INTERNAL MEDICINE
Instructions: Questions 1-2 : For each case, choose the single most appropriate diagnosis from the list of options proposed.
1. A 67 year old man presents with loss of weight, cough, numbness and tingling in both hands and feet and muscle weakness.
2. A 49 year old woman presents with polyuria, haematuria, abdominal pain and bone aches. On examination her blood pressure is 170/100mmHg.
Instructions : Questions3-9: For each case described below, choose the single best answer from the list of options proposed.
3. A 60 year old smoker presents with cough and weight loss. Chest x-ray shows a solitary pulmonary nodule at the periphery. What is the single most appropriate investigation?
4. A 50 year old woman had a recent ear infection and now presents with a swollen erythematous painful rash on her left cheek and high fever. What is the single most likely diagnosis?
5. A 50 year old woman notices slurred speech, a tendency to drop things at work and muscle cramps. On examination dysarthria, muscle atrophy of the lower limbs, radiculopathy and muscle fasciculation at rest are noted. What is the single most likely diagnosis?
6. A 40 year old man complains of blurry vision and eye pain. On examination, there is blepharospasm, photophobia and excessive tearing. You diagnose interstitial keratitis. What is the single most appropriate treatment?
7. A 70 year old woman with osteoarthritis presents with transient episodes of dizziness and fainting, loss of balance, difficulty walking, nausea and transient global amnesia. What is the single most likely diagnosis?
8. A 50 year old woman with metastatic breast cancer complains of severe bone pain. X-ray shows lytic lesions. What is the single most useful modality of pain relief for this patient?
9. A 21 year old high jumper presents with acute-onset dyspnea and right-sided pleuritic chest pain. Examination reveals increased resonance and reduced expansion on the right side.
10. A 40 year old man is brought to emergency with severe headache. On examination he has papilloedema and fundal haemorrhages. His BP is 220/145mmHg
11. A 24 year old man initially complaining of cough and intermittent haemoptysis presents a few weeks later with haematuria. Biopsy confirms a crescentic glomerulonephritis. Renal biopsy shows linear pattern deposition on immuno-fluorescence.
12. A 25 year old woman with systemic lupus erythematosus presents with an acute anaemia. She was successfully treated with steroids. Direct Coombs’ test was strongly positive; direct antiglobulin test was positive with IgG alone
Instructions :Questions 14-15: For each clinical scenario below, suggest the most appropriate therapy or management from the options proposed.
13. A 70 year old woman with a history of chronic heart failure presents with severe pulmonary oedema.
14. A 22 year old HIV positive individual on anti-retroviral therapy presents with pneumocystis jeroveci pneumonia.
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
15. A 42-year-old man develops shortness of breath (SOB) and chest pain 7 days after an open cholecystectomy. His blood pressure is 145/86 mm Hg, pulse is 120/min, respirations 24/min, and oxygen saturation of 97%. Pulmonary embolism is clinically suspected. Which of the following is the most common ECG finding of pulmonary embolism?
16. A 16-year-old boy is found to have hypertension on routine evaluation. On examination, the blood pressure in his arms is higher than in his legs by more than 10 mm Hg. Which of the following is the most likely diagnosis?
17. A 63-year-old woman presents with dyspnea and coughing up foul smelling purulent sputum. She has had many similar episodes in the past. There are no other constitutional symptoms and she denies excessive alcohol intake. On physical examination, she appears chronically ill with clubbing of the fingers. Heart sounds are normal, JVP is measured at 4 cm, and there are inspiratory crackles heard at the lung bases posteriorly. There is no hepatosplenomegaly or any palpable lymph nodes. CXR shows scaring in the left lower lobe, which on chest CT scan is identified as cystic changes with airway dilatation and bronchial wall thickening. Which of the following is the most appropriate initial next step in management?
18. A 19-year-old man presents with malaise, nausea, and decreased urine output. He was previously well, and his physical examination is normal except for an elevated jugular venous pressure (JVP) and a pericardial rub. His electrolytes reveal acute renal failure (ARF). Which of the following findings on the urinalysis is most likely in keeping with acute glomerulonephritis (GN)?
19. A 63-year-old woman has Type II diabetes mellitus, which is well-controlled. Her physical examination is positive for peripheral neuropathy in the feet and non proliferative retinopathy. A urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?
20. A 29-year-old man with acquired immune deficiency syndrome (AIDS) comes to the emergency department because of progressively increasing abdominal discomfort. Examination shows voluntary guarding in the upper abdomen. His biochemistry is normal except for an elevated amylase at 370 U/L (25–125 U/L). Which of the following infections can trigger this disorder in AIDS patients?
