A 20-year-old white man was stabbed in the chest in a bar fight and arrived at the emergency room within 30 minutes. You noticed that the trachea is deviated away from the side of the chest that suffered the puncture. Which one of the following would you find upon physical examination of the traumatized side?
1) increased fremitus
2) increased breath sounds
3) dullness to percussion
4) hyperresonant percussion!
5) wheezing and stridor
Question: 2
A 25-year-old Jehovah's Witness man is scheduled for emergency surgery following a motor vehicle accident in which he sustained pelvic fractures. The patient is competent and lucid before the surgery and refuses the administration of blood products. Which course of action is most appropriate in the event of significant intra-operative blood loss?
1) administration of packed red cells in the recovery
2) use of a cell saver
3) administration of hydroxyethyl starch
4) administration of packed cells after obtaining consent!
5) intra-operative autologous blood donation
Question: 3
A 58-year-old man presents to your office with a history of having an episode of sudden visual loss in his right eye. The patient describes the loss of vision as similar to someone pulling a cover over his right eye. Vision returned to the right eye after 10 minutes. This visual-field defect is secondary to which one of the following?
1) scotoma
2) amaurosis fugax!
3) strabismus
4) esotropia
5) night blindness
Question: 4
Two hours after application of the plaster cast for supracondylar fracture, a patient comes back to emergency room with a complaint of severe pain in the hand. Examination revealed swelling of the fingers and cyanosis. Which one of the following is the best management?
1) to observe the patient
2) to administer vasodilators
3) to administer analgesics
4) cut open the plaster near the fingers
5) cut open the entire plaster cast immediately!
Question: 5
A 40-year-old woman presents with a self-detected hard breast mass. Which one of the following is the procedure of choice for confirming the diagnosis?
1) mammography
2) thermography
3) ultrasonography
4) aspiration cytology
5) incisional biopsy histology!
Question: 6
A 48-year-old man complains of a 6-month history of shortness of breath and cough. Physical examination reveals clubbing with coarse crackles in both lung bases. Which one of the following is the most likely diagnosis?
1) asthma
2) reflux-induced cough
3) chronic bronchitis
4) idiopathic pulmonary fibrosis
5) sarcoidosis!
Question: 7
Within minutes of a bee sting, a 23-year-old woman develops generalized pruritus and hyperemia of the skin, followed shortly by swelling of the face and eyelids, dyspnea, and laryngeal edema. This reaction is mediated by which one of the following?
1) antigen-antibody complexes
2) cytotoxic T cells
3) IgA antibodies
4) IgE antibodies!
5) IgG antibodies
Question: 8 A 70-year-old woman presents to your office with a lump in her breast. Which one of the following is the greatest risk factor for cancer?
1) nulliparity
2) positive family history
3) use of hormone replacement therapy
4) early menarche
5) advanced age!
Question: 9
A 35-year-old woman is brought to the Emergency Department in severe distress. She has had the "flu" for three days. Past history reveals a six month history of fatigue and malaise. Physical exam reveals BP 120/65 mm Hg supine, 90/58 mm Hg standing, and darkened areas of skin on the knuckles, creases of the palm, elbows and on an abdominal scar. Laboratory values are Na 122 mmol/L, K 5.8 mmol/L, Cl 95 mmol/L, CO2 18 mmol/L. Which one of the following laboratory tests is most likely to assist in confirming your diagnosis?
1) Plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
2) 24 hour urine metanephrines and vanillylmundelic acid (VMA)
3) Plasma catecholamines, total and fractionated
4) Plasma cortisol and adrenocorticotropic hormone (ACTH)!
5) Plasma 17OH progesterone
Question: 10
A 24-year-old man is brought to the emergency room after being found unresponsive in a city park. Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per minute. Which one of the following is the most likely cause?
1) tricyclic antidepressant overdose
2) morphine overdose!
3) arsenic poisoning
4) lead intoxication
5) alcohol intoxication
Question: 11
A 21-year-old man presents with a recent suicide attempt. You are asked to assess him in the emergency room. Which one of the following statements concerning the suicide assessment of this patient is TRUE?
1) Discussing suicide with persons suspected of feeling suicidal may increase their risk of suicide. 2) Persons with a recent suicide attempt are at less risk for eventually killing themselves.
3) Depressed persons who commit suidide can do so as they begin to improve.!
4) Persons with schizophrenia are at less risk for suicide.
5) Persons with schizophrenia do not usually communicatE their intentions.
Question: 12
A patient is convinced that an intravenous (IV) injection he received has made him immortal. This is an example of which one of the following?
1) an illusion!
2) a delusion
3) a hallucination
4) a perseveration
5) a projection
Question: 13
A 41-year-old man reports that he washes his hands 50 times a day. In the evening, he will check the doors, windows, and stove at least a dozen times before retiring for the night. Which one of the following is the most likely diagnosis?
