General MCQ Flashcards
To stop an ACE inhibitor due to a dry cough, instead add: A. Alpha blocker B. Calcium channel blocker C. Thiazide type diuretic D. Ace inhibitor E. Angiotensin II receptor blocker
E.
Taken everyday for asthma treatment, regardless of whether or not patient has symptoms:
A. SABA
B. Oral corticosteroids
C. LABA
C. LABA
E.g. Salmeterol
Used in managing stable adult asthma for adults not controlled with SABA+ICS.
Taken everyday regardless of whether patients has symptoms.
Side effects include tremor.
Work by relaxing airway smooth muscle.
SABAs are used first line if patient is experiencing asthma exacerbation.
Next step if patient has poorly controlled hypertension, and is already taking a calcium channel blocker? To add a: A. Thiazide type diuretic B. Beta blocker C. Ace inhibitor D. Loop diuretic E. Calcium channel blocker F. Angiotensin II receptor blocker
C. Ace inhibitor
Oral medication used to treat acute asthma attacks: A. LABA B. Leukotriene receptor antagonists C. Oral corticosteroids D. SABA E. Inhaled corticosteroids
C. Oral corticosteroids
E.g. Prednisolone used in acute asthma attacks.
May affect growth in children, side effects include oral thrush, taken as oral medication.
SABAs, e.g. Salbutamol (blue inhaler), used in asthma exacerbations, relax airway smooth muscle, and may cause tremor.
A 70 y/o woman is found to have a pan-systolic murmur after presenting with dyspnoea. A soft S1 and split S2 is also noted is a stereotypical history of: A. Mitral regurgitation B. Dressler's syndrome C. Cardiac tamponade D. Constrictive pericarditis E. Aortic regurgitation F. Left ventricular free wall rupture
A. Mitral regurgitation
Pansystolic (holosystolic) murmurs start at S1 and extend to S2.
They are usually due to regurgitation in cases such as mitral regurgitation, tricuspid regurgitation or ventricular septal defect.
Which one of these cause of lung fibrosis typically affects the lower zones? A. Coal worker's pneumoconiosis B. Extrinsic allergic alveolitis C. Sarcoidosis D. Asbestosis E. Ankylosing spondylitis F. Tuberculosis
D. Asbestosis
Which of the following is most likely to cause a third heart sound? A. Hyperdynamic states B. Left to right shunts C. Systemic hypertension D. Pulmonary hypertension E. Constrictive pericarditis F. Mitral stenosis
E. Constrictive pericarditis
Mitral stenosis causes a loud S1
Which one of the following is most likely to cause folic acid deficiency? A. Crohn's disease B. Carcinoid syndrome C. Isoniazid therapy D. Hartnup's disease E. Pernicious anaemia F. Alcohol excess
F. Alcohol excess
Neutrophil chemotaxis is one of the main functions of: A. IL-1 B. IL-4 C. IL-2 D. Tumour necrosis factor-alpha E. IL-10 F. Interferon-gamma
D. Tumour necrosis factor alpha
Which of the following is/ are most characteristic of aortic stenosis? A. Loud S1 B. Wide pulse pressure C. Collapsing pulse D. S4 E. Low volume pulse F. Split S2
D. S4
Aortic stenosis: Narrow pulse pressure. Slow rising pulse. Delayed ESM. Soft/absent S2. S4. Thrill Duration of murmur Left ventricular hypertrophy/ failure
Caused by:
Degenerative calcification (common in >65 y/o)
Bicuspid aortic valve (<65 y/o)
Which of the following is a stereotypical history for left ventricular aneurysm?
A. Persistent ST elevation 4 weeks after sustaining a MI. Examination reveals bibasal crackles and the presence of a third and fourth heart sound.
B. 50 y/o male with marfan syndrome presents with palpitations and dyspnoea. On examination he has a collapsing pulse, the blood pressure is 160/60mmHg and a high pitched diastolic murmur is heard.
C. 40 y/o female present with dyspnoea and fatigue. On examination a mid-diastolic murmur is heard. An echocardiogram shows a pedunculated mass in the left atrium.
D. Pleuritic central chest pain and dyspnoea following a viral illness. His pain is worse when lying down.
E. Patient develops acute heart failure 5 days after an MI. A new pan-systolic murmur is noted on examination.
F. Patient develops bradycardia of 36/min following an MI. ECG shows no association between the P waves and QRS complexes.
A
Which adverse effect is characteristically associated with beta-blockers?
A. Hirsutism
B. Heart block
C. Neuroleptic malignant syndrome
D. Decreased absorption of fat-soluble vitamins
E. Impotence
F. Increased risk of myocardial infarction
E. Impotence
Which adverse effect is characteristically associated with verapamil? A. Palpitations B. Bradycardia C. Blurred vision D. Hypertension E. Fluid retention F. Ototoxicity
B. Bradycardia
Verapamil is a calcium channel blocker.
