Mount Kenya University · School of Medicine · Department of Internal Medicine
Paper details
- Unit: MBIM 4100, Internal Medicine (Year 4), Bachelor of Medicine and Bachelor of Surgery. University examinations 2018/2019.
- Sitting: 3 July 2019, 8.00 am, main exam, time 3 hours. This is "Paper One".
- Questions: Section A has 100 multiple choice questions (one answer only). Section B has 5 short answer questions (10 marks each, answer all). Section C has 3 essay questions (15 marks each, answer 2).
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The pen marks and notes on the scan were ignored.
- Topics tested: respiratory disease, sickle cell disease and anaemias, rheumatic fever, diabetes, TB, pulmonary embolism, connective tissue disease, HIV, gastroenterology, thyroid disease, gout, leukaemia and lymphoma, kidney disease and stroke.
- Questions that need care: Q49, Q50, Q53, Q57, Q61, Q88 and Q100 are loosely worded or incomplete. In Q57 the case it refers to ("the patient described above") is not in the scan. The explanation says what I chose and why.
Section A: Multiple choice questions
1. Bronchial asthma is characterised by all the following, except:
- A. Hyperactive airway
- B. Clubbing
- C. Spasmodic cough
- D. Bilateral chest wheezes
2. All of the following are common causes of empyema, except:
- A. Staphylococcal pneumonia
- B. Lung abscess
- C. Measles
- D. Chest injury
3. Wheezing is a hallmark symptom of:
- A. Asthma
- B. COPD
- C. Cystic fibrosis
- D. Lung cancer
4. "Tree in bud" findings and cysts on a high-resolution CT scan of the chest are indicative of:
- A. COPD
- B. Bronchiectasis
- C. Asthma
- D. Lung cancer
5. Which of the following is most likely to cause haemoptysis?
- A. Asthma
- B. COPD
- C. Lung cancer
- D. Pneumothorax
6. Haemoglobin S:
- A. Is the result of a mutation on chromosome 16
- B. Is due to the substitution of valine for leucine
- C. Is less soluble at low PO2 than HbA
- D. Has an equivalent half-life to HbA
- E. Levels greater than 5% are detected by the sickle cell test
7. Complications of sickle cell disease include all of the following, except:
- A. Sequestration crisis
- B. Aplastic crisis
- C. Haemolytic crisis
- D. Hypovolaemic crisis
8. Precipitants of a sickle cell crisis include all of the following, except:
- A. Blood transfusion
- B. Dehydration
- C. Infection
- D. Stress
- E. Hypoxia
9. Anaemia of chronic disease is mainly characterised by all of the following, except:
- A. Inadequate erythrocyte production
- B. Low serum iron
- C. Increased iron-binding capacity
- D. Normochromic normocytic anaemia
10. Causes of anaemia of chronic disease include the following, except:
- A. Viral infection
- B. Cancer
- C. Fungal infection
- D. Pregnancy
- E. Bacterial infection
11. Aplastic anaemia is characterised by:
- A. Iron deficiency anaemia
- B. Pancytopenia
- C. Lymphadenopathy
- D. Splenomegaly
- E. Jaundice
12. Tests useful in the diagnosis of aplastic anaemia include the following, except:
- A. Full blood count
- B. ANA
- C. Urine catecholamines
- D. Bone marrow aspirate
- E. Liver function tests
13. Aplastic anaemia is characterised by which of the following?
- A. ANC below 0.5 G/L
- B. Platelets below 100 × 10⁹/L
- C. Reticulocyte count below 10%
- D. Auer rods
14. Which one of the following is not a clinical feature of acute rheumatic fever?
- A. Migratory arthritis
- B. Carditis
- C. Sydenham's chorea
- D. None
15. Which laboratory investigation is used to diagnose acute rheumatic fever?
- A. ECG
- B. CXR
- C. ASO titre
- D. Throat culture
- E. There is no specific laboratory test
16. Major organs affected by rheumatic fever with long-term sequel:
- A. Heart
- B. Skin
- C. Joint
- D. CNS
- E. All
17. The commonest valve involved in acute rheumatic fever and rheumatic heart disease:
- A. Mitral valve
- B. Tricuspid valve
- C. Aortic valve
- D. Pulmonary valve
18. Which is used for prophylaxis of bacterial endocarditis in a patient with mitral regurgitation going to have a dental extraction?
