Section: 1

Question: 1
A 30-year-old man presents with severe pruritus that is
worse at night and reports similar symptoms among other
family members. Upon examination, areas of excoriated
papules are observed in the interdigital areas. Which one of
the following is the most likely diagnosis?
dermatitis herpetiformis
cutaneous larva migrans
contact dermatitis
scabies
pinworm infestation
Question: 2
A 33-year-old woman who is 29 weeks pregnant with her
fourth child presents to the obstetric unit with onset of
painless vaginal bleeding two hours ago, accompanied by
passage of significant blood and clots. Fetal heart rate is
regular at 150 beats/minute. She is having no uterine
contractions. Which one of the following is the most likely
diagnosis?
placenta praevia
abruptio placentae
vasa praevia
bloody show
disseminated intravascular coagulation

Question: 3
A 3-year-old boy presents to the emergency room following

a 40 second generalized tonic-clonic seizure. The infant has

been ill with a high fever for 24 hours. His history is
unremarkable, and physical examination is normal, CBC and
urinalysis are normal. Which one of the following would be
the best initial step?
Arrange to have an EEG performed urgently.
Admit to hospital for an immediate CT scan of the
head.
Carry out blood cultures.
Reassure the mother and recommend close
observation.
Perform a lumbar puncture.

Question: 4
Throughout the winter months, about 18% of 1000 people
working in a modern office building complain of headache,
eye irritation and sore throat. These symptoms develop each
day about noon and persist through the afternoon. The most
likely explanation for this phenomenon is
allergic rhinitis.
occupational stress.
mass psychogenic illness.
sick building syndrome (indoor air pollution).
endemic transmission of rhinovirus.
Question: 5
A 15-year-old boy presents with a history of repeated fire
setting. He collects lighters and enjoys watching fires in the
neighborhood. His mother and teachers describe his temper
as explosive and he is known to fight, lie and steal. With his
mother, he is frequently argumentative and disobedient.
Which one of the following diagnoses is most likely?

conduct disorder
oppositional defiant disorder
intermittent explosive disorder
attention deficit hyperactivity disorder (ADHD)
pyromania

Question: 6
A 30-year-old male presents with a three month history of
weight loss, fatigue and night sweats. He has palpable
lymph nodes in his neck and mild hepatosplenomegaly. A
chest x-ray shows a large mediastinal mass. What would be
the most appropriate method of obtaining tissue for
pathologic diagnosis in this patient?
neck lymph node biopsy under local anesthetic
biopsy of mediastinal mass under general
anesthetic
liver biopsy under local anesthetic
liver biopsy under general anesthetic
needle biopsy of the spleen under local anesthetic

Question: 7
For a 52-year-old sedentary, normotensive, non-smoking
white male who is not overweight, drinks 60 mL of whiskey
per day and plays golf occasionally, which one of the
following conditions is most likely to cause death within the
next 10 years?
motor vehicle accident
cerebrovascular disease

suicide
cirrhosis of the liver
ischemic heart disease
Question: 8
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?
congenital intrauterine infection
chromosomal or genetic abnormality
placental insufficiency
congenital hydrocephalus
maternal age

Question: 9
A previously normal 65-year-old African-American man
presents with a urinary tract infection. He is treated with
sulfamethoxazole-trimethoprim. One week later, routine
laboratory testing reveals a new normocytic anemia with
hemoglobin 89 g/L. Which one of the following is the most
likely diagnosis?
Glucose-6-phosphate dehydrogenase (G6PD)
hemolysis
thalassemia trait
occult blood loss from renal carcinoma
sickle cell trait
favism

Question: 10
A 27-year-old man is brought to the emergency room after
trying to smash a computer in the library. He says the
computer is being used to control his thoughts and that he
has a good idea that the government is behind this. This
patient is exhibiting which one of the following?
auditory hallucinations
delusions
visual hallucinations
obsessions
ruminations

Question: 11
What would be the best test to confirm the diagnosis of
hereditary spherocytosis?
Coombs test
bone marrow aspiration
osmotic fragility studies
red blood cell enzyme studies
human leukocyte antigens (HLA) studies

