MCCEE & MCCQE (1&2)

MCCEE questions (canada 2003)

2008-08-21T11:14:00.002-04:00

Threshold of a screening test is increased. How it will affect sensitivity and specificity?
a) Sensitivity increase & specificity decrease
b) Sensitivity decrease and specificity increase

2. A child has ingested overdose of iron tablets- first symptom?
a) Nausea and abdominal pain
b) Hyperventilation
c) Seizure

3. Rheumatoid arthritis patient develops tinnitus. Cause?
a) Due to ASA

4. WHO conference in 1978 in Alma Mata, Russia- declaration on
a)

5.Rheumatoid arthritis patient develops swelling left calf and ankle. Thigh normal. Cause?
a) DVT
b) Rupture of popliteal cyst

6. Child 3years with swelling of scrotum. Testis can be palpated through the swelling Fluctuant, painless. Observed for few months. Translucent. Definitive Management?
a) examine regularly
b) aspirate only
c) surgery
d) injecting sclerosant

7. Question on probability- probability of finding one disease is A and other is B. (Independent). Probability on finding the 2 diseases in one pt.
a) AX B
b) A+B
c) AXB- A+B ???

8. Most common occupational disease in Canada.
a) silicosis
b) dermatitis
c) asthma
d) asbestosis

9. Most common cancer in Canada/
a) lung
b) breast
c) prostate
d) brain

10. 23 year old lady presented with cramping abdominal pain and heavy bleeding. Pregnancy test positive. Bleeding stopped today morning. Pregnancy symptoms disappeared one week ago. USG shows empty uterus and 3 cm mass in adnexa. Diagnosis?
a) ectopic pregnancy
b) complete abortion with corpus luteal cyst
c) ves. Mole with corpus luteum
d) twin gestation- one aborted and one ectopic

11. Child with inguinal hernia. Presentation
a) scrotal swelling
b) thickening of spermatic cord

12. A mother brought to her son to your clinic with red spots around eye. You confirmed it as petechiae. What other finding is of concern to you
a) petechiae all over body
b) subconjunctival hemorrhage
c) he developed vomiting after few hours

13. A lady 50 years with swelling medial to femoral pulse. Firm and smooth. Diagnosis?
a) femoral hernia
b) inguinal hernia
c) saphena varix

14. galactorrhoea . cause?
a) pituitary infarction
b) hyperthyroidism
c) danazol
d) thoracic nerve stimulation
e) dopamine agonist

15. Mechanism of action typical antipsychotics
a) + dopamine receptors

16.a patient on antipsychotics, cannot sit still……
a] akathisia

17.best way to prevent benzodiazepine dependence
a) use the one with short half-life
b) use for short duration
c) use at nighttime only
d)

18. Most common gynecological infection in Canada
a) candidiasis
b) bacterial vaginosis
c) gonorrhea
d)

19. Most common cause for premenstrual itching (cyclical itching)
a) candidiasis
b) bacterial vaginosis
c) non specific vaginitis
d)

20. Most specific site to collect swab for gonococci
a) vulva
b) vagina
c) cervix
d) endometrium

21. Pap smear swab collected from
a) endo cervical and recto cervix
b) endocervical and endometrial
c) endo cervical

22. A patient presented with an ulcer near medial malleolus. Cause
a) ischemia
b) perforator incompetence

23. A patient with chronic bronchitis PaO2 60 mmHg. What advise you will give EXCEPT
a) no need for continuous O2 therapy
b) maintain healthy food hygiene
c) annual influenza vaccination
d) no need for prophylactic antibiotics
e) avoid hypnotics or sedatives

24. HIV positive patient, CD4 count 250 Presented with cold. What will you do
a) start multiple drug antiretroviral treatment
b) TMP+ Sulpha
c)
25. Full term child. Birth weight 3000. Develops respiratory distress. Xray shows air bronchogram. Diagnosis
a) Transient tachypnoea of newborn

26. Baby 8 hours after birth, staring and severe Cyanosis. Hypotonia of muscles. What investigation you will do?
a) CK
b) Echocardiogram
c) EEG

27. A child had headache, vomiting, and abdominal pain. Then he sleeps. What is your diagnosis?
a) migraine
b) temporal lobe epilepsy

28. A child 3 years presented with abdominal pain and Bleeding PR for 12 hours. What is your diagnosis?
a) meckel’s diverticulum
b) intussusception
c)

29.elderly –sensorineural hearing loss. Most common Cause
a) presbyacusis
b)

30. Occupational deafness. Usually caused by
a) high frequency loss
b) low frequency loss
c)
31. A passenger in bus got an injury in his eye with the newspaper of the neighboring person. Diagnosis
a) corneal abrasion
b)

32. Benzodiazepam. Cross-tolerance with which drug
a) chlorpromazine
b) alcohol
c) tricyclics
d)

33. A child has ingested 30 tablets of imipramine. What should be done mean while contacting the toxicology center.
a) forced diuresis
b) give ipecac syrup
c) drug to prevent convulsions.
d)

34. A child has ingested an overdose of imipramine. Pt. is stable. What investigation is done to monitor sign of toxicity.
a) ECG
b) EEG
c) Blood level of drug

35. Which combination should not be used?
a) tranyl cypramine-sertraline

36. A child with tic disorder- what is the first thing in management
a) benzodiazepine
b) family psychotherapy

37. Behavior therapy least useful
a) hallucination
b) depression with strong suicidal ideation
c) generalized anxiety
d)

38. Anti depressant drugs most useful in which of the following conditions?
a)

39. Which of the following is the most common condition in Canada?
a) cervical malignancy
b) endometrial malignancy
c) endometrial polyp
d) septulum uterus

40. Toxic shock syndrome. Not true
a) exo toxin
b) tampons
c) skin necrosis
d) fever
e) rash

41. A lady 50 years, 2 years nocturnal cough. Now develops fever sweats weight loss purulent sputum. X-ray shows consolidation apex of lower lobe. Diagnosis
a) tuberculosis
b)

42. Asian 53 years. Weight 93 kg. Arthritis. Now c/o head ache. Striae on abdomen, thinning of skin. What investigation to be done?
A) CT scan head
B) Random plasma cortisol
C) Enalapril enhanced renal angiogram
D)

43. Commonest cause of broncheolitis
RSV

44. Which of the following diseases can be prevented by a live attenuated vaccine except?
a) typhoid
b) measles
c) polio
d) rubella
e) diphtheria

44. If a child develops diphtheria now the mortality is almost the same as it was 50 years ago. But now the disease is not so common because
a) incidence decreased
b) prevalence decreased
c) effective antibiotics developed
d)

45. CAD is more in men compared to women. Which of the following is true?
a) MI investigation and treatment more effective in men
b) Chest pain in women is less frequently attributed to non cardiac causes
c) Awareness about MI is same in men and women
d) Hypertension is a strong risk factor in men compared to women

46. Which of following is the most important risk factor for CVA
a) systolic hypertension
b) smoking
c) elevated serum cholestrol

47. A child with proptosis, swelling and redness around eye, movement of eye painful. Diagnosis
a) orbital cellulites
b) preorbital cellulitis

48. Elderly people
a) prefer to live alone and like their children to visit them
b) live alone because of geographical distribution children have to live away
c) like to live alone and don’t like visitors

49. A man 65 years labile mood, depression forgetful for 2 years. He has long standing hypertension. O/E Cognitive functions partial impairment, absent ankle jerk. Diagnosis
a) alzhiemer’s
b) pseudo dementia
c) multiinfarct dementia

50. A man presented with injury of hand after a fight in beer parlor. Most likely injury
a) dorsal dislocation of 5th metacarpal
b) palmar dislocation of 5th metacarpal
c) radial dislocation of 5th metacarpal
d) ulnar dislocation of 5th metacarpal
e)

51. Which of the following antipsychotic has got least extrapyramidal side effects
a) chlorpromazine
b) haloperiodol
c) resperidone
d) clozapine
e) loxapine

52. Which of the following antipsychotic produce extrapyramidal SE in therapeutic dose?
a)chlorpromazine
b) haloperiodol
c)resperidone
d)clozapine
e)loxapine

53. A lady 33 years had a pregnancy with anencephaly and undergone abortion at 15 weeks. She wants to conceive in 6 months. What advise you will give
a) start folic acid now
b) she has to do amniocentesis at 16 weeks
c) neural tube defects are unlikely to recur in subsequent pregnancies
d)

54. Diabetic lady advice regarding risk of congenital anomalies.
a) risk is same for gestational diabetes and other diabetes
b) risk can be reduced to that of general population if strict control of sugar is maintained through out the pregnancy.
c) Sacral agenesis is the most common anomaly
d) USS for congenital anomaly is done at 32 weeks

56. Prostate cancer; most important in diagnosis
a) PSA
b) DRE
c) CT

59. Soldier returning from peacekeeping force. He has nightmares anxiety. Etc. what is the initial step in management
a) psychoanalysis
b) benzodiazepine for 1year
c) a trial of behavior therapy for s assort period

60. A 23 year old girl develops watery diarrhea after a picnic, 2 days later she develops purpuric rashes, oliguria, what is most likely
a) 2 other picnic mates developed rashes the next day
b) they made lemonade using water from a near by pond
c) many of the picnic people developed bite marks bitten by mosquito
d) few of the picnic people were returning from usa

61. Toddler’s diarrhea what seen
a) indigested food particles
b) fecal occult blood
c) vomiting
d)

62. hirshsprung’s most imp. Inv
a) Barium enema
b) Colonic transit time with radio opaque markers
c) X ray
d)

63. hirshsprung .diff from constipation
a) from birth
b) fecal soiling
c)

64. Male pain left lower quad. Mass. Neutrophilia. Inv?
a) rigid sigmoidoscopy
b) barium. Enema
c) colonoscopy
d) X-ray

65. Child ingested cleaning liquid with Iye. Lips & mouth corroded what is least useful
a) oeso.scopy
b) X ray chest
c)
66. Tension pneumothorax. All are features except
a) hyper translucent
b) mediastinal shift
c) inspiratory stridor
d) subcutaneous crunchy sound
e) decreased breath sounds

67. What is the first management of tension pneumothorax?
a) needle thoracotomy
b) needle thoracostomy
c) chest tube

68. Epiglottitis with mild stridor. all are true except
a) intubation
b) ABG to monitor prognosis
c)

69. Child with sore throat red tongue lymphadenopathy. How to differentiate viral etiology
a) throat swab,
b) white cell count

70. Man with gonorrhea. Treated with cef. Still symptoms. Urine microscopy no organism, cause
a) chlamydia

71. Gonococci
a) intracellular diplococci
b) extra cellular diplococci

72. RTA- blood at urinary meatus, what to do next?
a) urethrogram
b) catheterize
c)

73. Child h/o fall. Pain lumbar region with ecchymoses, gross hematuria. Renal CT shows peri renal hematoma. Child stable renal pedicle normal. Management?
a) surgical repair
b) close monitoring in ICU
c) catheterize and rest for 7-10 days
d) send home

74. Man 56 years. Father died of prostate ca. o/e a small nodule right lobe. PSA 2.2. What advice
a) follow up in 6 months DRE and PSA
b) foloow up in 3 months PSA
c) uss guided Biopsy now
d)

75. Post menopausal bleeding. What inv.
a) endometrial biopsy
b)

76. severe premenstrual syndrome. Definitive management
a) b/l oopherectomy
b) hysterectomy
c) prog
d) oes
e) NSAID

77. Girl 5 years. H/o vomiting since birth. Now complaints of dysphagia for solids. Cause
a) esophagitis
b) bazoar
c) hiatus hernia
d) duo ulcer

78. A man with tertiary syphilis. Which of the following is going to alter his management plan?
a) AIDS
b)

79. A man presented with contracture of PIP. He cannot flex Dip. Which s the pathology
a) flexor digitorum
b) extensor pollicis
c) extensor carpi
d)

80. Case control study useful in
a) study of rare disease.

81. Ethics- a man suspects to be having probable gonorrhea. His wife works in lab. He doesn’t want her to know his specimen. What to do.
a) ask him to tell his wife
b) put a code no. on the sample, not his name.
c) Don’t listen to him
d) Send him to the public sexually transmitted disease clinic

82. A couple comes to you. Husband wants to end the relation what the wife thinks to be a happy marriage. She is crying. What to next?
a) spend one and a half hours to each of them to psychotherapy
b) try to find out what made the crisis
c) send to lawyer
d)

83. For which of the following is behavior modification is best?
a) phobic anxiety
b) generalized anxiety
c) affective disorder
d) bipolar disorder

84. A man 50 years hp 156/95 sweating, palpitation, one of his relative had thyroid ca. what inv. To be done?
a) urine catecholamine
b) urine VMA
c) CT adrenal

85. A man 10 days after pancreatitis complains of abdominal pain, firm swelling
a) pseudocyst,
b) a/c hepatitis
c) cholangitis
d)
86. Peptic ulcer patient complaints of pain radiating to back. Diagnosis
a) perforation
b) penetration

87. Gastric ulcer patient. Treated for12 weeks. Asymptomatic now. When gastroscopy done ulcer is still present. Negative for malignancy and H.pylori. What to do?
a) treat for 8 more weeks
b) life long H2 receptor blocker
c) follow up only
d) partial gastrectomy with excision of ulcer

88. Known MI patient now presents with palpitation. He says he is on quinide, propranolol and digoxin 0.125
mg. O/e- PR-96,irregularly irregular. What should be done to prevent any complications?
a) increase the dose of digoxin
b) anti coagulant for long time
c) give digoxin and quinide togather

89. All are true about carbamazepine except
a) starting dose 200mg
b) causes leucocytosis

90. Mitral stenosis patient goes to a dentist for some procedure. He is asking for prophylactic antibiotics. Which of the following decides which to given?
a) type of procedure
b) presence of atrial fibrillation
c) presence of cardiac failure
d) type of procedure

91. Bier block (regional IV anesthesia). Which is true?
a) bupivacaine is better
b) effect lasts longer even after the procedure , giving adequate post op analgesia
c) suitable for all procedures in hand

92. Elderly lady, pain on hand and upper arm. Wasting of thenar eminence. Severe pain at night. Cannot carry shopping bag. Diagnosis
a) carpal tunnel syndrome
b) cervical spondylosis
c)

93. 75 year old man, sudden onset of back pain, severe pain right buttock, hamstrings, micturition problem. He was having UTI 2 weeks back Cause
a) multiple myeloma involving spinal cord
b) lung ca with metastasis
c) archnoiditis

94. A baby with birth wt.3.5kg now 4 weeks weighs 3.6 kg. Mother worried not drinking enough milk. What will you advise?
a) Tell her that nothing to worry, as some kids don’t gain much weight in the first month
b) start formula feeding
c) investigate the kid

95. A lady 33 weeks of gestation, admitted with uterine cramps and moderate bleeding. Nurse started IV line and blood taken for grouping and cross matching. What to do next?
a) start another IV line
b) arrange for CS
c) start tocolysis
d) examine for cervical dialtaton
e) USS

96. Triple screening done in the antenatal period. Which is true?
a) should be only offered to women who are willing for termination if any abnormality is found
b) should be offered only if proper pre test counseling is given

97. Regarding HRt, a lady ha h/o migraine and strong family history of osteoporosis what should be done/
a) offer oes-prog.HRT
b) progesterone only
c) biphosphonate only
d) oes only

98. Raloxifine, which is true
a) contraindicated in peptic ulcer
b) effective for hot flushes
c) effective for osteoporosis
d) breast ca increased risk

99. Infertility with c/c salpingitis. Which is not done?
a) laparoscopy
b) laparotomy
c) hysteroscopy
d)

100. Ophthalmoplegia with pupillary sparing. Cause?
a) diabetes
b) canernous aneurysum
c)

101.herpes simplex corneal ulcer. What is not done?
a) patching
b) corticosteroids use
c)

102. Otosclerosis.
normal ear drum

103. A child with sinusitis and otitis media. Treated with antibiotics. Serous effusion still present in middle ear. What to do?
a) another course of antibiotics
b) myringostmy with tube
c) myringoplasty

104. A lady gave birth to a cleft palate baby. You are going to send her home after counseling. For what reason she is going to come to your office more often?
a) feeding problem
b) recurrent otitis media
c) teeth problem
d)

105. You gave a new drug to your patients with dementia. Those suffering from multi infarct dementia improved while those with Alzheimer’s not.. What should you do before prescribing this to your patient

106. What type of trial is this?

107. In the Er you are planning to do a new trial on pts with retrosternal chest pain

108. A lady for laparoscopic tubal ligation on the way to theater asks for removal of a mole on her forearm while she is under GA. What you will tell?

109. Jehovah witness signed card

110. hemophilia A
Xlinked recessive

111. A carrier lady for an X linked recessive disease marries a normal man. They have 2 daughters. What is the probability of each of them to become carrier?
a) 1in 4
b) 1 in 8
c) 1 in 16
d) 1in 64

112. Which is not a cause for occupational asthma.
vinyl chloride

113. Which causes nasal sinus ca?
a) nickel
b)

114. condyloma accuminata, pregnant lady what is used
a) podophyllin
b) flurouracil
c) trichloracetic acid
d) imiquimod

115. Picture of tinea cruris. Treatment.
a) topical steroids
b) amphoterecin b
c) tolnaftate
d) grieseofulvin

116. A man presented with headache, photophobia, menigism. CSF_ cells increased, neutrophils 95% What is the most common cause
a) menigococci
b) s.pneumoniae
c) viral

117. Viral meningitis. Which is not true?
a) sugar normal
b) protein elevated
c) chloride high

118. A man with dark skin, liver 20 cm. Cirrhosis. Diagnosis
a) hemochormatosis

119. What inv. In the above patient
a) transferrin saturation

120. A child with necrotizing enterocolitis. All are true except
a) air in portal vein
b) pneumoperitonium
c) peritoneal calcification

121. a man presented with a mass right to his rectus below umbilicus while standing and straining. Disappears while lying down. Diagnosis
a) Richter’s hernia
b) spigelian hernia
c) desmoid’s tumor

122. Which of the following is toxic in overdose?
a) vit.A
b) vit.E
c) vit.K
d) vit.C
e) vit.B12

123. c/f of congenital hypertrophic pyloric stenosis.
Diagnosis.(2 questions)

124. A lady 50 years presented with mild hypercalcemia X-ray chest normal. Diagnosis.
a) sarcoidosis

125. A child had a/c sinusitis and you treated with a course of penicillin. His blood inv shows- TC increase, s.ca decrease others normal. You supplement with ca, what inv. To be done
a) s PTH
b) X-rays of hands
c)

126. A man presented with pain in flanks radiating to groin. He had similar episodes 2 times previously. And was diagnosed to have hyper calciuria. What should be done?
a) thiazides
b) allopurinol
c) reduce dietary calcium
d)

127.post appendicectmy pt develop s-subphrenic abscess

128.which of the following is most likely to be a drug reaction
a) IMN patient treated with pencillin produces rash
b) Sulpha
c) patient with sore throat treated with pen. Has rash

129. Intoxication. –Which one causes oliguria?
a) ethylene glycol
b) cannabis
c) cocaine
d) LSD

130. Intoxication- dry skin. Pupil sluggish reacting. Agitated. Paranoid
a) cannabis
b) cocaine
c) LSD

131. Child electrocuted. What is the cause of death?
a) cardiac arrest

132. A child has features of meningitis. Which is poor prognostic factor?
a) temp.38.5
b) generalized seizure
c) localizing sign
d) neck stiffness

134. Neonatal sepsis.a feature
a) hypothermia

135. A man complaints of severe headache for the last 12 hours. Vomiting + photophobia. Diagnosis
a) subarchnoid hemorrhage

136. A child had a fall and he was drowsy. While waiting in the ER he becomes more and more drowsy .one pupil dilated diagnosis
a) extradural hematoma
b) subdural hematoma

137. A man with a swelling in the right scrotum. O/e- tender mass above testis. skin of scrotum red and inflamed. Prostate enlarged He has pyuria. What is the diagnosis?
a) epididymitis
b) epididymitis and prostatitis
c) gonococcal urethritis

138. How to look for clue cells.
a) vaginal secretion with KOH and cover
b) vaginal secretion with saline and cover
c) cervical secretion with saline and cover
d) cervical secretion with KOH and cover
e) vaginal secretion with KOH and dry

139. Multiple pregnancy-cause of perinatal mortality
a) prematurity

140. Tocolysis contraindicated in all except
a) twins at 33 weeks
b) cervix 4 cm
c) chorioamnionitis

141. Persistent bradycardia in fetus due to
a) head compression
b) AV block
c)

142. Which is true about congenital anomalies?
a) congenital anomalies rarely affect growth
b) if symmetrical IUGR is detected look for congenital anomalies
c) trisomy 13&18 will not cause growth retardation

143. A child 3 years has BP 138/95. He has a systolic murmur right 2nd space, femoral pulse not palpable. Diagnosis ?
a)coarctation

144. apgar score

145. A pregnant lady with GCT 10.3 mmol/l, what is most imp.
Strict maintenance of euglycemia through out the pregnancy

146. A lady prepared for hysterectomy. What will you tell her regarding risk of thromboembolism
a) risk is highest after 72 hours
b) thromboembolism mostly originate from pelvic veins
c)

147. A lady post partum develops DVT. What is the management?
a) warfarin for 3 months
b) heparin IV for 1 week and warfarin for 3 months
c) heparin IV for 1 week and low molecular wt. Heparin for 3 months

148. A pregnant lady 20 weeks. Uterus 26 weeks. Beta HCG 30000.what is the management
a) suction curettage
b)

149. Which of the following is not poor prognosis in melanoma)
a) color change
b) spreading
c) bleeding
d) tuft of hair
e) irregular surface

150. C/f of thrombosed external pile. Diagnosis?

151. Same scenario. Management

152. c/f ischirectal abscess . management

153. A girl c/o continuous pain in the vulva for the last 8 hours. O/e a red tender swelling is seen on the post 1/3 of lab minora. What is the diagnosis?
a) bartholin’s cyst
b) bartholin’s duct abscess
c) skene’s gland abscess

154. A group of people returning from Rocky Mountains developed diarrhea. Cause
a) Rocky mountain spotted fever
b) giardiasis

155.esophageal atresia with tracheo esophageal fistula at the lower end. What is true?
a) gastric aspiration common
b) gastric air shadow not seen
c)
156. A man sustained a stab wound on the thigh anteriorly. He is bleeding profusely. What is the first thing to do?
a) apply tourniquet above the wound
b) press femoral artery
c) direct pressure
d) on wound
e) fill the wound with clothes

157. A child with 15% burns On face and chest. What is done?
a) oral midazoalm and i/v morphine
b) i/v midazolam and burn dressing
c) i/v cef.and morphine
d)

158. 2 year old child. burns 15% calculate fluid replacement

159. A lady brings her son to you saying that he is alcoholic who denies that . what question is least relevant
a) do you need an eye opener in the morning
b) do you hate criticism
c) do you drink only on social occasions

160. Features of anaphylaxis-treatment
a) epinephrine

161. Laryngeal nodule- not a risk factor-
medication

162. A man 64 years c/o hoarseness. What is the first thing to be done?
a) chest X ray
b) laryngoscopy
c)

163. Uncomplicated intestinal obstruction. All are seen except
a) increased bowel sounds
b) distension
c) guarding
d) tympanitic

164. Idiopathic thrombocytopenia

165. Most common cause of syncope in a young man
a) vasovagal
b) hypoglycemia

166. A man presented to Er after a party. Intoxicated. Blood values- HCO3 very low. All others normal. What other inv
a) urine osmolality
b) serum osmolaity
c)

167. Mallory weis – what inv.
a) senstaken tube
b) OG scopy
c) balloon

168. Clinical features suggestive of intestinal ischemia

169. Crohn’s. C/f given. Diagnosis?

170. Right upper quadrant pain, fever, jaundice. Diagnosis
a) a/c cholecystitis
b) cholangitis
c) hepatitis
d)

171. A/c cholecystis. Cause.
a) obstruction of cystic artery
b) onstruction of CBD
c) obstruction of GB by stone

172. post op 36 hours. Cause of fever,
a) atelectasis
b) UTI
c) Wound infection

173. Most common cause of incontinence in women
a) stress incontinence
b) urge incontinence
c) detrusor instability

174. Dementia patient. Treatment of which of the following could have prevented
a) Alzheimer’s
b) pernicious anemia.
c)

175. Another question on dementia.

176. What is the most imp. Thing to differentiate Alzheimer’s from pseudo dementia
a) Short duration
b) mental status examination
c)

177. Treatment for seasonal rhinitis
a) nonsedative antihistamines
b) oral steroids

178. Picture of a child. Mouth open.
a) adenoid hypertrophy.

179. Couple comes to you. Husband hypertensive says impotence 6 months but erection occurs in the morning and while reading the magazine. What should you do?
a) counseling

180. Cause for recurrent UTI in child
a) VU reflux

181. Treatment of nephritic syndrome. All except
a) diuretics
b) salt restriction
c) fluid restriction
d) prednisolone
e) protein restriction

182. Elderly lady fecal occult blood. All are true except.

183. Case of DUB.

184. All the following can be given to improve sexual function. Except
a) sildenafil
b) estrogen
c) testosterone
d) gonadotrophin analogues
e)

185. ADHD

186. A lady with previous h/o cs for footling breech is kept for trial. During labor she develops bleeding PV, fetal tachycardia. …. Diagnosis
a) rupture uterus.

187.a lady at 41 weeks of gestation likes to wait for spontaneous onset of labor. Which of the following require immediate delivery?
a) oligohydramnios
b) macrosomia
c) glycosuria
d)

188.CPS
a) interest of public is most

189. Which of the following is the most effective way to prevent dental caries in children?
a) fluoridation of water
b) dental flossing
c)

190. Periodic health examination not true
a) detection of chronic diseases
b) behaviour change and hygiene
c) more focused annual physical examination

191. ECG
a) LBBB
b) RBBB with RAD
c) RVH
d) WPW

192. Picture of a hand with a lump on the dorsal surface MCP jt.
a) h/o renal calculi

193. A lady develops dry cough. Treated with ampicillin few days later Develops rash, elevated liver enzymes. Cause
a) mycoplasma
b)

194. Bacterial vaginosis. All true except
a) PH-
b) Flagellated organism

195. Malaria treated. Recurrence after 1 year
a) dormant liver schizhont

196. Features of meningitis. What inv.
a) lumbar puncture

197. Features of multiple sclerosis all except
a) dysphagia
b) anosmia
c)

198. Horner’s with dysphagia.
a) PICA
b) ACA

199. Paranoid schizhoprenia- features given,

200. Psychotherapy

201. Elderly wife abusing husband who is suffering from arthritis what is not done
a) send hem to daycare
b) support to wife
c)

202. Status asthmaticus
a) hydration, inhaled beta agonist, IV steroid

203. Strawberry angiomas. Treatment.
a) spontaneous regression
b) excision
c) injection of sclerosant.

204. Ocd treatment
a) fluoxamine

205. Abruption placenta. Cause of DIC
a) fribrinolysis.

MCCEE- Bank of sample questions

2008-08-21T10:43:00.001-04:00

1. Which of the following is correct regarding Wernikes Encephalopathy :
-Often develops into Korsakof's even when treated
-It has a mortality rate of 70 % to 80 % if untreated
-The treatment is thiamine 100 mg. PO daily for 5 days
-The symptoms include Nistagmus ataxia and opisthotonos
-None of the above *

2. Which is the most serious complication of the supra condilar fracture of the Humerus ?
-A compartment syndrome of forearm
-Failure to heal
-Healing in a non anatomic position
-Injury into the median nerve.
-Permanent restriction of the Elbow motion.

