General Review

Question 1

Which of the following is true with regards to the anatomy involved in the rectal examination?

a) The sacrum is palpated anteriorly
b) The pubic bone is palpated anteriorly in both sexes
c) In the male the testes can be appreciated anteriorly
d) The cervix can sometimes be felt anteriorly in the female

Answer 1

d) The cervix can sometimes be felt anteriorly in the female

Question 2

Which of the following is true about haemorrhoids?

a) Bleeding haemorrhoids lead to melaena per rectum (PR)
b) Pregnancy is a predisposing factor in causing haemorrhoids
c) Bleeding from first degree haemorrhoids is associated with pain
d) Second degree haemorrhoids cannot be returned to the anal canal

Answer 2

b) Pregnancy is a predisposing factor in causing haemorrhoids

Question 3

Which of the following is true about the rectal examination?

a) If the patient refuses a chaperone the doctor can overrule them
b) The rectal examination is of no value in a neurological examination
c) The optimum position of the patient is on their right side with their knees extended
d) The rectal examination is indicated for the assessment of some gastrointestinal disorders

Answer 3

d) The rectal examination is indicated for the assessment of some gastrointestinal disorders

Question 4

which of the following is true about rectal bleeding?

a) A painful digital examination suggests an anal fissure
b) Bright red blood on the finger usually signifies a caecal lesion
c) Proctoscopy is of no value in the assessment of rectal bleeding
d) Rectal cancer is the commonest cause of rectal bleeding

Answer 4

a) A painful digital examination suggests an anal fissure

Question 5

Which of the following is true about possible rectal findings?

a) The finding of a palpable median groove in the prostate is an adverse finding
b) Impacted faeces can sometimes be mistaken for a rectal tumour
c) A thrombosed haemorrhoid is painless
d) Peri-anal warts can only be demonstrated on proctoscopy

Answer 5

b) Impacted faeces can sometimes be mistaken for a rectal tumour

Question 6

Which of the following is true of the assessment of power in the arms?

a) Grade 3/5 (MRC scale) represents movement of the arm only when gravity is eliminated
b) Flexion at the elbow is produced by the triceps muscle
c) The root value of shoulder abduction is C5
d) Grade 1/5 power represents no movement or muscle contraction

Answer 6

c) The root value of shoulder abduction is C5

Question 7

Which of the following is true about the assessment of arm reflexes?

a) The root value of the biceps reflex is C5, C6
b) If no reflex is elicited when you tap a tendon it is documented as absent
c) The triceps tendon is struck in the antecubital fossa
d) Brisk finger jerks confirm a lower motor neurone lesion

Answer 7

a) The root value of the biceps reflex is C5, C6

Question 8

Which of the following is true of a lower motor neurone lesion in the arm?

a) It leads to increased tone in the arm (hypertonia)
b) Fasciculations are never seen
c) The reflexes are brisk
d) An ulna nerve palsy is an example of a lower motor neurone lesion

Answer 8

d) An ulna nerve palsy is an example of a lower motor neurone lesion

Question 9

Which of the following is true about involuntary movements in the arm?

a) Alcohol makes the tremor of benign essential tremor worse
b) Hemiballismus is due to a stroke causing paralysis of the distal half of the arm
c) A ‘milkmaid’ grip is sometimes found in dystonia
d) Writer’s cramp is an example of a focal dystonia

Answer 9

d) Writers cramp is an example of a focal dystonia

Question 10

Which of the following is true in a sensory assessment of the arm?

a) It is acceptable to test pain with a venepuncture needle
b) Proprioception is appreciated via the same tracts as light touch
c) It is best to test vibration sense with a 256 Hz tuning fork
d) Impulses for pain travel principally up the dorsal columns

Answer 10

b) Proprioception is appreciated via the same tracts as light touch

Question 11

Which of the following is true about radial nerve palsy?

