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: Wednesday 14 August 2019, 8.00 am, special/supplementary exam, time 2 hours. This is "Paper Two".
- 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).
- Numbering: the paper prints the number 32 twice, so the second one is shown here as 32b. One page (page 9) appears twice in the scanned file.
- 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: lupus and scleroderma, anaemias and bleeding disorders, lung and pleural disease, DVT and heart failure, HIV and antiretroviral therapy, gastroenterology, thyroid disease, gout, leukaemia and lymphoma, kidney disease and stroke.
- Questions that need care: Q10, Q31, Q47, Q49, Q52, Q56, Q70 and Q89 are loosely worded or have more than one arguable option. The explanation says what I chose and why.
Section A: Multiple choice questions
1. Which of the following drugs is likely to cause a lupus-like syndrome?
2. Which antibodies are useful in making a diagnosis of systemic lupus erythematosus, except:
- A. ANA
- B. dsDNA
- C. Anti-centromere antibodies
- D. Anti-histone antibodies
3. What is the typical skin lesion in scleroderma?
- A. Butterfly rash over the face
- B. Vasculitic ulcers on the legs
- C. Thickened, hard skin
- D. Pitting oedema
4. In what condition are anti-centromere antibodies found?
- A. CREST syndrome
- B. SLE
- C. HIV
- D. Pneumonia
- E. Polymyalgia rheumatica
5. All the following are features of scleroderma, except:
- A. Dysphagia
- B. Raynaud's phenomenon
- C. Skin contracture
- D. Calcification in all long bones
6. A 35-year-old lady has dysphagia, Raynaud's phenomenon and sclerodactyly. Investigations show a positive antinuclear antibody. The diagnosis is:
- A. SLE
- B. Systemic sclerosis
- C. Mixed connective tissue disorder
- D. Rheumatoid arthritis
7. Which of the following is NOT a cause of microcytic anaemia?
- A. Thalassaemia
- B. Anaemia of chronic disease
- C. Iron deficiency anaemia
- D. Pancytopenia
- E. Lead poisoning
8. A patient with low MCV has a high serum ferritin and low TIBC. What is the most likely cause of the anaemia?
- A. Iron deficiency
- B. Anaemia secondary to inflammation
- C. Thalassaemia
- D. Haemoglobinopathy
9. Iron is absorbed in the:
- A. Stomach
- B. Duodenum
- C. Jejunum
- D. Ileum
10. Bone marrow transplant is indicated in which patient?
- A. 55 years old
- B. 34 years old
- C. 76 years old
- D. 82 years old
- E. 67 years old
11. Haemophilia A is characterised by which of the following features?
- A. Deficiency of factor VIII
- B. Prolonged INR
- C. Prolonged PT
- D. Deranged liver function tests
12. Haemophilia A is inherited by:
- A. Autosomal dominant
- B. Autosomal recessive
- C. X-linked recessive
- D. X-linked dominant
13. The term poikilocytosis means:
- A. RBCs with a normal content of haemoglobin
- B. Abnormally shaped RBCs
- C. RBCs that are irregular in size
- D. Increased content of haemoglobin
14. Anisocytosis is the change in the:
- A. Shape of RBCs
- B. Size of RBCs
- C. Haemoglobin content in RBCs
- D. Deposits within the nucleus
15. Disseminated intravascular coagulation is characterised by all of the following except:
- A. Prolonged APTT
- B. Prolonged PT
- C. Prolonged thrombin time
- D. Reduced fibrinogen levels
- E. Increased fibrinogen levels
16. Which of the following myelodysplastic syndromes has been found to have the poorest prognosis?
- A. Refractory anaemia
- B. Refractory anaemia with ringed sideroblasts
- C. Refractory anaemia with excess blasts
- D. Refractory cytopenias with multilineage dysplasia
17. Bronchial asthma is characterised by all the following, except:
- A. Hyperactive airway
- B. Clubbing
- C. Spasmodic cough
- D. Bilateral chest wheezes
18. All of the following are common causes of empyema, except:
- A. Staphylococcal pneumonia
- B. Lung abscess
- C. Measles
- D. Chest injury
19. Wheezing is a hallmark symptom of:
- A. Asthma
- B. COPD
- C. Cystic fibrosis
- D. Lung cancer
20. "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
21. All of the following increase the risk of developing lung cancer except:
- A. Smoking
- B. Exposure to radon or asbestos
- C. Exposure to coal products or radioactive substances such as uranium
- D. History of seasonal allergies
22. Which of the following is not a recognised manifestation of tuberculosis?
- A. Clubbing
- B. Gibbus
- C. Pericardial effusion
- D. Silicosis
23. What may be heard on thoracic auscultation in a patient with a pneumothorax?
- A. Increased lung sounds as the patient struggles to breathe
- B. Increased heart sounds
- C. Decreased or absent lung sounds
- D. Absent heart sounds
24. What causes a pneumothorax?
- A. An accumulation of pus in the thoracic cavity
- B. An accumulation of fluid in the thoracic cavity
- C. An accumulation of air in the thoracic cavity
- D. An accumulation of blood in the thoracic cavity
25. What is the first-line management for DVT?
- A. Aspirin
- B. Clopidogrel
- C. Warfarin
- D. Fondaparinux
- E. Low molecular weight heparin
26. What is the target INR for patients on warfarin for the management of DVT?
- A. 1 to 2
- B. 2 to 3
- C. 4 to 5
- D. 5 to 6
27. Which of the following is not included in the Wells score?
- A. Obesity
- B. Immobilisation
- C. Active cancer
- D. Previous DVT
- E. Previously bedridden
28. How long should a patient with recurrent DVT be anticoagulated for?
- A. 1 year
- B. 5 years
- C. 10 years
- D. Lifelong
29. The following are symptoms of heart failure, except:
- A. Shortness of breath
- B. Warm hands
- C. Reduced urinary output
- D. Oedema
- E. None of the above
30. Which of the following is not a primary cause of heart failure?
- A. Cardiomyopathy
- B. Blood pressure
- C. Polio
- D. Coronary artery disease
- E. Diabetes
31. Medications are an important component of heart failure. Which of the following is not routinely used in management of heart failure?
- A. Diuretics
- B. Digoxin
- C. Pantoprazole
- D. Benzodiazepines
- E. ACE inhibitors
32. In examining the pleural fluid, the following characteristics imply an exudative effusion except:
- A. Pleural/serum protein ratio greater than 0.5
- B. Pleural pH of 7.40
- C. Pleural/serum LDH ratio greater than 0.6
- D. WBC content of 6000
32. (the paper's second Q32) Which of the following might you ask the patient to help identify the cause of radiographic abnormalities?
