1.	Spherocytes are seen in the peripheral blood film of the following condition:

a.	auto-immune haemolytic anaemia.
b.	multiple myeloma.
c.	lead poisoning.
d.	acute lymphoblastic anaemia.
e.	splenectomy.

Answer: A

a.	Spherocytosis is present as a result of red cell damage.
b.	Protein electrophoresis characteristically shows a monoclonal band.
c.	Sideroblastic anaemia due to inhibition by lead of ALA synthetase.

2.	Gynaecomastia is caused by all of the following EXCEPT:

a.	cyproterone.
b.	cimetidine.
c.	tamoxifen.
d.	digoxin.
e.	spironolactone.

Answer: C

a.	Effective antiandrogens used in treatment of hirsutism in women.
b.	Used in treatment of duodenal ulcers. Side effects: tachycardia, breast tenderness, sexual impotence, skin rash, agranulocytosis, diarrhoea, gynaecomastia.
c.	Estrogen antagonist used alone as an adjunct to surgery and radiation therapy for the treatment of breast cancer in women. Side effects: skin rash, vaginal discharge, cataracts, hepatotoxicity, keratopathy, optic neuritis, pulmonary embolism, retinopathy, thrombosis.
d.	Used for digitalization and maintenance therapy in atrial fibrillation, atrial flutter and congestive heart failure. Side effects: yellow vision, confusion, vomiting, gynaecomastia.
e.	Used in management of edema associated with excessive aldosterone excretion and edema accompanying cirrhosis of the liver, nephrotic syndrome and congestive heart failure. Side effects: shortness of breath, sexual function impairment, impotence, anaphylaxis, headache.

3.	The following ECG changes are seen in hypokalaemia EXCEPT:

a.	widened QRS complexes.
b.	increased PR interval.
c.	tall U waves.
d.	depressed ST segments.
e.	flattened T waves.

Answer: A

a.	If > 0.12s suggests conduction defects.
b.	> 0.21s means delay in atrioventricular conduction.
c.	Prominent in hypokalaemia but may be normal.
d.	Depression of > 0.5mm implies ischaemia.
e.	Flattened in hypokalaemia.

4.	Diabetic neuropathy causes all of the following EXCEPT:

a.	nocturnal diarrhoea.
b.	deafness.
c.	impotence.
d.	postural hypotension.
e.	mononeuritis multiplex.

Answer: B

Somatic neuropathy: symmetrical sensory polyneuropathy (distal numbness, tingling & visceral pain), mononeuritis multiplex (esp. III & VI cranial nerves) & amyotrophy – painful wasting of quadriceps.
Autonomic neuropathy: postural hypotension, urine retention, impotence, diarrhoea at night. 

5.	The following are seen in severe bronchial asthma EXCEPT:

a.	paradoxical rise in blood pressure on inspiration.
b.	absence of wheeze on inspiration.
c.	pulse rate of more than 120/min.
d.	confusion.
e.	peak expiratory flow rate of more than 100L/min.

Answer: E

Features of severe asthma: inability to complete a sentence in one breath, pulse rate of > 110 beats/min, respiratory rate of >25/min, PEFR 33-50% of predicted value, pulsus paradoxus (exaggerated decrease in arterial blood pressure and increase in pulse rate on inspiration), reduced breath sounds.

6.	Respiratory failure with a decreased pO2 and decreased pCO2 is NOT seen in:

a.	pneumonia.
b.	chronic bronchitis.
c.	bronchial asthma.
d.	pulmonary edema.
e.	pulmonary embolism.

Answer: B

Respiratory failure occurs when gas exchange is inadequate, causing hypoxia. It is defined by PaO2 <8kPa. In type I, PaCO2 < 6.5kPa, in type II PaCO2 > 6.5kPa.
Causes of type I respiratory failure: pneumonia, asthma, pulmonary edema & embolism.
In chronic bronchitis, the airways are narrowed with decreased alveolar ventilation leading to retention of CO2.

7.	The following causes of central cyanosis are not corrected by administration of a high concentration of oxygen:

a.	Chronic cardiac failure.
b.	High hematocrit.
c.	Pulmonary fibrosis.
d.	Fallot’s tetralogy.
e.	Emphysema.

Answer: B.

8.	A single red hot joint is most likely due to:

a.	Rheumatic arthritis.
b.	Septic arthritis.
c.	Vasculitis.
d.	SLE.
e.	Reiter’s disease.

