Anesthesia and Preoperative Medicine

1) An elderly male with pain in his left hip is
scheduled for a hip arthroplasty. He
requests to have a spinal anesthetic. All are
potential complications of a spinal
anesthetic EXCEPT:
a) Hypotension
b) Infection at site
c) Hematoma at site
d) Local anesthetic toxicity
e) Nausea & Vomiting
3) A 24 week pregnant woman is in need of an
emergency appendectomy. All are
physiologic changes in pregnancy EXCEPT:
a) Decreased gastroesophageal sphincter
tone
b) Decreased haemoglobin
c) Decreased coagulation factors
d) Decreased Functional Residual Capacity
e) Decreased Systemic Vascular
Resistance

2) All of the following are contraindications to

spinal anesthesia EXCEPT:
a) Raised intracranial pressure
b) Hypovolemia
c) Coagulopathy
d) Infection at site of needle insertion
e) Kyphosis
ANSWERS

1. E 2. E 3. C
 Cardiology and CVS


1) Each of the following has been shown to 6) Which of the following is not a mechanism
improve mortality in heart failure patients for atrial fibrillation affecting cardiac function:
except: a) Decreased time for diastolic filling
a) Beta blocker b) Decreased ventricular compliance
b) ACEI c) Irregular ventricular response
c) Loop diuretic d) Loss of atrial contraction
d) Aldosterone antagonist e) Decreased time for coronary perfusion
e) Nitrate

7) Dressler's syndrome refers to:

2) Each of the following is a potential
component of the management of both
STEMI and UA/NSTEMI except:
a) PCI
b) ASA
c) Clopidogrel
d) Beta blocker
e) Fibrinolysis
3) Which of the following is not an absolute
contraindication to exercise ECG stress
testing?
a) Acute aortic dissection
b) Acute MI within 2 days
c) Unstable angina not stabilized by
medical therapy
d) Asymptomatic aortic stenosis
e) Symptomatic heart failure not controlled
by therapy
4) According to the newest set of ACC/AHA
Guidelines, which of the following is an
indication for infective endocarditis
prophylaxis before bowel surgery ?
a) Previous infective endocarditis
b) Mitral stenosis
c) Bicuspid aortic valve
d) Prosthetic cardiac valve
e) None of the above
a) Migratory superficial thrombophlebitis
b) The clinical features of myocarditis
c) Delayed pericarditis post MI
d) A preexcitation syndrome similar to
WPW
e) Cardiac myxoma
8) Each of the following is a cause of left axis
deviation except:
a) Left anterior hemiblock
b) Inferior MI
c) WPW
d) RV pacing
e) LBBB
9) Each of the following in and of itself is a
potential indication for AAA repair except:
a) Rate of enlargement 1.0 cm/yr
b) Comorbid HTN, COPD and smoking
c) Size = 5.5 cm in a male
d) Size = 5.5 cm in a female
e) Ruptured aneurysm

5) Each of the following is an ECG feature of

acute MI except:
a) U wave
b) T wave inversion
c) ST depression
d) New LBBB
e) Tall "hyperacute" T waves
10) The subendothelium is the most vulnerable
segment of the heart from an ischemic
standpoint. The major reason for this is:
a) The highest oxygen utilization is in the
subendocardium
b) Coronary flow to the subendocardium
occurs almost completely during diastole
whereas other regions receive some flow
during systole as well
c) The subendocardium has a diminished
aerobic capacity
d) There is less potential for
collateralization to the subendocardium
e) The ratio of capillary to myocyte is less in
the subendocardium than in other
regions
11) Impaired coronary flow reserve is
associated with each of the following
conditions EXCEPT:
a) Severe aortic stenosis
b) Severe systemic hypertension with left
ventricular hypertrophy
c) Severe mitral stenosis in the presence of
atrial fibrillation
d) A totally occluded coronary artery but
with excellent collateral supply from the
contralateral (i.e. opposite) coronary
artery
e) An isolated 30% diameter stenosis of a
coronary artery
12) Which of the following would NOT be part of
your plan for the treatment of acute
ventricular fibrillation?
a) Electrical defibrillation
b) Lidocaine
c) Epinephrine
d) Amiodarone
e) Manganese
13) Which of the following is not an aggravating
factor of congestive heart failure?
a) Hypertension
b) Thyrotoxicosis
c) Alcohol
d) Inactivity
e) Arrhythmia
14) Endocarditis in an I.V. drug user:
a) Is equally prevalent to that of the normal
population
b) Transthoracic Echocardiography is
highly sensitive in diagnosing
c) Is typically caused by S. pneumoniae
d) Is typically found on the tricuspid valve
e) Is typically found on the aortic valve,
producing a systolic ejection murmur
15) Nitroglycerin administered sublingually may
contribute to the relief of myocardial
ischemic pain by each of the following
mechanisms EXCEPT:
a) Coronary vasodilation
b) Decreased venous pooling resulting in
increased cardiac preload
c) Reduced systemic vascular resistance
d) Reduced ventricular volume
16) A 48 year-old male is brought to the ED with
CPR being administered. The ECG shows
electrical activity present but you cannot
palpate a carotid pulse. Which of the
following is not on the differential for
pulseless electrical activity?
a) Alkalosis
b) Hypokalemia
c) Cardiac tamponade
d) Hypothermia
e) Tension pneumothorax
17) Which of the following is not a surgically
correctable cause of hypertension?
a) Aortic coarctation
b) Renal artery atherosclerosis
c) Pheochromocytoma
d) Primary hyperaldosteronism (Conn
syndrome)
e) None of the above
18) Which of the following findings is
inconsistent with cardiac tamponade?
a) Hypotension
b) Pulsus paradoxus
c) Kussmaul sign
d) Jugular venous distension
e) Muffled heart sounds
19) Which of the following is the most common
cardiac manifestation of systemic lupus
erythematosus?
a) Myocarditis
b) Pericarditis
c) Myocardial infarction
d) Mitral valve prolapse
20) Which of the following is false regarding the
clinical findings of significant aortic
stenosis?
a) Cresendo-decresendo systolic murmur
with left ventricular hypertrophy
b) Diminished or absent S2
c) Severe cases cause paradoxical
splitting
d) Parvus-et-tardus carotid upstroke
e) Radiates to axilla
21) All of the following are signs of increasing
severity of AS except:
a) Late peaking of murmur
b) Diminished or absent S2
c) Radiation to carotids
d) Increased apical carotid delay
e) Lack of brachio-radial delay
22) All of the following can lead to elevation of
Troponin except?
a) Myocarditis
b) Hypothyroidism
c) Pulmonary embolism
d) Subarachnoid haemorrhage
e) Extreme exercise
23) All of the following are causes for low
voltage on a 12-lead ECG except?
a) Hypokalemia
b) Pericardial effusion
c) Thick chest wall, barrel chest, COPD,
orobesity
d) Generalized edema
e) Hypothyroidism with myxedema
24) All of the following are causes of left axis
deviation (LAD) on ECG except?
a) Inferior myocardial infarction
b) WPW / pre-excitation / bypass tract
c) Hyperkalemia
d) Mechanical shift: Expiration, high
diaphragm from pregnancy, ascites,
abdominal tumors, etc.
e) Aortic stenosis
25) All of the following are the causes of right
axis deviation (RAD) on ECG except?
a) Right ventricular hypertrophy
b) Right bundle branch block
c) Lateral infarction
d) Hypercalcemia
e) WPW / Preexcitation / Bypass tract
26) All of the following are criteria for the
CHADS2 score for assessing the risk for
stroke among patients with atrial fibrillation
except?
a) Heart Failure
b) High blood pressure
c) History of smoking
d) Over 75 years old
e) Diabetes mellitus
27) When wide complex tachycardia is seen on
an ECG, all of the following signs and
symptoms suggest ventricular tachycardia
(VT) rather than supraventricular
tachycardia (SVT)?
a) Carotid massage and adenosine
terminate the arrhythmia
b) Cannon A waves present on physical
exam
c) History of CAD and previous MI
d) Capture or fusion beats
e) AV dissociation
28) All of the following are causes of prolonged
QT interval except
a) Coronary artery disease
b) Hypercalcemia
c) Sotolol
d) Tricyclic antidepressants
e) Hypothermia
ANSWERS
7. C 13. D 19. B 25. D
1. C 8. E 14. D 20. E 26. C
2. E 9. B 15. B 21. E 27. A
3. D 10. B 16. A 22. B 28. B
4. E 11. E 17. E 23. A (hypocalcemia
5. A 12. E 18. C 24. E causes
6. B prolonged QT)
Clinical Pharmacology
1. Which one of the following statements is
TRUE regarding the biotransformation of
drugs:
a) Cigarette smoke and chronic alcohol
consumption induce P450 enzymes
b) Phase I reactions increase the lipid
solubility of drugs
c) Phenytoin (Dilantin™) is a potent
P450 enzyme inhibitor
d) Phase II reactions decrease the
water solubility of drugs
e) Biotransformation is increased in the
elderly
2. Which of the following statement is FALSE
with respect to pharmacodynamics?
a) Efficacy is a measure of the ability of
a drug to elicit an effect at its receptor
b) Potency is a concentration of a drug
needed to elicit a given effect
c) Agonists are drugs that bind to
endogenous ligands and exert an
effect
d) A partial agonist can be made into full
agonist by increasing its
concentration
e) Antagonists are drugs that have
affinity for its receptor, but no efficacy
ANSWERS

1. A 2. D
 Dermatology
1) A 20-year-old female presented with a
single non-pruritic plaque on her back with
inward pointing scale. She developed
similar smaller papules and plaques on the
back over a one week period. The most
appropriate management is:
a) Topical antifungal
b) Topical antibiotic
c) Oral antifungal
d) Topical corticosteroids as needed
e) Oral antibiotic
2) A 8-year-old black boy presented with a
round, scaly patch of hair loss on the
occipital scalp with scale and occasional
pustules. The most appropriate
management is:
a) Topical antifungal
b) Topical antibiotic
c) Oral antifungal
d) Intralesional corticosteroid injections
e) Oral antibiotic
3) A 29-year-old woman presents with a 5 day
history of arthralgias and a purpuric eruption
on the lower legs. The most appropriate
initial management is:
a) Topical cortyicosteroids
b) Oral corticosteroids
c) Compression of the lower legs
d) Reassurance
e) Urinalysis
4) The following statements regarding contact
dermatitis are true EXCEPT:
a) Phototoxic dermatitis following topical
application of creosote requires UV light
b) Photoallergic contact dermatitis requires
UV light to be manifested
c) Contact eczema involves a type IV
delayed hypersensitivity reaction
d) Contact urticaria or hives is a common
form of dermatitis
e) Chemical burns by HCl and KOH may
result in an irritant contact dermatitis
5) 18 year-old female with initial onset of
pruritic rash characterized by excoriations,
scaling and crusting and distributed on the
extremities, neck and eyelids. Past medical
history is significant for asthma and hay
fever. The most likely diagnosis is:
a) Scabies
b) Atopic dermatitis
c) Contact dermatitis
d) Shingles
e) Dyshidrotic eczema
6) 8 year-old black male comes in with an
asymptomatic erythematous eruption
characterized by oval patches with collarette
scaling. It is distributed as a "Christmas
tree" pattern on the back. Father states that
there was originally one lesion on the
abdomen a few weeks prior. What is the
most likely diagnosis:
a) Pityriasis rosea
b) Tinea corporis
c) Lichen planus
d) Psoriasis
e) None of the above
7) 30 year-old female comes in with a soft
smooth, glistening, erythematous nodule on
her lower lip. She states that a few weeks
prior she had some chapped lips with
occasional bleeding. Now, the lips have
healed but this lesion arose suddenly in its
place. It is occasionally tender on pressure.
The most likely diagnosis is:
a) HSV1
b) Cherry hemangioma
c) Pyogenic granuloma
d) Dermal nevus
e) None of the above
8) An 11 year-old male comes in with 12) Which of the following is associated with
erythematous pustules, inflamed nodules thyroid disease?
and cysts with some scaring distributed on a) Neurofibromatosis
the face predominantly. Diagnosis of acne b) Vitiligo
vulgaris was given. Topical erythromycin c) Erythema nodosum
was used for 2 weeks, several months ago, d) Pemphigus vulgaris
with no response. What treatment would you e) Icthyosis vulgaris
prescribe now?
a) Isoretinoin immediately
b) Topical tretinoin
c) Topical benzoyl peroxide
d) Topical antibiotic other than erythromycin
e) Oral antibiotic
f) Oral antibiotic and topical tretinoin

9) A 40 year-old woman develops recurrent

papules and pustules in a symmetrical
pattern on her cheeks, nose, chin and
forehead. She blushes easily, especially
when consuming hot liquids, alcohol, or
spicy foods. The most likely diagnosis is:
a) Acne vulgaris
b) Perioral dermatitis
c) Acne rosacea
d) Seborrheic dermatitis
e) Carcinoid syndrome

10) Which of the following is not associated with

thyroid disease?
a) Dermatitis herpetiformis
b) Urticaria
c) Porphyria cutanea tarda
d) Vitiligo
e) Alopecia areata

11) All of the following are treatments for non-

scarring alopecia EXCEPT:
a) Spironolactone
b) Minoxidil
c) Hair transplantation
d) Intralesional triamcinalone
e) Finasteride
ANSWERS

1. D 4. D 7. C 10. C
2. C 5. B 8. F 11. D
3. E 6. A 9. C 12. B
 Diagnostic Medical Imaging (Radiology)




1) CXR of a newborn showing a 5) CXR showing tension pneumothorax.
hypodensity in the left side. The child is Separation of visceral and parietal pleura
in respiratory distress. What is your initial (density), hyperlucent small dilated lung,
management? with lack of peripheral lung markings.
a) Needle aspiration of the left lung What is the management?
b) Intubation and ventilation 1 – needle aspiration
c) expectant therapy 2 – chest tube drainage
d) IV N/S bolus 3 – intubation
e) Thoracotomy 4 – air tight dressing
5 – surgery

2) CXR of a neonate few hours after birth. The a) 1 and 4

x-ray showing a full abdominal and chest b) 3 and 5
view. The abnormality in the chest is of a c) 1 and 2
large dense central shadow, which may d) All of the above
represent an infiltration in the lungs or a e) None of the above
large heart. The child is 32-wk gestation and
soon after birth he developed RDS. What is
your diagnosis? 6) CXR showing hyperlucent left lung
a) Hyaline membrane disease with mediastinal shift. The child is
b) Congenital heart disease coughing and wheezing. What is the
c) Pneumonia diagnosis?
d) Persistent fetal circulation a) TB infection
b) Pneumonia
c) Left hyperlucent lung syndrome
3) Knee x-ray of a 2-yr old child who has not (Swyer-James syndrome)
walked yet. It shows the tibia, which has d) Influenza
wide cupping at its proximal end and
obscure metaphysial plate. There is no
significant family history of any disease. 7) 5 yo child with stridor and respiratory
What is wrong with the child? distress. X-ray shows thumb sign. What is
a) Rickets the diagnosis?
b) Achondroplasia a) Acute epiglottitis
c) Hyperparathyroidism b) Acute asthma attack
d) Hypercalcemia c) Retropharyngeal abscess
d) Tracheo-laryngo-bronchitis

4) 4. 35yo pt with recurrent hemoptysis

and CXR with middle lobe infiltration. 8) Which of the following radiation has the
The most likely diagnosis is: deepest penetration in human tissue:
a) Bronchiectasis a) Alpha
b) Lung abscess b) Gamma
c) Chronic bronchitis c) X-ray
d) Emphysema d) Delta
e) UV
9) Patient fell on his hand, emergency x-ray
was normal, but the patient complained of
pain during wrist abduction. What is the
proper management?
a) Explain to him that the pain will
disappear after 2 weeks, its normal.
b) Bandage
c) Short cast plus x-ray in 15 days
d) NSAID's
10) Patient after big operation develops sudden
dyspnea, chest pain, the most likely finding
on chest x-ray is:
a) Air under diaphragm
b) Kerly B lines
c) Perihilar hyperdensity
d) Normal
e) Cardiomegaly
11) Patient with lower back pain, x-ray: anterior
osteophytes at L4-L5 and subchondral
sclerosis, diagnosis:
a) Degenerative spondylitis
b) Ankylosing spondylitis
c) Osteoarthritis
d) Rheumatoid arthritis
12) A 23 year old patient has a single thyroid
nodule. Which of the following will help
make a diagnosis of a malignancy?
a) Thyroid ultrasound
b) Cold nodule on thyroid scan
c) Hot nodule on thyroid scan
d) CT cervical spine
13) Child has stridor, fever, and a swollen,
painful neck. What investigation will you
order?
a) CT scan of the neck
b) Lateral neck x-ray
c) C-spine x-ray
d) MRI
14) Which investigation is confirmatory for IBD?
a) Barium enema
b) Colonoscopy
c) CT
d) MRI
15) A 70-year-old man is seen in your office for
assessment one week after experiencing a
brief episode of left arm and left facial
weakness. Blood pressure in your office is
140/80 mmHg. A CT scan showed no
evidence of hemorrhage or space-occupying
lesion. An EKG shows normal sinus rhythm.
Which one of the following is the most
important investigation to order at this time?
a) An magnetic resonance imaging (MRI) of
the brain
b) An echocardiogram
c) Cerebral angiography
d) A chest x-ray
e) A carotid artery ultrasound
16) A 75 year old man fell down and injured his
head. He is awake and not complaining of
neck pain. What investigation are you going
to do first?
a) CT of the head
b) MRI of the head
c) X-ray Skull
d) C-spine x-ray
17) Which of the following are NOT radiological
features of Rheumatoid Arthritis?
a) Soft tissue swelling
b) Periarticular Osteopenia
c) Bony erosions
d) Osteophytes
e) Joint subluxation
18) Which of the following can result in a ring- 19) A 75 year old man fell down and injured his
enhancing lesion on CT? head. He is unconscious. What investigation
1 – Brain metastases are you going to do first?
2 – Brain abscesses a) CT of the head
3 – High grade astrocytomas b) MRI of the head
4 – Demyelination c) X-ray Skull
d) C-spine x-ray
a) 1, 2 and 3 only
b) 1 and 2 only
c) 1, 2 and 4 only
d) 1 and 4 only
e) All of the above
ANSWERS

1. B 5. C 9. C 13. B 17. D
2. D 6. C 10. D 14. B 18. E
3. D 7. A 11. A 15. E 19. D
4. A 8. C 12. B 16. A
 Emergency Medicine




