EMQs and MCQs for medical finals PDF
Preview EMQs and MCQs for medical finals
EMQs and MCQs for Medical Finals This page intentionally left blank EMQs and MCQs for Medical Finals Jonathan Bath MBBS BSc (Hons) Resident in General Surgery John Hopkins Hospital Rebecca Morgan MBBS BSc (Hons) Foundation 2 doctor St. Thomas’ Hospital Mehool Patel MBBS MD MRCP Consultant Physician in Stroke and Elderly Medicine University Hospital Lewisham © 2007 Jonathan Bath, Rebecca Morgan & Mehool Patel Published by Blackwell Publishing Blackwell Publishing, Inc., 350 Main Street, Malden, MA 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photo- copying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 2007 1 2007 Library of Congress Cataloging-in-Publication Data Bath, Jonathan. EMQs and MCQs for medical finals / Jonathan Bath, Rebecca Morgan, Mehool Patel. p. ; cm. ISBN 978-1-4051-5707-0 (alk. paper) 1. Medicine—Examinations, questions, etc. I. Morgan, Rebecca. II. Patel, Mehool. III. Title. [DNLM: 1. Medicine—Examination Questions. W 18.2 B331e 2007] R834.5.B37 2007 610.76—dc22 2007000350 ISBN: 978-1-4051-5707-0 A catalogue record for this title is available from the British Library Set in 9.25/12 Meridien by Charon Tec Ltd (A Macmillan Company), Chennai, India www.charontec.com Printed and bound in Singapore by COS Printers Pte Ltd Commissioning Editor: Martin Sugden Editorial Assistant: Robin Harries Development Editor: Hayley Salter Production Controller: Debbie Wyer For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. Blackwell Publishing makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check that any product men- tioned in this publication is used in accordance with the prescribing information pre- pared by the manufacturers. The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book. Contents Preface, vi Part 1 Practice Papers, 1 Paper 1 Questions, 3 Paper 2 Questions, 35 Paper 3 Questions, 67 Paper 4 Questions, 99 Paper 5 Questions, 129 Part 2 Answers to Practice Papers, 159 Paper 1 Answers and notes, 161 Paper 2 Answers and notes, 195 Paper 3 Answers and notes, 229 Paper 4 Answers and notes, 265 Paper 5 Answers and notes, 297 v Preface Whilst studying for Finals it was hardly believable the number of textbooks, notes, lectures and other resources that were available to satiate even the most demanding of student. An unhealthy cul- ture of panic buying was almost encouraged, such was the vast amount of information that was expected and required. However, with such an impressive armament at our fingertips it seemed illogical that there were few avenues for those diligent (or just plain lucky) enough to have accrued sufficient knowledge to want to put it to the test. Question books often provided coverage of topics likely to be encountered in examinations but often left frustration when incorrect choices were not explained. This question book containing detailed answers was designed to address this need for explanation of not only the correct choice, but also why the other choices were incorrect, thereby providing the reader with positive feedback based on current medical prac- tice. With 450 questions, based across 24 commonly tested areas of medicine, surgery and subspecialities and divided into five practice examination papers covering a mixture of subjects, EMQs and MCQs for Medical Finals provides a comprehensive review of these topics as well as providing exposure to frequently encountered question formats to help engender familiarity with examination styles. All questions are original and written with the memories of Finals still very much fresh in our minds. We hope this book will help alleviate some of the anxiety regarding examinations by help- ing to prepare students for what is undoubtedly the most challeng- ing test of knowledge faced during one's medical career. Jonathan Bath Baltimore Rebecca Morgan London vi PART I Practice Papers This page intentionally left blank PAPER 1 Questions S N O TI S E U Q 1 P Multiple choice questions (single best answer) 1 A 75-year-old gentleman is referred by his GP to a consultant cardiologist for management of his newly diagnosed atrial fibril- lation (AF). Palpitations and occasional shortness of breath are the only symptoms he has noticed and he has no past history of cardiovascular disease, but has suffered a transient ischaemic event in the past. On examination he is found to have an irregu- lar heart rate ranging between 70 and 90 beats per minute and ECG confirms AF. Which of the following is the most appropri- ate next stage in his management? (cid:1) a. Start digoxin for rate control. (cid:1) b. W arfarinise the patient to reduce the risk of thromboem- bolism formation. (cid:1) c. Start a beta blocker for associated hypertension. (cid:1) d. Organise an echocardiogram. (cid:1) e. Refer back to GP as his case can easily be managed in the community. 2 A 38-year-old gentleman attends A&E at 9 p.m. during a busy medical take. He complains of chest pain which has intermit- tently been present since the morning. On further questioning his pain is central in location with no radiation and some associ- ated nausea. His father suffered with an MI at the age of 65 and his grandfather suffered from peripheral vascular disease. His troponin I is 0.05 (significant (cid:1)0.1) and ECG shows no ischae- mic changes. This gentleman asks you what happens next, what should you tell him? (cid:1) a. He needs to be admitted for further bloods tests. (cid:1) b. He requires an exercise tolerance test before he is dis- charged. (cid:1) c. An echo will be useful in his further management. (cid:1) d. He can be safely discharged without further follow-up. (cid:1) e. He should be started on aspirin. 33 3 An 84-year-old nun presented to A&E 2 weeks after discharge from hospital under the care of the cardiologists. Her present- P 1 ing complaint is one of feeling faint and dizzy and intermittently Q U short of breath. She mentions that during her last admission she E was started on digoxin because she had an irregular heart rate S TIO that was racing away. On discharge she claims that she had no N problems and only developed this dizziness in the past couple of S days. Her drug history includes atenolol 100mg once daily. Her ECG today shows a rate of approximately 40 beats per minute with no association between P waves and QRS complexes. What is the next step in her management? (cid:1) a. Insert a temporary pacing wire. (cid:1) b. Give regular atropine. (cid:1) c. Start amiodarone 200mg tds. (cid:1) d. Stop atenolol. (cid:1) e. Take bloods including drug levels. 4 A 69-year-old man was admitted from A&E 3 days after suffer- ing a myocardial infarction. He was complaining of increasing shortness of breath and on observation was tachypnoeic at rest whilst sitting up. On examination he had no peripheral signs of disease, his jugular venous pressure was raised, he was breath- ing at 30 breaths per minute and his heart rate was 120/minute. On auscultation there was evidence of a systolic murmur but no other findings. An erect chest X-ray was normal. Which of the following complications of MI is most likely to be the cause of this gentleman’s shortness of breath? (cid:1) a. Ventricular septal defect. (cid:1) b. Recurrent infarction. (cid:1) c. Aortic regurgitation. (cid:1) d. Heart failure. (cid:1) e. Dressler’s syndrome. 4
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