Review Quiz
Review Quiz
Review Quiz
1) An elderly male with pain in his left hip is 3) A 24 week pregnant woman is in need of an
scheduled for a hip arthroplasty. He emergency appendectomy. All are
requests to have a spinal anesthetic. All are physiologic changes in pregnancy EXCEPT:
potential complications of a spinal a) Decreased gastroesophageal sphincter
anesthetic EXCEPT: tone
a) Hypotension b) Decreased haemoglobin
b) Infection at site c) Decreased coagulation factors
c) Hematoma at site d) Decreased Functional Residual Capacity
d) Local anesthetic toxicity e) Decreased Systemic Vascular
e) Nausea & Vomiting Resistance
1. E 2. E 3. C
Cardiology and CVS
1) Each of the following has been shown to 6) Which of the following is not a mechanism
improve mortality in heart failure patients for atrial fibrillation affecting cardiac function:
except: a) Decreased time for diastolic filling
a) Beta blocker b) Decreased ventricular compliance
b) ACEI c) Irregular ventricular response
c) Loop diuretic d) Loss of atrial contraction
d) Aldosterone antagonist e) Decreased time for coronary perfusion
e) Nitrate
1. A 2. D
Dermatology
2) A 8-year-old black boy presented with a 6) 8 year-old black male comes in with an
round, scaly patch of hair loss on the asymptomatic erythematous eruption
occipital scalp with scale and occasional characterized by oval patches with collarette
pustules. The most appropriate scaling. It is distributed as a "Christmas
management is: tree" pattern on the back. Father states that
a) Topical antifungal there was originally one lesion on the
b) Topical antibiotic abdomen a few weeks prior. What is the
c) Oral antifungal most likely diagnosis:
d) Intralesional corticosteroid injections a) Pityriasis rosea
e) Oral antibiotic b) Tinea corporis
c) Lichen planus
d) Psoriasis
3) A 29-year-old woman presents with a 5 day e) None of the above
history of arthralgias and a purpuric eruption
on the lower legs. The most appropriate
initial management is: 7) 30 year-old female comes in with a soft
a) Topical cortyicosteroids smooth, glistening, erythematous nodule on
b) Oral corticosteroids her lower lip. She states that a few weeks
c) Compression of the lower legs prior she had some chapped lips with
d) Reassurance occasional bleeding. Now, the lips have
e) Urinalysis healed but this lesion arose suddenly in its
place. It is occasionally tender on pressure.
The most likely diagnosis is:
4) The following statements regarding contact a) HSV1
dermatitis are true EXCEPT: b) Cherry hemangioma
a) Phototoxic dermatitis following topical c) Pyogenic granuloma
application of creosote requires UV light d) Dermal nevus
b) Photoallergic contact dermatitis requires e) None of the above
UV light to be manifested
c) Contact eczema involves a type IV
delayed hypersensitivity reaction
d) Contact urticaria or hives is a common
form of dermatitis
e) Chemical burns by HCl and KOH may
result in an irritant contact dermatitis
8) An 11 year-old male comes in with 12) Which of the following is associated with
erythematous pustules, inflamed nodules thyroid disease?
and cysts with some scaring distributed on a) Neurofibromatosis
the face predominantly. Diagnosis of acne b) Vitiligo
vulgaris was given. Topical erythromycin c) Erythema nodosum
was used for 2 weeks, several months ago, d) Pemphigus vulgaris
with no response. What treatment would you e) Icthyosis vulgaris
prescribe now?
a) Isoretinoin immediately
b) Topical tretinoin
c) Topical benzoyl peroxide
d) Topical antibiotic other than erythromycin
e) Oral antibiotic
f) Oral antibiotic and topical tretinoin
1. D 4. D 7. C 10. C
2. C 5. B 8. F 11. D
3. E 6. A 9. C 12. B
Diagnostic Medical Imaging (Radiology)
1) CXR of a newborn showing a 5) CXR showing tension pneumothorax.
hypodensity in the left side. The child is Separation of visceral and parietal pleura
in respiratory distress. What is your initial (density), hyperlucent small dilated lung,
management? with lack of peripheral lung markings.
a) Needle aspiration of the left lung What is the management?
b) Intubation and ventilation 1 – needle aspiration
c) expectant therapy 2 – chest tube drainage
d) IV N/S bolus 3 – intubation
e) Thoracotomy 4 – air tight dressing
5 – surgery
1. B 5. C 9. C 13. B 17. D
2. D 6. C 10. D 14. B 18. E
3. D 7. A 11. A 15. E 19. D
4. A 8. C 12. B 16. A
Emergency Medicine
1) A 27 year-old man is brought into the ER 4) Prolonged vomiting is associated with what
after a bicycling accident. A car door electrolyte abnormality?
suddenly opened in front of him, of which he a) Hypochloremic hypokalemic metabolic
smashed into and was thrown 15 feet. On acidosis
examination, he is drowsy and confused. He b) Hypochloremic hypokalemic metabolic
opens his eyes when his name is called. He alkalosis
mumbles words that you understand but the c) Hyperchloremic metabolic acidosis
sentences do not make sense. He moves all d) Hyperkalemia
four limbs but does not respond to any e) None of the above
commands. He is able to pull both hands
away when pinched and squirms when his
sternum is rubbed, making no effort to stop 5) A 37 year-old male arrives at the
you. What is his Glasgow COMA Scale Emergency Department unconscious. He is
score? warm and sweaty. His heart rate is 52 bpm,
a) 10 his BP is 90/60. His pupils are constricted,
b) 11 his eyes are teary, and he is drooling. You
c) 9 assume he is suffering from a toxidrome.
d) 8 What antidote will you give him?
e) 7 a) Flumazenil
b) Naloxone
c) Glucagon
2) Which of the following are not consistent d) Atropine
with primary (spontaneous) bacterial e) Ethanol
peritonitis?
a) Abdominal discomfort and fever
b) Ascitic fluid neutrophil count of> 250x106 6) A 16 year-old girl is brought to hospital by
cells/L her frantic parents after a bee sting. Vitals
c) Ascitic fluid WBC count of >500x106 signs are BP 70/40, RR 30 and laboured,
cells/L HR 140, T 37.5. Which of the following
d) Multiple organisms on culture and would not be an option in her management?
sensitivity of ascitic fluid a) Epinephrine
b) Diphenhydramine
c) Methylprednisolone
3) A 25 year-old known substance abuser is d) Salbutomol
brought to the ED with a suspected e) Atropine
overdose. Which of the following is not
considered a universal antidote?
a) Glucose 7) Tension pneumothorax is best diagnosed
b) Oxygen with:
c) Calcium gluconate a) Stat CT scan
d) Naloxone b) Chest x-ray
e) Thiamine c) Watch and wait
d) Clinical exam
e) None of the above
8) A patient presents with decreased level of
consciousness. On exam he has pinpoint
pupils and is unresponsive. Which of the
following is NOT a likely etiology?
a) Cerebellar infarct
b) TCA overdose
c) Morphine overdose
d) Pons hemorrhage
e) Ethanol overdose
1. A 3. C 5. D 7. D 9. D
2. D 4. B 6. E 8. B
Endocrinology
1) A 76 year old man from a nursing home is 3) A 37 year old female is referred to you, an
brought into the emergency department endocrinologist, because she is concerned
after staff notice a decreased level of about her weight. She is obese with a BMI
consciousness. He has Type II diabetes of 35.2. On her last physical, her family
mellitus and is diagnosed with doctor found her LDL level to be extremely
hyperosmolar state. All of the following elevated. Her only medications are
may be features of hyperosmolar state acetaminophen PRN for headache and
EXCEPT: quetiapine, which she has been taking for
a) Hyponatremia the past several years for anxiety and to
b) Positive ketones on urine dipstick help her sleep at night. As you chat with
c) Positive glucose on urine dipstick her, you learn she has never married and
d) Elevated blood glucose level never had any children. In fact, she admits
e) History of decreased fluid intake to having few social supports. Apparently,
she has had poor self esteem since she
was young because of unwanted hair
2) All of the following are complications of growth and obesity. She agrees that she
diabetes mellitus EXCEPT: uses food for comfort. Which of the
a) Retinal detachment following statements apply to this case?
