MCCQE1 ques and CASES with answers PEDIATRICS . . . CONT. 51.

Turner syndrome is associated with the following clinical features EXCEPT: a) major learning difficulties b) short stature c) primary amenorrhea d) broad chest e) wide carrying angle at elbows 52. Which statement concerning delayed puberty is false? a) defined absence of pubertal development by age 13 in girls and age 14 in boys b) the most common cause is constitutional delay c) chronic disease may cause growth delay d) delayed puberty in males is more suggestive of pathology than delayed puberty in females e) bone age is an important investigation in determining the cause of delayed puberty in both males and females 53. A 3 year old Asian girl presents with a fever of 6 days, red lips and tongue, bilateral nonpurulent conjunctivitis, cervical lymphadenopathy and a polymorphic rash. The most likely diagnosis is: a) Streptococcal pharyngitis b) Kawasaki s disease c) infectious mononucleosis d) adenoviral infection e) none of the above 54. Which of the followng statements concerning minimal lesion glomerulonephritis is correct? a) it is a common cause of nephrotic syndrome in children, but it

is a very rare cause of nephrotic syndrome in adulthood b) glomerular filtration rate is usually preserved c) it is usually unresponsive to treatment such as prednisone and cyclophosphamide d) it is most often accompanied by severe hypertension e) the urine typically shows red blood cell casts (suggestive of proliferative glomerulonephritis) 55. A 1100 gram infant born at 36 weeks gestation develops respiratory distress syndrom and requires supplemental oxygen until 4 months of age. A CXR then shows hyperinflation of both lungs and cystic changes in the bases. The most likely diagnosis is: a) bronchopulmonary dysplasia b) cor pulmonale c) presistant pulmonary hypertension d) pneumonia e) cystic adenomatoid malformation of the lung 56. Breat feeding is a contraindication to which of the following vaccinations? a) diptheria b) influenza c) MMR d) hepatitis B e) none of the above 57. A 6 month old infant presents in the winter with fever, cough, wheezing, tachypnea and decreased appetite. A CXR shows hyperaeration and streaky perihilar infiltrates bilaterally. You diag nose bronchopneumonia. Which organism whould likely be causing this child s infection? a) chlamydia pneumonia b) mycoplasma pneumonia

c) streptococcus pneumonia d) haemophilus influenza e) respiratory syncitial virus 58. Prostaglandin E1 infusion can be used for the initial management in each of the following neonatal heart lesions EXCEPT: a) pulmonary atresia b) coarctation of the aorta c) Tetralogy of Fallot d) patent ductus arteriosus e) hypoplastic left heart syndrome 38 Sample Questions MCCQE 2002 Review Notes

PHARMACOLOGY 1. The first pass effect refers to: a) the first time the drug reaches its site of action b) passage of the drug from the skin into the body c) metabolism of the drug by the liver d) passage of the drug from the lung into the systemic circulation e) metabolism of the drug by kidneys 2. A patient with hypoalbuminemia requires: a) a higher dose of a highly protein bound drug b) the same dose of drug protein binding doesn t matter c) a lower dose of a highly protein bound drug d) no drug at all its just too dangerous 3. Compared to water soluble drugs lipid soluble drugs: a) are larger molecules b) have higher ionizations c) diffuse more easily through membranes d) more easily absorbed if given IV

4. The primary site of absorption of most drugs is the: a) mouth b) skin c) stomach d) small intestine e) lungs 5. The primary site of biotransformation of most drugs is the: a) liver b) lung c) small intestine d) skin e) kidneys 6. The main route of excretion for most drugs is the: a) liver b) lung c) small intestine d) skin e) kidneys 7. Regarding phase I drug reactions which is NOT correct: a) they are oxidation, reduction or hydrolysis reactions b) they involve conjugation with polar endogenous substrates c) they increase the water solubility of the drug d) they include the P450 mediated reactions 8. Regarding first order kinetics for drug metabolism which is NOT true: a) a constant fraction of drug is eliminated per unit of time b) elimination is based on drug concentration

c) drugs may go from zero to first order kinetics when the receptor is saturated d) it is a non-linear relation 9. A drug with a half life of 24 hours will take ____ to reach steady state: a) 12 hours b) 24 hours c) 48 hours d) 96 hours e) 120 hours 10. Regarding the figure below a) Drug A is less potent than drug B b) Drug A is less efficacious than drug B c) Drug A is more efficacious than drug C d) Drug A is equally efficacious to drug C e) Drug A is equally potent to drug C 11. A drug with a narrow therapeutic index: a) never requires therapeutic drug monitoring b) always require therapeutic drug monitoring c) can be given over a wide dose range with little worry about toxicity d) has a TD50 at a lower concentration than the ED50 e) has an ED50 that is very close to the TD50 12. The following is TRUE regarding type A adverse drug reactions a) they account for 80% of all adverse drug reactions b) they are an extension of the drugs pharmacological effect c) they are predictable d) they require discontinuation of the drug

