Medicine Colloquium Exam - 2010 B

Medicine Colloquium Exam – Second Session 2010
Ministry of Education and Higher Learning

IMPORTANT INSTRUCTIONS
Each candidate should read this page before answering the questions. The candidate
should follow the directions below:
1. Write clearly your FIRST and FAMILY NAME and APPLICANT NUMBER with ink
(pen) in the designated space (colored square).
2. Please use the pencil ONLY.
3. Do not use any pen (like bic) or ink.
4. Completely Fill the answer squares using pencil only.
5. Only ONE answer is allowed to each question.
6. Avoid erasing as much as you can.
7. When needed, do erase the cancelled answer COMPLETELY.
8. You may use the question bookle as scratch, and make sure to return it with the
answer sheet at the end of the exam.
9. On the answer sheet, you should fill up the square corresponding to the right
answer, in pencil only. No writing allowed at all.
10.Keep your answer sheet clean and tidy, do not fold or tear it.
11.The duration of the exam id THREE HOURS.
12.The composition consists of 180 QUESTIONS.
Important Note:
Any square filled up with a pen or ink cannot be read by the machine. It reads answers
filled up in PENCIL only.
Thank You
&
Good Luck
1
1. A 40-year-old female nurse was admitted to the hospital because of fever to b

41C. Despite a thorough workup in the hospital for over 3 weeks, no etiology
has been found, and she continues to have temperature spikes greater than
40C. The least diagnosis in this patient is:
a. Occult bacterial infection
b. Influenza
c. Lymphoma
d. Adult Still’s disease
e. Factitious fever
2. A 19-year-old male has a history of athlete’ foot but is otherwise healthy when c
he develops the sudden onset of fever and pain in the right foot and leg. On
physical exam, the foot and leg are fiery red with a well-defined indurated
margin that appears to be rapidly advancing. There is tender inguinal
lymphadenopathy. The most likely organism to cause this infection is:
a. Staphylococcus epidermidis
b. Tinea pedis
c. Streptococcus pyogenes
d. Mixed anaerobic infection
3. A 70-year-old, non-sexually active male complains of fever and pain in his left a
knee. Several days previously, the patient skinned his knee while working in
his garage. The knee is red, warm, and swollen. An arthrocentesis is
performed, which shows 200,000 leukocytes/l and a glucose of 20 mg/dl. No
crystals are noted. The most important next step is:
a. Gram stain and culture of joint fluid
b. Urethral culture
c. Uric acid level
d. Antinuclear antibody
4. A 60-year-old male complains of pain in both knees coming on gradually over a

the past 2 years. The pain is relieved by rest and worsened by the movement.
There is bony enlargement of the knees with mild inflammation. Crepitation
is noted on motion of the knee joint. There are no other findings except for
bony enlargement at the distal interphalangeal joint. The patient is 172 cm in
tall and weighs 95 kg. The best way to prevent disease progression is:
a. Weight reduction
b. Calcium supplementation
c. Total knee replacement
d. Aspirin
e. Oral prednisone
2
5. A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, b

and difficulty swallowing solid food. The most useful test to make a definitive
diagnosis is:
a. Rheumatoid factor
b. Antinuclear antibody
c. ECG
d. BUN and creatinine
6. A 50-year-old patient with long-standing chronic obstructive lung disease b

develops insidious onset of aching in the distal extremities, particularly the
wrists bilaterally. There is a weight loss. The skin over the wrists is warm and
erythematous. There is bilateral clubbing. Plain film is read as periosteal
thickening, possible osteomyelitis. You should:
a. Start ciprofloxacin
b. Obtain chest x-ray
c. Aspirate both wrists
d. Begin gold therapy
7. A 70-year-old patient with chronic obstructive lung disease requires 2L of c

nasal O2 to treat his hypoxia, which is sometimes associated with angina.
While receiving nasal O2 the patient develops pleuritic chest pain, fever and
purulent sputum. He becomes stuporous and develops a respiratory acidosis
with CO2 retention and worsening hypoxia. The treatment of choice is:
a. Stop oxygen
b. Begin medroxyprogesterone
c. Intubate the trachea and begin mechanical ventilation
d. Observe patient 24 hours before changing therapy
e. Begin sodium bicarbonate
8. A 35-year-old female complains of slowly progressive dyspnea. Her history is a

otherwise unremarkable, and there is no cough, sputum production, pleuritic
chest pain, or thrombophlebitis. She has taken appetite suppressants at
different times. On physical exam, there is jugular venous distention, a
palpable right ventricle lift, and a loud P2 heart sound. Chest X-ray shows
clear lung fields. ECG shows right axis deviation. A perfusion lung scan is
normal with no segmental deficits. The most likely diagnosis in this patient is:
a. Primary pulmonary hypertension
b. Recurrent pulmonary emboli
c. Cardiac shunt
d. Interstitial lung disease
3
9. A 75-year-old female is admitted with acute myocardial infarction and d

congestive heart failure, and then has an episode of ventricular tachycardia.
She is prescribed multiple medications and soon develops confusion and
slurred speech. The most likely cause of this confusion is:
a. Captopril
b. Digoxin
c. Furosemide
d. Lidocaine
e. Nitroglycerin
10. A 72-year-old male comes to the office with intermittent symptoms of a

dyspnea on exertion, palpitations, and cough occasionally productive of
blood. On cardiac auscultation, a low-pitched diastolic rumbling murmur is
faintly heard toward the apex. The origin of the patients problem probably
related to:
a. Rheumatic fever as a youth
b. Long-standing hypertension
c. Silent MI within the past year
d. Congenital origin
11. You are helping with school sport physicals and see a 13-year-old boy who has c
had some trouble keeping up with his peers. He has a cardiac murmur, which
you correctly diagnose as a ventricular septal defect based on which of the
following auscultatory findings?
a. A systolic crescendo-decrescendo murmur heard best at the upper right sternal
border with radiation to the carotids; the murmur is augmented with transient
exercise
b. A systolic murmur at the pulmonic area and a diastolic rumble along the left
sternal border.
c. A holosystolic murmur at the mid-left sternal border
d. A diastolic decrescendo murmur at the mid-left sternal border
e. A continuous murmur through systole and diastole at the upper left sternal
border
12. A 35-year-old male complains of substernal chest pain aggravated by c

inspiration and relieved by sitting up. He has a history of tuberculosis. Lung
fields are clear to auscultation, and heart sounds are somewhat distant. Chest
x-ray shows an enlarged cardiac silhouette. The next step in evaluation is:
a. Right lateral decubitus film
b. Cardiac catheterization
c. Echocardiogram
d. Serial ECGs
e. Thallium stress test
4
13. A 50-year-old female is 165 cm tall and weighs 82 kg. There is a family history b
of diabetes mellitus. Fasting blood glucose is 150 mg/dl on two occasions. She
is asymptomatic, and physical exam shows no abnormalities. The treatment of
choice:
a. Observation
b. Medical nutrition therapy (calorie intake + weight loss, exercise)
c. Insulin
d. Oral hypoglycemic agent
14. A 30-year-old female complains of fatigue, constipation, and weight gain. a

There is no prior history of neck surgery or radiation. Her voice is hoarse and
her skin is dry. Serum TSH is elevated and T4 is low. The most likely cause of
these findings is:
a. Autoimmune disease
b. Postablative hypothyroidism
c. Pituitary hypofunction
d. Thyroid carcinoma
15. A 90-year-old male complains of hip and back pain. He has also developed b
headaches, hearing loss and tinnitus. On physical exam the skull appears
enlarged, with prominent superficial veins. There is marked kyphosis, and the
bones of the leg appear deformed. Plasma alkaline phosphatase is elevated. A
skull x-ray shows sharpy demarcated lucencies in the frontal, parietal and
occipital bones; x-rays of the hips show thickening of the pelvic rim. The most
likely diagnosis is:
a. Multiple myeloma
b. Paget’s disease
c. Hypercalcemia
d. Metastatic bone disease
16. A 60-year-old woman comes to the emergency room in a coma. The patient’s b
temperature is 35C. She is bradycardic. Her thyroid gland is enlarged. There
is bilateral hyporeflexia. The next step in management is:
a. Await results of T4, TSH
b. Obtain T4, TSH; begin thyroid hormone and glucorticoid
c. Begin rapid rewarming
d. Obtain CT scan of the head
17. A 30-year-old woman is found to have a low serum thyroxine level after being a
evaluated for fatigue. Five years ago she was treated for Grave’s disease with
radioactive iodine. The diagnostic test of choice is:
a. Serum TSH
b. Serum T3
c. TRH stimulation test
d. Radioactive iodine uptake
5
18. A 52-year-old man complains of impotence. On physical examination he has b

