1.	Which of the following is correct?

a.	Hyperlipidaemia does not occur in myxoedema.
b.	A serum protein of less than 2.5gm indicates nephrotic syndrome.
c.	The presence of hypertension in a patient with nephrotic syndrome indicates a favorable prognosis.
d.	Systemic lupus erythematous may be present with features of nephrotic syndrome.
e.	A patient with hypertension complicated by albuminuria indicates that he has malignant or accelerated hypertension.

Answer: D

2.	The causes of hypertension are the following except:

a.	Chronic glomerulonephritis.
b.	Renal artery stenosis.
c.	Polycystic kidneys.
d.	Cushing’s disease.
e.	The nephrotic syndrome.

Answer: E

3.	Which of the following is not true?

a.	Polycystic renal disease can usually be diagnosed with a plain X-ray of the abdomen.
b.	A hypertrophic kidney may result from a previous contralateral nephrectomy.
c.	Falciparum malaria infection can result in acute renal failure.
d.	Albuminuria may not indicate significant renal impairment.
e.	Active chronic hepatitis may result in haematuria and albuminuria.

Answer: A

4.	Which of the following is correct?

a.	IgG is normally present in the serum in smaller amounts than IgA.
b.	Acute post-streptococcal nephritis is usually caused by an alpha streptococcus.
c.	The antinuclear factor is usually present in scleroderma more frequently than in SLE.
d.	Drugs such as penicillin and ampicillin usually produce allergy which results in pancytopenia.
e.	IgE is an antibody involved in symptoms of atopic allergy and anaphylaxis.

Answer: E

5.	Nephrotic syndrome can result from the following except:

a.	Glomerulonephritis.
b.	Diabetes mellitus.
c.	Hodgkin’s disease.
d.	Malaria.
e.	Uric acid nephropathy.

Answer: D

6.	The following are causes of acute renal failure apart from :

a.	Leptospirosis.
b.	Haemorrhage.
c.	Fluid loss from GIT.
d.	Myocardial infarction.
e	Severe anaemia.

Answer: E

7.	Which of the following statements is not correct?

a.	Nephrotic diabetes insipidus is due to inability of the tubules to reabsorb water.
b.	Renal glycosuria is the inability of the tubules to reabsorb glucose.
c.	Idiopathic hypercalciuria is the inability of the tubules to reabsorb calcium.
d.	The action of ADH is on the distal tubules resulting in increased absorption of sodium and excretion of potassium ions.
e.	In chronic pyelonephritis, there is sodium and potassium loss in the urine.

Answer: D

8.	Which of the following is correct?

a.	Hypokalaemia in a patient with renal failure is an indication for dialysis.
b.	Haemodialysis is of no benefit in a patient with salicylate poisoning.
c.	Chronic renal failure may be a cause of polyuria.
d.	Compulsive water drinking can result in renal impairment.
e.	Analgesic abuse predisposes to renal tuberculosis.

Answer: C

9.	Which of the following is not associated with polyuria?

a.	Compulsive water drinking.
b.	Nephrogenic diabetes insipidus.
c.	Urinary tract infection.
d.	Acute glomerulonephritis.
e.	Frusemide therapy.

Answer: D

10.	Which of the following is not correct?

a.	Hypernephroma may be a cause of polycythaemia.
b.	Polycystic kidney disease may be associated with polycystic liver disease.
c.	Red colored urine may be due to drugs or urobilin.
d.	Milky-yellow urine is due to hyperlipidaemia.
e.	Smoky urine may be due to the presence of erythrocytes.

Answer: D

11.	Which of the following is not correct?

a.	Prolonged PR interval and tall T wave is an ECG sign of hyperkalaemia.
b.	Flat or absent T waves with tall U waves are a sign of hypokalaemia.
c.	Digoxin poisoning may give rise to an irregular ECG rhythm and ST segment depression.
d.	Rheumatic carditis may give rise to a shortened PR interval with widened QRS complexes.
e.	The ECG changes in pericarditis can usually be distinguished from those of acute myocardial infarction.

Answer: D

12.	Which of the following is not correct?

a.	Megaloblastic anaemia results in a MCV of more than 96fl and a MCHC of more than 32.6g/dL.
b.	In the bone marrow smear a normoblastic erythropoiesis would exclude uncomplicated megaloblastic anaemia.
c.	Iron-deficiency anaemia would result in an MCV of less than 76fl and MCHC of less 32g/dL.
d.	A differential count of leucocytes showing 30% of monocytes is consistent with a diagnosis of infectious mononucleosis.
e.	Hypersplenism results in thrombocytopenia, leukopenia, anaemia and suppressed erythropoiesis in the marrow.

Answer: D

13.	Causes of normocytic anaemia are the following except:

a.	Acute blood loss.
b.	Haemolytic anaemia.
c.	Infection.
d.	Hypopituitarism.
e.	Pernicious anaemia.

Answer: E

14.	Which of the following is not true?

a.	A patient with G6PD deficiency may develop jaundice if he has ingested certain drugs.
b.	Thalaseemia is an anaemia due to the presence of abnormal haemoglobin.
c.	Acquired haemolytic anaemia is due to the presence of an antibody on the red cell or in the serum.
d.	Haemoglobinaemia and haemoglobinuria both indicate extravascular haemolysis.
e.	Presence of increased reticulocyte count indicates a recent haemorrhage.

Answer: D

15.	Folate deficiency may result from:

a.	Malabsorption from the ileo-caecal region.
b.	Ingestion of salicylates.
c.	Increased demand as in pregnancy.
d.	Myelosuppression due to drugs such as chloromycetin.
e.	Diphyllobothrium latum infection.