- A. Travel history
- B. Occupational exposures
- C. Smoking history
- D. Past medical history
- E. All of the above
33. All of the following are Light's criteria (for the diagnosis of pleural exudative effusions) EXCEPT:
- A. Pleural proteins/serum proteins greater than 0.5 ratio
- B. Pleural LDH/serum LDH greater than 0.6 ratio
- C. LDH greater than 2/3 upper limit of normal for serum
- D. Total proteins greater than 2/3 upper limit of normal for serum
34. Which of the following is the correct answer?
- A. Pleural effusion is a collection of fluid in the alveoli
- B. Pleural effusion is a collection of fluid in the airways of the lungs
- C. Pleural effusion is the collection of fluid in the pleural cavity
- D. Pleural effusion is a collection of fluid in the airspace
35. Symptoms of fibromyalgia include all of the following except:
- A. Pain
- B. Fatigue
- C. Vomiting and diarrhoea
- D. General body malaise
36. Treatment of fibromyalgia includes all of the following except:
- A. Antidepressants
- B. Muscle relaxants
- C. Sedatives
- D. Anticonvulsants
37. Different forms of lupus include all of the following except:
- A. Discoid lupus
- B. Neonatal lupus
- C. Diffuse lupus
- D. Drug-induced lupus
38. Which of these is a common symptom of lupus?
- A. Fever
- B. Skin rash
- C. Joint pains
- D. All of the above
39. Which of the following organs can be affected by SLE?
- A. Cardiovascular system
- B. Haematologic system
- C. Pulmonary
- D. None of the above
- E. All of the above
40. Which is the commonest group of people affected by lupus?
- A. Men
- B. Women
- C. Children
- D. Infants
41. Which of these are symptoms of HIV infection?
- A. Fatigue
- B. Enlarged lymph nodes
- C. Fever
- D. Weight loss
- E. All of the above
42. HIV attacks which type of cell of the immune system?
- A. Red blood cells
- B. Platelets
- C. White blood cells
- D. All of the above
43. Which of the following classes of drugs is not used for the treatment of HIV?
- A. Nucleoside reverse transcriptase inhibitors
- B. Calcineurin inhibitors
- C. Integrase inhibitors
- D. Non-nucleoside reverse transcriptase inhibitors
44. First-line therapy for treatment of HIV is which of the following regimens?
- A. AZT, 3TC, EFV
- B. TDF, 3TC, DTG
- C. TDF, FTC, EFV
- D. TDF, 3TC, EFV
45. The highest number of HIV infections worldwide is found in:
- A. Indonesia
- B. Malaysia
- C. Sub-Saharan Africa
- D. Europe
46. The commonest side effect of tenofovir includes:
- A. Haematologic abnormalities
- B. Renal dysfunction
- C. Liver dysfunction
- D. None of the above
47. Which of the following ARVs is contraindicated in the management of HIV?
- A. Zidovudine
- B. Nevirapine
- C. Efavirenz
- D. Dolutegravir
48. In which body fluid is HIV not present?
- A. Blood
- B. Semen
- C. Sweat
- D. Breast milk
49. Which group of individuals requires ARVs immediately?
- A. Discordant couples
- B. HIV-positive pregnant mothers
- C. Health care workers
- D. Same-sex partners
50. The main side effect of zidovudine is:
- A. Macrocytic anaemia
- B. Nausea
- C. Peripheral neuropathy
- D. Liver dysfunction
51. Gastro-oesophageal reflux can be reliably diagnosed by:
- A. Symptoms
- B. Biopsy histology of the gastro-oesophageal junction
- C. Manometry
- D. 24-hour pH monitoring
- E. Bernstein test
52. Drugs which have shown potential to improve mortality in gastrointestinal bleeding:
- A. Propranolol
- B. Isosorbide dinitrate
- C. Ranitidine
- D. Somatostatin
- E. Terlipressin
53. Barrett's oesophagus is an example of:
- A. Metaplasia
- B. Dysplasia
- C. Carcinoma in situ
- D. Neoplasia
54. Barrett's oesophagus increases the risk of developing:
- A. Squamous cell carcinoma
- B. Adenocarcinoma
- C. Sarcoma
- D. Adenoma
55. Where is H. pylori commonly found?
- A. Antrum
- B. Body
- C. Cardia
- D. Fundus
- E. Duodenum
56. Which of the following is not a main cause of peptic ulcer disease?
- A. NSAIDs
- B. Smoking
- C. Alcohol
- D. H. pylori infection
57. A patient is on management for hyperthyroidism. Which is the ideal drug?
- A. Levothyroxine
- B. Dexamethasone
- C. Lugol's iodine
- D. Potassium perchlorate
- E. Carbimazole
58. Which is the autoimmune disorder where the body attacks the thyroid gland, causing it to stop releasing T3 and T4? The patient has the typical features of hypothyroidism but may also present with what other sign?
- A. Myxoedema coma; joint pain
- B. Thyroid storm; memory loss
- C. Hashimoto's thyroiditis; goitre
- D. Toxic nodular goitre (TNG); goitre
59. The symptoms of hypothyroidism are:
- A. Dry skin and hair
- B. Depression
- C. Joint and muscle pain
- D. All of the above
60. Name the condition marked by a low TSH:
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Goitre
- D. Thyroid cancer
61. Gout is a type of arthritis that occurs due to the accumulation of ________ in the blood that causes needle-like crystals to form around the joints.
