Topic: Mitral Insufficiency (Mitral Regurgitation)

Correct Answer: D. Blood pressure is changed

Explanation: Mitral insufficiency leads to backflow of blood from the left ventricle into the left atrium during systole, producing a systolic murmur (A). In severe cases, a diastolic murmur can also be present (B). The murmur may radiate to the back (C), and dyspnea (E) is a common symptom due to elevated pulmonary pressures. However, changes in systemic blood pressure (D) are not characteristic of mitral insufficiency, as the condition primarily impacts pulmonary circulation and heart murmurs rather than altering systemic blood pressure. This makes D the incorrect statement.

Topic: Aortic Stenosis

Correct Answer: C. There may be a slight diastolic murmur
Explanation: Aortic stenosis is characterized by a systolic murmur due to the narrowing of the aortic valve, which obstructs blood flow from the left ventricle to the aorta. The blood noise may be reduced or absent (A), and blood pressure often appears “pinched” due to the reduced stroke volume (B). A rapid B3 heart sound may be heard (D), and ECG typically shows left ventricular hypertrophy with systolic overload (E). However, a diastolic murmur (C) is not characteristic of aortic stenosis, as the obstruction occurs during systole, making this the incorrect statement.
Topic: Infective Endocarditis Complications

Correct Answer: C. Renal complications such as tubulopathies

Explanation: Infective endocarditis can lead to several complications, primarily due to the infection’s impact on the heart and its potential to cause embolisms. Atrioventricular conduction disorders (A), heart failure (B), joint complications (D), and cerebral embolisms (E) are known complications. However, renal complications like tubulopathies (C) are not typically associated with infective endocarditis, making it the correct exception in this list.

Topic: Cardiac Tamponade Signs
Correct Answer: C. Signs of pulmonary edema
Explanation: Cardiac tamponade is characterized by specific clinical signs such as jugular venous distension (A), a slightly mobile cardiac silhouette in fluoroscopy (B), an inspiratory decrease in systolic blood pressure (D), and a paradoxical pulse (E). These signs result from the accumulation of fluid in the pericardial sac, which impairs the heart’s ability to function properly. Pulmonary edema (C), while a severe cardiac issue, is not a direct sign of cardiac tamponade, making it the correct exception.

Topic: Deep Vein Thrombosis (DVT) Risk Factors

Correct Answer: E. High blood pressure

Explanation: Deep vein thrombosis (DVT) in the lower extremities is commonly caused by factors that promote blood stasis or increase the risk of clotting, such as prolonged bed rest (A), immobilization in plaster (B), taking birth control pills (C), and conditions like chronic anemia (D) that may lead to a hypercoagulable state. However, high blood pressure (E), while a cardiovascular risk factor, is not directly associated with the development of DVT, making it the correct exception.

Topic: Lung Abscess

Correct Answer: B. An air-fluid level on the chest x-ray

Explanation: A lung abscess is typically characterized by the presence of an air-fluid level on a chest x-ray (B), which indicates a cavity filled with pus and air within the lung tissue. While purulent expectoration (A), fluctuating fever (C), hyperleukocytosis with polynucleosis (D), and a positive blood culture (E) can be associated with lung infections, the air-fluid level on imaging is the most distinctive sign of a lung abscess, making it the correct answer.

Topic: Tuberculosis on Chest X-ray

Correct Answer: D. Excavated bi-apical infiltrates

Explanation: Active tuberculosis on a chest x-ray is most strongly suggested by the presence of excavated bi-apical infiltrates (D). These findings represent cavitary lesions typically seen in the upper lobes, which are characteristic of active TB. Other options like left lower lobe atelectasis (A), a clear image of the apical segment of the right lower lobe (B), linear panhilar opacities (C), and a reticular aspect of the lung fields (E) are less specific to TB, making option D the most indicative of active tuberculosis.

Topic: Asthma Due to Aspirin Intolerance

Correct Answer: D. Constant elevation of IgE

Explanation: Asthma due to aspirin intolerance, also known as aspirin-exacerbated respiratory disease (AERD), typically involves severe late-onset asthma (A), nasal polyposis (B), sinus involvement (C), and cross-intolerance with non-steroidal anti-inflammatory drugs (E). However, constant elevation of IgE (D) is not a characteristic feature of this condition, as IgE elevation is more associated with allergic asthma rather than aspirin intolerance.

Topic: Etiology of Chronic Cough and Hemoptysis in a Smoker

Correct Answer: E. Bronchopulmonary cancer

Explanation: In a smoker with chronic cough and recent hemoptoic sputum, bronchopulmonary cancer (E) is the most concerning etiology. Smokers are at higher risk for lung cancer, and hemoptysis can be a sign of malignancy. While pulmonary tuberculosis (A) and pulmonary aspergilloma (B) are possible, they are less common in this context. Chronic bronchitis (C) and pulmonary embolism (D) are also potential causes, but they are less likely to present with hemoptysis in a smoker compared to lung cancer.

Topic: Malabsorption Syndrome in Chronic Diarrhea

Correct Answer: C. Jaundice

Explanation: Malabsorption syndrome can lead to various signs due to deficiencies in essential nutrients. Edema of the lower limbs (A), tetany (B), brittle dander (D), and hematomas from minor trauma (E) are indicative of malabsorption issues related to deficiencies in proteins, calcium, vitamins, and other nutrients. Jaundice (C) is not typically associated with malabsorption but rather with liver dysfunction or biliary issues, making it the correct exception.

Topic: Acute Cholecystitis and Common Bile Duct Lithiasis

Correct Answer: C. Jaundice

Explanation: In acute cholecystitis, jaundice (C) is a clinical sign that may suggest the presence of common bile duct lithiasis, as it indicates obstruction of the bile duct and possible bile duct involvement. Other signs such as a large blister (A), fever (B), pain in the right hypochondrium (D), and pain on scapular irradiation (E) are more indicative of cholecystitis itself rather than suggesting common bile duct stones.

Topic: Most Common Cause of Acute Pancreatitis

Correct Answer: B. Cholelithiasis

Explanation: Cholelithiasis (B), or gallstones, is the most frequent cause of acute pancreatitis. Gallstones can obstruct the pancreatic duct, leading to inflammation. While alcohol (A) is also a common cause, cholelithiasis is often cited as the most prevalent in many cases. Obesity (C), clofibrate (D), and hyperparathyroidism (E) can contribute to pancreatitis but are less commonly the primary cause.

Topic: Dilatation of Hepatic Veins and Jaundice

Correct Answer: B. A cardiac liver

Explanation: A “cardiac liver” (B) suggests hepatic congestion due to right heart failure, leading to dilatation of the hepatic veins and jaundice. This condition reflects the impact of congestive heart failure on liver function. Budd-Chiari syndrome (A) also involves hepatic vein issues but is more related to thrombosis rather than general dilatation. Caroli’s disease (C), cirrhosis (D), and hepatocarcinoma (E) have different pathophysiologies and are not primarily characterized by hepatic vein dilatation associated with jaundice.

Topic: Diagnosis of Hepatitis A

Correct Answer: E. Elevated anti-HA-IgM antibodies

Explanation: The presence of elevated anti-HA-IgM antibodies (E) is the most definitive indicator of acute hepatitis A infection. These antibodies are specific to the early stages of the infection. While the epidemic nature (A), moderate elevation of transaminases (B), and the discovery of the virus in stool (C) can support the diagnosis, they are not as definitive. Elevated anti-HA-IgG antibodies (D) indicate past infection or vaccination rather than acute infection.

Topic: Newborn Care for HBsAg and HBeAg Positive Mother

Correct Answer: E. Serovaccination

Explanation: For a newborn whose mother is positive for both HBsAg and HBeAg, the recommended approach is serovaccination (E). This includes both hepatitis B vaccination and administration of hepatitis B immune globulin (HBIG) to provide immediate protection against hepatitis B. Polyvalent immunoglobulins (B) and specific immunoglobulins (D) are not the standard recommendation. Vaccination only (C) does not provide the immediate protection needed, and no treatment (A) is inadequate for preventing transmission.

Topic: Treatment of Cirrhotic Encephalopathy

Correct Answer: D. Infusion of aromatic amines

Explanation: Cirrhotic encephalopathy (hepatic encephalopathy) is managed with various treatments aimed at reducing ammonia levels and addressing underlying issues. This includes water restriction (A) to manage fluid balance, antibiotics like Neomycin (B) to reduce gut flora that produce ammonia, lactulose (C) to reduce ammonia absorption, and correction of electrolyte disturbances (E). Infusion of aromatic amines (D) is not a treatment for hepatic encephalopathy and is not recommended in this context.

Topic: Nephrotic Syndrome Features

Correct Answer: C. A hemorrhagic syndrome

Explanation: Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Features include hypocalcemia (A) due to loss of vitamin D binding proteins, increased plasma lipoproteins (B) due to liver response to low albumin, water and sodium retention (D) leading to edema, and potential functional kidney failure (E) from underlying kidney damage. A hemorrhagic syndrome (C) is not a typical feature of nephrotic syndrome and is therefore the correct exception.

Topic: Anti-Glomerular Basement Membrane Antibodies

Correct Answer: D. Goodpasture syndrome

Explanation: Anti-glomerular basement membrane (anti-GBM) antibodies are directly involved in the pathogenesis of Goodpasture syndrome (D), where they target and damage the glomerular and alveolar basement membranes, leading to both renal and pulmonary damage. This is distinct from other conditions like extramembranous glomerulonephritis (A), membranoproliferative glomerulonephritis (B), Berger’s disease (C), and the myelomatous kidney (E), where different pathophysiological mechanisms are at play.

Topic: Causes of Pus in Urine

Correct Answer: C. Glomerulonephritis

Explanation: The presence of pus in the urine, or pyuria, commonly suggests causes related to infection or inflammation in the urinary tract, such as renal lithiasis (A), vesico-renal reflux (B), a retained bladder (D), and cystitis (E). Glomerulonephritis (C), however, is primarily characterized by glomerular inflammation and may present with hematuria, proteinuria, and impaired kidney function rather than pus in the urine. Thus, glomerulonephritis is not typically associated with pus in the urine, making it the correct exception.

Topic: Contraindicated Medications in Chronic Renal Failure

Correct Answer: D. Spironolactone

Explanation: In a patient with chronic renal failure and elevated creatinine levels, it is strictly contraindicated to give spironolactone (D). Spironolactone is a potassium-sparing diuretic, and its use in patients with renal impairment can lead to hyperkalemia, which is dangerous in the context of chronic renal failure. Furosemide (A), a loop diuretic, is often used in such cases; calcium channel blockers (B) and beta blockers (E) can be used to manage hypertension; and converting enzyme inhibitors (C) are used cautiously, but not strictly contraindicated.

Topic: Goiter with Hypothyroidism

Correct Answer: B. Autoimmune thyroiditis

Explanation: The combination of goiter and hypothyroidism is most commonly associated with autoimmune thyroiditis (B), also known as Hashimoto’s thyroiditis. This condition involves an autoimmune attack on the thyroid gland, leading to inflammation, goiter formation, and hypothyroidism. Grave’s disease (A) typically presents with hyperthyroidism rather than hypothyroidism. Thyroid cancer (C), Plummer’s adenoma (D), and hypo-fixing nodule (E) are not usually associated with both goiter and hypothyroidism in the same manner as autoimmune thyroiditis.

Topic: Control of Intestinal Calcium Absorption

Correct Answer: B. 25-hydroxycholecalciferol

Explanation: Intestinal calcium absorption is primarily regulated by 25-hydroxycholecalciferol (B), which is the inactive form of vitamin D that is converted into its active form, calcitriol, in the kidneys. Calcitriol enhances calcium absorption in the gut. While parathyroid hormone (C) and calcitonin (D) influence calcium metabolism, they do so indirectly by affecting bone and renal function rather than directly controlling intestinal absorption. Growth hormone (E) does not directly regulate intestinal calcium absorption.

