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Davidson MCQs
Davidson MCQs
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Question 10. The following are indications for anticoagulating a patient who has atrial fibrillation with warfarin:
(a) Age under 60 years. (False)
(b) Associated mitral stenosis. (True)
(c) Atrial fibrillation of more than 24 hours' duration. (True)
(d) A history of cerebral thromboembolism. (True)
(e) Associated left ventricular failure. (True)
Question 11. The following are true of ventricular tachycardia:
(a) It is a life-threatening condition. (True)
(b) It may be caused by myocardial ischaemia. (True)
(c) It may be caused by hypokalaemia. (True)
(d) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardia. (True)
(e) Acute ongoing ventricular tachycardia should be treated initially with drugs. (False)
Question 12. The following are signs of coarctation of the aorta:
(a) Radiofemoral delay in the pulses. (True)
(b) Rib notching. (True)
(c) Bruits heard over the scapula. (True)
(d) Ankle oedema. (False)
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Module 10 (Neurology)
Question 1. The following cranial nerves carry parasympathetic fibres:
(a) Oculomotor. (True)
(b) Trigeminal. (False)
(c) Facial. (True)
(d) Hypoglossal. (False)
(e) Vagus. (True)
Question 2. Myasthenia gravis:
(a) Is caused by antibodies to the acetylcholine receptor in the majority of cases. (True)
(b) Causes muscle wasting. (False)
(c) May show diurnal variation in symptoms. (True)
(d) Is associated with an improvement in strength after exertion. (False)
(e) May present with ophthalmoplegia. (True)
Question 3. The causes of a mixed upper and lower motor neuron picture include:
(a) Guillain-Barr syndrome. (False)
(b) Multiple sclerosis. (False)
(c) Syringomyelia. (True)
(d) Motor neuron disease. (True)
(e) Taboparesis. (True)
Question 4. Bilateral lower motor neuron facial weakness may occur in:
(a) Sarcoidosis. (True)
(b) Guillain-Barr syndrome. (True)
(c) Lyme disease. (True)
(d) Lymphoma. (True)
(e) Parasagittal meningioma. (False)
Question 5. In idiopathic Parkinson's disease:
(a) There is degeneration primarily of the cells of the globus pallidus. (False)
(b) The classical features include tremor, bradykinesia, and spasticity. (False)
(c) There is an associated vertical gaze palsy. (False)
(d) Anticholinergic drugs are most effective in relieving tremor. (True)
(e) Treatment is aimed at reducing dopamine levels. (False)
Question 6. The following features suggest that increased tone is due to rigidity:
(a) Tone is increased equally in flexors and extensors. (True)
(b) Extensor plantar responses. (False)
(c) Associated pill-rolling tremor. (True)
(d) Clasp-knife reflex. (False)
(e) Tone increases with synkinesis. (True)
Question 7. Causes of a small pupil include:
(a) Horner's syndrome. (True)
(b) Holmes-Adie syndrome. (False)
(c) Tabes dorsalis. (True)
(d) Optic neuritis. (False)
(e) Pilocarpine eye-drops. (True)
Question 8. Concerning optic neuritis:
(a) Visual loss is usually painless. (False)
(b) White-matter abnormalities on MR imaging increase the likelihood of developing multiple sclerosis in the future.