21. A 40-year-old male with long-standing alcohol abuse complains of abdominal swelling, which has been progressive over several months. He has a history of gastrointestinal bleeding. On physical exam, there are spider angiomas and palmar erythema. Abdominal collateral vessels are seen around the umbilicus. There is shifting dullness, and bulging flanks are noted. A paracentesis is performed on the patient. The serum albumin minus ascitic fluid albumin equals 1.4 g/dL. The most likely diagnosis is:
22. A 40-year-old man is injured in a car accident and fractures his left elbow. He now complains of numbness of his fourth and fifth fingers, and weakness in his hand grip. Neurologic findings confirm weakness of handgrip with weakness of finger abduction and adduction, and decreased sensation over the fifth finger and lateral aspect of fourth finger. Which of the following is the most likely diagnosis?
23. A 32-year-old man, previously well, develops a fever and dry cough. On examination, his chest is clear and heart sounds are normal. A chest x-ray (CXR) reveals a diffuse interstitial infiltrate. Which of the following is the most likely causative organism?
24. A patient with human immunodeficiency virus (HIV) infection has progressed to developing AIDS (clinical category C). Which of the following conditions is considered an AIDS defining illness?
25. A 19-year-old woman develops weight loss, tremor, and heat intolerance. On examination, she has goiter, warm skin, and a fine tremor of her hands. Her TSH is low and her free T4 and T3 are elevated. Which of the following cardiac findings is most likely to occur in her?
26. A 26-year-old woman develops a red rash over her cheeks and pain, and swelling in both wrists as well as several small joints in her hands. The rash gets worse on sun exposure and involves her cheeks, nose, ears, and chin. Medical evaluation reveals oral ulceration and 3+ proteinuria. Which of the following is the most specific test for diagnosis of this condition?
27. Which of the following statements concerning the articular manifestations of rheumatoid arthritis (RA) is correct?
28. A 25-year-old woman is pregnant for the first time. At prenatal assessment, she is found to have blood group A and Rhd. negative. Her husband is tested and he is Rhd. positive. Which of the following is the most appropriate initial test to determine her risk for hemolytic disease of the newborn (erythroblastosisfetalis) due to Rh incompatibility?
29. A 50 year old man presents with tiredness, dyspnoea and paraesthesia. On examination he showed extensor plantars, brisk knee jerks and absent ankle jerks. His blood film shows macrocytic anaemia.
30. An 18-year-old woman develops urticaria and wheezing after an injection of penicillin. Her blood pressure is 120/60 mm Hg, heart rate is 155 beats/min, and respiratory rate is 30 breaths/min. Immediate therapy should include
1 out of 5
PAEDIATRICS
Instructions: Questions 31-35: For each statement below choose the correct answer from the list of options proposed.
31. A 7 year old boy presents with persistent nocturnal enuresis. There is a family history of enuresis. Mainstream urine shows no growth. What is the single most appropriate form of treatment?
32. A 17 day old breast fed baby presents with jaundice. The mother is concerned as the stools are clay-coloured. What is the single most likely diagnosis?
33. A 6 week old baby is brought in by her mother, who is concerned as the baby is always hungry and cannot keep milk down. Mother denies that the baby has been vomiting bile. On examination, a small mass is palpated in the upper abdomen. What is the single most likely diagnosis?
34. A 7 year old child falls onto an outstretched hand. On examination, the radial pulse is absent. What is the single most likely diagnosis?
35. A 12 year old girl presents with a crusty yellow patchy rash on her face, leaking golden fluid. What is the single most likely diagnosis?
Instructions :Questions 36-37 For each statement choose the single most appropriate age from the list of options proposed.
36. Rolls from back to front or to side
Instructions : Questions 38-39 :For each case presented below, choose the right answer from the list of options proposed.
38. A 5 year old girl presents with oliguria, haematuria and diffuse oedema. She had a sore throat 3 weeks earlier. What is the diagnosis?
39. A 9 year old girl develops haemophilusinfluenzae type B meningitis. What is the single best advice?
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
40. The pediatric surgeon is requesting an echocardiogram on a hospitalized newborn with a congenital defect of the gastrointestinal tract. Which of the following defects has the highest incidence of associated cardiac defects?
41. You are formulating a differential diagnosis for a newborn infant with respiratory distress. Which of the following is most closely associated with the development of neonatal respiratory distress syndrome (hyaline membrane disease)?
