Monday, June 9, 2008

Family Medicine Practice MCQ (True False)

1. A 50 year old man is seen at the health clinic complaining of tiredness and abdominal distension of 4 weeks duration. He has 20 year history of alcohol consumption. On examination, presence of hepatomegaly and shifting dullness is positive.

Which of the following statements are true:

A. He is most likely suffers from alcoholic hepatitis.
B. Enlarge parotid gland is an associated finding.
C. Serum alpha feto protein level assists in the diagnosis.
D. If a liver bruit is audible in auscultation a provisional diagnosis is alcoholic liver cirhossis.
E. Per rectal bleed is a common finding.

F T T F (Liver bruit is a feature of hepatocellular carcinoma) F(Portal hypertension most often associated with bleeding esophageal varices. Per-rectal bleeding may indicate other colorectal pathology)

2. A 14 year old college student presents with fever, productive cough and mild dyspnea of 3 days duration. On examination presence of crepitations on the lower zone of his right lung.

A. Clubbing of the finger is an expected physical finding.
B. Presence of multiple blistering “target” skin lesion on the trunk indicate the diagnosis of chickenpox pneumonia.
C. If presence of macular rash on the trunk he can be reassured it is viral upper respiratory tract infection.
D. Penicillin is indicated if the sputum gram stain shows gram positive diplococci.
E. If the chest radiograph shows a cavitating lung lesion, Mycoplasma pneumonia is the mostlikely diagnosis.

F (Too acute for clubbing to develop) F (Target lesion is a characteristic feature of Mycoplasma infection) F (The clinical features suggest lower respiratory tract infection rather than URTI) T F (Pulmonary Tuberculosis)

3. A 35 year old house wife presents with palpitation and tiredness. Her serum thyroid function test results are as follow:

TSH 2.0 (0.15-3.5 mU/L)
Free T4 12 (0-30 pmol/L)
T3 3.0 nmol/L (1.0-2.6 )
Tyroid Binding Globulin 40 ( 15-30 mg/L)

The above findings are consistent with:

A. primary hyperthyroidism
B. subclinical hyperthyroidism
C. pregnancy
D. subacute thyroiditis
E. T3 thyroidtoxicosis

F F T F F ( TSH will be low in primary hyperthyroidism, T3 and T4 thyroitoxicosis, TBG is elevated in pregnancy can give a false positive high levels for T3 and T4. Measurement of Free T4 is normal )

4. A 30 year old foreign worker presents with multiple small lumps at the lateral aspect of his neck. On examination, there is a cheesy serous discharge seen and some of the lumps are matted together.

A. Chest radiograph is a mandatory investigation.
B. His ESR is expected to be raised.
C. Infected branchial cyst is the commonest diagnosis.
D. Cloxacillin is the drug of choice.
E. A cutaneous biopsy of the lump is indicated.

T T F F F ( The clinical diagnosis here is Tuberculous lymphadenitis)

5. The following features on the hands and fingers are known to occur in a patient who has 10-year history of rheumatoid arthritis.

A. Swan neck deformity
B. Carpal tunnel syndrome
C. Tenosynovitis
D. Palmar eryhthema
E. Bouchard’s nodes

T T T T F (Osteoarthritis)

6. A 25 year old housewife who has 3 previous episodes of first trimester spontaneous abortion. Now she is at 8th week period of amenorrhea.

A. Glucose tolerance test is indicated.
B. Speculum examination for cervical incompetence.
C. Lupus anticoagulant test.
D. Anticardiolipin antibody titer.
E. Transvaginal ultrasound.

T F (usually occur in 2nd trimester) T T F (transvaginal USG is used for investigating an ectopic pregnancy or ovarian cyst)

7. A 50 year old woman presents with sudden onset of blurring of vision and ocular pain. On examination the conjunctiva is injected surrounding the cornea and the anterior chamber is cloudy.

A. A foreign body injury must be excluded.
B. Measurement of intraocular pressure is mandatory.
C. Undiagnosed diabetes mellitus is a common cause.
D. Stage IV hypertensive retinopathy is the most likely cause.
E. Topical analgesic is contraindicated.

T T F F T (The clinical features are suggestive of Acute Angle Closure Glaucoma)

8. A 65 year old man with past history of benign prostatic hypertrophy treated by transurethral resection of prostate 3 years ago now presents with newly onset of hesitancy and terminal dribbling of 3 weeks duration. The following management plans are appropriate.

A. Urine analysis for microscopic hematuria.
B. Intravenous pyelogram
C. Micturating cystogram
D. Assessment of prostatic specific antigen levels
E. Refer him to urologist for a cystoscopy.

T F F T T ( New onset symptoms of prostatism in an elderly warrants further investigation to exclude Prostatic cancer or bladder cancer)

9. A new diagnostic instrument named ZZZ is invented for the purpose of investigating a disease MMM. The sensitivity of ZZZ is 85%, Specificity is 30% and the positive predictive value is 60%.
Which of the following statements are true?

A. ZZZ is useful as a diagnostic confirmatory instrument.
B. ZZZ has a role in screening of disease MMM.
C. If an asymptomatic person is tested positive by DIM, the chances that he is suffering from the disease MMM is 85%.
D. The false positive result is as high as 70%.
E. The positive predictive value of ZZZ will increase if the prevalence of disease MMM in the community is higher.

F (Low specificity is not good as diagnostic test) T F (Positive predictive value 60% means If an asymptomatic person is tested positive by DIM, the chances that he is suffering from the disease AAA is 60%.) T T

10. The following pedigree shows the mode of inheritance of a genetic disease.

Which of the following diseases are represented by the above pedigree?
A. Beta Thallasemia major
B. G6 PD deficiency
C. Cystic fibrosis
D. Hemophilia A
E. Familial Hypophosphatemia rickets

F T F T F (The mode of inheritance shown here is X-linked recessive)

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