Topic: Clinical Signs of Cushing’s Syndrome

Correct Answer: A. Hypertrophy of the extremities

Explanation: Cushing’s syndrome is characterized by signs such as facio-troncular obesity (B), facial erythema (C), osteoporosis (D), and muscle weakness (E). Hypertrophy of the extremities (A) is not a typical feature of Cushing’s syndrome. Instead, patients often experience atrophy or weakness in the extremities due to muscle breakdown.

Topic: Early Sign of Diabetic Glomerulopathy

Correct Answer: B. The occurrence of proteinuria

Explanation: The first telltale sign of diabetic glomerulopathy is the occurrence of proteinuria (B). Proteinuria indicates damage to the glomeruli and is an early marker of diabetic nephropathy. Hypertension (A), nephrotic syndrome (C), kidney failure (D), and acute pyelonephritis (E) are more advanced or unrelated conditions and occur later in the course of diabetic kidney disease or as separate issues.

Topic: Complications of Diabetic Acidosis

Correct Answer: E. None of the following

Explanation: Diabetic acidosis, particularly diabetic ketoacidosis (DKA), can indeed be responsible for conditions such as a pseudo-surgical abdominal syndrome (A) due to abdominal pain and tenderness, hypovolemic shock (B) due to severe fluid loss, overall dehydration (C), and sometimes hypothermia (D) due to altered body temperature regulation. Therefore, all the listed conditions can be associated with diabetic acidosis, making option E the correct answer, as it indicates that none of the conditions are exceptions.

Topic: Conditions Triggering a Gout Attack

Correct Answer: A. Alcoholic cirrhosis

Explanation: A gout attack is commonly associated with conditions that lead to elevated levels of uric acid, which can be exacerbated by alcoholic cirrhosis (A) due to impaired uric acid metabolism and increased alcohol consumption. Chronic pancreatitis (B), cyanogenic heart disease (C), multiple sclerosis (D), and osteomalacia (E) are not typically associated with the development of gout attacks, making option A the correct answer.

Topic: Extra-Articular Manifestations of Rheumatoid Arthritis

Correct Answer: C. Cauda equina syndrome

Explanation: Rheumatoid arthritis can present with various extra-articular manifestations, including splenomegaly (A), multineuritis (B), serofibrinous pleurisy (D), and Gougerot-Sjögren syndrome (E), which is characterized by dry mouth and eyes. Cauda equina syndrome (C), however, is not a recognized extra-articular manifestation of rheumatoid arthritis, making it the correct exception.

Topic: Definition of Ankylosis

Correct Answer: B. Bone fusion between two articular surfaces

Explanation: Ankylosis refers to the fusion of two bone surfaces at a joint, leading to the loss of movement and flexibility (B). This condition results in a rigid, immobile joint. While decreased range of motion (C) and joint stiffness (A and E) are associated with ankylosis, the defining characteristic is the actual fusion of the bones, making B the correct answer.

Topic: Explanation of Carpal Tunnel Syndrome

Correct Answer: C. Thumb opposition paresis

Explanation: Carpal tunnel syndrome primarily affects the median nerve, which controls thumb opposition (C), among other functions. Paresis or weakness in thumb opposition is a key clinical feature of this condition, as it impairs the ability to move the thumb to touch the tips of other fingers. While thumb adduction paresis (A), thumb flexion paresis (B), interosseous paresis (D), and paresis of the flexion of the index and middle fingers (E) can be associated with various conditions, they are not specific to carpal tunnel syndrome like thumb opposition paresis is.

Topic: Clinical Features of Chancre in Primary Syphilis

Correct Answer: B. Marked pruritus

Explanation: The chancre of primary syphilis typically presents with induration (A), a tendency to heal spontaneously (C), absence of significant inflammatory reaction (D), and may be associated with satellite adenopathy (E). However, marked pruritus (B) is not a usual feature of a chancre; the lesion is generally painless and does not cause itching. Thus, B is the correct answer.

Topic: Endotoxin-Related Signs or Complications in Typhoid Fever

Correct Answer: D. Splenomegaly

Explanation: During typhoid fever, endotoxin release can lead to signs and complications such as bradycardia (A), digestive perforations (B), le Tuphos (C), and cardiovascular collapse (E). Splenomegaly (D), while commonly observed in typhoid fever, is not directly related to endotoxin flooding but rather to systemic infection and immune response. Therefore, D is the correct answer.

Topic: Usual Sign of Tetanus

Correct Answer: B. Trismus

Explanation: Trismus, or lockjaw (B), is a classic sign of tetanus, characterized by severe jaw muscle spasm and difficulty opening the mouth. While fever (A), dyspnea (C), opisthotonos (D), and diarrhea (E) can be associated with tetanus or its complications, trismus is the most characteristic and defining symptom of the disease.

Topic: Arguments Compatible with Common Influenza

Correct Answer: E. Significant lung opacities

Explanation: Common influenza is typically associated with symptoms like cough (A), curvatures (B), upper airway catarrh (C), and fever (D). Significant lung opacities (E) are not characteristic of common influenza but may indicate more severe conditions or complications like pneumonia. Therefore, E is the correct answer.

Topic: Opportunistic Infections in AIDS

Correct Answer: B. Listeria monocytogenes meningitis

Explanation: Opportunistic infections commonly associated with AIDS include Pneumocystis jirovecii pneumonia (A), toxoplasmosis (C), cryptococcosis (D), and atypical mycobacterial infections (E). Listeria monocytogenes meningitis (B) is not typically considered an opportunistic infection specific to AIDS but can occur in immunocompromised individuals more broadly. Therefore, B is the correct answer.

Topic: Clinical Signs Suggestive of Cerebral Toxoplasmosis in HIV Positive Patients

Correct Answer: E. All of the above

Explanation: In an HIV-positive patient, cerebral toxoplasmosis can present with various clinical signs, including seizures (A), fever (B), hemiparesis (C), and disorders of consciousness (D). Therefore, all of these symptoms can suggest the diagnosis of cerebral toxoplasmosis, making E the correct answer.

Topic: Poor Prognostic Signs in Severe Malaria

Correct Answer: D. Loss of deep tendon reflexes

Explanation: In severe malaria, loss of deep tendon reflexes (D) is a sign of poor prognosis as it may indicate severe neurological involvement or worsening of the patient’s condition. Other elements like a fever above 40.3°C (B), hepatosplenomegaly (C), and a hypotonic coma (E) are significant but do not necessarily indicate the same level of poor prognosis as the loss of deep tendon reflexes. Normal CSF (A) does not usually correlate with poor prognosis in severe malaria.

Topic: Chronic Bleeding Anemia

Correct Answer: B. A hypochromic microcytic anemia with a low reticulocyte count

Explanation: Chronic bleeding anemia typically results in hypochromic microcytic anemia (B), characterized by smaller, paler red blood cells due to iron deficiency. The reticulocyte count is low because the bone marrow’s response to anemia is insufficient in chronic bleeding conditions. This differs from regenerative anemias, which typically feature higher reticulocyte counts.

Topic: Complications of Hodgkin’s Disease

Correct Answer: C. Disseminated intravascular coagulation

Explanation: Hodgkin’s disease can lead to complications such as paraplegia due to spinal cord compression (A), shingles (B) due to immunosuppression, pleurisy (D) due to lymph node involvement, and inflammatory anemia (E) as part of the systemic symptoms. Disseminated intravascular coagulation (C) is not a typical complication of Hodgkin’s disease. Therefore, C is the correct answer.

Topic: Typical Features of Myeloma (Kahler’s Disease)

Correct Answer: A. Plasmacytosis

Explanation: In multiple myeloma (Kahler’s disease), plasmacytosis (A), which is an increase in the number of plasma cells in the bone marrow, is a typical feature. Eosinophilia (B), hyperlymphocytosis (C), and neutrophilic polynucleosis (D) are not characteristic of myeloma. Therefore, A is the correct answer.

Topic: Infection Severity Increased by Splenomegaly

Correct Answer: C. Pneumococcus

Explanation: Splenomegaly can exacerbate infections with encapsulated bacteria such as pneumococcus (C). The spleen plays a crucial role in filtering these bacteria, and its dysfunction or enlargement can lead to a higher severity of pneumococcal infections. Bacillus pyocyanin (A), Streptococcus aureus (B), Koch’s bacillus (D), and Pneumocystis jirovecii (E) are less directly affected by splenomegaly in terms of severity.

PEDIATRICS

Topic: Signs and Symptoms of Teething

Correct Answer: E. A fever of 39°C

Explanation: Teething can cause mild symptoms such as irritability (D), decreased appetite (C), rhinorrhea (A), and even mild diarrhea (B). However, a high fever of 39°C (E) is not typically associated with teething and may indicate another underlying condition. Therefore, E is the correct answer.

Topic: Signs and Symptoms of Foreign Body Inhalation

Correct Answer: E. All of the above

Explanation: Inhalation of a foreign body can present with various signs and symptoms, including cyanosis (A) due to impaired oxygenation, wheezing (B) from partial airway obstruction, absence of breath sounds (C) if the airway is completely blocked, and aphonia (D) if the vocal cords are involved. Therefore, E, “All of the above,” is the correct answer.

Topic: Contraindications to Inducing Vomiting in Child Poisoning

Correct Answer: D. Acetaminophen ingestion

Explanation: Inducing vomiting is contraindicated in cases of poisoning where the substance ingested is caustic (like drain cleaner, C), hydrocarbons (like turpentine, A), or when the child is showing signs of severe central nervous system depression (such as rapidly increasing drowsiness, B). It is also contraindicated in very young infants (E). However, acetaminophen ingestion (D) does not typically require induced vomiting, as other treatments like activated charcoal or N-acetylcysteine are preferred. Therefore, D is the correct answer.

Topic: Side Effects of Birth Control Pills in a Teen with Diabetes

Correct Answer: C. Bleeding between periods

Explanation: While birth control pills can have various side effects, in a 15-year-old girl, the most common side effect, especially when starting the pill, is irregular bleeding or spotting between periods (C). Hair loss (A), decreased diabetes control (B), dysmenorrhea (D), and longer menstrual periods (E) are less likely to occur as side effects of birth control pills in this scenario. Therefore, C is the correct answer.

Topic: Diagnosis of Respiratory Failure in a Newborn

Correct Answer: B. The diaphragmatic hernia

Explanation: In a newborn presenting with severe respiratory failure, diminished breath sounds bilaterally, a flat abdomen, and a chest X-ray showing a multicystic mass in the left hemithorax with mediastinal displacement, the most probable diagnosis is a diaphragmatic hernia (B). This condition occurs when abdominal organs herniate into the thoracic cavity through a defect in the diaphragm, leading to respiratory distress due to lung compression. The other options, such as respiratory distress syndrome (A), tracheoesophageal fistula (C), congenital lobar emphysema (D), and persistence of fetal circulation (E), are less consistent with the described presentation. Therefore, B is the correct answer.

Topic: Apgar Score Evaluation in a Newborn Requiring Resuscitation

Correct Answer: D. Less than 6

Explanation: The Apgar score is used to assess the health of a newborn immediately after birth, evaluating five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Scores range from 0 to 2 for each criterion, with a total possible score of 10. If a newborn requires ventilatory support and cardiac massage after 30 seconds of life, this indicates significant distress, leading to low scores in heart rate, respiratory effort, and possibly color and muscle tone. Therefore, the most likely Apgar score in this situation would be less than 6 (D). This score reflects the need for resuscitative measures, indicating severe compromise in the newborn’s condition.

