1. A 62-year-old man with prior coronary artery disease presents with pre-syncope. her physical exam is normal except for bradycardia (pulse 55 beats per minute) and irregular pulse. the electrocardiogram (ECG) shows Wenckebach’s atrioventricular block. which of the following abnormalities are you most likely to see on the ECG?
2. A 22-year-old pregnant primi develops hypertension at 28 weeks. she is asymptomatic and the examination is normal except for the presence of a foot edema 1+. his blood count and count are complete, liver enzymes and electrolytes are normal. urinalysis is positive for proteinuria. which of the following is true for this type of hypertension?
3. A 23-year-old man develops acute left hemi-thoracic pain, fever and rubbing at the lower left border of the sternum unaffected by breathing. the pain is also aggravated by lying down and relieved by sitting. he is otherwise in good general condition with no other symptoms with the rest of the physical exam normal. which of the following is most likely the cause of these symptoms?
4. A 33-year-old farmer complains of recurrent episodes of wheezing after work in a barn where hay is stored. on auscultation there are crackles at both bases of the lungs with normal heart sounds. the paraclinical assessment is normal without hyper-eosinophilia and the chest x-ray reveals heterogenous infiltrated of the lower lobes. which of the following options is the most likely diagnosis?
5. A 25-year-old woman presents with nausea and vomiting lasting two days. she is not on any medication and has been doing well so far. her physical examination was normal except for a postural drop in her blood pressure of 110/80mmHg in the supine position and 90/80 mmHg in the standing position. her blood ionogram is sodium 130 mEq/l chloride 90 mEq/l bicarbonate 30 mEq/l urea 50 mgLdl and serum creatinine 0.8mg/dl. which of the substances is more likely to be filtered through the glomerulus but unaffected by tubal secretion?
6. A 67-year-old man presents with renal colic plain abdominal x-ray show no stones. intravenous pyelonephritis is requested to confirm the clinical diagnosis. which of the following coexisting medical conditions increases the risk of kidney disease?
7. A 77-year-old man with a mass in the lung develops asymptomatic hyponatremia. his jugular venous pressure is 4cm. these heart sounds are normal and the lungs are clear. the urinary sodium level is 64mEq/l and the osmolarity is 550 mosm/kg. which of the following is the most appropriate diagnosis?
8. A 56-year-old man is involved in a serious traffic accident. he develops kidney failure (ARI) after being admitted to hospital. one possibility for his AKI is posttraumatic renal vein thrombosis. which of the following is more likely to suggest renal vein thrombosis
9. A 79-year-old woman with severe constipation presents with multiple diverticula on colonoscopy. which of the following is the most appropriate next step for management?
10. A 33-year-old man has never been vaccinated against hepatitis. serological tests reveal a negative result for hepatitis surface antigen (AgHbs) and a positive result for anti-surface antigen antibody. which of the following conditions best matches this serological profile?
11. A 74-year-old woman had surgery for peptic ulcer years ago. he presents with symptoms including abdominal pain and bloating about 30-40 minutes after meals associated with nausea. symptoms are relieved when he vomits. which of the following is the most likely cause of his symptoms?
12. A 29-year woman complains of dysphagia to solids and liquids that worsens when she eats quickly or is anxious. manometry reveals normal basal esophageal sphincter pressure without sphincter relaxation during swallowing. which of the following is the most appropriate step for management?
13. A 40 year old male smoker complains of epigastric pain without radiation described as burning. the pain is partially relieved by food. there is no weight loss. the pain got progressively worse over several months. the most sensitive way to make a specific diagnosis is
14. A 53-year-old woman complains of clumsiness (left-handedness) in her two hands, characterized by difficulty in buttoning up the shirt or using her keys. physical examinations revealed muscle fasciculations in his thighs and forearms, diffuse muscle weakness, loss of muscle mass and hypertrophy of the upper and lower limbs. there is hyper-reflexia and a positive bilateral Babinski sign. which of the following is the most likely natural progression of this condition?
15. A 75-year-old woman presents with symptoms of visual change and facial weakness. on examination, the pupils are of equal diameter and react to light, the funds appear normal and there is a homonymous deficit in the right visual field. which of the following is the most likely cause of right homonymous hemianopia?
16. A 59-year-old woman has numbers and tingling in her feet. on examination there are signs involving the peripheral nerves in the form of decreased sensitivity motor weakness and loss of distal reflexes. findings are asymmetrical. which medical condition can best explain his peripheral neuropathy?
