‘Sa Assessment xem (MCCQEI-May 2005) to the right clavicle. The carotid upstroke is diminished. Which one of the following is the most likely cause of the syncopal episode? 1) _vasovagal syncope 2) heart block 3) tachyarchythmia 4) aortic stenosis 5) hypovolemia Question: 10 ‘Which one of the following best represents the major features of Cushing's syndrome? = 1) central obesity, moon facies, glucose intolerance and menstrual abnormalities 2) central obesity, moon facies, skin striae and hypotension 3) generalized obesity, hirsutisi, hypotension and renal failure 4) weakness, diabetes insipidus, osteomalacia and hypertension 5) _ web neck, short stature, obesity and amenorthea Question: 11 A 30-year-old female presents to her physician's office for an increase in fatigue over the last 2 months, On physical examination, the physician notes delayed capillary refill in the nsilbeds and a pale appearance of the inner lining of the eyelids. peripheral smear reveals hypochromic erythrocytes, Which one of the following tests would be most useful in confirming the probable diagnosis? => 1) serum ferritin and total iron-binding capacity (TIBC) 2) schilling's test 3) glucose 6-phosphate dehydrogenase assay 4) hemoglobin electrophoresis, 5) serum folate and cobalamin (vitamin B12) Question: 12 A 60-year-old man presents to your clinic with an 80-pack-year history of cigarette smoking, has an increased anteroposterior thickness ofthe thorax, and suffers from exertional dyspnea. Which one of the following is the most likely diagnosis? 1) chylothorax 2). bronchiectasis +3) panlobular emphysema 4) lung abscess 5) bronchial adenoma Question: 13 A study reports that 65 of 100 patients with multiple sclerosis have cats as household pets. The authors conclude that exposure to cats causes multiple sclerosis. Which one of the following statements ean be made about the authors’ conclusions? 1), correct, because itis specific for the study population, 2) correct, because the comparison is based on exposure rates, 3) incorrect, because of the failure to carry out an appropriate statistical analysis of the data 99‘Sat Asessment Exam (MCCQEI-May 2005) 4) incorrect, because the sample size is too small to permit generalization to the entire population of multiple sclerosis patients « 5) incorrect, because of the lack of an appropriate control or comparison group Question: 14 A 10-year-old boy, diagnosed with attention deficit hyperactivity disorder (ADHD), is being treated with methylphenidate (Ritalin®). Which one of the following best describes, this medication’s mechanism of action? 1) increased GABAergic transmission ‘+ 2) increased dopaminergic transmission ger = 3) serotonin reuptake inhibition 4) sodium channel stabilization 5) dopamine receptor antagonism Question: 15 ‘A 32-year-old unemployed man is brought to your office by his elderly parents. They report that he has never been able to hold a job and that he spends most of the night checking thatthe front door is locked and checking that the stove and the faucets have been tured off. He spends at least two hours a day in the shower. Which one of the following would you recommend in his treatment? 41) clomipramine 2) olanzapine 3) amitriptyline 24) paroxetine 5)_buy Geriea 6 aan eaeaer hese mary or ifst | oasedert chetas Geer pal sane er “eee many years on lithium carbonate. ‘She was recently diagnosed with hypertension: With regards to potential for lithium toxicity, which one of the following isthe safest? 1). nifedipine 2). ramipril 3) hydrochlorothiazide 4) valsartan 5) indepsmide Question: 17 A-25-year-old man has a longstanding history of shyness, avoidance of public speaking tnd discomfort in groups. You make a diagnosis of social anxiety disorder. What is the best treatment for this condition? 1) paroxetine (Paxil)® 2) interpersonal psychotherapy +3) cognitive behavioral therapy 4) sertaline (Zoloft®) 5) propranolol (Inderal) 100“A Set Assesment Exam (MCCQEI-May 2005) Question: 18, ‘After diagnosis and treatment of a urinary tract infection in a 3-year-old female child, further investigation should include 1) intravenous pyelogram only. 2) renal ultrasound only. 3) intravenous pyelogram and voiding cystogram. 14) renal ultrasound and voiding éystogram. 