Answer: B

a.	Typically with swollen, painful, and stiff hands and feet, especially in the morning. This gradually gets worse and larger joints become involved. Signs: sausage-shaped fingers and MCP joint swelling. Later, ulnar deviation and volar subluxation at MCP joints, Boutonniere and swan-neck deformities of fingers or Z-deformity of thumbs. The wrist subluxes and the radial head becomes prominent (piano-key).

b.	Clinically there is a hot painful red joint, often the knee, which has developed acutely. There may be fever and evidence of infection elsewhere. Results of infection of joint by pyogenic organisms, e.g. Staphylococcus aureus, streptococcus, pseudomonas brucella, gonococci, TB, salmonella. The organism reaches the joint through the bloodstream from a distant site of infection, from local spread of adjacent osteomyelitis, or through direct injury or trauma. Viruses cause a polyarthritis – mumps, rubella, EBV, hepatitis B, enteroviruses, HIV).

c.	Vasculitis such as polyarteritis nodosa and polymyalgia rheumatica causes a arthralgia and mild polyarthritis respectively.

d.	SLE is a non-organ specific, autoimmune vasculitis in which antinuclear antibodies (ANA) occur. It causes a non-erosive polyarthritis with periarticular and tendon involvement.

e.	Reiter’s syndrome: a triad of urethritis, conjunctivits and seronegative arthritis. Often large joint mono- or oligo-arthritis; it may be chronic relapsing.

9.	All of the following features are seen in Parkinson’s Disease except:

a.	Decreased blinking.
b.	Excess salivation.
c.	Micrographia.
d.	Negative Romberg’s sign.
e.	Grasp reflex.

Answer: D

c.	Micrographia: writing becomes small and spidery, with a tendency to tail off at the end of a line.
d.	The Romberg’s test is positive when unsteadiness increases with eye closure. This is usually seen with the loss of proprioceptive sensation.

10.	The Nephrotic Syndrome is complicated by all of the following EXCEPT:

a.	Hyperlipoproteinaemia.
b.	Thromboembolism.
c.	Decreased serum T4 levels.
d.	Lipiduria.
e.	Primary peritonitis.

Answer: D

Nephrotic syndrome: proteinuria (>3g/24h) causing hypoalbuminaemia and edema, often with hypercholesterolaemia.

b.	Thromboembolism from urinary loss of antithrombin III, low plasma volume, increased clotting factors II, V, VII, VIII and X.
e.	Primary peritonitis: especially with pneumococci – consider pneumococcal vaccination if nephrotic state persists.

11.	Platelet dysfunction or deficiency is seen in all of the following EXCEPT:

a.	Aspirin use.
b.	Warfarin use.
c.	Uraemia.
d.	HIV.
e.	Glanzmann’s disease.

Answer: B

Platelet dysfunction is associated with excessive bleeding and bruising and in some of the acquired forms, with thrombosis.

a.	Aspirin inhibits the synthesis of thromboxane A2, which causes platelets to release their granules & to aggregate, by irreversible acetylation of cyclooxygenase.
b.	Warfarin blocks -carboxylation of several glutamate residues in prothrombin, factors VII, IX, & X & protein C. The blockade results in incomplete molecules that are biologically inactive in coagulation. Therefore, warfarin does not impair platelet function in anyway.
e.	Glanzmann’s disease: lack of platelet membrane glycoprotein IIb/IIIa complex resulting in defective fibrinogen binding.

12.	Unconjugated hyperbilirubinemia is seen in the following:

a.	Gilbert’s disease.
b.	Rotor.
c.	Dublin-Johnson.
d.	Primary sclerosing cholangitis.
e.	Primary biliary cirrhosis.

Answer: A

Gilbert’s disease is the most common familial hyperbilirubinaemia and affects 2-7% of the population. It is asymptomatic and is usually detected as an incidental finding of a slightly raised bilirubin on a rountine check. 

13.	Pulsus paradoxus is seen in all of the following EXCEPT:

a.	Severe left ventricular failure.
b.	Severe asthma.
c.	Myocarditis.
d.	Constrictive pericarditis.
e.	Cardiac amyloidosis.

Answer: A

In normal subjects, the systolic pressure and pulse pressure fall during inspiration. In pulsus paradoxus, the systolic pressure falls by more than 10 mmHg during inspiration. The pulse characteristic of left ventricular failure is pulsus alterans – alternate beats that are weak and strong but with a regular rhythm.

14.	The following are seen in infective endocarditis EXCEPT:

a.	Systemic embolism.
b.	Splenomegaly.
c.	Osler’s nodes.	
d.	Anaemia.
e.	Deep vein thrombosis.

Answer: E

Infective endocarditis is an infection of the endocardium or vascular endothelium. The common organisms are Streptococcus viridans, Enterococcus faecalis, and Staphyloccous aureus. The lesion of infective endocarditis is a mass of fibrin, platelets and infecting organisms known as a vegetation. The chance of an organism sticking to a vegetation is increased because of the clumping together of bacteria caused by agglutinating antibodies. These can develop because of repeated infection with the bacterium over a period of years. In acute endocarditis, vegetations may be very large and may embolize. The extra-cardiac manifestations result either from embolization or from the deposition of immune complexes. Infective symptoms include splenomegaly and anaemia. Embolic lesions such as hard, painful, tender subcutaneous swellings occur in the fingers, toes, palms and soles as Osler’s nodes.

