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MBBS VI Medicine > M23 MCQ > Flashcards

M23 MCQ Flashcards

1
Q

A guy has been having on and off chest pain for 2 days. He was admitted to the AED, with TnT 1xxx (99th percentile < 14), CKMB 10 (67-XX), creatinine normal. ECG shows 2mm ST elevation and Q wave over V1-3. Which of the following is the likely timeframe of his MI?

A. > 7 days ago
B. 2-7 days ago
C. 8-24 hours ago
D. < 4 hours ag

A

B

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2
Q

A man with strong precordial pulses, CXR shows normal heart size, ECG shows left ventricular hypertrophy. Normal left and right ventricular function on echo. Exercise thallium scan found no myocardial ischemia. Which of the following is the most likely?

A. heart failure with preserved ejection fraction
B. ischaemic cardiomyopathy
C. dilated cardiomyopathy
D. late-onset asthma

A

A

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3
Q
A
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3
Q

If CHF, give what pharmacological conversion of AF?

A. Amiodarone
B. Digoxin
C. Quinidine
D. Sotalol

A

A. amiodarone

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4
Q

M/67, dizziness for several months. Adm. for fainting, dizzy for a few minutes. No acute MI. ECG: QRS missing every 3rd beat, PR constantly long, P waves always present. Mx?

A. IV atropine
B. IV isoprenaline
C. Permanent pacemaker
D. Nothing needs to be done for this benign rhythm

A

C. permanent pacemaker (mobitz type 2: as regular PR interval than drop)

Morbitz type 1 is increase in PR interval between beats than drop a QRS complex.

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5
Q

Which of the following cannot stop vomiting?

A. Codeine phosphate
B. Dexamethasone
C. Metoclopramide
D. Prochloperazine

A

A

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6
Q

Which of the following about a “dummy drug” (placebo) is true?

A. It reduces biased inferences in clinical trial
B. It is always necessary in a clinical trial evaluating a new drug
C. It is inherently unethical
D. It is unjustifiable to use placebo drugs in therapeutic trial of a new drug if there is already an established treatmen

A

D. its unethical to compare a drug not against the gold standard of the current treatment. Basically giving a sugar pill instead of something effective. Should always compare the current gold standard against new drug.

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7
Q

Woman with multiple comorbidities has good INR in the past, but suddenly INR increases to 7.X, which of the following is correct

A. Concomitant intake with aspirin will prolong INR
B. Drugs such as rifampicin, carbamazepine, phenytoin will inhibit metabolism of warfarin
C. Erythromycin and ciprofloxacin can significantly affect the pharmacodynamics of warfarin
D. Food and drink can affect the INR

A

D. Grapefruit juice

These drugs can affect pharmacokinetics no pharmacodynamics. Kinetics = absorption, distribution and metabolism excretion of these things.

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8
Q

Which of the following drugs is an inducer of liver enzymes?

A. Erythromycin
B. Isoniazid
C. Metronidazole
D. Rifampicin

A

D. rifampicin

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9
Q

A macrolide is used in the following scenarios EXCEPT:

A. Meningococcal Meningitis
B. H. pylori
C. Mycoplasma pneumoniae
D. Respiratory tract infectio

A

A

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10
Q

An elderly lady presents with generalised pruritus without underlying skin inflammation. Which of the following condition is likely?

A Chronic renal failure
B. Lichen planus
C. Psoriasis
D. Atopic dermatitis

A

A

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11
Q

You are a doctor in the geriatric outpatient clinic and an elderly lady with her daughters came in to discuss with you about not wanting to receive invasive treatment when she becomes terminally ill. She is worried that when her condition deteriorated, she might not be mentally competent to make any treatment decision. Which of the following option best respect patient’s autonomy?

A. Appoint a legal guardian
B. Draft an advanced directive
C. Make a legal will with lawyer
D. Have her daughters to decide for her?

A

B

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12
Q

Unconscious man comes in with family post road traffic accident. He has 5 children who are at the age of 14, 12, 8, 4, 2. Needs blood transfusion. Wife was delirious, but tells you that husband is Jehovah’s Witness so he cannot receive blood transfusion. You look into his pocket and find a church membership card, on which it says he does not want to receive blood transfusion. Next most appropriate management?