(True)
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Addison's disease should be considered a possible cause in a hypertensive patient with hirsutism (False)
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Question 35. The following are likely causes of splenomegaly in a patient with fever returning from the tropics
tuberculosis (False)
trypanosomiasis (True)
brucellosis (True)
visceral leishmaniasis (True)
infective endocarditis (True)
Question 36. The following statements about syphilis are true
infection is usually caused by Treponema pertenue (False)
Explanation: Due to infection with Treponema pallidum
cardiac murmurs are a typical early feature of infection (False)
Explanation: A feature of late disease
the primary lesion at the site of infection is initially macular (True)
Explanation: But becomes papular, then chancrous
the incubation period for primary syphilis is typically 2-4 weeks (True)
Explanation: But may be up to 90 days
tertiary syphilis usually develops within 1 year of infection (False)
Explanation: Takes at least 2 years to develop
Question 37. Characteristic features of late (tertiary and quaternary) syphilis include
negative specific treponemal antigen tests (False)
Explanation: The tests are typically positive
destructive granulomas (gummas) in bones, joints and the liver (True)
sensory ataxia (True)
Explanation: Due to dorsal column spinal disease
aneurysms of the ascending aorta (True)
Explanation: Typically with calcification
poor response of gummas to antibiotic therapy (False)
Question 38. The typical clinical features of gonorrhoea include
an incubation period of 2-3 weeks (False)
Explanation: 2-10 days
anterior urethritis and cervicitis (True)
Explanation: Dysuria, discharge or no symptoms
right hypochondrial pain due to perihepatitis (True)
pharyngitis (True)
good response to ciprofloxacin therapy in penicillin allergy (True)
Explanation: Or spectinomycin
Question 39. Anogenital herpes simplex is typically associated with
type 2 herpes simplex infection only (False)
Explanation: Type 2 and type 1 equally
primary attacks more severe and prolonged than recurrent attacks (True)
Explanation: Healing is more rapid in recurrent attacks
fever with painful genital ulceration and lymphadenopathy (True)
sacral dermatomal pain and urinary retention (True)
absence of clinical response to oral aciclovir (False)
Explanation: Shortens first attacks and may prevent recurrence
Question 40. HIV infection is associated with
an RNA retrovirus (True)
heterosexual transmission in the majority of cases world-wide (True)
Explanation: Superseding homosexual and parenteral
involvement of CD4 lymphocytes (True)
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Question 4. The following treatments are clinically useful in poisoning with the following agents
glucagons--blockers (True)
DMPS (dimercaprol)-heavy metal poisons (True)
Explanation: Useful in arsenic, gold and mercury poisoning
flumazenil-opioid analgesics (False)
Explanation: Used in benzodiazepine overdose
N-acetylcysteine-paracetamol (True)
Explanation: As indicated by plasma paracetamol concentrations post-ingestion
desferrioxamine-iron salts (True)
Question 5. Typical features following benzodiazepine poisoning include
ataxia, dysarthria, nystagmus and drowsiness (True)
severe systemic hypotension and respiratory depression (False)
Explanation: Severe cardiorespiratory depression is rare
nausea, vomiting and diarrhoea (False)
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Question 5. Factors associated with a higher suicide risk following attempted suicide include
females aged < 45 years (False)
Explanation: Older males
self-poisoning rather than more violent methods of self-harm (False)
Explanation: Self-poisoning is frequently parasuicidal
absence of a suicide note or previous suicide attempts (False)
Explanation: Suicide note often left and usually a history of previous attempts
chronic physical or psychiatric illness (True)
Explanation: And drug or alcohol misuse
living alone and/or recently separated from partner (True)
Explanation: Or bereavement
Question 6. Cardinal elements in cognitive therapy include
restructuring psychological conflicts and behaviour (False)
Explanation: Undertaken in psychotherapy
identification of negative patterns of automatic thoughts (True)
Explanation: E.g. in depression
awareness of connections between thoughts, mood and behaviour (True)
Explanation: Altering thoughts may alter behaviour
reorientation of negative views of the past, present and future (True)
Explanation: And development of positive views
personality assessment and transactional analysis (False)
Explanation: Features of psychotherapy
Question 7. The typical features of alcohol dependence include