Deep vein thrombosis is the formation of a thrombus in the deep veins of the lower limb. The risk factors are increased age, immobilization, pregnancy, surgery and malignancy.

15.	The following conditions caused dementia EXCEPT:

a.	Huntington’s disease.
b.	Schizophrenia.
c.	Pick’s Disease.
d.	Chronic alcohol dependence.
e.	Myxoedema.

Answer: B

Dementia is a syndrome due to disease of the brain in which there is a disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment.

a.	Huntington’s disease is characterized by progressive chorea and dementia in middle life. Inheritance is as an autosomal dominant trait with full penetrance; the children of an affected parent have a 50% chance of inheriting the disease. A mutation has been identified at the distal short arm of chromosome 4 with an abnormal sequence of randomly repeated trinucleotides. The expansion of a CAG-repeat sequence in DNA results in the translation of an extended glutamine sequence in the protein product of the gene called huntingtin.

b.	Covers a broad range of cognitive, emotional and behavioral disturbances. The illness can begin at any age but is rare before puberty. The symptoms are: auditory hallucinations, thought withdrawal, insertion and interruption, delusional perceptions, external control of emotions, somatic passivity and feelings.

c.	In Pick’s disease, a progressive dementia occurs, commencing in middle life and characterized by slowly progressive changes of social and personal deterioration. This is followed by impairment of intellect, memory and language functions.

d.	Chronic alcohol dependence can lead to Wernicke-Korsakoff syndrome with ocular signs, ataxia, confusion, decreased awareness, an amniestic syndrome, stupor and coma.

e.	‘Myxoedema madness’: depression is common in hypothyroidism but occasionally with severe hypothyroidism in the elderly the patient may become frankly demented or psychotic, sometimes with striking delusions.

16.	Features of dengue include all of the following EXCEPT:

a.	Hemodilution.
b.	Leukocytosis.
c.	Chronic carrier state.
d.	Life-long immunity.
e.	Hepatomegaly.

Answer: C

17.	Irritable bowel syndrome is associated with all of the following except:

a.	Mucus per rectum.
b.	Rectal bleeding.
c.	Sensation of incomplete evacuation.
d.	Abdominal distension.
e.	Loose and increased frequency of stools at onset of abdominal pain.

Answer: B

Irritable bowel syndrome is characterized by troublesome gastrointestinal symptoms experienced in the absence of any organic pathology. Differential diagnosis: colonic cancer, inflammatory bowel disease, coeliac disease, thyrotoxicosis.

18.	All of the following are seen in acute post-streptococcal glomerulonephritis EXCEPT:

a.	Hyperlipoproteinaemia.
b.	Haematuria.
c.	Granular casts.
d.	Hypertension.
e.	Acute pulmonary edema.

Answer: A.

19.	Hypothyroidism is associated with the following EXCEPT:

a.	Low thyrotropin.
b.	Cerebellar ataxia.
c.	Carpal tunnel syndrome.
d.	Hyperlipidaemia.
e.	Dry skin.

Answer: A

20.	Extensor plantar response and absent knee jerks are seen in the following except:

a.	T12 cord compression.
b.	Pernicious anaemia.
c.	Fredrich’s ataxia.
d.	Multiple sclerosis.
e.	Taboparesis.

Answer: D

a.	Acute spinal cord compression: spinal or root pain usually precedes the development of weak legs, weak arms and sensory loss. Bladder (and anal sphincter) involvement happens late and manifests itself as hestitancy, frequency and later painless retention.  Initially there will be a flaccid paresis with diminished reflexes in the limbs oat and below level of lesion (T12). Later, upper motor neuron signs (increased tone & reflexes, clonus, extensor plantar response) develop below the level of the lesion.

b.	Pernicious anaemia affects all cells of the body due to malabsorption of vitamin B12 resulting from lack of gastric intrinsic factor because of autoimmunity to parietal cells. Subacute combined degeneration of the spinal cord may be seen in any cause of a low B12. Posterior and lateral columns are often affected, not always together. Onset is usually insidious – with peripheral neuropathy. The classic triad is: extensor plantars, brisk knee jerks, absent ankle jerks.

c.	Friedreich’s ataxia: the spinocerebellar tracts degenerate causing cerebellar ataxia and dysarthria, nystagmus and dysdiadochokinesis. Loss of corticospinal tracts occurs (weakness and extensor plantars) and peripheral nerve damage, so the tendon reflexes are paradoxically depressed.

d.	Multiple sclerosis: this chronic, relapsing/remitting disorder is characterized by formation of plaques of demyelination at sites throughout the CNS. Presentations are unilateral optic neuritis, numbness or tingling in the limbs, leg weakness or brainstem or cerebellar symptoms such as diplopia or ataxia.

e.	Taboparesis: neurosyphilis in childhood with features of tabes dorsalis and general paralysis of the insane. The latter describes madness and weakness. Progressive cognitive decline, brisk reflexes, extensor plantar reflexes and tremor occur.