a) The radial nerve arises from the lateral cord of the brachial plexus
b) It is associated with sensory loss over the medial half of the hand
c) It leads to wrist drop
d) It can occur due to a superficial laceration over the wrist

Answer 11

c) It leads to wrist drop

The radial nerve arises from the posterior cord of the brachial plexus. It is associated with sensory loss over the posterior aspect of the hand (lateral half) as well as wrist drop. A superficial laceration of the wrist can injure the median nerve but not the radial

Question 12

Which of the following is true about the carpal tunnel syndrome?

a) It can be caused by rheumatoid arthritis
b) It is caused by compression of the ulna nerve
c) It causes pain and tingling in the medial three and half digits
d) Paraesthesia is worse during the day

Answer 12

a) It can be caused by rheumatoid arthritis

The carpal tunnel is caused by compression of median nerve. It causes pain and tingling in the lateral three and half digits and this is worse during the night or mornin

Question 13

Which of the following is true about an intention tremor?

a) It is worse at rest
b) It is caused by Parkinson’s Disease
c) It is indicative of a cerebellar lesion
d) Dyscalculia is a common association

Answer 13

c) It is indicative of a cerebellar lesion

An intention tremor is worse on movement rather than at rest. There is no association with dyscalculia.

Question 14

In the assessment of the hand function which of the following is true?

a) Abduction of the thumb is supplied by spinal root T2
b) Opposition of the thumb by opponens policis is supplied by spinal root T1
c) Finger adduction is supplied by the median nerve
d) Finger abduction is mediated by the palmar interossei

Answer 14

b) Opposition of the thumb by opponens policis is supplied by spinal root T1

Abduction of the thumb is supplied by spinal root T1. Finger adduction is supplied by the ulna nerve and finger abduction is mediated by the dorsal interossei.

Question 15

Which of the following is true in ulna nerve palsy?

a) The ulna nerve can be affected by a fracture of the spiral groove of the humerus
b) It gives rise to a positive phalen’s sign
c) It leads to loss of sensation over the medial half of the hand and medial one and a half digits on both palmar and dorsal aspects of the hand
d) It supplies the biceps muscles

Answer 15

c) It leads to loss of sensation over the medial half of the hand and medial one and a half digits on both palmar and dorsal aspects of the hand

It is the radial nerve that is vulnerable to injury by a fracture of the spiral groove of the humerus. The median nerve gives rise to a positive phalen’s sign and it is the musculocutaneous nerve which supplies the biceps muscles.

Question 16

Which of the following is true regarding the examination of the legs?

a) Sustained clonus occurs with hypotonia
b) Clonus can only be demonstrated at the ankle
c) The root value of hip flexion is L4, L5
d) The root value of toe extension is L5

Answer 16

d) The root value of toe extension is L5

Sustained clonus is associated with hypertonia. It can be demonstrated elsewhere such as the knee. The root value of hip flexion is L2, L3

Question 17

Which of the following is true regarding reflexes?

a) A positive babinski reflex is the same as a normal flexor response in the assessment of the plantar reflex
b) An extensor plantar response indicates a lower motor neurone lesion
c) The root value of the ankle reflex is S1
d) The root value of the knee reflex is L1, L2

Answer 17

c) The root value of the ankle reflex is S1

A positive Babinski reflex is synonymous with an extensor plantar response and indicates an upper motor neurone lesion. The root value of the knee reflex is L3, L4.

Question 18

Which of the following is true about the assessment of gait?

a) A stamping gait is caused by bilateral foot drop
b) An antalgic gait is caused by a painful leg
c) A waddling gait is sometimes called a steppage gait
d) An apraxic gait is due to hysteria

Answer 18

b) An antalgic gait is caused by a painful leg

A stamping gait is caused by sensory ataxia. The lack of sensation leads to the patient stamping their foot to increase proprioceptive feedback. A steppage gait is different to a waddling gait. An apraxic gait is due to cerebrovascular disease and not hysteria.