e) they require a dose reduction of the drug Response e.g. % of receptors blocked Log Dose C B Potency A > B > C Efficacy A = C > B A 100% 60% 50% 25% MCCQE 2002 Review Notes Sample Questions PLASTIC SURGERY 1. A 23 year-old male was involved in a snowmobile accident and sustained a closed displaced humeral shaft fracture. His neurovascular status is normal. You realign the fracture and place him in a splint. Prior to discharge he states he has numbness over the dorsum of this hand and he is unable to extend his metacarpophalangeal joints. Which of the following would you suspect to be the cause? a) ulnar nerve was damaged at the time of the fracture b) radial nerve was damaged at the time of the fracture c) radial nerve is trapped in the fracture site d) ulnar nerve is compressed by hematoma e) median nerve is trapped in fracture site 39

2. A 55 year old female complains of numbness and discomfort in her right hand, which is awakening her from sleep. Similar symptoms occur while steering the car or writing. You suspect carpal tunnel syndrome. Which of the following would lead you to consider alternative diagnoses? a) absence of sensory loss on testing with pinprick b) absence of thenar muscle wasting c) absence of weakness of abductor pollicis brevis d) presence of rheumatoid arthritic changes in the hands e) wasting of the thenar, hypothenar and interosseous muscles of the right hand 3. Which antibiotic is the first line drug of choice for an otherwise uncomplicated human bite infection of the hand? a) Gentamicin b) Penicillin c) Flagyl d) Cephalexin e) Erythromycin 4. Which of the following is correct regarding hemangiomas? a) they usually will require surgery b) most present in the teenage years c) they usually resolve on their own d) most are found on the extremities e) they are composed mostly of dilated veins 5. All the following are common conditions seen with a rheumatoid hand EXCEPT:

a) synovitis b) radial drift c) thumb deformity d) Swan neck deformity e) Boutonniere deformity 6. A 23 year old man is involved in a house fire, sustaining second and third degree burns to his face, anterior chest and trunk, entire left arm, groin, and both legs circumferentially. What is the estimated TBSA involved in the burn? a) 68.5% b) 67.5% c) 46% d) 55% 7. All of the following burns require extra fluid administration EXCEPT: a) burns greater than 70% TBSA b) electrical burn c) inhalation injury d) pediatric burns e) 4 burns 8. All of the following are complications of breast implants EXCEPT: a) capsular contraction b) increased risk of infection c) breast asymmetry d) systemic inflammatory reaction 9. All of the following statements are true concerning a hypertrophic scar EXCEPT: a) it frequently improves with corrective surgery

and/or pressure b) it is more common in blacks c) it does not outgrow its border d) it occurs soon after surgery and usually subsides with time 10. Regarding fractures of the mandible, all of the following are correct, EXCEPT: a) they frequently are compound b) they produce numbness of the lip c) deformity and malocclusion are the usual presenting features d) the muscles of mastication keep fragments from displacement e) the majority can be treated by dental fixation 11. All of the following are true statements regarding wound contractures EXCEPT: a) contracture is due to dehydration of coagulum and is not an active, energy-dependent process b) contracture begins at about the fourth or fifth post wound day c) myofibroblasts move surrounding dermis inward d) contraction may be inhibited by cytotoxic drugs e) contracture occurs in an inflammatory milieu 12. During wound healing, collagen is laid down by: a) the endothelial cell b) the fibroblast c) the wandering macrophage d) the surrounding epithelium e) none of the above 40 Sample Questions MCCQE 2002 Review Notes

PSYCHIATRY 1. Monoamine oxidase inhibitor drugs are used in the treatment of depression because they increase synaptic levels of: a) gamma-aminobutyric acid (GABA) b) histamine c) acetylcholine d) norepinephrine e) somatostatin 2. Neuropsychological effects of hallucinogens may include all of the following EXCEPT: a) miosis b) tremor c) hyper-reflexia d) incoordination e) blurred vision 3. Cocaine withdrawal can include all of the following EXCEPT: a) Crash sleep

b) anergia c) anhedonia d) euphoria e) continued craving 4. Alcohol withdrawal includes all of the following EXCEPT: a) autonomic hyperactivity b) tremor c) starts within 2-4 hours after prolonged drinking d) nausea e) irritability 5. Which would not be considered a risk factor for suicide in

