MORE MCQs

1. MORE MCQs

2. A 72 year old man underwent CABG 5 years ago and now presents with intermittent cramp like pain in the buttock, thigh and calf. The symptoms are worse on walking and relieved by rest. O/E both legs are normal in color, but the pedal pulses are difficult to palpate. Sensation is mildly reduced in the left foot. Which of the following is the single most appropriate action? • Advise him to reduce walking distance to prevent pain • Doppler ultrasound • Measure ankle: brachial systolic pressure index • MRI of lumbar spine • Referral for angiography

3. A 42 year old man attends for a general health check up. He is a non-smoker, drinks 21 units of alcohol per week, is physically well, active and enjoys regular moderate exercise and a healthy diet. His BMI is 27.2 kg/m2. His BP measured on 3 occasions was 162/100 mmHg, 165/100 mmHg and 168/102 mmHg. Which one of the following would be the most appropriate initial management? • Advise about lifestyle modification and review in 6 months • Refer for investigation of a secondary cause of hypertension • Start a calcium-channel blocker • Start a thiazide diuretic • Start an ACE inhibitor

4. A 67 year old woman who underwent hysterectomy 2 wks ago present with a one week history of pain in the left calf. There is no history of injury. O/E temperature is 37.7°C and the left calf is tender with erythema but no swelling. Which one of the following would be the most initial management? • Request D-dimer • Request pelvic ultrasound • Request Doppler ultrasound of leg • Start oral flucloxacillin • Treat with NSAIDs

5. A 47 year old man has recently suffered from MI. He has no oter significant conditions and prior to this event was not taking any meds.His BP is 135/80 and his fasting cholesterol is 186 mg/dl.Which of the follwoign combinations would be most appropriate to reduce the risk of further events? • Atenolol and aspirin • Atenolol, candesartan, aspirin and atorvastatin • Atenolol, ramipril, clopidogrel and aspirin • Nifedipine, atenolol, aspirin and simvastatin • Ramipril, atenolol, aspirin and simvastatin

6. A 21 year old female student with no significant medical history consults you 24 hours after collapsing in a shop. The event was witnessed by a friend who reports that she suddenly became pale and clammy, lost consciousness and fell to the floor. There was a short episode of twitching of all four limbs. She regained consciousness after less than 1 minute, rapidly became oriented and has felt well since the event. Examination was within normal limits. What is the most likely diagnosis? • Epilepsy • Hyperglycemia • Neurocardiogenic syncope • Paroxysmal arrhythmia • Pseudoseizure

7. A 74 year old woman who has long-standing osteoarthritis presents to the ER. She is hypotensive with a rapid pulse and gave a short history of severe upper abdominal pain. What is the most likely diagnosis? • Acute pancreatitis • Appendicitis • Cholecystitis • Intussusception • Visceral perforation

8. A 36 year old restaurateur was diagnosed with typhoid fever. Despite long-term antibiotic therapy he was found to have persistent positive typhoid stool cultures. Which one of the following is the most appropriate management option for him? • Change antibiotic therapy • Elective cholecystectomy • Reassure and discharge • Resect infected bowel • Stop all treatment and reassess in 6 mths

9. A 39 year old man with a history of alcoholism complains of malaise, anorexia and weight loss. Clinically he has a firm , enlarged liver, a palpable spleen and moderate ascites. Which of the following is the most likely diagnosis? • Acute cholecytitis • Acute cholangitis • Cirrhosis • Hepatocellular carcinoma • Liver abscess

10. A 42 year old woman is admitted with severe right sided abdominal pain that is radiating to the back, with nausea nad retching some hours after a meal. She is tender in the right upper quadrant and she has increased leucocytosis in blood film. Which of the following is the most likely diagnosis? • Acute cholecytitis • Acute cholangitis • Cirrhosis • Hepatocellular carcinoma • Liver abscess

11. A 46 year old woman with known gallstones is admitted acutely ill with progressive jaundice, upper abdominal pain and rigors. She has been confined to bed for the last 4 days. Which of the following is the most likely diagnosis? • Acute cholecytitis • Acute cholangitis • Cirrhosis • Hepatocellular carcinoma • Liver abscess

12. A patient presents to you with abnormal LFTs. His ALT IS 210 u/L and AST 260 u/L. He is otherwise asymptomatic. Which one of the following tests would you advise him? • Hep A IgM • Hep A IgG • Hep Bs Ag • Hep Bs Ab • Hep E IgM