3. Which one of the following descriptors of a diagnostic test is Influenced by the prevalence of the disease being tested for :
-Specificity
-Sensitivity
-Accuracy
-Positive predictive value
-Reliability

4. A 43 years M admitted for Emergency Gastrectomey present confusion on the 3rd post-Op day. complains of lack of sleep due to cockroaches on the ceiling he is noted to be flashed & tremelus by the nurses during the day .. the most likely problem is :
-Post-Op Electrolites Inbalance
-Paranoid Schizophrenia
-Depression Psychosis
-Delerium Tremons
-Anoxic brain system

5. Pt. with known type II DM. treated with Clorpropamide present to ED in comma .. blood sugar = 1 mmol / L. .. you give the Pt 1 ampule of D50W & the Pt wakes up promptley . what is the next appropriate management :
-Give another ampule then discharge.
-Give 2 ampules then discharge.
-Give another ampule then observe the pt for 6 h. in the ED.
-Give one more ampule , admit the Pt. & start IV. Glucose Infusion with frequent ongoing glucose measurement

6. Pregnant 36 weeks with vaginal watery discharge , management :
-do sterile speculum exam

7. Barbiturate withdrawal = convulsion

8. Retrovarted uterus complain = asymptomatic

9. G5 P4 post-delivery, postpartum hemorrhage, most likely cause is :
-Uterine atony

10. Anal skin tag in child associated with ,
-chronic Anal Fissure

11. Child with abdominal pain attacks , drowning his legs up , mucouid bloody stool. Diagnosis ?
-Intussusception

12. 1st sign of foot gangrene is = rest pain

13. Pt. M pain in both lower limbs with week popletial artery pulsation , management ?
transvertebral angiogram

14. basket ball player averted his ankle joint during jumping at match , on Examination Pain with Increased Various range. Management ?
-Repair ligament surgery
-Below knee cast

15. clean wound cut with laceration & incomplete section of nerve , management ?
-Suture of wound Immediately
-Leave the wound open

16. pain on walking increase in 2nd & 3rd metatarsal bone of forefoot. Diagnosis ?
-Stress fracture
-Sesamoid bone

17. Pt. 68 years going to elective surgery , he has 4 mo. history of chest pain & got same attack at night before the day of surgery , what do u do ?
-Lignocaine before surgery
-Trinatreate during surgery
-Send him for ICU
-Postpone the operation & check function of the coronaries

18. collage student F 20 years presented with lower abdominal pain , PE bilateral lower abdominal tenderness , febrile Vaginal exam : tender with cervical mobilization , pregnant test (-). Diagnosis ?
-Acute salpengitis
-Ectopic pregnancy
-UTI

19. vaginal bleeding , stooped at the day of admission , pregnancy test is (+) US shows empty uterus & left adnexal mass. Diagnosis ?
-Ectopic pregnancy

20. young Pt with history of non productive cough but clinically well .. C-X ray shows bilateral basal Infiltration .. Diagnosis. ?
-Mycoplasma Pneumonia

21. Pt with Ulcer in sole of the foot , at 2nd & 3rd metatarsal joint X Ray necrotic & destroyed part of 2nd & 3rd metatarsal bone .. what to do ?
-Radical debridment
-Above knee amputation
-Daily sterile dressing
-Oral antibiotic

22. Problem which cause most work days = back pain

23. Nicotinic skin patchy is contraindicated in:
-Pregnancy
-CVA
-Ischemic Heart disease
-Alcoholic

NB. (not sure)

24. Psychotherapy is superior to medication in:
-Schizophrenia
-Bipolar disorder
-Alcoholic withdrawal
-Dysthimia

25. mother worried about her child because of history of myopathy in family .. what Investigation to be done 1st ?
-CPK
-Muscle biopsy
-Nerve biopsy
-EMG

26. Pt on Lithium therapy became weak, lethargic, Intolerant to heat. what Investigation must be done ?
-Lithium level
-BP
-Thyroid Function test

27. surgical nurse 25 years old is concerned that she is loosing her mind, for the past 6 months she is been preoccupied with contamination, on his ward she has been not touching any patient ,door knobs ...etc.
She was also washing her hand excessively, which of the following treatments will help in reducing her preoccupation and hand washing ?
-Fluxetine
-Lorazepam
-Perphenazine
-Insight-oriented psychotherapy
-Nifedipine

28. M 50 years with Prostatic Cancer with bone metastasis. Treatment ?
radical prostatectomy
-Radiotherapy
-Hormonal therapy in the form of total androgenic blockage
-IV chemotherapy

29. Pt with family history of urticaria, presented with urticaria ... investigation revealed C1 esterase inhibitor deficiency ... Diagnosis. ?
-Hereditary Angioedema

30. thickened upper Lt. lip with mild vesicles ... Diagnosis ?
-Urticaria
-Angioedema
-HSV infection

31. Erithematous Vulva with whitish lesion of Candida of Groin & Satellite lesions .. what is the predisposing disease ?
-DM
-CA. vulva
-Lichen sclerosis

32. Pt with sudden cough & pain in the Rt. side of the chest .. you suspect aspiration of foreign body .. what finding of the C-X ray ?
-Hyperlucent Rt. side

33. Defrentiaion between Maxilary & Zigomatic fractures ???????

34. calculation of the effectiveness of a vaccine

Incidence Non Vaccinate - Incidence Vaccinated
--------------------------------------------------------------- x 100
Incidence Non Vaccinate

35. child chalking during eating .. he became Cyanotic, agitated, with forceful breathing .. 1st action to do is :
-Hit him from his back while head downward
-Introduce your finger in his mouth

36. 17 years F. at stage 3 Tanner still not menses .. management ?
-Examination of the pelvis
-Chromosome analysis
-Estrogen Progesterone level
-Reassurance

37. asthmatic Pt. presented in the ER with Dyspnea , used to inhaled salbutamol with no Improvement.. PE shows dyspnea slit rhonchi at the upper chest & neck ... management. ?
-IV. fluid + Aminophine
-Coricosteroids Inhaled
-Inhaled Salbutamol + IV hydrocortisone + IV Fluid

38. Alfa fetoprotein Increased in
-Menengomyelocele
-Renal Agenesis
-Down Syndrome

39. pt with abnormal pap smear .. what is the next step ?
-Colposcopy

40. 60 years F. presented with 5 x 5 cm. adnexal mass .. management. ?
-Surgery
-Chemotherapy
-Radiotherapy

41. Pt. found unconscious on the floor behind the bar, alcoholic, ER agitated semiconscious ... PE shows laceration on the head, all the limbs can be moved, all the others are normal… what is your action?
-CT of the head
-IV. fluid + Observation
-Discharge

42. Pt. fail down from the 2nd floor on his back .. the following will be part of the Initial management EXCEPT :
-Cervical collar
-IV. fluid
-Spine X Ray
-Urinary catheter

43. tertiary prevention is
-Rehabilitation.

44. in the ER. young Pt treated with Procainamide his BP. decreased to 80\60 you tried another time with Procainamide .. his BP. still decreasing .. what to do ?
-Benztropine
-Saline perfusion
-Digitalis
-Defibrillation
-Intubation

NB. the Pt. had Arrhythmia with hypertension (that’s why we gave him procainamide) & because its not decreasing we have to defibrillate him ...

45. F 23 years present with fibroadenoma of the Lt. breast in the lower medial quadrant of the breast all are possible EXCEPT :
-Give Estrogen
-Give Progesterone
-Fine needle aspiration will bring clear liquid
-Mammography can show abnormality
-The growth of the Tumor following cycles

46. F. febrile with tumor in upper Rt. quadrant of the anus .. the mass is painful & red .. what to do ?
hot bandages
-Cold sitz baths
-Surgery
-Systemic Antibiotics
-Topical Antibiotics

47. child with juvenile poliposis .. possible complication :
-Diarrhea
-Painless bleeding
-Painful bleeding
-Malignancy (cancer)
-Non of the above

48. a mother brought hear 12 years daughter who present repetitive UTI temp. 38.5 , IVP & cystography are normal .. what is the best test to do :
-Urine culture
-US & voiding cystography
-Blood culture
-Cystoscopey
-None of the above

49. fibroadenoma of the breast what is false :
-The most common benign tumor
-Fine needle aspiration bring clear fluid
-True solid tumor
-Tumor easy to find because encapsulated

NB. check it alone

50. F pregnant 28 years .. with nocturnal numbness in hands & forearm which wakes hear up for 3 months .. she also have difficulty grasping objects .. what is the most likely etiology ?
-Dermatomiosis
-Abruptio placenta
-Multiple sclerosis
-Carpal Tunnel Syndrome
-Hyperventilation syndrome

51. 72 years old with heart failure with high blood pressure treated for long time. He was brought to E R for hypotension 80\60 HR 110, what to give ?
-Procaine
-Lidocaine
-Cardioversion
-Digitaline
-Furosemide

52. Post-op. of Pancreas .. what is the cause of hypovolemic shock ?
-Initial necrosis of acute pancreatitis has produced tripsine
-Septic shock
-Loss of liquids
-Side effect of anesthesia

NB. not sure

53. 68 years F. with history of Hysterectomy, came to see u because of micturation trouble at effort, no digestive trouble, she has a feeling of a painless mass intravaginaly, she has to try twice in order to void her bladder what is the diagnosis ?
-Rectocele
-Cystocele
-Prolapse (Prosedentia)
-Urethral sphincter spasm
-Post-surgical stricture

54. young M. feels sudden crack in his calf, what is the best clinical sign to diagnose Achilles tendon rupture ?
-Decreased dorsal flexion
-Impossibility to walk on the toes
-Increased passive dorsiflection of the foot
-Squeezing calf does not passively planter flex foot

55. farmer 74 years M. present with bilateral semetrical neaurosensorial defenses , PE is normal . diagnosis ?
-Autosclerosis
-Professional defenses
-Acustic neuroma
-Presbiacusis
-Circulatory deficit

NB. Most common cause of hear losing in elderly is presbiacusis

56. F. 45 years with decreased visual acuity, no pain , no tears. what do u exam first ?
-Tonometry
-Refraction
-Angiography
-Neurologic test
-Rheumatoid factor screening

57. Burned Infant 2nd degree in the upper limb, what do u do ?
-Debrid & skin graft.
-Debrid & bandage
-Debrid & topic cream
-Clean the wound & systemic antibiotic
-Local care only

58. Cyclist attacked by bee comes to emergency with hypotension 80\60 , Heart rate 115 .. what do u do first ?
-Antihistamine H1 & H2
-Saline perfusion
-Epinephrine Injection
-Intubation
-IV. steroid

NB. we also give it by subcutaneous or IM. & in children IV or Endotracheal tube

59. child 5 years bitten by the neighbors dog .. the dog received all the vaccines. what do u do ?
-Observe the dog 10 days & anti rabbi serum
-Observe the dog & anti rabbis serum & vaccine
-Kill the dog
-Vaccinate the kid
-Observe the dog

60. F. 28 years present with chronic rhinorrhea , in the exam you found mucousal nasal atrophy .. diagnosis ?
-Sinusitis
-Cocaine intake
-Nasal poliposis
-Allergic rhinitis

61. F. 45 years back from a plane travel , complains vertigo, tenitus, moderate hearing loss, BP is 160\110 .. Diagnosis ?
-Hypertensive crise
-Miners disease
-Migraine
-Acustic neuroma
-Barotaruma

62. what is the most common cause of lung abscess in post-Op pt.
-Bacterial discrimination from operative site
-Atelectasia
-Pneumonia
-Aspiration

63. M. 25 years when he goes to toilet, he complains of painful defecation in the anal region, at the exam you will find bluish mass at the anal margin.. what is the Diagnosis ?
-Hemorrhoids internal sclerosed
-Hemorrhoids external strangulated
-Hemorrhoids external thrombosed
-Pyelonedle cyst
-Poliposis

64. all the following tumors favorized by TOBACCO Except...
-Bladder
-Esophagus
-Liver
-Cervix
-Lung

65. 5 years child have been beaten by a dog .. he had a deep wound, the dog is in a safe place .. what do u do ?
-Disinfect & clean the wound & put bandage

66. breast feeding women with DVT. treatment. ?
-Warferin
-IV. heparin
-Antistreptocinase
-Bandage

67. immediate post-op presents sudden hallucination , agitation & pretend that was miss treated .. Diagnosis ?
-Psychosis
-Depression
-Post-op delirium
-Analgesic withdrawal syndrome

68. a pt consult u for painless testicular swelling , transilumination was (-) after minor trauma ... Diagnosis ?
-Spermatocele
-Epidedimitis
-Varicocele
-Hydrocele
-Germinoma

69. F. 47 years present with sudden strong pain of the Rt. upper quadrant with fever 38.5 vomiting, no jaundice ... Diagnosis ?
-Colidutal obstruction
-CA of pancreas
-Acute cholicystitis
-Acute hepatitis
-Biliary lithiasis

70. Pt refared to u by his dentist because of whitish lesion at the base of the tongue .. what is your attitude ?
-Biopsy
-Identification of germs
-Ask for a correction of his dental prostheses
-Treat him by anti micotic oral bath

71. young boy present with frequent episode of rhinitis with purulent discharge & fever, from a maxillary sinus, what is the most likely complication if untreated ?
-Purulent meningitis
-Ethmoidal sinusitis
-Orbital cellulitis
-Frontal sinusitis

72. F pt. PE. painless mobile mass on Rt. upper quadrant without fever or Jaundice, what is the most likely diagnosis ?
-Tumor of Lt. inferior lobe of the Liver
-Hydrocholecyst
-Tumor of superior pole of the Rt. kidney
-Liver metastasis

73. child 13 years obese present with painful Rt. knee & pain of Rt. hip with difficulty walking & reduced abduction & Internal rotation , what is your diagnosis ?
-Juvenile Arthritis
-Septic arthritis of the hip
-Avascular necrosis of femoral head
-Cartilage dysplasia
-Slipped capital epiphysis

74. Pt. fell on his hand , Emergency X Ray was normal , but the pt. complain from painful wrist at abduction. management. ?
-Cast
-Explain him that the pain will disappear after 2 weeks, its normal.
-Bandage
-Short cast plus X Ray in 15 days
-NSAID's

NB. diagnosis is Scaphoid fracture & its very difficult to see it in X Ray.

75. Indication of elastic band in Hemorrhoids is :
-Thrombosed Hemorrhoids
-Type II bleeding Internal Hemorrhoids
-External Hemorrhoids
-Angioma

76. 65 years obese Pt. complains of strong & sudden mid abdominal pain radiating to Lt. flank, what is your diagnosis ?
-Acute pancreatitis
-Cholecystitis
-Ureteral stone
-Mesenteric Infarctus
-Rupture of abdominal aorta

77. Pt. complains of Rt. upper quadrant pain & fever , PE shows slight abdominal tenderness, what investigation do u do to comfirme the diagnosis ?
-Biopsy
-Barium meal
-Peritoneal Aspiration
-Rectosigmoidoscopy
-Echography

78. most common complication of Epidural Anesthesia in a pregnant woman:
-Fetal hypoxia
-Hypotension
-Decrease in contraction
-Arrest of labor

79. Child pulled by his mother from his arms .. PE shows that one arm is adducted & the forearm is on pronation. what is the most likely diagnosis ?
-Humeral fracture
-Laxation of the Inferior extremity of the ulna
-Subluxation of ulnar head
-Rupture of rotator cuff

80. defense mechanism in phobia = displacement, avoidance

81. defense mechanism in borderline PD. = splitting

82. Pt. doing the opposite of what he believes is good = reaction formation.

83. Pt. on lithium therapy complain of fatigue , increased weight , heat intolerance , what test would you order ?
-Thyroid stimulating hormone level test

84. Pt. presented with pulmonary edema & BP. 180\95 , what is the best treatment ?
-Furesemide

85. 47 years F. with jaundice & history of nausea & vomiting , anorexia & depression , she is on Rifampicine, INH, Pyridoxine. PE Hepatomegaly + tenderness, Investigation reveal :SGOT, SGPT increased x 5, ALP slightly increased . the most likely diagnosis is :
-Drug induced hepatitis
-Viral hepatitis
-Acute pancreatitis
-Liver CA.

86. Pt. complain from visual spatial defect , where is the lesion ?
-Rt. cerebral hemisphere
-Lt. cerebral hemisphere

87. 4 years African boy on septrine for tonsillitis presented with Jaundice , Investigations : Hb. 9.8 gm % , reticulocytes count 8 % , Hb. electrophoresis : Hb.A . what is the most likely diagnosis ?
-Sickle cell anemia
-Thalassemia
-Spherocytosis
-G6PD deficiency

88. F. 65 years present with recurrent painless lower GI bleeding, colonoscopy, gastroscopy, barium enema, endoscopy & upper GI series all are normal, what is the dig. ?
-Rt. colon angiodysplasia

89. F. 50 years operated for cholicistectomy presented with heavy wound bleeding , she gives you a history of massive bleeding when she had a tooth extraction , what will you find ?
-Increased PTT + Increased BT
-Increased PTT + decreased BT
-Normal PTT + Increased BT

NB. diagnosis is Von Willebrand disease

90. pregnant woman with abruptio placenta, developed echymosis & bleeding , your diagnosis is DIC. what is the most specific test to confirm it ?
-Increased FDP (fibrine degradation product)

91. RTA (road traffic accident) Pt. with multiple fracture & trauma, 24 h later he develop tachypnea, PCO2 = 32, PaO2 = 50. X Ray shows bilateral infiltrates what is the next step to do ?
-Lung scan
-Ventilator

92. all the following are primary prevention except :
-Immunization
-Health related education
-Pap smear

93. pregnant lady developed postpartum hemorrhage after vacuum delivery , what is the most likely cause ?
-Uterine atony
-DIC

94. primigravida after delivery of a 4000 gm baby, after a prolonged labor could not urinate. What is the most likely cause ?
-Bladder atony

95. Child RTA present with urethral bleeding & urinary retention. Management ?
-Retrograde urethrogram

96. M. 25 years RTA, 4 h. Later developed Rt. Flank pain with heamaturia. What to do ?
-IVP.

97. F. 65 years complains heamaturia with clotting, frequency, nocturia & no dysuria. Diagnosis. ?
-Bladder CA.

98. What is the most likely cause of no changing in variability in fetal heart on NST (non stress test) ?
-Fetal sleep

99. NST indicated in all except :
-IUGR
-DM
-HT.
-40 weeks Pregnancy

100. The most specific test in UTI in infants is :
-Sample obtained by catheter

101. How do u calculate the natural growth of a country ?
-Crude birth rate - death rate

102. Child 4-5 years can do all of the following except :
-Imitation
-Group play
-Autonomy
-Abstract thinking

103. All of the following are normal during pregnancy except :
-Spider telangiectasia
-Heart rate of 90
-Decreased BP.
-Palmar erythema
-White blood cell 3000

NB. The WBC is increased in pregnant But with impaired function

104. What is the best treatment of mild toxemia of pregnancy ?
-Bed rest & Lt. Lateral position

105. F. 16 years old complaining of loss of weight of 10 Kg. All of the following suggest non organic cause except :
-Does not worry about weight loss
-Engaged in athletic activity
-Family history of eating disorder
-Persistent complain of fatigue

NB. Its a case of Anorexia Nervosa

106. Which of the following suggest a DM in a 20 years M. ?
-Loss of weight despite good eating

107. All of the following suggest thyrotoxicosis except :
-Loss of weight
-Meanorrghe
-Diarrhea
-Sweating

108. Young lady present a feature of hypothyroidism (cold intolerance, fatigue, anorexia, weight gain, meanorraghe, dry & rough skin, hair dry & coarse .... ) TSH is increased & T4 is low. What is your treatment ?
-Start L-thyroxine

109. Lady develop severe PPH (post partum heamorrage), she present after 6 wks with fatigue an inability to breast feed (absence of breast milk). All will be decreased except .
-Prolactin
-TSH
-LH
-T4

NB. Diagnosis. is Sheehan’s syndrome (postpartum pituitary infarct)
The T4 has got a long 1\2t ..

110. Lady 15 days after delivery complain of epigastric pain radiating to the back with nausea & vomiting , history of group B strep. Infection. The pain is relieved by leaning forward, PE. reveal an epigastric tenderness what is the diagnosis ?
-Pancreatitis

NB. The pain is relieved by leaning forward (Inglefinger’s sign)

111. Lady who delivered after prolonged labor present to you after 2 days. All of the following suggest Endometritis Except :
-Tender uterus
-Foul smelling
-Uterus 9 cm. below umbilicus
-Pyrexia

112. Lady after delivery develops fever. She still febrile after 5 days of antibiotic therapy. PV exam is normal. Diagnosis. ?
-Pelvic-thrombo-phlebitis

113. Young M. Complains of pain after defecation. PE reveal a blue mass , tender . Diagnosis. ?
-External thrombosed Hemorrhoid
-Internal thrombosed Hemorrhoid

114. Recurrent perineal abscess associated commonly with :
-Perianal fistula

115. All of the following are contraindicated to epidural anesthesia except :
-Decrease platelet
-Bleeding diathesis
-Sepsis at site of injection
-Decreased BP.
-Labor at 35 wks.

116. M. came after 24 h. of attack of renal colic. IVP done shows stone 0.5 cm. at L4, the kidney is slightly enlarged. Management ?
-Observation
-Tranurethral removal of the stone after cystoscopy

NB. Conservative treatment if the stone is less than 5 mm & no complication.

117. M. 55 years with painless mass in scrotum (2 cm) transillumination is (+ve) . Diagnosis. ?
-Hydrocele
-Spermatocele
-Hernia
-Varicocele
-Testiular CA.

118. M. 25 years presented with solid scrotal mass, after minor trauma to the testis. Diagnosis. ?
-Seminoma

119. Experimental study done with 2 drugs, shows that the result is significant, the epidemiologist wrote in his report that “p” is less than 0.5. What does that mean ?
-The association is less than 1\20 (5%) likely to be due to chance alone

120. Ultrasound will diagnose all the following at 20 wks EXCEPT :
-Twin pregnant
-Poyhydramnios
-Trisomy 21

121. Alfa feto protein is increased in :
-Edward syndrome
-Down’s syndrome
-Myelomeningocele

122. Psoriasis ... All except :
-Decreased C3 , C4

123. Old man complain of low back pain, X Ray shows decreased joint space & osteophytes diagnosis ?
-Degenerative joint disease (osteoarthritis)

124. Boy 2 years, complain of knee pain, PE tender but not swollen knee, slightly warmer than the other joint. What is the best investigation to do ?
-Xray of the knee
-Bone scan

125. Pt. present with fracture, you want to make a caste. You advise him about compartment syndrome. What will appear first ?
-Pallor
-Coldness
-Numbness
-Decreased pulse
-Paralysis

126. The most effective treatment in Osteoporosis is :
-Exercise
-Analgesics
-Vitamins
-Estrogen

127. Pt. On OCP complain of amenorrhea 3 months after using the pills. What is true about amenorrhea?
-Due to high progesterone
-Due to Estrogen

128. Definition of potential years of life lost (PYLL) : .................................

129. Sexually active lady present with dysuria & vaginal discharge. All the following can cause this condition EXCEPT :
-Gonorrhea
-Chlamydia
-Trichomonasis
-Condyloma Accuminata

130. Bacterial vaginosis EXCEPT :
-Clue cells
-Fishy odour with KOH test
-Decreased lactobacilli
-Vaginitis
-Frothy offensive discharge

131. Pt. complain of vertigo, how can you diagnose labyrinthitis ?
-Nystagmus

132. Pt. Operated for pituitary tumor, then he developed polyuria, dehydration inspite of receiving 4 L IV fluid. What will u give ?
-Give more IV fluid
-Start oral rehydration
-Give vasopressin (DDAVP)

NB. This is a case of SIADH

133. Alcoholic Pt. Complain of instability in gait, he uses a cane to avoid frequent fall. Romberg test is (+ve). what is your diagnosis ?
-DT.
-Alcoholic withdrawal
-Alcoholic cerebellar syndrome

134. Pt. complain of Tinnitus in Rt. ear, on Exam u found sensorineural deafness. Diagnosis. ?
-Acustic neuroma

135. New born, all the following are increasing risk factors of deafness EXCEPT:
-Family history
-Used of gentamycin
-History of CMV infection
-Delayed speaking

136. What will be your management. For a 3 years boy with stuttering ?
-Reassurance

137. All the following neonates are prone to hypoglycemia EXCEPT:
-IUGR
-Diabetic mother
-Normal infant born at 36 wks
-Hypothermia
-Non of the above

138. 32 years F. consult u for inability to conceive for 2 years, she is married who has 3 children from another woman. Temperature chart shows ovulation. What to do first ?
-B-HCG
-Hysterosalpingogram
-Progesterone at 21 day
-Semen analysis

139. F. 18 years height 158 cm , normal breast, with primary amenorrhea , PE small uterus, all of the following to be done EXCEPT :
-TFT (Thyroid) & Prolactin level
-Progesterone test
-FSH, LH level
-Laparoscopy
-Skull X Ray

NB. MCCQ 2001 (GY 11) we normally do the others in the same order as it is ..

140. F. 21 years , with 2 months history of fibroid mass, asymptomatic. Management ?
-Reassess after one year
-Myomectomy
-Hysterectomy
-Hormonal therapy

141. What is the most common source of mercury poisoning in Canada ? & who are the most exposed group of people in Canada ?
-Fish - (native Indians)

142. Which of the following you should not notify the police about ?
-Child abuse
-Spouse abuse
-Child neglect
-None of the above

143. You do a stress test ECG for a Pt. All are significant EXCEPT :
-ST decreased by more than 2 mm
-Chest pain
-ST increased (upward slopping)
-Decreased in BP by more than 50 mmHg.

144. All are true with post infectious GN. Except :
-Normal C3 , C4
-Hypoalbuminemia
-Increased cholesterol
-Proteinuria is more than 2 gm.

145. M. 65 years , present with low back pain anemia & hypocalcemia. What will you do to confirm the diagnosis ?
-WBC. Count
-Bone marrow aspiration
-Platelet count

146. HIV Pt. With fever & weight loss , he may have all of the following EXCEPT :
-Esophageal candidosis
-Mycobacterium Avium
-Mycoplasma pneumonia
-CMV infection
-Mycoplasma cellulari

147. F. 35 years with ataxia, weakness of the Lt. Side of body , dysphagia & visual trouble . PE reveals diplopia & nystagmus. What is the Diagnosis. ?
-Multple Sclerosis.

148. What is the most common complication of Juvenile Rheumatoid Arthritis:
-Iridocyclitis
-Hepatitis
-Nephritis
-vasculitis

149. M. Brought to u by police, for assaulting a 12 years old boy. When asked his name by the police , he said that he don’t know , & when u ask him how many legs does the horse have , he said 5 . What is the diagnosis ?
-Malingering
-Factitious disorder
-Antisocial personality
-Fugue

150. In which pathology you have gloves & stocking anesthesia ?
-DM.

151. M. With bipolar disorder came with agitation & aggressive behavior. Best treatment ?
-IV Haloperidol
-Lithium & Antipsychotics

152. All are seen in DT. Except :
-HT.
-Fever
-Tachycardia
-Fixed hallucination

153. Best prophylaxis for a Canadian traveling to a Malaria area with no resistant train is :
-Chloroquine

154. Pt. Diagnosed with dysthymia what is the best treatment :
-Psychotherapy
-Fluoxetine
-Imipramine

155. In cardiac arrest due to Ventricular Fibrillation , what is true ?
-NaHCO3 should be given every 5-10 minutes unless blood gas are known
-Lignocaine must be given
-DC cardioversion first

156. Dyspepsia, all are helpful EXCEPT:
-Antacids
-Elevate bed head
-Cimetidine
-Misoprostol

157. Asthmatic Pt. On steroids , has to go for operation for perforated duodenal ulcer . What will u do ?
-100-200 mg Hydrocortisone IV before the surgery
-Beta-agonist inhalor before the surgery

158. Chinese restaurant food poisoning. All are true EXCEPT :
-Symptoms within 1\2 h.
-Resolves after 24 h
-Symptoms of ashma + ataxia + dyspnea

NB. Monosodium glutamate is the cause of this syndrome (its a pharmacological but not allergic reaction. Dose related symptom of burning sensation throughout the body, facial pressure, anxiety & chest pain)

159. RA. Pt. On aspirin present with a normocytic normochromic anemia . All are true except:
-Respond to treatment with B.12
-Feritine maybe Increased
-Decreased serum Iron
-Normal total Iron binding capacity

160. What is the most common cause of congenital heart failure in NB.
-VSD
-ASD
-TGA
-Tetralogy of Fallot

161. A nurse with hypoglycemia & decreased C-peptide. What to do ?
-Refer to Psychiatrist

162. All are feature of TSS Except :
-Fever
-Decreased BP.
-Pustular skin lesion
-Erythroderma

163. All are feature of KAWASAKI disease EXCEPT:
-Fever for 5 days
-Purulent conjunctivitis
-Skin rash
-Fissure of lip
-Strawberry tongue

164. Variable deceleration commonly seen in :
-Uteroplacental Insufficiency
-Cord compression
-Sleeping fetus

165. All increase the level of carbamazepin EXCEPT :
-Cimetidine
-Estrogen
-Phenobarbital

166. M. Present with Rt. Side horner’s syndrome & contralateral loss of sensation of the body. Where is the site of the lesion ?
-PICA
-ICA
-Internal Carotid

167. Pt. With hypokalemia . All true EXCEPT :
-Diarrhea
-Paralytic ileus
-Hypotension
-Hypoventilation
-Muscular weakness
-Polyuria & polydepsia

168. All are live attenuated vaccine except :
-BCG.
-Vaccine of yellow fever
-Polio
-Measles
-Diphtheria

169. How often do u give a booster in people previously adequately immunized against tetanus :
-Every 10 years

170. All are included in the routine immunization EXCEPT:
-Measles
-Pneomococus vaccination
-Mumps
-Rubella

171. Heamophilus Influenza contact, prophylaxis is :
-Refampicine

172. Pregnant , 8 wks, came into contact with a boy suspected of having Rubella infection . Management ?
-Rubella vaccination
-Give Rubella IgG.
-Do antibody titre in the pregnant lady
-Therapeutic abortion

173. Farmer came with a nail in his foot & temp. of 38.2 . Management :
-Antibiotics
-Tetanus toxoids + antititanus Ig. + antibiotic
-Antitetanus Ig.