Question: 12
The son of a 79-year-old woman wants a psychiatric
evaluation for his mother because she has been more

confused and lethargic during the past 6 months. She takes

several medications daily, although her son doesn't know
what they are. Mental status examination shows the
woman to be dishevelled, mildly agitated, and
delirious. Which one of the following is the most useful next
step in this woman's evaluation?
identifying her medications
eliciting a family history
ordering serum electrolytes
obtaining a CT scan of the head
prescribing haloperidol for agitation

Question: 13
A first-born male child develops vomiting at the age of five
weeks. The vomit is free of bile. The child remains hungry
and vomits after taking feedings. Examination reveals visible
peristalsis in the upper abdomen. Which one of the following
is the most likely diagnosis?
esophageal atresia
hypertrophic pyloric stenosis
duodenal web
midgut volvulus
incarcerated inguinal hernia

Question: 14
International comparisons suggest that the health status of
a population is most influenced by the
presence of a national health insurance plan.

physician/population ratio.
range of social and welfare programs.
method of paying the physicians.
number of hospital beds.

Question: 15
A patient with delirium tremens manifests all of the
following, EXCEPT
clouded consciousness.
hypothermia.
coarse tremor.
tachypnea.
hyperhidrosis.

Question: 16
A 4-year-old girl presents with areas of bluish discoloration
of the lower extremities, buttocks and upper trunk. She has
a low-grade fever but otherwise well looking. The complete
blood count reveals the following results: hemoglobin, 120
g/L; white blood cell, 8.2x109/L and platelets 170 x109/L.
Which one of the following is the most likely diagnosis?
henoch-Schnlein purpura
hemophilia A
meningococcemia
idiopathic thrombocytopenic purpura
acute leukemia

Question: 17

A 28-year-old pregnant woman develops sudden onset of

dyspnea and tachycardia. Which one of the following is the
most likely explanation?
acute mitral valve regurgitation
pulmonary embolism
myocardial infarction
acute respiratory distress syndrome
lobar pneumonia

Question: 18
A 10-year-old boy complains of headaches and stomach
aches each morning before school and has missed most
of the last 2 weeks of school. He has no history of
vomiting, change in stool patterns, weight loss or visual
disturbances. His physical examination is negative.
The most appropriate course of action is
propranolol prophylaxis for migraines.
referral back to school with reassurance to
parents.
computed tomography scan of the head.
Maalox before meals.
suggest withdrawal of privileges to deal with
truancy.
Question: 19
A 55-year-old overweight, non-smoking woman,
recently separated from her husband, complains of
severe chest pains radiating to both arms. During the
attacks, which are provoked by drinking cold liquids,
she is nauseated and may experience difficulty in
swallowing. The most likely diagnosis is

ischemic heart disease.

peptic ulcer disease.
panic disorder.
esophageal spasm.
biliary colic.

Question: 20
A 4-year-old boy has a history of easy bruising,
nosebleeds, and a similar history among male and
female family members. Laboratory investigations
show normal INR and prolonged APTT. Which one of
the following is the most likely cause of this boy's
tendency?
hemophilia A
Christmas disease
factor XIII deficiency
von Willebrand's disease
familial platelet function disorder

Question: 21
A 45-year-old business executive with advanced
cirrhosis of the liver and a history of alcohol abuse says
that he drinks only because of the constant nagging of
his wife. This is an example of which of the following
defense mechanisms?
rationalization
repression
sublimation

reaction formation
intellectualization

Question: 22
A 3-year-old boy presents with a swelling in the right
scrotum. On examination the swelling is irreducible, it
is possible to get above it and it is translucent. Which
one of the following is the most likely diagnosis?
indirect inguinal hernia
varicosity of testicular veins
torsion of the testis
acute epididymo-orchitis
primary hydrocele

Question: 23
To estimate survival from a follow-up study, "time zero"
must be defined precisely for each patient. This is best
ensured by
"back dating" the entrance to the date of onset of
the first symptoms, as obtained from the history.
enrolling all patients on the same calendar date.
measuring from the first instance when each
patient's symptoms met certain criteria for
severity.
measuring from the time the disease is detected
by a screening program.
selecting all patients at clinically comparable

points in the course of their disease.