an elevated jugular venous pressure, S3 gallop and hepatomegaly. He also
appears tanned, with pigmentation along joint folds. His left knee is swollen
and tender. The plasma glucose is 250 mg/dl, and liver enzymes are elevated.
Your next study to establish the diagnosis should be:
a. Detection of nocturnal penile tumescence
b. Determination of iron saturation
c. Determination of serum copper
d. Detection of hepatitis B surface antigen
e. Echocardiography
19. A 30-year-old man is evaluated for a thyroid nodule. The patient reports that c
his father died from thyroid cancer and that a brother had a history of
recurrent renal stones. Blood calcitonin concentration is 2000 pg/ml (normal
is less than 100), serum calcium and phosphate levels are normal. Before
referring the patient to a surgeon, the physician should:
a. Obtain a liver scan
b. Perform a calcium infusion test
c. Measure urinary catecholamines
d. Administer suppressive doses of thyroxine and measure levels of thyroid
stimulating hormone
e. Treat the patient with radioactive iodine
20. A 35-year-old alcoholic male is admitted for nausea, vomiting, and abdominal c
pain that radiates to the back. The laboratory value that suggests a poor
prognosis in this patient is:
a. Elevated serum lipase
b. Elevated serum amylase
c. Leukocytosis of 20.000/m
d. Diastolic pressure greater than 90 mmHg
21. A 43-year-old female presents with hypertension, edema, hyperlipidemia, and b

a deep venous thrombosis in her left leg. Which of the following is not
necessary to diagnose the nephrotic syndrome?
a. Edema
b. Hypertension
c. 24h urine albumin >6g
d. Hyperlipidemia
6
22. A 63-year-old male alcoholic with a 50-pack-year history of smoking presents b

to the emergency room with fatigue and confusion. Physical examination
reveals a blood pressure of 110/70 mmHg with no orthostatic change. Heart,
lung and abdominal examination are normal and there is no pedal edema.
Laboratory data is as follows:
Na+: 110 mEq/l Glucose: 100 mg/dl
K+: 3.7 mEq/l BUN: 5 mg/dl
Cl-: 82 mEq/l Creatinine: 0.7 mg/dl
HCO3-: 20 mEq/l Urinalysis: normal
The most likely diagnosis is:
a. Volume depletion
b. Inappropriate secretion of antidiuretic hormone
c. Polydipsia
d. Cirrhosis
23. A 35-year-old female who is recovering from Mycoplasma pneumonia b

develops increasing weakness. Her hemoglobin is 9.0 g/dl, and her MCV is
110. The best test to determine whether the patient has a hemolytic anemia
is:
a. Serum bilirubin
b. Reticulocyte count and blood smear
c. Mycoplasma antigen
d. Serum LDH
24. A 70-year-old male complains of 2 months of low back pain and fatigue. He a
has developed fever with purulent sputum production. On physical exam, he
has pain over several vertebrae and rales at the left base. Laboratory results
are as follows:
Hemoglobin: 7 g/dl Creatinine: 3.2 mg/dl
MCV: 86 fL (normal 86 to 98) Ca2+: 11.5 mg/dl
WBC: 12,000/l Chest X-ray: Left lower lobe infiltrate
BUN: 44 mg/dl Reticulocyte count: 1%

a. Multiple myeloma
b. Lymphoma
c. Metastatic bronchogenic carcinoma
d. Primary hyperparathyroidism
7
25. A 60-year-old asymptomatic man is found to have a leukocytosis when a c

routine CBC is obtained. Physical exam shows no abnormalities. The spleen is
of normal size. Lab data includes:
Hgb: 9 g/dl (normal14 to 18)
Leucocytes: 40,000/l (normal 4,300 to 10,800)
Peripheral blood smear shows a differential that includes 97% small
lymphocytes
a. Acute monocytic leukemia
b. Chronic myelogenous leukemia
c. Chronic lymphocytic leukemia
d. Tuberculosis
26. A 38-year-old female presents with recurrent sore throats. She is on no c

medications, does not use ethanol, and has no history of renal disease.
Physical exam is normal. A CBC shows Hgb of 9.0 g/dl, MCV is 85 fL (normal),
white blood cell count is 2.000/l, and platelet count is 30.000/l. The best
approach to diagnosis is:
a. Erythropoietin level
b. Serum B12
c. Bone marrow biopsy
d. Liver spleen scan
27. A 50-year-old female complains of vague abdominal pain, constipation, and a b

sense of fullness in the lower abdomen. On physical exam the abdomen is
nontender, but there is shifting dullness to percussion. The next step in
evaluation is:
a. Abdominal ultrasound
b. Pelvic examination
c. CA 125 cancer marker
d. Sigmoidoscopy
28. A patient complains of fatigue and night sweats associated with itching for 2 a
months. On physical exam there is diffuse nontender lymphadenopathy,
including small supraclavicular, epitrochlear, and scalene nodes. A chest x-ray
shows hilar lymphadenopathy. The next step in evaluation is:
a. Excisional lymph node biopsy
b. Monospot test
c. Toxoplasmosis IgG
d. Serum angiotensin converting enzyme level
8
29. A 62-year-old man presents with fatigue, decreased urine stream, and low b
back pain. The physical examination shows a hard, nodular left prostatic lobe
and percussion tenderness in the lumbar vertebral bodies, and left seventh
rib. The next step in evaluation is:
a. Bone scan
b. Biopsy of prostate
c. CT scan
d. Bone marrow biopsy
30. A 64-year-old male is hospitalized with a transient ischemic attack and is c

evaluated for carotid disease. Physical exam is normal. CBC on admission is
normal. The patient is started on heparin. A repeat CBC one week later shows
an Hgb of 14 g/dl (normal is 13 to 18 g/dl), WBC of 9.000/l and platelet count
of 10.000/l. You should:
a. Obtain a bone marrow study
b. Obtain a liver-spleen scan
c. Suspect drug-induced thrombocytopenia
d. Begin corticosteroids for idiopathic thrombocytopenia purpura
31. A 40-year-old cigarette smoker is found on routine physical exam to have a 1 c

cm white patch on his oral mucosa that does not rub off. There are no other
lesions in the mouth. The patient has no risk factors for HIV infection. The
lesion is nontender. The next step in management is:
a. Culture for Candida Albicans
b. Follow lesion with annual physical exam
c. Refer to oral surgeon for biopsy of lesion
d. Reassure patient that this a normal variant
32. A 30-year-old female with Grave’s disease has been started on c

propylthiouracil. She complains of low-grade fever, chills and sore throat. The
most important initial step in evaluating this patient’s fever is:
a. Serum TSH
b. Serum T3
c. CBC
d. Chest x-ray
e. Blood cultures
33. A 64-year-old man presents for evaluation of a painless “lump” in the left d
thigh. He first noticed the abnormality about 1 month previously and thinks it
has increased in size. There is no prior history of trauma. On exam, you find a
5 cm soft tissue mass, firm to hard in consistency, in the soft tissue above the
knee. There is no tenderness or erythema, the mass is deep to the
subcutaneous tissue and appears fixed to the underlying musculature.
Inguinal lymph nodes are normal. You should:
a. Reexamine the lesion in 3 months, as it is probably a lipoma
b. Obtain a bone scan
c. Treat with cephalexin 500 mg PO qid for presumed abscess
d. Refer the patient for surgical biopsy
9
34. A 70-year-old male complains of the sudden onset of syncope. It occurs b

without warning and with no sweating, dizziness, or light-headedness. He
believes episodes tend to occur when he turns his head too quickly or
sometimes when he is shaving. The best way to make a definitive diagnosis in
this patient is:
a. ECG
b. Carotid massage with ECG monitoring
c. Holter monitoring
d. Electrophysiologic studies to evaluate the AV node
35. A 17-year-old female presents with a pruritic rash located to the wrist. c
Papules and vesicles are noted in a bandlike pattern, with slight oozing from
some lesions. The most likely cause of the rash is:
a. Herpes simplex
b. Shingles
c. Contact dermatitis
d. Seborrheic dermatitis
36. A 45-year-old, generally healthy female on no medications comes to your c

office with a 10-day history of congestion, sore throat, dry cough, and initial
low-grade fever, all of which were nearly resolved. However, over the past 24
to 48h she has developed a sharp chest pain, worse with deep inspiration or
cough, but no dyspnea. Due to the severity of the pain, the nurse had obtained
an ECG, which showed diffuse ST elevation. On physical exam, you expect the
most likely finding to be:
a. A loud pulmonic component of S2
b. An S3 gallop
c. A pericardial friction rub
d. Bilateral basilar rales
e. Elevated blood pressure >160/100
37. An asymptomatic 35-year-old female comes to you for routine exam. She has a
no unusual family history of breast cancer. Based on guidelines for early
detection of breast, this patient at standard risk should be advised to:
a. Perform breast self-examination monthly
b. Obtain physician-performed breast examination yearly
c. Begin yearly mammograms
d. Obtain genetic testing via blood work as a baseline
e. Wait until age 40 to begin cancer screening
10
38. A 20-year-old college basketball player is brought to the university urgent a

