INTERNAL MEDICINE / PAEDIATRICS / PUBLIC HEALTH
Instructions: Questions 1-29 : For each clinical scenario below, select the single most appropriate answer from the proposed options
1. A 45 year old man complains of cold numb fingers and difficulty in swallowing. On examination he has tight skin, thickening of the fingers and telangiectasia
2. In community acquired pneumonia, the following signs exist except one. Which one?
3. Among the following etiologies of a transient ischaemic cerebral accident of a young subject which one is the commonest?
4. Concerning neuro-meningeal cryptococcosis, only one of the following statements is true. Which one?
5. You are called to assist a patient who is having a generalized tonico-clonic crisis. What should you do immediately (one correct answer only) ?
6. A 45 year old woman presents with dryness in the eyes and mouth. Her Schirmer’s test is positive.
7. A 45 year old man presents with fever, weight loss, tiredness and gout. On examination there is splenomegaly. White blood cell count is 112x109 /l. The Philadelphia chromosome is detected
8. Radio femoral delay of pulse in a patient with hypertension:
9. An anxious 26 year old woman presents with episodes of chest pain and palpitations precipitated by stress and smoking. Her 24-hour urine shows elevated catecholamines.
10. A 50 year old man presents with right sided hemiparesis. There is a bruit on neck auscultation. What is the single most appropriate investigation?
11. A 62-year-old man with coronary artery disease (CAD) presents with presyncope. His physical examination is normal except for bradycardia (pulse 56 beats/min) and an irregular pulse. The electrocardiogram (ECG) shows Wenckebach’s type atrioventricular (AV) block. Which of the following are you most likely to see on the ECG?
12. A 23-year-old man develops sharp left-sided chest pain, fever, and a friction rub heard at the lower left sternal border, unaffected by respiration. The pain is also aggravated by lying down and relieved by sitting up. He is otherwise well with no other symptoms and the remaining physical examination is normal. Which of the following is the most likely cause for his symptoms?
13. A 25-year-old woman presents with nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. Her physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, Page 78 of 463 potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following substances is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
14. A 77-year-old man with a mass in the lung develops asymptomatic hyponatremia. His JVP is 4 cm, heart sounds are normal, and the lungs are clear. The urine sodium is 64 mEq/L and osmolarity 550 mOsm/kg. Which of the following is the most likely diagnosis?
15. A 79-year-old woman with severe constipation is found to have multiple diverticuli on colonoscopy. Which of the following is the most appropriate next step in management?
16. A 74-year-old man underwent some type of peptic ulcer surgery years ago. He has symptoms that include abdominal pain and bloating about 30–40 minutes after eating, accompanied by nausea. If he vomits, the symptoms are relieved. Which of the following is the most likely cause for his symptoms
17. A 40-year-old cigarette smoker complains of epigastric pain, well localized, nonradiating, and described as burning. The pain is partially relieved by eating. There is no weight loss. He has not used nonsteroidal antiinflammatory agents. The pain has gradually worsened over several months. The most sensitive way to make a specific diagnosis is :
18. A 75-year-old woman presents with symptoms of visual change and facial weakness. On examination, the pupils are equal and reactive to light, the fundi appear normal, and there is a right homonymous visual field defect. Which of the following is the most likely cause of the right homonymous hemianopia?
19. A 22-year-old recent immigrant to Cameroon has never been vaccinated for tetanus. He sustains a minor, but soil-contaminated, injury. Which of the following statements is correct?
20. Three hours after a church social, eight people develop severe diarrhea. Other symptoms included nausea, vomiting, and abdominal cramps. Food served included chicken salad and cream-filled pastries. All affected individuals had the chicken salad. Which of the following is the most likely causative organism?
21. A 20-year-old man develops symptoms of weakness with numbness and tingling in his hands. The physical examination is normal, but his calcium is 7.4 mg/dL (N : 8.4–10.2 mg/dL). Which of the following additional serum values is most consistent with the diagnosis of vitamin D deficiency?
22. A 54-year-old man comes to the emergency room with severe pain in his right toe. He has had less severe episodes in the past, which he always treated with pain medications. The toe is red, inflamed, and exquisitely sensitive to movement. Needle aspiration of the toe confirms uric acid crystals, and he is treated with oral indomethacin (NSAID). One month later, he remains symptom free, and allopurinol is recommended for prevention of this condition. Which of the following is the most likely mechanism of action of allopurinol?
23. A 63-year-old man is worried that he has rheumatoid arthritis (RA) because his rheumatoid factor serology is positive in a low titer. He has pain in his left hand and right knee, which usually bothers him in the evening. He has not noticed any inflammation or swelling and there is no history of morning stiffness. On examination, there are no active joints. Which of the following statements regarding the presence of rheumatoid factor is correct?
24. A young man with leukemia is treated with methotrexate. Which of the following is the mechanism of action of this drug?