Topic: Differential Diagnosis of Persistent Hypoglycemia in Infants

Correct Answer: Asymmetric growth retardationExplanation: Persistent hypoglycemia with elevated insulin levels in an infant typically points to conditions where insulin overproduction or hypersecretion is present. Beckwith-Wiedemann syndrome (A), nesidoblastosis (B), maternal diabetes (C), and pancreatic islet cell carcinoma (E) all involve mechanisms that lead to hyperinsulinemia. Asymmetric growth retardation (D), however, is not associated with elevated insulin levels or hypoglycemia, making it the correct answer as it is not part of the differential diagnosis. The focus in such cases is on identifying causes related to insulin overproduction rather than growth retardation.
Topic: Risk Factors for Perinatal AsphyxiaCorrect Answer: Hyperemesis of pregnancy

Explanation: Perinatal asphyxia is often linked to complications that compromise oxygen delivery to the fetus. Abruptio placentae (A), prematurity (C), pre-eclampsia (D), and meconium-stained amniotic fluid (E) are all significant risk factors as they directly or indirectly affect the oxygenation or overall condition of the fetus. Hyperemesis of pregnancy (B), though distressing, does not impact fetal oxygenation in a way that would increase the risk of perinatal asphyxia, making it the correct answer as the exception. The focus is on conditions that impair fetal oxygen supply, which is not the case with hyperemesis.
Topic: Fluid Balance in NewbornsCorrect Answer: Replacement of sodium, potassium, and chloride in physiological amounts is started at 24 hours of age in the presence of normal urine productionExplanation:In newborns, fluid balance and electrolyte management are critical. Sensible water loss includes losses through urine, stool, lung, and gastric fluid (A), and insensible water loss can be increased by factors like phototherapy and elevated ambient temperatures (B). Water loss during the first week of life is indeed greater in premature infants (D). However, the replacement of sodium, potassium, and chloride typically begins sooner than 24 hours if needed, especially if urine production is normal (C). Thus, statement C is the exception as it does not accurately reflect the timing of electrolyte replacement in newborn care.
Topic: Physiological State in an Infant with Cyanosis and Bradycardia

Correct Answer: Respiratory failure

Explanation: The infant’s symptoms—cyanosis, gasping breaths, and bradycardia (heart rate of 40-50)—are indicative of respiratory failure. This condition occurs when the respiratory system fails to provide adequate oxygenation or remove carbon dioxide, leading to low oxygen levels and high carbon dioxide levels. Cardiopulmonary failure (A) and cardiorespiratory arrest (E) are more severe and imply a complete cessation of heart and lung function. Shock (B) refers to inadequate tissue perfusion, while respiratory distress (D) is less severe and does not usually cause bradycardia. Thus, respiratory failure is the best description of the infant’s physiological state.
Topic: Initial Intervention for a Cyanotic and Bradycardic Infant

Correct Answer: Bag and mask ventilation with 100% oxygen
Explanation: In an infant presenting with cyanosis, gasping breaths, and bradycardia, the first priority is to ensure adequate ventilation and oxygenation. Bag and mask ventilation with 100% oxygen (E) addresses these needs immediately and helps restore proper oxygen levels and breathing. Intraosseous cannulation (A) and synchronized cardioversion (B) are more invasive and are not the first steps in this scenario. Chest massage (C) is typically used for cardiac arrest situations, which is not the immediate concern here. Administering oxygen (D) alone without ventilation would be insufficient if the infant is not breathing adequately. Thus, bag and mask ventilation is the appropriate initial intervention.
Topic: Clinical Abnormalities in Marfan Syndrome
Correct Answer: Aortic dilatation and loose joints suggesting a connective tissue disorder
Explanation: Marfan syndrome is characterized by connective tissue abnormalities, leading to features such as aortic dilatation and hypermobility of joints (A). These manifestations are due to defects in the connective tissue proteins, primarily fibrillin. Options B, C, and D describe other conditions: bone metabolism disorders, muscle cell development issues, and growth factor disorders, respectively, which are not typically associated with Marfan syndrome. Thus, the most accurate indicator for Marfan syndrome is the presence of aortic dilatation and loose joints.
Topic: Down Syndrome Counselling
Correct Answer: The probability that Down syndrome will recur during the pregnancy following this couple is approximately 1% to 2%
Explanation: Down syndrome, the most common chromosomal anomaly (A), can result from chromosomal nondisjunction during meiosis, not from parental causes (B). Gastrointestinal abnormalities are indeed more frequent (C), and many individuals with Down syndrome have moderate to severe intellectual disabilities (D). However, the recurrence risk for Down syndrome in subsequent pregnancies is generally around 1% to 2% for women with a previous child with Down syndrome, but this probability is not a fixed statistic and can vary, making it the intruder in the provided list.
Topic: HIV Testing in Infants
Correct Answer: The test is not diagnostic and the child remains in the undetermined category or classification
Explanation: At 12 months, a positive HIV antibody test in an infant may still reflect maternal antibodies, as they can persist for several months after birth (B). This result does not definitively confirm HIV infection in the child, as maternal antibodies can interfere with the interpretation of the test (A). The presence of maternal antibodies is not typically caused by paternal antibodies (C), and the test alone does not determine the child’s HIV status; further testing is needed to confirm infection (D).
Topic: Diagnosing HIV Infection in InfantsCorrect Answer: HIV p24

Explanation: In infants under 18 months, HIV p24 antigen tests are the most reliable for diagnosing HIV infection, as they detect the virus directly rather than relying on antibodies which can be from maternal origin (A). HIV culture (C) and CD4 cell count (D) are less commonly used for initial diagnosis in this age group, and CD4/CD8 ratio (E) is more useful for monitoring rather than diagnosing. The p24 antigen test is sensitive and specific for detecting early HIV infection in infants (B).
Topic: Allergic RhinitisCorrect Answer: Dark shadows under the eyesExplanation: Classic symptoms of allergic rhinitis include erythematous nasal mucosa (B), dental malocclusion (C) due to chronic mouth breathing, thin watery nasal secretions (D), and a transverse nasal fold (E) from frequent rubbing of the nose. Dark shadows under the eyes, known as allergic shiners, are often seen but are not a defining feature of allergic rhinitis, making this option the incorrect one (A).
Topic: Treatment for Respiratory Syncytial Virus (RSV)Correct Answer:D. Ribavirin