17. A 22-year-old young man recently immigrated to Cameroon has never been vaccinated against tetanus. he is slightly wounded but the wound is contaminated by your earth. which of the following statements is correct?
18. A 23-year-old woman develops vesicular lesions on an erythematous background on the vulvar region. she has painful lymphadenopathy and dysuria. which of the following is the most likely causative organism?
19. A 7-year-old child who was not vaccinated because of his parents’ religious beliefs develops malaise, a cough, a cold and conjunctivitis associated with a high fever. examination of his mouth reveals whitish blue spots on a red background next to it of his second molars. the following day he develops an erythematous, non-itchy, maculo-papular rash along his hairline and behind his ears that extends over his body. which of the following is the most likely diagnosis?
20. Two students from the university campus have contracted meningitis. which of the following students from the campus can benefit from chemoprophylaxis?
21. three hours after a church social activity, eight people develop severe diarrhea. other associated symptoms are nausea, vomiting and cramping pain. the food served included a chicken salad from patisseries stuffed with cream. all affected individuals had eaten the chicken salad. of the following propositions which is the most probable causative organism?
22. A 43-year-old man weighs 85 kg for a height of 1.8m his body mass index (BMI) is 23kg/m2. which of the following conditions could be faced?
23. A 20-year-old man develops symptoms of weakness with numbness and tingling in his hands physical exam is normal but his serum calcium is 7 4mg/dl. which of the following additional diagnosis of vitamin deficiency?
24. A 25-year-old woman presents with intermittent symptoms of throbbing sweats and hunger. during each episode his blood sugar level is below 40mg/dl. her insulin level is low and her glucagon level is high. which of the following statements best describes the hormonal function of glucagon?
25. A 54-year-old man comes to the emergency room with severe pain in his right toe. He has had less severe episode in the past, which he always treated with pain medications. The toe is red, inflamed, and exquisitely sensitive to movement. Needle aspiration of the 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?
26. A 36-year-old woman develops a red rash on her cheeks, frequent ulcers in the oral cavity pain and swelling in both wrists and several small joints in her hands. evaluation reveals anti-nuclear antibody positivity and 3+ proteinuria. which of the following affected organs will cause the most symptoms during the evolution of this disease?
27. A 63-year-old man is worried that he has rheumatoid arthritis (RA) because his rheumatoid factor serology is positive in a low level. He has pain in his left-hand 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 statement regarding the presence of rheumatoid factor is correct?
28. A 21-year-old woman is suspected of having mycoplasma pneumoniae based on a dry cough fever a normal chest exam but an abnormal chest x-ray with bilateral infiltrates. she is also anemic with a hemoglobin level of 10.5fl/dl. reticulocyte count at 7% and white blood cell count at 12300/ml. cold agglutinin hemolytic anemia is suspected as the cause. what can be the cause of this anemia?
29. A young man with leukemia is treated with methotrexate. Which of the following is the mechanism of action of this drug?
30. A 17-year-old woman presents with an itchy rash localized to the wrist. papules and vesicles are seen arranged in a band with slight oozing from some lesions. the most likely cause of this rash is?
31. Which of the following is a characteristic of ringworm of the scalp as compared with other dermatophytosis?
32. A 76-year-old man presented with acute shortness of the breath, a cough with frothy blood-tinged sputum, and palpitations. on examination bilateral crackles at the end of inspiration are heard. the ECG shows sinus tachycardia. the doppler echo of two calves reveals no anomality
33. A 33-year-old unemployed alcoholic presents with hematemesis, a history of alcoholic liver disease, and ascites
34. A 49-year-old radiologist presents with pallor from recurrent infections and epistaxis
35. 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
36. 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.
37. A 22-year-old man reports that he was bitten by a stray dog. What is the single most appropriate management?
38. A 55-year-old man alcoholic man complains of severe abdominal pain radiating to the back, in addition to loose stools and weight loss. abdominal x-ray reveals calcifications. what is the correct diagnosis?
39. 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?
40. A 56-year-old man diabetic type 1 (insulin-dependent diabetes) presents with persistently elevated blood pressure at 180/ mmHg. a blood test is unremarkable. what is the most appropriate drug?
PAEDIATRICS
Instructions: For each of the following cases or situations presented below, select the single most appropriate answer from the list of options proposed
41. A 2-year-old infant has acquired sensorineural hearing loss. His mother is asking what the most likelycause could be. What is the least likely etiology of acquired sensorineural hearing loss in a toddler?
