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Dicm 333 :Medicine Ii Question Paper

Dicm 333 :Medicine Ii

Course:Clinical Medicine

Institution: Kenya Methodist University question papers

Exam Year:2014

KENYA METHODIST UNIVERSITY

''END OF1ST ''TRIMESTER 2014 (FQE) EXAMINATION
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : CLINICAL MEDICINE
UNIT CODE : DICM 333
UNIT TITLE : MEDICINE PAPER II
TIME : 3 HOURS

INSTRUCTIONS

1. Read the instructions carefully

2. Write your University number (Not name)

3. Number all the Questions correctly

4. Answer all the questions on the MCQ paper

5. Correct response earns 1 mark, for every incorrect response you lose 1 mark and you do not lose or gain a mark if you do not attempt

6. Do not use a pencil

7. Answer part A and B separately.

PART A

Question 1

Acute pericarditis can be:

Complication of PTB
Due to rheumatic fever
Caused by carcinoma of the breast
Lead to pericardial effusion
With pericardial rub which is pathogmonomic

Question 2

An obese woman is admitted with two days of history of a lower limits swelling, which is warm and tender.

She may be having cellulitis
Filiriasis is the most likely diagnosis
Hypoproteinaemia is the cause
Elevation of the limb is an important treatment
Recent surgical removal of abdominal malignancy is the contributing factor.

Question 3

The following are true of a case of ascites:

Hepatic malignancy may be the cause
There is asymmetrical abdominal distension
Tympanic note is found on percussion of the flanks
Paracentesis abdominis confirms the cause
Increased bowel sounds are noted.

Question 4

Risk factors in hypertension

Family history
Aortic stenosis
Consumption of fatty foods
Chronic respiratory disease
Proteinuria

Question 5

These are true of acute rheumatic fever:

Blood culture identifies the causative organism
Organisms respond well to Penicillin therapy
Emboli may cause stroke
Hepatomegally is the finding
Erythromycin is the alternative drug in case of patient being allergic to penicillin.

Question 6

Regarding frusemide:

It is a potassium sparing diuretic
Decreases renal calcium re-absorption
Reduces the passive re-absorption of water from the distal tube and collecting ducts
Decreases free water clearance in nephron
Increases sodium excretion by sodium pump in the loop of Henle

Question 7

Concerning valvular disease

The valve most commonly is tricuspid
The aortic valve is mostly due to syphilis
Two thirds of patients with rheumatic fever have valvular lesions
Pulmonary valve is the least affected
Mitral incompetence is due to myocardial infarction

Question 8

The following are true of bronchial asthma

It may result from mucosal swelling
Difficulty in breathing is more in inspiration
It runs in families
Spongy pillows may aggravate it
It is prone to people with allergy.

Question 9

In pleural effusion:

The onset is usually acute
Story dullness is the finding
Mediastinal structures deviate towards the affected side
Vocal resonance is increased
Breath sounds are absent

Question 10

Concerning pneumothorax:

It is the presence of air in the lungs
Iatrogenic cause is the commonest
Females are most commonly affected
An underlying lung disease is true in the case of the elderly patients
Pleuritic chest pain is of sudden onset.

Question 11

Clubbing of the fingers is found in the following conditions:

Pericarditis
Bronchitis
Bronchial carcinoma
Malabsorption syndrome
Emphysema

Question 12

Respond to the following concerning a patient who presents with purulent sputum:

He has bronchial asthma
Symptom of COPD
Seen in the early stages pulmonary tuberculosis
The responsible organisms may be spirochetes
Culture and sensitivity of the sputum confirms the organisms.

Question 13

Concerning Potts disease:

It is a complication of PTB
Infection starts from, the discitis
It causes kyphosis
Most frequently it involves the hip joint
Has an acute onset.

Question 14

The following findings are matched correctly:

Vesicular breathing – pneumonia
Bronchial breathing – lung consolidation
Ronchi – normal lung
Crepitations – bronchial asthma
Pleural rub – pleurisy.

Question 15

The following drugs used in bronchial asthma are administered correctly.

Theophylline – interventions route
Adrenaline – subcutaneously
Aminophylline – orally
Hydrocortisone – intramuscularly
Sulbutamol – intravenously

Question 16

The causes of chronic diarrhea include:

Strongyloidosis
Shigellosis
Tropical sprue
Salmonellosis
HIV enteropathy.

Question 17

The cause of a tender hepatomegally is likely to be:

Hepatoma
Congestive cardiac failure
Amoebic hepatitis
Alcoholic hepatitis
Hydatid cyst

Question 18

The following are the clinical features of acute pancreatitis

Pain is more on the right upper quadrant
Pain radiates to the back
Signs of shock may be seen
Serum amylase level is decreased from the normal
There is vomiting.

Question 19

The following are true of hepatoma.

