Participant Handout 5: First 100 MCQs

Instructions: Please answer ALL 100 MCQs. Each of the questions or incomplete statements below is followed by five or four suggested answers or completions. Select the ONE that is BEST in each case. Write your answers before discussion then write the correct answer with your important notes on the subject.
Question 1. A 35-year-old lady presents with fatigue and found to have a low serum thyroxine level. Four years ago she was treated for Graves disease with radioactive iodine. The diagnostic test of choice is: A) Radioactive iodine uptake B) Serum T3 C) Serum TRH D) Serum TSH E) TRH stimulation test Your Answer: Before After discussion: Discussion: Note s:

Question 2. A patient presents with a history of recurrent oral and genital ulcerations associated with uveitis. Which one of the following diseases most likely explains these symptoms? A) Reiter's syndrome B) inflammatory bowel disease C) Behet's syndrome D) systemic lupus erythematosus E) cyclic neutropenia Your Answer: Before After discussion: Discussion: Note s:

Question 3. Which of the following terms is synonymous with the term reliability? A) mean B) validity C) accuracy D) reproducibility E) variation Your Answer: Before After discussion: Discussion: Note s:

Question 4. A 29-year-old female comes to your office with a 4-day history of "unrelenting dizziness." The dizziness is associated with nausea and vomiting. There has been no hearing loss, no tinnitus, and no sensation of aural fullness. The patient has just recovered from an upper respiratory tract infection. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present. What is the most likely diagnosis in this patient? A) vestibular neuronitis B) acute labyrinthitis C) benign positional vertigo D) orthostatic hypotension E) Meniere's disease Your Answer: Before discussion: Note s: After Discussion:

Question 5. Which one of the following is the most common presenting complaint in patients with mitral valve prolapse? A) chest discomfort B) anxiety C) palpitations D) dyspnea E) fatigue Your Answer: Before discussion: Note s: After Discussion:

Question 6. Which one of the following would be the most likely diagnosis in a previously immunized six-year-old boy who presents with fever, anorexia, sore throat and abdominal pain, along with an erythematous rash that initially involved the face and then spread to the arms? A) rubeola B) erythema infectiosum (fifth disease) C) rubella D) roseola E) scarlet fever Your Answer: Before After discussion: Discussion: Note s:

Question 7. A 28-year-old male comes to your office with rectal bleeding and local burning and searing pain in the rectal area. The patient describes a small amount of bright red blood on the toilet paper. The pain is maximal at defecation and following defecation. The burning and searing pain that occurs at defecation is replaced by a spasmodic pain after defecation that lasts approximately 30 minutes. What is the most likely diagnosis in this patient? A) adenocarcinoma of the rectum B) squamous cell carcinoma of the rectum C) internal hemorrhoids D) anal fissure E) an external thrombosed hemorrhoid Your Answer: Before discussion: Note s: After Discussion:

Question 8. A 22-year-old woman complaining of episodes of severe anxiety accompanied by shortness of breath and rapid pulse rate occurring up to three days per week for seven months most likely has which one of the following problems? A) generalized anxiety disorder B) panic attacks C) major depression D) alcohol abuse E) benzodiazepine withdrawal Your Answer: Before discussion: Note s: After Discussion:

Question 9. A 26-year-old white male carpenter, who has always been healthy, reports daily episodes of chest tightness and dyspnea. He most likely has A) toxic pneumonitis B) byssinosis C) occupational asthma D) benign pleural effusion E) hypersensitivity pneumonitis Your Answer: Before discussion: Note s: After Discussion:

Question 10. The most frequent cause of amenorrhea is A) primary ovarian failure B) hypothyroidism C) pregnancy D) pituitary failure E) psychoneurosis Your Answer: Before discussion: Note s:

After Discussion:

Question 11. A 60-year-old man falls down with his hand stretched. His problem is possibly A) fracture of the clavicle B) supracondylar fracture of the humerus C) scaphoid fracture D) Colles fracture E) fracture of the shaft of the humerus Your Answer: Before discussion: Note s: After Discussion:

Question 12. What is the most common cause of traveler's diarrhea? A) Campylobacter jejuni B) Shigella C) enterotoxigenic Escherichia coli D) Clostridium difficile E) Rotavirus Your Answer: Before discussion: Note s:

After Discussion:

Question 13. An 81-year-old female comes to your office with a 5-day history of dysuria, frequency, urgency, and incontinence. She has no other symptoms, including no cardiovascular accident (CVA) tenderness or other symptoms. The patient lives at home by herself and has had no major medical problems. On examination, her temperature is 37 C. Her blood pressure is 150/80 mm Hg and her pulse is 84 bpm and regular. No other abnormalities are found on physical examination. Which of the following statements concerning this patient is true? A) the most likely diagnosis is acute bacterial cystitis B) the most likely organism is P. aeruginosa C) amoxicillin is a reasonable first-choice antibiotic D) this patient should be treated for 14 days E) Klebsiella and Proteus mirabilis are very rarely seen in elderly Your Answer: Before discussion: Note s: After Discussion:

Question 14. Which one of the following most increases insulin sensitivity in an overweight diabetic? A) NPH insulin B) Glyburide (DiaBeta, Micronase) C) Acarbose (Glucobay, Precose) D) Metformin (Glucophage( E) Glibenclamide Your Answer: Before discussion: Note s: After Discussion:

Question 15. What is the pharmacologic agent of choice for the treatment of chronic hypertension in pregnancy? A) atenolol B) propranolol C) alpha methyldopa D) nifedipine E) captopril Your Answer: Before discussion: Note

After Discussion:

s:

Question 16. A 45-yrs-old male came to the ER with sudden headache, blurred vision, excruciating eye pain and frequent vomiting. The most likely diagnosis: A) B) C) D) E) Your Answer: Before discussion: Note s: Acute conjunctivitis Acute angle glaucoma Acute iritis Corneal ulceration Episcleritis After Discussion:

Question 17. Which one of the following is true regarding the treatment of influenza with inhaled zanamivir (Relenza)?

A) It should not be given within 2 weeks of the influenza vaccine

B) For influenza prevention, it is more cost-effective than vaccine C) Treatment is effective when begun up to 5 days after the onset of symptoms D) It is inactive against influenza B E) It may cause bronchospasm in patients with asthma Your Answer: Before discussion: Note s: After Discussion:

Question 18. The drug of choice for methicillin-resistant staphylococcal infection is A) vancomycin (Vancocin) B) piperacillin/tazobactam (Zosyn) C) imipenem/cilastatin (Primaxin) D) cephalothin (Keflin) E) ampicillin/sulbactam (Unasyn) Your Answer: Before discussion: Note s:

After Discussion:

Question 19. The drug of choice for Swine influenza (A/H1N1 pandemic virus)infection is A) zanamivir B) acyclovir C) Amantadin D) Oseltanitomivir E) Famciclovir Your Answer: Before discussion: Note s:

After Discussion:

Question 20. A 25-year-old male visits your office concerned about a painless ulcer on the glans of his penis. After appropriate examination and testing you diagnose primary syphilis and treat him with 2.4 million units of benzathine penicillin intramuscularly in a single dose. Eight hours later, while you are working the evening clinic, he returns because he has a fever of 38.5O C and a bad headache, which he rarely gets. He says he "aches all over." Which one of the following is the most appropriate action at this time? A) Reassure and prescribe antipyretics B) Add doxycycline (Vibramycin), 100 mg orally twice a day for 14 days C) Perform a spinal tap D) Order a CT scan of his head E) Obtain three blood cultures from different sites at 30-minute intervals Your Answer: Before discussion: Note s:

After Discussion:

Question 21. A 27 year old man presents with fever, urethritis and arthralgia. He is found to have a swollen ankle with a pustular rash on the dorsal aspect of his foot. What is the most likely diagnosis? A) Gonococcal sepsis B) Lyme disease C) Reiter's syndrome D) Staphylococcal arthritis E) Tuberculous arthritis Your Answer: Before discussion: Note s: After Discussion:

Question 22. Which of the following anti-microbials is associated with prolongation of the QT interval? A) Co-amoxiclav B) Gentamicin C) Cefuroxime D) Erythromycin E) Isoniazid Your Answer: Before discussion: Note s:

After Discussion:

Question 23. Which one of the following reverses the effect of warfarin (Coumadin)? A) Vitamin A B) Vitamin C C) Vitamin D D) Vitamin E E) Vitamin K

Your Answer: Before discussion: Note s:

After Discussion:

Question 24. A 35 year old woman presented with a history of intermittent lightheadedness. Clinical examination and 12-lead ECG were normal. Which of the following, if present on a 24 hour Holter ECG tracing, would be the most clinically important? A) Atrial premature beats. B) Profound sleep-associated bradycardia. C) Supraventricular tachycardia. D) Transient Mobitz type 1 atrioventricular block. E) Vertricular premature beats. Your Answer: Before discussion: Note s: After Discussion:

Question 25. A 24-year-old woman lost her previous two pregnancies at approximately 20 weeks gestation, without having noted any contractions. She is currently at 15 weeks gestationand denies having uterine contractions. Her cervix is undilated and uneffaced. Treatment should consist of A) bedrest B) terbutaline C) hydroxyprogesterone D) diethylstilbestrol (DES) E) a cervical cerclage Your Answer: Before discussion: Note s: After Discussion:

Question 26. Which one of the following vaccines is contraindicated in pregnancy? A) Tetanusanddiphtheria (Td) B) Influenza C) Rabies D) Hepatitis B E) MMR Your Answer: Before discussion: Note s: After Discussion:

Question 27. Chronic tension-type headaches are: A) Almost always unilateral B) Restricted to hours of waking when stress is most apparent C) Characterized by tenderness to palpation of the muscles of the head and neck D) Best treated by regular, acute-relief medications Your Answer: Before discussion: Note s:

After Discussion:

Question 28. A 37-year-old woman has a hemoglobin level of 9 g/dL and a mean corpuscular volume of 112 fL. There are no megaloblasts present. The most likely cause is: A) B) C) D) E) Alcohol abuse. Vitamin B12 deficiency. Folic acid deficiency. Drug-related causes. Thalassemia.

