‘a. J7 Set Assessment Exam (MCCQEI-May 2005) rele la -Or—~ rn aD: ry. Omar Swath ! 5 Question: 1 4 A 38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating fom the left loin to grain and associated with nausea, perspiration, and the need for frequent urination. He is restless, tossing in bed, but has no abnormal findings. ‘Which one of the following is the most likely diagnosis? 1) Herpes zoster 22) Left ureteral calculus 3) Sigmoid diverticulitis 4) Torsion of the left testicle 5) Retroperitoneal haemorrhage Secti Question: 2 Following a car accident a 33-year-old man is admitted to the hospital with a fracture of the tenth rib on the left side. He is noted to be pale, restless, and sweating, and his blood pressure is low. On examination there is pronounced guarding in the left upper quadrant of the abdomen. Which one of the following viscera is most likely damaged? 1) Left lung 2) Pericardium 3) Left diaphragm 4) Left kidney 95) Spleen Question: 3 A 29-year-old man is admitted to the emergency department with a faciomaxillary injury and inability tc breathe. In the absence of special equipment, an airway is best made through which one of the following structures? 1) Thyrohyoid membrane 2). First ring of trachea 3) Thyroid cartilage > 4) Cricothyroid membrane 5) Cricotracheal ligament Question: 4 A 35-year-old woman presents with severe. stabbing abdominal pain radiating from the epigastrium fo the back and chest. She is nauseated and says that her abdomen feels bbloated as well as painful, and that the pain is worse lying down. She has tachycardia, a low-grade fever, and an absence of bowel sounds, guarding, and an exquisitely tender abdomen, Further questioning reveals that she drank exceasive amounts of algohol last ight. She has no prior medical or family history for cardiac disease. A plain radiograph of the abdomen shows no air under the diaphragm. Which of the following processes is most likely in this patient? ’ 1) Perforated duodenal uleer 2) Myocardial infarction‘Sa Aterment Exam (CCOEE 3) Abdominal wie euryam 4 eat pancretts af 5) Renal colic Question: § A 35-year-old man is seen in the Emergency Department after attempting suicide by taking an overdose of warfarin, Which one ofthe following i used asa treatment for this circumstance? 1) Heparin 2). Allopurinot 3) Coumarin 4) Vitamin E 75) Vitamin kK Question: 6 evaptoemeyey A 32-year-old woman has migratory antrtis of her wrists and ankles and a ‘re Pryteais.vesiculopustolar skin eruption. She is febrile. Physical examination reveals Se enone un wine. Whine of the flowing isthe most likely diagnosis? EEF 0 Gonccoceal ais re ‘fer |" 2). Reiters syndrome catcae my Ae emivengdin 3) Rheumatoid arthritis ace [| 4) Systemic upus erythematosus tect 5) Meningosceceria enaeytin 6 detracting er a tnmnatine Question: 7 S73 yond woman report that she hasbeen troubled by episodes during which she fels apprehensive and which ussly oor inthe moming Hes fear ate nreases She sets cresvely.Aatanon and vesteSne5 ME prominent. Whi one athe fale wing iberatry tests ould he onleed? 1) hyo incon teste 2}. txfologie seen 5) measurement of eum sud lve 964) eaeurenent of serum gcse vel 5) measurement of ram ammonia evel Question: & 1h 82-year-old woman hos recently experienced fatigue kepines, dy skin constipation, anda 45 kr-weight nin, Her thoi ffm and ie the normal ize : {Which one of the folowing laboratory teste most kel Yo confi he suspected Giggnosis of hypothyroidism? 1) serum thyroxine (T4) 2) serum triiodothyronine (T3) 3) Ta resinupiake 34} seri thyrid-tmating hormone (TSH) measurement = 5} amithyost amibdiesse Psy Sa Asessment Ext MCCOBL-May 2005) + Question: 9 ‘A 20-year-old man with abrupt onset of hematuria and proteinuria, accompanied by ‘eatin and salt sd water retention, ros likely has which one ofthe fllowing? 1) nephrotic eyndrome 2), multiple myeloma 3) diabetic nephropathy 4) nepholitisis 5) acute glomerutonephrts Question: 10 Which one of tie following populations is at greatest risk of completed suicide? #1) males over 45 years of age = 89 2) females over 45 years of age 3) females under 14 years of age 4) females age 1410 18 5) males age 14 to 18 Questions 1 Sehnnort prycherbe fa retamwion Doing + 49-year-old van complains ofa six month history of worying about his eal, breteed be increased desir o sleep, demmoralization, an difficulty focusing atention on tasks. Which one ofthe following is the most ikely diagnosis? 1) schizoid personality disorder fer oem 2) somatization diorder b ©) generalized ante dsoer + TH eet 4) depression ase ge 5) chronic fatigue syndrome ‘Susp Question: 12 All ofthe following substances are associated with withdrawal seizures, EXCEPT. 1) alprazolam, 2) opiates. 3) aleohol 49) barbiturates 5). diazepam, Question: 13 ‘A 45-year-old business executive with advanced cinthoss ofthe liver and a history of Alcohol abuse says that he drinks only because ofthe constan nagging of bis wife. This is an example of which ofthe following defense mechanisms? 1) rationalizacion 2) repression 3) subiimation 44) reaction formation 5). intellectualizationSt Awenment Erm (MCCOELMy 205) ‘Question: 14 A 2 year-old gi presents with generalized edema shortly after recovery from an upper ‘espratory infection. Laboratory studies revealed marked albuminuria as well as bhypoalbuminemia and hyperlipidemia. Which one of the following isthe most likely diagnosis? “D+ 1) minimal change disease 2) focal and segmental glomeruosclerosis 3) membranous glomerulonephritis 4) poststreptocoecalglomerulonephrtis 5) rapidly progressive glomerulonephtis Question: 15 A S-year-old girl is refered toa cardiolozst be ‘examination, Which one of the following ei innocent murmur? 1) audible only in diastole 2) audible throughout systole 3) associated witha precordial heave suse of a murmur heard during a routine I characteristies is consistent with an 62) ampicillin 5) doxyeyetine _ wirre fram 4) trimethoprime-sulfamethoxazole 5) ciprofloxacin C “Question: 19) ‘F the following is the most common cause of asymptomatic vaginal ulceration or erosion? > 1) tampons 2) toxic epidermal necrolysis (TEN) 3) herpes genitalis swestic ©4) vaginal carcinoma 5) bacterial vaginosis Question: 20 Which one of the following is the current best management of a pregnant woman with ‘a past history of herpes simplex genital infection on the inner labia minora? 1) Vaginal delivery in all cases. 2) Cesarean section if lesions are present at time of labor. 3) Elective cesarean section at 38 weeks in all cases. '4) Daily application of topical acyclovir to site of previous lesions '5) Cesarean section only if herpes culture positive. Question: 21 Molar pregnancy is most readily diagnosed by 1) urinary human chorionic gonadotropin in excess of 50,000 TU/24 hour. 2) elevated beta sub-units of human chorionic gonadotropin. -3) ultrasound, 4) magnetic resonance imaging. 5) computed tomography. a residency training and find that the percentage of women who plan to train in primary care is significantly higher than the pereentage of men (p<0.05). The probability is less than $% that 1) the sampled men will enter a primary care field, 2) the difference between the men and wor 3) _all the wore in the class will enter « primary care field 7 4) the difference between the sampled men and women is due to chance. 5) this sample reflects the choices of the whole class, en is real 1 Question: 23 on A total of 10,000 Vietnam veterans, half of whom are known by combat records to have been in areas where Agent Orange was used and half of whom are know to have been inSe Assestment Exam (MCCQEI-May 2005) areas where no Agent Orange was used, are asked to give a history of cancer since discharge. This scenario best illustrates which one of the following? 1) case series report ¥ 2) case-control study 3) clinical trial 4) cohort study 5) case report wer” Question: 24 ‘The population of less-developed countries is growing. Which one of the following statements is most responsible for this trend? 1) Policies to limit family size have been ineffective. &2) Their birth rates are increasing. 3) Birth control programs have been ineffective. 4) ‘Their mortality rates are decreasing 5) Population equilibrium cannot be attained in less-developed countries. Section: 2 Question: 1 A 30-year-old man presents to the emergency room with a 7-day history of increasing pain in the perianal region. On examination, he has an indurated, reddened and very tender area, extending from the anal verge out into the lef buttock. His temperature is 38°C. Which one of the following is the next most appropriate step in management? 1) order a CT scan of the pelvis 2) prescribe ciprofloxacin and metronidazole 3) prescribe analgesics and sitz baths 4) order a barium enema 2 5) incise the indurated area Question: 2 A baseball player was atruck on the left side of the head with the ball. The player fell to the ground, but did not lose consciousness. After a few hours he was seen to be confused and imritable. Which one of the following is the mos likely diagnosis? 1) extradural hematoma © 2) subdural hematoma 3) subarachnoid hemorrhage 4) intracerebral hemorrhage 5) _post-concussion syndrome Question: 5 Following a severe car accident, a 27-year-old man was found to have an unstable knee joint. On examination under anesthesia, it 1s possible to pull the tibia forward excessively ‘on the femur. Which one of the following structures is most likely injured in this patient? 1) medial collateral ligament 2) oblique popliteal ligamentede, 1) nephrotic syndrome Sat Assessment Exam (MCCOBL-May 208) (33). anterior cruciate ligament '2)_ lateral meniscus 5) ligamentum patelae Questic Ranson > CO An ZR pM 3 cosyearald man is sen in the emergency cum and is diagnosed ashaving acute rrwest ava Dantes. Which one ofthe folowing would sugges more severe ins? 1) sein anviselee>200 amy >A yg PEEYY © UEC SSS 2 ypersiyemi ad pycosuria eS 3) high urinary amylase level - LOH 7 asowll 44) serum lipase level > 20,000 se 37 eees lat 5) deereased serum calcium level asT Pese MIL Question: ‘A 25-year-old male patient is experiencing inability to swallow and has speech difficulty. ‘The patient was in perfect health prior fo the consumption of home-canned green beans, ‘Which one of the following isthe most appropriate treatment? 1) Administration of stepbylococeal enterotoxin antiserum. 2), Penicillin administration. 3) Immunization with Staphylococcus aureus enterotoxin toxoid 4) Administration of tetanus toxoid 5) Placement othe patient in hyperberic oxygen chamber K Question: 6 40-year-old woman has episodic headaches that ast 30 minutes and ae associated with sweating, palptaions and feelings of apprehension. She has lst 6.8 kg over the past three months, Physical examination revels hin woman wit a pals of 112 beatsmimite and a Blood pressure of 150100 mnffg ying and 130/80 mmlg standing ‘Which one ofthe fllwing is the most likely diagnesis? 