21.	Acidosis with increased anion gap is seen in the following EXCEPT:

a.	Diarrhoea.
b.	Diabetic ketoacidosis.
c.	Renal failure.
d.	Circulatory failure.
e.	Salicylate poisoning.

Answer: A

Anion gap = [Na+] + [K+] – [HCO3-] – [CI-]. The normal range is 8 – 16mmol/L. It is a measure of the difference between cations, and unestimated anions – ‘fixed’ or organic acids. An increase in the amount of these acids will increase the anion gap.

a.	Diarrhoea doesn’t increase the anion gap as it leads to loss of chloride ions from the body.
b.	This is a high-anion-gap acidosis resulting from the accumulation of organic acids, acetoacetic acid and hydroxybutyric acid, owing to increased production and some reduced peripheral utilization.
c.	Renal failure leads to the failure to excrete fixed acid.
d.	Circulatory failure leading to cardiogenic shock causes increased lactic acid production.

22.	The following are features of Pancost tumor except:

a.	ipsilateral miosis.
b.	pain on ipsilateral shoulder and arm.
c.	loss of sweating over ipsilateral side of face.
d.	ipsilateral ptosis.
e.	tracheal deviation.

Answer: E

Pancost tumor : carcinoma in the apex of the lung can erode the ribs and involve the lower part of the brachial plexus (C8, T1 and T2), causing severe pain in the shoulder and down the inner surface of the arm. The sympathetic ganglion can also be involved, producing Horner’s syndrome (ipsilateral miosis, partial ptosis and loss of sweating over ipsilateral side of face). Further extension may involve the recurrent laryngeal nerve as it passes down the aortic arch, causing unilateral vocal cord paresis with hoarseness and a bovine cough, and rarely the tumor causes spinal cord compression.

23.	The following are features of SLE except:

a.	More common in females than males.
b.	Usually associated with a raised ESR.
c.	CRP raised in the majority.
d.	May cause epileptic fits.
e.	May cause nepropathy.

Answer: C

24.	Upper motor neuron lesion causes

a.	Flaccid paresis.
b.	Fasciculations.
c.	Clonus.
d.	Increased abdominal reflex.
e.	Marked muscle wasting.

Answer: C

Ankle clonus: with the patient’s knee semi-flexed and the foot relaxed, the foot is suddenly pushed dorsally with moderate force and held there. In upper motor neuron lesions the posterior muscles of the leg will enter into a persistent contraction. The rest of the choices are features of lower motor neuron lesions.

25.	Flamed-shaped haemorrhages and soft exudates are characteristically seen in:

a.	Diabetes mellitus.
b.	Hypertension.
c.	Infective endocarditis.
d.	Raised intracranial pressure.
e.	Optic atrophy.

Answer: B

a.	Diabetic retinopathy: soft exudate and small haemorrhages, microaneurysms, retinal haemorrhages and hard yellow exudates.
b.	Hypertension: silver wiring of arteries, arteriovenous nipping, flame-shaped haemorrhages and soft exudates.
c.	Retinal or conjunctival haemorrhages.
d.	Papilloedema: loss of normal depression of optic disc, blurring at the margins, swollen without venous pulsation.
e.	Optic disc has a pale insipid white color.

26.	All of the following are found in heart failure EXCEPT:

a.	Displaced apex beat.
b.	Pulsus alterans.
c.	Loud first heart sound.
d.	Third heart sound.
e.	Inspiratory basal crackles.

Answer: C

The first heart sound is loud in mitral stenosis and soft in mitral regurgitation.

27.	When an elderly patient presents with an upper GI bleed, the earliest sign of hypovolaemia is:

a.	Thready pulse.
b.	Pulse rate of more than 100/min.
c.	Postural hypotension.
d.	Anaemia.
e.	Dyspnoea.

Answer: C

28.	Haematuria is a feature of:

a.	Diabetic nephropathy.
b.	Renal agenesis.
c.	Glomerulonephritis.
d.	Renal artery stenosis.
e.	Retroperitoneal fibrosis.

