Medicine Colloquium Exam - 2014 A

Medicine Colloquium Exam –First Session 2014
Ministry of Education and Higher Learning

Medicine Colloquium Exam – First Session 2014
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. Which of the following tests has a high positive predictive value for Juvenile e
Rheumatoid Arthritis?
a. Erythrocyte sedimentation rate
b. C-reactive protein
c. HLA-B27
d. Antinuclear antibody
e. None of the above
2. At what ages do febrile seizures occur? a

a. 6 months to 5 years
b. 2 years to 7 years
c. 1 year to 8 years
d. 1 year to 2 years
3. List ONE disease prevention measure NOT routinely administered to all c

newborns:
a. Antibiotic eye prophylaxis
b. Hepatitis B immunization
c. Inactivated polio
d. Vitamin K prophylaxis
4. In infants, treatment of bronchiolitis should include all of the following d

EXCEPT:
a. Supplemental oxygen for infants with hypoxia
b. Intravenous fluids and close monitoring of nutritional status
c. Good hand washing
d. Antibiotics
5. A year old child presents with a four day history of irritability and recurrent b
fevers. Today he is afebrile and had a diffuse erythematous rash on his trunk.
You diagnose the child with roseola. Which of the following is a common
complication of this disease?
a. Arthritis
b. Febrile seizures
c. Aseptic meningitis
d. Thrombocytopenia
e. Hepatitis
6. Which drug is associated with the development of Reye syndrome? b

a. Antidepressants
b. Salicylates
c. Cancer chemotherapy
d. Barbiturate
2
7. In cystic fibrosis, gastrointestinal abnormalities include all of the following d

EXCEPT:
a. Meconium ileus
b. Distal intestinal obstruction syndrome
c. Rectal prolapse
d. Intussusception
8. Which of the following is the most common cause of pneumonia in infants? c

a. Streptococcus pneumonia
b. Mycoplasma
c. Viruses
d. Chlamydia
9. Concerning CROUP, which of the following is/are true? d

a. Croup affects more girls than boys
b. Croup shows no seasonal prevalence
c. Most cases occur in teenagers
d. It is a common respiratory infection in children
e. All are true
10. When is adenoidectomy recommended? d

a. Upper airway obstruction
b. Recurrent otitis media
c. Sleep apnea
d. All of the above
11. A 9-month infant with runny nose, wheezy cough, T= 39C, and respiratory a
rate = 60/min. retractions are visible and pulse oximetry is 91%. The most
likely diagnosis is:
a. Bronchiolitis
b. Tracheitis
c. Bordetella pertussis
d. Pneumonia
12. A 5-year-old child is brought in with purpura on his legs and buttocks, c
abdominal pain, and joint pain. His smear appears normal, as are his
coagulation studies and electrolytes. IgA and C3 are deposited in the skin. The
most likely diagnosis is:
a. Post-streptococcus glomerulonephritis
b. Hemolytic uremic syndrome
c. Henoch-Schonlein purpura
d. Hemophilia
3
13. Definition of nephrotic syndrome: d

a. >3.5 g protein/24h
b. Hypoalbuminemia
c. Hyperlipidemia
d. All of the above
14. A 4-week-old infant presents with non-bilious vomiting and palpable “olive.” b
Metabolic complications are:
a. Hyponatremia, metabolic acidosis
b. Hypochloremic, metabolic alkalosis
c. Metabolic acidosis
d. None of the above
15. About headaches in children, which of the following item is not an indication c
for neuroimaging?
a. Headaches with recent school failure and behavioral changes
b. Headaches that awaken the child during sleep
c. Unilateral isolated headaches lasting for 2 to 12 hours
d. Visual graying-out occurring at the peak of the headaches
e. Focal neurological symptoms or signs developing during a headache
16. A newborn male was diagnosed prenatally to have bilateral hydronephrosis, c

the first radiologic exam to be done is:
a. Pyelography
b. Voiding cystourethrography
c. Ultrasound
d. Scintigraphy
e. CT scan
17. In the evaluation of the child who has short stature, the most important a
diagnostic information is determined from the:
a. Growth curve
b. Extended family growth history
c. Bone age
d. Growth hormone levels
e. Serum T4 and thyroid stimulating hormone
18. The most common cause of neonatal jaundice occurring in first day of life is: d
a. Physiological
b. Septicemia
c. Biliary atresia
d. Rh or ABO incompatibility
4
19. Which of the following are the most important and clinically useful risk c
factors for breast cancer?
a. Fibrocystic disease, age, and gender
b. Cysts, family history in immediate relatives, and gender
c. Age, gender, and family history in immediate relatives
d. Obesity, Nulliparity, and alcohol use
20. An 80-year-old man victim of a motor vehicle accident with head traumatism b
did not lose consciousness promptly. He was admitted to the ER with normal
neurologic examination. Three hours later he showed a progressive
deterioration of his level of consciousness with Glascow coma score (GCS)
8/18 and left hemiplegia. What is the most likely diagnosis?
a. Intracranial epidural hematoma
b. Intracranial acute subdural hematoma
c. Brain edema
d. Concussion
21. A 55-year-old man is complaining from visual disturbances. He is not able to c

see cars coming from both sides while driving. Visual acuity is preserved
bilaterally. There is no papilledema. What is the most likely diagnosis?
a. Multiple sclerosis (MS)
b. Occipital brain tumor
c. Pituitary gland macroadenoma
d. Chronic adult hydrocephalus
22. A 56-year-old man has been having bloody bowel movements on and off for c
the past several weeks. He reports that the blood is bright red, it coats the
outside of the stools, and he can see it in the toilet bowl even before he wipes
himself. When he does so, there is also blood on the toilet paper. After further
questioning, it is ascertained that he has been constipated for the past 2
months and that the caliber of the stools has changed. They are now very thin
compared to the usual diameter of an inch or so that was customary for him.
He has no pain. Which of the following is the most likely diagnosis?
a. Anal fissure
b. Cancer of the cecum
c. Cancer of the rectum
d. External hemorrhoids
e. Internal hemorrhoids
5
23. A 70-year-old man comes to the emergency department complaining of b

abdominal pain. He describes the pain as crampy and primarily in his left
lower quadrant. He has had minimal nausea, but complains of constipation.
His past medical history is significant for hypertension, hyperlipidemia, gout,
and diverticulosis. His medications include atenolol and simvastatin. He is
allergic to penicillin. His temperature is 38C, blood pressure is 140/60
mmHg, pulse is 100/min, and respirations are 20/min. His physical
examination is significant for tenderness to palpation at the left lower
quadrant without rebound or guarding. His stool is negative for occult blood.
His heart and lung examination are unremarkable. Which of the following is
the most likely diagnosis?
a. Appendicitis
b. Diverticulitis
c. Diverticulosis
d. Ischemic colitis
e. Sigmoid volvulus
24. A 54-year-old obese man gives a history of burning retrosternal pain and d
heartburn that is brought about by bending over, wearing a tight belt, or lying
flat in bed at night. He gets symptomatic relief from antacids or H2 blockers,
but has never been formally studies or treated. The problem has been present
for many years and seems to be progressing. He does not smoke cigarettes
and only drinks alcohol rarely. Which of the following is the most appropriate
next step in management?
a. Barium swallow
b. Cardiac enzymes and electrocardiogram
c. Proton pump inhibitors
d. Endoscopy and biopsies
e. Laparoscopic Nissen fundoplication
25. A 67-year-old man complains of the recent onset of passage of “bubbles” with a
his urine. He states that this started approximately 2 weeks ago and has not
improved. There is also some burning of urination and the patient thinks that
he may have even seen some fecal material when he urinates. His medical
history is significant for a hospitalization to treat diverticulitis approximately
1 year ago. He denies any recent weight loss, blood in the stool, or recent
change in bowel habits. Physical examination is normal, including guaiac-
negative stool. Which of the following diagnostic studies is most likely to
confirm the diagnosis?
a. CT scan
b. Cystoscopy
c. Retrograde urethrogram
d. Sigmoidoscopy
e. Urine culture
6
26. A 4-month-old girl is brought to the physician because of problems with c