Question: 24
A 45-year-old female presents with a history of a direct
blow over the shaft of her left humerus. Her x-ray
shows a spiral fracture of the distal third of the
humerus. On examination of her hand, sensation is
intact on the palmar side but absent on the dorsum of
her hand. Which one of the following nerves is most
likely injured?
axillary nerve
musculocutaneous nerve
median nerve
radial nerve
ulnar nerve

SECTION 2
Section: 2
Question: 1
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?
tricyclic antidepressant overdose
morphine overdose
arsenic poisoning
lead intoxication
alcohol intoxication
Question: 2
The following laboratory values were obtained during
investigation of a 45-year-old man:
Hemoglobin

90 g/L

Mean corpuscular volume

82 fL

Mean corpuscular hemoglobin

concentration

300 g/L (N = 310360 g/L)

Serum iron

7 mol/L (N = 13-27
mol/L)

Total iron binding capacity

36 mol/L (N = 5472 mol/L)

Sideroblasts in the bone

marrow

0.25 (N = 0.300.50)

Bone marrow iron

Normal

These results could be due to all the following

conditions, EXCEPT
iron deficiency anemia.
alcoholism.
chronic infection.
malignant disease.

rheumatoid arthritis.
Question: 3
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
the mortality rate is higher in women.
the case fatality rate is higher in women.
the duration of the disease is longer in women.
women receive less adequate medical care for the
disease.
this diagnosis is more often missed in women.

Question: 4
A 50-year-old woman has a 2 cm carcinoma in the
upper outer quadrant of her left breast, with no
palpable axillary nodes. Which one of the following is
the most appropriate treatment?
lumpectomy and tamoxifen
lumpectomy and axillary dissection
modified radical mastectomy
lumpectomy, axillary dissection and radiotherapy
lumpectomy followed by radiotherapy

Question: 5
A 16-year-old boy presents in the emergency room
with a history of a football injury to the left flank earlier
that day. He reports that at the time of injury he only
had the wind knocked out of him and recovered in a

few minutes. About 1 hour later he began to

experience pain in the left upper quadrant and left
shoulder and light-headedness on standing. Which one
of the following is the most likely diagnosis?
dislocation of the left shoulder
broken rib on the left side
left-sided pneumothorax
contusion of the left kidney
ruptured spleen

Question: 6
A 6-month-old girl presents with vomiting and diarrhea
of acute onset. Her systolic blood pressure is 40 mm
Hg, pulse is 160/minute, she has poor peripheral
circulation and is very lethargic. Her serum sodium
concentration is 158 mmol/L. Which one of the
following is the best initial management?
intravenous 5% dextrose in 0.9% saline, 20
mL/kg over 60 minutes
intravenous 5% dextrose in water at 80 mL/kg/24
hours
oral solution containing 50 mmol sodium per liter
septic workup
hydrocortisone 200 mg intravenously
Question: 7
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?
postcoital test
diagnostic laparoscopy
hysterosalpingogram on day 9 of her cycle
endometrial biopsy on day 26 of her cycle
basal body temperature charting

Question: 8
A 54-year-old man presents with extreme pain and
swelling of the left middle finger. Four days earlier, he
suffered a small puncture wound to the volar aspect of
the finger at the level of the distal flexor crease.
Passive extension of the proximal interphalangeal
(PIP) and distal interphalangeal (DIP) joints severely
aggravates his symptoms. Which one of the following
is the most likely diagnosis?
pulp space infection
cellulitis
mid-palmar space infection
septic tenosynovitis
septic arthritis distal interphalangeal (DIP) joint

Question: 9
A 52-year-old patient is complaining of hot flushes,
sweating, and sleep disturbance. After discussion she
feels hormone replacement therapy would not be
suitable for her. She wants to discuss herbal remedies
for menopause. Which one of the following natural

products is most likely to help her symptoms?

