Professional Documents
Culture Documents
ANESTHESIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEUROSURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . 26
CARDIAC AND VASCULAR SURGERY . . . . . . . 3 OBSTETRICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OPHTHALMOLOGY . . . . . . . . . . . . . . . . . . . . . . . . 28
COMMUNITY HEALTH . . . . . . . . . . . . . . . . . . . . . 5 ORTHOPEDICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
DERMATOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 OTOLARYNGOLOGY . . . . . . . . . . . . . . . . . . . . . . . 31
EMERGENCY MEDICINE . . . . . . . . . . . . . . . . . . . 9 PEDIATRICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
ENDOCRINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . 11 PHARMACOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . 38
FAMILY MEDICINE . . . . . . . . . . . . . . . . . . . . . . . . 14 PLASTIC SURGERY . . . . . . . . . . . . . . . . . . . . . . . . 39
GASTROENTEROLOGY . . . . . . . . . . . . . . . . . . . . 16 PSYCHIATRY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
GERIATRIC MEDICINE . . . . . . . . . . . . . . . . . . . . . 18 RESPIROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
GYNECOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
RHEUMATOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . 46
HEMATOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
UROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
INFECTIOUS DISEASES . . . . . . . . . . . . . . . . . . . . 22
ANSWERS TO SAMPLE QUESTIONS . . . . . . . 49
NEPHROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 KEY FEATURE QUESTIONS . . . . . . . . . . . . . . . . 52
NEUROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 KEY FEATURE SCORING GUIDE . . . . . . . . . . . 56
3. Which of the following methods is sufficient to 11. Which of the following is FALSE? Epidural analgesia:
determine if the EET has passed through the cords? a) causes uterine relaxation
a) chest movement b) controls blood pressure in preeclampsia
b) absence of abdominal distension c) can cause urinary retention
c) condensation of water vapour in the EET tube d) can contribute to the effect of caval compression
during expiration e) can cause itching
d) CO2 in exhaled gas as measured by capnogragh
e) refilling of reservoir during exhalation 12. All but one of the following increases the likelihood of
regurgitation at the time of induction:
4. Which of the following is CORRECT? a) obesity
a) extracellular fluid volume (ECF) equals 2/3 of total b) anxiety
body water c) upper airway obstruction
b) ECF volume deficit will cause hypotension and d) increased esophageal sphincter pressure
bradycardia e) hiccups
c) ECF volume expansion will cause increased JVP
and S3 13. Which of the following is used in the treatment of
d) moderate dehydration means 10% of the ECF malignant hypertension:
volume is lost a) succinylcholine
e) [Na+] determines ECF volume b) ketamine
c) dantrolene
5. Which of the following is NOT a transfusion reaction? d) tubocurarinee
a) fever e) neostigmine
b) hypercalcemia
c) anaphylaxis 14. Regarding pre-operative investigations, all of the following
d) intravascular hemolysis are true EXCEPT:
e) extravascular hemolysis a) EKG recommended for those > 40 year old
b) pulmonary function test (PFT’s) for those with COPD
6. Which of the following is NOT a side-effect of opioid c) Hb and urinanalysis are required for every surgical
analgesics? patient as indicated in the Public Health Act
a) diarrhea d) hospital policy dictate the indications for tests such as
b) constipation CXR
c) nausea
d) biliary spasm
e) respiratory depression
7. Opioid analgesics:
a) Prevent the release of inflammatory/pain mediators
at the site of injury
b) Block synaptic transmission along the pain pathway
c) Stimulate respiration and increase blood pressure
d) Are rarely associated with tolerance
e) Cause papillary dilation
2. Ischemic rest pain is: 5. The clinical findings of a ruptured abdominal aortic
a) unremitting pain in the most distal portion of the aneurysm include:
affected extremity a) pulsatile abdominal mass
b) a precursor to gangrene and limb-loss b) hypotension
c) associated with pallor on elevation and rubor on c) back pain
dependency d) hematemesis
d) should be treated with aggressive revascularization e) A, B, and C
surgery f) all of the above
e) all of the above
3. Regarding syncope: 9. Which of the following is not one of the major Jone’s
a) the etiology of as many as 50% of cases is never criteria:
identified a) pancarditis
b) vasovagal syncope (the common faint) results from a b) subcutaneous nodules
combination of peripheral vasodilatation and relative c) polyarthritis
bradycardia d) Huntington’s chorea
c) a common cause of syncope is a cortical stroke e) erythema margination
d) the final common pathway of most causes of
syncope is usually generalized cerebral 10. Which of the following is TRUE regarding the JVP:
hypoperfusion a) 3rd degree heart block is associated with cannon
e) cough, micturition, and defecation syncope all result a waves
in part from impaired venous return to the heart b) a positive Kussmaul sign is not correlated with
constrictive pericarditis
4. Which of the following statements is INCORRECT? c) C-V waves are seen in tricuspid stenosis
a) chronic sympathetic nervous system activation d) atrial fibrillatoin does not affect the JVP waveform
causes long-term changes in the myocardium in e) the “y” decent occurs during ventricular systole
heart failure
b) the development of heart failure requires an
initiating myocardial insult
c) dilated cardiomyopathy is a common cause of CHF
d) poor ventricular compliance results in an S3
e) Cheyne-Stokes breathing is frequently seen in
patients with CHF
11. Which clinical picture most likely corresponds to a 15. Fetal infection with Hepatitis B is most likely during the:
patient who has ingested “two bottles of aspirin”? a) first trimester
a) arterial thrombosis and hypothermia b) second trimester
b) hyperpnea, tinnitus, and respiratory alkalosis c) third trimester
c) metabolic acidosis, hypokalemia, hyperglycemia d) throughout pregnancy
d) weakness, ataxia, drowsiness e) Hepatitis B is not vertically transmitted
e) facial pallor followed later by hepatic tenderness
16. Appropriate treatment of a neonate born to a Hepatitis
12. Who should be screened for lead poisoning in Canada? B positive mother is:
a) all children with developmental delay a) hepatitis b immune globulin (HBIG) at birth
b) all children living in housing built before 1960 b) HBIG at birth and Hepatitis B vaccine at 2, 4, and 6
c) all children living in housing in high-risk districts months of age
d) children with unexplained symptom complex of c) HBIG and Hepatitis B vaccine at birth, 1, 6 months of
abdominal pain, anorexia, anemia, ataxia, and age
slurred speech d) HBIG at birth and Hepatitis B vaccine at birth, 1 and
e) none of the above 6 months of age
e) hepatitis B vaccine at 2, 4, and 6 months of age
13. Each of the following patients has a 5-mm reaction to a
5TU PPD skin test. Who should receive therapy for 17. With regards to the vertical transmission of Hepatitis B:
tuberculosis? a) there is a less than 1% risk if the mother is
a) an intravenous drug user known to be asymptomatic and HBsAG+
HIV-seronegative b) can be transmitted through the placenta and
b) a Vietnamese refugee through breast milk only
c) a 30-year-old long-term resident of a mental c) risk of vertical transmission is greater than 80% if
institution mother is HBsAg+ and HBcAg+
d) a 40-year-old with diabetes mellitus d) chronic active hepatitis B has no effect on prematurity
e) a 40-year-old female with known HIV infection e) hepatitis B vaccine should not be given to a pregnant
woman
14. A 54-year-old white female who is new to your practice
presents with a viral upper respiratory infection. She 18. Vertical transmission of HIV can be reduced by giving AZT:
insists that three days of penicillin is the only thing that a) during pregnancy
ever cures it. You explain your reasons for not using an b) during labour
antibiotic, but she continues to insist. You should: c) at the delivery
a) treat her symptomatically but do not give antibiotics d) to the neonate
b) refer her to a physician in your community who has e) all of the above
a reputation for frequently using antibiotics
c) have the patient sign a medical release before
giving her a script for gentamycin
d) tell her that if she is not better in three days you will
give her an antibiotic as a compromise
5. You have been referred an 80 year old man with a 13. Which of the following typically presents after acute
history of venous insufficiency, who complains of a streptococcal pharyngitis?
constant irritation of his lower legs of 6 months a) atopic dermatitis
duration. The most likely diagnosis is: b) guttate psoriasis
a) seborrheic dermatitis c) pityriasis rosea
b) stasis dermatitis d) plaque psoriasis
c) atopic dermatitis
d) allergic contact dermatitis 14. Which of the following is associated with gluten
intolerance?
6. The cause of “cradle cap” in infants is most commonly: a) Bullous pemphigoid
a) atopic dermatitis b) Pemphigus vulgaris
b) seborrheic dermatitis c) Dermatitis herpetiformis
c) pityriasis rosea d) Porphyria cutanea tarda
d) alopecia areata
15. Which is not a feature of lichen planus?
7. The most common causative agents of Impetigo a) purple
Vulgaris are: b) polygonal
a) pseudomonas and streptococcus c) pruritic
b) fungi d) purulent discharge
c) GABHS and Staphylococcus aureus e) peripheral distribution
d) GABHS and Group B Streptococcus
e) Mycoplasmae 16. All of the following are characteristics of basal cell
carcinoma EXCEPT:
8. Staph aureus group II exfoliating toxin is associated with a) associated with UV radiation
a) bullous impetigo in axillae and groin folds b) pearly nodule with telangiectasia
b) psoriatic knee patches c) located on body surfaces not exposed to sunlight
c) facial atopic dermatitis d) spread by local invasion
d) vitiligo e) age of onset >4 0
17. Which is NOT a feature of a cutaneous drug eruption? 20. Malignant melanoma involving the papillary dermis is
a) toxic epidermal necrolysis Clark Level:
b) angioedema a) I
c) phototoxicity b) II
d) hypopigmentation c) III
e) anaphylaxis d) IV
e) V
18. Which is NOT a feature of vitiligo and its management?
a) associated with thryoid disease and diabetes 21. All of the following are treatments for non-scarring
mellitus alopecia EXCEPT:
b) more common in blacks than whites a) spironolactone
c) treatment options include PUVA therapy b) minoxidil
d) destruction of melanocytes c) hair transplantation
e) well-demarcated white macules d) intralesional triamcinalone
e) finasteride
19. All of the following are skin diseases associated with
diabetes mellitus EXCEPT:
a) eruptive xanthomas
b) tinea pedis
c) acanthosis nigricans
d) necrobiosis lipoidica
e) pruritis
12. Which of the following is NOT true regarding allergy and 14. Which of the following toxins is NOT a cause of an
anaphylaxis? increased anion gap metabolic acidosis?