- A. Ampicillin/amoxicillin
- B. Vancomycin
- C. Gentamicin
- D. All
19. Which is not a risk factor for type 2 diabetes mellitus?
- A. Exposure to environmental pollutants
- B. Hypertension
- C. Obese individual
- D. First-degree relative with diabetes
- E. Age older than 45 years
20. Which test is the gold standard for checking long-term glycaemic control?
- A. Fasting C-peptide
- B. HbA1c
- C. Urine albumin excretion
- D. Fasting plasma glucose
21. Which is the most common complication of diabetes mellitus?
- A. Autonomic neuropathy
- B. Stroke
- C. Pancreatic neoplasms
- D. Peripheral neuropathy
22. Type 2 diabetes accounts for approximately what percentage of cases of diabetes?
- A. 20 to 25%
- B. 30 to 50%
- C. 60%
- D. 85 to 90%
23. Untreated diabetes mellitus results in all of the following, except:
- A. Cardiovascular disease
- B. Blindness
- C. Kidney disease
- D. Tinnitus
24. Diabetic neuropathies are diagnosed using all of the following, except:
- A. Nerve conduction studies or electromyography
- B. Ultrasound
- C. Foot examinations
- D. Minnesota Multiphasic Personality Inventory (MMPI)
25. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
- A. Sulfonylureas
- B. Meglitinides
- C. Biguanides
- D. Alpha-glucosidase inhibitors
26. Which cells produce insulin in the body?
- A. Beta cells
- B. Alpha cells
- C. Lipocytes
- D. Hepatocytes
27. Which of the following is not a sulfonylurea?
- A. Gliclazide
- B. Glimepiride
- C. Glibenclamide
- D. Metformin
28. Which of the following is not a microvascular complication?
- A. Nephropathy
- B. Myocardial infarction
- C. Neuropathy
- D. Retinopathy
29. What are the symptoms of active TB?
- A. Weight loss
- B. Night sweats
- C. Loss of appetite
- D. All of the above
30. How is TB diagnosed?
- A. Chest X-ray
- B. Sample of sputum
- C. Skin test
- D. All of the above
31. What is pulmonary embolism?
- A. A blood clot obstructing a pulmonary artery
- B. A blood clot obstructing the aorta
- C. A blood clot in the deep veins of the extremities or pelvis
- D. Right-sided heart failure
32. What is the most frequent cause of pulmonary embolism?
- A. Congestive heart failure
- B. Haemorrhagic fever
- C. Deep vein thrombosis
- D. Pneumonia
33. What are the symptoms of DVT?
- A. Swelling of the affected leg
- B. Cyanosis or redness of the skin above the DVT
- C. Warmth of the skin above the DVT
- D. Pain in the affected leg
- E. All of the above
34. Components of CREST syndrome include all of the following, except:
- A. Raynaud's phenomenon
- B. Constipation
- C. Sclerodactyly
- D. Esophageal dysmotility
- E. Telangiectasia
35. Which of these is an autoimmune disease?
- A. Type 1 diabetes
- B. Rheumatoid arthritis
- C. SLE
- D. HIV
- E. A, B and C
36. Which of these is a symptom of HIV infection?
- A. Swollen lymph nodes
- B. Fever
- C. Tiredness
- D. All of the above
37. What is the best way to protect yourself against HIV?
- A. Get yourself vaccinated for HIV
- B. Use birth control pills
- C. Use a latex condom during sexual intercourse
- D. B and C
38. The highest incidence of HIV/AIDS is seen in:
- A. USA
- B. Australia
- C. Asia
- D. Sub-Saharan Africa
39. The following drugs are antiretrovirals, except:
- A. Dolutegravir
- B. Zidovudine
- C. Tenofovir
- D. Rifampicin
40. Which group of people are at risk of contracting HIV?
- A. Men having intercourse with men
- B. Babies born to mothers with HIV
- C. Health care workers
- D. Drug addicts
- E. All of the above
41. What is the cut-off value for initiating antiretroviral medication?
- A. CD4 count 350 cells/µL
- B. CD4 count 500 cells/µL
- C. CD4 count 1000 cells/µL
- D. Any CD4 count level
42. The opportunistic infections one acquires in stage 3 include all of the following, except:
- A. Extrapulmonary tuberculosis
- B. Pulmonary tuberculosis
- C. Oral candidiasis
- D. Oral hairy leukoplakia
- E. Meningitis
43. Malignancies commonly associated with HIV include, except:
- A. Kaposi sarcoma
- B. Primary CNS lymphoma