A. Transfuse, as not doing this would breach the doctor’s duty of care to the patient
B. Transfuse, as to avoid doing harm to dependent party such as his children
C. Transfuse the patient when he is unconscious as he cannot give informed refusal of blood transfusion
D. Assess the validity of the membership card to be legal advanced directive before withholding blood transfusion

A

D

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12
Q

A patient came in for suspected Cushing syndrome and morning serum cortisol level is 90 (~130-1xx, anyway well below LLN). Which of the following best determine the cause for her Cushing syndrome?

A. Corticotrophin releasing hormone test
B. Low dose dexamethasone suppression test
C. High dose dexamethasone suppression test
D. Short synacthen test

A

D. Iatrogenic cushing (as the endogenous morning cortisol low (when should be highest normaly)

So SST to confirm adrenal suppression due to iatrogenic steroids

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13
Q

Type 1 DM develops a flu and was sick with poor appetite. What advice to give?

A. Decrease dose of insulin due to poor appetite
B. Don’t need to take insulin if vomiting
C. Check urine ketones
D. Reduce frequency of HBG

A

C (sick day rule)
Insulin deficiency will lead to release of free fatty acids into the circulation from adipose tissue (lipolysis) which undergo hepatic fatty acid oxidation to ketone bodies (BHB and acetoacetate) resulting in ketonemia and metabolic acidosis

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13
Q

A 30 years-old woman with a history of depression and anxiety presents to you with a few months of galactorrhoea and secondary amenorrhoea. Which of the following is the most likely culprit?

A. Mirtazapine
B. Risperidone
C. Lithium
D. Diazepam

A

B. Risperidone (dopamine antagonist: antipsychotic)

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13
Q

A 30-year-old woman attached your surgery with a history of fever and sore throat for 2 days. She was diagnosed to have Grave’s disease and was started on medication 6 weeks ago. What investigation would you immediately perform?

A. Anti-TSH receptor antibodies
B. Complete blood count
C. CRP
D. TFT

A

B. ATM induced granulocytosis

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13
Q

A patient presents with rapid weight loss and haemoptysis. proximal muscle weakness and hyperpigmentation of the skin. CXR reveals a lung nodule in hilum and HypoK, what is the diagnosis?

A. Bronchial carcinoid tumour
B. Sarcoidosis
C. TB
D. Small cell lung cance

A

D (SCLC more ectopic ACTH –> causing increased MSH)

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14
Q

F/55, hx of MVR w/ valve replacement on warfarin, Hb 6.5 requiring multiple transfusion. This time presents with positive fecal occult blood test, OGD and colonoscopy normal. Next step? (PP modified)

A. Confirm with guaiac FIT
B. Capsule endoscopy
C. Single balloon enteroscopy
D. Stop warfarin

A

B

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15
Q

Female patient you looked after for 10 years. Lives alone, husband died one year ago. Hypertension on thiazide. Well controlled HTN. One week ago, she came to see you complaining of fever, cough with yellow sputum. She is confused when seeing you now. She complained of metallic taste in mouth, urine incontinence

(renal function test, plasma & urine osmo given)
Na 103
K 2.9
Cl ?
HCO3 ?
Which of the following is the cause of her delirium?

A. Depression
B. Hypertension
C. Hypokalemia
D. Hyponatremia

A

Hyponatremia

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16
Q

70/M, visual hallucination, acting out at night, short term memory impairment(?), easy falling. Physical exam shows cogwheel rigidity and bradykinesia, what is the most likely diagnosis?

A. Lewy body dementia
B. Vascular dementia
C. Alzheimer’s disease
D. Delirium

A

A

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17
Q

An elderly lady presented with shortness of breath and ankle oedema. She was admitted to the medical ward and was treated accordingly. She was well but few days after admission, she developed excruciating big toe pain. Which of the following drug is responsible?

A. Amoxicillin + clavulanate
B. Furosemide
C. N-acetylcysteine
D. Pseudoephedrine+codeine+?

A

B. Hyperuricemia is a side effect of thiazide and loop diuretics, dehydration causes uric acid to precipitate and cause gout

18
Q

30-year-old woman with good past health presents with 2-month history of menorrhagia and malaise.

