CSSL

1FGiven: A patient has ingested 10g of paracetamol

Question: Gastric lavage is essential

2FGiven: A man is admitted after head injury; he has a Glasgow Coma Scale score of 15

Question: He requires an urgent CT brain scan

3FProgression of Alzheimer’s disease is halted by donepezil (Aricept)

4FTemazepam is a useful hypnotic for the treatment of early wakening

5THyponatremia is a recognised complication following head injury.

6FA normal magnetic resonance imaging (MRI) brain scan excludes a diagnosis of multiple sclerosis

7FGiven: A patient with carotid stenosis develops cerebral infarction

Question: The most likely mechanism is restriction of blood flow through the stenotic segment

8TThe ulnar nerve supplies sensation to the little finger

9FInflammatory joint disease such as rheumatoid arthritis rarely affects the hands

10TPatients with radial nerve palsy cannot extend the fingers

11TMalignant spinal cord compression is an emergency

12TThe stage of family role identification extends from 2 to 6 years of age

13TMajor depressive illness may be induced by corticosteroids

14TAll phenothiazine drugs have adverse extra-pyramidal effects

15FTopical corticosteroids can safely be prescribed for undiagnosed ‘red eye’

16FMetabolic alkalosis is a consequence of aspirin overdose

17TThe overall suicide rate in the United Kingdom has increased in the last 5 years

18FBefore referring a case to the Coroner, a Certificate of the Cause of Death must be completed and given to the family

19TCongenital heart block is a recognised consequence of maternal systemic lupus erythematosus

20THaloperidol is a dopamine D2 receptor antagonist

21FGiven: Schizophrenia is a natural disease

Question: Death following self-harm is a recognised complication of schizophrenia, and need not be referred to the Coroner

22TCognitive behaviour therapy improves the prognosis of schizophrenia

23FIntravenous antibiotics are the most important way of preventing osteomyelitis in open contaminated fractures of bone

24TWoven bone, formed during fracture repair, is generally converted to lamellar bone

25TIn suspected septic monoarthritis, both blood and synovial fluid cultures must be taken

26FAstrocytoma is a tumour that arises from neurones

27TRegular monitoring with full blood count and liver function tests is necessary for patients prescribed sulphasalazine

28FGiven: 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

29TRheumatoid arthritis causes synovial hypertrophy

30TChronic alcoholic brain disease involves permanent damage to the mamillary bodies

31TGlioblastoma multiforme arises from astrocytes

32TSecondary brain tumours are more frequent than primary brain tumours

33FGiven: A 20 year old student has a tonic-clonic convulsion after having a blood test

Question: He probably suffers from epilepsy

34TMultiple sclerosis can give rise to vertigo

35TGiven: An elderly patient complains of slowing down, and examination reveals unilateral tremor and bradykinesis

Question: The likely diagnosis is Parkinson’s disease

36TBisphosphonate treatment may control the symptoms of Paget’s disease

37FHypocalcaemia is common in osteoporosis

38FAfter femoral neck fracture, the three-month mortality rate is about 5%

39TEburnation of the joint surface is a feature of osteoarthritis

40TLysergic acid diethylamide (LSD) acts on 5HT receptors

41TLithium carbonate has a narrow therapeutic window

42FCarpal tunnel syndrome requires no investigation before surgical treatment

43FGiven: 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

44TCerebral haemorrhage is a complication of streptokinase therapy

45FA facial paralysis getting progressively worse over a period of one month is likely to be Bell’s palsy

46TGentamicin is more vestibulotoxic than cochleotoxic

47FAir conduction of sound is better than bone conduction

48THearing loss in Meniere’s disease is characteristically for low frequency sounds

49TOtitis media is the commonest cause of persistent deafness in young children

50FPeople with alcohol dependency syndrome are usually unaware of their addiction

51FBenzodiazepines are effective antidepressants

52TOesophageal bleeding is a complication of portal hypertension

53TSuicide is more common in men than women

54TThe annual incidence of agranulocytosis in patients taking clozapine is 1 to 2%

55FPostnatal depression often requires inpatient psychiatric care

56FSection 3 of the Mental Health Act can only be used by the patient’s own consultant

57TSexual dysfunction occurs in approximately 10 to 15% of patients treated with selective serotonin reuptake inhibitors (SSRIs)

58TThe symptom of hopelessness is associated with suicide

59FAntipsychotics must be discontinued during pregnancy

60TDepressive symptoms occur in about 50% of people with bulimia nervosa

F & C

61F Most subjects with autism have a diagnosable physical disorder

62FThe most common cause of poor attendance at school is truancy

63TThe mortality rate from female breast cancer in the United Kingdom is decreasing