Question 19

Which of the following is true in peripheral neuropathy?

a) Sensory loss is demonstrated in a stocking distribution
b) The tone is increased bilaterally in the legs
c) Reflexes are very brisk with reinforcement
d) Weakness is more marked proximally than distally

Answer 19

a) Sensory loss is demonstrated in a stocking distribution

Peripheral neuropathy leads to normal or decreased tone. Reflexes are diminished or absent and reinforcing reflexes is unnecessary if brisk reflexes are obtained. If there is a motor component to the neuropathy the weakness will be distal rather than proximal.

Question 20

Which of the following is true in spastic paraplegia?

a) Multiple Sclerosis can cause this neurological pattern
b) Proprioceptive loss is a common feature
c) Coordination in the legs is affected
d) The tone is normal or flaccid

Answer 20

a) Multiple Sclerosis can cause this neurological pattern

In spastic paraplegic proprioceptive loss is not a feature. Coordination is similarly unaffected. The tone is increased.

Question 21

Which of the following is true of headache?

a) When associated with neck stiffness is always due to meningitis
b) Severe pain usually indicates a life threatening cause
c) Temporal arteritis is strongly associated with rheumatoid arthritis
d) Tension headaches is a common cause of headache

Answer 21

d) Tension headaches is a common cause of headache

Neck stiffness can also be associated with sub-arachnoid haemorrhage. The severity of headache is no indication of its seriousness. Temporal arteritis is associated with polymyalgia rheumatica

Question 22

Which of the following is true of blackouts and dizziness?

a) Confusion following a blackout is strongly suggestive of a fit
b) Pre-syncope is another term for a blackout
c) An epileptic fit always leads to the loss of consciousness
d) In the investigation of a blackout a blood sugar estimation is of no value

Answer 22

a) Confusion following a blackout is strongly suggestive of a fit

Pre-syncope is the symptom experienced prior to blacking out. Complex partial seizures and focal fits are examples of epilepsy without loss of consciousness. A blood sugar estimation can exclude hypoglycaemia as a cause of blackout.

Question 23

In the assessment of visual fields which of the following is true?

a) A lesion at the optic chiasma leads to a homonymous hemianopia
b) Impulses from the retinal leave the eye via the optic radiation
c) An enlarged blind spot may occur because of papilloedema
d) The visual field examination maps out a patient’s central vision

Answer 23

c) An enlarged blind spot may occur because of papilloedema

A lesion at the optic chiasma causes bitemporal hemianopia. Impulses from the retina leave the eye via the optic nerve not radiation. Visual field examination maps out a patient’s peripheral vision.

Question 24

Which of the following is true in diplopia?

a) Diplopia can never occur if one eye is covered
b) The outer image is always the false image
c) A fourth nerve palsy occurs when the patient looks upwards
d) A sixth nerve palsy causes a divergent squint

Answer 24

b) The outer image is always the false image

Monocular diplopia can occur due to cataracts and corneal scarring. A fourth nerve palsy occurs if the patient looks down. A sixth nerve palsy causes a convergent squint.

Question 25

Which of the following is true of a hearing assessment?

a) Presbyacusis is a conductive deafness
b) Weber’s test requires the tuning fork to be placed on the mastoid process
c) A positive rinne’s test is where air conduction is greater than bone conduction
d) Sensorineural deafness causes a negative rinne’s test

Answer 25

c) A positive rinnes test is where air conduction is greater than bone conduction

Presbyacusis is a sensorineural deafness. Sensorineural deafness causes a positive rinne’s test. In Weber’s test the tuning fork is placed on the centre of the forehead.