42. During resuscitation of a vigorous term newborn in the delivery room. Which of the following must be done first?
43. Prevention of bilirubin encephalopathy or kernicterus is one of the appropriate diagnosis and treatment of hyperbilirubinemia. which of the following mechanisms has a role in preventing these adverse outcomes?
44. A child born at 29 weeks gestation is being resuscitated in the delivery room. Surfactant is administered intratracheally. Which of the following substances is the most physiologically active component of surfactant?
45. 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?
46. A 15-year-old child has exudative tonsillitis, cervical adenitis and splenomegaly, his monospot test is positive. Which of the following is the most frequently encountered complication?
47. A 3-year-old boy child is brought in for an adoption physical examination. He has a 4-5 mm foamy, mildly vascular, conjunctival lesion next to the cornea on the medial side of both eyes. Which nutrient deficiency is most likely to cause this lesion?
48. A mother has Concerns because her 20-month-old son prefers to eat with his fingers instead of using teaspoon. Which of the following statements is correct?
49. Parents appears in your office to discuss their considerations for adopting their 11 months 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-term problems. Undernutrition in the first year of life has which of the following effects?
50. Third-year medical students make their rounds in the nursery for normal newborns. They learn that most newborns actually lose weight after birth. One of the studies asks what is the average rate of wight gain following the initial born at term loss. After two weeks of age a child born at term will gain on average what increase in weight?
51. A girl grandmother goes on to report that she is sure that her granddaughter will be lefthanded, just like her. Consistent use of a dominant hand is established at which of the following ages?
52. A one weeks old male child presents to his family physician’s office for his first visit. His mother is worried because he sleeps a mot. Which of the following is the average amount of sleep per day that children have during the first month of life?
53. A 4-year-old child falls from back of the three-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
54. Cerebrospinal fluid examination of a mildly febrile 8-year-old child with stiff neck and intermittent stupor shows the following white blood cells 100/mm3 (all lymphocytes) gram-negative stain protein 150 mg/dl. The most likely diagnosis is
55. A 12-year-old has migratory arthritis with red, warm, swollen joints. He has serologic evidence of recent group A streptococcal infection. Arthritis in this condition is characterized by which of the following?
56. A 9-year-old child presents with anemia and a stroke. What is the most likely results of hemoglobin electrophoresis?
57. A previously healthy 5-year-old girl has acute onset of oedema and oliguria. Laboratory studies reveal hypoalbuminemia and hypercholesterolemia. Which of the following is the major cause of mortality with this condition?
58. The blood count and complete count of a 1-year-old child shows hyper-eosinophilia. Which of the following most frequently results in an increased eosinophil count in a peripheral blood smear?
59. A 6-year-old black boy passes brown urine and has lesions D healing impetigo. he presents with hypertension, dyspnea, periorbital edema and hepatomegaly. the most likely cause of his problem is
60. Iron deficiency is found in a 5-year-old child? On interrogation, his family reported several episodes of grossly bloody stools (dark red). Which of the following is the most likely explanation for his anemia?
61. A 16-year-old girl who recently has a sore throat now complains o severe left-sides abdominal pain. On examination, there is pallor. Bp is 60/40mm and the pulse rate is 130/ min abdomen is tense and rigid with no bowel sounds. What is the single likely diagnosis?
62. A 12-year-old child with a patchy, crusty yellow rash on her face oozing golden fluid. What is the most likely diagnosis?
63. A new born 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?
64. A 22-year-old boy is brought in by his parents they are concerned that he has a history of febrile seizures. Her last convulsion was 6 months ago. Also has a family history of epilepsy. What is the most appropriate support?
65. A 10-year-old boy has breathing difficulties and wheezing when playing football. What is the single most appropriate treatment to prevent this diagnosis?
66. A 17-day old breastfed child presents with jaundice. The mother is worried because the child’s stool are discolored. What is the most likely diagnosis?
67. A 5-year-old boy is noticed to have a clumpsy and gait mild scoliosis. When he rises from the ground, he uses his hand to climb up his legs. What is the single most likely diagnosis?
68. A mother of a 2-year-old boy is concerned that he does not ye speak in sentences. What is the most appropriate support?
69. A 6-week-old baby is diagnosed with pyloric stenosis. What is the single most likely electrolyte disturbance?
70. A 9-year-old girl develops haemophilus influenza type B meningitis. What is the best advice?
71. A 4-year-old girl present to emergency in distress, with temperature at 40°C. she is siting forward unable to speak or swallow, is drooling saliva and turning blue. What is the single most appropriate management?