- A. Purines
- B. Creatinine
- C. Uric acid
- D. Amino acids
62. Identify which patient is at MOST risk for developing gout:
- A. A 56-year-old male who reports consuming foods low in purines
- B. A 45-year-old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin
- C. A 39-year-old female hospitalised with bulimia who has a BMI of 24
- D. A 27-year-old female with ulcerative colitis
63. A patient is post-op from surgery with a history of gout. As the nurse, you know gout tends to start at what site?
- A. Elbow
- B. Big toe
- C. Thumb or index finger
- D. Knees
64. A 75-year-old male admitted for chronic renal failure has white/yellowish painless nodules on the helix of the ear and fingers. You document this finding as:
- A. Nodosa
- B. Keloid
- C. Dermoid
- D. Tophi
65. A patient with gout should avoid medications that can increase uric acid. Which medication below is NOT known to increase uric acid levels?
- A. Aspirin
- B. Niacin
- C. Cyclosporine
- D. Paracetamol
66. What is the typical skin lesion in scleroderma?
- A. Pitting oedema
- B. Butterfly rash over the face
- C. Vasculitic ulcers on the legs
- D. Thickened, hardened skin
- E. Associated psoriasis
67. Components of scleroderma include all of the following except:
- A. Sclerodactyly
- B. Raynaud's phenomenon
- C. Cobblestone appearance in the colon
- D. Calcinosis cutis
- E. Telangiectasia
68. A 35-year-old lady has dysphagia, Raynaud's phenomenon and sclerodactyly, and a positive antinuclear antibody. Her likely diagnosis is:
- A. SLE
- B. Systemic sclerosis
- C. Mixed connective tissue disorder
- D. Rheumatoid arthritis
69. Anti-centromere antibodies are most commonly associated with:
- A. Diffuse cutaneous systemic sclerosis
- B. Mixed connective tissue disease
- C. CREST syndrome
- D. Polymyositis
70. What is the antibody that is present in patients with scleroderma at the onset of the disease?
- A. Anti-centromere
- B. Anti-nuclear
- C. dsDNA
- D. Anti-Ro/SSA
71. What is the treatment for active inflammation of polymyositis and dermatomyositis?
- A. Cyclophosphamide
- B. IV immunoglobulin
- C. Corticosteroids
- D. Cyclosporine
72. The cause of leukaemia is unknown but risk factors associated with it include:
- A. Exposure to high amounts of radiation
- B. Exposure to chemicals like benzene
- C. Genetic problems like Down's syndrome
- D. All of the above
73. Common malignancies associated with HIV include all except:
- A. Non-Hodgkin's lymphoma
- B. Cervical cancer
- C. Anorectal cancer
- D. Primary CNS lymphoma
- E. Gastric cancer
74. Subtypes of Hodgkin's lymphoma include which of the above?
- A. Nodular sclerosing
- B. Mixed cellularity
- C. Lymphocyte predominant
- D. Lymphocyte depleted
- E. All of the above
75. Which of the following is first-line treatment for hyperkalaemia?
- A. Calcium gluconate
- B. Nebulised salbutamol
- C. Insulin and dextrose
- D. All of the above
- E. None of the above
76. Which of the following is not a feature of the nephrotic syndrome?
- A. Proteinuria greater than 5 g/day
- B. Hypercholesterolaemia
- C. Microscopic haematuria
- D. Peripheral oedema
- E. Hypoalbuminaemia
77. A 55-year-old man is admitted with a massive GI bleed. He is at risk for what type of acute kidney injury?
- A. Post-renal
- B. Intra-renal
- C. Pre-renal
- D. Intrinsic-renal
78. ________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream, but is excreted through the urine.