- C. Cervical cancer
- D. Lung cancer
44. Fibromyalgia is triggered by all of the following, except:
- A. Stress
- B. Hypothyroidism
- C. Infection
- D. Hypertension
- E. Depression
45. Symptoms of fibromyalgia include all of the following, except:
- A. Widespread pain
- B. Fatigue
- C. Weight gain
- D. Weight loss
- E. Poor sleep
46. Which part of the body may be affected by SLE?
- A. Skin
- B. Heart
- C. Brain
- D. All of the above
- E. None of the above
47. A 25-year-old female gives birth to a baby with complete heart block who subsequently requires pacemaker insertion. Which antibody is most likely to be detected in the maternal serum?
- A. Anti-double-stranded DNA
- B. Anti-endomysial
- C. Anti-Ro/SSA
- D. Anti-Scl-70
- E. Rheumatoid factor
48. A 69-year-old woman taking hydralazine for hypertension presents with joint pain and chest pain. On cardiac examination she has a pericardial rub. What is the diagnosis?
- A. Dermatomyositis
- B. SLE (drug-induced)
- C. Polymyalgia rheumatica
- D. Felty syndrome
49. The diagnosis and staging of a carcinoma of the oesophagus should ideally include:
- A. Upper gastrointestinal endoscopy and biopsy
- B. Carcinoembryonic antigen (CEA) level
- C. Oesophageal manometry
- D. Laparoscopy
- E. Transoesophageal ultrasound and lymph node biopsy
50. Achalasia of the cardia:
- A. Is associated with hyperactivity of the lower oesophageal sphincter
- B. Has an absence of ganglion cells in Auerbach's plexus
- C. Presents in children with dysphagia
- D. Diagnosis is confirmed by oesophageal function tests
- E. Cardiomyotomy may not totally relieve symptoms
51. The best duration of treatment to ensure 90% duodenal ulcer healing with an H2 receptor antagonist is:
- A. 1 week
- B. 2 weeks
- C. 4 weeks
- D. 8 weeks
- E. 1 year
52. Antacid therapy relieves symptoms:
- A. Rapidly
- B. By complete neutralisation of gastric acid
- C. By eradicating Helicobacter pylori
- D. Indefinitely
- E. By protecting the mucosa from acid
53. Helicobacter pylori:
- A. Lives in gastric acid
- B. Adheres to the gastric mucosa in an alkaline layer
- C. Is never seen in healthy people
- D. Can be simply identified in the endoscopy room by its urease activity
- E. Is associated with peptic ulcer relapse
54. Which of the following diseases is not related to the thyroid gland?
- A. Myxoedema
- B. Cretinism
- C. Acromegaly
- D. Goitre
55. Graves' disease is due to ________.
- A. Hyperactivity of the thyroid gland
- B. Hyperactivity of the adrenal medulla
- C. Hyperactivity of the adrenal cortex
- D. Hyperactivity of the islets of Langerhans
56. All the following are vitamin K-dependent coagulation factors, except:
- A. Factors X, IX, II
- B. Factor VII
- C. Protein C
- D. Protein S
- E. Factor VIII
57. "The patient described above" is found to have a right pulmonary embolus. She is started on low-molecular-weight heparin and warfarin. What is the goal INR and the duration of therapy?
- A. INR 3.5; 1 month
- B. INR 2.5; 3 months
- C. INR 3.5; 3 months
- D. INR 2.5; 6 months
- E. INR 3.5; 6 months
58. Which of the following is not true for Hashimoto thyroiditis?
- A. It is an autoimmune disease caused by CD4 cells with specificity to thyroid antigens
- B. Commonly presents as hypothyroidism
- C. Surgery is required in all cases
- D. Hashimoto's thyroiditis can progress to lymphoma of the thyroid
59. Goitre and cretinism occur due to deficiency of which of the following?
- A. Phosphorus
- B. Calcium
- C. Iodine
- D. Copper
- E. Iron
60. A patient on management for hypothyroidism: which is the ideal drug?
- A. Propylthiouracil
- B. Lugol's iodine
- C. Carbimazole
- D. Levothyroxine
61. The specific and commonest side effect of the use of propylthiouracil is:
- A. Nausea and vomiting
- B. Hepatic dysfunction
- C. Renal dysfunction
- D. Agranulocytosis
62. A patient has palpitations, sweating, heat intolerance, a changed appearance, protruding eyeballs and pretibial myxoedema. What is the likely cause?
