INTERNAL MEDICINE
Instructions: Questions 1-3 : For each case, choose the single most appropriate diagnosis from the list of options proposed.
1. A 69 year old diabetic man is found to have an irregular pulse with a rate of 110beats/min during his diabetic review. He admits to occasional palpitations. What is the single most appropriate diagnosis?
2. A 78 year old man presents with pain and swelling of the left first metarsophalangeal joint. He was started on thiazide diuretics 3 weeks earlier. What is the single most appropriate diagnosis?
3. A 78 year old man has been short of breath for a few weeks. His chest radiography shows a right basal shadow rising towards the axilla. What is the single most appropriate diagnosis?
Instructions : Questions 4-9: For each case described below, choose the single best answer from the list of options proposed.
4. A 40 year old man presents with headache and loss of temporal vision in both eyes. He states that his wedding band does not fit anymore, his fingers are too big. What is the single most useful investigation?
5. A 50 year old woman is found to have a fasting blood glucose of 9mmol/l. BMI is 30kg/m2. She has a history of polycystic ovarian cyst. What is the single next most appropriate management?
6. A 55 year old fireman has scratched his hand against a rusty soiled farm ladder and now presents with an open wound 24 hours later. He had tetanus vaccine 10 years ago. What is the single most appropriate management?
7. A 70 year old man returns from holiday in the US and has vague chest pain. On examination jugular venous pressure (JVP) is raised. Blood pressure (BP) is 110/60mmHg, pulse = 120/minute, ECG shows Q-wave and T-wave inversion in lead 3. What is the single most likely diagnosis?
8. A 70 year old female with chronic arthritis is taking arthrotec. She now presents with flank pain, polyuria, nocturia and cloudy bloody urine. What is the single most likely diagnosis?
9. A 55 year old man presents with breathlessness. You suspect heart failure. Which single investigation for heart failure has been shown to be the most cost effective?
Instructions : Questions 10-13 : For each presentation below, choose the most likely cause from the list of options proposed.
10. A 40 year old woman develops sudden-onset dyspnoea at rest following hip replacement surgery. On examination she is tachycardic and her electrocardiogram (ECG) shows right axis deviation.
11. Pulsus paradoxus, jugular venous pressure rises on inspiration, heart sounds muffled.
12. Hypertension in a 75 year old who is a heavy smoker with widespread peripheral vascular disease.
13. The chest radiograph of a 22 year old man with cystic fibrosis has tramline and ring shadows.
Instructions : Questions 14-15: For each clinical scenario below, suggest the most appropriate therapy or management from the options proposed.
14. A 65 year old man with heart failure requires rate control to treat coexisting atrial fibrillation.
15. A 32 year old patient taking maximum dose-inhaled therapy and slow-release theophylline shows persistently inadequate control of symptoms.
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
16. Which of the following antiarrhythmic drugs mediates its effect by interfering with movement of calcium through the slow channel?
17. A 57-year-old man with a 40-pack-per-year history of smoking experiences symptoms of shortness of breath on exertion. He has bilateral wheezes on expiration and increased resonance to percussion of the chest. Pulmonary function tests confirm the diagnosis of chronic obstructive lung disease (COLD). Which of the following is the best definition of this condition?
18. An 83-year-old man with Parkinson’s disease presents with low-grade fever and cough for several weeks. Lately, he has been experiencing more rigidity and difficulty with his walking. He is on a levodopa/carbidopa combination for treatment for the past 5 years. On examination, his gait is shuffling and slow. He has a tremor in his left hand at rest, and there is cogwheel rigidity of the forearm. There are crackles in the left lower lung field. CXR reveals a lung abscess in the left lower lobe. Which of the following is the most likely bacteriologic diagnosis for the lung abscess?
19. A 64-year-old woman has metabolic alkalosis and the bicarbonate level is 34 mEq/L. Which of the following is the most likely cause?
20. A 71-year-old man develops progressive weight loss and dysphagia over a 3-month period. Upper endoscopy and biopsy of the lesion confirm esophageal cancer. Which of the following statements regarding this cancer is most likely correct?
