self administered exam 4

Self-Administered Evaluating Exam

Section: 1

Question: 1

A man is indignant when his graduate school thesis committee refuses to approve his project. "They're just jealous of me because they know I'll be the most brilliant anthropologist in history," he remarks. He has had this attitude all of his life. Which one of the following is the most likely diagnosis?

narcissistic personality disorder

antisocial personality disorder

schizophrenia

borderline personality disorder

bipolar disorder

Question: 2

A female patient is 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.

immunodeficiency

neonatal lupus

hemolytic disease of the newborn

T cell immune deficiency syndrome

transient hypogammaglobulinemia

Question: 3

Streptococcus pyogenes is virulent to humans, causing pharyngitis and a variety of other infections. Which one of the following is the likely virulent factor?

the M protein

the specific group A polysaccharide

the presence of pili

penicillin resistance

the M and T type of streptococci

Question: 4

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 psychiatrists) 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?

cohort study

case-control study

cross-sectional prevalence survey

case series report

non-randomized controlled trial

Question: 5

A 22-year-old man sustains a blow-out fracture of his left orbit while playing squash. You expect to find

depression of the zygomatic arch on the left side.

horizontal diplopia.

retinal detachment.

left enophthalmos.

blood behind the left tympanic membrane.

Question: 6

A 25-year-old right-handed woman has recurrent spells during which she seems to be "out of contact" for about 30 seconds. These are associated with a feeling of fear and recollection of memories from the past. For a few minutes following an attack, she has trouble finding words to express herself. The most likely site of origin for these attacks is

the right temporal lobe.

the left parietal lobe.

the left frontal lobe.

the left temporal lobe.

both frontal lobes.

Question: 7

On physical examination of a 3-month-old child you detect a thrill and a machinery-type murmur at the left upper sternal border. A widened systemic pulse pressure and bounding peripheral pulses are also noted. Based on these findings, which one of the

following is the most likely diagnosis?

familial hypercholesterolemia

patent ductus arteriosus

tetralogy of Fallot

Marfan's syndrome

aortic stenosis

Question: 8

Reduced oxygen transfer to the fetus during a uterine contraction is most likely due to

compression of the umbilical cord.

impairment of venous outflow from the uterus.

impairment of arterial supply to the intervillous space.

maternal hypoxemia.

maternal hypotension.

Question: 9

Korsakoff psychosis is characterized by which one of the following?

visual hallucinations and altered levels of consciousness

visual hallucinations and memory impairment

auditory hallucinations and altered levels of consciousness

confabulation and altered levels of consciousness

confabulation and memory impairment

Question: 10

A 60-year-old man has an ulcerating carcinoma of the lateral side of the tongue. Which one of the following features has the most important effect upon his management?

He smokes 30 cigarettes daily.

He has a hard cervical lymph node 1.5 cm in diameter.

The tumor measures 2 cm in diameter.

The tumor is a squamous cell carcinoma.

He has severe dental caries.

Question: 11

A 75-year-old man with longstanding hypertension and congestive heart failure is

noted to have a mildly elevated serum calcium. He is taking a number of medications. Which of the following medications is most likely to elevate the blood calcium level?

Proton-pump inhibitor

Beta-blocker

ACE inhibitor

Thiazide diuretic

Non-steroidal anti-inflammatory

Question: 12

Within minutes of a bee sting, a 23-year-old woman develops generalized pruritus and hyperemia of the skin, followed shortly by swelling of the face and eyelids, dyspnea, and laryngeal edema. This reaction is mediated by which one of the following?

antigen-antibody complexes

cytotoxic T cells

IgA antibodies

IgE antibodies

IgG antibodies

Question: 13

A 56-year-old man with a 3-week history of fatigue, intermittent fever and cough, presents to the emergency department complaining of increasing shortness of breath. The patient's temperature is 38.4 °C. The white blood cell count is 16.5 x109/L. A chest x-ray shows a right-sided pleural effusion filling the lower two thirds of the hemithorax. At this point, which one of the following is the best investigation to conduct?