Kava
Ginseng
coenzyme Q10
Evening primrose oil
Bilberry

Question: 10
On physical examination of a 21-year-old woman, you
auscultate at the apex of her heart a low-pitched midto-late diastolic murmur with accentuation of S1. Upon
careful listening you notice a clicking sound just after
S2 and immediately preceding the rumbling
murmur. Which one of the following is the most likely
condition?
aortic insufficiency
atrial myxoma
mitral valve prolapse
mitral valve stenosis
patent foramen ovale

Question: 11
A 21-year-old primigravida at 20 weeks' gestation is
diagnosed as having herpes genitalis. Your suggestion
to her for her future care include which one of the
following?
Pap smears every 3 months
cesarean section if active lesions at the time of

delivery
termination of this pregnancy
refraining from sexual activity
amniocentesis to see if fetus is infected

Question: 12
The lupus patient you are following suddenly develops
a fever and notes that her urine is dark in
color. Analysis of her urine reveals the presence of red
cells. She has had some joint aching and been feeling
unwell for a few days. Her malar rash is about the
same as usual for her. Which one of the following
suggests she is experiencing an exacerbation of her
disease?
C3 and C4 are both normal.
C3 is low and C4 is normal.
CH50, C3 and C4 are normal.
C3 and C4 are low.
terminal complement components are absent.

Question: 13
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?

renal contusion
acute pancreatitis
ruptured spleen
retroperitoneal hematoma
ruptured bowel

Question: 14
A 40-year-old woman has a history of osteoporosis in
her family and seeks counseling. Which of the
following statements is true regarding an increased risk
of osteoporosis?
black women with a late menopause
white women with larger bone mass
women with regular physical exercise
women with history of cigarette smoking
white women with a late menopause

Question: 15
A 27-year-old woman seeks evaluation for her
"depression" in an out-patient clinic. She reports
episodic feelings of sadness since
adolescence. Occasionally she feels good, but these
periods seldom last more than 2 weeks. She is able to
work but thinks she is not doing as well as she
should. In describing her problems she seems to focus
more on repeated disappointments in her life and her
low opinion of herself than on discrete depressive
symptoms. In your differential diagnosis at this
point,which one of the following is the most likely

diagnosis?
major depression with melancholia
adjustment disorder with depressed mood
cyclothymia
childhood depression
dysthymia

Question: 16
Extrinsic allergic alveolitis may be acquired by
breathing air contaminated by which one of the
following substances?
urea formaldehyde foam insulation
fine silicaceous dust
chlorine gas
fungal spores
degreasing solvent

Question: 17
Following a car accident, a patient presents with
bruising of the eyelid and clear fluid is observed leaking
from his nose. Which one of the following is the most
likely cause?
linear fracture of the vault of skull
anterior cranial fossa fracture
petrous bone fracture

foramen magnum fracture

squamous temporal bone fracture

Question: 18
A infant girl presents with a webbed neck, shield chest,
coarctation of the aorta, and edema of the hands and
feet . Which one of the following conditions is she
likely to manifest?
kyphoscoliosis
deafness
cataracts
amenorrhea
renal failure

Question: 19
Between 1901 and 1981, the total mortality rate in
developed countries showed a dramatic decline. Which
one of the following factors accounted for the greatest
proportion of the decrease in mortality during this
time?
improvement in the geographic distribution of
health care professionals
increase in the number of health care
professionals
development of antibiotics
improvements in general living standards
improvements in diagnostic techniques

Question: 20

You see a cyanotic 1-day-old baby boy, born by difficult

delivery at 37 weeks' gestation. After administration of
100% oxygen, there is no significant change in the
arterial PaO2. Based on this finding, the most likely
primary diagnosis is
pulmonary disorder.
central nervous system damage.
congenital heart disease.
sepsis.
metabolic disorder.

Question: 21
Two medical students poll a random sample of
classmates concerning their choices for residency
training and find that the percentage of women who
plan to train in primary care is significantly higher than
the percentage of men (p<0.05). The probability is
less than 5% that
the sampled men will enter a primary care field.
the difference between the men and women is
real.
all the women in the class will enter a primary
care field.
the difference between the sampled men and
women is due to chance.
this sample reflects the choices of the whole
class.

