1. A 63-year-old man with a history of high blood pressure presents at emergency with sudden onset tearing chest pain radiating to the back
2. A 45-year-old man complains of cold numb fingers and difficulty in swallowing. On examination he has tight skin, thickening of the fingers and telangiectasia.
3. Gastro-duodenal ulcer can cause the following complications except one. Which one?
4. In community acquired pneumonia, the following signs exist except one. Which one?
5. Systemic corticotherapy is commonly used in dermatology. In which of the following diseases is it contraindicated?
6. Among the following metals which one is often responsible for contact eczema?
7. Anemia is said to be regenerative when the reticulocyte level is:
8. Among the following aetiologies of a transient ischaemic cerebral accident of a young subject which one is the commonest?
9. The diagnosis of Alzheimer’s disease has the following feature except one?
10. Concerning neuro-meningeal cryptococcosis, only one of the following statements is true. Which one?
11. The management of peripheral neuropathies due to antiretrovirals (ARV) consists of the following measures except one. Which one?
12. You are called to assist a patient who is having a generalized tonico-clonic crisis. Crisis. What should you do immediately (one correct answer only)?
13. The following constitute elements of management of cerebral toxoplasmosis except one. Which one?
14. Diagnostic criteria for tuberculosis meningitis are the following except one. Which one?
15. A 25 years old man has been referred to a rheumatology clinic with multiple painful stiff joints and uveitis. He also complains of ulcers on his penis and mouth
16. A 45 years old woman presents with dryness in the eyes and mouth. Her Schirmer’s positive.
17. A 25 years old man presents with enlarged painless lymph nodes in the neck. His peripheral blood film shows reed-sternberg cells
18. A 45 years old man presents with fever, weight loss tiredness and gout. On examination, there is splenomegaly. White blood count is 112x109/l. The Philadelphia chromosome is detected.
19. A 22 years old HIV positive individual on antiretroviral therapy presents with pneumocystis jiroveci pneumonia
20. A 19-year-old man contracts pneumonia with symptoms of headache; fever and dry cough. Serology shows evidence of chlamydia infection
21. Standard therapy for community acquired pneumococcal pneumonia not requiring hospital admission is
22.A previously healthy 65-years-old smoker with early COPD complains of shortness of breath on exertion.
23. A 22-year-old student with mild asthma that needs treatment for occasional early morning wheezes.
24. Kerley B lines, bat-wing shadowing, prominent upper lobe vessels, cardiomegaly
25. A 65-year-old smoker presents with shortness of breath, gallop rhythm and production of pink sputum.
26. A 22-year-old man presents with fever, night sweats, weight loss and cough productive of blood. Zeihl-Nelsen stain is positive for acid-fast bacilli.
27. A 63-year-old man presents to emergency with weight loss, cough, haemoptysis and shortness of breath. On examination, he is anaemic, clubbed and apyrexial.
28. Radio femoral delay of pulse in patient with hypertension:
29. Pulsus paradoxus, jugular venous pressure rises on inspiration, heart sounds muffled
30. A 65-yras-old man with heart failure requires rate control to treat coexisting atrial fibrillation
31. A 65-year-old woman being treated with large doses of loop diuretic requires add-on therapy for edema refractory to treatment.
32. A 70-year-old woman with a history of chronic heart failure presents with severe pulmonary edema.
33. A 56-year-old insulin dependent diabetic mellitus (IDDM) male presents with persistently elevated BP of 180/110mmHg. Blood tests are unremarkable. What is the most appropriate medication?
34. An anxious 26-year-old woman presents with episodes of chest pain and palpitations precipitated by stress and smoking. Her 24-hour urine shows elevated catecholamines
35. A 45-year-old man presents with right sided hemiparesis. There is a bruit on neck auscultation. What is the single most appropriate investigation?
36. A 50-year-old woman presents with weight gain, muscle weakness and hirsutism. On examination, she is hypertensive and has pedal edema.
37. A 52-year-old woman on hormone replacement therapy presents with a swollen left calf, chest pain and shortness of breath
38. A 78-year-old man has been short of breath for few weeks. His chest radiography shows a right basal shadow rising towards the axilla. It is
39. A 49-year-old woman presents with polyuria, haematuria, abdominal pain and bone aches. On examination, her blood pressure is 170/100mmHg
40. A 76-year-old man fell to the floor while standing in a long queue. He regained consciousness within 2minutes. He was not incontinent of urine or stools.