a) they are IgE mediated immune response to a) methanol
antigens b) ethylene glycol
b) epinephrine is the first line agent for the treatment c) salicylates
of minor skin eruptions to topical agents d) iron
c) signs and symptoms of an allergic reaction vary d) benzodiazepines
from minor cutaneous eruptions to cardiovascular
collapse, bronchospasm and laryngeal edema 15. Which of the following toxins is NOT matched to its
d) the ABC’s are the first step in the treatment of specific treatment?
any allergic reaction a) acetaminophen - N-acetylcysteine
b) carbon monoxide - hyperbaric oxygen
13. Which of the following is FALSE with respect to chest c) heroin - naloxone
pain? d) diazepam - bicarbonate
a) all patients presenting with chest pain should e) methanol - ethanol
receive an ECG
b) a normal ECG and normal cardiac enzymes rule
an ischemic event
c) a careful history is essential in determining the
etiology of the chest pain
d) reproducible chest pain on palpation of the chest
wall does not rule out an acute MI
10. In deciding upon the ideal dosage of replacement 14. All of the following statements correctly pair a useful
therapy for hypothyroidism, each of the following factors medication with its mechanisms of action EXCEPT
is considered EXCEPT: a) Propylthiouracil (PTU) blocks the coupling reaction in
a) subjective patient response T4 synthesis
b) findings on physical examination b) Methimazole (MMU) reduces peripheral conversion of
c) response of the radioactive iodine uptake T4 to T3
d) plasma TSH level c) Radioactive iodine destroys follicular cells in the
e) level of free thyroid hormone measured in the serum thyroid
d) Propranolol blocks the sympathetic components of
11. An asymptomatic postmenopausal 54-year-old woman thyrotoxicosis
sustained a slight concussion in an automobile accident. e) Prednisone may relieve the mechanical exophthalmos
X-rays of the skull show an enlarged sella turcica. and opthalmoplegia by reducing inflammation.
Computed tomography (CT scan) of the skull shows no
density within the sella turcica. This patient most likely 15. All of the following laboratory test results are consistent
has: with the clinical picture EXCEPT:
a) A familial syndrome associated with hypercalcemia a) decreased T3 resin uptake
and pheochromocytoma b) decreased TSH response to a TRH challenge
b) Pigmentation of skin, buccal mucosa, and pressure c) decreased serum TSH
areas d) increased serum T4 concentration
c) Elevated serum calcitonin levels e) positive test for circulating antibodies against the
d) Normal endocrine function TSH receptor
e) Hypogonadism with hyposomnia
16. Which of the following disorders is NOT associated with
12. A 32-year-old diabetic did not take his usual dose of osteoporosis?
30 units of lente insulin and 5 units of regular insulin a) pheochromocytoma
because he had an "upset stomach with vomiting". The b) prolactinoma
next day he was admitted to hospital. His plasma c) Cushing’s syndrome
glucose was 29.9 mmol/L and the urine was strongly d) Kleinfelter’s syndrome
positive for ketones. The serum bicarbonate was e) Graves’ disease.
6 mEq/L, arterial pH was 7.05 and serum potassium was
5.4 mEq/L. Which one the following statements is most 17. A 41-year-old man has been diagnosed with
likely to be TRUE? panhypopituitarism. Which of the following is not part of
a) The predominant ketone body in the serum is the appropriate management of this patient?
acetoacetate a) L-thyroxine
b) The elevated serum potassium level reflects total b) hydrocortisone
body potassium in this patient c) fludrocortisone
c) The plasma glucagon level will be increased d) testosterone
d) The serum phosphate concentration will rise during e) Medic Alert bracelet
insulin therapy
e) The patient followed the correct course by 18. While not always the presenting complaint, the earliest
withholding insulin in the absence of food intake symptom/sign of a pituitary tumour is usually:
a) visual disturbance (e.g. bitemporal hemianopsia)
For 13, 14, and 15. b) gonadal insufficiency
A 32-year-old woman visits her physician because of agita- c) headache
tion, weight loss, and inability to sleep. When questioned d) extraocular muscle paresis
further, she reveals an increased appetite, and an increased e) diabetes insipidus
frequency of bowel movements. Previously, she had regular
menstrual periods, but now they are less frequent and 19. An elderly diabetic woman with mild renal insufficiency
irregular. During the physical examination, the physician presents to the emergency room with confusion. Blood
notes that her skin is warm and moist and that she has a fine glucose was 1.5 mmol/L. She is treated with glucose IV
tremor of the fingers, hyperreflexia, and lid lag. The woman for 24 hours, discharged and instructed not to take any
has moderately severe exophthalmos, and her upward gaze medications. 6 hours after discharge, she is brought back
seems weak and uncoordinated. to the emergency department in a coma. Blood glucose
is now 1 mmol/L. Which of the following hypoglycemic
13. Which one of the following disease processes is most agents is the patient most likely using?
likely manifesting itself? a) repaglinide
a) A thyroid adenoma that is secreting thyroxine b) acarbose
b) Inappropriate hypothalamic secretion of TRH c) metformin
c) Graves’ disease d) rosiglitazone
d) Hashimoto’s disease e) glyburide
e) Sick euthyroid syndrome
20. A 47-year-old man is admitted to hospital to be 22. A 35-year-old man gives a history of paroxysmal
evaluated for hypertension and hypokalemia. After the hypertension, headache, diaphoresis and palpitations.
patient has been restricted to a 120 mEq/day Na diet for His father has hypertension and hypercalcemia and a
1 week, his plasma aldosterone twice the normal level. paternal aunt died from a thyroid cancer. The physician
Which is the next MOST appropriate step? would be most likely to measure serum levels of:
a) fludrocortisone suppression test a) calcitonin, calcium, and glucose
b) cosyntropin (ACTH) stimulation test b) glucagon, insulin, and cholesterol
c) measurement of plasma renin activity c) thyroid hormone, adrenomedullin, and phosphorus
d) CT adrenals d) CRH, gastrin, and renin
e) treat with spironolactone
11. Which of the following statements regarding pharyngitis 13. Acceptable methods of assessing for obesity include the
is/are TRUE: following but:
a) The most common etiologic agent is viral a) BMI
b) Bacterial causes for sore throats occur predominately b) daily calorie intake
in pre-school aged children c) waist-hip ratio
c) Delaying treatment for Group A ß-hemolytic d) percent body fat
Streptococcal pharyngitis by 48 hours does not
increase the risk of rheumatic fever 14. Which of the following is characteristic of alcohol
d) a) and c) dependence:
e) all of the above a) 23-year-old male college student who consumes an
average of 23 drinks per week and exhibits no
12. In the context of low back pain, x-ray imaging should be withdrawal symptoms
ordered in these cases except: b) 65-year-old recently retired engineer who binge
a) 25-year-old male i.v. drug user with 3 week history of drinks two times a month
low back pain c) 43-year-old married female, recently fired, and who
b) 64-year old female with 48-hour history of back pain has been in 2 MVAs involving alcohol this past year
and numbness in the right leg extending to the knee d) 35-year-old male former AA member who has not
c) Previously healthy 37-year-old male with 3 month drunk in 10 years
history of low back pain
d) 56-year-old woman with well controlled hypertension
and 4 week history of low back pain
e) 18-year-old construction worker with 1 week history
of low back pain
2. A 13 year old presents with increased serum bilirubin 9. Diagnosis of celiac sprue includes all of the following
and vague nonspecific complaints. Labs show increase in EXCEPT:
unconjugated bilirubin with normal liver function tests a) evidence of malabsorption
and negative hepatitis screens. There is no evidence of b) abnormal small bowel biopsy
liver abnormality or hemolysis. The most likely diagnosis c) improvement in sign and symptoms with a
is? gluten- containing diet.
a) Gilbert’s syndrome d) positive anti-endomysial antibody.
b) biliary atresia
c) hepatoma 10. You suspect a patient with a fat malabsorption syndrome.
d) cholecystitis Which symptom would you NOT expect?
e) cholangiocarcinoma a) night blindness
b) metabolic bone disease
3. After noticing his wife avidly eats clay, starch, and ice, her c) bleeding disorder
husband brings her to the ER. History reveals she is a d) lactose intolerance
vegetarian, and in her second trimester of pregnancy.
The most likely disease afflicting this woman is? 11. A 12-year-old boy is jaundiced and has an enlarged liver
a) megaloblastic anemia on palpation. Lab values show increased ALT,
b) hepatolenticular disease increased AST, increased conjugated bilirubin.
c) gastric carcinoma Kayser-Fleisher rings are noticed on the slit-lamp.
d) pica A diagnosis of Wilson’s disease is made. All of the
e) hypermethioninemia following are true EXCEPT:
a) the primary defect is a mutation in ceruloplasmin
4. The ecchymosis of the flank seen in patients with acute b) the patient likely has increased levels of serum free
pancreatitis is named after? copper and liver copper and increased urinary copper
a) Trousseau with penicillamine challenge
b) Goodpasture c) Wilson’s disease is inherited in an autosomal recessive
c) Grey-Turner pattern
d) Cullen d) patients can demonstrate increased serum
e) Wernicke-Korsakoff ceruloplasmin
e) in normal patients, more than 90% of serum copper
5. The best test for a massive lover GI bleed is? circulates bound to ceruloplasmin
a) colonoscopy
b) angiography 12. All of the following can be causes of conjugated
c) radiolabelled RBC scan hyperbilirubinemia EXCEPT:
d) barium enema a) Wilson’s disease
e) fecal occult blood a) Criggler-Najjar syndrome I
a) primary biliary cirrhosis
6. An elderly woman presents with blood per rectum with a a) gallstones
3 day history of severe ab pain, anemia, hypotension a) viral hepatitis
and CAD. The most likely diagnosis is?
