Medicine Colloquium Exam - 2011 A

Medicine Colloquium Exam – First Session 2011
Ministry of Education and Higher Learning

IMPORTANT INSTRUCTIONS
Each candidate should read this page before answering the questions. The candidate
should follow the directions below:
1. Write clearly your FIRST and FAMILY NAME and APPLICANT NUMBER with ink
(pen) in the designated space (colored square).
2. Please use the pencil ONLY.
3. Do not use any pen (like bic) or ink.
4. Completely Fill the answers squares using pencil only.
5. Only ONE answer is allowed to each question.
6. Avoid erasing as much as you can.
7. When needed, do erase the cancelled answer COMPLETELY.
8. You may use the question bookle as scratch, and make sure to return it with the
answer sheet at the end of the exam.
9. On the answer sheet, you should fill up the square corresponding to the right
answer, in pencil only. No writing allowed at all.
10. Keep your answer sheet clean and tidy, do not fold or tear it.
11. The duration of the exam id THREE HOURS.
12. The composition consists of 180 QUESTIONS.
Important Note:
Any square filled up with a pen or ink cannot be read by the machine. It reads answers filled up in
PENCIL only.
Thank You
&
Good Luck
1
1. A 60-year-old lady is consulting for pain in the legs. She pretends the pain is b
less when she leans forward. Most probably this lady has:
a. Lumbar disc herniation
b. Spinal stenosis
c. Leriche syndrome
d. Hysterical conversion syndrome
2. Anterior thigh pain can be caused by all the following EXCEPT: d

a. Hip osteoarthritis
b. Hip fracture
c. L4 root entrapment
d. L5 root entrapment
3. Regarding biliary stones, all are true EXCEPT: a

a. In Western countries, about 80% of gallstones are pure cholesterol stones
b. Most cholesterol gallstones are radiolucent
c. Black pigment gallstones are most often secondary to hemolytic disorders and
cirrhosis
d. Hydrops of the gallbladder is a cause of palpable gallbladder
e. Incidence of choledocholithiasis increases with age
4. A 60-year-old woman who is known to have a benign biliary stricture with a b

plastic stent in the common bile duct presents with a spiking temperature. On
physical examination she is icteric and has a pulse rate of 100/min and a
blood pressure of 100/60. Select the most appropriate diagnosis:
a. Liver abscess
b. Cholangitis
c. Stent migration
d. Biliary fistula
5. An 88-year-old woman presents with recurrent massive rectal bleeding. Both b

gastroscopy and colonoscopy have failed to reveal the cause. Choose the most
appropriate investigation:
a. Capsule endoscopy
b. Mesenteric angiography
c. CT enteroclysis
d. Urgent laparotomy
e. Technetium-labeled red blood cell scintigraphy
2
6. An 18-year-old female attends at midnight with lower abdominal pain. She is d

well and has a temperature of 37.5C. No history is available because of
language barrier. What is the most important investigation to be done while
observing her overnight?
a. Full blood count
b. Urine analysis
c. Pelvic ultrasound
d. Pregnancy test
e. Gynecology consultation
7. During nerve block with lidocaine, the patient complains of tingling around c
his mouth and lips. What would be the next symptom to expect in the
progression of lidocaine toxicity?
a. Seizures
b. Respiratory distress
c. Hallucinations
d. Cardiac arrest
e. Nausea and vomiting
8. A 40-year-old woman is admitted to ICU following a left adrenalectomy for b

pheochromocytoma. She is hypotensive. The most appropriate treatment of
her hypotension is:
a. Phenoxybenzamine
b. IV bolus of lactated Ringer’s solution
c. Epinephrine
d. Phenylephrine
e. IV glucose administration
9. A 59-year-old woman presents with a 2 cm parotid mass. What is the next step a
in the management of this patient?
a. Fine needle aspiration
b. Core-needle biopsy
c. Incisional biopsy
d. Enucleation
e. Observation
10. A 68-year-old man presents with pain in his left leg. Examination and workup d
confirms diagnosis of a popliteal aneurysm. What is the most common
complication that would result in the patient’s leg pain?
a. Popliteal aneurysm rupture
b. Nerve impingement by the popliteal aneurysm
c. Venous obstruction by the popliteal aneurysm
d. Thromboembolic events associated with the popliteal aneurysm
3
11. Management of ascites in the cirrhotic patient undergoing elective abdominal d

surgery includes all of the following EXCEPT:
a. Restriction of sodium-containing solutions
b. Postoperative fluid restriction
c. Diuretic therapy
d. Placement of a Closed Peritoneal Catheter for drainage of ascites
e. Intermittent paracentesis
12. Appendiceal abscess is best managed by: d

a. Appendectomy
b. Antibiotics alone then appendectomy
c. Percutaneous drainage
d. Percutaneous drainage, antibiotics, internal appendectomy
13. With regard to appendicitis (One correct answer): d

a. McBurney’s point lies one third of the way along a line drawn from the
umbilicus to the right anterior superior iliac supine
b. The presence of an appendix mass necessitates immediate surgical intervention
c. A normal white cell count excludes appendicitis
d. Loss of appetite is a common feature of acute appendicitis
e. Rovsing’s sign is an increase in pain in the left iliac fossa when the right iliac
fossa is palpated
14. With regard to peptic ulcer disease: e

a. A minority of duodenal ulcers are caused by Helicobacter pylori infection
b. A raised serum creatinine is a sign of a significant upper GI bleed
c. Triple therapy for H. pylori eradication involves the combination of an
H2-receptor antagonist, a proton pump inhibitor and an antibiotic
d. Following endoscopic therapy for a bleeding ulcer, a rebleed warrants
immediate open surgical intervention
e. A bleeding ulcer can be management by under-running the bleeding vessel
15. With regard to inguinal hernia: c

a. A direct hernia passes through the deep inguinal ring into the inguinal canal
b. A femoral hernia is more common than an inguinal hernia in females
c. An inguinal hernia can be distinguished from a femoral hernia by its relationship
to the inguinal ligament
d. The superior epigastric vessels lie medial to the deep inguinal ring
e. The floor of the inguinal canal is formed by the conjoint tendon
4
16. With regards to acute abdomen: a

a. Mesenteric adenitis is a common cause of abdominal pain in children
b. The absence of free air on an erect chest x-ray excludes an intra-abdominal
perforation
c. Free air under the right hemi-diaphragm can be mistaken for gas within the
stomach
d. A raised serum amylase is diagnostic of acute pancreatitis
e. Diverticulosis is a common cause of acute left iliac fossa tenderness associated
with pyrexia and a raised white cell count
17. With regards to obstructive jaundice: a

a. Ultrasound can readily reveal intrahepatic ductal dilatation
b. Obstructive jaundice is suggested by raised AST and ALT
c. Malabsorption of vitamin D in jaundiced patients can affect the synthesis of
coagulation factors
d. Endoscopic-retrograde cholangiopancreatography (ERCP) is not of diagnostic
and therapeutic value in jaundiced patients
e. Pale urine and dark stools are suggestive of obstructive jaundice
18. Which of the following investigations has the highest sensitivity to diagnose d
gastrinoma?
a. CT scan abdomen
b. Portal venous sampling
c. Arteriography
d. Somatostatin-receptor scintigraphy
19. Crohn’s disease. True statement is: c

