MCQs for 6th year Students
Dr.Dhaher JS Al-habbo FRCP London UK Assistant Professor in Medicine DEPARTMENT OF MEDICINEHow to answer the MCQs
Always calculate the time available for each question before the exam and stick to that time strictly. Do not allow yourself to become delayed by any single question. Instead, answer the question using your first impression and mark the question with a star so you can return to it. After finishing your first run through the all questions, you should then start a second run returning to those questions which you have starred giving them further consideration.How to answer the MCQs
You should aim to answer at least 90% (ideally 100%) of MCQs in every paper. There are extremely few MCQs for which an educated guess will not increase your chance of a correct answer to greater than 50%.How to answer the MCQs
Only use the information given to you and don’t assume anything else. The root, stem and the options contain everything you need to answer each question. Perhaps an important fact is missing and you will need to identify what that is.Pay close attention to the facts. If you change your understanding of a topic based on the question, include that adjustment in your analysis and selection of an answer.Try to approach the questions simply and avoid introducing further complications. The exam is there to test your knowledge, not to trick you, so avoid unique interpretations of the facts.How to answer the MCQs
A process of elimination You should start by eliminating answers that you are sure are incorrect, and narrow the options down until you have the most likely answer. Always remember: Read the alternatives very closely. Look quickly at the modifier, then analyse the reasoning and then the result. The response will not be correct if the reasoning is not correct. Of the limited options possible, only one of them will identify and resolve the central issue.How to answer the MCQs
‘Best’ answer questionsRemember :Not every question will have several “wrong” answers. Often you will be asked to choose the “best” answer because there may be more than one answer to solve the problem. When approaching a question like this, remember:If you can prove an answer more easily, it is likely to be the correct one.More precise answers are usually better, because they will address the factual situation better than less precise answers.Making educated guesses
When faced with an MCQ that you are unsure about, A number of points can help you make an educated guess. An understanding and familiarity with the key words and phrases that commonly feature in MCQs is vital to maximising your score . Questions which include absolute and sweeping statements such as never, always, or exclusively are generally false (because exceptions can be found to virtually any rule). Questions which include the keywords :could, possible, or may are more often true than not (after all, anything is possible).A 34-year-old man presents to the emergency department (ED) with intermittent melena of 3 days’ duration. He is mildly fatigued but hemodynamically stable and denies any hematemesis or coffee ground emesis. His HB level is 8.2 g/dL. Intravenous fluids are started. Physical examination is essentially unremarkable. What is the next best step in this patient’s evaluation? A-Check serum Helicobacter pylori antibody levels B-Perform a colonoscopy C-Perform an esophagogastroduodenoscopy (EGD) D-Start Proton Pump inhibitor E-Transfuse 2 U of packed red blood cells
The correct answer is (C)
Perform an EGD. The patient has melena, which suggests GI bleeding from Upper GIT. EGD allows for definitive endoscopic evaluation of the esophagus, stomach, and proximal duodenum. Any ulcers identified that warrant endoscopic therapy (eg, cauterization, clipping) could be treated at that time.17-year-old student is brought in by ambulance complaining of shortness of breath. He is known to be asthmatic and takes salbutamol and beclomethasone regularly. This is his first hospital admission with an acute asthma attack. Which ONE of the following features suggests a diagnosis other than severe asthma?
A -Pulse of 115/minute B -Inability to complete sentences C -Respiratory rate of 27/minute D -Inability to perform peak flow measurement E -Blood pressure of 90/60 mmHg
The Answer is (E)
Blood pressure of 90/60 mmHg Hypotension is a feature of life-threatening, not severe asthma. A useful aid to memory to remember the features of life-threatening asthma is BREATH: Bradycardia. Rising PaCO2. Exhaustion. Absent breath sounds (silent chest). Third of expected peak flow . Hypotension.A20-year old man has lost 10kg over the past 3months.He has been excessively thirsty .A venous blood sample for glucose was 16mmol/Which is the single most appropriate next step in management?
A-24h capillary glucose diary. B-Fasting venous blood glucose C-Oral glucose tolerance test(OGT). D-Repeat random venous blood glucose. E-Start treatment for diabetes.
The Answer is (E)
A twenty year old girl is taking anti tuberculosis treatment. She presents in eye clinic with out -door visual complaints. The most likely cause of her symptoms is side effect of:A-Isoniazid. B- Rifampicin. C- Ethambutol. D- Pyrazinamide. E- Streptomycin
The Answer is (C) Adverse Reaction of First Line Anti Tuberculosis Drugs
25 year old patient presents with mild fever and haemoptysis from Sinjar. Which of the following tests would be diagnostic of active tuberculosis disease?
A- Heaf test B-Mantoux test A C-T-cell assay e.g. Quantiferon, ELIspot D- Sputum or biopsy cultures E- All of the above
The Answer is (D) skin sensitivity tests (Heaf, Mantoux) and the newer T-cell based assays are only useful to determine latent tuberculosis infection and tell you nothing about disease activity.
