Section: 1 Question: 1 A 30-year-old man presents with severe pruritus that is worse at night and reports similar symptoms

among other family members. Upon examination, areas of excoriated papules are observed in the interdigital areas. Which one of the following is the most likely diagnosis? dermatitis herpetiformis cutaneous larva migrans contact dermatitis scabies pinworm infestation Question: 2 A 33-year-old woman who is 29 weeks pregnant with her fourth child presents to the obstetric unit with onset of painless vaginal bleeding two hours ago, accompanied by passage of significant blood and clots. Fetal heart rate is regular at 150 beats/minute. She is having no uterine contractions. Which one of the following is the most likely diagnosis? placenta praevia abruptio placentae vasa praevia bloody show disseminated intravascular coagulation Question: 3 A 3-year-old boy presents to the emergency room following a 40 second generalized tonic-clonic seizure. The infant has been ill with a high fever for 24 hours. His history is unremarkable, and physical examination is normal, CBC

and urinalysis are normal. Which one of the following would be the best initial step? Arrange to have an EEG performed urgently. Admit to hospital for an immediate CT scan of the head. Carry out blood cultures. Reassure the mother and recommend close observation. Perform a lumbar puncture. Question: 4 Throughout the winter months, about 18% of 1000 people working in a modern office building complain of headache, eye irritation and sore throat. These symptoms develop each day about noon and persist through the afternoon. The most likely explanation for this phenomenon is allergic rhinitis. occupational stress. mass psychogenic illness. sick building syndrome (indoor air pollution). endemic transmission of rhinovirus. Question: 5 A 15-year-old boy presents with a history of repeated fire setting. He collects lighters and enjoys watching fires in the neighborhood. His mother and teachers describe his temper as explosive and he is known to fight, lie and steal. With his mother, he is frequently argumentative and disobedient. Which one of the following diagnoses is most likely? conduct disorder

oppositional defiant disorder intermittent explosive disorder attention deficit hyperactivity disorder (ADHD) pyromania

Question: 6 A 30-year-old male presents with a three month history of weight loss, fatigue and night sweats. He has palpable lymph nodes in his neck and mild hepatosplenomegaly. A chest x-ray shows a large mediastinal mass. What would be the most appropriate method of obtaining tissue for pathologic diagnosis in this patient? neck lymph node biopsy under local anesthetic biopsy of mediastinal mass under general anesthetic liver biopsy under local anesthetic liver biopsy under general anesthetic needle biopsy of the spleen under local anesthetic Question: 7 For a 52-year-old sedentary, normotensive, non-smoking white male who is not overweight, drinks 60 mL of whiskey per day and plays golf occasionally, which one of the following conditions is most likely to cause death within the next 10 years? motor vehicle accident cerebrovascular disease suicide cirrhosis of the liver ischemic heart disease

Question: 8 A 26-year-old pregnant woman delivers a male infant at 40 weeks, with a birthweight of 2.0 kg. His head circumference is 34 cm and there are no dysmorphic features. Antenatal ultrasounds have been normal until 32 weeks, when intrauterine growth restriction has been diagnosed. Which one of the following is the most likely cause of the low birth weight? congenital intrauterine infection chromosomal or genetic abnormality placental insufficiency congenital hydrocephalus maternal age Question: 9 A previously normal 65-year-old African-American man presents with a urinary tract infection. He is treated with sulfamethoxazole-trimethoprim. One week later, routine laboratory testing reveals a new normocytic anemia with hemoglobin 89 g/L. Which one of the following is the most likely diagnosis? Glucose-6-phosphate dehydrogenase (G6PD) hemolysis thalassemia trait occult blood loss from renal carcinoma sickle cell trait favism Question: 10 A 27-year-old man is brought to the emergency room after trying to smash a computer in the library. He says the computer is being used to control his thoughts and that he

has a good idea that the government is behind this. This patient is exhibiting which one of the following? auditory hallucinations delusions visual hallucinations obsessions ruminations Question: 11 What would be the best test to confirm the diagnosis of hereditary spherocytosis? Coombs test bone marrow aspiration osmotic fragility studies red blood cell enzyme studies human leukocyte antigens (HLA) studies