64TDepressive disorder is less common in childhood than in adolescence

65FAn infant is clinging strongly to its mother, and so a diagnosis of physical abuse can be excluded

66TGiven: MMR vaccine is a live virus vaccine

Question: MMR vaccine should not be given to children being treated with systemic steroids

67FPyloric stenosis is associated with hyperchloraemic alkalosis

68FGiven: 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

69TGiven: 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

70FGiven: A 6 year old girl bleeds excessively after sustaining small cuts and abrasions

Question: The most likely diagnosis is anti-haemophilic globulin deficiency

71TRotavirus is the most common cause of gastroenteritis in infants and young children

72TCoeliac disease may present with small intestinal lymphoma

73FMental health problems are rare in childhood epilepsy

74TThere is a genetic contribution to the development of schizophrenia

75TFamily therapy can be an effective form of treatment for some childhood disorders

76TSeparation anxiety is a normal part of childhood development

77THallucinations can occur in non-psychotic conditions

78FThe average age for a child to first walk unaided is 24 months

79FThe iron content of breast milk is higher than that in standard formula milk

80TThe benefits of breast milk include protection from infections

81FBreast feeding increases conjugated bilirubin levels in the neonatal period

82TWheeze, hyperinflation and hepatomegaly are features of bronchiolitis associated with respiratory syncytial virus infection

83TIrritability and absent breath sounds are a poor prognostic sign in an attack of asthma

84TEarly and intensive physiotherapy improves survival in cystic fibrosis

85FIn a child, a bradycardia of 60/minute during sleep indicates severe cardiac disease

86FIn measles, the cutaneous rash precedes the appearance of Koplik’s spots

87TFor iron to be absorbed, it needs to be in the ferrous form

88TMore girls than boys develop urinary tract infections

89FGram positive cocci are the commonest organisms causing urinary infections in childhood

90TIn girls, breast development starts before pubic hair grows significantly

91TThe risk of developing ovarian cancer is less in women taking the combined contraceptive pill

92TA correctly-placed copper intrauterine contraceptive device will be effective for five years or more

93TRaised blood pressure is a contraindication to the combined oral contraceptive pill

94FAntibiotic therapy renders the emergency contraceptive (‘morning after’) pill ineffective

95FHealthy children have higher erythrocyte counts than adults

96TIron deficiency anaemia in pregnancy is associated with preterm labour

97FUrticaria and sneezing, occurring together, is highly suggestive of anaphylaxis

98FIn the antenatal detection of Down's syndrome. the maternal serum level of human chorionic gonadotrophin is the most powerful predictive factor

99FAntenatal screening for beta-thalassaemia need only be carried out in women of Mediterranean origin.

100FAmniocentesis carries a risk of abortion of 5% in excess of the background spontaneous abortion rate.

101FPulmonary embolism is the commonest cause of post partum collapse

102TRespiratory distress syndrome is more likely to occur in babies born of diabetic mothers, compared to non-diabetic mothers

103FLate decelerations are those which occur late in labour

104FEntonox is a mixture of oxygen and nitrous oxide in the ratio of 30:70

105TErgometrine is contraindicated in women with cardiac disease.

106FOxytocin has an antidiuretic effect equivalent to that of vasopressin.

107FVaginal breech delivery should not be permitted in primigravidae.

108FThe drug of choice to suppress lactation is stilboestrol.

109TBreast fed babies are less likely to be obese.

110FBreast abscesses are best treated by the administration of a broad spectrum antibiotic.

111TLaparoscopy should be performed if an ectopic pregnancy is suspected.

112TBreast cancer is less common in women who have breast fed their babies.

113THot flushes can occur before menopause

114FThe mean age of the menopause in the United Kingdom is 45 years.

115FThe commonest cause of post menopausal bleeding is endometrial carcinoma.

116FThe national cervical screening programme recommends that screening should begin at 16 years of age in sexually active women.

117TIn cervical cytology, an adequate sample includes endocervical cells.

118FIn cervical cytology screening programmes, the false negative rate is less than 1%.

