In sickle cell disease

a)      At least 50 per cent of the red cell haemoglobin is in the fetal form of haemoglobin (Hb F)

b)      Dactylitis is an early sign in infancy

c)      Splenomegaly is a characteristic finding in adults

d)      Iron therapy is valuable if the patient is anaemic

e)      Travel in an un-pressurised aircraft can precipitate a sickling crisis

 

Incautious use of oxygen in high concentrations in patients with chronic bronchitis is liable to

a)      Cause cataract formation

b)      Lead to a rise in intracranial pressure

c)      Be associated with a coarse flapping tremor

d)      Reduce alveolar ventilation

e)      Cause low molecular weight proteinuria

 

 

A plasma bicarbonate level of 32 mEq/1 is consistent with

a)      Hypokalaemia

b)      Persistent vomiting due to pyloric stenosis

c)      Diabetic ketoacidosis

d)      Chronic cor pulmonale

e)      Chronic renal failure

 

 

 

Accidental hypothermia with a core temperature below 30 C may cause

a)      Metabolic acidosis

b)      J waves in the electrocardiogram

c)      Ventricular fibrillation

d)      A rise in serum amylase

e)      Hyperglycaemia

 

 

Acutely reducing the inspired oxygen concentration to 10% at sea level can cause

a)      Decreased urinary pH

b)      Increased cardiac output

c)      Decreased binding capacity of Hb for oxygen

d)      A respiratory alkalosis

e)      Increased erythropoietin secretion

 

 

Administration of oxygen in hypovolaemic shock

a)      Increases the PaO2

b)      Decreases the physiological shunt

c)      Decreases alveolar dead space

d)      Increases pulmonary vascular resistance

e)      Increases the dissolved oxygen content of blood

 

 

 

The following decrease uterine muscle tone

a)      A.D.H

b)      Salbutamol

c)      Halothane

d)      PGF2-alpha

e)      Amyl nitrite

 

Factors speeding induction with an inhalational agent include;-

a)      An opiate premedication

b)      Decreased cardiac output

c)      Increased alveolar ventilation

d)      Substitution of an agent with higher blood gas solubility

e)      Increased inspired carbon dioxide concentration

 

Ketamine induced hallucinations and delirium

a)      Can be decreased by a benzodiazepine premedication

b)      Are less common in children

c)      Are less common after short surgical procedures

d)      Are less following IM administration

e)      Are caused only by its metabolites

 

 

 

 

 

Prilocaine

a)      Is 70% protein bound

b)      Is an amide

c)      Is used in eutectic mixtures

d)      Is metabolised by plasma cholinesterase

e)      Is more  toxic than lignocaine at the same dose

 

D-tubocurare

a)      Is monoquaternary

b)      Is a ganglion blocker

c)      Is excreted into bile

d)      Causes histamine release

e)      Blocks the cardioinhibitory nerve supply to the heart.

 

Alphs I Acid Glycoprotein

a)      Is increased in burns, trauma, malignancy and post MI.

b)      Is decreased in neonates, pregnancy and with the oral contraceptive.

c)      Is synthesised in the liver.

d)      Binds Atenolol.

e)      Significantly modifies the free fraction of propranolol

 

 

 

 

 

Causes of the anticoagulant effect of a massive blood transfusion includes:-

a)      Deficient factor V and VIII

b)      Inactive platelets

c)      Microaggregates

d)      Cold

e)      Vitamin K antagonism

 

The following are recognised causes of a raised fasting serum triglyceride concentration:

a)      High ethanol intake

b)      Treatment with propranolol

c)      Treatment with nifedipine

d)      Chronic renal failure without proteinuria

e)      Treatment with cholestyramine

 

The radial artery

a)      Is the main artery forming the deep palmar arch.

b)      Is medial to the radial nerve at the wrist

c)      Supplies al the digits

d)      Is  superficial to extensor pollicis longus tendon.

e)      Enters the palm between the heads of the first dorsal interosseous muscle.

