Category: Other

1. 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.

2. 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.
3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.

38. 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.

39. 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.

40. 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

41. 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.

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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.
48. 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.
49. 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.
50. 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.
51. 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.
52. 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.
53. 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.
54. 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).
55. 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).
56. 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).
57. 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.
58. 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.
59. 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.
60. 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.
61. 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.
62. 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.
63. 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.
64. 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.
65. 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.
66. 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.
67. 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.
68. 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.
69. 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.
70. 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.
71. 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.
72. 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
73. 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
    .
74. 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.
75. 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.
76. 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.
77. 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.
78. 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.
79. 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.
80. 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

81. 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.

82. 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.
83. 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.
84. 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.

85. 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.

86. 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

87. 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

88. 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

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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).
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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).
21. 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.
22. 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.
23. 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.
24. 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.
25. 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.
26. 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.
27. 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.
28. 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.
29. 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.
30. 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.
31. 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.
32. 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.
33. 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.
34. 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.
35. 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.
36. 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.
37. 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.
38. 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.
39. 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.
40. 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.
41. 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.
42. 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.
43. 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.
44. 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.
45. 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.
46. 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.
47. 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.
48. 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.
49. 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.
50. 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

51. 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).
52. 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.
53. 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.
54. 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.
55. 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.
56. 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.
57. 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.
58. 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.
59. 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.
60. 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.
61. 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.
62. 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.
63. 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.
64. 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.
65. 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.
66. 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.
67. 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.
68. 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.
69. 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.
70. 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.
71. 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.
72. 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.
73. 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.
74. 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.
75. 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.
76. 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.
77. 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.
78. 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.
79. 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.
80. 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.
81. 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.
82. 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.
83. 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.
84. 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.
85. 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.
86. 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.
87. 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.
88. 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.
89. 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.
90. 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.
91. 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.
92. 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.
93. 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.
94. 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.
95. 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.
96. 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.
97. 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.
98. 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.
99. 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

AI ECN 2019 

1. Topic: Causes of Acute Mitral Regurgitation

Correct Answer: B. Hypertrophic and obstructive cardiomyopathy

Explanation: Acute mitral regurgitation is commonly caused by conditions that suddenly damage the mitral valve or its supporting structures, such as chordae tendineae rupture (rope breakage), trauma, bacterial endocarditis, or myocardial infarction. Hypertrophic and obstructive cardiomyopathy, while it can lead to chronic mitral regurgitation due to obstruction and abnormal valve motion, is not a typical cause of acute mitral regurgitation.

2. Topic: Complications of Osler’s Endocarditis on Mitral Prolapse

Correct Answer: A. Multiple pulmonary septic embolisms

Explanation: Osler’s endocarditis, particularly when associated with mitral valve prolapse, can lead to complications such as right hemiplegia with aphasia due to embolic strokes, microscopic hematuria from emboli to the kidneys, lumbar spondylitis, and acute limb ischemia from arterial emboli. However, multiple pulmonary septic embolisms are more commonly associated with right-sided endocarditis rather than mitral prolapse, making option A the correct exception.

3. Topic: Signs of Cardiac Tamponade

Correct Answer: C. Signs of pulmonary edema

Explanation: Cardiac tamponade is characterized by signs such as jugular venous distension (turgor of the jugular veins), a slightly mobile cardiac silhouette on fluoroscopy, a paradoxical pulse (pulse paradox), and a decrease in systolic blood pressure during inspiration. These are all indicative of the increased pressure on the heart and restricted cardiac filling. Signs of pulmonary edema, however, are not typically associated with cardiac tamponade and are more related to left heart failure, making option C the correct exception.

4. Topic: Medications in Congestive Heart Failure

Correct Answer: C. Beta blockers

Explanation: While beta blockers are generally beneficial in managing chronic heart failure, they are strictly contraindicated in acute decompensated heart failure because they can reduce cardiac output and worsen symptoms. Other medications listed, such as digitalics, nitro derivatives, diuretics, and prazosin, are commonly used in managing congestive heart failure, especially during acute episodes.

5. Topic: Malignant Arterial Hypertension

Correct Answer: A. Stage 2 fundus

Explanation: Malignant arterial hypertension is a severe form of hypertension characterized by very high diastolic blood pressure (often above 130 mmHg), signs of left ventricular failure, significant neurosensory disturbances, and renal insufficiency. However, it is associated with Stage 4 hypertensive retinopathy (not Stage 2), which includes papilledema, hemorrhages, and exudates.

6. Topic: Risk Factors for Digoxin Toxicity

Correct Answer: C. Hyperthyroidism

Explanation: Digoxin toxicity is more likely in conditions such as kidney failure, very advanced heart failure, hyperkalemia, and hypercalcemia because these conditions affect digoxin’s metabolism and its effects on the heart. However, hyperthyroidism typically increases the metabolism of digoxin, potentially reducing its effect, rather than increasing the risk of toxicity.

7. Topic: Paraneoplastic Syndromes in Bronchial Cancer

Correct Answer: E. Enophthalmos

Explanation: Paraneoplastic syndromes commonly associated with bronchial cancer include Schwartz-Bartter syndrome (SIADH), digital clubbing, Cushing’s syndrome, and hypercalcemia. These syndromes result from the ectopic production of hormones or cytokines by the tumor. Enophthalmos, which refers to the posterior displacement of the eye within the orbit, is not typically associated with bronchial cancer and is not a paraneoplastic syndrome.

8. Topic: Diagnosis of Chronic Bronchitis

Correct Answer: A. Through interrogation

Explanation: Chronic bronchitis is primarily diagnosed based on clinical history, which involves questioning the patient (interrogation). The diagnosis is typically established when a patient reports a productive cough lasting for at least three months in two consecutive years. Although additional tests like respiratory functional exploration or imaging may help assess the extent of lung damage, the initial diagnosis hinges on the patient’s history.

9. Topic: Complications of Bronchial Dilations

Correct Answer: D. Cystic fibrosis

Explanation: Cystic fibrosis is a genetic disorder that leads to bronchiectasis (bronchial dilations) but is not a complication of bronchial dilations. The other options, such as lung abscess, hemoptysis, purulent pleurisy, and chronic cor pulmonale, are recognized complications that can arise from bronchial dilations.

10. Topic: Pre-capillary Pulmonary Arterial Hypertension

Correct Answer: A. Vasoconstriction due to hypoxia

Explanation: Pre-capillary pulmonary arterial hypertension in the context of chronic respiratory failure is primarily associated with vasoconstriction due to hypoxia. Hypoxia causes the pulmonary arteries to constrict, leading to increased pulmonary arterial pressure. The other options do not directly explain the mechanism behind pre-capillary pulmonary hypertension in this context.

11. Topic: Diffuse Interstitial Pulmonary Fibrosis

Correct Answer: C. Left cancer

Explanation: Diffuse interstitial pulmonary fibrosis is characterized by clinical signs such as clubbing, dyspnea, weight loss, and crackles. However, “left cancer” is not associated with this condition. The clinical manifestations of diffuse interstitial pulmonary fibrosis are related to lung fibrosis and its effects, rather than to malignancies.

12. Topic: Hemoptysis in a Former Tuberculosis Patient

Correct Answer: E. Bronchial candidiasis

Explanation: In a former tuberculosis patient experiencing hemoptysis, the following conditions are relevant: bronchial cancer, recurrence of pulmonary tuberculosis, parascaricidal dilatation of the bronchi, and aspergillosis as a sequel of tuberculosis. Bronchial candidiasis is not a common condition associated with hemoptysis in this context.

13. Topic: Gastroesophageal Reflux

Correct Answer: A. It is secondary to retrograde esophageal contractions

Explanation: Gastroesophageal reflux disease (GERD) is primarily related to the incompetence of the lower esophageal sphincter, not retrograde esophageal contractions. It can occur with or without hiatal hernia, is often marked by heartburn, may present as pseudoanginal pain, and is associated with lower esophageal sphincter incontinence.

14. Topic: Pyloric Stenosis in Young Adults

Correct Answer: C. Hypertrophy of the pylorus

Explanation: In young adults, the most common cause of a clinical syndrome resembling pyloric stenosis is hypertrophy of the pylorus. Gastric cancer, duodenal ulcer, and gastric ulcers are less commonly associated with this syndrome in this age group.

15. Topic: Assessment of Upper Gastrointestinal Hemorrhage

Correct Answer: C. The number of units of blood and fluids infused for hemodynamic maintenance

Explanation: The most precise criterion for assessing the importance of an upper gastrointestinal hemorrhage is the number of units of blood and fluids infused for hemodynamic maintenance. This measure provides a direct indication of the volume of blood lost and the extent of resuscitation required. Other options such as hematocrit, the volume of blood aspirated, drop in blood pressure, and initial central venous pressure are important but less directly related to quantifying the blood loss and necessary intervention.

16. Topic: Epigastric Pain Diagnosis

Correct Answer: A. Ulcerative pain

Explanation: Epigastric pain that is rhythmic, cramp-like, and occurs during the day without late postprandial irradiation is most suggestive of ulcerative pain. This type of pain is often associated with peptic ulcers, where the discomfort tends to follow a specific pattern and can be relieved by food or antacids. Other conditions like gastritis, gastroesophageal reflux, acute hemorrhagic pancreatitis, and hepatic colic have different pain characteristics or associated symptoms.

17. Topic: Diarrhea Due to Malabsorption

Correct Answer: A. Significant weight loss

Explanation: Diarrhea due to malabsorption is often associated with significant weight loss because the body is unable to absorb essential nutrients effectively, leading to malnutrition. While steatorrhea (fatty stools) can also indicate malabsorption, significant weight loss is a more direct and prominent sign of the condition. Mucous and bloody diarrhea are more typical of inflammatory or infectious causes, and stool weight at 150g/d is generally not indicative of malabsorption, as it is more relevant to osmotic or secretory types of diarrhea.

18. Topic: Isolated Functional Colonopathy

Correct Answer: B. Weight loss

Explanation: Isolated functional colonopathy, such as irritable bowel syndrome (IBS), typically presents with symptoms like abdominal pain, constipation, diarrhea, and postprandial bloating. Weight loss is not a common feature of functional colonopathy and often suggests other underlying issues or conditions.

19. Topic: Acute Pancreatitis

Correct Answer: B. Cholelithiasis

Explanation: Cholelithiasis (gallstones) is one of the most common causes of acute pancreatitis. While alcohol is also a significant cause, gallstones are more frequently associated with acute episodes. Other factors such as obesity, clofibrate use, and hyperparathyroidism are less common causes.

20. Topic: Nephrotic Syndrome

Correct Answer: C. An increase in serum gammaglobulins

Explanation: Nephrotic syndrome typically features hypoalbuminemia, hypercholesterolemia, a risk of thrombosis, and often a low urinary sodium concentration. However, an increase in serum gammaglobulins is not a typical feature of nephrotic syndrome; instead, it is often characterized by hypoglobulinemia due to protein loss in the urine.

21. Topic: Nephritic Syndrome

Correct Answer: B. Hypo protidemia less than 60g per liter

Explanation: Nephritic syndrome is characterized by hypertension, hematuria with cylindruria, edema, and persistent proteinuria. However, hypo protidemia (specifically less than 60g/L) is more commonly associated with nephrotic syndrome rather than nephritic syndrome.

22. Topic: Uric Acid Stone Dissolution

Correct Answer: B. An alkaline urinary pH

Explanation: Dissolving a uric acid stone requires an alkaline urinary pH. Uric acid stones form in acidic urine, so alkalinizing the urine helps to dissolve these stones by increasing their solubility.

23. Topic: Acute Prostatitis

Correct Answer: D. A hard and stony prostatitis

Explanation: Acute prostatitis typically presents with painful prostatitis, acute urinary retention, urinary burns, and a high fever. A “hard and stony” prostate is more characteristic of chronic prostatitis or prostate cancer, not acute prostatitis.

24. Topic: Pyuria (Pus in the Urine)

Correct Answer: C. Glomerulonephritis

Explanation: Pus in the urine (pyuria) is commonly associated with infections or conditions like renal lithiasis, vesico-renal reflux, a retained bladder, or cystitis. Glomerulonephritis, however, is primarily an inflammation of the glomeruli and typically presents with hematuria (blood in the urine) rather than pyuria.

25. Topic: Contraindications for Biguanides in Diabetes Mellitus

Correct Answer: B. Kidney failure

Explanation: Biguanides, such as metformin, are contraindicated in patients with kidney failure due to the increased risk of lactic acidosis, a serious and potentially life-threatening condition. Obesity, insulin-dependent diabetes, angina, and peripheral neuropathy do not directly contraindicate the use of biguanides.

26. Topic: Complications of Type 4 Hypertriglyceridemia

Correct Answer: B. Acute pancreatitis

Explanation: Type 4 hypertriglyceridemia, characterized by elevated triglyceride levels, can lead to acute pancreatitis, a serious and potentially life-threatening condition. While atheroma, hypertension, obesity, and gout are associated with lipid disorders, they are not specific complications of Type 4 hypertriglyceridemia like acute pancreatitis.

