MEDICAL MCQ BANK

Gastroenterology MCQ 04

noreply@blogger.com (XYDAU) — Thu, 04 Aug 2011 07:54:00 +0000

01.Meckel's diverticulum most commonly presents as:

A. Gastrointestinal bleeding.

B. Obstruction.

C. Diverticulitis.

D. Intermittent abdominal pain.

02.All of the following statements about the embryology of Meckel's diverticulum are true except:

A. Meckel's diverticulum usually arises from the ileum within 90 cm. of the ileocecal valve.

B. Meckel's diverticulum results from the failure of the vitelline duct to obliterate.

C. The incidence of Meckel's diverticulum in the general population is 5%.

D. Meckel's diverticulum is a true diverticulum possessing all layers of the intestinal wall.

E. Gastric mucosa is the most common ectopic tissue found within a Meckel's diverticulum.

03.Patients with established, complete, simple, distal small bowel obstruction usually have the following findings on plain and upright abdominal radiographs:

A. Distended small bowel identifiable by the valvulae conniventes.

B. Multiple air-fluid levels.

C. Modest amount of gas in the pelvis.

D. Peripheral, rather than central, distribution of gas.

E. Prominent haustral markings.

F. Free air.

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ANSWER

01.Answer: A
It is estimated that only 4% of patients who possess a Meckel's diverticulum will become symptomatic during their lifetimes.
The most common clinical presentation is incidental identification during abdominal exploration. Symptomatic presentations are secondary to hemorrhage, small bowel obstruction, diverticulitis, perforation, associated umbilical abnormalities, and tumors. Over half of patients presenting with symptoms are under the age of 2.
The most common clinical problem associated with Meckel's diverticulum is gastrointestinal bleeding presenting as bright red blood per rectum. The usual source of the bleeding is a chronic acid-induced ileal ulcer in the ileum adjacent to a Meckel's diverticulum that contains gastric mucosa. Another common symptom associated with a Meckel's diverticulum is intestinal obstruction.
The cause of this obstruction may be volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or rarely, incarceration of the diverticulum in an inguinal hernia (Littre's hernia).
Volvulus is usually an acute event and if allowed to progress, may result in strangulation of the involved bowel. In intussusception, a broad-based diverticulum invaginates and then is carried forward by peristalsis.

02.Answer: C
Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, usually arising from the antimesenteric border of the ileum 45–90 cm. proximal to the ileocecal valve. It is a vestige of the omphalomesenteric or vitelline duct, which usually undergoes complete obliteration during the seventh week of gestation. Autopsy studies have estimated the incidence of Meckel's diverticulum to be 1% to 2% with men being more commonly affected than women by a ratio of 2:1. Gastric mucosa is present in 50% of all Meckel's diverticula, but in over 75% of symptomatic individuals.

03.Answer: A AND B
Abdominal x-ray examination of patients with intestinal obstruction usually reveals abnormally large quantities of gas in the bowel. One can usually identify distended small intestine or colon. Gas in the small bowel outlines the valvulae conniventes, which usually occupy the entire transverse diameter of the bowel image. Colonic haustral markings occupy only a portion of the transverse diameter of the bowel.
Typically, the small bowel pattern occupies the more central portion of the abdomen, whereas the colon shadow is on the periphery of the abdominal files or in the pelvis. Patients with mechanical small intestinal obstruction usually have minimal colonic gas, if any.

Cardiology MCQ_PART 10

noreply@blogger.com (XYDAU) — Thu, 27 Jan 2011 00:56:00 +0000

1.A 35-year-old woman presented with a history of intermittent light-headedness is thought to have the Wenckebach phenomenon? Which is the type of arrythmia that this patient has?
a) Atrial premature beats
b) Profound sleep-associated bradycardia
c) Supraventricular tachycardia
MRCP Cardiology MCQs (Masterpass)d) Transient Mobitz type-1 atrioventricular block
e) Ventricular premature beats

2.What would typically cause the pressure–volume curve of the left ventricle to be shifted to the left?
a) Aortic regurgitation
b) Mitral stenosis
c) Aortic stenosis
d) Mitral regurgitation
e) Tricuspid stenosis

3.A 42-year-old man with acute renal failure is confused. His serum potassium is 8.1 mEq/L . The most likely abnormal ECG finding is
a) T wave inversion
b) PR interval of 300ms
c) QT interval of 0.4s
d) U wave
e) tall tented T waves test

Cardiology MCQ_PART 09

noreply@blogger.com (XYDAU) — Wed, 22 Sep 2010 00:54:00 +0000

A 45-year-old man with a strong family history of ischaemic heart disease presents with atypical chest pains. What pharmacologic agent is likely to be used to produce cardiovascular stress during stress echocardiography in this patient?

a) dipyridamole
b) Dobutamine
c) adenosine
d) arbutamine
e) Atropine

Familial hypertrophic cardiomyopathy is most likely to be secondary to a mutation in:
a) myosin regulatory proteins
b) myosin binding protein-C
c) Myosin light chains
d) Troponin I
e) Troponin T

A 56 year old male has a history of aortic stenosis. Which of the following is associated with aortic stenosis?
a) atrial fibrillation
b) systolic ejection murmur
c) increased pulse pressure
d) diastolic murmur
e) right heart failure

EXPLANATIONS

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MCQ 01 ANSWER

The correct answer is A
Stress echocardiography has been developed in recent years as an effective noninvasive test for the detection and assessment of coronary artery disease. This method combines exercise with 2-dimensional echocardiography, which can assess regional and global left ventricular function during stress. Dobutamine infusion, a pharmacologic means of producing cardiovascular stress, appears to be an excellent alternative to exercise in echocardiographic studies. Currently, it is reserved for patients who cannot exercise at a meaningful level because of advanced age, physical deconditioning, or other factors.

Dobutamine infusion is the method used most often for pharmacologic stress echocardiography. Graded dobutamine infusion--10 to 40 micrograms/kg per minute in 3-minute stages--increases myocardial oxygen demand in a fashion similar to that of staged exercise. During the dobutamine infusion, it is apparent that heart rate, contractility, and blood pressure are increased. Dobutamine has the advantage of rapid onset of action, and its effects can be reversed by giving an intravenous beta-blocker. A synthetic catecholamine that has a relatively short half-life (about 2 minutes) , dobutamine has strong agonist activity at the beta1 receptor and mild agonist activity at the beta2 and alpha1 receptors.

Atropine can be used to increase heart rate, if necessary, and is usually administered at the peak dobutamine dose. It is usually given as a 0.5-mg bolus and in 0.25-mg increments every 60 seconds (maximum dose, 1-1.5 mg) until the desired heart rate is achieved.

Dobutamine infusion is stopped after images are acquired at peak heart rate--or sooner if the patient has tachyarrhythmias.