Answer: C

29.	Commonest organism in acute exacerbation of chronic bronchitis is:

a.	Klebsiella.
b.	E. coli.
c.	Haemophilus influenzae.
d.	Staphylococcus aureus.
e.	Streptococcus pyogenes.

Answer: C

30.	The best indication for severity of aortic stenosis is:

a.	Loud systolic murmur.
b.	Slow rising carotid pulse.
c.	Prominent thrill.
d.	Third heart sound.
e.	Widely split second heart sound.

Answer: C

31.	Alveolar stability is dependent on:

a.	Mucus.
b.	Interstitial fluid.
c.	Surfactant.
d.	Inhaled particles.
e.	Alveolar fluid.

Answer: C

32.	The mainstay of pharmacological treatment of patients with persistent bronchial asthma should be:

a.	Inhaled sympathomimetic agents.
b.	Oral sympathomimetic agents.
c.	Oral theophylline.
d.	Steroid therapy.
e.	Oxygen.

Answer: D

33.	Pattern of lung function test in chronic obstructive bronchitis:

a.	FEV    RV    TLC 
b.	FEV normal   RV    TLC normal
c.	FEV    RV    TLC 
d.	FEV    RV    TLC
e.	FEV normal   RV    TLC 

Answer: A

34.	In pregnancy, the best test of thyrotoxicosis is:

a.	POI.
b.	Serum T3.
c.	Free T4.
d.	Computation of the Free Thyroxine Index.
e.	TSH.

Answer: D

35.	Punched out radiolucent areas of epiphyseal bone, seen on X-ray are diagnostic of:

a.	Hyperparathyroidism.
b.	Rheumatoid arthritis.
c.	Septic arthritis.
d.	Osteoarthritis.
e.	Gouty arthritis.

Answer: E

36.	Low serum calcium and high serum phosphate is associated with:

a.	Osteomolasis.
b.	Secondary hyperparathyroidism.
c.	Paget’s disease.
d.	Tertiary hyperparathyroidism in chronic renal failure.
e.	Malabsorption.

37.	The cause of the fourth heart sound is

a.	Atrial contraction.
b.	Closing of mitral valves.
c.	Closing of tricuspid valves.
d.	Ventricular contraction.
e.	Raised JVP.

Answer: A

38.	Pancytopenia occurs in all EXCEPT:

a.	Hypersplenism.
b.	Aplastic anaemia.
c.	Myelofibrosis.
d.	Chronic myeloid leukaemia.
e.	Infiltration from malignancy.

Answer: D

39.	Pruritus occurs in all EXCEPT:

a.	Polycythaemia vera.
b.	Hodgkin’s disease.
c.	Haemolytic anaemia.
d.	Chronic renal failure.
e.	Liver disease

Answer: C

Other systemic causes of pruritus: lymphomas, pregnancy, iron deficiency and thyroid disease.

40.	The following are side-effects of steroids except

a.	Cataracts.
b.	Diabetes mellitus.
c.	Osteoporosis.
d.	Myopathy.
e.	Hypoglycaemia.

Answer: E

41.	Thyrotoxicosis is associated with the following EXCEPT:

a.	Myotonia.
b.	Myasthenia gravis.
c.	Proximal myopathy.
d.	Pretibial myxoedema.
e.	Atrial fibrillation.

Answer: A

42. 	If PTT is normal, the following may be excluded:

a.	Factor V deficiency.
b.	Factor X deficiency.
c.	Prothrombin deficiency.
d.	Fibrinogen deficiency.
e.	All of above.

Answer: E

43.	Post-streptococcal glomerulonephritis is associated with the following EXCEPT:

a.	Haematuria.
b.	Raised blood pressure.
c.	Hypoproteinaemia.
d.	Oliguria.
e.	Proteinuria.

Answer: C

44.	Diabetics with chronic hypertension and proteinuria are usually associated with:

a.	Resistance to insulin.
b.	Ketoacidosis.
c.	Diabetic retinopathy.
d.	Peripheral vascular disease.
e.	Obesity.

Answer: C

45.	A thyroid scan is indicated in:

a.	Thyrotoxicosis.
b.	Myxoedema.
c.	Carcinoma of thyroid.
d.	Hashimoto’s disease.
e.	Grave’s disease.

Answer: C

46.	In status asthmaticus, if the patient is restless and cyanosed, the treatment is:

a.	40% oxygen.
b.	24% oxygen.
c.	Diazepam.
d.	Theophylline.
e.	Chest physiotherapy.

Answer: B

47.	Hypercalcacemia occurs in the following EXCEPT:

a.	Hyperparathyroidism.
b.	Sarcoidosis.
c.	Chronic renal failure.
d.	Antacid ingestion.
e.	Multiple myeloma.

