1TWide variability in peak flow measurements distinguish asthma from other forms of airflow obstruction
2F-adrenoceptor agonists are used as preventative therapy for asthma
3TAllergen avoidance is an important aspect of the care of a patient with asthma
4FNebulisers are more efficient than metered-dose inhalers for administering -adrenoceptor agonist medications
5FThe commonest class of paraprotein found in the blood in multiple myeloma is IgM
6FSurgical resection is the treatment of choice for small cell carcinoma of the bronchus
7TThe commonest type of lung cancer is squamous cell carcinoma
8FMesothelioma usually involves the major bronchi
9FMacMillan nurses have an important role in asthma care
10FBronchoscopy is the investigation of choice when a patient presents with a pleural effusion
11FA protein content of 12 g/l in pleural fluid is compatible with a diagnosis of pneumonia
12TStreptococcus pneumoniae is the commonest bacterial cause of community-acquired pneumonia
13TLegionnaires’ disease should be suspected in a patient with pneumonia who has recently returned from a Mediterranean resort
14FA ventilation / perfusion isotope lung scan is the best way to confirm the presence of pneumonia
15TBlood culture is useful in the investigation of the microbial cause of hospital-acquired pneumonia
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16TCaseating granulomatous inflammation is a typical histopathological finding in tuberculosis
17F Lymphadenopathy is a feature of multiple myeloma
18FIt is recommended that anti-tuberculous chemotherapy is continued for at least 12 months
19FRifampicin monotherapy is adequate for most cases of tuberculosis
20FThe typical pulmonary physiological abnormality in idiopathic fibrosing alveolitis is airflow obstruction
21FChronic physical illness predicts poor outcome in major depressive disorder
22TDepression in the physically ill is associated with greater physical disability
23TChronic physical illness is associated with a greater risk of suicide.
24TPsychological treatment for patients with the irritable bowel syndrome results in a reduction in gastrointestinal symptoms.
25FMental state examination includes the patient’s past psychiatric history.
26TA history from a relative, or close friend, about a patient’s current illness and pre-morbid personality is an important part of a psychiatric assessment.
27FIn hypertension, there is increased distensibility of the arteries.
28FThe diastolic pressure recorded should be the fourth Korotkoff sound.
29FDiabetes is a contraindication to the use of -blockers in a patient with hypertension.
30TAfrican-Caribbean people with hypertension may have a reduced response to treatment with angiotensin converting enzyme (ACE) inhibitors.
31FRenal failure is a common complication of chronic myeloid leukaemia
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32FCalcium antagonists are the drugs of first choice in the treatment of hypertension in the elderly.
33TAll patients with hypertension should be screened for hypercholesterolaemia
34FSecondary hypertension accounts for 25% of all cases of chronic hypertension
35FIn malignant hypertension, it is important to reduce the blood pressure to normal levels within six hours
36FA normal resting ECG excludes coronary artery disease as the cause of exertional chest pain
37TAnti-angina medication may cause breathlessness
38FGiven A 52 year old man presents a history of 2 hours of crushing chest pain
Question He should be given thrombolytic therapy before any further investigation
39FGiven A patient dies suddenly 3 hours following the onset of myocardial infarction
Question The likeliest explanation is an arrhythmia
40TIt is correct to prescribe a statin for a patient with angina who has a cholesterol level of 5.3mmol/l
41TThere is a recognised association of chronic myeloid leukaemia with previous exposure to ionising radiation
42FMyocardial infarction results from a slowly progressive build-up of atheroma within a coronary artery.
43TStable angina can be treated as an outpatient but unstable angina requires hospitalisation
44TMyocardial infarction can occur in the absence of any known risk factors.
45FOptimum control of blood sugar in diabetes mellitus reduces the risk of myocardial infarction to that of non-diabetics.
46FMedications are more effective than lifestyle changes in raising HDL cholesterol concentration
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47FHypertension is the commonest cause of cardiac failure in the United Kingdom
48FGiven A breathless patient has an ejection fraction on echocardiography of 55%
Question Left ventricular failure is the likely explanation
49FWhen Hodgkin’s disease has been diagnosed, splenectomy is performed routinely to allow accurate staging
50FGiven A patient develops infective endocarditis following dental treatment
QuestionStaphylococcus aureus is a likely causative organism.
51TIn atrial fibrillation, the risk of embolism depends on the cause of the arrhythmia
52TDigoxin is useful in the treatment of atrial fibrillation
53FAmpicillin is the treatment of choice for -lactamase positive Haemophilus influenzae infections.
54FInfluenza immunisation is advised for all health care workers.
55THaemoptysis is a common feature of bronchiectasis
56FChronic hypertension can be diagnosed from a single raised blood pressure reading
57TLifestyle modification is important in the initial management of a patient with chronic hypertension
58TAspirin reduces the mortality of acute myocardial infarction by approximately 30%.