27. Topic: Clinical Signs of Acromegaly

Correct Answer: D. Prognathism of the lower jaw

Explanation: The most suggestive clinical sign of acromegaly is prognathism of the lower jaw, which refers to the abnormal protrusion of the lower jaw. This feature is a hallmark of acromegaly due to excessive growth hormone, leading to characteristic facial changes. Swelling of the fingers, weight gain, hair loss, and exophthalmos may be present but are not as specific to acromegaly as prognathism.

28. Topic: Biochemical Parameters Indicative of Conn’s Adenoma

Correct Answer: B. Hypokalemia

Explanation: Hypokalemia is a key biochemical parameter that suggests the presence of a Conn’s adenoma (primary hyperaldosteronism) in a hypertensive patient. Conn’s adenoma leads to excessive secretion of aldosterone, causing the kidneys to retain sodium (leading to hypernatremia) and excrete potassium, resulting in hypokalemia. The other options are less specific or unrelated to Conn’s adenoma.

29. Topic: Erysipelas

Correct Answer: E. It has a gradual, non-painful onset

Explanation: Erysipelas typically presents with a sudden onset of symptoms, including pain, redness, and swelling in the affected area. The condition is often painful, and the rapid progression of symptoms contradicts the idea of a gradual, non-painful onset, making option E the incorrect statement among the provided options.

30. Topic: Candida Infections

Correct Answer: C. Ringworm of the scalp

Explanation: Candida species are responsible for infections such as vaginitis, thrush, black hairy tongue, and intertrigo. However, ringworm of the scalp (tinea capitis) is caused by dermatophytes like Trichophyton or Microsporum, not by Candida. Thus, option C is the correct answer.

31. Topic: Paget’s Disease

Correct Answer: E. Osteonecrosis

Explanation: Paget’s disease is a bone disorder that can lead to complications such as deafness, heart failure, headaches, and hip disease due to abnormal bone growth and deformation. However, osteonecrosis (bone death due to poor blood supply) is not a typical complication of Paget’s disease. Thus, option E is the correct answer.

32. Topic: Acute Gout in Chronic Renal Failure

Correct Answer: C. Colchicine

Explanation: For an acute attack of gout, especially in patients with chronic renal failure, colchicine is often used as it effectively reduces inflammation during an acute attack. Aspirin and phenylbutazone are not recommended due to their potential to worsen kidney function or interact adversely with renal conditions. Benzobromarone and allopurinol are used for chronic management and prevention of gout but are not suitable for treating acute attacks. Thus, option C is the most appropriate choice.

33. Topic: Diagnosis of Syphilitic Chancre

Correct Answer: E. Nelson’s test

Explanation: For diagnosing a syphilitic chancre, useful tests include ultramicroscopic examination (A) to visualize the spirochetes, the VDRL (B) for initial screening, TPHA (C) for confirmation of syphilis, and immunofluorescence (D) for detecting Treponema pallidum. Nelson’s test (E), which is not typically used for diagnosing syphilis, is therefore the least relevant in this context.

Top of Form

34. Topic: Persistent Salmonella Carrier After Typhoid Fever

Correct Answer: B. Cholelithiasis

Explanation: Salmonella Typh 1 can persist in the gallbladder of patients, leading to chronic carriage. Therefore, cholelithiasis (B) is a common finding as the bacteria may reside in the gallbladder and contribute to the formation of gallstones. Splenic abscess (A), stomach ulcer (C), Meckel’s diverticulum (D), and appendicular abscess (E) are not typically associated with persistent Salmonella carriage after typhoid fever.

35. Topic: Tetanus Prevention in a Vaccinated Individual

Correct Answer: D. A toxoid booster

Explanation: In individuals who are adequately vaccinated but who have not received a tetanus booster in the past 10 years, a single booster of the tetanus toxoid (D) is recommended. The initial vaccination at age 19 and the booster at 20 should provide long-term immunity, but routine boosters every 10 years are necessary to maintain protection. The human tetanus immunoglobulin (B, E) is only used in unvaccinated individuals or those with unknown vaccination status presenting with high-risk wounds. Two toxoid injections (C) are not required for someone with a recent vaccination history.

36. Topic: Antibiotic for Gas Gangrene

Correct Answer: C. Penicillin G

Explanation: Gas gangrene, typically caused by Clostridium species, is effectively treated with Penicillin G (C), which targets these anaerobic bacteria. Gentamycin (A) and Cotrimoxazole (D) are not primarily effective against Clostridia. Colistin (B) is used for Gram-negative infections, and Nalidixic acid (E) is used for urinary tract infections, making them unsuitable for gas gangrene.

37. Topic: Diagnosis of Cerebral Toxoplasmosis in HIV-Infected Patients

Correct Answer: D. Meningeal stiffness

Explanation:

Cerebral toxoplasmosis in HIV-infected patients is characterized by symptoms such as convulsive seizures (A), fever (B), hemiparesis (C), and altered consciousness (E). Meningeal stiffness (D), typically associated with meningitis, is not a common feature of cerebral toxoplasmosis. The presentation of this condition usually does not include meningeal signs but rather neurological deficits and systemic symptoms.

38. Topic: Blood Findings in Myeloma (Kahler’s Disease)

Correct Answer: E. None of the above

Explanation:

In the typical form of myeloma, or Kahler’s disease, blood findings typically include abnormalities such as monoclonal gammopathy, increased levels of paraproteins (M proteins), and anemia, but not the specific options listed. Plasma cells may be found in the bone marrow (A), but they are not typically seen in blood in significant numbers. Eosinophilia (B), hyperlymphocytosis (C), and neutrophilic polynucleosis (D) are not characteristic of myeloma. Therefore, the answer is that none of these findings are typically observed in the blood of a patient with myeloma.

39. Topic: Hemopathies and Splenomegaly

Correct Answer: B. Chronic myeloid leukemia

Explanation: Chronic myeloid leukemia (B) is commonly associated with splenomegaly due to the accumulation of abnormal leukocytes in the spleen. Biermer’s disease (A), also known as pernicious anemia, does not typically cause splenomegaly. Kahler’s disease (C) and hemophilia (D) are not characteristically associated with splenomegaly, and latrogenic agranulocytosis (E) involves a decreased white blood cell count but not necessarily splenomegaly.

40. Topic: Thrombocytopenia in Hepatic Cirrhosis

Correct Answer: D. Hypersplenism

Explanation: In hepatic cirrhosis with signs of portal hypertension, thrombocytopenia (low platelet count) is commonly due to hypersplenism (D), where the spleen is enlarged and sequesters platelets, leading to a reduced number in circulation. Bone marrow failure (A) is less likely given the normal D-dimer levels and absence of signs of bleeding. Disseminated intravascular coagulation (DIC) (B) typically shows elevated D-dimer levels, not low. Immunological destruction (C) and consumption at the level of esophageal varices (E) are less common causes in this context.

PEDIATRICS

41. Topic: Corticosteroid Therapy in Acute Rheumatic Fever (ARF)

Correct Answer: A. The decrease in SV

Explanation: In the management of acute rheumatic fever (ARF) with corticosteroids, the decision to reduce therapy is typically guided by clinical improvement. A decrease in the severity of symptoms (SV) such as inflammation or joint swelling supports tapering of corticosteroids. Increased leukocytosis (B) indicates ongoing inflammation, suggesting that corticosteroids might need to be continued or adjusted. Decreases in antistreptokinases (C) and antistreptolysins (D) indicate a reduction in streptococcal activity, but they are not as direct indicators for adjusting corticosteroid therapy. The throat swab result (E) is more relevant for diagnosing streptococcal infection rather than adjusting corticosteroid therapy.

42. Topic: Risk of Osler Endocarditis in Congenital Heart Diseases

Correct Answer: C. Interauricular communication

Explanation: Osler endocarditis, also known as infective endocarditis, is a condition that can affect congenital heart diseases with turbulent blood flow or abnormal heart structures. Interauricular communication (C), or atrial septal defect, generally carries a lower risk for Osler endocarditis compared to other congenital heart defects. Tetralogy of Fallot (A), persistent ductus arteriosus (B), ventricular communication (D), and coarctation of the aorta (E) are associated with higher risks due to turbulent blood flow and increased susceptibility to infections in these areas.

43. Topic: Generalized Cyanosis

Correct Answer: D. An excess of reduced hemoglobin

Explanation: Generalized cyanosis is characterized by a bluish discoloration of the skin and mucous membranes due to an excess of reduced (deoxygenated) hemoglobin in the blood (D). This condition typically arises when there is insufficient oxygenation of blood, which can occur with severe hypoxia (C) or conditions affecting oxygen transport. Alveolar hypoventilation (A) and hypercapnia (B) can contribute to hypoxia, but the direct cause of cyanosis is the excess of reduced hemoglobin. Polycythemia (E) can increase blood viscosity but does not directly cause cyanosis.

44. Topic: Viral Bronchopneumopathy in Infants

Correct Answer: D. Acute respiratory failure

Explanation: In infants with viral bronchopneumopathy, acute respiratory failure (D) is the primary concern due to their smaller airways and less efficient respiratory systems, which can quickly become overwhelmed by the infection. While bacterial superinfection (A) and heart failure (B) are also potential complications, the immediate risk is the inability to maintain adequate oxygenation and ventilation. Pneumothorax (C) and interstitial emphysema (E) are less common but can occur in severe cases.

45. Topic: Primary Tuberculosis Infection in Children

Correct Answer: A. An erythema nodosum

Explanation:

In children, primary tuberculosis infection can present with erythema nodosum (A), a skin condition often associated with tuberculosis. This finding is more specific to tuberculosis compared to the other options. Diarrhea (B), angina with hyperlymphocytosis (C), and wheezing dyspnea (D) are not typically associated with primary tuberculosis in children. While they may occur in various infections or conditions, erythema nodosum is a more indicative sign of tuberculosis.

46. Topic: BCG Vaccine

Correct Answer: D. A live but attenuated strain of Mycobacterium bovis

Explanation: The BCG (Bacillus Calmette-Guérin) vaccine is composed of a live but attenuated strain of Mycobacterium bovis (D). This strain is weakened so it does not cause disease but stimulates an immune response. It is not a killed strain (C) or an extract of heated bacilli (B), and it does not involve a mixture of different mycobacteria (E). The vaccine’s live attenuated nature is crucial for its effectiveness in providing immunity against tuberculosis.

47. Topic: Asthma Onset in Children Before Age 5

Correct Answer: E. He is very often corticodependent

Explanation: Asthma in children before age 5 is often of allergic origin (A) and commonly associated with other atopic conditions such as eczema or allergic rhinitis (C). It can sometimes resolve or improve significantly by puberty (B), and it can lead to chest deformities if left untreated over a long period (D). However, it is not necessarily “very often corticodependent” (E); many children with early-onset asthma may not require long-term corticosteroid therapy, especially if their symptoms are well-managed or if they experience significant improvement with age.

48. Topic: Treatment of Gastroesophageal Reflux Disease in Infants

Correct Answer: A. Administration of anticholinergics

Explanation: In managing gastroesophageal reflux disease (GERD) in infants, the following strategies are useful: administration of metoclopramide (B), which helps in gastric emptying; positioning the infant in a prone position or in dorsal decubitus with a 45-degree incline (C and D), which can reduce reflux; and thickening milk to reduce regurgitation (E). However, anticholinergics (A) are not typically used in the treatment of GERD in infants due to their side effect profile and lack of efficacy in this context.

49. Topic: Hematemesis in Infants

Correct Answer: D. Peptic esophagitis

Explanation: In infants, the most common cause of hematemesis is peptic esophagitis (D), which can result from acid reflux or irritation of the esophagus. Conditions like gastric ulcers (A) and Meckel’s diverticulum (E) are less common causes. Cow’s milk protein intolerance (B) and thrombocytopenia (C) can cause gastrointestinal symptoms but are not the primary causes of hematemesis in infants. Peptic esophagitis stands out as the most frequent culprit in this context.

50. Topic: Dysenteric Syndrome in Infants

Correct Answer: C. Salmonella

Explanation: Dysenteric syndrome in infant stools, characterized by frequent and painful diarrhea with blood and mucus, is most commonly associated with infections caused by Salmonella (C). Rotavirus (A) typically causes watery diarrhea rather than dysenteric syndrome. Cervical bacillus (B) and Candida albicans (D) are less commonly linked to dysenteric diarrhea in infants. Therefore, Salmonella is the primary pathogen associated with this condition in infants.

51. Topic: Recommendations for Newborns of HBsAg and HBeAg Positive Mothers

Correct Answer: E. Serovaccination

Explanation: For a newborn whose mother is positive for both HBsAg and HBeAg, the recommended approach is serovaccination (E). This involves administering both hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) to the newborn. This combined strategy provides immediate passive immunity and active vaccination to protect against hepatitis B virus infection. Options such as vaccination only (C) or specific immunoglobulins alone (D) are insufficient for full protection. Polyvalent immunoglobins (B) and no treatment (A) are not appropriate for this high-risk situation.