patients presenting with suicidal ideation: a) substance abuse b) male gender c) lack of social supports d) unsuccessful attempt at suicide in the past e) childless marriage 6. A 54 year-old man has become forgetful, preoccupied, withdrawn, irritable and disheveled. His physical examination was normal. The patient had been with his company for twenty-two years and was considered an excellent employee. Which of the following is the most likely diagnosis: a) multi-infarct dementia b) hypothyroidism c) schizophrenia d) alcoholism e) major depression 7. Which of the following is correct about depression in children: a) family therapy should be avoided because it scape goats a child who is already vulnerable b) symptoms may manifest as antisocial behaviour c) antidepressants generally are not effective in children d) the suicide rate in children aged 8-13 is higher than it is in older adolescents e) depression in children has been shown to be a prodrome to the later development of schizophrenia 8. All of the following are classified as paraphilias EXCEPT:

a) fetishism b) homosexuality c) exhibitionism d) sexual sadism e) transvestism 9. A 32 year old engineer has been uncharacteristically active for several weeks. He spends most of his time at work and gets little sleep. He has told another engineer that he is involved in a research project that will earn

me the Nobel Prize . Expensive research equipment keeps arriving at his office. The engineer is irritable, and it is hard to hold his attention. A classmate from graduate school recalls that the patient behaved in a similar twice during stressful periods at school. Long-term drug therapy for this patient would likely include: a) haloperidol b) valproic acid c) clozapine d) ascorbic acid e) chlordiazepoxide 10. Elderly male depressives typically present with all of the following EXCEPT: a) importuning b) anxiety c) weight loss d) little suicide risk e) insomnia 11. From among the drugs listed below, which would be the cause for most concern in an overdose:

a) paroxetine (SSRI) b) amitriptyline (tricyclic) c) diazepam (benzodiazepine) d) chlorpromazine (phenothiazine) e) fluoxetine (SSRI) 12. Which of the follow statements about schizophrenia is false? a) male schizophrenics to experience their first psychotic episode at a younger age than women b) male schizophrenics are more frequently hospitalized than female schizophrenics c) compared to young female schizophrenics, young male schizophrenics are at increased risk of movement disorders secondary to neuroleptics d) in women, the symptoms of schizophrenia tend to worsen after menopause e) all of the above statements are true 13. A 29 year old school teacher who lives alone is brought to the emergency room because she has become increasingly suspicious, hyperactive, and anorexic over the past two days. She believes that people in the neighbourhood are out to get me . She has not slept in 2 nights. She reports seeing snakes crawling on the wall. Based on this information, the most likely diagnosis of the woman s problem is: a) anorexia nervosa b) cocaine withdrawal c) paranoid personality d) psychostimulant abuse e) shared paranoid disorder

MCCQE 2002 Review Notes Sample Questions PSYCHIATRY . . . CONT. 14. Anti-a-1-adrenergic blockade causes: a) nausea b) constipation c) orthostatic hypotension d) dry mouth e) drowsiness

41

15. The following are common side effects of SSRIs EXCEPT: a) headache b) sexual dysfunction c) vomiting d) anorexia e) orthostatic hypotension 16. Clozapine is the neuroleptic of choice for schizophrenia when: a) the patient shows no evidence of tardive dyskinesia b) the patient has not improved with adequate dosages for 6 weeks of 3 other antipsychotics c) the patient is under fifteen years of age d) the patient has a WBC count of >10 000 e) the patient is very sensitive to anticholinergic side effects 17. Frequent conditions appearing comorbidly with ADHD include: 1) oppositional defiant and conduct disorders 2) anxiety disorder 3) learning disabilities 4) tic disorders 5) language disorders

Which are correct: a) only 1 is correct b) 1, 2, and 3 are correct c) 2 and 4 are correct d) all are true 18. A 35 year old man presents to the emergency room with suicidal ideation. He describes significant stress due to recent job loss and financial hardship. Further inquiry reveals a history of repeated job loss, fraud charges, and frequent arm slashing to decrease stress. The man was not disruptive as a child. The most likely diagnosis is: a) borderline personality disorder b) antisocial personality disorder c) adjustment disorder d) dysthymic disorder e) schizophrenia 19. Which of the following statements concerning childhood abuse and neglect is false: a) the abuser is commonly a friend or a relative b) physical indicators of sexual abuse include bruising or pain in the genital region c) children who have been abused often present with aggressive or anxious behaviors d) Mmentally retarded or physically handicapped 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 20. Which of the following statements concerning anorexia nervosa and bulimia nervosa is false:

a) patients with either of these eating disorders are preoccupied with weight, food, and body shape b) bulimia nervosa is more prevalent than is anorexia nervosa c) both of these eating disorders are more common in females than in males d) bulimia nervosa often presents earlier in adolescence than does anorexia nervosa e) bulimic symptoms may occur in both bulimia nervosa and anorexia nervosa 21. A pattern of unstable but intense interpersonal relationships, impulsivity, inappropriately intense anger, identity disturbance, affective instability, and problems with being alone suggest a diagnosis of: a) antisocial personality disorder b) narcissistic personality disorder c) histrionic personality disorder d) schizoid personality disorder e) borderline personality disorder 22. The criteria for diagnosis of a factitious disorder include: a) intentional production or feigning of physical signs or symptoms b) absence of secondary gain c) possibility of economic gain d) (a) and (b) e) (a) and (c) 23. A patient with a fear of heights is brought to the top of a tall building and required to remain there as long as necessary for the anxiety to dissipate. This is an example of:

a) graded exposure b) participant modeling c) positive reinforcement d) flooding e) relationship therapy 24. Hypnosis has been used successfully in all of the following conditions EXCEPT: a) pain b) phobia c) paranoia d) anxiety e) smoking 25. Cognitive therapy helps to correct which of the following cognitive distortions: a) depersonalization b) psychotic thinking c) over-generalizations d) selective inference e) hallucinations 26. The most frequently reported side effect of tricyclic antidepressants is: a) peripheral neuropathy b) photosensitivity c) agranulocytosis d) jaundice e) dry mouth PSYCHIATRY . . . CONT. 27. A high risk of suicide is associated with which one of the following factors: a) female aged less than 30 years

b) married male less than 30 years c) public setting d) secondary gain from attempt e) single male aged more than 60 years 28. A fixed unalterable belief that is false in its content and in its social and cultural setting is called: a) an illusion b) a hallucination c) a delusion d) agnosia e) paranoia 29. Criteria for involuntary hospitalization of a suicidal patient include: a) assessment done less than 72 hours prior to completion of Form 1 b) presence of a mental disorder c) acute risk of harm to themselves d) (a), (b), and (c) e) (b) and (c) 30. Each of the following statements about affective disorders is true EXCEPT: a) patients with bipolar disorder show roughly the same frequency of positive family history as do patients with unipolar disorder b) major depressive illness is more common in women than in men c) bipolar affective disorder is far less common than unipolar affective disorder d) there is a different response to lithium in unipolar and bipolar disorder

e) imipramine is more likely to produce hypomania in bipolar patients than in unipolar patients 31. A major depressive disorder is diagnosed only when the affective disturbance has existed for at least : a) two weeks b) four weeks c) six weeks d) eight weeks e) twelve weeks 32. A 30 year-old man presents in emergency with right lower quadrant abdominal pain. His wife reports that he had been drinking heavily in response to marital problems and had never had such pain before. Appendicitis was diagnosed and an appendectomy was successfully performed. Four days later the patient was anxious, restless, unable to sleep and claimed his wife was a stranger trying to harass him. The likeliest diagnosis is: a) paranoid reaction b) delirium tremens c) mania d) schizophreniform reaction e) post-operative delirium 33. Which of the following symptoms of schizophrenia responds best to anti-psychotic medication: a) asocial behavior b) flat affect c) paranoid delusions d) lack of motivation e) all of the above

34. A 53 year-old housewife presents with depression marked by early morning wakening, diminished energy and poor concentration. She is treated with supportive psychotherapy and imipramine 100 mg qhs. After four weeks she is no better. You would next: a) reassure her that antidepressants take 5-6 weeks to be effective b) begin intensive psychotherapy c) switch to a serotonin reuptake inhibitor d) increase the dose to 150 mg qhs e) add lithium carbonate 1200 mg daily 35. Hypertensive encephalopathy is a serious complication of treatment with: a) phenothiazines b) tricyclic antidepressants c) lithium carbonate d) MAOI antidepressants e) benzodiazepines 36. Electroconvulsive therapy (ECT) is a first line treatment in which one of the following conditions? a) obsessive compulsive disorder b) paranoid schizophrenia c) generalized anxiety disorder d) acute mania e) major depression with acute suicidal ideation 37. Tardive dyskinesia is: a) an acute extrapyramidal side effect of phenothiazines b) an acute anticholinergic side effect of tricyclic antidepressants c) a type of Parkinson s disease

d) a side effect of excessive ECT treatments e) a long term complication of chronic phenothiazine administration 38. Which of the following symptoms is most commonly found in schizophrenia? a) depressed mood b) flight of ideas c) elevated mood d) delusional fears e) thought insertion 39. Patients with conversion disorders will show each of the following EXCEPT: a) La belle indifference

b) severe depression c) loss of special sense function d) secondary gains e) paralysis of voluntary muscles 42 Sample Questions MCCQE 2002 Review Notes 43

MCCQE 2002 Review Notes Sample Questions PSYCHIATRY . . . CONT.