59TAbout half of all patients who die from myocardial infarction do so before reaching hospital.
60FLoop diuretics have been proven in large clinical trials to improve the prognosis in cardiac failure.
61FRadiotherapy alone will cure more than 80% of subjects with Hodgkin’s disease when the lesion is localised to one group of lymph nodes
62FAlzheimer’s disease is characterised by spongiform changes in the brain
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63FIn carbon monoxide poisoning, the lips often have a blue tinge
64FBy definition, dementia only occurs in subjects aged 65 years or over
65FDay care is inappropriate for demented patients because it exacerbates confusion
66TRivastigmine is an acetylcholinesterase inhibitor
67TCerebrovascular disease is a cause of dementia
68TAn overdose of aspirin can cause metabolic acidosis
69TPin point pupils are a feature of overdosage with opioid drugs
70FThe duration of action of an intravenous dose of naloxone is approximately 3 hours
71FGiven A 30 year old woman presents with a 2 year history of triphasic colour change of the fingers on cold exposure, with recent ulceration of the tips of two of her fingers
Question Primary (idiopathic) Raynaud's phenomenon is the most likely diagnosis
72FAntemortem toxicological confirmation of a fatal concentration of drugs allows a Coroner’s inquest to be avoided
73TSystemic lupus erythematosus can lead to a sterile endocarditis
74THabitual cannabis use causes impairment of learning
75FThe incidence of schizophrenia is greatest in inner city areas
76FPeople detained in hospital under the Mental Health Act cannot legally vote in a general election
77THigher premorbid intelligence is a good prognostic factor in schizophrenia
78FOccupational therapy has no role in the treatment of negative symptoms of schizophrenia
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79TThe proportion of sleep spent as slow wave sleep is reduced by benzodiazepine hypnotics
80TDistal radial fractures often result in a dinner fork deformity
81TEburnation of the joint surface is a feature of osteoarthritis
82FThe pain of bony fracture is transmitted by a rich plexus of nerves within the Haversian canals of the bone
83TSulphasalazine may produce remission in active rheumatoid arthritis
84TKnee swelling arising immediately after injury is usually caused by haemarthrosis
85FGiven A 55 year old man with psoriasis develops back pain radiating down to his right foot. Both walking and coughing make the pain worse
Question The back pain is probably due to psoriatic spondyloarthropathy
86FA normal x-ray of the knee excludes septic arthritis
87TPsoriasis may be complicated by arthritis mutilans
88TClonazepam enhances the action of GABA at its receptor
89FMost meningiomas invade the adjacent brain tissue
90FGiven The clinical condition of a patient with a known brain tumour suddenly deteriorates
Question A lumbar puncture should be carried out to establish whether there is raised intracranial pressure
91TGiven A young woman complains of recurrent brief attacks of nausea, hallucinations of taste, ‘butterflies in the stomach’ and a sense of detachment.
Question She probably suffers from complex partial seizures.
92TA chest radiograph should be part of the initial investigation of a man who has his first partial complex seizure at the age of 50 years
93TSigns of previous optic neuritis in a patient with diplopia suggests a diagnosis of multiple sclerosis
94TClassical migraine consists of recurrent attacks of unilateral headache, associated with prodromal gastrointestinal upset and visual disturbance.
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95TIncreased muscle tone can manifest as rigidity or spasticity
96FFemoral neck fracture has a three-month mortality rate of about 5%
97FIn Parkinson’s disease, the substantia nigra of the brain is characteristically darker than normal
98FGiven An 88 year old woman presents after a fall, and is found to have shortening and external rotation of her lower limb
Question The most likely diagnosis is a fracture of the acetabulum
99FGiven A 75 year old lady with dense cataracts in both eyes undergoes successful cataract surgery in the right eye with recovery of 6/6 vision.
Question Cataract surgery to the left eye will confer little additional benefit and is thus not indicated
100FLithium carbonate has a wide therapeutic window
101FMood elevation must be present if a diagnosis of bipolar affective disorder is to be made
102TWasting of the thenar muscles is a feature of carpal tunnel syndrome
103TA raised immunoglobulin level in the cerebrospinal fluid is a frequent finding in multiple sclerosis
104TBaclofen may be used to alleviate spasticity
105TAn upper motor neuron lesion of the facial nerve spares the forehead muscles
106FGiven A 70 year old patient describes multiple episodes of transient loss of vision (each lasting a minute or so) in his right eye and has a carotid bruit in the right side of his neck.
Question The likely cause of his symptoms is cholesterol embolism from a carotid plaque, temporarily occluding the central retinal artery in his right eye
107TThe incidence of cerebral infarction is greater than that of cerebral haemorrhage
108FGiven: A patient with chronically elevated intraocular pressure shows progressive cupping of the optic discs.