42. The mother of a 6-month-old child seeing you for a well visit, requests immunization against measles as she has heard it is present in the community. At what age should the first dose of live attenuated measles vaccine (as MMR) be routinely administered in the absence of a community measles outbreak?
43. A 5-year-old unimmunized child fell while playing in an old barn and sustained a laceration to his leg. After local wound care, what would be the most appropriate management regarding tetanus prophylaxis?
44. A worried mother brings her 2-year-old to the pediatrician for a well-child check. She is concerned because the child still has only 50 words in his vocabulary. Which of the following best describes the characteristic age of a toddler who speaks 50 words?
45. You suspect the diagnosis of a brain tumor in a 2-year-old girl with a recent history of ataxia, slurred speech, and early morning vomiting. Which statement about childhood brain tumors is true?
46. The family of a child just diagnosed with acute lymphoblastic leukemia asks for information about the child’s prognosis. Included as a poor prognostic sign is which of the following?
47. A 2 year old boy presents with painless jelly-like blood in his stool. Full blood count shows an iron-deficiency anaemia. What is the single most likely diagnosis?
48. A mother brings in her 15 month old for a measles, mumps, rubella vaccine. She informs you that she and her baby have HIV. What is the single most appropriate course of action?
49. A 4 year old girl presents with bloody diarrhoea and crampy abdominal pain. Blood tests show anaemia and thrombocytopenia. What is the most likely diagnosis?
50. A 20 day old neonate is brought to the emergency room with a temperature of 38.5oC. He is otherwise normal. The single best next step should be:
2 out of 5
SURGERY
Instructions: Questions 51-60: Choose the correct answer from the following propositions.
51. An empyemathoracis (purulent pleural effusion):
52. In Pagets’ disease of the breast:
53. The following statements are true for varicose veins, except one:
54. The following statements relate to common bile duct stones:
55. A 60 year old woman complains of pain, swelling and reduced mobility 4 months after suffering a fractured neck of femur. Her radiograph shows absence of callus at fracture site.
56. With regard to renal transplantation, which of the following statements is not correct?
57. Which of the following is a contradiction to major elective surgery requiring general anaethesia?
58. Patients with a major rectal haemorrhage:
59. A sliding type inguinal hernia:
60. A man aged 60 years who denies other symptoms reports a single episode of frank painless total haematuria:
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
61. Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 120 meq/L. Proper management would be:
62. A victim of blunt abdominal trauma requires a partial hepatectomy. He is rapidly transfused with 8 units of appropriately crossmatched packed red blood cells from the blood bank. He is noted in the recovery room to be bleeding from intravenous puncture sites and the surgical incision. His coagulopathy is likely due to thrombocytopenia and deficiencies of which clotting factors?
63. Which of the following conditions is most likely to follow a compression-type abdominal injury?
64. True statements regarding Paget’s disease of the breast include that it:
Questions 65-66: A 45-year-old woman is explored for a perforated duodenal ulcer 6 h after onset of symptoms. She has a history of chronic peptic ulcer disease treated medically with minimal symptoms.
65. The procedure of choice is:
66. Six weeks after surgery, the patient returns complaining of postprandial weakness, sweating, lightheadedness, crampy abdominal pain, and diarrhea. The best management would be:
67. A noncyanotic 2-day-old child has a systolic murmur along the left sternal border; the examination is otherwise normal. Chest X-ray and electrocardiogram are normal. These findings are most closely associated with which of the following congenital cardiac anomalies?
68. The condition shown in the X-rays below is compatible with which of the following manifestations?
69. Volkmann’s ischemic contracture is associated with:
70. Controlled hyperventilation (induced hypocapnia) is frequently recommended following head trauma. The therapeutic consequences of this therapy include:
3 out of 5
OBSTETRICS AND GYNAECOLOGY
Instructions : Questions 71-76 : For each question below, choose the best answer from the different options proposed.
71. A 25 year old primipare fails to progress in the first stage of labour. What is the single most appropriate management?
72. A 40 year old woman is brought in emergency with shock and profuse vaginal bleeding. She had delivered her third baby at home. On examination a low transverse scar is noted. What is the single most likely diagnosis?
73. A 30 year old woman complains of 7 months of amenorrhoea, facial hair and acne. She has put on 2kg in the past month. What is the single most likely diagnosis?
74. A 20 year old woman presents with intermenstrual bleeding. She has a new partner. What is the single most relevant investigation?