52. Topic: Diagnosis of Urinary Tract Infection in Children

Correct Answer: D. Uroculture 1,000,000 germs/ml 5,000 leukocytes/ml

Explanation: The diagnosis of a urinary tract infection (UTI) in children is supported by a high bacterial count and a significant presence of leukocytes. Option D indicates a uroculture with 1,000,000 germs/ml and 5,000 leukocytes/ml, which is indicative of a UTI due to the high bacterial count and elevated leukocytes, reflecting an infection and inflammation. Lower bacterial counts (A, B, C) with or without some leukocytes are not typically sufficient for diagnosing a UTI. Option E is incorrect because not all listed results are diagnostic for a UTI.

53. Topic: Diagnosis of Recurrent Pyelonephritis with Urography Findings

Correct Answer: B. Retrograde and voiding cystography

Explanation: In a case of recurrent pyelonephritis with no visible obstruction on urography but with renal atrophy and abnormal calyces, retrograde and voiding cystography are essential for diagnosing potential vesicoureteral reflux (VUR). VUR is a condition where urine flows backward from the bladder into the ureters and kidneys, which can lead to recurrent infections and renal damage. This test helps identify reflux, which is crucial for managing and preventing further renal damage. Other options like kidney biopsy (A), arteriography (C), lymphography (D), and ultrasound (E) are less specific in diagnosing VUR, which is a common underlying issue in such cases.

54. Topic: Diagnosis of Hematuria in Children

Correct Answer: D. Valves of the posterior urethra

Explanation: Hematuria in children can be associated with conditions like glomerulonephritis (A), Berger’s disease (B), and urinary lithiasis (C). These conditions commonly cause blood in the urine due to their effects on the renal and urinary systems. However, valves of the posterior urethra (D) primarily cause obstructive symptoms and may lead to urinary tract infections or hydronephrosis rather than hematuria directly. Hence, the discovery of hematuria is less commonly linked to this condition.

55. Topic: Childhood Nephrotic Syndrome

Correct Answer: A. It most often cortico-sensitive

Explanation: Childhood nephrotic syndrome is typically responsive to corticosteroid therapy (A), which is a key aspect of its management. Most cases of nephrotic syndrome in children do not require a renal biopsy before starting corticosteroid therapy (C) and are unlikely to progress to chronic renal failure (D). Although relapses can occur, the condition often does not require a sodium-restricted diet outside of flare-ups (E).

56. Topic: Impetigo

Correct Answer: E. It requires a bacteriological sample

Explanation: Impetigo is a highly contagious skin infection commonly affecting children (A) and typically involves crusty lesions around the face and mouth (C), and can sometimes present with bullous forms (D). It is generally advised to exclude affected children from school to prevent spread (B). While bacteriological samples can be helpful for diagnosis, they are not always required for clinical management (E). The diagnosis is often based on clinical presentation.

57. Topic: Infantile Scabies

Correct Answer: C. Involvement of the face

Explanation: Infantile scabies is characterized by pruritus (B) and lesions in the interdigital spaces (A) and on the soles of the feet (D). It is known for its widespread involvement in areas where adults might not typically see scabies, such as the soles and palms. However, it usually does not involve the face (C), which helps differentiate it from other skin conditions affecting infants. Thus, the face is not typically affected in infantile scabies, making C the correct answer.

58. Topic: Atopic Eczema in Infants

Correct Answer: A. It begins in the first month of life

Explanation:

Atopic eczema in infants typically does not begin within the first month of life (A). Instead, it often starts after the first few months of life and commonly begins on the face (C). The condition evolves with periods of flare-ups and remissions (B) and presents with erythemato-vesicular lesions (D). A family history of allergy is frequently observed (E), which aligns with the genetic component of atopic conditions. Thus, A is the exception as it is not characteristic of atopic eczema’s typical onset.

59. Topic: Tetanus Prophylaxis

Correct Answer: E. None of the above

Explanation: For a 7-year-old child who has been vaccinated correctly and has a minor scratch, routine prophylaxis typically involves checking the child’s tetanus vaccination status. If the child is up-to-date with vaccinations and the wound is minor, no additional prophylaxis is generally needed (E). Specific prophylaxis options like seroprophylaxis (B) or additional vaccination (A) are usually reserved for cases with higher risk or incomplete vaccination history. The correct choice is E because none of the listed options are necessary for a properly vaccinated child with a minor injury.

60. Topic: Measles Clinical Manifestations

Correct Answer: A. Dissociation of pulse and temperature

Explanation: Measles typically presents with a constellation of symptoms including conjunctivitis with photophobia (B), fever that often persists beyond the rash onset (C), redness and petechiae of the soft palate (D), and symptoms like coryza and cough (E). Dissociation of pulse and temperature (A) is not characteristic of measles; in fact, fever and pulse are usually correlated. Therefore, A is the correct answer as it does not align with the typical clinical manifestations of measles.

61. Topic: Kolick Sign

Correct Answer: C. Seeding of whitish spots on the oral mucosa

Explanation: The Kolick sign refers to the appearance of whitish spots on the oral mucosa, which are indicative of certain viral infections like measles. Options A, B, D, and E describe other clinical signs that do not correspond to the Kolick sign. Specifically, ulceration of the tonsils (A), gingival ulcers (B), purpura (D), and vesicles (E) are associated with different conditions or symptoms and do not define the Kolick sign.

62. Topic: Mumps Invasion Phase

Correct Answer: C. Turgor of the orifice of Stenon’s canal

Explanation: During the mumps invasion phase, the presence of turgor (swelling or tenderness) at the orifice of Stenon’s canal, which is the duct of the parotid gland, is a key diagnostic sign. This is due to inflammation of the parotid glands, leading to obstruction or swelling around this area. The other options—high fever with headache (A), erythematous pharyngitis (B), pre-tragal lymphadenopathy (D), and hypersalivation (E)—are less specific and can be associated with various conditions, not just mumps.

63. Topic: Facial Rash in a 9-Month-Old Child

Correct Answer: C. Herpes virus

Explanation: The facial rash resembling Kaposi-Juliusberg varioliform pustulosis in a 9-month-old child is caused by the herpes virus, particularly HSV (Herpes Simplex Virus). This condition can present with vesicular or pustular lesions on the skin. Varicella zoster virus (A) causes chickenpox, measles virus (B) leads to measles, and Staphylococcus (D) can cause impetigo but not the described rash. The term “unknown” (E) is not applicable as the herpes virus is a well-recognized cause.

64. Topic: Congenital Toxoplasmosis

Correct Answer: A. It is more frequent during the 3rd trimester of pregnancy

Explanation: Congenital toxoplasmosis occurs when the Toxoplasma gondii infection is transmitted from the mother to the fetus. The risk of transmission increases as the pregnancy progresses, making it more frequent in the 3rd trimester (A). While it is less common in the 1st trimester (B), the severity is not necessarily greater if contracted later in pregnancy; instead, earlier infections are often more severe. Pyrimethamine is used for treatment, but this is relevant for treating the infection, not the frequency of transmission (D). Fibroplasia is not the characteristic eye lesion in newborns; chorioretinitis is more typical (E).

65. Topic: Acute Leukemia in Children

Correct Answer: B. Lymphoblastic

Explanation: Acute lymphoblastic leukemia (ALL) is the most common type of acute leukemia in children, characterized by the proliferation of immature lymphoid cells (B). Acute myeloblastic leukemia (A) and other types such as monoblastic (C), promyelocytic (D), and erythroleukemia (E) are less common in the pediatric population.

66. Topic: Purpura in Children

Correct Answer: E. Rheumatoid purpura

Explanation: Rheumatoid purpura, also known as Henoch-Schönlein purpura, is characterized by purpura on the lower limbs, often accompanied by fever and a generally good condition (E). Acute leukemia (A) and Waldenstrom macroglobulinemia (B) are less common causes of purpura in this context. Flea bites (C) and monocyte angina (D) are unlikely to present with such systemic symptoms and purpura.

67. Topic: Hemophilia A

Correct Answer: D. Active partial thromboplastin time (APTT)

Explanation: In untreated hemophilia A, the Active Partial Thromboplastin Time (APTT) is prolonged due to deficiencies in clotting factors involved in the intrinsic pathway of hemostasis (D). Bleeding time (A), platelet count (B), Quick time (C), and thrombin time (E) are usually normal in hemophilia A. The APTT test is specifically sensitive to deficiencies in factor VIII, which is characteristic of hemophilia A.

68. Topic: Routine Vaccinations in Children

Correct Answer: C. Mumps

Explanation: In routine childhood vaccinations, children are vaccinated against pertussis (A), pneumococcal infections (B), Haemophilus influenzae type b infection (D), and diphtheria (E). Mumps (C) is included in the MMR (measles, mumps, rubella) vaccine, but it is not a standalone vaccination and is not separately emphasized in routine schedules as frequently as the others.

69. Topic: Medical Outcomes in Drowning

Correct Answer: C. Hypoxic brain damage

Explanation: In drowning, hypoxic brain damage (C) is the most serious medical outcome due to prolonged oxygen deprivation, leading to potential severe and irreversible neurological damage. Pulmonary edema (A) and acute renal failure (B) can occur, but they are secondary concerns compared to the immediate and profound impact of hypoxia on the brain. Blood loss (D) and cardiac arrhythmias (E) are less directly related to the primary consequences of drowning.

70. Topic: Causes of Sensory Hearing Loss in Children

Correct Answer: D. Acute otitis media

Explanation: Sensory hearing loss is primarily linked to conditions affecting the inner ear or auditory nerve. Acute otitis media (D) typically causes conductive hearing loss rather than sensory loss, affecting the middle ear. In contrast, rubella (A), meningitis (B), perinatal asphyxia (C), and the use of aminoglycosides (E) can lead to sensory hearing loss by impacting the inner ear or auditory pathways.

71. Topic: Complications of Perinatal Asphyxia

Correct Answer: B. Hyperemesis gravidarum

Explanation: Perinatal asphyxia is associated with complications that directly impact the fetus and the delivery process. Abrupt placenta (A), prematurity (C), pre-eclampsia (D), and amniotic fluid tinged with meconium (E) are complications related to or indicative of issues that can lead to perinatal asphyxia. Hyperemesis gravidarum (B), however, is a severe form of nausea and vomiting during pregnancy that does not directly relate to perinatal asphyxia.

72. Topic: Marfan Syndrome

Correct Answer: A. Aortic dilatation and loose joints suggestive of connective tissue disorder

Explanation: Marfan syndrome is a genetic disorder affecting connective tissue, which often presents with aortic dilatation and joint laxity (loose joints) (A). The other options relate to different conditions: excessive bone length and width suggest bone metabolism disorders (B), tendons and ligaments issues point to muscle metabolism disorders (C), and large size with excess subcutaneous tissue is indicative of growth factor disorders (D). Marfan syndrome is primarily characterized by connective tissue abnormalities, making option A the correct choice.

73. Topic: Melena in an 18-Year-Old

Correct Answer: E. Meckel’s diverticulum

Explanation: Meckel’s diverticulum is a congenital abnormality that can cause gastrointestinal bleeding and melena (black, tarry stools) due to the presence of ectopic gastric mucosa or ulceration. This condition can present with anemia and shock due to significant blood loss. Eosinophilic colitis (A) and hemolytic-uremic syndrome (B) are less likely to cause melena. Ulcerative colitis (C) usually presents with diarrhea and rectal bleeding, and juvenile polyps (D) are less commonly associated with such acute presentations. Hence, Meckel’s diverticulum is the most likely diagnosis in this case.

74. Topic: Prolonged Bleeding Time

Correct Answer: A. Hemophilia A

Explanation: Hemophilia A is a coagulation disorder characterized by a deficiency in clotting factor VIII, which primarily affects the clotting cascade and not the initial platelet function, thus it does not typically cause prolonged bleeding time. In contrast, Von Willebrand disease (B) affects both platelet function and clotting, resulting in prolonged bleeding time. Aspirin-induced thrombocytopathy (C) impairs platelet aggregation, extending bleeding time. Bernard-Soulier syndrome (D) involves platelet dysfunction, leading to prolonged bleeding time. Idiopathic thrombocytopenic purpura (E) results in reduced platelet count but can also affect bleeding time, making Hemophilia A the exception here.

75. Topic: Diabetic Ketoacidosis (DKA) in Type 1 Diabetes

Correct Answer: A. Overfeeding

Explanation: Diabetic ketoacidosis (DKA) is primarily triggered by factors that increase insulin requirements or decrease insulin effectiveness. Vomiting (B) can lead to dehydration and electrolyte imbalances, which can exacerbate DKA. Omission of insulin doses (C) directly leads to uncontrolled hyperglycemia and ketogenesis. Infection (D) can increase insulin needs and precipitate DKA due to inflammatory stress. Lack of patient education (E) can result in poor management and missed insulin doses. Overfeeding (A) is less likely to directly cause DKA compared to these other factors, making it the exception.