Your Answer: Before discussion: Note s:

After Discussion:

Question 29. A patient is admitted for treatment of multi-drug resistant tuberculosis. The patient is currently taking rifampicin, isoniazid and pyrazinamide. He is commenced on streptomycin. What is the most likely neurological side-effect from this medication? A) Vestibular damage B) Cochlear damage C) Optic nerve D) Autonomic E) Peripheral motor Your Answer: Before discussion: Note s:

After Discussion:

Question 30. The endemicity of a disease indicates that: A) The disease is present at a high prevalence and incidence all the time B) The disease spreads very quickly from person to person C) The disease is transmitted from one country to another country by carriers D) The infection is caused by a virulent pathogenic organism E) An unusually high number is present, greater than what one would normally expect for the place and time Your Answer: Before discussion: Note s:

After Discussion:

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Question 31. A 4-year-old girl complains of vaginal itching, especially at night when she is going to bed. The most likely diagnosis is A) ascariasis B) cutaneous larva migrans C) Enterobius vermicularis (pinworm) D) pubic lice E) molluscum contagiosum Your Answer: Before discussion: Note s:

After Discussion:

Question 32. The strongest clinical evidence is obtained from: A) Randomized control trials(RCT) B) Retrospective studies C) Prospective studies D) Systematic review

Your Answer: Before discussion: Note s:

After Discussion:

Question 33. A 4-year-old girl presents with spots on her legs and that her knees hurt. Her vital signs are stable. Her exam is significant for slight nasal drainage, which her father says is a residual from a cold she had last week. Her legs and buttocks have palpable purpura. Her knees are mildly swollen and are painful with range of motion. Her CBC is normal and urinalysis significant for 2+hematuria. he most likely diagnosis in this patient is: A) Henoch-Schnlein purpura. B) Rocky Mountain spotted fever. C) Meningococcemia. D) Acute exposure to lawn chemicals. E) Juvenile rheumatoid arthritis. Your Answer: Before After discussion: Discussion: Note s:

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Question 34. A woman at 41 weeks' gestation with an uncomplicated pregnancy is found to have oligohydramnios on a full biophysical profile (BPP). Which one of the following actions is the most appropriate next step? A) Repeat the nonstress test component of the BPP in 24 hours. B) Repeat the amniotic fluid index in 24 hours. C) Repeat the full BPP twice weekly and induce labor at 42 weeks' gestation. D) Perform ultrasonography and induce labor at 42 weeks' gestation if no fetal anomalies are found. E) Induce labor. Your Answer: Before discussion: Note s: After Discussion:

Question 35. Which of the following medications has been shown to be comparable to laparoscopic salpingostomy in the treatment of small ectopic pregnancy that has not ruptured? A) Bromocriptine B) Methotrexate C) Thalidomide D) Misoprostol E) Oxytocin Your Answer: Before discussion: Note s: After Discussion:

Question 36. A patient with diarrhea as the predominant symptom is suspected of irritable bowel syndrome. The physician should order testing of fecal specimens for the presence of: A) Yersinia. B) Campylobacter. C) Giardia. D) Salmonella. E) Shigella. Your Answer: Before discussion: Note s: After Discussion:

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Question 37. An elevated level of hemoglobin A2 in a patient with mild microcytic anemia suggests the diagnosis of: A) alpha-thalassemia B) sickle trait C) beta-thalassemia D) hereditary spherocytosis E) hereditary persistence of fetal hemoglobin Your Answer: Before discussion: Note s:

After Discussion:

Question 38. An 18 year-old female with initial onset of pruritic rash characterized by excoriations, scaling and crusting and distributed on the extremities, neck and eyelids. Past medical history is significant for asthma and hayfever. The most likely diagnosis is: A) scabies B) atopic dermatitis C) contact dermatitis D) shingles E) dyshydrotic eczema Your Answer: Before discussion: Note s:

After Discussion:

Question 39. A 26 year-old primigravida presents at 40 weeks in active labour with contractions every 2 minutes. She is diagnosed as having a transverse lie with the back up. Which of the following would be the most appropriate next step? A) start isoxuprine (Vasodilan) B) Pperform an external version C) prepare for an immediate C-section D) rupture membranes and then perform an internal version Your Answer: Before discussion: Note s:

After Discussion:

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Question 40. A 65 year-old male with back pain, nephrotic syndrome and anemia present to the ER. Ultrasound shows normal kidney size. His creatinine is 500. Which diagnosis best fits the scenario? A) polycystic kidney disease B) chronic GN C) multiple myeloma D) diabetic nephropathy E) analgesic abuse Your Answer: Before discussion: Note s:

After Discussion:

Question 41. You are caring for a 39-year-old woman who is dying of breast cancer. Her family wonders how to recognize the symptoms of impending death. Which of the following is a reliable sign that death is near in this patient? A) Delirium B) Desire to communicate with loved ones C) Limited attention span D) Desire for favorite food E) Increased attention to dates and time Your Answer: Before discussion: Note s:

After Discussion:

Question 42. A 65-year-old man presents to you complaining of abdominal pain. His pain is associated with anorexia, bloating, nausea and vomiting. He is afebrile and denies fever. On examination, his abdomen appears distended, and he has absent bowel sounds. Abdominal percussion produces tympani. What would his abdominal x-ray likely show? A) A fecalith in the right lower quadrant B) Free intraperitoneal air C) Stool throughout the colon D) Proximally dilated loops of bowel E) Stones in the right upper quadrant Your Answer: Before After discussion: Discussion: Note s:

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Question 43. A 60-year-old man is being evaluated for fatigue, weakness, and exercise intolerance. Laboratory assessment reveals: Hemoglobin 9.1 mg/dL (L), Serum iron 46 mcg/dL (L), Ferritin 9 ng/mL (L), Total iron binding capacity (TIBC) 626 mcg/dL (H), Mean corpuscular volume (MCV) 76 fL (L). What is the most common cause of this condition? A) Blood loss B) Poor nutrition C) Inadequate absorption of iron D) Chronic disease E) Folic acid deficiency Your Answer: Before After discussion: Discussion: Note s:

Question 44. You are evaluating a 63-year-old diabetic man who noted unilateral lower extremity edema. He denies dyspnea or recent trauma. On evaluation, you note pitting edema on the right with well-demarcated erythema from the ankle to the midthigh. Which of the following is the most likely diagnosis? A) Varicose veins B) Chronic CHF C) Venous insufficiency D) Deep venous thrombosis (DVT) E) Cellulitis Your Answer: Before After discussion: Discussion: Note s: Question 45. You are evaluating a patient in the office with hematochezia. He has had chronic constipation, and reports bright red blood from his rectum associated with extremely painful bowel movements. After defecation, he complains of a dull ache and a feeling of spasm in the anal canal. The pain resolves within a few hours. On external examination, no abnormalities are noted. What is his most likely diagnosis? A) Anal fissure B) Thrombosed external hemorrhoid C) Internal hemorrhoid D) Thrombosed internal hemorrhoid E) Peri-anal abscess Your Answer: Before discussion: Note s: After Discussion:

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Question 46. A 23-year-old woman presents to your office complaining of headaches. Which of the following characteristics is more likely to be associated with migraine headaches than other types of headaches? A) Unilateral symptoms B) Severe in intensity C) Nausea D) Rhinorrhea E) Sweating Your Answer: Before discussion: Note s: After Discussion:

Question 47. You are evaluating a 56-year-old generally healthy man who is seeing you after finding blood in his urine. He denies pain, dysuria, frequency, or urgency. He is a smoker, and has worked for years in the printing industry. What is the most likely cause of his hematuria? A) Acute prostatitis B) Chronic prostatitis C) A UTI D) Urinary stones E) Bladder carcinoma Your Answer: Before discussion: Note s: After Discussion:

Question 48. A 46-year-old female who had an external hemorrhoid for 4 years, with minimal discomfort and occasional soiling of under clothes, suddenly developed extreme pain during bowel movement. The patient is most likely suffering from: A) an internal hemorrhoid B) external skin tags C) a thrombosed hemorrhoid D) an anal fissure E) menopausal syndrome. Your Answer: Before discussion: Note s: After Discussion:

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Question 49. Tinnitus is most likely associated with A) retinal detachment B) hyperthyroidism C) hypertension D) acute otitis media E) acute rhinitis Your Answer: Before discussion: Note s: After Discussion:

Question 50. A 15-year-old male comes in with acne vulgaris. Topical erythromycin was used for 2 weeks, several months ago, with no response. What treatment would you prescribe now? A) accutane immediately B) topical tretinoin C) topical benzoyl peroxide D) topical antibiotic other than erythromycin E) oral antibiotic and topical tretinoin Your Answer: Before discussion: Note s: After Discussion:

Question 51. Conductive hearing loss is a symptom of: A) presbycusis B) Meniere disease C) cholesteatoma D) Bell palsy E) acoustic neuroma Your Answer: Before discussion: Note s:

After Discussion:

Question 52.