constipation. The mother states that the infant will go many days without a
bowel movement and when she does go, the stool is very hard. The infant was
born full-term without any difficulties. Her first 4 months of life have been
uneventful other than the constipation. The pediatrician has tried variety of
techniques to improve the stool, but none have been successful. On
examination, the abdomen is distended, soft, and nontender. Immediately
following rectal examination, the infant passes an explosive bowel movement
with flatus. After the bowel movement, the abdomen is much less distended.
Which of the following tests will most likely establish the diagnosis?
a. Anorectal manometry
b. Barium enema
c. Full-thickness biopsy of rectal mucosa
d. Plain films of the abdomen
e. Upper gastrointestinal series
27. A 14-year-old boy is brought to the emergency department because of d

persistent midepigastric pain for two days. The pain is getting no better, yet it
is no worse, and radiates to his back. The boy also has had fever, as well as
nausea and vomiting that is worse when his temperature rises in the
afternoon. On examination, his temperature is 39.2C, and there is marked
upper abdominal tenderness with guarding. Mild abdominal distention is
present with no audible bowel sounds. A complete blood count reveals an
elevated leukocyte count and a normal serum amylase. Which of the following
is the most likely diagnosis?
a. Fitz-Hugh-Curtis syndrome
b. Intussusception
c. Wilms tumor
d. Pancreatitis
e. Pyelonephritis
28. A 14-year-old girl is brought to the emergency department because of severe

lower mid-abdominal pain that has been increasing over the past 12 hours.
She describes it as crampy and sharp. Her last menstrual period was about 2
weeks ago and lasted 4 to 5 days. She has had menstrual periods for nearly 2
years, and over the past 6 months she has noticed some cramping pain the
first day or two of her menses. She denies sexual activity and has not had any
vaginal discharge. Her bowel movements have been normal and she reports
no urinary frequency, urgency, or burning with urination. Which of the
following is the most likely diagnosis?
a. Dysmenorrhea
b. Ectopic pregnancy
c. Ovarian cyst
d. Pelvic inflammatory disease
e. Mittelschmertz
7
29. A 23-year-old professional basketball player goes to the team physician 3 a

hours before game time complaining of abdominal pain. The symptoms began
approximately 8 hours earlier in a diffuse fashion. Two hours later, he began
feeling nauseated and vomited twice. Over the past 4 hours, the abdominal
pain has become more severe and well localized in the right lower quadrant.
His examination now reveals well-localized pain in the right lower quadrant
inferolateral to the umbilicus. Which of the following is the most likely
diagnosis?
a. Acute obstruction of the appendiceal lumen by a fecalith
b. Acute onset of ileocolitis
c. Acute onset of ischemic colitis
d. Acute Yersinia infection
e. Obstruction of the ileocecal valve by a mass
30. A 21-year-old woman comes to the physician because of abdominal pain. She b
states that the pain is in her right lower quadrant and has been getting worse
over the past 3 months. She has no other symptoms and a normal appetite.
Examination demonstrates mild right lower quadrant abdominal tenderness.
Pelvic examination reveals mild right adnexal enlargement and tenderness.
Urine human chorionic gonadotropin (hCG) is negative. A pelvic ultrasound is
obtained that shows a 4-cm heterogeneous hyperechoic lesion in the right
adnexa with cystic areas. On transvaginal ultrasound, hair and calcifications
are demonstrated within the cystic areas. Which of the following is the most
likely diagnosis?
a. Appendicitis
b. Benign cystic teratoma (Dermoid)
c. Corpus luteum cyst
d. Ectopic pregnancy
e. Tubo-ovarian abscess
31. A 9-month-old infant is brought to the clinic by her parents because she has a
an abdominal mass. Physical examination shows an umbilical defect about
1 cm in diameter, with a small bulge when the girl cries. The hernial contents
can be easily reduced. The hernia is not painful, and the girl is otherwise
asymptomatic. She is eating well and reaching all developmental milestones.
Which of the following is the most appropriate next step in management?
a. No therapy unless the hernia persists beyond the age of 2 years
b. Repeated injections of sclerosing agents
c. Elective laparoscopic surgical repair
d. Elective open surgical repair
e. Urgent surgical repair
8
32. A 57-year-old man is referred for a sigmoidoscopy as a colon cancer screening b

examination. He has been in good health without any recent change in bowel
habits, or thin caliber stools, gastrointestinal bleeding, or unintended weight
loss. There is no family history of colonic polyps or gastrointestinal
malignancy. His physical examination is unremarkable. A rectal examination
reveals no masses, and his stool is guaiac negative. A sigmoidoscopy reveals a
4 mm polyp in the mid-rectum. It is removed with a forceps, and the histology
reveals it to be a tubular adenoma. Which of the following is the most
appropriate next step in management?
a. Schedule colonoscopy in 3 years
b. Schedule colonoscopy now
c. Schedule colonoscopy in 5 years
d. Schedule sigmoidoscopy in 1 year
e. Schedule a barium enema in the immediate future
33. An infant girl is born to a healthy 32-year-old primigravida woman. Although a

the mother is healthy, she did not receive appropriate prenatal care. She
offered no significant history when she presented to the emergency
department in labor. The vaginal delivery is uneventful and the mother
remains stable. The infant begins experiencing respiratory distress soon after
birth, however. The infant is noted to have a scaphoid abdomen and the left
chest is prominent. The cardiac impulse is displaced to the right and breath
sounds are severely diminished over the left lung field. Which of the following
is the most likely diagnosis?
a. Congenital diaphragmatic hernia
b. Congenital esophageal stenosis
c. Esophageal atresia
d. Gastroschisis
e. Pneumothorax
34. Choose the correct answer concerning prostate cancer: c

a. Prostate cancer is most frequently aggressive, originating from the peripheral
zone of the prostate
b. Prostate cancer is very radiosensitive but hormone resistant, mandating
chemotherapy as the first line treatment
c. Adenocarcinoma of the prostate is a frequent cancer in men. It is found in about
75% of those of 85 years on autopsy
d. Screening for prostate cancer is done by yearly digital rectal examination and a
pelvic ultrasound starting at age of 50
35. A 91-year-old man was hospitalized to the ICU for pneumonia with c
desaturation. A foley catheter was inserted in the emergency room. Two days
after his admission, you were asked to see the patient for a painful edema of
the penis. What is the most probable diagnosis?
a. Severe Phimosis
b. Priapism
c. Paraphimosis
d. Peyronie’s disease
9
36. Regarding the examination of mobility of a traumatic joint, the following d

propositions are true EXCEPT:
a. It should be performed in comparison with the opposite side
b. The examination starts in the unaffected side
c. Active mobility is examined before passive mobility
d. Painful movements are first examined and tested
37. All the following propositions regarding fractures of the pelvic ring are d
correct EXCEPT:
a. Occurrence of hemorrhagic shock is possible
b. Fracture of the posterior part of the ring may be missed on simple radiographs
of the pelvic
c. Urinary complication may clinically presents as peritonitis
d. Associated intestinal and rectal lesions are never secondary to direct injury
from the bony fragments
38. Irreducibility of posterior hip dislocation should suspect: d

a. Fracture of the greater trochanter
b. Fracture of the iliac crest
c. Fracture the ischio-pubic ramus
d. Incarcerated intra-articular fracture of the posterior acetabular wall
39. The most accepted treatment in a 67-year-old patient with painful advanced d
osteo-arthritis of the hip is:
a. Arthrotomy and debridement of the hip joint
b. Large extensive synovectomy of the hip
c. Varus osteotomy of the proximal femur
d. Total hip joint replacement (total hip prosthesis)
40. In a mother that develops rubella during pregnancy, what immunoglobulin c

will the baby have that demonstrates an intrauterine fetal infection?
a. IgA
b. IgG
c. IgM
d. IgE
41. One-month old male baby presenting with crying, vomiting, and scrotal mass. a
What is your first diagnosis?
a. Intussusception
b. Hydrocele
c. Pyloric stenosis
d. Strangulated hernia
e. Cyst of the cord
10
42. In intestinal malrotation, the most dangerous complication is: a

a. Volvulus
b. Intestinal hernia
c. Duodenal stenosis
d. Left sided cecum
e. Associated malformation
43. Each of the following conditions is associated with an increased risk of b

premature labor EXCEPT:
a. Insulin-depended diabetes mellitus
b. Adolescent pregnancy
c. Twin gestation
d. Prior history of preterm delivery
44. Adenomyosis is diagnosed by finding islands of endometrium: c

a. In the ovary
b. On the uterine serosa
c. Below the basal layer of endometrium
d. In endometrial polyp
e. In the tube
45. The major symptom of rectocele is: c