MCQ 02 ANSWER

The correct answer is B

Molecular genetic research has demonstrated that familial hypertrophic cardiomyopathy
is caused by a mutation in one of nine genes that encode sarcomere proteins. Sarcomeres are the contractile units within the cardiac cells; these are composed of many proteins that are organized into thin and thick filaments. These filaments slide with respect to each other during cardiac contraction.
Hypertrophic Cardiomyopathy
Mutations in thick filament proteins called cardiac B myosin heavy chain or cardiac myosin binding protein-C appear to account for approximately 82% of hypertrophic cardiomyopathy. Mutations in thin filament proteins cardiac troponin T and a tropomyosin account for about 13% of hypertrophic cardiomyopathy. Mutations in two other sarcomere proteins, the myosin regulatory and essential light chains are quite rare and contribute less than 5% to hypertrophic cardiomyopathy. Although these percentages are only estimates, they indicate that more disease-causing genes will be identified.

A tenth gene has been identified that is a non-sarcomere protein (a subunit of protein kinase A) is associated with individuals who have both hypertrophic cardiomyopathy and Wolf-Parkinson-White syndrome.

MCQ 03 ANSWER

With aortic stenosis there is a systolic ejection murmur that is heard loudest at the second right intercostal space. Atrial fibrillation is common in mitral stenosis. It is also seen in mitral regurgitation, however, less commonly than with mitral stenosis.

Aortic stenosis typically is not associated with atrial fibrillation.The pulse pressure is the difference between systolic and diastolic pressure. An increased pulse pressure is seen with aortic regurgitation.It manifests itself with various signs: Quincke's sign, Duroziez's sign and a 'water hammer pulse'. diastolic murmur is heard with several different valvular conditions, including aortic regurgitation.

Cardiology MCQ_Part 08

noreply@blogger.com (XYDAU) — Sun, 22 Aug 2010 02:27:00 +0000

01.WHAT would be the most likely cause of Several episodes of gastrointestinal bleeding of unclear source with muscle pains in a 25 year old woman.
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

02.Acute onset severe back pain in a 26 year old woman in her 35th week of gestation for her third child could be due to
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

03.The cardiomyopathy of alcohol abuse is a/an:
A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Ischemic cardiomyopathy

04.The most commom cause of myocarditis in the United States:
A. Streptococcus viridans
B. Trypanosoma cruzi
C. Toxoplasma cruzi
D. Coxsackie B
E. Adenovirus

Anesthesia MCQ_Part 01

noreply@blogger.com (XYDAU) — Wed, 11 Aug 2010 14:31:00 +0000

1.Which of the following is a contraindication for using a laryngeal mask airway ?
a) when inhalational anaesthesia is required
b) large obstructive lesion in the oropharynx
c) Maintaining airway during difficult intubation
d) Emergency management of airway in failed intubation
e) bronchoscopy in the awake patient

2.In a lower Segment Caesarean Section which of the following techniques of anesthesia is least desirable ?
a) Spinal anesthesia
b) Caudal anesthesia
c) Combined Spinal Epidural anesthesia
d) epidural anesthesia
e) General anesthesia

3.Which of the following is likely to DECREASE the minimum alveolar concentration of an anesthetic ?
a) Hyperthermia
b) Hypernatraemia
c) Benzodiazepines
d) Hypercapnia
e) Thyrotoxicosis

EXPLANATIONS

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MCQ 01 ANSWER

The Correct Answer is B
The Laryngeal Mask Airway is an alternative airway device used for anesthesia and airway support. It consists of an inflatable silicone mask and rubber connecting tube. It is inserted blindly into the pharynx, forming a low-pressure seal around the laryngeal inlet and permitting gentle positive pressure ventilation.
The Laryngeal Mask Airway is an appropriate airway choice when mask ventilation can be used but endotracheal intubation is not necessary.

Contraindications:

Non-fasted patients
Morbidly obese patients
Obstructive or abnormal lesions of the oropharynx

It may be used as a rescue airway and fiberoptic conduit when intubation is difficult, hazardous or unsuccessful. And it can be used for bronchoscopy in the awake or asleep patient.

MCQ 02 ANSWER

The Correct Answer is B
Caudal anaesthesia is unpopular because of the risk of introducing needle passing through the mother's sacrum and rectum and into fetal presenting parts.

MCQ 03 ANSWER

The Correct Answer is C
The minimum alveolar concentration (MAC) is the concentration of anesthetic at 1 atmosphere of pressure that produces immobility in 50% of patients exposed to a noxious stimulus.It is inversely related to potency.

Factors Which Affect MAC

Increase MAC

Hyperthermia
Hypernatraemia
Sympathoadrenal stimulation
Chronic alcohol abuse
Increases in ambient pressure
Hypercapnia
Decreasing age
Thyrotoxicosis

Decrease MAC

Nitrous oxide
Hypothyroid/myxoedema
Hypocapnia
Hypothermia-decrease is roughly linear
Hyponatraemia
Increasing age
Hypoxaemia
Hypotension
Anaemia
Pregnancy
CNS depressant drugs - opioids,
benzodiazepines, major tranquilizers, TCA's
Other drugs - lithium, lidocaine, magnesium, methyl dopa, clonidine
Acute alcohol abuse

Obstetrics MCQ_Part 05

noreply@blogger.com (XYDAU) — Thu, 01 Jul 2010 15:04:00 +0000

True or false regarding Twin Pregnancy
A.Has increased in incidence in recent decades
B.Is associated with hyperemesis
C.Is suitable for biochemical screening for Down’s syndrome
D.Should be managed in hospital from 28 weeks
E.Prophylactic tocolytic drugs are of proven value

True or false regarding A raised Maternal Serum Alpha-fetoprotein level at 16 weeks
A.May be due to incorrect assessment of gestation
B.May be due to gastroschisis.
C.Is more likely if the fetus has T21
D.Is more likely if the fetus has T18
E.Is more likely after threatened miscarriage

True or false regarding Beta-HCG in early pregnancy
A.Levels are below normal in hydatidiform mole
B.Levels are increased in multiple pregnancy
C.Levels > 8,000 i.u./l with no scan evidence of an intrauterine pregnancy strongly suggest ectopic pregnancy
D.Modern pregnancy tests may become negative after 20 weeks
E.Production peaks at 20 weeks

Oncology MCQ_Part 01

noreply@blogger.com (XYDAU) — Thu, 01 Jul 2010 06:33:00 +0000

Typical features of a squamous cell carcinoma of the lung include all except:

   A.Hypercalcemia
   B.Central location
   C.Fungating mass
   D.Mucin production
   E.Keratin pearls

Elevated Alpha-fetaprotein in serum also found in tumor cells by immunohistochemistry can be seen in
A. Hepatocellular carcinoma
B. Cholangiocarcinoma
C. Both Hepatocellular carcinoma and Cholangiocarcinoma
D. Neither Hepatocellular carcinoma and Cholangiocarcinoma

A 74 year old man has a slowly growing parotid mass growing on his right arm. It is 3cm in diameter on evaluation, and 1 cm lesion is also found in his right paroid gland. the right lesion is excised and is well circumscribed. It is charecterized by small cystic spaces lined by cells with very granular pink cytoplasm. Abundant lymphocytes are seen in the supporting stroma.What would be the diagnosis