1) A 27 year-old man is brought into the ER 4) Prolonged vomiting is associated with what
after a bicycling accident. A car door electrolyte abnormality?
suddenly opened in front of him, of which he a) Hypochloremic hypokalemic metabolic
smashed into and was thrown 15 feet. On acidosis
examination, he is drowsy and confused. He b) Hypochloremic hypokalemic metabolic
opens his eyes when his name is called. He alkalosis
mumbles words that you understand but the c) Hyperchloremic metabolic acidosis
sentences do not make sense. He moves all d) Hyperkalemia
four limbs but does not respond to any e) None of the above
commands. He is able to pull both hands
away when pinched and squirms when his
sternum is rubbed, making no effort to stop 5) A 37 year-old male arrives at the
you. What is his Glasgow COMA Scale Emergency Department unconscious. He is
score? warm and sweaty. His heart rate is 52 bpm,
a) 10 his BP is 90/60. His pupils are constricted,
b) 11 his eyes are teary, and he is drooling. You
c) 9 assume he is suffering from a toxidrome.
d) 8 What antidote will you give him?
e) 7 a) Flumazenil
b) Naloxone
c) Glucagon
2) Which of the following are not consistent d) Atropine
with primary (spontaneous) bacterial e) Ethanol
peritonitis?
a) Abdominal discomfort and fever
b) Ascitic fluid neutrophil count of> 250x106 6) A 16 year-old girl is brought to hospital by
cells/L her frantic parents after a bee sting. Vitals
c) Ascitic fluid WBC count of >500x106 signs are BP 70/40, RR 30 and laboured,
cells/L HR 140, T 37.5. Which of the following
d) Multiple organisms on culture and would not be an option in her management?
sensitivity of ascitic fluid a) Epinephrine
b) Diphenhydramine
c) Methylprednisolone
3) A 25 year-old known substance abuser is d) Salbutomol
brought to the ED with a suspected e) Atropine
overdose. Which of the following is not
considered a universal antidote?
a) Glucose 7) Tension pneumothorax is best diagnosed
b) Oxygen with:
c) Calcium gluconate a) Stat CT scan
d) Naloxone b) Chest x-ray
e) Thiamine c) Watch and wait
d) Clinical exam
e) None of the above
8) A patient presents with decreased level of
consciousness. On exam he has pinpoint
pupils and is unresponsive. Which of the
following is NOT a likely etiology?
a) Cerebellar infarct
b) TCA overdose
c) Morphine overdose
d) Pons hemorrhage
e) Ethanol overdose

9) A 41 y/o male alcoholic is brought into the

ED by ambulance. He has been seizing for
approximately 20 minutes. Appropriate
actions in the next 5 minutes may include all
of the following EXCEPT:
a) Endotracheal intubation, if unable to stop
the seizure rapidly
b) Administration of IV anticonvulsants
c) Performing a complete set of vital signs
d) Ordering a stat EEG
ANSWERS

1. A 3. C 5. D 7. D 9. D
2. D 4. B 6. E 8. B
 Endocrinology
1) A 76 year old man from a nursing home is
brought into the emergency department
after staff notice a decreased level of
consciousness. He has Type II diabetes
mellitus and is diagnosed with
hyperosmolar state. All of the following
may be features of hyperosmolar state
EXCEPT:
a) Hyponatremia
b) Positive ketones on urine dipstick
c) Positive glucose on urine dipstick
d) Elevated blood glucose level
e) History of decreased fluid intake
2) All of the following are complications of
diabetes mellitus EXCEPT:
a) Retinal detachment
b) Gangrene in the feet
c) Calcification of cartilage
d) Abdominal bloating
e) Urinary retention
3) A 37 year old female is referred to you, an
endocrinologist, because she is concerned
about her weight. She is obese with a BMI
of 35.2. On her last physical, her family
doctor found her LDL level to be extremely
elevated. Her only medications are
acetaminophen PRN for headache and
quetiapine, which she has been taking for
the past several years for anxiety and to
help her sleep at night. As you chat with
her, you learn she has never married and
never had any children. In fact, she admits
to having few social supports. Apparently,
she has had poor self esteem since she
was young because of unwanted hair
growth and obesity. She agrees that she
uses food for comfort. Which of the
following statements apply to this case?
a) She is at risk for osteoarthritis in the
future
b) You should order gonadotropin levels in
her
c) She should be referred to a dietician
d) She should be started on cholesterol
lowering medications immediately
e) With such a high BMI, she should be
initiated on orlistat (pancreatic lipase
inhibitor) immediately
4) A patient complains of a non-tender mass
over the thyroid region on the left side of
her neck. Concerned about a thyroid
disorder, you order the appropriate
investigations. The results are as follows:
TSH: 6.0
Free T4: 20.2
Thyroid antibodies: none
RAIU: No “hot” spots seen
The next investigation(s) you choose to
do are:
a) Watch and wait for 3-6 months
b) FNA
c) Surgical biopsy
d) Trial of L-thyroxine therapy for 6 months
e) None of the above
5) An 8 year-old boy is brought to the office
because his mother is concerned he is
entering puberty already. You examine him
and note the beginnings of facial hair,
axillary hair and Tanner stage 2 external
genitalia. Choose the set of investigations
you initially want to do:
a) CBC, lytes, testosterone, bone age, CT
head
b) FSH, LH, testosterone, lytes, bone age,
DHEA-S
c) FSH, LH, testosterone, cortisol, DHEA-
S, 11-OH progesterone, bone age
d) Lytes, testosterone, DHEA-S, 17-OH
progesterone, cortisol, bone age
6) In the course of DKA, serum potassium
levels:
a) Remain unaffected
b) Can appear normal but total body
potassium may actually be low
c) Can appear normal but total body
potassium may actually be high
d) Will naturally be corrected by insulin
administration
e) None of the above
7) The “triple bolus” test of pituitary function
works by a rapid succession of IV
constituents as follows:
a) insulin – hypoglycemia mediated rise in
GH and ACTH
GHRH – rise in LH and FSH
TRH – rise in TSH and PRL
b) CRH – rise in GH and ACTH
GHRH – rise in LH and FSH
TRH – rise in TSH and PRL
c) estrogen – rise in LH, drop in FSH and
PRL
insulin – rise in GH and ACTH
TRH – TSH
d) cortrosyn – rise in GH and ACTH
GHRH – rise in LH and FSH
TRH – rise in TSH and PRL
8) A 58 year-old man with a past history of a
parathyroidectomy for primary
hyperparathyroidism is now in your office
complaining of headaches worse in the AM
(made worse by a small MVA he credits to
a loss of peripheral vision). You plan to:
a) Send to the Emergency Department for
an immediate CT head
b) Check his calcium to ensure there’s no
remaining parathyroid tissue
c) Check for a pheochromocytoma (which
you know causes H/As) because you
are concerned he has MEN I syndrome
d) Check for a homonymous hemianopia
because you are worried about a
pituitary tumor
e) Check for a bitemporal hemianopia
because you are worried about a
pituitary tumour
9) In the treatment of Type I Diabetes, which
of the following is true?
a) Sulfonylureas are useful as an
adjunctive therapy to insulin
b) Most patients are adequately controlled
with one type of insulin (non-mixed) only
c) Once diagnosed with Type I, patients
must immediately be assessed for
retinopathy
d) During periods of illness or infection,
patients may require additional insulin
e) The most common initial presentation is
visual disturbance
10) In the diagnosis and treatment of
dyslipidemia, which of the following is
false?
a) Men over age 40 and women over age
50 should be screened to obtain a
fasting lipid profile
b) Treatment with a statin is the treatment
of choice for patients with elevated LDL
c) Treatment with niacin or fibrate is the
treatment of choice for patients with
primarily elevated triglyceride level
d) Patients identified with dyslipidemia
should all meet the target LDL < 2.5
mmol/L and target TC/LDL < 4.0
e) A baseline CK before the start of statin
treatment should be obtained, and a
patient complaining of myalgia and
currently on a statin requires a repeat
CK level
ANSWERS

1. B 3. E 5. D 7. D 9. D
2. C 4. B 6. D 8. E 10. D
 Ethical, Legal and Organizational
1) To qualify for federal contributions,
provincial health insurance plans must
guarantee all of the following, EXCEPT:
a) Benefits include all necessary hospital
care and physicians' services
b) Universal coverage on uniform terms
and conditions
c) Portability of coverage from province to
province
d) Benefits include all necessary out-of-
hospital drugs, dental care and
prostheses
e) Administration on a non-profit basis
2) 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) A person has bizarre fantasies and
actions
b) Persons are mentally incompetent and
unable to manage their own affairs
c) A close relative submits a petition that
an individual is actually and presently
insane
d) The individual's continued liberty poses
a danger to themselves and/or to others
e) A person has visual and aural
hallucinations
3) In which one of the following situations
would it be unethical for the psychiatrist to
break confidentiality and notify the
authorities?
a) The psychiatrist believes that the patient
will probably commit murder
b) The psychiatrist believes that the patient
is actively suicidal
c) The patient has severely impaired
judgement and is in a responsible
position, e.g. an airline pilot
d) The patient has aggressive fantasies.
e) The patient has taken a significant
overdose
4) Which one of the following would justify a
patient's being declared incompetent with
respect to self care?
a) The patient has a major mental disorder
b) The patient has been admitted to
hospital
c) The patient is undergoing
psychotherapy
d) The patient is unable to understand the
consequences of his/her decisions
e) The patient is unable to work because of
a mental disorder
5) Concerning a physician's obligation to
provide due care to a patient, which one of
the following is correct?
a) Beneficence is a moral commitment but
not a legal obligation to the well-being of
the patient
b) Respecting autonomy is both a moral
commitment and a legal obligation to the
patient
c) A physician can be found guilty of
negligence even if he/she has acted in
accordance with a practice acceptable
to a responsible body of peers
d) Unanimity of practice is expected of
physicians
e) Where patient outcomes are poor,
physicians may have their practices
scrutinized by the courts but not by peer
organizations
6) Which of the following is not an element of
valid consent?
a) The patient arrives at his/her decision
voluntarily and without coercion
b) The patient is able to understand the
information and appreciate the
consequences of the decision
c) Consent is obtained in a written record
d) The consent is specific to the proposed
procedure and to the provider(s) of care
e) All information regarding the proposed
intervention, including very remote or
unlikely risks of the intervention, have
been discussed
7) You want to embark on a clinical trial of a
new drug for your research project and the
manufacturer of this drug has offered to
fund your trial. Which of the following
violates an ethical principle for human
research in this situation?
a) Obtaining informed consent personally
from your patients
b) Arranging for adverse effects and data
safety to be monitored by the drug
manufacturer
c) Authoring the trial results
d) Writing the study proposal for your
hospital's Research Ethics Board
e) Disclosing the source of funding and the
nature of your participation in this
research to prospective patients
10) Which one of the following is NOT a
necessary element of legally valid consent?
a) Consent must be given voluntarily by the
patient/patient’s agent
b) The consenting individual must be
deemed capable to give consent
c) Consent must be specific to the
proposed intervention
d) Consent must be written and signed by
the patient/patient’s agent
e) The patient/agent must be reasonably
informed of the risks and benefits of the
proposed intervention

8) All of the following regarding substitute

decision makers are false, EXCEPT:
a) A physician can ask for a substitute
decision maker to make a decision for a
capable patient
b) Substitute decision makers may override
wishes that the patient previously
expressed while still capable
c) Substitute decision makers need to be a
relative of the patient for whom the
decision is being made
d) A physician can appeal to a Consent
and Capacity Board if s/he feels the
substitute decision maker is not acting in
the patient's best interests
e) Informed consent cannot be obtained
from a substitute decision maker

9) Which of the following circumstances is not

automatically reported to the appropriate
authority?
a) Suspected child abuse
b) Suspected domestic violence among
adults
c) A death that occurs during pregnancy
d) A case of Chlamydia
e) A driver with new seizure disorder
ANSWERS

1. D 3. D 5. A 7. B 9. B
2. D 4. D 6. C 8. C 10. D
 Family Medicine




1) For anxiety, each of the following 5) A patient presents to the office requesting
pathologies should be considered in the assistance with quitting smoking. You are
differential EXCEPT: considering prescribing buproprion.
a) Arrhythmia Contraindications to this prescription include
b) Asthma/COPD all of the following EXCEPT:
c) Drug-induced a) Concurrent use of nicotine replacement
d) Acute renal failure therapy
e) Pheochromocytoma b) Seizure disorder
c) Eating disorder
d) Previous anaphylactic reaction to
2) A poor response to anti-hypertensive buproprion
therapy could be attributed to each of the e) MAOI use in the past 14 days
following EXCEPT:
a) Suboptimal regimen (e.g. insufficient
dose, inappropriate combination) 6) You suspect that a patient may have
b) Poor compliance developed a drinking problem over the last
c) Oral contraceptives few years, so decide to order some
d) Licorice bloodwork. All of the following are in keeping
e) Low sodium diet with your suspicions EXCEPT:
a) Elevated GGT
b) Elevated platelets
3) Which statement is correct regarding fecal c) Elevated AST
occult blood testing? d) Decreased hemoglobin
a) Every 1 to 2 years starting at 40 years e) Increased INR
old for the general population
b) Every 1 to 2 years starting at 50 years
old for the general population 7) The following is TRUE with regards to
c) Every 3 to 5 years starting at 55 years asthma:
old if a family history of colorectal cancer a) Onset typically occurs > age 10
d) Every 5 years starting at 50 years old for b) It is a restrictive airway disease
the general population c) Warm air is a common asthma attack
e) Unnecessary if the patient has ever had precipitator
a colonoscopy d) Symptoms are due to bronchial
inflammation and bronchodilation
e) Chest x-ray is often normal
4) Which of the following is NOT a major risk
factor for coronary artery disease?
a) Smoking 8) Patient SL presents with symptoms typical
b) Hypertension of a common cold. The organism most likely
c) Sedentary Lifestyle to be responsible is:
d) Family History a) Respiratory syncitial virus
e) Diabetes b) Parainfluenza virus
c) Adenovirus
d) Rhinovirus
e) Coxsackie virus
9) Which of the following is NOT a selective
serotonin reuptake inhibitor?
a) Venlafaxine
b) Paroxetine
c) Fluoxetine
d) Sertraline
e) Citalopram
10) Which of the following IS a diagnostic
criteria for diabetes mellitus?
a) HbA1c greater than 6%
b) Fasting blood glucose greater or equal to
6.0 mmol/L
c) Random blood glucose greater than 10
mmol/L
d) Blood glucose 2 hours post OGTT
greater than 10 mmol/L
e) HbA1c greater or equal to 7%
12) Mrs. HA presents to your office for the first
11) Which of the following is NOT TRUE when
considering treatment of a patient with
dysuria?
a) Risk factors for complicated UTIs include
male sex, indwelling catheter and
immunosuppresion
b) Patients should always be treated for
both gonorrhea and chlamydia, even if a
positive result for only one of these is
obtained
c) Prophylactic antibiotics may be
considered in a patient with recurrent
UTIs (>3 per year)
d) Pregnant women with bacteruria should
not be treated if asymptomatic
e) In adulthood, dysuria is more common in
women than men
time complaining of headaches. Of the
following symptoms, which is the LEAST
worrisome?
a) Sudden onset of severe headache
b) Headache is accompanied by nausea
and vomiting
c) Headache is present on awakening
d) New onset headache > 50 years of age
e) Headache accompanied by neck
stiffness
ANSWERS

1. D 4. C 7. E 9. A 11. D
2. E 5. A 8. D 10. E 12. E
3. B 6. B
Gastroenterology

1. Which one of the following is not a 5. Which of the following statements

symptom of Vitamin A deficiency? regarding esophageal and stomach
a) Keratomalacia disorders is false?
b) Poor wound healing a) Epigastric pain may be due to MI,
c) Osteomalacia so an ECG should be obtained in
d) Night blindness all elderly patients with epigastric
discomfort
b) H. pylori is a common, treatable
2. Which one of the following is not a cause of PUD
symptom of folic acid deficiency? c) Upper GI bleeding in most
a) Megaloblastic anemia patients stops spontaneously
b) Glossitis d) All patients with GI bleeding
c) Diarrhea should be risk stratified for proper
d) Neuropathy management and disposition
e) None of the above

3. Which of the following clotting factors is

dependent on Vitamin K? 6. Which of the following is/are considered
a) II risk factors for mesenteric ischemia?
b) VII a) Age greater than 50 years
c) IX b) Valvular or atherosclerotic heart
d) X disease
e) All of the above c) Recent MI
d) Critical illness with hypotension
or sepsis
4. Which of the following is not among the e) All of the above
most common deficiencies associated
with intestinal disease?
a) Folate 7. Which is the least common cause of
b) Calcium lower GI bleed in patients ≥ 60 years of
c) Vitamin B12 age?
d) Zinc a) Diverticulosis
e) None of the above b) Ischemic Bowel
c) AVM
d) Carcinoma
e) thrombocytopenia

8. Which of the following procedures

cannot be done with endoscopy?
a) Thermal Coagulation
b) Injection of alcohol, adrenaline, or
sclerosing agents
c) Variceal band ligation
d) Argon plasma coagulation
e) All of the above can be
performed through endoscopy
9. Which of the following provisions may
be necessary when transfusing blood or
blood products?
a) IV Calcium Gluconate
b) Platelets
c) FFP
d) All of the above
10. When UGI bleed is caused by PUD,
which of the following correlates best
with rebleeding
a) More than one ulcer at
endoscopy
b) Nonbleeding visible vessel
c) Adherent clots
d) Spurting bleeding at time of
endoscopy
e) Pigmented spot at endoscopy
11. What is the most common pathogenesis
of reflux?
a) Hiatus hernia
b) Decreased lower esophageal
sphincter pressure
c) Increased intra-abdominal
pressure
d) Delayed gastric emptying
e) Transient lower esophageal
sphincter relaxations
12. Which of the following statements is
wrong about Barrett’s esophagus?
a) It is a metaplastic process
resulting in replacement of
squamous epithelium with
columnar epithelium
b) Tobacco and alcohol abuse are
risk factors for the development
of Barrett’s esophagus
c) Adenocarcinoma may arise in
Barrett’s esophagus
d) Highest incidence of Barrett’s
esophagus is among Blacks.
e) None of the above
13. What is the most common benign tumor
of esophagus?
a) Fibroma
b) Lipoma
c) Leiomyoma
d) None of the above
14. What is the treatment of choice for
esophageal infection with herpes virus?
a) Ganciclovir
b) Acyclovir
c) Ketoconazole
d) Fluconazole
15. Which of the following tests are helpful
in evaluating RLQ pain?
a) WBC count > 10000
b) Urinalysis
c) B-HCG
d) Abdominal CT
e) All of the above
16. What is the most specific clue in the
diagnosis of acute appendicitis?
a) Pain over McBurney’s point
b) Leukocytosis
c) RLQ pain
d) Anorexia
17. What is the most common cause of non-
erosive gastritis?
a) Lymphocytic gastritis
b) Atrophic gastritis
c) Celiac Sprue
d) H. pylori
18. What should be suspected when a
gastric ulcer is refractory to appropriate
medical management?
a) Gastric cancer
b) Surreptitious NSAID use
c) Persistent H. pylori infection
d) Acid hypersecretory state
e) All of the above
19. What are the common metastatic sites 24. What is malabsorbed after distal bowel
for gastrinomas? resection?
a) Kidney a) Ca
b) Lung b) Folic acid
c) Bone c) Vitamin B6
d) A + B d) Vitamin B12
e) B + C e) C + D