a. Is caused by Mycobacterium paratuberculosis
b. Is more common in Asians than in Jews
c. Tends to occur in families
d. Is less frequent in temperate climates than in tropical ones
e. Is improved by smoking
20. An elderly man presents with complaints that he is passing gas with urination. b
The past medical history is positive for one episode of diverticulitis, treated
medically, transurethral resection of the prostate for benign prostatic
hypertrophy, and diabetes. Which of the following diagnostic tests is most
appropriate initially?
a. Abdomen ultrasound
b. Computed tomography of the abdomen and pelvis
c. Cystoscopy
d. Barium enema
e. Intravenous pyelography
5
21. The initial goal of therapy for acute toxic cholangitis is to: a
a. Prevent cholangiovenous reflux by decompressing the duct system
b. Remove the obstructing stone, if one is present
c. Alleviate jaundice and prevent permanent liver damage
d. Prevent the development of gallstone pancreatitis
22. Standard supportive measures for patients with mild pancreatitis include the a
following:
a. Intravenous fluid and electrolyte therapy
b. Withholding of analgesics to allow serial abdominal examinations
c. Subcutaneous octreotide therapy
d. Nasogastric decompression
e. Prophylactic antibiotics
23. All of the following are true of omeprazole EXCEPT: d

a. It is the only drug available that has the potential to achieve pharmacologically-
induced achlorhydria
b. It works by blocking the hydrogen/potassium ATPase in the parietal cell
c. It is parietal cell specific
d. It has a short half-life (about 90 min) when taken orally
e. It has been associated with gastric neoplasm in a rat model
24. What is the most likely cause of dysfunctional uterine bleeding in 28-year-old a
woman with a normal physical examination and no other complains?
a. Polycystic ovary syndrome
b. Hypothyroidism
c. Oral contraceptive pills
d. Physiologic dysmenorrhea
e. Gynecologic cancer
25. A positive Nitrite test in the urine means the presence in the urine of: c
a. Glucose
b. Bilirubin
c. Bacteria
d. Protein
e. Ketone
26. Granular casts are sign of infection in the: d

a. Urethra
b. Prostate
c. Bladder
d. Kidney
6
27. A patient presented with gait disturbance, early dementia, and urinary b
incontinence. The most likely diagnosis is:
a. Cervical myelopathy
b. Hydrocephalus
c. Alzheimer disease
d. Brain tumor
28. A female patient known to have breast cancer started complaining of back b
pain, lower legs numbness and urinary incontinence. The most likely
diagnosis is:
a. Median herniated disk
b. Vertebral metastasis with neural compression
c. Polyneuropathy post-chemotherapy
d. Transverse myelitis
29. The most frequent microorganism in acute otitis media is: a

a. Streptococcus pneumonia
b. Staphylococcus aureus
c. Pseudomonas
d. Hemophilus
e. Klebsiella
30. During early pregnancy a pelvic examination may reveal that one adnexa is e
slightly enlarged. This is most likely due to:
a. A paraovarian cyst
b. Fallopian tube hypertrophy
c. An ovarian neoplasm
d. A follicular cyst
e. A corpus luteum cyst
31. A postmenopausal patient has a Papanicolaou smear showing suspicious b

endometrial cells. Colposcopic examination and endocervical curettage are
negative. The next best step in her management is:
a. Diagnostic imaging of the pelvis
b. Dilatation and curettage
c. Hysterectomy
d. Repeat the papnicolaou smear in 1 month
e. Serum CA-125 determination
7
32. A 21-year-old multigravida woman at 39 week’s gestation undergoes e

induction of labor for preeclampsia. Immediately after delivery, she has the
sudden onset of dyspnea and cyanosis, followed rapidly by a grand mal
seizure and loss of consciousness. Her skin is cool and clammy, pulse is weak
and rapid at 120/min and blood pressure is 70/30 mmHg. Within minutes of
circulatory collapse, brisk hemorrhage from the uterus is apparent. The most
likely diagnosis is:
a. Eclampsia
b. Septic shock
c. Myocardial infarction
d. Aspiration pneumonitis
e. Amniotic fluid embolism
33. Vaginal bleeding in the first stage of labour may be due to all of the following b
EXCEPT:
a. Placental abruption
b. Cervical uterus fibroma
c. Ruptured uterus
d. Vasa praevia
34. The advantages of the midline episiotomy include all the following EXCEPT: c
a. Less blood loss
b. Reduced incidence of dyspareunia
c. Less anal sphincter damage
d. Less pain in the postpartum period
e. It is easier to repair
35. Which of the following risk factors predicts the highest risk of developing c
breast cancer?
a. Mother with breast cancer
b. Nulliparity
c. BRCA-1 or BRCA-2 mutation
d. Age >55 years
e. Biopsy-proven lobular carcinoma in situ
36. The most frequent diagnosis of the vertigo in adult patient is: a
a. Benign paroxystic positional vertigo
b. Meniere disease
c. Vestibular neuronitis
d. Acoustic neuroma
e. Multiple sclerosis
8
37. The best diagnostic measure to confirm a suspected cancer of the tonsils is: b
a. Biopsy of the tonsils
b. Amygdalectomy
c. MRI of oropharynx and neck
d. CT scan
e. None of the above
38. The most common sequelae of meningitis in children is: a

a. Hearing loss
b. Epilepsy
c. Vertigo
d. None of the above
39. The first vaccine that can be given to an infant at birth is against: a
a. Hepatitis B
b. Pertussis
c. Diphtheria
d. Mumps
e. Rubella
40. A 9-month-old infant was admitted to the emergency because of a generalized e

seizure that had lasted for 30 minutes. On admission, his rectal temperature
is 39C and there is a deterioration of consciousness and petechiae on the
body. The first diagnosis to consider is:
a. Typhoid fever
b. Infectious mononucleosis
c. Herpetic encephalitis
d. Mild viral disease
e. Meningococcal sepsis
41. In measles, all the following are correct EXCEPT: d

a. The incubation period + phase of invasion = 14 days
b. It is a well immunizing disease
c. May be responsible for a subacute sclerosing panencephalitis
d. The virus disappears from the body one week after skin eruption
42. Concerning rhinopharyngitis in its early stage, all of the following are true a
EXCEPT:
a. It is better to treat immediately using antibiotics
b. Seizures may inaugurate the disease
c. Possibility of otalgias without otitis
d. Viruses are the leading cause
9
43. A 3-year-old child with no previous history presents an abrupt onset of cough d
with cyanosis (Shoking episode). This episode is followed by a chronic cough.
You have to consider:
a. Acute bronchitis
b. Bacterial tonsillitis
c. Purulent sinusitis
d. Inhalation of a foreign body
44. Complications that may occur in a premature newborn is (are): d

a. Neurological
b. Metabolic
c. Respiratory
d. All of the above
45. All the following diseases seen in children may require corticosteroid b
EXCEPT:
a. Systemic lupus erythematosus
b. Infective endocarditis
c. Nephrotic syndrome
d. Asthma
46. In children aged between 1 and 10 years, the most common cause of a
secondary hypertension is:
a. Renal disease
b. Cardiac disease
c. Tumor
d. None of the above
47. In infants with acute diarrhea, the most common etiology is: c
a. Salmonella typhi
b. E. coli
c. Rotavirus
d. Yersinia
48. Among the following diseases, which one is systematically detected by a

biological screening in newborns during the first 5 days of life:
a. Congenital hypothyroidism
b. Duchenne muscular dystrophy
c. Hurler disease
d. Thalassemia
10
49. What are the disease(s) that are responsible for abdominal pain in a 4-year- d
old child?
a. Acute pneumonia
b. Episodes of supraventricular tachycardia
c. Purulent tonsillitis
d. All of the above
50. Indicate the pathology that is responsible for high blood pressure: c
a. Valvular aortic stenosis
b. Ventricular septal defect
c. Coarctation of the aorta
d. Dilated cardiomyopathy
51. You discovered in a small asymptomatic 3-year-old infant an intense c