- A. Urea
- B. Creatinine
- C. Potassium
- D. Magnesium
79. A patient with AKI has a urinary output of 350 mL/day. Morning labs show raised BUN and creatinine with potassium 6 mEq/L. What type of diet is most appropriate?
- A. Low sodium, high protein and low potassium
- B. High protein, low potassium and low sodium
- C. Low protein, low potassium and low sodium
- D. High protein and high potassium
80. The most common type of acute kidney injury in the inpatient setting is:
- A. Pre-renal
- B. Post-renal
- C. Intrinsic renal
- D. Pseudo renal
- E. Functional renal
81. Which of the following drugs can be administered to prevent contrast-induced nephropathy?
- A. Furosemide
- B. Dopamine
- C. N-acetylcysteine
- D. Nesiritide
82. Which of the following drugs can cause acute tubular necrosis?
- A. Quinolones
- B. Furosemide
- C. Acyclovir
- D. Gentamicin
83. Complications of kidney transplants include which of the following?
- A. Infections
- B. Blood loss
- C. Graft loss
- D. All of the above
- E. None of the above
84. The most common systemic disease that causes end stage renal failure is:
- A. Hypertension
- B. Diabetes mellitus
- C. Polycystic kidney disease
- D. Alport's syndrome
- E. Wegener's vasculitis
85. Patients with progressive chronic renal failure typically develop:
- A. Haemolytic anaemia
- B. Aplastic anaemia
- C. Normochromic normocytic anaemia
- D. Hypochromic microcytic anaemia
- E. Macrocytic anaemia
86. Benign prostatic hypertrophy will cause acute kidney injury through which mechanism?
- A. Pre-renal
- B. Intra-renal
- C. Post-renal
- D. All of the above
87. The normal values for blood urea nitrogen (BUN) is:
- A. 12 to 20 µmol/L
- B. 2.5 to 7.1 µmol/L
- C. 60 to 120 µmol/L
- D. None of the above
88. Which of the following is a complication of chronic kidney disease?
- A. Increased libido
- B. Hypokalaemia
- C. Anaemia
- D. Hypotension
89. Which of the following is a contraindication to renal transplant?
- A. Hepatic insufficiency
- B. HIV infection
- C. Diabetes mellitus
- D. Hypertension
90. How do you treat an anaemia associated with chronic kidney disease?
- A. B12 supplements
- B. Erythropoietin
- C. Blood transfusion
- D. Folate supplements
91. Which of the following options does not cause chronic kidney disease?
- A. Diabetes mellitus
- B. Hypertension
- C. Hypercholesterolaemia
- D. Polycystic kidney disease
92. Which stage of kidney disease is a patient with an eGFR of 42 mL/min?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. Stage 4
- E. Stage 5
93. Risk factors for stroke include:
- A. Diabetes mellitus
- B. Hypertension
- C. Obesity
- D. None of the above
- E. All of the above
94. Infarctive strokes constitute what percentage of all strokes?
- A. 65%
- B. 85%
- C. 10%
- D. 45%
- E. None of the above
95. Which of the following tests is not useful to make a diagnosis of a stroke?
- A. CT cerebral angiogram
- B. Urinalysis
- C. Carotid Doppler ultrasound
- D. MRI brain
96. Blood pressure in a patient with infarctive stroke:
- A. Should be dropped abruptly
- B. Should be dropped gradually
- C. Should be given a combination of 4 drugs
- D. None of the above
97. What is a risk factor of stroke that you can change?
- A. Hypercholesterolaemia
- B. Age
- C. Family history
- D. Genetic predisposition
98. Which of the following drugs is not useful in the management of a stroke?
- A. Anti-hypertensives
- B. Oral hypoglycaemic agents
- C. Aspirin
- D. Statin
- E. Antivirals
99. A cardiovascular accident on the right side of the brain affects which side of the body?
- A. Right side
- B. Left side
- C. Back
- D. Front
- E. None of the above
100. Which of the following drugs can help prevent further strokes?
- A. Warfarin
- B. Clexane
- C. Heparin
- D. Aspirin