1) paranoid disorder
2) paranoid schizophrenia
3) schizotypal personality disorder
4) obsessive-compulsive disorder!
5) presenile dementia
Question: 14
A mother brings her 10-year-old son to your office because he lost consciousness the day before while running. She says that he had had similar episodes in the past, but has never been seen by a doctor. She also states that he does not seem to be able to play as long as most of his friends. On physical examination you detect a systolic ejection murmur and find that the apical impulse is lateral to the mid clavicular line. Which one of the following is the most likely diagnosis?
1) mitral valve stenosis
2) aortic stenosis!
3) coarctation of the aorta
4) aortic insufficiency
5) patent ductus arteriosus
Question: 14
A mother brings her 10-year-old son to your office because he lost consciousness the day before while running. She says that he had had similar episodes in the past, but has never been seen by a doctor. She also states that he does not seem to be able to play as long as most of his friends. On physical examination you detect a systolic ejection murmur and find that the apical impulse is lateral to the mid clavicular line. Which one of the following is the most likely diagnosis?
1) mitral valve stenosis
2) aortic stenosis
3) coarctation of the aorta
4) aortic insufficiency
5) patent ductus arteriosus
Question: 15 A healthy 4-year-old girl presents with the following symptoms: rapidly progressing respiratory distress, high fever, muffled voice, and drooling. Which one of the following measures is most appropriate in the initial management of this problem?
1) endotracheal intubation!
2) ribavirin aerosol
3) bronchodilators
4) racemic epinephrine aerosol
5) high doses of intravenous steroids
Question: 16
A 3-year-old girl has had a low-grade fever, "raspy" cough, and clear rhinorrhea for 3 days. She is brought to the emergency room when she begins to develop difficulty breathing. On physical examination her vital signs include a temperature of 39.7°C, a pulse of 160 beats per minute, and respirations of 36 breaths per minute. Auscultation reveals bilateral rhonchi, wheezing, and some mild stridor. Which one of the following is the most likely diagnosis?
1) asthma
2) epiglottitis
3) laryngotracheobronchitis!
4) tonsilitis
5) pneumonia
Question: 17
A few hours after eating a dinner of stuffed turkey, a previously well 7-year-old boy and his parents develop vomiting, abdominal cramps, and diarrhea. Differential diagnosis of the cause of these gastrointestinal symptoms should include which one of the following?
1) Clostridium difficile
2) Campylobacter
3) pinworms
4) Staphylococcus aureus exotoxin!
5) Clostridium botulinum
Question: 18
A 30-year-old woman presents with a long standing history of irregular menstrual periods which are often associated with severe pelvic pain and menorrhagia She has also been experiencing dysparunia and pain during defecation. Which one of the following is most likely to assist you in diagnosing this patient's condition?
1) clinical history
2) laparoscopy!
3) pelvic examination
4) hysterosalpingogram (HSG)
5) culdocentesis during menses
Question: 19
A 28-year-old woman has a 3-year history of primary infertility. She presents with increasing symptoms of steady, aching lower abdominal pain at the time of menses. The pain persists throughout menstruation and often after, and radiates into the rectum. Tender nodules in the uterosacral ligaments are noted on pelvic examination. Which one of the following would be the most contributory investigation?
1) postcoital test
2) diagnostic laparoscopy!
3) hysterosalpingogram on day 9 of her cycle
4) endometrial biopsy on day 26 of her cycle
5) basal body temperature charting
Question: 20
A 72-year-old woman complains of a lump protruding through the vagina with local pressure symptoms. On examination, there is a visible uterine prolapse. All of the following may be etiologic factors, EXCEPT
1) multiparity.
2) chronic smoking.
3) history of large babies.
4) stress urinary incontinence.!
5) postmenopausal status.
Question: 21
Five physicians are deliberating over whether the patient they have examined is exhibiting the auscultatory signs of mitral valve prolapse or not. Assuming that there would be agreement by chance of 50%, but, in fact, four of the five physicians actually agree on the findings, what is the choice-corrected agreement (kappa) for the clinical findings?
1) 0.8
2) 0.75
3) 0.6!
4) 0.7
5) 0.5
Question: 22
Several studies have indicated that, in large urban areas, there is a higher prevalence of schizophrenia in the lower socioeconomic class. Epidemiologic studies tend to support the hypothesis that
1) unsatisfactory social circumstances "breed" an excess incidence of schizophrenia.
2) the fathers of schizophrenics also tend to come from a lower socioeconomic class.
3) people with schizophrenia tend to "drift" down the social scale, because of their illness.!
4) both intelligence and schizophrenia are negatively associated with social class.
5) schizophrenia "runs" in families and is primarily an inherited disorder.
Question: 23
To qualify for federal contributions, provincial health insurance plans must guarantee all of the following, EXCEPT
1) benefits include all necessary hospital care and physicians' services.
2) universal coverage on uniform terms and conditions.
3) portability of coverage from province to province.