care clinic after developing chest pain and palpitations during practice, but no
dyspnea or tachypnea. There is no unusual family history of cardiac disease,
and social history is negative for alcohol or drug use. Cardiac auscultation is
unremarkable, and ECG shows only occasional PVCs. The next step in
evaluation and/or management should be to:
a. Obtain urine drug screen
b. Arrange treadmill stress test
c. Obtain Doppler ultrasound of deep veins of lower legs
d. Institute cardioselective beta-blocker therapy
e. Institute respiratory therapy for this form of exercise-induced bronchospasm
39. A 20-year-old female develops urticaria that lasts for 6 weeks and then d
resolves spontaneously. She gives no history of weight loss, fever, rash, or
tremulousness. Physical exam shows no abnormalities. The most likely cause
of the urticaria is:
a. Connective tissue disease
b. Hyperthyroidism
c. Chronic infection
d. Not likely to be determined
40. A 30-year-old male develops skin rash, pruritis, and mild wheezing about 20 c
min after an intravenous pyelogram performed for the evaluation of renal
stone symptoms. The best approach to diagnosis of this patient includes:
a. Perform 24h urinary histamine measurement
b. Measure immunoglobulin E to radiocontrast media
c. Diagnose radiocontrast media sensitivity by history
d. Recommend intradermal skin testing
41. A 78-year-old woman with mild renal insufficiency complains of pain in the c
right knee on walking that has interfered with her day-to-day activities. Pain
is relieved by rest. There are no inflammatory symptoms of redness or
swelling. There is minimal joint effusion. An x-ray of the knee shows
osteophytes and asymmetric loss of joint space. ESR and white blood cell
count are normal. The best initial management of this patient is:
a. Nonsteroidal anti-inflammatory agent
b. Intraarticular corticosteroids
c. Acetaminophen
d. Total arthroplasty
42. Many physiologic changes are associated with aging. Which of the following c
physiologic parameters does not change with age?
a. Creatinine clearance
b. Forced expiratory volume
c. Hematocrit
d. Heart rate response to stress
e. Hours of REM sleep (rapid eye movement)
11
43. A 20-month-old child is brought to the emergency department because of a

fever and irritability and refusal to move his right lower extremity. Physical
examination reveals swollen and tender right knee that resist passive motion.
The most important test to confirm the impression of septic arthritis is:
a. Examination of joint fluid
b. X-ray of the knee
c. Erythrocyte sedimentation rate (ESR)
d. Complete blood count (CBC) and differential
e. Blood culture
44. A 16-year-old high school boy sustains an abrasion of the knee after a fall b
while Rollerblading in the school yard. School records reveal that his last DPT
booster was at age 6. In this situation, which of the following is appropriate?
a. Tetanus toxoid
b. Adult tetanus and diphtheria toxoid (Id)
c. DPT booster
d. Tetanus toxoid and tetanus immune globulin
e. Not immunization
45. A full-term newborn infant is having episodes of cyanosis and apnea which c
are worse when he is attempting to feed, but he seems better when he is
crying. The most important next step to quickly establish the diagnosis is:
a. Echocardiogram
b. Ventilation perfusion scan
c. Passage of catheter into nose
d. Hemoglobin electrophoresis
e. Bronchoscopic evaluation of palate and larynx
46. You are advised by the obstetrician that the mother of a baby he has delivered d
is a carrier of hepatitis B surface antigen (HBsAg-positive). The most
appropriate action in managing this infant would be to:
a. Screen the infant for HBs-Ag
b. Isolate the infant for enteric transmission
c. Screen the mother for hepatitis B “e” antigen (HBeAg)
d. Administer hepatitis B immune globulin and hepatitis B vaccine to the infant
e. Do nothing because transplacentally acquired antibody will prevent infection in
the infant
47. A 9-month-old infant accidentally ingests an unknown quantity of digitalis. c

The most important noncardiac manifestation of toxicity in this infant is:
a. Fever
b. Dizziness
c. Vomiting
d. Visual disturbances
e. Urticaria
12
48. During a regular checkup on an 8-year-old child, you note a loud first heart a
sound with a fixed and widely split second heart sound at the upper left
sternal border that does not change with respirations. The patient is
otherwise active and healthy. The most likely heart lesion to explain these
findings is:
a. Atrial septal defect
b. Ventricular septal defect
c. Isolated tricuspid regurgitation
d. Tetralogy of Fallot
e. Mitral valve prolapse
49. A child has a history of spiking fevers, which have been as high as 40C b
(104F). She has spindle-shaped swelling of finger joints and complains of
upper sternal pain. The most likely diagnosis is:
a. Rheumatic fever
b. Juvenile rheumatoid arthritis
c. Toxic synovitis
d. Septic arthritis
e. Osteoarthritis
50. A 10-year-old has had a “cold” for 14 days. In the 2 days prior to the visit to b
your office, she has developed a fever to 39C, purulent nasal discharge, facial
pain, and daytime cough. Examination of the nose after topical decongestants
shows pus in the middle meatus. The most likely diagnosis is:
a. Brain abscess
b. Maxillary sinusitis
c. Streptococcal throat infection
d. Sphenoid sinusitis
e. Middle-ear infection
51. A previously healthy 18-month-old has been in a separate room from his e
family. The family notices the sudden onset of coughing, which resolves over a
few minutes. Subsequently, the patient appears to be normal except for
increased amounts of drooling and refusal to take food orally. The most likely
explanation for this toddler’s condition is:
a. Severe gastroesophageal reflux
b. Foreign body in the airway
c. Croup
d. Epiglottitis
e. Foreign body in the esophagus
13
52. A 6-month-old infant has large, foul-smelling stools and is not gaining weight. b
Sweat chloride level was 68 mmol/l. Appropriate nutritional
recommendations include:
a. Supplementation with water-soluble vitamins
b. Pancreatic enzyme replacement
c. High-fat diet
d. Low-protein diet
e. Low-carbohydrate diet
53. A 14-year-old boy has sickle cell disease. He presents to the emergency room c
with the complaints of increased jaundice, abdominal pain, nausea, vomiting,
and fever. His examination is remarkable for jaundice, pain of the right upper
quadrant with guarding, and a clear chest. Chest radiographs appear normal.
The test most likely to reveal the cause of his pain is:
a. Serum chemistries
b. Complete blood count with platelets and differential
c. Ultrasound of the right upper quadrant
d. Upper GI series
e. Hepatitis panel
54. A 14-year-old girl has a 9-month history of diarrhea, abdominal pain (usually c
periumbilical and postprandial), fever, and weight loss. She has had several
episodes of blood in her stools. Which of the following is the most likely
diagnosis in this child?
a. Chronic appendicitis
b. Chronic pancreatitis
c. Crohn’s disease
d. Bulimia
e. Gallstones
55. Examination of the cerebrospinal fluid of an 8-year-old, mildly febrile child b

with nuchal rigidity and intermittent stupor shows the following white blood
cells 100/l (all lymphocytes), negative gram stain, protein 150 mg/dl, and
glucose 15 mg/dl. The most likely diagnosis is:
a. Tuberous sclerosis
b. Tuberculous meningitis
c. Stroke
d. Acute bacterial meningitis
e. Pseudotumor cerebri
14
56. A 6-year-old child is hospitalized for observation because of a short period of b

unconsciousness after a fall from a playground swing. He has developed
unilateral papillary dilatation, focal seizures, recurrence of depressed
consciousness, and hemiplegia. Appropriate management would be:
a. Spinal tap
b. CT scan
c. Rapid fluid hydration
d. Naloxone
e. Gastric decontamination with charcoal
57. A 17-year-old male complains of acute, painful, scrotal swelling. Ultrasound of d

the testes is normal, but the urinalysis reveals pyuria. The most likely
diagnosis in this patient is:
a. Incarcerated inguinal hernia
b. Torsion of the testes
c. Varicocele
d. Epididymitis
e. Urinary tract infection
58. A 16-day-old infant presents with fever, irritability, poor feeding, and a c
bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. The most
likely diagnosis is:
a. Listeria monocytogenes
b. Group A streptococcus
c. Group B streptococcus
d. Streptococcus pneumoniae
e. Staphylococcus aureus
59. A 14-month-old infant suddenly develops a fever of 40.2C. Physical a

examination shows an alert, active infant that drinks milk eagerly. No physical
abnormalities are noted. The white blood cell count is 22,000/l, with 78%
polymorphonuclear leukocytes, 18% of which are band forms. The most likely
diagnosis is:
a. Pneumococcal bacteremia
b. Roseola
c. Streptococcosis
d. Typhoid fever
e. Diphtheria
60. On a routine screening complete blood count, a 1–year-old is noted to have a b

microcytic anemia. A follow-up hemoglobin electrophoresis demonstrates an
increased concentration of hemoglobin A2. The child is most likely to have:
a. Iron deficiency
b. β-thalassemia trait
c. Sickle cell illness
d. Lead poisoning
15
61. A 12-year-old girl has a mass in her neck. Physical examination reveals a e
thyroid nodule, but the rest of the gland is not palpable. A technetium scan
reveals a “cold” nodule. The child appears to be euthyroid. Which of the
following diagnoses is the least likely?
a. Simple adenoma
b. Follicular carcinoma
c. Papillary carcinoma
d. Cyst
e. Dysgenetic thyroid gland
62. An adolescent with type I diabetes has a dramatically elevated glycosylated d

