1000 MCQ’s for Davidson’s Principles & Practice of Medicine

288 Pages·1999·32.03 MB·English

by  Michael J. Ford, A. T. Elder

- FOURTH EDITION
1000 McOs for Davidson’s
Principles and Practice of

Medicine
1000 Mcas for Davidson’s
Principles and Practice of

Medicine

M.J. Ford moracee

Consultant Physician, Western General Hospital, Edinburgh
Honorary Senior Lecturer, Edinburgh University, Edinburgh

A.T. Elder we cre rrcre

Consultant Physician, Western General Hospital, Edinburgh
Honorary Senior Lecturer, Edinburgh University, Edinburgh

FOURTH EDITION

EDINBURGH LONDON NEW YORK PHILADELPHIA ST LOUIS SYDNEY TORONTO 1999
CHURCHILL LIVINGSTONE
‘An imprint of Harcourt Publishers Limited

© Harcourt Publishers Limited 1999
@ sa registered trademark of Harcourt Publishers Limited

The right of MJ Ford and A T Elder to be identified as
authors of this work has been asserted by them in
accordance with the Copyright, Designs and Patents Act
1988

Al rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in
any form by any means, electronic, mechanical,
photocopying, recording or otherwise, without either the prior
permission of the publishers (Harcourt Publishers Limited,
24-28 Oval Road, London NW1 7DX), or a licence permitting
restricted copying in the United Kingdom issued by the
Copyright Licensing Agency, 90 Tottenham Court Road,
London W1P OLP.

First edition 1980
Second edition 1991
Third edition 1997

Fourth edition 1999

Fourth edition reprint rights 2005 by International House for
Cultural Investments S.A.E (IHCI), P.O. Box 5599 Heliopolis
‘West, Cairo, Egypt. (Egypt, Libya, Sudan, Iraq)

E-mail: [email protected]

jk, ELSEVIER Limited of Oxtord U.K

First edition by P. R. Fleming

Standard edition ISBN 0 443 06399 0
International Student Edition ISBN 0 443 06400 8
Egyptian Edition ISBN 977-282-206-7

British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British
Library

Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of
Congress

Note
Medical knowledge is constantly changing. As new
information becomes available, changes in treatment,
procedures, equipment and the use of drugs become
necessary. The authors and the publishers have, as far as it
is possible, taken care to ensure that the information given in
this text is accurate and up to date. However, readers are
strongly advised to confirm that the information, especially
with regard to drug usage, complies with the latest
legislation and standards of practice.
a PIECE ANS EARNAF SURCE

Contents

Introduction vii

Part1 Part2
Questions Answers
1 The molecular and cellular basis of disease 2 154
2 Diseases due to infection 9 160
3. Diseases of the cardiovascular system 25 172
4 Diseases of the respiratory system 40 184
5 Disturbances in water, electrolyte and acid-base balance 51 193
6 Diseases of the kidney and urinary system 56 197
7 Diabetes mellitus, and nutritional and metabolic disorders 62 202
8 Endocrine disease 72 210
9 Diseases of the alimentary tract and pancreas at 218
10 Diseases of the liver and biliary system 90 227
11. Diseases of the blood 98 234
12. Diseases of the connective tissues, joints and bones 107 242
13. Diseases of the skin 117 251
14 Diseases of the nervous system 122 255
15 Principles of critical care medicine 135 265
16 Principles of oncological and palliative care 139 268
17 Principles of geriatric medicine 142 270
18 Principles of medical psychiatry 144 272

19 Principles of drug therapy and management of poisoning 148 275
Introduction

Since the first edition of this book of multiple
choice questions supplementing Davidson's
Principles and Practice of Medicine by Dr
PR. Fleming was first published, medical
knowledge has continued to grow at an
exponential rate. MCQ companion books to
medical textbooks remain both popular and
useful methods of self-assessment for
medical undergraduates and postgraduates.
The aim of this book, like that of its
predecessor, is to help students efficiently
acquire the factual knowledge necessary for
good medical practice. The questions have
been arranged to correspond with the
chapters of Davidson's Principles and
Practice of Medicine, 18th edition, and, in
addition, annotated answers have been
compiled to enhance the educational value
of the book.

