MCCEE May 2003

1. Threshold of a screening test is increased. How it will affect sensitivity and specificity?
a)
Sensitivity increase & specificity decrease
b)
Sensitivity decrease and specificity increase
answer:b
2. A child has ingested overdose of iron tablets- first symptom?
a)
Nausea and abdominal pain
b)
Hyperventilation
c)
Seizure
answer :a
Acute iron intoxication :seen exclusively in young children, in them small numbers of any available
preparation ,even 10 tablets can be fatal .Symptms:Sx of necrotizing gasteroenteritis,vomiting,abdominal
pain,bloody diarrhea=>shock,lethargy,dyspnea,severe metabolic acidosis.
Tx:Whole bowel irrigation to remove unabsorbed tablets
Deferoxamine t remove absorbed tablets
Notice:activated charcoal cant bind to iron,so will have no benefit
chronic iron intoxication(hemochromatosis):excess of iron deposits in heart,liver,pancreas,etc.Its seen in
patient with multiple transfusions of RBC products over time,or in those who have inherited
hemochromatosis,not in normal individuals cause normal gut doesnt absorb excess iron intake,unless there is
really overingestion of iron in long period,cant be overcome by normal mechanisms esp. in those who have
anemia of chronic dis. Or hemolytic anemia.
Tx:phlebotomy-Deferoxamine
3. Rheumatoid arthritis patient develops tinnitus. Cause?
a)
Due to ASA
Adverse effects of ASA:
1-gastric upset(advise patients to have it with meal and enough water,and may be antiacids);2-PUD;3-erosive
gastritis;4-like other NSAIDS it can cause elevation in liver enzymes(rarely hepatitis);5-rash;6-aggreviates
asthma;7-may interfer to renal function;8-antiplatelet activity;9-Reye syn.;and 10-salicylism
What is Salicylism?vomiting,tinnitus,decreased hearing,vertigo with higher amounts of ASA.
Also,ASA in high doses results in hyperpnea,respiratory alkalosis,then,when acidic components accumulate,a
meabolic acidosis more complicates cases.
4. WHO conference in 1978 in Alma Mata, Russia- declaration on
Health-for-all by 2000,.the individuals,families,and community are the basis of health system,and the primary
health worker,as the first agent of health care system,dealed with by community,is the central health force.
5.Rheumatoid arthritis patient develops swelling left calf and ankle. Thigh normal. Cause?
a)
DVT
b)
Rupture of popliteal cyst
This is an old trick!When a RA patient has Sx of DVT,always consider a ruptured popliteal cyst(Bakers cyst).
6. Child 3years with swelling of scrotum. Testis can be palpated through the swelling Fluctuant, painless. Observed for
few months. Translucent. Definitive Management?
a)
examine regularly
b)
aspirate only
c)
surgery
d)injecting sclerosant
answer:c .Dx:Hydrocele,Tx:according to the case,if its well tolerated & there is no complication,nothing
;however, drinage+ injection of a sclerosing agent indicates for complicated cases or in order to prevent
recurrence.The last Tx modality is surgery.
According to Smiths urology textbook,if a hydrocele remains beyond 1 year old,surgery should be performed.
7. Question on probability- probability of finding one disease is A and other is B. (Independent). Probability on finding the
2 diseases in one pt.
a)
AX B
b)
A+B
c)
AXB- A+B ???
answer:a ..P[A and B]=P[A]xP[B],multiplication rule,but when both A and B cannt occur together,they are
referred to as beingmutually exclusive,means P[A and B]=0
8. Most common occupational disease in Canada.
a)
silicosis
b)
dermatitis
c)
asthma
d)
asbestosis

answer:b(?)
9. Most common cancer in Canada/
a)
lung
b)
breast
c)
prostate
e)
brain
answer:a.Lung cancer ,most common cancer,most common cause of cancer death in male & females(Toronto
notes,R34)
10. 23 year old lady presented with cramping abdominal pain and heavy bleeding. Pregnancy test positive. Bleeding
stopped today morning. Pregnancy symptoms disappeared one week ago. USG shows empty uterus and 3 cm mass in
adnexa. Diagnosis?
a)
ectopic pregnancy
b)
complete abortion with corpus luteal cyst
c)
ves. Mole with corpus luteum
d)
twin gestation- one aborted and one ectopic
answer:b .Firstly,as pregnancy symptoms disappeared,so this woman can not be pregnant now,so choice d
is easily ommitable.
Then,this patient showed Sx of miscarriage,and now uterus is empty,then we can think to these options:
A complete abortion.not given in choices
A complete abortion with a luteal cyst
An abnormal aborted pregnancy with luteal cyst
But which one?Did she have Sx of a molar pregnancy?no,not high titers of bHCG ,no excessive vomiting,etc.,so
answer c seems incorrect.
..but if pregnancy testis + now=>then patient has an EP.I personally think there is a mistake in typing this
question,and the betaHCG is not + now caz if it were so,why they emphasized on disappeared Sx of pregnancy?
11. Child with inguinal hernia. Presentation
a)
scrotal swelling
b)
thickening of spermatic cord
answer:ainguinal hernia:Testis is separated from hernia,spermatic cord is not palpable above the
swelling(unlike Hydrocele or Spermatocele,in which spermatic cord is palpable),negative transillumination
12. A mother brought to her son to your clinic with red spots around eye. You confirmed it as petechiae. What other
finding is of concern to you
a)
petechiae all over body
b)
subconjunctival hemorrhage
c)
he developed vomiting after few hours
13. A lady 50 years with swelling medial to femoral pulse. Firm and smooth. Diagnosis?
a)
femoral hernia
b)
inguinal hernia
c)
saphena varix
answer:a.....An old lady,with hernia medial to femoral pulse=femoral hernia,which has risk of
incarceration;however,the most common hernia in female population is inguinal hernia.Tx for both is
surgery.
14. galactorrhoea . cause?
a)
pituitary infarction
b)
hyperthyroidism
c)
danazol
d)
thoracic nerve stimulation
e)dopamine agonist
my answer:d
hypothyroidism,estrogenic drugs,antiandrogens(not danazol that is antiestrogenic),dopamine
antagonists,prolactinoma(not infarction of pituitary!)=>galactorrhea
any stimulation in chest wall( textbooks of Endocrinology)=>galactorrhea
15. Mechanism of action typical antipsychotics
a)
+ dopamine receptors
Typical neuroleptics:blockade of D2 receptors(dopamine),they treat Possitive symptoms like hallucination or
delusions..like haldol
Atypical neuroleptics:blockade of D2 &/or D1,5HT receptors(dopamine+ serotonin),they treat both pos. and
neg. symptomslike clozapine
16.a patient on antipsychotics, cannot sit still
a] akathisia
Akathisia is an unpleasant physical restlessness which results to unabillity to keep still,it usually occurs in the
first 2 weeks of treatment.The symptoms dont respond to antiparkinsonian drugs,but will disappear by
diminished doses.