a) ulcerative colitis 13. The most common cause of a significant
b) crohn’s disease upper GI bleed is:
c) irritable bowel disease a) Mallory Weiss tear
d) ischemic bowel (colitis) a) angiodysplasia
e) infectious diarrhea a) peptic ulcer
a) dieulafoy lesion
7. All are causes of splenomegaly EXCEPT: a) antritis
a) infectious mononucleosis
b) thalassemia minor 14. The medical treatment to be of most benefit in the
c) congestive heart failure therapy of both variceal and non-variceal
d) sarcoidosis upper GI bleed is:
e) diabetes a) octreotide
b) omprazole
c) ice water lavage
d) vasopressin
e) ranitidine
15. A 50 year old man was admitted for a bleeding duodenal 16. Which one of the following statements regarding liver
ulcer 2 months ago. He was discharged from hospital failure is TRUE?
with an appropriate course of H. Pylori eradication a) a liver biopsy is a not required with a good history of
treatment. He has since completed the therapy and is alcoholism
currently asymptomatic. Which of the following is the b) encephalopathy may be reversible
BEST non-invasive test to confirm eradition of H. Pylori: c) SBP (spontaneous bacterial peritonitis) is usually a
a) urea breath test result of blunt abdominal trauma
b) endoscopy and histology d) coagulopathy is a result of poor diet in most patients
c) IgG serology with cirrhosis
d) skin testing e) the size a varix is proportional to the degree of
portal hypertension
2. Which of the following physiological changes affect 5. Which of the following is NOT a cause of failure to thrive in
pharmacokinetics in the elderly? the elderly:
a) increased body albumin a) alopecia
b) decreased body fat b) poor dentition
c) increased GFR c) depression
d) decreased hepatic blood flow d) neglect
e) increased hepatic phase I reactions e) dementia
10. Which of the following are consistent with the clinical 13. A 20 year old G0 woman presents to your office with a
presentation of fibroids? (Multiple answers) 4-month history of amenorrhea. She had previously
a) menorrhagia normal and regular cycles since age 12 years. Your initial
b) abnormal bleeding pattern evaluation of this problem includes:
c) abdominal heaviness a) Thorough history and physical examination
d) increased abdominal girth b) A beta-hCG test
e) amenorrhea c) TSH and prolactin levels
f) infertility d) All of the above
g) abdominal pain e) none of the above
h) difficulty emptying bladder
i) difficulty defecating 14. Absolute contraindications to HRT include:
a) undiagnosed vaginal bleeding
11. Non-contraceptive benefits of oral contraception pills b) known or suspected cancer of the ovary
include: c) acute renal disease
a) Reduced benign breast disease and ovarian cysts d) obesity
b) Reduced dysmenorrhea e) none of the above
c) Reduced anemia
d) Reduced risk of ovarian carcinoma 15. Which of the following condition(s) are associated with
e) All of the above Polycystic Ovarian Syndrome?
a) obesity
12. Regarding infertility: b) hirsutism
a) It is defined as failure to conceive after one year of c) insulin resistance
regular unprotected intercourse d) acanthosis nigricans
b) It occurs in approximately 50-60% of couples e) All of the above
c) Most cases are due to unknown factors
d) A normal sperm count from semen analysis is
> 5 million sperm/mL
e) A hysterosalpingogram plays no role in potential
evaluation of infertility
2. All of the following characterize chronic ITP EXCEPT: 10. The cause of beta thalasemia minor is:
a) onset usually following recent viral infection a) Increase HbA2 production
b) spontaneous remission uncommon b) Reduced B chain production
c) peak age of onset 20-40 years c) Increased HbF production
d) occurs more frequently in women d) No B chain production
e) insidious onset of bleed e) Increased B chain production
3. Which of the following coagulation factors is NOT 11. Metabolic disturbances that may be seen in acute
effected by chronic liver disease myelogenous leukemia include:
a) factor VII a) high uric acid, high calcium, high magnesium
b) factor V b) high uric acid, low calcium, low magnesium
c) fibrinogen c) high uric acid, high calcium, high phosphate
d) factor VIII d) high uric acid, low calcium, low phosphate
e) factor IX e) low uric acid, high calcium, high phosphate
4. What disorder results in prolonged bleeding time and 12. Clinical features of chronic myelogenous leukemia include
decreased factor VIII coagulation activity? all EXCEPT:
a) Hemophilia A a) left upper quadrant pain and fullness
b) Hemophilia B b) pruritus
c) von Willebrand’s disease c) peptic ulcers
d) Vitamin K deficiency d) priapism
e) None of the above e) jaundice
5. A young girl with thalassemia is undergoing a blood 13. The MOST COMMON presentation of essential
transfusion and suddenly develops back pain, fever and thrombocythemia is:
becomes tachypneic. The likely diagnosis is: a) weight loss, fever
a) Delayed hemolytic transfusion reaction b) bleeding
b) Febrile non-hemolytic transfusion recaction c) thrombosis
c) Acute hemolytic transfusion reaction d) asymptomatic
d) Circulatory overload e) splenomegaly
e) Graft vs. host disease
14. A 22-year old male student presents with enlarged cervical
6. Which of the following is not accurate for iron stores: lymph nodes that become painful after alcohol
a) Serum Fe consumption. The only remarkable feature on history is an
b) Transferrin 8 lb weight loss over 2 months. The most likely diagnosis
c) Ferritin would be:
d) Hemosiderin a) ALL
e) TIBC b) Hodgkin’s lymphoma
c) Non-Hodgkin’s lymphoma
7. The most common cause of cold antibodies other than d) CLL
idiopathic is: e) multiple myeloma
a) Drug induced
b) Routine detection 15. Possible treatments for multiple myeloma or its
c) Secondary to infection complications include all EXCEPT:
d) Secondary to lymphoproliferative disorder a) corticosteroids
e) Autoimmune disease b) bisphosphonates
c) radiation therapy for bone lesions
8. Which of the following blood smear results are most d) renal transplant
likely to indicate G6PD deficiency? e) plasmapheresis
a) Rouleaux
b) Howell-Jolly bodies
c) Basophilic stipling
d) Heinz bodies
e) Tear drop cells
10. A 36 year old man presents with ankle edema and an 13. Treatment of hypertension caused by bilateral renal
elevated jugular venous pressure. Plasma creatinine is artery stenosis should NOT include which of the
350 umol/L. Past history reveals a polyarthritis for following?
6 months treated with ibuprofen and allergic rhinitis. a) weight reduction if obese
Physical exam reveals several active joints in both hands b) drug therapy with angiotensin-converting enzyme
and an itchy skin rash over the trunk. BP = 170/100 mm Hg inhibitors
and he has moderate peripheral edema. Urinalysis shows c) percutaneous transluminal renal angioplasty
a trace of protein, trace blood and on microscopy many d) surgical renal revascularization
white blood cells and white blood cell casts are seen. e) sodium restriction
The MOST LIKELY diagnosis is:
a) atheromatous emboli 14. Hyperkalemia is reduced by each of the following
b) interstitial nephritis EXCEPT:
c) lupus nephritis a) administration of calcium gluconate intravenously
d) membranous glomerulonephritis b) administration of glucose, insulin and sodium
e) renal artery stenosis bicarbonate intravenously
c) oral administration of potassium-exchange resins
11. Acute diffuse proliferative glomerulonephritis is usually with sorbitol
accompanied by each of the following findings EXCEPT: d) hemodialysis with low potassium dialysate
a) red blood cell casts on microscopic urinalysis
b) proteinuria 15. The anemia of chronic renal failure is usually due to which
c) pigmented casts on microscopic urinalysis of the following?
d) blood clots in the urine a) malabsorption of iron
e) none of the above b) vitamin B12 deficiency
c) blood loss
12. The anion gap is increased in metabolic acidosis d) decreased erythropoietin production
associated with each of the following EXCEPT: e) associated inflammatory conditions
a) diabetic ketoacidosis
b) renal tubular acidosis
c) acute tubular necrosis
d) ethylene glycol intoxication
e) lactic acidosis
7. Which of the following is associated with contact lens 16. Which of the following is NOT a cause of a relative
wear: afferent pupillary defect:
a) vernal conjunctivitis a) multiple sclerosis
b) iritis b) optic neuritis
c) scleromalacia perforans c) dense cataract
d) giant papillary conjunctivitis d) large retinal detachment
e) central retinal vein occlusion
8. Which of the following should never be given for corneal
abrasions: 17. Which of the following is associated with impaired pupil
a) topical analgesics dilation:
b) topical antibiotics a) sympathetic stimulation
c) pressure patch b) Adie’s tonic pupil
d) topical cycloplegics c) parasympathetic understimulation
d) Horner’s syndrome
9. Dendritic lesions are characteristic of:
a) herpes zoster keratitis 18. The most common ocular infection in HIV is:
b) arcus senilus a) herples simplex
c) herpes simplex keratitis b) pnuemocystis carinni
d) scleritis c) cytomegalovirus
d) candida
e) toxoplasmosis
19. In a newly diagnosed patient with type 2 diabetes, 22. Which of the following tests for a phoria:
appropriate screening for retinopathy should involve: a) Hirschberg test
a) begin screening five years after diagnosis b) cover test
b) repeat in four years and thereafter annually c) cover-uncover test
c) begin screening three years after diagnosis, then d) holler test
repeat annually e) accomadation reflex
d) begin screening after age 50; earlier if poor glycemic
control 23. The following are true in the management of chemical
burns to the eye EXCEPT:
20. Non-proliferative changes in diabetic retinopathy include a) alkali burns have a worse prognosis than acid burns
all of the following EXCEPT: b) an alkali burn should be neutralized immediately
a) microaneurysms c) an IV drip with water should be set-up for irrigation in
b) retinal edema the emergency room
c) intraretinal microvascular anomalies d) cyclopegic drops should be administered
d) retinal edema
e) dot and blot hemorrhages 24. In differentiating the causes of red eye, photphobia is
most characteristic of:
21. Grade 5 involvement in graves disease refers to: a) cataract
a) corneal involvement b) conjunctivitis
b) soft tissue involvement c) angle closure keratitis
c) sight loss due to optic neuropathy d) acute glaucoma
d) proptosis e) acute iritis
5. In general, traumatic perforations of the tympanic 12. The MOST sensitive test for nasal fracture is:
membrane: a) history
a) are a surgical emergency b) physical diagnosis
b) will heal spontaneously in most cases c) plain x-ray studies
c) usually require operative repair d) magnetic resonance imaging
d) require microsurgical repair e) computed tomography (CT) scanning
e) require a graft for repair
13. Mixed tumours of the salivary gland:
6. The MOST common organism in acute otitis media of a) are most common in the submaxillary gland
older children and adults is: b) are usually malignant
a) Staphylococcus c) are most common in the parotid gland
b) Streptococcus d) usually cause facial paralysis
c) Hemophilus influenzae e) are associated with calculi
d) Klebsiella pneumoniae
e) Pseudomonas 14. In epistaxis, what percentage of the cases will respond to
ten minutes of direct pressure?