Concerning tuberculin skin testing all are true except
A. patients with tuberculous pericarditis are usually tuberculin positive B. previous BCG vaccination May results in a positive reaction C. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases D. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive. E. the test is usually negative in miliary tuberculosisThe Answer is (D) Sputum negative, tuberculin negative pulmonary tuberculosis is being increasingly diagnosed. The patient may be HIV positive. The diagnosis is based on clinical features, exposure history and chest radiograph appearance and may need to be re-considered in the response to treatment is poor.
In meningococcal disease all the following are true except:
A. Vaccine Concerning is available for meningococci groups A and C B. Outbreaks of disease occur seasonally in parts of sub-Saharan Africa. C. Sporadic outbreaks in the UK. are usually due to type B meningococcus. D. Close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose. E. Is the most common cause of bacterial meningitis in the world wide?The Answer is (D) Contacts are usually given rifampicin 600mg b.d. for two days.
A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 60 per minute and skin is pale, coarse and dry. The most important investigation to find diagnosis in this case is:A-Adrenocorticotrophin hormone (ACTH). B-Cortisol level. C-Gonadotrophin levels. D-Insulin like growth factor (IGF). E-T4 and TSH level.
The Answer is (E)
Empyema thoracic all the following are true except
A-Empyema is always secondary to infection in a neighboring structure, usually the lung; B-Over 40% of patients with community-acquired pneumonia develops an associated pleural effusion. C- Fifteen percent of patient with community-acquired pneumonia develop secondary bacterial infection and empyema. D-Empyema rarely follows infection of haemothorax,& rapture of subphrenic abscess. E-Delay in the diagnosis and the appropriate treatmentThe Answer is (D)
An 70 year woman has a history of dry cough for 2 months. She has lost 5 kg of weight over the 2 months. Her chest X ray shows a left apical shadowing. Blood tests reveal a raised white cell count of 16. She has not managed to cough up any sputum. Which of following tests should be performed?The Answer is (E)
Transudative pleural effusion characterized by all the following ExceptA-Pleural fluid accumulates as a result of increased hydrostatic pressure B-Decreased osmotic pressure. C-The permeability of the capillaries to proteins is normal D-Pleural fluid accumulates as a result of increased microvascular permeability . E- Serous fluid accumulation in the pleural space either unilateral or bilateral.
The Answer is (D)
A 66-year-old woman presented with sudden retrosternal chest pain with nausea and diaphoresis. She has hypotension, jugular venous distention, and a murmur of tricuspid regurgitation. An ECG shows ST-segment elevation in the right precordial leads. Which of the following is the most likely diagnosis?The Answer is (E)
A 65-year-old man presents with central crushing chest pain for the first time. He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted. What are the most likely changes to have occurred on ECG during admission?
A. ST depression in leads V1–4B. ST elevation in leads V1–6C. ST depression in leads II, III and AVFD. ST elevation in leads V5–6E. ST elevation in leads II, III and AVF
The Answer is (D)
This patient with an ST elevation MI (STEMI) which is an indication for urgent primary percutaneous coronary intervention (PCI). Compare this to a non-ST elevation MI (NSTEMI) which indicates ischaemia rather than infarction and PCI should be carried out within 48 hours (answers A and C). The angiogram shows that the left circumflex artery is occluded, resulting in a lateral infarct. This area is represented by leads V5–6 (D). V1–4 represents the territory of the left anterior descending artery. If the entire left mainstem had been occluded, changes would have shown throughout leads V1–6 (B).Leads II, III and aVF (C and E) point to an inferior infarct and involvementof the right anterior descending arteryThe Answer is (D)
A 75-year-old woman presents to accident and emergency complaining of pain in her knees. She mentions that this has been troubling her for several months. Pain is generally worse in the evenings and after walking. On examination, there are palpable bony swellings on the distal interphalangeal joints of the fingers on both hands. In addition, there is reduced range of movement and crepitus in the knees. What is the most likely diagnosis?A. Rheumatoid arthritis B. Osteoarthritis C. Reactive arthritis D. Polymyalgia rheumatica E. Gout
The Answer is (B)
Osteoarthritis (B) is the most common type of arthritis. It is increasingly common with age and most people over the age of 60 will have some evidence of the disease on x-rays. Osteoarthritis the pain characterisitically worse in the evenings. Localized osteoarthritis includes nodal osteoarthritis, which usually involves the distal interphalangeal joints. Painful and painless bony swellings develop – Heberden’s nodes on the DIPs and Bouchard’s nodes on the PIPs.A70-year old man has had series of heavy epistaxis started yesterday, three days ago he started antibiotic for urinary tract infection. He has aterial fibrillation for which he takes warfarin. His INR(6.4).Which single antibiotics has he been taking?
A-Amoxicillin B-Cephalxin. C-Nitrofurantion D-Co-amoxiclave. E-Trimethoprim
The Answer is (E)
A 33-year-old woman presents to accident and emergency with severe right flank pain. The pain started 3 hours ago and is not constant, occasionally moving towards her right iliac fossa. The patient also feels nauseous and has a low-grade fever. The most appropriate investigation is:
A. Abdominal x-ray B. Magnetic resonance imaging (MRI) scan C. Intravenous urography D. Computed tomography (CT) scan E. Abdominal ultrasound (US) scan