76. Topic: Delayed Skeletal Maturation in Adolescents

Correct Answer: B. Psychosocial deprivation

Explanation: Delayed skeletal maturation in adolescents can be due to several underlying conditions. Growth hormone deficiency (A) affects bone growth and development, leading to delayed maturation. Hypothyroidism (C) can result in delayed skeletal development due to its impact on metabolic processes. Late (non-classic) onset of 21-hydroxylase deficiency (D) affects adrenal steroid production, which can impact bone age. Constitutional delay of puberty (E) is a common cause of delayed skeletal maturation, as it affects the timing of puberty and skeletal development. Psychosocial deprivation (B) is less directly related to bone age delays compared to the other conditions, making it the exception.

77. Topic: Newborn Hypothyroidism Screening

Correct Answer: E. None of the above

Explanation: Newborn hypothyroidism screening aims to ensure normal linear growth (A), support normal intellectual function (B), and can aid in genetic counseling (C). Although screening does not directly prevent sudden infant death syndrome (D), it is still crucial in preventing long-term complications by addressing hypothyroidism early. Therefore, “None of the above” (E) is correct because all the listed goals are relevant to newborn hypothyroidism screening.

78. Topic: Pheochromocytoma in Children

Correct Answer: E. Sufficiency

Explanation: Pheochromocytoma, a tumor of the adrenal glands, can cause symptoms like headache (A), weight loss (B), convulsions (C), and sweating (D) due to excess catecholamines. However, “sufficiency” (E) is not a recognized symptom of pheochromocytoma. The condition is associated with excess hormone secretion, not sufficiency.

79. Topic: Rett Syndrome

Correct Answer: D. Autosomal recessive inheritance

Explanation: Rett syndrome is a neurodevelopmental disorder characterized by autistic behavior (A), microcephaly (B), hand-wringing movements (C), and progressive dementia (E). However, Rett syndrome is typically inherited in an X-linked dominant pattern, not autosomal recessive (D). The inheritance pattern distinguishes Rett syndrome from other genetic disorders.

80. Topic: Spina Bifida Cystica

Correct Answer: B. It is fatal if not treated within 24 hours

Explanation: Spina bifida cystica is a type of neural tube defect often associated with hydrocephalus (A), which can be diagnosed in utero by ultrasound (C). It can lead to urological problems (D) and often requires orthopedic care (E). However, while prompt treatment is important, it is not necessarily fatal if not treated within 24 hours; rather, early intervention helps reduce the risk of severe complications. Therefore, statement B is incorrect.

PUBLIC HEALTH

81. Topic: Study Design

Correct Answer: C. A prospective cohort

Explanation: In a prospective cohort study, participants are followed over time to observe outcomes based on exposure status. In this case, women with a history of smoking are followed to determine their babies’ birth weights. This design allows for tracking the association between smoking and birth weight over time. Other designs like clinical trials (A), cross-sectional studies (B), case-control studies (D), and retrospective cohort studies (E) do not fit this description as closely as the prospective cohort design.

82. Topic: Blood Pressure Measurement and Study Design

Correct Answer: B. Regression to the mean

Explanation: Regression to the mean occurs when subjects with extreme measurements at the start of a study tend to have more average measurements upon re-evaluation, simply due to statistical variability. In this case, patients with high diastolic blood pressure may show a reduction over time, leading to fewer patients meeting the study’s criteria upon follow-up. Spontaneous resolution (A) and measurement error (D) are less likely to fully explain the reduction in qualifying patients, while basic drift (C) and the Hawthorne effect (E) do not directly address the statistical phenomenon observed.

83. Topic: Incidence Calculation

Correct Answer: D. Person-years of observation

Explanation: Person-years of observation is used as the denominator in calculating incidence rates to account for both the number of people and the time each person is at risk. This measure helps to reflect the time each individual contributes to the risk of developing the disease. The number of new cases observed (B) is the numerator for incidence calculation, while the number of cases observed (A) and asymptomatic cases (C) are not directly used. Persons lost to follow-up (E) do not contribute to the denominator but can affect the study’s accuracy.

84. Topic: Normal Distribution and Weight Analysis

Correct Answer: D. 16%

Explanation: To determine the percentage of women who weigh more than 59.5 kg, we need to find the z-score for 59.5 kg using the mean (52 kg) and standard deviation (7.5 kg).

The z-score is calculated as:

z=(X−mean)standard deviation=(59.5−52)7.5=1z = \frac{(X – \text{mean})}{\text{standard deviation}} = \frac{(59.5 – 52)}{7.5} = 1z=standard deviation(X−mean)​=7.5(59.5−52)​=1

A z-score of 1 corresponds to approximately the 84th percentile of the normal distribution, meaning that about 16% of women weigh more than 59.5 kg.

85. Topic: Measures of Central Tendency

Correct Answer: E. 3, 4, 3

Explanation: To find the mean, median, and mode:

1. Mean: Sum of all values divided by the number of values. Mean=4+6+2+2+4+3+2+1+79=309=3.33\text{Mean} = \frac{4 + 6 + 2 + 2 + 4 + 3 + 2 + 1 + 7}{9} = \frac{30}{9} = 3.33Mean=94+6+2+2+4+3+2+1+7​=930​=3.33 Approximated to the nearest integer, the mean is 3.
2. Median: The middle value when the numbers are sorted in ascending order. Sorted numbers: 1, 2, 2, 3, 4, 4, 6, 7 The median is 4.
3. Mode: The value that appears most frequently. In this case, the mode is 3 (as 3 appears most frequently).

Thus, the mean is 3, the median is 4, and the mode is 3.

86. Topic: Analyzing Data for Association Studies

Correct Answer: C. Fisher’s exact test

Explanation: Fisher’s exact test is used to determine if there are nonrandom associations between two categorical variables, especially in cases where sample sizes are small. In this scenario, where the association between coffee consumption (more than eight cups vs. not drinking coffee) and hypertension is being assessed, Fisher’s exact test is appropriate for analyzing the categorical data from a 2×2 contingency table. The Chi-square test (A) is typically used for larger sample sizes. The McNemar test (B) is used for paired nominal data, which doesn’t apply here. Student’s t-test (D) is used for comparing means between two groups, and Analysis of Variance (E) is used for comparing means among more than two groups.

87. Topic: Incidence Rate Calculation

Correct Answer: D. 10

Explanation: To calculate the incidence rate per 1000 people per year in households with a culture-positive case at the first survey, follow these steps:

1. Determine the number of new cases in the households with a culture-positive case during the follow-up period.
2. Find the total number of people at risk in those households.
3. Calculate the incidence rate using the formula: Incidence rate=Number of new casesTotal person-years at risk×1000\text{Incidence rate} = \frac{\text{Number of new cases}}{\text{Total person-years at risk}} \times 1000Incidence rate=Total person-years at riskNumber of new cases​×1000

If the study data results in 10 new cases per 1000 people per year, this is the incidence rate for the households with a culture-positive case from the first survey.

The other options (A, B, C, E) do not correctly reflect the given incidence rate calculation.

88. Topic: Incidence Rate Calculation in Households Without Culture-Positive Cases

Correct Answer: C. 0.5

Explanation: To calculate the incidence rate of new cases per 1000 person-years in households that had no culture-positive cases at the first survey:

1. Identify the number of new cases in these households during the follow-up period.
2. Determine the total person-years at risk for these households.
3. Apply the formula: Incidence rate=Number of new casesTotal person-years at risk×1000\text{Incidence rate} = \frac{\text{Number of new cases}}{\text{Total person-years at risk}} \times 1000Incidence rate=Total person-years at riskNumber of new cases​×1000

If the incidence rate is calculated to be 0.5 per 1000 person-years, this reflects the rate of new cases in households without initial culture-positive cases.

Other options (A, B, D, E) do not accurately represent the incidence rate of 0.5 per 1000 person-years.

89. Topic: Relative Risk of Contracting TB

Correct Answer: E. 20

Explanation: To calculate the relative risk (RR) of contracting TB in households with culture-positive cases compared to those without:

1. Determine the incidence rate of TB in households with culture-positive cases.
2. Determine the incidence rate of TB in households without culture-positive cases.
3. Apply the formula: Relative Risk (RR)=Incidence rate in exposed groupIncidence rate in unexposed group\text{Relative Risk (RR)} = \frac{\text{Incidence rate in exposed group}}{\text{Incidence rate in unexposed group}}Relative Risk (RR)=Incidence rate in unexposed groupIncidence rate in exposed group​

Given that the relative risk is 20, this indicates that individuals in households with culture-positive cases are 20 times more likely to contract TB compared to those in households without initial culture-positive cases.

Other options (A, B, C, D) do not accurately reflect the significant increase in risk associated with culture-positive households.

90. Topic: Experimental vs. Observational Studies

Correct Answer: E. Investigators determine who will or will not be exposed to the suspected causative factor

Explanation: In an experimental study, such as a randomized controlled trial, the researchers actively intervene and assign participants to either the exposed or non-exposed group to study the effect of an intervention or exposure. This control over exposure is what distinguishes experimental studies from observational studies. In observational studies, researchers simply observe and record exposures and outcomes without assigning exposure.

91. Topic: Rabies Prophylaxis in Children

Correct Answer: C. Administer rabies vaccine and rabies immunoglobulin

Explanation: Given the history of potential exposure to a bat, which is a known rabies vector, and the absence of visible scratches, it is still prudent to administer both rabies vaccine and rabies immunoglobulin. Rabies is a serious disease, and prophylactic treatment is essential even if no physical evidence of a bite or scratch is present. The combination of vaccine and immunoglobulin provides comprehensive protection against rabies.

92. Topic: Vaccination During Pregnancy

Correct Answer: B. Varicella vaccine

Explanation: The varicella (chickenpox) vaccine is a live attenuated vaccine and is contraindicated during pregnancy due to the potential risk to the fetus. Pregnant women should avoid this vaccine, as live vaccines can pose a risk to the developing baby.

93. Topic: Tetanus Prophylaxis

Correct Answer: A. No additional prophylaxis

Explanation: Given that the patient received the last dose of tetanus toxoid 7 years ago and has completed a primary series of immunizations, no additional prophylaxis is needed for this minor injury. Tetanus prophylaxis recommendations generally suggest a booster every 10 years, but since the injury is not classified as high risk and the patient is up-to-date on vaccinations, additional prophylaxis is not required.

94. Topic: Interval Between Whole Blood Administration and MMR Vaccine

Correct Answer: D. 6

Explanation: It is recommended to wait at least 6 months after receiving whole blood before administering the measles-mumps-rubella (MMR) vaccine. This is because whole blood transfusions can interfere with the effectiveness of live vaccines like MMR. Waiting 6 months ensures that the vaccine will be effective.

95. Topic: Etiological Agent of Lower Abdominal Pain and Cervical Findings

Correct Answer: B. Chlamydia trachomatis

Explanation: Chlamydia trachomatis is a common cause of cervicitis and can present with symptoms such as lower abdominal pain, friable cervix, and pain on cervical movement. This sexually transmitted infection often causes these findings without fever and can be associated with negative pregnancy tests.

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

Correct Answer: D. 20%

Explanation: Pelvic inflammatory disease (PID) can increase the risk of infertility due to scarring and damage to the reproductive organs. Each episode of PID contributes to this risk, and after two episodes, the cumulative risk of infertility is around 20%. This risk reflects the potential for complications such as blocked fallopian tubes and other reproductive tract issues.

97. Topic: Diagnosis of Genital Ulcers

Correct Answer: A. Syphilis

Explanation: A single, hard, painless ulcer on the penis that has been present for 2 days and is consistent with a primary chancre is characteristic of primary syphilis. The RPR test may be negative in the early stages of syphilis, as it can take several weeks for the antibodies to become detectable.

98. Topic: Sexual Partner Notification

Correct Answer: B. Partners less than 30 days old

Explanation: For sexually transmitted infections (STIs) like syphilis, partners from the last 30 days should be informed and evaluated. This timeframe is based on the typical incubation period of STIs, ensuring that recent exposures are addressed effectively to prevent further transmission and complications.

99. Topic: MMR Vaccination Safety

Correct Answer: A. A 15-month-old HIV infected child with a CD4 count of 700

Explanation: MMR (measles, mumps, rubella) vaccine is live attenuated and can be safely administered to children with HIV if their CD4 count is above 500 cells/mm³, indicating good immune function. A CD4 count of 700 suggests adequate immune status for receiving live vaccines.

100. Topic: HCV-Positive Women Counseling

Correct Answer: B. The probability of transmission to the newborn is 5%

Explanation: Hepatitis C virus (HCV) transmission from mother to infant occurs in about 5% of cases, which is a key counseling point for HCV-positive women. This transmission rate helps in understanding the risk and planning appropriate follow-up for the newborn.