hemoglobin (hemoglobin A1C) level, indicating poor control of his diabetes
over at least the preceding:
a. 8h
b. 1 week
c. 1 month
d. 2 months
e. 6 months
63. After a recent news segment about scoliosis, the mother of several of your c
female patients calls to ask about the condition. You explain to her that
idiopathic scoliosis would be most commonly found in her daughters in which
age range:
a. Birth to 3 years
b. 4 to 10 years
c. 11 to 18 years
d. 19 to 25 years
e. >25 years
64. An 18-year-old male is seen in clinic for urinary frequency, dysuria, and c
urethral discharge. Which of the following is likely to explain this condition?
a. Herpes simplex
b. Escherichia coli urinary tract infection
c. Chlamydia urethritis
d. Syphilis
e. HIV infection
65. A 20-year-old girl presents with lower abdominal pain and fever. On physical b
examination, a tender adnexal mass is felt. Further questioning in private
reveals the following: she has a new sexual partner, her periods are irregular,
and she has a vaginal discharge. The most likely diagnosis is:
a. Appendiceal abscess
b. Tuboovarian abscess
c. Ovarian cyst
d. Renal cyst
e. Ectopic pregnancy
16
66. The first line therapy in a 78-year-old man with positive stool test for d
Clostridium difficile following a 2-week amoxicillin course, should be:
a. Vancomycin
b. Clindamycin
c. Azithromycin
d. Metronidazole
e. Aztreonam
67. At a banquet, the menu includes fried chicken, home-fried potatoes, peas, e
chocolate eclairs, and coffee. Within 2 hours, most of the diners become
violently ill, with nausea, vomiting, abdominal pain, and diarrhea. Analysis of
the contaminated food is most likely to yield large numbers of which of the
following organisms?
a. Enterococcus faecalis
b. Escherichia coli
c. Proteus mirabilis
d. Salmonella typhimurium
e. Staphylococcus aureus
68. A newborn receives silver nitrate prophylaxis at birth. Twelve hours later, she b
has puffy eyelids, injected conjunctivae, and scant clear ocular discharge.
Which of the following is the most likely diagnosis?
a. Allergic conjunctivitis
b. Chemical conjunctivitis
c. Chlamydial conjunctivitis
d. Dacryocystitis
e. Gonococcal conjunctivitis
69. A 5-year-old boy presents with fever, shin pain, and inability to weight c
bearing. On examination his temperature is 38.4C, respiratory rate 20/min,
and pulse 100/min. He has local swelling and tenderness in the right leg.
Which of the following is the most likely diagnosis?
a. Henoch-Schonlein purpura
b. Juvenile rheumatoid arthritis
c. Osteomyelitis
d. Reactive arthritis
e. Septic arthritis
70. A 65-year-old woman presents with glossitis, weight loss, paresthesias, and c
diarrhea. Laboratory tests show a macrocytic anemia. The most likely cause
is:
a. Iron deficiency anemia
b. Thalassemia
c. Pernicious anemia
d. Multiple myeloma
e. Colon cancer
17
71. At her 6th week postpartum visit, a 17-year-old woman, gravida 1, para 1, tells d
her physician that she has a pinkish vaginal discharge that has persisted since
her delivery, although it is decreasing in amount. On physical examination,
the uterus is fully involuted, and there are no adnexal masses. Which of the
following is the most appropriate next step in management?
a. Administer ampicillin
b. Order a quantitative β-HCG test
c. Order a serum prolactin measurement
d. Reassure the patient that this is normal
e. Schedule a dilatation and curettage
72. A 55-year-old male who had a recent episode of atrial fibrillation that a
converted in the emergency department is asymptomatic and currently in
sinus rhythm. He is in good health otherwise and has no history of
hypertension, diabetes mellitus, heart failure, transient ischemic attack, or
stroke. Which one of the following would be best for preventing a stroke in
this patient?
a. Aspirin
b. Clopidogrel (Plavix), 75 mg daily
c. Warfarin (Coumadin), with a goal INR of 1.5-2.5
d. Warfarin, with a goal INR of 2.0-3.0
e. Warfarin, with a goal INR of 2.5-3.5
73. A 35-year-old man presents with a moderately tender, hard thyroid, c

approximately twice normal in size. The sedimentation rate is 60 mm/h. The
radioactive iodine uptake is 0.04 (normal 0.20-0.40) in 24 hours, the serum
thyroxin is 175 mmol/l (normal 60-150 mmol/l). The hemoglobin, white
blood count, urinalysis, and chest x-ray are within normal limits. The most
probable diagnosis is:
a. Grave’s disease
b. Riedel struma (chronic fibrosing thyroiditis)
c. Subacute thyroiditis
d. Iodide-induced thyrotoxicosis (Jod-Basedow disease)
e. Carcinoma of the thyroid
74. A 32-year-old man seen in the emergency department with an unsteady gait, e
mild bilateral oculoparesis, and spider angiomas, is confused and agitated.
Which of the following agents is the best immediate pharmacologic
treatment?
a. Anticoagulants
b. Haloperidol
c. Pentobarbital
d. Salicylates
e. Thiamine
18
75. A 45-year-old man with chronic pancreatitis has a 9 kg weight loss and d
diarrhea. Analysis of a 24-hour stool sample shows 28 g of fat. A deficiency of
which of the following enzymes is the most likely cause?
a. Amylase
b. Carboxypeptidase
c. Lactase
d. Lipase
e. Lipoprotein lipase
76. A 16-year-old male presents with swelling laterally in the neck of 6 months a
duration. Which ONE of the following is the most likely diagnosis?
a. Branchial cyst
b. Dermoid cyst
c. Thyroglossal cyst
d. Teratoma
77. A 27-year-old nulligravid woman has had severe dysmenorrhea that has b
caused her to miss at least 2 days of work during each menstrual cycle for the
past year. She has occasional pain during sexual intercourse. She weighs 50 kg
and is 160 cm tall. Pelvic examination shows a normal-appearing vulva and
vagina. The cervix is pink with minimal endocervical gland eversion. The
uterus is normal in size. The left ovary is 2x3 cm; the right ovary is 4x6 cm.
Which of the following is the most likely cause of her condition?
a. Chronic appendicitis
b. Endometriosis
c. Pelvic congestion syndrome
d. Polycystic ovarian disease
e. Premenstrual syndrome
78. A 32-year-old woman is diagnosed to have Trichomonas. She is entirely b

asymptomatic. Appropriate management should be to:
a. Reassure patient that no treatment is necessary
b. Treat regardless of symptoms
c. Repeat cultures after the next menstrual cycle and treat if the organism is
present
d. Treat only if the patient is pregnant
e. Treat only if symptoms are present
19
79. A 22-year-old lady presents at the emergency department with high fever, c
nausea, vomiting, myalgias, and lethargy. On examination, she is found to
have hypotension and a generalized erythematous rash and desquamation of
the hands and feet. Investigation shows an increased white blood cell count,
increased blood urea nitrogen, and increased serum creatinine with
decreased urine output. The most likely diagnosis is:
a. Gonorrhea
b. Lyme disease
c. Toxic shock syndrome
d. Tertiary syphilis
e. Pelvic inflammatory disease
80. A 72-year-old female is admitted to the hospital with her first episode of acute b
heart failure. She has a history of hypertension treated with a thiazide
diuretic. An echocardiogram reveals no evidence of valvular disease and no
segmental wall motion abnormalities. Left ventricular hypertrophy is
described, and the ejection fraction is 25%. Her pulse rate is 72 beats/min.
The most likely cause of her heart failure is:
a. Systolic dysfunction
b. Diastolic dysfunction
c. Hypertrophic cardiomyopathy
d. High-output failure
81. An infant 3 months of age brought to you with high fever for 12 hours. The e
infant temperature is 39.7C, pulse is 145/min, and respirations are 30/min.
She does not appear ill or toxic, and a complete physical examination is
unremarkable. Since you want to be sure not to miss any form of sepsis or
serious infection, the most appropriate next step in evaluation is to:
a. Order a chest x-ray
b. Perform a lumbar puncture and send cerebrospinal fluid for culture
c. Send a stool specimen for culture
d. Send a throat culture
e. Send a urine culture
82. A 56-year-old man has a small, slowly growing nodule on his chin during the b
past 3 years. The lesion is 1.3 cm in diameter, the center is ulcerated, and the
border is waxy. Examination of tissue obtained on excision of the lesion is
most likely to show which of the following?
a. Actinic keratosis
b. Basal cell carcinoma
c. Malignant melanoma
d. Seborrheic keratosis
e. Squamous cell carcinoma
20
83. A 31-year-old G3P2 lady has just delivered a 3.100 grams baby after oxytocin d
induction and vacuum-assisted delivery. The placenta spontaneously
detaches and delivers 6 minutes after delivery of the baby. After the placenta
delivers there is a significant blood loss. What is the most likely immediate
cause for the postpartum bleeding?
a. Multiparty
b. Retained placenta tissue
c. Instrumented delivery
d. Uterine atony
e. Oxytocin induction
84. A 32-year-old woman on a combined oral contraceptive pill plans to travel by d

air after 15 days. The flight lasts 8 hours. She is worried about the possibility
of developing thromboembolism. A sound advice is:
a. She should not worry as the risk for thromboembolism is similar to normal
women on no medications
b. To stop the pill a week before flying
c. Start a daily low dose salicylic acid a week before traveling
d. Take a subcutaneous injection of low molecular heparin immediately before the
flight
e. Take 5 mg of warfarin the day of the flight
85. A 20-year-old male presents for physical examination. He has no medical a