Question: Sequential visual field testing will show loss of central vision followed by loss of peripheral vision
109FAllergic nasal polyps are often unilateral
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110FOtitis externa is more common in children than in adults
111TThe prevalence of depression increases with age
112FAdmission of women to a psychiatric hospital is least likely in the first three months following childbirth
113TEating disorders have increased in prevalence over the last 20 years
114TFor chronic disorders, the prevalence always exceeds the incidence
115FPalpitations must be present to allow a diagnosis of panic attack to be made
116FInsight into memory loss is typically preserved in Alzheimer’s disease
117TPregnant women are at reduced risk of suicide
118FWernicke’s encephalopathy is caused by vitamin B12 deficiency
119FThe Mental Health Act cannot be used to detain someone who is drunk
120FFluoxetine treatment may cause violent behaviour
121FMost people who harm themselves deliberately are mentally ill
122TPerseveration is suggestive of a frontal lobe lesion
123TThe rate of deliberate self harm is increased by television dramas in which it is depicted
124TOnset of anorexia nervosa after the age of 20 years is associated with a poor prognosis
125FGiven A doctor is the registered general practitioner for a child, and for both his parents. The parents are suspected of child abuse, and the doctor is asked to contribute to a Child Protection Investigation
Question The doctor has a duty of confidentiality to the parents, and thus cannot participate in the Child Protection Investigation
126TGiven A twenty month year old boy presents with pyrexia.
Question Paracetamol is a suitable drug to control the fever
127FGiven An eighteen month old girl presents with her first urinary tract infection
Question It is not necessary to carry out any further investigation unless she has further infections
128FGiven A two year old girl presents with symmetrical scalds to her feet
Question The injury is most likely to have been non-accidental
129TWhooping cough in infants may lead to bronchiectasis
130TCystic fibrosis may present as failure to thrive
131FGiven A three month old child is admitted with bronchiolitis.
Question The immediate management should include antibiotic therapy
132FCerebral palsy is a contraindication to whooping cough immunisation
133TWhen a child presents with global development delay, neglect is a possible diagnosis
134FGiven A mother asks for advice on reducing the risk of cot death.
Question She should be advised to place her baby prone so that the risk of aspiration is reduced
135TGiven Three teenagers are diagnosed with Shigella gastroenteritis following a school party
Question The illness should be notified to the local consultant for communicable diseases control
136FIn a child with central cyanosis during the first day of life, the most likely diagnosis is ventricular septal defect
137FX-linked agammaglobulinaemia can present in the neonatal period
138TIn Kawasaki disease, the major cause of death is myocardial infarction
139TMeasles vaccine is a live vaccine
140FWhen tuberculosis occurs , children are less likely than adults to develop tuberculous meningitis
141TSickle cell anaemia is an autosomal recessive disorder
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142TIn an X-linked recessive disorder, all daughters of affected males are obligate carriers
143FDown’s Syndrome arises from the absence of a chromosome 21
144TMeiosis only occurs in germ cells
145TDuchenne muscular dystrophy commonly presents with delayed walking
146FImmunisation against chicken pox is routinely offered to pre-school children in the United Kingdom
147FIf a person under 16 years old requires psychiatric admission, but they do not agree, compulsory admission can be arranged under The Children’s Act
148T Urine dipstick examination is an useful investigation for a 3 year old boy presenting with generalised oedema
149TProlonged exclusive breast feeding is associated with vitamin D deficiency in the infant
150FThe shunt across an uncomplicated VSD is from right to left
151TA cyanosed infant with a murmur typical of pulmonary stenosis is likely to have Fallot’s tetralogy
152THaemorrhagic disease of the newborn can be prevented by vitamin K administration at birth
153TIn general, the body’s stores of fat soluble vitamins last longer than those of water soluble vitamins
154TMany people carry Neisseria meningitidis in the nasopharyx, but have no symptoms
155TThe absorption of iron from a vegetarian diet is enhanced by Vitamin C
156FA multiparous woman is usually aware of fetal movements at 14 weeks of pregnancy
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157FIn a vertex presentation, the engaging diameter of the fetal skull is the occipitofrontal diameter
158FThe placenta is usually attached to the lower posterior wall of the uterus
159TMaternal serum screening for Down’s syndrome can only be carried out between the fifteenth and twentieth weeks of pregnancy
160FA glucose tolerance test should be performed after a single episode of glycosuria in pregnancy
161FProteinuria detected at 12 weeks of pregnancy is most likely to be due to chronic renal disease