31) pheochromocytoma 2) ‘hyperaldosteronism 3) posterior fossa tumor 4) renal artery xenon 5) carcinoid syndrome Question: 7 ‘70-year-old man witha history of coronary heart disease and hypertension, presents ‘witha 3-week history of increasing shortness of breath. A chest x-ray show a maderate ‘zed right pleural effusion. Thoracentsis shows the protein in the pleuraseram ratio to be 0.5, consistent with a ansndate, ‘These results are compatible with a pleural effusion eauted by which one ofthe foloni ee ees 7s ur lat fe Seach ve 7h, 3) adenocarcinoma of the lung (cancer) 7 2) feces 3} SinaiPutra. Encbolisrr Pen EEA seh + Sef Asesmen Exam (MCCOELMay 2008) ree eeSetbote leer Oconee Question: [A 55-year-old asthmatic woman, on systemic steroids for | year, has developed a recent Fight pleural effosion. She feels unwell and tices easily. Aspiration revealed a turbid {lid with numerous Imphocytes and a high lactate dehydrogenase (LDH) an low slcose level Fu pHs 74. Te mos likely diagnosis is ee Trans Exudtine <3) tberclois rep) ° 5 4) a subphrenic abscess. i Size, 7 5) pancreatitis. Ler als coe Sok prwnth — 4) von Willebrand's disease 5) familial platelet function disorder Question: 16 A 6-year-old child presents complaining of patchy hair loss on the back of the scalp, Examination reveals well-demarcated areas of erythema and scaling, and although there is still some hair in the area, itis noted that the hairs are extremely short and broken in appearance. Which of the following is the patient mast likely suffering from? 1) cutaneous candidiasis 72) tinea capitis,Sef Assessment Exam (MCCQEL-M ay 2005) 3) alopecia areata 4) scalp psoriasis 5) seborrheic dermatitis, Question: 17 ‘The most common pathogen causing urinary tract infection (UTI) in pregnancy is 1) Pseudomonas aeruginosa 2) Proteus mirabilis 3) Haemophilus influenzae 4) Escherichia coli 5) Klebsiella pneumoniae Question: 18 ‘Which of the following physiologic changes occurs during a normal pregnancy? 1) hyperuricemia 2) proteinuria 3) hypertension 4) 2.40% increase in the glomerular filtration rate (GFR), 5) metabolic alkalosis Question: 19 Breast engorgement in a woman eager to breastfeed is best managed by 1) bromocriptine administration. 2) oxytocin nasal spray. 43) tight binder until condition relieved. 94) frequent nursing, 5) diuretics Question: 20 1) detachment. 2) hemorrhage. 3) exudates. 44) spasm of arterioles. 5) papilledeme: Question: 21 Live rubella vaccine should be given to = 1) children between one year and puberty 2) infants less than one year 3) all adults 4) pregnant women 5) all exposed patientsSf Anesment Exam (MCCQEI-May 2005) Question: 22 A pediatrician hypothesizes that children who consume large amounts of a particular food additive are more likely to be hyperactive than children who do not. To test this hypothesis, he interviews the parents of 100 hyperactive children (identified from the ‘medical records of six child paychiatrists) and 100 children undergoing treatment by one of the same six physicians for other behavioural problems to determine the dietary habits of their children over the preceding two years, This study is an example of which one of the following? 1) cohort study 2). case-control study 3) cross-sectional prevalence survey 4) case series report 3) _non-randomized controlled trial Question: 23 Conceming a physician's obligation to provide due care to a patient, which one of the following is correct? 1) =Beneficence is a moral commitment but not a legal obligation to the well-being of the patient 2) Respecting autonomy is both a moral commitment and a legal obligation to the patient 53) A physician can be found guilty of negligence even if he/she has acted in accordance with a practice acceptable to a responsible body of peers 4) ~Unanimity of practice is expected of physicians 5) - Where patient outcomes are poor, physicians may have their practices scrutinized by the courts but not by pecr organizations Question: 24 Six months after hepatitis B infection or immunization, which one of the following ‘markers would be the best indicator of acquired immunity? 1) HBsAg 2) Anti-HBs 3) Anti-HBe 4) HBeAg. 5) Anti-HBe Section: 3 stion: 1 Rectal prolapse in infants is most commoniy associated with which one of the following, diseases? 1) trisomy 21 2) microcephaly 3) cystic fibrosis 4) pyloric stenosis 5) intussusception “Self Assessment Exam (MCCQEI-M ay 2005) Question: 3) Sttersergd incision of an absces situated in the ight posterior ingle ofthe neck, the Patient could no longer ras he ight hand above her hea to brash her hair. Which one OF the following nerves is most Hkely injured in this patient? 1) Tong thoracic nerve #2). spinal acessory nerve 3) suprascapular nerve 4) dorsal sapolr nerve 5) nerve to sbelavins Question: 3 ‘A 3-week-old male is brought to the Emergency Room by his 17-year-old mother with a 14 hour history of ineonsolable crying, vomiting and a tender mass inthe right groin. Which one ofthe following is the mos ikely diagnosis? 1) ealic 2) acute hydrocele 3) testicular torsion 4) child abuse A) incarcerated hernia Question: 4 Echoviruses have been implicated as etiology of which one of the following diseases? 1). aseptic meningitis 2). Guillain-Barré syndrome * Echo vod 3). Reye's syndrome bees 4) orchitis a 5) hemolytic uremic syndrome Question: 5 ‘A 25-year-old woman has intermittent diplopia. She says she chokes on her food and regurgitates it, sometimes through her nose. Physical examination reveals drooping eyelids and bilateral facial muscle weakness without atrophy; deep tendon reflexes are normal, Which one of the following is the most likely diagnosis? 1) familial periodic paralysis 2) museuler dystrophy 3) _ polymyositis 24) myasthenia gravis S) multiple sclerosis Question: 6 40-year-old woman has episodic headaches that last 30 minutes and are associated with sweating, palpitations, and feelings of apprehension. She has lost 6.8 kg over the past three months. Physical examination reveals a thin woman with a pulse uf 112 beats/minute and a blood pressure of 150/100 mmlg lying and 130/80 mmHg standing, ‘Which one of the following is the most helpful diagnostic test? 1) CT scan of the brain 12Sa Assessment Exam (MCCQELMay 2005) 2) captopril renal nuclear medicine sean 3) 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) levels, 4) 24-hour urinary aldosterone levels #5) 24-hour urinary vanillylmandelic acid (VMA) and catecholamine levels Question: 7 A.49-yeer-old woman presents to'your office complaining of increasing fatigue. She has always had heavy menstrual periods. Her hemoglobin (Hb) is 85 g/L; mean corpuscular volume (MCV) is 75 fL; her ferritin is 10 umol/L. The next most appropriate step in the investigation of this patient is to do which one of the following? a / 1) prescribe ferrous gluconate and monitor response 2) pelvic ultrascund 3) bone marrow 4) colonoscopy 5) take a detailed dietary history uestion: 8 fren 1V drug abuser presets wit coh, eve, and an abnormal cesta showing hilar and mediastinal adenopathy and bilateral lower lobe infiltrates. His intermediate Mantoux skin test shows a greater than 5 mm induration. Which one of the following is the most likely underlying condition associated with this ines? 1) sickle-cell disease 2) alcoholism 3) drug abuse ~2)_man mene vi (HV) fection Hodgkin's disease ped lm > year-olf college stadent broke up with her boyfriend 72 hours ago. She now complains of depresed mood, ant iteulyconentalingon sue, nd preoccupation with *mistakes" she made in the relationship. Which one ofthe following isthe most approorate treatment a this time? 1) desipramine 2). diazepam 3) phenelzine 24) psychotherapy 5) thioridazine % pw Question: 10) The following herpes may be wen the mnegsment of conic psn, EXCEPT ‘operant conditioning, 2) chante therapy 3) biofeedback. 84) systematic desensitization. 5) relaxation therapy.‘Set Assessment Exam (MCCQEI-May 2005) Question: 11 Which one of the following is NOT a risk factor for Alzheimer disease? 1) trisomy 21 2) female sex 3) age 4) tobacco use : 5) family history of dementia Question: 12 ‘An 18-year-old woman previously in good health seeks helps at an emergency room for lightheadedness, headaches and nausea, She appears anxious and is tremulous, sweating and breathing heevily. While waiting to sce a physician, she begins to complain of tingling around her mouth and in her fingers. Which one of the following would be your first management step for this patient? 1) Ask her to breathe into a paper bag. 2) Order immediate intravenous infusion of a glucose solution. 3) Order a urine drug screen. 4) Give supplemental oxygen by mask. 5) Administer 2 mg of sublingual lorazepam (Ativan) Question: 13 A S-yearold develops difficulty breathing and facial swelling following subcutaneous injection of an allergen during desensitization therapy. Which one of the following treatments should be initiated immediately? 1) discontinuation of subsequent injections for three weeks 2) application of a tourniquet distal to the injection site 3) administration of steroids prior to the next injection 4) administration of aminophylline subcutaneously 5) administration of epinephrine (1:1000) subcutaneously Question: 14 A 2-year-old toddler is brought to the emergency room 8 hours after accidental ingestion ‘of gasoline. On examination she is afebrile and has no respiratory distress, Chest x-ray is normal. Which one of the following is the most appropriate intervention? 1) oral corticosteroid treatment 2) antibiotic to prevent pneumonitis Remove NE 3) induce vomiting to empty the stomach 4). admit to ward for observation only 5) discharge home, butt return if tachypneic ‘Question: 15 A 4-month-old baby has developed a fever of 40.2°C and become very ititable within 8 hours of receiving his second dose of routine immunization. He had a seizure lasting for 10 to 15 seconds. Which one of the following options would you consider for completing the immunization of this baby? 1) Next time omit pertussis vaccine from the schedule.Setf Assessment Exam (MCCQEI-May 2005) 2). Give DTP instead of acellular pertussis 3) Omit Hib and administer DTaP and IPV. 4) Reassure the mother and proceed with DTaP, IPV, Hib, 5) Omit diphtheria toxoid from the combination. Question: 16 ‘A newborn infant requires repeated resuscitations in the delivery room because of failure to breathe and cyanosis. During spells of crying, which appear to alleviate the cyanosis, his breath and heart sounds are normal, as is direct laryngoscopy. Vigorous respiratory ‘movernents appear ineffectual. Immediate management of this infant consists of which of the following? 1). obtaining a chest x-ray 2). obtaining an ECG 3) arterial blood gas determinations 2 4) inserting an oropharyngeal airway 5) administration of naloxone Question: 17 ‘A 24-year-old woman appears al 8 weeks of pregnancy and reveals a history of pulmonary embolism 7 years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin (Coumadin®) and has had no further evidence of thromboembolic disease for over 6 years. Which of the following statements about her current condition is true? 1) Having no evidence of disease for over 5 years means that et sisk of thromboembolism is not greater than normal. 2) Impedance plethysmography is not a useful study to evaluate her for deep ‘venous thrombosis in pregnancy. 