20. Which of the following statements is 25. Which of the following conditions favor
false? small bowel bacterial growth?
a) Most patients with acute diarrhea a) Diabetic gastroparesis
require antibiotics b) Hypochlorhydia
b) Correction of fluid and electrolyte c) AIDS
imbalance is the first step in the d) Fistula between large and small
treatment of acute diarrhea bowel
c) Antimotility agents should be e) All of the above
used with caution in the treatment
of diarrhea in IBD patients
d) Enteric salmonella infection must 26. Which of the following laboratory
be treated with antibiotics findings is least likely to be found in the
e) None of the above setting of malabsorption?
a) Iron deficiency
b) Ca deficiency
21. Which of the following must be avoided c) B12 deficiency
in patients with celiac sprue? d) Decreased PT
a) Wheat e) None of the above
b) Barley
c) Rye
d) Oats 27. Which of the following is likely in
e) All of the above untreated malabsorption?
a) Steatorrhea
b) Night blindness
22. What diseases are associated with c) Bone pain
celiac sprue? d) Glossitis
a) IDDM e) All of the above
b) Autoimmune thryoiditis
c) Dermatitis herpetiformis
d) IgA deficiency 28. Which of the following is least common
e) All of the above in IBS?
a) Mucus on the stool
b) Bloating
23. What is malabsorbed after proximal c) Sensation of incomplete fecal
bowel resection? evacuation
a) Ca d) Abdominal pain worsens after a
b) Folic acid bowel movment
c) Iron e) Alternating diarrhea and
d) None of the above constipation
e) All of the above
29. Which of the following extraintestinal 33. Which of the following is not a major
manifestations of IBD occurs cause of acute hepatitis?
independently of intestinal disease a) Hepatitis A
activity? b) Epstein-Barr virus
a) Uveitis c) CMV
b) Episcleritis d) Toxin exposure
c) Erythema nodosum e) None of the above
d) Peripheral arthritis (e.g. knee)
e) Primary sclerosing cholangitis
34. Which patients with hepatitis should be
admitted?
30. Which of the following constitutes the a) Coagulopathic patients
ED management of IBD? b) Patients who are actively
a) Analgesia bleeding
b) Sulfasalazine c) Encephalopatic patients
c) Steroids d) Those whose social situation
d) Antidiarrheal agents would make proper care difficult
e) All of the above e) All of the above

31. Which of the following statements is true
of bowel disorders?
a) Appendicitis is a common
condition with unusual
presentations; therefore, always
consider appendicitis in a patient
with abdominal pain
b) A patient with atrial fibrillation and
abdominal pain has mesenteric
ischemia until proven otherwise.
c) IBD can cause complicated rectal
abscesses or fissures which may
require surgical consultation
d) Postoperative adhesions,
incarcerated hernias and cancer
are the most common causes of
small bowel obstruction
e) All of the above
35. Which of the following constitutes the
mainstays of treatment in hepatic
encephalopathy?
a) Supportive care
b) Lactulose
c) Neomycin
d) Low-protein diet
e) All of the above
36. Which of the following is a complication
of chronic liver disease?
a) Spontaneous bacterial peritonitis
b) Esophageal varices
c) Increase risk of bleeding
d) Hepatorenal syndrome
e) All of the above

37. Which of the following is not a cause of

32. Which of the following are common acute pancreatitis?
ultrasound findings of cholecystitis? a) Hypercalcemia
a) Presence of gallstones b) Mumps
b) Gallbladder wall thickening > 3 c) Gallstones
mm d) Erythromycin
c) Pericholecystic fluid e) None of the above
d) Common bile duct dilatation > 6
mm
e) All of the above
38. Which of the following is not among the 43. Which of the following is not associated
common laboratory findings in acute with HCV infection?
pancreatitis? a) IV drug abuse
a) Elevated serum amylase b) Poverty
b) Elevated serum lipase c) High risk sexual behaviour
c) Leukocytosis d) Perinatal transmission
d) Hypoglycemia e) None of the above
e) Hypocalcemia

44. What is the leading cause of

39. Which of the following is not a mode of transfusion-related hepatitis?
transmission for HBV? a) Hepatitis A
a) Sexual contact b) Hepatitis B
b) Percutaneous c) Hepatitis C
c) Blood product transfusion d) Hepatitis D
d) Perinatal e) Hepatitis E
e) Fecal-oral

45. Which of the following increase the rate

40. Which of the following is an extrahepatic of progression to cirrhosis in HCV
manifestation of chronic HBV infection? infection?
a) Serum sickness a) Alcohol consumption
b) Glomerulonephritis b) Male sex
c) Aplastic anemia c) Older age at infection
d) Polyarteritis nodosa d) Co-infection with HIV
e) All of the above e) All of the above

41. Interferon is commonly used in the 46. Which of the following drugs can cause
treatment of chronic HBV infection. liver injury via direct toxicity?
Which of the following is a a) Ethanol
contraindication to interferon therapy? b) Acetaminophen
a) Decompensated liver disease c) Methotrexate
b) Autoimmune diseases d) Azathioprine
c) Active alcohol use e) All of the above
d) Pregnancy
e) All of the above
47. Which of the following laboratory tests
are important in cases of
42. Who should receive the hepatitis B acetaminophen toxicity?
vaccine? a) Liver enzymes
a) All infants b) PT_INR
b) Travelers at risk c) BUN/Creatinine
c) After sexual exposure to HBV d) Arterial blood gas
d) Patients with chronic liver e) All of the above
disease not caused by HBV
e) All of the above
48. Which of the following patient groups is 49. What are the most common primary
at higher risk of getting Primary Biliary benign liver tumors?
Cirrhosis? a) Hemangioma
a) Infants b) Adenoma
b) Elderly male c) Fibroma
c) Elderly female d) A + B
d) Middle-age female e) B + C
e) None of the above

50. Which of the following is an accepted

indication for liver transplantation?
a) Acute liver failure
b) Hepatocellular carcinoma
c) HCV liver disease
d) When no acceptable alternative
forms of therapy exist
e) All of the above
ANSWERS

1. C 12. D 23. E 34. E 45. E

2. D 13. C 24. D 35. E 46. E
3. E 14. B 25. E 36. E 47. E
4. E 15. E 26. D 37. E 48. D
5. E 16. A 27. E 38. D 49. D
6. E 17. D 28. D 39. E 50. E
7. E 18. E 29. E 40. E
8. E 19. E 30. E 41. E
9. D 20. A 31 E 42. E
10. D 21. E 32. E 43. D
11. E 22. E 33. E 44. C
 General Surgery




1) Which of the following is NOT an indication 7) Which anastamosis is NOT present in a
for urgent operation whippple procedure?
a) Pulsatile abdominal mass, abdominal a) Gastrojejunostomy
pain, and hypotension b) Hepaticojejunostomy
b) Pancreatitis c) Choledochjejunostomy
c) Strangulated Hernia d) Pancreaticojejunostomy
d) Cecal Volvulus

8) Indications for operative intervention rather

2) Which of the following is a BENIGN tumor of than conservative management for arterial
the liver? insufficiency include all the following
a) Adenoma EXCEPT:
b) Angiosarcoma a) Nocturnal limb pain
c) Hepatoblastoma b) Ischemic ulceration
d) Hepatocellular carcinoma c) Absent pulse
d) Ischemic neuropathy
e) Toe gangrene
3) What is NOT part of Charcot's Triad?
a) Fever
b) Shock 9) Surgical indications for diverticula include all
c) Right upper quadrant pain of the following EXCEPT:
d) Jaundice a) Peritonitis
b) Persisting hemorrhage
c) Fistula
4) Which is an indication for operation in d) Greater than two severe attacks
Diverticulitis e) Palpable abdominal mass in left lower
a) Hinchey Stage 3 quadrant
b) Previous appendiceal phlegmon
c) After 1 attack in an otherwise healthy
individual 10) Six days following a hemicolectomy for
d) Patient preference colorectal carcinoma, a 54 year-old woman
experiences calf pain unilaterally. On
physical examination, the affected side has
5) What is NOT on the differential diagnosis of a greater diameter than the other, and there
acute appendicitis? is tenderness to palpation. Which of the
a) Ovarian torsion following investigations would be the next
b) Dicerticulosis step?
c) Crohns disease a) Venogram
d) Ulcerating colon cancer b) Compression venous Doppler flow
studies
c) X-ray of the affected calf
6) Which of the following neoplasms is NOT d) Ventilation/perfusion scan
associated with HNPCC? e) Compartment pressure monitoring
a) Gastric
b) Renal
c) Pancreatic
d) Endometrial
11) Which of the following radiologic abdominal
plain film findings are consistent with
mechanical bowel obstruction:
a) A "step ladder" pattern
b) Dilated small bowel loops
c) Absence of gas in large bowel
d) Rows of small gas accumulations in
valvulae conniventes (i.e. "string of
pearls")
e) All of the above are true
12) After a weekend of heavy drinking, a 28
years-old male presents with abdominal
pain radiating to the back. What is the
investigative and prognostic modality of
choice for the suspected diagnosis?
a) Abdominal ultrasound
b) Abdominal CT
c) Abdominal plain film
d) Endoscopic retrograde
cholangiopancreatography
e) Laparoscopy
13) Which of the following is associated with
biliary colic?
a) Epigastric pain
b) Rebound tenderness
c) Jaundice
d) Murphy sign
e) All of the above
14) Which of the following is false regarding
post operative wound infections?
a) S. aureus is the most common cause
b) Usually present with fever post-op day 3-
4
c) Increased likelihood in diabetics
d) Mainly treated with antibiotics
e) Risk increases with length of surgery
15) Which of the following signs and symptoms
warrant surgical intervention for patients
with small bowel obstruction?
a) Abdominal tenderness
b) Air-fluid levels on abdominal x-ray
c) Worsening abdominal pain
d) Feculent vomitus
e) Air in the colon and rectum on abdominal
x-ray
16) A 59 year-old woman presents to her family
physician with a 3 cm palpable, well
circumscribed, non-tender breast mass. She
first noticed it several months ago and
believes it has increased in size since then.
Her mother and maternal aunt were
diagnosed with breast cancer in their early
50's. She has no other health complaints. A
subsequent mammogram shows no
abnormalities. Which of the following is the
next most appropriate step in management?
a) Prophylactic mastectomy
b) Repeat mammogram in 6 months
c) Repeat mammogram in 1 year
d) Core needle biopsy
e) Ultrasound
17) Which of the following is false regarding
pancreatic pseudocysts?
a) It is caused by duct leakage
b) Clinically suspected if persisting pain > 2
weeks following diagnosis of acute
pancreatitis
c) Majority are treated surgically
d) Surgical intervention is typically delayed
to allow pseudocyst to mature
e) Lacks true epithelium
18) An overweight, 45 year-old man presents 23) Which of the following accounts for the
with left lower quadrant tenderness and a change in pain pattern for appendicitis?
one week history of abdominal pain, loose a) Parasympathetic  Sympathetic
non-bloody stools and worsening fever. b) Sympathetic  Parasympathetic
Laboratory investigation yields leukocytosis c) Somatic  Visceral
with neutrophilia and left shift. What is the d) Visceral  Somatic
diagnostic modality of choice? e) None of the above
a) CT scan
b) Barium enema
c) Ultrasound 24) Which of the following statements is not true
d) Plain abdominal film regarding inguinal hernias:
e) Angiography a) A direct inguinal hernia occurs due to a
weakness in the transversalis fascia
b) Cooper’s ligament is an important
19) Risk factors for hepatocellular carcinoma surgical landmark in the repair of an
include all of the following EXCEPT: inguinal hernia
a) Hepatitis A c) Direct inguinal hernias are more
b) Cirrhosis common in boys
c) Exogenous steroid use d) A pantaloon hernia is a combined direct
d) Hemochromatosis and indirect inguinal hernia
e) Smoking e) An inguinal hernia involving the appendix
is known as an Amyand’s hernia

20) Which of the following is NOT a cause of

major lower gastrointestinal hemorrhage? 25) Which of the following is not true regarding
a) Diverticulitis thyroid carcinoma?
b) Angiodysplasia a) Family history and/or history of radiation
c) Aortoenteric fistula to the neck are indications for immediate
d) None of the above excision
b) These nodules are typically hot on iodine
scan
21) Of the following, the greatest risk factor for c) Symptoms may include voice changes or
breast cancer is? dysphagia
a) Age (>40 y.o.) d) Papillary is the most common subtype
b) >5 years HRT
c) Menarche < 12 y.o.
d) Nulliparity 26) All of the following are manifestations of
portal hypertension except:
a) Splenomegaly
22) Which of the following is not a characteristic b) Esophageal varices
suggestive of melanoma? c) Hemorrhoids
a) Diameter >6mm d) Caput medusae
b) Lack of symmetry e) Bowel ischemia
c) Homogeneous colour
d) Irregular borders
e) Surface elevations
ANSWERS

1. B 7. C 12. B 17. C 22. C

2. A 8. C 13. A 18. A 23. D
3. B 9. E 14. D 19. A 24. C
4. A 10. B 15. C 20. A 25. B
5. B 11. C 16. D 21. A 26. E
6. C
Geriatrics

1) The cause of the greatest decrease in 5) Consequences of immobility include which

Quality of life in the elderly is: ONE of the following:
a) Arthritis a) Diarrhea
b) Dementia b) Maintenance of muscle mass
c) Heart disease c) Urinary retention
d) Stroke d) Pneumonia
e) Hypertension e) Hastened wound healing

2) Which of the following is NOT an agerelated
change?
a) Impaired myocardial diastolic dysfunction
b) Increased gastric acid secretion
c) Decreased drug clearance
d) Increased nocturnal sodium and fluid
excretion
e) Decreased baroreflex sensitivity
3) Regarding the elderly patient, which of the
following apply?
a) Vague symptoms
b) Atypical presentations
c) Loss of function
d) Polypharmacy
e) All of the above
6) Which of the following is FALSE in terms of
falls in the elderly?
a) They are the most common cause of
mortality due to injury
b) Environment plays a significant role
c) Fractures most commonly involve the
humerus
d) Age-related sensory changes make the
elderly more susceptible
e) Fear of falling contributes to self-
protection immobility

4) An 80 year-old female with a 25% reduction

in her GFR requires which of the following
adjustments for a drug that is predominantly
cleared by the kidneys?
1. 25% decrease in individual doses
2. 25% increase in dosing intervals
3. Increase overall fluid intake
4. Decrease length of therapy by 25%