 

 

 

 

 

The following are the main buffers of hydrogen ions in the blood:

a)      Haemoglobin

b)      Ammonium ions

c)      Phosphate

d)      Bicarbonate

e)      Plasma proteins

 

Hyponatraemia may be seen with the following:

a)      Addison’s disease

b)      Renal disease

c)      Congestive cardiac failure

d)      Use of diuretics such as frusemide

e)      Carcinoma of the lung

 

The left recurrent laryngeal nerve;

a)      Hooks round the arch of the aorta

b)      Hooks round the subclavian artery

c)      Is related intimately to the superior thyroid artery

d)      Runs between the oesophagus and trachea

e)      Section causes abduction of the cords

 

 

 

 

 

The following conditions are likely to causes serious complications during pregnancy:

a)      Mitral stenosis

b)      Secundum atrial septal defect

c)      Ventricular septal defect with normal pulmonary artery pressure

d)      Primary pulmonary hypertension

 

The heart rate is increased by;-

a)      Raised intracranial pressure

b)      Inspiration

c)      Moving ot the upright position from lying down

d)      Adrenaline

e)      Stimulation of the pain fibres of the trigeminal nerve.

 

Reduced urine output during major surgery is due to

a)      Catecholamine release

b)      Rennin-aldosterone system

c)      Supine posture

d)      Hypotension

e)      ADH

 

 

 

 

 

 

Halothane

a)      Forms bromide

b)      Has 4 fluoride atoms

c)      Has MAC of 1.5 vol % at one atmosphere

d)      Is a coronary vasodilator

e)    Is a suitable agent for single breath induction

 

Isoflurane

a)      Is inflammable at high (oxygen)

b)      Slows AV conduction at clinical concentration

c)      Is a  methyl-ethyl ether

d)      Is more potent than enflurane

e)      Is a coronary vasodilator

 

Alfentanil

a)      Produces analgesia without sedation

b)      Induces convulsions

c)      Is more protein bound than morphine

d)      Has a lower Vd than fentanyl

e)      Is more potent than fentanyl

 

 

 

 

 

A total body potassium deficit due to gastro-intestinal loss may be consistent with:-

a)      A normal serum K_

b)      Normal adrenals and kidneys

c)      And acid urine

d)      Increased bicarbonate

 

Ptosis may be caused by damage to:-

a)      The occulomotor nerve

b)      The trigeminal nerve

c)      The cervical sympathetic ganglion

d)      The abducens nerve

e)      The parasympathetic system

 

Paroxysmal ventricular tachycardia can be arrested by:-

a)      Disopyramide

b)      Lignocaine

c)      Digoxin

d)      Phenoperidine

e)    Magnesium

 

 

 

 

 

 

Regarding innervations of uterus and birth canal

a)      Analgesia/anaesthesia of the birth canal can be effected by a pudendal block

b)      The sensory innervation of the uterus is carried via sympathetic efferents to L2

c)      Increase in gamma efferent activity will increase uterus tone.

d)    Nitrites influence uterine tone by there effect on parasympathetic system

e)    Lignocaine with adrenaline is safe in pudendal nerve block

 

Tendon jerks of the lower limb

a)      Are increased with ventral horn lesions

b)      Are increased with a lesion in the contralateral motor-cortex

c)      Are increased with a lesion in the ipsilateral spinothalamic tract

d)      Are increased with lesions of upper motor neurones

e)   Are uninfluenced by lesions in the extra-pyramidal system

 

In patient with severe hypovolaemia

a)  The physiological dead space is increased

b)  Arterio-venous oxygen difference is decreased

c)  Renal blood flow is diminished

d)  Ventilation is usually depressed

e)  Carbon dioxide retention occurs

 

 

 

 

 