17.best way to prevent benzodiazepine dependence

a)
use the one with short half-life
b)
use for short duration
c)
use at nighttime only
d)
answer:b
short half-life=>more dependency
18. Most common gynecological infection in Canada
a)
candidiasis
b)
bacterial vaginosis
c)
gonorrhea
d)
answer:bKeys:clue cells-grey,thin,diffuse discharge-fishy odour.,it needs no Tx if patient is
assymptomatic,non pregnant,not anticipating a pelvic surgery ,otherwise treat with oral metronidazole or tpical
clinda.in pregnancy treat with Amoxi.
19. Most common cause for premenstrual itching (cyclical itching)
a)
candidiasis
b)
bacterial vaginosis
b)
non specific vaginitis
answer:nonspecific vaginitis
d)
20. Most specific site to collect swab for gonococci
a)
vulva
b)
vagina
c)
cervix
c)
endometrium
answer:cervix......in Gonorrhea swabs from cervix,rectum,throat
21. Pap smear swab collected from
a)
endo cervical and ectocervix
b)
endocervical and endometrial
d)
endo cervical
answer:a..Pap smear:endocervical & exocervical cell sampling(+TZ)
22. A patient presented with an ulcer near medial malleolus. Cause
a)
ischemia
b)
perforator incompetence
c)
answer:b
leg ulcer esp. Over the medial malleolus=>venous ulcer secondary to venous stasis especially in
the presence of perfoator incompet
ence
Tx:reducing edema of leg+treating ulcers,if large ulcers,debridement+graft
23. A patient with chronic bronchitis PaO2 60 mmHg. What advise you will give EXCEPT
a)
no need for continuous O2 therapy
b)
maintain healthy food hygiene
c)
annual influenza vaccination
d)
no need for prophylactic antibiotics
e)
avoid hypnotics or sedatives
answer:a
indications of LTOT(long term oxygen therapy)from Harrisons textbook:1-Pao2= or < 55mmHg or o2 sat= or
<88%;2-[Pao2:56-59 and o2 sat= or < 89%] And [Hct=55% or corpulmonale or pulmonary HTN];3-Paco2= or <60
mmHg and o2sat= or >90%
indications for oxygen therapy according to Toronto Notes:Pao2= or <55 mmHg;o2 sat= or <89% with
rest,exercise,or sleep
Annual inf. Vaccination should be done in COPD cases,but prophylactic antibiotics are not recommended.
In COPD cases hypnotics or other drugs with depressant effects on respiratory centers in CNS should be
avoided.
24. HIV positive patient, CD4 count 250 Presented with cold. What will you do
a)
start multiple drug antiretroviral treatment
b)
TMP+ Sulpha
When should we start antiretroviral drugs in HIV+?
-symptomaic patients with any CD4 count(including wasting,unexplained fever>2 weeks,Thrush,other
opportunistic infections)
-asymptomatic patients with CD4<200
-asymptomatic patients with Cd4:200-350,or HIV RNA>55000
-asymptomatic patients with CD4>350 and HIV RNA<55000

CD4<200.prophilaxy for PCP with cotri

CD4<100prophilaxy for TOXO with cotri
CD4<50.prophilaxy for MAC with Rifabutin or Azithromycin
Cd4<50.prophilaxy for CMV
My answer:a..according to Harrisons textbook CD4<350 =>initiate antiretroviral drugs
c)
25. Full term child. Birth weight 3000. Develops respiratory distress. Xray shows air bronchogram. Diagnosis
a)
Transient tachypnoea of newborn
26. Baby 8 hours after birth, staring and severe Cyanosis. Hypotonia of muscles. What investigation you will do?
a)
CK
b)
Echocardiogram
c)
EEG
Answer:b
27. A child had headache, vomiting, and abdominal pain. Then he sleeps. What is your diagnosis?
a)
migraine
e)
temporal lobe epilepsy
answer:a..a typical case of migraine in a young child,which relieves by rest
temporal lobe Epi.:or Complex partial seizure,Petit mal seizure....associated with altered
memory,mood,perception in older children,young adults.it can have Aura,after aura,patient stares,and looks
unresponsiveness ordistant from environment.Then recovery comes with headache & confusion.IT DOES NOT
RELIEVE BY REST.
28. A child 3 years presented with abdominal pain and Bleeding PR for 12 hours. What is your diagnosis?
a)
meckels diverticulum
b)
intussusception
answer:b..both a & b are possible causes of GIB in children,but in most cases of Meckels div. There is a
painless bleeding from rectum,and only in small proportion child shows severe pain.
Certainly,there were some clues in main question referring to answer b,but unfortunately we dont have complete
question.
29.elderly sensorineural hearing loss. Most common Cause
a)
presbyacusis
b)
30. Occupational deafness. Usually caused by
a)
high frequency loss
f)
low frequency loss
answer:a..OLD WORKERS DO NOT HEAR THEIR WIVES SOUND!
c)
31. A passenger in bus got an injury in his eye with the newspaper of the neighboring person. Diagnosis
a)
corneal abrasion
b)
32. Benzodiazepam. Cross-tolerance with which drug
a)
chlorpromazine
b)
alcohol
c)
tricyclics
answer:b.BDZs have additive or synergistic effects with other central depressants such as
alcohol,barbiturates,and antihistamines.
33. A child has ingested 30 tablets of imipramine. What should be done mean while contacting the toxicology center.
a)
forced diuresis
b)
give ipecac syrup
g)
drug to prevent convulsions.
Answer:b.imipramine,a TCA,is extremely dangerous when taken in overdose quantities=>metabolic
acidosis,coma,sudden apnea,respiratory suppression,hyperpyrexia,seizure,conduction defects & arrythmias.
Tx: monitoring of heart in ICU
Sodium bicarbonate to overcome acidosis,and conduction block
Maybe antiarrythmic drugs
Supportive cares like:giving ipecac syrup,or gastric lavage,inducing emesis
d)
34. A child has ingested an overdose of imipramine. Pt. is stable. What investigation is done to monitor sign of toxicity.
a)
ECG
b)
EEG