problems. His physical examination reveals a grade 2/6 systolic flow murmur.
The hematocrit is 33% and the mean corpuscular volume is 66 fL. The
neutrophils count, platelet count, and iron studies are normal. Hemoglobin
electrophoresis reveals hemoglobin A of 95%, hemoglobin A2 of 4.5%, and
hemoglobin F of 0.5%. Numerous target cells are seen on peripheral blood
smear. Which of the following is the most likely diagnosis?
a. Thalassemia minor
b. Sickle cell anemia
c. Hereditary spherocytosis
d. Iron deficiency anemia
e. Anemia of chronic disease
21
86. A 55-year-old woman who has a history of severe depression and who had d
radical mastectomy for carcinoma of the breast 1 year previously develops
polyuria, nocturia, and excessive thirst. Laboratory values are as follows:
Serum electrolytes: Na+: 149 meq/l
K+: 3.6 meq/l
Serum calcium: 9.5 mg/dl
Blood glucose: 110 mg/dl
Blood urea nitrogen: 30 mg/dl
Urine osmolality: 150 mOsm/kg
What is the most likely diagnosis?
a. Psychogenic polydipsia
b. Renal glycosuria
c. Hypercalciuria
d. Diabetes insipidus
e. Inappropriate antidiuretic hormone syndrome
87. A 35-year-old woman is admitted to the hospital because of fever and dry c
cough for 3 days. An x-ray film of the chest shows abnormal findings.
Laboratory tests show cold agglutinating antibodies in serum. Results of
routine cultures of blood and sputum are negative. Which of the following is
the most likely pathogen?
a. Influenza virus
b. Mycobacterium tuberculosis
c. Mycobacterium pneumoniae
d. Staphylococcus aureus
e. Streptococcus pneumoniae
88. A 2-month-old infant has a 5 cm strawberry hemangioma on the cheek that is a

increasing in size. No other lesions are noted. Which of the following is the
most appropriate next step in management?
a. Observation of the lesion
b. Solid carbon dioxide application to the lesion
c. Intralesional corticosteroid treatment
d. Radiation of the lesion
e. Surgical removal of the lesion
89. A 35-year-old male comes to the clinic complaining of right upper quadrant b
pain for 2 days. Laboratory tests are as follows: total serum bilirubin 0.9
mg/dl, AST 1500 IU/L, ALT 600 IU/L, alkaline phosphatase 80 IU/L. Which one
of the following is the SINGLE MOST likely diagnosis?
a. Acute cholecystitis
b. Alcoholic hepatitis
c. Choledocholithiasis
d. Heart failure
e. Viral hepatitis
22
90. A 24-year-old pregnant woman had just vaginally given birth to 3.2 kg healthy d
infant; thirty-six hours after her delivery she started to have vaginal bleeding.
Which is the most common cause of late postpartum hemorrhage?
a. Bleeding disorders
b. Cervical lacerations
c. Bleeding from uterine myomas
d. Retained placental fragments
e. Uterine atony
91. A previously healthy 42-year-old male who is not on any medication has blood b
drawn for a routine pre-employment check-up. Laboratory studies are normal
except for a potassium level of 5.4 mmol/l (N: 3.5-5.0). Which one of the
following would be the most appropriate next step?
a. Obtain an ECG to rule out T-wave abnormalities
b. Repeat the blood sample collection
c. Prescribe oral sodium polystryrenesulfonate
d. Administer intravenous calcium
e. Administer intravenous insulin followed by an inhaled β2-agonist
92. A 14-year-old boy presents with tenderness associated with the right breast. e
There are no other findings. Testicular examination is unremarkable.
Appropriate management of this patient includes:
a. Mammogram
b. Ultrasound of the breast
c. Genetic typing
d. Biopsy
e. Reassurance and continued observation
93. Papillary tumors of the base of the bladder are usually treated by: a
a. Transurethral resection
b. Segmental cystectomy
c. Total cystectomy
d. Radiotherapy
e. Suprapubic fulguration
94. Adrenal incidentaloma is usually a: d

a. Pheochromocytoma
b. Hyperaldosteronism adenoma
c. Cortical cancer
d. Non secreting adenoma
e. None of the above
23
95. After an acute toxic event as a febrile illness, how long would you expect c
sperm counts to be depressed:
a. 1 week
b. 3 weeks
c. 3 months
d. 6 months
e. 1 year
96. A 40-year-old man presents for incapacity of abduction of the shoulder d

following a direct fall. The x-rays are normal. He probably has a:
a. C6 paralysis
b. C7 paralysis
c. C8 paralysis
d. Tear of the rotator cuff
97. Compression of the neural elements facing the L2 vertebra can result in all of d
the following except:
a. Entrapment of L2 root
b. Entrapment of the Cauda equina
c. Entrapment of the L5 root
d. Cord compression
98. Most patients with acute gallstone pancreatitis are best treated by which of c
the following measures:
a. Urgent (within 24h) cholecystectomy and common bile duct exploration
b. Urgent ERCP and subsequent laparoscopic cholecystectomy
c. Initial supportive therapy with cholecystectomy during the same admission
d. Initial supportive therapy with cholecystectomy within 6-8 weeks
e. Initial supportive therapy with cholecystectomy only if symptoms recur
99. A 47-year-old woman with a history of breast pain presents with a recent c
onset of bilateral green nipple discharge. She has generalized bilateral
tenderness and no palpable mass on breast examination. The discharge is
hemoccult negative. Mammogram shows diffuse fibroglandular tissue that is
slightly more pronounced in the upper outer quadrants bilaterally but
unchanged from a year earlier. Which of the following is the most appropriate
first step in management?
a. Obtain an ultrasound scan
b. Perform an ultrasound-guided core biopsy
c. Reassure the patient
d. Obtain a galactogram
e. Excise the major retroareolar duct
24
100. A 30-year-old woman has had recurrent episodes of headache and sweating. d
Her mother had renal calculi and died of thyroid cancer. Physical
examination reveals a thyroid nodule but no clinical signs of thyroid
dysfunction. Before performing thyroid surgery, the woman’s physician
should order:
a. A thyroid scan
b. Measurement of serum thyroid-releasing hormone and thyroid-stimulating
hormone levels
c. A 24h urine test for 5-hydrocyindoleacetic acid excretion
d. Serial 24h urine tests for catecholamine, metanephrine, and vanillylmandelic
acid excretion
101. The ideal time to give immunizations to patients undergoing elective

splenectomy is:
a. At least 2 months before surgery
b. At least 2 weeks before surgery
c. In the holding area just prior to surgery
d. On the day of discharge from the hospital after splenectomy
102. Female of 35 years old presenting recurrent episodes of vertigo with d

complete remissions intervals, and reporting tinnitus and neurosensoriel
hearing loss of the right ear. What is the likely possible cause:
a. Benign positional paroxystic vertigo
b. Vestibular neuronitis
c. Multiple sclerosis
d. Meniere syndrome
103. A 40-year-old man without previous history presented for sudden acute c
headache. He vomited many times. On physical examination there was
meningeal syndrome with ptosis of the right upper lid and right dilated
pupil. His temperature was 37.8, pulse 75, BP 13/8. The most probable
diagnosis is:
a. Viral meningitis
b. Bacterial meningitis
c. Subarachnoid hemorrhage
d. Migraine
104. Noncontraceptive effects of combination (estrogen-progestin) oral d

contraceptives include all but which of the following?
a. Decreased incidence of dysmenorrhea
b. Decreased incidence of PID
c. Increased menstrual cycle regularity with decreased blood loss
d. Increased incidence of benign breast disease
25
105. Which of the following is the last to develop in dehydration? a

a. Hypotension
b. Tachycardia
c. Weight loss
d. Decreased urine output
e. Weakness
106. Which of the following statements concerning newborn babies is correct? d

a. Jaundice occurring on the first day of life is physiologic
b. Hydrocele should be drained as early as possible to prevent testicular atrophy
c. Eosinophilic rash (erythema toxicum) is an allergic manifestation
d. Ductus arteriosus usually closes physiologically within 48 hours
e. Facial petechiae at birth are indicative of hemorrhagic disease
107. Which of the following antibiotics is not active against B. fragilis?