Answer: C

16.	Which of the following is not true?

a.	Folate deficiency may result from chronic anticonvulsant therapy.
b.	Partial gastrectomy is an established cause of malabsorption of vitamin B12.
c.	Blind-loop syndrome results in vitamin B12 deficiency because of over-utilization by bacteria.
d.	Both folate and vitamin B12 deficiency give rise to an anaemia known as aplastic anaemia.
e.	The clinical features of pernicious anaemia include peripheral neuritis, dorso-lateral column involvement, and mental changes.

Answer: D

17.	Some of the characteristic features of chronic myeloid leukaemia are as follows, except:

a.	It is a disease of middle life.
b.	The common manifestations are anaemia and splenomegaly.
c.	Pruritis is a common presenting symptom.
d.	The serum uric acid is frequently raised but clinical gout is not common.
e.	A frequent terminal event is blast cell transformation.

Answer: C

18.	Causes of an enlarged spleen are, except:

a.	Portal vein thrombosis.
b.	Hyperthyroidism.
c.	Infectious mononucleosis.
d.	Thalassaemia.
e.	Malaria.

Answer: B

19.	Which of the following is not correct?

a.	Thrombocytopaenia may result from uraemia.
b.	ITP is due to an immunological disorder involving predominantly persons above 50 years of age.
c.	Secondary thrombocytopaenia may be caused by acute leukaemia, septicaemia or SLE.
d.	Increased capillary fragility is a useful clinical sign in thrombocytopaenia.
e.	Prolonged prothrombin time and impaired clot retraction are useful tests for thrombocytopaenia.

Answer: B

20.	The causes of dysphagia are, except:

a.	Stomatitis and glossitis.
b.	Tonsillitis.
c.	Achalasia.
d.	Lower cranial nerve impairment.
e.	Pyloric ulcer.

Answer: B

21.	Stomatitis may be due to the following apart from:

a.	Steven-Johnson syndrome.
b.	Leukaemia.
c.	Neutropenia.
d.	Vitamin D intoxication.
e.	Cytotoxic drug.

Answer: D

22.	Which of the following is not true?

a.	Phenytoin therapy and scurvy are two causes of gingival swelling.
b.	Pigmentation of mucosa of mouth and circumoral region can be due to Addison’s disease and malnutritional megaloblastic anaemia.
c.	Wilson’s disease and lead poisoning are two causes of gingival discoloration.
d.	Diabetic ketoacidosis may be suspected by a characteristic smell of the breath.
e.	A smooth tongue associated with dysphagia may be due to iron deficiency anaemia.

Answer: C

23.	Which of the following is not correct?

a.	Hiatal hernia is frequently complicated by carcinoma of the esophagus.
b.	Paralytic ileus can manifest by vomiting.
c.	Viral hepatitis and appendicitis are causes of vomiting.
d.	Duodenal ulcer can be associated with a co-existing gastric ulcer.
e.	Vomiting may be due to a neurological condition such as raised intracranial pressure and meningitis.

Answer: A

24.	The following are causes of vomiting except:

a.	Gastric ulcer.
b.	Cholecystitis.
c.	Uraemia.
d.	Plummer-Vinson syndrome.
e.	Psychogenic conditions.

Answer: D

25.	Which of the following is correct?

a.	Dehydration and hypothyroidism are both causes of constipation.
b.	Opiate derivatives and anticholinergic drugs both are used for treatment of constipation.
c.	Irritable bowel syndrome manifests as chronic diarrhoea due to overgrowth of bacteria in the colon.
d.	Radiation of the female genital tract may be complicated by constipation similar to that in Hirschsprung’s disease.
e.	Migraine and motion sickness both are associated with vomiting and diarrhoea.

Answer: A

B.	Exactly the reverse; they are used to treat diarrhoea.
C.	The etiology is unknown.
D.	Radiation of the female genital tract results in malabsorption and consequent diarrhea.
E.	Associated with vomiting but not with diarrhea.

26.	Which of the following is not true?

a.	Helminthic infestation can give rise to diarrhoea as well as intestinal colic.
b.	A complication of gastrectomy is diarrhoea or increased frequency of motion.
c.	Milk intolerance is due to a dissaccharidase deficiency and occurs commonly in otherwise healthy Caucasians.
d.	One of the manifestations of thyrotoxicosis is frequency of motion associated with an increase in appetite.
e.	Idiopathic ulcerative colitis is a disease of the Caucasian races but occasionally affects Asians.

Answer: B

27.	The following are causes of diarrhoea except

a.	Food allergy.
b.	Colchicine medication.
c.	Chronic pancreatitis.
d.	Chronic lead poisoning.
e.	Pellagra due to vitamin B deficiency.

Answer: D

B.	Used in the treatment of gout.
C.	Leads to steatorrhoea.
D.	Results in constipation and severe abdominal colic.
E.	Abdominal symptoms are dermatitis, diarrhoea, dementia.

28.	The following may be associated with malabsorption except:

a.	Tetracycline medication.
b.	Radiation.
c.	Chronic laxative abuse.
d.	Multiple jejunal diverticuli.
e.	Mesenteric vascular insufficiency.

Answer: D

29.	Which of the following is not correct?

a.	In obstructive jaundice there may be malabsorption of calcium, vitamin A and vitamin K.
b.	Fulminant viral hepatitis and post-necrotic cirrhosis are both common causes of hepatosplenomegaly.
c.	Typhoid fever and malaria are both associated with an enlarged liver.
d.	The differential diagnosis of an enlarged, irregular and nodular liver are hepatoma, metastasis and cystic liver disease.
e.	Obstructive jaundice may be due to drug medication such as chlorpromazine.

Answer: B

30.	The following conditions or factors should be considered in cases of hepatosplenomegaly except:

a.	Infectious mononucleosis.
b.	Myelofibrosis.
c.	Prolonged steroid therapy.
d.	Lymphoma.
e.	Wilson’s disease.

Answer: C

31.	The following conditions are associated with acute abdominal pain except:

a.	Gastric dilatation.
b.	Acute intermittent porphyria.
c.	Lead poisoning.
d.	Haemolytic crisis.
e.	Portal hypertension.