a. Stress incontinence
b. Fecal incontinence
c. Difficult defecation
d. Falling out sensation
e. Dyspareunia
46. The fetus must obtain nutrients via the placenta. Which of the following e
nutrients is essential?
a. Water
b. Amino acid
c. Glucose
d. Fatty acid
e. All of the above
47. Which of the following is not a presumptive symptom of pregnancy? b

a. Nausea
b. Fatigue
c. Urine frequency
d. Constipation
48. Chadwick’s sign is: a

a. Discoloration of the vaginal mucosa
b. Pigmentation of the skin
c. Change in consistency of the uterus
d. Implantation bleeding
11
49. In asthma: a
a. Atopy is the single largest risk factor for the development of asthma
b. In asthmatic patients, asymptomatic periods, the airways are not edematous
and are not infiltrated by neutrophils and eosinophils
c. Pneumomediatinum is not a complication of asthma
d. Airway resistance, forced expiratory volume and flow rates are increased
e. Psychological stress has no effect on asthma
50. A 78-year-old female has progressive memory impairment over 2 years. No d

behavioral changes are noted. Neuroimaging shows hippocampal atrophy.
The most likely diagnosis is:
a. B12 deficiency
b. Heavy metal intoxication
c. Frontotemporal dementia
d. Alzheimer’s disease
e. Huntington’s disease
51. The following is a manifestation of Ebola virus infection: c

a. Insidious onset of symptoms
b. Vesiculo-bullous rash
c. Fever, headache, malaise, nausea, vomiting, following by diarrhea and chest pain
d. Marked leukocytosis early in the disease
e. Droplet transmission of the germ
52. The following is true in Diabetes Mellitus (DM) type 1: b

a. Patients are born with defective pancreatic beta cells
b. Type 1 A DM is a result of a combination of genetic, environmental, and
immunologic factors
c. Immunologic markers appear after the onset of overt diabetes
d. The risk of developing type 1 A DM is not increased in relatives of patients
e. Type 1 A DM is strongly associated to HLA B5 haplotype
53. The following is true in Diabetes Mellitus type 2: d

a. The disease has no genetic predisposition
b. Physical activity does not modulate the manifestations of the disease
c. Glucose tolerance is normal early in the disease
d. It is characterized by impaired and excessive hepatic glucose production
e. C-reactive protein, a marker of inflammation, is not elevated in DM type 2
12
54. A 25-year-old male presents with severe steady epigastric pain radiating to c
the back, and chest discomfort of 2 days duration. The pain is more intense in
the supine position. Tachycardia and hypotension are noted on physical exam,
as well as a positive Cullen’s sign. The most likely diagnosis is:
a. Tension pneumothorax
b. Splenic rupture
c. Acute necrotizing pancreatitis
d. Right ventricular infarction
e. Acute cholecystitis
55. An 18-year-old female patient presents with severe retrosternal chest pain of e
two hours duration, preceded by forceful vomiting. On physical exam,
subcutaneous emphysema is noted in the neck, as well as mediastinal
crackling on auscultation. The most likely diagnosis is:
a. Prinzmetal angina
b. Costochondritis
c. Pericarditis
d. Pneumonia
e. Boerhaave’s syndrome (esophageal rupture)
56. The most dreaded complication of Behçet syndrome is: b

a. Folliculitis
b. Scarring bilateral panuveitis
c. Arthritis
d. Gastrointestinal mucosal ulceration
e. Peripheral venous thrombosis
57. The following is true in Mobitz type II second-degree atrioventricular block: b

a. Progressive PR interval prolongation prior to block
b. May occur in the setting of anteroseptal infarction
c. Most often associated with a normal QRS duration
d. Has a low risk of progression to complete heart block
e. A cardiac pacemaker is an arbitrary therapeutic option
58. A 78-year-old female patient presents with exertional dyspnea, progressively d

worsening over the last 5 months. Lung exam reveals crepitant rales over
both lung bases. Your working diagnosis is:
a. Emphysema
b. Kyphoscoliosis
c. Pulmonary emboli
d. Congestive heart failure
e. Sarcoidosis
13
59. A 60-year-old male, smoker, presents with exertional dyspnea, sputum and a
cough. The most likely diagnosis is:
a. Emphysema
b. Kyphoscoliosis
c. Pulmonary edema
d. Congestive heart failure
e. Sarcoidosis
60. A 5-year-old man with type 2 diabetes mellitus has a BMI of 28. He has no a
history of coronary heart disease. BP is 145/85, and pulse is 82/min. Lab tests
reveal total cholesterol 168 mg/dl; triglyceride 165 mg/dl; HDL-C 35 mg/dl;
LDL-C 100 mg/dl; non-HDL-C 133 mg/dl; HbA1C 6.7%. The following
therapeutic option is the next best step:
a. Statin
b. Bile acid binding resin
c. Ezetimibe
d. Niacin
e. Fibrate
61. A 53-year-old man presents with mild hypertension. He gives a history of c

daytime sleepiness. On physical exam, he is moderately obese and has a large
neck circumference. The most likely diagnosis is:
a. Conn’s syndrome
b. Renal artery stenosis
c. Obstructive sleep apnea
d. Polycystic kidney disease
e. Primary hypoaldosteronism
62. A 40-year-old woman presents for severe headaches and weakness. On a

physical exam, her blood pressure is 160/120. Potassium kevel is 2 mmol/l.
a. Conn’s syndrome
b. Renal artery stenosis
c. Obstructive sleep apnea
d. Polycystic kidney disease
e. Cushing’s syndrome
63. Which of the following is the most common cause of death in patients whose b
hypertension is under control?
a. Aortic dissection
b. Coronary artery disease
c. Left ventricular dysfunction
d. Renal failure
e. Stroke
14
64. Bronchiectasis occurs: e

a. From adenovirus lower respiratory tract infection
b. With endobronchial carcinoid tumor
c. In Kartagener’s syndrome
d. With Mycobacterium tuberculosis infection
e. All of the above
65. Mobitz type I second-degree atrioventricular block is seen: e

a. As a transient abnormality with inferior wall infarction
b. With drug intoxication such as beta-blockers
c. With digitalis intoxication
d. In normal persons with heightened vagal tone
e. All of the above
66. A 52-year-old hypertensive woman on atorvastatin has urine dipstick positive e

for blood, but a microscopic examination negative for WBCs, RBCs, and casts.
a. Allergic interstitial nephritis
b. Glomerulonephritis
c. Hemolysis
d. Pyelonephritis
e. Rhabdomyolysis
67. Which one of the following medication can reactivate latent tuberculosis? a
a. Adalimumab
b. Amiodarone
c. Esomeprazole
d. Meloxificam
e. Ondansetron
68. A 28-year-old man tells you his older brother died of colon cancer which was b
diagnosed at age 40. He asks when he should have colonoscopy. You tell him:
a. Immediately
b. Wait till he is 30
c. Wait till he is 40
d. Wait till he is 45
e. Wait till he is 50
69. Which one of the following is the major mechanism of action of metformin d
(Glucophage)?
a. Stimulation of pancreatic insulin release
b. Improved insulin sensitivity of skeletal muscle
c. Inhibition of carbohydrate absorption in the small intestine
d. Inhibition of glucose production by the liver
15
70. Which one of the following is most likely required by a hypothyroid woman on b
levothyroxine when she becomes pregnant?
a. A decreased dosage of levothyroxine
b. An increased dosage of levothyroxine
c. The addition of liothyronine
d. Substitution of dessicated thyroid hormone preparation for the levothyroxine
71. Hypercalcemia due to the secretion of a parathyroid hormone-related protein c