- A. Thyroiditis
- B. Deficiency of iodine consumption
- C. Graves' disease
- D. Hypothyroidism
63. A patient in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication will she be started on?
- A. Propylthiouracil (PTU)
- B. Radioactive iodine
- C. Carbimazole
- D. Levothyroxine
64. A patient discharged on levothyroxine is re-admitted with heart rate 42, blood pressure 70/56, blood glucose 55 and body temperature 96.8°F. She is fatigued and drowsy and has not taken levothyroxine since discharge. Most likely diagnosis?
- A. Thyroid storm
- B. Myxoedema coma
- C. Iodism
- D. Toxic nodular goitre
65. A patient with gout has recently been started on allopurinol and is undergoing dose titration. What laboratory test should be monitored at monthly follow-up visits?
- A. Urinalysis
- B. Serum urate
- C. Serum creatinine
- D. Aspartate aminotransferase
- E. No routine lab monitoring is required
66. What is recommended as the first-line pharmacologic urate-lowering approach in gout?
- A. Colchicine
- B. Xanthine oxidase inhibitor therapy with allopurinol and febuxostat
- C. Corticosteroids
- D. NSAIDs
67. Which of the following drugs is most likely to cause systemic lupus-like syndrome?
- A. Baclofen
- B. Isoniazid
- C. Methotrexate
- D. Procainamide
- E. Sulfasalazine
68. Which of the following is not a criterion for remission in rheumatoid arthritis by the ACR/EULAR 2011 criteria?
- A. C-reactive protein of 1 mg/dL or less
- B. Swollen joint count of 1 or less
- C. Tender joint count of 1 or less
- D. Physician global assessment of 1 or less
69. A 69-year-old woman on hydralazine has joint pain and chest pain with a pericardial rub. What is the diagnosis?
- A. Dermatomyositis
- B. SLE
- C. Polymyalgia rheumatica
- D. Felty syndrome
70. A 25-year-old female gives birth to a baby with complete heart block who needs a pacemaker. Which antibody is most likely to be detected in the maternal serum?
- A. Anti-dsDNA
- B. Anti-endomysial
- C. Anti-Ro/SSA
- D. Anti-Scl-70
- E. Rheumatoid factor
71. Which variable is most closely associated with the development of gout?
- A. Diet
- B. Endogenous metabolism of purines
- C. Kidney disease
- D. TNF-alpha
72. Mr Kingfish, a 67-year-old man (5'4", 100 kg), has significant pain behind his left big toe. The toe is red and swollen, consistent with podagra. He eats shrimp several times a week and drinks 3 to 4 beers with dinner. His uric acid is moderately high (7 mg/dL). In addition to diet changes, which would be a treatment of first choice for his condition?
- A. Acetaminophen
- B. Allopurinol (high dose)
- C. Ibuprofen
- D. Methotrexate
- E. Pegloticase
73. Months later Mr Kingfish says NSAIDs and diet have helped, but ibuprofen causes stomach pain and he is reluctant to take higher doses. What other anti-inflammatory drug could you recommend for acute therapy that does not have similar side effects on the stomach?
- A. Allopurinol
- B. Colchicine
- C. Ketorolac
- D. Methylprednisolone
74. At a follow-up 6 months later he still has occasional flare-ups every few weeks despite diet, and his serum urate is 6.7 mg/dL. What medication could reduce his rate of uric acid production and so reduce attacks?
- A. Allopurinol
- B. Etanercept
- C. Hydroxychloroquine
- D. Probenecid
75. His physician adds a "uricosuric" drug that inhibits anionic transporters in the proximal tubule, reducing reabsorption of uric acid by 30 to 40%. It can promote uric acid kidney stones and is not effective with reduced renal function. Which drug fits this description?