PAEDIATRICS
Instructions: Questions 41-59 : For each question below, choose the single most appropriate answer from the list of options proposed.
41. Which of the following etiologies does not cause cardiac failure in the child ?
42. The following signs are features that can be observed in a case of viral diarrhea except one. Which one?
43. In the new-born, which clinical symptom constantly observed can lead to the suspicion of oesophageal atresia?
44. During the delivery room resuscitation of a vigorous term newborn, which of the following should be performed first?
45. A 29-week-gestation infant is being resuscitated in the delivery room. Surfactant is given through the endotracheal tube. Which of the following is the most physiologically active component of surfactant?
46. A 15-year-old has exudative tonsillitis, cervical adenitis, and splenomegaly. His monospot test is positive. Which of the following is the most common complication encountered?
47. A mother is concerned because her 20-month-old son prefers to eat with his fingers rather than use a small spoon. Which of the following statements is correct?
48. Third-year medical students are rotating in the normal newborn nursery. The students learn that most neonates actually lose weight after birth. One student asks what the average rate of weight gain is following the initial period of weight loss. After 2 weeks of age, a term neonate will gain an average of which of the following increments of weight?
49. A 1-week-old infant male presents to his primary care provider’s office for his first visit. His mother is concerned because he sleeps a lot. Which of the following is the average amount of sleep per day experienced by infants in the first month of life?
50. Examination of the cerebrospinal fluid of an 8-year-old, mildly febrile child with nuchal rigidity and intermittent stupor shows the following: white blood cells 100/µL (all lymphocytes), negative Gram stain, protein 150 mg/dL, and glucose 15 mg/dL. The most likely diagnosis is
51. A 9-year-old child presents with anemia and stroke. What is the most likely finding with hemoglobin electrophoresis?
52. During a routine-screening of a complete blood count (CBC), a 1-year-old is noted to have eosinophilia. Which of the following most commonly causes increased eosinophilia in the peripheral blood smear?
53. A 5-year-old child is noted to be iron deficient. Upon questioning, his family reports several episodes of grossly bloody (maroon) stools. Which of the following is a likely explanation for his anemia?
54. A 12 year old girl presents with a crusty yellow patchy rash on her face, leaking golden fluid. What is the single most likely diagnosis?
55. A 2 year old boy is brought in by his parents as they are concerned because he has a past history of febrile convulsions. His last convulsion was 6 months ago. There is also a family history of epilepsy. What is the single most appropriate management?
56. A 17 day old breast fed baby presents with jaundice. The mother is concerned as the stools are clay-coloured. What is the single most likely diagnosis?
57. A mother of a 2 year old boy is worried that he is not speaking in sentences yet. What is the single most appropriate management?
58. A 9 year old girl develops Haemophilus Influenzae type B meningitis. What is the single best advice?
59. A 4 year old girl presents with bloody diarrhoea and seizures. She had been visiting a farm recently. Her blood pressure is raised and she stopped making urine. Blood tests reveal anaemia, decreased platelets and haemolytic anaemia. Coombs test is negative. What is the single most likely diagnosis?
60. A 2 year old boy presents with fever, increased salivation and a swelling or lump on the left side of the neck.
61. A 5 year old child develops severe diarrhoea, nausea and vomiting 1 day after returning from a school trip.
62. A 12 year old girl presents with marked oedema. Blood tests show hypo-albuminaemia. Urine shows heavy proteinuria
63. A 15 year old girl presents with a short history of fever, malaise and fletting polyarthritis. Clinical examination reveals a soft apical systolic murmur and a pericardial rub. Investigations demonstrate elevated inflammatory markers (CRP and ESR). What is the single most likely diagnosis?
64. A full term new born becomes jaundiced 14 hours after delivery. His blood results confirm indirect bilirubinaemia and metabolic acidosis. His parents are both rhesus negative
65. A child presenting a flat face, slanting eyes, simian crease, hypotonia and learning difficulties.
66. A 12 year old girl presents with marked oedema. Blood tests show hypo-albuminaemia. Urine shows heavy proteinuria
67. Reduced synthesis of alpha-globin chains leading to haemolysis is called
68. A 14 year old boy presents with a 2 week history of abdominal pain and severe watery diarrhoea with occasional bright blood mixed with stools. He complains of poor sleep as he has about 20 motions per day. Examination reveals mild diffuse abdominal tenderness and perioral skin tags.