SURGERY

1. Topic: Traumatic Posterior Shoulder Dislocation

Correct Answer: B. Attitude of arm in internal rotation

Explanation: In a traumatic posterior shoulder dislocation, the affected arm typically assumes an internal rotation position. This is because the posterior dislocation causes the humeral head to move backward, leading to the arm being held close to the body with internal rotation.

2. Topic: Dislocation Erecta of the Shoulder

Correct Answer: B. Lower

Explanation: Dislocation erecta of the shoulder refers to a rare type of dislocation where the humeral head is displaced inferiorly or downward, causing the arm to be held in an extended position. This results in an unusual presentation where the arm is held in a position that appears as if it is standing upright, hence the term “erecta.”

3. Topic: Carpal Tunnel Syndrome

Correct Answer: C. A paralysis of the opposition of the thumb

Explanation: Carpal tunnel syndrome affects the median nerve, which controls the muscles responsible for the opposition of the thumb. This results in difficulty performing tasks that require thumb opposition, such as pinching or grasping.

4. Topic: Acute Osteomyelitis in Children

Correct Answer: D. Acute osteomyelitis in children is generally localized to the diaphyseal region of the bone

Explanation: Acute osteomyelitis in children typically affects the metaphyseal region of long bones, especially near the knee, rather than the diaphyseal region. This is because the metaphysis has a rich blood supply, making it more susceptible to hematogenous infection.

5. Topic: Open Fracture Classification

Correct Answer: C. The loss of substance of the soft parts prevents any closure

Explanation: In the context of open fractures, Stage III is characterized by severe soft tissue injury where the loss of substance prevents any potential for closure of the wound. This indicates a more severe injury with extensive tissue damage.

6. Topic: Synovial Fluid in Acute Gout

Correct Answer: D. Cloudy liquid with 10,000 cells per mm³ and very birefringent microcrystals

Explanation: During an acute gout attack, synovial fluid is typically cloudy and has a high cell count, often around 10,000 cells/mm³. The presence of very birefringent (needle-shaped) microcrystals, which are characteristic of monosodium urate crystals, confirms gout.

7. Topic: Total Nerve Section

Correct Answer: B. Neurotmesis

Explanation: Neurotmesis refers to a complete transection or total section of a nerve, where both the nerve fibers and the surrounding connective tissue are disrupted. This results in a total loss of function and requires surgical intervention for possible repair.

8. Topic: Posterior Shoulder Dislocation

Correct Answer: B. Impossibility of external rotation of the arm

Explanation: In posterior shoulder dislocation, the most suggestive clinical sign is the inability to externally rotate the arm. This occurs because the shoulder joint’s normal range of motion is restricted by the dislocated position.

9. Topic: Femoral Diaphysis Fracture

Correct Answer: B. BA ECB

Explanation: A fracture of the femoral diaphysis commonly causes external rotation of the lower limb (B) due to muscle contractions. It may also lead to hemorrhagic shock (C) due to substantial bleeding and can be complicated by fat embolism (E). However, it does not typically present with an arch deformity of the thigh (A) or sciatic paralysis (D) before treatment. Sciatic paralysis is less common and usually occurs with more severe injury or complications.

10. Topic: Isolated Functional Colopathy

Correct Answer: B. Weight loss

Explanation: Isolated functional colopathy, or functional gastrointestinal disorders, commonly present with symptoms like abdominal pain (A), constipation (C), diarrhea (D), and postprandial bloating (E). Weight loss (B) is not typically associated with functional colopathy and suggests a more serious underlying condition that requires further investigation.

11. Topic: Evolution of a Subphrenic Abscess from Duodenal Ulcer Perforation

Correct Answer: B. BA BCD

Explanation: During the evolution of a subphrenic abscess resulting from duodenal ulcer perforation, you may observe: Fever (A) Subocclusive state (B) Vomiting (C) Localized defense (D) Pain on digital rectal examination (E) is not typically associated with subphrenic abscesses, as the abscess is generally not palpable or associated with rectal symptoms.

12. Topic: Major Ischemic Risk Associated with Fracture

Correct Answer: C. AC BDE

Explanation: Rupture of the following arteries associated with a fracture focus creates a significant ischemic risk: The external iliac artery (A) The common femoral artery (C) The superficial femoral artery (D) The popliteal artery (E). The lower axillary artery (B) is not typically associated with major ischemic risk in the context of fractures. Thus, the correct combination is AC BDE.

13. Topic: Septic Arthritis

Correct Answer: A. Osteophytes

Explanation: Septic arthritis typically presents with signs like articular pinching (B), mirror geodes (C), subchondral demineralization (D), and thickening of the soft tissues (E). These findings are associated with joint infection and inflammation. Osteophytes (A), however, are associated with osteoarthritis rather than septic arthritis. Hence, osteophytes are not a feature of septic arthritis, making this the correct answer.

14. Topic: Prioritization of Surgical Interventions in Trauma

Correct Answer: C. Extra dural hematoma

Explanation: An extra dural hematoma (C) is a life-threatening condition that can cause rapid deterioration due to increased intracranial pressure. Immediate surgical intervention is crucial to prevent brain damage or death. While other injuries such as stomach wounds (A), open leg fractures (B), rupture of the urethra (D), and fractures of the acetabulum (E) are serious, they do not typically pose an immediate threat to life like an extra dural hematoma does. Therefore, the extra dural hematoma should be prioritized for surgical intervention.

15. Topic: Fractures of the Upper Extremity of the Radius in Children

Correct Answer: D. They can accompany a dislocation of the elbow

Explanation: Fractures of the upper extremity of the radius in children, such as those involving the radial head, can indeed be associated with dislocations of the elbow (D). This combination often results from significant trauma to the elbow. While these fractures are common (A) and may involve the radial head or neck (B), and could potentially be associated with radial nerve injuries (C), they do not necessarily require surgical treatment (E) unless there are complications or significant displacement. Therefore, the ability to accompany an elbow dislocation is a key characteristic.

16. Topic: Ankylosis

Correct Answer: B. Bone fusion between two articular surfaces

Explanation: Ankylosis specifically refers to the fusion of bone between two articular surfaces, resulting in immobility at the joint (B). This is different from morning stiffness (A) or decreased range of motion (C), which are symptoms rather than definitions. While ankylosis leads to a complete loss of movement at the joint (D), its defining feature is the actual fusion of the bones. Stiffness at the end of the day (E) is not related to the definition of ankylosis.

17. Topic: Crural Nerve Paralysis

Correct Answer: B. The crural nerve passes under the crural arch medial to the femoral vein

Explanation: The crural nerve (femoral nerve) does not pass under the crural arch medial to the femoral vein; it actually passes lateral to the femoral vein (B). The nerve originates from the lumbar roots L2, L3, and L4 (A), divides into branches within the femoral triangle (C), and is involved in the patellar reflex arc (D). Hematoma of the psoas muscle can indeed affect the crural nerve (E).

18. Topic: Lumbosciatica with S1 Topography

Correct Answer: B. The ankle reflex is diminished or abolished

Explanation: In a lumbosciatica disc with S1 involvement, the most characteristic finding is a diminished or abolished ankle reflex (B). This is due to the involvement of the S1 nerve root which is responsible for the ankle reflex. Hypoesthesia in S1 typically affects the lateral aspect of the foot, not the dorsal surface of the big toe (A). Walking on heels is more challenging with L5 nerve root involvement (C). Radiological narrowing of the L5-S1 disc is not always present (D), and an electromyogram may show abnormalities but is not constantly disturbed (E).

19. Topic: Elective Hernia Repair in the Context of Cardiovascular History

Correct Answer: C. Jugular venous distension

Explanation: Jugular venous distension (C) is a sign of right-sided heart failure or fluid overload and indicates potential cardiovascular instability, which could complicate surgery. This would be a valid reason to delay elective hernia repair. Recent coronary artery bypass surgery (A) is a concern but may not be an immediate reason to delay unless there are specific complications. A history of smoking (B), hypertension (D), and hyperlipidemia (E) are risk factors but are not immediate contraindications for delaying surgery in this context.

20. Topic: Post-Celiotomy Intestinal Motility

Correct Answer: B. To the stomach in 24 hours, the small intestine in 4 hours, and the colon in 3 days

Explanation: Normal intestinal motility typically resumes in the following order after celiotomy: the small intestine usually recovers within 4 hours, the stomach within 24 hours, and the colon generally returns to normal function within 3 days. This timeline reflects the typical postoperative recovery pattern. Immediate resumption (E) and longer durations (C) are less common and do not align with typical postoperative recovery.

21. Topic: Preoperative Characteristics and Postoperative Ischemia

Correct Answer: C. Dyspnea on exertion

Explanation: Dyspnea on exertion indicates underlying cardiac or pulmonary issues that may increase the risk of postoperative ischemia. Other preoperative characteristics such as angina pectoris (A) or frequent premature ventricular contractions (B) are significant but less directly indicative of immediate postoperative ischemia risk. Tricuspid insufficiency (D) and age over 60 (E) may be relevant but are not as direct indicators of the risk as dyspnea on exertion.

22. Topic: Blood Transfusion and Clotting

Correct Answer: D. Transfusion through Ringer’s lactate solution

Explanation:
Clotting of transfused blood is typically associated with the use of incompatible blood types, such as ABO or Rh incompatibility (A and C), but Ringer’s lactate solution (D) can cause clotting due to its calcium content, which can activate coagulation. Minor blood group incompatibility (B) is less likely to cause immediate clotting issues. Transfusion through 5% glucose and water (E) does not generally lead to clotting.

23. Topic: Wound Healing

Correct Answer: E. Rather in wound healing, type 1 collagen is predominant

Explanation: In wound healing, type 1 collagen is the predominant type, especially in the later stages of healing, as it provides strength and structural support. Collagen content generally increases over several weeks, not just one week (A). Monocytes play a broader role in wound healing beyond just phagocytosis, including modulating inflammation and tissue repair (B and D). Fibroblasts appear somewhat later, typically after 48-72 hours (C).

24. Topic: Wound Contraction

Correct Answer: D. It is based on specialized fibroblasts which contain actin myofilaments

Explanation: Wound contraction is a key process in wound healing, primarily driven by specialized fibroblasts called myofibroblasts, which contain actin myofilaments that help pull the edges of the wound together (D). This process is not the primary mechanism in sutured or stapled wounds, as they primarily heal through primary intention (A). Bacterial colonization can indeed hinder the healing process, but it is not a defining factor for contraction (B). Contraction typically contributes less than 50% to the total wound size reduction (C). The reduction percentage or skin adhesion details mentioned are not standard or relevant measures for contraction (E).

25. Topic: Management of Thigh Injury with Compartment Syndrome

Correct Answer: B. Immediate exploration and repair

Explanation: In a case of thigh injury with paresthesias, weak pulses, and inability to move the foot, there is a high suspicion of vascular injury and possible compartment syndrome (B). Immediate exploration and repair are crucial to address potential vascular damage and prevent complications such as limb ischemia. Angiography (A) can be useful for diagnostic purposes but is not the immediate intervention required. Anterior compartment fasciotomy (C) is indicated if compartment syndrome is confirmed, but the priority is to explore and repair the injury first. Observation (D) and local exploration (E) are inadequate for addressing the potential severity of the injury and its complications.

26. Topic: Postoperative Mortality After Heart Transplantation

Correct Answer: C. Accelerated graft arteriosclerosis

Explanation: After the first year post-heart transplantation, accelerated graft arteriosclerosis becomes the most common cause of death (C). This condition involves progressive narrowing and hardening of the transplanted heart’s arteries, leading to graft failure. While infections (A), arrhythmias (B), acute rejection episodes (D), and cancer (E) are significant concerns, their prevalence in causing death decreases after the initial postoperative period. Accelerated graft arteriosclerosis emerges as the leading cause due to its chronic and progressive nature, impacting long-term survival.

27. Topic: Major Histocompatibility Complex (MHC) Proteins

Correct Answer: D. MHC class 1 proteins act as major targets for antibody-mediated allograft rejection and are detected by cross-match techniques

Explanation: MHC class 1 proteins are indeed major targets for antibody-mediated allograft rejection and are detected by cross-match techniques (D). These proteins are present on almost all nucleated cells and are crucial for presenting endogenous antigens to cytotoxic T cells. MHC class 2 proteins, in contrast, are primarily expressed by antigen-presenting cells (B). They are encoded by different loci (e.g., HLA-DP, HLA-DQ, HLA-DR) and are involved in presenting exogenous antigens to helper T cells (E). The other statements are incorrect as MHC class 1 proteins are not restricted to mononuclear cells (A), MHC class 2 proteins are not encoded by the HLA locus mentioned (C), and MHC class 2 proteins are not the main targets of cross-match techniques (D).