3) Doppler ultrasonography is not a useful technique to evaluate her for deep venous thrombosis in pregnancy. #4) The patient should be placed on low-dose heparin therapy throughout her pregnancy and the puerperium, 3) She is at highest risk for recurrent thromboembolism during the second irimester of pregnancy. Question: 18 ‘A 34-year-old woman presents to the Emergency Department with a 6-hour history of intermittent severe crampy right lower quadrant pain, The patient is vomiting and is afebrile, There is a right adnexal tender mass on pelvic examination. The white blood cell count is 16 x 109/L per high power field; urinalysis is within normal limits; and the beta ‘human choriorie gonadotropin (HCG) is negative. The most probable diagnosis is 1) right pyelonephritis, i 2) acute appendicitis. 3) right ovarian endometrioma 4) acute salpingitis, 3). torsion of a right ovarian cyst. 15us oe 7 “ Question Sef Assessment Exam (MCCQELM ay 2005) Question: 19 nto nol lise siltinghomone lvls (FSH) are foun in patents with 1) premature oven xlure 2) tnorexi nevoen 4 FS yposnlenmine 3) pure gonadal dysgenesis 4) resistant ovary syndrome. 5) previous pelvic radiotherapy for cervical cancer. Question: 20 All of the following may occur as a result of postpartum pituitary necrosis (Sheehan syndrome), EXCEPT. 1) amenorrhea 2) asthenia, 3) pallor. x4) galactorrhea, 5) bradycardia sede dsc rmaninon tt ot i to prev t 1) person-to-person spread, 2) droplet spread 23) vector spread. 4) vehicle spread. #5) _airbome spread sv + Question: 22 A total of 300 newly diggnosed patients with laryngeal cancer are allocated to treatment with either surgical excision alone or surgical excision plus radiation treatment. This scenario best illustrates which one of the following? 1) case series repart 2) case-control study ve 3). clinical wal 4) cohort study 5) case report 3 In order to study the possible association between hair dye and cancer, the most feasible study design woulE be which one of the following? 1) randomized controlled trial 2) case-control study 63) cohort study o 4) focus groups LAN 5) case series report os an 16Sa Assesment Exam (MCCQEI-May 2005) Co ueston: 4 In a randomized controlled clinical trial, the purpase of randomization is to 1) keep the study subjects “blind” to treatment received. 2). keep the observers "blind" to treatment received. 3) get a random sample of the population for treatment. 4) minimize the bias between the two groups. 5) all those listed. Question: 1 ‘A/42-year-old man presents with an acute onset of severe right ocular pain and blurry vision. Physical examination reveals the pupil to be mid-ilated and fixed. No discharge is present. Which one of the following should the examining physician expect? 1). blood in the anterior chamber 2) an increased intraocular pressure 3) _a.comeal erosion on slit-lip examination 4) papilledema 5) bloodless arterioles and a cherry red fovea Question: 2 A.45 year old obese female patient presents to the Emergency Room with a history of right upper quadrant pain lasting two hours. She states that this is her third attack of similar pain in the past two months. ‘The pain started suddenly and is described as sharp, constant and radietes to her right shoulder. On examination she is afebrile and has mild ‘ight upoper quadrant tenderness. Which one of the following is the most likely diagnosis? 1) duodenal uleer 2) myocardial infarction 3) acute cholecystitis 4) hepatitis 25) biliary colic Question: {38-year-old woman is to be operated on fo carpal tunnel syndrome, Which one ofthe following structures is situated inthe tunnel along withthe median nerce? 11) flexor carp ulnaris 2) palmaris longus median Neve - 3) ulnar nerve 2 oliciS longus. 4) fewerpoltelonge, “Yo Flexor pellet longus 5) pronator teres Question: A 65-year-old men presents with progressive dysphagia of 4 months’ duration, Initially, swallowing solid food was difficult. Subsequently, swallowing liquids also became difficult. He has lost about 9 ky, Esophagrams show a ragged mucosal pattern with,Self Assessment Exam (MCCQEI-May 2005) annular constriction in the lower third of the esophagus. Proximal to the lesion, the esophagus is not dilated. Which one of the following is the most likely diagnosis? 1) carcinoma of the esophagus 2) reflux esophagitis 3) scleroderma 4) diffuse spasm of the esophagus 5) benign esophageal stricture Question: 5 The peripheral blood smear of a severely anemic patient reveals oval macrocytes, hypersegmented neutrophils, and decreased platelets. The most likely cause of the anemia is 1) ated cell membrane protein defect 92) vitamin B12 o1 folate deficiency 3) an amino acid substitution in the -globin chain 4) marrow hypoplasia 5) iron deficiency Question: 6 A 19-year-old woman is admitted unconscious to the Emergency Department following a car accident, She has facial lacerations and a displaced tibial fracture. Which one of the following is the first priority in management? 1) insert an intravenous line the tig '~ wayne 2). insert a Foley catheter : i 3) perform a thorough neurologic examination Pe fra ee 94) examine her airway 5) check her blood pressure Question: 8 A 28-year-old male has received several blood transfusions following a motor vehicle accident. He is noted to have abnormal liver funtion tests. Which of the following viruses is the most common cause of transfusion-mediated hepatitis? 1) hepatitis A » 2) hepatitis B 4,3) hepatitisC + 021 4) Epstein-Barr virus, 5) cytomegalovirus Question: 7 You are asked 10 assess a 65-year-old woman with a lung tumor. Routine blood test reveal that the patient is hyponatremic. You suspect the cause of hyponatremia is antidiuretic hormone (ADH) secretion by the tumor. Which one of the following lung, tumors does this patient have? 1) squamous cell carcinoma 2) adenocarcinoma 3) large cell carcinomaSelf Assesment Exam (MCCOEI-May 2005) iy Cn 94) small cell carcinoma ot ¢ 5) bronchioalveolar carcinoma ct ae year witha 70-earhisny of vee Croft nae eng patent Pospialzaton mpl be sent ono et hip pun ou waking Whee of the along th not ikly case oe a? 1) cote ; snipe odin, ~~ csterpors ‘Sosa ness stom fl in cating. Her physical examination and laboratory findings are normal. She has been awakening at § am, for several months and cannot fall back to sleep. She says she hes ‘been feeling anxious and helpless since her husband died 3 years ago. Which one of the following is reesonable medication to prescribe for her? 1) olanzapine (Zyprexa®) +2) venlafaxine (ettexor®) 3) clonazepam (Rivotri!®) 2 qetapne Seroquel) "speridone (Risperdol®) z Gre Following have ben found in association wth mane behavior, sertraline. digitalis, ails 4) methylphenidate 25) cimetidine ah Question: 12 ‘The son of a 79-year-old woman wants a psychiatric evaluation for his mother because she has heen more eanfised and lethargic during the past 6 months, She takea several ‘medications daly, although her son doesnt know what they are. Mental stats examination shows the woman to be dishevelled, mildly agitated, and delirious. Which one ofthe following is the most useful next step mn shis woman's evaluation 211) identifying her medications 2) eliciting a family history 3) ordering serum electrolytes 4) obvaining a CT sean ofthe head 5) prescribing haloperidel for ayiation‘Seif Assessment Exam (MCCQEI-M ay 2005) s Question: 13 A 7-year-old git! hospitalized for a tonsillectomy awakens and cries out in fight that a jg bear” is in her room. She is relieved when a nurse, responding to her cry, enters the room and tums on the light, revealing the bear to be an armchair covered with a coat. ‘This experience would be an example of — 1) adelusion 2) ahallucination ©3) anillusion 4) deja vu 5) dissociative reaction Question: 14 ‘A S-year-oldgitl is seen by her pediatrician after she has complained of headache, dizziness, tinnitus, sweating, and hyperventilation for 3 days. She was recently diagnosed with juvenile rheumatoid arthritis. Which one of the following drugs is ‘mast likely to be associated with these adverse effects? 1) naproxen sodium 2) acetaminophen 3) tolmetin 4) aspirin 5) prednisone Question: 15 A term newborn infantis noted to have abdominal distention and failure to pass meconium at 48 hours of age. Abdominal x-rays show dilated loops with air-luid levels and a granular "ground glass" material. A gastrografin enema is administered with good effect, as the infant passes meconium, Which one of the following investigations is indicated in the follow-up management of this infant? 1) glucose tolerance test io 2) sweat chloride test 3) fluid deprivation test 4) gastrointestinal motility test 5) small bowel biopsy Question: 16 A sin-week-old buy is adiitied te hospital with feeding. On examination during feeding » mass is palpable in the epigastric region. Which of the following is the most likely diagnosis? 1) malrotation of the gut 2) intussusception _e 3) hypertrophic pyloric stenosis 4) omental hernia 5) choledochal cyst ghistry of projectile vomiting afterAng hed rma + Loc > CTS if ~ve —> home 9 Woke him From Sot ansent Exam ONCCQET May 208) Pemdt ont he isnot tm Coma Sor ys brought ta physician’ oie afr alin fm hs bile nd Race hinhec/cothestiewntt Nol was peer sda binds aunt to SRE Gctince” Naso xamtuton eves sora ere Py cabason on beef fread: Which one of be fovingis th most toproprae mamgenent? vidiahn er Stan crear” oe 2) overnight admission for observation i 3) sll ray and sicharging the patent normal 4 _= 4) instructions tothe mother to observe the patient's neurological status during the next 24 hours 465) a skull x-ray, 24-hour observation, and discharge Question: 18 {patient at 17 weeks’ gestation is diagnosed as having an intrauterine fetal demise. She retums to your office 5 weeks later and has not had a miscarriage, although she has had ‘some ovcesionsl spotting. This patent sat increased risk for which of the following? 1) septue abortion 2). recurrent abortions 5) consumptive coagulopathy with hypotibrinogenemia 44) future inferiliy 5) ectopic pregnancies cited with which one ofthe fallowing fetal conditions? 1) tacheo-esophageal fistula talipes equinavarus (lub foot) 7 anencephialy fetal erythroblastosis Down syndrome Question: 20 ‘patient, who is 8 weeks pregnant, has been using a copper-contaning intrauterine device. On vaginal examination, the string is seen, Which one of the following would be the most appropriate management ofthis patient? 1) Remove the device immediately. 2) Recommend therapeutic abortion. 5) Remove the device if sigs of infection develop. 43). Cut the string high in the endover is allowing the device to retracts pregnancy develops, 5) Perform laparoscopy to rule out ectopic pregnancy. Question: 21 ‘Which one ofthe following conditions contraindicates routine childhood immunization? 1) prematurity 2). acute illness with an ora lemperarure over 39 °CSelf Assessment Exam (MCCQEI-M ay 2005) 3) antibiotic therapy 4) living with » pregnant woman 5) allergy to penicillin Question: 22 A total of 3500 patients with thyroid cancer are identified and surveyed by patient interviews regarding past exposure to radiation. This scenario best illustrates which one of the following? 