Mount Kenya University · School of Medicine · Internal Medicine
Paper details
- Paper: "End of Semester CAT for MBChB 4", time 2 hours. The scan has no printed date or unit code, so it is filed as undated.
- Questions: 30 multiple choice questions and 3 short answer questions.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. Student marks and pen marks on the scan were ignored and are not published.
- Topics tested: anaemias, iron studies, haemolysis, bleeding disorders, haemochromatosis, acute kidney injury, glomerular and tubulointerstitial disease, kidney stones, dialysis and chronic kidney disease staging.
- Questions that need care: Q1, Q5 and Q23 have more than one arguable option. The explanation says which is best.
Section A: Multiple choice questions
1. Which statement on anaemia is INCORRECT?
- A. A patient with a reticulocyte count of 5% has haemolysis
- B. Hypoproliferative anaemia is characterised by a reticulocyte count of less than 2.5%
- C. Acute blood loss is associated with reticulocyte changes
- D. Sideroblastic anaemia is associated with microcytic anaemia
- E. Anaemia of chronic disease is associated with reduced erythropoietin responsiveness
2. Which statement is FALSE?
- A. In iron deficiency anaemia the soluble transferrin receptor is increased
- B. In anaemia of chronic disease the transferrin saturation is increased
- C. Transferrin levels may be reduced in anaemia of chronic illness
- D. Ferritin is reduced in iron deficiency anaemia
- E. None of the above
3. All are associated with megaloblastic anaemia EXCEPT:
- A. Haemolysis
- B. Anticonvulsants
- C. ARVs
- D. Primary bone marrow disorders
- E. Atrophic gastritis
4. Which statement is TRUE?
- A. Alcohol is associated with neutrophil hypersegmentation
- B. Liver disease is typically associated with megaloblastic macrocytosis
- C. A ferritin of 200 mcg/L is likely with iron deficiency anaemia
- D. In cobalamin deficiency homocysteine levels rise
- E. None of the above
5. Findings consistent with haemolysis EXCEPT one:
- A. Raised serum haptoglobin
- B. Raised unconjugated bilirubin
- C. Microspherocytes
- D. Raised serum LDH
- E. Decreased urine urobilinogen
6. Which is the odd one out concerning haemochromatosis?
- A. May be associated with thyroid dysfunction
- B. It is an autosomal dominant disorder
- C. Association with HFE
- D. Low hepcidin is associated with severe iron overload
- E. Sepsis is a likely feature
7. A 15-year-old girl has bilateral haemarthrosis of the elbows and a tender fluctuant right knee. She has bled for 24 hours from a venepuncture site. Most likely diagnosis?
- A. Classical haemophilia
- B. Christmas disease
- C. Von Willebrand's disease
- D. Disseminated intravascular coagulopathy
- E. Protein C deficiency
8. A strict vegetarian has malaise, exertional dyspnoea and pallor. The film shows segmented neutrophils and MCV 110 fL. Which statement is TRUE?
- A. Gum hypertrophy occurs
- B. Serum ferritin levels are low
- C. Bone marrow Prussian blue stain is negative
- D. Paraesthesias are common
- E. The condition is invariably fatal
9. Statements on haemostasis are true EXCEPT:
- A. Bleeding time assesses platelet function
- B. Prothrombin time evaluates the extrinsic pathway
- C. Partial thromboplastin time evaluates the extrinsic pathway
- D. Partial thromboplastin time evaluates the intrinsic pathway
- E. Thrombin time evaluates conversion of fibrinogen to fibrin
10. Identify the INCORRECT statement.
- A. Petechiae are more common in coagulation factor disorders than in platelet disorders
- B. Bleeding after small cuts is more common in platelet disorders than in coagulation disorders
- C. Haemarthrosis is extremely rare in platelet disorders
- D. Ecchymosis is associated with both platelet and coagulation factor disorders
- E. None of the above
11. A 47-year-old teacher has poor concentration, fatigue, difficulty lifting and rising, tingling in the fingers, a positive Babinski sign and absent reflexes. Hb 10 g/dL, MCV 103 fL. Most likely diagnosis?
- A. Hypothyroidism
- B. Vitamin B12 deficiency
- C. Folic acid deficiency
- D. Liver disease
- E. Alcohol toxicity
12. A 55-year-old man has malaise, fatigue and weight loss. Hb 12 g/dL, MCV 90 fL, platelets 250, WBC 10, serum iron low (10 µmol/L), TIBC 40 µmol/L, ferritin 160 µg/L. Most likely diagnosis?
- A. Thalassaemia
- B. Iron deficiency anaemia
- C. Anaemia of chronic disease
- D. Macrocytic anaemia
- E. Aplastic anaemia
13. A 29-year-old vegetarian woman with weakness drinks much tea. CRP is below 5. Best investigation of her iron stores?
- A. Bone marrow biopsy
- B. Serum ferritin
- C. Serum transferrin
- D. Total iron-binding capacity
- E. Serum iron
14. A 65-year-old man has malaise, breathlessness and paraesthesia in the hands. Pulse 115. The Schilling test is positive, the blood film is macrocytic and Coombs is negative. Most likely diagnosis?