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. An important first step in the patient’s evaluation is:
22. An 18-year-old woman has periodic episodes that begin with severely decreased vision, followed by ataxia, dysarthria, and tinnitus. The symptoms last for 30 minutes and are then followed by a throbbing occipital headache. Which of the following is the most likely diagnosis?
23. A 94-year-old man presents with progressive headaches, light-headedness, drowsiness, and unsteady gait over 6 weeks. On examination, his blood pressure is 160/90 mm Hg, pulse 70/min, lungs clear, and he has no focal weakness. His gait is unsteady but sensation in the feet is normal. A CT scan reveals a hyperintense clot over the left cerebral cortex. Which of the following is the most likely cause for this clot?
24. A 60-year-old man presents with fever and malaise 6 weeks after mitral valve replacement. On examination, his temperature is 38oC, blood pressure 130/80 mm Hg, pulse 80/min, and a loud pansystolic murmur at the apex, which radiates to the axilla. He has no skin or neurologic findings. Which of the following is the most likely causative organism?
25. Which of the following is the most common presentation of anterior pituitary hyposecretion in a 26-year-old woman?
26. Which of the following is the most common manifestation of multiple endocrine neoplasia, type I (MEN I)?
27. A 63-year-old man develops pain and swelling in his knee. It appears warm, red, and swollen with decreased range of movement. A diagnostic aspiration is performed. Which of the following will most likely distinguish pseudogout from gout?
28. A 19-year-old man has had recurrent bleeding occur in his knee when playing contact sports. He has no history of spontaneous bleeding, but his brother had similar problems. Consultation with a specialist reveals that he has “mild” hemophilia A. Which of the following coagulation factor abnormalities is consistent with this diagnosis?
29. A 30-year-old black female has had a history of cough, and a chest x-ray shows bilateral hilar lymphadenopathy. A biopsy shows noncaseating granuloma. The skin lesion most consistent with the patient’s diagnosis is
30. A 45 year old man with chronic glomerulo-nephritis presents with severe headache. On examination he has papilloedema and bilateral retinal haemorrhages. His BP is 240/132 mmHg. What is the most appropriate treatment?
1 out of 5
PAEDIATRICS
Instructions: Questions 31-36: For each statement below choose the correct answer from the list of options proposed
31. A 2 year old boy is brought in by his parents as they are concerned because he has a past history of febrile convulsions. His last convulsion was 6 months ago. There is also a family history of epilepsy. What is the single most appropriate management?
32. A 10 year old boy is brought into casualty by his parents following a weaver fish sting on the local beach. What is the single most appropriate treatment?
33. A 5 year old boy is noticed to have a clumsy gait and mild scoliosis. When he gets up off the floor, he uses his hands to climb-up his legs. What is the single most likely diagnosis?
34. A 16 year old girl who had recently had a sore throat now complains of severe left-sided upper abdominal pain. On examination, there is pallor. BP is 60/40mmHg and the pulse rate is 130/min. Abdomen is tense and rigid with no bowel sounds. What is the single most likely diagnosis?
35. A mother of a 2 year old boy is worried that he is not speaking in sentences yet. What is the single most appropriate management?
36. A 4 year old boy presents with a right sided purulent nasal discharge. What is the single most likely diagnosis?
37. At which age will a child be able to drink from a cup?
Instructions : Questions 38-40 : For each case presented below, choose the right answer from the list of options proposed.
38. A 7 year old boy presents with night blindness.
39. A 3 year old boy with a history of recurrent chest infections presents with worsening shortness of breath. On examination there was a systolic thrill at the left lower sternal edge, pansytolic murmur and accentuated second heart sound.
40. A 5 year old girl presents with fever, nosebleeds and generalized joint pains. On examination, the lymph nodes, liver and spleen are enlarged. What is the single most likely diagnosis?
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
41. A medical student in your office is assessing a 1-week-old term infant. The mother has been exclusively breast feeding and the student is not sure how to interpret the change in the infant’s weight compared to the birth weight. Which of the following is the expected weight flux for an infant in the first week of life?