Question: 22
A 65-year-old previously healthy woman is seen for a
routine physical examination. You can palpate a 1-cm
mass in the upper outer quadrant of the left
breast. Which one of the following is the most likely
diagnosis?
fibrocystic disease
acute mastitis
fibroadenoma
carcinoma
Paget's disease of the breast
Question: 23
A 27-year-old woman in labour declines epidural
anesthesia. A nerve block is recommended instead. A
block of which one of the following would be
appropriate for pain control?
pelvic splanchnic nerve
obturator nerve
inferior gluteal nerve
pudendal nerve
pelvic sympathetic nerve

Question: 24
Which one of the following signs is consistent with an
overdose of morphine?
tremulousness

nystagmus
respiratory depression
mydriasis
hypertension

Self-Administered Evaluating Exam

Section: 3
Question: 1
Which one of the following features is characteristic of
central retinal artery occlusion?
painful phenomenon
progressive loss of vision
bilateral blindness
semi dilation of both pupils with poor response to
direct light
brisk constriction of pupil when the other eye is
illuminated

Question: 2
A 70-year-old woman complains of a 6-month history
of cough. She has a past history of hypertension and
myocardial infarction and she has been a smoker for 50
years. Which one of the following drugs may be
contributing to her cough?
enalapril
atorvastatin
hydrochlorothiazide
diltiazem
clopidogrel

Question: 3
Etiologic factors in female urinary stress incontinence
include all of the following EXCEPT
weakness of the urethral supports.
trauma from repeated deliveries.
estrogen deficiency.
procidentia.
chronic bronchitis.

Question: 5
A nulligravid woman with epilepsy comes for preconceptional counselling. She is taking phenytoin and
carbamazepine and has been seizure-free for the last 2
months. What advice should be given to her?
There is no significant increased risk of anomalies.
The risk of anomalies exceeds that of untreated
epilepsy if she continues her medication.
She needs anticonvulsants and should therefore
not undertake pregnancy.
The benefits of the drugs outweigh the risks, and
pregnancy may be attempted.
The fetal hydantoin syndrome is familial so the
status of relatives must be checked.

Question: 6
An assembly-line worker complains of awakening at

night with right-hand discomfort that resolves after

several minutes. After 3 weeks of continuing
symptoms, he seeks medical advice. Examination
reveals mild weakness of thumb abduction and
diminished pain sensibility on the palmar aspect of the
thumb and index finger. Which one of the following is
the most likely diagnosis?
carpal tunnel syndrome
cervical radiculopathy
reflex sympathetic dystrophy
tendinitis
radial nerve neuropathy

Question: 7
A 65-year-old man is on his second postoperative day
after colon resection for carcinoma. He is on
intravenous fluids and nasogastric suction. Which one
of the following would be the most reliable in assessing
the state of his hydration?
turgor of skin
body weight
urine output
amount of thirst
moistness of his tongue

Question: 8
A study of traffic safety showed that 61% of those
involved in accidents last year had more than 10 years
of driving experience, 21% had 6 to 10 years of

experience, and 17% had 1 to 5 years. Traffic experts

concluded that experience seems to make drivers more
complacent and careless. Which one of the following
statements best explains why this conclusion
is NOT justified?
The rates have not been standardized for age
differences.
The data are incomplete because of unreported
accidents.
A comparison needs to be made with similar data
on drivers not involved in accidents.
No test of statistical significance has been made.
Prevalence is used where incidence is required.

Question: 9
A serious suicide attempt is more likely in patients who
are quietly depressed.
threaten suicide.
have made previous serious attempts.
have received bad news.
are given inadequate antidepressant medication.