4) benefits include all necessary out-of-hospital drugs, dental care and prostheses.!
5) administration on a non-profit basis.
Question: 24
A 68-year-old man develops acute renal failure after surgery for ruptured aortic aneurysm. He refuses dialysis. Psychiatric consultation reveals him to be fully alert and oriented, cognitively intact, and not psychotic or clinically depressed. He says he is refusing dialysis because he has "lived a full life" and does not want to be "tied to a machine, even if this means I'll die." The psychiatrist should tell the man's internist that the man
1) is temporarily incompetent to decide on treatment, so treatment should be started.
2) is competent to decide on treatment, but his refusal should be overruled because of the existence of a medical emergency.
3) his refusal of dialysis must be respected because he is competent to decide on treatment.!
4) is behaving in a self-destructive manner, so he should be committed for treatment against his will.
5) shows no evidence of a major psychiatric illness but assessment of competency is required.
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Section: 2
Question: 1
A 28-year-old pregnant woman develops sudden onset of dyspnea and tachycardia. Which one of the following is the most likely explanation?
1) acute mitral valve regurgitation
2) pulmonary embolism!
3) myocardial infarction
4) acute respiratory distress syndrome
5) lobar pneumonia
Question: 2
A 50-year-old man comes to the emergency room with a history of vomiting for three days' duration. His past history reveals that for approximately 20 years, he has been getting epigastric pain, lasting for two to three weeks. He remembers getting relief from pain by taking milk and antacids. Physical examination showed a fullness in the epigastric area with visible peristalsis, absence of tenderness and normal active bowel sounds. Which one of the following is the most likely diagnosis?
1) gastric outlet obstruction!
2) small bowel obstruction
3) volvulus of the colon
4) incarcerated umbilical hernia
5) cholecystitis
Question: 3 A 40-year-old man complains to his doctor of impotence. Which one of the following medication could be implicated?
1) ranitidine.
2) sertraline!
3) clarithromycin
4) enalapril
5) hydrochlorthiazide
Question: 4
A 34-year-old female keyboard operator develops pain and numbness in her hands that radiates up her arms. Which of the following is most likely to have been injured?
1) axillary nerve
2) median nerve!
3) ulnar nerve
4) radial nerve
5) brachial plexus / triceps muscle
Question: 5
A 60-year-old man presents with a small lesion on his nose. On examination of the lesion you note the following: the lesion is 3-mm in diameter, slightly elevated with a waxy appearance, and has a slight vascular pattern on top. This lesion is most characteristic of which one of the following?
1) basal cell carcinoma!
2) squamous cell carcinoma
3) melanoma
4) varicella-zoster lesion
5) actinic keratosis
Question: 6
A 30-year-old woman presents with a headache, gradual development of a partial bitemporal hemianopia, and a history of cessation of menses several years ago. Which one of the following is the most likely cause?
1) dilated third ventricle
2) craniopharyngioma
3) saccular aneurysm of the circle of Willis
4) pituitary adenoma!
5) meningioma of the tuberculum sellae
Question: 7
A 30-year-old man has a history of recurrent pneumonias and chronic cough dating from early childhood. The cough, which is worse in the morning and on lying down, is productive of foul-smelling purulent sputum which is occasionally bloody-tinged. The patient is chronically ill and has clubbed fingers. Rales are heard over the lung bases posteriorly. Which one of the following is the most likely diagnosis?
1) chronic bronchitis
2) pulmonary aspergillosis
3) pulmonary neoplasm
4) chronic obstructive emphysema
5) bronchiectasis!
Question: 8
A 22-year-old woman presents with fever, malaise, generalized arthralgias, and a skin rash, over the nose and malar eminences. Which one of the following possible findings has the greatest relative significance in the overall prognosis for the patient?
1) immune complexes at the dermal-epidermal junction in skin
2) pleuritis
3) atypical verrucous vegetations of the mitral valve
4) perivascular fibrosis in the spleen
5) glomerular subendothelial immune complex deposition!
Question: 9
A 38-year-old woman presents to you convinced that she has chronic fatigue syndrome. The history reveals no evidence of fever or swollen glands, and no other symptoms other than fatigue and difficulty sleeping. Her physical examination is completely normal. She has a high thyroid-stimulating hormone level. You would then suspect and subsequently confirm
1) hyperthyroidism secondary to pituitary adenoma.
2) hypothyroidism.!
3) Grave disease.
4) thyroiditis.
5) chronic fatigue syndrome.
Question: 10
A 29-year-old quadriplegic woman (who is mentally intact) is shifted in bed every 2 hours to prevent pressure (decubitus) ulcers. The clinician examines her at the end of 2 hours on her right side. She is feeling well, not coughing, and is afebrile. Examination of the lungs reveals dullness and crackles in the lateral half of the right lung field. Which one of the following is the most reasonable interpretation of their cause?