42. You are seeing a healthy, full-term infant just after delivery. The mother plans on breast-feeding the baby and asks you how long immunity transferred to the baby from the pregnancy would be present. When does passively transferred maternal IgG antibody reach a nadir?
43. A 15-year-old female comes to your office with 4-day history of fever and cough. Chest x-ray findings include bilateral patchy infiltrates. Oxygen saturation is normal. What is the most likely etiology of her pneumonia?
44. You are in a health clinic in Cameroon. An 18-month old child is brought in for your help. On inspection you note that the child is edematous, has a dark desquamating skin rash over most of the pressure points on the body, has very thin hair, and what hair is left is reddish in color. Of the following, what laboratory test is most likely to be present?
45. An 11-month-old girl presents to your emergency department with irritability, fever, and stiff neck. When performing the lumbar puncture in this child, you should
46. A 2-year-old toddler has a large abdominal mass and pancytopenia. Which of the following diagnoses would most likely be established by bone marrow aspiration?
47. A 1-year-old child presents with failure to thrive, frequent large voids of dilute urine, excessive thirst, and three episodes of dehydration not associated with vomiting or diarrhea. Over the years, other family members reportedly have had similar histories. The most likely diagnosis is:
48. A 10 year old boy is given amoxicillin for otitis media. He presents an anaphylactic shock. His mother was not aware that amoxicillin was in the same class as penicillin and had not informed the doctor that the child was allergic to penicillin. What is the single most appropriate initial treatment?
49. A 14 year old boy complains of sudden pain in his groin after cycling 10 kilometres. What is the single most likely diagnosis?
50. A child presents with malabsorption and bronchiectasis with progressive productive cough and green sputum. What is the most likely diagnosis?
2 out of 5
SURGERY
Instructions: Questions 51-60 : Choose the correct answer from the following propositions.
51. A deteriorating level of consciousness in the accident department an hour after serious head injury:
52. Causes of thoracic aortic aneurysm include the following, except:
53. Which of the following statements relate to prostatic cancer?
54. Strangulating small bowel obstruction is less common in:
55. Venous thrombo-embolism prophylaxis is not required in:
56. A 25 year old man presents with a blue right arm with absent radial pulse and painful passive finger extension after a supracondylar fracture of the humerus:
58. Deep venous thrombosis:
59. The following points are related to abdominal pain. Which one is correct?
60. Direct inguinal hernias:
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
61. A 65-year-old man undergoes a technically difficult abdominoperineal resection for a rectal cancer during which he receives three units of packed red blood cells. Four hours later in the intensive care unit he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrombin, partial thromboplastin, and bleeding times. The fibrin degradation products are not elevated but the serum fibrinogen content is depressed and the platelet count is 70,000/µL. The most likely cause of the bleeding is
62. Compensatory mechanisms during acute hemorrhage include:
63. Which of the following statements regarding carpal tunnel syndrome is correct?
64. Among the physiologic responses to acute injury is :
65. Correct statement regarding rectal carcinoid tumors include:
66. A 2-year-old asymptomatic child is noted to have a systolic murmur, hypertension, and diminished femoral pulses. Which of the following is true about this child’s disorder?
67. Which of the following statements regarding benign prostatic hyperplasia (BPH) is true?
68. Which of the following statements regarding compartment syndromes following orthopedic injuries is true?
69. Which of the following statements regarding skull fractures is true?
70. A butcher cuts himself in the groin area. He used a towel which is full of blood. On examination the BP was 80/60 mmHg and pulse rate 130. The estimated amount of blood loss is:
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 35 year old woman presents with a discrete breast lump that persists after her next period. What is the single most appropriate management?
72. A 25 year old woman would like to know the mode of action of the mini-pill. What is the single best answer?
73. A 55 year old woman post vaginal hysterectomy only complains of constant urine dribbling. What is the single most likely diagnosis?
74. A 40 year old woman requests contraception. She has always had heavy painful periods. She has 3 children. She is needle phobic and has a busy schedule. What is the single most appropriate form of contraception?
75. A 36 year old woman is found to have blocked fallopian tubes on laparoscopy and hysterosalpingography. The uterus is normal. What is the single most appropriate next form of treatment?