Question 26

Which of the following is true of calcium metabolism?

a) Calcitonin causes a rise in plasma calcium
b) Primary hyperparathyroidism is usually asymptomatic
c) Vitamin D is secreted by the parathyroid glands
d) Oliguria is a symptom of hypercalcaemia

Answer 26

b) Primary hyperparathyroidism is usually asymptomatic

It is parathyroid hormone that elevates plasma calcium. With primary hyperparathyroidism the rise in plasma calcium is usually mild and asymptomatic. Vitamin D is produced in the skin from sunlight. Hypercalcaemia usually causes polyuria.

Question 27

Which of the following is true of Graves Disease of the thyroid?

a) It is a cause of ophthalmoplegia
b) It causes a large multi-nodular goitre
c) It is commoner in males than females
d) In the past, Grave’s disease sometimes caused ‘Derbyshire Neck’

Answer 27

a) It is a cause of ophthalmoplegia

Graves Disease usually produces a small diffuse goitre and is commoner in females. Derbyshire neck was due to iodine deficiency

Question 28

Which of the following is true about a thyroid swelling?

a) It always elevates on swallowing
b) Lymph node enlargement is a good prognostic sign
c) An ultrasound of the swelling is the best test to determine whether the nodule is actively secreting hormone
d) A functioning nodule on isotope scanning is unlikely to be due to cancer

Answer 28

d) A functioning nodule on isotope scanning is unlikely to be due to cancer

A thyroid swelling will usually elevate on swallowing. However if it is due to cancer which has spread locally then the swelling can become fixed and fail to elevate. Lymph node enlargement can also be due to lymphatic spread of a cancer which is an adverse prognostic sign. Ultrasound can only demonstrate structure rather than function.

Question 29

Which of the following is true regarding the complications of a large goitre?

a) It causes stridor due to compression of the oesophagus
b) Dysphagia is an indication for surgery
c) It causes hoarseness due to compression of the trachea
d) It causes a more florid thyrotoxicosis than a smaller goitre

Answer 29

b) Dysphagia is an indication for surgery

Stridor is caused by compression of the trachea rather than the oesophagus. It causes hoarseness through compression of the left recurrent laryngeal nerve. The size of goitre has no bearing on the amount of hormone secreted.

Question 30

Which of the following is true of hypothyroidism?

a) Weight loss
b) Pre-tibial myxoedema
c) A raised TSH level
d) An aversion to warm places

Answer 30

c) A raised TSH level

Weight gain is usual in hypothyroidism. Pretibial myxoedema is seen in hyperthyroidism along with heat intolerance.

Question 31

When you are taking a musculoskeletal history which of the following is true?

a) Drugs may be implicated in the causation of gout
b) A history of diarrhoea is not relevant
c) Difficulty rising from a chair is diagnostic of polymyalgic rheumatica
d) Joint stiffness of 5 minutes duration suggests an arthropathy

Answer 31

a) Drugs may be implicated in the causation of gout

Drugs such as diuretics can cause gout. Difficulty rising from a chair can occur with many musculoskeletal conditions such as arthritis. Joint stiffness of short duration is not significant.

Question 32

Which of the following is true of rheumatoid arthritis?

a) Rheumatoid factor is present in 25% of rheumatoid cases
b) It is an example of an oligoarthropathy
c) Anaemia is a common finding
d) Heberden’s nodes are a feature

Answer 32

c) Anaemia is a common finding

Anaemia can be due to a number of causes including the anaemia associated with chronic conditions. Rheumatoid factor is only present in 80% of rheumatoid cases. It is a polyarthropathy. Heberden’s nodes are a feature of osteoarthritis

Question 33

Which of the following is true about the knee joint?

a) The knee is a ball and socket joint
b) A baker’s cyst can sometimes be found anterior to the knee
c) The patellar tap is used to demonstrate an effusion
d) ‘knock knee’ deformity is due to bilateral genu varum

Answer 33

c) The patellar tap is used to demonstrate an effusion

The knee is a modified hinge joint. A Baker’s cyst is found posterior to the knee. A ‘knock knee’ deformity is due to bilateral genu valgum

Question 34

Which of the following is true of psoriatic arthropathy?

a) The absence of plaques of psoriasis excludes the diagnosis
b) The diagnosis can be confirmed by a blood marker
c) Tophi can sometimes be seen over affected joints
d) Nail pitting may give a clue to the diagnosis

Answer 34

d) Nail pitting may give a clue to the diagnosis

Nail pitting and onycholysis are typical features of the naily in psoriatic arthropathy. There is no blood test for psoriatic arthropathy. Tophi are seen in gout.