Answer: E

32.	The following conditions are associated with shunt surgery except:

a.	Encephalopathy.
b.	Epilepsy.
c.	Hepatoma.
d.	Gastric hypoacidity and gastritis.
e.	Gallstones.

Answer: D

33.	Hepato-lenticular degeneration is characterized by the following excpet:

a.	Cirrhosis.
b.	Kimmelstiel-Wilson kidneys.
c.	Chorea, dysarthria and rigidity.
d.	Kayser-Fleischer rings.
e.	Hereditary transmission.

Answer: B

34.	Which of the following is not true?

a.	Haemochromatosis is a cirrhosis associated with skin pigmentation.
b.	Pancreatic insufficiency may be associated with alcoholic cirrhosis.
c.	Haemochromatosis and alcoholic cirrhosis both can be complicated by hepatoma.
d.	Active chronic viral hepatitis and Wilson’s Disease both are associated with peripheral neuritis.
e.	In a known cirrhotic patient, a positive AFP and presence of blood-stained ascitic fluid indicates hepatoma.

Answer: D

35.	Which of the following drugs is usually associated with jaundice?

a.	Penicillamine.
b.	Frusemide.
c.	Ampicillin.
d.	Phenobarbitone.
e.	Isoniazid.

Answer: E

36.	Which of the following is true?

a.	Hiatus hernia is usually complicated by dysphagia.
b.	Chronic alcoholism induces haematemesis by vomiting, esophageal tears, or acute erosive gastritis.
c.	In patients with esophageal varices, upper GIT bleeding is almost always due to an associated peptic ulcer.
d.	All large gastric ulcers of the stomach should be resected because of a high incidence of malignancy.
e.	Aspirin and cimetidine are both associated with a significant incident of upper GIT bleeding.

Answer: A

37.	The medical complications of gastrectomies are except:

a.	Nutritional deficiency.
b.	Post-prandial diarrhoea.
c.	Fe, B12 or folate deficiency.
d.	High incidence of diabetes mellitus.
e.	Recrudescence of post-TB.

Answer: D

38.	Which of the following is not true?

a.	Crohn’s disease and amoebiasis both have predilection for ileo-caecal junction.
b.	Bleeding from ileo-caecal lesions may produce maroon colored stools or manifest as iron deficiency anaemia.
c.	Pseudopolyposis of the colon is a familial disorder predisposing to malignancy.
d.	One of the most dangerous complications of ulcerative colitis is toxic dilatation and perforation.
e.	Both ulcerative colitis and liver cirrhosis can be associated with finger clubbing.

Answer: A

39.	Which of the following is true?

a.	Decreased platelet counts are usually seen after splenectomy.
b.	Cushing’s disease and scurvy are both associated with bleeding tendency due to blood vessel defects.
c.	Disseminated TB can give rise to a blood picture like that of megaloblastic anaemia.
d.	Hypertension and diabetes mellitus both are associated with a qualitative platelet disorder.
e.	Malaria, SLE and lymphoma are conditions associated with massive splenomegaly.

Answer: B

40.	Which of the following is not true?

a.	Christmas factor and calcium ions are both coagulation factors.
b.	Vitamin K deficiency may affect several coagulation factors like prothrombin.
c.	Clot fragility and clot lysis are both useful tests of coagulation disorders.
d.	Heparin and warfarin are both used as anti-coagulants.
e.	Anti-hemophilic globulin is indicated when there is increased bleeding due to fibrinolysis.

41.	Which of the following is not true?

a.	The 1st heart sound is loud in mitral stenosis and in hyperdynamic circulation.
b.	The 2nd heart sound normally splits on inspiration especially in children.
c.	A loud and narrowly split second heart sound is present in pulmonary stenosis.
d.	Widely split fixed second heart sound is present in atrial septal defect.
e.	The mitral opening snap is best heart during expiration medial to the apex beat.

Answer: C.

C:	an ESM is heard. The P2 is delayed and soft.

42.	The 3rd heart sound is heard in the following except:

a.	Children and young adults.
b.	Right or left ventriculr failure.
c.	Aortic regurgitation.
d.	Constrictive pericarditis.
e.	Pulmonary hypertension.

Answer: E

A:	A physiological left ventricular S3 occurs sometimes in children and young people and is due to very rapid diastolic filling.

43.	Systolic ejection murmurs are heard in the following except:

a.	Aortic stenosis.
b.	In conditions with increased flow rates.
c.	Coarctation of the aorta.
d.	Tricuspid stenosis.
e.	Atrial septal defect.

Answer: D

D:	An MDM best heard at the left sternal edge is heard.

44.	Pansystolic murmurs are heard in the following except:

a.	Tricuspid regurgitation.
b.	Ventricular septal defect.
c.	Patent ductus arteriosus.
d.	Aortic regurgitation.
e.	Papillary muscle rupture.

Answer: C

45.	Which of the following is not true?

a.	Ventricular septal defect and mitral stenosis are both associated with pulmonary hypertension.
b.	The Graham-Steell murmur is usually heard over the pulmonary area.
c.	The Austin-Flint murmur is due to a functional mitral stenosis.
d.	The aortic regurgitation murmur is sometimes better heard over the right parasternal region in the 4th to 5th intercostal space.
e.	The tricuspid regurgitation murmur is louder during inspiration.

Answer: C

46.	Causes of left ventricular failure are as follows except:

a.	Hypertension.
b.	Mitral stenosis.
c.	Aortic stenosis.
d.	Acute myocardial infarction.
e.	Myocarditis.

Answer: B

B:	Mitral stenosis leads to pulmonary hypertension with eventual right heart hypertrophy and failure.

47.	Causes of right heart failure are as follows except:

a.	Left ventricular failure.
b.	Cor pulmonale.
c.	Primary pulmonary hypertension.
d.	Myasthenia gravis.
e.	Congenital bicuspid aortic valve.