119TInsulin resistance is associated with the polycystic ovarian syndrome

120TUrinary incontinence is more common in women than men

121FSurgery alone is usually curative of ovarian cancer

122FProgestogens are highly effective in the treatment of dysfunctional uterine bleeding

123FPhysiotherapy is an effective treatment for detrusor instability

124TEctopic pregnancy can be a consequence of chlamydial infection

125FIn the United Kingdom, pelvic inflammatory disease is most commonly due to gonorrhoea

HLB

126FGiven: Hyperkalaemia is noted during the investigation of a patient who has recently presented with hypertension

Question: Conn’s syndrome is the most likely diagnosis

127TGiven: A hypertensive patient presents with headaches, palpitations and sweating

Question: The symptoms are consistent with a diagnosis of phaeochromocytoma

128TGiven: 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

129FGiven: 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

130FPatients treated with captopril for essential hypertension have a higher risk of developing diabetes mellitus than do patients treated with atenolol

131TSpironolactone has been shown to reduce the mortality in patients with heart failure

132FGiven: 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

133FACE inhibitors should not be given to patients with moderately severe renal failure

134TOsteosclerotic secondary tumours are associated with carcinoma of the prostate

135FPatients with renal failure caused by diabetes mellitus characteristically have small kidneys

136FIn chronic systemic hypertension, the kidneys are usually large

137THyperglycaemia during the acute phase of myocardial infarction is an adverse prognostic marker

138FBeta blockers are the therapy of choice in patients with heart failure

139FThiazide diuretics are contraindicated in the treatment of hypertension in subjects with diabetes mellitus

140TBeta blockers exacerbate psoriasis

141FIn a clinical study, the main purpose of randomisation is to ensure that there are an equal number of subjects in each group

142TGiven: 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

143FThere is no correlation between the incidence of ischaemic heart disease and the number of cigarettes smoked

144FThe left main bronchus is more vertical than the right main bronchus

145TThe Fc component of immunoglobulin binds to macrophages

146TDiminution of the R wave is an early feature in acute myocardial infarction

147FHigh protein diets slow the progression of renal failure

148TTreatment with intravenous sodium bicarbonate may help to control the hyperkalaemia of renal failure

149TMost patients with hairy cell leukaemia have considerable splenomegaly

150TSputum coughed up by patients with pneumonia associated with Klebsiella pneumoniae is often visibly coloured with iron-containing pigment

151FCarcinoid syndrome causes high output cardiac failure

152TSmoking is associated with bladder cancer

153FMost myocardial infarcts occur in the wall of the right ventricle

154FMultiple myeloma is a disease of myocytes

155FReed-Sternberg cells are diagnostic of lymphoma

156TMost non-Hodgkin’s lymphomas are of B-cell type

157TFolic acid deficiency causes megaloblastic anaemia

158FThe Philadelphia chromosome is associated with acute lymphoblastic leukaemia

159FA low grade fever is a feature of iron deficiency anaemia

160TSickle cell anaemia is usually inherited by an autosomal recessive mechanism

161FGiven: 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

162FGiven: 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

163TMycobacterium tuberculosis showing resistance to both isoniazid and rifampicin is becoming more common

164FGiven: A patient has a PaO2 of 65mmHg, a PaCO2 of 65 mmHg, a pH of 7.5 and a HCO3- of 40mmol/l

Question: This is respiratory acidosis

165TDepression in the medically ill often goes undetected

166TChronic fatigue syndrome is classified as a functional somatic disorder

167FIn the irritable bowel syndrome, a patient’s anxiety is typically reduced by thorough physical investigation

168TAsthma is a contraindication to the use of beta-blockers

169FEmphysema is a disease of the terminal bronchioles

170TThe side effects of anti-hypertensive medication often cause non-compliance

171FThe electrocardiogram usually provides the earliest indication that a patient has had a myocardial infarction

NME

172FCarbimazole is a treatment for complex partial seizures

173TTriamcinalone is a corticosteroid for topical use

174TA fasting blood glucose of 8.1mmol/L is diagnostic of diabetes mellitus

175FMeasurement of serum thyroxine must be done in the fasting state in the morning

176FOestrogen replacement after the menopause increases the risk of ovarian cancer

177FA pulse rate of more than 150/min, after completing strenuous exercise, is abnormal

178TMost patients with nodular goitre of the thyroid gland are euthyroid

179FTherapy with oxygen at a concentration of 20% is helpful in patients with chronic obstructive airways disease when they become hypoxic

180FMost patients with mumps orchitis will become sterile

181TMumps vaccine provides protection for about 90% of recipients

182TGiven: A woman aged 35 years has a right submandibular swelling, of sudden onset, that is painful on eating

Question: The most likely diagnosis is a salivary duct calculus

183TGiven: A young man presents with a severe sore throat, tonsillar exudate and swelling of local lymph nodes

