MCQS

Question 1

MCQS
1. Which of the following approaches in history taking provides good information?
a. Interrogation
b. On direct questioning
c. Open ended questioning
d. Good rapport
e. Using patient’s exact words

2. The following are important information to ask under the past medical and surgical history
   a. Asthma
   b. Epilepsy
   c. Anaesthetic problems
   d. Stroke
   e. All of the above
3. A unit of alcohol equals
   a. A pint of beer
   b. A shot of Akpeteshie
   c. Half a glass of wine
   d. 2shots of whiskey
   e. None of the above
4. 0.5 pack-years, in terms, of cigarette smoking matches which of the following
   a. 20 cigarettes per day for a year
   b. About 3 packs a week for a year
   c. About 5 packs a week for a year
   d. 5 cigarettes a day for a year
   e. 1 pack a month for a year
5. Systemic causes of pruritus include all of the following except
   a. Diabetes Mellitus
   b. Pregnancy
   c. Uremic dermatitis
   d. Spinal cord tumors
6. Which of the following is true about falls and difficulty in walking?
   a. It is the commonest presentation in menopausal women
   b. Causes include UTI, anaemia and hypothermia
   c. The presence of ataxia always indicates chronic alcohol use
   d. Bilateral lower limb weakness rules out cord lesions
   e. Absence of urinary incontinence and saddle anaesthesia may suggest cord compression and requires urgent imaging
7. Differential diagnosis for night sweats include all of the following except
   a. Tuberculosis
   b. Lymphoma
   c. Chronic myeloid leukemia
   d. Mycobacterium ulcerans disease
   e. Hyperthyroidism
8. Which of the following is true concerning cyanosis?
   a. It represents 100g/L of haemoglobin in its hypoxic form
   b. Eisenmenger’s syndrome results in right-to-left shunting
   c. It occurs more readily in anaemia
   d. It cannot be determined in polycythaemia
   e. Cyanosis is reversed by increasing inspired oxygen
9. Conditions associated with obesity include (select more than 1)
   a. Hypothyroidism
   b. Lawrence-Moon syndrome
   c. Tuberculosis
   d. Metabolic syndrome
   e. Cushing’s disease
10. Which of the following statements are true? (select more than 1)
    a. Quincke’s sign indicates tricuspid regurgitation
    b. Osler’s nodes is a sign of infective endocarditis
    c. Narrow pulse pressure indicates aortic regurgitation
    d. A visible carotid may suggest right atrial hypertrophy
    e. The apex beat is usually located in the 5th left intercoastal space, anterior axillary line
11. Indicate whether true or false
    a. single blood pressure measurement can be used in diagnosing hypertension
    b. Optimal cuff width is 60% of the arm circumference
    c. Check blood pressure in both arms before a diagnosis of hypertension is made
    d. The lower reading is chosen when the blood pressure is measured in both arms
    e. Right arm diastolic is 5mmHg higher than the left
12. Concerning the jugular venous pressure
    a. The external jugular vein is used
    b. The jugular venous pressure can easily be observed as it passes directly medial to the clavicular head of the sternocleidomastoid muscle.
    c. The JVP is determined by using the directly measured value above the sternal angle
    d. Fixed raised JVP may be suggestive of a right heart failure
    e. The a wave indicates atrial filling
13. Concerning heart sounds
    a. S1 represents closure of the semi-lunar valves
    b. A loud S1 may indicate prolonged PR interval
    c. Splitting of S2 is best heard in the pulmonary area
    d. S3 and S4 summation gallop is the same as an ejection systolic murmur
14. Concerning heart sounds
    a. Area where a murmur is heard the loudest corresponds to the valve with the pathology
    b. Pansystolic murmurs are best heard in the tricuspid area
    c. Exercise accentuates the murmur of mitral regurgitation
    d. An early diastolic murmur is also described as crescendo-decrescendo
15. Concerning dyspnoea
    a. Right ventricular failure is associated with orthopnoea and paroxysmal nocturnal dyspnoea
    b. Ascites may cause breathlessness by causing diaphragmatic spasms
    c. Prolonged hyperventilation may cause respiratory acidosis
    d. None of the above
16. The following are true concerning respiratory examination
    a. Trachea and mediastinum shifts away from affected side in massive pleural effusion of ≥ 500mls
    b. Pneumothorax leads to a trachea and mediastinum shift away from the affected side
    c. Tension pneumothorax leads to a trachea and mediastinum shift towards the affected side
    d. Lung fibrosis leads to a trachea and mediastinum shift towards the affected side