174. F. Young present with Meanorrhagea. Commonest cause is :
-Deficient luteal phase
-Short secretory phase
-Prolonged secretotey phase

NB. Anovulation is the best answer if there.

175. Postmenopausal lady with MI. & she is an active smoker. She does not want to stop smoking. She is on Hormonal Replacement Therapy. What advice do u give ?
-Stop Estrogen & start exercise

176. Post-Op continued to bleed despite 10 units of packed RBC. Transfusion. What is the cause ?
-Hypercalcemia
-Hyperkalemia
-Dilutional thrombocytopenia

177. RA. Pt. On ASA. Developed ITP . What is the treatment ?
-Steroids

178. Pt. Developed excessive menstrual bleeding & purpura . All the following lab. Finding are expected EXCEPT:
-Decreased Hb.
-Decreased platelets
-Increased platelets
-Prolonged bleeding time

179. Bartholinitis abscess. What is the treatment ?
-Antibiotics
-Marsupialization

NB. I & D is a good answer as well.

180. Pt. With lymphadenopathy & splenomegaly & raised WBC . What is the confirmatorey test ?
-CBC deferential
-Bone marrow aspiration

NB. Leukemia case

181. Pt. With bilateral hilar lymphadenopathy with micronodular infiltrates. All can give this feature EXCEPT ?
-Sarcoidosis
-TB.
-Transbrbronchial bronchogenic carcinoma

182. Pt. With painful bluish mass protruding from the anus. Diagnosis. ?
-Prolapsed anal piles
-Thrombosed external piles
-Internal piles

183. All can Cause Pruritis ani EXCEPT:
-Laxative
-Hemorrhoids
-Fecal incontinence
-Colorectal CA

184. F. 24 years with (+ve) preg test , present with 2 days vaginal bleeding, US shows 3 cm mass in the Lt. Adnexa & empty uterus, pregnant Sympt & signs of preg has disapeared & the cervix is closed. Diagnosis. ?
-Complete abortion + luteal cyst.

NB. u consider ectopic pregnancy until otherwise proven.

185. Indication of C-section in breech presentation is:
-Footling
-Frontbreech presentation

186. Prevalence definition: total number of cases in a population at a given time.

life birth
187. Crude birth rate = ------------------------------- x 1000
Total medial population

188. The tree of autosomal dominant transmission

189. F. Consult you because of a possibility of her offsprings (kids) having Huntington’s Chorea. Her father is affected. Her husband family don’t have this disease What is the possibility that her children will develop the disease ?
-50 %
-0 %
-25 %
-100 %

190. F. With pregnancy like symptoms, US shows grape like masses in the uterus. All true EXCEPT:
Multiple gestation
-Bilat. Ovarian cyst
-Hyperthyroidism
-Hypothyroidism, coma, preorbital myxedema

191. All have risk factor to develop preeclampsia:
-Nulipara
-DM
-History of preeclampsia
-Multiparity

192. Pregnant Pt. 20 weeks The uterus size is 25 cm. All true EXCEPT:
-Normal pregnant
-Wrong estimation of gestational age
-Twin pregnant
-Bilat. Renal dysgenesis

193. Old lady with ankle edema at the right medial malleulus, with superficial ulcer & surrounding scar. Diagnosis. ?
-Venus insufficiency
-Venus valvular insufficiency

194. Preg. Lady with known fibroid, complaining from abdominal pain
-Red degeneration

195. M. 16 years old complain from loss of weight, he is passing bloody diarrhea, Investigation show normal upper indoscopy & segmoidoscopy. What to do next ?
-Upper GI series

196. Child 4 years old, presented with post. Mediastinal tumor. What is the commonest germ cell tumor ?
-Thymoma
-Neuroblastoma
-lymphoma

197. PT. With fat malabsorption, passing floating stools + loss of weight & easy bruising. Diagnosis. ?
-GI lymphoma
-GI TB
-Glutane antheropathy (celiac disease)
-Repeated episode of pancreatitis

198. Pt. With DKA. All occur EXCEPT:
-Increased Amylase
-Abd. Pain
-Increased K.
-Increased osmolarity
-Leukocytosis

NB. Merck 1999 (p.178) in DKA. serum amylase typically elevated while K is Increased or normal

199. F. Pt. On Insulin therapy, she has a baby. You will suggest her the following about Insulin Except:
-Hold insulin until the baby start eating

NB. (always Insulin & Heparin are SAFE during pregnancy & lactation)

200. Best site to obtain smear for Gonorrhea in a woman is:
-Vulva
-Vagina
-Cervix (mouth of the wound)

201. Which stage of sexual excitement according to Tonom criteria when the female is having clitoral erection, increased vaginal secretion, nipple erection ?
-Early excitement
-Resolution
-Late excitement
-Latent phase

202. F. With difficulty caring shopping bag, weak abduction of the thumb + minor wasting of the thumb (minor thenar atrophy) Diagnosis. ?
-Carpal tunnel syndrome

203. Radial nerve injury at the level of the head of Radius. What will u find ?
-Dropping wrist

NB. Merck 1999 (p.1493) The Saturday night palsy is another name for the Radial nerve palsy.

204. Which of the following is a sexual desire abnormality

-Does not imagine sexual fantasies
-No sexual activity for more than 2 wks
-Nervous about sexual act
-Try to avoid partner contact

205. Transvestitism disorder, all true EXCEPT

-Dressing clothes of other sex for sexual excitement
-More common in male
-They are female

206. All are known to cause depression EXCEPT:

-Clonidine
-Cimetidine
-Cyclosporine
NB. The drugs which cause depression are : Anti-HT, Anti-Parkinsonian, Hormones, Steroids, Anti-TB, Anti-Neoplastic

207. Pt. Brought to u mute & inaccessible to examination. Diagnosis.

?-Catatonia MCCQ PS6 (2001).

208. M. 35 years Found in the street wandering, he doesn't know his name, talk to him self. All are possible etiology EXCEPT:

-Schizophrenia
-Fugue
-Alzheimer disease

209. Girl came with midline neck cyst, which moves while protruding the tongue (with swallowing). Diagnosis.

?-Dermoid cyst
-Brachial cyst
-Thyroglossal duct cyst

210. All are routine investigation for an old lady with urinary incontinence EXCEPT:

-Urine analysis
-Cystogram
-Urinary diary
-Direct visualization of incontinence when Pt. with full bladder while coughing

211. Definitive test for chronic pancreatitis is-CT -ERCP-MRI

212. Pt. With pruritis & progressive jaundice, with increased ALP. & total bilirubine. What is the next investigation u do ?
-US.
-PTC (percutaneous tranhepatic cholangiography).
-ERCPNB.
Always start with the less invasive investigation.

213. In Necrotizing Enterocolitis. All feature exists EXCEPT:

-Pneumatosis Intestinalis (X Ray)
-Peritonitis-Peritoneal calcification
-Portal venous gas (X Ray)
-Pneumo peritonium (X Ray)

214. What is the commonest cause of non scarring alopecia on a young girl ?

-Alopecia Areata
-Tenia Capitis-Chemotherapy

215. During insertion of IUD. The Pt. Develop hypotension. What will u do ?

-Elevation of the legs

216. IUD. Tread seen dangling outside the cervical os during an examination of a pregnant Pt. What will happen if removed

-Normal pregnancy 55%

217. Pt. In the ER. With fracture of the femur , develop sudden hypotention. What is the cause ?

-hemorrhage

218. Verapamile given IV for treatment of SVT. The Pt. Develop hypotention. What will u do?

-Defibrillation (elictrical cardioversion)

219. Pt. With psychostimulant intoxication. What is the best management. When the Pt. Will be discharged ?

-Benzodiazepines
-Daily follow up in support group

220. All occur in DT. EXCEPT:-Tremor-Visual hallucination-Delusion -Psychomotor activity

221. About contact dermatitis. All true EXCEPT:

-Mostly with plant exposure
-Systemic steroids could be used-Local steroids are not useful
-Skin test is useful

222. All can cause inverted uterus EXCEPT:

-IV oxytocin stimulation
-Atonic uterus-Pressure on soft fundus
-Pull cord forcefully

223. Who is responsible for the ultimate (standard) health care quality ?

-Bord of directors -Staff -Chief physician
-Chief of staff

224. What is the rule of Royal collage of Canada ?

-Credentialing body (certification of specialist)

225. Pregnant Pt. With bicornuate uterus. What is the likely outcome of pregnant ?

-Abortion
-Preturm delivery
-Normal pregnancy outcome

226. Pt. With plasmodium vivax malaria, treated & recurrence. Most likely cause ?

-No Eradication of liver forms

227. The best screening for hyperaldosteronism in HT. (conn diseaseis):

-Serum renin activity levelNB.
Renin will be increased in secondary & decreased in primary

228. ASA use + alcohol abuse over weekend, the pt. Developed GI bleeding. Gastroscopy shows multiple areas of erosions. All can be done EXCEPT:

-NG tube
-H2 blocker
-Gastrectomy
-Vasopressin

229. F. Pt with (+ve) ANA, presented with ankle edema & arthralgia, protein + in urine. Diagnosis. ?

-SLE
-Scleroderma

230. Diagnosis. Of Condyloma Acuminata in pregnancy. You give all EXCEPT:

-Podophyllin

231. Elderly Pt. : Prefer to sit home & to be visited by relatives.

232. In Wolf Parkinson White syndrome : shortening of PR interval & Delta wave.

233. Child complain of headache, abdominal pain, nausea, vomiting then he sleeps. Diagnosis. ? -Abd. Migraine

234. Vit. K. Deficiency in new born will result into :-Increased PT. & PTT.NB. Vit. K. (Menadione) Toxicity will present with hemolytic anemia & kernikterus235. Which one of the following affect the outcome & feature planning of Canadian health program ?-Accident-Age

236. Post-partum psychosis EXCEPT:-Can cause residual effect

237. Best treatment for shigellosis is:-Septrim (cotrimoxazol)

238. Photo of down's syndrome baby. What will confirm the diagnosis ?-Kariotypes -Total blood count

239. Epileptic Pregnant Pt. Controlled on phenitoin asked for your advice about continuing the drug which she use ?-the benefit of risk out weight of it's teratogenicity (To continue using it)

240. Best screening test for hypothyroidisim :-TSH

241. Man had fighting problem at work. Now he complains from back pain. PE shows no pathological finding but the man is depressed & obsessed with it. Diagnosis. ?-Malingering -Hypochodriasis-Somatoform pain disorder

242. Charming manipulative does not learn from experience with lack of remorse (guilt). What PD is it:

-Antisocial PD
-Border line PD
-Histrionic-Narcissistic NB. The key is lack of remorse (guilt).

243. What is hypochondriasis ?-Its a belief of having chronic disease despite good reassurance
NB. The Pt. is stable & has no social problem & he will visit many doctors for the same problem, he recognizes that his reaction is exaggerated 244. Mother brought her baby to u , he is non sensitive to other feelings , having problem with learning & speech. Diagnosis. ?

-Autism
-Specific learning disorder

245. ADHD. What is true ?

-Persistent to adulthood
-Antisocial
-Increase criminal rate

246. Which are associated with highest risk of sudden death:

-Multiple Ventricular Arrhythmia on 24 h. Holter monitor-Ejection fraction less than 20 %
-Family history of sudden death
-Atrial fibrilation on aprevious AMI
-Severe narrowing of more than 1 coronary art.

247. Regarding suicide all are increased risk of successful attempt EXCEPT:

-Depression-Malignancy
-Female gender
-Lonely white old man

248. Most imp. Dietary modification of middle aged group is :

-Total calorie content
-Fiber diet-CHO content
-protein

249. In MS. All commonly occur EXCEPT:

-Diplopia
-Nystagmus
-Scotoma
-Anosmia
-Tremor

250. Treatment or drug of choice for cyclothymia

-Lithium
-Psychotherapy
-Haloperidol

251. In BN. All occur EXCEPT:-Dental caries

-GI reflux
-Parotid enlargement
-Stomach rupture
-Metabolic acidosis

252. Stridor is present in all EXCEPT:

-Retropharengeal abscess
-Acute asthmatic attack
-Tracheolaryngobronchitis
-Acute Epiglotitis

253. Pt. With diazepam withdrawal. Which one can't u give him ?

-Chlordiazepoxide
-Diazepam
-Lorazepam
-Buspirone

254. All are measure to avoid Botulinism, EXCEPT:

-Antiacid
-Below freezing temperature
-Vacuum
-Nitric preservation

255. DVT in postpartum period lady. All can be given EXCEPT:
-Coumadin
-Heparin
-Early mobilization

NB. We can use it to avoid the DVT & not after...

256. Which is true about mastitis ?
-Gram (-ve) commonest
-I&D is the treatment
-Associated with lactation

257. What is the commonest cause of pseudomembranous colitis ?
-Clostridium dificile toxin

258. Relation between asbestosis & smoking is called :
-Additive
-Synergistic
-antagonist

259. Defense mechanism in phobia is :
-Avoidance
-splitting

260. Defense mechanism is border line PD. is :
-Avoidance
-Splitting

261. Rt. Handed lady complains of feeling of being dissociated from environment, expressive dysphasia & automatism. Where is the lesion ?
-Lt. Temporal
-Rt. Temporal
-Lt. Parietal
-Rt. Parietal
-Frontal

262. Boy fell doun from a tree, he started abdominal Pain & heamturia. What will be your next investigation ?
-Renal scan
-IVP
-Retrograde urography
-Surgical exploration

263. Lady complains from bilateral abdominal Lower Quadrant pain with tenderness after the end of cycle by 2-3 days. What is the diagnosis ?
-Endomettriosis
-Salpingitis

264. What is the commonest cause of intestinal obstruction in males over 65 years. ?
-postsurgical adhesion

265. Child swallow a 2.5 cm screw, X Ray shows it in the upper quadrant region. What will be the management. ?
-Surgery
-Reassure & follow up Xrays after few days
-Endoscopy

266. Premature rupture of membrane associated with all EXCEPT:
-Pneumonitis
-Septisemia
-RDS

267. Gonorrhea treated with spectinomicin , after there is recurrence of symptoms. What is the diagnosis & what will be the management. ?
-Chlamydia & give tetracycline

268. What is the diagnostic test for myasthenia gravis ?
-Tensilon test

269. What is the diagnostic test for cushing syndrome ?
-DST (dexamethasone supression test)

270. Hypertensive Pt. PE. shows bilateral Femoral bruits. Diagnosis. ?
-Renal stenosis

271. F. Pt. Complains from severe headache, shoulder pain & bilateral Wrist weakness. Diagnosis. ?
-RA.
-Temporat Arteritis
-Polymyositis
-Sarcoidosis

272. Maximum time fro primary syphilis to be seen after sexual contact is :
-Three months

273. All are features of sexual arousal EXCEPT:
-Tumescence
-Pelvic congestion
-Uterine contraction

274. Pt. Has lower limb lymphedema following pelvic radiotherapy. What is your management. ?
-ASA regularly + diuretics occasionally
-Compression stocking + raising leg at bed time

275. Child with bilateral Burns of his lower limb, his mother said that crawling near the heater. What is the diagnosis ?
-Shaken baby syndrome
-Child abuse

276. Pt. With history of HT. & DM. , get acute MI. & died due to cardiac arrest. In writing the death certificate, what is the immediate cause of death. ?
-DM.
-HT.
-MI.
-Cardiac arrest

277. Pt. Complains of painful swelling on the face with fever & malaise. PE: erythematous swelling on the cheeks & nose. What do u expect to find on examination ?
-Vesicles on the ipsilateral ear
-Well demarcated sharp margin

NB. The diagnosis is Erysipelas

278. A woman came to your clinic claming that she is seeing creatures form the space, trying to kill her. Her husband denies the story. She was uncooperative. What should you do ?
-Admit & start antipsychotic treatment
-Send her home, ask husband to put her treatment in coffee & give it to her

NB. Diagnosis. is schizophrenia

279. Thiazide diuretics are the first choice for:
-HT alcoholic with malnutrition
-HT + DM
-HT + gout
-HT in elderly Pt.
-HT + LVF

280. Young F. Pt. with acne on face. PE: open & closed comedones + 2 papules on chin. What is the treatment ?
-Benzoyl peroxid
-Oral tetracyclin
-steroids

NB. Diagnosis. Is Acne vulgaris

281. Child present with severe dehydration with hypotension, investigation shows:
Na 120 mmol.\L.
K 3.0 mmol\L.
BUN 15mmol\L.
You decided to rehydrate orally. What will you give ?
-20 ml. Na 50% + K 10%
-50% normal saline + glucose 50% + 20 mmol KCl.
-Pure Water
-5% sugar in water
-milk.

282. M. 25 years. Histoty of diarrhea for 15 days, he has lost 5 kg., barium enema & rectosigmoidoscopey were normal. What is your next management. ?
-Stool culture
-Stool microscopy
-Plain abdominal X Ray
-Upper GI series

283. What is true Regarding smoking restriction in public places?
-Decreases the incidence of chronic respiratory disease
-Decreases the incidence of allergic respiratory disease
-Decreases the incidence of cardio vascular disease
-Shortens hospital stay

284. Regarding conversion disorder. All are true EXCEPT:
-Aphasia
-La belle indifference
-Involuntary character of the syndrome
-Can cause social or professional hindrance
-Can be induced voluntarily

285. A new vaccine against measles is being evaluated. The following results of one full year of study :
Diseased Healthy Total % age
nonvaccinated 137 --------- 378 36.30
Vaccinated less 1 yr 51 --------- 266 17.28
Vaccinated more 1 yr ----- --------- 408 --------

What is the Vaccine efficacy for the vaccinated before one year
- 0.6 %
-17.9 %
-49.0 %
-21.8 %
-36.3 %

NB. The efficacy = incidence of non-vac - vac

286. In a small town. The incidence of disease A is (iA) 8\1000 . The disease B not related to disease A has an incidence of (iB) 12\1000 . What is the probability that the Pt will have both of the disease In the same time ?
-iA + iB
-iA X iB
-(iA + iB) \ 1 - (iA + iB)
-(iA + iB) \ 2
-(iA + iB) \ (iA - iB)

287. The following disease are more frequent in poor than in rich Canadians EXCEPT:
-Suicide
-Coronary art. disease
-Lung CA
-Stroke
-Breast CA

288. The mother of a 12 years old child has to be admitted to the hospital for 2 wks. The boy present with loss of appetite, he remains in his bedroom & has insomia, his stool frequency is reduced. PE: soft abdominal & all the rest of the exam is normal. Diagnosis. ?
-GI infection
-Early schizophrenia
-Flu
-Separation anxiety
-neglect

289. Child 10 years with pyrexia & JRA (still's disease) What is the most common complication?
-Endocarditis
-Knee & hip arthritis
-Aseptic meningitis
-Iridocyclitis
-Nephrotic syndrome

290. Which of the following vaccine causes more side effect :
-Pertussis
-Measles
-Diphtheria
Yellow fever

291. Of the following CA. Which one is caused by vinylchloride :
-Lungs
-Esophagus
-Rhinopharynx
-Liver
-Bladder

292. F. 37 years has problems at work for several months, she also has episodes of hyperactivity & euphoria. These were preceded by episodes of sadness & inability to cooperates with her colleagues inspite trying hard to do her best. Diagnosis. ?
-Bipolar disorder
-Dysthymia
-Cyclothimia
-Masked depression
-Factitious disorder

293. A new test for CA Cervix allows better detection. Statistically all can be modified EXCEPT:
-Prevalence
-Incidence
-PPV
-NPV
-Survival rate

294. Propranolol can be used in all EXCEPT:
-Lithium induced tremor
-Panic attack
-Hyperglycemia
-HT.
-Angina

295. Newborn 2 wks old brought by mother, she complains of decreased milk secretion. The baby weights 4.9 kg. The birth weight was 3.7 kg. This problem is particularly marked in the evening. What is the most appropriate treatment
-Prolactine 2 mg. Bid to the mother
-Supplement the baby with one spoon of solid food every evening
-Supplement with formula every evening
-Reassure the mother
-No breast feeding in the evening to allow more milk to the next morning

296. F. 17 years with severe menorrhagea. Investigation reveals Hb 8.0 gm\dL. Pulse 110 BP. 80\60. BhCG (-ve). Initial management. ?
-IV Oxytocin
-Blood transfusion
-D&C
-IM. Medroxyprogesteron
-IV. Estrogen

297. Child with bronchospasm after hockey game. All can be given EXCEPT:
-Aminophylin
-Salbutamol
-Cromoglycate
-Betamethasone
-Oxygen (facial mask)

298. Pt. 65 years with COPD treated with oxygen (FiO2 44%) present with the following test results:
PaO2 PaCO2 pH.
65% 35% 7.30
52% 48% 7.26
48% 52% 7.21
What is management. ?
-O2 100%
-Increase FiO2 to 65%
-Stop O2
-Intubate
-IV Aminophylin

299. The following are carcinogenic EXCEPT:
-Fat
-Monosodium glutamate
-Benzene
-Nickel
-arsenic

300. Child 18 m. Old with dyspnea. X Ray shows normal Rt. Lung, Lt. Lung distention. mediastinum deviated to the Rt. With translucent Lt. lung. Diagnosis. ?
-RSV infection
-Pneumonia
-Foreign body
-Congenital anomaly
-Congenital pulmonary aplasia

301. All are carcinogenic EXCEPT:
-Uranium
-Arsenic
-Radon
-Chromium
-Lead

302. Which of the following radiation has the deepest penetration in human tissue:
-Alpha
-Gamma
-Xray
-Delta
-UV

303. Which is true regarding the side effects of radiation ?
-Microwaves cause superficial burns
-Laser radiation can cause retinal burns
-UV can cause Alopecia Areata
-Beta ray can cause Leukemia
-Delta ray are dangerous for the central grey nucleus

304. Characteristic of placebo effect. All true EXCEPT:
-50% effective
-Pt. Believes in treatment efficacy
-Its greater in IM than in PO.
-It decreases if used frequently because of dependence
-Naloxone effect shows that placebo effect occurs by inhibition by morphinic receptors

305. All are true about Turner syndrome EXCEPT:
-Short stature
-Ammenorrhea
-Coarctation of the Aorta
-Hirsutism
-Acne & micrognatia
-Low set hair

306. All are routinely done in infertility investigation EXCEPT:
-Semen analysis
-Temperature chart
-FSH. LH.
-HSG
-Post coital test
9
307. F. 74 years old admitted with urinary catheter, she has UTI. Urinanalysis shows 10 \ high power field. Culture shows sensitivity to nitrofurantoine, TMP\SMX, gentamycin, tetracyclin. PE: asymptomatic & no fever. What is your management. ?
-Nitrofurantoin 3 tab.\day for 20 days
-Gentamycin 2 injection IM. \ day for 10 days
-TMP\SMX 1 tab.\day for 14 days
-Doxycyclin 4 tab.\day for 10 days
-No treatment

308. In which case occupational deafness is mostly suspected
-Unable to hear the bell sound at 3 m.
-Decreased in hearing high intensity voices
-Decreased peak at 4000 hertz on the audiogram
-Deafness at speaking voice

309. The difference between M. & F. Sexuality is:
-F. Have more inhibition
-F. Have more erogenous zone
-F. Orgasm is less intense
-F. Refractory period is shorter
-F. Orgasm is shorter

310. Picture of old F. With temporal arthritis asking about which is common in these Pt. :
-Jaw claudication
-Headache
-blindness

311. Picture of a lady with goittrons papules & proximal muscle weakness. Diagnosis. ?
-Dermatomyositis
-Mixed Connective Tissue disease
-Scleroderma

312. Picture of a lady genitalia showing vesicles around vulva. Diagnosis. ?
-Syphilis
-Comdiloma acuminata
-Herpes simplex genitalia

313 picture of clubbing. Which is not causing it ?
-Chrons's disease
-Chronic bronchitis
-Ciliac disease

314. A child with fever , irritability & drooling. PE: there are numerous small ulcers on tongue + ant. Cervical Lymph node enlargement :
-Herpangina
-Herpes simplex stomatitis
-leucoplakia

315. Pt. With schizophrenia & on treatment. With akathisia (he cant sit still) What is the best treatment is ?
-Lorazepam

316. Which of the following drugs is the safest is Pt. With depression & heart problem ?
-Fluvoxamine
-Imipramine
-Doxepine
-Despiramine
-Phenelzine

317. Pt. With fatigue & no pleasure & decrease sleep. Diagnosis. ?
-Depression
-Anxiety
-Bipolar

318. Pt with DM. & HT. On propranolol, complains of progressive impotence & he didn't have sexual intercourse with his wife for more than 6 months He came to u with his wife, she told u privately that he has morning erection specially when he see adult magazine. What is your reaction ?
-Do night tumescence test (REM test)
-Marital psychotherapy
-Stop propranolol
-Impotence due to DM. (vascular problem)

319. Best treatment for DT.
-Lorazepam
-H’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’ñþ’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@
323. Pregnant during delivery (full term), cephalic-occiputoposterior, head of the baby at station (-1) Pt. Is exhausted & takes long time in 2nd stage of labor. What is your management.
-Symsons
-Kjelands forceps
-Vacuum delivery
-C-section

324. Pt with retain placenta. All are associated EXCEPT:
-Vaginal bleed
-Infection (endometritis)
-Purpura around umbilicus

325. Child with microcytic anemia with Nausea, vomiting, anorexea & costipation also has sleep disturbances & irritability. Diagnosis. ?
-Hg. Poisoning
-Thalassemia
-BPC poisoning
-Lead poisoning
-Vit. A poisoning

326. Most common source of silicosis exposure in Canada is:
-Sandblasting
-Coal dust
-Brake lining
-High consentration of Gases

327. Which of the following is the most common trigger of Asthma in children ?
-Dust housing
-Rugs
-Parental smoke
-Pets

328. What is the mode of transmission of Hydrocephalus ?
-Trisomy
-Monosomy
-Euploidy

329. The most Common cause of non reactive NST (non stress test) is :
-Sleeping fetus
-Multiple gestation
-Intrauterine death
-Morphine

330. Commonest cause of hirsutism in reproductive age group:
-Constitutional
-Polycystic Ovary disease
-Congenital Adrenal Hyperplasia