sputum culture

thoracentesis

CT of the chest

bronchoscopy

lung scan

Question: 14

A 30-year-old male patient has abused amphetamines for about five years. He wants to know what effects, if any, this has had on his cognitive abilities. Which one of the following is likely to be a problem?

verbal memory

general intellectual functioning

executive function

attention and concentration

spatial discrimination

Question: 15

A 28-year-old woman who is 30 weeks pregnant comes to the office because she is concerned about feeling no fetal movements for the past two days. Which one of the following is the method of choice in assessing fetal death?

persistent absence of fetal movements

change in positive serum pregnancy test to negative

amniocentesis for examination of amniotic fluid

real-time ultrasound assessment for cardiac motion

abdominal x-ray examination of the fetus

Question: 16

For the past day, a 16-year-old girl has had fever, vomiting, and watery diarrhea. She also complains of intermittent abdominal pain and generalized myalgia. On physical examination she is noted to be slightly lethargic. Temperature is 39.7oC, pulse is 154 beats/minute, and blood pressure is 80/46 mmHg. Her conjunctivae and pharynx are hyperemic, and she has a generalized erythematous maculopapular rash that spares her wrists. Which one of the following is the most likely diagnosis?

scarlet fever

Kawasaki's disease

ruptured appendix

Rocky Mountain spotted fever

toxic shock syndrome

Question: 17

A 3-year-old girl presents with generalized edema shortly after recovery from an upper respiratory infection. Laboratory studies revealed marked albuminuria as well as hypoalbuminemia and hyperlipidemia. Which one of the following is the most likely diagnosis?

minimal change disease

focal and segmental glomerulosclerosis

membranous glomerulonephritis

poststreptococcal glomerulonephritis

rapidly progressive glomerulonephritis

Question: 18

Medical complications of bulimia nervosa include all of the following, EXCEPT

metabolic acidosis.

esophagitis.

dental abnormalities.

hypokalemia.

parotid gland enlargement.

Question: 19

A 35-year-old female presents to your office with a one week history of hemorrhoids that slightly prolapse and bleed with some bowel movements. She finds them increasingly itchy. Which one of the following is the most likely treatment you would recommend for this patient?

hemorrhoidectomy

hemorrhoid banding

acetaminophen suppositories

stool softeners and high fibre diet

laxatives

Question: 20

Which one of the following is the most effective method of treatment for patients with pathological gambling disorders?

activity group therapy

self-help group therapy

family therapy

psychodrama

individual therapy

Question: 21

Cyanosis in the newborn is typical of

left-to-right cardiac shunt.

patent ductus arteriosis.

aortic stenosis.

transposition of the great vessels.

coarctation of the aorta.

Question: 22

A 23-year-old woman who is 39 weeks pregnant with her second child is having regular uterine contractions every three minutes. Which one of the following is the best criterion for assessing if she has entered the active phase of labour?

The cervix is effaced over 90%.

The contraction duration is over 30 seconds.

The presenting part is low in the pelvis.

The cervical dilation is at least 4 cm.

The membranes are ruptured.

Question: 23

Which one of the following cancers is responsible for the greatest annual death rate in women?

endometrial

breast

lung

colon

cervical

Question: 24

As a public health officer you are investigating a food poisoning outbreak. You suspect that it is resulting from ingestion of cream-filled pastry. Which one of the following is the likely causative agent?

Staphylococcus aureus enterotoxin

Clostridium botulinum

Clostridium perfringens

Salmonella typhi

Bacillus cereus enterotoxin


Section: 2

Question: 1

A 62-year-old alcoholic presents with complaints of poor balance, requiring a cane to keep from falling. He has a high stepping gait and cannot stand with his eyes closed. He has normal finger-nose testing and normal cranial nerve examination. His problem is most likely due to

alcoholic cerebellar disease.

chronic subdural hematoma.

alcoholic peripheral neuropathy.

Wernicke encephalopathy.

vitamin B12 deficiency.

