1.	When estimating plasma lipids:
 
a.	a test performed within 3 weeks of a myocardial infarction will be an accurate
	basis for treatment. 
b.	HDL cholesterol varies with age 
c.	lipids are typically raised in patients receiving long-term dialysis
d.	excessive alcohol intake raises lipid levels 
e.	failure to decrease cholesterol levels despite strict adherence to an adequate
	diet suggests a genetic cause

2.	Bulimia nervosa:

a.	typically involves an obsessional personality
b.	typically develops earlier than anorexia nervosa
c.	has a better outcome than anorexia nervosa
d.	is associated with laxative abuse
e.	is typically accompanied by excessive dental caries

 3.	Endometriosis: 


a.	is the commonest cause of secondary dysmenorrhea
b.	typically produces a colicky pain which starts on the first day of the period
c.	produces symptoms the severity of which is proportional to the extensiveness
	of the disease	
d.	can sometimes be effectively treated by danazol
e.	is associated with infertility

 4.	The following drugs have been banned by the Sports Council for competitive athletes: 

a.	Ibuprofen
b.	Coproxamol
c.	Pseudoephedrine
d.	Sodium cromoglycate
e.	Terfenadine

 5.	Non-accidental injury 

a.	toddlers are at a greater risk than babies
b.	a colour photograph can be submitted as legal evidence
c.	any bruise on a baby under 6 months is a warning sign
d.	case conferences are typically organised by the consultant paediatrician
e.	a torn frenulum of the tongue is a warning sign


 6.	Leg ulcers: 

a.	large gravitational ulcers are always painful
b.	treating superficial infection with antibiotics has been shown to be beneficial
c.	ulcers caused by arterial disease are typically treating by compression bandaging
d.	in diabetic ulcers the dressing should be left in situ for no more than 1 week
e.	diuretics have been shown to be of benefit in the treatment of associated oedema

 7.	Tinnitus has shown to be associated with: 

a.	anxiety
b.	occupational hearing loss
c.	otosclerosis
d.	Meniere's disease
e.	Paget's disease

 8.	The following are recognised causes of blistering eruptions: 

a.	staphylococcal skin infections
b.	dermatitis herpetiformis
c.	pemphigoid
d.	hand, foot and mouth disease
e.	scabies

 9.	Cataracts: 

a.	diabetic cataracts typically progress more rapidly than those in non-diabetics
b.	surgery is more successful if performed at an early age
c.	there is an increased risk of retinal detachment after cataract surgery
d.	patients are typically hospitalised for 10 days or more after removal of a 	
	cataract
e.	binocular vision is lost after a lens implant


 10.	Ethical principles dictate that a doctor: 

a.	should divulge the HIV positivity of a patient to the patient's spouse
b.	should divulge details of suspected child abuse to a social worker without the
	parent's consent
c.	report a colleague for unprofessional conduct
d.	obtain the patients' consent before notifying an infectious disease
e.	has the absolute right to determine to whom a patient should be referred for a
	second opinion


 11.	When evaluating a report of a clinical trial: 

a.	results are invalid if the trial is not of double-blind construction
b.	inadequate sample size has been shown to produce false-positives and
	false-negatives
c.	withdrawal of patients from a trial by the investigator may be a cause of bias
d.	if randomisation is conducted properly, chance differences are inevitable
e.	control and treatment groups must be equivalent in size

 12.	Medical records: 

a.	an NHS practitioner is legally obliged to keep records
b.	the records held by a general practitioner are his legal property
c.	the cost of conversion to A4 records is borne by the F.H.S.A.
d.	an attached district nurse has legal right of access to the notes of a patient
	who has been referred to her by the G.P.
e.	patients have legal right of access to what a practitioner has extracted from
	his records for an insurance report.

