Mount Kenya University · School of Medicine · Department of Internal Medicine
Paper details
- Unit: MBIM4100, Junior Clerkship in Internal Medicine, Bachelor of Medicine and Bachelor of Surgery.
- Sitting: Wednesday 31 January 2024, 8.00 am, main exam, time 3 hours. This is "Paper One".
- Questions: Section A has 70 multiple choice questions. Section B has 8 short answer questions (10 marks each, answer all).
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. Letters written on the scan were ignored.
- Topics tested: pneumonia, bronchiectasis, lung disease, hypertension, heart failure, endocarditis, rheumatic fever, rheumatoid arthritis and gout, anaemias and thalassaemia, liver disease and hepatitis, renal disease and stones, malaria, leishmaniasis and sepsis.
- Questions that need care: Q5, Q21, Q22, Q36, Q40, Q62, Q65 and Q69 are loosely worded or faulty. The explanation says which option is best and why.
Section A: Multiple choice questions
1. Which of the following is TRUE regarding the development of pneumonia?
- a) Pneumonia is an acute inflammatory condition within the parenchyma of the lung
- b) Immunocompromised individuals are at an increased risk of developing pneumonia
- c) Pneumonia often develops as a consequence of bacterial colonisation and microaspiration of upper respiratory tract secretions during a period of impaired host pulmonary defence mechanisms
- d) All of the above
2. Approximately what percentage of adult cases of community-acquired pneumonia involve both bacterial and viral pathogens?
- a) 10%
- b) 30%
- c) 50%
- d) 80%
3. All of the following are common symptoms of community-acquired pneumonia in adults, EXCEPT:
- a) Fever
- b) Bradycardia
- c) Sputum production
- d) Signs of consolidation
4. In adults with community-acquired pneumonia, which of the following is NOT among the minor criteria that would suggest the need for ICU admission?
- a) Uraemia
- b) Leukopenia
- c) Decreased respiratory rate
- d) Low PaO2/fraction of inspired oxygen ratio
5. Macrolides may be an acceptable choice for the outpatient treatment of mild pneumonia in previously healthy adults who have not been exposed to antimicrobials within the past:
- a) 2 weeks
- b) 30 days
- c) 3 months
- d) 12 months
6. As ongoing inflammation changes airway anatomy in bronchiectasis, colonisation with which organism tends to indicate severe disease and a rapid decline in lung function?