Question: 12 The son of a 79-year-old woman wants a psychiatric evaluation for his mother because she has been more confused and lethargic during the past 6 months. She takes several medications daily, although her son doesn't know what they are. Mental status examination shows the woman to be dishevelled, mildly agitated, and delirious. Which one of the following is the most useful next step in this woman's evaluation? identifying her medications eliciting a family history ordering serum electrolytes

obtaining a CT scan of the head prescribing haloperidol for agitation Question: 13 A first-born male child develops vomiting at the age of five weeks. The vomit is free of bile. The child remains hungry and vomits after taking feedings. Examination reveals visible peristalsis in the upper abdomen. Which one of the following is the most likely diagnosis? esophageal atresia hypertrophic pyloric stenosis duodenal web midgut volvulus incarcerated inguinal hernia

Question: 14 International comparisons suggest that the health status of a population is most influenced by the presence of a national health insurance plan. physician/population ratio. range of social and welfare programs. method of paying the physicians. number of hospital beds. Question: 15 A patient with delirium tremens manifests all of the following, EXCEPT clouded consciousness.

hypothermia. coarse tremor. tachypnea. hyperhidrosis. Question: 16 A 4-year-old girl presents with areas of bluish discoloration of the lower extremities, buttocks and upper trunk. She has a low-grade fever but otherwise well looking. The complete blood count reveals the following results: hemoglobin, 120 g/L; white blood cell, 8.2x109/L and platelets 170 x109/L. Which one of the following is the most likely diagnosis? henoch-Schnlein purpura hemophilia A meningococcemia idiopathic thrombocytopenic purpura acute leukemia

Question: 17 A 28-year-old pregnant woman develops sudden onset of dyspnea and tachycardia. Which one of the following is the most likely explanation? acute mitral valve regurgitation pulmonary embolism myocardial infarction acute respiratory distress syndrome lobar pneumonia Question: 18 A 10-year-old boy complains of headaches and

stomach aches each morning before school and has missed most of the last 2 weeks of school. He has no history of vomiting, change in stool patterns, weight loss or visual disturbances. His physical examination is negative. The most appropriate course of action is propranolol prophylaxis for migraines. referral back to school with reassurance to parents. computed tomography scan of the head. Maalox before meals. suggest withdrawal of privileges to deal with truancy. Question: 19 A 55-year-old overweight, non-smoking woman, recently separated from her husband, complains of severe chest pains radiating to both arms. During the attacks, which are provoked by drinking cold liquids, she is nauseated and may experience difficulty in swallowing. The most likely diagnosis is ischemic heart disease. peptic ulcer disease. panic disorder. esophageal spasm. biliary colic. Question: 20 A 4-year-old boy has a history of easy bruising, nosebleeds, and a similar history among male and female family members. Laboratory investigations show normal INR and prolonged APTT. Which one of the following is the most likely cause of this boy's tendency?

hemophilia A Christmas disease factor XIII deficiency von Willebrand's disease familial platelet function disorder Question: 21 A 45-year-old business executive with advanced cirrhosis of the liver and a history of alcohol abuse says that he drinks only because of the constant nagging of his wife. This is an example of which of the following defense mechanisms? rationalization repression sublimation reaction formation intellectualization Question: 22 A 3-year-old boy presents with a swelling in the right scrotum. On examination the swelling is irreducible, it is possible to get above it and it is translucent. Which one of the following is the most likely diagnosis? indirect inguinal hernia varicosity of testicular veins torsion of the testis acute epididymo-orchitis primary hydrocele

