2Cephalosporins Make Susceptible Bacteria More Sensitive to Environmental Osmolarity

1Compared with younger patients, the elderly tend to show greater first pass metabolism of drugs

2Cephalosporins make susceptible bacteria more sensitive to environmental osmolarity

3The General Medical Council's basic principles of good practice indicate that information given to a patient

should be noted in that patierifs clinical record

4It is known that mortality and morbidity from many diseases are correlated with occupational social class

5The Registrar General's Classification of Social Class is based on income

6More than half of patients are exempt from prescription charges in the United Kingdom

7A casecontrol study design is most efficient when one control is selected for each case

8A standardised mortality ratio (SMR) can only be estimated if the age distribution of the local population is

known

9When conducting a double blind controlled clinical trial, analysis should be performed several times during the

trial to check that results are going in a significant direction

10Thiazide diuretics decrease renal HCO; excretion

11The "c" wave of the jugular venous pulse is due to opening of the tricuspid valve

12Gram staining may help to predict the sensitivity of bacteria to a particular antibiotic

13Staphylococcus aureus is frequently implicated in an acute exacerbation of chronic bronchitis

14The mean cell volume (MCV) is raised in microcytic anaemia

15In hypercholesterolaemia, the statins have been shown to reduce serum cholesterol and thus the risk of

ischaemic heart disease

16Factors predisposing to thrombosis include arterial turbulence

17Vitamin B, deficiency is a recognised complication of oesophageal carcinoma

18Macrophages are present within the alveoli of healthy lungs

19Migrants to Britain from the Indian subcontinent have lower rates of heart disease than the indigenous white

population of the United Kingdom

20In the United Kingdom, Streptococcus pneumoniae is usually sensitive to ampicillin

21Hyponatraemia is a nonmetastatic manifestation of carcinoma of the bronchus

22Carcinoma of the larynx typically presents with a node in the neck

23Secondary hyperlipidaemia is typical of chronic renal failure

24Arterial blood oxygen content is reduced by a left to right shunt through a ventricular septal defect

25In patients with chest pain, but normal coronary arteries, panic disorder is one of the commonest diagnoses

26Mean pulmonary arterial pressure is normally about half of mean systemic arterial pressure

27Resistance to flow in a blood vessel is directly proportional to the radius of the vessel

28Frusemide has a greater maximal diuretic effect than bendrofluazide

29Captopril inhibits the conversion of angiotensin 1 to angiotensin 11

30Dilatation of systemic veins and venules decreases venous return to the heart

31A sustained rise in intrathoracic pressure decreases cardiac output

32Most of the blood flow into the ventricles occurs during atrial contraction

33The ORS complex of the electrocardiogram represents depolarisation of ventricular muscle

34Individuals of Type B personality are twice as likely to develop coronary heart disease as those of Type A

35Intravenous administration of the local anaesthetic lignocaine can control cardiac ventricular dysrhythmias

36Warfarin is metabolised by nonspecific mixed function oxidases in the liver

37The oxygen affinity of haemoglobin is decreased by a fall in blood pH

38The viscosity of blood is reduced when the red blood cell count is low

39Most of the carbon dioxide carried in blood is bound to haemoglobin

40In normal vertebral bone marrow, fat cells greatly outnumber haemopoietic cells

41Nicotinecontaining chewing gum is available on NHS prescription

42Six to twelve months after the end of a smoking cessation programme, the success rate is 3040%

43Cefuroxime is useful in the treatment of acute exacerbations of chronic bronchitis

44Peripheral cyanosis always accompanies central cyanosis

45Chronic bronchitis is associated with hypersecretion of mucus

46Thickening of the bronchiolar walls can be detected in chest radiographs

47In asthma, systemic arterial hypoxia is due to impaired distribution of inspired air within the lungs, rather

than inadequate total ventilation

48In allergic asthma, the antigen has to be inhaled to induce an attack

49During expiration, intraalveolar pressure rises above atmospheric pressure

50Collapse of a lung produces diminished breath sounds on the affected side of the chest

51Most patients with lung cancer present with swelling of the face and hands

52Squamous cell carcinoma of the bronchus may be complicated by hypertrophic osteoarthropathy

53Coal mining is a risk factor for bronchial carcinoma

54Inflammation containing granulomata may be a feature of tuberculosis

55Cardiac failure is a cause of pleural effusion with a protein content of 50g11

56Increased breath sounds are a clinical feature in a patient with a pleural effusion

57Group A haemolytic streptococci may be carried asymptomatically in the upper respiratory tract

58Betablockers are contraindicated if a patient has anaemia

59Cardiac failure may occur in rheumatic fever60 Magnetic resonance imaging is of value in assessing the severity of pulmonary emphysema