331. Ediopathic heamaturia with no other abnormality. Management ?
-Prednisolon
-Follow up the Pt. After one year
-LEEP

332. Which of the following is true regarding Chromoglycate ?
-Contraindicated with steroids
-Necessary in acute attack of asthma
-Prevent binding of IgE with cells
-Prevents histamin from synthesized cells

333. M. 42 years with glucosuia, dark skin, palpable liver. Which will help u in the diagnosis ?
-Ferittin level
-Ceruloplasmin
-Alphatrypsine
-Electrophoresis

334. Which will increase day care load in the next decade ?
-Heart disease
-CA.
-Dementia
-Accident

335. Which one is most suggestive of thyroid malignancy ?
-Solid cold nodules
-Cystic cold nodules
-Increased thyroxin level
-Increase TSH level

336. Young Pt. Came to u after electric shock due to falling down on subway. Burn was treated. ECG is normal. Management ?
-Send home if ECG is normal
-Keep monitoring the ECG for 24h.
-Cariad enzyme should be checked
-ECG must be monitored for three days

337. The most important cause of difference between M. & F. mortality rate is due to :
-Accident
-Puerperal
-suicide

338. Lower abdominal pain with tender abdominal mass in the cole-de-sac. Diagnosis. ?
-TOA (tubo-ovarian abscess)
-Infected endometrioma
-Teratoma

NB. Scenario is incomplete

339. F. 42 years hypothyroid Pt. with 8 month ammenorrhea asking u about osteoporosis. Your advice will be EXCEPT:
-Cyclical Est. & Prog.
-Vit. D.
-Ca supplement
-Continuos Est. & Progesterone

340. Pt. With chronic bronchitis and PaO2 of 60 mmHg. all are true EXCEPT:
-Continuos home O2 is not indicated
-Antibiotic prophylactics is helpful
-Bronchodilators can be used
-Corticosteroids may be useful
-Non of the above

341. Smoking withdrawl which of the following is the most common symptom:
-Insomnia
-Tachycardia
-Anorexia

342. Life expectancy is increased in canada due to:
-Decreased infant mortality rate
-Availability of Diagnosis and treatment
-Increased of socioeconmic status

343. The vaccine which is given to adults is:
-DT pertusis
-DT
-T
-DT and Polio

344. Middle aged lady came to you complaining of not sleeping at night because she finished her diazepam tablets which she used to take before sleeping now her Family physician is away .What will be your action:
-Assurance
-Give her diazepam

345. Pt. With frost bit, best treatment is:
-Put hands in warm water 38-40 degrees for 30 min.
-IV antibiotics
-Local antibiotics and debridments

346. Pt. Post M .I no more pain ,B P 90 over 60 mmhg , pulse is normal and regular.
Whats your management. ?
-Close observation in I C U
-Dopamin I V
-Dobutamin I V
-Digoxin

347. Pt. Came to you with cercumferencial burn on Lt. Forearm, complain of pain. PE: no radial pulsation. Best treatment is:
-Escharectomy
-Debridment
-fasciatomy

348. Mitral stenosis question: loud 1st heart sound, mid diastolic murmur at the apex, parasternal heave.

349. Young female presented with visual impairment in one eye which improve, in neck flexion an electric like shock is felt at the back & upper limb. Diagnosis. ?
-Mysthenia gravis
-Multiple sclerosis
-GBS (Guillain-Barre syndrome)

NB. The electric shock is called : Lhermitte's sign

350. Pt. Present with enlarged LN. In cervical inguinal & axillary regions, night sweat, fever & weight loss. X Ray shows widen mediastinum. Diagnosis. ?
-NHL (Non Hodgkin Lymphoma)
-AML
-IMN (Infec. Mono. N)

351. Typical case of large cervical LN. What will be your next step?
-Abdominal US
-Excisional biopsy

352. Old hypertensive lady with DM. What is the best treatment ?
-B-blocker
-Diuretics
-ACEI

NB. MCCQE FM 14. (2001)

353. F. With breast CA. complains of dyspnea & fatigue. PE: shows pulsus paradoxus. C-X ray shows large globular heart. Diagnosis. ?
-Pericardial effusion

354. Pt. with VonWillebrand disease Type I. Which is true ?
-Prolonged bleeding time
-Decreased platelet
-Increased PT.

355. Pt. on platelet transfusion developed anaphylaxis. What is the initial management. ?
-IV steroids
-Stop transfusion
-anti-histamine

356. Pt. in ICU post MI developed bradycardia, pulse at 32 \ min. What is the best management. ?
-Cardioversion
-Pacemaker
-IV Dobutamine

357. M. 72 years present with one year history of heamoptysis. X Ray shows infiltration of the lung. Diagnosis. ?
-Recurrent Pulmonary Embolism
-Bronchiectasis
-Foreign body

358. What is the drug of choice of mycoplasma pneumonia ?
-Tetracycline
-Bactrim
-Erythromycin

359. Typical case of heamolytic anemia. What is the most characteristic finding ?
-Reticulocytosis
-Increased haptoglobin

NB. findings Other than Reticulocytosis are:
Reduced haptoglobin
Increased LDH
Increased unconjugated bilirubine
Increased urine bilinogen

360. Pt with history of alcohol intake present with icteric sclera, Bad mouth smell (fetor hepaticus). Diagnosis. ?
-Hypoglycemia
-DKA
-Hepatic encephalopathy
-Viral hepatitis

361. Pt. With history of unilat. Loss of vision in the Lt. Side which completely recovered within 5 min. What is the most likely association ?
-Lt. Internal Carotid Art. Stenosis

NB. The Diagnosis is Amaurosis fugax

362. Which is false ?
-Cefazoline & Bacteroides
-Gentamicin & E-coli
-Metronidazol & Bacteroides
-Vancomycin & C. difficile

363. Young lady with anorexia, generalized fatigability, weight loss & intermittent fever for 2 wks. PE: multiple splinter heamorragea are noted on the finger nails. The most imp. Next spet is:
-Urine C & S
-Blood culture
-C-Xray

NB. Diagnosis is Subacute Endocarditis

364. A group of doctors preparing the EE. Develop nausea , vomiting, diarrhea, few hours after having lunch at a restaurant. The symptoms subside after 24h. Most likely cause is :
-E-coli FP (food poisoning)
-Staph. FP
-Salmonella FP

365. Obese Pt. With heart burn, progressive difficulty of swallowing & Epigastric pain which gets worse more in recumbency. Diagnosis. ?
-Achalasia
-Hiatus hernia & reflux esophagitis with stricture
-Esophageal CA.

366. F. Pt. With history of anorexia, weight loss, vomiting, diarrhea. BP show postural hypotension, Na 130, K 5.8 , what is the best initial investigation ?
-Measurment of ACTH in plasma in the morning
-ACTH stimulation test
-Abd. CT for adrenal
-Water deprivation test

NB. A case of Addison's dis (adrenocortical insufficiency).

367. Typical case of hepatic encephalopathy. What is the LEAST effective in the initial management. ?
-Look for signs of GI bleeding
-Take history of drug from relatives
-Look for signs of infection
-Order lactulose

368. Typical case of migraine. What is the most likely visual symptoms ?
-Scintillating scotoma (the cotton like scotoma)

369. All are sexually transmitted EXCEPT:
-EBV
-HBV
-HIV

370. All are transmitted feco-oraly EXCEPT:
-HAV
-EBV
-Norwalk virus
-Polio virus

NB. Kissing disease (EBV)

371. Typical case of irritable bowel syndrome. All are true EXCEPT:
-Nocturnal diarrhea
-Abdominal pain
-constipation

372. Young F. With supraventricular tachycardia. Complain of chest pain, palpitation & fainting. The best initial management. is :
-IV verapamil
-Cardioversion
-Increase vagal tone
-B blocker

373. A nurse injured by a needle of a pt. Who is HBV (+ve) & HIV (-ve) . management.?
-Give HB. Ig. Now & HB. Vaccine after 2 wks.
-Reassurance
-Give HB. Ig. & HB. Vaccine now

374. G2 P2 with history of lower segment C-section because of footling breech. During labor she present a sudden profuse gush of bright red blood. The fetal head is engaged. Diagnosis. ?
-Placenta Previa
-Ruptured uterus
-Placenta Abruptio

375. All are complication of copper IUD EXCEPT:
-Uterine perforation
-Infertility
-PID
-Liver toxicity

376. Young pregnant Pt. Diagnosed to have placenta previa at 20 wks. Where the placenta covers the internal os completely. What advise do u give ?
-Avoid sexual intercourse
-Reassesment US at 28 wks
-Inform the Pt. That she needs a C-section at delivery time.

377. Increase FSH is associated with all of the following EXCEPT:
-Turner syndrome
-Bilat. Dermoid cyst
-Post radiation to the pelvis

378. Which is responsible for decrease Oxygen delivery to the fetus during uterine contraction ?
-Decrease art. Supply to the intervillous space
-Decrease uterine venous outflow during contraction

379. The most common indication for amniocentesis is :
-Maternal age is more than 35 years
-Past history of down syndrome
-Past history with baby with NTD

380. Pt. With amenorhea, She was using BCP. Which is helpful test to check the endometrial function ?
-Progesterone challenge test

381. Young lady in labor, PV shows cervical dilatation of 3 cm. partially effaced cervix, uterine contraction every 5-10 min. & lasting 20-30 sec. What is true ?
-This is an active phase
-This is a latent phase
-Active phase arrest

382. Pregnant Pt. Did not feel the fetal movement for the last 2 days. PE: no heart sound could be heard. What is the next step to do ?
-Non stress test
-Obstetric US
-Biophysical profile

383. Primigravida in labor. All can be given EXCEPT:
-Oxytocin
-Narcotic analgesic

NB. You can give it only in early stage of labor

384. Pt. 20 wks Pregnant with fibroid present with abdominal Pain. PE: tenderness of the lower abdominal Best management. ?
-Analgesia & reassurance
-Myomectomy

NB. Red degeneration of fibroid.

385. All are risk factors for IUGR EXCEPT:
-Absence of weight gain by the mother
-Fetal weight 2000 gm at 32 wks
-Maternal malnutrition

386. Pt. 38 wks pregnant Presented with history of clear watery vaginal discharge 2 hours ago. Management ?
-US
-Sterile speculum examination & take swab for C & S (culture & sensitivity)
-Induce labor

387. Young girl after brake up of her relationship took 18 tab. of lorazepam, she only complains of dizziness & drowsiness. After 6 h. of observation she is well, feel remorse & want to be discharged. Management ?
-Discharge her & follow up as out pt.
-Futher 24 h. observation
-Call her boyfriend

388. Young girl found in coma in the street. PE: constricted pupils (pin point) & multiple marks of IV injection. Most likely cause is :
-Heroin
-Cocaine
-Diazepam

389. Case of drug over dose with fever, tachycardia, dilated pupils & BP: 220\110. Most likely cause is:
-Cocaine
-LSD
-Heroin
-Barbiturates

390. Psychic structure that relate desire to external environment is :
-ID
-Ego
-Superego
-Self
-Personality

NB. To be checked ...

391. All are true regarding OCD. EXCEPT:
-Ego dystonic
-Ego syntonic

NB. Dystonic = OC Disorder.
Syntonic = OC Personality.

392. Which is true regarding Alzheimer's disease ?
-Apraxia, agnosia, dysphasia
-Sudden onset
-More common in male

NB. Alzheimer's F. are more than M. & its not with sudden onset

393. Which of the following cause drug induced dementia ?
-Diazepam
-Imipramine
-Triazolam

394. Psychotherapy superior to medication in
-Schizophrenia
-Alcoholism
-Drug induced delirium
-dysthimia

395. Which is true regarding suicide in adolescent ?
-More common in summer
-Attempt to suicide is more common in F. Than in M.
-More common in F.

396. Child 9 years old studing in kindergarten, is unable to read, write or even to color a picture. He becomes happy when he answers simple questions. What is your diagnosis ?
-Autism
-Mental retardation
-Specific learning disability

397. What is the best management. of school phobia ?
-Force him to go to school
-Keep him at home until he miss his friends in school
-Give him anxiolytics

398. Which is regarded as an arousal symptom of PTSD:
-Restricted affect
-Feeling of detachment
-Hypervegilance

399. Pt. With multiple trauma came to hospital shocked but he is agitated & violent. Management Regarding treatment ?
-Wait until he becomes more shocked
-Sedate him & treat
-Treat him immediately even if you may physically restrain him

400. M. 33 years present with sudden onset of mood & memory changes, mute.on admission he developed convulsions. Diagnosis. ?
-AIDS Dementia complex

401. The most imp. Cause of increased complications of measles in developed countries is :
-Inadequate immunization
-Inadequate nutrition

402. Study has been done between risk factor & a disease, Ods ratio was 2.3. what is true ?
-There is significant association between risk factor & disease.
-The disease is 2.3 times more in those having risk factor

403. Which is the most practical measure to reduce occupational deafness ?
-The usage of daily prophylactic ear plugs during duty
-Measuring the noise frequency
-Usage of ear protection

404. All are true regarding incidence EXCEPT:
-Take only the new case in consideration
-Estimate the risk of acquiring the disease In community
-Useful measure of disease Problem in community
-Useful for both acute & chronic disease

405. Which of the following is true regarding non Ionizing radiation ?
-Can cause Chronic bronchitis
-Can cause Loss of vision
-Can cause cataract

406. Which is not true regarding O3 ?
-Increased around photocopy machine
-Can be harmful at ground level
-Its mainly due to incomplete combustion of fossil fuels

407. In placebo treatment . All are true EXCEPT:
-Response to placebo indicate that the cause is psychogenic
-Repeated use decreases its efficacy
-1\3 of those with organic causes respond to the placebo

408. All are true regarding the role of physician in trauma pt. EXCEPT:
-Assess the pt. Condition clinically
-Can determine the duration of treatment
-Estimate the compensation of the pt.

409. Information about mortality in Canada can be obtained from
-Canada statistics
-Public health center
-Out pt. clinic

410. Child 4 months old age. He must get his second vaccination. His mother is worried about the risk of fever. What is your advice ?
-Give antibiotic if temp. More than 39 C .
-ASA if temp. rises
-Give acetaminophen now & qid later .
-Call the doctor if temp. Rises more than 39 C

411. Baby 4 months of age. Microcytic hypochromic anemia. What is the
Cause ?
-Breast feed only
-His mother was taking erythromycin during pregnant
-Prematurity

412. Child with microcytic hypochromic anemia. His mother blood film shows basophilic stippling & microcytic hypochromic anemia. Similar finding were found in the father. Next step ?
-CBC
-Serum ferritin
-Packed plasma
-HB electrophoresis

413. An African 4 years old child, with dark urine, treated for a respiratory tract infection by Septrim, present with jaundice & pallor. What is the diagnosis. ?
-G6PD
-Cycle cell anemia
-Thalassemia

414. A Chlid with ALL. Will present with all of the following EXCEPT:
-Anemia
-Infection
-Thrombocytopenia
-Heamoglobinuria

415. Newborn 4 days old, with poor feeding, mottling skin, temp. 36.5, after stabilizing the baby, what is the next step ?
-ABG (art. blood gas)
-LP
-Electrolytes

416. Child with sever vomiting & diarrhea , became lethargic with sunken eyes, mottling skin, low BP, Increase pulse, Na 150 mmol ,what is your management. ?
-Plasma 10 cc\kg within 1st h.
-5% dextrose 20 cc\kg. Within 1st h.
-0.9 normal saline 20 cc\kg. Within 1st h.

417. Child with moderate to severe dehydration. Which of the following investigation helps in your management ?
-CBC
-Blood urea
-Electrolytes

418. Child with severe dehydration Na 170 mmol. What is the complication expected during your management. ?
-Shock
-Death
-Convulsions

NB: convulsions may happen due the rapid correction of hypernitremia. In hyponitremia cerebral edema may be developed due to rapid correction

419. All can cause abdominal Mass in neonate EXCEPT:
-Wilm's tumor
-Hydronephrosis
-Neuroblastoma
-Meckl's diverticulum

420. What is true regarding congenitla pyloric stenosis ?
-Commonly present at 3 months
-Associated with metabolic acidosis due to vomiting
-Visible peristalsis is seen in abdomen

421. Child with nephrotic syndrome presented with fever, abd. Pain & ascitis. What is your next step ?
Abd. Xray
US
Parasynthesis

422. A child presented with fever & small white lesion on the mucous memb. of the mouth followed by generalized macular papular rash. What is the manag. ?
Give ASA to decrease fever
Give gamma Ig.
Notify the public health unite
Isolation of the family member

NB: diag. Is Measles

423. Child 15 yrs present with BP. 155\90 mmHg. What is your manag. ?
Restrict salt in diet
Diuretics
Repeat measurement of BP at different times
Haloperidol

424. How can you diag. A 2 yrs old child with an HIV (+ve) mother ?
Urine analysis
CBC
CD4\CD8 ratio
ELISA

425. Child 12 yrs present with constipation , decreased school performance & suppressed growth for the last 12 months. Diag. ?
School phobia
Hyperthyroidism
Hypothyroidism

426. Newborn 10 days developed unconjugated hyperbilirubinemia, he was born at term. & he is otherwise well. Diag. ?
Galactosemia
Kernicterus
Breast milk jaundice

427. Child present with sore throat, fever & diagnosed as Infectious mononucleosis. He was treated conservatively but he returned to u with a severe pain in the throat. Manag. ?
Give ampicciline for 10 days
Throat swab for C&S
Xray

428. Child 18 months old present with generalized convulsions for 20 minutes. He has history of UTI, no history of similar attack before. After he was given O2 what will be the appropriate step in the mana. ?
Rectal diazepam
Rectal paraldehyde
Phenobarbital IM.

429. Preterm baby with feature suggest Iron def. Anemia. When will u give Iron supplement ?
3 months of age
5 months of age
4 wks of age

430. Child 9 yrs old with enuresis. Its usually associated with:
a part of generalized anxiety disorder.
UTI

431. How to differentiate between diverticulosis & proximal CA in narrowed segment of colon ?
-Colonoscopy & biopsy
-Sigmoidoscopy
-Barium enema

432. Pt. Complains of constipation, abdominal pain & frequent diarrhea mainly in the morning & with NO other problems. Diag. ?
-IBS (irritable bowel syndrome)
-Diverticulosis

433. Pt. With pleural effusion on the Rt. Side with no apparent lesion. Manag. ?
-Thoracocentesis
-Thoracotomy & biopsy
-CT

434. Drug causing mania EXCEPT:
-Steroid
-Cimetidine
-Imipramine

435. What is the most helpful sign in diagnosing inguinal hernia in children ?
-Thickening of the cord
-Wide external ring
-Bulging at the groin

436. Pt. Complain of headache, vomiting following Rt. Hemianopsia. Diag. ?
-Migraine
-Amaurosis fugax
-Rt. Retinal art. stenosis

437. Liver cirrhosis pt. Comes with massive heamatemesis. What is the best next step ?
-Vit. K IV.
-Factor II , VII , IX , X
-Give packed (whole) blood transfusion

438. Which is not true in a pt. With mycoplasma pneumonia ?
-Fever , persistent hacking cough
-Headache, diarrhea & non exudative pharyngitis
-Associated with erythema multiformis
-Associated with bullous myringitis
-Can cause rapid progressive pneumonia with cyanosis

NB. Its the walking pneumonia in young man ...

439. Newborn pale, HR = 80\min. Respiration is Irregular & slow, flabby, lazy, & he is weak for irritability. What is the APGAR score ?
-2
-3
-4
-5
-1

440. Pt. With syphilis & (+ve) VDRL 1:20 before. He receives penicillin for 2 months & the titer is 1:6 now. Which of the following is true ?
-Good response to treatment
-Decreasing in titer should be more faster
-Pt. Is immunosupressed
-Bacteria develop resistance to penicillin

441. Which of the following benefits from vasodilatation ?
-Cor pumonale
-Subaortic stenosis
-Mitral insufficiency
-Mitral stenosis
-ASD

442. Absolute contraindication of BCP. Is :
-History of Pulmonary embolism
-Migraine
-HT.

443. Which is true regarding the diag. of brain death for organ transplantation ?
-Absence of all spinal reflex
-EEG completely for 48 h.
-Could be diagnosed clinically

444. Vit.D deficiency associated with all EXCEPT:
-Hypocalcemia
-Hyperphosphatemia
-High ALP (alkaline phosphatase)

445. Vietnamese Pt. Has 15 mm. (+ve) Mantoux test (Tuberculin test) & (-ve) cytology. Manag. ?
-Treat the pt. without regard to sputum cytology
-Repeat Mantoux test after 3 years

446. Treatment of pt. With dystonia is :
-TCA
-MAOI
-Benztropine
-Haldol

447. Newborn with small head, small palpebral fissure, small philtrium & small eyes & flattened meat facial area. Diag. ?
-Fetal alcohol synd.
-Down synd.
-Edward synd.
-Turner synd.

448. 20 wks Pregnant with family history of Down synd. Which of the following should be done to rule out Down synd. ?
-Amniocentesis
-Chorionic villous sampling
-Abd. US

449. Which of the following is the treatment of choice of Rheumatic Fever ?
-Aspirin orally
-Benzathine penicillin G (1.2 million IU) IM.
-Penicillin IV.
-Ceftriaxone IV.

450. Sickle cell anemia with fever & severe abd. Pain. Manag. ?
-IV fluid, blood culture, antibiotics
-IV fluid, narcotic, blood culture
-Blood transfusion

451. Pt. With bilat. Lower limb pain exaggerated by night, nocturia & no history of urine incontinence. Investigation reveals glucosuria. Diag. ?
-Massive cord compression
-Diabetic peripheral neuropathy
-Herniation of spinal disk

452. All are true regarding folate deficiency EXCEPT:
-MCV = 96
-Normal serum folate
-Thrombocytopenia

NB: MCV has to be more than 100
We check the RBC folate & not the serum folate.

453. The company need to change the dipstick for detection of proteinuria because it was detecting it in low threshold (No. of false positive was high). Now it increases the threshold of the screening test to detect proteinuria. This will affect the test in terms of :
-Increased sensitivity & specificity
-Increased No. of FP.
-Increased No. of FN.

NB. Increasing the threshold will result in decreased sensitivity & increased specificity.

454. Best treatment for DM. type I is:
-Short acting insulin + NPH
-Short acting insulin + long acting insulin
-Utra acting insulin
-NPH + long acting insulin

NB. MCCQ E6. (2001)

456. Pt. Returned from vacation he is hypertensive on thiazide. He now complains of pain, swelling of Rt. Knee joint & fever. Best manag. Is ?
-Knee aspiration
-Serum uric acid level

NB: thiazide may cause increase level of Uric acid which can cause the swelling of the joint

457. RA. Pt. on gold salt + hydrochloroquine develop proteinuria & ascitis. What is the cause of his condition ?
-Due to his chronic dis.
-Due to Gold salt
-Due to hydrochloroquine

458. Which is true regarding Acoustic neuroma ?
-Decrease bone conduction in the same side
-Increase bone conduction in the same side
-Increase bone conduction in the same side

459. In Rt. Serous otitis media, Webber will give :
-Decrease bone conduction in the Rt. Ear
-Decrease bone conduction in the Lt. Ear
-Increase bone conduction in the Rt. Ear

460. The most predisposing factor to HT. is :
-Alcohol
-Hereditary
-Smoking
-Obesity

461. Which is the least cause of HIV infection :
-Homosexuality
-Prostitution
-Drug abuse (1999)
-Blood transfusion (1988)

462. Hypotonia, hypoglycemia, hepatosplenomegaly & poor feeding infant. Diag. ?
-Septicemia
-Glycogen storage dis.

463. Pregnant 14 wks with hydatid mole. Best treatment is ?
-Dilatation suction curettage
-Hysterectomy
-Hysterotomy
-Methotrexate

464. Pt. Came with multiple trauma. Which will u treat 1st ?
-Tension pneomothorax
-Cardiac tamponade
-Aortic rupture
-Skull fracture with visible brain

465. Pt. With multiple fracture in ICU. He developed dyspnea, increased CO2, decreased O2. Xray shows bilat. Infiltration (ARDS). Manag. ?
-Intubation & ventillation
-O2 mask
-HCO3 IV.

466. In sexually abused Child. Which will be the most suggestive sign:
-Vulva bruise
-Laceration on the labia
-Ruptured hymen
-Labial agglutination

467. Pt. With breast CA underwent operative surgery & chemoradiotherapy, she developed pneumonia followed by death. What is the underlying cause of death?
-Cytotoxic chemotherapy
-Breast CA
-Pneumonia

468. What is the most dangerous complication of maxillary sinusitis ?
-Periorbital cellulitis
-Cervical adenitis

469. What is the treatment of Tourettes syndrome ?
-Haldol
-Fleuxetine
-Lithium
-Cognitive behavioral therapy

470. Which is true regarding a childhood Schizophrenia ?
-Diagnostic criteria like adults
-Hallucinations & delirium are rare

471. Dysmenorrha in an 18 yrs old is mostly associated with:
-Normal pelvic exam

472. Retroverted uterus is mostly associated with
-Endometriosis
-Low back pain
-Infertility

473. All of the the following can be in the manag. hypercholestorelemia EXCEPT:
-Conservative for 4 to 6 months
-Simvastatin
-Serevastatin
-Lovastatin
-Liposuction

NB. Withdrawn from the market in Canada in August 2001 due to increase risk of death with this Serevastatin.

474. Which of the following will be a good treatment for ovarian tumor according to its adequacy ?
-Surgery
-Radiotherapy
-Chemotherapy

475. Post-pelvic radiation pt with diarrhea. What is the most common cause ?
-proctitis

476. Hydronephrosis associated with all EXCEPT:
-Post-uretral valve
-Obstructive uropathy
-BPH
-Nephrotic syndrome

477. Which is associated with dysuria but no pus cells in urine ?
-UTI
-Vulvovaginitis

478. Which is not associated with occupational asthma ?
-Polyvinyl chloride
-Isocyanate
-Anhydride
-Antibiotics
-resin

NB: polyvinyl chloride causes liver & brain CA.

479. Sexual abuse is associated with all of the following EXCEPT:
-Development of secondary sexual characteristics
-Most of assailants are known to the victim
-More common in F. Than in M.
-Specific or generalized fears, depression & night mares

480. Which is false regarding anencephaly in pregnancy:
-Sampling of umbilical art. Will not reveal the diag.
-4 mg. Folic acid is prophylactic
-Higher dose given for a pregnant who has history of anencephaly
-Amniocenthesis used in diag.
-Associated with high alpha fetal protein in mothers serum

NB: the correct dose should be (0.4 - 1 mg) in all pregnant women & we increase the dose to 4 mg if the pregnant has a history of NTD.