162TVenous thromboembolism in the puerperium may present with mild pyrexia only
163FWarfarin is contraindicated in breast feeding
164TMost heart murmurs detected for the first time in pregnancy are not associated with cardiac pathology
165FBabies born of diabetic mothers are likely to develop hyperglycaemia within a few hours of birth
166TPreterm labour is a recognised complication of acute pyelonephritis
167FIn order to reduce perinatal mortality, continuous fetal heart rate monitoring should be performed in all confinements
168FIf a women had delivery by Caesarean section, she must be delivered by Caesarean Section in subsequent pregnancies
169TA prolonged latent phase of labour is an indication for an infusion of oxytocin
170FEpidural analgesia is the most appropriate form of analgesia in a multiparous woman admitted in labour with a cervical dilatation of 8cm
171TPost partum haemorrhage is the commonest complication of Caesarean section
172T“Syntometrine” contains both oxytocin and ergometrine
173TThe commonest cause of a breech presentation is prematurity
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174FThe principal immunoglobulin in breast milk is IgM
175FBreast feeding should be stopped if acute mastitis occurs
176FIn primary postpartum haemorrhage, oxytocic agents should not be administered until the placenta has been expelled
177FMammography is routinely offered to women aged over 40 years
178FThe menopause occurs later in cigarette smokers
179TOestrogen replacement therapy decreases the risk of myocardial infarction in postmenopausal women
180FIn postmenopausal women, cervical carcinoma is more common than endometrial carcinoma
181FNeisseria gonorrhoeae is the most common bacterial cause of tubal infertility
182FThe treatment of acute pelvic inflammatory disease is salpingectomy
183TVasectomy has a failure rate of 2 to 4 per thousand operations
184TThe progestogen only pill must be taken at the same time each day to be effective
185TTo be effective, contraceptive diaphragms must be left in place for at least 6 hours after coitus
186FHelicobacter pylori-associated antral gastritis is seen in 50% of patients with duodenal ulcer
187FDuodenal ulcers are a precursor lesion of carcinoma of the ampulla of Vater
188FThe weekly safe limit for alcohol consumption recommended for males by the Department of Health is 21 units
189FUpper abdominal pain radiating to the back is more suggestive of peptic ulcer disease than of pancreatitis
190TNon-steroidal anti-inflammatory drugs may cause gastric ulceration
191TCigarette smoking may delay the healing of peptic ulcer disease
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192TThe incidence of right sided colonic carcinoma is equal in men and women
193FFamilial adenomatous polyposis is associated with ingestion of red meat
194FDiverticular disease is a precursor lesion of colorectal carcinoma
195TLong-standing ulcerative colitis predisposes to colorectal carcinoma
196FGenetic abnormalities are absent from the tumour cells within non-familial neoplastic polyps of the colon
197FMost colorectal cancers can be detected by a single blood test for genetic abnormalities
198FCrohn’s disease is frequently seen in sub-Saharan Africa
199TCrohn’s disease may present with oral ulceration
200THypocalcaemia in Crohn’s disease may indicate terminal ileal involvement
201FMacrocytic anaemia in Crohn’s disease is associated with folic acid deficiency
202FSteatorrhoea stools are pale because of a lack of stercobilinogen
203TMost pancreatic carcinomas are of ductal origin
204FThe histological features of islet cell tumours of the pancreas predict their clinical behaviour
205FPancreatic carcinomas metastasise early to liver and lung
206FHepatitis A causes chronic liver disease in more than 10% of patients
207TLeptospirosis is transmitted by contaminated water
208TA hepatic lesion similar to that of alcoholic steatohepatitis may be caused by obesity
209TSerum concentration of alanine transaminase (ALT) is more specific than serum concentration of aspartate transaminase (AST) as a marker of hepatocellular damage
210TGT (gamma glutamyl transpeptidase) is an useful marker of alcohol exposure
211FThe presence of IgG antibodies to hepatitis A virus in serum indicates recent infection
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212TThe success of hepatitis B immunisation is related to the age of the recipient
213T The presence of hepatitis B virus ‘e’ antigen in serum indicates active viral replication
214T Graves’ disease is associated with anti-thyroid antibodies
215FCarbimazole may cause a reduction in the platelet count
216TTumours of mucosa associated lymphoid tissue (MALTomas) may arise in the thyroid gland
217TCushing’s syndrome may be caused by small cell carcinoma of the bronchus
218FTuberculosis is the commonest cause of Addison’s disease
219FAnti-diuretic hormone (ADH) is produced by the anterior pituitary gland
220T Pituitary adenomas may present with visual field disturbances
221FMDMA (3,4-methylenedioxymethamphetamine, or ‘ecstasy’) causes water intoxication
222TPatients with adult type polycystic renal disease have an increased incidence of berry aneurysms
223FMost bladder carcinomas are squamous cell carcinomas
224FMost patients with mumps orchitis will become sterile.