Question: 2

A 23-year-old man presents with bizarre delusions, a blunted affect, and tangential thought processes. Which one of the following characteristics indicates a poor prognosis?

an extensive premorbid history of social withdrawal

a family history of schizophrenia

a sudden onset of symptomatology

magnetic resonance imaging (MRI) that shows no significant changes in brain morphology

catatonic symptomatology

Question: 3

A young couple bring their 30-month-old infant son to their pediatrician because he has not learned to speak, does not interact or play with other children, does not display eye contact and repeatedly flaps his hands. Physical examination is normal. Which one of the following is the most likely diagnosis?

oppositional defiant disorder

attention deficit disorder - inattentive type

Down syndrome

pervasive developmental delay (autism)

deafness

Question: 4

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?

left lung

pericardium

left diaphragm

left kidney

spleen

Question: 5

A 17-year-old high school student requests to see a psychiatrist for depression. She states that she does not want her parents to know about this. From a legal and ethical point of view, which one of the following should the psychiatrist do?

accept patient's request

contact the patient's parents

tell her she must bring her parents to the next session

ask the patients general practitioner to inform the parents

refuse to see her again without parental consent

Question: 6

A 58-year-old woman presents with vaginal bleeding of one week duration. She went through menopause seven years ago. Which one of the following is the diagnostic method of choice?

Pap smear

endometrial biopsy

dilatation and curretage

laparoscopy

colposcopy

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?

physostigmine

atropine

diazepam

naloxone

amphetamine

Question: 8

The most common pathogen causing urinary tract infection (UTI) in pregnancy is

Pseudomonas aeruginosa

Proteus mirabilis

Haemophilus influenzae

Escherichia coli

Klebsiella pneumoniae

Question: 9

A 20-year-old male arrives in the emergency room via ambulance after a domestic argument. He is actively opposing physical restraint, confused, uncooperative and combative, shouting names of imaginary persons. There is no history or physical signs of trauma. Physical examination reveals stable vital signs. There are no focal neurological deficits. Glucose reagent strip and pulse oximetry are within normal limits. He swings at staff with his fists and requires five-person physical restraint. Which of the following is the best choice in the further management of this patient?

Continue to establish rapport, verbalizing empathetic concern

Continue physical restraint, avoiding drugs because they might further complicate the picture

Call for police to transport the patient to jail

Administer parenteral haloperidol while maintaining physical restraint.

Request police assistance

Question: 10

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?

severe contusion

severe concussion

skull fracture

fracture of the nasal septum

subdural hematoma

Question: 11

A 3-year-old girl has had occasional urinary discomfort. A urine culture has grown 107 colony-forming units per L of Escherichia coli. A diagnosis of urinary tract infection is most likely if associated with

urinalysis (urine microscopy) with 10 to 15 red blood cells per high-power field.

significant proteinuria.

fever of greater than 38°C.

urinalysis (urine microscopy) of greater than 15 white blood cells per high-power field.

family history of urinary tract infection.

Question: 12

A 38-year-old man is brought to the Emergency Department on Christmas Eve by the police. They found him in the woods with an empty bottle of gin beside him. He is agitated and confused. His vitals signs are:

blood pressure 100/50 mm Hg

pulse 60/minute

respiratory rate 16/minute

He is gray and cool; there are vesicular formations on the dorsum of his feet, and both feet are red and edematous. Which one of the following is the most likely diagnosis?

superficial spreading cellulitis

second degree frostbite

gout

first degree frostbite

compartment syndrome

Question: 13

To promote good dental health among children living in areas with low natural fluoride in the water supply, it is recommended that fluoride supplements be given from

the third month of pregnancy to age 6 years.

birth to age 2 years.

birth to adolescence.

age 6 months to age 6 years.

the time of appearance of the first tooth until the eruption of the first molar.

Question: 14

Coryza in a 3-week-old infant may lead to upper airway obstruction when the baby sleeps, but not when awake and crying because

there is inflammation and edema of the larynx and trachea.

the extrathoracic trachea is floppy and collapses easily on quiet inspiration.

an infant is an obligate nose-breather.

the tongue falls back into the posterior oropharynx.

the tonsils become enlarged and obstruct the airflow in and out of the larynx.