481. Which is contraindicated in the last trimester ?
-Sulfonamide
-Ampicillin
-Diazepam
-Heparin

NB: increased risk of kernicterus

482. What will be the effect of Diazepam taken by a breast feeding mother on -her child ?
-Hypotonia
-Hyper ventilation
-Intra ventricular hemorrhage

483. Which of the following is contraindicated on pertusis vaccine ?
-Egg allergy
-Encephalitis after the previous dose
-Upper respiratory tract infection with slight fever

484. Child with bloody Diarrhea with dehydration can be managed by all EXCEPT:
-Loperamid
-Metronidazol
-Rehydration
-Stool culture

485. What is the complication caused by forceps delivery ?
-Cephalohematoma
-Caput succidanum

486. Complications caused by Vaccum delivery is :
-Cephalohematoma
-Caput sucidanum
-All of the above
None of the above

487. Which is not true in IUGR (Intrauterine Growth Retardation) :
-Absence of weight gain
-Maternal short stature
-Low fundal height

488. A study reveal that 10 yrs experienced driver contributed to 60% of accident. 5 yrs experienced driver contribute to 30%. & those with 2 yrs contribute to 10%. The conclusion was that the more experienced driver are more careless in driving. This conclusion is not right because of :
-It's not measuring the incidence of accident
-It's not standardized to the age
-Because there is no control group

489. Study about the benefit of exercise in decreasing the risk of heart dis. Applied to a group of voluntaries in the factory with a control group of the rest of the factory. Follow up was regular. The check up shows lower rate of IHD. Ischemic Heart Dis. In exercising group (voluntaries). The conclusion that exercise protect against IHD. may be rejected because of:
-Selection bias
-Only M. Were included
-Only one company was involved
-Some IHD may be silent

490. Differentiation between schizophrenia & mania:
-Thought broadcasting
-Flight of ideas

491. Which is false about Down syndrome ?
-Rocker Bottom Foot
-Brushfield spot
-Upward standing palpebrale fissure
-Brachiocephaly

492. In 15 wks. Normal pregnancy u will find all EXCEPT:
-Increased BP
-Fundal height midway between symphysis pubis and umbilicus
-Increased heart rate

493. Opiate abuse is commonly associated With:
-Miosis
-Euphoria
-Perforation of nasal septum

494. Old pt. Abused by his wife complain to u, you will do all the following EXCEPT:
-Send the pt. To day care
-Frequent visit to house
-Reassurance

495. Pt. Died after suffering from TB, what will you write in death certificate as cause of death ?
-Cardiac arrest
-TB
-Fever
-Loss of weight

496. ADHD associated with all the following EXCEPT:
-Stereotyped movement
-Short attention span
-Hyperactivity
-Impulsivity
-Interference with family & social functioning

497. Which of the following is contraindicated with tyramine rich food (cheese) ?
-Imipramine
-Phenelzine
-Fleuxitine

498. Which increases the risk of MI. ?
-History of father with MI
-History of smoking
-History of high animal fat diet

499. Pt. With chronic pain, can be treated with all EXCEPT:
-Biofeed back
-Operant conditioning
-Desensitization

500. Which of the following is most compatible with interstitial lung dis. ?
-Severe hypoxia on exercise (decreased PaO2)
-Emphysema
-Increase CO2 & O2

501. What will be your next step on a pt. with normal breast at PE. & -Abnormal mammogram ?
-Biopsy guided by wires
-Exisional biopsy
-Repeat after one year

502. All are part of the normal vaginal flora EXCEPT:
-Peptostreptococus
-Lactobacillus
-Staphylococus
-CMV

503. Which is the most likely to be associated with Leukemia ?
-Aromatic hydrcarbones
-Ionized radiation
-Benzoalphaperines

504. Surveillance in medical worker for radiation hazard include all EXCEPT:
-Heamatological examination
-Annual PE.
-Labelled panding
-Total body radiation count

505. All are true regarding aseptic meningitis EXCEPT:
-Increased chloride
-Normal blood sugar
-Increased lymphocyte
-Slight protein increase

506. Dysplastic nevi associated more with:
-Subungual
-Elevated
-Hypertrichosis

507. Drainage of lymph in lower vulva:
-Inguinal LN.
-Internal iliac LN.
-ParaAortic LN.

508. BCP reduces risk of which of the following ?
-Breast CA
-Endometrial CA

509. The most common complication of low dose of BCP is:
-Brake through bleeding

510. Pt stop her BCP & ask your advice for time of conceiving. What will u tell her ?
-Body tepm. Chart
-Pregnancy after 6 months
-Bleeding will occur within 28 days
-Try to conceive after she got the menstruation

511. Which is the best source of information for pt. With poisoning by a toxic substance ?
-Public health unit
-Environmental health protection unit
-Toxicology unit

512. Which is true regarding urticaria ?
-In 80% of cases the cause is not apparent & It'll resolve spontaneously

513. Regarding smoking cessation. All are true EXCEPT:
-Decreased lung CA occurrence as other nonsmoking population by 2-3 years of cessation
-Improvement of claudication

514. Gun shot to the lower abdomen, pt. Is in shock with BP 70\30 what is your immediate management. ?
-Laparotomy
-Peritoneal lavage

515. In cushing syndrome you find all EXCEPT:
-Low BP.
-Obesity
-Striation of skin
-Trunk obesity

516. Old pt. With history of head trauma, he has changes in behavior with frequent vomit & headache. U do All EXCEPT:
-Head CT
-Catheter
-IV. Fluid
-LP

517. (Case of Invalid consent eg.) Taking consent from a premedicated pt. On the way to theater for some procedure.

518. Thiazide is best ro be given to old hypertensive pt. With :
-Vasovagal attack
-DM.
-Gout

519. Pt. With suprachondilar fracture with splint & he is in complete flexion. He develops ischemia. What will be the initial management. ?
-Remove splint & flex the arm
-Keep splint & extend the arm
-Remove the splint & extend the arm
-Angiogram of brachial art.

520. Pt. Who ate BBQ. Developed diarrhea. Blood count shows eosinophelia. The best investigation to be done to reach the diagnosis ?
-Muscle biopsy
-Stool culture
-Stool microexamination

521. Pregnant came with breech presentation at 39 wks. All other parameters are normal. Management ?
-Continue ANC (antenatal care)
-C-section
-Normal vaginally delivery

522. Which is the most indicative of fatal distress:
-Base line heart rate at 115 beat\min
-Occasional late deceleration
-Early deceleration

523. Pt. On 100% O2 & ventilator.
PaO2 = 93%
PaCO2=56%
pH=7.3 HCO3=31
What will be your management. ?
-Decrease O2 saturation
-Increase respiratory rate
-Increase tidal volume

524. Laryngeal polyp can be caused by all of the following EXCEPT:
-Present medication
-Smoking
-Allergy

525. A secretary complains of painful lesion 7.5 cm above the anus in the anal cleft. Diagnosis. ?
-Infected pilonidal sinus cyst

NB. MCCQ 2001 (GS26)

526. Pt. With sigmoid volvulus. Management ?
-Sigmoidectomy
-Decompression by sigmoidoscope
-Hydrostatic barium enema

527. Pt. Present with dyspnea & fever 38.5 , 36h. Post-op. Diagnosis. ?
-DVT
-Atelectasis
-Pulmonary Embolism

528. What is true regarding mastitis ?
-Usually treated by I&D
-Temp. Never more than 39
-Associated with supressed lactation
-Usually start 2-4 wks. Postpartum

529. Which of the thyroid CA. Has the best prognosis ?
-Folicullar
-Papillary
-Anaplastic
-Medullary
-Embrionic

530. Burned Pt. Presented unconscious to ER. PE: smoke in the mouth, black tongue, intact pharynx & he was NOT cyanotic. What do u expect to find ?
-Low PaO2
-Carboxyheamoglobine more than 35%
-PaCO2 = 56 mmHg.

NB. To be checked ...

531. Post-op pt. Present with hypotension & central venous pressure 16 cm H2O. Diagnosis. ?
-Hypovolemic shock
-Cardiogenic shock

532. All are true regarding thoracic dissecting aortic aneurysm EXCEPT:
-Severe chest pain
-Systolic murmur, when present, is of great significant
-Involvement of aortic arch may lead to stroke
-Asymmetrical peripheral pulses

533. Most common indication of cricothyroidotomy is:
-Multiple severe facial injury
-Fracture C5-C6 with dislocation

534. Anal skin tags in a child is commonly associated with:
-Crohn's disease
-Chronic anal fissure
-Hemorrhoids

535. Lady 20 years presented with 3 cm mobile breast mass, it was increasing in size for the last 4 months. Diagnosis. ?
-Fat necrosis
-Fibroadenoma
-Firocystic disease of the breast

536. F. pt. Presented with history of abdominal Pain , fever , vomiting , the pain shifted to the Rt. Lower quadrant. The pt. Improved after a conservative treatment. 10 days after he present with R. abdominal Mass. Diagnosis. ?
-Appendicitis
-Apendicular abscess
-Acute sulpingitis

537. Which of the following is true regarding extraintestinal manifestation of an IBD of unknown origin ?
-Total colectomy result in relief of extraintestinal signs & symptoms
-Extraintestinal symptoms may precede gastrointestinal symptoms
-Arthritis usually involve small joints
-Arthritis are more cþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@’÷¿ÿÿÿÿ¨ñþ”@’÷¿ÿÿÿÿ¨ñþ“@
-Stop antihistamine 2-4 wks before
-Stop BCP 4-6 wks before
-Continue both drugs

NB: BCP will increase the risk of hypercoagulable state

541. What is Mallet finger ?
-Fixed flexion of DIP. With loss of active extension caused by rupture of the extensor tendon.

NB: MCCQ 2001 (PL9)

542. All the following occurs in intestinal obstruction EXCEPT:
-Distention
-Increased bowel sounds
-Guarding

543. Post-op lady complain of red painful swelling, calf is free of pain. Diagnosis. ?
-DVT
-Superficial thromboflebitis

544. The most consistent finding in Fetal Alcohol Synd. is:
-Microcephaly

545. Young boy with abdominal Mass not moving with respiration. All can be diagnosed EXCEPT:
-Wilm's tumor
-Neuroblastoma
-Double jejunum
-Meckel's diverticulum

546. Cholostrom protects infection by:
-IgM
-IgA
-IgG

547. Child have ingested 20 tablets of Iron. All can appear EXCEPT:
-Necrotizing Enterocolitis
-Shock
-Metabolic acidosis
-Coma & death
-Cerebellar involvement is an early symptom

548. Pt. Present increased ALP (alkaline phosphatase) & normal Ca++ . Diagnosis. ?
-Pagets dis of the bone
-Scurvy
-Hyperphosphatemia

549. All are irritant to mucus memb. EXCEPT:
-SO2
-NO2
-CO

550. In coarctation of the aorta we find all EXCEPT:
-Delayed radial femoral pulse
-Increase upper limb BP.
-Continues mumur in the chest

551. What is the most imp. risk factor for stroke ?
-Smoking
-Systolic HT.

552. What population group is expected to increase in Canada next years ?
Neonates
-10-15 years.
-20-40 years.
-40-65 years.
-Above 65 years.

553. The prevalence of a recessive gene is 1:40000. What is the prevalence of the disease In community ?
-1:200
-1:400
-1:4000

NB: square root of the 1:40000 = 1:200

554. What is the policy of Canada to decrease the health expenditure ?
-Advise the health professional to use the health resources

555. Pt. Presented with cardiac arrest. Which describes the best action ?
-IV lidocaine routinely given
-IV Adrenaline every 10 min.
-Chest compression will keep circulation for cerebral flow
-Atropine every 2 min.

556. F. Pt. Comlain of paralysis of the Rt. Side of body after divorce. What is your diagnosis ?
-Conversion disorder
-Malingering
-Factitious disorder

557. Nurse with repeated attack of hypoglycemia. Investigation reveal increased serum insulin but low serum C-peptide. Management ?
-GH test
-GTT (glucose tolerance test)
-Psychiatric assessment

558. Erb's palsy associated with
Shoulder distocia

559. The maneuver of Flexion of the thighs against the hips is helpful in the delivery of:
-Shoulder dystocia

560. The most common cause of late postpartum hemorrhage is
-Uterine atony
-Evacuation of vaginal hematoma
-Subinvoluted uterus
-Cervical laceration

561. Lady after a prolonged labor she delivered a 4 kg. Neonate. She is not able to urinate. Diagnosis. ?
-Urethral trauma
-Maternal dehydration
-Uterine atony
-Bladder atony

562. Postpartum lady present with failure to lactate, generalized weakness, you do all the following EXCEPT:
-TSH
-T4
-FSH & LH
-prolactine

563. Individual % of infertility, what is the highest ?
-Uterine abnormality
-Male factor
-Ovarian cause
-Cervical cause

564. Primigravida in labor, fetus at 0 station, cephalic presentation, occiputo-transverse, cervix 4 cm dilated for 6 h. Efficient uterine contractions every 5-10 min. lasting 10 sec. What is your diagnosis ?
-Obsructed labor
-Normal latent phase

565. Propranolol is used in all EXCEPT:
-Bipolar disorder
-Aggressive violent disorder
-Social phobia
-Lethium tremor
-Acathesia

566. The natural growth rate =
-Birth rate - immigration rate
-Birth rate - death rate + immigration
-Birth rate + immigration rate

567. While you are waiting for Culture & sensitivity test. What will you treat shigellosis with ?
-Ampicillin
-TMP\SMX
-Erythromycin

568. Child with BP 150\90 mmHg. You suspect coarctation of Aorta. What is the most common finding ?
-Increase BP. In Rt. Upper limb than in the Lt. Upper limb
-Increase BP. In lower limb more than Upper limb
-Increase BP. In the Upper limb more than the lower

569. Pt. With DM. Presented with history of diarrhea. What is the most likely cause ?
-Autonomic diarrhea
-Infectious diarrhea
-Inflammatory diarrhea

570. Young single M. With history of dementia, ataxia & cognitive disorder. Diagnosis. ?
-Depression
-AIDS related dementia
-Alzheimer's disease

571. F. Came with history of fever 39 , abb. pain. PE: febrile, bilateral lower abdominal pain with Lt. side Mass tender. One week ago pt. was diagnosed with clamedia by culture & sensitivity. Whats your approach to treat her ?
-Ceftriaxone
-Oral Doxycycline
-Out patien oral Doxycycline & IM. Ceftriaxone
-Inpatient oral Doxycycline & IV. Ceftriaxone

572. Pt. With repeated abortion. All are possible causes EXCEPT:
-Decreased lutheal phase
-Septate uterus
-Incompetent cervix
-Rupture heamorrhagic corpus luthium

573. Pt. came with an acute episode Lt. Renal colic, IVP shows Lt. Calculi at the ureter at the level of L.4 . There is small dye leak beyond the calculi, Lt. Kidney enlargement. Management ?
-Hydration
-Observation
-Remove the stone by retrograde cystoscopy
-Lithotripsy

574. Young man came with history of automobile accident, multiple anterior chest fracture and hoarseness , chest x-ray shows widened mediastinum, whats your immediate management?
-Intubation
-Support the anterior chest fracture
-Pericardial synthesis
-Aortic angiogram

575. Schizophrenic Pt. on phenothiazine came with history of gremacing, purposeless movements of the limbs, Diagnosis. ?
-Tar dive Dyscanasia
-Acathesia
-Neurolyptic Malignant Syndrome

576. A known Pt. With bipolar disorder brought to u with history of agitation , paranoid, delusion, and grandiosity . Whats your action ?
-Benzodiazepen
-Lithium and Antisycotic
-Antisycotic
-Antidepressant

577. Pt. Came to u after he divorced his wife, he has history of depressed mood, which of the following factors prompts you to start antidepressant ?
-History of divorcing before
-History of mother and sister treated with antidepressant
-History of alcohol

578. What is the commonest complication of DT. ?
-Heart failure
Renal failure
Respiratory failure

579. All are true regarding Hantington disease EXCEPT:
Onset at mid 60's
Autosomal dominant
Progressive disease
Associated with depression
Association with dementia

NB. The normal age of onset is between 40's & 60's

580. In thyrotoxicosis all are true EXCEPT:
Amenorrhoea
Weight loss
Change of appetite

581. The best time to amniosenthesis is:
16 wks
12 wks
20 wks
30 wks

582. F. Pt. 82 years, she has been on digoxin 25 mg & hydrochlorothiazide 50 mg daily for chronic congestive heart failure. Now she has increasing dyspnea. Lab finding:
Heamoglobin 12.5 gm\100 ml
BUN=18 mg\100 ml
Na=135 mEq\L
K=3.1 mEq\L
Cl=90 mEq\L
HCO3=30 mEq\L
C-X ray shows evidence of pulmonary congestion and ECG shows an atriel rate of 250\min, variable A-V block and a ventricular rate of 100\min. management. ?
-Continue digoxin & increase hydroclorothiazide to 50 mg\day
-Continue both the Digoxin and hydrochlorothizideand begin Furosenamid 40 mg daily.
-Stop Digoxin & Hydrochlorothiazid and begin potassium supplements
-Continue digoxin & stop hydrochlorothiazide & add K suplements
-Stop all drugs & immediatly carry on electrical rhythm reversion

583. Which of the following abnormalities is not true paradoxical:
-Paradoxical respiration
-Paradoxical Embolism
-Paradoxical Pulse
-Paradoxical Splitting of the 2nd Heart sound

584. A child with known Juvenile polyposis. What will be the most likely complication ?
-Diarrhea
-Painless bleeding
-Painful bleeding
-Cancer
-None of the above

585. All are associated with oligohydramnios EXCEPT:
-Renal agenesis
-Polycystic kidney
-Meningiocele
-Potter's syndrome
-Amniom nodosom

586. Neonate 1 month with pneumonia. What is the most likely causative agent ?
-E. Coli
-GBS
-S. Pneumoniae
-H. Influenza
-N. Meningetidis

587. Pt. Present with convulsion after she has been on IV fluid for a long time. Investigation shows
Na=120
K=3
HCO3=16
What will be the best treatment ?
-Normal saline
-Hypertonic saline + diuretics
-5% dextrose
-Furosemide
-Phenytoin

NB: MCCQ 2001 (NP11)

588. You can do ALL Regarding shoulder dystocia EXCEPT:
-Oxytocin
-Flex the mothers leg
-Break the clavicle
-Rotate the shoulders
-Suprapubic pressure

589. The most common complication in Epidural anasthesia is:
-Hypotension

590. All are side effects of B agonists during preterm labor EXCEPT:
Acute Pulmonary Edema
-Tachycardia
-Angina
-Increase of glycemia
-None of the above

591. Pt. Complains of pain in the LLQ. & fever. PE: slight abd tenderness. What do u do to confirm the diagnosis ?
-Biopsy
-Barium enema
-Peritoneal Lavage
-Rectosigmoidoscopy
-US

NB: diagnosis Is diverticulitis

592. Known alcoholic arrived to ER with large bilious vomiting, then he vomited large amount of red blood & complains of pain. What is the most likely diagnosis ?
-Perforated ulcer
-Esophageal junction rupture
-Ruptured Esophageal varice
-Acute gastritis

NB: (Mallory-Weiss tears)

593. After you insure vital function (ABC) what will be your initial step in the management. of a known alcoholic pt. brought in coma ?
-Vit. B1 (thiamine)
-Lorazepam
-Look for the subdural heamatoma
-Quick control of glycemia (finger prick)
-Administer K

594. What is the most imp. Side effect of CLOMIPHENE ?
-Ovarian cyst
-Stimulation of ovulation
-Treatment of anovulation
-Anti Estrogen

595. In all there is increased IgE. EXCEPT:
-Asthma
-Chronic bronchitis
-Allergic rhinitis
-Eczema

596. In Acute colicystitis what is the pathophysiology ?
-Bacterial invasion of gallbladder
-Obstruction of the common bile duct
-Obstruction of the cystic duct
-Obstruction of the common hepatic duct

597. With HPV infection you may find:
-Purulent discharge
-Nonpurulent discharge
-Condyloma accuminata
-Condyloma lata

598. Study shows that specific mortality rate for stomach CA tends to decrease. What is the most likely explanation ?
-Decreased Prevalence
-Decrease Incidence
-Better screening
-Better treatment

599. All the following will help you to suspect menopause in a 57 years lady EXCEPT:
-Vaginal mucous atrophy
-HT
-Flush
-Sleep disturbances
-Osteoporosis

600. All are indications of chorion villous sampling EXCEPT:
-Tay-Sachs disease
-Hygroma Coli
-Turner syndrome
-Translocation
-Myelomeningeocele

601. All the following can cause bloody diarrhea EXCEPT:
-Yersinia Enterolitica
-E. Coli
-Shigella
-Campylobacter
-Giardia lamblia (Rocky M.)

602. Which germ is found in uncooked eggs ?
-E. Coli
-Staph. Aureus
-Shigella
-Giardia
-Salmonella

603. 32 years old lady with agitation, hyperthermia, palpitation , loss of weight
And sweating. What is the initial test to do ?
-Thyroxin (T4)
-TSH
-Thyroid scintigraphy
-Thyroid U\S
-Triiodothyronin (T3)

604. Postpartum Pt. Wishes to stop lactation for personal reasons , how will you prevent the pain resulting from breast engorgement?
-Prescribe Oxytocin
-Apply bandage to protect clothes
-Medical treatment is useless most of the time
-Antiprolactin

605. 45 years old male 3 months after car accident, presents with agitation, insomnia and nightmares. He is anxious and there is deterioration in the sexual relationship with his wife. Whats your diagnosis?
-Impaired intimacy with his wife
-Depression
-Masked anxiety
-PTSD
-Sexual dysfunction

606. Female 60 years old with constipation for many months, she has not passed stools for the last 3 days. On examination the abdomen is distended but non tender. What is your management ?
-Laxative
-High fiber diet
-Mineral oil
-Enema

607. Following a gun shot a Pt. Presents with a swollen right leg, distal pulse is weak, veins are distended. What is the likely cause?
-Unilateral vein thrombosis
-Arterial emboli
-Femoral nerve injury
-Post traumatic superficial vein insufficiency
-Arteriovenous fistula

608. Female 60 years old on multiple drug treatment for breast cancer with bone metastasis. Lately she had severe pain and increased dose of opioid x 3,
now she presents with constipation ,lethargy ,and apathy. Whats the likely diagnosis?
-Gastroenteritis
-Gastrointestinal metastasis
-Drug intoxication
-Fecal impaction

609. Alpha Fetoprotein is increased in all of the following except?
-Omphalocele
-Potter syndrome
-Anencephaly
-Meningomyocele
-Spina bifida

610. Which test will help to objectively diagnose fetal heart beat at 16 weeks ?
-US
-NST (non stress test)
-Doppler
-Abdominal x-ray

611. Female 18 years old complaining of primary amenorrhoea, BhCG is negative .Which test will you do to diagnose an hypothalmopituatary disease?
-Pelvic examination
-Prolactin and TSH
-CT of the sella tursica
-Provera challenge test
-FSH and LH

612. Regarding symmetrical Intrauterine growth restriction , what is the most likely cause?
-Intrauterine infection
-Maternal renal disease
-Maternal diabetes
-Drug abuse

613. Rheumatoid factor will be found in all of the following EXCEPT:
-RA & Juvenile RA
-SLE
-Sjogren's disease
-Dermatomyositis
-None of the above

614. A child with hepatosplenomegaly and mental retardation, he has positive reducing substances in the urine ,Diagnosis?
-Galactosemia
-Cystinuria
-Von Gierke disease
-Fructose intolerance

615. Child 13 years old, obese with painful right knee and right hip, he is limping. On examination there is reduced abduction and internal rotation, diagnosis?
-Juvenile arthritis
-Septic arthritis
-Avascular necrosis of the femoral head
-Slipped femoral capital epiphysis

616. A known alcoholic man admitted in the E R with fever ,coughing off profuse and purulent sputum . On examination ronchi on the right lower lung, diagnosis ?
-Lobar pneumonia
-Lung abscess
-COPD
-TB

617. A lady with occasional severe attack of dyspnea with facial edema. On examination severe respiratory distress, red and inflamed pharynx. what is your management ?
-Adrenalin for out pt. usage
-Cortison I.V
-Lateral x- Ray of larynx
-Epinephrine SC (subcutaneous)
-Intubation

618. A carpenter has difficulties holding things with hypoesthesic trouble of fingers of the the Rt. Hand. Which exam will help u to establish the diagnosis ?
-Xray of the cervical spine
-Xray of hand
-EMG
-Examination of the rotator cuff
-Neurologic exam of the hand

619. F. 70 years present with muscle weakness with dysphagia & change of the skin color of the hand induced by cold weather, with telangiectasia. Diagnosis. ?
-Dermatomyositis
-Fibromyositis
-Sclerodermia
-SLE

620. Asiatic man recently came as immigrant to Canada. He took chloroquine 4 wks & 2 days before his arrival (to treat his Malaria infection). 2 years later he develops fever of unknown origin. What is the most likely cause ?
-Malaria reinfection
-1st episode of malaria was not treated sufficiently
-The strain was resistant to treatment
-Remnant active schizontes in the liver

621. All the following are characteristics of a narcotic intoxication EXCEPT:
-Myosis
-Bradycardia
-Dry mouth
-Constipation
-Orthostatic hypotension

622. Pt. 3 days postpartum develops Endometritis. Which is not a finding in this case ?
-Low abdominal pain
-Oliguria
-Tachycardia
-Purulent lochia
-Uterus below symphysis

623. Newborn 3 wks. Hypotonic & totally constipated, his abdominal seems distended but not painful. Diagnosis. ?
-Hirschprung disease
-Hypothyroidism
-Volvulos
-Intususception
-Milk intolerance

624. What is the sign which allows you to make a difference between -ankylosing spondylitis & RA.
-Joint deviation
-Joint nodules
-Joint effusion
-Sacroiliac involvement

625. Child 9 years brought by his mother, present headache, nausea & vomiting. He feels tired & easily falls asleep. Diagnosis. ?
-Migraine
-Cerebral tumor
-Temporal epilepsy
-Simulation (faking)

626. All are characteristics of Alzheimer’s disease EXCEPT:
-Aphasia, Apraxia, Agnosia
-Loss of acquisition of recent facts
-Loss of abstract thinking
-Loss of consciousness of his environment
-Loss of old imp. facts

627. All may cause epiglotitis in a child EXCEPT:
-Hemophilus influenza
-Tobacco smoke
-Parainfluenza virus
-Hydrocarbure ingestion
-Acute allergy

628. The most common cause of PP (precocious puberty) in a girl is:
-Gonadic tumor
-Von Reclinghausen disease
-Idiopathic PP
-Adrenogenital syndrome
-Pituitary Tumor

629. Which is the commonest cause of mortality in children aged 5 A 9 years in Canada ?
-Leukemia
-Cancer
-Accident
-Congenital malformation

630. Comparing characteristics of Infectious mononucleosis in a child Vs. Adult, which of the following is true ?
-Its more severe in children
-Typical form is rare in children
-Immunization is better
-Dis. last longer
-Need to do throat culture & sensitivity
-Mono spot test is negative.