Question 35

Which of the following is true of the spine?

a) Back pain is an uncommon complaint
b) Schober’s test is designed to quantify the flexion of the lumbar spine
c) Ankylosing spondylitis is a cause of hypermobility of the spine
d) Pregnancy is a cause of loss of lordosis of the lumbar spine

Answer 35

b) Schobers test is designed to quantify the flexion of the lumbar spine

Back pain is common and is one of the major reasons for sick leave in the employed. Ankylosing spondylitis causes decreased mobility of the spine. Pregnancy increases the lordosis of the lumbar spine.

Question 36

Which of the following is true of Paget’s Disease?

a) Bowing of a long bone is a characteristic feature
b) Spinal cord compression is a common complication
c) Heart failure is not a recognized complication
d) Pathological fractures are not a feature

Answer 36

a) Bowing of a long bone is a characteristic feature

Spinal cord compression is a rare complication. Heart failure is a recognized complication because the highly vascular bone causes high output heart failure. The resulting bone is more fragile and prone to fracture

Question 37

Which of the following is true of facial nerve palsy?

a) Bells palsy is another term for an upper motor neurone lesion
b) Ramsay Hunt Syndrome is an upper motor neurone lesion secondary to a Herpes Zoster infection
c) An inability to close the eyelid on the paralysed side indicates a lower motor neurone lesion
d) In Bell’s Palsy the sense of taste is never affected

Answer 37

c) An inability to close the eyelid on the paralysed side indicates a lower motor neurone lesion

Bells palsy is a lower motor neurone lesion. Ramsay Hunt syndrome is also a lower motor neurone lesion secondary to Herpes Zoster infection. Sometimes taste is affected if the chorda tympani branch of the facial nerve is involved. The inability to close the eyelid on the paralysed side is known as Bell’s phenomenon.

Question 38

Which of the following is true of Systemic Sclerosis?

a) It affects males more than females
b) If telangiectasia are seen this clinches the diagnosis
c) Arachnodactyly is a feature of the disease
d) Patients have a beaked shaped nose and waxy skin

Answer 38

d) Patients have a beaked shaped nose and waxy skin

Systemic sclerosis affects females more than males. Telangiectasia are present in the disease but can be found in other conditions so are not diagnostic. Arachnodactyly is seen in Marfan’s syndrome and it is sclerodactyly which is seen in Systemic Sclerosis.

Question 39

Which of the following is true about Cushing’s Syndrome?

a) It is due to a deficiency of cortisol hormone
b) Enlarged extremities are commonly seen
c) Osteoporosis is not a feature
d) A moon face and a buffalo hump are characteristic of the disease

Answer 39

d) A moon face and a buffalo hump are characteristic of the disease

Cushing’s Syndrome is due to excess glucocorticoids including cortisol not a deficiency. Enlarged extremities are seen with acromegaly. Osteoporosis is a featue of Cushing’s Syndrome along with the typical moon facies and buffalo hump over the posterior aspect of the neck,

Question 40

Which of the following is true about Addisons Disease?

a) It is due to a deficiency of prolactin hormone
b) Leads to generalized pigmentation
c) It is a recognized cause of hypertension
d) Diabetes is a complication

Answer 40

b) Leads to generalized pigmentation

Addison’s disease is due to a deficiency of glucocorticoids such as cortisol. It leads to dehydration and subsequent hypotension (and postural hypotension). Diabetes is a complication of cortisol excess not deficiency