BOF: 41

BOF: 41

A thirty four year old female presents with a deep vein thrombosis. She has a history of weight loss, recurrent mouth ulcers and chronic diarrhoea with the passage of a bulky stool, which is difficult to flush away. She has a macrocytic anaemia.

The underlying biochemical abnormality that would explain the DVT would be:

a) Vitamin B 12 deficiency

b) Folic acid deficiency

c) Iron deficiency

d) Protein S deficiency

e) Protein C deficiency

Answer:

b)

The patient has coeliac disease. In coeliac disease folic acid deficiency with resultant hyper-homocystinaemia increaBOF: 42

A twenty seven year old female presents with a rash. The rash consists of erythematous plaques, excoriations, and vesicles some of which have ruptured leaving a crust.

She also complains of diarrhoea with the passage of a bulky stool, which is difficult to flush away.

In this patient:

a) The rash responds rapidly to a gluten free diet

b) The rash responds slowly to treatment with Dapsone

c) The rash responds rapidly to treatment with Dapsone

d) Doxycycline is the drug of choice

e) Oral Steroids should be commenced immediately increases the tendency to thromboembolic phenomena

Answer:

c)

The patient has dermatitis herpetiformis, which is associated with coeliac disease. The rash responds within a few hours to treatment with dapsone.

.

BOF: 43

A twenty four year old female who is known to have ulcerative colitis presents with an ulcer above the medial malleolus. This is large has a necrotic base and the edges are undermined.

In this patient:

a) Immediate treatment should be with broad spectrum antibiotics

b) High dose steroids should be used in the first instance

c) Surgery is the first line treatment of the ulcer

d) Treatment of the colitis with high dose mesalazine preparation will cause the ulcer to heal

e) Colectomy is indicated

Answer:

b)

The patient has pyoderma gangrenosum complicating ulcerative colitis. The initial treatment should be with high dose steroids.

BOF: 44

A 50-year-old male presents with oral ulceration, and flaccid blisters on the skin especially the trunk. The blisters are sore but not itchy and they rapidly denude leaving weeping, erythematous erosions. Gentle sliding pressure on the blisters makes them extend. In this condition:

a) Low dose steroids are effective in controlling formation of new blisters

b) Local steroids are effective in controlling the disease

c) Long term tetracycline is effective treatment

d) Gold may be effective therapy in steroid resistant patients

e) Dapsone is effective on controlling the disease

Answer:

d)

The patient has pemphigus vulgaris. The physical sign described is Nikolsky's sign( extension of the blister with pressure). In pemphigus vulgaris high dose steroids may be needed to prevent formation of new blisters. Azathioprine and methotrexate may be needed to reduce the dose of steroids. Gold may be effective in steroid resistant patients.

BOF: 45

In patients with cystic fibrosis a FEV1 of less than 30 % would predict

a) 80% of patients would be infected with Pseudomonas aeroginosa

b) 60% would develop a digestive tract malignancy

c) 80 % would develop a variceal haemorrhage

d) 50 % would be dead within two years

e) 60 % would respond to treatment with high dose ibuprofen

Answer:

d)

In patients with cystic fibrosis a FEV1 of less than 30 % would predict 50 % mortality within two years.

BOF: 46

In lung cancer which of the following features would suggest response to cytotoxic chemotherapy

a) Horners syndrome

b) Wasting of small muscles of hand

c) Ectopic ACTH syndrome

d) Bone metastases

e) Pleural effusion

Answer:

c)

In small cell lung cancer the ectopic ACTH syndrome may occur. Small cell lung cancer responds to cytotoxic chemotherapy.BOF: 47

Which one of the following auscultatory signs is confirmatory for bronchial breathing?

a) Aegophony

b) Whispering pectoriloquy

c) Increased vocal resonance

d) Coarse crepitations

e) Fine crepitations

Answer:

b)

Whispering pectoriloquy is the confirmatory sign for bronchial breathing

BOF: 48

A 24-year-old male presents with sudden onset left sided pleuritic chest pain and difficulty in breathing. On examination he is distressed, tachypnoeic and has tracheal displacement to the right together with a hyper-resonant percussion note on the left side with absent breath sounds on the left. In this patient:

a) The lung will spontaneously expand within one week

b) Immediate insertion of an intercostal drainage tube is required c) Aspiration of the pneumothorax should be undertaken in the first instance d) Surgical pleurodesis will be required e) Chemical pleurodesis will be required Answer: c) Treatment of a complete pneumothorax would be initial aspiration. This is less painful, leads to a shorter duration of admission, reduces the need for pleurectomy, there is no increase in recurrence rate at one year. BOF: 49

In a man the commonest presentation of prolactinoma is with:

a) Galactorrhoea

b)Gynaecomastia

c) Impotence

d) Adiposity

e) Apathy

Answer:

c)

In men with prolactinoma the commonest of the features mentioned above is impotence. Approximately 8% of men presenting with sexual dysfunction have hyperprolactinaemia.

BOF: 50

An elderly female is admitted with loss of consciousness. She is hypothermic, has a bradycardia, evidence of cardiac failure, hypoventilation, hypoglycaemia and hyponatraemia. In this condition one of the treatment strategies would be:

a) Thyroxine 1000 micrograms by slow intravenous infusion every 8 hours

b) Prednisolone 60 mgs orally

c) Oral thyroxine 125 micrograms daily

d) Oral thyroxine 25 micrograms daily

e) Hydrocortisone 100 mgs iv 8 hourly

Answer:

e)

The patient has myxoedema coma. Hydrocortisone 100 mgs iv 8 hourly should be used to protect against the possibility of associated adrenocortical deficiency

BOF: 51

The commonest clinical manifestation of primary hyperparathyroidism is:

a) Renal stone disease

b) Bone disease

c) Peptic ulceration

d) Constipation

e) Polyuria

Answer:

a)

Renal stone disease occurs in 50 % of patients.