occurs in:
a. Breast cancer
b. Lymphoma
c. Squamous cell cancer of the lung
d. Multiple myeloma
72. Which of the following is the FIRST priority in preventing infections when a
providing care for a patient?
a. Hand washing
b. Wearing gloves
c. Using a barrier between client’s furniture and nurse’s bag
d. Wearing gowns and goggles
73. Which of the following procedures would be the most sensitive in detecting d
early iron overload?
a. Quantitative iron determination in a liver biopsy specimen
b. Urinary iron excretion in response to a test dose of desferoxamine
c. Serum ferritin concentration
d. Serum iron concentration, total iron binding capacity, and calculated transferrin
saturation
e. Iron stain of a bone marrow aspirate
74. Which of the following statements best characterizes the hemolysis associated d
with glucose-6-phosphate dehydrogenase (G6PD) deficiency?
a. It is more severe in affected blacks than in affected persons of Mediterranean
ancestry
b. It is more severe if females than in males
c. It causes the appearance of Heinz bodies on Wright staining of a peripheral
smear
d. The best time to perform the diagnostic test is during a hemolytic crisis
16
75. A 50-year-old man presents with a one-day history of recurrent swelling and a
pain of the left leg. He was discharged from the hospital one week ago after
being treated for deep vein thrombophlebitis of the same leg. Since discharge
he has been taking warfarin, 2.5 mg daily. His INR is 1.2. A venogram
documents recurrent thrombosis extending to the inferior vena cava. Which
therapy would you now recommend for this patient?
a. Increase the warfarin dose to bring the INR into therapeutic range
b. Switch to dicumarol
c. Interrupt the inferior vena cava with a filter
d. Discontinue warfarin and begin heparin at a therapeutic dose
e. Discontinue warfarin and begin thrombolytic therapy
76. A 31-year-old male presents with substernal pain that comes and goes and is b
happening over the last few weeks. He notices it after meals. It is associated
with a sour taste in his breath. No difficulty swallowing or blood in vomitus.
His physical exam is unremarkable. Which of the following is the first step in
the management of this patient?
a. Over-the-counter antacids
b. Omeprazole
c. Electrocardiogram
d. CT of the chest
e. Esophagogastroduodenoscopy
77. A 40-year-old man presents with severe substernal chest pain radiating to the c
neck; made worse by breathing, coughing, and lying on his back, 10 days
following a flu-like illness. Arterial blood gases are normal. His uncle has a
heart attack at age 58. What is the most likely diagnosis?
a. Acute myocardial infarction
b. Dissection of the aorta
c. Acute pericarditis
d. Pulmonary thromboembolism
e. Esophageal spasm
78. A 22-year-old male has had persistent low back pain for 4 years. It does not b
seem to be related to anything in particular, and he is now concerned because
his right eye is red and painful and the vision is decreasing. Which of the
following is your probable diagnosis of his systemic disease?
a. Rheumatoid arthritis
b. Ankylosing spondylitis
c. Tuberculosis of the spine
d. Sarcoidosis
e. Reiter’s syndrome
17
79. A 70-year-old female has recently undergone chemotherapy for ovarian c

carcinoma. She now presents with a skin rash that developed 2 days ago, on
the right side of her back. The area is very painful and shows multiple small
fluid filled vesicular lesions. What is the most likely diagnosis?
a. Drug allergy
b. Bullous impetigo
c. Herpes zoster
d. Molluscum contagiosum
e. Bacterial folliculitis
80. A 36-year-old mother, presents with a 5-month history of amenorrhea. Her e

menstrual cycle was regular until five months ago. Her children are ages 8 and
14. She has had bilateral clear nipple discharge for the past month. On
questioning she reports worsening headaches for two months. She also
complains of vaginal dryness and dyspareunia. Her blood pressure is normal
and she appears well. What is the most likely diagnosis in this woman?
a. Hypothyroidism
b. Polycystic ovarian disease
c. Premature ovarian failure
d. Adrenal adenoma
e. Pituitary adenoma
81. A 26-year-old woman goes to her GP with an offensive vaginal discharge and d
vaginal irritation. A vaginal swab is sent to the lab for culture and a heavy
growth of Trichomonas vaginalis is reported. A pregnancy test is negative.
What is the most appropriate treatment?
a. Acyclovir
b. Ampicillin
c. Fluconazole
d. Metronidazole
e. Nystatin
82. Use of medroxyprogesterone injections has been shown to be associated with: e

a. Liver cancer
b. Ovarian cancer
c. Hypertension
d. A change in clotting parameters
e. Weight gain
83. Which of the following should be screened for hepatitis C? e

a. Health care workers
b. The general population
c. Public safety workers
d. Pregnant women
e. Individuals with persistent abnormal ALT
18
84. Which murmur is best heard by having a patient lean forward in a sitting e
position while holding his breath, preferably in expiration?
a. Aortic stenosis
b. Tricuspid insufficiency
c. Mitral stenosis
d. Mitral insufficiency
e. Aortic insufficiency
85. Which one of the following is characteristic of osteoarthritis of the knee? e

a. Greater frequency in men than in women
b. Increased pain with rest
c. A direct correlation between radiographic changes and pain severity
d. Reduction of pain with repair of associated meniscal tears
e. Reduction of pain with muscle strengthening
86. A 5-year-old girl has had diarrhea and a decreased appetite for the past 2 c
days. She is still playing some. The mother reports no vomiting, but says her
daughter has complained of a dry mouth and does not have tears when she
cries. You suspect that the child may be mildly dehydrated. Which one of the
following would you advise?
a. Increased water intake
b. Clear liquids with sodium, such as chicken broth
c. An over-the-counter oral rehydration solution
d. Intravenous fluids in the emergency department
e. Loperamide (Imodium)
87. A 21-year-old primigravida at 10 weeks gestation has a negative titer for c

rubella. The best procedure to follow is to:
a. Institute gamma-globulin regimen and maintain it throughout her pregnancy
b. Administer rubella vaccine after 12 weeks gestations
c. Administer rubella vaccine immediately postpartum
d. Administer rubella vaccine 12 weeks postpartum
88. A 57-year-old previously healthy menopausal female is diagnosed with c

hyperthyroidism. In addition to a beta-blocker, which one of the following is
the most appropriate initial management?
a. Radioactive iodine ablation
b. Thyroidectomy
c. Methimazole (Tapazole)
d. Propylthiouracil (PTU)
19
89. A 39-year-old male with a BMI of 41 kg/m2 is interested in weight loss. His e
medical history includes adequately controlled type 2 diabetes mellitus, well-
controlled hypertension, hyperlipidemia, and obstructive sleep apnea. He has
no history of coronary artery disease or COPD. Which one of the following is
likely to be most effective for long-term weight loss in this patient?
a. A very low calorie diet
b. Increased physical diet
c. Frequent, long-term weight loss counseling
d. Pharmacotherapy
e. Bariatric surgery
90. For which one of the following respiratory infections should antibiotic b
therapy be initiated immediately upon diagnosis?
a. Bronchitis
b. Epiglottitis
c. Laryngitis
d. Rhinosinusitis
e. Tracheitis
91. Pretibial myxedema is a cutaneous manifestation of: e

a. Subclinical diabetes mellitus
b. Collagen vascular disease
c. Hyperlipidemia type III
d. Ischemia
e. Graves disease
92. A 45-year-old male presents with a 3-month history of hoarseness. He denies b

any other complaints and has not been ill recently. He is not on any
medication, has no history of chronic medical problems, and does not smoke
cigarettes or drink alcohol. Which one of the following would be the most
appropriate management of this patient?
a. Voice rest for 1 month
b. Laryngoscopy
c. A trial of a proton pump inhibitor
d. A trial of inhaled corticosteroids
e. Oral corticosteroids
93. Which one of the following is a classic finding in multiple myeloma? b

a. Hypokalemia
b. Bone pain
c. Polycythemia
d. Hepatic failure
e. Insomnia
20
94. Which one of the following is the recommended duration of c

thromboprophylaxis following total hip arthroplasty, starting from the day of
surgery and including outpatient prophylaxis?
a. 7 days
b. 14 days
c. 35 days
d. 60 days
e. 90 days
95. In women with polycystic ovary syndrome, the risk is increased the most for d
carcinoma of the:
a. Breast
b. Cervix
c. Colon
d. Endometrium
e. Ovary
96. Which one of the following cardiac rhythm abnormalities is most common in c
patients with anorexia nervosa?
a. Atrial fibrillation
b. Ventricular fibrillation
c. Sinus bradycardia
d. Sinus tachycardia
e. Paroxysmal supraventricular tachycardia
97. Which one of the following vaccines is CONTRAINDICATED in a

immunocompromised adults?
a. Herpes zoster
b. Human papillomavirus
c. Meningococcal
d. Pneumococcal polysaccharide
e. Tdap
98. Which one of the following is the treatment of choice for a 10 year-old with d
tonsillar hypertrophy, snoring, and moderate obstructive sleep apnea on
polysomnography?
a. Continuous positive airway pressure (CPAP)
b. Intranasal corticosteroids
c. Extended antibiotic therapy
d. Adenotonsillectomy
99. For which type of renal calculus is acidification of the urine indicated? d
a. Cystine
b. Uric acid
c. Calcium oxalate
d. Calcium phosphate
21
100. Which of the following electrocardiographic aspects is an early sign of a

hyperkalemia?
a. “Peaked” T waves
b. “Peaked” P waves
c. Large QRS
d. U wave
e. Left bundle branch block
101. Which of the following drugs cause hypomagnesemia? a