- a) Haemophilus influenzae
- b) Moraxella catarrhalis
- c) Pseudomonas aeruginosa
- d) Staphylococcus aureus
7. Which complication of bronchiectasis is most likely to result in massive haemoptysis?
- a) Vasoconstriction
- b) Neovascularisation of bronchial arteries
- c) Pulmonary hypertension
- d) Right-sided heart failure
8. Which of the following are symptoms of bronchiectasis?
- a) Chest pain, fever
- b) Shortness of breath
- c) Coughing up blood
- d) All of the above
9. A copious amount of foul-smelling cough with purulent sputum is a symptom of:
- a) Chronic bronchitis
- b) Asthma
- c) Bronchiectasis
- d) None of the above
10. Pulmonary fibrosis is not produced by:
- a) Tuberculosis
- b) Cor pulmonale
- c) Progressive systemic sclerosis
- d) Rheumatoid arthritis
11. The following is a cause of haemoptysis:
- a) Tuberculosis
- b) Chronic obstructive pulmonary disease
- c) Fibrosis
- d) None of the above
12. The following are true regarding bronchial carcinoma EXCEPT:
- a) Increased risk in smokers
- b) More common in males
- c) Associated with frank haemoptysis
- d) More common in children
13. The following are members of the suppurative lung diseases EXCEPT:
- a) Lung abscess
- b) Bronchiectasis
- c) Lung fibrosis
- d) Empyema with bronchopleural fistula
14. Common symptoms in pulmonary infarction are:
- a) Dyspnoea
- b) Chest pain
- c) Haemoptysis
- d) All of the above
15. The following are occupational lung diseases:
- a) Asbestosis
- b) Silicosis
- c) Tuberculosis
- d) A and B
16. Asbestosis is related to an increased risk of:
- a) Mesothelioma
- b) Pulmonary infarction
- c) Gastritis
- d) None of the above
17. Which class of antihypertensive drugs is not recommended for initial treatment?
- a) Thiazide-type diuretics
- b) Potassium-sparing diuretics
- c) ACE inhibitors
- d) Angiotensin receptor blockers
18. A 55-year-old woman, devoted to singing in her church choir, has hypertension that has been well controlled with enalapril for the past month. She reports a new, intolerable side effect and asks to be switched. Which adverse effect is most likely to be intolerable to her?
- a) Frequent urination
- b) Dysgeusia
- c) Dry cough
- d) Headache
19. The following investigations are appropriate as part of the initial assessment of a patient with newly diagnosed hypertension EXCEPT:
- a) Blood glucose
- b) Renal function tests
- c) Transthoracic echocardiogram
- d) Serum lipids
20. The following non-pharmacological methods reduce blood pressure in hypertension EXCEPT:
- a) Weight reduction
- b) Increased fruit and vegetable intake
- c) Regular aerobic exercise
- d) Drinking alcohol on the weekends only
21. Hypertension is caused by all of the following EXCEPT:
- a) Renal artery stenosis
- b) Coarctation of the aorta
- c) Oral contraceptive use
- d) Renin-secreting tumours
22. All of the following are aetiologies for dilated cardiomyopathy EXCEPT:
- a) Metabolic
- b) Viral
- c) Haemochromatosis
- d) Ischaemic
23. Which of the following is a sign or symptom of right ventricular failure in heart failure?
- a) Agitation
- b) Dyspnoea
- c) Fatigue
- d) Fluid accumulation
24. Ventricular septal defect (VSD) is the most common congenital heart defect. Which condition is it most likely to be associated with?
- a) Congenital rubella
- b) Down's syndrome
- c) Fetal alcohol syndrome
- d) Maternal diabetes
25. What are the characteristics of stable angina?
- a) Chest pain that occurs with exertion and/or emotional stress
- b) Severe and crushing chest pain (over 20 minutes)
- c) Chest pain that occurs at rest
- d) Bradycardia
26. What is the most frequent aetiologic agent of acute infective endocarditis in IV drug abusers?
- a) Streptococcus viridans
- b) Staphylococcus aureus
- c) Staphylococcus epidermidis
- d) Streptococcus bovis
27. Rheumatic fever is inflammation of the joints, heart, skin and nervous system that occurs in children as a complication of untreated streptococcal throat infection. Which part of the body may be permanently damaged in a small percentage of people?
- a) Digestive tract
- b) Ears
- c) Heart
- d) Lungs
28. Which is usually the first symptom of rheumatic fever?
- a) Chest pain or palpitations
- b) Jerky, uncontrollable movements
- c) Joint pain and fever
- d) Rash
29. Acute rheumatic fever is primarily caused by which bacterial species?
- a) Staphylococcus aureus
- b) Streptococcus pneumoniae
- c) Streptococcus agalactiae
- d) Streptococcus pyogenes (Group A Streptococcus)
30. Many disorders can simulate RA. In the differential diagnosis, which of the following distinguishes SLE from RA?
- a) Synovial fluid crystals
- b) Skin lesions
- c) RF
- d) GI symptoms
31. An elderly lady has chronic knee pain bilaterally that increases with activity and decreases with rest. The most likely diagnosis is:
- a) Osteoarthritis
- b) Rheumatoid arthritis
- c) Septic arthritis
- d) Tuberculous arthritis
32. Which of the following is TRUE about the aetiology of RA?
- a) It is likely an autoimmune disease
- b) It is believed that infectious, genetic and hormonal factors may be contributing factors
- c) If one monozygotic twin has RA, there is a 1 in 2 chance that the other twin will develop the same disease
- d) Both A and B
33. Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?