7. A 65-year-old white male who has been smoking pipes a) 10%
since early adulthood notes a small patch of white on the b) 30%
lateral anterior portion of the tongue. The patch is not c) 70%
painful for the first month, but gradually becomes more d) 90%
painful as it begins to enlarge and ulcerate. The MOST e) 0%
likely diagnosis is?
a) benign nonspecific ulceration 15. Which of the following is NOT a cause for conductive
b) leukoplakia (benign) hearing loss?
c) epulis a) otitis media
d) carcinoma of the tongue b) otosclerosis
e) ranula of the tongue c) noise-induced hearing loss
d) perforation of the tympanic membrane
e) ossicular chain disruption
16. Conductive hearing losses are usually reversible. Which 23. What is the MOST common cause of acquired subglottic
of the following conditions is reversible by surgical stenosis?
treatment? a) motor vehicle trauma
a) otosclerosis b) prolonged endotracheal intubation
b) presbycusis c) chronic bronchitis
c) sudden hearing loss d) tracheoesophageal fistula
d) ototoxicity e) previous tracheal surgery
e) meningitis
24. A 5-year-old child has persistent serous effusions in both
17. What is the BEST treatment for most cases of ears for 6 months after a routine acute infection. He has a
sensorineural hearing loss associated with 40-dB condutive heraring loss in both ears and has been
aging (presbycusis)? having trouble in school. What would be the BEST
a) nothing treatment for this child?
b) hearing aid a) observe the child for another 3 months
c) ear trumpet b) prescribe amoxicillin for 10 days
d) diuretic therapy c) recommend hearing aids
e) labyrinthectomy d) place ventilating tubes
e) prescribe prophylactic antibiotics for 3 months
18. The MOST common benign lesion of the external
ear is: 25. A 3-year-old child has has eight episodes of acute otitis
a) melanoma media in 6 months and has difficulty resolving the
b) chondrodermatitis nodularis chronicus helicus effusions between infections. What should be done to
c) cerumenoma effectively eliminate the infections?
d) actinic keratosis a) continuing treating each infection as it arises
e) exostosis of the canal b) place ventilating tubes
c) prescribe prophylactic antibiotics for 6 months
19. MOST of the infectious and/or inflammatory diseases d) remove the tonsils
involving the middle ear space are secondary to: e) give IV antibiotics for 4 weeks after infectious
a) ciliary dyskinesia disease consultation
b) resistant pathogens
c) eutstachian tube dysfunction 26. The following clinical entities are common causes for
d) tobacco abuse tinnitus EXCEPT:
e) allergic diathesis a) high-frequency hearing loss
b) Ménière’s disease
20. Acute otitis is: c) ototoxic drugs
a) a rare condition d) loud noise exposure
b) the most common reason ill children visit the doctor e) acute otitis media
c) usually not accompanied by pain and fever
d) caused by coliform bacteria 27. Vertigo is very common in all of the following conditions
e) treated by placing ventilating tubes EXCEPT:
a) vestibular neuritis
21. All of the following ar indications for tonsillectomy
b) Ménière’s disease
EXCEPT:
c) presbycusis
a) six to seven episodes of tonsillitis in 1 year
d) viral labyrinthitis
b) airway obstruction secondary to tonsillar
e) benign paroxysmal positional vertigo
hypertrophy
c) repeat ear and sinus infections
28. The fastest, safest means of establishing a surgical
d) recurrent peritonsillar abscess
airway is:
e) very large asymmetric tonsil in an adult
a) endoscopic intubation
22. The MOST common cause for infant stridor, accounting b) tracheotomy under local anesthesia
or 60% of the cases, is: c) tracheotomy under general anesthesia
a) subglottic hemangioma d) cricothyrotomy
b) vocal cord paralysis e) puncture through the thyroid membrane
c) laryngomalacia
d) congenital webs
e) laryngeal cleft
12. A 10 month-old child develops low-grade fever and sunburn-like 19. Which of the following statements is true?
erythema over much of the body, but most prominently a) cancer is the second most common cause of death in children
in the intertriginous areas. Within 36 hours, sheet-like b) Hodgkin's lymphoma is the most common childhood cancer
desquamation is noted in the flexures and around the mouth. c) Hyperploidy in leukemic cells is a poor prognostic indicator
The mucous membranes are spared. Which of the following is d) Wilm's tumor is rarely associated with other congenital
the most likely diagnosis: abnormalities
a) Kawasaki disease e) neuroblastomas usually occur in late adolescence
b) staphylococcal scalded skin syndrome
c) Stevens-Johnson syndrome 20. A 5 year-old girl with hypogammaglobulinemia and absent
d) toxic epidermal necrolysis immunoglobulin A (IgA) receives infusions of immune
e) toxic shock syndrome globulin monthly. Shortly after her most recent infusion
began, she developed hypotension, wheezing, and several
13. Which of the following is a contraindication to breast feeding urticarial lesions. Which of the following best explains her
in Canada: reaction?
a) allergic disease in the family a) anaphylactic reaction due to IgE anti-IgA antibodies
b) infantile diarrhea b) gram-negative sepsis due to contaminated immune
c) marijuana smoking globulin
d) HIV infection c) idiosyncratic reaction due to rapid infusion of immune
e) maternal use of ibuprofen globulin
d) serum sickness reaction from foreign serum in the immune
14. Central cyanosis in the newborn infant is most often caused by: globulin
a) congenital heart disease e) transfusion reaction due to ABO incompatibility
b) lung disease
c) central nervous system disease 21. When prophylactic antibiotic therapy is used for tooth
d) methemoglobinemia extraction in a patient with a ventricular septal defect:
e) hypoglycemia a) therapy is started 24 hours prior to the procedure
b) a throat swab should be taken prior to the procedure
15. In a premature infant who is suspected of having necrotizing c) a second generation cephalosporin (cefuroxime) is the
enterocolitis (NEC), each of the following is correct EXCEPT: therapy of choice
a) septicemia is associated with an increased risk of NEC d) therapy is given for one week following the extraction
b) NEC is thought to be caused by systemic hypertension e) erythromycin is the drug of choice for those allergic to penicillin
c) the finding of air in the portal vein indicates severe illness
d) respiratory distress increases the risk of NEC 22. Which of the following statements about stuttering in a
e) Apgar scores inversely correlate with the risk of NEC 4 year-old is incorrect:
a) it is characterized by intermittent difficulty in producing a
16. Which of the following is the most significant risk factor for the smooth flow of speech
development of childhood asthma: b) it is more than 3 times more frequent in girls than in boys
a) family social background c) it is exacerbated by anxiety
b) parental asthma d) more than 30% of children who stutter recover spontaneously
c) stress in the family e) none of the above
d) parental smoking
e) presence of pets in the house 23. A woman who is positive for hepatitis B surface antigen
(HBsAg), but negative for hepatitis B antigen (HBeAg),
17. Which of the following statements about sickle cell disease is true? delivers at term. What would be the best management for
a) all patients with sickle cell disease have a homozygous HbSS this woman's infant?
genotype a) administer gamma globulin intramuscularly immediately
b) sickle cell disease causes a severe chronic anemia that is not and at 1 month of age
routinely transfusion dependent b) administer hepatitis B (HB) vaccine immediately and at 1
c) patients have increased susceptibility to infection by month and 6 months of age
nonencapsulated organisms c) administer hepatitis B immune globulin (HBIG) if cord
d) patients usually present with sickle cell crises within one blood is positive for HBsAg
month of age d) administer HBIG and HB vaccine immediately, and HB
e) splenic dysfunction usually does not occur until the child vaccine again at 1 month and 6 months of age
enters his/her teens e) advise mother that breastfeeding is contraindicated
25. The viral infection most likely to cause CNS involvement and focal 32. A 16 year-old male has a 4 day illness of abrupt onset consisting of
neurological findings is : fever, sore throat, rhinorrhea, cough and mild abdominal pain. He
a) coxsackievirus has a red tonsillopharyngeal area, a whitish exudate on the tonsils
b) herpes simplex and tender anterior cervical nodes. The most likely cause of his
c) enterovirus infection is:
d) rabies a) adenovirus
e) rhinovirus b) Group A beta-hemolytic Streptococcus
c) Epstein-Barr Virus
26. Which of the following predisposes infants to chronic otitis media? d) Neisseria gonorrhea
a) bottle-feeding in upright position e) Staphylococcus
b) abnormal tympanic membrane formation
c) environmental factors such as daycare and passive smoking 33. A 13 month-old infant boy has chronic diarrhea, poor appetite,
d) allergies irritability and growth failure. He had been well previously,
e) none of the above developing until diarrhea began at 3 months of age. Findings
include weight loss less than 5th percentile and length at 25th
27. All infants less than 3 months of age who have fever and no percentile, cachectic appearance, wasted extremities and
localizing signs should have all of the following evaluations protuberant abdomen. His labs are: albumin 23, protein 40. Stool
EXCEPT: positive for reducing sugars and negative for enteric pathogens
a) blood cultures and ova and parasites. These findings are most consistent with
b) careful history and physical exam a) Celiac disease
c) chest x-ray b) cow milk allergy
d) CBC (with differential) c) Crohn’s disease
e) urine culture d) cystic fibrosis
e) none of the above
28. All the following statements regarding transient tachypnea of the
newborn (TTN) is true EXCEPT: 34. Which of the following is most likely to provide the basis for
a) infants born by C-section are at increased risk for making the correct diagnosis in an infant or child who has failure to
developing TTN thrive (FTT)?