25. Which of the following is a characteristic of ringworm of the scalp as compared with other dermatophytoses?
26. If end-diastolic pressure is held constant, increasing which of the following will increase the cardiac index?
27. Which of the following statements regarding adrenal cortical insufficiency is true?
28. Omeprazole has been added to the H2 antagonists as a therapeutic approach to the management of acute gastric and duodenal ulcers. It acts by
29. The complication of ß-mimetic drugs include one of these symptoms. Which one?
Instructions: Questions 30-34 : For each clinical scenario below, select the most appropriate management from the proposed options.
30. A 19 year old man contracts pneumonia with symptoms of headache, fever and dry cough. Serology shows evidence of Chlamydia infection
31. A previously healthy 65 year old smoker with early COPD complains of shortness of breath on exertion.
32. A 65 year old man with heart failure requires rate control to treat coexisting atrial fibrillation.
33. A 70 year old woman with a history of chronic heart failure presents with severe pulmonary oedema.
34. A 22 year old man reports that he was bitten by a stray dog. What is the single most appropriate management?
35. Kerley B lines, bat-wing shadowing, prominent upper lobe vessels, cardiomegaly.
Instructions: Questions 36-40 : For each case below, choose the single most appropriate diagnosis from the list of options proposed.
36. 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
37. A 76 year old man fell to the floor while standing in a long queue. He regained consciousness within 2 minutes. He was not incontinent of urine or stools.
38. A 53 year old unemployed alcoholic presents with haematemesis, a history of alcoholic liver disease and ascites.
39. A 24 year old athlete attends a routine medical insurance health assessment. His resting pulse is 48 beats/min with a regular rhythm and his blood pressure is 106/70mmHg.
40. A 20 year old woman presents with a neck lump. On examination, the lump lies beneath the anterior border of the sternomastoid. What is the single most likely diagnosis?
PAEDIATRICS
Instructions: Questions 41-63 : For each question below, choose the single most appropriate answer from the list of options proposed.
41. With respect to the ejection of breast milk, choose the correct statement among the following propositions.
42. The Apgar score measures the following parameters except one. Which one?
43. A child of 8 years has a recent primary tuberculosis infection. His tuberculin skin test is positive but he does not present any clinical, radiological or biologic signs. Choose among the propositions below the single best means of management.
44. Child who is HIV positive is due for measles, mumps and rubella (MMR) vaccine
45. A 2-year-old infant has acquired sensorineural hearing loss. His mother is asking what the most likely cause could be. What is the least likely etiology of acquired sensorineural hearing loss in a toddler?
46. Prevention of bilirubin encephalopathy or kernicterus is one of the goals for the appropriate diagnosis and treatment of hyperbilirubinemia. Which of the following mechanisms has a role in preventing these adverse outcomes?
47. A 6-year-old unimmunized child has fever of 40°C and cropped vesicles on the trunk with scattered scabbed lesions. Which of the following infections is the likely diagnosis?
48. A 3-year-old male child is brought in for an adoption physical examination. He has a 4–5 mm, foamy, mildly vascular, conjuctival lesion next to the cornea on the medial side of both eyes. Which nutrient deficiency is most likely to cause this lesion?
49. Parents appear in your office to discuss their considerations for adopting their 11-month-old foster son. They state he has a history of failure to thrive at 6 months of age and they are concerned about the possibility of long-term problems. Undernutrition in the first year of life has which of the following effects?
50. A girl’s grandmother goes on to report that she is sure that her grandaughter will be lefthanded, just like her. Consistent use of a dominant hand is established at which of the following ages?
51. A 4-year-old child falls from the back of a three-wheeled vehicle, hitting his head. He experiences no loss of consciousness. In the emergency room, he is alert and oriented without focal findings on examination. He has blood behind his left tympanic membrane. CT scan of the skull is likely to show
52. A 12-year-old boy has migratory arthritis with red, warm, and swollen joints. He has serologic evidence of recent group A streptococcal infection. Arthritis in this condition is characterized by which of the following?
53. A previously healthy 5-year-old girl has acute onset of edema and oliguria. Laboratory studies reveal hypoalbuminemia and hypercholesterolemia. Which of the following is the major cause for mortality with this condition?
54. A 6-year-old black boy has brown urine and healing impetigo lesions. He presents with hypertension, dyspnea, periorbital edema, and hepatomegaly. The most likely cause of his problem is :
55. 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?
56. A newborn is noted to have a large midline neck swelling involving the tongue. The mass is soft and transilluminates. What is the single most likely diagnosis
57. A 10 year old boy has breathing difficulties and wheezing when playing football. What is the single most appropriate treatment to prevent this condition?
58. 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?
59. A 6 week old baby is diagnosed with pyloric stenosis. What is the single most likely electrolyte disturbance?
60. A 4 year old girl presents to emergency in distress, with temperature at 40oC. She is sitting forward unable to speak or swallow, is drooling saliva and turning blue. What is the single most appropriate management?
61. Primary amenorrhoea, short stature, cubitus vulgus and normal intelligent quotient (IQ).
62. A 7-year-old child, unvaccinated because of his parents’ religious beliefs, develops malaise, cough, coryza, and conjunctivitis with a high fever. Examination of his mouth reveals blue white spots on a red base beside his second molars. The next day he develops an erythematous, nonpruritic, maculopapular rash at his hairline and behind his ears, which spreads over his body. Which of the following is the most likely diagnosis?