a) All of the above

b) 1 and 3
c) 2 and 4
d) 2,3, and 4
e) 1 and 2
ANSWERS

1. E 3. E 5. D
2. B 4. E 6. C
 Gynecology
1) A 62 year old female presents with post-
menopausal bleeding. The most important
diagnosis to rule out is:
a) Atrophic vulvovaginitis
b) Foreign body
c) Vulvar intraepithelial neoplasia
d) Endometrial cancer
2) Contraindications to hormone replacement
therapy include:
a) Known breast cancer
b) Acute liver disease
c) Thromboembolic disease
d) Undiagnosed vaginal bleeding
e) All of the above
3) Which of the following can NOT be used as
emergency contraception:
a) Post-contraception copper IUD
b) Post-contraception MirenaTM IUD
c) Yuzpe method
d) "Plan B"
4) A 22 year old G0PO presents to her
gynaecologist’s office complaining of
amenorrhea. The most important diagnosis
to rule out is:
a) Turner’s Syndrome
b) Imperforate hymen
c) Pregnancy
d) Hypothalamic/pituitary dysfunction
5) Which of the following is not a clinical
feature of PCOS:
a) Hirsutism
b) Infertility
c) Insulin Resistance
d) Dysmenorrhea
6) Which of the following is a correct statement
regarding vaginal discharge:
a) Candidiasis is characterized by “cottage-
cheese-like” vaginal discharge and KOH
wetmount would reveal hyphae and
spores
b) Bacterial Vaginosis is characterized by
white, thick discharge and a negative
KOH whiff test
c) Trichomoniasis is characterized by grey,
thin and diffuse discharge and saline
wetmount would reveal hyphae
d) All of the above are false
7) Which of the following is a correct statement
regarding the Menstrual Cycle:
a) The proliferative/follicular phase of the
menstrual cycle is of fixed duration
b) The secretory/luteal phase of the
menstrual cycle is of fixed duration, due
to the finite lifespan of the corpus luteum
c) Progesterone is the main hormone of the
proliferative phase, stimulating rapid
growth of endometrial glands and stroma
d) Estrogen is the main hormone of the
secretory phase
8) The most common site of occurrence of
Endometriosis is:
a) Ovaries
b) Rectosigmoid colon
c) Appendix
d) Broad ligament
9) What is the most common causative
organism of Pelvic Inflammatory Disease:
a) N. gonorrheae
b) C. trachomatis
c) E. coli
d) Actinomyces israelii
10) A 36 year-old female presents with a
mucopurulent vaginal discharge. Gram stain
of a cervical swab shows gram negative
diploccocci. Which of the following is
correct?
a) If untreated this condition will likely
resolve spontaneously
b) The most likely diagnosis is Strep group
B fractures
c) Appropriate treatment is Metronidazole
vaginal cream
d) Appropriate treatment is a single I.M.
dose of 250 mg of Ceftriaxone
e) Public Health will most likely need to be
notified
11) A one year-old female presents with vaginal
bleeding. Vaginal inspection reveals the
presence of a multicystic grape-like lesion.
The most likely diagnosis is?
a) Sexual abuse
b) DES syndrome
c) Sarcoma botyroides
d) Clear cell Adenocarcinoma
e) Exposure to exogenous estrogen
12) A 24 year-old female presents with
abdominal pain. Beta-HCG is negative.
Pelvic ultrasound shows a 5 cm right
ovarian cyst. You would:
a) Perform immediate laporotomy
b) Perform immediate laproscopy
c) Aspirate the cyst under ultrasonographic
guidance
d) Order a CBC and a CA125
e) Expectant management with repeat
ultrasound in 8 weeks
13) The commonest type of bleeding
encountered with uterine leiomyomata is:
a) Post-coital spotting
b) Mid-cycle bleeding
c) Hypermenorrhea
d) Oligomenorrhea
e) Post-coital staining
14) Which of the following statements about
estrogen therapy in postmenopausal women
is correct?
a) It is a major risk factor for breast cancer
b) It decreases hepatic triglyceride
production
c) It produces hypertension
d) It protects against vertebral compression
e) It directly stimulates the proliferation of
vascular endothelium
15) A couple are unable to conceive after 1
year. Of the following statistics regarding
infertility, which are correct:
a) 10-15% of couples are infertile
b) Only 40% of couples achieve pregnancy
within 6 months of trying
c) Only 20% achieve pregnancy within 1
year of trying
d) Male factors are responsible for over half
of infertility causes
e) Infertility is labelled after failure to
conceive within 2 years of trying
16) Vaginal discharge which is fishy in odor and
associated with >20% clue cells on
microscopy will not be associated with which
of the following:
a) Be due to gardnerella vaginalis
overgrowth
b) Can be treated with metronidazole or
clindamycin
c) With the addition of KOH may see
hyphae or spores
d) Must be treated in all pregnant women,
including asymptomatic
e) Is rarely associated with inflamed or itchy
vulva
17) A 55 year-old woman comes to the office to
discuss menopause. You tell her which of
the following are a part of this stage:
a) Hot flushes
b) Vaginal dryness
c) Mood swings
d) Insomnia
e) All of the above
18) All of the following features have been
described in women with androgen
insensitivity syndrome EXCEPT:
a) Mammary aplasia
b) Female phenotype
c) Absence of wolffian duct structures
d) Short vagina
e) Absence of mullerian duct structures
19) On colposcopy, the transformation zone:
a) Contains columnar epithelium
b) Is the area between original squamous
epithelium and columnar epithelium
c) Contains metaplastic epithelium
d) Contains atypical blood vessels
20) Regarding laparoscopy:
a) It is contraindicated in patients who are
menstruating
b) Patients with intestinal obstruction are
still able to undergo laparoscopy
c) The most common indication for
therapeutic laparoscopy is tubal
sterilization
d) All of the above are incorrect
21) One cause of secondary amenorrhea is:
a) Turner syndrome
b) Anorexia
c) Androgen insensitivity syndrome
d) Gonadal dysgenesis
e) Imperforate hymen
22) Risk factors for cervical carcinoma includes
all of the following EXCEPT:
a) Human papilloma virus type 16 and 18
b) Early age at first intercourse
c) Smoking
d) High socio-economic status
e) Multiple sexual partners
23) A 35 year-old G0P0 has severe pain during
menses which radiates into the anal region.
On bimanual exam, she has a small,
retroverted uterus and tender nodules can
be felt on palpation of the uterosacral
ligaments. Which of the following conditions
does she most likely have:
a) Chronic PID
b) Adenomyosis
c) Fibroids
d) Endometriosis
e) Uterine carcinoma
24) Which of the following statements is
correct?
a) Cervical carcinoma is the most common
gynecological malignancy in Canada
b) Lichen sclerosis is treated with estrogen
cream
c) Colposcopy is required after a finding of
mild cervical dysplasia on a routine Pap
smear
d) Follicular cysts typically regress with the
following cycle
e) Leiomyomata are malignant tumours
25) Which of the following statements regarding
malignant cervical lesions is true?
a) 95% are squamous cell carcinoma
b) CA-125 levels to monitor treatment
effectiveness are indicated
c) The majority of lesions arise outside the
transformation zone of the cervix
d) They are not associated with HPV
infection
e) Treatment for stage 4 disease is radical
hysterectomy with chemotherapy
26) In endometriosis, the most common location
for disease is:
a) Broad ligament
b) Cul-de-sac
c) Ovaries
d) Appendix
e) Uterosacral ligament
27) All of the following increase the risk of
developing ovarian cancer EXCEPT:
a) Family history
b) BCP
c) Nulliparity
d) Late menopause
e) Caucasian
28) A young female enters your office wanting to
start oral contraceptive pills. You remind
yourself of the reasons she may not start the
pill which are:
a) Impaired liver function
b) Undiagnosed abnormal uterine bleeding
c) Congenital hyperlipidemia
d) Past history thrombophlebitis
e) All of the above
29) Which of the following statements regarding
endometriosis is incorrect?
a) Theories proposed to explain the
histogenesis of endometriosis include
retrograde menstruation and coelemic
metaplasia
b) CA-125 is used to make the diagnosis of
endometriosis
c) Symptoms of endometriosis may include
urinary frequency and dyschezia
d) The differential diagnosis of
endometriomas include hemorrhagic
corpus luteum cysts as well as
neoplasms
e) The risk of endometriosis is several fold
greater if there is a first degree relative
with this condition
30) A 55 year-old female presents with a
"period-like" vaginal bleeding for 5 days that
stopped spontaneously. Your approach to
the problem would be to:
a) Reassure the patient and manage
expectantly
b) Administer provera 10 mg od for 15 days
c) Administer cyclic estrogen plus
progesterone
d) Obtain endometrial tissue
e) Perform a pap smear plus endocervical
curretage
31) The appropriate next step in a woman found
to have 1 abnormal Pap smear showing
ASCUS is:
a) Repeat in 1 year's time
b) Repeat in 4-6 months time with
colposcopy if abnormal
c) Send patient directly for colposcopy and
LEEP excision
d) Send for colposcopy after 1 abnormal
Pap
e) Repeat Pap immediately and treat for
HPV infection
32) A 41 year-old woman presents with obesity,
hirsutism and oligomenorrhea, which of the
following tests will give the least useful
information?
a) Prolactin
b) LH/FSH ratio
c) Free testosterone
d) TSH
e) 24-hour urine free cortisol
33) With respect to androgen insensitivity
syndrome, which of the following is true?
a) Genotype is XY
b) Breast development and uterus are
absent
c) Serum testosterone is below normal
male range
d) Secondary sex characteristics are male
e) The condition is autosomal recessive
34) The new selective estrogen receptor
modulators have all of the following benefits
EXCEPT:
a) No agonistic effect on breasts
b) Provides estrogenic benefit on bone
c) Minimal effect on triglycerides and
cholesterol
d) No agonistic effect on uterine tissue
e) Provides relief of hot flushes associated
with menopause
35) Regarding birth control, which of the
following is false?
a) It is contraindicated in women over age
35 who are smokers
b) Its efficacy may be decreased when
taking antibiotics
c) Reduces the risk of ovarian carcinoma
d) Is associated with only a 10% failure rate
e) Can be associated with nausea and
mastalgia
39) Which of the following disease and
treatment is correctly matched:
a) HSV and cryotherapy weekly until
lesions disappear
b) HPV and acyclovir 400mg po tid x 7d
c) Primary Syphilis and Benzathin Penicillin
G 2.4 million units IM single dose
d) Inpatient PID and Flagyl 500 mg po BID
x 14d
e) Bacterial Vaginosis and Clotrimazole 3d
cream

36) All of the following are contraindications for

the IUD EXCEPT: 40) HRT should be used for the treatment of
a) Uterine anomaly osteoporosis.
b) Pregnancy a) True
c) Cervical infection b) False
d) Fibroids 

e) Undiagnosed vaginal bleeding 




37) All of the following are types contraceptives

that release some type of hormone
(estrogen, progesterone or both) EXCEPT:
a) Mirena
b) Nuvaring
c) Orthoevra
d) Alesse
e) Novo-T

38) All of the following are associated with

PCOS EXCEPT:
a) Obesity
b) Hirsutism
c) Infertility
d) Hypertension
e) Oligomenorrhea
ANSWERS

1. D 9. B 17. E 25. A 33. A

2. E 10. E 18. A 26. C 34. E
3. B 11. C 19. C 27. B 35. D
4. C 12. E 20. C 28. E 36. D
5. D 13. C 21. B 29. B 37. E
6. A 14. D 22. D 30. D 38. D
7. B 15. A 23. D 31. B 39. C
8. A 16. C 24. D 32. B 40. B (false)
 Hematology

1. An elevated level of hemoglobin A2 in a 6. Which finding is NOT frequently found in

patient with mild microcytic anemia Chronic Myelogenous Leukemia (CML)?
suggests the diagnosis of: a) Elevated WBCs
a) Alpha-thalassemia b) Elevated vitamin B12 level
b) Sickle trait c) Elevated LDH
c) Beta-thalassemia d) Translocation between
d) Hereditary spherocytosis chromosomes 9 and 14
e) Hereditary persistence of fetal e) Increased uric acid level
hemoglobin

7. Schistocytes on blood film examination are

2. It is unlikely to see macrocytosis in a patient UNLIKELY to be seen in which of the
with anemia in which of the following? following:
a) Reticulocytosis a) Thrombotic thrombocytopenia
b) Vitamin B12 deficiency purpura (TTP)
c) Folate deficiency b) Thalassemia
d) Myelodysplastic syndrome c) Vasculitis
e) Sideroblastic anemia d) Disseminated intravascular
coagulation (DIC)
e) Glomerulonephritis
3. Hemolytic anemia is characterized by all of
the following EXCEPT:
a) Increased LDH 8. All of the following can INHIBIT the
b) Increased reticulocytosis absorption of ingested non-heme iron
c) Increased unconjugated bilirubin EXCEPT:
d) Increased haptoglobin a) Alcohol
e) Lead poisoning b) Achlorhydria
c) Phosphate (i.e. as found in milk)
d) Phytates (i.e. as found in cereals)
4. The treatment of choice for thrombotic e) Antacids
events in the antiphospholipid antibody
syndrome is:
a) Intravenous steroids 9. A 26 year old female presents to emergency
b) High-dose oral steroids with a rapid with widespread petechiae on her arms and
taper legs. Her past medical history is significant
c) Penicillamine for thyroid disease. Her lab values show
d) Aspirin hemoglobin of 115, WBC of 6.6 and platelet
e) Warfarin count of 9. INR and PTT are normal. What is
the most likely diagnosis?
a) ITP
5. All of the following are vitamin-K dependent b) TTP
proteins EXCEPT: c) HUS
a) Protein C d) VWD
b) Antithrombin III e) Iron deficiency anemia
c) Factor IX
d) Factor II
e) Factor VII
10. Which of the following is not associated 13. Which of the following occurs in about 90%
with elevated INR? of patients with chronic myeloid leukemia?
a) Liver disease a) Splenomegaly
b) Warfarin use b) Weight loss
c) Factor VII deficiency c) Hepatomegaly
d) Vitamin K deficiency d) Abdominal pain
e) Factor XII deficiency e) Fever

11.Which of the following is not a feature of 14. What is the most common type of
multiple myeloma? Hodgkin’s lymphoma?
a) Anemia a) Mixed cellularity
b) Hypercalcemia b) Nodular sclerosis
c) Fractures c) Lymphocyte depleted
d) Renal failure d) Lymphocyte predominant
e) Splenomegaly

12. Which of the following is not associated

with thrombotic thrombocytopenic purpura?
a) Fever
b) Elevated indirect bilirubin
c) Increased creatinine
d) Mental status changes
e) Rouleaux on blood film
ANSWERS

1. C 5. B 9. A 13. A
2. E 6. D 10. E 14. B
3. D 7. B 11. E
4. E 8. A 12. E
 Infectious Diseases




1) The various species of Campylobacter can 6) Entamoeba histolytica is transmitted to
cause diseases ranging from acute enteritis humans by:
to bacteremia. Which of the following a) Ingestion of infective eggs
modes of transmission does NOT apply to b) Ingestion of cysts
Campylobacter? c) Ingestion of animal tissue that contains
a) Contact with infected animals the larva
b) Contaminated food and water d) Penetration of the skin by infective larva
c) Improperly cooked poultry e) Ingestion of adult form
d) Aerolized droplets
e) Person to person spread via fecal-oral
route 7) Strongyloides spp. is transmitted to humans
by:
a) Ingestion of infective eggs
2) Which of the following is NOT a common b) Ingestion of cysts
infectious cause of acute diarrhea? c) Ingestion of animal tissue that contains
a) Escherichia coli the larva
b) Shigella d) Penetration of the skin by infective larva
c) Norwalk virus e) Ingestion of adult form
d) Vibrio cholerae
e) Helicobacter pylori
8) The biosynthesis of fungal ergosterol is
inhibited by:
3) A virus that is not inactivated by mild a) Amphotericin B
detergents that solubilize phospholipid b) Griseofulvin
membranes is: c) Flucytosine
a) Poliovirus d) Nystatin
b) Variola virus e) Ketoconazole
c) Cowpox virus
d) Vaccinia virus
9) At what CD4 count are HIV patients at
increased risk of developing PCP?
4) All the following are true statements about a) CD4 count >500x106
viruses EXCEPT: b) CD4 count 200-499x106
a) They are obligate intracellular parasites c) CD4 count <200x106
b) They are filterable agents d) CD4 count < 500x106
c) They are simply organized e) None of the above
d) They are devoid of enzymes
e) They may contain double stranded DNA
10) Which of the following is not a complication
of meningitis?
5) A viral genome that does not replicate in a) Hyponatremia
the cytoplasm of the infected cell is: b) Seizure
a) Poliovirus c) Deafness
b) Rabies virus d) Hydrocephalus
c) Cytomegalovirus e) None of the above
d) Rubella virus
e) Mumps virus
11) Which of the following does not cover
pseudomonas?
a) Imipenem
b) Tobramycin
c) Pip-tazo
d) Ceftazidime
e) Ceftriaxone

12) Which of the following ways is TB least

likely to present?
a) Hepatitis
b) Meningitis
c) Osteomyelitis
d) Septic arthritis
e) Peritonitis
ANSWERS

1. D 4. D 7. D 9. C 11. E
2. E 5. C 8. E 10. E 12. D
3. A 6. B
 Nephrology
1) What underlying diagnosis is suggested in a
patient with acute renal failure and white
blood cells or white blood cell casts?
a) Interstitial nephritis
b) Acute tubular necrosis
c) DIC
d) Nephrotic syndrome
e) Multiple myeloma
2) What is the etiology of stenosis in renal
artery stenosis?
a) 2/3 secondary to atherosclerosis, 1/3
secondary to fibromuscular dysplasia
b) 2/3 secondary to atherosclerosis, 1/3
secondary to DIC
c) 1/2 secondary to aortic dissection, 1/2
secondary to atherosclerosis
d) 2/3 secondary to fibromuscular
dysplasia, 1/3 secondary to Acute
tubular necrosis
e) 2/3 secondary to fibromuscular
dysplasia, 1/3 secondary to
atherosclerosis
3) What illness commonly presents with
arthralgias, purpura, abdominal pain,
microscopic hematuria, mild proteinuria,
azotemia, and proliferative
glomerulonephritis characterized by IgA
deposits?
a) Henoch-Schonlein purpura
b) Membranous nephropathy
c) Acute tubular necrosis
d) Hyperkalemia
e) Multiple myeloma
4) Which of the following is not an EKG change
in hyperkalemia?
a) Peaked T waves
b) Prolonged P-R
c) Wide QRS with bradycardia
d) V-fib with asystole
e) U waves
5) What is the most common etiology of
nephrotic syndrome among Caucasians?
a) Membranous nephropathy
b) Focal segmental glomerulosclerosis
c) Acute tubular necrosis
d) Lupus
e) IgA nephropathy
f) Post-streptococcal glomerulonephritis
6) What is the most common intrinsic renal
disease that leads to acute renal failure?
a) Acute tubular necrosis
b) Hypovolemia
c) Rhabdomyolysis
d) Wegener's granulomatosis
e) Multiple myeloma
7) What is the most common etiology of
nephrotic syndrome in African Americans?
a) Focal segmental glomerulosclerosis
b) Membranous nephropathy
c) Lupus
d) Sarcoidosis
e) IgA nephropathy
8) What is the main cause of End Stage Renal
Disease?
a) Diabetes
b) Essential HTN
c) Glomerulonephritis
d) Polycystic kidney disease
e) IgA Nephropathy
9) What is the most common form of idiopathic
glomerulonephritis?
a) Post-streptococcal glomerulonephritis
b) Essential HTN
c) Membranous nephropathy
d) Acute tubular necrosis
e) IgA Nephropathy
10) A 65 year-old male with back pain, nephrotic
syndrome and anemia present to the ER.
Ultrasound shows normal kidney size. His
creatinine is 500. Which diagnosis best fits
the scenario?
a) Polycystic kidney disease
b) Chronic GN
c) Multiple myeloma
d) Diabetic nephropathy
e) Analgesic abuse
11) Which of the following are indications for
dialysis in ARF?
a) Severe alkalosis unresponsive to
medical therapy
b) Severe acidosis unresponsive to medical
therapy
c) Severe hypokalemia unresponsive to
medical therapy
d) Severe hypercalcemia unresponsive to
medical therapy
e) b and d
12) Which of the following is true with respect to
diabetes and kidney disease?
a) Primarily affects the tubules
b) Earliest sign is decreased GFR
c) Microalbuminuria is a late sign of DM
nephropathy
d) Threshold for dialysis is same as other
CRF patients
e) BP control slows progression of DM
nephropathy
13) Which of the following is least likely to
contribute to renal failure in myeloma?
a) Hypercalcemia
b) Amyloidosis
c) Infiltration of the kidney by myeloma cells
d) Hyperuricemia
e) Intratubular light chain deposition
14) Which of the following is true with respect to
proteinuria?
a) All proteinuria is secondary to glomerular
disease > 2 g/24 h = nephrotic syndrome
b) Is always abnormal and indicative of
serious renal disease
c) It may be normal for an individual to
have <150 mg per day of proteinuria
d) If a patient has 1.5 g of protein in 24 h
they must have tubular-interstitial
disease
15) In acute pyelonephritis, which of the
following is most commonly associated with
bacteremic spread from a distant focus?
a) Escherichia coli
b) Proteus sp.
c) Staphylococcus aureus
d) Serratia sp.
e) Enterococcus sp.
16) A patient presents with a decreased level of
consciousness and visual difficulties. Blood
work reveals an anion gap of 22 and an
osmolar gap of 24. Which of the following is
most likely responsible?
a) Ethanol
b) Salicylates
c) Renal tubular acidosis type I
d) Methanol
e) Diabetic ketoacidosis
17) In which of the following disease processes
would you likely see a bland urine sediment
a) Goodpasture’s syndrome
b) Post streptococcal glomerulonephritis
c) Membranoproliferative
glomerulonephritis
d) Focal segmental glomerulosclerosis
e) Puaci immune glomerulonephritis
ANSWERS

1. A 5. A 9. E 13. C 17. D
2. A 6. A 10. C 14. C
3. E 7. A 11. B 15. E
4. E 8. A 12. E 16. C
 Neurology
1) For the management of an acute delirium
acquired in the hospital, which one of the
following options would be least
appropriate?
a) Treating the underlying cause
b) Promptly increasing antibiotic coverage
c) Antipsychotic medication as needed
d) Avoiding foley catheters and physical
restraints
e) Providing the patient with a well-lit room
2) When differentiating between seizure and
syncope, which of the following is important
to consider?
a) Onset
b) EEG
c) Autonomic features
d) Urinary incontinence
e) All of the above
3) In the early stages of Alzheimer's disease
what is the most common deficit to be
expected?
a) Major depression
b) Parkinsonism
c) Psychosis
d) Memory impairment for newly acquired
information
e) Memory impairment for events prior to
the onset of degeneration
4) A patient that has just suffered a stroke finds
it difficult to utter words in either English or
his native Portuguese. He is not pointing to
the ceiling when prompted with the aid of a
translator, nor does he respond when asked
to repeat a word he had just managed to
speak out. In an otherwise functional
individual, these deficits can be most likely
due to this type of aphasia:
a) Broca's non-fluent aphasia
b) Global non-fluent aphasia
c) Anomic fluent aphasia
d) Wernicke's fluent aphasia
e) Conduction fluent aphasia
5) When examining a patient with a working
diagnosis of Bell's palsy what is most
important too rule out?
a) A brainstem lesion
b) An idiopathic cause
c) An Ebstein-Barr virus infection
d) Diabetes melitus mononeuropathy
e) Parotid gland pathology
6) Which medication would you expect to
worsen the common symptoms of
Parkinson's Disease?
a) Bromocriptine
b) Benztropine
c) Lithium
d) Amantadine
e) Haldol
7) Which of the following interventions would
benefit any patient suffering from
myasthenia gravis?
a) Thymectomy
b) Acetylcholinesterase inhibitors
c) Edrophonium
d) Only a and b
e) All of a, b, and c
8) A 30-year old hairdresser is experiencing a
headache as you, a medical student about
to graduate, are sitting in the leather chair.
Which of the following questions would be
least useful in assessing her complaint?
a) Is there a family history of similar
headaches?
b) Does the pain seem to come from
behind one eye?
c) Did your headache develop suddenly
and unexpectedly?
d) Are you having trouble or discomfort
chewing gum and/or talking during the
headache?
e) At What time of day is the headache at
its worst?
9) When investigating for the cause of a stroke
which one of the following is most likely to
yield abnormal findings?
a) An echocardiogram
b) An EEG
c) An electrocardiogram
d) A biopsy from a large artery
e) A CT of all the long bones
13) A 25 year-old man is admitted with a history
suggesting seizures. Which of the following
would not support this diagnosis?
a) Urinary incontinence
b) The sound of voices preceding events
c) Drowsiness and weakness following the
event
d) Rarely occur when recumbent
e) None of the above