Answer: E

48.	Clinical features of bacterial endocarditis are as follows, except:

a.	Fever, anaemia, arthralgia.
b.	Splenomegaly.
c.	Heberden’s nodes.
d.	Petechiae and splinter haemorrhages.
e.	Focal nephritis.

Answer: C

The 4 cardinal signs of infective endocarditis are fever, haematuria, splenomegaly and murmurs. Heberden’s nodes are found at the base of the distal phalanx and are characteristic features of osteoarthritis.

49.	Clinical features of rheumatic fever are as follows, except:

a.	Previous streptococcal infection.
b.	Previous dental procedure.
c.	Migratory polyarthritis.
d.	Erythematous marginatum.
e.	Pericarditis.

Answer: B

50.	Which of the following is not true?

a.	The cardiac involvement in rheumatic fever includes mitral valvulitis and partial heart block.
b.	SLE may give rise to a form of endocarditis.
c.	Ruptured papillary muscle or chordae tendineae of the left ventricle results in mitral regurgitation.
d.	Marfan’s syndrome and ankylosing spondylitis both may be associated with aortic valvular disease.
e.	Aortic incompetence is not produced by bacterial endocarditis.

Answer: E

51.	The jugular venous pulse

a.	Normally has an ‘a’ wave followed by a ‘t’ wave.
b.	Produces a prominent ‘a’ wave when atrial fibrillation occurs.
c.	Has a prominent wave during tricuspid incompetence.
d.	Is normally examined best with the patient lying flat with head and neck in line.
e.	Has a diminished or absent ‘a’ wave during cardiac failure.

Answer: B

52.	Which of the following gives rise to a raised ST segment in the ECG?

a.	Sinus tachycardia.
b.	Supraventricular tachycardia.
c.	Atrial fibrillation.
d.	Pericarditis.
e.	Hypertensive heart disease.

Answer: D

The other causes of a raised ST segment are acute myocardial infarction, left ventricular aneurysm and Prinzmetal’s angina. The causes of a depressed ST segment are myocardial ischaemia, acute posterior myocardial infarction, digoxin, quinidine and ventricular hypertrophy.

53.	Which of the conditions give rise to an abnormal PR interval?

a.	Ventricular aneurysm.
b.	Rheumatic fever.
c.	Sinus bradycardia.
d.	Sinus arrhythmias.
e.	Hypertension.

Answer: B

Acute rheumatic myocarditis gives rise to a prolonged PR interval. The other causes of a prolonged PR interval are ischaemic heart disease, hypokalaemia, Lyme disease and drugs such as digoxin, quinidine, beta-blockers and calcium-channel blockers.

54.	The following may result in bradycardia except:

a.	Raised intracranial pressure.
b.	Digoxin.
c.	Myxoedema.
d.	Propranolol.
e.	Atropine.

Answer: E

Atropine is an anti-cholinergic which blocks the parasympathetic stimulus to the heart, thereby increasing the heart rate.

55.	Which of the following is not usually associated with an irregular pulse?

a.	Premature ventricular or atrial contractions.
b.	Atrial fibrillation.
c.	Pulsus paradoxus.
d.	2nd degree heart block.
e.	Digoxin intoxication.

Answer: C

The pulse pressure decreases on inspiration by more than 10 mmHg. It is usually associated with severe asthma and constrictive pericarditis.

56.	Which of the following is not true?

a.	Thyrotoxicosis and myocardial ischaemia both are associated with atrial fibrillation.
b.	1st degree heart block is indicated by a PR interval of more than 0.2 sec.
c.	2nd degree heart block is indicated by a shortened PR interval, irregular rhythm and widened QRS complexes.
d.	Complete heart block usually results in bradycardia but may be followed by hypotension and Stoke-Adams attacks.
e.	Pulsus alternans may be detected by taking the BP of the patient.

Answer: C

The PR is varying in a 2nd degree heart block and therefore cannot be measured.

57.	The following may be associated with hypertension except:

a.	Primary aldosteronism.
b.	Cushing’s disease.
c.	Acromegaly.
d.	Thyrotoxicosis.
e.	Raised intracranial pressure.

Answer: E

Raised intracranial pressure usually presents with headache, drowsiness, vomiting and seizures. The signs are listlessness, irritability, falling pulse, rising BP, coma, irregular breathing, pupil changes (constriction at first, later dilatation). The causes are primary or metastatic tumors, head injury, haemorrhages, brain abscess and cerebral edema.

58.	Which of the following is not true?

a.	Haemochromatosis and amyloidosis both result in cardiomyopathy.
b.	Alcoholic cirrhosis and Wilson’s disease can both cause cardiomegaly and cardiac failure.
c.	Pericardial effusion results in prominent jugular venous pulse and pulsus paradoxus.
d.	Digitalis and beta-blockers can both aggravate heart block.
e.	Polycythaemia vera is usually complicated by cardiovascular disorders like hypertension and vascular thrombosis.

Answer: B

The complications of cirrhosis are portal hypertension, hepatocellular carcinoma, ascites and renal failure. Wilson’s disease is a copper storage disorder which leads eventually to liver cirrhosis.

59.	Which of the following is not a complication of acute myocardial infarction?

a.	Pulmonary embolism.
b.	Systemic embolism.
c.	Ventricular septal defect.
d.	Cardiac aneurysm.
e.	Dissecting aneurysm of the thoracic aorta.

Answer: E

60.	Which of the following is not a cause of syncope?

a.	Stokes-Adams attacks.
b.	Prolonged coughing.
c.	Ball-valve thrombosis of the atrium.
d.	Hypokalaemic episodes.
e.	Severe cervical spondylosis.