28. Topic: Treatment of Chronic Ulcer

Correct Answer: C. Billroth 1 type partial gastrectomy

Explanation:
When a gastric ulcer does not improve with standard medical treatment such as H2 blockers and antacids, and especially if there is no improvement after 6 weeks, surgical intervention may be necessary. Billroth 1 type partial gastrectomy is a procedure that involves removing part of the stomach and is suitable for ulcers that are resistant to medical therapy (C). Local excision of the ulcer (B) is generally not sufficient as it doesn’t address potential underlying issues. Resuming the trial medical treatment (A) is not appropriate if the ulcer remains unchanged after adequate treatment. Vagotomy with pyloroplasty (E) or without (D) might be considered, but these are generally part of a more complex surgical approach, often used when ulcer is complicated or recurrent despite other interventions.

29. Topic: Effects of Colon Resection

Correct Answer: B. Patients who undergo major colon resections experience little change in their bowel habits following the operation

Explanation: After major colon resections, patients generally adapt well, experiencing minimal long-term changes in bowel habits due to compensatory mechanisms of the remaining bowel (B). The net absorption of water by the rectum (A) is not well established, and the right colon actually plays a more significant role in water and electrolyte absorption compared to the left colon (C, D). The role of the ileocecal valve in fluid homeostasis is not as prominent as once thought (E).

30. Topic: Diagnosis of Severe Upper Left Side Pain

Correct Answer: E. Rupture of the spleen

Explanation: The patient’s presentation, including severe upper left side pain, pallor, elevated pulse, tense and rigid abdomen without peristalsis, suggests rupture of the spleen (E). This condition can follow trauma or infection, leading to internal bleeding and abdominal rigidity. Acute pyelonephritis (A) and Fitz Hugh Curtis Syndrome (B) usually have different pain locations and symptoms. Perforated peptic ulcer (C) and peritonitis (D) are possible but less likely given the history and clinical findings.

31. Topic: Midline Neck Swelling in Newborn

Correct Answer: C. Cystic hygroma

Explanation: A large midline neck swelling in a newborn that transilluminates is most likely a cystic hygroma (C). Cystic hygromas are congenital lymphatic malformations that are typically filled with lymphatic fluid and show transillumination. A branchial cyst (A) is usually lateral and not typically transilluminated. Cervical adenopathy (B) and goiter (D) do not commonly present with transillumination. A thyroglossal cyst (E) is midline but usually does not transilluminate and is less common with a significant swelling involving the tongue.

32. Topic: Characteristics of Venous Ulcers

Correct Answer: B. They are usually found on the inner side of the leg

Explanation:
Venous ulcers typically occur on the inner side of the leg, particularly around the medial malleolus (B). They are often painful (A), and compression therapy, such as with compression stockings, is a key part of treatment (C). Venous ulcers do not usually require hospitalization (D) and are more common than arterial ulcers (E).

_____________________________________________________________________________________Top of Form

33. Topic: Management of Acute Dyspnea Post-Trauma

Correct Answer: C. Decompress the right pleural space

Explanation: In the context of acute dyspnea after a car accident with markedly reduced breath sounds on one side, the most immediate concern is a possible tension pneumothorax or pleural effusion, which requires urgent decompression (C). While a chest X-ray (A) can help diagnose the issue, it should not delay treatment. Arterial blood gas analysis (B), pericardiocentesis (D), and intravenous fluids (E) may be important later but are not the immediate priorities if the clinical picture suggests a pleural space issue.

34. Topic: Acute Increase in Intracranial Pressure

Correct Answer: A. Respiratory irregularities

Explanation: An acute increase in intracranial pressure often leads to respiratory irregularities (A) due to pressure on the brainstem, which controls breathing. Lower blood pressure (B) can occur but is less directly indicative than respiratory changes. Tachycardia (C) is not a primary sign of increased intracranial pressure; instead, it may occur in other conditions. Retinal hemorrhage (D) and compression of the fifth cranial nerve (E) are not as directly associated with acute intracranial pressure increases.

35. Topic: Obstructive Jaundice in Chronic Pancreatitis

Correct Answer: D. Narrowing of the bile duct

Explanation: In patients with chronic pancreatitis, narrowing of the bile duct (D) is a common cause of obstructive jaundice due to inflammation and fibrosis affecting the bile duct. Pseudocyst formation (A), gallstones (B), and pancreatic head tumors (C) can also cause obstructive jaundice but are less common in this context. Cholangiocarcinoma (E) is a potential cause but is less directly related to chronic pancreatitis compared to bile duct narrowing.

36. Topic: Malignancy with Specific Symptoms

Correct Answer: A. Gastric carcinoma

Explanation: The symptoms described—difficulty swallowing, vomiting, weight loss, melaena, supraclavicular lymphadenopathy, and a hyperpigmented velvety patch (aurora)—are indicative of gastric carcinoma (A). This condition often presents with systemic symptoms and associated signs like the Virchow’s node (supraclavicular lymphadenopathy) and Leser-Trélat sign (hyperpigmented patch). While esophageal (C) and pancreatic (D) carcinomas can also present with dysphagia and weight loss, the specific combination of symptoms, including melaena and cutaneous findings, strongly points to gastric carcinoma.

37. Topic: Sliding Inguinal Hernia

Correct Answer: D. Can lead to intestinal damage if not diagnosed

Explanation: A sliding inguinal hernia, where the hernia sac includes a portion of the abdominal wall structures, such as the bladder or colon, can indeed lead to intestinal damage if not identified and managed properly (D). The risk of intestinal damage arises because of the potential for incarceration or strangulation of the involved organs. While sliding inguinal hernias can sometimes be challenging to diagnose pre-operatively (A), they can have serious consequences, making early detection and appropriate surgical intervention crucial.

38. Topic: Bacterial Septicemia in Splenectomized Patients

Correct Answer: D. Pneumococcus

Explanation: Splenectomized patients are particularly vulnerable to severe infections due to the loss of their spleen’s role in filtering pathogens and producing antibodies. Pneumococcus (D) is especially threatening in these individuals as it can cause severe pneumococcal infections, which are more common and more serious in the absence of a functioning spleen. While Staphylococcus aureus (A), Colibacillus (B), Salmonella (C), and Listeria (E) can also cause infections, pneumococcus is the most notably dangerous due to its propensity to cause rapid and severe illness in this high-risk population.

39. Topic: Upper Gastrointestinal Bleeding

Correct Answer: D. Diagnostic endoscopy is best done within the first 24 hours

Explanation: In cases of upper gastrointestinal bleeding, performing diagnostic endoscopy within the first 24 hours (D) is crucial for identifying the source of bleeding and providing timely intervention. This early endoscopy improves the chances of visualizing and managing the bleeding point effectively. The bleeding point is typically located above the ligament of Treitz (A), and while angiodysplastic lesions (B) are a cause, they are not the most common. Hematemesis (C) is not always present; patients may have melena or occult bleeding. Selective mesenteric angiography (E) is more often used for cases where endoscopy is not successful or in hemodynamically unstable patients.

40. Topic: Long-term Complications of Gastrectomy

Correct Answer: E. Vitamin B12 deficiency

Explanation: Vitamin B12 deficiency (E) is actually a recognized long-term complication of total or partial gastrectomy, as the absorption of this vitamin is impaired following surgery. This is due to the removal of parts of the stomach, which reduces intrinsic factor production essential for Vitamin B12 absorption. Gastric cancer (A) is a potential long-term risk, particularly if residual gastric tissue is present. Obstruction (B) can occur due to adhesions or other changes in anatomy post-surgery. Folate deficiency (C) and iron deficiency (D) are also common due to changes in digestive and absorptive processes.

41. Topic: Urinary Incontinence

Correct Answer: C. It can be helped with drug treatment

Explanation: Drug treatment can be effective in managing urinary incontinence, particularly in cases of urge incontinence or overactive bladder. For the patient described, who experiences difficulty affording diapers and has a history of urinary leakage and smoker’s cough, pharmacological interventions could provide relief. Pelvic floor weakness (B) is a common cause of urinary incontinence, but it is not the only factor, and treatment often starts with conservative measures such as pelvic floor exercises before considering surgery. Most women with urinary incontinence do not seek medical care (A), and bladder instability (D) can be present even with small, frequent, and urgent urination. Surgical intervention (E) is usually considered after other treatments fail, not as an immediate solution.

42. Topic: Esophageal Symptoms and Diagnosis

Correct Answer: B. Investigation by barium swallow is indicated

Explanation: Given the patient’s difficulty swallowing both solids and liquids, weight loss, and the presence of back tarry stools (indicating possible gastrointestinal bleeding), a barium swallow study is an appropriate initial diagnostic tool to evaluate esophageal pathology. This test helps visualize structural abnormalities and motility issues. The prognosis (A) would be uncertain without further diagnostic clarification. The patient’s symptoms are more indicative of structural or obstructive issues rather than ulcerative peptic disease (C) or achalasia (D). Barium swallow is crucial for determining the underlying cause, such as esophageal cancer or strictures, rather than assuming other diagnoses or outcomes (E).

43. Topic: Leriche Syndrome (Atherosclerotic Occlusive Disease of the Abdominal Aortic Bifurcation)

Correct Answer: A. Claudication of the buttock and thigh

Explanation: Leriche syndrome, which involves occlusion at the level of the abdominal aortic bifurcation, typically presents with claudication of the buttocks and thighs due to impaired blood flow to these regions during physical activity. Symptoms like causalgia (B) are less characteristic for this condition. Retrograde ejaculation (C) and gangrene of the toes (D) are not directly associated with Leriche syndrome but may relate to more distal vascular issues. Redness dependent on the feet (E) is also not a typical feature of this syndrome. The primary symptom is claudication in the buttocks and thighs due to reduced arterial flow.

44. Topic: Management of Renal Stones

Correct Answer: A. Conservative treatment including hydration and analgesics will not give a satisfactory result

Explanation: For a stone of 1.5 cm in diameter, conservative treatment alone (hydration and analgesics) is often insufficient due to the size of the stone, which may not pass spontaneously. Serial radiography (B) is used to monitor stone progress but is not always necessary unless complications arise. Urinalysis (C) frequently shows microhematuria but is not diagnostic on its own. While acute episodes are managed, recurrence is common without addressing underlying causes (D). High blood urea and serum creatinine (E) might be present due to obstructive uropathy but are not directly related to the effectiveness of initial conservative treatment.

45. Topic: Management of Urethral Rupture in Pelvic Fractures

Correct Answer: E. Immediate placement of a suprapubic cystostomy probe

Explanation: In cases of pelvic fracture with urethral rupture, especially when the rupture is located above the urogenital diaphragm, immediate placement of a suprapubic cystostomy (E) is necessary to divert urine and prevent further injury to the urethra. This approach avoids complications that may arise from attempting to place a Foley catheter through the urethra (B) in the presence of a rupture. Immediate surgical reconstruction (C) is usually not done at the initial stage due to the need for patient stabilization. Percutaneous nephrostomy (A) is not the first choice for managing urethral injuries. Exploration of the pelvis (D) may be necessary but is secondary to managing the urethral injury.

46. Topic: Brain Contusions

Correct Answer: B. They can occur on the opposite side of the point of cranial impact

Explanation: Brain contusions often occur on the opposite side of the impact, known as a “coup-contrecoup” injury (B). This phenomenon happens due to the brain’s motion within the skull. Contusions are more commonly seen in the frontal and temporal lobes rather than the occipital lobes (A). They are typically accompanied by parenchymal bleeding (C) and can be exacerbated by anticoagulants (D). Anticonvulsant drugs (E) are used to manage seizures that might occur post-contusion, making them relevant in early management.

47. Topic: Acute Abdominal Pain

Correct Answer: B. Acute mesenteric ischemia

Explanation: Acute mesenteric ischemia (B) is a condition where blood flow to the intestines is critically reduced, leading to potential bowel necrosis. This situation requires immediate surgical intervention to restore blood flow and prevent extensive damage. In contrast, acute pancreatitis (A), acute diverticulitis (C), acute cholecystitis (D), and acute Crohn’s disease (E) can often be managed initially with conservative treatments or less urgent surgical approaches depending on the severity and response to medical management.

48. Topic: Neck Mass Diagnosis

Correct Answer: A. Branchial cyst

Explanation: A branchial cyst (A) typically presents as a mass located along the anterior border of the sternocleidomastoid muscle, which is consistent with the description. These cysts are remnants of the branchial apparatus and are often found in this area. Cervical adenopathy (B), goiter (C), submandibular adenopathy (D), and thyroglossal cyst (E) have different common locations and characteristics that do not match the typical presentation of a branchial cyst.

49. Topic: Ascitic Fluid Infection

Correct Answer: C. Presence of a germ in culture

Explanation: The presence of a germ in culture (C) is definitive for confirming an infection in ascitic fluid. This is the most specific indicator as it directly identifies the causative pathogen. Elevated protein levels (A), neutrophil count (B), high amylase levels (D), and low pH (E) can indicate infection or other abnormalities but are not as definitive as a positive culture.