holosystolic murmur throughout the left hemi-thorax with maximum
intensity in the 3-4th intercostal space; the remaining physical exam is normal.
Based on these data and in order of frequency, the most likely diagnosis is:
a. Large atrial septal defect
b. Tetralogy of Fallot
c. Small ventricular septal defect
d. Severe aortic valve stenosis
52. Visual field examination in a right handed man demonstrated lower left b
quadrantanopsia. The lesion most likely causing this visual field defect is
located in:
a. Right temporal lobe
b. Right parietal lobe
c. Left temporal lobe
d. Left parietal lobe
e. Optic chiasm
53. The most common differential diagnosis of myocardial infarction is: b

a. Pericarditis and pleuritis
b. Gastroesophageal disease such as reflux or esophageal motility disorders
c. Pulmonary embolism
d. Ruptured aortic aneurysm
e. Herpes zoster
54. A tuberculous patient on treatment develops bright orange red urine with no d
other symptoms. Which of the following medication is most likely to cause
this side effect?
a. Ethambutol
b. Streptomycin
c. Isoniazid
d. Rifampin
e. Pyrazinamide
11
55. A 40-year-old man with no known underlying pathology presents with an c

acute febrile illness 3 days after returning from a one week safari in Kenya.
The most important differential diagnosis should include all the following
EXCEPT:
a. Dengue
b. Sleeping sickness
c. Hepatitis
d. Typhoid fever
e. Malaria
56. In Addison disease, usual laboratory abnormalities include: d

a. Normal baseline cortisol level
b. Corticotropin stimulation of cortisol
c. Normal corticotrophin level
d. Elevated plasma renin level
e. Normal electrolytes level
57. In a young man presenting for dyspnea, physical exam reveals near absent b
lower extremities pulses. The most likely diagnosis is:
a. Arteriosclerosis
b. Coarctation of the aorta
c. Takayasu aortitis
d. Cocaine use
e. Ergotamine derivative use for migraine
58. A 56-year-old male patient presents with severe epigastric pain of several b
hours relieved by sitting and bending forward starting after a heavy meal and
drinking. The most likely diagnosis is:
a. Esophageal rupture
b. Acute pancreatitis
c. Acute myocardial infarction
d. Abdominal aortic aneurysm rupture
e. Perforated duodenal ulcer
59. Bad prognostic factors in unstable angina include all the following EXCEPT: e
a. Heart failure
b. Prolonged chest pain
c. ST elevation
d. High cardiac troponin T
e. Intermittent chest pain
12
60. A 65-year-old smoker is referred to you for neurologic evaluation. He is being c

followed by an ENT physician for hoarseness and evidence of left vocal cord
weakness or paralysis. The most important test to order is:
a. MRI brain
b. Thyroid scintigraphy
c. Chest X-ray
d. Electroencephalogram
e. Anti-cholinesterase antibodies
61. Which is the best initial treatment in pheochromocytoma? a

a. -blockers
b. β-blockers
c. Diuretics
d. Steroids
e. Calcium-channel blockers
62. The following family of antihypertensive agents is associated with leg edema: a
a. Calcium channel blockers
b. Beta adrenergic blockers
c. Angiotensin converting enzyme inhibitors
d. Diuretics
e. Central adrenergic blockers
63. The presence of red blood cell casts in the urinary sediment is suggestive of: b
a. Acute hemorrhagic cystitis
b. Glomerulonephritis
c. Adenovirus cystitis
d. Acute prostatitis
e. Pyelonephritis
64. Culture negative for endocarditis is most commonly due to: b

a. Poor culture technique
b. Prior intake of antibiotics
c. Fastidious organisms
d. Nutritionally deficient organisms
e. Fungal endocarditis
65. Which of the following antibiotics requires dose modification in renal failure? b
a. Clindamycin
b. Ciprofloxacin
c. Rifampin
d. Tigecycline
13
66. Vitamin D toxicity may produce: c

a. Bone pain
b. Diarrhea
c. Hypercalcemia
d. Hypophosphatemia
e. Increase intracranial pressure
67. The most important risk factor for mortality from a pneumonia is: c
a. Smoking
b. Immunodeficiency
c. Age
d. Comorbid cardiac conditions
e. Alcohol abuse
68. A 35-year-old lady presents to the Emergency Department for right wrist and c
hand swelling, pain, redness, and warmness since 24h. Which of the following
diagnoses is the less likely?
a. Septic arthritis
b. Chondrocalcinosis
c. Osteoarthritis
d. Gout
e. Insect bite
69. Oral steroid therapy given for a severe autoimmune disease should obey to d
one of the following statements. Which one?
a. Start slowly to improve tolerance
b. Start lowering the dose after 15 days of treatment
c. Give the total daily dose in the morning
d. Reduce the dose by progressive steps not exceeding 10% of the previous dose
e. Reduce the dose weekly
70. A 50-year-old man presents with gout attack of the big toe. Which of the c
following treatment will not relieve his symptoms?
a. Colchicine
b. Diclophenac
c. Allopurinol
d. Paracetamol
e. Prednisone
71. In anaphylactic shock, the first drug to be administered is: a

a. Subcutaneous or IM epinephrin
b. IV methylprednisone
c. Oral hydroxysine
d. Oral cetirizine
e. Oral ranitidine
14
72. A 55-year-old lady has an autoimmune disease that will require a long term b
steroid treatment. Which of the following test is important before starting the
treatment?
a. Osteodensitometry
b. Tuberculin PPD
c. Platelet count
d. Urine culture for candidiasis
e. Sputum culture
73. An 18-year-old lady presents with recurrent vasovagal syncopes. All what d
follows is characteristic of this condition EXCEPT:
a. It occurs in particular conditions such as pain, strong emotion
b. It is preceded by premonitory symptoms
c. Vagal reaction is preceded by sympathetic hypertonia
d. There is a severe drop in systolic BP but the diastolic BP is preserved
e. During the syncope, cardiac frequency may be preserved, accelerated or slow
74. During an episode of tachycardia, the following results can be obtained by b

carotid massage EXCEPT:
a. Slowing of an atrial fibrillation
b. Slowing of ventricular tachycardia
c. Slowing of atrial tachycardia
d. Slowing of a supraventricular tachycardia (Bouveret)
e. Slowing of atrial flutter
75. A 40-year-old migrainous women presents to the Emergency for sudden c

severe unusual headache that occurred during sleep. There is no fever and no
neurological deficit. Brain CT is normal. What is your next step?
a. Analgesics and surveillance
b. Electroencephalogram
c. Lumbar puncture
d. Eye fundus
e. Angiography
76. Which of the following statements is inconsistent with the diagnosis of e