Answer 1

2. E
3. E
7. D
9. 10
14. 16.

Question 2

SHORT QUESTIONS
17. List 2 questions under the CAGE questionnaire

18. A patient presents with menstrual problems for 6 months? List 7 questions you would ask to arrive at a diagnosis.
19. State a cause of each of the following
    a. Bounding pulse
    b. Collapsing pulse
    c. Pulsus alternans
    d. Anacrotic pulse
20. List 10 differential diagnosis of haemoptysis
21. Give the characteristic description of bronchial breath sounds
22. List all the signs of respiratory distress
23. List ten non-gastrointestinal causes of vomiting
24. List twenty causes of abdominal pain
25. State five causes of faecal incontinence
26. State 7 signs of chronic liver disease you might notice following examination of the gastrointestinal system
27. State 8 causes of hepatomegaly
28. What are the features of the spleen differentiating it from an enlarged kidney
29. In a stepwise approach, how would you perform a neurological examination of the upper limbs
30. How would you assess cranial nerve III, IV and VI
31. State 2 causes of trigeminal neuralgia
32. State 10 causes of finger clubbing

Answer 2

19. Causes of the following
    a. Bounding pulse— A bounding pulse and rapid heart rate both occur in the following conditions or events:
    Abnormal or rapid heart rhythms
    Anemia
    Anxiety
    Long-term (chronic) kidney disease
    Fever
    Heart failure
    Heart valve problem called aortic regurgitation
    Heavy exercise
    Overactive thyroid (hyperthyroidism)
    Pregnancy, because of increased fluid and blood in the body

b. Collapsing pulse—

c. Pulses alternans

d. An acrostic pulse

20. Differential diagnosis of haemoptysis ( coughing out blood 🩸)
    — lung cancers and
    — tuberculosis.
    — pulmonary embolism
    — bronchitis
    — or pneumonia.
    — cystic fibrosis
    — Bronchiectasis
    —
    —
    —
21. Characteristics description of bronchial breath sounds
    — Bronchial breath sounds are loud, harsh breathing sounds with a midrange pitch.
    —Doctors usually associate them sounds with exhalation, as their expiratory length is longer than their inspiratory length.
    — Bronchial breath sounds are normal as long as they occur over the trachea while the person is breathing out.
22. Signs of respiratory distress
    — Nose flaring
    —Retractions
    — wheezing
    —Shortness of breath.
    —Fast breathing, or taking lots of rapid, shallow breaths.
    —Fast heart rate.
    —Crackling sound in the lungs.
23. Non gastrointestinal cause of vomiting 🤮
    —certain medicines, such as antibiotics and opioid painkillers.
    — drinking too much alcohol.
    — motion sickness
    — migraine
    — food poisoning
    — anorexia nervosa
    — severe pain
    — kidney infections and
    — kidney stones.
    — a blockage in your bowel, which may be caused by a hernia or gallstones.
24. Causes of abdominal pain
    —Constipation
    —Irritable bowel syndrome
    —Food allergies 🤧
    —or intolerance (such as lactose intolerance)
    —Food poisoning
    —Stomach flu
    —Appendicitis
    —Abdominal aortic aneurysm (bulging and weakening of the major artery in the body)
    —Bowel blockage or obstruction
    —Cancer of the stomach, colon (large bowel), and other organs
    —Cholecystitis (inflammation of the gallbladder) with or without gallstones
    —Decreased blood supply to the intestines (ischemic bowel)
    —Diverticulitis (inflammation and infection of the colon)
    —Endometriosis
    —Heartburn, indigestion, or gastroesophageal reflux (GERD)
    —Inflammatory bowel disease (Crohn disease or ulcerative colitis)
    —Kidney stones
    —Muscle strain
    —Pancreatitis (swelling or infection of the pancreas)
    —Pelvic inflammatory disease (PID)
    —Ruptured ovarian cyst
    —Severe menstrual cramps
    —Tubal (ectopic) pregnancy
    —Ulcers
    —Urinary tract infections (UTI)
25. causes of faecal incontinence
    —Hemorrhoids
    — Childbirth by vaginal delivery
    — Constipation
    — Diarrhea
    — Nerve damage
    — Neurological disease 🦠
26. signs of chronic liver disease you might notice following examination of the gastrointestinal system
    — jaundice,
    — palmar erythema,
    — spider angiomata,
    —gynaecomastia
    — and alteration of mental status arising due to complications of cirrhosis.
    **Abdominal examination may show signs of
    — abdominal distension,
    — caput medusae,
    —splenomegaly
    — and flank dullness on percussion.
27. Causes of hepatomegaly.
    —Hepatitis
    -Infections: — Viral hepatitis (acute and chronic), EBV and CMV, Malaria, Abscesses – Amoebic or Pyogenic, -Autoimmune hepatitis