a. Amoxicillin-clavulanate
b. Imipenem
c. Clindamycin
d. Ceftriaxone
e. Piperacillin-tazobactam
108. Which one of the following conditions is not a fungal disease? d

a. Aspergillosis
b. Zygomycosis
c. Sporotrichosis
d. Actinomycosis
e. Coccidioidomycosis
109. A lung cancer is considered non surgical if: c

a. Diaphragm invasion
b. Chest wall invasion
c. Superior vena cava invasion
d. Pericardial invasion
110. A 63-year-old man is in his 2nd postoperative day after an abdomino- e

perineal resection for cancer of the rectum. An indwelling Foley catheter
was left in place after surgery. Even though his vital signs have been stable,
his urinary output in the past 2 hours has been zero. In the preceding 3
hours, they had collected 56 ml, 73 ml, and 61 ml. Which of the following is
the most likely diagnosis?
a. Acute renal failure
b. Damage to the bladder during the operation
c. Damage to the ureters during the operation
d. Dehydration
e. Plugged or kinked catheter
26
111. A 57-year-old woman with a history of hypertension is brought to the e

emergency department because of acute onset of headache and loss of
balance for 2 hours. She is conscious and oriented to person, space, and
time. She feels nauseated and cannot walk or stand without help. Neurologic
examination reveals paralysis of conjugated lateral gaze to the right side.
There is no decrease in muscle strength or sensory loss. A CT scan of the
head reveals an intracerebellar hematoma. Which of the following is the
most appropriate next step in management?
a. Lumbar puncture
b. MRI of the head
c. Supportive medical treatment
d. Anticoagulant treatment
e. Immediate surgical evacuation
112. An 18-year-old girl presents to the emergency department with the sudden c
onset of watery diarrhea tinged with blood. The girl was previously healthy.
Her only medications are topical benzoyl peroxide and oral clindamycin for
acne vulgaris. Physical examination reveals a slightly distended abdomen
that is diffusely tender. Her temperature is 38.1C. She has not been exposed
to any uncooked meat and has not eaten any unusual food. Which of the
following is the most likely diagnosis?
a. Gastroenteritis
b. Irritable bowel syndrome
c. Pseudomembranous enterocolitis
d. Salmonella infection
e. Ulcerative colitis
113. A 50-year-old man presents with a history of recurrent attacks of headache, b

which manifest with a peculiar rhythmic pattern. Each attack begins on
awakening, approximately at the same time. He reports severe unilateral
pain localized in the right eye and temple, and accompanied by running
nose, lacrimation, and sweating on the same side. The attack spontaneously
resolves after 2 hours. Neither his siblings nor his parents had similar
headaches. His temperature is 37C, blood pressure is 130/80 mmHg, and
pulse is 80/min. His pupils are equal and normally reactive to light.
Fundoscopic examination is unremarkable. Which of the following is the
most likely diagnosis?
a. Acute glaucoma
b. Cluster headache
c. Giant cell arteritis
d. Trigeminal neuralgia
e. Migraine
27
114. A 44-year-old woman has palpable nodule in the right lobe of her thyroid d
gland. The nodule measures 2 cm and is firm. The rest of the thyroid gland
cannot be felt and is not tender. She also describes losing weight in spite of
an excellent appetite, palpitations, and heat intolerance. She is thin, and
constantly moving, with moist skin and a pulse of 105/min. She has no
exophtalmos or pretibial edema. Her TSH is reported as much lower than
normal, and she has elevated levels of free T4. Which of the following is the
most appropriate next step in diagnosis?
a. Exploratory neck surgery
b. MRI of the pituitary gland
c. Needle core biopsy of the thyroid mass
d. Radionuclide thyroid scan
e. Serum levels of T3
115. A 70-year-old man presents to the emergency department complaining of b

abdominal pain. He describes the pain as crampy and primarily in his left
lower quadrant. He has had minimal nausea, but complains of constipation.
His past medical history is significant for hypertension, hyperlipidemia,
gout, and diverticulosis. His medications include atenolol and simvastatin.
He is allergic to penicillin. His temperature is 38.0C, blood pressure is
140/60 mmHg, pulse is 100/min, and respirations are 20/min. His physical
examination is significant for tenderness to palpation at the left lower
quadrant without rebound or guarding. His rectal examination is guaiac
negative. His heart and lung examinations are unremarkable. Which of the
following is the most likely diagnosis?
a. Appendicitis
b. Diverticulitis
c. Diverticulosis
d. Ischemic colitis
e. Sigmoid volvulus
116. The most common site of duodenal ulcer perforation is: a

a. Anterior wall of the duodenal bulb
b. Posterior wall of the duodenal bulb
c. Post bulbar region of the duodenum
d. Duodenal fornix
e. Pyloric channel
117. The most frequent cause of anemia is: a

a. Iron deficiency
b. Vitamin B12 deficiency
c. Folic acid deficiency
d. Hypothyroidism
e. Renal failure
28
118. In a patient presenting with pharyngitis, which of the following is not e

consistent with Streptococcus pyogenes infection?
a. Fever
b. Tonsillar exsudates
c. Lymphadenopathy
d. Odynophagia
e. Hoarseness
119. A 45-year-old woman presents to clinic with a 4-month history of headaches c

and changes in her vision. She has been previously healthy and has not been
on any medications. On examination, she is found to have a small field defect
in both eyes. The diagnosis of a pituitary microadenoma is entertained.
Which of the following tests would be the most sensitive in diagnosis of such
an entity?
a. Computerized tomography (CT) scan
b. Insulin-tolerance test
c. Magnetic resonance imaging (MRI)
d. Serum prolactin measurement
e. Visual field examination
120. A 43-year-old woman comes to the office for evaluation of high blood c
pressure. She was informed that she had high blood pressure 1 week ago
during a routine screening at a local pharmacy. She has been previously
healthy and is on no medications. On examination today her blood pressure
is 145/95 mmHg. Which of the following is the most appropriate step in
management?
a. Advise her to monitor her blood pressure twice a day and return in 6 months
b. Ask her to return for reexamination after her next menstrual cycle
c. Ask her to return for reexamination in 2 weeks
d. Ask her to return for reexamination in 4 months
e. Measure her blood pressure after she exercises for 5 minutes
121. A leukemic patient develops profound neutropenia (WBC 100/mm3) after b

induction chemotherapy. He develops high grade fever that persists despite
three days of broad spectrum antibiotic therapy. A chest x-ray reveals a
large nodular infiltrate with cavitation and crescent sign consistent with
invasive aspergillosis. In the management of this patient, which of the
following anti-fungal agents is not active in this situation?
a. Amphotericin B
b. Fluconazole
c. Itraconazole
d. Voriconazole
e. Caspofungin
29
122. A patient is brought to the emergency department because of a suicidal e

attempt by ingesting massive doses of aspirin. Which of the following would
be helpful in managing this patient?
a. Acetaminophen
b. Amphetamines
c. N-Acetylcysteine
d. Phenobarbital
e. Sodium bicarbonate
123. Which of the following disorders is an indication for lithium therapy? d

a. Panic attacks
b. Schizophrenia
c. Obsessive-compulsive disorder
d. Bipolar disorder
e. Anxiety
124. Hypercalcemia is associated with: b

a. Non-Hodgkin’s lymphoma
b. Squamous cell lung cancer
c. Hodgkin’s lymphoma
d. Squamous cell head and neck cancer
e. Hypernephroma
125. All the following diseases may be associated with diarrhea EXCEPT: b
a. Addison’s disease
b. Hyperparathyroidism
c. Hyperthyroidism
d. Medullary thyroid carcinoma
e. Pheochromocytoma
126. Which of the following complications of adult onset diabetes type II is not e
seen in patients with juvenile onset diabetes type I?
a. Retinopathy
b. Kidney disease
c. Accelerated atherosclerosis
d. Autonomic neuropathy
127. Complications of long standing hypertension include all of the followings e

EXCEPT:
a. Diastolic heart failure
b. Coronary artery disease
c. Stroke
d. Peripheral vascular disease
e. Systolic heart failure
30
128. The following signs indicate subclinical organ damage from hypertension c
with the exception of:
a. Ultrasound evidence of carotid artery wall thickening
b. Increased arterial stiffness
c. Left atrial dilatation
d. Reduced creatinine clearance
e. Fundus arterial changes
129. The following are signs of congestive heart failure EXCEPT: d

a. Hepatomegaly at palpation
b. Lower limb edema
c. Bilateral pulmonary crackles at mid-fields
d. Elevated hyperventricular end-diastolic pressure
e. Hepato-jugular reflux
130. Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, d

all are true EXCEPT:
a. Occult infection
b. Aggressive diuresis
c. Diarrhea or constipation
d. Treatment with oral neomycin
e. Excess dietary proteins
131. The following agents are responsible of bloody diarrhea EXCEPT:

a. Rotavirus
b. Salmonella
c. Yersinia
d. Enterovirus
e. Shigella
132. An exercise-induced hemoptysis suggests the following diagnosis: b

a. Acute pneumopathy
b. Mitral stenosis
c. Interstitial lung fibrosis
d. Chronic bronchitis
e. Esophageal cancer
133. A young woman presents with fever at 39C of rapid onset with chills, dry c
cough, pharyngitis and conjunctivitis. Some rales and crackles are found at
examination. Most likely diagnosis is:
a. Acute lobar pneumonia
b. Legionellosis
c. Viral pneumopathy
d. Infectious mononucleosis
e. Tuberculosis
31
134. Drug-induced gynecomastia may be due to all of the following EXCEPT: e