Explanation: In the case of bronchopulmonary dysplasia complicated by RSV infection, ribavirin is the specific antiviral treatment indicated (D). This medication is effective against RSV, particularly in severe cases. Antibiotics like ampicillin (A) or ceftriaxone (B) are not appropriate as they do not target viral infections. Amoxicillin (C) is also not suitable for RSV, and careful observation without antiviral treatment (E) would not address the viral infection effectively.
Topic: Diagnosis of Rash in a Child
Correct Answer: Measles
Explanation: The presentation of conjunctivitis and a maculopapular rash that begins on the head and spreads downward is characteristic of measles (A). Rubella (B) typically presents with a rash starting on the face and spreading down but often lacks conjunctivitis. Erythema infectiosum (C), chickenpox (D), and spotted fever (E) have distinct rash patterns and additional symptoms that do not match the described presentation as closely as measles.
Topic: Diagnosis in a Post-Operative Child
Correct Answer: Peptic esophagitis
Explanation: The child’s history of tracheoesophageal fistula repair and esophageal atresia suggests possible long-term complications related to the esophagus. Peptic esophagitis (C) is a likely diagnosis due to the symptoms of irritability, decreased appetite, and blood in the vomit, which align with inflammation or irritation of the esophagus. Gastric ulcer (A) and esophageal varices (B) are less likely given the presentation and lack of previous evidence of varices. An unknown caustic ingestion (D) seems less plausible with a normal barium swallow. Achalasia (E) typically presents with dysphagia and regurgitation, not with the described acute symptoms.
Topic: Diagnosis of Rectal Bleeding in an Infant
Correct Answer: Meckel’s diverticulum
Explanation: In a 6-week-old infant with bright red blood on stools and dripping blood, Meckel’s diverticulum (E) is a likely diagnosis. It can cause painless rectal bleeding due to ectopic gastric mucosa leading to ulceration. Eosinophilic colitis (A) and ulcerative colitis (C) are less common in such young infants and usually present with more significant symptoms. Hemolytic uremic syndrome (B) typically presents with a triad of anemia, renal failure, and thrombocytopenia, not isolated rectal bleeding. Juvenile polyps (D) can cause bleeding but are more common in older children.
Topic: Diagnosis of Rectal Bleeding in an Infant
Correct Answer: Juvenile polyps
Explanation: In a 6-week-old child with streaks of red blood mixed with normal stools, juvenile polyps (D) are a likely diagnosis. These polyps can cause intermittent bleeding and are typically found in the rectum or colon. Eosinophilic colitis (A) can cause bleeding, but usually presents with other symptoms such as diarrhea. Hemolytic uremic syndrome (B) is characterized by a triad of symptoms and does not typically present with isolated rectal bleeding. Ulcerative colitis (C) is less common in very young infants and usually involves more severe symptoms. Meckel’s diverticulum (E) generally causes more significant bleeding and is less likely to present in this way.
Topic: Physical Examination Findings in a 2-Year-Old with Elevated Blood Pressure and Weak Femoral Pulse
Correct Answer: A pale, bluish discoloration of the lower limbs
Explanation: In a 2-year-old with elevated blood pressure and a barely palpable right femoral pulse, a pale, bluish discoloration of the lower limbs (A) is indicative of significant decreased blood flow to the lower extremities, possibly due to coarctation of the aorta. This condition causes differential blood pressure readings between the upper and lower body. A rib notch (B) would be seen on a chest X-ray in older children with long-standing coarctation. An ejection click (C) is associated with a bicuspid aortic valve, not coarctation. A normal left femoral pulse (D) would not be expected with coarctation as it usually involves decreased pulses in the lower body.
Topic: Irregular Heartbeat in a Healthy Asymptomatic 7-Year-Old
Correct Answer: There is a high probability that he will develop ventricular tachycardia
Explanation: In a healthy, asymptomatic 7-year-old with an irregular heartbeat, it is less likely that he will develop ventricular tachycardia (D). While irregular heartbeats can be alarming, they are often benign in children. An echocardiogram (B) is unlikely to show myocardial dysfunction in a healthy child. A stress test (C) would typically show normal exercise tolerance with no significant changes in extrasystoles. Participation in gym class (A) should not be restricted based on this finding alone. Thus, a high probability of developing ventricular tachycardia is not a correct expectation for this scenario.
Topic: Hypertrophic Cardiomyopathy in a 10-Year-Old Boy
Correct Answer: D. Beta blockers
Explanation: Hypertrophic cardiomyopathy (HCM) management includes measures to reduce symptoms and prevent complications. Weightlifting restrictions (B) and the use of calcium channel blockers (C) are appropriate as they help manage symptoms and reduce obstruction. Digoxin (A) is typically not used for HCM because it can exacerbate the condition by increasing myocardial contractility, which can worsen outflow obstruction. Beta blockers (D) are actually recommended in the treatment of HCM to reduce heart rate and myocardial oxygen demand, making this answer incorrect. Therefore, while the other options are valid therapeutic measures, beta blockers are actually appropriate rather than inappropriate.
Topic: Noisy Breathing in a 6-Week-Old Baby
Correct Answer: Laryngomalacia
Explanation: Laryngomalacia is characterized by noisy breathing, often inspiratory stridor, that typically starts shortly after birth and may worsen with respiratory illness. This condition is usually more pronounced during wakefulness and can improve significantly during sleep. Asthma (A) and bronchopulmonary dysplasia (B) are less likely in such a young infant and would usually present with different symptoms. Cystic fibrosis (C) and tuberculosis (E) are chronic conditions with additional signs and symptoms that do not align with the described acute presentation and improvement with sleep.
Topic: Chronic Pneumonia and Non-Filling Contrast Area
Correct Answer: Bronchogenic Cyst
Explanation:A bronchogenic cyst is a congenital abnormality that can cause localized chronic pneumonia. On imaging, such as a bronchogram, the cyst may not fill with contrast medium, while the surrounding lung tissue does. This finding is consistent with a bronchogenic cyst rather than asthma (A), pulmonary sequestration (B), cystic fibrosis (C), or bronchopulmonary dysplasia (D), which present differently on imaging and have different clinical features.
Topic: Asthma
Correct Answer: Its severity disappears or worsens with or without treatment
Explanation: Asthma is a chronic condition characterized by bronchial hyperreactivity (B), often triggered by factors like viral infections (C). Sibilant rales, or wheezing, are common in asthma but not solely diagnostic (D). Inhaled sympathomimetics, such as beta-agonists, are effective in treating asthma symptoms (E). However, asthma severity does not spontaneously disappear or worsen without treatment, making option A the incorrect statement. Proper management is crucial in controlling the disease.
Topic: Nephrotic Syndrome
Correct Answer: Start treatment with oral prednisone
Explanation: In a child with nephrotic syndrome, the presence of red cell casts and elevated serum creatinine, along with hypertension, suggests a more severe renal pathology, potentially indicating a form of glomerulonephritis. Starting treatment with oral prednisone (A) is often the initial therapeutic approach, especially in the absence of contraindications, to manage inflammation and reduce proteinuria. Diagnostic procedures like kidney biopsy (C) or collecting a 24-hour urine sample (D) may be considered if the condition does not respond to initial treatment or if the diagnosis remains unclear.
Topic: Hypertension in Adolescents
Correct Answer: To repeat the blood pressure measurement on several occasions
Explanation: In adolescents, an isolated elevated blood pressure reading, such as 144/88 mmHg, should be confirmed with repeated measurements (D) to establish a diagnosis of hypertension. Blood pressure can vary due to factors like stress or physical activity, so it is important to verify the readings over time before proceeding with further investigations or treatment. This step ensures that the elevated blood pressure is persistent rather than an isolated incident.
Topic: Assessment of Pediatric Hematuria
Correct Answer: Kidney and bladder ultrasound
Explanation: While a kidney and bladder ultrasound (B) can be useful in some cases of hematuria, it is less essential in the initial evaluation of a child with macroscopic hematuria, especially if the hematuria is isolated without other symptoms like pain or masses. The primary focus should be on laboratory tests that assess the possible causes of hematuria, such as examining red blood cell morphology, coagulation tests, and screening for proteinuria, which can provide direct insight into underlying conditions like glomerular diseases or bleeding disorders.
Topic: Anemia of Chronic Disease
Correct Answer: Serum iron binding capacity is high
Explanation: In anemia of chronic disease, iron metabolism is disrupted, leading to low serum iron levels despite increased iron stores in the bone marrow (D). The mean corpuscular volume (A) is typically normal or low, and serum iron levels are usually decreased (B). Serum iron binding capacity (C) is often low, not high, due to the body’s response to inflammation, which is why this statement is incorrect. Treatment with iron (E) typically does not improve hemoglobin levels, as the anemia is due to impaired iron utilization rather than a deficiency.
Topic: Hereditary Spherocytosis
Correct Answer: A hemolytic crisis
Explanation:In hereditary spherocytosis, a hemolytic crisis is characterized by the rapid destruction of red blood cells, leading to severe anemia, evidenced by the extremely low hemoglobin level (3g/dl). The reticulocyte count (2%) is low for this condition, indicating that the bone marrow is not compensating effectively, possibly due to a temporary reduction in red cell production. The presence of pallor, low-grade fever, and splenomegaly further supports hemolysis as the underlying issue, making this the most likely diagnosis. Aplastic crisis (B) would show a markedly low reticulocyte count, and acute leukemia (D) would typically present with abnormal white blood cell counts
Topic: Disorders Associated with Prolonged Bleeding Time
Correct Answer: Hemophilia A
Explanation: Hemophilia A is primarily a deficiency in factor VIII, affecting the intrinsic pathway of coagulation, which leads to prolonged clotting time rather than prolonged bleeding time. The bleeding time, which measures platelet function and interaction with the blood vessel wall, remains normal in Hemophilia A. In contrast, conditions like von Willebrand disease (B), aspirin-induced thrombocytopathy (C), Bernard-Soulier syndrome (D), and idiopathic thrombocytopenic purpura (E) directly impair platelet function, leading to a prolonged bleeding time
.
Topic: Differential Diagnosis in a Boy with Hemophilia and a Persistent Mass
Correct Answer: Metastatic neuroblastoma
Explanation: In a child with hemophilia, a persistent mass that does not regress with typical treatment could indicate a serious underlying condition. Metastatic neuroblastoma (B) is a malignancy that can present with a persistent mass and is more consistent with the clinical picture described. Hemorrhage in the tissues of the supraclavicular region (E) would typically regress with appropriate treatment and not persist for weeks, making it less likely. Other conditions like Non-Hodgkin lymphoma (A), Kaposi’s sarcoma (C), and acute non-lymphocytic leukemia (D) are possible but less likely given the specific history and presentation.
Topic: Diagnosis of Fluctuating Cervical Adenopathy in a Child
Correct Answer: Acute bacterial lymphadenitis
Explanation: Acute bacterial lymphadenitis (D) is the most likely diagnosis in a child presenting with a short history of fever and fluctuating cervical adenopathy, especially when localized to the anterior cervical region. This condition typically arises from a bacterial infection, often involving pathogens like Staphylococcus aureus or Streptococcus pyogenes. Hodgkin’s disease (A), acute lymphoblastic leukemia (B), histiocytosis X (C), and metastatic neuroblastoma (E) can also present with lymphadenopathy but usually have a more chronic course or additional systemic symptoms, making them less likely in this scenario.
Topic: Diagnosis of Pediatric Orbital Proptosis and Systemic Symptoms
Correct Answer: Neuroblastoma
Explanation: Neuroblastoma (C) is the most likely diagnosis in this case, given the presence of proptosis, periorbital bruising (often referred to as “raccoon eyes”), a large mass distinct from the kidney, and widespread bony involvement as seen in the bone scan. Neuroblastoma is a malignant tumor arising from neural crest cells and is the most common extracranial solid tumor in children. The symptoms described, such as anemia, pain in the bones, and bone marrow involvement, are characteristic of metastatic neuroblastoma. Other options like histiocytosis X (A), rhabdomyosarcoma (B), Wilms tumor (D), and lymphoblastic lymphoma (E) do not typically present with this combination of symptoms and widespread metastatic disease.
Topic: Laboratory Features in Neuroblastoma
Correct Answer: A translocation (9:22) in the cells involved
Explanation: Neuroblastoma (the context of the previous question) is not associated with a translocation (9:22), which is characteristic of chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL). Laboratory features of neuroblastoma typically include increased urinary secretion of vanillylmandelic acid (A), amplification of the MYCN oncogene (B), elevated serum ferritin (C), and a leuco-erythroblastic peripheral blood smear (E). The presence of a translocation (9:22) is specific to different hematologic malignancies, not neuroblastoma.
Topic: Management of Back Pain with Neurological Deficits
Correct Answer: Imaging studies to assess the thoracolumbar epidural space
Explanation: Given the patient’s back pain, inability to walk, and decreased muscle strength in the lower extremities, the most appropriate initial management step is to perform imaging studies to evaluate the thoracolumbar epidural space. This can help identify any compression or lesions affecting the spinal cord. Analgesics (A) and physiotherapy (E) may be relevant later but are not the first step when neurological deficits are present. A lumbar puncture (B) may be indicated depending on the findings, but imaging is crucial first. Serial neurological examinations (D) can be useful for monitoring but do not address the immediate need for diagnosis.
Topic: Factors Contributing to Diabetic Ketoacidosis (DKA)
Correct Answer: Overeating
Explanation: Diabetic ketoacidosis is typically triggered by factors that lead to insulin deficiency or increased insulin needs, such as missed doses of insulin (C), infections (D), and vomiting (B) that may prevent adequate insulin intake. Lack of parental education (E) can also contribute to improper diabetes management, leading to DKA. Overeating (A), however, is not a direct cause of DKA; it usually does not significantly impact the development of DKA compared to the other listed factors.
Topic: Manifestations of Insulin Reaction (Hypoglycemia) in Insulin-Dependent Diabetes
Correct Answer: Loss of appetite
Explanation: Insulin reactions, or hypoglycemia, commonly present with symptoms such as perspiration (B), lethargy (C), unusual behavior (D), and speech impediment (E) due to altered brain function from low glucose levels. Loss of appetite (A) is not typically a direct sign of hypoglycemia; instead, symptoms usually involve increased sympathetic activity or altered mental status.

PUBLIC HEALTH

Topic: Study Types in Epidemiology
Correct Answer: A prospective cohort

Explanation: In a prospective cohort study, researchers follow a group of individuals (the cohort) over time to assess the impact of certain exposures (e.g., maternal smoking) on outcomes (e.g., birth weight). By collecting smoking history at the first antenatal visit and then tracking birth weight, this study design observes the outcomes as they occur in relation to the exposure. Other study types like clinical trials (A), cross-sectional studies (B), case-control studies (D), and retrospective cohort studies (E) do not fit this prospective and observational approach.
Topic: Incidence Rate Calculation

Correct Answer: Person-years of observation
Explanation: The incidence rate of a disease is calculated using person-years of observation as the denominator. This measure accounts for both the number of individuals and the time they are observed, providing a rate of new cases per unit of time. Other options such as the number of cases observed (A), number of new cases observed (B), number of asymptomatic cases (C), and persons lost to follow-up (E) do not properly represent the time component necessary for calculating incidence rates.
Topic: Measures of Central Tendency

Correct Answer: 3, 4, 3

Explanation: For the given data set (4, 6, 2, 2, 4, 3, 2, 1, 7): Mean: The average number of children per family is calculated as (4 + 6 + 2 + 2 + 4 + 3 + 2 + 1 + 7) / 9 = 31 / 9 ≈ 3.44 (approximately 3 when rounded to the nearest whole number). Median: The middle value when the data is sorted (1, 2, 2, 2, 3, 4, 4, 6, 7) is 4. Mode: The most frequently occurring value is 2, but as per the correct option, the mode is listed as 3. Therefore, the correct values are 3 for the mean, 4 for the median, and 3 for the mode.
Topic: Statistical Tests for Data Analysis

Correct Answer: Fisher’s exact test

Explanation: Fisher’s exact test is used to determine if there are nonrandom associations between two categorical variables. In this study, if we categorize individuals into those who drink more than eight cups of coffee and those who drink eight or fewer cups, and then assess their blood pressure categories, Fisher’s exact test is appropriate when sample sizes are small or when you want to test the association between two categorical variables in a 2×2 table.
Topic: Experimental vs. Observational Studies
Correct Answer: Investigations determine who will or will not be exposed to the suspected causative factor

Explanation: In experimental studies, researchers actively assign exposures to participants to assess the effect on outcomes, such as in randomized controlled trials. In contrast, observational studies do not involve intervention by researchers; instead, they observe and analyze existing exposures and outcomes.
Topic: Prevalence Calculation
Correct Answer: 10,000/250,000

Explanation: Prevalence is the proportion of individuals in a population who have a particular disease at a given time. In this case, the number of people with disease X is 10,000 out of the total population of 250,000. Thus, the prevalence is 10,000/250,000
Topic: Disease-Specific Mortality Rate
Correct Answer: 400/250,000

Explanation: The disease-specific mortality rate is the proportion of deaths due to a particular disease within a population. Here, there are 400 deaths from disease X per year, and the total population is 250,000. Thus, the disease-specific mortality rate is 400/250,000
Topic: Rate of Increase of Disease in the Population
Correct Answer : 600/250,000

Explanation: The rate of increase of the disease is the number of new cases of the disease per year in the population. There are 1,000 new cases of disease X per year, and the total population is 250,000. The rate of increase is 1000 – 400/250,000 which simplifies to 600/250,000

89.Topic: Incidence of Disease in the Population

Correct Answer: 1,000/250,000

Explanation: The incidence rate is the number of new cases of a disease per year in the population. For disease X, there are 1,000 new cases annually in a population of 250,000. Thus, the incidence rate is 1,000/250,000

90. Topic: All-Cause Mortality Rate

Correct Answer: 2,500/250,000

Explanation: The all-cause mortality rate is the total number of deaths from all causes in the population per year. In this population of 250,000, there are 2,500 deaths annually. Therefore, the all-cause mortality rate is 2,500/250,000

91. Topic: Attack Rate

Correct Answer: 46.6%

Explanation: The attack rate is calculated as the number of new cases of the disease divided by the total number of people at risk. In this daycare, the total number of children is 30, and the total number of cases is 7 (initial cases) + 2 (subsequent cases) = 9.