b) Gangrene in the feet a) She is at risk for osteoarthritis in the
c) Calcification of cartilage future
d) Abdominal bloating b) You should order gonadotropin levels in
e) Urinary retention her
c) She should be referred to a dietician
d) She should be started on cholesterol
lowering medications immediately
e) With such a high BMI, she should be
initiated on orlistat (pancreatic lipase
inhibitor) immediately
1. B 3. E 5. D 7. D 9. D
2. C 4. B 6. D 8. E 10. D
Ethical, Legal and Organizational
1) To qualify for federal contributions, 4) Which one of the following would justify a
provincial health insurance plans must patient's being declared incompetent with
guarantee all of the following, EXCEPT: respect to self care?
a) Benefits include all necessary hospital a) The patient has a major mental disorder
care and physicians' services b) The patient has been admitted to
b) Universal coverage on uniform terms hospital
and conditions c) The patient is undergoing
c) Portability of coverage from province to psychotherapy
province d) The patient is unable to understand the
d) Benefits include all necessary out-of- consequences of his/her decisions
hospital drugs, dental care and e) The patient is unable to work because of
prostheses a mental disorder
e) Administration on a non-profit basis
1. D 3. D 5. A 7. B 9. B
2. D 4. D 6. C 8. C 10. D
Family Medicine
1) For anxiety, each of the following 5) A patient presents to the office requesting
pathologies should be considered in the assistance with quitting smoking. You are
differential EXCEPT: considering prescribing buproprion.
a) Arrhythmia Contraindications to this prescription include
b) Asthma/COPD all of the following EXCEPT:
c) Drug-induced a) Concurrent use of nicotine replacement
d) Acute renal failure therapy
e) Pheochromocytoma b) Seizure disorder
c) Eating disorder
d) Previous anaphylactic reaction to
2) A poor response to anti-hypertensive buproprion
therapy could be attributed to each of the e) MAOI use in the past 14 days
following EXCEPT:
a) Suboptimal regimen (e.g. insufficient
dose, inappropriate combination) 6) You suspect that a patient may have
b) Poor compliance developed a drinking problem over the last
c) Oral contraceptives few years, so decide to order some
d) Licorice bloodwork. All of the following are in keeping
e) Low sodium diet with your suspicions EXCEPT:
a) Elevated GGT
b) Elevated platelets
3) Which statement is correct regarding fecal c) Elevated AST
occult blood testing? d) Decreased hemoglobin
a) Every 1 to 2 years starting at 40 years e) Increased INR
old for the general population
b) Every 1 to 2 years starting at 50 years
old for the general population 7) The following is TRUE with regards to
c) Every 3 to 5 years starting at 55 years asthma:
old if a family history of colorectal cancer a) Onset typically occurs > age 10
d) Every 5 years starting at 50 years old for b) It is a restrictive airway disease
the general population c) Warm air is a common asthma attack
e) Unnecessary if the patient has ever had precipitator
a colonoscopy d) Symptoms are due to bronchial
inflammation and bronchodilation
e) Chest x-ray is often normal
4) Which of the following is NOT a major risk
factor for coronary artery disease?
a) Smoking 8) Patient SL presents with symptoms typical
b) Hypertension of a common cold. The organism most likely
c) Sedentary Lifestyle to be responsible is:
d) Family History a) Respiratory syncitial virus
e) Diabetes b) Parainfluenza virus
c) Adenovirus
d) Rhinovirus
e) Coxsackie virus
9) Which of the following is NOT a selective 11) Which of the following is NOT TRUE when
serotonin reuptake inhibitor? considering treatment of a patient with
a) Venlafaxine dysuria?
b) Paroxetine a) Risk factors for complicated UTIs include
c) Fluoxetine male sex, indwelling catheter and
d) Sertraline immunosuppresion
e) Citalopram b) Patients should always be treated for
both gonorrhea and chlamydia, even if a
positive result for only one of these is
10) Which of the following IS a diagnostic obtained
criteria for diabetes mellitus? c) Prophylactic antibiotics may be
a) HbA1c greater than 6% considered in a patient with recurrent
b) Fasting blood glucose greater or equal to UTIs (>3 per year)
6.0 mmol/L d) Pregnant women with bacteruria should
c) Random blood glucose greater than 10 not be treated if asymptomatic
mmol/L e) In adulthood, dysuria is more common in
d) Blood glucose 2 hours post OGTT women than men
greater than 10 mmol/L
e) HbA1c greater or equal to 7%
12) Mrs. HA presents to your office for the first
time complaining of headaches. Of the
following symptoms, which is the LEAST
worrisome?
a) Sudden onset of severe headache
b) Headache is accompanied by nausea
and vomiting
c) Headache is present on awakening
d) New onset headache > 50 years of age
e) Headache accompanied by neck
stiffness
ANSWERS
1. D 4. C 7. E 9. A 11. D
2. E 5. A 8. D 10. E 12. E
3. B 6. B
Gastroenterology
20. Which of the following statements is 25. Which of the following conditions favor
false? small bowel bacterial growth?
a) Most patients with acute diarrhea a) Diabetic gastroparesis
require antibiotics b) Hypochlorhydia
b) Correction of fluid and electrolyte c) AIDS
imbalance is the first step in the d) Fistula between large and small
treatment of acute diarrhea bowel
c) Antimotility agents should be e) All of the above
used with caution in the treatment
of diarrhea in IBD patients
d) Enteric salmonella infection must 26. Which of the following laboratory
be treated with antibiotics findings is least likely to be found in the
e) None of the above setting of malabsorption?
a) Iron deficiency
b) Ca deficiency
21. Which of the following must be avoided c) B12 deficiency
in patients with celiac sprue? d) Decreased PT
a) Wheat e) None of the above
b) Barley
c) Rye
d) Oats 27. Which of the following is likely in
e) All of the above untreated malabsorption?
a) Steatorrhea
b) Night blindness
22. What diseases are associated with c) Bone pain
celiac sprue? d) Glossitis
a) IDDM e) All of the above
b) Autoimmune thryoiditis
c) Dermatitis herpetiformis
d) IgA deficiency 28. Which of the following is least common
e) All of the above in IBS?
a) Mucus on the stool
b) Bloating
23. What is malabsorbed after proximal c) Sensation of incomplete fecal
bowel resection? evacuation
a) Ca d) Abdominal pain worsens after a
b) Folic acid bowel movment
c) Iron e) Alternating diarrhea and
d) None of the above constipation
e) All of the above
29. Which of the following extraintestinal 33. Which of the following is not a major
manifestations of IBD occurs cause of acute hepatitis?
independently of intestinal disease a) Hepatitis A
activity? b) Epstein-Barr virus
a) Uveitis c) CMV
b) Episcleritis d) Toxin exposure
c) Erythema nodosum e) None of the above
d) Peripheral arthritis (e.g. knee)
e) Primary sclerosing cholangitis
34. Which patients with hepatitis should be
admitted?
30. Which of the following constitutes the a) Coagulopathic patients
ED management of IBD? b) Patients who are actively
a) Analgesia bleeding
b) Sulfasalazine c) Encephalopatic patients
c) Steroids d) Those whose social situation
d) Antidiarrheal agents would make proper care difficult
e) All of the above e) All of the above
31. Which of the following statements is true 35. Which of the following constitutes the
of bowel disorders? mainstays of treatment in hepatic
a) Appendicitis is a common encephalopathy?
condition with unusual a) Supportive care
presentations; therefore, always b) Lactulose
consider appendicitis in a patient c) Neomycin
with abdominal pain d) Low-protein diet
b) A patient with atrial fibrillation and e) All of the above
abdominal pain has mesenteric
ischemia until proven otherwise.
c) IBD can cause complicated rectal 36. Which of the following is a complication
abscesses or fissures which may of chronic liver disease?
require surgical consultation a) Spontaneous bacterial peritonitis
d) Postoperative adhesions, b) Esophageal varices
incarcerated hernias and cancer c) Increase risk of bleeding
are the most common causes of d) Hepatorenal syndrome
small bowel obstruction e) All of the above
e) All of the above
41. Interferon is commonly used in the 46. Which of the following drugs can cause
treatment of chronic HBV infection. liver injury via direct toxicity?