 13.	Osteoporosis in the elderly is associated with: 

a.	a history of back pain which remits spontaneously
b.	a previous history of urinary stone
c.	a raised serum phosphate
d.	a dorsal kyphosis
e.	an equal sex incidence

 14.	Polymyalgia rheumatica: 

a.	is the commonest inflammatory rheumatic disease in the elderly
b.	characteristically causes severe stiffness late in the day
c.	anorexia and weight loss are typical presenting features
d.	the initial ESR result is a guide to severity and prognosis
e.	NSAIDs are the treatment of choice whilst awaiting the results of further
	investigations


 15.	Recurrent genital herpes infection: 

a.	is significantly helped by topical acyclovir
b.	tends to diminish over time
c.	is due to herpes simplex virus 1 in the majority of cases
d.	is precipitated by menstruation
e.	is not transmitted once the lesions are painless 


 16.	The following conditions have been shown to cause constipation: 

a.	early pregnancy
b.	hyperkalaemia
c.	depression
d.	hyperthyroidism
e.	hypercalcaemia

 17.	The following factors typically indicate that an attempted suicide was of serious intent: 

a.	a suicide note
b.	informing others of the intention before the attempt
c.	making a will before the attempt
d.	admitting suicidal intent
e.	hoarding tablets for the attempt

 18.	Ectopic pregnancy: 

a.	the diagnosis is excluded by a history of regular menstruation
b.	the left fallopian tube is affected significantly more often than the right
c.	there is an association with a history of pelvic inflammatory disease
d.	vaginal examination should be performed prior to hospital referral
e.	typically there is an association with vaginal bleeding

 19.	The following drugs have been shown to cause a rise in blood glucose: 

a.	Frusemide
b.	Ethanol
c.	Aspirin
d.	Phenytoin
e.	Metronidazole

 20.	The following have been shown to indicate developmental delay: 

a.	lack of eye fixation at 6 weeks
b.	not walking at 15 months
c.	no definite words by 2 years
d.	not sitting alone at 7 months
e.	not speaking two-word sentences by 3 years

 21.	Cancer of the breast: 

a.	a G.P. with 2,500 patients will see on average two new cases per year
b.	the 5-year survival of all patients with breast cancer is less than 50%
c.	Alpha-fetoprotein is typically raised above normal
d.	surgery has been shown to improve survival rates more than radiotherapy
e.	the incidence has been shown to be less in women who have had previous
	bilateral oophorectomy for non-malignant disease


 22.	Secretory otitis media in children: 

a.	resolution occurs without treatment in the majority of cases
b.	typically there is a history of preceding acute inflammatory otitis media
c.	radial blood vessels of the eardrum exclude the diagnosis
d.	pain in the ear excludes the diagnosis
e.	the eardrum is typically concave

 23.	Genital warts: 

a.	they are always sexually transmitted
b.	the partner of a patient with penile warts should have annual cytology
c.	Podophyllin paint can be used with safety during pregnancy
d.	barrier methods of contraception are recommended until infection has resolved
e.	contact tracing is recommended

 24.	Sudden loss of vision has been shown to occur in: 

a.	tobacco amblyopia
b.	retinal vein occlusion
c.	cranial arteritis
d.	retrobulbar neuritis
e.	hysteria

 25.	The DVLC will consider withdrawing the licence of a car driver who has: 

a.	bilateral severe deafness
b.	a single recent epileptic fit
c.	a visual acuity of 6/60 in one eye and 6/9 in the other after correction
d.	unstable angina provoked by emotion
e.	diabetes maintained by diet alone

 26.	The following are true: 

a.	the prevalence tells how often a situation occurs
b.	the incidence tells how common is a situation
c.	the specificity of a test is the probability of a negative test given the
	absence of the condition
d.	the sensitivity of a test is the probability of the test being positive in
	somebody with the condition
e.	the reliability of a test is defined as the relevance of the test to the
	activities being treated



 27.	Claims for immediate and necessary treatment: 

a.	a night visit fee can be claimed in addition if the visit is between 10pm and 8am
b.	a claim is payable if the patient has been seen as a temporary resident by another
	practice in the area within 14 days
c.	the patient's signature is required
d.	a claim is not payable if the patient is accepted within 3 months onto the practice
	list
e.	the doctor must give any immediately necessary treatment for a period of 14 days
	once the form has been signed

 28.	Urinary incontinence in old age: 

a.	a carefully timed toilet regime is typically of benefit
b.	hypnotics typically reduce nocturnal incontinence
c.	if it is treated with a catheter, bacilluria is an indication for antibiotic therapy
d.	constipation has been shown to be a precipitating factor
e.	an association with atropic vaginitis has been shown