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A previously well 10-month-old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other members of the family had similar symptoms. Four hours ago, the patients cough became much worse. On physical examination, he is in moderate respiratory distress with nasal flaring, hyperexpansion of the chest, and easily audible wheezing without rales. The most likely diagnosis is A) Bronchiolitis B) Viral croup C) Asthma D) Epiglottitis E) Diphtheria Your Answer: Before After discussion: Discussion: Note s:

Question 53. What is the safest anatomic site to administer vaccines to an infant in the first year of life? A) Superior lateral gluteal area B) Center of the deltoid C) Superior lateral thigh area D) Inferior gluteal area near the midline Your Answer: Before discussion: Note s: After Discussion:

Question 54. A 22-year-old female presents with a 2-week history of pelvic pain and slight vaginal bleeding but no vaginal discharge. She is married with no children. Her menstrual periods have always been regular, and her last period occurred at its regular time. The MOST important diagnosis to exclude in this patient at this time is: A) Ruptured corpus luteum cyst B) Acute pelvic inflammatory disease C) Incomplete abortion D) Ectopic pregnancy E) Threatened abortion Your Answer: Before After discussion: Discussion: Note s:

Question 55.

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A 2-year old child, who was previously well, presents with a sudden onset of cough, respiratory distress and wheeze. Examination reveals that he is afebrile with diminished air entry and wheezing on the right side. Which one of the following is the most likely diagnosis? A) acute asthma B) acute pneumothorax C) congenital lung cyst D) foreign body inhalation E) bronchitis Your Answer: Before After discussion: Discussion: Note s:

Question 56. The following indicate the results of screening test .Q. in screening for disease .Z.: The specificity of test .Q. would be: a) 40/70 b) 120/130 c) 40/50 d) 120/150 e) 40/130 Screen Q. Disease Z +v e ve +v 40 10 e 30 12 ve 0 70 13 0

50 15 0 20 0

Your Answer: Before discussion: Note s:

After Discussion:

Question 57. The following indicate the results of screening test .Q. in screening for disease .Z.: The positive predictive value would be: a) 40/70 Disease b) 120/130 Z c) 40/50 +v d) 120/150 e ve e) 70/200 +v 40 10 e Screen Q. 30 12 ve 0 70 13 0 Your Answer: Before After

50 15 0 20 0

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discussion: Note s:

Discussion:

Question 58. Which one of the following descriptors of a diagnostic test is influenced by the prevalence of the disease being tested for: a) specificity b) sensitivity c) accuracy d) positive predictive value e) reliability Your Answer: Before discussion: Note s: After Discussion:

Question 59. Which of the following is the most important justification for population screening programs for a specific disease? a) early detection of the disease of interest is achieved b) the specificity of the screening test is high c) the natural history of the disease is favourably altered by early detection d) effective treatment is available e) the screening technology is available Your Answer: Before discussion: Note s: After Discussion:

Question 60. Differentiation between a point-source epidemic and a progressive (propagated) epidemic is made by: a) considering the characteristics of the infectious agent b) determining the level of immunity in the community c) determining the number of persons infected and calculating the attack rate d) plotting the distribution of cases by time onset e) none of the above Your Answer: Before discussion: Note After Discussion:

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Question 61. 70-year-old woman has been in long-standing poor health, with severe diabetes mellitus and rheumatoid arthritis. Her physician notes that she appears pale and orders a hematocrit, which shows a result of 35%. Examination of the blood smear reveals a microcytic anemia. The physician is considering a differential diagnosis of iron deficiency anemia versus anemia of chronic disease. Which of the following laboratory determinations would be most helpful in distinguishing these conditions? A. Erythrocyte:granulocyte ratio in bone marrow B. Presence or absence of polychromatophilic target cells C. Presence or absence of stippled erythrocytes D. Serum ferritin E. Serum iron Your Answer: Before discussion: Note s: After Discussion:

Question 62. Which of the following types of studies usually provides only a measure of prevalence? a) descriptive b) cross-sectional c) randomized controlled trial d) cohort Your Answer: Before discussion: Note s: After Discussion:

Question 63. The purpose of randomization is to: a) make sure that there are equal numbers of men and women in test and control groups b) increase the chances of getting a statistically significant difference c) ensure that the numbers of cases and controls are equal d) limit bias Your Answer: Before discussion: Note After Discussion:

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Question 64. Of the five items listed below, the one which provides the strongest evidence for causality in an observed association between exposure and disease is: a) a large attributable risk b) a large relative risk c) a small p-value d) a positive result from a cohort study e) a case report Your Answer: Before After discussion: Discussion: Note s:

Question 65. A 34-year-old woman just delivered a 4100-g boy after a 15-hour labor, including a 21/2-hour second stage. During the repair of a midline episiotomy, there is a marked increase in the amount of vaginal bleeding. Of the following, the most common cause of immediate postpartum hemorrhage is (A) retained placental fragments (B) uterine atony (C) cervical laceration (D) vaginal laceration (E) disseminated intravascular coagulation Your Answer: Before After discussion: Discussion: Note s:

Question 66. A 22-year-old gravida 2, para 1, at 38 weeks' gestation comes to the delivery floor because of contractions. She had an uncomplicated prenatal course. On examination her cervix is 3 cm dilated and 75% effaced. A few minutes later the patient experiences a large gush of fluid from the vagina and the fetal heart rate becomes bradycardic. Onexamination, the cervix feels about 5 cm in diameter and a pulsating segment of umbilical cord can be felt in the vagina. Which of the following is the most appropriate next step in management? A. Clamp and cut the umbilical cord B. Continue expectant management C. Perform a STAT cesarean delivery D. Perform forceps-assisted vaginal delivery E. Perform vacuum-assisted vaginal delivery Your Answer:

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Before discussion: Note s:

After Discussion:

Question 67. Cultural competence is defined as: A) Learning about multiple cultures. B) Being able to speak multiple languages. C) Taking diversity classes. D) Adopting a set of cultural behaviors and attitudes that enable you to deliver effective medical care to people of different cultures. E) Hiring staff from a variety of different cultures. Your Answer: Before discussion: Note s:

After Discussion:

Question 68. Iron stores in neonate are depleted by age of : A) 4 months B) 8 months C) 10 months D) 12 months Your Answer: Before discussion: Note s: After Discussion:

Question 69. A 22-year-old female presents to the ED with an overdose. She has a history of depression, and there were empty bottles found at her bedside. The bottles had contained clonazepam (a benzodiazepine) and nortriptyline (a tricyclic). The patient is unconscious with diminished breathing and is unable to protect her own airway. The BEST next step is to: A) Intubate the patient. B) Begin gastric lavage and administer charcoal. C) Administer flumazenil, a benzodiazepine antagonist, to awaken her and improve her respirations. D) Administer bicarbonate. Your Answer: Before discussion: Note After Discussion:

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Question 70. You get a call from a panicked mother because her 4-year-old took some of her theophylline. She thinks it may have been as many as 10 pills but is not clear on the actual number. She is about 35 minutes from the hospital. Your advice to her is: A) Give ipecac to promote stomach emptying and reduce theophylline absorption. B) Do not give ipecac and proceed directly to the hospital. C) Call poison control and then proceed to the hospital. D) give charcol. Your Answer: Before discussion: Note s: After Discussion:

Question 71. A 22-year-old female is referred to your clinic after being started on glucocorticoids for a new diagnosis of left optic neuritis seen on examination with disc pallor, and it is confirmed with quantitative visual field mapping. What further evaluation is indicated? A. Antinuclear antibodies B. Brain MRI C. Erythrocyte sedimentation rate D. No further evaluation unless symptoms recur E. Temporal artery biopsy Your Answer: Before discussion: Note s: After Discussion:

Question 72. A 2-year-old boy with hypertension and bilateral femoral pulses weakness and there is thrill, his ECG show Left ventricular hypertrophy , what is the diagnosis : A) Aortic coacurtation B) VSD C) ASD D) PDA E) Aortic stenosis Your Answer: Before discussion: Note After Discussion:

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Question 73. Mastitis is commonly due to A) B) C) D) E) breast carcinoma traumatic infection fibroadenoma of the breast lipoma of the breast lactation

Your Answer: Before discussion: Note s:

After Discussion:

Question 74. A 4-year-old child is brought in by his mother because of a painful, honeycolored, crusted lesions on his face. The most likely diagnosis is A) B) C) D) E) miliaria cellulitis chickenpox impetigo infantile eczema After Discussion:

Your Answer: Before discussion: Note s:

Question 75. What is the most common cause of anemia of chronic disease? A) B) C) D) E) chronic hepatic failure chronic renal failure congestive cardiac failure autoimmune disease chronic neurologic disease

Your Answer: Before discussion: Note s:

After Discussion:

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Question 76. A 23-year-old female consults her physician because of a breast mass; the mass is mobile, firm, and approximately 1 cm in diameter. It is located in the upper outer quadrant of the right breast. No axillary lymph nodes are present. What is the most likely diagnosis in this patient? A) B) C) D) carcinoma of the breast mammary dysplasia (fibrocystic disease) fibroadenoma Paget's disease of the breast After Discussion:

Your Answer: Before discussion: Note s:

Question 77. A 50-year-old lady presents with diffuse symmetric joint pain that is worse in the morning but improves as the day progresses. Examination shows inflammation of the proximal interphalangeal and metacarpophalangeal joints. The most likely diagnosis is: A) lupus erythematosis B) osteoarthritis C) polymyalgia rheumatica D) Reiter's syndrome E) Rheumatoid arthritis Your Answer: Before discussion: Note s: After Discussion:

Question 78. A 32-year-old female, gravida 3, para 2, presents in the emergency room with gushing, bright red vaginal bleeding without abdominal pain in her ninth month of gestation. The blood clots well, and her blood pressure is 120/80 mm Hg. The most probable diagnosis is: A) hydatidiform mole B) abruption placenta C) marginal sinus bleeding D) placenta previa E) induced abortion. Your Answer: Before discussion: Note s: After Discussion:

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Question 79. Which of the following statements about sickle cell anemia is true? A) The disease is a sex-linked, recessive, inherited disorder. B) The condition is related to a defective chains with sickling under conditions of low CO2. C) Hydroxyurea is contraindicated for patients with sickle cell anemia. D) Patients with sickle cell should receive pneumococcal vaccination. E) Individuals with sickle cell should avoid influenza vaccination. Your Answer: Before discussion: Note s: After Discussion:

Question 80. Of the following, the INITIAL treatment of choice in the management of severe hypertension during pregnancy is A) labetalol (Trandate, Normodyne) intravenously B) reserpine (Serpasil) intramuscularly C) nifedipine (Procardia, Adalat) sublingually D) enalapril (Vasotec) intravenously E) Magnesium sulfide sublingually. Your Answer: Before discussion: Note s:

After Discussion:

Question 81. Which one of the following is more likely to occur with glipizide (Glucotrol) than with metformin (Glucophage)? A) Lactic acidosis B) Hypoglycemia C) Weight loss D) Gastrointestinal distress Your Answer: Before discussion: Note s:

After Discussion:

Question 82.

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Which one of the following prophylactic treatments for episodic cluster headache is best supported by evidence from clinical studies? A) Sumatriptan. B) Verapamil. C) Prednisone. D) Ergotamine. E) Hydrocodone Your Answer: Before discussion: Note s:

After Discussion:

Question 83. Incidence is calculated by the number of: A) Old cases during the study period B) New cases during the study period C) New and old cases at a point in time D) Old cases at a point in time E) Existing cases at a study period Your Answer: Before discussion: Note s:

After Discussion:

Question 84. A six year-old boy is brought to emergency with a 5 day history of fever, cough, and poor appetite, but no vomiting. On exam, he appears unwell, is febrile, and has crusty nasal discharge and a wet-sounding cough. Chest xray reveals a pulmonary infiltrate in the right middle lobe. He is admitted to hospital for pneumonia. What is the best management for this child? A) observe for 24 hours with IV fluids only B) observe for 24 hours with IV fluids and acetaminophen C) give oral amoxicillin and acetaminophen D) give IV ampicillin and oral acetaminophen E) give oral erythromycin and acetaminophen Your Answer: Before discussion: Note s: After Discussion:

Question 85.

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Drug of choice for attention-deficit hyperactivity disorder (ADHD) in patients who do not respond to stimulants may include: A) diazepam B) fluoxetine C) phenelzine D) desipramine E) lithium Your Answer: Before discussion: Note s:

After Discussion:

Question 86. For a man aged 40 to 50 years with no known medical problems, which of the following screening tests should routinely be performed? A) Urinalysis B) Sigmoidoscopy C) Cholesterol D) Prostate specific antigen E) TB Your Answer: Before discussion: Note s: After Discussion:

Question 87. A 25-year-old healthy woman presents with a recent purified protein derivative tuberculin skin test that is positive. The woman has never had a positive test before. A chest radiograph is negative, and there are no signs of disease. The most appropriate treatment is: A) INH for 6 months B) INH, rifampin, and streptomycin (or ethambutol) for 12 months C) isoniazid (INH) and rifampin for 6 months D) reassurance E) streptomycin for 6 months Your Answer: Before discussion: Note s: After Discussion:

Question 88.

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An 8-year-old male has a presumptive diagnosis of meningococcal meningitis, based on clinical findings and the presence of gram-negative diplococci in the cerebrospinal fluid. Cultures are pending. Which one of the following would be the most appropriate intervention for other members of his household? A) No intervention unless they develop symptoms B) Immediate administration of oral rifampin (Rifadin) C) Immediate administration of meningococcal vaccine D) Isolation until the incubation period is past E) Waiting for throat swap results Your Answer: Before discussion: Note s: After Discussion:

Question 89. In children whose parents smoke, the incidence of which of the following childhood diseases is increased? A) Croup B) Leukemia C) Allergic rhinitis D) Otitis media E) Lymphoma. Your Answer: Before discussion: Note s: After Discussion:

Question 90. A 50-year-old farmer presents with on and off fever for the last seven weeks. There are also night sweats, chills, loss of appetite, low back pain, and headache, but he denied any history of cough, skin rash, vomiting or diarrhea. On physical examination, he is febrile and sweaty. No skin rash, pallor, jaundice or neck stiffness. An enlarged & tender spleen was felt 2 cm below Lt costal margin. What is the most likely diagnosis? A) Brucellosis B) Malaria C) Meningitis D) Tuberculosis E) Typhoid fever Your Answer: Before discussion: Note s: After Discussion:

Question 91.