A. Pleomorphic adenoma
B. Warthin tumor (adenolymphoma)
C. Adenoid cystic carcinoma
D. Mucoepidermoid carcinoma

Gastoenterology MCQ_Part 04

noreply@blogger.com (XYDAU) — Mon, 28 Jun 2010 07:03:00 +0000

A 75 year old woman complains of progressive type constipation and has noted bright red blood in her stools recently. She notes that the caliber of her stools has decreased.She was diagnosed to have Iron deficiency anaemia. You should:
A)provide iron supplements
B)have the patient eat more red meat and spinach
C)work the patient up for colonic carcinoma, which will probably be found on the left side
D)perform a total colectomy for ulcerative colitis
E)order a barium enema to rule out a colonic carcinoma, probably on the right side

All of the following have been associated with H. pylori infection except:
A)squamous cell of the esophagus
B)adenocarcinoma of the stomach
C)duodenal ulcer
D)chronic active gastritis
E)gastric lymphoma, MALT type (MALToma)

All of the following are characteristic of adenocarcinoma of the stomach except:
A)has been associated with bacterial infection
B)has increased in incidence in the United States due to changes in dietary patterns
C)is the most common malignant tumor of the stomach
D)has a higher incidence in Japan than in the United States
E)may arise in gastric polyps

EXPLANATIONS

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MCQ 01 ANSWER

The Correct answer is E

MCQ 02 ANSWER

The Correct answer is A
H. pylori is accepted as an etiologic factor in duodenal ulcers, peptic ulcer disease, gastric carcinoma, and primary B-cell gastric lymphoma.

MCQ 03 ANSWER

The Correct answer is B
Gastric carcinoma -accounts for over 90% of malignant tumors of the stomach
geographic differences in the incidence- 10 times higher in Japan than in the U.S. for example- environmental factors play role
precancerous lesions for gastric carcinoma include:
* chronic atrophic gastritis with dysplasia- its association with PA
* adenomatous polyps with dysplasia
* chronic peptic ulcers

Grossly:-
* early cancer- =gastric carcinoma restricted to the mucosa and submucosa
* recognized in Japan- diagnosis by endoscopic examination and biopsy
* advanced gastric cancer- =gastric carcinoma that invades the gastric wall-presents as- endoscopic gross morphology:
* fungating mass that protrudes into the lumen- polypoid
* as a malignant ulceration with raised edges
* as an ulcer resembling the peptic ulcer
* as a diffusely infiltrating lesion that causes diffuse thickening of the gastric wall

Microscopically:
* all gastric carcinomas are adenocarcinomas of varying degree of differentiation
* the most common -poorly differentiated so called diffuse carcinoma of signet-ring cell type
* well differentiated carcinoma resembling the tubular adenocarcinoma of the intestine is less common = intestinal type of gastric cancer

Spread:
* gastric carcinoma is locally aggressive- rapidly spreads through the whole wall of the stomach
* lymphatic spread- rapid,
* lymph node metastases -spread along the surfaces of the peritoneum
* bloodstream spread- to the liver and lungs

Prognosis: depends almost entirely on the depth of invasion of the tumor
* Early gastric cancer- 5-year survival rate of 85%
* Advanced cancer- only 30%

Cardiology MCQ_PART 07

noreply@blogger.com (XYDAU) — Sun, 20 Jun 2010 06:35:00 +0000

75 year old woman presents with severe headaches.What is the most likely diagnosis?

A. Takayasu arteritis

B. Giant cell arteritis

C. Aortic dissection

D. Polyarteritis nodosa

E. Wegener's granulomatosis

25 year old woman has Several episodes of gastrointestinal bleeding of unclear source with muscle pains.What is the most likely diagnosis?

A. Takayasu arteritis

B. Giant cell arteritis

C. Aortic dissection

D. Polyarteritis nodosa

E. Wegener's granulomatosis

Autopsy findings of a 57 year old woman are as follows: Multiple 2-4 mm vegetations were found on an otherwise normal mitral valve. the vegetations were made of fibrin on histological section, and the underlying valve was essentially normal. What would be the most likely history when you get her clinic chart:

A. Long history of intravenous drug abuse with recent history of fevers to 104 degree F

B. Pancreatic carcinoma being treated on an experimental protocol for chemotherapy

C. History of rheuthmatic fever at age nine with long term mitral stenosis and recent onset of fevers to 103 degree F.

D. Long history of systemic lupus erythematosis (SLE)

EXPLANATIONS

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MCQ 01 ANSWER

Correct Answer is Giant cell arteritis

Giant cell arteritis also known as temporal arteritis, is usually seen in individuals over 50 years of age. The onset is usually gradual but may be abrupt rarely. Presenting features include malaise, fever, fatigue and weight loss, with headaches, tenderness of the scalp particularly over the temporal arteries, visual loss, diplopia, jaw claudication and aortic arch syndrome being the more common manifestations. On examination the temporal arteries may be tender, thickened and erythemateous. The visual loss is usually abrupt and painless and may vary from a partial deficit of one eye to complete blindness in both eyes. In such patients, the examination of the eye may show ischemic retinopathy in the initial stages and optic atrophy after several weeks.

Takayasu's arteritis also known as Aortic arch syndrome or Pulseless disease is characterized by segmental and patchy granulomatous inflammation of the aorta and major derivative branches.It is more common in young Asian women. Females are about 8-9 times more likely to get it than males.and common age group is between 15 and 30 years of age.

Polyarteritis nodosa is a vasculitis of medium-sized arteries also called Kussmaul disease or Kussmaul-Maier disease.. It is caused by immune complex deposition in the walls of blood vessels, which makes it a type III hypersensitivity reaction.It can occur from childhood to old age but the most commonly affected age group is between the ages of 40 and 60.Men are more commonly affected than women in a ratio of 1.6:1.30% of patients with Polyarteritis nodosa are hepatitis B surface antigen positive.

MCQ 02 ANSWER

Correct Answer is Polyarteritis nodosa

Abdominal problems in Polyarteritis nodosa
* Abdominal pain
* Nausea and vomiting
* Bleeding
* Bowel infarction and perforation
* Cholecystitis
* Hepatic infarction
* Pancreatic infarction

Wegener's granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs.Heart, gastrointestinal tract, brain are rarely affected.

MCQ 03 ANSWER

Correct Answer is Long history of systemic lupus erythematosis (SLE)

Patients who inject narcotics or other drugs intravenously may introduce infection which will travel to the right side of the heart classically affecting the tricuspid valve, and most often caused by S. aureus.In other patients without a history of intravenous exposure, endocarditis is more frequently left-sided.In this patient mitral valve is affected and "Long history of intravenous drug abuse with recent history of fevers to 104 degree F" can be excluded.

SLE patients have Cardiac complications include pericarditis, endocarditis (heart murmurs and valvular damage secondary to Libman-Sacks vegetations on the mitral valve), and coronary artery disease (CAD). 50% of SLE patients have endothelial damage to their heart valves most commonly involves mitral and aortic valves.Endocarditis in the form of nonbacterial vegetations (Libman Sacks vegetations) vary from mild valvular thickening to large vegetations affecting the function of the valve.Presence of antibodies against phospholipids is associated with Libman Sacks vegetations in SLE patients.