10) A 74 year-old, right-handed man presents

with a past medical history of hypertension
and dyslipidemia for 30 years. He is a
retired banker who recently has had trouble
calculating his restaurant bill. He also
notices that his writing has deteriorated. On
physical exam, he has difficulty naming his
fingers and is confused with distinguishing
left from right. The lesion is most likely in
which part of the brain?
a) Right parietal
b) Left parietal
c) Left temporal
d) Right temporal
e) Frontal
11) Which of the following pair of CNS lesions
and corresponding visual field defects is
incorrect?
a) Temporal lobe tumour – superior
quadrantanopia
b) Frontal lobe tumour – altitudinal field
defect
c) Pituitary tumour – bitemporal
hemianopsia
d) Occipital lobe tumour – homonomous
hemianopsia
e) Multiple Sclerosis – central scotoma
14) Which of the following would not be
expected in a right-sided Brown-Séquard
syndrome?
a) Right-sided hemiparesis
b) Right-sided decreased proprioception
c) Left-sided decreased sensitivity to
pinprick
d) Left-sided decreased vibration sense
e) None of the above
15) Which of the following is true of Myasthenia
Gravis?
a) In patients older than 60, thymic
hyperplasia is a common etiology
b) Often associated with thyroid disease
c) Antibodies that are produced against
acetylcholinesterase
d) Associated with small cell lung
carcinoma

12) A 63 year-old woman develops intermittent

dizziness. Examination discloses diminished
corneal reflex and mild hearing loss in the
right ear. The most likely diagnosis is:
a) Cerebellopontine angle tumour
b) Benign paroxysmal positional vertigo
c) Lateral medullary syndrome
d) Méniére disease
e) None of the above
Neurology CASE 1:
A 45 year-old migrant farm worker comes to see you with sudden onset of severe pain in
his back and right leg after lifting some bales of hay. The pain radiates into the lateral
aspect of the right foot and is associated with numbness along the lateral aspect of the
foot. He has had a 5 year history of lower back pain with a similar episode of pain 1 year
ago which was concentrated at the posterolateral aspect of the right calf and lateral
aspect of the right foot. It became progressivelyworse and then resolved over a 3 week period.

1. What elements of the history would you ask 2. What elements of the physical exam would
about in order to formulate your diagnosis? you focus on? Choose up to five.
Choose up to five. 1. Examination of skin
1. Diffuse muscle cramps 2. Range of motion of lumbar spine
2. Alcohol intake 3. Blood pressure
3. Effect of NSAIDs 4. Inspection of muscle bulk in lower extremities
4. Family history of back problems 5. Sensory exam of arms
5. Previous history of back injury 6. Peripheral pulses
6. Shoulder pain 7. Reflexes in lower extremities
7. Weakness in right leg 8. Power testing of legs
8. Allergies 9. Power testing of arms
9. Knee problems 10. Sensory exam of legs
10. Urinary incontinence 11. Respiratory rate
11. Skin rashes 12. Temperature
12. Previous effective physiotherapy 13. Straight leg raise test
13. Headaches 14. Abdominal exam
14. Nocturia 15. Rectal exam
16. Pulse
17. Range of motion of knee
18. Auscultation of chest
19. Romberg test
ANSWERS

1. B 4. B 7. D 10. B 13. D
2. E 5. A 8. D 11. B 14. D
3. D 6. E 9. C 12. A 15. B

Neurology Case 1
Case 1 #1:
3, 5, 7, 10, 12

Case 1 #2:
7, 8, 10, 11, 14
 Neurosurgery
1) In taking a history from a patient with a ring-
enhancing lesion seeon CT, all of the
following should be considered in your
differentialdiagnosis EXCEPT:
a) Breast cancer metastasis
b) Meningioma
c) Glioblastoma
d) Infarct
e) Cerebral Abscess
2) A 75 year old man is brought to your office
by his daughter, who is his primary
caregiver. She describes a gradual decline
in her father's gait over the last two months.
She now describes his feet as being 'glued'
or 'magnetized' to the floor. He also has a
worsening dementia and has recently
become incontinent of urine. Assuming this
patient has had no prior investigations,
which of the following is the most
appropriate next step in his management:
a) Lumbar puncture
b) Routine Bloodwork (CBC, lytes, BUN,
Cr)
c) Urinalysis
d) CT or MRI of the head
e) Carotid dopplers
3) A 40 year old lady is hospitalized for
treatment of a severe, bilateral pneumonia
with parapneumonic pleural effusions. Two
days into her stay, she develops a severe
headache, then has a seizure overnight.
She has no prior history of epilepsy. What is
your most likely diagnosis:
a) Stroke
b) Cerebral abscess
c) Bacterial endocarditis
d) Migraine
e) Toxoplasmosis secondary to HIV/AIDS
4) Which of the following is not true concerning
Brown-Sequard syndrome?
a) Contralateral spinothalamic deficits
b) Ipsilateral spinothalamic deficits
c) Ipsilateral dorsal column deficits
d) Ipsilateral pyramidal tract deficits
5) A 52-year-old man presented to the urgent
care center 2 weeks ago with severe left
shoulder pain. He wasdiagnosed with
bursitis and treated with NSAIDs. The pain
has gradually improved, but the patient has
scheduled an office visit because he is
concerned about weakness of the left arm.
On examination, the patient has full passive
range of motion of the arm and shoulder
without pain. Marked atrophy and weakness
are noted in the left deltoid and shoulder
girdle muscles. Biceps and triceps reflexes
are absent. The remainder of the
examination is unremarkable. Which of the
following is the most likely diagnosis for this
patient?
a) Thoracic outlet syndrome
b) Brachial plexitis (Parsonage-Turner
syndrome)
c) Rotator cuff tear
d) Spinal cord tumour
e) Lacunar infarction
6) A 24-year-old man is brought to the
emergency department by the emergency
medical service (EMS). He suffered head
trauma 20 minutes ago while playing
football. Immediately after the event, he lost
consciousness for 3 minutes and then woke
up mildly confused. He complains of a
moderate frontal headache. On physical
examination, the patient's vital signs are
stable, his Glasgow Coma Scale (GCS)
score is 15, and he has no focal signs on
neurologic examination. What interventions
would be appropriate in the treatment of this
patient?
a) Continue with observation and repeat
neurologic examinations; repeat
assessment with the GCS periodically;
and consider imaging with a CT scan to
rule out contusions
b) Continue with observation and repeated
neurologic examinations; repeat
assessment with the GCS periodically;
and obtain an MRI
c) Admit the patient for prolonged
observation; obtain a CT scan to rule out
contusions; and start I.V. mannitol for
brain edema
d) Admit the patient to the ICU; obtain an
MRI; and consider intraventricular
monitoring of intracranial pressure (ICP)
7) A 46-year-old woman is brought to the
emergency department by EMS after being
involved in a car accident.She was a
passenger in the back seat of the car. The
accident involved frontal impact, with the car
moving at 50 mph. The patient was not
wearing a seatbelt. The driver says she has
not been awake since the accident, which
occurred 30 minutes ago. On admission, the
patient's vital signs are as follows: blood
pressure, 100/60 mm Hg; heart rate, 78
beats/min; respiratory rate, 8 breaths/min;
GCS score,7. CT scan shows a frontal
epidural hematoma with mass effect. How
would you treat this patient?
a) Intubate the patient, administer
hyperventilation to a carbon dioxide
tension (PCO2) of 25 to 35 mm Hg,
induce a barbiturate coma, and admit the
patient to the ICU for further evaluation
b) Intubate the patient, administer
hyperventilation to a PCO2 of 25 to 35
mm Hg, and ask for emergent
neurosurgery consult for evacuation of
the hematoma
c) Intubate the patient, administer
hyperventilation to a PCO2 of 25 to 35
mm Hg, admit to ICU for close
observation, and consult neurosurgery
for intraventricular ICP monitoring
d) Admit to ICU for further evaluation and
start mannitol and steroids
8) A 22-year-old man is transferred to your
hospital from a local hospital, where he
presented 3 hours ago with closed head
trauma. He lost consciousness for 10
minutes. At the first hospital where he was
taken, he was given pain medications, and a
CT scan was performed; the CT scan was
negative. The patient is awake and
complains only of moderate headache. His
physical examination is unremarkable. The
family is concerned about the development
of seizures in the future, because they had a
relative who had that problem. What would
you recommend regarding prophylaxis for
seizures in this patient?
a) Phenytoin for 1 to 2 weeks
b) Carbamazepine for 6 months
c) Obtain an electroencephalogram; if it is
abnormal, start phenytoin
d) Do not start any antiseizure medication
at this time
9) A 65 year-old gentlemen originally
hospitalized for work-up and treatment of a
subarachnoid hemorrhage is initially found
to have no focal neurological deficits. Six
days after being hospitalized, you are called
to his bedside by his nurse as he has
become increasingly lethargic, confused,
and has new focal weakness. What is the
likely cause of his deterioration?
a) Intra-cerebral hemorrhage
b) Re-ruptured aneurysm
c) Pneumonia
d) Vasospasm
e) Intra-ventricular hemorrhage
10) In a patient that has been hospitalized for a
subarachnoid hemorrhage, what is the
appropriate pharmacological prevention for
vasospasm?
a) Metoprolol
b) LMWH
c) Triple H Therapy
d) b & c
e) Nimodipine
11) In a patient that has been hospitalized for
subarachnoid hemorrhage with evidence of
vasospasm, which of the following are
appropriate treatment?
a) Triple H Therapy
b) Nimodipine
c) Angioplasty
d) a & c
e) a, b & c
12) Which of the following is not a classic sign of
a basal skull fracture?
a) Battle sign
b) Raccoon eyes
c) Hemotympanum
d) Freedman sign
e) CSF rhinnorhea/ottorrhea
13) A 19 year-old female with a traumatic head
injury is brought to the ED by EMS. She is
hemodynamically stable but requires
assisted ventilation through an endotracheal
tube. She does not open her eyes to painful
stimuli and maintains an abnormal extension
posture. Which of the following is incorrect?
a) Her GCS is 3T
b) A GCS of 8 is an indication for intubation
c) Isolated head injuries can cause shock
d) She should be ventilated to a pCO2 of
30-35 mm Hg
e) All are incorrect
14) A 52 year-old dentist comes to your office
complaining of severe bilateral buttock
cramps and thigh fatigue during a tennis
match and recent onset of impotence. The
most likely diagnosis is:
a) Lumbosacral disc problem
b) Multiple sclerosis
c) Leriche syndrome
d) Metastatic carcinoma of the spine
15) A young woman who was involved in a cliff
diving accident is brought into the
emergency department unresponsive to
deep pain with a right pupil that is dilated
and non-reactive. The left pupil is normal.
The most appropriate initial treatment is:
a) Endotracheal intubation
b) CT scan of the head
c) 500 cc normal saline IV
d) IV steroids
e) IV mannitol
16) A 78 year-old woman complains of
experiencing headaches and progressive
confusion for the last month. She has a left
hemianopia and cannot dress herself. A CT
scan demonstrates a large, irregularly
enhancing mass in the right parietal lobe.
There is no obvious systemic disease. The
most likely diagnosis is:
a) Brain abscess
b) Glioblastoma multiforme
c) Meningioma
d) Metastasis
e) CNS lymphoma
17) A patient with a subarachnoid hemorrhage
(SAH) caused by a right anterior
communicating artery aneurysm undergoes
successful surgery 2 days after the
hemorrhage. Three days later, right arm
weakness develops. The most likely
diagnosis is:
a) Hydrocephalus
b) Meningitis
c) Repeat hemorrhage
d) Vasospasm
e) None of the above
18) A 60 year-old man presents with back and
leg pain and trouble urinating. On
examination, he has decreased sensation
over the buttocks, normal motor power, and
absent ankle jerks bilaterally. How would
this patient best be investigated?
a) Plain films of the lumbar spine
b) CT of lumbar spine
c) MRI of spine
d) Investigate only if no improvement after
6 weeks of symptomatic treatment
e) Gallium scan of the spine
19) A 72 year-old man on physical examination
is found to have expressive dysphasia and
mild right arm weakness. The most probable
location of his lesion is:
a) Right parietal lobe
b) Left frontal lobe
c) Right frontal lobe
d) Left parietal lobe
e) Basal ganglia
20) Initial management of any patient with coma
of undetermined cause includes all
EXCEPT:
a) Clear and secure the airway
b) Naloxone
c) D50W 50 mL IV
d) Dexamethasone 16 mg IV
e) Thiamine
21) A 53 year-old male presents to the ED with
new onset of a severe headache associated
with nausea and vomiting. There is no
history of trauma. He is alert and oriented
with no neck stiffness. Anisocoria is present.
The most likely diagnosis is:
a) Intracranial bleed
b) Cluster headache
c) Meningitis
d) Migraine headache
e) Tension headache
22) A 24 year-old woman arrives at the
Emergency Department unconscious. Her
BP is 90/60, her heart rate is 60 bpm, she is
breathing at 8 breaths per minute and her
O2 sat is 86%. Her eyes remain closed even
after pain stimulation and the only sounds
she makes are incomprehensible. Her
elbows and wrists are flexed with her feet
extended. This patient’s GCS score is:
a) 3
b) 4
c) 5
d) 6
e) 7
23) Which physical exam finding below is
usually not associated with increasing
intracranial pressure?
a) Deteriorating level of consciousness
b) Increasing heart rate
c) Increasing blood pressure
d) Yawning, hiccoughing, vomiting
e) Unilateral sixth cranial nerve palsy
24) A 19 year-old woman is brought to the
emergency room following involvement in a
motor vehicle accident. On examination, she
has a GCS of 10 and swelling over the
occipital protuberance. The most
appropriate imaging study is:
a) MRI of skull and contents
b) Skull films
c) Head CT
d) Cerebral angiogram
e) CT myelogram
25) An 80 year-old woman suffers cervical
spinal soft-tissue injury in a motor vehicle
accident with no skeletal or neurologic
damage documented at the time. Three
months later, she presents with sudden
onset of homonymous right upper
quadrantanopia. CT demonstrates a non-
hemorrhagic lesion in the left lower occipital
lobe. Which imaging study would likely yield
the most useful information?
a) Carotid Doppler ultrasound
b) Echocardiography
c) MR angiography
d) SPECT scan
e) C-spine plain films
26) A neurosurgeon complains of a 3 week
history of awakening at night with right-hand
discomfort that resolves after several
minutes. On examination, he has mild
weakness of thumb abduction and
diminished pain sensibility on the palmar
aspect of the thumb and index finger. The
most likely diagnosis is:
a) Carpal tunnel syndrome
b) Cervical radiculopathy
c) Reflex sympathetic dystrophy
d) Tendonitis
e) Left middle cerebral artery ischemic
attacks
27) A 73 year-old woman presents with a 6
month history of deteriorating gait and low
back discomfort, exacerbated by walking.
Examination is unremarkable except for
hypoactive muscle stretch reflexes in the
legs. X-rays of the lumbosacral area shows
the expected degenerative changes
associated with a woman of her age. The
most likely diagnosis is:
a) Acute lumbar disc hernation
b) Lumbar stenosis
c) Myopathy
d) Normal pressure hydrocephalus
e) Cervical stenosis
28) L4/L5 disc prolapse. What is observed?
a) Loss of ankle-jerk reflex
b) Numbness on the lateral side of the foot
c) Positive femoral nerve stretch test
d) Weak quadriceps
e) Foot drop
ANSWERS

1. B 7. B 13. C 19. B 25. C

2. D 8. D 14. C 20. D 26. A
3. B 9. D 15. A 21. A 27. B
4. B 10. E 16. B 22. D 28. E
5. B 11. D 17. D 23. B
6. A 12. D 18. C 24. C
Obstetrics 


No Questions at this time

 Ophthalmology




1) Which statement about corneal abrasions is 6) Patients with type II diabetes should be
incorrect? initially seen by an ophthalmologist for a
a) Abrasions are accompanied by dilated fundus exam:
photophobia a) Within 5 years of diagnosis
b) Abrasions are painful b) Within a year of diagnosis
c) The eye is often red c) At 10 years
d) Fluorescein will delineate the abraded d) When vision changes
area e) At the time of diagnosis
e) Abrasions often cause scarring