40. The syndrome of delirium tremens is associated with each of the following EXCEPT: a) rapidly fluctuating level of consciousness b) dehydration c) visual hallucinations d) renal failure e) polyneuropathy 41. Which of the following is best treated with high dose benzodiazepines: a) schizophrenia, catatonic type

b) major depression c) generalized anxiety disorder d) delirium tremens e) psychogenic amnesia 42. Personality types predisposed to depression include which one of the following: a) dependent b) antisocial c) schizoid d) paranoid e) schizotypal 43. Which of the following neurological symptoms can be produced by antipsychotic drugs? a) akathesia b) shuffling gait c) oculogyric crisis d) tremor at rest e) all of the above 44. Absolute contraindications to ECT include: a) pregnancy b) recent myocardial infarction c) fractured pelvis d) brain tumor e) all of the above 45. In the elderly delirium may be produced by the use of: a) neuroleptics b) tricyclic antidepressants c) antiparkinsonian agents d) minor tranquilizers e) all of the above

46. Which of the following statements about simple phobia is correct? a) it responds well to simple reassurance b) it responds well to individual psychotherapy c) it responds well to benzodiazepines d) it responds well to relaxation and desensitization e) all of the above 47. Toxicity due to lithium carbonate is associated with all of the following EXCEPT: a) nausea b) serum lithium level of 0.1 mEq/L c) tremulousness d) convulsions 48. Which of the following investigations need not be performed before starting treatment with lithium carbonate? a) serum creatinine b) serum electrolytes c) thyroid function studies d) serum bilirubin e) all of the above 49. All of the following are common side effects of tricyclic antidepressants EXCEPT: a) dry mouth b) constipation c) parkinsonian tremor d) tachycardia 50. The Theory of Behavioral Therapy employs which of the following concepts: a) reaction formation

b) reinforcement c) imprinting d) autosuggestion e) sublimation 51. Which of the following represents a contraindication for psychoanalysis? a) the existence of transference feeling toward the analyst b) the existence of countertransference feeling in the analyst c) the resistance to change by the patient d) preoccupation with resolving a crisis situation e) the existence of an underlying neurotic style of behaviour 52. Which of the following is least helpful in treating depression? a) phenelzine b) imipramine c) lithium carbonate d) lorazepam e) all of the above 53. A young mother is very focused on the health of her 16 month-old. She keeps her house immaculate for fear that dirt will harm her baby, she checks the lock on the door at least ten times before retiring to bed, and she has to get up and check that her child is still breathing at least 3 times every night. She knows that her fears are irrational but persists with these behaviors. The most likely diagnosis is: a) paranoid delusions not otherwise specified

b) post-partum depression c) obsessive compulsive disorder d) generalized anxiety disorder e) paranoid personality disorder 54. A thorough assessment for the presence/absence of alcohol withdrawal should include questions about all of the following EXCEPT: a) nausea and vomiting b) mood c) difficulty walking (ataxic gait) d) visual disturbances e) tremulousness 44 Sample Questions MCCQE 2002 Review Notes

PSYCHIATRY . . . CONT. 55. Which of the following will be least helpful with respect to distinguishing delirium from dementia: a) disorientation at night b) duration of disorientation c) fluctuating level of consciousness d) mini mental status examination e) presence of visual hallucinations 56. Onset of schizophrenia is typically in an affected individual s: a) early teens b) late teens/early 20s c) late 20s/early 30s d) late 30s/early 40s e) late 40s/early 50s 57. Which of the following is an example of a negative symptom of schizophrenia:

a) nihilistic delusion b) flat affect c) auditory hallucinations d) catatonic behaviour e) all of the above 58. Helpful treatments for post-traumatic stress disorder symptoms include the following except: a) SSRIs b) relaxation techniques c) exposure therapy d) cognitive restructuring e) all of the above may be helpful 59. The primary difference between factitious disorder and malingering is: a) factitious disorder involves the feigning of symptoms for external rewards (e.g. economic gain) b) factitious disorder involves the unintentional production of symptoms c) there is an absence of primary gain in factitious disorder d) factitious disorder can involve only psychological symptoms e) there is an absence of secondary gain in factitious disorder 60. The following features tend to differentiate atypical antipsychotics from typical/conventional antipsychotics EXCEPT: a) atypicals are serotonin-dopamine antagonists b) atypicals tend to result in more specific dopamine blockade