a. Amphotericin
b. Penicillin
c. Cefuroxime
d. Ciprofloxacin
e. Succinylcholine
102. What percentage of the adult human body is water? d

a. 30 to 40%
b. 40 to 50%
c. 50 to 60%
d. 60 to 70%
e. 80%
103. Metabolic acidosis with normal anion gap is found in: d

a. Alcohol intoxication
b. Aspirin ingestion
c. Diabetic ketoacidosis
d. Small bowel fistula
e. Lactic acidosis
104. Concerning the organophosphate intoxication, which statement is false? c

a. It can be accidental or deliberate
b. A bronchorrea is often present
c. Gastric lavage is strictly contraindicated
d. The pupils are in tight myosis
e. Atropine and contrathion are part of the treatment
105. Regarding the colon obstruction, which of the following is false? d

a. Represent 15% of bowel obstruction in adults
b. The sigmoid is especially interested
c. The distension of the small intestine in this case depends on the competence
of the ileocecal valve
d. Complete obstruction of the colon is mainly due to an inflammatory disease
e. Vomiting occurs late
22
106. Regarding bowel obstruction of the small intestine, one proposition is true: c
a. Vomiting is earlier when the obstruction is distal
b. Abdominal distension is most important in the proximal obstruction
c. Hypovolemia can lead to multisystem organ failure
d. Occlusion by strangulation involves an organic obstacle
e. In a operated patient the most common cause of occlusion is an extrinsic
compression
107. A secondary acute generalized peritonitis is characterized by all the c

following EXCEPT:
a. It is polymicrobial
b. The location of the initial pain may point to an etiology
c. The clinical manifestations are independent of the age and condition of the
patient
d. It gives general signs
e. It gives local signs
108. Regarding gastroesophageal reflux, one answer is wrong: b

a. It can give esophagitis
b. It is always associated with an hiatal hernia
c. It can give ENT manifestations
d. It can cause respiratory manifestations
e. It can be complicated by stenosis of the esophagus
109. Regarding Barrett’s esophagus, a proposition is false: c

a. It can be a gastroesophageal reflux complication
b. It is a glandular metaplasia
c. It can be complicated by squamous cell carcinoma of the esophagus
d. It can be of variable length
e. It can be seen on endoscopy
110. Ultrasound of the first trimester at 12 weeks gestation allows to study all of d
the following EXCEPT:
a. Umbilical insertion
b. Bladder
c. Separation of the two hemispheres
d. Cleft lip
e. Fetal nasal bone
111. Choose from the following that represents an intestinal hernia between the b
vagina and rectum:
a. Rectocele
b. Elytrocele
c. Vaginocele
d. Cystocele
e. This type of hernia does not exist
23
112. Among the signs that a woman can usually feel twenty years after e
menopause, everything is true EXCEPT:
a. Dyspareunia
b. Lack of lubrication
c. Vaginal bleeding completely absent
d. The skin is thinner and less elastic
e. Flushing
113. A vaginal prolapse “type cystocele” can be aggravated by all the following e
EXCEPT:
a. Persistent cough
b. Constipation
c. Hemorrhoids
d. Hypoestrogenism after menopause
e. Efforts with Valsalva maneuver
114. Of the following, which one is the best indication for a surgical treatment of a d
cystocele?
a. His recent onset
b. The association with hysterocele
c. The association with a rectocele
d. Recurrent urinary tract infections
e. The presence of a recurrent vaginal pruritis
115. The bleeding that occurs at the plate end of a contraception pills cycle would c
be an example of:
a. Estrogen deficiency
b. Progesterone deficiency
c. Estrogen and progesterone deficiency
d. Breakthrough of estrogen
e. Breakthrough of estrogen and progesterone
116. Regarding adenomyosis, choose the wrong answer: c

a. Dysmenorrhea is common
b. Menorrhagia is common
c. Peak age at 30 years
d. Due to the presence of endometrial tissue in the myometrium
e. The uterus appears heterogeneous in ultrasound
117. Among the characteristics of the below menstrual cycle, an item is d

considered pathological:
a. A period of 29 days
b. Ovulation on the 15th day
c. A luteal phase of 14 days
d. Bleeding estimated to 100 ml
e. Pelvic pain at the 14th to 15th day of the cycle
24
118. In a normal pregnancy: d

a. The blood pressure increases slightly
b. The venous pressure decreases slightly
c. The cardiac output is unchanged
d. The supine position can cause symptomatic hypotension
e. The sensitivity to angiotensin II is increased
119. Which of the following is NOT a characteristic manifestation of pregnancy? e

a. Linea nigra
b. Chloasma
c. Spider angioma
d. Palmar erythema
e. Areola hypopigmentation
120. You receive a 15-year-old Armenian boy in the consultation for repeated b
febrile abdominal pain, lasting 48 hours. On the physical examination, the
abdomen is normal. Laboratory tests including serum amylase and lipase
are normal; abdominal scan and colonoscopy were normal. Which of these is
the most suitable?
a. Dosage of porphyrins in the urine of 24 hours o eliminate porphyria attack
b. Looking for a family history of Familial Mediterranean Fever, and if positive,
you start Colchicine
c. You suspect opioid intoxication and you begin urine alkalization
d. Looking for a history of joint pain, and if present, you start corticosteroids
e. Surgical exploration of the abdomen
121. What is the infection cause of a recurrent erythema multiform? b

a. Measles
b. Herpes virus infection
c. Syphilis
d. Scarlet fever
e. Rickettsia
122. Mr. AM, a 53-year-old, who are overweight with a body mass index of 29, c
consults you for a checkup and review a blood test recently conducted; its
CBCD shows: Hb 14, MCV 101, WBC 4,200, platelets 145 000, GGT 120 U/l,
SGPT 85 U/l, triglycerides 220 g/l, glucose 0.75 g/l, TSH normal, PT 100%,
vitamin B12 upper normal limits; normal clinical and neurological
examination. Which item in this data prompts you to ask if Mr. AM consumes
alcohol regularly?
a. Platelets and WBC
b. Overweight
c. MCV
d. Glucose and triglycerides
e. Vitamin B12 level
25
123. In the ER, you receive a young man, 2 hours after the bite of a snake with a c
triangular head and elliptical pupils. On examination, he is febrile with local
edema. What will you do? (Choose the most appropriate response)
a. You just calm the patient and mark the edges if edema
b. You prescribe Augmentin and you make a local debridement
c. You give antivenom and antihistamines
d. You prescribe an IV hydration and you give him Augmentin and
corticosteroids
e. You give antihistamines and corticosteroids
124. Mr. GB, a 67-year-old, is diabetic, hypertensive, and dyslipidemic under c

treatment. He regularly consume 4-5 glasses of alcohol per day; 3 months
ago, he became depressed after the death of his only son; he eats little and
merely a piece of chocolate, vegetables, and cooked potatoes. Tonight in the
ER, presents a diplopia. His rectal temperature is 37C, his blood pressure is
120/80 mmHg, and his heart rate is 85/min. What is the appropriate choice?
a. Hypertonic IV glucose
b. Brain CT scan and fundus exam
c. Inject 100 mg of thiamine IV
d. Give Mr. GB order based on multivitamin B
e. Lumbar puncture
125. A 75-year-old lady had amaurosis fugax 2 days ago. She also complained of b
prolonged fever and unexplained weight loss. The emergency will be:
a. A biopsy of the temporal artery
b. Glucocorticoid treatment
c. Holter of the blood pressure
d. Methotrexate treatment
e. Ultrasonography of the temporal arteries
126. A 19-year-old man has had fever, headache, sore throat, and swelling of the c
cervical lymph nodes for 5 days. His temperature is 40C (104F), pulse if
120/min, respirations are 20/min, and blood pressure is 125/85 mmHg. The
pharynx is red and swollen with enlarged tonsils and exudates. There is
tender cervical adenopathy and palpable lymph nodes in the axillary and
inguinal areas. The spleen tip is palpable. Leukocyte count is 14,000/mm3
(25% segmented neutrophils, 60% atypical lymphocytes, and 15%
monocytes). A throat culture is obtained. Which of the following is the most
likely pathogen?
a. Adenovirus
b. Cytomegalovirus
c. Epstein-Barr virus
d. Group A streptococcus
e. Toxoplasma gondii
26
127. A 14-year-old boy is brought to the physician because of constant right knee a
pain for 2 weeks. The pain is not relieved by rest or analgesics. There is no
history of trauma. He is at the 50th percentile for height and above the 95th
percentile for weight. He walks with a limp but is not in distress. His vital
signs are within normal limits. Examination shows full range of motion of
both knees; passive abduction and internal rotation of the right hip produce
pain. There is no swelling of either knee or hip. Neurologic examination
shows no abnormalities. Which of the following is the most likely diagnosis?
a. Juvenile idiopathic arthritis
b. Osgood-Schlatter disease
c. Septic arthritis
d. Slipped capital femoral epiphysis
e. Toxic synovitis
128. A 15-month-old girl is brought to the emergency department after a a