Hb 6; MCV 85; WBC 1; Plt 7

Peripheral Blood Smear: pronounced neutropenia, normal WBC morphology

A. Aplastic anaemia
B. Fanconi anaemia
C. Iron deficiency anaemia
D. Pernicious anaemia

A

A (panhypoplasia of the bone marrow with cytopenias in at least 2 haematopoietic lineages –> pancytopenia and marrow hypoplasia)

19
Q

A 45-year-old man with a history of chronic hepatitis B and cirrhosis, admitted for variceal bleeding. His blood group is O and Rh positive. He requires blood transfusion. Which of the following unit of red cells can be safely transfused to the patient?

A. A and Rh positive
B. AB and Rh positive
C. B and Rh positive
D. O and Rh negative

A

D

20
Q

Health check. Asymptomatic and good past health
Hb: Normal WBC: >800 Plt: Normal
Blood Smear: mature cells. Small lymphocytes
Which next diagnostic test

A. Immunophenotyping of blood cells
B. Cytogenetic of blood cells
C. Molecular tests of blood cells
D. Proliferation index of blood cells

A

A. Identify antigens (see if originate from T or B lymphocytes)

21
Q

Which of the following is true about immune thrombocytopenia?

A. Antiphospholipid antibody is always found
B. Steroid is indicated in all patients
C. More than half associated with systemic autoimmune disease
D. IVIG can be useful

A

D

22
Q

Sore tongue and cough for 2 weeks. beefy red tongue, pancytopenia, macrocytic anemia MCV 112, reticulocyte count normal (1%), high AST, bilirubin, LDH

A. AIHA
B. Hemolysis due to scarlet fever
C. Pernicious anaemia
D. Aplastic anemia

A

C

23
Q

What is the mechanism of action of aminoglycoside?

A. Inhibit bacterial cell membrane formation
B. Inhibit bacterial cell wall formation
C. Inhibit bacterial folic acid synthesis
D. Inhibit bacterial protein synthesis

A

D (30S inhibitor)

Macrolides (50S ribosomal inhibitor –> inhibits protein biosynthesis)

24
Q

Most common Abx associated with C. difficile colitis (pp)

A. Cefotaxime
B. Vancomycin
C. Doxycycline
D. Gentamicin

A

A. (cephalosporins (2nd and 3rd gen), fluoroquinolones, ampicillin/amoxicillin and clindamycin

25
Q

Which of the following is AIDS-defining condition

A. Aspergillosis
B. CD4 < 500
C. C. difficile
D. Talaromyces marneffei

A

D. Talaromyces marneffei (old name: penicillium marneffei)

26
Q

Dengue haemorrhagic fever is characterised by:

A. Marked thrombocytopenia
B. Long incubation period > 3 months
C. Repeated infection by the same serotypes
D. Anopheles mosquito

A

A

27
Q

Which of the following strain is included as part of the quadrivalent influenza vaccine?

A. H2N2
B. H5N1
C. H7N9
D. Influenza B

A

D

28
Q

A middle-aged man presents with sudden onset of haemoptysis and gross haematuria. Which of the following investigations are the most appropriate?

A. Something (ANA?), C3
B. Anti-GBM, ANCA, CRP
C. ANCA, CRP
D. ANA, anti-GBM, C3

A

B

29
Q

59/F with long history of DM nephropathy over 10yr, creatinine has been increasing steadily for past years. Her recent lipid and glucose control is normal. Her current medication which has been taking for 2 years already, including lorsartan 25mg BD, statin, metformin 500mg BD, dpp4 inhibitor. Her recent creatinine is 127 and eGFR is 42, 24h urine protein 1.3 g. her BP is 12x/xx. What is the most appropriate Mx?