a. Digoxin
b. Cimetidine
c. Stillboestrol
d. Spironolactone
e. Furosemide
135. The following symptoms and signs are found in facial nerve lesion EXCEPT: b
a. Disappearance of ipsilateral frontal wrinkles
b. Ipsilateral ptosis
c. Attraction of the mouth to the opposite side
d. Ipsilateral hyperacusis
e. Ipsilateral taste impairment
136. A 42-year-old man presents for sudden onset severe unusual headache for e
the last 2 days. His brain CT is reported normal. What is the next step?
a. Send him home with analgesics
b. Ask for a Doppler of neck vessels
c. Give him an antihypertensive drug because his BO was 165/82 mmHg
d. Ask for an ophthalmologic exam to rule out acute glaucoma
e. Admit him for a lumbar puncture
137. A 45-year-old man presents to the ED for acute abdominal pain and vomiting a
few hours after having drinked a bottle of whisky. His abdominal exam is
normal but he is tachyarrythmic. Blood work reveals hypertriglyceridemia
and mild hypoglycemia. Most likely diagnosis for this alcoholic patient is:
a. Acute pancreatitis
b. Hepatic cirrhosis
c. Mallory-Weiss syndrome
d. Aortic dissection
e. Acute myocardial infarction
138. A woman presents for possible psoriasis under her breasts. In which other e
areas would you look for psoriatic lesions: (One is false)
a. Nails
b. Umbilic
c. Scalp
d. Between buttocks
e. Palms and soles
139. Patients starting treatment with an SSRI for depression can expect c
improvement after:
a. Few days
b. 1-2 weeks
c. 2-4 weeks
d. 4-6 weeks
e. >3 months
32
140. The most common cancer of the pancreatic head can be revealed by the c
following symptoms and signs, EXCEPT:
a. Weight loss
b. Jaundice
c. Esophageal varices
d. Abdominal pain
e. Palpable gallbladder
141. From the following local ocular treatments, which one is prescribed for b
acute glaucoma?
a. Atropine
b. Pilocarpine
c. Neosynephrine
d. Antibiotic
e. Occlusive dressing
142. A 63-year-old patient presents with non painful claudication and weakness d
of both lower limbs. He has brisk reflexes of the 4 limbs. What is the first
investigation to do for this patient?
a. Lumbar MRI
b. Cerebral MRI
c. Lumbar puncture
d. Cervical MRI
e. EMG of lower limbs
143. What is the most appropriate treatment for a patient presenting with a d
cauda equina syndrome since 6 hours due to an L4-L5 voluminous disc
herniation?
a. Oral steroids
b. IV steroids
c. Epidural steroids
d. Surgery
e. Nonsteroidal anti-inflammatory drug with bed rest and physiotherapy
144. Most serious complication of a large abdominal aortic aneurysm is: a

a. Rupture
b. Infection
c. Embolization to tibial artery
d. Compression of neighboring organs
e. All are serious
145. Concerning arterial intermittent claudication of lower limbs: b

a. Numbness of lower limbs relieved by rest
b. Cramps relieved by rest
c. Patients cannot walk more than 10 meters
d. Is always associated with a limited toe gangrene
e. Is always due to diabetic arteriopathy
33
146. In front of a patient in the Emergency room with a severe arterial bleeding c
from a popliteal wound, leg ischemia and hypotension, the first action
should be:
a. Blood transfusion
b. Heparin to prevent leg gangrene
c. Stop bleeding
d. Perfusion of Ringer lactate
e. Send the patient to the Operating Room after contacting the surgeon and the
anesthesiologist
147. An intracranial hypertension of recent onset is characterized by the c

following, EXCEPT:
a. Headache
b. Bilateral papilledema
c. Severe loss of visual acuity
d. Abducens (VI nerves) paresis
e. Enlargement of blind spots on Campometry
148. The following signs suggest hydrocephalus in the neonate, EXCEPT: c

a. Bombing fontanelle
b. Eyes in sunset position
c. Diarrhea
d. Increased head circumference
e. Vomiting
149. Hypertrophic pyloric stenosis: c

a. Is often revealed by regurgitations starting on 3rd month of life
b. Can be accompanied with conjugated bilirubin jaundice
c. Is diagnosed by abdominal ultrasound
d. Needs anti-reflux treatment before operation
e. Provokes hypocalcemia
150. The following are indications of head CT and in-hospital surveillance after b
head injury in a child, EXCEPT:
a. Loss of consciousness for more than 3 min
b. Hemorrhagic scalp wound
c. Prolonged post-traumatic amnesia
d. Central neurological signs or symptoms
e. Signs of base of skull injury
34
151. What is your diagnosis for a child, who does not like to communicate with c
others, prefers isolation, does not speak or says words without relational
value and in whom auditory problems have been ruled out by appropriate
ENT exam?
a. Stuporous state
b. Mental retardation
c. Autism
d. Infantile schizophrenia
e. Infantile neurosis
152. A healthy 19-year-old primigravida is in the 12th week of her pregnancy b

when she develops vaginal spotting of blood and mild cramping abdominal
pain. The pregnancy up to that point has been uncomplicated. On physical
examination she is afebrile. There is minimal vaginal bleeding but no
exudate. A spontaneous abortion occurs a day later. Which of the following
conditions is most likely to produce these findings?
a. Placental insufficiency
b. Chromosomal abnormality
c. Congenital infection
d. Toxemia of pregnancy
e. Maternal drug use
153. A 20-year-old G2P1 woman has had an uncomplicated pregnancy, but she b
has received no prenatal care. She goes into labor at term. During the birth
process, she experiences sudden extensive hemorrhage evidenced by
profuse vaginal bleeding. The baby is liveborn and weighs 2790 g. Which of
the following is the most likely diagnosis?
a. Umbilical cord prolapse
b. Placenta previa
c. Chorioamnionitis
d. Placental infarction
e. Gestational diabetes
154. In pregnancy, aspirin may be prophylactically used in: a

a. Women with history of early onset preeclampsia
b. In all pregnancy women aged >35
c. Never because of perinatal adverse effects
d. Only if DBP is >100 mmHg
e. In women with chronic daily headache
155. The following conditions are causes of central amenorrhea EXCEPT: c

a. Intensive exercise
b. Prolonged fasting
c. Menopause
d. Physical stress
e. Psychological stress
35
156. In polycystic ovaries: d

a. Cysts are usually located around the hilum
b. Endometer is atrophic
c. Ratio LH/FSH is decreased
d. Most of the cycles are non-ovulatory
e. Progesterone is secreted more than estrogens
157. In the workup of infertile couple, the husband’s semen analysis reveals the d
following: a sperm count of 59 million/ml, motility of 60%, volume of 4 ml;
normal morphology of 20%, and a pH of 7.3. Which of the following
parameters is outside normal value?
a. Sperm count
b. Motility
c. Volume
d. Morphology
e. pH
158. In transient synovitis all of the following are true except one: e
a. Typically affect the hip
b. Sedimentation rate is normal
c. Boys are affected more than girls
d. Is preceded by a respiratory infection
e. Etiology is viral
159. Jaundice associated with severe pruritis is usually due to: d

a. Viral hepatitis
b. Drug-induced hepatotoxicity
c. Non-alcoholic hepatosteatosis
d. Obstructive jaundice
e. Hemolysis
160. Hepatomegaly may be due to the following cardiovascular processes e

EXCEPT:
a. Congestive heart failure
b. Constrictive pericarditis
c. Tricuspid regurgitation
d. Restrictive cardiomyopathy
e. Bacterial endocarditis
161. Which of the following is least likely to cause deep venous thrombosis? c
a. Heart failure
b. Pulmonary hypertension
c. Systemic hypertension
d. Prolonged airline travel
e. Pregnancy
36
162. Which of the following may be used to prevent calcium stone formation in a
the urinary tract?
a. Thiazide diuretics
b. Furosemide
c. Allopurinol
d. Colchicine
e. Biphosphonates
163. Which of the following complications of diabetes is not seen in adult onset b
diabetes (type II) as compared to juvenile onset diabetes (type I)?
a. Retinopathy
b. Ketoacidosis
c. Kimmelstiel Wilson glomerulopathy
d. Accelerated arteriosclerosis
e. Autonomic neuropathy
164. Which of the following neurotransmitters is thought to be deficient in c

Alzheimer’s disease?
a. Serotonin
b. Somatostatin
c. Acetylcholine
d. Noradrenaline
e. Gamma aminobutyric acid
165. In a patient with myoglobinuria, what would be the expected urinalysis c

finding?
a. Positive for hemoglobin and red blood cells
b. Negative for hemoglobin and red blood cells
c. Positive for hemoglobin, no red blood cells
d. Positive for hemoglobin and red blood cell casts
e. Negative for hemoglobin and red cell casts
166. An initial hematuria is associated with: e

a. Renal cell carcinoma
b. Ureteral lithiasis
c. Bladder papilloma
d. Invasive bladder transitional cell carcinoma
e. Prostatitis
167. Which manifestation of systemic lupus erythematosus is most predictive of a b

poor outcome?
a. Discoid rash
b. Lupus nephritis
c. Pleuritis
d. Pericarditis
e. Arthritis
37
168. Which organism is not a cause of pelvic inflammatory disease? c

a. Neisseria gonorrhea
b. Chlamydia trachomatis
c. Staphylococcus aureus
d. Escherichia coli
e. Bacteroides fragilis
169. Older people are at increased risk of drug toxicity because: e