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A 12-year-old boy presents with a painful sore in his mouth. He has had this occur two times previously, but this is the first office visit for the condition. On examination, a single small ulcer is noted on his lower labial buccal mucosa. It has a whitish pseudomembrane overlying it and mild surrounding erythema. Which one of the following is the most likely diagnosis? A) Erosive oral lichen planus. B) Erythema migrans. C) Oral candidiasis. D) Recurrent aphthous stomatitis. E) Reticular oral lichen planus. Your Answer: Before discussion: Note s: After Discussion:

Question 92. A 20-year-old woman has had menorrhagia leading to anemia. Which of the following regimens would lead to the most iron being absorbed? A) 300 mg iron sulfate twice a day B) 300 mg iron sulfate with ascorbic acid twice a day C) 300 mg iron sulfate with calcium carbonate twice a day D) 300 mg iron gluconate twice a day E) 300 mg iron gluconate with calcium carbonate twice a day Your Answer: Before discussion: Note s:

After Discussion:

Question 93. Which of the following has been shown to be beneficial in smoking cessation? A) Fluoxetine B) Venlafaxine C) Bupropion D) Sertraline E) Doxepin Your Answer: Before discussion: Note s: After Discussion:

Question 94.

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A middle-aged, obese man is chronically tired and sleepy although he sleeps from seven to nine hours every night and he takes occasional naps. He wakes up every morning with a headache and a dry mouth. His wife complains about his loud snoring. The most appropriate diagnosis is A) Obstructive sleep apnea B) Narcolepsy C) Central apnea D) Recurrent hypersomnia E) Depression Your Answer: Before After discussion: Discussion: Note s:

Question 95. In a study of the cause of lung cancer, patients who had the disease were matched with controls by age, sex, place of residence, and social class. The frequency of cigarette smoking was then compared in the two groups. What type of study was this? A) Prospective cohort B) Retrospective cohort C) Clinical trial D) Case-control E) Correlation Your Answer: Before After discussion: Discussion: Note s: Question 96. A 55-year-old married professor without a previous psychiatric history is early in her menopause. In addition to experiencing hot flashes and some irritability, she complains of episodes of dizzy spells and memory lapses, which she had experienced on several occasions earlier in life. She denies depressive symptoms either now or in the past. In particular, she should be evaluated for possible A) Schizophrenia B) Major depression C) Temporal lobe epilepsy D) Dysthymia E) Panic disorder Your Answer: Before After discussion: Discussion: Note s:

Question 97.

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One month after her mothers death from heart failure, a 25-yearold woman with no prior psychiatric history is still very sad and tearful. She has difficulty concentrating and falling asleep at night and has lost three pounds. The most likely diagnosis is A) Major depression B) Dysthymia C) Post-traumatic stress disorder D) Adjustment disorder E) Uncomplicated bereavement Your Answer: Before discussion: Note s: After Discussion:

Question 98. As soon as she returns home from the hospital, three days after delivering a healthy baby girl, a 23-year-old woman becomes increasingly irritable and tearful. She constantly worries about the baby, fearing she wont be an adequate mother. What is the most likely diagnosis? A Postpartum depression ) B Postpartum psychosis ) C Adjustment disorder ) D Postpartum blues ) E Major depressive episode ) Your Answer: Before discussion: Note s: After Discussion:

Question 99. A 6-week-old infant presents with excessive tearing of the right eye, as evidenced by overflow of tears onto the eyelid and cheek, and frequent appearance of mucoid material. The child exhibits no systemic symptoms. Of the following, the MOST appropriate primary management is A administration of systemic antibiotics ) B fluorescein staining of the cornea ) C instillation of ophthalmic corticosteroid drops ) D nasolacrimal massage and cleansing of the lids ) E referral to ophthalmolgy for nasolacrimal duct probing ) Your Answer: Before discussion: Note s: After Discussion:

Question 100.

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A 7-year-old male patient has complained of fever and sore throat for several days. The patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory wheezes. Which of the following would be the best course of action? A)begin outpatient treatment with amplicillin B)culture throat for beta-hemolytic streptococci C)admit to intensive care unit and obtain otolaryngologic consultation D)give hydrocortisone injection immediately E)schedule for chest X-ray. Your Answer: Before discussion: Note s: After Discussion:

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