Guillain-Barré syndrome?
a. Absence of previous infection
b. Absence respiratory disorder
c. Absence urinary disorder
d. Normal cerebrospinal fluid at onset
e. Sensory loss of lower limbs up to the umbilic
15
77. What is the most likely diagnosis in front of bilateral asymptomatic hilar and b
mediastinal voluminous adenopathies associated with good general state and
erythema nodosum in a 25-year-old female?
a. Tuberculosis
b. Sarcoidosis
c. Non-Hodgkin Lymphoma
d. Hodgkin’s disease
e. Viral illness
78. The following are considered to be risk factors for erectile dysfunction c
EXCEPT:
a. Obesity
b. Hypercholesterolemia
c. High uric acid
d. Hypertension
e. Depression
79. Your decision to treat a patient with prostatic hypertrophy should be based a
mainly on:
a. Symptoms
b. Rectal examination
c. Endorectal ultrasound
d. Pelvic ultrasound
e. PSA level
80. The main systemic disorder associated with retinal central vein occlusion is: b
a. Diabetes mellitus
b. Arterial hypertension
c. AIDS
d. Systemic lupus erythematosus
e. Hypertriglyceridemia
81. What is the main test to perform in case of oculomotor palsy? d

a. Fundus
b. Visual field
c. Fluorescein angiography
d. MRI
e. Electroencephalogram
82. A 60-year-old man operated for aorto-bifemoral bypass complains of pain in e

the right infraumbilical region. There is a painful mass of this region on
palpation. What is the most likely diagnosis?
a. Appendicular abscess
b. Strangulated crural hernia
c. Acute urinary retention
d. Diverticular sigmoiditis
e. Abdominal rectus muscle hematoma
16
83. A 40-year-old man complains of severe continuous shooting pain of the anal c
region since 24 hours, preventing him from sleep. What is the most likely
finding at anal examination?
a. Posterior anal ulceration
b. Several deep lateral ulcerations
c. Hot fluctuating perianal mass
d. Internal prolapsed hemorrhoids
e. Internal anal sphincter spasm
84. An 84-year-old man presents to the emergency department for severe lower a
digestive hemorrhage. He was resuscitated and nasogastric tube brought bile
liquid. The next step would be:
a. Rectal exam with anoscopy and rectoscopy
b. Colonoscopy
c. Abdominal-pelvic angioscan
d. Arteriography
e. Isotope scan with labeled RBCs
85. A 25-year-old man presents for right knee monoarthritis evolving for one e
week. The most useful examination in this case is:
a. Complete blood count
b. Blood culture
c. Tight knee X-ray
d. Right knee ultrasound
e. Examination of joint fluid
86. Between the following elements, which one is not a risk factor for melanoma? b
a. Past history of melanoma
b. Past history of basal cell carcinoma
c. Familial history of melanoma
d. Excessive sun exposure
e. Numerous noevi on the skin
87. A neonatal jaundice should be investigated in all the following situations d

EXCEPT:
a. Onset before 48 hours of life
b. Duration beyond 14 days
c. Extremely high bilirubin
d. Familial history of mother milk’s related jaundice
e. Familial history of Rhesus feto-maternal incompatibility
17
88. Which of the following statements regarding Familial Mediterranean Fever is c

true?
a. It is inherited as an autosomal dominant disorder
b. The onset of clinical manifestations is usually before age 3 year
c. Colchicine is the mainstay of treatment
d. The disease is common around the Mediterranean sea and among Scandinavians
e. Pulmonary insufficiency is the most important complication and determines the
prognosis
89. A 10-year-old girl has had diplopia and ptosis and weakness of her neck e
flexors for 2 months. Symptoms are worse in the evening and are usually less
severe on awakening in the morning. She has no fasciculations or myalgias,
and her deep tendon reflexes are present. The most likely diagnosis is:
a. Hysterical weakness
b. Muscular dystrophy
c. Spinal muscular atrophy
d. Botulism
e. Myasthenia gravis
90. Which condition from the followings is not associated to menopause? e

a. Hot flashes
b. Depression
c. Genital mucosa atrophy
d. Moderate hirsutism
e. Increase in endogenous progesterone
91. The contraceptive pill: c

a. Increases ovary cancer risk
b. Increases endometrial cancer risk
c. Decreases blood loss during menstruations
d. Increases dysmenorrhea
e. Decreases deep vein thrombosis risk
92. Radical and final treatment of preeclampsia is: b

a. Bed rest in left lateral position
b. Ending pregnancy
c. Magnesium sulfate
d. Low salt high protein diet
e. Diazepam
93. Thromboembolic phenomena in pregnancy start most commonly in the a

following veins:
a. Iliac
b. Femoral
c. Popliteal
d. Sural
e. Superficial of the legs
18
94. Which anti-hypertensive drug cannot be given to pregnant women? c

a. Calcium channel blockers
b. Beta-blockers
c. Inhibitors of angiotensin converting enzyme
d. Alpha methyldopa
e. Hydralazine
95. What is the most common cause of death in people with untreated a
hypertension?
a. Coronary disease
b. Cerebrovascular accident
c. Renal failure
d. Hypertensive encephalopathy
e. Cancer
96. An 18-year-old student was found to have a positive PPD (1.5 cm induration). c
The next step is to:
a. Give isoniazide for 9 months
b. Do case contact study among his family and friends
c. Obtain a chest X-ray
d. Obtain a CT-scan of the chest
97. A 20-year-old gravida 0 complains of galactorrhea. She has no other e

complaints. Her periods are regular, occurring every 28 days. Her physical
examination is normal except for her galactorrhea. A serum prolactin is 18
ng/ml (N 3.5-24.1 ng/ml). At this point you recommend a :
a. CT scan
b. Repeat prolactin
c. Mammography
d. Visual field examination
e. Follow-up in one year
98. A 28-year-old man with a past history of bilateral orchiopexy for c

cryptorchidism presents with a painless, unilateral right scrotal enlargement.
On examination, there is a palpable right testicular mass and enlarged
inguinal nodes. Scrotal ultrasonography demonstrates heterogeneity of the
testis, with an associated hydrocele. A CT scan of the abdomen and pelvis
demonstrated right-sided retroperitoneal adenopathy. CT scan of the chest is
normal. The next step to confirm the diagnosis should be:
a. Trans-scrotal needle biopsy
b. Trans-scrotal aspiration of the hydrocele for cytology
c. Radical orchidectomy through an inguinal incision
d. Trans-scrotal exploration and orchidectomy
e. Laparotomy with pelvic and retroperitoneal node dissection
19
99. A 22-year-old woman presents to your clinic with right lower extremity c
swelling. She denies having shortness of breath or chest pain. Ultrasound
Duplex shows right femoral deep venous thrombosis. Spiral CT of the chest
shows no pulmonary embolism. She reports start taking oral contraceptive
pills 2 weeks ago. You advise her to:
a. Stop oral contraceptive pills
b. Administer thrombolytics immediately
c. Stop oral contraceptives and start heparin then shift to oral anticoagulation
d. Stop oral contraceptives and start aspirin
e. Stop oral contraceptives and do exercise twice a day
100. A 55-year-old patient with a history of lymphoma is presenting to the clinic e

with dyspnea and shortness of breath. A chest x-ray shows the presence of a
pleural effusion. You suspect the presence of a chylothorax. To confirm a
chylothorax you order a :
a. Pleural fluid pH
b. Pleural fluid cholesterol
c. Pleural fluid glucose
d. Pleural fluid protein
e. Pleural fluid triglyceride
101. Nocturnal enuresis in an 8-year-old boy is most likely to be associated with: b

a. Genitourinary structural abnormalities
b. Familial history of enuresis
c. Genitourinary tract infections
d. Childhood psychosis
e. Attention deficit hyperactivity disorder
102. A 56-year-old man visits a doctor because he feels pain in his right knee. It e
started suddenly during the night and became very intense in a few hours.
He felt feverish and denied any recent trauma. It is the first episode. He has
dyslipidemia and arterial hypertension. On physical examination, his knee is
red, hot, swollen and extremely tender. Which one of the following is the
most probable diagnosis?
a. Osteoarthritis
b. Septic arthritis
c. Rheumatoid arthritis
d. Post-traumatic arthritis
e. Gout
20
103. A 40-year-old patient presents to the ER with altered mental status of 24 d

hours duration. He had a seizure prior to admission. In the ER he was found
to be febrile with neck stiffness. He was agitated and not following
commands appropriately, with mild right-sided weakness. The CSF showed
300 RBCs and 30 WBCs per mm3. The protein was elevated and the sugar
was normal. CT scan of the brain showed an edematous lesion in the left
temporal lobe. The most appropriate management in this patient includes:
a. IV ceftriaxone treatment
b. IV steroid treatment
c. Anti-convulsants
d. IV acyclovir treatment
e. Brain biopsy
104. A 10-month-old child who is “up-to-date” for her immunizations develops c