d)
Blood level of drug
Answer:aECG
35. Which combination should not be used?
a) tranyl cypramine-sertraline
36. A child with tic disorder- what is the first thing in management
a)
benzodiazepine
b)
family psychotherapy
answer:bTx in Tic disorders:Haldol,Pimozide,psychotherapy..in general apart from in nightmares
&somnambulism,BDZ are not prescribed in childhood
37. Behavior therapy least useful
a)
hallucination
b)
depression with strong suicidal ideation
c)
generalized anxiety
answer:a.indications:anxiety disordes,paraphilia,substance abuse
38. Anti depressant drugs most useful in which of the following conditions?
a)
39. Which of the following is the most common condition in Canada?
a)
cervical malignancy
b)
endometrial malignancy
c)
endometrial polyp
c)
septulum uterus
answer:b .endometrial cancer is the most common gynecological malignancy in Canada
40. Toxic shock syndrome. Not true
a)
exo toxin
b)
tampons
c)
skin necrosis
d)
fever
e)
rash
answer:c Toxic shock syndrome:a life threatening condition due to exoproteins from S.aureus,but a clinical
infection with S.aureus is not necessary for Dxsymptoms:fever,hypotension,rash,end organ
damage,scalingrisk factors:mens.,tampons,contraception devices.
41. A lady 50 years, 2 years nocturnal cough. Now develops fever sweats weight loss purulent sputum. X-ray shows
consolidation apex of lower lobe. Diagnosis
a)
tuberculosis
42. Asian 53 years. Weight 93 kg. Arthritis. Now c/o head ache. Striae on abdomen, thinning of skin. What investigation to
be done?
A)
CT scan head
B)
Random plasma cortisol
C)
Enalapril enhanced renal angiogram
Answer:a what is the most probable Dx?Cushing Dis.,an adenoma in pituitary,producesACTH => symptoms
of Cushing syndrome + compressive Sx of a space occupying lesion in brain(headache)=>perform a CT of head
Other choices are nonsense..a random plasma cortical is not a good test for Dx. Cushing syn. cause it has
great diurnal variations,and except in a few cases with very low early moning plasma cortisol (see Harrisons
textbook)it has no benefit.
43. Commonest cause of broncheolitis
RSV
44. Which of the following diseases can be prevented by a live attenuated vaccine except?
a)
typhoid
b)
measles
c)
polio
d)
rubella
f)
diphtheria
answer:f,.Typhoid vaccine(salmonella type)is not contraindicated in pregnancy .tetanus
vaccine:toxoid;pneumococcal vaccine(pneumovax):polysaccharide;BCG vaccine:attenuated M.Bovis
;meningococcal vaccine:polysaccharide;measles vaccine:attenuated virus;rubella vaccine:attenuated
vaccine;polio:two types IPV(inactivated poliovirus vaccine) & OPV(oral-attenuated virus);diphtheria
vaccine:toxoid in DTP (Diphtheria,Tetanus,Pertusis)

44. If a child develops diphtheria now the mortality is almost the same as it was 50 years ago. But now the disease is not
so common because
a)
incidence decreased
b)
prevalence decreased
d)
effective antibiotics developed
answer:aincidence of diphtheria has been in significant decrease for routine immunization.
d)
45. CAD is more in men compared to women. Which of the following is true?
a)
MI investigation and treatment more effective in men
b)
Chest pain in women is less frequently attributed to non cardiac causes
c)
Awareness about MI is same in men and women
e)
Hypertension is a strong risk factor in men compared to women
Answer:e.HTN
46. Which of following is the most important risk factor for CVA
a)
systolic hypertension
b)
smoking
f)
elevated serum cholestrol
answer:a .
47. A child with proptosis, swelling and redness around eye, movement of eye painful. Diagnosis
a)
orbital cellulites
b)
preorbital cellulites
answer:a.Tx:admit,IV antibiotics,B/C,orbital CT,surgical drinage of abscess,follow closely
48. Elderly people
a)
prefer to live alone and like their children to visit them
b)
live alone because of geographical distribution children have to live away
d)
like to live alone and dont like visitors
answer:a
49. A man 65 years labile mood, depression forgetful for 2 years. He has long standing hypertension. O/E Cognitive
functions partial impairment, absent ankle jerk. Diagnosis
a)
alzhiemers
b)
pseudo dementia
f)
multiinfarct dementia
answer:c..pseudodementia (depression in elderly resembling dementia) does not give absent ankle
jerk.alzheimers dementia has specific criteria,not fulfilled by this patient.Also,it has no focal neurologic sign
like an absent ankle jerk.
In the presense of a long standing HTN and focal neurologic sign=>multi-infarct dementia seems more
approproate.
50. A man presented with injury of hand after a fight in beer parlor. Most likely injury
a)
dorsal dislocation of 5th metacarpal
b)
palmar dislocation of 5th metacarpal
c)
radial dislocation of 5th metacarpal
d)
ulnar dislocation of 5th metacarpal
e)
51. Which of the following antipsychotic has got least extrapyramidal side effects
a)
chlorpromazine
b)
haloperiodol
c)
resperidone
d)
clozapine
g)
loxapine
answer:d ......each antipsychotic drug which has strong neuroleptic effect(like Halopridole),has greater
extrapyramidal side effect,but smaller anticholinergic side effects.In contrast,chlorpromazine with strong
anticholinergic side effects,has smaller extrapyramidal disadvantages.
Clozapine,an atypical antipsychotic,has no extrapyramidal effect.
52. Which of the following antipsychotic produce extrapyramidal SE in therapeutic dose?
a)chlorpromazine
b) haloperiodol
c)resperidone
d)clozapine
e)loxapine
answer:b