Answer: D

61.	Which of the following is not true?

a.	Cyanotic congenital heart disease and aortic stenosis can both be associated with syncope.
b.	Supraventricular tachycardia and atrial fibrillation can both be complications of acute myocardial infarction.
c.	Rheumatic fever and collagen disease (SLE) can be complicated by pericarditis.
d.	Constrictive pericarditis and thyrotoxicosis are both causes of a hyperdynamic circulation.
e.	Cardiac failure due to mitral stenosis and uraemia can both result in pulmonary edema and a characteristic chest X-ray.

Answer: D

62.	Which of the following is not true?

a.	In pulmonary physiology the vital capacity is less than the tidal volume.
b.	Total lung capacity is the sum of the vital capacity and residual volume.
c.	Hypoventilation can result from both neuromuscular disorder and atelectasis.
d.	Amphoric breath sounds are usually heard over a sizeable cavity in the lung.
e.	Bronchial breath sounds are usually heard over a consolidation of the lung but it may be heard also in normal persons.

Answer: A

63.	Which of the following is not true?

a.	Asthma is characterized by variable, often paroxysmal, dyspnoea due to widespread narrowing of the bronchioles.
b.	Emphysema is characterized by enlargement of air spaces distal to the terminal bronchioles with destruction of the alveolar walls.
c.	Cor pulmonale is enlargement of the heart usually secondary to polycythaemia or emphysema.
d.	Bronchitis and bronchogenic carcinoma are two medical complications of chronic cigarette smoking.
e.	Pneumoconiosis is an industrial chest disease due to inhalation of dust, such as coat dust and asbestos.

Answer: C

64.	Some of the harmful effects of cigarette smoking are, except:

a.	Buerger’s disease.
b.	Myocardial ischaemia.
c.	Hypotension.
d.	Tobacco amblyopia.
e.	Increased foetal mortality during pregnancy.

Answer: C

65.	The following may be related to slow resolution of pneumonia except:

a.	Inappropriate chemotherapy.
b.	Decreased host resistance.
c.	Foreign body in bronchus.
d.	Haemophilus influenzae infection.
e.	Presence of pharyngeal pouch.

Answer: D

66.	Which of the following is not a cause of pulmonary fibrosis?

a.	post-TB.
b.	Silicosis.
c.	Bronchogenic carcinoma.
d.	Radiation.
e.	Paraquat poisoning.

Answer: C

67.	Which of the following condition only rarely associated with lung abscess?

a.	Bronchial carcinoma.
b.	Oral or pharyngeal sepsis.
c.	Bronchiectasis.
d.	Staphylococcal pneumonia.
e.	Primary emphysema.

Answer: E

68.	Which of the following is not true?

a.	Bullae and localized emphysema both are predisposed to spontaneous pneumothorax.
b.	A transudate from a pleural effusion is shown by a protein content of less than 5 g/dL.
c.	Cardiac failure and the nephrotic syndrome are both causes of pleural effusion.
d.	Hodgkin’s disease and post-TB are both causes of enlarged hilar shadows and pleural effusion.
e.	Two complications of bronchial carcinoma are Horner’s syndrome and Cushing’s syndrome.

Answer: B

69.	Which of the following is not a complication of lung cancer?

a.	SVC obstruction.
b.	Haemorrhagic pericardial effusion.
c.	Myopathy and myositis.
d.	Lupus-like syndrome.
e.	Gynaecomastia.

Answer: D

70.	Which of the following is rarely associated with widened mediastinal shadows in the chest X-ray?

a.	Lymphoma.
b.	Bronchogenic carcinoma.
c.	Aortic aneurysm.
d.	Neurofibroma.
e.	Multinodular goitre.

Answer: E

71.	Which of the following is not true?

a.	Dysphasia is a disorder confined to difficulty of articulation.
b.	Apraxia is the inability to carry out purposive movements in the absence of motor paralysis.
c.	Agnosia is failure to recognize, visually or aurally.
d.	Fasciculation is spontaneous contraction of bundles of fibres which can be detected clinically.
e.	Alexia is the inability to learn to read.

Answer: A

Dysphasia is a disorder of the content of speech which usually follows a lesion of the dominant cortex. Dysarthria is an inability to articulate properly due to local lesions in the mouth or disorders of speech muscles or their connections. There is no disorder of the content of speech. The causes of dysarthria are paralysis of cranial nerves, cerebellar disease, Parkinson’s speech and pseudobulbar palsy.

72.	The commoner CNS associations of chronic alcoholism are, except:

a.	Delirium tremors.
b.	Wernicke’s encephalopathy.
c.	Korsakov’s psychosis.
d.	Dementia.
e.	Hemiparesis.

Answer: E

Effects of alcohol on CNS:
Wernicke’s encephalopathy: ophthalmoplegia, nystagmus, confusion and neuropathy.
Korsakoff’s psychosis: recent memory loss and confabulation.
Cerebellar degeneration.
Alcohol abuse leads to a chronic, initially sensory then mixed, axonal neuropathy.
Cause of hemiparesis: vascular events, tumor, multiple sclerosis.

73.	Defects of speech can result from the following, except:

a.	Motor neurone disease.
b.	Tumor in the medulla.
c.	Parkinsonism.
d.	Facial palsy.
e.	Thyrotoxic myopathy.

Answer: E

Speech is controlled by the muscles of eating/swallowing (9th and 10th nerves), facial muscles (7th nerve) and the tongue (12th) nerve. Defects in speech have three components: the content (dysphasia), articulation (dysarthria) and phonation (dysphonia).

Dysphasia is a disorder of the content of speech which usually follows a lesion of the dominant cortex. Dysarthria is an inability to articulate properly due to local lesions in the mouth or disorders of speech muscles or their connections. There is no disorder of the content of speech. Dysphonia is usually caused by vocal cord or recurrent laryngeal nerve lesions.