- a) Consumption of too much alcohol
- b) Inadequate elimination of uric acid via the kidneys
- c) Infection causing build-up of uric acid
- d) Production of too much uric acid
34. Which joint is most commonly affected by uric acid crystal accumulation and gout attacks?
- a) Big toe
- b) Fingers
- c) Hip
- d) Shoulder
35. Sudden gout flare-ups can occur without warning. Which of the following is NOT a known trigger?
- a) Illness
- b) Injury
- c) Anti-depressant medication
- d) Anti-hypertensive medication
36. Which of the following is not expected in a case of microcytic hypochromic anaemia?
- a) Reduced serum iron
- b) Reduced total RBC distribution width
- c) Normal ferritin levels
- d) Increased TIBC
37. Which of the following does NOT describe 1 unit of whole blood for transfusion?
- a) 450 ml in volume
- b) 100 ml of anticoagulant
- c) Has dysfunctional platelets
- d) None of the above
38. Which is usually associated with parvovirus B19 infection in those with hereditary spherocytosis?
- a) Gallstones
- b) Aplastic crisis
- c) Gallstones (repeated option)
- d) Haemolytic crisis
39. A 65-year-old fisherman from Homa Bay has anaemia, posterior column dysfunction and an extensor plantar response. Likely cause?
- a) Friedreich's ataxia
- b) Tabes dorsalis
- c) Vitamin B12 deficiency
- d) Vitamin B1 deficiency
40. Deletion of one alpha globin gene on one chromosome is best defined as:
- a) Alpha thalassaemia silent carrier
- b) Alpha thalassaemia major
- c) Hb Barts hydrops fetalis
- d) Alpha thalassaemia trait
41. Which is caused by deletion of all four alpha globin genes?
- a) HbH
- b) Beta thalassaemia major
- c) Hb Barts
- d) Alpha thalassaemia trait
42. Which finding is diagnostic of iron deficiency anaemia?
- a) Increased TIBC, decreased serum ferritin
- b) Decreased TIBC, decreased serum ferritin
- c) Increased TIBC, increased serum ferritin
- d) Decreased TIBC, increased serum ferritin
43. Which of the following is NOT a prognostic factor for acute pancreatitis?
- a) Serum amylase
- b) Serum calcium
- c) Serum glucose
- d) Serum AST
44. Which condition is associated with transudative ascites?
- a) Malignant peritonitis
- b) Budd-Chiari syndrome
- c) Cirrhosis of the liver
- d) Chylous ascites
45. All of the following are features of hepatocellular failure EXCEPT:
- a) Foetor hepaticus
- b) Flapping tremor
- c) Ascites
- d) Haematemesis
46. Interstitial nephritis is common with:
- a) NSAIDs
- b) Blackwater fever
- c) Rhabdomyolysis
- d) Tumour lysis syndrome
47. Which nucleic acid is present in hepatitis B virus?
- a) ds DNA
- b) ss DNA
- c) ss RNA
- d) ds RNA
48. A 53-year-old woman from Mwea has progressive jaundice with abdominal pain that radiates to the back and weight loss. Which investigation would be MOST useful?
- a) LFT
- b) CT abdomen
- c) Alpha-fetoprotein
- d) Alkaline phosphatase
49. Immunological evidence of immunity to hepatitis B is the presence of:
- a) Hepatitis B core antibodies
- b) Hepatitis B core antigens
- c) Hepatitis B surface antibodies
- d) Hepatitis B surface antigen
50. Jaundice in acute cholecystitis can be classified under:
- a) Haemolytic
- b) Obstructive
- c) Congenital hyperbilirubinaemia
- d) Hepatocellular
51. This is incorrect regarding hepatitis A virus:
- a) It is one of the known causes of hepatocellular carcinoma
- b) It may be cultured in cell culture to be used in primate and human cells
- c) It is one of the most stable viruses that infects humans
- d) None of these
52. Which is NOT true regarding the physiology of portal hypertension?
- a) Both the portal blood flow and portal resistance increase
- b) There is an extensive hyperdynamic circulation
- c) Blood flow towards the portal vein increases because the systemic venous pressure increases
- d) Splanchnic vasodilatation is caused by relaxation of splanchnic arterioles and splanchnic hyperaemia
53. The most common neurological disorder seen in chronic renal failure is:
- a) Restless leg syndrome
- b) Peripheral neuropathy
- c) Dementia
- d) Ataxia
54. A 45-year-old man has fever, chest pain, haemoptysis and haematuria. Urea 16 mmol/L, creatinine 140 µmol/L, eGFR 16, and anti-glomerular basement membrane (anti-GBM) antibodies. Likely diagnosis?