The principles and technique

Multiple choice questions are widely used
for examination purposes as a reliable and
discriminatory test of factual knowledge.
Lack of familiarity with the MCQ format may
result in unexpected failure, although more
usually failure is attributable to a lack of
adequate reading and understanding of
clinical medicine and the basic sciences.
Familiarity with the technique of MCQ
examinations is no substitute for the
systematic study required to achieve a
thorough understanding of medicine.

@ Read each stem question and the five
items carefully. The questions have been

worded to avoid ambiguity and have not
been designed to trick the unwary.

Identify the items which you can answer
with confidence and record the answer
“TRUE' or ‘FALSE" as appropriate.

© Identify those items to which you do not
know the answers. Do not guess the
answer if you know nothing about the
subject matter. Record the answer ‘DO
NOT KNOW ' and move to the next item.

There will be items the answers to which
you may feel you know but lack
confidence. After due consideration,
record your answer, providing this is not
a blind guess but informed and intuitive
reasoning

© Concentrate on each stem and item in
turn rather than passing quickly from
question to question. It is easier to
concentrate on the problem in hand than
to juggle with several unrelated questions
simultaneously.

How to use this book

Students preparing themselves for
examinations are recommended to read the
appropriate chapters of the textbooks and
then to assess themselves using the MCQ
technique described.

Record your answers and your reasoning
before checking the correct answer. Then
return to the appropriate section of a
medical textbook and read the relevant text
for a more detailed explanation.
PART 1
QUESTIONS
THE MOLECULAR AND CELLULAR
BASIS OF DISEASE

ANSWERS PAGE 154

1

In humans:

® somatic cell nuclei contain 22 pairs of
homologous autosomes

© gamete nuclei are haploid with a single X
or Y chromosome

@ the haploid male cell (sperm) contains 22
autosomes and a Y chromosome

© pairing of homologous chromosomes
occurs during mitosis:

@ both X chromosomes in females are
genetically active

2

In the chromosomal disorders

© aneuploidy is the addition or loss of a
chromosome

© deletions arise from the loss of a
segment of a chromosome

@ the majority of affected conceptions
result in miscarriage

© identical deletions produce the same
effects whether inherited from father or
mother

@ translocation is the exchange of
segments between chromosomes

3

In cellular protein synthesis

@ each tRNA molecule carries one
anticodon

© each tRNA molecule carries one amino
acid

© peptidy! transferase catalyses amino acid
polymerisation

© one of seven different stop codons is
necessary to terminate amino acid
polymerisation

@ recognition of the mRNA start codon
occurs after binding to the small 40S
ribosomal subunit

4

With regard to DNA

@ the mutation rate in genomic DNA is
around 10~$ to 10°

© single base coding errors are always
replicated to daughter strand DNA

@ the most frequent single base mutation is
aC toT substitution

© deamination initiates mutation

@ ionising radiation induces breakage of
double stranded DNA

5

In the human cell

@ the genome is separated from the
cytoplasm by a nuclear membrane

© the endoplasmic reticulum has a role in
cellular calcium metabolism

@ the golgi apparatus facilitates aerobic
metabolism

© mitochondria have their own genome

@ mitochondrial disease states are
associated with myopathy

6

In cellular protein metabolism

© most protein synthesis occurs on the
large ribosomal subunit

© ubiquitin facilitates protein degradation in
the cytoplasm

@ a protein's final conformation is
determined by its peptide sequence
(primary structure) alone

© v-SNARES participate in exchange of
proteins between intracellular vesicles

@ integral cellular proteins are responsible
for protein sorting and transport
THE MOLECULAR AND CELLULAR BASIS OF DISEASE | [CM