Question: 15

In a classroom of 25 students (15 males and 10 females), 5 males develop hepatitis A over a 2-week period. During the next 6 weeks, an additional 3 males and 2 females develop the infection. The source of this outbreak is most likely

common-source outbreak

continuing common-source outbreak

person-to-person transmission

common-source outbreak with secondary person-to-person transmission

continuing common-source outbreak with person-to-person transmission

Question: 16

Following introduction of a screening program in a population, the mean survival time after diagnosis of breast cancer increased by 18 months. The major problem in assessing the effectiveness of the program is

interobserver error.

lead time bias.

multiple comparisons.

selection bias.

changing natural history of the disease.

Question: 17

You are asked to see a 62-year-old man, two days following cardiac bypass surgery. He appears confused, seems to think he is in a hotel and describes seeing a policeman trying to get in through the window of his room. He describes the appearance of this person in vivid details. Which one of the following is this patient experiencing?

obsessional thoughts

compulsions

hallucinations

flight of ideas

delusions

Question: 18

You are asked to assess a 65-year-old man with retrosternal chest pain. On examination, he is diaphoretic and has mottled extremities. His systolic blood pressure is 60 mm Hg with a pulse rate of 140/minute. His jugular venous pressure is 6 cm above the sternal angle, and his heart sounds are very faint. Which one of the following describes this patient's condition?

increased systemic vascular resistance, decreased cardiac output

decreased systemic vascular resistance, decreased cardiac output

decreased systemic vascular resistance, increased cardiac output

increased systemic vascular resistance, increased cardiac output

normal systemic vascular resistance, decreased cardiac output

Question: 19

A full-term male is born by vaginal delivery. At one minute his heart rate is 80/min, he takes a gasp, grimaces to stimulation, and his limbs are limp at rest. He is centrally pink and has cyanosed fingers and toes. Which one of the following is the 1-minute Apgar score for this infant?

3

4

5

6

7

Question: 20

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 chorionic gonadotropin (ß-HCG) is negative. The most probable diagnosis is

right pyelonephritis.

acute appendicitis.

right ovarian endometrioma.

acute salpingitis.

torsion of a right ovarian cyst.

Question: 21

A 52-year-old man with a long history of alcohol use comes to the emergency room of a general hospital. He is confused and on examination is noted to have palsies of conjugate gaze, horizontal nystagmus, and ataxia. Which one of the following is the most likely diagnosis?

conversion reaction

alcohol intoxication

alcohol hallucinosis

delirium tremens

Wernicke's encephalopathy

Question: 22

An obese 42-year-old man is brought to the emergency room of a general hospital. He complains of anxiety, a feeling that he is suffocating, and numbness and tingling in his fingers. Examination of the chest and lungs reveals no abnormalities. What is the most likely diagnosis?

acute psychosis

depression

hyperventilation syndrome

Pickwickian syndrome

asthma

Question: 23

A 42-year-old woman, gravida 3, para 3, complains of progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a firm, diffusely enlarged uterus. Results of endometrial biopsy are normal. This patient most likely has

endometriosis

endometritis

adenomyosis

uterine sarcoma

leiomyoma

Question: 24

A gunshot wound to the upper arm causing shock-wave damage to the median nerve may leave the patient with which one of the following?

easily provoked pain in the hand

weakness on wrist extension

atrophy in the first dorsal interosseous muscle

numbness over the fifth digit

radial deviation of the hand


Section: 3

Question: 1

A 71-year-old woman with a history of coronary artery disease presents to her family physician for a routine check-up. The physician notices that she has lost 10 kg since her last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins 30 minutes after eating and lasts about 2 hours. She claims that the pain is worse after large meals and so she has begun to eat less out of fear of pain. Which one of the following is the most likely diagnosis?

pancreatitis

cholecystitis

small bowel obstruction

intestinal ischemia

peptic ulcer disease

Question: 2

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?

Vaginal delivery in all cases.

Cesarean section if lesions are present at time of labor.

Elective cesarean section at 38 weeks in all cases.

Daily application of topical acyclovir to site of previous lesions.

Cesarean section only if herpes culture positive

Question: 3

A 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 of 112 beats/minute and a blood pressure of 150/100 mmHg lying and 130/80 mmHg standing. Which one of the following is the most helpful diagnostic test?