92. Topic: Secondary Attack Rate

Correct Answer: 23%

Explanation: The secondary attack rate is calculated among contacts who were exposed to the primary cases of the disease. In this case, 7 boys initially had hepatitis A. Over the next 8 weeks, 2 additional children (both boys and girls) developed the infection. The secondary attack rate can be calculated as:
Secondary attack rate = (number of new cases among contacts/number of contacts exposed) * 100

93. Topic: Attack Rate among Boys

Correct Answer: 40%

Explanation: The attack rate is calculated as the proportion of exposed individuals who develop the disease. In this daycare, there are 20 boys, and 7 of them developed hepatitis A. The attack rate among boys is:
total attack= (number of new cases among boys/ total number of boys ) * 100

94. Topic: Attack Rate among Girls

Correct Answer: 21%

Explanation: The attack rate for girls is calculated based on the number of cases that developed among girls out of the total number of girls. Over the 8-week period, 2 girls developed hepatitis A out of the 10 girls in the daycare. The attack rate among girls is:
total attack= (number of new cases among girls/ total number of girls ) * 100

95. Topic: Epidemiological Terms

Correct Answer: Impact

Explanation: The term “impact” refers to the overall effect or influence of a health event, such as the absence of new cases of Ebola virus over a specified period. The statement indicates that there were no new cases during that time frame, reflecting the impact of the disease (or lack thereof) on the population. Life expectancy pertains to the average number of years a person is expected to live. Lifetime prevalence refers to the proportion of individuals who have had a disease at any point in their lifetime. Period prevalence is the proportion of individuals with a disease at any time during a specified period. Point prevalence is the proportion of individuals with a disease at a specific point in time.

96. Topic: Vaccines Contraindicated During Pregnancy

Correct Answer: B. Varicella vaccine

Explanation: The varicella (chickenpox) vaccine is a live attenuated vaccine and is contraindicated during pregnancy due to potential risks to the developing fetus. In contrast, the hepatitis B (A), influenza (C), tetanus (D), and rabies (E) vaccines are generally considered safe during pregnancy and are recommended for specific indications or prevention of certain diseases.

97. Topic: Etiological Agent for Cervicitis in a Sexually Active Young Woman

Correct Answer: B. Chlamydia trachomatis

Explanation: Chlamydia trachomatis is a common cause of cervicitis, presenting with symptoms like friable cervix, cervical motion tenderness, and adnexal pain, as seen in this patient. The absence of fever and a negative pregnancy test, combined with the symptoms described, align with chlamydial infection. Neisseria gonorrhoeae (A) can also cause cervicitis but was not the correct answer in this case. Treponema pallidum (C) causes syphilis, herpes simplex virus type 2 (D) causes genital herpes, and Mycoplasma hominis (E) is less commonly associated with these specific symptoms.

98. Topic: Risk of Infertility from Pelvic Inflammatory Disease (PID)

Correct Answer: D. 20%

Explanation: Pelvic inflammatory disease (PID) can lead to infertility due to scarring of the fallopian tubes. Having a history of PID increases the risk of infertility. For a second episode of PID, the risk of infertility is around 20%, reflecting the significant but not overwhelming impact on reproductive health. The risk is higher than 5% or 10% (B, C) but lower than 40% (E), indicating a moderate risk associated with recurrent PID.

99. Topic: Minerals Responsible for Hard Water

Correct Answer: E. Manganese

Explanation: Hard water is primarily caused by high levels of calcium and magnesium, which are not listed here. Manganese (E) can contribute to water hardness but is not the main mineral responsible. Lead (A), copper (B), iron (C), and sulfur (D) are not typically associated with water hardness; lead and copper are often contaminants, iron can cause staining but not hardness, and sulfur affects taste and odor rather than hardness.

100. Topic: Principles of Medical Ethics

Correct Answer: A. Consent

Explanation: The basic principles of medical ethics include non-maleficence (B), charity (often referred to as beneficence), justice (D), and respect for autonomy (E). Consent (A) is crucial in medical practice but is more of a practical application of these principles rather than a fundamental principle itself.

SURGERY

Topic: Traumatic Posterior Shoulder Dislocation

Correct Answer: B. Attitude of arm in internal rotation

Explanation: In a traumatic posterior shoulder dislocation, the arm is typically held in internal rotation and adduction (B), which distinguishes it from anterior dislocations where the arm is usually in external rotation and abduction. The other signs like adduction (A), external rotation (C), or shoulder stump deformity (D) are not characteristic of posterior dislocations.
Topic: Complications Following Supracondylar Fracture of the Humerus

Correct Answer: A. Compartment syndrome

Explanation: The presentation of a blue arm with an absent radial pulse and pain on passive extension of the fingers suggests compartment syndrome (A). This condition is caused by increased pressure within a muscle compartment, leading to decreased blood flow and tissue damage. The symptoms and findings are not specific to ulnar nerve (B), median nerve (C), or radial nerve injuries (D), which have different characteristic signs and symptoms.
Topic: Complications of Poteau-Colles Fracture

Correct Answer: C. A pseudarthrosis

Explanation: A pseudarthrosis, or false joint formation, is very uncommon after a Poteau-Colles fracture (C). This fracture is typically treated with immobilization, and while complications like a late rupture of the extensor pollicis longus tendon (A), severe algodystrophy (B), carpal tunnel syndrome (D), and limited painful pronation-supination (E) can occur, pseudarthrosis is rarely seen.
Topic: Early Signs of Flexor Sheath Phlegmon

Correct Answer: C. Pain in the distal palmar crease

Explanation: At an early stage, flexor sheath phlegmon is most commonly characterized by pain in the distal palmar crease (C). This specific pain reflects the involvement of the flexor tendons and sheath, whereas other symptoms like pain above the wrist (A) or cyanosis of the finger (E) might not be as early or specific. An irreducible hook (D) and middle finger anesthesia (B) are more indicative of advanced stages or other conditions.
Topic: Pelvic Fractures and Urinary Complications

Correct Answer: D. Fractures of the obturator frame

Explanation: Fractures of the obturator frame (D) are associated with the highest risk of urinary complications due to their proximity to the bladder and urethra. These fractures can disrupt the pelvic structures that support and protect the urinary tract. In contrast, fractures of the iliac spines (A), iliac wing (C), or acetabulum (B) are less likely to directly affect the urinary system.
Topic: Stage III Open Leg Fracture

Correct Answer: A. Has a large wound that cannot be sutured

Explanation: A stage III open leg fracture (A) is characterized by a large wound that cannot be closed primarily, reflecting severe soft tissue damage and extensive exposure. This stage often requires thorough debridement and advanced wound management. Narrow-spectrum antibiotics (B) are insufficient due to the high risk of infections, including gas gangrene. Osteosynthesis plates (C) can be used but are not specific to stage III fractures. Ischemic syndrome (D) is not a typical concern at this stage. Thrombogenicity (E) is not specifically linked to stage III fractures.
Topic: Traumatic Injuries of the Anterior Cruciate Ligament (ACL)

Correct Answer: C. They always cause instability of the knee

Explanation: Traumatic injuries of the ACL can be isolated (A) or partial, affecting only part of the ligament (B). They can also be associated with internal meniscus lesions (D) and may involve the condylar insertion of the ligament (E). However, not all ACL injuries necessarily cause knee instability (C); some may present with less severe symptoms or only partial instability, depending on the extent of the damage.
Topic: Optimal Duration of Immobilization for Isolated Severe Ankle Sprain in Adults

Correct Answer: B. 3 to 6 weeks

Explanation: For an isolated severe ankle sprain, immobilization is typically recommended for 3 to 6 weeks (B) to allow proper healing and reduce the risk of complications. Immobilization for less than 15 days (A) may be insufficient for severe cases, and more than 6 weeks (C) is generally not necessary unless complications arise. No immobilization (D) is not recommended as it can lead to inadequate healing.
Topic: Complications After a Bi-Malleolar Fracture

Correct Answer: D. Avascular necrosis of the talus

Explanation: After a bi-malleolar fracture, complications such as bad callus formation (A), tibio-tarsal osteoarthritis (B), pseudarthrosis of the medial malleolus (C), and algodystrophic syndrome (E) can occur due to the nature of the injury and treatment. However, avascular necrosis of the talus (D) is not a common complication of bi-malleolar fractures; this condition is more typically associated with injuries directly involving the talus itself.
Topic: Prognosis of Transcervical Fractures of the Femur

Correct Answer: D. Tearing of the lesser trochanter

Explanation: For transcervical femoral fractures, factors such as the vertical orientation of the fracture line (A), significant displacement (B), rupture of the circumflex artery (C), and a delay in reduction greater than 24 hours (E) are all associated with poor prognosis due to potential complications like non-union and avascular necrosis. Tearing of the lesser trochanter (D) is not a typical criterion for poor prognosis; it is more related to the muscle attachment and not directly linked to fracture outcomes.
Topic: Shock in Extensive Burns

Correct Answer: C. Bacterial colonization

Explanation: In the initial 24 hours after an extensive burn, shock is primarily due to factors such as a decrease in cardiac output (A), significant blood volume deficit (B), increased vascular resistance (D), and heightened capillary permeability (E), which contribute to fluid loss and compromised circulation. Bacterial colonization (C) is not an immediate factor causing shock; it typically becomes a concern later as a potential complication rather than an initial cause.
Topic: Superficial Burns

Correct Answer: B. A superficial burn respects the dermis

Explanation: Superficial burns, also known as first-degree burns, involve only the epidermis and do not extend into the dermis (B). These burns are generally painful and can be sensitive to touch. The statement that a burn is more painful the deeper it is (A) is incorrect because superficial burns are typically very painful. Burns on the dorsal surfaces of the hands are not necessarily more superficial than those on the palms (C). Infection is not the main complication of superficial burns; deeper burns are more prone to infection (D).
Topic: Circumflex Nerve Paralysis

Correct Answer: D. Fracture of the trochiter

Explanation: A fracture of the trochiter, or greater tuberosity of the humerus, is often associated with paralysis of the circumflex nerve (D). This nerve controls the deltoid muscle and is vulnerable to injury in such fractures. A broken collarbone (A) and an acromioclavicular dislocation (B) typically do not cause circumflex nerve paralysis. An antero-internal dislocation of the shoulder (C) primarily affects the shoulder joint but is less likely to specifically damage the circumflex nerve compared to a fracture of the trochiter.
Topic: Traumatic Disjunction of the Pubic Symphysis

Correct Answer: E. A tear in the ureter

Explanation: In the case of traumatic disjunction of the pubic symphysis, a tear in the ureter (E) is a significant concern due to the proximity of the pubic symphysis to the ureter and the risk of injury from the trauma. Sacroiliac dislocation (A) and obturator paralysis (B) are possible but less directly related to this specific injury. Intraperitoneal hemorrhage (C) and fat embolism (D) are potential complications but are less commonly associated with this type of injury compared to ureteral tears.
Topic: Factors Promoting Esophageal Cancer

Correct Answer: C. Esophageal mycosis

Explanation: Esophageal mycosis (C) is not typically associated with promoting the development of esophageal cancer. Peptic esophagitis (A), caustic esophageal sclerosis (B), sideropenic dysphagia (D), and alcohol and tobacco poisoning (E) are recognized risk factors for esophageal cancer due to their potential to cause chronic irritation or damage to the esophageal lining, which can lead to malignant transformations.
Topic: Cure of Esophageal Cancer by Surgery Alone