7

In the cell cycle

@ DNA replication occurs during the Gt
phase

© chromatids are joined at the telomere

© chromatid segregation occurs twice in
meiosis

© DNA recombination in meiosis occurs via
chiasmata

@ telomere shortening is associated with
cellular ageing

8

With regard to transport of molecules

into cells

@ passive diffusion directly through the lipid
bilayer cannot occur

© movement of molecules can only occur
down osmotic or concentration gradients

@ ion channels are always open for ion
transport

© endocytosis is responsible for
internalising larger particles

@ acetylcholine binds to a cellular. receptor
which facilitates potassium influx

9

With regard to receptor-regulated cellular

transport

each ligand-receptor interaction has a
specific cellular response

© receptors become ‘resistant’ to repeated
ligand stimulation

@ ligand-receptor interactions control
transcellular ionic movement

© G-protein coupied receptors stimulate
transmembrane adenyi cyclase

@ phosphorylation is a frequent component
of signalling cascades

10

With regard to the cell cycle and cell

death

© cyclin-dependent kinases regulate the
progression of the cell cycle

© transient arrest of the cycle at the G1-S
checkpoint is associated with an
increased chance of malignant cellular
transformation

@ the process of differentiation allows a cell
to withdraw from the cell cycle

© apoptosis (programmed cell death)
usually occurs when cells are in G1-S
phase

@ apoptotic cells discharge damaging
‘enzymatic contents to the exterior

"
The following cancers are of infective
origin

Burkitt's lymphoma

© cervical carcinoma

@ thyroid carcinoma

© Kaposi's sarcoma

@ ovarian carcinoma

12

Oncogenes

are genes which protect a cell from
cancerous change

© exert their effect by mimicking persistent
growth factor stimulation

© exert their effect by producing loss of a
cellular protective mechanism

© exert their effect by increasing cellular
susceptibility to apoptosis

@ arise from single or multiple mutations

13

The following may be features of

malignant cell

@ increased frequency of replication

© loss of capacity to differentiate

@ failure of chromosomal separation pre-
division

© down-regulation of cell surface receptor
molecules

@ synthesis of angiogenic factors
BW 1 THE MOLECULAR AND CELLULAR BASIS OF DISEASE

14

In the inflammatory response

© neutrophils have a half-life of 24-48
hours

© neutrophils arrive earliest at the site of
inflammation

@ macrophages cannot synthesise
cytokines

© eosinophils have a specific role in
defence against viruses

@ macrophages have a role in tissue repair

15

Excessive or inappropriate inflammation
is a feature of

@ acute respiratory distress syndrome

© Alzheimer's disease

@ bronchial asthma

© multiple sclerosis

@ rheumatoid arthritis

16

In acute lobar streptococcal pneumonia

neutrophils appear in the spaces within
30 minutes

@ peak monocyte migration into alveoli
occurs at 18-24 hours

@ there is local vasoconstriction to facilitate
leucocyte adhesion to endothelial cells

© integrin molecules facilitate leucocyte
adhesion to endothelial cells

@ some bacterial products act directly as
neutrophil chemotaxins

7

In the innate immune system

@ neutrophil leucocytes phagocytose
particulate antigens

© monocytes develop into tissue
macrophages

@ natural killer cells produce interferons

© acute phase proteins bind complement to
enhance opsonisation

@ macrophage-derived interleukin-1
mediates the febrile response

18

In the adaptive immune system

small granular lymphocytes transform
into killer cells

© T lymphocytes produce helper,
suppressor and cytotoxic cells

@ helper cells facilitate B cell-mediated
killer cell activity

© delayed hypersensitivity reactions are
mediated by T cells

@ interleukin-2 is a lymphokine stimulating
B cell proliferation

19

The following statements about

immunoglobulins are true

@ they are secreted by transformed T
lymphocytes

© IgA is produced by B cells in the lamina
propria of the gut

@ IgG is the only immunoglobulin to cross
the placental barrier

© IgA comprises 75% of the
immunoglobulins in normal serum

@ IgD is mainly found on the surface of B
lymphocytes

20

Pathophysiological functions of

immunoglobulins shown below include

© IgG—neutralisation of soluble toxins

© IgA—agglutination of bacteria

@ IgM—complement activation to produce
cell lysis

© 1g0—protection against viruses

@ 1g—major regulator of B cell functions

2

In immediate (anaphylactic)

hypersensitivity reactions

© eosinophils release histaminase to
suppress inflammation

© the severity depends on the antigen’s
portal of entry

@ most manifestations are due to mast cell
degranulation

© parenteral adrenaline therapy should be
given for severe reactions

@ urticaria is always induced by foreign
antigen