Question: 10
A 56-year-old alcoholic man, who has had chronic
bronchitis for the past 10 years, presents with

increasing cough. On examination, he has wheezing

over the right lower lobe and clubbing of his fingers.
Which one of the following diagnosis is the most likely?
bronchiectasis
aspiration pneumonia
alpha-1 antitrypsin deficiency
foreign body aspiration
bronchogenic carcinoma

Question: 11
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
a person has bizarre fantasies and actions
persons are mentally incompetent and unable to
manage their own affairs
a close relative submits a petition that an
individual is actually and presently insane
the individual's continued liberty poses a danger
a person has visual and aural hallucinations

Question: 12
A 24-year-old woman appears at 8 weeks of pregnancy
and reveals a history of pulmonary embolism 7 years
ago during her first pregnancy. She was treated with
intravenous heparin followed by several months of oral
warfarin (Coumadin) and has had no further evidence

of thromboembolic disease for over 6 years. Which of

the following statements about her current condition is
true?
Having no evidence of disease for over 5 years
means that her risk of thromboembolism is not
greater than normal.
Impedance plethysmography is not a useful study
to evaluate her for deep venous thrombosis in
pregnancy.
Doppler ultrasonography is not a useful technique
to evaluate her for deep venous thrombosis in
pregnancy.
The patient should be placed on low-dose heparin
therapy throughout her pregnancy and the
puerperium.
She is at highest risk for recurrent
thromboembolism during the second trimester of
pregnancy.

Question: 13
A student in a university residence has been diagnosed
with meningococcal meningitis. Which one of the
following is the most effective prophylaxis for
individuals exposed to this patient?
rifampin
erythromycin
penicillin G
tetracycline
ethambutol

Question: 14
The most common reason for antenatal genetic testing
is
paternal age greater than 50
a parent with a balanced translocation
mendelian disorders
maternal age 35 or older
repeated spontaneous abortions
Question: 15
A 65-year-old woman has developed coarse facial
features and an increase in her hand size. You suspect
she has acromegaly. In addition to growth hormone,
which one of the following would also be elevated?
adrenocorticotropic hormone (ACTH)
follicle-stimulatina hoemone (FSH)
prolactin
parathyroid hormone (PTH)
thyroid stimulating hormone (TSH)

Question: 16
A 25-year-old woman with depression repeatedly talks
about irrelevant topics when being interviewed by a
psychiatrist. Which one of the following symptoms is
the patient demonstrating?
suppression
denial

introjection
resistance
repression

Question: 17
A 3-year-old boy, diagnosed as having a hemolytic
uremic syndrome 4 months ago, presents with the
following laboratory findings (finger prick):

sodium

135 mmol/L

potassium

9 mmol/L

chloride

106 mmol/L

urea nitrogen

7.3 mmol/L

creatinine

60 mmol/L

The most appropriate management is to

order calcium intravenously.
do an electrocardiogram.
repeat the blood tests, taking an
intravenous specimen.
order Kayexalate by mouth.
repeat the blood tests in 1 week.

uestion: 18
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?
gravida 4, para 1
gravida 4, para 2
gravida 3, para 2
gravida 2, para 2
gravida 3, para 1

Question: 19
A 45-year-old man sustained an 8 cm ragged laceration
of his lateral thigh in a farming accident while
ploughing a field. The laceration had penetrated the
deep fascia into the muscles. He wrapped a towel
around the leg and finished his work. He finally arrived
in the Emergency Department 8 hours after the
accident. Local treatment should include thorough
debridement followed by
closure of wound.
instillation of antibiotics and closure.
leave wound open for secondary closure at a
later date.
closure with drains.
local antibiotics and closure of muscles only.

Question: 20
All of the following statements about postpartum
psychosis are true, EXCEPT
it should be treated as a psychiatric emergency.
residual symptoms are common.
lithium carbonate is useful for manic symptoms.
psychotherapy is beneficial after the period of
acute psychosis.
use of neuroleptics is often necessary.