 29.	Carpel tunnel syndrome: 

a.	presentation is typically unilateral
b.	symptoms are characteristically worse at night
c.	NSAIDS are the treatment of choice
d.	pain radiating to the shoulder suggests that the diagnosis is incorrect
e.	forced flexion of the wrist typically will reproduce the symptoms

 30. 	Head lice: 

a.	are typically found on the vertex of the scalp
b.	live for 3 months or more
c.	are treated with malathion applied to wet hair
d.	are able to hop or jump from one head to another host
e.	can be carried by family pets

 31.	The following are recognised causes of atrial fibrillation: 

a.	anxiety
b.	hyperthyroidism
c.	ventricular septal defect
d.	alcohol abuse
e.	pulmonary embolism



 32.	A normal grief reaction would be indicated by: 

a.	inability to express any emotion in the week following death of a spouse
b.	suicidal thoughts 4 weeks after bereavement
c.	prolonged absence from work 3 months after bereavement
d.	a feeling that the dead person is still present 1 month after their death
e.	insomnia 6 months after the funeral

 33.	When considering drug therapy during pregnancy: 

a.	Methyldopa is contra-indicated at all stages
b.	treatment with isotretinoin is a recognised indication for termination
c.	folic acid supplements should be given to patients taking phenytoin
d.	Heparin has been shown to cause central nervous system damage in the foetus if
	given in the second and third trimesters
e.	Thiazide diuretics have been shown to decrease placental perfusion


 34.	The following drugs have been shown to interact with alcohol: 

a.	Griseofulvin
b.	Triazolam
c.	Chlorpropamide
d.	Metronidazole
e.	Frusemide


 35.	Diamorphine elixir for the relief of pain in terminal patients: 

a.	initial sedation typically continues whilst the drug is administered
b.	analgesia is enhanced if cocaine is added
c.	constipation is a characteristic sequel to treatment
d.	dependence occurs rapidly
e.	the same amount of pain relief is produced as when the same dose is given via
	intramuscular injection
	
 36.	Meningococcal meningitis: 

a.	if it is suspected, benzylpenicillin should be administered prior to hospital
	admission
b.	vaccination is available against all strains of meningococcus
c.	sensorineural deafness has been shown to be the most common permanent 
	sequela
d.	it has been shown to be more common in those children in contact with cigarette smoke
e.	Rifampicin has been shown to be the treatment of choice for close contacts



 37.	Urinary tract infection in children: 

a.	is typically symptomless in the pre-school age group
b.	has an equal sex incidence
c.	is associated with failure to thrive
d.	should be investigated after the first bacteriologically proven attack in both sexes
e.	is associated with renal scarring if attacks start after the age of 8 years

 38.	At 6 weeks of age: 

a.	hip dysplasia is more easy to detect than at birth
b.	if present, squint is detectable
c.	typically the infant should fixate on the face of the examiner
d.	hearing defects are typically detectable
e.	infants who sleep prone have been shown to be more advanced at lifting their heads


 39.	Testicular torsion: 

a.	surgery should be performed within 4 hours if the testis is to remain viable
b.	pus in the first voided urine makes a diagnosis of torsion incorrect
c.	doppler blood flow test show an increased blood flow to the testis in torsion
d.	the patient is typically under 18 years of age
e.	torsion typically presents with a more acute onset than epididymitis

 40.	Malignant melanoma: 

a.	the histological stage of the disease determines the treatment
b.	people with fair hair and blue eyes are at risk
c.	the incidence is remaining stationary
d.	survival rates are independent of tumour thickness
e.	an increased incidence has been shown in the relatives of patients with a melanoma


 41.	The nails have been shown to be affected in: 

a.	treatment with chloroquine
b.	cirrhosis
c.	alopecia areata
d. 	peripheral lymphoedema
e.	cystic fibrosis



 42.	Acute allergic conjunctivitis: 

a.	eosinophils are characteristically present in the secretions
b.	the eye typically feels "sticky"
c.	crusts typically appear on the eyelids
d.	onset is typically repid
e. 	the mucosa shows characteristic appearances


 43.	A diagnosis of prolapsed intervertebral disc would be supported by: 

a.	pain which is worse on resting
b.	pain which is unremitting in character
c.	bilateral symmetrical nerve involvement
d.	compressions of a single nerve root
e.	no evidence of nerve compression