13. A 3 month old infant presents with non-bilious vomiting after feeds and poor weight gain. The mother has noticed the appearance of a palpable lump in the upper abdomen following a feed. What is the most likely diagnosis? • Erosive gastritis • Gastrocolic fistula • Hourglass stomach • Hypertrophic pyloric stenosis • Teapot stomach

14. A 38 year old stock broker with a history of hunger pains is admitted following an episode of hematemesis. What is the most likely diagnosis? • Gastric carcinoma • Gastrocolic fistula • Gastroesophageal reflux • Hypertrophic pyloric stenosis • Peptic ulcer disease

15. A 78 year old man with a 9 month history of poor appetite and weight loss has developed feculent vomiting. Barium meal investigation shows barium in the transverse colon. What is the most likely diagnosis? • Gastric carcinoma • Gastrocolic fistula • Gastroesophageal reflux • Hypertrophic pyloric stenosis • Peptic ulcer disease

16. Which one of the following predisposes to adenocarcinoma? • Achalasia • Barrett’s esophagus • Boerhaave syndrome • Cirrhosis of liver • Sliding hiatus hernia

17. Which one of the following causes progressive dysphagia to solids? • Achalasia • Barrett’s esophagus • Boerhaave syndrome • Cirrhosis of liver • Sliding hiatus hernia

18. Which one of the following causes severe retrosternal pain leading to hypotension and shock? • Achalasia • Barrett’s esophagus • Boerhaave syndrome • Cirrhosis of liver • Sliding hiatus hernia

19. Which one of the following causes waterbrash? • Achalasia • Barrett’s esophagus • Boerhaave syndrome • Cirrhosis of liver • Sliding hiatus hernia

20. Which one of the following is associated with esophageal varices? • Achalasia • Barrett’s esophagus • Boerhaave syndrome • Cirrhosis of liver • Sliding hiatus hernia

21. A 28 year old woman is admitted with a 14 our history of sudden onset of severe lower abdominal pain with nausea and retching. Her LMP was 10 weeks ago. Pulse is 120/min and BP is 90/70. What is the most likely diagnosis? • Appendicitis • Cholecystitis • Incarcerated hernia • Intussusception • Ruptured ectopic pregnancy

22. A 4 year old boy is seen with an 8 hour history of colicky central abdominal pain and vomiting. He presents with an irreducible lump in the left groin, extending into the scrotum. What is the most likely diagnosis? • Appendicitis • Cholecystitis • Incarcerated hernia • Intussusception • Malrotation

23. An 18 mth old toddler who has been on a weaning diet becomes fretful, clutches his abdomen and cries out. He refuses feeds and passes loose motions containing blood stained mucus. What is the most likely diagnosis? • Appendicitis • Cholecystitis • Incarcerated hernia • Intussusception • Malrotation

24. A 39 year old woman who works in a diary farm presents with a 9 mth history of poor appetite, malaise and weight loss. Abdominal radiography reveals mesenteric nodal calcifications. What is the most likely diagnosis? • Abdominal TB • Actinomycosis • Enteric Staph. aurues infection • Hydatid disease • Trypanasomiasis

25. Acute otitis media in a non-allergic child is treated with which one of the following antibiotics? • Amoxicillin • Ciprofloxacin • Erythromycin • Metronidazole • Penicillin V

26. Asymmetrical painful tonsil enlargement in a 40 year old man is best treated with which one of the following options? • Antifungals • Antibiotics • Referral for biopsy • Steroids • Watch and wait

27. A child presents with a 3 cm swelling to the left of the midline in the lower part of the anterior triangle of the neck. It moves with swallowing and tongue protrusion. What is the most likely diagnosis? • Branchial cyst • Lymph node • Thyroglossal cyst • Thyroid cyst • Sebaceous cyst

28. A 54 year old man wit a BMI of 22 kg/m2 complains pf snoring and waking up at night. He is tired during the day and his wife says that he seems to stop breathing for a minute every night. What is the most appropriate treatment? • Advice on lifestyle changes and weight loss • Advise on the use of ear plugs • Refer for sleep study • Refer for surgery • Refer to a dentist for a mandibular advancement splint device

29. A 6 year old girl has a 1 year history of 30 dB conductive hearing loss, flat tympanograms and poor school performance. What is the single most appropriate next stage treatment? • Adenoidectomy • Bilateral grommet insertion • Conservative treatment • Nasal decongestants • Tonsillectomy

30. A 45 year old patient presents with dizzy spells lasting for 1-2 hours. He says that the room seems to move and there is accompanying nausea and tinnitus. Hallpike maneuver is negative. His audiogram shows low frequency hearing loss. What is the most likely diagnosis? • BPPV • Cervical vertigo • Labrynthitis • Meniere’s disease • Vestibulitis