61When comparing the number of deaths from lung cancer in different populations, it is necessary to

know the age and sex structure of the respective populations

62Oedema of the foot is a common clinical sign in deep vein thrombosis of the leg

63It is the statutory responsibility of attending medical practitioners to notify tuberculosis to the relevant

authorities

64Low plasma potassium concentrations are known to be associated with treatment with aminophylline

65Hypertension has a worse prognosis if the patient also has diabetes mellitus

66In England and Wales it is accepted practice for a doctor to report, to the coroner, the death from

carcinoma of the bronchus of a man who has been exposed to asbestos

67In the drug treatment of hypertension, bendrofluazide commonly depresses the plasma potassium

concentration to below 2.5 mmol/litre

68Myeloma is a cause of microcytic anaemia

69Control of hypertension may be achieved by stopping smoking

70Prostacyclin (PG12) is synthesised in mast cells

71A paradoxical embolus is one which arises as a thrombus in the area of greatest flow in the aorta

72Type 1 hypersensitivity is classically seen in tuberculosis

73In untreated diabetes mellitus there is an increased sodium excretion by the kidney

74There is usually an increase in appetite in patients with duodenal ulcers

75Hormonal manipulation is a recognised treatment in renal carcinoma

76In a patient with jaundice, a plain radiograph of the abdomen is a sensitive test for the presence of gall stones

77In untreated diabetes mellitus urine is usually alkaline

78When a healthy person becomes dehydrated because of lack of fluid intake, the osmolality of fluid in the

proximal convoluted tubules of the kidneys increases above that of plasma

79Hepatitis C virus infection can be diagnosed using liver enzyme estimations

80Dopamine receptors in the renal vasculature mediate vasoconstriction

81Glomerular filtration rate increases when renal afferent arterioles dilate

82Longterm use of glucocorticosteroid drugs causes hypertension

83Benign prostatic hypertrophy is the result of hyperplasia of the fibromuscular capsule of the gland

84In a patient breathing 40% oxygen, the following arterial blood gas profile indicates metabolic alkalosis:

pH7.5

Pa0213 kPa

PaC026.1 kPa

HC0332 mmoill

Base Excess5.1

85Stones in the common bile duct cause gall stone ileus

86Prostatitis is a cause of chronic retention of urine

87The oxyntic (parietal) cells of the gastric glands secrete hydrogen ions

88Sweating is a symptom of hypoglycaemia

89The distribution of gas shadows on a plain abdominal Xray help to distinguish paralytic ileus from mechanical

intestinal obstruction

90Pure seminoma typically produces raised plasma tumour markers

91In a diabetic patient, glycosylated haemoglobin reflects blood glucose concentration over the preceding six

months

92In a diabetic patient, intercurrent infection typically precipitates hypoglycaemic episodes

93Colorectal carcinoma may cause iron deficiency anaemia

94H2 receptor antagonists reduce, but do not abolish, gastric acid production

95Secondary hyperparathyroidism is a cause of hypercalcaemia

96The absorption of a drug administered by mouth is most likely to be complete when the drug molecule is highly

acidic

97The detection of toxin in faeces is a diagnostic test for Clostridium difficileassociated diarrhoea

98Urine output is a satisfactory guide to the apparent volume of distribution of a drug

99Dopamine antagonists acting at D2 receptors decrease prolactin release

100Hepatocellular carcinoma is a long term complication of hepatitis A virus infection

101The presence of hepatitis B virus V antigen in the serum is indicative of active viral replication

102Familial polyposis coli usually presents in the fifth and sixth decades of life

103In carcinoma of the pancreas, there is early metastasis to inguinal lymph nodes

104Fissuring ulcers are often seen in ulcerative colitis

105Gastric carcinoma is a frequent complication of chronic gastric ulcer

106The majority of dietary iron is absorbed

107Pain complicating cancer may be reduced by nonsteroidal antiinflammatory drugs

108Subphrenic abscess may be detected on chest Xray

109Relief of pain with bowel movement is a common symptom with irritable bowel syndrome

110Nausea and vomiting are frequent symptoms in patients with duodenal ulcers

111A sodium excretion of 100m1Eq each 24 hours is consistent with the diagnosis of saltlosing nephritis

112The sensitivity of a screening test is the number of true positives divided by the total number of positive tests

113Clubbing of the fingers is a recognised feature of Crohn's disease

114Gold (sodium aurothiomalate) injections are not nephrotoxic when given to a patient with reduced renal function

115 Anal fissure is associated with Crohn's disease

116It is a statutory responsibility of the attending clinician to notify hepatitis B viral infection