Gastoenterology MCQ_Part 03

noreply@blogger.com (XYDAU) — Sun, 13 Jun 2010 13:29:00 +0000

Here are the Laboratory test results are of a homeless patient who has been ill for several weeks with fever, anorexia, malaise, and abdominal pain. HbsAg is negative, anti-HBs is negative, anti-HAV IgM is negative. Which of the following tests is most likely to resolve the question?
   A. anti-HBc IgG
   B. Hbe Ag
   C. anti-HDV
   D. anti-HBc IgM
   E. anti-HAV IgG

All of the following have been associated with H. pylori infection except:
   A. Squamous cell carcinoma of the esophagus
   B. Adenocarcinoma of the stomach
   C. Duodenal ulcer
   D. Cactive gastritis
   E. MALT type gastric lymphoma

Peptic ulcers:
   A. are most commonly found in the gastric antrum where H. pylori infection is most frequent
   B. are most commonly found in the duodenum where H. pylori infection is most frequently identified on endoscopic biopsies
   C. are most commonly found in the duodenum, while H. pylori infection (associated with peptic ulcers) is most frequently identified in the gastric antrum
   D. are most commonly found in the gastric body and fundus, while H. pylori infection is most frequently identified in the gastric antrum
   E. are never found outside the stomach and the duodenum, just as H. pylori is never found outside of the stomach

EXPLANATIONS

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MCQ ANSWERS

01.The Correct Answer is D
02.The Correct Answer is A
03.The Correct Answer is C

Obstetrics MCQ_Part 04

noreply@blogger.com (XYDAU) — Fri, 11 Jun 2010 16:17:00 +0000

Recognised associations with hypermesis gravidarum include:

A. Hydatidiform mole

B. Age More than 30 years
C. Smoking
D. Primiparous women under 20 years of age
E. Pre-eclampsia

You are called to attend the delivery of a 24-year-old primiparous female. After a prolonged 18-hour labor requiring oxytocin agumentation, she delivered a 4200 gm male infant. A vacuum-assisted delivery was performed , and the mother required repair of a third degree perineal laceration.Few minutes after the delivery you were reported that the mother’s blood pressure is 80 mmHg systolic and her bed is soaked with blood.The most likely cause of this problem is:

A.occult cervical lacerations.
B.hematoma.
C.uterine atony.
D.uterine rupture.
E.disseminated intravascular coagulopathy.

Treating preterm labor with beta agonists has been shown to decrease the rate of which one of the following?
A.Perinatal deaths
B.Preterm delivery
C.Low birth weight infants
D.Delivery within 48 hours of treatment

EXPLANATIONS

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MCQ 01 ANSWER

The Correct Answer is A

The cause of severe nausea and vomiting in pregnancy has not been identified. Hyperemesis Gravidarum may also have a genetic component.
Hyperemesis is also associated with hyperemesis in prior pregnancy, female gestation, multiple gestation, triploidy, trisomy 21, current or prior molar pregnancy, and hydrops fetalis.
Women with history of motion sickness, migraine headaches, psychiatric illness, pregestational diabetes, high or low pregestational weight, hyperthyroidism, pyridoxine deficiency, and gastrointestinal disorders are also at an increased risk.
Cigarette smoking and maternal age older than 30 years appear to be protective.

MCQ 02 ANSWER

The Correct Answer is C

Ninety percent of early and immediate postpartum hemorrhage is due to failure of the uterus to contract satisfactorily (uterine atony). Other less frequent causes are lacerations of the cervix, vagina, or perineum; hematomas, usually located near lacerations or episiotomy repairs; and uterine rupture, either spontaneous or iatrogrenic. All of these occur in the immediate postpartum period. Delayed hemorrhage, occurring beyond the first 24 hours after delivery, is usually caused by retained placental fragments. Interestingly, placenta accrete is among the most common causes of postpartum hemorrhage necessitating hysterectomy.

MCQ 03 ANSWER

The Correct Answer is D

In women with premature labor, beta-adrenergic agonists have been clearly shown to reduce the incidence of delivery within 24 and 48 hours of administration. These tocolytic agents have not been shown to consistently reduce the rates of preterm delivery, low birth weight, severe respiratory distress, or perinatal death. A statistically non-significant trend toward reduced perinatal mortality has been suggested in women given beta-adrenergic agonists earlier in pregnancy, for preterm labor before 28 weeks gestation. It appears that more effective use of the 24-48 hours gained by tocolysis with beta-adrenergic agonists holds promise for reducing perinatal morbidity and mortality, perhaps through more liberal use of predelivery glucocorticoid therapy.

Cardiology MCQ_PART 06

noreply@blogger.com (XYDAU) — Sun, 06 Jun 2010 12:12:00 +0000

Which of the following is not likely to see in mitral valve prolapse

A. Stroke

B. Arrhythmias

C. Infective endocarditis

D. Mitral stenosis

E. Embolism of leaflet thrombi

Disorders predisposing to cor pulmonale include all of the following except:

A. Cystic fibrosis

B. Chronic obstructive pulmonary disease

C. Left-sided heart failure

D. Kyphoscoliosis

E. Pulmonary embolism

Which of the following is less likely to be a manifestations of ischemic heart disease

A. Myocardial infarction

B. Chronic ischemic heart disease

C. Sudden cardiac death

D. Myocarditis

E. Angina pectoris

EXPLANATIONS

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MCQ 01 ANSWER

Correct ANswer is D
Mitral valve prolapse is a common condition which may be asymptomatic or may be associated with atypical chest pain, syncope, palpitations, and embolic events.
On auscultation there may be a mid-systolic click and late systolic murmur.

Complications of Mitral Valve Prolapse
Progressive elongation or Rupture of the Chordae Tendinae may lead to increasing mitral regurgitation
Congestive heart failure due to progressive mitral regurgitation
Infective Endocarditis
Benign Arrhythmias
Embolic Stokes or Transient Ischeamic Attacks(TIAs)

Management
Symptomatic treatment:beta blockers may produce improvement in patients with chest pain and/or palpitations
Prophylaxis for endocarditis
Antiplatelet therapy against thromboembolism

MCQ 02 ANSWER

Correct Answer is C

Cor pulmonale is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.Chronic corpulmonale usually results in right ventricular hypertrophy,whereas acute cor pulmonale usually results in dilation.

There are several mechanisms leading to pulmonary hypertension and cor pulmonale:
* Pulmonary vasoconstriction
* Anatomic changes in vascularization
* Increased blood viscosity
* Idiopathic or primary pulmonary hypertension(PPH)

Causes
Acute:Massive pulmonary embolization

Approximately 85% of people with cor pulmonale have chronic obstructive pulmonary disease.And 25% of people with chronic obstructive pulmonary disease eventually develop corpulmonale.