5 41) case series report 22) case-control study 3) clinical trial 4) cohort study 5) case report Question: 23 Lung cancer is an important cause of morbidity and mortality. With respect to lung cancer, which one of the following measures would be described as tertiary prevention? 1) higher taxes on tobacco products _» 2) pulmonary rehabilitation programs for patients following lung cancer resection 3) municipal bylaws to restrict tobacco smoking in the workplace 4) annual chest x-ray in smokers over the age 50 6 5)_high school ecinention programs describing the link between smoking and Jung cancer a Pie EN Baap arishrduneendl dene eed meer ne pia Soaps ee er ee eee le following? 1) 20% —2) 25% 3) 40% 4) 50% 5) 73% jon: 2 Question: 1 A young man sustains a severe blow to the head, Skull x-rays show air in the cranial vault. This finding represents which one of the following? 1) severe contusion 2) severe concussion 23) skull fracture 4) fracture of the nasal septum 5) subdural hematomaSef Asesment Exam (MCCQEI-May 205) Question: 2 A.S7-year-old woman is receiving total parenteral nutrition and pre-operative radiotherapy for obstructive esophageal carcinoma. She becomes lethargic and demonstrates bizarre behavior. Urine output is 3400 mLi24 hours. To determine the ‘cause, the most useful fest would be 1) lumbar puncture 2) computed tomography scan of brain. % tego o vpes She of Gehry eh 3)__urineserum creatinine ratio. hie eee 1.4) liver enzymes DnecberneD :phtrnethater er bel lint 02", @ 5) blood glucose aie) bese Question: 3 [A 38-yearuld mais brought wo the Eusrgency Deyartnent om Christmas Eve by the police. They found him in the woods with an empty bottle of gin beside him. He is agitated and confsed. His vitals signs are biood pressure 10050 mm Hg, pulse 60/minste espratorysate L6/aiute Fe ig pray ani-coo; there ae vesigelarformatigns on the dorsum of his feet, and both feet aretedand ecematous. Which Si of te fllowing ithe most ikely diagnosis? 1). supericial spreading cellulitis #2) second degree frostbite 3) gout 4) first degree frostbite 5) compartment symdrome Question: A laborer feels a sharp pain in his right shoulder as he is lifing a heavy erate. O/E, he has ‘moderate pain and soreness in the right shoulder. The shoulder can be moved passively ‘through most ofthe range, but active abduction can be achieved only if assisted. The most likely diagnosis is 1) rupture ofthe tendon of the long head of biceps. 2) subglenoid dislocation of the shoulder. 3) axillary nerve injury. we 4) acute subdeltoid bursitis agra see + 5) partial rupture of the rotator cuff: « s Question: 5 AA TSsyear-cld woman complains ofhaving to swallow her fod twice, accompanied by sugling noises in be throat, The mest key agnosis is ot). achalasia 2) myotonic dystrophy. 3) gastroesophageal reflux. © 4) _cricopharyngeal diverticulum. 5) myasthenia gravis. Question: 6‘Sa Asessmeat Exam QACCOFI-May 2005) Following induction of anesthesia fra vaginal hysterectomy the pte i placed inte Tio peiton Pestopetvly the patent complain of et ont drop, Which vate at kely to haecbeen nur daring he poeta? oy permed QOD sl 23) il 3 spbenoss 5) ner Question: 7 Hypertensive encephalopathy may be precipitated in patients taking monoamine oxidase inhibitors with the ingestion of foods containing high levels of which one ofthe following? et) tyramine 2) tryptophan 3) serotonin 42) tyrosine 5) dopamine Question: 8 A 19-year-old female presents with pain and swelling of her right knee and no other symploms, X-ray shows joint effusion, She has been sexually active since she was 15 and is seeing a gynecologist fr follow-up of cervical dysplasia. Rheumatoid factor was negative. Which one of the following is the most likely diagnosis? 1) osteoarthritis 2) pouty arthritis 3) pseudogout 16.4) gonococcal arthritis 5) systemic lupus erythematosus sf pi) pow) 0thee ow CP, Payelee rie 'A previously healthy, 68-year-old woman develops auditory hall She cannot rove many detlt bles er esi peaking Toe, She hs iy ‘cooperating during the interview and physical examination, which is unremarkable. Which one ofthe following isthe most likely diagnosis? 1) complex partal seizures = 2). Alzheimers cisease 3) adverse medication effect +4) hypertnyroudism 75) pedduncularhallucinosis Question: 10 ‘A 76-year-old man is brought to the Emergency Department by relatives who state that ‘he had collapsed suddenly, but regained conseiousness within minutes. There was no seizure activity. His electrocardiogram shosved a sinus Hhythm (76 beats per minute), aSel Assessment Exam (MCOQEI-May 05) right bundle branch bloc, and left anterior Sasciculr block (ef axis deviation). Which one of the following most likely accounts for this man's loss of conscioasness? “1)- entilar tachycardia 2) type lecond degrs etriovanticular block (Wenekcbach) 3) _paronysmal supreventricalar tachycardia BA) intermitent heart block 5) atrial flutter with 2:1 atrioventricular block Question: 11 Which one of the following most favors « diagnosis of cardiogenic shock in « patient ‘with scute myocardial infarction? 1). bypotension and sinus bradycardia 2) hypotension and low ceniral venous pressure 3) acute pulmonary edema refractory to standard treatment 4) ventricular arhythmia ard hypotension "yeer-cld man fs seen in your office for assessment one week after experiencing a brief episode of fet arm and eft facial weakness, Blood pressure in your ofliceis 140'80 mmHg, A CT'scen showed no evidence of hemorrhage or space-occupying lesion. An EKG shows normal sinis hythm. Which one of te following is the mos mporant investigation to onder a this tine? O_ Lay “enmagneticresonence imaging (MRI) ofthe brein + 9) mieiueadiogam 3). cerebral angiography: 4) achestx-ray > 5) acarotid artery ultrasound Question: 13 After a long history of multiple myeloma, a 67-year-old male is noted ‘o have abundant acelivlar eosinophilic deposits around the pulmonary microvasculature at autopsy, A congo red special stsin demonstrates apple green birefringence. Which one of the following conditions is the most likely explanation? 1) sarcoidosis 2) histoplasmosis, =3) amyloidosis 4) mesothelioma 5) silicosis Question: 14 A.50-year-old man with ahistory of hemochromatosis presems to the emergency room ‘orniting up bright red blood. He had his most recent phicooiomy yesterday. His blood pressurcis 110/85 mm Hy, is pulse 115’min, his face is flushed, and he is diaphoretic. During the physical examination splenomegaly and a venous pattem on bis chest and& o toe. ‘Sal Assesment Exam (MCCQEL-May 2005) abdomen are noted. He seems somewhat drowsy and confsed but has no fea feospe gn, Wht theme me ins pe oto 1) seve anemia 22) hrepaticencephatopatny — AR. cis 3} sibwachnenttemertage (764° Oe 2 4) vitamin B12 deficiency hes. a 3) eetmaron overload [Ecos by ek REESE gn ne ee ‘ox tigrse a 4.jear-ld woman wih &resson nd peseribe on andres Which on ofthe following fats would nrese le Hetnoo of hr eran with vein 1) apie fail history 2) the paients dev ofr nes (3) med secon gin 2) ahiphlove ef subjective dsres 3) shor walngoom time seo ode pelo . cack. ered Question: 16 ‘The development of a bipolar mood disorder is frequently associated with a history of 1) oss ofa parent before age 11 2) repetitive experiences of "leamed helplessness" 73) dysthymic or mood disorder. ? 4) night terrors 5) sibling suffering ftom hypothyroidism Question: 17 A 35-year-old woman with a history of aleohol abuse and depression presents in an “obtunded state after an overdose of alcohol, benzodiazepines and a tricyclic antidepressant, Which of the following represents the most serious threat under these circumstances? 1) delirium tremens 2) respiratory arrest FL wpsee3) status epilepticus é 4) cerebrovascular accident 5) cardiac arrest Question: 18 For the past 6 months, an 18-year-old man has withdrawn to the basement of his house. because he believes he is the subject of a conspiracy to kill him and thatthe home is, bugged’. Which ore of the following is the most likely diagnosis? 1) bipolar disorder - manic phase 2) antisocial personality disorder 3) obsessive.compulsive disorder 24) schizophrenia 5). delirium‘Sai Assessment Exam (MCCQEI-May 2005) Question: 19 A S-year-old boy presents to your office complaining of right ear pain, Upon ‘examination ofthe eat, pin i elicited with traction ofthe tragus, the tympanic ‘membrane isnot visualized well and sorme periuricularIymph nodes are palpable. ‘What the mos: kely dings? +) oe) 3) mastoiditis 4) ablocked eustachian tube 5) acute viral conjunctivitis Question: 20 A-mother brings her 2-yearold toddler to you because he does not eat. Pregnancy and ‘delivery were normal and his birth weight was 4kg, He was breastfed up to 6 months of age. He is now drinking 1 L of mill a day. and loves juices. His height (01 em) is inthe th percentile and his weight 16.5 kg i over the 97th percentile for his age. Which one of the following measures is most appropriate in the initial management of this problem? 1) Admit the child to hospital for adrenal, pituitary and thyroid function tests 2) Refer the mother and her son to a child psychiatrist 23) Plan an appropriate diet for his age 94) Reassure the mother and check his weight in 3 months. SL" 5) Add vitamin supplements to his regular diet ‘ Question: 21 An abdominal mass in the newbom is most frequently due to 1) neuroblastoma, #2) anomalies of the kidney and urinary tract. 3) anomalies of the bowel, 4) teratoma, 5) mesenteric cyst Question: 22 ‘A 4-year-oldgie presents with areas of bluish diseoloration of the lower extremities, buttocks and upper trunk. She has a low-grade fever but otherwise well looking. The complete blood sount reveals the following revolts hemoglobin, 120 g/L. white bloud cell, 8.22108 and platelets 170 x109/L. Which one ofthe flowing isthe most ikl diagnosis? hhenoch-Seh?nlein purpura Bee oes att idiopathic thrombocytopenic purpura Me acute levkeria.‘Sel Asessoent Exam (MICCQEI-May 2005) Question: 23 ‘A 27-year-old woman who is 15 weeks presnant with her first child presents to the office With exquisitely painful, blister-like lesions on her labia. She had similar episodes before pregnancy. Her temperature is normal. Which one of the following statements about her prognaney is TRUE? 1) She should undergo cesarean section to protect her infant from infection. 2) Her fetus hes an increased risk of congenital malformations 3). Transplacental transmission to her fetus isa significant concern. 4) Breastfeeding of her infant is probably unsafe 145) Decisions regarding route of delivery are best made at onset of labour Question: 24 Which one of the followin suspected food poisoning? £1) culture of vomitus of affected persons 2) culture of feces of affected persons 3) rapid identification of cases 44) collection of samples of food eaten 3) identification of foods consumed by individuals is LEAST licipful in the investigation of an outbreak of Question: 1 A 65-year-old woman with breast carcinomas was treated with a partial mastectomy. Which one of the following suggests a better prognosis? 