Answer: C

48.	Primary TB affects:

a.	Hilar lymph nodes.
b.	Middle lobe.
c.	Apex of lung.
d.	Base of lung.
e.	Mediastinal lymph nodes.

Answer: A

49.	In renal insufficiency, which of the following drugs should be reduced in dosage?

a.	Aminoglycosides.
b.	Erythromycin.
c.	Cimetidine.
d.	Allopurinol.
e.	Salbutamol.

Answer: A

50.	In SLE, prognostic points include:

a.	Renal involvement.
b.	CRP.
c.	Lupus cells.
d.	ESR.
e.	WBC count.

Answer: A

51.	AFP is positive in all of the following EXCEPT:

a.	Carcinoma of the liver.
b.	Chronic serum hepatitis.
c.	IUD.
d.	Testicular teratoma.
e.	Carcinoma of the colon.

Answer: C

52.	Nephrocalcinosis is associated with the following EXCEPT:

a.	Hyperparathyroidism.
b.	Renal TB.
c.	Chronic pyelonephritis.
d.	Hyperuricaemia.
e.	Analgesic nephropathy.

Answer: E

53.	Carcinoma of the bronchus can be caused by the following EXCEPT

a.	Benzpyrenes in cigarette smoke.
b.	Nickel.
c.	Chromate.
d.	Silica.
e.	Asbestos.

Answer: D

54.	Pulmonary eosinophilia is associated with the following EXCEPT:

a.	Sarcoidosis.
b.	Drug reaction.
c.	Ascaris.
d.	Tropical eosinophilia.
e.	Polyarteritis nodosa.

55.	The following distinguishes between primary and secondary liver carcinoma.

a.	Raised SAP.
b.	Liver scan.
c.	Hypochondrial pain.
d.	Bruit.
e.	Hepatic rub.

Answer: D

56.	The commonest gastrointestinal complaint in congenital spherocytosis is:

a.	Gastric ulcer.
b.	Duodenal ulcer.
c.	Hepatitis.
d.	Gallstones.
e.	Malabsorption.

Answer: D

57.	Raynaud’s phenomenon occurs in the following except

a.	Pneumatic drills.
b.	SLE.
c.	Ergot intoxication.
d.	Cryoglobulinaemia.
e.	Cervical spondylosis.

Answer: C

58.	Pre-frontal lobectomy is indicated in

a.	Personality disorders.
b.	Mania.
c.	Schizophrenia.
d.	Alcoholism.
e.	None of above.

Answer: E

59.	Myasthenia gravis resembles the effects of:

a.	Atropine.
b.	D-tubocurarine.
c.	Methacholine.
d.	Muscarine.
e.	Propranolol.

Answer: B

60.	The effects of organophosphate poisoning include the following except

a.	Muscle fasciculations.
b.	Miosis.
c.	Anhydrosis.
d.	Increased salivation.
e.	Bronchospasm.

Answer: C

61.	Paracetamol overdose causes:

a.	Pulmonary infarction.
b.	Cystinuria.
c.	No danger to life.
d.	Hepatic necrosis.
e.	Hypothermia.

Answer: D

62.	A 30-year-old woman presented with recurrent loin pain, fever, frequency, dysuria and gross haematuria. Repeated urine culture shows E. Coli. The next investigation should be:

a.	IVP.
b.	Retrograde pyelogram.
c.	Cystoscopy.
d.	MCU.
e.	Renal arteriogram.

Answer: A

63.	A school teacher in good health presented with severe left-sided headache of 12 hours’ duration associated with nausea and malaise and was preceded by a  transient left homonymous hemianopia lasting 10 minutes. Diagnosis:

a.	Epilepsy.
b.	Migraine.
c.	A-V malformation in the left cerebral cortex.
d.	Left intracerebral haemorrhage.
e.	Intracranial aneurysm.

Answer: B

64.	Absence of the oculo-cephalic reflex in a comatose patient indicates a lesion in the:

a.	Frontal lobe.
b.	Pons.
c.	Internal capsule.
d.	Midbrian.
e.	Medulla.

Answer: B

65.	Bullae do not occur in:

a.	Erythema multiforme.
b.	Secondary syphilis.
c.	Pemphigus vulgaris.
d.	Impetigo.
e.	Insect bites.

Answer: B

66.	Klinefelter’s syndrome affects predominantly the:

a.	Pituitary.
b.	Testes.
c.	Hypothalamus.
d.	Adrenals.
e.	Ovaries.

Answer: B

67.	Irreversible increase in total lung capacity is found in:

a.	Pneumothorax.
b.	Bronchial asthma.
c.	Emphysema.
d.	Lobar pneumonia.
e.	Pulmonary congestion.

Answer: C

68.	A 30-year-old woman developed rash from a waterstrap. The most likely metal she is sensitive to is:

a.	Nickel.
b.	Chromium.
c.	Gold.
d.	Silver.
e.	Aluminium.