Question: 23 To estimate survival from a follow-up study, "time zero" must be defined precisely for each patient. This is best ensured by "back dating" the entrance to the date of onset of the first symptoms, as obtained from the history. enrolling all patients on the same calendar date. measuring from the first instance when each patient's symptoms met certain criteria for severity. measuring from the time the disease is detected by a screening program. selecting all patients at clinically comparable points in the course of their disease. Question: 24 A 45-year-old female presents with a history of a direct blow over the shaft of her left humerus. Her xray shows a spiral fracture of the distal third of the humerus. On examination of her hand, sensation is intact on the palmar side but absent on the dorsum of her hand. Which one of the following nerves is most likely injured? axillary nerve musculocutaneous nerve median nerve radial nerve ulnar nerve

SECTION 2 Section: 2 Question: 1 A 24-year-old man is brought to the emergency room after being found unresponsive in a city park. Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per minute. Which one of the following is the most likely cause? tricyclic antidepressant overdose morphine overdose arsenic poisoning lead intoxication alcohol intoxication Question: 2 The following laboratory values were obtained during investigation of a 45-year-old man: Hemoglobin Mean corpuscular volume Mean corpuscular hemoglobin concentration Serum iron 90 g/L 82 fL 300 g/L (N = 310360 g/L) 7 mol/L (N = 1327 mol/L)

Total iron binding capacity Sideroblasts in the bone marrow Bone marrow iron

36 mol/L (N = 5472 mol/L) 0.25 (N = 0.300.50) Normal

These results could be due to all the following conditions, EXCEPT iron deficiency anemia. alcoholism. chronic infection. malignant disease. rheumatoid arthritis. Question: 3 The incidence of a particular disease is greater in men than in women, but the prevalence shows no sex difference. The most probable explanation is that the mortality rate is higher in women. the case fatality rate is higher in women. the duration of the disease is longer in women. women receive less adequate medical care for the disease. this diagnosis is more often missed in women. Question: 4 A 50-year-old woman has a 2 cm carcinoma in the upper outer quadrant of her left breast, with no palpable axillary nodes. Which one of the following is the most appropriate treatment?

lumpectomy and tamoxifen lumpectomy and axillary dissection modified radical mastectomy lumpectomy, axillary dissection and radiotherapy lumpectomy followed by radiotherapy Question: 5 A 16-year-old boy presents in the emergency room with a history of a football injury to the left flank earlier that day. He reports that at the time of injury he only had the wind knocked out of him and recovered in a few minutes. About 1 hour later he began to experience pain in the left upper quadrant and left shoulder and light-headedness on standing. Which one of the following is the most likely diagnosis? dislocation of the left shoulder broken rib on the left side left-sided pneumothorax contusion of the left kidney ruptured spleen Question: 6 A 6-month-old girl presents with vomiting and diarrhea of acute onset. Her systolic blood pressure is 40 mm Hg, pulse is 160/minute, she has poor peripheral circulation and is very lethargic. Her serum sodium concentration is 158 mmol/L. Which one of the following is the best initial management? intravenous 5% dextrose in 0.9% saline, 20 mL/kg over 60 minutes intravenous 5% dextrose in water at 80

mL/kg/24 hours oral solution containing 50 mmol sodium per liter septic workup hydrocortisone 200 mg intravenously Question: 7 A 28-year-old woman has a 3-year history of primary infertility. She presents with increasing symptoms of steady, aching lower abdominal pain at the time of menses. The pain persists throughout menstruation and often after, and radiates into the rectum. Tender nodules in the uterosacral ligaments are noted on pelvic examination. Which one of the following would be the most contributory investigation? postcoital test diagnostic laparoscopy hysterosalpingogram on day 9 of her cycle endometrial biopsy on day 26 of her cycle basal body temperature charting Question: 8 A 54-year-old man presents with extreme pain and swelling of the left middle finger. Four days earlier, he suffered a small puncture wound to the volar aspect of the finger at the level of the distal flexor crease. Passive extension of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints severely aggravates his symptoms. Which one of the following is the most likely diagnosis? pulp space infection cellulitis mid-palmar space infection