1) atelectasis secondary to mucus plugging
2) pulmonary edema, which has localized due to gravitational forces
3) compressive atelectasis
4) aspiration pneumonitis
5) chronic pulmonary fibrosis
Question: 11
You are called to see an elderly hospitalized patient with mild obstructive lung disease who was roused one morning with difficulty and appeared confused. Which of the following drug orders is most likely associated with this episode?
1) trimethoprim-sulfamethoxazole (Septra®) D.S. x 2 daily
2) hydrochlorothiazide 50 mg once daily!
3) flurazepam 30 mg h.s.
4) theophylline 200 mg x 2 daily
5) senna (Senokot®) 1 - 2 tablets as required
Question: 12
An 11-year-old girl has become markedly withdrawn during the past 8 months and has complained of persisting abdominal pain and constipation, for which no organic cause has been found. Which one of the following is the most likely diagnosis?
1) depressive disorder!
2) schizophrenia
3) conduct disorder
4) attention deficit hyperactivity disorder
5) infantile autism
Question: 13
A 30-year-old woman complains of episodic faintness, tingling sensation in her hands, shortness of breath, and severe anxiety. Thorough medical workup reveals no pathologic condition. During an episode of these symptoms, chemical analysis of the serum will probably reveal which one of the following?
1) decreased chloride
2) increased urea (BUN)
3) decreased protein
4) increased serum amylase!
5) increased pH
Question: 14
A 27-year-old man is suspicious of others, superstitious, believes he possesses telepathic powers, and has no friends. Which one of the following is most likely to be associated with this clinical description?
1) passive-aggressive personality disorder
2) histrionic personality disorder
3) schizotypal personality disorder!
4) avoidant personality disorder
5) compulsive personality disorder
Question: 15
A 2-year-old boy with visible abdominal distention is found to have a large left-sided flank mass. Which one of the following is the most likely diagnosis?
1) renal cell carcinoma
2) polycystic kidney
3) transitional cell carcinoma
4) Wilms' tumour!
5) hydronephrosis
Question: 16
A 3-year-old with a history of asthma is brought to the Emergency Department in acute respiratory distress. His mother relates that she stopped his twice daily sodium cromoglycate 1 week ago. Physical examination reveals a distressed child with a harsh cough. On auscultation of the chest, there are areas of reduced air entry and diffuse expiratory wheezes. Which one of the following is the most appropriate initial management?
1) aerosolized ipratropium bromide by nebulization
2) aerosolized sodium cromoglycate by nebulization
3) aerosolized budesonide
4) subcutaneous epinephrine, 1:1000 dilution
5) aerosolized salbutamol by nebulization!
Question: 17
A 13-year-old boy states that he is growing breasts and that they hurt. He has been growing taller this past year. He has no other complaints. On physical examination you note some acne on his face, his testes and phallus are appropriate for age, and he has fine sparse pubic hair. Which one of the following is the most likely diagnosis?
1) normal puberty!
2) Klinefelter's syndrome
3) pituitary tumor
4) adrenal tumor
5) gonadal tumor
Question: 18
A full-term infant presents to your office at 7 days of age with bilateral purulent conjunctive discharge, erythema and swelling at the medial aspect of the eyes. Which one of the following is the most likely diagnosis?
1) Neisseria gonorrhoeae infection
2) herpes simplex infection
3) nasolacrimal duct inflammation due to Staphylococcus aureus
4) chemical irritation from eye oinment received at delivery
5) chlamydia infection!
Question: 19
A 30-year-old primigravida presents at 34 weeks gestational age with blood pressure of 160/90 mmHg, headache, epigastric pain, visual abnormalities and 3 proteinuria. Biophysical profile of the fetus is 8/8. Which one of the following is the best course of action?
1) Induce labour and attempt vaginal delivery.
2) Start magnesium sulfate intravenously.!
3) Perform an emergency C-section.
4) Give betaclomethasone to induce fetal lung maturity.
5) Perform an amniocentesis to assess fetal lung maturity.
Question: 20
All of the following are considered possible indications for cesarean section, EXCEPT
1) placenta previa.
2) fetal distress.
3) genital herpes.
4) carcinoma in situ of the cervix.!
5) prior urethropexy.
Question: 21
The statistical measure of the degree of relationship between two sets of numbers is
1) the average
2) the standard deviation
3) the normal distribution
4) the standardized scores
5) the correlation coefficient!
Question: 22
When interpreting a diagnostic test, the term "gold standard" refers to a definitive diagnosis obtained by some independent means. All of the following would be examples of gold standards useful in clinical practice, EXCEPT
1) coronary angiography in evaluating a cardiac stress test.
2) bacteriologic culture in testing a rapid diagnostic kit for gonorrhea.
3) bronchoscopy with biopsy in evaluating sputum cytology.
4) autopsy results in evaluating electrocardiography.
5) results of long-term follow-up in a test for early rheumatoid arthritis.!