53. A lady 33 years had a pregnancy with anencephaly and undergone abortion at 15 weeks. She wants to conceive in 6
months. What advise you will give
a)
start folic acid now
b)
she has to do amniocentesis at 16 weeks
c)
neural tube defects are unlikely to recur in subsequent pregnancies
answer:b:Hx of NTD=>higher risk of NTD in future pregnancies comparing to normal populationevery
pregnant woman should take 0.4 mg/day Folic acid PO for 1-3 months preconceptually & throughout T1,so its
soon to start Folic acid for this woman.
Amniocentesis should be done for every woman with Hx of having a child with birth defect,in 15-16 weeks of
gestation.
d)
54. Diabetic lady advice regarding risk of congenital anomalies.
a)
risk is same for gestational diabetes and other diabetes
b)
risk can be reduced to that of general population if strict control of sugar is maintained through out the
pregnancy.
c)
Sacral agenesis is the most common anomaly
d)
USS for congenital anomaly is done at 32 weeks
Answer:din a diabetic lady=>increased risk for GDM compared to normal population,with tight glycemic
control preconception this risk decreases,but not to measures for normal population.
Sacral agenesis is an uncommon complication in infants of diabetic mothers. US+amniocentesis are used to
evaluate fetal situation in 37-38 weeks(for programming delivery according to lung maturation). Also,OCT in
32 weeks ..GDM can not cause congenital defects cause it starts after organogenesis!
56. Prostate cancer; most important in diagnosis
a)
PSA
b)
DRE
c)CT
Answer:b .important?from what point of view??PSA is specific to prostate,but not specific for Prostate
cancer.DRE just shows an enlargement or a nodule,so isnt specific,but its done as a routine PH.E.
59. Soldier returning from peacekeeping force. He has nightmares anxiety. Etc. what is the initial step in management
a)
psychoanalysis
b)
benzodiazepine for 1year
c)
a trial of behavior therapy for s assort period
answer :dwhy (d) and not (a)?..Psychanalysis: its a long Tx modality(3-5 years,4-5 times every
week),esp. used to improve patients insight ,and emphasizes on early childhood events,so I dont think its
appropriate Tx for this acute illness.
Then, short-term/brief psychotherapy is used for acute crisis(like this case) or particular emotional
problems.Number of sessions agreed at outset(6-20 times)
60. A 23 year old girl develops watery diarrhea after a picnic, 2 days later she develops purpuric rashes, oliguria, what is
most likely
a)
2 other picnic mates developed rashes the next day
b)
they made lemonade using water from a near by pond
c)
many of the picnic people developed bite marks bitten by mosquito
d)
few of the picnic people were returning from usa
answer:b? ..my first guess was HUS,but..watery diarrhea after picnic=>2 days later Sx of low
plt.,oliguria;all in a 23 y/o girl?!!!.it cant be simply a HUS,neither course of dis. ,nor age of patient do not
match to HUS..;however,none of other common causes of food poisoning(esp. those related to
contaminated water) can cause all of these symptoms together,not a V.cholorea(rice water stool,no
purpura),not S.aureus,etc..so I guess its an atypic case of HUS(still unsatisfied with Dx!) due to shigatoxin
or E.coliO157:H7..then, answer (b) seems correct.What is your idea?
e)
61. Toddlers diarrhea what seen
a)
indigested food particles
b)
fecal occult blood
c)
vomiting
answer:a
d)
62. hirshsprungs most imp. Inv
a)
Barium enema
b)
Colonic transit time with radio opaque markers
c)
X ray
answer:a .. some abnormal findings in barium enema,as adilated sigmoid colon before anarrower segment
as transition to dilated colon,and then a normal caliber aganglionic rectum distally,summing up
means,abnormal aganglionic segment has normal caliber,but former segment is dilated.
BUT Dx in HIRSHPRUNG dis. IS BY BIOPSY.
63. hirshsprung .diff from constipation

a)
from birth
b)
fecal soiling
answer:a.:Sx of hirshprung in first 24 hours of life,unless there is a very small aganglionic segment,showing
itself in later childhood with constipation and maybe overflow incontinence in barium enema,functional
constipation shows dilated rectum & colon,but in hirshprungs dis. Just colon is dilated.
64. Male pain left lower quad. Mass. Neutrophilia. Inv?
a)
rigid sigmoidoscopy
b)
barium. Enema
c)
colonoscopy
d)
X-ray
answer:d..Dx:Diverticulosis(left-sides appendicitis)=>Do not perform barium enema or
sigmoidoscpy/colonoscopy during an acute attack!
The optimal method of investigation is CT scan,if not available Hypaque enema(water soluble) is SAFEshowssawtooth appearance
US may be useful for following up an abscess.
Tx in Diverticulitis: admit+NPO+fluid+IV antibiotics that cover B.Fragillis(Ciprofluxacin,metronidazole)
Surgery if: 1-Hinchey stages 3 or 4(purulent or feculent peritonitis)
2-after 1 attack if: a)less than 50 years old,b)immunocompromized ,
c)abscess needing percutaneous drinage
3-after 2 attacks in others
4-cmplications: bleeding,fistula,obstruction
5-R/O colon cancer, or refractory medical management
SURGERY WITH HARTMANN PROCEDURE
65. Child ingested cleaning liquid with Iye. Lips & mouth corroded what is least useful
a)
oeso.scopy
b)
X ray chest
answer:a..a CXR is necessary to investigate perforation and free gas in mediastinum,and although
esophagoscopy is our most important investigation,its done after primary resusciation,usually in the first 12
hours of admition.
66. Tension pneumothorax. All are features except
a)
hyper translucent
b)
mediastinal shift
c)
inspiratory stridor
d)
subcutaneous crunchy sound
d)
decreased breath sounds
answer:c ..trachea away from pneumothorax,distended neck veins,respiratory
distress,cyanosis,asymmetry,hyperresonance on percussion,absent breath sounds,unilaterally..NO
RADIOGRAPHIC Dx,a CLINICAL Dx.
67. What is the first management of tension pneumothorax?
a)
needle thoracotomy
b)
needle thoracostomy
c)
chest tube
answer:b
68. Epiglottitis with mild stridor. all are true except
a)
intubation
b)
ABG to monitor prognosis
Answer:b
c)
69. Child with sore throat red tongue lymphadenopathy. How to differentiate viral etiology
a)
throat swab,
b)
white cell count
answer:awhy not (b)?In your clinic,do you perform a WBC count to differentiate a bacterial pharyngitis
from a viral ?
then a WBC diff can differentiate between these two, not simply a WBC count.
70. Man with gonorrhea. Treated with cef. Still symptoms. Urine microscopy no organism, cause
a) chlamydia
ALWAYS treat a patient with Gonorrhea both for Gonorrhea and Clamydia!
Tx for Gon. :Ceftriaxone 125 mg IM single dose
Tx for Cla.: Doxy. 100 mg Bid for 7 days or Azithr. 1 go orally as a single dose
If your patient is pregnant, for bth diseases you can give Amoxi. Or Erythro.
Both diseases should be reported on the next working day to health system ,and in the case of presence of any
of them=>treat partner!
Screen high risk ppulation for Gon. And Clamydia!
71. Gonococci
a)
intracellular diplococci
b)
extra cellular diplococci