1) recurrence-free in the first 6 months 2). the primary tumor was 2 cm in diameter 3) absence of metastasis inthe liver ‘e4)__prosence of estrogen receptors 5) positivity of only 5 lymph nodes ‘Question: 2 A 53-year-old woman is brought to the Emergency Department for epistaxis present for ‘45 minutes. Upon arrival, her blood pressure is 210/120 mm Hg, palse 90/minute and respiratory rate 24/minute. Examination of the anterior septum shows no active bleeding, Your management will include al ofthe following, EXCEPT 1) posterior packing (92) vasopressin IV 3) oxygen supplement, 4) anterior packing 5) keep blood in reserve. rnestion: © TRO PeA A yewcrally debilitated yuan ian extended are facility has a chronic Escherichia coli bacteriuria. About once every 6 months, he develops mild fever, frequeney of micturition and some urinary incontinence. On several of theseSof Assessment 1m (ICCOEL-May 2008) ‘exacerbations, his urine cultures grow Escherichia coli with colony counts greater than 100,000'mL.. Which one ofthe following would be the most appropriate management? 1) Determine the cause ofthe infection by cystoscopy and TV pyelogram. Place him on continuous low-dose antibiotic therapy. Catheterize and irrigate the bladder daly. ‘Treat only the acute episodes of infection with appropriate antibiotic, x Do not give specific treatment but maintain a high fluid intake. Ques Ri yetrld patent wo fad aplenty 2 yet ag fr tuna, pees the Emergeney Department with confusion, cough and fever which have developed over the past 12 hours, On atval, his vital signs are: temperature 41°C, respiratory rate 28iminute, blood pressure 90/70 mum Hs, pulse {S0/minute ‘Whics one of the following investigations would best confirm the diagnosis? 7 al) chest x-ray Comp rtakier Iq dtaeg 7 perwnceeraP 4 2) lending 2 bho) Ee urine culture sputum culture 4) o SPiqh) Plood cutee Question: 5 A previously well 13-year-old boy experiences a sudden onset of pain inthe ight testicle with accompanying nausea and vomiting. On examination 8 hours ater the enset of pai, the testicles located high in the scrotum and is swollen and exquisitely ender, The overlying epididymis cannot be separately palpated. The most likely dlagnoss is 1) Acute Epicidymitis. 7 Qe. #2) Torsion ofthe appendix testis. Ss Torsion ofthe spermatic cord 2» Incarcerated inguinal hei. “Testislar mar. Question: 6 Following surgery fora left hemi-thyroidectomy the patient is found to have persistent hhoarseness. Which one of the following nerves is most likely to have been injured? 1) chorda tympani nerve 2) superior laryngeal nerve 3) glossopharynueal nerve +4) reenrrent laryngeal nerve 5) thyraglossal nerve Question: 7 A 20-year-old man presents with respiratory distress, You establish that he has a severe acute asthmatic attack. In addition to oxygen, which one of the following is the most important medication he requires? 1) morphine 2) corticosteroidsSa Assesment Exam (MCCQEI-May 2005) 5.3) salbutamol (Ventolin®) 4) montelukast sodium (Singulair®), leukotriene receptor antagonist 5) sodium cromoglycate (Intal®) Question: & A 67-year-old woman develops delirium 3 days after an acute myocardial infarction, She is markedly agitated. Which one of the following is the most useful treatment? 1) diazepam 2) morphine 3) nitroglycerine 4) chlorpromazine + 5) haloperidol Question: 9 An 86-year-old man has diminished vibratory sensation at the knees and toes, although his reflexes are intact, temperature sensation is normal, and he feels well apart from headaches. Which one of the following is the most likely explanation? $+ fB,1) peripheral neuropathy iy hy 2) normal age-related change ~ 3) spinal cord lesion 4) small strokes 5) brain or brain stem tumor Question: 10 ‘A 45-year-old woman is brought to the Emergency Department after she fainted in a supermarket. Her husband tells you she was diagnosed as "hypoglycemic by a homeopath 2 years ago. Which one of the following criteria is most in favor ofthe diagnosis of hypoglycemia? 1)” Abnormal S-hour glucose tolerance test ‘¢ 2) Low blood glucose while symptomatic 3) Typical prodrome of tachycardia 4) History of post-prandial syncope 5) Improvement of patient status after easing Question: 11 A 72-year-old man has suifered a fall. His daughter reports that, for several months, she has noticed that he walks with smaller, shulfling footsteps and that his spine and arms seem alway’ to be flexed when walking, ‘Il of the Following may be found. EXCEPT i € 1) intention tremor of the hand, 2) a fine rapid tremor in the right foot 3) pill rolling tremor in both hands. 4) micrography. 5) mild dementia,Self Asesment Exam (MCCQEI-May 2005) es Seer anlar as econ naar eae enemreerean Se ee a rey cr mme rmmne Se ee ee ee ce cance tae eis See ee ain atta ee Cee eee an er eacae waa See er rae mais Tae oa oan oe aerriy siiceeeee Lee see Se onaeal ee iaaeie Dr pala oe cer cee er eeetocaneas cue nt ocs eeaee ees Hipcrmehacreeqen eemeacira 4) a 24-hour urine collection for cortisol Man be ae eime ene eso eal 2 tobe meal ied Question: 13 A-48-year-old man complains of fatigue and shortness ‘and hemoglobin is 103 g/L. Peripheral blood smear reveals macrocytosis. Serum in B12 level is 66 pmol/L (N=150-750 pmol/L); serum folate level is 16 nmol/L. -22 nmol/L). Which one ofthe following causes listed below is most unikely?” 01) vegetarianism 277) colonic diverticulitis 3) regional enteritis 4) pancreatitis 5) fish tapeworm infection Question: 14 |A 43-year-old man who is being treated with hydrochlorothiazide for control of mild edema presents complaining of malaise. fatigue, muscular weakness, and muscle cramps. Which one ofthe following isthe most likely cause of the patient's symptoms? 1) hyperglycemia 2). hyperuricemia 3) drug hypersensitivity 44) hyperkalemia 25) hypokalemia Question: 15 GAM The tnt sani of defoein pi esto i oy 1) displacement, 2) projection. 3) splitting 4) sublimason. 5) isolation. “Question: 16 AA 28-year-old married mother of one presents to her family physician with a history of sudden onset of palpitations, feelings she can not get enough air and that she is going t die, She has had several of these episoses in the last two months. She has been to the‘Sat Asesment Exam (MCCOELMay 2005) ‘emergency department on three occasions and was told that her blood pressure, ECG, and chest x-ray are normal. Which one of the following is the most likely diagnosis? 1) hyperthyroidism 2) premature arial contractions 3) pheochromocytoma 4) recurrent major depression 5) panic disorder uestion: 17 Which one ofthe following would justify a patient's being declared incompetent with respect to se care? 1) The patient has a major mental disorder. 2) The patient has been admitted to hospital, 53) The patient is undergoing psychotherapy. ‘@4) The patients unable to understand the consequences of hisher decisions. 5) The patient is unable to work because of a mental disorder. Question: 18 87 tomes 30-yeuotd man dese i tered cotesis rout ino the Emergency Room by pice afer he was found haranguing passersby. ‘Which one ofthe flowing is tno snggntive of pyc? 1)” hyperelgontyand set ving habits 2) rumination shout the mennngesaness of mae ings 463) boli hat is thought ar controled vin ere! eevision messages 4) dioretaon tne and place 3). sm unfounded svpicion tht oer ae poting again (he goverment Question: 19 A 24-hout-old newborn is observed to have a red conjunctival iitation with a clear discharge after an uneventful delivery. Which one of the following is the most likely a - ® og. inte ococea ophthalmia eres cavern 2) Chlamydial conjunctivitis WS Chemdath bg > 3) Staphylococeus aureus conjunctivitis >> 94). drug-indvced conjunctivitis 5) acral duct obstruction "eve weave blood pressure is, un Hg, pulse is 16iminute, she has poor peripheral circulation andSet Assessment Exam (MCCQEI-May 2605) Question: 21 ‘The pattern of inheritance in Duchenne muscular dystrophy is. 1) autosomal recessive. 2) autosomal dominant ) _sex-linked recessive. '4) sex-linked dorninant, 5) multifactorial, examination is normal Which one of the following investigations would be most helpful? ALD) exrthroeyesetimentation rte +2) blood culture 3) fumbar punetze 4) cheatxray GP) wine analysand cltre Question: 23 . A 24-year-old{biacl) woman with { seizuré disorder treated with(phenytoins noted fo have the fllottngfndinos at 15 weeks af pregnancy» Complefend ent (CRC), hemoglobin (High) 93 1, hematocrit (HHCT) 29, mean copusevlar volume (MCV) 105 {L. Which one ofthe folowing isthe most likely cause fr these findings? 1) sickle cel trait De bhle 2) iron deficiency , 3). physiologic anemia PU PE fy. ur 4). Pilate deficiency —— a 79) thalassemia See gute» Diack «6 poles Question: 24 A pediatrician wished to determine the relationship between chronic otitis media in young children and parental history of such infections, From the records of large pediatric practice, he identified 50 children between one and three years of age who had experienced atleast three middle ear infections during the preceding yea. Fifty children in the same age group, treated by the same practice for other linesses, were also ‘identified. The pediatrician interviewed the parents of subject in bat sroups to determine their history af chronic ritis mons young children. OF the chytden with recurrent er infections, 30 had family history of chronic otis medi, compared to 20 af the children treated for ther lineses. This isan example of which one ofthe following study types? 1) cross-sectional 2) cohor study 163) case-control study 7h 4) controled iil 5). randomized clinical ial‘Sa Assesment Exam (MCCQEE A 45-year-old man enters the hospital because of an episode of acute flank pain and hematuria. Abdominal radiograph reveals a stone in the right kidney. An intravenous turogram shows the stone to be non-obstructing. Laboratory studies demonstrate normal serum calcium and phosphate, and urine culture is negative. Which type of kidney stone is most likely to have caused this patient's condition? 1) calcium oxalate 2) uric acid 3) xanthine 4) struvite 5) cystine Question: 2 A 75-year-old male is admitted to hospital with let lower quadrant abdominal pain, nausea, a low-grade fever, and left lower quadrant tendemess, Your diagnosis is acute diverticulitis. Treatment should include all of the following, EXCEPT. 1) broad spectrum antibiotics, 72). immediate laparotomy. 3) intravenous fluids 4) meperidine. 5) nasogastric suction Question: 3 A young adult is brought to the hospital 8 hours after a motor vehicle accident. He is in shock and severe respiratory distress. His upper airway is clear. Neck veins are not distended and the trachea is deviated to the right. Breath sounds are absent over the left chest, and the percussion note over the left chest is dull. Breath sounds are normal on the right side, The patient has ‘ani 1) tension pneumothorax, 72) massive hemothorax. 3) flail chest 4) ruptured bronchus. 5) obstructed mainstem bronchus. Gem sshd A 45-year-old man sustained an § om rs laceration of his lateral thigh in a farming while ploughing a field. The laceration had penetrated the deep fascia into the ‘muscles. He wrapped a towel around the leg and finished his work. He finally arrived in the Emergency Department 8 hours after the accident, Local treatment should include thorough debridement followed by 1) closure of wound, ¥2) instillation of antibiotics and closure 3) leave wound open for secondary chosus 4) closure with drains 5) local antibiotics and closure of muscles only 1 a later date,® Question: 5 ‘While intoxicated, a young man falls through a store-frontplate-glass window, severely lacerating his left wrist In the emergency room, the physician assesses the integrity of the ‘ulnar nerve at the wrist by asking the patient to perform which one of the following, 1) Oppose the thumb and litle finger. 