76. A 20 year old nulliparous woman presents with deep dyspareunia for months. She reports that her cycles are short but last for 8 days. She has pain a few days before her period is due and for 2 days into the period. On examination, there is adnexal tenderness but no cervical motion excitation. She is married. She is a nonsmoker. What is the single most likely useful investigation?
77. The placenta of twins may be:
Instructions : Questions 78-79 : For each case below, choose the single most appropriate investigation from the list of options proposed
78. A 23 year old smoker is started on a combined oral contraceptive pill for the first time. She returns 2 months later complaining of inter-menstrual bleeding
79. A 30 year old pregnant woman (31 weeks) presents with severe chest pain of acute onset. There is a family history of ischaemic heart disease (IHD). Clinical examination demonstrates dyspnea, cyanosis, hypotension (90/50mmHg) and distended neck veins.
Instructions : Questions 80-84 : For each case below, choose the single most appropriate management from the list of options proposed.
80. A 31 year old primaparous woman is fully dilated for 4 hours and has been pushing for 1.5hours. The foetal head is in occipito-posterior position 4cm below the ischial spine.
81. A 62 year old woman presents with post-coital bleeding, dyspareunia and urinary stress incontinence.
82. A 15 year old school girl complains of period pains. She has a regular cycle. What is the single most appropriate management?
83. A 46 year old woman informs you that her mother was diagnosed with ovarian cancer at age 55. She is concerned as she now smokes, drinks and is on HRT(hormone replacement therapy). What is the single most appropriate management?
84. A 40 year old woman with a pregnancy of 34/40 weeks is noted to have an incidental BP of 160/100mmHg on an antenatal review. She denies blurring vision. There is no proteinuria and no signs of peripheral oedema. Blood tests are normal. What is the single most appropriate management?
Instructions: Questions 85-90 Each item below contains a question or incomplete statement followed by suggested responses.
85. A patient comes to your office with last menstrual period (LMP) 4 weeks ago. She denies any symptoms such as nausea, fatigue, urinary frequency, or breast tenderness. She thinks that she may be pregnant because she has not gotten her period yet and is very anxious to find out because she has a history of a previous ectopic pregnancy and wants to be sure to get early prenatal care. Which of the following evaluation methods is most sensitive in diagnosing pregnancy?
86. Which of the following statements concerning placenta previa is true?
87. A pregnant woman is discovered to be an asymptomatic carrier of Neisseria gonorrhoeae. A year ago, she was treated with penicillin for a gonococcal infection and developed a severe allergic reaction. Treatment of choice at this time is:
88. A 21-year-old G2P1 with a history of asthma presents to the emergency room at 25 weeks gestational age complaining of an acute exacerbation of her asthma. On presentation, she is tachypneic and struggling to breathe. All of the following are appropriate next steps in the management of this patient except:
89. A 21-year-old has difficulty voiding 6 h postpartum. The least likely cause is which of the following?
90. Which of the following findings characterizes a normal semen sample?
4 out of 5
PUBLIC HEALTH
Instructions: For each presentation below, choose the single most appropriate answer from the options proposed.
91. The ability of a test to detect people who do have the disease is called:
92. Relative risk can be obtained from this type of study design:
93. The most frequently occurring observation in a series is:
Questions 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
94. Using the same table, what is the relative risk?
95. Among the observational study designs, the prospective cohort design offers which of the following advantages?
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
Questions 96-98
The results of a study of the incidence of pulmonary tuberculosis in a village in Cameroon are given in the table below. All persons in the village are examined during two surveys made two years apart, and the number of new cases was used to determine the incidence rate
96. What is the incidence of new cases per 1000 person-years in house-holds that had a culture-positive case during the first survey?
97. What is the incidence of new cases per 1000 person-years in households that did not have a culture-positive case during the first survey?
98. What is the relative risk of acquiring tuberculosis in households with a culture-positive case compared with households without tuberculosis?
99. The use of matching as a technique to control for confounding is most appropriate for which type of study?
100. Which of the following substances is causally associated with pneumoconiosis?
5 out of 5
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