Internal Medicine MCQs (part 3)

Part 3:

1. Which one of the following serum levels would help in distinguishing an acute liver disease from chronic liver disease?
A. Amino transaminase
B. Alkaline phosphatase
C. Bilirubin
D. Albumin
Correct answer : D. Albumin
Albumin is significantly decreased in chronic liver diseases.

2. 5’-Nucleotidase activity is increased in:
A. Bone diseases
B. Prostate cancer
C. Chronic renal failure
D. Cholestatic disorders
Correct answer : D. Cholestatic disorders
5′ nucleotidase and Gamma glutamyl transferase are specific for cholestatic disorders.

3. Which one of the following conditions commonly predisposes to Colonic carcinoma?
A. Ulcerative colitis
B. Crohn’s disease
C. Diverticular disease
D. Ischaemic colitis
Correct answer : A. Ulcerative colitis
Risk of colonic carcinoma is more in Ulcerative colitis compared to Chron’s disease

4. Serum angiotensin converting enzyme may be raised in all of the following, except:
A. Sarcoidosis
B. Silicosis
C. Berylliosis
D. Bronchogenic carcinoma
Correct answer : D. Bronchogenic carcinoma
Some conditions causing increase in serum angiotensin converting enzyme

Silicosis
Granulomatous hepatitis
Asbestosis
Sarcoidosis
Leprosy
Lymphoma

5. The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes:
A. Decreased RV and TLC
B. Reduced FEV1/ FVC ratio
C. Reduced FEF 25-75%
D. Increased FRC
Correct answer : A. Decreased RV and TLC
Kyphoscoliosis is a restrictive lung disease. There is decrease in residual volume and total lung capacity. FEV1 and FVC are proportionately decreased. Hence the ratio of FEV1 to FVC remains normal or is increased. The forced expiratory flow rate (FEF) is normal. Functional residual capacity (FRC) is decreased.

6. A 50 year old man, an alcoholic and a smoker presents with a 3 hour history of increasing shortness of breath. He started having this pain while eating, which was constant and radiated to the back and interscapular region. He was a known hypertensive. On examination, he was cold and clammy with a heart rate of 130/min, and a BP of 80/40 mm Hg. JVP was normal. All peripheral pulses were present and equal. Breath sounds were decreased at the left lung base and chest x-ray showed left pleural effusion. …

7. A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic, with a left ventricular ejection fraction of 45% and an end-systolic diameter index of 2.9 cm/m2. The most appropriate treatment is:
A. Mitral valve repair or replacement
B. No treatment
C. ACE inhibitor therapy
D. Digoxin and diuretic therapy
Correct answer : A. Mitral valve repair or replacement
Surgical treatment of severe mitral regurgitation is recommended even if the person is asymptomatic when the LV ejection fraction drops below 60% and there is progressive LV dysfunction.

8. All of the following may cause ST segment elevation on EKG, except:
A. Early repolarization variant
B. Constrictive pericarditis
C. Ventricular aneurysm
D. Prizmetal angina
Correct answer : B. Constrictive pericarditis
ST elevation can occur in acute pericarditis.

9. Palpable purpura could occur in the following conditions, except:
A. Thrombocytopenia
B. Small-vessel vasculitis
C. Gonococcal infection
D. Acute meningococcemia
Correct answer : A. Thrombocytopenia
Palpable purpura does not occur in thrombocytopenia.
Causes of palpable purpura

Rocky mountain spotted fever
Acute meningococcemia
Disseminated gonococcal infection
Ecthyma gangrenosum
Henoch Schonlein purpura
Polyarteritis nodosa
Leucocytoclastic vasculitis

10. All of the following are the causes of relative polycythemia except:
A. Dehydration
B. Dengue haemorrhagic fever
C. Gaisbock syndrome
D. High altitude
Correct answer : D. High altitude
People living at high altitudes have absolute polycythemia due to increased erythropoietin synthesis.