A. Add ramipril
B. Change losartan to amlodipine
C. Stop metformin immediately
D. Increase dose of losartan

A

D (24h urine protein is high, aim at a lower albuminuria for DM nephropathy. ACEI aims to control proteinuria, lowering BP is only a secondary effect)

30
Q

79/F OAHR Had graves 10yr ago with total thyroidectomy and on 100mcg daily thyroxine replacement since then. Recent COVID positive with RLL haziness. Her Na is 110, K is 3.9, serum osmol is 269(?), urine osmol is 600+, urine Na is 60+. What is the cause of hypoNa.
A. SIADH
B. Depletional hypoNa
C. Hypothyroidism
D. Addison’s disease

A

C. Need to rule out hypothyroidism before reaching dx of SIADH, which is by exclusion. Pneumonia is a stressor and will need more thyroxine replacement for her.

31
Q

F/45 newly diagnosed HTN. Physical examination unremarkable except BP 160/105.

Na 145 K 2.5 Cl 67 (ref >100) Total CO2 34 mmol/L (high, xx-30) Creatinine 80. Physical exam is unremarkable and she is euvolemic and does not have ankle edema.

What is the most likely diagnosis?

A. Gitelman syndrome
B. Liddle syndrome
C. Primary hyperaldosteronism
D. Renovascular hypertension

A

A (defective NaCl transporter causing thiazide like effect. metabolic alkalosis with excretion of H+)

32
Q

A middle-aged lady presented with fever, urgency and frequency. She was diagnosed with acute pyelonephritis and was given IV Augmentin. Her fever resolved quickly soon after, but two days later, she develop sudden onset of haematuria and sth.

Which of the following is the next investigation?

A. Ultrasound of kidney
B. Radioisotope scan
C. 24h urine protein
D. Renal biops

A

A. required to do USG (to detect size, if chronic renal disease atrophic contraindicated to renal biopsy)

33
Q

A middle-aged lady is on lithium and had untreated chronic hepatitis C. She presented with ankle oedema and facial swelling for few months.

Na 136? Serum osmolality low? (jung g not DI)

HCV RNA low, +ve anti-HCV, HIV and HBV negative and RF negative

Proteinuria 4+

What is the most likely diagnosis?

A. Cryoglobulinemia
B. MPGN
C. Minimal change disease
D. Nephrogenic diabetes insipidu

A

B. (MPGN classically assciates with hepC and gives a nephrotic picture

HCV infection associated renal diseases: MPGN, membranous nephropathy, FSGS, fibrillary glomerulonephritis, IgA nephropathy, vasculitic renal involvement and interstitial nephritis.
Most common association: type 1 MPGN associated with type 2 mixed cryoglobulinemia

34
Q

69/F Hypertension, valvular AF on warfarin, INR 1 month ago 2.6. Presents with headache, CT shows basal ganglion hematoma 3x4x5cm. What to give?

A. Factor 8 and 9 concentrate
B. Recombinant Factor 7 and 8 concentrate
C. Vit K and factor 8 concentrate
D. Vit K and FFP

A

D

35
Q

Old man on amlodipine and simvastatin. Maxillary pain, lightening pain, intermittent, 20-30 episodes per day. How to manage?

A. Carbamazepine
B. Phenytoin
C. Baclofen
D. Diazepam

A

A. for trigeminal neuralgia

36
Q

Young woman was admitted to the emergency department for GTCS lasting 10 minutes at home. She had recovered complete consciousness after 1 hour. She was studying late and had little sleep in the past week. Complete blood count, renal function test and blood glucose are all normal. Urgent CT brain showed no lesion. After admission, she had another episode of GTCS for 1 min, she regained consciousness before intravenous medication was given. What is the best management?

A. IV phenytoin
B. IV thiamine
C. IV propofol infusion
D. IV midazolam infusion

A

A

37
Q

Which of the following is TRUE about status epilepticus

A. Give IV midazolam/diazepam after securing airway, breathing and circulation, the give IV of phenytoin as loading dose
B. It can only happen in generalized seizures
C. It can never happen in absence seizures
D. Give IV phenytoin after securing airway, breathing and circulation

A

A

38
Q

Stroke pp (changed from law prof). 91yo professor of engineering. On NOAC, stopped for 2 days before dental surgery. Left hemiplegia, dysarthria, dysphagia, facial asymmetry on 1030. Attended AnE 1400. BP 180/100mmHg. Urgent CTB shows hypodense area over frontal lobe.

You seeing him now at 1430, his wife wants IV tPa, which one is contraindication?