b) residual pulmonary function disability is common among a) blood chemistries
infants who have TTN b) cultures
c) the incidence of TTN is higher than Respiratory Distress c) history and physical
Syndrome (RDS) among term infants d) radiograph studies
d) TTN shows marked improvement with 12-24 hrs e) none of the above
29. Antibiotic prophylaxis against infective endocarditis is required for 35. A 8 year-old boy has had paroxysmal abdominal pain since his
all of the following EXCEPT: parents separated 6 months ago. Which of the following symptoms
a) rheumatic valve lesions would support an organic basis for his disease?
b) prosthetic heart valves a) headaches accompanies the pain
c) isolated secundum atrial septal defect b) pain located in the periumbilical region
d) pacemaker leads c) pain awakens child at night
e) patent ductus arteriosus d) symptoms last < 1hr
e) none of the above
30. Causes of microcytic anemia include all of the following EXCEPT:
a) excessive cow's milk intake 36. The most common cause of chronic diarrhea in a
b) iron deficiency 6 month - 36 month old child is:
c) folic acid deficiency a) chronic non-specific diarrhea
d) thalassemias b) disaccharidase deficiency
e) lead poisoning c) enteric infection
d) malabsorption
31. The latest time after the onset of group A ß hemolytic e) protein intolerance
Streptococcus pharyngitis that initiation of penicillin therapy can be
expected to prevent acute rheumatic fever is: 37. Which of the following is NOT required for a diagnosis of juvenile
a) 24 hrs rheumatoid arthritis?
b) 48 hrs a) arthritis in at least one joint
c) 96 hrs b) arthritis lasting for at least 6 weeks
d) 9 days c) positive rheumatoid factor
e) 2 weeks d) onset before the age of 16
e) other causes of arthritis excluded
38. A child presents with bilateral shin pain. Which of the following 45. All of the following are appropriate in the initial assessment of a
suggests that this is NOT growing pains? child with failure to thrive EXCEPT:
a) pain is poorly localized a) diet history
b) pain awakens the child at night b) social history
c) no fever or rash c) measurement of height, weight and head circumference
d) pain abates with reassurance and massage d) growth hormone levels
e) child may limp in the morning from stiffness e) bone age x-ray
39. Which of the following steps is NOT indicated in the management 46. Which of the following statements about a child with short stature
of croup? is CORRECT?
a) keeping the child calm a) the bone age is delayed in a child with constitutional growth
b) hydration delay
c) antipyretics b) height crosses a major percentile line on the child’s growth
d) antibiotics chart
e) humidified oxygen c) weight is more affected than height in a child with an
endocrine deficiency
40. Which of the following pairs shows the CORRECT stage of normal d) karyotyping part of the routine investigation of all children with
development? short stature
a) 6 months - pulls to stand e) growth hormone replacement is helpful in a child with familial
b) 12 months - pincer grasp growth delay
c) 18 months - handedness
d) 2 years - draws a cross 47. Which of the following developmental milestones in not a cause for
e) 3 years - tells a story concern?
a) 15 month old not walking
41. Which of the following is NOT characteristic of a functional b) 12 month old not talking
murmur? c) 12 month old who does not search for hidden objects
a) pansystolic murmur d) 3 year old unable to stand on one foot momentarily
b) murmur varies with position e) 6 month old with a persistent grasp reflex
c) variably split S2
d) murmur becomes louder with fever 48. All of the following immunizations should be administered to a
e) no extra clicks 7 year-old child who is a recent immigrant, with unknown
vaccination status EXCEPT:
42. Which of the following is the most common congenital heart lesion a) tetanus
in children? b) MMR
a) atrial septal defect c) diptheria
b) ventricular septal defect d) pertussis
c) patent ductus arteriosus e) polio
d) Tetralogy of Fallot
e) coarctation of the aorta 49. A 3 year old girl has a 2 month history of left knee swelling and
morning stiffness. There is no history of fever or rash. The child
43. Choose the INCORRECT statement about breastfeeding: appears very healthy. The most likely tentative diagnosis is:
a) for healthy term babies, breastfeeding is recommended over a) pauciarticular juvenile rheumatoid arthritis (JRA)
formula feeding b) systemic lupus erythematosus (SLE)
b) breastmilk contains more amino acids than cow’s milk. c) rheumatic fever
c) exclusively breastfed babies should be supplemented with d) Kawasaki’s disease
iron after 6 months of age e) Henoch-Schonlein purpura
d) assessment of adequate intake can be done by counting
the number of wet diapers in a day 50. An 8 year old boy has had 2 episodes of loss of awareness. These
e) an HIV-positive mother should not breastfeed last 5 seconds and consist of eyes and head turning to one side.
EEG reveals 3Hz spike and wave activity. First line therapy would
44. All of the following are characteristics of a child with Pervasive include:
Developmental Disorder (PDD) EXCEPT: a) ACTH
a) abnormal speech pattern b) phenytoin
b) stereotypic behaviours, such as head-banging or hand-flapping c) carbamazepine
c) abnormal cognitive function d) ethosuximide
d) consuming interest in one topic or activity e) phenobarbital
e) tendency to reciprocate in peer interactions
51. Turner syndrome is associated with the following clinical features 55. A 1100 gram infant born at 36 weeks gestation develops respiratory
EXCEPT: distress syndrom and requires supplemental oxygen until 4 months
a) major learning difficulties of age. A CXR then shows hyperinflation of both lungs and cystic
b) short stature changes in the bases. The most likely diagnosis is:
c) primary amenorrhea a) bronchopulmonary dysplasia
d) broad chest b) cor pulmonale
e) wide carrying angle at elbows c) presistant pulmonary hypertension
d) pneumonia
52. Which statement concerning delayed puberty is false? e) cystic adenomatoid malformation of the lung
a) defined absence of pubertal development by age 13 in girls
and age 14 in boys 56. Breat feeding is a contraindication to which of the following
b) the most common cause is constitutional delay vaccinations?
c) chronic disease may cause growth delay a) diptheria
d) delayed puberty in males is more suggestive of pathology than b) influenza
delayed puberty in females c) MMR
e) bone age is an important investigation in determining the d) hepatitis B
cause of delayed puberty in both males and females e) none of the above
53. A 3 year old Asian girl presents with a fever of 6 days, red lips and 57. A 6 month old infant presents in the winter with fever, cough,
tongue, bilateral nonpurulent conjunctivitis, cervical wheezing, tachypnea and decreased appetite. A CXR shows
lymphadenopathy and a polymorphic rash. hyperaeration and streaky perihilar infiltrates bilaterally. You diag
The most likely diagnosis is: nose bronchopneumonia. Which organism whould likely be causing
a) Streptococcal pharyngitis this child’s infection?
b) Kawasaki’s disease a) chlamydia pneumonia
c) infectious mononucleosis b) mycoplasma pneumonia
d) adenoviral infection c) streptococcus pneumonia
e) none of the above d) haemophilus influenza
e) respiratory syncitial virus
54. Which of the followng statements concerning minimal lesion
glomerulonephritis is correct? 58. Prostaglandin E1 infusion can be used for the initial management in
a) it is a common cause of nephrotic syndrome in children, but it each of the following neonatal heart lesions EXCEPT:
is a very rare cause of nephrotic syndrome in adulthood a) pulmonary atresia
b) glomerular filtration rate is usually preserved b) coarctation of the aorta
c) it is usually unresponsive to treatment such as prednisone and c) Tetralogy of Fallot
cyclophosphamide d) patent ductus arteriosus
d) it is most often accompanied by severe hypertension e) hypoplastic left heart syndrome
e) the urine typically shows red blood cell casts (suggestive of
proliferative glomerulonephritis)
Response e.g. % of
c) a lower dose of a highly protein bound drug
receptors blocked
d) no drug at all its just too dangerous 60% B
14. Anti-α-1-adrenergic blockade causes: 20. Which of the following statements concerning anorexia
a) nausea nervosa and bulimia nervosa is false:
b) constipation a) patients with either of these eating disorders are
c) orthostatic hypotension preoccupied with weight, food, and body shape
b) bulimia nervosa is more prevalent than is anorexia
d) dry mouth nervosa
e) drowsiness c) both of these eating disorders are more common in
females than in males
15. The following are common side effects of SSRIs EXCEPT: d) bulimia nervosa often presents earlier in
a) headache adolescence than does anorexia nervosa
b) sexual dysfunction e) bulimic symptoms may occur in both bulimia
c) vomiting nervosa and anorexia nervosa
d) anorexia
21. A pattern of unstable but intense interpersonal
e) orthostatic hypotension relationships, impulsivity, inappropriately intense anger,
identity disturbance, affective instability, and problems
16. Clozapine is the neuroleptic of choice for with being alone suggest a diagnosis of:
schizophrenia when: a) antisocial personality disorder
a) the patient shows no evidence of tardive dyskinesia b) narcissistic personality disorder
b) the patient has not improved with adequate c) histrionic personality disorder
dosages for 6 weeks of 3 other antipsychotics d) schizoid personality disorder
c) the patient is under fifteen years of age e) borderline personality disorder
d) the patient has a WBC count of >10 000 22. The criteria for diagnosis of a factitious disorder include:
e) the patient is very sensitive to anticholinergic a) intentional production or feigning of physical signs or
side effects symptoms
b) absence of secondary gain
17. Frequent conditions appearing comorbidly with ADHD c) possibility of economic gain
include: d) (a) and (b)
1) oppositional defiant and conduct disorders e) (a) and (c)
2) anxiety disorder
23. A patient with a fear of heights is brought to the top of a
3) learning disabilities tall building and required to remain there as long as
4) tic disorders necessary for the anxiety to dissipate. This is an
5) language disorders example of:
a) graded exposure
Which are correct: b) participant modeling
a) only 1 is correct c) positive reinforcement
b) 1, 2, and 3 are correct d) flooding
c) 2 and 4 are correct e) relationship therapy
d) all are true 24. Hypnosis has been used successfully in all of the following
conditions EXCEPT:
18. A 35 year old man presents to the emergency room with a) pain
suicidal ideation. He describes significant stress due to b) phobia
recent job loss and financial hardship. Further inquiry c) paranoia
reveals a history of repeated job loss, fraud charges, and d) anxiety
frequent arm slashing to decrease stress. The man was e) smoking
not disruptive as a child. The most likely diagnosis is:
25. Cognitive therapy helps to correct which of the following
a) borderline personality disorder cognitive distortions:
b) antisocial personality disorder a) depersonalization
c) adjustment disorder b) psychotic thinking
d) dysthymic disorder c) over-generalizations
e) schizophrenia d) selective inference
e) hallucinations
19. Which of the following statements concerning childhood
abuse and neglect is false: 26. The most frequently reported side effect of tricyclic
a) the abuser is commonly a friend or a relative antidepressants is:
b) physical indicators of sexual abuse include bruising a) peripheral neuropathy
b) photosensitivity
or pain in the genital region
c) children who have been abused often present with c) agranulocytosis
aggressive or anxious behaviors d) jaundice
d) Mmentally retarded or physically handicapped e) dry mouth
children may be at increased risk of abuse
e) local child welfare authorities must be notified in
cases of suspected child abuse, however there is no
duty to report child neglect
27. A high risk of suicide is associated with which one of the 33. Which of the following symptoms of schizophrenia
following factors: responds best to anti-psychotic medication:
a) female aged less than 30 years a) asocial behavior
b) married male less than 30 years b) flat affect
c) public setting c) paranoid delusions
d) secondary gain from attempt d) lack of motivation
e) single male aged more than 60 years e) all of the above
28. A fixed unalterable belief that is false in its content and 34. A 53 year-old housewife presents with depression
in its social and cultural setting is called: marked by early morning wakening, diminished energy
a) an illusion and poor concentration. She is treated with supportive
b) a hallucination psychotherapy and imipramine 100 mg qhs.