- a) Vasculitis
- b) Wegener's granulomatosis
- c) Goodpasture's syndrome
- d) Pyelonephritis
55. Which is least relevant to history-taking when interviewing a patient with recurrent UTI?
- a) Family history of postmenopausal UTIs
- b) Spermicide use
- c) Childhood voiding dysfunction
- d) History of urologic surgery
56. In patients with stone disease, all of the following are true EXCEPT:
- a) Gross haematuria is always present
- b) Pyuria may occur in the absence of infection
- c) The presence of cystine, urate or calcium oxalate crystals may indicate the type of calculus
- d) Urinary pH may provide a clue to the type of stone found
57. A 75-year-old woman with recurrent urinary tract infections (Proteus on culture) has a staghorn calculus on CT. What is the most likely stone composition?
- a) Cysteine
- b) Uric acid
- c) Struvite
- d) Calcium oxalate
58. A 32-year-old man has a renal stone 3 years after laparotomy and ileal resection for Crohn's disease. Which metabolic factor most likely accounts for this?
- a) Hypocitraturia
- b) Hyperoxaluria
- c) Hyperuricosuria
- d) Hypocalciuria
59. Haematuria, hypertension, proteinuria and red cell casts in the urine are indicative of:
- a) Nephrotic syndrome
- b) Hepatorenal syndrome
- c) Nephritic syndrome
- d) Rhabdomyolysis
60. A clinical situation in which the immune system or a therapy failed to eliminate all the Plasmodium infected erythrocytes, and numbers begin to increase again with subsequent clinical symptoms, is called:
- a) Latency
- b) Re-infection
- c) Relapse
- d) Recrudescence
61. Blackwater fever is a special manifestation of malaria caused by:
- a) P. falciparum
- b) P. malariae
- c) P. ovale
- d) P. vivax
62. Which of the following regarding Plasmodium falciparum is NOT true?
- a) Causes more severe disease in pregnancy
- b) Is associated with recurrent relapses after initial treatment because of liver hypnozoites
- c) Is the only malarial parasite causing greater than 20% parasitaemia
- d) Infection is typically associated with thrombocytopenia
63. Crescent-shaped or banana-shaped gametocytes are seen in infection with:
- a) Plasmodium vivax
- b) Plasmodium falciparum
- c) Plasmodium ovale
- d) Plasmodium malariae
64. What is the reservoir of kala-azar?
- a) Rodent
- b) Dog
- c) Fox
- d) All of the above
65. What is the drug of choice for the treatment of leishmaniasis?
- a) Sodium stibogluconate
- b) Amphotericin B
- c) Paramomycin
- d) Pentamidine
66. Which is a method of diagnosing leishmaniasis?
- a) Blood test
- b) Urine test
- c) Skin biopsy
- d) All of the above
67. Which is the best matched definition of SIRS?
- a) An acquired infective state
- b) Pyrexia, leucocytosis and tachycardia or tachypnoea
- c) Hypovolaemic state evidenced post-Hartmann bolus resuscitative attempts
- d) Oliguria and organ failure
68. Noradrenaline will be most useful in which kind of shock?
- a) Cardiogenic
- b) Distributive
- c) Ischaemic
- d) Hypovolaemic
69. Which of the following is the LEAST clinically relevant to guide uncomplicated treatment of septic shock?
- a) Skin temperature
- b) Urine output
- c) Carotid pulses
- d) Respiratory rate
70. A transudative pleural effusion is present in all EXCEPT:
- a) Pulmonary embolism
- b) Chronic liver disease
- c) Chronic renal failure
- d) Cirrhosis