BOF: 52

A 50-year-old female has been referred for investigation of abnormal liver function tests. She consumes 52 units of alcohol per week. On examination she is obese with mainly truncal obesity, with a moon face and a buffalo hump shaped deposit of fat across her shoulders. Her face is plethoric and there are numerous telangiectasiae. The abdomen is protuberant and there are striae. In this patient:

a) The biochemical abnormalities do not return to normal with abstinence

b) There is little relationship between the degree of liver damage and the plasma cortisol levels

c) Urinary 17 hydroxycorticosteroid levels are suppressed

d) Plasma cortisol levels are suppressed

e) Plasma ACTH levels are elevated

Answer:

b)

The patient has alcoholic pseudocushings. There is little relationship between the degree of liver damage and the plasma cortisol levels

BOF: 53

A 50-year-old man presents with malaise, weight loss, diarrhoea and pain in the joints. He is pigmented, has clubbing and lymphadenopathy. He has ascites and ophthalmoplegia. Investigations show him to be anaemic. ECG shows a right bundle branch block and paracentesis abdominis reveals chylous ascites.

The investigation most likely to give a diagnosis would be:

a) Lumbar puncture

b) CT head

c) Ascitic fluid cytology

d) Small bowel biopsy

e) Transoesphageal echocardiography

Answer:

d)

The patient has Whipples disease, which is diagnosed by the demonstration of multiple macrophages in the lamina propria and the presence of rod shaped bacteria both within and without the abnormal macrophages.

BOF: 54

A 32-year-old female who is known to have Crohns disease presents with increased frequency of micturition. She is demonstrated to have sterile pyuria. The lesion is likely to be:

a) Left colonic

b) Colo-vesical fistula

c) Terminal ileal

d) Recto-vesical fistula

e) Vesico-vaginal fistula

Answer:

c)

Crohns disease of the terminal ileum or left colon may involve the right ureter and result in steri BOF: 55

A 30-year-old male presents with several weeks history of blood and mucous diarrhoea. He has a frequency of bowel movement of 8 times during the day and has to wake up 3 times at night to have a bowel movement. Unprepared flexible sigmoidoscopy shows an inflamed colonic mucosa. A feature that will show that this patient has disease affecting the right colon would be:

a) Serum albumin level of less than 30 g /l

b) CRP of greater than 100

c) Thumb printing on plain abdominal x-ray

d) Distended loops of small bowel

e) A tachycardia of greater than 100 per minute

Answer:

d)

The patient has ulcerative colitis.

The presence of distended small bowel loops would suggest incompetence of the ileo-caecal valve indicating right colonic involvement

le pyuria

BOF: 56

A 20-year-old male presents with bleeding oesophageal varices. On examination he has Kayser- Fleischer rings in the cornea. The inheritance of this disorder is:

a) Autosomal dominant

b) Autosomal recessive

c) X-linked recessive

d) X-linked dominant

e) Polygenic inheritance

Answer:

b)

This patient has Wilsons disease, which is inherited in an autosomal recessive fashion due to a BOF:57

A 35-year-old female presents with acute severe abdominal pain associated with tachycardia, hypotension and tachypnoea. The finding of a raised serum amylase in this patient:

a) Is diagnostic of acute pancreatitis

b) Makes ectopic pregnancy less likely

c) Makes diabetic ketoacidosis less likely

d) Could indicate a perforated duodenal ulcer

e) Makes mesenteric ischaemia less likely

Answer:

d)

A raised serum amylase may occur in all these conditions

mutation on the long arm of chromosome 13

BOF: 58

In primary sclerosing cholangitis:

a) There is clear female predominance

b) It is associated with Crohns colitis but not with ulcerative colitis

c) The liver biopsy features are diagnostic

d) Colectomy prevents the progression of the disease

e) Ursodexoycholic acid improves clinical symptoms and reduces the level of cholestatic enzyme markers

Answer:

e)

Ursodexoycholic acid improves clinical symptoms and reduces biochemical evidence of cholestasis but no effect on morbidity and mortality has been demonstrated.

BOF: 59

In psoriatic arthropathy: a) There is a strong relationship between the skin changes and the severity and extent of arthritis

b) There is a close relationship between the onset of nail dystrophy and arthritis

c) Nail dystrophy is more common in patients with the spinal form of arthritis

d) Longitudinal ridging of the nails is diagnostic of psoriatic arthropathy

e) Acute anterior uveitis is common in patients with the mutilating form of psoriatic arthropathy

Answer:

b)

There is poor correlation between the skin changes and the arthritis although there is closer relationship between nail changes and arthritis. Nail dystrophy is common in those with distal interphalangeal joint involvement. Longitudinal ridging is not a specific associated feature of psoriatic arthropathy. Anterior uveitis is associated with sacroiliitis.

BOF: 60

In polymyalgia rheumatica: a) The disease is common in those over 80 years of age

b) A dramatic onset is unusual

c) The onset is more common in the pelvic girdle

d) Morning stiffness is not a common feature

e) Anorexia and weight loss are features

Answer:

e)

Polymyalgia rheumatica is common between 60 and 70 years. It is seldom seen before 45 or after 80. The onset is often dramatic. Immobility is most severe on waking and may persist for hours. Anorexia and weight loss may be striking.