69. A 6 year old boy presents with mild fever and maculopapular rash. His mother reported that the rash started on the face then became generalized. On examination, there is palpable cervical and occipital lymphadenopathy.
70. A 14 year old girl presents an intensely pruritic rash with pustules. On examination the rash is generalized but is more in the folds between the fingers and toes.
71. A 6 year old girl presents with fever, frequency of micturition, dysuria and abdominal pain.
72. A 1 year old child presents with vomiting, crying and lifting her legs. Nappy is stained red. On examination, a sausage shaped mass is palpated per abdominally.
73. A 14 year old boy complains of sudden pain in his groin after cycling 10 kilometres. What is the single most likely diagnosis?
74. A nine year old girl with chronic asthma presents to emergency with rapidly worsening wheeze not relieved with inhaled bronchodilators.
75. History of convulsions. Child due for DPT, Haemophilus influenza vaccines etc
76. A 1 year old child develops swollen lips after eating peanuts. What is the single most appropriate management?
77. A 2 year old boy has been developing well but now has decreased hearing. Motor function is normal.
78. An 18 month old patient can still say a few words. Mother is worried.
79. A 3 year old with a persistent and rough voice:
Instructions: Questions 80 : For the presentation given below, choose the single most likely mechanism of the disease from the list of options proposed.
PUBLIC HEALTH
Instructions : Questions 81-86 : Choose the correct answer from the following propositions
81. Dialogue structures
82. Concerning the functioning of the dialogue structure
83. Suppose that the blood sugar level is approximatively normal for a group of women whose standard deviation is unknown. What is the appropriate test to compare the means?
84. In a bid to compare at 5% the CD4 cell counts between 20 men and 22 women, a p-value of 0.06 was found. What conclusion can be drawn?
85. We want to test whether there is an association between obesity (1, II, III) and religion. The number of subjects in one of the cells is 2.4, which test is the most appropriate?
86. Which set of pairs below always goes together?
Questions 87-89: A group of male workers between the ages of 20 and 39 years are being screened for lung disease by spirometry. Nine subjects are examined. Their forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FEV1/FVC%) results are 80, 76, 73, 61, 64, 79, 64, 64, and 78
87. What is the modal reading?
88. What is the median value?
90. The laboratory test has a sensitivity of 85% and a specificity of 70%. You want to have 1000 persons take the test. To estimate the positive predictive value of the test for this population, you need to know which of the following?
91. Which of the following is not a health programme in Cameroon?
92. A study is undertaken to determine whether drinking more than eight cups of coffee a day is associated with hypertension. The blood pressure readings were taken of persons who drink more than eight cups and persons who drink no coffee. The results are as follows
93. You have just finished conducting a case-control study to measure the association between alcohol use and lower respiratory tract infections. The most appropriate method to control for smoking as a confounder is
94. A 6-year-old child is brought to the emergency room by her parents on a Friday night because they are concerned about rabies. A bat was present in the child’s bedroom when they arrived at their country home that evening. It started flying around the head of the girl when she entered her room and it ruffled her hair. Page 139 of 463 The parents heard her scream, ran up to her room, and shoowed the bat out the window. Upon examination, there is no visible bite or scratch marks. Which is the most appropriate intervention at this time?
95. A 25-year-old man presents with a single, indurated, painless ulcer on the penis that appeared two days ago. His most recent unprotected sexual contact was 21 days before. An immediate rapid plasma reagin (RPR) test is negative. The most likely diagnosis is
96. Which of the following residential environmental pollutants is the leading cause of lung cancer?
97. Which of the following diseases is found almost exclusively among persons who have worked with or have been exposed to asbestos?
98. A 27-year-old pregnant woman is brought to the emergency room with multiple ecchymoses to the chest and abdomen. Her breath smells of alcohol. The most likely cause of these findings is
99. One of your patients returns to your office for the results of his HIV test. You inform him that his test is positive for antibodies to HIV. He is married and sexually active with his wife. In the course of subsequent counseling, you tell him it is important that his wife be advised of the exposure. He refuses to tell his wife or have anyone else inform her of the exposure. At this time, what is the most appropriate management of the situation?
100. Which of the following is NOT a medical ethics basic principle?