7) Which of the following is false concerning

2) A patient complains of sudden onset herpes zoster ophthalmicus:
flickering lights and a persistent loss of part a) It is more common in elderly and
of the visual field but no pain. This patient immunocompromised patients
likely has: b) Vesicles on the tip of the nose suggest
a) Posterior cerebral artery occlusion involvement of first branch of the fifth
b) Retinal detachment cranial nerve
c) Migraine c) Corneal sensation may be reduced on
d) Optic neuritis testing
d) Early treatment with an antiretroviral
such as Acyclovir is of limited benefit
3) The most common cause of an ISOLATED e) Referral to ophthalmology should be
third cranial nerve palsy with pupil made if ocular involvement is suspected
involvement is:
a) Vascular hypertension
b) Multiple sclerosis 8) Which of the following concerning a
c) Diabetes mellitus chalazion is false?
d) An aneurysm a) Systemic antibiotics are a useful initial
e) A neoplasm treatment
b) It is a chronic granulomatous
inflammation of the meibomian gland
4) A patient with acute angle closure glaucoma c) Hot compresses are of value as initial
can present with all of the following treatment
EXCEPT: d) A recurrent lid mass should be biopsied
a) A fixed, dilated pupil e) Initial treatment with topical antibiotics
b) Nausea and vomiting may be beneficial
c) Complaint of haloes around objects
d) Ocular hypotension
e) A steamy cornea on ocular exam 9) If multiple vertical epithelial lesions are seen
on slit lamp exam, one should suspect:
a) Herpes zoster ophthalmicus
5) Signs of diabetic retinopathy include all of b) Herpes simplex keratitis
the following EXCEPT: c) Foreign body behind the upper lid
a) Dot and blot hemmorhages d) A chalazion
b) Hard exudates e) Dye eye syndrome
c) Venous beading
d) Macroaneurysms
e) Macular Edema
10) Which is not a major risk factor for open
angle glaucoma?
a) Black race
b) Family history of glaucoma
c) Intraocular hypertension >21 mm Hg
d) Hyperthyroidism
e) Age
11) A 57-year-old female patient presents with a
6-day history of new onset headache that is
moderate-severe in nature. She says that
the headache is unilateral and she has also
experienced a blurring of her vision during
this time. Upon further questioning she also
complains of some pain in her jaw when
eating. On examination, you find a pale optic
nerve in her left eye. What is the next step in
this patient’s management?
a) Reassure the patient that she is
experience migraine headaches and
advise her to follow-up after 2 weeks
with a headache diary
b) Order bloodwork for ESR and CRP and
treat with oral Prednisone if these are
elevated
c) Treat the patient through surgical
excision of her temporal artery
d) Obtain a temporal artery biopsy and start
the patient on oral prednisone therapy
12) A 55-year-old male patient presents to the
ER with sudden painless loss of vision in his
right eye. The patient’s medical history
consists of Rheumatoid Arthritis currently
well controlled on Plaquenil and poorly
controlled Hypertension. The patient says
that he had sudden loss of vision in his right
eye 5 days ago and that the vision has not
recovered since. On ocular examination,
you discover a normal anterior segment
while fundoscopy reveals widespread
hemorrhages and areas of infarction
throughout the retina. What is the most likely
diagnosis?
a) The patient has likely developed uveitis
secondary to his diagnosis of
Rheumatoid Arthritis
b) Bulls-eye maculopathy caused by
Plaquenil
c) Retinal Detachment
d) Central Retinal Vein Occlusion
13) An 84-year-old female patient presents with
a 2-year history of gradually worsening
vision. She continues to see 20/40 in both
eyes. On examination, you see a normal
anterior segment and normal lenses.
Fundoscopy reveals mild drusen in both
maculae with no hemorrhages visible. What
is the most appropriate next step in the
management of this patient’s condition.
a) Treat with anti-VEGF agents such as
Avastin or Lucentis
b) Place the patient on a regimen of ocular
vitamins such as Vitalux
c) Laser Photocoagulation
d) Photodynamic therapy with Visudyne
14) A 55-year-old man presents with a
complaint of seeing floaters in his vision
over the last 1.5 years. There has been a
gradual increase in the number of these
floaters but there has not been any sudden
change in his vision. He does not complain
of seeing any flashes of light and has not
noticed any shadows or curtains over his
vision. There is no photophobia and no
ocular pain. Examination reveals mild
cataracts in both eyes and his retina appear
normal and healthy. What is the most likely
cause for this patient’s symptoms?
a) Peripheral Retinal Detachment not
visible with slit lamp examination
b) Central Retinal Artery Occlusion
c) Posterior Vitreous Detachment
d) Cataract
15) Which lesion would produce a homonymous
hemianopia?
a) To the optic tract
b) To the optic nerve
c) At the chiasm
d) At the retina
16) In Horner's syndrome
(choose correct answer)
a) 1.0% hydroxyamphetamine will dilate a
postganglionic lesion
b) 1.0% phenylephrine will dilate a
preganglionic lesion
c) The miosis is most apparent in low light
levels
d) The ptosis only affects the upper lid
17) In afferent pupil defects (choose correct
answer)
a) The pupil is fixed and dilated
b) The pupil responds to light shone into
the second, normal eye
c) Both pupils constrict when light passes
from the normal to the abnormal eye
d) The damage could be to the oculomotor
nerve
18) The causes of efferent pupil defects
include… (choose the correct answer)
a) Damage to the medial geniculate
nucleus
b) Damage to the optic nerve
c) Adie's syndrome
d) Damage to the lateral geniculate nucleus
19) A 59-year-old male presents to his family
physician with a 6-month history of
progressive ptosis and diplopia. On
examination, the left eye is normal, but the
right eye exhibits a significant ptosis,
limitation of all extraocular movements, a
small pupil not reactive to light, and loss of
corneal sensation. What is the most likely
diagnosis?
a) Graves ophthalmopathy
b) Myasthenia gravis
c) Multiple sclerosis
d) Intercavernous internal carotid artery
aneruysm
20) A 2-year-old girl presents with a white
pupillary reflex (leukocoria) which the child’s
mother noticed in some recent family
photos. What is the least likely diagnosis?
a) Retinopathy of prematurity
b) Retinoblastoma
c) Congenital glaucoma
d) Cataract
ANSWERS

1. E 5. D 9. C 13. B 17. B
2. B 6. E 10. D 14. C 18. C
3. D 7. D 11. D 15. A 19. D
4. D 8. A 12. D 16. C 20. C
 Orthopedics
1) A 17 year old male was skateboarding and
fell while attempting to jump a flight of
stairs. He lands with his upper arm against
the edge of a step and hears a crack. At
the hospital he is told that he has suffered
a fracture of the left humeral shaft. What
nerve and artery are at risk in this type of
injury?
a) Ulnar nerve and axial artery
b) Axial nerve and radial artery
c) Median nerve and brachial artery
d) Radial nerve and brachial artery
e) Musculocutaneous nerve and axillary
artery
f) Posterior interosseous nerve and dorsal
scapular artery
2) A 23 year old male is playing soccer on a
muddy field when he is tackled from the
side. He immediately grabs his lower right
leg and to his horror feels a bone
protruding through the skin. At the hospital
he is diagnosed with an open fracture of the
right tibia. Which of the following initial
antibiotic regimens is appropriate:
a) Cefazolin for 24 hours
b) Cefazolin for 48 hours
c) Cefazolin, gentamicin and penicillin for
72 hours
d) Cefazolin and gentamicin for 48 hours
e) Gentamicin for 48 hours
3) A 45 year old female is picking apples from
a tree when she slips and falls from a
height of 14 feet, landing on her feet. Her
right ankle is very sore after the injury so
she proceeds to the local emergency room.
According to the Ottawa Ankle Rules, which
of the following would be an indication for
x-ray imaging of the affected ankle?
a) Inability to weight bear immediately after
the injury
b) Inability to weight bear immediately after
the injury and pain in the malleolar zone
c) Pain in the malleolar zone and body
tenderness over the posterior aspect of
the lateral malleolus
d) Bony tenderness over the posterior
aspect of the medial malleolus
e) Bruising over the anterior aspect of the
medial malleolus
4) A 23 year old male is involved in a multiple
vehicle collision during morning rush hour.
After arriving to the hospital via ambulance
around noon, it is discovered that the
gentleman is suffering, among a variety of
other minor injuries, from an open fracture
of his left distal radius. Upon questioning, it
is revealed that this gentleman is quite
healthy and taking no medications. He
denies any allergies. On physical exam,
the open fracture is quite obvious, although
the laceration is <2cm. A neurovascular
exam is unremarkable for any worrisome
findings. At this point, the most important
step in management would be:
a) Immobilize in a cast and follow-up in 1
week to reassess healing
b) Proceed straight to the OR for an I and
D, followed by ORIF
c) Inquire about tetanus status and
respond accordingly
d) Administer antibiotics that target gram
negative and anaerobic bacteria
e) Inquire about tetanus, give antibiotics
and book the patient for an
intraoperative I and D, and possible
ORIF, to be done the following day
5) You are the on call orthopedic surgery
resident during a stormy winter night.
During the evening hours, you are paged to
see a 73 year old lady who slipped on a
patch of black ice. She is complaining of
severe right hip pain and nothing else.
Upon questioning, you find out she suffers
from hypertension and osteoporosis;
moreover, you also discover that she has
broken her right distal radius on 2 other
occasions û fixed with closed reduction on
both occasions. Her osteoporosis is being
managed with calcium, vitamin D and an
unknown bisphosphonate. Her anti-
hypertensive medication is unknown, but
she admits that her blood pressure is well
controlled. There are no other medications.
The history also reveals that she has had
an appendectomy and C-section in the
past, has no allergies, has never smoked
and her last meal was lunch time. On
physical examination, her right leg is
shortened and in marked external rotation.
Her right leg, as well as her other
extremities, are neurovascularly intact.
The rest of the exam is unremarkable. You
send this lovely lady for an X-ray which
shows a grade 4 subcapital fracture of her
right hip. Her intraoperative treatment
would include:
a) Hemiarthroplasty of her right hip
b) Total arthroplasty of her right hip
c) Dynamic hip screw
d) Gamma nail
e) ORIF femoral neck
6) A 53 year old male suffers an undisplaced
fracture of his medial malleolus. It is
immobilized with a plaster cast. He has a
follow up visit in the fracture clinic in 2
weeks time to assess bone healing. You
explain to him the potential complications of
this fracture, including all of the following
EXCEPT:
a) Mal-union
b) Non-union
c) Infection
d) Fat embolism
e) DVT
7) An 18 year-old motorcyclist presents in the
emergency department following an
accident. He has a compound tibia and
fibula fracture of the right leg and on
examination the right leg has no pulses.
Your immediate treatment should be:
a) Immediate angiogram
b) Immediate surgery
c) Casting and/or splinting
d) Reduction and splinting
e) X-ray
8) Which of the following is the most serious
complication of a displaced supracondylar
fracture of the humerus?
a) Compartment syndrome of the forearm
b) Failure to heal
c) Healing in a non-anatomical position
d) Injury to the median nerve
e) Significantly limited range of elbow
motion
9) All of the following statements regarding
knee injuries are correct EXCEPT:
a) Locking of the knee may be due to a
torn meniscus
b) Minor tears of the medial collateral
ligament can be treated with brief
immobilization then range of motion and
strengthening exercises
c) Lateral meniscus tears are more
common than medial meniscal tears
d) Anterior cruciate ligament tears may
give a positive Lachman test
e) A knee dislocation may be associated
with major ligament damage
10) An 83 year-old man has fallen while walking
down stairs. He is brought to the
emergency department with a 3-part
intertrochanteric hip fracture. Which of the
following procedures would you choose to
perform?
a) Hemiarthoplasty
b) Total hip replacement
c) Multiple pin fixation
d) Bipolar arthroplasty
e) Pin and plate
11) A 16 year-old female fell while roller-blading
on her outstretched right hand. At a nearby
emergency department X-rays confirmed
the diagnosis of a closed Colles fracture.
The proper reduction technique for this
wrist fracture is which of the following:
a) Slight extension, full pronation, and full
ulnar deviation
b) Slight flexion, full supination, and full
radial deviation
c) Slight extension, full supination, and full
ulnar deviation
d) Slight flexion, full pronation, and full
ulnar deviation
e) Slight extension, full pronation, and full
radial deviation
12) Which of the following is least likely to
cause avascular necrosis:
a) Sickle cell disease
b) Septic arthritis
c) Steroid use
d) Constrictive dressings
e) Post-traumatic fracture
15) All of the following have been associated
with posterior shoulder dislocation
EXCEPT:
a) Ethanol
b) Electricity
c) Exercise
d) Epilepsy
e) Encephalitis
16) Management of an open fracture should
always include each of the following
EXCEPT:
a) Assessment of neurovascular status
b) Reduction and fixation of fracture
c) Irrigation and debridement of wound
d) Application of sterile dressing
e) Application of topical antibiotics

13) A 24 year-old football player severely

fractures his ankle while playing in a game
and subsequently requires ORIF treatment.
Indications for ORIF treatment of an ankle
fracture include all of the following
EXCEPT:
a) A fracture-dislocation
b) Undisplaced fracture with Grade II ATFL
tear
c) Trimalleolar fracture
d) Unstable talar tilt
e) Unable to maintain a closed reduction

14) Which of the following radiographic features is

most consistent with osteoarthritis of the
knee?
a) Marginal erosions
b) Juxta-articular osteopenia
(demineralization)
c) Loss of articular cartilage with narrowing of
the radiologic joint space
d) Osteonecrosis (avascular necrosis) of
the medial femoral condyle
e) Syndesmophyte formation
ANSWERS

1. D 4. C 7. D 10. E 13. B
2. C 5. B 8. A 11. D 14. C
3. C 6. D 9. C 12. D 15. C
16. E
Otolaryngology
1) The following statements regarding noise
are true EXCEPT:
a) Temporary threshold shift recovers
following cessation of noise exposure
b) Permanent threshold shift is
characterized by a progressive pattern of
hearing loss
c) Most cases of permanent threshold shift
are surgically treatable
d) Higher frequency noise is more
damaging than low frequency noise
e) None of the above
2) The frequencies most necessary for the
understanding of speech extend from about:
a) 20-20 000 Hz
b) 400-4 000 Hz
c) 250-8 000 Hz
d) 100-5 000 Hz
e) None of the above
3) Conductive hearing loss is a symptom of:
a) Presbycusis
b) Meniere disease
c) Cholesteatoma
d) Bell palsy
e) Acoustic neuroma
4) The following statements regarding epistaxis
are false EXCEPT:
a) Epistaxis rarely occurs in children
b) It commonly results from rupture of
posterior placed nasal vessels
c) It may be treated by ligation of the
ipsilateral internal carotid artery
d) Epistaxis may be treated by cautery of
Little's area with silver nitrate
e) It is not a common cause of emergency
admission to ENT wards
5) What is the typical audiogram finding in
noise induced hearing loss:
a) Conductive loss in the low frequencies
b) Conductive loss at 2000 Hz
c) Sensorineural loss at 2000 Hz
d) Sensorineural loss at 4000 Hz
e) Mixed broad spectrum hearing loss
6) Which of the following is not a complication
of untreated otitis media?
a) Cholesteatoma
b) Meningitis
c) Tympanic membrane perforation
d) Trigeminal neuralgia
e) Conductive hearing loss
7) Complications of tonsillectomy include all of
the following EXCEPT:
a) Secondary hemorrhage
b) Severe otalgia
c) Quinsy
d) Nasopharyngeal stenosis
e) None of the above
8) Features characteristic of acute tonsillitis
include all of the following EXCEPT:
a) Odynophagia
b) Cough
c) Referred otalgia
d) Cervical lymphadenopathy
e) Dysphagia
9) A 6 month-old baby has had mild inspiratory
stridor for the last 2 months. The most likely
cause of this is:
a) Laryngomalacia
b) Acute epiglottitis
c) Croup
d) Tonsillar hypertrophy
e) Foreign body aspiration
10) Which of the following is true regarding 14) Which of the following is an absolute
mandibular fractures? indication for a tonsillectomy?
a) They are predominantly unilateral a) Airway obstruction
b) Compound fractures are rarely intraoral b) Recurrent (>5) episodes of tonsillitis
c) They may manifest with numbness in the c) Peritonsillar abscess
V2 facial nerve distribution d) Tonsillar hypertrophy
d) Malocclussion of teeth is a common sign e) Halitosis
e) They seldom result in trismus

15) Which of the following is not a cause of

11) Nasopharyngeal carcinoma: sensorineural hearing loss:
a) Is most common in people from south- a) Ossicular discontinuity
east Africa b) Ototoxicity
b) Presents early with nasal pain c) Méniére disease
c) Is treated by wide surgical excision d) Noise
d) Is monitored by measurement of e) Presbycusis
Epstein-Barr virus antibodies
e) Is curable in 90% of patients
16) Which of the following is not true of
Meniere’s disease?
12) Factors which contribute to the development a) Characterized by quadrad of vertigo,
of squamous cell cancers of the head and hearing loss, tinnitus and aural fullness
neck include all of the following EXCEPT: b) Vertigo burns out with time
a) Cigarette smoking c) Can be treated with diuretics
b) Alcohol ingestion d) It is the result of an abnormal buildup of
c) Aging potassium
d) Exposure to particular emission from e) The vertigo lasts for seconds
diesel engines
e) Solar irradiation
17) What is the most common type of thyroid
cancer?
13) Which of the following statements about a) Medullary
aspiration of a peanut into the b) Papillary
tracheobronchial tree is FALSE? c) Follicular
a) The peanut is more likely to be in the left d) Lymphoma
lower lobe bronchus e) Anaplastic
b) Expiratory wheeze is the most likely
finding on physical exam
c) The peanut should be removed with the
patient under general anesthesia through
an open bronchoscope with forceps
designed to grasp peanuts
d) A chest x-ray may show atelectasis distal
to the blocked bronchus
e) Pneumonia may be a complication
ANSWERS

1. C 5. D 9. A 13. A 17. B
2. B 6. D 10. D 14. A
3. C 7. B 11. D 15. A
4. D 8. C 12. D 16. E
 Pediatrics
1) 6-month-old boy is brought to you with white
patches on mucous membranes of mouth,
the most likely diagnosis is:
a) Herpes simplex
b) Candida infection
c) Molluseum contagiosum
d) Staphylococcal folliculitis
6) Children with fifth disease (erythema
infectiosum, caused by parvovirus B19) do
NOT have:
a) Fever
b) “Slapped-cheek” rash
c) “Lacy” rash on the trunk
d) Rash on palms and soles

2) A child is born with jaundice and has 7) As opposed to nutritional marasmus,

seizures, CT head shows intracranial kwashiorkor is characterized by:
calcifications, the most likely diagnosis is: a) Anorexia
a) Hepatitis B b) Alopecia
b) Congenital rubella c) Severe muscle wasting
c) Congenital syphilis d) Edema
d) Congenital toxoplasmosis

8) Anterior bowing of the tibias (saber shins) is

3) Of the following, the most common associated with:
presentation of child abuse are: a) Beriberi
a) Burns b) Multiple sclerosis
b) Bruises c) Congenital syphilis
c) Bone fractures d) Duchenne muscular dystrophy
d) Intraabdominal injuries

9) 2 year old child develops barking cough and

4) 3 year old child has respiratory distress, stridor and symptoms of an upper
stridor and cough, chest X-ray shows respiratory infection. The most likely
subglottic narrowing (steeple), the most diagnosis is:
likely cause is: a) Croup
a) Klebsiella b) Sinusitis
b) Streptococcus c) Epiglottitis
c) Parainfluenza virus d) Pertonsillar abscess
d) Staphylococcus aureus

10) The most common cause of otitis externa in

5) A premature infant has abdominal children and adults is:
distention, X-ray shows bubbly intestinal a) Proteus
wall and hepatic portal venous gas, your b) Candida
diagnosis is: c) Escherichia coli
a) Celiac disease d) Pseudomonas aeruginosa
b) Cystic fibrosis
c) Ulcerative colitis
d) Necrotizing enterocolitis
11) One year old child has septic arthritis, the 17) A baby turns blue whenever it stops crying.
most likely cause is: The most likely diagnosis is:
a) Escherichia coli a) Lung abscess
b) Neisseria meningitidis b) Cystic fibrosis
c) Staphylococcus aureus c) Mitral stenosis
d) Haemophilus influenzae d) Choanal atresia
e) Tetralogy of Fallot

12) Ambiguous genitalia in infants is most

commonly due to: 18) Which of the following should be ruled out in
a) Congenital adrenal hyperplasia a 15 year old boy with gynecomastia?
b) Testicular feminization a) Down's syndrome
c) Ovarian tumor b) Edward's syndrome
d) Pituitary adenoma c) Turner's syndrome
e) Gonadal dysgenesis d) Fragile X syndrome
e) Klinefelter's syndrome