Which of the following is a a) Ethanol
contraindication to interferon therapy? b) Acetaminophen
a) Decompensated liver disease c) Methotrexate
b) Autoimmune diseases d) Azathioprine
c) Active alcohol use e) All of the above
d) Pregnancy
e) All of the above
47. Which of the following laboratory tests
are important in cases of
42. Who should receive the hepatitis B acetaminophen toxicity?
vaccine? a) Liver enzymes
a) All infants b) PT_INR
b) Travelers at risk c) BUN/Creatinine
c) After sexual exposure to HBV d) Arterial blood gas
d) Patients with chronic liver e) All of the above
disease not caused by HBV
e) All of the above
48. Which of the following patient groups is 49. What are the most common primary
at higher risk of getting Primary Biliary benign liver tumors?
Cirrhosis? a) Hemangioma
a) Infants b) Adenoma
b) Elderly male c) Fibroma
c) Elderly female d) A + B
d) Middle-age female e) B + C
e) None of the above
2) Which of the following is NOT an agerelated 6) Which of the following is FALSE in terms of
change? falls in the elderly?
a) Impaired myocardial diastolic dysfunction a) They are the most common cause of
b) Increased gastric acid secretion mortality due to injury
c) Decreased drug clearance b) Environment plays a significant role
d) Increased nocturnal sodium and fluid c) Fractures most commonly involve the
excretion humerus
e) Decreased baroreflex sensitivity d) Age-related sensory changes make the
elderly more susceptible
e) Fear of falling contributes to self-
3) Regarding the elderly patient, which of the protection immobility
following apply?
a) Vague symptoms
b) Atypical presentations
c) Loss of function
d) Polypharmacy
e) All of the above
1. E 3. E 5. D
2. B 4. E 6. C
Gynecology
1) A 62 year old female presents with post- 6) Which of the following is a correct statement
menopausal bleeding. The most important regarding vaginal discharge:
diagnosis to rule out is: a) Candidiasis is characterized by “cottage-
a) Atrophic vulvovaginitis cheese-like” vaginal discharge and KOH
b) Foreign body wetmount would reveal hyphae and
c) Vulvar intraepithelial neoplasia spores
d) Endometrial cancer b) Bacterial Vaginosis is characterized by
white, thick discharge and a negative
KOH whiff test
2) Contraindications to hormone replacement c) Trichomoniasis is characterized by grey,
therapy include: thin and diffuse discharge and saline
a) Known breast cancer wetmount would reveal hyphae
b) Acute liver disease d) All of the above are false
c) Thromboembolic disease
d) Undiagnosed vaginal bleeding
e) All of the above 7) Which of the following is a correct statement
regarding the Menstrual Cycle:
a) The proliferative/follicular phase of the
3) Which of the following can NOT be used as menstrual cycle is of fixed duration
emergency contraception: b) The secretory/luteal phase of the
a) Post-contraception copper IUD menstrual cycle is of fixed duration, due
b) Post-contraception MirenaTM IUD to the finite lifespan of the corpus luteum
c) Yuzpe method c) Progesterone is the main hormone of the
d) "Plan B" proliferative phase, stimulating rapid
growth of endometrial glands and stroma
d) Estrogen is the main hormone of the
4) A 22 year old G0PO presents to her secretory phase
gynaecologist’s office complaining of
amenorrhea. The most important diagnosis
to rule out is: 8) The most common site of occurrence of
a) Turner’s Syndrome Endometriosis is:
b) Imperforate hymen a) Ovaries
c) Pregnancy b) Rectosigmoid colon
d) Hypothalamic/pituitary dysfunction c) Appendix
d) Broad ligament
12) A 24 year-old female presents with 16) Vaginal discharge which is fishy in odor and
abdominal pain. Beta-HCG is negative. associated with >20% clue cells on
Pelvic ultrasound shows a 5 cm right microscopy will not be associated with which
ovarian cyst. You would: of the following:
a) Perform immediate laporotomy a) Be due to gardnerella vaginalis
b) Perform immediate laproscopy overgrowth
c) Aspirate the cyst under ultrasonographic b) Can be treated with metronidazole or
guidance clindamycin
d) Order a CBC and a CA125 c) With the addition of KOH may see
e) Expectant management with repeat hyphae or spores
ultrasound in 8 weeks d) Must be treated in all pregnant women,
including asymptomatic
e) Is rarely associated with inflamed or itchy
13) The commonest type of bleeding vulva
encountered with uterine leiomyomata is:
a) Post-coital spotting
b) Mid-cycle bleeding 17) A 55 year-old woman comes to the office to
c) Hypermenorrhea discuss menopause. You tell her which of
d) Oligomenorrhea the following are a part of this stage:
e) Post-coital staining a) Hot flushes
b) Vaginal dryness
c) Mood swings
d) Insomnia
e) All of the above
18) All of the following features have been 23) A 35 year-old G0P0 has severe pain during
described in women with androgen menses which radiates into the anal region.
insensitivity syndrome EXCEPT: On bimanual exam, she has a small,
a) Mammary aplasia retroverted uterus and tender nodules can
b) Female phenotype be felt on palpation of the uterosacral
c) Absence of wolffian duct structures ligaments. Which of the following conditions
d) Short vagina does she most likely have:
e) Absence of mullerian duct structures a) Chronic PID
b) Adenomyosis
19) On colposcopy, the transformation zone: c) Fibroids
a) Contains columnar epithelium d) Endometriosis
b) Is the area between original squamous e) Uterine carcinoma
epithelium and columnar epithelium
c) Contains metaplastic epithelium
d) Contains atypical blood vessels 24) Which of the following statements is
correct?
20) Regarding laparoscopy: a) Cervical carcinoma is the most common
a) It is contraindicated in patients who are gynecological malignancy in Canada
menstruating b) Lichen sclerosis is treated with estrogen
b) Patients with intestinal obstruction are cream
still able to undergo laparoscopy c) Colposcopy is required after a finding of
c) The most common indication for mild cervical dysplasia on a routine Pap
therapeutic laparoscopy is tubal smear
sterilization d) Follicular cysts typically regress with the
d) All of the above are incorrect following cycle
e) Leiomyomata are malignant tumours
21) One cause of secondary amenorrhea is:
a) Turner syndrome
b) Anorexia 25) Which of the following statements regarding
c) Androgen insensitivity syndrome malignant cervical lesions is true?
d) Gonadal dysgenesis a) 95% are squamous cell carcinoma
e) Imperforate hymen b) CA-125 levels to monitor treatment
effectiveness are indicated
22) Risk factors for cervical carcinoma includes c) The majority of lesions arise outside the
all of the following EXCEPT: transformation zone of the cervix
a) Human papilloma virus type 16 and 18 d) They are not associated with HPV
b) Early age at first intercourse infection
c) Smoking e) Treatment for stage 4 disease is radical
d) High socio-economic status hysterectomy with chemotherapy
e) Multiple sexual partners
11.Which of the following is not a feature of 14. What is the most common type of
multiple myeloma? Hodgkin’s lymphoma?
a) Anemia a) Mixed cellularity
b) Hypercalcemia b) Nodular sclerosis
c) Fractures c) Lymphocyte depleted
d) Renal failure d) Lymphocyte predominant
e) Splenomegaly
1. C 5. B 9. A 13. A
2. E 6. D 10. E 14. B
3. D 7. B 11. E
4. E 8. A 12. E
Infectious Diseases
1) The various species of Campylobacter can 6) Entamoeba histolytica is transmitted to
cause diseases ranging from acute enteritis humans by:
to bacteremia. Which of the following a) Ingestion of infective eggs
modes of transmission does NOT apply to b) Ingestion of cysts
Campylobacter? c) Ingestion of animal tissue that contains
a) Contact with infected animals the larva
b) Contaminated food and water d) Penetration of the skin by infective larva
c) Improperly cooked poultry e) Ingestion of adult form
d) Aerolized droplets
e) Person to person spread via fecal-oral
route 7) Strongyloides spp. is transmitted to humans
by:
a) Ingestion of infective eggs
2) Which of the following is NOT a common b) Ingestion of cysts
infectious cause of acute diarrhea? c) Ingestion of animal tissue that contains
a) Escherichia coli the larva
b) Shigella d) Penetration of the skin by infective larva
c) Norwalk virus e) Ingestion of adult form
d) Vibrio cholerae
e) Helicobacter pylori
8) The biosynthesis of fungal ergosterol is
inhibited by:
3) A virus that is not inactivated by mild a) Amphotericin B
detergents that solubilize phospholipid b) Griseofulvin
membranes is: c) Flucytosine
a) Poliovirus d) Nystatin
b) Variola virus e) Ketoconazole
c) Cowpox virus
d) Vaccinia virus
9) At what CD4 count are HIV patients at
increased risk of developing PCP?