75. A 21 week pregnant female complains of headache, nausea and vomiting. BP is 150/100mmHg. On examination, there is right upper quadrant abdominal tenderness. Blood test reveals a platelet count of 80.000 with total bilirubin of 1.5mg/dl, SGOT=80IU/R and LDH=650IU/L. What is the single most likely diagnosis?
76. A 59 year old-postmenopausal woman presents with a month’s history of per vaginal bleeding. On speculum examination, the cervix appears normal and there is no vaginal discharge. What is the single most appropriate diagnostic test?
Page 30 of 463 Instructions : Questions 77-78 : For each case below, choose the single mostappropriate investigation from the list of options proposed
77. An 18 year old woman presents with a 6 months history of secondary amenorrhoea, hersutism, and weight gain of 4 kg. She has suffered from irregular periods since mensarche at the age of 13. Her BMI is 31.
78. A 20 year old married woman presents with a 2 week history of sporadic lower abdominal pain accompanied by a low grade fever. She also reports an increasing amount of cloudy, non-irritating discharge and dysuria.
Instructions :Questions 79-80 : For each case below, choose the single most appropriate management from the list of options proposed.
79. A 34 year old obese multiparous woman presents in early labour. On examination the presenting part has not engaged to the pelvic outlet.
80. A 34 year old woman presents with a 2 year history of gradually worsening painless menorrhagia. On examination, she is pale and has an enlarged bulky uterus.
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
81. A 24-year-old woman has had three first-trimester spontaneous abortions. Which of the following statements concerning chromosomal aberrations in abortions is true?
82. A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as:
83. A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit secondary to right-sided groin pain. She describes the pain as sharp and occuring with movement and exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The application of a heating pad helps alleviate the discomfort. As her obstetrician, what do you tell this patient is the most likely etiology of this pain?
84. True statements about pregnancy-induced hypertension include which of the following?
85. When treating urinary tract infection (UTI) in the third trimester, the antibiotic of choice should be:
86. In the mother, suckling leads to which of the following responses?
87. An 18-year-old consults you for evaluation of disabling pain with her menstrual periods. The pain has been present since menarche and is accompanied by nausea and headache. History is otherwise unremarkable, and pelvic examination is normal. You diagnose primary dysmenorrhea and recommend initial treatment with which of the following?
88. A 40 year old woman has an antenatal serum triple marker test. The alpha foeto-protein and oestriol levels are low but the HCG is twice normal. What is the single most likely potential diagnosis?
89. A 45 year old woman reports nipple changes. On examination, there are scaly, erythematous plaques on and around the inverted nipple. On squeezing the nipple, a serosanguinous discharge appears. What is the single most likely diagnosis?
90. A 21 year old female with a 7 weeks history of amenorrhoea with lower abdominal pain has fainted twice. What is the single most likely diagnosis?
4 out of 5
PUBLIC HEALTH
Instructions: For each presentation below, choose the most appropriate answer from the proposed options.
91. Measure of dispersion of data on a variable is called:
92. The best indicator of a central value when one or more of the lowest or the highest observation are wide apart or not so evenly distributed is called:
Questions 93-94:A large segment of the population in your community smokes. In order to convince your patient population that it would be beneficial to quit smoking in order to prevent lung cancer, you conduct a case-control study of cigarette smoking and lung cancer. The results from that study can be found in table below: Table: Cigarette smoking and lung cancer
93. What is the odds ratio (OR) in your study?
94. Which of the following is most true concerning ORs and relative risk calculations, as pertaining to this study?
95. Vitamin A is given to children at the age of 6 to 11 months in Cameroon at the dose of:
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
96. In nine families surveyed, the numbers of children per family were 4, 6, 2, 2, 4, 3, 2, 1, and 7. The mean, median, and mode numbers of children per family are, respectively,
97. In a study of the cause of lung cancer, patients who had the disease were matched with controls by age, sex, place of residence, and social class. The frequency of cigarette smoking was then compared in the two groups. What type of study was this?
Questions 98-99 : On a Friday afternoon, a 30-year-old nurse is brought to employee health for evaluation following a needle-stick injury that occurred at the AIDS clinic. The source patient is known to be infected with HIV and has advanced AIDS.
98. Which of the following factors carries the greatest risk for transmission of HIV to the health care worker?
99. Which is the most appropriate course of action for this health care worker?
100. A 10-year-old boy with sickle cell disease presents with headache, anorexia, and fever. He complains of pain in the right tibia and local inflammation is noted. Osteomyelitis is diagnosed. The most likely etiologic agent is:
5 out of 5