Question: 21
Which one of the following hormones is responsible for
the proliferation of the milk ducts during pregnancy?
human chorionic gonadotropin
progesterone
prolactin
estrogen
human placental lactogen
Question: 22
A 35-year-old woman who was born in Vietnam has
had her dyspepsia diagnosed by endoscopy as a
duodenal ulcer. Her pathology is positive
forHelicobacter pylori. She has not previously been
diagnosed with peptic ulcer disease. What would be the

preferred treatment option?

combination antibiotics plus omeprazole
omeprazole alone
surgical vagotomy and pyloroplasty
octreotide
ranitidine

Question: 23
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?
clinical history
laparoscopy
pelvic examination
hysterosalpingogram (HSG)
culdocentesis during menses

Question: 24
A 45-year-old woman is brought to the Emergency
Department after she fainted in a supermarket. Her
husband tells you she was diagnosed as
"hypoglycemic" by a homeopath 2 years ago. Which
one of the following criteria is most in favor of the
diagnosis of hypoglycemia?

Abnormal 5-hour glucose tolerance test

Low blood glucose while symptomatic
Typical prodrome of tachycardia
History of post-prandial syncope
Improvement of patient status after eating

Section: 4
Question: 1
A patient at 17 weeks' gestation is diagnosed as having
an intrauterine fetal demise. She returns to your office
5 weeks later and has not had a miscarriage, although
she has had some occasional spotting. This patient is
at increased risk for which of the following?
septic abortion
recurrent abortions
consumptive coagulopathy with
hypofibrinogenemia
future infertility
ectopic pregnancies

Question: 2
An 80-year-old woman with a history of congestive
heart failure develops angina pectoris. Her medications
are adjusted to include furosemide, digoxin,
nitroglycerin, and potassium supplements. Shortly
thereafter, she develops intermittent frontal throbbing
headaches. Which one of the following is your initial
management step?
Perform a temporal artery biopsy.
Begin propranolol.
Begin sumatriptan (Imitrex).

Obtain a brain computed tomography (CT) scan.

Discontinue nitroglycerin.

Question: 3
A newborn infant has excessive drooling along with
coughing and choking with feeding. Cyanosis is
present and is unrelieved by crying. Bilateral
pulmonary rales are present. There is abdominal
distention with tympany on percussion. Which one of
the following is the most likely diagnosis?
choanal atresia
respiratory distress syndrome
Zenker's diverticulum
tracheoesophageal fistula
duodenal atresia

Question: 4
In a classroom of 25 students (15 males and 10
females), 5 males develop hepatitis A over a 2-week
period. During the next 6 weeks, an additional 3 males
and 2 females develop the infection. The secondary
attack rate of hepatitis A is which one of the following?
20%
25%
40%
50%

73%

Question: 5
The ovarian lesion most likely to undergo torsion is
a dermoid cyst.
a papillary serous cystadenocarcinoma.
a papillary pseudomucinous cystadenoma.
an endometrial cyst.
an inflammatory cyst.

Question: 6
A 40-year-old man states that he is feeling somewhat
down and in conflict with his wife. As your history
proceeds, you elicit that he has always been somewhat
rigid; he is a conscientious hard worker at his
employment. You note that he is dressed very neatly
and that, while giving his personal history, he rambles
and gives you all the details. The most likely
personality type is
passive-aggressive.
narcissistic.
obsessive-compulsive.
dependent.
self-defeating (masochistic).

Question: 7
The karyotype of a hydrocephalic infant would likely

show
mosaicism.
nondisjunction.
polyploidy.
translocation.
euploidy.

Question: 8
Which one of the following is the most important initial
task of the doctor doing the psychiatric interview?
make a diagnosis
establish a rapport
give advice
reassure the patient
develop a treatment plan

Question: 9
A 54-year-old woman sustained an anterior wall
myocardial infarction complicated by pulmonary
edema. She is symptomless at discharge from hospital
7 days later. Which one of the following treatments
isINAPPROPRIATE?
propranolol
captopril
acetylsalicylic acid
diltiazem

isosorbide dinitrate

Question: 10
Which one of the following features is of most specific
value in differentiating optic neuritis from papilledema?
swelling of the optic disc
loss of vision
distension of retinal veins
enlargement of the blind spot
blurring of the disc margins

Question: 11
A new test is being evaluated for the diagnosis of a
pulmonary embolus. Studies indicate that a positive
test result has the likelihood ratio of 15, and that a
negative test result has a likelihood ratio of 0.85.
Which one of the following is a correct conclusion?
This test may be helpful for ruling in a pulmonary
embolus.
This test is highly sensitive for pulmonary emboli.
This test will be very helpful in a clinical setting.
This test has a negative predictive value is 85%.
This test is very reliable.