Disorders that produce cor pulmonale include:

- obstructive lung diseases, such as bronchiectasis and cystic fibrosis
- restrictive lung diseases, such as black lung and scleroderma
- loss of lung tissue after extensive lung surgery
- diseases of the lungs’ blood vessels
- respiratory insufficiency without lung disease, as seen in muscular dystrophy and amyotrophic lateral sclerosis
- obesity hypoventilation syndrome (pickwickian syndrome) and upper airway obstruction
- living at high altitudes (chronic mountain sickness)
- T1-4 Vertebral subluxation
- Obstructive sleep apnea
- Sickle cell anemia
- Bronchopulmonary dysplasia (in infants)

MCQ 03 ANSWER

The Correct Answer is D

Gastroenterology MCQ_Part 02

noreply@blogger.com (XYDAU) — Fri, 04 Jun 2010 14:21:00 +0000

Which of the following is not likely to cause mechanical obstruction of the bile duct?
a. Lymph node enlargement in Hodgkins lymphoma at the liver hilum
b. cholangiocarcinoma at the bifurcation of the right and left hepatic ducts (“Klatzkin tumor”)
c. primary biliary cirrhosis
d. chronic gallstone disease
e. carcinoma of the head of the pancreas

Which of the following is not a feature hepatocellular adenoma:
a.Hepatocellular adenomas have no risk of malignant transformation.
b.Athletes taking anabolic steroids are at increased risk of developing hepatocellular adenomas.
c.Hepatocellular adenomas have a small risk of malignant transformation.
d.Hepatocellular adenomas often out grow their blood supplies giving rise to focal hemorrhagic necrosis.
e.Hepatocellular adenomas are not associated with chronic liver disease.

Which of the following appearances correlate with gallstone constituents ?
a.yellow appearance with cholesterol
b.black appearance with bilirubin
c.radio-opacity with calcium
d.brown color with infection
e.all are true

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MCQ 1 ANSWER

The Correct ANSWER is C
CAUSES Of Extrahepatic bile duct obstruction

Cholelithiasis

Inflammation of the common bile duct (choledochitis)

Cancer

Malformation of bile ducts

Parasitic infestation (flukes)

Compression of the bile duct from surrounding tissues (such as lymph nodes, cancer, pancreatitis, diaphragmatic hernia)

Duct fibrosis, such as secondary to trauma, peritonitis,pancreatitis

Narrowing of the bile duct, secondary to blunt trauma, surgical manipulations/procedures

http://mediqbank.blogspot.com/2010/06/gastroenterology-mcqpart-01.html

MCQ 2 ANSWER

The Correct ANSWER is A
Hepatocellular Adenoma:Causes
* Oral contraceptive medications
* Anabolic steroids

Hepatocellular adenomas occur mostly in women of childbearing age and are strongly associated with the use of oral contraceptive pills (OCPs) and other estrogens.
Hepatocellular adenomas are extremely rare

* Histologically these tumors compromise of only hepatocytes without hyperplasia of the bile ducts.
* These are truly benign tumors of the liver with a very small risk of malignancy. These tumors also show a tendency to regress spontaneously after a period of time.
* Characterized by yellow-tan nodules with sheets and cords of hepatocyte-like cells. This tumor is hard to differentiate from well-differentiated hepatocellular carcinoma. However unlike carcinomas, these are not associated with chronic liver disease.
* The mortality rate associated with an acute hemorrhage into the peritoneum may be as high as 25-30% in patients with large tumors. Therefore, it is usually excised.

MCQ 3 ANSWER

The Correct ANSWER is E

Most gallstones are composed of precipitated cholesterol, which is supersaturated in the bile of most humans. Gallstones need not always be compromised of Cholesterol and may be composed of precipitated unconjugated bilirubin in a minority of cases.

Such gallstones are termed as pigmented gallstones as these are usually dark/black in colour. In addition there might be precipitation of Calcium, forming a complex with bilirubin to form insoluble calcium bilirubinate. These are generally radio-opaque and are among the only gallstones detected by an X-Ray.

Secondary infection may cause change in color of these pigmented stones to a Brown/chocolate color depending upon the amount of inflammation and hemolysis at the site.

Genetics MCQ_Part 01

noreply@blogger.com (XYDAU) — Thu, 03 Jun 2010 15:22:00 +0000

The CFTR abnormality is most likely to be associated with

   a) Malabsorption
   b) Congenital absence of the vas deferens
   c) Azospermia
   d)Bronchiectasis
   e) Recurrent chest infections

Familial hypertrophic cardiomyopathy is most likely to be secondary to a mutation in :
a) myosin regulatory proteins
b) myosin binding protein-C
c) Myosin light chains
d) Troponin I
e) Troponin T

A one year old male infant is brought to the pediatrician by his mother because of a copious nasal discharge. He is noted to have coarse features with thick lips, a large tongue, a large bulging head and a flattened nose. On examination he is found to have an enlarged liver and spleen. His history is unremarkable, he was born by a normal vaginal delivery and was examined and thought normal at birth. A likely diagnosis is
a) osteogenesis imperfecta type 1
b) osteogenesis imperfecta type 2
c) congenital indifference to pain
d) Hurler's syndrome
e) Marfan syndrome

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MCQ 1 ANSWER

The Correct Answer is B
Nearly all males with CYSTIC FIBROSIS have obstructive azoospermia with sexual function that is otherwise normal; there is normal spermatogenesis, but no vas deferens.

MCQ 2 ANSWER

The correct answer is B
Mutations in thick filament proteins called cardiac B myosin heavy chain or cardiac myosin binding protein-C appear to account for approximately 82% of hypertrophic cardiomyopathy.
Mutations in thin filament proteins cardiac troponin T and a tropomyosin account for about 13% of hypertrophic cardiomyopathy.

Mutations in two other sarcomere proteins, the myosin regulatory and essential light chains are quite rare and contribute less than 5% to hypertrophic cardiomyopathy.

MCQ 3 ANSWER

The correct answer is D.
An infant with Hurler syndrome appears normal at birth. Diagnosis is made between 6 and 24 months with evidence of hepatosplenomegaly, skeletal deformity, coarse facial features, corneal clouding, large tongue, prominent forehead, joint stiffness, and short stature. Acute cardiomyopathy may be a feature in some infants less than 1 yr of age.

Most children with Hurler syndrome acquire only limited language skills because of developmental delay, chronic hearing loss, and an enlarged tongue. Hearing loss is common and is due to a combination of conductive and neurosensory problems.

Most patients have recurrent upper respiratory tract and ear infections, noisy breathing, and persistent copious nasal discharge. Progressive ventricular enlargement with increased intracranial pressure caused by communicating hydrocephalus also occurs.

Corneal clouding, glaucoma, and retinal degeneration are commonly seen. Obstructive airway disease develops in many patients, necessitating tracheostomy. Obstructive airway disease, respiratory infection, and cardiac complications are the common causes of death.

Gastroenterology MCQ_Part 01

noreply@blogger.com (XYDAU) — Wed, 02 Jun 2010 13:37:00 +0000

Which of the following is not a feature of primary biliary cirrhosis ?
a. sclerosis of extrahepatic bile ducts
b. granulomatous distruction of small to medium size bile ducts
c. serum anti-mitochondrial antibodies
d. increased incidence in women
e. increased incidence after the 5th decade of life

Activity of disease in chronic hepatitis may feature all of the following EXCEPT:
a. interface hepatitis (“piecemeal necrosis”)
b. lobular hepatitis
c. bridging necrosis
d. portal inflammation
e. portal-portal fibrous septa

Elevations of unconjugated (indirect) bilirubin in serum:
a. are not seen with hemolytic anemias
b. may have a genetic basis
c. do not have the potential to cause neurologic damage
d. will be cleared through the kidney
e. are not seen in cirrhosis

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MCQ 01 ANSWER

The Correct answer is A
Primary biliary cirrhosis, is an autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts (bile canaliculi) within the liver.Destruction of the bile canaliculi and cholestasis can lead to scarring, fibrosis and cirrhosis.The sex ratio is at least 9:1 (female to male).Common Age group between 30 and 65.