 44.	Trigeminal neuralgia: 

a.	the pain typically lasts for more than 5 minutes
b.	it has been shown to be associated with multiple sclerosis
c.	the pain is typically bilateral
d.	the majority of cases have a recognisable stimulus
e.	removal of retained dental roots has been shown to be curative in some cases


 45.	Huntington's disease: 

a.	inheritance is autosomal recessive
b.	the mean age of onset is 40 years
c.	new mutations account for the majority of cases
d.	paternal transmission of children typically leads to an early onset of the disease
e.	CT scanning typically shows changes in the brain


 46.	Senile dementia: 

a.	typically has an abrupt onset
b.	typically produces a fluctuating level of consciousness
c.	has been shown to occur more frequently in first-degree relatives of those affected
d.	typically involves outbursts of tears and anger
e.	is typically aggravated by physical illness, if the dementia is mild


 47.	Agoraphobia: 

a.	women are more commonly affected than men
b.	the mean age of onset is 30 - 40 years
c.	there is a typical history of neurotic disorder in childhood
d.	the majority of sufferers experience depersonalization
e.	attacks have been shown to be less likely in places where there are a lot of people


 48.	The following factors have been shown to predispose to pre-eclampsia: 

a.	multiparity
b.	multiple pregnancy
c.	migraine prior to the pregnancy
d.	family history of pre-eclampsia
e.	diabetes with vascular disease


 49.	The climacteric: 

a.	the average age of the menopause in the United Kingdom has been shown to be 50 years
b.	demineralisation of bone takes place after the menopause
c.	the level of prolactin rises after the last period
d.	the severity of flushing has been shown to be related to the level of oestrogen
	in the blood
e.	clinical studies have shown that the later the menarche the earlier the 	
	menopause

 50.	Benzodiazepines: 

a.	long acting compounds have been shown to cause more dependency problems than
	shorter acting compounds
b.	Lorazepam has been shown to be an effective anti-emetic in patients receiving chemotherapy
c.	on withdrawal, rebound anxiety takes 2 weeks to develop
d.	epileptic seizures have been shown to occur on withdrawal
e.	the majority of long-term users will have symptoms of withdrawal


 51.	Gilbert's syndrome: 

a.	the serum alkaline phosphate concentration is typically raised above normal
b.	characteristically the level of icterus is variable
c.	the liver typically show no histological abnormality
d.	the urine typically shows excess urobilinogen
e.	there is typically familial distribution



 52.	Oat cell carcinoma of the bronchus: 

a.	is typically radiosensitive
b.	occurs with equal frequency in smokers and non-smokers
c.	has a 5 year survival greater than 20%
d.	has been shown to cause hyponatraemia
e.	is the commonest cause of ectopic parathormone secretion


 53.	Parkinson's disease: 

a.	an association with dysphagia has been shown
b.	the majority of patients are above their optimal weight
c.	tremor is typically unilateral in the early stages
d.	constipation is characteristic
e.	there is an association with accelerated mental retardation


 54.	Influenza vaccine: 

a.	is a live vaccine
b.	is contra-indicated in those people who have severe egg allergy
c.	elderly patients in residential homes are considered an "at risk" group by the DHSS
d.	protective levels of antibody will last for 6 months
e.	the protective rate in immunised patients approaches 100%


 55.	In the Mental Health Act of 1983: 

a.	a dependence on alcohol is accepted as a reason for compulsory admission
b.	Section 2 requires the recommendation of a consultant psychiatrist
c.	Section 2 does not permit relatives to make an application for admission
d.	Section 3 allows admission for a maximum of 6 months
e.	Section 4 requires the recommendation of only one doctor


 56.	Bell's palsy: 

a.	an association with diabetes mellitus has been shown
b.	it is a recognised complication of severe hypertension
c. 	numbness of the affected side of the face excludes the diagnosis
d.	the majority of patients make a complete recovery without treatment
e.	Corticosteroids have been shown to be effective in decreasing the severity of symptoms
	

 57.	Proteinuria in the absence of renal disease has been shown to occur in: 

a.	joggers
b.	febrile upper respiratory tract infection
c.	congestive cardiac failure
d.	diabetes mellitus
e.	hypertension


 58.	Gluten is found in: 

a.	oats
b.	rye
c.	wheat
d.	barley
e.	rice