The serum potassium concentration:-

a)      In a normal subject is increased suxmethonium

b)      Is increased by thiopentone

c)      Influences the toxicity of digoxin

d)      Is lowered in extensive burns

e) Is increased by hyperventilation

 

In a patient with oedema due to cardiac failure there is:-

a)      Increased sympathetic nervous activity.

b)      Increased plasma rennin activity

c)      Reduced sodium reabsorption  by the renal tubules.

d)      Increase serum sodium

e)      An interstitial fluid volume of about 10L

 

The following increase the speed of induction with an inhalational agent:-

a)   Opiate pre-medication

b)      Increased alveolar ventilation

c)      Increased cardiac output

d)      Replacing it with an agent that has a blood / gas solubility twice that of the one in use

e)      The second gas effect

 

 

 

 

 

Lignocaine

a)      Decreases nitrous oxide requirements

b)      Is metabolised by liver esterases

c)      Its clearance is reduced by constant IV infusion for 24 hours

d)      Causes a decrease in the resting membrane potential

e)      Affects potassium ion flux during the action potential.

 

Alveolar uptake of anaesthetic gas is dependent on

a)      Blood solubility of the agent

b)      Potency of the agent

c)      Alveolar ventilation inspired concentration of the agent

d)      Venous concentration of the agent

e)   Fresh gas flow

 

 The following are positive ionotropes:-

a)      Verapamil

b)      Potassium

c)      Propranolol

d)      Elucagon

e)      Theophylline

 

 

 

 

 

The following have a blood/ gas solubility less than 2

a)      Cyclopropane

b)      Nirous oxide

c)      Halothane

d)      Isoflurane

e)      Trilene

 

Isoflurane is:-

a)      A fluorinated hudrocarbon

b)      Has a MAC of 0.5 in 70% N20

c)      Causes less respiratory depression than halothane

d)      Should not be used with sodalime

e)      Has a greater oil/gas solubility than halothane

 

Concerning intravenous regional anaesthesia:-

a)      Up to 30 mls of 1% lignocaine may be used

b)      Systemic side effects may occur despite an effective tourniquet

c)      Prilocaine 1% is contraindicated

d)      May be used on the lower limb.

e)   Works as long as tourniquet is in place

 

 

 

 

 

The following are true concerning ABO blood

a)      In an individual three allelic genes determine blood groups

b)      Genotype is determined by serological tests

c)      Blood group may change during bone marrow transplantation

d)      Subgroup incompatibility may cause severe transfusion reactions

e)      Antibodies to blood group substances A and B occur naturally

 

The following occur as a response to major surgery:-

a)      Natriuresis

b)      Hypocalcaemia

c)      Reduced Lipolysis

d)      Increased peritoneal uptake.

e)      Potassium retention.

 

The following increase in normal pregnancy:-

a)      Plasma albumin

b)      Blood urea

c)      ESR

d)      Serum thyromine

e)      Serum uric acid.

 

 

 

 

 

The following drugs should be avoided in renal failure:-

a)      Gentamicin

b)      Doxycycline

c)      Aluminium hydroxide

d)      Frusemide

e)      Nirtofurantoin.

 

In tardive dyskinesia:-

a)      The condition can be caused by metoclopramide

b)      Symptoms can be exacerbated by emotional stress

c)      Is due to hypersensitivity of dopamine receptors

d)      Anticholinergic drugs are a useful therapy.

e)      The lesion is in the cerebellum.