Question: 23
A new screening test for a type of cancer is carried out on 10,000 subjects. One hundred and sixty have a positive result, of whom eight are determined to actually have the disease. These eight subjects survive longer than other persons suffering from the same type of cancer diagnosed by other means. Which one of the following statements is correct?
1) The sensitivity of this test is [snip].4% (10,000-160)/10,000.
2) The incidence of the disease in this population is 80 per 100,000.
3) Early detection by this test improves survival.
4) The predictive value of a positive test is 5% (8/160).!
5) The predictive value of a negative test is 95% (152/160).
Question: 24
An active 75-year-old woman relocates to your town. She has hypertension, arthritis, and diabetes. Her medication regimen includes hydrochlorothiazide, potassium elixir, diltiazem, acetaminophen, ibuprofen and glyburide. Which factor is most related to compliance with the medication regimen?
1) age
2) number of drugs in the regimen!
3) gender
4) number of comorbid diseases
5) use of tablets versus use of elixirs
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Section: 3
Question: 1
A gunshot wound to the upper arm causing shock-wave damage to the median nerve may leave the patient with which one of the following?
1) easily provoked pain in the hand!
2) weakness on wrist extension
3) atrophy in the first dorsal interosseous muscle
4) numbness over the fifth digit
5) radial deviation of the hand
Question: 2
A 9-year-old boy is brought to the hospital with a history of having fallen from his bike. He fainted and is now complaining of abdominal pain and thirst. There is general abdominal tenderness and rebound tenderness. Approximately 4 hours after the accident, the white blood count is 20 x 109/L and the hemoglobin is 80 g/L. What is the most likely diagnosis?
1) renal contusion
2) acute pancreatitis
3) ruptured spleen!
4) retroperitoneal hematoma
5) ruptured bowel
Question: 3
A 50-year-old man presents to the emergency room with severe epigastric pain, low-grade fever, tachycardia, and mild hypotension. The patient relates a history of moderate to heavy social drinking. The chief resident suspects acute pancreatitis. Which one of the following is the single most important laboratory finding to confirm the diagnosis of pancreatitis?
1) hyperlipidemia
2) hyperbilirubinemia
3) elevated serum amylase!
4) elevated serum phospholipase A
5) elevated serum alkaline phosphatase
Question: 4
A 22-year-old male, working as a waiter in a nightclub, noticed a gradual hearing loss. He admitted that the noise level in his job is very high and that he was not advised to wear ear defenders. Which one of the following does he most likely suffer from?
1) sensory hearing loss and vertigo
2) both sensory and conductive hearing loss
3) conductive hearing loss and ataxia
4) sensory hearing loss and tinnitus!
5) conductive hearing loss and nystagmus
Question: 5
A 68-year-old man presents with a chief complaint that solid food gets stuck in the middle of his chest. In addition, he admits to a 11 kg weight loss over the last 3 months. Which one of the following is the most likely diagnosis?
1) esophagitis
2) lower esophageal ring
3) esophageal carcinoma!
4) cerebrovascular accident
5) myocardial infarction
Question: 6
A 52-year-old man with a long history of alcohol use comes to the emergency room of a general hospital. He is confused and on examination is noted to have palsies of conjugate gaze, horizontal nystagmus, and ataxia. Which one of the following is the most likely diagnosis?
1) conversion reaction
2) alcohol intoxication
3) alcohol hallucinosis
4) delirium tremens
5) Wernicke's encephalopathy!
Question: 7
A 71-year-old woman with a history of coronary artery disease presents to her family physician for a routine check-up. The physician notices that she has lost 10 kg since her last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins 30 minutes after eating and lasts about 2 hours. She claims that the pain is worse after large meals and so she has begun to eat less out of fear of pain. Which one of the following is the most likely diagnosis?
1) pancreatitis
2) cholecystitis
3) small bowel obstruction
4) intestinal ischemia
5) peptic ulcer disease!
Question: 8
In a woman under 40 years of age, which one of the following breast abnormalities would have the highest predictive value for malignancy?
1) painful, moveable mass
2) painless, moveable mass
3) blood nipple discharge
4) clear nipple discharge
5) breast skin edema with dimpling!
Question: 9
A 68-year-old man presents with cardiac arrest due to ventricular rupture. Which one of the following myocardial changes is the most frequent cause?
1) Abscess formation and tissue destruction due to infective endocarditis .
2) Fatty change due to interaction of diphtheria exotoxin and carnitine .
3) Aschoff bodies associated with rheumatic fever.
4) Inflammation due to coxsackie B infection .
5) Necrosis due to coronary artery obstruction .!
Question: 10
A 49-year-old man who smokes two packs of cigarettes a day presents with a lung mass on x-ray and recent weight gain. Laboratory examination shows hyponatremia with hyperosmolar urine. The patient probably has which one of the following diagnoses?
1) renal failure
2) pituitary failure
3) Conn's syndrome
4) cardiac failure
5) inappropriate ADH (secretion)!
Question: 11
Which one of the following types of hallucination is normal?