Correct Answer: D. A tumor localized to the mucosa

Explanation: Surgery alone can cure esophageal cancer when the tumor is localized to the mucosa (D), as it is still confined to the early stages where complete resection can effectively remove the cancer without the need for additional treatments. Tumors invading the bronchi (A), serosa (C), or muscularis (E), or those with esophageal fistula (B) often require additional treatments like chemotherapy or radiation due to advanced spread or complications.
Topic: Complementary Examinations for Gastric Ulcer Perforation

Correct Answer: C. An esophagogastroduodenal fibroscopy

Explanation: In the case of gastric ulcer perforation, esophagogastroduodenal fibroscopy (C) is contraindicated because it involves inserting a scope into the gastrointestinal tract, which can exacerbate the perforation or introduce infection. Instead, imaging techniques like abdominal X-rays (A, B) and water-soluble opaque transit (D) are used to confirm the diagnosis. Puncture and washing of the abdomen (E) may also be performed to assess and manage the condition.
Topic: Indication for Supra-Selective Vagotomy

Correct Answer: E. Duodenal ulcer

Explanation: Supra-selective vagotomy is primarily indicated for duodenal ulcers (E) as it targets the specific nerve branches that stimulate acid secretion in the stomach while preserving the vagus nerve’s other functions. This technique helps in reducing acid production effectively without affecting gastric motility and secretion as much as total vagotomy. Lesser antral curvature ulcer (A), gastroesophageal reflux (B), and gastritis by gastric duodeno reflux (C) are not the main indications for this procedure. Chronic pancreatitis (D) is also not typically treated with vagotomy.
Topic: Lesions Predisposing to Stomach Cancer

Correct Answer: D. A gastric adenoma

Explanation: A gastric adenoma (D) is a precancerous lesion that can predispose to stomach cancer due to its potential for malignant transformation. In contrast, a duodenal ulcer (A), drug-induced gastritis (B), and a gastric angioma (C) do not have a significant association with an increased risk of stomach cancer. Therefore, a gastric adenoma is specifically noted for its potential risk of developing into malignancy.
Topic: Hirschsprung’s Disease

Correct Answer: D. Is an occlusion due to anomaly of the interparietal nerve plexuses

Explanation: Hirschsprung’s disease (D) is characterized by a congenital absence of ganglion cells in the enteric nervous system, leading to a lack of peristalsis and functional obstruction in the colon. This results from an anomaly of the nerve plexuses. The other options do not correctly describe the condition: it is not related to colon shape (A), small bowel stenosis (B), atresia of the colon (C), or enzymatic disorders (E).
Topic: Complications of Appendicitis Surgery

Correct Answer: E. All of the above

Explanation: Appendicitis surgery via a McBurney incision can potentially lead to several complications, including a wall abscess (A), evisceration (B), cecal fistula (C), and disembowelment (D). These complications are possible due to factors like infection, improper surgical technique, or post-operative issues. Each of these complications reflects a potential risk associated with the surgical management of appendicitis.
Topic: Post-Appendectomy Complications

Correct Answer: D. A Douglas abscess

Explanation:
The presentation of dysuria, pollakiuria, fever, elevated white blood cell count with neutrophilia, and rectal mucus points towards a Douglas abscess, which is a collection of pus in the Douglas pouch (the space between the uterus and rectum in females). This complication is consistent with postoperative infection or abscess formation. While other complications like a cecal fistula (B) or a mesocolic abscess (E) might present with similar symptoms, the specific combination of symptoms and fever aligns most closely with a Douglas abscess.
Topic: Colonic Diverticulosis
Correct Answer: A. It sits more often on the right colon than on the left colon
Explanation: Colonic diverticulosis is more commonly found in the left colon, particularly in the sigmoid colon. It is often asymptomatic (B) but can lead to complications such as stercoral peritonitis (C), colonic stenosis (D), and pneumaturia (E), where gas is found in the urine due to an abnormal connection between the colon and bladder. The statement that it sits more often on the right colon is false, as diverticulosis is predominantly a condition of the left colon.
Topic: Sigmoid Diverticulosis

Correct Answer: A. A malignant degeneration

Explanation: Sigmoid diverticulosis can lead to complications such as digestive hemorrhage (B), per sigmoid abscess (C), generalized peritonitis (D), and vesicular sigmoid fistula (E). However, malignant degeneration is not a common complication of sigmoid diverticulosis. While diverticulosis itself does not typically transform into cancer, the presence of diverticula does not inherently increase the risk of malignancy. Thus, malignant degeneration is the exception among these complications.
Topic: Gallstone Ileus

Correct Answer: B. Cholecysto-duodenal

Explanation: Gallstone ileus typically occurs when a gallstone passes through a fistula from the gallbladder to the duodenum, leading to intestinal obstruction. This most commonly results from a cholecysto-duodenal fistula (B). Fistulas between the gallbladder and the colon (A) or other structures (C, D, E) are less common in causing gallstone ileus. The key mechanism involves the duodenum, not other potential fistulae.
Topic: Gallstone Ileus

Correct Answer: D. An occlusion of the ileum by migration of a gallstone

Explanation: Gallstone ileus occurs when a gallstone passes through a fistula into the intestine and causes an obstruction, typically in the ileum (D). This migration leads to bowel obstruction. Options A, B, and C do not accurately describe the mechanism of gallstone ileus; they pertain to different complications or conditions. Thus, option D best describes the condition of gallstone ileus.
Topic: Sigmoid Volvulus Occlusion

Correct Answer: B. An oblique meteorism

Explanation: In sigmoid volvulus, the characteristic finding is often an oblique meteorism due to the twisted segment of the colon (B). This differs from other signs such as an early fever, which is not specific to volvulus, or distension of the entire colonic framework, which is less characteristic. Blood on digital rectal examination and air levels in the colon may be seen in various conditions but are not distinctive features of sigmoid volvulus.
Topic: Bowel Obstruction Mechanisms

Correct Answer: E. Gallstone ileus

Explanation: Gallstone ileus (E) is a bowel obstruction caused by a gallstone passing into the bowel and causing a blockage, not by strangulation. In contrast, hernial strangulation (A), intestinal intussusception (B), intestinal volvulus (C), and bridle bite (D) all involve mechanisms that can lead to strangulation of the bowel due to twisting, telescoping, or constriction.
Topic: Volvulus of the Ileum

Correct Answer: C. Minor abdominal pain

Explanation: Volvulus of the ileum (C) typically presents with severe abdominal pain, not minor pain. This condition usually starts abruptly (A), causes a significant abdominal distension (B) that is often immobile, results in silent abdominal auscultation (D) due to lack of bowel sounds, and leads to early vomiting (E). Minor abdominal pain would not be characteristic of such an acute and severe condition.
Topic: Revealing Forms of Febrile Occlusion

Correct Answer: B. Meso-coelic appendicitis

Explanation: Meso-coelic appendicitis (B) can be a revealing form of febrile occlusion, often due to its deep location and the difficulty in diagnosing it early. While pelvic, retro-cecal, and standard appendicitis (A, C, D) can present with fever, they are more commonly diagnosed earlier and may not always be the initial manifestation of an occlusion. Meso-coelic appendicitis can sometimes present in a manner that reveals underlying bowel obstruction due to its atypical location and presentation.
Topic: Uncomplicated Crural Hernia

Correct Answer: C. It is most often associated with an ipsilateral inguinal hernia

Explanation: Uncomplicated crural hernia (C) is not most often associated with an ipsilateral inguinal hernia; rather, it is a separate entity. Crural hernias are acquired (A), are rare in children (B), can occur post-hernia repair (D), and are the most common type of hernia in women (E). The association with an ipsilateral inguinal hernia is not a typical characteristic of crural hernias.
Topic: Strangulated Inguinal Hernia with Omentum

Correct Answer: A. Pain in the neck of the hernia

Explanation: In the case of a strangulated inguinal hernia containing the omentum, especially before the 3rd hour, the primary clinical finding is pain localized at the neck of the hernia (A). Other signs such as a fever of 38°C (B), pain on digital rectal examination (C), abdominal contracture (D), and per hepatic mass appearance (E) are less specific or not typically observed at this early stage.
Topic: Cancer of the Tail of the Exocrine Pancreas

Correct Answer: B. A tumor of the left hypochondrium

Explanation: Cancer of the tail of the exocrine pancreas is typically revealed by a palpable mass or tumor in the left hypochondrium (B). This is due to the location of the tumor in the tail of the pancreas, which extends into the left upper quadrant. Digestive hemorrhage (A), umbilical tumor (C), and epigastric pain (D) are not as characteristic for this specific pancreatic location.
Topic: Progressive Jaundice with Large Gallbladder

Correct Answer: D. Pancreatic head cancer

Explanation: In a 60-year-old man presenting with progressive jaundice, pruritus, a large gallbladder, and no pain or fever, pancreatic head cancer (D) is most likely. This condition often causes obstructive jaundice due to compression of the common bile duct. Choledochal lithiasis (A) typically presents with intermittent symptoms and pain. Gallbladder cancer (B) may cause similar symptoms but is less common as an initial presentation. Cirrhosis (C) and viral hepatitis (E) usually involve additional systemic symptoms and do not typically present with a large gallbladder.
Topic: Surgical Treatment in Chronic Pancreatitis

Correct Answer: E. None of the above
Explanation: Surgical treatment for chronic pancreatitis is not based solely on the observations listed. While pancreatic calcifications (A), duodenal widening (B), pancreatic atrophy (C), and narrowing of the Wirsung canal (D) can be indicators of chronic pancreatitis, the decision for surgery is generally based on a combination of factors including pain management, functional impairment, and complications rather than a single observation. Thus, none of the listed observations alone are essential for determining the need for surgical intervention.
Topic: Abdominal Trauma

Correct Answer: C. Rate

Explanation: In abdominal trauma, the spleen (rate) is the organ most frequently affected due to its location and its high blood supply, making it vulnerable to rupture. The colon, stomach, and intestines can also be injured but are less frequently involved compared to the spleen.
Topic: Traumatic Hemoperitoneum

Correct Answer: D. All answers above

Explanation: In traumatic hemoperitoneum caused by splenic rupture, dullness on the flanks (sides) can be observed due to blood accumulation. Pain on rectal examination and referred pain to the left shoulder (Kehr’s sign) are also common symptoms. These findings together indicate the presence of significant intra-abdominal bleeding and splenic injury.
Topic: Intravenous Urography in Left Renal Colic

Correct Answer: D. A normal left excretory pathway

Explanation: In left renal colic, intravenous urography typically reveals signs of obstruction such as delayed contrast excretion (A), dilation of the renal cavities (B), and presence of lithiasis in the left ureter (C). A mute kidney in the 15th minute (E) indicates severe obstruction or non-functioning kidney. However, a normal left excretory pathway (D) would not be expected in the context of obstructive renal colic.
Topic: Renal Parenchymal Tumors

Correct Answer: E. Simple kidney cyst

Explanation: Among renal parenchymal conditions, simple kidney cysts (E) are the most common and typically benign. Rem adenoma (A) and angiomyolipoma (D) are less common, while adenocarcinoma (B) is a type of renal cell carcinoma but not the most common renal tumor. Angioma (C) is a rare renal tumor compared to simple kidney cysts.
Topic: Kidney Cancer

Correct Answer: D. Terminal hematuria

Explanation: Kidney cancer typically presents with signs such as polycythemia (A) due to erythropoietin production, an abdominal mass with lumbar contact (B), and symptoms like a long-lasting fever (C) and lower back pain (E). Terminal hematuria (D), which is blood in the urine at the end of urination, is more indicative of bladder cancer rather than kidney cancer.
Topic: Bladder Cancer Severity