 

Anaphylactic and anaphylactoid reactions.

a)      Anaphylactoid reactions commoner than anaphylactic

b)      Bronchospasm is a common feature of anaphylaxis

c)      Hydrocortisone is a first line drug

d)      Muscle relaxants are commonest triggering agents during anaesthesia

e)      Thiopentone more likely to cause anaphylactic type reaction

 

 

 

 

 

Post-op nausea and vomiting.

a)      Five times commoner in females

b)      Increases with increasing age

c)      Commoner with Propofol than thiopentone

d)      Isoflourane least emetogenic of the inhalational agents

e)      Ondansetron clearance significantly reduced in renal failure

 

 Massive transfusion of filtered blood may lead to:-

a)      Hypothermia

b)      Increased plasma ionised calcium

c)      Hypokalaemia

d)      Right shift of oxyhaemoglobin dissociation curve

e)        Metabolic acidosis

 

Congenital diaphragmatic hernia

a)      Presents usually bilateral

b)      Presents usually in the first day or two of life

c)      Is not a contraindication for use of N20.

d)      May usually be diagnosed by CXR

e)   has a better prognosis than Traceho-oesophgeal Fistula

 

 

 

 

 

Characteristic features of the re-feeding syndrome include:-

a)      Acute hypophosphataemia.

b)      Glycosuria

c)      Decreased red cell survival.

d)      Reduced S.V.R

e)      Parasthesia

 

Features of acute post-infective polyneuropathy includes:

a)      Frontal balding

b)      Sympathetic neurone involvement

c)      Weakness of upper motor neuron type.

d)      Invariable progression of ventilation

e)      Normal CSF protein.

 

Regarding Reflex sympathetic dystrophy.

a)      Osteoporosis common

b)      Dysaesthesia a feature

c)      Cryoablation is useful

d)      Trophic changes occur rarely

e)      May follow trivial injury.

 

 

 

 

 

Trigeminal Neuralgia

a)      Radiofrequency lesioning via foramen rotundum is effective

b)      Typically produces altered sensation

c)      Commoner in females

d)      Mandibular branch of trigeminal nerve most commonly involved

e)      Carbamazepine more efficacious than phenytoin

 

 

Stellate ganglion block produces:-

a)      Miosis

b)      Enopthalmos

c)      Hyperhidrosis

d)      Ipsilateral nasal congestion

e)      Facial flushing

 

Brachial Plexus

a)      Radial nerve formed by superior, middle and inferior trunks

b)      Cords are formed proximal to first rib

c)      Interscalene approach has lowest success rate for plamar surgery

d)      Subclavian approach most appropriate for surgery on medial arm

e)      Axillary approach best for radial nerve blockade.

 

 

 

 

Loss of weight with a normal or increased appetite is found in:-

a)      Carcinoma of the stomach

b)      Thyrotoxicosis

c)      Diabetes mellitus

d)      Addison’s disease

e)   Prostatic Cancer

 

The following are features of chronic renal failure:-

a)      Bleeding tendency

b)      Macrocytic anaemia

c)      Hypertension

d)      Splenomegaly

e)      Tetany

 

Pracetamol poising may cause:-

a)      Loss of consciousness at an early stage:-

b)      Metabolic acidosis

c)      Hypoprothrombinaemia

d)      Hyperprothrombinaemia

e)      Hyperfibrinoginaemia

 

 

 

 

 

A patient is receiving intravenous antibiotic therapy for S.B.E she gradually becomes more dyspnoeic, b.p. 130/50, CVP 18 cm H2O, diastolic and systolic murmurs are heard at the L.stemal edge. The most likely diagnosis (es) are:-

a)      Ruptured aneurysm of the ascending aorta

b)      penicillin sensitivity

c)      Cardiac failure

d)      Ruptured valve cusp

e)      Myocardial infarction

 

In severe salicylate poisoning you may find:-

a)      Coma

b)      Metabolic acidosis

c)      Hypoprothrombinaemia

d)      Hyperprothrombinaemia

e)      Hyperfibrinoginaemia

 

Recognized causes of persistent or recurrent painless nausea and vomiting include:-

a)      Hiatus hernia

b)      Chronic cholecystitis

c)      Hypercalcaemia

d)      Diabetes mellitus

e)      Vertebro-basilar insufficiency

 

 

 

 

Recognised early manifestations of methanol poisoning include:-

a)      Dilated pupils

b)      Hyperventilation

c)      Respiratory alkalosis

d)      Episodes of apnoea

e)      Raised serum amylase

 

Pain in the back:-

a)      Due to secondary carcinoma of the vertebrae is worst at night

b)      Due to ankylosing spondylitis is improved by rest

c)      Due to degenerative disease is accompanied by limitation of flexion and extension but not of lateral flexion

d)      Due to ankylosing spondylitis is accompanied by bilateral limitation of lateral flexion

e)      If accompanied by flattening of the lumbar lordosis is probably due to inflammatory disease.