— Alcoholic liver disease

— Non-alcoholic fatty liver disease (previously known as NASH)

— Tumors— Metastases, Hepatocellular carcinoma (HCC), Hepatoma,

— Hematological Disorders— , Leukaemia (CML and CLL), Lymphoma,
Haemolytic anaemias. (Thalassaemia; red cell defects; sickle cell anaemia)

— Infiltration:— Amyloidosis, Sarcoidosis

— Drugs:— Statins, Amiodarone, Macrolides

— Metabolic:— Haemochromatosis, Wilson’s disease, Glycogen storage disorders(Porphyria).

— Biliary Disease:— Extra-hepatic obstruction (Pancreatic cancer; cholangiocarcinoma), Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis

— Congestive:— Right ventricular failure, Congestive cardiac failure, Constrictive pericarditis

— Budd-Chiari

34. Causes of finger clubbing
    — Cyanotic heart🫀 disease 🦠
    — Cystic fibrosis
    — Lung 🫁 cancer
    — Lung 🫁 abscess
    — Ulcerative colitis
    — Bronchiectasis
    — Benign mesothelioma
    — Infective endocarditis
    — Idiopathic pulmonary fibrosis
    — Neurogenic tumors
    — Gastrointestinal disease 🦠

Question 3

Select the most appropriate
1. Concerning symptoms
a. They are usually elicited by the bedside
b. They are often ambiguous
c. They are always meaningless
d. They should be recorded in medical terminology