4) All the following are true statements about a) CD4 count >500x106
viruses EXCEPT: b) CD4 count 200-499x106
a) They are obligate intracellular parasites c) CD4 count <200x106
b) They are filterable agents d) CD4 count < 500x106
c) They are simply organized e) None of the above
d) They are devoid of enzymes
e) They may contain double stranded DNA
10) Which of the following is not a complication
of meningitis?
5) A viral genome that does not replicate in a) Hyponatremia
the cytoplasm of the infected cell is: b) Seizure
a) Poliovirus c) Deafness
b) Rabies virus d) Hydrocephalus
c) Cytomegalovirus e) None of the above
d) Rubella virus
e) Mumps virus
11) Which of the following does not cover
pseudomonas?
a) Imipenem
b) Tobramycin
c) Pip-tazo
d) Ceftazidime
e) Ceftriaxone
1. D 4. D 7. D 9. C 11. E
2. E 5. C 8. E 10. E 12. D
3. A 6. B
Nephrology
1) What underlying diagnosis is suggested in a 5) What is the most common etiology of
patient with acute renal failure and white nephrotic syndrome among Caucasians?
blood cells or white blood cell casts? a) Membranous nephropathy
a) Interstitial nephritis b) Focal segmental glomerulosclerosis
b) Acute tubular necrosis c) Acute tubular necrosis
c) DIC d) Lupus
d) Nephrotic syndrome e) IgA nephropathy
e) Multiple myeloma f) Post-streptococcal glomerulonephritis
2) What is the etiology of stenosis in renal 6) What is the most common intrinsic renal
artery stenosis? disease that leads to acute renal failure?
a) 2/3 secondary to atherosclerosis, 1/3 a) Acute tubular necrosis
secondary to fibromuscular dysplasia b) Hypovolemia
b) 2/3 secondary to atherosclerosis, 1/3 c) Rhabdomyolysis
secondary to DIC d) Wegener's granulomatosis
c) 1/2 secondary to aortic dissection, 1/2 e) Multiple myeloma
secondary to atherosclerosis
d) 2/3 secondary to fibromuscular
dysplasia, 1/3 secondary to Acute 7) What is the most common etiology of
tubular necrosis nephrotic syndrome in African Americans?
e) 2/3 secondary to fibromuscular a) Focal segmental glomerulosclerosis
dysplasia, 1/3 secondary to b) Membranous nephropathy
atherosclerosis c) Lupus
d) Sarcoidosis
e) IgA nephropathy
3) What illness commonly presents with
arthralgias, purpura, abdominal pain,
microscopic hematuria, mild proteinuria, 8) What is the main cause of End Stage Renal
azotemia, and proliferative Disease?
glomerulonephritis characterized by IgA a) Diabetes
deposits? b) Essential HTN
a) Henoch-Schonlein purpura c) Glomerulonephritis
b) Membranous nephropathy d) Polycystic kidney disease
c) Acute tubular necrosis e) IgA Nephropathy
d) Hyperkalemia
e) Multiple myeloma
9) What is the most common form of idiopathic
glomerulonephritis?
4) Which of the following is not an EKG change a) Post-streptococcal glomerulonephritis
in hyperkalemia? b) Essential HTN
a) Peaked T waves c) Membranous nephropathy
b) Prolonged P-R d) Acute tubular necrosis
c) Wide QRS with bradycardia e) IgA Nephropathy
d) V-fib with asystole
e) U waves
10) A 65 year-old male with back pain, nephrotic 14) Which of the following is true with respect to
syndrome and anemia present to the ER. proteinuria?
Ultrasound shows normal kidney size. His a) All proteinuria is secondary to glomerular
creatinine is 500. Which diagnosis best fits disease > 2 g/24 h = nephrotic syndrome
the scenario? b) Is always abnormal and indicative of
a) Polycystic kidney disease serious renal disease
b) Chronic GN c) It may be normal for an individual to
c) Multiple myeloma have <150 mg per day of proteinuria
d) Diabetic nephropathy d) If a patient has 1.5 g of protein in 24 h
e) Analgesic abuse they must have tubular-interstitial
disease
1. A 5. A 9. E 13. C 17. D
2. A 6. A 10. C 14. C
3. E 7. A 11. B 15. E
4. E 8. A 12. E 16. C
Neurology
1) For the management of an acute delirium 5) When examining a patient with a working
acquired in the hospital, which one of the diagnosis of Bell's palsy what is most
following options would be least important too rule out?
appropriate? a) A brainstem lesion
a) Treating the underlying cause b) An idiopathic cause
b) Promptly increasing antibiotic coverage c) An Ebstein-Barr virus infection
c) Antipsychotic medication as needed d) Diabetes melitus mononeuropathy
d) Avoiding foley catheters and physical e) Parotid gland pathology
restraints
e) Providing the patient with a well-lit room
6) Which medication would you expect to
worsen the common symptoms of
2) When differentiating between seizure and Parkinson's Disease?
syncope, which of the following is important a) Bromocriptine
to consider? b) Benztropine
a) Onset c) Lithium
b) EEG d) Amantadine
c) Autonomic features e) Haldol
d) Urinary incontinence
e) All of the above
7) Which of the following interventions would
benefit any patient suffering from
3) In the early stages of Alzheimer's disease myasthenia gravis?
what is the most common deficit to be a) Thymectomy
expected? b) Acetylcholinesterase inhibitors
a) Major depression c) Edrophonium
b) Parkinsonism d) Only a and b
c) Psychosis e) All of a, b, and c
d) Memory impairment for newly acquired
information
e) Memory impairment for events prior to 8) A 30-year old hairdresser is experiencing a
the onset of degeneration headache as you, a medical student about
to graduate, are sitting in the leather chair.
Which of the following questions would be
4) A patient that has just suffered a stroke finds least useful in assessing her complaint?
it difficult to utter words in either English or a) Is there a family history of similar
his native Portuguese. He is not pointing to headaches?
the ceiling when prompted with the aid of a b) Does the pain seem to come from
translator, nor does he respond when asked behind one eye?
to repeat a word he had just managed to c) Did your headache develop suddenly
speak out. In an otherwise functional and unexpectedly?
individual, these deficits can be most likely d) Are you having trouble or discomfort
due to this type of aphasia: chewing gum and/or talking during the
a) Broca's non-fluent aphasia headache?
b) Global non-fluent aphasia e) At What time of day is the headache at
c) Anomic fluent aphasia its worst?
d) Wernicke's fluent aphasia
e) Conduction fluent aphasia
9) When investigating for the cause of a stroke 13) A 25 year-old man is admitted with a history
which one of the following is most likely to suggesting seizures. Which of the following
yield abnormal findings? would not support this diagnosis?
a) An echocardiogram a) Urinary incontinence
b) An EEG b) The sound of voices preceding events
c) An electrocardiogram c) Drowsiness and weakness following the
d) A biopsy from a large artery event
e) A CT of all the long bones d) Rarely occur when recumbent
e) None of the above
1. What elements of the history would you ask 2. What elements of the physical exam would
about in order to formulate your diagnosis? you focus on? Choose up to five.