septic tenosynovitis septic arthritis distal interphalangeal (DIP) joint Question: 9 A 52-year-old patient is complaining of hot flushes, sweating, and sleep disturbance. After discussion she feels hormone replacement therapy would not be suitable for her. She wants to discuss herbal remedies for menopause. Which one of the following natural products is most likely to help her symptoms? Kava Ginseng coenzyme Q10 Evening primrose oil Bilberry Question: 10 On physical examination of a 21-year-old woman, you auscultate at the apex of her heart a low-pitched midto-late diastolic murmur with accentuation of S1. Upon careful listening you notice a clicking sound just after S2 and immediately preceding the rumbling murmur. Which one of the following is the most likely condition? aortic insufficiency atrial myxoma mitral valve prolapse mitral valve stenosis patent foramen ovale Question: 11 A 21-year-old primigravida at 20 weeks' gestation is

diagnosed as having herpes genitalis. Your suggestion to her for her future care include which one of the following? Pap smears every 3 months cesarean section if active lesions at the time of delivery termination of this pregnancy refraining from sexual activity amniocentesis to see if fetus is infected

Question: 12 The lupus patient you are following suddenly develops a fever and notes that her urine is dark in color. Analysis of her urine reveals the presence of red cells. She has had some joint aching and been feeling unwell for a few days. Her malar rash is about the same as usual for her. Which one of the following suggests she is experiencing an exacerbation of her disease? C3 and C4 are both normal. C3 is low and C4 is normal. CH50, C3 and C4 are normal. C3 and C4 are low. terminal complement components are absent. Question: 13 A 9-year-old boy is brought to the hospital with a history of having fallen from his bike. He fainted and is now complaining of abdominal pain and thirst. There is general abdominal tenderness and

rebound tenderness. Approximately 4 hours after the accident, the white blood count is 20 x 109/L and the hemoglobin is 80 g/L. What is the most likely diagnosis? renal contusion acute pancreatitis ruptured spleen retroperitoneal hematoma ruptured bowel Question: 14 A 40-year-old woman has a history of osteoporosis in her family and seeks counseling. Which of the following statements is true regarding an increased risk of osteoporosis? black women with a late menopause white women with larger bone mass women with regular physical exercise women with history of cigarette smoking white women with a late menopause Question: 15 A 27-year-old woman seeks evaluation for her "depression" in an out-patient clinic. She reports episodic feelings of sadness since adolescence. Occasionally she feels good, but these periods seldom last more than 2 weeks. She is able to work but thinks she is not doing as well as she should. In describing her problems she seems to focus more on repeated disappointments in her life and her low opinion of herself than on discrete depressive symptoms. In your differential diagnosis at

this point,which one of the following is the most likely diagnosis? major depression with melancholia adjustment disorder with depressed mood cyclothymia childhood depression dysthymia Question: 16 Extrinsic allergic alveolitis may be acquired by breathing air contaminated by which one of the following substances? urea formaldehyde foam insulation fine silicaceous dust chlorine gas fungal spores degreasing solvent

Question: 17 Following a car accident, a patient presents with bruising of the eyelid and clear fluid is observed leaking from his nose. Which one of the following is the most likely cause? linear fracture of the vault of skull anterior cranial fossa fracture petrous bone fracture foramen magnum fracture squamous temporal bone fracture

Question: 18 A infant girl presents with a webbed neck, shield chest, coarctation of the aorta, and edema of the hands and feet . Which one of the following conditions is she likely to manifest? kyphoscoliosis deafness cataracts amenorrhea renal failure Question: 19 Between 1901 and 1981, the total mortality rate in developed countries showed a dramatic decline. Which one of the following factors accounted for the greatest proportion of the decrease in mortality during this time? improvement in the geographic distribution of health care professionals increase in the number of health care professionals development of antibiotics improvements in general living standards improvements in diagnostic techniques Question: 20 You see a cyanotic 1-day-old baby boy, born by difficult delivery at 37 weeks' gestation. After administration of 100% oxygen, there is no significant change in the arterial PaO2. Based on this finding, the most likely primary diagnosis is

pulmonary disorder. central nervous system damage. congenital heart disease. sepsis. metabolic disorder. Question: 21 Two medical students poll a random sample of classmates concerning their choices for residency training and find that the percentage of women who plan to train in primary care is significantly higher than the percentage of men (p<0.05). The probability is less than 5% that the sampled men will enter a primary care field. the difference between the men and women is real. all the women in the class will enter a primary care field. the difference between the sampled men and women is due to chance. this sample reflects the choices of the whole class.