1) hypnagogic!
2) lilliputian
3) tactile
4) olfactory
5) auditory
Question: 12
A 20-year-old college student presents to you with a history of intermittent chest pain for about 6 months. He states that the pain can occur at any time, but often occurs late in the day. The pain can be sharp, dull, or aching and may last for hours. He is physically active and is carrying a full academic load. The pain is unrelated to exercise and does not restrict his activities. His father and paternal uncle have both had myocardial infarctions within the past year. Physical examination is normal, although the patient appears restless and has a heart rate of 100/min. Which one of the following is the most likely diagnosis?
1) feflux esophagitis!
2) generalized anxiety disorder
3) transient myocardial ischemia
4) myocardial infarction
5) costochondritis
Question: 13
A 25-year-old man is hospitalized after weeks of worsening psychosis. He is given thiothixene, an antipsychotic medication. Five days later, he develops a fever of 39.8 °C, becomes delirious and lies stiffly in his bed. His family reports that he had been physically well prior to his admission. Which of the following diagnosis is of most immediate concern?
1) tardive dyskinesia
2) viral meningitis
3) neuroleptic malignant syndrome!
4) ruptured cerebral aneurysm
5) unsuspected opioid dependence
Question: 14
A 31-year-old man is shy, socially withdrawn, low in self-esteem, yet eager to please when called on by persons in authority. Which one of the following personality disorders is most likely to be associated with this clinical description?
1) passive-aggressive personality disorder
2) histrionic personality disorder
3) schizotypal personality disorder
4) avoidant personality disorder!
5) compulsive personality disorder
Question: 15
A 5-year-old girl is admitted to the Children's Hospital after swallowing an undisclosed number of her mother's ASA tablets. She is hypotensive, flushed and tachypneic. Which of the following acid-base disturbances would be most likely?
1) pH low ; HCO3 low ; pCO2 high
2) pH normal ; HCO3 high; pCO2 low
3) pH low; HCO3 low; pCO2 high
4) pH low; HCO3 high; pCO2 low
5) pH high; HCO3 high; pCO2 high
Question: 16 A 5-year-old patient has axillary freckling, several firm subcutaneous masses on both arms and seven light-brown macules on his trunk which are greater than 1.5 cm. Which one of the following is the most likely diagnosis?
1) Peutz-Jeghers syndrome
2) tuberous sclerosis
3) Sturge-Weber syndrome
4) Albright's disease
5) neurofibromatosis!
Question: 17
A 13-year-old girl sustains a minor injury to the left side of her back in a school basketball game. On examination little is found except for asymmetric shoulder levels. While she bends over, the right posterior chest is elevated. Which of the following are these findings most readily suggestive of?
1) an accessory rib
2) an iliopsoas muscle spasm
3) rhabdomyosarcoma
4) scoliosis!
5) hematoma
Question 18
A 24-year-old woman is seen because of high fever, prostration, vomiting, and diarrhea. Her pulse is rapid and thready, and her blood pressure is recorded at 60/40 mmHg. A diffuse generalized macular rash is noted. Following stabilization with fluid and vasoactive medications, culture of which of the following specimens will most likely lead to the correct diagnosis?
1) sputum
2) urine
3) stool!
4) cervicovaginal secretions
5) cerebrospinal fluid
Question: 19
Which one of the following hormones is responsible for the proliferation of the milk ducts during pregnancy?
1) human chorionic gonadotropin
2) progesterone
3) prolactin
4) estrogen!
5) human placental lactogen
Question: 20
Amniocentesis is used in the diagnosis of all of the following conditions, EXCEPT
1) trisomy 21 (Down syndrome).
2) metabolic errors.
3) neural tube defects.
4) genitourinary anomalies.!
5) trisomy 18.
Question: 21
From information recorded at school A it was found that, out of a total of 400 missed 'person days' during November, 100 were due to measles; 200 to "flu"; and the rest to various other causes. At school B in the same neighborhood, during the same period of time, a total of 75 children were absent for 1 or more days. Of these, 25 had suffered from measles; 25 from "flu" and the rest from various other causes. It can be concluded that
1) the incidence of measles was greater in school "B" than in school "A".
2) the incidence of "flu" was greater in school "A" than in school "B".
3) the overall morbidity rate was higher in school "A" than in school "B".!
4) the incidence of "other causes" was greater in school "A" than in school "B".
5) none of the above conclusions can be reached with the data provided.
Question: 22
Exposure to lead can cause all of the following, EXCEPT
1) anemia.
2) cirrhosis of the liver.!
3) paresis.
4) abdominal pain.
5) porphyrinuria.
Question: 23
A case control study was conducted in which 50 cases and 50 controls were interviewed to inquire about their history of exposure to substance 'X'. The following 2 X 2 table resulted: Cases Controls Totals Exposed 40 20 60 Not exposed 10 30 40 Totals 50 50 100 The 'odds ratio' (estimate of the relative risk) is
1) 0.17
2) 1.50
3) 2.00
4) 3.00
5) 6.00!