5) voiding eystogram only. Question: 19 ‘A I-year-old child who has had gastroenteritis is asymptomatic after 2 days dietary ‘management. A stool culture then is reported positive for Salmonella group B. Which one ofthe following treatments isthe most appropriate? 1) oral ampicillin 2) ora cefaclor 3) oral chloramphenicol +4) dietary management only 5) oral sulfamethoxazoleltrimethoprim Question: 20 Which one of the following conditions is most often co-morbid with attention deficit hyperactivity disorder in childhood? 1). oppositional defiant disorder £2) Cocduct disorder comevkid with CO ane 3). major depressive disorder ope 4) separation anxiety disorder 05) tie disorder ‘Question: 21 Although the skin lesions of scabies that occur in older children are similar to those in adults, the findings in infants differ in which one of the following ways? 1) ullae and pustules are uncommon 2) burrows are absent qwuetved chi eho 3) the palms and soles ae often involved Ni) the free is spared ae ee 5) the rash is pruritic Question: 22 Which one of the following cancers is responsible for the greatest annual death rate in 1) endometrial 2) breast +3) tung. 4) colon 5) cervical 101‘Sat Assessment Exam (MCCQEI-May 2005) Question: 23 Extrinsic allege alveotts may be acquired by breathing sir contaminated by which one of the following substances? 1) urea formaldehyde foam insulation 2) fine silicaceous dust 3) chlorine gas 4) fungal spores 5) degreasing solvent Question: 24 K ski Noo esta being evsoted forthe agnosia oa pulmonary embolus. Sais indicate that a positive tes eslt has the likelihood ratio of 15, and that a negative test eslt has a likelihood rato of 0.85. Which one ofthe following i a correct conclusion? 1) This test maybe helpful for ruling ina pulmonary embolus, 72) This testis highly sensitive for pulmonary emboli. 3) This test willbe very helpful ina clinical seting. yg Seen 4) This test ha a negative predictive value is 85% 5) This testis very reliable, Secti Question: 1 A previously well 55-year-old man presents to the emergency room with a 4-day histor of central abdominal colicky pain and distention. He has not had a bowel movement for one week. X-ray suggests partial bowel obstruction, From this history alone, which one of the following is the most likely diagnosis? 1) sigmoid volvulus 2) carcinoma of colon 3) acute diverticulitis 4) gallstone ileus 5) Crohn's disease Question: 2 An 86-year-old woman fell at the local nursing home and sustained an intertrochanteric fracture of her left hip. On clinical examination, you would expect to find her left le 1) shortened, abducted and internally rotated. 2) lengthened, abducted and internally rotated. shortened, adducted and extemally rotated 4) shortened, abducted and externally rotated, 5) lengthened, abducted and externally rotated. Question: 3 A 38-year-old woman is in the recovery room for 15 minutes following surgery for a hemithyroidectomy. You are called to the recovery room urgently to deal with acute respiratory distress. What is the most likely cause of her problem? 1) hypocalcemia 102ot) Self Assessment Exam (MCCQEI-May 2005) 2) wound hematoma 3) vocal cord paralysis, 4) aspiration 5) bronchospasm Question: 4 A 16-year-old boy presents in the emergency room with a history of a football injury to the left flank earlier that day. He reports that at the time of injury he only had the wind knocked out of him and recovered in a few minutes. About 1 hour later he began to experience pain in the left upper quadrant and left shoulder and light-headedness on standing. Which one of the following is the most likely diagnosis? 1) dislocation of the left shoulder 2) broken rib on the left side 3) left-sided pneumothorax 4) contusion of the left kidney 5) ruptured spleen Question: 5 A 32-year-old woman with vitamin B12 deficiency is most likely to present with which of the following symptoms? 1) oral ulcers 2). skin rash 3) confusion 4) diffase myalgia 5) tingling of hands and feet Question: 6 You prescribe a benzodiazepine hypnotics to one of your elderly patients for anxiety. Which one of the following reactions could occur? 