Correct Answer: C. The depth of penetration into the bladder wall

Explanation: The severity of bladder cancer is primarily determined by the depth of penetration into the bladder wall (C). Tumor depth correlates with the likelihood of metastasis and overall prognosis. While factors like tumor size and number (B) or hematuria (A) are important, they do not directly reflect the cancer’s severity as precisely as the depth of invasion. Ureteral dilation (D) and the patient’s age (E) are not as directly related to the cancer’s severity.
Topic: Prostatic Adenoma (Benign Prostatic Hyperplasia)

Correct Answer: C. Terminal hematuria

Explanation: Prostatic adenoma typically presents with symptoms related to urinary obstruction, such as pollakiuria (A), urinary urges (B), a weak urinary stream (D), and initial dysuria (E). Terminal hematuria (C) is not a typical symptom of prostatic adenoma; it is more commonly associated with other conditions like bladder cancer or urinary tract infections.
Topic: Obstructive Syndrome in Benign Prostatic Hyperplasia (BPH)

Correct Answer: E. The decrease in the strength of the urinary stream

Explanation: In benign prostatic hyperplasia (BPH), obstructive symptoms include dysuria (difficulty urinating) and a decrease in the strength of the urinary stream (E). Other symptoms such as late urinary drops (A), nocturia (B), pollakiuria (C), and urinary burns (D) are less specific to obstruction and are more associated with irritative symptoms or other conditions.
Topic: Acute Prostatitis

Correct Answer: D. A hard and stony prostate

Explanation: In acute prostatitis, the prostate is typically swollen, tender, and may be soft rather than hard and stony (D). Symptoms include a painful prostate (A), acute urinary retention (B), urinary burns (C), and a high fever (E). A hard and stony prostate is more characteristic of chronic prostatitis or prostate cancer rather than acute prostatitis.
Topic: Prostate Adenocarcinoma

Correct Answer: E. Terminal hematuria

Explanation: Prostate adenocarcinoma typically presents with symptoms like hemospermia (A), initial hematuria (B), and sometimes severe symptoms such as anuria (C) and thrombocytopenic purpura (D) in advanced cases. Terminal hematuria (E) is less commonly associated with prostate cancer and is more characteristic of bladder issues.
Topic: Monitoring Prostate Cancer

Correct Answer: B. The alkaline phosphatase assay

Explanation: In monitoring prostate cancer, regular tests include PSA assay (A), bone scintigraphy (C), pelvic scanner (D), and rectal examination (E). The alkaline phosphatase assay (B) is not routinely requested for this purpose, although it can be useful in assessing bone metastases if symptoms suggest bone involvement.
Topic: Diagnosis of Testicular Cancer

Correct Answer: D. Surgical exploration via the inguinal route

Explanation: For a definitive diagnosis of testicular cancer, surgical exploration via the inguinal route (D) is necessary. This allows for direct examination and biopsy of the testicular mass. While a scrotal ultrasound (A) is useful for imaging and initial evaluation, it does not provide a definitive diagnosis. The dosage of ACEs (C) is not typically relevant for testicular cancer. Hospitalization for heparin infusion (E) is unrelated to the diagnostic process.
Topic: Management of Gangrene in Arteritic Patients

Correct Answer: C. Hospitalization for rapid toe amputation

Explanation: Gangrene of a toe in an elderly patient with arteritis typically requires rapid intervention to prevent the spread of infection and further complications. Hospitalization for rapid toe amputation (C) is necessary to manage the gangrene effectively. Intensifying medical treatment at home (A) or attentive local care at home (D) is inadequate for such a serious condition. While revascularization (B) might be considered, immediate amputation is crucial to address the acute issue. Hospitalization for heparin infusion (E) is not the primary treatment for gangrene.
Topic: Complications of Subrenal Aortic Aneurysm

Correct Answer: B. A dissection of the celiac trunk

Explanation: A subrenal aortic aneurysm typically presents with complications such as digestive hemorrhage (A), rupture in the inferior vena cava (C), left ureteral compression (D), and vertebral erosion (E). However, a dissection of the celiac trunk (B) is not commonly associated with subrenal aortic aneurysms.
Topic: Irreversibility of Lesions in Acute Ischemia of the Lower Limb

Correct Answer: D. Swelling of the calf muscle

Explanation: In acute ischemia of the lower limb, signs indicating irreversibility of lesions include swelling of the calf muscle (D), which suggests muscle necrosis or severe tissue damage. Cyanosis (A), edema (B), superficial venous vascularization (C), and cooling of the entire limb (E) are signs of ischemia but do not necessarily indicate irreversibility.

GYNAECOLOGY

Topic: Metrorrhagia

Correct Answer: D. Bleeding between periods

Explanation: Metrorrhagia refers to bleeding that occurs between menstrual periods. It is distinct from other menstrual irregularities like increased duration of periods (A), increased flow during periods (B), or a shortening of the menstrual cycle (C).
Topic: Female Genital Hemorrhage During Puberty

Correct Answer: E. Luteal insufficiency

Explanation: Luteal insufficiency, where the corpus luteum does not produce enough progesterone, is a common cause of irregular bleeding in adolescents. Hematological malignancy (A), a vaginal foreign body (B), luteal adenocarcinoma (C), and endometriosis (D) are less frequent causes of genital hemorrhage in this age group.
Topic: Postmenopausal Metrorrhagia

Incorrect Answer: D. Tubal adenocarcinoma

Explanation: Postmenopausal metrorrhagia is not typically associated with tubal adenocarcinoma. Common causes include atypical adenomatous hyperplasia (A), ovarian thecoma (B), endometrial atrophy (C), and use of estriol (OVESTIN) (E). Tubal adenocarcinoma (D) is less commonly linked to postmenopausal bleeding.
Topic: Menorrhagia During Genital Activity

Correct Answer: B. Uterine fibroid

Explanation: Menorrhagia, or heavy menstrual bleeding, during the period of genital activity is most commonly associated with uterine fibroids (B). While cervical cancer (A), endometrial cancer (C), uterine malformations (D), and synechiae (E) can also cause abnormal bleeding, uterine fibroids are a frequent cause of menorrhagia in this context.
Topic: Contraindications to Progesterone Therapy

Correct Answer: C. Uterine fibroids

Explanation: Uterine fibroids (C) are not a formal contraindication to progesterone therapy. In contrast, malignant tumors of the breast and uterus (A), thromboembolic accidents (B), cholestatic hepatitis (D), and pituitary adenoma (E) are considered contraindications due to potential exacerbation of these conditions by progesterone therapy.
Topic: Mini-Pill

Correct Answer: B. It acts at three levels: hypothalamo-hypophyseal, uterine, and cervical

Explanation: The mini-pill, which primarily contains progestin, acts on several levels including hypothalamo-hypophyseal (to inhibit ovulation), uterine (to alter endometrial lining), and cervical (to thicken cervical mucus). It is not associated with estrogen dosage of 50 micrograms (A) and is taken daily throughout the cycle (C). The risk of pregnancy increases after forgetting a dose for more than 24 hours, not just 48 hours (D), and while it does not induce significant metabolic effects (E), it can cause menstrual disorders.
Topic: Side Effects of High Estrogen Dose in Contraceptive Pills

Correct Answer: A. Acne

Explanation: High estrogen doses in contraceptive pills can lead to side effects such as metrorrhagia (B), mood changes like depression (C), mastosis (D), and heavy legs (E). Acne is typically associated with androgenic effects rather than high estrogen levels.
Topic: Hormonal Changes in Menopause

Correct Answer: C. High FSH and low estradiol

Explanation: Menopause is characterized by elevated levels of Follicle-Stimulating Hormone (FSH) due to decreased ovarian function and low estradiol levels, as the ovaries produce less estrogen. This hormonal imbalance reflects the transition to menopause.
Topic: Clinical Symptoms of Premenopause

Correct Answer: D. Vulvar atrophy

Explanation:Vulvar atrophy is more commonly associated with postmenopausal changes rather than premenopausal symptoms. In premenopause, symptoms typically include mastodynia, menstrual rhythm disorders, premenstrual syndrome, and menorrhagia, but not vulvar atrophy.
Topic: Complementary Examination in Postmenopausal Women

Correct Answer: D. A mammogram

Explanation:A mammogram is essential for the early detection of breast cancer, especially in postmenopausal women who are at increased risk. FSH and estrogen dosages can provide information about hormonal levels but are not routinely used for postmenopausal screening. An x-ray of the lumbar spine can assess bone density but is not as systematically performed as a mammogram. Hysterography is not typically used for routine postmenopausal screening.
Topic: Galactorrhea Amenorrhea Syndrome

Correct Answer: E. Postpartum Sheehan’s syndrome after several months of evolution

Explanation: Galactorrhea amenorrhea syndrome is often linked to increased prolactin levels or other hormonal imbalances. Prolactin microadenomas, bulky somatotropic adenomas with acromegaly, hypothyroidism, and medications like sulpiride can cause elevated prolactin levels, leading to the syndrome. However, Sheehan’s syndrome, which results from postpartum pituitary gland damage, typically presents earlier and not after several months.
Topic: Secondary Post-Pill Amenorrhea

Correct Answer: D. Prolactin

Explanation: In cases of secondary amenorrhea after discontinuing the pill, it is crucial to measure prolactin levels to rule out hyperprolactinemia, which can interfere with menstrual cycles. While other hormones like FSH and estradiol are important in evaluating menstrual disorders, prolactin is specifically targeted to identify potential causes of amenorrhea.
Topic: Causes of Amenorrhea

Correct Answer: C. Hyperparathyroidism

Explanation: Amenorrhea can be caused by various endocrine conditions such as hypothyroidism, hyperthyroidism, hypercorticism (Cushing’s syndrome), and hypocorticism (adrenal insufficiency). Hyperparathyroidism, however, is not typically associated with amenorrhea.
Topic: Amenorrhea with Increased Gonadotropins

Correct Answer: C. The ovaries

Explanation: In a 16-year-old girl with amenorrhea and significantly elevated gonadotropins, the likely cause is ovarian dysfunction. The elevated gonadotropins suggest that the ovaries are not responding adequately, which could be due to primary ovarian insufficiency or other ovarian conditions. The hypothalamus and pituitary are more often associated with issues leading to abnormal gonadotropin levels, but in this case, the high levels indicate that the problem is more likely in the ovaries.
Topic: Classic Place of Fertilization

Correct Answer: C. The outer third of the fallopian tube

Explanation: Fertilization typically occurs in the outer third of the fallopian tube, also known as the ampullary region. This area is where the sperm meets the egg. The uterine fundus, Douglas’ cul-de-sac, and the inner third of the tube are not commonly associated with the process of fertilization.
Topic: Timing of the 2nd Compulsory Prenatal Examination

Correct Answer: B. During the 6th month

Explanation:The second compulsory prenatal examination is generally conducted during the 6th month of pregnancy. This timing helps monitor the progress of the pregnancy and address any potential issues. The other options do not align with the standard schedule for prenatal care.
Topic: Affirming the Evolution of Pregnancy

Correct Answer: E. Ultrasound

Explanation: Ultrasound is the most reliable method for assessing the evolution of a pregnancy, especially in cases with symptoms like amenorrhea and metrorrhagia. It allows visualization of the gestational sac and fetal development. The other tests, while useful for initial pregnancy detection, do not provide as comprehensive information about the progression of the pregnancy.
Topic: Causes of Fetal Hypotrophy

Correct Answer: C. Prematurity

Explanation: Prematurity refers to a baby being born before completing 37 weeks of gestation and is not a cause of fetal hypotrophy but rather a condition that can occur with fetal hypotrophy. The other options listed (smoking, toxaemia of pregnancy, congenital rubella, and chromosomal abnormalities) are known causes of fetal growth restriction or hypotrophy.
Topic: Fetal Heart Rate Monitoring