Diagnostic blood tests include:
* LFT (high alkaline phosphatase, elevated AST, ALT)
* Presence of antimitochondrial antibody(AMA), antinuclear antibody(ANA)
*Biopsy
First stage- destructive inflammatory lesions of multiple interlobar and septal small bile ducts characterized by granulomatous inflammation accompanied by dense mixed infiltrate in portal tracts

Progressive lesion- global involvement of hepatic portal tracts with secondary obstructive changes and eventually with development of cirrhosis

End stage- indistinguishable from other forms of cirrhosis

MCQ 02 ANSWER

The Correct Answer is E

Chronic active hepatitis- more progressive liver destruction

Microscopic findings: severe portal and periportal infiltrates of lymphocytes, plasma cells and macrophages, active destruction of hepatocytes in the vicinity of portal tracts- so-called piecemeal necroses, fibrosis and cirrhosis it is getting to be evident now that both forms are related may overlap.

MCQ 03 ANSWER

The Correct answer is B

Patients with unconjugated hyperbilirubinemia should be examined for evidence of hemolysis. This includes reticulocyte count, examination of a peripheral smear, serum level of lactic dehydrogenase, and haptoglobin levels.
The diagnosis of exclusion for unconjugated hyperbilirubinemia is Gilbert’s disease, which is a benign disease of a partial defect in the enzyme uridine diphosphoglucuronyl transferase (UDPGT), characterized by mild, chronic, and intermittent unconjugated hyperbilirubinemia.

Unconjugated hyperbilirubinaemia in a neonate can lead to accumulation of bilirubin in certain brain regions, a phenomenon known as kernicterus, with consequent irreversible damage to these areas manifesting as various neurological deficits, seizures, abnormal reflexes and eye movements. The neurotoxicity of neonatal hyperbilirubinemia manifests because the blood-brain barrier has yet to develop fully, and bilirubin can freely pass into the brain interstitium, whereas more developed individuals with increased bilirubin in the blood are protected.

Bilirubin is excreted in bile and urine.
In the liver Bilirubin is conjugated with glucuronic acid by Glucuronyltransferase and Much of it goes into the bile and thus out into the small intestine. Some of the conjugated bilirubin remains in the large intestine and is metabolised by colonic bacteria to urobilinogen, which is further metabolized to stercobilinogen, and finally oxidised to stercobilin. This stercobilin gives feces its brown color. Some of the urobilinogen is reabsorbed and excreted in the urine along with an oxidized form, urobilin.

Nephrology MCQ_Part03

noreply@blogger.com (XYDAU) — Fri, 28 May 2010 05:48:00 +0000

The most common complication of minimal change disease is:
1.Infection
2.Hemorrhage
3.Side-effects of steroid therapy
4.End-stage renal disease
5.Renal vein thrombosis

Primary IgA nephropathy is believed to result from which immunopathogenetic mechanism?

1.Deposition of immune complexes containing IgA1 in mesangium with activation of alternative complement pathway
2.Defective hepatic clearance of immune complexes containing IgA
3.Increased mucosal synthesis of IgA that cross reacts with mesangial antigens
4.monoclonal B cell proliferation producing mesangiopathic IgA
5.planted viral antigens in mesangium inducing an autoimmune response

A 39year old man is complaining of the worst groin pain that he has ever experienced. He feels that he may have strained his groin playing football earlier in the week but notes that the pain seems to begin in the flank. It is affecting his left side and is colicky type and the pain is worsening on urinating. Dipstick reveals microscopic haematuria. He has no past history of abdominal problems and has had no operations in the past. His observations reveal a heart rate of 120 beats/minute, respiratory rate 24 breaths/minute, sats 92%, blood pressure 157/91mmHg. What is the likely diagnosis?

A. Pyelonephritis
B. Renal calculus
C. Ureteric calculus
D. Renal cell carcinoma
E. Prostatism

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MCQ 1 ANSWER

The Correct Answer is C - Minimal change disease

Is a commonest cause of nephrotic syndrome in children in whom this disease occur frequently. Despite massive proteinuria, the renal function remains normal. Over 90% of patients are corticosteroid sensitive while small numbers of patients are corticosteroid dependent or resistant. The later can be treated by immunosuppressive agents. The disease is characterized by normal appearing glomeruli on light and immunofluorescence microscopy and the only abnormality detected is effacement of epithelial cell foot processes which is identified on electron microscopy only. No immune-complexes are identified and so the disease is not an immune complex in origin but several associated features suggests immune mediation. The current hypothesis is that the cell-mediated immunity seems to play an important role where T-lymphocytes are said to produce vascular permeability factor which is responsible for massive proteinuria.

MCQ 2 ANSWER

The Correct Answer is A - IgA NEPHROPATHY

IgA NEPHROPATHY Causes: Nephrotic syndrome
Epidemiology/At risk individuals: Most common type of GN worldwide, occurs 1-2 days after URTI/GIT infections in patients

Clinical features: There is an acquired or genetic defect in regulating production of IgA antibodies. After URTI / GIT infection, too much IgA is produced a forms immune complexes and trapped in mesangium and activate alternate complement pathway a injury. Patient will develop Proteinuria + haematuria (Nephrotic syndrome). Progress to ESRF in 25-50% of patients.

Morphology: Light Microscope: mesangial proliferation, matrix deposition. Immunofluorecence: IgA in mesangium + C3.

MCQ 3 ANSWER

The Correct Answer is C - Ureteric calculus

Surgery MCQ_Part 01

noreply@blogger.com (XYDAU) — Tue, 25 May 2010 12:55:00 +0000

Stones in the common bile duct
a. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)
b. Can present with Charcot's Triad
c. Are suggested by an bile duct diameter more than 8mm on ultrasound
d. ERCP, sphincterotomy and balloon clearance is now the treatment of choice
e. If removed by exploration of the common bile duct the T-tube can be removed after 3 days

Regarding stones in the gallbladder
a. Cholesterol stones are the most common
b. Pigment stones are due increased excretion of polymerised conjugated bilirubin
c. Are not a risk factor for the development of gallbladder carcinoma
d. 90% of gallstones are radio-opaque
e. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch

Regarding appendicitis
a. The risk of developing the illness is greatest in childhood
b. Mortality increases with age and is greatest in the elderly
c. 20% of appendices are extraperitoneal in a retrocaecal position
d. Faecoliths are present in 75-80% of resected specimens
e. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

Nephrology MCQ_Part 02

noreply@blogger.com (XYDAU) — Sun, 23 May 2010 11:09:00 +0000

Which of the following does not complicate pyelonephritis:

A. pyonephrosis

B. papillary necrosis

C. renal stones

D. perinephric abscess

E. renal cell carcinoma

Fanconi syndrome, a tubular functional disorder characterized by abnormal proximal tubular function, has all of the following characteristics except:

A. aminoaciduria

B. polyuria and polydipsia

C. glucosuria

D. phosphaturia and hypophosphatemia

E. excess bicarbonate loss and hence metabolic acidosis

Renal tubular carcinoma has all of the following characteristics except:

A. a disease of middle-aged and elderly individuals

B. a transitional cell neoplasm

C. metastases may affect a wide variety of organs

D. associated with the von Hippel Lindau tumor suppressor gene on chromosome 3p

E. the likelihood of metastases is strongly linked to the size of the tumor

EXPLANATIONS

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MCQ 01 ANSWER

The Correct answer is E
Pyelonephritis is an ascending urinary tract infection that has reached pelvis of thekidney.It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys and may lead to chronic renal failure.
Papillary necrosis is complication of pyelonephritis.
Kidney stones formation or urolithiasis is comprised of calcium carbonate crystals in the presence of hypercalciuria and a common complication is chronic pyelonephritis.

