss. He is an ex smoker and used to work in a coal mine. Chest X ray shows a large right sided pleural effusion and several pleural plaques in both lung peripheries. Pleural aspiration reveals an exudate. What is the next best investigation? A. Bronchoscopy nmlkj B. Lung function tests nmlkj C. Spiral CT of the chest nmlkj D. Thoracoscopy and biopsy nmlkj E. Sputum for AFB nmlkj Do question later! nmlkji Exit Test 60. Answer: c) diffusion capacity (DLCO) of 17 (predicted 23). A decrease in diffusion capacity (DLCO) indicates interstitial lung disease, which is likely in a patient with basal crepitations and a predisposing connective tissue disease. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 23 of 35 (Guessed: 0 | Skipped: 23 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0014] A 35 year old lady with systemic sclerosis has breathlesness on exertion. She has bilateral basal crepitations in the chests and corresponding interstitial shadowing on the CXR. Which is likely to be found on her lung function tests? A. P02 of 11 desaturating to 10 on exertion nmlkj B. FEV1 to FVC ratio of 65% nmlkj C. Diffusion capacity (DLCO) of 17 (predicted 23) nmlkj D. Increased residual volume nmlkj E. FEV1 of 5 L nmlkj Do question later! nmlkji Exit Test 61. Answer: c) lymphoma of the lung. The patient has Sjogren's syndrome. This predisposes to lymphoma of the lung. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 24 of 35 (Guessed: 0 | Skipped: 24 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0092] A 32 year old man has a history of dry eyes and mouth. His blood tests reveal a positive ANA, Ro and La extra nuclear antigens are also positive. Which of the following is he predisposed to developing? A. SLE nmlkj B. Small cell carcinoma of the lung nmlkj C. Lymphoma of the lung nmlkj D. Restrictive lung disease nmlkj E. Pulmonary eosinophilia nmlkj Do question later! nmlkji Exit Test 62. Answer: b) a fall in lung compliance. Fibrosis leads to type I respiratory failure. Reduced lung compliance is also due to fibrosis. Elastic recoil pressure is increased due to fibrosis around alveoli. Endobronchial sarcoid causes an obstructive picture rather than a restrictive picture. The total lung capacity measured by helium dilution is reduced. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 25 of 35 (Guessed: 0 | Skipped: 25 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0082] A 65 year old woman with breathlessness has fibrotic changes on her CXR. She has arterial blood gases and lung function tests. Which one of the following features suggests progressive pulmonary sarcoid? A. A high pCO2 nmlkj B. A fall in lung compliance nmlkj C. A reduced maximum lung elastic recoil pressure nmlkj D. An restrictive flow volume loop nmlkj E. A normal helium dilution total lung capacity nmlkj Do question later! nmlkji Exit Test 63. Answer: d) byssinosis. Byssinosis is caused by cotton dust, and is commoner among smokers. Immunologically, it is different from farmers lung but is more akin to occupational asthma wheeze occurs after exposure to cotton and hemp. The condition is typically worse on Mondays when work begins and lung function stabilises throughout the week. The CXR is normal, unlike extrinsic allergic alveolitis, where mottling is seen on CXR (interstitial pneumonitis). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 26 of 35 (Guessed: 0 | Skipped: 26 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0109] A 45 year old man who works in a cotton mill presents with fluctuating breathlessness. He has been getting progressively more breathless for 10 months. There is also associated chest tightness and cough. He has been smoking 10 cigarettes a day for the past 10 years. Upon assessment the patient has oxygen saturations of 95% and a normal chest x ray. What is the likely diagnosis? A. Occupational asthma nmlkj B. Berylliosis nmlkj C. Extrinsic allergic alveolitis nmlkj D. Byssinosis nmlkj E. Sarcoidosis nmlkj Do question later! nmlkji Exit Test 64. Answer: e) bronchoscopy. This patient is likely to have TB due to the apical shadowing. In a patient who is unable to expectorate sputum, bronchoscopy with lavage (send for AFB) should be performed to confirm the diagnosis. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 27 of 35 (Guessed: 0 | Skipped: 27 | Bookmarked: 0 ) Time taken: 3s Respiratory Medicine [id:0111] An 70 year woman has a history of dry cough for 2 months. She has lost 5 kg of weight over the 2 months. Her chest X ray shows a left apical shadowing. Blood tests reveal a raised white cell count of 16. She has not managed to cough up any sputum. Which of following tests should be performed? A. CT scan of the chest nmlkj B. Serum ANCA nmlkj C. Ultrasound of the chest nmlkj D. Kveim test nmlkj E. Bronchoscopy nmlkj Do question later! nmlkji Exit Test 65. Answer: c) malignancy. A protein of >35 g/L suggests an exudate. Causes of transudate are: Congestive heart failure Nephrotic syndrome Cirrhosis Hypoalbuminaemia Peritoneal dialysis Atelectasis (early) Caues of exudate are : Infection (Bacterial, viral, or