MEDICINE PRACTICE 6

           INSTRUCTION: SELECT THE SINGLE BEST OPTION

  

1.        Immediate management of pericarditis resulting from myocardial infarction, will usuallY best require:
   a.       Opiate based analgesia
   b.      Non-steroidal anti-inflammatory drugs
   c.       Steroidal anti-inflammatory drugs
   d.      Aspirin therapy
   e.      Diflunisal
   2.       The following statements about Dressler’s syndrome are correct except:
   a.       It is a post myocardial infarction syndrome
   b.      It is a post pericardiotomy pericarditiss
   c.       Autoimmunity is a suggested cause  of the syndrome
   d.      It is typically treated with colchicine
   e.      Indomethacin is a first line drug for treating it.
   3.       Typical features of Dressler’s syndrome include the following except:
   a.       Persistent fever
   b.      Pericarditis
   c.       Prostration
   d.      Pleurisy
   e.      Pericardial effusion
   4.       The complication of using tissue plasminogen activator to treat myocardial infarction, is:
   a.       Intracerebral bleeding
   b.      Myocardial stunning
   c.       Rupture of papillary muscle
   d.      Atrioventricular block
   e.      Addisonian crisis
   5.       Which of the following is incorrect about dobutamine:
   a.       It is a β₁-adrenegic stimulant
   b.      It can be used for stress echocardiography
   c.       Asthma and ischaemic heart disease are not contraindications to its use.
   d.      The most dangerous side effect is increased risk of arrhythmias
   e.      If administered for more than 72 hours, tachyphylaxis may occur
   6.       The following are positively ionotropic in the heart except:
   a.       Digoxin
   b.      Nitroglycerin
   c.       Dobutamine
   d.      Milrinone
   e.      Levosimendan
   7.       The malar rash of systemic lupus erythematosus is usually characterized by the following except:
   a.       It is erythematous
   b.      It spares the nasolabial fold
   c.       It is photosensitive
   d.      It may be flat or raised
   e.      None of the above.
   8.       Drug induced systemic lupus erythematous is not a known adverse effect of:
   a.       Isoniazid
   b.      Hydralazine
   c.       Colchicine
   d.      Sulfasalazine
   e.      Methyldopa
   9.       The following diseases may present adrenal insufficiency except:
   a.       Histoplasmosis
   b.      Cryptococcosis
   c.       X-linked adrenoleukodystrophy
   d.      Familial glucocorticoid deficiency
   e.      Toxoplasmosis
   10.   Which of the following is incorrect about X-linked adrenoleukodystrophy:
   a.       There is accumulation of very long chain fatty acids in tissues throughout the body.
   b.      It is a disorder of peroxismal fatty acid beta oxidation
   c.   It is a common cause of pericarditis
   d.      Lorenzo’s oil is a recognized dietary therapy.
   e.      The white matter of the brain and Leydig cells of the testes may be affected
   
   
   
   
   
   
   
   
   ANSWERS:
   1. a
   2. e
   3. c
   4. a
   5. c
   6. b
   7. e
   8. c
   9. e
   10. c

MEDICINE PRACTICE 5

     INSTRUCTION: SELECT THE SINGLE BEST OPTION:
 