answer:aa gr negative diplococci,intracellular

72. RTA- blood at urinary meatus, what to do next?
a)
urethrogram
b)
catheterize
answer:aa retrograde urethrogram ..DONT PLACE A CATHETER BEFORE R/O OF URETHRAL INJURY!
73. Child h/o fall. Pain lumbar region with ecchymoses, gross hematuria. Renal CT shows peri renal hematoma. Child
stable renal pedicle normal. Management?
a)
surgical repair
b)
close monitoring in ICU
c)
catheterize and rest for 7-10 days
c)
send home
answer:c renal trauma with laceration/hemaoma=>minor trauma=> seldom surgical repair
renal trauma with laceration,extending to medulla and collecting system,major renal vascular
injury,shattered kidney=>major trauma
microscopic hematuria+minor trauma+stable=>no admition
gross hematuria+contusion/minor trauma=>admit+bedrest+repeat CT if bleeding persists
hemorrhage & hemodinamicly unstable=>surgery
74. Man 56 years. Father died of prostate ca. o/e a small nodule right lobe. PSA 2.2. What advice
a)
follow up in 6 months DRE and PSA
b)
foloow up in 3 months PSA
c)
uss guided Biopsy now
answer:c..a nodule on DRE=>check PSA,TURP ,and perform Bx
75. Post menopausal bleeding. What inv.
a)
endometrial biopsy
post-menopausal bleeding=endometrial cancer until proven otherwise.
76. severe premenstrual syndrome. Definitive management
a)
b/l oopherectomy
b)
hysterectomy
c)
prog
d)
oes
d)
NSAID
Answer:b........Tx in PMS:1-symptomatic,according to main chief complain,if pain:NSAIDS,if
edema:diuretics,etc.;2-psychological support;3-diet;4-regular exercise
So prog. And NSAIDS could be correct answers provided that what exactly had been asked in exam.
In a severe & refractory dysmenorrhea,after all conservative Tx,if patient doesnt want to have a child in
future,do hysterectomy.
77. Girl 5 years. H/o vomiting since birth. Now complaints of dysphagia for solids. Cause
a)
esophagitis
b)
bazoar
c)
hiatus hernia
e)
duo ulcer
answer:c
78. A man with tertiary syphilis. Which of the following is going to alter his management plan?
a)
AIDS
AIDS + Syphilis(esp. Neurosyphilis)=>higher rate of recurrence of infection,or higher rate of resistance to usual
Tx..In syphilis+AIDS ,CSF should be inspected by LP.
79. A man presented with contracture of PIP. He cannot flex Dip. Which s the pathology
a)
flexor digitorum
b)
extensor pollicis
c)
extensor carpi
answer:a.FLEXION in hand:Flexor Policis Longus=>felex IP joint of thumb;Flexor Digitorum
Profundus(FDP)=>flex DIP of fingers;Flexor Digitorum Superficialis(FDS)=>flex PIP;Flexor Carpi
Ulnaris(FCU),Flexor Carpi Radialis(FCR),Policis Longus(PL)=>flex wrist & oppose thumb to small finger
80. Case control study useful in
a)
study of rare disease.
81. Ethics- a man suspects to be having probable gonorrhea. His wife works in lab. He doesnt want her to know his
specimen. What to do.
a)
ask him to tell his wife
b)
put a code no. on the sample, not his name.
c)
Dont listen to him

c)
Send him to the public sexually transmitted disease clinic
Answer:a gonnorhea should be reported to local public ealth unit,its a STD and communicable,so partner
should know about it, ask your patient to tell his wife about his ailment.
82. A couple comes to you. Husband wants to end the relation what the wife thinks to be a happy marriage. She is crying.
What to next?
a)
spend one and a half hours to each of them to psychotherapy
b)
try to find out what made the crisis
c)
send to lawyer
answer:b
83. For which of the following is behavior modification is best?
a)
phobic anxiety
b)
generalized anxiety
c)
affective disorder
d)
bipolar disorder
answer:a.Behaviour Therapy is beneficial in: anxiety disorders, substance abuse, paraphilis
Cognitive therapy is more useful in: depression, anxiety disorder, self-esteem problems.
In Behavioural therapy we try to change patients internal or external responses that precipitate or maintain
emotional distress,while in Cognitive therapy we change patients thoughts.
Why not (b)?isnt it an anxiety disorder? Yes!it is,but we use CBT in treating with GAD.Then, Behaviour therapy
is the most useful Tx in Phobias.
84. A man 50 years hp 156/95 sweating, palpitation, one of his relative had thyroid ca. what inv. To be done?
a)
urine catecholamine
b)
urine VMA
d)
CT adrenal
Answer:afor screening pheocromocytoma.(This patient is a probable case of MEN-II.)
85. A man 10 days after pancreatitis complains of abdominal pain, firm swelling
a)
pseudocyst,
b)
a/c hepatitis
c)
cholangitis
answer :a.complications of acute pancreatitis :abscess, pseudocyst
d)
86. Peptic ulcer patient complaints of pain radiating to back. Diagnosis
a)
perforation
b)
penetration
answer:bcomplications of PUDs:1-perforated ulcer(ant. Surface) with sudden onset of the pain,a
chemical peritonitis followed by bacterial peritonintis;2-posterior penetration(post. Surface), maybe to
pancreas=>increased amylase-pain=>radiating to back,unrelated to meals;3-hemorrhage(post.
Surface),bleeding from Gasterodudenal artery;4-GOO
87. Gastric ulcer patient. Treated for12 weeks. Asymptomatic now. When gastroscopy done ulcer is still present. Negative
for malignancy and H.pylori. What to do?
a)
treat for 8 more weeks
b)
life long H2 receptor blocker
c)
follow up only
c)
partial gastrectomy with excision of ulcer
answer:b..life-long H2 agonist or PPI to decrease the risk of recurrencein refractory cases, ZES should
be R/Out.
88. Known MI patient now presents with palpitation. He says he is on quinide, propranolol and digoxin 0.125
mg. O/e- PR-96,irregularly irregular. What should be done to prevent any complications?
a)
increase the dose of digoxin
b)
anti coagulant for long time
c)
give digoxin and quinide togather
89. All are true about carbamazepine except
a)
starting dose 200mg
b)
causes leucocytosis
answer:b .Carbamazepine:a tricyclic compound,effective in Tx. Of bipolar disorders as a mood
stablizer,also used to treat trigeminal neuralgia,epilepsy.It has only oral forms,useful in children too.Its fatal
toxic effect is Agranolucytosis,esp. in elderly patients with trigeminal neuralgia.Other adverse effects
include:mild LEUKOPENIA ,skin rashes.
Dosage:750-3000mg/day,tid-Theraputic range:350-700 micromol/liter
90. Mitral stenosis patient goes to a dentist for some procedure. He is asking for prophylactic antibiotics. Which of the
following decides which to given?
a)
type of procedure

b)
c)

presence of atrial fibrillation

presence of cardiac failure
d)type of procedure
answer:a ..Mitral valve prolapse or MR or MS all prosthetic heart valves-HX of bacterial endocarditis-PDACo of Aorta-surgical shunts- VSD-hypertrophic cardiomyopathy,and some other cases need prophylactic
antibiotic before some dental,respiratory,GI,GUT procedures.Among dental procedures those need
prophylactic Ab are: distraction,periodontal procedures(leading to gum bleeding),implant, root
canal,orthodontic Tx(not brackets),intraligamantal anaesthetic injections,so we must ask what procedure
will be done for patient.