13) Patients with Klinefelter syndrome have:

a) Small testes 19) Children with pectus excavatum (funnel
b) Short stature chest) are most likely to develop:
c) 47 XYY karyotype a) Kyphosis
d) Increased facial hair b) Sarcoidosis
e) Decreased serum estradiol c) Osteosarcoma
d) Cystic hygroma
e) Achondroplasia
14) Diagnosis of hemolytic-uremic syndrome is
most likely to be confused with:
a) Thalassemia 20) X-ray of lateral neck of a 6 year old child
b) Pyelonephritis shows thumb-print sign, the most likely
c) Hydronephrosis diagnosis is:
d) Polycystic kidney disease a) Croup
e) Thrombotic thrombocytopenic purpura b) Epiglottitis
c) Cystic fibrosis
d) Bronchial asthma
15) Of the following, the best medication for e) Epiglottal cancer
absence seizures (“petit mal”) is:
a) Phenobarbital
b) Diazepam 21) Croup (laryngotracheobronchitis) is:
c) Ethosuximide a) Most commonly caused by fungus
d) Clonazepam b) Associated with inspiratory stridor
e) Levodopa c) Usually occur in ages 10 to 15 years
d) More common in males than in females
e) Characterized by high fever for 3 days
16) Hirschsprung's disease (congenital
aganglionic megacolon /rate of 1 in 5000
live births) is best diagnosed by: 22) A couple had a child with bilateral cleft lip
a) Sigmoidoscopy and palate, the chance of having another
b) Rectal examination child with the same defect is:
c) Rectal biopsy a) 3%
d) Barium enema b) 13%
e) Plain abdominal X ray c) 30%
d) 53%
23) Infants born to diabetic mothers often have: 29) The most common cause of acute
a) Hypercalcemia gastoenteritis in developed countries is:
b) Hyperglycemia a) Viral
c) Cardiomegaly b) Fungal
d) None of the above c) Bacterial
d) Parasitic
24) Sudden, symmetric adduction and flexion of
limbs with concomitant flexion of head and
trunk in a one year old child is most likely 30) The most common extracutaneous site of
due to: involvement of chickenpox in children is:
a) Petit mal a) Genitourinary system
b) Grand mal b) Cardiovascular system
c) Febrile convulsions c) Central nervous system
d) Infantile spasms (West's syndrome) d) Gastrointestinal system

25) The most common malignant hepatic

tumour in a one year old child is:
a) Hepatoblastoma
b) Cholangiocarcinoma
c) Fibrolamellar carcinoma
d) Hepatocellular carcinoma

26) What would you order for a 12 year old girl

with recurrent episodes of edema lasting 48-
72 hours affecting the face?
a) Monospot test
b) Lymph node biopsy
c) Muscle enzyme levels
d) C1 inhibitor levels

27) Ewing’s tumor is a:

a) Bone cyst
b) Benign tumor
c) Malignant sarcoma
d) A form of multiple myeloma

28) Infants with congenital heart diseases may

present with:
a) Hemoptysis
b) Hepatomegaly
c) Both
d) Neither
ANSWERS

1. B 7. D 13. A 19. A 25. A

2. D 8. C 14. E 20. B 26. D
3. B 9. A 15. C 21. B 27. C
4. C 10. D 16. C 22. A 28. B
5. D 11. C 17. D 23. C 29. A
6. D 12. A 18. E 24. D 30. C
 Plastic Surgery
1) A 30 year old man was trapped in a burning
house. When he was rescued and brought
to hospital, it was found that he had first
degree burns to his torso, second degree
burns to the anterior aspect of both his arms
and third degree burns to both his legs. His
weight is approximately 70 kg. You are the
emergency physician that first received him
in the Emergency Room, which fluid
resuscitation would you initiate if he
presented 1 hour after his burn injury.
a) Ringer's Lactate 525 ml/hr
b) Ringer's Lactate 788 ml/hr
c) Ringer's Lactate 900 ml/hr
d) Ringer's Lactate 1420 ml/hr
e) Ringer's Lactate 1620 ml/hr
2) A 56 year old woman who works as a
medical secretary comes into the office
complaining of pain in her left hand. After a
detailed history and physical, it was
concluded that her pain is most likely
attributed to carpal tunnel syndrome. Which
of the following is not a feature of carpal
tunnel syndrome?
a) Numbness and pain in the affect hand
leading to frequent night awakenings
b) Decreased ability to abduct the thumb
c) Decreased sensation in the 4th and 5th
digits
d) Flattening of the thenar eminence
e) Percussion over the median nerve at the
wrist reproduces symptoms
3) A 50 year old healthy man who recently
underwent day surgery for right inguinal
hernia repair presents with fever and pain
over his incision area. On examination, it
was found that there is a poorly defined
erythematous region around his incision that
is tender to palpation with no areas of
necrosis. Which of the following organism is
most likely the cause of his infection?
a) Escherichia coli
b) Pseudomonas aeruginosa
c) Streptococcus pyogenes
d) Clostridium perfringens
e) Pasteurella multocida
4) You are working in the emergency
department when a burn victim is brought in.
Which of the following is not an indication for
transfer to a burn center:
a) A 40 year old man who fell asleep while
smoking and sustained a mixed 2º and
3º burn to 15% of his body including his
right hand, arm and chest
b) A five year old boy with a mixed 2º and
3º burn to 15% total body surface area
on his back from a scald injury
c) A 30 year old woman who was rescued
from a burning building. She has a 5%
TBSA mixed 2º and 3º burn on her right
forearm and 12% mixed 2º and 3º on her
thigh. She was also trapped in a smoke-
filled room and appears to be in
respiratory distress
d) A 45 year old factory worker who
sustained a 0.5% total body surface area
partial thickness burn to his left forearm
after coming into contact with
hydrofluoric acid
e) A 58 year old woman who sustained a
high voltage electrical injury
5) A 32 year old man comes into the
emergency department after a sustaining
facial blow injuries from a fight. The CT
head reveals that he has sustained facial
bone fractures. Which of the following is an
indication for him to have immediate
surgery:
a) He has a displaced nasal bone fracture
b) His CT head reveals an orbital floor
fracture with no soft tissue entrapment
c) He has ptosis and proptosis of his left
eye and is complaining that he cannot
see out of this eye even when the eyelid
is held open
d) He has an unstable fracture of the
zygomatic complex
e) He has a bilateral LeFort I fracture
6) Which of the following is not a sign or
symptom of carpal tunnel syndrome:
a) Loss of sensation to the proximal palm
b) Positive Phalen test
c) Positive Tinel sign
d) Pain involving the thumb, index, long,
and part of the ring digits
e) Delayed transit time on nerve conduction
study
7) A 35 year-old intoxicated man presents to
the Emergency Department with a deep
laceration to his right distal forearm after
putting his hand through a window. On
examination, he has no sensation to his little
finger and the ulnar aspect of his ring finger.
Power on abduction and adduction of all
fingers is markedly decreased. He is unable
to flex the distal joint of his little finger. When
he flexes his wrist, his hand deviates
radially. The examination was otherwise
normal. What structure(s) have been
damaged?
a) Ulnar nerve
b) Flexor carpi ulnaris and flexor digitorum
profundus muscles
c) Median nerve
d) Radial nerve
e) Brachioradialis
8) In which of the following are systemic
antibiotics not indicated:
a) Animal bite to hand
b) Laceration over metacarpalphalangeal
joint sustained after punching someone
in a fight
c) Cellulitis
d) Burn wound to 75% of the dorsal aspect
of the hand
e) Acute suppurative tenosynovitis
9) Which of the following is not a finding in
mandibular fractures?
a) Palpable step along mandible
b) Loose teeth
c) Trismus
d) Numbness in V2 distribution
e) Malocclusion
10) A 43 year-old woman is brought to the
Emergency Department after being burned
in a house fire. You estimate first degree
burns to 20% of her body, second degree
burns to 11% of her body, and third degree
burns to 9% of her body. She weighs 60 kg
and is 120 cm tall. What IV therapy would
you begin immediately?
a) Normal saline at 200cc/hr for 24 hours
b) Normal saline at 400cc/hr for 24 hours
c) Normal saline at 150cc/hr for 8 hours,
then 75cc/hr for the next 16 hours
d) Normal saline at 300cc/hr for 8 hours,
then 150cc/hr for the next 16 hours
e) Normal saline at 600cc/hr for 8 hours,
then 300cc/hr for the next 16 hours
11) Which of the following statements is
incorrect with respect to wound healing?
a) Epithelialization can occur within 24
hours following primary closure of a
wound
b) Maximum wound strength is often
achieved after 2 years
c) Wounds continue to gain strength after
collagen synthesis has reached an
equilibrium
d) Wound contraction is mediated by
myofibroblasts
e) The incidence of wound infection
increases with healing by secondary
intention
12) Which of the following is not a stage in the
development of pressure ulcers?
a) Ischemia
b) Congestion
c) Hyperemia
d) Ulcer
e) Necrosis
13) A 45 year old woman with a history of
hypothyroidism comes to your office
complaining of problems with extending the
middle finger of her left hand for the last two
months. She complains of a snapping of
her finger when she forces extension and on
examination, you can feel a nodule on the
palmar aspect of her left hand proximal to
the third MCP joint. Based on your history
and physical exam, you conclude that her
symptoms are most likely attributed to
stenosing tenosynovitis. Which one of the
following options is incorrect:
a) You suspect that her symptoms are
arising at the A-1 pulley. This is the
most common site for this condition to
arise
b) The ring finger is one of the most
commonly affected fingers
c) This condition is also associated with
rheumatoid arthritis and diabetes mellitus
d) The most appropriate therapeutic option
at this time would be conservative
treatment with NSAIDs and steroid
injections
e) The most appropriate therapeutic option
at this time is surgical incision of the A-1
flexor tendon sheath
ANSWERS

1. C 4. D 7. A 10. D
2. C 5. C 8. D 11. E
3. C 6. A 9. D 12. B
13. E
 Community and Population Health
1) The following is an example of primary
prevention:
a) Routine mammography to detect early
breast cancer tumour growth
b) Routine Pap smear to detect early
endocervical cytological changes
c) ACE inhibitor to treat hypertension
d) Vaccination to prevent diphtheria
e) Lithium to manage mood symptoms
associated with bipolar disorder
2) The number one cause of potential years of
life lost (PYLL) in Canada is:
a) Neoplasm
b) Circulatory disease
c) Unintentional injuries
d) Suicide
e) Respiratory disease
3) Which of the following statements regarding
sensitivity of Test X for Disease Y is true?
a) It is defined as the true positives divided
by the false negatives
b) It refers to the proportion of the people
who do not have Disease Y whose Test
X is negative
c) If Test X is sensitive and is found to be
negative, it can be used to rule out a
disease hypothesis
d) Sensitivity and specificity are not useful
in determining the likelihood ratio of a
test
e) The positive predictive value of Test X is
the inverse of the sensitivity of Test X
4) Which of the following statements regarding
measurements of the effectiveness of
interventions is false?
a) Relative risk reduction (RRR) is defined
as the proportional reduction in rates of
bad outcomes between experimental
and control participants in a trial
b) Absolute risk reduction (ARR) is defined
as the absolute arithmetic difference in
rates of bad outcomes between
experimental and control participants in
a trial
c) The number needed to treat (NNT) is
defined as the inverse of the absolute
risk reduction (ARR) -- i.e. 1/ARR
d) Compliance is defined as the degree to
which a patient adheres to a treatment
plan
e) Effectiveness is defined as the extent to
which a specific intervention produces a
beneficial result under ideal conditions
achieved in a clinical trial
5) Which is not a result of chronic lead
exposure?
a) Peripheral motor neuropathy
b) Nephrotoxicity
c) Hemolytic anemia
d) Microcytic anemia
6) Which is not a function of municipal public
health units?
a) Tobacco legislation enforcement
b) Inspections of restaurants
c) Approval of new medications
d) Reportable disease surveillance and
follow-up
7) Which of the following is not a reportable
disease?
a) HIV
b) Measles
c) Tetanus
d) Streptococcal pharyngitis
8) Which is an example of a propagated
epidemic?
a) Exposure is brief and essentially
simultaneous after exposure to a
common source
b) Begins with only a few exposed
persons, but is maintained by person-
to-person transmission
c) Exposure to a common source lasts for
a period of days to weeks
9) Which is an example of a cohort study?
a) Subjects are sampled, and as a group
are classified on the basis of presence
or absence of exposure to a particular
risk factor
b) Samples a group of people who already
have a particular outcome and
compares them to a similar sample
group without that outcome
c) Status of individual with respect to
presence and absence of both
exposure and disease assessed at one
point in time
d) Random distribution of baseline
characteristics and treatment between
groups
10) Which is not true of the WSIB?
a) The WSIB decides benefits for workers
b) The employers pay for WSIB costs
c) Once a claim has been made,
physicians are required to provide the
WSIB with information about a worker's
health
d) Workers are able to sue the employer
up to a maximum of $100,000 in cases
of negligence
11) Which one of the following is not a typical
feature of asbestosis?
a) Increased risk of cancer
b) Pleural thickening and calcification
c) Interstitial fibrosis
d) Obstructive pattern on pulmonary
function tests
e) None of the above
12) Lead exposure typically results in:
a) Chronic dermatitis
b) Resting and intention tremor
c) Extensor muscle weakness
d) Arrhythmias
e) Cerebellar ataxia
13) Which of the following statements
concerning the Worker’s Compensation Act
is true?
a) The worker reserves the right to sue the
employer for negligence
b) Funding is provided by the provincial
government
c) The worker is guaranteed payment from
the first day of injury/illness if it is
deemed to be work-related
d) The Worker’s Compensation Board is
an independent, private agency
e) None of the above
14) Which of following statements regarding
radiation is false?
a) Natural background radiation accounts
for about half of a typical person’s
exposure
b) Ionizing radiation causes intestinal villi
to become denuded
c) Exposure to non-ionizing radiation may
result in cataracts
d) Ionizing radiation results in an increased
incidence of neoplasia such as lung and
thyroid
e) None of the above
15) Which statement concerning vibration
induced white finger disease is false?
a) Early symptoms include tingling and
numbness of the fingers when at rest
b) Swelling of the fingers over knuckles
may be an early feature
c) Cold, damp conditions may precipitate
symptoms
d) The affected area eventually spreads to
involve all fingers
e) None of the above
16) In a cohort study of disease “X” in people 19) The following indicate the results of
with risk factor “Y” versus those who are screening test “Q” in screening for disease
without risk factor “Y”, the following results “Z”:
were obtained: Disease Z
+ -
X no X Total + 40 10 50
Y 80 20 100 Screen - 30 120 150 Q
no Y 50 50 100 a)70 130 200

The relative risk of developing “X” in “Y” The specificity of test “Q” would be:
versus no “Y” is: a) 40/70
a) 80 x 50 = 4 c) 50 x 80 = 4 b) 120/130
50 x 20 20 x 50 c) 40/50
d) 120/150
b) 50 _ 20 = 0.3 d) 80/100 = 1.6 e) 40/130
100 100 50/100

e) it is not possible to calculate risk in a 20) The positive predictive value would be:
cohort study a) 40/70
b) 120/130
17) The attributable risk of factor “Y” to disease c) 40/50
“X” would be: d) 120/150
a) 80/100 = 1.6 c) 80 x 50 = 4 e) 70/200
50/100 50 x 20