c) atypicals tend to result in lower levels of prolactin d) atypicals tend to cause fewer extrapyramidal side effects e) atypicals tend to be more effective for the treatment of negative symptoms 61. Which of the following statements is true about sexual dysfunction: a) it is secondary to physical factors alone b) it occurs only in females c) the commonest cause is medications d) psychological factors account for 10% in women e) none of the above 62. Which of the following statements is true about premature ejaculation: a) most common male sexual dysfunction 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 63. Which of the following statements is true about paraphilias: a) almost never diagnosed in women b) treated with androgen drugs c) includes: exhibitionism, fetishm, voyeurism, pedophilia d) a and b e) a and d 64. All of the following statements are correct EXCEPT: a) female orgasmic disorder can be caused by

denervation of the lumbosacral spine a) having a rigid, conservative sexual upbringing can result in delayed ejaculation in men a) phenothiazines are used to treat delayed ejaculation disorder in males a) most delayed ejaculation is situational a) most orgasmic disorders in women are psychological. 65. Major Depressive Disorder with melancholic features is most likely accompanied by: a) echololia and /or echopraxia b) hypersomnia c) severe anhedonia d) weight gain e) inappropriate posturing 66. Long acting antipsychotic medications: a) are available in both typical and atypical preparations b) are administered IM or SC c) are first line treatment for severe schizophrenia d) are less likely to cause EPS compared to the oral form e) should be ideally started after the patient has had exposure to the oral form 67. A 55-year-old man with chronic schizophrenia is brought to the E.R. He is diaphoretic, pale and has a temperature of 41C, blood pressure of 170/100, and heart rate of 120. He also exhibits muscle rigidity and a fluctuating level of consciousness. The most diagnosis is: a) acute dystonic reaction b) tardive dyskinesia c) neuroleptic malignant syndrome d) psychosis secondary to a general medical condition

e) substance-induced psychosis 68. Obsessive-compulsive disorder is most consistent with: a) perfectionism, meticulous organization and cleanliness a) the persistent need to shower because of the belief that aliens are contaminating one s body b) recurrent and intrusive thoughts that are inserted into one s mind by others c) a persistent preoccupation with food and one s appearance accompanied by bingeing, purging and/or restricting behaviours d) compulsively avoiding cracks in the side walk for fear that if one does not, a relative might be subject to harm 69. Bipolar disorder may be characterized by: a) rapid cycling: at least one episode (manic or depressed) every 4 weeks b) an increased risk in females c) a lower risk in higher socioeconomic groups due to decreased psychosocial stressors d) hypomanic episodes without depressed episodes, as in Bipolar II disorder e) none of the above MCCQE 2002 Review Notes Sample Questions RESPIROLOGY 1. which of the following is an incorrect statement regarding transudative pleural effusions? a) pleural LDH/serum LDH is > 0.6 b) pleural protein/serum protein is < 0.5 c) pelural LDH <2/3 upper limit of normal serum LDH 45

d) all of the above e) none of the above 2. Which of the following organisms causes walking pneumonia ? a) S. aureus b) S. pneumoniae c) H. fluenzae d) Mycoplasma e) Legionella 3. Which of the following is considered a positive tb skin test? a) induration of > 5 mm in close contact with an HIV positive individual b) induration of < 5 mm in an adult with no risk factors c) induration of < 5 mm in a person with silicosis d) induration of > 5 mm in a person with known TB exposure 4. The following are typical chest x-ray findings of a malignant solitary nodule: a) > 3 cm b) ill-defined margins c) popcorn pattern of calcification

d) associated pleural effusions e) cavitation with thick wall 5. All of the following but one are indicative of poorly controlled asthma: a) night time awakenings b) use of a beta-agonist 2x/week c) mild limitation of activities d) chronic dry cough

6. All of the following but one are typical chest x-ray findings in a person with COPD: a) hyperinflation b) flat hemidiaphragm c) increased AP diameter d) increased retrosternal air space e) increased peripheral markings 7. Which of the following is NOT an indication of home O2 in a person with COPD? a) PaO2 < 55 mmHg b) PaO2 < 60 mmHg with erythrocytosis or cor pulmonale c) persistant hypoxemia after 3 weeks of maximal therapy d) PaO2 maintained > 80 mmHg during wakeful res increased by 250 ml during exercise or sleep 8. Which of the following are associated with upper lobe fibrosis? a) farmer s lung b) silicosis c) sarcoid d) histiocytosis e) X asbestos 9. The differential diagnosis of obstructive lung disease includes: a) COPD b) asthma c) bronchiectasis d) CF e) chest wall disease

10. Which is NOT a feature of adenocarcinoma of the lung? a) solitary peripheral pulmonary nodule b) may appear as an alveolar infiltrate simulating pneumonia c) frequently unilateral d) metastasizes early 46 Sample Questions MCCQE 2002 Review Notes

