Test Prep MCQS Online Practice Questions and Exam Preparation

Test Prep MCQS Online Questions & Answers

• Question 61:

  Hypogammaglobulinemia is often present at the time of the diagnosis.

  Which one of the following clinical findings is NOT characteristic of chronic lymphatic leukaemia?

  A. Coombs test is positive in 10-20% of cases
  B. Bone marrow examination is essential to confirm the diagnosis
  C. B-lymphocytes are the leukaemia cell line in the majority of cases
  D. It converts to lymphoma
  A. Coombs test is positive in 10-20% of cases

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  Bone marrow examination is essential to confirm the diagnosis Chronic lymphatic leukaemia (CLL) is characterized by accumulation of small mature lymphocytes in the bone marrow and peripheral blood. The presenting features are persistent lymphocytosis, lymphadenopathy and hepatosplenomegaly. Hypogammaglobulinemia is often present at the time of the diagnosis. Autoimmune hemolytic anemia occurs in 25% of cases. The diagnosis is usually confirmed on peripheral blood examination; bone marrow examination is rarely needed. Evolution in to a more aggressive disease such as diffuse large cell lymphoma (Richter's syndrome) can occur.

• Question 62:

  Most common nerve injured in supracondylar fracture humerus?

  A. Radial
  B. Anterior interosseous nerve
  C. Median
  D. Ulnar
  B. Anterior interosseous nerve

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  In order studies, the radial nerve was found to be the one most commonly injured. But recent studies have median nerve, particularly the anterior interosseous branch is the most commonly damaged in supracond humerus.

• Question 63:

  A 3-month-old female infant is brought in because her parents say she will not eat anymore. Upon physical examination, a loud pansystolic murmur is appreciated. The child also appears small for her age, but her records show no maternal or delivery complications.

  Which of the following is the most likely finding on EKG?

  A. ST segment elevation
  B. Right ventricular hypertrophy
  C. QT interval elongation
  D. Right bundle branch block
  B. Right ventricular hypertrophy

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  The key to this case is understanding that a child who was otherwise healthy but presents with a holosystolic murmur and symptoms of failure to thrive most likely has a VSD. Right ventricular hypertrophy occurs from blood shunting from the high pressure left system to the low pressure right system. This could later lead to Eisenmenger syndrome (ES). ES is defined as the process in which a left-to-right shunt caused by a VSD reverses into a right-to-left shunt due to hypertrophy of the right ventricle.

• Question 64:

  A 42-year-old salesman was admitted with a diagnosis of pneumonia. He is allergic to erythromycin. X-ray shows a hazy opacity in the right lower and mid-zone. Blood investigations show hyponatremia and slight rise in the level of liver aminotransferase. After starting the medication on the fifth day he became acutely jaundiced and his liver aminotransferase level became very high. He also complained of discoloration of his urine, which did not show hematuria on dipstick testing.

  Which of the following drugs probably caused the jaundice?

  A. Ciprofloxacin
  B. Clarithromycin
  C. Amoxicillin
  D. Rifampicin
  E. Flucloxacillin
  D. Rifampicin

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  This patient has legionella pneumonia and therefore rifampicin was prescribed. However, rifampicin, as it is a hepatic enzyme inducer, can lead to acute jaundice with a rise in the liver aminotransferase level. It also causes red or orange discoloration of the urine and other body fluids. Patient should be warned about this side-effect. Rifampicin is generally not used as a monotherapy to treat legionella pneumonia. As this patient is allergic to the macrolides, ciprofloxacin is the other drug of choice. Monotherapy with rifampicin is associated with the development of resistance.

• Question 65:

  A 28 year's woman has been on treatment for Rheumatoid arthritis for 3yrs. She has gradual loss of vision Her ocular pressure is normal. Red reflex is absent in both eyes. What is the single most likely diagnosis?

  A. Hypermetropia
  B. Cataract
  C. Macular degeneration
  D. HTN retinopathy
  E. DM retinopathy
  B. Cataract

• Question 66:

  A 29-year-old lady who is a bank manager is referred by the GP to the medical OPC due to a long history of tin in the joints. An autoimmune screen result showed smooth muscle antibodies positive. What is the most appropriate investigation?

  A. Jejunal biopsy
  B. Thyroid function test
  C. Liver function test
  D. Serum glucose
  E. ECG
  C. Liver function test

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  Autoimmune hepatitis. Definitive investigation is liver biopsy Steroid [start with high dose prednisolone]. Azathioprine is commonly added with steroid to reduce its dose as more side effects than azathioprine.

• Question 67:

  A 80 year's man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal ECG. What is appropriate investigation?

  A. DEXA scan
  B. Redionuclide bones scan
  C. Serum calcium concentration
  D. MRI spine
  C. Serum calcium concentration

• Question 68:

  An 18years female has periorbital blisters. Some of them are crusted, others secreting pinkish fluid. What likely diagnosis?

  A. Rubella
  B. Shingles
  C. Measles
  D. Chicken pox
  E. Varicella
  B. Shingles

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  Shingles Ophthalmic division of trigeminal nerve. Typically, shingles is unilateral.

• Question 69:

  Patient with normal pressure hydrocephalus. CT brain picture distended ventricles.

  What is initial treatment?

  A. Lumber punctures and drains fluid
  B. Shunt
  C. Diuretics
  B. Shunt

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  Management Surgery Surgical CSF shunting remains the main treatment modality for NPH (NORMAL PRESSURE HYDROCEPHALUS)). Prior to embarking upon surgical therapy, knowing which patients may benefit from surgery is necessary. Detailed testing is performed before and after CSF drainage (e.g., baseline neuropsychological evaluation, timed walking test, large-volume lumbar puncture, external lumbar drainage, CSF infusion testing).

• Question 70:

  A 45-year-old man presents to the ED after acute onset of lower back pain that began after he tried to lift an engine block at his job. He says he feels like lightning bolts are shooting down his legs and he is unable to move. Physical exam reveals a positive straight leg raise test and positive anal wink.

  What is the most appropriate next diagnostic step?

  A. ESR
  B. MRI of the spine
  C. X-ray of the cervical spine
  D. CBC
  B. MRI of the spine

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  A patient who presents with acute onset of back pain and is under the age of 50 should have an MRI to rule out spinal cord compression due to a slipped disc or lumbar disc herniation. If asked for the most appropriate next step in management, answer anti-inflammatory agents. The most common sites of lumbar disc herniation are L4-L5 and L5-S1.