72. A 4-year-old girl presents with bloody diarrhea and seizures. She visits a farm recently. Her blood pressure is high and she has stopped passing urine. Blood tests reveal anemia, decreased platelet count and hemolytic anemia. The Coombs test is negative. What is the most likely diagnosis?
73. A full-term, healthy newborn becomes jaundiced on the 2nd day. his total bilirubin is 10mg/dl. his jaundice gradually disappears over a few days
74. A full term new born becomes jaundices 14 hours after delivery. His blood results confirm indirect bilirubinemia and metabolic acidosis. His parents are both rhesus’s negative
75. A child with a flat face bridle eyes simian folds hypotonia and learning diificulties
76. A 12-year-old girl presents with marked oedema. Blood tests show hypo-albuminemia. Urine shows heavy proteinuria
77. A boy has night blindness
78. A 2-year-old boy was developing well but now has impaired hearing. normal motor function.
79. An 18-month-old patient still cannot say a word. The mother is worried.
80. A 3-year-old child with a persistent rough voice
PUBLIC HEALTH
Instructions: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question
81. 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 andassigning birth weight at delivery according to smoking histories. What type of study is this?
82. A study is undertaken to determine whether drinking more than eight cups of coffee a day is associated with hypertension. The blood pressure of people who live more than eight cups is taken as well as that of people who do not drink coffee. The results are as follows
83. About 1% of children are born with cryptorchidism. To determine whether prenatal tobacco smoke is a cause of cryptorchidism in newborns, 100 newborns with cryptorchidism and 100 newborns without cryptorchidism were asked about their smoking habits during pregnancy. the study found an odds ratio (the 2.6 associated with smoking with a 95% confidence interval (CI) of 1.1 to 5.3). some reviewers are concerned that the study may overestimate the association between smoking and cryptorchidism in your children because of potential
84. what is the most appropriate conclusion to draw from the study?
85. A randomized clinical trial in a company to examine the effects of a new combination of antiretrovirals on the viral load compared to the usual treatment. The randomization used for altercation (assignment) of subjects to the control group (usual treatment) in experimental studies. Randomization ensures that
86. You have just finished conducting a case-control study to measure the association between alcohol consumption and lower respiratory tract infections. The most appropriate method to control smoking as a confounder is
87. Consider the following distribution curve
Which statement best applies to this curve?
88. A child is taken to the emergency department on Friday night by his parents because they are worried about rabies. A bat was present in the child’s room when they arrived from their country home that evening. Ella flew around the girl’s head when she entered her room and ruffle her hair. Her parents heard her squeal, ran into her room and let the bat out through the window. on examination there was no visible scratches. so what is the most appropriate intervention?
89. Which of the following vaccines is during pregnancy?
90. A 25-year-old man presents with a single hard painless ulceration on the penis that appeared 2 days ago. his most recent unprotected sexual contact was 21 days ago. the syphilitic or classic serology is negative. the most likely diagnosis is
91. Which water purification system is the most effective for the elimination of microsporidium parvum
92. Which of the following residential environment pollutants is the leading cause of lung cancer?
93. Which of the following smokers has the highest risk of developing lung cancer?
94. Which of the following diseases is found almost exclusively among people who have worked or been exposed to asbestos?
95. A 16-year-old boy is diagnosed with depression following his parents’ divorce. he suffers from lack of appetite, insomnia and feeling worthless with difficulty concentrating? he is prescribed antidepressants and is referred to a psychologist for weekly psychotherapy visits. which of the following is the strongest risk factor for committing suicide?
96. A 27-year-old pregnant woman with multiple bruises on her chest and abdomen is taken to the emergency department. Her breath gives off the smell of alcohol. the most likely cause for these findings is
97. In country A there are 35 cases of breast cancer per 100,000 adult women per year. what is the most likely explanation?
98. A patient of yours returns to your office for the results of his test. You inform him that the test is positive for HIV antibodies. He is married and sexually active with his wife. During subsequent counselling you tell him that it is important for his wife to know about the exposure. At this point what is the most appropriate management of the situation?
99. A 15-year-old girl comes to your service because she has a vaginal discharge. during the interrogations she informs you that she is sexually active with her friend who is also 15 years old. the examination reveals purulent mucosal cervicitis but without pain in the lower abdomen on mobilization of the cervix or palpation of the tubes. the most appropriate intervention is to
100. Which of the following is not a basic principle of medical ethics