Answer: A

69.	The following are characteristic of acoustic neuroma except

a.	High-tone deafness.
b.	Ipsilateral diminished corneal reflex.
c.	Ipsilateral hemiparesis.
d.	Facial nerve paresis on the same side as the deafness.
e.	Ipsilateral cerebellar signs.

Answer: C

70.	Sacro-iliac joints are not involved in:

a.	Ankylosing spondylitis.
b.	Gout.
c.	Rheumatoid arthritis.
d.	Reiter’s syndrome.
e.	TB.

Answer: C

71.	In moderate renal insufficiency, the following may be given:

a.	Streptomycin.
b.	Crystalline Penicillin.
c.	Gentamycin.
d.	Cephalosporin.
e.	Kanamycin.

Answer: B

72.	The following features would be consistent with the diagnosis of bronchiectasis except:

a.	Haemoptysis.
b.	Persistent chest infection.
c.	Digital clubbing.
d.	Enlarged hilar lymph nodes.
e.	Normal CXR.

Answer: D

73.	The commonest cause of hypopituitarism in adolescence is:

a.	Sarcoidosis.
b.	CVA.
c.	Acute blood loss.
d.	Trauma.
e.	Craniopharyngioma.

Answer: E

74.	A posterior mediastinal opacity is seen in the CXR of:

a.	Cystic hygroma.
b.	Lymphoma.
c.	Neurofibroma.
d.	Teratoma.
e.	Thymoma.

Answer: C

75.	The following may be a feature of haemolytic anaemia with the exception:

a.	Total serum bilirubin < 4mg/dl.
b.	Splenomegaly.
c.	Shortened RBC survival time.
d.	Bilirubin in the urine.
e.	Presence of gallstones.

Answer: D

76.	A schizophrenic patient may show the following features except:

a.	Paranoid delusion.
b.	Dementia.
c.	Catatonia.
d.	Dissociation from reality.
e.	Flight of ideas.

Answer: B

77.	The following are features of chronic myeloid leukaemia except

a.	Thrombocytosis.
b.	Reticulocytosis.
c.	Philadelphia chromosome.
d.	Neutrophil alkaline phosphatase.
e.	Gout.

Answer: A

78.	A 30-year-old woman presenting with secondary amenorrhoea, lassitude, weakness, loss of secondary sexual characteristics. The most likely diagnosis is:

a.	Stein-Lavanthal syndrome.
b.	Ovarian dysgeneration.
c.	Sheehan’s syndrome.
d.	Myxoedema.
e.	Addison’s disease.

Answer: C

79.	Ocular complications of diabetes include all of the following except:

a.	Exudates and haemorrhages.
b.	Ophthalmoplegia.
c.	Cataracts.
d.	Retinopathy.
e.	Keratomalacia.

Answer: E

80.	A 25-year-old woman presenting with recurrent UTI with an IVP showing hydronephrosis and hydroureter with no obstructive element. The next investigation would be:

a.	Repeat IVP with nephrotogram.
b.	MCU.
c.	Renal biopsy.
d.	Urine for AFB.
e.	Cystoscopy.

Answer: B

81.	A 40-year old woman with previously compensated mitral stenosis developed cardiac failure in the first 2 months of pregnancy and is now in the 9th week of gestation. What would you advise?

a.	Continuation of pregnancy with valvotomy.
b.	Valvotomy followed by TOP.
c.	Immediate TOP.
d.	TOP with tubal ligation.
e.	Continuation of drugs in pregnancy.

Answer: B

82.	A patient presents with retrosternal pain after meals, worse on lying down. What is the diagnosis?

a.	Hiatus hernia.
b.	Carcinoma of the esophagus.
c.	Achalasia.
d.	Benign esophageal stricture.
e.	Perforated esophagus.

Answer: A

83.	Which of the following arthritis has no systemic correlation?

a.	Rheumatoid.
b.	Ankylosing spondylosis.
c.	Osteoarthritis.
d.	Gout.
e.	Septic arthritis.

Answer: C

84.	A 20-year old male presents with acute renal failure, fever and hepatomegaly. The least likely diagnosis is:

a.	Leptospirosis.
b.	Wilson’s disease.
c.	Falciparum malaria.
d.	Paraquat poisoning.
e.	Ascending cholangitis with septicaemia.

Answer: D

85.	Radioactive I-131 uptake is influenced by the following except

a.	Low iodide store.
b.	High iodide store.
c.	Cholecystographic studies.
d.	Expectorants.
e.	Size of thyroid.

Answer: D

86.	Hyperglycaemia is aggravated by:

a.	Frusemide.
b.	Prednisolone.
c.	Cholrthiazide.
d.	Diazoxide.
e.	Spironolactone.