Question: 24
Under certain circumstances, it may be legitimate to detain individuals in an institution against their wishes, for their own good and to protect others. This situation may arise when
1) a person has bizarre fantasies and actions
2) persons are mentally incompetent and unable to manage their own affairs
3) a close relative submits a petition that an individual is actually and presently insane
4) the individual's continued liberty poses a danger!
5) a person has visual and aural hallucinations
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Section: 4
Question: 1
A 27-year-old carpenter dropped his circular saw and severed his lower leg. Which one of the following would be indicative of a severed tibial nerve?
1) paralysis of the plantarflexors of the foot!
2) paralysis of all the muscles in the posterior compartment of the leg
3) anesthesia of most of the sole of the foot
4) paralysis of the muscles in the lateral crural compartment
5) anesthesia to the medial aspect of the lower leg
Question: 2
A middle-aged woman is admitted unconscious to the Emergency Department following a head injury in a car accident. There is bruising over the upper abdomen. Blood pressure is 80 mm Hg systolic, pulse 120/minute. What is the most important initial step in the management of this patient?
1) x-ray (three views) of abdomen
2) immediate laparotomy
3) draw blood sample and start IV fluids!
4) perform emergency burrholes
5) diagnostic peritoneal lavage
Question: 3
On examining a 51-year-old man with chest pain who was just involved in a motor vehicle accident, you find that at the end of expiration his blood pressure is 130/90 mmHg and at the end of inspiration it is 110/92 mmHg. Which one of the following conditions is most likely?
1) cardiac tamponade!
2) pneumothorax
3) multiple rib fractures
4) acute myocardial infarction
5) aortic rupture
Question: 4
A 78-year-old man complains of 3 months of fatigue and a 10 kg weight loss. Physical examination reveals jaundice without abdominal tenderness or organomegaly. Which one of the following is the most likely diagnosis?
1) cholecystitis
2) pancreatitis
3) hemochromatosis
4) hepatic vein thrombosis
5) pancreatic carcinoma!
Question: 5
A 55-year-old man presents to the hospital with the complaint of severe intermittent pain in his right lower back that radiates around his trunk into his lower quadrant and upper right thigh. Which one of the following is the most likely diagnosis?
1) hepatitis
2) appendicitis
3) a ureteral stone!
4) pyelonephritis
5) biliary obstruction
Question: 6
You are performing pulmonary function tests on a 80-year-old male with persistent cough . Which one of the following would occur normally with age?
1) fall in vital capacity
2) fall in FEV1/FVC!
3) fall in arterial p02
4) increase in arterial pCO2
5) decrease in arterial pH
Question: 7
A 26-year-old man developed hemoptysis and dyspnea over the course of 3 months. His physician suspected tuberculosis and started him on triple therapy with isoniazid, rifampin, and ethambutol. After 2 months, the patient complained of pins-and-needles sensations in his feet. Neurologic examination was otherwise unremarkable. Strength was good in all limbs. Which one of the following nutritional deficiencies is most likely responsible?
1) vitamin B12 deficiency
2) vitamin B6 (pyridoxine) deficiency!
3) vitamin E (alphatocopherol) deficiency
4) vitamin D deficiency
5) vitamin B1 (thiamine) deficiency
Question: 8
A 56-year-old patient presents with polycythemia. He is found to have low oxygen saturation, increased red blood cells mass, normal plasma volume and increased erythropoietin levels. Which one of the following is the most likely diagnosis?
1) polycythemia rubra vera
2) chronic obstructive pulmonary disease (COPD)!
3) stress polycythemia
4) renal adenocarcinoma
5) congenital spherocytosis
Question: 9
While being investigated for long-standing hypertension, a 55-year-old woman is found to have the following serum laboratory test values: normal creatinine, total protein, albumin, and globulin; increased calcium and alkaline phosphatase; and decreased phosphorus. Which of the following do these findings suggest the presence of?
1) carcinoma metastatic to bone
2) excessive dietary calcium intake
3) multiple myeloma
4) parathyroid adenoma!
5) sarcoidosis
Question: 10
A 40-year-old woman presents with painful swelling of the joints of her fingers, excessive fatigue and a malar rash. Which one of the following diseases is is most likely?
1) psoriasis
2) pseudogout
3) systemic lupus erythematosus (SLE)!
4) rheumatoid arthritis
5) serum sickness
Question: 11
A 32-year-old married woman describes experiencing panic attacks every time she goes to the local store. These have been getting more frequent and she is finding it increasingly difficult to leave her home. Which one of the following should form part of her treatment?
1) psychodynamic therapy
2) interpersonal psychotherapy
3) family therapy
4) supportive psychotherapy
5) cognitive behavioral therapy!