631. What will be the effect of increasing the prevalence of a disease for a screen test ?
-Increase in the sensitivity of the test
-Increase in the specificity of the test
-Increase in the PPV.
-Increase in the NPV.
-Increase in the sensitivity & PPV. of the test

632. Which is contraindicated for forceps delivery ?
-The presenting part at station -1
-3rd degree laceration
-Breech presentation
-Large caput

633. Pt. In labor after delivery of 1st twin has the other twin in vertex presentation & at station -1, memb. are ruptured. There is no contraction for 20 minutes. What will u do ?
-Oxytosin drip
-C-section
-Forceps
-Vacuum
-Wait

634. F. Came from Greece complaining from fatigue & weakness, she is pale. Investigation shows
Hb.= 10 gm \ dl.
MCV=70
What are you going to do next to reach the diagnosis ?
-Bone marrow aspiration
-Reticulocyte level
-Hb. Electrophoresis
-Serum iron level
-Trial treatment with B.12

635. Pt. 17 years with factitious disorder. All can be found EXCEPT:
-Family history of similar episode
-The pt. knows about medical treatment
-He wishes to attract attention on him
-He has a particular interest in medical profession
-Works in medical profession

636. Pt. 23 years with single thyroid nodule. What will make u suspect malignancy ?
-Thyroid US
-Cold nodule on thyroid scan
-Hot nodule on thyroid scan
-CT of the cervical spine

637. An infant present with inflamed pharynx & fever. He was treated with antibiotics. A week later he presents again with trismus. Diagnosis. ?
-Tetanus
-Pharyngitis
-Infectious mononucleosis
-Peritonsillar abscess
-Streptococal tonsillitis

638. Why is chorionic vilous sampling not commonly done in Canada ?
-Its expensive
-Doctors dont have enough experience
-Results are not reliable
-Its dangerous
-Because the prevalence of the diseases that it can detect is low

639. All can cause mania EXCEPT:
-Phenelzine
-Trazodone
-Methyphenidate
-Cortisone
-Levodopa

640. A 74 years old pt. With whitish asymptomatic urethral discharge. The investigation of the germ will reveal :
-Chronic prostatitis and gonococcal urethritis
-Non specific urethritis
-Urinary infection
-Acute prostatitis

641. What is the allowed amount of GNP (gross national product) to health in Canada ?
-4% A 8%
-8 % A 12 %
-12 % A 15 %
-16 % A 24 %
-25 % A 36 %

642. Hyperglycemic Pregnant Pt. with level 9.8 gm\L. after OGTT (oral glucose tolerance test) with 50 gm. Which of the following should not be done ?
-Prescribe chlorpopramide
-Give Insulin
-Administer B blocker
-Do a OGTT at 75 gm. at 2 h.
-Diet

NB: screening with 50 gm OGTT :
# If blood glucose between 7.8 & 10.3 mmol\L then repeat with 2 hrs. 75 gm. OGTT
# If blood glucose more than 10.3 mmol\L then diagnosis of diabetes is made ...
# Oral hypoglycemics are contraindicated in pregnancy

643. Child 6 years old brought by his mother with fever and red throat, lips fissures ,cervical adenopathies and rash of extremities. You found a fine peeling at the hands, palms and soles of the feet. you will think of:
-Streptococcal infection
-Rubeolla
-Infectious mononucleosis
-Kawasaki disease
-Measles

644. Child 12 months old adopted from eastern Europe. He presents with loss of weight and multiple adenopathies plus splenomegaly associated with skin lesion. What is the diagnosis?
-Proteino\caloric malnutrition
-Acute leukemia
-Infection with pneumocystis carinii
-Child abuse
-HIV infection

645. Form 1971 A 1992 life expectancy for men has increase from 68 A 73 years ,women 73-81 years. What is the most likely cause of these changes ?
-Vaccination
-Better management of ischemic diseases
-Use of antibiotics
-Improvement of life style
-Generalization of health care

646. All the following are a part of diagnosing leukemia in children EXCEPT:
-Thrombocytopenia
-Anemia
-Hemoglobinuria
-Granulocytopenia
-Neutropenia

647. You can do all of the following investigations in a pregnant pt. Post term EXCEPT:
-U\S for examination of amniotic fluid
-Amniocentesis for dosage of alpha fetoprotein
-BPP
-Fetal biometry
-Non stress Test

648. F. 55 years old presents for 1 month memory trouble plus hallucination, agitation, hypotension, and hot flashes. She has visual trouble with pupils fixed in mydriasis, what is the most likely causative substance ?
-Haloperidol
-Benztropin
-TCA
-Fluxotin
-Phenelzine

649. Upon the lung cancers which one is the most sensitive to radiotherapy?
-Dermoid carcinoma
-Squamous cell carcinoma
-Adenocarcinoma
-Small cell carcinoma
-Undifferentiated small cell carcinoma

650 which of the following is the main complication of dermoid ovarian cyst ?
-Infection
-Necrosis
-cancerisaton
-Torsion

651. Which of the following is a characteristic of a person with somatization trouble ?
-The person knows that he has psychological trouble
-Multiple somatization trouble
-Hypochondria
-Feeling of malformation
-Knows that his troubles are not true but he can’t avoid them

652. What’s the best criteria for estimating population health?
-Amount of money spent on health
-GDP
-Ratio of physicians per habitant
-Number of hospitals

653. What is the best way to appreciate health care quality during pregnancy and delivery in Canada?
-Neonatal mortality rate
-Perinatal mortality rate
-Infant mortality rate
-Maternal mortality rate

654. Regarding child schizophrenia which is true ?
-Signs are identical to the adults
-Risk is 10 % if one of the parents has schizophrenia
-Pronostic is good if it appears early
-Complete presentation from the beginning
-Hallucinations are more frequent

655. A couple went for holiday in Mexico, they severe diarrhea. Diagnosis. ?
-E. Coli
-Giardia lambia
-Enterobacter
-Salmonellosis

NB. The treatment of choice for traveler’s diarrhea caused by Enterotoxigenic E. Coli is : Cyprofloxacin.

656. Pt. 27 years. Known to have manic trouble for many years, he is brought to the ER. Agitated & Excited. What is the most appropriate treatment ?
-Carbamazepin
-Imipramine
-Clonazepam
-Lorazepam
-Phenelzine

657. All are part of KAWASAKI EXCEPT:
-Coronary heart disease
-Lips fissures
-Peeling of extremities
-Generalized adenopathy
-Strawberry tongue

658. Pt. Presents with lumbar pain after lifting a heavy object. Lumber X Ray shows lesions at L5-S1 level. Waht will u find on examination ?
-Absent knee jerk reflex & paresis of gastrocnemius muscle
-Absent knee jerk reflex & achiles reflex & paresis of quadriceps
-Absent achiles (ankle jerk) reflex & paresis of gastrocnemius muscle
-Absent achiles (ankle jerk) reflex & paresis of peroneal muscle

659. B agonist used for preterm labor, may cause all EXCEPT:
-Headache
-Respiratory distress
-Tachycardia
-Hyperglycemia
-Angina

NB: to be checked

660. Which of the following CA is caused by vinyl chloride ?
-Lung CA
-Esophagus CA
-Rhinopharynx CA
-Liver CA
-Bladder CA

661. Proparonol may be given in ALL the following EXCEPT:
-Hypertension
-Hyperglycemia
-Lithium induced tremors
-Panic disorder
-Chest Angina

Good Luck in the real exam ..

Done by ;

Dr. Athir Ghanim
Dr. Firas Al-Hanafi
Dr. Roger
Dr. J. C.
Dr. Tariq Al-Qubaty

1. D
2. A
3. D
4. D
5. D
6. A
7. A
8. A
9. A
10. A
11. A
12. A
13. A
14. B
15. A
16. A
17. D
18. A
19. A
20. A
21. A
22. A
23. A
24. D
25. A
26. C
27. A
28. B
29. A
30. C
31. A
32. A
33.
34.
35. A
36. D
37. C
38. A
39. A
40. A
41. B
42. D
43. A
44. D
45.
46. B
47. C
48. B
49. B
50. D
51. D
52.
53. B
54. D
55. D
56. A
57. C
58. C
59. E
60. D
61. B
62. D
63. C
64. C
65. A
66. B
67. C
68. C
69. C
70. A
71. B
72. B
73. E
74. D
75. B
76. D
77. E
78. B
79. C
80. A
81. A
82. A
83. A
84. A
85. A
86. A
87. D
88. A
89. A
90. A
91. B
92. C
93. A
94. A
95. A
96. A
97. A
98. A
99. D
100. A
101. A
102. D
103. E
104. A
105. D
106. A
107. B
108. A
109. D
110. A
111. C
112. A
113. A
114. A
115. E
116. B
117. A
118. A
119. A
120. C
121. C
122. A
123. A
124. B
125. C
126. D
127. A
128.
129. D
130. D
131. A
132. C
133. C
134. A
135. D
136. A
137. E
138. B
139. E
140. A
141. A
142. B
143. C
144. A
145. B
146. C
147. A
148. A
149. A
150. A

151. B
152. D
153. A
154. B
155. C
156. D
157. A
158. C
159. A
160. A
161. A
162. C
163. B
164. B
165. C
166. A
167. A
168. E
169. A
170. B
171. A
172. C
173. B
174. A
175. A
176. C
177. A
178. C
179. B
180. B
181. C
182. B
183. D
184. A
185. A
186.
187.
188.
189.
190. D
191. D
192. D
193. B
194. A
195. A
196. B
197. C
198. D
199. A
200. C
201. A
202. A
203. A
204. A
205. C
206. C
207. A
208. C
209. C
210. D
211. A
212. A
213. C
214. A
215. A
216. A
217. A
218. A
219. B
220. C
221. C
222. A
223. D
224. A
225. C
226. A
227. A
228. C
229. A
230. A
231. A
232. A
233. A
234. A
235. B
236. A
237. A
238. A
239. A
240. A
241. A
242. A
243.
244. A
245. A
246. B
247. C
248. A
249. D
250. B

251. E
252. B
253. D
254. C
255. C
256. C
257. A
258. B
259. A
260. B
261. A
262. B
263. B
264. A
265. B
266. C
267. A
268. A
269. A
270. A
271. B
272. A
273. C
274. B
275. B
276. C
277. B
278. A
279. D
280. A
281. B
282. D
283. B
284. E
285. C
286. B
287. E
288. D
289. D
290. A
291. D
292. C
293. B
294. C
295. D
296. E
297. C
298. C
299. B
300. C
301. E
302. B
303. B
304. D
305. D
306. E
307. E
308. C
309. D
310. A
311. A
312. C
313. B
314. A
315. A
316. A
317. A
318. B
319. A
320. A
321. A
322. A
323. D
324. C
325. D
326. A
327. D
328. C
329. A
330. A
331. B
332. D
333. A
334. C
335. A
336. B
337. A
338. B
339. A
340. E
341. A
342. A
343. D
344. A
345. A
346. A
347. A
348. A
349. B
350. A
351. A
352. C
353. A
354. A
355. B
356. B
357. B
358. C
359. A
360. C
361. A
362. A
363. B
364. B
365. B
366. B
367. B
368. A
369. A
370. B
371. A
372. C
373. C
374. B
375. D
376. B
377. B
378. A
379. A
380. A
381. B
382. B
383. B
384. A
385. B
386. B
387. B
388. A
389. A
390.
391. B
392. A
393. C
394. A
395. B
396. B
397. A
398. C
399. C
400. A
401. B
402. A
403. C
404. D
405. C
406. A
407. A
408. C
409. A
410. D
411. C
412. D
413. A
414. D
415. B
416. C
417. C
418. C
419. D
420. C
421. C
422. C
423. C
424. D
425. C
426. C
427. B
428. A
429. A
430. B
431. A
432. A
433. A
434. B
435. A
436. A
437. C
438. E
439. B
440. A
441. C
442. A
443. C
444. B
445. A
446. C
447. A
448. A
449. B
450. B
451. B
452. A
453. V
454. .C
455. A
456. A
457. B
458. A
459. C
460. D
461. D
462. B
463. A
464. A
465. A
466. C
467. C
468. A
469. A
470. A
471. A
472. A
473. C
474. A
475. A
476. D
477. B
478. A
479. A
480. B
481. A
482. A
483. B
484. A
485. A
486. C
487. B
488. C
489. A
490. A
491. A
492. A
493. A
494. A
495. B
496. A
497. B
498. A
499. A
500. A

501. A
502. D
503. B
504. C
505. A
506. B
507. A
508. B
509. A
510. D
511. C
512. A
513. A
514. A
515. A
516. D
517. A
518. A
519. C
520. A
521. A
522. B
523. B
524. A
525. A
526. A
527. B
528. D
529. B
530. B
531. B
532. B
533. B
534. B
535. B
536. B
537.
538.
539.
540.
541. A
542. C
543. A
544. A
545. C
546. B
547. E
548. A
549.
550. C
551. A
552. D
553. A
554. A
555. C
556. A
557.
558. A
559. A
560.
561. D
562. B
563. B
564. A
565. A
566. B
567. B
568. C
569. A
570.
571.
572. D
573. C
574. A
575. A
576. B
577. C
578. A
579. A
580. A
581. A
582. C
583. C
584. B
585. C
586. B
587. B
588. A
589. A
590. D
591. E
592. B
593. D
594. A
595. B
596. C
597. C
598. B
599. B
600. E
601. E
602. E
603. B
604. C
605. D
606. D
607. E
608. C
609. B
610. A
611. E
612. A
613. E
614. A
615. D
616. B
617. D
618. C
619. C
620. D
621. C
622. E
623. B
624. D
625. C
626. D
627. B
628. C
629. C
630. B
631. C
632. A
633. A
634. C
635. A
636.
637. D
638. D
639. D
640. B
641. B
642. A
643. D
644. E
645. D
646. C
647. B
648. B
649. B
650. D
651. B
652. B
653. B
654. B
655. A
656. A
657. D
658. C
659.
660. D
661. B
662.
663.
664.
665.
666.
667.
668.
669.
670.
671.
672.
673.
674.
675.
676.
677.
678.
679.
680.
681.
682.
683.
684.
685.
686.
687.
688.
689.
690.
691.
692.
693.
694.
695.
696.
697.
698.
699.
700.
701.
702.
703.
704.
705.
706.
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708.
709.
710.
711.
712.
713.
714.
715.
716.
717.
718.
719.
720.
721.

Qx / Sample Questions from MCCEE January 2004

2008-08-21T10:04:00.000-04:00

1. Wrist drop, which nerve is affected?
a) median nerve
b) radial nerve
c) ulnar nerve
answer: b

2. Characteristic of borderline personality disorder is:
Answer: splitting

3. Femur fracture with angulation, lower leg is pale, pulseless and cold, what’s the first management?
a) straighten the leg and traction
b) immediate operation

4. In designing a community prevention program, which one should be undertaken first?
a) obtain guarantee of funding
b) estimate the cost-benefit of intervention
c) quantify objectives
d) carry out a community needs assessment
e) formulate possible strategies of screening
answer: d

5. All can cause depression except:
a) cimetidine
b) corticosteroids
c) cephalosporines
answer: c

6. cricothyroidectomy is indicated for
a) foreign body in the trachea
b) severe facial injuries
c) C5-C6 spine injuries

7. child with yellow skin, which one is indication of carotenemia?
a) no discoloration of the sclera

8. patient said his boss let him come to see u because he always cannot keep good relationship with his colleagues, he thinks his boss is harassing him, what’s the probable diagnosis?
a) borderline personality discorder
b) dependent personality discorder
c) schizotypal personality discorder

9. young lady with sudden onset right lower quadrant pain, pregnancy test is negative. Pelvic examination reveals 6cm severe tender right adnexal mass, diagnosis?
a) adnexal torsion
b) ruptured ovarian cyst
c) ectopic pregnancy

10. old patient referred by his dentist with white lesion in his mouth, management?
Answer: biopsy

11. old patient with whitish thickening lip, management?
a) biopsy

12. child bitten by some kind of insect came with symptoms of anaphylactic shock, management?
Answer: SC epinephrine

13. picture shown whitish lesions on the tongue (oral thrush) of an old woman after taking antibiotics for 10 days. Management?
a) mycostatin gurgle
b) coticosteroids
c) amphotericin
answer: a

14. all drugs r teratogenic except:
answer: heparin

15. typical senario of trigeminus neuralgia, what do u give?
Answer: carbamazepine

16. all of the following is true about incidence except:
a) estimate the risk of acquiring the disease in community
b) useful for etiology analysis for both acute and chronic diseases
answer: b

17. most common irritant for child asthma at home:
a) rugs
b) pets
c) plants
d) smoking

18. best diagnosis of chronic pancreatitis:
a) CT
b) ERCP
c) serum amylase
answer: b

19. common symptom of cardial tamponade and pneumothorax:
a) hypotension
b) bradycardia
c) decreased venous pressure
answer: a

20. which of the folloing most suggests a pneumothorax?
a) deviation of trachea
b) paradoxical respiration

21. 30 y.o. female patient, her father has huntinton chorea, how big is the chance that she also has the disease?
Answer: 50%

22. patient after big operation develops suddenly dyspnea, chest pain (probably PE), the most likely finding on chest x-ray is:
answer: normal

23. patient with obstructive pulmonary disease, which of the following ABG finding suggests oxygen therapy may be dangerous:
a) pH=7.34, pCO2=60, bicarbonate=30
b) pH=7.4, pCO2=40, bicarbonate=24
c) pH=7.19, pCO2=25, bicarbonate=forgotten
answer: a (primary respiratory acidosis and compensation with metabolic alkalosis)

24. imperforated hymen is associated with all of the following except:
a) abdominal mass
b) limb paralysis
c) obstruction of venous return
d) hydronephrosis

25. police took a man who sexually assaulted a boy. When u asked him how many legs does the horse have, he answered ‘5’. Dignosis?
Answer: factitious disorder

26. followings r characteristics of psychoanalysis except:
a) contertransference
b) resistance
c) rehearsal

27. 18 y.o. freshman came to u asking about the best way to prevent HIV transmission, your best answer is:
a) combination use of condom and spermacide
b) sexual abstinence
c) judicious use of condom
d) HIV test of partners

28. patient taking many drugs including ACEI, TCA and… complaints of impotence, which drug is most likely to cause this symptom?
a) ACEI
b) TCA

29. female patients presents with palpitation, EKG shows occasional premature ventricular beats, management?
Answer: reassurance

30. young lady complaints of hopelessness, decreased in concentration especially at the end of the day. management?
a) time off work
b) antidepressant
c) psychosocial support and return visit
d) psychosocial support and lorazepam

31. young female patient with genital herpes, what do u suggest?
a) she can not conceive in the future
b) she can conceive but she should tell her obstetrics about her herpes history
answer: b

32. newborn with hart rate 40/min, irregular respiration, some flexion of the extremities, grimace to nasal catheter. He is pale and blue. Apgar score is?
a) 2
b) 3
c) 4
d) 5
e) 6

33. newborn with congestive heart failure, is acyanotic, most likely cause?
a) TOF
b) ASD
c) aoteric stenosis

34. patient on warfarin for phlebitis presents with spontaneous bruises and petechiae. INR is also increased. Management?
a) reduce warfarin
b) stop warfarin
c) stop warfarin + vitamin K
d) stop warfarin + fresh frozen plasma

35. scenario of endometriosis, definitive diagnostic method?
Answer: laparoscopy

36. female patient presents with right lower quadrant pain. Now she also complains of epigastric and left abdominal pain. On examination, she has tenderness on epigastrium and left abdomen. Fever 38C, labor:… your management within 30 min includes all of the following except:
a) repeat abdominal examination
b) check BP and pulse on standing
c) pelvic examination
d) requisition of ultrasound which is scheduled in next week

37. one disease family tree, ask what inheritance type
a) autosomal recessive
b) autosomal dominant
c) X linked recessive
d) X linked dominant
e) multifactorial

38. patient on lithium presents with fatigue, weight gain and constipation. Investigation?
a) serum electrolytes
b) serum lithium level
c) TSH
answer: c

39. black woman, nullipara, jogs 30 minutes three times a week. She smokes for 20 years. Height 150cm, weight 50kg. which of the factors increase the osteoporosis?
a) her race
b) her BMI
c) exercise
d) smoking
e) nullipara
answer: d

40. an evidence of decreasing osteoporosis in post-menopausal woman who are taking calcium supplement can be strongest obtained from
a) a randomized control trial of giving calcium tablets and follow up for fractures for 10 years
b) comparison of fracture incidence in postmenopausal women who are living in high and low diary products available
answer: a

41. the most common cause of absence from work is
answer: back strain

42. most important bias factor in cohort study is
a) follow up
b) recall
answer: a

43. patient presents with hematuria and albuminuria. Which test can confirm the diagnosis of acute glomerolonephritis?
a) abdomen US
b) ASO titre

44. all of the following are associated with posterior hip dislocation except:
a) avascular necrosis of femoral hear
b) sciatic nerve injury
c) femoral nerve injury

45. your colleague was preparing to do a surgery. You found out his gait is abnormal and you got smell from him. You let him not to do the surgery but he said it was not your business. What should you do?
a) inform the chief of staff on the next morning
b) inform the CEO immediately
c) let another colleague help to talk to him

46. patient on clozapine, important side effect of this drug:
answer: agranulocytosis

47. pap smear is
a) primary prevention
b) sencondary prevention
c) tertiary prevention
answer: b

48. scenario of acute pyelonephritis, the most common cause is:
a) staphylococcus aureas
b) E. coli
c) Chlamydia trachomatis
answer: b

49. woman with breast cancer was treated with radiotherapy. She was responding well but developed depression. Then, she got pneumonia and died. What is the cause u should write on her death certificate?
a) pneumonia
b) depression
c) brest cancer
answer: a

50. your neighbor called u because their child was choking during eating. U should do:
answer: put the child facing down and give blows on the back at the interscapular area

51. best treatment of bullous impetigo:
a) penicillin
b) amoxicillin
c) cloxacillin

52. patient with lower back pain, x-ray: anterior osteophytes at L4-L5 and subchondral sclerosis, diagnosis:
a) degenerative spondylitis

53. middle aged female patient with gastroesophageal reflux complaints of dysphagia for liquid and solid food. Cause?
a) barrett esophagus
b) squamous cell carcinoma of esophagus
c) adnocarcinoma of esophagus
d) peptic stricture

54. picture shown 6-month-old infant with umbilical hernia. Your management?
Answer: reassurance and recheck at 1 year of age

55. in postoperative period, a patient demanded for morphine for relief of his pain every 4 hours. The attending nurse thought that this patient was lying and told you that the patient should be treated with placebo. What will u do?
a) give placebo
b) not give placebo
c) tell the patient’s relatives for consent to give placebo

56. U are family physician of a lab technician. He always drinks. U will report all the conditions except:
a) you know that a lab technician disturbs his lab works
b) he drives car during drunk
c) he occasionally drives his private airplane during drunk
d) has sexual relationship with his 14-year-of daughter

57. patient presents with recurrent gouty arthritis attack, urinary uric acid is increased, you will prescribe:
a) colchicine
b) allupurinol + colchicines
c) benzbromaron

58. patient post-MI, develops bradycardia with pulse 32/min, the best management
a) atropine
b) pacemaker
answer: b

59. scenario of neuroleptic malignant syndrome, treatment?
a) benzodiazepine
b) bromocriptine
c) benztropine
d) buspirone
answer: b

60. which neurotransmitter in schizophrenia?
Answer: dopamine

61. definition of ergonomics?
Answer: concerned with human factors in the design and operations of machines and the physical environment

62. patient postoperative presented with heavy wound bleeding, she also gave a history of massive bleeding when she had a tooth extraction. Blooding time is increased. You will give:
a) DDAVP
b) factor XIII
c) fresh frozen plasma
answer: a

63. KOH is used to diagnose:
a) candidiasis
b) bacterial vaginosis
c) thichomoniasis
answer: a

64. young male patient with painless scrotal mass, transilumination –ive, management?
Answer: refer to surgery

65. hepatitis B can be transmitted through the following ways except:
answer: fecal-oral

66. the best screening test of primary hyperaldosteronism in hypertension:
answer: serum rennin activity level

67. male patient had problem at work. Now he complains of back pain. Physical exam shows no pathological finding but he obsessed with it. Diagnosis?
Answer: malingering

68. patient with deceitfulness, impulsivity and lack of remorse. Diagnosis?
a) antisocial PD
b) borderline PD

69. boy fell from a tree, presented with abdominal pain and hematuria. U will do:
a) renal scan
b) CT
note: there were no option like ‘IVP’ so I chose CT

70. central tendency: mean systolic pressure: 115mmHg with standard deviation of 15mmHg, ask 95% of the population will have SP of:
Answer: 85-145mmHg

71. incidence of a disease in the exposure group is 137, in the non-exposure group is 8, ask 137/8 is called:
Answer: relative risk

72. decreased mortality rate of stroke is due to:
a) better control of blood pressure
b) regular use of aspirin
c) improvement of surgery process

73. patient treated with amoxicillin for 10 days developed diarrhea, how to confirm your diagnosis?
a) stool culture for clostridium dificile
b) coloscopy
c) test of clostridium dificile toxin

74. newborn needs:
a) 75 kcal/kg/day
b) 115 kcal/kg/day
c) 200 kcal/kg/day
answer: b

75. female with adenomyosis is likely to present with
Answer: bulky uterus

76. scenario of angle closure glaucoma, your first management:
a) miotic eye drop
b) mydriatic eye drop
Answer: a

77. 75 years old man presented with bilateral loss of vision, he gave history of herpes zoster. What is the most likely cause of his visual loss
a) bilateral corneal opacity due to herpes zoster
b) macular degeneration
c) glaucoma
Answer: b

78. post trauma, which of the following signs enforces you to admit the patient?
a) corneal abrasion
b) conjunctival tear
c) soft eye
answer: c

79. shock baby syndrome
answer: you may find intraocular hemorrhage

80. picture shown clubbing fingers, which is NOT the cause?
a) lung cancer
b) chronic bronchitis
c) infective endocarditis

81. child with 2 years history of tourette’s syndrome, now developed obsessive compulsive disorder, what would your give?
a) haloperidol
b) fluvoxamine

82. which cancer can caused by vinyl chloride?
Answer: liver CA

83. which one is not a symptom of lead poisoning?
Answer: liver cirrosis

84. which of the following trauma must be treated first?
Answer: pneumathorax

85. picture of female newborn shown vaginal bleeding, management?
Answer: reassurance

86. patient with anxiety, dysphoria, muscle pain, accasionally convulsion, these are the withdrawal symptoms of which of the followings?
a) benzodiazepine
b) cocain
c) cannabis

87. the difference between male and female sexuality is:
Answer: female has shorter refractory period

88. most common source of silicosis exposure is:
Answer: sandblasting

89. 12 months infant only with breast feeding till now is most on risk of what deficiency?
a) vitamin D
b) iron
c) folic acid

90. child with knee pain, swelling and redness of the knee joint, management?
Answer: knee aspiration

91. Down’s syndrome is associated with the followings except:
Answer: rocker bottom foot

92. patient had barbecue, developed muscle pain, diarrhea, eosinophelia. Best investigation to confirm the diagnosis?
Answer: muscle biopsy

93. scenario of vaginal candidiasis and groin skin candidiasis, the patient probably has:
Answer: DM

94. patient presented with inability to dorsiflex the foot and loss of sensation over the dorsum of the foot, diagnosis?
a) peripheral neuropathy
b) disc compression
Answer: b

95. conversion disorder, all are true except:
a) la belle indifference
b) unconsciousness of the symptoms
c) defence mechanism of projection and intellectualization

96. female vaginal lubrication during sexual excitement period is due to secretion of:
a) cervical glands
b) vaginal glands
c) vaginal transudat

Some Important topics from where maximum questions came in MCCEE May 2005:

2008-08-21T09:32:00.000-04:00

1. Gynaecology: cervical cancer, Pap smear, endometrial cancer, menopause etc.
2. Obstetrics: placenta praevia, ectopic pregnancy, PID, abortions, complications at delivery, eclampsia, pre-eclampsia etc.
3. Paediatrics: Don’t leave anything. Study everything, esp. child psychology.
4. Psychiatry: Read whole of Psychiatry very thoroughly esp. the Personality disorders, childhood disorders.
5. Social Medicine & ethics: read " doing right" by Philip c. Hebert very thoroughly. A lot of questions were covered from PSM & ethics.

Some remembered topics of questions:

1. Diabetic foot
2. Treatment of bacterial infection of SKIN.
3. Patient had AIDS. He died of pneumonia. What will u write as the cause of his death in the death certificate?
4. Side effects of SSRIs?
5. Treatment of ADHD?
6. Source of Vit.D?
7. Pre-eclampsia
8. Prevalence & incidence of disease.
9. Positive predictive value of disease.
10. Pedigree of autosomal dominant disease.
11. Huntington’s chorea- AD, AR?
12. Schizophrenia
13. Alcohol abuse.
14. Toddler’s diarrhoea
15. Alcoholic dementia.
16. Crohn’s disease vs. ulcerative colitis
17. When can behavioural psychotherapy be started?
18. Ectopic pregnancy
19. OCPs
20. Endometrial carcinoma
21. Menopause
22. Cancer of cervix
23. Relationship problems- husband wife. (Counselling question)
24. Duties of a psychiatrist towards his patient
25. Some questions on accident & trauma.
26. Universal antidotes
27. Burns in children
28. Twin pregnancy-one in breach other in transverse lie. How to proceed with delivery?
29. Ethics: pt. has terminal stage of cancer. Should we discuss his condition with him or his relatives only?
30. pt. has terminal illness & is in hospital. Death is near. He acquires pneumonia in hospital. Should he be treated for pneumonia or not since he has to die anyways.
31. Elderly abuse
32. Child abuse
33. Acoustic neuroma
34. Pneumothorax

Medical Ethics/ 5 Questions

2008-08-18T16:10:00.000-04:00

1- In the ER you are planning to do a new trial of a new treatment on patients with retrosternal chest pain. Which of the following is true
a) Such studies should not be done on emergency patient as they need immediate management b) Take consent only from patient if capable.
c) Take consent from patient if capable or from SDM if not.