Choose up to five. 1. Examination of skin
1. Diffuse muscle cramps 2. Range of motion of lumbar spine
2. Alcohol intake 3. Blood pressure
3. Effect of NSAIDs 4. Inspection of muscle bulk in lower extremities
4. Family history of back problems 5. Sensory exam of arms
5. Previous history of back injury 6. Peripheral pulses
6. Shoulder pain 7. Reflexes in lower extremities
7. Weakness in right leg 8. Power testing of legs
8. Allergies 9. Power testing of arms
9. Knee problems 10. Sensory exam of legs
10. Urinary incontinence 11. Respiratory rate
11. Skin rashes 12. Temperature
12. Previous effective physiotherapy 13. Straight leg raise test
13. Headaches 14. Abdominal exam
14. Nocturia 15. Rectal exam
16. Pulse
17. Range of motion of knee
18. Auscultation of chest
19. Romberg test
ANSWERS
1. B 4. B 7. D 10. B 13. D
2. E 5. A 8. D 11. B 14. D
3. D 6. E 9. C 12. A 15. B
Neurology Case 1
Case 1 #1:
3, 5, 7, 10, 12
Case 1 #2:
7, 8, 10, 11, 14
Neurosurgery
1) In taking a history from a patient with a ring-
enhancing lesion seeon CT, all of the 4) Which of the following is not true concerning
following should be considered in your Brown-Sequard syndrome?
differentialdiagnosis EXCEPT: a) Contralateral spinothalamic deficits
a) Breast cancer metastasis b) Ipsilateral spinothalamic deficits
b) Meningioma c) Ipsilateral dorsal column deficits
c) Glioblastoma d) Ipsilateral pyramidal tract deficits
d) Infarct
e) Cerebral Abscess
5) A 52-year-old man presented to the urgent
care center 2 weeks ago with severe left
2) A 75 year old man is brought to your office shoulder pain. He wasdiagnosed with
by his daughter, who is his primary bursitis and treated with NSAIDs. The pain
caregiver. She describes a gradual decline has gradually improved, but the patient has
in her father's gait over the last two months. scheduled an office visit because he is
She now describes his feet as being 'glued' concerned about weakness of the left arm.
or 'magnetized' to the floor. He also has a On examination, the patient has full passive
worsening dementia and has recently range of motion of the arm and shoulder
become incontinent of urine. Assuming this without pain. Marked atrophy and weakness
patient has had no prior investigations, are noted in the left deltoid and shoulder
which of the following is the most girdle muscles. Biceps and triceps reflexes
appropriate next step in his management: are absent. The remainder of the
a) Lumbar puncture examination is unremarkable. Which of the
b) Routine Bloodwork (CBC, lytes, BUN, following is the most likely diagnosis for this
Cr) patient?
c) Urinalysis a) Thoracic outlet syndrome
d) CT or MRI of the head b) Brachial plexitis (Parsonage-Turner
e) Carotid dopplers syndrome)
c) Rotator cuff tear
d) Spinal cord tumour
3) A 40 year old lady is hospitalized for e) Lacunar infarction
treatment of a severe, bilateral pneumonia
with parapneumonic pleural effusions. Two
days into her stay, she develops a severe
headache, then has a seizure overnight.
She has no prior history of epilepsy. What is
your most likely diagnosis:
a) Stroke
b) Cerebral abscess
c) Bacterial endocarditis
d) Migraine
e) Toxoplasmosis secondary to HIV/AIDS
6) A 24-year-old man is brought to the 7) A 46-year-old woman is brought to the
emergency department by the emergency emergency department by EMS after being
medical service (EMS). He suffered head involved in a car accident.She was a
trauma 20 minutes ago while playing passenger in the back seat of the car. The
football. Immediately after the event, he lost accident involved frontal impact, with the car
consciousness for 3 minutes and then woke moving at 50 mph. The patient was not
up mildly confused. He complains of a wearing a seatbelt. The driver says she has
moderate frontal headache. On physical not been awake since the accident, which
examination, the patient's vital signs are occurred 30 minutes ago. On admission, the
stable, his Glasgow Coma Scale (GCS) patient's vital signs are as follows: blood
score is 15, and he has no focal signs on pressure, 100/60 mm Hg; heart rate, 78
neurologic examination. What interventions beats/min; respiratory rate, 8 breaths/min;
would be appropriate in the treatment of this GCS score,7. CT scan shows a frontal
patient? epidural hematoma with mass effect. How
a) Continue with observation and repeat would you treat this patient?
neurologic examinations; repeat a) Intubate the patient, administer
assessment with the GCS periodically; hyperventilation to a carbon dioxide
and consider imaging with a CT scan to tension (PCO2) of 25 to 35 mm Hg,
rule out contusions induce a barbiturate coma, and admit the
b) Continue with observation and repeated patient to the ICU for further evaluation
neurologic examinations; repeat b) Intubate the patient, administer
assessment with the GCS periodically; hyperventilation to a PCO2 of 25 to 35
and obtain an MRI mm Hg, and ask for emergent
c) Admit the patient for prolonged neurosurgery consult for evacuation of
observation; obtain a CT scan to rule out the hematoma
contusions; and start I.V. mannitol for c) Intubate the patient, administer
brain edema hyperventilation to a PCO2 of 25 to 35
d) Admit the patient to the ICU; obtain an mm Hg, admit to ICU for close
MRI; and consider intraventricular observation, and consult neurosurgery
monitoring of intracranial pressure (ICP) for intraventricular ICP monitoring
d) Admit to ICU for further evaluation and
start mannitol and steroids
8) A 22-year-old man is transferred to your 11) In a patient that has been hospitalized for
hospital from a local hospital, where he subarachnoid hemorrhage with evidence of
presented 3 hours ago with closed head vasospasm, which of the following are
trauma. He lost consciousness for 10 appropriate treatment?
minutes. At the first hospital where he was a) Triple H Therapy
taken, he was given pain medications, and a b) Nimodipine
CT scan was performed; the CT scan was c) Angioplasty
negative. The patient is awake and d) a & c
complains only of moderate headache. His e) a, b & c
physical examination is unremarkable. The
family is concerned about the development
of seizures in the future, because they had a 12) Which of the following is not a classic sign of
relative who had that problem. What would a basal skull fracture?
you recommend regarding prophylaxis for a) Battle sign
seizures in this patient? b) Raccoon eyes
a) Phenytoin for 1 to 2 weeks c) Hemotympanum
b) Carbamazepine for 6 months d) Freedman sign
c) Obtain an electroencephalogram; if it is e) CSF rhinnorhea/ottorrhea
abnormal, start phenytoin
d) Do not start any antiseizure medication
at this time 13) A 19 year-old female with a traumatic head
injury is brought to the ED by EMS. She is
9) A 65 year-old gentlemen originally hemodynamically stable but requires
hospitalized for work-up and treatment of a assisted ventilation through an endotracheal
subarachnoid hemorrhage is initially found tube. She does not open her eyes to painful
to have no focal neurological deficits. Six stimuli and maintains an abnormal extension
days after being hospitalized, you are called posture. Which of the following is incorrect?
to his bedside by his nurse as he has a) Her GCS is 3T
become increasingly lethargic, confused, b) A GCS of 8 is an indication for intubation
and has new focal weakness. What is the c) Isolated head injuries can cause shock
likely cause of his deterioration? d) She should be ventilated to a pCO2 of
a) Intra-cerebral hemorrhage 30-35 mm Hg
b) Re-ruptured aneurysm e) All are incorrect
c) Pneumonia
d) Vasospasm
e) Intra-ventricular hemorrhage 14) A 52 year-old dentist comes to your office
complaining of severe bilateral buttock
cramps and thigh fatigue during a tennis
10) In a patient that has been hospitalized for a match and recent onset of impotence. The
subarachnoid hemorrhage, what is the most likely diagnosis is:
appropriate pharmacological prevention for a) Lumbosacral disc problem
vasospasm? b) Multiple sclerosis
a) Metoprolol c) Leriche syndrome
b) LMWH d) Metastatic carcinoma of the spine
c) Triple H Therapy
d) b & c
e) Nimodipine
15) A young woman who was involved in a cliff 19) A 72 year-old man on physical examination
diving accident is brought into the is found to have expressive dysphasia and
emergency department unresponsive to mild right arm weakness. The most probable
deep pain with a right pupil that is dilated location of his lesion is:
and non-reactive. The left pupil is normal. a) Right parietal lobe
The most appropriate initial treatment is: b) Left frontal lobe
a) Endotracheal intubation c) Right frontal lobe
b) CT scan of the head d) Left parietal lobe
c) 500 cc normal saline IV e) Basal ganglia
d) IV steroids
e) IV mannitol
20) Initial management of any patient with coma
of undetermined cause includes all
16) A 78 year-old woman complains of EXCEPT:
experiencing headaches and progressive a) Clear and secure the airway
confusion for the last month. She has a left b) Naloxone
hemianopia and cannot dress herself. A CT c) D50W 50 mL IV
scan demonstrates a large, irregularly d) Dexamethasone 16 mg IV
enhancing mass in the right parietal lobe. e) Thiamine
There is no obvious systemic disease. The
most likely diagnosis is:
a) Brain abscess 21) A 53 year-old male presents to the ED with
b) Glioblastoma multiforme new onset of a severe headache associated
c) Meningioma with nausea and vomiting. There is no
d) Metastasis history of trauma. He is alert and oriented
e) CNS lymphoma with no neck stiffness. Anisocoria is present.