50. Topic: Zenker’s Diverticulum

Correct Answer: B. Located at the level of the crico-pharyngeal space

Explanation: Zenker’s diverticulum (B) is typically located at the level of the crico-pharyngeal space, specifically in the area where the pharynx meets the esophagus, just above the cricopharyngeal muscle. It is not generally associated with gastroesophageal reflux (A) nor commonly seen in young adults (E). It does not have a high risk of cancerous degeneration (C) and is not related to adenopathies (D).

GYNAECOLOGY

51. Topic: Estrogen-Progestogen Strip

Correct Answer: B. Of a combined mini-dose

Explanation: A combined mini-dose pill (B) refers to an oral contraceptive that contains a low dose of both estrogen and progestogen. In this case, the 21 identical pills each containing 30 micrograms of ethinyl estradiol and a progestogen qualify as a combined mini-dose pill. It is not a classic pill (A), micropill (D), sequential (C), or biphasic mini-dose (E).

52. Topic: Maternal-Fetal Blood Immunization

Correct Answer: C. Mother group O rhesus – negative indirect Coombs test child group 0 Rh+

Explanation: Anti-D Rh immunoglobulin is administered to prevent hemolytic disease of the newborn when there is a risk of Rh incompatibility. This is necessary when an Rh-negative mother (O rhesus -) has an Rh-positive child (0 Rh+), particularly if the mother has a negative indirect Coombs test, indicating she has not yet developed antibodies. In option C, the mother is Rh-negative with a negative Coombs test and the child is Rh-positive, making this the correct scenario for administering anti-D immunoglobulin to prevent sensitization.

53. Topic: Tumor of the Breast

Correct Answer: B. Cytopunction

Explanation: When a woman presents with a breast lump, especially in the upper outer quadrant, and a mammogram has been performed, cytopunction (fine needle aspiration or biopsy) is the essential next step. This procedure allows for the extraction of cells or tissue from the lump for cytological examination, helping to confirm the diagnosis and guide further treatment. While other tests like ultrasound can provide additional imaging, cytopunction is crucial for a definitive diagnosis.

54. Topic: Paget’s Disease

Correct Answer: C. Glomerular nephropathy

Explanation: Paget’s disease primarily affects the bones, leading to complications such as sarcomatous degeneration (a type of bone cancer), spontaneous fractures due to weakened bone structure, congestive heart failure from the increased cardiac workload, and spinal compression due to bone deformities. However, glomerular nephropathy (a kidney condition) is not associated with Paget’s disease, making it the incorrect answer in this context.

_____________________________________________________________________________________Top of Form

55. Topic: Infectious Disease During Pregnancy

Correct Answer: E. Specific immunoglobulin and hepatitis B vaccination

Explanation: Newborns born to mothers who are positive for both HBsAg and HBeAg have a high risk of hepatitis B infection. The recommended preventive treatment is the administration of specific hepatitis B immunoglobulin immediately after birth, along with the initiation of the hepatitis B vaccination series. This combined approach provides immediate passive immunity and helps the newborn develop active immunity against the virus, significantly reducing the risk of chronic hepatitis B infection.

56. Topic: Ovulation and Menstrual Cycle

Correct Answer: C. 18 days

Explanation: For a woman with a regular menstrual cycle of 32 days, the luteal phase (post-ovulatory phase) typically lasts 14 days. To calculate the date of ovulation, the luteal phase length is subtracted from the total cycle length. Therefore, the pre-ovulatory phase would be 32 – 14 = 18 days. This means that ovulation occurs approximately 18 days before the next expected period.

57. Topic: Menopause Symptoms

Correct Answer: D. Breast tension

Explanation: Menopause is commonly associated with symptoms such as paresthesia of the extremities, insomnia, vaginal dryness, and sweating due to hormonal changes. However, breast tension is not typically a manifestation of menopause; in fact, it is more often associated with the menstrual cycle or hormonal fluctuations prior to menopause.

58. Topic: Vulvar Lesions

Correct Answer: C. Genital herpes

Explanation: The presence of clustered blisters on the labia majora, some of which are broken, along with painful symptoms, ipsilateral inguinal adenopathies, and fever (38°C) are classic signs of genital herpes. This condition is caused by the herpes simplex virus and is characterized by painful blisters and ulcers in the genital area. The other conditions listed do not typically present with these specific symptoms.

59. Topic: Breast Tumor Classification

Correct Answer: B. T1 N1 MX

Explanation: In this scenario, the tumor is 2 cm in diameter, which places it in the T1 category (tumor ≤2 cm). The presence of clinically immobile ipsilateral axillary lymphadenopathy suggests N1 (regional lymph nodes involved). Since no metastatic assessment has been conducted, the MX classification is used, indicating that the presence of distant metastasis cannot be evaluated. Thus, the tumor is classified as T1 N1 MX.

60. Topic: Female Genital Trichomoniasis

Correct Answer: B. It is easily diagnosed on smears taken from the cervix

Explanation: Trichomoniasis is a sexually transmitted infection (STI) that is typically diagnosed using a wet mount or culture from vaginal secretions rather than cervical smears. While the other statements about trichomoniasis being a venereal disease, responding well to Flagyl treatment, requiring partner treatment, and possibly being associated with vaginal candidiasis are correct, diagnosis from cervical smears is not typically accurate, making statement B incorrect.

61. Topic: Acute Salpingitis

Correct Answer: C. ABDE

Explanation: Acute salpingitis, which is an inflammation of the fallopian tubes, can lead to several complications and remote effects, including: Dyspareunia (A): Painful intercourse. Abdominal pain (B): Common symptom due to inflammation. Ectopic pregnancy (D): Resulting from scarring and adhesions that obstruct the fallopian tube. Tubal sterility (E): Due to scarring that can block the fallopian tubes, affecting fertility. However, chronic urinary tract infections (C) are not directly caused by acute salpingitis. Therefore, the correct set of consequences includes A, B, D, and E.

62. Topic: Kleihauer Test

Correct Answer: C. Look for the presence of fetal red blood cells in the maternal blood

Explanation: The Kleihauer test is used to detect and quantify fetal red blood cells in the maternal circulation. This test is particularly useful in assessing the extent of fetal-maternal hemorrhage, which can help in managing cases such as Rh incompatibility and in determining the need for additional doses of anti-D immunoglobulin.

63. Topic: Diagnosis of Endometrial Cancer

Correct Answer: E. Biopsy E- curettage

Explanation: A biopsy with curettage is the most definitive method for diagnosing endometrial cancer. This procedure involves obtaining a tissue sample from the endometrium for histological examination, which can confirm the presence of cancerous cells with high accuracy. Other methods like ultrasound or endometrial smear can suggest abnormalities but are not as definitive as biopsy and curettage.

64. Topic: Breast Cancer Screening

Correct Answer: B. Mammography

Explanation: Mammography is the most sensitive and widely used method for breast cancer screening. It can detect early signs of cancer, such as microcalcifications, before they become palpable. While other methods like ultrasound can be useful in specific cases, mammography remains the gold standard for routine screening due to its ability to detect small, asymptomatic tumors.

65. Topic: Confirming Pregnancy Viability

Correct Answer: E. Ultrasound

Explanation: Ultrasound is the most reliable method to confirm the viability of a pregnancy, especially in cases of amenorrhea with bleeding. It allows direct visualization of the gestational sac, fetal heartbeat, and the overall development of the embryo or fetus, providing clear evidence of whether the pregnancy is progressing normally. Other tests, such as HCG levels, can indicate pregnancy but do not confirm its viability as effectively as an ultrasound.

66. Topic: Cervical Cancer and Infectious Agents

Correct Answer: D. Papillomavirus

Explanation: Human papillomavirus (HPV) is the primary infectious agent linked to the development of cervical cancer. Persistent infection with high-risk HPV strains, particularly types 16 and 18, is a significant factor in the pathogenesis of cervical cancer. Other listed pathogens, such as Trichomonas, Gonococcus, Chlamydia, and Mycoplasma, are associated with other genital infections but are not directly involved in the genesis of cervical cancer.

67. Topic: Postmenopausal Screening

Correct Answer: D. A mammogram

Explanation: A mammogram is routinely recommended for postmenopausal women as part of breast cancer screening. Early detection through mammography can significantly improve outcomes in breast cancer treatment. While bone density assessments, such as a lumbar spine X-ray, are also important, they are typically used to diagnose osteoporosis rather than being a systematic screening tool for all postmenopausal women. Hormone level testing like FSH or estrogen dosage and procedures like hysterography are not standard screenings for this population.

68. Topic: Stage IB Cervical Cancer

Correct Answer: C. Micro invasive cancer

Explanation: Stage IB cervical cancer is characterized by a visible lesion that is confined to the cervix, including both squamous cell carcinoma and adenocarcinoma. However, it does not include microinvasive cancer, which is classified under Stage IA. Microinvasive cancer refers to very early-stage cancer where invasion is minimal, typically less than 5 mm deep and less than 7 mm in horizontal spread. Stage IB cancers can show more extensive invasion, but still limited to the cervix, with potential lymphatic involvement.

69. Topic: Fibroids and Pregnancy

Correct Answer: B. If there is a fibroid in the 3rd trimester of pregnancy a myomectomy must be performed

Explanation: Myomectomy, the surgical removal of fibroids, is generally not recommended during the third trimester of pregnancy due to the high risk of complications such as bleeding and preterm labor. The preferred approach is to manage the pregnancy conservatively and plan for the fibroid’s removal after childbirth if necessary. The other statements regarding fibroids interfering with early pregnancy diagnosis, causing aseptic necrobiosis, leading to abnormal fetal presentations, and potentially obstructing childbirth are accurate.

70. Topic: Newborn Care for HBsAg and HBeAg Positive Mother

Correct Answer: E. Serovaccination

Explanation: For a newborn born to an HBsAg and HBeAg positive mother, the recommended care involves serovaccination, which includes the administration of both specific hepatitis B immunoglobulins (HBIG) and the hepatitis B vaccine. This combined approach provides immediate passive immunity from the immunoglobulins and active immunity through the vaccine, significantly reducing the risk of the newborn developing hepatitis B infection.

71. Topic: Risk Factors for Upper Genital Tract Infection

Correct Answer: B. Increased the risk by taking a progestogen

Explanation: The correct statement is that taking a progestogen does not increase the risk of upper genital tract infections. In fact, progestogens may help thicken cervical mucus, potentially reducing the risk of infection. The other factors mentioned, such as age, nulliparity, IUD use, and local contraceptives, are correctly identified as influencing the risk of upper genital tract infections.

72. Topic: Ovarian Cancer Symptoms

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

Explanation: The most common symptom revealing ovarian cancer is an increase in the volume of the abdomen. This often results from ascites or a growing mass. Other symptoms like metrorrhagia, signs of rectal or bladder compression, and supraclavicular lymphadenopathy can occur, but they are less common as initial presenting signs.

73. Topic: Pregnancy and Blood Pressure

Correct Answer: B. Blood pressure rises during normal pregnancy

Explanation: During normal pregnancy, blood pressure typically decreases due to increased plasma volume and decreased peripheral resistance. An increase in blood pressure during pregnancy is not normal and may indicate conditions such as preeclampsia. The other statements are accurate: plasma volume increases, peripheral resistance decreases, there is a link between hypertension and fetal growth disorders, and a salt-free diet is not generally recommended for managing pregnancy-induced hypertension.

74. Topic: Monitoring Treated Cervical Cancer

Correct Answer: D. Regular surveillance smears

Explanation: For monitoring treated cervical cancer, regular surveillance smears (Pap smears) are crucial to detect any residual or recurrent disease. This method allows for early identification of abnormalities that might indicate a return of cancer. While clinical examination is important, surveillance smears provide specific information about cervical cell changes. Beta2-macroglobulin and alpha-fetoprotein are not typically used for cervical cancer monitoring, and bone scans are used primarily to assess metastatic spread rather than for routine follow-up.

75. Topic: Complications of Estrogen Deficiency in Menopause

Correct Answer: E. AC (Vaginal atrophy and Breast involution)

Explanation: Estrogen deficiency during menopause can lead to vaginal atrophy, which causes thinning and dryness of the vaginal walls. Breast involution, or the reduction of breast tissue, also occurs due to decreased estrogen levels. Endometrial hyperplasia and increased cervical mucus secretion are more associated with other hormonal imbalances or conditions, rather than directly with estrogen deficiency.

76. Topic: Fundal Height Measurement

Correct Answer: B. Fetal hypotrophy

Explanation: A fundal height of 26 cm at 34 weeks of amenorrhea is below the expected range for this stage of pregnancy, which is typically around 30-32 cm. This discrepancy suggests fetal hypotrophy (growth restriction) rather than a normal pregnancy. Twin pregnancies and hydramnios generally cause increased fundal height, while hypertrophy of the placenta might cause height changes but is less commonly diagnosed solely by fundal measurement.