CT scan of the brain

captopril renal nuclear medicine scan

24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) levels

24-hour urinary aldosterone levels

24-hour urinary vanillylmandelic acid (VMA) and catecholamine levels

Question: 4

A 23-year-old asymptomatic woman is seen for routine examination. You are able to palpate a 4-cm diameter right-sided cystic adnexal mass. The appropriate management is

laparoscopy.

trans-vaginal aspiration.

pelvic ultrasound examination.

gonadotropin-releasing hormone (GnRH) agonist.

reassessment in 1 month.

Question: 5

A 32-year-old married woman describes experiencing panic attacks every time she goes to the local store. These have been getting more frequent and she is finding it increasingly difficult to leave her home. Which one of the following should form part of her treatment?

psychodynamic therapy

interpersonal psychotherapy

family therapy

supportive psychotherapy

cognitive behavioral therapy

Question: 6

Which of the following physiologic changes occurs during a normal pregnancy?

hyperuricemia

proteinuria

hypertension

a 40% increase in the glomerular filtration rate (GFR)

metabolic alkalosis

Question: 7

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 heavily. While waiting to see 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?

Ask her to breathe into a paper bag.

Order immediate intravenous infusion of a glucose solution.

Order a urine drug screen.

Give supplemental oxygen by mask.

Administer 2 mg of sublingual lorazepam (Ativan)

Question: 8

A 44-year-old school principal has symptoms of chronic fatigue and has not worked for one year. She is applying for long-term disability and asks you to complete a medical report for this. Physical examination is normal. The complete blood count, liver function tests, thyroid-stimulating hormone and erythrocyte sedimentation rate are all normal. You should tell her that

she is not disabled because physical exam and test are normal.

chronic fatigue syndrome is not a valid illness.

you will refer her for psychiatric evaluation.

you are not under any obligation to complete the report.

you will complete the report based on these findings

Question: 9

A 1-day-old full-term infant has become jaundiced. He is breast-feeding well. The initial step in management is to

order a septic work-up.

obtain an abdominal ultrasound.

review birth history and physical examination.

begin phototherapy.

discontinue breast-feeding.

Question: 10

A 28-year-old man presents to the emergency room with a 2-hour history of chest tightness, 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 crackles are audible. Pulse is 130/min and regular. An emergency arterial PO2 is 65 mmHg. Pulmonary function studies are most likely to show which one of the following?

decreased FEV1

increased vital capacity

decreased residual volume

decreased airway resistance

increased arterial PO2

Question: 11

A 65-year-old woman with osteoarthritis is prescribed naproxen. There is a significant rise in the patient's serum creatinine, over 2 months. Naproxen causes this problem by which one of the following mechanisms?

Acting indirectly as a renal vasodilator.

Inhibiting prostaglandin F2 activity.

Indirectly reducing renal blood flow.

Increasing renal tubular flow rates.

Reducing renal water conservation

Question: 12

A 3-year-old with a history of asthma is brought to the Emergency Department in acute respiratory distress. His mother relates that she stopped his twice daily sodium cromoglycate 1 week ago. Physical examination reveals a distressed child with a harsh cough. On auscultation of the chest, there are areas of reduced air entry and diffuse expiratory wheezes. Which one of the following is the most appropriate initial management?

aerosolized ipratropium bromide by nebulization

aerosolized sodium cromoglycate by nebulization

aerosolized budesonide

subcutaneous epinephrine, 1:1000 dilution

aerosolized salbutamol by nebulization

Question: 13

In early childhood, masturbation and sexual play with other children are generally regarded as

developmental disturbances.

indications of sexual overstimulation at home.

normal behaviour at this age.

indications of immaturity.

indications of early sexual deviancy

Question: 14

A 38-year-old woman has a firm 3-cm thyroid nodule. She has mild hoarseness. Which one of the following tests would be most appropriate?

thyroid scan

ultrasound

serum thyroid-stimulating hormone

radionuclide scan

fine needle aspiration

Question: 15

The occurrence of malignant mesothelioma has been correlated with industrial exposure to

asbestos

beryllium

coal dust

nitrogen dioxide

silica

Question: 16

Patients admitted for carcinoma of the stomach are age- and sex-matched with fellow patients without a diagnosis of cancer and surveyed as to smoking history to assess the possible association of smoking and gastric cancer. This scenario best illustrates which one of the following type of studies?