Question: 22 A 65-year-old previously healthy woman is seen for a routine physical examination. You can palpate a 1-cm mass in the upper outer quadrant of the left breast. Which one of the following is the most likely diagnosis?

fibrocystic disease acute mastitis fibroadenoma carcinoma Paget's disease of the breast Question: 23 A 27-year-old woman in labour declines epidural anesthesia. A nerve block is recommended instead. A block of which one of the following would be appropriate for pain control? pelvic splanchnic nerve obturator nerve inferior gluteal nerve pudendal nerve pelvic sympathetic nerve Question: 24 Which one of the following signs is consistent with an overdose of morphine? tremulousness nystagmus respiratory depression mydriasis hypertension

Self-Administered Evaluating Exam Section: 3 Question: 1 Which one of the following features is characteristic of central retinal artery occlusion?

painful phenomenon progressive loss of vision bilateral blindness semi dilation of both pupils with poor response to direct light brisk constriction of pupil when the other eye is illuminated Question: 2 A 70-year-old woman complains of a 6-month history of cough. She has a past history of hypertension and myocardial infarction and she has been a smoker for 50 years. Which one of the following drugs may be contributing to her cough? enalapril atorvastatin hydrochlorothiazide diltiazem clopidogrel Question: 3 Etiologic factors in female urinary stress incontinence include all of the following EXCEPT weakness of the urethral supports. trauma from repeated deliveries. estrogen deficiency. procidentia. chronic bronchitis.

Question: 5 A nulligravid woman with epilepsy comes for preconceptional counselling. She is taking phenytoin and carbamazepine and has been seizure-free for the last 2 months. What advice should be given to her? There is no significant increased risk of anomalies. The risk of anomalies exceeds that of untreated epilepsy if she continues her medication. She needs anticonvulsants and should therefore not undertake pregnancy. The benefits of the drugs outweigh the risks, and pregnancy may be attempted. The fetal hydantoin syndrome is familial so the status of relatives must be checked. Question: 6 An assembly-line worker complains of awakening at night with right-hand discomfort that resolves after several minutes. After 3 weeks of continuing symptoms, he seeks medical advice. Examination reveals mild weakness of thumb abduction and diminished pain sensibility on the palmar aspect of the thumb and index finger. Which one of the following is the most likely diagnosis? carpal tunnel syndrome cervical radiculopathy reflex sympathetic dystrophy tendinitis radial nerve neuropathy

Question: 7 A 65-year-old man is on his second postoperative day after colon resection for carcinoma. He is on intravenous fluids and nasogastric suction. Which one of the following would be the most reliable in assessing the state of his hydration? turgor of skin body weight urine output amount of thirst moistness of his tongue Question: 8 A study of traffic safety showed that 61% of those involved in accidents last year had more than 10 years of driving experience, 21% had 6 to 10 years of experience, and 17% had 1 to 5 years. Traffic experts concluded that experience seems to make drivers more complacent and careless. Which one of the following statements best explains why this conclusion is NOT justified? The rates have not been standardized for age differences. The data are incomplete because of unreported accidents. A comparison needs to be made with similar data on drivers not involved in accidents. No test of statistical significance has been made. Prevalence is used where incidence is required.

Question: 9 A serious suicide attempt is more likely in patients who are quietly depressed. threaten suicide. have made previous serious attempts. have received bad news. are given inadequate antidepressant medication.