RHEUMATOLOGY 1. A 21 year-old bisexual man has a 4 week history of intermittent diarrhea, urethral discharge, and pain in the right knee and left second toe. He has several oral ulcers, a clear urethral discharge, a scaly papular rash on palms and soles, onycholysis, sausage-like swelling of the left second toe, and heat and swelling of the right knee. The results of Gram stains and cultures of urethral discharge are negative. Rheumatoid factor is not present. The most likely diagnosis is: a) Reiter s syndrome b) gonococcal arthritis c) Behet s disease d) acquired immune deficiency syndrome e) psoriatic arthritis 2. A 53 year-old presents to your office with pain and stiffness in both hands and knees of 6 months duration. Which of the following findings on your physical examination may help with a diagnosis: a) joint tenderness/effusions b) maculopapular rash c) iridocyclitis d) hepatosplenomegaly

e) all of the above 3. Radiographic features of osteoarthritis of the knee include which of the following: a) marginal erosions b) juxta-articular osteopenia (demineralization) c) loss of articular cartilage with narrowing of the radiologic joint space d) osteonecrosis (avascular necrosis) of the medial femoral condyle e) high riding patella (patella alta) 4. Which of the following is true about serologic testing in SLE? a) A positive ANA is specific for SLE b) ds-DNA level correlates with disease activity in SLE c) Anti-histone antibodies are seldom positive in non-drug induced SLE d) The majority of patients with SLE have anti-Sm antibodies e) Anti-Ro antibody is specific for SLE 5. The treatment of choice for thrombotic events in the antiphospholipid antibody syndrome is: a) intravenous steroids b) high-dose oral steroids with a rapid taper c) penicillamine d) aspirin e) warfarin 6. A 70 year-old woman presents with acute knee arthritis. Radiographs show meniscal calcification (chondrocalcinosis). Analysis of the synovial fluid reveals weakly positive birefringent rhomboid-shaped

crystals. The crystals are most likely: a) monosodium urate b) calcium hydroxyapatite c) cholesterol d) calcium pyrophosphate dihydrate e) dicalcium phosphate dihydrate (Brushite) 7. Which of the following is not a disease modifying agent for rheumatoid arthritis? a) infliximab b) gold c) high dose corticosteroid d) methotrexate e) hydroxychloroquine 8. A 25-year-old male presents to the emergency room with a 6-week history of progressive weakness. On questioning, the man has difficulty combing his hair, brushing his teeth, and climbing stairs. Night sweats, fever and malaise are present. He has noticed a purplish swelling around his eyes. Bloodwork shows a high AST and ALT. ALP is normal. High on your differential diagnosis is: a) rheumatoid arthritis b) trauma-related back pain c) inflammatory myopathy d) polyarteritis nodosa e) polymyalgia rheumatica 9. A 39-year-old female presents to your office with an insidious onset of right knee pain. The differential diagnosis includes: a) synovitis b) degenerative arthritis

c) ligament derangement d) bursitis e) all of the above 10. Systemic lupus erythematosus may be characterized by all of the following EXCEPT: a) hemolytic anemia b) discoid rash c) serositis d) erosive arthritis e) psychosis 11. Physical examination manoeuvres specific to inflammatory spondyloarthropathies include all of the following EXCEPT: a) straight leg raising b) occiput-wall distance c) chest expansion d) Scheber s test MCCQE 2002 Review Notes Sample Questions RHEUMATOLOGY . . . CONT. 12. Cautions and contraindications of NSAIDs include: a) a creatinine of 180 mmol/L b) peptic ulcer disease c) warfarin use d) cirrhosis e) all of the above 13. Small vessel vasculitides include all of the following EXCEPT: a) Wegener s granulomatosis b) Churg-Strauss syndrome c) essential cryoglobulinemia vasculitis d) Kawasaki s disease 47

e) predominantly cutaneous vasculitis 14. A 30-year-old male presents with a history of mild upper respiratory tract infection progressing to a severe cough and hemoptysis. Upon examination, you note a nasoseptal perforation. Tests you should order include: a) chest x-ray b) urine routine and microscopy c) CBC d) c-ANCA e) all of the above 15. A 50-year-old female presents with headache, scalp tenderness and painless loss of vision in her right eye. Your initial management is: a) temporal artery biopsy b) prednisone 1mg/kg c) infliximab infusion d) cyclophsophamide 2mg/kg e) consult to Ophthalmology 16. Psoriatic arthritis may be characterized by: a) subungual hyperkeratosis b) DIP involvement c) conjunctivitis d) dactylitis e) all of the above 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 18. Cauda equina syndrome is characterized by the following EXCEPT: a) saddle anesthesia b) urinary retention c) weak plantar flexion d) decreased anal sphincter tone e) posterior thigh pain 19. First line pharmacologic treatment for osteoarthritis is: a) acetaminophen 1000 mg po QID b) celecoxib 200 mg po BID c) glucosamine 500 mg po QID d) ibuprofen 400 mg po TID e) depo-medrol 20 mg intra-articularly 20. Which of the following medications is not associated with drug-induced lupus syndrome? a) isoniazid b) propranolol c) hydralazine d) cyclosporine d) carbamazepine 21. A 30-year-old woman comes to your office with a 1-day history of right knee pain and swelling. She has never had joint pain. She spent the day before working in her garden, and was kneeling for most of the time. She has no other associated symptoms, but has had several sexual partners within the last year. You aspirate her knee because you are worried about septic arthritis and send