c) a delusion After four weeks she is no better. You would next:
d) agnosia a) reassure her that antidepressants take 5-6 weeks to
e) paranoia be effective
b) begin intensive psychotherapy
29. Criteria for involuntary hospitalization of a suicidal c) switch to a serotonin reuptake inhibitor
patient include: d) increase the dose to 150 mg qhs
a) assessment done less than 72 hours prior to e) add lithium carbonate 1200 mg daily
completion of Form 1
b) presence of a mental disorder 35. Hypertensive encephalopathy is a serious complication of
c) acute risk of harm to themselves treatment with:
d) (a), (b), and (c) a) phenothiazines
e) (b) and (c) b) tricyclic antidepressants
c) lithium carbonate
30. Each of the following statements about affective d) MAOI antidepressants
disorders is true EXCEPT: e) benzodiazepines
a) patients with bipolar disorder show roughly the
same frequency of positive family history as do 36. Electroconvulsive therapy (ECT) is a first line treatment in
patients with unipolar disorder which one of the following conditions?
b) major depressive illness is more common in women a) obsessive compulsive disorder
than in men b) paranoid schizophrenia
c) bipolar affective disorder is far less common than c) generalized anxiety disorder
unipolar affective disorder d) acute mania
d) there is a different response to lithium in unipolar e) major depression with acute suicidal ideation
and bipolar disorder
e) imipramine is more likely to produce hypomania in 37. Tardive dyskinesia is:
bipolar patients than in unipolar patients a) an acute extrapyramidal side effect of phenothiazines
b) an acute anticholinergic side effect of tricyclic
31. A major depressive disorder is diagnosed only when the antidepressants
affective disturbance has existed for at least : c) a type of Parkinson’s disease
a) two weeks d) a side effect of excessive ECT treatments
b) four weeks e) a long term complication of chronic phenothiazine
c) six weeks administration
d) eight weeks
e) twelve weeks 38. Which of the following symptoms is most commonly found
in schizophrenia?
32. A 30 year-old man presents in emergency with right a) depressed mood
lower quadrant abdominal pain. His wife reports that he b) flight of ideas
had been drinking heavily in response to marital c) elevated mood
problems and had never had such pain before. d) delusional fears
Appendicitis was diagnosed and an appendectomy was e) thought insertion
successfully performed. Four days later the patient was
anxious, restless, unable to sleep and claimed his wife 39. Patients with conversion disorders will show each of the
was a stranger trying to harass him. The likeliest following EXCEPT:
diagnosis is: a) “La belle indifference”
a) paranoid reaction b) severe depression
b) delirium tremens c) loss of special sense function
c) mania d) secondary gains
d) schizophreniform reaction e) paralysis of voluntary muscles
e) post-operative delirium
40. The syndrome of delirium tremens is associated with 48. Which of the following investigations need not be
each of the following EXCEPT: performed before starting treatment with lithium
a) rapidly fluctuating level of consciousness carbonate?
b) dehydration a) serum creatinine
b) serum electrolytes
c) visual hallucinations c) thyroid function studies
d) renal failure d) serum bilirubin
e) polyneuropathy e) all of the above
41. Which of the following is best treated with high dose 49. All of the following are common side effects of tricyclic
benzodiazepines: antidepressants EXCEPT:
a) schizophrenia, catatonic type a) dry mouth
b) major depression b) constipation
c) parkinsonian tremor
c) generalized anxiety disorder d) tachycardia
d) delirium tremens
e) psychogenic amnesia 50. The Theory of Behavioral Therapy employs which of the
following concepts:
42. Personality types predisposed to depression include a) reaction formation
which one of the following: b) reinforcement
a) dependent c) imprinting
b) antisocial d) autosuggestion
e) sublimation
c) schizoid
d) paranoid 51. Which of the following represents a contraindication for
e) schizotypal psychoanalysis?
a) the existence of transference feeling toward the
43. Which of the following neurological symptoms can be analyst
produced by antipsychotic drugs? b) the existence of countertransference feeling in the
a) akathesia analyst
b) shuffling gait c) the resistance to change by the patient
d) preoccupation with resolving a crisis situation
c) oculogyric crisis e) the existence of an underlying neurotic style of
d) tremor at rest behaviour
e) all of the above
52. Which of the following is least helpful in treating
44. Absolute contraindications to ECT include: depression?
a) pregnancy a) phenelzine
b) recent myocardial infarction b) imipramine
c) fractured pelvis c) lithium carbonate
d) lorazepam
d) brain tumor e) all of the above
e) all of the above
53. A young mother is very focused on the health of her
45. In the elderly delirium may be produced by the use of: 16 month-old. She keeps her house immaculate for fear
a) neuroleptics that dirt will harm her baby, she checks the lock on the
b) tricyclic antidepressants door at least ten times before retiring to bed, and she has
c) antiparkinsonian agents to get up and check that her child is still breathing at least
d) minor tranquilizers 3 times every night. She knows that her fears are irrational
but persists with these behaviors. The most likely
e) all of the above diagnosis is:
a) paranoid delusions not otherwise specified
46. Which of the following statements about simple phobia b) post-partum depression
is correct? c) obsessive compulsive disorder
a) it responds well to simple reassurance d) generalized anxiety disorder
b) it responds well to individual psychotherapy e) paranoid personality disorder
c) it responds well to benzodiazepines
d) it responds well to relaxation and desensitization 54. A thorough assessment for the presence/absence of
alcohol withdrawal should include questions about all of
e) all of the above the following EXCEPT:
a) nausea and vomiting
47. Toxicity due to lithium carbonate is associated with all b) mood
of the following EXCEPT: c) difficulty walking (ataxic gait)
a) nausea d) visual disturbances
b) serum lithium level of 0.1 mEq/L e) tremulousness
c) tremulousness
d) convulsions
55. Which of the following will be least helpful with respect 63. Which of the following statements is true about paraphilias:
to distinguishing delirium from dementia: a) almost never diagnosed in women
a) disorientation at night b) treated with androgen drugs
b) duration of disorientation c) includes: exhibitionism, fetishm, voyeurism,
c) fluctuating level of consciousness pedophilia
d) mini mental status examination d) a and b
e) presence of visual hallucinations e) a and d
56. Onset of schizophrenia is typically in an affected 64. All of the following statements are correct EXCEPT:
individual’s: a) female orgasmic disorder can be caused by
a) early teens denervation of the lumbosacral spine
b) late teens/early 20s a) having a rigid, conservative sexual upbringing can
c) late 20s/early 30s result in delayed ejaculation in men
d) late 30s/early 40s a) phenothiazines are used to treat delayed ejaculation
e) late 40s/early 50s disorder in males
a) most delayed ejaculation is situational
57. Which of the following is an example of a negative a) most orgasmic disorders in women are psychological.
symptom of schizophrenia:
a) nihilistic delusion 65. Major Depressive Disorder with melancholic features is
b) flat affect most likely accompanied by:
c) auditory hallucinations a) echololia and /or echopraxia
d) catatonic behaviour b) hypersomnia
e) all of the above c) severe anhedonia
d) weight gain
58. Helpful treatments for post-traumatic stress disorder e) inappropriate posturing
symptoms include the following except:
a) SSRIs 66. Long acting antipsychotic medications:
b) relaxation techniques a) are available in both typical and atypical preparations
c) exposure therapy b) are administered IM or SC
d) cognitive restructuring c) are first line treatment for severe schizophrenia
e) all of the above may be helpful d) are less likely to cause EPS compared to the oral form
e) should be ideally started after the patient has had
59. The primary difference between factitious disorder and exposure to the oral form
malingering is:
a) factitious disorder involves the feigning of 67. A 55-year-old man with chronic schizophrenia is brought to
symptoms for external rewards (e.g. economic gain) the E.R. He is diaphoretic, pale and has a temperature of
b) factitious disorder involves the unintentional 41ºC, blood pressure of 170/100, and heart rate of 120. He
production of symptoms also exhibits muscle rigidity and a fluctuating level of
c) there is an absence of primary gain in factitious consciousness. The most diagnosis is:
disorder a) acute dystonic reaction
d) factitious disorder can involve only psychological b) tardive dyskinesia
symptoms c) neuroleptic malignant syndrome
e) there is an absence of secondary gain in factitious d) psychosis secondary to a general medical condition
disorder e) substance-induced psychosis
60. The following features tend to differentiate atypical 68. Obsessive-compulsive disorder is most consistent with:
antipsychotics from typical/conventional antipsychotics a) perfectionism, meticulous organization and
EXCEPT: cleanliness
a) atypicals are serotonin-dopamine antagonists a) the persistent need to shower because of the belief
b) atypicals tend to result in more specific dopamine that aliens are contaminating one’s body
blockade b) recurrent and intrusive thoughts that are inserted into
c) atypicals tend to result in lower levels of prolactin one’s mind by others
d) atypicals tend to cause fewer extrapyramidal side c) a persistent preoccupation with food and one’s
effects appearance accompanied by bingeing, purging and/or
e) atypicals tend to be more effective for the restricting behaviours
treatment of negative symptoms d) compulsively avoiding cracks in the side walk for fear
that if one does not, a relative might be subject to
61. Which of the following statements is true about sexual harm
dysfunction:
a) it is secondary to physical factors alone 69. Bipolar disorder may be characterized by:
b) it occurs only in females a) rapid cycling: at least one episode (manic or
c) the commonest cause is medications depressed) every 4 weeks
d) psychological factors account for 10% in women b) an increased risk in females
e) none of the above c) a lower risk in higher socioeconomic groups due to
decreased psychosocial stressors
62. Which of the following statements is true about d) hypomanic episodes without depressed episodes, as
premature ejaculation: in Bipolar II disorder
a) most common male sexual dysfunction e) none of the above
b) usually secondary to performance anxiety
c) has a 90% success rate with regards to treatment
d) treatment includes: excercises to focus on
experience vs performance, increasing stimulation
and control exercises
e) all of the above
2. Which of the following organisms causes 7. Which of the following is NOT an indication of home
“walking pneumonia”? O2 in a person with COPD?