A:	Leads to bulbar or pseudobulbar palsy. Bulbar palsy is a lower motor neuron lesion of the tongue, muscles of chewing/swallowing, and facial muscles due to loss of function of brainstem motor nuclei. The speech is quiet, hoarse, or nasal. Causes are Guillain-Barre syndrome, polio and syringobulbia.
Pseudobulbar palsy is an upper motor lesion involving muscles of eating, swallowing, and talking due to bilateral lesions above the midpons. The tongue is spastic and speech like Donald Duck. It is caused by strokes affecting the corticobulbar pathways bilaterally, multiple neurone disease and multiple sclerosis.

B:	Tumors in the medulla affects the motor nuclei of the 7th, 9th, 10th and 12th nerve.

C:	Parkinson’s speech is slow, quiet, slurred, and monotonous.

E:	Thyrotoxicosis causes proximal myopathy which does not affect the muscles controlling speech. The other causes are diabetic amyotrophy, Cushing’s syndrome, osteomalacia and hypothyroidism.

74.	Which of the following is not true?

a.	Cerebral arteriosclerosis and hypertension can both be associated with epilepsy.
b.	Uraemia and hypoglycaemia are both common causes of fits.
c.	Epileptic attacks are usually followed by Todd’s paralysis which can be confirmed by eliciting the Kernig’s sign.
d.	Fulminant viral hepatitis can be complicated by fits as a result of cerebral edema and hepatic failure.
e.	Chronic epilepsy as well as prolonged vitamin B12 deficiency may result in dementia.

Answer: C

Todd’s paralysis is temporary weakness of the affected limb after a partial seizure involving the motor cortex. Kernig’s sign is positive in meningitis. When elicited, there is pain and resistance on passive knee extension with hips fully flexed.

75.	Which of the following conditions does not result in decreased CSF sugar?

a.	TB meningitis.
b.	Pyogenic meningitis.
c.	Encephalitis.
d.	Carcinomatous meningitis.
e.	Sub-arachnoid haemorrhage.

Answer: C

CSF composition: lymphocytes: < 4mm3; polymorphs: 0; protein < 0.4g/L; glucose > 2.2mmol/L; pressure: < 200mmCSF. CSF glucose is diminished in the presence of white blood cells and malignant cells. Encephalitis is most commonly caused by viruses; the CSF glucose is usually raised in such aseptic infections.

76.	Which of the following is not true?

a.	Straight-leg raising test detects abnormality of the sciatic nerve or its spinal roots.
b.	Brudzinski’s sign elicits meningeal irritation by straightening the leg with the hip flexed.
c.	A positive Chovstek’s sign indicates excessive neuromuscular irritability due to hypocalaemia.
d.	Guillian-Bare syndrome is the commonest cause of acute ascending paralysis, often associated with a symmetrical peripheral neuropathy.
e.	Duchenne’s disorder is the commonest type of progressive muscular dystrophy affecting usually young boys.

Answer: B

A:	The most common abnormality of the sciatic nerve is due to compression of L5 and S1 roots by lateral prolapse of the L4-L5 and L5-S1 discs respectively. There is low back pain and sciatica. (pain radiating down the buttock and lower limb). Straight-leg raising is limited. There is loss of reflexes and weakness of plantar flexion (S1). Sensory loss is found in the affected dermatome.

B:	This describes Kernig’s sign. Brudzinski’s sing: hips flex on bending head forward.

C:	Chovstek’s sign: tap over the facial nerve and there is contraction of the lips and facial muscles. The other sign is Trousseau’s sign: the cuff is inflated just above systolic pressure for 3 minutes and this will cause the hand to go into spasm.

D:	Guillian-Barre syndrome usually begins seven to ten days after an infective illness. It results in flaccid proximal and distal muscle paralysis, which typically ascends from the lower to the upper limbs. It is an acute, predominantly motor, demyelinating neuropathy.

E:	Duchenne’s dystrophy, inherited as sex-linked recessive and is confined to boys. The Duchenne gene is on the short arm of the X chromosome (Xp21), and its product, dystrophin, is absent. The serum creatine kinase is raised at least 40-fold. The main symptoms is progressive weakness of the calves, deltoids and proximal limb muscles. It presents at about 4 years of age with increasingly clumsy walking progressing to difficulty in standing up. Few survive to 20 years.

77.	In a known alcoholic presenting in coma, which of the following is the least likely possibility?

a.	Hypoglycaemia.
b.	Hepatic encephalopathy.
c.	Subdural haemorrhage.
d.	Diabetic ketosis.
e.	Post-epileptic coma.

Answer: D

A:	Alcohol-induced hypoglycaemia: alcohol inhibits gluconeogenesis. It is commonly found in poorly nourished chronic alcoholics and in children since they have a diminished hepatic glycogen reserve. The clinical presentation is with coma and hypothermia.

B:	Chronic alcoholic abuse is associated with liver cirrhosis and failure which can lead to hepatic encephalopathy.

C:	Subdural haemorrhage is bleeding from bridging veins between the cortex and venous sinuses, resulting in accumulation of haematoma between dura and arachnoid. This causes a gradually increasing intracranial pressure, shift of midline structures away from the side of the clot and, if left untreated, eventual tentorial herniation and coning. Most subdurals are secondary to trauma but they can occur without. The interval between injury and symptoms may be days, weeks or months. Chronic, and unsuspected subdural is common in the elderly and in patients with alcohol abuse. Headache, drowsiness and confusion are common; the symptoms are indolent and often fluctuate. Focal deficits such as hemiparesis or sensory loss develop. Epilepsy occasionally occurs. Stupor and coma gradually ensue.

D:	Diabetic ketosis is the hallmark of NIDDM. It has little correlation with chronic alcohol abuse. Ketoacidosis is a state of uncontrolled catabolism associated with insulin deficiency. Its main causes are previously undiagnosed diabetes, interruption of insulin therapy and the stress of intercurrent illness. In the absence of insulin, hepatic glucose production accelerates, and peripheral uptake by tissues such as muscle is reduced. Rising glucose levels lead to an osmotic diuresis, loss of fluid and electrolytes, and dehydration. Accumulation of ketone bodies produces a metabolic acidosis associated with nausea & vomiting, leading to further loss of fluid and electrolytes. Respiratory compensation for the acidosis leads to hyperventilation. Respiratory depression, high plasma osmolality and dehydration lead to confusion and stupor and eventual coma. 