1) occult sleep apnea may be increased 2) drug dependency may develop 3) nocturnal myocionus may be improved 4) drugs with long half-lives may accumulate 5) all of the above Question: 7 A 28-year-old comatose man is brought into the emergency room with pinpoint pupils. depressed respiration, and no sign of physical trauma. Laboratory results are pending, He receives intravenous glucose without response. Which of the following is the most appropriate drug to administer next? 1) physostigmine 2) atropine 3) diazepam 4) naloxone 5) amphetamineSelf Assessment Exam (MCCQEI-May 2005) Question: 8 A 70-year-old man begins coughing up blood and develops increased stiffness and pain in his joints. He begins having nosebleeds and has blood in his urine. He comes to the hospital after developing a purpuric rash on his legs. Which one of the following tests is most likely associated with this condition? 1) ANCA, 2) C3 complement 3) ANA 4) Rheumatoid factor 5) anti-parietal cell antibody Question: 9 ‘A normal 21-year-old woman is married to a man with severe factor VIII deficiency. Which one of the following is the correct statement regarding the risk of inheriting hemophilia by her children? 1) All sons have hemophilia; none of the daughters are carriers. 2) 50% of sons have hemophilia; all daughters are carriers. 3) 50% of sons have hemophilia, 50% of daughters are carriers, 4) All sons are normal, all daughters are carriers. 5) All children regardless of their sex inherit the hemophilia gene. Question: 10 A.42-year-old woman presents to her family physician complaining of a one year history of an 8 kg weight gain, trouble concentrating, hirsutism and headaches. Her weight is 80 kg. Her blood pressure is 150/90 mmig and she has several bruises over her abdomen. She is unable to rise from a squatting position. Which one of the following is the most important diagnostic test? 1) a fasting blood glucose 2) glycated hemoglobin 3) fasting serum cortisol 4) TSH and free Ta 5) 224 hour urine cortisol Question: 11 A.47-year-old woman presents with a history of joints pains of 6 months duration. More recently the joints of her fingers became swollen and red. Upon awakening in the morning her fingers, toes, wrists. and knees are stiff and do not improve until she is up for more than an hour. Physical examination reveals redness and swelling of the proximal interphalangeal joints and multiple small nodules over the extensor surfaces of the elbows. Which one of the following is the most likely diagnosis? 1) osteoarthritis 2) gout 3) scleroderma 4) psoriatic arthritis 5) theumatoid arthritis‘Saf Assessment Exam (MCCQEI-May 2005) Question: 12 A regular visitor to your emergency room presents in his usual inebriated state and is short of breath, febrile and coughing up a foul-smelling sputum. Which one of the following is the most likely diagnosis? 1) stricture due to ingestion of lye 2) pneumothorax due to blunt trauma 3) spontaneous pneumothorax 4) lung abscess secondary to aspiration 5) bronchogenic carcinoma Question: 13 oo Which of the following denotes a disturbance in stream of thonght in which there isan involuntary and sudden cessation or interuption of thought processes because of Imeonscious emotional factors? 1) ruminating: 2) obsessing 3) perseverating 4) tationalizing © 5) blocking Question: 14 om) You are asked to see a 62-year-old man, two days following cardiac bypass surgery. He appears confuse, sem to think hei na hotel and deseribes sein policeman trying to getin trough the window of his room. He deseribes the appearance of his person in \ivid details, Which one of the following is this patient experiencing? 1) obsessional thoughts 2) compulsions +3) hallucinations 4) fight of ideas 5) delusions OG) Quetons as A 26-year-old man requests help. He says he fells like he is really a woman "trapped in a man’s body." Which of the following is the most likely diagnosis? 1) body dysmorphie disorder 2) transvestism <3) gender identity disorder 4) sexual desire disorder 5) depersonalization disorder 105Self Assesment Exam (MCCQEI-M ay 2005) ‘committed serious sins for which he is going to be punished. Which of the following is the most likely diagnosis? 1) schizophrenia 2). somatization disorder 2 3). major depression 4) dysthyhmic disorder '5)_organic brain syndrome { Questions Of letters in a 5-year-old is usually 21) momma. 2) _asign of perceptual handicap. 