91. Bier block (regional IV anesthesia). Which is true?

a)
bupivacaine is better
b)
effect lasts longer even after the procedure , giving adequate post op analgesia
c)
suitable for all procedures in hand
answer:?b?Im not sure about my answer,but as IV reginal block is used for procedures up to 1.5 hours,
(b) seems right.
IV regional block is used for both upper & lower exteremity procedures,more commonly used in UE.Its
simple,reliable and with few absolute contraindications.
Blockades, in general, are more suitable for upper exteremity procedures.Intercostal blockade is suitable for
after-surgery pain.
Peripheral nerve blockades(especially Biers blockade),often used for procedures,done on superficial
structures in exteremities.
92. Elderly lady, pain on hand and upper arm. Wasting of thenar eminence. Severe pain at night. Cannot carry shopping
bag. Diagnosis
a)
carpal tunnel syndrome
b)
cervical spondylosis
answer:a
93. 75 year old man, sudden onset of back pain, severe pain right buttock, hamstrings, micturition problem. He was
having UTI 2 weeks back Cause
a)
multiple myeloma involving spinal cord
b)
lung ca with metastasis
c)
archnoiditis
answer:a..I run for this answer because the patient haspain,is old ,and has had UT problems.There is
nothing supporting a suspection to lung cancer(xcept for being an old man),no Hx of smoking,no cough,etc.
What is Arachnoiditis?chronic arachnoiditis, inflammatory in its nature,but sometimes occurs after
SAH,meningitis,intraspinal injection of penicillin, contrast media,trauma,and surgery.The initial symptom is
usually a radicular pain,but LMN symptoms can be seen.In last stages,an ataxic spastic paraparesis and
dysfunction in sphincters will appear.There is high protein level in CSF,with increased WBC(in LP).MRI can be
helpful in Dx. Myelography shows contrast fragmentation into some saccular lesions in spinal cordTx:NSAIDS
or steroids,surgery in localized spinal involvement.(Aminoff neurology,1999)
94. A baby with birth wt.3.5kg now 4 weeks weighs 3.6 kg. Mother worried not drinking enough milk. What will you
advise?
a)
Tell her that nothing to worry, as some kids dont gain much weight in the first month
b)
start formula feeding
c)
investigate the kid
answer:c. in the first month baby should gain 20-30 gr/day,not gained by this child(only 100 gr weight gain
during the first month!)=>investigate the child
95. A lady 33 weeks of gestation, admitted with uterine cramps and moderate bleeding. Nurse started IV line and blood
taken for grouping and cross matching. What to do next?
a)
start another IV line
b)
arrange for CS
c)
start tocolysis
d)
examine for cervical dialtaton
d)
USS
Answer:USS ..bleeding in third trimester:FIRSTLY DO AN USS to R/O placenta previa why do you
run for (a) Dr9_9_9?there is no severe hemorrhage,nedding two large bores,eh?
96. Triple screening done in the antenatal period. Which is true?
a)
should be only offered to women who are willing for termination if any abnormality is found
b)
should be offered only if proper pre test counseling is given
answer:b
97. Regarding HRt, a lady ha h/o migraine and strong family history of osteoporosis what should be done/
a)
offer oes-prog.HRT
b)
progesterone only

c)

biphosphonate only
d)oes only
answer:c migraine is a relative contraindication of HRT,so a is not a good drug for her.We can give her
bisphosphonates

98. Raloxifine, which is true

a)
contraindicated in peptic ulcer
b)
effective for hot flushes
c)
effective for osteoporosis
d)breast ca increased risk
answer:c raloxifene(SERMs) maybe protective against breast cancer,DOES NOT RELIEVE
HOTFLASHES(MAY MAKE THEM WORSE) OR OTHER MENOPAUSAL SYMPTOMS.
99. Infertility with c/c salpingitis. Which is not done?
a)
laparoscopy
b)
laparotomy
c)
hysteroscopy
answer:b?????
100. Ophthalmoplegia with pupillary sparing. Cause?
a)
diabetes
b)
canernous aneurysum
answer:a......pupils spared in DM.
c)
101.herpes simplex corneal ulcer. What is not done?
a)
patching
b)
corticosteroids use
answer:b
102. Otosclerosis.
normal ear drum
103. A child with sinusitis and otitis media. Treated with antibiotics. Serous effusion still present in middle ear. What to do?
a)
another course of antibiotics
b)
myringostmy with tube
c)
myringoplasty
answer:aa failure in therapy by Amoxicillinn=>double dose Amoxi. Or give Amoxi-clav..patient has none of
indications of myringotomy & tympanoplasty(Toronto Notes,otolaryngology,34)
104. A lady gave birth to a cleft palate baby. You are going to send her home after counseling. For what reason she is
going to come to your office more often?
a)
feeding problem
b)
recurrent otitis media
c)
teeth problem
answer:a..if untreated,the baby will have feeding problems,speech pathologies,and recurrent infections, but in
the first months feeding problem have greater importance=>surgical repair in 6-9 months
105. You gave a new drug to your patients with dementia. Those suffering from multi infarct dementia improved while
those with Alzheimers not.. What should you do before prescribing this to your patient
106. What type of trial is this?
107. In the Er you are planning to do a new trial on pts with retrosternal chest pain
108. A lady for laparoscopic tubal ligation on the way to theater asks for removal of a mole on her forearm while she is
under GA. What you will tell?
109. Jehovah witness signed card
110. hemophilia A
Xlinked recessive
111. A carrier lady for an X linked recessive disease marries a normal man. They have 2 daughters. What is the
probability of each of them to become carrier?
a)
1in 4
b)
1 in 8

c)

1 in 16
d)
1in 64
answer:a..a XX marries a XY=>XX - XY - XX - XY=>1/4 carrier girl

112. Which is not a cause for occupational asthma.

vinyl chloride
113. Which causes nasal sinus ca?
a)
nickel
b)
114. condyloma accuminata, pregnant lady what is used
a)
podophyllin
b)
flurouracil
c)
trichloracetic acid
d)
imiquimod
answer:c?.condyloma should be treated early during pregnancy,if not =>do C/S condyloma cannt be
prevented by condomIn pharmacological textbooks a 6% systemic absorption is considered after
dermatologic application of 5FU cream,which is not enough to induce syatemic adverse effects.Im not sure
about answer,but as I remember trichloroacetic acid is safe in pregnancy.
115. Picture of tinea cruris. Treatment.
a)
topical steroids
b)
amphoterecin b
c)
tolnaftate
e)
grieseofulvin
answer:c(tolnaftate) ..topical clotrimazole or terbinafine ,not oral drugs for Tinea capitis or cruris or
pedis(interdigital type),among choices only tolnaftate is topical..using topical teroids before Dx of any
typpe of Tines results in Tinea incognito.
116. A man presented with headache, photophobia, menigism. CSF_ cells increased, neutrophils 95% What is the most
common cause
a)
menigococci
b)
s.pneumoniae
d)
viral
answer:b
117. Viral meningitis. Which is not true?
a)
sugar normal
b)
protein elevated
c)
chloride high
answer:c
118. A man with dark skin, liver 20 cm. Cirrhosis. Diagnosis
a) hemochormatosis
119. What inv. In the above patient
a) transferrin saturation
120. A child with necrotizing enterocolitis. All are true except
a)
air in portal vein
b)
pneumoperitonium
e)
peritoneal calcification
answer:a & b are true
121. a man presented with a mass right to his rectus below umbilicus while standing and straining. Disappears while lying
down. Diagnosis
a)
Richters hernia
b)
spigelian hernia
c)desmoids tumor
answer:b
122. Which of the following is toxic in overdose?
a)
vit.A
b)
vit.E
c)
vit.K
d)
vit.C
f)
vit.B12
answer:a
123. c/f of congenital hypertrophic pyloric stenosis.
Diagnosis.(2 questions)