E:	Chronic alcohol abuse is a common cause of seizures. These occur either while drinking heavily or during periods of withdrawal.

78.	Which of the following is rarely associated with headache?

a.	Contraction of the scalp and neck muscles.
b.	Post-lumbar puncture.
c.	Middle ear infection.
d.	Cerebellar tumor.
e.	Bell’s palsy.

Answer: E

A:	This is characteristic of tension headaches.

B:	Incidence of post-lumbar headache is 30%, typically occurring within 24h of LP, with resolution over hours to 2 weeks. Patients describe a constant, dull, achy pain bilaterally which is more frontal than occipital. The most characteristic symptom is of positional exacerbation – worse when upright and usually pain free when recumbent. There may be mild meningism or nausea. The pathology is thought to be continued leakage of CSF from the puncture and intracranial hypotension.

E:	Bell’s palsy is an idiopathic palsy of the facial nerve resulting in a usually unilateral facial weakness or paralysis (HSV-1 has been implicated). The onset of facial weakness is rapid and may be associated with or preceded by an ache below the ear. Weakness worsens for 1-2 days before stabilizing and pain resolves within a few days. There is dysarthria, taste impairment, intolerance of loud or high-pitched sound (hyperacusis) and failure of eye closure.

79.	Which of the following is not true?

a.	The chorda tympani is a branch of the facial nerve supplying the tongue.
b.	Acoustic neuroma and trigeminal neuralgia are 2 causes of facial pain.
c.	Myocardial ischaemia pain may occasionally radiate up the neck to the face.
d.	Diseases of the teeth and sinusitis not only cause headache but also facial pain.
e.	Bell’s palsy affects the face bilaterally but more severely on the ipsilateral side.

Answer: E

80.	Which of the following is not usually related to nystagmus?

a.	Refractory errors.
b.	Ocular muscle paresis.
c.	Pituitary tumor.
d.	Brainstem lesion.
e.	4th or 6th nerve palsy.

Answer: A

Nystagmus is a series of involuntary, rhythmic oscillations of one or both eyes. It may be horizontal, vertical or rotatory.
Jerky nystagmus: lesion s of labyrinth, vestibular apparatus, brainstem or cerebellum, intoxication with alcohol, barbiturates, or phenytoin toxicity.
Vestibular nystagmus: labyrinthitis, Meniere’s syndrome, acoustic neuroma, otitis media, stroke, multiple sclerosis, tumors, alcoholism.

81.	Which of the following is not associated with vertigo?

a.	Labyrinthitis.
b.	Salicylates or quinine.
c.	Cerebellar lesions.
d.	Meniere’s disease.
e.	Alcohol intoxication.

Answer: B

Salicylate poisoning is associated with tinnitus. The other clinical presentations are lethargy, coma, seizures, vomiting, decreased blood pressure and heart block, pulmonary edema, hyperthermia. Quinine overdose leads to convulsions and arrhythmias.

82.	Romberg’s sign:

a.	May be positive in disorders involving the pyramidal tracts.
b.	Is positive when the patient sways to and fro on standing.
c.	Is positive when the patient moves with a high stepping gait.
d.	Is present when there is a lesion involving the posterior columns of the spinal cord, as in vitamin B12 deficiency.
e.	Is negative in labyrinthine disorders.

Answer: D

The Romberg’s test is positive when unsteadiness increases with eye closure. This is usually seen with the loss of proprioceptive sensation which are mediated by the posterior (dorsal) columns of the spinal cord.

A:	These are the corticospinal tracts affecting motion.

B:	Eyes must be closed.

C:	A high stepping gait is indicative of a footdrop which is commonly caused by common peroneal nerve palsy, peripheral neuropathy, 

83.	Which of the following arteries is not included in the basal arteries of the brain?

a.	Vertebral artery.
b.	Basilar artery. 
c.	Anterior cerebral artery.
d.	Posterior communicating artery.
e.	Internal carotid artery.

Answer: E

84.	Which of the following is not true?

a.	Pituitary or peri-sellar tumors are causes of bitemporal hemianopia.
b.	Complete lesion of the right optic nerve results in loss of right eye vision.
c.	Lesions of the right occipital cortex results in bilateral hemianopia of the opposite side.
d.	Optic atrophy may result from chronic papilloedema and glaucoma.
e.	Optic neuritis is a cause of severe impairment of vision and it may result from a variety of causes such as diabetes mellitus and methyl alcohol toxicity.

Answer: C

Causes of bilateral hemianopia are pituitary tumor, craniopharyngioma and suprasellar meningioma. Causes of optic atrophy: chronic papilloedema or optic neuritis, optic nerve pressure, glaucoma, ischaemia, retinitis pigmentosa and Friedreich’s ataxia. Causes of optic neuritis are multiple sclerosis, ethambutol, chloroquine, nicotine, vitamin B12 deficiency, diabetes mellitus and infectious mononucleosis.

85.	Which of the following is never associated with cataracts?

a.	Diabetes insipidus.
b.	Prolonged corticosteroid therapy.
c.	Congenital rubella.
d.	Irradiation.
e.	Down’s syndrome.

Answer: A

86.	Which of the following is not true?

a.	The Argyll Robertson pupils respond to accommodation reflex but not to light reflex.
b.	It is present in patients with syphilis, esp. tabes dorsalis.
c.	Tabes dorsalis is also a cause of sensory ataxia when patient walk with a high stepping gait.
d.	Other complications of secondary syphilis are dementia and aneurysm of the aorta.
e.	In neurosyphilis, the CSF has highly characteristic abnormalities such as high globulins.