generalized tonic-clonic seizure at home. The seizure stopped
spontaneously after 2 minutes, and she seemed sleepy afterward. Her
temperature prior to arrival was 39.6C (103.2F), and paramedics
administered rectal acetaminophen. Her parents state that yesterday she
had a mild runny nose but otherwise has been well. There is no personal or
family history of serious medical illness or seizures. Development has been
appropriate for age. On arrival, she is afebrile, alert, and interactive.
Physical examination shows a supple neck. Neurologic examination shows
no focal findings. Which of the following is the most appropriate next step in
management?
a. Reassurance
b. CT scan of the head
c. Oral administration of phenobarbital
d. EEG
e. Lumbar puncture
129. A previously healthy 15-year-old boy is brought to the emergency b

department 30 minutes after the onset of headache, nausea, and dizziness.
He had been practicing football twice daily in outside temperatures of 38C.
On arrival, he is alert and cooperative. His temperature is 39C (102.2F),
pulse is 120/min, respirations are 28/min, and blood pressure is 90/60
mmHg. Examination shows profuse diaphoresis. Mental status examination
shows no abnormalities. Which of the following is the most likely diagnosis?
a. Heat cramps
b. Heat exhaustion
c. Heat stroke
d. Malignant hyperthermia
e. Neuroleptic malignant syndrome
27
130. A 15-year-old boy is brought to the emergency department 2 hours after the b
onset of severe left scrotal pain that began while he was playing ice hockey.
There is no history of trauma. Over the past year, he has had several
episodes of mild left scrotal discomfort that have resolved spontaneously.
The left side of the scrotum is enlarged, erythematous, and exquisitely
tender. The left testicle is higher in the scrotum compared with the right.
Which of the following is the most likely underlying cause of this patient’s
condition?
a. Failure of the testicle to fully descend
b. Torsion of the left testis
c. Overactive cremasteric reflex
d. Patent processus vaginalis
e. Presence of an appendix testis torsion
131. A 3-year-old boy is brought to the emergency department because of a b

2-week history of persistent cough and wheezing. His mother states that his
symptoms occur when he laughs or runs. He has not had any other
symptoms, and no one else at home is sick. Three weeks ago, he had an
episode of choking and coughing while eating dinner. His temperature is
37.6C (99.7F), pulse is 90/min, respirations are 20/min, and blood
pressure is 70/45 mmHg. Expiratory wheezes are heard on the right with
normal airflow. The remainder of the examination shows no abnormalities.
His symptoms do not improve after administration of nebulized albuterol.
An expiratory chest x-ray shows hyperinflation of the right lung; there is no
mediastinal or tracheal shift. Which of the following is the most likely
diagnosis?
a. Asthma
b. Foreign body aspiration
c. Laryngotracheobronchitis (croup)
d. Psychogenic cough
e. Tension pneumothorax
132. A previously healthy 67-year-old man is admitted to the hospital because of d

lethargy, confusion, muscle cramps, and decreased appetite for 7 days. He
appears ill. His temperature is 37C (98.6F), pulse is 98/min, respirations
are 20/min, and blood pressure is 120/70 mmHg. Breath sounds are
diminished at the right lung base. Neurologic examination shows no
abnormalities except for lethargy. Serum studies show: Na+ 114 mEq/l, K+
4.3 mEq/l, creatinine 1 mg/dl, TSH 4.1 U/ml. An x-ray of the chest shows a 2
cm nodule in the right lower lobe and mediastinal adenopathy. A biopsy
specimen of the nodule is most likely to show which of the following?
a. Adenocarcinoma
b. Clear cell carcinoma
c. Mesothelioma
d. Small cell carcinoma
e. Squamous cell carcinoma
28
133. A 67-year-old woman is brought to the emergency department because of b

severe chest pain 4 hours after undergoing outpatient endoscopy and
dilatation of an esophageal stricture caused by reflux. At discharge, she
reported no chest pain. Three hours later, she vomited a small amount of
blood and had severe pain. She is pale. Her temperature is 38C (100.4F),
pulse is 125/min, respirations are 22/min, and blood pressure is 140/85
mmHg. Examination shows crepitus in the neck and moderate epigastric
tenderness. The lungs are clear to auscultation, and breath sounds are equal
bilaterally. Rectal examination shows no masses; test of the stool for occult
blood is positive. Which of the following is the most likely cause of these
symptoms?
a. Bleeding from erosive esophagitis
b. Esophageal perforation
c. Mallory-Weiss syndrome
d. Myocardial infarction
e. Perforated gastric ulcer
134. A 72-year-old woman is brought to the emergency department one hour e

after the sudden onset of right facial droop and weakness of the right arm
and leg. She takes captopril for hypertension and daily aspirin. Her pulse is
80/min, respirations are 16/min, and blood pressure is 150/90 mmHg.
Examination shows a left carotid bruit and right central facial paralysis.
There is moderate expressive aphasia. A CT scan of the head shows no
abnormalities. Which of the following is the most appropriate initial
pharmacotherapy?
a. Oral ticlopidine
b. Oral warfarin
c. Sublingual nifedipine
d. Intravenous Nitroprusside
e. Intravenous tissue plasminogen activator
135. One day after undergoing cholecystectomy, a 37-year-old man becomes c

increasingly tremulous, and anxious. He is irritable with the staff and moves
around restlessly in bed. He has no previous history of serious medical
illness and takes no medications. He does not smoke. His temperature is
37.4C (99.4F), pulse is 120/min, and blood pressure is 160/100 mmHg.
Physical examination shows a well-healing incision without erythema. He is
oriented to person but not to place or time. Administration of which of the
following is the most appropriate next step in management?
a. Intravenous ceftriaxone
b. Oral buspirone
c. Oral diazepam
d. Oral naltrexone
e. Oral sertraline
29
136. Fourteen hours after admission to the hospital for treatment of severe e
hypertension, a 32-year-old woman has stridor. On admission, she was given
captopril. She appears anxious. Her pulse is 140/min, respirations are
32/min, and blood pressure is 140/85 mmHg. Examination shows swelling
of the lips and tongue. Diffuse stridorous wheezes are heard on auscultation.
There is diminished air movement. Which of the following is the most
a. Observation only
b. Measurement of serum captopril concentration
c. Measurement of serum IgE concentration
d. X-ray of the chest
e. Tracheal intubation
137. A previously healthy 27-year-old woman comes to the physician because of a b

3-month history of moderate abdominal pain that improves for a short time
after she eats. She has not had any rectal bleeding. Her temperature is
36.4C (97.5F), pulse is 80/min, and blood pressure is 110/70 mmHg.
Abdominal examination shows midepigastric tenderness. Her hemoglobin
concentration is 12 g/dl, and leukocyte count is 8,000/mm3. Serum
Helicobacter pylori antibody assay is positive. Which of the following is the
most appropriate next step in management?
a. HIDA scan
b. Amoxicillin, clarithromycin, and omeprazole therapy
c. Ciprofloxacin therapy
d. Omeprazole, magnesium hydroxide, and metoclopramide therapy
e. Ranitidine therapy
138. A 30-year-old woman comes to the physician for a routine examination. She b
has a 10-year history of type 1 diabetes mellitus. Examination shows normal
findings. She has microalbuminuria; her HbA1C is 7%, and serum creatinine
concentration is 1.8 mg/dl. Which of the following is the most appropriate
intervention?
a. Administration of a calcium-channel blocking agent
b. Administration of an angiotensin-converting enzyme (ACE) inhibitor
c. Administration of an oral hypoglycemic agent
d. Administration of aspirin daily
e. Increase in the dose of insulin
30
139. Two days after undergoing surgical repair of a ruptured abdominal aortic d
aneurysm, a 67-year-old man requires increasing ventilatory support. He
remains intubated and is being mechanically ventilated at an FIO2 of 0.6 and
a positive end-expiratory pressure of 7.5 cmH2O. He has chronic obstructive
pulmonary disease. He had a myocardial infarction 2 years ago. His only
medication is a sedative. He has smoked two packs of cigarettes daily for 40
years. He appears diaphoretic. His temperature is 38.1C (100.6F), pulse is
120/min, and blood pressure is 90/60 mmHg; the ventilatory rate is 25/min.
examination shows jugular venous distension. Breath sounds are absent on
the left. The trachea is shifted to the right. Pulse oximetry shows an oxygen
saturation of 82%. Which of the following is the most appropriate next step
in diagnosis?
a. ECG
b. Transthoracic echocardiography
c. CT scan of the chest
d. Needle aspiration of the left side of the chest
e. Transesophageal echocardiography
140. A previously healthy 72-year-old man comes to the physician because of d