It is a highly malignant tumour of the liver
Difficulty in swallowing fluids is the first symptom
Achalasia of the cardia is a complication
Weight loss is a striking feature
Radiotherapy cures the condition

Question 20

The following statements on true of Caesophagus

Most commonly seen in men
Difficulty in swallowing fluids is the first symptom
Achalasia of the cardia is a complication
Weight loss is a striking feature
Radiotherapy cures the condition.

Question 21

The following statements are true of community acquired pneumonia

The infection is spread through contact
Alcohol drinking may predispose to the disease
One lobe is usually affected in lobar pneumonia
Bronchial breathing is a finding
There is pleuritic pain

Question 22

The following vitamins are matched correctly with conditions where they are deficient.

Vitamin A – Night blindness
Vitamin B12 – Rickets
Vitamin C – Beriberi
Niacin – Pellagra
Vitamin K – Haemaolytic anaemia

Question 23

The following are true of haemolytic jaundice

Pale conjunctiva
Pale stools
Dark urine
Normal liver function test
Raised indirect bilitubin.

Question 24

Concerning typhoid fever

It is an infectious disease
Constipation may be present
Rose-red spots may be noted on the skin
Haemoptysis may be a complication
Widal test is a confirmatory test

Question 25

The following are true of ankylostomiasis

The parasite is transmitted through oral route
Haemoptysis may be a symptom
Megaloblastic anaemia may develop
Stool for occult blood test is positive
Single dose of albendazole 400mg is that best choice.

Question 26

Concerning impetigo

It is caused by a virus
It is highly contagious
It is best treated with cloxacillin
It is the same as erysipelas
Cellulitis is the complication.

Question 27

Peripheral neuropathy may be a complication of the following:

Leprosy
HIV infection
Alcoholism
Diabetes mellitus
Hypoglycemia

Question 28

Concerning osteoarthritis

It is an infective arthritis
It is degenerative arthritis
It is an acute inflammatory arthritis
Osteophytes are typical radiological finding
Mainly affects weight bearing joints.

Question 29

The side effects of quinine include:

General body weakness and dizziness
Coma
Tinnitus
Hypertension
Tachycardia

Question 30

A 20 year old student presents to you with thick yellowish urethral discharge and dysuria.

Gram stain will probably show gram negative intra-cellular diplococcu
Metronidazole is indicated
It is most likely hymphogranuloma venereum
Diagnostic counseling and testing is advisable
Clamyadia may be the cause.

PART B

Question 1

The following are true about headaches:

Cluster headaches are more common in men than women
Neurological signs on examination rules out migraine as a diagnosis
Headaches can be cause by raised intracranial pressure
Manitol is a drug used to reduce cerebral aedema
Tensions headaches include migraines.

Question 2

Concerning HIV infection and AIDS

Preumocystis pneumonia can present with cyanosis and is a feature in stage III of HIV infection
Tuberculosis in AIDS presents like that in non-Aids patient
Oral candidiasis is a late feature a AIDS
Toxoplasmosis is usually a cerebella disease
Karposis sarcoma is found in stage III of HIV infections.

Question 3

In hypoglycemia:

Coma is an early presentation in patients with diabetes
Sweating and shaking are always late symptoms of insulin - dependent hypoglycemia
Insulin-dependent patients may lose their warning symptoms of hypoglycemia after many years of diabetes
The symptom characteristically come over hours rather than minutes
Can be managed with metformin and glihencamidc

Question 4

Concerning cushings syndrome.

Diagnosis is made by a high-dose dexametuasone test
Can only be cured by bilateral adrenalectory
Excessive use of steroids can be a predisposing factor
Serum ACTH is important in diagnosing the underlying cause.

Question 5

Acute renal failure is likely a complication of the following:

Sepsis
Polycystic kidney disease
Carcinogenic shock
Severe dehydration
Renal carcinomas

Question 6

In patients with acute renal failure

Most patients with acute renal failure need long term dialysis
Treating the underlying cause usually reverses the damage cause
Urinary catheterization is sometimes needed to monitor the response to therapy
Skin turgor is a reliable guide to the need for I.V fluids therapy
Abdominal ultra-sound can be used for diagnosis.

Question 7

With respect to lumber puncture.

Coagulopathy is a contraindication
The procedure may cause meningitis
High pressure CSF is indicative of viral meningitis
Can cause nerve damage and consequent muscle weakness above the level of the lumber puncture
Should be done routinely in patient suspected to be suffering from meningitis.

Question 8

Outcome of bacterial meningitis relates to:

Age of the patient
Time to first administration of antibiotics
The causative organism
Immunity of the patient
CSF concentration of antibiotics.

Question 9

The following may cause microcytic anaemic.

Sickle all disease
The thalassamia
Anaemia of chronic diseases
Hemolytic diseases
Malaria.

Question 10

Diseases typically acquired from animals include:

Leptospirosis
Mycobacterium tuberculosis
Hepatitis
Toxoplasmosis
Mycobacterium bovis

Question 11

Live viruses are usually used for active immunization against.