Question: 10 A 56-year-old alcoholic man, who has had chronic bronchitis for the past 10 years, presents with increasing cough. On examination, he has wheezing over the right lower lobe and clubbing of his fingers. Which one of the following diagnosis is the most likely? bronchiectasis aspiration pneumonia alpha-1 antitrypsin deficiency foreign body aspiration bronchogenic carcinoma

Question: 11 Under certain circumstances, it may be legitimate to detain individuals in an institution against their wishes, for their own good and to protect others. This situation may arise when a person has bizarre fantasies and actions

persons are mentally incompetent and unable to manage their own affairs a close relative submits a petition that an individual is actually and presently insane the individual's continued liberty poses a danger a person has visual and aural hallucinations Question: 12 A 24-year-old woman appears at 8 weeks of pregnancy and reveals a history of pulmonary embolism 7 years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin (Coumadin) and has had no further evidence of thromboembolic disease for over 6 years. Which of the following statements about her current condition is true? Having no evidence of disease for over 5 years means that her risk of thromboembolism is not greater than normal. Impedance plethysmography is not a useful study to evaluate her for deep venous thrombosis in pregnancy. Doppler ultrasonography is not a useful technique to evaluate her for deep venous thrombosis in pregnancy. The patient should be placed on low-dose heparin therapy throughout her pregnancy and the puerperium. She is at highest risk for recurrent thromboembolism during the second trimester of pregnancy.

Question: 13

A student in a university residence has been diagnosed with meningococcal meningitis. Which one of the following is the most effective prophylaxis for individuals exposed to this patient? rifampin erythromycin penicillin G tetracycline ethambutol Question: 14 The most common reason for antenatal genetic testing is paternal age greater than 50 a parent with a balanced translocation mendelian disorders maternal age 35 or older repeated spontaneous abortions Question: 15 A 65-year-old woman has developed coarse facial features and an increase in her hand size. You suspect she has acromegaly. In addition to growth hormone, which one of the following would also be elevated? adrenocorticotrop

ic hormone (ACTH) folliclestimulatina hoemone (FSH) prolactin parathyroid hormone (PTH) thyroid stimulating hormone (TSH) Questio n: 16 A 25year-old woman with depressi on repeated ly talks about irrelevan t topics when being intervie wed by a psychiat rist. Wh ich one of the following

sympto ms is the patient demonst rating? supp ressi on deni al intro jecti on resis tanc e repr essio n Question: 17 A 3-year-old boy, diagnosed as having a hemolytic uremic syndrome 4 months ago, presents with the following laboratory findings (finger prick):

sodium

135 mmol/

L potassiu m 9 mmol/ L 106 mmol/ L 7.3 mmol/ L 60 mmol/ L

chloride

urea nitrogen

creatinine

The most appropriate management is to order calcium intravenously. do an electrocardiogr am. repeat the blood tests, taking an intravenous specimen. order Kayexalate by mouth. repeat the blood tests in 1 week.

uestion: 18 You are taking a history from a 24-year-old mother of three who is currently 10 weeks pregnant and has had one previous abortion and one previous twin gestation. Which one of the following is her gravidity and parity? gravida 4, para 1 gravida 4, para 2 gravida 3, para 2 gravida 2, para 2 gravida 3, para 1

Question: 19 A 45-year-old man sustained an 8 cm ragged laceration of his lateral thigh in a farming accident while ploughing a field. The laceration had penetrated the deep fascia into the muscles. He wrapped a towel around the leg and finished his work. He finally arrived in the Emergency Department 8 hours after the accident. Local treatment should include thorough debridement followed by closure of wound. instillation of antibiotics and closure. leave wound open for secondary closure at a later date. closure with drains. local antibiotics and closure of muscles only.