2. When a patient’s symptoms are unclear, it is best to
   a. Dismiss them
   b. Seek clarification
   c. Issue prescriptions
   d. None of the above
4. Concerning history and examination
   a. 70% of diagnoses depend on the history
   b. The diagnosis solely depends on the investigations
   c. Physical examination contributes about 10% to the final diagnosis
   d. None of the above
5. Concerning history taking
   a. Medical terminology should be used to record the patient’s presenting complaints
   b. The key is to be interrogative and ensure good rapport
   c. Establishing chronology characterizes the past medical and surgical history
   d. Holt’s law is a helpful technique
   e. Allergies include minor reactions and full blown anaphylaxis only
6. A tot of akpeteshie may be equivalent to
   a. 8g of ethanol
   b. 2 units
   c. A glass of wine
   d. A pint of beer
7. 3 pack-years of cigarette smoking may be equivalent to
   a. 3 packs of cigarette in 3 years
   b. 3 packs of cigarette per year for 3 years
   c. 3 packs of cigarette per week for 3 years
   d. None of the above
8. Concerning pruritus
   a. Local causes include eczema, atopic dermatitis and uremic dermatitis
   b. Systemic causes include malignancies and spinal cord tumors
   c. Treatment includes soothing agents with sedative antihistamines taken at night
   d. None of the above
9. Which of the following is true about falls and difficulty in walking?
   a. It is the commonest presentation in menopausal women
   b. Causes include UTI, anaemia and hypothermia
   c. The presence of ataxia always indicates chronic alcohol use
   d. Bilateral lower limb weakness rules out cord lesions
   e. Absence of urinary incontinence and saddle anaesthesia may suggest cord compression and requires urgent imaging
10. Fatigue
    a. Is a common presentation to the outpatient department
    b. The commonest cause is depression
    c. Hyperthyroidism must be ruled out
    d. None of the above
11. Concerning night sweats, all of the following are true except
    a. It is associated with brucellosis
    b. It is a common presentation in anxiety
    c. Myocardial infarction must be ruled out
    d. None of the above
12. Primary hyperhidrosis is seen in
    a. Hydradenitis suppurativa
    b. Neuroleptic malignant syndrome
    c. Amyloidosis
    d. Bethanechol overdose
13. Concerning insomnia
    a. Always issue a prescription
    b. Organic causes include gastro-esophageal reflux disease, dementia, and nicotine withdrawal
    c. Self-limiting causes include grief, stress, shift work, and obstructive sleep apnoea
    d. None of the above
14. Which of the following aptly describe tenesmus?
    a. Feeling of rectal pain
    b. Feeling of a mass per rectum
    c. Discomfort associated with incomplete voiding
    d. None of the above
15. The following drugs may cause excessive sweating except
    a. Ciprofloxacin
    b. Ritonavir
    c. Omeprazole
    d. Pioglitazone
    e. Amiodarone
16. All of the following diseases cause yellowish discolouration of skin except
    a. Pernicious anaemia
    b. Uraemia
    c. Carotenaemia
    d. Conn’s syndrome
17. Which of the following statements is true?
    a. Oral temperature of 37.1OC constitutes a fever
    b. Rectal temperatures are generally 0.6OC above oral temperatures
    c. Temperatures are usually higher in elderly patients and therefore fevers may not be as pronounced
    d. A core temperature of <36.2OC indicates hypothermia
18. Concerning cyanosis, which of the following is not true?
    a. Cyanosis occurs more readily in polycythaemia than in anaemia
    b. Cyanosis represents 0.5g/dl of haemoglobin in its deoxidized form
    c. Cyanosis is not reversible by increasing inspired oxygen in status asthmaticus
    d. Causes may include pulmonary embolism, acute pulmonary oedema, Eisenmenger’s syndrome
    e. Acute cyanosis is a medical emergency
19. All of the following statements are true about pallor except
    a. Stoke-Adams attack results in flushing followed by pallor
    b. Causes include thromboembolic phenomenon, hypothyroidism and albinism
    c. Anaemia is defined as reduced haemoglobin concentration as compared to age, sex, and population of a group
    d. Pallor may racial or familial
20. The following are infiltrative causes of lymphadenopathy except
    a. Sarcoidosis
    b. Metastatic carcinoma
    c. Acute lymphoid leukaemia
    d. Benign histiocytosis
21. Concerning oedema
    a. Angioedema is hereditary
    b. Oedoema due to hydostotatic pressure includes deep vein thrombosis, left heart failure, and chronic veinous insufficiency
    c. Epstein-barr virus may cause proptosis
    d. Irritant contact dermatitis does not cause oedema
22. The following areas are correctly linked to their sensory dermatomes
    a. Palmar aspect of Medial half of palm – C6
    b. Medial and proximal two-thirds of supinator aspect of forearm – T1
    c. The thumb – C8
    d. The little finger – C7
23. All of the following are true concerning cranial nerves except
    a. Tongue movement is controlled by cranial nerve XII
    b. Cranial nerves IX and X are responsible for gag reflex
    c. Corneal reflex is the first sensory loss to occur in cranial nerve V lesions
    d. Cranial nerve III lesions cause nystagmus and cerebellar lesions
24. Causes of non-pitting oedema include all of the following except
    a. Milroy’s syndrome
    b. Radiotherapy
    c. Grave’s disease
    d. Lymphatic filariasis

Question 4

25. Following ward rounds, you are asked to request for a consult from the haematologist. State five (5) key questions you should prepare for, in anticipation of the haematology consult.
26. State 7 signs you are expected to look out for when standing at the end of the bed
27. List ten non-gastrointestinal causes of vomiting
28. State five causes of faecal incontinence
29. State 2 causes of trigeminal neuralgia
30. State 10 causes of finger clubbing
31. State 5 causes of hepatomegaly
32. State 5 causes of splenomegaly
33. State 10 causes of haemoptysis

Question 5

CLINICAL VIGNETTE
34. 25 year old male patient was rushed to the ER with worsening of breathlessness and onset of palpitations of a day’s duration. Patient has a 6 months history of cough which started gradually with associated mild pleuritic chest pains. Patient was experiencing intermittent low grade fever and chills over the period and kept on self-medicating with cough syrup and over the counter antibiotics. Cough intensified and became associated with blood stained sputum with worsening of chest pains and onset of breathlessness on exertion (that is, walking for about 30 minutes). There was progression of breathlessness with occurrence on minimal exertion and then subsequently at rest. Patient resorted to herbal treatment but was rushed to the ER when breathlessness worsened with associated onset of palpitations.
ODQ = Breathlessness +, night sweats, weight loss +, anorexia +,

The rest of patient’s history provided no additional information

The emergency nurse on duty requested for an HIV screening test which came back positive.
Patient was put on oxygen.

a. List five additional investigations you would request for this patient

b. All laboratory investigations to diagnose pulmonary tuberculosis produced negative results. What organism could be responsible for this patient’s clinical presentation aside Mycobacterium tuberculosis?

c. Outline your preliminary management of the above patient