a) S. aureus a) PaO2 < 55 mmHg
b) S. pneumoniae b) PaO2 < 60 mmHg with erythrocytosis
c) H. fluenzae or cor pulmonale
d) Mycoplasma c) persistant hypoxemia after 3 weeks of
e) Legionella maximal therapy
d) PaO2 maintained > 80 mmHg during wakeful res
3. Which of the following is considered a positive tb skin increased by 250 ml during exercise or sleep
test?
a) induration of > 5 mm in close contact with an 8. Which of the following are associated with upper
HIV positive individual lobe fibrosis?
b) induration of < 5 mm in an adult with no risk factors a) farmer’s lung
c) induration of < 5 mm in a person with silicosis b) silicosis
d) induration of > 5 mm in a person with known TB c) sarcoid
exposure d) histiocytosis
e) X asbestos
4. The following are typical chest x-ray findings of a
malignant solitary nodule: 9. The differential diagnosis of obstructive lung disease
a) > 3 cm includes:
b) ill-defined margins a) COPD
c) “popcorn” pattern of calcification b) asthma
d) associated pleural effusions c) bronchiectasis
e) cavitation with thick wall d) CF
e) chest wall disease
5. All of the following but one are indicative of poorly
controlled asthma: 10. Which is NOT a feature of adenocarcinoma of the lung?
a) night time awakenings a) solitary peripheral pulmonary nodule
b) use of a beta-agonist 2x/week b) may appear as an alveolar infiltrate simulating
c) mild limitation of activities pneumonia
d) chronic dry cough c) frequently unilateral
d) metastasizes early
12. Cautions and contraindications of NSAIDs include: 19. First line pharmacologic treatment for osteoarthritis is:
a) a creatinine of 180 mmol/L a) acetaminophen 1000 mg po QID
b) peptic ulcer disease b) celecoxib 200 mg po BID
c) warfarin use c) glucosamine 500 mg po QID
d) cirrhosis d) ibuprofen 400 mg po TID
e) all of the above e) depo-medrol 20 mg intra-articularly
13. Small vessel vasculitides include all of the following 20. Which of the following medications is not associated with
EXCEPT: drug-induced lupus syndrome?
a) Wegener’s granulomatosis a) isoniazid
b) Churg-Strauss syndrome b) propranolol
c) essential cryoglobulinemia vasculitis c) hydralazine
d) Kawasaki’s disease d) cyclosporine
e) predominantly cutaneous vasculitis d) carbamazepine
14. A 30-year-old male presents with a history of mild upper 21. A 30-year-old woman comes to your office with a 1-day
respiratory tract infection progressing to a severe cough history of right knee pain and swelling. She has never had
and hemoptysis. Upon examination, you note a joint pain. She spent the day before working in her
nasoseptal perforation. Tests you should order include: garden, and was kneeling for most of the time. She has no
a) chest x-ray other associated symptoms, but has had several sexual
b) urine routine and microscopy partners within the last year. You aspirate her knee
c) CBC because you are worried about septic arthritis and send
d) c-ANCA requisitions for cell counts, microscopy, stat Gram stain,
e) all of the above glucose, LDH and culture. The lab phones you back in the
next hour with the following results:
15. A 50-year-old female presents with headache, scalp WBC 40,000
tenderness and painless loss of vision in her right eye. % PMN 35%
Your initial management is: Stat Gram stain negative
a) temporal artery biopsy Crystals negative
b) prednisone 1mg/kg Glucose 1.1mmol/L
c) infliximab infusion
d) cyclophsophamide 2mg/kg What is your next step?
e) consult to Ophthalmology a) Send the patient home and advise her to take extra-
strength acetaminophen - this is probably traumatic
16. Psoriatic arthritis may be characterized by: b) Advise her to go to the emergency room with a letter
a) subungual hyperkeratosis instructing the emergency staff to draw blood cultures
b) DIP involvement and start antibiotics
c) conjunctivitis c) Give the patient intra-articular steroids
d) dactylitis d) Send the patient home and ask her to return to your
e) all of the above office tomorrow
e) Refer her to a rheumatologist
17. All of the following statements about septic arthritis are
true EXCEPT:
a) permanent joint damage can quickly occur
b) N. gonorrhea accounts for 75% of cases in young
adults
c) Salmonella species characteristically infect those
with idiopathic thrombocytopenic purpura
d) predisposing factors include prior antibiotic use
e) IV antibiotics should be started empirically
CARDIOLOGY
1. B 2. B 3. C 4. D 5. C 6. B 7. D 8. E 9. D 10. A
COMMUNITY HEALTH
1. B 2. D 3. D 4. A 5. D 6. D 7. E 8. A 9. B 10. A
DERMATOLOGY
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
21. D
EMERGENCY MEDICINE
1. C 2. C 3. B 4. D 5. D 6. E 7. E 8. B 9. C 10. B
ENDOCRINOLOGY
1. B 2. D 3. C 4. A 5. E 6. C 7. B 8. B 9. C 10. C
11. D 12.C 13.C 14. A 15. B 16. B 17. C 18.B 19. E 20. B
21. E 22.A
FAMILY MEDICINE
1. C 2. D 3. B 4. E 5. A 6. C 7. D 8. A 9. C 10. B
GASTROENTEROLOGY
1. B 2. A 3. D 4. C 5. B 6. C 7. E 8. B 9. C 10. D
GERIATRIC MEDICINE
1. B 2. D 3. E 4. B 5. A
GYNECOLOGY
1. B 2. C 3. B, C, E, F, G, H, I 4. B, C, D, E, F, G, H 5. 1, B, C, D, E, G 6. B, C, F
HEMATOLOGY
1. B 2. D 3. E 4. B 5. A
INFECTIOUS DISEASES
1. D 2. A 3. C 4. D 5. B 6. E 7. B 8. D 9. C 10. E
NEPHROLOGY
1. A 2. C 3. C 4. D 5. C 6. B 7. A 8. A 9. B 10. B
NEUROLOGY
1. B 2. D 3. A 4. C 5. C 6. D 7. A 8. E 9. C 10. C
11. E 12.D
NEUROSURGERY
1. B 2. D 3. B 4. A 5. C 6. D 7. B 8. A 9. B 10. C
11. D 12.D 13.C 14. B 15. A
OBSTETRICS
1. D 2. D 3. E 4. E 5. B 6. E 7. A 8. A 9. A 10. A
11. A 12.D 13.A 14. D 15. D
OPHTHALMOLOGY
1. B 2. A 3. B 4. C 5. D 6. B 7. D 8. A 9. C 10. C
11. A 12.C 13.D 14.B 15.A 16.C 17.D 18.C 19.B 20.C
21.A 22.C 23.B 24.E
ORTHOPEDICS
1. B 2. C 3. D 4. B 5. E
OTOLARYNGOLOGY
1. C 2. B 3. C 4. E 5. B 6. B 7. D 8. C 9. C 10. A
11. B 12.B 13.C 14. D 15. C 16. A 17. B 18.D 19. C 20. B
21. C 22.C 23.B 24. D 25. B 26. E 27. C 28.D
PEDIATRICS
1. E 2. A 3. A 4. B 5. C 6. B 7. E 8. A 9. B 10. E
11. D 12.B 13.D 14. B 15. B 16. B 17. B 18.C 19. A 20. A
21. E 22.B 23.D 24. C 25. B 26. C 27. C 28.B 29. C 30. C
31. D 32.B 33.A 34. C 35. C 36. A 37. C 38.E 39. D 40. C
41. A 42.B 43.B 44. E 45. D 46. A 47. B 48.D 49. A 50. D
51. A 52.D 53.B 54.B 55. A 56. E 57. E 58.D
PHARMACOLOGY
1. C 2. C 3. C 4. D 5. C 6. E 7. B 8. D 9. E 10. D
11. 12.D
PLASTIC SURGERY
1. C 2. E 3. B 4. C 5. B 6. A 7. A 8. D 9. B 10. D
11. A 12.B
PSYCHIATRY
1. D 2. A 3. D 4. C 5. E 6. E 7. B 8. B 9. C 10. D
11. B 12.E 13.D 14. C 15. E 16. B 17. D 18.A 19. E 20. D
21. E 22.E 23.D 24. C 25. E 26. E 27. E 28.C 29. E 30. A
31. A 32.B 33. C 34. D 35. D 36. E 37. E 38.D 39. B 40. D
41. D 42.A 43.E 44. D 45. E 46. D 47. B 48.D 49. C 50. B
51. D 52.D 53.C 54. C 55. A 56. B 57. B 58.E 59. C 60. B
61. C 62.E 63.A 64. C 65. C 66. E 67. C 68.E 69. E
RESPIROLOGY
1. A 2. D 3. A 4. C 5. B 6. E 7. D 8. E 9. E 10. C
RHEUMATOLOGY
1. A 2. E 3. C 4. B 5. E 6. D 7. C 8. C 9. E 10. D
11. A 12.E 13.D 14. A 15. B 16. E 17. C 18.E 19. A 20. D
21. B
UROLOGY
1. B 2. C 3. A 4. A 5. D 6. D
CASE1
A 30 year-old homeless male presents with a 4 week history of feeling
generally unwell with anorexia, weight loss and intermittent fever. He
lives primarily on the streets or occasionally in a men’s shelter. He admits
to regular use of intravenous heroin for the last seven years and often
shares needles.