b) 80 _ 50 = 0.3 d) 50 x 20 = 0.25 21) To determine an odds ratio one would have

100 100 80 x 50 to perform which of the following studies?
a) A cross sectional/prevalence study
e) it is not possible to calculate b) A randomized controlled trial
atrributable risk in a cohort study c) A cohort study
d) A case study
e) A case control study
18) A group of 50 people are exposed to virus
“A”. Of those 50 people, 9 develop a mild
infection, 10 become seriously ill, and 3 die. 22) Examples of secondary prevention would
The attack rate of virus “A” in the population include all of the following EXCEPT:
would be: a) Pap smear for cervical cancer
a) 22/50 b) Chemoprophylaxis in a recent TB
b) 9/50 converter
c) 10/50 c) Proctoscopy for rectal cancer
d) 19/50 d) Immunization for Haemophilus
e) 13/50 influenzae B
e) Mammography for breast cancer
23) Alpha error is:
a) The probability of declaring a difference
to be absent when it in fact is present
b) The probability of declaring a difference
to be present when it is not
c) The probability of declaring a difference
to be absent when it is indeed absent
d) The probability of declaring a difference
to be present when it does exist
24) Which one of the following descriptors of a
diagnostic test is influenced by the
prevalence of the disease being tested for:
a) Specificity
b) Sensitivity
c) Accuracy
d) Positive predictive value
e) Reliability
25) Which of the following statements regarding
the measurement of health and disease in a
population is true?
a) A rate is the number of times an event
has occurred during a certain time
interval divided by the number of
persons at risk during the same interval
b) When calculating a ratio, the numerator
is a portion of the denominator
c) A ratio is the number of times an event
has occurred during a certain time
interval multiplied by the number of
times an event has occurred during the
same interval
d) When calculating a rate, the numerator
is not a portion of the denominator
e) None of the above
26) In 1990, which country spent the least on
health care as a percentage of GDP (gross
domestic product):
a) Canada
b) France
c) Sweden
d) UK
e) USA
27) The component of Canada's health care
system that receives the highest
percentage of the health care budget is:
a) Hospitals
b) Physician fees
c) Drug benefit plans
d) Laboratory services
e) Administration
28) The British North America Act (BNA):
a) Was mainly concerned with health care
legislation
b) Granted exclusive powers over health
care to the provinces, including powers
over marine hospitals
c) Replaced the Canada Health Act
d) Applied to British Columbia only
e) None of the above
29) Regarding health expenditure and health
outcomes:
a) The U.S. has the greatest health
expenditure and the lowest infant
mortality rates
b) There is a positive association between
national expenditure on health and GDP
c) Increased national health expenditure
always increases health status of a
country
d) All of the above
e) None of the above
30) Which of the following is the most important
justification for population screening
programs for a specific disease?
a) Early detection of the disease of interest
is achieved
b) The specificity of the screening test is
high
c) The natural history of the disease is
favourably altered by early detection
d) Effective treatment is available
e) The screening technology is available
31) Regarding the regulation of health
professionals, provincial colleges of
physicians and surgeons:
a) Have the advancement of the public
interest as their primary goal
b) Protect the public from incompetent or
unfit MDs
c) Act as licensing bodies for MDs
d) Do not advance the professional and
political interests of MDs
e) All of the above
32) Active immunization was important in
control of each of the following childhood
communicable diseases EXCEPT:
a) Diphtheria
b) Polio
c) Measles
d) Scarlet fever
e) Pertussis
33) All of the following statements are true
EXCEPT:
a) One indirect measure of a population’s
health status is the percentage of low
birth weight neonates
b) Accidents are the largest cause of
potential years of life lost in Canada
c) The Canadian population is steadily
undergoing rectangularization of
mortality
d) Morbidity is defined as all health
outcomes excluding death
e) The neonatal mortality rate is the
number of infant deaths divided by the
number of live births multiplied by 1000
34) All of the following statements are true
EXCEPT:
a) The data collected on a death certificate
is uniform and in conformity with WHO
guidelines
b) Section 7 of the Coroner’s Act states
that the coroner’s office must be notified
if a patient dies after some mishap such
as leaving an instrument in the body at
surgery
c) Diseases which must be reported to the
local medical officer of health include
AIDS, food poisoning, influenza and
gonorrhea
d) A tuberculin reaction greater than 5 mm
is considered positive in all individuals
e) All of the above
35) In describing the leading causes of death in
Canada, two very different lists emerge,
depending on whether proportional
mortality rates or person-years of life lost
(PYLL) are used. This is because:
a) One measure uses a calendar year and
the other a fiscal year to calculate
annual experience
b) One measure includes morbidity as well
as mortality experience
c) Both rates exclude deaths occurring
over the age of 70
d) Different definitions of “cause of death”
are used
e) One measure gives greater weight to
deaths occurring in younger age groups
36) Differentiation between a point-source
epidemic and a progressive (propagated)
epidemic is made by:
a) Considering the characteristics of the
infectious agent
b) Determining the level of immunity in the
community
c) Determining the number of persons
infected and calculating the attack rate
d) Plotting the distribution of cases by time
onset
e) None of the above
37) The occurrence of an illness at a rate of
above that expected is called:
a) Hyperendemic
b) Epidemic
c) Endemic
d) Enzootic
e) Pandemic
38) Each of the following statements applies to
case control studies EXCEPT:
a) Starts with disease
b) Suitable for rare diseases
c) Relatively inexpensive
d) Prolonged follow-up required
e) There may be a problem in selecting
and matching controls
39) A clinician who has been examining the
patterns of mortality in your community
says that the rates for heart disease and
lung cancer are higher in this community
than in an adjacent community. Which of
the following questions should you ask
first?
a) How did the clinician choose the
comparison community?
b) Have the rates been standardized for
age?
c) Are tobacco sales significantly different
in the two communities?
d) Are the facilities to treat these diseases
comparable in the two areas?
e) Are the numbers of deaths comparable
in each area?
40) The purpose of randomization is to:
a) Make sure that there are equal numbers
of men and women in test and control
groups
b) Increase the chances of getting a
statistically significant difference
c) Ensure that the numbers of cases and
controls are equal
d) Limit bias
e) All of the above
41) Which of the following types of studies
usually provides only a measure of
prevalence?
a) Descriptive
b) Cross-sectional
c) Randomized controlled trial
d) Cohort
e) None of the above
42) The major advantage of cohort studies over
case-control studies is that:
a) They take less time and are less costly
b) They can utilize a more representative
population
c) It is easier to obtain controls who are not
exposed to the factor
d) They permit estimation of risk of disease
in those exposed to the factor
e) They can be done on a “double-blind”
basis
43) All of the following statements concerning
occupational health are true EXCEPT:
a) Disorders of reproduction are among the
top 10 work-related diseases and
injuries
b) Most workers are covered by both
federal and provincial legislation with
respect to workplace health and safety
c) Skin problems and hearing problems
together are responsible for half of WCB
claims
d) A complete occupational medical history
includes investigation of the temporal
relationship between symptoms and
exposure
44) Which of the following statements
concerning exposure to solvents in the
workplace is true?
a) Each solvent compound has a specific
antidote that can be used to treat
exposure
b) A prominent symptom of solvent
exposure is memory loss
c) Some solvents can cause skin dryness
and loss of subcutaneous adipose
tissue
d) Solvents do not affect the bone marrow
e) All of the above
45) In 1981, the crude birth rate in Ontario was
approximately 14 per 1000 and the crude
death rate was 7 per 1000. The estimated
rate of net migration was –1 per 1000. The
growth rate of the province, per 1000
population was:
a) 6
b) 7
c) 8
d) 20
e) 22
46) All of the following statements about
environmental health are true EXCEPT:
a) Levels of toxic agents measured in the
environment may not reflect internal
organ levels
b) The federal government monitors the
quality and types of industrial emissions
and toxic waste disposal
c) Sick building syndrome is associated
with Pontiac fever and Legionnaire’s
disease
d) All humans have detectable levels of
PCBs
e) None of the above is true
47) The effectiveness of a preventative
measure is assessed in terms of:
a) The effect in people to whom the
measure is offered
b) The effect in people who comply with
the measure
c) Availability with the optimal use of
resources
d) The cost in dollars versus the benefits in
improved health status
e) All of the above
48) All of the following statements about the
Canada Health Act (1984) are true
EXCEPT:
a) It did not define all medically necessary
hospital and physician services
b) The CHA replaced the Hospital
Insurance and Diagnostic Services Act
of 1957
c) The CHA banned all forms of extra
billing
d) According to the CHA, provinces must
meet all the terms and conditions of
Medicare to qualify for federal transfer
payments
e) None of the above
49) Each of the following is an example of
primary prevention EXCEPT:
a) Genetic counselling of parents with one
retarded child
b) Nutritional supplements in pregnancy
c) Immunization against tetanus
d) Chemoprophylaxis in a recent tuberculin
converter
e) Speed limits on highways
50) The classical “epidemiological triad” of
disease causation consists of factors which
fall into which of the following categories:
a) Host, reservoir, environment
b) Host, vector, environment
c) Host, agent, environment
d) Reservoir, agent, vector
e) Host, age, environment
51) Of the five items listed below, the one which
provides the strongest evidence for
causality in an observed association
between exposure and disease is:
a) A large attributable risk
b) A large relative risk
c) A small p-value
d) A positive result from a cohort study
e) A case report
52) The difference between a common point
source outbreak and a propagated outbreak
of illness is that:
a) All cases in a common point source
outbreak occur within one incubation
period of the exposure
b) The attack rates in propagated
outbreaks are higher
c) Person-to-person transmission is a
feature of common source outbreaks
d) Case fatality rates in common source
outbreaks are generally higher
e) The source of infection in propagated
outbreaks is more easily contained than
in common source outbreaks
53) Which of the following are strategies for
control of disease:
a) Population immunization
b) Contact tracing to offer treatment to all
who could be infected
c) Monitoring increases in the population of
certain disease vectors
d) Having physicians report curable,
potentially serious diseases
e) All of the above are true
54) During a clinical trial, the difference in the
success rates of two drugs was not
statistically significant. This means that:
a) There is no difference in drug
effectiveness
b) There is a sizable probability that the
demonstrated difference in the drugs’
effectiveness could occur due to chance
alone
c) The demonstrated difference in the
drugs’ effectiveness is too small to be
clinically meaningful
d) The two samples of patients on which
the drugs were tested came from the
same population
e) None of the above are true
55) 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:
a) The mortality rate is greater in women
b) The case fatality rate is higher in women
c) The duration of the disease is longer in
women
d) Women receive less adequate medical
care for the disease
e) This diagnosis is more often missed in
women
56) All of the following statements about
statistical tests are true EXCEPT:
a) Linear regression is used to describe
the relationship between two continuous
variables
b) A confidence interval is a range of
values giving information about the
precision of a measurement
c) ANOVA tables are used to make
comparisons among the means of 3 or
more groups simultaneously
d) In a normal distribution, the mean,
median and mode are equal
e) The chi-square test evaluates the
statistical significance of 2 or more
percentages of categorical outcomes
57) All of the following are responsibilities of 61) Which of the following is not in the top 10
local public health units in Canada leading causes of death in Canada?
EXCEPT: a) Respiratory diseases
a) Communicable disease control b) Malignant neoplasms
b) Health education c) Diseases of the heart
c) Investigation of sudden death d) Accidents
d) Immunization e) Viral hepatitis
e) Health promotion

62) Which of the following will increase the

58) Who is ultimately responsible for the quality power of a study?
of care in a hospital? a) Increase beta
a) Chief executive officer b) Analyze data using more powerful
b) Board of trustees statistical tests
c) Medical director c) Change from z-test to a t-test
d) Chief of staff d) Increase sample size
e) Attending physicians e) None of the above

59) Which of the following is not one of the 5

Terms and Conditions of Medicare?
a) Portability
b) Flexibility
c) Universality
d) Comprehensive coverage
e) Accessibility

60) You are given this data pertaining to an

outbreak of diarrhea in a daycare:

Age Number of Number of

Children Diarrhea
1 25 20
2 20 10
3 40 10
4 40 5
5 20 4
6+ 25 1

What is the attack rate of this illness?

a) 25% d) 40%
b) 30% e) 66%
c) 33%
ANSWERS

1. D 13. C 25. A 37. B 49. D

2. A 14. E 26. D 38. D 50. C
3. C 15. E 27. A 39. B 51. B
4. E 16. D 28. E 40. D 52. A
5. C 17. B 29. B 41. B 53. E
6. C 18. A 30. C 42. D 54. B
7. D 19. B 31. E 43. B 55. C
8. B 20. C 32. D 44. C 56. E
9. A 21. E 33. E 45. A 57. C
10. D 22. D 34. D 46. B 58. D
11. D 23. B 35. E 47. A 59. B
12. C 24. D 36. D 48. C 60. C
61. E
62. D
 Psychiatry


1) A 40 year old males states he is feeling 3) Which benzodiazepine has the shortest half-
down and is in conflict with his wife. You life in the body?
elicit he has always been somewhat rigid; a) Triazolam
he is a conscientious employee. You note b) Clorazepate
that he is dressed very neatly and that while c) Nitrazepam
giving you his history he rambles, giving you d) Chlordizepoxide
all the details.The most likely personality e) Diazepam
type described here is:
a) Narcissistic 4) All of the following statements are true about
b) Dependent depression in the elderly EXCEPT:
c) Passive-aggressive a) Somatic symptoms are frequently
d) Self-defeating (masochistic) substituted for emotional symptoms
e) Obsessive-compulsive b) Tricyclics should not be used because of
cardiotoxicity
2) In panic disorder, studies suggest the most c) Precipitating events are usually related
effective and long-lasting treatment is: to loss
a) Behaviour therapy d) Some cases may benefit from ECT
b) Psychoanalysis e) May present with abnormalities in
c) Diazepam cognitive function
d) Imipramine
e) Hypnotherapy
ANSWERS

1. E 2. A 3. A 4. B
 Respirology
1) A 16 year old presents to the ER with a
severe asthma exacerbation. All of the
following may be considered as part of the
management plan EXCEPT:
a) Pulmonary Function tests
b) Peak Flow meters
c) Chest X-Ray
d) Oral prednisone
e) Counselling for better treatment
compliance
2) A 56 year old gentleman is referred to your
clinic for evaluation of an incidental lung
nodule on CXR. Which of the following
findings makes it more likely to be benign:
a) Greater than 3cm in diameter
b) Ill-defined margins
c) Calcification
d) Doubles in size on repeat CXR in 15
months
e) Clubbing
3) A 36 year old woman presents to your clinic
with suspected pulmonary hypertension.
Which of the following conditions is more
suspicious of a secondary cause for
pulmonary hypertension?
a) Raynauds phenomenon
b) Previous use of appetite suppressant
drugs
c) An isolated history of pneumonia 5 years
ago
d) Recurrent pulmonary emboli
e) No family history of pulmonary disease
4) Which of the following pulmonary function
tests most reliably discriminates “pure”
chronic bronchitis from emphysema?
a) Total lung capacity
b) Functional residual capacity
c) Residual volume
d) Single breath diffusing capacity
e) Low at 50% vital capacity
5) Which is more often associated with hospital
acquired pneumonia than community-
acquired pneumonia?
a) Streptococcus pneumoniae
b) Hemophilus influenza
c) Pseudomonas
d) Chlamydia pneumoniae
e) Mycoplasma pneumoniae
6) A 30 year-old patient with asthma complains
of daily wheezing and occasional waking at
night with cough and chest tightness for
three weeks. His usual medication is
salbutamol two puffs tid-qid. The next step
in management is:
a) Add long-term theophylline
b) Increase salbutamol to two puffs q4h
c) Add ipratropium bromide two puffs qid
d) Add beclomethasone two puffs qid
e) Discontinue salbutamol and begin
prednisone 50 mg od and taper over 2
weeks
7) Which is not a feature of asbestosis?
a) Increased risk of cancer
b) Pleural thickening and effusion
c) Interstitial fibrosis
d) Obstructive pattern on pulmonary
function tests
e) All of the above are features of
asbestosis
8) A 55 year-old man with a history compatible
with chronic bronchitis presents to your
office with shortness of breath on exam. In
the history, all of the following would be
anticipated EXCEPT:
a) A 20-year history of smoking
b) Worsening of symptoms with exposure
to smog
c) Worsening of symptoms with acute
respiratory infections
d) Recurrent episodes of pleurisy
e) Increased incidence of chronic
respiratory disease in family members
9) A 55 year-old woman with asthma is on
systemic steroids for one year. She
develops a recent right-sided pleural
effusion. She feels unwell and tires easily.
Aspiration reveals a turbid fluid, a high
lymphocyte count, high LDH, low glucose,
and a pH of 7.4. The most compatible
diagnosis is:
a) Pulmonary embolism
b) Empyema
c) Tuberculosis
d) Subphrenic abscess
e) Pancreatitis
11) Each of the following is a correct statement
about COPD EXCEPT:
a) The type of emphysema associated with
smoking is usually centriacinar
b) Clubbing is not a clinical feature
c) Long-term oral steroids should be
avoided
d) Smoking cessation does not lead to
improvement of pulmonary function
e) The aim of supplemental O2 therapy is to
provide relief of shortness of breath

10) Diagnosis of acute symptomatic pulmonary

embolism can be excluded when which of
the following is normal?
a) Chest x-ray
b) Ventilation-perfusion lung scan
c) Bilateral leg Doppler ultrasounds
d) Arterial blood gases
e) CT scan of the chest
ANSWERS
4. D 7. D 10. B
1. A 5. C 8. D 11. E
2. C 6. D 9. C
3. D
 Rheumatology


1) Ankylosing spondylitis is associated with each 3) A 70 year-old woman visits you with a 2 day
of the following EXCEPT: history of a swollen right wrist. You aspirate
a) Sacroiliitis the wrist and find intracellular rhomboid-
b) An increased frequency of HLA B27 shaped weakly positive birefringent crystals.
c) Iritis All of the following are consistent with the
d) Symmetrical peripheral erosive arthritis diagnosis of pseudogout, EXCEPT:
e) Inflammatory bowel disease a) Chondrocalcinosis
b) Erosions seen on x-ray of the wrist joint
c) Rapid response to nonsteroidal anti-
2) Which of the following is LEAST likely to be a inflammatory drugs
cutaneous manifestation of systemic lupus d) History of a similar episode in her knee 2
erythematosus? years previously
a) Butterfly rash e) Rapid response to intraarticular
b) Discoid rash corticosteriods
c) Palpable purpura due to leukocytoclastic
vasculitis
d) Petechiae due to thrombocytopenia 4) A 22 year-old man presents with a subacute
e) Urticaria onset over 3 weeks of an asymmetrical
oligoarthritis involving the lower limbs. The
MOST LIKELY type of arthritis the patient has
is:
a) Osteoarthritis
b) Gout
c) Rheumatoid Arthritis
d) Reactive Arthritis
e) Septic Arthritis
ANSWERS

1. D 2. E 3. B 4. D
 Urology
1) Patients with an organic cause for
impotence are often characterized by all of
the following EXCEPT:
a) Diabetes
b) Older age
c) Intermittent difficulty
d) Nocturnal penile tumescence absent
e) None of the above
2) In the investigation of infertility, a normal
semen analysis MUST contain:
a) A volume of 0.5-1 mL
b) Morphology > 85% normal forms
c) WBC < 1 per high power field
d) Motility > 75%
e) Sperm count > 20 million sperm/mL
3) With respect to control of micturition, all of
the following are true EXCEPT:
a) Damage to the cerebral cortex results in
hyperactivity of the detrusor
b) The basal ganglia inhibits bladder over
activity
c) The cerebellum coordinates emptying of
the bladder
d) Damage to the cerebellum results in
hypotonicity of the detrusor
e) Injury above the brainstem results in
hyperactive bladder only
4) Which of the following drugs will not
promote urine retention?
a) Sympathomimetics
b) Anticholinergics
c) Cholinergic agonists
d) TCAs
e) Smooth muscle depressants
5) A 75 year-old man with a history of nocturia
has not micturated for the last 10 hours, and
is complaining of severe lower abdominal
pain. The most likely cause is:
a) BPH
b) Prostate cancer
c) Renal failure
d) UTI
e) Prostatitis
6) A 28 year-old male presents with painless
swelling in the testicle. On examination, it
appears to be a rubbery, hard mass. He has
no palpable abdominal masses. A testicular
ultrasound confirms the diagnosis of
testicular tumour, and an abdominal CT
reveals normal retroperitoneal nodes. Which
statement is correct with respect to this
case?
a) His overall prognosis is very poor
b) The testicular mass is likely a secondary
tumour
c) A needle aspiration of the tumour is
indicated
d) A transcrotal approach for biopsy is
contraindicated
e) He will likely require chemotherapy
7) A 34 year-old woman presents with a 3 day
history of increasing fever with chills,
sweats, nausea, and 2 episodes of vomiting.
On examination, she has costovertebral
angle tenderness and urine reveals gross
pyuria. Initial management should include:
a) Abdominal ultrasound
b) Abdominal CT
c) Empirical treatment with antibiotics;
image only if she fails to respond to
therapy
d) Treat with antibiotics and perform IVP 4-
6 weeks after resolution of illness
e) Immediate DTPA renal scintigraphy
8) A 45 year-old man with a history of
polycystic kidney disease presents with
painless gross hematuria. You order:
a) No investigation is required since the
hematuria is most likely due to the
rupture of renal cyst(s)
b) No investigation at this time. Investigate
if gross hematuria persists
c) U/S
d) U/S, urine C&S, cystoscopy
9) With respect to painful scrotal swelling, all of
the following are true EXCEPT:
a) Torsion of testicular appendages will
usually subside without surgical
intervention
b) Nausea/vomiting is very common in
epididymitis
c) Ultrasound is helpful in determining the
cause of hematocele
d) Torsion most commonly occurs in young
males
e) Orchitis may result in testicular atrophy
10) Which is following statement about PSA is
true?
a) Every man past the age of 50 should
have an annual PSA test as a primary
screen for prostate cancer
b) PSA is best used to follow disease
progression or recurrence post-
operatively
c) PSA is a useless test
d) Increased complex PSA to total PSA
ratio favors BPH over prostate cancer
e) All of the above
11) A 40 year-old women presents to the ER
with fever, no nausea or vomiting, and left
flank pain radiating to the groin. Body CT
reveals 8 mm stone in the left proximal
ureter. You should:
a) Send her home because renal stone is
benign disease
b) Send her home with oral analgesics and
ask her to come back if the pain does not
resolve in the next 24 hours
c) Admit, close monitoring, hydration and
analgesics
d) Admit, hydration, analgesics and IV
antibiotics. (e.g. Amp and Gent), and
consider stenting if the symptom persists
12) Which of the following is not a type of non-
seminomatous germ cell tumor of the
testicle?
a) Teratoma
b) Embryonal carcinoma
c) Yolk sac carcinoma
d) Leydig cell tumour
e) Choriocarcinoma
13) A 46-year-old male patient comes to the ER
because of a painless swelling of his left
testis; he gives history of mild trauma a few
days earlier. The swelling is cystic, involving
the superior region of the testis and
transilluminates. The diagnosis is:
a) Varicocele
b) Tumour
c) Spermatocele
d) Hydrocele
e) Hematocele
ANSWERS

1. C 4. C 7. C 10. B 13. C
2. E 5. A 8. D 11. D
3. D 6. D 9. B 12. D