- A. Iron deficiency anaemia
- B. Haemorrhage
- C. Anaemia of chronic disease
- D. Pernicious anaemia
- E. Autoimmune haemolytic anaemia
15. A 21-year-old woman has frequency, nocturia, constipation, polydipsia and left flank pain. Urine dipstick is normal. Most appropriate investigation?
- A. Serum phosphate
- B. Serum calcium
- C. Parathyroid hormone
- D. Plasma glucose
- E. Serum potassium
16. A 19-year-old with newly diagnosed type 1 diabetes asks about future kidney complications. Which investigation is most appropriate for early signs of renal impairment?
- A. Blood pressure
- B. Microalbuminuria
- C. Serum creatinine
- D. Serum electrolytes
- E. Urine dipstick for glucose
17. A 58-year-old with CKD has altered mental status and asterixis. GFR 20 mL/min. A chest X-ray shows large bilateral pleural effusions and the ECG shows diffuse ST elevation with PR depression. All are indications for haemodialysis EXCEPT:
- A. Altered mental status and asterixis
- B. GFR of 20 mL/min
- C. Diffuse ST elevation and PR depression
- D. Low albumin level
- E. Bilateral pleural effusions
18. A 55-year-old with renal colic has a 4 mm stone. All of these predispose to stones EXCEPT:
- A. Crohn's disease
- B. High sodium diet
- C. Short bowel syndrome
- D. Sarcoidosis
- E. Hypercitraturia
19. Which best depicts beta-thalassaemia major?
- A. Decreased MCV, increased haemoglobin A2, increased haemoglobin F
- B. Decreased MCV, decreased haemoglobin A2, increased haemoglobin F
- C. Increased MCV, increased haemoglobin A2, increased haemoglobin F
- D. Increased MCV, decreased haemoglobin A2, increased haemoglobin F
- E. Increased MCV, increased haemoglobin A2, decreased haemoglobin F
20. Which is NOT true of acute interstitial nephritis?
- A. Can present with eosinophilia
- B. Mostly associated with non-oliguric kidney injury
- C. Always associated with rapid renal impairment
- D. Dacryoadenitis may be a presentation
- E. Urinalysis is often sterile
21. Immune-mediated causes of chronic interstitial nephritis include all EXCEPT:
- A. SLE
- B. Tacrolimus
- C. Sarcoidosis
- D. Sjögren's syndrome
- E. None of the above
22. All are true of dialysis EXCEPT:
- A. In peritoneal dialysis fluid and diet are less restricted than in haemodialysis
- B. Failure to grow is an indication for dialysis in CKD
- C. About 12 litres of dialysate are used for 4 to 6 hours in continuous ambulatory peritoneal dialysis
- D. Dialysis aims at reducing BUN by one third during the first dialysis
- E. None of the above
23. All describe focal segmental glomerulosclerosis EXCEPT:
- A. Must always have crescent formation
- B. Often associated with systemic disease
- C. Small vessel vasculitis
- D. Responds to immunosuppressants
- E. None of the above
24. Correct statements about hypoproliferative anaemias EXCEPT:
- A. Inflammation is a key cause
- B. There is erythroid hyperplasia in the bone marrow
- C. Iron deficiency anaemia is a key cause
- D. Microcytosis is not always the case
- E. None of the above
25. Which is NOT true about urolithiasis?
- A. Spinach can be a cause
- B. Hydrochlorothiazide reduces calcium excretion
- C. Vitamin C supplementation reduces oxalate excretion
- D. Vitamin C supplementation increases oxalate excretion
- E. Alkalinisation discourages cystine formation
26. Which stone size would pass spontaneously in over 90% of cases?
- A. 1 mm
- B. 3 mm
- C. 2 mm
- D. None of the above
- E. All of the above
27. Which statement about acute kidney injury is the ODD one out?
- A. Prerenal AKI: renal hypoperfusion
- B. Prerenal AKI: renal hyperperfusion
- C. Prerenal AKI: NSAIDs
- D. Prerenal AKI: ARBs
- E. None of the above
28. Which statement is TRUE of azotaemia?
- A. FeNa above 1% may be seen in acute tubular necrosis
- B. FeNa below 1% may be seen in acute tubular necrosis
- C. RBCs in urine suggest interstitial nephritis
- D. Muddy brown casts in urine suggest vasculitis
- E. None of the above
29. A 54-year-old has malaise, easy fatiguability and haematuria for weeks, with dysmorphic RBCs and proteinuria over 500 mg/24 h. All are other likely findings EXCEPT:
- A. Anti-GBM antibody
- B. Hepatitis C
- C. HIV
- D. WBC casts
- E. Hepatitis B
30. Which is correctly matched with the K/DOQI classification of chronic kidney disease?
- A. Stage 2: GFR 60 to 79 mL/min/1.73 m²
- B. Stage 1: GFR above 80 mL/min/1.73 m²
- C. Stage 3: GFR 40 to 59 mL/min/1.73 m²
- D. Stage 4: GFR 15 to 39 mL/min/1.73 m²
- E. None of the above