A. Age
B. AF on DOAC
C. High BP
D. Severe neurological deficit (dysphasia, dysarthria, facial asymmetry and hemiplegia

A

D

39
Q

55/F, long standing diffuse bronchiectasis for 10 years. Pw increase purulent sputum and haemoptysis. On NOAC for Afib. Sputum culture Gram -ve bacilli positive and AFB smear positive. Sputum TB PCR negative. Which of the following is the most appropriate tx to give.

A. Augmentin
B. Anti-TB Treatment
C. Azithromycin
D. Ceftazidime

A

D. Conolisation of mycobacterium leads to AFB+ but its not TB, gram-ve bacteria in bronchiectasis = pseudomonas hence D

40
Q

A woman presents with SOB for four weeks, low grade fever pleural effusion.

Pleural fluid analysis:
WBC 1350 x 10^6 (93% lymphocytes)
Pleural: serum protein >0.6
Pleural: serum LDH >0.9
ADA: 15 (lower than normal)

Which of the following is the most likely cause of the pleural effusion?

A. Bacterial pneumonia
B. Fungal pneumonia
C. TB
D. Lung cancer

A

C. Lymphocyte predominant and exudative pleural fluid (light criteria)

41
Q

30/M admitted for right pleuritic chest pain. CXR show small pneumothorax at the right apex. He has no shortness of breath. He has good past health and is a non-smoker. What is the most appropriate management?

A. Pain control
B. Small bore chest drain
C. Needle aspiration
D. CT thorax to determine the size of pneumothorax

A

A. can do conservative tx: observe and oxygen therapy (size < 2cm and minimal symptoms)

Size >2cm or symptomatic: chest drain insertion or consider needle aspiration if skills and expertise is available

42
Q

43/M GPH is admitted to ICU for severe CAP with septic shock. His condition continue to deteriorate despite 100% oxygen delivered through face mask.
pH 7.23
PaO2 8.2
PaCO2 high (forgot exact value)
HCO3 15
BE -11
Which of the following is correct?

A. Metabolic acidosis with respiratory comp
B. Mixed metabolic and respiratory acidosis
C. Respiratory acidosis only
D. Respiratory acidosis with metabolic comp

A

B. respiratory acidosis (due to high pco2 –> indicates hyperventilation) with BE-11 (> -2) so metabolic acidosis
There is inadequate compensation as pH is abnormal

43
Q

Which one is correct for COPD?

A) ACEI are contraindicated
B) Oral beta agonists are useful
C) Anticholinergics are useful as inhaler
D) Inhaled steroids are indicated in all patients

A

C

44
Q

70yo chronic smoker with COPD. Frequent dyspnea. PaO2 measured twice 7.1 and 7.2 kPa. Already on inhaled combined Salbutamol and Ipratropium and inhaled steroid. P/e shows cyanosis, dyspnea, but no ankle edema. Which of the following should be given?

A) Long term O2 therapy
B) NIV
C) Lasix (forgot route)
D) Prolonged course of Augmentin

A

A

45
Q

45yo man with CREST syndrome, well controlled by HCQ. Persistent raised bp for 3 months. Doctor wants to start anti-hypertensive treatment

Which drug should he avoid?

A. Amlodipine
B. Indapamide
C. Propranolol
D. Ramipril

A

C (exacerbates raynauds)

Drugs exacerbating Raynauds
BB (vasoconstriction)
Dopaminergic agonist
SSRI (vasoconstriction)
Cyclosporine
Chemotherapeutic agents (endothelial damage)
TKI
IFN
Sulfazalazine

46
Q
A

B

47
Q
A

B. Sjogren a/w 44x risk of lymphoma

48
Q

Korean tourist just came to HK 2 days ago and presented with left leg pain. He had a history of painful erythematous nodular rash on the shin and recurrent oral and scrotal ulcers.

What is the cause for his swelling leg?

A. Urticarial vasculitis
B. Venous thrombosis
C. Folliculitis
D. Ruptured Baker’s cyst

A

B. Erythema nodosum with Bechet complicated by DVT. Bechets a/w higher risk of VTE (common complication)

MBBS VI Medicine (99 decks)

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