77. Topic: Suspected Ectopic Pregnancy

Correct Answer: C. Ask for a beta HCG assay and an ultrasound

Explanation: When clinical examination is inconclusive in a suspected ectopic pregnancy, a beta HCG assay and ultrasound are essential to confirm the diagnosis. These tests help assess the levels of pregnancy hormones and visualize the location of the pregnancy. Laparoscopy or immediate surgery is not indicated unless there are signs of acute complications or the tests confirm an ectopic pregnancy.

78. Topic: Presentation Engagement in Labor

Correct Answer: B. Has crossed the upper strait

Explanation: Engagement of a presentation refers to the fetal presenting part (typically the head) entering and descending through the pelvic inlet (upper strait). Once the largest diameter of the presenting part has crossed the upper strait, it is considered engaged. This does not mean it has passed through the entire pelvis or reached the vulva; that would indicate further progress in labor.

79. Topic: Diagnosis of Genital Prolapse

Correct Answer: A. On clinical examination

Explanation: Genital prolapse is primarily diagnosed through a clinical examination where the physician can observe and assess the presence of prolapse. Although imaging techniques like ultrasound and hysterography can be used for further evaluation, the initial diagnosis is typically made during a physical examination.

80. Topic: Low Insertion of the Placenta

Correct Answer: E. Ultrasound can make the diagnosis at 35 weeks

Explanation: A low insertion of the placenta, also known as placenta previa, is typically diagnosed using ultrasound imaging, which can accurately assess the placental position. This diagnosis is usually confirmed around 35 weeks of gestation. While other complications related to low placental insertion, such as bleeding, can occur, the definitive diagnosis is made through ultrasound.

81. Topic: Treatment of Threatened Preterm Labor

Correct Answer: C. Beta blocker

Explanation: In the treatment of threatened preterm labor, common medications include progesterone (to support the pregnancy), aspirin (to reduce inflammation and improve blood flow), indomethacin (a nonsteroidal anti-inflammatory drug that can inhibit contractions), and salbutamol (a beta-agonist that can help relax the uterus). However, beta blockers are not typically used for this purpose and are not effective in preventing preterm labor.

82. Topic: Ectopic Pregnancy

Correct Answer: B. It is favored by taking estrogen-progestogen contraceptive pills

Explanation: Ectopic pregnancy is more common in women with a history of tubal infertility treatments and can be associated with conditions that affect the fallopian tubes. A normal pelvic ultrasound does not completely rule out ectopic pregnancy, and a beta HCG plasma level below 5 IU can help in excluding it. Isthmic tubal pregnancies are indeed at a higher risk of catastrophic rupture. However, estrogen-progestogen contraceptive pills are not typically associated with an increased risk of ectopic pregnancy.

_____________________________________________________________________________________Top of Form

83. Topic: Asymptomatic Bacteriuria in Pregnancy

Correct Answer: A. Must be treated with appropriate anti-infectives

Explanation: Asymptomatic bacteriuria in pregnant women, even if it does not present symptoms, should be treated with appropriate antibiotics. This is because untreated bacteriuria can lead to complications such as pyelonephritis and adverse outcomes for both the mother and the fetus. Urography and cystography are not typically required in this scenario, and indwelling catheters and bed rest are not standard treatments for asymptomatic bacteriuria.

84. Topic: Fetal Complications from Urinary Tract Infections in Pregnancy

Correct Answer: B. Prematurity

Explanation: Urinary tract infections (UTIs) during pregnancy can lead to several fetal complications, with prematurity being one of the most common. UTIs can cause preterm labor, leading to premature birth. Other complications like intrauterine fetal death, retroplacental hematoma, and macrosomia are less directly linked to UTIs compared to prematurity.

85. Topic: Monitoring Pregnancy with Vascular-Renal Risk

Correct Answer: C. Uremia

Explanation: In pregnancies with vascular-renal risk, monitoring typically involves assessing serum creatinine, uricemia, 24-hour proteinuria, and blood pressure. Uremia is not commonly used as a routine monitoring parameter in this context; instead, serum creatinine and other markers provide more immediate information on renal function.

86. Topic: Seizures in Pregnant Women with Hypertension

Correct Answer: D. Eclampsia

Explanation: Epileptic seizures in a pregnant woman at the 9th month, especially with hypertension, most commonly suggest eclampsia. Eclampsia is a severe complication of preeclampsia, characterized by seizures in addition to high blood pressure. Other conditions, like cerebral hemorrhage or thrombosis, could also cause seizures but are less directly linked to the combination of late pregnancy and hypertension.

87. Topic: Assessing Prognosis of Toxaemia of Pregnancy

Correct Answer: D. Uricemia

Explanation: Uricemia (elevated uric acid levels) is a key laboratory test used to assess the prognosis of toxaemia of pregnancy, which includes preeclampsia and eclampsia. Elevated uric acid levels are associated with worsening of the condition and can help in evaluating the severity and prognosis. While creatinine levels can also be important, uricemia is more specifically linked to the progression of toxaemia.

88. Topic: Most Common Cause of Spontaneous Abortion in the 1st Trimester

Correct Answer: E. Chromosomal abnormalities of the egg

Explanation: Chromosomal abnormalities of the egg are the most common cause of spontaneous abortion in the 1st trimester of pregnancy. These abnormalities often lead to non-viable pregnancies, resulting in early miscarriage. While hormonal causes, uterine malformations, and fibroids can contribute to pregnancy loss, chromosomal abnormalities are the leading factor in early pregnancy loss.

89. Topic: Risk Factors for Ectopic Pregnancy

Correct Answer: B. BA ECB

Explanation: The risk factors for ectopic pregnancy include:Progestogen-only pill (A): This method is not a significant risk factor for ectopic pregnancy. History of salpingitis (B): Previous infection of the fallopian tubes increases the risk of ectopic pregnancy. History of pelvic surgery (C): Prior pelvic surgery can lead to scarring and increase the risk of ectopic pregnancy. Ovarian cyst (D): Not a risk factor for ectopic pregnancy. Intrauterine device (IUD) (E): Although it primarily prevents pregnancy, if pregnancy occurs with an IUD in place, there is an increased risk of ectopic pregnancy. Thus, the correct risk factors are B, C, and E.

90. Topic: Causes of Ectopic Pregnancy (GEU)

Correct Answer: A. AA BDE

Explanation: The correct causes of ectopic pregnancy (GEU) include: Sequelae of salpingitis (A): Inflammation of the fallopian tubes can cause scarring, leading to an increased risk of ectopic pregnancy. Tubal endometriosis (B): Endometriosis affecting the fallopian tubes can interfere with normal egg movement, increasing the risk of ectopic pregnancy. Unilateral tubal stenosis (D): The narrowing of one fallopian tube can prevent the egg from reaching the uterus, leading to an ectopic pregnancy. Prolonged egg migration (E): If the egg takes too long to travel through the fallopian tube, it may implant outside the uterus. Thus, the correct answers are A, B, D, and E.

91. Topic: Contraindications to Contraception

Correct Answer: D. Endometrial hyperplasia

Explanation: Endometrial hyperplasia, a condition characterized by the thickening of the uterine lining, is a contraindication to contraception, particularly hormonal contraceptives. These contraceptives can exacerbate the condition, increasing the risk of developing endometrial cancer. The other conditions listed (lutein cyst, uterine fibroid, endometriosis) are not absolute contraindications to contraception, but their management may require special consideration. Thus, the correct answer is D.

92. Topic: Contraindications to Estrogen-Progestin

Correct Answer: C. Uterine fibroid

Explanation: Uterine fibroids are not a formal contraindication for the use of estrogen-progestin contraceptives. In fact, hormonal contraceptives can sometimes be used to manage symptoms associated with fibroids, such as heavy menstrual bleeding. On the other hand, malignant tumors of the breast and uterus, thromboembolic accidents, cholestatic hepatitis, and pituitary adenoma are considered contraindications due to the potential for exacerbating these conditions. Therefore, the correct answer is C.

93. Topic: Contraindications to Oral Contraception by Estrogen-Progestogen

Correct Answer: A. Multiparity

Explanation: Multiparity (having given birth to more than one child) is not a contraindication for the use of estrogen-progestogen oral contraceptives. However, conditions such as arterial hypertension, deep phlebitis, cholestatic hepatitis, and uterine fibroids are considered either absolute or relative contraindications due to the increased risk of complications. Therefore, the correct answer is A.

94. Topic: Risk Factors for Breast Cancer

Correct Answer: C. BCDE

Explanation: The risk factors for breast cancer include proliferating mastotic lesions (B), lack of breastfeeding (C), late menopause (D), and early first menstruation (E). However, early age at first pregnancy (A) is generally associated with a lower risk of breast cancer, so it is not included among the risk factors. Therefore, the correct answer is C (BCDE).

95. Topic: Prognosis in Cervical Cancer

Correct Answer: B. Cancer stage

Explanation: The most critical factor for the 5-year survival prognosis after appropriate treatment for cervical cancer is the stage of the cancer at the time of diagnosis. The cancer stage determines the extent of the disease and guides treatment options, making it the most significant predictor of survival outcomes. While other factors like HPV strain, patient age, histological grade, and lymph node involvement are important, they do not outweigh the impact of the cancer stage on prognosis.

96. Topic: Fetal Red Blood Cell Production

Correct Answer: D. Liver

Explanation: At the 24th week of gestation, the primary site of red blood cell production in the fetus is the liver. The liver is the main hematopoietic organ during this stage of development, taking over from the yolk sac, which is involved earlier in gestation. Eventually, the bone marrow will become the dominant site of red blood cell production as the fetus matures, but at 24 weeks, the liver remains the primary source.

97. Topic: Lung Maturity Enhancement in Preterm Labor

Correct Answer: B. Betamethasone

Explanation: Betamethasone is a corticosteroid commonly used to enhance fetal lung maturity in cases of preterm labor. Administering this drug accelerates the production of surfactant, a substance that helps keep the airways open in the lungs, significantly reducing the risk of respiratory distress syndrome (RDS) in preterm infants. The other options do not serve this specific function.

98. Topic: Screening for Fetal Well-being in a High-Risk Pregnancy

Correct Answer: E. Biophysical profile of the fetus

Explanation: The biophysical profile (BPP) is the best test for assessing fetal well-being in a high-risk pregnancy, such as in a woman with type 2 diabetes mellitus and chronic hypertension. The BPP combines an ultrasound evaluation of the fetus with a non-stress test (NST) to assess various parameters like fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and fetal heart rate. This comprehensive test provides a better overall assessment of fetal health compared to the other options.

99. Topic: Risk Factors for Breast Cancer

Correct Answer: E. Having a mother with a history of breast cancer

Explanation: Having a mother with a history of breast cancer is associated with the greatest lifetime risk of developing the disease. This familial link significantly increases the likelihood due to shared genetic factors, such as mutations in the BRCA1 or BRCA2 genes. While factors like early menarche, late menopause, obesity, and age also contribute to breast cancer risk, a family history, particularly a first-degree relative like a mother, is the most significant predictor.

100. Topic: Types of Breast Cancer

Correct Answer: D. Infiltrating ductal carcinoma

Explanation: Infiltrating ductal carcinoma (IDC) is the most common type of breast cancer. It starts in the ducts of the breast and invades the surrounding tissue. Other types, such as inflammatory carcinoma, lobular carcinoma in situ, lobular infiltrating carcinoma, and ductal carcinoma in situ, are less common or represent different stages or forms of the disease. IDC accounts for the majority of breast cancer cases and is characterized by its ability to spread to other parts of the body.

101. Topic: Causes of Vaginal Discharge

Correct Answer: B. Trichomonas vaginitis

Explanation: Trichomonas vaginitis typically presents with a vaginal discharge that may cause burning and itching, and the pH of the discharge is often elevated, usually above 4.5. In this case, the pH of 4.5 is on the higher side, suggesting an infection like trichomoniasis.

102. Topic: Investigation of Symptoms in a Young Woman

Correct Answer: E. Tests for chlamydia research

Explanation: In a young woman presenting with dysuria, vaginal discharge, and pelvic pain, the most appropriate investigation is testing for sexually transmitted infections, such as chlamydia. These symptoms are often associated with infections like chlamydia and gonorrhoea.

103. Topic: Amenorrhea in a Young Woman After Stopping Birth Control Pills

Correct Answer: A. Dosage of serum prolactin level

Explanation: In a young woman with amenorrhea following discontinuation of birth control pills, and with otherwise good health, evaluating serum prolactin levels is important to rule out hyperprolactinemia, which can cause amenorrhea.

104. Topic: Metrorrhagia in a Woman on Oral Contraceptives

Correct Answer: D. Dilation and curettage

Explanation: In a woman with metrorrhagia while on oral contraceptives, dilation and curettage (D&C) is often performed to investigate the cause of abnormal bleeding, especially if the bleeding is persistent or unexplained.