The most likely diagnosis is:
a) Intracranial bleed
17) A patient with a subarachnoid hemorrhage b) Cluster headache
(SAH) caused by a right anterior c) Meningitis
communicating artery aneurysm undergoes d) Migraine headache
successful surgery 2 days after the e) Tension headache
hemorrhage. Three days later, right arm
weakness develops. The most likely
diagnosis is: 22) A 24 year-old woman arrives at the
a) Hydrocephalus Emergency Department unconscious. Her
b) Meningitis BP is 90/60, her heart rate is 60 bpm, she is
c) Repeat hemorrhage breathing at 8 breaths per minute and her
d) Vasospasm O2 sat is 86%. Her eyes remain closed even
e) None of the above after pain stimulation and the only sounds
she makes are incomprehensible. Her
18) A 60 year-old man presents with back and elbows and wrists are flexed with her feet
leg pain and trouble urinating. On extended. This patient’s GCS score is:
examination, he has decreased sensation a) 3
over the buttocks, normal motor power, and b) 4
absent ankle jerks bilaterally. How would c) 5
this patient best be investigated? d) 6
a) Plain films of the lumbar spine e) 7
b) CT of lumbar spine
c) MRI of spine
d) Investigate only if no improvement after
6 weeks of symptomatic treatment
e) Gallium scan of the spine
23) Which physical exam finding below is 26) A neurosurgeon complains of a 3 week
usually not associated with increasing history of awakening at night with right-hand
intracranial pressure? discomfort that resolves after several
a) Deteriorating level of consciousness minutes. On examination, he has mild
b) Increasing heart rate weakness of thumb abduction and
c) Increasing blood pressure diminished pain sensibility on the palmar
d) Yawning, hiccoughing, vomiting aspect of the thumb and index finger. The
e) Unilateral sixth cranial nerve palsy most likely diagnosis is:
a) Carpal tunnel syndrome
b) Cervical radiculopathy
24) A 19 year-old woman is brought to the c) Reflex sympathetic dystrophy
emergency room following involvement in a d) Tendonitis
motor vehicle accident. On examination, she e) Left middle cerebral artery ischemic
has a GCS of 10 and swelling over the attacks
occipital protuberance. The most
appropriate imaging study is:
a) MRI of skull and contents 27) A 73 year-old woman presents with a 6
b) Skull films month history of deteriorating gait and low
c) Head CT back discomfort, exacerbated by walking.
d) Cerebral angiogram Examination is unremarkable except for
e) CT myelogram hypoactive muscle stretch reflexes in the
legs. X-rays of the lumbosacral area shows
the expected degenerative changes
25) An 80 year-old woman suffers cervical associated with a woman of her age. The
spinal soft-tissue injury in a motor vehicle most likely diagnosis is:
accident with no skeletal or neurologic a) Acute lumbar disc hernation
damage documented at the time. Three b) Lumbar stenosis
months later, she presents with sudden c) Myopathy
onset of homonymous right upper d) Normal pressure hydrocephalus
quadrantanopia. CT demonstrates a non- e) Cervical stenosis
hemorrhagic lesion in the left lower occipital
lobe. Which imaging study would likely yield
the most useful information? 28) L4/L5 disc prolapse. What is observed?
a) Carotid Doppler ultrasound a) Loss of ankle-jerk reflex
b) Echocardiography b) Numbness on the lateral side of the foot
c) MR angiography c) Positive femoral nerve stretch test
d) SPECT scan d) Weak quadriceps
e) C-spine plain films e) Foot drop
ANSWERS
1. E 5. D 9. C 13. B 17. B
2. B 6. E 10. D 14. C 18. C
3. D 7. D 11. D 15. A 19. D
4. D 8. A 12. D 16. C 20. C
Orthopedics
1) A 17 year old male was skateboarding and 3) A 45 year old female is picking apples from
fell while attempting to jump a flight of a tree when she slips and falls from a
stairs. He lands with his upper arm against height of 14 feet, landing on her feet. Her
the edge of a step and hears a crack. At right ankle is very sore after the injury so
the hospital he is told that he has suffered she proceeds to the local emergency room.
a fracture of the left humeral shaft. What According to the Ottawa Ankle Rules, which
nerve and artery are at risk in this type of of the following would be an indication for
injury? x-ray imaging of the affected ankle?
a) Ulnar nerve and axial artery a) Inability to weight bear immediately after
b) Axial nerve and radial artery the injury
c) Median nerve and brachial artery b) Inability to weight bear immediately after
d) Radial nerve and brachial artery the injury and pain in the malleolar zone
e) Musculocutaneous nerve and axillary c) Pain in the malleolar zone and body
artery tenderness over the posterior aspect of
f) Posterior interosseous nerve and dorsal the lateral malleolus
scapular artery d) Bony tenderness over the posterior
aspect of the medial malleolus
e) Bruising over the anterior aspect of the
2) A 23 year old male is playing soccer on a medial malleolus
muddy field when he is tackled from the
side. He immediately grabs his lower right
leg and to his horror feels a bone 4) A 23 year old male is involved in a multiple
protruding through the skin. At the hospital vehicle collision during morning rush hour.
he is diagnosed with an open fracture of the After arriving to the hospital via ambulance
right tibia. Which of the following initial around noon, it is discovered that the
antibiotic regimens is appropriate: gentleman is suffering, among a variety of
a) Cefazolin for 24 hours other minor injuries, from an open fracture
b) Cefazolin for 48 hours of his left distal radius. Upon questioning, it
c) Cefazolin, gentamicin and penicillin for is revealed that this gentleman is quite
72 hours healthy and taking no medications. He
d) Cefazolin and gentamicin for 48 hours denies any allergies. On physical exam,
e) Gentamicin for 48 hours the open fracture is quite obvious, although
the laceration is <2cm. A neurovascular
exam is unremarkable for any worrisome
findings. At this point, the most important
step in management would be:
a) Immobilize in a cast and follow-up in 1
week to reassess healing
b) Proceed straight to the OR for an I and
D, followed by ORIF
c) Inquire about tetanus status and
respond accordingly
d) Administer antibiotics that target gram
negative and anaerobic bacteria
e) Inquire about tetanus, give antibiotics
and book the patient for an
intraoperative I and D, and possible
ORIF, to be done the following day
5) You are the on call orthopedic surgery 7) An 18 year-old motorcyclist presents in the
resident during a stormy winter night. emergency department following an
During the evening hours, you are paged to accident. He has a compound tibia and
see a 73 year old lady who slipped on a fibula fracture of the right leg and on
patch of black ice. She is complaining of examination the right leg has no pulses.
severe right hip pain and nothing else. Your immediate treatment should be:
Upon questioning, you find out she suffers a) Immediate angiogram
from hypertension and osteoporosis; b) Immediate surgery
moreover, you also discover that she has c) Casting and/or splinting
broken her right distal radius on 2 other d) Reduction and splinting
occasions û fixed with closed reduction on e) X-ray
both occasions. Her osteoporosis is being
managed with calcium, vitamin D and an
unknown bisphosphonate. Her anti- 8) Which of the following is the most serious
hypertensive medication is unknown, but complication of a displaced supracondylar
she admits that her blood pressure is well fracture of the humerus?
controlled. There are no other medications. a) Compartment syndrome of the forearm
The history also reveals that she has had b) Failure to heal
an appendectomy and C-section in the c) Healing in a non-anatomical position
past, has no allergies, has never smoked d) Injury to the median nerve
and her last meal was lunch time. On e) Significantly limited range of elbow
physical examination, her right leg is motion
shortened and in marked external rotation.