- A. Anakinra
- B. Azathioprine
- C. Colchicine
- D. Febuxostat
- E. Probenecid
76. Reed-Sternberg cells are characteristic of:
- A. Non-Hodgkin's lymphoma
- B. Hodgkin's lymphoma
- C. Castleman's disease
- D. Lymphocytic leukaemia
77. Philadelphia chromosome is present in:
- A. Acute myeloid leukaemia
- B. Acute lymphocytic leukaemia
- C. Chronic lymphocytic leukaemia
- D. Chronic myeloid leukaemia
78. Most common form of cancer in children is:
- A. Acute lymphocytic leukaemia
- B. Acute myeloid leukaemia
- C. Chronic myeloid leukaemia
- D. Chronic lymphocytic leukaemia
79. Treatments for leukaemia include all of the following, except:
- A. Chemotherapy
- B. Radiotherapy
- C. Immunotherapy
- D. Antiretrovirals
80. Thrombocytopenia can be all of the following, except:
- A. ITP
- B. ALL
- C. AML
- D. Essential thrombocythaemia
81. All of the following are features of multiple myeloma, except:
- A. Increased haemoglobin level
- B. Increased plasma abnormal cells in the bone marrow
- C. Increased peak of serum monoclonal protein on electrophoresis
- D. Pathological fractures
82. Hodgkin's disease: the most common histological subtype is:
- A. Lymphocyte predominant
- B. Mixed cellularity
- C. Nodular sclerosing
- D. Lymphocyte depleted
83. On a blood smear you notice a blast with an Auer rod in it. This patient has:
- A. A bacterial infection
- B. No disease, unless 20% of the nucleated cells have Auer rods
- C. A myelodysplastic syndrome
- D. Acute myeloid leukaemia
- E. Acute lymphoblastic leukaemia
84. All of the following terms are technically incorrect, EXCEPT:
- A. Acute lymphocytic leukaemia
- B. Chronic myeloblastic leukaemia
- C. Chronic lymphoid leukaemia
- D. Acute myeloproliferative leukaemia
- E. Chronic myeloid leukaemia
85. Examples of nephrotoxic drugs include all of the following, except:
- A. Gentamicin
- B. NSAIDs
- C. ACE inhibitors
- D. Levofloxacin
86. Complications of acute kidney injury include which of the following?
- A. Metabolic acidosis
- B. Pulmonary oedema
- C. Hyperkalaemia
- D. All of the above
- E. None of the above
87. Indications for dialysis include all except:
- A. Uraemic encephalopathy
- B. Metabolic acidosis
- C. Creatinine of 350 µmol/L
- D. Fluid overload
- E. Refractory hyperkalaemia
88. Modifiable risk factors for chronic kidney disease include:
- A. Diabetes mellitus
- B. Hypertension
- C. Use of NSAIDs
- D. History of AKI
- E. All of the above
89. At what stage of chronic kidney disease does one commence dialysis?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. Stage 4
- E. Stage 5
90. Which of the following is not an absolute contraindication to renal transplant?
- A. Active substance abuse
- B. Active malignancy
- C. Life expectancy of less than 2 years
- D. GFR below 20 mL/min
91. When should a patient be referred to nephrology?
- A. eGFR 60 or below
- B. Presence of proteinuria, microalbuminuria or microscopic haematuria irrespective of the eGFR
- C. Strong family history
- D. All of the above
92. The most important nutrition goals for patients with CKD include:
- A. Limit sodium, decrease hypertension
- B. Reduce protein
- C. Glycaemic control and weight
- D. All of the above
- E. None of the above
93. Which medication has been associated with interstitial nephritis?
- A. Metronidazole
- B. Erythromycin
- C. NSAIDs
- D. Rifampicin
- E. All of the above
94. A 28-year-old woman with HIV on antiretrovirals notices her legs swelling and reduced urine output. Which drug could be causing renal dysfunction?
- A. Zidovudine
- B. Stavudine
- C. Dolutegravir
- D. Tenofovir
95. Which of these symptoms signify onset of a stroke?
- A. Sudden confusion
- B. Sudden weakness in an arm or leg
- C. Sudden severe headache with no cause
- D. Sudden trouble seeing
- E. All of the above
96. The commonest type of stroke is:
- A. Haemorrhagic stroke
- B. Infarctive (ischaemic) stroke
- C. Cardioembolic stroke
- D. None of the above
97. All are risk factors for stroke, except:
- A. Hypertension
- B. Diabetes mellitus
- C. Low homocysteine levels
- D. High homocysteine levels
- E. Heart disease
98. The golden period for thrombolysis for stroke is:
- A. 1 hour
- B. 2 hours
- C. 6 hours
- D. 8 hours
- E. 3 hours
99. Haemorrhagic strokes constitute what percentage of all strokes?
- A. 25%
- B. 15%
- C. 85%
- D. 60%
- E. None of the above
100. Recovery of neurologic deficit in a patient with a stroke typically occurs within:
- A. 10 hours
- B. 5 hours
- C. 24 hours
- D. 48 hours
- E. None of the above