expansion of the drinking repertoire (False)
Explanation: Narrowing of choices of alcoholic beverages
increasing tolerance of alcohol (False)
Explanation: Decreasing tolerance
subjective compulsion to drink (True)
use of alcohol to relieve withdrawal symptoms (True)
Explanation: Classical
recurrent withdrawal symptoms (True)
Question 8. The typical features of depression include
depressed mood for most of the day (True)
Explanation: But diurnal variation may occur
insomnia or hypersomnia (True)
Explanation: Or early morning wakening
loss of pleasure, self-esteem and hope (True)
Explanation: 'Anhedonia'-loss of sense of enjoyment
loss of energy, libido and interest (True)
Explanation: Perhaps with other somatic symptoms
psychomotor retardation and suicidal thoughts (True)
Explanation: With delusions of worthlessness
Question 9. Clinical features of generalised anxiety disorders include
feelings of worthlessness and excessive guilt (False)
Explanation: Suggest depression
depersonalisation and derealisation (True)
Explanation: May be seen in affective disorders
feelings of apprehension and impending disaster (True)
Explanation: With irritability
breathlessness, dizziness, sweating and palpitation (True)
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Question 29. Features consistent with the diagnosis of chronic pancreatitis include
abdominal or back pain persisting for days (True)
Explanation: Sometimes relieved by crouching or leaning forward
chronic opiate dependency (True)
Explanation: In 20%
increased sodium concentration in the sweat (False)
Explanation: Occasionally in cystic fibrosis
abdominal pain induced and relieved by alcohol intake (True)
pancreatic calcification on plain radiograph or ultrasound (True)
Explanation: But insensitive diagnostic tests
Question 30. Typical causes of chronic pancreatitis include
annular pancreas (False)
Explanation: Associated with pancreas divisum
alcoholism (True)
Explanation: Accounts for 70-80% of instances
gallstones (False)
Explanation: Common but not the cause of chronic pancreatitis
cystic fibrosis (True)
mumps (False)
Question 31. Typical complications of chronic pancreatitis include
pancreatic pseudocyst formation (True)
Explanation: Also associated with acute pancreatitis
obstructive jaundice (True)
Explanation: Due to stricture of the common bile duct as it passes the head of the pancreas
portal vein thrombosis (True)
Explanation: And splenic vein thrombosis leading to gastric varices
diabetes mellitus (True)
Explanation: Occurs in 30% overall
opiate drug dependence (True)
Explanation: May occur in up to 20% of patients
Question 32. The typical features of pancreatic carcinoma include
adenocarcinomatous histology (True)
Explanation: The vast majority
origin in the body of the pancreas in 60% of patients (False)
Explanation: Head of pancreas is the origin in 60% of patients
presentation with diabetes mellitus (True)
Explanation: Indicating advanced disease
back pain and weight loss indicate a poor prognosis (True)
Explanation: Even in the absence of metastatic spread
presentation with painless jaundice (True)
Explanation: Usually due to a tumour in the head of pancreas
Question 33. Characteristic features of ulcerative colitis include
invariable involvement of the rectal mucosa (True)
Explanation: Proctitis is a typical finding
segmental involvement of the colon and rectum (False)
Explanation: Suggests Crohn's disease
pseudopolyposis following healing of mucosal damage (True)
Explanation: Due to oedema and hyperplasia
inflammation extending from the mucosa to the serosa (False)
Explanation: Affects mucosa and submucosa only
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Question 30. The presence of lymphadenopathy and splenomegaly would be expected findings in
multiple myeloma (False)
Explanation: Neither is characteristic
chronic lymphocytic leukaemia (True)
Explanation: Mild splenomegaly, generalised lymphadenopathy
chronic myeloid leukaemia (False)
Explanation: Moderate to massive splenomegaly, no lymphadenopathy
infectious mononucleosis (True)
Explanation: Usually both mild
myelofibrosis (False)
Explanation: Splenomegaly without lymphadenopathy
Question 31. Recognised clinical features of multiple myeloma include
peak incidence between the ages of 30 and 50 years (False)
Explanation: Peak prevalence in males aged 60-70 years
secondary amyloidosis (True)
Explanation: Amyloidosis occurs in 10% of cases
median survival > 10 years with chemotherapy (False)
Explanation: Median survival of 40 months
recurrent infections and pancytopenia (True)
Explanation: Reduction of normal plasma cells causes immunodeficiency
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