1.         The adrenal insufficiency precipitated by inappropriate withdrawal of suppressive glucocorticoid therapy, is known as:
   a.       Addison’s disease
   b.      Secondary adrenal insufficiency
   c.       Primary adrenal insufficiency
   d.      Simmond’s disease
   e.      Sipple’s syndrome
   2.       The following investigations are usually done for a patient with adrenal insufficiency except:
   a.       Short synacthen test
   b.      Random plasma cortisol
   c.       Long ACTH stimulation test
   d.      Measurement of dehydroepiandrosterone level in men
   e.      Chest X-ray
   3.       In the management of Addisonian crisis, the following are among the initial steps except:
   a.       Giving intravenous saline to correct volume depletion
   b.      Giving intravenous hydrocortisone succinate
   c.       Administration of 10% dextrose water
   d.      Administration of fludrocortisone usually in acute phase of treatment.
   e.      Treatment of acute precipitants
   4.       The dose of synacthen used for tetracosactrin test , is usually:
   a.       125 microgram
   b.      250 microgram
   c.       500 microgram
   d.      375 microgram
   e.      875 microgram
   5.       The following are usual findings in autoimmune polyendocrinopathy type 2 (Schmidt’s syndrome) except:
   a.       Addison’s disease
   b.      Type 2 diabetes mellitus
   c.       Primary hypothyroidism
   d.      Primary hypogonadism
   e.      Graves’ disease
   6.       Which of the following is incorrect about the management of adrenal insufficiency?
   a.        Dehydroepiandrosterone is usually given to male patients
   b.      Adequacy of fludrocortisone therapy is objectively assessed by measurement of plasma rennin activity
   c.       Hydrocortisone is usually the drug of choice
   d.      Aggressive correction of hyperkalaemia may lead to pontine demyelination
   e.      In patients already receiving glucocorticoids, short synacthen test is usually performed first thing in the morning.
   7.       Acquired ventricular septal defect is usually a complication of:
   a.       Mitral regurgitation
   b.      Myocardial infarction
   c.       Tetralogy of Fallot
   d.      Eissenmenger syndrome
   e.      Dressler’s syndrome
   8.       Considering the most correct, the following features are primarily ascribed to pulmonary oedema except:
   a.       Breathlessness
   b.      Cyanosis
   c.       Oliguria
   d.      Inspiratory crackles
   e.      Hypoxaemia
   9.       Swan Ganz catheter is used to measure...................... to guide fluid replacement:
   a.       Pulmonary congestion
   b.      Pulmonary artery wedge pressure
   c.       Central venous pressure
   d.      Tidal volume of respiration
   e.      Urine ouput
   10.   The phenomenon whereby the viable myocardium surrounding a fresh infarct, contracts poorly for a few days and recovers, in a patient with recent myocardial infarction, is known as:
   a.       Dressler’s syndrome
   b.      Myocardial stunning
   c.       Conversion disorder
   d.      Raynauld’s phenomenon
   e.      Sokolow-Lyon index
   
   
   
   
   
   
   ANSWERS:
   1. b
   2. d
   3. d
   4. b
   5. b
   6. a
   7. b
   8. c
   9. b
   10. b
   
   

MEDICINE PRACTICE 4

              INSTRUCTION: SELECT THE SINGLE BEST OPTION:

1.          The following will usually necessitate a reduction in the quantity of intravenous fluid to rehydrate a patient with diabetic ketoacidosis except:
   a.       When the patient is elderly
   b.      When the patient is an adolescent
   c.       Co-morbid heart failure
   d.      All of the above
   e.      None of the above
   2.       Which of the following is incorrect about diabetic ketoacidosis and its management?
   a.       May present with acute abdomen
   b.      May present with protracted vomiting
   c.       The mortality rate of diabetic ketoacidosis is higher than that of hyperosmolar hyperglycaemic state
   d.      Nasogastric tube may be necessary in unconscious patients
   e.      There may be need to give mannitol.
   3.       The following are usual findings in a patient with Addisonian crisis except:
   a.       Hypotension
   b.      Hypokalaemia
   c.       Hypoglycaemia
   d.      Hypercalcaemia
   e.      Hyponatraemia
   4.       Addison’s disease is also known as:
   a.       Primary adrenal insufficiency
   b.      Secondary adrenal insufficiency
   c.       Tertiary adrenal insufficiency
   d.      Odine’s curse
   e.      None of the above
   5.       The following findings are usually common to both diabetic ketoacidosis and Addisonian crisis except:
   a.       Hypotension
   b.      Fever
   c.       Weakness
   d.      Abdominal pain
   e.      Tachycardia
   6.       Which of the following is not a feature of secondary hypoadrenalism?
   a.       Hyperpigmentation of the skin
   b.      Postural hypotension
   c.       Anorexia
   d.      Weightloss
   e.      Malaise
   7.       Common precipitants of Addisonian crisis does not include:
   a.       Intercurrent disease/infection
   b.      Surgery
   c.       Trauma
   d.      Sorghum meal
   e.      None of the above
   8.       A patient with vitiligo was found to have adrenal insufficiency. The most likely cause of this presentation of adrenal insufficiency is:
   a.       Autoimmune
   b.      HIV/AIDS
   c.       Amyloidosis
   d.      Metyrapone therapy
   e.      Withdrawal of suppressive glucocorticoid therapy
   9.       The following may cause adrenal insufficiency except:
   a.       Use of drugs like ketoconazole and etomidate
   b.      Haemochromatosis
   c.       Sheehan’s syndrome
   d.      Simmond’s disease
   e.      None of the above
   10.   Which of the following is incorrect about Waterhouse-Friedrichsen syndrome:
   a.       It usually causes Cushing’s disease
   b.      It may cause primary adrenal insufficiency
   c.       It is adrenal gland failure from bleeding into the adrenal glands
   d.      Neisseria meningitidis is a common cause
               e.   It is preventable by vaccination 

                                                      

                                        ANSWERS 
                                           1. b
                                           2. c
                                           3. b
                                           4. a
                                           5. b
                                           6. a
                                           7. d
                                           8. a
                                           9. e
                                          10. a