a. Because they receive a multiple of drugs
b. Because of age-related changes in pharmacokinetics
c. Because of poor compliance
d. Because of loss of organ function
e. All of the above
170. As soon as she returns home from the hospital, three days after delivering a c
healthy baby girl, a 23-year-old woman becomes increasingly irritable and
tearful. She constantly worries about the baby, fearing she won’t be an
adequate mother. What is the most likely diagnosis?
a. Postpartum psychosis
b. Adjustment disorder
c. Postpartum blues
d. Major depressive episode
171. A 28-year-old man with chronic nephritis comes to the clinic for a checkup. b
He has a creatinine of 6.7 mg/dl, urea nitrogen of 70 mg/dl, and hemoglobin
of 8.4 g/dl. His platelet count is 200,000/mm3. He feels well except for some
mild fatigue with exercise. His blood pressure is 140/80 mmHg, his lungs are
clear. His heart is regular with a soft systolic murmur. His abdomen is soft.
He is guaiac negative for occult blood. His ferritin level is 200 ng/ml and his
iron saturation is 25%. His mean corpuscular volume is 85 m3. Which of
the following would be the most appropriate treatment for his anemia?
a. No treatment, follow values
b. Erythropoietin
c. Folic acid
d. Trial of iron therapy
e. Blood transfusion
172. Of the following, the finding that is most indicative of bacterial endocarditis a
in an adolescent who has mitral valve prolapse is:
a. Blood culture positive for streptococcus viridans
b. Echocardiographic evidence of valve thickening and redundancy
c. Fever and splenomegaly
d. Microscopic hematuria
e. Mitral regurgitation murmur and fever
38
173. A 40-year-old man presents for incapacity of abduction of the shoulder d

following a direct fall. The x-rays are normal. He probably has a:
a. C6 paralysis
b. C7 paralysis
c. C8 paralysis
d. Tear of the rotator cuff
174. All the following diseases may be associated with diarrhea EXCEPT: b
a. Addison’s disease
b. Hyperparathyroidism
c. Hyperthyroidism
d. Medullary thyroid carcinoma
e. Pheochromocytoma
175. Which of the following statements about patients with borderline-high a

triglyceride levels (150 to 199 mg/dl) is correct:
a. They should be screened for metabolic syndrome
b. Triglyceride reduction is the primary goal of treatment
c. Most should receive fibrate therapy
d. Most should receive niacin therapy
176. A 50-year-old woman reports night sweats and hot flushes. Which blood test d
would you order to confirm menopause?
a. LH
b. Progesterone
c. Prolactin
d. FSH
e. Testosterone
177. You are seeing a 55-year-old man who presents with syncope. Regarding of c
the cause, which of the following tests is always indicated in the workup?
a. Complete blood count
b. Thyroid stimulating hormone (TSH)
c. ECG
d. Holter monitoring
e. Ambulatory loop ECG
178. A 40-year-old woman presents with weakness, fatigue, anorexia, and weight b
loss. Her blood pressure is 90/60; she has diffuse skin and mucous
membranes hyperpigmentation. Her serum sodium is low and serum
potassium high. The most likely diagnosis is:
a. Hypothyroidism
b. Adrenal failure
c. Pituitary adenoma
d. Hyperaldosteronism
e. Ovarian tumor
39
179. Multivitamin supplements in the geriatric age group: a

a. Are not recommended for prevention of any disorder
b. Should be prescribed to reduce elevated homocysteine levels
c. Decrease coronary atherosclerosis
d. Decrease the incidence of lung cancer
e. Decrease the incidence of colon cancer
180. A 40-year-old male complains of hematuria and an aching pain in his flank. b
Laboratory data show normal BUN, creatinine, and electrolytes. Hemoglobin
is elevated at 18 g/dl, and serum calcium is 11 mg/dl. A solid renal mass is
found by ultrasound. The most likely diagnosis is:
a. Polycystic kidney disease
b. Renal carcinoma
c. Adrenal adenoma
d. Urolithiasis
GOOD LUCK
40
ANSWERS
1. b 2. c 3. a 4. a 5. b 6. b 7. c 8. a 9. d 10. a
11. c 12. c 13. b 14. a 15. b 16. b 17. a 18. b 19. c 20. c
21. b 22. b 23. b 24. a 25. c 26. c 27. b 28. a 29. b 30. c
31. c 32. c 33. d 34. b 35. c 36. c 37. a 38. a 39. d 40. c
41. c 42. c 43. a 44. b 45. c 46. d 47. c 48. a 49. b 50. b
51. e 52. b 53. c 54. c 55. b 56. b 57. d 58. c 59. a 60. b
61. e 62. d 63. c 64. c 65. b 66. d 67. e 68. b 69. c 70. c
71. d 72. a 73. c 74. e 75. d 76. a 77. b 78. b 79. c 80. b
81. e 82. b 83. d 84. d 85. a 86. d 87. c 88. a 89. b 90. d
91. b 92. e 93. a 94. d 95. c 96. d 97. d 98. c 99. c 100. d
101. b 102. d 103. c 104. d 105. a 106. d 107. d 108. d 109. c 110. e
111. e 112. c 113. b 114. d 115. b 116. a 117. a 118. e 119. c 120. c
121. b 122. e 123. d 124. b 125. b 126. e 127. e 128. c 129. d 130. d
131. d 132. b 133. c 134. e 135. b 136. e 137. a 138. e 139. c 140. c
141. b 142. d 143. d 144. a 145. b 146. c 147. c 148. c 149. c 150. b
151. c 152. b 153. b 154. a 155. c 156. d 157. d 158. e 159. d 160. e
161. c 162. a 163. b 164. c 165. c 166. e 167. b 168. c 169. e 170. c
171. b 172. a 173. d 174. b 175. a 176. d 177. c 178. b 179. a 180. b
41

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Medicine Colloquium Exam – Second Session 2010

Ministry of Education and Higher Learning

1. A 40-year-old female nurse was admitted to the hospital because of fever to b

4. A 60-year-old male complains of pain in both knees coming on gradually over a

5. A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, b

6. A 50-year-old patient with long-standing chronic obstructive lung disease b

7. A 70-year-old patient with chronic obstructive lung disease requires 2L of c

8. A 35-year-old female complains of slowly progressive dyspnea. Her history is a

9. A 75-year-old female is admitted with acute myocardial infarction and d

10. A 72-year-old male comes to the office with intermittent symptoms of a

12. A 35-year-old male complains of substernal chest pain aggravated by c

14. A 30-year-old female complains of fatigue, constipation, and weight gain. a

18. A 52-year-old man complains of impotence. On physical examination he has b

21. A 43-year-old female presents with hypertension, edema, hyperlipidemia, and b

22. A 63-year-old male alcoholic with a 50-pack-year history of smoking presents b

23. A 35-year-old female who is recovering from Mycoplasma pneumonia b

The most likely diagnosis is:

25. A 60-year-old asymptomatic man is found to have a leukocytosis when a c

26. A 38-year-old female presents with recurrent sore throats. She is on no c

27. A 50-year-old female complains of vague abdominal pain, constipation, and a b

30. A 64-year-old male is hospitalized with a transient ischemic attack and is c

31. A 40-year-old cigarette smoker is found on routine physical exam to have a 1 c

32. A 30-year-old female with Grave’s disease has been started on c

34. A 70-year-old male complains of the sudden onset of syncope. It occurs b

36. A 45-year-old, generally healthy female on no medications comes to your c

38. A 20-year-old college basketball player is brought to the university urgent a

43. A 20-month-old child is brought to the emergency department because of a

47. A 9-month-old infant accidentally ingests an unknown quantity of digitalis. c

55. Examination of the cerebrospinal fluid of an 8-year-old, mildly febrile child b

56. A 6-year-old child is hospitalized for observation because of a short period of b

57. A 17-year-old male complains of acute, painful, scrotal swelling. Ultrasound of d

59. A 14-month-old infant suddenly develops a fever of 40.2C. Physical a

60. On a routine screening complete blood count, a 1–year-old is noted to have a b

62. An adolescent with type I diabetes has a dramatically elevated glycosylated d

73. A 35-year-old man presents with a moderately tender, hard thyroid, c

78. A 32-year-old woman is diagnosed to have Trichomonas. She is entirely b

84. A 32-year-old woman on a combined oral contraceptive pill plans to travel by d

85. A 20-year-old male presents for physical examination. He has no medical a

88. A 2-month-old infant has a 5 cm strawberry hemangioma on the cheek that is a

94. Adrenal incidentaloma is usually a: d

96. A 40-year-old man presents for incapacity of abduction of the shoulder d

101. The ideal time to give immunizations to patients undergoing elective

102. Female of 35 years old presenting recurrent episodes of vertigo with d

104. Noncontraceptive effects of combination (estrogen-progestin) oral d

105. Which of the following is the last to develop in dehydration? a

106. Which of the following statements concerning newborn babies is correct? d

107. Which of the following antibiotics is not active against B. fragilis?

108. Which one of the following conditions is not a fungal disease? d

109. A lung cancer is considered non surgical if: c

110. A 63-year-old man is in his 2nd postoperative day after an abdomino- e

111. A 57-year-old woman with a history of hypertension is brought to the e

113. A 50-year-old man presents with a history of recurrent attacks of headache, b

115. A 70-year-old man presents to the emergency department complaining of b

116. The most common site of duodenal ulcer perforation is: a

117. The most frequent cause of anemia is: a

118. In a patient presenting with pharyngitis, which of the following is not e

119. A 45-year-old woman presents to clinic with a 4-month history of headaches c

121. A leukemic patient develops profound neutropenia (WBC 100/mm3) after b

122. A patient is brought to the emergency department because of a suicidal e

123. Which of the following disorders is an indication for lithium therapy? d

124. Hypercalcemia is associated with: b

127. Complications of long standing hypertension include all of the followings e

129. The following are signs of congestive heart failure EXCEPT: d

130. Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, d