case series

case-control

clinical trial

cohort

survey

Question: 17

A 68-year-old man presents with a chief complaint that solid food gets stuck in the middle of his chest. In addition, he admits to a 11 kg weight loss over the last 3 months. Which one of the following is the most likely diagnosis?

esophagitis

lower esophageal ring

esophageal carcinoma

cerebrovascular accident

myocardial infarction

Question: 18

A 20-year-old man was brought to the hospital lying in a rigid position on a stretcher. He did not respond to outside stimuli and had mask-like facies. His eyes were open, and he appeared to be aware of his surroundings. He did not answer questions, but would shut his eyes tightly for a few moments and refuse to open them when asked to do so by the examining physician. This patient is showing signs of which one of the following types of schizophrenia?

paranoid

catatonic

hebephrenic

residual

latent

Question: 19

A 73-year-old man has had an aortic aneurysm repair and requires artificial ventilation. His inspired oxygen is 50% (FiO2 0.5), tidal volume 800 mL, respiratory rate 8/minute. An arterial blood gas determination shows a pH of 7.26, a PaO2 of 170 mm Hg and a PaCO2 of 52 mm Hg. Which one of the following is the best management option?

Decrease the tidal volume to 700 mL and decrease the FiO2.

Decrease the tidal volume to 700 mL and leave the FiO2.

Increase the respiratory rate to 10/minute and increase the FiO2.

Increase the tidal volume to 1 L and decrease the FiO2.

Add sodium bicarbonate to the intravenous fluids.

Question: 20

Oligohydramnios is associated with which one of the following fetal conditions?

tracheo-esophageal fistula

talipes equinovarus (club foot)

anencephaly

fetal erythroblastosis

Down syndrome

Question: 21

The most common complication of varicella infection is

postinfectious encephalopathy.

secondary bacterial skin infection.

Reye syndrome.

pneumonia.

herpes zoster.

Question: 22

A case control study was conducted in which 50 cases and 50 controls were interviewed to inquire about their history of exposure to substance 'X'. The following 2 X 2 table resulted:

Cases Controls Totals

Exposed 40 20 60

Not exposed 10 30 40

Totals 50 50 100

The 'odds ratio' (estimate of the relative risk) is

0.17

1.50

2.00

3.00

6.00

Question: 23

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 lower part of the right deltoid muscle. X-ray shows anterior dislocation of the right shoulder. Which one of the following nerves is most likely injured?

radial nerve

musculocutaneous nerve

ulnar nerve

long thoracic nerve

axillary nerve

Question: 24

At about what age do separation and stranger anxiety occur most frequently?

the first week of life

the first month of life

six months

ten months

two years


Section: 4

Question: 1

A 17-year-old high school student has just returned from Costa Rica. She presents with a 10-day history of crampy abdominal pain, bloody diarrhea and weight loss of about 2,5 kg over a two-week period. She is anorexic but denies having nausea or vomiting. Examination reveals tenderness in both right and left iliac fossa. Which one of the following conditions is the most likely cause of this patient's weight loss and diarrhea?

Salmonellae enterocolitis

Campylobacter species

Entamoeba hystolytica colitis

Giardia Lamblia infection

Cryptosporidium parvum infection

Question: 2

A 72-year-old woman complains of a lump protruding through the vagina with local pressure symptoms. On examination, there is a visible uterine prolapse. All of the following may be etiologic factors, EXCEPT

multiparity.

chronic smoking.

history of large babies.

stress urinary incontinence.

postmenopausal status

Question: 3

A 40-year-old woman presents with chest pain. Preliminary evaluation reveals no obvious cause. She reported numerous symptoms in her systems review. A full diagnostic workup, including cardiac catheterization, yielded normal results. Her twin children have recently left home for college. Which one of the following would be most appropriate in the management of this woman?

