Thursday, August 21, 2008
Qx / Sample Questions from MCCEE January 2004
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:
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.
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
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
Monday, August 18, 2008
Medical Ethics/ 5 Questions
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.
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.
Thursday, August 14, 2008
Common 10 Questions for Family Medicine for QE1 exam
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.
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
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.
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
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
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
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
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
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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*
..........................................................................................................
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
..........................................................................................................
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
..........................................................................................................
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)
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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
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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
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)*
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
..........................................................................................................
44). Level of hCG is highest during:
a). 12 weeks gestation*
b). 22 weeks gestation
c). 25 weeks gestation
d). 28 weeks gestation
• Fall to lower levels in the second and third trimesters β-hCG
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
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
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
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
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
• 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
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*
73). Causes of melasma (chloasma) include:
a). Pregnancy
b). Birth control pills (OCP)
c). Both*
d). Neither
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*
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*
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
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
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
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*
..........................................................................................................
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
..........................................................................................................
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
..........................................................................................................
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
..........................................................................................................
18). A woman who has never completed a pregnancy to term is called:
a primigravida
b nulligravida
c primipara d nullipara***
e multipara
..........................................................................................................
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
..................................................................................................................................................
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
..........................................................................................................
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
..........................................................................................................
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 include1. 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
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