Answer: B

87.	A 17-year old boy is found to have a patent ductus arteriosus. Cardiac catherization revealed a left-to-right shunt. What would you advise?

a.	Leaving the lesion alone.
b.	Deferring surgery until symptoms occur.
c.	Deferring surgery until some cardiac enlargement is seen.
d.	Surgical ligation now.
e.	That the lesion is no longer operable.

Answer: D

88.	Diagnosis of typhoid fever during the first week include:

a.	Blood culture.
b.	Tissue culture.
c.	Rose spots.
d.	Therapeutic response.
e.	Serology.

Answer: A

89.	In temporal lobe epilepsy, the following are seen except:

a.	Dejavu.
b.	Depersonalization.
c.	Delirium.
d.	Olfactory aura.
e.	Automatism.

Answer: C

90.	Which of the following statements is not correct?

a.	The normal arterial pH is between 7.36 and 7.42.
b.	Hypercapnia means a pCO2 of more than 40mmHg.
c.	Respiratory acidosis is indicated by a drop of pH and rise of CO2.
d.	Neuromuscular disorders are not associated with any changes of pH and CO2.
e.	Hyperventilation may be caused by salicylates.

Answer: B

91.	Metabolic acidosis is shown by:

a.	A fall in pH and rise in CO2.
b.	A rise in pH and a fall in CO2.
c.	A fall in pH and a fall in CO2.
d.	A pH of 7.30 and bicarbonate of 35 mEq/l.
e.	Hypercapnia with mental confusion.

Answer: C

92.	Respiratory alkalosis can be due to:

a.	Hyperventilation.
b.	Prolonged vomiting.
c.	Small doses of salicylates.
d.	Depression.
e.	All of the above causes.

Answer: A

93.	Which of the following is not correct?

a.	Metabolic acidosis may be caused by severe diabetes.
b.	Acute tubular necrosis is a cause of renal failure.
c.	Severe infections and hypercatabolic states result in usually severe diarrhoea.
d.	Ammonium chloride loading can aggravate metabolic acidosis.
e.	High protein diet aggravate chronic renal failure because of acidosis.

Answer: D

94.	Which of the following is correct?

a.	Hypernatraemia may be due to obesity.
b.	Diabetes mellitus results in polyuria because of osmotic diuresis.
c.	Hyponatraemia is due to loss of pure water, or water in excess of salt.
d.	Hypernatraemia is usually seen in heart failure, liver cirrhosis and the nephrotic syndrome.
e.	Addison’s disease is associated with sodium retention, hypernatraemia and renal failure.

Answer: B

95.	The causes of hyponatraemia are the following except:

a.	Prolonged vomiting.
b.	Severe diarrhoea.
c.	Small intestinal fistulae.
d.	Primary aldosteronism.
e.	Congestive heart failure.

Answer: D

96.	Which of the following is not true?

a.	Hypokalaemia can result from renal tubular disease.
b.	Diuretic therapy is a common cause of hypokalaemia.
c.	Potassium therapy should be used cautiously in patients with chronic renal failure.
d.	Overdose of vitamin D may give rise to hypercalcaecmia.
e.	Bony metastases result usually in hypocalcaemia.

Answer: E

97.	Which of the following is not correct?

a.	Hypercalciuria is caused by hypercalcaeima.
b.	Hypercalciuria may be idiopathic and then renal stones may form.
c.	Prolonged recumbency predisposes to osteoporosis and hypercalciuria.
d.	Hyperuricaemia predisposes to lymphoma and renal stone formation.
e.	Hyperuricaemia can be caused by drugs interfering with renal clearance of urates.

Answer: D

98.	Which of the following is not correct?

a.	Diuretics given excessively result in hyponatraemia.
b.	Hypokalaemia will result from primary aldosteronism and Cushing’s disease.
c.	Hypoparathyroidism results from hypocalcaemia.
d.	Milk/alkali excess may cause hypercalcaemia.
e.	Hyperuricaemia may be secondary to chronic renal failure.

Answer: C

99.	The following are causes of hypergammaglobulinaemia except:

a.	Chronic active hepatitis.
b.	Rheumatoid arthritis.
c.	Chronic infections.
d.	Multiple myeloma.
e.	Diabetic nephropathy.

Answer: E

100.	Which of these statements is not true?

a.	Osteoporosis does not result in hypercalcaemia and hyperphosphataemia.
b.	Osteomalacia may be caused by chronic renal failure.
c.	Primary hyperparathyroidism results in hypercalcaemia and hypercalciuria.
d.	Renal function may be impaired in patients with chronic gout.
e.	Renal impairment is very rarely encountered in multiple myeloma.

Answer: E