Poliomyelitis
Pertusis
Typhoid measles rubella
Mumps measles, rubella
Hepatitis B

Question 12

Recognized features of brucellosis include:

Fever, night sweats and chronic back pain
Splenomegally
Spondylitis and oligoarthritis
Thrombocytopenia
Rapid response to doxycycline and streptomycin

Question 13

Clinical features of anthrax includes:

Occupational exposure to animal and animal products
An incubation period of 2-3 weeks
A painless cutanous papules
Itchy cutaneous papules
Gastroenteritis

Question 14

Clinical features of amoebic dysentery include:

An incubation period of 2-4 weeks
May present with blood and mucus in the rectum
Good responses to metronidazole in intestinal disease
Antibodies detectable by immunofloresence only in a small minority of patients
Presents with rice-watery diahorrea

Question 15

In HIV injection.

80% of vertically transmitted infections are transplacental
A child born to an infected mother has a 90% chance of acquiring HIV
Transmission can occur via breast milk
HIV infection is associated with PNA retrovirus
Risk of fetal transmission is unaffected by pre-partum antiviral agents

Question 16

Indicate if True or False.

In patient with AIDS, cryptococcal meningities is the commonest cause of meningitis
The normal urine output ranges from 800-2500mls per 24 hours
Protenuria is suggestive of diseases affecting the glomeruli
A patient with diabetes mellitus should be started on insulin if the rbs is ?5mmollit
Methotrixate can be used in the treatment of sickle-cell disease.

Question 17

Oral activated charcoal is indicated following poisoning with.

Paractamol
Acetylsalicylic acid
Lithium bicarbonate
Ferrous sulphate
Organophosphate poisoning

Question 18

Causes of folic acid deficiency include:

Vegetarian diet
Pregnancy
Hemolytic anaemia
Antibiotic therapy
Gastric disorders e.g. PUD & ulcerative colitis

Question 19

Typical features of viral encephalitis include:

Acute onset of headache and fever
Convulsions and coma may rapidly ensue
Decreased CSF glucose concentration
Meningitis
Raised CSF glucose

Question 20

The following drugs are used in the management of status epilepticus

Tegresttol
Phenobartitone
Glibeucamide
Sodium valporate
Clouazepa

Question 21

Pharmacologic agents used in the treatment of OM include:

Insulin
Biguanides
Sulponylurease
Clonazepam
Sodium bicarbonate

Question 22

Regarding sick-cell disease

Acidosis can be a predisposing factor
Hepatospheuomegally is a clinical presentation in a sicklier
Sick-cell crisis include sequestration and haenolysis only
I.V fluids can be administered as part of the treatment
Oxygen therapy is essential in hemolytic crisis

Question 23

Concerning thyroid storm.

Hypoglycemia is a feature Antibiotics have a role in management
Atrial fibrillation is a feature
It may follow partial thyroidectomy
It’s a life threatening medical emergency

Question 24

When urinalysis’s is conducted in patient with send disease

Epithelial cells are normal in urine and are insignificant in small qualities
Casts are formed by disintegration of rbc
Very yellow urine is doe to bilirubin in the urine
Proteins (numerous) can be a sign of extensive kidney damage
Turbid and cloudy urine is usually due to red blood cell deposits.

Question 25

Predisposing factors to sickling disease include the following:

Metabolic disturbance
Acidosis
Hypoxia
Dehydration
Surgery

Question 26

Concerning epilepsy, indicate true or false

Absent seizures are classified as generalized seizures
Electroencephalogram is an important investigation
During an epileptic attack one should attempt to avoid biting of the tongue by inserting a metallic object in the mouth
Phenobarbitone is the choice of drug to start with
In status epilepticis, patients regain consciousness between attacks

Question 27

In patients with urinary retention

Finability to pass urine can be cause by renal stone
Urethral catheterization is recommended in patients with urethral structures
Benign prostatic hyperplasia (BPH) can be a cause
They may present with pyuria and haematuria
Polyuria is a feature.

Question 28

In meningitis

C & F glucose levels in bacterial meningitis are raised
Neck stiffness, photophobia and severe headache can be a presenting feature
Amphofercin – B is used in the treatment of fungal meningitis
Positive barbinski and kerning sign is a sign of meningeal irritation
Intravenous chloran phenical can be used to manage meningities as a monotherapy.

Question 29

Indicate true or false in the following:

Hemophilia is a condition inherited due to lack of factor 6
Urinalysis can be done as a diagnostic test to confirm presence of BPH
Flipside can be classified as an oral hypoglycemic
Glasgow coma scale is used in the assessment of conscious patients who have suffered head injury
Repeated blood transfusion can cause iron overload in the body.

Question 30

Nephritic syndrome presents in the following ways indicate true or false

Facial pudginess
Generalized body malace
Hyperbilirubinaemia
Massive proteinuria
Odema of the lower limbs.

Dicm 333 :Medicine Ii Question Paper

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