2- A lady for laparoscopic tubal ligation on the way to theater asking you for removal of a mole on her forearm while she is under GA. She is already on premedication. What you will tell her?
a) You cannot do the procedure, as consent should be taken before coming to theatre before giving premedication.
b) Agree to do the procedure

3- A 35- year old male, one of your patients’s for four years, has contacted you and asked you to sign a form for him that he was sick last week. He has to present the form to his employer and mention that during this time he had flu and it was not severe enough to make him come to you and he did not want to abuse the health system. You believe your patient. what will be your action?
A. Tell him that this is illegal and you can not sign the form
B. Sign the form but indicate that you did not see the patient
C. Sign the form because you know your patient very well
D. Call his employer and explain what was the situation

4- A 58-year old patient was admitted to the hospital for appendicectomy. During the surgery his condition deteriorated and he passed into coma. You started tube feeding. The patient has no family member or friends around and no advanced directive. When can you stop the tube feeding?
A. You can not stop it except by the court order
B. You stop it according to the need of his bed for another patient
C. appoint legal guardian to take decision
D. You can stop it according to the opinion of another physician
E. You consult CEO of the hospital to take a legal action.

5- 40-year old patient of yours comes to you and tells you that he is separated from his wife and his wife filed a case that he is sexually abusing their child. He was found guilty and was in jail and just released. He said he has got gun and immediately after leaving the hospital he is going to their house to shoot his wife , he knows the time when his wife is coming back from office What will you do?
A. Inform the police
B. Inform the wife
C. You don’t have to breech the confidentiality of your patient
D. persuade him not to kill his wife
E. asks him to give the gun to you.

Common 10 Questions for Family Medicine for QE1 exam

2008-08-14T15:06:00.000-04:00

1. Which one of the following statements about antithyroid drug therapy is correct?

A. Methimazole (Tapazole) should not be given with a beta blocker.
B. The medication of choice for patients who are pregnant is methimazole.
C. The most serious complication of antithyroid drug therapy is agranulocytosis.
D. Relapse is more common in nonsmokers.

2. Which one of the following is the best modality for initially evaluating patients with suspected gallstones?

A. Magnetic resonance imaging.
B. Cholecystography.
C. Plain radiography.
D. Ultrasonography.
E. Computerized axial tomography.

3. The highest cure rates for cutaneous warts are achieved when cryotherapy is administered at which one of the following time intervals?

A. Seven to 10 days.
B. Two to three weeks.
C. Four to five weeks.
D. Seven to eight weeks.

4. A patient with hepatitis C virus (HCV) infection presents with a detectable RNA viral load higher than 50 copies per mL and portal fibrosis and necrosis on liver biopsy. Which one of the following is the recommended treatment?

A. Pegylated interferon (PEG-Intron) plus ribavirin (Rebetol).
B. Ribavirin alone.
C. Pegylated interferon alone.
D. Interferon alfa-2a recombinant plus ribavirin.
E. Interferon alfa-2a recombinant alone.

6. A 24-year-old man has stabbing tendon pain during increased activity. Which one of the following factors points to a diagnosis of tendinosus rather than tendonitis?

A. The initial pain should resolve in three days.
B. The likelihood of a full recovery is greater than 95 percent.
C. Surgical excision of abnormal tendon tissue is effective if conservative treatment fails.
D. A and C is correct
E. The focus of conservative therapy is anti-inflammatory agents.

7. A Wood's light examination can help identify which of the following?

A. Erythrasma.
B. Candida species.
C. Pseudomonas infection.
D. Group A beta-hemolytic streptococcus.
E. A and C is correct
f. all of the above

8. A 67-year-old woman presents with a list of herbal therapies she has been using for her hot flashes. She states that she does not believe in taking prescription medicines but wants guidance about which herbal therapies are safe and effective. Which one of the following is the best herbal therapy option for hot flashes based on current evidence?

A. Black cohosh.
B. Ginseng.
C. Dong quai.
D. Evening primrose oil.

9. Which one of the following is the most accurate noninvasive screening method for peripheral arterial disease (PAD)?

A. Palpation of peripheral pulses.
B. Validated PAD questionnaire.
C. History taking.
D. Ankle-brachial index.
E. History taking and physical examination combined.

10. Which one of the following findings suggests a diagnosis of functional constipation?

A. Fecal soiling.
B. Absence of pain with defecation.
C. Soft, small-caliber stools.
D. Abnormal anal sphincter tone.

MCCEE Practice Questions/ sections 1, 2,3 & 4

2008-08-14T11:29:00.000-04:00

Question: 1

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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A Hundred Questions in Obstetrics + some NOTEs

2008-08-14T09:57:00.000-04:00

1). Ovulation occurs:

a 15 days after menstruation
b 7 days after menstruation
c 14 days before menstruation*
d 20 days after menstruation
e 10 days before menstruation …………………………………………………………………………………………………………………

2). How many times a year will a healthy 25 year old woman ovulate?

a 5 to 7 times
b 9 to 11 times
c 13 to 14 times*
d 15 to 20 times
…………………………………………………………………………………………………………………
3). Ovulation is best proved by:

a). Laparoscopy
b). Endometrial biopsy*
c). Basal body temperature
d). Vaginal epithelial cell histology …………………………………………………………………………………………………………………

4). Monophasic body temperature is seen in:

a pregnancy only
b ovulatory cycle only
c anovulatory cycle only*
d both pregnancy/ovulatory cycle e both pregnancy/anovulatory cycle …………………………………………………………………………………………………………………

5). Mittelschmerz is pain associated with:

a vomiting
b ovulation*
c defecation
d sexual intercourse …………………………………………………………………………………………………………………

6). The increase of the basal body temperature in menstrual cycle is due to:

a hCG
b FSH
c androgen
d estrogen e progesterone* …………………………………………………………………………………………………………………

7). The time between fertilization (occurs in the tubal ampulla) and implantation of the embryo is:

a 4 days
b 7 days*
c 10 days
d 14 days e 31 days …………………………………………………………………………………………………………………

8). A normal pregnancy is defined to last from:

a). 36 to 44 weeks
b). 36 to 42 weeks
c). 38 to 42 weeks*
d). 38 to 46 weeks
………………………………………………………………………………………………………….……..

9). A woman with strong desire for pregnancy falsely believes she is pregnant, this is called:

a pseudocyesis*
b factitious disorder
c dissociative disorder
d somatoform disorder
..........................................................................................................

10). Which of the following is the first indication of pregnancy?

a). Skin pigmentations
b). Nausea and vomiting
c). Increase in breast size
d). Missed menstrual period*
………………………………………………………………………………………………………………....

11). During the first trimester of pregnancy the source of elevated both estrogen and progesterone is:

a placenta
b fetal liver
c corpus luteum*
d maternal ovaries
e Fetal adrenal gland
..........................................................................................................

12). Placenta produces:
a human chorionic gonadotropin (hCG)
b human chorionic thyrotropin (hCT)
c human chorionic adrenochorticotropine (hACT)
d human placental lactogen (hPL)
e all of the above*
..........................................................................................................

13). Placenta produces:

a relaxin
b prolactin
c prostaglandins
d estrogen and progesterone
e all of the above*
..........................................................................................................

14). Placenta can be best localized by:

a pelvic X ray
b radioisotopic scan
c physical examination
d colposcopy
e ultrasound*

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15). Which of the following immunoglobulins crosses the placenta and provides immunity for the newborn?
a IgG*
b IgA
c IgM
d IgD
e IgE

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16). Nullipara is a woman who:

a has just given birth
b had never been pregnant
c had two or more miscarriages
d has never completed a pregnancy to term*
e has never completed two or more pregnancies to term

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17).A woman who has been pregnant only once giving birth to a set of twins is called:

a puerpera
b nulligravida
c primipara*
d nullipara
e multipara

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18). A woman who has never completed a pregnancy to term is called:

a primigravida
b nulligravida
c primipara d nullipara***
e multipara

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Trimesters

• T1 (First trimester)à 0 to 12 weeks
• T2 (Second trimesters)à 28to 40 weeks
• T3 (Third trimesterà 28 to 40 weeks ………………………………………………………………………………………………………………..

Gestational Age (GA) & Size Classification by gestational age (GA)

• Pre-termà<37>
• Termà 37 to 42 weeks
• Post-termà >42 weeks

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Classification by birth weight
• Small for gestational age (SGA)à 2SD <>
• Accurate for gestational age (AGA)à with 2SD of mean weight for GA
• Large for gestational age (LGA)à 2SD>mean weight for GA or > 90th percentile Methods of determining postnatal GA Assessment at delivery of physical maturity (eg, planter creases, lanugo, ear maturation) and neuromuscular maturity (eg, posture, arm recoil)

..........................................................................................................

GTPAL format
1. Gravidity (G) • Total number of pregnancies of any gestation These include recurrent pregnancy, abortion, ectopic pregnancy and hydatiform mole (twins = one pregnancy).
2. Parity (TPAL) • Tà number of term infants delivered (>37 weeks)

• Pà number of premature infants delivered (20-37 weeks)
• Aà number of abortions (loss of intrauterine pregnancy prior to viability of fetus <20>
• Là number of living children ………………………………………………………………………………………………………………...

19). A woman has an obstetric history of 5-1-2-3, how many abortions she had?
a 5
b 1
c 2*
d 3

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20). A woman has an obstetric history of 5-1-2-3, how many premature deliveries she had?

a 5
b 1*
c 2
d 3

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21). 30 yr old Primigravida, at term with twin pregnancy
a). Gravida1 para2
b). G2 P2
c). G 1 *
d). G2 P1
………………………………………………………………………………………………………………....

22). A woman who has visible triplet in her first pregnancy is described as:

a). Gravida 1 and para 0
b). Gravida 1 and para 1*
c). Gravida 1 and para 3
d). Gravida 3 and para 1 ………………………………………………………………………………………………………………....

23). You are taking a history from a 24-year-old mother of three who is currently 10 weeks pregnant and has had one previous abortion and one previous twin gestation. Which one of the following is her gravidity and parity?

1) gravida 4, para 1
2) gravida 4, para 2*
3) gravida 3, para 2
4) gravida 2, para 2
5) gravida 3, para 1 ………………………………………………………………………………………………………………....

24). In an obstetric history of G5P6789, digit 5 stands for the number of:
a). Abortions
b). Pregnancies*
c). Living children
d). Term pregnancies ………………………………………………………………………………………………………………....

25). In an obstetric history of G5P6789, digit 6 stands for the number of:
a). Abortions
b). Pregnancies
c). Living children
d). Term pregnancies* ………………………………………………………………………………………………………………....
26). In an obstetric history of G5P6789, digit 7 stands for the number of:
a). Abortions
b). Pregnancies
c). Living children
d). Preterm pregnancies*
………………………………………………………………………………………………………………....
27). In an obstetric history G5P6789, digit 8 stands for:

a). Abortions*
b). Pregnancies
c). Live children
d). Term pregnancies ………………………………………………………………………………………………………………....

28). In an obstetric history of G5P6789, digit 9 stands for the number of:

a). Abortions
b). Pregnancies
c). Living children*
d). Preterm pregnancies

..........................................................................................................

29). Chadwick’s, Goodell’s and Hegar’s signs are associated with:

a). Puberty
b). Pregnancy*
c). Pancreatic carcinoma
d). Hypertrophic pyloric stenosis …………………………………………………………………………………………………………………

30). A 4 weeks of pregnancy, cyanosis, and softening of the cervix is due to increased vascularity of the cervical tissue, this is known as:

a). Ladin’s sign
b). Hegar’s sign
c). Goodell’s sign*
d). Von Fernwald’s sign …………………………………………………………………………………………………………………

31). Chadwick’s sign refers to:
a). Vulvar swelling
b). Increased vaginal secretion
c). Softening of the cervix
d). Bluish discoloration of the vagina* …………………………………………………………………………………………………………………

32). Softening of the cervical isthmus in early pregnancy is called:

a). Cullin’s sign
b). Hegar’s sign*
c). Hoover’s sign
d). Chadwick’s sign
........................................................................................................................................................
1. Goodell’s signà softening of the cervix (4-6 weeks)
2. Chadwick’s signà bluish discoloration (cyanosis) of the cervix and vagina due to pelvic vasculature engorgement (6 weeks)
3. Hegar’s signà softening of the cervical isthmus(cervicouterine junction) 6-8 weeks ………………………………………………………………………………………………………………..

33). At 6 weeks of pregnancy, the uterus softens in the anterior midline along the uterocervical junction, this is known as:

a). Ladin’s sign*
b). Hegar’s sign
c). McDonald’s sign
d). Von Fernwald’s sign ………………………………………………………………………………………………………………..

34). A 7-8 weeks of pregnancy, the uterus becomes flexible at the uterocervical junction, this is known as:
a). Ladin’s sign
b). Hegar’s sign
c). McDonald’s sign*
d). Von Fernwald’s sign ………………………………………………………………………………………………………………..

35). At 4-5 weeks of pregnancy, an irregular softening of the uterine fundus develops over the site of implantation, this is known as:

a). Ladin’s sign b).
Hegar’s sign
c). McDonald’s sign
d). Von Fernwald’s sign* ………………………………………………………………………………………………………………..

36). Adler sign is associated with:
a). Adrenal tumor
b). Ectopic pregnancy*
c). Testicular torsion
d). Polycystic kidney disease ………………………………………………………………………………………………………………..

37). Adler sign (fixed abdominal tenderness on turning the patient) is associated with:
a). Peptic ulcer
b). Ectopic pregnancy*
c). Testicular torsion
d). Chronic pancreatitis ………………………………………………………………………………………………………………..

38). In the absence of intra-abdominal abscess the X-ray shows sternocondral widening, this is called:
a). Cullin’s signs
b). Hegar’s sign
c). Hoover’s sign*
d). Chadwick sign …………………………………………………………………………………………………………………

39). The upper pole (fundus) of the uterus is palpable at the level of the umbilicus at:
a 4 weeks of pregnancy
b 8 weeks of pregnancy
c 20 weeks of pregnancy*
d 28 weeks of pregnancy
e 36 weeks of pregnancy
..........................................................................................................................................
SFH uterine fundus at pubic symphysisà1. 12 weeks
Fundus is atà2. 20 weeks umbilicus
• SFH should be within 2 cm of GA between 20 and 37 weeks 3.
Fundus at sternum.à27 weeks ………………………………………………………………………………………………………………..

40). A lady with 6 months of amenorrhea, pregnancy test positive. She felt fetal movements 2 months back. PE- fundal height is 27 cm. What the approximate gestational age?

................................................................................................................................................
27 weeksàType one answer After 20 wks gestational age in weeks corresponds to centimeters e.g, 27 cm = 27 weeks

........................................................................................

Differential diagnosis of pregnancy

1. Non-pregnant uterus enlarged by myomas can be confused with "the gravid uterus but it is usually very firm and irregular
2. Ovarian tumor may be found midline, displacing the nonpregnant uterus to side or posteriorly. ………………………………………………………………………………………………………………..

41). β-hCG is positive in serum:
a). 1 day postconception
b). 7 day postconception
c). 8 day postconception
d). 9 day postconception*
e). none of the above ………………………………………………………………………………………………………………..
42). β-hCG is positive in urine:

a). 1 day postconception
b). 7 day postconception
c). 8 day postconception
d). 9 day postconception
e). 28 days after last menstrual period (LMP)*

.........................................................................

• Produced by placental trophoblastic cells • Maintains the corpus luteum during pregnancy ………………………………………………………………………………………………………………..

43). In the first 100 days of pregnancy, human chorionic gonadotropin titre doubles:

a. every day
b. every week
c. every 2 days*
d. every month
e. every 2 weeks

................................................................................

• Double every 48 hours (after every 2 days)

..........................................................................................................

44). Level of hCG is highest during:
a). 12 weeks gestation*
b). 22 weeks gestation
c). 25 weeks gestation
d). 28 weeks gestation

.............................................................................................

• 10th wk= 100,000 IUàReach a peak at 50-75 days
• Fall to lower levels in the second and third trimesters β-hCG

..................................................................................................

rule of 10s
1. 10 IU at time of missed menses
2. 100,000 IU at 10 weeks (peak)
3. 10,000 IU at term …………………………………………………………………………………………………………….…..

45). Pregnancy test is positive from the first day of missed period until:

a 2 weeks of pregnancy
b 20 weeks of pregnancy*
c 37 weeks of pregnancy
d the end of pregnancy e 20 weeks after delivery

...............................................................................................................................................................

46). Pregnancy test can be positive in:
a ectopic pregnancy
b trophoblastic disease
c spontaneous abortion
d all of the above*
..................................................................................................................................................................

47). Urinary pregnancy tests are positive in ectopic pregnancy in about:
a 30%
b 50%
c 70%
d 90%
e 100%*

..........................................................................................................

48). Increased human chorionic gonadotropin (hCG) after pregnancy may suggest the diagnosis of:
a carcinoma of the cervix
b uterine choriocarcinoma/hydatidiform mole*
c carcinoma of the uterine corpus
d granulosa cell tumor of the ovary
e anencephalic pregnancy

...................................................................................................................................................................

48). hCG/estriol levels are decreased in:

a). Normal pregnancy
b). Hydatiform mole
c). Fetal death in utero*
d). Testicular mixed germ cell tumor

.......................................................................

Levels below expected by dates suggest
1. Ectopic pregnancy
2. Abortion
3. Wrong dates

………………………………………………………………………………………………………………...................................
49). hCG is NOT increased in association with:

a). Seminoma
b). Hydatiform mole
c). Fetal death in the uterus*
d). Nonseminomatous testicular carcinoma

.....................................................................

Levels higher than expected suggest:
1. Multiple gestations
2. Molar pregnancy
3. Trisomy 21 4. Wrong dates

………………………………………………………………………………………………………………..

50). Elevation of either AFP or hCG is found in 80 to 90 percent of patients with:

a hepatoma
b nonHodgkin's lymphoma
c gastric and colon cancer
d nonseminomatous germ cell testicular tumors*

..........................................................................................................

51). Hydatidiform mole is NOT associated with:
a). snowstorm appearance on ultrasound scan
b). Increased hCG and positive pregnancy test
c). Increased hCS (human chorionic somatomammotropin)*
d). Vaginal bleeding and first trimester preeclampsia ………………………………………………………………………………………………………...……….

52). After the delivery of hydatidiform mole, the woman should have repeated:

a chest X rays
b dilatation/curettage
c hCG titers*
d uterine biopsies
e ultrasound

..........................................................................................................

53). The serum levels of which of the following should be tested in suspected testicular carcinoma?
a). Creatinine
b). IgA and IgM
c). Alkaline phosphatase
d). Alpha-fetoprotein and hCG*

………………………………………………………………………………………………………………..

54). Testicular tumor is associated with:

a). hCG
b). AFP
c). LDH
d). Al of the above ………………………………………………………………………………………………………………..

55). Tumor markers for testicular tumor include all of the following EXCEPT?

a). AFP
b). LDH
c). AST*
d). hCG
………………………………………………………………………………………………………………..

56). The incidence of elevated serum hCG is lowest in which of the testicular tumors?

a). Embryonal
b). Seminoma*
c). Choriocarcinoma
d). Teratocarcinoma ………………………………………………………………………………………………………………..

57). Fetal mortality rate refers to:

a). Fetal deaths per 1,000 total births
b). Fetal deaths per 5,000 total births
c). Fetal deaths per 10,000 live births
d). Fetal deaths in the third trimester of pregnancy* …………………………………………………………………………………………………………..……..

58). In normal pregnancy, fetal movements (quickening) starts:

a). Between 16 and 18 weeks*
b). Between 20 and 28 weeks
c). Between 26 and 38 weeks
d). Between 28 and 40 weeks

....................................................................

"Quickening" (perception of first movement noted at about the 18th week) ……………………………………………………………………………………………………………….. .........................

59). Starting at what month of pregnancy the mother feels fetal movements (quickening)?

a). Third month
b). Fourth month*
c). Fifth month
d). Sixth month

.........................................................................

• First noticed by
18-20 weeks (primigravidas),
14-16 wks (multigravida)
………………………………………………………………………………………………………………..

60). Starting at what month of pregnancy the fetal heartbeat can be heard with stethoscope?

a). Third month
b). Fourth month
c). Fifth month*
d). Sixth month

........................................................................................................

Fetal' heart tones can be heard by
• Doppler at 10-12 weeks of gestation
• Ordinary fetoscope at 10-12 weeks
Transvaginal U/S • 5 weeksà gestational sac visible (β-hCG = 100-1500 mIU/mL)
• 6 weeksàFetal pole scan
• 7-8 weeksà Fetal heart tone visible Transabdominal U/S
• 6-8 weeksà intrauterine pregnancy visible (β-hCG = 6,500 mIU/mL) ………………………………………………………………………………………………………………..

61). Starting at what month of pregnancy the fetal lungs are capable of breathing air?

a). Fifth month
b). Sixth month
c). Seventh month*
d). Eighth month

………………………………………………………………………………………………………………..

62). Regarding fetal development, lungs are capable of breathing air at:

a). 10th week of pregnancy
b). 14th week of pregnancy
c). 20th week of pregnancy
d). 25th week of pregnancy*

………………………………………………………………………………………………………….……...
63). Organogenesis occurs in

a). 1-3 weeks
b). 3-8 weeks*
c). 8-12 weeks
d). 12-15 weeks

.........................................................................

• 3-8 weeks GA is a critical period of organogenesis, so early preparation is vital. ………………………………………………………………………………………………………….……...

64). Starting at what month of pregnancy the fetal uterus forms?

a). Third month
b). Fourth month
c). Fifth month*
d). Sixth month

……………………………………………………………………………………………………………..…..

65). Starting at what month of pregnancy the fetal testes forms?

a). Third month
b). Fourth month
c). Fifth month*
d). Sixth month

…………………………………………………………………………………………………………………

66). Initial work up of Gynecomastia include all of the following EXCEPT

a). Mammography*
b). Serum hCG
c). Serum estrogen
d). Medication history ………………………………………………………………………………………………………………..

67). A woman with strong desire for pregnancy falsely believes she is pregnant, this is called:

a pseudocyesis*
b factitious disorder
c dissociative disorder
d somatoform disorder

..........................................................................................................

68). All are diagnosed by pelvic US antenatally except

a). Down*
b). hydrocephalus
c). hypoplastic left ventricle

..........................................................................................................

69). The average increase of cardiac output in a normal pregnancy is:

a 5%
b 10%
c 20%
d 40%*
e 70%

………………………………………………………………………………………………………………....

70). The BP measurement used to define hypertension during pregnancy is:

a). 80/150 mmHg
b). 90/140 mmHg*
c). 95/160 mmHg
d). 100/170 mmHg ………………………………………………………………………………………………………………....

71). ECG changes during pregnancy include all of the following, EXCEPT:

a). Inferior Q waves
b). Left axis deviation
c). Nonspecific ST-T wave changes
d). Prolonged PR and prolonged QT intervals*

………………………………………………………………………………………………………………....

72). Which of the following disorder is most likely to occur in women in their first trimester of pregnancy?

a). Tennis elbow
b). Trigger finger
c). Frozen shoulder
d). Carpal tunnel syndrome*

..............................................................

During pregnancy there is ↑ incidence of carpal tunnel syndrome and Bell’s palsy ………………………………………………………………………………………………………………....

73). Causes of melasma (chloasma) include:

a). Pregnancy
b). Birth control pills (OCP)
c). Both*
d). Neither

....................................................

Skin changes during pregnancy there are:
1. ↑ Pigmentation of perineum and areola,
2. Chloasma (pigmentation changes under eyes and on bridge of nose)
3. Linea nigra ( midline abdominal pigmentation)
4. Other • Spider angioma • Palmar erythema • Stria gravidarum
………………………………………………………………………………………………………………....

74). Which could be the causes of hyperamelasemia in a 16 year old girl?

a). Ovarian cyst
b). Normal pregnancy
c). Ruptured ectopic pregnancy
d). All of the above*

………………………………………………………………………………………………………………....

75). Pruritus is LEAST likely to be associated with:

a). Pregnancy
b). Acne vulgaris*
c). Hyperthyroidism
d). Carcinoid syndrome
e). Pregnancy

………………………………………………………………………………………………………………....

76). Which of the following is unchanged during pregnancy?

a). Vital capacity*
b). Residual volume
c). Inspiratory capacity
d). Expiratory capacity
..........................................................

Respiratory changes during pregnancy include:
1. ↑ O2 requirement,
elevated diaphragm,
↑ CO2 sensitivity due to progesterone constant VC
2. ↓ in TLC, FRC and RV with an ↑ in minute ventilation ………………………………………………………………………………………………………………....

77). Which of the following is decreased during pregnancy?

a). Cardiac output
b). Urinary frequency
c). Gastrointestinal motility*
d). Gastroesophageal reflux
..............................................................................................
1. GERD = ↑ intra-abdominal pressure + progesterone (↑ sphincter tone and delayed gastric emptying)

2. Progesterone ↑ gallstones (↑ gallbladder stasis), constipation + hemorrhoids (↓ GI motility)

3. Upward displacement of appendix (atypical appendicitis presentation) ………………………………………………………………………………………………………………....

78). Which of the following is increased during pregnancy?

a). Renal blood flow
b). GFR
c). Renin, angiotensin 1 and 11
d). All of the above*

...........................................................................

Genitourinary changes during pregnancy include:
1. ↑ urinary frequency
2. ↑ incidence of UTI and pyelonephritis
3. Glycosuriaà can be physiologic, must test for GDM
4. Uterus and renal pelvis dilation (R>L) due to progesterone-induced smooth muscle relaxation and uterine enlargement

………………………………………………………………………………………………………………....

79). What is the most common cerebral neoplasm during pregnancy?

a). Glioma*
b). Meningioma
c). Neurofibroma
d). Pituitary adenoma ………………………………………………………………………………………………………………....

80). Sex hormone binding globulin (SHBG) is NOT decreased in:

a). Obesity
b). Acromegaly
c). Corticosteroid therapy
d). Pregnancy and hyperthyroidism*

.......................................................................

Thyroid changes during pregnancy include
1. Moderate enlargement and increased basal metabolic rate
2. ↑ total thyroxine & TBG (thyroxine binding globulin)
3. Free thyroxine index and TSH levels are normal

Adrenal changes during pregnancy include
• Maternal cortisol rises throughout pregnancy (total and free) ………………………………………………………………………………………………………………....

81). Sex hormone binding globulin (SHBG) is increased in:

a obesity
b pregnancy*
c acromegaly
d hypothyroidism
e corticosteroid therapy ………………………………………………………………………………………………………………....

82). SHBG is decreased in:
a). cirrhosis
b). hirsutism*
c). pregnancy
d). estrogen therapy ………………………………………………………………………………………………………………....

83). Which of the following is decreased during pregnancy?

a). Serum calcium
b). Resin T4 uptake
c). Both*
d). Neither

..................................................................

Calcium changes during pregnancy include:
1. ↑ total maternal Ca due to ↓ albumin
2. Free ionized Ca (i.e active) proportion remains the same due to parathyroid hormone (PTH) which results in ↑ bone resorption and gut absorption
3. ↑ bone turnover but no loss of bone density because estrogen inhibits resorption ………………………………………………………………………………………………………………....

84). All of the following are cardiovascular adaptation to pregnancy EXCEPT:

a. cardiac output increases 33-45%
b. stroke volume increases 10-30%
c. heart rate decreases 1-18 beats per minute*
d. systolic blood pressure decreases 4-5 mmHg
e. diastolic blood pressure decreases 8-15 mmHG

...........................................................................................................................................................

85). Which of the following are decreased in pregnancy?

a. weight/heart rate/cardiac output/plasma volume
b. tidal volume/total lipids/total RBCs
c. diastolic blood pressure/functional residual volume*
d. T3/T4/thyroxine binding globulin (TBG)
e. serum cortisol/serum amylase/renal blood flow

................................................................................

Cardiovascular changes during pregnancy include:

1. Hyperdynamic circulation • ↑ CO, HR, and blood volume • ↓ BP due to↓ PVR
2. Enlarging uterus compresses IVC and pelvic veins • ↑ venous return (risk of hypotension) • ↑ venous pressure (varicose veins, hemorrhoids and leg edema)

..........................................................................................................

86). Which of the following is increased during pregnancy?
a). Renin*
b). Uric acid
c). Creatinine
d). All of the above ………………………………………………………………………………………………………………....

87). Hematocrit is decreased in:

a). Pregnancy*
b). dehydration
c). High altitude
d). Polycythemia ………………………………………………………………………………………………………………....

88). Pregnancy is associated with increased:

a). Hemoglobin
b). BP
c). WBCs*
d). None of the above

...............................................................................

