50 - medicine mcqs - 75 to 78

75 - Chronic heart failure:
A is incorrectly diagnosed in only 10% of cases
B often occurs when ECG and chest X-rays are completely normal
C has been shown not to respond to ACE inhibitors in large epidemiological studies
D should be routinely investigated using thyroid function tests
E in the elderly, if treated with ACE inhibitors may be complicated by a deterioration in renal function.
3. A=F, B=F, C=F, D=T, E=T.
As many as 30-50% cases diagnosed as chronic heart failure (CHF) are incorrectly labelled as such. CHF rarely occurs if both ECG and chest X-rays are normal. The JVP is a particularly useful clinical sign. In the CONSENSUS study Angiotensin Converting Enzyme (ACE)inhibitors promoted a dramatic mortality reduction in patients with severe heart failure. Thyroid function tests are important, because thyrotoxicosis is a treatable cause of heart failure. ACE inhibitors may be problematic in the elderly with hypotension and effects on renal function as two severe side effects.
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76 . Chronic fatigue sufferers:
A often complain of low-grade fever
B often have a self-induced pressurised lifestyle
C have a problem-focused coping style
D tend to feel socially unsupported prior to their illness
E usually have type A personalities

1. A=T, B=T, C=T, D=T, E=F.
Apart from weakness, muscular pain and other physical symptoms chronic fatigue sufferers may also complain of low-grade fever. Compared to controls and sufferers of irritable bowel syndrome chronic fatigue patients have the most pressurised lifestyles, usually self-imposed. They also have a problem-focused coping style. Although this can help them solve problems better than others, they tend to dwell on problems rather than directing their energies and emotions elsewhere. The concept of type A and type B personalities has now fallen out of vogue and the validity of the type A personality has even been questioned in relation to coronary heart disease.
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77. Patients with chronic fatigue:
A adopt a slower lifestyle after their illness
B may have Epstein-Barr virus which can be reactivated by psychological stress
C are equally as likely as muscular dystrophy patients to be fatigued by emotional distress
D are much more likely to report physical weakness than psychiatric patients
E all believe that they have a physical illness
F show physical responses to stress rather than emotional responses
2. A=T, B=T, C=F, D=F, E=F, F=F.
A 'lifestyle transformation' is often reported after an illness with a rejection of the ethos of over-work and achievement orientated success. Chronic fatigue patients are more likely to be fatigued by emotional distress than muscular dystrophy patients, but are as likely to report physical weakness as psychiatric patients. Although many do believe that they have a 'physical' illness there is a spectrum of beliefs amongst sufferers with some assuming a psychological cause. There is however a skew of beliefs towards a physical model. When stressed sufferers are just as likely to show emotional responses as physical ones.
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78. The differential diagnosis of chronic fatigue includes:
A leukaemia
B solid white cell tumours
C systemic lupus erythematosus
D hypothyroidism
E depression
3. All true.
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