prescribe a benzodiazepine

develop a therapeutic alliance with the patient

reassess when new symptoms develop

progressive exercise program

intensive individual psychotherapy

Question: 4

A 48-year-old alcoholic man has had a deep venous thrombosis (DVT) and the INR is well-controlled on 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?

alcohol intake decreases the volume of distribution of warfarin

alcohol intake increases the absorption of warfarin from the gut

alcohol competes for and reduces the hepatic metabolism of warfarin

alcohol reduces the plasma protein binding of warfarin

alcohol reduces the renal execution of warfarin

Question: 5

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?

bullae and pustules are uncommon

burrows are absent

the palms and soles are often involved

the face is spared

the rash is pruritic

Question: 6

A 30-year-old menstruating woman presents at the Emergency Department with a high fever, vomiting and diarrhea of 24 hours' duration. Her blood pressure is 90/50 mm Hg and there is a diffuse erythematous rash. All of the following laboratory results are in keeping with a diagnosis of toxic shock syndrome, EXCEPT

creatine kinase 290 U/L.

calcium (total) 1.66 mmol/L.

white blood cell count 18 x 109/L.

aspartate aminotransferase 100 U/L.

glucose 2.2 mmol/L.

Question: 7

A 60-year-old man presents with a small lesion on his nose. On examination of the lesion you note the following: the lesion is 3-mm in diameter, slightly elevated with a waxy appearance, and has a slight vascular pattern on top. This lesion is most characteristic of which one of the following?

basal cell carcinoma

squamous cell carcinoma

melanoma

varicella-zoster lesion

actinic keratosis

Question: 8

Which one of the following populations is at greatest risk of completed suicide?

males over 45 years of age

females over 45 years of age

females under 14 years of age

females age 14 to 18

males age 14 to 18

Question: 9

A 20-year-old man has acute fever, malaise and pain in and just below the left knee. There has not been any injury. Which one of the following physical findings is most consistent with acute osteomyelitis?

an effusion into the knee joint

marked localized tenderness over the tibial metaphysis

inability to flex the knee because of pain

swelling of the prepatellar bursa

relief of pain by rest and elevation of the leg

Question: 10

Which one of the following is the best indicator of adequate control in a patient with

diabetes mellitus?

fasting blood glucose

24-hour glycosuria

blood glucose 2 hours after meals

glycosylated hemoglobin (hemoglobin AIC)

urine free of glucose

Question: 11

Which one of the following is more typical of "fainting" as a conversion symptom than of a syncopal attack due to orthostatic hypotension?

bradycardia

muscle twitching

absence of pallor or sweating

urinary incontinence

rapid recovery

Question: 12

You are asked to see a 48-year-old male patient because of persistent hypertension despite taking metoprolol, enalapril and nifedipine. There is no history of palpitations or flushing, and the patient does not use any nonsteroidal anti-inflammatory drugs. Blood pressure in your office was found to be elevated at 160/110 mmHg. Recent laboratory testing shows sodium: 143 mmol/L; potassium: 2.4 mmol/L and creatinine: 85 µmol/L. There is no proteinuria on urinalysis. Which one of the following is the most appropriate test to arrange at this time?

a 24-hour urine collection for aldosterone

a 24-hour urine collection for catecholamines and creatinine

a 24-hour ambulatory blood pressure monitor

a 24-hour urine collection for cortisol

a nuclear medicine captopril renal scan

Question: 13

The most important factor in improving perinatal outcome in diabetic pregnancies is

the use of nonstress tests.

serial biparietal diameter estimations.

amniocentesis for fetal lung maturity.

control of maternal glucose levels.

intrapartum fetal monitoring.

Question: 14

A healthy 35-year-old woman with regular menses presents with a 2-year history of primary infertility. Her husband has fathered three children from a previous marriage. Her only significant past illness was a perforated appendix and a history of hospital admission for possible pelvic inflammatory disease. Temperature graphs are compatible with ovulatory cycles. Pelvic examination is unremarkable. The most important further investigation would be

lupus anticoagulant.

endometrial biopsy.

hysterosalpingogram.

semen analysis.

postcoital test.