117Hypopituitarism is usually associated with weight loss

118The incidence of anorexia nervosa is similar in all social classes

119Oedema can be a consequence of increased capillary hydrostatic pressure

120A pigmented skin lesion should be removed if it changes in size or colour

121Exposure to betanaphthylamineis a cause of hepatocellular carcinoma

122Carcinoma of the lower rectum may present with bloodstained faeces

123A goitre may increase in size as a result of treatment with carbimazole

124In England and Wales the incidence of prostatic cancer is increasing

125In acute appendicitis in adults, vomiting usually precedes the onset of pain

126Stones in the common bile duct may cause acute pancreatitis

127Secondary haemorrhage should be suspected when a patient develops fever and mild dyspnoea two days after

abdominal surgery

128The longterm use of glucocorticosteroid drugs may cause osteoporosis

129Hormonal manipulation is a recognised treatment in papillary thyroid cancer

130In a jaundiced patient, percutaneous transhepatic cholangiography should be delayed until a coagulation screen

has been completed

131When arterial blood pressure falls as a result of a severe haemorrhage, there is vasoconstriction in the renal

vascular bed

132In the United Kingdom, more men than women are obese

133In a patient lacking antidiuretic hormone secretion, urine output may exceed 10 litres each 24 hours

134In Britain, the recommended upper limit of alcohol consumption for a young adult woman is 4 units each day

135The main reason for heavy proteinuria in the nephrotic syndrome is inhibition of protein reabsorption in proximal

tubules

136Prolonged complete obstruction to the flow of bile into the duodenum will result in steatorrhoea

137Congenital hypertrophic pyloric stenosis causes bile stained vomitus

138Postmenopausal bleeding requires endometrial biopsy

139Ultrasonography at 16 to 18 weeks gestation can recognise neural tube defects

140The blood in glandular fever characteristically contains cold agglutinins

141Cardiac arrhythmias are an important toxic effect when imipramine is accidentally ingested by a child

142The likelihood of psychiatric disturbance in childhood and adolescence is increased by a rural upbringing

143Otitis media may present with a febrile convulsion

144Appropriate treatment for chronic otitis media includes regular aural lavage with saline

145Slipped upper femoral epiphysis is nearly always unilateral

146The production of yellow faeces by a five day old breast fed infant is a sign of jaundice

147A patient with Turner's syndrome has a karyotype of 46XX

148Physiologicaljaundice of the newborn is associated with a positive Coombs test

149Duchenne muscular dystrophy is inherited in an Xlinked recessive manner

150Postmenopausal bleeding indicates endometriosis

151Emotional deprivation is a cause of short stature

152In a patient with anteparturn haemorrhage, the absence of uterine tenderness suggests placenta praevia

153Muffled stridor is a striking feature of acute epiglotitis

154Diminished levels of afetoprotein in the amniotic fluid are characteristic of neural tube defects

155Polyhydramnios is associated with renal agenesis

156A cervical smear test is routinely used to detect invasive cancer

157AntiD antibody is present in plasma of Rh negative blood from infancy

158A child aged 13 years can give legal consent to medical treatment

159Pelvic inflammatory disease characteristically causes backache

160Cancer of the breast arises from a fibroadenoma

161The incubation period of rotavirus infection is less than a week

162Chickenpox vesicles usually appear within a week of exposure to the virus

163Increased fetal breathing movements are a sign of fetal compromise during pregnancy

164Subdural haematoma in infancy is associated with apnoeic episodes

165In glandular fever, the blood characteristically contains atypical lymphocytes

166The third stage of labour begins as soon as the head is delivered

167Clubbing of the fingers is a feature of Fallot's tetralogy

168In a normal menstrual cycle, there is a surge of follicle stimulating hormone immediately before ovulation

169In the United Kingdom, acute osteomyelitis in children is most commonly caused by Haemophilus inf7uenzae

type B

170Codeine phosphate is useful in relieving cough in acute severe asthma

171Human papilloma virus is associated with carcinoma of the endometrium

172Trichomonas vaginalis infection can be confirmed when clue cells are seen

173Haematemesis is an important toxic effect when large amounts of ferrous gluconate is ingested by a child

174Type 1 hypersensitivity is the principal mechanism of hay fever

175Psychiatric disturbance in childhood or adolescence is more common in large families

176High academic achievement is a risk factor for deliberate selfharm in childhood and adolescence

177Alcohol abuse is a risk factor for adolescent suicide

178In England and Wales, accidental injury is more commonly detected amongst children of social class V than

in any other social class

179School refusal is more common in children from social class 1 than in any other social class

180Puerperal breast infection is best treated by aspiration

181Phenyiketonuria is inherited as an autosomal dominant trait

182In a postmenopasual woman with early breast cancer, oestrogen receptor levels in the tumour are the most

important guide to prognosis

183Most cases of congenital hydrocephalus are associated with chromosomal abnormalities