Question: 12
A total of 300 newly diagnosed patients with laryngeal
cancer are allocated to treatment with either surgical
excision alone or surgical excision plus radiation
treatment. This scenario best illustrates which one of
the following?
case series report
case-control study
clinical trial
cohort study
case report

Question: 13
You are seeing a 1-day-old infant and note that she is
jaundiced. Which one of the following would be more
likely to cause kernicterus?
prematurity
breastfeeding
conjugated bilirubin
ABO incompatibility
hepatomegaly

Question: 14

A panic disorder with agoraphobia has been diagnosed

in a 33-year-old patient. Which one of the following
drugs is LEAST likely to be useful in preventing panic
attacks?
clonazepam
paroxetine
alprazolam
buspirone
desipramine

Question: 15
Which one of the following conditions contraindicates
routine childhood immunization?
prematurity
acute illness with an oral temperature over 39 C
antibiotic therapy
living with a pregnant woman
allergy to penicillin

Question: 16
A 35-year-old man suddenly develops a generalized
pruritic macular erythematous rash and fever. Four
days ago he saw his physician because of a sore throat
that started the day before and was started on
penicillin after a throat culture grew beta-hemolytic
streptococci. Laboratory studies now reveal a urea of
14 mmol/L Urinalysis shows no casts, 2 protein,
50 RBC/high power field, and 50 WBC/high power
field. Complete blood cell count is normal except for
eosinophilia (12%). Urine protein concentration is 650

mg/24 h. Which one of the following is the most likely

diagnosis?
acute poststreptococcal glomerulonephritis
membranous glomerulonephritis
polyarteritis nodosa
Schonlein-Henoch purpura
drug-induced interstitial nephritis

Question: 17
The pattern of inheritance in Duchenne muscular
dystrophy is
autosomal recessive.
autosomal dominant.
sex-linked recessive.
sex-linked dominant.
multifactorial.

Question: 18
An 18-year-old woman develops weakness, weight gain,
amenorrhea, abdominal striae, and behavioural
abnormalities. Physical examination reveals lateral visual
field loss. Which one of the following is the most likely
diagnosis?
a functional pituitary tumour
adrenal hyperplasia
anorexia nervosa with bulimia
glioblastoma multiforme

multiple sclerosis

Question: 19
A 9-year old boy who had been suffering from a gait
disturbance for several weeks was found to have a
posterior fossa mass on CT scan. Which of the following
is the most likely cause for these findings?
a berry aneurysm
astrocytoma
medulloblastoma
oligodendroglioma
pseudotumor cerebri

Question: 20
Which type of colonic polyp is most likely to become
malignant?
hyperplastic polyp
tubular adenoma
villous adenoma
Peutz-Jeghers polyp
juvenile polyp
Question: 21

For physicians who understand their task to be the

diagnosis and treatment of significant physical disease,
which one of the following patients would be perceived
as being the most difficult?
a somatizing patient
an emphysematous patient who continues to
smoke
a patient with senile dementia
a patient who requests a second opinion
another physician
Question: 22
Between 7 and 8 years of age, your patient has grown
4.5 cm. His height, however, remains below and
parallel to the 5th percentile. Clinical examination is
entirely normal. His mother is anxious for further
investigations to be undertaken. Which one of the
following would you undertake?
growth hormone secretion using insulin-induced
hypoglycemia
computed tomography scan of the head
thyroid-stimulating hormone (TSH)
24-hour urine collection for cortisol
none of those listed

Question: 23
A 34-year-old female keyboard operator develops pain

axillary nerve
median nerve
ulnar nerve
radial nerve
brachial plexus / triceps muscle

Question: 24
All of the following are more common in the families of
children who are sexually abused, EXCEPT
the family is not well integrated into the local
community.
three generations live under the one roof.
mother delegates homemaking responsibilities to
the children.
a history of sexual abuse in either parents.
a rigid patriarchal family structure.