Her right leg, as well as her other
extremities, are neurovascularly intact. 9) All of the following statements regarding
The rest of the exam is unremarkable. You knee injuries are correct EXCEPT:
send this lovely lady for an X-ray which a) Locking of the knee may be due to a
shows a grade 4 subcapital fracture of her torn meniscus
right hip. Her intraoperative treatment b) Minor tears of the medial collateral
would include: ligament can be treated with brief
a) Hemiarthroplasty of her right hip immobilization then range of motion and
b) Total arthroplasty of her right hip strengthening exercises
c) Dynamic hip screw c) Lateral meniscus tears are more
d) Gamma nail common than medial meniscal tears
e) ORIF femoral neck d) Anterior cruciate ligament tears may
give a positive Lachman test
e) A knee dislocation may be associated
6) A 53 year old male suffers an undisplaced with major ligament damage
fracture of his medial malleolus. It is
immobilized with a plaster cast. He has a
follow up visit in the fracture clinic in 2 10) An 83 year-old man has fallen while walking
weeks time to assess bone healing. You down stairs. He is brought to the
explain to him the potential complications of emergency department with a 3-part
this fracture, including all of the following intertrochanteric hip fracture. Which of the
EXCEPT: following procedures would you choose to
a) Mal-union perform?
b) Non-union a) Hemiarthoplasty
c) Infection b) Total hip replacement
d) Fat embolism c) Multiple pin fixation
e) DVT d) Bipolar arthroplasty
e) Pin and plate
11) A 16 year-old female fell while roller-blading 15) All of the following have been associated
on her outstretched right hand. At a nearby with posterior shoulder dislocation
emergency department X-rays confirmed EXCEPT:
the diagnosis of a closed Colles fracture. a) Ethanol
The proper reduction technique for this b) Electricity
wrist fracture is which of the following: c) Exercise
a) Slight extension, full pronation, and full d) Epilepsy
ulnar deviation e) Encephalitis
b) Slight flexion, full supination, and full
radial deviation
c) Slight extension, full supination, and full 16) Management of an open fracture should
ulnar deviation always include each of the following
d) Slight flexion, full pronation, and full EXCEPT:
ulnar deviation a) Assessment of neurovascular status
e) Slight extension, full pronation, and full b) Reduction and fixation of fracture
radial deviation c) Irrigation and debridement of wound
d) Application of sterile dressing
e) Application of topical antibiotics
12) Which of the following is least likely to
cause avascular necrosis:
a) Sickle cell disease
b) Septic arthritis
c) Steroid use
d) Constrictive dressings
e) Post-traumatic fracture
1. D 4. C 7. D 10. E 13. B
2. C 5. B 8. A 11. D 14. C
3. C 6. D 9. C 12. D 15. C
16. E
Otolaryngology
1) The following statements regarding noise 5) What is the typical audiogram finding in
are true EXCEPT: noise induced hearing loss:
a) Temporary threshold shift recovers a) Conductive loss in the low frequencies
following cessation of noise exposure b) Conductive loss at 2000 Hz
b) Permanent threshold shift is c) Sensorineural loss at 2000 Hz
characterized by a progressive pattern of d) Sensorineural loss at 4000 Hz
hearing loss e) Mixed broad spectrum hearing loss
c) Most cases of permanent threshold shift
are surgically treatable
d) Higher frequency noise is more 6) Which of the following is not a complication
damaging than low frequency noise of untreated otitis media?
e) None of the above a) Cholesteatoma
b) Meningitis
c) Tympanic membrane perforation
2) The frequencies most necessary for the d) Trigeminal neuralgia
understanding of speech extend from about: e) Conductive hearing loss
a) 20-20 000 Hz
b) 400-4 000 Hz
c) 250-8 000 Hz 7) Complications of tonsillectomy include all of
d) 100-5 000 Hz the following EXCEPT:
e) None of the above a) Secondary hemorrhage
b) Severe otalgia
c) Quinsy
3) Conductive hearing loss is a symptom of: d) Nasopharyngeal stenosis
a) Presbycusis e) None of the above
b) Meniere disease
c) Cholesteatoma
d) Bell palsy 8) Features characteristic of acute tonsillitis
e) Acoustic neuroma include all of the following EXCEPT:
a) Odynophagia
b) Cough
4) The following statements regarding epistaxis c) Referred otalgia
are false EXCEPT: d) Cervical lymphadenopathy
a) Epistaxis rarely occurs in children e) Dysphagia
b) It commonly results from rupture of
posterior placed nasal vessels
c) It may be treated by ligation of the 9) A 6 month-old baby has had mild inspiratory
ipsilateral internal carotid artery stridor for the last 2 months. The most likely
d) Epistaxis may be treated by cautery of cause of this is:
Little's area with silver nitrate a) Laryngomalacia
e) It is not a common cause of emergency b) Acute epiglottitis
admission to ENT wards c) Croup
d) Tonsillar hypertrophy
e) Foreign body aspiration
10) Which of the following is true regarding 14) Which of the following is an absolute
mandibular fractures? indication for a tonsillectomy?
a) They are predominantly unilateral a) Airway obstruction
b) Compound fractures are rarely intraoral b) Recurrent (>5) episodes of tonsillitis
c) They may manifest with numbness in the c) Peritonsillar abscess
V2 facial nerve distribution d) Tonsillar hypertrophy
d) Malocclussion of teeth is a common sign e) Halitosis
e) They seldom result in trismus
1. C 5. D 9. A 13. A 17. B
2. B 6. D 10. D 14. A
3. C 7. B 11. D 15. A
4. D 8. C 12. D 16. E
Pediatrics
1) 6-month-old boy is brought to you with white 6) Children with fifth disease (erythema
patches on mucous membranes of mouth, infectiosum, caused by parvovirus B19) do
the most likely diagnosis is: NOT have:
a) Herpes simplex a) Fever
b) Candida infection b) “Slapped-cheek” rash
c) Molluseum contagiosum c) “Lacy” rash on the trunk
d) Staphylococcal folliculitis d) Rash on palms and soles
2) A 56 year old woman who works as a 4) You are working in the emergency
medical secretary comes into the office department when a burn victim is brought in.
complaining of pain in her left hand. After a Which of the following is not an indication for
detailed history and physical, it was transfer to a burn center:
concluded that her pain is most likely a) A 40 year old man who fell asleep while
attributed to carpal tunnel syndrome. Which smoking and sustained a mixed 2º and
of the following is not a feature of carpal 3º burn to 15% of his body including his
tunnel syndrome? right hand, arm and chest
a) Numbness and pain in the affect hand b) A five year old boy with a mixed 2º and
leading to frequent night awakenings 3º burn to 15% total body surface area
b) Decreased ability to abduct the thumb on his back from a scald injury
c) Decreased sensation in the 4th and 5th c) A 30 year old woman who was rescued
digits from a burning building. She has a 5%
d) Flattening of the thenar eminence TBSA mixed 2º and 3º burn on her right
e) Percussion over the median nerve at the forearm and 12% mixed 2º and 3º on her
wrist reproduces symptoms thigh. She was also trapped in a smoke-
filled room and appears to be in
respiratory distress
d) A 45 year old factory worker who
sustained a 0.5% total body surface area
partial thickness burn to his left forearm
after coming into contact with
hydrofluoric acid
e) A 58 year old woman who sustained a
high voltage electrical injury
5) A 32 year old man comes into the 8) In which of the following are systemic
emergency department after a sustaining antibiotics not indicated:
facial blow injuries from a fight. The CT a) Animal bite to hand
head reveals that he has sustained facial b) Laceration over metacarpalphalangeal
bone fractures. Which of the following is an joint sustained after punching someone
indication for him to have immediate in a fight
surgery: c) Cellulitis
a) He has a displaced nasal bone fracture d) Burn wound to 75% of the dorsal aspect
b) His CT head reveals an orbital floor of the hand
fracture with no soft tissue entrapment e) Acute suppurative tenosynovitis
c) He has ptosis and proptosis of his left
eye and is complaining that he cannot
see out of this eye even when the eyelid 9) Which of the following is not a finding in
is held open mandibular fractures?
d) He has an unstable fracture of the a) Palpable step along mandible
zygomatic complex b) Loose teeth
e) He has a bilateral LeFort I fracture c) Trismus
d) Numbness in V2 distribution
e) Malocclusion
6) Which of the following is not a sign or
symptom of carpal tunnel syndrome: 10) A 43 year-old woman is brought to the
a) Loss of sensation to the proximal palm Emergency Department after being burned
b) Positive Phalen test in a house fire. You estimate first degree
c) Positive Tinel sign burns to 20% of her body, second degree
d) Pain involving the thumb, index, long, burns to 11% of her body, and third degree
and part of the ring digits burns to 9% of her body. She weighs 60 kg
e) Delayed transit time on nerve conduction and is 120 cm tall. What IV therapy would
study you begin immediately?