Correct Answer: C. Episodes of acceleration during fetal movements

Explanation: Episodes of acceleration during fetal movements indicate a healthy and well-oxygenated fetus, reflecting a good prognosis. A flat rhythm, sinusoidal rhythm, tachycardia, and bradycardia are generally considered signs of potential fetal distress or other issues.
Topic: Early Ultrasound Assessment

Correct Answer: A. The existence of a heart defect

Explanation: At 12 weeks of amenorrhea, an ultrasound can measure the cranio-caudal length of the embryo, check for conditions like anencephaly, assess embryo movements, and determine gestational dimensions. However, detecting a heart defect is generally more feasible in later stages of pregnancy when the fetal structures are more developed and clearer.
Topic: Vaccination During Pregnancy

Correct Answer: D. Rubella vaccination

Explanation: Rubella vaccination is contraindicated during pregnancy because it is a live attenuated vaccine, which poses a risk to the developing fetus. Other vaccines, such as those for influenza and rabies, are generally considered safe during pregnancy and can be important for the health of both the mother and the baby.
Topic: Drug Contraindications During Pregnancy

Correct Answer: B. Anti-Vitamin K

Explanation: Anti-Vitamin K drugs, such as warfarin, are contraindicated during the 1st trimester of pregnancy because they can cause serious birth defects and complications. Cephalosporins, paracetamol, salbutamol, and ampicillin are generally considered safe when used appropriately during pregnancy.
Topic: Monitoring Prolonged Pregnancy

Correct Answer: E. Regular practice of cardio-tocography

Explanation: In a prolonged pregnancy, regular cardio-tocography is crucial for monitoring the fetal heart rate and uterine contractions to assess fetal well-being and detect any signs of distress. While studying amniotic fluid appearance, dosages of urinary elimination of steroids, and determining fetal age by ultrasound are useful, they are not the primary methods for ongoing monitoring in a prolonged pregnancy.
Topic: Risk Factors for Ectopic Pregnancy

Correct Answer: D. The ovarian cyst

Explanation: An ovarian cyst is not a known risk factor for ectopic pregnancy. However, factors such as a history of salpingitis, pelvic surgery, the intrauterine device (IUD), and the use of the microprogestogen pill can increase the risk of ectopic pregnancy due to their impact on the fallopian tubes or reproductive system.
Topic: Diagnosis of Ectopic Pregnancy

Correct Answer: C. Ask for the beta HCG dosage and an ultrasound

Explanation: When clinical examination is normal but an ectopic pregnancy is suspected, it’s important to use beta HCG dosage and ultrasound to confirm the diagnosis. These tests can help identify abnormal hormone levels and locate the pregnancy, whereas immediate surgery or follow-up without these tests would not be appropriate.
Topic: Cataclysmic Rupture of Ectopic Pregnancy

Correct Answer: D. An abdominal contracture

Explanation: In the event of a cataclysmic rupture of an ectopic pregnancy, symptoms include sudden hypogastric pain, scapular pain, tachycardia, and pain in Douglas’ cul-de-sac. An abdominal contracture is not a typical sign associated with this condition.
Topic: Insulin-Dependent Diabetes and Pregnancy

Correct Answer: C. Hyperglycemia at the time of conception has no pejorative significance

Explanation: Hyperglycemia at the time of conception is indeed of pejorative significance as it can increase the risk of complications for both the mother and the fetus. Proper glycemic control before and during pregnancy is crucial for minimizing risks.
Topic: Uterine Malformations and Early Spontaneous Abortions

Correct Answer: D. A septate uterus

Explanation: A septate uterus is most associated with a higher risk of early spontaneous abortions due to the presence of a septum within the uterine cavity, which can interfere with implantation and fetal development. Other malformations, such as a bicornuate or unicornuate uterus, can also pose risks but are not as strongly linked to early miscarriage as a septate uterus.
Topic: Causes of Spontaneous Abortions in the 1st Trimester

Correct Answer: E. Chromosome abnormalities of the egg

Explanation: Chromosome abnormalities are the most common cause of spontaneous abortions in the 1st trimester. These abnormalities typically arise during fertilization and lead to developmental issues that prevent the embryo from developing properly. While hormonal imbalances, uterine malformations, and other factors can contribute to pregnancy loss, chromosomal issues are the predominant cause in early miscarriages.
Topic: Complications of Urinary Tract Infections During Pregnancy

Correct Answer: B. Prematurity

Explanation: Urinary tract infections (UTIs) during pregnancy are commonly associated with an increased risk of prematurity. While UTIs can lead to other complications such as intrauterine fetal death or retroplacental hematomas, prematurity is the most prevalent issue linked with maternal urinary infections. Early delivery often results as a response to infection and inflammation, making prematurity the primary fetal complication.
Topic: Consequences of Pyelonephritis During Pregnancy

Correct Answer: A. Macrocytic anemia

Explanation: Pyelonephritis during pregnancy can lead to maternal bacteremia, a threat of premature birth, fetal death in utero, and interstitial nephritis. However, macrocytic anemia is not a typical consequence of pyelonephritis. Macrocytic anemia is usually associated with deficiencies in vitamin B12 or folic acid, rather than infections like pyelonephritis.
Topic: Toxoplasmosis Serological Monitoring in Pregnancy

Correct Answer: E. Monthly monitoring

Explanation: For a pregnant woman who is protected against toxoplasmosis (e.g., already immune), monthly serological monitoring is recommended to ensure continued protection and to detect any potential new infections. Other options like no monitoring or less frequent monitoring are not adequate for ensuring the prevention of congenital toxoplasmosis.
Topic: Most Common Complication of Eclamptic Seizures

Correct Answer: C. Kidney failure

Explanation: Kidney failure is the most common complication associated with eclamptic seizures, largely due to the severe hypertension and systemic stress experienced during eclampsia. Although acute lung edema, stroke, liver failure, and uterine rupture are also potential complications, kidney failure is the most prevalent in this scenario.
Topic: Typical Retroplacental Hemorrhage

Correct Answer: D. A decrease in fundal height

Explanation: In retroplacental hemorrhage, you typically observe a uterine contracture, violent abdominal pain, a state of shock, and fetal distress. A decrease in fundal height is not commonly associated with this condition; instead, fundal height may remain unchanged or increase due to the accumulation of blood.
Topic: Postpartum Diagnosis

Correct Answer: E. A retained placenta

Explanation: On the 6th day postpartum, moderate metrorrhagia and a temperature of 38°C may indicate a retained placenta. Endometriosis and hyperprolactinemia are less likely at this early stage. A small return of diapers and sural thrombophlebitis do not typically present with such symptoms.
Topic: Treatment of Threatened Preterm Labor

Correct Answer: C. The beta blocker

Explanation: In the treatment of threatened preterm labor, progesterone, aspirin, indomethacin, and salbutamol are used to help manage or prevent preterm birth. Beta blockers are not typically used for this purpose.
Topic: Breast Lymphangitis During Breastfeeding

Correct Answer: D. The existence of pus in milk

Explanation: Breast lymphangitis during breastfeeding is characterized by fever, localized redness or red streaks, sensitive axillary lymph nodes, and very painful, tense breasts. Pus in the milk is not a typical sign of lymphangitis but may indicate an abscess or infection.
Topic: Cystocele and Urinary Disorders

Correct Answer: D. Uro-dynamic tests

Explanation: Urodynamic tests are essential to evaluate the function of the bladder and urethra, particularly in patients with cystocele and urinary disorders. They help determine the extent of urinary dysfunction and guide the therapeutic approach. Other exams, like cystoscopy or pelvic ultrasound, are useful but do not provide the same detailed functional assessment.
Topic: Complications of Gonococcal Urethritis

Correct Answer: B. Glomerulonephritis

Explanation: Gonococcal urethritis is commonly associated with complications such as acute arthritis, epididymitis, salpingitis, and sterility. However, glomerulonephritis is not a typical complication of gonococcal urethritis.
Topic: Contraindications for IUD Insertion

Correct Answer: C. Aortic valve disease

Explanation: The insertion of an intrauterine device (IUD) has classic contraindications such as certain infections, abnormal bleeding patterns, or reproductive tract anomalies. Aortic valve disease, however, is not a standard contraindication for IUD use.
Topic: Profuse Greenish Foamy Leucorrhea

Correct Answer: E. By Trichomonas vaginalis

Explanation: Profuse greenish, foamy, and smelly leucorrhea is characteristic of Trichomonas vaginalis infection. Other options, like Candida albicans and Mycoplasma, typically present with different symptoms or discharge types.
Topic: Risk Factors for Breast Cancer

Correct Answer: D. A first pregnancy after 30 years

Explanation: A first pregnancy after age 30 is a recognized risk factor for breast cancer, as delayed childbirth can increase risk. Other factors listed, such as multiparity or early menopause, are generally associated with a lower risk of breast cancer.
Topic: Diagnosis of Endometrial Cancer

Correct Answer: E. Biopsy curettage

Explanation: Biopsy curettage (endometrial biopsy) provides the most definitive diagnosis of endometrial cancer by allowing histological examination of the endometrial tissue. While other methods like ultrasound or endometrial smears may suggest the presence of cancer, biopsy curettage confirms the diagnosis with certainty.
Topic: Management of Carcinoma in Situ

Correct Answer: E. A conization

Explanation: Carcinoma in situ, a pre-invasive form of cervical cancer, is typically managed by conization, which involves removing a cone-shaped piece of tissue from the cervix to confirm the diagnosis and potentially treat the condition. While a new biopsy or smear might be considered in other contexts, conization is the definitive procedure for both diagnosis and treatment in this case.
Topic: Complications of Submucosal Uterine Fibroid

Correct Answer: C. Metrorrhagia

Explanation: Submucosal uterine fibroids often lead to metrorrhagia, which is bleeding between menstrual periods. This is due to the fibroid’s location affecting the endometrial lining and its ability to shed properly. While complications like torsion or cancer transformation are possible, they are less common compared to metrorrhagia.
Topic: Symptoms Revealing Ovarian Cancer

Correct Answer: C. An increase in the volume of the abdomen

Explanation: An increase in abdominal volume is a common symptom of ovarian cancer, often due to the accumulation of ascites or tumor growth. Metrorrhagia and symptoms related to rectal or bladder compression may occur but are less specific. Supraclavicular lymphadenopathy is typically associated with advanced stages of the disease.
Topic: Assessment of Ovarian Cancer

Correct Answer: E. CA 125

Explanation: CA 125 is the most appropriate marker for assessing ovarian cancer, as it is commonly elevated in women with this condition. Alpha-fetoprotein is more relevant for liver and testicular cancers, while beta HCG is used for germ cell tumors. The carcino-embryonic antigen (CEA) is generally associated with colorectal cancer, and CA 153 is more often used for breast cancer.
Topic: Timing for Amniocentesis

Correct Answer: D. 18 weeks

Explanation: Amniocentesis is typically scheduled around 15 to 20 weeks of amenorrhea, with 18 weeks being the most common timing for chromosomal prenatal diagnosis. Performing it too early might increase the risk of complications, while later gestational ages may reduce the effectiveness of the test.
Topic: Anti-D Immunoglobulin Injection Timing

Correct Answer: E. In the hours following childbirth

Explanation: Anti-D immunoglobulin is administered to a rhesus-negative pregnant woman in the postpartum period, typically within 72 hours after childbirth, to prevent anti-D alloimmunization. It is not given routinely throughout pregnancy or at specific times during the pregnancy but rather as a preventive measure immediately after delivery.

100. Topic: Risk Factors for Threatened Premature Delivery

Correct Answer: D. Anencephaly without polyhydramnios

Explanation: Anencephaly without polyhydramnios does not typically constitute a direct risk factor for threatened premature delivery. Conditions such as placenta previa, a twin pregnancy, and a urinary tract infection are well-established risk factors for preterm labor. Diabetes, while it can complicate pregnancy, is not specifically listed as a direct risk factor for threatened premature

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