fever and irritability. A complete physical examination reveals no positive
findings and all laboratory tests are negative. After five days she develops a
transient maculopapular rash as she become afebrile. What is the most
likely diagnosis?
a. Rubeola
b. Rubella
c. Roseola
d. Erythema infectiosum
e. Kawasaki disease
105. Following a 5-day course of Clomiphene citrate, ovulation is expected to c

occur:
a. Immediately
b. In 1 to 4 days
c. In 5 to 11 days
d. In 12 to 18 days
e. At any time
106. A 60-year-old woman is evaluated because of a 1-year history of bilateral c

knee pain and low back pain. She has some stiffness for approximately 15
minutes when she awakens in the morning, and during the afternoon her
pain is worse. As she describes her pain, she slides her hand down the
anterior thigh to her knee on the right to show where the pain is most
severe. On physical examination, she has slight swelling and tenderness to
pressure of the distal interphalangeal joints on both hands. There is slight
crepitus with motion of the right knee. Which of the following is the most
likely diagnosis?
a. Rheumatoid arthritis
b. Psoriatic arthritis
c. Osteoarthritis
d. Ankylosing spondylitis
e. Osteonecrosis of the femoral condyle
21
107. A 30-year-old man presents to the emergency department with acute a

carpopedal spasm. Chvostek and Trousseau signs are positive. Both serum
total calcium and serum phosphate are low while serum alkaline
phosphatase is high. The diagnosis that fits best this combination of findings
is:
a. Severe vitamin D deficiency
b. Hysterical hyperventilation
c. Metabolic alkalosis due to Conn’s syndrome (primary aldosteronism)
d. Hypoparathyroidism
e. Renal osteodystrophy
108. A 45-year-old woman is seen with wasting of the interosseous muscles of the a
hand, weakness, and pain in the wrist. Which of the following nerves has
most likely been injured?
a. Ulnar nerve
b. Radial nerve
c. Brachial nerve
d. Axillary nerve
e. Thenar and hypothenar nerves
109. A 46-year-old patient presents with pancytopenia. Bone marrow aspirate is b

hemodilute. Bone marrow biopsy revealed a severely hypocellular bone
marrow with increased fat tissue. This condition may be secondary to:
a. Malaria
b. Beta thalassemia major
c. Treatment with G-CSF (granulocytes colony stimulating factor)
d. Hepatitis B infection
e. Chronic myeloid leukemia
110. A 78 year-old woman is evaluated because she has had a headache for the e
past 8 days and has noted the onset of blurring and double vision. The
double vision lasted for approximately 15 minutes this morning but then
resolved. She has lost 6.8 kg over the past 2 months. She had been taking
lisinopril for mild hypertension for 5 years. Which of the following is the
best next step in this patient's management?
a. Refer her to an ophthalmologist or a neurologist
b. Schedule a temporal artery biopsy as soon as possible
c. Test her erythrocyte sedimentation rate and schedule a temporal artery
biopsy if it is >50 mm/h
d. Administer sumatriptan
e. Administer prednisone 60 mg immediately and schedule a temporal artery
biopsy
22
111. A 40-year-old gentleman presents to Emergency Room after he wakes up c

this morning feeling dizzy with nausea and vomiting. The symptoms are
aggravated with change of head position especially to the right. He denies
any hearing loss or tinnitus. On examination no neurological deficit was
noted. Which of the following is the most likely diagnosis?
a. Meniere disease
b. Transient ischemic attack
c. Benign positional vertigo
d. Labyrinthitis
e. Acoustic neuroma
112. A 14-year-old boy has sickle cell disease. He presents to the emergency room c
with the complaints of increased jaundice, abdominal pain, nausea, vomiting
and fever. His examination is remarkable for jaundice, tenderness of the
right upper quadrant with guarding and a clear chest. Chest radiographs
appear normal. The test most likely to reveal the cause of this pain is:
a. Serum chemistries
b. Complete blood count with platelets and differential
c. Ultrasound of the right upper quadrant
d. Upper GI series
e. Hepatitis panel
113. A 40-year-old man presents with pharyngitis and jaundice. Physical exam a
shows a tender enlarged liver and cervical lymphadenopathy. The most
likely diagnosis is:
a. Infectious mononucleosis
b. Chlamydia pneumoniae infection
c. Streptococcal pharyngitis
d. Adenovirus pharyngitis
e. Hepatitis C
114. On exam, an otherwise healthy 2-month-old infant has a harsh grade 2/3 e
holosystolic murmur that is low pitched heard over the lower left sternal
border. Of the following, the diagnosis most consistent with these findings is:
a. Aortic stenosis
b. Atrial septal defect
c. Patent ductus arteriosus
d. Tetralogy of Fallot
e. Ventricular septal defect
115. A 35-year-old non-smoking patient reports that her sister has recently died d
of ovarian cancer. To prevent ovarian cancer, you recommend:
a. Prophylactic oophorectomy
b. Serial sonography
c. Serial tumor markers
d. Oral contraceptives
23
116. A 44-year-old man presents to ER after vomiting bright red blood. No b

significant past medical history. BP 90/50, heart rate 130. Rectal exam
reveals bloody stools. Passage of NG tube is:
a. Indicated to prove there is an upper source of bleeding
b. Indicated to asses on-going bleeding
c. Indicated to test the gastric aspirate for occult blood
d. Indicated to treat the bleeding with ice water
e. Contraindicated as it may worsen the bleeding
117. A 4-year-old girl presents with a painful, honey-colored crusted lesion on c

her face. On examination, she is afebrile and active. What is the most likely
diagnosis?
a. Cellulitis
b. Chickenpox
c. Impetigo
d. Miliaria
e. Seborrheic dermatitis
118. A 75-year-old male has vague upper abdominal pain and lower thoracic d
back pain for the past 5 to 6 months. He had loose bowel movements for 2
months and has noticed undigested fat in the toilet. He has lost 10% of his
body weight. On examination, the patient has jaundice and appears to have
lost a large amount of weight. What is the most likely diagnosis?
a. Chronic cholecystitis
b. Acute pancreatitis
c. Cancer of the cecum
d. Pancreatic cancer
e. Primary biliary cirrhosis
119. A 26-year-old trauma victim is being resuscitated with packed red blood d
cells following an auto-accident complicated by hypotension from a
fractured pelvis and resultant hemorrhage. The patient becomes
hypotensive with a normal central venous pressure (CVP), oliguric and
febrile and complains of flank pain. Which of the following is the most likely
diagnosis?
a. Hypovolemic shock
b. Acute adrenal insufficiency
c. Gram-stain bacteremia
d. Transfusion reaction
e. Ureteral obstruction
120. The most common site for endometriosis is: b

a. Rectosigmoid
b. Ovary
c. Appendix
d. Uterosacral ligament
e. Fallopian tube
24
121. The drug of choice in recurrent absence seizures is: c

a. Phenytoin (Epanutin)
b. Phenobarbital
c. Valproic acid (Depakene)
d. Carbamazepine (Tegretol)
e. Lamotrigine (Lamictal)
122. A 5-year-old girl is found to be unconscious. She has wheezy respiration, e

constricted pupils and profuse salivation. Which drug is the best choice to
treat this patient?
a. N-acetyl-cysteine
b. Activated charcoal
c. Amphetamine
d. Furosemide with forced diuresis
e. Atropine
123. The initial therapy for a sigmoid volvulus is: e