CASE 2 CASE 3
A babysitter brings a 14-month-old to emergency because of incon- An 84 year-old female is brought to the Emergency Department by her
solable crying. The child appears well cared for and healthy but a daughter who states that her mother has not been herself over the past
"bruise" is noted on the left humerus and a well-circumscribed small three days. Further questioning reveals that the mother has been less
fresh burn is noted on the other shoulder. attentive than usual and more withdrawn, her conversation is often
rambling and she has not been sleeping well. Prior to this, she functioned
QUESTION 3 (CASE 2) very well.
List four well recognized risk factors for child abuse: QUESTION 6 (CASE 3)
1. _____________________________________________________________
What diagnoses would you consider at this time? List up to two.
2. _____________________________________________________________
1. _____________________________________________________________
3. _____________________________________________________________
2. _____________________________________________________________
4. _____________________________________________________________
QUESTION 7 (CASE 3)
QUESTION 4 (CASE 2)
What additional aspects of history would be most important to know?
Which of these physical findings are most suggestive of child abuse? Select up to four.
Select up to four. 1. Alcohol use
1. Alopecia 2. Complete psychiatric history
2. Blue sclera 3. Family history of Alzheimer’s disease
3. Bruises on shins and elbows 4. Financial status
4. Buttocks wasting 5. History of fever
5. Caput medusa 6. History of incontinence
6. Clubbing 7. History of osteoarthritis
7. Condylomata acuminata 8. History of Parkinson’s disease
8. Eczema 9. History of previous CVA
9. Full fontanelle 10. Immunization status
10. Healed laceration on chin 11. Marital status
11. Hutchison teeth 12. Medication history
12. Impetigo 13. Occupational history
13. Large purple macular lesion on buttock 14. Pattern of symptoms over the course of the day, e.g. fluctuations
14. Limp 15. Presence of hallucinations
15. Oral thrush 16. Previous history of depression
16. Petechiae 17. Previous seizure disorder
17. Pitted finger nails 18. Previous surgery
18. Proptosis 19. Recent travel
19. Retinal hemorrhage 20. Smoking history
20. Seborrhea
QUESTION 8 (CASE 3)
QUESTION 5 (CASE 2)
The interview confirms the daughter's description of the mother. Physical
You suspect this is a case of child abuse. Which of the following are exam reveals: BP 120/80 supine and 100/70 sitting, RR=22, P=104,
appropriate steps in the initial management. Select up to four. T=38.7ºC. JVP is at the sternal angle. Respiratory exam reveals dullness,
1. Abdominal ultrasound increased tactile fremitus, crackles and bronchial breath sounds all in the
2. Ascorbic acid level left base. Heart sounds are normal. The abdominal exam is normal. CNS
3. Bone density studies exam does not reveal any focal findings. What would you include in your
4. CBC initial investigations? Select up to four.
5. Chest x-ray 1. ALT
6. Coagulation studies 2. AST
7. Creatinine 3. Blood cultures
8. Dietary history 4. B12
9. ECG 5. CBC
10. Factor VIII assay 6. Chest x-ray
11. Liver/spleen scan 7. CPK
12. MRI 8. CT scan of head
13. Notify CAS (Children’s Aid Society) 9. Drug screen
14. Notify police 10. EEG
15. Notify public health nurse 11. Electrolytes
16. Ophthalmology consult 12. HIV test
17. Psychiatry consult 13. MRI of head
18. Serum calcium, phosphorus and alkaline phosphorus 14. Protein electrophoresis
19. Skeletal survey 15. PT and PTT
20. Urinalysis 16. RBC folate
17. SPECT scan
18. TSH
19. Urea and creatinine
20. VDRL
CASE 4 CASE 5
A 57 year-old man presents to the Emergency Department with a 12 hour A 30 year-old woman comes to your office with a 3 day history of vulvar
history of left flank pain. and vaginal pruritus.
QUESTION 12 (CASE 5)
QUESTION 9 (CASE 4)
What diagnosis would you consider at this time? List up to three.
What diagnoses would you consider at this time?
Select up to four. 1. _____________________________________________________________
1. Ruptured abdominal aortic aneurysm
2. Bowel obstruction 2. _____________________________________________________________
3. Appendicitis
4. Pyelonephritis 3. _____________________________________________________________
5. Diverticulitis
6. Renal calculi QUESTION 13 (CASE 5)
7. Biliary colic
8. Renal cell carcinoma What features on the history would you inquire about to make a diagno-
9. Pneumonia sis? Choose up to seven.
1. Date of last menstrual period
2. Sexual history
QUESTION 10 (CASE 4) 3. Vaginal discharge
4. Vulvar erythema
On history and physical exam, what symptoms and signs might aid in 5. Vaginal odor
diagnosis? Choose up to seven. 6. Recent antibiotic therapy
1. Fever/chills 7. Diabetes
2. Weight loss 8. Macular rash
3. Rebound tenderness 9. Psychiatric history
4. Costovertebral angle tenderness 10. Headache
5. Urgency and frequency 11. Allergies
6. Pruritus 12. Dysuria
7. Hypotension 13. Use of douches
8. Pulsatile abdominal mass 14. Sore throat
9 Nausea and vomiting 15. Previous history of STDs
10. Left flank mass
11. Productive cough QUESTION 14 (CASE 5)
12. Abdominal guarding
13. Pale stools and dark urine What tests would you do to confirm the diagnosis? Choose up to four.
14. Hematuria 1. Urine C&S
2. Wet prep of vaginal discharge for microscopy
3. Urinalysis
QUESTION 11 (CASE 4) 4. CBC
5. ESR
What tests might be necessary to confirm your diagnosis? 6. Culture for gonorrhea
Choose up to six. 7. Culture for chlamydia
1. ESR 8. Abdominal CT
2. Serum amylase 9. Pelvic ultrasound
3. Urine R&M 10. Culture for Trichomonas vaginalis
4. Chest x-ray
5. Abdominal/pelvic ultrasound
6. 3 views of the abdomen
7. Urine C&S
8. Abdominal CT CASE 6
9. IVP
10. Total bilirubin A 65 year-old man in the emergency department has RUQ pain. He is
11. Electrolytes otherwise healthy.
12. 24 hour creatinine clearance
13. KUB QUESTION 15 (CASE 6)
14. Serum Mg
15. Serum alkaline phosphatase List three diagnoses you should consider in this patient.
16. Barium enema
17. Serum Ca 1. _____________________________________________________________
18. CBC
2. _____________________________________________________________
3. _____________________________________________________________
2. The Number you selected (S): = ___ 2. The Number you selected (S): = ___
3. Is “S” greater than the Maximum? YES Your Score = 0. 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue. NO Continue.
4. There are 5 correct answers: 2, 4, 8, 13, 20 4. There are 4 correct answers: 6, 13, 16, 19
5. Number of correct answers you selected: = ___ 5. Number of correct answers you selected: = ___
2. The Number you selected (S): = ___ 2. The Number you listed (L): = ___
3. Is “S” greater than the Maximum? YES Your Score = 0. 3. Is “L” greater than the Maximum? YES Your Score = 0.
NO Continue. NO Continue.
4. There are 5 correct answers: 9, 13, 14, 18, 20 4. There are 2 correct answers:
4. There are 8 correct answers: 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue.
1. Prematurity
2. Difficult child 4. There are 5 correct answers: 1, 5, 12, 14, 15
3. History of parental child abuse
4. History of substance abuse 5. Number of correct answers you selected: = ___
5. Social isolation
6. Developmental delay
7. Poverty
8. Parental character/personality disorder QUESTION 8, CASE 3
5. Number of correct answers you listed: = ___ 1. Maximum Number to be selected: = 4
QUESTION 4, CASE 2 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue.
1. Maximum Number to be selected: = 4
4. There are 5 correct answers: 3, 5, 6, 11, 19
2. The Number you selected (S): = ___
5. Number of correct answers you selected: = ___
3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue.
2. The Number you selected (S): = ___ 2. The Number you selected (S): = ___
3. Is “S” greater than the Maximum? YES Your Score = 0. 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue. NO Continue.
5. Number of correct answers you selected: = ___ 5. Number of correct answers you listed: = ___
2. The Number you selected (S): = ___ 2. The Number you listed (L): = ___
3. Is “S” greater than the Maximum? YES Your Score = 0. 3. Is “L” greater than the Maximum? YES Your Score = 0.
NO Continue. NO Continue.
4. There are 4 possible answers: 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue.
1. Bacterial vaginosis
2. Vaginal/vulvar candidiasis 4. There are 7 correct answers: 1, 2, 3, 5, 6, 7, 8
3. Trichomonas vaginalis
4. Chemical vaginitis 5. Number of correct answers you selected: = ___
2. The Number you listed (L): = ___ 2. The Number you selected (S): = ___
3. Is “L” greater than the Maximum? YES Your Score = 0. 3. Is “S” greater than the Maximum? YES Your Score = 0.
NO Continue. NO Continue.
2. The Number you selected (S): = ___ 4. Essential answers are: 7 and 10
3. Is “S” greater than the Maximum? YES Your Score = 0. 5. Did you select both essential answers?
NO Continue. NO Your Score = 0.
YES Continue.
4. There are 6 correct answers: 1, 5, 8, 9, 10, 13
6. There are 5 correct answers: 3, 5, 7, 10, 12
5. Number of correct answers you selected: = ___
7. Number of correct answers you listed: = ___