3) a sign of minimal brain dysfunction, 4) asign of dyslexia. 5) due to unestablished laterality Question: 18 All of the following are features of chronic non-specific (toddler's) diarthea of childhood, EXCEPT 1) onset at age 6-30 months. 2) three to six loose watery stools per day. © 3) failure to thrive. 2 familial tendency. reduced intake of Gictary fat, tonic-clonic seizure, followed by a prologed period of drowsiness. Shei brought to the emergency room and seems to be rousing. Which one of the following is the next most important step? 1) complete biood count (CBC) 2) prescribe amoxicillin 3) intravenous antibiotics 4) lumbar puncture = 5) history and physical examination n female urinary stress incontinence include all of the following 1) weakness of the urethral supports, 2) trauma from repeated deliveries. 3) estrogen deficiency. 4) procidentia. 5) chronic bronchitis. 106M ‘Satf Assessment Exam (MCCQEI-May 2005) Question: 21 A proses core uy desend 0 identify risk factors associated with coronary haarraisease (CHD), initiated in 1960, is still underway. Of the sample of 1000 white men randomly selected to participate in the study in 1960, 50 had CHD when the study bogan and 950 were healthy. Two hundred of these healthy subjects could be classified 1s hypertensive (diastolic blood prescure >90mmHg), while 750 were normotensive. At the 20-year recall in 1980, 50 of the 200 hypertensive subjects had suffered an acute myocardial infarction (AMI. Only 75 of the normotensive subjects had suffered an. AMI during this period (1960-1980). ‘The prevalence of coronary diseases in white men in 1960 ae 1) was 950/1000. 2) was 50950. 3) was 50/1000. 4) was 200/950. 5) was not discemible from the data ‘Question: 22, ‘The incidence of an autosomal recessive disorder is 1 per 2500 live births. Assuming that the population in a given community is relatively isolated and homogeneous, what is the recessive gene frequency for unaffected individuals in this community? 1) Lin 1250 2) 1 in 500 3) 1in250 4) Lin 50 3) Vin 25 Question: 23 A tuberculin-negative health science student is exposed to an infectious tuberculous patient, If the student develops tuberculosis, which one of the following forms of the disease is most likely to occur? 1) tuberculous glands in the neck 2) tuberculous pneumonitis 3) Pott disease (spinal tuberculosis) 4) genitourinary tuberculosis 5) Miliary tubereutosis ‘Question: 24 30-year-old male patient has abused amphetamines for about five years, He wants t0 know what effects, if any, this has had on his counitive abilities, Which one of the following is likely to be a problem? 1) verbal memory 2) general intellectual functioning 3) executive function 4) attention and concentration 5) spatial discrimination 107Sef Assessment Exam (MCCQEI-May 2005) Section: 4 Question: 1 During a routine pelvic examination, a woman is found to have a tender, open lesion on the vagina, ‘The patient states diat ste had sinilar esivus [2 signths previously. Whicls cone of the following is the most likely causative agent? 1) echovirus 2). coxsackie virus 3) mubella virus 4) herpes simplex virus 5) meastes virus Question: 2 A 25-year-old man presents to your office with a 2-week history of intermittent bright red blood per rectum. He is otherwise well. From this history alone, the most likely diagnosis is: 1) anal fissure 2). ulcerative colitis 3) multiple polyposis coli 4) lremorthuids 5) rectal carcinoma Question: 3 ‘Which one of the following features is of most specific value in differentiating optic neuritis from pepilledema? 1) swelling of the optic dise . 2) loss of Vision 2 3). distension of retinal veins No vemen Ct sett 4) enlargement ofthe blind spot 5) blurring of the disc margins Question: 4 A 60-year-old woman developed sudden onset of upper abdominal pain radiating to the back associated with nausea, vomiting, fever, and chills. Subsequently, she noticed yellow discoloration of her selera and skin. On physical examination, the paticnt was found to he febrile with a temperature of 38.9 °C, along with right upper quadrant tenderness. Which one of the following is the most likely di Hy choledocholithiesis 2) malignant biliary stricture 3) metastatic disease of the liver 4). cirthosis of the liver 5) pancreatitis 108