a) Normal saline at 200cc/hr for 24 hours
b) Normal saline at 400cc/hr for 24 hours
7) A 35 year-old intoxicated man presents to c) Normal saline at 150cc/hr for 8 hours,
the Emergency Department with a deep then 75cc/hr for the next 16 hours
laceration to his right distal forearm after d) Normal saline at 300cc/hr for 8 hours,
putting his hand through a window. On then 150cc/hr for the next 16 hours
examination, he has no sensation to his little e) Normal saline at 600cc/hr for 8 hours,
finger and the ulnar aspect of his ring finger. then 300cc/hr for the next 16 hours
Power on abduction and adduction of all
fingers is markedly decreased. He is unable
to flex the distal joint of his little finger. When
he flexes his wrist, his hand deviates
radially. The examination was otherwise
normal. What structure(s) have been
damaged?
a) Ulnar nerve
b) Flexor carpi ulnaris and flexor digitorum
profundus muscles
c) Median nerve
d) Radial nerve
e) Brachioradialis
11) Which of the following statements is 13) A 45 year old woman with a history of
incorrect with respect to wound healing? hypothyroidism comes to your office
a) Epithelialization can occur within 24 complaining of problems with extending the
hours following primary closure of a middle finger of her left hand for the last two
wound months. She complains of a snapping of
b) Maximum wound strength is often her finger when she forces extension and on
achieved after 2 years examination, you can feel a nodule on the
c) Wounds continue to gain strength after palmar aspect of her left hand proximal to
collagen synthesis has reached an the third MCP joint. Based on your history
equilibrium and physical exam, you conclude that her
d) Wound contraction is mediated by symptoms are most likely attributed to
myofibroblasts stenosing tenosynovitis. Which one of the
e) The incidence of wound infection following options is incorrect:
increases with healing by secondary a) You suspect that her symptoms are
intention arising at the A-1 pulley. This is the
most common site for this condition to
arise
b) The ring finger is one of the most
12) Which of the following is not a stage in the commonly affected fingers
development of pressure ulcers? c) This condition is also associated with
a) Ischemia rheumatoid arthritis and diabetes mellitus
b) Congestion d) The most appropriate therapeutic option
c) Hyperemia at this time would be conservative
d) Ulcer treatment with NSAIDs and steroid
e) Necrosis injections
e) The most appropriate therapeutic option
at this time is surgical incision of the A-1
flexor tendon sheath
ANSWERS
1. C 4. D 7. A 10. D
2. C 5. C 8. D 11. E
3. C 6. A 9. D 12. B
13. E
Community and Population Health
The relative risk of developing “X” in “Y” The specificity of test “Q” would be:
versus no “Y” is: a) 40/70
a) 80 x 50 = 4 c) 50 x 80 = 4 b) 120/130
50 x 20 20 x 50 c) 40/50
d) 120/150
b) 50 _ 20 = 0.3 d) 80/100 = 1.6 e) 40/130
100 100 50/100
e) it is not possible to calculate risk in a 20) The positive predictive value would be:
cohort study a) 40/70
b) 120/130
17) The attributable risk of factor “Y” to disease c) 40/50
“X” would be: d) 120/150
a) 80/100 = 1.6 c) 80 x 50 = 4 e) 70/200
50/100 50 x 20
25) Which of the following statements regarding 29) Regarding health expenditure and health
the measurement of health and disease in a outcomes:
population is true? a) The U.S. has the greatest health
a) A rate is the number of times an event expenditure and the lowest infant
has occurred during a certain time mortality rates
interval divided by the number of b) There is a positive association between
persons at risk during the same interval national expenditure on health and GDP
b) When calculating a ratio, the numerator c) Increased national health expenditure
is a portion of the denominator always increases health status of a
c) A ratio is the number of times an event country
has occurred during a certain time d) All of the above
interval multiplied by the number of e) None of the above
times an event has occurred during the
same interval
d) When calculating a rate, the numerator 30) Which of the following is the most important
is not a portion of the denominator justification for population screening
e) None of the above programs for a specific disease?
a) Early detection of the disease of interest
is achieved
26) In 1990, which country spent the least on b) The specificity of the screening test is
health care as a percentage of GDP (gross high
domestic product): c) The natural history of the disease is
a) Canada favourably altered by early detection
b) France d) Effective treatment is available
c) Sweden e) The screening technology is available
d) UK
e) USA
31) Regarding the regulation of health 34) All of the following statements are true
professionals, provincial colleges of EXCEPT:
physicians and surgeons: a) The data collected on a death certificate
a) Have the advancement of the public is uniform and in conformity with WHO
interest as their primary goal guidelines
b) Protect the public from incompetent or b) Section 7 of the Coroner’s Act states
unfit MDs that the coroner’s office must be notified
c) Act as licensing bodies for MDs if a patient dies after some mishap such
d) Do not advance the professional and as leaving an instrument in the body at
political interests of MDs surgery
e) All of the above c) Diseases which must be reported to the
local medical officer of health include
AIDS, food poisoning, influenza and
32) Active immunization was important in gonorrhea
control of each of the following childhood d) A tuberculin reaction greater than 5 mm
communicable diseases EXCEPT: is considered positive in all individuals
a) Diphtheria e) All of the above
b) Polio
c) Measles
d) Scarlet fever 35) In describing the leading causes of death in
e) Pertussis Canada, two very different lists emerge,
depending on whether proportional
mortality rates or person-years of life lost
33) All of the following statements are true (PYLL) are used. This is because:
EXCEPT: a) One measure uses a calendar year and
a) One indirect measure of a population’s the other a fiscal year to calculate
health status is the percentage of low annual experience
birth weight neonates b) One measure includes morbidity as well
b) Accidents are the largest cause of as mortality experience
potential years of life lost in Canada c) Both rates exclude deaths occurring
c) The Canadian population is steadily over the age of 70
undergoing rectangularization of d) Different definitions of “cause of death”
mortality are used
d) Morbidity is defined as all health e) One measure gives greater weight to
outcomes excluding death deaths occurring in younger age groups
e) The neonatal mortality rate is the
number of infant deaths divided by the
number of live births multiplied by 1000 36) 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
37) The occurrence of an illness at a rate of 41) Which of the following types of studies
above that expected is called: usually provides only a measure of
a) Hyperendemic prevalence?
b) Epidemic a) Descriptive
c) Endemic b) Cross-sectional
d) Enzootic c) Randomized controlled trial
e) Pandemic d) Cohort
e) None of the above
1. E 2. A 3. A 4. B
Respirology
1) A 16 year old presents to the ER with a 5) Which is more often associated with hospital
severe asthma exacerbation. All of the acquired pneumonia than community-
following may be considered as part of the acquired pneumonia?
management plan EXCEPT: a) Streptococcus pneumoniae
a) Pulmonary Function tests b) Hemophilus influenza
b) Peak Flow meters c) Pseudomonas
c) Chest X-Ray d) Chlamydia pneumoniae
d) Oral prednisone e) Mycoplasma pneumoniae
e) Counselling for better treatment
compliance
6) A 30 year-old patient with asthma complains
of daily wheezing and occasional waking at
2) A 56 year old gentleman is referred to your night with cough and chest tightness for
clinic for evaluation of an incidental lung three weeks. His usual medication is
nodule on CXR. Which of the following salbutamol two puffs tid-qid. The next step
findings makes it more likely to be benign: in management is:
a) Greater than 3cm in diameter a) Add long-term theophylline
b) Ill-defined margins b) Increase salbutamol to two puffs q4h
c) Calcification c) Add ipratropium bromide two puffs qid
d) Doubles in size on repeat CXR in 15 d) Add beclomethasone two puffs qid
months e) Discontinue salbutamol and begin
e) Clubbing prednisone 50 mg od and taper over 2
weeks
1. D 2. E 3. B 4. D
Urology
1) Patients with an organic cause for 5) A 75 year-old man with a history of nocturia
impotence are often characterized by all of has not micturated for the last 10 hours, and
the following EXCEPT: is complaining of severe lower abdominal
a) Diabetes pain. The most likely cause is:
b) Older age a) BPH
c) Intermittent difficulty b) Prostate cancer
d) Nocturnal penile tumescence absent c) Renal failure
e) None of the above d) UTI
e) Prostatitis
1. C 4. C 7. C 10. B 13. C
2. E 5. A 8. D 11. D
3. D 6. D 9. B 12. D