 

Myoedema may present with:-

a)      Coma

b)      Bradycardia

c)      Flat T-waves on E.C.G

d)      Carpel tunnel syndrome

e)      Macrocytic anaemia

 

 

 

 

A 20 years old man is unconscious following a head injury. It is dangerous to :-

a)      Give homatropine eye drops to visualise the discs better

b)      Give morphine 10 mgs I.M.

c)      Do a lumbar puncture

d)      Give Mannitol 25 ml of 20% I.V.

e)      Give a G.A for reduction of his colles fracture.

 

A 60 years old man is brought in by ambulance unconscious breathing O2 at 6L/min from a face mask. He is sweating; twitching his limbs and has bilateral papilloedema. His blood gases are:-

PO2 70 mmHg., PO2 70 mmHg, PH 7.16

You should:-

a)      Give phenytoin 100 mgs I.M. to prevent epileptic fits

b)      Do a lumbar puncture

c)      Arrange for an E.E.G.

d)      Give Na bicarbonate I.V to raise the arterial pH.

e)      Intubate and ventilate him

 

Acute pancreatitis may cause:-

a)      Retro peritoneal abscess

b)      Pancreatic abscess

c)      Pancreatic pseudocyst

d)      Hyperglycaemia

e)      Tetany.

 

 

In a 20 years old fit young adult with a history of vomiting for 3 weeks with no other symptoms, you would expect to find:-

a) Raised blood urea

b) Potassium 3 mEq/L

c) HCO3

d) Na↑

e) Na↓

 

In a patient with a vocal cord palsy due to bronchial carcinoma:

a)      It is often bilateral

b)      The R. is more often affected than th left

c)      The L. is more often affected than the right

d)      It is usually due to metastases

e)      It is usually do to radiotherapy.

 

A 30 years old female patient wit increasing dyspnoea has the following results on cardiac catheterisation :-

R.A. 5, R.V. (normal), P.A. mean 50, Wedge 9, L.A. (normal), L.V. 110/8, Aorta 110/70, The diagnosis(es) are:-

a)      Mitral stenosis

b)      Mitral incompetence

c)      Idiopathic pulmonary hypertension

d)      Aortic incompetence

e)      Aortic stenosis

 

 

 

Dystrophia myotonica is characterised by:-

a)      Testicular atropy

b)      Ptosis

c)      Frontal baldness

d)      Diabetes mellitus

e)      Optic atropy.

 

Post dural puncture headache

a)      Reduced incidence using paramedian approach

b)      Incidence reduced following bed rest versus early mobilization

c)      Is associated with visual and auditory disturbances

d)      Features identical of those seen in cervical myofascial pain syndrome

e)   ACTH is useful adjunct in tratment

 

Nerve block at ankle

a)      Superficial peroneal never innervates first  interdigital cleft

b)      Sural nerve blocked at superior border for lateral malleolus

c)      Tibial nerve innervates sole of foot.

d)      Deep peroneal nerve blocked at medial aspect of medial malleolus

e)      Saphenous nerve is sensory extension of femoral nerve

 

 

 

 

 

Balloon-tipped pulmonary artery flotation catheters.

a)      Provide direct measurement of left atrial pressure

b)      Transducer should be zeroed at level of sternal angle

c)      Pressures should be measured at end expiration

d)      P.E.E.P should be involved during P.C.W.P measurement

e)      Catheter tip should be sited in lung zone III