Question: 15

A 5-year-old girl is referred to a cardiologist because of a murmur heard during a routine examination. Which one of the following clinical characteristics is consistent with an innocent murmur?

audible only in diastole

audible throughout systole

associated with a precordial heave

attenuated with change in body position

radiates from apex to the axilla

Question: 16

A 35-year-old farmer had a mild flu-like illness three days ago. His symptoms have progressed rapidly and he now has developed dyspnea on minimal exertion, mild cyanosis, productive cough and fever of 39.6°C. You notice a slightly raised painless lesion over his right index finger another lesion over his lip. These superficial lesions have a dark scab in the centre. Which one of the following is the most likely diagnosis in this patient?

systemic infection with Aspergilla species

group A streptococcal infection

anthrax

blastomycosis

staphylococcal skin infection and pneumonia

Question: 17

An 11-year-old girl has become markedly withdrawn during the past 8 months and has complained of persisting abdominal pain and constipation, for which no organic cause has been found. Which one of the following is the most likely diagnosis?

depressive disorder

schizophrenia

conduct disorder

attention deficit hyperactivity disorder

infantile autism

Question: 18

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?

tuberculous glands in the neck

tuberculous pneumonitis

Pott disease (spinal tuberculosis)

genitourinary tuberculosis

Miliary tuberculosis

Question: 19

A 24-year-old male arrives at your office complaining of pain in his rectum. Examination reveals a perianal abscess. All of the following signs are characteristic, EXCEPT

external swelling.

redness.

induration.

rectal ulcer.

tenderness on rectal examination

Question: 20

A 45-year-old 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 establish the diagnosis is

tomography.

computed tomography scan of chest.

tuberculin skin test.

pulmonary function test.

bronchoscopy.

Question: 21

The impact of cigarette smoking on the health of the population has been studied. The following statistics are found:

Death rate from lung cancer in smokers = 1/1000/year

Death rate from lung cancer in non-smokers = 0.05/1000/year

Prevalence of cigarette smoking = 50%

Total death rate from lung cancer = 0.525/1000/year

The relative risk of lung cancer due to smoking is

1/1000/year - 0.05/1000/year = 0.95/1000/year.

0.525/1000/year ÷ 0.05/1000/year = 10.5.

1/1000/year ÷ 0.05/1000/year = 20.

1/1000/year ÷ 0.05/1000/year x 50% = 10.

1/1000/year ÷ 0.525/1000/year x 50% = 0.98.

Question: 22

An 86-year-old generally debilitated man in an extended care facility has a chronic Escherichia coli bacteriuria. About once every 6 months, he develops mild fever, frequency of micturition and some urinary incontinence. On several of these exacerbations, his urine cultures grow Escherichia coli with colony counts greater than 100,000/mL. Which one of the following would be the most appropriate management?

Determine the cause of the infection by cystoscopy and intravenous pyelogram.

Place him on continuous low-dose antibiotic therapy.

Catheterize and irrigate the bladder daily.

Treat only the acute episodes of infection with appropriate antibiotic.

Do not give specific treatment but maintain a high fluid intake.

Question: 23

A healthy 4-year-old girl presents with the following symptoms: rapidly progressing respiratory distress, high fever, muffled voice, and drooling. Which one of the following measures is most appropriate in the initial management of this problem?

endotracheal intubation

ribavirin aerosol

bronchodilators

racemic epinephrine aerosol

high doses of intravenous steroids

Question: 24

A 17-month-old boy is found to have multiple fractures and blue sclerae. Which one of the following is this most characteristic of?

osteogenesis imperfecta

osteoporosis

achondroplasia

osteomalacia

osteitis deformans

A 76-year-old man is brought to the Emergency Department by relatives who state that he had collapsed

suddenly but regained consciousness within minutes. There was no seizure activity. His electrocardiogram

showed a sinus rhythm (76/minute), a right bundle branch block and left anterior fascicular block (left axis

deviation). Which one of the following most likely accounts for this man’s loss of consciousness?

1. Ventricular tachycardia.

2. Type I second degree artrioventricular block (Wenckebach).

3. Paroxysmal supraventricular tachycardia.

4. Intermittent heart block.

5. Atrial flutter with 2 :1 artrioventricular block.