Hematologic changes during pregnancy include:

1. Hemodilutionà apparent↑ in hemoglobin and hematocrit The rise in plasma volume is greater than red cell mass with relative hemodilution.

2. ↑ leukocyte count but impaired function- improvement in autoimmune disease

3. Gestational thrombocytopeniaà mild (platelets > 70,000/µL) and asymptomatic, normalizes within 2-12 weeks following delivery

4. Hypercoagulable stateà↑ risk of DVT and PE ………………………………………………………………………………………………………………....

89). All of the following may be observed in a normal pregnancy except?

a). Fall in serum iron concentration falls.
b). Increase in serum iron building capacity.
c). Increase in blood viscosity increases.*
d). Increase in blood oxygen carrying capacity. ..........................................................................................................

90). Decreased Hematocrit (hemoglobin) is associated:

a). Heart stroke
b). Cigarette smoking
c). Severe hypothermia
d). Normal or ectopic pregnancy*

………………………………………………………………………………………………………………....

91). Which of the following increases during pregnancy?

a). Hematocrit
b). Hemoglobin
c. Plasma volume* ………………………………………………………………………………………………………………....

92). Decreased vitamin B12 is seen in:

a). Leukemia
b). Pregnancy*
c). Both
d). Neither

………………………………………………………………………………………………………………....

93). Circulatory system changes at birth include the closer of:

a. Ductus arteriosus and ductus venosus
b. Umbilical arteries
c. Umbilical veins
d. Foramen ovale
e. All of the above*

..........................................................................................................

94). During pregnancy:

a. RBF is decreased
b. GFR is decreased
c. Kidney size is decreased
d. Serum creatinine and urea are decreased*
e. Renal pelvis and ureters are constricted

..........................................................................................................

95). During pregnancy, blood flow to which of the following organs is NOT increased?

a. Skin
b. Brain*
c. Breast
d. Kidney

..........................................................................................................

96). Which of the following is decreased during pregnancy?

a. Renin
b. Fibrinogen
c Albumin*
d. Prolactin
e. Cholesterol

.........................................................................................................

97). Which of the following is increased during pregnancy?
a Bicarbonate
b Urea
c Uric acid
d Alkaline phosphatase*
e Creatinine

..........................................................................................................

98) Following are increased in pregnancy, EXCEPT:

a alkaline phosphatase
b cholesterol
c bilirubin*
d fibrinogen
e white blood cells

..........................................................................................................

99). Pregnant women with positive Phalen's test are most likely to have:

a eclampsia
b preeclampsia
c abruptio placentae
d carpal tunnel syndrome*

..........................................................................................................

100). Pregnancy is associated with low levels of plasma:

a. renin
b. aldosterone *
c. both
d. neither

*******************************************

*******************************

********************

************

********

*****

Some practice questions for QE1

2008-08-14T09:14:00.000-04:00

Please answer questions 1-3 based on information from the following vignette.

Mr. John Wong, a 34-year-old restaurant owner, visits his family physician’s office for a routine check-up. On repeated testing his blood pressure is elevated at 180/105 mmHg. He admits to stress at work and states that his father was diagnosed as hypertensive at the age of 60 but, thus far, has not required treatment. He has no symptoms with the exception of mild constipation for which he takes bran supplements. He is on no prescribed medication although he does admit to occasionally taking Chinese herbal remedies. He denies taking any other medications. He smokes 25 cigarettes per day but takes no alcohol. On physical examination he is not obese, has no signs of cardiovascular disease, and no hypertensive retinopathy. The results of investigations are given below: Urine analysis negative Na 146 mmol/L K 2.8 mmol/L Cl 102 mmol/L HCO3 33 mmol/L Urea 4.2 mmol/L Creatinine 92 mmol/L Glucose 6.2 mmol/L 1. What is the most likely explanation for hypokalemia

A. increased urinary losses of potassium
B. reduced dietary intake
C. surreptitious laxative abuse
D. metabolic alkalosis
E. chinese herb nephropathy

2.Which of the following investigations is/are indicated?

a. dietary intake assessment
b. captopril renal isotope scan
c. urine metanephrines
d. plasma Renin Activity
e. 24 hour urine collection for aldosterone estimation

3. Which of the following is/are appropriate step(s) in management?

a) Arrange for the patient to go to the nearest ER
b) 5 mmol of Potassium Chloride intravenously
c) Refer the patient for further investigation
d) Oral Potassium supplements
e) Thiazide diuretic for treatment of hypertension

*****

Please answer questions 4 – 6 based on information from the following vignette.

Primary hypertension is almost always the most likely diagnosis for patients with hypertension. For each patient in questions 1-3 select the SECONDARY CAUSE of hypertension worthy of investigation from choices A-N. If No secondary cause is worthy of investigation, SELECT CHOICE “O”. Choices A-O may be used once, more than once or not at all.
A. Acute renal failure
B. Birth control pills
C. Chronic renal failure
D. Coarctation of the aorta
E. Licorice ingestion
F. Pheochromocytoma
G. Polycythemia
H. Primary hyperaldosterone (mineralocorticoid excess)
I. Renal artery stenosis, bilateral
J. Renal artery stenosis, unilateral
K. Renal parenchymal disease
L. Sympathomimetics (e.g. ephedrine for nasal congestion)
M. Transplant donor
N. White coat hypertension
O. None of the above

4. Mr. Harry Conroy, a 52-year-old newspaper assistant editor, is seen in the office of his family physician complaining of blood in the urine over the past four days. He states that he has had this on two previous occasions, both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared spontaneously over a period of five to seven days. At the time of the present visit he states that he has been feeling lethargic with a sore throat for the past five days. He is a vegetarian and smokes a pack of cigarettes each day. Blood pressure is 170/95 mmHg in both arms, sitting and supine, on repeat testing. Urine analysis shows specific gravity 1020, nitrites negative, +++ blood and +++ protein. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red cell casts.

5. Mr. James McKeen, a 49-year-old tax assesor, visits his family physician’s office for his monthly blood pressure check. He has been hypertensive for the past four years and his blood pressure control has been erratic during this time. His only other medical problem is gout, which he experiences on average once every eighteen months. He continues to smoke two packages of cigarettes per day. He has a maternal family history of hypertension and cerebrovascular disease and a paternal family history of lung carcinoma. His present antihypertensive medications are hydrochlorothiazide and adalat XL. On physical examination he is obese with blood pressure is 174/96 mmHg. Urine analysis at his last three visits has shown a trace of protein. Urine microscopy is unremarkable. A 24 hour urine collection shows a normal creatinine clearance with excretion of 340mg of albumin during this time period. Serum liver enzymes are normal.

6. Ms. Jane Wallace, a 29-year-old interior decorator, visits his family physician’s office for a routine check-up. On repeated testing her blood pressure is elevated at 180/105 mmHg. She admits to stress at work and states that her father was diagnosed as hypertensive at the age of 60 but, thus far, has not required treatment. She has no symptoms with the exception of mild constipation for which she takes bran supplements. She is on no prescribed medication although she does admit to occasionally taking Vitamins C and E. She denies taking any other medications. She does not smoke but takes alcohol socially. On physical examination she is not obese, has no signs of cardiovascular disease, and no hypertensive retinopathy. The results of investigations are given below: Urine analysis negative Na 146 mmol/L K 2.8 mmol/L Cl 102 mmol/L HCO3 33 mmol/L Urea 4.2 mmol/L Creatinine 92 mmol/L Glucose 6.2 mmol/L

*****

Please answer questions 7 – 9 using information from the following vignette.

Mrs. Hogan brings her daughter Natascha to the emergency room. Natascha is a previously well, one-year-old girl who developed a fever two days ago. Her temperature, measured orally by her mother, was 39.8o C. For the past two days Natascha has been listless and has eaten very little other than juice and milk. She has had neither diarrhea nor vomiting. Her mother thinks she may have had a bit of a runny nose earlier in the week. Her mother has been treating her with Tylenol, and although Natascha appears flushed and ill when the fever is high, she is her usual self when the fever is down. Her mother is concerned because Natascha has had a fever once before and it was an ear infection that required antibiotics. Her mother is wondering if she needs some today. Natascha has otherwise been a healthy child and has received all her immunizations including MMR vaccine one week ago. On examination, she is sleeping in her mother’s arms during the interview. She cries during the entire exam, but is comforted after by her mother and stops crying. Her temperature is 40 degrees Celsius rectally. Her tympanic membranes are normal. Her throat is mildly erythematous, with no exudate. Her lungs are clear, respiratory rate is 30/min, and there are no extra heart sounds. Abdomen is soft. She has a diaper rash.

7. What causes of fever must you consider in this case?
a. viral infection
b. vaccine reaction
c. meningitis
d. occult bacteremia
e. urinary tract infection

8. What investigations would you undertake in this case?
a. lumbar puncture
b. urinalysis & urine culture
c. CBC and differential
d. chest X ray
e. blood cultures

9. A CBC is drawn and her WBC is 20 x 109/L, with a high neutrophil count. All other investigations are normal. How would you manage this case?

a. administer aspirin q4h
b. administer ibuprofen q6h
c. administer acetaminophen q4h
d. admit to hospital, refer to a pediatrician
e. administer Ceftriaxone im

*****

Please answer questions 10 - 13 using information from the following vignette.
Ms Angela Keating, a 38-year-old woman originally from Australia , presents with a 3-month history of fatigue and diarrhea. Over the last 4 months she has been having between 3 to 5 soft bowel movements per day. She denies constipation, blood in her stool or liquid stool. Her normal bowel routine that dates back to childhood is 1 to 3 bowel movements per day and she remembers the occasional episode of liquid stool and rarely hard, painful to pass bowel movements. She is normally very active, but recently she has had to take leave of absence from her job as a waitress at a hotel in the mountains. She states she has lost about 5 kg in the last 6 months. Her past medical history is negative except for two therapeutic abortions. About two weeks ago she finished a course of antibiotics prescribed for a Chlamydia infection. Her medications include acetaminophen 500 mg po tid prn for joint pains, the birth control pill, a multivitamin, and a topical hydrocortisone cream she uses for a an itchy skin rash that she has had for several years on her back and buttocks. Her family history is negative except that her mother has osteoporosis (age 63) and her father has panic attacks. Her physical examination revealed a thin, pale, tired looking female appearing younger than her stated age. Vital signs revealed a BP of 110/70 mmHg, HR 90/min, temperature 36.5 C. Pale conjunctiva, no oral lesions or lymphadenopathy. Her chest and cardiovascular exam was normal except for a 2/6 systolic ejection murmur at the LSB. MSK and CNS exam were normal except for leukonychia, a vesicular rash and excoriations on her buttocks. Mild hepatomegally was noted by percussion and palpation but no masses, tenderness or splenomegally were noted. Rectal exam was normal. CBC: Hgb 82 g/l, microcytic red cells and Howell Jolly bodies were noted on the peripheral smear. Her electrolytes and glucose were normal.

10. In assessing the cause of her diarrhea which of the following is/are correct;
a. If diarrhea continues with fasting it is more likely to be an osmotic diarrhea.
b. Smaller volumes of diarrhea and tenesmus are more commonly associated with small bowel diarrhea.
c. Chronic diarrhea is defined as any diarrheal episode lasting longer than 10 days.
d. Irritable bowel syndrome can be associated with the passage mucus per rectum.
e. Antibiotic associated colitis can cause chronic diarrhea.

11. Which of the following is/are consistent with the diagnosis of irritable bowel syndrome;
a. chronic alternating constipation and diarrhea
b. pain relieved by having a bowel movement
c. pain or diarrhea waking the patient from sleep
d. onset before the age of 45 years
e. a feeling of incomplete evacuation following a bowel movement.

12. Which of the following is/are a likely causes of Ms AK’s problems;

A. Ulcerative colitis
B. Antibiotic associated colitis
C. Celiac disease
D. Cystic fibrosis
E. Hemochromatosis

13. In regards to investigating the cause of Ms A.K.’s problems which of the following are true.

a. There is a reproducible and accurate blood test for the diagnosis of Crohn’s disease.
b. There is a reproducible and accurate blood test for the diagnosis of Celiac disease.
c. An upper endoscopy may aid in the diagnosis of both Celiac disease and Giardia.(0.5)
d. HIV serology should be ordered
e. A macrocytic anemia favors the diagnosis of ulcerative colitis over Crohn’s disease.

*****

Please answer questions 14 – 15 based on information from the following vignette.

Cody, a six-year-old boy presently undergoing treatment for Wilm's tumor, visits the oncology clinic regarding a sudden loss of vision in his right eye of one day's duration. He has completed his treatment protocol six months ago and has been stable until this new symptom developed. His general physical examination shows no obvious problems. His vision in the right eye is restricted to light perception only. His vision in the left eye is 20/20. Pupils are 4 mm in size each eye, pupillary reactions are sluggish right eye, but brisk with a normal consensual reaction when the light is shown to the left eye. Swinging the flashlight from left to right eye, the right pupil dilates. Swinging the flashlight from right to left eye, the left pupil constricts. Fundal examination shows a normal optic nerve, peripheral retina, within normal vessel pattern.

14. The pupillary reactions demonstrated represent:

A Horner’s Syndrome (impaired pupil dilatation)
B. Adie’s pupil (pathological pupil reaction)
C. afferent pupillary defect (Marcus-Gunn pupil)
D. normal pupillary reactions
E. anisocoria (inequality of pupils in diameter)

15. The most likely diagnosis is:
A metastasis to the right optic nerve
B. Orbital tumor
C. hemorrhage within the right optic nerve sheath
D. retinal detachment
E. Increased Intracranial Pressure

*****

16. A 64-year-old man is brought to see you by his wife because of increasing memory problems and confusion over three months. He has become gradually more listless and apathetic, with a significant change in personality. She has noted that he has had increasing difficulty with recalling recent events. One week ago, while he was driving home with her from visiting a friend, he became lost and was unable to find his way home. The patient does not complain of memory problems, but has complained of bilateral headache over the past two months, for which he has been taking acetaminophen, 1mg daily. Review of systems shows that he smokes one pack per day, and has drunk four bottles of beer every day for twenty years, although his drinking has decreased over the last two months. On examination, the patient is disoriented for time, does not recall the name of the current Prime Minister, and has difficulty subtracting 7 from 100. He shows hyperactive reflexes in his legs, and plantar responses are upgoing bilaterally. His gait is slightly unsteady and wide-based.

What is the most likely diagnosis?

A. Chronic bilateral subdural hematoma.
B. Glioma involvingboth frontal lobes.
C. Azheimer’s disease.
D. Hypothyroidism.
E. Lewey-body dementia.

********

Please answer questions 17 – 18 based on information from the following vignette.

A fourteen-year-old boy attends his family physician’s office for examination of his eyes. His mother believes something is wrong with them because he is constantly blinking. The boy is otherwise well. He was suspected to have Attention Deficit / Hyperactivity Disorder (AD/HD) in elementary school, but was never placed on stimulant medication. He currently takes no medications. He was adopted at birth, thus his family history is not known. During conversation with the boy, you note that he frequently clears his throat, yet he denies sore throat or other upper respiratory tract symptoms. He blinks frequently, yet is able to hold his eyes open during examination with an ophthalmoscope. His fundi, visual acuity, extraocular movements, visual fields, eyelids and eyelashes are normal. He also exhibits intermittent facial grimacing without apparent pain. The remainder of his examination is normal.

17. This boy’s eye movements are most consistent with which of the following?

A. Fidgeting
B. Motor tics
C. Simple partial seizures
D. Blepharospasm
E. Blepharitis

18. Which of the following conditions are frequently associated with this boy’s diagnosis?

a. Oppositional Defiant Disorder (ODD)
b. Attention Deficit / Hyperactivity Disorder (AD/HD)
c. Conduct Disorder (CD)
d. Obsessive Compulsive Disorder (OCD)
E. Developmental Coordination Disorder (DCD)

*****

Please answer questions 19 – 20 based on information from the following vignette.

A 14-year-old male presents to your office complaining of recent growth of his breasts. He has a history of cardiac disease and is currently taking digoxin and hydrochlorothiazide. On examination your patient is slim, his blood pressure is 160/96 mmHg, and he has bilateral non-tender gynecomastia. The remainder of his physical examination is within age normal limits.

19. The patient asks you why his breasts are growing and you site which of the following reasons as a possible cause?

A. His slender body habitus
B. Digitalis
C. His elevated blood pressure
D. Hydrochlorothiazide
E. His underlying cardiac disease

20. Your patient desires more information about breast enlargement in males. Which of the following information should be given?
a. Gynecomastia is very uncommon and he needs to have his breast tissue biopsied as soon as possible to exclude breast carcinoma.
b. Asymptomatic palpable breast tissue can be seen in normal males, particularly in neonates, at puberty and with increasing age above 45 years.
c. Avoid heavy alcohol abuse since it may be lead to gynecomastia
d. Gynecomastia will almost never spontaneously regress leading to the single therapeutic option of surgical removal of the breast tissue.
e. Gynecomastia results from an increased estrogen to testosterone ratio.

*****

Please answer questions 21 – 23 based on information from the following vignette.

Mr. William Connell, a 41-year-old freelance photographer, is seen in the office of his family physician complaining of red discolouration of his urine over the past four days. He states that he has had this on two previous occasions, both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared spontaneously over a period of five to seven days. At the time of the present visit he states that he has been feeling lethargic with a sore throat for the past five days. He is a vegetarian and smokes a pack of cigarettes each day. Blood pressure is 170/95 mmHg in both arms, sitting and supine, on repeat testing. Urine analysis shows specific gravity 1020, nitrites negative, +++ blood and +++ protein. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red cell casts.

21.Which ONE of the following is the most likely diagnosis?

A. IgA nephropathy
B. Ingestion of beets
C. Renal calculi
D. Bladder carcinoma
E. Post-streptococcal glomerulonephritis

22. Which of the following investigations does this patient require?
a. Cystoscopy
b. Urine culture
c. Serum creatinine
d. Plain X-ray of the kidney, ureter and bladder
e. 24 hour urine collection for creatinine clearance and protein excretion

23. The presence of dysmorphic red blood cells is indicative of:
A. Urine infection
B. Delay in analysis of the urine sample
C. Glomerular bleeding
D. Urothelial malignancy
E. Urinary tract calculus

*****

Please answer questions 24 – 25 based on the following vignette.

Miss Tracy Patterson, a 17-year-old university student, visits her family physician’s office complaining of fatigue and “strong smelling” urine. Her only past medical problem is infectious mononucleosis two years previously form which she made a complete but protracted recovery. Her only medication is the birth control pill. She is a member of the university basketball team and has noted a dip in her performance since the onset of these symptoms. She denies any other symptoms. There are no abnormal findings on examination. Blood pressure is 110/68 mmHg. Urine analysis shows specific gravity 1030, nitrites negative, + protein. Urine microscopy reveals a few vaginal epithelial cells/hpf, 0-1 wbc’s/hpf, and 0-1 hyaline casts/hpf. A 24 hour urine collection shows a normal creatinine clearance with 0.41g of protein for this time period.

24. Which ONE of the following is the most likely diagnosis?

A. IgA nephropathy
B. Membranous glomerulonephritis
C. Exercise-induced proteinuria
D. Urinary tract infection
E. Reflux nephropathy

25. Which of the following investigation(s) does this patient require?
a. Cystoscopy
b. Split urine collections (0800 – 2000, and 2000 – 0800)
c. Repeat 24 hour collection after avoiding exercise
d. Renal biopsy
e. Serum and urine electrophoresis

*****

Please answer questions 26 – 27 based on information from the following vignette.

Theresa Gallagher, arrives at her family physician’s office complaining of easy bruising over the past month. She is not as concerned about her “rash-like” skin bruising as she is about her gums bleeding with brushing her teeth over the past three days. Theresa is 25 years old and otherwise healthy. She is not taking any medications, and drinks only socially. She has never been hospitalized except for the birth of her daughter three years ago after an uneventful pregnancy. Family history is completely negative. She denies any large bruises, denies deep muscle or joint pain, and has not noticed any blood in her urine.

26. What investigations would you order?

a. CBC and differential
b. Serum electrolytes & creatinine
c. fibrin split products
d. PT & PTT (includes INR)
e. AST, ALT, alkaline phosphatase

27. The only abnormality detected is a platelet count of 70,000/mm3. What is/are the possible cause(s)?
a. Renal failure
b. Folate/B12 deficiency
c. Lymphoma/leukemia
d. Factor VIII deficiency
e. SLE

*****

28. A concerned father calls your office because his three-week-old son Damien has a fever of 39.5 degrees Celsius measured axially. He was born at term and had no complications after a spontaneous vaginal delivery. He was breast-feeding well until yesterday. Since then he has been sleeping more. He has a two-year-old brother who has a cold.

What is the best advice to give the parents?

A. Treat the fever with Tylenol, bring the baby to the office if fever lasts over 48 hours
B. Bring baby to the office for further evaluation sometime later today.
C. Take baby to the emergency room for hospital admission
D. Make a house call
E. Make appointment for the baby with a pediatrician

*******

Please answer questions 29 – 31 based on information from the following vignette.

Mr. David Wallace is a 57 year old male that presents with a longstanding history of heartburn and reflux of acid-like material in to his mouth. He usually treats himself with oral antacids but lately they have not been as effective. Yesterday he had some pain and a sticking sensation after swallowing a piece of bread. He has noticed this on at least on 3 separate occasions before, these episodes having occurred over the last 2 months or so. When asked to point to where he feels the food is sticking he points to he points to an area just below his thyroid gland. Each time he could not swallow, he was able to down the food with water and did not need to seek medical attention. He has not had trouble swallowing hot or cold liquids. His past medical history is significant for polio as a child and feels he has some arm and leg weakness due to that. He has a 50-pack year smoking history. His family history is negative except he has one sister that died of breast cancer. His physical exam is completely normal.

29. In assessing Mr. Wallace which of the following is/are correct;

a. Since he points to an area near his thyroid he probably has oropharyngeal dysphagia secondary to post polio syndrome.
b. Assess for signs of stroke or post-polio syndrome since his dysphagia is likely due to a neuromuscular disease.
c. He likely has uncomplicated reflux esophagitis and should be managed with a proton pump inhibitor and requires no further investigation.
d. Esophageal carcinoma usually presents with both liquid and solid dysphagia
e. Since coughing, choking, and aspiration are absent, difficulty in initiating swallowing (in contrast to difficulty swallowing) may be safely excluded

30. Which of the following management/investigation strategies is/are most appropriate for Mr. Wallace?

a. Start him on H2 antagonist (ranitidine) and arrange for him to have an upper endoscopy.
b. If a barium swallow is normal and his symptoms progress start him on a proton pump inhibitor and advice him that since the barium swallow is normal no further investigation are required.
c. Since an upper endoscopy is not available in your community you order a chest xray and a barium swallow.
d. His barium swallow is normal but the dysphagia persists, order a CT scan of his head to rule out a neurological cause of his dysphagia.
e. Since dysphagia can occur in uncomplicated reflux esophagitis you reassure the patient that he has uncomplicated gastroesophageal reflux and counsel him on conservative management of reflux disease suggest he eat small meals, quits smoking and limits his caffeine consumption.

31. The most likely diagnosis for Mr. D. W. is:

A. Lower esophageal ring
B. Peptic stricture
C. Esophageal carcinoma
D. Esophageal spasm
E. Achalasia

*****

32. The emergency room nurse pages you to come examine a two-year old girl who is the daughter of one of your patients. Upon arriving in the emergency room, you see an obtunded girl with no known prior medical problems. Her father states that his daughter fell down the stairs earlier in the evening, but he does not think that she hit her head during the fall. Physical examination shows no visible signs of external injury. After a brief but complete physical examination, the only abnormality detected was on examination of her eyes. Although examination of her anterior chambers is normal, posteriorly in each eye there are large, dome-shaped hemorrhages in the macula. In addition, there are multiple scattered retinal hemorrhages visible in the retinal periphery of each eye.

The most likely diagnosis in this case is:

A. acute myelogenous leukemia
B. diabetic retinopathy
C. childhood hypertensive retinopathy
D. child abuse (shaken baby s yndrome)
E. retinal edema

*******

33. A 63-year-old man experienced a ten-minute attack of right-sided weakness with associated difficulty speaking one week ago. Carotid ultrasound testing showed bilateral carotid atheroma, with a 20% carotid stenosis on the left, and an 80% carotid stenosis on the right. Past illnesses include mild hypertension under treatment. Review of systems reveals no symptoms suggestive of coronary artery disease. His neurological examination is normal.

Appropriate management of this patient would be:

A. Left carotid endarterectomy.
B. Right carotid endarterectomy.
C. Coumadin anti-coagulation.
D. Enteric coated aspirin.
E. Hydergine (ergoloid mesylates).

*****

34. Sara has terminal bone cancer unresponsive to chemotherapy. She is 7 years old and has been in hospital for palliative care for just over 3 weeks. Today she is feeling tired, she is repeatedly complaining of pain in her leg, and wants to be held in her mother’s arms. She refuses to eat because according to her there is no point in eating if she will die anyway.

Which of the following procedures is/are appropriate for Sara (choose all correct ones):

a. force feed
b. provide adequate analgesia
c. initiate parental nutrition
d. prescribe antidepressants
e. provide emotional support

**********

Please answer questions 35 – 36 based on information from the following vignette.

A full term infant with a birth weight of 3.5 kg, length of 50 cm and head circumference of 35 cm (all at 50th percentile) comes for an office appointment at 2 weeks of age. The mothers states that the infant was discharged home at 24 hours of age and has done well since. The infant is being fed Carnation milk diluted to 25%. The child’s sleep pattern is characterised by 1.5 hours of sleep after each feed. His weight today is identical to birth. On exam the infant appears to be well hydrated, the mucosa colour is normal and in no distress. The exam is unremarkable except for irritability.

35. Why has the infant failed to gain weight?

A. This infant was small for gestational age at birth
B. This infant is microcephalic
C. The nutritional support provided to this child is adequate for a newborn
D. Encourage breast feeding or change milk to an appropriate infant formula
E. Recommend that the dilution of the milk be changed to 50% 36.

Considering the appropriate nutritional management of infants, select the appropriate advice to be given to new mothers:
A. Avoid feeding newborn infants in the first 12 hours of life in order to prevent aspiration
B. Breast milk is deficient in iron and iron supplementation is recommended for breast fed infants
C. Breast milk does not contain enough vitamin D and vitamin D supplementation is recommended for exclusively breast fed infants
D. Institute solid food at three months of age
E. Breast milk may causes diarrhea if used exclusively, so formula should be added

*****

Please answer questions 37 – 39 based on information from the following vignette.

Mr. Lyle Murrin, a 75-year-old retired train engineer, saw his family physician on March 18, 2000 complaining of breathlessness. He had signs of cardiac failure with atrial fibrillation. Serum creatinine at that time was 145 mmol/L, similar to the value from eight months ago. Because he was in moderate distress, he was admitted to hospital. No invasive procedures were considered necessary. His diagnosis of congestive heart failure led to treatment with enalapril, furosemide, and digoxin. He was discharged from hospital on March 28, 2000. Today, April 3rd, 2000 he returns to the office of his family physician complaining of increasing nausea, vomiting, decreasing amounts of urine, pain in his right great toe and difficulty sleeping. He has a history of hypertension and ischemic heart disease. On physical examination he appears unwell with a heart rate of 46 bpm (irregularly irregular). Sitting BP is 190/88 mmHg. JVP is 5cm above the sternal angle. He has an apical pan-systolic murmur, a right carotid and bilateral femoral artery bruits, bilateral basal inspiratory crackles and a red tender swollen right first metatarsal phalangeal joint. The results of his initial investigations are given below: Na 139 mmol/L Hb 114g/L K 5.8 mmol/L WBC 14.3 x109/L HCO3 22 mmol/L Plat 274 x109/L Cl 101 Urea 13.5mmol/L Creatinine 325mmol/L 37.

What is the most likely explanation for the rise in serum creatinine?

A. Hypertensive nephrosclerosis
B. Bilateral renal artery stenosis
C. Dehydration secondary to diuretics
D. Urate-containing renal calculi
E. Chronic glomerulonephritis

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