MCQ 02 ANSWER

Correct answer is B
Fanconi syndrome is a generalized disorder of the Proximal Tubules. The defect can lead to glycosuria, aminoaciduria, phosphaturia, bicarbonaturia and excessive urinary loss of K+, Na+, Ca++, Mg++, uric acid and other organic acids.It may be inherited, or caused by drugs or heavy metals.

Clinical features

Polyuria, polydipsia and dehydration

Hypophosphatemic rickets (in children) and osteomalacia (in adults)

Growth failure

Renal tubular Acidosis

Hypokalemia

Hyperchloremia

Hypophosphatemia/phosphaturia

Glycosuria

Proteinuria/aminoaciduria

Hyperuricosuria

Causes

Cystinosis(most common)
Wilson's disease
Lowe syndrome
Galactosemia
Glycogen storage diseases

MCQ 03 ANSWER

The Correct answer is B
Renal Carcinoma( hypernephroma/Grawitz tumour) originates in the epithelium of the proximal
tubule.
Epidemiology
* 90% renal cancers
* Mean age 55 years, male: female is 2:1

Risk factors
Cigarette smoking
Obesity
Positive family history
Hypertension
Dialysis patients with acquired cystic disease of the kidney
Patients with certain inherited disorders such as von Hippel-Lindau disease

Clinical features
* 50% incidental findings during abdominal imaging for other symptoms
* Haematuria, loin pain, abdominal mass, anorexia, malaise, weigh loss and Pyrexia of unknown origin
* Polycythemia or Anaemia,Hypertension
* Rarely, invasion of left renal vein compresses testicular vein causing a left varicocele
*Stauffer syndrome - paraneoplastic, non-metastatic liver disease
* Spread may be direct, via lymph nodes, or haematogenous (bone, liver, brain)
If tumour is confined to the renal parenchyma, the 5-year survival rate is 60-70%

Classification of Classification
* Clear cell carcinoma (associated with the loss of von Hippel Lindau tumor suppressor gene on chromosome 3p)
* Papillary carcinoma
* Chromophobe renal carcinoma
* Collecting duct carcinoma

Investigations
* Bloods – FBC (polycythemia from epo secretion), ESR, U+E, alk phos (bony metastasis)
* Urine – RBC, cytology
* Imaging – USS, CT/MRI, IVU
* Renal angiography if partial nephrectomy or palliation are being considered
* CXR – cannon ball metastasis

Neurology MCQ_PART 04

noreply@blogger.com (XYDAU) — Sat, 22 May 2010 13:53:00 +0000

Causes of dilated pupil:
a. Children.
b. Topical cycloplegic agents.
c. Cataract surgery.
d. 3rd cranial nerve palsy.
e. Cocaine abuse.

Subacute combined degeneration of the cord:
a. Anemia is absent in 20% of cases.
b. Can result in a sensory level on the trunk.
c. A family history of pernicious anemia can be obtained.
d. There are upgoing planters.
e. MRI of the cord is diagnostic.

Chronic subdural hematoma:
a. Usually bilateral.
b. A history of head trauma is seen in 90% of cases.
c. Epilepsy is a risk factor.
d. Small ones may resolve spontaneously.
e. Papilloedema is seen in 90% of cases.

EXPLANATIONS

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MCQ 01 ANSWER

Correct Answer - T T T T T

Causes

In dark Environment
Strong sexual arousal
Oxytocin
Oculomotor nerve palsy
Head injury or orbit trauma (eye injury),or any iris trauma including Surgery
Anticholinergics such as atropine
Cycloplegics(agents that paralysis of the ciliary muscle of the eye) are also mydriatic(an agent that induces dilation of the pupil)- cyclopentolate,tropicamide
Cocaine - inhibits the normal reuptake of norepinephrine into presynaptic nerve terminals resulting in an increased level of extracellular norepinephrine. The released norepinephrine then proceeds to bind to adrenergic receptors,and the end result is dilation of the pupil
Drugs that increase serotonin levels - fenfluramine, antidepressants such as the SSRIs and MAOIs
Adie's pupil - benign condition affecting the young women
Migraine

MCQ 02 ANSWER

Correct Answer - T F T T F
Subacute combined degeneration of spinal cord,refers to patchy degeneration of myelin of
the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency.

Causes
Inadequate diet
Increased requirments - Pregnancy
Defective absorption - Pernicious anaemia,malabsorption(coeliac disease,pancreatitis,gastric
surgery,tapeworm infestation)

Clinical Features

Weakness of legs,arms and trunk
Tingling and numbness that progressively worsens (never get a sensory "level")
Bilateral spastic paresis
Pressure, vibration and touch sense are diminished
A positive Babinski sign may be seen
Ataxic gait with positive Romberg's sign
Optic Atrophy
Cerebral demyelination with enchephalopathy and dementia

Investigations
Pheripheral Blood film - megalloblastic anaemia but Anemia And macrocytosis may be absent in 20% of cases ; but hyper segmented neutrophils are still usually seen in these cases.
Serum B12/folate levels
MRI - may show spinal and cerebral white matter hyperintensity on T2 images.But not diagnostic

MCQ 03 ANSWER

Correct Answer - F F T T F

A chronic subdural hematoma (SDH) is an old clot of blood on the surface of the brain beneath its outer covering. It predominantly occursin infancy and in the elderly. 1/6th of cases are bilateral.