decreased urinary output during the past 2 days; he has had no urinary
output for 8 hours. Examination shows suprapubic fullness and an enlarged
prostate. His serum urea nitrogen concentration is 88 mg/dl, and serum
creatinine concentration is 3.5 mg/dl. Which of the following is the most
a. Ultrasonography of the prostate
b. Ultrasonography of the kidneys
c. CT scan of the abdomen
d. Bladder catheterization
e. Intravenous pyelography
141. Ten days after admission to the hospital because of acute pancreatitis, a a
56-year-old man with alcoholism develops chills and temperatures to 39.4C
(103F). Examination shows a tender abdomen with hypoactive bowel
sounds. Which of the following is the most likely diagnosis?
a. Pancreatic abscess
b. Pancreatic insufficiency
c. Perforated duodenal ulcer
d. Retroperitoneal hemorrhage
e. Splenic vein thrombosis
31
142. A 50-year-old man is admitted to the hospital within 2 hours of the onset of e
nausea, vomiting, and acute crushing pain in the left anterior chest. He has a
family history of early coronary artery disease. The pain does not subside
with the administration of nitroglycerin, sublingually. An ECG shows
ST-segment elevation in leads aVL and V2 through V4. Which of the following
is the most appropriate management to decrease myocardial damage and
mortality?
a. Administration of digitalis
b. Administration of lidocaine
c. Administration of quinidine
d. Coronary artery bypass grafting within 1 week
e. Thrombolytic therapy
143. A previously healthy 62-year-old man comes to the physician because of a d

2-month history of cough. He has smoked two packs of cigarettes daily for 40
years. Examination shows no abnormalities. An x-ray of the chest shows a
2.5 cm noncalcified pulmonary nodule in the right upper lobe. A CT scan of
the chest confirms the x-ray findings. An x-ray of the chest obtained 1 year
ago showed no abnormalities. Which of the following is the most
appropriate next step in diagnosis?
a. Measurement of serum calcium concentration
b. Second x-ray of the chest in 6 weeks
c. Ventilation-perfusion lung scans
d. Bronchoscopy with transbronchial biopsy
e. Median sternotomy
144. About early management of fall from height victim, all of the following a
statements are true EXCET:
a. A cervical collar should be postponed until cervical spine fracture are proved
b. Arrest of external bleeding by compression takes priority over splinting of
fractures
c. Cervical spine x-ray is a routine part of early management
d. Pelvis x-ray is a routine part of early management
145. The following statements about fibrocystic breast are all true EXCEPT: b
a. May be asymptomatic
b. May cause nipple retraction
c. Is a cause of breast pain
d. Produced breast nodularity
e. May cause discharge per nipple
32
146. A 17-year-old female presents with a 3 cm thyroid nodule. FNA shows e

papillary structures. There is no evidence of metastasis, the appropriate
treatment is:
a. Thyroxine therapy
b. Radioactive iodine therapy
c. Excision of the nodule
d. Hemithyroidectomy
e. Total thyroidectomy
147. The possible complications of ERCP include all the following EXCEPT: c
a. Acute pancreatitis
b. Acute cholangitis
c. Perforation of the gallbladder
d. Perforation of the duodenum
e. Bleeding
148. Which statement is FALSE concerning primary HIV infection? b

a. Incubation period is 2 to 4 weeks after exposure
b. A generalized rash is an uncommon manifestation
c. Self-limited encephalopathy may accompany acute HIV infection
d. Patients with primary HIV infection are highly contagious to others, given the
typical high viral loads that are seen transiently
149. Among the following which is not a classical neurological complication of d

HIV infection?
a. Progressive multifocal leukoencephalopathy
b. Cognitive disorder
c. Peripheral neuropathy
d. Mononeuritis multiplex
150. Compared to stenting, endarterectomy is most likely to increase the risk of b

which of the following outcomes?
a. Death
b. Myocardial infarction
c. Renal failure
d. Sepsis
e. Stroke
33
151. A 19-year-old female presents with a non-productive chronic cough that has b
been present for two weeks. The symptoms first began with headache, fever
of 39C, and malaise. The symptoms were slow in developing and she
vaguely remembers a sore throat. She took amoxicillin but did not feel any
better. The cold agglutinins test is positive. This a lower respiratory
infection caused most likely by:
a. Influenza virus
b. Mycoplasma pneumonia
c. Respiratory syncytial virus
d. Streptococcus pneumoniae
e. Staphylococcus aureus
152. Rheumatoid arthritis is associated with which of the following HLA b

antigens?
a. B27
b. DR4
c. DW4
d. DW14
e. DW4/DFW14
153. A 55-year-old woman presents with increasing loss of memory and a

paroxysmal abnormal movements. The next best test for diagnosis is:
a. EEG
b. Brain MRI
c. CT head
d. Lumbar puncture
154. The pathogenetic factors responsible for acute renal failure with contrast d
dyes does NOT include:
a. Osmolarity
b. Proteinuria
c. Immunologic reaction
d. Microvascular injury
e. Direct toxicity
155. An 18-year-old student was found to have a positive PPD (1.5 cm c

induration). 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
34
156. A 20-year-old patient, 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 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
157. 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. Transscrotal needle biopsy
b. Transscrotal aspiration of the hydrocele for cytology
c. Radical orchidectomy through an inguinal incision
d. Transscrotal exploration and orchidectomy
e. Laparotomy with pelvic and retroperitoneal node dissection
158. Which of the following laboratory parameters increases during pregnancy? d

a. Serum albumin
b. Blood urea nitrogen
c. Creatinine
d. Erythrocyte sedimentation rate
e. Bicarbonate
159. All of the following are thought to be risk factors for the development of e
gastric adenocarcinoma EXCEPT:
a. Helicobacter pylori infection
b. High salt diet
c. Diet high in smoked foods
d. Cigarette smoking
e. Alcohol consumption
160. Which of the following is the most common cause of death in patients whose b
hypertension is under control?
a. Aortic dissection
b. Coronary artery disease
c. Left ventricular dysfunction
d. Renal failure
e. Stroke
35
161. The single confirmatory investigation for acute myocardial infarction is: e
a. Electrocardiogram
b. LDH level
c. Creatinine kinase isoenzyme
d. Echocardiography
e. Cardiac troponin levels
162. Rifampicin is the drug of choice for postexposure prophylaxis for household b
contacts of a patient with:
a. Escherichia coli sepsis
b. Hemophilus influenza type B disease
c. West Nile virus
d. Streptococcal meningitis
e. Staphylococcal skin infections
163. Which one of the following disorders is most likely to be associated with d
Helicobacter pylori infection?
a. Non-ulcer dyspepsia
b. Reflux esophagitis
c. Celiac disease
d. Gastric lymphoma
e. Achalasia of the cardia
164. Which one of the following statements is correct about the initial dose of d
aspirin for patients with ST-segment elevation myocardial infarction?
a. A single low-dose aspirin (81 mg) is the appropriate dose
b. Adding a nonsteroidal anti-inflammatory drug further increases benefit
c. Aspirin is not necessary if the patient already took aspirin earlier in the day
d. Aspirin should be chewed before swallowing
e. Aspirin should not be given to patients who will receive fibrinolytic therapy
165. Which one of the following statements is correct about obesity and c
overweight in children?
a. Bariatric surgery is not effective for weight loss in children
b. Endocrine etiologies of obesity are identified in nearly 25% of obese children
c. Normative values for body mass index (BMI) do not exist for children younger
than 2 years
d. Obesity in children is defined as a BMI greater than 25 kg/m2
e. Obesity in children is defined as a BMI greater than the 90th percentile
166. 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
36
167. 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
168. 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
169. An 88-year-old woman presents with recurrent massive rectal bleeding. b