Answer: D

A:	The features of Argyll Robertson pupil are: small and irregular pupils, absent light reflex, intact accommodation reflex and depigmentation of the iris. The causes are tabes dorsalis, diabetes mellitus and multiple sclerosis.

B & C:		Tabes dorsalis is a complex syndrome in which demyelination occurs in the dorsal roots. The features are: lightning pains, ataxia, stamping gait, loss of reflexes, widespread sensory loss and some muscle wasting, neuropathic joints, ptosis, optic atrophy and Argyll Robertson pupils.

D:	Neurological complications are present only in tertiary syphilis.

87.	Which of the following is true?

a.	Raised intracranial presusre and arterial hypertension both may be complicated by glaucoma.
b.	Hypoxia and hypercapnia can both be complicated by an exophthalmos.
c.	Subacute combined degeneration of the cord is usually caused by vitamin B12 or pernicious anaemia.
d.	Chronic lead poisoning produces encephalopathy, foot drop and a blood picture similar to pernicious anaemia.
e.	An isolated 4th nerve palsy is usually an early sign of raised intracranial pressure.

Answer: C

D:	Clinical features of lead poisoning: anorexia, nausea & vomiting, a blue line on the gums, constipation and severe abdominal colic, anaemia, with erythrocytes showing basophil stippling, peripheral nerve lesions giving wrist drop and foot drop, with muscle involvement, lead encephalopathy, with eventual seizures and impairment of consciousness.

E:	It is a false localizing sign.

88.	Which of the following is rarely complicated by papilloedema?

a.	Cerebellar tumor.
b.	Hydrocephalus.
c.	Subarachnoid haemorrhage.
d.	Thrombosis of the central retinal vein.
e.	Optic atrophy.

Answer: E

89.	Which of the following is not associated with ptosis?

a.	Oculomotor nerve lesion.
b.	Facial palsy.
c.	Cervical sympathetic lesion.
d.	Myasthenia gravis.
e.	Fredreich’s ataxia.

Answer: B

90.	Which of the following is not associated with retinal haemorhage?

a.	Diabetes mellitus.
b.	Hypertension.
c.	Raised intracranial pressure.
d.	Subarachnoid haemorrhage.
e.	Retinal artery thrombosis.

Answer: E

91.	In a cross-section of the spinal cord,

a.	The fibres subserving pain and temperature and situated postero-laterally.
b.	The pyramidal tracts are situated anteriorly.
c.	The fibres subserving position and vibration sense are situated anteriorly and medially.
d.	Syringomyelia is a condition where the posterior and lateral fibers are all affected.
e.	In poliomyelitis and viral meningitis, the anterior horn cells are the earliest to be affected.

Answer: D

92.	Which of the following is not true?

a.	The ankle reflex is subserved by S1 and S2.
b.	The knee reflex is subserved by L1 and L2.
c.	The triceps reflex is subserved by C6 and C7.
d.	The abdominal superficial reflex is subserved by T6-L1.
e.	The biceps reflex is subserved by C5 and C6.

Answer: B

The knee reflex is subserved by L3 and L4.

93.	Which of the following is not true?

a.	The median nerve supplies the opponens pollicis muscle.
b.	The carpel tunnel syndrome of the hand involves the median nerve.
c.	Lesion of the ulnar nerve produces the ‘claw’ hand.
d.	Diabetes mellitus is the only condition which can affect multiple peripheral nerves.
e.	Lesion of the radial nerve may cause ‘wrist drop’.

Answer: D

A:	It supplies the LOAF muscles: Lateral two lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis.

D:	Mononeuritis multiplex refers to the separate involvement of more than one peripheral nerve by a single disease. The other causes besides diabetes are: rheumatoid arthritis, SLE, acromegaly, leprosy and polyarteritis nodosa.

94.	Which of the following is rarely associated with peripheral neuritis?

a.	Vitamin B1 deficiency.
b.	Carcinoma.
c.	Guillain-Barre syndrome.
d.	Diphtheria.
e.	Acute renal failure.

Answer: E

95.	Which of the following are rarely associated with wasting of the small muscles of the hand?

a.	Cervical spondylosis.
b.	Syringomyelia.
c.	Cervical rib.
d.	Charot-Marie-Tooth disease.
e.	Chronic rheumatoid arthritis.

Answer: D

96.	Which of the following is rarely associated with tremors of the hands?

a.	Alcoholism.
b.	Raynaud’s disease.
c.	Phenothiazines.
d.	Anxiety.
e.	Toxic nodular goitre.

Answer: B

97.	Which of the following is not true?

a.	Parkinsonism consists of tremor, rigidity and hypokinesia.
b.	It may be a sequela of encephalitis.
c.	The treatment of choice is methyldopa.
d.	The characteristic gait consists of quick, shuffling steps with tendency to fall forwards.
e.	Parkinsonian features may also occur in Wilson’s disease.

Answer: C

The treatment of choice is L-dopa. 

98.	In adult onset epilepsy:

a.	An EEG is only necessary if a focal lesion is suspected.
b.	An abnormal CT brain scan is found in less than 30% of cases.
c.	Driving should be allowed if patient is under treatment.
d.	Migraine is usually associated with the highest incidence of status epilepticus.
e.	Excision surgery is usually the mode of treatment in the majority.

Answer: B
99.	Which of the following is not associated with epilepsy?

a.	Cysticercosis.
b.	Alcoholism.
c.	Wenckebach phenomenon.
d.	Hypertensive encephalopathy.
e.	Tuberous sclerosis.

Answer: C

100.	Which of the following is not a characteristic feature of a carotid TIA?

a.	Amaurosis fugax.
b.	Dysphasia.
c.	Dysarthria.
d.	Contralateral weakness.
e.	Transient global amnesia.

Answer: E

Transient global amnesia are episodes of amnesia with confusion lasting for several hours caused by ischaemia in the posterior cerebral circulation.