Question: 20 All of the following statements about postpartum psychosis are true, EXCEPT it should be treated as a psychiatric emergency. residual symptoms are common. lithium carbonate is useful for manic symptoms. psychotherapy is beneficial after the period of acute psychosis. use of neuroleptics is often necessary. Question: 21 Which one of the following hormones is responsible for the proliferation of the milk ducts during pregnancy? human chorionic gonadotropin progesterone prolactin estrogen human placental lactogen Question: 22 A 35-year-old woman who was born in Vietnam has had her dyspepsia diagnosed by endoscopy as a duodenal ulcer. Her pathology is positive forHelicobacter pylori. She

has not previously been diagnosed with peptic ulcer disease. What would be the preferred treatment option? combination antibiotics plus omeprazole omeprazole alone surgical vagotomy and pyloroplasty octreotide ranitidine Question: 23 A 30-year-old woman presents with a long standing history of irregular menstrual periods which are often associated with severe pelvic pain and menorrhagia She has also been experiencing dysparunia and pain during defecation. Which one of the following is most likely to assist you in diagnosing this patient's condition? clinical history laparoscopy pelvic examination hysterosalpingogram (HSG) culdocentesis during menses Question: 24 A 45-year-old woman is brought to the Emergency Department after she fainted in a supermarket. Her husband tells you she was diagnosed as "hypoglycemic" by a homeopath 2

years ago. Which one of the following criteria is most in favor of the diagnosis of hypoglycemia? Abnormal 5-hour glucose tolerance test Low blood glucose while symptomatic Typical prodrome of tachycardia History of post-prandial syncope Improvement of patient status after eating

Section: 4 Question: 1 A patient at 17 weeks' gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for which of the following? septic abortion recurrent abortions consumptive coagulopathy with hypofibrinogenemia future infertility ectopic pregnancies

Question: 2 An 80-year-old woman with a history of congestive heart failure develops angina pectoris. Her medications are adjusted to include furosemide, digoxin, nitroglycerin, and potassium supplements. Shortly thereafter, she develops intermittent frontal throbbing headaches. Which one of the following is your initial management step? Perform a temporal artery biopsy. Begin propranolol. Begin sumatriptan (Imitrex). Obtain a brain computed tomography (CT) scan. Discontinue nitroglycerin.

Question: 3 A newborn infant has excessive drooling along with coughing and choking with feeding. Cyanosis is present and is unrelieved by crying. Bilateral pulmonary rales are present. There is abdominal distention with tympany on percussion. Which one of the following is the most likely diagnosis? choanal atresia respiratory distress syndrome Zenker's diverticulum tracheoesophageal fistula duodenal atresia

Question: 4 In a classroom of 25 students (15 males and 10 females), 5 males develop hepatitis A over a 2-week period. During the next 6 weeks, an additional 3 males and 2 females develop the infection. The secondary attack rate of hepatitis A is which one of the following? 20% 25% 40% 50% 73% Question: 5 The ovarian lesion most likely to undergo torsion is

a dermoid cyst. a papillary serous cystadenocarcinoma. a papillary pseudomucinous cystadenoma. an endometrial cyst. an inflammatory cyst. Question: 6 A 40-year-old man states that he is feeling somewhat down and in conflict with his wife. As your history proceeds, you elicit that he has always been somewhat rigid; he is a conscientious hard worker at his employment. You note that he is dressed very neatly and that, while giving his personal history, he rambles and gives you all the details. The most likely personality type is passive-aggressive. narcissistic. obsessive-compulsive. dependent. self-defeating (masochistic).

Question: 7 The karyotype of a hydrocephalic infant would likely show mosaicism. nondisjunction. polyploidy. translocation. euploidy.

Question: 8 Which one of the following is the most important initial task of the doctor doing the psychiatric interview? make a diagnosis establish a rapport give advice reassure the patient develop a treatment plan Question: 9 A 54-year-old woman sustained an anterior wall myocardial infarction complicated by pulmonary edema. She is symptomless at discharge from hospital 7 days later. Which one of the following treatments isINAPPROPRIATE? propranolol captopril acetylsalicylic acid diltiazem isosorbide dinitrate

Question: 10 Which one of the following features is of most specific value in differentiating optic neuritis from papilledema? swelling of the optic disc loss of vision distension of retinal veins

enlargement of the blind spot blurring of the disc margins

Question: 11 A new test is being evaluated for the diagnosis of a pulmonary embolus. Studies indicate that a positive test result has the likelihood ratio of 15, and that a negative test result has a likelihood ratio of 0.85. Which one of the following is a correct conclusion? This test may be helpful for ruling in a pulmonary embolus. This test is highly sensitive for pulmonary emboli. This test will be very helpful in a clinical setting. This test has a negative predictive value is 85%. This test is very reliable.