Both gastroscopy and colonoscopy have failed to reveal the cause. Choose
the most appropriate investigation:
a. Capsule endoscopy
b. Mesenteric angiography
c. Enteroscan
d. Urgent laparotomy
e. Technetium-labeled red blood cell scintigraphy
170. 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
171. 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
37
172. 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
173. A 25-year-old man with motor vehicle accident and contusion on the left a
side of the abdomen presents to the ER with pallor, cold extremities,
hypotension at 8 and tachycardia at 130. What is the organ most likely
injured?
a. Spleen
b. Stomach
c. Small intestine
d. Rectum
e. Left colon
174. Lower endoscopic evaluation is recommended in which of the following c

groups of patients with iron deficiency anemia with no obvious benign
cause?
a. Men under 50
b. Premenopausal women
c. Postmenopausal women
d. Infants and children
175. On routine annual examination, a 78-year-old man has a 2 cm circular c

peripheral density in his right upper lobe on chest radiograph. To help
established a diagnosis what should come next in the workup of this finding?
a. Sputum analysis
b. Lactate dehydrogenase level
c. Contrast-enhanced thoracic CT
d. F-2-fluoro-2-deoxy-D-glucose-positron emission tomography (PET scan)
e. Fiberoptic bronchoscopy
176. A 54-year-old woman with a low rectal cancer undergoes an c

abdominoperineal resection in what proves to be a challenging procedure
that lasts 9 hours. Which of the following would be the earliest indicator of
compartment syndrome in the lower extremities?
a. Paresis
b. Pallor
c. Pain
d. Pulselessness
e. Paralysis
38
177. Which of the following is the most common form of cancer affecting the skin? a
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Cutaneous T cell lymphoma
e. Metastatic lung cancer
178. All the following characteristics are typical of hypertensive crisis EXCEPT: a
a. Diastolic blood pressure 140 mmHg
b. Retinal hemorrhage
c. Normal mental status
d. Proteinuria and azotemia
179. Each of the following statements regarding acute severe mitral regurgitation d
is true EXCEPT:
a. Left ventricular pressures are usually normal
b. The ECG may show an acute infarction pattern
c. The diagnosis of effective endocarditis should be considered
d. Cardiac size is usually normal
e. The loudness of the murmur does not correlate with the severity of
regurgitation
180. Patients with obstructive sleep apnea may manifest each of the following a
symptoms EXCEPT:
a. Anemia of chronic disease
b. Ventricular arrhythmias
c. Elevated pCO2
d. Peripheral edema
GOOD LUCK
39
ANSWERS
1. e 2. a 3. c 4. d 5. b 6. b 7. d 8. c 9. d 10. d
11. a 12. c 13. d 14. b 15. c 16. c 17. a 18. d 19. c 20. b
21. c 22. c 23. b 24. d 25. a 26. c 27. d 28. e 29. a 30. b
31. a 32. b 33. a 34. c 35. c 36. d 37. d 38. d 39. d 40. c
41. a 42. a 43. b 44. c 45. c 46. e 47. b 48. a 49. a 50. d
51. c 52. b 53. d 54. c 55. e 56. b 57. b 58. d 59. a 60. a
61. c 62. a 63. b 64. e 65. e 66. e 67. a 68. b 69. d 70. b
71. c 72. a 73. d 74. e 75. a 76. b 77. c 78. b 79. c 80. e
81. d 82. e 83. e 84. e 85. e 86. c 87. c 88. c 89. e 90. b
91. e 92. b 93. b 94. c 95. d 96. c 97. a 98. d 99. d 100. a
101. a 102. d 103. d 104. c 105. d 106. c 107. c 108. b 109. c 110. d
111. b 112. e 113. e 114. d 115. c 116. c 117. d 118. d 119. e 120. b
121. b 122. c 123. c 124. c 125. b 126. c 127. a 128. a 129. b 130. b
131. b 132. d 133. b 134. e 135. c 136. e 137. b 138. b 139. d 140. d
141. a 142. e 143. d 144. a 145. b 146. e 147. c 148. b 149. d 150. b
151. b 152. b 153. a 154. d 155. c 156. e 157. c 158. d 159. e 160. b
161. e 162. b 163. d 164. d 165. c 166. a 167. b 168. d 169. b 170. d
171. c 172. b 173. a 174. c 175. c 176. c 177. a 178. a 179. d 180. a
40

Medicine Colloquium Exam - 2014 A

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Medicine Colloquium Exam - 2014 A

Hochgeladen von

Copyright:

Verfügbare Formate

Medicine Colloquium Exam –First Session 2014

Ministry of Education and Higher Learning

2. At what ages do febrile seizures occur? a

3. List ONE disease prevention measure NOT routinely administered to all c

4. In infants, treatment of bronchiolitis should include all of the following d

6. Which drug is associated with the development of Reye syndrome? b

7. In cystic fibrosis, gastrointestinal abnormalities include all of the following d

8. Which of the following is the most common cause of pneumonia in infants? c

9. Concerning CROUP, which of the following is/are true? d

10. When is adenoidectomy recommended? d

13. Definition of nephrotic syndrome: d

16. A newborn male was diagnosed prenatally to have bilateral hydronephrosis, c

21. A 55-year-old man is complaining from visual disturbances. He is not able to c

23. A 70-year-old man comes to the emergency department complaining of b

26. A 4-month-old girl is brought to the physician because of problems with c

27. A 14-year-old boy is brought to the emergency department because of d

28. A 14-year-old girl is brought to the emergency department because of severe

29. A 23-year-old professional basketball player goes to the team physician 3 a

32. A 57-year-old man is referred for a sigmoidoscopy as a colon cancer screening b

33. An infant girl is born to a healthy 32-year-old primigravida woman. Although a

34. Choose the correct answer concerning prostate cancer: c

36. Regarding the examination of mobility of a traumatic joint, the following d

38. Irreducibility of posterior hip dislocation should suspect: d

40. In a mother that develops rubella during pregnancy, what immunoglobulin c

42. In intestinal malrotation, the most dangerous complication is: a

43. Each of the following conditions is associated with an increased risk of b

44. Adenomyosis is diagnosed by finding islands of endometrium: c

45. The major symptom of rectocele is: c

47. Which of the following is not a presumptive symptom of pregnancy? b

48. Chadwick’s sign is: a

50. A 78-year-old female has progressive memory impairment over 2 years. No d

51. The following is a manifestation of Ebola virus infection: c

52. The following is true in Diabetes Mellitus (DM) type 1: b

53. The following is true in Diabetes Mellitus type 2: d

56. The most dreaded complication of Behçet syndrome is: b

57. The following is true in Mobitz type II second-degree atrioventricular block: b

58. A 78-year-old female patient presents with exertional dyspnea, progressively d

61. A 53-year-old man presents with mild hypertension. He gives a history of c

62. A 40-year-old woman presents for severe headaches and weakness. On a

64. Bronchiectasis occurs: e

65. Mobitz type I second-degree atrioventricular block is seen: e

66. A 52-year-old hypertensive woman on atorvastatin has urine dipstick positive e

71. Hypercalcemia due to the secretion of a parathyroid hormone-related protein c

79. A 70-year-old female has recently undergone chemotherapy for ovarian c

80. A 36-year-old mother, presents with a 5-month history of amenorrhea. Her e

82. Use of medroxyprogesterone injections has been shown to be associated with: e

83. Which of the following should be screened for hepatitis C? e

85. Which one of the following is characteristic of osteoarthritis of the knee? e

87. A 21-year-old primigravida at 10 weeks gestation has a negative titer for c

88. A 57-year-old previously healthy menopausal female is diagnosed with c

91. Pretibial myxedema is a cutaneous manifestation of: e

92. A 45-year-old male presents with a 3-month history of hoarseness. He denies b

93. Which one of the following is a classic finding in multiple myeloma? b

94. Which one of the following is the recommended duration of c

97. Which one of the following vaccines is CONTRAINDICATED in a

100. Which of the following electrocardiographic aspects is an early sign of a

101. Which of the following drugs cause hypomagnesemia? a

102. What percentage of the adult human body is water? d

103. Metabolic acidosis with normal anion gap is found in: d

104. Concerning the organophosphate intoxication, which statement is false? c

105. Regarding the colon obstruction, which of the following is false? d

107. A secondary acute generalized peritonitis is characterized by all the c

108. Regarding gastroesophageal reflux, one answer is wrong: b