63. A 15-year-old girl presents to your office because she has been having vaginal discharge. In the course of the history, she informs you that she is sexually active with her boyfriend who is also 15 years of age. The examination reveals mucopurulent cervicitis, but no lower abdominal, cervical motion or adnexal tenderness. The most appropriate intervention is to
64. A child dresses and undresses almost independently:
66. A 2 year old boy presents with a 12 hour history of fever, cough and hoarseness of the voice. While waiting in the consultation room, he develops stridor
67. A healthy full term newborn becomes jaundiced at day two. His total bilirubin is 10mg/dl. His jaundice gradually disappears over the next few days.
68. A male child infertile with testicular atrophy, gynaecomastia and learning difficulties.
69. 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
70. A 3 year old boy presents with a large left-side abdominal mass. Intravenous urography (IVU) shows a mass within the left kidney which encroaches on the collecting system. Chest radiography shows multiple pulmonary nodules.
71. A 7 year old boy who presents with night blindness has
72. A 4 year old girl presents with bloody diarrhoea and crampy abdominal pain. Blood tests show anaemia and thrombocytopenia
73. A 9 year old boy presents with conjunctivitis and maculopapular rash. The rash started on the head and spread downwards.
74. A 4 year old boy presents with a vesicular rash that appears in crops.
75. A 3 week old child presents with projectile vomiting, appearing hungry after each emesis. On examination dehydration is present and there is a mass in the abdomen
76. Child with vomiting and diarrhoea. Brother had a similar problem 2 weeks ag
Instructions: Questions 77-79 : For each of the presentations given below, choose the single most appropriate management from the list of options proposed.
77. A young boy with polyuria, has very high blood glucose levels.
78. A 10 year old child presents with 15% body surface area burns. What is the single most appropriate management?
79. A 14 year old boy, with well controlled asthma, using inhaled steroids and a bronchodilator comes to emergency department with breathlessness and swollen lips after eating a peanut butter-sandwich.
Instructions: Questions 80 : For the presentation given below, choose the single most likely mechanism of the disease from the list of options proposed.
80. A boy with mental retardation and learning difficulties. Father and uncle had similar problems.
PUBLIC HEALTH
Instructions : Questions 81-91 : Choose the correct answer from the following propositions
81. Concerning the functioning of dialogue structures:
82. Concerning the organization of the health district:
83. In Cameroon Health System the district hospital is considered as:
84. To test an association between tobacco use (Yes/No) and pneumonia (Yes/No), a Chi square value of 2.96 was found. What decision will you take?
85. Which of the following sets of three elements constitutes characteristics of central tendency?
86. The most frequently occurring observation in a series is:
87. In which case is the Chi2 test and variance not applicable?
88. In which circumstance is it necessary to use non-parametric tests?
89. A new screening test for prostate cancer becomes available. You assess whether this will be useful to your practice by reviewing the operating characteristics of the test. The test’s ability to correctly classify diseased persons as having disease is called:
90. Among the observational study designs, the prospective cohort design offers which one of the following advantages?
91. The association between low birth weight and maternal smoking during pregnancy can be studied by obtaining smoking histories from women at the time of the first prenatal visit and then subsequently assessing and assigning birth weight at delivery according to smoking histories. What type of study is this?
Questions 92-93 About 1% of boys are born with undescended testes. To determine whether prenatal exposure to tobacco smoke is a cause of undescended testes in newborns, the mothers of 100 newborns with undescended testes and those of 100 newborns whose testes had descended were questioned about smoking habits during pregnancy. The study revealed an odds ratio of 2.6 associated with exposure to smoke, with 95% confidence intervals (CI) from 1.1 to 5.3.
92. Some reviewers are concerned that the study may overestimate the association between maternal smoking and undescended testes in the offspring because of potential:
93. What is the most appropriate conclusion to be drawn from the study?
94. A randomized clinical trial is undertaken to examine the effect of a new combination of antiretroviral drugs on HIV viral load compared to usual therapy. Randomization is used for allocation of subjects to either treatment or control (usual care) groups in experimental studies. Randomization ensures that :
95. Consider the following distribution curve.
Which statement best applies to this curve?
96. Which of the following vaccines is contraindicated during pregnancy?
97. Which engineered water purification system is the most effective for the elimination of Cryptosporidium parvum?
98. Which of the following smokers has the highest risk of developing lung cancer?
99. A 16-year-old boy is diagnosed with depression following the divorce of his parents. He suffers from lack of appetite, insomnia, feelings of worthlessness, and difficulty in concentrating. He is given antidepressants and is referred to a psychologist for weekly psychotherapy visits. Which of the following is the most important risk factor for committing suicide?
100. In country A, there are 35 new cases of breast cancer per 100,000 adult women per year. In country B, the number is 90 per 100,000. Which of the following is the most likely explanation?