2) Abduct the little finger. 3). Flex the ite finger. 4) Adduet the thumb, 7 5). Flex the thomb. shel Question: 6 A 23-yearold soccer playes yreseuts with swelling UPhis Tel knee. The injury occurred ‘while he was turning with his left knee slightly bent. Which one of the following is most likely injured? 1) medial meniscus 2) medial collateral ligament 3) anterior ervciate ligament 4) fibrous capsule ofthe knee 5) Higarmentum patellae 27 An inerease in the alveolar-arteral PO? difference may occur in 1) asthma 2) acute hypoventilation 3) anemia 4) mild exercise 5) high altitude Question: § ‘A long-time user of smokeless tobacco noticed several whitish, thickened, painless patches on the ‘ining of his checks, Which ofthe following is the most probable Giagnosis? 1) aphthous ulcers 2) adenocare:noma A) keloid 4) oral leukoplakia » 5) epidermolysis bullosa Question: » ‘Which one ofthe following drugs or groups of drugs is contraindicated in the ‘management of patients with moderately severe uleerative colitis? 1) antbioties 2) hydrophil e bulking agents OD comicoste-oids % +4) narcotic antdiarrheal agents 5) oral sulfasalazineSa Assessment Exam (MCCQE1May 2005) Question: 10 ‘A 38-year-old epileptic man, brought in unconscious in the middle of the night, has a shallow respiration at arate > 40/minute and is cyanotic. His pulse is 130/minute and his blood pressure is 80/50 mm Hg. The first thing you should do is to 1) call a close relative and inquire about any new drug intake. 2) install a nasogastric tube. 3) administer 35-40% FiO2 by nasal cannula. / 4). perform endotracheal intubation. 5) order electrocardiogram and chest x-ray and reassess Question: 11 An elderly woman notes the gradual onset of fatigue and feeling tired. She has gained a significant amount of weight over the lost year. She complains frequently that the house is too cold and is tuming up the thermostat, Constipation has become a problem. Which of the following is true of this condition? 1) TSHis depressed 2) _anti-thyroglobulin antibody are elevated 3) _anti-thyroid microsomal antibodies are decreased 4) TRH iselevated 5) TSHis increased Question: 12 ‘A heavy-set 62-year-old man with normocytic, normochromic anemia presents with an acute backache after sitting down on the toilet. He is unable to pass his urine and unable to stand up because of weakness in his legs. Which one of the following is the most appropriate next investigation? 1) serum calcium level 2), renal function assessment 8) _umine test for Bence Jones protein 4) protein electrophoresis x-ray of the spine A) a Fearhahsines execute with aévanced cmos ofthe iver ana histo alcohol abuse claims that he does not have a problem with drinking and can quit any time he wants to, Eventually he quits drinking but continues to have the symptoms of ‘advanced cirrhosis of the liver, Despite the obvious discomfort caused by his illness, he tells everyone how bappy he is to have cirrhosis because it has led to the cessation of his drinking. ‘The defence mechanism he is using is best identified as 1) projection, 2) denial ~ counterphobic behaviour. we) S56) reaction formation 3° +5) isolation of affected ‘Sar Assesment Exam (MCCQETMay 2005) Question: 14 A 28-year-old man presents to the emergency room with a 2-hour history of chest tighmess, coughing, and wheezing. He has had many such attacks in the past, generally treatable by self-medication at home. Physical examination reveals dyspnea, orthopnea, and cyanosis. Wheezing is noted on inspiration and expiration and some coarse erackles ‘are audible. Pulse is 130/min and regular. An emergency arterial PO2 is 65 mmlig, Pulmonary function studies are most likely to show which one of the following? 1) decreased FEV 2) increased vital capacity 3) decreased residual volume 4) decreased airway resistance 5) increased arterial PO2 Question: 15 Which one of the following is more typical of “fainting” as a conversion symptom than ‘of syncopal artack due to orthostatic bypotension?” 1) bradycardia 2) muscle twitching ~ 3) absence of pallor or sweating 4) urinary incontinence 5) rapid recovery Question: 16 ‘The wife of a 45-year-old executive says that over the past 6 months her husband has been accusing her of having an extramarital affeir. He has been phoning her work place, checking her mail and phone calls. She says that there is absolutely no truth to the allegation, but despite the efforts of herself and his family to reassure him, he continues to accuse her. Which one of the following is the likely cause? 1) delusional disorder 2) paranoid schizophrenia 3) anxiety disorder 4) antisocial personality disorder 5) schizoid personality disorder + Question: 17 A 32-year-old woman has a history of general anxiety disorder. Which one of the following medications is she most likely to develop a physical dependence to? 1) trazodon, 2) hydroxyzine 73). diazepam 4) venlafaxine 5). sertraline= 20 RBCYHPF), Cystoscopy is negative. Abdominal ultrasound reveals a S.om solid mass in the upper pole ofthe left kidney, confirmed by computerized tomography scan. Which one ofthe following is the most appropriate management? +1) computerized tomography scan guided percutaneous biopsy 2) retrograde pyetozram D3) repeat computerized tomoyraphy scan in 6 months, intravenous pyelogram 5) surgical resection Question: 2 A 62-year-old male is brought to the Emergency Department by family members after having experienced a seizure, They report his recent complaints of headache and. weakness of his left hand. ‘The most likely diagnosis is 1) idiopathic epilepsy 22) brain neoplasm, 3) migraine.Salf Assessment Exam (MCCQEI-May 2005) 4) temporal erterits. 5) cluster headache. Question: 3 A 40-year-old woman mother of four children and whose last child had problems at birth with hemolytic disease of the newbom has just been rushed to the emergency room following a motor vehicle accident. She has lost a lot of blood and needs immediate transfusion but there is no time to cross and type her blood. She should receive blood that is 1) O, Rh postive 2) AB, Rh positive. 3) O, Rh negative 4) AB, Rh negative. 5) B, Rh positive. Question: 4 A 75-year-old man with chronic bronchitis develops a bulge in his left groin. On examination, an elongated swelling is seen above the medial end of the inguinal ligament. When the patient coughs, the swelling enlarges, but does not descend into the scrotum. Which one of the following is the most likely diagnosis? 1) femoral hernia 2) acquired hydrocele 3) inguinal lymphadenopathy +4) direct inguinal hemia 5) incomplete descent of left testis Question: 5 -year-old woman complains of "pins and needles” in her hand and difficulty in buttoning her clothes when dressing. She complains of discomfort in the thumb, index and middle fingers. On examination there was no impairment of sensation and ni loss of power or wasting of the thenar eminence. Which one of the following nerves is most likely affected? 1) ulnar nerve 2) radial nerve = 3) median nerve 4) musculocutaneous nerve 5)_axillary nerve fan with a history of unresected lung cancer and new onset decreased level of consciousness is found to have a large cerebral metastasis with some edema and midline shift on an magnetic resonance imaging: MRI of the brain. Which one of the following would be consistent with the diagnosis? Pe 1) unilateral neadache sf 2) increased heart rate eget te 3) increased respiratory rate as) 4) reduced blood pressure 42 3 ee +5) reduced heart rate Ce ies g Srey yee : oC >Self Assessment Exam (MCCQEI-May 2008) Question: 7 An 18-year-old university student is brought to your office by her mother who is concerned about her daughter's 6-month history of weight loss and anorexia. The girl states that she feels perfectly well. She is able to maintain her normal activities, including a rigorous exercise program at the university, She measures 162 cm and weighs 38 kg. Her skin is dry, and there is bilateral, painless swelling in both parotid regions. Investigations are most likely to show + 1). low basal levels of luteinizing hormone. * 2) a low thyroid-stimulating hormone level 3) an elevated serum glucose. 4) a mediastinal mass on chest x-ray. 5) an abnormal small bowel biopsy. “42-year-old woman presents with her second episode of shingles. Which one of the following is characteristic of recurrent herpes zoster infections? ~> 1). The virus is confined to the initial site of infection, ~— 2) The recurrences are preceded by acute clinical disease. + 3) They elicit a poor antibody response. , 4) They involve infected carrier individuals, 5) The principal reservoir is zoonotic. Question: 9 ‘A 28-year-old lawyer woman presents to you with a three-month history of fatigue, ‘weight gain, menstrual irregularity ané declining memory. Which of the following laboratory results is helpful in diagnosing the underlying problem? 1) TSH increased, free T4 increased 2) TSH decreased, free T4 increased #3) TSH increased, free T4 decreased 4) TSH decreased, tree '1'4 decreased 5) TSH within normal range, free T4 within normal range Question: 10 A 52-year-old woman, recently diagnosed with hypertension, presents to her family physician complaining of hirsutism and acne. Laboratory examination (normal range shown within brackets) reveals: cortisol 1500 nmoV/L (200 - 660 nmol/L) aldosterone 200 pmol/L. (140 - 415 pmol/L) ACTH 4 pmol/L (4 - 22 pmol/L) Which one of the following is the most likely diagnosis? » 2). Cushing's syndrome 3) Bartter’s Syndrome 4) Renal artery stenosis 5) Conn’s SyndromeSelf Assessment Exam (MCCQEI-May 2005) Pee businessman has come to the Emergency Room complaining of fever and _sheadlache for the last six days. He travels extensively for his company. In the last year . alone, he has been to Bangkok, New Delhi, Jeddah, and Dar es Salaam He retuned from ‘Africa only three weeks ago, Which of the following diagnosis is most likely? 1) dengue fever 5 | 2) meningococcal meningitis +3). tuberculosis 24) malaria 5) acute retroviral (HIV) syndrome HK Question: 12 A 20-year-old man is referred for assessment of proteinuria found on an insurance examination. The history is unrevealing, Physical examination is normal. Urinalysis (urine microscopy) shows 1-2 proteinuria hy "dipstick" and is otherwise remarkable. 3 Urea nitrogen is 5.4 mmol/L and serum creatinine is 88.4 nmol/L. Which one of the following would be the correct management? 1) Reassurance and reassessment in 6 months. 2) Admission to hospital for percutaneous renal biopsy. 