Mitral regurgitation is associated with:
A. Mid-late diastolic murmur, “rumbling” in character
B. Early diastolic murmur, high pitched and “blowing” in character
C. Holosystolic murmur, “harsh” in character
D. Continuous “machinery” murmur
E. Late systolic murmur
F. Holosystolic murmur, high-pitched and “blowing” in character
F. Holosystolic, high pitched and blowing in character
Which adverse effect is associated with amiodarone? A. Angioedema B. Lactic acidosis C. Haemolytic anaemia D. Gynaecomastia E. Photosensitivity F. Hypotension
E. Photosensitivity
Anti-arrhythmic agent used in atrial, nodal and ventricular tachycardia.
Blocks potassium channels, inhibiting repolarisation, thus prolonging the action potential. Can also block sodium channels.
Has a long half-life(20-100 days). Should be delivered into central veins (causes thrombophlebitis).
Has pro-arrhythmic effects due to lengthening QT interval.
Interacts with drugs commonly used concurrently, e.g. decreases metabolism of warfarin.
Numerous long-term adverse effects;
Thyroid dysfunction
Corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Peripheral neuropathy, myopathy
Photosensitivity
Slate-grey appearance
Thrombophlebitis and injection site reactions
Bradycardia
Which is a stereotypical history for acute pericarditis?
A. New early-to-mid systolic murmur 10 days after being admitted for an MI
B. 25 y/o male investigated for recurrent syncope and dyspnoea. On examination he has an ejection systolic murmur.
C. Man presents with central, pleuritic chest pain and fever following a myocardial infarction. The ESR is elevated.
D. 60 y/o male with history of tuberculosis presents with dyspnoea and fatigue. JVP is elevated, loud S3 and Kussmaul’s sign is positive. Hepatomegaly is also noted.
E. Pleuritic central chest pain and dyspnoea following a viral illness. His pain is worse when lying down.
F. Patient develops acute heart failure 10 days after an MI. He had raised JVP, pulsus paradoxus and diminished heart sounds.
E.
Which cell type is the main source of IL-2? A. B cells B. Dendritic cells C. Macrophages D. Th1 cells E. Th2 cells
D. Th1 cells
Th1 cells produce IL-2 and interferon-gamma.
IL-2: stimulates growth and differentiation of T cell response.
Interferon-gamma: activates macrophages.
Which is most characteristic of mitral stenosis? A. Wide pulse pressure B. Soft S2 C. Soft S1 D. Slow rising pulse E. Malar flush F. Collapsing pulse
E. Malar flush
Which recognises antigens presented by MHC class II molecules? A. Helper t cells B. Macrophages C. Plasma cells D. Cytotoxic T cells E. Mast cells F. B cells
A. Helper T cells
Involved in cell-mediated immune response.
Recognise antigens presented by MHC class II molecules.
Expresses CD4, CD3, TCR & CD28.
Major source of IL-2.
Mediates acute and chronic organ rejection.
Which is most likely to stimulate release of aldosterone?
A. Decreased renal perfusion.
B. Renin
C. Elevated ACTH levels
C. Elevated ACTH levels
Which is a major source of IL-1? A. Neutrophils B. Plasma cells C. Mast cells D. Helper T cells E. Macrophages F. Natural killer cells
E. Macrophages
Atrial septal defect is associated with:
A. Holosystolic murmur
B. Ejection systolic murmur
C. Holosystolic murmur, high-pitched and blowing in character
D. Mid-late diastolic murmur, rumbling in character.
E. Continuous machinery murmur
F. Late systolic murmur
B. Ejection systolic murmur
E.g.
- Aortic stenosis
- Pulmonary stenosis
- Hypertrophic obstructive cardiomyopathy
- Tetralogy of Fallot
- Atrial septal defect
50 year old male with marfan syndrome presents with palpations and dyspnoea. On examination he has a collapsing pulse, blood pressure is 160/60mmHg and a high pitched diastolic murmur is heard. This is typical of:
A. Hypertrophic obstructive cardiomyopathy
B. Aortic regurgitation
C. Arrhythmogenic right ventricular cardiomyopathy
D. Mitral regurgitation
E. Tetralogy of fallot
F. Left ventricular free wall rupture
B. Aortic regurgitation
Early diastolic murmur
Collapsing pulse
Wide pulse pressure
Mid diastolic austin flint murmur in severe AR- due to only partial closure of the anterior mitral valve cusps by regurgitation streams .
Causes due to valve disease: rheumatic fever, infective endocarditis, connective tissue disease e.g. RA/SLE, bicuspid aortic valve.
Causes due to aortic root disease: aortic dissection, spondylarthropathies (e.g. Ankylosing spondylitis), hypertension, syphilis, Marfan’s, Ehler-Danlos syndrome.
Sensitivity is:
A. The chance that the patient has the condition if the diagnostic test is positive.
B. Proportion of patients with the condition who have a positive test result.
C. A hypothesis that two treatments are equally effective.
D. A measure of strength of the linear relationship between two variables.
E. The chance that the patient does not have the condition if the diagnostic test is negative.
F. The possibility of getting the results if the null hypothesis is true.
B