requisitions for cell counts, microscopy, stat Gram stain, glucose, LDH and culture. The lab phones you back in the next hour with the following results: WBC 40,000 % PMN 35% Stat Gram stain negative Crystals negative Glucose 1.1mmol/L What is your next step? a) Send the patient home and advise her to take extrastrength acetaminophen - this is probably traumatic b) Advise her to go to the emergency room with a letter instructing the emergency staff to draw blood cultures and start antibiotics c) Give the patient intra-articular steroids d) Send the patient home and ask her to return to your office tomorrow e) Refer her to a rheumatologist 48 Sample Questions MCCQE 2002 Review Notes

UROLOGY 1. An 84 year old man presents to your office complaining of a five day history of passing terminal bright red bloody urine. He reports marked urgency and frequency but is otherwise well and afebrile. In retrospect, he remembers being quite ill with an infection in the recent past. Analysis of a voided specimen shows 3 smooth and rounded RBCs/hpf. Which of the following is NOT included in your differential diagnosis? a) benign prostatic hpertrophy (BPH)

b) post-streptococcal glomerulonephritis c) a stone lodged at the vesico-ureteric junction d) a superficial bladder tumour e) a coliform positive UTI 2. Of the following conditions, which is not considered a urological emergency? a) paraphimosis b) priapism c) orchitis d) testicular torsion e) autonomic dysreflexia 3. A normal semen analysi includes all of the following EXCEPT: a) pH between 7.5-8.1 b) a sperm count > 20 million sperm/ml c) WBC < 10/hpf d) motility > 50% e) > 60% normal morphological forms 4. A mother brings her toilet-trained, 5 year old daughter to see you with a 3 day history of dysuria, increased frequency, and urgency incontinence. Her past medical history is significant for a bag-specimen positive UTI charaterized by high fever and vomiting at 2 years of age. At the time, she was lost to follow up. Which of the followin would be appropriate for your initial management of this patient? a) voiding cystourethrogram (VCUG) b) a mid stream urine specimen c) nuclear cystogram d) DMSA renal scan

e) abdominal ultrasound 5. A 55 year old man reluctantly admits to difficulty in maintaining an erection sufficient for sexual intercourse for the past two years. He reports being healthy, however, he has not seen a physician in 10 years. Which of the following would not suggest a potential cause for his erectile dysfunction? a) elevated blood pressure b) galactorhea c) acanthosis nigracans d) varicocele e) eruptive xanthoma 6. A 50 year old man presents with a 2 month history of irritative voiding symptoms and a fever. He initially saw his family doctor who treated him for cystitis with ciprofloxacin for 5 days. He now presents to you because his symptoms have returned soon after he finished his course of antibiotics. All of the following are likely TRUE except: a) he never had a UTI b) he might have complained of discomfort when riding a bicycle c) he might have also experienced back pain d) this patient does not need to be investigated e) he could of had prostatitis and should have been treated at least 3 weeks MCCQE 2002 Review Notes Sample Questions ANSWERS TO SAMPLE QUESTIONS ANESTHESIA 1. B 2. B 3. D 4. C 5. B 6. A 7. B 8. E 9. C 10. C 49

11. A 12.D 13. C 14. C CARDIAC AND VASCULAR SURGERY 1. 2. 3. 4. 5. 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 11. B 12.E 13.E 14. A 15. C 16. D 17. C 18.E 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 11. B 12.B 13.B 14. E 15. D 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 11. D 12.E 13. B 14. C GASTROENTEROLOGY 1. B 2. A 3. D 4. C 5. B 6. C 7. E 8. B 9. C 10. D 11. A 12.B 13.C 14. A 15. A 16. B 50 Sample Questions MCCQE 2002 Review Notes

ANSWERS TO SAMPLE QUESTIONS . . . CONT. 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 7. A, B, E, G 8. B, C, G 9. A, E, F 10. A, B, C, D, F, G, H, I 11. E 12. A 13. D 14. E 15.E 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 11. B 12.C 13.B 14. A 15A NEPHROLOGY 1. A 2. C 3. C 4. D 5. C 6. B 7. A 8. A 9. B 10. B 11. D 12.B 13.B 14. A 15. D 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