3) Determination of urine protein electrophoretic patter, 4) Intravenous ayelogram and cystoscopic examination L-©5) Determination of 24-hour urine protein excretion, fractionated into supine and upright samples, Question: 13, A 55-year-old woman presents with ptosis and diplopia. On examination of the eye, the pupil is widely dilated and non-reactive ta light. Which one of the following is likely injured? +1) oculomotor nerve 2) trochlear nerve 3) trigeminal nerve 4) _abducent nerve 5) opticnerve Question: 14 In the emergency room you are asked to ussess a man with alcoholic cirthosis and recent alcohol cessation He's eitated confused and hlluatng, You make «presume 1) diazepam (Valium®) ctadol 0 rspecdors ( 2} nittacpam (Nivazedox®) - help ? Ay Hersieepexide (brine) ) Toraeepain (Ativan) cee nae: 5) clonazepam (Rivotril®) 4 Le lava = ote ~ yen” 42Sei Assessment Exam (MCCQEI-May 2008) Question ‘A 35-year-old woman who was born in Vietnam has had her dyspepsia diagnosed by endoscopy as a duodenal ulcer. Her pathology is positive for Helicobacter pylori. She has not previously been diagnosed with peptic ulcer disease. What would be the preferred ‘treatment option? 2 1) combination antibiotics plus omeprazsle 2) omeprazale alone 3) surgical vagotomy and pyloroplasty » octreotide ranitidine x > SSVEHF ald woman with depression repeately talks about irrelevant topies when aaa interviewed by a psychiatrist. Which one of the following symptoms is the patient demonstrating? 1) suppression 82) denial + 13) introjection 2 resistance repressien ia ‘RSSSVEN-id female with history of depression presents wih restlessness, nausea and Unstable vital signs. She was revently switched fiou etalopram (SSRI) to phenelzine (MAOD. On examination her blood pressure is 140/90 mmig and she is tachycardic and tachypneic. Her neurological examination is normal aside from hyperreflexia and myoclonous. What is the most likely diagnosis? 1) neuroleptic malignant syndrome « 2). serotonin syndrome 3) akathisis 4) hypertensive crisis 5) SSRI withdrawal Question: 18 A 5-year-old boy is seen because of torticollis, clumsiness and gait difficulties for the _t month Which one onthe following he ost Hkely diagnosis? 1) behavior disorder problems with vision cerebellar damage atlantoaxial subluxation 5) myopathy = Question: 19 {amor OFT infant boy presents for routine vaccination in your office. His mother tells you that 2 weeks ago, he tried a small amount of scrambled eggs and developed 43Set Aecoment Exam (MCCQEL-May 205) zs hives, wheezing and swelling. He was treated in the emergency room. Which of the following would you be particularly concerned that he may resct to? 1) diphtheria toxoid 2) telanos toxeid i 3) MMR vaccine sp beet Gas 44) polio vaccine 5) pertussis vaccine a wl Question: 20 ‘A 10-year-old is referred to you for evaluation of hypertension. He has a history of recurrent urinary tract infections. Which one of the following is the most likely diagnosis? 1) vesico-ureteral reflux 2). horseshoe kidney 3) dominant polyeystic disease 44) juvenile diahetes mellitus 5) poststreptococeal glomerulonephritis Question: 21 Ata oy adit whi at lr, Them, pot eels Tomo, Which on oft flowing mon ile he Soe cacrcnogun? eras “AP wee 1) incre Fone ample pb ee aes 2 Soamendeaion Lely —Aq— fiolmer femme a A 3 feed Rue 3) sean Qn Question: 22 ‘A S.year old boy who had been suffering from a gait disturbance for several weeks was found to have a posterior fossa mass on CT sean, Which of the following is the most likely cause for these findings? Bre ae inten reste 1). abery sneuryem, eramegh. exbebilln. Asan 2) astrocytoma cere belle Co eet ne Cancer 2) medileblasoms : 4) cligodendrogiiona POY pene mean 5) pseidotimor corer Meni) Ambo. Question: 23 ‘A.23-year-old woman regularly has episodes of pain Following investigations, you diagnose endometri commonest site ofthis disease outside of the pelvis? 1) gastrommestina act ssociated with menstrual periods. ‘Which one of the following is the govern ~ bh gamed > pee h me ce hinach surfer 3 Brey apr hnn suther oy aaSelf Assessment Exam (MCCQEIMay 2005), ‘Question: 24 A 17-year-old high school student has just retumed from Gosta Rica She presents with a 10-day history cf crampy abdominal pain, bloody diarrhes and Weight oss of about 2,5 kg over a two-week period, She is anorexic but denies having nausea or vomiting. Examination reveals tendemess in both right and left iliac fossa. Which one of the following conditions if THE most likely cause ofthis patients weightloss and diarthea? 1) Salmonella: enterocolitis aaa 2) » Campylobacter species +3) Entamoeba hystolytica colitis. - 4) Giardia Lamblia infection wo G8 Ne fore me mase 5) Cryptosporidium parvum infection Section: 2 ‘Question: 1 ‘A first-bom male child develops vomiting at the age of five weeks. The vomit is free of bile. The child remains hungry and vomits afer taking feedings. Examination reveals visible peristalsis in the upper abdomen. Which one of the following is the most likely diagnosis? 1) esophageal atresia « 2). hypertrophic pyloric stenosis 3) duodenal web 4) midgut volvulus 5) incarcerated inguinal hemia ——/ Question: 2 = srs pects female patient presents to the emergency room with a history of right upper quadrant pain lasting two hours. She states this is the third attack of similar pain in the past two months. The pain started suddenly and is described as sharp, constant and radiates to her right shoulder. On examination, she is afebrile and has mild right ‘upper quadrant tenderness. Which diagnostic test would be most appropriate for this pt? 21) abdominal ultrasound 2). upper GI contrast study 3) upper Gl endoscopy 4) electrocardiogram (ECG) 5) Tung sean Question: 3 ‘A 32-year-old male is admitted to the Emergency Department | hour after he sustained ‘major burns to the thorax, the neck and the face. Aside from hypovolemic shock, the ‘most immediate life-threatening complication to anticipate is, 1) acute renal failure. 2) hemorthage secondary to a stress ulcer. 3) acute gastric dilatio 4) Gram-negative sepsis. +5) secondary inhalation airway injury 48Saf Assessment Exam (MCCOEL-May 2005) Question: 4 ‘You are asked to harvest the organs from an asystolic organ donor. Which one of the following organs has the greatest probably of survival? 1) bone #2) comea 3) kidney 4) heart + 5) lung Question: 5 A 32-year-old-male presents with history of trauma to the right shoulder. On ‘examination the outer aspect of the right shoulder is flattened and the shoulder cannot be moved. Skin sensation is absent over the wart of the right deltoid muscle. X-ray shows antenor dislocation othe righ SOMES WHE one es hee one most likely injured? 1) radial nerve 2) musculocutaneous nerve 3) ulnar nerve 4) long thoracic nerve +5) axillary nerve Question: 6 ‘A JSzyear-old man comes to the emergency room (ER) with a history of pain in the abdomen and back. He is found to be hypotensive, with a pulsatile, tender abdominal ‘mass. The correct immediate management ofthis patient consists of which one of the following? tela pani eas +1) transfer to the operating room Sat a 2) transfer to the x-ray department for abdominal ultrasound ~ © S? _ 3) transfer to the x-ray department for CT sean = esl Ad. mats 44) resuscitation in the ER with intravenous fluids 7 = 5) workup in the ER to rule out myocardial infarction 1 re entre Zcloot eS cTSca ee OF Question: 8 A 17-year-old gil has a diffuse, red skin rash a fever of 39.4°C, and mild, watery diarnea. She had a sore throat recenly for which sulfamethoxazole was administered She began her senses 9 days ayo. Physical examination shows diffuse erythematous changes ofthe skin With eaiTy desquamation. The mouth and conjanctivae are red Which one of the fellowing conditions best explains the process? 1) salmonella bacteremia + 2) toxie shock syndrome (TSS) ; > tuberculosis sii TE clo keallin 4) Epstein-Barr virus mononucleosis 5) sulfa allergy5 ‘Seif Asessment Exam (MCCQEL-May 2005) Question: 7 Following a myocardial infarction, a 65-year-old man is noted to have a wide physiological splitting of S2 on cardiac auscultation, Which one of the following conditions is most likely to be causing this finding? 1) left bundle-branch block 92) right bundle-branch block © 3) right ventricular ectopic beats 4) atrial septal defect 3) aortic stenosis, Question: 9 A patient with chronic renal failure is being treated with furosemide for edema on a long term basis. Which one of the following is the most common adverse effect? 1) depression 92) hypokalemia 3) metabolic acidosis, 4) hypervolemia 5) bradycardia * Question: 10 Hemochromatosis has a prevalence of 0.5% in the general population. The treatment of choice is regular ahlebotomy. Von have decided to initiate a new test for this disease, ‘The literature indicates a sensitivity of 80.5% and a specificity of 89.5% for this test You decide to screen 1000 people and institute treatment solely on the results of the test. Which one of the following is correct? 1) you will treat 40 people with phlebotomy 2) 995 people will not be treated 3) 100 people who do not have the disease will be treated with phlebotomy 44) 80% of the sabjects will be correctly diagnosed 5) 200 people who have the disease will be denied treatment Question: 11 ‘A 48-year-old alcoholic man has had a deep venous thrombosis (DVT) and the INR is well-controlled 1 warfarin, He is noted to have an INR of 6.0 following a weekend binge, Which one of the following is the most likely pharmacological explanation of this, finding? 1) alcohol intake decreases the volume of distribution of warfarin 2) alcohol intake increases the absorption of warfarin from the gut 3) alcohol competes for and reduces the hepatic metabolism of warfarin 4) alcohol reduces the plasma protein binding of warfaria 5) alcohol reduces the renal execution of warfarin Question: 12 ‘A 68-year-old man presents to the emergency room with a four day history of worsening headaches and confusion. He is on no medications. Physical examination confirms the confusion, but is otherwise normal. His plasina sodium is found to be 117 mmol/L.Self Assessment Exam (MCCQEI-May 2005) (normal 135 - 145 mmol/L) and plasma osmolality is 248 mmol/kg H20 (normal 285 - 295mmol/kg H20). Which one of the following is the most likely diagnosis? 1) hypoadrenalism #2) syndrome of inappropriate antidiuretic hormone secretion 3) congestive heart failure gus wre 4) pseudohyponetremia awe an 5) hyperthyroidism ci conan te <2be ane Wy) cogent byyorBr Question: 13 ‘An 18-year-old male presents with a 2-week history of cough, headache, malaise, and fever. Physical examination shows a patient in good general condition with no abnormal findings on auscul:ation. Gram stain of the sputum is negative and the white blood cell count is normal. Chest x-ray shows bilateral pneumonia in the lower lobes without pleural effusion. Which one of the following is the most likely cause? 1) Haemophilus influenzae 2) Staphylococcus aureus 3) Mycoplasma pneumoniae 4) Klebsiella pneumoniae 5) Streptococcus pneumoniae Question: 14 A 66-year-old dinhetic man presents with constriction of the pupil, drooping of the upper lid and gnophthalmos on the left. Which one of the following nerves is most likely involved? 1) oculomotor +2) sympathetic 3) trochlear 4) trigeminal 5) abducent Question: 15> eve Id woman smoker, on steroids for seropositive rheumatoid arthritis, presents with cough, hemoptysis, and a perihilar lung nodule on chest x-ray. The best way to tablish the diagnosis is 1) tomography. 