184Dysfunctional uterine bleeding may result from psychogenic stress

185Multiparity predisposes to preeclampsia

186Herpangina associated with Coxsackie virus infection may cause a sore throat

187HenochSch6Mein purpura readily responds to prednisolone

188Uterine contractions increase placental blood flow

189Total resistance to airflow is greater in the upper airways than the lower airways

190The incidence of asthma in children is rising

191Sodium cromoglycate is poorly absorbed after oral administration

192Surfactant reduces pulmonary compliance

193Intestinal absorption of fatty acids occurs mainly by carrier mediated transport

194Digestion of carbohydrates is aided by the low pH in the stomach

195A spinal fracture at the level of T12 vertebra is unlikely to interfere with sitting balance

196In those over 75 years of age, dementia usually leads to longstay hospital care

197Paget's disease most commonly presents with a pathological fracture

198A patient with back pain which radiates down the back of one leg to the lateral border of the foot, with

exacerbations of pain associated with coughing and sneezing, would be appropriately investigated with

magnetic resonance imaging (MR1)

199Electroconvulsive therapy is contraindicated in elderly people

200Depressive illness should be considered in the differential diagnosis of thought broadcasting

201Abnormal illness behaviour is a major feature of dermatitis artefacta

202Choroiditis is a possible diagnosis in unilateral sore eye

203Euphoria is a feature of Parkinson's disease

204In cognitive behavioural counselling, the counsellor discourages the client from viewing negative beliefs as

hypotheses to be tested

205Aspirin overdose is characterised by metabolic alkalosis

206Pressure sores are caused by tissue ischaemia

207In carpal tunnel syndrome, apposition of thumb and little finger is unaffected

208The spinal cord ends at the level of L2 vertebra

209A past history of self poisoning is associated with an increased risk of suicide in the future

210Dementia usually requires neuroleptic medication

211Abnormal illness behaviour is a major feature of somatisation disorder

212Sensorineural deafness may result from exposure to excessive noise

213Renal failure is a common feature of paracetamol overdose

214The sarcoplasmic reticulurn releases calcium ions when the membrane is depolarised

215Damage confined to Wernicke's area results in expressive dysphasia

216Glucocorticosteroids inhibit the enzyme cyclooxygenase

217Shoulder dislocation commonly damages the radial nerve

218Each cerebral hemisphere receives visual information from both eyes

219The most common form of intracranial haemorrhage in boxers is a subdural haematoma

220Boggy swelling in joints is caused by accumulation of synovial fluid

221Patients with carotid stenosis may benefit from antiplatelet therapy

222Anabolic steroids increase the risk of coronary heart disease

223Clozapine produces less severe extrapyramidal side effects than typical antipsychotic agents

224Childhood squint is commonly associated with diplopia

225The scalp has a blood supply from the internal cartoid artery

226IgM rheumatoid factor may cross the placenta

227Retrograde memory loss following head injury usually recovers completely

228Patients with lesions of the sixth cranial nerve are likely to complain of diplopia

229Atrial fibrillation is associated with amaurosis fugax

230Meniere's disease generally presents in patients over 65 years of age

231Increased uptake of tracer on a radioactive bone scan is pathognomonic of bone malignancy

232The incidence of bone sarcomas is highest in the fifth and sixth decades of life

233Atypical grief is suggested by hearing the voice of the dead person two months after the bereavement

234Benzodiazepine withdrawal may cause convulsions

235Magnetic resonance imaging is of value in the diagnosis of prolapsed intervertebral disc

236Hypertension is a complication of spinal injury

237The sympathetic supply of the pupil is impaired in Horner's syndrome

238Flight of ideas strongly favours a diagnosis of schizophrenia

239In meningoccocal meningitis, there is high protein, low glucose and increased lmyphocytes in the cerebrospinal

fluid

240Electroconvulsive therapy is effective in puerperal psychoses

241When tremor appears on the second dayafter admission to hospital, alcohol dependence should be suspected

242Depressive illness should be considered in the differential diagnosis of hysterical conversion

243In petit mal epilepsy, the electroencephalogram characteristically shows a spike and wave pattern with a

frequency of 3 per second

244Induced physical illness is a major feature of Munchausen syndrome by proxy

245Atropine may be appropriate in the treatment of acute angle closure glaucoma

246In an 87 year old patient, traction is the treatment of choice for an intertrochanteric fracture of the neck of the

femur

247Rectus abdominis is supplied by intercostal nerves

248People with chronic illness often regard themselves as healthy

249Cerebellar disease is commonly associated with tremor at rest

250Dementia is associated with clouding of consciousness