a. Nasogastric suction and intravenous hydration
b. Immediate laparotomy with loop colostomy
c. Placement of a Cantor tube and intravenous hydration
d. Subtotal colectomy
e. Sigmoidoscopic decompression
124. A patient with a history of breast cancer who was treated with lumpectomy c
and axillary node dissection, followed by postoperative radiotherapy 5
years earlier, develops recurrence in the ipsilateral breast. At this point, the
patient should be treated with:
a. Lumpectomy with additional postoperative radiotherapy
b. Systemic chemotherapy
c. Total mastectomy
d. Tamoxifen alone
e. Additional radiotherapy isolated to the recurrence
125. The most common cause of primary amenorrhea in a non pregnant woman b
is:
a. 17-hydroxylase deficiency
b. Gonadal failure
c. Late-onset congenital adrenal hyperplasia
d. Pituitary tumor
e. Absent uterus
25
126. A 52-year-old para 4 complains of a bulging vaginal mass, constipation, and d

incomplete stool evacuation. The anatomic defect most likely to contribute
to these is:
a. Cystourethrocele
b. Uterine prolapse
c. Poor anal sphincter tone
d. Rectocele
e. Enterocele
127. The mainstay of treatment of infectious diarrhea is: b

a. Antibiotics
b. Fluid and electrolyte replacement
c. Anti-diarrheal agents
d. Diet advice
e. Anti-pyretics
128. A 70-year-old man presents with back pain and increasing difficulty with d
initiating a urinary stream. On rectal exam, he is found to have a hard,
irregularly enlarged prostate. He has an elevated prostate-specific antigen
(PSA), and osteoblastic lesions in the vertebral column and bones of the
pelvis. A needle biopsy of the prostate shows well-differentiated
adenocarcinoma. The treatment of choice is:
a. Radical prostatectomy
b. Transurethral prostatectomy
c. Cytotoxic chemotherapy
d. Hormonal manipulation
e. Radiotherapy
129. On postop day 3 following repair of a ruptured aortic aneurysm, the patient b
develops dark-colored diarrhea but remains normotensive, on full
mechanical ventilation, and is awake. Laboratory analysis reveals normal
electrolytes, blood urea nitrogen (BUN), and creatinine; hematocrit of 30;
and WBC of 15,000. Which is the most appropriate next step in
management?
a. Stool for Clostridium difficile toxin and institution of metronidazole
b. Sigmoidoscopy
c. Air contrast barium enema
d. Ct scan
e. Abdominal x-rays
26
130. A 68-year-old man, who has a history of hypertension, diabetes, and d

osteoarthritis, develops massive tongue swelling at 2 am. There is no
accompanying urticaria, wheeze or dizziness. Which of his following
medications is most likely to be responsible for the tongue swelling?
a. Clopidogrel
b. Metformin
c. Atenolol
d. Lisinopril
e. Codeine phosphate
131. A 42-year-old woman has a childhood history of third-degree scald burn to c

her right lower extremity that did not require skin grafting. She states that
she experienced trauma to the wound one year ago and since then she had
persistent nonhealing of the area. A biopsy of the wound is performed.
Which of the following is the most likely diagnosis?
a. Angiosarcoma
b. Malignant melanoma
c. Squamous cell carcinoma
d. Kaposi’s sarcoma
e. Keloid
132. A 30-year-old woman presents with secondary amenorrhea and b

galactorrhea. Her serum prolactin was 50 ng/dl (normal 5-25). Serum
creatinine and TSH were both normal and she was on no medications. She
has a normal BMI and has no hirsutism. The most appropriate next step is:
a. Measuring serum free T4
b. MRI of sella
c. Serum testosterone
d. Ultrasound of ovaries
133. A 52-year-old physician was well until 3 weeks ago when he developed a b
urinary tract infection. He was treated with ampicillin for 10 days, taking his
last dose 7 days ago. Four days ago, he developed abdominal pain, fever and
bloody diarrhea. On examination he appears acutely ill with a temperature
of 38.3C and a diffusely tender abdomen. The most likely diagnosis is:
a. Shigella superinfection
b. Pseudomembranous colitis
c. Amebic colitis
d. Ischemic colitis
e. Toxic megacolon
27
134. A 45-year-old female, with a history of oral contraceptive use and right b
upper quadrant abdominal pain, has a 4 cm lesion in the right lobe of the
liver seen on ultrasound. A CT scan reveals a hypodense lesion consistent
with a hepatic adenoma. Which of the following is the most feared
complication of the lesion?
a. Malignant transformation
b. Rupture and bleeding
c. Obstructive cholangitis
d. Anaphylactic shock
e. Peritoneal sepsis
135. The earliest signs and symptoms of increased intracranial pressure include: d
a. Papilledema
b. Decerebrate posturing
c. Respiratory arrest
d. Headache and vomiting
e. Cushing’s response
136. A 50-year-old female presents to your clinic for evaluation of increased b

abdominal girth. Physical exam shows shifting dullness and an ultrasound of
abdomen confirms the presence of ascites. The best test to perform at this
stage is:
a. Viral hepatitis serologies
b. Analysis of the ascitic fluid for albumin
c. CT of abdomen and pelvis
d. Analysis of ascitic fluid for LDH and glucose
e. Gynecologic evaluation
137. Which of the following factors on pelvic ultrasound is suspicious of c

malignancy?
a. A single loculated cyst of 7 cm diameter
b. Multiple cysts around the periphery of the ovary with a dense stroma
c. Solid elements and septae
d. Calcification and fats
138. The causes of goitrous hypothyroidism include all the following EXCEPT: c
a. Hashimoto thyroiditis
b. Dyshormonogenesis
c. Drug-induced
d. Iodine deficiency
e. Post-ablative
28
139. Torsion of the spermatic cord: a

a. Occurs in young individual and requires urgent treatment
b. Is a benign lesion usually resolve spontaneously
c. May be caused by epididymitis
d. Is often bilateral
e. Is associated with fever
140. Papillary tumors of the base of the bladder are usually treated by: a
a. Transurethral resection
b. Segmental cystectomy
c. Total cystectomy
d. Radiotherapy
e. Suprapubic fulguration
141. A 20-year-old sportsman presents with pain and swelling of his knee a
following a rotational trauma in football. X-rays are normal. The most
probable diagnosis would be:
a. A tear of the medial meniscus
b. A tear of the lateral meniscus
c. A tear of the anterior cruciate ligament
d. A tear of the posterior cruciate ligament
142. While eating breakfast on the morning after undergoing resection of the c
right middle lobe of the lung, a 65-year-old woman has acute abdominal
pain. Her stomach is distended and tympanic; she is bradycardic,
hypotensive, tachypneic, and sweating profusely. What is the most
appropriate course of action?
a. Emergency exploratory surgery
b. Obtain supine and erect abdominal x-rays
c. Place a nasogastric tube
d. Increase the patient’s pain medication
143. In interstitial lung disease, which is not true? a

a. Hypercapnia
b. Oxygen responsive hypoxemia
c. Exercise-induced hypoxemia
d. Chest X-ray may be normal
e. Clubbing may be present
144. A 35-year-old woman presents with swollen ankles. Evaluation reveals a 24h c
urine protein level at 7 g. What is the most likely renal pathology?
a. Focal segmental glomerulosclerosis
b. Minimal change disease
c. Membranous glomerulonephritis
d. IgA nephropathy
e. Mesangiocapillary glomerulonephritis
29
145. Which of the following is the most reliable test to distinguish iron deficiency c
anemia from anemia of chronic disease in older adults?
a. Percent iron saturation
b. Serum iron
c. Serum ferritin
d. Total iron-binding capacity
e. Serum transferrin
146. The reticulocyte index in a patient with anemia is 4.2. The least likely b
etiology of this anemia is:
a. Immune hemolysis
b. Hypersplenism
c. Chronic renal failure
d. Pyruvate kinase deficiency
147. Which of the following is least likely to be of benefit in a patient with d

