MEDICINE: PRACTICE 10

                             SINGLE BEST OPTION SERIES
           INSTRUCTION: SELECT THE SINGLE BEST OPTION

1.        Which of the following is incorrect about rheumatic fever?
   a.       Aschoff nodules occur only in the heart
   b.      Multinucleated giant cells surrounded by macrophages and T-lymphocytes are seen in the acute phase
   c.       it usually presents 2 to 3 weeks after episode of streptococcal pharyngitis
   d.      It is triggered by an immune-mediated response
   e.      It is the most common cause of acquired heart disease in childhood.
   
   
   2.       Presentation of carditis in rheumatic fever include the following except:
   a.       Pericardial friction rub
   b.      Carey Coombs murmur
   c.       Cardiac failure
   d.      Breathlessness.
   e.      None of the above.
   3.       Concerning Carey Coombs murmur, which of the following is the most correct?
   a.       Results from mitral regurgitation
   b.      Results from aortic regurgitation
   c.       They are soft mid-diastolic murmur
   d.      Result from pericardial friction rub
   e.      They are soft systolic murmur.
   4.       Which of the following is incorrect about the polyarthritis seen in rheumatic fever?
   a.       It is an acute painful asymmetric lesion and migratory
   b.      It is the most common major manifestation of the disease.
   c.       The pain characteristically respond to aspirin
   d.      Presents as early morning joint stiffness
   e.      Large joints are affected.
   5.       The following findings in rheumatic fever occur more commonly in women than men except:
   a.       Subcutaneous nodules
   b.      Valvular heart disease
   c.       St. Vitus dance
   d.      All of the above
   e.      None of the above.
   6.       The descending order of cardiac valve affectation in rheumatic heart is:
   a.       Pulmonary → tricuspid → aortic → mitral
   b.      Tricuspid → pulmonary → aortic → mitral
   c.       Aortic → mitral → tricuspid → pulmonary
   d.      Mitral → aortic →tricuspid → pulmonary
   e.      Aortic → pulmonary → mitral → tricuspid
   7.       The features of Syndenham’s chorea include the following except:
   a.       It is usually the first symptom to appear in rheumatic fever
   b.      Emotional liability is usually the first feature
   c.       Purposeless involuntary choreiform movements of the hands, face and feet occurs
   d.      Spontaneous recovery may occur
   e.      Speech may be explosive and halting.
   8.       Which of the following is incorrect about the management of rheumatic fever?
   a.       Single dose of benzylpenicillin 1.2 million I.U is necessary.
   b.      Long term steroids are usually necessary
   c.       Teachers even more than 21 years of age need prophylaxis after acute episodes
   d.      Aspirin should be given until the erythrocyte sedimentation rate has fallen and then gradually tailed off.
   e.      Sulphonamides prevent infection but are not effective in eradicating group A streptococci
   9.       The following investigations are matched with usual findings in rheumatic fever except:
   a.       Full blood count.............................................leucocytosis
   b.      ASO titre........................................................ Greater than 200   I.U in adults.
   c.       Chest X-ray....................................................cardiomegaly
   d.      ECG................................................................first degree heart block
   e.      Echocardiography..........................................reduction in QRS complexes
   10.   Which of the following is incorrect about rheumatic fever/rheumatic heart disease?
   a.       Erythema marginatum starts as red macules that fade in the centre but remain red at the edges
   b.      Attacks of rheumatic fever are unusual after the age of 21 years.
   c.       Subcutaneous nodules are best felt over flexor surfaces
   d.      There is positive throat swab culture in only about 10 to 20%  of cases
   e.      Pleurisy, pleural effusion and pneumonia are rare manifestions.
   
   
   
   
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