Question: 12 A total of 300 newly diagnosed patients with laryngeal cancer are allocated to treatment with either surgical excision alone or surgical excision plus radiation treatment. This scenario best illustrates which one of the following? case series report case-control study clinical trial cohort study case report

Question: 13 You are seeing a 1-day-old infant and note that she is jaundiced. Which one of the following would be more likely to cause kernicterus? prematurity breastfeeding conjugated bilirubin ABO incompatibility hepatomegaly

Question: 14 A panic disorder with agoraphobia has been diagnosed in a 33-year-old patient. Which one of the following drugs is LEAST likely to be useful in preventing panic attacks? clonazepam paroxetine alprazolam buspirone desipramine Question: 15 Which one of the following conditions contraindicates routine childhood immunization? prematurity acute illness with an oral temperature over 39 C antibiotic therapy

living with a pregnant woman allergy to penicillin Question: 16 A 35-year-old man suddenly develops a generalized pruritic macular erythematous rash and fever. Four days ago he saw his physician because of a sore throat that started the day before and was started on penicillin after a throat culture grew beta-hemolytic streptococci. Laboratory studies now reveal a urea of 14 mmol/L Urinalysis shows no casts, 2 protein, 50 RBC/high power field, and 50 WBC/high power field. Complete blood cell count is normal except for eosinophilia (12%). Urine protein concentration is 650 mg/24 h. Which one of the following is the most likely diagnosis? acute poststreptococcal glomerulonephritis membranous glomerulonephritis polyarteritis nodosa Schonlein-Henoch purpura drug-induced interstitial nephritis Question: 17 The pattern of inheritance in Duchenne muscular dystrophy is autosomal recessive. autosomal dominant. sex-linked recessive. sex-linked dominant. multifactorial.

Question: 18 An 18-year-old woman develops weakness, weight gain, amenorrhea, abdominal striae, and behavioural abnormalities. Physical examination reveals lateral visual field loss. Which one of the following is the most likely diagnosis? a functional pituitary tumour adrenal hyperplasia anorexia nervosa with bulimia glioblastoma multiforme multiple sclerosis

Question: 19 A 9-year old boy who had been suffering from a gait disturbance for several weeks was found to have a posterior fossa mass on CT scan. Which of the following is the most likely cause for these findings? a berry aneurysm astrocytoma medulloblastoma oligodendroglioma pseudotumor cerebri Question: 20 Which type of colonic polyp is most likely to become malignant? hyperplastic polyp tubular adenoma

villous adenoma Peutz-Jeghers polyp juvenile polyp Question: 21 For physicians who understand their task to be the diagnosis and treatment of significant physical disease, which one of the following patients would be perceived as being the most difficult? a somatizing patient an emphysematous patient who continues to smoke a patient with senile dementia a patient who requests a second opinion another physician Question: 22 Between 7 and 8 years of age, your patient has grown 4.5 cm. His height, however, remains below and parallel to the 5th percentile. Clinical examination is entirely normal. His mother is anxious for further investigations to be undertaken. Which one of the following would you undertake? growth hormone secretion using insulin-induced hypoglycemia computed tomography scan of the head thyroid-stimulating hormone (TSH) 24-hour urine collection for cortisol none of those listed

Question: 23 A 34-year-old female keyboard operator develops pain and numbness in her hands that radiates up her arms. Which of the following is most likely to have been injured? axillary nerve median nerve ulnar nerve radial nerve brachial plexus / triceps muscle Question: 24 All of the following are more common in the families of children who are sexually abused, EXCEPT the family is not well integrated into the local community. three generations live under the one roof. mother delegates homemaking responsibilities to the children. a history of sexual abuse in either parents. a rigid patriarchal family structure.