parasitic) Malignancy Connective tissue disease Chylothorax Pancreatitis Postcardiotomy syndrome Drug-induced (eg, by amiodarone) Esophageal rupture Uremia Subdiaphragmatic abscess Light's criteria (suggests exudate) is satisfied if pleural fluid protein/serum protein ratio greater than 0.5 Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6 Pleural fluid LDH greater than two-thirds the upper limit of normal for serum LDH (a cut-off value of 200 IU,/L was used previously) Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 28 of 35 (Guessed: 0 | Skipped: 28 | Bookmarked: 0 ) Time taken: 2s Respiratory Medicine [id:0117] A 55 year old man has a pleural effusion which was aspirated. Tests of the pleural fluid show : protein 35 g/L, LDH 350 ( 250 g /g of dry weight). Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 9 of 34 (Guessed: 0 | Skipped: 9 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0220] A 20 year old man is referred for investigation of abnormal liver function tests. He has a previous history of diabetes diagnosed 5 years ago. His albumin is 35 g/l, bilirubin 15 mol/l, ALP is 390 U/l and ALT is 350 U/l. He has a serum copper of 30 mol/l (12-26) and caeruloplasmin of 90 mol/l (200-350). What is the diagnosis? A. Cholangiocarcinoma nmlkj B. Autoimmune hepatitis nmlkj C. Primary biliary cirrhosis nmlkj D. Haemochromatosis nmlkj E. Wilson's disease nmlkj Do question later! nmlkji Exit Test 82. Answer: A) observation. The natural history of asymptomatic gallstones suggests that a large number of affected individuals will remain asymptomatic throughout life; only 1-4% per year will develop symptoms or complications of gallstone disease. Therefore, the natural history of asymptomatic gallstones is so benign that surgery is generally not recommended and watchful waiting is the best course of management. Laparascopic cholecystectomy is recommended for asymptomatic patients with risks factors such as sickle cell disease and diabetes. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 10 of 34 (Guessed: 0 | Skipped: 10 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0035] A 38 year old lady who is asymptomatic has an ultrasound of her abdomen done privately. It showed several gallstones and no biliary dilatation. She has no other past medical history. What should be the management? A. Observation nmlkj B. Open cholecystectomy nmlkj C. Laparascopic cholecystectomy nmlkj D. ERCP nmlkj E. Lithotripsy nmlkj Do question later! nmlkji Exit Test 83. Answer: c) H.pylori eradication. Most cases of MALT lymphoma affecting the stomach are associated with infection by a bacterium called Helicobacter pylori (often abbreviated to H. pylori). If tests its presence then a course of intensive antibiotic treatment will sometimes lead to a remission of the lymphoma. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 11 of 34 (Guessed: 0 | Skipped: 11 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0598] A 65 year old lady has epigastric pain for several months and is referred for endoscopy. Biopsy confirms MALT lymphoma. What is the treatment of choice? A. Chemotherapy nmlkj B. Radiotherapy nmlkj C. H.pylori eradication nmlkj D. Interferon nmlkj E. Surgery nmlkj Do question later! nmlkji Exit Test 84. Answer: b) B12 deficiency. In chronic pancreatitis, trypsin secretion is reduced. Trypsin is required in the processing of dietary B12 which enables absorption and hence B12 deficiency is the most likely in this case. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 12 of 34 (Guessed: 0 | Skipped: 12 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0211] A 30 year old man presents with longstanding epigastric pains. Abdominal CT showed dilated pancreatic ducts. The secretin test is positive. The patient has a HB of 13 g/dl, MCV of 105 fl and platelet count of 350 x 10 ^ 9/l . The high MCV is most likely due to: A. Folic acid deficiency nmlkj B. B12 deficiency nmlkj C. Myelodysplastic syndrome nmlkj D. Reticulocytosis nmlkj E. Paroxysmal nocturnal haemoglobinuria nmlkj Do question later! nmlkji Exit Test 85. Answer: C) intrahepatic cholestatis of pregnancy. Intrahepatic cholestasis of pregnancy usually presents during the third trimester, at a mean of 30 weeks of gestation. The characteristic symptom is itching (pruritus gravidarum), which involves the trunk, extremities, palms, and soles. The features of obstructive jaundice, including pale stools and dark urine, may be present, but patients do not have constitutional symptoms. Intrahepatic cholestasis is associated with an increased risk of prematurity and stillbirth. Cholestyramine, given in divided doses totaling 10 to 12 g per day, may help relieve pruritus. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 13 of 34 (Guessed: 0 | Skipped: 13 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0595] A 28 year old lady is 34 weeks pregnant. This is her second pregnancy, the first pregnancy was uneventful. She has pruritus and on examination, was mildly jaundiced. Liver function tests showed: ALT 75 (5-35) U/l AST 70 (1-31) U/l ALP 350 (20-120) U/l Bilirubin 70 (1-22) mol/l Albumin 38 (37-49) g/l What is the likely diagnosis? A. Primary biliary cirrhosis nmlkj B. Gallstones nmlkj C. Intrahepatic cholestasis of pregnancy nmlkj D. Cholangiocarcinoma nmlkj E. Viral hepatitis nmlkj Do question later! nmlkji Exit Test 86. Answer: d) Carcinoid syndrome. Carcinoid syndrome is diagnosed by raised urinary 5-HT levels. A precursor of 5HT, tryptophan is highly metabolised and consequently niacin deficiency (pellagra) occurs. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 14 of 34 (Guessed: 0 | Skipped: 14 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0588] A 40 year old man visit his GP with symptoms of flusing and dizziness. He also has watery diarrhoea several times a month. On examination he has a systolic murmur in the tricuspid area and a parasternal heave over the left sternal edge. A 24 hour urine for a 5 HT is raised. What is the likely diagnosis? A. Zollinger Ellison syndrome nmlkj B. Chronic pancreatitis nmlkj C. Appendicitis nmlkj D. Carcinoid syndrome nmlkj E. Phaeochromocytoma nmlkj Do question later! nmlkji Exit Test 87. Answer: d) primary sclerosing cholangitis. Primary sclerosing cholangitis is usually seen in males. It is typically associated with ulcerative colitis. A positive pANCA can occur. The best investigation to confirm this is ERCP, which will reveal multiple strictures in the biliary system. 10% of patients with PSC will progress towards developing cholangiocarcinoma. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 15 of 34 (Guessed: 0 | Skipped: 15 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0034] A 35 year old man presents with lethargy and pruritus. He has had no abdominal pains and he is not jaundiced on examination. Blood tests show a bilirubin of 16 mol/l, albumin 35 g/l, ALT 350 U/l, ALP 1200 U/l. ANA and AMA is negative. Ultrasound of the liver shows normal intrahepatic bile ducts and increased echotexture of liver parenchyma. Which is the likely diagnosis? A. Primary biliary cirrhosis nmlkj B. Chronic active hepatitis nmlkj C. Autoimmune hepatitis nmlkj D. Primary sclerosing cholangitis nmlkj E. Cholangiocarcinoma nmlkj Do question later! nmlkji Exit Test 88. Answer: e) celecoxib. COX 2 inhibitors such as celecoxib are used as analgesics instead of NSAIDS in patients who are at high risk of upper GI dyspepsia or ulceration. However, there remains an increased risk of ulceration, though less so compared to NSAIDS. Misoprostol (prostaglandin analogue) and cimetidine are used in treatment of gastro-oesophageal ulceration. COX 2 inhibitors have also recently been shown to increase the mortality rate of patients with coronary artery disease by blocking the antithrombotic effects of certain prostaglandins. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 16 of 34 (Guessed: 0 | Skipped: 16 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0215] A 45 year old man has symptoms of epigastric pains. He is on several medications. Which of the following medications may cause lower oesophageal ulcerations? A. Misoprostol nmlkj B. Cimetidine nmlkj C. Calcichew D3 nmlkj D. Salmeterol nmlkj E. Celecoxib nmlkj Do question later! nmlkji Exit Test 89. Answer: e) pantoprazole. Proton pump inhibitors such as omeprazole, lansoprazole and pantoprazole are more effective than H2 receptor blockers such as ranitidine, cimetidine or nizatidine. Healing in oesophagitis is beter with a PPI although all of the options can reduce symptoms due to acid reflux. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 17 of 34 (Guessed: 0 | Skipped: 17 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0208] A 50 year old lady complains of epigastric burning pains due to stress. She finally undergoes an OGD which shows gastro-oesophageal reflux. Which medication is the most effective for her condition? A. Nizatidine nmlkj B. Bismuth nmlkj C. Gaviscon nmlkj D. Magnesium trisilicate nmlkj E. Pantoprazole nmlkj Do question later! nmlkji Exit Test 90. Answer: E) Whipples disease. PAS stained macrophages on the jejunal biopsy indicates a diagnosis of Whipples disease. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 18 of 34 (Guessed: 0 | Skipped: 18 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0224] A 65 year old woman complains of fevers, weight loss, joint pains and diarrhoea. A jejunal biopsy reveals flattened mucosa containing periodic acid-Schiff (PAS) positive macrophages. What is the most likely diagnosis? A. Coeliac disease nmlkj B. Campylobacter infection nmlkj C. Tropical sprue nmlkj D. Giardiasis nmlkj E. Whipple's disease nmlkj Do question later! nmlkji Exit Test 91. Answer: A) High IgG. Antinuclear antibodies of IgG class are frequently strongly positive (e.g. to a titre of 1/10000) in autoimmune hepatitis. Antibodies to dsDNA and to smooth muscle are also good markers. HLA-DR3 and DR4 antigen are associated with autoimmune hepatitis. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 19 of 34 (Guessed: 0 | Skipped: 19 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0585] A 35 year old woman presented with a 5-month history of weight loss (half a stone), anorexia and generalized pruritus. On examination, she was jaundiced with numerous spider naevi, scratch marks, palmar erythema and hepatosplenomegaly. Investigations showed : Haemoglobin 9.5g/dl white-cell count 7 x 10^9/l erythrocyte sedimentation rate 140mm/h serum albumin 42g/l serum bilirubin of 37 mol/l alanine transaminase of 122 iu/l aspartate transaminase of 154 iu/l alkaline phosphatase level 83 iu/l Which one of the following findings is suggestive of autoimmune hepatitis? A. High IgG nmlkj B. HLA DR2 nmlkj C. HLA DR6 nmlkj D. Antimitochondrial antibodies nmlkj E. Anti neutrophil cytoplasmic antibodies nmlkj Do question later! nmlkji Exit Test 92. Answer: d) Fluconazole. This is a patient with possible HIV who has oesophageal candidiasis. Fluconazole, ketoconazole and itraconazole can be used. Oesophageal Candidiasis Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 20 of 34 (Guessed: 0 | Skipped: 20 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0591] A 28 year old intravenous drug user complains about severe epigastric pains, nausea and vomiting. He has upper GI endoscopy which shows small areas of ulceration and white plaques. What of the following is the best treatment option? A. Metronidazole nmlkj B. Amoxycillin nmlkj C. Ranitidine nmlkj D. Fluconazole nmlkj E. Aciclovir nmlkj Do question later! nmlkji Exit Test 93. Answer: B) small bowel biopsy. The combined iron and folate deficiency anaemia, as well as symptoms suggestive of malabsorption makes, celiac disease the likely diagnosis. Small bowel biopsy may show partial or subtotal villous atrophy. Anti endomysial antibodies will also be helpful. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 21 of 34 (Guessed: 0 | Skipped: 21 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0217] A 60 lady has symptoms of intermittent abdominal pain and loose stool. Investigations reveal: Hb 8.5 g/dl MCV 85 fl WCC 6 x 10^9/l Iron 11 (14-29) mol/l Ferritin 20 (15-200) mol/l Folate 2 (3-20) g/l What investigation should be done? A. Ultrasound of abdomen nmlkj B. Small bowel biopsy nmlkj C. Smooth muscle antibodies nmlkj D. ERCP nmlkj E. Rigid sigmoidoscopy nmlkj Do question later! nmlkji Exit Test 94. Answer: b) retroperitoneal fibrosis. The symptoms of fevers, weight loss and lower back pain are classical for retroperitoneal fibrosis. There is an association with inflammatory conditions such as SLE, rheumatoid arthritis, ankylosing spondylitis, Hashimoto's thyroiditis and glomerulonephrosis. CT or MRI shows can fibrotic para-aortic masses causing ureteric obstruction. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 22 of 34 (Guessed: 0 | Skipped: 22 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0223] A 65 year old man is investigated for lower back pain. He also complains of weight loss and fevers. On reviewing his history, he has been told before that he has ankylosing spondylitis. On admission, his blood tests show a urea of 25 mol/l and a creatinine of 350 mol/l. An ultrasound of the kidneys shows hydronephrosis bilaterally. CT scan shows fibrotic para-aortic masses. Which of the following is the diagnosis? A. Carcinoid syndrome nmlkj B. Retroperitoneal fibrosis nmlkj C. Amyloidosis nmlkj D. Metastatic bladder cancer nmlkj E. Lymphoma nmlkj Do question later! nmlkji Exit Test 95. Answer: E) Coeliac disease. Weight loss and iron deficiency anaemia, along with diabetes are associations with coeliac disease. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 23 of 34 (Guessed: 0 | Skipped: 23 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0599] A 25 year old lady has had type 1 diabetes for three years. She presents with weight loss of half a stone. She had normal menstrual cycles and her bowel habit was unchanged. On examination her BMI was 25 kg/m2. Investigations reveal a haemoglobin of 7.7 g/dl and a MCV of 65 fl. Which one of the following is the likely diagnosis? A. Beta thalassemia nmlkj B. Bacterial overgrowth nmlkj C. Crohns disease nmlkj D. Anorexia nervosa nmlkj E. Coeliac disease nmlkj Do question later! nmlkji Exit Test 96. Answer: B) porphyria cutanea tarda. The spectrum of hepatitis C also includes several nonhepatic manifestations, including arthritis, keratoconjunctivitis sicca, lichen planus, glomerulonephritis, and essential mixed cryoglobulinemia (EMC). A final clinical manifestation of chronic hepatitis C is porphyria cutanea tarda (PCT). This form of porphyria is found in several forms of chronic liver disease often in association with iron overload. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: If you find any unexpected behaviour at any time please report it to the webmaster for correction! www.MRCPass.com Question: 24 of 34 (Guessed: 0 | Skipped: 24 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0221] A 45 year old man has chronic hepatitis C. Which one of the following features is associated? A. Polyarteritis nodosa nmlkj B. Porphyria cutanea tarda nmlkj C. Wegeners granulomatosis nmlkj D. Sclerosing cholangitis nmlkj E. Erythema chronicum migrans nmlkj Do question later! nmlkji Exit Test 97. Answer: a) intravenous hydrocortisone. The features are consistent with colitis, probably on a background of likely ulcerative colitis. Steroids are used in severe cases of colitis. If there are mild episodes of colitis then 5- aminosalicylates such as sulfasalazine can be used. Anti TNF antibody ias used for severe Crohn's disease. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 25 of 34 (Guessed: 0 | Skipped: 25 | Bookmarked: 0 ) Time taken: 3s Gastroenterology questions [id:0209] A 45 year old lady has rectal bleeding during bowel movements for 10 weeks. She has severe lower abdmoninal pains. Her appetite is poor and she has also lost 7 kg in weight. On examination she has a tender left lower abdomen and loud bowel sounds. Her abdomen is not distended. Rectal examination reveals small streak of blood. Her Hb is 11.1g/dl, WCC 13.5 x 10^9/l, platelets 600 x 10^9/dl, urea 6 mol/l, creatinine 100 mol/l and CRP of 80 mg/l. A rigid signoidoscopy shows inflammatory changes with ulceration and areas of bleeding. Which treatment option is the best at present? A. Intravenous hydrocortisone nmlkj B. Amoxycillin and metronidazole nmlkj C. 5-aminosalicylate given intravenously nmlkj D. Anti-TNF antibody infusion nmlkj E. Intravenous gamma globulin nmlkj Do question later! nmlkji Exit Test 98. Answer: d) ursodeoxycholic acid. Primary biliary cirrhosis is described. L Histology shows white cell damage to the biliary epithelium with non necrotising granuloma formation in the portal triad. Ursodeoxycholic acid lowers serum bilirubin and symptoms of itching, and prolongs the progression towards requirement for liver transplantation. IgM levels are particularly high in PBC. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 26 of 34 (Guessed: 0 | Skipped: 26 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0586] A 35 year old lady has mild jaundice and complains of itching. Her liver function tests show a bilirubin of 25 mol/l, ALT 100 U/l, ALP 480 U/l. ANA is negative, anti-mitochondrial antibody is positive at 1/320. What treatment will help her symptoms? A. Prednisolone nmlkj B. Metronidazole nmlkj C. Allopurinol nmlkj D. Ursodeoxycholic acid nmlkj E. Omeprazole nmlkj Do question later! nmlkji Exit Test 99. Answer: A) gastrin levels. Diarrhea and recurrent gastric ulceration is common with Zollinger Ellison syndrome (gastrinoma). There would be demonstrable high fasting plasma gastrin levels. Gastrinomas may occurs as part of a multiple endocrine neoplasia syndrome type 1. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 27 of 34 (Guessed: 0 | Skipped: 27 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0584] A 44 year old man presents with frequent diarrhoea and upper abdominal pains. He has had a partial gastrectomy 3 years ago for upper GI bleeding. He is now on high dose omeprazole regularly. A repeat endoscopy now shows two oesopnageal ulcers. What is the appropriate investigation? A. Gastrin levels nmlkj B. Barium enema nmlkj C. Insulin tolerance test nmlkj D. H. pylori serology nmlkj E. Colonoscopy nmlkj Do question later! nmlkji Exit Test 100. Answer: c) reassure her that no intervention is required. She is likely to have irritable bowel syndrome from the history and normal investigation. She should be reassured and also recommended to have a high fibre diet. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 28 of 34 (Guessed: 0 | Skipped: 28 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0033] A 35 female has a 6 year history of intermittent loose stool and constipation. Her blood tests are normal. An ultrasound of the abdomen and flexible sigmoidoscopy showed no abnormality. What should be the next management plan? A. Secretin test nmlkj B. Upper GI endoscopy nmlkj C. Reassure her that no intervention is required nmlkj D. CT scan of abdomen nmlkj E. MRI of abdomen nmlkj Do question later! nmlkji Exit Test 101. Answer: b) serum Cu and caeruloplasmin. Wilson's disease can present with early Parkinsons, psychiatric symptoms and dysarthria. It also causes abnormal liver function. It is an autosomal recessive condition. Serum copper and caeruloplasmin are low. Urinary copper excretion is raised. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 29 of 34 (Guessed: 0 | Skipped: 29 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0309] A 40 year old man presents with slurring of his speech and unsteadiness. He has a coarse tremor in his hands and ataxic, shuffling gait on examination. His blood tests show normal renal function. AST is 250 (1-30) U/l, ALP is 350 (1-250) U/l and Bilirubin is 45 (1-22). Which is the best investigation to confirm a diagnosis? A. Hepatitis screen nmlkj B. Serum Cu and caeruloplasmin nmlkj C. MRI of brain nmlkj D. Serum ferritin nmlkj E. IT 15 gene test for Huntington's nmlkj Do question later! nmlkji Exit Test 102. Answer: b) sclerosing cholangitis. 75% of patients with primary sclerosing cholangitis have inflammatory bowel disease, especially ulcerative colitis. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 30 of 34 (Guessed: 0 | Skipped: 30 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0219] A 40 year old man has ulcerative colitis. Which condition is most likely to be associated? A. Gallstones nmlkj B. Sclerosing cholangitis nmlkj C. Erythema nodosum nmlkj D. Renal calculi nmlkj E. Vitamin B12 deficiency nmlkj Do question later! nmlkji Exit Test 103. Answer: d) botulinum toxin. Botulinum injections are most effective of all the options for relieving a lower oesophageal sphincter restriction which leads to achalasia. Nifedipine, nitrates or sildenafil can also be used, but are less effective. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 31 of 34 (Guessed: 0 | Skipped: 31 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0213] A 65 year old woman presents with dysphagia and intermittent vomiting. Endoscopy shows a tight lower oesophageal sphincter. Which of the following medical therapies is most effective? A. Diltiazem nmlkj B. Bismuth nmlkj C. Glyceryl trinitrate nmlkj D. Botulinum toxin nmlkj E. Glypressin nmlkj Do question later! nmlkji Exit Test 104. Answer: e) spontaneous bacterial peritonitis. A white cell count of > 350 mm3 is diagnostic of spontaneous bacterial peritonitis. There is underlying cirrhotic liver disease and this should always be considered related to decompensation. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 32 of 34 (Guessed: 0 | Skipped: 32 | Bookmarked: 0 ) Time taken: 7s Gastroenterology questions [id:0216] A 35 year old man has chronic liver disease secondary to hepatitis. He comes on having had a depressive episode but also feels tired and unwell. He reveals that he has had a bottle of wine a day for a week. On examination he has gross abdominal distension. A peritoneal tap is done. Results from the tap show that it has albumin of 25 g/l, LDH of 320 U/l, glucose 3.5 mmol/l (serum glucose 6.5) and a white cell count of 700 per mm3 (90% neutrophils). What is the diagnosis? A. Acute reactivation of hepatitis B nmlkj B. Tuberculous peritonitis nmlkj C. Alcoholic liver disease decompensation nmlkj D. Chylous ascites nmlkj E. Spontaneous bacterial peritiontis nmlkj Do question later! nmlkji Exit Test 105. Answer: E) Liver function tests. The features are suggestive of autoimmune hepatitis. Liver function tests may demonstrated elevated levels of bilirubin, AST and ALT. A liver biopsy may then be warranted. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 33 of 34 (Guessed: 0 | Skipped: 33 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0031] A 42 year old man has a diagnosis of Ulcerative Colitis. He was incidentally found to have positive anti smooth muscle antibodies by the GP who sent an autoimmune screen. Which is the next appropriate test for this patient? A. CT of the abdomen nmlkj B. Colonoscopy nmlkj C. ESR nmlkj D. Endoscopy nmlkj E. Liver function tests nmlkj Do question later! nmlkji Exit Test 106. Answer: ) Angiodysplasia. Angiodysplasia is the most common vascular abnormality of the GI tract. After diverticulosis, it is the second leading cause of lower GI bleeding in patients older than 60 years. Angiodysplasia has been reported to be associated with aortic stenosis. Created in:0.0002 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 34 of 34 (Guessed: 0 | Skipped: 34 | Bookmarked: 0 ) Time taken: 2s Gastroenterology questions [id:0032] A 68 year old man with severe aortic stenosis presented with melaena. Upper GI endoscopy was normal. What may be the cause of bleeding? A. Haemorrhoids nmlkj B. Caecal carcinoma nmlkj C. Angiodysplasia nmlkj D. Duodenal ulcer nmlkj E. Ulcerative colitis nmlkj Do question later! nmlkji Exit Test 107. Answer: d) MRI of abdomen. The tests so far suggest an insulinoma. Localisation of the insulinoma can be done with MRI, CT, superior mesenteric angiography or pancreatic venous catheterisation. Insulinoma Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 1 of 34 (Guessed: 0 | Skipped: 1 | Bookmarked: 0 ) Time taken: 6s Endocrinology [id:0341] A 30 year old lady has recurrent attacks of dizziness and blackouts. A 72 hour fast reveals periods where her plasma glucose is 2.5 mmol/l with elevated insulin and C peptide levels. What is the next best investigation? A. Repeat 72 hour fast nmlkj B. Glucagon stimulation test nmlkj C. Glucose tolerance test nmlkj D. MRI of abdomen nmlkj E. Insulin antibodies nmlkj Do question later! nmlkji Exit Test 108. Answer: d) commence on gliclazide and reassessment with BM monitoring at home. He is a type 1 diabetic but there are no features of ketonuria or acidosis. He may have some residual islet cell function and hence sulphonylureas may help to stimulate insulin production. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to keep track of questions you are randomly guessing. Find out if you are a good guesser at the end of the test! You can also quickly navigate between guessed questions by clicking on the icon above! www.MRCPass.com Question: 2 of 34 (Guessed: 0 | Skipped: 2 | Bookmarked: 0 ) Time taken: 3s Endocrinology [id:0323] A 30 year old of average height and weight presents with polyuria and thirst. He has a blood glucose of 15 mmol/l. There is no ketonuria and pH on the blood gas is 7.35. How should he be treated? A. Start metformin nmlkj B. A fasting blood glucose should be sent before treatment nmlkj C. Subcutaneous insulin should be started nmlkj D. Commence on gliclazide and reassessment with BM monitoring at home nmlkj E. Dietary advice, review in a month with repeat glucose without any treatment nmlkj Do question later! nmlkji Exit Test 109. Answer: b) convert gliclazide to actrapid and insulatard insulin injections. Gliclazide can cross the placenta and cause fetal hypoglycaemia. In order to avoid macrosomia and congenital disorders, glycaemic control is best achieved with insulin therapy during pregnancy. A tds actrapid (short acting) regime with night insulatard (long acting) will achieve best glycaemic control. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 3 of 34 (Guessed: 0 | Skipped: 3 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0327] A 25 year old lady has mature onset diabetes of the young (MODY). Her blood sugars have been well controlled with gliclazide 80mg bd. Her obstetrician refers her to the physician for shared management of diabetes. Which is the best management step? A. Increase gliclazide doses to 160 mg bd nmlkj B. Convert gliclazide to actrapid and insulatard insulin injections nmlkj C. Convert gliclazide to metformin nmlkj D. Leave gliclazide doses unchanged nmlkj E. Stop gliclazide and monitor blood glucose nmlkj Do question later! nmlkji Exit Test 110. Answer: e) colloid goitre. A colloid goitre is most likely. Presentation is with mildly elevated TSH (0.3-4.0 mU/l) and normal free T4. Mild iodine deficiency or a pregnancy can cause the goitre to become more noticeable. Colloid Goitre -increased size of follicles and flattening of follicular epithelial cells Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 4 of 34 (Guessed: 0 | Skipped: 4 | Bookmarked: 0 ) Time taken: 11s Endocrinology [id:0302] A patient who is 8 months pregnant has a thyroid function test because she has a smooth palpable goitre. Her Free T4 is 20 pmol/l and TSH is 5 mU/l. Which of these diagnoses is most likely? A. Medullary thyroid carcinoma nmlkj B. Multinodular goitre nmlkj C. Grave's disease nmlkj D. Thyroid adenoma nmlkj E. Colloid goitre nmlkj Do question later! nmlkji Exit Test 111. Answer: b) adrenal tumour. An adrenal tumour is most likely, with androgen secretion. Virilisation occurs. These are aggressive tumours and the treatment option is surgery or radiotherapy. MRI of a Large Right adrenal tumour Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 5 of 34 (Guessed: 0 | Skipped: 5 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0306] A 35 year old lady has had no periods for two years. She also notices increased hair growth. Examination reveals male pattern balding and hair growth, and clitoromegaly. What is the likely diagnosis? A. Cushing's disease nmlkj B. Adrenal tumour nmlkj C. MEN nmlkj D. Congenital adrenal hyperplasia nmlkj E. Ovarian tumour nmlkj Do question later! nmlkji Exit Test 112. Answer: b) sickle cell disease. HBA1c readings can be artificially low in the context of sickle cell disease, haemolysis or in pregnancy. Created in:0.0006 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: You can now treat a test like a mock exam by navigating through questions using the and icons above without scoring them on the spot! You will have the option to review the test and explanations at the end of the test! www.MRCPass.com Question: 6 of 34 (Guessed: 0 | Skipped: 6 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0303] A 45 year old patient of African origin has polyuria. Her BM stick readings have been 15 on several occasions. However, her HBA1c value is good at 6.5. Which disease may cause this? A. Thalassemia nmlkj B. Sickle cell disease nmlkj C. Phaeochromocytoma nmlkj D. Thyrotoxicosis nmlkj E. Hypothyroidism nmlkj Do question later! nmlkji Exit Test 113. Answer: c) metformin. Metformin is a biguanide. It improves insulin sensitivity and is helpful especially in patients who are overweight as it does not stimulate appetites in the way that sulphonylureas do. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New Feature: You can turn OFF these help tips, by choosing the appropriate option from the main menu! www.MRCPass.com Question: 7 of 34 (Guessed: 0 | Skipped: 7 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0300] A 45 year old lady has recently been diagnosed as a diabetic. Despite strict diet control, her blood sugars are running at 12 mmol/l. She weighs 80kg. Which of the following is the best medication to start with? A. Insulin nmlkj B. Glibenclamide nmlkj C. Metformin nmlkj D. Troglitazone nmlkj E. Gliclazide nmlkj Do question later! nmlkji Exit Test 114. Answer: e) pernicious anaemia. Addison's disease is described. Many autoimmune diseases are associated e.g. vitiligo, diabetes, primary ovarian failure and pernicious anaemia. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the and icons above to navigate between questions. You can skip a question by selecting the do question later option. You can quickly navigate to the next skipped question by clicking on the icon above! www.MRCPass.com Question: 8 of 34 (Guessed: 0 | Skipped: 8 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0315] A 35 year old lady has skin pigmentation, hypotension, hyponatraemia. A short synacthen test shows a rise in cortisol from 100 to 140 g/ml. Which one of the following conditions is associated? A. Papillary thyroid carcinoma nmlkj B. Ovarian fibroids nmlkj C. Phaeochromocytoma nmlkj D. Hepatocellular carcinoma nmlkj E. Pernicious anaemia nmlkj Do question later! nmlkji Exit Test 115. Answer: d) blood taken from a drip arm. There is hyponatraemia, hypokalaemia and low urea with normal osmolality. This is most likely due to inaccurate sampling from a drip arm. In the other causes of hyponatraemia, the plasma osmolality should be low as well. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Any questions you choose to do later, will be counted as WRONG in the final result! Just guess by clicking on icon and find out if you are a good guesser or not! www.MRCPass.com Question: 9 of 34 (Guessed: 0 | Skipped: 9 | Bookmarked: 0 ) Time taken: 3s Endocrinology [id:0340] A 30 year old man has been admitted diarrhoea. His blood pressure is 130/80 mmHg, and temperature 38C. Blood results show: Na 118 mmol/l K 2.8 mmol/l urea 2 mol/l creatinine 50 mol/l chloride 70 mmol/l bicarbonate 20 mmol/l Serum osmolality is 287 mosm/l urine osmolality is 700 mosm/l Which is the most likely diagnosis for the hyponatraemia? A. Addisonian crisis nmlkj B. Diarrhoea and salt loss nmlkj C. SIADH nmlkj D. Blood taken from a drip arm nmlkj E. Drugs nmlkj Do question later! nmlkji Exit Test 116. Answer: b) anaplastic thyroid carcinoma. Anaplastic thyroid carcinoma is commoner in female patients. It can present with dysphagia, cough and neck pain. It is more invasive than papillary carcinoma. A fine needle aspiration can yield the diagnosis. Anaplastic (undifferentiated) carcinoma of the thyroid gland is composed mainly of undifferentiated malignant cells. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Note: Did you know that you can reset your statistics and start FRESH again with an option in the main menu? www.MRCPass.com Question: 10 of 34 (Guessed: 0 | Skipped: 10 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0304] A 50 year old man presents with a hoarse voice. He has a unilateral swelling of the thyroid gland. An ENT surgeon diagnoses a right recurrent laryngeal nerve palsy. Which one of the following diagnoses is most likely? A. Single thyroid nodule nmlkj B. Anaplastic thyroid carcinoma nmlkj C. Medullary thyroid carcinoma nmlkj D. Thyroglossal cyst nmlkj E. Lymphoma nmlkj Do question later! nmlkji Exit Test 117. Answer: c) adrenal tumour. Rapid development of hirsutism is usually caused by an adrenal tumour. There are high testosterone or DHEA levels in the plasma. MRI showing an adrenal tumour Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the future! You can also quickly navigate between bookmarked questions by clicking on the icon above! www.MRCPass.com Question: 11 of 34 (Guessed: 0 | Skipped: 11 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0339] A 40 year old lady has increasing hirsutism. She is embarassed about having to shave her chin and also her chest. Her voice is becoming deeper. What is the most likely diagnosis? A. Drug induced hirsutism nmlkj B. Polycystic ovarian syndrome nmlkj C. Adrenal tumour nmlkj D. Congenital adrenal hyperplasia nmlkj E. Ovarian carcinoma nmlkj Do question later! nmlkji Exit Test 118. Answer: b) chlorpromazine. Hyperprolactinaemia can be caused by drugs (OCP or phenothiazines), hypothyroidism, liver or renal failure, pituitary adenoma /acromegaly. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster Bug: Express your opinion about the new software and mrcpass.com by emailing the webmaster ! www.MRCPass.com Question: 12 of 34 (Guessed: 0 | Skipped: 12 | Bookmarked: 0 ) Time taken: 2s Endocrinology [id:0342] A 25 year old lady has oligomenorrhoea. As part of the hormone screen, she has a prolactin level of 700 mU/l (90- 520). Which of these is a cause of this biochemical picture? A. Thyrotoxicosis nmlkj B. Chlorpromazine nmlkj C. Primary ovarian failure nmlkj D. Endometrial tumour nmlkj E. Post transsphenoidal surgery nmlkj Do question later! nmlkji Exit Test 119. Answer: d) renal tubular acidosis. The diagnosis is normal anion gap metabolic acidosis. The normal anion gap is 8-16. The anion gap in this question is Na+K-(Cl+HCO3)=11.5. The causes of a normal anion gap metabolic acidosis are renal tubular acidosis, ileal conduit, carbonic anhydrase inhibitors, ammonium chloride ingestion. Created in:0.0003 s with superMCQ 2.1 (c) 2006-7 MN | Questions (c) LY limited | Email problems to: the webmaster New feature: Click on the icon above to bookmark this question for future reference. An option in the main menu allows you to do bookmark questions at any time in the futur