Question: 12
A 38-year-old woman tells her physician that for several months she has been experiencing palpitations, dizziness, shortness of breath, a feeling of impending doom and a fear of dying. Which of the following would be the most appropriate initial step in managing this patient?
1) offer psychotherapy
2) prescribe benzodiazepines
3) perform a physical examination!
4) refer the patient to a psychiatrist
5) teach relaxation techniques
Question: 13
A patient reports that, on his way to your office he saw a man feeding two squirrels in the park. He says that this means that his future will be decided within 2 weeks. Which one of the following terms best describes this mode of thinking?
1) illusion
2) hallucination
3) delusion
4) loose association!
5) neologism
Question: 14
A 3-year-old boy presents to the emergency room with a history of recurrent cough. A review of his previous records reveals recurrent episodes of right lower lobe pneumonia. An x-ray chest in the current admission also confirms a right lower lobe pneumonia. He has no other major health issues. What is the most likely diagnosis?
1) cystic fibrosis!
2) congenital lung abnormality
3) chronic granulomatous disease
4) asthma
5) bronchiectasis of the lingula
Question: 15
Haemophilus influenzae Type B vaccine has been recommended for which one of the following groups?
1) All children at the time of their first birthday.
2) Any child with impaired immunity or chronic disease.
3) All children after the age of 5 years.
4) Siblings and daycare contacts of children who develop systemic Haemophilus influenzae Type B infections, regardless of age.
5) All children at age 2 months.!
Question: 16
A 26-year-old pregnant woman delivers a male infant at 40 weeks, with a birthweight of 2.0 kg. His head circumference is 34 cm and there are no dysmorphic features. Antenatal ultrasounds have been normal until 32 weeks, when intrauterine growth restriction has been diagnosed. Which one of the following is the most likely cause of the low birth weight?
1) congenital intrauterine infection
2) chromosomal or genetic abnormality
3) placental insufficiency!
4) congenital hydrocephalus
5) maternal age
Question: 17
A 4-year-old child presents with an enlarged submandibular node that is 4 cm in diameter, nontender, and not fluctuant. The node has been enlarged for about 4 weeks and there is no history of fever or contact with any person who was ill. A complete blood count (CBC) is normal, and a Mantoux test with 5 tuberculin units of purified protein derivative shows 6 mm of induration. Which one of the following is the most likely diagnosis?
1) cat-scratch fever
2) acute pyogenic lymphadenitis
3) acute lymphoblastic leukemia!
4) tuberculous lymphadenitis
5) atypical mycobacteria lymphadenitis
Question: 18
A 23-year-old woman in her first trimester of pregnancy is diagnosed as having deep venous thrombosis in her right lower extremity. Which one of the following is the most appropriate therapy?
1) warfarin
2) heparin!
3) clopidogrel
4) dipyridamole
5) streptokinase
Question: 19
A 27-year-old multiparous woman is admitted to the case room at 31 weeks' gestation with a 1-hour history of vaginal bleeding. She has painful uterine contractions, with poor uterine relaxation. The most probable diagnosis is
1) blood-stained show.
2) vasa previa.
3) placenta previa.
4) abruptio placentae.!
5) uterine rupture.
Question: 20
A 30-year-old menstruating woman presents at the Emergency Department with a high fever, vomiting and diarrhea of 24 hours' duration. Her blood pressure is 90/50 mm Hg and there is a diffuse erythematous rash. All of the following laboratory results are in keeping with a diagnosis of toxic shock syndrome, EXCEPT
1) creatine kinase 290 U/L.
2) calcium (total) 1.66 mmol/L.!
3) white blood cell count 18 x 109/L.
4) aspartate aminotransferase 100 U/L.
5) glucose 2.2 mmol/L.
Question: 21 The incidence of a particular disease is greater in men than in women, but the prevalence shows no sex difference. The most probable explanation is that
1) the mortality rate is higher in women.
2) the case fatality rate is higher in women.
3) the duration of the disease is longer in women.!
4) women receive less adequate medical care for the disease.
5) this diagnosis is more often missed in women.
Question: 22
All of the following are responsibilities of local public health units in Canada , EXCEPT
1) communicable disease control.
2) health education.
3) investigation of sudden death.!
4) immunization.
5) health promotion.
Question: 23
All of the following are characteristics of provincial voluntary health organizations, EXCEPT
1) provincial governments contribute to their funding in proportion to the number of members.!
2) they are governed by volunteers rather than by professionals.
3) they often carry out programs of education for the public, patients, their families, or health professionals.
4) they may provide direct services to patients.
5) they may conduct research or provide funds to others for research.
Question: 24
The causative organism of cholera, Vibrio cholerae, has been recognized for 100 years. Outbreaks of cholera often reach epidemic proportions; the history of seven pandemics can now be traced. The most recent only just now appears to be subsiding. Which one of the following is the spread of this infection, enhanced by modern transportation?
1) fomites
2) mosquitoes
3) contaminated food sources!
4) person-to-person
5) domestic flies
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