subacute granulomatous thyroiditis?
a. Prednisone
b. Propranolol
c. Ibuprofen
d. Methimazole
e. Aspirin
148. On the third postoperative day, a patient develops a swollen, tender, painful, b
and warm right leg. The recommended treatment with the fewest
complications is:
a. Intravenous heparin
b. Subcutaneous low-molecular-weight heparin
c. Oral warfarin
d. Intravenous warfarin
e. Local treatment only, such as heat and elevation
149. Which of the following is recommended on an annual basis to assess renal a

function in an asymptomatic patient with spinal cord injury and a
neurogenic bladder?
a. A 24-hour creatinine clearance level and a renal ultrasound
b. Cystoscopy
c. Abdominal computed tomography
d. All of the above
150. Characteristics of patients with type 2 diabetes typically include: b

a. Age under 30 years at disease onset
b. Obesity greater than 20 percent over ideal body weight
c. A negative family history for the disease
d. All of the above
30
151. Which of the following is an appropriate counseling recommendation for all a

patients with heart failure?
a. Obtain daily body weight measurements
b. Record blood pressure on a daily basis
c. Self-titrate diuretics according to the degree of edema present
d. Restrict daily fluid intake to less than 800 ml
152. A 32-year-old asymptomatic patient presents for a chest x-ray after a a

positive result on a purified protein derivative test. The x-ray shows hilar
and paratracheal adenopathy and also reveals evidence of diffuse
pulmonary disease. The physical examination is normal. The most likely
diagnosis in this patient is:
a. Sarcoidosis
b. Silicosis
c. Alpha-1-antitrypsin deficiency
d. Cystic fibrosis
153. Which of the following types of lung cancer has the poorest five-year d
survival rate?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Large cell carcinoma
d. Small cell carcinoma
154. A woman is diagnosed with breast cancer. Which of the following is the b
strongest predictor for local recurrence of her breast?
a. Age at the time of diagnosis
b. Number of axillary lymph nodes involved
c. Size of the lesion
d. Estrogen receptor status of the tumor
e. Progesterone receptor status of the tumor
155. A 70-year-old male hypertensive, diabetic, smoker. Not known to have heart a
failure presenting with acute heart failure decompensation. Which one of
the following scenarios is most likely?
a. Ischemic cause is most likely and should be ruled out first by performing an
ECG and cardiac biomarkers
b. Take TSH first to rule out hyperthyroidism as the cause of his decompensation
c. Do Holter monitor to rule out paroxysmal atrial fibrillation as the etiology
d. Do cardiac MRI to evaluate for the etiology
31
156. A teenager boy falls off his bicycle and is run over by a truck. On arrival in c
the emergency room, he is awake and appears frightened but not in distress.
The chest radiograph suggests an air-fluid level in the left lower lung field
and the nasogastric tube seems to coil upward into the left chest. Which of
the following is the next best step in his management?
a. Placement of left chest tube
b. Thoracostomy
c. Laparotomy
d. Esophagogastroscopy
e. Diagnostic peritoneal lavage
157. Hepatocellular carcinoma (HCC), all are true EXCEPT: e

a. Occurs in the background of cirrhosis in up to 80% of cases
b. Chronic hepatitis B infection is the commonest cause worldwide
c. May be treated by liver transplantation
d. Any patient with cirrhosis should be screened for the development of HCC by
serial serum alpha fetoprotein and liver ultrasound
e. The fibrolamellar variant has a very poor prognosis
158. The following microbiological investigations should be done in all cases of c

community acquired pneumonias EXCEPT:
a. Sputum for gram stain and culture
b. Sputum for acid fast bacilli and culture
c. Pleural fluid aspirate
d. Blood cultures
159. On rectal examination, a patient is found to have a large, fungating mass e

protruding into the rectal lumen. Biopsy of this mass demonstrates an
invasive malignant tumor composed of glandular structures. The
development of this condition is most strongly associated with:
a. Diverticulitis
b. Diverticulosis
c. Juvenile polyposis syndrome
d. Peutz-Jegher’s syndrome
e. Ulcerative colitis
160. Gastric cancer: a

a. When shown to be an adenocarcinoma on histology, is associated with
Helicobacter pylori
b. Is usually a squamous cell carcinoma
c. Usually has a good prognosis
d. Most commonly presents with hematemesis
e. Is usually diagnosed on barium swallow
32
161. Causes of elevation of the hemidiaphragm include all the following EXCEPT: e
a. Severe pleuritic pain
b. Subphrenic abscess
c. Pulmonary infarction
d. Eventration of the diaphragm
e. Intercostal nerve palsy
162. In infective endocarditis which one is false? d

a. Streptococcus viridans is the cause of up to 50% of native valve endocarditis
b. Staphylococcus species may be the cause in 50% of prosthetic valve
endocarditis
c. The commonest cause of culture negative endocarditis is partial treatment
with antibiotics
d. Three negative serial blood cultures usually exclude infective endocarditis in
the appropriate clinical setting
e. The sensitivity of transesophageal echocardiography here is 95% versus 65%
in the transthoracic approach
163. The correct statement regarding renal cell carcinoma is: a

a. It is more common in men
b. It usually does not have a capsule
c. It may cause fever due to secondary infection
d. It is often bilateral
164. A 65-year-old patient complains of pain in the lower extremities after 10 d

minutes of walking that subsides on standing still. The most probable
diagnosis is:
a. Spinal canal stenosis
b. Cervical myelopathy
c. Bilateral L4-L5 disc herniation
d. Arterial occlusion
165. A patient came to the emergency room with sudden onset and unusual c
headache with vomiting. The first act to do is:
a. Brain CT scan
b. MRI of the brain
c. Look for nuchal rigidity
d. Spinal tap
166. Patients at increased risk for gastric carcinoma include all of the following c
EXCEPT:
a. Those who have undergone gastric resection for duodenal ulcer
b. Those with pernicious anemia
c. Those who have undergone gastric bypass for morbid obesity
d. Those with blood group A
33
167. A 23-year-old student complains of sore throat for three days. He started a
with a runny nose and a slight cough. The symptoms are a little better this
morning. Which of the following is most likely?
a. Rhinovirus
b. Neisseria gonorrhea
c. Hemophilus influenza
d. Corynebacterium diphtheria
e. Streptococcus pyogenes (A)
168. Which of the following signs or symptoms is against the diagnosis of d

bacterial pharyngitis?
a. Fever
b. Cervical lymphadenopathy
c. Purulent pharyngeal exsudates
d. Hoarseness
e. Throat pain
169. In evaluating a lymphoma, which of the following abnormal laboratory c

finding indicates a poor prognosis?
a. Elevated uric acid
b. Elevated erythrocyte sedimentation rate
c. Elevated LDH
d. Elevated ALT (SGPT)
e. Elevated glucose
170. Which of the following joint is never affected by gout? e

a. Metatarso-phalangeal joint
b. Knee joint
c. Hip joint
d. Interphalangeal joints
e. Intervertebral joints
171. Acute bacterial sinusitis is diagnosed on the basis of: c

a. Greenish nasal discharge and facial discomfort for 2 days
b. Greenish nasal discharge and facial discomfort for 5 days
c. Greenish nasal discharge and facial discomfort that worsens after 5 days
d. Low grade fever, greenish nasal discharge, and low grade fever for 5 days
e. Cough, low grade fever, greenish nasal discharge, and low grade fever for 5
days
172. All of the following statements are used to assess a chronic constipation e
EXCEPT:
a. Manometry
b. Colonic transit time
c. Defecography
d. Barium enema
e. Study of rectal compliance
34
173. A 40-year-old man is found to have hemoglobin of 10 g/dl on routine a