124. A lady 50 years presented with mild hypercalcemia X-ray chest normal. Diagnosis.
a)
sarcoidosis
125. A child had a/c sinusitis and you treated with a course of penicillin. His blood inv shows- TC increase, s.ca decrease
others normal. You supplement with ca, what inv. To be done
a)
s PTH
b)
X-rays of hands
Answer:b..as our friend Dr9_9_9 says,we must r/o rickets=>X-ray f hands
126. A man presented with pain in flanks radiating to groin. He had similar episodes 2 times previously. And was
diagnosed to have hyper calciuria. What should be done?
a)
thiazides
b)
allopurinol
c)
reduce dietary calcium
answer:a
127.post appendicectmy pt develop s-subphrenic abscess
128.which of the following is most likely to be a drug reaction
a)
IMN patient treated with pencillin produces rash
b)
Sulpha
d)
patient with sore throat treated with pen. Has rash
answer:a
129. Intoxication. Which one causes oliguria?
a)
ethylene glycol
b)
cannabis
c)
cocaine
e)
LSD
Answer :a
130. Intoxication- dry skin. Pupil sluggish reacting. Agitated. Paranoid
a)
cannabis
b)
cocaine
c)
LSD
answer:b
131. Child electrocuted. What is the cause of death?
a) cardiac arrest
132. A child has features of meningitis. Which is poor prognostic factor?
a)
temp.38.5
b)
generalized seizure
c)
localizing sign
d)
neck stiffness
answer:b
134. Neonatal sepsis.a feature
a) hypothermia
135. A man complaints of severe headache for the last 12 hours. Vomiting + photophobia. Diagnosis
a) subarchnoid hemorrhage
136. A child had a fall and he was drowsy. While waiting in the ER he becomes more and more drowsy .one pupil dilated
diagnosis
a)
extradural hematoma
b)
subdural hematoma
answer:b
137. A man with a swelling in the right scrotum. O/e- tender mass above testis. skin of scrotum red and inflamed. Prostate
enlarged He has pyuria. What is the diagnosis?
a)
epididymitis
b)
epididymitis and prostatitis
c)
gonococcal urethritis
answer:b.this patient surely has an epididymitis, but is there any prostatitis in conjunction?.the cause of
his epididymitis can be gnorrhea or clamydia(<35y/o),or GI organisms esp. E.coli(>35y/o)
138. How to look for clue cells.
a)
vaginal secretion with KOH and cover
b)
vaginal secretion with saline and cover

c)
d)

cervical secretion with saline and cover

cervical secretion with KOH and cover
d)
vaginal secretion with KOH and dry
answer:a..for Dx. Of bacterial vaginosis,we should add KOH 10% on vaginal secretion=>fishy odor , clue
cellswhy do you choose N/S?where have you seen it?I think we should add KOH(?)

139. Multiple pregnancy-cause of perinatal mortality

a) prematurity
140. Tocolysis contraindicated in all except
a)
twins at 33 weeks
b)
cervix 4 cm
c)
chorioamnionitis
answer:b.. contraindications of tocolysis:bleeding(placenta previa or abruption),maternal HTN,maternal
DM,maternal heart disease,eclampsia or pre-eclampcia,chorioamnionitis,errythroblastosis fetalis,severe
congenital anomalies,fetal distress/demise,IUGR,multiple gestation(relative)
141. Persistent bradycardia in fetus due to
a)
head compression
b)
AV block
Answer:b.causes of fetal bradycardia:maternal beta-blocker
therapy,hypothermia,hypoglycemia,hypothyroidism,or fetal cardiac conduction defect(like AV block due to CMV
infection,or anti-SS-A antibodies)
142. Which is true about congenital anomalies?
a)
congenital anomalies rarely affect growth
b)
if symmetrical IUGR is detected look for congenital anomalies
c)
trisomy 13&18 will not cause growth retardation
answer:b
143. A child 3 years has BP 138/95. He has a systolic murmur right 2nd space, femoral pulse not palpable. Diagnosis ?
a)coarctation
144. apgar score
145. A pregnant lady with GCT 10.3 mmol/l, what is most imp.
Strict maintenance of euglycemia through out the pregnancy
146. A lady prepared for hysterectomy. What will you tell her regarding risk of thromboembolism
a)
risk is highest after 72 hours
b)
thromboembolism mostly originate from pelvic veins
answer:athromboembolism mostly originates from calf veins,mostly shows itself POD5+(7-10)
.even in the cases undertaken a surgery like hysterectomy,TE arises from calf veins,and also from
ileofemoral veins.
147. A lady post partum develops DVT. What is the management?
a)
warfarin for 3 months
b)
heparin IV for 1 week and warfarin for 3 months
d)
heparin IV for 1 week and low molecular wt. Heparin for 3 months
answer:d
148. A pregnant lady 20 weeks. Uterus 26 weeks. Beta HCG 30000.what is the management
a)
suction curettage
149. Which of the following is not poor prognosis in melanoma)
a)
color change
b)
spreading
c)
bleeding
d)
tuft of hair
e)
irregular surface
answer:d
150. C/f of thrombosed external pile. Diagnosis?
151. Same scenario. Management
152. c/f ischiorectal abscess . management
incision & drinage+/- antibiotics