Question: Broad spectrum penicillins should not be given

184TOesophageal pain is usually felt at the site of disease

185FAnti-thyroid drugs are contraindicated in pregnancy because they cause fetal macrosomia

186TIn the treatment of non-insulin dependent diabetes mellitus, insulin can be given in combination with metformin

187TChronic gastro-oesophageal reflux increases the risk of developing adenocarcinoma of the oesophagus

188TThe treatment of choice for severe reflux oesophagitis is a proton pump inhibitor

189FMeckel’s diverticulum is a malformation of the duodenum

190FAlcohol abuse causes acute pancreatitis, but not chronic pancreatitis

191TColonisation of the stomach with Helicobacter pylori may lead to gastric cancer

192FThe commonest site of cancer of the stomach in British patients is the gastric antrum

193FGiven: A 25 year old man presents with a six week history of epigastric pain

Question: Upper gastrointestinal endoscopy is mandatory

194TCarcinoma of the caecum commonly presents with anaemia

195TInguinal hernia may cause troublesome groin pain

196TTesticular atrophy is a complication of inguinal hernia repair

197TPruritus is a feature of cholestatic jaundice

198FRadioactive iodine treatment for thyrotoxicosis causes infertility

199FPhaeochromocytoma is a tumour of the kidney which secretes renin

200TGiven: A 28 year old woman has secondary amenorrhoea, galactorrhoea and infertility

Question: Bromocriptine is likely to alleviate these symptoms

201TKeratomalacia is a feature of Vitamin A deficiency

202TRifampicin reduces the plasma binding of bilirubin

203FGout is the commonest cause of renal stones in the United Kingdom

204TRecurrent haematuria is a feature of IgA nephropathy

205TCirrhotic patients often have a low grade fever unrelated to infection

206T Fevers and rigors are a feature of primary biliary cirrhosis

207FAutonomic neuropathy is the commonest cause of diarrhoea in patients with

diabetes mellitus

208TPatients with diabetes mellitus should be screened annually for retinopathy

209FRenal carcinoma is more common in women than men

210F Sulphonylureas, used in the treatment of diabetes mellitus, reduce insulin resistance

211FThe concordance rate between identical twins for the incidence of insulin dependent diabetes mellitus is 100%

212TIrritable bowel syndrome can cause symptoms affecting the urinary tract

213FThere is no effective treatment for fat atrophy at insulin injection sites

214TPainless haematuria is a feature of cancer of the urinary bladder

215TMost forms of glomerulonephritis are immunologically mediated

216FIn renal disease, loss of renal function is more closely correlated with the degree of glomerular damage than with the degree of tubulointerstitial damage

217TPodocytes are cells with fenestrations

218FRenal cell carcinoma typically spreads by direct invasion along the main renal artery

219FNon-caseating granulomata are a characteristic histological finding in ulcerative colitis

220TRaised mean cell volume is a frequent finding in the blood of patients who drink excessive amounts of alcohol

221TMetabolic bone disease is a complication of coeliac disease

222FSmoking cessation is clearly beneficial in the management of ulcerative colitis

223FConsumption of large amounts of chicken is a risk factor for cancer of the colon

224THepatitis C is associated with previous blood transfusion

225TPancreatic insufficiency causes malabsorption of fat

226TBreast cancer is associated with a high dietary intake of saturated fat

227FA raised serum alkaline phosphatase indicates cholestatic liver disease

228TGiven: Clostridium difficile toxin has been detected in the stool of a patient with diarrhoea

Question: Oral metronidazole is an useful first line treatment

229FGiven: A young woman has urinary frequency and dysuria

Question: Mid-stream urine culture is mandatory

General

230FMalignant melanoma is the commonest form of skin cancer

231FGiven: The sensitivity of a particular screening test is 95%

Question: This means that the number of false positive results is low

232TPsoriasis occurs in approximately 2% of the population of the United Kingdom

233THypertrichosis is a side-effect of cyclosporin therapy

234FBrief advice given in a general practice setting has no statistically significant effect on the number of people stopping smoking

235FThere is no itching in psoriasis

236FAromatherapy is a proven treatment for the long-term management of anxiety

237FIschaemic heart disease is the most prevalent chronic illness seen in general practice.

238FGiven: A man aged 55 years is found to have a blood pressure of 215/115mmHg

Question: Drug treatment should be started immediately.

239FGlycopeptide antibiotics are not usually active against methicillin-resistant Staphylococcus aureus