preoperative testing. The best next test is:
a. Peripheral smear
b. Coombs test
c. Stools for occult blood
d. Iron, ferritin, vitamin B12, and folate levels
e. TSH
174. All the following treatments are used in asthmatic crisis EXCEPT: c
a. Anti-muscarinic
b. Beta-2- adrenergic
c. Antileukotrienes
d. Corticoids
175. The most definitive diagnostic test for pulmonary embolism is: c
a. Arterial blood gases
b. Ventilation-perfusion scan
c. Pulmonary angioscan
d. Chest CT scan
e. D-dimers
176. In which one of the following time periods should a partial effect from d
antidepressant medication therapy be evident in elderly patients?
a. Two days
b. Five days
c. One week
d. Two weeks
177. A 50-year-old woman reports night sweats and hot flushes. Which blood test d
would you order to confirm menopause?
a. LH
b. Progesterone
c. Prolactin
d. FSH
e. Testosterone
178. Dexamethasone is indicated in: a

a. Croup
b. Amygdale’s abscess
c. Acute epiglottitis
d. Viral rhino-pharyngitis
35
179. All the following can induce microalbuminuria EXCEPT: e

a. Type 1 diabetes
b. Essential hypertension
c. Obesity
d. Exercise
e. Excess intake of proteins
180. Which of the following laboratory parameters increases during pregnancy? d

a. Serum albumin
b. Blood urea nitrogen
c. Creatinine
d. Erythrocyte sedimentation
e. Bicarbonate
GOOD LUCK
36
ANSWERS
1. b 2. d 3. a 4. b 5. b 6. d 7. c 8. b 9. a 10. d
11. d 12. d 13. d 14. e 15. c 16. a 17. a 18. d 19. c 20. b
21. a 22. a 23. d 24. a 25. c 26. d 27. b 28. b 29. a 30. e
31. b 32. e 33. b 34. c 35. c 36. a 37. b 38. a 39. a 40. e
41. d 42. a 43. d 44. d 45. b 46. a 47. c 48. a 49. d 50. c
51. c 52. b 53. b 54. d 55. c 56. d 57. b 58. b 59. e 60. c
61. a 62. a 63. b 64. b 65. b 66. c 67. c 68. c 69. d 70. c
71. a 72. b 73. d 74. b 75. c 76. e 77. b 78. c 79. a 80. b
81. d 82. e 83. c 84. a 85. e 86. b 87. d 88. c 89. e 90. e
91. c 92. b 93. a 94. c 95. a 96. c 97. e 98. c 99. c 100. e
101. b 102. e 103. d 104. c 105. c 106. c 107. a 108. a 109. b 110. e
111. c 112. c 113. a 114. e 115. d 116. b 117. c 118. d 119. d 120. b
121. c 122. e 123. e 124. c 125. b 126. d 127. b 128. d 129. b 130. d
131. c 132. b 133. b 134. b 135. d 136. b 137. c 138. c 139. a 140. a
141. a 142. c 143. a 144. c 145. c 146. b 147. d 148. b 149. a 150. b
151. a 152. a 153. d 154. b 155. a 156. c 157. e 158. c 159. e 160. a
161. e 162. d 163. a 164. d 165. c 166. c 167. a 168. d 169. c 170. e
171. c 172. e 173. a 174. c 175. c 176. d 177. d 178. a 179. e 180. d
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Medicine Colloquium Exam - 2011 A

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Medicine Colloquium Exam – First Session 2011

Ministry of Education and Higher Learning

2. Anterior thigh pain can be caused by all the following EXCEPT: d

3. Regarding biliary stones, all are true EXCEPT: a

4. A 60-year-old woman who is known to have a benign biliary stricture with a b

5. An 88-year-old woman presents with recurrent massive rectal bleeding. Both b

6. An 18-year-old female attends at midnight with lower abdominal pain. She is d

8. A 40-year-old woman is admitted to ICU following a left adrenalectomy for b

11. Management of ascites in the cirrhotic patient undergoing elective abdominal d

12. Appendiceal abscess is best managed by: d

13. With regard to appendicitis (One correct answer): d

14. With regard to peptic ulcer disease: e

15. With regard to inguinal hernia: c

16. With regards to acute abdomen: a

17. With regards to obstructive jaundice: a

19. Crohn’s disease. True statement is: c

23. All of the following are true of omeprazole EXCEPT: d

26. Granular casts are sign of infection in the: d

29. The most frequent microorganism in acute otitis media is: a

31. A postmenopausal patient has a Papanicolaou smear showing suspicious b

32. A 21-year-old multigravida woman at 39 week’s gestation undergoes e

38. The most common sequelae of meningitis in children is: a

40. A 9-month-old infant was admitted to the emergency because of a generalized e

41. In measles, all the following are correct EXCEPT: d

44. Complications that may occur in a premature newborn is (are): d

48. Among the following diseases, which one is systematically detected by a

51. You discovered in a small asymptomatic 3-year-old infant an intense c

53. The most common differential diagnosis of myocardial infarction is: b

55. A 40-year-old man with no known underlying pathology presents with an c

56. In Addison disease, usual laboratory abnormalities include: d

60. A 65-year-old smoker is referred to you for neurologic evaluation. He is being c

61. Which is the best initial treatment in pheochromocytoma? a

64. Culture negative for endocarditis is most commonly due to: b

66. Vitamin D toxicity may produce: c

71. In anaphylactic shock, the first drug to be administered is: a

74. During an episode of tachycardia, the following results can be obtained by b

75. A 40-year-old migrainous women presents to the Emergency for sudden c

76. Which of the following statements is inconsistent with the diagnosis of e

81. What is the main test to perform in case of oculomotor palsy? d

82. A 60-year-old man operated for aorto-bifemoral bypass complains of pain in e

87. A neonatal jaundice should be investigated in all the following situations d

88. Which of the following statements regarding Familial Mediterranean Fever is c

90. Which condition from the followings is not associated to menopause? e

91. The contraceptive pill: c

92. Radical and final treatment of preeclampsia is: b

93. Thromboembolic phenomena in pregnancy start most commonly in the a

94. Which anti-hypertensive drug cannot be given to pregnant women? c

97. A 20-year-old gravida 0 complains of galactorrhea. She has no other e

98. A 28-year-old man with a past history of bilateral orchiopexy for c

100. A 55-year-old patient with a history of lymphoma is presenting to the clinic e

101. Nocturnal enuresis in an 8-year-old boy is most likely to be associated with: b

103. A 40-year-old patient presents to the ER with altered mental status of 24 d

104. A 10-month-old child who is “up-to-date” for her immunizations develops c

105. Following a 5-day course of Clomiphene citrate, ovulation is expected to c

106. A 60-year-old woman is evaluated because of a 1-year history of bilateral c

107. A 30-year-old man presents to the emergency department with acute a

109. A 46-year-old patient presents with pancytopenia. Bone marrow aspirate is b

111. A 40-year-old gentleman presents to Emergency Room after he wakes up c

116. A 44-year-old man presents to ER after vomiting bright red blood. No b

117. A 4-year-old girl presents with a painful, honey-colored crusted lesion on c

120. The most common site for endometriosis is: b

121. The drug of choice in recurrent absence seizures is: c

122. A 5-year-old girl is found to be unconscious. She has wheezy respiration, e

123. The initial therapy for a sigmoid volvulus is: e