153. A girl c/o continuous pain in the vulva for the last 8 hours. O/e a red tender swelling is seen on the post 1/3 of lab
minora. What is the diagnosis?
a)
bartholins cyst
b)
bartholins duct abscess
d)
skenes gland abscess
answer:b
154. A group of people returning from Rocky Mountains developed diarrhea. Cause
a)
Rocky mountain spotted fever
b)
giardiasis
answer:a...you are right!they like to trick us as foreign MDs! This is Giardiosis,with waterborne
transmission(especially in the Rockies) and fecal-oral transmission of infective cyststreat patients with
metronidazole..and diarrhea is not seen in RMSF!
155.esophageal atresia with tracheo esophageal fistula at the lower end. What is true?
a)
gastric aspiration common
b)
gastric air shadow not seen
answer:a
c)
156. A man sustained a stab wound on the thigh anteriorly. He is bleeding profusely. What is the first thing to do?
a)
apply tourniquet above the wound
b)
press femoral artery
c)
direct pressure
d)
on wound
e)
fill the wound with clothes
answer:c..we never FILL wounds with clothes,even with clean clothes
157. A child with 15% burns On face and chest. What is done?
a)
oral midazoalm and i/v morphine
b)
i/v midazolam and burn dressing
c)
i/v cef.and morphine
answer:b?.. firstly admit patient(face burn),then suppress pain with appropriate analgesic ang give
prophylactic antibiotic if there is deep second or third degree burn wound
158. 2 year old child. burns 15% calculate fluid replacement
Parkland formula=> fluid in the first 24 hours=TBSA x weight(Kg) x 4cc.1/2 of this fluid in first 8 hours,the other
in the next 16 hours
159. A lady brings her son to you saying that he is alcoholic who denies that . what question is least relevant
a)
do you need an eye opener in the morning
b)
do you hate criticism
c)
do you drink only on social occasions
answer:c.a & b are two questions of CAGE questionnaire
C:ever felt need to Cut down on drinking?
A:ever felt Annoyed at criticism of your drinking?
G:ever felt Guilty about your drinking?
E:ever need a drink first thing in morning?Eye opener
160. Features of anaphylaxis-treatment
a) epinephrine
161. Laryngeal nodule- not a risk factormedication
162. A man 64 years c/o hoarseness. What is the first thing to be done?
a)
chest X ray
b)
laryngoscopy
answer:b
163. Uncomplicated intestinal obstruction. All are seen except
a)
increased bowel sounds
b)
distension
c)
guarding
d)tympanitic
answer:c
164. Idiopathic thrombocytopenia
165. Most common cause of syncope in a young man

a)
vasovagal
b)
hypoglycemia
answer:a
166. A man presented to Er after a party. Intoxicated. Blood values- HCO3 very low. All others normal. What other inv
a)
urine osmolality
b)
serum osmolaity
answer:b
167. Mallory weis what inv.
a)
senstaken tube
b)
OG scopy
c)
balloon
answer:b
168. Clinical features suggestive of intestinal ischemia
169. Crohns. C/f given. Diagnosis?
170. Right upper quadrant pain, fever, jaundice. Diagnosis
a)
a/c cholecystitis
b)
cholangitis
c)
hepatitis
answer :b
171. A/c cholecystis. Cause.
a)
obstruction of cystic artery
b)
onstruction of CBD
c)
obstruction of GB by stone
answer:c
172. post op 36 hours. Cause of fever,
a)
atelectasis
b)
UTI
c)Wound infection
answer:a
173. Most common cause of incontinence in women
a)
stress incontinence
b)
urge incontinence
d)
detrusor instability
answer:stress incontinence
174. Dementia patient. Treatment of which of the following could have prevented
a)
Alzheimers
b)
pernicious anemia
answer:b
175. Another question on dementia.
176. What is the most imp. Thing to differentiate Alzheimers from pseudo dementia
a)
Short duration
b)
mental status examination
answer:ba patient with pseudodementia is not cooperative during interview,unless we can encourage
him/her.an Alzheimer patient in contrast shows interest to interview but makes mistakes in answering our
questions.
177. Treatment for seasonal rhinitis
a)
nonsedative antihistamines
b)
oral steroids
answer:a
178. Picture of a child. Mouth open.
a) adenoid hypertrophy.
179. Couple comes to you. Husband hypertensive says impotence 6 months but erection occurs in the morning and while
reading the magazine. What should you do?
a) counseling
this patient has non-organic impotence=>counselling

180. Cause for recurrent UTI in child

a) VU reflux
181. Treatment of nephritic syndrome. All except
a)
diuretics
b)
salt restriction
c)
fluid restriction
d)
prednisolone
e)
protein restriction
answerc? ..I searched for answer in Cecil,Harrison,Toronto Notes,Kumar, Furtunately there is a brief
explanation regarding this issue in Kumar,fifth edition,page 607:dietary protein restriction only in severe
cases,but salt restriction always necessary.Diuretics and corticosteroids are used in Tx, so fluid restriction (c)
seems to be the answer?its obvious that we should monitor body volume by daily weighting too,so there should
be a careful observation for fluid excess,especially when we remember there is always a risk of pulmonary
edema in the presence of an impaired kidney.
182. Elderly lady fecal occult blood. All are true except.
183. Case of DUB.
184. All the following can be given to improve sexual function. Except
a)
sildenafil
b)
estrogen
c)
testosterone
d)
gonadotrophin analogues
answer:b..if we are asked for Tx of male sexual dysfunction,estrogen will be correct answer.
185. ADHD
186. A lady with previous h/o cs for footling breech is kept for trial. During labor she develops bleeding PV, fetal
tachycardia. . Diagnosis
a) rupture uterus.
187.a lady at 41 weeks of gestation likes to wait for spontaneous onset of labor. Which of the following require immediate
delivery?
a)
oligohydramnios
b)
macrosomia
b) glycosuria
answer:a
188.CPS
a) interest of public is most
189. Which of the following is the most effective way to prevent dental caries in children?
a)
fluoridation of water
b)
dental flossing
answer:a
190. Periodic health examination not true
a)
detection of chronic diseases
b)
behaviour change and hygiene
c) more focused annual physical examination
answer:c..Toronto Notes,family medicine,page3:most notable recommendation is the abolition of the
annual physical exam,replaced by the periodic health examination(PHE)
191. ECG
a)
LBBB
b)
RBBB with RAD
c)
RVH
d)
WPW
192. Picture of a hand with a lump on the dorsal surface MCP jt.
a) h/o renal calculi
193. A lady develops dry cough. Treated with ampicillin few days later Develops rash, elevated liver enzymes. Cause
a)
mycoplasma
b)
194. Bacterial vaginosis. All true except

a)

PHb)
Flagellated organism
Answer:b.ph in bacterial vaginosis is acidic(5->5.5),Gardenella is a small gr negative bacillus.

195. Malaria treated. Recurrence after 1 year

a) dormant liver schizhont
196. Features of meningitis. What inv.
a) lumbar puncture
197. Features of multiple sclerosis all except
a)
dysphagia
b)
anosmia
answer: neither dysphagia, nor anosmia
198. Horners with dysphagia.
a)
PICA
b)
ACA
Answer:PICA
199. Paranoid schizhoprenia- features given,
200. Psychotherapy
201. Elderly wife abusing husband who is suffering from arthritis what is not done
a)
send hem to daycare
b)
support to wife
answer:b.elder abuse is a criminal offence under the Criminal Code
202. Status asthmaticus
a)
hydration, inhaled beta agonist, IV steroid
203. Strawberry angiomas. Treatment.
a)
spontaneous regression
b)
excision
c)
injection of sclerosant.
Answer:a
204. Ocd treatment
a)
fluoxamine
205. Abruption placenta. Cause of DIC
a) fribrinolysis.