Predisposing factors
Less than 50% might have a traumatic event
Other risk factors include alcohol abuse, seizures, shunts that drain excess cerebrospinal
fluid from the brain,brain atrophy,blood thinning medications such as Coumadin and coagulation disorders

Symptoms
The symptoms of a chronic subdural haematoma do not usually appear until about 2-3 weeks
after the initial head injury (in some people it may be months)
The symptoms tend to progress gradually
The most common complaint is headache, seen in up to 80 percent of patients. Other symptoms
include lethargy, memory impairment, confusion, weakness, nausea, vomiting, impaired vision
and seizures
Patients with large hematomas may develop varying degrees of paralysis and coma
Papilloedema is uncommon

Management
If there is a small,subdural haematoma that is not producing any symptoms,it can sometimes be treated just by careful monitoring and observation. The blood clot is left to re-absorb by itself
Surgery - Burr Hole or Craniotomy

Obstetrics MCQ_Part 03

noreply@blogger.com (XYDAU) — Fri, 21 May 2010 08:04:00 +0000

In pregnancy Which of the following statements are correct
a.Renal blood flow increases by more than 20 %
b.GFR increases
c.Serum urea levels fall
d.Serum creatinine levels fall
e.Tubular reabsorption of glucose declines, causing glycosuria in the presence of normal blood glucose levels

Shoulder dystocia
a.associated with high maternal weight
b.associated with diabetes
c.associated with mid-cavity forceps delivery
d.associated with premature labour
e.has been successfully managed by Caesarean section

Secondary amenorrhoea
a.is defined as cessation of menstruation for more than 12 months
b.should be not be investigated unless persisting for more than 12 months
c.may be due to Asherman’s syndrome
d.is commonly due to stress
e.may be due to hyperprolactinaemia

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ANSWER

MCQ 01 Correct Answer - T T T T F
Physiology of pregnacy psecentation

Renal blood flow increases by about 25 % from 1.2 to 1.5 litres perminute.This occurs early in pregnancy. Changes in renal functionroughly parallel those in cardiac function. GFR increases 30 to 50%,peaks between 16 and 24 wk gestation, and remains at that level until
nearly term, when it may decrease slightly because uterine pressure onthe vena cava often causes venous stasis in the lower extremities.Renal plasma flow increases in proportion to GFR. As a result, BUNdecreases, usually to less than 10 mg/dL (less than 3.6 mmol urea/L), and creatinine levels decrease proportionally to 0.5 to 0.7 mg/dL (44 to 62 μmol/L). Marked dilation of the ureters (hydroureter) is caused by hormonal influences (predominantly progesterone) and by backup due to pressure from the enlarged uterus on the ureters, which can also cause hydronephrosis. Postpartum, the urinary collecting system may take as long as 12 wk to return to normal. Glucose transfers in bulk through the glomerulus and is then reabsorbed by the proximal tubule.With the increased GFR, much more sugar is dumped on the tubule and may swamp its reabsorptive capacity. The result is the common pregnancy finding of glycosuria in the presence of normal blood glucose levels.

MCQ 02 Correct Answer - T T T F T
Shoulder dystocia presentation

Shoulder dystocia occurs in approximately 1% of vaginal births.There are well-recognised risk factors, such as diabetes, fetal macrosomia, and maternal obesity. Premature labour means small babies and a reduced risk. Mid-cavity forceps suggests some difficulty in descent of the head. Zavanelli's maneuver, which involves pushing the fetal head back in with performing a cesarean section is one way of managing Shoulder Dystocia. MCQ 03

Correct Answer -F F T F T
Secondary amenorrhea presentation

It is defined as the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhea.

Causes

Intrauterine adhesions (Asherman's Syndrome)
Pregnancy (most common cause)
Anovulation
Premature menopause
Menopause
Polycystic ovary syndrome (PCOS)
Hypothalamic: Exercise amenorrhoea, related to physical exercise, Stress amenorrhoea, Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia
Pituitary: Sheehan syndrome, Hyperprolactinemia, Hemochromatosis
Other central regulatory: hypothyroidism, hyperthyroidism

Cardiology MCQ_PART 05

noreply@blogger.com (XYDAU) — Mon, 17 May 2010 13:08:00 +0000

Sudden chest pain and acute aortic insufficiency in a 67 year old hypertensive Afro-American male
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

Hemoptysis, hematuria and recent Epistaxis in a 43 year old man may be found to have
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

What is the most likely cause of Constrictive pericarditis:
A. Uremia
B. Congestive heart failure
C. Rheumatic fever
D. Myocardial infarction
E. Tuberculosis

Medicine MCQ_part 02

noreply@blogger.com (XYDAU) — Wed, 12 May 2010 08:28:00 +0000

Regarding Bronchiectasis

A. Characterized by the production of large amount of sputum

B.Haemoptysis is a feature

C.Cystic Fibrosis is a known cause

D.Ring Shadows and Tram like Shadows seen in the Chest Xray

What of the folowing are features of Small Cell Carcinoma of the Lung

A.ACTH production

B.Clubbing

C.Eaton Lambert Myasthenic Syndrome

D.Hypercalcaemia

True or False regarding the Iron Metabolism

A.Absorbed in the terminal Ileum

B.Absorption is increased when there is a defieciency

C.Ferrratin and Haemosiderin are transporters

D.Albumin is the Transporter

Paediatrics MCQ_Part 08

noreply@blogger.com (XYDAU) — Tue, 11 May 2010 11:30:00 +0000

Which of the following are recognised causes of clubbing:
A. Cystic fibrosis.
B. Familial.
C. Bacterial endocarditis.
D. Fallot's tetralogy.
E. Ulcerative colitis.

Autosomal dominant conditions are
A. Gilbert syndrome.
B. Becker muscular dystrophy.
C. Turner syndrome.
D. Tuberous sclerosis.
E. Cystic fibrosis.

Cystic fibrosis:
A. It is most common in sub-Saharan Africa.
B. The most common mutation is called delta-F508.
C. The responsible gene is located on chromosome 14.
D. Can present in neonates with intestinal obstruction.
E. Can be investigated by measuring sweat electrolytes.

Paediatrics MCQ_Part 07(Antral Gastritis and Epilepsy)

noreply@blogger.com (XYDAU) — Sun, 09 May 2010 11:55:00 +0000

A 15-year-old boy presents with melena and anemia. Endoscopy demonstrates a nodular
gastritis of the antrum and an ulcer. Biopsies of the antrum demonstrate spiralshaped
organisms consistent with Helicobacter pylori. You prescribe amoxicillin,
clarithromycin, and lansoprazole for 2 weeks. At a follow-up visit, the family asks whether the
treatment has been successful in eradicating the organism.
Of the following, the PREFERRED noninvasive test to evaluate whether the pathogen has been
eradicated is
A. fecal Campylobacter-like organisms (CLO) test
B. fecal H pylori antigen
C. salivary H pylori antibody concentrations
D. serum H pylori immunoglobulin G serology
E. serum H pylori urease concentrations

Concerning epilepsy in children:
A. There is an association with cerebral palsy.
B. Most forms of childhood epilepsy require lifelong treatment.
C. Infantile spasms may respond to corticosteroid treatment.
D. Consciousness is usually impaired in absence seizures.
E. A post-ictal hemi-paresis may occur.

Paediatrics MCQ_Part 06

noreply@blogger.com (XYDAU) — Fri, 07 May 2010 06:29:00 +0000

Concerning asthma:

A. Inhaled steroids are useful in the treatment.

B. Wheeze on auscultation is pathognomonic.

C. It is seldom a cause of hospital admission.

D. Exacerbation of symptoms can occur with exercise.

E. Sufferers should be excluded from sport at school.

Concerning systemic lupus erythematosus (SLE):
A. It causes a characteristic "butterfly rash".
B. Is more common in males.
C. Arthralgia is a rare feature.
D. Maternal SLE can cause heart block in the neonate.
E. Anti-nuclear antibodies are usually present.

Compared with cow's milk, human breastmilk contains:
A. Less sodium.
B. Less calcium.
C. Less protein.
D. Less fat.
E. Less carbohydrate