2) computed tomography scan of chest 73) tuberculin skin test. 4) pulmonary function test. 5) bronchoscopy. Question: 16 A 35-year-old man suddenly develops a generalized pruritic macular erythematous rash 1d fever. Four days ago he saw his physician because of a sore throat that started the before and was started on penicillin aficr a throat culture grew-_beta-hemolytic streptococci. Laboratory studies now reveal a urea of 14 mmoV/L Urinalysis shows no Cihigh power field, and 50 WBC/high power field. Complete) S 3 9 Self Assessment Exam MCCQEI-May 2005) blood cell count is normal except for eosinophilia (12%). Urine protein concentration is 650 mg/24-h Which one of the following is the most likely diagnosis? “T) acute poststreptococcal glomerulonepiaritis 2) membranous glomerulonephritis 3) _polyarteritis nodosa 4) Schonlein-Henoch purpura 25) drug-induced interstitial nephritis. * Question: 17 ‘A 40-year-old man presents with sporadically occurring behaviour automatisms and cifacoryballucintlans, Which one ofthe followings the most ily diagnosis? “iy schizophrenia 2) schizophreniform psychosis 2) hysteeal personaly disorder 4) nondominant parietal lobe lesion 25) temporal lobe lesion Question: 18 You are considering treating a 21-year-old female with a history of anorexia nervosa and depression with an antidepressant. Which one of the following should you avoid? 1) desipramine TAD wr awn 11 cele Ly ae Hh os venlafaxine Favey Ps) Sposn 9E, 5) phenelzine tA! Question: 19 A 3-year-old boy presents to the emergency room following a 40 second generalized tonic-clonic seizure. The infant has been ill with a high fever for 24 hours. His history is ‘unremarkable, and physical normal, CBC and urinalysis are normal, Which one of the following would be the best initial step? 1). Arrange to have an EEG performed urgently 2) Admit to hospital for an immediate CT scan of the head. 3) Carry out blood cultures. a4) Reassure the mother and recommend close observation. > 9) Perform a luinbar puncture KX Question: 20 hhad this before during the summer months, The rash is composed of blisters arranged in lings. In this condition, which one of the following is TRUE? T) antibodies hi-ve been formed 2) acell mediated response is responsible 3) this isa type I allergic response 4) antibodies are directed against skin basement membrane 5) the antigen is bound to a cell surface protein,pan sar a Sat Assessment Exam (MCCQEI-May 2005) ic XH Question: 21 {A T-year-old git! has a blood pressure of 130/90 mmHg, She has had recurrent urinary tract infections in the past, She has proteinuna. Which one ofthe following would be the most appropriate investigation? A) renal ultrasound 2) renal scan 3) plasma renin activity 4) computerized tomography of abdomen 5). digital substraction angiography of renal vessels Question: 22 Xen old tit, who warily wel ress wih den oat of xu resi and wheeze. Exarnination reveals that hei. with diminished Aicentry and wheszing ‘on the right side. Which one of the following is the most likely isgnds 1) acute asthma 2) acute pneumothorax 3) congenital lung eyst 4) foreign body inhalation 3) bronchitis Question: 23 ‘A female patient s a newcomer to the country. She is single and in labor. She has had no prenatal care. You decide to give her anti-Rh Ig (RhoGam) to prevent which one of the following in subsequent pregnancies. 1) immunodeficiency 2), neonatal Lupus 73) hemolytic disease of the newborn 4) T cell immune deficiency syndrome 5) transient hypogammaglobulinemia Question: 24 ‘A 28-year-old mother hae delivered a foll-term healthy newborn baby. Mother has tested positive for hepatitis HBe antigen and HBs antigen two weeks before delivery. Which ‘one of the following would you recommend for managing the newborn? 1) Check mother’s serum for anti-HBsAy before giving the infant any immunizations 2) Advise not to breast-feed to prevent hepatitis B virus transmission to the infant © 3) hepatitis B vaccine and intravenous IgG 4) hepatitis B vaccine and hepatitis B hyper immune globulin 5) hepatitis B hyper immune globulin in the first 12 hours after deliverSelf Assessment Exam (MCCQE}-May 2005) Section: 3 Question: 1 55 year old male known to have citthosis. comes to the hospital because he has been vorniting blood. Which one of the following is the diagnostic study most useful in ‘Wenig the source of Bleeding? 1) esophagogastroduodenoscopy 2) upper gastrointestinal series 3) abdominal ultrasound 4) CT scan of the abdomen 5) celiac angiography Question: 2 A 24-year-old male arrives at your office complaining of pain in his rectum. Examination reveals a perianal abscess. ll of the following signs are characteristic, EXCEPT 1) external swelling, 2) redness 3) induration 44) rectal ulcer. 5) tendemess on rectal examination Question: 3 A 24-year-old male presents to the Emergency Department with fever and mild diarrhea of I day's duration. Ten days ago, he had a perforated appendix removed. The present diagnosis probably is 1) subphrenic abscess. 2) regional enteritis (Crohn disease) 3) pseudomembranous enterocolitis. 4) pelvic abscess. 5) bacterial enterocolitis (e.g., Salmonella, Shigella). Question: 4 A 65-year-old man presents with a discoloured skin lesion which has been diagnosed as basal cell carcinoma, Which one of the following is the best treatment option? 1) radiotherapy 2) cryotherapy : 3) curettaze 4) chemotherapy 5) surgical excision Question: 5 A 45-year-old female presents with a history of a direct blow over the shaft af her left humerus. Her x-ray shows a spiral fracture of the distal third of the humerus. O/E of het hand, sensation is intact on the palmar side but absent on the dorsum of her hand. Which one of the following nerves is most likely injured?” eee‘Se Ascesment Exam (MCCQE 1) axillary nerve 2) musculocutaneous nerve 3) median nerve #4) radial nerve 5) ulnar nerve Question: 6 ‘An 80-year-old man who is taking warfarin because of a history of atrial fibrillation, is ~ found enroutne blood work o have an INK of 7.2. Wye ag ofthe following isthe y: best immediate management of this problem? =e SW 61) hold the warfarin for3 days * A 2) vitamin K 1 mg orally . favo 3) vitamin K 10:mg intravenously 4 ere os ° fresh fruzen phesima intravenously 528 5} desmopressin (DDAVP) ‘developed fever, night sweats and a chronic progressive cough resistant to antibiotic treatment’ An x-ray shows a coin-like lesion in the upper lobe of the right lung. The TB skin test was negative twice. Which one of the following is the most likely cause? 1) legionellosis 2) tuberculosis = 3) silicosis +4) dimorphic mycosis 3) atypical mycobacteria wali! Question: 8 An enlarged axillary lymph node is removed from a 61-year-old female. Microscopically the nodal architecture is effaced by anaplastic gland-forming cells. Special studies on the tissue confirm the presence of estrogen and progesterone receptor proteins. Which one of the following is the most likely diagnosis?” 1) sinus histiocytosis #2) metastatic carcinoma < 3) Hodgkin's disease 4) sarcoidosis 5) angiosareoma {Sy Question: 9 SUNG Dyer eating» patent with hea failure nd have put her on digoxin, Which on of the following symptoms indicates there is digoxin toxicity? 1). pleural effusions +2) bradycardia 3) blue nose 4) diminished tearing 5) abdominal distentionSelf Assessment Exam (MCCQEL-May 2605) Question: 10 A 30-year-old womand presents with complaints of heat intolerance, sleeplessness, nervousness and weight loss despite an excellent appetite. What changes in TSH and free 74 would you expect? 1) decteased TSH, increused free T4 2) increased TSH, increased free T4 3) decreased TSH, normal free T4 4) increased TSH, decreased free T4 $)_normal TSH, increased free T4 Question: 11 A previously well 54-year-old woman with a three-month history of weight loss and recurring chest infections is found to have aleft hilar mass on chest xaay. Brouchoscopy and biopsy reveal small cell carcinoma. All staging investigations are normal, suggesting, disease is confined tothe lung. Which one of the following treatment strategies is most appropriate? 1). left pneumonectomy 2) pre-operative radiation therapy followed by pneumonectomy 3) radiation therapy to the chest 4) chemotherapy followed by left pneumonectomy 85) chemotherapy and radiation therapy to the chest Question: 12 Which one of the following is the best indicator of adequate control in a patient with diabetes mellitus? 1) fasting blood glucose 2) 24-hour glycosuria 3) blood glucose 2 hours after meals 4) glycosylated hemoglobin (hemoglobin AIC) 5) urine free of glucose Question: 13 ‘A 39-year-old woman presents with pain on the lateral aspect of her elbow. Her pain is reproduced by extending the wrist against resistance with the elbow extended, Which one of the following is the most likely diagnosis? 1) olecranon bursitis, 2) triceps tendonitis 3) subluxation of the radial head 4) biceps tendonitis 5) epicondylitis Question: 14 Five weeks after the removal of a cast from a 56-year-old woman's leg, she finds out that she is unable to dorsiflex her foot. Which one of the following nerve is most likely injured?Self sessment Exam (MICCQEL-May 2005 geal Wer 1) tibial — ¢ 2). sural 3) saphenous 4) femoral 25) common peroneal Question: 15 ‘A 32-year-old unemployed alcoholic who underwent a mastoidectomy as @ youngster presents with headaches, nausea, vomiting, drowsiness and confusion. He does not have a fever, but his right eardrum is not visualized, and there appears to be some discharge there. ‘There is slight neck stiffness as well. Which one of the following investigations is, the most appropriate at this time? 1) lumbar puncture 2) clectroeneephalogram 3) skull x-ray #4) computed tomography scan of the head oN 5) lod culture Question: 16 An elderly woman is admitted to a psychiatric unit for workup of possible depression. Her symptoms consist primarily of lethargy and indifference. She appears to ignore the left side of her body in her daily activities. and when questioned about this, she denies any difficulties. This patient should be suspected of having a bilateral froncal lobe lesion. » 392) sight parietal lobe lesion + 73) right tempore lobe lesion. 4) left pontine lesion. 5) left cerebellar lesion Question: 17 A patient with previously-known but undiagnosed psychiatric disorder is admitted after ‘multiple physical trauma, with impending hypovolemie shock and violent behavior. He refuses all treatment. Initial treatment is to 1) wait for shock to develop further, then commence ageressive treatment. 2) sedate and medicate to a level of patient compliance and treat 3) obtain a psychiatric opinion before any intervention. 4) certify insanity quickly and administer chlorpromazine 5) commence immediate treatment, using restraints i) Question: 18 A. 10-year-old white male presents to the emergency room with @ 24-hour history of painful lower extremities and severe abdominal pain. On physical exam, you note a temperature of 37.4°C and severe arthritis of both knees along with a purpurie rash located on the lower extremities and buttacks, The stool guaiac is positive, as is a urine

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